L-glutamine, an amino acid that occurs naturally in the body and plays an important role in digestion, has been studied as a potential way to ease side effects in other cancers. But this was the first trial to evaluate it as an anti-cancer therapy in human patients, said Jun Gong, MD, associate professor of Medicine, medical director of Colorectal Cancer at Cedars-Sinai Cancer and first author of the study.

“Current treatment for stage 4 pancreatic cancer is a cocktail of chemotherapy, with overall survival ranging from eight to 13 months,” Gong said. “We found that by adding L-glutamine to this treatment, we increased overall survival to as much as 22 months—and these positive results merit larger clinical trials of this combination.”

In this Phase I clinical trial, investigators studied 16 patients with advanced pancreatic cancer. All patients were treated with a standard chemotherapy combination of gemcitabine and nab-paclitaxel, along with clinical-grade L-glutamine supplements.

“We began the trial in the hope of improving gut health in these patients,” said Neil Bhowmick, PhD, Mark Goodson Chair in Oncology Research, professor of Medicine and Biomedical Sciences, research scientist at Cedars-Sinai Cancer, and senior author of the study. “Patients with pancreatic cancer do not absorb nutrients well, and often develop a condition called cachexia—a loss of weight and muscle that can be fatal. Glutamine is known to help the gut heal.”

Half of the patients in the study maintained their weight, and investigators found a correlation between the way the bacteria in the gut responded to the glutamine and patient outcomes, Gong said.

“At the time of our paper’s publication, the life expectancy of these patients taking glutamine and chemotherapy was more than double the average life expectancy associated with the historical standard of care,” Gong said. “The study did not compare the two options head-to-head, but our result is striking enough for us to advance to a larger randomized trial where patients are given glutamine or not.”

In the lab, investigators also found that cancer cells exposed to high-dose glutamine were particularly vulnerable to chemotherapy, a result in line with the reduction in tumor size seen in patients.

“It is really satisfying to see science from the bench translated so well into patient outcomes,” Bhowmick said.

The supplements used in the study are approved by the Food and Drug Administration for treatment of sickle cell disease, meaning they are federally regulated, Bhowmick and Gong said.

“The survival rate for advanced pancreatic cancer is poor,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “This trial points to a potential new option for optimizing first-line chemotherapy for patients while also opening up a number of new avenues for our physician-scientists to study.”

Additional Cedars-Sinai authors include Hayato Muranaka, So Yung Choi, Mourad Tighiouart, Aleksandr Stotland, Jennifer Van Eyk, Omer H.M. Elmadbouh, Mouad Edderkaoui, Sunao Tanaka, Hideki Furuya, Arsen Osipov, Jeremy Lorber, Sandrine Billet, Stephen J. Pandol, and Andrew Hendifar.

Other authors include Shrikant Bhute, Ezinne R. Aja, Jonathan P. Jacobs, Alexzandra Morris, Johanna ten Hoeve-Scott, and Thomas Graeber.

Funding: This project was funded by the 2019 Tower Cancer Research Foundation Experimental Therapeutics Endowed Fund/Cedars-Sinai Cancer 2019 Developmental Funds for Investigator-Initiated Trials (IITs; J.G.). This project was also supported in part by the NIH National Center for Advancing Translational Sciences (NCATS) UCLA CTSI (UL1 TR001881-01; M.T.) and NCI grants P01CA233452 (M.T., S.J.P., N.A.B.) and U01 grant CA232859-01 (M.T.).

Competing Interest Statement: H.M., N.A.B., J.G. and A.H. have a pending patent related to the work.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

An average woman has about a 13% chance of developing breast cancer during her lifetime, according to the National Cancer Institute. A BRCA1 or BRCA2 gene mutation raises breast cancer risk to 30%-70%, and BRCA testing is recommended for women with personal or family history of certain cancers, a known BRCA mutation in the family, or Ashkenazi Jewish ancestry.

“While most women who undergo genetic testing do not test positive for a cancer-risk-increasing BRCA mutation, they have generally been referred for testing because of strong personal or family cancer history,” said Fahima Dossa, MD, PhD, surgical oncologist at Cedars-Sinai Cancer and lead author of the study. “Future cancer risk for these women has not been well studied, and our findings are the first to calculate that risk so that we can better guide all women who undergo BRCA testing.”

Looking at the health records of almost 16,000 women who underwent BRCA testing in Ontario, Canada, from 2007 to 2016, investigators found that women who tested negative for a BRCA gene mutation still had a 25% lifetime risk of developing breast cancer.

And lifetime risk for those with a variant of unknown significance, which means little is known about that particular variant, was 30%, according to the findings.

Each patient’s individual risk for breast cancer was substantially affected by their family history. Among women who tested positive for a BRCA mutation, breast cancer risk varied from roughly 56% to 86%, depending on the number of immediate family members who had breast or ovarian cancer, the study found.

“Based on these findings, a physician might recommend more frequent mammograms or breast MRI to a BRCA-positive patient in their 50s or 60s with no family history of breast cancer, but suggest preventive mastectomy as an option for a young BRCA patient with several cases of breast cancer in the family,” Dossa said.

Dossa said that the only women in the study with the same breast cancer risk as the general population were those who had family history of cancer and a known BRCA mutation in the family, and were tested for that specific mutation but did not have the mutation.

“This study is a reminder to patients about the importance of having discussions with their doctors about genetic test results,” Dossa said. “We finally have some data to help inform those conversations.”

In July, Cedars-Sinai opened the Cedars-Sinai Cayton BRCA Center to provide coordinated screening, guidance and treatment to patients with BRCA mutations.

“Our leading-edge research supports our efforts to care for and improve outcomes for these patients,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “Connecting science with cancer care is at the heart of what we do.”

Other study authors include Kelly Metcalfe, RN, PhD; Zharmaine Ante, MSc; Ning Liu, PhD; Jordan Lerner-Ellis, PhD; Andrea Eisen, MD; and Nancy N. Baxter, MD, PhD.

Funding: This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health (MOH) and the Ministry of Long-Term Care (MLTC). This study also received funding from the Canadian Cancer Society (grant #315358). This work was also supported by the Canadian Institutes of Health Research (CIHR) grant funding no #148470.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The preclinical study was published in Cell Reports Medicine. 

“Our study is the first to show how metabolites produced by select bacteria can induce changes in the body’s immune response when the body is fighting cancer,” said Ze’ev Ronai, PhD, director of the Translational Research Institute at Cedars-Sinai, professor of Surgery and senior author of the study. “Previous research established that gut bacteria affect the immune system and can help fight cancer. Our new findings are an important step forward because they give us a specific metabolite that can be used for future therapies.” 

The investigators focused on B. rodentium in the guts of mice and a related bacteria species, B. uniformis, in the guts of humans. When these bacteria break down the amino acid tryptophan, they produce different forms of metabolites called indoles. 

In laboratory mice, investigators found that treatment with B. rodentium restricted the growth of melanoma and colon, breast and pancreatic cancers, and that treatment with indole on its own restricted the growth of melanoma.

“Indole was more effective against these tumors than other metabolites produced by tryptophan breakdown, which are used in immunotherapies,” said Ximena Diaz Olea, a research scientist in the Ronai Lab and first author of the study. 

The investigators also looked at data from human patients who were responding well to immunotherapy for melanoma. In these patients, investigators found increased levels of the enzymes used to produce indole, suggesting higher levels of indoles were contributing to the patients’ good outcomes. 

“We are now evaluating whether increasing the levels of indoles in the gut would be sufficient to inhibit cancer,” Ronai said. “We hope to turn these findings into a therapy that will benefit patients.”

Investigators say this might be possible by giving patients capsules containing B. uniformis, then following up with nutrients to increase the bacteria’s reproduction and indole levels in the gut.

While this study focused on B. uniformis and B. rodentium, as many as 20 different bacteria species produce the enzyme that creates indole, opening further avenues for exploration, Ronai said. 

“These findings provide the foundation for modes of treatment that could complement or replace existing ones,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “This type of translational science paves the way toward new options for patients.” 

If investigators are successful at translating their findings into an anticancer therapy, Ronai said that it would likely be useful against many cancer types, as the immune cells bolstered by indole are effective against many cancers.

Additional Cedars-Sinai authors include Ximena Diaz Olea, Aagam Shah, Hyungsoo Kim, Ashok Kumar Sharma, Anthony Martin, Mark B. Faries, Omid Hamid, Suzanne Devkota, and Simon Knott.

Other authors include Kristin Beede, Gabriel Pereira, David Scott, Christopher Petucci, Eric Martens, Dmitri Rodionov, Miguel P. Martinez, Tongwu Zhang, Andrei Osterman, Emile E. Voest, Nadim J. Ajami, Jennifer Wargo, and Amanda E. Ramer-Tait.

Funding: This work was supported by the Cedars-Sinai shared resources in genomics, vivarium and microbiome studies; NCI grant R35CA197465 (to ZAR); the Hervey Family / San Diego Foundation (to ZAR); grant R21CA249822 (to ART and HK); and the Buffett Cancer Center funds (to ART) via NCI grant CA036727.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“Continuity of care throughout the lifespan is important for sarcoma patients,” said Leo Mascarenhas, MD, director of the Adult and Pediatric Sarcoma Program and the Division of Pediatric Hematology/Oncology at Cedars-Sinai Cancer. “Our multidisciplinary expertise, which includes pathology, radiation oncology and surgical care, means both adults and children with sarcoma can receive all of their care in one place.”

Mascarenhas is a professor of Pediatrics and Medicine at Cedars-Sinai Health Sciences University and pediatric hematologist-oncologist who has more than 25 years of clinical and research experience. He has led multi-institutional clinical trials for Ewing sarcoma, rhabdomyosarcoma, osteosarcoma and other rare pediatric solid tumors.

Additional Cedars-Sinai Sarcoma Experts

James Hu, MD, associate director of the Sarcoma Program, has more than 30 years of clinical experience in medical oncology. His research focuses on evaluating novel biomarkers and liquid biopsy methods to improve the treatment of bone and soft tissue sarcomas and examining risk factors for young patients facing rare forms of cancer.

Earl Brien, MD, surgical director of the Sarcoma Bone Tumor Program and professor of Orthopaedics, is an orthopedic oncology specialist. His research focuses on surgical strategies for treating complex soft tissue sarcomas, improving surgical techniques for the removal of bone cancers while avoiding amputations, and use of circulating tumor DNA to noninvasively assess treatment response.

Jason Chan, MD, is a board-certified medical oncologist who specializes in the care of people with sarcoma, including desmoid tumors, gastrointestinal stromal tumors (GIST), as well as other soft tissue and bone sarcomas. He studies how cancers adapt and become resistant to treatment, with a focus on the ability of cancer cells to shift into different cell states that may allow them to grow, spread and survive therapy.

Fahima Dossa, MD, PhD, surgical oncologist in the Jim and Eleanor Randall Department of Surgery, primarily treats soft tissue sarcoma, including gastrointestinal stromal tumors (GIST), liposarcoma, leiomyosarcoma and desmoid tumors. She also specializes in treatment of retroperitoneal sarcoma, which develops deep in the fat or muscle of the abdomen, using a specific operative technique to help prevent recurrence.

Behrooz Hakimian, MD, is an assistant professor of Radiation Oncology whose research merges clinical trial exploration with advanced radiation oncology techniques, focusing on patient safety during therapy for complex sarcomas and soft tissue tumors.

Mitchell Kamrava, MD, is a professor of Radiation Oncology whose sarcoma research centers on optimizing preoperative radiation, reducing treatment timelines and predicting post-surgical complications. He has been a co-investigator on pivotal clinical trials evaluating a condensed five-day preoperative radiation regimen for high-risk primary soft tissue sarcomas.

Eugene Kim, MD, is a professor of Surgery and Pediatrics, director of the Division of Pediatric Surgery and vice chair of the Department of Surgery. He is recognized for his expertise in pediatric surgical oncology and he is a key member of the sarcoma team.

Joseph Schwab, MD, director of Spine Oncology in the Department of Orthopaedics, is a specialist in managing sarcomas of the spine—including rare, complex tumors like chondrosarcomas and chordomas—in adults. His research focus includes use of algorithms and machine learning to build tools that optimize clinical decision-making for bone and soft tissue tumors.

Media Contact

To schedule an interview with a Cedars-Sinai sarcoma expert, contact Christina Elston at christina.elston@cshs.org or 626-298-0702.

The new

“The generosity and foresight of the Cayton Goldrich Family Foundation gave us the resources to conduct outreach and coordinate care for these patients,” said Cristina Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai. “By bringing together our dedicated physicians and recruiting top talent from around the country, we are making this centralized BRCA center unlike any other.”

Individuals of Ashkenazi Jewish descent, and those with family history of breast, ovarian, prostate or pancreatic cancer, or people who have been diagnosed with one of these cancers, should be screened for BRCA1 and BRCA2 mutations, Ferrone said.

Cancer Screenings

“This center will provide every relevant service: comprehensive risk assessment, state-of-the-art surveillance, prevention strategies, clinical trials, and access to the latest scientific discoveries,” said Farin Amersi, MD, a surgical oncologist who treats patients with BRCA mutations. “More importantly, it will create a true home for patients and families facing hereditary cancer risk.” 

A patient’s first visit to the center begins with genetic counseling to help patients understand their unique cancer risk. For women, the initial visit also includes a breast MRI or mammogram, and a pelvic ultrasound and blood test to screen for ovarian cancer. Men undergo imaging to screen for breast cancer and an exam and blood test to screen for prostate cancer. For pancreatic cancer, both men and women may have abdominal imaging and discuss the possibility of endoscopy screening, depending on their individual risk.

“At many other institutions, patients diagnosed with a BRCA mutation have to make appointments for each of these screenings separately, with different physicians,” Amersi said. “Our patients will have all their screenings—and receive their test results—in one visit. This will help relieve the anxiety of juggling multiple appointments and waiting to learn the results of these tests.”

The process condenses what could be eight to 12 different appointments into a single day, Ferrone said.

“For patients with BRCA mutations, these screenings are repeated every six to 12 months, so you can imagine how disruptive separate appointments are for patients, many of whom work and have families,” Ferrone said.

Based on their test results, patients meet with a team of specialists about the best path forward, taking into account the patient’s age, fertility goals and individual cancer risk.

Preventive Treatment

For breast and ovarian cancer prevention, patients and their care team discuss the need and timing for possible preemptive surgery.

BRCA1 and BRCA2 mutations have slightly different risks associated with them, said Marla Scott, MD, a gynecologic oncologist.

“People with BRCA1 mutations have roughly a 40% higher risk for gynecologic cancers, and are a younger average age when cancer tends to appear,” Scott said. “This means we have a discussion about removing the fallopian tubes and ovaries, as well as consideration for hysterectomy and mastectomy, between ages 35 and 40.”

A reproductive endocrinologist is on-site to discuss fertility preservation—including egg and embryo freezing and in-vitro testing and fertilization—as well as hormone replacement options to manage symptoms of surgically-induced menopause, Scott said.

For people with BRCA2 mutations, there is a slightly lower increased risk of gynecologic cancer, and age of cancer onset tends to be about 10 years later, allowing doctors to delay preventive surgeries, Scott said.

“With the exception of regular breast exams, patients may get to ‘graduate’ out of further screening for gynecologic cancers if they have a risk-reducing surgery and show no signs of cancer,” Scott said.

Scott added that while managing cancer risk can be challenging for people with a BRCA mutation, having a place they can go for guidance is empowering. The hope, Ferrone said, is that community outreach efforts will bring these benefits to even more patients.

“We are incredibly fortunate to be able to offer free genetic testing in high-risk populations in the near future,” Ferrone said. “This will help us identify more at-risk patients and get them enrolled in the appropriate programs to help them manage their risk and preserve their health.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Andrew Hendifar, MD, professor of Medicine and medical director of the Cancer Clinical Trials Office and the Gastrointestinal Oncology Disease Research Group at Cedars-Sinai, was a principal investigator on the trial and a co-author of the study, which was sponsored by Revolution Medicines, makers of the new drug. He sat down with the Cedars-Sinai Newsroom to talk about the study results.

How does this new drug work?

The medication, called daraxonrasib, is the first drug that targets cancer-causing mutations in pancreas cells.

The drug targets a mutation in the KRAS gene, part of the RAS genetic family. KRAS mutations are present in 92% of pancreatic cancers. KRAS genes normally act as an “on-off” switch for cell growth. Mutated KRAS genes are stuck in the “on” position and send out a signal that causes cells to divide and grow uncontrollably, allowing cancer to form.

Daraxonrasib blocks the KRAS signal by fitting into a keyhole-type spot on the gene. That spot has a complex shape and is difficult to reach within the cell. The drug gets around this problem by using a “passenger protein” as a Trojan horse. When the cell allows this protein in, daraxonrasib tags along.

Why are these clinical trial results so groundbreaking?

There are no targeted treatments approved for pancreas cancer, and we haven’t had any significant progress for a long time. We've only come up with different chemotherapy combinations, and those are only moderately effective. This new treatment is staggeringly better than chemotherapy. Usually, when we think of an improvement in pancreatic cancer survival, we think of 25% improvement. This medication actually doubled survival in patients with advanced disease. We have patients who participated in the trial who are still alive, which is unheard of because the five-year survival rate for pancreatic cancer patients is only 13%-14%. If the drug is approved by the FDA, it will most likely become the new standard of care for advanced pancreatic cancer and could replace chemotherapy as a first-line treatment.

What comes next?

We are now testing the drug in patients with earlier-stage pancreatic cancer, prescribing it while their tumors are still operable and before their cancer spreads.

Could daraxonrasib be effective against other cancer types?

RAS mutations are one of the most common cancer-causing genetic mutations, and the drug is now being studied in several cancer types. I think it's going to work especially well in tumors that are primarily RAS driven, including colon cancer and lung cancer. It might also work in other cancer types in combination with drugs targeting other genetic mutations, but further research is needed.

How will this discovery change cancer science?

This is a win for the field. Until now we have been focused on immune therapies that might make tumors more vulnerable to the body’s immune system, and on finding new chemotherapy combinations that kill cancer cells.

This new treatment has given us a new focus, and I think it will spur a lot of scientific discovery over the next few years. There have only been a handful of KRAS researchers and their relevance to therapy was always questioned. That is about to change.

The most important next step for the field is to better understand the biology of cancer. We know that many pancreatic tumors will eventually become resistant to daraxonrasib, and we need to understand how this happens. We also need to identify additional genetic pathways and treatments that can target them. That’s how we will turn pancreas cancer from a deadly, deadly cancer into something we can manage—and one day, even cure.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Andrew Hendifar, MD, medical director of the Cedars-Sinai Cancer Clinical Trials Office and professor of Medicine, is available to discuss late-breaking, embargoed results of a trial of a new therapy for advanced pancreatic cancer, as well as Phase II results from a trial of a combination therapy that targets specific genetic mutations in pancreatic cancer cells.

Additional Cedars-Sinai Experts

Leslie Ballas, MD, professor of Radiation Oncology, will participate in a panel discussion and can discuss evidence related to use of biomarkers or circulating tumor DNA in treatment decisions for patients with muscle-invasive bladder cancer.

Fahima Dossa, MD, PhD, a surgical oncologist, will present research on which patients with high-risk localized soft tissue sarcoma are most likely to benefit from chemotherapy.

Stephen Freedland, MD, director of the Center for Integrated Research in Cancer and Lifestyle, will present a post hoc analysis of the EMBARK trial in advanced prostate cancer, detailing testosterone recovery following treatment suspension. Freedland can also discuss research from his lab on use of olaparib, an enzyme blocker, in metastatic castration-resistant prostate cancer, and statin use in prostate cancer patients receiving hormone treatment after prostate-removal surgery.

