Banner MD Anderson Rounds - Winter 2014
A publication for community physicians. A first look at Banner MD Anderson's new advanced research and clinical trials.
WINTER 2014 A PUBLICATION FOR COMMUNITY PHYSICIANS Battling for better outcomes Banner MD Anderson participates in international collaboration to find answers for colorectal cancer patients BY BRIAN SODOMA D r. Tomislav Dragovich is a colorectal cancer (CRC) expert. But he’s also very aware of how much more he still has to learn about the complex disease. It’s this humbling realization that keeps him constantly striving to better patient care and seek out new research opportunities. Today, the division chief for hematology and oncology at Banner MD Anderson Cancer Center in Gilbert is a collaborator in a multi-institution, international effort that seeks a greater understanding of the genetic alterations that occur in CRC patients. The hope is that the effort will eventually result in improved outcomes for CRC patients around the world. “You can say there’s a lot in common in colorectal cancers but probably no two are alike when it comes to prognosis,” Dragovich said. “Not all of them behave the same way.” MOLECULAR SUBSETS There has been considerable recent progress made in treatment outcomes for melanomas, breast and lung cancers. This advancement was enabled by the discovery of unique molecular subsets of these cancers that can be effectively targeted by personalized therapies. But CRC tumors tend to have a higher number of potential genetic alterations, making it difficult to effectively pinpoint unique subsets that current treatments can successfully target. Dr. Dragovich and the team from Banner MD Anderson are joining with The University of Texas MD Anderson Cancer Center in Houston and a team of collaborators from cancer centers in China, Brazil, Mexico and Turkey to collect and analyze tissue samples from 150 patients with colon cancers who have the KRAS gene mutation. Using the latest in high through-put technology and bio-informatics, the team will attempt to identify unique tumor subtypes in order to match them more effectively with some of the new targeted cancer therapies. UNIQUE GENE SIGNATURES “Today some CRC patients with metastatic disease live three to four INSIDE years while others only have a year to year-and-a-half,” he says. “We’re trying to identify clusters of genetic alterations that will predict how the CRC will behave and tell us whether or not it will respond to a specific treatment.” The collaboration will also involve looking into how these unique gene signatures are distributed in different populations, including Asians, Latin Americans and Caucasians. With initial funding and infrastructure support provided by MD Anderson (through its Sister Institution Network Fund), the hope is that the effort’s findings will spur an expanded follow-up study using larger national research grant funds. “We’re really proud to be a part of this project,” Dragovich added. “When we understand the underlying molecular subset in CRC, we will achieve better treatment outcomes for our patients.” 2 Preventative steps to fight cancer 6 New clinical trials 3 Cancer prevention event 7 What’s happening at Banner MD Anderson 4 Meet the new docs 8 Banner MD Anderson physicians PREVENTATIVE STEPS TO FIGHT CANCER HOW ROUTINE SCREENINGS CAN DETECT CANCER EARLY, RESULT IN BETTER OUTCOMES BY MEGHANN FINN SEPULVEDA E ducating your patients on cancer screening recommendations is considered one of the best ways to help them stay in control of their health. Screenings for each type of cancer can vary, but if your patients follow these recommendations for detecting breast, cervical and skin cancer, they’ll be armed with a powerful defense: knowledge. Breast imaging specialists say that while regular screenings are the most effective strategy to identify early breast cancer in high risk women, there are other options available. “Additional screenings and preventative medications are available and should be discussed with a physician or breast health specialist,” Loving said. “Surgical options such as preventative mastectomies can reduce the chance of breast cancer by 90 percent.” MAMMOGRAMS EVERY YEAR Starting at age 40, women should have an annual mammogram, or sooner, if family history of breast cancer is present in a first degree relative such as a mother or sister. Specifically, women who are considered at high risk should consider screening 10 years earlier than the age of the relative at the time of diagnosis, but not before age 25. If family history is present, it may be beneficial to speak to a genetic counselor to determine risk, and discuss testing for high risk gene mutations such as BRCA1 or BRCA2. “When a woman is at significantly high risk for breast cancer, we typically suggest annual mammograms in combination with a breast MRI to complement our detection methods,” said Vilert Loving, M.D., director of Breast Imaging at Banner MD Anderson Cancer Center in Gilbert. 