Cancer Update May 2017

Christiana Care Medical Oncologist Gregory Masters, M.D., and Cancer Research Director Kandie Dempsey, DBA, MS, RN, OCN

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Is su e No. 35 IN THIS IS SU E 5 COLORECTAL CANCERS: Life-changing treatments 8 TEAMWORK: Seeking a blood test for breast cancer 10 IN THE NEWS: Genomic cancer research

Transforming cancer care in our community The Helen F. Graham Cancer Center & Research Institute’s NCI Community Oncology Research Program brings the latest cancer care close to home STORY ON PAGE 2

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hen Judy Wyatt was diagnosed with breast cancer, she didn’t have far to travel for the very latest treatment options. Clinicians at the Helen F. Graham Cancer Center & Research Institute offered Wyatt the opportunity to participate in a national clinical trial designed to boost the healing power of current proven breast cancer therapy.

“I could have gone to Baltimore or Philadelphia for treatment, but I didn’t need to,” Wyatt said. “I felt safe and secure with my doctors here in Newark, and that I would be carefully monitored on the clinical trial.”

Now, years later, she is helping to spread the word about the potential benefits of clinical trial opportunities as one of Christiana Care’s Oncology Patient Advocates for Clinical Trials (OPACT).

“Clinical trials are important for people with all types of cancer, and we want them to know what is out there for them,” Wyatt said. “If people in the community know that clinical trial opportunities are available close by, they may be more likely to ask their doctors about participating if they get sick.”

As a National Cancer Institute (NCI) Community Oncology Research Program (NCORP), the Graham Cancer Center continues to bring leading-edge prevention, cancer control, treatment and imaging research trials to more people in places closest to where they work and live. The program – now in year three of a five-year, $8.2 million grant award – is a top enroller of patients to these trials, raising the bar for what is now routine cancer care in our community.

“As an NCI Community Oncology Research Program, we are changing the landscape of cancer care delivery in Delaware and throughout the country in similar communities, where we know 80 percent of patients receive their cancer care.”

The Graham Cancer Center is one of the original NCI-selected Community Cancer Center programs (NCCCP) and now one of 43 NCORP sites in the country, joined by 12 Minority/ Underserved Community Sites and seven research bases engaged in implementing the latest, most scientifically advanced clinical research designed and led by NCORP. The clinical trials arising from this work bring added opportunity to test new technologies and strategies to fight cancer. They also include studies of how cancer care is delivered in today’s changing health care environment, all with an eye toward improving outcomes and reducing disparities of care.

“Making quality cancer care more accessible to our patients is the hallmark of Christiana Care’s cancer program and mission,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of Christiana Care’s Helen F. Graham Cancer Center & Research Institute.

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We are changing the landscape of cancer care delivery in Delaware ... where we know 80 percent of patients receive their cancer care.

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NIC HOL A S J . PE T RELLI , M . D.

Christiana Care Medical Oncologist Gregory Masters, M.D., is the NCORP principal investigator at the Graham Cancer Center. In this role, Dr. Masters keeps up with the latest research nationwide and educates Christiana Care physicians, nurses and research staff about available trials that may be appropriate for their patients.

Dr. Masters also oversees trials at Christiana Care.

“Our program is at the cutting edge and goes above and beyond the national standard,” he said. “The potential of larger, more diverse patient enrollment at a community cancer center such as ours makes it more CO N T I N U E D

“I could have gone to Baltimore or Philadelphia for treatment, but I didn’t need to. I felt safe and secure with my doctors here.”

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feasible to test new interventions and strengthens the ability to generalize study findings to an even broader population of cancer patients.”

Dr. Masters added that the program provides patients with more opportunities to find the most effective treatments and allows patients to be part of the overall advancement of what may become routine cancer care in their own community.

Dr. Masters is one of 40 members serving on the board of directors of the Alliance for Clinical Trials in Oncology, an NCORP research partner in which Christiana Care is a top enroller. His post gives him a bird’s eye view of what is happening in research at the national level and the ability to affect its direction.

“We meet several times a year to share our findings and decide on the development of new research,” he said.

“This also increases the portfolio of trials available at Christiana Care and gives our patients earlier access to new treatments.”

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Our program is robust because of the physician participation and the efforts of our research nurses who seek out eligible patients. ... We want to be on the forefront of science.

