KCC Ranked as One of Best Cancer Hospitals in US

Men’s Health magazine recently ranked the Kimmel Cancer Center at Jefferson among the best in the nation, calling out its success in treating prostate cancer, a leading cancer in men.

The American Cancer Society estimates there will be more than 1.5 million new cancer diagnoses in 2013.

Jefferson scientist, Matthew Schiewer, Ph.D., recently received the Prostate Cancer Benjamin Franklin Young Investigator Award, and will use the funds to help find treatments for advanced-stage prostate cancers.

Jefferson is home to top-of-the-line equipment and high-tech features like electron and photon-beam treatment and complete 3-D treatment planning.  We offer comprehensive diagnostic and treatment options for prostate cancer in addition to state-of-the-art prostate imaging and biopsy service.

When indicated, a prostatectomy can be performed either laparoscopically or via open surgery.  Jefferson physicians were the first in the Delaware Valley to remove the prostate laparoscopically, and have extensive experience with and numerous scientific publications on the use of the da Vinci® Surgical System.

“It is rewarding for our team to be recognized for excellence in cancer care,” says Richard G. Pestell, MD, PhD, MBBS, FRACP, MBA, Kimmel Cancer Center Director.  “We are one of only eight NCI-Designated cancer centers in the United States with a prostate program formally reviewed and endorsed by the National Cancer Institute. This program, led by Leonard Gomella, MD and Karen Knudsen, PhD, is a powerhouse of key advances in prostate cancer.  Our leading edge research and clinical care excellence across a wide spectrum of cancer specialties, including men’s health, enable us to deliver the best outcomes for our patients.”

Kimmel Cancer Center at Jefferson

The Kimmel Cancer Center at Jefferson is a National Cancer Institute (NCI)-designated clinical cancer center for excellence in cancer care and research. U.S.News & World Report also recognizes Jefferson as one of the best hospitals in the nation for Cancer care. Taking into account your varied needs, our nationally renowned cancer experts bring together a team of specialists in a wide range of disciplines to work with you and your primary care or referring physician to devise a personalized treatment plan.

The physicians and scientists of the Kimmel Cancer Center have helped pioneer new approaches to cancer treatment by transforming scientific discoveries into improved patient care. Our physicians are experienced in using the most advanced treatment methods and technologies and are at the forefront of developing new therapies. As a result, you may have the opportunity to take part in one of the more than 120 clinical trials for promising new cancer treatments being conducted at Jefferson at any given time.

by Danielle Servetnick on Tuesday, July 16th, 2013 in Cancer CareIn The News.



ASCO: Liver Metastases and its Prognostic Significance in Men With Metastatic Castration-Refractory Prostate Cancer

Liver metastases predicts shorter overall survival in men with metastatic castration-refractory prostate cancer (mCRPC), according to data being presented at the 2012 American Society of Clinical Oncology Annual Meeting in Chicago. (Abstract # 4655, Sunday, June 3, 8:00 AM – 12:00 PM CST, S Hall A2).

In a phase III trial, lead study author William Kevin Kelly, DO, Thomas Jefferson University Hospital and the Kimmel Cancer Center at Jefferson, and colleagues from the Alliance for Clinical Trials in Oncology, found that men without liver metastases lived 8.2 months longer compared to men whose cancer did metastasize, despite both groups having similar progression free survival and response to docetaxel based chemotherapy.

The multi-institutional study included 1,050 patients from the CALGB 90401 trial, a randomized, double-blind, placebo-controlled phase III trial comparing docetaxel, prednisone, and placebo with docetaxel, prednisone, and bevacizumab in men with mCRPC.

For the investigation, researchers assessed the prognostic significance of liver metastases in predicting overall survival and progression free survival, adjusting for stratification factors.

