Cancer Update May 2015

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2015

Issue No. 31

IN TH I S I SSU E 5 RESEARCH: Scientists collaborate on screening lung cancer 7 PARTNERSHIPS: Training the next generation of physicians 10 RECOGNITION: Nicholas J. Petrelli, M.D., honored with Delaware BioScience Service Award

Helen F. Graham Cancer Center & Research Institute recognized as national model for treatment of thoracic and esophageal cancers Charles Mulligan, Jr., M.D., and Brian Nam, M.D., at the Thoracic/Esophageal Multidisciplinary Center STORY ON PAGE 2

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etired firefighter Andy Spedden and Guinness, his German shepherd, are familiar faces around the Helen F. Graham Cancer Center & Research Institute.

The pair regularly visits patients and staff, and is part of the Paws for People therapy dog program. But last fall, the roles were reversed. Andy became the patient.

“I thank God for this place,” Andy said. “Our connection to the Graham Cancer Center led me to the best treatment for my lung cancer. Guinness and I knew about the good work they do here, and now we brag about it to everyone who will listen.”

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HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

Andy Spedden and Guinness spend hours at the Graham Cancer Center comforting patients and staff with the Paws for People therapy dog program.

Multidisciplinary approach improves outcomes

Latest, minimally invasive treatments

Patients with lung or esophageal cancer have the option to sit down with family members and an entire team of cancer specialists at the Thoracic/Esophageal Multidisciplinary Center (MDC).

A surgeon, a medical oncologist, an interventional pulmonologist, a radiologist and a radiation oncologist team with health professionals from every pertinent discipline – a nurse navigator and research nurse, a dietitian, a health psychologist and social worker. The entire team has one focus: an effective treatment plan for each patient’s individual type of cancer.

The Graham Cancer Center offers the most advanced, minimally invasive ways to detect and treat lung/ esophageal cancers, reducing the need for higher-risk procedures and increasing treatment options.

“This scenario was unheard of just 10 years ago,” explained Chief of Thoracic Surgery Charles Mulligan, Jr., M.D., “but it has proven to be highly effective in facilitating the most comprehensive treatment plan and the shortest time to treatment for the patient.”

Depending on the patient’s individual needs, experts in other fields may join the team. In addition, the Graham Cancer Center offers a host of specialized services including survivorship, pain and symptom management, genetic counseling, wellness and well-being programs, pastoral care, smoking cessation and a follow-up clinic for young adults who have survived childhood cancer.

Dr. Mulligan and Andy’s thoracic surgeon, Brian Nam, M.D., along with Interventional Pulmonologist Tuhina Raman, M.D., specialize in endobronchial ultrasound and the latest navigational bronchoscopy techniques, offered at few other centers in the region. These technologies helped to diagnose and stage Andy’s cancer and to facilitate treatment planning to surgically remove the cancer with only a few small incisions.

“Where appropriate, there are techniques beyond conventional surgery, such as video-assisted thoracic surgery (VATS) and minimally invasive esophagectomy, that offer patients shorter hospital stays with less pain and quicker recoveries,” Dr. Nam said.

Next generation medicines and technologies Many lung and esophageal cancers require a multidisciplinary approach that combines surgery, medical oncology and radiation oncology.

“Guinness and I knew about the good work they do here, and now we brag about it to everyone who will listen.” Andy Spedden

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Where appropriate, there are techniques beyond conventional surgery ... that offer patients shorter hospital stays with less pain and quicker recoveries.

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BRI AN N AM, M. D.

The Graham Cancer Center model of multidisciplinary cancer care has become the standard for leading institutions around the country and abroad.

Through the MDC, patients can benefit from standard and experimental therapies for all stages of disease, including tumors that resist all conventional treatments. These experimental treatments include vaccines, immunotherapy and the latest targeted molecular therapy.

As one of the original National Cancer Institute selected Community Cancer Center sites and a leader in NCI’s Community Oncology Research Program, the Graham Cancer Center has one of the top clinical trial enrollment ratios in the country.

A burgeoning Translational Cancer Research Program pairs scientists with clinicians to move discoveries closer to everyday medicine, including research with The Wistar Institute in Philadelphia to design the world’s first blood test to detect lung cancer.

