Cancer Update Special Genome Issue

Issue No. 19 / November 2008

In this issue 3

Map of U.S. cancer centers tissue collection sites

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Dr. Petrelli explains The Cancer Genome Atlas project goals and what it means to the Helen F. Graham Cancer Center and cancer care in Delaware

cancer update The Helen F. Graham Cancer Center Joins NCI’s Cancer Genome Atlas Project to Speed Cancer Research The National Institutes of Health (NIH) has selected the Helen F. Graham Cancer Center at Christiana Care to participate in The Cancer Genome Atlas (TCGA) project, a ground breaking, federally funded effort to accelerate cancer research to find new cures. The $4.6 million, four-year research subcontract to the Helen F. Graham Cancer Center was awarded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI).

Personalized medicine

Some members of the team that helped put the CGAP grant together include; Nicholas Petrelli, M.D., Brenda Rabeno, Gary Witkin, M.D., Pat Swanson, Beverly Wilson, Pat Grusenmeyer, ScD, FACHE. Missing from the photo are; Jerry Castellano, Pharm D. CIP, Richard Dashefsky and Mary Iacocca, M.D.

“We are right on the cutting edge of cancer research,” says Nicholas Petrelli, M.D., Bank of America endowed medical director of the Helen F. Graham Cancer Center. “The cancer genome atlas project will help establish medicine where patients’ diagnoses and treatments for cancer will be based on their own genetic profiles.”

Using the latest genetic technologies, a broad crosssection of the cancer research organizations and individuals are collaboratively working to develop a comprehensive catalog-an atlas-of the many genomic changes that occur in three specific cancers.

Data will be placed into a public database for use by the international cancer research community.

Critical resource The vital role for the Helen F. Graham Cancer Center is to collect, store and share tissue and hold samples for cancer research at other sites.

“The excellence of clinical care, the spectrum of patients treated, and the Helen F. Graham Cancer (continued on page 2)

“We are right on the cutting edge of cancer research. The cancer genome atlas project will help establish medicine where patients’ diagnoses and treatments for cancer will be based on their own genetic profiles.”

— NICHOLAS PETRELLI, M.D. Bank of America endowed medical director of the Helen F. Graham Cancer Center at Christiana Care

(continued from cover)

Center’s commitment to quality bio banking—which is an integral part of the NCI Community Cancer Center Program plan—offer extraordinary opportunities for synergies between cancer care in local communities where more than 80 percent of cancer care is delivered and cutting edge science,” says Carolyn Compton, M.D., Ph.D., director of the Office of Bio repositories and Bio specimen Research (OBBR) that manages genome atlas project. “These synergies will provide benefits to cancer patients on many levels.”

Genetic trail blazing The Cancer Genome Atlas project is initially focusing on cancers of the brain (glioblastoma multiforme or GBM), the lung (squamous cell of the lung) and ovarian (serous cystadenocarcinoma of the ovary). These cancers, which generally have a poor prognosis, account for more than 258,480 cancer cases each year. “The contribution of highquality tissue samples to translational research will transform cancer medicine and improve outcomes for patients,” Dr. Compton explains. “Patient biospecimens and the molecules in them fuel the research and product development necessary to realize the dream of molecular medicine – to better treat cancer.

These molecules hold the secrets of the biologic and pathologic processes that we need to understand and control cancer.”

Early results from the atlas pilot describe the discovery of new genetic mutations and other types CAROLYN COMPTON, M.D., of DNA alterations present in PH.D., director of the Office GBM, including resistance to a of Biorepositories and common chemotherapy drug.

Biospecimen Research This discovery could impact the (OBBR) way doctors diagnose and treat brain cancer in the future. The Cancer Genome Atlas Research Network, (October 23, 2008). Comprehensive genomic characterization defines human glioblastoma genes and core pathways. Nature, 455, 1061-68.

Making the team Centers selected to participate as tissue collection sites went through an extensive three-phase evaluation that included a site-visit from NCI reviewers. “We met NCI’s strict scientific and technical requirements, demonstrating our ability to enroll significant numbers of patients in research clinical trials and to collect and process the required numbers of high quality tissue samples,” says Patrick Grusenmeyer, Sc.D., FACHE, cancer program vice president. According to Senior Counsel Richard Dashefsky, “Our selection by NCI

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“We met NCI’s strict scientific and technical requirements, demonstrating our ability to enroll significant numbers of patients in research clinical trials and to collect and process the required numbers of high quality tissue samples.”

— PATRICK GRUSENMEYER, SC.D., FACHE, vice president of the Helen F. Graham Cancer Center at Christiana Care

is as much a testament to the strict legal and ethical standards we follow as it is to our scientific capabilities.”

Other U.S. cancer centers serving as tissue collection sites include: • Duke University • Emory University School of Medicine • Memorial Sloan-Kettering Cancer Center • The University of Pittsburgh • Henry Ford Hospital System • Mayo Clinic • Gynecologic Oncology Group Tissue Bank • MD Anderson Cancer Center • The University of California at San Francisco Medical Center • Cedars-Sinai Medical Center • University Hospitals Case Medical Center • University of Florida • Washington University

High clinical trial participation The Cancer Genome Atlas scientists will extract both DNA and RNA (part of the unique genetic material that carries instructions for how a person’s body develops and functions) from each tissue specimen. When deprived of normal blood supply, this tissue degrades rapidly, necessitating the need for speed in collecting and preserving the tissue. In fact, the tissue procurement team will have less than 20 minutes to collect, process, and flash freeze each specimen in liquid nitrogen. Each sample must be confirmed for diagnosis and viability by the pathologist. “Our selection as one of the few sites to participate in TCGA shows we have demonstrated this is a process we can do very well,” says Gary Witkin, M.D., chair of the pathology department.

