Myelofibrosis Overview
The medical team at the Hemato-Oncology Division of Sheba Medical Center in Israel comprises experienced, leading doctors from a wide variety of disciplines. Our physicians have trained at premier medical facilities worldwide, and we bring our unique frontline expertise to custom-designing cancer therapies for every patient. Working together, we offer the latest, cutting-edge treatments for people with myelofibrosis (MF). At present, there is no cure for myelofibrosis, yet this rare bone marrow disease can be a very treatable form of leukemia.
If your Sheba doctors recommend performing a bone marrow/stem cell transplant, we can use our on-site molecular laboratory, in addition to an advanced HLA laboratory, to find a perfectly matched donor. Sheba is also a member of the National Marrow Donor Program and has access to their extensive data bank of stem cells, when necessary.
Sheba is committed to providing holistic, integrative healthcare. We pay attention to every individual’s physical and emotional needs in order to make personalized decisions and tailor our medical care. Patient comfort and overall well-being is a top priority. Our supportive, compassionate team is devoted to keeping the lines of communication open, so that you understand your treatment program and always know what to expect.
Multiple Myeloma Overview
At Sheba Medical Center in Israel, we offer frontline treatments for multiple myeloma, based on the latest clinical research. Our Hemato-Oncology Division comprises many internationally recognized experts from a range of medical disciplines, including hematologists, medical oncologists, bone marrow transplant specialists, and radiation oncologists. Our doctors bring their top qualifications and extensive experience to designing effective and personalized treatments for every patient with multiple myeloma.
The entire team at Sheba is committed to practicing holistic, tailored healthcare. Your doctors will customize your treatment program for multiple myeloma with a focus on your overall quality of life. As you undergo various therapies at Sheba, we will strive to fulfill your unique physical, psychological, and lifestyle needs. Our doctors believe in clear and open communication, and our compassionate staff is always available to answer any questions you may have about your diagnosis of multiple myeloma and its treatment.
Hodgkin Lymphoma Overview
At Sheba Medical Center in Israel, our Hemato-Oncology Division offers you cutting-edge treatments for Hodgkin lymphoma. Our world-class doctors are experienced in treating many types of lymphoid malignancies, and we personalize every therapy. Using the newest laboratory and clinical based research, multidisciplinary medical specialists – including hematologists, radiation oncologists, and medical oncologists – will evaluate your case to design the most effective treatment program.
If a bone marrow/stem cell transplant is needed, we use a precise HLA laboratory and our molecular laboratory to identify the ideal donor match. If no genetically suitable donor is located, Sheba is also a member of the National Marrow Donor Program, which has a massive data bank of stem cells.
Our approach to treating Hodgkin lymphoma is holistic, taking into account the whole body and not just the cancer. Beginning with your initial consultation all the way through follow-up appointments and testing, our compassionate team will strive to preserve your quality of life and keep you as comfortable as possible. Cancer can have devastating effects on your physical and emotional well-being, which is why your treatment program at Sheba includes a variety of support services.
Myelodysplastic Syndromes Overview
Myelodysplastic syndromes (MDS) are a rare group of blood disorders comprising several types of diseases. A precise diagnosis is necessary for determining the most effective treatment. It is therefore critical to find the right medical team and facilities to make an accurate diagnosis of MDS and design your individualized therapy.
At Sheba Medical Center in Israel, our Hemato-Oncology Division has cutting-edge diagnostic equipment and a world-class team of doctors to evaluate your cancer. Many leading physicians, including hematologists and medical oncologists, will collaborate to ensure that you receive the most progressive care possible to fight cancer. We are involved in the latest scientific research to treat myelodysplastic syndromes, and we will base your treatment program on the results of these studies. In addition, if you require a bone marrow/stem cell transplant, we utilize a precise HLA laboratory and our molecular laboratory to identify the perfect donor match. When necessary, we can also use stem cells from the National Marrow Donor Program data bank, of which Sheba is a member.