Fifty-nine (5.6%) of those patients had documented liver metastases.  Patients with liver metastases had higher baseline alkaline phosphatase (ALK) and lactate dehydrogenase (ADH) levels compared to patients without liver metastases. The median overall survival time in patients with liver metastases was 14.4 compared to 22.6 months for patients without liver metastasis(hazard ratio (HR) 1.4) . The HR for treatment effect (docetaxel and prednisone with either bevacizumab or placebo) for liver metastases was not statistically significant for either group.

The full abstract can be found here. http://abstract.asco.org/AbstView_114_96038.html



Jefferson Receives $2.6 Million NIH Grant to Study Imaging Method to Stage Prostate Cancer Without Biopsy

Mathew Thakur, PhD, professor of Radiology at Jefferson Medical College of Thomas Jefferson University and the Director of the Laboratories of Radiopharmaceutical Research and Molecular Imaging

Jefferson’s Kimmel Cancer Center and the Department of Radiology at Thomas Jefferson University received a five-year, $2.6 million grant from the National Institutes of Health (NIH) to investigate a potentially revolutionary method that can stage prostate cancers and detect recurrent disease so accurately, it would significantly reduce the number of confirmation biopsies. Such biopsies can be invasive, costly, and often lead to false-positive readings.

The new technique involves the use of a positron emission tomography (PET) scan and a novel imaging agent.

The study is being led by Mathew Thakur, PhD, professor of Radiology at Jefferson Medical College of Thomas Jefferson University and the Director of the Laboratories of Radiopharmaceutical Research and Molecular Imaging.

Prostate specific antigen (PSA) measurements, ultrasonography and magnetic resonance imaging (MRI) remain standard tools for diagnosis and management of prostate cancer; however, each requires an invasive biopsy for histologic confirmation.

Biopsies are associated with morbidity and high costs, and more than 65 percent of the 1.5 million biopsies performed each year in the U.S. show benign pathology, indicating a high false-positive rate for these standard diagnostic tools.

These limitations, the researchers say, demonstrate a dire need for noninvasive methods that can accurately stage prostate cancer, detect recurrent disease and image metastatic lesions with improved reliability.

Dr. Thakur and colleagues are studying Cu-64 peptide biomolecules to evaluate prostate cancer tumors via PET imaging. These agents detect prostate cancer by finding a biomarker called VPAC1, which is overexpressed as the tumor develops.

“The challenge has been to develop an imaging agent that will target a specific, fingerprint biomarker that visualizes prostate cancer early and reliably,” said Dr. Thakur, who is also a member of Jefferson’s Kimmel Cancer Center.

Previous studies with Cu-64 peptides from Dr. Thakur yielded promising results in stratifying breast cancer.  A preclinical study published in the Journal of Nuclear Medicine in late 2009 found that 64Cu-TP3805 detected tumors overexpressing the VPAC1 oncogene more accurately in mice than 18F-FDG, a commonly used agent for imaging tumors.

With this NIH grant, the researchers will test the hypothesis in both mice and humans.  They will evaluate two Cu-64 peptides specific for VPAC1 in mice and perform a feasibility study in 25 pre-operative prostate cancer patients, using the best suited Cu-64 peptide determined from the mouse studies.

“This noninvasive method could significantly contribute to the management of prostate cancer,” said Dr. Thakur. “It would result in a reduction of unnecessary biopsy procedures and under treatment or over treatment that yield minimal benefits, incontinence, or impotence.”

Other researchers include Ethan Halpern, MD, Charles Intenzo, MD, and Sung Kim, MD of the Department of Radiology, Edouard Trabulsi, MD of the Department of Urology and Eric Wickstrom, PhD, of the Department of Biochemistry and Molecular Biology. The team will partner with NuView, a molecular imaging technology firm, on the study.