“We have a number of clinical trials of the new ‘targeted’ drugs that hone in on the specific genetic makeup of a patient’s individual tumor,” said Medical Oncologist Gregory Masters, M.D., a member of the Thoracic/ Esophageal MDC. CONTINUED

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For example, patients who test positive for commonly identified genetic mutations such as EGFR and ALK may qualify for oral medications designed to attack the mechanisms their tumors are using to grow. “These drugs are often more effective and less toxic than systemic therapies,” he said. “We are using clinical trials to determine the best ways to incorporate them at an earlier stage of treatment for optimum results.”

Lung cancer screening

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We have a number of clinical trials of the new ‘targeted’ drugs that hone in on the specific genetic makeup of a patient’s individual tumor.

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G R E G O R Y M A S T ERS , M .D.

Radiation Oncology, chaired by Christopher Koprowski, M.D., employs the latest technologies to safely deliver powerful external beam radiation to precisely target tumor cells. The Graham Cancer Center is home to one of the largest high dose brachytherapy (internal radiation) programs, as well as Delaware’s first and only CyberKnife robotic radiosurgery system. CyberKnife targets hardto-reach lung tumors with pinpoint accuracy and offers new options for patients who cannot tolerate surgery or whose tumors are inoperable.

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Right now only about 17 in 100 patients survive five years from their diagnosis of lung cancer, and the mortality rate for lung cancer exceeds that of breast, colon and prostate cancers combined.

The Graham Cancer Center team is working to change those numbers.

Studies show that finding lung cancer early is key to increasing the number of patients who survive it. That is why the Graham Cancer Center supports the Christiana Care Medical Group and the State of Delaware to make lowdose CT scan screening for lung cancer accessible to those at risk, according to national guidelines. Counseling and services to help people quit smoking are essential components of the Graham Cancer Center’s program.

Andy’s history of smoking, coupled with 15 years investigating and putting out fires made him an ideal candidate for Christiana Care’s Lung Cancer Screening program. A low-dose CT lung scan, recommended by his family doctor, Dana L. Newswanger, D.O., pinpointed the cancer in Andy’s right lung.

“I feel I’m the most blessed man on earth,” Andy said. “I would tell everyone to get screened if your doctor recommends it. The CT scan found my lung cancer early, before it had a chance to spread. Now the cancer is out, and I can breathe easy. I couldn’t have asked for better care.” ¤

LEARN MORE For more information about lung screening or to sign up for an appointment with the Nurse Navigator, call 302-623-CARE (2273).

HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

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Andy Spedden’s history of smoking made him an ideal candidate for Christiana Care’s Lung Cancer Screening program.

A low-dose CT scan pinpointed his lung cancer.

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Finding New Ways to Detect Lung Cancer

COLLABORATION IS KEY Brian Nam, M.D., from the Helen F. Graham Cancer Center & Research Institute (left) and Qihong Huang, M.D., Ph.D., from The Wistar Institute are partnering to develop a blood test for lung cancer.

Wistar scientists team with Graham Cancer Center to advance development of first blood test for lung cancer

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linicians at the Helen F. Graham Cancer Center & Research Institute are working with scientists at The Wistar Institute in Philadelphia to develop the first commercially viable blood test for lung cancer.

“Collaborating with Wistar scientists to develop an early screening tool for lung cancer is one compelling example of our growing translational research effort,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Graham Cancer Center.

“Our ongoing partnership with Wistar, established in 2011, to speed discoveries from their labs to clinical trials now touches on nearly every

major cancer. Successful outcomes will benefit patients everywhere.”

In his laboratory at Wistar, Qihong Huang, M.D., Ph.D., is using next generation sequencing technology to identify and validate biomarkers in the blood that could signal the presence of lung cancer. Dr. Huang and his team at Wistar’s Tumor Microenvironment and Metastasis Program have identified a

highly accurate marker for the most commonly diagnosed form of lung cancer, known as non-small cell lung cancer (NSCLC).

His goal is to develop a simple blood test that looks for this marker as an early indicator of NSCLC. Dr. Huang predicts that such a test potentially could distinguish malignant from benign lung nodules found in those CONTINUED

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at high risk, saving them many years of follow-up CT scans and needless invasive procedures to remove or biopsy the nodules. Also, testing someone’s blood after surgery to remove the cancer could indicate whether the surgery was successful and if the cancer might return.

“Christiana Care and the Graham Cancer Center provide an excellent infrastructure for our project,” Dr. Huang said. “The ability for us to acquire as many as 500 donated patient blood samples over the next five years will help build a foundation for validating our findings.”

