Winship Magazine - Spring 2022

SPRING 2022

RACIAL DISPARITIES in cancer

HOW WINSHIP IS WORKING TO BRIDGE THE GAPS

In si d e : CANCER ACT ANNIVERSARY

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W I N SHI P AT EMORY MI DTO WN

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“For cancers like multiple myeloma and breast cancer, it is important to get as many people enrolled as possible so that we can get a better handle on the disease.”

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Theresa Gillespie, PhD Winship‘s associate director for community outreach and engagement

PHOTO BY JACK KEARSE

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“With the tower construction well underway, the focus now is on purchasing cutting-edge technology and furnishings for its interior, as well as recruiting exceptional staff to care for patients. . . .”

10 On the cover: Racial disparities and how Winship is bridging the gap. Illustration by Jason Raish

Sheryl Bluestein vice president of operations for Winship at Emory University Hospital Midtown

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PHOTO BY RICHARD NIXON PRESIDENTIAL LIBRARY AND MUSEUM

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ILLUSTRATION BY KEITH CHAMBERS/SCIENCE PHOTO LIBRARY

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PHOTO BY JACK KEARSE

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Winship Magazine | Spring 2022 From the Executive Director 2

Kudos 8

The Team Approach 24

Faculty Awards and Distinctions

Collaboration is the Key to Treating

in 2021

Kids’ Head and Neck Cancers

Madhav V. Dhodapkar:

Features

Around Winship

The Future of Cellular Cancer

Cover Story Racial Disparities 10

Three New Endowments 28

Immunotherapy at Winship

in Cancer Are All Too Real:

And Why They Matter

In the News Pioneering Perspective 3

How Winship is Working to

Game Changers 4

Bridge the Gaps

the World of Cancer

Best and Brightest 6

Applying Data and Technology 30 Improving Outcomes

Four Scientists Who Have Changed Only the Beginning 16 Taking Stock 50 Years After

Better Imaging 31

the National Cancer Act

For Better Prostate Treatment Outcomes

Winship at Emory Midtown 22

Inspiring Hope 32

Nine New Stars in Winship’s Growing Pantheon

Moves Toward Setting a New

Emory | Winship Magazine is published biannually by the communications office of Winship Cancer Institute, a part of the Woodruff Health Sciences Center of Emory University, emoryhealthsciences.org. Articles may be reprinted in full or in part if source is acknowledged. If you have story ideas or feedback, please contact john.manuel.andriote@emory.edu. © Emory University 22-EVPH-Winship-0015

Standard for Cancer Care

Women in Winship inside back cover

Emory University is an equal opportunity/equal access/affirmative action employer fully committed to achieving a diverse workforce and complies with all federal and Georgia state laws, regulations and executive orders regarding nondiscrimination and affirmative action. Emory University does not discriminate on the basis of race, age, color, religion, national origin or ancestry, sex, gender, disability, veteran status, genetic information, sexual orientation, or gender identity or expression.

Website: winshipcancer.emory.edu. To view past magazine issues, go to winshipcancer.emory.edu/magazine.

Editor: John-Manuel Andriote Art Director: Stanis Kodman and Peta Westmaas

Photographer: Jack Kearse Production: Stuart Turner

Winship | From the Executive Director

A

WELCOME TO THE SPRING 2022 ISSUE OF WINSHIP

We’ve gained tremendous knowledge and momentum from discoveries that are changing the way cancer is prevented, detected and treated.

MAGAZINE. In the following pages, you will find stories and images of the people and spaces that together make up Winship Cancer Institute of Emory University.

They offer glimpses into the exciting work of our researchers, clinicians and educators, and the impact in the lives of our patients and their families, with the ultimate goal to achieve a world free of cancer.

These stories and images help to illustrate Winship’s overarching commitment to put our patients at the center of everything we do, what we call “The Winship Way.” I was honored last July to be appointed Winship’s executive director. My personal journey as an immigrant from Chennai, India, where I grew up, to the leadership of Winship is a tribute to the United States and its people; I also owe a debt of gratitude to my mentors who guided me along the way and opened new doors of opportunities.

[ Winship Magazine

I am pleased to assume this important role at this particular time in Winship’s history. We are at a very exciting period of growth at Winship. This spring we will submit the application to renew our status as a National Cancer Institute-designated Comprehensive Cancer Center. We continue to make significant investments in research, faculty recruitment and retention, clinical trials infrastructure, and community engagement. We have also undertaken extensive renovations in several of the clinical and research spaces on our Clifton Road campus. In addition, Emory’s new research building under construction, Health Sciences Research Building II, will house a substantial amount of space for cancer research.

The crown jewel of Winship’s growth and progress is our new 17-story tower under construction in Midtown Atlanta, thanks to an extraordinary gift from the Woodruff Foundation. When it opens in 2023, Winship at Emory Midtown will showcase “The Winship Way” in a high-tech facility purpose built to bring together health care providers and researchers in specialized care communities that revolve around the patient to deliver personalized and innovative cancer care. You will find an update on the project here in the magazine.

Your continued support enables us to dream big and work towards discovering cures for cancer and to inspire hope. Thank you.

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Suresh S. Ramalingam, MD

]

Winship | In the News

PIONEERING PERSPECTIVE

The Future of Cellular Cancer Immunotherapy at Winship

by MADHAV V. DHODAPKAR, MBBS

I

cell therapy revolution in cancer takes shape. T cellbased therapies, including CAR-T cells, may benefit from advanced genetic engineering to improve their function. Winship researchers are also exploring new ways to help such cells persist longer and more effectively kill cancer cells. Others are exploring new ways to target tumors, use immune cells to deliver drugs to the tumor site or engineer cells to target specific mutations or proteins within tumor

N 2013, SCIENCE MAGAZINE NAMED CANCER IMMUNOTHERAPY AS THE BREAKTHROUGH OF THE YEAR. The past decade has

PHOTOS BY: A. JACK KEARSE, B. JACK KEARSE, ILLUSTRATION BY KEITH CHAMBERS/SCIENCE PHOTO LIBRARY

established immune therapy as one of the major pillars of modern cancer therapy, alongside surgery, radiation, chemotherapy and targeted therapy. Investigators at Winship have played a major role in this immune revolution, which in several cancers has led to substantial improvements in survival and served as a source of hope and inspiration for patients and researchers alike.

Most current immune approaches against cancer involve two broad strategies. One involves “checkpoint inhibitors,” therapies aimed at removing the natural brakes against immune cells and allowing them to unleash their effects against cancer. The other, my focus here, involves infusing immune cells into cancer patients. This strategy has already led to impressive and durable responses in patients with hematologic (blood) cancers, and it is poised to transform care and yield cures in several other cancers.

cells. Improving scalability and reducing costs associated with cellular therapy are additional unmet needs. This is why it is likely that advances in cellbased therapies would occur through personalized approaches and may benefit from “on-site” manuThis strategy has facturing to help rapidly test innovative approaches already led to and reduce costs. impressive and Academic centers of excellence and new partnerdurable responses ship models involving industry, regulatory and fundin patients with ing agencies are critical to delivering on this promise.

The National Cancer Institute in 2020 chose Winship hematologic Why Winship? as one of a limited number of cancer centers to form (blood) cancers, As Georgia’s only Comprehensive Cancer Center and a consortium focused on cell therapy. Winship also and is poised to a prolific contributor to cancer immunology research, is actively engaged in partnerships with other centers transform care and Winship is poised to help lead this revolutionary new involved in cell therapy. yield cures in sevway to treat cancers. Winship investigators have already In the past year, Winship has invested in a new been engaged in seminal studies that led to the approval cell manufacturing laboratory, Emory Cellular eral other cancers. of engineered T cell therapies called chimeric antigen and ImmunoTherapy Core (ExCITE) lab, which receptor (CAR) T cells. Several Winship researchers are actively we expect to begin manufacturing CAR-Ts for cancer patients studying and developing new methods to improve these therapies. in 2022. We anticipate this facility will help translate preclinical studies from several Winship labs to It takes a village test new cell-based therapies in the While cell-based therapies such as CAR-T cells or other immune clinic and will be central to recruiting cells, offer considerable promise, safely collecting and administering additional cell therapy researchers to them require infrastructure and a team with specialized expertise. enhance the critical mass of cell-therThis is particularly important for optimally managing early toxiciapy research at Winship. ties in patients receiving therapies. Winship has created dedicated In spite of the remarkable progress B teams of researchers, clinicians, nurses and other staff who specialand promising clinical results in recent A noted immunobiologist, ize in caring for patients before and after immune cell infusion. years, the best for cell therapy in cancer Dhodapkar is working to harness is yet to come, and I encourage you to the immune system’s properties to detect, prevent and treat Home-grown and personalized therapies are the future stay tuned. w cancer, particularly multiple Several opportunities for improvement have become clear as the myeloma. [ Winship Magazine

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Winship | In the News

GAMECHANGERS

Meet four of Winship’s outstanding research scientists whose work has literally

primary driver of discovery and evaluation of novel therapeutic options for cancer patients at Winship. Fu, PhD, is associate dean for innovation and international strategies, professor and chair of the Department of Pharmacology and Chemical Biology, and A professor in the Department of Hematology and Medical Oncology at Emory University School of Medicine.

At Winship, Fu holds the Winship Partner in Research Endowed Chair and is leader of the Discovery and Developmental Therapeutics Program and director of the Emory Chemical Biology Discovery Center.

targeted therapies, leaving a large population of patients with limited treatment options.

We focus on cancer-associated protein-protein interactions (PPI) that both enzymes and non-enzymes utilize to transmit oncogenic signals in cancer. While most cancer drugs act on an individual target molecule, the PPI-targeted approach aims to perturb the interface between two proteins to block the transmission of cancer-driving signals. The PPI targets were historically regarded as highly challenging and undruggable.

Our effort has led to the discovery of a landscape of neo-interactions encompassing both oncogenic and tumor suppressor mutations, offering a fertile ground for genomics-directed therapeutic exploitation. These firstin-class mutation-directed PPI modulators are expected to accelerate the development of patient tumor-specific precision medicine.

