C3 Collaborating to Conquer Cancer: Spring 2014
The University of Colorado Cancer Center's Spring 2014 edition of C3 Magazine.
C O L L A B O R AT I N G T O C O N Q U E R C A N C E R 12: THERE’S NO ME IN STATISTICS 16: CHARTING THE COURSE 10: Q&A WITH DANIEL BOWLES, MD 11: C3 MD ELAINE LAM 18: SUPPORTER FOCUS ON PLAY STRONG SPRI NG 2014 ecycling R ellular Waste ANSCHUTZ MEDICAL CAMPUS GLE NN ASAKAWA N3WS TA S K F O R C E R E L E A S E S R E C O M M E N D AT I O N S F O R LU N G C A N C E R S C R E E N I N G The U.S. Preventive Services Task Force released its recommendations for lung cancer screening of high risk individuals: Current smokers or smokers who have quit in the last 15 years between the ages of 55 and 80 with a smoking history of a pack of cigarettes a day for 30 years should be tested. In all recomNEW STUDY TARGETS CAREGIVER DISTRESS, PATIENT QUALITY OF LIFE Administering medication, managing side effects, driving to appointments and processing complex information are only a snapshot of caregivers’ duties. Coupled with holding down full-time jobs and maintaining a household, it’s no surprise caregivers are stressed. What’s surprising, though, is how little research has been conducted on mitigating caregiver distress and its impact on patient quality of life. “The distress of caring for patients with cancer has only recently begun to be researched, yet we know that it is becoming increasingly necessary to include them in patient-centered care. Patients and caregivers need to be a team in cancer survivorship,” says Mark Laudenslager, PhD, a CU School of Medicine professor of psychiatry who received a $2 million grant to study interventions to reduce caregiver distress and improve quality of life in allogeneic hematopoietic stem cell transplant patients. A new randomized study is recruiting 225 caregivers of allogeneic patients from CU Cancer Center and Presbyterian/St Luke’s Medical Center to be followed for six months post transplantation. Caregivers will be randomly assigned to receive a stress management intervention or treatment as usual. If the research study mendations mean approximately HI RSCH 10 million smokers and former smokers will qualify for yearly screenings. “The recommendations represent a significant breakthrough in the prevention of lung cancer deaths,” says Fred R. Hirsch, MD, PhD, CU Cancer Center investigator and CEO of the International Association for the Study of Lung Cancer. “In the United States, more than 228,000 new patients are diagnosed with lung cancer every year and more than 160,000 patients die from the disease annually. The screenings have the potential to have an enormous impact.” is successful, Laudenslager hopes to create a caregiver program that can be accessible to all caregivers, whether they live in rural areas or outside Colorado. So far his interventions have been proven to help the caregiver. Only time will tell if they help the patient too. “If caregivers are not able to care for themselves or they are sick, they will not be able to adequately care for their loved one,” Laudenslager says. STUDY: BEAUTY NOT DISEASE MOTIVATES TEENS TO WEAR SUNSCREEN After offering information about UV light and sun-protective behaviors, the two health-education videos Get more CU Cancer Center news on our blog: www.coloradocancerblogs.org Sign up for our bimonthly newsletter, Colorado Cancer News. diverge: One describes the increased skin cancer risk of UV exposure and the other describes effects on appearance, including wrinkles and premature aging. Which of these two videos do you think caused A CU Cancer Center study published in the Journal of the American Academy of Dermatology shows that while teens who watched both videos learned and retained the same amount of knowledge about UV light and sun-protective behaviors, only the teens who watched the appearance-based video (and not the health-based video) actually changed these behaviors. “For teenagers, telling them UV exposure will lead to skin cancer is not as effective as we would hope. If our endgame is to modify their behavior, we need to tailor our message in the right way and in this case the right way is by highlighting consequences to appearance rather than health,” says April W. Armstrong, MD MPH, vice chair of clinical research at the CU School of Medicine Department of Dermatology. However, despite knowing the skin cancer risk from UV exposure, the group that had watched the health-based video showed no statistically significant increase in their sun-protective behaviors. On the other hand, the group that had been shown the appearance-based video reported a dramatic increase in the use of sunscreen. 2 WWW.COLORADOCANCERCENTER.ORG F LI CKR CREATI VE COM MON S teenagers to use more sunscreen six weeks after it was shown? R AT E S TRIPLED IN 30 YEARS MILK THISTLE EXTRACT, SILIBININ, REDUCES SELF-RENEWAL OF COLORECTAL CANCER STEM CELLS Colorectal cancer stem cells thrive in conditions of inflammation. A CU Cancer Center study shows that the chemical silibinin, purified from milk thistle extract, affects cell signaling associated with inflammation and thus also the formation and survival of colorectal cancer stem cells. “We have been deeply involved in this line of research that extends from silibinin to its chemopreventive properties in colorectal cancer, and the current study takes another important step: We see both a likely chemopreventive mechanism and the result of this mechanism in animal models,” says Sushil Kumar, PhD, postdoctoral fellow in the lab of CU Cancer Center Investigator Rajesh Agarwal, PhD. STUDY HIGHLIGHTS LONG-TERM EFFECTS OF CHILDHOOD OBESITY “We have been following this CSC signaling back to its source and we see now that silibinin affects the signaling of colorectal cancer stem cells very near their genesis,” Kumar says. C ASE Y C ASS ON LATE-LIFE HEALTH Childhood obesity rates have nearly tripled in the past 30 years and researchers are asking the important question of how this epidemic will impact the future health of these obese children and public health in general. A CU Cancer Center article published in the journal Gerontology shows that even in cases in which obese children later lose weight, the health effects of childhood obesity may be long-lasting and profound. “There were two things going on here. First, the earlier you are exposed to obesity, the earlier we may see the onset of complications including type II diabetes, cardiovascular disease, metabolic syndrome and cancer,” says Kristen Nadeau, MD, associate professor of pediatric endocrinology at the CU School of Medicine. “But then it looks like independent of this increased-exposure effect, kids’ maturing bodies may be especially vulnerable to the detrimental health effects of obesity. It may be that childhood obesity changes the way the whole metabolism is working—and changes it during a critical developmental time frame.” A second major finding, Nadeau points out, is that obesity is difficult to cure. “It doesn’t just go away. It’s hard to correct once it is established,” she says. Thus as our understanding continues to point to dramatic detrimental effects of childhood obesity, Nadeau and colleagues suggest that in addition to treatment for those already suffering from obesity, additional monies are needed for prevention. MAJOR GENETIC STUDY LINKS LIVER DISEASE GENE TO BLADDER CANCER A study by CU Cancer Center Director Dan shRNA screen, Theodorescu and colleagues turned Theodorescu, MD, PhD, details the discovery of a off the gene AGL. The result was dramatic. new genetic driver of bladder cancer: silencing of the gene AGL. “We tend to think of cancer resulting from mutations that let genes make things they shouldn’t or “In tumors that were seeded in mouse models, it was only the cells low in AGL that were able to grow,” Theodorescu says. To discover this mechanism’s clinical rel- turn on when they should be quiet. But cancer can evance, Theodorescu and colleagues looked at also result from loss of gene function. Some genes AGL expression in 561 samples of human bladder suppress cancer. When you turn off these suppres- cancer. Sure enough, patients with low-AGL tumors sors, cancer grows,” says Theodorescu. fared worse than patients with high-AGL tumors. To discover which genes, when deactivated, “First, this shows that AGL could be used in might drive bladder cancer, Theodorescu and col- bladder cancer prognosis. With lower AGL, prog leagues turned off genes, one by one, in bladder nosis is worse and may inform treatment decisions. cancer cell models. Of course, the vast majority In addition, these genes may be targetable players of the genes researchers silenced made no differ- in a pathway that drives cancer. By affecting these ence—they weren’t functionally related to tumor levels, we may be able to