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K AN D IE DEM P SE Y, DBA , M S , RN , OCN

Clinical trials on tap Clinical trials often compare a standard treatment to a new one, or compare combinations of treatments with one another.

“At any one time, Christiana Care has about 110 trials that are available to eligible patients,” said Cancer Research Director Kandie Dempsey, DBA, MS, RN, OCN. “Those include trials for cancer treatment, cancer control and cancer prevention. Our program is robust because of the physician

participation and the efforts of our research nurses who seek out eligible patients and talk to them about entering clinical trials. We want to be on the forefront of science.”

In 2015, there were 3,253 new cases of cancer diagnosed at Christiana Care.

At the same time, about 690 patients were participating in clinical trials. The Graham Cancer Center’s patient enrollment rate of 21.1 percent far exceeds the national average of 3 to 5 percent.

Some of the most exciting trials on the list represent a bold new effort in “precision medicine,” thought to revolutionize how we improve health and treat disease.

“Precision medicine considers a person’s own genetic information in making treatment decisions for their specific disease,” Dempsey explained.

“Treatment can be targeted to an individual’s molecular tumor type.”

One such trial is called NCI-MATCH, coordinated by the ECOG-ACRIN research base and opened at the Graham Cancer Center through membership in CO N T I N U E D

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the National Clinical Trials Network.

NCI-MATCH seeks to show the effectiveness of treating cancers according to their molecular abnormalities.

The trial will analyze tumors from about 6,000 patients using DNA sequencing to determine whether they contain gene abnormalities for which a targeted drug exists (also known as “actionable mutations”).

Patients enrolled in the trial will be assigned to one of 30 different treatment arms based on their specific tumor abnormalities.

The Aspirin for Breast Cancer (ABC) trial is enrolling patients at the Graham Cancer Center in partnership with the Alliance for Clinical Trials in Oncology. The ABC trial is recruiting 3,000 women with Stages II and III breast cancer to explore the therapeutic benefits of aspirin.

Previous observational research has found that breast cancer survivors who were regular aspirin users had a 50 percent lower risk of breast cancer recurrence and death compared to those who did not use aspirin. Patients on the ABC trial will randomly receive either a daily aspirin or a placebo.

“Our successful NCORP program is strengthened by excellent collaboration between the physicians, the clinical research associates, the nurses, the

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The potential of larger, more diverse patient enrollment at a community cancer center such as ours makes it more feasible to test new interventions.

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GREG ORY M A S T ERS , M . D.

technicians, our institutional review board members and former clinical trial participants who reach out into the community,” Dempsey said. “Everyone has a voice in what we are doing to help our patients.”

An important affirmation for patients who participate in a clinical trial is knowing the overall results of that trial once completed. The clinical trials team has formalized efforts to write and distribute lay summaries of trial results to participants and, through the Oncology Patient Advocates for Clinical Trials

IN 2015 T HE GR AH AM C AN CER CEN T ER’S 21% PAT IEN T ENROLL MEN T IN C AN CER C LINIC AL T RI AL S FAR E XCEEDED T HE N AT ION AL AV ER AGE OF 3 T O 5% .

program, make them available as part of its mission to educate the community about the availability and benefits of cancer clinical trials.

OPACT volunteers like Wyatt also serve as resources for both new patients considering clinical trials and clinical trial practitioners to improve the overall experience for the patient.

“Being part of a breast cancer clinical trial was empowering to me. I felt safe and secure as a participant as well as part of the research team not only helping me but also other women in the future who may be fighting breast cancer,” Wyatt said. “Without clinical trials how do we know what works and what doesn’t?” ¤ Cancer Research Director Dr. Kandie Dempsey leads the cancer research team, among the top in the nation in oncology clinical trial recruitment.

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The Colon, Rectal and Anal Cancer Multidisciplinary Clinic (MDC) at the Helen F. Graham Cancer Center & Research Institute

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uis Delgado, 28, was over the moon at the birth of his daughter last spring at Christiana Hospital.

So tiny at 23 weeks, she spent the next six months under the expert care of NICU doctors and nurses as she struggled for life. Holding baby Arielys, no bigger than his hand, Delgado never dreamed his own fight for life would begin just two months later with a diagnosis of rectal cancer.