The journey from laboratory to clinic can take many years of research labor.

Basic science first attempts to answer the most fundamental questions concerning a discovery and then to validate preliminary findings. Those findings are then translated into studies involving human subjects and may progress to clinical trials long before the results ever become clinical practice.

Dr. Huang is at the stage where he is ready to validate his preliminary studies using a larger test group. That is why he is collaborating with thoracic surgeon Brain Nam, M.D., and the Thoracic/Esophageal MDC team at the Graham Cancer Center to collect and analyze blood samples donated from lung cancer patients. The samples are prepared precisely according to protocol at the Christiana Care Tissue Procurement Center and delivered to Dr. Huang’s lab on dry ice.

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Finding New Ways to Detect Lung Cancer

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“Our ability to collect large numbers of patient volunteers to provide sufficient quantities of blood is critical for Dr. Huang’s research,” Dr. Nam said. Christiana Care and the Graham Cancer Center are the place where many patients come for their initial diagnosis and treatment. “This enables us to draw from a diverse group of patients who have not yet been treated for lung cancer, which is exactly the cohort Dr. Huang requires.”

Currently, the U.S. five-year survival rate for lung cancer is only about 17 percent, and lung cancer-related deaths are higher than mortality for breast, prostate, colon, and pancreatic cancers combined. “The patients who are participating in this study have the potential to help dramatically improve those miserable statistics in the future,” Dr. Huang said.

Graham Cancer Center physician investigators also have supported lung cancer research at Wistar in collaboration with Louise C. Showe, Ph.D., a professor in Wistar’s Molecular & Cellular Oncology program and associate director of the Center for Systems and Computational Biology. With blood samples contributed by Graham Cancer Center patients and others, Dr. Showe demonstrated it is possible to detect early stage non-small cell lung cancer by examining changes in gene activity in white blood cells. Her findings are now being evaluated in a much larger human clinical trial. Other collaborative studies involve therapies for melanoma, head and neck and ovarian cancer. ¤

HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

“Collaborating with Wistar scientists to develop an early screening tool for lung cancer is one compelling example of our growing translational research effort.

Our ongoing partnership with Wistar to speed discoveries from their labs to clinical trials now touches on nearly every major cancer.

Successful outcomes will benefit patients everywhere.”

NIC HOL A S J. P E T RELLI, M. D. B AN K OF AM E R I CA E N DOWED M E D I CAL D I R E CTOR OF T H E HE L E N F. G R AHAM CAN CE R CE N T E R & R E S E AR CH I N S T IT U T E

Graham Cancer Center physician co-investigators on the lung cancer project include: Chief of Thoracic Surgery Charles Mulligan, M.D.; Medical Oncologists Michael Guarino, M.D., and Gregory Masters, M.D.; Radiation Oncology Chief Christopher Koprowski, M.D.; and Interventional Pulmonologist Tuhina Raman, M.D.

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Training the Next Generation

shared strength The Graham Cancer Center is partnering with Philadelphia’s Hahnemann University Hospital to teach medical residents.

New Radiation Oncology residency program launched with Drexel College of Medicine and Hahnemann Hospital

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he Helen F. Graham Cancer Center & Research Institute has initiated its first Radiation Oncology residency program, with approval from the Accreditation Council for Graduate Medical Education (ACGME). The four-year program is offered in partnership with Drexel University College of Medicine and Hahnemann University Hospital in Philadelphia, with one of the oldest radiation oncology training programs in the country.

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Christiana Care radiation oncologists are experts in the latest imaging and treatments, including a residency program in radiation oncology physics — one of only a few in the U.S.

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Training the Next Generation

“We have a track record for high quality patient care, and the resources for doctors to learn their craft in a community setting where most of cancer care takes place. We have a lot to offer in training the next generation of leaders in radiation oncology.”

J ON S T R A S SER , M. D. R E S I D E N CY PR OG R AM DI R E CTOR HE L E N F. G R AHAM CAN CE R CE N T E R & R E S E AR CH I N S T I T UT E

J O N S T R A S S E R , M .D.

“We now offer an accredited radiation oncology residency program, thanks to the work of our Radiation Oncology team led by Christopher Koprowski, M.D., and Education Chief Jon Strasser, M.D., who will serve as residency program director,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Graham Cancer Center & Research Institute. “Our partnership with Drexel and Hahnemann leverages the combined strengths of our respective institutions and strategically positions us on the national stage to educate physicians in this specialty.”

