Tuesday, September 16, 2014

The 2014 Breast Cancer Symposium was held September 4-6 in San Francisco. This is a unique meeting as it is multidisciplinary, co-sponsored by 6 organizations: the American Society of Clinical Oncology (ASCO), The American Society of Breast Surgeons (ASBrS), the Society of Surgical Oncology (SSO), the American Society for Radiation Oncology (ASTRO), the National Consortium of Breast Centers (NCBC) and the American Society of Breast Disease (ASBD). This is a unique meeting as it brings together all of the specialists involved in treating patients with breast cancer.
As usual, this was a well-attended meeting. Many interesting abstracts were presented, and the general sessions covered timely issues related to the care of breast cancer patients. However, I did hear several patients and advocates (via twitter) who were in attendance express frustration about the lack of consensus for management of certain conditions, the focus on obesity and exercise as methods to reduce the risk of disease development and recurrence, and the lack of “real” progress.
Unfortunately, while we currently know more about breast cancer than at any other point in time, meetings like this reinforce that what we know is just the tip of the iceberg – cancer is incredibly complex. Various pathways have been identified as targets for treatment, but no one treatment will work in all patients. Targeted therapies, immune system modulators, and other novel treatments are in development, but may not come fast enough for the individual patient, especially those living with metastatic disease. Trust me, this is just as frustrating for the physicians as it is for patients. But this is also what motivates us to keep asking questions and researching, until we have some real solutions – ones that work for everyone.
Some of the topics that stood out for me:
Mammography and MRI screening: we are trying to identify which women should be screened and with what technology (mammogram, ultrasound, MRI). Personalized screening based on an individual’s risk is the ideal, but we cannot yet truly pinpoint an individual patient’s risk. Even in those with BRCA gene mutations, not all will develop breast cancer. Dr. Steven Feig discusses that personalized screening must be based on only well-established medical knowledge.
Can we identify patients with breast cancer who do not need treatment? We know that many early-stage breast cancers, especially ductal carcinoma in-situ (stage 0 breast cancer, or DCIS) will never progress to invasive disease, and are not a threat to a woman’s breast or life. DCIS Treatment vs. Observation was the subject of a debate between Drs. Henry Kuerer (MD Anderson) and Shelly Hwang (Duke University). Both surgeons made excellent points, but in the end, there was no consensus on how to identify an individual patient who would not progress without treatment. The best we can do right now is use assessments of tumor biology, volume of disease, and patient factors to help guide discussions with our patients.
An excellent talk was given by Dr. Susan Boolbol (Mount Sinai Beth Israel in New York) on genetic testing. A key point made is that all cancer is genetic, but not all cancer is hereditary. All cancers have at their core a mutation in one or more genes, but not all cancer-inducing mutations are passed down from one generation to the next.  Approximately 5-10% of breast cancers are hereditary; the majority are sporadic. Taking a thorough family history is essential to provide a cancer risk assessment, to identify other family members who may be at increased risk, and to recommend risk management options such as increased surveillance, genetic testing, chemoprevention and prophylactic surgery.
Red flags for hereditary breast cancer –
-       3 or more family members with the same or similar type of cancer
-       2 or more generations affected
-       1 or more cancers diagnosed before age 50
BRCA 1 and 2 are the most common DNA repair genes; there are 2 copies in each cell. When one copy of BRCA 1 or 2 is defective, other malignant DNA mutations (which occur from time to time for various reasons) cannot be repaired, which leads to uncontrolled cell reproduction and cancer growth.  Approximately 1 in 500-800 patients in the general population are estimated to have a BRCA 1/2 mutation; in patients of Ashkenazi Jewish ancestry, approximately 1 in 40 may carry a mutation.
When possible, the family member who has had cancer should be tested, and if a mutation is found, then other family members can undergo targeted testing. If testing is negative, counseling is still required as it can have a variable meaning depending on the overall family history. The risk of breast and ovarian cancer development depends on the specific mutation as well as the age of the patient.  Contralateral (opposite side) breast cancer incidence is increased, and is also related to age of the patient and her age at initial diagnosis.
