Mays Cancer Center 2018 Annual Report

A N N U A L

R E P O R T

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OUR MISSION The mission of the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center, is to reduce the cancer burden in South Texas through the highest quality cancer care, groundbreaking research aimed at reducing the incidence and mortality of cancer, education of future cancer scientists and clinicians, and cancer prevention programs focused on our unique population.

DIRECTOR

Ruben A. Mesa, M.D., FACP

DEPUTY DIRECTOR Tim H. M. Huang, Ph.D.

ASSOCIATE DIRECTORS

Virginia Kaklamani, M.D., D.Sc. Robin Leach, Ph.D. Susan Padalecki, Ph.D. Amelie Ramirez, Dr. P.H. Luzhe Sun, Ph.D.

CONTRIBUTING WRITERS Ginger Hall Carnes Salwa Choucair Catherine Duncan Joe Michael Feist Rosanne Fohn Susie Phillips Gonzalez Sheri Ortiz Laurie Perryman Will Sansom Lauren Smith Stephanie Smith Sabrina York

MANAGING EDITOR Catherine Duncan

DESIGN & PRODUCTION Kris Enders Doyle

PRINTING UT Print

Photos provided by Brandie Jenkins, Creative Media Services 7979 Wurzbach Rd. • San Antonio, TX 78229 • 210-450-1000

UTHealthsaMDAnderson.org

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ABOUT THE COVER

The oak tree symbolizes lasting strength and endurance. It is also a symbol of hospitality and safety, as the oak tree’s expansive branch span can make for a very comfortable and shady spot to rest.

The acorn of the oak tree has very special meaning. It symbolizes unlimited potential: Something so small can grow into something so big and strong. The acorn can also remain dormant, which shows that it is beneficial to rest. “Mighty oaks from little acorns grow.” This is a proverb that gives power to the potential of one person and his or her ability to endure and make a difference.

At the Mays Cancer Center, a devoted team of physicians, nurses, researchers and support staff work tirelessly to make lives better for patients and families. Through its strength, knowledge, commitment and kindness, the Center every day brings new hope.

The University of Texas Health Science Center at San Antonio (UT Health San Antonio) complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. UT Health San Antonio does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Language assistance services are available to you free of charge. Contact the clinic where you will be treated or call 210-450-6101.

Español (Spanish)

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GREETINGS AND UPDATES William L. Henrich, M.D. ______________________ 4 Ruben A. Mesa, M.D. _________________________ 5 Robert Hromas, M.D._________________________ 6 Peter Houghton, Ph.D. ________________________6 Recruitments and Renovations Ramp Up Cancer Care and Research __________________ 7 Mays Family Foundation _______________________8 Leadership__________________________________ 10 New Faculty and Members ___________________ 12 By the Numbers _____________________________13

UNDERSTANDING CANCER BIOLOGY

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Patient Supportive Care Program Dedicated to All Patients, Families __________ 29 Clinical Trial Helps San Antonio Woman Battle Brain Cancer with Her Own Cells _______ 30

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Sometimes Small Things Make the Biggest Difference _________________ 21 Immunotherapy Research: On the Fast Track for Cancer Treatment _______ 22 Brain Imaging Advances Targeted Treatments and State-of-the-Art Patient Care ______________________________ 24 Clinical Investigator of the Year Physician-researcher Dedicated to Patients with Metastatic Cancer _____________ 26

OUR COMMUNITY Mays Cancer Center Hosts Biden Cancer Community Summit ________________ 35

Primary Care Physicians’ Proactive Approach to Screen for Cancer _____________ 38

Discovery of the Year A New Direction in Understanding Ewing Sarcoma ___________________________ 18

BETTER CANCER TREATMENTS

Focusing on Pediatric Cancer Treatments _______ 32

South Texas Oncology Roundtable Details Collaborative Plans for Patients ______ 36

Top Recruit Joins Mays Cancer Center ________ 15 Researchers Find Link Between Congenital Heart Defects, Adrenal Gland Cancer______________ 16

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SUPPORTING CANCER PATIENTS AND SURVIVORS

Circle of Hope ______________________________ 39

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Advancing the Science of Cancer in Latinos _________________________________ 40

GIVING San Antonio Cancer Foundation ______________ 43 SA Cancer Council __________________________ 44 Board of Governors _________________________ 45 Dedicated to the Fight Against Cancer ________ 46 Leadership Community Support ______________ 48

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 210-450-6101.

Tiếng Việt (Vietnamese)

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn.

Gọi số 210-450-6101.

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SPECIAL THANKS FROM THE PRESIDENT Thank you for your role in supporting the Mays Cancer Center, the newly named home to UT Health San Antonio MD Anderson Cancer Center. Without your generous support, we would not have been able to achieve the historic success that was realized in 2018.

Early in the year, UT Health San Antonio became a partner member of the MD Anderson Cancer Network®. In preparation for this new affiliation, we completed a new Patient and Family Welcome Center, Medical Oncology Infusion Center and Pharmacy. These are all significant improvements to our patient care experience.

We also saw the recruitment of key investigators in DNA/genome repair, patient-centered nursing research, epidemiology and metabolomics. Patrick Sung, D.Phil., who is recognized internationally for his DNA repair discoveries, came from Yale with the support of a $6 million award from the Cancer Prevention & Research Institute of Texas. Kumar Sharma, M.D., a kidney disease and kidney cancer expert, brought $4 million to UT Health for a research project funded by the National Institute of Diabetes and Digestive and Kidney Diseases for its multi-institution Kidney Precision Medicine Project.

In addition, we realigned the efforts and leadership structure of the clinical trials office to support our robust trial portfolio and these changes have resulted in extramural funding increasing by 18 percent to $37 million with many new grants as well as important progress on multi-physician-initiated funding projects.

The Mays Cancer Center continues to host the world’s premier breast cancer symposium with almost 8,000 attendees participating in the 41st Annual San Antonio Breast Cancer Symposium® in December 2018. While this meeting of the world’s top researchers in breast cancer continues to grow, we also saw the first-ever international conference on “Advancing the Science of Cancer in Latinos” in San Antonio in February 2018. Under the leadership of Amelie Ramirez, Dr.P.H., associate director for population sciences at the Mays Cancer Center, the conference brought together more than 225 cancer experts. The second conference is planned for February 2020.

WILLIAM L. HENRICH, M.D., MACP PRESIDENT, UT HEALTH SAN ANTONIO

John P. Howe, III, M.D., Distinguished Chair in Health Policy Professor of Medicine

We are grateful for your steadfast support of the Mays Cancer Center and your commitment to outstanding cancer research, compassionate patient care and treatment and dedicated cancer prevention — which is our noble mission. Together, we make lives better.

With Great Respect,

William L. Henrich, M.D., MACP

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GREETINGS FROM THE DIRECTOR 2018 was a tremendous year for our Cancer Center. Thanks to each of you for supporting our efforts in cancer care, innovative clinical research and discovery, and excellence in education and training.

Early in 2018, we celebrated a transformative $30 million legacy gift from the Mays Family Foundation.

Their contribution is dedicated to establishing and recruiting new clinical investigators, medical oncologists, hematologists, radiation oncologists, surgical oncologist, radiologists and pathologists to support our mission to end cancer and better serve patients in San Antonio and South Texas.

In February, we officially launched our partnership with the MD Anderson Cancer Network® to provide greater access to the most advanced cancer treatments for patients in our community.

Additionally, we celebrated over a dozen new world-class scientists whose superb research is helping us meet our scientific mission as an NCI-Designated Cancer Center — with the focus on decreasing the burden of cancer in San Antonio and South Texas.

Our core purpose is patient-centered cancer care across the entire enterprise of UT Health San Antonio, with the delivery of care that is deeply tied to scientific advances rising from our cancer laboratories, investigators, and over 180 clinical trials. We have centered our efforts on developing a “virtual” cancer service line with shared leadership and engagement of all specialties caring for patients with cancer.

These efforts are stewarded by a team that is dedicated to advancing cancer prevention and screening, cancer care delivery, and supportive-palliative and survivorship care.

A centerpiece of this past year has been our partnership in cancer care with MD Anderson. Our aim is to deliver the “MD Anderson model of care” for cancer patients in San Antonio. Key to this model are the multi-disciplinary clinics we have opened — and plan to open in the future — which are team-based around careful treatment planning for each new cancer patient, thereby availing each patient with full access to all the disciplines involved in comprehensive cancer care.

The treatment care plans follow MD Anderson’s protocols and patient care guidelines. 2019 will focus on close alignment between San Antonio and Houston on treating specific types of cancer, using molecular diagnostics, early phase clinical trials and state-of-the-art post-therapy care.

RUBEN A. MESA, M.D., FACP

I offer my personal thanks to each of you for your abiding support. Through your continued investment of your time and treasure, we are inspired to strive, every day, to alleviate the burden of cancer.

Mays Family Foundation Distinguished University Presidential Chair Professor of Medicine

Sincerely,

DIRECTOR, MAYS CANCER CENTER at UT Health San Antonio MD Anderson Cancer Center

Ruben A. Mesa, M.D., FACP

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MESSAGE FROM THE DEAN ROBERT HROMAS, M.D., FACP Dean, Joe R. & Teresa Lozano Long School of Medicine Vice President for Medical Affairs, UT Health San Antonio

Since assuming the role of dean in February 2018, I have had the pleasure of seeing firsthand the advancements being made at the Mays Cancer Center.

I’m excited about the trajectory to expand patient-centered cancer care to all residents in San Antonio and throughout South Texas.

Our physicians, researchers, nurses and staff strive daily to find better ways to prevent, diagnose and treat cancer. We offer hope and compassionate care to patients when they need it the most. Our patients have access to more than 180 clinical trials that bring new therapies to attack this disease.

In addition to providing outstanding cancer care, the Mays Cancer Center continues to be the region’s leader in cancer education through high school to undergraduate college programs, multiple graduate and medical education programs, as well as highly specialized post-doctoral and fellowship programs.

These pursuits are crucial to training the next generation of physicians, researchers and health care providers. We are the largest provider of physicians to care for the increasing health demands in our region.

Because of its history of offering cutting-edge cancer treatments, the Mays Cancer Center has maintained its National Cancer Institute-Designated Cancer Center designation for 27 years. With our partnership with MD Anderson Cancer Network®, the potential for the future of the Mays Cancer Center is limitless. Together, we will defeat cancer in our lifetimes.

MESSAGE FROM THE DIRECTOR OF THE GREEHEY CHILDREN’S CANCER RESEARCH INSTITUTE PETER HOUGHTON, PH.D. Director, Greehey Children’s Cancer Research Institute Greehey Distinguished Chair for the Children’s Cancer Research Institute

The Greehey Children’s Cancer Research Institute experienced an outstanding year, recruiting some of the best young scientists in their fields to enhance our programs and initiate new avenues of research.

In the area of cancer biology, we added two stellar researchers: Myron Ignatius, Ph.D., from Harvard Medical School and Katsumi Kitagawa, Pharm.D., Ph.D., from Ohio State University.

One of our objectives is to target the cancer drivers that are unique to certain childhood cancers. To this end, we recruited two outstanding structural biologists: Yogesh Gupta, Ph.D. (X-Ray structure), and David Libich, Ph.D. (Nuclear Magnetic Resonance).

The third area of growth has been in bioinformatics, where we recruited Siyuan Zheng, Ph.D., from MD Anderson Cancer Center, and Xiaojing Wang, Ph.D., from Baylor College of Medicine.

Along with efforts to attract exceptional talent, federal and state funding has increased by almost three-fold since 2015, with grant support of $11.6 million in 2018. In addition, our submission of multi-investigator grants to the National Cancer Institute and the Cancer Prevention and Research Institute of Texas also increased.

The Greehey Institute looks forward to continuing its focused efforts on developing new drugs and innovative drug combinations that move into clinical trials at UT Health San Antonio and through the Children’s Oncology Group, an NCI-supported clinical trials group and the world’s largest organization devoted exclusively to childhood and adolescent cancer research.

Your devotion to our unique mission to end childhood cancer inspires us every day.

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Recruitments and Renovations Ramp Up Cancer Care and Research Over the past year, the Mays Cancer Center has achieved a synergy of recruitment excellence for new researchers and modern renovations of patient-friendly facilities to advance our exciting affiliation with MD Anderson Cancer Center.

“A centerpiece of this past year has been our partnership with MD Anderson and our aim to deliver the MD Anderson model of care. Central to this are multidisciplinary clinics that allow patients to receive care in one location on the same day, rather than going to different places at different times for tests, diagnosis, treatment and follow-up care,” said Ruben Mesa, M.D., FACP, Mays Cancer Center director. “This approach helps us deliver world-class care in a timely manner that is convenient for our patients and their families.”

Supporting patient-centered care are a new Welcome Center, Family Center, Medical Oncology Infusion area and Pharmacy built in renovated space in the Center. The new Welcome Center provides personalized assistance with patient check-in, including additional blood draw stations to decrease patient waiting, a wayfinding system and private counseling stations.

The new Patient and Family Welcome Center is large, colorful and comfortable. Areas include multipurpose rooms for yoga, support group meetings and health-related classes, and a full-service kitchen that offers nutrition-based cooking classes. Consultation rooms give patients and family members privacy as they receive nutritional counseling or discuss treatments with medical providers.

Project. Dr. Sharma’s group is solely responsible for performing mass spectrometry imaging for the project over five years.

The Medical Oncology Infusion Center provides 26 chemotherapy minisuites located near the windows, offering natural sunlight to lift patients’ spirits.

There also are six private treatment rooms. “There is plenty of room for family members to sit with their loved ones as they receive their treatments,” said Jeremy Viles, D.N.P., M.B.A., RN, NE-BC, chief nursing officer.

More than a dozen key research and clinical faculty members have been recruited over the year to UT Health San Antonio and its Mays Cancer Center including Patrick Sung, D.Phil., an internationally known biochemist whose discoveries focus on DNA repair. His recruitment from Yale was supported by a $6 million award from the Cancer Prevention & Research Institute of Texas in May. Kumar Sharma, M.D., an expert in kidney disease and kidney cancer, brought more than $4 million to UT Health San Antonio last summer for a major research project funded by the National Institute of Diabetes and Digestive and Kidney Diseases for its multi-institution Kidney Precision Medicine

Other key research recruits include Wilson Zhao, Ph.D., and Sandheep Burma, Ph.D., experts in DNA repair; Dimpy Shah, Ph.D., who studies cancer epidemiology; David Libich, Ph.D., who studies a heat shock protein as a novel target to induce programmed destruction in tumor cells at the Greehey Children’s Cancer Research Institute; and Siyuan Zheng, Ph.D., also from the Greehey Children’s Cancer Research Institute, who has extensive experience in the development of computational tools and mining of highthroughput datasets, allows him to focus on using data analysis to gain understandings about the cancer genome, the complete set of genes present in cancer cells.

Key faculty recruits include Dr. Viles, chief nursing officer and assistant dean of clinical practice in the School of Nursing; Robyn Scherber, M.D., chronic leukemia; Chethan Ramamurthy, M.D., genitourinary cancer; Vinu Madhu, M.D., medical oncology, and head and neck cancer; Matthew Butler, M.D., hematology/ oncology and myeloma; Enrique Diaz, M.D., hematology/oncology and lymphoma; Maryam Elmi, M.D., surgical oncology specializing in breast cancer; Mohamad Fakhreddine, M.D., radiation oncology; Marjorie Parker David, M.D., molecular pathology; and Tim Wagner, M.D., radiation oncology.

Overall, research funding at UT Health San Antonio MD Anderson has increased by 18 percent, Dr. Mesa said.

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Mays Family Foundation: A Transformational $30 Million Gift Dedicated to Patients with Cancer

2018 kicked off with a historic announcement on January 30, a chilly winter morning.

William L. Henrich, M.D., MACP, president of UT Health San Antonio, announced that the Mays Family Foundation increased its legacy gift supporting UT Health San Antonio MD Anderson Cancer Center to $30 million.

A $25 million contribution in 2018 builds on the Mays Family Foundation’s earlier gift of $5 million in 2015 that established the Mays Family Foundation Distinguished University Presidential Chair for the Director of the Cancer Center at UT Health San Antonio.

In recognition and appreciation of the Mays’ generosity, the UT System Board of Regents authorized naming the Mays Cancer Center.

