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St. Jude Physician Leading Study, continued from page 1 Per the American Cancer Society, PD-1 inhibitors are being used to treat melanoma, non-small cell lung cancer, kidney cancer, bladder cancer, head and neck cancers, and Hodgkin lymphoma. Whereas PD-L1 inhibitors like avelumab, atezolizumab or durvalumab are currently being prescribed for treating bladder cancer, non-small cell lung cancer and Merkel cell skin cancer. The success of immune checkpoint inhibitors in adults with various cancers with high rates of mutations “provided some interest for us in treating our patients” said Bishop about the study at St. Jude, as osteosarcoma is one of the most highly mutated pediatric tumors. This new class of treatment has shown promise in adults especially when combined with other checkpoint inhibitors with different targets such as CTLA-4. The use of immune checkpoint inhibitors is relatively new in pediatric oncology said Bishop, and studies like the avelumab phase two

Michael Bishop

research study provide a window into the possibilities for children with recurring osteosarcoma. But, the immune checkpoint inhibitors can lead to the immune system attacking non-cancerous cells and serious side effects like nausea or issues with organs like the lungs. Even though the drug

is approved by the FDA for treating adults with certain cancers, there are less data on toxicity in children and quality of life concerns. Bishop is monitoring the quality of life and side effects of avelumab in the trial at St. Jude by having patients complete questionnaires about physical and emotional wellbeing throughout the study. The trial also includes several correlative biology studies developed in conjunction with St. Jude Immunology members. These include looking at expression of certain markers on tumor cells, as well as markers of “exhaustion” on T cells related to chronic antigen exposure and the likelihood of tumors to respond based on their presence. Bishop hopes that these studies will improve our understanding of the use of immune checkpoint inhibitors by making “novel insights on how the interplay between tumor and immune system impact the ability to generate a response to these types of therapies.” Physicians at St. Jude are studying the

response of the tumors and the length of time patients are receiving the drug without tumor growth. For the trial, St. Jude is studying patients ages 12 or older with measurable recurrent or progressive osteosarcoma. St. Jude is hoping to recruit 32 patients in total over the course of this three-year trial. Every two weeks, patients are treated with avelumab and evaluated by imaging at 8 weeks, 16 weeks and then every 12 weeks following. Currently, St. Jude is the only hospital testing avelumab in adolescents and young adults, but Texas Children’s Hospital, Memorial Sloan Kettering and Children’s Hospital of Los Angeles will be opening this trial soon. While it’s too early to tell if the immune checkpoint inhibitor avelumab will be useful for children with osteosarcoma and potentially other cancers, it is hopeful to have a potential treatment for the recurrence of the most common type of pediatric bone cancer.

Memphis VA’s New Director Makes a Return to His Roots, continued from page 1 of patient care, long wait times to see doctors and understaffed and aging campuses. But Dunning accepted the job fully aware of the criticisms and stresses faced in Memphis and elsewhere, and they have strengthened his resolve to improve the welfare of veterans. Dunning believes his military background provides an insider’s advantage that will aid in accomplishing the task. “I’m a veteran of 30 years, and while I can’t share all the experiences of every veteran who comes to the VA, I do have a valuable context to draw upon because I’ve been there,” he said. “I have three decades of military experience that help me understand where they’re coming from, and I understand their issues.” Those issues are complex and numerous. The Memphis VA serves nearly 200,000 veterans from Memphis and 53 counties in West Tennessee, North Mississippi and Northeast Arkansas. Dunning is determined to elevate the healthcare experience for all those served by the institution. “The Memphis VA is similar to places I’ve worked in the past, and I’m convinced that as good as I believe the care is here – and it is very good – we can get even better,” he said. “Memphis has true potential to be a national leader among VA centers, and we’re committed to realizing that vision.” Dunning leads a new executive team that he said initially will be focused on improving access and quality of care, increasing patient safety and meeting and exceeding veterans’ and employees’ expectations. Now that a permanent team is in place, he is confident that stability from leadership will generate better and standardized care across the board. “We have tremendous support from the VA central office and the Mid-South district to carry out this mission,” he said. “We’re short on people and we’re working to recruit highly qualified personnel and 4


