Banner MD Anderson Rounds - Spring 2015

A PUBLICATION FOR COMMUNITY PHYSICIANS

SPRING 2015

Serving the children Banner MD Anderson Cancer Center expands to pediatrics

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anner Health and MD Anderson Cancer Center are proud to announce the addition of pediatric cancer care for Arizona’s children. Banner Children’s MD Anderson Cancer Center will open later this year at Cardon Children’s Medical Center and Banner Thunderbird Medical Center. This program will provide a new level of cancer care to Arizona’s children through Banner’s unique affiliation with this worldrenown cancer leader that offers stateof-the art pediatric cancer care through advanced treatment protocols.

Banner Health and MD Anderson first joined forces in 2011 with the opening of Banner MD Anderson Cancer Center in Gilbert. Since that time the program has expanded Radiation Oncology services to Banner Thunderbird and Banner Desert Medical Centers, and will open a radiation treatment program at Banner Boswell Medical Center later this year.

“We are thrilled to extend our relationship with MD Anderson to Arizona’s children,” said Becky Kuhn, Banner’s Arizona East President. “Their pediatric oncology expertise coupled with Banner Children’s current cancer resources will offer Arizona families the comprehensive services needed to face a cancer diagnosis. Another valued benefit will be the development of Banner Children’s MD Anderson Cancer Center as a trusted resource for Arizona’s pediatricians and pediatric specialists,” Kuhn added.

Banner Children’s MD Anderson will offer the same multidisciplinary

We are thrilled to extend our relationship with MD Anderson to Arizona’s children.

—Becky Kuhn, Banner Health’s Arizona East President approach to care pioneered at MD Anderson. Children will receive customized, comprehensive and compassionate care from a team of cancer experts who understand the special needs of young patients and their families.

“MD Anderson’s Children’s Cancer Hospital is one of the largest multidisciplinary pediatric cancer care programs in the nation and we’re committed to one mission — curing cancer in children and young adults,” said Laura Worth, M.D., Pediatrics Professor at MD Anderson. “We’re excited to combine our cancer expertise, research and model of family-centered care with Banner’s outstanding program, physicians and staff to offer innovative, researchdriven therapies and the most advanced childhood cancer

treatments to the children of Arizona.”

A critical component of Banner Children’s MD Anderson Cancer Center will be a stem cell transplant program for children with blood cancers and other blood disorders to be established this year. Stem cell transplants can be used to treat cancers such as leukemia and lymphoma, and certain hereditary blood disorders, by replacing defective or damaged blood cells with new, normal ones.

More information will be available on programs and services as the opening date approaches.

INSIDE 2

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Clinical trials

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Success through innovation Radiation therapy accreditation 3 Stem cell transplantation accreditation 4 Meet the new physicians

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Committed to answers Banner MD Anderson physicians

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Success through innovation Revolutionary technique brings more precise treatment for radiation oncology patients

BY BRIAN SODOMA

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revolutionary new imaging technique for radiation oncology procedures is being evaluated at Banner MD Anderson Cancer Center in Gilbert. The new approach could have a great impact on success rates for certain cancer patients.

The new technique uses 4-D (movie) cone-beam CT imaging guidance software on a linear accelerator to obtain “intra-fraction” images. This allows a physician to see the location of a tumor while delivering radiation treatment.

TARGETED TREATMENT

IMPROVED SUCCESS RATE

Historically, a cone-beam CT scan is taken prior to radiation treatment in order to help a physician position the patient so that the tumor can be accurately targeted. Then, a multi-leaf collimator, or MLC, on the linear accelerator used to deliver the radiation, sculpts the radiation beams to the precise shape of the tumor —with one to twomillimeters accuracy. This image guidance technology helps to successfully guide the beams to the tumor’s location.

But in cancers of the lung, liver and other sites in the abdomen, a tumor’s location can be affected by breathing.

The location can change after the pretreatment image scan, creating a situation where the targeted tumor could be missed and healthy tissues irradiated instead.

“This gives us the ability to collect images while treating instead of only in between treatments, and allows us to determine if there’s been movement,” said Steve Sapareto, Ph.D., director of medical physics for Banner MD Anderson’s Division of Radiation Oncology.