The announcement was made at an outside celebration honoring the Mays family at the Cancer Center, located at 7979 Wurzbach Road in the South Texas Medical Center.

“Peggy and Lowry Mays and their family, through the Mays Family Foundation, are committed to ensuring that patients in San Antonio and South Texas receive world-class cancer care, close to their community. This remarkable San Antonio family has made a significant investment in our region’s only National Cancer Institute (NCI)-Designated Cancer Center to make exceptional, comprehensive cancer care a reality for South Texans,” Dr. Henrich said.

The combined contributions from the Mays Family Foundation will provide a substantial

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is the day,” said Sara Martinez Tucker, then-chairman of the UT System Board of Regents, at the January celebration.

Then-UT System Chancellor William McRaven added, “Philanthropy is essential to the success of any NCI-Designated Cancer Center, which by its very nature is a leader in cancer care and research in its region. We all understand the toll cancer takes on patients, families and communities. For more than four decades, the Mays family has set a high bar in strategic investing to help those engaged in the battle with cancer.”

Peggy and Lowry Mays with daughter, Kathryn Mays Johnson, and her husband, Bill Johnson, at the naming ceremony.

endowment to perpetually support the director of the Mays Cancer Center and to establish up to 10 new permanent distinguished endowed chairs to support key faculty recruitment and retention. The gift also will establish the Mays Cancer Center Excellence Endowment to support top priorities for future success and long-term sustainability for generations to come.

“This legacy contribution from the Mays Family Foundation will provide vital support for top-quality cancer care, innovative cancer research, investment in new drug discovery, and support for educating and training the next generation of leaders in cancer. It also invests in the leadership and vision of the Cancer Center director and university president to capitalize on strategic opportunities now and in the future,” said Mays Cancer Center Director Ruben A. Mesa, M.D., FACP. “The Board of Regents is honored to recognize the Mays family for a monumental investment not only in an institution, but in the people of their great city. We are proud that three of the four NCI-Designated Cancer Cancers in this state are UT health institutions, including UT Health San Antonio, MD Anderson Cancer Center and UT Southwestern. The Mays’ gift comes at a very important time, given UT Health San Antonio’s developing affiliation with MD Anderson, and its grand vision to enhance access to the most advanced cancer care available.

If there ever was a perfect time to use the word ‘transformational,’ this

Peggy and Lowry Mays and their family have been key supporters of our Cancer Center in San Antonio since its early years. Peggy Mays, a former member of the Board of Governors of the Cancer Center, founded its highly successful annual fund program — the Cabinet — in 1996. The Cabinet has raised more than $8 million over the program’s 22-year history. Cabinet gifts provide essential support for innovative cancer research, state-of-the-art equipment, critical cancer education and patient care programs.

Kathryn Mays Johnson, president of the Mays Family Foundation, is a member of the Board of Governors of the Mays Cancer Center and is a past president of the SA Cancer Council (formerly known as the Cancer Center Council). Over the past 34 years, the council has supported the Mays Cancer Center through fundraising, volunteer services, community outreach and education, and patient assistance. The SA Cancer Council has raised more than $4.7 million for these purposes.

“As longtime supporters and advocates of our Cancer Center in San Antonio, we are pleased to provide significant financial support at this critical time.

We are inspired by the Cancer Center’s exceptional leadership, mission, vision and goals, and we are especially pleased that our investment will support the Mays Cancer Center as we continue to develop the affiliation with MD Anderson,” said Lowry Mays. “We are very proud that our family name will forever be associated with this Cancer Center — now the Mays Cancer Center — which serves millions of people in San Antonio and across South Texas.”

In addition to their support for UT Health San Antonio and the Mays Cancer Center, the Mays family has generously supported MD Anderson Cancer Center, bringing their cumulative giving to the two UT System institutions to more than $55 million.

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SENIOR LEADERSHIP

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SENIOR CLINICAL LEADERS

Ruben Mesa, M.D., FACP Director

Gail Tomlinson, M.D., Ph.D. Population Science & Prevention Co-Leader

Jeremy Viles, D.N.P., M.B.A., RN, NE-BC Chief Nursing Officer

Tim H. M. Huang, Ph.D. Deputy Director

Pratap Kumar, Ph.D. Population Science & Prevention Co-Leader

Stephanie Shelton, M.A. Senior Director, Finance and Administration

Virginia Kaklamani, M.D., D.Sc. Associate Director for Clinical Research

Andrew Brenner, M.D., Ph.D. Experimental and Developmental Therapeutics Co-Leader

Anand Karnad M.D. Chief, Hematology/Oncology

Susan Padalecki, Ph.D. Associate Director for Research Administration

Tyler Curiel, M.D., Ph.D. Experimental and Developmental Therapeutics Co-Leader

Niko Papanikolaou, Ph.D. Chair, Radiation Oncology, ad interim

Amelie Ramirez, Dr. P.H. Associate Director for Population Sciences

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SCIENTIFIC PROGRAM LEADERS

Robert Svatek, M.D. Experimental and Developmental Therapeutics Co-Leader

Javier Hernandez, M.D. Cancer Surgery Lead

Luzhe Sun, Ph.D. Associate Director for Basic Research

Patrick Sung, D.Phil.

Cancer Development and Progression Co-Leader

Pamela Otto, M.D. Chair, Radiology

Robin Leach, Ph.D. Associate Director for Education

Ratna Vadlamudi, Ph.D. Cancer Development and Progression Co-Leader

Marsha Kinney, M.D. Chair, Pathology

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LEADERSHIP Sheri Ortiz Senior Director, Major Gifts Cindy McKeown Director, Clinical Trials Office Melissa Nashawati Director, Quality Assurance Division Cynthia Smith Director, Financial Operations Stephanie Smith Director, Development Mariana Cagle Manager, Pharmacokinetics Laboratory Elizabeth Thompson Manager, Pathology Laboratory Lauren Smith Manager, Marketing & Communications Ivan Reveles, Pharm.D. Pharmacy Supervisor

SHARED RESOURCES BIOSTATISTICS Jonathan Gelfond, M.D., Ph.D. Director Joel Michalek, Ph.D. Co-Director

FLOW CYTOMETRY Michael Berton, Ph.D. Director Karla Gorena Technical Director GENOMICS Robin Leach, Ph.D. Director Teresa Johnson-Pais, Ph.D. Co-Director

MACROMOLECULAR STRUCTURE & INTERACTIONS Dmitri Ivanov, Ph.D. Director, MSISR, NMR

Robert Svatek, M.D. Genitourinary Oncology

Timothy Wagner, M.D., M.B.A Head and Neck Oncology

Ron Rodriguez, MD., Ph.D. Professor and Chair, Urology

Chethan Ramamurthy, M.D. Genitourinary Oncology

Chatchawin Assanasen, M.D. Pediatric Oncology

P. John Hart, Ph.D. Co-Director, X-ray

Francisco Cigarroa, M.D. Liver

Richard L. Crownover, M.D., Ph.D Pediatric Oncology

Randal D. Robinson, M.D. Professor and Chair, Obstetrics & Gynecology

Eileen Lafer, Ph.D. Co-Director, MMI

Fred Poordad, M.D. Liver

Kristen Cano, Ph.D. Technical Director, NMR

Danielle Fritze, M.D. Pancreas

Laura Tenner, M.D. Palliative/Support/ Survivorship Care

Alex Taylor, Ph.D. Technical Director, X-ray

Sukeshi Arora, M.D. Pancreas

Liping Wang, Ph.D. Technical Director, MMI

Andrew Brenner, M.D., Ph.D. Neuro-Oncology

MASS SPECTROMETRY Susan Weintraub, Ph.D. Director

NEXT GENERATION SEQUENCING AND BIOINFORMATICS Zhao Lai, Ph.D. Co-Director, Sequencing

Yidong Chen, Ph.D. Co-Director, Bioinformatics

John Floyd, M.D. Neuro-Oncology

Dawn Garcia Technical Director, Sequencing

OPTICAL IMAGING James Lechleiter, Ph.D. Director

Gregory Aune, M.D., Ph.D. Palliative/Support/ Survivorship Care Ramon Cancino, M.D. Prevention and Screening

Frank Miller, M.D., FACS Professor and Chair, Otolaryngology Francisco Cigarroa, M.D. Director, University Transplant Center and Professor, Surgery John Floyd, II, M.D. Chair, Neurosurgery Robert H. Quinn, M.D. Professor and Chair, Department of Orthopaedics

Gail Tomlinson, M.D. Prevention and Screening

Anand Karnad, M.D. Hematology Oncology

DEPARTMENT/ DIVISION CHAIRS

Chul Ha, M.D. Hematology Oncology

Pam Otto, M.D. Professor and Chair, Radiology

Gail Tomlinson, M.D., Ph.D. Chief, Pediatric Hematology/ Oncology Interim Chair, Pediatrics

Dan DeArmond, M.D. Thoracic Oncology

John H. Calhoon, M.D. Professor and Chair, Cardiothoracic Surgery

Howard T. Wang, M.D. Chief, Division of Plastic & Reconstructive Surgery

W. Brian Reeves, M.D. Professor and Chair, Medicine

Anand Karnad, M.D. Chief, Hematology/Oncology

Ronald Stewart, M.D. Professor and Chair, Surgery

John Sarantopoulos, M.D. Interim Director, Institute for Drug Development

Federico Tozzi, M.D. Melanoma/Cutaneous Oncology Sandra Osswald, M.D. Melanoma/Cutaneous Oncology Rajiv Rajani, M.D. Sarcoma

Exing Wang, Ph.D. Co-Director

Aaron Sugalski, D.O. Sarcoma

CANCER DISEASE GROUP LEADERS

Georgia McCann, M.D. Gynecologic Oncology

Virginia Kaklamani, M.D., D.Sc. Breast Oncology

Mohamad Fakhreddine, M.D. Gynecologic Oncology

Maryam Elmi, M.D. Breast Oncology

Jay Ferrell, M.D. Head and Neck Oncology

Ismail Jatoi, M.D., Ph.D. Professor and Chief, Surgical Oncology & Endocrine Surgery

Sandra S. Osswald, M.D. Chief, Dermatology and Cutaneous Surgery

Nikos Papanikolaou, Ph.D. Professor and ad interim Chair, Radiation Oncology

Daniel DeArmond, M.D. Chief, Division of Thoracic Surgery

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NEW MAYS CANCER CENTER FACULTY AND MEMBERS Maryam Elmi, M.D. Assistant Professor Division of Surgical Oncology & Endocrine Surgery Clinical Specialties: Surgical management of both female and male breast cancer, familial breast and ovarian cancer syndromes, risk-reduction (prophylactic) surgery, and oncoplastic surgical techniques.

Research interests: Surgical research, focusing on breast cancer surgical outcomes and cancer epidemiology.

Josefine Taverna, M.D. Assistant Professor Division of Hematology and Oncology Research Interests: The effects of targeted therapy on epithelial-to-mesenchymal transition to prevent metastatic tumor spread in lung cancer patients.

Vinu MadhusudanannairKunnuparampil, M.D. Assistant Professor Division of Hematology and Oncology Research and Clinical Interests: Improving outcomes in patients with sarcomas, head and neck cancer and genitourinary cancers.

Chethan Ramamurthy, M.D. Assistant Professor Division of Hematology and Oncology Clinical Specialties: Medical oncology and internal medicine Matthew Butler, M.D. Assistant Professor Division of Hematology and Oncology Clinical Specialties: Full range of blood disorders with a special interest in multiple myeloma. Finding better treatments for malignant lymphomas.

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Adolfo Diaz Duque, M.D. Assistant Professor Division of Hematology and Oncology

Pamela Myers, Ph.D. Assistant Professor Department of Radiation Oncology

Research and Clinical Interests: Improving outcomes in patients with lymphomas and also on health care disparities.

Research Interests: Treatment planning comparison studies as well as HDR brachytherapy and cervical SBRT.

Robyn Scherber, M.D. Assistant Professor Division of Hematology and Oncology

Deepak Pruthi, M.D. Assistant Professor Department of Urology Clinical specialties: Urology

Research and Clinical Interests: Focusing on chronic myeloid blood cancers, specifically the myeloproliferative neoplasms.

Marjorie David, M.D. Assistant Professor Department of Pathology Research Interests: Molecular genetic pathology and pathology anatomical/ clinical.

Mohamad Fakhreddine, M.D. Assistant Professor Department of Radiation Oncology Clinical Specialties: Treating gynecologic cancers and genitourinary cancers, including cervical, endometrial, prostate and bladder cancer.

Research Interests: Using artificial intelligence to improve radiation treatment planning and delivery, large-scale cancer database studies, as well as research aimed at improving physicianpatient communication in difficult circumstances.

David Libich, Ph.D. Assistant Professor Graduate School of Biomedical Sciences Research Interests: The determination of the structure and elucidation of the molecular mechanisms of highly dynamic and transient protein interactions. Current efforts are focused on understanding the assembly and functional interactions of low-complexity RNAbinding proteins involved in cancer and neurodegenerative processes.

Alexis Ortiz, Ph.D., PT, SCS, CSCS, FACSM Professor and Chair Department of Physical Therapy School of Health Professions Clinical Specialties: As a boardcertified sports physical therapist, he concentrates on human performance and return to activity and sports.

Siyuan Zheng, Ph.D. Assistant Professor Department of Epidemiology & Biostatistics Research Interests: Using genomic and proteomic data to understand the mechanisms behind the initiation, progression, treatment responses of pediatric and adult cancers. Research is focused on identifying aberrations in cancer, including single nucleotide variations, insertions, deletions, DNA and RNA structural rearrangements, DNA copy number alterations, that facilitate the various aspect of the cancer ecosystem.

Alexei Tumanov, M.D., Ph.D. Associate Professor Department of Microbiology, Immunology and Molecular Genetics Graduate School of Biomedical Sciences Research Interests: Focuses on the regulation of mucosal immunity, cancer and host response to pathogens. Investigating how the immune system regulates the delicate balance between protective immunity and immunopathology at mucosal surfaces, in particular in the gut and lung. Main research centered on understanding the biology of lymphotoxin (LT), a member of tumor necrosis factor superfamily of cytokines.

Mays Cancer Center by the Numbers Did you know… our physicians subspecialize in specific cancers to provide patients with the best options for their cancer? the Mays Cancer Center has 105 full members and 54 associate members all focused on finding new and better ways to prevent, understand and treat cancer? our Cancer Center has more than 180 clinical trials open to patients each year, some of which are only available here at our center? our members secured more than $43 million in extramural funding in 2018? our physicians cared for more than 25,000 patients in 2018? our Cancer Center cared for more than 3,500 newly diagnosed cancer patients in the last year?

Mays Cancer Center patients are evaluated in multidisciplinary clinics, allowing for input from numerous specialties at one time? our Cancer Center supports eight shared resource laboratories that provide our scientists with access to state-of-the-art technology to assist with their research? last year, the Mays Cancer Center enrolled approximately 1,500 patients in clinical trials­— where the newest life-saving therapeutics and techniques are tested and developed?

159

Faculty and research members

180+

Open clinical trials

1,500+

Accrual to clinical trials

3,500+

New patients

Use of funds by type: Clinical & Research Faculty/Staff Technology & Equipment Education & Administration Other

33% 48% 14% 5%

Funding source:

Patient Care Research Grants & Contracts Community Support Other

Mays Cancer Center

58% 32% 7% 3%

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UNDERSTANDING CANCER BIOLOGY

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Top Recruit Joins Mays Cancer Center

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n internationally renowned biochemist, Patrick Sung, D.Phil., joined the Mays Cancer Center in January 2019 thanks to a $6 million award from the Cancer Prevention & Research Institute of Texas (CPRIT) aimed at recruiting outstanding cancer researchers to Texas. Dr. Sung is a recognized leader in the mechanistic biochemistry of DNA repair.

His discoveries have increased the understanding of how DNA can repair damage induced by metabolic processes, radiation, carcinogens and other causes. Dr. Sung’s research has significant implications for many areas of cancer science, including the potential development of targeted therapeutics to treat breast, ovarian and other types of cancer linked to the BRCA1 and BRCA2 genes.

Dr. Sung leads a new research program in genetic integrity at the Mays Cancer Center. He occupies the Robert A. Welch Distinguished Chair in Chemistry and will be appointed professor in the Department of Biochemistry and Structural Biology. Additionally, he serves as associate dean for research in the Joe R. & Teresa Lozano Long School of Medicine.