2 WINTER 2014 ROUNDS Dr. Vilert Loving PAP TEST AND HPV VACCINATION It may be surprising to learn that you can begin protecting your children from cervical cancer at age nine. The American Academy of Pediatrics says that children, teenagers and adults between the ages of 9-26 should receive the Human Papillomavirus (HPV) vaccine to prevent exposure to common viruses associated with cervical cancer. After age 26, experts say the vaccine is not recommended because the majority of people have already been exposed to the virus and it would not be beneficial. The good news is that the progression to cervical cancer from normal cervical cells is slow. “It takes about 10 years for a patient to develop cervical cancer after infection with HPV, which allows for pre-cancerous lesions to be discovered and treated early,” said Matthew Schlumbrecht, M.D., gynecologic oncologist and surgeon at Banner MD Anderson. The American Congress of Obstetricians and Gynecologists say women ages 21-30 should have a pap test, which checks for changes in the cells found in the cervix, once every three years. Beginning at age 30, women should get a pap test and a HPV test. If both tests are normal, this should be repeated every five years until age 65. An annual pelvic exam during a wellwoman visit is still recommended. PROTECT YOUR SKIN Of all cancer types, skin cancer is predominant. More than 3.5 million people are diagnosed each year in the U.S., according to the Skin Cancer Foundation, and one in five Americans will develop skin cancer in the course of a lifetime. The majority of skin cancer is caused by excessive ultraviolet ray exposure from the sun. “People should apply sunscreen with SPF 15 or 30 every day, even if they are not planning on being outdoors” said Randall Craft, M.D., plastic and reconstruction surgeon at Banner MD Anderson. Melanoma can be found on the face, neck and arms, which are the most common sun exposed areas of the body. Other typical locations are the back and chest in men, and legs in women. People should apply sunscreen with SPF 15 or 30 every day, even if they are not planning on being outdoors. — Randall Craft, M.D. A biopsy of the lesion can determine the method of treatment. “The most important thing people can do is to get a periodic skin exam from a physician to identify changes in the skin,” Craft said. “While research shows there isn’t a high correlation between family history and melanoma, there is a greater incidence of skin cancer in people who burn easily or have a history of blistering sunburns, have blue eyes, red hair, or freckling.” Benign skin tumors like moles are common and often harmless, but are sometimes removed to be safe. Cancer prevention event BY GREMLYN BRADLEY-WADDELL Y our patients can get expert advice on cancer prevention at the Power of Prevention event at Banner MD Anderson Cancer Center in Gilbert, 2946 E. Banner Gateway Drive, on Saturday, March 22 from 9 a.m. to 1 p.m. The event, which is free and open to the public, will feature the following presentations by leading oncology authorities and physicians: • Integrative Healing Modalities Research • Genetic Risk Assessments • Lifestyle and Cancer • Skin cancer prevention • Breast Cancer Screening and Imaging In addition, nutrition and exercise specialists will be on hand to share tips for reducing the risk of cancer, and information about the latest cancer screening recommendations and guidelines will be available. Open house attendees are also welcome to tour the center’s new clinic, the James M. Cox Center for Cancer Prevention and Integrative Oncology. Named for the founder of Cox Enterprises, the communications, media and automotive services company that operates two subsidiaries in Arizona. To RSVP for the event or for more information, call (602) 230-2273. BannerMDAnderson.com 3 Meet the new docs We’d like to introduce you to eight physicians who have joined us in the past year… REBECCA ARMENDARIZ, M.D. is a palliative medicine specialist. She specializes in the treatment of musculoskeletal, myofascial and neuropathic pain. She also focuses on improving patients’ functional deficits and enhancing quality of life goals for patients and their families. After graduating from Creighton University School of Medicine in Omaha, Dr. Armendariz completed an internship in internal medicine and her residency in physical medicine and rehabilitation at Virginia Commonwealth University Health System in Richmond. She also completed postgraduate training in oncology pain and hospice/ palliative medicine at Memorial Sloan Kettering Cancer Center in New York. “I believe cancer care is multidimensional and