However, new research from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, presented at the annual meeting of the American Association for Cancer Research suggests that this type of diet may put non-smoking Americans under the age of 50 at greater risk of developing lung cancer.  

“Our research shows that younger non-smokers who eat a higher quantity of healthy foods than the general population are more likely to develop lung cancer,” said Jorge Nieva, MD, a medical oncologist and lung cancer specialist with USC Norris and lead investigator of the study. “These counter-intuitive findings raise important questions about an unknown environmental risk factor for lung cancer related to otherwise beneficial food that needs to be addressed.”  

Nieva and his fellow researchers speculate that this risk factor may be the pesticides used to keep crops pest-free. Commercially produced (non-organic) fruits, vegetables and whole grains are more likely to be associated with a higher residue of pesticides than dairy, meat and many processed foods, according to Nieva. He also notes that agricultural workers exposed to pesticides typically have higher rates of lung cancer, which adds credence to the theory.  

The study also showed that young women who don’t smoke have a higher incidence of lung cancer than men, and that women tended to also have a diet higher in produce and whole grains than men.  

A New Epidemic of Lung Cancer 

Lung cancer has typically been a disease that affects older adults (the average age of lung cancer onset is 71), men more than women, and smokers. 

Smoking rates have fallen since the mid-1980s, which has led to fewer lung cancer cases across the United States, except for one unique group — non-smokers age 50 and younger, especially women, who are now more likely to get lung cancer than men.  

To investigate this trend, researchers launched the Epidemiology of Young Lung Cancer Project, which surveyed 187 patients who were diagnosed with lung cancer by age 50. Patients provided details on demographics, diet, smoking history and lung cancer diagnosis.  

Most patients had never smoked and had a form of lung cancer biologically different from lung cancer caused by smoking. A 2021 study from the Epidemiology of Young Lung Cancer Project, the Genomics of Young Lung Cancer Project, found that the subtypes of lung cancer seen in people under 40 were distinct from lung cancer in older adults.  

Researchers used the Healthy Eating Index (HEI), a ranking of the overall quality of Americans’ diet on a scale of 1-100, to compare patients’ diets with the broader United States population. Young non-smoking lung cancer patients had an average HEI score of 65 out of 100, compared to the national average of 57. Among participants in the study, women had higher HEI scores than men. 

On average, the young lung cancer patients ate more daily servings of fruit, vegetables and whole grains than the general population. For example, participants averaged 4.3 servings of dark green vegetable and legumes and 3.9 servings of whole grains per day, while the average U.S. adult eats 3.6 servings of dark green vegetables and legumes and 2.6 servings of whole grains per day. 

More Research Needed 

The link between pesticides and lung cancer in young people, especially women, needs more research, said Nieva. 

In the study, researchers did not test specific foods for pesticides. Instead, they used published data on average pesticide levels for food categories such as fruits, vegetables and grains to estimate exposure. The next step, said Nieva, is to confirm the link by directly measuring pesticide levels in blood or urine samples from patients. This could also help reveal whether or not some pesticides increase lung cancer risk more than others. 

“This work represents a critical step toward identifying modifiable environmental factors that may contribute to lung cancer in young adults," said Nieva. “Our hope is that these insights can guide both public health recommendations and future investigation into lung cancer prevention.”  

The research is supported by the Addario Lung Cancer Medical Institute, a nonprofit focused on advancing lung cancer research and care, as well as AstraZeneca, the Beth Longwell Foundation, Genentech, GO2 for Lung Cancer and Upstage Lung Cancer.  

Researchers also received funding from the National Institutes of Health, grant number R25CA225513 and the National Cancer Institute, grant number P30CA014089. 

Immune checkpoint inhibitors, medications that allow the body’s own immune system, particularly cancer-fighting T-cells, to recognize, find and attack tumor cells, can help stop the recurrence of cancer in many parts of the body.  

However, these drugs are not usually effective on brain cancers like astrocytoma due to the blood-brain barrier — a tightly sealed layer of cells that acts as a protective boundary between the brain and the bloodstream. Because this barrier is so effective, it also limits the ability of immune cells, including cancer-fighting T-cells, to enter the brain and reach the tumor.  

But now, Keck Medicine of USC researchers may have discovered a way to break through this blood-brain barrier and make immune checkpoint inhibitors effective for patients with recurrent, high-grade astrocytoma, thus potentially extending patients’ lives.   

Stunning results 

In a Phase 1/2b clinical trial, investigators combined a minimally invasive procedure that uses laser heat to both destroy the tumor tissue and disrupt the blood-brain barrier, with a common immune checkpoint inhibitor drug, pembrolizumab. 

The results, published today in Nature Communications, were striking. Nearly half of patients treated with laser interstitial thermal therapy (LITT), followed by pembrolizumab were still alive at 18 months. In comparison, none of the patients who received a conventional treatment of surgery followed by pembrolizumab were alive at the 18-month-mark.  

In addition, more than one-third of patients treated with LITT and the immune checkpoint inhibitor lived more than three years, far exceeding the typical four-to-five-month survival for patients with recurrent high-grade astrocytoma. 

“These results suggest that LITT can help the immune checkpoint inhibitor pembrolizumab work more effectively against high-grade astrocytoma,” said David Tran, MD, PhD, chief of neuro-oncology with Keck Medicine, co-director of the USC Brain Tumor Center and lead author of the study. “Patients with this type of advanced cancer have few remaining options and poor outcomes, and this approach could meaningfully extend their survival time and provide new hope for patients and their loved ones.” 

How LITT breaks through the blood-brain barrier  

Tran and his colleagues based the study on their past research showing that the heat produced by LITT can disrupt the blood–brain barrier for several weeks, which is enough time for T-cells to detect and target cancer cells once they have been activated by an immune checkpoint inhibitor.  

During the trial, participants received either LITT or surgery/biopsy, then the pembrolizumab. For those receiving LITT, neurosurgeons used magnetic resonance imaging (MRI) to locate the tumor in the brain, guide the LITT probe into the tumor, then precisely deliver laser heat to the tumor. The heat destroys the tumor while surgeons work to ensure no healthy brain tissue is damaged; and as a side product, the heat disrupts the blood-brain barrier.  

Once patients receive the immune checkpoint inhibitor, this disruption allows tumor materials to slip past the blood-brain barrier and into the blood. “This alerts T-cells to the presence of the tumor and provides easy passage of these T-cells to rush in, find and attack the tumor,” said Tran.  

About the clinical trial  

Forty-five patients enrolled in the study. All trial participants were in their second recurrence of astrocytoma, with nearly 15% in their third recurrence, meaning the cancer was at a very advanced stage. 

The LITT plus pembrolizumab combination was found to be generally safe and well-tolerated. 

Since the trial began, the U.S. Food and Drug Administration has cleared LITT for treating certain brain tumors, and pembrolizumab has been approved for several cancers.  

Keck Medical Center of USC was one of the three clinical trial sites nationwide, alongside researchers from Washington University in St. Louis and the University of Florida.  

Other USC authors for the study include Son B. Le, PhD, assistant professor of research neurological surgery at the Keck School of Medicine of USC; Harshit Manektalia, MS, computational research scientist at the Keck School; and Dongjiang Chen, MD, assistant professor of research neurological surgery at the Keck School. 

In the majority of cases, the cancer disappeared after only three months of treatment, and almost half the patients were cancer-free a year later. 

“Traditionally, these patients have had very limited treatment options. This new therapy is the most effective one reported to date for the most common form of bladder cancer,” said Sia Daneshmand, MD, director of urologic oncology with Keck Medicine of USC and lead author of a study detailing the clinical trial results published in the Journal of Clinical Oncology. “The findings of the clinical trial are a breakthrough in how certain types of bladder cancer might be treated, leading to improved outcomes and saved lives.” 

How the drug delivery system works  

TAR-200 is a miniature, pretzel-shaped drug-device duo containing a chemotherapy drug, gemcitabine, which is inserted into the bladder through a catheter. Once inside the bladder, the TAR-200 slowly and consistently releases the gemcitabine into the organ for three weeks per treatment cycle.  

Traditionally, gemcitabine has been delivered to the bladder as a liquid solution that only stays in the bladder for a few hours, which had limited effect destroying the cancer, said Daneshmand, who is also a member of the USC Norris Comprehensive Cancer Center. 

“The theory behind this study was that the longer the medicine sits inside the bladder, the more deeply it would penetrate the bladder and the more cancer it would destroy,” he said. “And it appears that having the chemotherapy released slowly over weeks rather than in just a few hours is a much more effective approach.” 

The patient population in the clinical trial  

The clinical trial, known as the SunRISe-1, was conducted at 144 locations globally, including at Keck Hospital of USC. It included 85 patients with high-risk non-muscle-invasive bladder cancer.  

Non-muscle-invasive bladder cancer is the most common form of bladder cancer. The disease is considered high risk when, depending on the type and location of the tumors, the cancer carries a higher chance of recurrence and/or spreading to the bladder muscles or other parts of the body. 

The standard treatment for this type of bladder cancer is an immunotherapy drug, Bacillus Calmette-Guérin, which may be ineffective in a percentage of patients. All the patients in the clinical trial had been previously treated with this drug, but their cancer had returned.  

“The standard treatment plan for these patients was surgery to remove the bladder and surrounding tissue and organs, which has many health risks and may negatively impact patients’ quality of life,” said Daneshmand. 

To offer patients a better option, urologic oncologists treated patients with TAR-200 every three weeks for six months, and then four times a year for the next two years. In 70 out of 85 patients, the cancer disappeared and for almost half the patients, was still gone a year later. The treatment was well-tolerated, with minimal side effects.  

The study also showed that administering TAR-200 along with another immunotherapy drug (cetrelimab) did not prove as effective as TAR-200 on its own and had more side effects.  

While participants in the clinical trial will be followed for another year, the study is closed to new participants. 

The future of slow-release cancer drugs  

This clinical trial is one of several ongoing ones investigating the effect of TAR-200 and the slow release of cancer-fighting drugs into the bladder to fight cancer.  

“We are at an exciting moment in history,” said Daneshmand, who has been researching this novel treatment since 2016. “Our mission is to deliver cancer-fighting medications into the bladder that will offer lasting remission from cancer, and it looks like we are well on our way toward that goal.”  

The U.S. Food and Drug Administration has granted TAR-200 a New Drug Application Priority Review, which means the FDA plans to take quicker action on the application than other applications. 

The health care corporation Johnson & Johnson manufactures TAR-200.

The study involved 140 patients from the IGNYTE clinical trial, which included Keck Medicine and other sites worldwide. These patients had advanced melanoma that did not respond or stopped responding to immunotherapy, which uses the body’s own immune system to fight cancer.

Patients were treated with a genetically modified HSV-1 in combination with an immunotherapy (nivolumab). By the end of the clinical trial, one-third of the participants had their tumors shrink by at least 30%, and nearly one out of six patients had tumors completely disappear.

“These findings are very encouraging because melanoma is the fifth most common cancer for adults, and about half of all advanced melanoma cases cannot be managed with currently available immunotherapy treatments,” said Gino Kim In, MD, a medical oncologist with Keck Medicine and principal investigator at the Keck Medicine clinical trial site. Dr. In is also a member of the IGNYTE trial steering committee and one of the lead investigators on the trial. “The survival rate of untreatable advanced melanoma is only a few years, so this new therapy offers hope to patients who may have run out of options to fight the cancer.”

A novel class of drugs to fight cancer

The genetically modified HSV-1 evaluated in the study, RP1, is one of a relatively new, innovative class of cancer immunotherapy drugs known as oncolytic viruses that are designed to target and destroy cancer tumors while generating an anti-tumor immune response throughout the entire body. RP1 does not cause herpes.

In January 2025, the U.S. Food and Drug Administration granted priority review to RP1 with nivolumab for patients with advanced melanoma whose cancer had not responded to prior immunotherapy.

When injected into a tumor, RP1 replicates, killing off the cancer cells while leaving healthy cells unharmed. Additionally, RP1 stimulates the body’s white blood cells to seek out and destroy any other cancer cells in the body.

