2020 Volume I
Wilmot Cancer Institute | University of Rochester Medical Center
RESEARCH AT WILMOT
LETTER FROM THE DIRECTOR Hello Friends of Wilmot Cancer Institute,
Jonathan W. Friedberg, M.D., M.M.Sc. Director, Wilmot Cancer Institute
While the COVID pandemic has brought many challenges, it has also brought the opportunity for the teams at Wilmot Cancer Institute to demonstrate their ingenuity, resilience and compassion. Many of us chose medicine for times like these, and I’m proud of how quickly our clinical teams mobilized to ensure the safety of our patients and colleagues. As COVID reached our region, our nurses volunteered to begin screening patients as they entered our facilities, and many were reassigned to other parts of the hospital to help care for COVID patients. We had a multidisciplinary team immediately begin evaluating how best to modify our operations to ensure everyone’s safety. Wilmot’s scientists took unprecedented steps to wind down their laboratories to help prevent the spread of COVID, and they offered their supplies of masks, gloves and other personal protective equipment to help clinical colleagues across the medical center. Our administrative teams helped equip and transition staff to work from home. Our schedulers and front-end staff began helping physicians and patients alike shift to telemedicine, and our Environmental Services teams have been working non-stop to ensure that high-touch surfaces and patient areas are kept clean and disinfected. Through all of this disruption, we have stayed true to our mission to provide high-quality cancer care and services to our region. We have not lost sight of the importance of cancer research, and in this issue, you can read about our latest class of early-career scientists. We have also kept our momentum in preparing to apply for National Cancer Institute designation. We still have work to do, but we have a clear path forward that includes continued investment in our education programs and in our Community Outreach and Engagement efforts. We have reaffirmed our commitment to eradicating cancer disparities in our region and ensuring that every member of our community gets the screening and care they need. Paula Cupertino, Ph.D., our new Associate Director for Community Outreach, Engagement and Disparities, will lead these efforts, and you can read more about her and her vision on Page 12. I have never been more proud to be a part of Wilmot, and I am truly grateful for your support, especially during these uncertain times.
Jonathan W. Friedberg, M.D., M.M.Sc. Director, Wilmot Cancer Institute
On the Cover
Isaac Harris, Ph.D., is among the latest scientific recruits at Wilmot Cancer Institute. Photo by Matt Wittmeyer The Wilmot Cancer Institute is a component of Strong Memorial Hospital.
Wilmot Cancer Institute Advisory Board Members, 2019-2020 Richard Yates, Chair Richard “Dick” Bell Elaine Bucci Scott Burdett Rina Chessin Patrick Cunningham Malik Evans Kathleen Landers Michael Linehan Jett Mehta Carol Mullin Ralph Olney Doug Parker Walter Parkes Mary Pluta Ronald Pluta Barbara Pluta-Randall
Cheryl Pohlman Donald Rhoda Erika Stanat Dr. Eduardo Torrado Steve Whitman Paul Wilmot Keith Yeates John Zicari Faculty Members Yuhchyau Chen, M.D., Ph.D. Aram Hezel, M.D. Gary Morrow, Ph.D., MS Christian Peyre, M.D. Paula Vertino, Ph.D. Emeritus Members Judy Linehan Jim Ryan, Jr.
Ex-Officio Members Kellie Anderson Jonathan W. Friedberg, M.D. Hucky Land, Ph.D. David Linehan, M.D. Mark Taubman, M.D. Honorary Board Members Dr. George Abraham Michael Buckley Elaine Del Monte Richard DiMarzo Joan Feinbloom Janet Felosky James Hammer Paul Hanrahan Gary Haseley Sandra Hawks Lloyd Mark Kokanovich Alyssa Lozipone Ronald Maggio
Steve McCluski Michael Norris Jeffrey Pierce Larry Rabinowitz Gregory Smith Philip Wehrheim Timothy W. Williams Colleen Wilmot Dennis Wilmot Timothy P. Wilmot Thomas Wilmot Bruce Zicari II
Editor / Writer Lydia Fernandez (585) 276-5788 Contributing Writers Leslie Orr Art Director / Designer Kathy Mannix Brittany Colton Feature Photography Matt Wittmeyer
CONTENTS COVER STORY
Fresh Faces, New Energy Young scientists bring urgency and the latest skills in parsing technology, big data, genomics and bioinformatics to Wilmot’s research programs.
2020 Volume I
12 Driving Momentum for Change As Wilmot’s first-ever Associate Director of Community Outreach, Engagement and Disparities, Paula Cupertino, Ph.D., is leading efforts to improve cancer outcomes in communities across upstate New York.
16 Moving Forward in MDS A team of Wilmot researchers is translating their science from the lab into a clinical trial that is now benefitting patients.
