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For his groundbreaking work in immunotherapy, Jim Allison, Ph.D., chair of Immunology at MD Anderson Cancer Center, was awarded the nation's highest honor for clinical medical research.
By Scott Merville
Allison, who invented a completely new way to strike cancer by unlocking a shackled immune system attack, was named the 2015 winner of the Lasker-DeBakey Clinical Medical Research Award from the Albert and Mary Lasker Foundation. The Lasker awards, in their 70th year, honor major achievements in basic science, clinical research and public service around the world.
"I'm honored and grateful to receive the Lasker award. As a basic scientist, I was pleasantly surprised, really kind of stunned, to receive the clinical award," Allison says. "This award is also important recognition of the early success of cancer immunotherapy and its great potential to extend survival of cancer patients for decades and ultimately to cure some types of cancer."
Lasker recipients are chosen by a distinguished international jury to recognize major advances in the understanding, diagnosis, treatment, cure and prevention of human disease.
Allison's research into the biology of T cells, white blood cells that serve as the immune system's customized guided weapons, led him to develop an antibody that blocks an "off switch" on those cells, unleashing an immune response against cancer.
Drugs using this approach, called immune checkpoint blockade, now are approved for treating late-stage melanoma and lung cancer. Hundreds of clinical trials worldwide are underway in earlier stages of the disease and against other cancers.
Founded in 1942, the Lasker Foundation seeks to improve health by accelerating support for medical research through recognition of scientific excellence, public education and advocacy.
Mary Lasker, who led the foundation for decades, was a prominent activist for public investment in medical research and is widely credited with motivating Congress and several presidents to expand federal funding, particularly through the National Institutes of Health.
"It is a rare medical scientist who makes a fundamental discovery and then propels that discovery all the way to a clinical breakthrough. That is what Jim Allison has done, and that is why he is receiving the 2015 Lasker Clinical Medical Research Award," said Nobel Laureate J. Michael Bishop, Ph.D., of the University of California, San Francisco, while presenting the award at a ceremony in New York.
The first drug developed from Allison's research became the first treatment ever shown to extend the survival of patients with late-stage, untreatable melanoma. Long-term studies show 20% of such patients treated with ipilimumab, marketed as Yervoy, survive for at least 10 years, previously unheard of results for the disease.
"The Lasker Award highlights Jim's genius, creativity and passion to make an impact, all of which contributed to one of the most important therapeutic advances in a generation. One that continues to change the practice of oncology around the world," says MD Anderson President Ronald DePinho, M.D. "As we explore the full potential of immunotherapy, countless cancer patients already have experienced renewed promise and health, thanks to this groundbreaking advance, and we remain hopeful for so much more."
After an early career posting at MD Anderson, Allison returned in 2012 to lead its immunology department and establish the cancer immunotherapy platform, a combination of expertise and infrastructure that brings together scientists and clinicians to better understand and advance cancer immunotherapy.
The platform is part of MD Anderson's Moon Shots Program, which is designed to harness scientific knowledge and develop new technologies that will dramatically reduce cancer deaths through prevention, early detection and treatment.
"Jim once described his motivation as 'the selfish desire to be the first person on the planet to know something,'" Bishop said. "He has satisfied that desire in spades and, as a result, the planet promises to become a far better place for cancer patients. Bravo, Jim!"
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MD Anderson has appointed former U.S. Public Health Service four-star Admiral Joxel Garcia, M.D., as the inaugural executive director of the cancer prevention and control platform, part of MD Anderson's Moon Shots Program.
By Clayton Boldt, Ph.D.
"I'm honored to join the No. 1 cancer center in the nation," says Garcia.
"It's truly exciting to join the MD Anderson family and work with world-class leaders, researchers and clinicians."
The cancer prevention and control platform implements and disseminates evidence-based, community-focused programs to advance cancer prevention, screening, early detection and survivorship.
"Dr. Garcia is an internationally recognized health care leader with proven experience and success in a variety of health care settings," says Giulio Draetta, M.D., Ph.D., professor of Genomic Medicine and Molecular and Cellular Oncology and co-leader of the Moon Shots Program. "We're excited to have someone of his caliber on board and know he will contribute a great deal to the platform and the program overall."
The platform focuses on providing policy, education and services to achieve a measurable and sustainable reduction in the cancer burden, especially in the underserved population, for which cancer and cancer risk factors pose a particular threat. This effort is taking what's known about diet, exercise, sun protection, tobacco avoidance and human papillomavirus (HPV) beyond MD Anderson to reach people throughout Texas, the nation and the world.
Garcia began his medical career as an obstetrician/gynecologist and then became the commissioner for the State of Connecticut Department of Public Health. After serving as the deputy director for the Pan American Health Organization/World Health Organization in Washington, D.C., he moved into the corporate sector. There he worked as a senior vice president and senior medical officer at Maximus Federal Services Inc.
President George W. Bush appointed Garcia as the 13th U.S. assistant secretary for health. At the same time, he was appointed as a four-star Admiral for the United States Public Health Service and as the U.S. Representative to the World Health Organization. During this time, and as the highest ranking medical and public health official in the U.S., Garcia led more than 6,220 U.S. Public Service Commissioned Corps officers in the U.S. and in 88 countries for the protection, promotion and advancement of health.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
In a first-of-its-kind study, researchers at MD Anderson have demonstrated a benefit in overall survival among epithelial ovarian cancer (EOC) patients receiving generic heart medications known as beta-blockers.
Survival was shown to be greatest among those prescribed first-generation nonselective beta-blockers. According to investigators, the drugs block the effects of stress pathways involved in tumor growth and spread. With further research, they may also prove beneficial in conjunction with other treatment regimens and across other cancer types.
This study builds on a large body of research by principal investigator Anil Sood, M.D., professor of Gynecologic Medical Oncology and Cancer Biology at
MD Anderson. It shows that stress hormones fuel progression of ovarian and other cancers, and beta-blockers — among the most proven drugs in cardiovascular medicine — might be a new way to stifle that effect.
"Beta-blockers treat a variety of conditions, such as heart disease, high-blood pressure, glaucoma and migraines. They target a receptor protein in heart muscle that causes the heart to beat harder and faster when activated by stress hormones," Sood says. "Our research has shown that the same stress mechanisms impact ovarian cancer progression, so these drugs could play a new role in cancer treatment."
Published in the journal CANCER, the findings are the result of a multi-institutional retrospective analysis of the medical records of 1,425 women with ovarian cancer treated
between 2000 and 2010.
Researchers compared overall survival among patients with documented beta-blocker use during chemo and those without.
Among the 269 patients who received beta-blockers, 193 (71.7%) received SBBs and the remaining patients received NSBBs. The research team found:
For patients receiving any beta-blocker, the median overall survival was 47.8 months versus 42 months for nonusers.
Median overall survival based on betablocker receptor selectivity was 94.9 months for those receiving NSBBs versus 38 months for those receiving SBBs.
Even among patients with hypertension, a longer median overall survival was observed among users of NSBBs compared with nonusers (90 months versus 38.2 months).
According to Sood, the usefulness of beta-blockers was unclear until now. "The ability to show improved survival using nonselective agents, which inhibit a specific stress pathway, is the culmination of years of research into ovarian cancer biology and pathogenesis."
Although further study is needed, Sood says these results highlight the importance of the beta-2 adrenergic receptor, a signaling pathway important to ovarian carcinogenesis and targeted by nonselective beta antagonists (NSBBs) versus the beta-1 adrenergic receptor pathway targeted by selective agents (SBBs).
Sood talked to Cancer Frontline about the new findings, how they relate to his earlier research and what this new discovery means for patients.
Your earlier research has shown that stress hormones fuel progression of ovarian and other cancers, and beta-blockers might be a way to slow or stop that. How does this study build on that research?
In the present study, we examined whether the type of beta-blocker matters with regard to clinical outcomes. Consistent with the previous research from our group and others, broad (nonselective beta antagonists) beta-blockers were associated with better clinical outcomes.
How does stress affect tumor growth?
Chronic stress and related hormones — the so-called fight-or-flight hormones — can stimulate tumor growth via beta adrenergic receptors, which are key to ovarian carcinogenesis and targeted by NSBBs.
What would you tell ovarian cancer patients who ask about taking beta-blockers? Is it too soon to recommend ovarian cancer patients take beta blockers?
It's too soon to prescribe beta-blockers for routine use, but feasibility studies are ongoing.
What other cancer types could this potentially benefit?
Other cancers that express beta-adrenergic receptors could also be relevant here. Those include colon, breast and other cancers.
Where does your research go from here?
Clinically, we're carrying out prospective feasibility studies at present. Following these studies, we would like to conduct others to understand the effects of these drugs on specific biomarkers before starting larger-scale studies. Preclinically, there's still a lot to understand. For example, we're looking at the role of nerves that deliver the stress hormones to the tumor. We want to determine what role the nervous system plays in the spread of cancer.
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By Clayton Boldt, Ph.D.
For the first time, a new drug from the field of immuno-oncology has proven to extend survival for patients with advanced kidney cancer, a patient population with limited treatment options.
In an MD Anderson study, patients taking nivolumab, marketed as Opdivo, had a median survival of 25 months — 5.4 months longer than patients given the drug everolimus, the current standard of care for patients with metastatic kidney cancer.
Opdivo is an immune checkpoint inhibitor — a drug that takes the brakes off the immune system and allows it to attack cancer. It's currently used to treat metastatic melanoma and advanced non-small cell lung cancer. Scientists have long believed that immunotherapy had the potential to make an impact in kidney cancer.
"Until now, we haven't been able to demonstrate such a significant survival benefit in patients with advanced kidney cancer. We have a real opportunity to change clinical practice for these patients when other therapies have failed," says principal investigator Padmanee Sharma, M.D., Ph.D., professor of Genitourinary Medical Oncology and Immunology.
The findings of the trial provide definitive evidence that an immune checkpoint inhibitor is a valid treatment strategy for patients with advanced kidney cancer, and supports a change in the standard-of-care treatment, Sharma says.
In addition to demonstrating increased overall survival, the trial showed that the number of patients who responded to nivolumab was higher than those treated with everolimus.
Of the 821 patients enrolled, 25% responded to nivolumab versus 5% of those treated with everolimus. Among these patients, partial responses were observed in 24% of those treated with nivolumab and 5% of patients treated with everolimus; complete responses were observed in 1% (four patients) treated with nivolumab and fewer than 1% (two patients) treated with everolimus.
Further, among patients who showed a response, the impact was "durable," according to Sharma. For some patients, even after treatment with nivolumab ended, response to the drug continued.
"The immune system has a memory, so even when treatment has stopped, the body continues to exhibit a long-term response — meaning these patients can live normal lives without progressive disease," says Sharma.
Finally, the investigators observed fewer treatment-related adverse events, including fatigue and nausea, and improved quality of life, with nivolumab.
These results were so significant that the trial was halted early and the FDA granted "breakthrough therapy designation" to nivolumab, meaning the FDA will expedite its review of the drug for use in patients with advanced kidney cancer.
Read about the latest progress in Making Cancer History® at Cancer Frontline.
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MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Laura Sussman
A study presented at this year's American Society of Clinical Oncology conference found that, contrary to prior belief, attacking tumors by radiating the whole brain harms patients' thinking, memory and speech, and does not improve their survival.
"Our study shows that the negative effects of whole-brain radiation far outweigh the positive," says study author Paul Brown, M.D., professor of Radiation Oncology at MD Anderson.
Conventionally, cancer that spreads to the brain is treated with radiosurgery — ultra-focused beams of radiation aimed at the tumor with millimeter precision, followed by whole-brain radiation to reduce the likelihood of future tumors cropping up.
Radiosurgery usually involves a one-time-only, highly focused treatment with a tool such as a Gamma Knife. Whole-brain radiation therapy, on the other hand, exposes the entire brain to 20-minute doses of less-intense radiation once a day for 10 to 15 days.
At MD Anderson, Brown led a study of 213 patients with one to three brain tumors to determine whether the risks of whole-brain radiation are worth its benefits for controlling cancer. Half the patients had radiosurgery only, while the other half had radiosurgery followed by whole-brain radiation.
Three months later, almost all — 92% — of patients who received both treatments had cognitive decline, versus 64% of those who had radiosurgery only.
Patients who underwent whole-brain radiation also experienced significant declines in their quality of life compared with radiosurgery patients. Hair loss, skin redness, dry mouth, fatigue and thinking problems are typical side effects of whole-brain radiation, Brown says. Radiosurgery's side effects are minimal.
"Our study confirms that giving less treatment offers the best results for our patients with brain tumors that have spread from other locations," Brown says.
An estimated 400,000 patients in the U.S. each year have cancer that spreads to the brain, usually from the lungs, breasts or other sites. Brown predicts that, based on this study, doctors likely will begin recommending radiosurgery alone for many of these patients, combined with close monitoring. If patients develop new tumors, targeted radiation will zap the tumors as they occur, without ever resorting to whole-brain radiation.
"Whole-brain radiation will be reserved for patients whose cancer is more advanced," he says.
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MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Ron Gilmore
For years, scientists conducting lab experiments and clinical researchers doing patient studies had very little interaction with one another. But the National Cancer Institute (NCI) tore down these silos in 1992 when it created its Specialized Programs of Research Excellence, or SPOREs.
"The SPOREs' very purpose is to move new drugs and therapies to patients as promptly as possible by combining knowledge from laboratory and clinical researchers," says Robert Bast, M.D., vice president of Translational Research at MD Anderson. "The end goal is to improve survival and quality of life."
Initially, the NCI funded eight SPOREs to address three cancers. Today, the program has mushroomed to 42 SPOREs investigating 18 cancers in 21 states.
Among academic medical centers,
MD Anderson has had the highest number of SPORES in the nation with its eight programs in myeloma, leukemia, ovarian, uterine, bladder, brain, skin and prostate cancers. It shares two SPORES for lung and thyroid cancers with other institutions.
SPORES often mirror the goals of
MD Anderson's Moon Shots Program, Bast says, with both programs aiming to fast-track patient therapies.
At the heart of the SPORE program is a requirement to collaborate. "Collaboration can be among academic institutions, government organizations, industry, foundations or clinical trials groups," says Nancy Hubener, project director for Translational Research, the office that oversees MD Anderson's SPORE programs.
