A time of hope
Treatments once were limited for multiple myeloma. Winship researchers have helped change that.
A time of hope
Treatments once were limited for multiple myeloma. Winship researchers have helped change that.
Mark Saturday, Oct. 15, on your calendars! We will be looking for you to join us that day at the inaugural Winship Win the Fight 5K Run/Walk.
Welcome to the latest edition of Winship Magazine. You will find a number of exciting narratives in this issue about the progress we are making against cancer in just the past few months. Winship laboratory and clinical investigators are leading the way in some key areas of cancer research that we believe will translate to improved patient outcomes. Please read about the accomplishments of Sagar Lonial, MD, Lawrence Boise, PhD, and their team in understanding the fundamental basis of multiple myeloma, a malignancy for which treatment options were once very limited. Now, thanks to pioneering research and new drug development to which Sagar and Larry have substantially contributed, patients have options – and more hope. This team has established Winship Cancer Institute as one of the top cancer centers for the treatment for multiple myeloma and related conditions.
Executive Director
Winship Cancer Institute
Walter J. Curran, Jr., MD
Deputy Director
Fadlo R. Khuri, MD
Executive Administrator
Diane G. Cassels, MS
Director of Nursing
Deena Gilland, RN MSN
Director of Communications
Vincent J. Dollard, APR
Editor Virginia L. Anderson
Art Director Peta Westmaas
Graphic Designer Linda Dobson
Photographer Jack Kearse
Production Manager
Carol Pinto
Emory Winship is published twice yearly by the Winship Cancer Institute
Communications office for patients, families, staff, and friends. If you have story ideas or feedback, please contact virginia.l.anderson@emory.edu.
Website: cancer.emory.edu
You’ll also read about Winship’s commitment to support promising research of outstanding young researchers, such as Sumin Kang, PhD, and Mylin Torres, MD, with pilot grants. The extraordinary generosity of the Wilbur and Hilda Glenn Family Foundation will allow us to fund more pilot projects, such as these awards to Sumin and Mylin by the Kennedy Foundation, in our breast cancer program. In both of these cases, these pilot grant awards led to major grant awards from outside agencies. The Glenn Family Foundation gift will allow us to accelerate the work of our breast cancer program in ways that support Winship as an emerging national leader in breast cancer research and treatment.
Please mark Saturday, Oct. 15, on your calendars, because we will be looking for you to join us that day at the inaugural Winship Win the Fight 5K Run/Walk. The Winship 5K will start right on the Emory track, and registration is already ahead of schedule! This event will bring non-runners and runners alike together as a community in our shared fight against cancer. I personally can’t think of a better way to raise money for cancer research and to gather like-minded people together than with an autumn run/walk. I look forward to personally seeing you there at this Peachtree Road Race qualifier event. Most of all, I want to thank each one of you for your continued support of Winship Cancer Institute and our efforts to win the fight.
Sincerely,
Fadlo R. Khuri, MD, becomes Editor-in-Chief of Cancer | World renowned surgeon William C. Wood, MD, to share his talents in Africa.
Reprogramming Ewing sarcoma | Low-dose CT scans decrease lung cancer mortality | C-Reactive protein sheds light on kidney cancer outcomes, and more...
Winship researchers are pressing hard on new lung cancer treatments, bringing hope to patients of the nation’s biggest cancer killer.
Nurse navigators lighten the load, coordinate care and explain important medical information.
Treatment options once were limited for patients with multiple myeloma. Winship researchers have helped change that.
Pilot projects are soaring at Winship, propelled by new gifts –and brilliant research.
Bone marrow transplant survivor Bob Falkenberg raises money and awareness by pedaling 1,700 miles.
Run a race, win the fight | Patient Assistance Fund | Help from T.J.’s Friends | Thank you, Friends of Winship!
WalterJ. Curran Jr., MD
Executive Director, Winship Cancer Institute of Emory University
“Each time there is a relapse, it’s a new disease with its own personality: aggressive, intent on its own survival... I wouldn’t have survived all these years without his efforts.”
– Rudolph Byrd on Sagar Lonial.
Following a year-long international search, Winship Cancer Institute’s Deputy Director has been named Editor-in-Chief of Cancer, a peerreviewed journal of the American Cancer Society(ACS). Fadlo R. Khuri, MD, professor and chair of hematology and medical oncology at Emory University and Roberto C. Goizueta Distinguished Chair in Cancer Research, began his term on Sept. 1, succeeding Dr. Raphael E. Pollock. Khuri will retain his multiple responsibilities at Winship.
“Fadlo’s selection as editor-in-chief is a tremendous honor that puts him at the helm of one of the most prestigious cancer journals in the world,” says Winship Executive Director Walter J. Curran, Jr. “His energy, expertise, and integrity will influence the national and international cancer research conversation. He is a world-class researcher and clinician, and we – not just Winship but Georgia – are very fortunate to have someone of his stature in the fight against cancer.”
“The Search Committee reviewed many exceptional candidates and is very pleased to have been able to select Dr. Khuri,” says Otis W. Brawley, MD, chief medical officer of the ACS “As an accomplished molecular oncologist who has conducted seminal research on oncolytic viral therapy and has led major chemoprevention efforts against lung and head and neck cancer, Dr. Khuri brings an expertise that will benefit our journal and the entire oncology community.”
Khuri, who has served as the editor for the journal’s lung cancer section since 2005, is equally thrilled.
“It is a great privilege for me to serve as editor-in-chief of Cancer, succeeding my long-time friend and colleague, Dr. Raphael Pollock, who has done an outstanding job,” says Khuri. “I received my first peer-reviewed grant from the American Cancer Society and published my first senior authored paper in Cancer. Given my long-standing relationship with both this exceptional journal and the ACS this is a particularly meaningful honor for me and for Emory University. Cancer is one of the oncology community’s oldest and most prestigious journals. We will work hard to enhance its already stellar and hard-earned reputation by publishing only the very best work in the field.”
Khuri serves as a grant reviewer for the ACS National Cancer Institute (NCI), the American Association for Cancer Research, and the American Society of Clinical Oncology. He serves the NCI as a permanent member of its Thoracic Malignancies Steering Committee and its Clinical Oncology Study Section and serves on the Council for Extramural Funding of the America Cancer Society. He has published more than 200 peer-reviewed articles and has received numerous awards, including the Nagi Sahyoun Award from the Middle East Medical Assembly and the Waun Ki Hong Award from MD Anderson Cancer Center for his work on targeting signaling pathways in lung and aerodigestive cancers.