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This study was funded by NIH’s National Cancer Institute (Grant No. 1R01CA157372-01A)



Dr. Leonard Gomella, Program Director for IPCC in New York

Dr. Leonard Gomella, Program Director of 2012's IPCC

Leonard G. Gomella, M.D., FACS, Chair of Urology at Thomas Jefferson University Hospital and Director of Clinical Affairs at the Kimmel Cancer Center at Jefferson, will serve as the Program Director for the Fifth Annual Interdisciplinary Prostate Cancer Congress (IPCC) at the New York Marriott East Side in New York City on March 31.

This full-day continuing medical education (CME) activity entitled Novel Perspectives – Evolving Therapies and Advances In Standard of Care will address the differences that currently exist between urologists’, medical oncologists’, and radiation oncologists’ approaches to treating prostate cancer.

World-renowned thought leaders have been brought together to foster consensus about the best management of prostate cancer from the vantage point of interdisciplinary care teams. Topics of vital interest that will be include: hormonal therapies; imaging and staging; surgical advances; radiation therapies; and emerging multimodal therapies.

The IPCC will include interactive cases designed to highlight multidisciplinary approaches for the management of prostate cancer with the overall goal of improving patient outcomes.

Topics include  prostate-specific antigen testing in diagnosing patients with prostate cancer, and emerging bone-related therapies for treating prostate cancer.

Dr. Gomella told OncLive that the value of the conference for attendees is its focus on practical applications of these new developments. “When they go back to the patient setting, they can actually use [this information] in their daily patient care,” he said.

For more information, please visit, http://cancerlearning.onclive.com/index.cfm/fuseaction/conference.showOverview/id/5/conference_id/702/index.php

http://www.onclive.com/publications/Oncology-live/2012/january-2012/IPCC-Conference-to-Focus-on-Issues-Facing-Clinicians



Curry spice component may help slow prostate tumor growth

Karen Knudsen, PhD, a Professor of Cancer Biology, Urology and Radiation Oncology

Curcumin, an active component of the Indian curry spice turmeric, may help slow down tumor growth in castration-resistant prostate cancer patients on androgen deprivation therapy (ADT), a study from researchers at Jefferson’s Kimmel Cancer Center suggests.

Reporting in a recent issue of Cancer Research, Karen Knudsen, Ph.D., a Professor of Cancer Biology, Urology and Radiation Oncology at Thomas Jefferson University, Supriya Shah, a Jefferson graduate student in Cancer Biology, and colleagues observed in a pre-clinical study that curcumin suppresses two known nuclear receptor activators, p300 and CBP (or CREB1-binding protein), which have been shown to work against ADT.

ADT aims to inhibit the androgen receptor—an important male hormone in the development and progression of prostate cancer—in patients. But a major mechanism of therapeutic failure and progression to advanced disease is inappropriate reactivation of this receptor. Sophisticated tumor cells, with the help of p300 and CBP, sometimes bypass the therapy.

Thus, development of novel targets that act in concert with the therapy would be of benefit to patients with castration-resistant prostate cancer.

For the study, prostate cancer cells were subjected to hormone deprivation in the presence and absence of curcumin with “physiologically attainable’ doses. (Previous studies, which found similar results, included doses that were not realistic.)

Curcumin augments the results of ADT, and reduced cell number compared to ADT alone, the researchers found. Moreover, the spice was found to be a potent inhibitor of both cell cycle and survival in prostate cancer cells.

To help support their findings, the researchers also investigated curcumin in mice, which were castrated to mimic ADT. They were randomized into two cohorts: curcumin and control. Tumor growth and mass were significantly reduced in the mice with curcumin, the researchers report.

These data demonstrate for the first time that curcumin not only hampers the transition of ADT-sensitive disease to castration-resistance, but is also effective in blocking the growth of established castrate-resistant prostate tumors.

“This study sets the stage for further development of curcumin as a novel agent to target androgen receptor signaling,” said Dr. Knudsen. “It also has implications beyond prostate cancer since p300 and CBP are important in other malignancies, like breast cancer. In tumors where these play an important function, curcumin may prove to be a promising therapeutic agent.”