We treat cancer with a holistic approach that pays attention to your whole body, and not just MDS. From your initial consultation through follow-up examinations, our compassionate team will focus on optimizing your quality of life and comfort. Cancer can have devastating effects on your physical and psychological health, which is why your treatment program at Sheba includes a variety of professional support services.
Non-Hodgkin Lymphoma Overview
The Hematology Clinic at Sheba Medical Center in Israel provides complete and comprehensive care to patients with Non-Hodgkin Lymphoma (NHL). With our 360-degree approach, patients from all over can benefit from our highly skilled team of multidisciplinary specialists, state-of-the-art technology, experimental treatments, and individualized treatment plans.
At our clinic, NHL patients are treated by a team of specialists who have trained in internationally renowned cancer centers around the world. Each case is evaluated closely from before diagnosis all the way through specialized treatment plans that may include advanced bone marrow transplants when necessary. We also offer CAR T-cell therapy, a promising and innovative new cancer treatment.
Our clinic offers access to new experimental treatments, as well as holistic care and guidance to patients with every stage of the disease. You and your family will have the support of the compassionate therapists, psychologists, and social workers on our team. We will keep you informed every step of the way throughout your treatment at Sheba.
Overview
Immunotherapy for cancer describes a variety of treatments that utilize your body’s own immune system to combat the disease. These treatments work in several different ways – either by boosting your immune system in general or by stimulating your immune system to recognize and attack specific cancer cells. In recent years, immunotherapy has become an essential part of treating certain types of cancer and often works when other treatments fail.
A basic understanding of your immune system is helpful for understanding the effects of immunotherapy. Immune cells and the substances they produce travel through your body to protect it from any germs that could cause infection. When your immune system identifies a particular substance as foreign, it attacks and destroys it. However, cancer cells may transform themselves in order to “hide” from the immune system. In addition, the immune response is not always strong enough to destroy cancer cells. In order to overcome these challenges, scientific researchers have developed immunotherapy drugs that can help the immune system to better identify cancer cells, as well as to respond more powerfully against them.
Our team of oncologists at Sheba Medical Center is skilled and experienced in using immunotherapy strategies to detect and fight cancer. We collaborate with doctors from a wide range of hospital divisions to apply the latest clinical-based research towards treating cancer with advanced immunotherapy. At present, scientific studies worldwide are investigating new ways to maximize immunotherapy to treat even more types of cancer, and our world-leading physicians are involved in the most progressive research. We provide immunotherapy at Sheba with a holistic approach, paying attention to how your cancer and its treatment affect your entire body and overall quality of life.
Side effects of immunotherapy
Immunotherapy generally causes fewer side effects than other cancer treatments because it only targets your immune system, and not all the cells in your body. The side effects that you experience depend largely upon the type of cancer you have, the specific immunotherapy drug, the dose you receive, and how healthy you are when you begin treatment. At Sheba, we aim to keep the side effects to a minimum, and we encourage our patients to inform us about any bothersome symptoms – so we can help to alleviate them.
The most common side effects include:
- Fatigue
- Fever
- Flu-like symptoms, such as muscle or joint aches, weakness, dizziness, chills, headache, nausea, diarrhea, and a runny nose
- Skin problems, including itching, swelling, redness, blisters, and mouth sores
- Autoimmune disorders, such as myocarditis (inflamed heart muscle), pneumonitis (inflamed lungs), colitis (inflamed bowel), endocrine disorders (problems with your hormones), hepatitis (inflamed liver), arthritis (pain in your joints), uveitis (inflamed eye); usually, these conditions present as mild, but sometimes they can be more severe.
Types of cancer immunotherapy
Experiments with many newer types of immunotherapy are ongoing, and Sheba Medical Center is committed to staying up-to-date with the newest treatments.
The types of immunotherapy that are used to help the immune system combat cancer directly include:
Monoclonal antibodies
These are man-made versions of antibodies (immune system proteins) that are custom-designed to attach to specific targets, called antigens, found on cancer cells. These monoclonal antibodies work to mark the cancer cells so the immune system can identify them better.
