® Winter 2013 | cancer.uchicago.edu MR-Guided Focal Laser Ablation Shows Promise for Prostate Cancer Treatment I nvestigators at the A Little More With… Aytekin Oto, MD Professor of Radiology and Surgery If you were not a physician, what would your profession be? I would probably be an engineer. Almost all of my close friends in high school chose to be engineers. UCCCC are developing a new method that combines magnetic resonance (MR) imaging with a technique called focal laser ablation to treat lowrisk prostate cancer precisely. If proven effective, the technique may offer patients a safe, new treatment option. What is the most rewarding part of your job? Always being on the side of helping people who cannot help themselves and learning something new almost everyday. Where have you been that you feel everyone should go? Prostate Cancer Detection A longstanding issue in prostate cancer, the second-leading cause of cancer deaths in American men, is the method by which patients are diagnosed. Based on abnormal results of a prostatespecific antigen (PSA) exam, patients typically undergo a biopsy to sample tissues from different areas of the prostate Aytekin Oto, MD, professor of radiology and surgery, and colleagues are pursuing image-guided focal treatment gland using ultrasound guidance. Often, repeat biopsies are methods to expand existing therapeutic options for patients with low-risk prostate cancer. needed to confirm a diagnosis. A Less Aggressive Treatment Option In May, the U.S. Preventive UCCCC researchers are evaluating new Services Task Force discouraged methods to detect aggressive cancers PSA screening, concluding that more accurately, which have the potential screening may be harmful due to spare patients with indolent cancers to “false-positive” results and from unnecessary biopsies, surgeries, and overtreatment of cancers that treatments while simultaneously identifywould not have caused future ing men with large or aggressive cancers health issues. who are most likely to benefit from “Most people who are diagtreatment. Researchers are also pursuing nosed with prostate cancer will image-guided focal treatment methods to not die of the disease, but there’s expand existing therapeutic options. no perfect way to differentiate “We’re looking for better ways to between deadly and non-deadly Aytekin Oto, MD determine who benefits from treatcancers,” said Aytekin Oto, MD, ment and who could be safely observed or undergo focal professor of radiology and surgery. therapy––that’s really the ‘Holy Grail’ of prostate cancer He explained that treatment options range from surgical research,” said Scott Eggener, MD, associate professor of removal of the entire prostate, which carries a 5-10% chance surgery. Focal laser ablation therapy is a minimally invasive of incontinence and up to 30% chance of impotence, to treatment that precisely targets and destroys the cancer. active surveillance, a strategy of ”keeping a close eye” on the Drs. Oto and Eggener teamed up to develop a Phase I cancer with the goal of never requiring treatment but interclinical trial to evaluate the feasibility and safety of using vening in the future, if needed. Most people who are diagnosed with prostate cancer will not die of the disease, but there’s no perfect way to differentiate between deadly and non-deadly cancers. Continued on Next Page An ancient, seven-story underground city in Cappadocia, Turkey. It was built in the soft volcanic rock many centuries BC and extends to a depth of 200 feet. The city has served as a refuge to many people over the centuries. It was fascinating to feel the history while going through the underground tunnels. What projects are you working on at home? We just completed redoing our kitchen, and I think I will take a long break from home projects for a while. Who is the person you most admire? I would say my dad, and this is kind of a secret admiration. He passed away when I was 19, and I could only recently realize how much impact he had in my character development, major life decisions, and parenting. What is your favorite way to relax? I love the quiet moments at home after everyone goes to bed and I relax either by reading my book, listening to music, or even watching TV. What was the last book you read? On China by Henry Kissinger What is the most daring thing you have ever done? I took my 7-year-old son parasailing last summer. Looking back, it was not a wise decision. If you had one piece of advice for someone considering your field, what would it be? I would advise them to be focused and have patience. Patience creates confidence and the ability to think rationally, which can eventually lead to success. As the old saying goes, “A handful of patience is worth more than a bushel of brains.” From the Director As a world-class academic research center, we continuously pursue new knowledge in cancer that could lead to life-saving treatment and prevention. However, what makes us truly unique is our commitment to public outreach and sharing our knowledge with those who can benefit the most. Michelle M. Le Beau, PhD In this issue, we report on many of our initiatives that build bridges with our community. For example, we are examining the role that religion and spirituality plays in the medical decisions made by our patients with cancer. By understanding this relationship, we may be able to add chaplains to enhance our patients’ cancer care team. We are also reaching out to our older patients with cancer, many of whom are afflicted with other medical conditions that may be affected by cancer treatments. Our specialized geriatric oncology clinic helps elderly patients maintain function and quality of life by factoring each patient’s situation into treatment decisions. The future generation of researchers and physicians is another group to which we are connected. This past summer, we hosted high school students interested in science to give them valuable work experi- cancer.uchicago.edu ence in a cancer research laboratory. More recently, we partnered with an urban university to integrate a cancer disparities concentration into their curriculum, giving graduate students the opportunity to make a positive impact in the Southside community. In addition to health disparities, much of our research is directed at improving the quality of life for patients. We are currently investigating a new method of treatment that may precisely treat prostate cancer without the risk of serious complications. Finally, a young woman treated by our lymphoma experts has a new appreciation for life. Now a seven- year survivor, she offers support and encouragement to others going through the cancer experience. As we continue to develop innovative ways to reduce the devastating effects of cancer, we look for every opportunity to strengthen ties with the communities we serve. Regards, Michelle M. Le Beau, PhD Director, The University of Chicago Medicine Comprehensive Cancer Center Arthur and Marian Edelstein Professor of Medicine Pathways to Discovery Research Explores Role of Religion in Cancer Care N is examining how religion and spirituality guide treatment decisions in patients with cancer. By understanding this relationship, UCCCC researchers may find new ways