LaBahn Pancreatic Cancer Program's Purple Post: Volume 1 Issue 2

PURPLE POST

LaBahn Pancreatic Cancer Program Newsletter VOLUME I, ISSUE 2 | OCTOBER 2021

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@MCWPancreasProgram @MCWPancreasProgram Picture: The Hoan Bridge in Milwaukee lit purple for pancreatic cancer awareness month.

@MCWPancProgram

WELCOME With the changing of the seasons, the MCW LaBahn Pancreatic Cancer program is humming with activity. We remain vigilant and cautiously optimistic that Wisconsin is making progress against COVID. We continue to work tirelessly to care for patients with pancreatic cancer and have been committed to provide uninterrupted care during this time.

Amid the current challenges, we are looking forward to Pancreatic Cancer Awareness month. Throughout November, we have organized an evening lecture series for patients and families which runs the gamut from chemotherapy and surgery to how to manage diet and diabetes. If you live nearby, several restaurants are participating in Giveback Days, where a portion of their proceeds will go towards supporting pancreatic cancer research. You'll have special chances to win prizes like an autographed jersey from a Milwaukee Brewers player.

Inside this edition, we highlight Ms. Annie Nichols, a pancreatic cancer survivor, whose faith supported her through her treatment. In our Team Member Spotlight, we feature Dr. Kersting, a health psychologist who specializes in the care of cancer patients. Finally, ongoing program research is highlighted, including a glimpse into the exciting work of Dr. Gwen Lomberk, who focuses on epigenetic changes in pancreatic cancer as well as a summary of recent national presentations from our program. I hope that you will enjoy catching up with all that is going on in our program and encourage you to join us in November for our Pancreatic Cancer Awareness events.

Sincerely, Susan Tsai, MD, MHS Director, LaBahn Pancreatic Cancer Program

IN THIS ISSUE: 2 Awareness Action Items 3 Upcoming Events 4 Patient Profile 4 Faculty and Staff Honors 5 Team Member Spotlight 6 Lomberk Research Laboratory 7 Nationally Presented Research

Purple Post Purple Post Newsletter is a quarterly publication by the LaBahn Pancreatic Cancer Program to provide patients, family, and loved ones with informative and current topics at the Medical College of Wisconsin.

Art + Production Lori Keiser, BS, MA Melissa Mena, BS, CCRC Editing Beth Krzywda, APNP

Pancreatic Cancer Awareness Month

Five Ways to Take Action for Pancreatic Cancer Awareness Month Wear purple on World Pancreatic Cancer Day, November 18, 2021

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LaBahn Pancreatic Cancer Program Director Susan Tsai, MD, MHS LaBahn Pancreatic Cancer Program 8701 W Watertown Plank Rd Wauwatosa, WI 53226 mcwpancreas@mcw.edu © Copyright 2021 LaBahn Pancreatic Cancer Program All rights reserved. No part of this publication may be reproduced by any means, prints, electronic, or any other, without prior written permission of the publisher.

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mcwpancreas@mcw.edu or 414955-1423.

Facebook | Instagram: @MCWPancreasProgram Twitter: @MCWPancProgram

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Donate to support pancreatic cancer research

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Contact members of congress and ask them to fund pancreatic cancer research

For questions, comments, or to submit an idea for an upcoming newsletter, please contact us at

Share photos of yourself wearing purple on social media and tag us!

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Join any or all of our events featured on the following page Purple Post| Volume I, Issue 2 | Page 2

EVENINGS WITH EXPERTS- VIRTUAL LECTURE SERIES

Virtual

Join each night to learn about pancreatic cancer and have a little fun with the chance to win a $25 gift card at the end of each presentation.