Q. What insights has your team contributed to molecular target-based cancer drug discovery, biomedical technology and clinical trials for therapeutic development?

A. Currently, most targeted cancer therapeutics act on dysregulated enzymes in cancer, such as protein kinases, to block their cancer-causing catalytic functions. However, most cancer driver genes encode non-enzymes, such as adaptor proteins, which have no

Q. Please explain how patients benefit from this research?

A. Our approach to disable or modify tumor mutation-created neoPPIs and hypoPPIs aims to develop a new generation of anticancer agents that can be tailored specifically to patients with a particular mutation that does not exist in a healthy individual. We hope that this strategy will transform our way of treating patients by targeting the oncogenic mutation-driven cancer-causing programs with precision.

HAIAN FU leads a research program that is the

CHRYSTAL M. PAULOS’s research aims to develop

novel T cell–based therapies for patients with melanoma. Her research team has contributed significant insight into how to mount T cell memory responses to tumors. Paulos, PhD, is an associate professor in the Department of Surgery and the B Department of Microbiology and Immunology at Emory University School of Medicine.

Q. What insights has your team contributed toward understanding how to mount T cell memory responses to tumors?

A. We discovered that specially selected immune T cells that contain the novel anti–tumor CD4 marker, when given back to patients directly,

[ Winship Magazine

cause tumors to shrink and can orchestrate other immune cells in the patient’s body to prevent tumor relapse.

Q. How do patients benefit from this research?

A. Harnessing immunity to tumors via checkpoint blockade or adoptive T cell transfer therapy has revolutionized medicine. All NCI-designated cancer centers provide their patients with some form of immunotherapy.

While this has been impactful for many patients, there is still room for improvement, as not everyone benefits. Even if a patient does respond to immunotherapy, sometimes this benefit is not long-lasting. We think that if we can bolster effective memory T cell responses via our approach, we may be able to further augment PD-1 or cell-based immunotherapies with our clinical team.

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PHOTOS BY: A. JACK KEARSE, B. ATLANTABUSINESSHEADSHOTS.COM, C. KAY HINTON, D. CHILDREN’S HEALTHCARE OF ATLANTA

“changed the game” in some way for people with cancer.

Winship | In the News

SUMIN KANG’s research centers on using trans-

lational and preclinical studies to better understand the protein kinase signaling as well as metabolic reprogramming in tumorigenesis and tumor metastasis. Kang, PhD, is associate professor in the Department of Hematology and C

Medical Oncology at Emory University School of Medicine and director of Winship’s Basic and

and transcriptomics to detect genes, transcripts, proteins and metabolites, and to better understand cancer in an unbiased manner.

We not only put effort into understanding the underlying mechanisms of new networks in tumor recurrence but also into the identification of specific and effective small molecule inhibitors to target these novel factors. We validate them in preclinical settings, which in the long run will contribute to overcoming cancer recurrence that is mediated by therapy resistance and metastatic switch.

Translational Science Division of HMO. Kang’s work is supported with competitive peer-reviewed federal grants, including NIH R01s for pro-metastatic and cisplatin-resistant signaling of RSK2 and MAST1 in cancer.

Q. In what ways would you describe your research as “changing the game” in cancer treatment?

A. The main cause of cancer death is not the primary tumor but the recurrence of metastatic disease that follows cancer therapies. We are focusing on identifying a novel critical factor that leads to tumor recurrence. We look at cancer recurrence as a complex process rather than a single factor– driven disease. Therefore, we use integrated metabolomics, proteomics

DOUGLAS K. GRAHAM focuses clinically in pediatric leukemia and is a National Institutes of Health–funded investigator with an active laboratory focusing on developing novel therapeutics for pediatric cancer, recently validating MerTK as a novel cancer agent in multiple cancer types. In particular, his lab studies the D MerTK and Axl pathways in pediatric leukemia and non-small cell lung cancer. His research team has helped develop a first-in-class small molecule inhibitor against MerTK, and this cancer drug is being tested at Emory in clinical trials. Graham, MD, PhD, is professor of pediatrics and chief of the Aflac Cancer and Blood Disorders Center of Children’s Healthcare of Atlanta. He holds the William G. Woods Chair and is the division chief of pediatric hematology/oncology/BMT at Emory University.

Q. What role has your lab played in developing potential new “game-changing” treatments?

A. Our research team has worked to identify and validate a new cancer target, MerTK. When this receptor tyrosine kinase is abnormally activated, cancer cells do not respond well to therapy. However, we [ Winship Magazine

Q. How do patients benefit from your research?

A. A correct understanding of how current drugs work and how cancers evade therapy will help patients receive optimal and right drug combinations that work best for their diseases. For instance, we found that a kinase called MAST1, which drives cancer cells to become resistant to cisplatin-based chemotherapy, and glucocorticoids, which are often used together with cisplatin as supportive care, facilitated MAST1 induction.

Based on this finding, we suggest that MAST1 inhibition may be considered when patients receive glucocorticoids together with cisplatin.

have helped develop a new cancer drug that can turn off this cancer protein and make cancer cells die, particularly when combined with other treatments. We have also discovered that our new drug turns on the patient’s immune system in a manner that further fights cancer cell growth. Our research group is particularly excited that the cancer drug is completing initial testing in human solid tumor cancer trials and the early data warranted further testing in follow-up studies. Recently, three additional clinical trials testing the efficacy of this cancer drug at Emory, as well as other sites in the US and internationally, have opened.

Q. How does your research benefit pediatric patients?

A. The initial clinical trial focused on testing this drug in adult cancer patients with solid tumors who have not responded well to other cancer treatments. The more recent trials have focused on evaluating the benefit of this drug in lung cancer. We will soon open a trial at Winship and at the Children’s Healthcare of Atlanta to determine the benefit of this new cancer drug in patients with acute lymphoblastic leukemia and acute myeloid leukemia. This leukemia trial will enable adults and pediatric patients (ages 12 and up) to be enrolled in the study. A future trial is also planned to expand the availability of this drug to children with leukemia who are below the age of 12. w | 5 | Spring 2022

]

Winship | In the News

BEST & BRIGHTEST Why did you come to Winship?

1

Rafick-Pierre Sékaly, PhD Professor and vice chair, Translational Research Pathology & Laboratory Medicine

2

Kevin Kalinsky, MD, MS

Associate professor and director of breast oncology, Hematology & Medical Oncology

“A lot of my work is focused on developing and understanding immunotherapies—including CAR-T cells and why some respond and others don’t respond.

Being able to be in a center like Winship that does research and clinical trials that include these immunotherapies is ideal to me.

I am working with leaders in the field who are also friends.”

4

3 Yong Wan, PhD

Professor, Pharmacology & Chemical Biology

“I am honored to lead the breast cancer research effort of the Glenn Family Breast Center at Winship. Winship is a terrific breast cancer resource and an outstanding infrastructure for building team science that integrates basic and patientbased translational studies.”

5 Edjah K. Nduom, MD, FAANS

Sunil Badve, MD, FRCPath

Associate professor, Neurosurgery

Professor and vice chair, Cancer & Pathology Laboratory Medicine

“I knew that Winship was the perfect place for me to help establish a truly world-class brain tumor program. When I left the National Institutes of Health, I did have my choice of other institutions to join, but coming home to Emory was always foremost in my mind.

Winship provided me with every resource I could want to continue to build our brain tumor program.”

“I was provided with a phenomenal opportunity to bridge two excellent institutions: Winship Cancer Institute and the Department of Pathology at Emory. Both have excellent leaders and resources to make a successful and lasting impact on quality of research and health care for our patients.” [ Winship Magazine

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PHOTOS BY: 1. BILLY HOWARD, 2. JACK KEARSE, 3. JACK CHI , 4. KAY HINTON, 5. JACK MANNING III, 6. PROVIDED BY DR. YONG TENG, 7. PROVIDED BY CHRISTINE EKENGA, 8. JACK KEARSE, 9. JACK KEARSE

“We are from the Southeast, and we moved back to Atlanta to serve the community in which we grew up.

Atlanta is a highly diverse population—and we want to make sure that our work is reflecting this—whether it is understanding disparities and health outcomes or developing new therapeutic approaches and evaluating novel treatments for our patients diagnosed with breast cancer.”

Winship | In the News

6

Yong Teng, PhD

9

Associate professor, Hematology & Medical Oncology

David Frank, MD, PhD, FACP Professor and division director, Hematology & Medical Oncology

“Winship has an incredible academic setting, which allows me to work alongside talented, creative and insightful cancer experts and trainees to solve complex problems and flesh out scientific questions related to my research interest.

Winship was just the perfect choice for my career goals.”

7

Christine Ekenga, PhD, MPH Assistant professor, Environmental Health

“I chose Winship because Winship provides a unique opportunity for me to work with some of the best physicians and scientists in the nation while fulfilling my mission to advance knowledge that promotes healthy environments for the prevention and control of cancer.”

88

Ticiana Leal, MD

Associate professor, director of the Thoracic Medical Oncology Program, Hematology & Medical Oncology

“I chose to come to Winship because I am excited about the opportunity to join an awesome team of clinicians and researchers with the goal of providing the best care for our patients and advancing the field of thoracic oncology.” [ Winship Magazine

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“What attracted me to the Winship Cancer Institute was the opportunity to join an institution that completely shared my focus on optimizing the care of cancer patients today and improving outcomes even more in the future. I am particularly looking forward to working with my colleagues to advance new therapeutic approaches from the laboratory to the clinic, so that Winship will be the nationally recognized destination for the most innovative and patient-centered cancer care.” w

KUDOS

WINSHIP MEMBERS

Achieve Honors Worldwide RAFI AHMED, PhD, was among five Emory professors to be elected to the American Academy of Arts and Sciences.