Fadlo Khuri is such a presence at Winship Cancer Institute that he has been called its “essential man.” While many know that he is a graduate of Yale University (1985) and Columbia University College of Physicians and Surgeons (1989) and came to Winship via Boston City Hospital, New England Medical Center and MD Anderson, many of us may not know that he likes Italian food and Led Zeppelin. Read on for some other things you might not know about Dr. Khuri:
Birth date: Sept.13, 1963.
Birthplace: Boston
Family: Wife Lamya and two daughters and a son. What is your favorite type of music?
Bob Dylan or Led Zeppelin
What was the last concert you attended?
Robert Plant on Feb. 5, 2011, with daughter Layla, for her 17th Birthday
As a child, what did you want be when you grew up?
Astronaut, English league soccer player or the Godfather!
If you could trade places with anyone at Winship for a day, who would it be?
No one, really. My colleagues are all great, but I am very fortunate to have a fantastic wife, family, and job. Well, maybe Haian Fu — to understand what it is like for a day or so to be a true genius!
breast cancer because of his leadership and clarity of thought. “
Wood, who was honored by Winship on Aug. 20 with a day-long breast cancer symposium, is hardly going quietly into retirement. He is a professor of surgery at Emory’s medical school and professor also in the Hubert Department of Global Health in the Rollins School of Public Health. Of special meaning to Wood will be his work to train doctors in Africa to treat cancer. Wood will leave in late September to visit several sites where residents are trained and to see how he can best contribute to their medical training and education.
Among smiles, hugs and and words of good wishes, many tears fell on Friday, Aug. 19, as patients of world-renowned breast cancer surgeon William C. Wood, MD, bade farewell to the man whom many credit with saving their lives.
“He is so, so wonderful,” says Annie Miller, of Atlanta. She was one of hundreds of former patients who came to say goodbye to Wood, who retired officially Sept. 1, at a breakfast reception at the Whitehead Room at Emory University Hospital.
Patient after patient had stories to tell about the man they describe as humble, compassionate and reassuring. “That first day, I was so nervous, and he was so encouraging,” says Gloria Sykes, also of Atlanta.
While patients appreciate Wood’s gentle, encouraging manner, scientists and physicians praise his contributions to cancer therapy and his influence on the design and analysis of national clinical trials. Wood, a 1966 graduate of Harvard Medical School, was chair of surgery in
the Emory University School of Medicine for 19 years. He stepped down from that post in 2010 and focused his attention on innovations in cancer therapy and clinical care. During his time at Emory and Winship Cancer Institute, where he served for a time as interim director, Wood was awarded the American Society of Clinical Oncology Statesman Award in 2007. In 2000, at the San Antonio Breast Cancer Symposium, he was presented the “Celebrating Survival Award,” which went to the principal investigators “of the 10 most influential clinical trials in breast cancer in the last century.”
“His medical expertise can be looked at from two levels: his patients and his colleagues,” says Grant Carlson, MD, a Winship breast cancer surgeon. “He is an outstanding clinician who is a paragon of empathy, always listening to his patients. Every one of them adored him. On the second level, he taught his colleagues how to think critically and not to accept dogma blindly. He was instrumental in coordinating many of the clinical trials in
“I am leaving with a sense of great gratitude, and I’m happy to wear an Emory hat (in his work in Africa),” says Wood. “I look forward to it with real joy.”
Annie Miller of Atlanta says she set her alarm clock early on Aug. 19 to make sure she would not be late for a reception at Emory University Hospital to honor Dr. Wood.
A protein that was once the molecule of the moment for its ability to predict heart disease is now showing promise in predicting survival of patients with renal cell carcinoma, or kidney cancer.
According to an article in the July 14 edition of Molecular Diagnosis & Therapy, senior author Viraj Master, MD, PhD and
director of urology clinical research at Winship Cancer Institute, clinicians should consider taking pre-operative levels of C-Reactive protein (CRP) into account when treating patients with localized renal cell carcinoma. CRP is a marker for inflammation, which is considered by many to be a cause of diabetes, some cancers, arthritis and other serious illnesses.
The study, which looked at 257 patients with localized RCC who underwent surgery to remove a kidney, sought to determine what effect, if any, lifestyle factors have on the prognostic value of CRP levels in patients with localized disease. The researchers looked at several variables,
including tumor size, stage of disease and CRP levels. They found that CRP level “remained a robust predictive tool” — even when the analysis was controlled for other lifestyle factors.
About 30 percent of patients with localized RCC eventually develop metastatic disease, despite having potentially curative surgery. Thus, the study is significant because it may help clinicians know better how to treat those patients whose CRP levels are elevated.
“Prognostic tools are very important in the management of cancer,” says Master. “Knowing how a patient may do after surgery provides insight into knowing how to treat them before surgery. We hope this study advances that knowledge.”
A study conducted at 33 centers nationwide showed that low-dose CT scanning of heavy smokers resulted in a 20 percent decrease in mortality from lung cancer. Between August, 2002 and April, 2004, the National Lung Screening Trial enrolled more than 53,000 people at high risk of developing lung cancer. They were randomly assigned to receive either low-dose CT scanning or a chest X-ray as a means to detect lung cancer. Data were collected on the participants through 2009. Deaths from lung cancer were reduced by 20 percent in the group who underwent the low-dose CT scans. The results were published this summer in the New England Journal of Medicine.
“I think all of us who were working on it were very pleased,” says Kay Vydareny, MD, professor emerita of thoracic radiology, who was the principal investigator at the Emory University School of Medicine site. “It seemed to have such strong conclusions for the narrow age range we were studying.” That age range was 55 to 74.
Emory Healthcare began offering low-dose CT scans in August to screen current and former heavy smokers aged 55 to 74. Vydareny explains that there is likely to be a high rate of false positives – that is, scans may suggest a lesion or mass that likely will turn out to be benign. Those who wish to be scanned should be braced for that possibility, she says, because false positives can cause anxiety and often necessitate further testing.
If you or someone you know is interested in having a low-dose CT scan, and you are between 55 and 74 and have been a heavy smoker, call 404-686-LUNG, or visit: www.emoryhealthcare.org/lungCT.