His appointment brings him back to UT Health San Antonio, where he worked from 1997 to 2003, first as assistant professor and later as the Zachry Distinguished Professor of Molecular Medicine. From 2001 to 2003, he was co-director of a National Cancer Institutefunded training program in DNA repair at the university. Dr. Sung will rejoin UT Health from Yale University, where he served as professor of molecular biophysics and biochemistry, therapeutic radiology and epidemiology.

“Dr. Sung’s recruitment represents a strong commitment by the Mays Cancer Center and UT Health San Antonio to bring the most cuttingedge research and cancer care to San Antonio,” said Director Ruben Mesa, M.D., FACP. The CPRIT award that enabled Dr. Sung’s recruitment is aimed at attracting senior research faculty with distinguished professional careers and established cancer research programs to academic institutions in Texas. Dr. Sung brought a lab team of more than a dozen members with him to San Antonio.

Patrick Sung, D.Phil.

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Patricia Dahia, M.D., Ph.D., and her team discovered why people born with cyanotic congenital heart disease are at higher risk for developing adrenal gland tumors.

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Researchers Find Link Between Congenital Heart Defects, Adrenal Gland Cancer

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hy do adults with severe congenital heart defects who live with low levels of oxygen in their blood have a dramatically high risk for developing adrenal gland cancer? An international team led by Patricia Dahia, M.D., Ph.D., a member of the Mays Cancer Center, has found an explanation.

In a study that focused on patients who were born with cyanotic congenital heart disease and later developed adrenal gland or related tumors called pheochromocytomas or paragangliomas, Dr. Dahia and her team discovered mutations in a gene that regulates a hypoxia (low oxygen)-related pathway called EPAS1, also known as HIF2A. The finding was made public March 29, 2018, in the New England Journal of Medicine.

Nearly 4,000 babies are born with cyanotic congenital heart disease each year in the United States. The disease causes low levels of oxygen in the blood, and a common symptom is a bluish tint to the skin, called cyanosis.

As adults, patients with cyanotic heart disease have a six-fold higher risk of developing the adrenal gland tumors than individuals without this severe type of heart disease, but the genetic basis for this heightened incidence was previously unknown.

“It was suspected that in patients with cyanotic heart disease, the low oxygen levels might lead directly to the growth of pheochromocytomas,” said Dr. Dahia, professor of medicine (hematology/oncology) at UT Health San Antonio. “We found instead that a genetic mutation is the main reason why the tumor can appear in these patients. Most remarkably, the mutation turns on the main gene that causes the body to respond to low oxygen, further amplifying this response.”

“This finding provides important insights into our understanding of how the body adapts to conditions of low oxygen and how this can lead to tumors,” she said. “We found that this mutation is not inherited but is

Ph.D. candidate Shahida Flores, M.Sc., (center) co-led the work in the lab of Patricia Dahia, M.D., Ph.D. With Dr. Dahia, research scientist Zi-Ming Cheng, M.D., Ph.D., is an author of the findings published in the New England Journal of Medicine.

acquired later. The patient’s heart disease may create conditions that make it more likely for the mutation to appear.”

Importantly, clinical-grade inhibitors of HIF2A exist and are in early clinical trials for a variety of conditions, including pheochromocytomas.

“Thus, this discovery can potentially have an impact on patients’ lives,” Dr. Dahia concluded, although she stressed that further studies are necessary to fully understand the mechanism.

The work in Dr. Dahia’s lab was co-led by graduate student Shahida Flores, M.Sc., and collaborator Anand Vaidya, M.D., Harvard Medical School.

Other authors on the paper are research scientist Zi-Ming Cheng, M.D., Ph.D.; postdoctoral fellow Yilun Deng, M.D., Ph.D.; and pathologist Marlo Nicolas, M.D., at UT Health San Antonio. Collaborators from the University of São Paulo, Brazil, and Vall D’Hebron Institute, Spain, also participated in the project.

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Discovery of the Year A New Direction in Understanding Ewing Sarcoma A surprising discovery from the lab of Alexander J.R. Bishop, D.Phil., at the Greehey Children’s Cancer Research Institute at UT Health San Antonio is shedding new light on a childhood cancer called Ewing sarcoma and providing hope for future clinical treatments.

Principal Investigator Alexander J.R. Bishop, D.Phil., and Aparna Gorthi, Ph.D., postdoctoral fellow, worked in his lab at the Greehey Children’s Cancer Research Institute.

This research was funded through grants from the Max & Minnie Tomerlin Voelcker Fund, Hyundai Hope on Wheels, the National Cancer Institute and the Cancer Prevention & Research Institute of Texas.

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The research earned Dr. Bishop the 2018 Discovery of the Year award from the Mays Cancer Center.

Ewing sarcoma is a bone or soft tissue cancer that affects children between the ages of 10 and 20. While current treatments, including chemotherapy, have a positive initial response rate of 70 percent, physicians, researchers and families are devastated by the recurrence of the disease — with only a 10 percent response rate to those same treatments if it returns.

Scientists at the Bishop lab discovered a connection between BRCA1, the well-known breast cancer suppression gene, and Ewing sarcoma raising many questions in the world of molecular biology and pediatric cancer. Led

by Dr. Bishop, the principal investigator, the revelation was published in the highly revered science journal, Nature, in March 2018.

“What this discovery does is raise more questions, but I believe that now we are asking the right questions,” says Dr. Bishop, associate professor in the Department of Cell Systems & Anatomy at the Joe R. & Teresa Lozano Long School of Medicine.

“I don’t think we were necessarily doing that before. Based on our new knowledge and research, we can ask, ‘Are there other ways that we can treat these cancers in a nontoxic fashion?’ This is very much what we are chasing now.”

Currently the chemotherapy drugs being used to treat Ewing sarcoma are very toxic, and when given at a maximum tolerated dose, they often lead to longterm problems with a patient’s heart and kidneys.

“Because we are treating youngsters with these toxic drugs, in 30 to 40 years, the harm it is causing in their DNA will show up as another disease,” Dr. Bishop says. “Trying to understand how this works and trying to come up with new targets is the key.”

Helping advance childhood cancer research is the main reason Dr. Bishop chose to study biology and follow in the footsteps of his parents who are both molecular biologists. With an expertise and interest in DNA repair, he joined UT Health in 2005 as one of the first researchers at the Greehey Institute.

His interest in Ewing sarcoma began seven years ago after he learned about its response to treatment. While it appeared to have a DNA repair defect, no one understood how or why. He was further intrigued when a study was published showing that Ewing sarcoma was sensitive to poly (ADP-ribose) polymerase (PARP) inhibitors. PARP inhibitors are drugs that block DNA repair and may cause cancer cells to die.

Since PARP inhibitors are used to treat breast and ovarian cancers, specifically with BRCA1 and BRCA2 gene defects, Dr. Bishop thought there could be a connection with BRCA1.

While the full scope of the discovery itself is complicated, Dr. Bishop explains it with two key points. The first being a realization that in Ewing sarcoma, which is driven by a rearrangement of two genes which have fused together, the fusion interferes with the normal function of one of these genes. This function is known as transcription, which is the process where DNA is read and transcribed to RNA to make protein. In Ewing Sarcoma, it turns out, that transcription occurs at very high levels.

This led Dr. Bishop’s team to the second key point in the discovery — the connection to BRCA1. In the nucleus of many types of normal cells, the BRCA1 protein interacts with several other proteins to mend breaks in DNA. More specifically, BRCA1 is attached to the machinery that is reading/transcribing DNA, waiting to be released to perform repair of the DNA when needed. This release occurs normally when this machinery runs into damage on the DNA. It shuts off this transcription process and releases BRCA1, which then allows it to complete DNA repair.

However, in Ewing sarcoma, as determined in the first key point, the transcription never stops.

It doesn’t seem to recognize that there is damage and the RNA polymerase keeps on functioning so hard that BRCA1 protein can never jump off or be released. It is like a runaway train.

“You basically have BRCA1 being kept away from its function of DNA repair, and so you have what looks like a BRCA1 defect,” Dr. Bishop says.

“Instead, you have a problem with BRCA1 protein not being able to do its job because it is being held in the wrong place.”

This new discovery is truly a paradigm shift when it comes to how scientists look at cancer cells.

Hopefully, it’s just the tip of the iceberg.

“I am very much a molecular basic scientist,” Dr. Bishop concludes, “and the hope is to find something that is clinically relevant. That is why this discovery is such a big deal for me. Now we can actually start asking the questions that can change peoples’ lives.”

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BETTER CANCER TREATMENTS

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Sometimes Small Things Make the BIGGEST Difference

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new study by UT Health San Antonio researchers found that a molecule thousands of times smaller than a gene is able to kill medulloblastoma, the most common childhood brain cancer.

This tiny molecule, named MiR-584-5p, is quite efficient in its action.

MiR-584-5p sensitizes the cancer to chemotherapy and radiation, making it plausible to treat the tumors with one-tenth the dose that is currently required, said study senior author Manjeet Rao, Ph.D., associate professor of cell systems and anatomy at UT Health San Antonio and a member of the university’s Greehey Children’s Cancer Research Institute.

“Currently we barrage the brain with radiation and chemo, and patients have poor quality of life,” Dr. Rao said. “Using this molecule, we could dial down those therapies considerably, by 90 percent. That’s exciting.”

MiR-584-5p is at very low levels or absent altogether in medulloblastoma.

Increasing it to the amount found in healthy cells robs the cancer of mechanisms it uses to survive, studies show. “This can serve as a potent therapeutic for treating cancer,” Dr. Rao said.

The journal Nature Communications published the findings October 31, 2018.

The other excitement about MiR-584-5p is that it is normally present at high levels in brain cells and not so in other tissues, Dr. Rao said. Therefore, when it is used in the brain as therapy to kill tumors, it will have negligible effects on the healthy cells because those cells have seen it before. “They may not treat the molecule as something foreign,” Dr. Rao said. A future therapy based on the molecule should be well-tolerated, he said.

A big challenge for treating brain cancer patients is the inability of cancer drugs to cross the blood-brain barrier, a protective mechanism that holds up brain cancer therapies. Because it is so petite, MiR-584-5p may be able to cross this barrier, which is leaky in some medulloblastoma patients. In the future, Dr. Rao said, the molecule may be delivered using a nanoparticle carrier.

Aside from medulloblastoma, the properties of MiR-584-5p make it an excellent drug candidate for treatment of glioblastoma, an aggressive and lethal adult brain cancer, Dr. Rao said.

A patent on the MiR-584-5p technology has been filed with Dr. Rao and Nourhan Abdelfattah, Ph.D., first author on the paper, listed as inventors.

Dr. Abdelfattah completed her doctoral work in the Rao laboratory and is a postdoctoral fellow at the Houston Methodist Research Institute.

A second patent with Dr. Rao as inventor was “The molecule under study sensitizes cancer to issued by the U.S. Patent chemotherapy and radiation, making it plausible and Trademark Office.

Multiple commercialization to treat tumors with one-tenth the dose that is currently required.” business models are under review, including a possible — Manjeet Rao, Ph.D. start-up company, according to the Office of Technology Commercialization at UT Health San Antonio.

Dr. Rao’s research has been supported by the National Cancer Institute, the William and Ella Owens Medical Research Foundation of San Antonio, the Cancer Prevention and Research Institute of Texas, and the Max and Minnie Tomerlin Voelcker Fund.

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IMMUNOTHERAPY RESEARCH on the Fast Track for Cancer Treatment

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sing the body’s own immune system to kill or stop cancer cells is a basic explanation of immunotherapy. Discovered more than 40 years ago, immunotherapy is now on the fast track at the Mays Cancer Center, where researchers believe they are on the verge of discovering immunotherapy treatments that will change the lives of cancer patients.

In fact, Robert S. Svatek, M.D., associate professor of urology and the Glenda & Gary Woods Chair in GU Oncology, believes the work he and his colleagues are conducting in immunotherapy are game changers when it comes to the treatment of bladder cancer, which is his specialty. With a National Cancer Institute Phase III trial called Prime and the research being conducted in the lab of internationally respected immunologist Tyler J. Curiel, M.D., M.P.H., Dr. Svatek is excited about the future of immunotherapy to fight cancer.

Nationally recognized as an expert in the management of superficial and advanced bladder cancer, Dr. Svatek, chief of the Division of Urologic Oncology at UT Health San Antonio, became fascinated by an immunotherapy drug called BCG (Bacillus Calmette-Guerin) 14 years ago when he saw the results the drug had on patients with bladder cancer.

“I was drawn to immunotherapy because of the dramatic response I saw in a patient who I treated early in my career,” says Dr. Svatek, co-leader of the Experimental and Developmental Therapeutics (EDT) Program at the Mays Cancer Center. “If I could show you the picture, you would be amazed. When given BCG, which is placed into the bladder through a catheter once a week for six weeks, you see a complete disappearance of the red lesions. Complete removal of all the cancer. It is just remarkable, and it doesn’t hurt the tissue. The normal cells are still there. It just gets rid of the cancer.”

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While BCG is an amazing drug, it is in short supply with manufacturers shutting down production due to quality control problems; Dr. Svatek and Dr. Curiel hope to change that. One of the main goals of Prime, the NCI Phase III trial with 170 patients enrolled, is to develop a new product, another BCG strain and to seek its approval by the FDA for use in the United States. In addition, the trial is testing a vaccine. The vaccine will cost less than $100 and will be administered in the patient’s shoulder in addition to the BCG given in the bladder.

If this trial shows the benefit of the vaccine, it could make a big difference in terms of bladder cancer treatment.

Currently, Dr. Svatek is the principal investigator for five clinical trials of bladder cancer, one of which is a major national cooperative group trial.

Recruited to UT Health San Antonio to build a bladder cancer center of excellence in 2010, Dr. Svatek has established a significant referral base for complicated bladder cancer cases and has used his laboratory to focus primarily on

his initial questions about BCG, how it works and why does it work on some cancers but not all cancers. He also partnered with Dr. Curiel, who became his mentor and is also a co-leader of the EDT.

Robert S. Svatek, M.D., associate professor of urology and the Glenda & Gary Woods Chair in GU Oncology

“While I provide expertise in bladder cancer as a surgeon and urologist, Dr. Curiel is trained in medical oncology and infectious disease. He brings an array of experiences that I don’t have when it comes to cancer immunology,” Dr. Svatek says.

“The work that Dr. Curiel is doing to understand immunotherapy is important not only for bladder cancer management but also for melanoma, lung and other types of cancer. His work will help us see how immune therapy is working and how it will work in all sorts of diseases.”

Initially, the duo conducted their research with the help of two grants — a Voelcker young investigator award from the Max and Minnie Tomerlin Voelcker Fund in San Antonio and a K23 NIH career development award — that they received.

While these grants are completed, the two continue to work together on research, recently submitting a grant proposal offering a novel approach to people with bladder cancer who are undergoing bladder removal. The idea is to give patients an immune therapy drug prior to bladder removal.

“It is important to note that the research we do locally, here in San Antonio, can have an impact across the nation,” Svatek says. “The science that Dr. Curiel is conducting will be utilized by scientists across the world. Sometimes it is hard to see how an investment here locally will make a national impact, but you can invest right here in the researchers and scientists in San Antonio and know that it can be transmitted onto a bigger platform.”

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Brain Imaging Advances Targeted Treatments and State-of-the-Art Patient Care This year two new linear accelerators were installed in Radiation Oncology at the Mays Cancer Center.

Radiation Oncology now boasts four image-guided radiotherapy linear accelerators.

Three of which are identical, and one specialty unit is designed for stereotactic radiosurgery. All four units provide external beam radiation treatments for patients with cancer.

Niko Papanikolaou, Ph.D., professor and interim chair of radiation oncology and chief of the division of medical physics, said, “We are the only center in San Antonio with image-guided, stereotactic radiotherapy that treats pediatric patients. Our state-ofthe-art technology allows us to deliver with high precision radiation treatments to our pediatric patients. Their compacted anatomy and young age make it critical for us to be very accurate in the design and delivery of the radiation treatment.”

Richard L. Crownover, M.D., Ph.D., professor of radiation oncology, said Radiation Oncology treats pediatric patients from all local hospitals and from Corpus Christi.