Brachytherapy reduced death rates in high-risk prostate cancer patients, study finds

Xinglei Shen, M.D., a resident in Jefferson’s Department of Radiation Oncology and a part-time master’s degree student in the Jefferson School of Population Health

Brachytherapy for high-risk prostate cancers patients has historically been considered a less effective modality, but a new study from radiation oncologists at the Kimmel Cancer Center at Jefferson suggests otherwise. A population-based analysis looking at almost 13,000 cases revealed that men who received brachytherapy alone or in combination with external beam radiation therapy (EBRT) had significantly reduced mortality rates.

Their findings are reported online January 23 in the International Journal of Radiation Oncology,Biology,Physics.

Brachytherapy involves the precise placement of radiation sources directly at the site of a tumor and is typically used to treat low and intermediate risk prostate cancers. However, brachytherapy treatment for high-risk patients is less common and controversial, given in part to early retrospective studies that found it to be associated with lower cure rates compared to EBRT.

Many experts believe that these early series were limited by poor brachytherapy technique, and that high-quality contemporary brachytherapy may be an effective tool against high-risk prostate cancer.

“The study contradicts traditional policies of using brachytherapy in just low and intermediate risk patients by suggesting there may instead be an improvement in prostate cancer survival for high-risk patients,” said co-author Timothy Showalter, M.D., assistant professor in the Department of Radiation Oncology at Thomas Jefferson University Hospital, and associate research member of Jefferson’s Kimmel Cancer Center. “Although studies like this cannot prove an advantage for brachytherapy, our report does suggest that brachytherapy is no less effective than EBRT and should be considered for some men with high-risk prostate cancer.”

Researchers identified 12,745 Surveillance, Epidemiology and End Results database patients diagnosed from 1988 to 2002 with high-grade prostate cancer of poorly differentiated grade and treated with brachytherapy (7.1 percent), EBRT alone (73.5 percent) or brachytherapy plus EBRT (19.1 percent). The team used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on prostate cancer-specific mortality.

Treatment with brachytherapy alone or brachytherapy in combination with EBRT, the researchers found, was associated with significant reduction in prostate cancer-specific mortality rates compared to EBRT alone.

Significant predictors of use of brachytherapy or brachytherapy plus EBRT were younger age, later year of diagnosis, urban residence and earlier T-stage.

According to the researchers, including lead author Xinglei Shen, M.D., a resident in Jefferson’s Department of Radiation Oncology and a part-time master’s degree student in the Jefferson School of Population Health, the study’s findings provide ample evidence to further study brachytherapy as part of an effective treatment strategy for men with high-grade prostate cancer.

“Today, for the most part, brachytherapy is not being used for these high-risk patients or even recommended,” Dr. Shen said. “But if you look at the biology and theory behind it, it makes sense: you can really give a lot more dose with brachytherapy than with EBRT alone to the prostate. And this presents an opportunity for high-risk patients.”



KCC’s 3rd Annual Men’s Event

Another successful year! The Kimmel Cancer Center hosted its 3rd annual Men’s Event at the Prime Rib in Philadelphia on November 15.

About 150 people joined Richard Pestell, M.D., Ph.D., Director, Kimmel Cancer Center at Jefferson, Leonard Gomella, M.D., Chair, Department of Urology at Jefferson and 2011 Men’s Event Co-Chairs Edward Glickman, President of Pennsylvania Real Estate Investment Trust, and Joseph Weiss, Chairman, Electronic Ink, for an evening of cocktails, dinner, entertainment, auctions and friends.

The dinner and auction raised more than $100,000 to build awareness about prostate cancer and benefit research at Jefferson’s National Cancer Institute Designated Cancer Center.

At this year’s event, John W. Buehler, Jr., a prostate cancer survivor and KCC patient, received the “Symbol of Courage” award, and Kenny Boone was recognized for his support of prostate cancer research and awareness with a “Symbol of Caring” award.

Here’s a glimpse of the night.