to integrate religion and medicine to improve outcomes for patients. ew research We hope to bring scientific and religious communities together by opening dialogue and creating discourse that will ultimately lead to improved outcomes for patients. Coping with Cancer Several years ago, Blase N. Polite, MD, MPH, an assistant professor of medicine who has expertise in colon cancer and health disparities, interviewed patients to understand why some failed to receive chemotherapy treatment. He hypothesized that social support was a factor; however, questions related to religion and spirituality drew the largest response. “It jumped off the page,” he said. “That was what people wanted to talk about.” Dr. Polite conducted a larger follow-up study and observed marked differences by race. He sought help from religiosity experts to understand differences in how people view the role of God. For many patients, particularly African Americans, religion and spirituality played a prominent role in their cancer diagnosis, but with varying implications. For example, although faith can be an important resource for coping during illness, it can also be an impediment to seeking or adhering to treatment. The data showed that patients who strongly agreed with the statement, “God is in control of my cancer,” and “If a person prays about cancer, God will heal it without medical treatment,” were less likely to complete curative chemotherapy. Blase N. Polite, MD, MPH Blase N. Polite, MD, MPH, an assistant professor of medicine who has expertise in colon cancer and health disparities, consults with a patient. He is leading a study to explore how religion and spirituality guide treatment decisions in patients with cancer. A Deeper Understanding With funding from the Templeton Foundation, Dr. Polite and colleagues are now pooling data from 600 patients at 9 different hospitals across the Chicago area, including the University of Chicago Medicine, to analyze how spirituality is incorporated into treatment-related decisions. The study will focus on colon cancer, a disease for which a widening survival disparity exists among African Americans compared to other ethnic groups. Detailed surveys and focus groups will capture how religion influences patient healthcare decisions, as well as how healthcare teams might address the faith of their patients. “Through a much more elaborate set of questions, this study will provide us with a much deeper understanding of how people’s relationship with God relates to cancer,” said Dr. Polite. For the subset of patients who hold a fatalistic view of cancer (“It’s God’s will” and “God will decide what happens to me”), the researchers are interested in finding ways to help this group use their religious faith as a source of strength and comfort, rather than avoid care. Chaplaincy-Based Interventions Since religion has been traditionally left out of patient-physician dialogue, Dr. Polite and colleagues have teamed with George Fitchett, DMin, PhD, associate professor of Open Cancer Clinical Trials Patient enrollment is under way for more than 350 clinical trials at The University of Chicago Medicine Comprehensive Cancer Center. A few of our newly launched clinical trials include: Phase II trial of sequential SGN35 therapy A with adriamycin, vinblastine, and dacarbazine SAVD for older patients with untreated Hodgkin lymphoma – Sonali Smith, MD, principal investigator. n T he CATCH prostate cancer trial: cabazitaxel and tasquinimod in men with castration-resistant heavily pre-treated prostate cancer – Russell Szmulewitz, MD, principal investigator. n A pilot study to evaluate magnetic resonance thermal image-guided interstitial thermal therapy for focal ablation of breast cancer – Hiroyuki Abe, MD, principal investigator. n A multicenter, open-label, single-arm, Phase 1b/2 study of the safety and efficacy of combination treatment with pomalidomide, dexamethasone, and carfilzomib in subjects with relapsed and relapsed/refractory multiple myeloma – Andrzej Jakubowiak, MD, PhD, principal investigator. To learn more about these or any other UCCCC clinical trial, call toll-free 1-855-702-8222 for adult clinical trials or 1-773-702-6808 for pediatric clinical trials, or go to cancer.uchicago.edu and click on Search Clinical Trials in the blue box. n Pathways to Executive Editor and Writer ® Hoyee Leong, PhD managing editor and Writer Pathways to Discovery is a quarterly publication of The University of Chicago Medicine Comprehensive Cancer Center. Winter 2013, Volume 8, Number 1 Jane Kollmer The University of Chicago Medicine 5841 S. Maryland Ave., MC1140, H212 Chicago, IL 60637 Michelle M. Le Beau, PhD Marcy A. List, PhD MR-Guided Focal Laser Ablation Shows Promise for Prostate Cancer Treatment Continued from Front Page MR-guided focal laser ablation therapy to treat clinically low-risk prostate cancer. Combining these two technologies is advantageous because MR imaging guidance facilitates direct visualization and targeting of prostate tumors in real-time. Dr. Oto compared the procedure to lumpectomy for breast cancer, where surgeons remove the cancer instead of the whole breast. “The goal of focal ablation is to effectively treat the cancer without serious complications,” he said. Nine patients with low-risk prostate cancer were treated without significant complications. After one year of followup, residual cancer was detected in two patients––the other seven remained cancer-free. Because the Phase I trial Scott Eggener, MD successfully demonstrated the safety of the procedure, the researchers are initiating a Phase II trial in early 2013 to evaluate the effectiveness of focal therapy in controlling lowrisk prostate cancer. Dr. Oto is hopeful that the research will change the paradigm for prostate cancer therapy, presenting an alternative to more aggressive treatment options. “With this focal treatment method, we hope to one day tell our patients that we’re taking care of their cancer without risk of serious complications,” he said. “That will be a huge service to them.” Gr aphic Designer Photos Adam Indyk David Christopher OCECD UCCCC UCCRF UChicago UChicago Medicine Printing AFLOTS Inc. Editorial Advisors Phone: 1-773-702-6180 • Fax: 1-773-702-9311 [email protected] © 2013 by The University of Chicago Medicine Comprehensive Cancer Center. All rights reserved. 