JUNE 2017

make this a better place for healthcare professionals already in place. “I’m also making it a priority to walk around the campus and talk to veterans and employees to find out what they need. The best way to find out how we can improve is to speak directly to the patients receiving care and the people providing services.” In addition to services and experiences inside the VA, Dunning said plans are in place to address parking problems, which he admits aren’t unique to his facility. “Parking is a huge dissatisfier, but you can’t ignore it just because every other healthcare facility suffers from similar situations,” he said. “We’re working to eliminate some of those headaches. Our ER renovation should be complete soon, and that will open up several dozen spaces that have been blocked. When the north tower renovation is complete, that also will help overcrowded parking.” On the facility’s west side, construction on a new three-level parking garage will begin once funding has been awarded later this year. The two-year project likely will get under way in 2018. The garage will be built over an existing parking lot, resulting in 315 total spaces. Also in the works is a plan to reconfigure the interior spaces where veterans access patient services. The current diagram can be confusing and frustrating, Dunning said, but that will change. “Our goal is to re-create the VA as a state-of-the-art facility, and part of that strategic plan includes taking a hard look at the halls and walls,” he said. “We want to offer a seamless and easy experience for our veterans rather than requiring them to walk all over the building. I’d like to see a one-stop shop in the lobby that streamlines the process and makes it more efficient and less cumbersome for everyone.” Dunning is also excited about the VA’s partnership with the University of Tennessee Health Science Center, and he looks forward to working closely with UTHSC

officials to build the VA’s residency program and produce more medical professionals. “The VA does not stand alone in this community,” he said. “Our strength comes from collaborating with existing ties within our community.” When Dunning says “our community,” he indicates an investment in an area he has called home for his entire life. A Memphian by birth – his family lived in Somerville, but he was born at the old Baptist Hospital in the Downtown Memphis medical district – Dunning has two brothers who attended the former Memphis State University, and he still counts family members here. After spending his first three years in West Tennessee, Dunning moved with his parents to Columbia, Tennessee, and lived there several years before the family relocated to Syracuse, New York. He spent his teen years there before being awarded an ROTC scholarship that led him to Greenville, South Carolina, where he studied at Furman University, and earned a bache-

lor’s degree in political science. He earned a master’s degree in public administration from the University of Missouri at Kansas City and a master’s degree in strategic studies from the U.S. Army War College. His professional experience includes an internship at Walter Reed National Medical Center, a couple of years as a military consultant in Saudi Arabia and medical administrative posts in Germany, Hawaii, Kansas, Louisiana, North Carolina and Texas. And through 13 career moves in 19 years, Dunning always considered Memphis a part of him. After completing 30 years of military service, he looked for opportunities to continue serving, and the Memphis VA seemed to be a perfect fit. “Although this is the first time I’ve actually lived in Memphis, I’ve visited family here off and on my entire life and I’m very familiar with the city,” Dunning said. “My wife is so excited for us to move here that we call this our forever home. This is where we plan to stay.”

A Mind for Research, continued from page 2 During her residency, Mariencheck was exposed to both medical and cosmetic dermatology but her interest remained on the clinical side. While it has been over 20 years since she was a resident, she says skin cancer and skin diseases are still the predominant issues she treats in her practice. “We are a lot more aware of skin cancer and the risks of tanning bed use today than when I was a resident,” said Mariencheck. “Most of my skin cancer patients are getting younger. I now see basal cell carcinoma in patients under the age of 30, and almost all of them are those who have used tanning beds. Genetics can also play a role as well as sun exposure, but whether it runs in your family or not, you can control sun exposure and avoid tanning beds.” Advances in the treatment of skin

disease, such as psoriasis and eczema, has been one of the most significant changes Mariencheck has seen over the years. “Many skin diseases have been found to have an auto immune basis and using injections of biologic treatments has been found to be quite effective,” she said. While this accomplished dermatologist may have gotten her degrees in the big city, her heart remains a small-town girl’s who still enjoys the simple things. With both girls in college at Washington University, she and Bill enjoy running, cooking and hiking in the Appalachian Mountains in North Carolina. Family is also at the top of her list. Her mother makes her home with the Marienchecks during the summer months and they all love time at the beach whenever they can. westtnmedicalnews


June 2017 WTMN  

West TN Medical News June 2017

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