includes treating the physical, social, emotional, cognitive and spiritual symptoms that affect a person’s life,” she said. JULIE BILLAR, M.D., board certified by the American Board of Surgery, specializes in breast and lymph node surgeries. A graduate of the University of Rochester School of Medicine and Dentistry, Dr. Billar completed her internship and residency in general surgery at Mayo School of Graduate Medical Education in Scottsdale, where she received the General Surgery Peer Service Excellence Award. She also completed postgraduate training in breast surgical oncology at the John Wayne Cancer Institute in Santa Monica, Calif. “As a fellowship-trained breast surgeon, my practice is solely dedicated to patients with breast disease,” she said. She relies on “a multidisciplinary approach to breast cancer care so each patient leaves with a solid understanding of what to expect and knows her plan.” DANIEL CHAMBERLAIN, M.D. specializes in treating head and neck, lung and gastrointestinal cancers. A board certified radiation oncologist, he is a graduate of the Columbia University College of Physicians and Surgeons in New York. Dr. Chamberlain completed his internship at the Mayo Graduate School of Medicine in Scottsdale and his residency at the YaleNew Haven Medical Center in Conn. “I chose to work at Banner MD Anderson Cancer Center in Gilbert because I wanted to be able to offer my patients the best care available,” Dr. Chamberlain said. “When I heard that Banner Health was partnering with The University of Texas MD Anderson Cancer Center to form a new cancer center in Arizona, it seemed like the perfect opportunity to offer world-class care here in the Phoenix area.” PHILIPPE LANAUZE, M.D. is an interventional radiologist specializing in diagnosing cancer. He completed a fellowship in vascular and interventional radiology at The University of Texas MD Anderson Cancer Center, St. Luke’s Hospital and Memorial Hermann Hospital in Houston and his residency in radiology at MD Anderson. I chose to work at Banner MD Anderson Cancer Center in Gilbert because I wanted to be able to offer my patients the best care available. — Daniel Chamberlain, M.D. 4 WINTER 2014 ROUNDS ANNA LIKHACHEVA, M.D. is a radiation oncologist who specializes in treating breast cancer, gynecologic malignancies and lymphoma with radiation. A graduate of the University of Arizona College Of Medicine, Dr. Likhacheva completed her internship at The University of Texas Medical School at Houston and her residency at The University of Texas MD Anderson Cancer Center. “I know that Banner MD Anderson brings the values of caring, integrity and discovery to the care of cancer patients in Phoenix,” Dr. Likhacheva said. “I am very fortunate to work with a tremendous team of physicians, physician assistants, nurses and therapists here whose dedication ensures a positive experience for patients who come through our doors.” JIGNESH PATEL, M.D. specializes in women’s imaging, as well as body and cardiovascular MRI and is board certified by the American Board of Radiology A graduate of Rutgers Medical School in New Jersey, Dr. Patel completed his residency at the University of North Carolina and his internship at Albert Einstein Medical Center in Philadelphia. Winner of the Alexander R. Margulis First Time Presenter Award, Dr. Patel’s goal is simply “to provide the best radiologic services possible in the diagnosis and treatment of cancer.” I believe in a holistic approach to cancer care prevention as well as secondary prevention, focusing on all aspects of care. —Santosh Rao, M.D. SANTOSH RAO, M.D. specializes in medical oncology, breast oncology, survivorship, cancer prevention and integrative oncology. He wants to help those with cancer or at high risk of developing cancer to confront this disease. “I believe in a holistic approach to cancer care prevention as well as secondary prevention, focusing on all aspects of care,” he said. “I believe that no matter the circumstance, as caregivers we can offer hope and support and educate patients how they can participate in their own care.” Board certified by the American Board of Integrative and Holistic Medicine, Dr. Rao is a graduate of the University of Michigan and completed his residency and internship at Albert Einstein Medical Center in Philadelphia. MATTHEW ULRICKSON, M.D. specializes in hematology, oncology and stem cell transplantation, treating various types of lymphomas and leukemias. Dr. Ulrickson completed a hematology/oncology fellowship at the Fred Hutchinson Cancer Research Center at the University of Washington in Seattle. He completed his internship and residency at Massachusetts General Hospital in Boston. He received his medical degree from The University of Texas Health Science Center in Houston. “I want physicians in the Phoenix area