Inaugural resident Surgei Castaneda, M.D., who has just completed a medicine residency at Mount Sinai in New York City, enters the program in July 2015. A successful national match for July 2016 will bring on board a second resident, David Gasalberti, M.D., who is currently a fourth year

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medical student at Drexel. “We have a track record for high quality patient care, and the resources for doctors to learn their craft in a community setting where most of cancer care takes place,” Dr. Strasser said. “We have a lot to offer in training the next generation of leaders in radiation oncology,” he said.

The Graham Cancer Center is the primary clinical site in addition to rotations at Hahnemann University Hospital. Residents will work with Christiana Care radiation oncologists who are experts in the latest imaging and treatment advances, including CyberKnife robotic radiosurgery, Intensity Modulated Radiotherapy (IMRT), Image Guided Radiation Therapy (IGRT), Volumetric Modulated Arc Therapy and Versa HD.

HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

The department is home to one of the largest prostate brachytherapy programs in the country under the guidance of Viroon Donavanik, M.D., and Adam Raben, M.D. There is also the opportunity for a rotation in medical physics, under the direction of Firas Mourtada, MSE, Ph.D., D.ABR, chief of Clinical Physics and program director of the newly accredited radiation oncology physics residency program, one of only a few in country.

The residency program’s associate director is Lydia Komarnicky, M.D., professor and chair of Drexel’s Department of Radiation Oncology and director of its Cancer Program.

“The Graham Cancer Center is an impressive facility, and its technology is state-of-the-art. We are proud to be associated with such a fine group of radiation oncologists,” she said.

A slate of electives offered on the two campuses includes medical oncology, pediatric radiation oncology and proton therapy. Hahnemann’s joint program with the world-renowned Wills Eye Surgery Center offers training for the treatment of ocular malignancies. Affiliation with Drexel University also provides unique opportunities in Philadelphia with the School of Public Health, Biomedical Engineering, and Information and Technology. ¤

T E C H N O L O G Y

U P D A T E DESIGNED WITH PATIENTS IN MIND Ergonomically designed for maximum patient comfort the Versa HD system with softer lighting, less noise and shorter treatment times make for a more relaxed treatment experience.

versatile versa hd Christiana Care’s Radiation Oncology Department has installed its newest generation linear accelerator, the Elekta Versa HD. This ultra-sophisticated technology is capable of delivering both conventional and high-dose-rate radiation therapy, faster and more accurately for a wide range of cancers, including tumors in the lung, head and neck, prostate, breast, brain and spine.

“With Versa HD, the radiation oncology team can shape maximum doses of radiation with exceptional accuracy to the contours of the tumor, adjusting and controlling for anatomical changes such as tumor movement or shrinkage and patient breathing patterns over the course of treatment,” said Firas Mourtada, MSE, Ph.D., DABR, FAAPM, chief of Clinical Physics.

The latest generation radiation technology goes online at the Helen F. Graham Cancer Center & Research Institute.

More precise tumor targeting means healthy tissue is better protected on all sides. “This machine is much more versatile than what we have had in the past,” Dr. Mourtada said. “The capability for precise dose sculpting and better modulation allows us to provide the patient with options to include intensity modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT) or volumetric modulated arc therapy (VMAT), for example, without increasing treatment times,” he said.

Environmentally speaking, the Versa HD system is ergonomically designed for maximum patient comfort. Softer lighting, less noise and shorter treatment times make for a more relaxed treatment experience. ¤

FIR A S MOUR TADA , MSE , P H . D., DA B R , FA A P M

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Nicholas J. Petrelli, M.D., receives Delaware BioScience Service Award Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute is the Delaware BioScience Association’s 2015 Service Award winner.

In 13 years, Dr. Petrelli has championed the fight against cancer in Delaware and developed the Graham Cancer Center into a national model of cancer care, prevention, outreach and research.

His leadership, in partnerships across the state, helped drive down Delaware’s cancer mortality rate, dropping it twice as fast as the national rate. The state is outpacing the nation in reducing deaths from breast, colorectal and other cancers.