influence the course of growth. But eventually in this genome-wide the disease,” Theodorescu says. NON-INVASIVE IMAGING INSTEAD OF REPEATED BIOPSY IN ACTIVE MONITORING OF PROSTATE CANCER Prostate cancers don’t tend to use glucose as an to block prostate cancer cells’ ability to oxidize this metabolic technique to allow PET imaging to energy source, but PET scanning looks for glucose lipids. With the lipid energy source removed, monitor prostate cancer progression without the uptake. A CU Cancer Center study describes a cells switched to glucose metabolism. need for so many biopsies.” novel method to “manipulate the lipid metabolism “Because prostate cancer can be a slow- CU Cancer Center is currently recruiting par- in the cancer cells to trick them to use more radio growing disease, instead of immediate treatment, ticipants for a human clinical trial of the fat-burning labeled glucose, the basis of PET scanning,” says many men choose active surveillance: They watch inhibitor ranolazine to enhance PET imaging Isabel Schlaepfer, PhD. and wait. But that requires repeated prostate biop- during the active monitoring of prostate cancer sies,” says Schlaepfer. “Instead, now we could use (NCT01992016). The study used the clinically safe drug etomoxir 3 C3: SPRING 2014 ecycling ellu R O When your cells have extra or dangerous material, they recycle it into energy or building blocks. Cells put trash into bins and transport it to recycling centers where waste becomes energy. 4 WWW.COLORADOCANCERCENTER.ORG n April 26, 2003, engineer, adventurer and Aspen local Aaron Ralston was making his way down remote Blue John Canyon just south of Canyonlands National Park. Canyoneering is a strange activity, requiring some hiking, some climbing and maybe some swimming. Blue John was no exception. At a place where the floor fell away, Ralston found himself “chimneying” downward, using his hands and feet to press against the tight, opposing walls the way a child might climb the inside of a door frame. A boulder blocked his descent. And as Ralston scrambled down and around the boulder, it moved, crushing his right arm and pinning it against the canyon wall. You know the rest of the story: Five days later, the delirious and severely dehydrated Ralston used the 2-inch blade on his multi-tool to cut off his arm so he could live. Every cell in your body has a similar ability. In times of stress, your cells sacrifice parts of themselves to save the whole. The process is called autophagy (literally, in Greek, “to eat oneself”) and here’s how it works: In your cells are many tiny things that float around doing stuff (to use the scientific terminology). One of these things is called a lysosome. Think of lysosomes as little sacks of acid into which your cells throw proteins, pathogens, and even other cellular things that are either malfunctioning or extra. Whatever the material, like ripping apart a Lego kit, lysosomes break it down and recycle it into energy or building blocks for other, more important things. But lysosomes can’t just float around the cell looking for things to recycle. Instead, they depend on other things called authophagosomes that act as dump trucks, bringing recyclable material to the lysosome. These autophagosomes are constantly assembling themselves and unlike most “things,” autophagosomes have two cell walls—an inner and an outer—so they can encapsulate dangerous recyclable material inside their inner wall. The autophagosome encases material and brings it to the lysosome; then the two organelles fuse together and the material passes from dump truck to recycling facility. Autophagy is a wonderful thing. It helped you survive in that testy period just after birth when you lost the umbilical connection to your mother; it now helps you survive between meals; and it engulfs and degrades junk you would rather not float around your cells, including but not limited to damaged or mutated proteins that could otherwise cause cancer. So the headline is this: Autophagy helps your cells survive stress and protects you against cancer. But, unfortunately, the same protection that autophagy offers to your healthy cells, it also offers to any cancer cells that grow despite your body’s best attempts at suppressing them. There’s a paradox: The body uses autophagy to keep itself safe from cancer and cancer cells use autophagy to keep themselves safe from all the doctors and researchers at the University of Colorado Cancer Center who would very much like to make them go away. So we’re left with a dilemma. To combat cancer, should we boost or lower autophagy? ular Waste BY GARTH SUNDEM “A common lab technique is to treat cells with what’s called the IC50 of a drug—the drug concentration at which half of the cells should die and half should survive,” says Andrew Thorburn, PhD, deputy director at CU Cancer Center, and one of the world’s leading experts on this paradox of autophagy. “Now, cancer scientists have traditionally thought of this stochastically—that is, at this concentration, it’s chance that 50 percent of cells live while 50 percent of cells die. What our work is showing is that this cell death and survival might not be chance at all. Which cells live and which cells die when faced with an anti-cancer drug may be determined in part, or even in large part, by autophagy,” Thorburn says. But, again, it’s not as simple as squelching autophagy to nix cancer cells’ protection. Take this recent finding from CU postdoc Jacob Gump, working in the Thorburn Lab: Imagine you have dishes of cells, some with high autophagy and some with low autophagy, and then you hit these cells with two drugs known to activate the machinery that leads to cell death. Gump found that with one drug (abbreviated TRAIL), cancer cells were protected by autophagy, but with the other drug (called Fas ligand), autophagy sensitized cells to the drug. But what if we were able to manipulate autophagy and patients on one drug would benefit while patients on the other drug would not? “If this finding applies in human contexts, decreasing autophagy could make a cancer cell you’re trying to kill more or less resistant to whatever you’re using to try to kill it,” Thorburn says. So which cells are which? What cancers are hurt, helped or indifferent to autophagy? Working in Thorburn’s lab, Paola Maycotte, PhD, postdoctoral researcher, has one important answer. PATRICK CAMPBELL TH E PROM I S E AUTO P HAGY I N TR I P LE - N E GATI V E B R EAST CAN C E R “Sometimes with cells, the answer comes from trying new techniques on many cell lines, noticing what works, and then working to discover why the technique worked,” Maycotte says. In this case, Maycotte and colleagues gathered a panel of breast cancer cell lines, turned off autophagy in these cells, and watched closely. “One wonderful thing about working in the system of an academic medical and research center is that we have access to these important cells for our experiments,” Maycotte says, crediting CU Cancer Center’s Tissue Culture Shared Resource for providing the cell panel. After knocking down autophagy in these many kinds of breast cancer cells, Maycotte found a striking result: Nixing autophagy made chemotherapy drugs more effective in all cell lines tested, but even more striking was the result specifically in triple-negative breast cancers—the most dangerous form of the disease that is still without a targeted treatment. Andrew Thorburn, PhD, deputy director at CU Cancer Center, is one of the world’s leading experts on this paradox of autophagy. 