MD Anderson SPOREs have collaborations with the University of Colorado, Johns Hopkins University, the University of Pennsylvania, Texas A&M University's Health Science Center, the Mayo Clinic, and The University of Texas' Health Science Center in Houston and Southwestern Medical Center in Dallas.
"SPORE faculty share data because findings from one type of cancer may impact other cancers," says Bast, whose office awards $250,000 in pilot grants to support development of SPOREs and other projects enlisting four or more investigators.
Nationwide, SPOREs have generated revolutionary cancer solutions such as therapies for late-stage prostate cancer, novel drugs for multiple myeloma, new diagnostics for non-small cell lung cancer and detection methods for papillary thyroid cancer.
The federally funded Science and Technology Policy Institute, which advises the White House and the National Science Foundation on science and technology issues, reports that 93% of SPORE projects nationwide led to clinical trials or other studies.
"At MD Anderson and throughout the nation, SPORES will continue to be of paramount importance in the rapid and efficient movement of basic scientific findings into the clinical setting," says Bast.
Texas has 11 specialized programs of research excellence (spores) — more than any other state. and MD Anderson leads the nation with eight spores.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Clayton Boldt, Ph.D.
Loretta Preston kicked her cigarette addiction two years ago.
"Quitting wasn't easy," she says. "I'd smoked for 40 years."
Then, the unthinkable happened. Her beloved pit bull, Tip, who she'd raised from a puppy, was stolen in a carjacking.
"I thought my life was over," she says.
Unable to cope with the pain, the
MD Anderson patient and four-time cancer survivor started smoking again.
Breaking a tobacco addiction isn't easy. Quitting tobacco while dealing with the stress of battling cancer is twice as hard.
Tobacco is the single most preventable cause of cancer, and is responsible for more than 30% of all cancer-related deaths. Each year, smoking causes one of every five deaths in the United States.
In cancer patients, tobacco use can limit treatment effectiveness, complicate healing and lead to relapse or additional cancers.
"I decided I was tired and I didn't want to die," Preston says.
The program helped her stop smoking two years ago, and she would use it again to help her quit after losing Tip.
The Tobacco Treatment Program was established in 2006 to help all
MD Anderson patients who use tobacco to quit, free of charge. It's also open to patients' families as well as MD Anderson employees and their dependents.
All patients who list themselves as current smokers or recent quitters are automatically referred to the program.
"This is a radical shift from traditional programs that require patients to be referred by a physician," says Paul Cinciripini, Ph.D., the program's director.
The patient's journey begins with a phone call from a program staffer who discusses the benefits of tobacco cessation and gauges the patient's interest in participating in the program.
Some may be ready to kick the habit right away. Those who are more hesitant receive sustained support with regular follow-ups and phone calls.
"One way or another, we touch the lives of all these patients," says Cinciripini, who also is chair of Behavioral Science.
New patients first receive an in-person consultation, followed by six to eight counseling sessions, with medications given to ease withdrawal symptoms and help participants stick to the program. Those unable to participate in person may phone in.
"We do everything possible to help people quit smoking," says Maher Karam-Hage, M.D., the program's associate medical director. "That includes regular phone calls and aggressive medication management. We want to give every participant the best possible chance to quit."
"If you're willing to work, you can have success," says Preston. "They gave me the tools that I needed and a number to call to talk to someone if I wasn't feeling complete. They called, they checked on me, and they made sure I was OK."
Psychological support is key to the program's success. Medications ease cravings, but counselors teach patients how to cope with behavioral triggers that stimulate cravings.
"We leave patients with tools to use after their medications are completed," explains Karam-Hage, an addiction psychiatrist.
Some patients participate in clinical trials that help researchers identify new and improved interventions.
Since the program began, more than 6,400 patients have received in-person or phone-based counseling, with an average of eight follow-up appointments each. Almost 10,000 more have benefited from literature and other resources distributed through the program. All totaled, that's nearly 70,000 patient contacts in just over nine years.
Thirty-five to 46% of people remain tobacco-free nine months after treatment ends. Most others have cut their tobacco use by more than half.
"That's as good as, or better, than the best-reported outcomes from pivotal clinical trials in tobacco cessation," says Cinciripini.
Participants who are unsuccessful the first time are able to try again.
When Preston relapsed, she was welcomed back. After her second round, she's once again tobacco-free. And she has a new pit bull named Dallas.
She urges others never to give up hope.
"After smoking for almost 40 years, life is good. I have a new puppy, and I'm finally free from those nasty cigarettes."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Ron Gilmore
But they're among the local, national and international locations that MD Anderson patients call home.
Last year, patients traveled from more than 100 countries, 228 Texas counties, 49 states, Washington, D.C., and the U.S. Virgin Islands for the very best in cancer care. Whether it's Muleshoe, Memphis, North or South Korea, the institution's patients seek out the expertise of America's No. 1-ranked cancer center.
Just ask Eileen Sullivan, who's been coming to MD Anderson for four years. Originally diagnosed with chronic myeloid leukemia in her hometown, the 91-year-old Huntsville, Alabama, native was referred to MD Anderson in 2011 when her cancer progressed.
Houston and the often overwhelming city-within-a-city that is the Texas Medical Center were an immediate challenge for Sullivan and her caretaker, Amy Shadoin, who is also her daughter.
"We contacted Patient Travel Services and they made everything seamless," says Shadoin. "It was such a blessing because there are so many moving parts at
MD Anderson."
Shadoin marvels at how her patient travel representative, William Perla, immediately recognizes her voice over the phone.
"He doesn't even have to ask who it is," she says. "He knows my voice. I've also heard his co-workers ask how people's grandbabies are doing. They're that familiar with their patients."
That level of familiarity was a comfort to Sullivan during the past three years when she was enrolled in a clinical trial. With that completed, she now returns every three months for regular follow-ups.
Patient Travel Services is just one of the offices available to help patients during a stressful transition. Gwen Hurst, a program manager in Finance, Accounts Payable and Travel, understands how scary things can be for patients when their chief concern is their health, not how they'll get to Houston or where they'll stay.
"We have two full-time travel agents who help patients find lodging, offer recommendations for things to do, work with airlines to waive fare-change fees for patients whose schedules are unpredictable, and provide other services," Hurst says. "We help patients better understand the scope of just how big MD Anderson is. And, in general, we're just there for them throughout their visits."
Other offices, such as the International Center and Social Work, also provide assistance to patients traveling to Houston for care.
Coming to MD Anderson can be daunting for patients traveling from other states or small Texas towns. For international visitors, it is can be downright mind-boggling. Not only are they adjusting to a new geographical location, they are immediately immersed in an unfamiliar culture.
Enter the International Center, which offers a menu of services, including helping patients obtain their first appointment, pre-arrival preparation, visa and other arrangements, airport and transportation needs, referrals to banking and business services, lodging, financial inquiries, religious and dining queries, and more.
Martha Coleman, who has been a nurse manager at the International Center for nearly a decade, knows exactly what drives patients to travel thousands of miles to MD Anderson.
"It's simple. They want to go to the best," she says. "They hear about us through word-of-mouth from other family members and friends and from our global reputation."
Coleman describes how one Lebanese patient even wrote a book about her positive experiences when being treated for breast cancer here.
"She was instrumental in getting the word out and helping other women talk about breast cancer, something not so common in the Middle East," says Coleman.
Last year, MD Anderson welcomed more than 1,200 international patients from across the world. The "top 10" are United Arab Emirates, Saudi Arabia, People's Republic of China, Qatar, Mexico, Kuwait, Ecuador, Canada, Peru and Venezuela.
"We're seeing a surge in patients coming from India, however," says Coleman. "And recently we've had inquiries from Cuba."
Xiaobing Ding, an electrical engineer from Guangzhou, China, has experienced firsthand the International Center's services. Diagnosed in China with lung cancer, he and his wife, Ping Wang, came to Houston after researching top cancer hospitals.
"I was diagnosed this February with an advanced metastasis in the adrenal gland and was given two cycles of chemotherapy in China," says Ding. "But when we came to MD Anderson in April, my physician confirmed that the cancer was not metastatic."
Ding has received treatment at MD Anderson and has been impressed with International Center staff such as Meiling Zhuang, an international patient assistant who also served as Ding's translator. Neither he nor his wife speaks English.
"The International Center has helped smooth things over with paperwork, physician referrals, airport logistics, assistance with wheelchairs, and, of course, translation. They even recommended a good place to get barbecue."
— Xiaobing Ding, a patient from Guangzhou, China
Patients often find help through representatives from the MD Anderson Physicians Network®, a multidisciplinary network of providers offering MD Anderson-branded oncology services to local hospitals in the U.S.
Janice Kitchens, a department manager with the Physicians Network, says patients arrive at MD Anderson for many reasons.
"They may want a second opinion or be participating in a clinical trial, or their physician may refer them because they aren't able to offer the subspecialty care required," she says. "For example, we get referrals for proton therapy because it's not widely available."
Robert McAlister, 76, a rancher who drove to MD Anderson from Hico, Texas, feels he was fortunate to have met the Physicians Network's Patricia Moore.
"I came to Anderson after I had been feeling sick," he says. "My doctor ran some tests and after a biopsy, said I had prostate cancer. I sought a second opinion at MD Anderson."
Shortly after arriving from his 450-acre ranch in Central Texas, McAlister was contacted by Moore, who he says "quarterbacked everything."
"She was just outstanding and I felt we were kindred spirits," says McAlister. "I came to look at Patricia as my 'go-to' person for trouble spots."
With Moore's help, McAlister was quickly referred to MD Anderson's Brian Chapin, M.D., assistant professor of Urology.
"He just sat down and started talking with me with no laptop, no notebook," McAlister says. "He said I didn't need surgery and that the cancer was not aggressive. He recommended a biopsy in six months and put me on a 'watch' program."
Moore, who has been at MD Anderson for 18 years, was glad she could help McAlister.
"We're often able to help patients cut through a lot of things," she says. "The processes can be cumbersome and we establish a relationship with patient access specialists in each clinic area so we can help them more efficiently."
While patients often develop close day-to-day relationships with the MD Anderson staff who help them while they're here, it's often a mutual benefit.
"These patients become like our family members," Moore says. "We watch over them nonstop."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Jacqueline Mason
A cadre of elite surgeons is making a mark as pioneering researchers at
MD Anderson. In the operating room, they're not just excising tumors, they're testing innovative therapies to stop cancer in its tracks.
The surgeons you're about to meet have dedicated their careers to curing and preventing cancer, often through less-invasive procedures. Curiosity spurs their motivation: Can doing less to patients — or something dramatically different — allow doctors to manage their disease and return them to a reasonable quality of life?
To get answers, their patients have enrolled in clinical trials that unfold in the operating room and are often over in just minutes or hours.
Neil Gross, M.D., associate professor of Head and Neck Surgery, wants to know how well patients regain normal function after treatment for cancers affecting the back of the throat, the base of the tongue or the tonsils — an area known as the oropharynx. He's comparing patients who had surgery to those who had radiation.
It's an especially timely question, because these cancers, called oropharyngeal cancers, are up 225% since the late 1980s. Researchers associate this rise with the spread of the human papillomavirus (HPV) — the most common sexually transmitted virus in the United States.
Radiation and chemotherapy traditionally have been used to treat oral cancers, and patients' prognoses are generally good, Gross says. But long-term side effects of radiation include scarring, tightness in the throat, trouble swallowing and loss of saliva.
Before 2009, surgery wasn't a commonly used option because it meant splitting the jaw to access the cancer. That's when the Food and Drug Administration approved the use of robotic surgery for head and neck cancers.
Gross became one of the first surgeons to perform the less-invasive surgery.
In his latest study, Gross is collecting data from patients who've undergone either robotic surgery or radiation to treat early-stage oropharyngeal cancer. Participants wear a Fitbit-style band that tracks their daily activity and provides Gross with a better understanding of the impact various treatments have on patients' quality of life.
"Operative robotic technology has improved. So now we can access these areas surgically that we couldn't access very well before," he says. "My hope is to offer patients as many options as possible and then help them choose the best treatment."
Women who have advanced or difficult-to-treat cancer in the lining of the uterus face the dangerous risk of the cancer spreading from the uterus to the lymph system in the pelvic and abdominal area.
To determine if this has happened, doctors typically remove all the lymph nodes in that region at the time of initial staging surgery. However, the surgery can cause complications for women who are obese, and for those who have diabetes or high blood pressure.
Pamela Soliman, M.D., associate professor of Gynecologic Oncology and Reproductive Medicine, is leading a study to pinpoint precisely which lymph nodes are the most likely to be invaded by cancer of the endometrium — the lining of the uterus.
In the operating room, participants undergo sentinel lymph node mapping followed by a full lymph node dissection, the current standard of care. Early findings suggest that in the future, surgeons may need to remove only patients' sentinel nodes — the first few lymph nodes into which a tumor drains — as opposed to all their lymph nodes in the affected region.
This shift away from complete lymph node removal has been proven when treating melanoma, breast cancer and vulva cancer, Soliman says.
"It's a little more challenging in endometrial cancer because the lymphatic drainage in the uterus appears to be multi-channeled. It doesn't follow one pattern," she says. "But, at least so far, we've had a good accuracy rate."
For some patients of Frederick Lang, M.D., getting a virus is just what they need.
The Neurosurgery professor is working to wipe out brain tumors using an active and highly virulent adenovirus — the kind that causes the common cold.
"We go to the operating room and inject the virus into the tumor for 10-15 minutes," says Lang. "The patient theoretically doesn't have to do anything more. There's no chemotherapy after it."
The virus has been engineered to multiply and attack cancer cells while leaving healthy cells alone. In some patients, it even alerts the immune system to fight the tumor, a concept called antigen spread.
In a recent clinical study, the virus — combined with antigen spread — completely eliminated glioblastomas in three of Lang's patients. Although the tumors later returned, the patients lived three to four years longer than what's typical. Other patients in the study lived an average of nine months longer.
For Lang, the question now becomes: How do we create antigen spread in everyone?
Juan Fueyo-Margareto, M.D., professor of Neuro-Oncology, and Candelaria Gomez-Manzano, M.D., associate professor of Neuro-Oncology, may have the answer.
The duo created the amped-up adenovirus used in Lang's clinical trials. Now, they're using discoveries by James Allison, Ph.D., chair of Immunology, to further modify the virus to prompt an immune response.