NOV 1 | 5:00PM - 6:00 PM CST

NOV 8| 5:00PM - 6:00 PM CST

NOV 15| 5:00PM - 6:00 PM CST

NOV 2 | 5:00PM - 6:00 PM CST

NOV 9| 5:00PM - 6:00 PM CST

NOV 16 | 5:00PM - 6:00 PM CST

NOV 3 | 5:00PM - 6:00 PM CST

17 | 5:00PM - 6:00 PM CST NOV 10 | 5:00PM - 6:00 PM CST NOV Karen Kersting, PhD, LCP: Self-care

Susan Tsai, MD: Pancreatic Cancer Staging and What to Expect After Surgery

Douglas Evans, MD: Hope and A Plan

Ben George, MD: Incorporation of Precision Medicine in Systemic Therapy for Pancreatic Cancer

NOV 4 | 5:00PM - 6:00 PM CST Parag Tolat, MD: pancreas cancer Imaging: What we look for

Amanda Jacquart, CGC: Genetic Testing in Pancreatic Cancer

Zach Smith, DO: Understanding the Role of Endoscopic Interventions in Pancreatic Cancer Beth Erickson, MD: Radiation Therapy for pancreatic cancer

NOV 11 | 5:00PM - 6:00 PM CST Douglas Evans, MD: How to Contribute to Pancreatic Cancer Research

Olivia Cassiday DNP, APNP: The ABCs of Diabetes Management

Michele Derdzinski, RD: Nutritional Challenges in Pancreatic Cancer

and Emotional Wellness in Pancreatic Cancer Patients

NOV 18 | 5:00PM - 6:00 PM CST Susan Tsai, MD: What's on the Horizon for Pancreatic Cancer Research

Register: bit.ly/NovPanc | Lecture series co-sponsored by the Seena Magowitz Foundation

Join us for good eats and a chance to support pancreatic cancer research. The following restaurants have graciously agreed to donate a portion of the proceeds from sales during a giveback event.

Vendor EVENTS

Date: November 6th

Date: November 10th

Locations: Brookfield, Milwaukee

Locations: Brookfield, Greenfield, Waukesha

Time: 8:00 AM - 3:00 PM

Time: 4:00 PM - 10:00 PM

10% of proceeds from dine-in, online, and

20% of proceeds from dine-in, carryout, or

delivery orders will be donated to MCW

delivery when you mention this fundraiser.

Online orders use code FUNDMCW21

Social Media EVENTS

Like & follow our social media pages for a chance to win prizes like an autographed basketball from Jrue Holiday and so much more!

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PATIENT FEATURE: Meet Annie Nichols One Saturday in March of 2018, Annie headed to church, but wasn’t feeling like her normal self. Her friends were concerned and even noticed she was not drinking her daily tea. The next week she decided to make an appointment to see her doctor who noticed that her eyes were yellow. Medical testing was started and the next day, Annie got a call telling her she needed to go to the hospital.

Once admitted, additional testing lead to the diagnosis of pancreatic cancer.

At the time of her diagnosis, Annie was the primary caregiver for both her mom and younger brother. She had to adjust from being the one taking care of others to the one needing care. Her cousin came to stay with her and to help take care of both Annie and her family. She shared it was a little difficult to make that transition, but was very grateful for the support during her treatment.

Annie can’t say enough good things about her clinical team. She distinctly remembers her surgeon, saying “I’m going to take very good care of you,” when they first met. Annie appreciated that her surgeon would take the time to check on her in the hospital in the morning and again in the evening. Along with her medical team, Annie credits her faith in God for keeping her positive throughout her cancer journey. She says she never got upset, prayed a lot, and knew “she had the good Lord on her side.”

It has been three years since Annie's surgery and treatment for pancreatic cancer. She spends her days helping her brothers and staying active with her church family. She wants other patients to know that staying positive and having a good attitude really makes a difference.

Distinguished Honors & Awards

Douglas Evans, MD was selected as the 2021 Honorary Member of The American Society for Radiation Oncology (ASTRO). This is the highest accolade that this organization bestows upon distinguished physicians and researchers in disciplines other than radiation oncology, radiation physics, and radiobiology.