5 C3: SPRING 2014 Working in Thorburn’s lab, Paola Maycotte, PhD, postdoctoral researcher, and colleagues gathered a panel of breast cancer cell lines, turned off autophagy in these cells, and watched closely. “Most of our studies imagine making existing drugs more effective by raising or lowering autophagy, but in the case of triple-negative breast cancer cells, many were so addicted to autophagy that when we limited it, these cells died without even the addition of another drug,” Maycotte says. Of all these breast cancers, triple-negative tumors were by far the most dependent on autophagy. The reason why depends on something called STAT3, which in breast and many other cancers makes tumors harder to kill and makes cells more likely to grow and spread. In other words, having too much STAT3 makes most tumors aggressive. However, in triple-negative breast cancer, STAT3 may also be the cancer’s Achilles heel. Not only does the breast cancer use STAT3 to drive its aggressive growth, it also depends heavily on the STAT3-type growth for its survival. If you take away a cell’s ability to use STAT3 it whithers and dies. Drugs that inhibit autophagy do just that: They block the ability of STAT3-addicted, triple-negative breast cancer cells to use the survival and growth signals they need in order to stay alive. ZO M B I E CAN C E R C E LLS EAT TH E M S E LV E S TO L IV E Meanwhile, at the University of Colorado Boulder, about 30 miles northwest of Thorburn’s lab, Joaquin Espinosa, PhD, a molecular biologist, has been exploring autophagy from another angle. “Andrew [Thorburn] was up here on campus giving a talk about his findings and I realized that what he was saying could explain some of the things we had been seeing in our lab,” Espinosa says. Espinosa, like Thorburn, has a specific, world-renowned expertise. Espinosa’s expertise is with a gene called p53, which is also known as the tumor-suppressor gene. When it notices DNA damage, p53 calls in repair machinery. And (like autophagy), when DNA damage is beyond repair, p53 puts machinery in motion that kills the cell before it can do harm. 6 WWW.COLORADOCANCERCENTER.ORG GLE NN ASAKAWA At University of Colorado Boulder, Joaquin Espinosa, PhD, a molecular biologist, has been exploring autophagy by focusing on a gene called p53, which is also known as the tumor-suppressor gene. Now the next part gets a little tricky, so stick with it. The p53 protein kills cells by bursting little creatures called mitochondria that live in your cells. They are literally “creatures” because mitochondria aren’t built from your DNA and instead have their own. In fact, because you inherit mitochondrial DNA from your mother, science can see the existence of what it calls (in shorthand and with no intentional biblical reference) a “mitochondrial Eve.” We are all the descendants of one early human female that lived about 140,000 years ago. For the purpose of this article, that’s just cool trivia. More relevant is the fact that in addition to being the body’s energy factories, mitochondria also hold poisonous, cell-death chemicals. Woe be unto the cell that pops its mitochondria. But just as autophagy keeps us cancer free by recycling dangerous proteins, the p53 gene keeps us cancer free by exploding mitochondria, thus killing cells with damaged DNA. “And we realized that autophagy was encapsulating and safely degrading these distressed mitochondria before they could release their cell-death chemicals,” Espinosa says. In other words, autophagy was protecting cancer cells from the release of mitochondrial poisons that should have resulted in the death of the cancerous cell. It was as if by eating themselves, these zombie cancer cells could be brought back from the dead. Literally, in a video that accompanies the group’s paper describing this finding (Cell Reports, March 2014), you can see mitochondria release their deathsignaling poisons, at which point the cells are technically “dead.” But then you can see rescue by autophagy and these cells go on to recover and divide. They are back from the beyond. “You take down autophagy and cell death goes up,” Espinosa says. Importantly, the cells that are killed in this way are only the cells that p53 has recognized as holding damaged DNA. Healthy tissue is unharmed while cancer cells are killed. IT WAS AS IF BY EATING THEMSELVES, THESE ZOMBIE CANCER CELLS COULD BE BROUGHT BACK FROM THE DEAD. 7 C3: SPRING 2014 PAT RIC K C AMPBE LL The study of autophagy is gaining traction at the base of CU Cancer Center’s research pyramid—the labs of molecular biologists, pharmacologists and geneticists. AUTO P HAGY I N US E All this deep-science talk of p53, STAT3 and IC50 is enough to make your brain pop right along with those poison-containing mitochondria. Add the strange soup of autophagy, in which it’s sometimes helpful and sometimes hurtful in cancer care, and it can quickly seem like we’re years or decades away from its use. Except if you type in “chloroquine AND cancer” at the website clinicaltrials.gov, you’ll quickly see otherwise. Inhibiting autophagy is being tried right now in cancers ranging from lung to pancreatic and breast to brain. Surprisingly, it’s being done with a malaria drug. The drug chloroquine was developed in 1934, but only after World War II was it put into use for the prevention of malaria. Chloroquine does a couple of things: In malaria it keeps the parasite from “digesting” a toxic molecule until the malaria parasite eventually drowns in its own metabolic waste. In autophagy, chloroquine keeps the autophagosome from being able to fuse with the lysosome so it can’t deliver recyclable material. Most of the trials of chloroquine are in their early stages. For example, a Phase I trial of chloroquine with erlotinib in lung cancer found the drug combination was “well tolerated.” For results, you’ll have to wait. A trial at the National Institute of Neurology and Neurosurgery in Mexico City offered promising “midterm survival” results. That’s about it in terms of human results right now. Yet, it’s the kind of interest that starts as a groundswell. You can see the study of autophagy gaining traction at the base of CU Cancer Center’s research pyramid—the labs of molecular biologists, pharmacologists and geneticists. You can see the excitement building toward the level of translational researchers who turn deep science into possible clinical techniques. And the possibility of manipulating autophagy to control cancer is just now starting to reach a human population here at CU Cancer Center and other cutting-edge research institutions. Might this odd, complicated and largely overlooked mechanism, as Thorburn suggests, create the difference between which cancer cells live and which die in the presence of chemotherapy? “Many people think we know the effects of autophagy, but I think we’re just touching the tip of the iceberg of its relevance to patients,” says Maycotte. 8 WWW.COLORADOCANCERCENTER.ORG DEC DINGCANCER How Y our Body AUTOPHAGY: Recycles Waste Inside your cells, the process called autophagy breaks things down. Usually, these things are extra material that your body recycles into energy, but autophagy can also recycle or “digest” dangerous materials including poisons and pathogens. Unfortunately, cancer cells use autophagy to digest chemotherapy drugs before these drugs can kill the cells. That’s why CU Cancer Center researchers are experimenting with blocking autophagy: If autophagy goes down, the power of chemotherapy to kill cancer cells may go up. Here’s how it works: Your cells accumulate extra Autophagosome surrounds and Autophagosome transports materials they no longer need. encapsulates that material. material to lysosome. N Autophagosome and lysosome fuse Lysosome accepts and digests material Lysosome releases energy or usable proteins 9 C3: SPRING 2014 A CONVERSATION WITH DANIEL BOWLES, MD Assistant Clinical Professor of Medicine, Medical Oncology at CU School of Medicine BY GA RT H S U N D E M “In 2009 when the rules regarding the establishment of dispensaries changed, all of a marijuana smokers. Studies thus far have been sudden they showed up on my way to work and in my neighborhood. I wanted to know mixed. For example, a lung cancer study in Sweden what it was all about,” says Daniel Bowles, MD. Here we talk with Dr. Bowles about his followed people for 40 years and found a small involvement with medical marijuana practice and policy, as well as the current knowledge increased risk of lung cancer in heavy marijuana of risks and benefits associated with the drug as they relate to cancer. smokers even when adjusted for cigarette use. But then a study of head and neck cancer found slightly C3: You mentioned noticing a boom in C3: And do you see promise in this decreased rates of oral cavity cancers but increased medical marijuana dispensaries, but how possibility? risks of oropharynx cancer in heavy marijuana users. did you move from seeing dispensaries to Bowles: Well, it’s been a bit difficult to study. While we know about the developmental and mental getting involved? Cannabis is a Schedule 1 drug by federal law, and health issues associated with marijuana use, the Bowles: A few years ago, the Colorado General much of funding we receive in a university research science in terms of cancer is just now starting to Assembly passed laws that changed and clarified setting comes from the federal government through catch up. medical marijuana rules and regulations, and part agencies like the National Institutes of Health and of this reorganization was the establishment of a National Cancer Institute. There have been a decent C3: Do you find it’s difficult or stigmatizing marijuana task force to advise policy makers. I heard number of preclinical studies of cannabinoids and to be a researcher in this field? about it on public radio and thought it sounded their role in cancer suppression or growth inhibition, Bowles: The field in general is a giant morass right interesting. It turned out the advisory committee was particularly with prostate, breast and brain cancers. now. It’s something