RETHINK
NOT TOO LONG AGO, CANCER WAS A NEARLY ALWAYS FATAL DISEASE. Today, we know that cancer is not a single disease, but a collection of more than 100 distinct types. Many of these cancers can be treated and, in some cases, cured. The good news is people are living longer with cancer. With every exciting advance that results from research, we are getting closer to stopping cancer in its tracks. But there are many challenges ahead. Our researchers are addressing these challenges with revolutionary science. They are seeking the answers to cancer’s most challenging questions through inquiry, creativity, and collaboration. In this report, we take a look at the progress we’ve made on many fronts in cancer research and imagine how the advances of today will bring endless possibilities for the future. This is just the beginning.
A CLOSER LOOK AT ‘COMPREHENSIVE’ STATUS 3
RETHINK RESEARCH
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RETHINK COMMUNITY OUTREACH
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RETHINK EDUCATION & TRAINING
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RETHINK PHILANTHROPY
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CONTENTS
DIRECTOR’S LETTER 2
DIRECTOR’S LETTER and physicians who are rallied around one goal—to reduce cancer’s devastating effects. By constantly pushing the boundaries of knowledge to find new ways to prevent, diagnose, and treat cancer, we have made remarkable progress in our quest to help patients live longer, healthier lives. It is our ability to rethink what’s possible that allows us to challenge the status quo and bring about new results in cancer care and discovery.
Nobel laureate Charles B. Huggins, MD, founded the University of Chicago’s Ben May Laboratory for Cancer Research. PHOTO CREDIT: UNIVERSITY OF CHICAGO PHOTOGRAPHIC ARCHIVE, APF2-00689, SPECIAL COLLECTIONS RESEARCH CENTER, UNIVERSITY OF CHICAGO LIBRARY
This year’s annual report invites you to imagine the endless possibilities that advances in basic, clinical, and population research can bring to life for cancer patients in Chicago and beyond. Most importantly, imagine a world where cancer is no longer a threat. That’s our vision. We believe it’s possible—because discovery is our business. With deepest gratitude,
University of Chicago cancer researcher Charles B. Huggins, MD, was known for saying, “Discovery is our business.” He dedicated his life to scientific inquiry, spending 10 hours in the lab every day. His hard work paid off.
Huggins won the Nobel Prize for his discovery that depriving prostate cancer cells of chemical signals, such as hormones, caused them to die. This finding radically changed prostate cancer treatment in the 1940s and launched a medical revolution that still impacts patients today. Huggins’ legacy reminds us to “think bigger.” The dogged pursuit of discovery leads to the biggest medical breakthroughs, transforming cancer from fatal to treatable. And we are quickly heading for a future where cancer is controllable. Our nationally recognized Comprehensive Cancer Center brings together scientists
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Michelle M. Le Beau, PhD Arthur and Marian Edelstein Professor of Medicine Director, University of Chicago Medicine Comprehensive Cancer Center
PHOTO CREDIT: JOHN KILKUS
A CLOSER LOOK AT ‘COMPREHENSIVE’ STATUS FAST FACTS
1973
Date of first NCI designation
Norman E. “Ned” Sharpless, MD, director of the National Cancer Institute with Comprehensive Cancer Center Director Michelle M. Le Beau, PhD.
The National Cancer Institute (NCI) designates certain academic institutions as being centers of excellence in cancer research. The “Comprehensive” designation is the top honor for such centers, and the University of Chicago Medicine Comprehensive Cancer Center is one of just 49 in the nation—and one of two in Illinois.
This year, the NCI renewed our designation as a comprehensive cancer center. In their review, they gave us an “outstanding” rating, noting our strengths in basic, clinical, and translational cancer research. “Our successful competitive grant renewal and re-designation from NCI is a testament of the scientific excellence we’ve worked hard to cultivate,” says Director Michelle M. Le Beau. “We are honored to be among the top tier of cancer centers in the nation that are working to reduce cancer’s devastating effects and improve people’s lives both in Chicago and around the world.”
2008
Date of Comprehensive status
>200
# of physician/scientist members
5
# of scientific research programs
10
# of shared research core facilities
>350
Therapeutic trials in all phases as a Lead Academic Participating Site of the National Clinical Trials Network
>7,000
# of cancer patients diagnosed and/or treated each year
>$42M
Peer-reviewed grant funding annually
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RETHINK RESEARCH
IMAGINE THE TREATMENTS WE COULD DEVELOP IF WE REALLY UNDERSTOOD THE INNER WORKINGS OF CANCER. IT’S BECOMING POSSIBLE.
Cancer research is one of the most difficult disciplines in medicine. Every malignancy begins in one of the human body’s trillions of cells. Each cell contains webs of signaling networks. Harmful mutations or an intricate combination of changes in a signaling system can cause cells to reproduce uncontrollably, crowding out and killing healthy ones. That is why cancer research is comparable to exploring a maze of infinite complexity with an unknown number of beginning and end points. Our researchers apply the latest advances in imaging, molecular biology, information technology, genetics, genomics, systems biology, and other disciplines to the study of human cancer. Highlighted herein are some key research initiatives that Comprehensive Cancer Center investigators are collaborating on to bring fresh, new ideas to the forefront. RETHINK WHAT’S POSSIBLE 5
ACCELERATING PROGRESS ON THE HARDEST-TOTREAT CANCERS Sometimes called the “silent killer,” ovarian cancer is frequently diagnosed without obvious symptoms when it has already advanced to a late stage and is difficult to treat. In fact, more than 14,000 women die from ovarian cancer in the U.S. annually.
Researchers and physicians at the Compre hensive Cancer Center are approaching deadly ovarian cancer from all perspectives— from cancer prevention to understanding cancer mechanisms, developing novel therapies, and improving survivorship. For women who may be at a higher risk of ovarian cancer because of genetic factors, personalized risk assessment and prevention recommendations are critical for healthcare decision-making. Gynecological oncologist Iris Romero, MD, leads the Hereditary Breast and Ovarian Cancer Risk and Prevention Clinic with Olufunmilayo Olopade, MD, to provide screening and coordinated care for these women and their families. Current screening options do not always detect ovarian cancer at a treatable stage, even in these high-risk women. “This group
The University of Chicago team at the NOCC’s Illinois Chapter Run/Walk to Break the Silence on Ovarian Cancer.
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of patients can’t rely on screening as a way to manage their cancer risk,” says Romero. Many of these women choose surgery in which the ovaries are removed despite other health consequences. Therefore, Romero serves as the Comprehensive Cancer Center’s lead investigator for the national WISP trial (Women ChoosIng Surgical Prevention) to test whether delaying removal of the ovaries can prevent or delay sexual dysfunction in women who are at high risk for developing ovarian cancer. The project is also addressing how to increase access to genetic testing to identify individuals as high risk due to hereditary factors. Developing novel therapeutic approaches to ovarian cancer requires a deeper understanding of the molecular causes and evolution of the disease. A team led by Ernst Lengyel, MD, PhD, discovered last year that while some ovarian cancers originate in the fallopian tubes, some originate outside the fallopian tubes and metastasize there, challenging current paradigms about prevention and treatment. Lengyel’s pioneering work has also painted a more complete picture of how the ovarian cancer microenvironment—the surrounding cells and tissues—promotes cancer spread. His laboratory has created a novel threedimensional co-culture system to mimic the interactions of tumor cells with the microenvironment. They recently found that microenvironment-associated fibroblasts mobilize glycogen as an energy source in ovarian cancer cells to promote metastasis (Curtis et al., Cell Metabolism 29:141-55, 2019). This finding has implications for being able to cripple tumor cells by cutting off this energy source.
“I LOVE BRINGING A CLINICAL TRIAL FROM THE INITIAL CONCEPT ALL THE WAY TO FRUITION. THERE’S SOMETHING TRULY EXCITING ABOUT WORKING WITH NEW AGENTS.” Gini Fleming, MD
Furthermore, Lengyel recently characterized some of the molecular signals from fat cells that promote the spread of ovarian cancer cells in the abdominal cavity (Ladanyi et al., Oncogene 37:2285-2301, 2018) and identified a new biomarker, called CT45, associated with treatment success and patient outcomes (Coscia et al., Cell 175:159-70, 2018). Extension of these promising laboratory results, and their translation into the clinic, will be the focus of future studies by Lengyel and his team. Leadership in clinical trials is another key way that our investigators are working to improve treatment and outcomes for patients with ovarian cancer, especially those with advanced cancer. Oncologist Gini Fleming, MD, and John Moroney, MD, are national leaders in conducting clinical trials, from early-phase trials testing drug safety to large phase III trials assessing the potential benefit of new treatments compared to the standard of care. Recently, Fleming and colleagues tested a new type of drug called a hypomethylating agent in combination with chemotherapy in patients with advanced ovarian cancer who were previously treated with other agents, and were resistant to the chemotherapy. This multicenter phase I study showed that this combination therapy was safe and had anticancer activity, supporting a follow-up randomized phase II trial (Matei et al., Clin Cancer Res 24:2285-93, 2018). Fleming is also an integral member of the Stand Up to Cancer-Ovarian Cancer
Research Fund Alliance-National Ovarian Cancer Coalition (NOCC) Dream Team testing the effects of a new class of anticancer drugs called PARP inhibitors in ovarian cancers with specific molecular defects in how cells repair damage to their DNA. Because these new therapies are already used for some inherited forms of breast cancer, their application to ovarian cancer treatment could be rapid.
Fleming (left) is a national leader in conducting clinical trials in gynecologic and breast cancer. PHOTO CREDIT: NANCY WONG
Making improvements in the quality of life, not just quantity of life, for ovarian cancer patients is motivating for the Comprehensive Cancer Center ovarian cancer team. Lengyel was an active participant in Ovarian Cancer Awareness Month in September, including several TV interviews with his patient and ovarian cancer survivor Michelle Mekky. Michelle is a proud volunteer for the NOCC not only to help her cope with her own ovarian cancer journey, but to also spread awareness and support for other survivors. The NOCC partnered with the Comprehensive Cancer Center for their annual education event in September, and the ovarian cancer team participates annually in—and has raised tens of thousands of dollars for—the NOCC’s Illinois Chapter Run/Walk to Break the Silence on Ovarian Cancer. Our physicians and scientists recognize that the biggest impact comes from working side by side with patients, caregivers, advocacy organizations, community partners, and the public to promote discovery, awareness, and survivorship.
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PHOTO CREDIT: SHAUN SARTIN
Stephanie Harris established a fund that helps advance our understanding of the origins of ovarian cancer and uncover new ways to treat it.
“WE ARE ARMING OUR BRILLIANT MINDS, OUR DOCTORS, WITH THE ABILITY TO EXPLORE IDEAS MUCH FASTER THAN THEY’VE BEEN ABLE TO IN THE PAST.” Stephanie Harris
ARMING THE BRILLIANT MINDS IN OUR BACKYARD When Stephanie Harris’ mother was diagnosed with ovarian cancer, Stephanie searched the world for the number one mind specializing in that area. It just so happened that that person was S. Diane Yamada, MD, leader of the gynecologic oncology program.
Stephanie is a University of Chicago Medical Center trustee, which she finds incredibly exciting. “We have a front-row seat to some of the most leading-edge medicine and discussions about the future of medicine,” she says.
