Basics of Personalized Cancer Medicine


Natasha Tiffany MD

Natasha Tiffany MD

Natasha Tiffany, MD, serves as a physician and partner at Oregon Oncology Specialists in Salem, Oregon. Dedicated to advancing options for cancer treatment, Natasha Tiffany, MD, uses patient testing to offer personalized treatment plans.

Medical science has known for some time that different types and stages of cancer require different treatments. However, even when two patients with the same type of cancer receive a particular treatment, each person’s body reacts differently.

Over the past few decades, research has revealed that a number of genetic errors may lead to cancer, and the disease is often the result of multiple malfunctions converging to cause abnormal cell growth. This understanding led researchers in the late 1990s and early 2000s to develop the first targeted therapy drugs, which interrupt the reproductive functions of cancer cells and cause the death of those cells.

As personalized medicine has continued to develop, doctors have found that different patients with the same type of cancer can experience different genetic changes. This has led to the creation of tumor profiling, which evaluates the genetic makeup of a cancer to determine the treatments that may be most effective. Profiling can help the treatment team better understand how a patient’s body will react to a particular treatment.


Exercise During Adjuvant Chemo Has Long-Term Benefits


Natasha Tiffany MD

Natasha Tiffany MD

For nearly 15 years, Natasha Tiffany, MD, has served as a full-time physician at Oregon Oncology Specialists (formerly Hematology Oncology of Salem) in Salem, Oregon. Alongside her work as a clinician and MD, Dr. Natasha Tiffany maintains membership in the American Society of Clinical Oncology (ASCO).

Recent research published by the ASCO reveals patients who take part in an exercise program while undergoing post-surgical chemotherapy for breast and colon cancer can increase their ability to engage in physical activity as they get older. At a four-year follow-up interval, patients who took part in an 18-week exercise regimen during adjuvant chemotherapy averaged approximately 20 minutes more physical activity per day than those who didn’t.

The supervised education programs consisted of an hour of aerobic and weight training activities two times per week, with an additional half-hour of in-home exercise three days each week. Prior research already had shown this exercise plan provided short-term benefits to patients, but extended follow-up now reveals it also helps them continue to be active long after their treatment cycles have ended.

Precision Oncology Creates Amazing Advances in Cancer Care

Natasha Tiffany MD

Natasha Tiffany MD

Board certified in internal medicine, hematology, and medical oncology, Natasha Tiffany, MD, has been a partner at Oregon Oncology Specialists (formerly Hematology Oncology of Salem) in Salem, Oregon, for over a decade. Alongside her activities as the owner of a private medical practice, Natasha Tiffany, MD, pursues her lifelong passion for education through affiliations with several organizations. She currently serves on the board of trustees for Abiqua Academy and teaches as an affiliate assistant professor at Oregon Health & Science University (OHSU).

The age of precision oncology has drastically changed how Dr. Tiffany treats patients with cancer. “When I started my career in oncology, now nearly 2 decades ago, we had only a handful of targeted therapies. The first truly targeted drug was Gleevec, developed to treat chronic myelogenous leukemia. Since then, there has been a revolution in oncology with more and more medications designed not to simply kill rapidly dividing cells like standard chemotherapy, but to target molecular pathways that drive cancer cell growth and survival.”
Dr. Tiffany notes that chemotherapy side effects are due in large part to the fact that chemotherapy kills rapidly dividing cells, like cancer cells. However, other rapidly dividing cells are killed, like the cells that line our gastrointestinal tract, or our hair cells. They repopulate, but not before patients suffer the side effects of nausea, vomiting, diarrhea and hair loss.
Targeted therapy, in general, has less side effects as it effects a smaller population of normal cells in our body. We now use targeted therapy or immunotherapy to treat many cancer types. Perhaps the most dramatic benefits of targeted therapy and immunotherapy have been seen in lung cancer, kidney cancer, and melanoma.
Dr. Tiffany feels that precision oncology has been a remarkable leap forward in our ability to kill cancer cells. “People are living now many years longer than before due to these new technologies. In lung cancer, we no longer use chemotherapy as the first treatment option for many patients with metastatic disease. We first look for genetic mutations in the tumor that might make it susceptible to a targeted therapy. Additionally, we look to see if the tumor would be sensitive to immunotherapy.”
Now, instead of making a patient sick and fatigued with chemotherapy, Dr. Tiffany states she has the option to treatment some patients up front with immunotherapy, which, in general, is very well tolerated. Those patients whose tumors respond to immunotherapy can have prolonged survival, with benefit lasting several years.
“I am grateful to have lived through this molecularly driven cancer care revolution. I look forward to the advances that we will see in the next decade and trust they will be equally dramatic.”