Dr. Boolbol touched on the 2013 Supreme Court decision regarding gene copyrights. This has increased the number of companies offering genetic testing.  Many companies now offer extended panel testing, as it is recognized that other gene mutations may also be responsible for breast cancer development. However, guidelines for treatment do not necessarily exist for many of these other mutations (such as PALB2). An additional caution in evaluating any genetic test results is that an abnormal test may not necessarily indicate an increased risk of developing breast cancer. Some of the mutations detected (including in the BRCA 1/2 genes) may be variants of unknown significance (VUS) which may or may not lead to an increased risk of breast and/or other cancers.  It is important for patients undergoing genetic testing to have thorough consultations with their physicians and/or a genetic counselor, as “not all genetic mutations are created equal”.
Dr. Banu Arun from MD Anderson discussed the management of patients with hereditary mutations or who are otherwise considered to be high-risk.  Options include surveillance / screening, prophylactic surgery, and chemoprevention.
For surveillance / screening, clinical breast exams (an exam by your physician) is recommended every 6-12 months starting around age 25. Annual MRI is recommended from age 25-29 (mammogram if MRI not available), annual mammogram and MRI age 30-75, and after age 75 individualized management is recommended.  These recommendations may change depending on a relative’s age at diagnosis. Note that at this point, the 2014 NCCN guidelines do not specify the use of screening ultrasound although it is often used.
Preventive mastectomy can reduce the risk of breast cancer by >95%. Patients already diagnosed with breast cancer  may have as high as a 65% risk of developing a contralateral breast cancer which is why bilateral mastectomy is often recommended. A bilateral salpingo-oophorectomy (BSO – removal of the ovaries and fallopian tubes) can reduce the risk of breast cancer by 50%, and is ideally performed between age 35-40 (for maximum breast cancer risk reduction).  BSO is also associated with a 95% reduction in the risk of developing ovarian cancer.
75% of BRCA1 related breast cancers are ER negative; 58% are triple negative. Studies evaluating tamoxifen for chemoprevention in BRCA positive patients have conflicting results.
Dr. Ann Partridge from Dana Farber discussed the non-medicinal approach to risk modification. Opportunities to modify risk factors include reducing exposure to environmental toxins and health behaviors. Much of the research to date has focused on individual points in time, but current research is focusing on the exposure a woman faces over her lifetime.
Modifiable exposures include radiation exposure, exposure to contributor chemicals, combination hormone replacement therapy, active / passive smoking, alcohol intake, and diet.
Exercise and weight control are crucial to helping to reduce the risk of breast cancer – we’ve all heard this many times, but the evidence continues to grow. Clearly this is not the only factor – we all know women who exercised regularly and still developed breast cancer – but it is important. The benefit appears to be with 3+ hours of moderate paced walking per week. No studies have looked at survival benefits to weight training, but weight training does help with overall weight maintenance.
Interestingly, a low body mass index (BMI) as a young adult or premenopausal woman is associated with an increased breast cancer risk, yet in postmenopausal women, an elevated BMI is associated with an increased breast cancer risk. The reasons are unclear, but Dr. Partridge did not recommend that premenopausal women gain unhealthy amounts of weight!
It’s very challenging to study nutrition and cancer. Many food items are inter-related, and nutrition is often related to weight and other health behaviors.  Long-term dietary habits are more important than short-term, and she reinforced that the concept of a “magic bullet” is not likely. She also cautioned about over-interpreting the results of small nutritional studies.  Regarding alcohol, there does not seem to be any increased risk of breast cancer with consumption of <3 drinks per week, but increased consumption is associated with an increased risk.
The metastatic breast cancer tumor board was also a good session. As with the other sessions, there was no true “news”. However, it was a good example of the multidisciplinary discussions that we all have with our colleagues in order to decide what treatment options are best for an individual patient.  Dr. Ben Anderson (a surgical oncologist with Seattle Cancer Care Alliance) also stressed that the patient needs to be treated, not the disease – we need to work with our patients to get their thoughts on quality of life and symptom control, and then tailor our treatments to their preferences.
Finally, I had the opportunity to present the #BCSM research as a poster. Based on the survey earlier this year, we found that knowledge regarding various aspects of breast cancer increased, and anxiety was diminished. Obviously these are the results as a whole, and as they say, “individual results may vary”.  I believe we have a lot to do to improve this community, but these results tell me that we’re on the right track.