Kulwinder Dua, MD, DMSc, FRCP (Edinburgh), FACP, FRCP (London), was selected by the American Society of Gastrointestinal Endoscopy as one of the 65 best endoscopists in the world. He was also inducted into the inaugural class Masters of the American Society of Gastrointestinal Endoscopy, ASGE: MASGE. Purple Post | Volume 1, Issue 2 | Page 4

Team Member Spotlight Karen Kersting, PhD Health Psychologist I’m Karen Kersting, a licensed psychologist and faculty member in the Division of Surgical Oncology. In my clinical work, I provide psychotherapy and behavioral health interventions to patients. Total wellness encompasses both physical and mental wellbeing. Like any psychologist, I work with patients on issues around anxiety and depression, but, as a health psychologist specializing in cancer care, I also help people cope with the unique stressors related to going through treatment for a serious health Karen Kersting, Ph.D. Assistant Professor/Clinical Psychologist

problem.

I work with patients when behavioral issues arise like difficulties with sleep and eating. I work with patients on maintaining positive communication and collaborative relationships with all the people in their life, providers, family, and friends. And I help patients find ways to incorporate relaxing and joyful activities activities into their lives during their treatment. In a typical first session with me, I will ask questions about your activities and social connections, learn how you’ve coped with your diagnosis and treatment so far, screen for struggles with mood and excessive worry, and work with you to decide if ongoing or intermittent psychotherapy would be helpful and what our goals would be. Sometimes I meet with patients who are already coping incredibly well and don’t need my support; in these cases, it is my great pleasure to celebrate that success and offer an open door for further support as needed. In other cases, I provide ongoing support by developing a treatment plan for anxiety or depression, engaging in problem solving with patients, or teaching strategies for integrating mindfulness into daily life. At times, this may include planning on how to cope with recovery from surgery - almost like a coach!

It has been a particular privilege to work closely with pancreatic cancer patients and learn about the unique challenges they face in moving through treatment. Through this work I’ve developed tailored strategies that have been helpful to a range of patients, and I am able to bring this familiarity into my work with new patients. But I also cherish the variety of experience among pancreatic patients and focus on what matter most to each individual.

I grew up in Wauwatosa and was happy to return to the area after graduate school in Virginia and a post-doctoral fellowship in Ohio.

Now, I live in Milwaukee with my husband and two-year-old son, Gus. We enjoy biking around the area and are heavily involved in our

OU KNOW? DID Y Evidence from randomized trials shows that psychological interventions in cancer patients with distress may lead to a survival advantage over those who do not receive psychosocial care.

National Comprehensive Cancer Network.

Distress Management (Version 1.2019)

neighborhood association – when we’re not chasing after Gus!

For more information or to make an appointment with Dr. Kersting, please contact your surgical team for a referral.

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Scientific Investigator highlight: Lomberk Research Laboratory Pancreatic cancer remains a challenge to treat, making the identification of new targets and development of novel treatment strategies of paramount importance to help patients. The long-term goal in the Lomberk laboratory has been to uncover windows of opportunity leading to novel targets and treatment approaches for pancreatic cancer. Our most recent work focuses on vulnerabilities that occur each time a cancer cell divides. All cells are equipped with machinery to duplicate or replicate their DNA (genome). Cancer cells have driving forces to make this machinery work harder and more frequently, which is one reason why cancer cells proliferate in number more rapidly than normal cells. A common driving force behind this in pancreatic cancer is the abnormal activation of the protein KRAS. As a result of this frequent accelerated DNA replication, the machinery in charge

Gwen Lomberk, PhD Joel and Arlene Chair in Pancreatic Cancer Research

of this process starts making mistakes or accidentally collides with other

Director, Basic Science Research

complexes that are transcribing the information contained within our genome.

Department of Surgery

These mistakes and accidents during DNA replication lead to signals of stress within the cell, known as replication stress. A normal cell would respond to replication stress by pausing to repair the problem or if the error is severe enough,

Associate Professor of Surgery and Pharmacology & Toxicity Leader, Precision Oncology Initiative, Cancer Center

enter a program of cell death. However, cancer cells find devious ways to compensate for these stress signals and continue dividing at rapid rates. Notably, DNA does not exist in the nucleus of the cell on its own, rather it gets packaged by wrapping around proteins to form chromatin, which we refer to as the epigenome. So, when DNA replicates, our epigenome also needs to duplicate at the same moment to package the newly made DNA appropriately.