2018 also saw upgrades in software and hardware for the linear accelerators that are allowing the Mays Cancer Center team to treat for the first time patients with multiple brain metastases and patients with spine metastases.

“We are the first in Texas to implement the BrainLab Elements software that was engineered specifically to treat stereotactically lesions in the brain and the spine,” said Dr. Papanikolaou. “Our combined imaging and delivery capabilities — together with an outstanding team of physicians, medical physicists and therapists — allow us to capitalize on the technological advancements and offer superior care to our patients.”

Dr. Crownover said they also are using the stereotactic body radiation therapy for lung cancer and liver cancer in adults and children. “We have used this therapy as a bridge to transplant. If someone is on the liver transplant list, but is diagnosed with a tumor, the patient will often be removed from the list. We can treat the tumor so it goes down in size so the patient can remain a candidate for a life-saving transplant,” he said.

Another recent acquisition is a system that allows surface image-guided radiotherapy.

“This allows us to use video cameras to monitor the patient during treatment. First, it helps with positioning the patient accurately and quickly for treatment. Second, it enables us to continuously monitor the patient during treatment.

Niko Papanikolaou, Ph.D., at the CT Simulator in Radiation Oncology.

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“We are the only center in San Antonio and South Texas that has active imageguidance for patient positioning and monitoring during treatment,” he added.

Richard L. Crownover, M.D., Ph.D., examines a patient in Radiation Oncology.

Dr. Crownover, a nationally recognized expert in breast radiation, said the new technology has allowed them to create a new protocol for treatment of breast cancer.

“The current standard-of-care for breast radiotherapy is based on a treatment planning CT obtained while the patient breathes freely; this can result in a reference scan that may be in a slightly different position than the patient will be during treatment. Now, we use surface imaging, and we can watch their breathing cycle. We can perform the radiotherapy at the right time in their breathing cycle. Also, we can see very precisely where we are aiming the radiation,” he said.

Radiation Oncology also offers brachytherapy, which is the treatment of cancer using radioactive sources that are placed inside the tumor. Dr. Papanikolaou said, “We have a very active brachytherapy program for gynecological cancers and sarcomas.

Our newly upgraded digital high dose rate brachytherapy unit allows for optimized delivery of radiation treatments directly to the tumor, while sparing surrounding healthy tissue.”

Dr. Crownover, who serves as residency program director for radiation oncology, said they receive brachytherapy referrals for gynecological cancers from the south and southwest regions of Texas.

Dr. Papanikolaou said on the research side, “we are the only institution in San Antonio that is a National Cancer Institute-Designated Cancer Center. In addition to being able to provide the best patient care, we have a mission to conduct research and discover new ways to battle cancer. Our medical physics team has an international reputation for high productivity in publications and presentations in the field of radiotherapy.”

The team also is devoted to its educational and training programs. Dr. Papanikolaou said, “At UT Health San Antonio, the Department of Radiation Oncology is overseeing several academic programs and provides training for future professionals in the field. We offer a radiation oncology and medical physics residency program, a Doctor of Medical Physics professional degree, a doctoral degree in medical physics research, and a certificate program in medical dosimetry.

“We have a reputation for excellence in education based on feedback we receive from colleagues who employ our graduates,” he said. “Our trainees are exposed to a diverse population of patients and diagnoses which broadens their clinical training while also creating some unique opportunities for clinical research. This is a win-win scenario both for our patients and for our faculty and staff that provide outstanding care to our patients.”

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Clinical Investigator of the Year Physician-researcher dedicated to patients with metastatic cancer The recipient of the 2018 Clinical Investigator of the Year Award is on the forefront of bringing new drugs to those who have exhausted the U.S. Food and Drug Administration-approved agents and are willing to enter early clinical trials for drugs ready for human testing.

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ohn Sarantopoulos, M.D., a medical oncologist and clinical investigator at the Mays Cancer Center, can’t point to a personal reason for studying cancer. Rather his compassion for others is evident in his goal “to provide options for clinical cancer patients who may not have options.”

He finds this work exciting because he is helping patients extend their lives to “spend time with their family, spend more time locally in the community, and do the things that patients would like to do.”

Dr. Sarantopoulos was nominated for the award by Anand Karnad, M.D., chief of the Division of Hematology-Oncology and the Karen Lee & David Zachry Distinguished Chair in Women’s Cancer at the Mays Cancer Center. Dr. Karnad described his colleague’s passion for experimental therapeutics. “John deserves this award in recognition of a substantial body of work in experimental therapeutics spanning more than 15 years at this institution,” he said. “He has exceeded clinical revenue targets while continuing to open trials, enroll patients, and complete complex trials.”

Born and raised in Canada where he received his medical training, Dr. Sarantopoulos was drawn to a drug development fellowship in San Antonio in 2004 because “San Antonio and drug development are synonymous as a world-renowned program.”

Dr. Sarantopoulos sees patients from throughout the United States who are referred to the Mays Cancer Center. He has been the principal investigator or co-principal investigator in more than 100 studies and a sub-investigator in more than 250 studies.

Experimental therapeutics — his passion — refers to patients who have metastatic cancer that has progressed or recurred. It has spread from its primary tumor outside the initial organ.

Some of the studies are being used for the first time in the clinic. Others have a longer track record but are used in a different way or perhaps in a different combination, making them new.

This clinical investigator can point to “a number of different medications that have been approved by the FDA after our involvement over the years. The main thing that sticks out is providing options and minimizing side effects for these patients.”

He has been the program director of the Advanced Drug Development Fellowship Program for two years where he mentors young clinical investigators for careers in experimental therapeutics.

John Sarantopoulos, M.D., in the window-lined Infusion Center designed for an improved patient experience.

They look at first-in-human studies, which occur after the lab studies on mice. They focus on first-in-class compounds, which are on the cutting edge of science and use new mechanisms for treating a medical condition. They also look at drug interaction studies, cardiac studies, food effect studies, and those involving organ dysfunction, such as in the kidney, liver or bladder.

His efforts have been recognized nationally. He received the National Cancer Institute’s Clinical Investigator Team Leadership Award in 2011 and 2012. He recently completed a five-year term on the inaugural NCI Central Institutional Review Board. His research includes various levels from the pharmaceutical companies to NCI-funded studies and cooperative group studies with the SWOG, one of the cooperative groups focused on running clinical trials to advance patient care in the U.S. Acknowledging his background of hard work and dedication to his patients and studies, Dr. Sarantopoulos is emphatic that he wouldn’t be able to do his work without his colleagues from the research team and the clinic. Those important people are the study coordinators, clinical nursing staff, treatment staff, data entry personnel, lab staff, regulatory team and administrative staff.

Despite the long and late hours, this award recipient says, “It doesn’t feel like work because we’re helping patients and improving patient care.”

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SUPPORTING CANCER PATIENTS & SURVIVORS 28

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Patient Supportive Care Program Dedicated to All Patients, Families

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s the inaugural chief nursing officer for the Mays Cancer Center, Jeremy Viles, D.N.P., M.B.A., RN, NE-BC, and his team oversee efforts to improve the patient experience and enhance the patient-centered environment.

Dr. Viles leads the Mays Cancer Center’s clinical operations, nursing and oncology support programs. He also serves as the liaison to medical experts who are all focused on decreasing the burden of cancer in San Antonio and South Texas.

“We try to take care of the whole person, not just treat the disease,” said Dr. Viles, who is also assistant dean of clinical practice for the School of Nursing. He arrived in San Antonio in February 2018 after eight and a half years in Houston at MD Anderson Cancer Center, UT Health San Antonio’s sister institution. He served as executive director of projects and operations for the MD Anderson Cancer Network®.

His staff strives to focus on the patient experience, he said.

“It’s our goal to have patients and family members as equal partners in their care team, so their opinion and their voice have just as much weight as a surgeon or medical oncologist,” Dr. Viles said.

To reinforce this concept, Dr. Viles is forming a Patient and Family Advisory Council to give input and feedback on the patient experience, ranging from the public website to clinic flow, to electronic medical records. He plans to have the group in place for the 2019 fiscal year, meeting monthly to discuss key issues and inviting patients and family members to shape future care, treatment and education programs.

“Adding a focus on the community is one of four pillars in our organization’s mission. A second is the experience of our patients. The third area of emphasis is improved Jeremy Viles, D.N.P., M.B.A., RN cancer treatment, which includes expanding screening and Today’s model of cancer care is multidisciplinary, which means prevention programs, because the best cancer treatment is that treatment can involve surgical, medical and radiation oncologists who devise preventing it in the first place,” he said. The fourth is research, an area not a highly individualized treatment plan tailored to the patient. Since he supports directly under his supervision, but important because the clinical and research physicians, Dr. Viles said his role is similarly multidisciplinary — bringing in nurses, aspects of the program share the same patients. genetic counselors, primary care practitioners and staffers working with nearly Once patients complete treatment, Dr. Viles’ staff transitions them to a every clinical department at UT Health. survivorship mode through a survivorship care plan. Such plans include At the Mays Cancer Center, one of Dr. Viles’ areas of focus is the Patient specifics for a patient to maintain health, knowing whether additional imaging Supportive Care Program to help cancer patients and their families learn about or screening is recommended and how often. The team works to return services ranging from financial help for procedures and testing, wellness and patients to their primary care team. nutrition offerings, to free transportation for those in need. In addition, social workers stand ready to assist patients as they navigate the course of treatment to the In the future, Dr. Viles wants to develop holistic oncology support plans for all patients because “it’s what every patient deserves.” He adds, “It used to be that path of survivorship, he said. patients went to the doctor and would follow whatever recommendations the One example of patient support in the area of nutrition is that many cancer doctor gave for their course of treatment. Now, patients and family members patients may not feel well and be overcome by nausea which suppresses their are encouraged to have a voice in those discussions and the decision-making appetite, Dr. Viles said. At the same time, they need calorie-dense foods to help process. We encourage our patient to share their goals and help them weigh the the body heal, and he explains that the patient support team may suggest eating pros and cons of all treatment options so they have more of a say in making the ice cream or sipping a milk shake to bolster energy and provide comfort. decisions that work best for them and their family members.”

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Clinical trial helps San Antonio woman battle brain cancer with her own cells

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uring and after her honeymoon, Christy Wheeler suffered painful headaches. She and her new husband, Ty, returned to San Antonio where she started waking up with headaches that would make her black out. Ty talked Christy into going with him to a primary care appointment where his physician immediately ordered an MRI which revealed a mass in her right temporal lobe.

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Before undergoing surgery to remove the large brain mass, the couple asked if there were any clinical trials available. Neurosurgeon John Floyd, M.D., with UT Health Physicians told them about a national, multisite Phase III clinical trial of a therapeutic cancer vaccine. Led locally by Andrew Brenner, M.D., Ph.D., a neuro-oncologist at the Mays Cancer Center, the clinical trial involves taking the brain tumor immediately after surgery and dissolving it to retrieve proteins.

“When a patient is going in for surgery and you expect a glioblastoma, which is a malignant brain tumor, the neurosurgeon removes the brain tumor, it is put on ice, and then sent to the Cancer Center,” Dr. Brenner said. “We dissolve the tumor so the proteins can be removed. These proteins are unique to the tumor and not found elsewhere in the body. We want to use those proteins to trigger an immune response.”

Christy Wheeler and Dr. Andrew Brenner discuss treatment successes.

Dr. Brenner explained that glioblastomas are infiltrative tumors and invade into nearby regions of the brain. The tumor cells reproduce and divide at any given time. They have finger-like tentacles that infiltrate the brain so it is difficult to remove completely.

After Christy recovered from surgery, she underwent a leukapheresis procedure where her blood is passed through a machine that takes out the white blood cells and returns the rest of the blood cells and plasma into her bloodstream.

The procedure was completed in a day; blood is removed through one IV and then returned in the body through another IV. “These millions of white blood cells and the proteins from the tumor are shipped to a lab run by Northwest Biotherapeutics. They take the white blood cells and mature them to an antigen presenting or dendritic cell. Then these cells are exposed to the protein collected from the tumor.

Now, you have an antigen presenting cell that is matured to stimulate the immune system to the proteins that were found in the patient’s tumor,” Dr. Brenner explained.

The goal is to train the patient’s immune system so it will fight residual tumor on its own, he said.

“This is only for patients who are candidates for surgery. You need to be able to remove enough of the tumor to make the protein, and you want a small volume of tumor remaining so the immune system isn’t overwhelmed. For immune therapy to work, you want the patient to have a lower burden of disease.”

Richard Crownover, M.D., Ph.D., a radiation oncologist at the Mays Cancer Center, specializes in brain tumors. When Christy recovered from surgery, she began a regiment of chemotherapy and radiation at our Brain Tumor Center.

After six weeks of radiation and chemotherapy, Christy started receiving injections of the dendritic cell vaccine for cancer immunotherapy. Dr. Brenner said Christy was a good candidate because after surgery she had minimal residual tumor.

“She received these injections just under the skin repeatedly over time,” he said. “Christy is now well beyond the expectations in terms of survival for a patient with glioblastoma. A person with it lives on average 21 months. We are hoping her immune system has been trained to fight these tumor cells. We hope they continue surveilling and stopping the cancerous cells.”

Christy said she was interested in trying the clinical trial because it was not invasive and used her own cells to attack the cancer cells. “I wasn’t trying some drug. I was using my own immune system to fight the tumor,” she said. “I feel blessed that all the doctors, especially Dr. Brenner, are dedicating their lives to research and offering new trials. Dr. Brenner is going out there every day and fighting for his patients.”

Christy said she doesn’t think she would have her son, who was born in 2017, if the clinical trial hadn’t been available to her. “We are really fortunate to have a place like the Mays Cancer Center here. It is a wonderful environment. The people there make you feel better while you are enduring a very difficult experience. I don’t think you can find care like this anywhere else.”

In terms of the study nationwide, Dr. Brenner and his coauthors recently published an interim report but the study is still blinded. As Christy and Dr. Brenner both explained, they do not know if she received the vaccine or a placebo.

“What is important is that we have options available to people in San Antonio and South Texas. They should be afforded every opportunity to fight cancer. Our responsibility is to give them the best studies — the best options to fight it.

Pamla R. Hernandez, receptionist in Radiation Oncology, visits with Christy Wheeler.

“However, this is not just about having clinical trials. It is about having good clinical trials that have the potential for making a difference for patients. Medicine doesn’t evolve without patients participating in clinical research. We would still have women dying from breast cancer and children dying from leukemia if it weren’t for clinical trials to evaluate the benefit of these therapies,” he said.

“We have an obligation to society to evaluate these therapies so medicine continues to progress.”

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GREEHEY CHILDREN’S CANCER RESEARCH INSTITUTE FACULTY Peter Houghton, Ph.D. Director, Greehey Children’s Cancer Research Institute Gregory J. Aune, M.D., Ph.D. Assistant Professor • Pediatrics Alexander J.R. Bishop, D.Phil.

Associate Professor • Cell Systems & Anatomy Yidong Chen, Ph.D. Professor • Epidemiology Biostatistics Allison Grimes, M.D. Assistant Professor • Pediatrics Yogesh Gupta, Ph.D. Assistant Professor Biochemistry & Structural Biology Myron Ignatious, Ph.D. Assistant Professor • Molecular Medicine Katsumi Kitagawa, Pharm.D., Ph.D. Associate Professor • Molecular Medicine Raushan Kurmasheva, Ph.D. Assistant Professor • Molecular Medicine Zhao Lai, Ph.D. Assistant Professor/Research Microbiology, Immunology & Molecular Genetics David Libich, Ph.D. Assistant Professor Biochemistry & Structural Biology Luiz O. F. Penalva, Ph.D. Associate Professor • Cell Systems & Anatomy Alexander Pertsemlidis, Ph.D. Associate Professor • Pediatrics Manjeet K. Rao, Ph.D. Associate Professor • Cell Systems & Anatomy Yuzuru Shiio, M.D., Ph.D. Associate Professor Biochemistry & Structural Biology Gail Tomlinson, M.D., Ph.D. Professor, Chief of Hematology-Oncology Pediatrics Xiaojing Wang, Ph.D. Assistant Professor/Research Epidemiology and Biostatistics Siyuan Zheng, Ph.D. Assistant Professor Epidemiology and Biostatistics 32 | Mays Cancer Center | Annual Report 2018

FOCUSING ON PEDIATRIC CANCER TREATMENTS Improving Quality of Life After Cancer Care

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n the last 30 years, more than 80 new cancer drugs were approved by the FDA, specifically for treating adult cancers while four — yes, only four — were FDA-approved for pediatric cancers.