“I find more often than not when people call me looking for a great mind in cancer, that person sits right here in our backyard at the University of Chicago, which is amazing,” Stephanie says.
“If someone like Dr. Yamada has a hunch about a treatment for cancer, you throw whatever you can behind it,” she explains. “It’s like investing in a great CEO. You’re investing in a great mind, and that’s a worthwhile investment.”
In 2013, Stephanie and her husband, John, established an ovarian cancer research fund at the Comprehensive Cancer Center. Since its creation, the fund has helped advance our understanding of the origins of ovarian cancer, while also laying the groundwork for new treatments.
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She compares investing in physicianscientists like Yamada to venture capital.
“We are arming our brilliant minds, our doctors, with the ability to explore ideas much faster than they’ve been able to in the past,” she adds. “The pace of discovery is speeding up, and to have the whole University and all of its resources behind you is exciting.”
BIG DATA UNCOVERS CANCER’S HIDDEN SECRETS The University of Chicago Medicine Comprehensive Cancer Center continues to lead national efforts in using cancer bioinformatics and cloud computing to get an in-depth view of cancer genomics, epigenetics, proteomics, and gene expression. These data are allowing cancer researchers to get an unprecedented glimpse into the inner workings of cancer and helping to identify promising molecular targets at an accelerated pace.
The National Cancer Institute (NCI) Genomic Data Commons housed at UChicago and led by Robert Grossman, PhD, provides an invaluable resource to the international cancer research community, containing more than 14 petabytes of data accessed by more than 20,000 users per month. An extension of this effort focused exclusively on childhood cancer, also being developed at the University of Chicago, is the Pediatric Cancer Data Commons. Given the rarer nature of pediatric cancer and the need to compile and share data from across the globe, this will serve as a critical resource for improving
risk classification, treatment, and survivorship for childhood cancer. Project GENIE (Genomics Evidence Neoplasia Information Exchange) is another national genomic data initiative now involving the Comprehensive Cancer Center. Led by the American Association for Cancer Research (AACR), Project GENIE is centralizing clinical-grade genomic and clinical outcomes data from 19 institutions, including the University of Chicago. After the fifth public data release from GENIE, in January 2019, the database includes nearly 60,000 de-identified genomic records from patients treated at the consortium’s institutions. Like genomic data, imaging data hold extraordinary power to better understand and “see” cancer more closely. One of the world’s experts in incorporating imaging data with other cancer clinical features— a field called radiomics—is Maryellen Giger, PhD. Giger’s team has created innovative computational and bioinformatics approaches to better classify breast cancers and distinguish between benign and malignant tumors.
Grossman (left) provides NCI Director Norman E. “Ned” Sharpless, MD, an update on the progress of the Genomic Data Commons. PHOTO CREDIT: JANE KOLLMER
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RNA TAGS MAY HOLD A KEY TO CANCER Even just a decade ago, scientists didn’t know that RNA molecules—encoded by DNA and made into proteins that carry out cell processes—were sometimes tagged with modifications, like molecular barcodes, and that these tags could impact RNA expression and function. These discoveries have transformed our view of the RNA code and opened up a new field in cancer research.
In 2011, the laboratory of Comprehensive Cancer Center investigator Chuan He, PhD, identified the first known enzyme responsible for removing an RNA tag called N6-methyladenosine (m6A). Since then, He has identified other tag “erasers” (removes tags), discovered some tag “writers” (adds tags), and collaborated with other Comprehensive Cancer Center faculty to interrogate the importance of these players in cancer. A recent study involving He’s laboratory and gynecologic oncologist Ernst Lengyel, MD, PhD, reported that 70 percent of endometrial cancers have reduced levels of m6A methylation because of mutations or reduced expression of components of the “writer” complex (Liu et al., Nat Cell Biol 20:1074-83, 2018). Because of these alterations, cancer cells are able to grow faster and form tumors more easily. By dissecting the precise molecular networks disrupted as a result, the team hopes to be able to use drugs to block or slow down tumor growth. Additionally, in collaboration with gasteroenterologist and researcher B. Marc Bissonnette, MD, He has shown that these tagged RNA molecules contribute to the development of colorectal cancer. The team received a large grant from the National Cancer Institute (NCI) to understand the
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molecular players involved, and further their development of a novel sensitive biomarker for colorectal cancer based on RNA tags uniquely found in tumor cells but not surrounding normal tissue. To further these research efforts and train future experts in this field, He and Tao Pan, PhD, established the Center for Dynamic RNA Epitranscriptomes through a grant from the National Institutes of Health (NIH). This center focuses on developing technologies to decode RNA tags and is one of only eight Centers of Excellence in Genomics Science established, and the only one dedicated to RNA modifications. Generous support by the University of Chicago Cancer Research Foundation Women’s Board in 2017 and 2018 has also fostered research in cancer RNA epitranscriptomics. Pilot Project grants awarded included one to Yu-Ying He, PhD, for her collaborative project with Chuan He focused on mapping and targeting m6A modifications in skin cancer. Already, this funding has been instrumental for securing larger grants from the NIH to extend the science, pushing the boundaries of knowledge and ensuring that the Comprehensive Cancer Center will remain a leader in the field for years to come.
PHOTO CREDIT: EDDIE QUINONES
He’s pioneering work in the field of epitranscriptomics earned him the 2017 Paul Marks Prize for Cancer Research.
BY DISSECTING THE PRECISE MOLECULAR NETWORKS DISRUPTED AS A RESULT, THE TEAM HOPES TO BE ABLE TO USE DRUGS TO BLOCK OR SLOW DOWN TUMOR GROWTH.
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THE MICROBIOME’S ROLE IN CANCER AND ITS TREATMENT The human gut is inhabited by millions of bacteria—both good and bad— comprising the “microbiome” that scientists now realize impacts many facets of health, including cancer. Our investigators are uniquely positioned to investigate the microbiome-cancer connection because of the wealth of microbiome experts and research tools at UChicago.
Although gene mutations are clearly important, and often required, for cancer to develop, it is clear that other factors in the host, such as the microbiome, are also involved. Comprehensive Cancer Center researchers Bana Jabri, MD, PhD; Lucy Godley, MD, PhD; Eugene Chang, MD; and colleagues, including computational biologist A. Murat Eren, PhD, recently discovered that the microbiome contributes to pre-leukemia myeloproliferation, a leukemia precursor, in the presence of a mutation in the TET2 gene (Meisel et al., Nature 557:580-4, 2018). TET2 encodes an epigenetic modifier enzyme, and it has been known for many years that its mutation drives the development of some blood cancers. The team reported that in TET2-mutant mice or
Gajewski is leading research to discover how bacteria in the human gut impact cancer. PHOTO CREDIT: NANCY WONG
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humans, dysfunction of the gut barrier allows for some bacteria normally present to cross the gut barrier and initiate a set of signals. This signaling drives growth of blood stem cells and other cellular changes associated with cancer. A new Team Science grant funded by the University of Chicago Cancer Research Foundation (UCCRF) Women’s Board is allowing this research to be extended into understanding how the microbiome contributes to progression from early changes in blood stem cells into leukemia in both mice and humans. In addition to exploring how the microbiome contributes to the formation of cancer, we are also leaders in determining the influence of the microbiome on cancer treatment, especially immunotherapy, which harnesses the immune system to fight cancer. This year, Thomas Gajewski, MD, PhD, and his laboratory followed up on his landmark discovery that specific strains of bacteria are associated with immunotherapy resistance in mouse models of the deadly form of skin cancer, melanoma. In this recent study with collaborators Marisa Alegre, MD, PhD; Jason Luke, MD; and bioinformatician Riyue Bao, PhD, they showed that the commensal microbiome that normally lives within the human gut is associated with immunotherapy effectiveness in patients with metastatic melanoma (Matson et al., Science 359:104-8, 2018). The team is now testing the effect of probiotics on patients with melanoma in a clinical trial, underscoring the potential clinical impact of this research. Funding from the UCCRF Women’s Board in 2017 and 2018 has brought new scientists from the cancer and microbiome research communities to work at the interface of the two fields. Pilot Project grants awarded to Anne Sperling, PhD; Fotini Gounari, PhD; and B. Marc Bissonnette, MD, represent promising new lines of inquiry of the impact of the microbiome on chemotherapy response, leukemia development, and colorectal cancer mechanisms, respectively.
PHOTO CREDIT: EDDIE QUINONES
“THE EXTENSION OF CENTRAL CONCEPTS OF THE OLIGOMETASTATIC PARADIGM IS A POTENTIALLY EXCITING STEP TOWARD THE CURE OF SOME PATIENTS WITH METASTATIC DISEASE.” Ralph Weichselbaum, MD
NOT ALL METASTASIS IS CREATED EQUAL Back in 1995, Ralph Weichselbaum, MD, and Samuel Hellman, MD, coined the phrase “oligometastasis” to describe a state in which patients have a few metastases, or sites of cancer that has spread, in contrast to those with widespread metastases throughout the body. Since then, Weichselbaum and his colleagues have not only learned how to treat these patients with oligometastases effectively, but have also led efforts to understand the differences between these metastatic states and the molecular mechanisms that are involved.
New work from Weichselbaum and other Comprehensive Cancer Center members Sean Pitroda, MD; Mitchell Posner, MD; Kevin White, PhD; and Jeremy Segal, MD, PhD, identified three distinct subtypes of de novo colorectal liver metastasis through integrative molecular analysis (Pitroda et al., Nat Comm 9:1793-1801, 2018). These molecular subtypes complement clinical information
to distinguish low-, moderate-, and high-risk patients with very different survival rates, and have the potential to change how we evaluate metastasis clinically. Weichselbaum was recognized for the impact of his paradigm-shifting research with the 2018 American Society for Clinical Oncology (ASCO) David A. Karnofsky Award (Weichselbaum, J Clin Oncol 26:3240-50, 2018). “The extension of central concepts of the oligometastatic paradigm is a potentially exciting step toward the cure of some patients with metastatic disease and fits with concepts in personalized medicine, molecular staging and targeting, and the integration of immunotherapy with cytoreductive agents,” he says.
Weichselbaum specializes in the treatment of potentially curative treatment of oligometastasis with radiotherapy.
He was also the recipient of the 2018 American Society for Radiation Oncology (ASTRO) Gold Medal Award, the highest honor the organization bestows upon its members for outstanding contributions to research, clinical care, teaching, and service.
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NEW ANTICANCER DRUG SHOWS PROMISE IN AGGRESSIVE NON-HODGKIN LYMPHOMA In a small, multicenter clinical trial testing the combination treatment of an experimental anticancer antibody known as 5F9 (Hu5F9-G4) and the established anticancer antibody rituximab, about 36% of the patients with non-Hodgkin lymphoma went into complete remission from their cancers.
Smith (right) with a patient. PHOTO CREDIT: ANDREW NELLES
This new approach to immunotherapy relies on immune system cells called macrophages, rather than T cells, to attack and kill cancer cells. 5F9 is a macrophage immune checkpoint inhibitor.