18 Building on Success CAR T-cell therapy is showing more promise than ever in treating blood cancers, and Wilmot’s team is helping to lead progress with this immunotherapy.
Navigating Telemedicine in Cancer Care Cancer Researchers Pivot to Tackle COVID-19 News Briefs
Wilmot Cancer Institute
Transforming Research at Wilmot Some of them are homegrown; others hail from as far away as the crowded streets of India and the island of Corsica in the Mediterranean Sea. All of them, incredibly talented, grabbed an opportunity at the University of Rochester, entering positions as independent investigators on a tenure track. Whatever their roots, they are in Rochester now as part of a team that pledges to defeat cancer. In recent years, leadership at the Wilmot Cancer Institute went on a recruitment spree to draw young talent from top institutions around the world and establish a new generation of wunderkinds. They enlisted bright minds from MIT and Harvard in the Northeast, Stanford and Utah out West, and many places in between. They built an extraordinary class of junior faculty with interests and expertise to complement Wilmot’s strengths. The investigators — nearly all of them are Millennials — also brought the latest skills in parsing technology, big data, genomics and bioinformatics. Hucky Land, Ph.D., Wilmot’s deputy director, describes the group as a “brain tsunami,” adding depth and freshness to Wilmot’s outstanding research team for years to come. “The goal was to build cohesion through attracting high-
By Leslie Orr performing individuals who can offer new ideas and new perspectives to our research environment,” Land says. “On top of that, you’re happy if you can attract from the best organizations in the world — and we’ve done that.” Cancer is a private concern for many of them. Stephano Mello’s wife, for instance, had cancer at a young age. She is doing well, but the experience moved him deeply. Isaac Harris lost a close friend to breast cancer, and it stirred an urgency that drives him daily. Rachael Turner decided to pursue cancer research, in part, because her mother, grandmother, and great-grandmother struggled with the disease. As the newcomers settle in — buying houses, starting or growing their families, competing for research funding — all of them are also coping with 2020’s unique challenges due to the coronavirus pandemic, including temporary lab shutdowns. They’ve needed to sort out life’s hurdles while planning for professional goals. “Rochester is a great place for all of that,” says Land, who was central to the recruiting effort. “People here can have a good life while working very hard.”
JEEVISHA BAJAJ, PH.D. An assistant professor of Biomedical Genetics, Bajaj spent many days as a 20-something graduate student sitting outside government hospital clinics in India collecting tissue samples from impoverished cancer patients who were in pain, with little hope, in the late stages of the disease. They were often women with cervical cancer and children with acute leukemia. “I wanted to do better for those patients,” she says. Bajaj was studying cancer stem cells and needed live samples. So, a nurse or doctor would summon her to the clinic when they had a piece of tumor; they would drop it into a tube and Bajaj would put in on ice and race across the city of Bangalore to her lab to analyze the cancer stem cell population. Today, following a post-doctoral stint at University of California, San Diego, and her move to Wilmot, she is still investigating cancer stem cells — but her tools are much 2
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more sophisticated. Bajaj uses gene-editing CRISPR technology and a combination of fluorescence-activated cell sorter and magnetic cell sorter to separate as many as 300 million cells in a couple of hours. This is lightning-fast and more powerful than most technologies, allowing her lab to conduct experiments quickly and with high precision. Bajaj is investigating the genes that fuel the earliest stages of aggressive blood cancers — a subpopulation of very active cells that control the spread of the disease — and how they function and interact with the microenvironment, the non-cancerous tissues that surround tumors. Using these advanced techniques, she has already discovered new genes linked to leukemia, a devastating disease, and recently published the findings in Nature Cancer. Her goal is to find treatments that can inactivate cancer stems cells.
BRIAN ALTMAN, PH.D. An assistant professor of Biomedical Genetics, Altman lost his grandfather and his wife’s uncle to lung cancer. With the sadness came curiosity: Could he use his expertise in circadian rhythms to investigate lung cancer and improve survival? Turns out, lung function is governed by wake-sleep cycles, and lung inflammation is highest at night. Many questions shape his research mission: Do people who get lung cancer have disrupted circadian rhythms? Would it be helpful to give treatments at the point in a cancer cell’s 24-hour cycle when the cells are most vulnerable to being destroyed? What about finding therapies for cancer patients that strengthen circadian rhythms and possibly extend their lives? Circadian rhythms include any 24hour rhythm in a biologic process that coordinates the day-night cycle. Each cell also has its own molecular clock, which is linked to cyclical regulation of gene
expression. When circadian rhythm is disrupted in humans by jet lag, late-shift work, or even by snacking after dinner, it messes up the biological clock and creates a higher risk for metabolic conditions such as obesity, high blood pressure, diabetes and even cancer. At the University of Pennsylvania and later at the Wistar Institute in Philadelphia, Altman studied how and why the clock gets off track in cancer. When the Nobel Prize was awarded to circadian rhythm scientists in 2017, it stoked Altman, and he started to focus on lung cancer. At Wilmot, he’s creating new platforms to investigate how cancer relies on circadian rhythms and how to strategically treat cancers based on their clock status. Meanwhile, Altman practices what he’s learned and has some healthy lifestyle advice to keep all of our rhythms smooth: “Eat within a 12-hour window each day, and stay on a regular sleep schedule.”