"If we can make the virus activate the immune system the way we want, then we've got the solution all packaged in the virus," Lang says.
For more on this approach, see "Unleashing the cold virus to kill cancer".
Kelly Hunt, M.D., ad interim chair of Breast Surgical Oncology, envisions a future where some breast cancer patients avoid surgery altogether.
"That's where the field is going," she says, pointing out the evolution from pre-1970s radical mastectomies to today's breast-conserving therapies.
Hunt helped lead a study that confirmed women with early-stage breast cancer don't need to undergo aggressive lymph node removal to stop the cancer's spread. The study led to a new standard of care for breast cancer patients worldwide.
"We're now starting to look at the same paradigm in women with more advanced breast cancers," Hunt says.
Along with physician researchers like Henry Kuerer, M.D., Ph.D., and Abigail Caudle, M.D., in her department, Hunt is offering candidate patients who have advanced breast cancer the option of removing fewer lymph nodes.
"Because the standard treatment has been performed for so many years, it's hard for physicians and patients to accept that you're going to take something away and do something less radical and still get the same outcomes," Hunt says. "That's why trials are needed to prove this had to be done."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Ronda Wendler
Medically speaking, Phil Baumann shouldn't be alive.
Four years ago, at age 47, he was diagnosed with a fast-growing and incurable form of brain cancer called glioblastoma.
I'd been having some pretty bad headaches," says Baumann, now 51. "Then one night, I had the worst headache of my life."
The pain convinced the usually stoic paint-and-body shop owner to seek care at a freestanding emergency center, where doctors ordered a CT scan.
Phil's wife, Misty, remembers what happened next "like it was yesterday."
"The doctor showed us Phil's scan. It revealed a tangerine-sized mass on the right side of his brain."
Baumann sought treatment at MD Anderson where surgeons removed the tumor and doctors prescribed aggressive radiation and chemotherapy. As predicted, in six months the tumor came roaring back.
"You can't escape glioblastoma," Baumann says. "My doctors warned me it would return, and it did. It's scary stuff."
Glioblastomas, or malignant gliomas, are sometimes called "grow-and-go" tumors. They make their own blood supply, which fuels the tumors' rapid growth and helps them hatch satellite tumors. Each tumor sends out tentacles that infiltrate and dig deep into normal brain tissue.
"My doctor told me a glioblastoma is like a weed that keeps sprouting runners or tendrils," Baumann says.
Without treatment, a glioblastoma tumor doubles in size every two to three weeks.
Neurosurgeons may seemingly remove the entire tumor, but hidden cancer cells remain seeded in the brain and, inevitably, the tumor comes back.
When glioblastoma returns, time is short. Even with treatment, survival time following diagnosis is 14 months. Baumann was faced with those dismal odds and worried he'd become one of the 12,000 Americans who die from the disease each year. The brain cancer has been named a target of the Moon Shots Program (see "Moon shots mission escalates to confront six more cancer types").
Worry turned to hope when he was offered the opportunity to enroll in an
MD Anderson clinical trial that uses the common cold virus to battle glioblastoma.
"This was my last chance, so I jumped at it," he says. "It's an aggressive tumor, so I wanted an aggressive therapy."
The experimental therapy is the brainchild of husband-and-wife researchers Juan Fueyo, M.D., and Candelaria Gomez-Manzano, M.D., who have been laboring over what they call their "big idea" for 15 years.
Working in a secured laboratory at MD Anderson, they found a way to genetically modify the adenovirus that causes the common cold, transforming it instead into a cancer-seeking missile that attacks brain tumors.
"We could have experimented with any virus," Fueyo says, "but we chose the cold virus because it doesn't need to be re-engineered much to make it safe for patients, yet it's effective against cancer."
The altered virus is injected through a hole in the skull, directly into the patient's tumor. It's the first time the cold virus has been used in this way.
Some called the couple medical explorers. Others called them crazy.
"At first, everybody had doubts," says Fueyo, research director in MD Anderson's Brain Tumor Program. "They didn't understand the concept and they thought it was dangerous. We're talking about a live virus, injected into patients in enormous doses."
Gomez-Manzano remembers being unable to sleep the night the first patient was injected.
"I was so apprehensive," she recalls, "and very relieved to learn the next morning that the patient suffered zero side effects."
Fueyo and Gomez-Manzano named their virus Delta 24 — a moniker shared with a type of submarine that seeks out targets and blasts them with ballistic missiles.
"Our virus behaves similarly," Fueyo says. "It's engineered to be safe for cancer patients by targeting proteins that exist only in cancer cells, while leaving healthy tissue alone."
When the virus detects a cancer cell, it enters the cell and begins making copies of itself nonstop. The malignant cell fills with viral particles, then explodes. With each explosion, the Delta 24 viral particles burst forth and move forward in a wave-like motion to infect other cancer cells. This continues until all tumor cells have burst.
If a patient's cancer comes back, as glioblastoma almost always does, Delta 24 continues to recognize and attack it.
"We're almost creating a vaccine inside the brain, specifically against the tumor," says Frederick Lang, M.D., a professor of Neurosurgery at MD Anderson who helped move the therapy beyond the lab and into clinical trials for patients.
Virus-based cancer treatments, sometimes referred to as "virotherapy," are generating a tremendous amount of excitement in the oncology world, says Lang, who also is director of clinical research in MD Anderson's Neurosurgery department.
"All human cancers develop a protective shield that makes them invisible to the immune system," Lang explains. "Viruses deactivate this shield in a very sneaky way."
By infecting a tumor with the Delta 24 cold virus, the immune system is tricked into thinking, "there's a common cold here, let's go kill it." Immune cells rush to the tumor and unleash an all-out attack against the cold virus. The tumor, caught up in this "war," becomes "collateral damage" as it is destroyed in the same attack.
Delta 24, working with the immune system, delivers a one-two punch to knock out cancer cells.
"Cancer can be wily because it does everything possible to dodge destruction," Lang says. "But viruses are equally tricky in their mission to invade cells and propagate."
Six weeks after Baumann was injected with Delta 24 — and against all odds — his brain scan showed his tumor stopped growing. Eventually the tumor vanished and Baumann remained cancer free for four years — until this fall when the tumor reappeared.
Doctors are discussing the next steps for Baumann, who Lang says has made history by living cancer free longer than any other participant in the trial.
"I'm extremely blessed that I've been given extra time to be a husband to Misty and a father to our 12-year-old son, Colby," Baumann says.
Like Baumann, two of the other 25 patients enrolled in the trial to test Delta 24's effectiveness also saw their tumors vanish, though both relapsed, and one has died.
Half the remaining patients experienced what doctors call a "partial response." Their tumors shrank but didn't disappear, and they lived longer than expected. The other half simply didn't respond to the virus. Overall, the trial's results are medically significant, says Lang. "To have these kinds of results in an early-stage trial — where half of patients exceeded life expectancy, and three saw their tumors vanish — is beyond all expectations.
Lang shared the trial's initial results at the Society for Neuro-Oncology's annual meeting this past November, where he said we've reached "a turning point in cancer care."
To bring the therapy to more patients faster, and to make it even more effective, the Delta 24 virus is now being tested in combination with other drugs at several sites throughout the world. Studies testing new ways to deliver the virus are also in the works, Lang says.
One will use a new type of catheter that prevents Delta 24 from leaking out of the tumor — a problem of the current procedure — while another will use stem cells to deliver the virus.
"We'll load Delta 24 into stem cells, inject those stem cells through a puncture in the groin, and then those loaded stem cells will snake their way upward through the network of veins and arteries until they home in on the tumor," Lang explains. "Instead of injecting the tumor in just one spot, we're painting the entire tumor with a cancer-fighting virus."
But the most intriguing challenge, Lang says, is to pinpoint what's unique about the immune systems of Baumann and the other two patients whose tumors disappeared after the virus was injected.
"Can we make patients who didn't respond look like the three who did? This is what we'll be working on."
To raise money for brain cancer research at MD Anderson, Phil and Misty Baumann, with help from family and friends, host an annual nonprofit event known as CureFest.
Held each spring at the Humble Civic Center, CureFest features a dozen live bands performing on two stages, a classic car exhibition, more than 75 vendor booths offering community services, retail items and handcrafted goods, and a live and silent auction. Favorite auction items in the past have included autographed memorabilia from NFL players such as Troy Aikman, exotic fishing trips, Texans tickets, and even a tricked-out golf cart custom-painted by Phil Baumann.
Children's activities include an inflatable moonwalk, face painting, an obstacle course, rock wall climbing and more.
Recently, the Baumanns expanded CureFest by adding fundraising golf and tennis tournaments, held separately throughout the year.
"Friends have asked, 'What can we do, what do you need?'" says Phil Baumann. "All I ask now is that you help us pay the hope forward to help other families in need of a cure."
Since launching in 2012, CureFest has raised more than $500,000 for brain cancer research at MD Anderson.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
MD Anderson's Moon Shots Program has expanded its targets, adding some of the most intractable cancers to its campaign to more rapidly convert scientific discoveries into life-saving advances.
The innovative program's transdisciplinary team-science approach and transformative professional platforms now pursue meaningful progress against B-cell lymphoma, glioblastoma (brain cancer), HPV associated cancers (caused by the human papilloma virus), high-risk multiple myeloma, colorectal and pancreatic cancers.
These join the original moon shots launched in 2013 to address breast/ovarian cancer, chronic lymphocytic leukemia, lung cancer, melanoma, myelodysplastic syndrome/acute myeloid leukemia and prostate cancer.
"Our multidisciplinary, goal-oriented moon shots programs, enabled by the deep expertise and advanced technology of our execution-oriented platforms, are poised to accelerate declines in mortality for some of the most common types of cancer," says MD Anderson President Ronald DePinho, M.D. "After the first two years, we're transitioning from the foundational phase to the results phase, and some moon shots already are making practice-changing advances in the clinic and in cancer prevention and control."
All 12 moon shots have planned or opened novel clinical trials of new immunotherapies, drugs that free the immune system to attack tumors, as well as targeted therapies and drug combinations.
In the longer term, collaboration with moon shots platforms and basic scientists will heighten understanding of the molecular details of cancers, treatments and how the two interact. Ten platforms provide expertise and technology in the areas of cancer prevention and control, drug development, and big data-driven patient care and research. Many moon shots include prevention and early detection projects.
The six new moon shots began life as pilot projects that were chosen by external reviewers during the summer of 2014 from among 14 proposals. Leaders received initial funding to plan and develop their ideas a year ago.
Both pilots and inaugural moon shots were again peer-reviewed this summer by the program's external Scientific Advisory Board, which scored all 12 based on criteria that included potential to measurably reduce cancer mortality, breadth and depth of multidisciplinary teams and quality of scientific plans. The board's feedback helped mold priorities and funding for fiscal year 2016.
Leaders: Michael Wang, M.D., professor of Lymphoma/Myeloma and Richard Champlin, M.D., professor and chair of Stem Cell Transplantation and Cellular Therapy About 80,000 new cases of this group of blood cancers are diagnosed annually.
The cure rate is 30%. This moon shot will focus on overcoming resistant disease by developing new predictive tools, finding new targets for therapy and using new immunotherapy drugs, targeted therapies and engineered immune system T cells to attack these lymphomas.
Leaders: Scott Kopetz, M.D., Ph.D., associate professor of GI Medical Oncology; Stanley Hamilton, M.D., division head of Pathology and Laboratory Medicine; and Ernest Hawk, M.D., vice president and head of Cancer Prevention and Population Sciences
This cancer is the second-leading cause of U.S. cancer-related deaths — 49,700 in 2015. Projects focus on improving early detection and prevention as well as testing personalized treatment with immunotherapies before surgery. Another program builds on leadership by MD Anderson investigators to classify colorectal cancers by subtype based on integrated molecular and genomic analysis to improve targeted treatment.
Leaders: Robert Wolff, M.D., chair ad interim of GI Medical Oncology; Jason Fleming, M.D., professor of Surgical Oncology; and Anirban Maitra, M.B.B.S., professor of Pathology
An estimated 49,000 people receive a pancreatic cancer diagnosis each year, and only about 6% of patients survive five years. This moon shot focuses on early detection methods, development of predictive biomarkers to guide presurgical targeted therapy and testing of new immune T cell-based therapies.
Leaders: Robert Orlowski, M.D., Ph.D., professor of Lymphoma/Myeloma; Donald Berry, Ph.D., professor of Biostatistics; and Richard Eric Davis, M.D., associate professor of Lymphoma/Myeloma Patients with high-risk disease make up about 20% of the estimated 27,000 people expected to receive a diagnosis in 2015.
While new drug combinations and blood stem-cell transplants have improved survival for patients, prospects for those with high-risk disease have lagged. This moon shot will work to develop risk-prediction models and immunotherapeutic approaches to hit high-risk disease at earlier stages and to treat advanced disease.
Leaders: Amy Heimberger, M.D., professor of Neurosurgery; Frederick Lang, M.D., professor of Neurosurgery; and John de Groot, M.D., associate professor of Neuro- Oncology
Of the 15,000 people who receive a diagnosis of this most lethal brain cancer, only 5-10% survive to five years.This moon shot will examine existing and experimental immunotherapy drugs and customized T cells designed to attack specific targets. Other projects include further development of an engineered, cancer-killing virus (see page 20) and identification of new targeted therapies.
Leaders: Erich Sturgis, M.D., professor of Head and Neck Surgery; Bonnie Glisson, M.D., professor of Thoracic/Head & Neck Medical Oncology; Lois Ramondetta, M.D., professor of Gynecologic Oncology and Reproductive Medicine; Cathy Eng, M.D., professor of GI Medical Oncology; and Kathleen Schmeler, M.D., associate professor of Gynecologic Oncology and Reproductive Medicine
An estimated 17,500 women and 9,300 men yearly develop a cancer caused by this sexually transmitted virus. One moon shot goal is to boost HPV adolescent vaccination rates to 80% to prevent cervical, throat, anal and other cancers. Other projects extend cervical cancer screening to women in medically underserved communities, seek to develop HPV-related cancer screening for men and aim to more fully characterize HPV-related tumors across multiple disease sites to develop targeted drugs and immunotherapies.
So far, the Moon Shots Program has received $290 million in private philanthropic commitments.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Ronda Wendler
When Bill Baun finished the 15 rounds of radiation needed to treat his prostate cancer this summer, the mood was celebratory. Onlookers applauded and cheered as he rang the brass bell in MD Anderson's Radiation Oncology Department — a longstanding tradition that signals the end of treatment.