Erwin Van Meir, PhD, and research associate Shaoman Yin, PhD, started a fishing expedition with a tiny bit of bait – a small chemical molecule – and ended up reeling in a big finding – that the molecule binds with an oncoprotein at the root of Ewing sarcoma, a childhood cancer that has been particularly challenging to treat.
The Ewing sarcoma family of tumors share something in common, explains Van Meir, director of Winship’s Cancer Cell Biology scientific program and professor of neurosurgery, hematology and medical oncology. That is the unique translocation of chromosomes 11 and 22, which fuses two unrelated genes into a new chimeric gene. This abnormal gene encodes oncoprotein EWS/FLI1, which is
the molecular signature of Ewing tumors and is only found in the tumor cells. That translocation is, as Van Meir describes it, “a nasty fusion.” But as it turns out, the molecule the two went fishing with reprograms the oncoprotein.
“The tumor cells don’t like it,” Van Meir says. “They start dying.” This work resulted in Van Meir and Yin receiving a $100,000 grant from the Samuel Waxman Cancer Research Foundation to study the reprogramming of Ewing sarcoma with the molecule that targets the EWSFLI1 oncoprotein. “We are very grateful to the foundation,” says Van Meir. “These are critical seed funds.”
The next step will be to understand
just how the molecule reprograms the tumor cells and whether it can antagonize Ewing tumor growth in mouse models. “If all this ends up being successful, we hope it will be destined for a clinical trial,” says Van Meir.
The largest randomized trial of its kind has demonstrated that short-term hormone therapy (androgen deprivation therapy, or ADT), when given in combination with radiation therapy for men in early-stage prostate cancer increases survival rate when compared with that of those who receive the same radiation therapy alone. The study was conducted by the Radiation Therapy Oncology Group (RTOG) and published in the New England Journal of Medicine July 14. The study followed the health status of almost 2,000 men at low and intermediate risk of prostate cancer progression for a nine-year span at 212 centers in the United States and Canada. The study’s findings may have a significant effect on
treatment methods for prostate cancer, a disease which is estimated to affect about 240,890 American men in 2011.
The authors of the study have also indicated that the increased radiation dosages combined with modern treatment technology, which have demonstrated high success rates, could potentially provide benefits equal to or greater than the addition of short-term ADT. “RTOG launched a trial in 2009 to examine the role of short-term ADT combined with modern radiotherapy techniques for men with intermediate-risk prostate cancer,” says Walter J. Curran, Jr., executive director of Winship Cancer Institute and RTOG Group Chair. “The results of the RTOG 0815 trial will build on the important knowledge gained from the landmark study findings.”
Winship Cancer Institute melanoma specialist David Lawson, MD, helped bring to light encouraging news about advanced melanoma, typically one of the most difficult cancers to treat. Lawson, professor of hematology and medical oncology, was a co-author of a study published in June 2 in the New England Journal of Medicine showing that a therapeutic melanoma vaccine improves responses and progression-free survival rates when combined with Interleukin-2, an immunotherapy drug.
“It makes the point that you can add vaccine to Interleukin-2 and possibly improve response rates,” says Lawson.
No vaccine is yet available to treat melanoma, Lawson explains, and it could be years before one is available. But the study was significant because it marked the first vaccine study in melanoma to show clinical benefit in a randomized Phase III trial. While vaccines have been studied as a way to help the body fight cancer, none has been approved by the FDA for use in advanced disease.
Patients in the trial were randomized to receive high-dose IL-2 or IL-2 plus a vaccine, a peptide known as gp100. Those receiving the vaccine and IL-2 had a response rate of 16 percent, while those receiving only IL-2 had a response rate of 6 percent. Progression-free survival for the vaccine group was 2.2 months, compared with 1.6 months for the IL-2 group.
drugs such as tamoxifen or Herceptin.
“Right now, there aren’t effective treatments for triple-negative breast cancer besides chemotherapy,” says Ruth O’Regan, MD. These aggressive tumors disproportionally affect African American women at a young age.
second class of drugs, mTOR inhibitors, may be able to block the cancer cells’ escape route.
Winship researchers are testing whether a combination of drugs can stop the growth of a hard-to-treat form of breast cancer. “Triple-negative” breast cancers get their name because they lack three biological markers that make other breast cancers vulnerable to
After researchers showed that lapatinib combined with rapamycin can stop growth in cell lines and in animal models, this approach is being tested in a clinical trial at Winship designed by O’Regan. The lab studies were published recently in Molecular Cancer Therapeutics
Although the molecule EGFR (epithelial growth factor receptor) is hyper-activated in many breast cancers, so far EGFR inhibitors such as lapatinib have not been effective by themselves in the clinic. O’Regan says that adding a
The rationale for the combination grows out of a concept called “enhanced oncogene addiction,” she says. The idea is that mTOR inhibitors such as rapamycin can make cells more dependent on a growth factor pathway like EGFR, an approach that was previously successful with Herceptinresistant breast cancers.
The clinical study is designed for patients with triple-negative breast cancer who have already been through first-line chemotherapy. O’Regan says the study includes biopsies, as part of an effort to understand what mutations and genetic signatures distinguish patients who have a better chance of responding.
Winship lung cancer researchers are aggressively pursuing the nation’s number one cancer killer, pushing the program to the front – and hoping to push the disease aside.
Small cell lung cancer has long been one of the most difficult cancers to treat, in part because it is usually diagnosed in an advanced stage and in part because it is so aggressive, outdistancing the therapies used to treat it and spreading to other organs almost vengefully. The disease typically responds to chemotherapy with or without radiation in a majority of the patients but often returns much more aggressively, frequently after a short remission.
“It is a tragic disappointment when the cancer returns,” says Taofeek Owonikoko, MD, PhD, “The options for retreatment are often limited, and the chances of a durable response are not great.”
Owonikoko is one of many Winship Cancer Institute lung cancer researchers helping to shift the national treatment paradigm for lung cancer, the nation’s number one cancer
killer. He just opened a Phase II clinical trial in which he will be testing the effectiveness of arsenic trioxide, a drug typically used to treat leukemia, for patients who fail standard treatment for small cell lung cancer. His trial, for which he hopes to accrue 35 patients, also has another important goal – to gather tissue samples from patients to better understand the biology of this form of lung cancer.
Winship is supporting Owonikoko’s trial, and he also has received a Winship pilot grant from the support received from the Kennedy Foundation.
