Imagine - Fall 2012 - University of Chicago Medicine
Imagine magazine is published three times a year by the University of Chicago Medicine. The publication is designed to keep consumers updated on the latest breakthroughs and news from the Forefront of Medicine®, the University of Chicago Medicine.
Imagine FALL 2012 AT THE FOREFRONT Pioneering scientists like Janet Rowley, MD, and her University of Chicago Medicine colleagues are transforming cancer treatment BREAKTHROUGHS Shedding light on bladder cancer INNOVATIONS New clinic for teens, young adults IMAGINE THAT! Sneak attack on brain tumors ANNU AL ER CANC ISSUE The University of Chicago Medicine & Biological Sciences has been at the forefront of medical care, research and teaching for more than 90 years. Located in historic Hyde Park on the South Side of Chicago, the University of Chicago Medicine & Biological Sciences includes: GREETINGS FROM THE FOREFRONT OF MEDICINE Patient Care » Bernard A. Mitchell Hospital (adult) » Comer Children's Hospital » Duchossois Center for Advanced Medicine » Numerous outpatient locations throughout the Chicago area Teaching Programs » Pritzker School of Medicine » Master's and doctoral degree programs » Postdoctoral programs Research » Medical and basic science units Among our many honors and acknowledgements: 12 Nobel laureates; ranked 10th of all U.S. medical schools; one of only 41 National Cancer Institute-designated comprehensive cancer centers; ranked second in nation for National Institutes of Health grant support per researcher. University of Chicago Medicine & Biological Sciences Executive Leadership The University of Chicago Medicine strives every day to turn cancer research from the laboratory into groundbreaking treatments at the bedside, and every day, our success grows. Kenneth S. Polonsky, MD, Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago Few of us are not That’s why we’re the top-ranked University of Chicago Medical Center touched by cancer, cancer program in Illinois, according Richard Baron, MD, dean for clinical either through our to U.S. News & World Report, and a T. Conrad Gilliam, PhD, dean for own battles or those National Cancer Institute-designated research and graduate education, of family, friends and Comprehensive Cancer Center. Sharon O'Keefe, president of the practice, University of Chicago Medicine Biological Sciences Division Holly J. Humphrey, MD, dean for medical colleagues. In this edition of Imagine, we’d like to education, Pritzker School of Medicine IMAGINE IS PUBLISHED QUARTERLY BY THE UNIVERSITY OF CHICAGO MEDICINE & BIOLOGICAL SCIENCES. Editors Anna Madrzyk and Ginny Lee-Herrmann Email us at: email@example.com Design TOKY Branding + Design Contributing writers Katie Scarlett Brandt, Tanya Cochran, John Easton, Elizabeth Gardner, Eileen Norris, Brooke O’Neill, Stephen Phillips, Gretchen Rubin, Anita Slomski and Shanna Williams Contributing photographers Megan Doherty, Jean Lachat, Sandro Miller, Bruce Powell and Thomas Rossiter Hopefully this will not always be the case. introduce you to our rich history of Pioneering scientists like Janet Rowley, MD, discoveries, the breadth of our ongoing who graces our cover, give us cause clinical trials and the leading-edge for hope as we struggle with this disease technologies we’re using to detect and and search for its causes and its cures. treat cancer. But, most of all, we’d like They’re also the reason we’re at the you to meet Dr. Rowley and some of her forefront in the battle against cancer. colleagues who are behind these efforts. As an academic medical center, the Not only are they among the best minds University of Chicago Medicine strives in cancer science and medicine, they are every day to turn basic research from among the best reasons to choose the the laboratory into groundbreaking University of Chicago Medicine and its treatments at the bedside, and every technologically advanced, patient-focused day, our success grows. cancer program. ADDRESS The University of Chicago Medicine 5841 S. Maryland Ave., Chicago, IL 60637 The University of Chicago Medicine Comer Children's Hospital 5721 S. Maryland Ave., Chicago, IL 60637 Telephone 1-773-702-1000 SHARON O’KEEFE President, the University of Chicago Medical Center Appointments 1-888-824-0200 Follow the University of Chicago Medicine on Twitter at twitter.com/UChicagoMed or visit our Facebook page at facebook.com/ UChicagoMed. You can read more about our news and research at uchospitals.edu/news and at sciencelife.uchospitals.edu. This publication does not provide medical advice or treatment suggestions. If you have medical problems or concerns, contact a physician who will determine your treatment. Do not delay seeking medical advice because of something you read here. For urgent needs, call 911 right away. Read Imagine online at uchospitals.edu/imagine. KENNETH S. POLONSKY, MD Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago AT THE FOREFRONT OF CANCER CARE A B CANCER RISK & SURVIVORSHIP BLADDER CANCER Special Programs Focus on Cancer Prevention, Helping Survivors New Imaging Method Lets Doctors See What They Have Been Missing Elizabeth Noreen beat overwhelming odds in overcoming bone cancer that spread to her lungs when she was only 6 years old. But the aggressive therapy that saved her life left the 21-year-old college student from Tinley Park, Ill., with complex health challenges requiring careful management. “We develop a care plan for each patient based on their prior treatments,” said Tara Henderson, MD, MPH, Noreen’s physician and director of the Childhood, Adolescent and Young Adult Cancer Survivors Center at the University of Chicago Medicine Comer Children’s Hospital. Henderson is an expert on the long-term effects of cancer treatment in childhood, including susceptibility to second cancers. The center is one of several specialized programs in cancer prevention and survivorship at the University of Chicago Medicine. The Cancer Risk Clinic helps people at risk for breast, ovarian, colon, endometrial, pancreatic and other cancers. Patients work with counselors to develop a personalized action plan — diet and exercise, screening, medication or surgery — to mitigate their individual risk. The Upper