Checkpoint inhibitors
These drugs boost the power of the immune system so that it can respond more effectively to a tumor.
Adoptive cell transfer
These treatments strengthen the natural ability of your white blood cells to conquer cancer. To perform this type of immunotherapy, your active T-cells are withdrawn, modified and/or grown in a laboratory, and then injected back into your body. CAR T-cell therapy is a particular type of adoptive cell transfer.
Cancer vaccines
These substances are administered to people either as a way to treat existing cancers by optimizing the body’s immune system against specific cancer or to prevent cancer from developing. When used as a treatment vaccine, these immunotherapy drugs are often combined with other types of therapies. Provenge is an example of a customized cancer treatment vaccine that triggers an immune response against metastatic prostate cancer. Tests are being conducted on a variety of experimental treatment vaccines for other types of cancers, such as brain tumors, melanoma, breast cancer, leukemia, kidney cancer, and others.
The types of immunotherapy that are used to improve the body’s general immune response to fighting cancer:
Cytokines
Your body produces cytokines, which are proteins that assist in the body’s normal immune responses to cancer. Two examples of cytokines that may be used to fight cancer are interleukins and interferons.
BCG
This type of immunotherapy involves the use of a weakened form of the bacteria that causes tuberculosis in order to treat bladder cancer. The injection of BCG (Bacillus Calmette-Guerin) into the bladder leads to an immune response against the cancer cells.
Depending on the form of immunotherapy being administered, it can be given intravenously, as an oral medication, as a topical cream, or intravesically (directly into the bladder).
Overview
CAR T therapy is a revolutionary type of blood cancer treatment that programs a patient’s own altered white blood cells to kill cancer cells. Advanced technology is used to separate white blood cells (an essential part of your immune system) from the rest of your blood cells. The white blood cells are then sent to a specialized laboratory, where they are engineered to produce specific chimeric antigen receptors (CARs) on their surface. Before returning these cells to the patient, they are multiplied in a laboratory in order to obtain millions of modified cells.
These CAR T-cells are then injected back into your bloodstream. Now, the new CARs can help the modified cells latch on to the coordinating antigen on tumor cells – effectively hunting down and killing cancerous cells.
When other blood cancer treatments fail, CAR T-cell therapy has worked, putting some people’s cancers into remission. A significant benefit of CAR T-cell therapy is that it not only instructs the T-cell to kill the cancer, but it also triggers the T cell to grow and divide. Therefore, after just one CAR T-cell treatment, the cells remain in your body and continue to attack the tumor for months or even years.
CAR T-cell therapy is highly specialized and personalized, and it is available at a limited number of cancer centers around the world. At Sheba Medical Center in Israel, our oncologists have trained at premier medical institutions and we are pleased to offer this breakthrough therapy. Our physicians provide CAR T-cell therapy with a customized and holistic approach that pays attention to your unique needs and the overall well-being of your whole body.
Diseases Treated by CAR T-Cell Therapy
At Sheba, we offer therapy for the following types of cancer:
- Acute Lymphocytic Leukemia (ALL), Adult
- Non-Hodgkin Lymphoma (NHL), Adult and Child
- Leukemia (ALL), Child
- Multiple Myeloma
- Acute Myelogenous Leukemia (AML)
Side Effects of CAR T-Cell Therapy
In general, most patients who receive CAR T-cell therapy do not experience the typical side effects that are associated with chemotherapy, such as nausea, vomiting, and hair loss. However, there are risks of other serious side effects. Because CAR T-cell therapy is given as a one-time infusion (and not in sessions, like chemotherapy), most of the possible complications occur within the first one to two weeks after treatment. They are usually temporary and can be resolved with medication. It is extremely important to communicate with your medical team at Sheba, so our skilled doctors can help to alleviate and manage your side effects.
The most common side effects include:
- Cytokine release syndrome, which involves symptoms that resemble the flu – high fever, chills, low blood pressure, muscle or joint pain, shortness of breath, and a fast heart rate. These symptoms can range from mild to severe.