Targeted Cancer Therapy – An Introduction

Targeted Cancer Therapy pic

Targeted Cancer Therapy

A privately practicing hematologist and oncologist in Salem, Oregon, Natasha Tiffany, MD, also serves as oncology medical director at Salem Hospital and affiliate assistant professor at the Oregon Health and Science University School of Medicine. Natasha Tiffany, MD, draws on an in-depth knowledge of targeted therapies and other advancements in cancer care.

Targeted therapies for cancer are individualized cancer treatment options that work by identifying the molecular processes that speed tumor growth. Unlike traditional chemotherapies, which kill both cancerous and noncancerous cells, targeted therapies focus particularly on a particular process. Some are laboratory-produced antibodies that act on a particular cell target, while others are synthetic small-molecule chemicals.

Many targeted therapies block the chemical signals that tell cancer cells to grow. Others induce apoptosis, or cell death, by interrupting the breakdown of proteins that facilitate this process. Still others prevent the development of new blood vessels which, if left to grow uninterrupted, provide tumors with the nutrients that allow them to grow uncontrollably.

Within these general categories of targeted therapies exist a number of specific drugs. EGFR inhibitors, for example, block the growth of lung and colorectal cancers as well as some other tumors, while BRAF inhibitors target certain melanomas. Only an oncologist with experience in targeted cancer treatment can determine if such a therapy would be appropriate and, if so, which would provide the patient with the best chance of success.

The Facts on Sickle Cell Disease

sickle cell disease Image:

sickle cell disease


Natasha Tiffany, MD, is a board-certified hematologist and medical oncologist with experience in a hospital setting. Since 2004, Natasha Tiffany, MD, has been providing care at her private practice for patients diagnosed with such serious conditions as sickle cell disease.

Sickle cell disease involves disorders of hemoglobin in the blood. People with the disease have inherited two abnormal hemoglobin genes, one from each parent, and at least one of the genes causes the body to make hemoglobin S, the defective form of hemoglobin in red blood cells.

Instead of the normal disc shape, these red blood cells are shaped like a sickle (hence the name) and are inflexible and tend to stick to blood vessel walls, obstructing the flow of blood. This deprives tissues of oxygen, leading to sudden attacks of pain, called pain crises. A lifelong illness, sickle cell disease requires the patient to remain under an oncology doctor’s care.

The disease mainly affects those of African descent. In the United States, approximately 1 in 365 black children are born with the disease, and around 100,000 Americans live with sickle cell disease today.

A Brief Introduction to Aromatase Inhibitors

A triple board-certified physician specializing in hematology and oncology, Natasha Tiffany, MD, serves as a partner and practicing physician at Hematology Oncology of Salem in Salem, Oregon. Natasha Tiffany, MD, and the medical staff at Hematology Oncology of Salem utilize the latest cancer treatments, therapies, and medications, including aromatase inhibitors.

Aromatase inhibitors are a newer class of drugs that are often used to treat breast cancer or prevent its recurrence following surgery in postmenopausal women. Drugs in this class, which include letrozole, anastrozole, and exemestane, work by inhibiting the action of aromatase, the enzyme responsible for converting androgen into estrogen. These drugs are particularly effective in treating estrogen receptor-positive (ER+) breast cancers because they reduce the amount of available estrogen, which these types of cancers need to grow.

Either used alone or in combination with other drugs, aromatase inhibitors have been shown to be an effective treatment for both early and metastatic or recurring ER+ breast cancer. These drugs are also often prescribed off-label to treat conditions such as infertility and endometriosis. While they tend to be milder than other cancer drugs, the most common side effects of aromatase inhibitors include joint pain or stiffness, hot flashes, and bone thinning.

Genetically Targeted, Personalized Cancer Treatments Increasingly Available

Cancer treatments are rapidly evolving. Traditional chemotherapy targets rapidly replicating cells. This kills the cancer cells, but can also lead to side effects such as hair loss, nausea and vomiting because the hair cells and the cells lining the gastrointestinal tract also divide quickly.

In recent years, scientists have been designing targeted treatments that are designed to block pathways needed for cancer cells to replicate and survive. Many cancer cells have genetic mutations in them that drive tumor growth. If we can identify a driving mutation in a tumor, we can design treatments that shut down the pathway it uses to promote cell division and survival. This targeted approach often has fewer side effects than traditional chemotherapy.

This personalized cancer therapy is very promising. We are committed to providing our patients the most up to date and cutting edge treatments available. We may talk to you about doing genetic testing of your tumor to see if you might benefit from targeted therapy.

Currently, many of the targeted treatments are available only through clinical trials, but some are already available as standard of care. We can help you find the best treatment options for you. If you have questions about personalized cancer treatments, please talk to your oncologist.