Banner MD Anderson Rounds - June 2013

A PUBLICATION FOR COMMUNITY PHYSICIANS

june 2013

Finding answers, leading the way Advanced research underway at Banner MD Anderson Cancer Center

By Debra Gelbart

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anner MD Anderson Cancer Center in Gilbert is developing as a center for advanced research through its clinical trials and new biorepository. The tissue bank is a collaborative venture with The University of Texas MD Anderson Cancer Center in Houston, the first such initiative by MD Anderson outside of its main campus in Houston.

“Each of our organizations cares for unique populations of patients,” says Lee Seabrooke, research director at Banner MD Anderson. “We are looking forward to having the best minds in the country working together on studies involving genomic sequencing, looking for genetic variances corresponding to certain cancers.”

We are looking forward to having the best minds in the country working together on studies involving genomic sequencing, looking for genetic variances corresponding to certain cancers.

— Lee Seabrooke, Research Director, Banner MD Anderson Cancer Center

Trials are ‘mission-critical’ Like other medical organizations that operate tissue banks, Banner MD Anderson offers a “front door consent” to patients scheduled to undergo a biopsy or surgical procedure.

Lee Seabrooke, research director at Banner MD Anderson Cancer Center in Gilbert.

inside 2 Finding answers, leading the way

6 What’s happening at Banner MD Anderson

3 Banner MD Anderson

7 A new angle

Cancer Center expanding 4 Meet the new docs

8 Introducing Banner MD Anderson physicians

Co-directors for Banner MD Anderson Biorepository are chief of pathology Kevin McCabe, D.O. and division chief of surgical oncology Judith Wolf, M.D. Banner MD Anderson opened in September 2011 and the organization already is in the midst of cutting-edge clinical trials. “Research is missioncritical in the field of oncology,” Seabrooke said.

A Phase III trial sponsored by GlaxoSmithKline and led by principal investigator Jade Homsi, M.D. at Banner MD Anderson is comparing the combination of the BRAF inhibitor dabrafenib and the MEK inhibitor trametinib to vemurafenib in patients with Stage IIIC (unresectable) or Stage IV BRAF V600E or V600K mutation-positive melanoma. The primary endpoint is overall survival for subjects receiving the combination therapy compared with those receiving vemurafenib. “Banner MD Anderson is the only site in Arizona out of 180 worldwide participating in this trial,” Seabrooke said. The study is currently recruiting patients; Banner MD Anderson hopes to enroll 10 of them.

Hematology and Medical Oncology Division Chief Tomislav Dragovich, M.D. is the principal investigator for an open label, randomized Phase III trial of MM-398 Versus 5fluorouracil (5-FU) and leucovorin (also known as folinic acid) in metastatic pancreatic cancer patients who have progressed on prior gemcitabine-based therapy.

The trial is sponsored by Merrimack Pharmaceuticals. The sponsor is looking to enroll 405 patients, including 10 through Banner MD Anderson.

Front-line therapy Another Phase III trial has just gotten underway to investigate a new frontline therapy for ovarian and related

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(From left) Kathleen Benson, Lee Seabrooke, Shannon Johnson and Barbara Lambeth.

Researchers key to new treatments, strategies Meet the research team at Banner MD Anderson Cancer Center Lee Seabrooke is the research administrative director for Banner MD Anderson. Seabrooke provides high level administrative, operational and strategic oversight for research activities at the center.

Barbara Lambeth is a research nurse at Banner MD Anderson. She works with investigators on studies involving gynecologic cancers. The five main gynecologic cancers are cervical, ovarian, uterine, vaginal and vulvar.

She works with investigators on studies involving hematological, gastrointestinal and skin cancers.

Shannon Johnson is a clinical research coordinator at Banner MD Anderson.

Johnson works with investigators on studies involving breast, genitourinary, and thoracic head and neck cancers.

Kathleen Benson is a clinical research coordinator for Banner MD Anderson.