2 preventative medicine at Rush University and a national leader in training chaplains, to design a pilot chaplain-led intervention program that acknowledges the importance of spirituality when a patient is diagnosed. “If we can work together with our chaplains and patients to continue using religion as a source of strength during their treatments, then we may be able to address an important factor in cancer disparities,” said Dr. Polite. He added that future research will assess whether the chaplaincy intervention improves patient satisfaction and compliance with therapy. “We hope to bring scientific and religious communities together by opening dialogue and creating discourse that will ultimately lead to improved outcomes for patients,” he said. Aasim Padela, MD, MSDc, assistant professor of medicine, is also studying the impact of religious beliefs on healthcare behaviors among American Muslims. cancer.uchicago.edu Cancer Program ranked #15 in nation and #1 in Illinois by U.S. News & World Report. Follow us for news, events, and other interesting information. At the Forefront of Discovery® UCCCC Partners with Chicago State University to Address Cancer Disparities on South Side C are on the rise on the South Side of Chicago, creating an urgent need for cancer prevention efforts at the community level. For example, a disproportionately greater number of African American women die from breast cancer than any other group in the U.S., but in Chicago, the numbers are even worse. One potential approach to prevent these and other cancer-related deaths is to increase the presence of underrepresented minorities from Southside communities, which are predominantly African American, in the healthcare workforce. “Part of filling the gap in disparities is being able to encourage researchers and scientists who are from those communities to engage in disparities research and help put the specific concerns and needs of the community in context,” said Karen E. Kim, MD, MS, professor of medicine and director of the UCCCC’s Office of Community Engagement and Cancer Disparities. nity members. In the subsequent two years, content from the mini-courses will be integrated into the MPH curriculum at CSU and the Pritzker School of Medicine’s Healthcare Disparities in America course curriculum. The UCCCC and CSU will also work closely with community-based health organizations to prepare them for collaborative projects with students, who will receive mini-grants from the CSCDI to conduct community-based participatory research, which entails working side-by-side with community members to help translate knowledge into action. Karen E. Kim, MD, MS, professor of medicine (middle), pictured here at a conference about health disparities among minorities in the Midwest, is joined by colleagues from Chicago State University, Col. Damon T. Arnold, MD, MPH, CMT (Ret.), director of the MPH program, and Thomas Britt, MD, MPH (left), assistant professor and chair of health studies. Dr. Britt is also the co-principal investigator with Dr. Kim for the Chicago Southside Cancer Disparities Initiative. A Timely Partnership The UCCCC has partnered with Chicago State University (CSU) to create opportunities for Master of Public Health (MPH) graduate students interested in biomedical and cancer research that addresses cancer disparities in the surrounding community. The partnership, called the Chicago Southside Cancer Disparities Initiative (CSCDI), recently received funding from the National Cancer Institute (NCI)1 to develop a new cancer disparities concentration within CSU’s MPH program, with an emphasis on cancer education, training, and community engagement. As the largest minority-serving institution in the Midwest, CSU has a long history of education, leadership, and commitment to Chicago’s South Side. Their MPH program was developed in 2010 to focus on minority health and health promotion. The partnership presents a timely opportunity to pair minority students with nationally recognized UCCCC educators and researchers. University of Chicago faculty advisors include UCCCC members Dr. Kim and Habibul Ahsan, MBBS, MMedSc, Louis Block Professor of Health Studies, Medicine, and Human Genetics, as well ancer disparities Grand Auction Raised $700,000 for Cancer Research Women’s Board member Diane Thomas, Jim Haag, vice president of sales and business development for Verdura, Women’s Board President Jill Pollock, and Women’s Board member Cindy Chereskin as Doriane Miller, MD, associate professor of medicine and director of the Center for Community Health and Vitality; and Monica Peek, MD, MPH, assistant professor of medicine. Town hall meetings will be held at the UCCCC, CSU, and in the Southside community to gain a deeper understanding of the community’s needs and research strengths. Over the next year-and-a-half, information generated from the town hall meetings will shape the development of mini-courses that will be offered to CSU students, University of Chicago Pritzker School of Medicine students, and commu- A Focus on Public Health Although laboratory work and clinical trials focus on the biological aspects of health, leading research centers such as the UCCCC also need to look at the “bigger picture” of public health, according to Dr. Kim. These efforts involve developing community-based programs that sustain healthy lifestyles and prevention, such as the CSCDI. “We have the wonderful ability to disseminate scientific findings out into the community to help reduce cancer disparities,” she said, commenting that the public can also inform researchers about how to approach their studies. “It’s the integration of science and health.” 1 This project is being supported by grant number CA165582 from the National Cancer Institute of the National Institutes of Health. The 46th Annual Grand Auction was hosted by the Women’s Board of the University of Chicago Cancer Research Foundation at the Four Seasons Hotel Chicago. This year’s theme, “Viva la Vida,” was celebrated with cocktails, dinner, dancing, and a live and silent auction. Children of some of the Women’s Board members sold raffle tickets. Picture here: Allison Finkel and Krissie Sullivan (from left) UCCCC Director Michelle Le Beau, PhD, Event Co-Chair Astrid McKinnon, Women’s Board President Jill Pollock, and Event Co-Chair Wendy Chronister The entertainment included Spanish music and dance provided by the Bill Pollack Orchestra Community Members Experience ‘The Journey’ Taken by Patients with Breast Cancer The UCCCC Office of Community Engagement and Cancer Disparities (OCECD) recently launched “The Journey,” a program that brings community members to the University of Chicago Medicine to learn firsthand about diagnostic, treatment, and survivorship services. The program began in October with 30 members of Chicago’s Chinese community and was conducted in Mandarin, Cantonese, and English. The event was funded by a grant from the Exelon Corporation. The OCECD held their second event in November for 45 African American Members of the Roseland and Washington Heights communities women from the Roseland and Washington Heights visit breast cancer facilities in the Duchossois Center for Advanced communities. “The Journey” walk-through event was Medicine at the University of Chicago Medicine. designed to provide “experiential learning,” by which participants gain knowledge through direct experience. Participants toured (left to right) Dr. Kim presents an hospital facilities, including procedural rooms for mammography, radiation overview of breast cancer care therapy, and chemotherapy, and met with breast cancer specialists who while OCECD Community Health explained how breast cancer is detected, diagnosed, and treated. Students Educator Helen Vallina, PhD, RN, from the University of Chicago Pritzker School of Medicine helped OCECD translates to Cantonese. Director Karen E. Kim, MD, MS, professor of medicine, present information. cancer.uchicago.edu 3 Pathways to Discovery Cancer Researchers Mentor High School Students Interested in Science E for nearly a decade, the UCCCC has welcomed highly motivated high school juniors into