Typically, radiation is delivered during two arcs of the linear accelerator around the patient. These new images taken during the first arc give the physician the opportunity to adjust the location of treatment before the second arc if the image taken during

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SPRING 2015 ROUNDS

the first reveals tumor movement.

Bringing more precision to radiation treatment has dramatically improved the success rate of treatment in some lung cancers, increasing the effectiveness to more than 70 percent of patients, up from less than 20 percent about a decade ago. “We hope this new capability will help even more,” added Sapareto.

This technique has already begun use in Europe and Japan, but is relatively new in America. Banner MD Anderson is one of the first in the country to successfully use the approach on a lung cancer patient.

Physicians are currently evaluating other patients who might benefit from intra-fraction cone beam CT scans.

“We’re putting together protocols and studying this to determine under what situations this is going to be most useful,” Sapareto said.

Radiation therapy accreditation

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ate last year, Banner MD Anderson’s radiation oncology division in Gilbert earned a three-year accreditation from the American College of Radiology (ACR), the gold standard for radiation oncology accreditations.

The distinction came after a yearlong effort where the ACR assessed patient care, treatment and safety, personnel qualifications, facility equipment, quality control procedures and quality assurance programs, among other processes.

“There was really good cooperation between all the major representatives within radiation oncology to show we are meeting the ACR’s standards,” said Sapareto, who himself visited other accredited sites to learn more about best practices.

The findings were submitted to the ACR’s Committee on Radiation Oncology Accreditation and can be accessed by Banner MD Anderson officials to help its division continuously improve.

“In the end this comes down to quality assurance and delivering treatments to patients in the best way possible,” he added.

Editor’s Note: Banner MD Anderson also provides radiation treatment at Banner Desert Medical Center in Mesa and Banner Thunderbird Medical Center in Glendale.

Stem cell transplantation program accreditation recognizes quality, complexity of care Delivering life-saving treatment for patients at Banner MD Anderson Cancer Center

BY MEGHANN FINN SEPULVEDA

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anner MD Anderson Cancer Center in Gilbert was recently awarded FACT (Foundation for the Accreditation of Cellular Therapy) accreditation for autologous stem cell transplants, a complex procedure used to treat blood and bone marrow cancers.

The national recognition is a result of the collaboration, initiation and support from the institution’s hematology oncology and subspecialty physicians, advanced practice professionals, certified nurses and health care leaders, and in partnership with MD Anderson Cancer Center.

ACCREDITATION PREPARATION During the rigorous application process to achieve FACT accreditation, the team at Banner MD Anderson performed approximately 30 stem cell transplants prior to the review since the medical center opened in 2011.

“It’s been three years of relentless, meticulous and challenging, yet incredible work,” said Tomislav Dragovich, division chief of medical oncology and hematology at Banner MD Anderson. “We are extremely proud of the achievements made by our stem cell transplant team led

by Gorgun Akpek, M.D.”

Dr. Tomislav Drogovich

STANDARDS AND GUIDELINES

MULTIDISCIPLINARY APPROACH

FACT is an accrediting agency that focuses on the overall quality of cellular therapy and transplantation.

“There are strict requirements and evidence-based guidelines to meet in order for a cancer center to prepare for an inspection,” Dragovich said. “The accreditation tells providers and payers that we can do it well and safe.”

The process involves a thorough review of the clinical, collection and laboratory procedures and best practices of the stem cell transplant program.

“Our FACT accreditation offers a potentially curative treatment modality for patients with many types of hematologic malignancies and conditions that prove fatal,” said Gorgun Akpek, M.D., director of the stem cell and cellular therapy program at Banner MD Anderson. “We fully adopted MD Anderson’s transplant algorithms, standard operating procedures and guidelines of care.”

FACT site inspectors praised the facility and support from both Banner Health and the partnership with MD Anderson.

Meeting and maintaining guidelines, reporting changes and outcomes and following specific criteria are required to uphold accreditation.

Banner MD Anderson’s stem cell transplant team, comprised of physicians who specialize in transplant, nurses and other medical professionals, were all involved in the application and review process.

The dedicated team is prepared to care for patients who undergo stem cell transplant and may require additional medical care.