But in some ways, the most challenging part of the cancer experience begins when treatment is done.
"Cancer changes everything in your life," says Baun, who's not only a patient but also a wellness consultant at MD Anderson. His role is to help patients cope with their diagnoses and live life as fully as possible.
"Some patients have a simple diagnosis, sail through treatment and return to their everyday lives. But for most of us, cancer is a game changer that impacts every aspect of who we are and who we'll become during and after our cancer journey."
— Bill Baun, prostate cancer survivor
During treatment, patients are surrounded by the world's best army of cancer fighters. Brilliant medical professionals and supportive family and friends work tirelessly to help them heal.
"But when treatment ends, the constant flood of doctors' appointments, medical tests and phone calls from concerned family and friends dwindles to a slow trickle," Baun says. "Patients who are done with cancer care sometimes feel a void and struggle to figure out who they are."
A growing body of evidence suggests that cancer patients continue to wrestle with medical, financial and psychological issues long after treatment ends. For some, the experience is transformative and provides a renewed sense of purpose and appreciation for life. But many who try to rebuild their lives after something as devastating as cancer find the experience to be deeply disorienting and destabilizing, says Baun, who likens the experience to post-traumatic shock.
"You may no longer be sick, but you're not well," he says. "You need help navigating the road back."
One of the first medical professionals to recognize this unmet need was Fitzhugh Mullan, M.D., a pediatrician who helped form the National Coalition for Cancer Survivorship advocacy group in the 1980s. Having survived cancer himself, Mullan recognized that the unmet physical, emotional and psychosocial needs of survivors needed to be addressed by the cancer community.
In an essay in the New England Journal of Medicine, he shared his own cancer experience and wrote "survivorship begins from the moment of diagnosis — because that is when cancer patients must first confront their mortality — and lasts for the rest of a patient's life."
Mullan described what it's like for patients to pass through "the three seasons of survival": diagnosis and treatment, watchful waiting after treatment ends while hoping cancer doesn't return, and permanent survival. The latter being a nebulous term that generally describes those who are cancer-free five years after diagnosis.
Since then, the definition of survivorship has expanded to include those living long-term with cancer with the help of new treatments that keep tumors at bay, and those who have cancer that goes away and comes back, sometimes more than once.
"A number of patients at MD Anderson fall into those categories," says Paula Lewis-Patterson, D.N.P., executive director of Cancer Survivorship at
MD Anderson.
Like many new concepts in medicine, Mullan's survivorship movement was slow to gain acceptance. Numerous studies were published over the years to prove its worth, and finally in 2006 the Institute of Medicine issued a report recommending that every cancer patient receive a plan that is individualized to his or her care at the end of treatment.
To promote survivorship, MD Anderson regularly offers conferences for health care professionals, funding for survivorship studies, and educational and recreational activities for patients and caregivers.
"An increasing number of cancer treatment centers have now begun offering post-treatment care and support groups for survivors," Lewis-Patterson says. "But many patients, especially in rural areas, continue to fall through the cracks."
MD Anderson patients who show no evidence of cancer are monitored in 12 survivorship clinics, each one specializing in a particular type of the disease. Nurse practitioners manage the clinics and check for recurrence of cancer, lingering side effects or signs of psychological or emotional stress. When needed, patients are referred to physicians, nutritionists, social workers or psychologists.
The American Cancer Society estimates 14.5 million cancer survivors live in the U.S. today. With new treatments that extend lives, that number is expected to rise to 19 million by 2024.
"We have a responsibility," says Lewis-Patterson, "to step up our efforts and meet the needs of this rapidly growing population."
Cancer is a two-part journey, says Alma Rodriguez, M.D., vice president of Medical Affairs at MD Anderson.
"It's physical, it's emotional, and it's never over when treatment's over," says Rodriguez, who developed and oversees the cancer center's Survivorship Program.
On the physical side, chemo, radiation and other treatments can cause cardiac problems, reduced lung capacity, nerve damage, infertility, debilitating fatigue and a host of other problems years after treatment ends. The impact of these late effects, as they are called, can vary and depend on how old the patient was when diagnosed, frequency and dosage of chemo and radiation, parts of the body exposed, types of surgery performed and types of medication taken, as well as the severity of the cancer itself.
Depression may take over as survivors face life with a body image altered by surgery or ongoing physical limitations. Patients may struggle financially if they're too fatigued to hold down a steady job or if their coffers have been drained by costly out-of-pocket expenses not covered by insurance. Relationships with spouses may suffer if sexual function is lost. Survivors often blame themselves for these challenges and suffer crushing guilt.
"The good news is there are many ways to rally your resilience," says MaryBeth Baun, who, like her husband, Bill, is a cancer survivor and wellness coach. After treatment for stage 2 breast cancer, she was left with nerve and joint pain, "monster" hot flashes and chills, and foggy thinking and memory problems.
Months of physical and occupational therapy, faith and patience have helped Baun cope with her symptoms and regain function. It's also helped to have an understanding husband and a new puppy who adds joy to her days.
Perhaps the greatest concern shared by all survivors is the fear of relapse. When treatment ends, "the wait" begins. Patients whose cancer is in remission wait for the other shoe to drop, and worry that an ache or pain, or even a nagging cough, is a sign the cancer has returned.
In the wee hours of the night, some survivors lay awake, contemplating what they'll do if the cancer comes back. Bill Baun counsels his clients to transform that fear into energy-producing fuel.
"You know that trip you've been planning to take someday? Do it now. Live in the present. Start living your dreams."
Baun calls himself a cancer "thriver," not a cancer survivor.
"I'm much more aware of my mortality on a minute-by-minute basis than I ever was," he says. "Realizing your future may be foreshortened expands your present. There's a sense of preciousness of the moment. The sky is bluer, flowers smell sweeter, time with family is more cherished. I wake up each morning grateful for another day and mindful of the gifts I've been given."
Baun, like many survivors, is living with advanced cancer. Until the introduction of radiation therapy and chemotherapy, advanced cancer was a veritable death sentence. But new and innovative treatments in recent years have radically improved the outlook for many cancer patients, and fundamentally changed what it means and feels like to have the disease.
"In many cases, we've seen cancer turn from a deadly illness into something that patients live with and manage for many years," says Rodriguez.
Cancer for these patients is a chronic illness. They've far outlasted the prognosis they were handed years ago, and are living beyond limits. Their tumors are controlled, but not eliminated. Or, like Baun, whose cancer was diagnosed eight years ago, their tumors go through continuous cycles of remission and recurrence.
"There's a knack to living with the unknown," says Baun. "I think about how lucky I am to be alive instead of how unlucky I am to have cancer."
Patients with chronic cancer take pills to keep tumors at bay, and have monthly blood tests and imaging scans. This limbo state can be exhausting. Balancing treatment, job and family while living with uncertainty takes a toll.
Yet as researchers learn more about the character of people who are managing their disease for years or even decades, they're realizing that these long-term survivors are masters at balancing the negative aspects of cancer with the positive ones.
Some people, like Baun, actually flourish. Cancer changes their lives for the better. They get more out of life, and they relish every second.
In their ability to live fully in the present, people in cancer's limbo send a powerful message to people who are always focused on the imagined future.
"We're all terminal," says Baun. "No one lives forever. Starting my day with that thought helps me change my priorities and perspective. I have an intense appreciation for the here and now."
MD Anderson patients are provided with a Passport to Health — a master plan for the patient's care. The passport includes a history of the patient's disease; the treating physicians' names, addresses and phone numbers; a summary of all treatments received; potential late effects that might be caused by the cancer treatments; a schedule of screening tests to monitor for cancer recurrence; a list of lifestyle, behavioral and nutritional guidelines that may help prevent the cancer from returning; and referral to specialists for those patients experiencing physical or emotional problems due to the treatments they received.
"Patients are encouraged to share their passports with their primary care physicians," says Paula Lewis-Patterson. "This is especially important for patients who live in another city, state or even another country. Our MD Anderson doctors want to keep lines of communication open with patients' doctors back home. Our goal is to work together as a team to provide the best possible care."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Andy Olin
"God bless Jimmy Carter. Isn't he a trooper?"
Jan Wallace is referring to the former president's recent cancer diagnosis.
"I think he's an inspiration. He gives people hope, and his attitude is incredible. He just says, 'Whatever will be, will be,'" she says.
At 40 years, Jan Wallace is MD Anderson's longest-serving volunteer. She's put in close to 8,800 hours of time to make life easier for patients.
Her service predates Carter's presidency by two years. Gerald Ford was in office in January 1975 when Wallace and her best friend and former roommate from SMU decided they wanted to do something to make a difference.
"Forty years ago a lot of women didn't work outside the home. So we decided we wanted to do volunteer work. Something that was worthwhile," she says. "We decided we needed to help people with cancer. And cancer was so terrible. So, first week of January, we got in the car, drove down to MD Anderson and walked through the front — the old clinic entrance — and said, 'We want to volunteer.'
"They gave us two jackets and sent us upstairs to the information desk."
Back then the well-known blue jackets volunteers wear today were "real bright orange and white," a nod to The University of Texas.
Her first assignment? Making sure patients were the ones who got the available chairs in the waiting room.
"It would get really, really crowded in the waiting room. People were sitting on the floor … sitting outside," she says. "My friend, who stood nearly 6 feet tall, would go stand in the middle of the room and tell the crowd of patients and visitors, 'Everyone who's not a patient, get out of the chairs.'"
People listened.
Over the years, Wallace has worked in patient advocacy, the pharmacy, Camp AOK ("It's amazing, the spirit of the children. It's just an upper.") and, for the past six years, the third-floor information desk near Garage 10.
There she sees that patients coming into the Main Building find their way and does all she can to assist them. That includes just being there to chat or listen.
It may not sound like a lot, but, as Wallace will tell you, it is.
"Jan has been an inspiration to all volunteers!"
— Susan French,
associate vice president for Volunteer Services and Merchandising
"Years ago, somebody said to a friend of mine, 'What does Jan Wallace do besides put on a jacket and walk around and talk?'"
But she says talking to patients is one of the most important things volunteers do — it always has been. It's one of the few things that haven't changed about
MD Anderson in the past 40 years.
What are some differences?
A brief look at some of the differences four decades have made at MD Anderson, which, in 1975, was known as The University of Texas System Cancer Center:
One of the most beneficial changes for patients Wallace has seen over the years is the development of technology.
"The most wonderful thing that's happened, really, are all of these handheld gadgets," she says, referring to smart phones and tablets that provide much-needed diversion for patients during long waits. "They help people pass the time."
And, oftentimes, she says, they allow caregivers — a spouse or a friend — to work remotely so they can be at their loved ones' side.
"It lets them be together, which is so wonderful."
And what hasn't changed since 1975? She points to the kindness of the staff and the determination of the patients. She tears up a little thinking back through the years about so many of the wonderful people she's met.
"I so admire the people who work at MD Anderson every day. Their attitudes and kindness are incredible," she says. "I have been blessed to be able to volunteer here. It's been a blessing in my life. I've met so many wonderful people. It's a special place."
Something else that hasn't changed is the disease itself. "Cancer is mean. No two ways about it."
Wallace was never more aware of that fact than in 2013, when her youngest daughter died of lung cancer at age 50.
Devastated by the loss, Wallace found solace in her work at MD Anderson.
"When my daughter died, someone asked, 'How can you keep volunteering at
MD Anderson when you see so many suffering from that disease?' And I said, 'Well, it's the only way I have to fight cancer.'
"What else can I do?" she says. "But if I can help someone just a little bit, that's all I can do right now. I'm not a doctor. It's the last thing my daughter would want me to stop. Quitting isn't going to help anything."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
Filling out college or job applications is a normal part of life for most teens and young adults. But for cancer survivors wanting to start college or a career, it can be a daunting task.
"These patients may have conquered cancer, but now they face a whole new challenge," says Sandra Medina-George, vocational counselor at MD Anderson Children's Cancer Hospital. "Transitioning into college, trade schools or the workplace can be a difficult adjustment."
The Adolescent and Young Adult Career and Vocational Counseling Program, launched more than 20 years ago under the leadership of Martha Askins, Ph.D., associate professor of Pediatrics, helps patients move beyond cancer by connecting them with educational and career counseling.
"Treatment is much more advanced today, and children with cancer benefit from comprehensive behavioral, psychosocial support programs like this one," says Askins, who is also a clinical psychologist in Pediatrics.
Through the program, patients focus on pursuing higher education and transitioning into a job that fits their desired career path. As a vocational counselor in the program, Medina-George has helped many patients follow their dreams with the help of strategic roadmaps designed specifically for them.
Medina-George doesn't just guide patients through the college application process. She also finds schools that best fit each patient's needs, and provides resources to help them master college entrance exams and navigate the financial aid process.
"We guide patients to a career path or field of study that they are most likely to enjoy and in which they'll be successful," said Medina-George.
Julian Vasquez was diagnosed with acute lymphoblastic leukemia when he was 7. After receiving vocational counseling at MD Anderson, Vasquez, now 27, enrolled in the Bridge to Career Human Services Program at Texas A&M University. The two-semester program trains students who have developmental disabilities for careers helping others who are disabled.
"I have two passions," says Vasquez. "Making music that has a very positive message and giving back to the community that serves the rehabilitated. I'm grateful for the opportunity to pursue these goals."
Other services available through vocational counseling include transitioning patients into the workforce, teaching job-seeking skills and interview techniques, and critiquing résumés.
"Some cancers and even treatments may affect a patient's abilities to think or process information," says Askins. "This could be devastating to some patients who envisioned specific career paths that may no longer be realistic to pursue."
Askins says the assessment tools used in the program, such as the Myers-Briggs personality test that helps identify strengths, can help determine if the patient's desired career is in their best interest. The assessment tools and vocational counseling can also help guide patients who are unsure of what they want to do.
"The ability to see that there is quality of life after cancer is an important part of recovery for any patient," says Askins. "Our program gives patients the confidence to move beyond treatment and pursue normalcy in their lives."
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MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
MD Anderson researchers believe they may have found a way to detect pancreatic cancer at an early stage, before it has spread to other organs and becomes too difficult to treat.