many people feel strongly about, looking specifically for an expert in cancer. I applied This work is still in its very early stages, but in my one way or the other. So in addition to science, you for the position and was selected as the oncology opinion it’s a line of research worth following. have belief and policy. We’re learning new things representative. about cannabis and cancer every day, but what we C3: Are there also cancer risks associated know is only one piece of the puzzle, alongside very C3: I think most people are fairly comfort- with cannabis or cannabinoids? strong opinions. I try to focus on the science and able with the idea of medical marijuana used Bowles: The big worry is whether there’s an not necessarily get embroiled in the emotion of the to alleviate symptoms in cancer patients. increase in smoking-related cancers in chronic larger, societal debate. Do you see other potential uses of the drug? FL ICKR CREATI VE COM MON S Bowles: First, I think it’s important to make the distinction between the plant and “drugs” that may be contained in the plant. There’s cannabis, the plant, and then there are cannabinoids, which are the 60-something active chemicals that happen to be derived from the plant. C3: Are the potential benefits different? Wouldn’t the plant itself have similar implications for cancer as the drugs the plant contains? Bowles: When we give patients paclitaxel chemotherapy, we don’t give them the whole yew tree. Paclitaxel was originally derived from natural sources, but its clinical use required being able to properly dose it and control its effects. Similarly, smoking or ingesting cannabis is far too uncontrolled, too variable, for use in a clinical setting, but studying and then administering drugs based on cannabinoids is a real possibility. 10 WWW.COLORADOCANCERCENTER.ORG Smoking or ingesting cannabis is far too variable for use in a clinical setting, but studying and then administering drugs based on cannabinoids is a real possibility. MD CLINICAL CARE It Starts in the Pharmacy E LAI N E L A M, M D, I S N’T WASTI N G TI M E WAITI N G F O R TH E R I G HT D R U G S F O R H E R PAT I E NTS. I N STEAD , S H E ’ S E X PAN D I N G P R E C I S I O N M E D I C I N E, MATC H I N G I N D I V I D UA L G E N E S TO TAR G ETE D TH E RAP I E S. BY E R I K A MATI C H University of Colorado Cancer Center investigator Medical oncologists at academic institutions Elaine Lam, MD, is on a mission to make personal- like the University of Colorado often choose only ized medicine a reality. Though Lam realizes there one type of cancer to treat and research. Lam are still many advances to be made, she works chose genitourinary oncology so she could treat toward finding the mechanisms that drive cancer a variety of cancers, including prostate, bladder, and matching them to targeted drugs. testes and kidney. Additionally, drug development ABOUT ELAINE LAM, MD Investigator, University of Colorado for these cancers has rapidly expanded in the past Cancer Center of her life. Growing up in Littleton, she attended decade, which perfectly matched her background Assistant Professor, Division of Medical Heritage High School and then went on to receive in pharmacy. Oncology, University of Colorado School Colorado has been home to Lam for much a bachelor of arts in biochemistry at the University Traditionally, chemotherapy treatment options of Colorado Boulder and a bachelor of science depend mainly on a patient’s cancer type. But in pharmacy at the University of Colorado Health that’s not good enough. Lam believes treatment Sciences Center, as it was then known. Fresh out types need to depend on the genetic mutation of school, Lam became a clinical pharmacist but each patient has—the basis of precision medicine. quickly realized she longed for patient interaction. “We can do better and need to do better,” says “I loved my work as a clinical pharmacist, but Lam. “The examples of erlotinib and crizotinib in always felt that something was missing. I wanted to lung cancer and vemurafenib for melanoma have have more patient contact and be directly involved taught us that certain genetic changes and muta- in the care of patients,” Lam says. “I decided that tions in cancer cells may be predictive of whether going back to [medical] school was the way to a specific treatment will work. By targeting the make that happen.” genetic drivers within a patient’s cancer cells, we Her Colorado roots continued. Lam landed at the CU School of Medicine for medical school and completed her residency in internal medi- could potentially treat the cancer more effectively with fewer side effects.” of Medicine “By targeting the genetic drivers within a patient’s cancer cells, we could potentially treat the cancer more effectively with fewer side effects.” —elaine lam, md Recently Lam launched a new clinical trial at cine, serving as chief medical resident. During CU Cancer Center in which patients with very her residency, she became interested in treating advanced cancer may undergo a biopsy to deter- patients with cancer and developing new cancer mine the genetic characteristics of their tumors School of Medicine and Cancer Center, Lam is able drugs while working under S. Gail Eckhardt, MD, using a panel of 200 cancer genes. While this will to gain valuable expertise in molecular pathology, CU Cancer Center investigator and director of the provide a plethora of information, Lam says the bioinformatics, genomic sequencing, interventional Phase I Clinical Trial Program. Lam later went on to questions will become more complex from there. radiology and clinical investigations. And donors In collaboration with colleagues in the CU complete a fellowship in hematology and medical Which gene is the main driver of the cancer? oncology at The Ohio State University, but in 2010 Can they reliably validate the findings? If a mutation Mrs. Monty Rifkin are generously supporting the decided Colorado was truly home. is identified, are there drugs available to the patients effort to move this research forward. “I received excellent training at OSU, but either through clinical trials or through drugs already like Cancer League of Colorado and Mr. and “There is a great urgency for cancer researchers wanted to return to Colorado after fellowship,” approved for other cancer conditions? Will insur- to find more personalized approaches to treat- Lam says. “When an opportunity arose to return to ance companies pay for these drugs? Will our ing cancer so that patients don’t waste time and the University of Colorado to become a part of the hypothesis of one gene, one drug pan out across resources on therapies that aren’t likely to work,” Phase I and Urologic Oncology teams, I jumped at a variety of cancers? Lam says. “Now more than ever, we have a chance the chance to work with Gail again and become a part of our growing Cancer Center.” While the questions are indeed complex, Lam to make precision medicine a reality.” works tirelessly to discover the answers. But she has help. 11 C3: SPRING 2014 BY K I M C H R I SCA D E N THERE’S NO M 1N STAT1ST1CS Pancreatic cancer patient Jim Dysart proves his diagnosis is more than statistics JIM DYSART KNOWS NUMBERS. With a background in economics and finance, and a career in the commercial banking industry, he knows when numbers look good and when they don’t. In 2001, at age 62, Jim knew the numbers were grim— a pancreatic cancer diagnosis with a four to six percent 12 WWW.COLORADOCANCERCENTER.ORG chance of being alive past five years. After his primary care physician broke the news, Jim drove home repeating the words “Jim you have cancer” over and over in his head. That’s when Jim Dysart stopped being a numbers guy. “Despite the numbers there’s never been a time where I thought I wasn’t going to beat it,” he says. C OURT E SY OF JIM DY SART CAS E B Y CA S E Pancreatic cancer is a rare disease. In 2014, approximately 46,000 Americans will be diagnosed with pancreas cancer and 39,000 people will die from it. Of those diagnosed this year, 73 percent will not survive more than 12 months. These statistics are indeed grim, but they don’t tell the whole story. Statistics describe what’s likely to happen to most people in a large group. They can tell you how likely it is to rain, but they can’t tell you whether or not to bring an umbrella to work. And statistics don’t answer the key question, how long do patients like Jim have to live? If fact, statistics completely leave out the individual experience. “These cancers are more heterogeneous than people think,” says Wells Messersmith, MD, leader of the Gastrointestinal Cancer Program at the University of Colorado Cancer Center. “Patients will search on Google for all the statistics after they’ve been diagnosed, but what they don’t recognize is that these are just