RACHAEL TURNER, M.D., PH.D. An assistant professor of Medicine and Obstetrics and Gynecology, Turner has always been interested in science, but the loss of her grandmother and greatgrandmother to uterine cancer made it personal. Her mother is also a long-time breast cancer survivor, and Turner comes from a large family with four siblings (including three sisters) and 50 first cousins in western New York. Very early in her training, she volunteered at a hospice home. “What struck me the most,” Turner says, “was that people would give anything to have more time with their families.” The Niagara County native decided to pursue a grueling M.D./Ph.D. program at the University at Buffalo to explore all sides of medicine. Having dual degrees taught her to care for patients while simultaneously researching how to stop their cancer. She conducts clinical trials as well.
These days, Turner is working hard to give patients that additional time. Her specialty is gynecological malignancies, such as ovarian cancer, and thanks to research, the once-lethal disease can, in many cases, look more like a chronic illness. As a Wilmot Cancer Institute fellow, Turner studied in a lab that pioneered the discovery of an ovarian cancer biomarker, HE4, which allows doctors to design more precise treatments. HE4 also suppresses the immune system, and now, Turner is investigating the gene’s role in cancer initiation, how it interacts with the surrounding environment, and its impact on immunotherapy. The goal is to find a way to block HE4 with a targeted drug, and she is optimistic on many fronts. “Things are changing at the speed of light,” Turner says. “I feel like every time I open my email, there’s a new approval for a gynecological cancer treatment.”
Wilmot Cancer Institute
PAUL BOUTZ, PH.D. An assistant professor of Biochemistry and Biophysics, Boutz grew up in Albuquerque, N.M., and as a kid, he was all-in on science. An aspiring paleontologist, a frequent visitor to science museums, and a budding naturalist and biologist, he liked to stomp around in ponds and investigate species in the shadows of the brilliant Sandia Mountains. Boutz made it to the big time when he was accepted as a post-doctoral scientist at the renowned Koch Institute for Integrative Cancer Research at the Massachusetts Institute of Technology. There, he studied with one of the most prominent RNA biologists in the world and was immersed for the first time in the language of cancer biology. He had days early on when “I had no idea what they were talking about,” Boutz says, laughing, but he grew into the job and became part of a team that published an important paper
on glioblastoma, a deadly brain cancer. They discovered a gene essential for some normal cells but whose loss benefits tumors. The brain cancer project set him on a new path as a cancer investigator, landing at Wilmot. He’s currently focused on prostate cancer RNA to develop more potent treatments. Boutz brings two key skills rolled into one — molecular and computational biology — which allow him to dive into the profound gene changes that drive cancer cells and to map individual genomes to look for the most personalized treatments possible. From a scientific perspective, cancer cells are “almost superhuman,” he says, for their extraordinary ability to grow and evolve despite obstacles. The holy grail is to restrain the genes responsible for sending normal cells down the dark road toward cancer formation.
THOMAS CIUCCI, PH.D. An assistant professor of Microbiology and Immunology, Ciucci recalls extracting DNA from lentils with salt and soap at age 12 and feeling excited by seeing how things work. Science teachers further ignited his interest in research, but there was a “problem.” He lived in the middle of the Mediterranean Sea on the island of Corsica. It’s a breathtaking place, for sure, but known more as the birthplace of Napoleon Bonaparte and for tourism than for medical research. After Ciucci earned a doctoral degree in Nice, France, he decided to move to the United States in 2012 to leverage a paramount discovery in the world of cancer research: that immune cells known as T cells can destroy tumors. As a postdoc at the National Cancer Institute, he took advantage of a boom in technology,
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allowing him to study how disease-fighting T cells respond to infections and how genes could make T cells into even better killers. His work fits well with the exciting opportunities that are unfolding as state-ofthe-art forms of immunotherapy emerge to treat cancer. When searching for his next move, Ciucci says he found synergy with Wilmot scientists and knew he would not be alone in Rochester, despite the distance from home. He’s using advanced technology and computational approaches to find gene changes within immune cells that could be used as a proxy to understand what T cells can accomplish against cancer. The potential for manipulating the immune system to clear the disease is excellent, he says: “It’s just a matter of time.”