Dr. Petrelli’s accomplishments include:  14 multidisciplinary disease site centers at the Helen F. Graham Cancer Center, selected as an original National Cancer Institute Community Cancer Center with one of the country’s top clinical trial accrual rates at 24 percent.  The first, statewide High Risk Family Cancer Registry of more than 5,640 families and 220,000 individuals.  A research partnership with The Wistar Institute of Philadelphia to facilitate cancer discoveries that benefit patients in our community.  The Center for Translational Cancer Research, where scientists and clinicians work together to find new cancer treatments.

Dr. Petrelli (center) received his award from William Mongan, vice president of business development at AstraZeneca (left) and Bob Dayton, president of the Delaware BioScience Association.

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Dr. Petrelli has received numerous awards and has authored more than 300 peer-reviewed manuscripts.

He has served on several advisory panels of the National Cancer Institute, the American Society of Clinical Oncology and the Society of Surgical Oncology. In 2013, he received the Order of the First State Award by Governor Jack Markell for his dedication to excellence in serving the community and the State of Delaware.

Dr. Petrelli received his Service Award on April 22, at the Delaware Bio Annual Awards Gala, held at the DuPont Country Club in Wilmington. This premiere bioscience event in Delaware honors men and women who have helped build Delaware’s biotechnology industry. ¤

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Medical oncologist Gregory Masters, M.D., is lead author on ASCO report: “Progress Against Cancer” this year’s 18-member panel and is co-executive editor of their report, entitled “Clinical Cancer Advances 2015: ASCO’s Annual Report on Progress Against Cancer.”

For the last 10 years in its annual report, the American Society of Clinical Oncology (ASCO) has announced a top advancement in cancer, selected by a panel of experts who represent a wide range of cancer specialties.

This year’s ASCO Cancer Advance of the Year is the introduction of four new drugs to treat chronic lymphocytic leukemia (CLL) that are highly effective and much easier to tolerate.

Medical Oncologist Gregory Masters, M.D., at the Helen F. Graham Cancer Center & Research Institute, served on

“We focused on CLL because the developments in this disease, particularly

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The report covers new developments in our ability to diagnose and treat virtually every type of cancer.

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over the last couple of years, incorporate all the new elements that we are learning about to treat cancer, such as molecular targets, precision medicine and immunotherapy,” Dr. Masters explained. “But in total, the report covers new developments in our ability to diagnose and treat virtually every type of cancer.”

CLL is the most common adult leukemia and disproportionately affects the elderly. Until now, many older patients who were frail or who had multiple health problems had to forego treatment because of serious and even life-threatening side effects.

According to Dr. Masters, the four new drugs offer many of these patients their first real chance for effective treatment.

The 2015 ASCO report is published online in the Journal of Clinical Oncology.

It includes a retrospective of the previous decade in oncology and a look at projected trends and top research advances. ¤

GREGO R Y M A S T ERS , M. D.

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Jim Leone

Patient Guides offer a warm, helpful welcome First impressions can be lasting. No one knows this better than Patient Guide Jim Leone. His is often the first smile visitors see as they step through the doors of the Helen F. Graham Cancer Center & Research Institute. “My job is to present a true impression of what we do here.” That means treating each patient and visitor with kindness, caring and a smile. “Everyone on our team has a great outlook and a positive attitude. Being the ‘out front’ person, I can help set the tone for our visitors, maybe lower their anxiety levels and relieve a little stress. Everybody needs a little inspiration now and then.” ¤

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PRSRT STD U.S. POSTAGE PAID WILMINGTON DE PERMIT NO. 357

P.O. Box 1668 Wilmington, DE 19899-1668

One of the original 14 cancer centers in the nation selected for the National Cancer Institute Community Cancer Centers Program.

The Multidisciplinary Cancer Centers at the Helen F. Graham Cancer Center & Research Institute offer comprehensive care and treatment.

Breast Cancer Bone Sarcoma Genetic Risk Assessment Genitourinary Cancer Head & Neck Cancer/Thyroid Hepatobiliary/Pancreatic Cancers Lymphoma Medical Support Melanoma/Soft Tissue Sarcoma Ostomy Care Rectal/Anal Cancers Skin Screening Thoracic/Esophageal Cancers Young Adult Follow-up

Learn how we are transforming cancer care and treatment at www.christianacare.org/cancer Christiana Care is a private, not-for-profit regional health care system that relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about our mission, please visit christianacare.org/donors.

Cancer Update is produced by Christiana Care Health System. Š Christiana Care Health System, 2015. All rights reserved.

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