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Life-changing treatments Jenia Jenab-Wolcott, M.D., and Luis Delgado May 2017

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When his doctor referred him to the Colon, Rectal and Anal Cancer Multidisciplinary Clinic at the Helen F. Graham Cancer Center & Research Institute, Delgado was reassured that he came to the right place.

“I don’t deny it, I was really scared the first time I went to meet my doctors,” he recalled. “I had never experienced anything like cancer before, but when they talked to me and told me they could help me, I started to believe I could survive this.”

Multidisciplinary cancer care At the MDC, a multidisciplinary team of specialists, including a colon and rectal surgeon, a medical oncologist and a radiation oncologist, regularly takes on routine as well as the most complicated cancer cases, offering a full scope of targeted, evidence-based treatments that often lead to shorter recovery times, fewer lasting side effects and lower cancer recurrence rates.

The team includes a host of other health professionals, including a nurse navigator to coordinate and guide patients through treatment, research nurses who help identify available clinical trials, specially trained dietitians, social workers, genetic counselors, health psychologists, physical therapists and many others who provide a wide array of support services to patients and their families.

“The MDC’s are raising the bar for the standard of cancer care,” said Medical Oncologist/Hematologist Jenia Jenab-Wolcott, M.D., a member of the colorectal cancer care team.

“At the MDC, patients are seen by the same group of doctors who specialize in treating their particular cancer and who work together to follow nationally accepted best practices.

All patients benefit from the MDC model including those with psychosocial issues that can be barriers to care.”

“I feel better than when I first came here. When I go for treatment, I feel happy I can go home to my family. This is my life right now.” LUI S DELG ADO Often, a combination of therapies is most effective for treating rectal cancer. This includes surgery, chemotherapy and radiation tailored to the patient’s specific needs.

That is why, at his first meeting, Delgado sat down with not just Dr. Wolcott but also colorectal surgeon Fred

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Denstman, M.D., and radiation oncologist Lindsay Romak, M.D., to map out his treatment plan.

“At first when we met Mr. Delgado his tumor appeared to be unable to be removed by surgery,” said Dr. Denstman, “but after his pre-operative chemoradiation therapy, we successfully removed the tumor with clean margins. At the MDC our goal is to cure the patient first and foremost. Our standardized protocol for treating rectal cancer includes precise pre-op and pre-treatment planning, the latest proven techniques and diligent follow-up.”

As part of their pre-surgical planning, Dr. Denstman’s team has incorporated a dedicated radiologic protocol under the expert guidance of radiologists Mandip Gakhal, M.D., and Vinay Gheyi, M.D., that includes an MRI scan to more accurately stage and evaluate rectal tumors. “These precise MRI images not only guide our surgical approach but also enable us to more accurately determine who will benefit from pre-operative chemo-radiation therapy,” Dr. Denstman said.

Depending on the individual cancer, open surgery to remove the tumor may be the best option. Dr. Denstman’s team offers the latest nerve sparing techniques to minimize side effects such as sexual dysfunction or incontinence, as well as advanced reconstruction and sphincter sparing approaches that dramatically lower the risk of permanent colostomy. For selected colon cancer cases, minimally invasive, laparoscopic or robotic surgery may be performed.

For many patients, the first step toward treating rectal cancer is a combination of chemotherapy and radiation. Oral drugs, such as Xeloda (capecitabine), are easier for patients to swallow as they slow down cancer growth and sensitize tumor cells to radiation.

Using CT scans, along with the MRI protocol and other imaging techniques, Dr. Romak and the radiation oncology team design a radiation treatment plan specific to each patient.

“The addition of MRI imaging allows me to clearly delineate tumor boundaries as well as to better understand which lymph node regions are at risk of harboring microscopic disease, so that I can appropriately incorporate them in or exclude them from the radiation target,” she said.

After surgery, a chemotherapy regimen called FOLFOX, a combination of folinic acid, fluorouracil and oxaliplatin, is shown to be effective in targeting remaining cancer cells.

Dr. Wolcott says these types of drugs have long been the standard for treating colorectal cancers, but new treatment trials are looking at alternative doses and regimens that could minimize the need for radiation prior to surgery, thus lowering risk for radiation side effects.

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“The MDC process forms a cocoon around our patients who come to know that our team will do everything we can to cure their cancer. That sets the tone for their entire treatment experience.”

F RED D E N S T M A N , M .D.