BEN FRISCH, PH.D. An assistant professor of Pathology and Laboratory Medicine and Biomedical Engineering, Frisch grew up in rural Nunda, 53 miles south of Rochester, where his family raised calves for dairy farmers. He and his sisters woke up daily at 5 a.m. to feed the cows before school. He certainly developed a strong work ethic, but Frisch discovered another keen insight about science from farm work: They’re both 24/7 operations. “You never stop thinking about it and put it away,” he says. Since completing undergraduate and graduate degrees at the University of Rochester, Frisch has been in non-stop motion at Wilmot, putting that work ethic into play and building smart connections to advance his career and help cancer patients. He is part of a trio that’s designing a unique drug-delivery system for cancer, for example, and has done groundbreaking
work on blood cells in some of the most prominent labs at the University. He praises his mentors and the camaraderie among Wilmot researchers: “I don’t think I’ve ever asked someone to work with me and had them say no.” As an independent investigator, Frisch focuses on bench science that can be applied to leukemia and other blood diseases. His special interest is to further understand what happens in the bone marrow that leads to malignancy, and likewise, how cancer impacts the healthy bone marrow. One of his latest cool projects involves building a model of the human bone marrow on a microchip — allowing his lab to more faithfully recreate the human marrow environment and quickly compare the cells of several leukemia patients and how they react to treatments.
MICHAEL GIACOMELLI, PH.D. An assistant professor of Biomedical Engineering, Giacomelli has two babies. One is his daughter Samantha, who was born just as he was setting up his lab in Rochester. The other is a prized invention, a novel 3D imaging device, which can be rolled on a small cart into an operating room so that surgeons can detect in less than three minutes whether a biopsy is cancerous. Each is taking a lot of time, patience, and care. The son of an engineering professor, Giacomelli has degrees in computer science and computer engineering and, over time, realized that he could “be a part of medicine without being a doctor.” He started working on the invention more than five years ago while a doctoral student at the Massachusetts Institute of Technology. Currently, if a woman has a lumpectomy to treat breast cancer, for example, she undergoes surgery to remove the tumor
and surrounding tissue. But she must wait for days until pathologists determine if any cancer cells remain in the outer margins of the breast. A second operation is required if all of the cells were not removed Giacomelli’s technology allows surgeons to see immediately, during the first surgery, if more tissue should be excised to get clean margins. He’s also evaluating it for skin cancer biopsies. The next step is to ensure that nonengineers are comfortable using the imaging device, and to conduct clinical trials. Students recently used it to study human prostate samples and discovered the device was 97 percent accurate at finding microscopic cancer cells near the tissue margins. At one time in history, Giacomelli says, biopsies were studied by candlelight. “Our device jumped 100 years into the future.”
Wilmot Cancer Institute
ISAAC HARRIS, PH.D. An assistant professor of Biomedical Genetics, Harris wears a tattoo on his arm as a reminder of the way he wants to fight cancer. It shows a lumberjack sharpening his axe, symbolizing for Harris that researchers must not only work hard, but work smart. His urgency to “crack the code of how cancer cells stay alive” became even greater when, about a year ago, a close friend died of breast cancer at age 34. A native of Ottawa, Canada, with undergraduate and graduate degrees from the University of Toronto, Harris trained as a post-doc at Harvard Medical School and decided on an uncommon path to investigate breast cancer. He studies antioxidants — but not in terms of eating a plant-based diet or taking supplements to stay healthy. Rather, he looks at the way cancer cells make their own antioxidants
and rely on them as defense mechanisms to grow and resist treatment. The good-guy antioxidants, he says, can be bad guys in certain molecular settings. He also conducts sophisticated laboratory tests using the latest technology on potential treatments. He’s focused on the most destructive form of breast cancer, known as triple-negative disease, and how to block the way these tumors use antioxidants to survive. Few others are doing this type of work, and Harris was encouraged by mentors in Toronto and Boston to run with the opportunity. Just like that sharp axe, his perspective on science is pointed: “We have a lot of work to do. We have to hustle. There’s no room for egos and bureaucracy… We need to be asking very big questions and making big discoveries.”
