Jefferson’s Kimmel Cancer Center Establishes Center to Eliminate Cancer Disparities

Dr. Edith Mitchell, director of newly-established Center to Eliminate Cancer Disparities, and Robin Evans, a patient.

PHILADELPHIA—In an effort to reduce and eventually eliminate cancer disparities among adults in the Philadelphia region, the Kimmel Cancer Center at Jefferson has established the Center to Eliminate Cancer Disparities.

Edith P. Mitchell, M.D., FACP, a medical oncologist at Thomas Jefferson University Hospital and Clinical Professor of Medicine and Medical Oncology in the Department of Medical Oncology at Jefferson Medical College of Thomas Jefferson University, will serve as its Director.

Despite the decline in cancer incidence and mortality rates in the United States, disparities in cancer burdens continue to exist among certain population groups and the gap continues to widen.  The Philadelphia region in particular has a disproportionately high number of residents suffering from cancers, many of which are preventable and treatable.

Such disparities include differences in incidence, prevalence, mortality and burden of cancer and related adverse health conditions. Disparate population groups may be characterized by gender, age, race and ethnicity, income, social class, disability, geographic location or sexual orientation.

“I have dedicated my career to the treatment of cancer patients and have had the opportunity to experience, as a physician and as a researcher, the significance cancer disparities can have on the outcome of a patient’s treatment,” said Dr. Mitchell. “The first step in the elimination of these disparities is to raise awareness through public and professional education about what resources are available to groups in their fight against cancer.”

The Center aims to accomplish its mission through the facilitation of disparities-focused research, researcher and clinician education, training and teaching, and increased patient access to quality supportive services, such as palliative care, cancer screening and prevention, and survivorship programs.

Dr. Mitchell and her fellow clinicians and researchers at Jefferson are dedicated to the ongoing study of cancer and other health disparities among patients of diverse ethnic and socioeconomic backgrounds. They have created strategic priorities for eliminating such disparities through innovative research, education and training, advocacy, community outreach, and quality medical care.

The need for research into cancer, and other health care disparities, has become increasingly evident in recent years as doctors and scientists learn more about how slight variations in genetic makeup can have drastic effects on the way cancer invades an individual’s body.  Knowing that these disparities exist can improve how screening processes are established and help doctors understand which treatments will and will not be effective.

Dr. Mitchell has spent her medical career helping individuals in medically underserved areas to realize that simple changes in lifestyle can have a dramatic impact on cancer care. Through her work, Dr. Mitchell has demonstrated the importance of community service and outreach especially to those individuals who may not have the means to seek out more conventional medical advice.

She holds board certifications in both Internal Medicine and Medical Oncology and is a Fellow in the American College of Physicians. She has also served as the Program Leader in gastrointestinal oncology for more than 15 years and has a focused research effort in aggressive breast cancers.

“We want all researchers and clinicians to be aware of the disparities that exist in cancer diagnoses among diverse ethnic groups so that they can incorporate these important factors into their research efforts and clinical practice,” said Dr. Mitchell.

“The Center will also provide patients with contact information for cancer advocacy and support groups both locally and nationally that serve the needs of their demographic background. We are proud to host and sponsor several annual events where patients can come together to share their stories and plan for a future free of cancer disparities,” she said.



High Dose Vitamin C for Advanced Pancreatic Cancer

By Josh Goldstein, The Daily Dose @Jefferson

A small phase I clinical trial at Jefferson University Hospitals of high-dose, intravenous vitamin C in combination with chemotherapy medications show that this treatment is safe and may have promise for patients with advanced pancreatic cancer.

The study published in the open access online journal PLoS ONE tested the use of intravenous ascorbic acid (vitamin C) three times a week over an eight week cycle in nine patients with metastatic stage IV pancreatic cancer in addition to standard gemcitabine and erlotinib chemotherapy regimens.

“These initial safety data do not reveal increased toxicity with the addition of ascorbic acid to gemcitabine and erlotinib in pancreatic cancer patients,” wrote the team of researchers from the Kimmel Cancer Center at Jefferson as well as the National Institutes of Health (NIH). “This combination with the observed response to treatment suggests the need for a phase II study of longer duration.”

The research was conducted at Jefferson by a multidisciplinary team from the Jefferson-Myrna Brind Center of Integrative Medicine, Jefferson’s Department of Medical Oncology, Department of Surgery, Department of Radiology, and National Institute of Diabetes and Digestive and Kidney Diseases of the NIH.

