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Sanford researchers helping to bring cancer care into new era

Childhood cancer researcher Dr. Sam Milanovich Submitted photo

SIOUX FALLS, S.D.—The most common cancer in children is leukemia and in 90 percent of the cases treatments are successful.

It's the other 10 percent that bothers physicians and scientists such as Sanford Research Center researcher Dr. Sam Milanovich, who grew up in western North Dakota. He's glad to be back on the Northern Plains to help in the fight to reach a goal of 100 percent success in leukemia treatment from his study area at the Sioux Falls facility.

"Survival rates are much higher, but our goal is 100 percent," said the son of a former basketball coach at Dickinson State University. He studied at the University of North Dakota in Grand Forks and Augustana University in Sioux Falls before moving on to residencies and oncology work in Pittsburgh and Milwaukee.

With clinical trials and studies making strides on many fronts in the fight against cancer and possibly a new era in cancer care arriving, Milanovich said pediatric cancer is still somewhat rare.

But when it hits a family, it's devastating.

Milanovich, who still sees patients while doing his research, said investigations into childhood cancer on the national level involves a rather cooperative and close-knit group who often know each other.

"We even work with contacts in Europe," he said.

In the Dakotas, there are four Sanford Health pediatric cancer specialists in South Dakota and the same number in North Dakota.

And although some cases don't end up in success, there are many efforts underway in the Dakotas to find the best treatment options available.

Genetic testing and using a person's own immune system to fight cancer cells are promising studies underway.

In the genetic testing area, Milanovich said the advancements include testing the DNA of not only the patient, but also the tumor to find the best possible medicine or treatment, and to better understand the genes involved.

"This is a big deal," he said. "We can tailor treatments using the DNA."

If lower levels of chemotherapy are used, that's also a big benefit to lower the toxic side effects and also prevent long-term health problems.

By using the DNA, that treatment can be more precise and do a better job of killing the cancer cells.

Then there's immunotherapy, which is offering promising and meaningful results in the cancer fight.

Immunotherapy is treatment that uses parts of a person's immune system to fight cancer by stimulating a person's own immune system to work harder or smarter to attack cancer cells, or giving a patient's immune system components such as man-made immune system proteins.

Some components boost the body's immune system in a general way. Others help train the immune system to attack cancer cells specifically.

Just this past week, weeks ahead of schedule, U.S. Food and Drug Administration regulators approved a revolutionary new treatment from Novartis that modifies the body's immune-system cells and reinjects them to treat, and in many cases cure, patients with deadly blood cancers who have run out of other options.

Known as CAR-T therapy, the Novartis treatment is the first of several such drugs under development or review.

"We're entering a new frontier in medical innovation with the ability to reprogram a patient's own cells to attack a deadly cancer," FDA Commissioner Scott Gottlieb said in a statement. "New technologies such as gene and cell therapies hold out the potential to transform medicine and create an inflection point in our ability to treat and even cure many intractable illnesses."

The treatment will be sold under the name Kymriah, and is approved for children and young adults up to age 25 with cancers that don't respond to traditional treatment, or who are suffering from a second relapse, a broad indication that will give more patients access to the novel technology.

With the treatments available now, fewer than 10 percent of patients with the relapsed, hard-to-treat leukemia are alive five years after diagnosis. In a trial of Kymriah, 83 percent of 63 patients with the hard-to-treat disease were in remission within three months, according to Novartis.

"It shows a lot of promise," said Milanovich, who noted that Sanford doesn't offer the CAR-T therapy. He said doctors there can steer patients to other clinical trials or treatments across the country.

Numerous studies are underway at Sanford involving cancer research. For example, one clinical trial announced last spring at locations in Sioux Falls, Fargo and Bismarck is examining whether FDA-approved medications for one cancer can effectively treat another.

While the studies go on, Milanovich said that progress in some areas is incremental.

"We can learn something then that leads to 10 more questions," he said.

But he does know that children undergoing treatment at the Sanford Children's Hospitals in Sioux Falls and Fargo are one resilient group.

"They are tougher than adults sometimes," he said. "They can sure teach us something."

Milanovich said when the effort to fight cancer fails, it's important to be there for the child and the family.

"You have to try to provide the best quality of life," he said.

For those too sick to go back home, Sanford has been working on a pediatric hospice care facility called "Ava's House."

Ava's House will be a 20-bed, inpatient hospice facility serving all ages with 24-hour nursing care in a home-like environment on the Sioux Falls Sanford campus.. It will be one of just four in the country to include inpatient pediatric hospice services.

Milanovich said Sanford in Sioux Falls is not the big university, big-city setting that many associate with high levels of cancer treatment.

However, he said if a clinical trial or new treatment isn't available in the Dakotas, he and the other doctors know where to go.

And that can be comforting in itself.

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