“This is one of the first successful anticancer drugs that can stimulate a macrophage to attack a cancer cell,” says study senior author Sonali Smith, MD, who directs the Lymphoma Program at UChicago Medicine. “It opens a whole new door.” The cell surface marker CD47, displayed by many cancer cells, is a “don’t eat me signal,” Smith explains. Macrophages don’t normally attack those cells. But there is a second “eat me” signal that is potentiated by the other antibody, rituximab. The combination of 5F9 and rituximab “can overcome the signals that protect these cancer cells,” she says. “This is incredibly exciting, especially because checkpoint inhibitors don’t work very well in non-Hodgkin lymphomas,” she says. “Now we may have a way to manipulate the immune system for people with non-Hodgkin lymphomas that have relapsed and progressed after multiple prior therapies.” All 22 patients in the study had failed to respond to, or relapsed after, at least two and as many as 10 previous types of therapy. Fifteen patients had diffuse large B-cell lymphoma (DLBCL), and seven had follicular lymphoma. DLBCL, when it progresses after second-line treatment, is usually a fatal disease. The first full remission in the trial was a University of Chicago Medicine patient. She had relapsed within three months of an autologous stem cell transplant, was wheelchair bound, with rapidly progressive, very aggressive lymphoma. Within a week after starting therapy, “she began to feel better,” says Smith. “By the first assessment, after four weeks of treatment, she was in a complete remission” (Advani et al, N Engl J Med 2018; 379:1711-21).
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RESTORING THE IMMUNE SYSTEM’S ABILITY TO RECOGNIZE CANCER Cancer treatment has traditionally involved one of three options—surgery, radiation, or chemotherapy. In recent years, however, a new treatment option has entered the playing field and has become the preferred first-line treatment for certain cancers.
Immunotherapy—an approach that harnesses a person’s immune system— has changed how we treat many cancers, especially those that are hard to treat. In 2018, James Allison and Tasuku Honjo were awarded the 2018 Nobel Prize in Physiology or Medicine for discoveries that led to the development of “checkpoint inhibitors”—a type of immunotherapy that helps the immune system mount an attack by deactivating specific molecules that control immune checkpoints, which cancer cells use to avoid detection. The Nobel Committee called their discoveries a landmark in our fight against cancer. Treatments based on their work are now in use against several forms of cancer, with many more trials underway. Still, the approach doesn’t work in all cases, and our researchers are working to better understand what determines the success of the therapies and the many factors involved. Additionally, multiple clinical trials at the Comprehensive Cancer Center are testing combinations of immunotherapies in various tumor types, including melanoma, an aggressive and deadly skin cancer. Researchers have also found that combining immunotherapies with other treatments may elicit an even better
Luke (left) with his patient, Anwar Hakim. PHOTO CREDIT: JEAN LACHAT
clinical response in patients than either treatment alone. Jason Luke, MD, and Steven Chmura, MD, PhD, led a phase I trial to test the safety of combining pembrolizumab with stereotactic body radiotherapy (SBRT) in patients with solid cancers that have spread, or metastasized, to other parts of the body. SBRT precisely delivers high-dose radiation to a target tissue in a limited number of treatments, and has been shown to be effective for several types of early-stage and advanced cancer. In the clinical trial, patients received SBRT and at least one cycle of pembrolizumab. The combination therapy was generally well tolerated and safe, as similar rates of toxicity (side effects) were observed with the combination as each treatment alone. Furthermore, the combination therapy showed promising clinical activity, and the percentage of patients whose cancer shrank or disappeared (called the overall response rate) was 13.2%. Future studies are aimed at testing the immunotherapy/SBRT combination in larger, randomized studies and identifying biomarkers in the tumors that predict responsiveness to the combination (Luke et al, J Clin Oncol 36:1611-18, 2018). In 2018, Luke was awarded a National Cancer Institute Cancer Clinical Investigator Team Leadership Award and the Humanitarian Award from the Melanoma Research Foundation, and was included on Crain’s Chicago Business “40 Under 40” list.
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BREAKTHROUGH CAR T-CELL THERAPY CONTINUES TO ADVANCE New and promising types of immunotherapy have emerged in the past five years, giving doctors who have exhausted traditional chemotherapies another tool to use. For example, CAR (chimeric antigen receptor) T-cell therapy involves reprogramming a patient’s own disease-fighting white blood cells (T cells) to recognize and destroy cancer cells without harming healthy cells.
Select medical centers in the United States, including UChicago Medicine, lead clinical trials of this new treatment for leukemia and lymphoma. During clinical trials of CAR T-cell therapy, 70 to 90 percent of patients with acute lymphoblastic leukemia (ALL) went into remission after this treatment. And 40 to 50 percent of patients with non-Hodgkin lymphoma experienced complete remission. Although it’s too early to say these patients are cured, the results are encouraging for individuals with hard-totreat (refractory) or relapsed leukemia or lymphoma.
Cedric Elery (center, surrounded by nurse Gracie Foote and Dr. Michele Nassin) was Comer Children Hospital’s first pediatric patient to receive CAR T-cell therapy. PHOTO CREDIT: KAT CARLTON
Our academic health system was the first in the country to offer the groundbreaking therapy for both adult and pediatric patients. This year, CAR T-cell therapy was named as the Clinical Advance of the Year by the American Society for Clinical Oncology, marking its importance as a breakthrough for advanced blood cancers. Research at UChicago Medicine continues to play a key role in the development of this exciting new immunotherapy. CAR T-CELL THERAPY IMPROVES OUTCOMES FOR PATIENTS WITH B-CELL LYMPHOMA On May 1, 2018, the FDA approved the CAR T-cell therapy tisagenlecleucel for adults with certain types of non-Hodgkin lymphoma, making it the second CAR T-cell therapy approved for lymphoma and the second FDA approval for this drug. The FDA’s approval of tisagenlecleucel in patients with diffuse large B-cell lymphoma (DLBCL) that has come back or gotten worse after prior treatment is based on the phase II JULIET clinical trial, the largest study examining a CAR T-cell therapy in DLBCL. At the 2018 American Society of Hematology Annual Meeting, an international team of researchers presented findings from the trial. They evaluated 93 patients with DLBCL and found that 52% of those patients responded favorably to the therapy. Forty percent had a complete response, and 12% had a partial response. Sixty-five percent of those patients were relapse-free one year later, including 79%
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Lab technicians work in the ISO-7-classified clean room of the new Advanced Cellular Therapeutics Facility. PHOTO CREDIT: JOHN ZICH
of the complete responders. The first patient, treated in May 2016, has been back at work for two and a half years. “This trial demonstrates that CAR T-cell therapy can provide a high rate of durable responses,” says study co-author Michael R. Bishop, MD, who directs the Cellular Therapy Program at UChicago Medicine. “Our current results are a promising sign of the potential for long-term benefit.”
only provides increased capacity for manufacturing cells for existing therapies, but also adds new capabilities for processing and manufacturing new types of cellular therapy products for treating blood cancers and benign conditions such as sickle cell disease. The new facility will support the Hematopoietic Stem Cell Transplantation Program in the hospital by processing and manufacturing all blood-based cells for stem cell/bone marrow transplantation for adult and pediatric patients.
NEW FACILITY BRINGS THE MOST ADVANCED CELLULAR THERAPIES TO PATIENTS
In addition, the new facility will have the capabilities for manufacturing novel cell therapies such as CAR T cells.
Stem cell transplant (also known as bone marrow transplant) is an established cellular therapy for many cancers, but mostly for blood diseases once considered incurable. For some types of blood cancers such as leukemia and myeloma, stem cell transplant is the standard of care; for others, it’s only considered if other treatments have been unsuccessful.
The new, 10,000-square-foot facility houses work spaces for manufacturing cells under Good Tissue Practices guidelines (GTP), as well as clean rooms that are compatible with current Good Manufacturing Guidelines (cGMP). Besides these clinical manufacturing spaces, the facility also houses space for quality testing and for developing and scaling up new cellular therapies from investigator-initiated and pharmaceutical company-sponsored clinical trials.
Today, ongoing advances in stem cell transplant continue to expand its availability and improve outcomes for patients, both young and old. This year, UChicago Medicine replaced the existing 17-year-old stem cell transplant facility and opened a brand-new, state-of-the-art facility to process and manufacture cells for therapeutic purposes. The new facility, named the Advanced Cellular Therapeutics Facility (ACTF), not
The University of Chicago Medicine was named a Blue Distinction Center for Cellular Immunotherapy by Blue Cross Blue Shield. This highly respected designation acknowledges the expertise providers have demonstrated and their commitment to improving quality and affordability.
The ACTF is registered with the FDA. Currently, the Hematopoietic Stem Cell Transplantation Program performs over 200 adult and pediatric stem cell transplants a year in addition to a large number of clinical trials, and has commercial cell therapy contracts with pharmaceutical/ biotechnology companies.
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PHOTO CREDIT: JEAN LACHAT
“ IN THE LAST FIVE YEARS OR SO, THIS CHECKPOINT INHIBITOR APPROACH HAS LED TO A LONG SERIES OF CONQUESTS.” Akash Patnaik, MD, PhD
UNEXPECTED SUCCESS FOR PROSTATE CANCER IMMUNOTHERAPY Patnaik’s research focuses on innovative approaches involving immunotherapy to treat advanced prostate cancer.
Ralph Stuart was in his 80s with advanced prostate cancer. Standard therapies were no longer an option, so Akash Patnaik, MD, PhD, suggested treatment built around immunotherapy.
He had recently launched a phase II clinical trial, known as CheckMate 650, for men with metastatic prostate cancer that is resistant to hormonal therapy. The study combined two immune system-boosting drugs: ipilimumab and nivolumab. “In the last five years or so, this checkpoint inhibitor approach has led to a long series of conquests,” Patnaik says. Ipilimumab was first tested in melanoma, where it worked well for a small but significant group of patients, quickly becoming a standard
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of care. The combination of ipilimumab with nivolumab produced higher response rates than either agent alone, but with greater toxicity. These drugs have since gained approval for use in advanced kidney cancer, metastatic lung cancer, and many others. However, these medicines still do not work in large subsets of patients with different types of cancer, including advanced prostate cancer. The approach, however, proved successful for Stuart. Once he started responding, his prostate-specific antigen (PSA) level— a measure of tumor burden—started to plummet. By the time of the last infusion, it had decreased to 0.04, a level associated with “disease that is below the level of detection,” Patnaik says, where it has remained.
CLINICAL TRIAL TESTS STRATEGY TO ‘KEEP UP WITH THE TUMOR’ Personalized medicine aims to incorporate information about patients’ and/or their cancer’s genetic makeup into treatment decisions. Yet, tumor cells have the capacity to evolve; thus, tumors consist of many individual cancer cells with distinct molecular features, including DNA mutations, chromosomal abnormalities, and gene expression profiles. This inherent complexity, also referred to as tumor heterogeneity, is a major challenge to refining treatment strategies so that they are as effective as possible.