Lawrence Liu, MD, a hematology oncologist, will present research on recent advances in CAR T-cell therapies for patients with relapsed multiple myeloma. The work involves mezigdomide, part of a new drug class in myeloma, following infusion with idecabtagene vicleucel, a genetically modified CAR T therapy derived from the patient’s own cells.

Arsen Osipov, MD, associate professor of Medicine and medical director of Pancreatic Cancer, can discuss research from his lab on the comprehensive molecular profiles associated with variants of the KRAS gene and patient survival in pancreatic cancer. KRAS mutations are found in more than 90% of pancreatic cancer cases.

Karen Reckamp, MD, professor of Medicine and director of the Division of Medical Oncology, can discuss the treatment landscape for non-small cell and small cell lung cancer. She can explain research from her lab on a machine learning approach for predicting immune-related pneumonitis, a noninfectious lung inflammation that can occur following treatment with immune checkpoint inhibitors. She can also speak about new data from Lung MAP, a clinical trial designed to efficiently test treatments for advanced non-small cell lung cancers. And she will make a presentation on support of academic nonclinical efforts for cancer investigator faculty at the Association of American Cancer Institutes.

Kamya Sankar, MD, assistant professor of Medicine and co-director of the Thoracic Disease Research Group, will present an analysis of factors associated with early cachexia—also known as cancer wasting disease—in metastatic non-small cell lung cancer. She can also speak about treatment of both non-small cell and small cell lung cancer.

From The Angeles Clinic and Research Institute

Mark Faries, MD, surgical oncologist and professor of Surgery, can discuss a five-year update from the KEYNOTE-942 study in resected melanoma and a new study of lymph node resection versus therapeutic dissection in advanced melanoma, as well as recurrence in advanced melanoma across time.

Erwin Grussie, MD, a hematology oncologist, can discuss results from the Targeted Agent and Profiling Utilization Registry (TAPUR) study testing targeted therapies in patients with solid tumors.

Omid Hamid, MD, professor of Medicine and chief of Translational Research and Immuno-Oncology, will present results from a study of a medication that blocks the action of cortisol in patients with advanced solid tumors, as well as a study of causes of limited immunotherapy response in melanoma. He can also discuss new results from three trials of therapies in advanced melanoma.

Inderjit Mehmi, MD, a hematology oncologist, can discuss the association of prior immunotherapy treatment with limited response to subsequent immunotherapy in melanoma.

Media Contact

To schedule an interview, contact Christina Elston at christina.elston@cshs.org or 626-298-0702.

The rookies made stops throughout Cedars-Sinai Guerin Children’s, the Neonatal Intensive Care Unit (NICU) and Cedars-Sinai Cancer, where they posed for photos, signed autographs and handed out Rams-themed gifts.

Players and cheerleaders were greeted with smiles and posed for selfies with patients, families and staff members across both campuses.

At Guerin Children’s, players spent time talking football with pediatric patients and played a few rounds of Connect Four with patients in the courtyard.

“The fact that the Rams came created a sense of normalcy and it really brightened my son’s day,” said Nadyia Blakemore, whose 6-year-old son is a Guerin Children’s patient. “I appreciate the Rams coming through. It was a blessing to my family”.

In the NICU, rookies met new parents and visited some of the hospital’s smallest patients. At Cedars-Sinai Cancer, patients, physicians and staff joined Rams rookie Chad Lindberg for a football toss game, taking turns throwing passes at an inflatable football target.

“Seeing the Rams players connect with our patients and families in such a genuine and compassionate way means so much to everyone across our hospitals,” said Jill Martin, executive vice president of Cedars-Sinai Medical Network. “These visits create joyful moments, lift spirits and reflect the strong partnership between Cedars-Sinai and the Rams organization.”

The patients were clearly touched by their visits, said Joanne Laguna-Kennedy, MSN, RN, vice president of Hospital Operations and chief operating officer of Cedars-Sinai Marina Hospital.

“The players shared that they felt the same sense of joy,” Laguna-Kennedy said. “We’re incredibly grateful for their time, support and enthusiasm.”

Cedars-Sinai is the official healthcare partner and trusted doctors of the Los Angeles Rams.

Read more from Cedars-Sinai Stories and Insights: Childhood Cancer Survivor Aiden Duong in Rams Spotlight

The new tool, called Path2Space, predicts gene expression across the tumor area based on digital images of biopsy slides, which contain thin slices of tumor tissue that can be examined under a microscope.

Because tumors do not have the same composition and gene expression throughout, Path2Space predicts what is known as “spatial” gene expression, estimating it at many different points within the tumor. The process takes only minutes and costs significantly less than conventional spatial gene expression profiling, which typically takes several weeks and costs thousands of dollars.

“This tool makes two major contributions,” said Eytan Ruppin, MD, PhD, deputy director of the Translational Research Institute at Cedars-Sinai and senior author of the study. “It will enable us and others to study larger datasets and understand the spatial structure of tumors. But what really motivates me is that, if we can successfully validate the tool in clinical trials, it could improve cancer care for patients.”  

Investigators “trained” Path2Space using data from a large group of patients with breast cancer, where the biopsy slides and spatial sequencing were both available. They then tested the tool on three additional patient datasets to validate its performance.

“For each sample, we looked at the actual, measured gene expression and compared it with our tool’s prediction,” said Eldad Shulman, PhD, co-first author of the study and a research fellow at the National Cancer Institute, who will soon join Ruppin's lab as a research scientist. “For each sample, we predicted the spatial expression of almost 5,000 genes, and the predictions matched the measured expression well across all three patient groups.”

Path2Space is also designed to help scientists discover new biomarkers that could guide treatment decisions and identify patients at higher risk of poor outcomes.  

“The tool looks at characteristics within the tumor, such as whether a gene is expressed in some areas of the tumor and not others,” said Emma Campagnolo, co-first author of the study and a research fellow in Ruppin’s lab. “We found specific spatial patterns of gene activity in tumors that predict how patients respond to treatment.”

Identifying spatial biomarkers is challenging, Shulman said, because the high cost of spatial profiling by traditional methods means very little of this data is available.

“Before we developed Path2Space, the largest cohort we could find to study the spatial organization of the tumor environment was about 30 patients,” Shulman said. “With this tool, we can study slides from thousands of patients. Path2Space is tapping into the potential of spatial biology in a way that has not been possible until now.”

Path2Space could be applied to other cancer types once it is trained on the correct data, and the lab is finalizing a study applying it to head and neck cancer, Campagnolo said. The team is also working to make the tool more precise. It currently looks at groups of 10 to 20 cells together, and the goal is to eventually be able to assess individual cells.  

“With the help of clinical collaborators, we next want to bring Path2Space into clinical trials,” Ruppin said. “It represents an exciting development in a growing field and has to be tested carefully. But we are hopeful that it could make an impactful contribution to science and to patient care.”

Robert Figlin, MD, interim director of Cedars-Sinai Cancer, noted that translational research is a hallmark of the institution.

“The development of tools that apply leading-edge science to patient care is the best way to serve our patients—and to improve cancer care on a global scale,” Figlin said.

Additional Cedars-Sinai authors include Yuan Yuan, Karine Sargsyan, and Simon R.V. Knott.

Other authors include Roshan Lodha, Youngmin Chung, Amos Stemmer, Thomas Cantore, Beibei Ru, Tian-Gen Chang, Sumona Biswas, Saugato Rahman Dhruba, Sumeet Patiyal, Sushant Patkar, Andrew Wang, Ranjan K. Barman, Chuhan Wang, Rohit Paul, Sarath Chandra Kalisetty, Tom Hu, MacLean P. Nasrallah, Ellis Patrick, Jean Yang, Amy Plotkin, Padma Sheila Rajagopal, Stephen-John Sammut, Stanley Lipkowitz, Peng Jiang, Carlos Caldas, Kenneth Aldape, Joo Sang Lee, and Danh-Tai Hoang.

Funding: This research was supported by the Intramural Research Program of the NIH, NCI, and the Center for Cancer Research. The contributions of the NIH authors were made as part of their official duties, as NIH federal employees are in compliance with agency policy requirements and are considered works of the U.S. government. This research was also partially supported by a grant of the Korea-United States Collaborative Research Fund, funded by the Ministry of Science and ICT and the Ministry of Health and Welfare, Republic of Korea (grant number: RS-2024-00468417; Y.C. and J.S.L.), and by an Institute of Information & Communications Technology Planning & Evaluation (IITP) grant funded by the Korea government (MSIT) (RS-2019-II190421, AI Graduate School Support Program, Sungkyunkwan University; Y.C. and J.S.L.). This work has utilized the computational resources of the NIH HPC Biowulf cluster.

Competing interests: E.D.S., E.M.C. and E.R. are listed as inventors on a provisional patent (application no. 63/703,060, United States, 2024) filed based on the methodology outlined in this study. E.R is (non-paid) member of the scientific advisory boards of Pangea Biomed (divested), GSK Oncology and the ProCan project. E.R is a founder of MedAware Ltd. The other authors declare no competing interests.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Through more than 20 talks, panels, symposia and poster presentations, they will cover topics ranging from cancer biology to the tumor microenvironment, biomarkers that can guide cancer treatment, clinical trial results, and the role of AI in precision oncology.

Late-Breaking Presentation

Inderjit Mehmi, MD, medical oncologist at Cedars-Sinai The Angeles Clinic and Research Institute, will deliver a late-breaking oral presentation about an ongoing Phase I/IIa study of the immune checkpoint inhibitor GV20-0251 in patients with advanced melanoma that is resistant to anti-PD1 and other standard therapies. The presentation builds on clinical data presented at ASCO 2025 and will report translational findings from the study.

Additional Cedars-Sinai Cancer Experts and Topics

Eytan Ruppin, MD, PhD, an investigator at the Translational Research Institute and the Jim and Eleanor Randall Department of Surgery, will chair an Advances in Technology session exploring approaches for harnessing AI to learn about the spatial organization of human tissues. Speakers will describe computational approaches to spatial omics experiments, recent studies on developing agents that facilitate the analysis and characterization of pathology slides and spatial transcriptomics data, and ways to infer spatial biology and cancer treatment response biomarkers directly from histopathology slides.

Sergei Grivennikov, PhD, professor of Medicine and Biomedical Sciences, will co-chair a mini-symposium on the tumor microenvironment and its role in tumor evolution and immune system evasion.

Karen Reckamp, MD, a thoracic medical oncologist and director of the Division of Medical Oncology, will present final results from Pragmatica-Lung, a prospective randomized clinical trial with a pragmatic design that evaluated ramucirumab plus pembrolizumab versus standard of care in more than 800 patients with stage 4 or recurrent non-small cell lung cancer.

Cedars-Sinai investigators will also present research on:

• New understanding of and treatments for breast cancer
• Disparities in heart disease deaths among breast cancer patients
• Antitumor responses in pancreatic and breast cancer
• Radiation and antitumor therapies in prostate cancer
• Immune rejection and antitumor activity in bile duct cancer
• The tumor microenvironment’s role in pancreatic cancer spread

Experts Available to Comment

Cedars-Sinai investigators are available to discuss their work and other news coming out of the meeting. To schedule an interview, contact Christina Elston at christina.elston@cshs.org or 626-298-0702.

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that causes chronic inflammation and sores in the colon.

“Ulcerative colitis greatly increases a person’s risk of developing colorectal cancer, but we don’t have a noninvasive way to determine how great each patient’s risk might be,” said Hajar Hazime, PhD, a project scientist in the Abreu Lab at Cedars-Sinai and co-first author of the study. “Undergoing frequent surveillance colonoscopies can help, but preparing for that procedure is especially difficult for someone with ulcerative colitis.”

Additionally, colonoscopy results can be inconclusive, forcing the physician and patient to decide whether to remove all or part of the colon to prevent cancer from developing, Hazime said. Investigators hoped to find a more conclusive and less invasive way to screen these patients.

“Our physician-scientists are continually working to improve cancer screening for our patients,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “We treat more than 60 types of cancer, but our ultimate goal is prevention.”

Each person’s gut is populated with trillions of microbes—bacteria, viruses, fungi and other organisms too small to see with the naked eye. These interact with each other and appear to influence several aspects of a person’s health, including IBD.

Hazime said that these microbes use QSMs to communicate and coordinate their behavior, and that a goal of the study was to determine whether QSMs play a role in causing colon cancer in patients with ulcerative colitis.

When the investigators examined blood samples from human patients with ulcerative colitis and conducted experiments using colon organoids and laboratory mice, they found:

• In the blood of ulcerative colitis patients, there were higher levels of QSMs in patients at higher risk for cancer, who had experienced symptoms for 10 years or longer, than in patients at lower cancer risk, with symptoms for five years or less.
• In colon organoids—tiny clusters of cells that mimic some functions of the human colon—exposure to QSMs caused inflammation, which is a risk factor for tumor development. Because organoids do not contain gut microbes, this showed that elevated QSM levels and the activity of microbes they regulate can increase cancer risk.
• In laboratory mice with a condition that mirrors ulcerative colitis, investigators found higher levels of QSMs in the blood of those that developed tumors than in those that did not. Also, mice exposed to extra levels of QSMs developed more tumors, more quickly, than those not exposed.

“These results show us that quorum sensing molecules are not only associated with colon cancer risk in patients with ulcerative colitis, but that they actually contribute to the formation of these tumors,” said Maria T. Abreu, MD, executive director of the F. Widjaja Inflammatory Bowel Disease Institute and co-corresponding author of the study. “That makes these molecules a potential way to screen patients for cancer risk, but also a possible target for reducing risk.”

Investigators will next focus on pinpointing how QSMs contribute to tumor formation, studying the molecules as a biomarker to predict cancer development, and finding ways to target these molecules to disrupt cancer development, Abreu said.

Additional Cedars-Sinai authors include Irina Fernández, Katerina M. Faust, and Maria A. Quintero.

Other authors include Gregory O’Connor, Juan F. Burgueño, Ana M. Santander, Nivis Brito, Yuguang Ban, Sapna K. Deo, and Sylvia Daunert.

Funding: This work was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK099076) and the Micky & Madeleine Arison Family Foundation Crohn's & Colitis Discovery Laboratory to MTA as well as from the National Institutes of Health (R01GM127706) and the Department of Defense (W81XWH-20-1-0697) to SD and SKD and the Lucille P. Markey Chair in Biochemistry and Molecular Biology to SD.

Disclosures: MTA is a consultant or on the advisory board of the following companies: AbbVie Inc., Alimentiv Inc., Amgen, Bristol Myers Squibb, Eli Lilly and Company, Genetech, Gilead Sciences, Janssen Pharmaceuticals, Pfizer Pharmaceutical, Takeda Pharmaceuticals, and UCB Pharma.

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“These rising cancer rates are expected worldwide, and large-scale efforts need to be made to encourage lifestyle changes and develop screening programs to reduce them,” said Ju Dong Yang, MD, medical director of the Liver Cancer Program and professor of Medicine at Cedars-Sinai and co-corresponding author of the study.

Liver Cancer

Yang said that up to 70% of liver cancers could be prevented through lifestyle changes, because while hepatitis B and C were once leading causes of liver cancer in the U.S., they are being eclipsed.

“Metabolic dysfunction-associated steatotic liver disease, or MASLD, is emerging as a leading cause of liver cancer in Western countries, including the U.S.,” Yang said. “This is a buildup of fat in the liver that is associated with diabetes, obesity, and uncontrolled high cholesterol and high blood pressure.”

Taking steps to help control these risk factors is the best way to reduce risk, Yang said.

Yang said that only about 20% of people in the U.S. with cirrhosis from hepatitis and other chronic liver conditions receive liver cancer screening, which could help improve early detection and patient outcomes. Only about 30% of liver cancers are detected at an early enough stage for cure, Yang said.

Esophageal and Gastric Cancers

Lifestyle factors and limited screening also come into play in risk for esophageal and gastric cancers, said Alexandra Gangi, MD, director of the Division of Surgical Oncology in the Jim and Eleanor Randall Department of Surgery and director of the Gastrointestinal Tumor Program.

“These tumors cause few symptoms before the cancer has spread—and they tend to spread rapidly,” Gangi said. “To reduce risk, focus on preventable issues such as obesity, tobacco and alcohol use, and diet. And if you have other risk factors such as chronic acid reflux, gastritis or family history of these cancers, speak with your doctor about screening.”

Colorectal Cancer

Everyone should be screened for colorectal cancer by age 45—but those with a family history of the disease should begin sooner, said Alessio Pigazzi, MD, PhD, director of the Division of Colorectal Surgery. Results of that first screening, along with other risk factors, will help determine how often follow-up screenings are needed.

“Late diagnosis makes colorectal cancer highly lethal, while early diagnosis leads to very high cure rates,” Pigazzi said. “To reduce risk, everyone should eat a diet focused on whole foods that are high in fiber and low in sugars and animal fats, exercise regularly, keep up with screenings, and watch for colon cancer symptoms such as frequent rectal bleeding or unexplained changes in bowel habits.”

Pancreatic Cancer

Pancreatic cancer is another GI cancer usually diagnosed in advanced stages—with 50% of people diagnosed when the disease has already spread, said Arsen Osipov, MD, medical director of Pancreatic Cancer and Multidisciplinary Programs and Integration.

“There have been recent advances in early detection and treatment, including blood-based ‘liquid biopsy’ tests and structured screening programs for those with strong genetic risk,” Osipov said. “And multidisciplinary clinics, such as one pioneered at Cedars-Sinai, help accelerate diagnosis and treatment planning, and improve access to clinical trials and patient outcomes.”

To reduce pancreatic cancer risk, Osipov recommended paying attention to modifiable lifestyle factors similar to those for other GI cancers. He also suggested that people with chronic pancreatitis or family history of pancreatic cancer consider genetic counseling and participation in a high-risk surveillance program.

On the Horizon

Cedars-Sinai research is changing the landscape of GI cancer detection and treatment, said Katelyn Atkins, MD, PhD, interim chair and medical director of Radiation Oncology. Blood-based biomarkers such as circulating tumor DNA are improving early detection and allowing for tailored treatments and better detection of recurrence in colorectal cancer—and are now being leveraged for other GI sites, Atkins said.

“Improvements in radiation oncology techniques are allowing us to deliver the therapy more precisely and better protect nearby organs, making it safer to deliver more intense and effective treatment,” Atkins said. “There is also growing use of radiotherapy as an alternative to radical surgery in rectal, esophageal and gastroesophageal cancers.” 

Biomarker-driven treatment is also improving integration of radiotherapy into treatment regimens that also include surgery, chemotherapy and immunotherapy.  

“This shift toward more personalized, biology-driven treatment approaches helps us extend survival and preserve quality of life for patients with GI cancers,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “We will continue to work to improve treatment options and prevent cancer incidence in our community.”  

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

If validated in further studies, the artificial intelligence-based platform could be used to improve treatment selection in virtually any cancer type. Results from a study of the platform’s effectiveness are published in the Journal of Clinical Oncology.

“Currently, we have no conclusive data to show which of the two approved chemotherapy regimens for patients with advanced pancreatic cancer is more effective,” said Andrew Hendifar, MD, medical director of Pancreatic Cancer at Cedars-Sinai Cancer and first author of the study. “So we start with one, do our best to quickly gauge the patient’s response, and switch if needed.”

The problem with this, Hendifar said, is that putting an ill patient on a chemotherapy regimen that isn’t working worsens their health rather than improving it. Biomarkers from blood or tissue can help predict treatment response and guide these decisions in other cancer types, but currently, no biomarkers exist for pancreatic cancer.