to know that I believe reputations are earned. I want the opportunity to prove that I will take excellent care of their patients. I want physicians to know that if a patient is referred for stem cell transplant, I will make every effort to return the patient to their care as soon as it is appropriate.” He is a member of the American Society of Hematology, the American Society of Clinical Oncology, the Society of Hematologic Oncology and the American Society of Blood and Marrow Transplantation. BannerMDAnderson.com 5 Conducting research at the cancer center means interested patients who meet individual study requirements have access to treatments that are otherwise unavailable. — Lee Seabrooke, Research Director, Banner MD Anderson Cancer Center Lee Seabrooke New clinical trials engage community Radioembolization’s role in liver cancer treatment BY KRISTINE BURNETT S ince opening in September 2011, Banner MD Anderson Cancer Center in Gilbert has ramped up what will ultimately become a robust research program. Clinical program directors like Judith Wolf, M.D., gynecologic oncologist and division chief of surgery, and Mary Cianfrocca, D.O., director of the breast cancer and clinical cancer genetics programs, identify and initiate trials that align with the cancer care needs of those they serve. Lee Seabrooke, administrative director of research at Banner MD Anderson, says having autonomy and taking a selective approach to research ensures a program that is tailored to and engages the local community. “Conducting research at the cancer center means interested patients who 6 WINTER 2014 ROUNDS meet individual study requirements have access to treatments that are otherwise unavailable,” he says. “Not only does this offer another treatment option, it gives them greater hope.” The cancer center wrapped up 2013 with nearly 20 trials underway, 10 of which remain open for enrollment. More than 30 trials are in the approval process, with many set to begin this year. Clinical trials at Banner MD Anderson, which are funded by both the pharmaceutical industry and philanthropy, span multiple cancer types, ranging from ovarian and gynecologic cancers, to bladder, blood, skin and pancreatic cancers. OVARIAN CANCER: TESTING A NEW FIRST-LINE TREATMENT Under Wolf’s direction, Banner MD Anderson, in the summer of 2013, became one of several sites across the country to take part in a multi-institutional clinical trial from the Gynecologic Oncology Group. The trial will evaluate the efficacy of a new drug as a first-line treatment for women newly diagnosed with advanced-stage ovarian cancer. This phase 3 randomized trial is an extension of a previous study of the cancer drug Avastin that proved to delay disease progression by an average of about three months. The new trial will evaluate the benefits of taking Avastin in combination with chemotherapy, the current standard treatment for ovarian cancer. “We hope to enroll between 10 and 12 women who have not yet begun treatment for ovarian cancer to test this approach as a first-line treatment,” Wolf says. “Women who have undergone surgery but have not yet had chemotherapy or radiation could still be eligible.” The trial is expected to run for several years and will enroll upwards of 2,000 participants across the country. “We have more trials planned,” she says. “I encourage physicians and their patients who have been diagnosed with any type of gynecologic cancer to reach out to Banner MD Anderson. It’s always worth a call to see if we have a trial that they may benefit from.” EVALUATING A COMBINATION THERAPY FOR ADVANCED BREAST CANCER Banner MD Anderson also is enrolling patients in a breast cancer trial to evaluate a first-line treatment for metastatic breast cancer, that is, cancer that has spread beyond the breasts. The study will test the effectiveness of the drug everolimus in combination with letrozole. Everolimus is currently approved by the Food and Drug Administration for second-line treatment in combination with aromasin. As of December 2013, two Banner MD Anderson patients are enrolled in the trial that is part of a larger study sponsored by pharmaceutical company Novartis and operated by researchers at several institutions across the country. Cianfrocca, who serves as the principal investigator for the study at Banner MD Anderson, hopes to enroll upwards of 20 patients over the course of what is expected to be a multi-year research investigation. Participants must not have undergone any prior therapy to treat the metastatic breast cancer. “Patients in the trial will stay on the combination therapy for as long as they continue benefiting without experiencing unacceptable side effects,” notes Cianfrocca. “We will follow patients for several years after they complete the trial therapy to track and monitor their results.” Call 