By Ron Gilmore
Their study, which was published in the science journal Nature, shows a protein present on cancer exosomes was found in the blood of pancreatic cancer patients, but not in the blood of those who don't have the disease or who have chronic pancreatitis. The findings could lead to an accurate, noninvasive diagnostic and screening tool to detect the deadly cancer, which often is only diagnosed in the later stages after metastasis has occurred.
Close to 50,000 people are diagnosed with pancreatic cancer in the United States each year, and almost 41,000 deaths are caused by the disease annually. The average five-year survival rate is 7.2%.
Exosomes are tiny, virus-sized particles released by cancer cells and contain DNA, RNA and proteins. Scientists isolated and monitored the circulating exosomes (crExos) enriched with the glypican-1 (GPC1) protein — called GPC1+ crExos — from pancreatic cancer patients' blood.
"GPC1+ crExos were detected in small amounts of serum from about 250 pancreatic cancer patients with absolute specificity and sensitivity. It importantly distinguished patients with chronic pancreatitis from those with early- and late-stage pancreatic cancer," said Raghu Kalluri, M.D., Ph.D., chair of Cancer Biology.
The study also found that the levels of the exosomes were significantly lower in patients following surgery to remove the tumors. Circulating exosomes from healthy donors and breast and pancreatic cancer patients were examined, and elevated levels of the GPC1+ exosomes were seen in both cancers.
"GPC1+ crExos can be detected and isolated in blood samples that were stored in freezers almost 30 years ago, unlike circulating tumor cells, which require large amounts of fresh blood," said Kalluri. "DNA, RNA and proteins can be isolated from cancer exosomes taken from a stored specimen for further genetic and biological analyses. Therefore, cancer exosomes aren't just a biomarker. Isolating them provides a trove of cancer-specific information."
That information could be used to help physicians choose the best treatment for particular cancers, as well as show the effectiveness of treatments.
These markers appear to be a more reliable screening tool than the commonly used CA 19-9 biomarker, which results in many false negatives and false positives.
The study showed that the presence of GPC1+ exosomes predicted pancreatic cancer 100% of the time. And GPC1+ crExos detected the possibility of pancreatic cancer in mouse models of pancreatic cancer at a time when the mice showed no signs of pancreatic disease by MRI.
"Routine screening of the general population for pancreatic cancer using MRIs or CTs would be prohibitively expensive with the likelihood for many false positives," said David Piwnica-Worms, M.D., Ph.D., chair of Cancer Systems Imaging. "Our study suggests the potential for GPC1+ crExos as a detection and monitoring tool for pancreatic cancer combined with imaging, with an emphasis on its application in early detection."
If detected early, surgery involving a pancreatico-duodenectomy or the Whipple procedure can be a cure for pancreatic cancer patients. Since pancreatic cancer is often diagnosed after the disease has spread, only about 15% of patients qualify for the surgery.
"Studies comparing stage of disease with outcome following surgery suggest that death rates for pancreatic cancer would be reduced if the disease were diagnosed at an earlier stage," said Kalluri. "This presents an unprecedented opportunity for informative early detection of pancreatic cancer and in designing potential curative surgical options."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
MD Anderson has been ranked the No. 1 hospital for cancer care in the nation by U.S. News & World Report's "Best Hospitals" survey.
Since the annual survey launched in 1990, the institution has been named one of the top two cancer hospitals in the United States. It has ranked first 11 times in the past 14 years.
"We're honored by this tremendous national recognition, but the true measure of our success is the number of lives we've impacted with our care, research and support," said Ron DePinho, M.D., president of MD Anderson. "We owe our gratitude to the more than 20,000 cancer fighters, including world-class faculty and nurses, and 1,000-plus volunteers working every day to end cancer for our patients and others around the world. Our culture of exceptional care and genuine caring is second to none."
Two subspecialties also were ranked highly in this year's survey. In the Ear, Nose and Throat specialty, MD Anderson's Head and Neck Surgery service was ranked No. 5, the same ranking as last year. In Gynecology, MD Anderson's Gynecologic Oncology and Reproductive Medicine service moved forward one ranking, coming in at No. 7.
These specialty rankings are particularly notable because they include care provided at general hospitals across the nation, not just cancer centers. Both of these specialties have been consistently ranked high for the past two decades.
The survey also named MD Anderson as "high performing" in Urology, meeting the survey's standards for excellence.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
This time of year, kids are out of school, families are vacationing and people are heading to the beach and the pool. Yes, summer is on full blast, which means it's a good idea to brush up on your sun safety skills. To prevent skin cancer — the most common type of the disease — it's important to be informed about the sun's harmful effects and diligent about using sunscreen correctly. (And don't forget to wear protective clothing.) More than 3.5 million people are diagnosed with skin cancer each year in the United States. Follow these tips from MD Anderson experts to help keep your skin healthy.
|Even a few minutes in the sun increases your skin cancer risk. So don't head outside without sunscreen — not even for vitamin D.
|Your skin takes 30 minutes to absorb sunscreen, so apply sunscreen with SPF 30 or higher 30 minutes before you head outside.
|You'll use sunscreen more often if you like its texture. Test different sunscreens and find one with a texture you like.
|Shopping for sunscreen? Choose one with titanium dioxide or zinc oxide. They both block UV-B and UV-A rays.
Talk to your kids about the dangers of tanning beds. Tanning bed use before age 30 increases melanoma risk by 75%.
Your age doesn't matter when it comes to skin cancer. What matters is your exposure to UV radiation. Seek shade when the sun's rays are strongest.
|Tanning beds are not safer than natural sunlight. Tanning beds emit the same harmful UV rays as the sun, so avoid using them.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
In April, new federal data was released showing that while smoking combustible cigarettes continues to go down among teenagers, e-cigarette use has tripled among students in middle and high school.
We asked MD Anderson's head of Cancer Prevention and Population Sciences, Ernest Hawk, M.D., to share his thoughts on the trend:
Parents, cancer researchers, physicians and public health practitioners should all be encouraged by substantial declines in the use of traditional cigarettes among teenagers. From 2011-2014, the percentage of high school students that smoke cigarettes fell from 16% to 9%, according to Centers for Disease Control and Prevention's annual youth tobacco survey.
The same report, however, showed an increase of nearly 9% — from 4.5% to 13.4% — between 2013 and 2014 in the use of e-cigarettes among high-schoolers. That's a jump from 660,000 to 2 million in the span of just one year.
This dramatic rise in the use of e-cigarettes, which may be related to the decline in the use of combustible tobacco, is troubling.
There's been no shortage of theorizing about whether e-cigarettes are less dangerous than smoking. But at this time, there is no sufficient evidence-based research to support e-cigarettes as a healthy alternative to tobacco products for current smokers.
Paul Cinciripini, Ph.D., MD Anderson's chair ad interim of Behavioral Science, shared these concerns last year:
"The absence of smoke, which is replaced by the odorless vapor, gives smokers a false sense of security that there's less risk involved with using e-cigarettes, known as vaping," said Cinciripini. "Because e-cigarettes aren't regulated by the Food and Drug Administration (FDA), we have no evidence to prove they're safe."
More than a year ago, the FDA proposed regulations for the e-cigarette industry, which operates with little oversight and uses marketing tactics such as candy flavoring that likely contribute to the swell of younger users. The proposals would ban the sale of e-cigarettes to those below the age of 18, halt the distribution of free samples, place health warnings about nicotine on packages and disclose their ingredients. To date, no action has been taken by the federal government.
As tobacco use is ultimately a result of nicotine addiction, the uptake of e-cigarettes among non-smokers is of particular concern. Regardless of what science tells us about the potential long-term health effects of e-cigarettes, we must not forget these are products intended to deliver nicotine, an addictive substance that can be detrimental to developing adolescent brains and can potentially lead to future tobacco use.
At this time, 42 states prohibit the sale of e-cigarettes to minors. That number may soon increase.
Texas lawmakers are considering extended restrictions on tobacco products to e-cigarettes. We're pleased that Texas and other states are taking seriously the health impacts of e-cigarettes on future generations. And we're hopeful the FDA will quickly follow suit.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Ron Gilmore
For some time, cancer researchers have considered alpha-amanitin, the toxin derived from "death cap" mushrooms, as a possible cancer treatment. However, because of its penchant for causing liver toxicity, its potential as an effective therapy has been limited.
MD Anderson scientists looked at antibody-drug conjugates (ADCs) based on alpha-amanitin as one solution. They found that ADCs, when aimed at a gene called POLR2A, are highly effective in mouse studies in treating colorectal cancer. The drug caused complete tumor regression and greatly reduced toxicity. ADCs combine powerful anticancer toxins linked to antibodies that allow for improved targeting of cancer cells, resulting in less impact on healthy cells.
Xiongbin Lu, Ph.D., associate professor of Cancer Biology, observed that when the common tumor suppressor gene TP53 is deleted, resulting in cancer growth, another nearby gene, POLR2A, also is deleted. Normal cells have two copies of POLR2A and TP53 genes. Lu's study targeted cancers that had a single copy of both genes, representing 53% of colorectal cancers, 62% of breast cancers and 75% of ovarian cancers.
"POLR2A is an essential gene for cell survival, including cancer cells," said Lu. "Because there's only one copy, the cancer cells are more susceptible to suppression of this gene."
Lu's study was published in Nature.
The discovery that POLR2A is deleted at the same time as TP53 means that therapies can more specifically target the genetic processes that allow cancer cells to thrive. Understanding that one copy of POLR2A can allow cancer to grow gives researchers a new target to hit. As it turns out, it can be suppressed by an ADC based on the mushroom toxin. Lu's team tested alpha-amanitin because it was believed to specifically inhibit POLR2A.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Julie Penne
Doctors from MD Anderson and Houston Methodist Hospital have performed what is believed to be the world's first partial skull and scalp transplant on a man whose treatment for a rare cancer of the scalp muscle left him with a deep head wound that wouldn't heal.
During the same surgery, the patient also received a donor kidney and pancreas.
"This has been a long journey, and I'm so grateful to all the doctors who performed my transplants," said Jim Boysen, a 55-year-old software developer from Austin, Texas. "I'm amazed at how great I feel and am forever grateful that I have another chance to get back to doing the things I love and be with the people I love."
Boysen's first kidney-pancreas transplant was in 1992, to treat diabetes he's had since age 5. The immune suppression drugs he took at the time to prevent organ rejection raise his risk of cancer, and he developed leiomyosarcoma, a rare type of cancer affecting the smooth muscle under his scalp.
Radiation therapy for the scalp cancer left Boysen with a large head wound, and the immune suppression drugs kept his body from repairing the damage. In addition, the transplanted organs he received 23 years ago were starting to fail.
Yet doctors could not perform a new kidney-pancreas transplant as long as he had an open wound.
Jesse Selber, M.D., a reconstructive plastic surgeon at MD Anderson, conceptualized a solution: give Boysen a new partial skull and scalp, a new pancreas and a new kidney, all at once.
"When I first met Jim, I made the connection between him needing a new kidney and pancreas and the ongoing anti-rejection medication to support them.
Receiving a full scalp and skull transplant at the same time that would be protected by those same medications," Selber said. "This was a truly unique clinical situation that created the opportunity to perform this complex transplant."
The surgery took place on May 22 at Houston Methodist Hospital. A team of about a dozen doctors and 40 health care professionals participated, led by Selber and Houston Methodist's A. Osama Gaber, M.D., director of the Houston Methodist J.C. Walter Jr. Transplant Center.
LifeGift, a Houston-based organ procurement agency, obtained the organs for transplant.
Last year, doctors in the Netherlands replaced most of a woman's skull with a 3-D printed plastic one. The Texas operation is the first skull-scalp transplant from a human donor.
Read about the latest progress in Making Cancer History® at Cancer Frontline.
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
Palliative medicine isn't hospice care, it's a support system devoted to improving quality of life
By Ronda Wendler
Bre Tipps' life turned upside down in January 2012 after she underwent routine surgery to remove benign fibroid tumors from her uterus.
"I woke up in the recovery room to see my doctor standing over me, looking concerned," she recalls. "He told me I didn't have fibroids after all. I had ovarian cancer."
The 26-year-old mother of three was given six months to live. That's when she decided to make the five-hour drive to Houston from her tiny hometown of Grand Saline in northeast Texas. She wanted a second opinion from MD Anderson cancer specialists. And she wanted to fight.
"I have a husband. My kids are still young," she says. "I have a lot to live for."
At MD Anderson, Tipps sailed past her six-month end-of-life prognosis, and today at age 29, she's well into her third year of treatment. Her cancer was advanced when detected and is still there, but she's managed to stay a few steps ahead of it with chemotherapy, surgery and experimental drugs.
Sometimes the medical procedures are grueling and the side effects severe. Tipps has suffered pain, nausea, fatigue and, occasionally, depression.
"I know I'm getting the best medical treatment," she says, "but I need somebody to help me deal with the side effects and everything else cancer brings."
That "somebody" is a team of health care providers, counselors, clergy members and others who are specially trained in palliative care — a branch of medicine that helps patients deal with the physical side effects and emotional stress that come with cancer treatment and diagnosis.
At MD Anderson, outpatients receive palliative care in the hospital's Supportive Care Center. Each new patient undergoes a 10-point checkup, much like a car in a mechanic's garage, explains Eduardo Bruera, M.D., chair of Palliative, Rehabilitation and Integrative Medicine. From that initial visit, a team is assembled to address each patient's requirements.
"We're adding life to their days, not just days to their lives."
— Eduardo Bruera, M.D., chair of Palliative,
Rehabilitation and Integrative Medicine
"One person may need a gastroenterologist for nausea, a psychiatrist for anxiety and a pain specialist for discomfort," Bruera explains. "Another may need a sleep specialist for insomnia, a respiratory therapist for shortness of breath and a chaplain for spiritual support. Others may benefit from having a social worker, pharmacist, nutritionist or oncology massage therapist on their teams."
When visiting the Supportive Care Center, patients meet with their team members in one appointment, under one roof.
"Instead of visiting five specialists in five clinics, your custom-designed palliative care team is here in the Supportive Care Center," Bruera explains. "In one day you see them all, then you go home."
Hospitalized patients can receive palliative care in their hospital room as well. On the 12th floor Andreas Beck Inpatient Palliative Care Unit, patients with advanced cancer are preparing to transition to hospice or end-of-life care, but first need their symptoms brought under control. Each morning, teams of palliative care professionals visit each patient, dispensing comfort and care.
