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Cancer Made Me a Kinder Person

The cleanliness of drinking water can vary, so for those who are immunocompromised, it can be a good idea to take precautions.


Should Immunocompromised Patients With Cancer Worry About Drinking Water?

The utility of SpaceOAR Hydrogel, a polyethylene glycol-based hydrogel spacer placed between the prostate and rectum, led to a reduction in hazard of developing bowel disorders as well as a reduction in requirement of procedures such as colonoscopy in patients undergoing radiation therapy for prostate cancer, according to a study published in JAMA Network Open.

Because of the rectum’s close proximity to the prostate, radiation exposure due to prostate cancer treatment can lead to complications such as diarrhea, rectal bleeding and discomfort during bowel movements. In some cases, these side effects can be severe enough to require medical intervention, impacting a patient’s quality of life after treatment ends. 

In order to address these needs, investigators launched a retrospective cohort study of SpaceOAR to better understand the incidence of radiation-related bowel toxicity, including bowel disorders and related medical procedures, among patients who received radiation therapy for prostate cancer.

Dr. Ron Morton, the chief medical officer and vice president of medical affairs of Urology at Boston Scientific, sat down for an interview with CURE to discuss what these findings mean for patients considering radiation therapy, the broader implications for long-term bowel health and questions patients should ask their oncologists when evaluating their treatment options.

CURE: How does radiation therapy for prostate cancer impact bowel health, and why is minimizing bowel toxicity a critical concern for patients?

: Radiation therapy aims to kill cancer cells while avoiding damage to surrounding healthy tissue. But radiation to treat prostate cancer can cause damage to the rectum due to its proximity to the prostate, which can lead to issues with bowel function, including diarrhea, painful bowel movements and rectal bleeding.

These side effects can negatively impact patients’ quality of life. And in rare cases, these complications can be serious and require hospitalization or surgical intervention to manage.

Can you explain how SpaceOAR Hydrogel works and why it is an option for patients undergoing radiation therapy for prostate cancer?

SpaceOAR Hydrogel is an absorbable polyethylene glycol (PEG)-based hydrogel that temporarily creates space between the prostate and rectum. It’s designed to reduce the radiation dose delivered to the rectum during radiation therapy to help lessen damage to the rectum and minimize side effects.

The procedure to place SpaceOAR is minimally invasive and typically happens in an outpatient setting – a doctor’s office, hospital or clinic. It’s composed of biodegradable material and is naturally absorbed by the body after approximately six months. SpaceOAR is an option for patients because it may help maintain a patient’s quality of life and reduce the often frustrating and embarrassing side effects of radiation therapy.

The recent study published in JAMA Network Open found that patients receiving SpaceOAR had a 25% lower hazard of developing bowel disorders. What does this mean for patients considering radiation therapy?

In this large retrospective database review of patients with prostate cancer, those who received SpaceOAR as part of their treatment had a significantly lower chance of developing bowel complications due to radiation therapy as compared to patients that did not receive SpaceOAR as part of their treatment.

The findings of this study are consistent with other clinical trial results, further supporting SpaceOAR as a safe and effective treatment option that can potentially protect quality of life for prostate cancer patients. This is good news for patients who are considering radiation therapy for prostate cancer and want to minimize bowel-related side effects.

Many patients worry about long-term side effects of treatment. How does the use of SpaceOAR Hydrogel compare to not using it in terms of bowel-related quality of life years after treatment?

The study findings show that the use of SpaceOAR was associated with a significant reduction in the incidence of bowel disorders and related procedures in the four years after radiation treatment. A cancer diagnosis can be scary and overwhelming, and patients are often faced with having to make challenging decisions about their treatment plans. Knowing that SpaceOAR can help minimize long-term side effects of radiation therapy and maintain quality of life post-treatment can hopefully ease some of the concern’s patients may have as they make those important decisions.

This study also found that patients who received SpaceOAR had a 46% lower hazard of requiring procedures such as colonoscopies and rectal resections. How significant is this reduction for a patient’s long-term health and overall quality of life?

The significant reduction of bowel-related procedures in the SpaceOAR group compared to the non-SpaceOAR group is indicative of the ability of SpaceOAR to preserve normal bowel function and help protect quality of life for patients undergoing radiation therapy for prostate cancer. Anecdotally, what I’ve heard from fellow physicians is that because of the higher risk of bowel complications with stereotactic body radiation therapy (SBRT), many of them won’t perform SBRT without placing a perirectal spacer.