Monday, September 15, 2014

Mentoring for new cancer survivors

By Sheryl M. Ness, R.N. June 22, 2013
This week, I'd like to put a call out to all of the veteran cancer survivors who are reading and participating on the blog. One of the primary goals for the blog is to support and reassure each other on this journey.
My question to you is this: "What do you know today that you wish you'd known in the beginning as a new cancer survivor?"
We frequently partner mentors with newly diagnosed cancer patients in person. I thought it would be interesting to try virtual mentoring through this discussion.
If you're interested in posting your pearls of wisdom for other survivors, keep a few things in mind as you write your comments.
In the first year after diagnosis:
  • What did you experience that was most unexpected?
  • What about your emotions in the first weeks and months? It's OK to talk about the negative feelings too — that way everyone knows this is a normal experience.
  • What was the most difficult experience of the first year? What helped you get through?
Everyone's experience is unique — however, it can be a great comfort to hear from others who've already been down the path yet to come. Please share your words of support and wisdom.
Follow me on Twitter at @SherylNess1. Join the discussion at#livingwithcancer.

Thursday, September 4, 2014

I'm on my third round of chemotherapy, and I've been diagnosed with anemia. I feel very tired and weak. Why does chemo cause anemia? Is there anything I can do to feel better?

Answers from Timothy J. Moynihan, M.D.
Your bone marrow makes blood cells, including red blood cells. Chemotherapy can damage your bone marrow. When this happens, your body makes fewer red blood cells or destroys them before their normal life span is over.
Your body's ability to produce platelets — a blood cell that plays an important role in forming clots — also may decrease, so you're more likely to bleed, further reducing your red blood cell levels.
Your red blood cells contain an iron protein called hemoglobin, which carries oxygen from your lungs to the rest of your body. Anemia means you have too little hemoglobin, so parts of your body aren't getting enough oxygen, which is why you feel tired and weak a lot.

What you can do

Consider the following step to help manage your anemia.
  • Talk to your doctor. Ask about getting a blood transfusion or certain medications to increase production of red blood cells, which can relieve your anemia.
  • Prioritize your tasks. Do only the most important ones. Let your family and friends help with other tasks.
  • Get plenty of sleep. Aim for at least eight hours a night. Take short naps during the day.
  • Eat well. Foods high in iron such as red meat and leafy greens are good choices.

What's taboo to you as a cancer survivor?

By Sheryl M. Ness, R.N. August 28, 2014
This week, let's talk about taboo topics. As a cancer survivor, you probably have certain topics that are taboo to either you, or your family and friends.
Taboo topics aren't easy to talk about. A few that come to my mind are diagnosis, prognosis, recurrence, and end-of-life discussions. Others include sex, body image, and feelings of guilt and loss. Perhaps you're returning to work after treatment and you need a way to update your co-workers on how you're doing.
Taboo topics are difficult to think about, talk about and confront. However, they're probably the ones that cause a lot of emotional pain or anxiety if you have no way of talking about them. This is true for both a person living with cancer and their family and close friends. We worry about each other, this is a natural reaction. We also have fear and anxiety over things that we can't control.
So, how do you bring up taboo topics?
One way is to first write out your thoughts so that you have a way of putting words to your feelings and emotions. Next, reflect on what you wrote, and next to each concern, identify one way that those around you might help you with the concern. Also think about what you can do to address the fear or concern on your own.
Practice bringing up the topic, like you would when you're with the other person. This is a practical way to lessen the fear and anxiety when the time comes to talk about it for real.
Many times, the people around you who love and care about you are waiting for a cue from you, to let them know it's OK to talk about the subject. Once you open up, you may find that they're ready to talk about it and provide the support you need. If you never bring it up, they may think you aren't worried about it or are also too afraid to bring it up.
What's taboo to you? Share on the blog the topics that you've found difficult to bring up to others around you. This is the perfect, safe place to talk about it with others who are probably feeling the same way. What worked best for you?