research labs as part of the Illinois Division of the American Cancer Society’s (ACS) Summer High School Research Program. Students spend 8 weeks learning about the scientific process, attending lectures, touring laboratories, and contributing to ongoing research projects at major academic institutions. This past summer, Maryellen Giger, PhD, professor of radiology, hosted Kathy Rodogiannis, a student at Dwight D. Eisenhower High School in Blue Island, Ill. “I’m so grateful to the University of Chicago for giving me the chance to do research in their top-rated facilities,” said Rodogiannis, who plans to pursue a career in medicine. very summer Evaluating DCIS Using quantitative image analysis methods, Dr. Giger’s lab is investigating image-based biomarkers for ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer that may progress to become invasive and metastasize. Currently, there are no methods available to predict which cases of DCIS are likely or not likely to spread, so women with suspicious lesions are often subjected to biopsies and surgeries. During her internship, Rodogiannis helped collect and analyze a dataset of DCIS cases imaged with digital mammography. Using quantitative image analysis software, her goal was to identify image-based breast tumor characteristics that may potentially be used to classify patients based on their risk of developing invasive disease. Her summer research yielded promising preliminary results, facilitating future studies that will help guide treatment decisions. Dr. Giger called the early data promising, but stressed the importance of verifying and expanding those results using a larger database that includes images from both mammography and magnetic resonance imaging (MRI). Her research team has already begun to increase the dataset by collecting and analyzing MRIs. The availability of an accurate and reliable imaging method that can distinguish between threatening and non-threatening cases of DCIS would be highly beneficial in breast cancer diagnosis and spare some women from overtreatment, said Dr. Giger. “A potential future scenario would be that a woman with an initial diagnosis of DCIS could have her mammographic and MR images assessed by the computer’s quantitative analysis software, which would provide additional information to physicians for their patient-management decisions.” Mentoring Future Scientists Patrick La Riviere, PhD, associate professor of radiology, also hosted a student this past summer. Kyler Gillespie from King College Prep in Kenwood helped develop a novel approach to high-resolution X-ray imaging using light-field microscopy. Dr. La Riviere’s lab is looking at how this approach could be used to image tumor samples at very high resolution without physically slicing the specimen. With additional testing, the light-field microscope could potentially be used alongside full-size human X-ray imaging systems as a new tool for cancer imaging. “ACS’s past and future contributions are important to the development and mentoring of our next generation of scientists,” said Dr. Giger, who has mentored students in the ACS program for the past 8 years. “The earlier we bring students into the lab, the more likely it is that they will go into science.” Kathy Rodogiannis spends time in a UCCCC laboratory working on identifying image-based biomarkers for ductal carcinoma in situ on mammography. She was one of the high school students selected to gain direct experience with cancer research through the Illinois Division of the American Cancer Society’s (ACS) Summer High School Research Program. Clinic Provides Cancer Care for Older Adults Cancer is predominately a disease of with national leaders to discuss methods for older adults, yet the majority of participants generating the highest quality research in enrolled in most clinical trials fall into much older adults with cancer. Based on the success younger age groups. As a result, a lack of of this conference, a second meeting was evidence-based data exists to guide oncolorecently held in Chicago to propose trials for gists in properly tailoring therapy for patients older, frailer adults with a number of types of in their sixties, seventies, and even older. This cancer. limitation is especially troubling, since the Dr. Dale’s research also focuses on population of older patients with cancer is improving treatment decision-making strateexpected to grow rapidly in the next 20 years. gies for older men with prostate cancer. One “Despite a robust outpouring of studies study found that an increasing number of on cancer and a similar number on aging older men elect to start receiving hormone separately, it’s remarkable and concerning how therapy primarily because they are anxious little we still know about the intersection of about their prostate cancer, despite a lack of the two,” said William Dale, MD, PhD, associclinical benefit for starting hormone therapy ate professor of medicine and chief of the early. Dr. Dale is currently testing decision Section of Geriatrics & Palliative Medicine. aids —such as an interactive video—to To address these limitations, Dr. Dale help patients understand the side effects of founded the UCCCC Specialized Oncology Patient Thomas Percell (center) receives care in the UCCCC Specialized Oncology Care and Research in the Elderly hormone therapy. He is also studying the Clinic with (left to right) Monica Malec, MD, William Dale, MD, PhD, James Wallace, MD, and Joan Bigane, APN. Care and Research in the Elderly (SOCARE) benefits of physical therapy before patients Clinic in 2006. SOCARE is staffed with professionals with Adequate social support is another consideration, he said, undergo such therapies. since dehydration, muscle weakness, or memory loss may expertise in oncology, geriatrics, and palliative care who “We’ve reduced overtreatment in the elderly by just realmake it unsafe for patients to be at home alone during coordinate and individualize care for older patients diagizing that they’re often overly nervous and need more explacancer treatments like chemotherapy. At SOCARE, vulnernosed with cancer. He explained that, because many older nation about the tradeoffs,” said Dr. Dale. Overall, he and patients have multiple conditions in addition to cancer, their able older patients are connected with community resources his colleagues are helping maintain function and quality of to aid with transportation, safety evaluations, and home care life by matching therapy to the patient’s situation. He envioverall medical situation must be factored into treatment services. In fiscal year 2012 alone, the clinic served over decisions. For example, if a patient diagnosed with lung sions SOCARE helping to increase the recruitment of older 1,300 patients. cancer also has heart disease, osteoporosis, and recently fell, patients into UCCCC-based clinical studies and implement Along with providing clinical care, Dr. Dale focuses physicians must determine if needed chemotherapy can be ing social support initiatives, such as a program that places his research on improving the enrollment of older adults tolerated. older patients who live alone into supervised long-term care in cancer clinical trials. “We want to include as many “As people get older, two of their main health risks are settings while undergoing treatments, thereby extending the patients as possible in potentially curative therapies,” he physical frailty and cognitive impairment,” said Dr. Dale. group who can benefit from cancer therapy. 