THE TEAM IN YOUR CORNER Members of the colorectal cancer team (from left) Fred Denstman, M.D., Lindsey Romak, M.D., Jenia Jenab-Wolcott, M.D., Karen Sites BSN, RN, OCN, and Shirley Brogley, ACHPN, ANP-BC

For patients with lower rectal or anal cancer, a highly sophisticated type of radiation called VMAT (Volumetric Modulated Arc Therapy) delivers a 360-degree arc of radiation around the patient. “VMAT allows for delivery of very conformal, focused radiation to the tumor and areas at risk of harboring microscopic cancer, while reducing radiation exposure to nearby normal tissues such as the bladder and uninvolved bowel,” Dr. Romak explained.

Daily image guidance with X-rays or a low dose CT scan prior to each treatment, allows the radiation therapists to make any shifts necessary for the patient to be in the exact same position for each treatment. Study evidence shows these types of techniques reduce the side effects of treatment for patients.

“The MDC process forms a cocoon around our patients who come to know that our team will do everything we can to

cure their cancer,” Dr. Denstman said. “That sets the tone for their entire treatment experience.”

Luis Delgado would agree. After surgery to remove his tumor and a second procedure to create a temporary colostomy, Luis is undergoing a bimonthly regimen of chemotherapy to target any remaining cancer cells. He moved his family from Puerto Rico four years ago in search of better prenatal care for his wife. That move has led to the joy of a healthy new daughter and the hope for time to watch her grow.

“Everyone at the Graham Cancer Center is very friendly and professional. They are straight with me, and I expect nothing more, nothing less,” Luis said. “I feel better than when I first came here. When I go for treatment, I feel happy I can go home to my family. This is my life right now.” ¤

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Progress Toward Personalized Genetic Medicine

Graham Cancer Center scientists seek to patent first diagnostic blood test for breast cancer

At the Center for Translational Cancer Research (CTCR), a team of scientists is developing a novel blood test, the first of its kind, to diagnose breast cancer.

“We anticipate that this simple blood test, used along with mammography, will be a valuable new screening tool to determine whether cancer is present in the breast and whether cancer is likely to spread,” said Senior Scientist Jennifer Sims-Mourtada, Ph.D., director of CTCR’s Breast Cancer Translational Research.

This research includes a therapeutic component, which eventually may lead to a new type of immunotherapy for breast cancer.

Dr. Sims-Mourtada is partnering to develop the test with scientists at Genome Profiling LLC (GenPro) at the Center for Translational Cancer Research at the Helen F. Graham Cancer Center & Research Institute. Their upcoming application for a provisional patent is the next step toward making the test commercially available. Future royalties gained from a fully patented, licensed blood test will help support breast cancer research at the Graham Cancer Center.

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Unlike other diagnostic tests that target cancer tumors, this test looks for changes in gene patterns within circulating blood cells that are part of the body’s immune system.

“We know that immune cells in the blood react differently if they are responding to an infection versus a cancer, an invasive tumor or when there is no cancer present at all,” Dr. Sims-Mourtada explained. The test is designed to monitor DNA changes in the blood cells that could signal an early-stage aggressive tumor.

“Currently, we are working to transform the complex genome-sequencing-based measurements we’ve obtained into a much simpler and cost effective blood screening test,” said GenPro co-founder Adam Marsh, Ph.D. “The ability to ‘package up’ a genetic diagnostic test into a quick and cheap clinical assay could have huge implications for early intervention strategies in a range of cancers.”

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Dr. Marsh started GenPro in 2014, based around epigenetics software he developed to analyze gene activity while he was a faculty member at the University of Delaware.

The company’s first proof-of-concept project was with Dr. Sims-Mourtada to profile DNA methylation patterns, how gene expression is regulated, in triple-negative breast cancer tumors. That project started a fruitful collaboration that progressed to GenPro establishing a laboratory at the CTCR and a growing research partnership.

Why do we need this test?

As the technology has become more sensitive and more women are having mammograms, numbers have risen dramatically for a commonly diagnosed cancer called ductal carcinoma in situ (DCIS), where abnormal cells are found in the milk ducts or lobules of the breast. While DCIS is considered a precursor to invasive breast cancers, in actuality, only a small percentage (2-8 percent) of cases progress to invasive cancers or become life-threatening.

