Fighting cancer in the lab and at the bedside

Leading Canadian cancer researcher Prof. Karen Gelmon collaborates with Israelis to fight the comlpex disease.

By JUDY SIEGEL-ITZKOVICH
Prof Karen Gelmon 311 (photo credit: Courtesy)
Prof Karen Gelmon 311
(photo credit: Courtesy)
Physicians who not only treat patients but also conduct medical research (and usually also teach in medical schools) are too rare a breed today – in Israel and in North America as well. But there still are some of these busy, energetic and dedicated people, such as Prof. Karen Gelmon, a senior medical oncologist at the department of medicine at Vancouver’s University of British Columbia and clinical head of the investigational drug unit in her field at the British Columbia Cancer Agency (BCCA).
Amazingly, she has also published over 400 medical journal articles and writes articles in the quarterly Canadian magazine Abreast in the West for the layman/woman and anxious cancer patients on treatments, diet and other updated information. Gelmon is married to a writer and is the mother of two daughters aged 24, neither of then involved in medicine.
“Daughters of cancer doctors,” she says in an interview with The Jerusalem Post during her recent “12th or more” visit to Israel, “have a realistic expectation of life and death.”
Her first time here was in 1971 as a posthigh school volunteer at Kibbutz Hulda near Rehovot. Her latest trip was to lecture at various universities about her “translational” (from lab to bedside) cancer research. She has also conducted cancer research at Jerusalem’s Shaare Zedek Medical Center and continues to be in contact with physician/researchers there.
Gelmon was born in Saskatoon (named for the Cree Indian tribe) in the province of Saskachewan to one of the 150 Jewish families from Eastern Europe that immigrated directly to Canada (and not via New York) in the early 20th century. Her great-grandparents were tradesmen born in Russia and escaping from the pogroms. Her Canadianborn father was a dentist and her mother a social worker; her brother is involved in tropical medicine in Nairobi; one sister is a special education teacher in Vancouver and the other a professor of health administration in Portland, Oregon.
After completing an undergraduate degree in philosophy, getting a medical degree and becoming a specialist in internal medicine, in 1984 she studied oncology at the University of British Columbia and in New York State and England.
“I was just interested in it,” she says. “I wanted to know why cancer happens and what medical sense it made. Cancer crosses across many medical fields and thus is very multidisciplinary. It also has a very spiritual and humanistic side as patients and families try to cope with it.”
Cancer is not just about tumors, continues Gelmon.
“it’s about the people who contract cancer.
In my career, I have seen a lot of improvements in less-toxic treatments, and better survival rates. I have also seen an increased appreciation for cancer prevention and survivorship – the two ends of the spectrum.”
Since becoming an oncologist, she says, “there has been an explosion of knowledge in the field. There is an understanding that cancer is one word for many diseases. There are up to a dozen types of breast cancer and many more of lung cancer, for example. I always wonder how the disease will behave in the patient,” Gelmon said.
“We oncologists are now beginning to understand the genetic aspects and predict how the tumor will develop and react to treatment,” she says, pushing back her reddish curls. “That means targeted therapy. I also am involved in a number of drug trials.”
Sometimes she is at work as early as 7 a.m.
One of her main activities has been clinical research into new therapies and prognostic and predictive markers. As co-chair of the National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG), she has participated in many cooperative group trials. She has also been involved in both pharmaceutical company-sponsored research and developing and running treatment protocols. She is mainly involved in breast cancer treatment and research, but has also done work in prostate cancer, among others, including those resulting from HIV/AIDS.
She has developed strong collaborations across Canada as well as internationally, and this, she says, aids in the coordination and conduct of trials.
“But ultimately I am a clinician, and my goal is to improve the treatment of my cancer patients. Any work that I do is focused on trying to eventually introduce any new knowledge into other trials and, ultimately, care or diagnostic guidelines... Much of the work is about mentoring and collaboration as well as promoting new information.”
She usually leads Phase 1 trials [the preliminary phase of clinical trials] “because seeing them at the beginning is very exciting to me. But I also conduct Phase II and III trials.”
She has also been involved with “some very exciting studies that look at the role of exercise. We have done two large studies looking at exercise during chemotherapy to determine the effect exercise has on tolerating chemotherapy and disease outcomes, as well as to assess what kind of exercise a woman can do during chemotherapy. We have built a small gym that is really a research lab. The participating women – 100 in the most recent study – were very excited by both the exercise and the camaraderie, and it appears to have improved their recovery after chemotherapy.”