The second cancer drug used in the study, nivolumab, is a standard immunotherapy treatment in fighting advanced melanoma and other cancers that have spread through the body. Researchers theorized that nivolumab, which works by using the body’s own immune system to fight and destroy cancer cells, would enhance the potential effect of RP1.

How the treatment was administered

Patients admitted into the study had already been treated with minimal success by one or more immunotherapy therapies and had to have more than one tumor that could be injected with RP1. Some tumors were considered “superficial” — meaning visible on the skin, or just below the skin’s surface — and some were located deeper in the body, such as in the liver or lungs. Researchers injected both superficial and deep tumors with RP1.

Encouraging Findings  

During the clinical trial, patients were given a combined therapy of RP1 and nivolumab every two weeks for up to eight cycles. If patients responded to the treatment, they continued on nivolumab alone every four weeks for up to 30 cycles (or two years).

Researchers measured both treated tumors and untreated tumors. They discovered that not only did injected tumor size shrink in one third of the patients by 30%, but that patients’ uninjected tumors also shrank or even disappeared, just as frequently and as deeply.

“This result suggests that RPI is effective in targeting cancer throughout the entire body and not just the injected tumor, which expands the potential effectiveness of the drug because some tumors may be more difficult or impossible to reach,” said Dr. In, who is also a member of USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC.

The study also found that RP1 was well-tolerated and had a favorable safety outcome.

While it is too soon to tell if the positive outcomes remain permanent, Dr. In is optimistic about the future of RP1 therapy. “I believe that oncolytic viruses will open up an important new approach to fighting cancer in some patients in the near future,” he said.

Other clinical trial researchers include Phillip M. Cheng, MD and Ali Rastegarpour, MD, diagnostic radiologists with Keck Medicine.

Phase 3 clinical trial now open

Phase 1-2 of the IGNYTE clinical trial examined the safety, side effects, best dosing and effectiveness of administering RP1 along with nivolumab on a limited patient population. Dr. In and his fellow researchers have launched the phase 3 trial, known as IGNYTE-3, to confirm their findings in a global population of more than 400 participants.

Keck Medicine will again be one of the sites of the clinical trial, with Dr. In heading up the site. Patients interested in participating can contact Sandy Tran at sandy.tran@med.usc.edu.

Replimune, a manufacturer of RP1 and other oncolytic immunotherapies, is the sponsor of the IGNYTE clinical trial

Disclosure: In Dr. In’s role as a member of the steering committee for the IGNYTE clinical trial, he has served on advisory boards for the sponsoring company and received honoraria.

The study, published today in Cancer Research Communications, showed that high doses of steroids, when given before and/or during a specific type of immunotherapy, caused patients’ tumors to shrink less than those of patients not on steroids. Those patients also did not live as long. 

“Steroids were the biggest predictor of why certain immunotherapies may not be effective, even when considering multiple other factors such as stage and progression of the disease,” said Keck Medicine oncologist and immunologist Fumito Ito, MD, PhD, lead author of the research. 

Additionally, researchers believe they have found the mechanism behind why steroids and some immunotherapies may not mix.  

“Our findings reveal that steroids stop the body’s natural cancer-fighting cells, T-cells, from maturing. This makes them unable to attack the cancer as vigorously as they usually would, leading to worse outcomes for patients,” said Ito, who is also a member and co-leader of the translational and clinical sciences research program at USC Norris Comprehensive Cancer Center. “While other research has indicated steroids may negatively impact immunotherapy’s efficacy, we are one of the first to pinpoint a probable cause and effect.”  

Ito and his colleagues also discovered that steroids blocked circulating biomarkers in the body — bits of cells in the bloodstream that signal when cancer is progressing so oncologists can adjust the patient’s treatment. 

“Without the presence of circulating biomarkers to inform our decisions, oncologists cannot treat the cancer as effectively and patients may miss out on the best treatment for their cancer,” said Ito. 

Two competing medications 

The study examined the effect of steroids on a type of immunotherapy known as immune checkpoint inhibitors (ICIs). ICIs help the body's immune system fight cancer by blocking proteins that prevent T-cells from attacking cancer cells. ICIs are often used to treat non-small cell lung cancer, the most common form of lung cancer. 

Steroids are often prescribed to alleviate symptoms of the cancer or treatments given for a variety of reasons, such as fatigue and vomiting, or more serious side effects like brain swelling and lung inflammation. Steroids suppress the immune system, which reduces the inflammation that can cause these conditions. 

How the studies were conducted  

Ito and fellow researchers retrospectively studied the medical records of 277 patients with Stage II-IV non-small cell lung cancer who were treated with ICIs alone or in combination with other therapies. They compared outcomes (tumor shrinkage and survival rate) between patients prescribed steroids and those who were not at three centers, including USC Norris Comprehensive Cancer Center.  

They analyzed up to eight years of data to determine that steroids were the sole factor impeding the effectiveness of the immunotherapy.  

They also determined that the T-cells of significant numbers of patients on steroids were not fully matured and launched a preclinical study using mice to observe the effects of steroids on ICI therapy in real time. This mouse model study led to the discovery that steroids given before/during immunotherapy inhibit T-cells from fully maturing.  

The future of steroids  

While the Keck Medicine research indicates steroids can interfere with ICIs, Ito acknowledges that for some patients, steroids may be necessary to manage their cancer-related symptoms.  

“We know that steroids will continue to play an important role in lung cancer care, but it is important to understand their potential limitations,” said Ito. “Each patient should talk to their oncologist to make sure they have the best possible care plan tailored to their specific needs.”  

He hopes this research will lead to more studies examining the effect of steroids on immunotherapy so oncologists can make fully informed decisions that will best benefit their patients.  

Other study authors include Keck Medicine medical oncologists Jorge Nieva, MD and Robert Hsu, MD. 

The study was supported with grants from the National Cancer Institute, P30CA016056 (RPCCC), P30CA014089 (USC), K08CA197966, R01CA255240, R01CA272827 (F. Ito), R01CA188900, R01CA267690 (B.H. Segal) as well as the Department of Defense Lung Cancer Research Program and the Uehara Memorial Foundation.  

As the newest addition to the renowned academic health system, the location will significantly expand Keck Medicine clinical care for residents of Pasadena and neighboring communities in the San Gabriel Valley.  

What sets the new Pasadena location apart  

“This new location — our largest and most advanced outpatient setting — will bring even more of our research-based clinical care to the Pasadena area, where many of our patients live and work,” said Rod Hanners, CEO of Keck Medicine. “The new location offers state-of-the-art technology and access to acclaimed specialists who translate medical discoveries into groundbreaking treatments and cures.” 

Patients will have access to the same expert physicians who treat patients at Keck Medical Center of USC, including researchers and doctors from USC Norris Comprehensive Cancer Center, one of the nation’s top comprehensive cancer centers designated by the National Cancer Institute; the esteemed USC Cardiac and Vascular Institute; and the nationally recognized USC Orthopaedic Surgery team, the official orthopedic medical services providers for USC Athletics and the LA Kings. 

The building will provide an airy, nature-filled environment designed to promote well-being. Each of the location’s four floors will be suffused with light from floor-to-ceiling windows, showcasing views of the San Gabriel Mountains. 

Convenient access to comprehensive services  

The location will feature a wide range of services including: 

• Autoimmune diseases care, such as rheumatology (rheumatoid arthritis and lupus), allergy/immunology, and autoimmune skin conditions (psoriasis and scleroderma)
• Cardiovascular care  
• Comprehensive oncology care  
• Infusion therapy 
• Orthopedics and spine care 
• Outpatient imaging  
• Outpatient surgery  
• Pain management 

“The new Pasadena medical office building doubles down on our commitment to the health of our community, allowing patients to visit one location for a variety of health care needs while providing access to the high-quality care only an academic health system can offer,” said Smitha Ravipudi, MPH, CEO of USC Care Medical Group and CEO of Keck Medicine ambulatory care services.  

Location complements existing Pasadena office 

In addition to the new location, Keck Medicine will continue to treat patients at the existing Keck Medicine of USC - Pasadena building located at 625 S. Fair Oaks Ave., Suite 400 with an expanded range of primary care services, including an emphasis on digestive and metabolic health; brain health and aging; and advanced ear, nose and throat and ophthalmology services.  

Keck Medicine is one of only two university-based health systems in the Los Angeles area. Keck Medical Center of USC, which includes Keck Hospital of USC and USC Norris Cancer Hospital, is among the top 50 hospitals in the country in eight specialties, as well as the top three hospitals in metro Los Angeles and top 10 hospitals in California, according to U.S. News & World Report’s 2024-25 Best Hospitals rankings.  

LOS ANGELES — USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, has opened Keck Medicine of USC – Newport Beach Radiation Oncology and Imaging, a state-of-the-art radiation oncology and imaging center, at 4590 MacArthur Blvd. in Newport Beach.  

The 12,500 square-foot clinical space houses new-to-market imaging and radiation therapy technology in a serene, beach-inspired space designed to help patients feel at ease.  

“Our new radiation oncology and imaging center demonstrates our ongoing commitment to providing Orange County with world-class care,” said Rod Hanners, CEO of Keck Medicine. “We recognize the importance of keeping cancer care close to home and are proud to expand our presence in the community.” 

The center is equipped with positron emission tomography – computed tomography (PET-CT) imaging and computed tomography (CT) scanners for diagnosis, treatment simulation and monitoring, as well as two state-of the-art linear accelerators to deliver precision radiation therapy treatment.  

Keck Medicine of USC – Newport Beach Radiation Oncology and Imaging will be the first clinical site in Orange County, and just the third in California, to offer SCINTIX^® biology-guided radiation therapy (BgRT) using the new-to-market RefleXion^® X1 system.  

Unlike other types of radiation therapy that use static images of a patient’s anatomy to map treatment areas, BgRT is the first and only radiation therapy delivery modality that uses a PET radiotracer compound that, once injected into the body, interacts with cancer cells to send up-to-the-minute “signals” about the location of cancer cells, even as the patient breathes or moves slightly. This helps radiation oncologists track, target and treat cancer cells in real time while minimizing damage to healthy cells, which may alleviate some of the side effects of radiation.  

BgRT also eliminates the need for placing markers (tiny metal objects positioned inside the patient in or near cancerous tissue to identify where to deliver treatment), as well as enables radiation oncologists to more efficiently treat multiple tumor locations in the same course of therapy.  

BgRT recently received breakthrough device designation from the U.S. Food and Drug Administration for treating lung tumors and is currently approved for certain patients with lung and bone tumors. 

Keck Medicine will install a second X1 system with BgRT at a medical facility in Pasadena opening later this year. It will be the first university-based academic institution to offer BgRT at multiple locations, bringing new cancer treatment options for the Los Angeles area, Orange County and surrounding communities. 

“This groundbreaking technology enables us to provide the best possible care and offer treatment for patients whose options may be very limited,” said May Lin Tao, MD, radiation oncologist and director of clinical operations, regional radiation oncology clinics, with Keck Medicine. Tao is also clinical associate professor of radiation oncology with the Keck School of Medicine of USC. “We are thrilled to be the first to offer this revolutionary and potentially life-saving treatment to patients in Orange County.” 

Keck Medicine of USC – Newport Beach Radiation Oncology and Imaging is less than 15 minutes away from USC Norris’ oncology locations in Newport Beach and Irvine, where patients can make appointments with respected medical oncologists who have served Orange County for decades, and who treat more medical oncology outpatients in Newport Beach than any other provider.  

“This new location expands our spectrum of cancer services in Orange County, ranging from diagnostic imaging to multiple treatment options that optimize outcomes and provide personalized radiation medicine,” said Eric Chang, MD, radiation oncologist with Keck Medicine and chair and professor of radiation oncology with the Keck School.  