Current treatment for DCIS (surgery followed by radiation) may not be necessary in all cases. A diagnostic test that could discriminate between DCIS and invasive cancer would be beneficial to avoid over diagnosis and treatment while potentially saving billions of dollars a year in related health care costs.

Dr. Sims-Mourtada’s research has focused previously on gene profiling cancer tumors to develop new treatment targets. Her lab has shown that a growth factor associated with inflammation and wound healing, known as hedgehog, can promote growth of highly resistant, breast cancer stem cells after treatment with radiation and chemotherapy. More recently, she has focused on what drives TNBC growth and its resistance to current therapy.

As an immunologist, her interest in the body’s immune response to breast cancer has led to developing with GenPro this diagnostic blood test, which will improve care for all women who undergo mammograms, as well as for those diagnosed with breast cancer, and could eventually lead to a promising new therapy. ¤

The test is designed to monitor DNA changes in the blood cells that could signal an early-stage aggressive tumor.

J ENNIFER SIM S - M OUR TA DA , PH . D.

“Right now there is no method for routine monitoring of patients to follow response to treatment and possible recurrence of these cancers,” Dr. Sims-Mourtada said. “Using the assay we have developed, with regular blood tests we could follow changes in the immune response to detect an increase in tumor cells over time, allowing for much earlier detection of recurrence or metastatic disease before it is visible with standard imaging and much earlier treatment.”

Additionally, mammograms are more difficult to interpret for women with high breast density who may be more at risk for a false negative reading.

Also, certain forms of breast cancer, such as triple negative breast cancer (TNBC), are less likely to be detected by a screening mammogram. Thus, mammograms alone may not be optimal for diagnosing these cancers.

IN THE LAB Jennifer Sims-Mourtada, Ph.D., and Adam Marsh, Ph.D., in the CTCR. May 2017

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New Partnerships Drive Discoveries in Genomic Cancer Research

Richard Dashefsky, senior counsel, Legal/Risk Management at Christiana Care; Michael Vidne, Ph.D., CCO of NovellusDx; Haim Gil-Ad, co-founder and CEO of NovellusDx; Nicholas Petrelli, M.D.; and Eric B. Kmiec, Ph.D.

BIRD Foundation grant funds genomic cancer research at Helen F. Graham Cancer Center & Research Institute For its enormous potential to accelerate the development of personalized cancer therapies, the Gene Editing Institute at the Helen F. Graham Cancer Center & Research Institute has received a grant of $900,000 from the U.S.-Israel Binational Industrial Research and Development (BIRD) Foundation in partnership with the biotechnology company NovellusDX. The Gene Editing Institute, led by Director Eric Kmiec, Ph.D., has licensed its innovative gene editing technology to Jerusalem-based NovellusDx to improve the efficiency and speed of the company’s cancer diagnostic screening tools. Using advanced gene editing technology, NovellusDx will be able to identify the genetic mechanism responsible for both the onset and progression of many types of cancer and determine the most effective cancer therapy. The company will pay royalties to Christiana Care for 10 years to use its innovative gene editing technology.

“This partnership promises to redefine and transform cancer treatment by speeding progress in breakthrough personalized medicine for many forms of cancer,” said Nicholas J. Petrelli, M.D., the Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute.

NovellusDx has established a unique approach to identify unknown “driver” gene mutations that often accelerate or facilitate cancer progression. With clinical partners throughout the world, NovellusDx obtains DNA sequence information and creates a personal profile of the genetic mutations from individual patients.

“Combining our state-of-the-art gene editing technology with NovellusDx’s expertise will accelerate and improve their diagnostic testing process, reducing the time it takes to generate the treatment options for the physician and the patient,” Dr. Kmiec said. “This will lead to immediate clinical applications and the delivery of precise and personalized cancer therapy at its very best.” ¤

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“This partnership promises to redefine and transform cancer treatment by speeding progress in breakthrough personalized medicine for many forms of cancer.”

NIC HOL A S J . PE T RE L L I , M . D.

Gene Editing Institute develops new system for precise ‘surgery’ on the human genome Molecular biologists at the Gene Editing Institute at the Helen F. Graham Cancer Center & Research Institute have developed a new system that allows them to repair damaged DNA within human cells, as well as to detect any unwanted genetic changes that might occur alongside or instead of the desired repair.