"I've seen patients with unrelenting pain and nausea arrive on our unit, and within 48 hours they're calm and comfortable," says licensed professional counselor Martha Aschenbrenner. "Our palliative care team works magic."
On other floors, patients battling various stages of cancer are visited by mobile palliative teams.
The goal of palliative medicine, Bruera says, is to give patients the best quality of life possible, not by providing primary cancer care — the oncologist does that — but by delivering pain and symptom relief, as well as spiritual and psychosocial support.
"Think of it this way," he says. "Oncologists treat the patient's cancer; palliative care teams treat the cancer patient. The emphasis is on the patient's needs, not the disease."
Modern medicine offers wonderful therapies to treat cancer, Bruera says, but many of those treatments produce unpleasant side effects. Palliative care, sometimes called "comfort care" or "symptom management," provides an extra layer of support, beyond the medical care provided by oncologists.
"Palliative care helps patients tolerate their treatments and get on with their lives," Bruera says.
Tipps has been able to continue working as an office assistant at a natural gas pipeline company and even organized a "Paint the Town Teal" ovarian cancer fundraising event in Grand Saline. Last year she attended the National Ovarian Cancer Coalition's annual conference in Washington, D.C., and testified before Congress about the need for increased ovarian cancer research funding.
Throughout her cancer journey, Tipps has had a strong support network of friends and family, including her husband, Terry; her parents, Liz and Ronald; and her hometown church family.
"My family and friends are wonderful, but my palliative care team keeps me going," she says. "They tell me things like, 'You don't need to suffer. We can lessen your pain.' I'm grateful for their help. I couldn't have made it this far without them."
Derived from the Latin palliare, "to cloak," palliative care addresses a patient's "total pain."
"Cancer patients may question why God is letting them suffer," says Aschenbrenner. "They may fear their treatment won't work or worry about cancer's effect on their marriage or children. They're in physical, spiritual and psychological pain."
These various forms of pain are deeply interconnected, Aschenbrenner says.
"It's hard to control physical pain in a person who's having a spiritual crisis, and it's difficult to soothe psychological pain in someone whose physical pain is uncontrolled," she explains. "They're all part of one big package.
"We want to help people live as well as they can, as long as they can."
Palliative care often is confused with hospice. That's understandable because it's an important component of hospice care, says Suresh Reddy, M.D., director of Palliative Care Education.
But while hospice is tailored to patients whose life expectancy is generally six months or less, palliative care "is in no way limited to those who are at the end of life, have a terminal disease or whose outcome is expected to be terminal," Reddy says.
From infants to the elderly, from the newly diagnosed to the critically ill, palliative care is appropriate "at any age, at any stage."
"Most people who need palliative care are not dying, but living for a long time with serious and complex illness," Reddy says.
If a patient's cancer cannot be treated, only then does the palliative care focus shift to end-of-life care, which is often provided by a hospice.
At the heart of palliative medicine is a conversation, or series of conversations, about a patient's goals and preferences for care.
This requires skill, compassion, a good listening ear and, if the patient is terminally ill, a level of comfort with topics many people would rather avoid.
Palliative care specialists help patients and families weigh the benefits and drawbacks of various treatments. Some patients want to "pull out all the stops" and try everything, while others may prefer comfort-focused care or something in-between.
"We ask our patients their understanding of their disease," explains Paul Walker, M.D., medical director for the hospital's inpatient Palliative Care Unit. "We find out what they know and, if their disease is terminal, what they hope to achieve in the time they have left. Then we help them achieve those things that are important to them."
Aschenbrenner says the inpatient palliative care team is privileged to witness some extraordinary events.
"We've had several weddings on the unit," she says. "Families are so willing, at one of the most daunting times of their lives, to let us come in and walk alongside them. I've witnessed vulnerability and sadness, along with remarkable tenderness, resilience and healing."
Aschenbrenner readily admits to shedding a tear with families.
"This job is not a piece of cake," she says, "but I wouldn't dream of doing anything else."
Every doctor who sees seriously ill patients should possess the skills to lead conversations that put patients' desires first, says Bruera. But research shows that between one-quarter and two-thirds of patients with advanced cancer don't have such talks with their physicians, and when they do occur, the conversations often take place in the hospital just a month or so before death.
"In fact, palliative care is most useful when it's started early, along with cancer treatment," Bruera says. "This way, it can help treat common symptoms caused by treatment and ensure the best quality of life."
It boils down to this, Bruera says:
"People have priorities in their lives besides just living longer. We must find out what their priorities are by asking, but we don't ask. As physicians we're not rewarded for having conversations. We're rewarded for doing operations or procedures well."
Regardless of a patient's prognosis, Bruera says his message to patients is this: "'We hope you get better, but if you don't, what do you want?' We push the envelope on what's important to the patient."
Just knowing that there's a plan in place offers families peace of mind," he says. "And that helps them concentrate on their loved one."
After battling bile duct cancer for two years, Rachel Henry was tired. She'd made countless round trips from her home in Huntsville, Texas, to MD Anderson, endured numerous chemo and radiation sessions, tried a host of different drugs and been confined to the intensive care unit four times.
Earlier this year, the palliative care team helped Henry clarify how she'd like to spend the time she had left. Instead of more medical procedures, she opted for "comfort care," or treatment of symptoms. No more poking and prodding, no more machines.
"It took Rachel all of 10 seconds to make that decision," says her sister, Mary Gail Doddridge. "She was ready."
Before she died on April 17 at age 64, Henry, a retired home economics teacher, was able to spend valuable time with her children and grandchildren and share family recipes from her hospital bed.
That extra time focusing on loved ones and quality of life is something the family will always cherish, Doddridge says.
Palliative care has come a long way since it was first introduced in the United States in the 1970s.
"At first, physicians and other health care providers were suspicious of palliative care practitioners, because they didn't understand our role," Bruera says. "They thought of us as 'grim reapers.' Acceptance was slow."
Today, palliative care is the fastest growing medical specialty in the United States, and the fastest growing department at MD Anderson. Almost 90% of large hospitals — those with 300 beds or more — now have palliative care programs, and most cancer centers have added palliative care supportive services.
Several groundbreaking studies have fueled this growth, including results from a lung cancer patient trial published in the New England Journal of Medicine in 2010. The study revealed that lung cancer patients who received palliative care at the same time as their cancer treatment felt better, had fewer emergency room visits, were less depressed, less likely to die in the hospital and lived three months longer than similar patients getting excellent cancer care but no palliative care.
Recognizing these benefits, the Institute of Medicine last fall issued a report that said every patient should have access to high-quality, affordable palliative and hospice care when and where they need it. The report, which Bruera helped author, is expected to produce sweeping changes in patient care across the country.
"Helping people live longer is great," says Bruera. "But what's really important is that we're improving quality of life for our patients. We're adding life to their days, not just days to their lives."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
10 platforms of expertise and technology support the program's progress
By Scott Merville
Since discovering that leukemia cells contain a target that can attract an immune attack leading to remission, Jeff Molldrem, M.D., and his colleagues have doggedly sought ways to help the immune system home in on the cancer.
In 2011 the team developed an antibody that recognizes and binds to that target, a peptide called PR1/HLA-A2. This attack triggers destruction of acute myeloid leukemia (AML) cells by the complement system, a component of our overall immune system.
The antibody, named h8F4, became a prime candidate for a clinical trial — one that could potentially result in a new drug to treat AML. However, that step from successful preclinical research to first clinical trial is where many ideas falter and die.
"Unfortunately, advancing novel discoveries from the laboratory to drug development has been historically challenging," says Molldrem, a professor of Stem Cell Transplantation and Cellular Therapy. "Antibodies pose their own difficulties, including a more complex and expensive manufacturing process than other types of drugs."
Molldrem connected with Carlo Toniatti, M.D., Ph.D., a scientist with a long record of research achievements in the pharmaceutical industry and executive director of a platform for MD Anderson's Moon Shots Program called Oncology Research for Biologics and Immunotherapy Translation, or ORBIT. The platform is designed to help accelerate and execute the translation of MD Anderson immune system discoveries into therapeutic treatments.
ORBIT accelerated development of H8F4 by funding the start of the manufacturing process for the antibody, developing a detailed, three-year plan to bring the drug to clinic, and reaching out to potential pharmaceutical company partners.
As a result, in April, MD Anderson signed an agreement with the international drug company Astellas Pharma Inc., to develop h8F4, with clinical trials set for 2017.
"Jeff Molldrem's connection with ORBIT is a good example of how the Moon Shots Program meets its promise of applying existing scientific knowledge to bring new therapies to patients at an accelerated pace," says Giulio Draetta, M.D., Ph.D., co-leader of the Moon Shots Program and director of the Institute for Applied Cancer Science (IACS).
ORBIT is one of 10 platforms, or research engines, built by the moon shots, which are designed to harness established knowledge and new, disruptive technologies to dramatically reduce cancer deaths through prevention, early detection and treatment. The platforms provide an empowering infrastructure of expertise and technology to support the program's efforts.
"Platforms are a unique aspect of the program. We've embedded these industry-quality capabilities in an academic organization to allow scholars who are really good at discovery to translate their findings more systematically, rapidly and deliberately to save as many lives as possible in the next five to 10 years."
— MD Anderson President Ron DePinho
The initial moon shots are targeting chronic lymphocytic leukemia, breast and ovarian cancer, melanoma, myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) and lung and prostate cancers. A number of additional moon shots pilot programs have been initiated.
With their expertise and capabilities in drug development, prevention, cancer genetics and proteomics, immunology, preclinical cancer modeling, and the storage, processing and use of massive amounts of medical and scientific information, the platforms are primed to deliver on the cutting edge of science and medicine.
ORBIT, IACS and the Center for Co-Clinical Trials (CCCT) and Applied Cell Therapy (ACT) are platforms devoted to novel drug development. They discover potential medicines to offer the moon shots and MD Anderson clinical departments and also collaborate with the institution's investigators who have ideas for new drug targets.
The institute specializes in small-molecule drug development and functions much like a biotech company, if one was embedded in an academic institution.
Many IACS scientists honed their craft in the biotech/pharmaceutical sector and apply that insight in their collaboration with MD Anderson's clinical experts.
As an example, IACS, collaborating with the CCCT platform and the MDS/AML Moon Shot, is in the final stages of Food and Drug Administration mandated safety testing of IACS-10759, a novel inhibitor of a key cellular component required for energy production to which some tumors appear addicted.
Working together, the team rapidly advanced IACS-10759 through preclinical development and plans to start clinical trials in early 2016, beginning with AML.
"The drug discovery team designed, synthesized and evaluated multiple rounds of compounds, steadily improving their overall profiles over 18 months to identify a single compound to move into clinical development. IACS-10759 is in the final stages of preclinical testing leading to an Investigational New Drug submission," says Phil Jones, Ph.D., head of Drug Discovery at IACS. "IACS-10759 starves certain vulnerable cancer cells of energy in a new way."
In addition to AML, preclinical work on the drug indicates it might also work for some patients with lymphomas, colon, pancreatic and skin cancers, and glioblastoma.
ACT is a new platform that develops customized cellular therapies, including immune system T cells, to attack cancer, and will guide the moon shots in this promising area of research. Clinical trials of T cells genetically engineered to more efficiently find and kill cancer are in the works.
Another trial cultivates different types of immune cells, called natural killer cells, from donated umbilical cord blood and gives them to patients as immunotherapy in the Chronic Lymphocytic Leukemia Moon Shot, along with chemotherapy.
The CCCT focuses on how genomic alterations drive tumor growth and progression, and seeks to identify vulnerabilities that will enhance treatment. It conducts comprehensive preclinical research using patient-derived tumor models, cancer cell lines and unique engineered mouse models to position novel drugs with distinct patient populations.
In collaboration with the Melanoma Moon Shot, MD Anderson scientists developed a promising new two-drug targeted therapy for a specific group of melanoma patients. The dosing schedule used in a first-in-human phase I clinical trial showed promise but also significant toxicity, says Tim Heffernan, Ph.D., CCCT co-director.
"We've taken what we learned from the clinical trial back into the mouse model to develop an effective but less toxic treatment schedule," he says.
This repeat process, from preclinical insight to clinical trial, then back to the lab to improve treatment before returning the therapy to the clinic, is a hallmark of the CCCT. The same drug combination is being tested in colorectal and pancreatic cancers.
"Based on initial clinical experience, the CCCT's approach will likely be critical to maximizing the clinical impact of these very promising approaches by identifying safe and effective treatment regimens," says Michael Davies, M.D., Ph.D., associate professor of Melanoma Medical Oncology and co-leader of the moon shot.
The Cancer Genomics Laboratory (CGL) is a platform that provides genomic tumor sequencing on an accelerated schedule. Samples are sequenced and analyzed within 10 to 12 weeks after submission. In addition to supplying information for an investigator's specific project, everything is deposited into
MD Anderson's big data platform, where it's available to all researchers.
"CGL provides rapid, high-quality sequencing with open access to data," says Maggi Morgan, the platform's scientific manager.
Earlier this summer, eight projects were in the CGL platform's pipeline, and that number is expected to increase. Investigators in the pilot moon shot for human papillomavirus (HPV)-related cancers are using CGL sequencing results to better understand how the virus inserts its DNA into a person's DNA, and the role that genomic integration plays in the development of cervical and head and neck cancers.
A follow-up study of nine HPV-positive and 50 HPV-negative cell lines and patient samples will further examine the role of HPV in tumor origination, patient outcomes and as a biomarker for personalized treatment.
Tumor and matched blood samples also are sent to the immunotherapy platform led by James Allison, Ph.D., the scientist who opened up a new way to treat cancer by unleashing the immune system to attack it.
Allison's platform conducts preclinical and clinical research to identify and evaluate new single-agent and combination therapies, including immune monitoring of tumors before, during and after treatment. More than 60
MD Anderson immunotherapy clinical trials for a variety of cancers rely on the platform for immune analysis.
Long-term research shows that 22% of patients with untreatable, late-stage melanoma survive 10 years or longer when treated with Allison's drug, Yervoy.
Drugs such as Yervoy, which amp up the immune system, have shown similar improvements in clinical trials for lung, bladder, kidney, liver, head and neck and other cancers.
Allison believes combination therapies will yield even better results. The key is to identify the most promising combinations out of a multitude of potential choices.