As one of the eight original National Cancer Institute-designated Comprehensive Cancer Centers in the United States, USC Norris has revolutionized cancer treatment, research and prevention for 50 years. In 2024-25, U.S. News & World Report ranked USC Norris Comprehensive Cancer Center among the top 25 cancer centers nationally and recognized USC Norris Cancer Hospital as a Best Specialty Hospital. 

“The addition of this new location means so much for our patients and their loved ones,” said Louis Vandermolen, MD, medical oncologist with USC Norris Comprehensive Cancer Center, practicing in Newport Beach. “Our convenient location near our medical oncology offices means that our patients can truly benefit from multidisciplinary, collaborative care from doctors they know and trust.” 

To make an appointment at Keck Medicine of USC – Newport Beach Radiation Oncology and Imaging, call (949) 507-6700 or visit KeckMedicine.org/OCRad to learn more. 

USC Norris opened the new facility in collaboration with Advanced Radiotherapy Technologies (ART Health), a leading developer of radiotherapy centers. ART Health is a division of Kingsbarn Realty Capital, a national investment manager.  

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LOS ANGELES — Steam eliminates wrinkles and germs, but can it destroy cancer cells too?  

Keck Medicine of USC is participating in a national, multisite clinical trial examining if a water vapor system that uses small, targeted amounts of steam to kill cancer cells is a safe and effective treatment for prostate cancer. 

Researchers hope that steam may offer patients a less invasive way of controlling or curing cancer than currently exists.  

“The most common therapies for prostate cancer often cause life-altering side effects, and we are investigating if this new treatment may not only treat the cancer, but offer our patients overall better quality-of-life outcomes,” said Andre Abreu, MD, a Keck Medicine urologist and lead investigator of the Keck Medicine clinical trial site. Abreu also leads focal therapy and artificial intelligence efforts for prostate cancer with USC Urology. 

Who may benefit from the trial   

The clinical trial is designed for patients with intermediate-risk prostate cancer, meaning that the tumor is localized in the prostate gland and has not spread to other organs. This type of cancer accounts for approximately one-third of all localized prostate cancers, according to Abreu. 

Some patients with prostate cancer may not need any treatment if the cancer is small enough and slow growing. However, when treatment is necessary, traditionally, physicians have treated patients with either surgery or radiation.  

These techniques are generally effective in treating the cancer, however, there can be side effects. The prostate is located in between the bladder, the urethra (a duct that transports urine from the bladder) and the rectum. It is surrounded by numerous nerves responsible for penile erections and the muscle that controls urine flow, the urinary sphincter. During surgery or radiation, there is a risk of injuring healthy tissue along with the cancer and damaging the delicate structures that lie next to the prostate.  

The most common side effects of surgery and radiation are impotence, urinary incontinency and bowel dysfunction. 

“While patients are happy to be free of cancer, the costs of the cure are very high,” said Abreu. “There is a growing amount of literature in the field suggesting that select patients could benefit from a procedure with fewer risks that allows them to maintain their quality of life after cancer.” 

How steam might fight cancer 

Heat is one therapy to help damage and kill cancer cells, according to the National Cancer Institute. Steam offers a targeted way to deliver heat into the body, according to Abreu.  

Before the procedure, physicians use magnetic resonance imaging (MRI) to locate the tumor cells in the patient’s prostate. During the procedure, doctors use an ultrasound and prostate mapping to guide a thin catheter through the patient’s urethra and into the area of the prostate where the tumor is located.  

Once the catheter is positioned, a fine needle is deployed in the tumor. Doctors then release a quick, targeted 10-second burst of steam from the needle, and more bursts as needed, to destroy the tumor.  

“This procedure is thought to be much gentler on the body than traditional therapies and is designed to target the cancerous tissue within the prostate,” said Abreu. “We are exploring if steam may be effective at destroying cancer cells without damaging the surrounding organs.”  

Another potential advantage to the investigational therapy is that unlike surgery, which requires an overnight stay in the hospital, the water vapor therapy is an outpatient procedure. And unlike radiation, which usually involves multiple sessions, the water vapor therapy is designed to work using only one application. 

Clinical trial details  

The clinical trial is being conducted at up to 30 hospitals and health centers across the nation. So far, more than 180 procedures have been completed. 

Keck Hospital of USC is the only Los Angeles area site participating in the study. Patients’ post-treatment cancer outcomes will be followed for five years.  

The study is sponsored by Francis Medical, Inc., a privately held medical company that developed the device being used, the Vanquish^® Water Vapor Ablation System.  

The water vapor ablation system is one of several minimally invasive treatments for prostate cancer either already in use or being developed within the field of urology.  

“Over the next decade or so, we hope to see innovative therapies revolutionize how we help patients become cancer-free while maintaining their quality of life,” said Abreu.  

Dr. Abreu declares no conflict of interest with the sponsor.

However, the majority of American adults are unaware that HPV can cause throat cancer and are not taking advantage of the one proven method for prevention — the HPV vaccine.  

These are the conclusions of two recent studies from the USC Head and Neck Center, part of Keck Medicine of USC and the USC Caruso Department of Otolaryngology – Head and Neck Surgery, that examined public knowledge of the link between HPV and throat cancer and HPV vaccination rates among adults, respectively.  

The research suggests that less than one-third of Americans associate HPV with throat cancer and less than 7% of adults eligible for the vaccine have completed the full course of the HPV vaccine, which is three doses for adults.  

“This data is very worrisome because knowledge is the first step toward disease prevention,” said Daniel Kwon, MD, a head and neck surgeon with Keck Medicine and lead author of a study examining trends in HPV vaccination rates for adults. “The public is missing crucial information about the link between throat cancer and HPV, as well as the fact that vaccines may prevent HPV-related throat cancer.”  

The need for greater HPV-related throat cancer awareness  

Each year, some 43 million Americans are infected with HPV, and most sexually active adults will contract HPV at some time in their lives. Most HPV infections are asymptomatic and resolve on their own. However, in some cases, the infection can lead to cancer, including throat cancer.  

In 2006, an HPV vaccine was made available to females ages 9-26, then expanded to males ages 9-26 in 2009. In 2018, the vaccine was expanded to adults ages 27-45. While HPV vaccination for this older group may provide less benefit because most have already been exposed to HPV, there still may be benefits of vaccination, according to the Centers for Disease Control and Prevention (CDC).   

To determine public awareness of HPV-related throat cancer, Dr. Kwon and fellow researchers compared data between the 2018 and 2020 iterations of the National Cancer Institute Health Information National Trends Survey, which tracks Americans’ knowledge about cancer and health information related to cancer.  

They focused on adults ages 27-45, who were newly eligible for the vaccine in 2018, to see how much of an impact the expansion of eligibility had on knowledge of HPV and throat cancer.  

Study authors compared data from 3,504 adults in the 2018 survey with data from 3,865 adults in the 2020 survey assessing people's knowledge of HPV, the vaccine, the link between HPV and throat cancer and changes in awareness between 2018 and 2020.  

While they found that most respondents were aware of HPV in both years studied, they were disappointed to discover that knowledge of the connection between HPV and throat cancer remained poor. In 2018, 27% of respondents reported they were aware of the link between HPV and throat cancer; in 2020, that number barely moved upward to 29.5%.  

“These results are particularly disheartening because since the vaccine eligibility was expanded in 2018, health advocates have issued many guidelines and recommendations about HPV and throat cancer,” said Kwon. “Clearly, more efforts are needed to educate the public about this risk.”  

Cervical cancer used to be the most widespread HPV-related cancer, but cervical cancer rates have declined through concerted efforts of the health care industry, according to Kwon. “HPV-related cervical cancer cases have decreased in large part due to successful HPV awareness campaigns targeting women,” he said. He also notes that women get screenings for cervical cancer through regular Pap smears, but there is no screening available for throat cancer.  

He emphasized the need for more education about the risk of HPV and throat cancer in men, as throat cancer affects men at a higher rate than women, he added. 

Investigating HPV vaccination rates 

In a second study, researchers from the USC Head and Neck Center examined HPV vaccination rates among a nationally representative cohort of more than 26,000 adults ages 30-44 who completed questions on HPV vaccination from 2018-2022 through the Behavioral Risk Factor Surveillance System survey, a nationwide telephone survey conducted by the CDC. 

The authors discovered that only 6.5% of those surveyed were fully vaccinated, and only 15.8% had completed any HPV vaccination.  

Many factors play into the low HPV vaccination rate, according to the lead author of the study, Niels Kokot, MD, a head and neck surgeon with Keck Medicine. He cites not only a lack of general knowledge of the link between HPV and cancer, but also a lack of advertising about the HPV vaccine in comparison to other well-publicized campaigns such as for the flu or COVID-19 vaccines and growing vaccine hesitancy in the United States.  

Socioeconomic status, race, education level, access to health care, sexual orientation and gender also play roles in who is getting vaccinated, he added, with men, Asian Americans, African Americans, Hispanics and those not having a personal health care provider among those less likely to be vaccinated.  

Kokot hopes these findings will help spur greater public education on the HPV vaccine. He also recommends that any eligible adult who has not yet been vaccinated talk to a health care provider about vaccinations. “Every patient’s circumstances are different, and the subject is worth a discussion to see if an individual would benefit from the vaccine,” he said.  

Besides cervical and throat cancer, HPV can also cause anal, penile, vaginal and vulvar cancers. Learn more about HPV and cancer here.  

The study also reports that the number of suicide deaths in the AYA male cancer survivor group (ages 15-39) increased three-fold during the 21-year-study period. In 2021, one in 65 deaths among the group was attributed to suicide. Suicide deaths have also increased for other cancer survivor groups, but the gap in suicide rates between young men and other populations significantly widened over time.

Cancer is becoming more common among young people, and cancer survivors are more likely to struggle with anxiety, depression and thoughts of suicide, according to the American Cancer Society and the National Comprehensive Cancer Network. This study, one of the first to examine suicide rates by gender for AYA patients with cancer, characterized the increasing suicide rate among this population as alarming.

Researchers used data from the National Cancer Institute’s Surveillance, Epidemiology and End Results Program to assess some 4.5 million deaths among cancer survivors between 2000-2021. A cancer survivor is defined as anyone who has ever been diagnosed with cancer, no matter where they are in the course of their disease. 

They then divided the data according to three age groups: ages 15-39, 40-59, and sixty-plus, and further divided each group by males or females.

The study found that in 2000, 4.9 deaths per 1,000 deaths of male AYA cancer patients were caused by suicide and the suicide rates for all other age/gender cancer patient groups ranged from 0.4 to 3.1 per 1,000 deaths.

Nearly two decades later in 2021, the number of suicide deaths per 1,000 deaths for male AYA cancer patients mushroomed to 15.4. While the rates of suicide deaths for all other age/gender cancer patient groups also increased, the rates were much lower than that of the male AYA cancer patients, ranging from 0.6 to 7.4 per 1,000 deaths.

In other findings, researchers determined that thyroid cancer, testicular cancer and melanomas of the skin were the three most common cancer diagnoses leading to suicide among male AYA cancer patients. According to the American Cancer Society, these three cancers are among those with the highest five-year-survival rates. Researchers did not have access to certain information about the patients, such as mental health status before cancer diagnosis, the reason or method of suicide death, patients’ cancer prognoses, and status of the cancer, such as disease recurrence or remission, at the time of death.

However, despite these limitations, the study authors believe that their findings warrant a call for attention focused on the suicide rate of AYA patients, specifically males. They recommend that AYA cancer patients be provided with more long-term support and resources that could potentially reverse this trend. 

Resources 

Keck Medicine provides support for its young cancer patients through The Adolescent and Young Adult Program at USC, which offers cancer patients ages 15-39 supportive care, advocacy, support groups, events and other resources to improve their health outcomes and quality of life.

National resources for young cancer survivors include: 

• Guidelines and support for AYA patients from the National Comprehensive Cancer Network
• Resources for AYA patients from The American Cancer Society

For anyone with thoughts of suicide, the National Institute of Mental Health’s suicide prevention resources and suicide lifeline can help.