“Patients can generally get very sick and need comprehensive inpatient care,” Dragovich said. “There are other supportive specialty departments within the cancer center that are well-equipped to care for transplant patients such as cardiology, intensive care and infection control.”

Stem cell transplant has proven outcomes and is considered a potentially life-saving treatment.

POSITIVE RECOGNITION The accreditation comes at a critical time when more patients are in need of stem cell transplantation. Today, many health insurance plans and government agencies are requiring hospitals to be FACT-accredited for reimbursement.

“We no longer have to turn some of those patients away,” Dragovich said. “Often this is their only hope for a cure.”

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Meet the new physicians

at Banner MD Anderson Cancer Center YERKO BORGHERO, MD

THERESA LIU-DUMLAO, MD

SPECIALTY: Radiation Oncology

SPECIALTY: Medical Oncology

MEDICAL SCHOOL: Pontifical Catholic

MEDICAL SCHOOL: Cebu Institute of

University of Chile, Santiago RESIDENCY: The University of Texas MD Anderson Cancer Center, Houston

Medicine, Philippines RESIDENCY: University of

BOARD CERTIFICATION:

American Board of Radiology LOCATION: Banner Desert

Medical Center

RACHIT KUMAR, MD SPECIALTY: Radiation Oncology MEDICAL SCHOOL: Doctor of

Medicine, University of Arizona, Tucson RESIDENCY: Radiation Oncology, Johns Hopkins University, Baltimore, MD BOARD CERTIFICATION:

American Board of Radiology

Illinois-Chicago, Michael Reese Hospital FELLOWSHIP: Brookdale University Hospital Medical Center, Brooklyn, NY; The University of Texas MD Anderson Cancer Center, Houston BOARD CERTIFICATION: American Board of Internal Medicine, Hematology and Medical Oncology LOCATION: Banner MD Anderson Cancer Center

LOCATION: Banner Thunderbird

Medical Center IVANA DZELETOVIC, MD SPECIALTY: Gastroenterology and

Advanced Endoscopy MEDICAL SCHOOL: Rush Medical College of Rush University, Chicago, IL RESIDENCY: Mayo School of Graduate Medical Education, Mayo Clinic, Scottsdale, AZ FELLOWSHIP: Gastroenterology and Hepatology, Mayo School of Graduate Medical Education, Mayo Clinic, Scottsdale, AZ; Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA BOARD CERTIFICATION: American Board of Internal Medicine, Gastroenterology and Hepatology LOCATION: Banner MD Anderson Cancer Center

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SPRING 2015 ROUNDS

MARGARET MILLER, MD SPECIALTY: Internal Medicine MEDICAL SCHOOL: University of

Virginia School of Medicine, Charlottesville RESIDENCY: University of Virginia Health Sciences Center, Charlottesville BOARD CERTIFICATION: American Board of Internal Medicine LOCATION: Banner MD Anderson Cancer Center

MADAPPA KUNDRANDA, MD, PHD SPECIALTY: Medical Oncology MEDICAL SCHOOL: Meharry Medical

College, Nashville, TN RESIDENCY: Fairview Hospital,

a Cleveland Clinic Hospital, OH FELLOWSHIP: Hematology/Oncology, Mayo School of Graduate Medical Education, Mayo Clinic, Scottsdale, AZ BOARD CERTIFICATION: American Board of Internal Medicine, Medical Oncology LOCATION: Banner MD Anderson Cancer Center

JOSEPH MASHNI, MD SPECIALTY: Surgical Oncology,

Urology

JEFFREY RICHMOND, MD, FACRO

MEDICAL SCHOOL: Loma Linda

SPECIALTY: Radiation Oncology

University School of Medicine, CA RESIDENCY: William Beaumont Hospital, Royal Oak, MI FELLOWSHIP: Urologic Oncology, Memorial Sloan Kettering Cancer Center, New York BOARD CERTIFICATION:

American Board of Urology LOCATION: Banner MD Anderson

Cancer Center

MEDICAL SCHOOL: University of

Michigan, Ann Arbor RESIDENCY: Henry Ford Hospital,

Detroit, MI FELLOWSHIP: Palliative Medicine,

University of Arizona, Tucson BOARD CERTIFICATION: American

Board of Radiology, Radiation Oncology and Palliative Medicine LOCATION: Banner MD Anderson Cancer Center

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Clinical trials

esearch is a fundamental part of how Banner MD Anderson Cancer Center in Gilbert is making a difference in people’s lives through excellent patient care while simultaneously Making Cancer History®. Virtually all of our physicians take part in clinical trials and other studies designed to validate hypotheses, test theories and, ultimately, lead to new treatment protocols.