The current studies in our lab are centered on better understanding this process. Our experiments have found that tolerance of replication stress when abnormal activation of KRAS is present in the cell is sustained by one regulator of the epigenome, called G9a. We hypothesize that if we target the G9a epigenomic regulator, we can interrupt this compensation of KRAS-driven replication stress and ultimately destroy the cancer cell.

Furthermore, we can enhance the effectiveness of this approach by increasing the levels of replication stress using pharmacological agents available for this specific purpose. Together, the combined targeting of the epigenomic regulator and a modulator of replication stress represents a previously unrecognized vulnerability for pancreatic cancer cells. Our sincere hope is that we can harness this knowledge to provide potential future avenues for much-needed, novel treatments to improve the lives of pancreatic cancer patients.

Laboratory Members: From Left: Lishu He (Pharmacology & Toxicology graduate student), Madeline Dzikowski (Pharmacology & Toxicology graduate student), Guillermo Urrutia, MD (Research Associate II), Gwen Lomberk (Principal Investigator), Daniela Oliveira, PhD (Postdoctoral Fellow), Ann Salmonson (Lab Manager), Anju Thomas, PhD (Research Associate I) Purple Post | Volume I, Issue 2 | Page 6

Research Presented at National Conference Physicians at the LaBahn Pancreatic Cancer Program work with surgical fellows and residents on cutting-edge research for the treatment of pancreatic cancer.

Several exciting projects were recently shared at the international Americas Hepato-Pancreato-Biliary Association (AHPBA) 2021 meeting. The AHPBA is the largest international organization of surgeons with the purpose of improving the care of patients with diseases of the liver and pancreas. There is always an interest in the work being done at the Medical College of Wisconsin and specifically, the LaBahn Pancreatic Cancer Program at these meetings.

Some of the highlights include:

Sam Thalji, MD (General Surgery resident) presented a study on evaluating tumor response to chemotherapy for patients with pancreatic cancer. The goal for patients treated at MCW is to receive four months of chemotherapy prior to radiation and surgery. The tumor’s response to therapy is evaluated at multiple time points along the treatment process. The study focused on a pancreatic tumor marker called CA19-9.

In many patients with pancreas cancer, CA 19-9 levels are elevated. In this study, CA 19-9 levels that declined during treatment were seen in patients with more controlled disease. The findings in this study show the importance of following the CA19-9 trends during treatment.

This information may be used to help design the best treatment plans for each individual patient.

Ben Seadler, MD (General Surgery resident) and Osamu Yoshino, MD (Surgical Oncology fellow) presented a study on patients with pancreatic cancer who have tumor involvement of the major arteries in the abdomen.

These patients require complex operations that are performed only at expert centers like the Medical College of Wisconsin. When the tumor involves important arteries, the surgeon may be able to carefully dissect the tumor away from the artery. If this is not possible, the artery may have to be removed and then replaced. The study examined nearly 100 patients treated with these advanced operations at the Medical College of Wisconsin. The data showed that these operations are both safe and effective for the treatment of advanced pancreatic cancer.

Erin Ward, MD (Surgical Oncology fellow) presented a study on the use of radiation treatment prior to surgery for pancreatic cancer. Patients who received chemotherapy and radiation prior to surgery at the Medical College of Wisconsin were compared to patients who received just chemotherapy (without radiation) at other institutes. Patients who received radiation prior to surgery experienced a higher rate of complete microscopic resection of the pancreas cancer and had lower rates of cancer present in lymph nodes. Over time, patients who received radiation prior to surgery had lower rates of disease recurrence at the site of surgery. The study provides evidence that the use of radiation prior to surgery for pancreatic cancer has important benefits.

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LaBahn Pancreatic Cancer Program Medical College of Wisconsin Division of Surgical Oncology 8701 Watertown Plank Rd. Milwaukee, WI 53226

NOVEMBER IS PANCREATIC CANCER AWARENESS MONTH

LaBahn Pancreatic Cancer Program Newsletter

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