1 “Those can both be affected by many standard cancer treat- said. In 2010, with funding support from the National This project was supported by grant number U13 AG038151 from the 1 National Cancer Institute of the National Institutes of Health. Institutes of Health and the UCCCC, Dr. Dale and other ments.” SOCARE evaluates the fitness of older patients in geriatric oncology leaders held a conference in Chicago tolerating treatments to help inform treatment decisions. Racetrack Event Supports Cancer Research In August, the Arlington Million Ladies held a luncheon, auction, and raffle at the Arlington Park Race Track. The group raised more than $12,000, which was donated to the University of Chicago Cancer Research Foundation (UCCRF) to benefit cancer research at the UCCCC. 4 Linda Block and Judi Duchossois Front row, left to right: Janice Campbell, Mary Zimmerman, and Kelcey Roberts; Back row, left to right: Angie Cristel, Maxwell Skor, and Penny Ffitch-Heyes cancer.uchicago.edu At the Forefront of Discovery® Member News & updates The Cancer Research Foundation (CRF) selected 1 Kenan Onel, MD, PhD, associate professor of pediatrics, and 2 Ernst Lengyel, MD, PhD, professor of obstetrics and gynecology, as 2012 Fletcher Scholars. Dr. Onel was awarded funding for his work, “Exploiting Darwin to Overcome Drug Resistance in Leukemia,” and Dr. Lengyel for “Characterization of the Bi-directional Cross Talk between Cancer Cells and Carcinoma-associated Fibroblasts.” The CRF Fletcher Scholars Awards were established in 1988 by the estate of Eugene and Dorothy S. Fletcher to fund the work of individual senior cancer scientists. 3 Janet D. Rowley, MD, Blum-Riese Distinguished Service Professor of Medicine, Molecular Genetics and Cell Biology, and Human Genetics, won the 2012 iCON Innovator Award from the Illinois Biotechnology Industry Organization Institute. Dr. Rowley was chosen for her influential work in identifying a chromosomal translocation as the cause of leukemia and other cancers, which paved the way for future breakthroughs. She received the award at a dinner held at the Field Museum on Oct. 4. 4 Samuel Volchenboum, MD, PhD, assistant professor of pediatrics, has been named an associate director of the University of Chicago Institute for Translational Medicine (ITM). Dr. Volchenboum is involved in various collaborative projects involving 7 biomedical informatics across the institution. In his new role with the ITM, he is promoting resources available to investigators, including the Clinical Research Data Warehouse, an electronic data repository that houses patient data. 5 Philip Hoffman, MD, professor of medicine, and 6 David Rubin, MD, who was recently promoted to professor of medicine, were selected as Senior Faculty Scholars by the Bucksbaum Institute for Clinical Excellence, a unique initiative created by the University of Chicago Medicine in 2011 to improve the doctorpatient relationship and communication in medicine. Drs. Hoffman and Rubin are among four faculty involved in a new program recognizing distinguished senior clinicians for their superior skills as physicians and teachers. UCCCC Director 7 Michelle M. Le Beau, PhD, Arthur and Marian Edelstein Professor of Medicine, recently became the new president of the Association of American Cancer Institutes (AACI). The organization unites 94 cancer research 2 1 3 8 9 4 6 centers to educate policy leaders and the public about the important role cancer centers play in reducing the burden of cancer in their communities. Dr. Le Beau bears the distinction of being the association’s first female president. She was elected as AACI’s vice president/ president-elect in October 2011. UCCCC co-deputy director 8 Richard Schilsky, MD, professor of medicine and chief of the Section of Hematology/ Oncology, accepted the newly created 5 position of chief medical officer for the American Society of Clinical Oncology, effective February 2013. Dr. Schilsky, who has served as a valued member of the University of Chicago faculty since 1984, will retire from the University at the end of the year. Dr. Schilsky also recently received the 2012 Pinedo Cancer Care Prize by the Society for Translational Oncology (STO). on a genomic approach for the assessment and treatment of acute leukemias at the Argentina Society of Hematology’s Symposium on Acute Leukemia in Buenos Aires. He also delivered two lectures on acute lymphoblastic leukemia at the 3rd International Conference on Hematopoietic Stell Cell Transplantation in the Treatment of Acute Lymphoblastic Leukemia in Poznan, Poland. In October, 9 Richard Larson, MD, professor of medicine, presented a lecture UCCCC leukemia experts traveled to Beijing, China, in September to participate with their colleagues in a hematologic malignancies workshop. Faculty from the University of Chicago, Peking University, and other universities in China are working together to develop therapeutic strategies for hematologic malignancies using alternative donor stem cell transplantation. Because finding a matched related or unrelated donor is much less likely for patients in China, doctors are exploring the use of alternative donors, such as haploidentical (having the same alleles at a set of closely linked genes on one chromosome) donors, cord blood stem cells, or combined haploidentical/cord stem cell transplantation. Hongtao Liu, MD, PhD, instructor of medicine, organized the workshop, and Richard (left to right) Wendy Stock, MD, her husband James Baird, Larson, MD, professor of medicine, Wendy Stock, MD, professor of medicine, and John former UCCCC member Koen van Besien, MD, and Richard Larson, MD, visit the Great Wall of China. Cunningham, MBBCh, MSc, professor of pediatrics, shared their expertise. Elementary Students Don Pink, Raise Money for Breast Cancer Students at John V. Leigh School in Norridge, Ill., donated almost $200 to the University of Chicago Cancer Research Foundation (UCCRF) in support of breast cancer research and care. As part of a service-learning project, the children asked anyone who wore pink to contribute $.50 and collected donations from family and friends. cancer.uchicago.edu 5 Pathways to Discovery Research Highlights The following represent some of the research accomplishments of UCCCC members published August–October 2012. PET/CT Scanning Predicts Overall Survival Rates in Patients with NonSmall-Cell Lung Cancer New research shows that tumor measurements from PET/CT scanning can be used as a prognostic index of survival in patients who have undergone surgery for nonsmall-cell lung cancer (NSCLC). Yonglin Pu, MD, PhD, associate professor of radiology, and colleagues performed a retrospective study of surgical patients diagnosed with NSCLC who had baseline tumor measurements taken from 18 Flurodeoxyglucose (FDG)-PET/CT scans. Whole-body metabolic tumor burden was assessed by measuring the volume of tumor tissue showing increased uptake of FDG on PET, known as metabolic tumor volume (MTV), and total lesion glycolysis (TLG), a measure that reflects both the volume and metabolic rate of tumors. High MTV and TLG measurements were both associated with decreased overall survival rates. Previous studies have already shown the prognostic value of these PET/CT measurements in nonsurgical patients with NSCLC. However, this is the first study demonstrating its value in surgical patients with NSCLC independent of disease stage. (Zhang et al., Acad Radiol published online ahead of print, September 2012) Stress Lowers Prostate-Specific Antigen (PSA) Screening Rates Researchers find that perceived stress and anxiety significantly influence the likelihood of prostate-specific antigen (PSA) screening for prostate cancer among men. Current guidelines emphasize the importance of men making shared, informed decisions about PSA screening for prostate cancer. However, the impact of psychological health and emotions on these decisions is unclear. William Dale, MD, PhD, associate professor of medicine, and colleagues evaluated the relationship between stress, anxiety, and depression on PSA testing rates in over 1100 men between the ages of 57 and 85 without prostate cancer from the National Social Life, Heath and Aging Project (NSHAP). This sample is representative of older men across the United States. They found that increasing levels of perceived stress significantly lowers PSA screening rates. Furthermore, anxiety influences rates depending on how often patients visit their doctors—men who visit their doctors frequently and are anxious receive much more screening. These findings suggest that more attention to patients’ emotions like perceived stress and anxiety may improve the appropriateness of PSA screening. (Kotwal et al., Medical Care 50:1037-44, 2012) This work was supported by the National Social Life Health and Aging Project (grant number R01-AG021487 from the National Institutes of Health). Study Identifies a New Biomarker for Breast Cancer Progression and Metastasis Researchers discover that the WAVE3 gene promotes breast cancer metastasis and can be used as a predictive marker for patient survival. Swati Kulkarni, MD, associate professor of surgery, and colleagues from Cleveland Clinic and Roswell Park Cancer Institute, analyzed the expression of WAVE3 in the peripheral blood cells of women with breast cancer. They found that WAVE3 was highly expressed in patients with metastatic breast cancer, and that expression levels were positively correlated with aggressive tumors that are classified as “triple-negative,” or those lacking HER2, estrogen receptor, and progesterone receptor expression. These findings support the use of WAVE3 as a biomarker for the early detection of women who may be at risk of their cancer progressing to a more aggressive and metastatic disease. Identification of these women would help physicians determine which patients would most benefit from additional therapies. (Kulkarni et al., PLoS One 7:e42895, 2012) This work was supported by the Cleveland Clinic Foundation, grant number W81XWH-08-1-0236 from the U.S. Department of Defense, grants P01 HL073311 and P50 HL077107 from the National Institutes of Health, and pilot funding from the Case Comprehensive Cancer Center (P30 CA043703). Aspirin Is Associated with a Reduced Risk of Prostate Cancer Mortality A recent clinical study suggests that the use of anticoagulants, particularly aspirin, is associated with a lower risk of death in men undergoing therapy for prostate cancer. The study investigators, including Stanley Liauw, MD, associate professor of radiation and cellular oncology, analyzed a large registry of nearly 6,000 men with prostate cancer who were treated with either radical prostatectomy or radiotherapy. The death rate from prostate cancer was significantly lower in men who were taking anticoagulants compared to those who were not. This reduction was most pronounced in patients with high-risk disease (4% versus 19% at 10 years after diagnosis). Follow-up clinical trials are required to confirm these results before aspirin can be routinely recommended to patients with prostate cancer. (Choe et al., J Clin Oncol 30:3540-4, 2012) This work was supported by Abbott Laboratories, grant number 5RC1 CA146596 from the National Cancer Institute, and grant number 1U01 CA88160 from the Agency for Healthcare Research and Quality of the National Institutes of Health. Genomic Markers Predict Sensitivity to Common Chemotherapy Drug A team of UCCCC investigators identified new genetic variants and genes associated with sensitivity to capecitabine, an oral chemotherapy drug widely used to treat breast, colorectal, and gastric cancers. The researchers conducted a genomewide association study to identify underlying genetic factors that influence the response to capecitabine treatment. They examined genetic information in cell lines derived from over 500 individuals across world populations and found a new genetic variant near the 5-methyltetrahydorfolatehomocysteine mehtyltransferase reductase (MTTR) gene, as well as a genetic variant of the DNA regulating SMARCAD1 gene, associated with drug sensitivity. Results from this study may help physicians personalize cancer therapy by selecting patients who would most likely respond to treatment. M. Eileen Dolan, PhD, professor of medicine, Peter O’Donnell, MD, assistant professor of medicine, Nancy Cox, PhD, professor of medicine, and Stephanie Huang, PhD, assistant professor of medicine, were among the study authors. The group is also evaluating top genetic variants from the preclinical study in a clinical trial of capecitabine initiated by Dr. Just the Stats1 O’Donnell with the Translational Breast Cancer Research Consortium. (O’Donnell et al., Cancer 118:4063-73, 2012) This work was supported by grant numbers P50 CA125183 from the University of Chicago Breast Cancer Specialized Program of Research Excellence (SPORE), U01 GM61393 from the Pharmacogenomics of Anticancer Agents Research Group and K08 GM089941 funded by the National Institute of General Medical Sciences, F32 CA136123 from the National Cancer Institute, and TL1 RR25001 from the National Institutes of Health. Researchers Discover How a Drug Used in Transplant Patients Increases Skin Cancer Risk Cyclosporin A, an immunosuppressive drug used to prevent rejection following organ transplantation, increases the risk for skin cancer by inhibiting the repair of and the response to DNA damage from ultraviolet B (UVB) exposure. Immunosuppression has been widely assumed to be the major cause for skin cancer in organ transplant recipients, which occurs up to 250 times more frequently in this group of patients than in the general population. Yu-Ying He, PhD, assistant professor of medicine, led a study to determine the mechanisms of skin carcinogenesis using mice that lack an active immune system, as well as human skin cells. Results showed that following UVB exposure, cyclosporine A increases activation of the PI3K/AKT signaling pathway, which deregulates normal expression of the XPC gene and cyclophilin A protein, leading to a reduced ability to repair DNA damage and activate DNA damage response. These findings, indicating that cyclosporin A increases the risk for skin