Dr. Richard Pestell, director of the KCC

Men's Event auction raised over $100,000

Co-chair Joe Weiss

Eagles long snapper Jon Dorenbos emceed the event

Prostate cancer survivor John Buehler received the "Symbol of Courage" award

Drs. Adam Dicker and Neal Flomenberg

Jessica Soens, Guy Galcerno, Ellen Doubet, and Don Seitz






Robert B. Den, M.D., Joins the Department of Radiation Oncology at Jefferson

Robert M. Den, M.D., Department of Radiation Oncology

Radiation oncologist Robert B. Den, M.D., recently joined Thomas Jefferson University Hospital as an attending physician, and was also named an assistant professor at Jefferson Medical College of Thomas Jefferson University in the Department of Radiation Oncology.

Dr. Den is a clinical scientist who specializes in the treatment of prostate cancer, combining his laboratory research that investigates novel anticancer agents in combination with radiation and hormonal therapy for locally advanced and high risk prostate cancer.

A graduate of Yale University with a B.S. in chemistry, Dr. Den received his medical degree from Harvard University in 2006. Dr. Den’s postgraduate training began at Massachusetts General Hospital in Boston as an intern of medicine before becoming a resident in radiation oncology at Thomas Jefferson University Hospital from 2007 to 2010, and ultimately serving as chief resident (2010-2011).

Dr. Den will serve as a radiation oncologist in the Bodine Center for Radiation Therapy at the Kimmel Cancer Center at Jefferson.

“I’m looking forward to continuing my prostate cancer research with my colleagues here at Jefferson, including the department’s chair, Dr. Adam Dicker, and Dr. Karen Knudsen,” said Dr. Den. “What’s equally important is taking that research to bedside so patients may benefit.”

“Our goal is to personalize the care for each man with prostate cancer, to effectively eradicate the disease,” he added.

Dr. Den is the 2010 recipient of the prestigious Prostate Cancer Foundation Ben Franklin Young Investigator Award. That work is examining the importance of the retinoblastoma tumor suppressor gene, RB, in the response of prostate cancer cells to radiation and hormonal therapy. The research begins to address the ability to personalize therapy based on RB status.

Expanding on that research, Dr. Den is also the principal investigator for a Department of Defense Physician Research Training Award to study whether RB can be used to determine which therapeutic modalities should be administered to patients with locally advanced prostate cancer.  He is also working towards opening a clinical trial to study preoperative radiation for high risk prostate cancer patients.

Dr. Den is member of several professional societies including the American Society for Therapeutic Radiology and Oncology and the American Society of Clinical Oncology, and has co-authored over 25 scientific papers, abstracts and book chapters.



Radiation after prostate removal is cost-effective, but less likely to be recommended by urologists

Timothy Showalter, MD, Department of Radiation Oncology

Receiving radiation therapy immediately after a radical prostatectomy is a cost-effective treatment for prostate cancer patients when compared with waiting and acting on elevated prostate-specific antigen (PSA) levels, according to a new study by researchers at Thomas Jefferson University and Hospital.

What’s more, a separate, but related study, found that urologists were less likely than radiation oncologists to recommend adjuvant radiation therapy or to believe it improves overall survival.

There has been question over whether administering adjuvant radiation therapy after removing the prostate is an appropriate course of action because of associated toxicities, risk of overtreatment and costs, even with data supporting its benefits to overall survival, but a new decision analysis published online in the Annals of Oncology on June 9 found that the procedure is a practical option for patients.

“This work demonstrates that adjuvant radiation therapy is a cost-effective strategy for selected patients after prostatectomy,” said Laura Pizzi, PharmD, associate professor at the Jefferson School of Pharmacy, and senior author of the study. “It is typical for cancer treatments to provide clinical be

nefit at a cost; however, the cost per success that we reported for adjuvant radiation therapy is on the low end when one broadly considers the cost per success reported for other cancer treatments.”