averages. Averages don’t tell us what each individual patient will experience, and these experiences can be quite variable.” Since Messersmith knows the fear factor behind pancreatic cancer, he always pairs statistics with personal stories when meeting with newly diagnosed patients. “I tell patients that many people with operable cancer do live longer than five years,” Messersmith says. “I communicate those averages but also balance them with stories of patients like Jim who do live longer. While the averages aren’t good, each patient is different—some do much better than average.” Numbers like “4 percent” seem hopeless. Jim’s story of living more than 13 years adds hope. M I L E S F O R CAR E Unlike lung or colon cancer, pancreatic cancer does not produce a lot of early symptoms. Jaundice, nausea, weight loss and abdominal pain are often blamed on other health issues so the cancer goes undiagnosed until it’s too late. Jim, however, was fortunate. Persistent flu-like symptoms alarmed his primary care physician enough to order blood work. While the blood work came back “off the wall,” the diagnosis was stage I pancreatic cancer located in the head of the pancreas. It had yet to spread to other organs. Treatment options looked good. Through a friend of their youngest son, Jim and Betty learned that a complex surgery known as the Whipple procedure could help extend his life and possibly cure the cancer, but he needed to find an experienced surgeon. At the time, Colorado didn’t have the experience. He and his wife, Betty, would need to fly to MD Anderson Cancer Center in Houston, Texas for treatment. Travel was going to add up quickly. Unbeknownst to Jim and Betty, their oldest son, a captain for FedEx, had a plan. He sent an email to college friends who were commercial airline pilots and asked for buddy passes for free travel to Houston. Passes were offered left and right. Opposite: Jim and Betty Dysart in front of their Colorado home. Above: Jim riding in his seventh Ride the Rockies in 2002, a year after his Whipple surgery. “That was real kind,” Jim says, with tears in his eyes. “After that, life changed overnight and we started flying back and forth to Houston.” In spring 2001, Jim started chemotherapy and radiation in preparation for the Whipple. Betty and Jim remember spending long days in “over air-conditioned buildings.” By July 2001, Jim was ready for surgery. Because the pancreas is so integrated with other organs, the Whipple procedure removes the first part of the small intestine, gallbladder and the end of the common bile duct in addition to the head of the pancreas. Though Jim’s surgery and recovery went well, he was told “they couldn’t get it all.” During the next six years Jim and Betty flew back and forth to Houston for follow-up appointments and procedures until the cancer went into remission. Jim was cut loose. He had beaten the five-year survival statistics. “There aren’t too many examples of a patient living as long after a Whipple,” Betty says. “We’re setting the precedent.” A N EW TEAM In Colorado time didn’t stand still while Jim was receiving treatment in Houston. The University of Colorado Anschutz Medical Campus, home of CU Cancer Center, was rapidly expanding. Expert medical, radiation and surgical oncologists were being recruited from across the nation, many from Johns Hopkins University. Patients were being enrolled in new clinical trials left and right. Additional stories were added to the Anschutz Cancer Pavilion at the University of Colorado Hospital. Soon, a new gastrointestinal oncology team and Multidisciplinary Pancreas and Biliary Cancer Clinic were ready for patients like Jim. 13 C3: SPRING 2014 GLE NN ASAKAWA Above: The laparoscopic Whipple procedure is now offered at the Multi-disciplinary Pancreas and Biliary Cancer Clinic. Left: Wells Messersmith, MD, leads the Gastrointestinal Cancer Program at the University of Colorado Cancer Center. “We’ve built our program rapidly in the past five to seven years,” Messersmith says. “Six years ago we didn’t even have a pancreas cancer multidisciplinary clinic, molecular testing capabilities or pathologists. Now, we offer expert care all in one place. Patients no longer have to travel to get the care they need.” This was music to Jim’s ears when his symptoms returned in 2008. He’d kept up with the progress of the program at CU Cancer Center and knew he was done traveling. He needed to find someone to treat what was now stage III pancreatic cancer. “I remember calling the Cancer Center and they told me ‘can you wait a week or two until our new oncologist is back in the office? He’s really the best for you to see,” Jim says. That oncologist was Messersmith. “When I started seeing him, I knew I wasn’t going back to MD Anderson,” Jim says. Jim’s first appointment was scheduled with not just Messersmith but the entire multidisciplinary team of 15 to 20 surgeons, medical and radiation oncologists, dieticians, gastroenterologists and pharmacists who specialize in treating pancreatic cancer. Do you have an inspirational story? Tell your story at http://story.coloradocancercenter.org or contact Kimberly.Chriscaden@ucdenver.edu. 14 WWW.COLORADOCANCERCENTER.ORG “I was really impressed that we could meet with all of the doctors in one day,” Jim says. “The tumor board is a wonderful entity. They can change the treatment regimen by meeting together and discussing each case individually.” The Multidisciplinary Pancreatic and Biliary Cancer Clinic takes place weekly. Each patient case is presented in detail and experts in different disciplines review and discuss the treatment options. Collectively, the group will design the best course of action for each patient, and the patient is seen by several providers at once. But communication is key, says David Raben, MD, radiation oncologist at CU Cancer Center. “All of the different teams really communicate together. We review past treatments, discuss options and select the best approaches together,” he says. “It’s really nice to have a clinic dedicated solely to pancreas and biliary cancer because we can focus on each individual patient’s case and make treatment decisions quickly.” The treatment plan for Jim: surgery, additional radiation and then wait and see. This time treatment would be different. Betty and Jim wouldn’t have to suffer the Houston heat. They’d simply drive 35 minutes from their home in Centennial to Aurora. Before they knew it another six years had passed. Jim had surgery in 2011 and completed his fifth round of radiation in February of this year. Statistics are completely out the door. “I didn’t ask to have cancer, but if I’m going to have it I want to have it here,” Jim says. “I’m still kicking mainly due to the University of Colorado Cancer Center.” WAITI N G AN D WATC H I N G Though Jim retired more than a decade ago, he treats life as a job. Raised by his grandmother in Amarillo, Texas, Jim shagged cars, delivered newspapers and worked in oil fields to save for the “extras” he didn’t get at home. Ask him about his hobbies and his answer will probably relate to some type of work. “I’ve always enjoyed working and really consider that my hobby,” Jim says. Now beating cancer is his job. “Cancer becomes your job when you’re diagnosed,” says Jim. “It’s your everything. While I think about it every day from the moment I wake up I don’t let it control my life.” And it hasn’t. Jim still rode in his seventh Ride the Rockies the year after his Whipple procedure. He travels to his vacation home outside Tucson, Ariz. as often as he can—enjoying golf, tennis, pickleball and daily walks while he is there. And he and Betty meet monthly with the supper club they joined more than 40 years ago, but “instead of counting kids, they’re now counting grandkids,” Betty says. Life keeps going and Jim continues to prove statistics wrong. “I’ve never wanted to give up,” Jim says. “I’m going to fight this.” What does he have to lose? He’s already the shining star for pancreatic cancer. ST RY INSIDE Multidisciplinary team tightens timelines, unifies care If ever there were a disease that begged for a magic wand of medical and surgical expertise, it’s pancreatic cancer. It strikes silently and races forward without obvious symptoms. By the time it’s detected, survival often depends on precise decision making and aggressive treatments: surgery, chemotherapy, and radiation therapy. Usually a patient makes different appointments with a medical oncologist, a surgical oncologist, a radiation oncologist and others. It might all happen in a few days. But it also might take a couple of weeks. Meanwhile, care languishes at a time patients can least afford it. For the past year and a half, that scenario has been a memory at University of Colorado Hospital. Now patients walk in the door in the morning with a lot