“This endeavor is an example of applying AI technology to an unmet clinical need, and offers tremendous translational potential,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “It aligns perfectly with our goal of personalizing cancer treatment for our patients and improving outcomes for all.”

To develop the tool, investigators used a platform called Computational Histology Artificial Intelligence, or CHAI. CHAI analyzes images of microscope slides containing samples of tumor tissue, which are stained to highlight minute details of the cells. Almost all patients have these samples taken when their tumors are biopsied.

The team analyzed tissue characteristics in samples from 25,000 pancreatic cancer patients who had received one chemotherapy regimen or the other. The platform’s AI capabilities made it possible to analyze more than 30,000 different features of the tissue samples. Investigators then matched tissue characteristics to treatment response to create the predictive tool.

When they tested the tool on data from a large clinical trial using the two pancreatic cancer treatment regimens, they found that it was able to accurately predict each patient’s response to the treatment received.

“Unlike most biomarker tests, where you need an extra sample of tissue or blood, this test requires only a scanned image of the patient’s existing biopsy slide,” Hendifar said. “You just send the image electronically and quickly receive a result with the treatment preference. And you don’t just learn which treatment is preferred. You learn how much more effective it is likely to be.”

The tool needs to be further validated in patients undergoing treatment before it is ready for clinical use, but Hendifar said that with that validation it could eventually be applied to other solid tumor types. It could even compare the potential benefit of different types of therapy, such as radiation therapy versus surgery.

“If the chance that a particular treatment will benefit a patient is 50-50, which is quite common in cancer therapy, then this may serve as a powerful tool to aid physician and patient decision-making,” Hendifar said. “And we can train the digital tool not just to choose between two available treatments, but to choose between multiple available treatments.”

Additional Cedars-Sinai authors include Brent K. Larson, DO; Vladimir Kazarov, MS; Natalie Moshayedi, BS; and Arsen Osipov, MD.

Other authors include Viswesh Krishna, BS; Vrishab Krishna, BS; Haochen Zhang, PhD; Katelyn Smith, BA; Kawther Abdilleh, PhD; Snehal Sonawane, MD; Akshay Neema, MS; Asit Tarsode, MS; Ekin Tiu, MS; Vivek Nimgaonkar, MD; Shawn Hutchinson, MSc; Daniela Bevacqua, BS; Sudheer Doss, PhD; Alejandra Alvarez, MS; Drew Watson, PhD, MBA; Waleed M. Abuzeid, MD; Barbara T. Grunwald, MD; Marcus Noel, MD; Rashmi Samdani, MD; Dove Keith, PhD; Rosalie C. Sears, PhD; Davendra Sohal, MD, MPH; Christos Fountzilas, MD; Grainne M. O’Kane, MD; Robert C. Grant, MD, PhD; Eric A. Collisson, MD; Lesli A. Kiedrowski, MS, MPH; Trevor J. Royce, MD, MS, MPH; Anirudh R. Joshi, MS; Aatur D. Singhi, MD, PhD; and Jennifer J. Knox, MD, MSc.

Funding: Supported in part by the Pancreatic Cancer Action Network (PanCAN - Know Your Tumor), the University Health Network, Toronto (COMPASS trial), and Valar Labs, Inc.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“After 35 years of marriage, my heart still sings when I look at her,” Philip said. “My cancer was much worse on Linda than it was on me, and her cancer was worse on me than it was on her. Whichever one of us was sick, the other one filled in the gaps. But that’s the way we normally live our lives. Whatever one needs, the other one provides.”

Philip’s pancreatic cancer was detected in early 2024 during an unrelated MRI of his kidneys. Arsen Osipov, MD, medical director of the Pancreatic Cancer Multidisciplinary Clinic and Multidisciplinary Cancer Programs and Integration at Cedars-Sinai, Philip’s oncologist, said it was a stroke of luck.

“He was diagnosed at a curable stage, before the cancer had spread,” Osipov said. “Only 10 to 20% of patients with pancreatic cancer are diagnosed this early.”

Philip was one of the first patients to visit the multidisciplinary clinic, where in a single day he met with medical oncologists, radiation oncologists, surgeons, gastroenterologists and other experts, and agreed on a treatment plan: four months of chemotherapy, followed by radiation and a complicated surgery called a Whipple procedure.

“This is a complex operation where we remove what’s called the head of the pancreas, the first part of the small intestine, the gallbladder and the bile duct,” said Nicholas Nissen, MD, director of Hepatobiliary and Pancreatic Surgery. “After removal, these structures are reattached to restore normal function.”

This procedure once required large incisions, but because radiation and chemotherapy successfully shrank Philip’s tumor, Nissen was able to perform the procedure robotically.

“This allows us to make smaller incisions, with lower risk of complications and a shorter recovery time for the patient,” Nissen said.

After four days in the hospital and two more months of chemotherapy, Philip was declared cancer-free in June.

But the couple had just a few days to celebrate.

Less than a week after Philip learned he was cancer-free, Linda was diagnosed with breast cancer after undergoing a routine mammogram.

“As a health system, we focus on screening and are always developing new ways to detect cancer early,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “For both of these patients, early detection was key to the best possible outcome.”

Still, the diagnosis was a bit of a shock to Philip and Linda.

“It was sort of unbelievable,” Linda said. “But we had been through the whole process with Phil, and his surgery was much more serious than mine, and he did so well that I felt much more comfortable.”

And she, too, was lucky, said Armando Giuliano, MD, director of Breast Surgical Oncology at Cedars-Sinai Cancer and Linda’s surgeon.

“She had a screen-detected cancer that has no symptoms. You can't feel it. It causes no pain, no discharge,” Giuliano said. “The only way you can detect a cancer like that is with breast cancer screening. And those cancers are the smallest cancers—the cancers that are the easiest to cure.”

Giuliano was able to perform a breast-sparing therapy known as a partial mastectomy or lumpectomy.

“We remove the area of the breast that has cancer, all the way around so that we have clean margins,” Giuliano said. “And then we do an internal reconstruction to make the breast look as natural as possible.”

Giuliano also performed a procedure he pioneered, which he continues to develop at Cedars-Sinai, called a sentinel lymph node biopsy, removing one or two lymph nodes to be certain the cancer had not spread beyond the breast.

“He did such a beautiful job that if you were to look at my breast, you would not know I had had surgery,” Linda said.

Linda’s cancer was an infiltrating ductal carcinoma, a cancer that starts in the breast ducts and can spread throughout the body. It was also HER2 positive, so it required further treatment.

“Around 20% of cancers have this overexpression of the HER2 protein, which makes them more aggressive and at higher risk of spreading,” said medical oncologist Philomena McAndrew, MD. “For this reason, after Linda’s surgery we treated her with chemotherapy and immunotherapy. We followed that with radiation therapy, and Linda did incredibly well throughout each of these steps.”

One important element for Linda was McAndrew’s recommendation to use a cooling cap to help avoid hair loss during chemotherapy.

“I'm so thrilled that I did,” Linda said. “Dr. McAndrew told me that when women lose their hair, it's very traumatic. When they look in the mirror, they realize how sick they are. Fortunately, that didn’t happen to me, and I was so grateful.”

Linda completed her final radiation treatment in January and will continue preventive therapy for five years. She and Philip will also have regular follow-up screenings.

But for now they are headed from their “city house” in Culver City to their main house in Lake Arrowhead, to spend time with friends they haven’t seen in a while.

Then they’ll continue their journey, in sickness and in health, together.

“We’re going on a cruise to Hawaii at the end of February,” Linda said. “We're just trying to pack some fun into the next 20 years.”

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These outcomes place the medical center at the top of rankings recently released by the Center for International Bone and Marrow Transplant Research (CIBMTR). Cedars-Sinai is one of just seven adult transplant centers out of 176 in the U.S. where patient survival after transplant is significantly better than predicted.

“We have a carefully chosen approach to pretransplant conditioning and graft-versus-host disease prevention for our patients, which plays a vital role in our strong survival outcomes,” said John Chute, MD, director of the Division of Hematology and Cellular Therapy at Cedars-Sinai Cancer. “We also have a dedicated system for keeping patients in touch with their care team, which helps identify problems before they become serious.”  

The greatest risk to stem cell transplant patients is during the first 100 days after transplant, said Ronald Paquette, MD, clinical director of the Stem Cell and Bone Marrow Transplant Program at Cedars-Sinai Cancer.  

“We have modified our pretransplant regimens and post-transplant care to minimize toxicity to the patients and give them the best chance for a successful recovery,” Paquette said. “We also are careful to select stem cell donors who can provide the best-quality stem cell and immune cell recovery.”

An allogeneic transplant uses stem cells from a donor, rather than the patient’s own cells, and Paquette said the approaches to these transplants are specific to each institution.

Along with a uniform approach to pretransplant therapy, Chute and Paquette attributed Cedars-Sinai’s top ranking to the frequent use of younger half-matched donors—often a child or grandchild of the patient—to get patients to transplant more quickly.

“In addition to that, there is no replacement for the people who take care of the patients, from the transplant coordinators to the physicians, nurses and advanced practice providers,” Chute said. “The dedication of our team provides that crucial element that yields the best possible results for our patients.”

Chute and Paquette are currently exploring stem cell transplant for patients who would once have been thought “too old” for the procedure.

“Age 75 used to be the upper limit, but that was arbitrary,” Paquette said. “We have transplanted several patients over age 75 and all are doing well so far. We are hoping to learn more about the biology of transplant via these patients, to learn about the pluses and minuses of doing transplants in patients this age. We want to learn not only how to extend their survival but also how to maximize their quality of life.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Cedars-Sinai has received a $30 million gift from the Cayton Goldrich Family Foundation to establish the Cedars-Sinai Cayton BRCA Center, a first-of-its-kind in Southern California. The state-of-the-art center will concentrate on the research, diagnosis and comprehensive treatment of illnesses linked to mutations in the genes known as BRCA1 and BRCA2.

These genes, when functioning properly, help repair damaged DNA to prevent tumors from forming. However, mutations in the genes can significantly increase the risk of certain inherited cancers, including breast, ovarian, prostate and pancreatic malignancies.

“We can help prevent harmful BRCA mutations from being passed down from carriers to their children and grandchildren and work toward ending the cycle of inherited cancer risk,” said foundation trustee Barry Cayton.

Trustee Andrea Goldrich Cayton added, “Our family has personally been affected by BRCA gene mutations, so we feel especially compelled to make a transformative mark in the healthcare space linked to holistic BRCA research and care.”

The Cayton and Goldrich families are longtime supporters of Cedars-Sinai. In 2019, the Goldrich Family Foundation donated $10 million to establish the Jona Goldrich Center for Alzheimer's and Memory Disorders at Cedars-Sinai. The center was named for the late patriarch of the Goldrich family, who was a Holocaust survivor and prominent Los Angeles real estate developer and philanthropist.

“Cedars-Sinai is truly humbled and honored by our continued visionary partnership with the Cayton Goldrich Family Foundation,” said Peter L. Slavin, MD, president and CEO of Cedars-Sinai and the David and Meredith Kaplan Presidential Chair. “They embody humanitarianism and hold a strong belief in science’s ability to transform healthcare and improve human life.”

About 1 in 400 people in the U.S. carry a BRCA mutation. Males are less likely to be tested for the mutations, and female carriers are more likely to be diagnosed with breast cancer. BRCA mutations increase cancer risk in both genders, but the specific forms of cancer and rates of diagnoses differ.

Some population groups are more prone to BRCA mutations, including people of Eastern European Jewish, Korean, Mexican, and African American ancestries. Currently, there is no comprehensive BRCA clinical and research center in Los Angeles to serve high-risk communities. Cedars-Sinai leaders said the new center will play a major role in advancing research, education and clinical innovation.

“The Cedars-Sinai Cayton BRCA Center will offer patients personalized guidance and timelines for their care, including risk-reducing procedures, genetic testing, specialized screenings and reproductive medicine services to help break the cycle of genetic cancer risk,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences, dean of the Medical Faculty and the Helene A. and Philip E. Hixon Distinguished Chair in Investigative Medicine. “We will develop a hub of translational discovery science devoted to eradicating the cellular underpinnings of BRCA mutations.”

Read more on the Cedars-Sinai Blog: 7 Tips to Reduce Your Breast Cancer Risk

As a highlight of the symposium, Armando E. Giuliano, MD, division director of Breast Surgical Oncology in the Jim and Eleanor Randall Department of Surgery at Cedars-Sinai, will receive the William L. McGuire Memorial Lecture Award in recognition of his significant contributions to the field of breast cancer research.

“It is a great honor to receive the 2025 McGuire Award,” Giuliano said. “We’ve made tremendous progress in the surgical treatment of this disease, and I am especially grateful to the brave patients who participated in the trials that helped us develop new standards of care and improve the lives of patients with early metastatic breast cancer.”

Giuliano was instrumental in refining sentinel lymph node biopsy for breast cancer in the early 1990s, sparing many women from more invasive breast cancer surgery. This technique identifies and removes only the first lymph node where cancer is most likely to spread to determine whether removing additional nodes is medically necessary.

Through two large multicenter trials, ACOSOG Z0010 and ACOSOG Z0011, Giuliano and team validated the technique that led to establishing the less-invasive sentinel lymph node biopsy as the standard of care, as opposed to axillary lymph node dissection, which removed most or all nodes and is associated with increased surgical complications. The findings from these trials transformed surgical management of breast cancer.

“The pioneering contributions Dr. Giuliano has made to breast oncology have not only changed the field, but they have directly and positively impacted the lives of millions of women worldwide,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. “It is a privilege to work alongside Dr. Giuliano, and I wholeheartedly congratulate him on this well-deserved honor.”

Giuliano, the Linda and Jim Lippman Chair in Surgical Oncology, associate director of the Samuel Oschin Comprehensive Cancer Institute and co-director of the Saul and Joyce Brandman Breast Center—A Project of Women’s Guild, will present his award lecture on Wednesday, Dec. 10, at 9 a.m. CT.

Additional Cedars-Sinai experts attending the meeting:

Yuan Yuan, MD, PhD, director of Breast Oncology and medical director of Breast Cancer Research, will present data on how patient-derived organoids—tiny groups of cells—can guide therapy in patients with metastatic breast cancer. She also will present research on AI-driven H&E slides predicting triple-negative breast cancer patients’ response to therapy, as well as data from an ongoing clinical trial of a novel PD1-VEGF bispecific antibody for early-stage triple-negative breast cancer.

Stephen Shiao, MD, PhD, professor of Radiation Oncology and radiation oncology director of the Breast Oncology Disease Research Group, will participate in a plenary talk regarding a randomized trial of no-, low- or high-dose preoperative radiation with pembrolizumab and chemotherapy in node-positive, HER2-negative breast cancer. He can also discuss the potential of GLP-1 receptor agonists in combination with radiotherapy to improve overall survival in triple-negative breast cancer. Luxi Chen, MD, who will present a poster detailing this research at the conference, is a recipient of a San Antonio Breast Cancer Symposium Young Investigator Award.

Scheduling interviews:

To schedule an interview with a Cedars-Sinai expert, please contact:

Jillian Scholten | 949-244-2561 | jillian.scholten@cshs.org

Read more in Cedars-Sinai Discoveries: Abreast of Trends in Cancer

Addison, who previously smoked, was referred to the Cedars-Sinai Lung Cancer Screening Program by her primary care physician because Addison met screening guidelines. Those guidelines recommend screening those 50-80 years old who currently smoke or have smoked the equivalent of one pack of cigarettes a day for 20 years or more.

“Once Addison entered our Lung Cancer Screening Program, her care was guided by our nurse practitioner, Deborah Gregory, who ensured she felt informed and supported from screening through diagnosis,” said Sara Ghandehari, MD, medical director of the Lung Cancer Screening Program at Cedars-Sinai Cancer. “Deborah presented her case to our multidisciplinary team, delivered timely expert recommendations, and navigated insurance hurdles to keep her care on track. The Lung cancer Screening Program facilitates the screening process and provides fast access to diagnosis and follow-up care.  For people at increased risk for developing lung cancer, screening and early detection can save lives.”

That’s exactly what happened to Addison. Today, Addison is cancer-free, following screening, early detection and treatment at Cedars-Sinai Cancer.

The screening process involves a noninvasive, low-dose CT scan that can detect cancer or precancerous nodules inside the lungs. Addison had been undergoing screenings since 2021, and her screening in 2024 detected a change in a previously identified nodule in the middle lobe of her right lung.

“The nodule measured 11 millimeters, which is quite small,” said Christopher Lee, MD, radiologist and imaging director of the Lung Cancer Screening Program, who read Addison’s scans. “A nodule of this size would never be noticed without a CT scan since they do not cause symptoms until they become much larger. That's basically what we're trying to catch with screening: early-stage cancers that are potentially curable.”

After a biopsy confirmed the nodule was cancerous, Addison met Andrew Brownlee, MD, thoracic surgeon and assistant professor of Surgery.

“He told me that my cancer was at an early stage and in the best place that I could have it,” Addison said. “He said he would remove that lobe and my cancer would be gone. So I didn’t have to have chemotherapy, I didn’t have to have radiation. I have to have a CT scan every six months for the next two years, but that is all.”

After a series of tests and other preparation, she was scheduled for surgery Feb. 17. Because her tumor was so small and at such an early stage, she was able to have a robotic “keyhole” procedure to remove it.

“Lung cancer surgery has made tremendous advances in recent decades, and one of those is the use of minimally invasive procedures,” Brownlee said. “We perform the lion's share of lung cancer surgeries using the robotic platform. Patients have the same outcomes, but with a faster, easier recovery—less time in the hospital, less postoperative discomfort and a faster return to their everyday life with minimal impact on their breathing.”

Brownlee said that the area of Addison’s lung that was removed, the middle portion on the right side, participates in only about 5% to 10% of lung function, so the remaining portions of her lungs can make up for the missing portion.

“We all start out with more lung capacity than we need,” Brownlee said. “So when we remove one lobe, the other lobes can compensate.”

After just two days in the hospital, Addison was able to go home.

“Early detection and leading-edge treatment are hallmarks of patient care at Cedars-Sinai Cancer,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “We are dedicated to producing the best possible outcomes at every turn.”

The mother of four and grandmother of three advises everyone who is eligible to seek out lung cancer screening.

“It is very important,” she said, “especially if you are a smoker or have been a smoker. If it hadn’t been for my screening, my cancer wouldn’t have been caught in time.

“Cancer is a scary word,” said Addison, whose mother died from breast cancer and whose father died from colon cancer. “Nobody wants to hear that word. But my philosophy of life is that God is not going to put anything on my plate that he does not already have the solution to. So, I made my doctor's appointments, went to get my X-rays and blood work, and then I had my surgery, and here I am cancer-free. I do not need radiation, do not need chemotherapy, and I'm fine. I can go ahead and live my life.”

Read More on the Cedars-Sinai Blog: Clearing the Air—Your Lung Cancer Screening Questions Answered

“Cedars-Sinai Cancer is uniquely placed to offer expert specialty care to patients of all ages with these complex cancers,” said Leo Mascarenhas, MD, director of the Adult and Pediatric Sarcoma Program and the Division of Pediatric Hematology/Oncology at Cedars-Sinai Cancer. “We are one of just three centers in California providing both pediatric and adult sarcoma care.”

As associate director of the Sarcoma Program, Hu provides care for patients at Cedars-Sinai and its affiliate, Huntington Cancer Center, and leads research and teaching initiatives.

“Sarcoma is relatively rare and can come in many forms,” Hu said. “A general oncologist might see only a handful of cases over a decades-long career. As a sarcoma specialist, it is so satisfying to work with these patients and to have the experience and expertise to deliver the care they need. They are so grateful that someone understands what they are dealing with.”