Below are the clinical trials that are currently being offered at Banner MD Anderson:

BLADDER CANCER

SHERVIN SHERVANI, MD SPECIALTY: Radiation Oncology MEDICAL SCHOOL: Duke University

School of Medicine, Durham, NC RESIDENCY: Internal Medicine, Stanford University Medical Center, Palo Alto, CA; Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston BOARD CERTIFICATION:

American Board of Radiology LOCATION: Banner Thunderbird

Medical Center

• Multi-center Phase 2 Trial of Single-Agent Amrubicin as Second-Line Therapy in Patients with Advanced/Metastatic Refractory Urothelial Carcinoma (NCT01331824)

BREAST CANCER • A Randomized, Phase 2 Study of the Efficacy and Tolerability of Veliparib in Combination with Temozolomide or Veliparib in Combo with Carbo and Paclitaxel vs.

Placebo Plus Carb and Paclitaxal in Subjects with BRCA1 or BRCA2 Mutation and Metastatic Breast Cancer (NCT01506609) • An open-label, phase II, single-arm study of everolimus in combination with letrozole in the treatment of postmenopausal women with estrogen receptor positive metastatic breast cancer (NCT01698918) • A Phase 3 Randomized, Double-Blind Study Of PF-05280014 Plus Paclitaxel Versus Trastuzumab Plus Paclitaxel For The First-Line Treatment Of Patients With HER2-Positive Metastatic Breast Cancer (NCT01989676)

LUNG CANCER

WARREN TSENG, MD SPECIALTY: Surgical Oncology MEDICAL SCHOOL: University of

Kansas, Kansas City RESIDENCY: University of California Davis, Sacramento FELLOWSHIP: Complex and General Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston BOARD CERTIFICATION:

American Board of Surgery LOCATION: Banner MD Anderson Cancer Center

• An Open-Label, Randomized, Phase 3 Trial of Nivolumab Versus Investigator’s Choice Chemotherapy as First-Line Therapy for Stage IV or Recurrent PD-L1+ NonSmall Cell Lung Cancer (CheckMate 026) (NCT02041533) • A Phase II, Multicenter, Single-arm Study of MPDL3280A in Patients with PD-L1-Positive Locally Advanced or Metastatic Non-Small Cell Lung Cancer (NCT01846416)

LYMPHOMA • Phase 3 Frontline Therapy Trial in Patients With Advanced Classical Hodgkin Lymphoma (NCT01712490) • A Study of PCI-32765 (Ibrutinib) in Combination With Either Bendamustine and Rituximab or Rituximab, Cyclophosphamide,

Doxorubicin, Vincristine, and Prednisone in Participants With Previously Treated Indolent Non-Hodgkin Lymphoma (NCT01974440) • Phase III Randomized, Open Label Study of Single Agent Ofatumumab vs Single Agent Rituximab in Follicular Lymphoma Relapsed After Rituximab-Containing Therapy (NCT01200589) • A Multicenter Open-Label, Randomized Phase 1b/2, Study of the Bruton’s Tyrosine Kinase (BTK) Inhibitor, Ibrutinib, in Combination With Lenalidomide, With and Without Rituximab in Subjects With Relapsed or Refractory Diffuse Large B-Cell Lymphoma (NCT02077166)

MELANOMA • A Multi-National, Prospective, Observational Study in Patients With Unresectable or Metastatic Melanoma (NCT01511913)

PANCREATIC CANCER • A Phase 2, Randomized, Multicenter Study of PEGPH20 (PEGylated Recombinant Human Hyaluronidase) Combined with nab-Paclitaxel Plus Gemcitabine Compared With nab-Paclitaxel Plus Gemcitabine in Subjects With Stage IV Previously Untreated Pancreatic Cancer (NCT01839487)