Arsenic trioxide is typically used to treat a type of leukemia called acute promyelocytic leukemia, or APL, Owonikoko explains, and not lung cancer. Owonikoko says he has come to believe that small cell lung cancer behaves somewhat like hematologic malignancies such as leukemia in that it responds well initially to treatment only to become resistant to further treatment.
However, evidence from lab work showing the potential benefit of arsenic trioxide for small cell lung cancer provided the strongest impetus to study arsenic trioxide in small cell lung cancer patients, Owonikoko says.
As for procuring tissue samples, Owonikoko says it is imperative to collect more tissue samples from lung cancer patients.
“There is often insufficient tissue from small cell lung cancer patients for testing in the lab,” explains Owonikoko. Given what researchers know about other cancers, Owonikoko and other lung cancer researchers believe that small cell lung cancers may not be a single type of disease at the genetic level, even though most all are caused by cigarette smoke and are currently treated the same way. Obtaining tissue samples from patients for extensive testing will provide an opportunity for the researchers to see whether there are subtle or significant differences in small cell lung cancer genomics from patient to patient and whether these differences may explain how and why patients might respond to different therapies.
Suresh Ramalingam, above, and Taofeek Owonikoko , right, are leading trials to advance treatment of lung cancer. Ramalingam recently has been named chair of the thoracic malignancies committee of the Eastern Cooperative Oncology Group, one of the largest clinical cancer research groups in the country.
“Once we get the biopsy, we would take the tumor specimen to the lab and grow it in laboratory animals and thereby establish a sort of small cell tumor bank that we can always go back to for detailed testing,” Owonikoko says. The goal would be to obtain tissue from about 20 patients. “That would be very, very useful,” he says.
The clinical study drug will be provided free to patients, and the treatment duration will be a year if the patient is benefiting from treatment. Because the trial will allow Owonikoko and team to study not only the effect of arsenic trioxide on patients but also create a great opportunity to study the tumor tissue, Owonikoko says the study is “getting the absolute bang for the buck.”
In another effort to define a new treatment paradigm, Winship’s Suresh Ramalingam, MD, director of the division of medical oncology, is chairing a Phase III trial of the Eastern Cooperative Oncology Group (ECOG) that is studying the optimal maintenance strategy for patients with advanced non-small cell lung cancer (NSCLC) who received bevacizumab as part of their first-line therapy. This is important because most patients diagnosed with NSCLC have advanced disease, and maintenance therapy has emerged as an option for those patients who benefited from firstline combination chemotherapy. This trial will enroll about 1,300 patients with advanced stage nonsquamous non-small cell lung cancer. They will receive four cycles of carboplatin, paclitaxel and bevacizumab. Those with a response or stable disease will be randomized to treatment with bevacizumab, pemetrexed, or a combination of the two agents.
“This study illustrates the important role played by Winship researchers in defining new standards of care for the treatment of lung cancer,” says Ramalingam. “Our lung cancer program has a major focus on developing individualized treatment options, and we are helping to change the treatment paradigm for lung cancer.”
“These trials are meant to further advance the treatment of lung cancer, and we at Winship are dedicated to being at the forefront,” says Ramalingam. “Though there have been improvements in treating lung cancer, we’re a long way from a cure for most patients. These trials are meant to move us in that direction.”
Richard Crowers, a World War II veteran, a retired engineering consultant, a sports car enthusiast and an accomplished euphonium player, is so poised and polished that it’s hard to imagine that anything could stymie the 87-year-old human dynamo.
Not even a diagnosis of colorectal cancer — 20 years after being treated for prostate cancer — has slowed him down.
“I’m still greatly addicted to 80,” Crowers says of his love of driving fast.
And yet, Crowers readily admits that having a nurse navigator during his cancer treatment has been a godsend.
“It takes away from the dread that you might have if you’re battling cancer,” Crowers says of the nurse navigator program at Winship Cancer Institute. “All of a sudden, there is someone to make method out of madness.”
Engineers, of course, typically love method, but it’s hard to have much of it with the madness of a cancer diagnosis. Winship nurse navigators — registered nurses assigned specifically to newly diagnosed cancer patients to help coordinate medical care and provide psychosocial support — are angels and heroes to many. And, they are an example of how Winship is constantly striving to improve patient care.
“I am just so pleased with the idea of Winship establishing these positions. The system is good, and Bonnie is excellent,” Crowers says of nurse navigator Bonnie Josaphs, RN, BSN
Others apparently are equally pleased. In a survey of nurse navigator patient satisfaction conducted in March through April, two-thirds of patients said that Winship’s nurse navigator services influenced their decision to be treated at Winship Cancer Institute.
Winship’s first nurse navigator started in May, 2010. Heather Pinkerton, RN, BSN, OCN, was assigned specifically to navigate breast cancer patients, who make up the single largest population at Winship, through their treatment.
Winship leadership recognized that although new technology and advanced treatment options improve patient outcomes, they also make understanding and evaluating treatment options more confusing for patients. For example, new scanning technology gives a physician a much better picture of a patient’s particular case. But getting those scans and reports together in one place can be challenging. Nurse navigators make sure all scans, all lab reports and treatment notes are together. They then coordinate with other departments to schedule consultations, tests and procedures necessary for the patient’s first visit, explains Mary Potter, NP, who supervises the nurse navigators program.
“It’s the navigator coordinating all of that,” Potter explains.
The navigators often give patients their telephone numbers so that patients can call them any time with a question, things that may range from “what’s the difference between a radiation oncologist and a medical oncologist?” to “what are my chances?” to “how do I deal with this?”
Based on the great response of patients, Winship added more nurse navigators recently for lung cancer, gastrointestinal cancer and hematology cancers.
Pinkerton has navigated more than 185 patients since May, 2010, including one from Ivory Coast whom she helped guide through the astounding
challenge of getting out of war-torn Ivory Coast, through Paris to pick up her tissue samples and then to Atlanta for treatment.
“We communicated through email, and I had everything arranged for her when she arrived,” Pinkerton explains.
Once patient Jeannette Danho Kakou arrived in Atlanta, Pinkerton’s work was not done. Pinkerton also smoothed out details – small but important – that were
personally and compassionately as possible. Certainly patients have medical questions about their diagnosis, but they also have real-life issues.