However, a new study focused on describing genetic variations within tumors, between a primary tumor and metastases derived from that tumor, and in tumor DNA detected in blood could help physicians make better treatment choices for patients with gastric and esophageal adenocarcinoma (GEA). GEAs are often detected and diagnosed late and can be difficult to control as they frequently recur after surgery, and those recurrences are generally incurable. GEAs lead to more than 700,000 deaths a year globally. “The extensive genetic variation of these cancers from patient to patient has recently become better understood,” says the study’s senior author, Daniel Catenacci, MD. “Our study was designed to quantify the level of variation within each patient’s cancer at baseline, prior to receiving any treatment.” For this multi-institutional study, Catenacci and colleagues, including other Comprehensive Cancer Center faculty Hedy Kindler, MD; Blase Polite, MD; John Hart, MD; Yuan Ji, PhD; Mitchell Posner, MD; Kevin Roggin, MD; and Kiran Turaga, MD, explored the genetic landscape of tumors in four independent groups or cohorts of patients with metastatic GEA.
The fourth cohort—an ongoing trial known as PANGEA, Personalized ANtibodies for GastroEsophageal Adenocarcinoma, designed by Catenacci and based at the Comprehensive Cancer Center—included 28 patients. The PANGEA trial addresses tumor heterogeneity by gathering information about the distinct tumor cell populations and what drives their behavior, and then using molecularly targeted therapies to eliminate them. Investigators conducted genetic analysis of biopsies of both the primary and metastatic tumors, as well as cell-free DNA (cfDNA) found in blood. Examination of cfDNA, which is much less invasive and costly than a biopsy, revealed the presence of several altered cancer-related genes. Although these cfDNA genomic alterations were not always consistent with those found in the primary tumors, there was high concordance with data from the metastases. Importantly, when molecular analyses from the metastatic lesions and the cfDNA, rather than the primary tumor, were used to guide treatment decisions, medication changes were made in 32 percent of cases (9 out of 28). Therefore, cfDNA in blood can be used to identify patients whose metastases acquire targetable alterations. “This strategy of ‘keeping up with the tumor’ may be better than matching drugs based solely on the primary tumor analysis and then, when this fails, proceeding blindly to the next therapy, as is the current approach,” Catenacci says (Pectasides et al. Cancer Discov 8:37-48, 2018). Funding for the PANGEA clinical trial was provided by the National Institutes of Health, University of Chicago Medicine Comprehensive Cancer Center, Live Like Katie Foundation, the Anthony F. and Helen J. Castle Scholarship Foundation, Salvatore Ferrara II Esophageal Cancer Research Fund at University of Chicago, American Cancer Society, H.T. Berry Open for Gastrointestinal Cancer Research, Conquer Cancer Foundation, and the Korean Health Technology R&D Project.
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CLINICAL TRIALS Breakthroughs in research over the past several decades are shifting the paradigms for cancer care faster than ever before. The more we learn about the conditions that give rise to cancer, the better we can develop treatments that target its vulnerabilities.
With a portfolio of more than 350 open therapeutic clinical trials, the Compre hensive Cancer Center is a national leader in cancer clinical trials, improving the standard of care and providing patients with more options. This year, several clinical trials have led to sophisticated therapies that are tailored to the unique characteristics of a person’s cancer.
Our basic and clinical investigators work closely to develop innovative, personalized, and effective cancer therapies and make them available to more patients. They do this through clinical trials, which are designed to evaluate promising new strategies to detect, treat, and prevent cancer. Clinical trials lead to answers such as whether a treatment is safe, effective, and better than existing therapies.
NUMBER OF UCHICAGO MEDICINE PATIENTS ENROLLED IN THERAPEUTIC CANCER CLINICAL TRIALS IN 2018
93 Breast
Advanced Solid Tumors
64
91
70
58
Kidney, Bladder, Urinary Tract
Stomach, Esophagus, Pancreas, Liver
Head and Neck
Cervix, Ovarian, Uterus, Fallopian
41
264
Skin (Melanoma)
Leukemia, Lymphoma, Multiple Myeloma
71
87
Lung, Mesothelioma
20
212
Prostate
OUR TEAM Our accomplishments this past year would not have been possible without the approximately 200 dedicated scientists and clinicians comprising the cancer research team. In 2018, we welcomed new members, including:
Daniel Arber, MD
Alexander Pearson, MD, PhD
Peter Riedell, MD
Randy Sweis, MD
ASSOCIATE MEMBERS Osmanuddin Ahmed, MD
Michele Nassin, MD
Christine Bestvina, MD
Gage Redler, PhD
Guangbin Dong, PhD
Lauren Ritterhouse, MD, PhD
Jessica Donington, MD
Loren Saulsberry, PhD
Michael Drazer, MD
Deepa Sheth, MD
Oliver Eng, MD
Benjamin Shogun, MD
Gabrielle Lapping-Carr, MD
Marcia Tan, PhD, MPH
Aresha Martinez-Cardoso, PhD
Jennifer Tseng, MD
Jeffrey Mueller, DO
RETHINK WHAT’S POSSIBLE 2 1
RETHINK COMMUNITY OUTREACH
IMAGINE IF WE COULD HELP PEOPLE TAKE STEPS TO REDUCE THEIR RISK OF DYING FROM CANCER. IT’S POSSIBLE.
Finding new ways to detect cancer earlier and prevent it altogether is a large part of our mission to reduce cancer’s burden in Chicago’s highly socioeconomically diverse, urban community. We strengthen links with the communities we serve with outreach and engagement that increases public awareness of advances in cancer research and encourages participation in cancer clinical trials. We also encourage residents to adopt healthier lifestyles and to recognize the value of cancer screening and early detection. Our researchers and outreach team strive to eliminate health inequities, known as disparities, among ethnic and social groups, by implementing new cancer prevention and control research studies and improving screening rates. LAKE (IL)
COMMUNITIES WE SERVE The geographic area we serve includes 8.02 million people across 5 counties. To decrease cancer incidence and mortality among populations within this area, including minority and underserved populations, we partner with other health delivery systems and state and community agencies for dissemination of evidence-based findings. UChicago Medicine is an NCI-designated Cancer Center: a local, regional, and national resource, directly serving its community and, through the knowledge it creates, the nation as a whole.
DUPAGE
WILL
CHICAGO
COOK
LAKE (IN)
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HPV VACCINATION PRESENTS AN OPPORTUNITY TO ELIMINATE CERTAIN CANCERS The U.S. Food and Drug Administration recently expanded its recommendation for the human papillomavirus (HPV) vaccine, approving its use for people over the age of 25. The HPV vaccine is approved for prevention of cervical, vulvar, vaginal, and anal cancers, as well as precancerous or dysplastic lesions and genital warts.
Although the best time to vaccinate is at a younger age, the expansion of the HPV vaccine is an important step in cancer prevention because it will reach those who missed their adolescent vaccines and accelerate our ability to eliminate HPVrelated cancers.
At the Comprehensive Cancer Center, we are collaborating across the disciplines of oncology, gynecology, surgery, and adult and pediatric primary care to both promote HPV vaccination and raise awareness about HPV-related cancers such as cervical cancer, oropharyngeal (throat) cancer, and anal cancers. The Comprehensive Cancer Center played an instrumental role in local and statewide conversations about HPV vaccine cancer education and prevention through the HPV Cancer-Free Illinois Roundtable Event in November. The event brought together health professionals, patients, government officials, and advocates to discuss ways to eliminate HPV-related cancers and increase HPV vaccination rates.
INCREASING COLORECTAL CANCER SCREENINGS AMONG VULNERABLE POPULATIONS
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Colorectal cancer screening detects disease early and can also prevent many cancers by finding and removing precancerous polyps. Yet uptake of colorectal screening is poor, especially among underrepresented populations in Illinois and especially Cook County.
Screening and Follow-up through Implementation Science (ACCSIS) program, led by Karen Kim, MD, and Blase Polite, MD, MPH, will provide an evidence base for multilevel interventions that increase rates of colorectal cancer screening, follow-up, and referral to care. It will also establish best practices for how to scale up interventions to reduce colorectal cancer.
This year, the Comprehensive Cancer Center has been awarded nearly $6 million over five years to test novel ways to improve colorectal cancer screening and follow-up among groups that have not been screened. The Accelerating Colorectal Cancer
Kim says, “ACCSIS-Chicago has the potential to transform our understanding of the health system and community factors that enhance or impede colorectal screening and follow-up.�
PHOTO CREDIT: OMAR VILLALOBOS
During Breast Cancer Awareness Month in October, UChicago Medicine partnered with the American Cancer Society on the “PINK: Powered by People,” campaign to raise awareness of breast cancer screening and early detection, and the need for increased research funding. On October 19, the entire medical campus held a “pink out” to celebrate National Mammography Day.
CLOSING THE BREAST CANCER DEATH GAP Biologically aggressive subtypes of breast cancer occur more frequently in women of African ancestry. Studies have demonstrated that underserved minority populations experience higher rates of mutations in the breast cancer-linked BRCA1 and BRCA2 genes and have less access to genetic testing and uptake of risk-reducing interventions.
Their research will lay the groundwork for a disparities and health equity–focused NCI Specialized Program of Research Excellence (SPORE) grant application in a few years. Olopade says, “Our results will change clinical practice by allowing us to individualize risk assessment, diagnosis, and treatment of breast cancer and improve overall outcomes for each patient.”
Olopade’s team will test the hypothesis that state-of-the-art genomic testing combined with innovative MRI techniques can comprehensively characterize early breast cancers in genomically defined high-risk women, and provide effective and affordable strategies for risk-adapted management of mutation carriers in diverse populations.
PHOTO CREDIT: JOHN ZICH
To close the gap in breast cancer mortality among women of African ancestry, a research team led by breast cancer geneticist Olufunmilayo Olopade, MD, is developing a sophisticated tool that can be used to classify women into risk categories and then develop and personalize culturally tailored risk-reducing interventions in the clinic.
Olopade is one of six Illinoisans who will receive the 2019 Order of Lincoln, the state’s highest honor for professional accomplishments and public service.
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RETHINK EDUCATION & TRAINING
IMAGINE IF AN ENTIRELY NEW GENERATION OF CANCER RESEARCHERS FROM DIVERSE BACKGROUNDS WERE WELL EQUIPPED TO DEVOTE THEIR CAREERS TO SOLVING CANCER. IT’S BECOMING POSSIBLE.
Unraveling cancer’s many complexities takes the very brightest scientific minds. Every new generation of scientists holds potential to make important cancer discoveries that will lead to improved treatment and prevention strategies for patients and the medical community. With a rich legacy in scientific discovery, the Comprehensive Cancer Center is committed to training future leaders in cancer research and treatment, as well as expanding the opportunities available to existing cancer professionals. We provide robust educational opportunities and professional development at every level to help ensure talented investigators continue to enter the field and lead in cancer care and discovery. RETHINK WHAT’S POSSIBLE 2 7
The Comprehensive Cancer Center offers pipeline programs to introduce young people to the exciting and rewarding field of cancer research. High school and undergraduate students interested in cancer research benefit from two intensive pipeline programs to deepen their knowledge of cancer science, broaden their awareness of careers in the field, and build mentoring relationships with leaders in the scientific community working to unravel cancer’s mysteries.