The future of cancer care is exciting, says Gelmon. Each patient has not only a unique tumor, she said, “but a unique reaction to the disease and how they are treated.
This will shape our entry into personalized medicine. There is also a better understanding of the continuum of cancer care, from diagnosis to follow-up and onwards.
And I think there will be more success in prevention strategies for people at a higher risk of developing cancer.”
Gelmon has also been involved in a number of prevention activities, including a large trial with the NCIC-CTG that reported a beneficial effect for the aromatase inhibitor chemotherapy drug exemestane (Aromasine) for actually preventing breast cancer.
“I am also involved in a new study looking at shift work and breast cancer. We are looking at biological samples of women with cancer and their breast density to try to better understand how breast cancer develops.”
The Canadian oncologist says that “we may not be able to prevent or cure all cancers, but if we can decrease the numbers of cancers that develop and improve the treatments for those that do occur – including higher cure rates – then we will have made incredible strides.”
Cancers can evolve over time.
“It may change in response to treatment or from environmental factors. We may have to customize more,” Gelmon says, “and do more fine-tuning.”
A breakthrough drug for breast cancer was trastuzumab (Herceptin). But some women still didn’t do well enough with it. Then there were Lapatinib (Tykerb) and the antibody drug pertuzamab (Omnitarg). Herceptin was then tested with Omnitarg. It improves the outlook of women with breast cancer, but there are many additional drugs, such as TDM1. It is not yet clear if all women need all drugs, she said.
“You have to know which women will be cured with chemotherapy and Herceptin [and which will] need others. There are always potential toxicities.”
Asked whether Jewish women are more likely to carry the defective BRCA genes that significantly raises the risk of breast cancer, Gelmon explains: “We have BRCA in every cell; it is the mutations than can cause cancer.
Ashkenazi Jews [have] three specific mutations. A large minority of Ashkenazi Jewish men and women carry one of these mutations. But most Jews don’t get breast cancer from BRCA mutations but from other causes.”
In Gelmon’s private practice in Vancouver, the cancers of 93 percent of the women she sees do not stem from mutations, she says, but rather from hormones, obesity and even smoking if one starts as a teen.
“In Israel, about 10% [of cases] are inherited,” she says. Thus the added risk is not very significant. “We are gradually learning more about inherited factors that cause higher risk.”
She notes that taking a family history of cancer is more difficult among Jewish children and grandchildren of Holocaust victims, because most died young and didn’t live long enough to be diagnosed with cancer.
“So you can’t trace back. There is not enough knowledge about them.”
Mutations are not just inherited but also appear spontaneously or due to environment.
Testing specifically for BRCA mutations “will soon become moot, because testing one’s whole genome will soon become so inexpensive that almost anyone will be able to get a printout,” says Gelman, who has not yet had her own genome mapped yet.
but mutations can happen in anyone, inherited and spontaneous.
When the use of hormone replacement therapy for menopausal women was drastically reduced due to cancer scares, the incidence in the US of breast cancer went down, recalls Gelman.
“Bringing down insulin levels may improve results in breast cancer patients as well. There are studies showing that taking vitamin D may also be helpful. And remember that the lifetime risk for breast cancer in women is one in nine or eight. If there were 100 90- year-old women in a room, one in nine or eight would have had it.”
The oncologist is pleased that Israel has decided to add a new drug for treating the dangerous skin cancer melanoma to the basket of medical technologies this year.
“Melanoma is a devastating disease. Early diagnosis is very important because most advanced cancers can’t be cured.”
Gelmon admires Israeli physicians, scientists and its health system. As for the Canadian health system, it is also highly praised.
“You have to be a resident for only three months, after which you get comprehensive health care.”
One pays income tax, which covers it, as the Israeli system is progressive and based on income but deducted by the National Health Insurance. Taxpayers may pay a small additional premium, which is “$1,000 per family each year. Not all drugs are covered, but people over 65 have full coverage for medications.
Cancer treatment is fully paid for if it is evidence based. A Canadian can go to any hospital and doctor in his province.”
Sixty percent of medical students are women, but many women doctors do not work full time. At present, Gelmon concludes, there are enough physicians in Canada except for the farthermost provinces, “but there is a nursing shortage everywhere.”