PhD, RN, MSN, FAAN, together with DEBORAH WATKINS BRUNER, RN, PhD,

JINBING BAI,

FAAN, was presented the Mentor-Mentee Research Award at the NINR-ONS-NCI Symptom Science Advances in Oncology Nursing virtual colloquium held February 4–5, 2021. Bai also was honored by the Oncology Nursing Society (ONS) with the 2021 Victoria Mock New Investigator Award, recognizing his contributions to building a scientific foundation for oncology nursing practice.

PhD, received a 2021 Eleanor Main Student Mentor Award, recognizing individuals who exemplify mentoring of the highest quality in graduate education.

ALISINA BAZRAFSHAN,

Academy of Inventors (NAI). The NAI Fellows Program highlights academic inventors who have demonstrated a spirit of innovation in creating or facilitating outstanding inventions that have made a tangible impact on quality of life, economic development and the welfare of society.

AuntMinnie.com’s annual award program recognizing radiology excellence.

MD, was elected to the board of directors of the American Academy of Hospice and Palliative Medicine.

KIMBERLY CURSEEN,

MD, has been named to the steering committee of the American Association for Cancer Research (AACR) Cancer Immunology Working Group.

KAVITA DHODAPKAR, VANESSA BRAMBLE, MS, MBA, CRA, RT (R) (M), Winship’s director of network development, has been named a Fellow of the American College of Healthcare Executives.

MD, PhD, received the ASTRO-MRA Young Investigator Award in Radiation Oncology.

ZACHARY BUCHWALD,

MD, MPH, was elected to be a board member of the American Thyroid Association.

AMY CHEN,

PhD, MPH, RN, CPON, received a K23 career development award from the National Institute of Nursing Research.

BREE EATON, MD, is a recipient of a 2021 Peach Bowl LegACy Fund grant to support Eaton’s project on sMRI for pediatric highgrade gliomas.

PhD, has received a five-year NIH Director’s New Innovator Award to support her project, “A Novel Framework for Quantifying Metabolic Brain Health.”

CANDACE FLEISCHER,

BROOKE CHERVEN,

MD, received the Daniel D. Von Hoff Innovative Protocol Award by the ASCO/AACR Methods in Clinical Care Workshop.

JAMES BATES,

MD, Winship’s former executive director (2009–2021), is among the 2021 OncLive Giants of Cancer Care inductees in the radiation oncology category.

MD, MS, was a finalist for the Most Influential Radiology Researcher award in the 2021 Minnies, AuntMinnie.com’s annual award for radiology excellence.

JUDY GICHOYA,

WALTER J. CURRAN, JR.,

MD, was named to the board of directors of the American Board of Ophthalmology.

HANS GROSSNIKLAUS,

PharmD, was recognized by the American Society of Clinical Oncology (ASCO) as an ASCO Advocacy Champion.

R. DONALD HARVEY,

Emory’s Department of Radiology was recognized as a finalist for Best Radiologist Training Program by the 2021 Minnies,

[ Winship Magazine

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PHOTO BY STEPHEN NOWLAND

PhD, has been named Emory University’s new provost and executive vice president for academic affairs.

Bellamkonda also received a five-year NIH Director’s Transformative Research Award for his work using electrical fields to treat an aggressive pediatric cancer. Together with MAX COOPER, PhD, Bellamkonda was named a 2021 fellow of the National RAVI BELLAMKONDA,

Winship members and faculty in 2021 received numerous awards, commendations and fellowships demonstrating their professional achievements in the cancer field.

PhD, was appointed to serve on the National Science Advisory Board for Biosecurity (NSABB), 2021–2024; received the Color Magazine Women of Color: Innovator in STEM award; and was named by Cell Mentor as one of “1,000 inspiring Black Scientists in America.”

KARMELLA HAYNES,

CURTIS HENRY, PhD, was recognized by Cell Mentor as one of the “1,000 Inspiring Black Scientists in America.”

GREGORY LESINSKI, MD, MPH, was elected as a special expert in immuno-oncology translational science by the Hepatobiliary Task Force of the National Cancer Institute (NCI) Gastrointestinal Steering Committee (GISC).

MD, PhD, was appointed the regional representative (Georgia) to the board of directors, Southeastern Section of the AUA.

VIRAJ MASTER,

PhD, MSPH, was recognized by Cell Mentor as one of the “1,000 inspiring Black Scientists in America.”

LAUREN MCCULLOUGH, CIMONA HINTON, PhD, was recognized by Cell Mentor as one of the “1,000 Inspiring Black Scientists in America.”

PhD, MS, KAREN EFFINGER, MD, MS, JORDAN MARCHAK, PhD, ABPP, and colleagues from the Aflac Cancer and Blood Disorders Center were honored with the 2021 Survivorship Champion’s Prize from Children’s Cancer Cause, in recognition of the team’s innovative work to provide comprehensive, integrated care for childhood cancer survivors.

ANN MERTENS,

BAKER HUBBARD, MD was named a Distinguished Alumnus Award/Lecturer

by Washington University School of Medicine.

CTR, has been elected administrator for the National Cancer Registrars Association’s Council on Certification.

CRYSTAL JORDAN,

PhD, received the Journal of the American Chemical Society Young Investigator Award and The Journal of Materials Chemistry B Emergent Investigator Award.

WILBUR LAM, MD, PhD, received the Atlanta Business Chronicle Healthcare Innovator/ Research Award.

MD, was recognized by Cell Mentor as one of the “1,000 Inspiring Black Scientists in America.”

EDJAH K. NDUOM,

MD, Winship’s newly designated executive director, has been named editor-in-chief of Cancer, the peer-reviewed journal of the American Cancer Society.

SURESH S. RAMALINGAM,

PhD, MS, postgraduate fellow, and doctoral students CAROLINE JANSEN and NATALIYA PROKHNEVSKA are recipients of Young Investigator Awards from the Society for Immunotherapy of Cancer (SITC).

SRUTHI RAVINDRANATHAN,

PhD, MS, was highlighted on International Women’s Day on March 8, 2021, by the Leukemia and Lymphoma Society for her pivotal work in multiple myeloma.

MAIA SHANMUGAM,

MD, received the George Solomon Lecture Award from the Psychoneuroimmunology Research Society.

ANDREW MILLER,

YONGGANG KE,

PhD, a member of the Marcus lab, has received a National Cancer Institute (NCI) Research Specialist Award, which provides salary support for exceptional scientists to pursue research within an NCI-funded cancer research program.

JANNA MOUW,

PhD, First Fellow at the Emory University Rollins School of Public Health, was named by Cell Mentor as one of the “1,000 Inspiring Black Scientists in America.”

JASMINE MILLER-KLEINHENZ,

[ Winship Magazine

| 9 | Spring 2022

]

PhD, RN, WHNP-BC, is one of nine members of Emory’s Nell Hodgson Woodruff School of Nursing selected for induction as a fellow of the American Academy of Nursing (AAN). w JESSICA WELLS,

RACIAL DISPARITIES in cancer

by TONYA RUSSELL

Illustration Jason Raish

[ Winship Magazine

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]

The US has a troubled relationship with its marginalized groups, and medicine is not immune to scrutiny. Black Americans in particular often struggle with pervasive mistrust.

THIS HESITANCY SHOWS UP IN ALL ASPECTS OF CANCER CARE.

Black people make up

13.4%

of the US population.

They account for 5% of clinical trials.

83% of research participants are white people.

At Winship Cancer Institute, there is a 30% Black participation rate; for interventional trials, the rate is closer to 25%.

ith histories of abuse, including the Tuskegee Experiment and the sterilizations of Native Americans and Puerto Ricans, marginalized people have been stripped of informed consent and care that wasn’t predatory. It is no wonder they aren’t first in line to sign up for studies. The truth is, Black people make up 13.4% of the US population, yet nationally account for 5% of clinical trials: 83% of research participants are white people with bodies that may present symptoms differently than the rest of the population. That may also mean that these characteristics, as well as factors that impact their care, are elevated.

The lack of diversity leads to a widening gap in care for some cancers, such as melanoma, which may be difficult to spot, since the advice given for recognizing this type of cancer only applies to white skin.

Not only is there a delay in diagnosis, but skin cancers are often more fatal in Black people. If more people of color participate in clinical research, the gap may start to close.

WHAT WINSHIP IS DOING TO BRIDGE DISPARITIES While we can’t right the wrongs of the past, we can continue to work towards [ Winship Magazine | 11 |

Spring 2022

]

a more equitable health care system.

At Winship Cancer Institute of Emory University, we are doing just that.

Our researchers are working towards innovative treatments and centering on the experiences of people of color through clinical trials.

At Winship, there is a 30% Black participation rate in clinical trials.

Although that may be low considering the number of Black residents in the Atlanta area, it is still significant when compared to the 5% overall participation rate nationwide. Winship is working diligently to increase these numbers, and this could potentially change the available data. That means a more accurate picture of health outcomes and barriers.

Theresa W. Gillespie, PhD, MA, BSN, FAAN, Winship’s associate director for community outreach and engagement, has a long-standing association with cancer treatment and research as well as identifying and addressing disparities.“You want your clinical trial accrual to reflect the population that you serve,” says Gillespie, “which in the case of Winship is the state of Georgia.”

For certain studies, such as those for multiple myeloma— prevalent among African Americans— there is a higher participation rate than the 30% average.

Georgia is among the states with high incidence of the disease; about 27% of patients will succumb to it.

For certain Winship studies, such as those for multiple myeloma—prevalent among African Americans—there is a higher participation rate than the 30% average. Gillispie explains that patients are very responsive. “For cancers like multiple myeloma and breast cancer,” she says, “it is important to get as many people enrolled as possible so that we can get a better handle on the disease.”

Diagnoses of multiple myeloma, a cancer that affects plasma, have been steadily increasing over the last 40 years. It is more prevalent in certain states, and Black people are more than twice as likely to develop it than any other ethnic group. They are also twice as likely to die, even though the cancer and dying from the cancer overall are rare. Georgia is among the states with high incidence of the disease; about 27% of patients will succumb to it.

According to Gillespie, “African American populations have been very responsive in terms of enrolling on those trials,” which she hopes will help to alter the trajectory for these and future patients.