Shana Clark (missing above) is the research regulatory affairs coordinator for Banner MD Anderson. She assists investigators in the processing and submission of regulatory documents to both the Institutional Review Board and study sponsors.

cancers. Judith Wolf, M.D. is the principal investigator. This is a Phase III randomized, double-blind, placebocontrolled, multicenter study of AMG 386 with Paclitaxel and Carboplatin as first-line treatment of subjects with FIGO Stage III-IV epithelial ovarian, primary peritoneal or fallopian tube cancers.

The study is sponsored jointly

by AMGEN and the National Cancer Institute Gynecologic Oncology Group. The sponsors hope to enroll 2,000 patients, including 10 at Banner MD Anderson. “This is the first

study of an agent specifically targeted against ovarian and related cancers,” Seabrooke said. All other pharmacological agents used to treat these cancers until now were originally developed for other indications, he said.

Information about these and all other clinical trials underway at Banner MD Anderson can be found at www.BannerMDAnderson.com/ ClinicalTrials. Physicians also are invited to follow a weekly update of the cancer center’s clinical trials on Twitter at @bannermdandersn (or search “BannerMDAnderson” on Twitter).

Banner MD Anderson Cancer Center expanding

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he need for cancer care in our community coupled with the trust our patients have put in our team have resulted in the rapid growth of cancer treatment at Banner MD Anderson Cancer Center in Gilbert.

This has led the Banner Health Board of Directors to approve a $62.6 million dollar expansion project for the Banner Gateway Campus. Early this year, Banner MD Anderson broke ground to expand its outpatient cancer facility.

The 111,000-square-foot expansion is taking place to the south of the existing 130,000-square-foot building and will add: • Three linear accelerators (two at opening and one vault for future use) for a future total of six • 30 additional clinic exam rooms for a total of 60 rooms • 13 additional infusion bays for a total of 53 (and shelled space to

bring the future total to 76) • Expansion of Laboratory Intake Center and Welcome Center • The Cox Center for Integrative Oncology and Cancer Prevention funded in large part by a grant from the James M. Cox Family Foundation • Additional shell space for future expansion needs.

“This is an exciting development for our campus and for the members of our community that entrust us with their care,” said Todd Werner, chief executive officer for Banner MD Anderson and Banner Gateway Medical Center.

Since opening its doors in 2011, Banner MD Anderson has experienced rapid growth in outpatient volume and has attracted more than 5,000 patients and resulted in 50,000 patient visits. In addition, more than 50 subspecialty physicians are now providing cancer care to patients at the cancer center.

Todd Werner,

chief executive officer for Banner MD Anderson and Banner Gateway Medical Center

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Meet the new docs

We’d like to introduce you to eight of our physicians who have joined us in the past year

Görgün Akpek, M.D., MHS is the director of the Stem Cell (Bone Marrow) Transplantation and Cellular Therapy (SCTCT) Program at Banner MD Anderson Cancer Center in Gilbert. He cares for patients with acute and chronic leukemia, Hodgkin’s and non-Hodgkin’s lymphoma, multiple myeloma, myelodysplastic syndrome, myelofibrosis, aplastic anemia and other conditions.

Dr. Akpek is nationally and internationally recognized through his work on stem cell transplantation with a major focus of interest in allogeneic transplantation, graft-versus-host disease and adoptive immune therapy in various malignant conditions. He was a faculty member at Johns Hopkins University Department of Oncology and University of Maryland, Baltimore between 2000 and 2012 before joining the Banner Medical Group.

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Farshid Dayyani, M.D., Ph.D. specializes in genitourinary and gastrointestinal system cancers. His focus is treating prostate and bladder cancers at Banner MD Anderson. Board certified in both internal medicine and medical oncology, Dr. Dayyani completed his fellowship in medical oncology at The University of Texas MD Anderson Cancer Center in Houston.

“We offer true multidisciplinary cutting-edge treatments at Banner MD Anderson and we will continue to open new clinical trials,” he said. “I’m looking forward to contributing to the cancer center’s growth and being part of the process of developing it into the cuttingedge leader in cancer care in the Valley,” he said.