"I think with immunotherapy drugs we're going to succeed very quickly in improving survival in patients with a number of cancers," Allison says. "Patients will survive decades — not just months or weeks as they did with conventional therapies."
The proteomics platform identifies and analyzes the thousands of proteins in cancer cells to find the few that can be used as drug targets or biomarkers for screening or diagnosis.
"The platform is helping the MDS/AML Moon Shot understand drug resistance and identify new targets for these diseases," says moon shot leader Guillermo Garcia-Manero, M.D., professor of Leukemia.
One outcome: An agreement with drug company Amgen to provide and test proteins for a new type of therapy the company is developing to connect immune T cells to cancer cells.
Two other platforms are focused on efficiently gathering and managing information and combining it with medical data to improve patient care and research.
Adaptive Patient-Oriented Longitudinal Learning and Optimization (APOLLO) provides a framework to comprehensively and systematically gather relevant clinical information, tumor genomics and samples over time for each patient and to integrate it with research information. This improved system is designed to benefit individual patients and inform research for better treatment for future patients.
All these data are aggregated in the big data platform to improve physicians' and scientists' access to relevant information. APOLLO and big data are being piloted in the MDS/AML and Lung Cancer Moon Shots.
"The idea is to have each patient contributing to and benefiting from research," says Andy Futreal, Ph.D., co-leader of the Moon Shots Program and the APOLLO and big data platforms.
"Thanks to these platforms and our world-leading clinical trials engine, we now are positioned to precisely match any one of hundreds of novel drugs for our patients in so-called smart clinical trials," DePinho says. "Nowhere else is there such a powerful confluence of in-depth molecular profiling, clinical data integration and myriad clinical trials."
Through its Moon Shots Program, MD Anderson offers ways to help people stay healthy and avoid cancer altogether.
The Lung Cancer Moon Shot includes smoking cessation and research programs such as ASPIRE (A Smoking Prevention Interactive Experience) — a multimedia, Web-based smoking cessation and prevention program for adolescents.
The Melanoma Moon Shot supports legislation that bans minors from using tanning beds. And the moon shot developed a sun safety program for preschoolers called Ray and the Sunbeatables. The program is a project of the CATCH Foundation, a national organization that promotes healthy lifestyles for children. The cancer prevention and control platform supports these efforts and launches them in the community.
MD Anderson has always been strong in developing evidence-based prevention programs, says Ernest Hawk, M.D., vice president of prevention, and it now devotes greater effort to translating those findings into public policy, patient care and education.
"Our platforms and the moon shots are central to our efforts to translate evidence-based cancer prevention to the clinic and community," he says.
|Cancer genomics laboratory
|Provides rapid, high-quality genomic sequencing services and institution-wide access to genomic data
|Sifts through thousands of cancer-related proteins to find those useful for diagnosis, imaging or as targets for treatment
|Enables design of preclinical studies and clinical trials to evaluate novel immunotherapies as single treatments or in combination with other drugs
|Cancer prevention and control
|Develops and implements evidence-based programs involving public policy and public/
professional education, and service delivery to advance prevention, screening, early
detection and survivorship
|Big data
|Integrates MD Anderson's information systems to improve patient outcomes with efficient, secure use of research and clinical data
|APOLLO – Adaptive Patient-Oriented Longitudinal Learning and Optimization
|Provides an operational framework to accelerate research-driven patient care by standardizing clinical workflows and sample collection. The goal is to ensure that high-quality clinical/research data are captured systematically over time for each patient to enhance learning and improve outcomes
|Center for Co-Clinical Trials
|Functions as an industrialized pharmacology unit to test the impact and tolerability of
single drugs or combinations in appropriate preclinical models
|Institute for Applied Cancer Science
|Applies scientific knowledge of factors that drive tumor formation and progression to develop small-molecule cancer therapies for specific cancer patients, targeting areas of unmet medical need
|Applied Cell Therapy
|Innovates, develops and implements novel cell-based immunotherapies, including customized T cells to attack cancer
|ORBIT – Oncology Research for Biologics and Immunotherapy Translation
|Focuses on the rapid discovery and development of innovative monoclonal antibodies — targeted biologic drugs to treat cancer
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
New procedure allows women who carry BRCA gene mutations to lower their chances of developing cancer by removing their fallopian tubes, but not their ovaries
By Ronda Wendler
Jenna Arnold inherited her mother's love of traveling, passion for volunteering and strong religious faith.
But she's determined not to inherit the cancer that took her mother's life.
Arnold's mother, Judy Kenesson, was battling ovarian cancer when she took the blood test that detects inherited genetic mutations that greatly increase a woman's chance of developing breast and ovarian cancer. When her results came back positive, she urged her daughter to be tested as well.
"My mom knew her mutation could be passed on to future generations, so she wasted no time warning me," says Arnold, who also tested positive. "She's my hero."
The test looks for mutations in the BRCA1 and BRCA2 genes, known as the breast and ovarian cancer susceptibility genes. Normally, these genes protect people from getting cancer. But when mutated, the genes' protective abilities are weakened and cancers can arise more readily.
Women with BRCA1 mutations have a 39% risk of ovarian cancer compared to the general population's risk of 1.3%, while women with BRCA2 mutations fare slightly better with a 17% risk, according to the National Cancer Institute. Breast cancer rates are similarly elevated.
"But here's the good news," says Denise Nebgen, M.D., Ph.D., associate professor of Gynecologic Oncology and Reproductive Medicine. "If you know that you carry a BRCA mutation, there are steps you can take to greatly reduce your chance of getting cancer. Knowledge is power."
In women at high risk for ovarian cancer, the common prevention strategy is to remove fallopian tubes and ovaries after childbearing is completed — typically between the ages of 35 and 40.
"It seems drastic, but removing ovaries and fallopian tubes reduces the risk for ovarian cancer by 80 to 90%," Nebgen says.
And there's an added benefit, she says. Because the ovaries make the hormone estrogen — which fuels many breast cancers — removing the ovaries reduces breast cancer risk by 50%.
The downside is that removing the ovaries and their accompanying supply of estrogen plunges women into instant menopause and all the unpleasant symptoms that come with it, including hot flashes, vaginal dryness and painful intercourse, and may place them at a higher risk for developing cardiovascular disease and osteoporosis.
Arnold, who's 37 and has a 10-year-old son, didn't want that.
"My husband and I were confident that we were done having children, but I felt far away from menopause," she says. "I was afraid of the hormonal changes and imbalances it can cause."
Nebgen understands.
"It's life-changing to have your ovaries removed 10 to 15 years before menopause would happen naturally," she says.
Now, women participating in a first-in-the-nation MD Anderson clinical trial have a way to reduce their risk while leaving menopause for later: a surgery known as salpingectomy removes the fallopian tubes while leaving ovaries intact.
The technique is built on intriguing science that suggests most cases of high-grade serous cancer — the most common and lethal form of ovarian cancer — arise from the fallopian tubes rather than the ovaries. A scientific literature review authored by Karen Lu, M.D., chair of Gynecologic Oncology and Reproductive Medicine at MD Anderson, suggests that in the future, ovarian cancer may be described as fallopian tube cancer. The study was published in the April 2015 edition of Cancer Prevention Research.
"For about 30 years, almost everyone thought ovarian cancer arose on the surface of the ovaries," says Nebgen, who works closely with Lu. "But within the last five years, we've come to understand that many genetic 'ovarian cancers' appear to start in the fallopian tubes. So removing these tubes may greatly reduce risk."
Researchers were tipped off by two phenomena: First, women who practiced birth control by having their fallopian tubes tied developed ovarian cancer 50% less often than women whose tubes weren't tied.
Second, the initial wave of surgeries performed on BRCA mutation carriers in the 1990s showed early evidence of cancer in the fallopian tubes but not in the ovaries.
Nebgen considers removing only the fallopian tubes as an intermediary step before later removing the ovaries, and recommends it only as part of a clinical trial.
"I tell women that salpingectomy is an interim measure we can take. Eventually these women will also want their ovaries out to decrease not only ovarian cancer risk, but also breast cancer risk due in part to the ovaries' production of estrogen," she says. "But having the tubes out early, and then the ovaries out later, can be a stop-gap that reduces risk in this window without initiating menopause."
The MD Anderson trial, led by Nebgen and conducted through the High Risk Ovarian Cancer Screening Clinic, is following 80 BRCA-positive women who choose one of three paths: screening only, the recommended traditional combination of ovary and fallopian tube removal, or, Arnold's choice — fallopian tube removal followed by ovary removal years later.
Nebgen suggests removing the fallopian tubes while sparing the ovaries may be appropriate for women who don't plan to have more children, are below age 40 and are strongly opposed to the idea of immediate menopause, to the point of refusing the current risk-reducing surgery that removes both ovaries and tubes.
Arnold fits that description and is comfortable with her decision.
"I didn't want to have my ovaries out yet," she says. "But I wanted to feel like I was doing something to reduce my risk."
As BRCA testing becomes more common, clinicians are encountering more and more women who have been blindsided in their 20s and 30s — in the prime of their reproductive life — by the knowledge that they carry a potentially life-threatening genetic mutation.
"They could dramatically reduce their risk of cancer with surgery, but some women simply refuse," Nebgen says. "They want to keep their options open until they marry or until they have one or two more children."
These women believe they're invincible, Nebgen says, and don't realize they're gambling with their lives.
Unlike breast cancer, no reliable screening test has been developed to detect ovarian cancer. And because the disease produces no obvious symptoms, it remains undetected as it silently grows. Nearly two-thirds of ovarian cancers aren't caught until they've spread beyond the ovaries to elsewhere in the body. By then, the five-year survival rate is 45% — far below the 92% survival rate for ovarian cancer that's found and treated before it spreads outside the ovaries.
Exactly how much salpingectomy reduces cancer risk is a question yet to be answered. The procedure is fairly new, and Nebgen is quick to point out that proving its effectiveness will require multiple studies in the years to come.
This spring, MD Anderson became one of five institutions chosen to participate in a new Ovarian Cancer Dream Team funded by Stand Up to Cancer, an organization started in 2008 by film and media leaders to quickly translate lab research into treatments for cancer patients. Dream Team members will pool their different areas of expertise and work together to prevent ovarian cancer in high-risk women. MD Anderson's role on the team is headed by Lu, who this fall will be principal investigator of a new Dream Team-funded clinical trial that looks at fallopian tube removal in 350 women with BRCA mutations. The multi-site trial builds on Nebgen's pilot study, which concludes as this larger trial gets underway.
"Dr. Nebgen is conducting a proof-of-concept study — a smaller-scale study that is confirming for us that women are interested in salpingectomy to reduce cancer risk and stave off menopause," Lu says. "Now we're ready to build on that initial research with larger studies that give us data on salpingectomy's safety and effectiveness."
Until then, Nebgen considers salpingectomy an option for women who say "absolutely no" to the recommended, more aggressive fallopian tube and ovary removal surgery.
"Salpingectomy is not yet the standard of care," she says. "But it's an evolving alternative."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
When they aren't fighting cancer, these faculty and staff members are expressing themselves
By Ron Gilmore
Given that his father's big band once opened for Nat King Cole at New York's Paramount Theater, it's no surprise that music's in Geoff Giacco's blood.
Giacco is among many MD Anderson faculty and staff members with artistic sides, which they pursue outside the confines of their labs, offices and nursing stations. This wealth of talent is one reason the institution annually offers avenues for showcasing creativity such as
"MD Anderson Idol" and the Faculty Art Exhibition.
For Giacco, a manager of MD Anderson's Tumor Registry, which catalogs and tracks patient information, music provides much-needed balance to his work life.
"It helps free my mind for the analytical thinking that's required in my job as an epidemiologist," he says. "It's a great way to relieve the stress of the day."
For more than 30 years, Giacco has performed guitar and vocals with his band, Cowjazz. The group can be heard on musician-development website Reverbnation and regularly plays at Houston venues such as Bohemeo's, Last Concert Café and Natachees. Giacco's 89-year-old father occasionally joins them on stage to play flute.
During the last three years, Giacco has been a finalist in "MD Anderson Idol." He also participates in the employee choir.
"It's a lot of fun to entertain my co-workers and our patients. It's a very different experience from the normal workday," he says.
Despite a demanding schedule, Hagop Kantarjian, M.D., chair of Leukemia, finds time to paint. In fact, many of his paintings, stunning in their use of vibrant primary colors and eclectic in style, line the hallways of his department's suite.
For Kantarjian, who's modest about his artistic abilities, the impetus of his work is enjoyment, not fame.
"I'm not good enough to exhibit my work," he says. "Perhaps never. Painting is just fun and it relaxes me and alleviates my anxieties. I will be a long-time amateur painter."
Amateur or not, his work adheres to styles that he prefers, particularly those of an artistic movement popular at the turn of the 20th century known as fauvism. French for "the wild beasts," fauvism emphasizes strong, bold colors. Among its leaders are Henri Matisse and André DeRain. Kantarjian's work also is influenced by artists from other genres including post-impressionists Paul Cézanne and Paul Gauguin, and impressionist Edgar Degas.
"I call myself a post-modern surreal impressionistic neo dada-fauvist," he says with a grin. "I love fauvistic colors, post-impressionist and abstract work. My style has evolved over the years and is often influenced by my evolving love of different artists."
Born and raised in Beirut, Kantarjian began painting as a child, but put down his brush for several years because of the Lebanese civil war, which lasted from 1975 to 1990.
"I picked it up in 1993 under the tutelage of a Russian émigré from St. Petersburg named Efim Fruman," he says. "I evolved with his mentorship over the next four years, and then decided to paint as I like."
Although several of Kantarjian's paintings depict cityscapes and urban settings — including neighborhood scenes from his childhood — he also enjoys other subjects including still life and nudes. Of the nudes, he jokes: "No one else likes them or wants them, so they end up in the garage."
Beyond providing him with a relaxing hobby, Kantarjian says he gets some of his best ideas in leukemia research when he's painting.
"However," he adds, "at my age, I often forget them as soon as I leave the studio."
During the day, Karen Stepan dedicates her time to addressing the emotional, spiritual, social and practical needs of MD Anderson patients and their families through her work with the Psychosocial Council.
But at night, she slips on her dancing shoes.
We're not talking about two-stepping at the local honky-tonk. Stepan is an accomplished ballroom dancer. In 2013, she won the National Dance Council of America's World Pro-Am Bronze Rhythm Championship and took second place in the World Pro-Am Smooth Championship.