cancer independent of its immunosuppressive effects, facilitate efforts to improve skin cancer prevention in patients who receive this drug. (Han et al., Cancer Prev Res (Phila) 5:1155-62, 2012) This work was supported by grant number ES016936 from the National Institutes of Health, pilot funding from the University of Chicago Comprehensive Cancer Center (P30 CA014599), the Clinical and Translational Science Awards program (UL1 RR024999) funded by the National Institutes of Health, and University of Chicago Friends of Dermatology Research Funds. Tumor Endothelial Inflammation Predicts Cancer Outcome A new study identifies the first cancer gene signature associated with inflammation of endothelial cells, which line the inner layer of blood vessels. The signature predicts lower survival rates in four types of cancer. Ralph Weichselbaum, MD, professor of radiation and cellular oncology, and colleagues demonstrated that endothelial inflammation promotes tumor growth. By disrupting inflammatory gene expression in tumor-associated endothelial cells, the researchers inhibited tumor growth in mice. Following up on this observation, they analyzed the expression of over 500 inflammatory genes and identified six genes associated with reduced overall survival in lung, breast, and colon cancer, as well as glioma. Results indicated that patients expressing this gene signature have an increased risk for death from cancer compared to those who do not express the gene signature. These findings indicate that the gene signature is predictive of overall survival in multiple human cancers, and may serve as a potential target for the development of new cancer therapies. (Pitroda et al., PLoS One 7:e46104, 2012) This work was supported by the Virginia and D.K. Ludwig Fund for Cancer Research, Lung Cancer Research Foundation, Chicago Tumor Institute, Brain Tumor Program Project (P01 CA07193312), grant numbers HL58064, HL98050, and HL105371 from the National Institutes of Health, and a gift from the Foglia family. 6 cancer.uchicago.edu At the Forefront of Discovery® Young Woman’s Experience with Hodgkin Lymphoma Changes Her Outlook on Life I n 2005, Cheryl Albovias, then 31, became so sick that her doctor in Orland Park suspected she had either pneumonia or cancer. She was referred to associate professor of medicine Sonali Smith, MD, at the University of Chicago Medicine Comprehensive Cancer Center (UCCCC). A biopsy confirmed that the source of Albovias’ symptoms was Hodgkin lymphoma. A large tumor in her chest had already spread to her neck. Albovias’ initial reaction was shock and fear, as her mother was diagnosed with breast cancer 2 years earlier and she had lost other relatives to cancer. “Once you hear cancer, you think of it as being really negative,” she recalled. Without lifesaving treatment, Albovias was facing a potentially fatal outcome within a matter of months. She experienced a range of emotions. As someone fully engaged in her career and preparing to buy a house, she felt that the cancer diagnosis came just as she was beginning her life. “I felt a lot of regret,” she said. “There were still so many things I hadn’t yet accomplished.” Albovias was so nervous that she broke out into hives on the first day of chemotherapy treatment, but she soon began to feel more at ease. She credits this to the nurses who patiently explained everything to her, her friends and family who remained by her side, and the team of Cheryl Albovias (left, middle & above, top) celebrates her remission status with her family. She was treated for Hodgkin lymphoma by doctors at the UCCCC. volunteers who encouraged her. Fortunately, cure rates for Hodgkin lymphoma are as high as 70 to 80 percent, making it one of the most treatable cancers. After 6 cycles of chemotherapy, Albovias was amazed to see the image showing that her tumor had vanished. In most cases, radiation therapy would be the next step; however, Albovias’ lymphoma had responded so favorably that Dr. Smith and her colleagues recommended against further treatment. “We really try to avoid unnecessary radiation therapy in younger patients to protect them from long-term complications, such as infertility and increased risk for therapyrelated cancers,” said Dr. Smith. At the UCCCC, ongoing studies are evaluating the long-term effects of treatment on cancer survivors. This knowledge helps physicians consider all factors that may affect a patient’s quality of life before choosing a course of therapy. Now 38, Albovias remains cancerfree, but her experience left her with a newfound appreciation for life. She created a list of what she wants to accomplish during her lifetime and has been working toward crossing each item off. Her career has taken a backseat as she spends her time visiting with friends and family, reading books, learning to cook, and traveling to new destinations. She recently zip-lined in Hawaii, overcoming a lifelong fear of heights. She also offers support and encouragement to others battling cancer and has become involved in fundraising for cancer research. “I don’t think I would take any part of the experience back,” she said. “It opened up my eyes and changed my life in a positive direction.” Focus on: Core Facilities High-Performance Computing Facility Assists Researchers with Imaging Needs Imaging plays an important role in cancer research, both in the clinic and the laboratory. Studying cancer from all angles requires not only state-of-the-art imaging tools, but also the expertise to analyze and integrate the resulting data properly. Such tasks require sophisticated computing power and storage capacity that researchers generally do not have in their own laboratories. Researchers at the UCCCC can access computing and analysis services from the Image Computing, Analysis, and Repository (ICAR) Facility, one of the UCCCC’s shared resources. The ICAR Facility includes a computing cluster optimized for image processing, analysis, and visualization, and an animal imaging repository (AIR), which provides network file sharing services for animal researchers. “One of the advantages of the ICAR Facility is that researchers have access to high-speed computing power with real-time interactivity and a fast turnaround,” said Scientific Co-Director Robert M. Nishikawa, PhD. For example, developing a computer algorithm for image processing may take months to a year on a standard desktop computer, but ICAR can complete the task in a matter of days. From basic consultation to shared development of new analysis software, the ICAR Facility helps researchers who may not have imaging expertise take advantage of state- of-the-art imaging modalities. Services include modeling and simulations, the development of new image analysis methods, data construction and reconstruction, as well as computer-aided diagnosis (CAD). The University of Chicago Medicine pioneered the field of CAD and leads the field of breast imaging. With support from the ICAR Facility, UCCCC researchers are now developing new methods to obtain high quality images while lowering radiation exposure to patients. ICAR Technical Director Chun-Wai Chan, MS, said, “It’s much easier and more efficient to have the job done by expertly trained personnel within a dedicated