Hu earned his medical degree at Uniformed Services University. He completed his residency training in internal medicine at William Beaumont Army Medical Center in El Paso, Texas, and his fellowship in hematology and oncology at Madigan Army Medical Center in Tacoma, Washington. He also served as military commander of the 325th Combat Support Hospital in Independence, Missouri.

“As an oncologist in the military, you basically see everything,” Hu said. “You see a lot of young patients, and sarcoma is more prevalent in the young population, so we saw a fair amount of sarcoma. After success in building sarcoma programs at other institutions, I was excited for the opportunity to help expand the program at Cedars-Sinai.”

In addition to Hu and Mascarenhas, a leading pediatric hematologist-oncologist and sarcoma expert, the program includes Joseph Schwab, MD, director of Spine Oncology in the Department of Orthopaedics and a specialist in managing sarcomas of the spine. The growing program also includes Earl Brien, MD, surgical director of the Sarcoma Bone Tumor Program.

The program offers multidisciplinary care with the latest diagnostic techniques, including liquid biopsy and the identification of genetic and molecular abnormalities in tumor tissues that can help guide treatment decisions.

“Sarcomas have interesting genetics and our cancer predisposition program is investigating those that might have inherited risk,” Mascarenhas said. “We have expertise in genetic testing and counseling, and also are investigating factors that contribute to risk of developing sarcoma in childhood through adolescence, young adulthood and adulthood.”

Cedars-Sinai sarcoma patients also have access to a variety of clinical trials, including cooperative national studies and investigator-initiated trials unique to Cedars-Sinai, Mascarenhas said.

“The growth of our Sarcoma Program, and the growth of Cedars-Sinai Cancer as a whole, reflects our institution’s commitment to caring for the patients in our community and beyond,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “As patients’ need for care expands, so will the care that we offer.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Ruppin comes to Cedars-Sinai from the National Cancer Institute, where he was founding chief of the Cancer Data Science Lab.

“We are delighted to welcome Dr. Ruppin to Cedars-Sinai as a prestigious senior scientist enriching our cancer discovery programs,” said Shlomo Melmed, MB, ChB, executive vice president of Medicine and Health Sciences and dean of the Medical Faculty. “We continue to recruit the highest-quality faculty dedicated to translational research and advancing leading-edge cancer diagnosis and care.”

The Translational Research Institute will support Ruppin’s endeavors and offer what Ruppin calls a “golden opportunity” to work with the diverse patient populations served by Cedars-Sinai Cancer. His goal is to test, in clinical trials, the methods he has been developing.

“The Translational Research Institute is committed to establishing Cedars-Sinai as a global leader in translating scientific discoveries into life-changing patient care, and Dr. Ruppin’s work dovetails perfectly with this mission,” said Ze’ev Ronai, PhD, professor of Surgery and Biomedical Sciences and director of the institute.

Ruppin is developing artificial intelligence-based approaches to match patients to the best treatments in a personalized manner, which may complement existing approaches that identify molecular alterations in tumor cells. Currently, many cancer patients do not have their tumors sequenced in-depth because the process is expensive, available only at major academic medical centers and takes several weeks—which can cause treatment delays.

Ruppin’s approach, which will complement traditional laboratory techniques, uses digital images of tumor histopathology slides, thin slices of tumor tissue routinely obtained from patient samples so they can be examined beneath a microscope.

“We have discovered that by applying AI prediction tools to these slides, which have been the backbone of cancer diagnosis for 100 years, we can infer key parts of the molecular information that could be yielded by traditional sequencing—but without the associated time or expense,” Ruppin said.

Ruppin’s lab has successfully validated this approach in breast cancer, comparing molecular data from patients whose tumors have been sequenced in the traditional way with the tumor data inferred by his computational tools, and is now studying its application in other cancer types.

“Collaboration and translational science are central to improving patient outcomes,” said Cristina R. Ferrone, MD, chair of the Jim and Eleanor Randall Department of Surgery. “We must attack cancer in a multidimensional way and Dr. Ruppin’s expertise in deep-learning approaches adds another dimension to our arsenal.”

Ruppin earned his medical degree and a PhD in computer science from Tel Aviv University, where he served as a professor of Computer Science and Medicine. He has also served as a professor of Computer Science and director of the Center for Bioinformatics and Computational Biology at the University of Maryland, before moving to the National Institutes of Health.

A fellow of the International Society for Computational Biology, he received an NCI Director’s Award for his work on precision oncology in 2022, the DeLano Award for Computational Biosciences from the American Society for Biochemistry and Molecular Biology in 2023, and an NIH Director’s Award for developing new computational paradigms for precision oncology in 2024.

“Cedars-Sinai Cancer has a longstanding commitment to bringing precision oncology to as many patients as possible—here and around the world,” said Robert Figlin, MD, interim chair of Cedars-Sinai Cancer. “We’re proud to have Dr. Ruppin join us and to support his work.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“We’ll take care of you,” they told her.

Sanchez, 29, had been a patient at Pasadena-based Huntington Health, an affiliate of Cedars-Sinai, for months. She and her husband were airlifted there after a near-fatal head-on collision in the San Gabriel Mountains near Los Angeles. She had grown close to the trauma surgeons, nurses and other providers who saved their lives and cared for them throughout their long recoveries.

Her caregivers’ prompting to always listen to her body and her confidence in their expertise led Sanchez back to the medical center two years later when she felt a lump in her breast and felt certain it was cancer.

“There are closer hospitals to where I live, but I knew the doctors and nurses at Huntington cared about my health and wellbeing,” Sanchez said. “If they were able to save me after my car accident, I knew they would take great care of me during cancer, as well.”

Today, thanks to Huntington Cancer Center, Sanchez is cancer-free.

While Sanchez’s intuition about where to go for cancer care was spot-on, her medical oncologist, Niki Tank, MD, praised her for immediately noticing a change in her body and seeking a diagnosis.

“I remind patients they are their own best advocate and to not be intimidated by the medical system,” Tank said. “Wendy paid attention to her body and her instincts, and she is doing well today. Her future is very, very bright.”

Healing Habit Sparks Discovery

The car accident in 2022 left Sanchez with a fractured collarbone, ribs and sternum; a broken lumbar spine; a broken tibia and fibula; and damaged internal organs. Surgeons had to remove her colon and two feet of her small intestine. Multiple surgeries to repair her body left her with additional scars.

Her plastic surgeon, Sanjeev Puri, MD, recommended a therapeutic ointment for a long scar stretching from her abdomen to her chest. Applying the ointment became part of her nightly routine.

One evening, smoothing the ointment up her torso, she felt a lump just above her breast.

“I panicked,” Sanchez said. “I told my husband, ‘I think I’m touching cancer.’”

The next morning Sanchez went to her doctor at Huntington Ambulatory Care Center. A subsequent mammogram, ultrasound and biopsy led to a diagnosis of triple-positive ductal carcinoma. This type of breast cancer has receptors for estrogen, progesterone and HER2 and can be treated with targeted therapies.  

Tank, who specializes in breast cancer for adolescents and young adults (people ages 15 to 39), said triple-positive ductal carcinoma is more common in women younger than 50.

“Breast cancer among people in Wendy’s age group tends to be very aggressive and spread quickly,” Tank said.

Sanchez’s cancer was diagnosed at stage 1, meaning it had not spread. But the tumor cells in the breast were large.

Her care team, including Tank and surgical oncologist Amy Polverini, MD, advised chemotherapy and a bilateral mastectomy.

“I didn’t need a second opinion,” Sanchez said. “I trusted them immediately.”

On May 2, 2025, Polverini removed the tumor, five lymph nodes and Sanchez’s breasts. When Sanchez later underwent breast reconstruction, her plastic surgeon of choice was Puri—who had recommended the scar ointment that led to her discovery of the lump.

Breast Cancer in Young Women

Breast cancer among women under 50 is on the rise. According to the American Cancer Society, the number of cases has increased about 1.4% each year since 2012—double the rate seen in older women. A 2024 JAMA Network study showed rising rates of hormone receptor-positive tumors in younger women.

Experts are not entirely sure why.

Sanchez asked Tank if extreme trauma to her body from the car accident could have spurred cancer.

“There are things we still don’t know about why breast cancer develops,” Tank told Sanchez, who was not at high risk to develop the disease.

“While the data isn’t conclusive, there may be a link between physical trauma, the body’s stress response and inflammation that can create an environment where cancer cells thrive. But this doesn’t mean car accidents cause cancer.”

Among known breast cancer risk factors are family history of the disease, tobacco and alcohol use, and a diet of heavily processed foods.

In another nod to the importance of self-advocacy, Tank noted that because Sanchez was not at high risk for developing breast cancer, she would not have been screened for the disease at her age. American Cancer Society guidelines recommend mammogram screening for women at average risk beginning at 45.

A Full New Life

Sanchez is embracing her new life and new memories these days. She and her husband are just back from Disney World, still on a Magic Kingdom high.

“Looking back, I can’t believe everything I’ve survived,” Sanchez said. “I miss the life I had before, but I’m living this new life to the fullest.”

As she left a recent doctor’s appointment, Sanchez met another breast cancer survivor who shared that it had been 30 years since her own diagnosis.

Sanchez smiled.

“I look forward to saying that one day, too,” she said.

Read more on the Cedars-Sinai Blog: 7 Tips to Reduce Your Breast Cancer Risk

The combination therapy, which adds a drug called enzalutamide to commonly prescribed hormone therapy, reduced deaths in patients with recurrent prostate cancer after surgery or radiation for whom other treatments are no longer an option. The trial results were published in The New England Journal of Medicine (NEJM) with simultaneous presentation during the European Society for Medical Oncology Congress (ESMO) Oct. 19 in Berlin.

“After initial treatment, some patients see their prostate cancer come back in an aggressive way and are at risk for their disease to spread quickly,” said Stephen Freedland, MD, director of the Center for Integrated Research in Cancer and Lifestyle at Cedars-Sinai Cancer and co-principal investigator of the study. “Hormone therapy, which is what we’ve been offering patients for 30 years, has not improved survival and neither has anything else. That makes these findings a real game changer.”

The trial included more than 1,000 patients from 244 sites in 17 countries. All the patients were diagnosed with what is known as high-risk biochemically recurrent prostate cancer. Following the patients’ surgery or radiation therapy, the levels of prostate specific antigen, or PSA, in their blood had risen rapidly. PSA is a protein used to detect prostate cancer, and a rapid rise in PSA levels after treatment indicates a patient’s cancer is likely to return and spread—often to the bones or spine.

“We know these patients are at high risk of developing metastatic disease and dying of their cancer unless we offer a meaningful treatment option,” said Freedland, professor of Urology and the Warschaw, Robertson, Law Families Chair in Prostate Cancer.

Patients were randomly selected to receive standard hormone therapy alone, enzalutamide alone, or a combination of the two. After eight years, the risk of death was 40.3% lower in the combination group than in the other two groups, Freedland said.

“This clinical trial, one of many that Cedars-Sinai Cancer has offered to its patients, is an example of the translational work being done by our physician-scientists,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “The result will be improved treatment and better outcomes for patients everywhere.”

Freedland noted that, based on previous results published by the team, enzalutamide is approved by the Food and Drug Administration and listed in National Comprehensive Cancer Network treatment guidelines. These latest results, he said, are likely to strengthen the network’s recommendation and solidify this drug combination as the standard of care for patients with high-risk biochemically recurrent prostate cancer.

“These important findings identify a treatment that prolongs survival in men with aggressive prostate cancer,” said Hyung Kim, MD, a urologic oncologist and chair of the Department of Urology at Cedars-Sinai.  “The latest analysis complements previous studies that found enzalutamide significantly improved survival in other prostate cancer settings, and will change how we take care of our patients.”

Additional authors include Neal D. Shore, M.D.; Murilo de Almeida Luz, M.D.; Ugo De Giorgi, M.D., Ph.D.; Martin Gleave, M.D.; Geoffrey T. Gotto, M.D., M.P.H.; Christopher M. Pieczonka, M.D.; Gabriel P. Haas, M.D.; Choung-Soo Kim, M.D.; Miguel Ramirez-Backhaus, M.D.; Antti Rannikko, M.D., Ph.D.; Matko Kalac, M.D., Ph.D.; Swetha Sridharan, M.B.B.S.; Matt Rosales, Ph.D.; Yiyun Tang, Ph.D.; Ronald F. Tutrone Jr, M.D.; Balaji Venugopal, M.B.B.S., M.D.; Arnauld Villers, M.D., Ph.D.; Henry H. Woo, M.B.B.S., D.Med.Sc.; and Fong Wang, M.D., Ph.D.

Funding: The study was sponsored by Pfizer Inc. and Astellas Pharma Inc., the co‑developers of enzalutamide.

Disclosures: Stephen J. Freedland reports being a consultant to Astellas Pharma Inc., AstraZeneca, Bayer, Eli Lilly, Johnson & Johnson Innovative Medicine (formerly Janssen), Merck, Novartis, Pfizer Inc., Sanofi, Sumitomo Pharma America, Inc. (formerly Myovant Sciences, Inc.), and Tolmar.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

According to the Centers for Disease Control and Prevention, about 10 percent of new breast cancer cases in the U.S. are in women younger than 45.

“We don’t have routine screening recommendations for patients younger than 40, and people aren’t aware that if they have a strong family history, especially in a first-degree relative like a mother, sister or aunt, they should be screened sooner,” said Mary El-Masry, MD, the hematologist-oncologist who led Dade’s care team.

Dade, who received her care from an integrated team at Cedars-Sinai Cancer Beverly Hills, is dancing once again, but treatment for triple-negative breast cancer wasn’t easy. It began with a regimen known as KEYNOTE-522. The protocol included four types of chemotherapy medications to shrink the tumor, plus an immunotherapy drug to help Dade’s immune system do its part in fighting the cancer.

Also there to help were her mother and her partner, Marcus Mack.

“I really just kind of fell into the hands of my care team, knowing that this treatment regimen was going to be extremely rough,” Dade said. “I had moved in with Marcus only three months before I was diagnosed. And then my mom moved in. Who would have thought that my mother and my partner would both be taking care of me.”

Tumors like Dade’s are “negative” for three important receptors—estrogen, progesterone and HER2—that many treatments use to target tumors, making them among the most aggressive and challenging to treat. El-Masry called the protocol Dade received a “breakthrough” in the world of triple-negative breast cancer.

“Mataya has an excellent prognosis,” El-Masry said. “She had a complete clinical response to her treatment. We could see her tumor shrinking.”

Following her chemotherapy and immunotherapy regimen, Dade opted for a double mastectomy with reconstructive surgery. And as a social media influencer, she chose to document her treatment journey.

“This is a message to my future me that I am a baddie and I will get through cancer,” she said to her followers.

For young women like Dade, El-Masry said that it is important to seek out earlier screening if there is family history of cancer—and to be your own advocate.

“If you feel something, bring it to someone’s attention and push to have some imaging done,” El-Masry said. “That could mean a mammogram or, if you are concerned about radiation exposure, an ultrasound. And if imaging isn’t showing anything but you feel a lump, you should ask to have it biopsied so we can be sure it isn’t something we need to be concerned about.”

Several days after her surgery, Dade was able to post the news her friends and family had been waiting for: “I, Mataya Dade, am cancer free.”

With that, she is at work creating a podcast—supported by Mack, a composer and producer—called “You Survived! Now What?” The plan is to offer advice and create a community for other young cancer survivors who are taking their next steps in life—just like Dade and Mack are taking theirs.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Widely known as a pioneer in robot-assisted colorectal surgery, Pigazzi performed the world’s first robot-assisted tumor removal for rectal cancer more than 20 years ago. He has continued to advance the colorectal surgery field with his expertise in robot-assisted, laparoscopic and open surgical techniques to treat complex colorectal conditions such as recurrent and metastatic colorectal cancer.

Pigazzi brings to Cedars-Sinai a rich history of surgical leadership. Most recently, Pigazzi was division director of Colorectal Surgery at New York-Presbyterian/Weill Cornell Medical Center. He also was executive director for Surgical Services, vice chair of Clinical Network, and professor in the Department of Surgery at City of Hope Orange County.

In his new role at Cedars-Sinai, Pigazzi will concentrate on developing the academic colorectal practice, opening novel clinical trials and advancing translational research.

“Cedars-Sinai’s new Faculty Division of Colorectal Surgery will continue to build best-in-class, patient-centered care by staying on the forefront of the latest surgical techniques, clinical trials and clinical practices,” said Cristina Ferrone, MD, chair of the Department of Surgery at Cedars-Sinai. “Under Dr. Pigazzi’s esteemed leadership, we will also enrich our training programs as we develop the colorectal surgical leaders of tomorrow.”

In addition to his clinical practice, Pigazzi is involved in many significant research initiatives, including a translational research effort investigating the role dietary sugars play in the development of colorectal cancer. His extensive publication record includes more than 150 peer-reviewed articles and 16 book chapters. 

“Dr. Pigazzi’s innovative clinical work and research discovery for colorectal cancer aligns perfectly with our commitment to providing leading-edge expertise and care for our Cedars-Sinai Cancer patients,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer.  

Pigazzi earned both his medical and doctoral degrees at Boston University School of Medicine. He then completed his general surgery residency at New York-Presbyterian/Weill Cornell Medical College, followed by advanced fellowship training in minimally invasive surgery at Hackensack University Medical Center and in colorectal surgery at the University of California, Irvine.

“I’m grateful for the opportunity to bring my passion to this leadership role in the Department of Surgery at Cedars-Sinai,” Pigazzi said. “I look forward to growing the division to be the best in the region in terms of clinical, research and academic excellence.”

Read more on the Cedars-Sinai Blog: Taking the Fear Out of Colon Cancer Screening

“Cancer patients are a vulnerable population,” said Jane Figueiredo, PhD, director of Community Health and Population Research at Cedars-Sinai and senior author of the study. “Their immune systems can be weakened by their disease and the treatments they receive, which is why major health organizations recommend that these patients be vaccinated against COVID-19. Our study supports these recommendations. We used real-world data across four major health systems in the U.S. to show that these booster vaccines reduce the risk of hospitalization and severe illness.”

Investigators analyzed data on more than 161,000 patients treated for cancer during 2022 and 2023 at Cedars-Sinai, Kaiser Permanente Northern California, Northwell Health, and the Veterans Health Administration.

The data showed COVID-19 boosters reduced cancer patients’ hospitalizations and ICU admissions by 29% and prevented one hospitalization or ICU admission for every 150-166 boosted patients.

“The reduction in hospitalizations was significant, and the number of patients we needed to treat to see a benefit to the boosters is quite low,” said Figueiredo, who is also program leader of Cancer Prevention and Control at Cedars-Sinai. “This shows a great benefit to our cancer patients and should encourage patients to discuss vaccination with their healthcare providers.”

Figueiredo noted that among their sample, the percentage of patients receiving boosters was quite low. By Jan. 1, 2022, 68% had received a booster. And after updated boosters targeting more than one COVID-19 strain had become available, only 38% of patients had received one.  

“Whether this is due to patient concerns about safety or provider uncertainty about whether to administer a vaccine during treatment is not clear,” Figueiredo said. “What is clear is that we need to advocate strongly for vulnerable groups, including cancer patients, to receive these vaccines.”

Figueiredo noted that the COVID-19 pandemic was the first opportunity for investigators to examine data on mRNA vaccines, and five years later there is still much to learn about the effectiveness of these vaccines in various populations.

“This is the largest study to date of COVID-19 booster effectiveness in cancer patients, a high-risk population of critical importance,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “It adds substantially to our understanding of the effectiveness of COVID-19 vaccines, and we will undertake additional studies as vaccine formulations change and new variants emerge so that we can make recommendations that best protect the health of our patients.”

