With gastric cancers, it all comes down to the lymph nodes. These bean-size organs of the immune system located throughout the body can be filters for cancer cells, gathering them up and providing the vehicle for them to travel from the main tumor to other tissues and organs. ago, so he had a personal interest. After reading an article about the disease in the New York Times, he was struck by how little money was available for pancreatic cancer research. After meeting with Kern and other leading researchers, he was even more inspired to take action. “Their expertise was quite impressive,” says Kovler. “They were very persuasive about the need and timing for funding, and I believe what Johns Hopkins offers is as good as it gets anywhere in the world.” His goal was to ensure continuity of funding, so his family’s foundation donated $2.5 million to establish the Everett and Marjorie Kovler Professorship in Pancreas Cancer Research. Kern, who is funded through the professorship, says it is the only fully-funded chair for pancreatic cancer research, a commentary to the money issues facing this cancer. “It seems to me that the philanthropic community has an obligation to help when there is a good chance for progress,” Kovler says. He calls it venture philanthropy. “Here is an opportunity for philanthropists to step up and take a leadership role in moving things forward. In this disease, the numbers run against you. Despair is deep, but there is real hope if we invest in the research. This Johns Hopkins team is making great progress. Maybe success is five years away, or maybe it doesn’t come for 20-30 years, but someone has to do this or we’ll never get there.” Other champions of the cause include the Goldman family, who have most recently provided lead funding for a pancreatic cancer genome study, the largest gene study every conducted, and whose earlier gift established the Sol Goldman Pancreas Cancer Research Center. The Commonwealth Foundation supports both cancer vaccine research and C.Novyi-NT research, and the Lustgarten Foundation, the Skip Viragh Charities and the Viragh Family Foundation have been major contributors to pancreatic cancer research, patient care and clinical studies. Just as important to the fight are donors like Russell Weisman. Weisman came up with $100,000 to cover the costs of therapy for a friend whose insurance company had denied payment. When the insurance company finally came through, instead of taking his money back, Weisman donated it to the Kimmel Cancer Center.
22
PROMISE AND PROGRESS
I Fall
2008 —Winter 2009
MAKING THE CUT
For GI cancers, the critical role of surgery cannot be overstated. With gastric cancers, it all comes down to the lymph nodes. These bean-size organs of the immune system located throughout the body can be filters for cancer cells, gathering them up and providing the vehicle for them to travel from the main tumor to other tissues and organs. The number of lymph nodes containing cancer can tell if it has just begun to spread or it has already made a complete escape. The American Society of Clinical Oncology (ASCO) reports, however, that a quarter of surgeons (and many experts believe it is actually as high as one-half) do not take out the adequate number of lymph nodes during surgery, and as a result, they don’t get an accurate assessment of the cancer and how far it has progressed. Yet data show that the number of lymph nodes removed directly correlates with longer survival, says gastric cancer expert Mark Duncan, so patients suffer when surgeons aren’t aggressive enough. “It’s simple math,” he says, “I would be more confident that the cancer was not widespread if I found that just two out of 19 lymph nodes were positive for cancer as opposed to two out of nine. Maybe two out of nine was really three out of 21. Or zero out of six could really be two out of 21. You won’t know unless you take out the right number of lymph nodes,” says Duncan Duncan, who performs more than 300 gastric surgeries a year, says patients need to be aware that it does matter where they go to be treated. The ASCO report found that surgeons outside of major medical and academic centers were not even getting lymph nodes adjacent to the stomach. Johns Hopkins surgeons take an aggressive approach because the current statistics are dismal for the rare cancer. Of the more than 21,000 people diagnosed each year, only about 25 percent will be cured. The rest—75 percent—will die from the cancer. Surgery may be the only opportunity to cure the patient because, for now, chemotherapy and radiation have shown minimal benefits. So, Duncan and colleagues take out all lymph nodes near and around the stomach in an effort to change the direction of these numbers. “Gastric cancers all behave the same and respond to the same anticancer drugs, so we are looking for better drugs,” he