of questions; in the afternoon, they walk out with a path forward and a bit more hope. It’s not magic; it’s the Multidisciplinary Pancreas and Biliary Cancer Clinic. The clinic is the product of focused intent and hard work. In this case, the spark came from Richard Schulick, MD, chairman of CU School of Medicine’s Department of Surgery, who at the time had been recruited from Johns Hopkins University. He’s a gastrointestinal surgeon who specializes in complex cancer surgeries, not least those involving pancreatic cancer. Johns Hopkins has a multidisciplinary clinic for pancreatic and biliary cancers that brings in a wide spectrum of experts to look at cases together and then talk to patients. It has made a big difference: More than 20 percent of patients saw their disease management change as a direct consequence of more accurate tests and the expertise of experienced doctors. The same is holding true for CU Cancer Center’s clinic. Patients that were told by other physicians their cancers were inoperable are now being operated on quickly and with success. Multidisciplinary care does not just happen, however. Schulick brought in three former Johns Hopkins colleagues to lead the way. Tatyana Popkova, University of Colorado Health’s new director for Cross Enterprise Collaborations, was charged with developing multidisciplinary programs. Barish Edil, MD, an associate professor of surgery, arrived as director of pancreatic surgery. Nurse Practitioner Cheryl Meguid, DNP, came in to be the clinic’s nurse navigator (see page 16 to learn more about navigation). Together, they worked to coordinate the many experts already on the campus like Messersmith and Raben (who also have Johns Hopkins roots) and incorporate the newly recruited ones into a single, cohesive group. Popkova’s goal was simple: “One call, one appointment, all perspectives,” as she described it. One of the biggest challenges of the clinic is coordinating the schedules of busy specialists from different departments to put them all in the same place at the same time. But, it happens. Every Tuesday starting at 8 a.m. the clinic schedules six patients for appointments at 30-minute intervals. Meguid assembles patient clinical histories and greets each one with a folder containing a personal schedule. The patient heads to radiology for a CT scan and has blood drawn and other testing needed for a lab workup. Meguid then does a health assessment and physical. At 11 a.m. or so, there’s a 30-minute session with a nutritionist followed by a 30-minute education session with a physical therapist. Patients then have a break for lunch. As patients and families dine, some of the country’s best minds in pancreatic and biliary cancer meet to discuss their cases. Present are surgeons, GI oncologists, radiation oncologists— usually more than one from each discipline—plus a pathologist and a radiologist. Residents and fellows, recognizing the learning opportunity, line the walls. “We’re sitting in one room and can communicate in real-time, disagree, present options, and debate,” Schulick says. “But when we leave the room, we have one plan.” At 1:30 p.m. or so, patients meet with one or more specialists, depending on the plan of care. They can make appointments for surgery, radiation treatment, chemotherapy or combinations thereof. At the end of the day all patients leave with a treatment plan and recommendations. With the success of the Pancreas and Biliary Cancer Clinic, Popkova and others hope to formalize more multidisciplinary care across GI cancers and beyond. It’s good for patients and it’s good for business, Popkova says. “Why wouldn’t you come here? In a single day, you’re going to be seen by every sort of specialist you need,” she says. “Also, you’ll be getting the best care in the region.” —By Todd Neff Watch the video to learn more about the Multidisciplinary Pancreas and Biliary Cancer Clinic at http://bit.ly/PGFsM4 15 C3: SPRING 2014 Charting The Course Nurse navigators help patients find the care they need hen Linda Lindberg learned she had stage IV colon cancer it wasn’t what she expected. After all, she was scheduled for a hysterectomy to treat what she and her doctor thought was uterine cancer that same morning. One last test, a colonoscopy the previous day, revealed colon, not uterine cancer. Not only was it a different kind of cancer than she expected, but the cancer had spread. Emotions were high. “My diagnosis was an emotional rollercoaster,” Lindberg remembers. Living in Stockton, Mo., a town of 2,000 people, meant Linda’s access to treatment was limited. The nearest big city, Springfield, was more than an hour away. While she could start basic chemotherapy, her physicians advised her to seek advanced care. “My option was to try multiple rounds of chemotherapy, but then the party would be over,” Lindberg says. “They said if I was willing to travel I could go to a place where they could do surgery and clinical trials.” The many treatment options sent Lindberg on another rollercoaster ride. She didn’t know where to start. She needed an advocate. Her son, a physical therapist in Colorado, knew she could get good care on the University of Colorado Anschutz Medical Campus, but he needed to find the right contact. An internet search led him to Julie Banahan, RN, BSN, OCN, a nurse navigator for the Gastrointestinal Oncology Program at the University of Colorado Cancer Center. “Julie was a critical contact person,” Lindberg says. “I didn’t have a lot of faith in how fast things would start moving with treatment, but I wanted things taken care of right away.” Julie Banahan helped make that happen. A few days later, Lindberg traveled 750 miles for her first appointment—a feat that wouldn’t have taken place without Banahan, her nurse navigator. BY KIM CHRISCADEN gastrointestinal cancer, and Christine Frodella, RN, BSN, OCN, in blood cancer and bone marrow transplant. “We were getting so many new patients, but we weren’t getting them where they needed to be in a timely manner,” Banahan says. “We needed to rein in the program.” At no additional charge, Banahan and Frodella are the first point of contact for all new patients in their clinics. Beyond scheduling appointments and collecting medical records, they offer tips on dealing with treatment side effects, referrals to support services, and clarity to the treatment plan. In short, as navigators, they provide roadmaps for patients’ cancer journeys. “I’ve been told we’re the concierge of nursing,” Banahan says. Frodella agrees. “I’m their welcoming committee. Those first few days after diagnosis are one of the most important times for patients,” she says. “I hear patients’ sighs of relief when they finally contact someone who can walk them through the process step by step.” On average, Banahan and Frodella navigate 12-16 new patients into their clinics each week. In order for a new patient to be seen quickly, they ensure all blood work, scans and staging have been done prior to patients seeing a physician. And, instead of seeing one physician at a time, new patients meet with a multidisciplinary team of medical, surgical and radiation oncologists, pharmacists and nutritionists all in one visit. That timely coordination was what patients like Lindberg need. PATRI CK CAM PBELL W TH E R I G H T C ON NE C TIO N Originally created more than 20 years ago to help reduce patient barriers to healthcare, patient navigation now includes not only helping patients find the best treatment, but following patients along the care continuum, from diagnosis to survivorship. While the concept is not new, CU Cancer Center did not have a nurse navigator until five years ago when it hired one focused on breast cancer. Three years later, as patient referrals increased, the Center added two more navigators—Banahan, in 16 WWW.COLORADOCANCERCENTER.ORG NUTRITION Christine Frodella, RN, BSN, OCN, a nurse navigator for the Blood Cancer and Bone Marrow Transplant Clinic, serves as the first point of contact for all newly diagnosed patients. PAT RIC K C AMPBE LL , I N S U R A N C E , P S Y C H O S O C I A L , S U R G E R Y, C H E M O T H E R A P Y, R A D I A T I O N , PA T H O L O G Y, S O C I A L W O R K “I want patients to feel that we know them. They’re not just a number in our clinic,” Frodella says. “We want them to feel comfortable, educated and supported—that’s my job.” It turns out nurse navigators not only ease patient frustration, they also improve care. INCREASED PATIENT SATIS FA C T I O N Medical Oncologist Christopher Lieu, MD and Nurse Navigator Julie Banahan, RN, BSN, OCN, work together to coordinate treatment plans for patients in the Gastrointestinal Oncology Clinic. C A L M I N G F RUSTRATION S By the time Lindberg left Missouri for treatment in Colorado, she was frustrated with the medical system. Her health