Tuesday, September 2, 2014

Patient Voices: Pancreatic Cancer


Patient Voices: Pancreatic Cancer

It is estimated that 5 percent of patients diagnosed with pancreatic cancer survive past five years. What is it like to be faced with such statistics? To survive? Here, in their own words, are the experiences of seven men and women. (Join the discussion here. )

Saturday, August 30, 2014

'Strikingly Effective' Approach for Depression

in Cancer Patients

Roxanne Nelson
August 28, 2014

A new integrated program for treating depression in cancer patients is reported to be "strikingly more effective" at both reducing depressive symptoms and improving quality of life than the current standard of care. The new approach, known as Depression Care for People with Cancer (DCPC), was tested in 2 clinical trials: the SMaRT-2 study, reported in theLancet , and the SMaRT-3 study, reported in the Lancet Oncology.
The integrated collaborative care model that was tested in these trials utilized a team of specially trained nurses, primary care doctors, and psychiatrists and showed that this strategy can greatly improve outcomes for depressed patients with cancer compared with usual care, David Kissane, MD, head of psychiatry for Monash University, Victoria, Australia, writes in an accompanying commentary in the Lancet Psychiatry.
"The approach used in the SMaRT Oncology trials combined with systematic screening provides an outstanding model of how to begin to deliver this much-needed care for patients with cancer everywhere," he says.
The commentary accompanied a new analysis published in theLancet Psychiatry showing that the majority of cancer patients (73%) with depression are not getting any treatment for their depression, as reported by Medscape Medical News.
This finding comes from a study of 21,000 cancer patients using clinics in Scotland, which found that major depression is substantially more common in cancer patients than in the general population. These symptoms were most commonly observed in lung cancer patients (13%) and were the least common in genitourinary cancer patients (6%).
Unrecognized and untreated depression in patients with cancer shortens survival, harms quality of life, and increases risk for suicide...Dr. David Kissane
"If unrecognized and untreated depression in patients with cancer shortens survival, harms quality of life, and increases risk for suicide, a compelling case emerges for using both screening and an integrated collaborative model of depression management," Dr. Kissane noted.
New 'Strikingly Effective' Protocol
One of the clinical trials that tested the new DCPC protocol was the SMaRT Oncology-2 randomized trial, which found that at 6 months, significantly more of the patients who received DCPC responded to treatment (with at least a 50% reduction in the severity of their depression) compared with those who received usual care. The overall response to treatment was 62% with DCPC vs 17% with usual care (< .001).
"The huge benefit that DCPC delivers for patients with cancer and depression shows what we can achieve for patients if we take as much care with the treatment of their depression as we do with the treatment of their cancer," lead author Michael Sharpe, MD, from the Department of Psychiatry, University of Oxford, United Kingdom, commented in a statement.
Dr. Sharpe and colleagues compared the effectiveness of the DCPC for major depression in cancer patients with usual care. The integrated program is delivered by a multidisciplinary group working in collaboration with the patient's cancer team and general practitioner. The program includes both pharmaceutical and psychological therapy.
The study included 500 adults with major depression as well as cancer who had a good prognosis (predicted survival of longer than 12 months). The patients were randomly assigned to receive either DCPC or usual care. Treatment for the usual-care group consisted of informing the patient's primary care physician and oncologist of the major depression diagnosis; they were then asked to treat the patient under normal protocol. In the United Kingdom, this might mean antidepressant drug therapy or a referral to mental health services, the authors note.
When compared with those in the usual-care group, participants in the DCPC arm had less depression, anxiety, pain, and fatigue; and better functioning, health, quality of life, and perceived quality of depression care at all time points (all < .05).
During the study period, there were 34 cancer-related deaths (19 in the DCPC group and 15 in the usual-care group). In addition, 1 patient was admitted to a psychiatric ward, and 1 attempted suicide. Although both were in the DCPC group, the events were not deemed to be related to the trial treatments or procedures.
Effective for Good- and Poor-Prognosis Patients
The other trial, SMaRT-3, evaluated a version of DCPC that was specifically adapted for patients with cancer who had a typically poor prognosis. For this study, lead author Jane Walker, MBChB, PhD, a consultant psychiatrist at the University of Oxford, and colleagues randomly assigned 142 patients with primary lung cancer and with a predicted survival of at least 3 months to DCPC (n = 68) or usual care (n = 72).
The DCPC arm and the usual-care arm followed protocols and care similar to those followed in the SMaRT Oncology-2 study. The primary outcome was depression severity (on the Symptom Checklist Depression Scale [SCL-20], range 0 - 4) averaged over the patient's time in the trial (up to a maximum of 32 weeks).
Of this group, 43 (30%) of the patients had died of cancer-related causes by 32 weeks. Outcome data were based on 131 (92%) of the cohort (59 in the group receiving depression care for people with lung cancer and 72 in the usual-care group).
The authors found that the average depression severity was significantly lower in the DCPC group (mean score on the SCL-20, 1.24 [SD, 0.64]) than in those who received usual care (mean score, 1.61 [SD, 0.58]; difference, -0·38). The self-rated depression improvement, anxiety, quality of life, role functioning, perceived quality of care, and proportion of patients achieving a 12-week treatment response were also significantly higher among patients in the DCPC group, compared with usual care.
"Patients with lung cancer often have a poor prognosis," said Dr. Walker in a release. "If they also have major depression, that can blight the time they have left to live. This trial shows that we can effectively treat depression in patients with poor-prognosis cancers like lung cancer and really improve patients' lives."
Both studies were funded by Cancer Research UK and Chief Scientist Office of the Scottish Government. None of the authors or the editorialist have reported any relevant financial relationships.
Lancet. Published online August 28, 2014. Abstract
Lancet Oncol. Published online August 28, 2014. Abstract
Lancet Psychiatry. Published online August 28, 2014. Commentary