The new location address is 4590 MacArthur Blvd. in Newport Beach, less than 15 minutes away from USC Norris’ oncology centers in Newport Beach and Irvine. Those centers are staffed by respected oncologists who have served Orange County for decades, and who treat more medical oncology outpatients in Newport Beach than any other providers.  

“We are excited to build upon USC Norris’ well-established, robust cancer practices in Orange County and broaden our spectrum of services,” said Louis Vandermolen, MD, medical oncologist with USC Norris Oncology/Hematology. “Our radiation oncology and imaging center is a testament to our continued commitment to offer world class, comprehensive cancer services for patients without having to leave the local community.” 

As one of the eight original National Cancer Institute-designated Comprehensive Cancer Centers in the United States, USC Norris has revolutionized cancer treatment, research and prevention for 50 years. In 2024-25, U.S. News & World Report ranked USC Norris Comprehensive Cancer Center among the top 25 cancer centers nationally and recognized USC Norris Cancer Hospital as a Best Specialty Hospital. 

USC Norris is collaborating on their new Newport Beach facility with Advanced Radiotherapy Technologies (ART Health), a leading developer of radiotherapy centers. ART Health is a division of Kingsbarn Realty Capital, a national investment manager.  

However, a new Keck Medicine of USC study in Leukemia Research suggests that a bone marrow transplant from a haploidentical, or half-identical relative, may greatly increase patients’ odds of success, in addition to being easier to find. Parents and children are guaranteed half-matches, while siblings have a 50% chance of being half-matches, which is twice as likely as finding a fully matched sibling (25%).

The study retrospectively assessed outcomes from 88 patients with B-cell ALL (an aggressive type of leukemia wherein the body overproduces abnormal white blood cells called B-lymphocytes) who underwent a bone marrow transplant at USC Norris Comprehensive Cancer Center, part of Keck Medicine. Bone marrow donors included fully matched sibling donors, fully matched unrelated donors identified through the national donor registry, and half-matched donors from the patient’s family. The study assessed patient outcomes after two years following transplantation.

Patients who received their transplant from a half-identical relative were about 70% more likely to avoid relapse than those who received a bone marrow transplant from a fully identical relative.

Compared to patients who received a bone marrow transplant from an identically matched registered donor, half-identical relative transplant recipients were more than twice as likely to avoid both relapse and graft versus host disease, a debilitating condition wherein the body rejects the transplanted stem cells.

“These results suggest that Hispanic patients may benefit more from receiving a bone marrow transplant from a half-matched parent, child or sibling, rather than a full match from the national donor registry,” said George Yaghmour, MD, a hematologist with USC Norris Comprehensive Cancer Center and lead author on the study. “This creates opportunities for patients to receive a life-saving procedure that may otherwise be out of reach.”

Finding a Perfect Match

Prior to receiving a bone marrow transplant, potential recipients must first find a donor with a matching human leukocyte antigen (HLA) tissue type. HLAs are proteins on cells that act like a signature or passcode for the immune system. When white blood cells find foreign cells with an unfamiliar HLA type, it triggers an attack response. To ensure that a patient’s immune system accepts the new bone marrow stem cells, doctors aim to find a donor with the closest possible match for the patient.

Because HLA tissue type is inherited, patients often look first to immediate family members as potential donors. Unrelated matched donors may be available through the National Marrow Donor Program (NMDP), which manages the largest registry of potential bone marrow donors.

Despite the size of the NMDP registry, certain ethnic backgrounds have more difficulties finding a match due to being underrepresented in the registry. While white patients have a 79% chance of finding a match through the registry, Hispanic patients are only 48% likely to find a match.

Hispanic patients have a higher incidence of ALL compared to white patients, and often present with higher-risk disease characteristics that are associated with more challenging outcomes and require complex care. This makes finding a bone marrow donor all the more crucial.

New Opportunities with Half-Identical Donors

Bone marrow transplants from half-identical family members have been performed more frequently due to the challenges in finding a fully matched donor, as well as due to treatment advances that help the body accept the new cells despite not having a fully matched HLA type.

Yaghmour hopes the study results will inspire larger clinical trials to further investigate the findings and provide insight as to why bone marrow transplants from half-identical relatives result in positive outcomes, particularly among patients with high-risk subtypes of ALL.

 “These findings are a strong basis to continue researching the clinical benefits of haploidentical bone marrow donation, particularly among patient groups with historically limited access to fully matched donors,” said Yaghmour, who is also the associate director of transplant and cellular therapy with USC Norris and an associate professor of clinical medicine at the Keck School of Medicine of USC. “Future studies can potentially address health disparities while optimizing outcomes, and ultimately provide more hope for all patients facing this difficult diagnosis.”

Immunotherapy, medicines that use the body’s immune system to eliminate or control cancer cells, are effective for many cancer patients, but are currently only administered intravenously (into the vein) in a doctor’s office or hospital. 

The study will examine if a new formulation of atezolizumab, an immunotherapy approved for treating certain types of non-small cell lung cancer, can instead be safely and effectively administered subcutaneously, meaning it is injected under the patient’s skin, by a nurse at the patient’s home, along with telemedicine appointments and remote monitoring through wearable trackers.  

This will be the first clinical trial to test at-home administration of subcutaneous immunotherapy and could potentially lay the foundation for the future of at-home cancer care. 

“Many types of drugs are now being delivered subcutaneously at home for several conditions, and we hypothesize that this method of drug delivery can also be successful for cancer patients,” said Jorge Nieva, MD, a medical oncologist and lung cancer specialist with Keck Medicine, a member of USC Norris Comprehensive Cancer Center and lead investigator of the clinical trial. “Additionally, since COVID-19, we’ve learned that physicians have the digital tools to provide patients with excellent remote care.” 

The benefits of at-home treatment 

Lung cancer is the second most diagnosed cancer in the world and the leading cause of cancer deaths for both men and women worldwide. Non-small cell lung cancer accounts for 81% of all lung cancer cases in the United States.  

Immunotherapy is a relatively new treatment option that has been approved to treat many cancer types both on its own or in combination with other therapies, such as radiation and chemotherapy.  

Nieva believes that moving immunotherapy from a medical setting to the home will benefit patients. Patients will save time and energy traveling to a clinic or doctor’s office, which can be especially difficult for those who are very sick, and they may feel more relaxed in their own homes. This could also potentially expand access to cancer treatment to patients who live in more remote areas or lack reliable access to transportation. 

Delivering the drug under the skin rather than through an intravenous line (IV) has advantages as well.  

“The procedure is easier and faster to administer and less likely to cause infection or complications, and patients avoid the potential discomfort of being stuck with a needle several times in the attempt to find a suitable vein for the IV,” said Nieva.  

Nieva was motivated to research at-home cancer treatments during the COVID-19 pandemic when a patient who was afraid of catching the virus died after he stopped going into the hospital for his cancer treatments. 

“I realized we had to change the delivery of cancer care,” said Nieva.  

Clinical trial will use an immunotherapy consisting of monoclonal antibodies 

The drug used in the clinical trial, atezolizumab, consists of a monoclonal antibody, a man-made protein that triggers the immune system to attack cancer cells. It was approved by the Food and Drug Administration in 2016 for late-stage lung cancer and more recently in 2021, for early stage, non-small cell lung cancer. 

Investigators aim to enroll 37 patients with non-small cell lung cancer who are deemed eligible to receive immunotherapy as treatment. Patients will receive treatments administered by a nurse who will visit their home every three weeks for one to two years.  

Additionally, Nieva and his colleagues will use the latest digital tools to track patients’ vital signs, physical activity and other markers of health remotely and monitor patients with telehealth visits.  

The study will not only examine the feasibility of home administration of the medication, but how well patients comply with the program and how satisfied they are with being treated remotely and through telehealth appointments. 

Nieva hopes that the clinical trial will not only benefit patients with non-small cell lung cancer, but other cancer patients as well. 

“Increasingly, health care is moving in a direction where instead of patients going to us for services, we are able to come to them, increasing access to care and potentially addressing existing health care disparities,” said Nieva. “If this study can show that at-home cancer immunotherapy is safe and feasible for non-small cell lung cancer, it will open the door for more home treatments for other types of cancers in the future.” 

To learn more about the criteria to participate in the clinical trial, click here. Those who are interested in participating in the trial may contact Sandy Tran at (323) 865-3935 or sandy.tran@med.usc.edu.  

The sponsors of the clinical trial are the National Cancer Institute (NCI), grant number ML43326, and Genentech, Inc. 

The study will investigate if chemotherapy followed by a novel type of surgery to remove the cancer is a safe and effective option for patients with locally advanced pancreatic cancer, meaning that the cancer has not spread to other organs, but has grown into or close to nearby blood vessels that surround the pancreas. 

“Usually, these types of tumors cannot be safely removed with surgery because of the risk of damaging the blood vessels, which supply blood to the stomach, liver and other abdominal organs. However, due to recent advancements by Keck Medicine surgeons, we believe that patients with locally advanced cancer can be candidates for successful surgery, which could significantly improve outcomes,” said Steven Grossman, MD, PhD, co-lead investigator of the study. Grossman is a medical oncologist with Keck Medicine and deputy director for cancer services at USC Norris Comprehensive Cancer Center, part of Keck Medicine.  

The challenge of treating pancreatic cancer 

Pancreatic cancer accounts for only about 3% of cancers in the United States, but it is one of the deadliest. People usually have no symptoms until the cancer has become very large or metastasized throughout the body, so the cancer is caught late, and patients have poor prognoses.  

Only 13% of pancreatic cancer patients survive five or more years after diagnosis.  

The life expectancy of patients with locally advanced pancreatic cancer, which accounts for one third of all pancreatic cancer cases, has historically been about one year.  

For most forms of cancer, surgery is considered the most effective treatment for localized tumors that have not spread to other areas of the body. However, surgery has traditionally not been offered for tumors involving the blood vessels near the pancreas because if the blood vessels were to become damaged during the procedure, and the blood flow to organs interrupted, it could result in serious side effects or death.  

Therefore, typically the only treatment option for patients with locally advanced cancer is chemotherapy and/or radiation, both of which have limited effectiveness killing pancreatic cancer cells.  

“The situation is frustrating because research shows that in the rare cases where locally advanced tumors were safely removed, the progression of the disease was slowed and the patient’s length of survival on average increased from one year to 28 months, more than doubling life expectancy,” said Sandra Algaze, MD, a medical oncologist with Keck Medicine, a member of USC Norris and one of the study’s investigators. “Surgery, therefore, appears to strongly benefit a patient’s survival rate, which is why the medical field has been eager for a surgical solution.”  

How new surgical advances can benefit patients  

The clinical trial will use surgical protocols pioneered by Keck Medicine surgeons to safely remove locally advanced pancreatic tumors attached to arteries. The surgical team will be led by study co-lead investigator Yuri Genyk, MD, a hepatobiliary and pancreatic surgeon with Keck Medicine who is an expert in vascular reconstruction, which is the removal and reconstruction of blood vessels. Genyk has already successfully removed about 30 pancreatic tumors that were attached to adjacent arteries.  

“While this surgery is very complex, we have the skills and expertise to execute it and train other skilled surgeons in the procedure. If the trial results are positive, we envision that the technique could become the gold standard for how this stage of pancreatic cancer is treated in the future,” said Genyk. 

Patients in the clinical trial will first undergo chemotherapy to attempt to shrink the tumor. Two to eight weeks after completing chemotherapy, they will undergo a laparoscopic evaluation to determine the position and size of the tumor before the tumor is surgically removed and involved blood vessels are removed and reconstructed. 

Patients will be followed every three months for the first year post-surgery and then every six months for two years after that.  

The clinical trial will also examine if certain biomarkers, such as the tumor’s DNA, as well as a patient’s demographic factors such as age and gender, play a role in patient outcomes. 

The study hopes to enroll 20 patients with locally advanced pancreatic cancer who have evidence of arterial involvement by their tumors. The surgeries will be performed at Keck Hospital of USC.  