records were stuck at two different hospitals. Phone calls seemed to go nowhere. Without records, she’d potentially miss her first appointment. Banahan wasn’t going to let that happen. She picked up the phone and called both hospitals. The records were transferred. A daunting task was completed. Lindberg could relax. “When she said she’d do something, she did it,” Lindberg says. Banahan knows Lindberg’s frustrations and anxieties firsthand. She, too, is a cancer survivor. She’s been through the shock, worry and daunting task of making treatment decisions. “I’ve been in the same place as my patients,” Banahan says. “I know how scared they are and I know what it’s like to just want answers.” After all, it’s the reason she became a nurse navigator in the first place. “I wanted to help our patients transition into the Cancer Center,” she says. “They need a friendly face in an extremely difficult time, and I want to bring them comfort when they need it most.” No matter the caseload, each patient is treated individually. Banahan and Frodella take the time to figure out what each patient needs. Some have language barriers and need translation. Others aren’t sure what to eat and need a dietician. Each patient is different. According to a 2013 study published in the Journal of Clinical Oncology, patients who were supported by nurse navigators early in their diagnosis reported fewer problems with care, especially in the areas of health information, care coordination and psychosocial support. Nearly 90 percent of navigated patients in the study said a doctor, nurse or social worker went out of their way to make them feel better emotionally, while only half of those not navigated reported the same findings. Under a new requirement for accreditation by the American College of Surgeons Commission on Cancer, cancer centers must provide patient navigation services by 2015. University of Colorado Health hospitals have started the process by developing a navigator affinity group. The group, comprising nurses with varying navigation responsibilities, is working to define systemwide navigation standards so that all patients receive the same level of service regardless of which location they receive care. Additionally, they are working to fill the gaps in other cancer types without navigation services. “We’ve seen the importance of navigation in our center,” says Jamie Bachman, executive director of oncology services at the University of Colorado Hospital. “Patients and physicians benefit from coordinated multidisciplinary care, a consistent introduction to supportive services and guidance through a complex health system. It also adds a personal touch and response to each patient’s changing needs throughout his or her cancer journey.” Since arriving in February, Lindberg has started chemotherapy and enrolled in a clinical trial. While she is beyond her initial diagnosis and need for a first appointment, Banahan still visits her during all her appointments and is there to answer questions as needed. “She was so supportive of what I had been through prior to coming to the Cancer Center and really understood what I was going through,” Lindberg says. “She is still an advocate for me.” As for Banahan, she continues to be the “voice of reason” for UCH patients. “Every day I get to be a part of patients’ lives when they’re in a state of turmoil,” she says. “While I may not always have the answers, I know where to get them. It’s a privilege to help each one of my patients through this journey.” 17 C3: SPRING 2014 S U P P O R T E R F CUS T JB PH OT OGRAPH Y In It Together CH E R RY CR E E K COM M U N ITY, STU DE NTS “PLAY STRONG” TO H E LP FU N D CANCE R R E S EARCH BY TAY L O R B A K E M EY E R No matter their age, parents and students in Cherry “Light the Night Dam Cancer Run 5k,” another race Creek are organizing to support a cause that that was later founded by the group. Mimmack is brought them together twice in a six-month span— the sponsor of the club. Hodgkin’s lymphoma. “Our events have been embraced by the high On Aug. 15, 2011, Faye Walker, a standout school, but we also want to embrace anyone who athlete on the Cherry Creek girls’ club soccer team, wants to be involved in the cause—helping to fight found herself struggling to breathe. Her team was against pediatric and other cancers right here in competing for state cup. Not knowing what was Colorado,” Mimmack says. wrong, she was taken out of the game for her own Faye’s 5k was founded by Play Strong Cherry Creek, a high school club created by Faye’s teachers, coaches and fellow students. nurses and staff always kept me smiling and The support for Faye didn’t stop with the stu- laughing,” says Ericson, which is a reason why she wanted to give back to the Center. safety. The next day, she’d learn what took her dents. Parents and local volunteers embraced the breath away—Hodgkin’s lymphoma, a cancer that cause and decided to found Play Strong Colorado originates in the white blood cells. to help organize the races and raise money for Strong Colorado’s two annual events have raised cancer research. more than $30,000 for innovative and groundbreak- After the shocking diagnosis, Cherry Creek High School, where Faye was a student, and the Not long after the first race, the adult group Together Play Strong Cherry Creek and Play ing blood cancer research at CU Cancer Center. “The generosity of Play Strong Colorado has local community came together to support her and found themselves facing another diagnosis. In others struggling with the disease. Math teacher December 2011, Carol Ericson, a parent and race really had an impact on the University of Colorado and cross country coach Karl Mimmack knew volunteer, learned she had stage IV Hodgkin’s Cancer Center and my program,” says Pollyea. where to start. He’d work with students and parent lymphoma. It had only been five months since “Their fundraising efforts are supporting the highly volunteers to start a 5k run/walk in her honor. Faye’s diagnosis. innovative and groundbreaking work that we are After all, he’d spent the past 12 years with the “I ran the first race and one week later I was doing—work that is sometimes unconventional Walker family on many athletic fields and knew diagnosed,” Ericson explains. “I knew something and often not amenable to receiving funding from sports would bring everyone together. was wrong during the race. I just did not feel right.” traditional sources. Play Strong Colorado is allowing Ericson quickly found herself at the University this work to continue, and we are deeply apprecia- “I know that there are, unfortunately, too many young kids battling their own cancer fights,” says of Colorado Cancer Center under the care of Dan tive of their hard work to help us eradicate these Mimmack, “but Faye’s struck us a little too close Pollyea, MD, MS, assistant professor and clinical diseases,” he says. to home.” director of leukemia services. While she’s quick to Shortly after Faye’s diagnosis the high school created Play Strong Cherry Creek, an extracurricular club focused on drumming up support for the “Creek Tramples Cancer—Faye’s 5k” and the Today Ericson is cancer free and continues to point out cancer treatment isn’t fun, Ericson found be a strong voice for Play Strong Colorado. As the a second home at CU Cancer Center. organization’s community outreach coordinator, “I don’t want to make it sound like chemotherapy is fun, but every time I went in, the infusion Ericson contacts local businesses around Cherry Creek to gain support for Play Strong Colorado TJB PHOTOG RAPHY events. She also works with the Play Strong Cherry Creek students to develop new ideas for the races. “The kids are amazing and work so hard for Play Strong,” Ericson says. “They create all the designs for the t-shirts, come with me to talk to local businesses and restaurants to gather support, and have a lot of fun.” Despite two cancer diagnoses, Cherry Creek students and parents continue to be champions for their community and local cancer research. “It is very important to us that we stay local and support local doctors,” explains Ericson. “Not to mention the fact that Faye went to CU Cancer Center for a second opinion and I received great care from Dr. Pollyea during my treatment.” Together Play Strong Cherry Creek and Play Strong Colorado have raised more than $30,000 for blood cancer research at CU Cancer Center. 