Daniel A. Monti, MD, Executive and Medical Director of the Jefferson-Myrna Brind Center of Integrative Medicine and lead author of the study said, “We are pleased and encouraged by these results.”

Dr. Monti added, “it is a Jefferson priority to study promising therapies for pancreatic cancer. It is crucial to explore anything that might feasibly give these patients an edge. We are now actively enrolling eligible patients into the Phase II trial.”



New Clinical Trial: Cabazitaxel with Radiation and Hormone Therapy May Improve Prostate Cancer Survival

Jefferson’s Kimmel Cancer Center has started a Phase I clinical trial investigating the latest prostate cancer chemotherapy drug to extend survival, Cabazitaxel, in combination with radiation and hormone therapy. This first-of-its-kind multimodality approach could improve disease control and eventually survival for locally advanced prostate cancer patients.

The single-center, open-label, non-randomized Phase I study of weekly Cabazitaxel with concurrent intensity modulated radiation therapy (IMRT) and androgen deprivation therapy will test its safety and the tolerable maximum dosing.

Cabazitaxel was approved in the U.S. for second-line use in advanced hormone-refractory prostate cancer in men in 2010, and has been described as a major advance in chemotherapy for advanced prostate cancer. It extended overall survival by 2.4 months when compared with mitoxantrone in patients who were previously treated with docetaxel. However, a multimodality approach with the drug has never been studied.

“We know the drug is effective in prostate cancer, but there is no study with radiation and hormone therapy yet,” said principal investigator Jianqing Lin, M.D., an assistant professor of medical oncology at Thomas Jefferson University Hospital. “Concurrent radiation may have a better control for localized disease, and better long-term survival for these high-risk patients.”

IMRT is a type of 3-dimensional radiation therapy that uses computer-generated images to show the size and shape of the tumor; androgen deprivation therapy is a treatment to suppress or block the production or action of male hormones. Enrolled men will receive weekly treatments of the chemotherapy drug and hormone therapy and then every three months until two years after completion of IMRT.

For the clinical trial, Dr. Lin is partnering with co-investigator Timothy Showalter, M.D., an assistant professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital.

For further information, please contact the Kimmel Cancer Center at Jefferson’s Clinical Research Management Office at 215-955-1661.



New Half-Match Bone Marrow Transplant Procedure Featured in Philadelphia Inquirer

Neal Flomenberg, M.D., chair of the Department of Medical Oncology at Jefferson and Dolores Grosso, DNP, co-principal investigator of the study, have developed a way to make stem-cell transplants work, even when only half the immune markers are matched.

Featured in the “Check Up” section of The Philadelphia Inquirer, this research has major implications. Half-match transplants would triple the pool of suitable donors, giving new hope to patients with terminal leukemia, lymphoma, sickle-cell anemia and other blood diseases. “You could help almost everybody,” said Grosso.

Learn more by reading “Check Up: Innovation in stem-cell donation.”



Half-Match Bone Marrow Transplant Procedure Yields Promising Outcomes for Cancer Patients

Dolores Grosso, DNP, Co-Principal Investigator and lead author of the article

Half-matched bone marrow or stem cell transplants for blood cancer patients have typically been associated with disappointing clinical outcomes. However, a clinical trial conducted at the Kimmel Cancer Center at Jefferson testing its unique, two-step half-match procedure has produced some promising results: the probability of overall survival was 45 percent in all patients after three years and 75 percent in patients who were in remission at the time of the transplant.

Reporting in the journal Blood in a published-ahead-of-print article dated August 25, Neal Flomenberg, M.D., Chair of the Department of Medical Oncology at Thomas Jefferson University Hospital, Dolores Grosso, DNP, Co-Principal Investigator and lead author of the article, and colleagues discuss the results of 27 patients treated on this phase I/II trial who had diagnoses that included leukemia, lymphoma and myelodysplasia.

The patients received their transplant in two steps. First, after receiving radiation therapy to further treat their disease, the patients were given a specified dose of T cells (a type of immune cell that fights infection) from their half-matched family donor. The donors were parents, siblings or children of the patient. The patients next received the drug cyclophosphamide to help the newly infused donor T cells to be more tolerant to the patient’s body. The second step of the transplant occurred when the patients received a dose of their donors’ stem cells to help their blood counts return to normal and further strengthen their new immune system.