What should patients ask their oncologists about SpaceOAR to determine whether it is the right option for their specific case?

SpaceOAR Hydrogel is widely available in the United States and covered by many insurance plans. It’s also available globally in many countries where contemporary radiation therapy techniques are practiced.

I encourage patients to engage in shared decision-making with their care team about their prostate cancer treatment. Available options, including surgery, radiation therapy and watchful waiting should be considered. Patients who decide to undergo radiation therapy should discuss with their physician the risks and benefits of including a perirectal spacer such as SpaceOAR in their treatment plan.

“Bowel Disorder Incidence and Rectal Spacer Use in Patients With Prostate Cancer Undergoing Radiotherapy” by Dr. Michael R. Folkert, et al., JAMA Network Open

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SpaceOAR Hydrogel, a polyethylene glycol-based spacer, reduces radiation-induced bowel disorders in prostate cancer patients undergoing radiation therapy. By creating space between the prostate and rectum, it minimizes radiation exposure to the rectum, thereby decreasing complications like diarrhea and rectal bleeding. A study in JAMA Network Open showed a 25% reduction in bowel disorder risk and a 46% decrease in procedures like colonoscopies for patients using SpaceOAR. This intervention supports long-term bowel health and quality of life, making it a valuable consideration for patients.

SpaceOAR Hydrogel reduced the risk of bowel disorders, the need for colonoscopy and rectal resection following radiation therapy in prostate cancer.

Tumor

Reducing Bowel Complications Following Radiation in Prostate Cancer

Circulating tumor DNA (ctDNA) is described by The University of Texas MD Anderson Cancer Center website as DNA fragments which are released into the bloodstream from tumor cells and these fragments of tumor cells can often lead to minimal residual disease (MRD), which is when cancer cells remain in the body after treatment.

In a presentation given by Dr. Debu Tripathy at the recent 

Annual Miami Breast Cancer Conference and the Educated Patient Breast Cancer Summit

, he explained how ctDNA is used to in cancer detection and how it can also indicate the presence of MRD, a signal suggesting there is cancer in the body, according to the National Institute of Health.

“Tumors that are in the body are fed by blood vessels, and the veins also drain these areas, just like they drain other organs and tissues, and DNA that comes from the cells are present in the blood. They do get broken down eventually, but we can actually measure this, and we've been able to do this for a long time, but our techniques have become very sensitive, so that we can now pick up very small amounts of residual tumor that may ultimately lead to a metastasis.,” he explains.

Tripathy previously served as a professor and chairman of the Department of Breast Medical Oncology, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, in Houston, and as the editor-in-chief at CURE, prior to his retirement in March of 2025.

Understanding ctDNA and its Applications in Oncology

For years, researchers have suspected that small clusters of tumor cells can exist in patients with early-stage cancer, contributing to late recurrences. In breast cancer, for example, recurrence can occur decades later, implying the presence of dormant tumor cells. Now, with recent advances in technology, investigators have been able to detect minuscule amounts of tumor-derived DNA in the bloodstream, even at single-molecule levels. This development has provided evidence that ctDNA generally signals an impending relapse.

Tripathy goes on to explain that by using highly sensitive techniques, researchers are beginning to distinguish tumor DNA from normal DNA. In recent studies, patients have been tracked over time to evaluate those with detectable ctDNA and those without; consistently, patients who have detectable ctDNA experience worse disease-free survival compared to those without.

“The big question is: how can we now really prove that we can not only measure tumor DNA? However, there's no point in doing it unless we can do something about it, of course. [Therefore], the goal here is to refine the technology to make it as sensitive and accurate as possible, and then to test different strategies to see if we can lower the risk of recurrence, as we have done over the last 50 years or so,” he emphasized.

Because many patients with advanced breast cancer have already undergone primary surgery and adjuvant therapy, Tripathy describes this approach as a “potential second chance at a cure” if the patient is at risk of recurrence. To achieve this, studies have been designed to detect ctDNA; if no detectable tumors appear on scans and only MRD is identified through ctDNA, patients can be enrolled in trials aimed at altering the course of their disease. Tripathy says the goal of this approach is to prevent recurrence entirely, offering the possibility of long-term remission.

