Cancer Striking Younger Insights from University Hospitals CEO Cliff A. Megerian

Cliff A. Megerian shared on LinkedIn:

“With rising cancer rates in younger adults, our innovative therapies and groundbreaking research at University Hospitals are leading the charge against this evolving threat. Check out my latest blog where I discuss how dedicated oncologists, public health researchers and other scientists are addressing this new reality.

Cancer Striking Younger: UH Seidman Cancer Center Fighting to Outsmart a Shifting Foe

Cancer is a wily and relentless adversary. We in healthcare are constantly looking for new therapeutic approaches to outwit such a seemingly determined — and moving — target. It’s a battle we can’t afford to lose, and cancer’s ability to evade even our most advanced treatments often makes it feel almost alive – always adapting and finding new ways to strike.

But despite the formidable nature of cancer, we do make progress every day, here at UH Seidman Cancer Center and other hospitals, centers and labs across the country. Since 1991, the number of Americans dying of cancer dropped by a remarkable 33%, according to the American Cancer Society.

But the terrain of the disease is constantly shifting, requiring redoubled efforts and unwavering focus. This past summer, for example, we saw news about disturbing emerging trends in younger adults. A large study from the American Cancer Society found that Americans under age 50 were the only age group to experience an increase in overall cancer incidence between 1995 and 2020.

Another report looked at 34 different cancers among Americans from 2000 to 2019. It revealed that for adults under 50, there were increases in incidence in 17 of these cancers, with five also showing increases in cancer deaths. These include liver cancer among women, as well as uterine corpus, gallbladder, testicular and colorectal cancers.

Dedicated oncologists, public health researchers and other scientists are addressing this new reality.

At UH Seidman, for example, our experts are laser-focused on studying why colorectal cancer – now the leading cause of cancer deaths among men under 50, and the second for women behind breast cancer – is striking younger adults with such force.

Our experts, for example, working in tandem with colleagues at other leading cancer centers, have uncovered key insights into early-onset colorectal cancers: they are more commonly left-sided and have certain important symptoms that should not be ignored, such as diarrhea, rectal bleeding, abdominal pain and iron-deficiency anemia. Too often, younger adults dismiss these warning signs as minor issues — a bad case of hemorrhoids or a bout of food poisoning — when something far more serious may be happening.

What’s more, African American patients also seem to be disproportionately affected. Researchers have also shown that these cancers are not molecularly different than those diagnosed at a later age, and the vast majority don’t appear to be linked to inherited genetic risks. These findings mean that aggressive treatment based solely on age is not the answer – a nuanced, personalized approach is.

But the question remains: why is colorectal cancer happening earlier? Our team tells me the causes are likely multifactorial. Diet appears to play a role. Data from the Nurses’ Health Study II shows that two servings per day of sugar-sweetened beverage was associated with a more than two-fold increase in early-onset colorectal cancer.

A person’s specific genomics, chronic disease status and microbiome – the bacteria that live in the gut — are other likely predisposing factors.Research shows that specific bacterial species may in fact be involved in the genesis of a colorectal cancer, while also promoting resistance to chemotherapy.

In fact, early work is underway at UH Seidman Cancer Center to launch a prospective microbiome study with our early-onset colorectal cancer patients. The goal is to understand if there are differences in the bacteria that live in the gut that may be contributing to these patients’ risk and outcomes. And that is just the beginning.

Innovating on all fronts

• At UH Seidman Cancer Center, we are not just reacting to these trends – we’re actively developing and refining treatments that are reshaping the fight against cancer.
• Our newly expanded Wesley Center for Immunotherapy produces our own cellular therapies on site for patients enrolled here in clinical trials – one of just a handful of centers to do so nationwide. Turnaround time can be as short as 24 hours to generate the cells, with the patient receiving them about a week later.
• This is a crucial difference from commercial vendors, especially for patients who have cancer that is spreading quickly. Patients with certain blood cancers receive CAR T-cell therapy, where a patient’s own immune cells are removed, modified to fight their cancer and given back to the patient to fulfill their mission. Think of it as a “living drug.”
• On the radiation therapy front, we’ve led the effort to reduce the number of radiation treatments a patient must complete. For example, prostate cancer has typically required 40 to 45 treatments of radiation therapy over nine weeks. Today, patients receive as few as five treatments over 10 days.
• What’s more, the advanced technology we employ for patients with brain tumors reduces treatment time from hours to just minutes. In addition, UH Seidman Cancer Center will soon be the first in our region to have technology known as adaptive radiotherapy. It can track the tumor in real time – an invaluable feature for treatment planning.
• For example, if a patient has treatment before eating lunch one day, but then has treatment the next day after eating lunch, the tumor may have moved. This groundbreaking adaptive radiotherapy system accounts for that, which can spare healthy tissue and precisely deliver the radiation to the tumor’s exact location. Our team has the longest experience of any team in the world with this technology, with experts we’ve recruited having used the system for almost a decade.
• In the medical oncology realm, one important project focuses on a naturally occurring enzyme found in pancreatic cancer cells. This enzyme helps those cells survive, which helps the tumor persist. However, our team has found that a drug called ivosidenib may offer promise against this most deadly cancer. This drug is already used to treat cancer where the genetic code of the enzyme has mutated – just about 1 percent of cases. But our UH Seidman research shows that it may also work to combat the remaining 99 percent of cancers with an unmutated version of the gene.
• For certain surgery patients at UH Seidman Cancer Center, treatment involves surgery plus a form of heated chemotherapy. Patients who have colon or stomach cancer that has spread to the lining of the abdominal wall receive cancer-killing medicine directly to the abdominal cavity to destroy any leftover cancer cells. UH Seidman Cancer Center has one of the country’s largest teams of physicians with the expertise to provide this crucial treatment, known as HIPEC.

The road ahead

Cancer may be evolving, but so are we. From groundbreaking research on early-onset colorectal cancer to innovative treatments that push the boundaries of what’s possible, we’re fully committed to fighting this disease on every front.

It takes all of us. Beyond the research and highest-quality clinical care we provide, our Community Outreach team is constantly out in force at events all across our region, encouraging us all with a message of prevention and early detection. For so many, simply stopping smoking or getting a recommended colonoscopy can make a world of difference in a life that is disrupted by cancer and one that is not.

Personal responsibility to protect yourself against cancer always plays an important role. But rest assured, we also take our awesome responsibility as cancer caregivers and healers seriously.

We’re standing with our community in the fight against this formidable foe, and we’re always looking for new ways to defeat it, starting in the lab and ultimately for the patients we serve. When cancer rears its ugly head, we’ll be here – no matter when or how it strikes.”

Cliff A. Megerian is the Chief Executive Officer of University Hospitals in Cleveland. He is also a Professor in the Department of Otolaryngology, Head and Neck Surgery at Case Western Reserve University (CWRU) School of Medicine, where he served as Chair from 2012 to 2018.

Dr. Megerian held the Julius McCall Professorship at CWRU and the Richard and Patricia Pogue Endowed Chair in Auditory Surgery and Hearing Sciences at UH. Additionally, he is an Adjunct Professor of Surgery at Northeast Ohio Medical University. As a surgeon, he co-founded UH’s Cochlear Implant Program, performing over 1,500 cochlear implant surgeries with his team.