Visit Your Local PBS Station PBS Home PBS Home Programs A-Z TV Schedules Watch Video Donate Shop PBS Search PBS
NOVA ScienceNOW

Judah Folkman: Expert Q&A

  • Posted 08.05.08
  • NOVA scienceNOW

On August 5, 2008, Marsha Moses and Robert D'Amato answered questions about angiogenesis research and therapies, particularly as they relate to cancer and eye disease.

Marsha Moses

Marsha Moses

Marsha Moses is a Professor of Surgery at Harvard Medical School and Co-Director (interim) of the Vascular Biology Program at Children's Hospital Boston. Full Bio

Photo credit: Kris Snibbe/Harvard News Office, Courtesy Harvard Gazette

Robert D'Amato

Robert D'Amato

Robert D'Amato is an Associate Professor of Ophthalmology at Harvard Medical School and Director of the Center for Macular Degeneration Research at Children's Hospital Boston. Full Bio

Photo credit: Jon Chase/Courtesy Harvard Gazette

Marsha Moses

Marsha Moses is a Professor of Surgery at Harvard Medical School and Co-Director (interim) of the Vascular Biology Program at Children's Hospital Boston, the program formerly led by Judah Folkman. Her lab works to identify and characterize the biochemical and molecular mechanisms underlying angiogenesis during tumor progression, from the initial "angiogenic switch"—when a tiny tumor begins to recruit new blood vessels—through metastasis. Moses and her group have discovered five different angiogenesis inhibitors, three of which are in clinical development for use against a variety of cancers. In addition, the Moses Lab has developed non-invasive urine tests for different cancers. A number of these urine tests are currently in clinical testing as potential cancer diagnostics and prognostics. Moses received a Ph.D. from Boston University and completed a National Institutes of Health postdoctoral fellowship at Children's Hospital Boston and MIT.

Robert D'Amato

Robert D'Amato is an Associate Professor of Ophthalmology at Harvard Medical School and Director of the Center for Macular Degeneration Research at Children's Hospital Boston. In the 1990s, while working as a postdoctoral research fellow in Judah Folkman's laboratory at Children's, D'Amato discovered that thalidomide is an angiogenesis inhibitor. In doing so, he not only provided an explanation for the drug's notorious ability to cause birth defects, but also suggested a therapeutic use for thalidomide in inhibiting abnormal angiogenesis in disease. D'Amato's current research focuses on the genetic control of angiogenesis and the development of new therapeutic agents, especially for the treatment of eye disease. D'Amato received his B.A., M.D., and Ph.D. from Johns Hopkins University.

Q: I sat on my couch and blew a kiss to the image of Dr. Judah Folkman. I am a three-year survivor of stage 4 lung cancer. A combination of Avastin and Tarceva have saved my life. I am mother to a six year old and a wife, and though my life has changed due to cancer, I am still here to be with my family and raise my daughter. I am so grateful for Dr. Folkman's and all of your work. It gives me hope that when my cancer does begin to grow again there will be another generation of anticancer drugs.

How far out is the general use of a urine test for a specific cancer or for all cancer? Anonymous

Marsha Moses: Thank you for your kind words. There are a number of promising anti-angiogenic treatments being tested in clinical trials and many more being studied at the pre-clinical level in laboratories around the world.

The urine tests referred to in the program that are based on our work are licensed for development to a local company that is now working to develop and to bring these non-invasive cancer tests into the market, where they would be widely available.

Q: Surviving a very rare cancer, I'm very interested in your urine test to determine early cancer. Will it be available soon to the general public? If not, are you accepting research clients? Anonymous

Moses: That is wonderful news. As I noted above, the urine tests referred to in the program and based on our work are licensed for development to a local company that is now working to develop and to bring these non-invasive tests onto the market, where they would be widely available.

The urine samples that we study are provided by patients under regulations established by the institutional review boards of the hospitals with whom we collaborate.

Q: What drug or drugs are effective in shutting down the blood supply to cancer growth? Do they have a lot of side effects, and how much do they extend the life of the patient? Can they cut the growth entirely, as in the story of the macular degeneration being reversed? We're looking for something that's effective against advanced lymphoma, along with acupuncture and a change in diet to change the body pH to make it more alkaline. Reports are that cancer thrives in acidic environments. PJ, Denver, Colorado

Moses: Dear PJ,
In the piece, you heard about Avastin, an FDA-approved anti-angiogenic drug that is being used in the treatment of a variety of human cancers. It has been shown to extend the life of colorectal cancer patients with metastatic disease and has also been approved for the treatment of non-small cell lung cancer (NSCLC) and advanced breast cancer. One of the interesting, pre-clinical characteristics of anti-angiogenic therapy is that it tends to induce less toxicity and fewer side effects than do other standard anti-cancer approaches. There are also a number of ongoing FDA-approved clinical trials that are testing a variety of anti-angiogenic therapies for many different cancer types. These trials can viewed by going to www.clinicaltrials.gov and entering the type of cancer and angiogenesis in the search box.

Q: My sister was diagnosed with stage 4 colon cancer a number of years ago at the age of 35. She is fighting it hard, but local doctors are beginning to give up. I heard about angiogenesis many years ago when a cousin died from cancer. Anyway, my question is, how do I find out if there is any place willing to help (or experiment on) her? From my reading on cancer and angiogenesis, it seems that there might be some cures for some types of cancer very soon, and I would hate to find out she simply missed out by asking the wrong people and not being informed on cutting-edge cancer research. Any advice would be of help. Tony J. Barrett, Green Bay, Wisconsin

Moses: Dear Tony,
Avastin is an FDA approved anti-angiogenic drug that was originally shown to extend the life of colorectal cancer patients with metastatic disease. There are also a number of ongoing FDA-approved clinical trials that are testing a variety of anti-angiogenic therapies for this disease. They can viewed by going to www.clinicaltrials.gov and entering colon cancer and angiogenesis in the search box.