“The patients just love the fact they can call me about anything,” says lung cancer nurse navigator Nancy McCormick, RN, BSN
“The idea is to really help facilitate services in a timely manner, trying to get them on a treatment plan as quickly as possible,” says Bonnie Josaphs, Crowers’ nurse navigator. “At the beginning, when they first get their diagnosis, part of the problem is in just not knowing what to expect.”
Another big problem can be not knowing what the doctor is saying. The specialized language of cancer is bewildering for newly diagnosed patients.
“Sometimes, someone will say ‘can you just go over that with me one more time?’” says Josaphs.
And she does, until she is sure that the patient understands his or her treatment plan.
Heather Pinkerton says that a key piece of the success of Winship’s nurse navigator program – and what distinguishes it from other navigator programs – is that the nurse navigator is an integral part of the treatment team.
“You’re getting real expertise when you get a navigator,” Pinkerton says. “I can present the patients’ concern to the provider and be the intermediary. It lets me be a patient advocate.”
winship Magazine communicated with Jeannette Danho Kakou via email about her experiences at Winship Cancer Institute and the nurse navigator program. Following are Danho Kakou’s thoughts and feelings in her own words about her experience.
WM: How did you come to be treated at Winship Cancer Institute?
Danho Kakou: I was diagnosed for breast cancer in Paris after a check-up in October, 2010. got the results when I was on mission in Johannesburg. My colleagues and my cousin instantly recommended me to look for treatment in Winship Cancer Institute in Atlanta to increase my chance of healing.
WM: How did Heather Pinkerton help you?
Danho Kakou: My cousin who is living in Atlanta contacted the Winship Cancer Institute. He was fortunately directed to Heather Pinkerton, who made all arrangements for my appointments within the Emory Hospital in linkage with my insurance company. She also
asked me to send to her all required documents. Her assistance and guidance were also helpful during my stay in the USA through all the process of treatment at Emory. I also benefited from counseling, knowledge and information sharing in management of breast cancer.
WM: Do you think the nurse navigator program is important?
Danho Kakou: For my part, I feel very blessed. Meeting Heather Pinkerton on my way for healing is somewhat a blessing, as I was so far from USA and with no idea on how I could find my way to a best treatment. Moreover, the nurse navigator program is critical to ensure the linkages between the different units in Emory. Without a nurse navigator, one could feel very lost, especially when it is a foreigner.
WM: What are your feelings about Winship Cancer Institute? Are you happy you were treated here?
Danho Kakou: I sincerely think that Emory Winship Cancer is an excellent place for cancer treatment. People who are serving over there are so compassionate and very professional. was impressed by the fact that Winship Cancer Institute could provide comprehensive services in addressing breast cancer. The Institute ensures that each patient was treated with dignity in a holistic manner.
Indeed I was happy to be at Winship Cancer Institute. I met so many great and exceptional persons, and would like to thank each of them for their expertise, professionalism and kindness. God Bless Emory Winship Cancer Institute.
crucial to Danho Kakou’s treatment. For example, while Pinkerton and Winship insurance specialists had pre-certified Danho Kakou’s insurance information, there was still a glitch. The insurance company had the wrong birthdate; birthdates are recorded differently in different countries. So the insurance company was unable to identify her.
Pinkerton ironed out the wrinkles, and Danho Kakou was able to begin treatment on time.
That incident speaks to the complex issues that arise when a person is diagnosed with cancer and how Winship aims to meet those needs as expertly,
Pinkerton stays in touch with many of her former patients, whom she has been happy to turn over to the survivorship team at the end of their treatment. Many have given her gifts, which she treasures. Danho Kakou gave her an angel, saying that Heather reminded her of one.
Being the tough World War II vet that he is, Richard Crowers stops short of using the word “angel” to describe Bonnie Josaphs.
But he does have a word that he thinks fits her just fine.
“Perfect,” Crowers says. “She’s just perfect.”
Jeannette Danho Kakou (right) with her nurse navigator Heather Pinkerton (left).“I am just so pleased with the idea of Winship establishing these positions. The system is good, and Bonnie is excellent.”
-Richard Crowers on nurse navigator Bonnie Josaphs
Rudolph Byrd has built a career teaching students about literature, race and the civil rights movement. For the past decade, he’s been teaching in a different way: informing researchers about cancer – in his own body. Through his participation in several clinical trials at Winship Cancer Institute, he’s helped doctors such as Sagar Lonial, MD, identify drugs that now have become part of a standard regimen for people battling multiple myeloma.
Survival rates for multiple myeloma, a blood cell cancer, have traditionally been grim. Effects of multiple myeloma’s malignant growth can include bone breakdown, kidney failure and anemia. Twenty years ago, most patients died within two or three years after diagnosis.
In the past decade, several new drugs have been developed and approved for use in multiple myeloma, including bortezomib, thalidomide and its cousin lenalidomide. Lonial has been integrally involved in many of the studies that led to the approval of these new drugs, and he currently is leading a nationwide trial on the use of lenalidomide to treat smoldering myeloma, or myeloma that is asymptomatic at diagnosis.
Together with traditional chemotherapy and stem cell transplantation, new therapies have doubled
average survival times. The greatest benefit is seen in patients younger than 60, though these new drugs are helping all ages now, Lonial says.
Byrd’s experience illustrates these trends. He was diagnosed with multiple myeloma in 2000 while on sabbatical in Boston. Then 47, he decided to return home for treatment. His internist advised him to contact Lonial, then a new faculty member at Winship. Lonial says a mentor in Boston, Ken Anderson, MD, had urged him to begin testing a promising drug against multiple myeloma.
“I’ve been honored to be an adviser and watch Sagar Lonial develop a world-class multiple myeloma program at Winship,” says Anderson, who heads DanaFarber Cancer Institute’s multiple myeloma program. “He recognized from the earliest days that bortezomib,
By Quinn Eastman | Illustrations by Brian StaufferTreatments once were limited for multiple myeloma. Winship has helped change that.
works against multiple myeloma did not come to light until after the drug’s approval, says Boise, professor of hematology and medical oncology and Georgia Cancer Coalition Distinguished Scholar.
It turns out that multiple myeloma cells’ vulnerability to bortezomib may have a link to the healthy cells the cancerous cells arise from: plasma cells. Plasma cells are part of the immune system and live in the bone marrow. Their job is to produce antibodies, proteins that fight invaders like bacteria or viruses.