Childhood cancers are not little adult cancers. They are genetically and biologically different.

That’s why UT Health San Antonio has a separate facility — the Greehey Children’s Cancer Research Institute — for those studying childhood cancers. It is the only stand-alone research facility for childhood cancer in the nation other than St. Jude Children’s Research Hospital in Memphis, Tenn.

UT Health’s Children’s Cancer Research Institute was established in 1999 with $200 million from the state’s tobacco settlement. The research center opened in 2004.

A $25 million transformative gift from the Greehey

Greg Aune diagnosed with Hodgkin’s Lymphoma at age 16.

Family Foundation resulted in the naming of the Greehey Children’s Cancer Research Institute (GCCRI) in 2007.

That stand-alone facility is what attracted Gregory Aune, M.D., Ph.D., a pediatric oncologist and physician scientist. A 28-year cancer survivor who was diagnosed with Hodgkin’s Lymphoma when he was 16, Dr. Aune is studying the late effects of those toxic adult drugs that are given to children with cancer. While only in his 30s, he underwent open-heart surgery, had his aortic valve replaced, and had a triple bypass, because of the combined effects of chemotherapy and radiation he received 20 years earlier.

Pharmaceutical companies develop drugs for the most prevalent of cancers, including lung cancer and breast cancer. Although cancer remains the No. 1 cause of

Dr. Aune today.

disease-related mortality for children 19 years and younger, pediatric cancer research as a whole is underfunded, Dr. Aune said.

law by President Donald Trump on June 5, 2018, and appropriated $30 million to pediatric cancer.

Dr. Aune is one of two representing childhood cancers on the National Cancer Institute Council of Research Advocates, and he travels throughout the year to meet with pediatric cancer scientists and oncologists to collaborate and organize people working to develop more robust survivorship research models.

“We have an 80 percent survival rate of childhood cancer using the drugs we have now. They work, but the quality-of-life issue is not included in the commonly quoted survival statistics,” he said.

“By age 50, 60 percent of childhood cancer survivors will be either dead or suffering from a life-threatening late effect directly related to their previous cancer treatment. People are having heart surgeries and dying from stroke, and they’re young people. That hasn’t been a major part of a research focus in a lab.

“We need to advocate for better drug development for our cancers because there’s still a significant death rate. We need to improve cancer treatment so patients have a better quality of life,” added Dr. Aune, who is the Stephanie Edlund Distinguished Professor in Pediatric Cancer Research at the Greehey Institute.

Dr. Aune’s lab is looking at organ damage, specifically to the heart, caused by pediatric cancer treatment. Research has shown that former patients who were exposed to anthracycline in their chemotherapy are now suffering from heart failure. He is searching for the answer: What specifically about drugs used on children actually damages the heart?

“We need more tools in our toolbox to be able to treat cancer,” he said. “When we’re designing trials at our clinical trial meetings, there are not a lot of agents to choose from, and there are very few, if any, that have been developed specifically for children’s cancer.”

Dr. Aune’s lab has developed a model about how chemotherapy damages the heart. “The condition

He is organizing other cancer researchers to become advocates for children so that a person who survives cancer as a child doesn’t have a lifetime of severe health problems.

Dr. Aune shares his stethoscope with a young patient.

we see in patients takes decades to develop. We don’t do heart biopsies on patients,” he explained.

They take very young mice, expose them to chemotherapy and radiation, and study what happens in the cells that make up the heart.

Most of the other investigators in the Greehey Institute’s 17 labs are focused on tumors. “Let’s understand how these tumors grow, behave biologically and the genetics of these tumors. By understanding that, you can create new drugs. As those drugs move into clinical trials, we’ll find those that are logically designed to hit the tumor target and have less effect on normal tissues,” he explained.

In addition to conducting research, advocacy is a primary focus for Dr. Aune and his fellow pediatric cancer researchers.

Dr. Aune, a pediatric hematologist-oncologist, was a key participant in moving the Childhood Cancer STAR (Survivorship, Treatment, Access and Research) Act through Congress. It was signed into

Funded by the St. Baldrick’s Foundation — a volunteer-driven charity specifically committed to finding cures for childhood cancers and helping survivors enjoy long and healthy lives — and the San Antonio Medical Foundation, among others, Dr. Aune has four very personal reasons to want to live a longer life. At the persistence of his mother, his sperm was preserved before his radiation and chemotherapy at age 16. Married to Christine, a neonatologist and U.S. Army major, they have two sets of twins, 15 and 10, through in vitro fertilization. He wants to watch them grow up.

Dr. Aune said, “Think of it in life years. Big diseases like breast cancer or lung cancer in adults cause a few decades of life lost. But when a child dies, they lose a whole life — 70 to 80 years of life.”

With that in mind, San Antonio can point with pride to the Greehey Children’s Cancer Research Institute and its researchers who are dedicating their careers to studying childhood cancer in tandem with the Mays Cancer Center.

“That’s why I came here,” Dr. Aune shared. “I wanted to be somewhere that made a difference.”

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OUR COMMUNITY

Mays Cancer Center Hosts Biden Cancer Community Summit The Mays Cancer Center hosted a local meeting of the Biden Cancer Community Summit on Sept. 21, 2018. At the summit, local cancer leaders, health care providers, patient advocates and representatives from cancer-related organizations discussed ways to improve cancer care in San Antonio.

The summit included panel discussions with experts from the Mays Cancer Center and the broader cancer community. The topics focused on the patient journey through cancer prevention, education, diagnosis, treatment and survivorship.

The summit was hosted nationally by former Vice President Joe Biden and his wife, Dr. Jill Biden. In 2015, the Bidens lost their son, Beau, to brain cancer. They launched the nonprofit Biden Cancer Initiative as a national forum hosted in communities throughout the U.S. The aim is to create a more cohesive, comprehensive and timely approach to prevent, diagnose, treat and promote healthy recovery from cancer.

Ruben Mesa, M.D., FACP, Cancer Center director, set the stage for discussion by noting how far cancer care has come since his mother-in-law was diagnosed with breast cancer 30 years ago. “When she finished her treatment, they sent her home and told her to hope for the best, but she never fully recovered from the experience,” he said. “Now we know that it is important to provide support services before, during and after treatment. What we hope to accomplish today is to share ideas that can be turned into action.”

After the three panel discussions — “Preventing cancer: technology, education and access,” “Harnessing innovation to improve and save lives,” and “Survivorship and the path ahead” — participants answered questions about how cancer care can be improved here. The suggestions were summarized and sent to the Biden Initiative.

The biggest concerns of the community were: • the financial burden of cancer treatment for patients, • the lack of access to better care due to patients having no insurance or being underinsured, • the lack of funding for cancer research, and • the need for better communication about all the available cancer clinical trials being offered in the San Antonio area.

Dr. Mesa said the consensus for the next steps were: • strengthening community partnerships across San Antonio to reduce the burden of cancer for the people of South Texas, and • initiating a database of clinical trials at all San Antonio cancer practice locations for all to access.

He added that the summit helped identify additional community partners that can be approached to help improve hospital outreach, promote advances in care, and provide patient navigators to help cancer patients through diagnosis, treatment and survivorship.

OF NOTE Dr. Greg Aune, a childhood cancer physician-researcher at UT Health San Antonio, gave a short update on the Children’s Cancer Survivorship, Treatment, Access and Research (STAR) Act. He said the bill, signed into law in June, will provide much-needed funds for research, tumor banks and more. “This will do a lot to move the field forward,” Dr. Aune said.

Dr. Amita Patnaik from the START Center emphasized the importance of offering patients the opportunity to participate in clinical trials. “The number of patients participating in clinical trials is still dreadfully low. Patients should be offered this opportunity,” she said.

Ana Ramon, Texas Grassroots manager at the American Cancer Society’s Cancer Action Network, reminded audience members of the upcoming state legislative session. “Texas has a budget the size of France, and education and health care make up two very large portions of it. It’s important to watch the budgetary process,” she said.

Dr. Paul Shaughnessy from Methodist Physicians San Antonio discussed the possibility of using in the future “off the shelf” immunotherapy to treat cancer. Rather than taking a patient’s T-cells and genetically engineering them to fight cancer in a specific patient, he noted that research may one day make it possible for normal, healthy T-cells from the general public to be processed and saved, like blood in the blood bank, to fight specific types of cancer. This could save valuable treatment time that is now used in processing patients’ own cells for treatment.

Dr. Robert Svatek, a bladder cancer surgeon at the Mays Cancer Center, said it is an exciting time to be a urologic surgeon. “It is not unrealistic to think that soon telemedicine can be used in surgery in distant locations.

It may be that we will be able to operate using robotic equipment here in San Antonio on a patient in Laredo.”

PANELIST: William Henrich, M.D., MACP QUESTION: You have stated many times publicly, based on your own personal experience, the importance of having accessible cancer care at home. Share your vision for the university and how it impacts patients related to local access to advanced cancer care and research.

ANSWER: UT Health San Antonio is a nexus of teaching and education, health-related research and innovative clinical care matched only by a handful of other academic health centers in Texas, and, in numerous areas of disease, matched only by few in the United States. Cancer is one of those diseases.

We exist to serve this community and bring our collective expertise, extensive knowledge and advancements in health care to make lives better for all those we serve. Part of that mission is to deliver the most robust cancer care system to San Antonio and South Texas. By bringing together two NCI-Designated Cancer Centers, this partnership is most able to advance cancer care in a profound way.

Research has demonstrated that receiving cancer care closer to home can improve outcomes. Traveling to receive care can be extremely stressful and expensive for the patient and their family/caregiver. By offering robust patient care here in San Antonio with the latest treatment protocols, access to advanced cancer research and more than 180 cancer clinical trials, as well as the world’s most experienced, multidisciplinary care teams that includes our colleagues at MD Anderson who collaborate on the most complex cancers, the level of service here at home is unequaled.

The health needs of our community are increasing. We have looked at the projected need for cancer care in our region, and over the next 10 years we are expecting a significant growth in population. Unfortunately, with that growth will come many more cancer cases. This partnership combines the strengths of each of our institutions to improve cancer care and to be ready to serve the increasing needs of our region with better outcomes and an improved patient experience.

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South Texas Oncology Roundtable Details Collaborative Plans for Patients On Sept. 5, 2018, UT Health San Antonio MD Anderson Cancer Center hosted a roundtable discussion with esteemed cancer leaders from UT Health San Antonio and MD Anderson Cancer Center to talk about the impact of cancer in San Antonio and how collaboration in patient care and research is essential to improving not only the outcomes for patients, but also using proven protocols and processes to best support families and caregivers.

During this special discussion, thought leaders and clinicians explained the rising incidence of the disease in San Antonio. They also laid out plans for how their work together will positively impact patients and their families while focusing on the overall cost or “value� of health care spent on this disease that strikes aging and Hispanic populations disproportionately. The roundtable was attended by community members, business leaders, health care providers and donors.

Panelists were William L. Henrich, M.D., MACP, UT Health president; Peter WT Pisters, M.D., MHCM, MD Anderson president; Michael E. Kupferman, M.D., M.B.A., MD Anderson senior vice president of clinical and academic network development; Ruben A. Mesa, M.D., FACP, UT Health San Antonio MD Anderson director; and Cynthia Sickora, D.N.P., RN, UT Health School of Nursing vice dean of practice and engagement.

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UT Health Physicians’ Primary Care Center Director Ramon S. Cancino, M.D., M.Sc.

Primary Care Physicians’ Proactive Approach to Screen for Cancer

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dult patients who visit one of the seven UT Health Physicians’ Primary Care Centers are regularly screened for one or more types of cancer depending on risk, said the network’s Primary Care Center Director Ramon S. Cancino, M.D., M.Sc. “We want to know what is important to our patients,” Dr. Cancino said. “That way we can make sure we are directly addressing their needs and concerns during our visits with them. At the same time, we are also assessing other types of information such as risk factors for different types of cancers.”

At UT Health Hill Country outside of Boerne, where Dr. Cancino practices, cancer screening metrics are tracked on a daily basis. The medical team, which gathers every morning to discuss the scheduled patients for the day, reviews information, such as patient history and immunization records. The goal is to paint as complete as possible a picture of each patient and his or her medical needs, including the potential risks for cancer.

This team-based approach helps in the prevention and treatment of diseases such as cancer. “Our primary care approach is to be patientcentered, proactive and consistent,” Dr. Cancino said, adding that the staff discusses risk factors such as obesity, alcohol intake or cigarette smoking with patients.

“In primary care, one of the most important things a patient can do is to lead and sustain a healthy lifestyle,” he said. The primary care team provides education and resources on any risk factors a patient might have.

Often a team member, such as a behavioral health consultant, might meet with a patient to discuss positive changes one can make to decrease risk of cancer.

Additionally, the team-based practice allows clinicians the time to develop a relationship with patients, Dr. Cancino said. “Oftentimes, patients you are meeting for the first time are very ill. I want my patients to know that they are receiving expert care and that our entire team will work to make them feel safe and cared for.”

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Circle of Hope Surgery is not performed at the primary care facilities, but if a risk of cancer is found in a diagnostic screening, Dr. Cancino refers the patient to the Mays Cancer Center. A specialist there will determine whether surgery, chemotherapy, radiation or another treatment is indicated or whether a “wait and see” stance should be taken.

Family medicine doctors at UT Health Hill Country see patients of all ages, Dr. Cancino said. He seeks to bring in medical professionals who put the patient first and are willing to “go the extra mile for the patient,” he said.

All of this relates to the move in today’s health care environment toward high-quality care.

“High-quality primary care starts with developing a trusting relationship with our patients,” he said. “As it relates to cancer, delivering highquality care includes making sure all patients receive the appropriate cancer screenings.

“Building cancer screening into what we do every day makes it easier to talk about sensitive topics like cancer with patients.

We talk about fears and challenges and the difficulties of this emotionally weighted topic. This is something that a primary care clinician must be prepared to do every day.

A patient-clinician relationship built on trust can help patients through difficult moments in their lives.”

Physicians and scientists who have a theory about a new way to diagnose, treat or prevent cancer must test it for viability before significant funding can be attained. Our community is helping to move research forward by joining a Circle of Hope — which consists of 10 donors who contribute $2,500 each to fund transformational pilot research.

The SA Cancer Council started these Circles of Hope in 2015, and, to date, three groups have invested $100,000 and participated in the selection and funding of four pilot projects. We are currently finalizing the formation of our fourth circle.

A $25,000 donation can be daunting for many, but a $2,500 commitment, which can be paid over the course of a year, is less so.

During the first meeting with the circle, several projects are presented

by Dr. Ruben Mesa, director of the Mays Cancer Center. After learning about research projects, the group votes on which one they would like to fund. Six months later, the group is invited to meet “their” scientist and hear a formal, in-depth explanation of their work. Six months later, the group is given an update about their project while meeting to discuss the second project they will fund. Circle participants are asked to make a two-year commitment.

The Mays Cancer Center is deeply grateful to the SA Cancer Council for establishing the Circle of Hope Program to fund innovative research that is vital to providing hope to those fighting cancer.

If you are interested in participating in a Circle of Hope, please contact Sabrina York, senior director of development, at 210-567-2508 or Yorks4@uthscsa.edu

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Inaugural International Conference:

Advancing the Science of Cancer in Latinos The Mays Cancer Center and the Institute for Health Promotion Research at UT Health San Antonio hosted the first-ever international conference on “Advancing the Science of Cancer in Latinos” on Feb. 21-23, 2018, in San Antonio. The conference brought together more than 225 cancer experts from 23 states and Puerto Rico to tackle topics in Latino cancer.

With the growing U.S. Latino population expected to face a 142 percent rise in cancer cases in the coming years, there is a tremendous need for a Latinooriented focus on important issues such as access to care, use of proven screening tests, incidence and mortality rates, survivorship, and quality of life after cancer.

“We have the power to take a health disparity and turn it into health equity.”

“It was the first time Latino cancer researchers came together to share what we know about cancers in Latinos,” and the energy was palpable, said Amelie Ramirez, Dr.P.H., who serves as associate director for population sciences for the Mays Cancer Center and is also the director of the Institute for Health Promotion Research.

