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New Jersey hospitals continue to move ahead with new cancer treatments. By thinking out-of-the box, they’re moving beyond traditional radiation or chemotherapy treatments, using bold approaches that include immune cell therapy, which enlists individuals’ own cells to fight the deadly disease.

“Immune-cell therapy begins by collecting immune cells from your blood,” explained Dr. Eric Whitman, medical director of Atlantic Health System‘s Oncology Service Line. “Those cells are then taken to a lab, modified, and returned to the individual to spur their immune system to more effectively identify, target and knock out cancer. It’s a big shift, as Atlantic Health and other cancer centers are increasingly moving from traditional chemotherapy to immune-cell therapy.”

Another major advance is genetic therapy, which involves inserting genes into cancer cells — usually through a controlled virus — making it easier for chemotherapy, radiation therapy, or hormone therapies to attack cancer cells. “Some types of cancer, including colon and rectal cancer, have responded extremely well to genetic therapy,” Whitman added. “Other advances include cellular therapy, like CAR T, which is offered at Morristown Medical Center and is designed to improve the ability of a person’s immune system to fight cancer. This involves collecting certain sets of cells from the blood, modifying them to attack cancer, and then reinjecting them into the patient.”

Traditionally, he noted, cancer was treated by either using radiation to kill it or by cutting it out of a patient’s body. “But now we have a greater understanding of the genetics behind cancer — and how they target cells and how they hide from the immune system — so we can treat the disease in a manner that is even more effective. Along with these advances, robotic surgery and improvements in radiation therapy, and cutting-edge biotech research offer even more hope for cancer patients.”

Broad gains

Other health care professionals pointed to a variety of advances in their fields. In recent years, there have been several developments in breast and gynecologic cancers, said Dr. Eleonora Teplinsky, head of breast medical oncology at Valley-Mount Sinai Comprehensive Cancer Care. “We continue to move toward a personalized approach to cancer treatment and away from a ‘one size fits all’ model. We have seen the approval of pembrolizumab, an immunotherapy drug, in the treatment of early-stage triple negative breast cancer, which is an aggressive form of breast cancer.”

She added that other new treatments also offer hope. “Trastuzumab deruxtecan is an antibody drug conjugate [biopharmaceutical drugs that target cancer cells while sparing healthy ones] approved for use in HER2-positive metastatic breast cancer and, most recently, the DESTINY-Breast04 Trial demonstrated efficacy for this drug in HER2-low metastatic breast cancer, fundamentally changing our treatment paradigm and impacting survival for 50% of all patients with metastatic breast cancer. In gynecologic cancer, there is increasing research with targeted therapies such as antibody drug conjugates and PARP inhibitors [blocking PARP, an enzyme, may help prevent cancer cells from repairing their own damaged DNA, causing the cancer cells to die] in ovarian cancer to decrease cancer recurrence and improve outcomes.”

Today, more research is focused on a personalized approach to cancer therapy, Teplinsky added. “More and more, we are using molecular testing to determine which patients will benefit from treatment and which will not. A personalized medicine approach helps us to identify where we can de-escalate care and also where we need to escalate care. We are seeing increased research and use of circulating tumor DNA technology, a new, promising non-invasive tool to detect cancer cells and biomarkers in the blood stream — which in some cases is also known as ‘liquid biopsy.’”

Dr. Matthew Puc, program director of the Penn Medicine Virtua Cancer Program in Voorhees, is “excited by the steady decrease in the rate of cancer deaths, thanks to a series of advances like targeted therapies and genomic testing.” Traditional treatments like chemotherapy and radiation, for example, are no longer the only options, notes Puc, who is also a thoracic surgeon at Virtua Health.

“Thanks to advances in treating specific targets such as an EGFR (epidermal growth factor receptor) mutation — which may be found at high levels on some types of cancer cells, causing them to grow and divide — we may be able to block the process with inhibitor pills that may keep cancer cells from growing,” said Puc. “The use of these pills and other treatments is exploding at Virtua and other cancer-treatment sites, and we’re seeing month-to-month advances.”