Figueiredo’s team is preparing to publish vaccine effectiveness data on patients with autoimmune diseases and patients who have undergone solid organ transplants.

“There are several different groups whose immune systems have been affected in different ways, which gives us an opportunity to expand further our understanding of how these vaccines work,” Figueiredo said.

Additional Cedars-Sinai authors include Elham Kazemian, PhD; Karen L. Reckamp, MD; and Akil Merchant, MD.

Additional authors include Jacek Skarbinski, MD; Eric P. Elkin, MPH; Yonah C. Ziemba, MD; Brigid M. Wilson, PhD; Hinnah Siddiqui, MPH; Cheryl B. Schleicher, MS; Crystal A. Hsiao, MPH; Joshua R. Nugent, PhD; James M. Crawford, MD, PhD; David A. Zidar, MD, PhD; and Lawrence H. Kushi, ScD.

Funding: This work was supported by the National Cancer Institute Serological Sciences Network (SeroNet) [U01CA260584 to JS and LHK; U01CA260513 to DZ; 2UG1CA189850-09S1 to YCZ, CBS, JMC; 3U54CA260591-02S3 to JF], the Physician Researcher Program of The Permanente Medical Group Delivery Science and Applied Research Program (JS), and the United States Veteran Administration (COVID19-8900-05 to DZ).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Calederón Hernández, who goes by the nickname “Gina,” is the 100th patient to receive CAR T-cell therapy at Cedars-Sinai, said Akil Merchant, MD, Lymphoma Program co-director.

“In cancers such as lymphoma, immune cells, which are some of the most powerful anticancer tools that we have, don’t work very well,” said Merchant, who is Calderón Hernández oncologist. “In CAR T-cell therapy we remove those immune cells from the patient, engineer them in the lab to target the cancer cells, then give them back to the patient so they can kill the cancer.”

Since the Cedars-Sinai CAR T program opened in 2020, it has seen rapid, exponential growth, said Justin Darrah, MD, co-director of the Lymphoma Program and director of the CAR T Program.

“Cedars-Sinai is now able to offer this great treatment to many more patients,” Darrah said. “The fact that we have been able to treat 100 patients so far is just an incredible feeling. And the program continues to grow.”

Calderón Hernández, who will turn 60 in August, said her illness began with what she thought was a throat infection.

“I went to the ER in Long Beach. They admitted me and started many tests,” she said. “They removed my tonsils and sent them to pathology. That’s when they said, ‘We’re sorry, but you have lymphoma. You have cancer.’”

When chemotherapy treatment caused Calderón Hernández to lose her hair—for her the most difficult part of treatment—her great nephew Mateo, who is 7, was there to comfort her.

“I was crying in my room,” she said. “He came in and saw me crying. He said, ‘I know why you’re sad, Auntie. It’s because you don’t have hair. But you know what? That haircut doesn’t look bad. You look good, Auntie.’”

Calderón Hernández was cancer free for just under a year and had returned to work as a nanny. But soon she found herself back in the hospital receiving news that her lymphoma had returned.

“Starting over was very hard,” Calderón Hernández said. “The only thing that’s held me up has been God. I thank God for this new chance at life and for the doctors.”

Her oncologist in Long Beach connected Calderón Hernández with the CAR T Program at Cedars-Sinai. This therapy gave Calderón Hernández  an alternative to a bone marrow transplant, which is more difficult on the body, said Darrah, a member of Calderón Hernández's care team.

“CAR T-cell therapy is designed for patients who are having a poor response to other treatment and allows us to cure patients who otherwise were incurable,” Darrah said.

And while Merchant warned Calderón Hernández that CAR T-cell therapy could come with side effects—including memory issues, nausea and dizziness—she said that she didn’t experience those during her seven-day hospital stay.

“After the second day of treatment, I walked 20 minutes around the hospital and took selfies to send my sister,” Calderón Hernández said. She was doing so well she was sent home three days early.

In an active clinical research program, scientists are working to understand which patients are most likely to benefit from existing CAR T-cell therapies and to develop new ones, Merchant said.

“Patients whose cancers may not be treatable with currently approved CAR T-cell therapies could access the next generation of therapies here through clinical trials,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “Some of those options could be more effective than those currently FDA [Food and Drug Administration] approved, and making them available is part of our commitment to pair each patient with the most effective possible treatment.”

He said that most patients who are still in remission nine to 12 months after CAR T treatment are cured, and that is his hope for Calderón Hernández.

“We're going to continue to do scans to look for lymphoma,” Merchant said. “Her scans are negative, and I hope that they stay that way. Fingers crossed for Gina.”

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Robert Figlin, MD, interim director of Cedars-Sinai Cancer and professor of Medicine and Biomedical Sciences at Cedars-Sinai, sat down with the Cedars-Sinai Newsroom to answer common questions about the disease and options for patients.

What does it mean to have stage 4 prostate cancer?

All cancers are diagnosed by stage. Stage 4 is when the disease has spread from the primary area or organ—in this case, the prostate gland—to other areas. The most common place that prostate cancer spreads is to the bone, although it can spread to other organs such as the lungs, lymph nodes or liver.

How is prostate cancer treated?

The standard of care for prostate cancer, by and large, when newly diagnosed, is to turn off the stimulation of the prostate cancer cell by blocking androgens, including testosterone, either where they are made or where they act with the cancer to cause cancer to grow. So, androgen suppression through treatments that reduce testosterone levels is the treatment of choice, primarily for hormone-sensitive prostate cancer. Having said that, recent evidence suggests that you can add chemotherapy to hormone treatment for men with prostate cancer that improves both their progression-free survival and their overall survival.

What is the expected prognosis for a patient with stage 4 prostate cancer?

Prostate cancer, when metastatic, whether it's aggressive or nonaggressive, is not currently a curable disease. So, what we can expect is that control of the cancer should be easily obtained using hormone ablation. This will certainly improve what's called progression-free survival, meaning that it'll slow the growth of the cancer to other areas, it will prolong survival, but it will not be curative.

What are the screening recommendations for prostate cancer?

The standard screening recommendation for men is a digital rectal examination and a PSA blood test on an annual basis. The PSA test measures a hormone called prostate-specific antigen, which may indicate prostate cancer when found at high levels. But currently, it's not recommended that men beyond the age of 70 have routine screenings, because in population studies, there's been no evidence that screening elderly men improves overall survival. Having said that, that should still be a discussion between the physician and the patient to see whether screening is appropriate.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

Hyperthermic intraperitoneal chemotherapy (HIPEC) is a special type of treatment for patients with certain cancers that have spread to the abdominal cavity (peritoneum).

Unlike regular chemotherapy, which is often delivered through an intravenous (IV) drip and then circulates throughout the entire body, HIPEC is delivered during a surgical procedure. Also called “hot chemotherapy,” HIPEC involves delivering high doses of heated chemotherapy directly to the abdomen during the surgical procedure. The chemotherapy solution is heated to about 41 to 42 degrees Celsius (about 108 F).

“Bathing the peritoneal cavity with heated chemotherapeutic agents helps to target and kill cancer cells that might be too small to remove through surgery alone,” said Alexandra Gangi, MD, director of the Gastrointestinal Tumor and Cancer Regional Therapies programs at Cedars-Sinai Cancer and associate professor at the Jim and Eleanor Randall Department of Surgery.

Gangi recently spoke with the Cedars-Sinai Newsroom about how HIPEC works and who can benefit from the targeted surgical procedure.

What is HIPEC and who gets it?

HIPEC is a regional therapy used for patients with peritoneal disease, where cancer spreads to the peritoneum—the smooth membrane lining the abdominal wall and surrounding organs. When cancer from sites like the colon or the peritoneum itself spreads into the abdominal cavity, after removing visible tumors through surgery, heated chemotherapy is circulated in the abdomen to target and destroy remaining cancer cells at a cellular level.

Who is a good candidate for the HIPEC procedure?

Good candidates for HIPEC are patients with certain cancers that have spread within the peritoneum, a membrane that lines the inside of the abdomen and pelvis abdominal cavity. These patients have stage 4 cancer. This can include appendix cancer, colon and rectal cancer, mesothelioma, and primary peritoneal cancer. Some patients with gastric and ovarian cancer are eligible for the procedure, as well.

What does the HIPEC procedure involve?

The procedure typically begins with a cytoreductive surgery, where visible tumors are removed. Afterward, large catheters are placed into the abdominal cavity and the abdomen is closed. Heated chemotherapy is then circulated for 30 minutes to about an hour and a half at temperatures between 41 to 42 degrees Celsius—the solution is really hot.

Once that's done, we drain all the fluid from the belly and we open the patient back up. If there are any new surgical connections we may need to create, as in scenarios where we have removed some colon or intestine, we do that. We rinse the abdomen with saline, and then we close up the abdomen, and the patient goes to recovery.

How is HIPEC different from regular chemotherapy?

The procedure offers a more focused approach compared to regular chemotherapy, which circulates through your bloodstream throughout your body. Typically, patients won't see major fluctuations in their blood count, and they’re not necessarily considered immunocompromised. Unlike IV chemotherapy, which requires repeated sessions every few weeks, HIPEC is typically a one-time procedure, but can be repeated in some cases.

Systemic chemotherapy, which is given through an IV, relies on blood flow to reach tumors, but small tumors may not receive enough blood flow to be effectively treated this way. In HIPEC, chemotherapy is used after the visible disease is removed to kill any remaining cancer cells that exist at a cellular level since it only penetrates about three millimeters into the abdominal wall.

How does HIPEC improve survival rates?

For certain late-stage cancers, the survival rate is quite a bit lower, at around the 20% range. However, for certain mucinous tumors like pseudomyxoma peritonei, a type of appendix cancer, HIPEC can be life changing. The surgery significantly improves survival rate and can reduce the risk of recurrence. In some cases, survival without recurrence can be over 80%. It's a huge range but it is dependent on what type of cancer we're ultimately trying to treat and the patient's overall response to treatment.

What is the recovery process following the HIPEC procedure?

After surgery, some patients experience delayed return of bowel function, where the intestines take time to "wake up." This might lead to symptoms like reduced appetite, constipation or diarrhea, depending on what was removed during the surgery. Patients may also experience some discomfort or bloating. It’s best to avoid heavy lifting for about 6-8 weeks to allow proper healing. I typically advise patients that the first three months are kind of tough. And then you kind of start to feel more like your normal self. It’s a marathon, not a sprint.

Read more on the Cedars-Sinai Blog: The Need for Colorectal Cancer Screening in the Hispanic Community

“We set out to determine what drives melanoma metastasis in aging, and whether we can introduce changes that stop the cancer from spreading,” said Ze’ev Ronai, PhD, director of the Translational Research Institute and interim scientific director of Cedars-Sinai Cancer, and senior author of the study. “We identified a possible target for age-dependent therapies in melanoma and in other tumor types that could help us address difficult-to-treat cancers.”

Working with aged laboratory mice, investigators discovered that aging alters the activity of immune cells called macrophages in the immediate vicinity of the tumor. This supports tumor cell spreading, resulting in metastases. Their experiments found that inhibiting expression of a protein called TREM2 on the surface of macrophages prevented melanoma from spreading to the lungs of aging mice. They confirmed these results by looking at the cell composition of tumor samples from human melanoma patients age 70 and older.

Additional authors include Marzia Scortegagna, Rabi Murad, Parinaz Bina, Yongmei Feng, Rebecca Porritt, Alexey Terskikh, Xiao Tian, Peter D. Adams and Kristiina Vuori of Sanford Burnham Prebys Medical Discovery Institute (SBP), where the work was initially performed.

Funding: This work was supported by shared resources at the SBP Cancer Center supported by NCI grant P30CA030199, NCI grant R35CA197465 (to ZR) and NIA support grants P01 AG073084 (PA), and R00AG068303 (XT).

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“One of the most challenging tumors to treat is cancer that has spread to the brain,” said Lali Medina-Kauwe, PhD, associate director of Basic Research at Cedars-Sinai Cancer, professor of Biomedical Sciences, and senior author of the study. “Our findings show that our tumor-invading protein can deliver a potent payload of therapy directly to these tumors. It is like a cancer smart bomb.”

A challenge in delivering chemotherapy to brain tumors has been the blood-brain barrier, which stops harmful particles from traveling from the bloodstream to the brain but also blocks therapeutic agents. Medina-Kauwe and team found that a protein called HER3 is present on the blood-brain barrier, and that it helps their tumor-invading protein cross from the bloodstream to the brain.

The investigators conducted experiments using a unique blood-brain barrier “organ chip.” In this laboratory device, small groups of induced pluripotent stem cells are transformed into blood vessel cells and brain cells and put in compartments in a pattern that mimics what happens in the human brain.

When investigators flowed their protein through the blood vessel portion of the chip, they saw that it crossed over and accumulated in the brain matter, Medina-Kauwe said. And when they blocked HER3 proteins in the chip, tumor-invading proteins did not cross over, which suggests that HER3 aids their passage from the bloodstream into the brain.

“These blood-brain barrier organ chips are the next best thing to experiments in humans,” said Clive Svendsen, PhD, executive director of the Board of Governors Regenerative Medicine Institute at Cedars-Sinai and a co-author of the study. “They allow us to create the ideal conditions for testing therapies such as this one. We can even use the patient’s own stem cells and make personalized organ chips to test how the drug may work for each person.”

The HER3 protein is also present on the surface of many types of cancer cells—especially in tumors that have spread from another part of the body to the brain. And the investigators’ experiments in laboratory mice showed that tumor-invading proteins directly targeted these HER3-positive tumors, reducing their growth without accumulating in other organs.

“Most cancer drugs enter healthy cells as well as cancerous cells, causing major side effects, but this tumor-invading protein selectively enters tumor cells and spares the healthy cells,” said study co-author Ravinder Abrol, PhD, associate professor of Chemistry and Biochemistry at California State University, Northridge (CSUN), and member of the Cancer Biology Program at Cedars-Sinai. “Our ability to actively target tumor cells is a major step toward cancer therapies with reduced toxicity and enhanced safety profiles.”

Once the protein enters tumor cells, a unique feature allows it to evade their defenses.

“Most cells, including tumor cells, encapsulate invading particles in a bubble that allows the cell to harmlessly digest them,” Medina-Kauwe said. “Our tumor-invading protein includes a pinwheel-like structure that prevents digestion. When our protein enters the unique environment of the tumor cell, it opens this pinwheel and breaks out of the bubble. When we pair the protein with chemotherapy, it can deliver a lethal blow.”  

Medina-Kauwe said the findings are promising and are a step toward developing therapies that can deliver treatment to advanced tumors that currently have no other clinical option.

“We are finding that more and more tumor types—including breast, lung and colorectal tumors, and metastatic melanoma, as well as many primary brain tumors—are HER3 positive,” Medina-Kauwe said. “We’re looking forward to pursuing further studies to determine whether we can develop treatments for these tumor types.”

Additional Cedars-Sinai Authors: Felix Alonso-Valenteen, Simoun Mikhael, HongQiang Wang, Jessica Sims, Michael Taguiam, James Teh, Sam Sances, Michelle Wong, Tianxin Miao, Dustin Srinivas, Nelyda Gonzalez-Almeyda, Ryan H. Cho, Kimngan Nguyenle, Erik Serrano, Briana Ondatje, Rebecca L. Benhaghnazar, John Yu, Clive N. Svendsen, Ravinder Abrol

Additional Authors: Romny Sanchez, Harry B. Gray, Zeev Gross

Funding: This research was supported by grants from the National Institutes of Health (NIH) [NCI R01 CA258204, R01 CA270324, and NCATS UL1 TR001881 core vouchers V002, V087, and V176 to L.M.K]; and the Department of Defense (DoD) [BCRP W81XWH-15-1-0604, W81XWH1910592 to L.M.K and R.A.]. F.A.V. was supported in part by a training grant from the National Institutes of Health [T32 HL134637]. B.O. and S.S. were supported by National Institutes of Health (NIH) UG3NS105703.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

The research was published in the peer-reviewed journal The Lancet Diabetes & Endocrinology.

“Many studies have established that the incidence of thyroid cancer has dramatically increased for at least four decades, but the probability of dying of thyroid cancer has remained exactly the same,” said Zachary Zumsteg, MD, associate professor of Radiation Oncology and Biomedical Sciences at Cedars-Sinai Cancer and senior author of the study. “This means we are diagnosing and treating many cancers that would do no harm despite recent efforts to reduce overdiagnosis.”

Cancer of the thyroid, a hormone-secreting gland at the front of the neck, is treated surgically. All surgeries have risk, and removing the thyroid often requires patients to take hormone supplements for life, Zumsteg said.

Investigators analyzed data from more than 91,000 thyroid cancer patients registered in public databases from 1975 to 2019 to determine trends in thyroid cancer incidence according to year of birth and year of diagnosis.

A plateau: Zumsteg said efforts have been made to curb overdiagnosis of thyroid cancer over the past several decades, and previous research suggested that rates of thyroid cancer were finally beginning to decline in recent years.

“When we looked at a broader range of data, we found there has been no decline in thyroid cancer diagnoses,” Zumsteg said. “Rates have hit a plateau, with no further increases over the past decade or so. However, the plateau is at peak levels. We continue to diagnose many patients who will not benefit from surgery, and we have essentially made no progress in reducing unnecessary treatments.”

Increased medical imaging over time: Investigators found that the main factor linked with increased thyroid cancer incidence appears to be the passage of time. They theorized that this is mainly due to increased detection of thyroid nodules in modern medical practice.

“People visiting the doctor in 1975 were less likely to receive imaging than those visiting the doctor in 2019,” Zumsteg said. “So today doctors are finding thyroid nodules that would not have been detected in previous decades, leading to more biopsies and diagnoses of small, slow-growing thyroid cancers that might not require treatment.”

A bump in middle age: The study also found that thyroid cancer incidence has increased disproportionately in middle-aged individuals, who are more likely to interact with the medical system.

“Our analysis found that in 1975, the probability of being diagnosed with thyroid cancer was basically the same in people of all ages,” Zumsteg said. “Over time, the increase has been concentrated in women ages 40-69 and men ages 50-79. This especially affected women, who tend to interface with the medical system more often than men.”

Zumsteg said that thyroid cancer overdiagnosis could be addressed with a two-pronged approach. Raising the threshold for both imaging and biopsy of thyroid nodules would reduce overdiagnosis. Less aggressive management would further reduce thyroid cancer overtreatment.

A practice called “active surveillance,” where doctors monitor thyroid cancer patients with regular imaging and perform surgery only if the cancer appears to be growing, could help. There are several ongoing clinical trials of active surveillance, including one at Cedars-Sinai.

“The hope is that these trials will make clinicians and patients more comfortable with active surveillance and that updated clinical guidelines will bring the practice into widespread use,” said study co-author Allen Ho, MD, co-director of the Thyroid Cancer Program and professor of Surgery at Cedars-Sinai, and leader of the Cedars-Sinai clinical trial. “If current trends continue, we will continue to overdiagnose thyroid cancer and to needlessly treat patients—doing more harm than good.”

Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair, said that research such as this is an important part of a community-based approach to cancer prevention and treatment.

“Through our office of Community Outreach and Engagement we promote preventive screening throughout the communities that we serve,” Theodorescu said. “And through our research, we are working to ensure that when we offer treatment, it will yield the best possible outcomes for patients.”