Aerodigestive Cancer Risk Clinic is a special program for people at high risk for the development or recurrence of lung cancer, head and neck cancer, esophageal cancer, mesothelioma and other malignancies. The Pediatric Familial Cancer Clinic at the University of Chicago Medicine Comer Children’s Hospital helps children and families with an increased risk of cancer, including those with familial cancer syndromes. | B E L OW | Tara Henderson, MD, MPH, and Elizabeth Noreen To improve treatment, start with a better diagnosis. The University of Chicago Medicine is the first hospital in the region to employ a new tool, Cysview bluelight cystoscopy, which uses a fluorescent dye to better determine the location, extent and stage of bladder cancers. | A B O V E | A: View of bladder under standard white light. B: Cancerous areas fluoresce bright red under blue light. Courtesy of Photocure USA. into the bladder before the examination. The solution is a special type of dye that accumulates primarily in cancerous cells. The surgeon then inserts the cystoscope to examine the bladder. After looking at the bladder under the standard bright white light, the surgeon can switch to blue light. When the blue light hits cells that have taken up the dye, they fluoresce bright red, highlighting the cancerous areas and tumors. The first symptom of bladder cancer, the fourth most common type of cancer in men and the eighth most common in women, usually is blood in the urine. Evaluation often begins with cystoscopy, using a tiny scope that can peer into the bladder. But the procedure is not always “as effective as “When we switch from white to we would like,” said Gary blue light, it’s like a big neon D. Steinberg, MD, director sign,” Steinberg said. “I find it of urologic oncology. extremely helpful. We can see the smaller tumors, often far “The bladder is a threeremoved from the original site.” dimensional organ,” he said. “We can’t always see around the corners. That’s why we routinely repeat a cystoscopy and biopsy six weeks later. At least 30 percent of the time, we pick up new tumors on that second look.” One clinical trial of Cysview confirmed that blue light cystoscopy significantly improves detection of bladder cancer, leading to a more complete operation that may reduce the risk the cancer will recur. In Cysview blue-light cystoscopy, 2 ounces of a colorless solution is injected For more information, visit uchospitals.edu/physicians/ gary-steinberg.html. U C M C O N N E C T 1 - 8 8 8 - 8 2 4 - 0 2 0 0 | UCHICAGOKIDSHOSPITAL.ORG | UCHOSPITALS.EDU » 1 Imagine that! GRAPEFRUIT JUICE DRUG BENEFITS A glass of grapefruit juice a day won’t keep the doctor away, but it lets patients gain the same benefits from an anticancer drug as they would get from more than three times as much of the drug by itself. In a study published in the August issue of Clinical Cancer Research, researchers at the University of Chicago Medicine showed that 8 ounces a day of the citrus drink slows the metabolism of a drug called sirolimus, which has been approved for transplant patients and also may help many people with cancer. Study director Ezra Cohen, MD, says this combination could help patients avoid side effects associated with high doses of this drug and reduce the cost of taking the medication. AT THE FOREFRONT NUMBER ONE #1 cancer center in Illinois in U.S. News & World Report’s 2012 rankings A TROJAN HORSE AGAINST BRAIN TUMORS Treating brain tumors is tricky. They often are difficult to remove surgically without causing serious damage to surrounding tissues. Radiation produces side effects and only holds the tumor back for so long. And the blood-brain barrier thwarts chemotherapy agents from reaching the brain. Looking for ways to overcome these obstacles, scientists at the University of Chicago Medicine and the City of Hope Comprehensive Cancer Center in California designed a sneak attack against brain tumors. The battle plan, according to University of Chicago Medicine neurosurgeon Maciej S. Lesniak, MD, involved loading an army of customized, tumor-killing viruses into an unusual vehicle: neural stem cells. These stem cells have the natural ability to seek out and target invasive brain tumor cells while leaving normal tissues unharmed. Study results, published in Molecular Pharmaceutics and Molecular Therapy, are promising, and the therapy is on track for clinical trials in humans within the next two years. The National Institutes of Health has committed more than $5 million for the development of this therapy. AT THE FOREFRONT 210 laboratory and clinical scientists focusing their efforts on cancer THE ASPIRIN EFFECT We’ve all heard that taking a daily aspirin can lower the risk of heart attack and stroke. Now researchers at the University of Chicago Medicine believe it also may prevent the development and progression of prostate cancer. A research team directed by radiation and cellular oncologist Stanley Liauw, MD, recently explored the association between aspirin use and prostate cancer in 6,000 men undergoing treatment. The results of the study, published in the Journal of Clinical Oncology, showed aspirin users were less likely to die from the disease, especially those patients with high-risk disease. Liauw cautions that further studies are necessary before the anticoagulant should be routinely suggested for prostate cancer patients. “A randomized study would be necessary to help weigh the potential risks and benefits of the therapy in men with prostate cancer,” Liauw said. 2 » THE UNIVERSITY OF CHICAGO MEDICINE IMAGINE MAGAZINE | FA L L 2 0 1 2 EXPLORING AN ESSENTIAL VITAMIN Vitamin D is well known for its part in promoting calcium absorption and forming and maintaining healthy bones. Researchers now suggest the vital nutrient also may help prevent and treat disease, including cancer. At the University of Chicago Medicine, Yan Chun Li, PhD, and his colleagues recently identified how cellular and molecular mechanisms in vitamin D suppress cancer in laboratory models. In collaboration with Marc Bissonnette, MD, Li is preparing a preclinical study to determine if vitamin D supplements will reduce colon cancer tumor growth. A parallel clinical trial will evaluate whether the