The objective of the study was to construct a decision analytic model to estimate the real world cost of adjuvant radiation therapy versus observation from the payers’ perspective, using peer-reviewed, published data from a Southwest Oncology Group prospective, randomized trial. Side effects, overtreatment and the price tag were taken into account.

Nearly one-third of newly diagnosed men with prostate cancer—almost 220,000 men were diagnosed in 2010—undergo radical prostatectomy. Previous studies have shown that adjuvant radiation therapy improves biochemical progression-free survival and overall survival for these patients; however, most do not receive the treatment.

“Despite being shown to be effective, less than 20 percent of qualifying patients receive it,” said Timothy Showalter, M.D., assistant professor of Radiation Oncology at Thomas Jefferson University, associate research member of the Kimmel Cancer Center at Jefferson, and lead author of the study. “Although not all patients will benefit from adjuvant radiation therapy, the level of utilization is low

er than expected based on the positive, published results of randomized clinical trials.”

“Studies like this one are an important step toward establishing the value of this treatment and suggest that adjuvant radiation therapy should have a role in the treatment of selected patients. Our group has embarked on a large-scale research program to evaluate and improve treatments after prostatectomy for patients with high-risk prostate cancer, and these studies are critical foundational accomplishments,” he added.

Side effects, risk of overtreatment (the subset of patients who may not have failed PSA tests after radiation therapy despite adverse pathologic factors) and the high price have cast some doubts for patients and physicians alike. In many cases, physicians choose to observe patients closely with serial PSA tests and offer radiation therapy only as a salvage treatment after a rise in the PSA levels.

But this new analysis, Dr. Showalter says, “substantiates the benefit of adjuvant radiation therapy,” taking these factors into consideration, including toxicity and overtreatment.

Another study by Dr. Showalter and colleagues, published online in the International Journal of Radiation Oncology, Biology and Physics on May 25, attempted to gauge physician beliefs and practices for adjuvant radiation therapy after a radical prostatectomy.

Leonard Gomella, MD, Department of Urology

Significant discordance was identified. An online survey found that urologists were less likely to recommend radiation therapy immediately after a radical prostatectomy than radiation oncologists. Instead, those clinicians most likely opt to perform frequent PSA tests to monitor cancer, recommending salvage therapy if levels become elevated.

The investigators designed a Web-based survey of post-radiation prostatectomy radiation therapy beliefs and policies. A total of 218 radiation oncologists and 92 urologists completed the survey instrument. Adjuvant radiation therapy after a radical prostatectomy was recommended for qualifying patients by 78 percent of radiation oncologists and only 44 percent of urologists.

Urologists were also less likely to believe that adjuvant radiation therapy improves overall survival (71 percent of radiation oncologists vs. 63 percent of urologists), and perceived higher rates of radiation-related toxicities than radiation oncologists. Physicians’ estimates of radiation-induced urinary problems affected their likelihood of recommending radiation therapy.

The fact that adjuvant radiation therapy use has not increased since the publication of randomized trials supporting the therapy suggests that clinicians have not embraced it, according to the researchers.

“These two studies provide important insights into decision-making regarding radiation therapy after prostatectomy,” said Leonard Gomella, M.D., the Bernard W. Godwin, Jr. Professor of Prostate Cancer and Chairman of the Department of Urology at Thomas Jefferson University. “The disagreement between urologists and radiation oncologists highlights the need for additional research to determine the role of adjuvant therapy in selected patients, and is another example of the importance of multidisciplinary prostate cancer care for our patients to make informed medical decisions.”



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



Free Prostate Cancer Screenings

11-0199 Prostate Cancer Flyer 2010

The Kimmel Cancer Center at Jefferson and Prostate Health International’s Gary Papa Run are offering free prostate screenings as part of a research program. Prostate cancer is the second leading cause of cancer death among men. Screening is important because prostate cancer shows no symptoms in its earliest stages.

Read more…