480-256-6444 and speak with a research coordinator to inquire about open trials and eligibility requirements at Banner MD Anderson. More information can be found online at BannerMDAnderson.com/ ClinicalTrials. What’s happening at Banner MD Anderson Cancer Center Dear Colleagues and Friends, H appy New Year! I hope that 2014 is off to a good start for you both professionally and personally. At Banner MD Anderson Cancer Center in Gilbert, we are excited about what the year has in store. As you know, every year brings new scientific and medical advances that allow us to provide the very best care to our patients. Every discovery, every clinical trial and every new medication approval helps give our patients hope. We’re also pleased to expand our reach as the Valley’s leading cancer center. We are closing in on the completion of our $63 million expansion, which will nearly double the size of our outpatient center, providing 30 new exam rooms as well as additional space for radiation treatment and chemotherapy. Our expansion is expected to be completed by April 1, and will include 13 new infusion bays, two new linear accelerators and shelled space for a third, and dedicated clinic space for our stem-cell transplant program. This expansion also includes The James M. Cox Center for Cancer Prevention and Integrative Oncology. Plus, in January, we expanded our radiation oncology program to patients at Banner Thunderbird Medical Center in Glendale and Banner Desert Medical Center in Mesa, which also provides pediatric care at Banner Children’s at Cardon Children’s Medical Center. Banner Thunderbird and Banner Desert already have excellent radiation oncology facilities. We have merged the radiation oncology teams from those hospitals with our team at Banner MD Anderson and are bringing new physicians to these locations. This is an exciting program expansion because it gives patients access to The University of Texas MD Anderson Cancer Center’s worldrenowned approach to cancer care throughout the Valley. Patients who live closer to Banner Thunderbird or Banner Desert now have the option of receiving the same high level radiation treatment they are accustomed to receiving at Banner MD Anderson— but without the additional drive time. As you know, for patients getting regular treatments and coping with any side effects, cutting back on time spent in the car can be a significant benefit. It’s also a likely help to spouses and other caregivers. We are now well into our third year of serving the Phoenix metropolitan area and these are just a couple of the exciting recent developments. I look forward to sharing more news with you throughout the year. Best wishes for 2014, Dr. Edgardo Rivera MEDICAL DIRECTOR BannerMDAnderson.com 7 BANNER HEALTH 1441 N. 12th SREET PHOENIX, AZ 85006-2887 NONPROFIT ORG U.S. POSTAGE PAID LONG BEACH, CA PERMIT NO.1677 Banner MD Anderson PHYSICIANS B anner MD Anderson Cancer Center in Gilbert physicians are highly specialized in their fields of expertise. Below is a listing of physicians currently on our full time staff. Physicians continue to join Banner MD Anderson, so this list will continue to evolve. PATIENT REFERRALS To make a referral to a physician on our staff, please call 480-256-3433. To contact a member of medical staff, call 480256-6444 and ask for the physician to be paged. HEMATOLOGY & MEDICAL ONCOLOGY SECTION Tomislav Dragovich, MD, PhD, Division Chief Gorgun Akpek, MD, MHS Santosh Rao, MD Shakeela Bahadur, MD Mary Cianfrocca, DO Farshid Dayyani, MD, PhD Jade Homsi, MD H. Uwe Klueppelberg, MD, PhD Javier Munoz, MD Edgardo Rivera, MD, Medical Director Kerry Tobias, DO Rebecca Armendariz, MD Matthew Ulrickson, MD Klaus Wagner, MD PhD Bryan Wong, MD ONCOLOGY SURGERY SECTION Judith K. Wolf, MD, Division Chief Stephanie Byrum, MD Al Chen, MD Randall Craft, MD Mark Gimbel, MD Karen Pitman, MD, Matthew Schlumbrecht, MD, MPH Rob Schuster, MD Thomas Shellenberger, MD Diljeet Singh, MD Benny Tan, MD Julie Billar, MD RADIATION ONCOLOGY SECTION Matthew Callister, MD, Division Chief Dan Chamberlain, MD Emily Grade, MD Anna Likhacheva, MD Terence Roberts, MD Shervin Shirvani, MD Andrew Price, MD, CAQ Interventional Radiology Philippe Lanauze, MD Jignesh Patel, MD CRITICAL CARE SECTION Shiva Birdi, MD, Division Chief Jijo John, MD Deven S. Kothari, MD Dean Prater, MD Ravindra Gudavalli, MD INTERNAL MEDICINE SECTION Nikunj Doshi, DO, Division Chief Shefali Birdi, MD Ronald Servi, DO DIAGNOSTIC IMAGING SECTION PATHOLOGY SECTION Donald Schomer, MD, Division Chief, CAQ Neuroradiology John Chang, MD, PhD Vilert Loving, MD Harvinder Maan, MD, CAQ Neuroradiology Rizvan Mirza, MD Susan Passalaqua, MD Kevin McCabe, DO, Division Chief To learn more about our physicians at Banner MD Anderson in Gilbert , please visit BannerMDAnderson.com/OurPhysicians.