Advancements in Liquid Biopsies for MRD Detection

Liquid biopsies, an important part of MRD detection, focuses on ctDNA and is a minimally invasive blood tests that analyzes DNA fragments shed by cancer cells to gain insights into a patient's cancer status, according to The University of Texas MD Anderson Cancer Center website. Importantly, Tripathy goes on to note that these liquid biopsies are an important subject that is under investigation at present. Many of these biopsies, he says, are being performed in patients with advanced breast cancers to better understand their biology, as well as better understand their mutations. In turn this helps direct physicians to the the type of therapy that is best suited for each patient.

Other areas of ongoing research are now even looking for healthy patients who've never had cancer for early detection, he explains. For these research areas, investigators are aiming to better understand what alterations are present in the DNA that may predict not only a patient’s risk of developing cancer, but what type of cancer or what organ it may originate from.

Tripathy also went on to note some of the limitations and challenges in detecting residual disease with conventional imaging. While the Signatera assay is widely used and was recently approved for Medicare reimbursement, its sensitivity may be insufficient for certain applications. More sensitive assays are needed for reliable detection of MRD, and ongoing interventional trials are evaluating different approaches. Institutions conducting these trials are working toward more precise methods to improve clinical decision-making and patient outcomes, Tripathy emphasizes.

“It's a wonderful tool to look at DNA in the blood from tumor cells, or even from people who may have such a small amount that they're at risk for developing a cancer or recurring from a cancer that they had earlier, and how we're starting to use this and test this."

Future trials will likely focus on integrating novel, more potent therapies and refining ctDNA detection to improve patient stratification and outcomes, he concludes.

Circulating tumor DNA (ctDNA) is a promising tool for detecting minimal residual disease (MRD) and predicting cancer recurrence. Advances in technology have enabled the detection of ctDNA at single-molecule levels, providing evidence of impending relapse. Liquid biopsies, which analyze ctDNA, offer a minimally invasive method to assess cancer status and guide treatment decisions. Ongoing research aims to refine ctDNA detection techniques and explore its potential in early cancer detection. Despite challenges in sensitivity, future trials will focus on integrating novel therapies to improve patient outcomes.

Dr. Debu Tripathy explains how ctDNA is used to in breast cancer detection and how it can also indicate the presence of MRD.

Advancing ctDNA for Minimal Residual Disease Detection in Breast Cancer

The first patent has been dosed in the phase 1b/2a clinical trial P300-02-001, which is evaluating pocenbrodib alone, and in combination with Zytiga (abiraterone acetate), Lynparza (olaparib) or Pluvicto (177Lu-PSMA-617) in patients with metastatic castration-resistant prostate cancer, according to a news release from manufacturer Patos AI.

"Our precision medicine approach allows us to target the underlying resistance mechanisms to [androgen receptor]-targeted therapy through CBP/p300 inhibition, addressing a significant area of high unmet need for patients with advanced prostate cancer,” Dr. Jens Renstrup, Chief Medical Officer of Patos AI, said in the news release.

The study is expected to enroll approximately 203 patients with metastatic castration-resistant prostate cancer who have progressed despite prior therapy and have been treated with at least one anti-androgen therapy.

The study is currently recruiting at three locations across the United States, in Omaha, Nebraska at Nebraska Cancer Specialists, in Houston, Texas, at Oncology Consultants, and in Fairfax, Virginia, at NEXT Oncology — Virginia.

Key inclusion criteria for the study includes patients who are 18 years or older, with histologic documentation of prostate adenocarcinoma and metastatic disease, which must be confirmed by imaging. Imaging performed within 56 days prior to screening is acceptable.

Key exclusion criteria include current or prior evidence of any small cell or neuroendocrine histology on the most recent prostate biopsy and any liver metastases confirmed by biopsy or lesions greater than 1 centimeter consistent with liver metastases on imaging. Additionally, participants who have received intervention with any chemotherapy, investigational agent or other anticancer drug, including Xtandi (enzalutamide), Erleada (apalutamide) or Nubeqa (darolutamide) within 14 days prior to screening or five half-lives, whichever is shorter, are excluded.

Participants with any other serious underlying medical, psychiatric, psychological, familial or geographical conditions, as determined by the investigator, that may interfere with study participation and compliance or place the participant at high risk for treatment-related complications are also excluded.

P300-02-001 is a multicenter, open-label, dose-finding phase 1b/2a clinical trial. The study aims to confirm the safety, pharmacokinetics, preliminary antitumor activity and pharmacodynamics of pocenbrodib, both alone and in combination with Zytiga, Lynparza or Pluvicto, in adults with metastatic castration-resistant prostate cancer.