IAN KLECKNER, PH.D., M.P.H. An assistant professor of Surgery and Neuroscience, Kleckner is fascinated by the mind-body connection and has been a competitive bodybuilder and CrossFit athlete for years. As a kid, growing up in Pittsford, he tended to overthink and had some anxiety, and exercise gave him a sense of control. He moved away from the Rochester area for a decade, earning a doctorate in biophysics at The Ohio State University and for post-doc training at Northeastern University in Boston. Those experiences pushed him to consider how using bodybased treatments might help people with cancer to calm brain circuits and negative emotions. He found kindred souls and excellent mentors in the Cancer Prevention and Control research program at Wilmot, where yoga and other exercise therapies have long been studied and proven to be safe and effective at reducing side effects 6
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for individuals going through cancer. Kleckner carved out his own niche in this booming field, focusing on clinical studies to quell neuropathy, a common side effect from taxane-based chemotherapy. With no established treatments for neuropathy, Kleckner employs brain imaging to investigate how it occurs during cancer treatment and to test new exercise interventions. He’s conducted several trials, received accolades, and plans to expand his studies into mindfulness and neurofeedback. Kleckner’s vision is clear for the not-toodistant future: He sees cancer patients who are treated with chemotherapy and also receiving an app to download with a personalized exercise prescription based on their own fitness level and drug treatment regimen. “I think we’re coming to it,” he says. “It’s so needed.”
STEPHANO MELLO, PH.D. An assistant professor of Biomedical Genetics, Mello is a cancer biologist who trained at Stanford University in California. He lives for those “aha” intellectual moments in the lab. Whether he’s trying to understand gene changes or DNA damage essential for cancer, he is constantly on the lookout for ways to predict how the disease arises and how it will progress. But it was a series of personal eureka moments that gave his research real purpose. His wife was diagnosed with breast cancer at age 30 while Mello was completing post-doctoral studies in his native Brazil. That was 13 years ago, and she is doing well, but “it moved me a lot and drove me to understand what’s going on.” Later, his supervisor at Stanford had lost a close family member to pancreatic cancer, and around the same time, Mello
had discovered some important non-coding RNA genes involved in that dismal disease. As a result, his supervisor created a special project for him, and to this day, he’s digging into how a normal cell turns into a cancer cell. The goal is to develop a blood test for pancreatic cancer that would expose early biomarkers. To get there quickly, he’s using the most modern laboratory techniques to study known cancer genes such as KRAS, which promotes tumors, and p53, which suppresses tumors — and what happens when they’re both mutated. He’s also studying ways to boost p53 to prevent cancer in people who’ve suffered from pancreatitis and have a 100-fold increase in cancer risk. “Having the power to predict who’s at risk and who is not,” Mello says, “is so important.”
PATRICK MURPHY, PH.D. An assistant professor of Biomedical Genetics and Biology, Murphy describes himself as “an abstract thinker, an artist, a weirdo.” As a teenager, he dreamt of escaping his working-class hometown, the tiny village of Angola, south of Buffalo. Science presented an opportunity. Murphy’s high school biology teacher lobbied for him to attend the esteemed Howard Hughes Medical Institute Scholars program for two summers at Villanova University. He was one of 30 kids in the world chosen, and “I was just blown away,” he says, by medical research. He started to think big. He graduated in three years from St. John’s University in New York City, conducted research at the National Institutes of Health, and attended graduate school at Cornell University. Spending hours in a lab, he was intrigued by discovering things, even if they were small insights, because no one had seen them
before. As a post-doctoral fellow at the Huntsman Cancer Institute in Utah, Murphy investigated DNA packaging into chromatin in zebrafish, a model organism with similarities to humans. A mentor taught him that the most likely way to solve complex problems like cancer meant diving into deep fundamental questions, such as how cells transition from one type to another through epigenetic regulation. In Rochester, he uses the fish to study how cells divide and change inappropriately, what genes are turned on and off in cancer, and why drugs that target epigenetic changes work in some cancers and not in others. Murphy’s expansive mind has allowed him to hone many skills: computer programming, bioinformatics, computational analysis of big data. “Science is the answer,” he says. “I’d like to do this for the rest of my life… Retirement sounds awful to me.”