RENAL CELL • A Phase 3, Randomized, Controlled Study of Cabozantinib (XL184) vs Everolimus in Subjects With Metastatic Renal Cell Carcinoma That Has Progressed After Prior VEGFR Tyrosine Kinase Inhibitor Therapy (NCT01865747)

STEM CELL TRANSPLANT • Protocol For A Research Database For Hematopoietic Stem Cell Transplantation, Other Cellular Therapies and Marrow Toxic Injuries (NCT01166009)

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Committed to answers Banner MD Anderson provides full continuum of services

BY KRISTINE BURNETT

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hen the question is cancer, accurate and timely answers are paramount. As a comprehensive cancer prevention, diagnosis and treatment facility, Banner MD Anderson Cancer Center in Gilbert is committed to providing answers, personalized care and, above all, hope. From genetic counseling, screening exams and consults, to caring for all types of cancer, Banner MD Anderson delivers a full continuum of individualized oncology services.

GENETIC COUNSELING AND TESTING Five to 10 percent of cancer is inherited. Since those with a genetic predisposition have a much higher chance of developing cancer, often occurring earlier, more aggressively and being more difficult to treat, early identification is imperative. The Clinical Cancer Genetics Program at Banner MD Anderson is a one-stop genetic counseling, testing, and cancer surveillance and management resource for those with hereditary cancer syndromes.

Persons who may benefit from genetic counseling and, if appropriate, genetic testing include those who have: • Cancer present younger than age 50 • Two or more cancers • Two or more relatives on the same side of the family with the same cancer or cancer syndrome (e.g. breast and ovarian cancer) • A rare cancer (e.g. sarcoma or male breast cancer) • Certain ethnic ties such as Ashkenazi Jewish ancestry (Eastern or Central European) Genetic testing requires a simple blood draw and DNA analysis to identify the presence of a particular cancer-causing gene.

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SPRING 2015 ROUNDS

UNDIAGNOSED BREAST CLINIC An abnormal screening mammogram can leave many lingering questions. The Undiagnosed Breast Clinic at Banner MD Anderson can provide answers by evaluating women with abnormal mammograms or breast lumps quickly, giving a diagnosis within 48 hours.

Patients meet with a physician in the clinic in the morning. All diagnostic tests are performed the same day in the Women’s Imaging Center at Banner MD Anderson, a designated Breast Imaging Center of Excellence by the American College of Radiology. Tests may include a diagnostic mammogram, MRI, ultrasound, biopsy, 3D tomosynthesis or other procedure.

Our dedicated breast radiologists, mammography technologists and breast health specialists use the most advanced imaging technologies available. We leverage digital technology to perform screening and diagnostic mammograms that produce computerized images instead of traditional film, giving physicians a better view and the ability to adjust images at needed.

When the diagnosis is cancer, an appointment with our breast cancer team is arranged within a few days. The team can include a breast surgeon, medical oncologist, radiation oncologist and other support staff working together to create individualized treatment plans. If testing does not show breast cancer, ongoing monitoring may be recommended.

LUNG CANCER SCREENING Despite being the leading cause of cancer death, screening for lung cancer has historically been lacking. With clinical trials suggesting that screening improves lung cancer outcomes, Banner MD Anderson launched a screening program to help identify the cancer early, when it may be easier to treat.

Those who may benefit most from lung cancer screening include: • Individuals between the ages of 55 and 80 adults aged 55 to 80 who have a 30 pack-year smoking history and currently smoke or have quit within the past 15 years. * Calculate pack per year history by multiplying the number of packs smoked in one day by number of years smoking The lung cancer screening includes a non-invasive, low-dose CT scan to identify abnormalities with greater accuracy than a basic chest X-ray. A National Lung Screening trial suggests that more than 80 percent of lung cancers could be cured if detected early. Screening is endorsed by the American Lung Association, American College of Chest Physicians, American Society of Thoracic Surgeons, National Comprehensive Cancer Network and American Cancer Society.