supplements can prevent colon polyps in AfricanAmericans, who tend to have lower levels of vitamin D and higher incidences of colorectal cancer. READY FOR THE GREATEST CHALLENGES Our Cancer Experts in Your Community At the University of Chicago Medicine, we are bringing our cancer specialists and their advanced treatment programs closer to you. Meet three of our physicians who are providing leading-edge patient care at locations throughout the Chicago and Northwest Indiana region. ANNE R. M C CALL, MD AZHAR M. AWAN, MD Anne R. McCall, MD, is medical director of radiation oncology at the University of Chicago Azhar M. Awan, MD, is medical director of radiation oncology at the Sherman Hospital Cancer Care Center in Elgin, Ill. The University of Chicago Medicine provides professional radiation oncology services at this center. Awan is an expert in leading-edge cancer treatments, including intensity-modulated radiation therapy (IMRT). Medicine Comprehensive Cancer Center at Silver Cross Hospital in New Lenox, Ill. McCall, associate professor of radiation and cellular oncology, has a background in both academic and community hospital settings. “We are a direct link to the University of Chicago Medicine. We have the same technology and expertise here, including the leading-edge TrueBeam system for targeted radiation therapy. Patients benefit from receiving their care closer to home, where their families can offer more support.” “Since radiation therapy is a daily treatment often lasting several weeks, patients from the Elgin area would have to travel long distances every day. By going to Sherman for their treatment, they save a long daily commute and receive the same quality of care that they would receive at the University of Chicago Medicine main campus.” AT THE FOREFRONT GOING UP! The 10th floor of our new hospital is devoted to cancer care, including a bone marrow transplant unit. The University of Chicago Medicine Center for Care and Discovery opens in early 2013. 10 JENNIFER M C NEER, MD, MS Pediatric oncologist Jennifer McNeer, MD, MS, treats children at the University of Chicago Comprehensive Cancer Center at Silver Cross Hospital in New Lenox, Ill., and at offices at Edward Hospital in Naperville, Ill., and in Merrillville, Ind. McNeer also is a clinical researcher, focusing on improving treatment for highrisk leukemia patients. “We work closely with our clinical trials office to offer patients access to clinical trials through the Children’s Oncology Group and other cooperative groups. This provides patients with the most up-to-date treatment options available, regardless of where they receive their therapy.” FIND A CANCER EXPERT NEAR YOU + THE UNIVERSITY OF CHICAGO MEDICINE COMPREHENSIVE CANCER CENTER at Silver Cross Hospital, New Lenox, Ill., provides multidisciplinary, comprehensive cancer care for adult and pediatric cancers. Our leading-edge cancer care also is available at additional locations throughout the region: + PEDIATRIC CANCER CARE Edward Hospital, Naperville, Ill., and in Palos Heights, Ill., and Merrillville, Ind. + GYNECOLOGIC ONCOLOGY Silver Cross Hospital, New Lenox, Ill., and University of Chicago Health Specialists, Schererville, Ind. + RADIATION ONCOLOGY Sherman Hospital Cancer Care Center, Elgin, Ill. The strength and resiliency of every one of our patients will never cease to amaze me. JENNIFER M C NEER, MD, MS U C M C O N N E C T 1 - 8 8 8 - 8 2 4 - 0 2 0 0 | UCHICAGOKIDSHOSPITAL.ORG | UCHOSPITALS.EDU » 3 TRANSLATING TODAY’S DISCOVERIES Laboratory discoveries by University of Chicago Medicine scientists are leading to a better understanding of the biological basis of cancer and personalized therapies Taking on the challenge of lung cancer, one tiny worm at a time In the wild, C. elegans is practically invisible. Barely a millimeter in length, these tiny worms burrow in soil and compost heaps. Yet in lung cancer specialist Dr. Ravi Salgia’s laboratory at the University of Chicago Medicine, they’re helping to dig up more personalized cancer treatments. “C. elegans turned out to be a very powerful tool,” said Salgia, MD, PhD, the vice chair for translational research in the Department of Medicine. For the past decade, he and his team have been pinpointing genetic abnormalities that occur in patients’ lung cancer tumors. As the first researchers to implant human cancer mutations into the worm and observe its effects, his team can more quickly determine which genes make promising drug targets. It’s a pioneering approach that often takes only a few weeks, versus the year or more required for more traditional experiments. “What we want are better answers faster,” said Salgia, who also is the associate director for translational sciences for the University of Chicago Medicine Comprehensive Cancer Center. That means not only speeding up the research process with novel experimental models like C. elegans, but also bringing the latest genetics-based findings directly to cancer patients through more personalized therapies and clinical trials. “From years of research done at the University of Chicago and elsewhere, we have learned that each person’s tumor is unique,” said Richard L. Schilsky, MD, hematology/oncology section chief. “Our goal is to understand what makes a patient’s tumor tick at the molecular level and, based on that knowledge, deliver the best available therapy for that individual.” Recently, for example, Salgia treated a patient whose tumor had already spread beyond the lung. Rather than starting chemotherapy, once standard for advanced lung cancer, Salgia did a molecular-level analysis of the tumor tissue and discovered a rare mutation, called ALK translocation, was fueling the cancer cells. 4 » THE UNIVERSITY OF CHICAGO MEDICINE IMAGINE MAGAZINE | FA L L 2 0 1 2 “There’s a specific targeted therapy that works against that,” explained Salgia, who spearheaded clinical trials for the drug at the University of Chicago SALGIA Medicine in 2010. The therapy, now known as crizotinib, was approved by the FDA in August 2011 and is just one example of how the University of Chicago Medicine is giving cancer patients access to more powerful personalized treatments, often before they are available elsewhere. “It’s very important that patients and their families realize that just having a lung cancer diagnosis may not be enough,” Salgia said. “We ask, ‘What kind of lung cancer?’ Then, based on the genetic abnormalities that can occur, we design the treatment appropriately.” Meanwhile in his lab, the researcherclinician continues to narrow the gap between understanding how tumors work and what will stop them in their tracks. With every mutation he studies in C. elegans, Salgia knows he’s creating a more promising future for patients. “We take pride in taking care of our patients,” he said, “but we also take pride in making sure we can do state-of-the-art research and then combine the two to provide even better care.” For more information, visit uchospitals. edu/physicians/ravi-salgia.html. | L E F T | By implanting human cancer mutations into tiny C. elegans worms, researchers are helping find out which genes make promising drug targets. INTO TOMORROW’S TREATMENTS Collaborating on an innovative approach to chemo-resistant breast cancer Imagine scientists discovering a way to help patients with advanced breast cancer that has become resistant to chemotherapy. That’s just one of the potential outcomes of groundbreaking research being conducted at the University of Chicago Medicine, where scientific discoveries are being translated into leading-edge care for patients. In reviewing other studies, Conzen found that the GR was overexpressed in 40 percent of breast cancers. This led her to theorize that the GR activates a tumor cell survival pathway, making it resistant to chemotherapy. To test this theory, Conzen and Nanda designed a trial for patients with advanced breast cancer. Nanda and Conzen predict the “Mifepristone is an FDA-approved approach may provide a significant medication used for emergency benefit for patients with triplecontraception. Mifepristone, however, negative breast cancer, an aggressive is also a powerful blocker of GR subtype of breast cancer found at activity,” Nanda explained. “The goal a higher rate in young women and of our study is to see if combining women of African ancestry. mifepristone with standard chemotherapy can improve outcomes for “The ultimate goal of this study is to patients with advanced breast cancer.” improve outcomes for patients with advanced breast cancer,” Nanda said. To support this work, Nanda and The collaboration between physician“If we can do that while maintaining Conzen applied for funding from the scientist Suzanne D. Conzen, MD, quality of life, then we will have University of Chicago’s Institute for and clinical researcher Rita Nanda, MD, accomplished something incredibly stems from Conzen’s ongoing research Translational Medicine (ITM). significant.” In November 2011, Nanda’s project on stress signaling pathways in cells was awarded funding to begin a and their role in cancer. phase 1 clinical trial to determine OPEN FOR PARTICIPANTS Resistance to conventional the appropriate dose of mifepristone chemotherapy is a problem patients to combine with the chemotherapy with metastatic breast cancer This study is currently open to drug nab-paclitaxel (Abraxane). eventually face. Conzen, an expert qualified patients who are interested Nanda enrolled the first patient in in the treatment of breast cancer, in enrolling in the clinical trial. If the study in January 2012, and to has been studying chemotherapy you have advanced breast cancer date a total of eight patients have resistance since opening her lab and have not received Abraxane joined the study. in 1998. She observed that the (paclitaxel) in previous treatments, stress hormone cortisol activates you may be eligible to participate. the glucocorticoid receptor (GR) Contact intake coordinator pathway and contributes to Romella Lee at 1-773-702-8222 chemotherapy resistance in a or firstname.lastname@example.org subset of breast cancers. for more information. CONZEN NANDA U C M C O N N E C T 1 - 8 8 8 - 8 2 4 - 0 2 0 0 | UCHICAGOKIDSHOSPITAL.ORG | UCHOSPITALS.EDU » 5 For more than 70 years at the University of Chicago Medicine, the brightest minds in medicine have been changing how physicians and scientists think about, diagnose and treat cancer THE EVOLUTION OF CANCER Anjuli Nayak, MD, of Bloomington, Ill., survived an aggressive form of leukemia because of a cancer treatment sparked by a scientific breakthrough 40 years ago in a University of Chicago laboratory. Janet Rowley, MD, discovered the first recurring chromosomal abnormality linked to cancer. That eventually led to the development of targeted therapies for cancer, including the drug that helped save Nayak’s life. See Nayak’s story on page 8. PAST Janet Rowley, MD, changed the way scientists think about cancer and how to treat it. Her discovery in 1972 that cancer is a genetic disease opened the door to effective targeted therapies for leukemia, lymphoma and other forms of cancer. At 87, Rowley continues to be an active cancer researcher at the University of Chicago Medicine and a mentor to future groundbreaking physician-scientists. She is the winner of many prestigious awards, including the Presidential Medal of Freedom, the highest civilian honor bestowed in the U.S. ARE YOU SURPRISED WHERE YOUR DISCOVERY IN 1972 HAS LED US? Yes. When I identified the chromosomal translocation in patients with chronic myelogenous leukemia (CML), what these 6 » THE UNIVERSITY OF CHICAGO MEDICINE IMAGINE MAGAZINE | FA L L 2 0 1 2 genetic anomalies really did in the cell was completely unknown. We didn’t know whether they were in exactly the same point in different patients. We didn’t know why chromosomes were breaking in these patients. We learned later that they involved specific genes. That you could target those genes with specific treatments would have been a wild fantasy at the time. WHAT DO YOU THINK IS THE MOST EXCITING/PROMISING AVENUE OF CANCER RESEARCH TODAY? Genetic changes in tumors are different in different patients. Therefore, the treatments may be different. For patients, it’s critical that their physician knows the genetic changes in their tumor and understands what this means for treatment. Certainly the targeted therapy for CML is one of the most outstanding examples, but the new strategies for identifying