“Pancreatic cancer is a devastating diagnosis, and Keck Medicine is committed to finding better solutions for the disease,” said Grossman. “Anything we can do to improve patients’ quality of life and extend life expectancy will be a huge milestone that could benefit countless patients and their loved ones.” 

Those interested in participating in the study can contact: Charlean Ketchens, RN, at (323) 865-3035 or ketchens_c@med.usc.edu. 

Urologists with Keck Medicine of USC have launched a clinical trial to perform the world’s first human bladder transplant.

The trial is actively screening potential participants for this first-ever type of transplantation.

During the procedure, the patient’s diseased bladder will be removed and replaced with a healthy bladder from a deceased donor.

“Transplantation is a lifesaving treatment option for conditions affecting many major organs, and transplanting a bladder could be a historic step in improving lives,” said Inderbir Gill, MD, founding executive director for USC Urology, part of Keck Medicine. Gill is also the principal investigator of the clinical trial and leading the transplantation efforts. “We could be on the verge of a medical advance that has the potential to revolutionize how we treat terminally compromised bladders.”

Hundreds of millions of people around the globe experience varying degrees of bladder disease and dysfunction. Some patients with these conditions may require a bladder reconstruction, a surgical procedure wherein the bladder is removed, and a new bladder is made from the patient’s own intestines. However, the procedure carries a high risk of early and delayed adverse side effects, and not every patient is a candidate for this surgery.

“The intention of this clinical trial is to develop a new treatment option for a certain subset of patients with debilitating bladder conditions that can severely hamper quality of life and ultimately, even shorten life,” said Nima Nassiri, MD, urologic surgeon and researcher with the Keck School of Medicine of USC and Gill’s collaborator on the clinical trial. “We have worked diligently to expand the boundaries of what is considered possible for severely compromised patients who traditionally have had few options.”

Bladder transplants have not been done previously, in part because of the complicated vascular structure of the pelvic area and the technical complexity of the procedure. Gill, Nassiri and their colleagues have spent the past few years developing and practicing numerous research procedures to prepare for the first-in-human bladder transplant, which will be done completely using robotic surgery.

Robotic surgery is an advanced form of minimally invasive surgery in which surgeons use a high-definition, three-dimensional camera to guide a robot to perform surgery using smaller, more precise incisions with more dexterity than is possible using hand-held surgical tools.

Under Gill’s direction, USC Urology has established itself as a pioneer and world leader in robotic, minimally invasive techniques for kidney, bladder and prostate cancer surgery, and achieved important milestones leveraging machine learning and artificial intelligence to optimize patient outcomes.

Keck Medicine’s USC Transplant Institute, which has a robust and nationally recognized kidney, liver, heart and lung transplant program, further provided Keck Medicine with the needed resources and skills to pioneer the first bladder transplant.

As part of the research and development stage, Gill, Nassiri and colleagues successfully completed many practice transplantation surgeries, including the first-ever robotic bladder retrievals and successful robotic transplantations in five recently deceased donors with cardiac function maintained on ventilator support.

The procurement, surgery and post-surgical monitoring during transplantation were aligned with current clinical and research standards. OneLegacy Foundation, an organ procurement organization serving Southern California, provided clinical trial funding and, with the generous agreement of donor families, enabled bladder donations that made the trial possible.

Nassiri and Gill are presenting their surgical research update April 30 at the annual meeting of the American Urologic Association, the world’s leading association for urology professionals.

Gill, in addition to directing USC Urology, is chairman and Distinguished Professor of the Catherine and Joseph Aresty Department of Urology and the Shirley & Donald Skinner Chair in Urologic Oncologic Surgery at the Keck School.

Photo caption: The Keck Medicine of USC surgical team evaluates the integrity of a bladder during the research and development stage of bladder transplantation.

Seminoma is a slow-growing form of testicular cancer that if untreated, typically metastasizes (spreads) to lymph nodes in an area behind the abdomen lining called the retroperitoneum. The standard treatment for patients at this stage is chemotherapy and radiation to shrink and kill the cancerous lymph nodes.  

While effective, chemotherapy and radiation are associated with long-term side effects, such as cardiovascular disease and secondary cancers, that adversely affect a patient’s quality of life.

Now, however, the results of a multi-institutional clinical trial recently published in the Journal of Clinical Oncology show that surgically removing the affected lymph nodes in the retroperitoneum is an effective alternative to chemotherapy and radiation with fewer long-term side effects.

“We found that the majority of participants in the study were cured with surgery alone, avoiding the toxicities associated with traditional therapies. We are confident that surgery for this disease state will be included into treatment guidelines in the near future,” said Sia Daneshmand, MD, a urologic oncologist with Keck Medicine of USC and lead investigator of the clinical trial.  

Daneshmand is also a member of USC Norris Comprehensive Cancer Center, part of Keck Medicine.

Testicular cancer is generally a treatable cancer that most commonly affects men ages 15-35. When testicular cancer only spreads to the retroperitoneum, it is classified as early metastatic or stage 2 seminoma.

The procedure to remove lymph nodes from the retroperitoneum — known as a retroperitoneal lymphadenopathy — is an established treatment for metastatic testicular cancer when chemotherapy fails to eradicate all affected lymph nodes. However, surgery has not traditionally been considered a viable stand-alone treatment for early metastatic seminoma.

The national study enrolled 55 patients across 12 institutions to investigate if surgery could replace chemotherapy and radiation as an effective treatment, thereby sparing patients the long-term risks associated with the two traditional therapies.

Study participants had previously undergone surgery to remove the testicle(s) where the original cancer occurred, and their cancer had progressed no further than to the retroperitoneum. Once enrolled, the patients underwent a retroperitoneal lymphadenopathy by certified surgeons at participating institutions around the country and one site in Canada.

Keck Hospital of USC performed 15 of the surgeries. Most of the Keck Medicine patients were able to go home 24 hours after surgery with minimal or no complications, according to Daneshmand.

Daneshmand and his colleagues found that 81% of the patients demonstrated a two-year recurrence-free survival rate. The 20% who did experience recurrence of the cancer were successfully treated with either chemotherapy or additional surgery for an overall survival rate of 100%.

“A 100% survival suggests that a cure can still be achieved even in patients who experience recurrence after the surgery,” said Daneshmand.

Daneshmand acknowledges that not all hospitals or medical centers have the expertise or resources to successfully complete retroperitoneal lymphadenopathy. He advises patients to look for an academic medical center to discuss the possibility of surgery over traditional therapies.

“Early metastatic seminoma has a very high survival rate; however if treated with chemotherapy and radiation, the cure can come at a high cost,” he said. “Surgery gives patients both the opportunity to be cured and experience a high quality of life post-cancer.”

Anne Schuckman, MD, a urologic oncologist with Keck Medicine, was also an investigator in the clinical trial.

“This prestigious national honor, which highlights a hospital’s achievements in patient safety and quality, is one of the most competitive awards a hospital can receive,”  said Marty Sargeant, MBA, CEO of USC Norris Cancer Hospital and Keck Hospital of USC. “I am proud of our efforts to maintain the highest standards of care.” 

This is the second year in a row the hospital has won a Top Teaching Hospital award.

To qualify for the Top Hospitals distinction, hospitals must rank highest among peers on the Leapfrog Hospital Survey, which assesses the quality of patient care across many areas of hospital performance, including practices for safe surgery and preventing patient risks.

Over 2,200 hospitals nationwide were considered for a Top Hospital award, which recognized hospitals in four categories: children’s, general, rural and teaching.

A total of 115 hospitals were selected as Top Hospitals, including 58 Top Teaching Hospitals.

USC Norris Cancer Hospital is part of the USC Norris Comprehensive Cancer Center, which is part of Keck Medicine of USC. The National Cancer Institute (NCI) has designated the cancer center as one of the nation’s 51 comprehensive cancer centers, a select group of institutions providing leadership in cancer treatment, research, prevention and education.

To see the full list of institutions honored as 2022 Top Hospitals, please visit https://www.leapfroggroup.org/ratings-reports/top-hospitals.

However, the socket didn’t fit well, resulting in painful skin irritations. The leg was difficult to walk on or even stand on, and sometimes fell off.

The husband and father could not work, exercise or even pick up his young daughter for fear he would fall and drop her.

But thanks to an innovative procedure known as osseointegration, performed by Lawrence Menendez, MD, an orthopaedic oncologist with Keck Medicine of USC and a professor of clinical orthopaedic surgery at the Keck School of Medicine of USC, life has opened up for Robert.

“There’s new hope for me now,” he said. “I can finally hold my daughter safely in my arms and do so many other things I couldn’t before the surgery.”

A groundbreaking new surgery

Osseointegration is a new surgical procedure that permanently anchors an artificial limb into the bone. It is currently offered at only 10-15 medical centers across the United States, including Keck Medicine.  Menendez is one of only a few surgeons in the country to have extensively trained in the surgery.

The technique was developed in Sweden some 25 years ago, and has been performed there for many years. Osseointegration for adults with above-the-knee amputations was approved by the U.S. Food & Drug Administration in December 2020.

During a two-part procedure, a metal implant is inserted into the bone of the residual limb remaining after the amputation. The bone grows into the implant until the implant is secure and fully integrated. Next, an additional device is attached to the implant, which protrudes from the skin and attaches to the prosthesis. Patients take up to a year to heal from the surgeries and require physical therapy.

The benefit of osseointegration is that it eliminates the need for a socket, which solves the fit problem that Robert, and many others who wear a prosthetic limb, experience.

Typically, said Menendez, socket prosthetics either fit too tightly or too loosely around the stump, causing skin irritations and infections and putting people at constant risk of falling.

Osseointegration allows for a stable attachment of the artificial limb, improving mobility, range of motion and avoiding skin irritations. It also gives patients an increased sense of proprioception, the awareness of the position and movement of the body, according to Menendez.

“The end result is that patients are out of pain, better able to stand, walk and climb stairs, and can get back to more physical activities they enjoyed before the amputation,” he said. “We hope that this procedure can improve the quality of life for patients who have undergone an above-the-knee amputation such as veterans, bone cancer patients and people who have been in accidents. We believe that Robert is just one of many we can help.”

Robert’s pre-osseointegration life

In 2016, Robert was a healthy, active 22-year-old when his right leg began to hurt. Over the next year, a bump formed above his knee. Robert visited several doctors to see what might be wrong, but no one had an answer.

The lump continued to grow, and in 2019, Robert decided to seek more specialized help at Keck Medicine’s USC Musculoskeletal Oncology Center. Menendez diagnosed Robert with osteosarcoma, an invasive type of bone cancer most common in people under 30.

Menendez removed the tumor, and surgery went well. However, Menendez and his team realized that to stop the cancer from spreading further and save Robert’s life, they would have to amputate his right leg above the knee.

After the wound healed and six months of chemotherapy, Robert was cancer-free and fitted with a socket prosthesis. He tried to return to normal life, but the ill-fitting prosthetic leg would not let him.

A new procedure and hope

In early 2021, Robert learned that his doctor, Menendez, was offering osseointegration to patients. Robert was immediately interested.

Menendez determined that Robert would be an excellent candidate for osseointegration, and Robert finished the second surgery in June 2021. He healed well, and is amazed at how much his life has improved.

Relieved of socket issues, he can stand for relatively long periods of time on his prosthetic leg and is able to work out at the gym for the first time in three years. When he walks on the treadmill, he is thrilled that when he sets his foot onto a surface, he can feel the sensation.

One day, he hopes to run. He also looks forward to eventually going back to work and even starting his own business.

But for now, he is savoring the small joys, such as being able to pick up and hold his daughter.

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To learn more about osseointegration surgery with Keck Medicine, please call 323-442-5860 or email Sherry.Quinteros@med.usc.edu.

Download photos and b-roll package below.

The 33,000-square-foot offices consist of an oncology clinic with 24 rooms equipped with cutting-edge technology, and an infusion center with 32 semiprivate, spacious bays with beach views and room for visitors. It also includes two fully private bays for patients with longer infusions or cold caps, which are used to prevent hair loss during treatment.