Javier Munoz, M.D. specializes in treating hematological malignancies, particularly lymphomas. His interests include molecular heterogeneity of lymphomas and subclassification of specific lymphoma subtypes amenable to targeted treatment. “Our goal is to bring cutting-edge clinical trials and new therapeutic regimens to Banner MD Anderson while providing the highest level of expertise and quality of care,” he said.

Dr. Munoz completed an investigational cancer therapeutics fellowship at The University of Texas MD Anderson Cancer Center. He is triple board certified in internal medicine, hematology and medical oncology.

Karen Pitman, M.D. focuses on surgical management of tumors of the mouth, throat, thyroid, sinus and skull base, along with melanomas of the head and neck. She comes to Banner MD Anderson from the University of Mississippi School of Medicine in Jackson. “I’m looking forward to helping build a head and neck cancer program here,” she said.

Referring physicians, she said, remain involved with their patients’ care, especially because each patient receives an individualized treatment plan that can include radiation and chemotherapy, in addition to surgery. “This is a great opportunity for cancer patients to receive state-of-the-art care,” she said.

Matthew Schlumbrecht, M.D., MPH is expanding the minimally invasive GYN oncology surgery program at Banner MD Anderson. “We offer a full range of surgical services, including laparoscopic, robotic and open procedures,” he said. “We’re excited about the new, upgraded platform and additional instrumentation of our surgical robot.”

Dr. Schlumbrecht also looks forward to the weekly multidisciplinary conference that’s held to discuss optimal treatments for GYN patients. “Patients and their primary care physicians benefit from the expertise of three GYN oncologists, a radiation oncologist, a radiologist and a pathologist gathered together to offer their perspective on a patient’s care,” he said.

Thomas Shellenberger, M.D. is a surgical oncologist leading the head and neck cancer program at Banner MD Anderson.

Unlike many other surgical specialists, head and neck surgeons typically follow their patients through “their entire cancer journey, from diagnosis to initial staging to selecting the right treatment and monitoring the patient throughout all phases of treatment, including radiation and chemotherapy,” he said. A head and neck surgeon often will follow a patient for five years.

Dr. Shellenberger completed fellowships in head and neck surgical oncology, oral and maxillofacial tumor and reconstructive surgery and hyperbaric medicine and problem wounds.

Diljeet Singh, M.D., DrPH is program director for gynecologic oncology. She also provides the integrative medicine and cancer prevention services. She is fellowship-trained in gynecologic oncology at MD Anderson and in integrative medicine at the University of Arizona.

She is interested in helping people who have survived cancer “maximize their quality and quantity of life.” Because everyone is at risk for cancer, she said, “we want to reach as broad a population as possible with the message of how important diet, exercise and stress management are to preventing cancer.”

Klaus Wagner, M.D., Ph.D. specializes in lung and head and neck cancer. He completed an oncology fellowship at MD Anderson and was an assistant medical director at Genentech.

At Banner MD Anderson, his focus will be on treating patients with lung cancer and head and neck cancer and on clinical trials that may have implications for a number of different cancers. He emphasizes that referring physicians can be assured that at Banner MD Anderson, specialists for each tumor type care for patients in a multidisciplinary setting. “The oncologists in the head and neck cancer program here focus only on those cancers,” he said.

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What’s happening at

Banner MD Anderson Cancer Center

By Dr. Edgardo Rivera, Medical Director

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ne thing I’ve learned in my career is the importance of listening.

As healthcare providers, we know that the information our patients share with us is essential. It’s how we make accurate diagnoses and adjust treatment plans.

I’ve also learned the value of listening to my colleagues. Your feedback is how we make things better. So, when we heard from you that our patient intake process wasn’t working, my team and I listened.

In April, Banner MD Anderson Cancer Center in Gilbert implemented a new scheduling process as a direct result of the feedback we received.

This process has already improved the experience for both our patients as well as our referring physicians.