critical genes are important. HORMONE THERAPY CHEMOTHERAPY Hormone therapy is a mainstay of treatment for several types of cancer, including prostate and breast cancer. Many cancer drugs still in use are derived from nitrogen mustard. TODAY TODAY 1939 1943 Charles B. Huggins, MD, uses hormone therapy to treat a patient with prostate cancer. He was awarded the Nobel Prize in 1966. Genetics is important in all human diseases — cardiac, pulmonary, diabetes — and the University of Chicago Medicine is leading the way. DO YOU THINK IT WILL BE POSSIBLE TO CURE CANCER? That’s a difficult question and probably depends on whether one is an optimist or a pessimist. Being an optimist, I believe we will find the tools to at least control cancers, if not cure them. There are already some cancers in which many patients are cured, such as testicular cancer, some types of childhood leukemias and Hodgkin lymphoma. It’s quite possible that the control/cure will be partly through drugs and partly through the immune system. “Being an optimist, I believe we will find the tools to at least control cancers, if not cure them.” JANET ROWLEY, MD Leon Jacobson, MD, is the first to study the effectiveness of the chemical nitrogen mustard for terminally ill patients with leukemia and lymphoma. The University of Chicago is considered one of the birthplaces of cancer chemotherapy. | L E F T | Janet Rowley, MD, is a cancer researcher at the University of Chicago Medicine and a mentor to future groundbreaking physicianscientists. Her discovery of the first recurring chromosomal abnormality associated with cancer led to development of the first targeted therapy. BONE MARROW TRANSPLANT GENETIC BASIS OF CANCER The University of Chicago Medicine’s innovative approach makes transplants possible for patients who do not have a standard match and for high-risk patients. Gleevec is used in the treatment of several cancers, including leukemia, lymphoma and gastrointestinal stromal tumor (GIST). TODAY TODAY Late 1940s 1972 Leon Jacobson, MD, performs the first bone marrow transplant on a mouse. Twenty years ago, the University of Chicago Medicine started the first pediatric bone marrow transplant program. Janet Rowley, MD, discovers the first recurring chromosomal abnormality associated with cancer, demonstrating that cancer is a genetic disease. Her research led, decades later, to the development of Gleevec (imatinib), the first, and most successful, targeted cancer therapy. PRESENT Although she is a physician, Anjuli Nayak, MD, had never been on an oncology unit. She realized that was going to change the moment she learned the results of a routine blood test. Her white blood cell count measured 22,000 — more than twice the upper limit of normal. “I wasn’t sick, and I didn’t have any symptoms, but I knew I had leukemia,” said Nayak, an allergist-immunologist with a practice in Bloomington-Normal, Ill. By that evening, Nayak and her family huddled together to discuss the options. After researching the top leukemia programs in the country, she decided to see Wendy Stock, MD, a hematologist-oncologist at the University of Chicago Medicine and a nationally known authority on leukemia. | B E L OW | Leukemia patient Anjuli Nayak, MD, right, and her physician, Wendy Stock, MD Nayak was diagnosed with acute lymphoblastic leukemia (ALL), an aggressive type of cancer of the blood and bone marrow. Genetic analysis showed the leukemia tested positive for the Philadelphia chromosome, a mutation that results when breaks occur in each of two chromosomes and genetic material switches places to create a “fusion” gene. This new gene codes for a protein that causes leukemia. Forty years ago, the University of Chicago’s Janet Rowley, MD, was the first to show that these chromosomal translocations were a trigger for development of leukemia and other cancers. This pivotal discovery laid the groundwork for the development of imatinib (Gleevec) and other targeted therapies. Nayak’s initial treatment combined traditional chemotherapy with dasatinib (Sprycel) — a second generation of imatinib. The medical team felt her best chance for cure was to proceed with a stem cell transplant once the leukemia went into remission. Because Nayak did not have a matched donor, she was offered an opportunity to enroll in a unique clinical trial: a National Cancer Institute-sponsored research study involving transplantation of stem cells from both a half-match donor and from donated 8 » THE UNIVERSITY OF CHICAGO MEDICINE IMAGINE MAGAZINE | FA L L 2 0 1 2 umbilical cord stem cells. Nayak received her half-match cells from her middle son, Zachary, then in medical school. “This approach allows us to make transplant available to patients who do not have complete immunological matches,” Stock said. Almost two years after her diagnosis, Nayak has no measurable evidence of lingering leukemia. She continues to take dasatinib daily. Using highly sensitive and sophisticated diagnostics, the medical team checks her blood monthly to be sure no cancer cells are detected. “I am so grateful to the leukemia transplant team for the care, compassion and courage received from the doctors and nurses,” Nayak said. “They have given me a rebirth, for which I am eternally grateful.” FUTURE University of Chicago Medicine researchers are discovering radical new ways to fight cancer, one cell at a time, by applying the principles of evolutionary biology and population genetics. Lay people may think of tumors as homogeneous masses of cells. But some cancer researchers, including University of Chicago Medicine scientists PERSONALIZED TREATMENT University of Chicago Medicine researchers are working to develop personalized, targeted therapies for cancer based on the patient’s — and the tumor’s — genetic makeup. YUSUKE NAKAMURA, MD, PHD TODAY FUTURE “I would like to cure cancer.” 