The location offers an on-site laboratory as well as sterile compounding pharmacy services, which customize medications based on patients’ needs and allows for coordinated, convenient and personalized treatment.

The Newport Beach clinic and infusion center is licensed by USC Norris Cancer Hospital, part of USC Norris Comprehensive Cancer Center. The National Cancer Institute (NCI) has designated USC Norris as one of the nation’s 51 comprehensive cancer centers, a select group of institutions providing leadership in cancer treatment, research, prevention and education.

“We are proud to offer patients the most effective and advanced cancer therapies available,” said Rod Hanners, CEO of Keck Medicine. “This new location triples our footprint in Orange County and underscores our commitment to provide world-class oncology care.”

Among services provided, patients will have access to on-site testing, which offers quick results about their tumor markers so their care teams can promptly design personalized treatment plans.

Additionally, the location will offer on-site genetic counseling, social work support to help patients navigate any additional resources and art therapy. Patients will also have access to telehealth appointments with a dietician.

Patients needing infusion can conveniently have their lab work done on-site just before their appointments. The pharmacy will then use the lab work to develop and customize their infusion treatments.

Keck Medicine is also expanding its Orange County clinical trials program at the Newport Beach location, further increasing patients’ access to potentially life-saving care.

Additionally, physicians at the Newport Beach clinic regularly participate in USC Norris and Hoag Hospital Newport Beach tumor boards, ensuring that each patient receives thoughtful, multidisciplinary treatment plans.

The Newport Beach location was designed to cater to both patients’ physical health and mental well-being. To put patients at ease, the space is designed to feel airy, bright and coastal with plenty of natural light, soothing nautical artwork and clear lines of sight for staff to watch over patients.

“Dealing with cancer is stressful, and we want to create the best patient experience possible,” said Louis VanderMolen, MD, a medical oncologist with Keck Medicine and a professor of clinical medicine and vice chair of clinical oncology, Orange County program, at the Keck School of Medicine of USC. “Our patients’ comfort and peace of mind — and that of their loved ones — is an essential part of their treatment.”

The new offices are located at 330 Old Newport Blvd., Newport Beach, California 92663.

For more information about services and treatment offered, please visit the clinic’s website.

The trial is currently recruiting breast cancer patients whose cancer has metastasized (spread to other areas of the body) and whose tumors show increased levels of a protein called human epidermal growth factor receptor 2 (HER2). Participants must also have experienced resistance or disease progression while on treatment plans containing T-DM1, and/or T-DXd, and/or tucatinib, which are typically prescribed for HER2-positive breast cancer patients.

About 20% of breast cancers are HER2 positive. The HER2 protein promotes cancer cell growth, which can make HER2-positive breast cancer more aggressive and difficult to treat, despite the availability of therapeutic options specific to this type of cancer.

Chemotherapy may be used in combination with targeted therapies, but can cause difficult side effects because the drug is administered throughout the body rather than just to the areas affected by cancer.

“At USC Norris, we treat a large volume of patients with HER2-positive, metastatic breast cancer and we’ve found that resistance to existing therapies is a major issue,” said Janice Lu, MD, PhD, a medical oncologist with Keck Medicine, medical director of the USC comprehensive breast oncology program and global lead principal investigator of the trial. “We are excited to lead this effort in assessing a possible alternative solution for breast cancer patients, and hope to expand our ability to provide effective personalized care.”

Michael Press, MD, PhD, a pathologist with Keck Medicine, member of USC Norris and the director of the Breast Cancer Analysis Lab at the Keck School of Medicine of USC, will lead the study’s pathological evaluation.

ARX788 is an antibody drug conjugate, which is a type of therapy that combines a monoclonal antibody with a potent dose of medication, allowing for precise, targeted drug delivery that could potentially lessen side effects. ARX788 is designed with an anti-HER2 monoclonal antibody that identifies HER2-positive tumor cells to deliver a powerful dose of Amberstatin269, which destroys cancer cells and prevents new cells from forming.

Results from two phase 1 clinical trials demonstrated promising anti-tumor activity in patients who had previously received aggressive treatment plans, showing an overall response rate of 74% and a disease control rate of up to 100%, depending on dosing. ARX788 was well-tolerated, with most adverse events being mild or moderate.

“If this drug is effective, it could provide a hopeful alternative to patients with a difficult prognosis and help them maintain a quality of life in ways that chemotherapy cannot,” said Lu, who is also a member of USC Norris.

The trial is currently recruiting participants at more than 20 sites across the United States and Australia, with plans to open 150 sites worldwide, including Europe and Asia.

Those interested in enrolling at the USC Norris site can contact (323) 865-BRST (323-865-2778). To learn more about USC Norris breast cancer research, treatment and prevention please visit the USC Breast Center.

The trial is sponsored by Ambrx, which manufactures ARX788. Those wishing to learn more about the trial can email breast03trialinquiry@ambrx.com.

This study will be presented at the San Antonio Breast Cancer Symposium on Dec. 7-10, 2021 as an ongoing trial.

Routine screenings for gynecologic and breast cancers

“There is only one type of gynecologic cancer for which routine screenings are proven to detect early cancers and prevent death — cervical cancer. Cervical cancer is slow-growing and typically preventable with regular pap tests (or pap smears), which look for abnormal cells that can lead to cancer. A newer screening, the HPV (human papillomavirus) test, also screens for cervical cancer. Both screenings can be done during the same visit.

“The recommendation for cervical cancer screenings has changed over the years. The following schedule is now recommended:

• Women 21-29 should receive a pap smear every three years (or more frequently, depending on past results). HPV screenings are generally not recommended at these ages.
• Women 30-65 should receive both the pap and HPV screenings every three to five years. (The length of time depends on if there is a history of abnormal test results.)
• Women 65 or over, depending on their health history, can often stop having cervical cancer screenings. Women should discuss if further screenings are needed with their doctor.

“Mammogram recommendations have also changed. The American College of Obstetrics and Gynecology recommends women receive a mammogram every one to two years beginning at age 40, based on shared decision-making with their health care provider, until they are at least 75 years old.

“It is very important that women receive the screenings available to them. My practice is seeing more later stages of breast and cervical cancer due to women putting off important preventive screenings during the pandemic. I urge women not to delay their cancer screenings.”

• Anjali Mahoney, MD, MPH, a family medicine physician with Keck Medicine of USC

When are extra screenings appropriate for gynecologic cancers?

“Ovarian cancer is the rarest but deadliest form of gynecologic cancer. In 75% of cases, it is diagnosed at an advanced stage because the symptoms are hard to detect. Unfortunately, no ovarian cancer screenings have been shown to consistently detect early cancer and prevent deaths.

“However, women with a history of ovarian or uterine cancer or who are at high risk due to family history may benefit from either a transvaginal ultrasound that uses sound waves to examine the uterus, fallopian tubes and ovaries, or the CA-125 blood test that measures the amount of a protein found in many women with ovarian cancer. The concern about these screenings is that we see a lot of false positives with the blood test, and the ultrasound picks up masses that may not be cancerous, requiring unnecessary biopsies and surgeries for women.

“I recommend that women with a personal or family history of ovarian or breast cancer or who are of Ashkenazi Jewish or Eastern European ancestry receive genetic testing to see if they carry the BRCA1 and BRCA2 gene mutations, which put them more at risk for breast, ovarian and other cancers.

“My biggest advice for all women is to visit your OB/GYN or family doctor yearly for a pelvic exam, even if you are not scheduled for a pap or HPV test. Often cancer is first detected at these annual visits.”

• Annie Yessaian, MD, a gynecologic oncologist with Keck Medicine of USC

When do women need more than a mammogram to detect breast cancer? 

“Women with dense breasts can benefit from more thorough breast screenings because dense breasts put them at a higher risk of developing breast cancer. Additionally, it can be challenging to determine the difference between the dense breast tissue and cancer on a mammogram, leading to missed cancer diagnoses. 

“I recommend that all women, especially those with dense breasts, ask for a 3D mammogram (digital breast tomosynthesis), which can detect small cancers hidden within dense breast tissues. Scientific literature indicates that by adding a 3D mammogram, there is an increase in invasive cancer detection rates by 40%-50%. Additionally, for the most accurate results, all women should request that a dedicated breast radiologist read their mammograms. 

“There are two other options for women with dense breasts. The first is a whole-breast screening ultrasound, which can be performed in addition to a mammogram. For women at a high risk of developing breast cancer, a breast MRI is recommended, alternating with a mammogram every six months. A breast MRI is 99% effective in detecting invasive breast cancer. However, the whole breast ultrasound and breast MRI can pick up benign masses that can require additional workup and biopsies.

“Any woman with dense breasts and at high risk should consult with her doctor to determine the best course of screening unique to her situation and background.”

•  Mary Yamashita, MD, a diagnostic radiologist specializing in breast imaging with Keck Medicine of USC 

For informational videos about breast cancer from Keck Medicine experts, please click here.

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A new study from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, suggests that the region cancer spreads to in the brain may not be random, but rather, is dependent on where the cancer originated in the body.

“We discovered that different types of cancer are more likely to show up in specific parts of the brain once they metastasize, indicating the location of tumors follow a distinct pattern,” said Gabriel Zada, MD, a brain and tumor neurosurgeon with Keck Medicine of USC and senior author of the study. He is also a member of USC Norris and director of the USC Brain Tumor Center.

Zada and colleagues analyzed the location of brain tumors caused by five common types of cancer – melanoma (a type of skin cancer), lung, breast, renal (kidney) and colorectal. They discovered that lung cancer and melanoma showed a higher likelihood for the metastasis to be at the frontal and temporal lobes (which sit behind the ears). Breast, renal and colon cancers had a higher propensity to spread to the back of the brain, such as the cerebellum and brainstem.

The findings are important not only because they may predict where a specific cancer may spread in the brain, but because they also have implications for how brain tumors grow.

“It may be that cancer cells have the ability to adapt to regional microenvironments in the brain that allow them to colonize and progress, while other areas of the brain are inhospitable to the same cells,” said Josh Neman, PhD, assistant professor of neurological surgery and physiology and neuroscience at the Keck School of Medicine of USC, scientific director of the USC Brain Tumor Center and lead author of the study. He is also a member of USC Norris.

To reach their conclusions, the researchers collected data from patients with metastatic brain cancer treated using stereotactic radiosurgery (SRS), a minimally invasive, targeted form of radiosurgery used to treat brain tumors and other lesions. The SRS allows surgeons to define the coordinates of a tumor in the brain with precise accuracy.

The researchers used the SRS coordinates from 970 patients with approximately 3,200 brain metastatic tumors arising from skin, lung, breast, kidney or colon cancers treated at Keck Medical Center of USC from 1994-2015. They created two predictive mathematical models to analyze the exact locations of brain metastases based on the primary cancer origins.

One model showed that distinct regions of the brain were relatively susceptible to certain types of cancer; another provided the probability of each cancer metastasizing in certain brain regions. Both models resulted in the approximate same results as to which areas of the brain were most likely to develop cancer-specific tumors.

The researchers believe the results of the study could be useful in the eventual prevention and treatment of brain tumors.

“If we can understand what factors either facilitate or block the process of metastasis, such as certain chemicals or neurotransmitters in the brain, there might be a way to intervene and prevent a cancer from metastasizing in the first place or treat it once it has spread,” Neman said. “In fact, we are already conducting studies to learn why certain areas of the brain are not receptive to certain cancer cells in hopes of developing better targeted therapies for patients.”

Zada and Neman are currently using the data from this study to participate in an international trial involving multiple sites to further study the patterns of brain metastasis based on primary cancer type.

“We are excited to see what new information this larger study will yield in our efforts to better understand and treat this complication of so many common cancers,” said Zada.

Historically, the rates of HCC are lower in rural areas than urban. However, a new study from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, shows that while cases of HCC have begun slowing in urban communities, the incidence of the cancer is rising at a rate of 5.7% annually in rural areas and approaching the rates seen in urban areas.