- Neurologic difficulties, such as confusion, tiredness, seizures, agitation, aphasia (difficulty with speech or understanding), encephalopathy (brain malfunction, disease, injury), and loss of balance.
- Anemia (low red blood cell count)
- Neutropenia (low white blood cell count)
How is CAR T-Cell Therapy Given?
Your medical team at Sheba will design your customized CAR T-cell therapy to target your specific type of cancer. We are committed to clear and open communication with every patient, so there is no confusion and you always know what to expect. The following outline is a step-by-step explanation of how CAR T-cell therapy is given.
- Testing for Candidacy: We will perform various tests and screenings to evaluate whether CAR T-cell therapy is a suitable treatment for you.
- T-Cell Collection: By using a special machine for apheresis, T cells will be separated from the rest of your blood cells.
- Cell Engineering: Your T-cells will be sent to a lab where they are genetically modified to produce CARs on their surface. CARs are proteins that enable the T-cells to identify particular antigens on the surface of tumor cells.
- Growing T-cells: The specially altered T-cells are grown in our on-site Sheba laboratory until there are millions of them; this process can take a few weeks.
- Chemotherapy: Before we infuse the CAR T-cells into your body, we may give you chemotherapy treatments to kill additional cancer cells, which creates more space for the CAR T-cells to proliferate in your body.
- Infusing T-cells: Shortly after chemo, you will be hospitalized so that we can re-infuse the CAR T-cells into your body. This process is performed in a similar manner to a blood transfusion.
- Recovery: While you will only receive a one-time infusion, you may need to stay in the hospital for a few weeks so our doctors can monitor your condition closely and manage any side effects, as needed. Typically, it takes about two to three months to recover.
- Follow-up: Your Sheba doctors will instruct you about how frequently you must return over the next few months for periodic follow-up appointments. We will evaluate your overall health thoroughly, checking your body’s response to the therapy. Over the next several years, you will return for blood tests, physical examinations, and/or bone marrow biopsies and PET or CT scans.
Patient Testimonial – After CAR T-Cell Therapy
Meet Mylène: CAR-T Therapy Saved Her Life
Mylène, a Swiss 15-year old, was diagnosed with acute lymphoblastic leukemia (ALL). She underwent months of intensive chemotherapy in Switzerland, only to suffer a relapse shortly afterwards. Her leukemia was extremely resistant, and her prognosis was poor. After further treatments with high-dose chemo and biopharmaceutical drugs, the only remaining treatment for Mylène was CAR T-cell therapy. She traveled to Sheba Medical Center in Israel for this treatment. A few months later, she returned back to Switzerland – having conquered her progressive resistant leukemia with CAR T-cell therapy.
Read Mylène’s story here
Overview
Stem cell transplants, also called bone marrow transplants, have become an important treatment to fight specific blood cancers. To date, over one million stem cell / bone marrow transplantations have been performed worldwide, and this number continues to rise. Following a transplant, many people with blood cancer live longer or have been cured.
Stem cells are immature blood cells found in your bone marrow and blood, and they produce the blood cells that you need to survive. But cancers of the blood, chemotherapy, and radiation therapy can all damage your bone marrow, thereby affecting your stem cells’ ability to make more blood cells for your body. This is where a stem cell transplant can help. Transplanted cells (which come from bone marrow, peripheral blood, or umbilical cord blood) replace the destroyed bone marrow, so your body can produce healthier, life-sustaining blood cells. In addition, a stem cell transplant from a donor can actually help to treat specific types of cancer. Sometimes, the donated cells recognize and kill cancer cells more effectively than the person’s original immune cells.