CLINICAL STUDIES ONLY TELL PART OF THE STORY

While increased clinical trial participation helps, cancer epidemiologist Lauren McCullough, MD, explains that all disparities [

can’t just be chalked up to a lack of participation.

“Black women tend to be diagnosed at later stages,” she says. “There’s some people who posit that ‘Black women just aren’t being screened and that they’re not following the guidelines.’ In Georgia, that’s not necessarily the case.”

She points out how CDC data on breast cancer screening shows Black women are actually more likely to be screened than their white counterparts.

That begs the question: What is leading some Black women to have poor outcomes?

According to McCullough, “There are a lot of those downstream outcomes that are a result of some of the upstream factors related to screening, and they say diagnosis and tumor aggression and those kinds of things. So it’s all tied together.”

One major factor is access. “The challenge comes in the follow-up care, since there are legitimate access issues,” says McCullough. She explains, “You’ve already taken off half a day of work to go and get the mammogram. Now they’re saying you need to come back, but you are the head of household, and you have to worry about dependent care. All of these things are barriers to return from screening.” McCulough says it would make a huge difference to fix issues around access, on top of solving the matter of Black women being diagnosed at later stages.

THE BIOLOGY OF CANCER DISPARITIES

Biological factors are the least understood drivers of the differences in incidence and outcomes of particular cancers among racial and ethnic groups. Advanced genomics, other molecular technologies and sophisticated computational tools are beginning to help us understand how biological factors interact with other relevant factors such as diet and the environment and contribute to cancer disparities.

Disparities in three particular types of cancer — breast cancer, colorectal cancer and prostate cancer — highlight what is known at this point about the correlation between biological factors and disparities in prevalence and prognosis in women and men of different racial and ethnic ancestry.

African American women have a higher prevalence of triple-negative (estrogen-receptor negative, progesterone-receptor negative and HER2-protein negative) breast cancer. There is some evidence suggesting a genetic mechanism(s) may be behind the

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poorer prognoses in African American women with triple-negative breast cancer compared with other women. McCullough’s research suggests that a higher prevalence of self-reported obesity among African American women may be a factor in breast cancer, since obesity can affect tumor progression and treatment efficacy.

Olatunji B. Alese, MD, associate professor and Winship’s director of gastrointestinal oncology, notes that African Americans have the highest colorectal cancer rates of all ethnic groups in the US, with an associated mortality rate that is 20% higher than non-Hispanic Whites. “It is unclear if these differences are purely biologic or largely due to other factors,” he says. “We are still trying to tease out how much tumor biology contributes to racial disparities in colorectal cancer.”

According to the National Cancer Institute, a research study of more than 100 patients in Ohio diagnosed with colorectal cancer found that 15 of the 20 genes that are significantly mutated in colorectal cancer appear to be preferentially associated with colorectal tumors in African Americans, accounting for 41 percent of colorectal cancers in African Americans versus 15 percent of colorectal cancers in Whites.

African American men die from prostate cancer at a rate more than double that of men of any other race or ethnicity, marking the largest disparity in cancer mortality of any tumor site in US men or women. Some evidence indicates that prostate cancer progresses faster in African American men, which may partly explain why they disproportionately present with advanced disease at the time of their diagnosis. Researchers have proposed that genetic variations in certain chromosomes are associated with greater susceptibility to prostate cancer.

This is where social determinants may come into play. These include food insecurity, which impacts every group, but is most likely to affect Black and Brown people. Others include access to safe housing and transportation, which hinder someone’s ability to make appointments or even receive calls or mail. Lack of a stable job can mean no health insurance, making treating their cancer costly and/or impossible.

For colon cancer specifically, Chawla explains that colonoscopies can be challenging to their sense of masculinity, so Black men are putting them off for too long. He believes that treating physicians should be mindful of how these various aspects can impact care, as well as mistrust.

“There is a whole body of research which says that there are certain inherent biases that we have,” says Chawla. “For instance, if an obese unhealthy person from a low socioeconomic background comes in, who has other medical problems, maybe the perception is that this person may not be compliant with screening, so let’s not worry about that right now. Let’s focus on managing their diabetes.

So, you know, there are so many layers to this.”

SOCIAL DETERMINANTS OF HEALTH

Sarahb Chawla, MD, director of endoscopy at Emory Saint Joseph’s Hospital, is a gastroenterologist who specializes in digestive cancers. “For the longest time,” he says, “we believed that minorities were predisposed to having more cancers than Caucasians. Now we know that there are social factors, and that it isn’t just genetics.”

In his work, Chawla has studied pancreatic cancer, which has an early onset in minorities, as well as colon cancer, which has a high mortality rate for Black men being diagnosed at younger ages across all ethnic groups.

He says there isn’t just one cause that impacts whether or not someone develops cancer or survives their diagnosis. [

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Sarahb Chawla

Lauren McCullough

RACISM STILL PLAYS A ROLE

“Racism is a public health emergency of global concern,” says a 2020 editorial in the Lancet. “It is the root cause of continued disparities in death and disease between Black and White people in the USA.” We saw this at the height of the COVID-19 pandemic as Black and Brown communities were impacted most

by COVID-19–related deaths and unemployment. We also saw it in how Black people were being turned away from ERs, despite having severe symptoms.

“Historically, [people of color] have been abused,” says Chawla. Not only can implicit bias and racism affect someone’s ability to receive quality care, but they do not help to facilitate trust in a system that was designed to protect the survival of white bodies—often at the expense of Black and Brown people. That is why anti-racism work is essential for current and future medical workers.”

McCullough says that racism in medicine is “structural.” She explains, “The intervention is massive, and it’s important to identify the policies that

Racism is a public health emergency of global concern.

It is the root cause of continued disparities in death and disease between Black and white people in the USA. 2020 editorial in the Lancet

[ Winship Magazine

PHOTO BY KAY HINTON

PHOTO BY JACK KEARSE

PHOTO BY JACK KEARSE

Olatunji B. Alese

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have allowed these systems to be created that disproportionately impact persons of color, and persons who are not economically advantaged.” She adds, “We must ask what are the other things that we can be doing to ensure that these people aren’t falling through the cracks?

I think those things have to be done in parallel.”

To overcome implicit bias, clinicians must acknowledge that many of their beliefs are deeply ingrained, and by no fault of their own. They must also be willing to listen, since data often paints an incomplete picture of a problem.

“I always say that your degrees don’t trump my experience as a Black woman,” says McCullough. “We hear the stories from our friends, parents and grandparents, and you’re not operating in those environments.”

Still, McCullough is hopeful. “I’m fortunate to be at Emory in the School of Public Health and Winship, where the research that we do is well received,” she says. “People believe it, and they want to support it.” w

PREVENTING CANCER Ngoc “Cam” Escoffery, PhD, MPH, is a professor of behavioral, social and health education sciences at Rollins School of Public Health and leads Winship’s Intervention Development, Dissemination and Implementation Shared Resource. She details quite a few current trials and initiatives, with her passion and current research addressing HPV outcomes and vaccination hesitancy.

Escoffery believes that what’s paramount and needs to improve is provider-patient communication. “I work with a lot of chronic diseases,” she

BEFORE IT BEGINS

Cancer centers have developed more care teams, so social workers, nurses and others can level up with patients when they’re not taking medication as prescribed. . . .

Ngoc “Cam” Escoffery

in preventing disease so that people don’t have to get sick and deal with all of the associated consequences,” she explains. That, and a family history of cancer, is the source of her dedication.

The Prevention Research Center works within the community, which is why staff have such insight into the plight of marginalized and rural communities. Many clinical trials are conceived out of what is gleaned from the community. According to Kegler, “We practice community-based participatory research for a bunch of reasons: to

says, “and physicians and care teams

help make sure our research is relevant

have to take time to explain things and

and culturally appropriate, and to help

maybe provide information in ways that

build community ownership, which can

they can understand.”

lead to doing something with results and not just a journal article, which is

She describes how the cancer cen-

what we’re all hoping for.”

ter has taken a team approach to offer

Kegler’s goal is also to eliminate

more care teams,” she says. “So social

behaviors that ultimately cause cancer.

PHOTO BY JACK KEARSE

care. “Cancer centers have developed workers, nurses and others can level up with patients when they’re not taking medication as prescribed or if they need to figure out what the barriers are

“There are more upstream costs of health issues, and they help explain why people engage in behaviors that can ultimately cause cancer, like

Ngoc “Cam” Escoffery

tobacco use, obesity and other things.”

in some of these areas.”

Winship is on a mission to make

Escoffery explains that Winship’s approach has been developed with

cancer treatment equitable and as

Emory’s faculty, since researchers

innovative as possible. That dedication

are busy addressing the factors that

has led to more than 300 trials taking

affect outcomes.

place in 2020 with more than 900 participants. There is no doubt that

One faculty member, Michelle

Winship’s deliberate attempts to recruit

ing to curb and remedy the obesity

and reach the exact people who live in

PHOTO BY KAY HINTON

Kegler, DrPH, MPH, has been workepidemic. Kegler is a professor at Rollins, and she also serves as the director of Emory Prevention Research Center. “I’ve always had an interest

Michelle Kegler

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the community will alter the trajectory and empower the lives of those who must face the “Big C.”

by JOHN-MANUEL ANDRIOTE

Rein Saral, MD, was a new researcher at the National Institutes of Health when President Richard Nixon signed the National Cancer Act (NCA) on Dec. 23, 1971.

At the time, a cancer diagnosis was terrifying—and with good reason. Only Rein Saral

about half of cancer patients survived five years. There simply weren’t many treatment options. Chemotherapy and radiation were promising, but were still blunt instruments, effective in only a small number of cancers.

That’s changed over the ensuing 50 years. With a stroke of the president’s pen, the “war on cancer” was underway. The NCA infused record amounts of federal dollars into research labs around the country—and helped transform cancer prevention, detection, diagnosis, treatment and survivorship.