Other initiatives include immunotherapies and minimally invasive robotic surgery. “It offers smaller incisions with less post-operative pain, which leads to a faster recovery,” Puc noted. “Significant advances also include liquid biopsy, which, in certain cases, enables us to test tumors with the patient’s blood instead of taking a sample of the tumor itself. This emerging approach is less invasive and allows clinicians to take more samples over a period of time, compared to a traditional biopsy,” he added.

A South Jersey first

In an advance for the South Jersey area, Virtua Health will open the region’s “first proton therapy center this October, in partnership with Penn Medicine,” according to Puc. He described proton therapy as a “newer type of radiation treatment that delivers more focused radiation to the tumor, thus sparing the surrounding healthy tissue. Proton therapy can treat a variety of cancer types, including brain cancer, breast cancer, and lung cancer, among others.”

Virtua Health is also expanding “mind-body connection” initiatives, added Puc, highlighting acupuncture, meditation, and massage therapy as beneficial options for relieving stress and pain. “Equally important is our ‘nurse navigator’ program, which offers personal assistance, online or by phone, in scheduling appointments, coordinating lab or radiology tests, and connecting patients to all of the relevant support services Virtua offers through the Penn Medicine Virtua Cancer Program. This helps to guide patients to the exact care they need, when they need it.”

The list of innovative approaches to cancer treatment includes image-guided surgery, which provides a more precise way to localize tumors and spare healthy tissue using fluorescence, according to Dr. Steven Brower, medical director of the Lefcourt Family Cancer Treatment and Wellness Center at Englewood Health. “Fluorescence is a lifesaving imaging tool that lights up tumors and cancer cells as well as nerves and other anatomical features for easy identification.”

The use of robotic and minimally invasive surgical techniques has also “greatly impacted cancer treatment, resulting in shorter hospital stays, quicker recoveries, and better outcomes for patients,” he added.

In fact the overall approach to disease prevention and treatment is changing, as more health care providers adopt an approach known as “precision medicine,” Brower noted. “Precision medicine takes into account a patient’s genes, environment and lifestyle, and customizes medical decisions based on that information. The Lefcourt Family Cancer Treatment and Wellness Center at Englewood Health has applied precision medicine initiatives to the treatment of cancer and seen great progress using targeted therapies and immunotherapy, which have been incredibly successful in treating some of the most complex cancers such as lung cancer, head and neck cancer, bladder cancer, and non-Hodgkin’s lymphoma.”

The Lefcourt facility recently launched a “tumor board,” or group of cancer experts that meets regularly, that focuses on examining the unique genetic pathways of individual tumors. “This has greatly improved our ability to tailor treatments to specific patients,” said Brower. “Our weekly roundtable includes medical professionals who gather to discuss new patients. At the table sit experts in medical, surgical and radiation oncology, as well as experts in genetics, survivorship, and pain management. Specialists in all types of cancer are present to discuss thoroughly the best and most precise options for patients. Personalized care plans are developed for cancer treatment and recovery that improve individuals’ quality of life and reduce the risk of secondary cancers.”

A new spin on early screening and diagnosis could prompt more patients to take those life-saving steps, noted Dr. Andre Henri Goy, who leads the John Theurer Cancer Center at Hackensack Meridian Health‘s Hackensack University Medical Center.

“It is estimated that up to two-thirds of cancer diagnosis and deaths were in patients that were not originally screened,” he said. “Screening is essential. Current screening tests include mammography, pap smears, colonoscopies and more. Also, for the most important killers such as lung, pancreatic and ovarian cancer, the diagnosis is typically too late. Over 80% – 90% of cancer can be cured if it is diagnosed at an early stage. Unfortunately, only 3% of heavy smokers, for example, are taking advantage of lung cancer screening. This is due in part to the fact that traditional cancer screening procedures can be inconvenient for patients; so we’re trying to make the screening process easier and less complicated for patients.”