Dr. Flomenberg and his team found that after a follow-up of 28-56 months, overall survival for the patients after one year was 54 percent and 48 percent at three years. Patients in remission at the time of the transplant fared better with an overall survival of 75 percent. Seventeen of the 27 patients—with a median age of 52 years old—were alive six months after their transplant, which was the official end point of the trial.

While more recent studies have shown promising increases in overall survival for patients undergoing half-match transplants, historically, clinical outcomes for these types of transplants have been poor, which has limited the use of this type of procedure.

The results of the Jefferson trial represent a very promising improvement in this area.

Bone marrow or stem cell transplants are performed in order to replace a patient’s diseased immune system with that of a healthy donor. Traditionally, the use of a genetically fully matched donor has been associated with the best results in bone marrow transplant, but many patients lack a fully-matched related or unrelated donor. Almost every patient will have a half-matched donor (also known as a haploidentical donor) in their family, however.

The successful use of haploidentical donors would greatly expand the number of donors available to a patient, extending this therapy to almost everyone who would benefit from receiving a transplant.  This would include minority patients, including patients with sickle cell anemia, who do not have as many fully-matched unrelated donors available to them.

“Our half-match bone marrow transplant results open up many doors for different types of patients who can’t find an exact match,” said Dr. Flomenberg. “It also justifies recommending that patients at high risk for relapse should consider having a half-match transplant early in the treatment of their disease.”

“Jefferson’s two-step procedure provides promising results that could serve as the basis for further exploration and optimization of the technique,” he added.

Jefferson medical oncologists’ approach is unique in that the dosage, timing and treatment of donor T cells was carefully controlled and optimized. No other transplant regimen controls the exact amount of donor T cells given.  The investigators believe that dosing the T cells in this way helped avoid many of the life-threatening side effects of this type of transplant.

“We believe the dosage and timing of T cells from the donor into the patient is essential for success. In fact, it’s equally as important as prescribing specific doses of radiation and chemotherapy to initially treat the disease,” said Dr. Grosso. “The goal of this two-step regimen was to develop a better technique for half-matched patients with relapsed blood cancers initially, but we also showed that it can be appropriate for high risk patients earlier in their disease who lacked fully matched donor options.”



Jefferson Clinical Trial: Can a Cholesterol Drug Prevent Colon Cancer?

Thomas Jefferson University has started recruiting patients for a new National Cancer Institute (NCI)-sponsored clinical trial to test whether the cholesterol-reducing drug rosuvastatin is effective in the prevention of recurrent colon cancer.

Previous laboratory research and population studies have shown that patients taking statins, the class of drugs that lowers cholesterol, had fewer colon polyps, which can lead to cancer if left untreated. However, those findings come largely from retrospective, observational studies originally designed to investigate lipid-lowering or cardiovascular endpoints in the short term rather than tumor endpoints.

“The jury is still out, and we need to get definitive answers,” said Bruce Boman, M.D., Ph.D, professor of medical oncology at Thomas Jefferson University and principal investigator for the national clinical trial. “This prospective design comparing a statin against a placebo is what is needed to address the question: Are statins effective chemoprevention agents or not?”

This five-year, nationwide study will be the first randomized, prospective, placebo-controlled, double-blind study to evaluate the drug’s role in preventing colon cancer and will involve 1,740 patients in total.

Conducted by a network of cancer research professionals from the National Surgical Adjuvant Breast and Bowel Project (NSABP) at 400 medical centers across North America, including Jefferson, the study involves patients who have recently been diagnosed with early stage colon cancer, and who were not already taking statins for high cholesterol.  Those recruited have been surgically treated for stage I and II colon cancers previously.

Patients will be randomly assigned to one of two groups.  Each group will take one pill a day for five years.  One group will receive rosuvastatin, while the other group will receive a placebo.

The cumulative incidence for developing colorectal adenomas three years after surgery/treatment for early stage colon cancer is 50 percent. Thus, the benefit/risk ratio for chemoprevention intervention is potentially very positive in this high-risk population.

“There will be an estimated 102,900 new cases of colon cancer in the United States this year,” said Norman Wolmark, M.D., NSABP’s chairman.  “In fact, colorectal cancer is the third most common cancer found in men and women in this country.   We hope this trial will be an important step in reducing these numbers.”