TODAY, CANCER CAN STILL BE FRIGHTENING. But

for an increasing number of patients, it has become a disease that can be managed—and even cured—through methods that would have seemed unthinkable 50 years ago. Now, the body’s immune system can be harnessed to kill some types of cancer. Blood biomarkers help tailor precise treatment for individual patients. Cutting-edge imaging technology can detect cancer sooner. And aggressive prevention efforts are helping many to avoid cancer altogether.

Most importantly—more cancer patients are living longer. [ Winship Magazine

Winship Cancer Institute of Emory University has helped drive that progress. As Georgia’s NCI-designated Comprehensive Cancer Center, it has led the way on patient care, research and education.

Saral was recruited in 1991 to direct Emory’s Bone Marrow Transplantation Program and has witnessed an “explosion” of new discoveries in the decades since then.

“I think it’s unmatched for any other disease afflicting mankind,” he says, “except, perhaps, some of the vaccine developments we’ve seen here recently.”

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PHOTOS BY: A. WINSHIP CANCER INSTITUTE, B. RICHARD NIXON PRESIDENTIAL LIBRARY AND MUSEUM, C. DR. ELLIOTT WINTON

A

“We only had so many tools in the toolkit,” she recalls.

Currently a professor in Emory’s Department of Surgery, Gillespie, PhD, says that’s changed.

PHOTO BY ANN WATSON

Some centers focus on underserved groups. Winship, for instance, is committed to Georgia’s large African American population. Having an NCI-designated cancer center in Georgia, and in other states, “has really democratized outstanding cancer care for our nation,” says Curran.

Winship first achieved NCI designation in 2009, and subsequent NCI Comprehensive Cancer Center designation in 2017—marking an important milestone in providing research-based cancer treatment and care for the state and region.

“That would not have existed in the state of Georgia if Emory had not had the discipline over many years to overcome the obstacles to get NCI designation,” says Curran.

Walter J. Curran was Winship’s executive director at the time of its 2009 NCI Cancer Center designation and 2017 designation as a Comprehensive Cancer Center.

DEMOCRATIZING OUTSTANDING CANCER CARE The National Cancer Act “really acknowledged that the problem of cancer needs to be tackled in a coordinated, national way,” says Walter J. Curran, MD, Winship’s former executive director. In 1973, the federal government established the first NCI-designated cancer centers in cities around the country.

“There was already an understanding that not only did you need quality, you needed geographic distribution,” he says.

“Now we have so many treatment options,” she says.

We’ve gone from the little bistro that has a one-page menu where there’s one appetizer, one entree, one dessert, and now we have the Cheesecake Factory menu where it’s just page after page.”

Theresa W. Gillespie

WINSHIP’S ROLES IN THE REVOLUTION

PHOTO BY ANN WATSON

Theresa Gillespie, PhD, MA, BSN, FAAN, remembers the funerals.

Starting her career as an inpatient oncology nurse in rural South Carolina, Gillespie says, “I went to a funeral of one of my patients every weekend.”

Theresa W. Gillespie, Winship’s associate director for community outreach and engagement, began her oncology nursing career in rural South Carolina in 1981, before coming to Winship in 1986 and organizing its early clinical trials program.

50 YEARS OF ADVANCES IN THE “WAR ON CANCER”

1971

1985

1979

• President Nixon signs the National Cancer Act on Dec. 23, 1971, effectively launching the “war on cancer.”

It gives new authority to the National Cancer Institute and establishes national cancer research centers and national cancer control programs.

• First bone marrow (stem cell) transplant performed at Emory by Elliott Winton, MD, an associate professor of hematology and medical oncology at Winship Cancer Clinic.

C

B

Advances in surgery as well as imaging and pharmaceutical treatments.

Signing the National Cancer Act, President Richard M. Nixon.

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• The Winship Cancer Clinic is renamed Winship Cancer Center and begins coordinating cancer research and treatment for Emory University Hospital, Crawford Long (now Emory University Hospital Midtown), Grady Hospitals and the Atlanta VA Medical Center.

50 YEARS OF ADVANCES IN THE “WAR ON CANCER” •

• Cancer deaths peak at 215 per 100,000 people and then begin steady decline.

Tamara Mobley survived multiple myeloma and gladly shares her story to encourage others facing the same diagnosis.

“I feel like I am part of a revolution in terms of multiple myeloma, how to treat patients, and it not being a death sentence. Winship treats a lot of multiple myeloma patients, and the doctors on staff that treat multiple myeloma are renowned in the field.”

Tamara Mobley, multiple myeloma survivor

continued

• Winship opens its new 280,000-square-foot, stateof-the-art facility (“Clinic C”) on Emory’s Clifton campus.

1991

A

2003

C

1999

2006

• The center changes its name to Winship Cancer Institute.

D

B

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• NCI selects Emory University and Georgia Tech’s joint research program as one of seven National Centers of Cancer Nanotechnology Excellence.

PHOTOS BY: A. STEPHEN NOWLAND, B. ANN WATSON, C. STEPHEN NOWLAND, D. STEPHEN NOWLAND, E. BRIAN MELTZ, F. JACK KEARSE, G. STEPHEN NOWLAND, H. STEPHEN NOWLAND

Gillespie’s own role in helping to create that menu began when she came to Emory in 1986 to set up a consolidated clinical trials program. She hired clinical research nurses and data managers and developed standard operating procedures so everybody was doing it the same way.

“We work very hard to develop [clinical trials], and accrue patients, and really make a mark,” she says.

“There have been dramatic improvements and advances in cancer because of

PHOTO BY JACK KEARSE

PHOTO BY DR. ELLIOT WINTON

At the Elliot Winton Research Laboratory, scientists continue the pioneering work of its namesake.

contributions from Emory in clinical trials,” says Gillespie, “both investigator-initiated studies as well as contributing to other national trials.” She adds, “That’s a big deal because that’s really how advances are made in terms of patient care.”

Winship has made lifesaving contributions in preventing, detecting and treating cancer. These include demonstrating the effectiveness of biennial fecal occult blood screening that led to a statistically significant reduction in deaths from colorectal cancer; a new method of pediatric screening for neuroblastoma; and developing an amino acid probe that prostate tumor cells take up, allowing for better prostate cancer screening.

In late 2021, Winship’s Bone Marrow and Stem Cell Transplant Center reported it had completed 7,000 transplants, marking the progress since Elliott Winton, MD, performed the first one at Emory 42 years earlier.

“I’ve known from the beginning that if a certain treatment wasn’t working, I didn’t have to fret because there were others that we could test.”

Tamara Mobley, multiple myeloma survivor

POSITIVELY IMPACTING PATIENTS’ LIVES Advances in patient care—new, targeted medications, imaging technologies, radiation and surgical procedures—are the real hallmarks of progress.

Mobley’s doctor, Sagar Lonial, MD, professor and chair of the Department of Hematology and Medical Oncology and Winship’s chief medical officer, is renowned for his pioneering work in treating multiple myeloma. He described some of the giant strides made under the NCA in advancing the research and development of pharmaceutical therapies — drugs, used in combination, that have

transformed the once invariably fatal illness into a manageable chronic condition.

“Back in the seventies,” says Lonial, “the only drugs that were available were alkylating agents like melphalan and cyclophosphamide, and corticosteroids.

That’s pretty much all you had. And the median expected survival for a patient with myeloma was two and a half to three years.”

It’s very different today.

“You fast forward now to 2020, for instance, when we published our 1,000-patient retrospective paper, all treated at Emory, and the median expected survival is 10 years. And that’s with eightyear-old data,” he says.

“You’ve now got nine or 10 different approvals with different drugs and targets to use all throughout the course of a patient’s journey.”

Offering treatment options is reassuring for patients, Mobley says.

During Lung Cancer Awareness Month in November 2021, Suresh S. Ramalingam, MD, Winship’s executive

director and the Roberto C. Goizueta Distinguished Chair for Cancer Research, offered an update from where he stands in the lung cancer pantheon.

“In the United States, deaths related to lung cancer are declining steadily in the past 10 years,” says Ramalingam. “Because of that, we can confidently say that long-term survival is possible even with advanced stages of lung cancer.”

Ramalingam credited investments and research into personalizing therapies, new treatment approaches and immunotherapies to treat lung cancer.

“We now have a platform that positions us well to move to the next higher level by pushing research and care towards improving the outcomes for all patients with lung cancer,” he says.

CHANGING THE PARADIGM TOWARD PATIENT-FOCUSED CARE AND QUALITY OF LIFE In the 1980s, Deborah Watkins Bruner, RN, PhD, Emory’s senior vice president

• Winship earns prestigious cancer center designation from NCI. • Walter J. Curran, Jr., MD, appointed new Winship executive director.

• Winship is first in the U.S. to test new brain tumor drug.

• Winship opens Phase I Clinical Trials Unit.

E

2009

G

2012 2010

2013

• Changed official name to Winship Cancer Institute of Emory University.

• Glenn Family Breast Center established at Winship.

H

F

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PHOTO BY STEPHEN NOWLAND

Deborah Watkins Bruner, Emory’s senior vice president for research, professor and Robert W. Woodruff Chair in Nursing

“When I was named, it was the first time that a nurse and a scientist in the area of patient-reported outcomes was named alongside the legends in chemo prevention and cancer detection. This is recognition that behavioral science, patient-reported outcomes, is valid and important.”

for research, professor and Robert W. Woodruff Chair in Nursing, says clinical trials were focused primarily on gathering morbidity, mortality and physicianreported outcomes.

“It wasn’t even until 1989 that the NCI put out a call for patient-reported outcomes to be measured in clinical trials,” says Bruner.

Bruner was among a group of researchers whose work led to a paradigm shift in the assessment of clinical trial outcomes.

“And now,” she notes, “patient-reported outcomes have become a standard focus of especially large phase 3 clinical trials.”

A presidentially appointed member of the NCI National Cancer Advisory Board, Bruner was recognized in 2021 as one of only 14 scientist “Champions and Changemakers” in cancer prevention and control. While she said she is “extremely honored” to be named, she pointed to a bigger backstory that marks another dimension of progress.

RAISING AWARENESS OF DISPARITIES One thing researchers need is data.