core rather than scattered throughout the University.” Staff can perform new emerging techniques, such as image fusion, where images of the same object taken by different modalities are combined. The ICAR Facility frequently collaborates with the Integrated Small Animal Imaging Research Resource (iSAIRR), a separate UCCCC shared facility that provides comprehensive small animal imaging services. Researchers obtain initial consultation from iSAIRR to identify appropriate imaging studies and to learn of methods to achieve maximum imaging quality. The data generated from Radiology and radiation oncology experts at the UCCCC use sophisticated computer models to simulate how X-ray beams scatter. They are investigating strategies to reduce the X-ray dose to patients resulting from computed tomography (CT) used for image guidance in radiation therapy. Normally, these simulations consume 500-1,000 hours of time on standard desktop computers, but the ICAR Facility’s computer cluster can return results in a day or less. imaging studies is stored in the ICAR Facility’s AIR, a centralized repository that streamlines research workflow by storing, retrieving, and backing up data from multiple imaging modalities. After imaging, the ICAR Facility analyzes the data and extracts the desired information. For example, researchers are currently using the Facility’s imaging analysis expertise to measure the effect of treatment on tumor shrinkage. The ICAR Facility also collaborates with the Human Imaging Research Office’s Biomedical Imaging Repository to develop methods to connect researchers with large imaging databases, which are useful for developing algorithms to detect and diagnose diseases such as cancer by radiologic imaging. These and other ICAR Facility services facilitate groundbreaking cancer research and new collaborations at the UCCCC. Cancer Survivor Support Group Offered in Chinese Community In September 2012, the UCCCC Office of Community Engagement and Cancer Disparities (OCECD) held its first Chinese Cancer Survivor Support Group meeting at the Chinese American Service League (CASL). Participants included Chinese cancer survivors who were diagnosed with cancer within the past 2 years and participated in the Cancer Transitions™ program (funded by the LIVESTRONG® organization) held by the OCECD for seven consecutive weeks from April to May 2012. The Cancer Survivor Support Group is a joint effort between the OCECD and CASL to help Chinese cancer survivors take control of their survivorship. Adapted from the LIVESTRONG® program, the meeting is conducted in English, Mandarin, and Cantonese, and is the first cultureand language-specific cancer support group in Illinois. The group meets every 2 months and is open to all Chinese cancer survivors in the community and their family members. cancer.uchicago.edu Cancer survivors in the Chinese community come together at the first meeting of the Chinese Cancer Survivor Support Group. 7 Pathways to Discovery UCCRF Board of Trustees Steers Philanthropic Efforts to Aid Cancer Research save the dates! The University of Chicago Cancer Research Foundation (UCCRF) presents a list of upcoming fundraising events: United by the common goal of reducing the devastating effects of cancer, members of the University of Chicago Cancer Research Foundation (UCCRF) have worked together to raise money to support cancer research since the 1940s. This non-profit organization continues to play an important role in helping the UCCCC accelerate research discoveries that improve cancer care. T UCCRF comprises four boards—one governance board (Board of Trustees) and three fundraising boards (Women’s Board, Auxiliary Board, and Associates Board). The Board of Trustees comprises leaders from all sectors of the business and healthcare communities, grateful patients, and the leadership of the Foundation’s three auxiliary boards. Although these boards are distinct and operate independently, Margaret Benjamin, who has served as the Board of Trustees president for the past year, plans to use her leadership role to create more opportunities for the four boards to coordinate their efforts. “By doing so, we will give the Foundation a more unified voice so that our messaging is as compelling as our cause,” she said. Benjamin, who worked in business before raising her children, became involved with the UCCRF 16 years ago when she tagged along to a Women’s Board event with a friend. Benjamin feels passionately about giving back to the community, so raising money for cancer research was a perfect fit. “As volunteers and philanthropists, he Aux iliary Boar d we are exposed to sion of the UCCCC’s wonderful, interesting Cancer Prevention people who are workand Control research ing to solve problems in program, designacancer,” Benjamin said. tion of the UCCCC “We feel really privias a National Cancer leged to hear about their Institute-designated latest findings, strategies, Comprehensive Cancer and accomplishments.” Center, and a new Part of Benjamin’s UCCRF Women’s strategy to foster Board Laboratory in collaboration among the Gwen and Jules the Boards is to identify Knapp Center for ways to use their unique Biomedical Discovery. strengths to learn from Looking forward, the each other. For example, Board of Trustees will every year the Women’s Margaret Benjamin, UCCRF Board of work in concert with Trustees President the fundraising boards Board organizes the to embrace the next opportunity to Grand Auction, which has become a launch a campaign and further propel the highly regarded event in the City of UCCCC’s mission to personalize Chicago. Benjamin said that this type of cancer care. success happens when everyone comes together to work toward a common goal. “We are lucky because our group is concentrated solely on raising money In 2005, the Board of Trustees for cancer research,” she said. “Under the collaborated with the Women’s Board direction of Dr. [Michelle] Le Beau, there to launch a 5-year capital campaign, will continue to be promising research successfully raising $7 million for cancer research. This effort supported the expan- opportunities at the UCCCC.” “Light the Way to a Cure” Auxiliary Board Auction and Gala • S aturday, February 2, 2013 Michigan Shores Club, Wilmette A ss o c iate s Boar d “Gatsby Gala” No Tie Ball • F riday, March 1, 2013 The Palmer House, Room 1512, Chicago K u h lman ’s K r usad e r s Family-Friendly Fundraiser • S unday, April 21, 2013 Harry Caray’s, Lombard For more information, please contact [email protected]. Pathways to Winter 2013 cancer.uchicago.edu ® In this issue… 1 2 A new method to treat prostate cancer may give patients more options. 3 Research explores religion’s role in cancer care. The University of Chicago Medicine 5841 S. Maryland Ave., MC1140 H212 Chicago, IL 60637 [email protected] The UCCCC helps graduate students address cancer disparities in the Southside community. 4 Older patients with cancer receive specialized care at the UCCCC. 4 Cancer researchers mentor high school students during summer program. 7 Young Hodgkin lymphoma survivor gains new appreciation for life. Support cancer research through the UCCRF: cancer.uchicago.edu/donations
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