The first time Jeff Capstran was diagnosed with melanoma, at the age of 25, the treatment was relatively straightforward. The cancer was surgically removed – with no chemo, no radiation.
The next time, things weren’t so simple. Thirteen years after his original diagnosis, he noticed a lump in his left thigh – the same limb that had been affected before. His dermatologist took a tissue sample and told him there was nothing to worry about. But the bruising and pain from the procedure lingered for what seemed like an unusually long time. Capstran went back to the dermatologist twice, but was told he was fine. Then he found a new doctor – and discovered he had stage IV metastatic melanoma.
Researching his options, Capstran learned of a promising trial being conducted at the National Institutes of Health in Bethesda, Md. A Milwaukee native, he was more than happy to travel given all that was at stake. “I thought, ‘It has some pretty strong possible side effects, but if it works, it really, really works. I’ve got three little kids and a wife that I love; I might as well go with the latest and greatest [treatment],’ ” he says.
Now cancer-free for more than a year, Capstran is happy to talk about his involvement in the trial, a phase of which is now taking place at Aurora St. Luke’s Medical Center. His story underscores the importance of taking an active role in your own medical care, but also emphasizes the great value of research. From cutting-edge cancer treatment to minimally invasive surgical and imaging techniques, a number of exciting new medical developments are taking place right here in Milwaukee.
The trial in which Capstran took part stands to add a powerful new tool to cancer treatments. “We believe there are four ways to treat cancer now,” says Dr. John P. Hanson Jr., medical director of the Immunotherapy Program at Aurora St. Luke’s Medical Center. “There’s surgery, radiation and drugs … and there is immunologic treatment.”
The phase 2 clinical study being conducted at Aurora St. Luke’s – one of few institutions in the world to offer the research – falls into the latter category. “The idea was, why can’t we just use the patient’s own immune system to fight the cancer?” explains Hanson, who is principal investigator of the Milwaukee study. Called the Young Tumor-Infiltrating Lymphocyte (Y-TIL) trial, the study works essentially by training the patient’s immune system to kill the cancer cells.
The trial focuses exclusively on patients with metastatic melanoma – skin cancer that has spread to other parts of the body. Eligible patients give blood and tumor tissue samples, which are processed in the immunotherapy lab. During this stage, immune system cells called lymphocytes are removed from the tumor and grown in the laboratory. These special cells are trained to recognize and attack the cancer.
After the lymphocytes have been grown in the lab, the patient receives chemotherapy drugs – not to fight the cancer, but to suppress the immune system so it doesn’t fight the cells once they are transferred back to the body. The cells are then returned to the body via “a painless, 30-minute process,” Capstran explains. The patient receives a medication to help the cells continue to grow and reproduce in his or her body and begin to attack the cancer. “You transfer back to the patient their own means to do the job,” says Hanson. “It’s a one-and-done treatment.” The whole process takes between five and eight weeks. Several weeks later, the patient undergoes testing to begin to determine the effects of the study.
Not all melanoma patients are good candidates for the trial, the early results of which show a 51 percent response rate. So far, the treatment can only be used for melanoma because that cancer has easily identifiable immune markers, Hanson explains. In the case of lung, colon, breast and prostate cancers, for example, researchers haven’t been able to get the lymphocytes to recognize the cancer they are supposed to fight. But developing the technology so that it works for other cancers is certainly a goal.
Mapping the Brain
Another exciting medical advance is MEG technology, a noninvasive diagnostic tool that can be used to evaluate and “map” brain activity before surgery. The first in the state to offer MEG in a patient-care setting, Froedtert & The Medical College of Wisconsin is among just 20 or 25 institutions in the country using the technology clinically.
MEG (which stands for magnetoencephalography) works by recording magnetic fields outside of the head, which are generated by electrical currents inside the brain. By measuring these currents, MEG produces high-resolution images of brain function. In comparison to other brain-imaging techniques, such as MRI, with MEG “there is virtually no limit in the temporal resolution of these measurements, meaning that we are able to pick up the brain activity millisecond by millisecond, if not faster,” explains Dr. Sylvain Baillet, an associate professor of neurology and the scientific director of the MEG Program at Froedtert & The Medical College.
For patients with brain tumors or severe epilepsy that requires surgery, MEG technology can mean a more successful procedure. By allowing physicians to precisely identify the brain tissue that needs to be removed, MEG ensures the surgery is not only thorough, but is also exact, minimizing potential loss of brain function. Before a neurosurgeon removes a brain tumor, for example, MEG can help her determine “whether there is some crucial brain function going on [at] the fringes of the tumor or even within the tumor,” Baillet explains. Such precision can spare vital functions such as language, memory and motor performance in patients.