At Sheba Medical Center’s Hemato-Oncology Division, our physicians are highly experienced with stem cell / bone marrow transplants and have performed over 2,000 of these advanced procedures. Our team comprises world-renowned experts, including hematologists, medical oncologists, and radiation oncologists, who evaluate each case on an individual basis to provide optimized, personalized treatment. Sheba utilizes a cutting-edge HLA laboratory and our on-site molecular laboratory to find a perfect donor match for stem cell transplantation. If no genetically suitable donor can be located, Sheba is a member of the National Marrow Donor Program and may use stem cells from this data bank. Throughout the transplantation process, we practice holistic medicine that considers your overall well-being and quality of life.
Diseases Treated by Stem Cell / Bone Marrow Transplantation
At Sheba, we offer stem cell transplantation for the following types of cancer:
- Acute Lymphocytic Leukemia (ALL), Adult and Child
- Acute Myeloid Leukemia (AML), Adult and Child
- Chronic Lymphocytic Leukemia (CLL), Adult and Child
- Chronic Myelogenous Leukemia (CML), Adult and Child
- Non-Hodgkin Lymphoma (NHL), Adult and Child
- Hodgkin Lymphoma, Adult and Child
- Multiple myeloma, Adult
- Myelofibrosis, Adult
- Osteosarcoma, Child
- Neuroblastoma, Child
- Ewing’s sarcoma or Ewing sarcoma, Child
- Wilms’ tumor (Nephroblastoma), Child
- Medulloblastoma, Child
- Rhabdomyosarcoma, Child
Side Effects of Bone Marrow / Stem Cell Transplantation
A number of side effects may be caused by stem cell transplantation. Some of the problems occur during the conditioning process, which prepares your immune system for the transplant, while other symptoms may appear during and following the infusion of new stem cells. Side effects can range from mild to severe and life-threatening, which is why it is critical to inform your Sheba medical team about any symptoms or changes you notice. Our transplant team can help to prevent and relieve the discomfort of many side effects.
Side effects during conditioning
Conditioning treatments get your body ready for a stem cell transplant, and they may involve chemotherapy and/or radiation therapy. Side effects may include:
- Nausea, vomiting
- Diarrhea
- Mouth sores
- Fatigue
- Dry mouth
- Rashes
- Hair loss
- Difficulty breathing
Side effects during stem cell infusion
As you receive your new stem cells, the most common symptoms include:
- Headaches
- Fever
- Chills
- Nausea
- Flushing
These side effects can present up to one hour after the infusion is completed.
Side effects during engraftment
Engraftment is the phase that follows the infusion of new stem cells. This is when the transplanted stem cells start to produce new blood components in your body, such as platelets and red blood cells. Typical side effects during engraftment include:
- Trouble sleeping
- Nausea
- Skin rashes
- Mucositis (causes difficulty with eating and drinking)
- Lack of appetite
- Diarrhea
- Fatigue
Post-transplant side effects
After transplantation is complete, you may experience:
- Nausea, vomiting
- Diarrhea
- Fatigue
- Lack of appetite
- Hair loss
- Skin rash
- Decreased libido
- Inflammation
- Weight changes
With time and as your immune system recovers, these side effects will usually subside.
Types of Stem Cell / Bone Marrow Transplantation
There are two main types of stem cell transplants, categorized by the source of the donor marrow: autologous transplants and allogeneic transplants.
Autologous transplants
Autologous transplants are taken from your own stem cells, typically sourced from peripheral blood that is frozen and preserved. Your stem cells must be harvested from your blood before you receive any cancer-killing treatments.
The advantage of autologous transplants is that you do not need to worry about graft-versus-host disease, which refers to when the engrafted cells attack your body.
Allogeneic transplants
Allogeneic transplants are performed using donor tissue from someone who is genetically suitable, often a close family member. The stem cells may be sourced from peripheral blood, bone marrow, or cord blood. When a perfect genetic match cannot be located, a mismatched allogeneic transplant may also be performed. In this case, the stem cells are sourced from peripheral blood and must undergo a refinement process to compensate for the riskier mismatch.
A possible advantage of allogeneic transplants is that the donor stem cells create their own immune cells, which may help to kill cancer kills that remain in your body after treatment. However, graft-versus-host disease is a risk when performing allogeneic transplants.