Q: No question-just thanks to Dr. Judah Folkman for having the insight and the drive to answer the questions about blood vessels and cancer. I'm alive today because of his discoveries. I just finished an Avastin and AZD2171 drug trail. I was treated at MD Anderson in Houston. Being curious, I looked into how Avastin was created. Thanks to Dr. Judah Folkman's vision, I'm a survivor. I had to go to MD Anderson once I became allergic to Carboplactin and Gemzar chemos. I'd like to thank all of you and Dr. Judah Folkman for making it possible to treat and beat cancer. God Bless you all. Nancy Hagel-Luther, Richardson, Texas

Moses: Dear Nancy,
Thank you so much for your kind and supportive words. Dr. Folkman's tenacity and vision have not only led to currently approved anti-angiogenic therapies, but also to a growing pipeline of potential new drugs that are in clinical trials for the treatment of a variety of human cancers as well as those that are being developed in laboratories around the world. We look forward to the next generation of anti-angiogenic therapies that they represent.

Q: Please, I need the info about the treatment of eye disease-macular degeneration-from Dr. D'Amato. How can we get the best information on where to get treatment based on his research? Thanks, Anamaria Aliste, Seattle, Washington

Q: My 87-year-old father is going blind with macular degeneration. He also has glaucoma. He is in good health otherwise and sharp as a tack. Are there any test programs to treat macular degeneration that he could enter? Allyn Hart, Ophir, Colorado

Q: My mom has been diagnosed with age-related macular degeneration, dry type. She is taking very expensive, holistic vitamins. How can we find out more info on how angiogenesis can help her? Can I bring her somewhere for treatment?
Thank you, Valerie Ramirez, Great Mills, Maryland

Q: My father has macular degeneration. What is the drug and/or treatment that was discussed in the piece that reversed the disease in the subject? Is it experimental? Would this be something that only a select group of doctors would be aware of as a treatment? I would like my dad to see better as this has caused him great distress.
Thank you. Anonymous

Robert D'Amato: Dear Tony, Valerie, Allyn, and Anamaria,
Age-Related Macular Degeneration (ARMD) is a disorder, most commonly seen in persons older than 60, that damages the center of the retina known as the macula. There are two stages of the disease. In the early form, deposits called drusen form under the retina. We call this dry ARMD. Vision loss is generally not severe for this form of the disorder. Unfortunately, 10-20 percent of patients with dry ARMD will progress to wet ARMD. It is called wet ARMD because new blood vessels grow under the retina. These new blood vessels can leak fluid and bleed. When this happens there is commonly progressive loss of central vision.

The anti-angiogenic treatment referred to in the show is called Lucentis. It is a therapy that neutralizes a blood vessel growth factor called VEGF. Clinical trials of patients with wet ARMD showed a significant improvement of vision after injections of Lucentis. Since Lucentis is now FDA approved for wet ARMD, most ophthalmologists around the country will be able to assist you in obtaining treatment with this drug. However, keep in mind that this treatment is only for the 10-20 percent of ARMD patients with the wet form of the disease. For more information see these links:

http://www.nei.nih.gov/health/maculardegen/armd_facts.asp
http://www.lucentis.com/lucentis/treating.html

Q: What are the names of RNAi therapy drugs currently available for macular degeneration? Peter, Toronto, Canada

D'Amato: There are no FDA-approved RNAi therapies for ARMD.

Q: I have recently been treated successfully for lymphoma. Previously I have been diagnosed with macular degeneration. Is there any connection? Francis Fahey, Lexington, Massachusetts

D'Amato: Dear Francis,
Excellent question. This is an area of great interest. There may be a connection between diseases that are dependent on angiogenesis. We have found in animals that there are some strains that will grow blood vessels aggressively while others are very resistant to form new blood vessels. If this is true in humans, then a person who is "angiogenesis sensitive" may support the rapid progression of diseases such as cancer and the wet form of Age-Related Macular Degeneration. In contrast, a person who is "angiogenesis resistant" will resist the growth the blood vessels needed to support the progression of angiogenic diseases.

Q: I wanted to know if the benefits for macular degeneration would mean that similar drugs could be used for Cotes disease. My brother was one of the first laser surgeries by Dr. Lesbronx (spelling?) after a childhood diagnosis that he was going to be blind in one eye. In any case, the capillaries still leak, which leads to vaporizing the deposits on the retina twice yearly. So, could he be helped if the cells could be strengthened by promoting new blood vessel growth? Jonathan, Los Angeles, California

D'Amato: Dear Jonathan,
There has been interest in exploring the use of VEGF blockers in patients with Coats disease. Indeed, there is a clinical trial that is now recruiting:

http://www.clinicaltrials.gov/ct2/show/NCT00470977?term=NCT00470977&rank=1

Related Links

  • Profile: Judah Folkman

    Once scorned for his ideas about how cancer grows through angiogenesis, Judah Folkman is now hailed as a visionary.

  • Angiogenesis Explained

    See how cancerous tumors recruit their own blood supply in order to grow and how this process might be stopped.

  • Cancer Warrior Judah Folkman

    In this extensive interview, Judah Folkman reflects on his cancer research, his hopes for future treatments, and more.

  • Cancer Nanotech

    Structures smaller than a single red blood cell could revolutionize cancer diagnosis and treatment.