“Considering that one in five Americans live in a rural community, this study suggests that HCC is a critical underrecognized public health issue affecting rural Americans,” said Kali Zhou, MD, MAS, a gastroenterologist and hepatologist with Keck Medicine and co-lead author of the study. She is also an associate member of USC Norris and an assistant professor of clinical medicine at the Keck School of Medicine of USC.

The rural subgroups experiencing a rapid rise in HCC included men ages 60-69, non-Hispanic Blacks, American Indian/Alaskan Natives and those who live in either the Southern part of the country or in a high-poverty area.

The researchers also discovered that certain urban subgroups experienced declining incidence rates of HCC starting in 2013, including both men and women, younger individuals ages 40-59, Asian Pacific Islanders, and people who live in the Western United States. No rural subgroups experienced a clear decline during the study period, which was between the years of 1995-2016.

Prior research indicates that this rising trend among rural communities is not evident with other common cancers, the study noted. The rate at which rural residents are developing lung, breast and colorectal cancer is falling.

Zhou and her colleagues examined HCC trends across rural and urban communities over the past 20 years for which data is available using the North American Association of Central Cancer Registries database, which covers 93% of the United States and well-represents the rural parts of the country. They looked at cases diagnosed between 1995-2016 of adults over 20 years of age.

Of the more than 310,000 new cases of HCC, 85% were diagnosed in urban and 15% in rural areas. The researchers tracked new cases per year for both geographic groups to discover that while over the entire 20 years, the average rate of new cases was still lower in rural areas compared to urban ones, cases increased at a higher average percentage rate per year in rural areas.

The rates of increase were similar for the two groups from 1995-2009. However, in 2009, the pace of new HCC cases in urban America began to slow down with a peak around 2014, with no corresponding slowing in rural America. By 2016, this meant the number of cases increased 218% from 1995 in rural settings, compared to 118% in urban ones.

While the study did not examine the reasons rural America’s annual change in new HCC cases is outpacing that of urban communities, the researchers speculate there may be several factors at play. “Obesity and alcohol use, both risk factors for liver cancer, may be more prevalent in rural populations,” Zhou said.

Residents in rural areas also may lack the same access to health care as urban dwellers, she added, leading to a lack of preventive cancer care.

Zhou’s previous research showed that people living in rural parts of the country are also more likely to have a late-stage liver cancer diagnosis and worse survival rates than those in urban communities.

She hopes this study will encourage further research into the health care needs of rural populations, as well as an investment into more medical resources.

“With the widening rural-urban disparity in HCC incidence, such interventions are key to better understanding and tackling this growing inequality,” Zhou said.

Christina Gainey, MD, a medical resident in the LAC+USC Medical Center Pediatric Residency program, which is jointly sponsored by the Keck School and LAC+USC Medical Center, co-authored the study. Other researchers include Jennifer Dodge, MPH, an assistant professor of research medicine and population and public health sciences at the Keck School; Wendy Setiawan, PhD, a professor of population and public health sciences at the Keck School and co-leader of the USC Norris Cancer Epidemiology Program; Lihua Liu, PhD, associate professor of clinical population and public health sciences at the Keck School; Myles Cockburn, PhD, professor of population and public health sciences at the Keck School; and Norah Terrault, MD, a Keck Medicine gastroenterologist and division chief of gastroenterology and liver diseases at the Keck School.

The study was funded by the USC Research Center for Liver Diseases.

A new study from USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, discovered there is a greater likelihood that Hispanic and non-Hispanic Black women will have a post-surgery emergency department visit within 90 days than non-Hispanic white women.

“It is well-documented that women of color consistently experience worse outcomes in breast cancer — for example, they tend to be diagnosed with later-stage cancer and experience longer delays in treatment — and we wanted to see if this disparity was reflected in emergency department visits following surgery as well,” said Mary Falcone, PhD, a research scientist at the cancer center and lead author of the study.

Led by Caryn Lerman, PhD, director of USC Norris and senior author of the study, researchers used data from the California Cancer Registry and California’s Office of Statewide Health Planning and Development to identify approximately 151,000 women in California who were diagnosed with stage 0-3 breast cancer between 2005 and 2013 and received surgical treatment.

After examining other potential influences on emergency room visits, such as age, socioeconomic status, and the type of hospital where the patients received their treatment, they discovered that non-Hispanic Black women had an almost 40% greater chance of an emergency room visit and Hispanic women an 11% greater chance than non-Hispanic white women.

The study tracked both breast cancer-related emergency department visits and non-breast cancer-related visits. Among those with breast cancer-related emergency department visits, the most common reasons included complications from surgery or cancer treatments, such as chemotherapy.

The study also found increased rates of emergency department visits for women covered by Medicaid and Medicare versus commercial insurance. However, not all patients benefitted equally from similar insurance coverage: Hispanic and non-Hispanic Black women with commercial insurance showed a slightly smaller reduction in visits than non-Hispanic white women.

Notably, receiving surgery at a National Cancer Institute (NCI)–designated comprehensive cancer center was associated with reduced odds of an emergency department visit across all demographics. USC Norris is an NCI-designated comprehensive cancer center, but not all cancer centers have received this designation, which applies rigorous standards.

“Understanding and reducing inequities in access to cancer care is vital to reducing the significant ethnic and racial disparities in cancer mortality,” said Lerman, who is also the H. Leslie and Elaine S. Hoffman Chair in Cancer Research and associate dean for cancer programs at the Keck School of Medicine of USC. “Women should not have to seek emergency treatment for conditions that may be avoided with access to proper care.”

Future studies at USC Norris will examine the interaction between insurance coverage, health care utilization and race and ethnicity, as well as how culturally competent patient navigation might improve outcomes for patients of diverse ethnic and racial backgrounds.

“We hope our study can shed light on a previously unreported problem and in doing so, guide the development of interventions to reduce the burden of cancer for patients,” Falcone said.

Lerman joined the AACI Board of Directors in 2019 and was elected vice president/president-elect in 2020.

“This is a time of rapid change in not only cancer research, education and patient care, but also in terms of social justice issues that we must tackle as we elevate the national cancer program to the next level,” said Lerman, who also serves as associate dean for cancer programs and the H. Leslie and Elaine S. Hoffman Chair in Cancer Research at the Keck School of Medicine of USC. “I am looking forward to collaborating with AACI cancer centers to embrace change and address issues that matter most to them, including cancer equity and the diversification of the nation’s oncology leadership pipeline.”

Lerman will formally announce her presidential initiatives at the 2021 AACI annual meeting held October 19-21.

An elected member of the National Academy of Medicine, Lerman has served as a member of the National Cancer Institute Board of Scientific Advisors, the National Human Genome Research Advisory Council and the National Institutes on Drug Abuse Advisory Council. A cancer population scientist, she has received numerous awards for her work, including the American Cancer Society Cancer Control Award, the American Society of Preventive Oncology Joseph Cullen Award, the Alton Ochsner Award Relating Smoking and Health and the National Institutes of Health Matilda White Riley Award.

During Prostate Cancer Awareness Month (September), physicians from USC Urology with Keck Medicine of USC are available to answer questions about risk factors, screening and treatment options.

Knowing your risk factors can help inform your screening decisions

“Prostate cancer is more common in men over age 50, so men should be more vigilant about screening as they age. Many of the known risk factors for prostate cancer are genetic – African American men and men with a family history of prostate cancer may need to screen earlier or more frequently.

“I recommend that men between the ages 45 to 49 have a baseline prostate specific antigen (PSA) blood test. Depending on the baseline PSA levels, they should have a PSA test every 1 to 2 years until the age of 70. Ultimately, the decision to do a PSA test should be a shared one between the patient and physician.”

- Andrew Hung, MD, urologist, Keck Medicine, and assistant professor of clinical urology, Keck School of Medicine of USC

Prostate cancer diagnostics is more than just a PSA test

“An abnormal PSA test result could indicate prostate cancer, but it also could be due to other non-cancerous prostate conditions. A prostate biopsy is typically the next step to confirm the presence of cancer; but because the prostate is a sensitive area, this can cause negative side effects like pain, incontinence or erectile dysfunction. Also, because cancer does not grow uniformly throughout the prostate, it is possible to get a false negative result.

“Keck Medicine is leading a National Institutes of Health-funded clinical trial to see if using magnetic resonance imaging (MRI) and ultrasound imaging can help us more accurately predict potential cancerous areas of the prostate. This may lead to more accurate results, fewer biopsy targets and, in some cases, eliminate the need for a biopsy altogether.”

- Inderbir S. Gill, MD, founding and executive director of USC Urology, Distinguished Professor and chair of the Catherine and Joseph Aresty Department of Urology, Shirley and Donald Skinner Chair in Urologic Cancer Surgery and associate dean for clinical innovation at the Keck School

Prostate cancer innovations help urologists create personalized treatment plans for each patient

“Urologists, oncologists and radiation oncologists have a big toolbox of treatments for prostate cancer patients, including radical therapy, like robotic prostatectomy (surgical removal of the prostate) or radiation therapy, as well as systemic treatments like hormone deprivation therapy or chemotherapy. Additionally, for select patients, focal cryoablation and high-intensity focused ultrasound (HIFU) ablation are treatments that have a lower risk of complications or side effects.

“Patients and doctors should communicate openly about all potential options to strategize tailored treatment plans for each patient’s individual needs.”

- Andre Abreu, MD, urologist, Keck Medicine, and assistant professor of clinical urology and radiology at the Keck School.

A new study from USC Urology with Keck Medicine of USC demonstrates that focal (or targeted) high-intensity focused ultrasound (HIFU) ablation of the prostate is an effective alternative to surgery or radiation, with encouraging outcomes and shortened recovery time.

Focal HIFU ablation is an outpatient procedure that uses a focused ultrasound beam to raise the temperature inside the prostate to approximately 90 degrees Celsius (194 degrees Fahrenheit) to destroy targeted areas of prostate tissue. The procedure takes around two hours and the patients are often discharged home the same day.

The study, published in The Journal of Urology, followed 100 men in the United States who underwent a HIFU procedure for prostate cancer between 2015-2019. This is the first and largest study examining the outcomes of focal HIFU ablation as a primary treatment for prostate cancer in the United States.

During follow-up, 91% of HIFU patients successfully avoided radical treatment. Also, 73% of patients did not experience treatment failure, which the researchers defined as clinically significant cancer recurrence, metastases or mortality, or the need for additional hormone therapy, chemotherapy, surgery or radiation.

The results demonstrated that focal HIFU carries a low risk of complication and can help preserve quality of life. In fact, all patients remained continent and there was no significant decrease in sexual function. There also were no serious adverse events or major complications. Minor complications, including difficulties with urination and urinary tract infection, occurred in a small proportion of the patients, and were addressed without major interventions. Patients were typically discharged the same day as their procedure and resumed regular activities shortly thereafter.

“This positive data empowers urologists to use focal HIFU ablation to effectively address prostate cancer without the intrinsic side effects of radical treatments,” says Andre Abreu, MD, urologic surgeon with Keck Medicine and first author of the study. Abreu is also an assistant professor of clinical urology and radiology at the Keck School of Medicine of USC. “We hope this study encourages prostate cancer patients to talk to their doctor about all potential treatment options to ensure that they receive a personalized care plan that addresses their individual needs.”

Urologists worldwide have used HIFU ablation to treat prostate cancer patients for many years; however, the technology was only approved by the Food and Drug Administration (FDA) for prostate tissue ablation in 2015. Keck Medicine was among the first U.S. institutions to use this technology following the FDA approval.

“USC Urology is dedicated to refining cancer care through collaboration and innovation,” says Inderbir S. Gill, MD, founding and executive director of USC Urology and senior author of the study.

“Throughout screening, diagnosis and treatment, it is important to balance accuracy and efficacy. Our physicians will continue working toward better methods to personalize that balance for every prostate cancer patient,” continues Gill, who is also Distinguished Professor and chair of the Catherine and Joseph Aresty Department of Urology, Shirley and Donald Skinner Chair in Urologic Cancer Surgery and associate dean for clinical innovation at the Keck School.

