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.

Diabetes is a chronic condition where the body does not produce or effectively use insulin. A lack of insulin leads to raised blood glucose (sugar) levels, which can cause heart disease and stroke, kidney disease, nerve damage and other severe complications.

Keck Medicine of USC has launched a Phase 2 clinical trial investigating the effectiveness of a new outpatient, nonsurgical endoscopic procedure in stabilizing blood glucose levels for patients. 

“Currently, the only treatment for diabetes not managed with lifestyle changes are oral medications or, in the case of advanced disease, insulin injections, both of which can be costly or have side effects,” said Luke Putnam, MD, lead investigator of the clinical trial and a gastrointestinal surgeon with Keck Medicine. “If this therapy is proven effective, it could eliminate the need for medication or insulin, or potentially prevent disease progression so it does not lead to organ failure and other debilitating conditions.”

This innovative procedure is designed for patients before they require insulin and targets the duodenum, the first part of the small intestine that works with the pancreas to regulate insulin and blood glucose levels.

Recent data suggests the duodenum plays an important role in glucose regulation, and in patients with Type 2 diabetes, the cells lining the duodenum become damaged.

The clinical trial is testing a device inserted via an endoscope into the duodenum that ablates (removes) the poorly functioning cells through precise, controlled electrical pulses.

The study researchers hypothesize that ablating the damaged cells will promote the regrowth of healthy cells, which will better regulate blood glucose levels.

The procedure takes about an hour and is done under general anesthetic. Patients are discharged the same day and can continue normal activities a few days later.

“Previous studies have shown that ablation of cells in the duodenum is effective in controlling blood sugar levels, so we are optimistic this study will produce successful results,” said Putnam.

Clinical trial participant Mark Canning, a 60-year-old Los Angeles resident who was diagnosed with Type 2 diabetes in 2015, is seeing progress controlling his blood glucose since undergoing the procedure in January. “My blood sugar levels are falling, and I am feeling very encouraged,” he said.

The clinical trial is currently enrolling new patients. To qualify for the study, patients must be between the ages of 22-65 and have a history of Type 2 diabetes between three to 10 years. Participants can be on oral medications but not insulin.

Those interested in participating in the study should contact Christian Romero at christian.romero@med.usc.edu.

John Lipham, MD*, a gastrointestinal surgeon with Keck Medicine, is co-investigator of the study.

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Download b-roll below of clinical trial participant Mark Canning undergoing an outpatient, nonsurgical endoscopic procedure that may help patients stabilize blood glucose levels.

* Lipham has a financial interest in the company sponsoring this study. He is a consultant for the sponsoring company, Endogenex, Inc. The nature of this conflict and the management of the conflict of interest have been reviewed by the USC Conflict of Interest Review Committee.

Atherosclerosis, the accumulation of plaque in arteries, is a leading cause of death in the U.S., and almost always occurs in women after menopause. Cognitive concerns such as memory loss, dementia and Alzheimer’s disease are dramatically more common in postmenopausal than premenopausal women.

Now, Keck Medicine of USC has launched a clinical trial to study the effect of a novel hormone replacement therapy on postmenopausal cardiovascular disease and cognitive decline.

“Data supports the concept that estrogen, a hormone that the ovaries stop producing after menopause, protects both the heart and brain from damage,” said Howard N. Hodis, MD, director of the USC Atherosclerosis Research Unit, internal medicine specialist with Keck Medicine and lead researcher of the study. “Our study seeks to determine whether estrogen-containing hormone therapy can prevent or slow atherosclerosis progression and cognitive impairment in women after menopause.”

A key aspect of the study is that it is designed for women who are postmenopausal for six years or less.

“We have studied previous data and conducted clinical trials showing that the timing of when a woman starts hormone therapy is crucial,” said Hodis, who is also a professor of medicine and population and public health sciences at the Keck School of Medicine of USC. “There appears to be a limited window of time wherein women benefit from hormone replacement therapy. Beyond six years of menopause, prevention appears to be too late.”

Improving standard hormone replacement therapies

The hormone therapy being studied has been approved by the Food and Drug Administration since 2013 and consists of estrogen paired with a non-hormone drug known as bazedoxifene.

Traditional hormone replacement therapy combines estrogen with progesterone, or more commonly with progestin, a synthetic progesterone. Estrogen alone can cause the lining of the uterus to thicken, causing bleeding and other health issues, which the progesterone or progestin prevents.

However, progestin/progesterone combined with estrogen has been associated with cancer risks. Bazedoxifene prevents the uterine lining from thickening while appearing not to present the same risks, said Hodis.