“If you look at both plasma cells and multiple myeloma cells, they are chock full of the machinery cells use to pump out proteins,” Boise says.
Lenalidomide is a chemical relative of thalidomide, which has its own peculiar history.
Itwas first marketed as a sedative in the 1950s, often to pregnant women with morning sickness. The revelation of thalidomide’s awful effects on limb development in unborn children eventually helped drive expansion of the regulatory powers of the FDA in the 1960s.
As a helpful drug, thalidomide was reborn a decade ago, when it was first tested on leprosy. How thalidomide works in the context of multiple myeloma is complex – it appears to both block blood vessel growth and encourage the immune system to fight the cancer. Lenalidomide was designed to soften the side effects, which can include neuropathy and blood clots.
Rudolph Byrd, diagnosed with multiple myeloma 11 years ago, embarked on his eighth clinical trial in the summer of 2011.
for example, had the potential to be qualitatively different than conventional treatments and was instrumental in the clinical trials leading to its approval.”
Byrd, a professor of African American studies and founding director of the James Weldon Johnson Institute at Emory, underwent what would be the first of three stem cell transplants the following spring. Under Lonial’s care, Byrd was one of the first people in Georgia with multiple myeloma to receive bortezomib (Velcade), then an experimental drug. In the summer of 2011, he was embarking on his eighth clinical trial.
Participating in clinical trials made sense to Byrd as a historian and researcher. His core beliefs instructed him: “If you can choose to be helpful to others, you make that choice.”
In turn, Lonial has helped him, he says. “Each time there is a relapse, it’s a new disease with its own personality: aggressive, intent on its own survival,” Byrd says. “All this means he [Lonial] has had to be extremely creative. I wouldn’t have survived all these years without his efforts.”
“Every successful drug in myeloma, he’s gotten them before they were approved,” Lonial says. “It also really shows
the importance of clinical trials in providing a foundation for scientific advances.”
Although Byrd received bortezomib and lenalidomide as well as other drugs after his stem cell transplant, they are now standard as initial treatment for most patients.
This transformation of the field means that patients like Kate Groover, embarking on a course of treatment for multiple myeloma in the summer of 2011, will receive a panel of effective therapies without having a stem cell transplant scheduled, perhaps for years.
During the time Lonial was conducting clinical trials in Atlanta and studying the effects of bortezomib, another young researcher in Miami was investigating how cells make decisions to live and die in response to stress and had begun to focus on multiple myeloma.
Lawrence Boise, PhD, joined Winship in 2009 so he could work side by side with clinicians like Lonial to better understand multiple myeloma with the hope of developing more effective therapeutic strategies.
“Larry’s arrival has been a turbo boost for our program,” Lonial says. “He’s a phenomenal scientist who’s tuned in to the problems we face in multiple myeloma.”
Much of researchers’ understanding of how bortezomib
He and his co-workers have shown that multiple myeloma cells are more sensitive to drugs that perturb their ability to clean up the waste byproducts of all that protein production. This may explain the effectiveness of bortezomib, which inhibits proteasomes, cellular machines that act as garbage disposals.
Part of Boise’s lab’s research is oriented toward exploiting this vulnerability, by finding ways to heighten the stress on myeloma cells. If proteasomes, one way for cancer cells to clean up, are shut down, they might escape by directing waste down a second path. Drugs have been identified that could specifically interfere with this second path, called aggresomes.
Based on these insights, Lonial and another colleague, Jonathan Kaufman, MD, assistant professor of hematology and oncology, have designed a clinical study, in which an add-on drug to the standard regimen, vorinostat, might further interfere with cancer cells’ trash cleanup. Lonial and R. Donald Harvey, PharmD and director of Winship’s phase I clinical trials program, are testing a new drug against multiple myeloma, ACY-1215, with the same rationale.
“Our objective isn’t to improve response rates, because response rates to the standard treatment panel are already quite high,” Lonial says. Rather, his aim is to purge myeloma cells so effectively from the body that sensitive laboratory assays can’t detect them for months or years – what he gingerly calls “closer to a cure.”
Sagar Lonial is leading a nationwide clinical trial, coordinated by the Eastern Cooperative Oncology Group, on the use of lenalidomide with “smoldering” multiple myeloma. Multiple myeloma that is asymptomatic at diagnosis is called smoldering. For example, Rudolph Byrd’s cancer was initially discovered as a result of a blood test, and remained asymptomatic for some time.
The study compares treatment with lenalidomide versus a “watch and wait” approach. Lonial says the study is designed to address the questions: is giving patients lenalidomide early using up valuable ammunition; and can it prevent long-term damage and improve quality of life?
Sagar Lonial, left, says that having Lawrence Boise, right, at Winship “has been a turbo boost for our program. He’s a phenomenal scientist.”“Each time there is a relapse, it’s a new disease with its own personality: aggressive, intent on its own survival... I wouldn’t have survived all these years without his efforts.”
– Rudolph Byrd on Sagar Lonial.
The young researcher has taken $30,000 and parlayed it into $820,000 – within a year. But more important to Kang, head and neck cancer patients may one day benefit from what may look like financial wizardry but is really more about a passion for a protein called RSK2. Kang’s painstaking research into how RSK2 programs head and neck cancer cell invasion and results in metastasis has resulted in grant awards totaling more than threequarters of a million dollars. And it all stemmed from a $30,000 Robbins Scholar pilot grant awarded to her in 2010 by Winship.
The real benefit of Kang’s ground-breaking work is not so much about financial reward as it is advancing knowledge about how to best treat patients with head and neck cancer. That said, her grant support shows the success of recent pilot projects of brilliant, young Winship researchers with extraordinary vision and passion. Not only have pilot projects become more and more a Winship priority, but they are beginning to pay off exponentially – not only in additional grant awards but also in findings that show great promise in improving patient outcomes.
Kang, who became an assistant professor at Winship two years ago, received her Robbins pilot grant from Winship Cancer Institute only last year.
Her research not only resulted in nine publications and presentations but also resulted in a $720,000 grant from the American Cancer Society (ACS) and a $100,000 award from the Georgia Cancer Coalition. While she and her lab team gathered critical preliminary data the first year, she isn’t close to finished.
“We want to further study how this protein works,” Kang explains. “It’s about finding all
the downstream targets and signaling.” The goal of understanding that, of course, is about therapeutic strategies to keep head and neck cancers from metastasizing.