One way is with relatively simple noninvasive “cell-free DNA” blood tests, which are easily performed and have the potential to detect cancer biomarkers years before conventional diagnostic approaches. “The blood samples from patients are tested using next-generation genetic sequencing, which is a highly sensitive technology and can now be done on both DNA and RNA, as we do at the John Theurer Cancer Center,” Goy said.

The John Theurer Cancer Center and other institutions are also focusing on using liquid biopsies in a post-treatment setting to see if there is residual disease after initial treatment. “Even if a patient is in complete remission, they may still have MRD, or Minimal Residual Disease where a small number of cancer cells are left in the body after treatment,” Goy cautioned. “The patients typically relapse, providing an opportunity in the future to develop strategies to prevent recurrence and improve outcomes.”

But advanced techniques may help to uncover hard-to-detect MRDs. “For example, next-generation genetic sequencing may help us detect minimal residual disease that cannot be observed under a microscope,” explained Goy. “With an aging population and increased incidence of known cancer risk factors, the incidence of cancer worldwide is expected to increase by 75% in the next 25 years, and early detection will be key to ensuring that this increase does not lead to a proportionate increase in the number of unnecessary deaths.”

The connection

An increasing number of health care professionals acknowledge that effectively treating cancer means focusing on a patient’s mind, as well as their body.

“An integrative approach to cancer care is critical,” Teplinsky said. “It can help decrease the risk of cancer recurrence, improve other health outcomes such as cardiovascular health and mental health. At the Valley Health System Breast Center, we have created the SHINE Program (Survivorship and Health Interventions in Nutrition and Exercise). The SHINE Program focuses on incorporating the three pillars of nutrition, exercise and community to address care for the whole person, empowering individuals to live their healthiest lifestyle both during and beyond cancer. A diagnosis of cancer is life-altering and we believe that patients cannot and should not have to go through treatment alone. We incorporate our patients’ families and support systems into all aspects of their cancer care.”

Atlantic Health System is another medical institution that’s exploring mind-body connections as part a holistic approach to treating cancer, according to Lydia Nadeau, executive director of AHS’ Oncology Service Line. “We’ve been placing more emphasis on bringing family members into the decision-making process,” she said. “At Atlantic Health, we’ve also integrated massage therapy, reiki (a Japanese form of energy, or hands-on healing), and a variety of support groups — all at no cost to patients — into our medical programs.”

The health care institution has also embraced support groups — currently conducted on a virtual basis, due to COVID concerns — and employs a full-time music therapist and licensed social workers to help patients deal with stress reduction. “We offer a variety of programs designed to help patients relax, cope and reduce stress through activities like journaling, drumming, and mindfulness-based meditation,” Nadeau added. “We continue to keep up with the latest research that enables us to improve the experience for patients, one person at a time.”

This kind of expanded view has also been embraced by the Graf Center for Integrative Medicine at Englewood Health, where “We are reimagining what wellness looks like through a holistic approach, focusing on the mind and body as one,” Lefcourt’s Brower said. “Led by a physician, our center’s team of licensed and/or certified practitioners offers evidence-based services to promote prevention, recovery, and support in a safe, comfortable environment. Our services can help minimize nausea, reduce pain, lower blood pressure, and relieve stress and anxiety—all of which are hugely important during cancer treatment.”

The Graf Center offers acupuncture, massage, reiki, guided meditation, yoga classes, and smoking cessation programs on the hospital campus. “Spiritual, emotional, and social support are also made available to patients,” said Brower. “The goal is to care for the whole person — mind, body, and soul — not just to treat the disease.”

Editor’s note: This story was updated at 2:58 p.m. EDT on Aug. 5, 2022, to include remarks from Dr. Andre Henri Goy, chairman and executive director of John Theurer Cancer Center at Hackensack Meridian Health’s Hackensack University Medical Center.