Patient Testimonial – After Bone Marrow Transplantation
Yulia Egorova’s young son, Ivan, was diagnosed with leukemia in Russia and needed a bone marrow transplant. After extensive research to locate the best medical facility for this advanced procedure, Yulia decided on the Bone Marrow Transplant Clinic at Sheba Medical Center. Ivan underwent a bone marrow transplant at Sheba, and the donor cells survived. He recently returned to school and lives life just like other kids.
Read Ivan’s story here
Overview
Radiation therapy, also called radiotherapy or irradiation, is one of the most common approaches to cancer therapy. Over half of all people with cancer will be treated with radiation therapy; sometimes the head area is also treated by radiotherapy or radiosurgery.
In contrast to chemotherapy, which can expose your entire body to drugs that fight cancer, radiation therapy is typically localized. Radiation aims high-energy rays precisely to destroy cancer cells, thereby minimizing the harm to healthy surrounding tissues. Radiotherapy damages the DNA inside cancer cells so they cannot continue to grow and divide, and they die instead. There are several different reasons radiation therapy may be used:
To shrink or cure early-stage cancer
Some cancers are highly sensitive to radiation, and this therapy may therefore be enough to cure your cancer completely. Radiation may also be administered in order to shrink a tumor before surgery, or used after surgery to help prevent the cancer from recurring. Sometimes, radiation is used along with chemotherapy, as specific chemo drugs (radiosensitizers) can enhance the effects of radiation by increasing the sensitivity of cancer cells to radiation.
To destroy cancer cells before bone marrow/stem cell transplantation
Prior to undergoing a stem cell transplant, radiation therapy may be administered to the entire body to destroy cancer cells in the bone marrow.
To prevent cancer from recurring
Cancer can spread from where it originated to other parts of your body. Sometimes, radiation may be used to treat the organ that your specific cancer spreads to most often, thereby killing any cancer cells before they form tumors.
To treat the symptoms of advanced cancer
When cancer has spread too extensively to be cured, the tumors can sometimes be treated with radiation in order to alleviate pain or other symptoms. This type of radiation therapy is called palliative radiation.
To treat a recurrence of cancer
Radiation may be used to treat a cancer that has returned, or to treat the resulting symptoms.
At Sheba Medical Center, we administer radiation therapy in the Radiation Unit. Depending on the type and stage of your cancer, our skilled and dedicated doctors will design the most effective program of radiation therapy for your condition. Typically, the treatment lasts for two weeks, with the patient receiving small doses of therapy each day.
In accordance with Sheba’s holistic approach to medicine, we will also pay attention to how the cancer is affecting your overall well-being and quality of life in order to determine the ideal radiation treatment plan.
Side Effects of Radiation Therapy
Radiation therapy can lead to a variety of side effects that vary widely from person to person. The side effects that you may experience depend on the type of radiation, the dose, and which part of your body is being treated (where the radiation is aimed). Your overall health condition is also significant. Sometimes the side effects are mild and limited, while other times there are many side effects and they are severe. There is no reliable way to predict how radiation will affect each individual.
In general, there are two categories of side effects from radiation therapy: early and late. Usually, early side effects appear immediately and are short-lived. Late side effects may only appear much later on, and they can be permanent.
Early Side Effects
- Skin problems
- Hair loss in the area being treated. This hair loss is temporary, and the hair will grow back after treatment.
In addition to the general side effects listed above, radiation therapy can have other, highly specific side effects related to the part of the body that is being treated. Before beginning radiation, your Sheba doctors will meet with you to discuss all of the possible side effects, so you know what to expect.
How is Radiation Therapy Administered?
At Sheba, we plan radiation therapy very carefully to help ensure the best results. Planning is an important part of the whole treatment process.
First, it is important to note that before radiation can be administered, the patient undergoes a simulation.
The simulation is then tested on a mannequin.
Only after these stages are completed is the patient scheduled to undergo radiation therapy.