This past summer, a total of 43 students, as well as several teachers, had the opportunity for hands-on experience conducting biomedical research alongside a mentor faculty member. Formerly known as the Continuing Umbrella of Research Experience (CURE) program, Chicago EYES (Educators and Youth Enjoy Science) on Cancer is a cancer research training program for high school and college students interested in careers in biomedicine. For eight weeks each summer for two years, participants work full-time in the laboratories of established cancer researchers at the University. Chicago EYES on Cancer is funded by a five-year, $1.9 million grant from the National Cancer Institute (NCI) in addition to generous donations. Programming is provided in part through a partnership with Chicago’s Museum of Science and Industry. Applicants come from underrepresented groups including racial and ethnic minorities (68%), economically disadvantaged students (91%), first-generation college or college-bound students (82%), and those with a disability (9%). “We believe it’s important for our Cancer Center, located on Chicago’s South Side, to impact our surrounding community and reach students who might not have an opportunity to learn about cancer research,
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PHOTO CREDIT: MEGAN MEKINDA, PHD
NURTURING BUDDING SCIENTISTS
Chicago EYES on Cancer student Jose Acebedo at work in Dr. Anita Chong’s laboratory.
medicine, and biological sciences,” says M. Eileen Dolan, PhD, who leads the cancer education programs. “That’s the part that’s so rewarding for us. Once you work with these kids, you see how they get so motivated by the experience. Their excitement is contagious.” In addition to hands-on experience in a cutting-edge laboratory or research group, participants benefit from year-round career development and skill-building workshops, as well as ongoing mentorship from a network of university faculty, research professionals, program personnel, and peers. Beginning in the summer of 2018, the program also welcomes secondary science educators. In addition to their research experience, educators receive mentored curriculum development focused on project-based scientific inquiry and access to state-ofthe-art laboratory equipment, supplies, and scientific literature for classroom use. Jen Sichory, a Chicago Public Schools teacher, was excited to find a program that celebrates diversity and equal opportunity to students of color. “This summer has helped me fall in love with science all over again,” she says. “I plan on creating a series at my school to celebrate the diversity that I have seen this summer, because I want my students to see their faces in successful people.”
HIGH SCHOOLERS GET THEIR START IN CANCER RESEARCH ResearcHStart, a program launched in 2015, welcomes high school students from the Chicago and Urbana-Champaign areas to explore exciting careers in cancer research. For eight weeks during the summer, participants work full-time in the laboratories of established cancer researchers, gaining hands-on experience.
Similar to the EYES program, research training is complemented by career development and skill-building workshops, a cancer-based faculty lecture series, and a network of faculty and peer mentors dedicated to students’ success. The program introduces students to scientific research to promote career opportunities in the field, while helping them gain a broad understanding of cancer and its devastating impact on Illinois residents. “The individualized experience I had gave me a summer that may not have been filled with vacations or sleep, but something much more valuable—a stepping stone for my future,” says Hannah Lin, a high school student in the researcHStart program. “This is truly one of those experiences that you have in your formative years that changes you and provides just the right amount of fuel to spark your passions.” Philanthropic support for the researcHStart program was provided by a donation from Debra and Ira Cohen and subsequent support from other generous donors. While the program is housed at the Comprehensive Cancer Center, the University of Chicago partners with the University of Illinois at Urbana-Champaign, the University of Illinois
at Chicago, and Northwestern University to place students with faculty mentors at all four sites. Chicago EYES on Cancer and researcHStart culminated in research symposia for family, friends, and members of the scientific community to showcase participants’ work across basic, translational, clinical, and population-based cancer research. United States Senator Dick Durbin (D-IL) came to hear the students present their research and inspired the future scientists by sharing his personal connection to cancer and underscoring the importance of cancer research.
ResearcHStart student Lin with mentor Dr. Brandon Pierce at the researcHStart symposium. PHOTO CREDIT: MEGAN MEKINDA, PHD
Innovative pipeline programs like Chicago EYES on Cancer and researcHStart offer a rare opportunity for students to understand how they might be able to contribute to the cancer community as they explore their own career interests. “These programs open their eyes to possibilities in medicine and research they may have never considered,” says Kathleen Goss, PhD, director for strategic partnerships at the Comprehensive Cancer Center. “For many of these students, this is a lifechanging experience.”
M. Eileen Dolan, PhD, looks on as Senator Dick Durbin addresses students, teachers, and their guests at the programs’ research symposium. PHOTO CREDIT: MEGAN MEKINDA, PHD
RETHINK WHAT’S POSSIBLE 2 9
RETHINK PHILANTHROPY
IMAGINE IF THE BRIGHT MINDS WORKING TO DEFEAT CANCER HAD THE FUNDING SUPPORT THEY NEEDED TO PURSUE THEIR MOST INNOVATIVE IDEAS. THANKS TO PHILANTHROPY, IT’S POSSIBLE.
Innovative science requires several key pieces: the brilliant minds of ambitious researchers, a strong infrastructure capable of supporting their work, and eager postdoctoral fellows and graduate students making contributions in the lab each day. It also requires funding. Without this last piece of the puzzle, many game-changing ideas would never come to fruition. Philanthropy—generous gifts from individuals, foundations, and corporations—has a profound impact on scientific discovery and is playing a vital role in shaping tomorrow’s breakthroughs. Researchers across the globe, including our own, have pursued their most innovative ideas because of the generosity of donors. Following are examples of how the philanthropy of a few can impact the lives of many. RETHINK WHAT’S POSSIBLE 3 1
TRAINING TOMORROW’S LEADERS IN CANCER CARE FOR YOUNG ADULTS In 2008, Comprehensive Cancer Center researchers made a groundbreaking discovery: adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) fared better when they received an intensive pediatric therapy regimen compared to an adult regimen. This finding—which the team later verified in a clinical trial—defined a new standard of care, benefiting young adult patients with ALL nationwide. Seymour and Merle Cohen (front row, center) and Lisa Schenkman (back row, third from left) and family. PHOTO COURTESY OF THE FAMILY
Today, physician-scientists Wendy Stock, MD, and Jennifer McNeer, MD, are studying what makes cancers in this age group biologically different from other age groups, while also developing strategies to improve patients’ compliance with their treatment plans.
To prepare future physician-scientists to continue this important work, Merle and the late Seymour Cohen and their daughter, Lisa Schenkman, established the Seymour A. Cohen Fellowship in AYA Oncology at UChicago Medicine Comer Children’s Hospital. One of the few fellowships of its kind in the country, the Cohen Fellowship will train future leaders in AYA oncology committed to improving outcomes for young adults with cancer. “The Cohen-Schenkman family was so generous and forward-thinking to create this fellowship to promote care and research in this patient population,” Stock says. The inaugural Cohen Fellows—Nicole Sunseri, MD, PhD, and Joseph Wynne, MD, PhD— are already working with Stock and McNeer to develop new treatments for AYA patients. “We have amazing patients who teach us so much,” Sunseri says. “You want to be better because of them.” Merle, an honorary member of the UCCRF Women’s Board, and Lisa, a member of the Comer Development Board, are excited to see the fellowship grow over time and train a cohort of talented, compassionate physician-scientists. “This gift is really just the beginning,” Merle says. “And as far as I’m concerned, there’s no better place in the world to make this kind of investment.”
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PHOTO CREDIT: MOLLIE KOLOSKY
Ted’s parents, Mary Henry (third from left) and Rick Mullin (far right), with the Ted Mullin Scholars at the University of Chicago.
ATHLETE INSPIRES THOUSANDS TO GIVE When it came to swimming, Ted Mullin’s motto was “leave it in the pool.” A member of Carleton College’s swimming and diving team, Ted passed away in 2006 at age 22 from synovial sarcoma, a rare malignant tumor. Today, his legacy lives on, inspiring thousands to participate in the Hour of Power, an annual swim relay that supports sarcoma research.
Ted’s parents, Mary Henry and Rick Mullin, established the Ted Mullin Fund for Pediatric Sarcoma Research, which advances research in sarcoma and other rare pediatric cancers at UChicago Medicine Comer Children’s Hospital, where Ted was treated. Since its inception, the fund has generated more than $1.25 million. Funds raised support a variety of programs that advance knowledge of the biological underpinnings of pediatric cancers and inform the development of new treatments.
stunned that so many people are doing something in an effort to raise awareness and funds for this disease.” In 2012, Ted’s parents established the Ted Mullin Scholars Program, which offers undergraduate student-athletes the opportunity to gain hands-on laboratory and clinical experience through work with the pediatric cancer specialists at Comer Children’s. “This program was an incredible opportunity to explore and broaden my knowledge of medicine and science,” says Yifan Mao, a 2017 Ted Mullin Scholar. A history major at Carleton, Mullin was twice elected captain of the men’s swimming and diving team. “He was a very good student and had a very strong analytical mind,” Rick Mullin says. “If the University of Chicago can help create better outcomes for adolescents and young adults with this disease, that would be the most we can hope for.”
“This is a way of honoring Ted’s spirit,” Mary Henry says. “I think he’d be absolutely
RETHINK WHAT’S POSSIBLE 3 3
ABOUT THE UCCRF The University of Chicago Cancer Research Foundation (UCCRF) is a not-for-profit organization, founded by Maurice Goldblatt in the 1940s, to support basic and clinical research programs related to the treatment and prevention of cancer at the Comprehensive Cancer Center.
Members of the UCCRF Board of Trustees with Comprehensive Cancer Center director Michelle M. Le Beau, PhD, (top right) at one of their meetings.
BOARD OF TRUSTEES
Members of the UCCRF Auxiliary Board at their annual gala.
As the UCCRF’s governing body, the Board of Trustees builds a strong culture of philanthropy and supports all modalities of fundraising to ensure that the cancer faculty and researchers achieve their aspirations. The UCCRF Board of Trustees is made up
of the presidents of the subsidiary boards, representatives of other foundations, and distinguished philanthropists. This wealth of experience and knowledge provides counsel, guidance, and support for the UCCRF.
AUXILIARY BOARD The UCCRF Auxiliary Board comprises 30 women who actively work toward raising funds for selected physician-scientists, whose research is supported for three years. Currently, the Auxiliary Board supports the research of Jane Churpek, MD, Nita Karnik Lee, MD, MPH, and Russell Szmulewitz, MD. Since its inception, the Auxiliary Board has raised almost $4 million for cancer research.
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PHOTO CREDIT: FIG MEDIA
“NOT EVERYONE IS IN THE POSITION TO SPEND THEIR LIFE STUDYING CANCER, BUT THAT DOESN’T MEAN THAT YOU CAN’T CONTRIBUTE IN A MEANINGFUL WAY. WE COULD NEVER HAVE MADE THE PROGRESS THAT WE’VE MADE WITHOUT YOUR HELP.” Jason Luke, MD
(From left) Gala Co-Chair Eileen Murphy; Comprehensive Cancer Center Director Michelle M. Le Beau, PhD; UCCRF Women’s Board President Diane Hutchinson Reilly; and Gala Co-Chair Jennifer Rhind.