2010 The University of Chicago Medicine Center for Personalized Therapeutics opens. Director Mark J. Ratain, MD, and Deputy Director Yusuke Nakamura, MD, PhD, one of the world’s top experts on pharmacogenomics, lead the efforts to translate genomic discoveries into improved care for patients. Marsha Rosner, PhD, Kenan Onel, MD, PhD, and Chung-I Wu, PhD, have discovered that each tumor is a unique community of diverse cells that compete against one another and vary, sometimes dramatically, in their ability to dodge a given chemotherapy agent. That’s why cancers often don’t completely succumb even to a complex chemotherapy regimen, and why some cancer cells can lurk for years and then start growing another tumor, which in its turn becomes a genetically diverse entity. Rosner, Onel and Wu study how that diversity develops. All three researchers work by sequencing the genomes of cells taken from the same cancer and identifying the small variations among them. “We’re realizing there’s a big distribution, and some cells have more mutations than others,” said Rosner, chair of the university’s Ben May Department for Cancer Research. Rosner theorizes that stresses in the tumor cells’ environment, including those caused by cancer treatments, can change both their genes and the additional genetic material around them that determines whether and how the genes are activated. She thinks outliers — cells with greater levels of genetic change — may be more likely to survive treatment and pass along those changes, and she’s looking at what can be done to reduce their protective power. Onel, a pediatric hematologist-oncologist, and Wu, an evolutionary biologist, are applying the principles of population biology to their studies of cancer cell diversity. Wu holds an appointment at the Beijing Institute of Genomics, which has the gene-sequencing firepower and critical mass of genetic scientists to complement the University of Chicago Medicine’s patient data and ability to get patient samples. Onel said the same mechanisms of natural selection that apply to animal and plant populations also apply to the cell populations found in tumors. While some mutations may be caused by cancer treatment, most already exist. “What we’re doing is a completely unique area of investigation.” KENAN ONEL, MD, PHD The treatments just weed out susceptible cells and leave others to prosper. Onel and Wu are working to figure out which genetic variations survive cancer treatment, and why. “The University of Chicago has incredible strength in population genetics and cancer genetics,” Onel said. “We are sitting at the intersection merging the two to help our patients.” The adaptability of cancer cells may thwart a cure, as such, but there’s still hope. “We might just be able to manage it like a chronic disease,” Rosner said. “The goal is to put your finger on two or three drugs that can keep it tamped down.” For more information about cancer breakthroughs at the University of Chicago Medicine, visit uchospitals.edu/cancer. Kenan Onel, MD, PhD U C M C O N N E C T 1 - 8 8 8 - 8 2 4 - 0 2 0 0 | UCHICAGOKIDSHOSPITAL.ORG | UCHOSPITALS.EDU » 9 BRINGING TOGETHER Why a Clinical Trial May Be Your Best Chance Clinical trials often are the best way to develop new targeted therapies for cancer patients, especially those who have a serious or life-threatening diagnosis. The University of Chicago Medicine Comprehensive Cancer Center is one of the few institutions in the nation where patients have access to phase 1, phase 2 and phase 3 clinical trials sponsored by the National Cancer Institute. “Besides getting the best standard of care, there’s also the potential for getting tomorrow’s standard of care,” said Walter M. Stadler, MD, associate dean for clinical research at the University of Chicago Medicine and director of the genitourinary program. Stadler recently examined a patient who was in a clinical trial six years ago for a new therapy for renal cancer. That therapy now is the approved, ongoing standard of care. “She got it as part of a clinical trial years ago and continues to do well today,” he said. The University of Chicago Medicine has 320 clinical trials testing the safety and effectiveness of new medications, procedures and devices for just about every type of cancer. Patients enrolled in clinical trials benefit from being closely followed by an expert team of caregivers, including physicians, researchers and other specialists, Stadler said. Many patients also are pleased that their involvement in a clinical trial is likely to benefit future patients with the same type of cancer. Stadler suggests patients ask their physician if a clinical trial is available for their type of cancer, especially if the disease is advanced. For more information about clinical trials at the University of Chicago Medicine, go to uchospitals.edu/clinical-trials. AT THE FOREFRONT 320 CANCER CLINICAL TRIALS THE BEST MINDS When A Diagnosis Is Cancer, Where You Are Treated First Matters Warren Bratton and his wife, Eugenia, were taking a leisurely drive along Lake Michigan when “that feeling” came on again. He felt like he was about to pass out in the passenger seat. His wife drove him straight to the University of Chicago Medicine emergency department. “If I had not been treated at the University of Chicago Medicine, I wouldn’t be here today,” Bratton said. “I literally owe my life to Dr. Smith and her team.” “Where you are treated first can make a difference,” said Smith. Along with access to new chemotherapy drugs and targeted therapies, patients may benefit from seeing a specialist and a team of physicians who treat a high volume of patients with their disease. Bratton, who had been suffering from episodes of chest pain and feeling faint, did not have heart disease or vertigo, as physicians at a local hospital had suggested. Tests revealed that a large growth in Bratton’s chest had wrapped around his aorta and was cutting off the blood supply to his brain. The Aurora, Ill., resident also had a mass on his neck. Sonali Smith, MD, director of the lymphoma program at the University of Chicago Medicine, diagnosed a rare and aggressive form of non-Hodgkin lymphoma. For the most effective treatment, an accurate diagnosis is critically important. The University of Chicago Medicine’s multidisciplinary lymphoma team has the experience and expertise to help identify even the most difficult to diagnose of the approximately 60 different types of lymphoma. Physicians from around the world consult with the team’s renowned hematopathologists on complex cases. I literally owe my life to Dr. Smith and her team. WARREN BRATTON “It’s important that the expertise all be in one place — the best team to get the Lymphoma patients at the University curative approach we’re after,” said Ezra of Chicago Medicine also have access to Cohen, MD, an oncologist who specializes clinical trials of promising new drugs. in head and neck cancer and associate director for education for the University of Bratton, who had a rare and challenging Chicago Medicine Comprehensive Cancer cancer, began an aggressive chemotherapy approach that saved his life. Five years later, Center. “Many cancers are not commonly the 69-year-old retired locomotive engineer seen in a community. I see patients all the time whose outcome could have been feels great and is considered cured. different had we seen them sooner.” 