- During the first phase of radiation therapy, we will instruct the patient precisely about what position to lie in. It is necessary that this same position is maintained throughout each session of the treatment, so that the irradiated area remains constant. On the first visit, the parameters of the irradiated area will be determined with the aid of a simulation; sometimes, a CT scanner will be used for this purpose.
- When treating the head and neck area, a special plastic mask helps to match the radiation exactly. The mask is fixed to the couch during the session and maintains the precise head position. The irradiated area is marked and recorded on the mask. If the radiation treatment is administered without a mask, the radiation technician will mark the skin to indicate the exact position. These marks must remain on the skin throughout the entire span of treatment.
- We will provide the patient with detailed instructions on how to take care of the skin in the irradiated area.
- Before each radiation session, the technician will ensure that the patient is positioned comfortably on the couch. During the treatment, which lasts only a few minutes, the patient will be left alone in the treatment room. The radiation technician will watch the patient via a monitor in an adjacent room.
- Radiation therapy is painless, yet requires lying still for a few minutes
The above process describes the external radiation method of administering radiotherapy. In addition to external radiation, there are two other ways to administer radiotherapy:
- Internal radiation: Also called brachytherapy, this type of radiation involves implanting a sealed radioactive source inside or near the tumor. This can be done with either a temporary or permanent implant, depending on your type of cancer. Internal radiation enables a higher dose of radiation in a small area, while causing very little harm to nearby healthy cells.
- Systemic radiation: Radioactive drugs (radiopharmaceuticals) may be taken orally or injected intravenously to treat particular types of cancer, such as thyroid, prostate, and bone. These drugs travel throughout your bloodstream, and an attached antibody makes them bind to the cancer cells. There, they emit radiation and kill the cancer cells. You may need to be hospitalized while receiving this type of radiation therapy.
Overview
Targeted therapy drugs are officially classified as biological treatment. They do not operate the same way that chemo does. In recent years, medical research has shed light on some of the primary differences in cancer cells that enable them to grow and spread. This information led to the development of specialized drugs to target these differences and treat cancer precisely.
In order to determine the optimal targeted therapy for a particular cancer, a biopsy will generally be performed to test for targets. Targeted therapy can be used alone, but it is more often used in conjunction with other cancer treatments, such as chemotherapy, radiation, and surgery. Depending on the specific type and stage of your cancer, your cancer team at Sheba Medical Center will design your total treatment plan. We will also consider how the cancer is affecting your overall health and well-being in order to customize your therapies.
As cancer treatment research continues and advances, new and better targeted therapies are being engineered continuously. At Sheba, our skilled scientists and oncologists are leading the way in the clinical application of cutting-edge targeted therapies.
Diseases Treated by Targeted Therapy
At Sheba, we offer targeted therapy for the following types of cancer:
- Acute Lymphocytic Leukemia (ALL), Adult
- Acute Myeloid Leukemia (AML), Adult + Children
- Chronic Lymphocytic Leukemia (CLL), Adult + Children
- Chronic Myelogenous Leukemia (CML), Adult + Children
- Non-Hodgkin Lymphoma (NHL), Adult + Children
- Hodgkin Lymphoma, Adult + Children
- Multiple myeloma, Adult
- Myelofibrosis, Adult
- Leukemia (ALL), Children
- Osteosarcoma, Children
- Retinoblastoma, Children
- Astrocytomas, Children
- Neuroblastoma, Children
- Ewing’s sarcoma or Ewing sarcoma, Children
- Wilms’ tumor, Nephroblastoma, Children
- Glioma, Children
- Medulloblastoma, Children
- Rhabdomyosarcoma, Children
Side Effects of Targeted Therapy
Targeted therapies can cause a range of side effects, although not every patient gets every side effect and some people do not experience any at all. The severity of these side effects varies widely, depending on the specific drug and the individual. Although many of the side effects can be very uncomfortable, it is essential to remember that the less extreme ones should be measured against the need to fight your cancer.