The primary objectives are to assess the safety, objective response rate and PSA decline of pocenbrodib alone and in combination with Zytiga, Lynparza or Pluvicto, and to define a preliminary recommended phase 2 dose of pocenbrodib in combination with these treatments.

“By integrating multiomic data tied to real-world outcomes to identify specific molecular signatures, our PathOS platform enables us to select the right patients for treatment, potentially improving outcomes in a disease with limited therapeutic options as resistance develops,” Renstrup continued. “This study builds on the previously reported data from COURAGE study in metastatic castration-resistant prostate cancer and reinforces our confidence in pocenbrodib's potential to improve outcomes for these patients."

Pocenbrodib is an oral, small-molecule inhibitor with the potential to benefit patients with advanced prostate cancer, either alone or with other treatments, according to the release. It works by inhibiting CREBBP/EP300, proteins that activate genes promoting cancer cell growth and proliferation. This inhibition affects the expression of key cancer drivers, including the androgen receptor and its variants, making pocenbrodib relevant to advanced prostate cancer and other cancer indications.

For more information on the trial, use the trial ID, NCT06785636, at clinicaltrials.com.

For more news on cancer updates, research and education,

don’t forget to subscribe to CURE®’s newsletters here.

The phase 1b/2a clinical trial P300-02-001 is evaluating pocenbrodib, alone and in combination with Zytiga, Lynparza, or Pluvicto, in patients with metastatic castration-resistant prostate cancer. The trial aims to address resistance mechanisms to androgen receptor-targeted therapy through CBP/p300 inhibition. Approximately 203 patients will be enrolled, with key inclusion and exclusion criteria outlined. The study's primary objectives include assessing safety, objective response rate, and PSA decline, while determining a recommended phase 2 dose. Pocenbrodib targets CREBBP/EP300 proteins, potentially benefiting advanced prostate cancer patients.

First patient dosed in phase 1b/2a trial for castration-resistant metastatic prostate cancer, evaluating pocenbrodib alone and with other drug combinations.

First Patent Dosed With Pocenbrodib in Trial for Metastatic Prostate Cancer

The first patients have been dosed in a phase 2 clinical trial evaluating a new off-the-shelf CAR-T cell therapy for the treatment of pediatric and adult patients with relapsed or refractory (R/R) T cell acute lymphoblastic leukemia or T cell lymphoblastic lymphoma (T-ALL/LBL).

, according to a news release from biotechnology company Wugen, Inc., is a potential first-in-class, investigational, anti-CD7 CAR-T cell therapy.

The trial is currently recruiting participants and will have an estimated enrollment of approximately 125 patients, according to its listing on clinicaltrials.gov. The trial has eight locations: City of Hope in Duarte, California, Children’s Hospital Los Angeles, Moffit Cancer Center in Tampa, Florida, Washington University Saint Louis in Missouri, Children’s Hospital of Philadelphia and The University of Texas MD Anderson Cancer Center in Houston, as well as two locations in Victoria, Australia.

The trial, according to the listing, aims to evaluate the composite complete remission rate of WU-CART-007 in patients with R/R T-ALL/LBL and the treatment’s effectiveness in inducing complete minimal residual disease negative response.

The trial has an estimated primary completion date of Dec. 30, 2026, and a study completion date of Dec. 30, 2028, according to the listing.

“It’s been 20 years since a new medicine was approved for patients with relapsed or refractory T-ALL/LBL, which remain challenging hematologic malignancies with limited treatment options in the relapsed or refractory setting," said Dr. Cherry Thomas, chief medical officer of Wugen, in the news release. "WU-CART-007 has shown clinical response and manageable safety, making it a promising off-the-shelf cell therapy candidate to fill a longstanding treatment gap. The enthusiasm around the program and the need for new treatments have been reflected in the study recruitment thus far, as it is enrolling faster than anticipated.”

CAR-T cell therapy is typically a type of treatment that, as defined by the National Cancer Institute, involves a patient’s T cells — part of their immune system — being extracted and changed in a laboratory so that they will now attack cancer cells, and then are given back to the patient.

However, WU-CART-007 is made using healthy donor-derived T cells, according to the news release from Wugen, in order to eliminate the risk of malignant cell contamination.