Trial eligibility and protocols

The clinical trial, titled Advancing Postmenopausal Preventive Therapy, is open to healthy women six years or less post-menopause, who have a uterus, are 45-59 years of age and do not have cardiovascular disease. Upon enrollment, trial participants:

• Receive an ultrasound of their neck artery that is used as a non-invasive baseline measure of atherosclerosis.
• Undergo several tests to gauge their baseline cognitive function and memory.

Every six months, participants have an ultrasound of the neck artery to monitor any progression of atherosclerosis. They also have electrocardiograms to check for different heart conditions, which are done yearly.

At the end of the study, which lasts approximately three years, women retake the cognitive and memory tests so researchers can determine whether there has been any change since enrollment.

The clinical trial is a double-blinded, placebo-controlled trial, meaning neither participants nor the researchers know who is receiving hormone replacement or a placebo. When the clinical trial is completed, researchers will compare results between the therapy and placebo recipients, and participants will be informed which option they received.

So far, some 260 women are participating in the trial; researchers are looking for 100 more women to enroll. Those interested in participating should contact the USC Atherosclerosis Research Unit at (323) 442-2257 or visit aru.usc.edu.

“Our ultimate goal is to help women and their physicians make informed decisions to promote good health post-menopause,” said Hodis.

The trial is funded by the National Institute on Aging (grant R01-AG058691), part of the U.S. National Institutes of Health (NIH). 

Donna Shoupe, MD, a reproductive endocrinologist specialist with Keck Medicine and professor of obstetrics and gynecology at the Keck School of Medicine and Wendy J. Mack, PhD, a professor of population and public health sciences with the Keck School of Medicine, are co-investigators of the clinical trial.

To help determine predictors of success or failure in elite military training, Leslie Saxon, MD, executive director of the USC Center for Body Computing, and fellow Center for Body Computing researchers monitored the physical and psychological activity of three consecutive classes of Marines and sailors enrolled in a 25-day specialized training course.

The results were published in the Journal of Medical Internet Research mHealth and uHealth.

A total of 121 trainees participated. Only slightly more than half (64) successfully completed the course.

Researchers found there was no correlation between finishing and performance on physical training standards, such as hikes or aquatic training. Physical markers such as heart rate or sleep status also did not play a role.

Rather, the biggest determinant was mental. Trainees who identified themselves as extroverted and having a positive affect – the ability to cultivate a joyful, confident attitude – were most likely to complete the course.

“These findings are novel because they identify traits not typically associated with military performance, showing that psychological factors mattered more than physical performance outcomes,” says Saxon, who is also a cardiologist with Keck Medicine of USC and a professor of medicine (clinical scholar) at the Keck School of Medicine of USC.

Researchers were also able to pinpoint psychological stressors that triggered dropping out of the course. Trainees typically quit before a stressful aquatic training exercise or after reporting an increase in emotional or physical pain and a decrease in confidence. This led researchers to be able to predict who would drop out of the course one to two days in advance.

While Saxon has been studying human performance in elite athletes for 15 years, this was her first study involving the military. She partnered with the USC Institute for Creative Technologies, which has established military research programs, to run the study with a training company in Camp Pendleton, Calif. that trains Marines in amphibious reconnaissance. Typically, only around half of the participants finish the training.

The study authors collected baseline personality assessments of the trainees before the recruits began the course, assessing personality type, emotional processing, outlook on life and mindfulness. Researchers next provided subjects with an iPhone and Apple Watch, and a specially designed mobile application to collect continuous daily measures of trainees’ mental status, physical pain, heart rate, activity, sleep, hydration and nutrition during training.

The mobile application also prompted trainees to answer daily surveys on emotional and physical pain, well-being and confidence in course completion and instructor support.

“This study, the first to collect continuous data from individuals throughout a training, suggests that there may be interventions the military can take to reduce the number of dropouts,” says Saxon. “This data could be helpful in designing future training courses for Marines and other military units to increase the number of elite service members, as well as provide insights on how to help athletes and other high performers handle challenges.”

Saxon is already testing whether or not various psychological interventions or coaching might encourage more trainees to stay the course.

Other USC Center for Body Computing study authors include Rebecca Ebert, BS, senior research coordinator, and Mona Sobhani, PhD, director of research and operations. Researchers from the USC Marshall School of Business and the Department of Computer Science at the USC Viterbi School of Engineering also contributed to the study.

To help Californians receive the highest level of care regardless of where they live, epilepsy experts have established the USC Epilepsy Care Consortium, a unique partnership of six independent comprehensive epilepsy centers serving patients in Los Angeles County, Orange County and the Central Valley. Keck Medicine of USC serves as the academic medical center and anchor of the consortium.

Charles Liu, MD, PhD, and Christianne Heck, MD, who serve respectively as surgical and medical director for the USC Comprehensive Epilepsy Center, sought to collaborate with other institutions after noticing that patients often drove for hours to seek services at the Center because their local hospitals did not offer epilepsy care.