WOMEN’S BOARD The UCCRF Women’s Board was established in 1947 and has allocated more than $19 million in funding for cancer research at UChicago. The Women’s Board invests in innovative experimentation, enabling UChicago scientists to pursue promising avenues of investigation that would otherwise remain unexplored. In 2018, the Board allocated $1.15 million to support 12 research areas, including: • Innovative, high-risk, high-yield research projects through the Janet D. Rowley Discovery Fund. • The recruitment of an outstanding junior faculty member to join the Ben May Department for Cancer Research and enhance the cancer research enterprise,
including the development of more effective targeted cancer therapies. • A Team Science project aimed at improving breast cancer screening and diagnosis by optimizing MRI imaging technology and approaches. • Staff support for the Human Tissue Resource Center to expand access to tissue that is linked to clinical and patient data, which is critical to the development of personalized cancer treatments. • The recruitment of top cancer research students to maintain the Committee on Cancer Biology graduate program, one of only a handful of specialized cancer biology PhD training programs in the nation.
EVERY GIFT MAKES AN IMPACT Gifts from generous donors like you support the efforts of our cancer researchers, who are dedicated to improving care and outcomes for people with cancer, and finding ways to prevent cancer. Because of your generosity, our faculty are pioneering clinical trials in immunotherapy, changing treatment paradigms with big data, and improving diagnostics through new imaging techniques. We are grateful for your commitment to advancing the forefront of science and medicine. Thank you.
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Some of the members of the UCCRF Associates Board during their annual spring fundraiser.
ASSOCIATES BOARD The UCCRF Associates Board is composed primarily of young philanthropists committed to the fight against cancer. Although it is the UCCRF’s newest board, the Associates Board has already made significant contributions to advance
PHOTO CREDIT: ROB HART
SHUBITZ AWARD Since 1978, the Simon M. Shubitz Cancer Prize and Lectureship has recognized excellence in cancer research and brought internationally respected scientists who have made significant contributions to the study of cancer to the University of Chicago. The award is named in honor of Simon M. Shubitz, MD, a distinguished alumnus known for his dedication as a physician and his efforts as a humanitarian and philanthropist.
Le Beau with Caligiuri, winner of the 2018 Simon M. Shubitz Cancer Prize.
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cancer research at the University of Chicago. Since its inception, the Associates Board has provided more than $475,000 in funding to support mesothelioma and immunology research.
In 2018, the Comprehensive Cancer Center and the University of Chicago Cancer Research Foundation presented the award to Michael A. Caligiuri, MD, president and physician-in-chief at City of Hope National Medical Center in Duarte, CA, and a leading researcher in the fields of immunology, lymphoma, and leukemia.
WHAT’S POSSIBLE
THERE ARE NEARLY 16 MILLION CANCER SURVIVORS IN THE U.S. TODAY, THANKS TO ADVANCES IN TREATMENT. Our collaborative teams use the latest technologies and minimally invasive techniques to preserve patients’ quality of life. Many of these technologies and treatments can shorten recovery time, spare healthy tissue, or reduce side effects so that patients can return to regular activities sooner. However, a patient’s cancer journey doesn’t end once treatment is complete. With more people surviving cancer now than ever before, our researchers and clinicians are focused on improving quality of life for these patients and supporting their physical, social, and emotional needs. The following stories are but a sample of the work happening at the Comprehensive Cancer Center to ensure our patients benefit from leading-edge care that makes a difference in outcomes.
2
RETHINK SURVIVORSHIP
12
THE NUMBERS 18
LEADERSHIP & CREDITS 20
CONTENTS
RETHINK PATIENT CARE
RETHINK PATIENT CARE
IMAGINE IF CANCER COULD BE TREATED WITH FEWER THERAPY-RELATED SIDE EFFECTS AND COMPLICATIONS SO THAT PATIENTS COULD HEAL MORE QUICKLY AND GET BACK TO THEIR LIVES SOONER. IT’S BECOMING POSSIBLE.
More than 1.7 million people in the United States were diagnosed with cancer in 2018. In addition to being a serious and, potentially, life-ending disease, cancer causes a host of issues that make it one of the hardest challenges a person can face. Cancer is physically, mentally, and emotionally demanding, often putting a strain on a family’s resources. It not only threatens people’s lives, but also takes a toll on their lifestyle and their ability to work. Cancer is also a leading driver of healthcare costs, one of the biggest challenges for the U.S. economy. Our researchers are working to reduce cancer’s devastating effects on people’s lives. We focus on providing compassionate care that considers the whole person, not just their tumor. But the most important thing we try to do for our patients is to help them get back to what matters most— living a longer, healthier life. RETHINK WHAT’S POSSIBLE 3
REDUCING SIDE EFFECTS FROM HEAD AND NECK CANCER TREATMENT The incidence of head and neck cancers caused by a human papillomavirus (HPV) infection has increased dramatically. Fortunately, patients with HPV-related head and neck cancers have a better prognosis than those with cancers caused by alcohol and tobacco. Long-term survival and even cure rates are typically in the 80 percent range, much better than the 50 to 60 percent seen in smoking-related (HPV-negative) head and neck cancers.
The treatments developed for HPV-negative tumors, combining surgery, radiation, and
THE “DE-ESCALATION” APPROACH YIELDS DRAMATICALLY FEWER ACUTE AND LONGTERM SIDE EFFECTS WHILE ACHIEVING A 95% CURE RATE.
chemotherapy, are too aggressive for most patients with HPV-related disease. Side effects can be dramatic, and most patients are affected by long-term problems with speech, swallowing, tooth decay, dry mouth, and diminished sense of taste and smell. Head and neck cancer specialist Tanguy Seiwert, MD, and others are conducting clinical trials and studying new methods to improve treatment, while minimizing side effects. They are adjusting treatment for patients with HPV-related cancers with an approach called “de-escalation.” This involves a limited amount of chemotherapy up front to shrink the tumor, followed by surgery or 35 to 40 percent less radiation with smaller radiation fields. This approach yields dramatically fewer acute and long-term side effects while achieving a 95% cure rate—as good or better than the national average with more intensive therapy. Patients recover quickly, often within a few weeks. The Comprehensive Cancer Center is the only center in Chicago and one of only a handful nationally and internationally offering de-escalation clinical trials.
OUR COMMITMENT TO EXCELLENCE IN CANCER CARE The Comprehensive Cancer Center has received another three-year accreditation from the Commission on Cancer (CoC), a voluntary program administered by the American College of Surgeons. To earn this distinction, UChicago Medicine met or exceeded 34 CoC standards that cover numerous aspects of patient-centered care, including cancer prevention, early diagnosis, treatment, genetic testing and counseling, supportive care, clinical trials, and survivorship. “CoC standards provide the benchmark for quality in cancer care,” says Comprehensive Cancer Center Director Michelle Le Beau, PhD. “For our patients, this means they can expect to receive quality, comprehensive care that includes a multidisciplinary team approach, a complete range of state-of-the-art services and treatments, and access to early detection programs, cancer education, and support services.”
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PHOTO CREDIT: JEAN LACHAT
SURGERY OFFERS HOPE TO PATIENTS WITH PANCREATIC CANCER Certain cases of pancreatic cancer can be treated successfully with surgery. The Whipple procedure is a special surgical technique that seeks to remove an entire tumor in the head or neck of the pancreas.
UChicago Medicine is one of a few centers in the country that offer the Whipple procedure using both traditional open and robot-assisted techniques. The traditional open method requires an incision down the middle of the patient’s belly. Patients usually recover in the hospital for seven to 10 days. The minimally invasive robot-assisted
Kevin Roggin, MD, (left) performs a robotic Whipple surgery for pancreatic cancer.
method involves multiple small incisions. This may result in a shorter hospital stay and reduced pain and scarring. Depending on the type and stage of the tumor, patients may undergo outpatient chemotherapy before or after surgery, or both. Whether open or robotic, the Whipple procedure requires a high level of surgical training and excellent technical skills. With one of the most experienced teams of surgeons in the country performing the Whipple procedure, UChicago Medicine is giving patients with pancreatic cancer a better chance of beating their disease.
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CARDIOLOGISTS GUIDE AT-RISK PATIENTS THROUGH CANCER TREATMENT Heart disease on its own is a serious medical condition but when combined with cancer, it can create additional complications. Furthermore, aggressive cancer treatments can create a strain on the body, especially the heart.
To address these unique needs, interdisciplinary programs in cardiology and oncology have cropped up at medical centers around the country in recent years. Cardiologists Jeanne DeCara, MD, and Tamar Polonsky, MD, were among the first in the Chicago area to develop a cardiooncology program in 2011. Working closely with oncologists, they see patients with cardiovascular risk factors, such as those who have been diagnosed
with cancer who either have pre-existing cardiovascular disease that may hinder or complicate their cancer treatment, or those who develop cardiovascular complications/ toxicities as a result of their cancer treatment. The cardio-oncology program works to identify at-risk patients and optimize their heart health so that they can undergo cancer treatment safely and without interruption. “It’s critically important to identify and modify cardiovascular risk factors as much as possible,” says DeCara. “Equally important is ensuring these patients are getting appropriate surveillance and follow-up care.” Combining cardiology and oncology allows UChicago Medicine to provide individualized cancer care based on each patient’s unique situation.
TURNING THE HEAT UP ON CHEMOTHERAPY Cancer that has spread to the lining of the abdomen is traditionally difficult to treat. But patients with a variety of abdominal cancers have a new, effective treatment option in the form of HIPEC, hypothermic or heated intraperitoneal chemo perfusion.
Immediately after removing visible tumors through what’s called cytoreductive surgery, our surgeons pump a powerful dose of heated chemotherapy inside a patient’s abdomen. The 108-degree chemo bath circulates throughout the abdominal area, also called the peritoneal cavity, delivering highly
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concentrated doses of hot chemotherapy. That allows doctors to intensify the drugs’ cancer-fighting abilities while directly targeting cancerous cells. HIPEC helps with fewer side effects than traditional chemotherapy, deeper penetration of the medicine, and greater effectiveness in killing cancer cells than conventional chemotherapy. UChicago Medicine is one of the only hospitals to offer the treatment for both children and adults. The HIPEC team is led by Kiran Turaga, MD, MPH, one of the nation’s preeminent HIPEC surgeons, and continues to expand with the addition of Oliver Eng, MD, a highly skilled gastrointestinal surgeon, in 2018.
PHOTO CREDIT: JEAN LACHAT
IMAGINE IF WE COULD VIEW LUNG CANCER AS A CHRONIC DISEASE, NOT THE LEADING CANCER KILLER IN MEN AND WOMEN. IT’S BECOMING POSSIBLE.
A NEW ARSENAL TO FIGHT LUNG CANCER Every three minutes, someone in the U.S. is diagnosed with lung cancer, which causes more deaths than the other most common cancers—prostate, colon, and breast—combined. Fifteen percent of those people never smoked, and 60% are former smokers. Twenty years ago, getting diagnosed with lung cancer was essentially a death sentence. Today, 80 percent of people with stage 1 lung cancer will be cured, and survival has increased dramatically for those with advanced lung cancer, thanks to better insights into the disease, new therapies, advanced technology, and lessinvasive surgery.
Patel is a medical oncologist specializing in the treatment of lung cancer and other thoracic cancers. She is actively researching new cancer treatments, including personalized therapies that target specific genetic mutations in tumors.