Additional Cedars-Sinai authors: Michael Luu, MPH; Wendy L. Sacks, MD; Jon Mallen-St. Clair, MD, PhD

Additional authors: Michelle M. Chen, MD, MHS; Lisa Orloff, MD; Lauren P. Wallner, PhD, MPH; Susan C. Pitt, MD, MPHS

Read more on the Cedars-Sinai Blog: Active Surveillance for Thyroid Cancer

“Mary Ann and her husband told me that he had been working for 45 years, was retiring at the end of the year, and that they were planning this trip,” said breast surgical oncologist Ronald Hurst, MD. “I worked to quickly determine her tumor type, the treatment that she would need and whether it could be completed in time.”

Hurst, who saw Loef at Cedars-Sinai Marina del Rey Breast Health, first needed to find out whether the cancer was HER2 positive so he would know whether Loef would need to complete chemotherapy and immunotherapy before undergoing surgery to remove the tumor. Hurst also needed to determine whether the cancer had spread to her lymph nodes, and whether it was likely to recur, so he would know whether she would need to follow surgery with chemotherapy.

“If you don’t push things along, some of these steps can take weeks,” said Hurst, who also sees patients at The Angeles Clinic and Research Institute, an affiliate of Cedars-Sinai Cancer. “I became her advocate because I knew her trip was already planned, and I think we cut at least a month from the usual timeline. Everything aligned perfectly and we were able to complete surgery and determine her full course of treatment within two weeks.”

After finding the lump and having a mammogram at RadNet Westchester Advanced Imaging and a biopsy at RadNet Mink Radiology—both Cedars-Sinai affiliates—Loef was referred to Hurst by her primary provider.

It was September, and she and her husband had a January departure date set for the cruise. Hurst diagnosed an early-stage HER2-negative, estrogen-driven tumor that was localized to a small segment of her breast and had not spread. This meant she was a candidate for breast-conserving surgery and would not need chemotherapy or immunotherapy before or after the procedure.

“It was such a relief because I thought I was going to be in the hospital for a week,” she said. “But Dr. Hurst said I would be home by lunchtime. I had just a few stitches, and it was almost painless. Tylenol was the only pain medicine I needed.”

Hurst said many people diagnosed with breast cancer imagine they have a much more difficult road ahead.

“Most patients, when they hear a cancer diagnosis, automatically think of mastectomy and chemotherapy, with a lengthy recovery and side effects. And I have to tell them to take a deep breath, because that's not necessarily going to be their journey,” Hurst said. “If it is, we know how to help them through that, but let's not get ahead of ourselves.”

In fact, many patients with early-stage breast cancer are candidates for breast-conserving surgery, where the tumor and a perimeter of normal tissue are removed but the breast is preserved, Hurst said. And some types of cancers can be managed without chemotherapy.

“We treat breast cancer one patient at a time,” said Armando Giuliano, MD, director of the Division of Surgical Oncology at Cedars-Sinai. “There are many factors in addition to the medical diagnosis that need to be taken into account, including quality of life and peace of mind for the patient.”

Cedars-Sinai Marina del Rey Breast Health, a partnership between Cedars-Sinai, Breastlink and RadNet, offers a one-stop shop for screening, evaluation and diagnosis of breast cancer—under the care of Hurst and his colleague Marissa K. Boyle, MD, a surgical oncologist. The goal is to speed patients through the initial steps of imaging and biopsy, to get them more quickly into treatment.

With surgery behind her, Loef completed four weeks of radiotherapy before her departure. She saw Lauren Midthun, MD, a medical oncologist at The Angeles Clinic and Research Institute, who prescribed a hormone suppressor that Loef will take for five years to help prevent cancer recurrence.

During their four-month world cruise, she and her husband will visit Hawaii, Fiji, New Zealand, Australia, South Africa, Namibia, the Cape Verde Islands, Italy, Greece, Turkey, France, Spain, Corsica, Marseille, Montenegro, Malta, Morocco, the Canary Islands, Colombia, the Panama Canal, Costa Rica, Guatemala and Mexico.

“Our honeymoon was a cruise, and for 38 years, that's been our preferred method of vacationing,” Loef said. “During all that time, my husband has been so devoted to providing for our family, and this round-the-world trip has been our dream. The thought of not getting to go through with it really was weighing heavily on me, because he deserves this, and it will just be really, really, really something very special to share.”

Read more on the Cedars-Sinai Blog: What Does It Mean to Have Dense Breasts?

Traditional cervical cancer screening is done during a pelvic exam. As an alternative, the U.S. Preventive Services Task Force published new draft guidance in December stating that women may self-collect vaginal samples for HPV testing at their clinician’s office. Experts believe this could improve screening rates and detect more cases of cervical precancers and cancers.

“I think this testing is going to make it much easier for women to ensure they are up to date with cervical cancer screening, said Caroline Goldzweig, MD, chief medical officer of Cedars-Sinai Medical Network. “Many women see primary care physicians who may not routinely perform pelvic exams, and having to make a separate visit to a gynecologist can be a barrier for patients. Cervical cancer is so preventable, given what we now know about how to manage early abnormalities, that every case is a tragedy.” 

January is Cervical Cancer Awareness Month, and gynecological oncologist BJ Rimel, MD, medical director of the Cancer Clinical Trials Office at Cedars-Sinai Cancer, sat down with the Cedars-Sinai Newsroom to discuss this new option.

First, what is the difference between HPV and high-risk HPV?

HPV is the most common sexually transmitted infection (STI) in the U.S. HPV is transmitted through skin-to-skin contact, usually during sex with someone who has the virus. There are more than 200 types of HPV, but not all cause cancer. Certain types, which we call high-risk HPV, can avoid the body’s immune system and linger, causing damage to cells that can then cause those cells to become cancerous.

How does this type of self-collection work?

The kits currently approved by the Food and Drug Administration are for collection in a clinician’s office, so most people would likely receive them from their primary care provider. The patient is given an instruction sheet and a collection swab to be inserted into the vagina. Then the patient goes into the restroom to collect their sample. The patient returns the sample to the clinician, who sends it to the lab for evaluation. It isn’t at all complicated. If you can insert a tampon, you can do this.

What are the potential benefits for patients?

These tests make HPV screening much easier for patients who cannot—or do not want to—make it in to see a gynecologist for whatever reason. Maybe they don’t have access to a gynecologist, or have experienced trauma that makes a pelvic exam especially difficult, or their schedule is so busy that their visit keeps getting put off.

If they make it in to see their primary caregiver, they can do one of these HPV tests right there. If they get a negative result—meaning HPV is not present—they will not need another test for cervical cancer for 5 years. If they get a positive result, they need to prioritize seeing a gynecologist for further screening. I think these tests will increase screening and help us identify people with high-risk HPV and prevent deaths from cervical cancer.

Is there a similar test to detect high-risk HPV in men?

No. Currently, there is no standard medical test for high-risk HPV, which can also lead to penile, anal and oral cancers, in men. However, there are other tests that can detect HPV-caused cancer in men.

Why is HPV screening so important?

Caught early, cervical cancer is completely curable. Cervical cancer caught late is very difficult and often impossible to cure. Pap tests give us a fantastic ability to test for precancerous changes to the cervix, which we can then eliminate to prevent cancer.

HPV, it turns out, is the predictor of those precancerous changes, and precancer doesn’t usually develop unless HPV is present.

We have very good vaccines against HPV available and we strongly recommend that children are vaccinated beginning at age 9. For those not vaccinated as children, we recommend that teens, young adults, and even some adults up to age 45 receive the HPV vaccine in consultation with their doctors. For people who are infected with high-risk HPV, we can recommend things to help improve immune responsiveness. For example, smoking and HPV are a very high-risk combination, so if we know someone is infected, we will advise them to quit right away.

What do we know about how accurate the tests are?

The kits were approved by the FDA in May for self-collection in a clinician’s office, and we know that they work very well. They are similar to the tests gynecologists use to screen patients for high-risk HPV. Eventually, self-collection from home could become an option.

Are there potential downsides to self-collection?

The potential downsides are fairly small. If people take this test and do not visit a gynecologist, they aren’t being assessed for other gynecologic conditions that might need to be treated. During a pelvic exam, we can detect large masses. We can detect painful areas. We can detect nodules. We can answer questions that the patient may have about something that may be painful or “off” or itchy or discolored, and we miss all of that information with a self-swab. For example, I will never find an early vaginal melanoma if I never look for one.

That being said, for some patients these tests will be highly valuable, and I’m hopeful that they will become widely available in primary care offices.

Read more on the Cedars-Sinai Blog: HPV Vaccine Recommendations Changed—Is It Right for You?

The study, published in the peer-reviewed journal Science Advances, could improve the effectiveness of the widely used platinum-based medication and reduce the required dosage, minimizing side effects.

“We found that by inhibiting the action of a gene that limits the importation of the drug into tumor cells, we can increase the uptake of cisplatin and thus its effectiveness,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer, the PHASE ONE Foundation Distinguished Chair, and co-senior author of the study. “This gives us a druggable target to enhance patient response, especially in cases of advanced disease, and we have demonstrated this in multiple cancer types. We hope these findings will make cisplatin therapy more effective and an option for more patients.”

Cisplatin is widely used as part of first-line therapy for many cancer types, including bladder, ovarian, cervical, testicular, lung, and breast cancer, as well as sarcomas, lymphomas, and leukemias. Nearly 50% of all patients who receive chemotherapy receive platinum-based drugs, which work by damaging the DNA of tumor cells to prevent them from multiplying. However, tumor cells are often able to “escape” the drugs’ effects, so these therapies rarely cure advanced disease.

To explore ways to overcome cancer cells’ resistance to cisplatin, investigators from Cedars-Sinai, the University of Colorado Anschutz Medical Campus, and Erasmus University Medical Center, Rotterdam, The Netherlands, worked with bladder cancer cells in laboratory mice and in cell culture, and also with organoids grown from patients’ bladder cancer cells. Tumor organoids are clusters of cells, grown in a petri dish, that share many characteristics with actual tumors.

“We showed that inhibition of a gene called NPEPPS increased sensitivity to cisplatin in these cells and organoids, providing the first description of this gene’s role in cisplatin resistance,” Theodorescu said. “Our data have shown the importance of this pathway in various cancer types and in patients who had platinum-based therapy. Our data have clearly identified NPEPPS as a promising target for drug development for patients with treatment-resistant cancer.”

Previous research has shown that platinum-based chemotherapy used along with immunotherapy can improve immunotherapy effectiveness, which further broadens the impact of these findings, Theodorescu said.

“All cells have channels that sit on the cell surface and control what goes in and out of the cell. It turns out that some of these channels import platinum drugs into cells,” said James Costello, PhD, associate professor of Pharmacology at University of Colorado Anschutz Medical Campus and co-senior author of the study. “What we discovered in this study is that NPEPPS is the protein that gets turned up in response to platinum drugs and it blocks the channels that import platinum drugs. So, by targeting NPEPPS therapeutically, we can prevent it from blocking these channels. We are continuing to study how blocking NPEPPS therapeutically affects both tumor and normal cells, including interactions with the immune system.”

Ongoing studies are aimed at more fully understanding how NPEPPS inhibits the import of cisplatin into cancer cells and at discovering drugs that can inhibit NPEPPS. Combining these drugs with cisplatin would make the cisplatin more effective at killing cancer cells, leading to better patient outcomes.

Additional Cedars-Sinai authors: Saswat Mohapatra, Fangyuan Qu, Corazon Gutierrez, Huihui Ye, Sarah Parker

Additional authors: Lily Elizabeth R Feldman, Robert T Jones, Charlene B Tilton, Michael V Orman, Molishree Joshi, Cailin S Deiter, Eric T Clambey, James C Costello, Mathijs Scholtes, Tokameh Mahmoudi, Tahlita Zuiverloon, Travis P Broneske

Funding: Anschutz Foundation to J.C.C., CA268055 to J.C.C. and D.T., Pharmacology T32 Training Grant GM007635 supported L.E.F., Cancer Center Shared Resources, NIH NCI CA046934

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

“The incidence of pancreatic cancer among the Black population is at least 50% higher than the incidence of other racial groups. Furthermore, research has shown that Black patients have the lowest survival rate,” said Debiao Li, PhD, director of the Biomedical Imaging Research Institute and professor of Biomedical Sciences and Imaging at Cedars-Sinai, and co-principal investigator of the study. “We know that there are genetic, socioeconomic and lifestyle differences between ethnic and racial populations, and we suspect some of these differences might affect pancreatic tissue and pancreatic cancer risk.”

Li and co-investigators received a grant from the National Cancer Institute in 2022 and developed a tool that uses CT scans and AI to detect minute changes in the pancreas, which is part of the digestive system. These changes can indicate a patient is likely to develop pancreatic cancer years before they develop the disease, thus enabling an earlier diagnosis when treatments are most effective. This investigative team has received a new grant to conduct a pilot study that will allow them to determine whether those characteristics differ in Black patients.

The team will collaborate with Cemal Yazici, MD, associate professor of Medicine at the University of Illinois Chicago, which, like Cedars-Sinai, serves a large population of Black patients.

Predictive models for pancreatic cancer based on symptoms, genetics and weight haven’t been shown to be accurate on their own, said Stephen Pandol, MD, director of Basic and Translational Pancreas Research at Cedars-Sinai and co-principal investigator of the study. Meanwhile, blood and urine tests for pancreas cancer are still in development.

“Packaging these tests with our imaging tool could eventually prove effective in predicting who will develop pancreatic cancer,” Pandol said. “Our goal is to perfect our tool, then apply it to a population to see if we can diagnose individuals earlier.”

Pancreatic cancer is one of the deadliest cancers, with only around 10% of patients surviving five years after diagnosis. Early detection and surgical intervention can increase five-year survival rates to more than 50%, but this is rare because early pancreatic cancer causes few symptoms.

“Drilling down to understand cancer risk at precision levels is key to the Cedars-Sinai Cancer mission to bring personalized cancer care to every patient,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. "This work in early detection nicely complements recent work showing that a new AI-based precision medicine approach called the Molecular Twin Precision Oncology Platform can predict outcomes of pancreatic cancer."

With the help of improved predictive tools, patients at the highest risk can be monitored via annual imaging so any cancer that develops is detected at the earliest stage.

“If we can diagnose a patient’s pancreatic cancer two or three years earlier, that could make a life-and-death difference,” Li said.

Read more on the Cedars-Sinai Blog: Pancreatic Cancer Clinic Saves Time and Lives

Their achievement, described in the peer-reviewed journal Nature Communications, significantly expands AI’s healthcare applications. 

The new AI method, also called a model, offers a much-needed alternative to tumor registries, the databases maintained by governments and hospitals. Researchers normally use tumor registries to screen cancer patients for clinical trials. Cancer registries require specially trained employees to manually identify a patient’s cancer stage by reviewing laboratory reports, clinicians’ notes and other information. The process can be slow and tedious.

“By the time a cancer patient’s data is entered into a tumor registry, months may have passed, along with the opportunity for the patient to participate in relevant clinical trials or other treatments,” said Nicholas Tatonetti, PhD, vice chair of Computational Biomedicine at Cedars-Sinai, associate director for Computational Oncology at Cedars-Sinai Cancer and corresponding author of the study. “Our AI model can dramatically reduce that delay, accelerating the pace of research and expanding patients’ access to clinical trials.”

The team’s AI model quickly identifies the cancer stage by extracting and interpreting the text of just one element of a patient’s electronic health record: the pathology report, which describes the findings of pathologists examining tissue specimens from the patient. In tests involving thousands of patient records, the study’s investigators confirmed that the AI model they created was highly effective in staging patients’ cancers.

The method is based on a so-called transformer model of AI, which is designed to simulate the complex decision-making power of the human brain. The study team first “trained” the model to stage cancers using publicly available pathology reports from a government database, The Cancer Genome Atlas. These reports covered nearly 7,000 patients and included 23 types of cancers.

To make sure the model worked in various settings, investigators then applied it to nearly 8,000 pathology reports maintained by a single medical center. The results, as measured by a standard statistic for evaluating AI models, rated the method as highly accurate. “This was an important finding because it means that our AI model is an ‘off- the-shelf’ tool that can be generalized to other institutions without requiring that it be trained for each location,” Tatonetti said.

Besides screening patients by their cancer stages for clinical trials, the AI model also can be used to automate classification of patients for observational and retrospective data analysis, and for potential treatments, according to Tatonetti. “Future research could build on our method to integrate the pathology text with other types of clinical data, potentially advancing personalized cancer treatment,” he said.

The creation of the AI model was made possible by earlier research, also led by Tatonetti, that removed technical obstacles to computers extracting and analyzing pathologists’ notes from electronic health records.

In a notable decision, the investigators in the new study have made their AI model, which they named BB-TEN: Big Bird – TNM staging Extracted from Notes, available to other institutions for academic uses and certain other purposes.

“By speeding up the selection of candidates for cancer clinical trials, this innovative AI model shows promise for accelerating the development of relevant treatments and making them available to more patients,” said Jason Moore, PhD, chair of the Department of Computational Biomedicine at Cedars-Sinai.

Other Cedars-Sinai authors include Jacob Berkowitz, Jose M. Acitores Cortina and Kevin K. Tsang. An additional author was Jenna Kefeli.

Kefeli and Tatonetti were supported by award number R35GM131905 from the National Institute of General Medical Sciences of the National Institutes of Health.

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Numerous laboratory studies have shown that drug-radiotherapy combinations increase the effectiveness of cancer therapy, but clinical trials in humans have been less successful. Only one new non-chemotherapeutic drug has been approved by the Food and Drug Administration for concurrent treatment with radiation.

“One of the biggest reasons for this is that early-phase clinical trials investigating these combinations are challenging to design and implement,” said Zachary Zumsteg, MD, associate professor of Radiation Oncology and Biomedical Sciences at Cedars-Sinai and first author of the paper. “Since many side effects of radiotherapy occur after treatment is completed, it can take longer to determine the appropriate dose of treatment. Testing of drug-radiation therapy combinations often occurs in patients receiving first-line therapy, leading to less tolerance of unexpected side effects. And because radiotherapy affects each organ differently, new drug-radiotherapy combinations must be tested separately for cancers arising in different parts of the body.”

To address these challenges, investigators suggest designing trials that use mathematical models with real-time toxicity data to calculate appropriate doses for each patient, allowing for continuous patient enrollment and making trials more efficient. They also advocate testing multiple drug-radiotherapy combinations simultaneously to limit the number of patients receiving any specific drug-radiotherapy combination at a given time. They note that these trial designs require substantial infrastructure and expertise, making them best suited for implementation in large cooperative group clinical trial networks.

The authors suggest that if these clinical trial designs are widely adopted, they are more likely to lead to the development of additional safe and effective cancer treatments.

Additional authors: Siddharth Sheth, Salma K Jabbour, Krishnan R Patel, Randall J Kimple, Terence M Williams, Meng Xu-Welliver, Pedro A Torres-Saavedra, Arta M Monjazeb, Jyoti Mayadev, Steven E Finkelstein, John M Buatti, Sandip P Patel, Steven H Lin.

Follow Cedars-Sinai Academic Medicine on LinkedIn for more on the latest basic science and clinical research from Cedars-Sinai.

A syndrome called cachexia, which triggers unexplained loss of weight and muscle mass, causes severe illness and death among patients with cancer and other serious health conditions.

November is a month designated for raising awareness about lung and pancreatic cancers, and Andrew Hendifar, MD, medical director of Pancreatic Cancer at Cedars-Sinai Cancer, sat down to talk with the Cedars-Sinai Newsroom about cancer cachexia. Hendifar is co-author of recent clinical trial results, published in The New England Journal of Medicine, that could yield the first Food and Drug Administration-approved medication for the condition.

Why is understanding cachexia so important?

More than 25% of cancer-related deaths can be attributed to cachexia. It affects 80% of patients with pancreatic cancer, and half of patients with advanced lung cancer. We also see it among patients with colon, kidney and stomach cancer, as well as heart, lung and kidney disease.