The principal investigator for the trial at Jefferson is Scott Goldstein, M.D, director of the Division of Colon and Rectal Surgery at Thomas Jefferson University.

People recently diagnosed with a Stage I or II colon cancer and interested in the study should contact Vicki Squire of Thomas Jefferson University at  Vicki.Squire@jeffersonhospital.org or 215-503-5641.

A list of other sites in North America that are participating in the study may be found at http://www.nsabp.pitt.edu/P5_Sites.asp



Dr. Leonard Gomella co-chairs ASCO GU in Orlando

Dr. Leonard G. Gomella, chair of the Department of Urology and director of Clinical Affairs at the Kimmel Cancer Center at Jefferson, co-chaired the American Society of Clinical Oncology (ASCO) 2011 Genitourinary (GU) Cancers Symposium meeting in Orlando on Feb. 17 though Feb. 19.

The “2011 Genitourinary Cancers Symposium: An Evidence-based Multidisciplinary Approach,” was a three-day Symposium that offered educational sessions and oral and poster abstract presentations focused on genitourinary cancers of the prostate, penis, urethra, testis, bladder and kidney.

Over 1,800 physicians, researchers, care givers and survivors attended the meeting sponsored by ASCO, the American Society for Radiation Oncology (ASTRO) and the Society of Urologic Oncology (SUO).

Orlando, FL – 2011 Genitourinary Cancers Symposium – Dr. Leonard G Gomella, co-chair the 2011 Genitourinary Cancers Symposium (GU) meeting at the Marriott World Center on Thursday, February 17, 2011. Photo by © Todd Buchanan

Dr. Gomella’s talk during the opening remarks was titled “Decision Making Based on Predictors of Clinical Progression.”

To learn more about this symposium, visit http://gucasymposium.org/Home.aspx



Shifting a paradigm: A molecular approach to staging colorectal cancer

A quantitative, molecular analysis of lymph nodes in patients deemed colorectal cancer-free was found to be an effective predictor of recurrence, according to a study from researchers at the Kimmel Cancer Center at Jefferson and published online Feb 9. in Clinical Cancer Research.

Recurrence occurs in about 25 percent of node-negative patients (pN0), suggesting that occult metastases escaped detection, be it imaging modalities or histopathology.

To better predict recurrence and accurately stage these patients, Terry Hyslop, Ph.D. and Scott A. Waldman, M.D., Ph.D. of the Department of Pharmacology and Experimental Therapeutics of Thomas Jefferson University and the Kimmel Cancer Center at Jefferson, and colleagues explored a novel molecular approach, using the biomarker GUCY2C for metastatic colorectal cancer cells.

Using 291 colorectal cancer patients who were node-negative, the researchers analyzed lymph nodes by histopathology and GUCY2C quantitative qRT-PCR. They were followed for a median of 24 months and categorized as having either low, intermediate or high tumor burdens.

The researchers had previously concluded that expression of GUCY2C increased risk of recurrence. However, it is apparent that nodal metastases do not assure recurrence; rather they indicate risk.

The researchers found that patients with greater occult tumor burden have a greater risk of recurrence compared to patients with less burden. Thus, molecular tumor burden in lymph nodes are independently associated with time to recurrence and disease-free survival in patients with node-negative colorectal cancer.

“This approach can improve prognostic risk stratification and chemotherapeutic allocation in pN0 patients,” the authors write. “More generally, this study reveals a previously unappreciated paradigm to advance cancer staging, clinically translating emerging molecular platforms that complement histopathology, laboratory diagnostic, and imaging modalities.”



Dr. Leonard G. Gomella Studies the Effect of Dutasteride on the Risk of Prostate Cancer

GomellaLeonardG

Dr. Leonard G. Gomella

Dr. Leonard G. Gomella and colleagues conducted a landmark international
randomized, double-blind, placebo-controlled, parallel-group multi-center
clinical trial to determine whether dutasteride reduces the risk of incident
prostate cancer, as detected on biopsy, among men who are at increased risk for
the disease. Over the course of the 4-year study period, dutasteride reduced
the risk of incident prostate cancer detected on biopsy and improved the
outcomes related to benign prostatic hyperplasia. These results were published
in the New England Journal of Medicine on April 1, 2010 ( Pubmed Abstract ).