18 WWW.COLORADOCANCERCENTER.ORG Learn more about Play Strong Colorado at playstrong.drupalgardens.com. N E W S C U C ANC E R C E NT E R FUND C O M M U N I T Y DONATED TABLETS HELP PATIENTS FIGHT BOREDOM Gordon Gamm knows the hours patients spend at CU Cancer Center. He was a patient himself – having survived stage 4 colon cancer that spread to his liver and lungs. From blood work to chemotherapy, patients can easily log an 8-hour “workday” in one visit. While books and magazine easily pass an hour or two, boredom quickly sets in by hours three and four. Recognizing that patients needed a way to pass the time, Gordon made a donation to CU Cancer Center to purchase 10 Kindle Fire tablets. “The magazines in the clinics were several years old and often irrelevant to cancer patients—like one on extreme sports,” Gordon says. “We wanted to have tablets that could not only provide entertainment, but also inform patients about preventive care and how to take care of themselves.” Loaded with entertainment resources like Netflix and Hulu, and educational materials about nutrition, exercise, treatment and port care, the tablet share program is providing both relaxation and education to patients and caregivers. Currently, the tablets are being piloted in the infusion center with plans to expand the program to clinic waiting rooms. 40TH ANNUAL MEN’S EVENT “The hospital provides outstanding care, but it’s not just the medical services that matter—customer RAISES $120K service and making patients feel more comfortable while they are sitting in waiting rooms and undergoing CU Cancer Center Fund’s annual Men’s Event chemotherapy is just as important,” Gordon says. raised $120,000 for prostate cancer research. “This program is a great way for the cancer center to distinguish itself from the rest.” KIM CHRISCADEN Nearly 150 men enjoyed listening to a prostate cancer discussion featuring the Cancer Center’s latest treatments and research while feasting on a three-course meal at one of Denver’s most well-known restaurants: Elway’s. “The Men’s Event is a unique opportunity for us to raise money for cancer research and highlight the Center’s accomplishments with many of Colorado’s top business, government and community leaders,” says Dan Theodorescu, MD, PhD, CU Cancer Center director. “We are grateful for 40 years of fellowship and philanthropy at this event and we look forward to many years to come.” UPCOMING EVENTS • June 8: Babes & Dudes Golf Tournament • July 27-28: Golfers Against Cancer Gala and Golf Tournament • August 9: Dinner In White • September 12: Don’t Fear the Finger PLEASE SAVE ANOTHER DONATES $283K FOR PROSTATE CANCER RESEARCH On March 4, Please Save Another presented Mike Glodé, MD and Tom Flaig, MD, CU Cancer Center investigators, a $283,000 check for prostate cancer research. Please Save Another, benefitting The William R. Meyn Foundation, is dedicated to increasing awareness, supporting families and funding cutting-edge research that results in a cure for prostate cancer. Join PSA at their annual “Don’t Fear the Finger” Golf Tournament on September 12 at Sanctuary Golf Course. Learn more at pleasesaveanother.org. Golf Tournament • September 20: Gift of Life & Breath 5k CANCER CENTER AWARDED GRANTS FROM ALEX’S LEMONADE STAND • October 4: Scope it Out 5k CU Cancer Center member Doug Graham, MD, PhD, is one of the first scientists to receive a two-year, • October 30: Wings of Hope for Pancreatic $250,000 Reach Award from Alex’s Lemonade Stand Foundation. The new grant for childhood cancer Cancer Research Benefit For more details about these events, visit http://events.coloradocancercenter.org. researchers is designed to help move research ideas from lab to clinic more quickly. “The funding from Alex’s Lemonade Stand will provide crucial funding for our research team to complete preclinical testing and validation of UNC2025 as a novel therapeutic agent for pediatric ALL,” says Graham. “This drug has the potential to provide greater targeted efficacy against pediatric leukemia with less toxic side effects than standard chemotherapeutic agents.” Lia Gore, MD, CU Cancer Center member, also is the recipient of an award from the Foundation. Gore received a Phase I/II Infrastructure Grant to accelerate early phase research efforts, increase patient participation and speed up completion of studies. The grant provides $625,000 over the course of five years. Additionally, to sustain the momentum, at the close of the initial five-year grant period, the Foundation will match the project’s institutional funding for a subsequent five years. 19 C3: SPRING 2014 UNIVERSITY OF COLORADO DENVER SPRI NG 2014 13001 EAST 17TH PLACE, MSF434 AURORA, CO 80045-0511 www.coloradocancercenter.org Non-profit organization U.S. POSTAGE PAID Denver, CO Permit No. 831 R ET U R N S E RV I C E R E Q U E ST E D C3: Collaborating to Conquer Cancer Published twice a year by University of Colorado Denver for friends, members and the community of the University of Colorado Cancer Center. (No research money has been used for this publication.) Editor: Kim Chriscaden | 303-724-0114 | Kimberly.Chriscaden@ucdenver.edu Contributing Writers: Garth Sundem, Erika Matich, Todd Neff, Taylor Bakemeyer Photos: Glenn Asakawa, Patrick Campbell, Casey Cass, Kim Chriscaden, TJB Photography, Dan Weaver The CU Cancer Center Consortium Members UNIVERSITIES Colorado State University University of Colorado Boulder University of Colorado Denver INSTI TUTIONS University of Colorado Hospital Children’s Hospital Colorado National Jewish Health Denver Health Medical Center Denver Veterans Affairs Medical Center Kaiser Permanente Institute for Health Research Visit us on the web: www.coloradocancercenter.org The CU Cancer Center is dedicated to equal opportunity and access in all aspects of employment and patient care. T H E M E S S A G E Turning Drug Development on Its Head D iscovering new cancer medicines used to mean trying Center are taking on more responsibility than ever before. We’re thousands of drugs against billions of cells and seeing still picking apart the science of cancer cells; we’re still matching what worked. These drugs tended to only discrimi- drugs to the cells’ weaknesses; we’re still testing new drugs in nate very imperfectly between tumor and healthy tissue and so dishes of cells and with mice; but then in order to make new, tar- patients suffered from the medicines as well as from the disease. geted drugs for smaller, targeted patient populations, academic Now the University of Colorado Cancer Center and other cutting- medical centers are increasingly taking on the responsibility of edge research and care institutions are turning the direction of early human testing. drug development on its head. Now, we start from the individual features of the cancer and then work to design drugs to target these features. First, this new approach to drug design and development requires knowing what is inside cancer—knowing what makes cancer cells different and more dangerous than healthy cells. FROM THE DIRECTOR DAN THEODORESCU, MD, PhD This requires looking inside the cancer genome, which new techniques allows us to do with speed and precision that was unimaginable even five years ago. Then our evolving understanding of how drugs interact with cells lets us build promising new “Our goal is to create a Colorado Cancer Drug Discovery and Development Program that will allow us to reinvent the process of cancer drug development, making it personalized for each patient from the outset of their care.” medicines from their molecules, up. Have you heard of “protein folding”? Well, we’re using it to make people’s lives better. But the new process of drug design also comes with chal- Our goal is to create a Colorado Cancer Drug Discovery and Development Program that will allow us to reinvent the process of lenges. For example, instead of targeting all bladder cancers, a cancer drug development, making it personalized for each patient new drug may target only a small percentage of bladder cancers from the outset of their care. To do this, we need to develop the with a specific genetic mutation. Drugs are no less expensive capacity in house to create new drugs based on our research in to develop, but now drug companies are looking at a smaller cancer biology, and bring them through the completion of Phase market—only the people with a specialized kind of cancer. This I testing. After completion of Phase I testing, we will partner with means that in order for a new drug to make it from an academic the pharmaceutical industry and license the drug to others for medical institution where it is discovered, to patients who need wider trials. it, we’re working to streamline the process in a way that lets drug To do this work, we need your help. You have the power companies see a drug’s promise and potential right at the begin- to accelerate our work toward a new day of truly individualized ning of testing. cancer care. Consider partnering with the University of Colorado In other words, the new mechanics of cancer drug development mean that academic medical centers like CU Cancer 20 Cancer Center to make this new paradigm of drug development a reality. FSC logo WWW.COLORADOCANCERCENTER.ORG