In the Jan. 3 issue of the scientific journal, PLOS ONE, a team of researchers led by Director Eric Kmiec, Ph.D., published findings using a modified version of the cutting-edge CRISPR/ Cas9 gene editing technique.

The published paper, entitled “Insertional Mutagenesis by CRISPR/Cas9 Ribonuclear Gene Editing in Cells Targeted for Point Mutation Repair Directed by Short Single-Stranded DNA Oligonucleotides,” describes how the ExACT CRISPR/ Cas9 technique can be used to repair what are called point mutations — single changes in the DNA code that can render genes non-functional and produce hereditary diseases in humans, such as sickle cell anemia or Gaucher’s disease.

“We are more optimistic now, seeing this data, that we will be able to fix point mutations efficiently, using this mechanism as opposed to other things that are now being reported in the literature,” Dr. Kmiec said. He hopes that CRISPR/Cas9 gene therapy with ExACT could be in human clinical trials at Christiana Care within 18 to 24 months.

The present study follows an earlier report published in the Sept. 9, 2016, issue of Scientific Reports, in which Dr. Kmiec and his colleagues established that their ExACT CRISPR/ Cas9 gene editing technique functions using the “Band-Aid template” repair mechanism that they had predicted.

“It’s an advance that I think will give people hope that these kinds of point mutations can be fixed if we use the proper tools to fix them,” Dr. Kmiec said.

The Gene Editing Institute at the Graham Cancer Center is a worldwide leader in personalized genetic medicine, unlocking the genetic mechanisms that drive cancer and that can lead to new therapies and pharmaceuticals to revolutionize cancer treatment. Founded and led by Dr. Kmiec, the Gene Editing Institute also provides instruction in the design and implementation of these precise new genetic tools.

Eric Kmiec, Ph.D., with researcher Natalia Rivera-Torres, MS.

“The applications for this in genetic and cancer research are vast.”

Contributors to the PLOS ONE paper included Pawel Bialk at the Gene Editing Institute, Natalia Rivera-Torres and Kelly Banas at the University of Delaware Department of Medical Laboratory Science, and Kevin Bloh at the Nemours Center for Childhood Cancer Research. ¤

ERIC KM IEC , PH . D.

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New Partnerships Drive Discoveries in Genomic Cancer Research

New genetic counseling master’s degree program advances genomic medicine As the role of genetics rapidly expands in disease research, diagnosis and treatment, the Helen F. Graham Cancer Center & Research Institute is partnering with Thomas Jefferson University in a master’s degree program to prepare people to become genetic counselors.

The new master’s degree program, Human Genetics & Genetic Counseling, earned accreditation in January 2017 from the Accreditation Council for Genetic Counseling. It is offered through the Jefferson College of Biomedical Sciences in Philadelphia. Master’s students will do their academic work primarily at Jefferson and then rotate into Christiana Care hospitals and various outpatient settings in Delaware for hands-on experience with patients. The new program is accepting applications for September 2017.

ZOHR A A LI- KH A N CAT T S , M S , LC GC

this science will allow us to accomplish in our effort to improve the health of our patients,” said Nicholas J. Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center & Research Institute. “Congratulations to Zohra Ali-Khan Catts and Dr. Bartoshesky and the entire team for their hard work and dedication in establishing this master’s program and moving it through the lengthy accreditation process.”

“We are excited to begin our new graduate program and to welcome our first cohort of students this fall,” said Gerald B. Grunwald, Ph.D., dean of the Jefferson College of Biomedical Sciences at Jefferson. “We are especially grateful for the collaboration in this endeavor with Christiana Care, one of our fellow members of the Delaware Health Science Alliance.”

LOUIS BA R TO SHE SK Y, M . D. , M PH

“The role of genetic counselors is critical as we move forward in advancing medicine through genomics. We have only experienced the tip of the iceberg as to what this science will allow us to accomplish in our effort to improve the health of our patients.”

N I C HO L A S J . PE T RE L L I , M .D.

The medical director of the program is Louis Bartoshesky, M.D., MPH, senior pediatric clinical geneticist at the Graham Cancer Center, a professor of Pediatrics at Jefferson, and a member of the medical staff at Nemours Children’s Health System. Co-directors are Zohra Ali-Khan Catts, MS, LCGC, director of Genetic Counseling and Gene Testing at the Graham Cancer Center, and Rachael Brandt, Ph.D., MS, LCGC, who have been working with several colleagues to develop the curriculum for the new master’s program.