Prior to your treatment, your medical team at Sheba will inform you about the specific targeted therapy drugs that you will be given and the possible side effects. We will also monitor you closely throughout your entire course of treatment. It is important that you inform our doctors about any side effects or changes in how you feel, so we can treat any problems and help to mitigate any discomfort.
Many of the same side effects that are seen with standard chemotherapy drugs are also associated with some targeted therapy drugs, such as nausea, vomiting, diarrhea or constipation, mouth sores, headache, fatigue, shortness of breath, hair loss, and increased risk of certain infections.
Other side effects of targeted therapies may include:
Skin Problems
Targeted therapies attack the same blood vessels and growth factors that your body needs to maintain healthy skin. Prior to starting treatment, you are advised to switch to gentle, chemical- and fragrance-free soaps and shampoos. It is typical to experience:
- Rashes that itch or burn
- Sensation of a bad sunburn (even if nothing is noticeable)
- Extreme sensitivity to sunlight
- Very dry skin that may crack open
- Painful sores on your fingernails and toenails
- Sores on your scalp; hair loss or changes in hair color
- Red and swollen eyelids
High Blood Pressure
Your Sheba medical team will keep close watch on your blood pressure if you are taking one of the targeted therapy drugs, such as angiogenesis inhibitors, which can raise blood pressure. Sometimes it is necessary to take medication to lower blood pressure to safe levels.
Bleeding or Problems with Blood Clotting
Certain types of target therapy drugs interfere with the growth of new blood vessels, which can lead to problems with bleeding and bruising. If internal bleeding occurs, such as from the stomach or intestines, it can be life-threatening. If you vomit blood or dark matter (resembling coffee grounds), or see black stools or bright red blood in your stools, notify your doctor immediately.
Some types of drugs can also cause blood clots in your legs and lungs, as well as lead to a heart attack or stroke. If you suffer chest pain or sudden shortness of breath, have pain in the arm or leg, or experience a seizure – seek emergency medical care.
Slow Healing of Wounds
Targeted therapy drugs may interfere with the healing of wounds. They can also lead to perforations (holes) opening up in the intestine or stomach, which causes pain or vomiting.
Autoimmune Reactions
In some people, targeted therapies trigger the immune system to attack healthy parts of the body. This is relatively uncommon, but can be very serious.
Swelling
Inflammation around the eyes and in the face may occur. Sometimes swelling in the feet, legs, and hands also happens. Treatment isn’t always necessary, but a diuretic may be prescribed in extreme cases.
How Do Targeted Therapy Drugs Work?
Cancer cells have many changes in their DNA (genes) that makes them distinct from healthy cells. For example, these changes might cause the cell to grow or divide more rapidly than normal. However, there are many different kinds of cancer, and the gene changes in each type can be different. Targeted therapy drugs focus on some of these changes and aim to attack them. Sheba’s doctors will analyze your test results to determine which type of targeted therapy will achieve the most effective potential outcome.
There are two primary categories of targeted therapies, small molecule medicines and monoclonal antibodies. Small molecule drugs are minute enough to enter the cancer cells directly and destroy them from within. Monoclonal antibodies, which are larger, work from the outside. They attack targets on the external surface of the cells or surrounding them.
Different targeted drugs function in different ways, such as:
- Signal transduction inhibitors, the most common targeted drugs, block the signals that instruct cancer cells to rapidly divide.
- Gene expression modulators function to change the proteins that regulate how the genes in cancer cells get carried out abnormally
- Immunotherapies utilize your natural immune system to destroy cancer cells, either by boosting the immune system so it is more effective or by marking cancer cells so they are more easily identified
- Hormone therapies stop your body from producing the hormones that some cancers, such as breast and prostate, need to grow
- Angiogenesis inhibitors block the creation of new blood vessels that feed the cancer cells; these drugs can cut off blood supply to a tumor
- Apoptosis inducers cause cancer cells to follow the normal process of dying when they are old or damaged (cancer cells can often bypass this natural process)