The NCA established population-based registries to count the incidence and mortality numbers needed to figure out who is getting cancer, what stage they are in, how long they have to live and who is dying. Atlanta, Emory specifically, became one of these registries beginning in 1973.

“This is incredibly important,” for knowing how cancer is affecting different subsections of the population, says Otis Webb Brawley, MD. Now the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, Brawley was formerly Winship’s deputy director for cancer control.

Brawley, who co-chaired the US Surgeon General’s Task Force on Cancer Health Disparities, explained that this new data for the first time allowed researchers to recognize how racial,

Deborah Watkins Bruner

continued

• Winship earns elite Comprehensive Cancer Center designation from NCI.

• NCI selects Winship as lead academic participating site in the National Clinical Trials Network.

• New Emory University Hospital Tower welcomes its first cancer patient.

2014

A

2017

C

2018

2016 • The Emory Proton Therapy Center treats its first patient.

• Congress creates Cancer Moonshot initiative to invest in research with the potential to transform cancer care, detection and prevention.

B

D

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PHOTOS BY: A. STEPHEN NOWLAND, B. JACK KEARSE, C. JACK KEARSE, D. JACK KEARSE, E. JACK KEARSE, F. DR. WALLER, G. JACK KEARSE

50 YEARS OF ADVANCES IN THE “WAR ON CANCER” •

GAZING IN THE CRYSTAL BALL Where will the momentum that has built up since passage of the 1971 National Cancer Act take us next? Longer survival and more effective treatments, for one thing.

Lonial expects the near future could hold even more remarkable advances for multiple myeloma patients.

“The new paradigm is using all the tools we have,” he says. “Putting them together in a limited duration treatment so that you can ultimately stop and hopefully will have cured a large number of patients.”

Curran foresees more personalized therapy.

“We’ve already seen a rapid shift to much more individualized plans,” he says, “much more individualized ability to predict the benefit of one therapy over another for patients. I think we’re going

to see, over the next years, not only some new categories of care, as well as diagnosis, but a better ability to sort of work with a patient to say, ‘If we go down path A, we think there’s a one out of three chance of success. If we get on path B, we think it’s one out of two chance,’ and so forth.”

Saral recalls a symposium he attended in 1972, where participants offered predictions for the year 2000. “These were the smartest people in the field that I’d been involved with, and a lot smarter than I was,” he says. “And you know what? Thirty years later, in 2002, every prediction they made was wrong. We had advanced much more rapidly than anyone thought.”

Saral looks back across the decades since the National Cancer Act’s signing, and looks ahead too. “It’s a remarkable story,” he says. “But it’s only the beginning.” w

• NCI awards Winship the prestigious Lung Cancer SPORE grant.

Sagar Lonial, director of the Department of Hematology and Medical Oncology, and Winship’s chief medical officer, is renowned for his pioneering work treating multiple myeloma.

“I love seeing patients that I’ve taken care of, some of them for 22 years. That kind of story was unheard of 20 years ago. But I also remember the ones that didn’t make it to 10 years or didn’t make it to five years.

And that’s the fire that keeps us going every day.”

Sagar Lonial

• Winship multiple myeloma team awarded prestigious center of excellence grant.

• Groundbreaking held for the new Winship at Emory Midtown tower, set to open in 2023.

2019

PHOTO BY ANN WATSON

economic and social disparities factor into patient outcomes.

• Winship treats first lung cancer patient with T-cell receptor therapy.

E

F

2020 2021

2020 • Suresh S. Ramalingam, MD, appointed Winship’s new executive director.

• NCI funds Winshipled study of COVID-19 immune responses in patients with cancer.

G

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WINSHIP’S MIDTOWN TOWER Winship at Emory Midtown took a major step toward revolutionizing cancer care in Georgia and beyond when Emory University Hospital Midtown and Winship Cancer Institute of Emory University on August 26 construction with a traditional topping out ceremony at the site.

When Winship at Emory Midtown opens in 2023, the 450,000-square-foot facility will represent a dream fulfilled. It embodies Winship’s vision of providing personalized care, leading-edge cancer treatment, routine testing and other services at the patient’s own bedside.

Winship Executive Director Suresh S. Ramalingam, MD, FACP, FASCO, in remarks at the event said, “The most advanced scientific teams providing care, all the resources and support staff that are necessary to help patients treat their cancer will happen right at their bedside.” He added, “That’s the transformative care model that’s going to happen in this building —the Winship Way, as we call it.”

The topping out ceremony is a traditional event to mark the placement of the last steel beam at the highest point of a building. In this case, three steel beams—after making their way across Winship’s facilities for faculty, staff and patients to sign them—were lifted by a crane to the top of the new building. The beams were topped by the traditional construction “Christmas tree” to symbolize good luck for the building’s future occupants and continued growth and to celebrate an important achievement. [ Winship Magazine

Also speaking at the topping out event, Dan Owens, CEO of Emory University Hospital Midtown, offered a brief history of the building project. “We had a dream of building a facility for over a decade,” he said. “About four years ago that dream became clear as to what we should build on this campus.” Owens said the vision was a “never seen or imagined” state-of-the-art facility cancer center “that could bring revolutionized cancer care to not only the citizens of Atlanta and the state of Georgia but regionally and internationally.”

To make the dream a reality, Owens said, “obviously we needed money—and a lot of it.” Winship at Emory Midtown is made possible by a generous gift from the Robert W. Woodruff Foundation—the largest ever received by Emory University—of $400 million, with half of it dedicated exclusively for the new cancer care facility in Midtown Atlanta.

Looking back over the two years since breaking ground on Winship at Emory Midtown, Sheryl Bluestein, vice president of operations for Winship at Emory University Hospital Midtown, recounted the many people whose perspectives were sought and included in conceptualizing and designing the futuristic cancer hospital. “More than 200 key stakeholders,” she said, “including frontline staff, physicians, patient and family advisors and so many others, have spent countless hours planning for every element of the tower to ensure the optimal experience for patients and care team.”

With the tower construction well underway, Bluestein said the focus now is on purchasing cutting-edge technology and

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PHOTOS BY: A. JACK KEARSE, B. JACK KEARSE, C. BATSON-COOK CONSTRUCTION CO.

A

celebrated the 17-story building under

B

“We had a dream of building a facility for over a decade. . . a never seen or imagined state-of-the-art facility cancer center that could bring revolutionized cancer care to not only the citizens of Atlanta and the state of Georgia but regionally and internationally.”

Dan Owens, CEO of Emory University Hospital Midtown

furnishings for its interior, as well as recruiting exceptional staff to care for patients in what she called “our new care model, where patients are at the center of our multidisciplinary clinics in a disease-specific care community.”

Lee Williams, project manager for CBRE Healthcare, the company overseeing construction of Winship at Emory Midtown, spoke about the new hospital in terms that folks in the building business don’t always use to describe a project. “I knew this was a special project,” he said.

“I’ve been calling it ‘once-in-a-career.’”

C

He added, “Over the last three years it has exceeded my already high expectations. The level of sustained involvement and engagement by the Emory Winship team and our project team (SOM/May, Batson-Cook) has been remarkable.”

Williams provided a sense of the place Winship at Emory Midtown will occupy in Atlanta and Georgia, and beyond, in an anecdote he shared with the project executive steering committee. In an October 12 meeting that included more than 200 tradesmen and women—held in the loading dock of the Winship at Emory Midtown building—attendees were asked to speak up about anything on their mind related to safety. One worker spoke up [ Winship Magazine

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about the importance of keeping ductwork covered to prevent contamination—something stressed during quality control inspections in health care facilities.

“Usually,” said Williams, “the concern is that the vendors will incur extra cost and time for having to clean the ductwork after it’s installed. This man emphasized that this procedure has extra importance to provide protection for the patients and visitors that will be entering this facility.”

He added, “I’ve not heard a comment like this from boots on the ground in a long time. These men and women know what they’re creating will be special, and are approaching their work every day with care and concern for those that will inhabit Winship at Emory Midtown long after construction is complete.” w

THE TEAM APPROACH

by JERRY GRILLO

Collaboration is the key in attacking head and neck cancer in kids [ Winship Magazine

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PHOTO BY JACK KEARSE

The moment she walked through

PHOTOS BY: CHILDREN’S HEALTHCARE OF ATLANTA

the front door that August day in 2020, Maggie Long could tell something was wrong. It was the mood in the house. “Dark and dreary,” she says. “Heavy.”

Her parents sat there on the couch. “I could tell she’d been crying,” says Long, 17, after seeing her mother’s eyes. “They were like, ‘sit down.’ Then it took Mom a second, but she told me, ‘Your biopsy came back. It’s cancer.”

Long was diagnosed with mucoepidermoid carcinoma, a type of salivary gland cancer. It showed up a few months earlier as a burning bruise on the roof of her mouth, then it took a few biopsies to clarify exactly what was going on, “and it became a high-speed chase after that,” says Long’s mom, Ashleigh Thurman.

“Everything went into motion.”

That’s how they landed in the collaborative care of Winship Cancer Institute’s Head and Neck Oncology Surgery Center at Emory University Hospital Midtown and Children’s Healthcare of Atlanta. Those care centers, along with the Emory Proton Therapy Center, have turned the Atlanta area into a hub for the treatment of rare pediatric head and neck cancers.

“These solid tumor cancers are very unusual in children,” says Kara K. Prickett, MD, a pediatric otolaryngologist at Winship and Children’s and associate professor in Emory University School of Medicine. “That’s where the collaboration between Emory and Children’s is so important – we can bring in experts from the adult world who are used to dealing with these more complex tumors.”

When a patient like Maggie Long shows up in her office, Prickett becomes like a quarterback for the care team­­. Experts from Emory and Children’s form a tumor board and together with the patient’s family develop a treatment plan. They need experts from the adult world in the room.

“There aren’t enough kids with these types of cancers to form a routine protocol treatment, so it requires a multidisciplinary team. The Emory docs who work with adult patients are a big benefit for us and our young patients,” says Winship and Children’s pediatric oncologist Sarah G. Mitchell, MD, an [ Winship Magazine

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MORE COLLABORATIONS

“These solid tumor cancers are very unusual in children.”