Wilmot Cancer Institute
in Cancer Care
With three daughters on three continents, Doug and Jean Whitney of Fairport are used to using technology to keep them in the loop on Doug’s treatment for glioblastoma. With WhatsApp, they’ve been able to send updates and relay questions from their daughters in North Carolina, France and Malaysia. When possible, each of their daughters would come home to go to the appointments in person. But this spring, when the COVID-19 pandemic opened the opportunity for telemedicine appointments with videoconferencing, they all wanted to be there. They scheduled a visit to accommodate three time zones that span 12 hours, and the family all logged into Zoom with Doug’s Neuro-Oncology team at Wilmot. “For our family, it has been very helpful to be able to follow Dad’s medical care this way,” says Susan Woindrich, the Whitneys’ eldest daughter, who lives in France. Telemedicine may be one of the positive legacies of the COVID crisis. For many years, health care providers have sought to use technology as an option for seeing patients remotely, but insurance coverage proved to be a major barrier. That quickly changed
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By Lydia Fernandez
when the federal government declared a national and public health emergency in March, and health insurers nationwide began to cover telemedicine visits. At Wilmot, a team of doctors, nurses and administrative staff moved quickly to get providers and patients online. By the time the Rochester and Finger Lakes region hit its COVID peak in May, Wilmot was doing as many as 50 percent of its appointments
via telemedicine. As of September, about a quarter of all visits are done remotely. Although telemedicine is not ideal for every aspect of oncology care, teams at Wilmot expect it will be an important tool as long as physical distancing is essential to preventing COVID infection. “Telemedicine is likely to stay with us, both from a patient satisfaction standpoint and also to help in decongesting the
Doug and Jean Whitney, center, arranged a telemedicine visit with their three daughters from three continents and Doug’s Neuro-Oncology team at Wilmot.
facility,” says Jonathan W. Friedberg, M.D., M.M.Sc., Wilmot’s director. “But in-person care is still important, and we’re still learning the optimal balance.”
Finding that balance Beyond safety in the COVID era, telemedicine offers opportunities to expand patients’ access to specialists, especially for rural patients or those who have mobility or transportation challenges. It is ideal for appointments that don’t necessarily require a physical examination, such as routine follow-up visits, second opinion consultations, patient education and supportive care, says Erika Ramsdale, M.D., a geriatric oncologist who helped lead Wilmot’s transition to telemedicine. Because video conferencing platforms like Zoom and FaceTime have become very mainstream for social interactions, patients have taken to telemedicine more readily than Ramsdale expected. “I had some anxiety, as a geriatrician, about older adults, but a number of them are already using it to communicate with their children and grandchildren,” says Ramsdale. She has even had patients log in for appointments who have taken their own vitals, including pulse, temperature and blood pressure. Not all patients are that comfortable with technology or have access to a computer or other device with higherspeed internet services. Wilmot’s nursing and administrative teams spent countless hours with patients and families to get them signed in for appointments, and when necessary, they have arranged either for inperson or telephone visits.
Erika Ramsdale, M.D.
concerned about that we don’t get to talk about at an in-person visit because those family members aren’t there,” Serventi says. “I think that we’re also getting a better sense of how patients are doing in their environment, in their homes, because we see them in their homes.” She also says telemedicine is giving patients a new perspective on their care teams, who also sometimes do the visits from home. “They’re seeing us as people too, where in the office, we’re just the white coats,” Serventi says. “I actually think it’s helped us build and solidify our relationship with patients.” Jean Radice agrees. Last spring, she had two visits with the Neuro-Oncology team via telemedicine, and she has appreciated not
Finding and Missing Connection The effort has been worth it, especially when additional family members can participate in the visits, says Jennifer Serventi, MS, PA-C, a Neuro-Oncology physician assistant and senior research associate. “I think we’re getting more information from families about the things the patient might be struggling with or things they’re
Ashley Hendershot, DNP, FNP-BC
having to travel two hours each way from her home in Ithaca to see them. “It has given me a little more insight into them than they maybe realize,” Radice says. “You feel that you see them as a person.” While she says the care she gets through telemedicine is as good as if it were inperson, she does miss her team, including their hugs. “You miss that kind of personal, human element, and it can only be conveyed to a certain level when it’s on a TV screen,” she says. Likewise, Doug Whitney says he would rather go to the clinic. Communicating in-person, he says, can be more fluid and conveys so much more information. “You can see how the faces change, which you can do here,” he says, gesturing to the screen. “But there’s body language other than above the shoulders, and I miss that.”
New Opportunities for Care Since Wilmot began using telemedicine, some teams have been able to expand their reach to patients. The Hereditary Cancer Screening and Risk Reduction Program, for example, has found that more patients are willing to have genetic testing and learn about how to manage risks if they are found to have a cancer-associated mutation. “It’s opened up regular testing of patients who live farther away,” says Ashley Hendershot, DNP, FNP-BC, a nurse practitioner with the program. “It used to be you’d have to come in for an appointment. Now it’s just a phone call, and people are more likely to get tested because we ship a saliva kit to them.” Telemedicine is also facilitating crucial conversations about advance care planning and goals of care. Benzi Kluger, M.D., M.S., is a neuropalliative care specialist and the director of a new university-wide Palliative Care Research Center. He is working closely with teams at Wilmot, including NeuroOncology. For the past four years, he has run a randomized clinical trial of palliative care for people with Parkinson’s disease through
Wilmot Cancer Institute
In addition to helping connect with patients, telemedicine is helping health care providers connect with each other and find new opportunities for collaboration. For example, Hendershot and her colleagues in the Hereditary Screening program are looking to work more closely with teams at Bassett Health in Cooperstown, which is a three-hour drive from Rochester. Likewise, Kluger has been able to collaborate more with his home care colleagues and do virtual house calls whenever they or the family need.