“OUR UNDERSTANDING OF LUNG CANCER GENETICS HAS OPENED NEW OPPORTUNITIES TO PERSONALIZE THERAPY FOR EACH PATIENT.” Jyoti Patel, MD
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ADVANCED LUNG CANCER IS NO LONGER AN AUTOMATIC DEATH SENTENCE “The pace of progress in treating lung cancer has been astounding,” says Jyoti D. Patel, MD, director of thoracic oncology. “The therapies that we used just five years ago to treat patients with advanced disease are already obsolete.” A more comprehensive understanding of lung cancer biology today has led to novel targeted therapies and genomic profiling of tumors so treatment can be customized for individual patients and their cancer.
“Developing personalized therapies requires patient-centered care by a multidisciplinary team that includes specialists in
Juanita Segura received a therapy that targeted the specific gene mutation driving her type of non-small cell lung cancer. Juanita continued her CrossFit workouts during treatment and has since opened up her own CrossFit gym, using her story to inspire hope in others. PHOTO COURTESY OF JUANITA SEGURA
pulmonology, pathology, radiation oncology, medical oncology, and surgical oncology,” says Patel. “We are providing treatment that is the most effective and least toxic for each patient. Too often, many people are overtreated because therapy isn’t tied to their tumor type.” Research and clinical trials at the Comprehensive Cancer Center have also created opportunities to offer immunotherapy to every patient with non-small cell lung cancer. This includes innovative drugs that block proteins that cancer cells use to disarm an immune response, thereby enabling disease-fighting T cells to attack, shrink, or destroy tumor cells. “We also continue to research ways to reduce treatment toxicity and to understand why some tumors resist treatment so we can find new therapies to treat them,” says Patel. Another huge advancement is screening for lung cancer using low-dose computed tomography (CT), which can decrease lung cancer mortality by 26 percent in men and 61 percent in women. “We have the most advanced radiology capabilities in the region, which allows us to more precisely detect very small cancerous abnormalities or nodules in the lung,” says Patel. “Screening allows us to find lung cancer early so we can cure it. And multiple new treatment strategies for advanced disease are turning lung cancer into a chronic disease—not a fatal one—for many more people than ever before.”
Lung cancer screening can help diagnose lung cancer in its earlier stages and improve outcomes for patients. UChicago Medicine is a Lung Cancer Screening Center designated by the American College of Radiology. This important distinction signifies that the program has met rigorous quality standards to provide safe and effective lung cancer screening services. Screening is recommended for adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years.
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PHOTO CREDIT: JOE STERBENC
Hogarth helped a company design a robotic device that allows physicians to access deeper pockets of the lung than ever before, which creates opportunities for earlier, and more accurate, lung cancer diagnoses.
NEW ROBOTIC DEVICE DETECTS LUNG CANCER EARLIER Pulmonologist D. Kyle Hogarth, MD, was frustrated by his inability to navigate the s-curves and intricate spaces of the lung with existing technology—a semi-flexible scope with a tiny camera at the end. A conventional bronchoscope prevented him from seeing into the far reaches of the lung and limited which patients he could evaluate for lung disease with the minimally invasive procedure.
So, Hogarth worked with a company that invented a robotic device that lets him see 360 degrees in the airways while a flexible nested scope ventures far into the periphery of the lung to the exact spot Hogarth needs to reach for an accurate diagnosis. The Monarch Platform was approved for robotic bronchoscopy by the U.S. Food and Drug
Administration in March 2018, and three months later, UChicago Medicine became the second hospital in the nation—and the first in the Midwest—to use the novel device. The Monarch allows Hogarth to spot lung cancer early, when a cure is much more attainable. Most lung cancer diagnoses come at a late stage, resulting in five-year survival rates that are under 20 percent. But the technology that created Monarch is just the beginning of more precise diagnosis and treatment of lung cancer, says Hogarth. In the near future, pulmonologists will likely be able to spot and diagnose cancerous lung tissue and then immediately kill it through a device that delivers targeted microwaves. “Now I have a tool that gets me to a spot deep in the lung,” Hogarth says. “From there, the sky’s the limit.”
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PHOTO CREDIT: JEAN LACHAT
Donington (left) talks with a patient.
NATIONAL EXPERT DIRECTS TEAM OF SURGEONS DEDICATED TO LUNG CANCER Jessica S. Donington, MD, a nationally recognized expert in lung cancer, joined University of Chicago Medicine as the inaugural chief of the newly created section of thoracic surgery. Carving out thoracic surgery from the section of cardiothoracic surgery reflects UChicago Medicine’s commitment to excellence in lung cancer care. All the surgeons in the new section are experts in lung cancer surgery and, therefore, can perform robotic or other minimally invasive lung resections, giving patients smaller incisions, shorter recovery times, and fewer complications after surgery.
UChicago Medicine was recognized by U.S. News & World Report as “high-performing” in lung cancer surgery.
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Donington wants to ease access and streamline care for patients with lung cancer. She is collaborating with oncologist Jyoti Patel, MD, and colleagues from pulmonary medicine and supportive care to create a multidisciplinary team with a single clinic and a shared educational and research infrastructure. “Most lung cancer patients need to see various specialists during their treatment,”
she says. “A multidisciplinary team will be able to care for them from screening and diagnosis through treatment and into, survivorship.”
In October 2018, Donington was selected as an Honorary Member of the American Society for Radiation Oncology—the highest honor the professional society awards to distinguished cancer researchers and leaders in disciplines outside of radiation oncology, radiobiology, or radiation physics. Donington has long supported collaborations between thoracic surgeons and radiation oncologists to provide lung cancer patients with the best care, and contributed to recent clinical practice guidelines for stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer.
ADDICTION RESEARCH AND SMOKING CESSATION INITIATIVES AIM TO CURB LUNG CANCER VAPE PEN TRIGGERS URGE TO SMOKE IN YOUNG ADULTS
A RESEARCH PROJECT TO HELP HEAVY DRINKERS STOP SMOKING
Not all lung cancers can be prevented, but tobacco use is the leading preventable cause of cancer. E-cigarettes and vape pens may not look like cigarettes, but they produce the same powerful urge to smoke as watching someone smoke a tobacco cigarette. Despite initial hopes that e-cigarettes and vape pens, a second-generation electronic nicotine-delivery system, could help smokers break away from tobacco, they instead create an immediate and lasting desire to smoke—even in people who had never used the newer devices, says Andrea King, PhD, director of the Clinical Addictions Research Laboratory and co-leader of the Comprehensive Cancer Center’s Cancer Prevention and Control Research Program.
The health problems caused by cigarette smoking, including cancer, are well known. However, many smokers have a hard time quitting, and even more so for smokers who are heavy drinkers. This group faces unique challenges that aren’t fully addressed by the current standard of care.
King and colleagues studied the vape pen’s effects on the urge to smoke in young adults aged 18 to 35, a highly susceptible group. The 108 participants smoked, on average, 8.7 cigarettes most days of the week, and more than 80 percent had used e-cigarettes. During an hour-long session, a researcher disguised as a study participant smoked either a tobacco cigarette or a vape pen. Both created a heightened desire among research subjects to smoke. The researchers then provided participants with cigarettes and offered them 20 cents for every five minutes they resisted smoking—$2 over 50 minutes. Most held out for only 20 minutes, regardless of whether the researcher had previously smoked a vape pen or cigarette. “Vape pens share too many salient features of the act of smoking, including inhalation, exhalation, and hand-to-mouth behaviors,” says King of the study, which was published in Nicotine & Tobacco Research. “This makes them a potent trigger, encouraging people to smoke.”
Research shows that medication (such as Chantix or bupropion), nicotine-replacement aids (e.g., patch, gum, lozenge, inhaler), behavioral counseling, or some combination of these can help people become smoke free. Although these treatments may work for some heavy-drinking smokers, most are ineffective for long-term abstinence from smoking. Also, few primary care physicians are trained to provide intensive treatment and counseling to help heavy drinkers quit smoking. For these people (estimated to be about 6 million people in the U.S.), research suggests that a comprehensive treatment strategy that simultaneously addresses drinking and smoking behaviors may be the best bet, but there is still work to be done. King developed the Chicago STOP Smoking Research Project (C-STOP), a clinical trial to assess the effectiveness of a three-part smoking cessation intervention in adult, heavy-drinking smokers, using Chantix, the nicotine patch, and brief behavioral coaching. C-STOP aims to find an effective, targeted treatment plan that primary care physicians can implement in the clinic. King’s group thinks this combination of medications and behavioral support will help smokers cope with cravings, triggers, and nicotine withdrawal symptoms.
RETHINK WHAT’S POSSIBLE 1 1
RETHINK SURVIVORSHIP
IMAGINE IF PATIENTS HAD ALL THE SUPPORT TO NOT ONLY SURVIVE THEIR CANCERS BUT TO THRIVE IN THE PROCESS. IT’S ALREADY POSSIBLE.
There are more than 15.5 million cancer survivors in the U.S. today, a number that will grow to more than 20 million by 2026. Over 10,000 children are diagnosed with cancer each year, and more than 80 percent will beat their disease. More than ever, there is a need to support people during and after their journey through cancer, and to research ways to mitigate the long-term toxic effects of treatment to enable people to live full and long lives. Tara Henderson, MD, MPH, is leading the Childhood Cancer Survivor Study, which found that a reduction in dosage of radiation therapy has led to a decreased risk of second cancers, or malignancies, among childhood cancer survivors. “Improving cancer treatment is not just about figuring out the next new drug,” Henderson says. “It’s our mission to take care of patients across the cancer-care spectrum, from prevention through survivorship.” RETHINK WHAT’S POSSIBLE 1 3
PHOTO CREDIT: JEAN LACHAT
RECOVERING SEX LIVES AFTER CANCER Lindau (left) says, “Sexual function can be preserved and restored after cancer, but not if no one is talking about it.”
Oncologists tend to talk early and often to men with prostate cancer about preserving sexual function. But although breast and gynecologic cancers are rough on a woman’s sexuality, female patients tend to get the silent treatment regarding sex, says Stacy Tessler Lindau, MD, who directs the Program in Integrative Sexual Medicine (PRISM) for Women and Girls with Cancer. According to Lindau’s research, most women don’t get treatment for sexual problems related to cancer, although half said they wanted it.
“There are few clinics in the United States with the expertise to treat sexual problems in women and girls with cancer,” says
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Lindau, who started PRISM with gynecologists, psychologists, oncologists, physical therapists, and nurses. PRISM is the only such clinic in Illinois, and one of a few in the country. Women come into the PRISM clinic with depression and strained marriages, and rarely realize that their sexual problems are legitimate physical effects of cancer treatment. The PRISM team has cared for more than 500 women with all types of cancer, and they are working with physicians around the country to create more clinics like it. Lindau’s team recently launched WomanLab, an online platform that provides straightforward information and guidance to women and their doctors about preserving and recovering sexual life after cancer.
SOFTENING CANCER’S FINANCIAL BLOW A cancer diagnosis is emotionally wrenching enough without having to worry about the personal financial toll it may take. Yet an alarming number of cancer patients deplete all their financial assets to fight their disease. Mark Ratain, MD, associate director for clinical sciences at the Comprehensive Cancer Center, studies the “financial toxicity” of cancer, the now widely used term coined by Ratain to describe the economic burden of cancer treatment on patients.