Kara Prickett Pediatric otolaryngologist at Children’s and associate professor in Emory University School of Medicine

“There aren’t enough kids with these types of cancers to form a routine protocol treatment, so it requires a multidisciplinary team.”

Sarah Mitchell Children’s pediatric oncologist and assistant professor in Emory University School of Medicine

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PHOTO BY JACK KEARSE

[[ Winship Winship Magazine

“The resources, when you bring them all together, are formidable . . . comprehensive care, because that’s what a lot of these families need.”

PHOTOS BY: CHILDREN’S HEALTHCARE OF ATLANTA

Sarah Mitchell assistant professor in Emory University School of Medicine.

The resources, when you bring them all together, are formidable, she says: radiation oncologists, Children’s surgeons, Emory reconstructive surgeons, psychologists, nutritionists, usually an oncologist like Mitchell or surgeon like Prickett running point, not to mention social workers, school teachers, “comprehensive care, because that’s what a lot of these families need,” Mitchell says.

In Maggie Long’s case, the emphasis was on extensive surgery, which took more than 10 hours. Prickett removed the tumor then, which is typical in this kind of procedure, she gave way to another surgeon, Mark W. El-Deiry, MD, director of Winship’s Head and Neck Surgery Center, where he treats predominantly adult patients.

“You need someone with technical proficiency and expertise in reconstruction,” Prickett says.

El-Deiry played a key role in forming what he calls, “this ad hoc pediatric head and neck cancer center. It began with some forward-thinking oncologists who realized that we could combine all our expertise and knowledge.

It became readily apparent that children who went through that collaborative process were better off in terms of clinical treatment.”

Before the children’s solid tumor program existed, five or six years ago, “a lot of these kids weren’t offered surgery as a treatment because the presumption was that it would be too disfiguring or too compromising,” Prickett says. “They were just treated with chemotherapy and radiation, even if that was not the ideal treatment.”

For patients who do need radiation therapy, the Emory Proton Therapy Center, which opened in 2018, offers a high-tech

treatment option that is particularly important for patients with head and neck cancers.

“Photon therapy reduces the radiation exposure to normal, healthy tissues and organs in the area we treat,” notes Bree Eaton, MD, Winship’s pediatric medical director at the proton center and an assistant professor of radiation oncology at Emory University School of Medicine. “And that reduces side effects, which is really critical when you’re talking about that part of the body, where a lot of tissues and organs are still developing in a child.”

When discussing her treatment plan, Maggie Long was given a choice. She decided against radiation. Fortunately for her, the surgery seems to have done the job.

She had what Prickett describes as, “a relatively simple tumor in a complicated place.”

After Prickett removed the tumor, El-Deiry performed a free tissue reconstruction, surgically removing tissue and blood supply from Long’s left arm and transferring it to her mouth.

“Now she has a cool looking scar on her arm, a tiny scar on her neck, and the roof of her mouth looks better than yours or mine,” says Thurman.

A year after the procedure, Long was immersed in her life, considering going out for the track team at school and charting a new course. She’d always dreamed of working for Disney, an artist designing attractions for their theme parks. Now she wants to be a nurse.

“This whole experience influenced me a lot,” she says while sitting at her drawing table one evening. “I saw how my nurses were. Patient, kind, wonderful, and I thought, ‘This is what I want to do. This is what I need.’” w

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“It became readily apparent that children who went through that collaborative process were better off in terms of clinical treatment.”

Mark El-Deiry Director of the Head and Neck surgery center

“Photon therapy reduces the radiation exposure to normal, healthy tissues and organs in the area we treat.”

Bree Eaton Pediatric medical director at Winship’s proton center and an assistant professor of radiation oncology in Emory University School of Medicine

BETTER OUTCOMES

Around Winship

Hope and Gratitude Inspire ENDOWED CHAIRS AND PROFESSORSHIPS BEHIND EACH ENDOWED PROFESSORSHIP AND CHAIR IS A POWERFUL STORY OF HOPE AND GRATITUDE. Winship in 2021 created

Continuing their father’s legacy Winship Advisory Board members and siblings Ann Reynolds Crouse and Rick Reynolds in 2021 continued their late father Tom Reynolds’ commitment to Winship by elevating the Patricia R. Reynolds Endowment for Sarcoma Research, which Tom Reynolds established in 2008 to honor his late wife, into the Patricia R. Reynolds Professor in

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Kenneth Cardona B

Nabil F. Saba

Sarcoma. Kenneth Cardona, MD, associate chief of surgery for Emory University Hospital Midtown and Sarcoma Disease Team lead for Winship, was named the inaugural holder of the Reynolds Professorship.

“My father was energized by the passion and challenged by the vision that Winship leadership had as to what could happen here at Emory with the proper staffing and resources directed toward a cure,” says Rick Reynolds. “Sarcoma was my dad’s focus, and this led to his participation in the Winship Advisory Board and establishment of the endowment in my mother’s name to create not only awareness of sarcoma but also initiate a higher level of research and staffing.”

Wanting to help other patients “I was awestruck by the care and concern of everyone at Winship,” says former patient Howard Halpern. “Chemo and radiation treatments are no fun, but everyone at Winship was compassionate and caring, and made the ordeal so much more bearable.”

After his successful recovery, Halpern says, [ Winship Magazine

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“It was then time for me to give back. With a recommendation of Winship leaders, and in honor of those who supported us, we have established the Lynne and Howard Halpern Chair in Head and Neck Cancer Research.” Nabil F. Saba, MD, professor of hematology and medical oncology in Emory University School of Medicine, was named the inaugural holder of the Halpern Chair.

“Endowed chairs such as this one,” says Jonathan S. Lewin, MD, Emory University’s executive vice president for health affairs, “are critically important to the success of an academic health center. They allow us to accelerate the pace of breakthrough discoveries that lead to better care and cures, and they offer powerful opportunities to recruit and retain stellar faculty.”

Honoring her physician Brenda Nease, a lifetime member of the Winship Advisory Board, in 2021 donated the requisite $1.5 million to establish the David H. Lawson, MD, Professorship in

PHOTOS BY: A. JACK KEARSE, B. JAVIER DE JESUS, C. BRYAN MELTZ, D. JACK KEARSE

three new endowed professorships, and the stories behind them offer compelling evidence to potential donors of the tremendous impact they can make by using their financial contributions to drive discovery and innovation in the cancer field.

In fact, a single professorship can raise the bar for an entire department. Although a great honor, a Winship professorship or chair is not used as an honorific. Faculty in these endowed positions are among the most active members of our scientific community. They are the scientists most likely to have a profound impact on advancing new knowledge in cancer prevention, early detection, treatment and survivorship.

“Endowed chairs/professorships are critical to support the research efforts of top-notch Winship faculty,” says Suresh S. Ramalingam, MD, holder of the Roberto C. Goizueta Distinguished Chair for Cancer Research in Emory University School of Medicine and Winship’s executive director.

“Our collective aspirations to end cancer as we know it are accelerated through the support of the generous gifts that make the endowed positions possible.”

Around Winship

WHY THEY’RE IMPORTANT AND HOW THEY WORK ENDOWED CHAIRS AND PROFESSORSHIPS provide faculty with the

resources necessary to run their labs and free up more time for research, mentoring students and publishing more research papers.

The endowments, usually $2 million for endowed chairs and $1.5 million for endowed professorships, are typically tarC

David H. Lawson

geted to a research program or disease focus. The chair or professorship recipient receives an annual allocation of funds and a

Cancer Research, named for and honoring Lawson’s more than four decades at Emory with a notable focus on cancer immunology. Nease made the gift in gratitude for Lawson’s care for her after she was diagnosed with breast cancer more than two decades earlier. Says Nease, “I hope future holders of the Lawson Professorship will be encouraged by Dr. Lawson’s example of compassion and commitment to research that makes a difference for those faced with a cancer diagnosis.”

Responding to Nease’s honor, Lawson says, “So much of what Mrs. Nease has done is to try to make Winship a place of healing, not just a place where you go to get your chemo and go home, but a place where there can be some healing of the soul, spirit.” He adds, “There’s a saying, ‘the secret to the care of the patient is in caring for the patient.’ And I think that’s a lot of it. Letting the patients into your heart is a lot of it. It’s important for patients to feel heard and cared about.

I’ve tried to do that. I really do care about what happens to each of my patients.” w

prestigious academic title. They

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benefit Winship by supporting a competitive academic environment and advancing scientific

Endowed chairs and

discoveries that improve the

professorships benefit

lives of cancer patients.

Winship by supporting

Supporting a Winship chair or professorship gives the donor an opportunity to support a cancer researcher whose role is deemed critical to advancing scientific inquiry relevant for understanding the mechanisms and pathways common to many different types of cancer and

a competitive academic environment and advancing scientific discoveries that improve the lives of cancer patients.

developing elegant solutions to what are now intractable problems.

Winship is actively recruiting and striving to retain top talent focused in cancer immunology/immunotherapy, harnessing the immune system to kill cancer; drug discovery, seeking to develop novel compounds and therapeutic combinations to treat cancer more effectively; and bioinformatics, the data collected from research that can provide insight into the underpinnings of disease and expedite the progress of precision medicine with tailored prevention, diagnosis and treatment strategies based on the molecular characteristics of a patient’s unique disease profile.

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Around Winship

Applying Data and Technology to Improve Outcomes

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Ajay Nooka

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Madhusmita Behera

MINING AND MANAGING THE DATA NEEDED FOR ANY CANCER STUDY IS COMPLEX. The clinical and molecular data generated by

Winship’s annual average of 17,000 patients drive more than 300 studies in cancer immunology, prevention and control, cell and molecular biology and discovery and developmental therapeutics.

Winship’s Data and Technology Applications Shared Resource (DATA SR) assists by providing informatics and technological support for studies led by Winship and other Emory investigators.