If lung cancer is confirmed, Banner MD Anderson’s new Lung Cancer Clinic delivers multidisciplinary care and treatment from a team of lung care experts.

UNDIAGNOSED HEAD AND NECK CANCER CLINIC A suspicious mass or other abnormality in the head, neck or oral cavity can certainly give patients and physicians reason to pause. To help determine whether these findings or other symptoms commonly associated with head and neck cancer are something to worry about, Banner MD Anderson unveiled an Undiagnosed Head and Neck Cancer Clinic earlier this year.

Those who may benefit most from evaluation by a head and neck cancer specialist include patients with: • A mass or abnormality discovered in the head, neck or oral cavity during a physical exam • Voice hoarseness lasting longer than two weeks • Non-healing lesions in the oral cavity or another abnormality in the oral cavity discovered during a dental exam Findings are presented to a team of head and neck cancer specialists for review and, when appropriate, follow-up testing, evaluation and, if needed, treatment.

REFERRING A PATIENT To refer a patient to Banner MD Anderson for screening, diagnostic, consultation or cancer care services, please contact us.

Call (480) 256-6444 to schedule an appointment for: • Genetic Counseling • Undiagnosed Breast Clinic • Undiagnosed Head and Neck Cancer Clinic Call (480) 543-6900 to schedule an appointment for: • Mammograms • Lung Cancer Screening If you have any other questions, please contact us at (480) 256-6444.

Our Patient Financial Services specialists will assist patients with all insurance and authorization requirements.

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INTRODUCING

Banner MD Anderson PHYSICIANS

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anner MD Anderson Cancer Center physicians are highly specialized in their fields of expertise. In addition to our main facility in Gilbert, Banner MD Anderson provides radiation oncology treatment at Banner Desert Medical Center in Mesa and Banner Thunderbird Medical Center in Glendale.

PATIENT REFERRALS To make a referral to a physician on our staff or contact a member of our medical staff, please call (480) 256-6444.

Banner Thunderbird Radiation Oncology: (602) 865-5445 Banner Desert Radiation Oncology: (480) 412-3808

HEMATOLOGY & MEDICAL ONCOLOGY SECTION Tomislav Dragovich, MD, PhD, Division Chief Rebecca Armendariz, MD Gorgun Akpek, MD, MHS Shakeela Bahadur, MD Jade Homsi, MD H. Uwe Klueppelberg, MD, PhD Madappa Kundranda, MD Theresa Liu-Dumlao, MD Javier Munoz, MD Boris Naraev, MD, PhD Santosh Rao, MD Matthew Ulrickson, MD Klaus Wagner, MD PhD Bryan Wong, MD ONCOLOGY SURGERY SECTION Karen Pitman, MD, Interim Division Chief Julie Billar, MD Stephanie Byrum, MD Mark Gimbel, MD Joseph Mashni, MD Matthew Schlumbrecht, MD, MPH

Thomas Shellenberger, MD Benny Tan, MD Warren Tseng, MD RADIATION ONCOLOGY SECTION Matthew Callister, MD, Medical Director Terence Roberts, MD, Interim Division Chief Yerko Borghero, MD Daniel Chamberlain, MD Emily Grade, MD Rachit Kumar, MD Anna Likhacheva, MD Jeff Richmond, MD Shervin Shirvani, MD DIAGNOSTIC IMAGING SECTION Donald Schomer, MD, Division Chief, CAQ Neuroradiology John Chang, MD, PhD Philippe Lanauze, MD Vilert Loving, MD Harvinder Maan, MD, CAQ Neuroradiology Rizvan Mirza, MD

Susan Passalaqua, MD Andrew Price, MD, CAQ Interventional Radiology Jignesh Patel, MD CRITICAL CARE SECTION Shiva Birdi, MD, Division Chief Jijo John, MD Dean Prater, MD Ravindra Gudavalli, MD INTERNAL MEDICINE SECTION Mary Cianfrocca, DO, Division Chief Shefali Birdi, MD Ivana Dzeletovic, MD Margaret Miller, MD Ronald Servi, DO PATHOLOGY SECTION Kevin McCabe, DO, Division Chief To learn more about our physicians at Banner MD Anderson, please visit BannerMDAnderson.com/OurPhysicians.