As many as 75% of patients with cancer have significant unexplained weight loss six months before they are diagnosed, but this clue is often missed. People just think the latest weight loss strategy they have tried is finally working. Unintentional weight loss is a significant health problem, and anyone who is losing weight unexpectedly should immediately seek the care of a health provider to investigate it further. It’s a huge problem and a huge unmet need. At this point, all we are really able to offer patients with cachexia is a referral to a dietitian.

What causes cachexia?

For decades we've been trying to figure out what causes cachexia and what we can do to treat it. After pursuing many different pathways, we recently made significant progress with a drug that targets the GDF-15/GFRAL pathway.

GDF-15, growth differentiation factor 15, is a hormone that is elevated in patients with cancer and certain other medical conditions, and in patients on certain types of chemotherapy. Its role in normal physiologic function is not yet fully understood. It seems to be associated with appetite and with stress, and there have been several attempts over the past few years to target GDF-15 with various therapies.

Tell us about the recent clinical trial.

The therapy we tested, a monthly injection that caused few side effects, blocks the action of GDF-15. Our Phase 2 clinical trial included patients with non-small cell lung, pancreatic and colorectal cancers. Patients taking this new drug had improved weight gain and physical activity as compared with patients receiving a placebo. Not only is this the first promising cachexia drug, it is also the first drug showing promise in blocking the action of GDF-15.

What will happen next with this drug?

Several new clinical trials should be opening soon at various institutions, targeting cachexia not only in patients with cancer, but in those with other diseases as well. Patients with cachexia should be referred to a dietitian and also work with a physical therapist to help recover muscle mass. And they can ask their health care provider about opportunities to participate in one of these clinical trials.

Have there been any other promising options for cachexia patients?

Cedars-Sinai was recently part of an international consortium that conducted a Phase 3 trial called the MENAC trial. This trial found that a combination of protein and omega 3 supplementation, dietary counseling, a home exercise program and ibuprofen improved weight by roughly 2 pounds. But this hasn’t yet become part of official guidelines for cachexia care.

Read more on the Cedars-Sinai Blog: The Link Between Pancreatic Cancer and Diabetes

After her stage 4 breast cancer diagnosis, independent filmmaker Kailee McGee decided not to leave her director’s chair. Instead, she leaned in and produced an award-winning short film about her experience. And, thanks to her care team at

“I'm on the other side of active treatment,” said McGee, who turned 37 in August. “I did chemotherapy, I had a double mastectomy, and I had radiation, and I'm still currently on an immunotherapy drug. But I want to point out that I'm cancer-free. I've been cancer-free for a while. I've gotten several clean scans, and that is just so exciting.”

After feeling a lump and having a mammogram and other tests, McGee was diagnosed with triple-negative breast cancer, an especially difficult type to treat. That’s because triple-negative cancer cells lack surface proteins that would make them vulnerable to estrogen receptor-targeted therapy or HER2-targeted therapy. Triple-negative is a rare type of the disease, representing only 10%-15% of breast cancers.

“Also, with treatments such as chemotherapy, those triple-negative breast cancers often outsmart the treatment. Fortunately, the addition of immune checkpoint inhibitors to the chemotherapy backbone represents a breakthrough in treating these cancers,” said McGee’s oncologist, Yuan Yuan, MD, PhD, director of Breast Medical Oncology at Cedars-Sinai Cancer. “Huntington Cancer Center is an affiliate of Cedars-Sinai Cancer, so we were able to offer Kailee leading-edge treatment close to her home.”

The cancer had spread from the breast to the lymph nodes in McGee’s neck, and Yuan recommended treating it aggressively. McGee underwent 16 rounds of chemotherapy, along with immunotherapy to help her immune system attack the cancer. After six months of therapy, she had a complete clinical response and the Cedars-Sinai Huntington Health tumor board decided to proceed with a double mastectomy. The surgery, performed by breast oncology surgeon Amy Polverini, MD, was followed by radiation treatment.

Ruth Williamson, MD, medical director of Radiation Oncology at Huntington Cancer Center, an affiliate of Cedars-Sinai Cancer, was McGee’s radiation oncologist. Williamson said that there was no evidence of active cancer after McGee’s chemotherapy and immunotherapy, and that radiation therapy reduced the risk that her cancer would return by 75%-80%.

“If there's one cell left behind in the regional lymph nodes, the cancer comes back,” Williamson said. “The radiation is extremely effective for targeting the areas where it might come back, and increasing the chance that Kailee is going to be cured of this disease.”

In the middle of treatment, McGee decided to write, produce, direct and star in a film about her experience. Called “Can,” the film won the Audience Award at South by Southwest Film Festival earlier this year.  

“Creating art has always been the way that I've processed my own life, and the world, and what's inspiring me or haunting me,” McGee said. “So I didn't really know what else to do to make sense of this experience.”

At Kailee’s side throughout was her partner, JP Bolles, also a filmmaker and director.

“I think it was incredible to see Kailee have such a drive to do something,” Bolles said, “to take the experience that she was having and make art with it, and just how beautiful that is.”

McGee credits Bolles and her film project with creating a healing environment for her.

“I know that part of the reason that I was so optimistic and strong going through this journey was because of the support that I had from JP and from my family and friends,” McGee said. “I created this community with my collaborators and my friends to heal with me in the moment. It gave me a job and a purpose, and it gave me something to think about that wasn't just going to doctor appointments and getting treatment.”

Rather than focusing on her cancer treatment, McGee’s film centers around what she calls her “existential identity crisis,” examining what it means to be a woman and an artist, and her inner struggle during treatment.

“At the beginning of cancer, I couldn't wait for it to be over so I could close that chapter and never have to think about cancer again,” McGee said. “And now my reality is that in so many different ways—health and spiritually and community-wise—cancer is just part of who I am, and it's part of my life, and it's part of my story, and the journey continues, and acceptance of that is what I want to share with this film.”

After breast reconstruction surgery later this year with James Andersen, MD, McGee will continue to be monitored by Yuan—through imaging and a new type of test that looks for cancer DNA in her blood—to make sure she stays cancer-free.

Both Yuan and Williamson found McGee’s film eye-opening, and believe it has important messages for breast cancer survivors—and all women.

“I thought it was a beautiful way of letting women with breast cancer understand, especially those who have gone through a mastectomy, that those self-image issues and those personal issues are somewhat universal,” Williamson said, “and that we can talk about them and identify those issues and help.”

Read more on the Cedars-Sinai Blog: How Do Your Genes Fit? Cracking the Code on Breast Cancer Risk

“Cancer is the leading cause of death in most Asian American ethnic groups, a fact that has been understudied for years,” said Zul Surani, associate director of Community Outreach and Engagement at Cedars-Sinai Cancer and the Cancer Research Center for Health Equity at Cedars-Sinai. “Because of our continual work to build partnerships in the community, Cedars-Sinai is well positioned to contribute to this incredibly important undertaking.”

Cedars-Sinai is the largest single center enrolling participants into the national effort, which is funded by the National Cancer Institute and will include 20,000 people over the next four years. Asian Americans ages 30-75 who have not been diagnosed with cancer are eligible to participate.

“This study will look at traditional cancer risk factors such as lifestyle and environmental exposures, but it will also examine the effects of bias and discrimination on cancer risk,” said Robert W. Haile, DrPH, MPH, associate director of Population Sciences at Cedars-Sinai Cancer and director of the Cancer Research Center for Health Equity, the Cedars-Sinai Chair in Cancer Population Health Sciences and a co-principal investigator of the study. “This is the first large-scale study to look at these effects on cancer risk in Asian Americans.”

Information will be gathered through online questionnaires, Haile said. Participants will not need to visit Cedars-Sinai in person to take part in the study, though staff fluent in multiple languages will be available to assist participants who prefer to complete questionnaires in person or by phone.

As a medical center with access to large Asian American populations and nationally recognized expertise in community outreach and engagement, Cedars-Sinai is charged with enrolling 4,680 participants from various Asian American communities, including Asian Indian, Bangladeshi, Cambodian, Filipino, Korean, Pakistani, Thai and others.

“We will be able to do this quickly because of the infrastructure we have in place,” Surani said. “We are ready to start meeting with trusted community leaders, such as pastors and leaders of community organizations, to disseminate information about the study. They can reach thousands of people at a time.”

The study was motivated by research showing large disparities in cancer rates among various Asian American populations, Haile and Surani said. These include sharp increases in certain cancers: breast cancer in Korean and Filipino women, thyroid cancer across all Asian ethnicities, and lung cancer among Asian American women who have never smoked.

“We don’t know why this is happening, and no one has studied Asian Americans on this scale before,” Haile said. “Most of the studies that exist are small in scale and look at people who have already developed cancer. This is the first study that starts with Asian Americans who don’t have cancer and then follows them over time to see who develops cancer and who does not.”

The plan is to follow these participants for decades into the future, but the first preliminary information about risk factors and demographics could be released at the end of the first year, Haile said.

“Cedars-Sinai Cancer serves one of the most diverse populations anywhere, and a key part of our mission is to bring equity to every aspect of our research and patient care,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “Studies such as this one allow Cedars-Sinai Cancer to contribute invaluable insights into the needs of our cancer community.”

This work is a leading effort and part of a broader Cedars-Sinai strategy to engage diverse patients, according to Michael Farkouh, MD, associate dean for Research and Clinical Trials at Cedars-Sinai. Farkouh said the institution is committed to learning more about the diverse patients it serves and finding ways to understand the unique challenges faced by Asian Americans.

“Finding opportunities to serve patients who have historically been underrepresented is a real challenge in clinical research, and one that people often aren’t aware exists,” Farkouh said. “Community engagement is a cornerstone of Cedars-Sinai’s work and building it out even further can help participants feel safe and supported, leading to even greater local and global impact.”

Read more from Discoveries: Cancer Prevention in Every Language

Radiation therapy is part of the standard treatment for advanced lung cancer, but can cause heart rhythm abnormalities, also called arrhythmias.

In a study published in the peer-reviewed journal JACC: CardioOncology, Cedars-Sinai and Harvard University investigators devised a way to predict, based on the area of the heart exposed to radiation, the type of heart arrhythmia that can result. These findings could help radiation oncologists reduce lung cancer patients’ risk of arrhythmias and identify patients who may need additional cardiac monitoring.

“In this study, radiation oncologists, cardiologists, electrophysiologists and artificial intelligence specialists worked together to intricately map radiation exposure for lung cancer therapy to different regions of the heart,” said Katelyn Atkins, MD, PhD, assistant professor of Radiation Oncology at Cedars-Sinai Cancer, assistant professor of Cardiology at Cedars-Sinai and first author of the study. “We observed that radiation exposure to key structures such as pulmonary veins, coronaries, and atria was associated with distinct arrhythmia types, potentially pointing to unique pathways of injury.”

Additional authors: Samuel C. Zhang, MD; Christopher Kehayias, PhD; Christian Guthier, PhD; John He, BA; Jordan O. Gasho, BS; Mina Bakhtiar, MD; Katrina D. Silos, BA; David E. Kozono, MD, PhD; Paul C. Zei, MD; Anju Nohria, MD; Andriana P. Nikolova, MD, PhD; Raymond H. Mak, MD.

Funding: Dr. Mak has received grant funding from AstraZeneca and ViewRay. Dr. Nohria has received research support from Bristol Myers Squibb; and has received consulting fees from Altathera Pharmaceuticals, AstraZeneca, Bantam Pharmaceuticals, Regeneron Pharmaceuticals, and Takeda Oncology.

Follow Cedars-Sinai Academic Medicine on LinkedIn for more on the latest basic science and clinical research from Cedars-Sinai.

In this study, investigators looked at data from more than 48,000 patients in the National Cancer Database. Based on preoperative imaging, all of the patients in the study had either stage 1 or stage 2 pancreatic cancer.

Following surgery to remove their tumors, more than 78% of stage 1 patients and more than 29% of stage 2 patients were upstaged—generally to a stage that includes lymph node involvement.

“Our research reveals that staging—essential for making treatment decisions and determining research eligibility—is often inaccurate in early-stage pancreatic cancer,” said Srinivas Gaddam, MD, associate director of Pancreatic Biliary Research at Cedars-Sinai and senior author of the study. “As the field is racing toward earlier diagnosis, early staging will become increasingly important.”

Diagnosis and staging of pancreatic cancer are difficult for the same reason. The pancreas, a digestive organ, is located deep in the body and current imaging technology isn’t always able to detect smaller tumors or lymph node involvement, said Gaddam, who is also an associate professor of Medicine and runs the Pancreatic Cancer Screening and Early Detection Program at Cedars-Sinai.

Lymph nodes, clusters of small immune structures, are an important factor in cancer staging and a key difference between early-stage and later-stage pancreatic cancer.

“Patients who have lymph node involvement have a worse survival rate than those without lymph node involvement,” Gaddam said. “When imaging is unable to detect lymph node involvement, staging may not reflect the true extent of the disease. Our findings suggest that lymph node involvement is being missed in four out of every five patients during the staging process.”

The five-year survival rate for stage 1 pancreatic cancer is more than 83%, but that drops to just 3% for patients with stage 4 disease—which is when most patients are currently diagnosed.

“Pancreatic cancer is a difficult diagnosis and there is a tremendous need to improve outcomes for patients,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “Through leading-edge tools, such as our Molecular Twin Precision Oncology Platform, we are developing tests that will guide precision treatment of pancreatic and other cancers. We first demonstrated the utility of Molecular Twin by identifying new biomarkers for pancreatic cancer; these biomarkers assist in the diagnosis, which must be coupled with accurate cancer staging to appropriately guide therapeutics.”

Gaddam’s take-home message for clinicians staging pancreatic cancer is to recognize the limitations of current imaging technology and actively assess and report lymph node involvement. And for those at the forefront of innovation, he stresses the urgent need to improve screening and diagnostic technologies.

Pancreatic cancer screening employs MRI and endoscopic ultrasound. Screening is recommended for people with a family history of pancreatic cancer and those who carry variants in certain genes associated with the disease.

“We know that our current screening and staging tools aren’t great,” Gaddam said. “My hope is that within the next 10 years, we will develop advanced tools for screening and staging pancreatic cancer, allowing us to diagnose most patients at stage 1 and stage 2 rather than stage 4. With these advancements, we can catch this disease much earlier, improving outcomes for many more patients.”

Additional Cedars-Sinai authors of the study: Gerardo Perrotta, MD; Ghada Mohamed, MD; Brent K. Larson, DO; Arsen Osipov, MD; Cristina R. Ferrone, MD; Simon K. Lo, MD.

Funding: Srinivas Gaddam received funding from the AGA (American Gastroenterological Association) Research Foundation’s 2022 AGA-Bern Schwartz Family Fund Research Scholar Award in Pancreatic Cancer for time dedicated to research.

Learn more on the Cedars-Sinai Blog: Pancreatic Cancer Clinic Saves Time and Lives

Funded by a gift from the Lippin Family Trust and launched by the Tower Cancer Research Foundation, The Ronnie Lippin Cancer Support and Navigation Project is part of Cedars-Sinai Cancer’s Community Outreach and Engagement. Eligible patients do not need to receive their cancer care from Cedars-Sinai to participate.

The project was established in honor of the late trailblazing music publicist and manager Ronnie Lippin, who died of breast cancer in 2006. Her husband, Dick Lippin, founder of The Lippin Group public relations firm, established the grant in collaboration with the foundation.

“I see Tower Cancer Research Foundation and Cedars-Sinai as my partners in a pioneering venture that I believe enriches the lives of people needing a guiding hand through this very difficult period in their lives,” Lippin said.  

The project funds two “navigators”—multilingual specialists who are fluent in Spanish, Korean, Tagalog and Swahili. The navigators guide patients through all stages of cancer treatment—including arranging transportation to and from medical appointments, accompanying patients to those appointments, and scheduling screenings and treatments. If mental health assistance is required, navigators also offer referrals to qualified professionals. 

“Cedars-Sinai Cancer serves one of the most diverse patient populations in the country,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “This new program is in line with our commitment to serve all patients, and will provide patients with a trusted partner who understands their culture and can guide them through this challenging diagnosis in their primary language.”

Any Los Angeles County resident is eligible to participate in the program, free of charge, regardless of financial or citizenship status, age, sexual identity, belief system or education level. Project leaders are intending to reach geographic areas and groups across Los Angeles County that are documented as having higher rates of late-stage diagnoses.

A 2022 Cedars-Sinai study published in Frontiers of Oncology showed that ethnic groups in Los Angeles had high rates of particular cancers. For example:

• Black people have higher rates of prostate cancer, triple-negative breast cancer and pancreatic cancer than people who identify with other groups.
• Latinos have higher incidence rates of certain cancers, including liver cancer and late-stage melanoma than non-Latino white people.
• Rates of breast cancer among Koreans have increased more significantly than among people who identify with other groups.  

“This project’s whole-person approach to helping cancer patients will chip away at disparities by providing timely access to treatment, and equitable allocation of survivorship tools—all provided by trusted navigators working in the community,” said Zul Surani, associate director of Community Outreach and Engagement, and an administrator of the Cancer Research Center for Health Equity at Cedars-Sinai Cancer. “Culturally tailored navigation across the cancer continuum is a massive undertaking and has proven effective through decades of research, and this program aims to reduce the cancer burden across Los Angeles neighborhoods.”

To participate in the program, patients should fill out the Ronnie Lippin Cancer Support and Navigation Project application.  

Read more from the Newsroom: Annual Report Highlights From Cedars-Sinai Cancer

According to Nima Gharavi, MD, PhD, chief of the Department of Dermatology at Cedars-Sinai, too much exposure to ultraviolet rays, or UV rays, can increase your risk for melanoma—a type of aggressive skin cancer.

“With every sunburn, the risk for melanoma increases slightly,” said Gharavi, who also serves as the director of Dermatologic Surgery and Mohs Micrographic Surgery and associate clinical professor of Medicine and Pathology.

Gharavi recently spoke with Cedars-Sinai Newsroom on how to spot melanoma, treatment options and steps you can take to lower your risk of skin cancer. 

What is melanoma?

Melanoma is cancer that arises from the melanocyte, which is the cell type that makes up moles and pigments that give skin its color.

What are the signs and symptoms of melanoma?

The most important clue is a mole that's changing. One of the criteria we typically follow is called the ABCDE of melanoma.

• A stands for Asymmetry. Moles are asymmetric if one half doesn't equal the other half.
• B is for the Borders. Are the borders irregular?
• C is for Color. If there are multiple colors within a mole, get it checked.
• D is Diameter. If the mole is bigger than six millimeters, which is about the size of a pencil eraser, it should be evaluated.
• E is for Evolving. Has the mole evolved or changed recently?

How do you diagnose melanoma?

Some patients, when they notice something suspicious, will present it to the primary care doctor, who will then refer the patient to a dermatologist. Others may present directly to the dermatologist.

A dermatologist would look at the mole and see if there's anything clinically suspicious about it. If it meets clinical criteria for a biopsy, a biopsy would be performed to rule out atypical features and to rule out melanoma.

Based on the biopsy, it'll tell us not only the diagnosis, but also what type of melanoma the patient has. And more importantly, you get some information about how deep the melanoma has spread into the skin. That information is probably the most important because it determines what stage of cancer the patient has.

Who’s at risk for melanoma?

Melanoma can affect every skin type. That being said, there are certain people who have a higher risk for developing melanoma. Patients who have light skin, light eyes or red hair are at a higher risk.

Patients who have a previous history of skin cancer or a family history of skin cancer, including melanoma, are at higher risk. Genetics obviously plays an important role.