"I've always enjoyed watching others dance, especially in the Rodgers and Hammerstein musicals," says Stepan. "When I was growing up, I wanted to jump into one of those stories and be part of that experience. I hope audiences I perform for feel the same way."
Stepan's competitive dance journey began in 2008 by training with professional dance partner Christopher Muller. She participated in local competitions, winning her dance level and age group. As her confidence grew, she set her sights on national and international competitions.
"It's an entirely new experience at that level," says Stepan, who has mastered the waltz, tango, fox trot, cha-cha, rumba and swing. "I really didn't know what to expect, but I knew it would be tough."
Dancing has also helped Stepan in her work at MD Anderson. It's helped her lead as well as follow, which has been useful because her job calls for guiding and supporting those she serves.
"It's important to be mindful of the balance between being a leader and a follower," she says. "Both are important roles, and the key is being able to excel at either one."
Although Irene Tamí-Maury, Dr.PH, says her paintings hang mostly at home or in friends' houses, she shared her colorful, expressive work at the MD Anderson Faculty Art Exhibition in early May.
She has shown before, taking first place at an art exhibit for one of her sculptures while attending dental school in Venezuela.
Tamí-Maury, an assistant professor of Behavioral Science, gravitates toward landscapes. One of her paintings, Parakupá-Vená, portrays a magnificent waterfall in pastel tones, emulating stained glass. Parakupá-Vená is the indigenous name for Angel Falls, the world's highest waterfall located in Canaima National Park, Venezuela. Tamí-Maury created her favorite painting, Twilight, with her son when he was 13. The work portrays moody, dark colors applied with sponges, a technique that allows colors to overlap and fade into one another. She prefers landscapes because wilderness has always served as an emotional retreat.
"Painting is therapeutic," she says. "It provides me a sense of tranquility and helps me focus on something else besides work. It also keeps my brain oxygenated and open to new ideas and thinking."
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MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
In fact, World Health Organization scientists predict that number will reach 24 million cases a year by 2035. To avoid a "tidal wave" of cancer tomorrow,
MD Anderson and other health care institutions are taking action today.
"Our mission and vision challenge us to be the single most impactful institution in relieving the burden of cancer globally, and we can achieve this by extending our brand of prevention, care, research and education to like-minded organizations worldwide," says
MD Anderson President Ron DePinho, M.D.
To do that, the institution's Global Academic Programs (GAP) facilitates the Sister Institution Network — the largest global network of cancer centers (32 institutions in 23 countries) working collaboratively on research and education. Currently, MD Anderson is involved in 93 international research projects in 24 countries. The MD Anderson Cancer Network® allows the institution to collaborate with healthcare providers to provide MD Anderson's model of multidisciplinary care to patients in the communities where they live. Here's a look at new cancer cases by region and where the Cancer Network and GAP are teaming with hospitals, health systems and institutions across the nation and around the globe in Making Cancer History®.
American Cancer Society / Global Cancer Facts & Figures, 3rd Edition
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
A decade after Red and Charline McCombs gave $30 million to MD Anderson, the funds are fueling groundbreaking advances in cancer research
By Miriam Spradling
Ten years ago, San Antonio businessman Red McCombs and his wife, Charline, made a transformative, unsolicited $30 million gift to establish the Red and Charline McCombs Institute for the Early Detection and Treatment of Cancer at MD Anderson. The donation was the largest the institution had received to fund research at the time, and led to the most aggressive expansion of cancer research in its history.
The 87-year-old McCombs says his desire to give comes from examples set by his parents.
"My father made 25 bucks a week, which he'd give to my mom so she could put $2.50 aside for the church," he says. "And although we didn't have any extra space, and certainly no extra money, Mom would take in children and keep them while their families worked out their problems."
McCombs first encountered MD Anderson as a college student while visiting a patient. He was impressed by what he saw, and the experience stuck with him. Years later, he reached out to then-President Charles LeMaistre (1978-1996) to offer some praise.
"I called Mickey LeMaistre and complimented him on the care I saw being offered to everyone there," he says. "Mickey explained how everyone they see is troubled, either because they're a patient or because a loved one is a patient, so they take extra care not to add to that. I told him it was the best program I'd ever seen."
Through the years, McCombs's relationship with MD Anderson continued to develop. He joined the MD Anderson Cancer Center Board of Visitors (BOV) in 1986, led the Institutional Initiatives Committee (1993-1994) and chaired the BOV (1995-1997). His daughter, Marsha Shields, joined the BOV in 2009.
"I have a soft place in my heart for MD Anderson because they're the best in the world at what they do," he says.
In 2005, McCombs received a brochure describing the South Campus Research Initiative (SCRI), and its potential impact on cancer care and research immediately appealed to him. Once again, he picked up the phone.
"I told John Mendelsohn (MD Anderson president, 1996-2011) the SCRI was the greatest approach to this dreadful problem, and I'd give $25 million to support it," he says. "Then Dr. Mendelsohn called back and said for $30 million they could put my name on the facility. I said, 'For $5 million more, we'd like that.'"
From there, given McCombs' belief in the value of early detection, the McCombs Institute for the Early Detection and Treatment of Cancer was born.
"The best treatment we have in the world — with all the zillions of dollars and brilliant scientists working on this — is early detection and prevention. Period," McCombs says.
Sam Hanash, M.D., Ph.D., who was recruited to lead the McCombs Institute in 2009, shares McCombs' passion. About 20 years ago, he met a patient who changed the trajectory of his career.
"I diagnosed a patient with an advanced-stage brain tumor," Hanash says. "The father was so distraught and wanted to know why we couldn't have detected the cancer earlier when it probably could've been cured. That's what locked me into wanting to see how we can prevent cancer and detect it earlier."
Now, 10 years after the McCombs' gift, more than one-third of MD Anderson research is channeled through the McCombs Institute and its seven centers, each devoted to a particular area of cancer research (see below).
The numerous groundbreaking advances made in the first decade of the McCombs Institute are extremely promising. Yet, McCombs didn't become a legendary entrepreneur by being satisfied with standing still. In a letter to Hanash, he indicated that "the institute is on the right track but must press onward — because if you're on the right track and stop, you'll be run over."
"Mr. McCombs is eager to see scientific discovery applied in the clinic. And that's exactly what we're committed to — translational medicine — so that the discovery passes what's known as the `valley of death' — the abyss that must be crossed when laboratory research is translated into drugs or therapies that help patients," says Hanash. He adds that in another 10 years he expects early detection to have a marked impact on cancer mortality worldwide.
"This disease is a bigger threat to the world than terrorism," McCombs says. "Someone in every extended family is going to go down with cancer. It's that big of a robber of life and dignity, and we all need to do everything we can to stop it."
Center for cancer immunology research
Center for radiation oncology research
Center for advanced biomedical imaging
Center for targeted therapy
Center for global cancer early detection
Center for rna interference and non-coding RNAS
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
By Ron Gilmore
"I am not a teacher, but an awakener."
With that line, poet Robert Frost captured the essence of what it means to be a good mentor, a key to success for young physicians and researchers new to the world of academic medicine.
New scientists and clinicians rely on the guidance and wisdom of their more senior colleagues as they "awaken" their own inspirations and abilities. The end result? More informed caregivers, teachers and scientists who can better help
MD Anderson's patients, educate future cancer specialists and spur next-generation innovations in cancer treatment.
"I had terrific mentors as a student, as a postdoctoral fellow and as a fellow at the National Institutes of Health," says Sharon Dent, Ph.D., chair of Epigenetics and Molecular Carcinogenesis at MD Anderson. "They provided me opportunities to meet leaders in the field and to present my research findings at conferences. They also gave me very practical advice."
Dent recalls her NIH mentor advising her to look carefully at faculty members who worked in institutions where she was applying for jobs.
"He knew they would influence my thinking, my students' thinking and my opportunities going forward," says Dent. "He was absolutely right."
The department of Faculty and Academic Development's raison d'être is helping junior faculty succeed personally and professionally.
To promote collegiality among faculty, trainees and students, the department hosts social gatherings and offers exercise programs, stress reduction programs, and counseling and advising. To help develop participants professionally, it offers workshops that teach grant writing, lab management, teaching skills and how to plan for promotion and tenure.
"The testimonials from faculty who have benefited from good training and mentoring are inspirational and heart-warming," says Janis Yadiny, associate vice president for Faculty and Academic Development. "That's why we offer mentoring materials on our website and events that support mentors and mentees. We also support faculty members establishing new programs in their departments and divisions."
The department sponsored the first Faculty Mentoring Day in 2008, and annually selects winners of the Distinguished Faculty Mentor Award. Last year, recipients included Michael Keating, M.B.B.S., professor of Leukemia, Elizabeth Grimm, Ph.D., professor of Melanoma Medical Oncology, and Gordon Mills, M.D., Ph.D., chair of Systems Biology.
Han Liang, Ph.D., associate professor of Bioinformatics and Computational Biology, says he was "tremendously impacted" by Mills' mentoring.
"I joined MD Anderson with little knowledge or training about cancer research," says Liang. "Gordon's passion about helping our patients through science, his creative thinking about big ideas, his unconditional support for junior faculty and trainees, and his high standard for scientific research are amazing."
Liang says he feels "extremely lucky" to work with Mills.
"I'm trying my best to adopt his characteristics and, hopefully, pass on these traits to my trainees," he says. "Without Gordon's support, I wouldn't have achieved half of what I've been able to accomplish."
Today, Liang is a talented scientist and mentor.
"The most enjoyable thing about research," he says, "is working with trainees and discussing science daily."
One mentor, George Calin, M.D., Ph.D., professor of Experimental Therapeutics, adheres to a basic but time-honored approach.
"The simplest philosophy is to keep pushing my trainees to think outside the box, ask them to think and write science all the time, and let them prove to themselves just how good they are," Calin says.
Creativity, imagination and the "desire to discover" are traits he cultivates in his mentees. Calin recalls his own experiences as a young scientist.
"I had the opportunity to have three mentors in Romania, Italy and the United States," he says. "They contributed fundamentally to my way of understanding science and making discoveries."
Mein-Chie Hung, Ph.D., chair of Molecular and Cellular Oncology, mirrors Calin's experience with his mentors.
"I've been very lucky to have some great and inspiring mentors throughout my career," says Hung. "As a naïve young man in Taiwan interested in science, two mentors in particular really opened my eyes to the powers of modern science. They turned on my curiosity and passion."
Hung says he learned from his mentors how to be happy and successful and to follow his heart. Today, he looks for that same passion, commitment and innovation, along with a solid track record, to ensure his mentees will succeed. His advice to young faculty is to be persistent.
"A career in science will have many ups and downs," he says. "It's important to always get right back up."
Conquest iPad app
MD Anderson's award-winning Conquest magazine is available on the iPad. If you want to combine the design of the print version with the convenience of your tablet, then the iPad version is for you. It's filled with multimedia extras and features sleek, user-friendly navigation. Download for free at the App Store, and use the free subscription offer to receive notifications each time a new issue is published.
One woman's tale of conquering cancer and Kilimanjaro
By Julie Penne
Breast cancer survivor Bree Sandlin's inner strength and inner voice helped her overcome two of the toughest challenges she's ever faced.
"Keep going. Put one foot ahead of the other," the mother of two told herself as she battled aggressive, Stage III triple negative breast cancer in 2012. "I have a great team supporting me."
Two years later, the 39-year-old cancer survivor whispered similar encouraging words as she and husband Stephen scaled Tanzania's Mount Kilimanjaro, the world's tallest freestanding mountain.
"I'm learning from this every day," Bree told herself during the challenging eight-day climb. "My life will be better for this experience."
Always active and adventurous, the Sandlins participated in Survivor Summit, sponsored by the LIVESTRONG Foundation. Each year, the program teams cancer survivors and caregivers with seasoned guides who navigate the mountain as they raise pledge funds to benefit cancer patients. For the Sandlins, the trip was a way to honor the more than 32 million people affected by cancer worldwide.
Averaging about five miles a day, it took the climbers six days to reach Kilimanjaro's 19,000-foot summit. Their descent took another two.
It was a climb that mirrored Bree's arduous year of treatment in many ways.
"The analogy of climbing Mount Kilimanjaro and the cancer journey is remarkable," says Bree. "Every day we climbed I was reminded that it was really hard and something you couldn't do alone.
You tell yourself to keep going and not give up. You also remind yourself that this climb is nothing compared to chemotherapy."
With the terrain, altitude and conditions, Stephen says the trek was "the equivalent of doing 14 miles per day and climbing six mountains over eight days." The climbers worked their way through a rain forest and warm temperatures at the base, but as they advanced, the trees thinned out and the climate became windy and cold. Only 20% of Kilimanjaro climbers make it to the summit.
Most are content to walk the rim instead of going the full distance to the peak.
At 15,500 feet, Bree was hit with altitude sickness, and the ensuing nausea and headache almost prevented her from continuing. The physicians on the trip gave her a steroid that kept her going.
That experience reminded her that a great team is invaluable and the importance of leaning on others.
Once she was back on her feet, Bree and Stephen were determined to reach the summit with their team.
On the last day of their ascent, the group woke early and climbed until lunchtime. They then rested for about nine hours in camp. At 10 p.m., they climbed in the dark almost straight up until they reached the top of Kilimanjaro at 8 the next morning.
When they arrived at the summit, the temperature was zero degrees, the wind was wailing at 40 miles per hour and the sun was rising.
The group had an hour at the top of the mountain to savor the view, reflect on their accomplishments, think about the people for whom they climbed and how the experience will influence the rest of their lives.
For Bree, it was about the beauty of the moment and the people who helped get her there, especially Stephen. They both thought about their 8-year-old twin sons, Beck and Elliott, back home in Katy, Texas, with supportive family members, who also were vital during Bree's treatment.
"After I completely lost it, I thought about how cancer teaches us the beauty of the world and how the Kilimanjaro experience reinvented that lesson," she says. "Oh, and I told everyone in the group that I loved them at least four times. It was glorious up there."
Back home in Katy, Bree and Stephen say they both think about the trip every day.
"It wasn't just about making it to the summit," says Stephen. "It was about personal growth, and proving that you have the strength to do something like this. I was so excited and proud to share this with Bree, and we certainly brought home many lessons to our boys, family members and community."
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