WU-CART-007, according to the news release, has already received Regenerative Medicine Advanced Therapy (RMAT), Fast Track, Orphan Drug and Rare Pediatric Disease designations from the U.S. Food and Drug Administration (FDA).

The company previously announced results from a phase 1/2 cohort expansion study that, according to the news release, showed clinically manageable safety and evidence of anti-leukemic activity, with an overall response rate of 91% and a composite complete remission rate of 73% in heavily pretreated patients with R/R T-ALL/LBL.

"The data we have previously reported from our Phase 1/2 study on the WU-CART-007 program has paved the way for the initiation of this pivotal study, and suggests it has the potential to set a new standard of care for relapsed or refractory T-ALL/LBL," said Kumar Srinivasan, president and CEO of Wugen, in the news release. "The program has earned multiple U.S. Food and Drug Administration accelerated approval pathway designations, including RMAT, Fast Track, Orphan Drug and Rare Pediatric Disease, as well as Priority Medicines designation in the EU. With this pivotal study now underway, we are advancing toward a much-needed off-the-shelf CAR-T option for patients who face historically poor outcomes and limited treatment alternatives."

A phase 2 clinical trial is underway to evaluate WU-CART-007, an off-the-shelf CAR-T cell therapy for relapsed or refractory T cell acute lymphoblastic leukemia or lymphoblastic lymphoma. This investigational therapy, derived from healthy donor T cells, aims to address the treatment gap in these challenging hematologic malignancies. The trial, involving approximately 125 patients across multiple locations, seeks to assess the therapy's complete remission rate and effectiveness. WU-CART-007 has received several FDA designations, indicating its potential as a new standard of care.

The first patients have been dosed in a trial of CAR T therapy in relapsed/refractory T cell acute lymphoblastic leukemia or T cell lymphoblastic lymphoma.

First Patients Dosed in WU-CART-007 Trial for Blood Cancer Subtypes

Breast cancer research increasingly highlights the role of genomic testing in refining treatment strategies, particularly for African American women, who face distinct challenges in diagnosis and treatment, according to Dr. Regina Hampton, who added that understanding these genetic differences is critical to advancing personalized treatment.

In an interview with CURE, Hampton shared case studies from her own practice, illustrating how genomic insights have reshaped treatment plans and improved patient outcomes for those with breast cancer. She also highlights the continued need for expanded access to genomic testing and research into racial disparities in breast cancer care.

Read more from our conversation with Hampton, a breast surgeon and the chief of Breast Surgery at Doctors Community Medical Center, Luminous Health, in Lanham, Maryland, 

where she expands on the importance of genomic testing,

CURE: Ongoing research into gene testing suggests that race can influence breast tumor biology. How does this impact treatment decision making and what advancements in genomic testing are helping to refine treatment plans for African American women?

: It's not just the tumor itself, knowing the size and the type of tumor it is. Instead, it's really digging deep and finding out what are the genetics of the tumor. There are many tests out there that look at the genes in the tumor, as we talked about with the FLEX study, and using that information to give us as clinicians information on if we should be aggressive or not; if these patients just need hormone therapy alone; or if chemotherapy [should] be given.

Where the MAMMAPRINT test stands out from a lot of the other tests is that it looks at 150 different genes in the tumor. Not only does it tell us whether the patient needs hormone therapy or chemotherapy, it is giving us a guide to the type of tumor. Where I think this is important for African American women is that the tumors are different in some way, but we didn't know why. Yes, they're younger women. Yes, they're more aggressive tumors. However, we found, even in tumors that are hormone-positive, they tend to be very aggressive tumors. The question is, “Why is that?” Where MAMAPRINT is superior to some of the other tests is that it's giving us that information.

Genomic testing is increasingly crucial in breast cancer treatment, especially for African American women who face unique challenges. Understanding genetic differences is vital for personalized treatment, as highlighted by Dr. Regina Hampton. She emphasizes the importance of tests like MAMMAPRINT, which analyze numerous genes to guide treatment decisions. Case studies demonstrate how genomic insights can alter treatment plans, improving outcomes. Expanding access to genomic testing and addressing racial disparities in breast cancer care are essential. Clinicians and policymakers must collaborate to enhance awareness and access to these critical resources.

Dr. Regina Hampton shares case studies from her own practice, illustrating how genomic insights have improved patient outcomes in those with breast cancer.

Roberta Codemo

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