In new research, Ratain and Russell Szmulewitz, MD, and other colleagues tested a strategy to lower the cost of abiraterone acetate, a prostate cancer drug that costs as much as $11,000 per month— or more than $300,000 over the three years many patients take the medication. They found that patients who took a lower dose of the drug with a low-fat meal kept their
disease under control just as well as patients who took the higher recommended dose on an empty stomach. The cost savings: 75 percent less. “At least three-quarters of this expensive drug is wasted,” Ratain says. “It’s excreted and flushed away.” These results encouraged Ratain and other oncologists who are members of the nonprofit Value in Cancer Care Consortium to identify additional oral oncology drugs with costs that might be similarly reduced with less frequent or lower dosing. The researchers found 34 cancer drugs for which so-called value-based prescribing could potentially lower costs up to 89 percent without compromising efficacy. “We calculated, using U.S. prices, that the average saving per patient-year for the 34 drugs is $94,000,” Ratain says. “Reducing the prescribing costs of oncology drugs is a major opportunity to mitigate the financial toxicity of cancer.”
ADVOCACY GIVES CANCER PATIENTS THE CHANCE TO PRESERVE FERTILITY Young people with cancer shouldn’t have to decide between lifesaving treatment or their desire to one day have a family, says obstetrics/gynecology resident Michelle Brown, MD. Cancer treatment can leave patients infertile or unable to have biological children. Yet private insurance doesn’t typically cover costly fertility preservation options, such as sperm or egg banking.
Brown petitioned legislators to change Illinois insurance law to cover the procedures that would give young cancer patients a chance to have a biological family. In August, then-Governor Bruce Rauner signed a bill that made Illinois the fifth state in the country to require insurers to provide coverage for fertility preservation.
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SUPPORT IS A CRUCIAL PART OF TREATMENT
The Center offers palliative care, which focuses on providing relief from pain and other symptoms and stressors of cancer to improve quality of life for patients and their families. Patients with cancer often experience emotional distress, anxiety, and depression—which can negatively affect their cancer treatment. The Center’s psycho-oncology program can help relieve psychological distress through pharmacotherapy and a variety of psychotherapies
(Left to right) Jill Bice, a registered dietitian, Julie Dalla Rosa, a licensed clinical social worker, and Daugherty discuss how to best support cancer patients in the Center for Supportive Oncology suite. PHOTO CREDIT: NANCY WONG
PHOTO CREDIT: BENJAMIN VIGEANT
Patients and their families face multiple challenges coping with the life changes that accompany a cancer diagnosis, in addition to the logistics of treatment. The Coleman Foundation Center for Supportive Oncology, under the leadership of Christopher Daugherty, MD, provides comprehensive support for adult patients during and after treatment.
Comer teen patient, Kara Savitt, 19, stands with acclaimed South Side graffiti artist, Hebru Brantley, in front of his artwork that adorns the teens-only space.
provided by a multidisciplinary team involving psychiatrists, psychologists, and oncology social workers. Other services include cancer nutrition, physical and occupational therapy, smoking cessation, and social services. Cancer can be particularly hard on teenagers, especially during extended hospital stays when they crave some freedom in a place they can call their own. Now teens getting treatment at the University of Chicago Medicine can escape to a beautiful new lounge that was designed by a group of current and former teen patients. The 240-square-foot room in Comer Children’s Hospital is bright in bold hues of red and blue and splashes of yellow, with artwork by acclaimed South Side graffiti artist Hebru Brantley, whose work has been purchased by several celebrities including hip-hop mogul Jay-Z. Teens can relax, talk, and game on Xbox and PlayStation systems.
“SUPPORTIVE ONCOLOGY IS THE CARE THAT PATIENTS REQUIRE TO REDUCE CHALLENGES AND OBSTACLES TO HAVE THE BEST POSSIBLE OUTCOMES.” Christopher Daugherty, MD
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PHOTO CREDIT: HILARY HIGGINS
‘CANCER CAN’T COMPETE’ SUPPORTS FAMILIES GOING THROUGH CANCER When Chicago Cubs first baseman Anthony Rizzo (pictured) was 18, he was diagnosed with Hodgkin lymphoma, which went into remission after chemotherapy. Remembering how difficult his fight against cancer was for his family, he established the Anthony Rizzo Family Foundation in 2012 to raise money for cancer research and to support families of patients. This year the Rizzo Family Foundation expanded its reach by partnering with the University of Chicago Medicine, Mariano’s grocery chain, and the Chicago Tribune. Proceeds from the multifaceted awareness and fundraising campaign, called Cancer Can’t Compete, were split evenly between the Comprehensive Cancer Center and the Rizzo Family Foundation. “This campaign is an initiative that our whole city can get behind to lend support to families everywhere fighting cancer,” says Rizzo.
GOING THE DISTANCE FOR PROSTATE CANCER In June 2018, Rich Stearns embarked on a 333-mile sailing adventure. Starting in Chicago, his sailboat guided him through the waters of Lake Michigan to Lake Huron and his final destination, Mackinac Island.
He made the bucket-list trip by himself. As a sailing enthusiast, Stearns is no stranger to the allure of the water. He has been racing sailboats since 1962 and has been selling sailboats through his company, Stearns Boating, LLC, for nearly two decades. But this time, the trip was personal.
hours to complete, with temperatures averaging 40 to 50 degrees at night. Stearns completed the challenge in 70 hours, placing first in his class and fifth overall. He raised more than $10,000 for prostate cancer supportive services provided by UChicago Medicine’s Section of Urology under the direction of Arieh Shalhav, MD. “This sailing event raised money so others will be able to get the knowledge they need if it happens to them,” he says. “Cancer is not something that always happens to someone else.”
Stearns aboard his boat as he sailed from Chicago to Mackinac Island for prostate cancer awareness. PHOTO COURTESY OF RICH STEARNS
“After a bout with prostate cancer, I thought it might help survivors to see someone doing crazy things, and show them that prostate cancer is not the end of the world,” he says. “So, I decided to undertake the challenge to raise money for prostate cancer awareness and information.” Stearns’ trip was part of the 22nd Great Lakes Singlehanded Society’s Chicago to Mackinac Island Challenge. Considered one of the toughest sailing challenges on the Great Lakes, it takes between 50 to 80
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CANCER INCIDENCE BY TYPE 2017 Cancer Cases by Site MALE
FEMALE
DIGESTIVE SYSTEM 946 MALE GENITAL SYSTEM 652 BREAST 610 URINARY SYSTEM 443 RESPIRATORY SYSTEM 406 FEMALE GENITAL SYSTEM 338 LYMPHOMA 244 ENDOCRINE SYSTEM* 188 LEUKEMIA 176 ORAL CAVITY & PHARYNX 134 SKIN 136 BRAIN & CNS† 128 MISCELLANEOUS‡ 86 MYELOMA 76
KEY
MESOTHELIOMA 58
Newly Diagnosed (Analytic)
SOFT TISSUE 57 BONES & JOINTS 20
Recurrent/ Progressive Disease (Non-Analytic)
EYE & ORBIT 5
* Endocrine System includes benign pituitary adenomas † B rain & CNS includes benign neoplasms ‡ Miscellaneous includes blood dyscrasias, myelodysplastic/myeloproliferative disorders, and cancers with other histology/primary site designations
0 15 0 20 0 25 0 30 0 35 0 40 0 45 0 50 0 55 0 60 0 65 0
10
0 50
0 60 0 55 0 50 0 45 0 40 0 35 0 30 0 25 0 20 0 15 0 10 0 50
KAPOSI SARCOMA 1 65
THE NUMBERS
The Cancer Registry reports on patients who were newly diagnosed and/or received their first course or subsequent treatment for a cancer diagnosis or recurrent/progressive disease at the University of Chicago Medicine. The total number of patients seen with cancer, including all consult visits, is higher.
PATIENT DEMOGRAPHICS
PEER-REVIEWED CANCER RESEARCH GRANTS AWARDED TO MEMBERS
2017 Cancer Cases by Race/Ethnicity
Annual direct costs as of August 31, 2018
OTHER PEER-REVIEWED PROJECTS
1654 WHITE 1388
$3,577,056
489 BLACK 627
NATIONAL CANCER INSTITUTE PEER-REVIEWED PROJECTS
106 HISPANIC 142 51
UNKNOWN/ 86 NOT DECLARED
80
ASIAN/INDIAN/ 73 PAKISTANI
0
AMERICAN INDIAN/ ALEUTIAN/ESKIMO
$16,168,222
$42.5M
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TOTAL $42,529,032
OTHER NATIONAL INSTITUTES OF HEALTH PEER-REVIEWED PROJECTS $22,783,754
PATIENT GEOGRAPHICS 2017 Patient Residence at Diagnosis
KEY 0–10
11–50
50–100
ILLINOIS 3,713
100–2,500
International Patients ARGENTINA
BRITISH COLUMBIA
CHINA
COLUMBIA
KUWAIT
PAKISTAN
QATAR
SAUDI ARABIA
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LEADERSHIP Michelle Le Beau, PhD Director; Arthur and Marian Edelstein Professor of Medicine
Professor of Medicine; Dean for Faculty Affairs, Biological Sciences Division; Director, Center for Asian Health Equity
Marcy List, PhD Associate Director for Administration
Mark Ratain, MD Associate Director for Clinical Sciences; Leon O. Jacobson Professor of Medicine
Walter Stadler, MD Deputy Director; Chief, Section of Hematology/Oncology; Fred C. Buffet Professor of Medicine and Surgery Habibul Ahsan, MBBS, MMedSc Associate Director for Population Research; Louis Block Distinguished Service Professor of Public Health Sciences, Medicine, and Human Genetics; Dean for Population and Precision Health; Director, Institute for Population and Precision Health M. Eileen Dolan, PhD Associate Director for Education; Professor of Medicine Geoffrey Greene, PhD Associate Director for Basic Sciences; Virginia and D.K. Ludwig Professor and Chair, Ben May Department for Cancer Research; Co-Director, Ludwig Center for Metastasis Research Karen Kim, MD Associate Director for Community Engagement and Cancer Disparities;
Amy Kahn Director of Development for The University of Chicago Cancer Research Foundation Robyn Egan, BA Director for Finance Rajan Gopalakrishnan, MS Director for Informatics Kathleen Goss, PhD Senior Science Writer and Director for Strategic Partnerships Jane Kollmer, BA Director for Communications Amanda Spratt, BS, CCRP Director for Clinical Research Operations; Technical Director for Cancer Clinical Trials Office
FOR MORE INFORMATION Call 1-773-702-6180 or visit cancer.uchicago.edu
CREDITS Executive Editor Jane Kollmer Scientific Writer Kathleen Goss, PhD Contributors Ana Beiriger Kat Carlton Kate Dohner John Easton
Elizabeth Edwards Bethany Hubbard Gretchen Rubin Anita Slomski Matt Wood Design Pivot Design, Inc., Chicago, Illinois Printing G Thomas Partners LLC, Lemont, Illinois
THE UNIVERSITY OF CHICAGO MEDICINE COMPREHENSIVE CANCER CENTER 5841 S. Maryland Avenue, MC 1140, Chicago, IL 60637-1470 cancer.uchicago.edu
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