“The role of genetic counselors is critical as we move forward in advancing medicine through genomics. We have only experienced the tip of the iceberg as to what

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Genetic counseling is one of the fastest growing medical professions. In addition to working in hospital settings and cancer centers, genetic counselors are integrated into health care management and laboratory settings, where they can help decide what tests are appropriate so that health care dollars are used wisely. The demand for these professionals is growing in almost every medical specialty, including cardiovascular, neurology, pediatrics, prenatal, reproductive and psychology.

Today, there are only 37 genetic counseling degree programs in the United States and four in Canada. ¤

HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

Christiana Care researchers reveal advance in breast cancer detection A research team at the Helen F. Graham Cancer Center & Research Institute found that a new mammography approach, synthesized 2D digital breast tomosynthesis (DBT-s2D), had lower recall rates and less radiation exposure to patients, while maintaining a high standard for cancer detection.

The study examined more than 78,000 mammograms over a five-year period and appears in the April 2017 issue of Radiology. The team compared the new FDA-approved DBT-s2D mammography to others used today, 2D and 3D or full-field digital mammography alone and digital breast tomosynthesis with full-field digital mammography.

“Not only did fewer women have to return for biopsies and additional testing with the new synthesized DBT approach, but a greater percentage of invasive cancers, which are the more lethal cancers, were found,” said senior author Jacqueline S. Holt, M.D., FACR, director of Breast Imaging at the Graham Cancer Center.

“The cancer detection rate overall was similar between the synthesized approach and 3D, and the synthesized DBT approach exposed the women to less radiation.”

“Lowering recall rates and biopsies is very important to us. Radiation exposure and additional testing are the so-called ‘harms’ of mammography, and we have them now down to the absolute lowest rate, while continuing to maintain cancer detection rate,” Dr. Holt said.

Dr. Holt predicts DBT-s2D will become a standard of care for those cancer centers with the technology because of the many clinical and cost benefits it brings.

“I think we have shown at the Graham Cancer Center that we have decreased the risks in our mammography as much as possible and also have improved our overall clinical performance. The bottom line is we have proven that we provide the highest quality of care for our patients.”

“With our focus of providing our patients with the best care available, we adopt the latest technologies if they prove themselves.”

JACQ UELINE S . HOLT, M . D. , FAC R

Study co-authors were Mireille P. Aujero, M.D., Sara C. Gavenonis, M.D., Ron Benjamin, D.O., and Zugui Zhang, Ph.D., supported by the entire research team and Christiana Care’s Value Institute. ¤

In the study, 78,810 mammograms were performed at the Breast Center between October 11, 2011, and June 30, 2016.

Of those mammograms, 16,173 used the new synthesized method, 30,561 used 3D, and 32,076 used 2D. The call-back rate for the new synthesized method was 4.3 percent, compared to 5.8 percent for 3D and 8.7 percent for the 2D, showing continued improvement with less false positives using the progressing technologies.

Co-authors of the research study Sara C. Gavenonis, M.D., Jacqueline S. Holt, M.D., FACR, and Mireille P. Aujero, M.D. Not pictured are Ron Benjamin, D.O., and Zugui Zhang, Ph.D. May 2017

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Specialists in Your Corner

Welcome the newest members of our team Sujung Park, M.D. Medical Oncologist/Hematologist Sujung Park, M.D., joined Medical Oncology Hematology Consultants, PA, and the Head & Neck Cancer MDC at the Graham Cancer Center in July 2016, after completing a fellowship in the Department of Hematology-Oncology at Thomas Jefferson University Hospital, in Philadelphia.

Dr. Park graduated from Drexel University College of Medicine and Johns Hopkins University School of Public Health. She completed residency training in Internal Medicine at Tufts Medical Center in Boston in 2013. She is board certified in internal medicine and board eligible in both hematology and medical oncology. ¤

Jason Palopoli, M.D. Medical Oncologist/Hematologist Jason Palopoli, M.D., is an attending physician with Regional Hematology & Oncology, PA, at the Graham Cancer Center. He recently completed fellowship training in his specialty at the Drexel University College of Medicine, Hahnemann University Hospital, in Philadelphia. He is board certified in internal medicine, oncology and hematology and holds both ACLS and BLS certifications.