Despite substantial advances in cancer prevention, screening, diagnosis and treatment over the past decades, the rate of Latinos diagnosed with cancer continues to climb and addressing Latino cancer health disparities has not kept pace with progress.

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The conference on “Advancing the Science of Cancer in Latinos” welcomed scientists, doctors, public health workers, community leaders, health educators, and students to network and discuss the progress of Latino-focused basic research, clinical best practices, community interventions and prevention. Participants heard presentations from dozens of Latino cancer leaders, including Eliseo Perez-Stable, M.D., director of the National Institute on Minority Health & Health Disparities, and Edith Perez, M.D., vice president of U.S. Medical Affairs BioOncology at Genentech.

Presenters from across the United States were joined by UT Health San Antonio faculty to discuss

certain cancers that carry an unequal burden among Latinos. Francisco Cigarroa, M.D., head of pediatric transplant surgery and division head of liver transplant surgery at UT Health, spoke about the genetic and epigenetic alterations in hepatocellular carcinoma — the most common form of liver cancer — among South Texas Latino patients. Ronald Rodriguez, M.D., Ph.D., professor of medicine and chair of the Department of Urology, spoke about the high rates of kidney cancer in South Texas.

Ruben Mesa, M.D., director of the Mays Cancer Center, spoke about overcoming barriers for Latinos on cancer clinical trials. Although cancer is the leading cause of death among Latinos, Latino cancer patients make up only 2 percent to 5 percent of participants in cancer clinical trials in the United States, according to the National Cancer Institute. This is problematic because there are real differences in how people of diverse backgrounds respond to different diseases. Dr. Mesa also chaired a session on emerging policies in U.S. health care that featured U.S. Rep. Joaquin Castro, among other speakers.

At the inaugural conference, Amelie Ramirez, Dr.P.H., (second from left) visits with cancer researchers from across the country.

“These are the people who have the power to take those ugly Latino cancer statistics and reverse them,” Dr. Ramirez said, speaking of the illustrious list of conference presenters and participants. “To take a detestable cancer and learn what makes it tick. Then make it treatable.

Then make it preventable. Then take a message of prevention to all corners of our nation.”

“We have the power to take a health disparity and turn it into health equity,” continued Dr. Ramirez. The second conference is being planned for February 2020 in San Antonio.

Mays Cancer Center Director Ruben Mesa, M.D., leads a session on emerging policies in health care in the U.S.

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GIVING

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A LASTING LEGACY FOR CANCER CARE AND RESEARCH Since 2006, the Board of Directors of the San Antonio Cancer Foundation has contributed a total of $150 million in grants, operational support and in-kind gifts to The University of Texas Health Science Center at San Antonio, all of which was dedicated to the support of our Cancer Center and its unique mission to reduce the burden of cancer for San Antonio, the South Texas Region and beyond.

Other areas of focus for the Foundation were for faculty recruitment and retention, patient assistance, operational improvements, new equipment and technology, and facility improvements and renovations. In 2018 the Board of the San Antonio Cancer Foundation determined to dissolve the Foundation and transfer all of its assets to the stewardship of UT Health San Antonio President William L. Henrich, M.D., MACP.

Originally established in 1991, the name of the Foundation was updated a few years ago to San Antonio Cancer Foundation, but its mission remained focused — to support and advance cancer research, treatment, prevention and education for the people of San Antonio and South Texas — a mission to which we remain bound.

In tribute to the Board for its exemplary service and longstanding dedication and commitment to patients with cancer in our community, Dr. Henrich said, “We would not be where we are today without the steadfast support and vision of the board members of the San Antonio Cancer Foundation. Our community owes each of them a great debt for setting the path we are on today. The Foundation has left a legacy for cancer care and research in our community and beyond that will endure forever.”

The Foundation’s most recent contributions were dedicated to supporting our Cancer Center in its new affiliation with our UT System sister institution, MD Anderson Cancer Center. This affiliation created a new operational entity for our University and the community: UT Health San Antonio MD Anderson Cancer Center.

SAN ANTONIO CANCER FOUNDATION BOARD Gary V. Woods, Chair Louise Beldon Jim Callaway Barbara Dreeben James W. Gorman John Kauth Judy Palans Tom Ransdell W. Lawrence Walker Jr. Mark E. Watson Jr.

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DEDICATED TO THE CAUSE The SA Cancer Council is a non-profit organization, founded in 1984, and dedicated to the lifesaving work of the Mays Cancer Center. With the support and efforts of more than 400 members, SA Cancer Council has raised more than $4.7 million for patient supportive care and research.

The main fundraising efforts of the SA Cancer Council are the Cure Cancer Card (formerly know as the Partners Shopping Card) and the Spring Luncheon. Each fall, the Cure Cancer Card is sold for $50 and entitles the owner to a 20 percent discount during the designated shopping days at more than 200 San Antonio and surrounding area retailers.

The Spring Luncheon is an opportunity for council members and guests to hear inspiring and personal experiences of cancer survival and caregiving while supporting a great cause. UT Health San Antonio President William Henrich, M.D., and his son, John, were the featured keynote speakers at the 2018 luncheon and shared their experience during Dr. Henrich’s battle with a rare form of blood cancer. During the luncheon, we learned about their touching journey — through the diagnosis, stem cell transplant from John, hope, and recovery.

These two events, along with annual membership donations, have allowed the council to fund 16,000 patient rides, 566 cases of nutritional supplements and water, 2,200 pounds of food, and much needed financial assistance for emergency needs of our patients.

Bob Rivard, of the Rivard Report, moderates a discussion with John Henrich (middle), son of UT Health San Antonio President William L. Henrich, M.D., (far right) during the 2018 SA Cancer Council Spring Luncheon.

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NEW BOARD OF GOVERNORS CHAIR TAKES THE HELM Supporting the Mission to Reduce the Burden of Cancer in South Texas

Charles Martin “Marty” Wender began his two-year term as Chairman of the Mays Cancer Center’s Board of Governors on September 1, 2018. Marty and his wife, Rene, are extremely active in the community and have been longstanding supporters and advocates of the Mays Cancer Center.

“When former Board Chairs Lori Wright and Karen Lee Zachry asked me to consider serving in this important role, I was honored to be considered and it is a privilege to work closely with our Mays Cancer Center Director Dr. Ruben Mesa and University President Dr. Bill Henrich to ensure our San Antonio and South Texas communities have access to the highest quality cancer care and research,” explained Marty.

Photo courtesy of Scott Ball/Rivard Report

The past year has been an exciting one and our Board members play a vital role in the continued success of the Mays Cancer Center. This dedicated group of community and business leaders donate their time, talent, expertise and philanthropic support to help advance the mission and goals of our Cancer Center.

Marty Wender, Board Chair

2018 BOARD OF GOVERNORS Marty Wender, Board Chair Christine D. Alderete Wayne Alexander Ernesto Ancira Yolanda Anderson Dr. Forrest Aven Emerson Banack, Jr. Rose Marie Banack Louise D. Beldon Michael D. Beldon Nel Belt Michael Belz Beverly A. Birnbaum Michael L. Birnbaum Stanley L. Blend Donna Block Mary Ballenger Brook Jamie Browning Pam Burdick T. Randall Cain Jim Callaway Dya C. Campos Charles E. Cantu Jean Cheever Graciela Cigarroa Lisa H. Cohick Liz Conklyn Col. (Ret.) Gil Coronado Bob Cowan Lynn Finesilver Crystal J. Russell Davis Laura Dixon Barbara B. Dreeben Gerald Z. Dubinski Stephen M. Dufilho Arthur Emerson Cheryl Ernst Helen Eversberg Brian Feld Dr. Kelley Frost

Patrick B. Frost Dr. Homero Garza Steven W. Garza James W. Gorman Rhonda Gurinsky Patricia Hayes Roxana C. Hayne Christine L. Haynes Karen L. Heintz Roger R. Hemminghaus Adel Hernandez Karen H. Herrmann Janet Holliday Robert L. Jemerson Kathryn Mays Johnson Laurie A. Kaplan John L. Kauth Edward B. Kelley Nancy L. Kelley Margie Klesse John C. Korbell Carolyn Labatt Andreae LeMaistre Molly Light Jeff Lott Louise Mandel Tracie Martin Charles McAleer III Edith S. McAllister Walter W. McAllister David P. McGee Joe C. McKinney Sherry McNeil Dr. Thomas M. McNish Yona McNish Mark Meador Balous T. Miller Lou Miller Jennifer Moriarty Karen Norman Mueller

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Gregg E. Muenster Terrie E. Musselman Dr. Dacia H. Napier Jan Newton Michael J. Novak Margie K. O’Krent Sam O’Krent Judy Palans Camilla M. Parker Donna M. Pasacrita Phil Pfeiffer Jane Cheever Powell Karen Presley Dr. Carl F. Raba, Jr. Thomas R. Ransdell Robert A. Rosenthal Dianna Roy Jane R. Satel Cynthia Schluter Lisa M. Sechler Stephen D. Seidel C. Frederick Shannon Dr. Gurvinder P. Singh James B. Smith Lauren Stanley Harris J. Sterling Ruth Eilene Sullivan Nancy Torgerson Mary West Traylor Jon Turner W. Lawrence Walker Mark E. Watson, Jr. Lora Watts Mertie Wood Gary V. Woods Lori Wright Mark H. Wright Karen Lee Zachry

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DEDICATED TO THE FIGHT AGAINST CANCER Thank you for your continued support

VULCAN MATERIALS ANNUAL FUNSHOOT For 24 years, Vulcan Materials has supported the Mays Cancer Center through its annual Vulcan Funshoot at the National Shooting Complex in San Antonio. This year’s Funshoot on April 21, 2018, raised $141,986.

Since 1994, this successful event, which is organized by Vulcan employees, has raised more than $2.6 million to support research and patient care at the Mays Cancer Center. The Vulcan team recruits sponsorships, participants and auction items.

ALAMO HEIGHTS HIGH SCHOOL The Alamo Heights High School Cheer Team, Spurs Dance Team and the Volleyball Team donated $1,800 from the sale of pink T-shirts during the month of October to support breast cancer research at the Mays Cancer Center.

CHECKS IN THE MAIL

On August 16, the Mays Cancer Center held its annual skin cancer screening giving those who are underinsured or uninsured the opportunity to be examined — free of charge — by a dermatologist at UT Health San Antonio.

A total of 96 patients were screened, of which 32 were referred for further evaluation and 15 were recommended to receive a biopsy for a concerning lesion. This important community service is one of the many ways the Mays Cancer Center fulfills its mission to provide exceptional care to people in San Antonio and South Texas.

HELOTES FESTIVAL ASSOCIATION Beginning in 2006, the Helotes Festival Association, Inc. has donated a total of $26,000 to support breast cancer awareness and research at the Mays Cancer Center through its “Tough Enough to Wear Pink” night at the Helotes Rodeo. Participants in the rodeo are encouraged to wear pink on this special night to show their support of breast cancer awareness. Each year, the rodeo’s donation is presented by members of the Miss Helotes Court to the Mays Cancer Center director.

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Since 2005, Checks in the Mail, a division of Harland Clarke, has donated more than $165,500 to the Mays Cancer Center to support cancer research. With many of its employees and families touched by cancer, the company decided to support a local cancer center with a percentage of sales from their products which display a cancer ribbon. Cindi Champion, marketing director, said it is important to the company to be able to offer these products to their customers who wish to show their support for cancer research in our community.

NIMITZ MIDDLE SCHOOL For the third consecutive year, the students of Nimitz Middle School raised funds to support breast cancer awareness and research at the Mays Cancer Center. Under the guidance of Athletic Director Jennifer Hall, the students enthusiastically embraced the fundraising challenge and did their part to make a difference in the battle against breast cancer.

GIVE CANCER THE BOOT FUN RUN/WALK The Wilenchik Walk for Life celebrated its 10th Anniversary with a check presentation to the Mays Cancer Center.

The Mays Cancer Center hosted the third annual Give Cancer the Boot Survivorship Fun Run/Walk on March 24, 2018, in honor of cancer survivors everywhere. The fun run is a wonderful event to celebrate life and survivorship and gives friends and family members a chance to show support for loved ones.

This year’s race had 465 registrants and raised more than $12,000 for the Cancer Center’s patient and family assistance fund. Cancer survivors were treated with their own tent that offered refreshments, complimentary chair massages and makeup makeovers from Saks Fifth Avenue. When survivors crossed the finish line, they were congratulated and presented a carnation and a big hug.

Some of the other activities available to attendees were vendor booths from more than 15 sponsors, a food truck, the Kids Fruit Walk, bean bag toss, best dressed dog contest, and a photo booth from one of our sponsors, A Drop In Time Photo.

Others showing support included The Miss Helotes Court 2017, which presented the Mays Cancer Center with donated blankets and hats for cancer patients who are undergoing treatment, and percussionists from Tom C. Clark High School Band who helped kick off the race and brought people in as they crossed the finish line.

WILENCHIK WALK FOR LIFE The 10th Anniversary Wilenchik Walk for Life on March 3, 2018, honors Tony Wilenchik, a former city councilman and civic leader in the City of Schertz. He was a Phase I patient at the Mays Cancer Center before losing his cancer battle in 2009.

Hosted by the City of Schertz, the annual walk benefits the Mays Cancer Center’s Institute for Drug Development. In the last 10 years, the Wilenchik Walk has raised more than $177,000.

SAN ANTONIO EXPRESS-NEWS BOOK & AUTHOR LUNCHEON The 27th annual San Antonio Express-News Book & Author Luncheon was held Nov. 16, 2018, and featured an incredible array of authors and books. Since its inception in 1991, the event has raised more than $4 million.

The highly successful luncheon benefits the Phase I Clinical Research Program at the Mays Cancer Center. This crucial program helps to further the center’s mission to conquer cancer through research, prevention and treatment.

This year’s authors featured Sarah Bird, Julian Castro, Elizabeth Crook, Adrian Davila, Joe Holley, Pat Mora and Mimi Swartz. Luncheon co-chairs were Lavonne Garrison and Kris Mesa.