Nimish Mohile, M.D.
telemedicine and has found the interactions to be just as effective. He often meets new patients this way and does not find online interaction to be a barrier. “I feel that people are much more comfortable and more comfortable talking about things in the comfort of their own home that they wouldn’t be when they’re under fluorescent lights in a clinic,” Kluger says. “We have a conversation that feels natural,” he adds. “In the course of that, I learn what I need to know about them to help advocate for them, and they learn what they need to know about me, including that I care about them as a person, and even though we have this distance between us, that I’m going to do everything that I can to help them meet their goals.”
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Hope for the Future As the COVID pandemic continues, the future of telemedicine is uncertain. Although there have been hints that insurers will roll back on their coverage of telehealth, Wilmot’s providers hope they’ll be able to continue these kinds of visits. “We need to be adamant about advocating for this care because it does make a difference,” Kluger says. “It does improve access. It certainly provides an opportunity for better care for people with mobility issues and transportation issues, and it’s much more efficient for people with serious illness.” Telemedicine, for example, has great potential for improving access to clinical trials. Not only could it help ease the burden of frequent follow-up visits, but if allowed, it could also open the door for more people to participate.
“It would be good for clinical trials,” says Nimish Mohile, M.D., who leads Wilmot’s Neuro-Oncology team and is a clinical investigator. “For patients who live far away, you can explain what they are, give information about the trials, assess eligibility and get a sense of who our team is before traveling for an in-person visit,” says Mohile, who with Kluger and radiation oncologist Sara Hardy, M.D., Ph.D., helped organize a webinar with the National Cancer Institute on telemedicine for brain tumors this spring. Ramsdale is optimistic about telemedicine’s impact and its staying power. “We have momentum on our side,” she says. “It’s harder to stop something once it’s started and once you realize what it’s worth.”
Jennifer Serventi, MS, PA-C
Cancer Researchers Turn Their Attention to COVID-19
Wilmot scientists Josh Munger, Ph.D., and Isaac Harris, Ph.D., are searching for new and existing medications that could block COVID-19.
When coronavirus precautions put cancer research on pause, Wilmot Cancer Institute scientists Isaac Harris, Ph.D., and Josh Munger, Ph.D., turned their expertise on COVID-19. Using their specialized knowledge of viruses and genomics technology, the duo began searching for new and existing U.S Food and Drug Administration-approved medications that could block the coronavirus. They tested 624 drugs on thousands of human lung cells infected with a strain of the coronavirus to see if the drugs had any impact. They discovered 15 potential compounds that appear to have anti-viral activity. Their criteria for a “hit” was for the drug to block 50 percent of virus-induced cell death. The team is now validating the 15 drugs and trying to understand the mechanisms behind their potential anti-viral activity, Harris says. This type of research is known as high-throughput drug screening. It uses automated, robotic equipment to match drug candidates with cellular events that occur during disease transformation. High-throughput screening is often less expensive and faster than developing treatments from scratch, and Harris uses the technique in his breast cancer research to study vulnerabilities in cancer cells. Munger, who has been studying cell metabolism in connection
with viral infection and cancer for years, has found that it might be possible to block some of the key enzymes involved in coronavirus cell metabolism. These enzymes fuel biochemical reactions that cells use to convert nutrients into energy and cell growth and that viruses hijack to produce millions of viral offspring. “We might have a unique approach,” Munger says, “but if we find something that someone else is seeing, too, then that’s also helpful. It will be further confirmation of the science. We’re all in this together and as we all look for ways to stop the coronavirus, the more evidence we can generate on potential treatments, the quicker that can happen.” Harris also emphasized that their drug-discovery process is more advanced, as it evaluates the effectiveness of each drug in 10 different concentrations, simultaneously. This allows the team to focus on doses that can block the virus from reproducing, while not being toxic to uninfected cells. “We’re trying to figure out two problems at once,” says Harris, who was recently recruited to Wilmot from Harvard Medical School. “Maybe at a lower dose you could still block the virus but have fewer side effects.” Harris and Munger were able to restart their cancer research operations over the summer, but they will continue to work on their COVID project. Wilmot Cancer Institute
Face-to-Face: Paula Cupertino on Finding Community and Eliminating Health Disparities As Wilmot Cancer Institute’s first Associate Director of Community Outreach, Engagement and Disparities, Paula Cupertino, Ph.D., came to Rochester knowing that she had big challenges ahead. Not only would she need to build a program, but she had also been warned during her interviews that, despite support from Wilmot, she would likely face the challenges of limited diversity and inclusion at the University. Yet, she came, undaunted and with enthusiasm. “I’m a believer,” Cupertino says. “I saw an amazing opportunity to have an impact at Wilmot.” Now, Cupertino says that taking on this challenge was the right decision, and she has been overwhelmed by the positive