10 » THE UNIVERSITY OF CHICAGO MEDICINE IMAGINE MAGAZINE | FA L L 2 0 1 2 Ask the Expert MI C H E LL E M. L E B E AU , PH D When it comes to cancer centers, the word “comprehensive” isn’t just an adjective. It’s a national distinction for excellence. Q: WHAT IS A COMPREHENSIVE CANCER CENTER? A: A Comprehensive Cancer Center is distinguished by its scientific excellence and its efforts to translate new discoveries from the laboratory into improved cancer care and cancer prevention. Physicians and scientists work together to find new approaches for cancer screening, diagnosis, treatment and survivorship, and for reducing cancer disparities across different ethnic populations. At the University of Chicago Medicine Comprehensive Cancer Center, we have 210 scientists studying cancer from every angle to bring new hope to our patients. Q: HOW DOES AN INSTITUTION EARN THE NATIONAL CANCER INSTITUTE ‘COMPREHENSIVE’ DESIGNATION? The designation recognizes an institution’s dedication to innovative research that will lead to new cancer treatments. The standards are rigorous. We must conduct research that spans the fields of basic, clinical and population science. The goal of this research is to uncover the underlying causes of the disease, and to use this information to discover and develop the newest treatments for cancer through clinical trials. We must also demonstrate accomplishments A: in cancer education for our scientists, physicians and other medical professionals, as well as education and outreach to our community, such as promoting colon cancer screening in underserved communities. Q: WHAT ARE THE ADVANTAGES FOR A PATIENT? A: We have the best minds in cancer research working to solve the challenge of our patients’ specific cancer. We provide care for our patients by bringing together experts from multiple medical disciplines to develop the most effective treatment strategies. Importantly, we also focus on preserving the patient’s quality of life. We have 320 cancer clinical trials offering the newest treatment options to our patients. From the time cancer is diagnosed, we focus on meeting the needs of our patients and their families as they face the challenges of cancer. Q: WHAT ELSE SETS THE UNIVERSITY OF CHICAGO MEDICINE COMPREHENSIVE CANCER CENTER APART? A: We are transforming the routine practice of medicine by developing personalized therapies for each individual patient. By taking into account a patient’s genetic makeup, the biology and behavior of the patient’s tumor, as well as the patient’s social and environmental factors, we are developing more effective treatment strategies. For example, our 1200 Patients Project is collecting genetic information that will help physicians predict which patients are most likely to respond to a specific treatment with the fewest side effects. Efforts such as this put the University of Chicago Medicine Comprehensive Cancer Center at the forefront of cancer care. Q: WHERE IS THE UNIVERSITY OF CHICAGO MEDICINE COMPREHENSIVE CANCER CENTER? A: We provide compassionate, state-of-the-art care for adults and children on our main medical campus in Hyde Park and at the new University of Chicago Medicine Comprehensive Cancer Center at Silver Cross Hospital in New Lenox, Ill. Our cancer specialists also see patients at several affiliated clinics in the Chicagoland area. MICHELLE LE BEAU Michelle M. Le Beau, PhD, director of the University of Chicago Medicine Comprehensive Cancer Center and a leading authority on cancers of the blood, explains what “comprehensive” means for patients and families. For more information, visit cancer. uchicago.edu. AT THE FOREFRONT WE ARE 1 OF 41 NATIONAL CANCER INSTITUTE-DESIGNATED COMPREHENSIVE CANCER CENTERS IN THE NATION U C M C O N N E C T 1 - 8 8 8 - 8 2 4 - 0 2 0 0 | UCHICAGOKIDSHOSPITAL.ORG | UCHOSPITALS.EDU » 11 COMMIT TED TO COMPASSION & CARE Young Adults with Blood Cancer: Why It’s Better to Treat Them Like Kids Jenn Georges recently completed her master’s degree and started a new job. She is busy planning her upcoming wedding. With her adult life on track, the 24-year-old doesn’t mind that when it came to fighting leukemia, she was treated — in one way — like a child. “We are testing the pediatric regimen in young adults ages 16 to 39 to assess toxicity, tolerance and compliance.” Final results from the trial will be reported next year. In August, the University of Chicago Medicine began a new program designed specifically for AYAs. The clinic’s multidisciplinary medical team includes adult and pediatric hematologists, advanced practice nurses and social workers, as well as specialists in survivorship, psychology, fertility and genetics. Diagnosed with cancer soon after graduating from college downstate in 2009, the Lombard, Ill., resident returned home to get her care at “In addition to offering the latest therapies the University of Chicago Medicine. In her for these patients, we address personal initial meeting with hematologist-oncologist and psychosocial issues and other medical Wendy Stock, MD, Georges learned that a challenges that are unique to AYAs,” said clinical trial testing a pediatric protocol for Stock, co-director of the program. young adults battling leukemia could give her the best chance at survival. Georges told NEW CANCER PROGRAM Stock to “sign me up.” Georges is part of a distinct group of patients referred to as AYAs: adolescents and young adults with cancer. Until recently, most AYAs