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LEADERSHIP COMMUNITY SUPPORT CASH DONATIONS, PLEDGES AND BEQUESTS TO SUPPORT THE MAYS CANCER CENTER (Gifts received through October 31, 2018) MAJOR GIFTS Gifts ($25,000,000 +) Mays Family Foundation San Antonio Cancer Foundation Gifts ($1,000,000 +) Estate of Bessie Bell Dean “Bebe” Bowen Dale and Edna Walsh Gifts ($300,000 +) Ovarian Cancer Research Fund SA Cancer Council Gifts ($200,000 +) William and Ella Owens Medical Research Foundation Gift ($100,000 +) Jodi and Richard Wells Gifts ($50,000 +) Anonymous Donor Karen and Ronald Herrmann Rancho Foods, Inc. 2018 CABINET GIFTS Patron’s Circle ($20,000 +) Charles C. Butt McFadin Foundation Leadership Circle ($10,000 +) Robert A. and Kathey K. Anderson Wilma and Thomas Boyd Checks In The Mail, Inc. The Douglass Foundation Patty and Bob Hayes Margie and Bill Klesse Dacia and Lanham Napier Cheryl and John Schoolfield Dee and Jack Willome Director’s Circle ($5,000 +) Pam and Art Burdick Nancy and Charlie Cheever Liz Conklyn

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Betty Ebrom Kris and Jim Ellis The Alfred S. Gage Foundation Karen Heintz Kathy and Jim Musgrave Harris K. and Lois G. Oppenheimer Foundation Camilla M. Parker Lori and Mark Wright Karen Lee and David Zachry Sustainer’s Circle ($2,500 +) Margaret Anderson and Bill Crow Kelly and Carl Felbaum Dr. Kelley Frost and Mr. Pat Frost Sylvia and Steve Garza Kathy and Bill Johnson Jan and Bob Marbut McClure Charitable Foundation Lynn Merritt Dr. Carl F. Raba, Jr. Ann and Tom Ransdell The Arch and Stella Rowan Foundation, Inc. Karen Salsman Lucille and Jim Travis Mr. Dale Tremblay and Dr. Sandra Tremblay Rene and Marty Wender Partner’s Circle ($1,500 +) Mr. and Mrs. Ben Adams Jim Adams Wayne and Barbara Alexander Rose Marie and Buddy Banack Louise and Michael Beldon Susan and Brad Beldon Mr. and Mrs. Walter E. Belt, III Ann Biggs Linda and Stanley Blend Donna Block Margery L. Block Mr. and Mrs. Michael Bolner Marrs McLean Bowman

Annual Report 2018

Paula and Jim Callaway Mr. and Mrs. Richard W. Calvert Charles E. Cantu Catholic Life Insurance/Michael Belz Jean M. Cheever Dr. and Mrs. Francisco Cigarroa Lisa and Don Cohick Mr. and Mrs. Robert L. Cook, Jr. Bob and Diane Cowan Lynn Finesilver Crystal Mr. and Mrs. Charles H. Davis Steve and Adele Dufilho Mr. and Mrs. Arthur R. Emerson Cheryl and Joe Ernst Mr. and Mrs. Richard W. Evans, Jr. Susan and Allen Pierce Caroline A. Forgason Georgia P. Garcia Dr. Homero R. Garza and Judge Sandee Bryan Marion Mr. and Mrs. S. J. Goebel Dr. and Mrs. Roy R. Gonzales, Sr. Glenn Halff and Mindi Alterman Sally Halff Jim and Roxie Hayne Tina and Joe N. Haynes Dot and Roger Hemminghaus Lynn and Peter Hennessey Adel and George Hernandez Karen and Ronald Herrmann Anne Holt and C.D. Schultz Mr. and Mrs. A. Jackson Holt Mr. and Mrs. Leonard Holzman Mr. and Mrs. H. Glenn Huddleston Janet Annabelle Jones Laurie and Michael J. Kaplan Linda and David E. Kehl Mr. and Mrs. Herbert D. Kelleher Nancy and Ed Kelley Robert E. Kelso Joan and Pat Kennedy Bonnie and John Korbell Carolyn and Joseph Labatt Judith R. Lachman Lambda Construction Company, LTD. Leco Management Sarah and Milton Lee Andi LeMaistre Mr. and Mrs. Gary R. Light

Louise A. Mandel Charles F. McAleer, III Edith McAllister W.W. “Bo” McAllister, III Charline and Red McCombs McGaughy Construction Co. Sherry and Laird McNeil Yona and Tom McNish Judy and Palmer Moe Karen Norman Mueller Terrie and Jamie Musselman Jan and Frank Newton Karen and Mike Novak The Jesse H. and Susan Oppenheimer Foundation Sheri and Manny Ortiz Judy and Seymour Palans Diane and Phil Pfeiffer Minnie Stevens Piper Foundation Jane Cheever Powell Katie and Jim Reed Joan and Carl Register Art and Helene Riklin Mr. and Mrs. Stanley D. Rosenberg Jenn and James Rosenblatt Jill and Bobby Rosenthal Dianna and Drew Roy Karen Salsman Mr. and Mrs. James L. Satel Cynthia and Thomas Schluter Mr. and Mrs. Stanley Schoenbaum Lisa Dreeben Sechler and Kelly Sechler Ann Stevens Ruth Eilene Sullivan Timothy Swan Richard Thum/Five Star Cleaners LLC Mr. and Mrs. Richard C. Traylor Vanguard Charitable Courtney and Mark E. Watson, Jr. Lora and Jim Watts Martha and Geoffrey Weiss Linda and Ed Whitacre Barbara and George Williams Wong Family Enterprises Ltd. Tim and Suzanne Word Foundation Barbara R. Wulfe Mr. and Mrs. James P. Zachry

2018 PRESIDENT’S GALA BENEFITING THE PEGGY AND LOWRY MAYS PATIENT CARE ENDOWMENT Platinum Sponsor ($25,000 +) Mr. and Mrs. William E. Greehey H-E-B Mr. and Mrs. Herbert D. Kelleher University Health System The USAA Foundation, Inc. Valero Energy Foundation Karen Lee and David S. Zachry Diamond Sponsor ($15,000 +) Mr. and Mrs. Charles E. Cheever, Jr. Margie and Bill Klesse Gold Sponsor ($10,000 +) Mr. and Mrs. Carlos E. Alvarez Mr. and Mrs. Bruce Barshop The Brown Foundation Phyllis and Jamie Browning Karen J. Hixon Elizabeth and Robert Lende Judy Renick Silver Sponsor ($5,000 +) Mr. and Mrs. Curtis V. Anastasio BioBridge Donna Marie Block Mr. and Mrs. Francis N. Burzik Frost Bank Valerie and Jack Guenther Nancy and Edward B. Kelley Robert L. Oliver Mr. and Mrs. Scott Petty, Jr. J. Tullos Wells Bronze Sponsor ($2,500 +) Ann D. Biggs BlueCross BlueShield of Texas Dr. and Mrs. Michael West Brennan Broadway National Bank Cadence Bank Christopher Colmenero Harriet and Robert Dominique Barbara B. Gentry and C. Michael Gentry Grand Hyatt Helen K. Groves Mr. and Mrs. James C. Hasslocher Harriet and Austin E. Helmle Mr. and Mrs. W. Michael Humphreys Mr. and Mrs. Patrick J. Kennedy, Sr.

Amy and Carl C. Liebert, III LifeCare Hospitals of San Antonio Mr. and Mrs. Wilbur Lee Matthews, II Dr. and Mrs. Ruben A. Mesa Mr. and Mrs. Daniel S. McNamara Mr. and Mrs. Frank S. Morrill Mr. and Mrs. David Oppenheimer The Doctors Sandra and Michael Osswald Pape-Dawson Mr. and Mrs. George P. Parker, Jr. Dr. and Mrs. Thomas R. Pollard Sendero Wealth Management, LLC South Texas Money Management, Ltd. Texas Capital Bank UT Health San Antonio Lori and Mark H. Wright Supporters ($1,000 +) Dr. Teresa D. Bell and Ms. Kimberly M. Lane Mary Alice and Henry G. Cisneros Dr. and Mrs. Ralph A. DeFronzo Mr. and Mrs. Curtis C. Gunn, Jr. Dr. and Mrs. William L. Henrich The Doctors Maged and Eman Mina Dr. Huyen Thi Dieu Nguyen Diane and Phil Pfeiffer Mr. Gary Candy and Ms. Diane D. Rath Ruth Eilene Sullivan Dr. and Mrs. Barry David Winston Friends (under $1,000) Dr. and Mrs. Bakthavathsalam S. Athreya Lisa Karen Bailey Dr. and Mrs. Alan David Baribeau Margaret Barron The Doctors Wei-Ann and Michael Bay The Doctors Melora and Peter Berardo Dr. and Mrs. Arnold Steven Berns Dr. Elizabeth Block Blencowe Celita Pappas Borchers Dr. and Mrs. Warren B. Branch Dr. Patricia K. Brougher and Mr. John R. Brougher Dr. and Mrs. John Joseph Bussa Dr. Charles Donald Cardenas Dr. Elizabeth A. Casiano Evans Dr. Chiquita A. Collins Mr. and Mrs. James D. Dannenbaum Dr. Jonathan S. Dowben

Kris Enders Doyle Alex Echeveste John Mark Edgmon Colette and Ty Edwards Mr. and Mrs. David Wayne Felsing Mr. and Mrs. Alfredo Lorenzo Flores, Jr. Dr. and Mrs. Antonio Furino Dr. John H. Garr and Colonel (Ret.) Mary E. Garr Dr. and Dr. Arnulfo Rolando Garza-Vale Mr. and Mrs. Fernando S. Godínez Dr. and Mrs. Roland Adolph Goertz Ginny L. Gomez-Leon Mr. and Mrs. Drew Grant Mr. and Mrs. James L. Hayne, Sr. Carlos Herrera, III Dr. and Mrs. Pat Hezmall Dr. Frederic Eugene Hiller Mr. and Mrs. Robert H. Holliday Dr. and Mrs. Stephen Thorsheim Hougen Dr. Sandra Jean Hufsmith Dr. and Mrs. Christopher C. Hunter The Doctors William and Chiufang Hwang Dr. and Mrs. David Joseph Jones Patrick Michael Kaminski Dr. Kevin E. Kendall Carla Knobloch Bart C. Koontz The Doctors David G. Leibold and Pamela F. Etchison Dr. and Mrs. Randolph Carl Lester Dr. and Mrs. Erwin Richard Lochte, III Dr. and Mrs. James Lloyd Lovell Dr. Brant Steven Mittler and Ms. Louise A. Mandel Lieutenant Colonel Paul E. Manna, USA, Ret. Mr. and Mrs. Andrew Marks Dr. and Mrs. Stephen Maroda, Jr. Colonel (Ret.) Maria Alicia Mayorga, USA, Ret. The Doctors G. Duncan and Karis McCarroll The Doctors James and Melinda McMichael Dr. Jacqueline Lee Mok and Dr. V. Grayson Dyer Dr. and Mrs. William Lee Mok Judith N. Morton Dr. and Mrs. David Ryan Mullican Dr. and Mrs. Joseph J. Naples Mr. and Mrs. James Andrew Nelson

Patrick O’Hara Sheri and Manny Ortiz Mr. and Mrs. Bobby R. Peugh Dr. and Mrs. Philip Brent Plattner Dr. Jennifer Sharpe Potter and Mr. Lloyd Potter Dr. Elizabeth M. Rebello and Mr. Savio Rebello Ronald J. Reed Mr. and Mrs. William C. Reed Mr. and Mrs. Raymundo Rivera, Jr. Dr. and Mrs. Carlos A. Rosende Dr. Sharon Kay Rosenthal Christine Saalbach Cynthia Saks The Doctors Steven R. Seidner and Laura Beizer Dr. Selena Juarez Stuart and Mr. Burton Stuart Patrick H. Swearingen, Jr. Dr. and Mrs. Harold Lee Timboe Kenneth P. Trevett Dr. and Mrs. Richard S. Urso The Doctors Hasi and Manjeri Venkatachalam Dr. James Lee Vosberg and Mr. James Rubio Catherine Elaine Wages Dr. and Mrs. Lewis P. Walker, III Dr. and Mrs. Kaye Evan Wilkins Dr. Janet F. Williams and Mr. William B. McDonald Mr. and Mrs. John Hamshire Williams Sabrina and Brandon York Faustino Yturria, Jr. 2018 SAN ANTONIO BREAST CANCER SYMPOSIUM Premier ($200,000 +) AstraZeneca Lilly Oncology Novartis Oncology Pfizer Oncology Angel ($125,000 +) Eisai Genentech Genomic Health Merck

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Patron ($75,000 +) Amgen GlaxoSmithKline Immunomedics Major Supporter ($50,000 +) Abbvie/Pharmacylics Bristol-Myers Squibb NanoString Technologies Puma Biotechnology, Inc. TESARO Contributers ($25,000 +) Biotheranostics Breast Cancer Research Foundation Celgene Corporation Daiichi Sankyo Inc. H3 Biomedicine Lumicell MacroGenics, Inc. Menarini Silicon Biosystems Myriad Genetic Laboratories, Inc. Natera Odonate Therapeutics Inc. Seattle Genetics Spectrum Pharmaceuticals Syndax Pharmaceuticals Wolters Kluwer Donors ($10,000 +) 23andMe Agendia Ambry Genetics Caris Life Sciences Cepheid Cianna Medical Coherus BioSciences Dignitana Elsevier, Inc. Epic Sciences Faxitron Helsinn Therapeutics US, Inc. JAMA Network Mitra Biotech NeoGenomics Laboratories The Oncologist Paxman USA Inc. Philips Molecular Pathway DX PreludeDx Radius Health, Inc. RareCyte, Inc. R-Pharma US

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Springer Healthcare Education Tempus TerSera Therapeutics Toray International America, Inc. TRIO - Translational Research in Oncology Zero Gravity Skin Special Thanks AACR Susan G. Komen Foundation 2018 GREEHEY CHILDREN’S CANCER RESEARCH INSTITUTE AMBASSADORS’ CIRCLE Gifts ($10,000 +) Margie and Bill Klesse Mr. and Mrs. William N. Latham Terri Katherine Rogers-Ivie Stewart Asset Management, LLC Gifts ($5,000 +) Michael Ciskowski Mr. and Mrs. Charles A. Granstaff Gifts ($2,500 +) Amy Shelton McNutt Charitable Trust Mr. and Mrs. William Thomas Maloy Ms. Cheryl Lynn Raba and Ms. Lisa Bell Dr. and Mrs. Gary Wayne Raba Mr. and Mrs. William Laurence Raba, Jr. Minnie Stevens Piper Foundation The Riklin Charitable Trust Gifts ($1,000 +) Mr. and Mrs. Raymond S. McClellan Mr. and Mrs. J. Ralph Leatherman, Jr. Louise and Michael Beldon Mr. and Mrs. Charles E. Cheever, Jr. Mr. and Mrs. Mark Cirinna Katie and Jim Reed Mr. and Mrs. Jerome P. Hoog The Doctors Anne-Marie R. Langevin and Peter M. Ravdin McCombs Foundation, Inc. Linda M. McManus Debbie and Frank Morrill Mr. and Mrs. William P. O’Hara Courtney and Mark E. Watson, Jr. Gifts (under $1,000) Dr. and Mrs. Ralph A. DeFronzo Barbara Smith Akins Mr. and Mrs. Curtis Vincent Anastasio

Judith G. Cavender Dr. and Mrs. Taylor P. Cotton Georgia Garcia Valerie Jauer Dr. Marsha C. Kinney and Mr. Gregory M. Kinney Mr. and Mrs. Joe C. McKinney Emilie Pitman-Kreager Dr. Robert H. Poirier Mr. and Mr. John William Russell, Jr. Jillian Gayle Gomez Dr. and Mrs. Everett P. Bratcher The Doctors Larry Greif and Cindy Swann Mr. and Mrs. James L. Hayne, Sr. Dr. and Mrs. Robert L. Jones Mr. and Mrs. David Oppenheimer Mr. and Mrs. Richard M. Peacock Dr. Alexander Pertsemlidis Dr. Amelie G. Ramirez and Mr. David Fernando Ramirez South Texas District of Optimist International Patrick H. Swearingen, Jr. The Jesse H. and Susan Oppenheimer Foundation William Odis Walker, Jr. Dr. and Mrs. Mark Berton Weinstein Jane Cheever Powell Mr. and Mr. John William Russell, Jr. Cesar J. Cabello, Jr. Mr. and Mrs. Vincent Joseph Bila Mr. and Mrs. W. R. Butler Isabel Christian Dr. and Mrs. Julio E. Figueroa, Jr. Dr. Mary Jo McGuire Mr. James E. Pianta and Ms. Marie L. Pohls Mr. and Mrs. Louis Thomas Rosenberg Mr. James Walker Ross Ann D. Biggs Dr. G. Robert Bradley and Ms. Darla Krause Mr. and Mrs. Donald M. Cohick Mr. and Mrs. Ty Edwards Billie-Kite Martin Howlett Admiral and Mrs. Bobby R. Inman Dr. and Mrs. Philip T. LoVerde J. Scott Miller, D.D.S., P.C. Mr. and Mrs. Kenneth A. Sanchez Mr. and Mrs. Stanley Schoenbaum

Doris Barshop Spector Mr. and Mrs. Joseph R. Straus, Jr. Dr. Marilyn Elizabeth Wilhelm Dr. and Mrs. Max Frank Adler Dr. Bonnie L. Blankmeyer Sam A. Bybee Johanna U. Comuzzi Mr. and Mrs. Jorge Del Alamo, Jr. Jack Frost Mr. and Mrs. Robert E. Gurwitz Mr. and Mrs. James C. Hasslocher Gary Hierholzer Mr. and Mrs. Albert Hinojosa Colonel Jerry Eugene Marshall, USAF, Ret. Martinez Insurance Agency Mr. and Mrs. McCottingham Miles Roberta Tiner Nelms Marie L. Pauerstein Rebecca C. Price Robert B. Price, BBA Gayle S. Ramsey Dr. Elizabeth M. Rebello Roger L. and Laura D. Zeller Charitable Foundation Mylinda Sorenson Janice M. Stong Dr. Gail E. Tomlinson Dr. and Mrs. Rafael V. Urrutia, Jr. Mr. and Mrs. Brian L. Weiner Dr. and Mrs. Rex Edward Wilcox Brenda L. Williams Mr. and Mrs. James G. Wueste Barbara R. Wulfe Anne D. Burney Mr. and Mrs. William Carson Sandlin Melinda I. De Arman Sharron Florene Hawk Mr. and Mrs. Daniel R. Morales Mr. and Mrs. Robert C. Murray Brandon Scott Newell Dr. Hyman M. Penn and Ms. Lynn Gordon Mr. and Mrs. Alfredo Ramirez Mr. and Mrs. Alex Scharlack Susan A. Nichol-Johnson Mr. and Mrs. Edward E. O’Boyle Laura Hallowell American Legion Post 547 Kathy Hawk Mr. and Mrs. Daniel Mota Dr. and Mrs. Kenneth R. Wiedenfeld