Friday, August 15, 2014

Breast Cancer Chemotherapy Varies Widely: Study Raises Questions About Early Treatment Choices

Last month, the Journal of Clinical Oncology reported that six chemotherapy regimens commonly given to patients with early-stage breast cancer vary widely in their side effects. The researchers found that some drug combinations are more likely to lead to hospitalization than others.
The finding, while hardly surprising, points to the value of patients and doctors having fuller discussions about chemotherapy choices. An accompanying editorial emphasizes that because most patients are likely to live for a long time after initial therapy for breast cancer, and options abound, chemotherapy decisions should be more granular than is typical in practice.
The takeaway is that major differences exist among chemotherapy regimens that are routinely given to patients with early-stage breast cancer. Taking “it,” chemotherapy, is not an all-or-none decision.
This matters because over 230,000 people – almost entirely, but not exclusively women – will receive a new breast cancer diagnosis this year in the United States. Most will have early-stage disease. And while many of those individuals will consider if they should have chemotherapy, or not, very few will ask their oncologists details about specific drug combinations.
Their hesitation is understandable. The chemotherapy regimen names sound like gobbledygook, acronyms loaded with A’s for Adriamycin (aka doxorubicin), C’s (cyclophosphamide), T’s (docetaxel, a taxane most often branded as Taxotere) and P’s (paclitaxel, another taxane, aka Taxol). Yes, it gets confusing. The drugs can be given in different combinations, at distinct doses and frequencies, such as every two weeks, or every three weeks. There are many permutations. This is the kind of thing that oncologists study, and patients rarely know much about before beginning treatment.
But maybe they should. Recent articles point to the fact that patients may be legitimately concerned about the costs of various cancer treatment options. Some suggest that doctors should somehow know or find the answers to their reasonable financial questions. But what about the physical, health-related side effects of the drugs?
The new study looked at various combinations of what’s called adjuvant – or extra – therapy for breast cancer after surgery. As reviewed in the paper, multiple randomized controlled studies have established that giving chemotherapy to a newly-diagnosed patient, after surgery for an invasive tumor of at least a certain size, lowers the chances that it will spread or otherwise recur.
The main finding was that for women under age 65 with early-stage breast cancer, the rate of hospitalization for chemotherapy-related problems ranged between 6 and 10 percent. The differences between regimens were statistically significant. In older women the hospitalization rates were significantly higher for all regimens evaluated, ranging between approximately 13 and 24 percent.
As the authors consider, the probability that patients will develop side effects may be predicted, in part, by their age and other health problems, besides which drugs they’re prescribed and the doses given. Taxotere, for instance, has become a more popular drug in recent years and tends to cause neuropathy. Adriamycin, an older drug used for treating many cancer types, may cause heart problems and lower blood counts, sometimes dangerously. Like other chemotherapy drugs in its class, Adriamycin slightly raises the recipient’s chances of developing leukemia later on, especially if it’s given in combination with radiation therapy.
English: Six bottles of different types of can...
Six bottles of different types of cancer drugs (source: Wikipedia, adapted from a National Institutes of Health image)
My intention is not to outline all the possible side effects of these drugs, but to give the reader a sense of how loaded a topic this is. It’s hard for a patient, however well-educated, to know what questions to ask.
To carry out this retrospective analysis, which was admittedly limited in its scope, the investigators culled information for patients with Stage I, II or III breast cancer found between 2003 and 2007. They used two databases: one for those over age 65 (a Medicare-linked registry) and those under 65 years (MarketScan). Based on coding for diagnoses, chemotherapy drug bills and hospitalizations, the researchers determined when patients who received certain drug combinations entered the hospital within six months of treatment.
Hospitalization, per se, is usually a short-term side effect and was the only measured outcome in this study. Neutropenia, meaning a low white blood count, when accompanied by fever is another immediate toxicity of some chemotherapy regimens and is relatively straightforward to assess. Mouth sores and hair loss, and nausea, happen during treatment and then go away. But things like frailty, or depression, or long-term cognitive defects, neuropathy – those can be harder to measure and know.
This paper doesn’t cover newer drugs typically given in Her2 positive cases, sometimes in combination with the older “A” “C” and “T”-like chemotherapies. And it’s worth noting a shift in recent years toward prescribing endocrine treatment, sometimes without chemotherapy, for women with hormonally- sensitive small tumors. The study doesn’t examine toxicities of anti-estrogens, like Tamoxifen, or aromatase inhibitors, of which there are several on the market. But they, too, have significant side effects, some subtle, which warrant detailed evaluation.
Whether a patient gets “AC,” as I did eleven years ago, or “T+AC,” or “dose-dense AC + P” or a newer regimen may seem like a trivial decision to an oncologist who gives these drugs to women with early-stage breast cancer like butter on bread, algorithmically based on his or her community’s local practice. But the differences in outcomes – over the long and short term – are worth examining further.
My conclusion is that this retrospective analysis doesn’t offer enough information, in itself, to guide any woman’s decision about chemotherapy. Or a doctor’s advice. But it suggests that we should collect more nuanced data, over years and decades, about how women fare after treatment for early-stage breast cancer.