Some patients also have a large number of moles on their body. So, if you have a lot of larger abnormal-looking moles, then usually there's a higher risk associated with that as well. Lastly, patients who have either had a lot of sun exposure throughout their life or use or have used indoor tanning in the past are at higher risk for melanoma.

How do you treat melanoma?

If a patient is diagnosed with early-stage melanoma, the treatment is surgery and surgery alone. The amount of skin that's removed is also determined by how deep that melanoma has spread into the skin. Surgery is typically performed by either a dermatologist/dermatologic surgeon or a surgical oncologist. As melanoma starts spreading deeper into the skin, patients might be candidates for other options.

For aggressive cases that are stage 3 and beyond, using systemic medications like immunotherapy—medications that activate the immune system to fight off any remaining melanoma cells that may be circulating through the bloodstream—seems to be the best option.

What is Mohs micrographic surgery?

Mohs micrographic surgery (MMS) is an option for a subtype of melanomas—those that are predominantly on the head and neck or on other cosmetically sensitive areas with extensive sun damage. So, typically we're talking about melanomas on the scalp, forehead, cheeks, nose or ear.

With MMS, the surgeon is the pathologist, and the lab is right there in the office. This allows the surgeon to perform the examination in real time. So, what you do is you surgically remove the melanoma tissue along with a small border of healthy tissue and send it to the lab for processing slides. The lab processes it within 45 minutes and sends the slides back to the surgeon. The surgeon looks at the tissue under the microscope and determines if the border that was removed is free of melanoma. The advantage of that is you get the results a lot quicker. The other advantage is, if you need to do more surgery, you can do it right away. You don't have to bring the patient back in two to three days later. Lastly, MMS allows for a high level of precision when removing skin cancer, which leads to superior cure rates for these types of melanomas.

Can you prevent melanoma?

There are a few things that we can do to minimize the risk of getting melanoma. No. 1 is to avoid the sun during peak hours, which are typically between 10 a.m. and 2 p.m.

If you're going to be out during the peak hours, seek shade. If you can, wear sun-protective clothing, such as long sleeves and pants. There is also clothing out there with a UV protective factor. Also, wear hats, ideally a wide-brimmed hat that covers the ears as well. Lastly, wear sunscreen. The recommendation is at least SPF 30 or higher.

If you do have a history of sun damage or skin cancer or a personal or family history of melanoma, then visiting a dermatologist routinely for skin checks is invaluable because the sooner we can diagnose melanoma, the treatments afterwards might be less debilitating.

One of the things we tell patients to do is do skin checks at home. When you're in the shower, maybe once a month, just take a look at the skin, look at any moles, see if anything looks out of the ordinary. You can take a picture of it with your phone or have your significant other or family member take a picture of it. And then maybe a month later, take another picture and compare the pictures and see if there is any noticeable change.

Read more on the Cedars-Sinai Blog: Dermatology for Skin of Color

The prostate, a small gland that helps make semen, also produces a protein called prostate-specific antigen, or PSA. Blood levels of PSA tend to be elevated in people who have prostate cancer, and the PSA test, which measures those levels, is a common prostate cancer screening tool.

“Many transgender women take estrogen as part of their gender-affirming care,” said Stephen Freedland, MD, the Warschaw, Robertson, Law Families Chair in Prostate Cancer at Cedars-Sinai and senior author of the study. “This drastically lowers PSA levels, which could mean the threshold we are using as ‘normal’ is too high to detect early-stage cancer in these patients. We undertook this study to determine typical PSA values for this population so that we can screen them more appropriately.”

According to current guidelines, PSA levels above 4.0 nanograms per milliliter of blood (ng/mL) suggest cancer could be present, and that additional investigation, such as a prostate biopsy, is needed.

"In the study, we used Veterans Health Administration records to identify 210 transgender women without known prostate cancer who were taking estrogen,” said Farnoosh Nik-Ahd, MD, a urology resident at the University of California, San Francisco, and first author of the study. “We found that the median PSA value, the midpoint in the range of participants, was 0.02 ng/mL, which is fiftyfold lower than PSA values reported in similar-aged cisgender men.”

This suggests that if they are taking estrogen, transgender women who develop prostate cancer wouldn’t see their PSA rise to levels that trigger additional screening until their cancer was at a later stage, making it more difficult to treat. Nik-Ahd said that patients and clinicians should be aware of this and interpret results with caution.

“Cedars-Sinai Cancer serves one of the most diverse patient populations in the country,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “This work is part of our mission to conduct research that helps us understand the unique needs of our patients, then translate our findings into practices that improve patient outcomes.”

Additional research is needed to pinpoint a specific PSA level that indicates a transgender woman taking estrogen is at high risk for developing prostate cancer. And Freedland, who is also a professor of Urology at Cedars-Sinai and staff physician at the Durham VA Medical Center in North Carolina, said this study is not a call for transgender women to be screened.

“We know that PSA screening reduces the risk that cisgender men ages 55 to 69 will die of prostate cancer, but we don’t know that it does the same thing for transgender women taking estrogen,” Freedland said. “However, because some of these women are being screened, we want to raise awareness that their typical PSA levels are different.”

Along with increased awareness, Freedland hopes to eventually see updated PSA screening guidelines. In the meantime, he advises transgender women who are taking estrogen to consult with their healthcare providers.

“Don't forget that you have a prostate and that prostates can become cancerous,” Freedland said. “The best way we know to find those cancers early and reduce the risk of death is a PSA test. And if you choose to do that, keep in mind that the test values are not calibrated for you. Bring your results—and possibly this study—to your urologist so that your results will be interpreted by someone who understands what to do with that information.”

Funding: Research reported in this publication was supported by NIA grant number R38AG07017, the 2023 Urology Care Foundation Residency Research Award Program, and the Robert J. Krane, MD, Urology Research Fund.

Additional authors include: Amanda M. De Hoedt, MS; Christi Butler, MD; Jennifer T. Anger, MD; Peter R. Carroll, MD, MPH; and Matthew R. Cooperberg, MD, MPH.

Read more on the Cedars-Sinai Blog: More Options to Treat Prostate Cancer

Usher consulted her primary care physician, who ordered blood tests that revealed Usher had anemia, a condition caused by not having enough healthy red blood cells or hemoglobin to carry oxygen to the body's tissues. To determine the source, Usher’s physician sent her to a gastroenterologist for a colonoscopy to check for polyps or cancer.

The procedure revealed the culprit of Usher’s anemia: a colon tumor that would later be diagnosed as stage 2 colon cancer. Usher, then 37 years old, was stunned. Like many, Usher thought she was too young to get colon cancer.

“I was in shock,” Usher said. “I was really like, ‘God, what are you trying to teach me here?’”

Colorectal cancer in those younger than 55 has been steadily rising by 1% to 2% during the past 30 years, according to the American Cancer Society. The increase has been driven mostly by Native Americans and white people, although Black people are still more likely to get colorectal cancer at a young age.

The rise led experts to reduce the recommended age to begin colorectal cancer screenings from 50 to 45 several years ago.  But the cause isn’t entirely clear.

“Risks of colorectal cancer can include lifestyle, obesity, a low-fiber diet, alcohol and tobacco. We attribute some of this to the rise of cancer in younger people,” said colorectal surgeon Juliane Golan, MD, with Huntington Health, an affiliate of Cedars-Sinai. “But there may be new factors that have not been completely unearthed yet—changes in the normal bacteria in our gut that may be related to diet and environmental exposures that are leading to these increased cancers.”

Catching Cancer Early

Getting diagnosed with cancer at such a young age frightened Usher, who already had been managing two chronic conditions, rheumatoid arthritis and lupus. She wasn’t expecting a third diagnosis that could possibly lead to death.

In January 2023, Golan performed robotic surgery on Usher to remove the cancerous tumor and a section of her colon.

“She had a very early-stage cancer, luckily,” Golan said. “She did not have to undergo chemotherapy. She was cured with just surgery.”

Today, Usher is 39 and grateful for her health and the new opportunities it has brought her. She is back to devouring books, recently took up watercolor painting and got married.  

“I'm feeling great now. I feel like I have a new lease on life,” Usher said. “I'm able to put things into perspective and let the little things go that maybe easily upset me before.”

Golan credits Usher’s recovery to her positive attitude and the tremendous support she received from her loved ones.

“Getting the cancer diagnosis was a big surprise to her, but she really dealt with it with such grace,” Golan said. “But one thing I think is truly important, for any patient with cancer, is she had her family. I saw her mom and her dad at every appointment. Having that familial support, whether it's actual family or close friends, I think is something really important to get patients through the cancer process.”

Usher also is thankful for her medical team at Huntington Cancer Center, an affiliate of Cedars-Sinai Cancer. She appreciated her nurse navigator, who guided her through the surgery process, and especially Golan.

“The rise in colorectal cancer among younger patients is one of many factors that strengthens our commitment to precision detection and prevention of this disease,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “We are also continually opening new clinical trials to bring leading-edge therapies to these patients to improve survival rates and quality of life.”

Avoiding Cancer at a Young Age

Usher hopes her story will encourage other people to listen to their body, seek help from their physicians and get colonoscopies. Golan agrees, stressing the importance of screening, especially for adults 45-50 years old.  

“The whole point of a colonoscopy is to find precancerous lesions early, so we can take them out and they never have the chance to grow into cancer,” Golan said. “Even if we, unfortunately, find cancer or a tumor, stage 1 to 3 of colorectal cancer essentially is curable.”

To reduce the risk of developing colorectal cancer, Golan says maintaining a healthy, balanced lifestyle is key: eating a healthy, high-fiber diet, limiting red meat, avoiding tobacco, enjoying alcohol in moderation, and getting exercise.

She also encourages young people to watch for symptoms like unexplained blood in their stool, darkening of the stool and abdominal pain. She recommends getting established with a primary care provider who can order routine, annual lab tests to check for anemia.

“If you're having those symptoms, seek care,” Golan said. “Don't just assume it's something normal or benign, like hemorrhoids. Make sure that it's nothing more serious.”

Read more on the Cedars-Sinai Blog: The Need for Colorectal Cancer Screening in the Hispanic Community

for patients, caregivers and clinicians. Melanoma, which originates in the skin’s pigment-producing cells, accounts for only 1% of skin cancers but is responsible for most skin cancer deaths.

“In our 14th year hosting this symposium, we remain fully committed to our role as one of the largest melanoma treatment centers in the U.S.,” said Lawrence Piro, MD, president and CEO of the institute. “Continually educating melanoma clinicians, patients and survivors is an essential part of that role.”

The symposium will take place from 9 a.m.-noon Saturday, May 11, at The Angeles Clinic and Research Institute and online. Topics will include immunotherapy, cellular therapy, radiation therapy, clinical trials, survivorship, and advances against less common forms of melanoma.

“Each presentation is a conversation between our experts and the community of patients, caregivers, and physicians,” said Omid Hamid, MD, chief of Translational Research and Therapy and director of Melanoma Therapeutics.

Hamid and Mark Faries, MD, head of Surgical Oncology and co-director of the Melanoma Program, sat down with the Cedars-Sinai Newsroom to discuss advances in melanoma patient care.

How has melanoma treatment changed over the past decade or so?

Hamid: When we began hosting these events, there were virtually no approved treatments for melanoma. Over the course of these last 14 or 15 years, we’ve seen the development of many therapies, including bispecifics (a type of antibody) and cellular therapies. We're now looking not just to improve outcomes in cutaneous melanoma, the most common type, but to improve outcomes for other melanomas as well.

Faries: The advances that we've seen in systemic therapies have also allowed us to be more selective and targeted, and less invasive, with the surgical approaches that we use. Surgical procedures still have an important role in treatment, but we're able to use more discretion about the sorts of surgeries we employ.

How do cellular therapies work?

Faries: T cells, which are part of the body’s immune system, recognize melanoma as abnormal and attack it. Sometimes, however, the response is not adequate and the cancer spreads. We can remove one of the patient’s tumors and put that tissue into culture to allow the T cells in the tumor to become stronger and grow. Then we expand those cells to enormous numbers and give them back to the patient to shift the balance of power, so that the T cells have the upper hand.

What clinical trial options are available for melanoma patients?

Hamid: We have a multitude of clinical trials available. These include trials of cellular therapies, bispecific antibodies that recruit immune cells to attack tumors, and oncolytic viruses that can infect and kill cancer cells—including some that can be given intravenously to reach tumors that we cannot reach directly with an injection.

Faries: One of our goals is to have clinical trial options available to patients at every stage of their disease and treatment that build on the advances of recent years. Across all points along the patient’s journey, there are clinical trial options that give them opportunities that they might not have otherwise.

How has survivorship for melanoma patients evolved?

Hamid: Survivorship services are more important than ever as we see patients with metastatic melanoma surviving years and decades, some continuing treatment and some cleared of their cancer. Survivorship is not only living longer, but also living better. It's learning to cope with issues like long-term toxicities that can come from therapy, survivor's guilt, how to become involved in care, and getting involved in giving back to this community as a survivor. Many of the therapies leading to improved survival have originated here at The Angeles Clinic and Research Institute, and our symposium will provide a wealth of information about the programs and services available to support melanoma survivors.

Learn more about The Angeles Clinic and Research Institute on X at @angelesclinic.

Read more on the Cedars-Sinai Blog: A Lifesaving Second Opinion for Melanoma

“It’s an honor to continue to serve COG, a research network that has contributed significantly to most children surviving cancer today,” said Mascarenhas, director of Pediatric Hematology and Oncology and a professor of Pediatrics. “I look forward to even more progress in the next five years and beyond, thanks to the research and therapeutic advancements from healthcare professionals at research institutions that are part of COG.”

COG is a National Cancer Institute-funded clinical trials network comprising more than 200 leading hospitals and cancer centers across North America, Australia and New Zealand. All members work to advance progress in treating pediatric and adolescent cancer patients. As such, it is the largest clinical trials group in the world.

COG notes that patient participation in clinical research from member institutions, including Cedars-Sinai, has led to a combined five-year survival rate of 85% for children with cancer.

Mascarenhas has been a member of COG for more than 25 years and a member of the COG voting body, composed of principal investigators from each member institution, for 17 years. As voting body chair, Mascarenhas appoints leaders, coordinates and oversees elections within COG, and serves as a liaison between various COG scientific and administrative committees advocating for and facilitating smooth and efficient conduct of COG trials at each member site.

“Dr. Mascarenhas’ reelection to voting body chair for Children’s Oncology Group is a testament to his outstanding leadership in the pediatric and adolescent cancer field,” said Ophir Klein, MD, PhD, executive director of Cedars-Sinai Guerin Children’s and the David and Meredith Kaplan Distinguished Chair in Children’s Health. “His service and that of his fellow clinicians and scientists is what will lead to more benefits for patients locally and globally.”

Mascarenhas is known for his expertise in treating sarcomas and pediatric solid tumors. Sarcomas are rare cancers that occur in bone or soft tissue. Mascarenhas has led and collaborated on several clinical trials that have resulted in key insights and improvements in treatments for these cancers.   

“Dr. Mascarenhas’ research is fueling critical learnings that continue to give new hope to pediatric cancer patients and their families,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics at Guerin Children’s. “His yearslong involvement with Children’s Oncology Group underscores that the most robust science often stems from dedicated experts around the world working together to answer the most challenging questions.”

 In addition to his roles with Guerin Children’s, Mascarenhas is a senior investigator in the Samuel Oschin Comprehensive Cancer Institute Cancer Therapeutics Program at Cedars-Sinai and medical director of the Sarcoma Program at Cedars-Sinai Cancer.

“We congratulate Dr. Mascarenhas on his reelection to Children’s Oncology Group voting body chair and commend him on his longtime commitment to the cancer field,” said Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Foundation Distinguished Chair. “Patients treated at Cedars-Sinai and beyond will continue to benefit as a result of Dr. Mascarenhas and all the physician-investigators in COG who are determined to save more lives.”

Mascarenhas’ second term as voting body chair began in April 2024 and will continue through March 2029.

Read more on the Cedars-Sinai Blog: When Your Child Has Cancer | Tips for Parents

“We identified a new subtype of cells surrounding therapy-resistant soft tissue sarcomas,” said Jlenia Guarnerio, PhD, a research scientist at Cedars-Sinai Cancer and senior author of the study. “These cells secrete a molecular ‘Velcro’ called CXCL16 that traps immune cells, especially T cells, and keeps them from entering the tumor. With very few T cells inside the tumor, available immunotherapies aren’t effective.”

Soft tissue sarcomas originate in muscle, fat, blood vessels, nerves, tendons and joint lining, and can occur anywhere in the body. Some of these tumors do not respond to immunotherapy, which helps the body’s own immune system fight cancer cells, said Marina Broz, a PhD student in the Guarnerio Lab at Cedars-Sinai and first author of the study.

“Previous studies have shown that cells called cancer-associated fibroblasts prevent immune cells from entering these tumors, leading to therapy resistance, but the way they achieve this is poorly understood in many cancers and particularly in soft tissue sarcomas,” Broz said.

Investigators found a particular subtype of cancer-associated fibroblasts surrounding therapy-resistant soft tissue sarcomas in laboratory mice.

“These are the cells that are trapping T cells outside the tumors,” Broz said. “And we noted that they rely on glucose to make energy, which turned out to be the key to turning non-responding tumors into responders.”

When investigators treated the mice with a glycolysis inhibitor to stop the cells from using glucose, the fibroblasts no longer secreted CXCL16—and T cells invaded the previously therapy-resistant tumors. This dramatically improved the abundance of T cells, thus making the tumors more vulnerable to chemotherapy as well.

“Without the inhibitor, the tumors were barely responsive to therapy,” Guarnerio said. “The inhibitor alone didn’t reduce tumor growth at all, but in combination with chemotherapy it significantly reduced tumor growth.”

Because glycolysis inhibitors aren’t safe for patients, investigators will work to develop a therapy to target CXCL16, said Guarnerio, who is also an assistant professor of Radiation Oncology and Biomedical Sciences at Cedars-Sinai.

“Targeting CXCL16 could also improve outcomes for patients with other types of immunotherapy-resistant tumors,” Guarnerio said. “We would like to see if we can engineer a therapy to improve treatment response in all tumor types with poor T cell infiltration.”

Dan Theodorescu, MD, PhD, director of Cedars-Sinai Cancer and the PHASE ONE Distinguished Chair, said that the study is an example of translational research that may produce targeted therapies.

“This work represents our commitment at Cedars-Sinai Cancer to the promise of precision medicine, which may produce targeted therapies and further enhances our clinical adult and pediatric sarcoma program,” Theodorescu said.

Additional Cedars-Sinai authors participating in this study included Emily Y. Ko, Kristin Ishaya, Jinfen Xiao, Marco De Simone, Xen Ping Hoi, Roberta Piras, Basia Gala, Fernando H. G. Tessaro, and Anja Karlstaedt.

Other authors included Sandra Orsulic, Amanda W. Lund, and Keith Syson Chan.

Funding: J.G. was supported by the K99/R00 grant (CA212200) and R01 (CA258265) for the execution of this work. Additionally, J.G. was supported by grants from the Sarcoma Foundation of America (Grant 2019 SFA 15–19), and the Cedars-Sinai Cancer Accelerator Award. M.B. was supported by a National Cancer Institute F31 fellowship (1F31CA284888). K.S.C was supported by R01CA175397, R01CA175397-Supplement, U54CA274375. X.P.H received funding from U54CA274375. A.W.L. received support from the Cancer Research Institute (Lloyd J. Old STAR Award). A.K. was supported by the National Heart, Lung and Blood Institute (R00 HL141702) and the Leukemia Research Foundation New Investigator Award (Grant No. 941997).

Read more on the Cedars-Sinai Blog: Immunotherapy – The Fourth Pillar of Cancer Care