“Many patients were burdened with long travel times, and we were concerned that those without the means to travel were not getting treatment,” says Heck, professor of clinical neurology at the Keck School of Medicine of USC. “We realized we needed to join forces with other hospitals to help build additional epilepsy programs and provide them with access to ours.”

The two physicians, who also direct and co-direct the USC Neurorestoration Center, along with support from fellow USC Neurorestoration Center doctors, created a network of collaborating epilepsy centers spanning a variety of medical settings: public and private, adult and pediatric, urban and rural.

The USC Comprehensive Epilepsy Center, a National Association of Epilepsy Centers accredited level 4 center — the highest level possible — acts as the hub of the consortium. Patients with complex cases that require advanced treatments or surgeries that can’t be addressed at a collaborating hospital can be treated at Keck Medical Center of USC.

Consortium members share cases and recommendations through weekly teleconferences. They track patients’ progress through a shared electronic data reporting system, resulting in a network-based system of care for each patient.

“The consortium is a bold and exciting initiative that offers patients the combined resources and expertise of six different centers,” says Liu, professor of clinical neurological surgery at the Keck School. “Patients can take advantage of the top technology and treatments available in the field, as well as the combined collective wisdom of multiple epilepsy experts.”

Epilepsy, a brain disorder marked by seizures due to abnormal electrical activity in the brain, is one of the most common neurological disorders worldwide. Without treatment, those with epilepsy are at greater risk for seizure-related accidents, such as falling, as well as a fatal complication known as sudden unexplained death in epilepsy, when patients die for no known cause. Untreated epilepsy also can lead to greater rates of unemployment and depression because seizures, which often cannot be anticipated, may interfere with holding down a job and enjoying life.

In addition to the USC Comprehensive Epilepsy Center, other participating institutions in the consortium include Children’s Hospital Los Angeles, Rancho Los Amigos National Rehabilitation Center in Downey, Hoag Hospital in Newport Beach, Kern Medical Center in Bakersfield and Valley Children’s Healthcare in Madera.

USC CBC researchers provided free and unlimited Lyft rides for three months to 150 older patients with chronic disease to see if better access to transportation could improve their access to medical centers and reduce their social isolation. The researchers also wanted to know its overall impact on their health.

Ninety-three percent of patients used the Lyft rides to access medical care and a significant number learned to use smartphone apps and a telephone concierge service to do so. While visiting their doctors counted for a third of all rides (31%), the seniors used the remaining rides to get to fitness, social and leisure activities, and reported that this improved their perceived quality-of-daily-life (92%).

“Access to transportation is more than getting from point A to point B; it encompasses multiple human facets of life,” says Leslie Saxon, MD, executive director of the USC Center for Body Computing and principal investigator of the study. “This research underscores how ride-sharing platforms can provide a significant benefit to the well-being of older adults, empowering them to become active participants in their own care as well as in other areas of their lives.”

The researchers concluded that while older adults can be willing, even enthusiastic novel technology adopters who are motivated to overcome barriers disrupting their own health, they needed education and support to be successful.

In the study, 150 English-speaking Keck Medicine of USC patients over the age of 60 (63% female and 54% Caucasian) with chronic diseases were screened for psychological factors and to ensure that access to transportation was a factor in missed appointments. The patients lived an average of 20 miles away from Keck Medical Center of USC and over 45% relied on others for transportation.

The patients were offered free rides to both medical and non-medical destinations for three months and received personalized training in summoning a ride from a ride-sharing app. They also had the option to schedule rides via the Lyft phone concierge platform. Each participant was assigned a wrist-worn daily activity tracker.

The majority of older adults reported that cost was the primary barrier preventing them from continuing to use the ride shares after the study concluded, as the average cost of a month of unlimited rides in Los Angeles is $500. “Because study participants expressed challenges with the costs associated with ride-sharing, our next steps will be to compare the long-term costs of using these apps for health care needs versus the opportunity costs of inconsistent access to transportation,” Saxon says. “Our findings on the benefits to seniors could incentivize similar programs on a larger scale by cities and insurance companies.”

The study was supported by a $1 million grant from the AARP Foundation as part of a broader collaboration with United Healthcare to address the needs of seniors. Lyft provided the rides and transportation data as well as the app and telephone concierge platform.

“Access to reliable, affordable transportation is essential for older adults,” says Lisa Marsh Ryerson, president of AARP Foundation. “When older adults can’t get to medical appointments or social activities, the negative effect on well-being — whether from untreated medical conditions or lack of social interaction — is enormous. This study highlights the vital connection between good transportation and good health in our communities, especially for seniors who can no longer drive.”

This research was supported by the AARP Foundation. No funding support was contributed by Lyft.

— Wendy Wolfson