The four-year ACS grant will allow Kang to move in that direction, allowing her to fully establish her research program, taking her from a senior post-doctoral fellow to an independent investigator studying pathways of a protein that plays a key role in a major cancer killer.
Kang’s success is emblematic of Winship’s intensifying emphasis on ever more aggressive, novel research that begins with pilot projects. These projects, often under the direction of senior-level faculty mentors, allow younger faculty an opportunity to blossom and to conduct research that shows great promise to improve patient outcomes.
“These pilot projects are really at the heart of what we do every day,” says Walter J. Curran Jr., executive director of Winship Cancer Institute. “These grants allow us to push forward aggressively in several different directions.”
The Robbins Scholars program, funded
through the generosity of Sarah and Jim Kennedy and named in memory of their friend Jim Robbins, has launched many Winship pilot projects.
Winship recently received a boost for its ability to fund pilot projects thanks also to the generosity of the Wilbur and Hilda Glenn Family Foundation. The Glenn Family Foundation’s extraordinary gift of $5 million is specifically earmarked for breast cancer research, and a portion of the gift will allow Winship to fund several breast cancer pilot projects over the next few years.
“The generosity of the Glenns will allow us to galvanize the breast cancer program here in a way we haven’t been able to do before,” says Curran, noting that the breast cancer program will be named the Glenn Family Breast Program. “This is a tremendous boost that will accelerate discovery in Winship’s breast cancer research programs.”
Already, breast cancer patients stand to benefit from a pilot project underway by Mylin Torres, MD, assistant professor in the department of radiation oncology.
She was named a Robbins Scholar last year. In July, she learned that she has been awarded an NIH grant for $370,838 for two years. Torres is studying why women treated for breast cancer often develop persistent, debilitating fatigue.
This is especially important, Torres says, as the number of breast cancer survivors is growing, with about three million breast cancer survivors in the U.S.
“Right now, there’s no treatment for this type of fatigue, and no one knows when and if it will end,” she says.
So, working with her faculty mentor, Torres began to explore if radiation to the breast can cause a generalized inflammatory response that in turn causes fatigue and depression.
An especially novel aspect of her study is that study participants will have an ultrasound measurement of the breast skin to objectively quantify the thickness of the tissue – a measure of inflammation –before, during and after radiation.
“I don’t think there’s anywhere else in the country that has this capability,”
Torres says, crediting Tian Liu, PhD associate professor in radiation oncology and a specialist in ultrasound who is assisting in the study. “The ultrasound really allows you to objectively quantify what’s going on, instead of saying ‘this breast looks red. I’m going to grade this side effect as a grade 1 toxicity.’”
As with the work of all Winship researchers awarded pilot grants, the goal is to improve patient outcomes.
“What if a medication could be administered that doesn’t interfere with a cure but minimizes the side effects?” Torres wonders. “You hear of this debilitating fatigue, where women feel like they can’t wake up in the morning, and depression.”
Torres says she could never have received the NIH grant without the Robbins Scholar pilot grant, thus underscoring the importance of receiving that first grant to gain the larger national award.
“It’s very difficult to receive an NIH grant without the laboratory work behind it,” Torres says. “You want to have the scientific rationale to show them, and reviewers want biological reasons why things succeed or not. They want to know the molecular effect behind what you see.”
An added benefit is that she has been mentored, she says, by “one of the world’s experts on symptoms from cancer treatment.” That would be Andrew Miller, MD, professor of psychiatry and hematology and medical oncology, and coleader of Winship’s Cancer Prevention and Control Program.
Kang also credits her mentor, Jing Chen, PhD, assistant professor in the department of hematology and oncology, himself a pioneer in the study of cancer metabolism and an internationally renowned expert in cancer metabolism. Chen also serves as the leader of the basic research component of the Winship leukemia program.
‘This kind of pilot grant helped me very much,” Kang says. “It says, ‘I can do it.’”
Leukemia survivor bikes 1,700 miles to raise money for Winship; doctor and nurses share the journey.
Every once in a while, circumstances conspire to give courage and compassion a special vehicle – and recently, that vehicle was a bicycle. Actually, several of them.
been members of Bob’s bone marrow transplant team only 18 months earlier.
Amelia Langston, MD, associate professor of hematology and oncology and medical director of the Emory Bone Marrow and Stem Cell Transplant Center, and nurses
planning on doing to seek permission, and the first thing she said, was ‘Cool. I’d like to join you.’”
very sick. When someone comes out of this, it’s very uplifting.”
And what about Bob? How is he?
“I feel so lucky to be alive, and I know I have Dr. Langston, the others who helped treat me at Winship, and my bone marrow stem cell donor to thank.”
It started a couple of years ago when Alpharetta resident Bob Falkenberg was diagnosed with acute lymphoblastic leukemia and underwent a bone marrow transplant at Winship. It ended this year on June 30 in Key West, Fla., when Falkenberg, his daughter Katie and best friend Carl Kooyoomjian finished a month-long bike odyssey of nearly 1,700 miles. Bob wanted to undertake the ride to raise money for Winship and heighten awareness about the need for bone marrow donors. Falkenberg’s Lifeblood Ride raised more than $18,000 for Winship and also immeasurable awareness. The trio left Beverly Farms, Massachusetts on June 2 and traveled down the east coast, through the car-clogged streets of Manhattan, through humid air filled with chicken feathers in rural Virginia and over roads littered with dead alligators in Florida.
“It was interesting to see how the road kill changed along the way,” says Katie, Bob’s daughter. Toward the end of their route, they were met by more pleasant things. Several members of Falkenberg’s treatment team drove close to 500 miles to meet up with the trio in Palm Coast, Fla. and then biked more than 100 miles with them to show their support for Bob’s efforts. They had
Jessica Thomas, Rachel Veldman and Christina Gragnaniello drove to Palm Coast, Fla., to meet Bob, Katie and Carl on June 24. With bicycles strapped on the back of Langston’s car, the four left Winship that Friday after clinic. At about 6:30 that evening, the team walked into the Palm Coast Fairfield Inn, pushing their bikes into the lobby.
It was hard to tell who was happier – the Winship treatment team or Bob, Katie and Carl, who had had such a rainy, sandy day on A1A in northern Florida that Bob had put his bike into the shower at the motel to clean it.