He has presented and published on various oncology topics, including palliative care of the cancer patient, published in the 2016 Journal of Clinical Oncology. ¤

Mona Yezdani, M.D. Surgeon/Urologist Mona Yezdani, M.D., joined the Graham Cancer Center in August 2016, as an attending physician with Brandywine Urology Consultants, in Wilmington. She completed fellowship training in minimally invasive urologic surgery, including robotics and laparoscopy, at the University of Pennsylvania in June 2016.

Dr. Yezdani graduated from Jefferson Medical College in Philadelphia, and completed her internship and residency training in general surgery and urology at the George Washington University Hospital in Washington, D.C., earning recognition for service and clinical care. She also completed six-month fellowships at the National Cancer Institute’s Urology Oncology Branch and the Children’s National Medical Center.

Her research on robotic prostatectomy with Dr. David Lee at the University of Pennsylvania resulted in abstracts and video presentations to the American Urology Association in 2016 and the World Congress of Endourology in 2015 and publication in the 2016 Current Urology Reports. ¤

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HELEN F. GRAHAM CANCER CENTER & RESEARCH INSTITUTE

Cassandra Leigh Thomas, M.D. Medical Oncologist/Hematologist Cassandra Leigh Thomas, M.D., joined the Graham Cancer Center as an attending physician with Delaware Clinical & Laboratory Physicians, PA, after completing residency and fellowship training at Thomas Jefferson University, in Philadelphia.

Dr. Thomas is board certified in internal medicine and board eligible in medical oncology and hematology.

Dr. Thomas graduated in 2009 from New York’s Mount Sinai School of Medicine, where she received the Irwin Gelernt, M.D. Service Award. While in training, her research focused on mantle cell lymphoma and CMV retinitis caused by the human cytomegalovirus, which occurs predominately in immune-compromised patients including those with AIDS. ¤

Kenneth Trzepkowski, M.D. Palliative Medicine Specialist Kenneth Trzepkowski, M.D., is medical director of the newly established Supportive and Palliative Care Center at the Graham Cancer Center. Dr. Trzepkowski and his team provide an extra layer of support and symptom management to people living with cancer, helping to improve quality of life with care that is focused on each patient’s personal goals.

Previously, Dr. Trzepkowski served as chief of the Department of Pain Management and as a palliative medicine physician at the Madigan Army Medical Center, Joint Base Lewis-McChord, in Tacoma, Wa. Dr. Trzepkowski is a decorated Army Family Practice physician, who served more than three decades at postings in the U.S. and Germany, and as a member of the multi-national forces deployed in support of Iraqi Freedom from 2005 to 2006.

His numerous awards include a Bronze Star, three Meritorious Service medals, a NATO ribbon, and two Legion of Merit awards. He graduated from the Uniformed Services University of the Health Sciences, in Bethesda, Md, and completed family practice residency training at the Dwight David Eisenhower Army Medical Center, in Fort Gordon, Ga., where he earned the American Academy of Family Physicians Research Award in 1994. His study of palliative care for heart failure patients is published in the 2013 Journal of Cardiac Failure. ¤

F E A T U R E D

E M P L O Y E E

Ellen M. Justice, MLIS, AHIP Communi t y H ea l t h L ib r ar ia n at th e He le n F. G r a ha m C a nce r C e nte r & Re sea rc h I nst i t ut e’s Ju n io r B oa r d C an ce r Re s o urce s Lib r a r y

“On a daily basis, I serve people who are going through cancer treatments – patients, their families, their support people and caregivers. They come to the library looking for information that educates, supports, and even inspires. I also help health care professionals locate the latest evidence-based literature that supports patient care and research.”

“The library offers a variety of clinical and consumer health resources, including easyto-read handouts in various languages, CDs that teach relaxation, memoirs of those who have experienced cancer, picture books to share with children, movies, creative coloring kits, the Writing as Healing program, magazines, journals and much more. As their librarian, I can help our visitors find the information they might be seeking, but I also understand that for some, the library is a haven, a respite from clinical appointments and treatments, and a place to feel less like a patient. Sometimes a friendly hello and a cup of tea make all the difference.” ¤ May 2017

CA N C E R U P DAT E

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

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

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, 2017. All rights reserved.

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