MEG technology does not replace but rather complements an MRI, notes Baillet. While MEG offers very high temporal resolution, the MRI has better spatial resolution, yielding a clearer image of the brain’s anatomical structure. The two are used in tandem to provide a more complete map of the way a patient’s brain is functioning.
Long-term, researchers hope to extend MEG’s imaging capabilities to evaluate other conditions, such as Alzheimer’s, Parkinson’s, schizophrenia and even depression. “Every time there is a condition that affects the brain, there should be an electromagnetic signature in the brain that reveals this condition or illness,” explains Baillet. By revealing such signatures, MEG may one day help researchers better understand and treat such diseases.
New Gallbladder Surgery
Another new medical advance improves upon one of the most common general surgery procedures performed in America: gallbladder surgery. Often arising as a result of a high-fat, high-calorie diet, gallstones can be extremely painful, producing symptoms that may resemble a heart attack.
About 750,000 Americans undergo gallbladder surgery a year. Women are more likely to develop gallstones than men.
In recent years, medical advances have made gallbladder surgery less invasive and easier to recover from. The latest step in this evolution is the single-incision laparoscopic surgical (SILS) procedure, which allows doctors to remove the gallbladder through the use of one small incision. Dr. Joseph Regan, laparoscopic surgeon and medical director of the Bariatric Center at Columbia St. Mary’s, performed what is believed to be the first SILS procedure in Wisconsin.
“We’re always striving to make our surgical procedures less invasive, [and] this is as close as we can get to scarless surgery,” says Regan. While traditional laparoscopic surgery requires four to five small incisions on the patient’s torso, the SILS procedure makes a single, half-inch incision through the belly button. The surgeon then uses a special video camera and other surgical instruments to remove the gallbladder through the incision. Because it is inside the belly button, the incision virtually disappears once it heals.
The procedure takes about 30 minutes to perform, and most patients go home the same day, says Regan. In addition to a superior cosmetic result, the SILS procedure may lead to more rapid recovery and less pain, although that remains to be seen.
Currently, patients who are obese, have significant abdominal scar tissue from previous surgeries, or pronounced abdominal infection are generally not good candidates for the procedure, although that may change over time, notes Regan.
Though gallbladder surgery is currently the most common application for SILS, the procedure may also be used for removal of the appendix and kidneys. One of the advantages of the SILS procedure is that it builds on existing technology, says Regan. “We are essentially using the same instruments that we use to perform a standard laparoscopic procedure, so that helps to control costs. It’s nice, in this age of rising health care costs, to be able to offer a new technology and new procedure that does not have a large increase in cost associated with it.”
Caroline Goyette is Milwaukee Magazine’smonthly health columnist.
Health Tips by Scott R. Weinberger
Instant back-pain relief! Patients who applied 4 grams of comfrey root ointment, made from a medicinal herb, cut their back pain intensity scores by 95 percent, notes an online report of the British Journal of Sports Medicine.Patients experiencing acute lower or upper back pain applied the ointment three times per day for five days. Pain relief usually began in less than an hour.
Depression and diabetes: A vicious cycle. A new study suggests people with major depression may have problems processing glucose (blood sugar), making them more likely to develop diabetes. Diabetes is three times more likely to occur in depressed people. It’s
possible that depression helps cause diabetes and that diabetes helps cause depression. The report, presented at the American Psychiatric Association 162nd Annual Meeting, recommends that all patients with major depression be screened for blood sugar problems to treat or prevent diabetes.
No TV for young children. The American Academy of Pediatrics recommends that children under the age of 2 should not watch any TV. And a new study in the Archives of Pediatric & Adolescent Medicine found that very young children “talk” much less while watching TV, which can result in poorer language skills. Adults watching TV with their kids also speak much less frequently, which means less interaction with their children. To foster normal brain growth, the AAP recommends no more than two hours of watching TV per day for children above age 2.
Adopt an embryo. As an alternative to the lengthy, expensive process of adopting a child, you can adopt an embryo through the Advanced Institute of Fertility in Milwaukee. The institute had more than 100 donated embryos available at press time. The institute has completed 42 embryo adoption cycles, resulting in 23 pregnancies. The pregnancy rate through the program is 53 percent; 96 percent of pregnancies resulted in a live birth. Most embryos are donated by couples who went through in vitro fertilization and want no additional pregnancies.
Watch kids with lupus for signs of artery disease. Childhood lupus may lead to premature atherosclerosis (hardening of the arteries) in the young- to mid-adult years. That’s according to a study of 221 patients with systemic lupus erythematosus (SLE) that was published in Arthritis & Rheumatism.The authors recommend that patients who had childhood SLE be screened earlier than usual for cardiovascular disease risk factors and take preventative steps, such as diet, exercise and medications.