In 2010, USC Urology launched a focal therapy and image-guided surgery program to develop more accurate methods to diagnose and treat prostate cancer. Since the program’s inception, USC Urology has increased its annual image-guided prostate biopsies six-fold, with the vast majority of these procedures using a combination of MRI and ultrasound imaging. Additionally, USC Urology physicians are skilled in the most innovative therapies, including focal HIFU, cryoablation and robotic prostatectomy.

USC Urology physicians also collaborate with Keck Medicine radiologists and pathologists to create tailored, multidisciplinary treatment plans for each prostate cancer patient.

This year, U.S. News and World Report ranked Keck Medicine No. 9 in the country for Urology.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

The new center, named in honor of Brown’s parents, will focus on accelerating the development of groundbreaking cancer treatments.

“The importance of conducting research to develop more effective and less toxic cancer therapies cannot be overestimated,” says Caryn Lerman, PhD, director of the USC Norris Comprehensive Cancer Center and associate dean for cancer programs at the Keck School. “This gift will enable us to leverage the talent of USC Norris scientists and dedicated clinicians and ensure that our groundbreaking discoveries move not from bench to bookshelf, but from bench to bedside, transforming cancer care and survivorship for all people.”

Brown, who will celebrate his 90^th birthday in August, is a previous donor to USC Norris and graduated from USC with a Bachelor of Science degree in 1959.

“I have been fortunate to do well in business, and now through my efforts as trustee of the Rosalie and Harold Rae Brown Charitable Foundation, want to give back to a cause that is not only personally important to me, but addresses a great need in society, finding a cure for cancer,” says Brown. “Honoring my parents and creating the Rosalie and Harold Rae Brown Center for Cancer Drug Discovery at USC Norris is a rewarding and fitting legacy.”

This gift will have an immediate impact by supporting the development of new clinical trials that build on USC Norris discoveries of the underlying causes of cancer and disease progression. Initial projects will be sharply focused on cancers that disproportionately affect members of the community for whom there are dramatic ethnic and racial disparities, such as breast cancer, prostate cancer and colorectal cancer.

“This generous gift will help position USC Norris and the Keck School at the forefront of innovative cancer research and treatment,” says Laura Mosqueda, MD, dean of the Keck School. “It will significantly enhance our mission of finding cures and offering renewed hope for all who are impacted by cancer.”

Researchers at the USC Norris Comprehensive Cancer Center found that identifying a metastatic colorectal cancer patient’s Consensus Molecular Subtype (CMS) could help oncologists determine the most effective course of treatment. CMS also had prognostic value, meaning each subgroup was indicative of a patient’s overall survival, regardless of therapy. The results are from the multi-center Phase III CALGB/SWOG 80405 trial and published in the Journal of Clinical Oncology.

CMS categorizes colorectal cancer into four distinct, biologically characterized subgroups based on how mutations in the tumor behave. The subgroups were created using data from several research teams around the world that had previously analyzed tumors of colorectal cancer patients who were treated with surgery and adjuvant chemotherapy. Although CMS classification is not based on clinical outcomes, there seemed to be patterns in how different subtypes responded to treatment.

“We wanted to understand the importance of CMS for patients with metastatic disease who are treated with the two most important first-line therapies,” said Heinz-Josef Lenz, MD, professor of medicine at the Keck School of Medicine of USC and J. Terrence Lanni Chair in Gastrointestinal Cancer Research at USC Norris. Lenz was the lead author on the study. “We anticipated that CMS had prognostic value, but we were impressed at how strongly CMS was associated with outcomes.”

The study compared the efficacy of two different therapies (chemotherapy and cetuximab versus bevacizumab) on 581 metastatic colorectal cancer patients categorized by CMS. The data showed a strong association between a patient’s CMS subtype and both overall survival and progression-free survival. For example, patients in CMS2 had a median overall survival of 40 months compared to 15 months for patients in CMS1.
CMS also was predictive of overall survival among patients on either treatment, with patients in certain subtypes faring better on one therapy over the other. Survival for CMS1 patients on bevacizumab was twice that of those on cetuximab, whereas survival for CMS2 patients on cetuximab was six months longer than for bevacizumab.

“This study establishes the clinical utility of CMS in treating colorectal cancer,” Lenz said. “It also provides the basis for more research to uncover additional clinically significant predictive signatures within these subtypes that might better personalize patient care.”

Currently, it is not possible to order patient subtyping, though multiple efforts are underway to develop an assay approved for clinical use. Lenz estimates that this could happen in a matter of months. Until then, he and his colleagues continue to analyze data from more than 44,000 samples of blood, tissue and plasma in one of the largest, most comprehensive research efforts to characterize DNA, RNA and germline DNA in colon cancer.

“This is only one study of many more to come that will help us understand this disease at the molecular level so we can provide better care for patients,” Lenz said.

CALGB/SWOG 80405 is sponsored by the National Cancer Institute. Primary study contributors included teams led by Alan Venook, MD, from the University of California, San Francisco; Federico Innocenti, MD, PhD, from the University of North Carolina, Chapel Hill; Omar Kabbarah, PhD, from Genentech; and Fang–Shu Ou, PhD, from Alliance for Clinical Trials in Oncology at Mayo Clinic. Genentech also funded the study.

— Wendy Wolfson

V. Wendy Setiawan (Photo/Ricardo Carrasco III)

“There are very few studies on diabetes and pancreatic cancer that include Latinos and African Americans,” said the study’s lead author V. Wendy Setiawan, PhD, associate professor of preventive medicine at the Keck School. “Both groups have a high rate of diabetes and African Americans, in particular, have a higher risk of developing pancreatic cancer relative to other racial/ethnic groups. Because most people with pancreatic cancer are diagnosed at a late stage, the five-year survival rate is low — about 8 percent. Identifying people who are at high risk early on could potentially save their lives.”

Symptoms of pancreatic cancer typically present when the disease is in its later stages and no screening methods currently exist.

Using prospective data from approximately 49,000 African Americans and Latinos, the researchers found that people who were diagnosed with diabetes between the ages of 65 and 85 were more likely to develop pancreatic cancer within three years as compared with people without diabetes. The data showed that Latinos were four times more likely to develop pancreatic cancer within three years of a diabetes diagnosis, and African Americans were three times more likely.

The research team also looked at whether late-onset diabetes was associated with breast, prostate or colorectal cancer, and no association was found.

“What we found is that, yes, diabetes is associated with pancreatic cancer in African Americans and Latinos, but we also discovered that there is a different type of diabetes here, a late-onset diabetes that’s associated with developing pancreatic cancer within 36 months. The evidence suggests that late-onset diabetes may be an early sign of pancreatic cancer,” Setiawan said.

Late-onset diabetes may be a useful marker for pancreatic cancer, she added, providing an opportunity to screen high-risk groups with new tools such as liquid biopsy, which is a test that looks for cancer cells or DNA from cancer cells in the blood.

“Pancreatic cancer is a rare disease, but if you are diagnosed with late-onset diabetes, have a conversation with your clinician about your individual risk,” Setiawan said. “Early intervention could improve survival.”

— Erica Rheinschild

Hilda Haug, who generously willed the donation, first became familiar with USC Norris while her husband Bruno was treated at the center for lymphoma. Haug spent nearly two decades as her husband’s dedicated full-time caregiver, becoming highly engaged in his medical care. Shortly after Bruno passed away in 2015, Haug was diagnosed with ovarian cancer and saw Roman for treatment. Haug extensively researched her disease and found that there were limited treatment options and a general lack of information compared to other types of cancer.

Lynda Roman (Photo/Van Urfalian)

“Hilda recognized the need for more research about gynecologic cancers, and it is a great testament to her kindness that she will help make that possible for future patients,” Roman said. “While I met her under unfortunate circumstances, I am grateful for the time I was able to treat her and will ensure that her legacy has an impact in this field.”
Haug passed away in 2017 at age 78 and is survived by her brother. In the last few years of her life, she often spoke about how much she missed her husband and how her own cancer diagnosis made her appreciate each day all the more. In addition to the research fund, she left Roman a collection of hand-stitched embroidery, one of Haug’s favorite hobbies.
Ovarian cancer funding is low
The Center for Disease Control and Prevention reports that approximately 20,000 women are diagnosed with ovarian cancer each year. Among women, it is the 10th most common cancer and the fifth-leading cause of cancer death. Funding for gynecologic oncology research is considerably lower than other types of cancer research — National Cancer Institute funding from the last reported fiscal year shows ovarian cancer research received only 18 percent of the total financial support received for breast cancer research. This is due to a lack of awareness of gynecologic cancers as well as a lower incidence rate.

A portion of Haug’s donation will support Roman’s research collaboration with the Institute and Department of Translational Genomics at USC. The initiative will sequence the genes of gynecologic cancer tissue in the hopes of better understanding development, prognostic indicators or therapeutic targets of the disease.

“Although breast cancer gets a lot of attention, and rightfully so, other female reproductive and gynecologic cancers exact a heavy burden on our community and the health care system,” said John Carpten, PhD, professor and chair of translational genomics at the Keck School and director of the Institute of Translational Genomics. “This gift will allow us to grow a world-class clinical translational research program focused on gynecological cancers at the Keck School.

“We will bring to bear our considerable technology and expertise in molecular profiling to make new discoveries that will arm clinicians with new tools for precision prevention, diagnosis and treatment for ovarian, endometrial and cervical cancer.”

— Mary Dacuma

“One of the most promising areas in cancer research is immunotherapy, including chimeric antigen receptor-T (CAR-T) cells. It is also one of the most difficult because the methods for testing immunotherapies are not ideal,” said corresponding author Preet M. Chaudhary, MD, PhD, professor of medicine at the Keck School, chief of the Jane Anne Nohl Division of Hematology and Center for the Study of Blood Diseases, and director for bone marrow transplant at USC Norris Comprehensive Cancer Center. “Radioactive chromium release assay is the gold standard for testing whether an immunotherapy kills cancer cells. This method is expensive, complicated and requires special disposal practices. Other available methods also suffer from limitations and don’t allow scientists to rapidly screen immunotherapeutic agents to find the best candidates.”
The team set out to develop a simple, precise and inexpensive test based on marine animal luciferases, the enzymes responsible for bioluminescence. A group of small crustaceans and deep sea shrimp were selected for their bright bioluminescence, and their luciferases became the basis of the test, called the Matador assay. Engineered to get trapped inside cells, the luciferases leak out of cells when they die, causing a visible glow. The level of luminescence can then be measured with a luminometer.

To test the Matador assay’s effectiveness at measuring cell death, several different types of cancer cells, including chronic myelogenous leukemia, acute myelogenous leukemia, Burkitt’s lymphoma and solid tumors, were treated with a variety of immunotherapies, including CAR-T cells, bispecific T-cell engagers and monoclonal antibodies. Results showed that the assay was so sensitive that it could detect the death of a single cell, a level of sensitivity far exceeding existing assays. Chaudhary’s lab has since developed more than 75 cancer cell lines expressing the marine luciferases and used them successfully in the Matador assay to develop next-generation CAR-T cells.

The assay is fast, inexpensive and can be performed in a 384-well plate format, saving time and reagents.

“In our hands, the Matador assay can detect cell death in as little as 30 minutes, which can ultimately translate to more expedient treatments for patients getting cellular immunotherapies such as CAR-T cells,” Chaudhary said.

The Matador assay has many potential applications in biomedical research and cellular therapy manufacturing, he explained.
“It could potentially play a role in screening other types of anticancer agents or even measuring environmental toxins.”

Hittu Matta, PhD, assistant professor of research medicine, Ramakrishnan Gopalakrishnan, PhD, research associate, Sunju Choi, PhD, research associate, Rekha Prakash, MS student, Ruben Prins, research technician, Venkatesh Natarajan, assistant professor of research medicine and Sonjie Gong, research technician, among others, also contributed to this study.

— Erica Rheinschild