“We are in for a lot of hard work, but everyone is excited and up for the challenge of contributing to an incredibly valuable effort for the future of cancer research.”

Map of U.S. Cancer Centers Tissue Collection Sites

University Hospitals Case Medical Center Cleveland, Ohio Henry Ford Hospital System Detroit, Michigan

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Mayo Clinic Rochester, Minnesota

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Gynecologic Oncology Group Tissue Bank Columbus, Ohio Washington University St. Louis, Missouri

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University of Pittsburgh Pittsburgh, Pennsylvania

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MD Anderson Cancer Center Houston, Texas

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Memorial Sloan-Kettering Cancer Center New York, New York

9 Duke University Durham, North Carolina

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Cedars-Sinai Medical Center Los Angeles, California

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Emory University School of Medicine Atlanta, Georgia

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University of Florida Jacksonville, Florida

Collecting, storing and sharing tissue and blood samples for research

research nurses and technicians to meet the increased demand.

“This is a real ‘go live’ moment for all of us who have been banking research tissue for the last five to six years,” says pathologist, Mary V. Iacocca, M.D., medical director of the Tissue Procurement Center at Christiana Hospital. “It is certainly a feather in the cap of the Helen F. Graham Cancer Center and a tribute to the leadership of Dr. Petrelli, that our tissue collection and banking program is judged to be on par with NIH standards.” What is more, she adds, “Patients who agree to participate can feel confident that their tissue specimen will be used immediately for studies that could potentially benefit others in the future with the same type of cancer.”

Dr. Petrelli cited Christiana Care thoracic, gynecologic and neurosurgeons, plus operating room personnel under supervision of Jackie Crawford, RN, BSN, PCC., as important partners in procuring tissues.

“This is a real ‘go live’ moment for all of us who have been banking research tissue for the last five to six years.”

— MARY V. IACOCCA, M.D. medical director of the Tissue Procurement Center at Christiana Hospital

“The processes are in place to support TCGA in the collection of ovarian, lung and brain cancers,” says Brenda Rabeno, MT, MBA, manager of the tissue procurement center. “Right now we are streamlining our procedures to maximize specimen viability. We expect to start collecting specimens from patients with other types of cancer as the award period progresses, she added noting that the award will fund the eventual hiring of nine individuals including

The Helen F. Graham Cancer Center has one of the highest rates in the nation of patients participating in cancer clinical trials. All research involving patients and/or their data must be approved and is monitored by the Christiana Care Institutional Review Board (IRB), a committee of physicians, philosophers, ethicists, nurses, clergy members, educators and community lay members who protect the rights and welfare of participants in all clinical research trials conducted at Christiana Care. “The Christiana Care IRB has worked closely with the members of the research team to assure a detailed review of the research protocol and procedures for informed consent so that potential research participants will be able to make an educated decision about being part of this important project,” says Jerry Castellano, Pharm.D. CIP, corporate director.

“The Christiana Care IRB has worked closely with the members of the research team to assure a detailed review of the research protocol and procedures for informed consent so that potential research participants will be able to make an educated decision about being part of this important project.”

— JERRY CASTELLANO, PHARM.D., CIP, corporate director, Helen F. Graham Cancer Center at Christiana Care

Cancer Update 3

Dr. Petrelli explains The Cancer Genome Atlas project goals and what it means to the Helen F. Graham Cancer Center and cancer care in Delaware Q. What is The Cancer Genome Atlas (TCGA) project?

A. TCGA, a National Institute of Health research program, seeks to create a genetic map of cancer in order to understand how it behaves. TCGA is key to creating a new generation of protocols for preventing, diagnosing and treating cancer. The Human Genome Project, which mapped entire human genome and was completed in 2003, laid the groundwork for improving our understanding of cancer biology.

Now, with TCGA, we are taking a critical next step forward by attempting to create a comprehensive road map of all the genetic changes involved in cancer.

Q. How will TCGA work?

A. Small samples of cancer and normal tissues will be collected for TCGA with permission from patients undergoing surgery to remove their cancer. Teams of researchers will study and compare

the genetic material from these tissues along with information provided from each patient’s medical history (coded to protect their identity). This information, collected from the thousands of people who participate, will provide important insight into the makeup of each cancer and the response to different therapies. All of this information will be used to create the atlas of genomic changes in cancer and will be made available to investigators conducing research worldwide.

Q. How will this lead to better cancer care?

A. This research is the first critical step in personalized medicine – allowing health care providers to tailor diagnosis and treatment to a patient’s unique genetic profile.

What we learn also will drive improved cancer prevention strategies and allow us to develop better diagnostic tools to identify people at risk.

Q.What will change for Delaware patients with cancer?

A. As we provide bio specimens to the TCGA, we are also expanding our Tissue Procurement Center here in Delaware. At the Helen F. Graham Cancer Center, our multidisciplinary approach to treatment has always focused on translational investigations to more quickly translate cancer research into patient care. So we are increasing our support for local cancer studies conducted through the Center for Translational Cancer Research, a collaborative program of the Helen F. Graham Cancer Center and the University of Delaware, along with the Nemours Research Institute at the Alfred I. duPont Hospital For Children and the Delaware Biotechnology Institute.

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Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission.

Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2008. All rights reserved.

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