It is one of 11 core facilities at Winship that provide specialized services and equipment to support research.

“Basically, our core helps researchers gather and manage data,” says Ajay K. Nooka, MD, MPH, medical director of the DATA SR. “It provides them with tools to analyze data, builds databases for them, provides access to additional applications and gathers information from national data sets.” Nooka adds, “Because we’re a shared resource, we can provide our services at a fraction of what outside vendors cost.”

Cancer data services have long been a priority at Winship, one reason the National Cancer Institute designated it a Comprehensive Cancer Center—the only one in Georgia.

Madhusmita Behera, PhD, joined Winship in 2016 as director of what is now the DATA SR. She also serves as the institute’s chief informatics and data officer, a new position aimed at growing technology services to further accelerate cancer research. “Winship is always looking to discover new drugs and treatments for our patients,” says Behera. “By using a shared [ Winship Magazine

resource like ours, researchers can apply data in the right clinical context to help patients live longer.”

The DATA SR’s team of software developers and business and informatics analysts collaborate daily on studies that have local, regional and national impact, including: • Supporting the Winship Lung Cancer SPORE (Specialized Program of Research Excellence), an NCI-funded project to improve outcomes for patients with non-small cell lung cancer.

It is one of four SPORE grants in the U.S. dedicated to lung cancer. Winship’s SPORE grant has its own Biostatistics and Biomedical Informatics Core, which Behera co-leads.

• Developing a human papilloma virus (HPV) web portal linking state immunization coverage in Georgia with sociodemographic data to support collaborative research, provide visuals and information on HPV vaccine uptake and connect HPV-related cancer control groups and organizations around the state.

• Providing technical support for the start up, implementation and effectiveness evaluation of the Winship Tobacco Cessation Program to help cancer patients stop smoking and improve their treatment outcomes.

Nooka himself relies on the DATA SR to study multiple myeloma patients. He recently showed that autologous stem cell transplantation (ASCT) can markedly prolong survival for elderly patients newly diagnosed with multiple myeloma. Although ASCT has been shown to help many younger patients, it typically is not offered to patients 75 and older out of concern for treatment tolerance and safety related to age.

In his study, Nooka found that ASCT can effectively prolong life for elderly patients when they are assessed for transplant eligibility using criteria other than age. His finding was based on data from elderly patients treated at Winship from 2006 to 2016. The average survival rate for these myeloma patients was 80 months.

The data helped Nooka prove that age should not be the sole factor in determining ASCT eligibility for elderly patients.

As Behera notes, “It’s a great example of how the services the DATA SR provides translate into improving patient care.” w

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ILLUSTRATION BY GETTY IMAGES, PHOTOS BY: A. KAY HINTON, B. JACK KEARSE, C. KAY HINTON, D. EMORY RADIOLOGY PHOTOGRAPHER, SCAN PROVIDED BY: DR. DAVID SCHUSTER

by PAM AUCHMUTEY

Around Winship

Better imaging for better prostate treatment outcomes

by SYLVIA WROBEL COMBINING PET AND CT SCANS HAS BEEN A POWERFUL DIAGNOSTIC TOOL FOR MANY CANCERS. But it has not traditionally been as useful for

prostate cancer. That changed, thanks to the addition of a novel radioactive tracer molecule called fluciclovine, invented and developed by Mark M. Goodman, PhD, and a team of researchers at Winship Cancer Institute.

Combination PET/CT scans incorporate both positron emission tomography to detect metabolic differences between cancer and noncancerous cells and computed tomography to detect anatomical differences that can reveal the presence, size and shape of cancer. First used successfully to image brain tumors, fluciclovine in 2016 became the first FDA-approved fluorinated ET radiotracer for prostate cancer staging.

Winship radiation oncologist Ashesh B. Jani, MD, MSEE, FASTRO, the James C. Kennedy Professor in Prostate Cancer, and David M. Schuster, MD, FACR, director of the Division of Nuclear Medicine and Molecular Imaging, wanted to know whether combining this enhanced imaging with conventional imaging could achieve more positive outcomes for men whose disease recurred after their prostate was surgically removed (prostatectomy).

“We knew that conventional imaging was not doing a very good job of detecting recurrent prostate cancer,” says Schuster, “so it made sense that radiotherapy treatments based on that imaging would be handicapped. We wanted to change that.” He explains that since fluciclovine PET/CT more accurately identifies where and how much prostate cancer is in the body after surgery, they (correctly) theorized that patient outcomes would improve by basing newer, more powerful radiotherapy treatments on this newer, more powerful imaging.

Comparing treatment outcomes In 2012, Jani and Schuster designed and headed the $2.2 million EMPIRE-1 (Emory Molecular Prostate Imaging for Radiotherapy Enhancement) clinical trial. It enrolled 165 men whose PSA levels dropped close to zero following surgery but then rose again, indicating that cancerous prostate cells were hiding out somewhere in the body.

One group received radiation therapy based on conventional imaging, using bone and either CT or MRI scans. The other group [ Winship Magazine

D

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Ashesh B. Jani

David M. Schuster

also received radiation therapy based on PET/CT imaging with fluciclovine. After four years, 75.5% of patients in the fluciclovine arm of the study had no evidence of cancer. Only 51.2% of patients whose treatment was guided by conventional imaging were cancer free. What happened? Jani and Schuster say the fluciclovine radiotracer helped clinicians make better decisions about which patient should receive what treatment, and more precisely guided radiation treatment planning.

Fluciclovine helps detect “hot spots” PET/CT imaging with fluciclovine detected “hot spots” in the pelvis that conventional imaging missed. If PET imaging found no, or more limited, uptake in the pelvic lymph nodes than expected, the radiation field could be reduced. If cancerous cells were found outside the pelvis—meaning the disease was already system-wide—treatment could skip radiation therapy, going straight to systemic hormone or chemotherapy and sparing patients unnecessary radiation.

Advanced fluciclovine imaging is now available at most leading medical institutions. At Emory, clinicians go a step further, registering the PET/CT scan with the radiation planning scan so changes can be made in the size of the target volume. “This extra step,” says Jani, “allows us to target the region(s) of prostate cancer more accurately with less possibility of missed areas of cancer.” w | 31 | Spring 2022

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Around Winship

INSPIRING HOPE - Adam Marcus, PhD, Winship 5K Professor Winship Magazine: Where does hope live for this dreadful disease?

Adam Marcus: Hope begins with research. The concept of working in silos, all alone in a

research lab, is long gone. Hope lives in research teams that span multiple disciplines with a clear mission of making a difference in the lives of the patients we serve. These teams will change the way we think about cancer, prevent cancer, diagnose cancer and treat cancer.

WM: How have/will jumps in technology made a difference in thinking about cancer?

AM: In many ways, technology has moved beyond our understanding of the disease. For

example, we can use technology to probe the underlying genomes of single cancer cells in a fast and relatively cost-efficient manner to generate terabytes of data; however, the challenge is figuring out what this all means for the biology of the cancer and most importantly for the patient. A ton of progress has been made in this area but we are probably at the tip of the iceberg on this, with so much more to be done. Going forward, I would envision in the not-too-far future a scenario where the technology and biology fully synergize, allowing us to understand the behavior and genetics of any tumor cell, neighboring non-tumor cells, across multiple points in time and in any specific location in the tumor. Furthermore, understanding how all these different tumor cells work together to ultimately create a tumor/non-tumor cell “system” is on the horizon.

WM: You describe personalized cancer medicine as “the next revolution in cancer treatment.” How is the revolution playing out at Winship?

AM: Clearly this has been a game changer with numerous success stories in the clinic

across different tumor types. It is now becoming even more relevant as we have moved into the age of immunotherapy for cancer treatment. We are now at a critical intersection of figuring out who will respond to immunotherapy, and this will likely take a similar personalized approach.

WM: What are you most excited about in the Marcus Lab these days?

AM: Understanding the genetics of single cells is a major technological advance. Now we

are at a crucial juncture of understanding how those single cells behave, then merging all of this information together. If we can connect the genetics with the behavior of the cancer cell, we have a much more complete data set that will reveal which cancer cells we need to kill, which cancer cells may initiate the cancer, and which cancer cells may spread. This research will take multidisciplinary teams like we have here at Winship to drive this forward and translate it to patient care in a safe and effective manner.

WM: How has being designated the Winship 5K Professor supported your work?

us to conduct high-risk, high-reward research that challenges current paradigms. We have used this information to discover new concepts for treatments, discovered new drugs that we are developing, and new biomarkers for determining which cells are likely to spread. w [ Winship Magazine

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PHOTO BY STEPHEN NOWLAND

AM: The Winship 5K, and more broadly Winship, support for my research has allowed

WOMEN IN WINSHIP BRIDGE GENDER DISPARITIES WOMEN IN WINSHIP WAS FOUNDED IN 2017 to address

ILLUSTRATION BY JASON RAISH

gender disparities in the academic environment and promote women’s career development at Winship. The group is co-led by Kristin Higgins, MD, medical director of radiation oncology of the Emory Clinic and Winship’s disease team lead for lung cancer; Ragi Kudchadkar, MD, chair of Winship’s Protocol Review and Monitoring Committee; and Madhu Behera, PhD, Winship’s chief informatics and data officer.

Women in Winship hosts workshops to support Winship women’s professional development, leadership, communication and negotiation skills. The group also works to increase the number of female invited speakers for Grand Rounds and the Elkin lecture series. From only 33% of Grand Rounds and 13%

[ Winship Magazine

of Elkin lectures given by women in 2019, the group succeeded in increasing the number to 38% of Grand Rounds and 50% of Elkin lectures in 2021. The group also serves as a liaison between the Winship Executive Committee and female faculty members and trainees.

Co-chair Higgins says, “Part of our job is to really represent our women faculty members, scientists, clinicians and trainees, and bring the issues to the forefront with our leaders.” She says the group allows the women to bring up issues that may be hard to talk about on an individual level. “What we can do with our committee is come forward with a unified voice and say, ‘Look, this issue is really hurting our women faculty members, we need to address it.’”

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