We have created the Patient Access Department, which is committed to communicating regularly with physicians and patients. When physicians call the Patient Access Department to refer a patient, a patient access coordinator will contact the doctor the same day we receive the referral. We’ll also contact the referring physician when we have scheduled the patient. Plus, our staff will reach out to patients every two to three business days to keep them informed of our progress in scheduling their appointment. And — something I’m very proud of — our goal is to have the complete intake-scheduling process take seven days or less.

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Another exciting development that I’m pleased to share is our first stem cell harvest, which was completed in March. The patient’s stem cells were then re-infused into the patient in May. It’s this kind of advanced treatment that makes Banner MD Anderson an exciting place to work. We’ve invested a great deal of time and energy into building the Stem Cell Transplant & Cellular Therapy Program, and this milestone is just the first of many that we’ll see from this program.

As always, thank you all for your commitment to Banner MD Anderson and for helping us continue to evolve and improve the service we provide.

Sincerely, Edgardo Rivera, M.D. Medical Director

Patient Access: TO REFER A PATIENT TO BANNER MD ANDERSON, call us at 480-256-6444 and ask for the Patient Access Department or email BMDACCpatientaccess@ bannerhealth.com.

FOR PHYSICIAN TO PHYSICIAN REFERRALS, call us at 480-256-6444 and ask to be connected with the specific physician.

The operator will take your return call phone number and page the physician with your contact information.

Please continue to provide feedback on this process so that we can further enhance the experience for our patients and physicians alike.

(From left) Matthew Callister, M.D., Karen T. Pittman, M.D. and Thomas Shellenberger, M.D.

A new angle

Bringing robotic technology into head and neck surgeries

By Jake Poinier

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hile robotic surgery has made its largest impact in prostate cancer procedures, this technology is now making inroads in head and neck surgeries.

“Robotic surgery permits us to do a lot of things we haven’t been able to do in the past, and we’re even doing operations that haven’t been done by a comparable open procedure,” said Thomas Shellenberger, M.D., a head and neck surgical oncologist at Banner MD Anderson Cancer Center in Gilbert. “It’s particularly salient for head and neck tumors because of the access and angles required. For instance, a small tumor located in the area of the tonsils or base of the tongue would ordinarily require dividing the mandible in order to access the tumor through an incision in the neck — and reconstruction would mean taking tissue from elsewhere in the body.”

Breaking the mold A traditional open surgery in that area of the body might mean a hospital stay of seven to 10 days and a lengthy recovery. In contrast, a similar operation performed robotically could allow the patient to head home the next day, with far better functional outcomes and less alteration of anatomy.

“All treatments have potential side effects, so anything we can do to minimize the impact of our therapies on function, such as swallowing and speech, is an advance for our patients,” said Matthew Callister, M.D., radiation oncology division chief. “From a program development perspective, it’s the highest in tech being used by our surgeons, and we complement that with best possible radiation oncology techniques. It’s another example of Banner MD Anderson investing in its expertise, technology and state-of-the-

art therapy for patients, and it opens the door to new research and study where we can improve outcomes.”

Team approach While robotic surgery is currently limited to certain types of early-stage head and neck tumors, Shellenberger’s surgical partner Karen T. Pitman, M.D., FACS, said it’s an important tool within the multidisciplinary team.

“Every new patient with any sort of cancer is presented at our weekly tumor conference,” she said. “Between all the experts — surgery, radiation oncology, medical oncology, radiology, pathology — we come up with the appropriate treatment plan for each patient.”

Going forward, Shellenberger sees the robotic technology changing the paradigms for difficult-to-access cancers that have traditionally been treated with radiation.

“We’ll still use radiation therapy, but alter it in a way to reduce the toxicity or side effects,” he said. “The patient benefits from equivalent cancer control with less morbidity — and better quality of life.”

BannerMDAnderson.com

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Introducing Banner MD Anderson Physicians

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anner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. Below is a listing of physicians currently on our full time staff.

Physicians continue to join Banner MD Anderson, so this list will continue to evolve.