“I think it’s fantastic,” says Bob when asked what he thought about his doctor and nurses making such an effort to support him. “I remember when I told Dr. Langston what I was
And so she did. When the nurses on the treatment team heard about it, they were on board, too. Jessica, a two-time cancer survivor, rode with Langston on June 25 and 26 while Rachel and Christina drove down A1A, through Daytona Beach, New Smyrna and on to Titusville, Fla..
Langston, Thomas and other members of the bone marrow treatment team have participated in fundraisers, walks and runs for other patients, and they are honored to do so, they explained.
“He’s doing a lot more,” says Christina. “We just came down here to support.”
Langston said that Bob’s good health and his extraordinary effort to give back are inspirational to everyone associated with Winship.
“I think part of what it is, is whether you’re a patient here or staff member, we see a lot of bad things. People get very,
Nearly two years post bone marrow transplant, Bob’s blood counts are great, and he feels better than he felt before a blood pressure spike sent him to the emergency room when his leukemia was diagnosed.
“I feel so lucky to be alive, and I know I have Dr. Langston, the others who helped treat me at Winship, and my bone marrow stem cell donor to thank,” says Bob.
Do you have a story of heroism or kindness about a patient, doctor, nurse or staffer at Winship that you’d like to share? Tell us about it for The Winship Way. Send your story to: virginia.l.anderson@ emory.edu, or call at 404778-5452.
—Bob Falkenberg, far right
“Every dollar makes a difference,” says Walter J. Curran, Jr., executive director of the Winship Cancer Institute. “We very much appreciate the trust our patients and their family members put into Winship, and community support makes a tremendous difference in our cutting-edge research against this disease.”
The Winship Win the Fight 5K is USTF-certified, making it a Peachtree Road Race qualifier. It is the only metro area 5K to be held in historic Druid Hills, one of Atlanta’s most beautiful neighborhoods. Runners and walkers will be able to enjoy the treecanopied streets of the neighborhood, which should be dressed in autumn regalia for the event.
“We are looking forward to bringing our community together for cancer and cancer research awareness and to introducing a terrific new route for Atlanta families who enjoy running and walking,” Curran says.
Runners and walkers, take your mark on Oct. 15 for Atlanta’s newest 5K. Winship Cancer Institute of Emory University will hold its inaugural “Winship Win the Fight 5K” on Saturday Oct.15, 2011, to bring the community together in the fight against cancer.
The run/walk will begin and end at Emory University’s McDonough Field complex on Asbury Circle on the west side of the Emory campus. Registration is $25. Participants can organize teams or raise funds in a variety of ways and direct their fundraising efforts toward the Winship cancer research program of their choice. Register early at winshipcancer.emory.edu/winthefight5k
Late-comers can register the morning of the race at 6:30 a.m. until 7:30 a.m. Start time is 8:00 a.m. Ample parking is available at no charge in the Peavine Parking Deck on campus.
“This is a fight that matters now more than ever,” Curran says of the efforts to find cures for cancer. “Scientific research moves closer toward answers to some of cancer’s most difficult questions, but the toll of this disease remains tragically high. Cancer touches every American in some way. I want people to know what Winship is doing to minimize cancer’s lethal toll, and we can all run to support our life-saving research programs. ”
Registration and more information are available online at winshipcancer.emory.edu/winthefight5k.
Receiving a cancer diagnosis not only leads to the question of “How will beat this disease?”, but also “How do I afford it?” Jim Hankins, social services director of Winship Cancer Institute, aimed to answer the latter concern when he established the Winship Patient Assistance Fund in 2002.
The funds come from a variety of sources, with donations often varying in size, says Hankins. Many donations are made by family and friends in memory of patients, he says.
The fund also receives support from fundraising endeavors, both from patients as well as from the Winship community. “Everyone’s coming together to make this happen,” says Hankins.
Because of the sluggish economy, more patients are facing financial challenges than they are when times are good, Hankins says, so donations are especially appreciated – and needed.
This support has added up; so far this year, the fund has raised close to $40,000. Donations are accepted in form of cash or check made out to the Winship Patient Assistance Fund. Contact Mark hughes at (404) 778-1288 for any further questions about donating.
Winship getting a lot of help from T.J.’s friends
and raised $50,000 doing so for T.J.’s Friends, a charity that raises money for cancer and AIDS research. The group is a spinoff of the T.J. Martell Foundation, begun in 1975. That group was started by music industry executive Tony Martell after he lost his 19-year-old son, T.J., to leukemia. The T.J. Martell Foundation has since raised $250 million for cancer and AIDS research.
Winship welcomed a visit in June from the Perry sisters and Sarah Caplinger on behalf of T.J.’s Friends. The group delivered a $50,000 check to aid leukemia research, help fund the Winship Summer Scholars Research Program, directed by Mary Jo Lechowicz, MD, and support Students for Science, run by Adam Marcus, PhD, to interest students of all ages in science.
An extraordinary group of teens recently made fundraising fun – and gave the proceeds to Winship. Led by sisters Sarah Beth, 14, and Grace Ann Perry, 13, teenagers from schools around the metro area baked, cooked, sold ornaments –
“We don’t receive gifts like this every day, and certainly not from young people,” says Winship Executive Director Walter J. Curran, Jr. “We are overwhelmed by their compassion, hard work and generosity. We are very grateful for this gift, which will help our research programs focused on malignancies that especially affect young people.”
If there’s something cool going on, you can bet that the Friends of Winship are involved. And so it was on a recent steamy August afternoon when the Friends served cookies and cold lemonade to patients and staff on the first floor and on the plaza level at Winship Cancer Institute. The Friends of Winship hold many functions to raise spirits, as they did at the lemonade social, and to raise money for Winship Cancer Institute. If you would like to become involved, call 404-778-1769, or visit winshipcancer.emory.edu/friends
EdyE Bradford fell in love with the people at Emory’s Winship Cancer Institute during her treatment for colon cancer in 2006. The surgeon gave her hugs. The nurses made her laugh. Her care team fought so fervently to restore her health, she called them “the three musketeers.”
Winship Cancer Institute is known for its expertise, and Bradford is now cancer-free. Deeply moved by the experience, she has left her estate to Winship to fund cancer research. “In my small way, I am providing a means to knowledge,” she says, “and that is my real gift.”
Learn how you can support Winship in your estate plans. Call 404.727.8875 or visit www.emory.edu/giftplanning.