with leukemia were treated on adult protocols. But a 2008 retrospective study conducted by Stock Jenn Georges and her colleagues demonstrated that patients treated on pediatric regimens had higher survival rates. This observation led to the nationwide clinical trial that enrolled Georges and more than 300 other patients. “While the adult and pediatric chemotherapy drugs are the same, the doses and schedules are different,” explained Stock. “The intensity of the pediatric therapy gets harder to tolerate as patients age. AIMED AT YOUNG ADULTS The new Adolescent and Young Adult (AYA) Oncology Program at the University of Chicago Medicine helps young adults take an active role in their care. We offer diagnostic, treatment and support services for young adults (ages 15 to 30) with leukemia or lymphoma. As leaders in AYA cancer research, the experts on our medical team have access to the latest clinical trials and protocols. The AYA Oncology Program sees patients in the Comer Center for Children and Specialty Care, a new state-of-the-art outpatient clinic and infusion suite adjacent to the University of Chicago Medicine Comer Children’s Hospital on the medical center’s Hyde Park campus. For more information about the AYA Oncology Program, visit uchospitals.edu/ specialties/cancer/young-adult. | A B O V E , L E F T | Jenn Georges, 24, was the first patient seen in the new AYA clinic at the University of Chicago Medicine. 12 » THE UNIVERSITY OF CHICAGO MEDICINE IMAGINE MAGAZINE | FA L L 2 0 1 2 Working to Overcome Barriers to Breast Cancer Treatment in Nigeria Liese Pruitt, a third-year student at the University of Chicago’s Pritzker School of Medicine, recently visited Ibadan, Nigeria, for the second time to study social and cultural barriers that cause women there to delay treatment for breast cancer. Pruitt, whose research was funded by the Dennis Lee and Anita Cheng Lee Global Health Scholarship, thinks there are ways to cut through misinformation about breast cancer and get women care sooner. She hopes to pilot an education program by collaborating with clerics to urge women to seek medical care in addition to spiritual healing when they find a breast lump. “Liese’s work has opened new opportunities for interventions to improve breast cancer outcomes in low-resource settings,” said Olufunmilayo I. Olopade, MD, director of the Cancer Risk Clinic at the University of Chicago Medicine. COLON CANCER SCREENING INITIATIVE The University of Chicago Medicine has partnered with the American Cancer Society Illinois Division in a statewide initiative to increase colorectal cancer awareness and screenings in at-risk populations, including members of the African-American and AsianAmerican communities on Chicago’s South Side. L A C E Y ’ S S TO RY: THE GIFT OF LIFE LACEY’S STORY INSPIRES BONE MARROW DONORS, CONTRIBUTIONS TO RESEARCH The bond between Lacey Horwitch and her father, David, runs much deeper than the typical father-daughter relationship. When the 9-year-old was diagnosed with two very rare disorders, one of which causes the body to attack its organs, she desperately needed a blood stem cell or bone marrow donor. Determined to find a match, her family partnered with numerous organizations to hold bone marrow donor drives near their home in Northbrook, Ill. With no success and Lacey’s condition quickly deteriorating, her father — who was just a 50 percent match — donated his stem cells, offering Lacey the lifeline she needed. Since the bone marrow drives, at least four people have been contacted by the national bone marrow registry as potential matches for sick patients. “I look at it as Lacey has saved three or four lives by these drives, which otherwise would not have happened,” said Lacey’s mother, Laura Horwitch. When they’re old enough to be eligible, Lacey’s sisters, Maya, 11, and Jenna, 6, will register to become donors themselves. In the meantime, Laura says the family is simply focused on never taking a moment for granted. Her spirit and energy keep us going. This was a wake-up call to appreciate every moment of life. LAURA HORWITCH “She’s had some transplant complications, but we believe she’s going to overcome those hurdles,” said David, a Chicago-based attorney. The University of Chicago Medicine Comer Children’s Hospital is one of the only centers in the Midwest offering stem cell transplants from parents, made possible by stateof-the-art cell purification technologies. The little girl’s family credits renowned experts John Cunningham, MD, chief of pediatric hematology/oncology, and Roy E. Weiss, MD, PhD, chief of adult and pediatric endocrinology, diabetes and metabolism, with saving Lacey’s life. “All the medical staff was very committed and dedicated to their work,” said David. “We found the doctors to be accessible and responsive.” In recognition of the care she received and wanting to give back, the Horwitch family hosted several fundraising events and raised nearly $50,000 for research. Better still, they have recruited more than 1,000 potential bone marrow donors through these events. CONTINUED » To learn how you can become a bone marrow donor, visit bethematch.org. For more information or to support Weiss’s or Cunningham’s research, please contact Jennifer Goodnow at email@example.com. | ABOVE, LEFT | Lacey Horwitch with her mother, Laura | R I G H T | John Cunningham, MD The University of Chicago Medicine 5841 S. Maryland Avenue Chicago, IL 60637 If you receive an extra copy of this publication, please share it with a neighbor or friend. If you prefer to be removed from our mailing list, please call 1-855-622-6116. JOIN US FOR A CHICAGO-AREA COMMUNITY OPEN HOUSE INTRODUCING OUR NEW HOSPITAL The Center for Care and Discovery DECEMBER 8, 9 AM â€” 5 PM Opening in early 2013, the Center for Care and Discovery is a state-of-the-art hospital providing complex specialty patient care with a focus on cancer, gastrointestinal disease, neurosciences and advanced surgery. The event will feature tours, wellness screenings and information about community resources. REGISTRATION IS REQUIRED To register for your timed tour, visit uchospitals.edu or call 1-855-655-2627. The Center for Care and Discovery is located at 5700 S. Maryland Ave., Chicago