Diagnostic Imaging Donald Schomer, MD, Division Chief, CAQ Neuroradiology Oncologic diseases of the brain, spine, head and neck John Chang, MD, PhD Advanced MR and CT imaging of gastrointestinal and genitourinary systems; imaging guided biopsies

To make a referral to a physician on our staff, please call 480-256-6444. To contact a member of medical staff, call 480-256-6444 and ask for the physician to be paged.

Vilert Loving, MD Breast imaging and intervention

Hematology & Medical Oncology

Klaus Wagner, MD PhD Thoracic and Head & Neck Cancers

Harvinder Maan, MD, CAQ Neuroradiology, Director of Neuroradiology Neuroradiology and interventional spine procedures

Tomislav Dragovich, MD, PhD, Division Chief Digestive tract cancers including colorectal, esophageal, stomach, pancreatic, hepatobiliary

Bryan Wong, MD Genitourinary cancers

Gorgun Akpek, MD, MHS Director of Stem Cell Transplantation and Cellular Therapy program Shakeela Bahadur, MD Lung, colorectal, breast cancers Mary Cianfrocca, DO Breast Cancer Program Director Farshid Dayyani, MD, PhD Genitourinary and Gastrointestinal cancers Jade Homsi, MD Melanoma, sarcoma, immunotherapy H. Uwe Klueppelberg, MD, PhD Multiple myeloma and other plasma cell disorders, lymphomas, myelodysplastic syndrome, brain cancers, head and neck cancers, thoracic cancers Javier Munoz, MD Lymphoma and other blood cancers Edgardo Rivera, MD, Medical Director Breast cancer Kerry Tobias, DO Pain management, palliative medicine, physical medicine, rehabilitation

Oncology Surgery Judith K. Wolf, MD, Division Chief Gynecologic oncology Stephanie Byrum, MD Breast surgery Al Chen, MD General surgery Randall Craft, MD Full spectrum of both implant-based and autologous breast reconstruction, comprehensive plastic and reconstructive options for all areas of the body Mark Gimbel, MD Melanoma, sarcoma, cancer of the stomach, small bowel, colon and rectum, thyroid, pancreas, liver, breast, and other rare cancers Dr Karen Pitman, MD Head and Neck Surgery Matthew Schlumbrecht, MD, MPH Gynecologic oncology; gestational trophoblastic disease; a variety of surgical techniques including radical abdominopelvic exploration and minimally invasive procedures.

Rob Schuster, MD General surgery

Thomas Shellenberger, MD Recurrent thyroid cancers, cancers of the oral cavity, oropharynx, and larynx, salivary gland cancers, advanced skin cancers and melanoma of the head and neck, complications from treatment of head and neck cancer.

Rizvan Mirza, MD Abdominal and pelvic magnetic resonance imaging

Diljeet Singh, MD Program Director, Gynecologic Oncology; Program Director, Cancer Prevention & Integrative Medicine

Susan Passalaqua, MD, Director of Nuclear Medicine and Molecular Imaging Oncologic imaging, nuclear medicine, radiology, PET/CT

Benny Tan, MD Plastic and reconstruction surgeon Breast cancer reconstruction and most forms of cancer reconstruction

Andrew Price, MD, CAQ Interventional Radiology Interventional radiology, including percutaneous tumor ablation, chemoembolization, and radioembolization

Radiation Oncology Matthew Callister, MD, Division Chief Gastrointestinal, skin, sarcomas, and head and neck cancers Dan Chamberlain, MD Thoracic and head and neck malignancies, and body radiosurgery Emily Grade, MD Breast treatment including partial breast brachytherapy, prostate brachytherapy, gynecological and thyroid cancers Terence Roberts, MD, JD Brain, lung and prostate tumors; stereotactic radiosurgery; partial breast brachytherapy

Critical Care Shiva Birdi, MD, Division Chief Jijo John, MD Deven S. Kothari, MD Dean Prater, MD Ravindra Gudavalli, MD

Internal Medicine Nikunj Doshi, DO, Division Chief Shefali Birdi, MD David Edwards, MD Ronald Servi, DO

Pathology Kevin McCabe, DO, Division Chief