Wednesday, August 13, 2014

Synthetic molecule uses salt to trigger self-destruction of cancer cells

August 13, 2014
A team of international researchers has developed a new synthetic molecule that triggers s...
A team of international researchers has developed a new synthetic molecule that triggers self-destruction of cancer cells using salt (Photo:Shutterstock)
A team of international researchers has developed a molecule capable of triggering cancer cell death by carrying chloride into cancer cell membranes. The molecule flushes the cells with salt and causes them to self-destruct, potentially paving the way for new types of anti-cancer drugs.
The international effort involves researchers from the UK, Texas and South Korea who have collaborated to develop a synthetic ion transporter with a chloride payload. Once it reaches the cancer cells, the chloride interacts with the sodium in the cell membranes and leads to its demise.
"This work shows how chloride transporters can work with sodium channels in cell membranes to cause an influx of salt into a cell," says the University of Southampton's Professor Phillip Gale, one of the study's co-authors. "We found we can trigger cell death with salt.”
The survival of cells in the human body is reliant on the regulation of ions inside their membranes. Upsetting the balance causes them to self-destruct through what is known as apoptosis, a mechanism the body uses to dispose of dangerous or damaged cells.
We have seen apoptosis form the basis of a number of cancer researchefforts. The most recent being a cloaked DNA nanodevice that evades the body's immune system to hone in on leukemia and lymphoma cells to activate the suicide switch. The chloride-carrying molecule is the first to demonstrate the effects of salt on cancer cells, however, with the researchers also claiming it could bring benefits to sufferers of cystic fibrosis.
The molecule works by binding to the chloride ions in the cell's membranes. It then draws on the membrane's sodium channels, creating a blanket surrounding the ion and causing it to dissolve. The researchers first found this to be effective in a model with an artificial membrane, a team from South Korea's Yonsei University then tested its efficacy in cultured human cancer cells. An important finding was that the cell's ion balance was disrupted prior to the death of the cell, rather than resulting from the apoptotic process, indicating it was indeed the chloride payload causing its death.
"We have thus closed the loop and shown that this mechanism of chloride influx into the cell by a synthetic transporter does indeed trigger apoptosis," said Professor Jonathan Sessler from the University of Texas and one of the study's co-authors. "This is exciting because it points the way towards a new approach to anticancer drug development."
One complication the researchers will have to overcome for its molecule to be used in cancer treatments is limiting it to cancerous cells. As it stands, the molecule triggers the death of both cancerous and healthy cells so the team will need to modify the synthetic transporter to bind only to the more cancerous ones.
The team's research was published in the journal Nature Chemistry.