2018 SAN ANTONIO EXPRESS-NEWS BOOK & AUTHOR UNDERWRITERS Nobel Laureate ($20,000 +) Klesse Foundation San Antonio Express-News Valero Energy Foundation Pulitzer ($10,000 +) AT&T Foundation Mays Family Foundation Scantland Charitable Foundation Silver Eagle Distributors Best Sellers ($5,000 +) Ancira Cars, Trucks and RVs Argo Group Frost Bank Nancy and Ed Kelley The Tobin Endowment Program Design Sponsor Causality Studios Volunteer Sponsor SA Cancer Council First Editions ($2,500 +) Burdick Custom Homes Jane Cheever Powell Zachry Corporation Classics ($1,500 +) Beldon Roofing Company Broadway Bank Phyllis and Jamie Browning Catholic Life Insurance CeCe Cheever Nancy and Charlie Cheever Computer Solutions Helen K. Groves Rhonda and Charlie Gurinsky South Texas Money Management Special Thanks Causality Studios Dr. Coleen Grissom Janet Holliday and the CE Group The Prestigious Mark The Twig Book Store 2018 SAN ANTONIO EXPRESSNEWS BOOK & AUTHOR LUNCHEON ADVERTISERS Akin, Doherty, Klein and Feuge, PC

Britton Orthodontics, PA Burdick Custom Homes Causality Studios Cheever Books Robert Cowan, Attorney at Law O’Krent’s Abbey Flooring Center San Antonio Book Festival San Antonio Express-News Rosanna Schulze Luxury Real Estate Silver Eagle Distributors Sutherland Cloud Senior Consultants The UPS Store Thyroid and Endocrine Center of South Texas Valero Energy Foundation 2018 VULCAN MATERIALS COMPANY FUNSHOOT Platinum Sponsors ($5,000 +) Midstate Environmental Services, LP Paloma Blanca Enterprises, Inc. Rush Truck Center Urban Concrete Contractors Ltd. W.T. Byler Co., LP Diamond Sponsors ($2,500 +) Alamo Cement Company, Ltd. Austin Powder Company Bexar Concrete Works I, Ltd. Buckley Powder Company Burlington Northern Santa Fe Railway CEI Enterprises, Inc. G5 Industrial Services Gencor Industries Holt Cat Plant Fabricators, Inc. S. Kanetzky Engineering, LLC Waukesha-Pearce Industries, Inc. Gold Sponsors ($1,500 +) Aggregate Haulers Airgas Anthony Machine Applied Industrial Technologies Atascosa Recycling Austin Powder Beck Industrial Benke Consulting Brannan Paving Buckley Powder Company Cemex Curran Contracting Eagle Foundry Co. / GW Van Keppel Co.

Excel Machinery EZ Bel Construction GCR Tires Grande Truck Center Hoyt / Van Keppel ICPG Industrial Electric Service Jebro Keystone Concrete (Stewart Builders) Kirby Smith Machinery Inc Kyrish Truck Centers M&M Contracting McCourt and Sons Morlandt Electric Ray Faris Inc Safecar Rail Services San Antonio Armature Works Superior Industries / Van Keppel Titan Transportation TNW Corporation TRR Ranch Truss Construction DBA GNW Concrete Unified Screens and Crushing V.K. Knowlton Construction Van Keppel Vibra Tech Inc Warren Cat Westward Environment Y Bar Ranch Individual Participants Asphalt Express Martin Engineering Purvis Industries Sponsors, Donors, Supporters Alamo Cement Company, Ltd. Allen A. Schaefer Anonymous Donor Borderline Transports Brian Bailey Capitol Aggregates, Inc. Christopher Michael Havelka Christopher Stanford CL Dews Foundry Continental ContiTech Craig Spiser Daryl Lee Zumwalt Donald Papini Door Brute Edward M. Kelley Ford Steel Company Geof Flora

Great Northwest Concrete Gulf Coast Limestone, Inc. GW Systems Hazemag USA HDR Engineering Herbst & Associates ICPG Industrial Electric Service Ishmael David Garcia James Coffland Jason Boney Jebro Jeff and Sharla Lott Karen D. Savelle Kirby-Smith Machinery, Inc. Liberty Construction Services, LLC Lone Star Paving Martin Engineering Mason Patrick Duchamp Mike Bess Orlando A. Escobar Patrick David Kerry Pro-Line Pavement Maintenance Purvis Industries Railroad Infrastructure & Terminal Robert E. Chapman Ryan Construction, Inc. Specialized Transport Service Spokane Industries Starco Stephen Boudreaux Steven Quinn Neal Superior Commercial Concrete, LLC Terracon Consultants, Inc. Tom Tanner Turnkey Processing Solutions, LLC Union Pacific Railroad United Rentals Valero Mktg. Supply Co. Westward Environmental, Inc. Williams Supply Company, LTD Z Technologies Industrial Automation, Inc. Zlien 2018 FASHION FOR A CAUSE Table Sponsors ($1,000 +) Frost Bank Barbara B. Gentry Stephen Grossman Lisa Grove Phil Hardberger Conservancy/ Denise Gross

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Carmen Laverne Kamiya Nancy Kelley Patricia Elizabeth Rivet Jennifer Torres Supporters (under $1,000) Bridget Archer Carla Bergner Tracy Blitz Anna Laura Howell Block Mary Burch Pam Burdick Elizabeth Cox Joan Cunningham Helene DeParalta Barbara B. and C. Michael Gentry Jean Gross Melissa Haberstroh William and Margery Hoffman Lori Johnson Carmen and Jason Kamiya Carolyn Karulak Terri Lennane BJ Mamuzic Susanne Marco Cynthia Marmole Cathy Riley Nancy Catherine Roof Stacy Lynda Strieby Betty Sutherland

Harriet Marmon Helmle, CPA, CFP Leonard May Albert C. Molter, Jr. The Louise Schuetze Lodge No. 3-3 of the Hermann Sons Life Dolores Hardwick Diane and Phil Pfeiffer CHEEVER FOUNDATION FUND Sally and Charlie Cheever Foundation DERMATOLOGY ONCOLOGY AND RESEARCH FUND Karen and Ronald Herrmann Mr. and Mrs. Michael D. Burke Dr. Gavin Richard Corcoran James Kone, Jr. Mr. and Mrs. Harry Halff Dr. Pamela Rhea Maxwell Kay Green Celeste Lira Barry Wilson Alicia Nelson Salveo Health Communications, LLC Castle Biosciences, Inc.

DIRECTOR’S CRITICAL NEEDS FUND Mr. and Mrs. George A. Ellis Alvin Hayes Mr. and Mrs. Bartlett Cocke, Jr. Truist Benevity Community Impact Fund BREAST CANCER RESEARCH AND Denise J. Beverage TREATMENT FUND Charles Schwab Charitable Fund Susan G. Komen for the Cure San AntonioJames Garner Helotes Festival Association, Inc. Mr. and Mrs. John Thomas Harvey Alamo Heights High School Holt Atherton Education Foundation Nimitz Middle School Dr. Marsha C. Kinney and Jack Edward Calentine Mr. Gregory M. Kinney Richard A. Marini Dr. George C. Mani Roxana and Malcolm McGregor RICHARD CARNWATH Mr. and Mrs. Christopher Newhouse CANCER RESEARCH FUND Richard K. Carnwath and Anna Childers Mr. and Mrs. Jeffrey Train Commander and Mrs. Matt Woodruff CANCER RESEARCH FUND The Boeing Company William and Ella Owens Employee Individual Giving Program Medical Research Foundation Dr. Roxanne Carmichael-Rosales Anonymous Donor Nancy Tropoli SA Cancer Council Courtney and Mark E. Watson, Jr. H-E-B Mr. and Mrs. Jess Bryan Culpepper William Norwood Mr. and Mrs. Kurt A. Jones Carolyn Cole Janice DeVille Angela Dooms

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Ricardo Garza Mary Denise Haley Bradley Perkins Texans for Joe Straus Aneda Arriaga J. R. Avant Briscoe Ranch, Inc. Mr. and Mrs. Robert C. Cowan, Jr. Dr. Kelley L. Frost and Mr. Patrick B. Frost Mr. and Mrs. Jeffrey Jost Luke Andrew Forgerson Mr. and Mrs. Terry Bailey Martin Kramer Jerrold H. Rehmar Patricia S. Schendel Dr. and Mrs. James M. Stedman Stoll Berne Virginia Evers Mohr Dr. and Mrs. Thomas M. McNish Deborah Tamez Discovery Acquisition Services A. Medrano Produce, LLC Beldon Roofing Company Joe B. Brooks Isabel Christian Amanda Jean Collums Johanna U. Comuzzi Cram Roofing Company, Inc. Roland Dulllnig Mr. and Mrs. Addison Baker Duncan, Jr. Mr. and Mrs. Richard C. Elliott Ben Plummer Mrs. Paula Yvette Gold-Williams Mr. and Mrs. James D. Goudge Lori Hillman Marion F. Hillman Holland and Knight LLP Lawrence Alan Kroman Vijayalakshmi Kumarasamy Lancaster Development Company Holli Leggett Mr. and Mrs. Russell Lott Jill Mason Mr. and Mrs. William J. Merrill Tinh Nguyen Mr. and Mrs. Jesse Ortiz Elaine Rudd Mr. and Mrs. Alex Scharlack Lynda Brooks Schell Elizabeth J. Silva

Jacque Smith Diana Sonnen South Texas Money Management, Ltd. Lauren Tew The Jack and Valerie Guenther Foundation Olga Tschirhart Joann Valentine James Allen Wheeler Mr. and Mrs. Stephen J. Silver Rick Rothe Helen Geyer Stanley Blackstone Virginia Ellen Burkholder Mr. and Mrs. John H. Busse Nancy Bauerle Campbell Steven James Carrola Mr. and Mrs. Robert W. Caves, Jr. Mr. and Mrs. Nick Clevenger Vivion Collier Katherine Costello Dr. and Mrs. Thomas Murray DeMoor Rajkumar Duraipandian Carol Fox-Good Jacqueline Greene Mr. and Mrs. Robert E. Gurwitz Carol Hausler Caroline Kensing Bill McFeeters Mr. and Mrs. Hank Molenaar Stephanie C. Perrin Mr. and Mrs. Bill Petmecky Laurie Louise Remschel Esthermae Rooke Karla Sarran Uttara Mohan Sawant Mr. and Mrs. Steve Schindler Ruth Eilene Sullivan Texas Star Nut and Food Co., Inc. The Herrmann Family Charitable Foundation The Kevin McLoughlin Agency dba Nationwide Insurance The Doctors Donald and Dixie Van Eynde Alfredo Vitela, Jr. Barbara B. Wood Kimberly Paige Wright Mary Teresa Hatten Camilla M. Parker Jeanette M. Lowell Shannon Braymen Helen R. Carr Gerald J. Cohn

Rena DuBose Mr. and Mrs. Earl Fowler Mr. and Mrs. Juan D. Garza Cecile Huck Gloier JCPenney Change for the Better Campaign Mr. and Mrs. Billy David Langley Emma Lee Mapp Gloria Gouger Massey Dr. and Mrs. Joe Robert McFarlane, Jr. Denise Miller Mr. and Mrs. Melvin Malone Mitchell Mr. and Mrs. Richard Moos Mr. and Mrs. Seymour M. Palans Laura M. Pantoja Carrie Self Anonymous Donor Mary Beth Fournier Pastor Donna Magee Mr. and Mrs. Gerald Reese Mathis Dr. and Mrs. Lawrence Y. Moore Ms. Debra Rae Maltz and Mr. Anthony Athens, III Marcy Cato

Arthur A. Tolbert, Jr. Yolanda Uranga Aaron M. Shakocius Tenesha Miller

JOHN AND AMY ERWIN CANCER RESEARCH AND PROGRAM FUND Mr. and Mrs. John W. Erwin, Jr.

OVARIAN CANCER RESEARCH AND TREATMENT Ovarian Cancer Research Fund

GU CANCER RESEARCH AND TREATMENT Alamo Group, Inc. Sanchez-Salazar and Associates, LLC

PATIENT AND FAMILY SERVICES SA Cancer Council The Estate of Dr. James W. Yancy The Estate of Lois F. Yancy Five19 Event Productions, LLC Amgen USA John L. Santikos Charitable Foundation Fund Courtney and Mark E. Watson, Jr. Phyllis Browning Company Eisai, Inc. Genentech, Inc. Michael Aguirre Financial Services

HEMATOLOGY ONCOLOGY Mr. and Mrs. Gary Ray Light KAREN AND RONALD HERRMANN BLADDER CANCER PROGRAM FUND Karen and Ronald Herrmann Mr. and Mrs. Jay Morey Mr. and Mrs. J. Scott Beckendorf Mr. and Mrs. Mark Jonathan Berridge Mr. and Mrs. Austin Alexander Herrmann

LUNG CANCER RESEARCH AND TREATMENT Glenda L. Alter MPN/MF CANCER RESEARCH AND TREATMENT Rancho Foods, Inc. Annette Kay MacDonald Florence Gorlin NEURO-ONCOLOGY RESEARCH AND TREATMENT Edy Pineda Miller Margaret Anne Norton JESSE H. AND SUSAN R. OPPENHEIMER FELLOWSHIP IN NEW ANTICANCER DRUG DEVELOPMENT Susan Oppenheimer

Jon H. Smith Agendia Seno Medical Instruments, Inc. University Health System Deborah Ann Yancy Mays Family Foundation Puma Biotechnology, Inc. Mr. and Mrs. Patrick Stehling Dr. George C. Mani Louise and Michael Beldon Mr. and Mrs. Vaughn Alan Zimmerman Cynthia Beard Judith G. Cavender Biodynamic Research Corporation Mr. and Mrs. Lee Mueller Mr. and Mrs. Paul A. Rohlfs Mr. and Mrs. Ricks L. Wilson, Sr. Dr. and Mrs. Joe Robert McFarlane, Jr. Evangeline Cantu Davis Law Firm Sandra Kiolbassa Jo Anne Lutz Shirley L. Mayer Lori Moctezuma Mr. and Mrs. William Thomas Pensyl Barbara B. Wood Mr. and Mrs. Victor Smilgin Shannon Braymen Melvin Lipsitz

Gloria Gouger Massey Mr. and Mrs. Melvin Malone Mitchell Mr. and Mrs. Charles R. Parnall Madison T. Wilson Armando Cardenas Marla Jayne Hargrave Janet and Ron Goebel PILOT RESEARCH PROGRAM SA Cancer Council Barbara and George Williams PLANNED GIFTS The Estate of Jamie C. Boerner The Estate of Karen Carew The Estate of Dr. James W. Yancy The Estate of Lois F. Yancy PROSTATE CANCER RESEARCH FUND Colonel and Mrs. John H. Sherner SCHORP MEMORIAL CLINICAL FUND Dorothy C. Schorp VANCE WALLER CANCER RESEARCH FUND Vance F. Waller DRS. WASHBURN AND MAHALINGAM ENDOWMENT FOR CLINICAL RESEARCH Legacy Global Foundation, Inc.

KAREN AND RONALD HERRMANN BREAST CANCER PROGRAM FUND Mr. and Mrs. J. Scott Beckendorf Mr. and Mrs. Mark Jonathan Berridge Mr. and Mrs. Austin Alexander Herrmann HERRMANN ZELLER FOUNDATIONS BREAST CANCER ENDOWMENT Dr. and Mrs. Jay Howard Heizer INSTITUTE FOR DRUG DEVELOPMENT City of Schertz Regan Arevalos Michael C. Fisher

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