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reception, desire and determination to collaborate with others on diversity and inclusion as a priority at Wilmot. Cupertino fills a key role at Wilmot, leading efforts to strengthen and expand Wilmot’s research and partnerships across its catchment area, the 27-county region in upstate New York that Wilmot serves. These efforts will include enhancing community partnerships, new community-driven research on cancer disparities, bringing diverse communities closer to Wilmot, and improving recruitment into clinical trials from across the region, especially from minority and underserved communities. As a social and behavioral scientist in cancer primary prevention for the past 20 years, who is trilingual and has expertise in community-driven research in the Latino
By Lydia Fernandez
immigrant communities in the U.S., Mexico and Brazil, Cupertino is uniquely qualified for this role. The goal of her Community Outreach, Engagement and Disparities Office is to reduce the burden of cancer by guiding effort and attention where the need is the greatest and to begin a path with communities toward understanding and addressing cancer disparities throughout Wilmot’s catchment area. Her arrival in Rochester could not have happened at a better time. The COVID-19 pandemic has put a spotlight on poor clinical outcomes in communities of color, clearly showing how differences in race, ethnicity and other social determinants of health can disproportionately impact specific groups and put them at higher risk for disease. It has also brought renewed
attention and action to addressing the social and economic impacts of racism that are at the heart of those disparities. We sat down with Cupertino to talk about her vision; her research in population health, community-driven cancer disparities research, and tobacco cessation and prevention; and how she and her team are beginning to build community trust and engagement in a time of social distancing. Following is an edited version of our conversation. Cancer disparities are the result of so many factors. How do you begin to address them? We know that in all outcomes, there are specific groups that are doing worse than others. This usually overlaps with poverty, housing segregation, language barriers, discrimination and lack of trust in mainstream health care. Consequently, these social determinants are all together influencing racial and ethnic cancer disparities. We have known about these unfair and unjust disparities for decades, and it is time to say enough is enough. We all must go beyond observations and reports to significantly increasing our actions. The only way you can begin to eliminate disparities at the population level is by identifying the groups that have greater needs or are disproportionally facing a cancer burden for decades, such as the Black communities or Latinos. More than that, you have to build trust with the groups that have been kept outside the health care system for decades as they are the experts on the solutions that can be sustainable in their communities. This takes time to build, but it is the only way to establish the necessary pillars to address cancer disparities. I can only understand these disparities by working alongside communities impacted by them. This is the solid beginning that, when done right, can help us fly fast and furious toward better outcomes. We will do this in Rochester as many other cancer centers are doing around the country. This work begins with machine learning and geographic information systems that allow you to map cancer incidence, and you
can find hot spots at the Zip code level. We just recently learned that smoking rates in rural areas are alarming. Cayuga County has the highest smoking rate and lung cancer incidence out of the 27 counties in Wilmot’s catchment area. Now our work begins with the communities to understand why, when did this a fact, where are the citizens suffering from lung cancer. We need to go out there. Nobody knows better about why Cayuga County has such a high rate of lung cancer and smoking than the people living there. I can read, I can go online and learn about Cayuga County, but that’s nothing like going there and developing partnerships and integrating into existing coalitions. We care a lot about developing trust and sustainability over time, sharing power and knowledge, in such a way that we are together no matter what around one goal. Through community outreach and engagement, we can integrate Wilmot’s lung cancer disease group with Cayuga County to identify research gaps, open clinical trials and begin a new journey toward eliminating cancer. And you’ll be surprised by the amount of citizens, faith-based communities, hospitals or physicians, community-based organizations who are eager to partner with Wilmot and are committed to improving the cancer outcomes in their counties. Sometimes you find a group of community leaders that are like, “Tell me what I can do, I can’t stand this anymore, how can we face this together?” You find people who are more and more aligned with, “Let’s act, let’s change that now.” Before my arrival at Wilmot, Dr. Charles Kamen worked diligently to set the foundation for the Community Outreach, Engagement and Disparities Office. Without his leadership and dedication, we would have not been able to move this effort as quickly as we have. I am passionate about my work on outreach and engagement for the past 20 years. Since my arrival, I have had the opportunity to drive in areas with high concentration of Blacks, Latinos and farm workers and in rural distant counties. As a next step, I need to be able to get out of the
“We are together, no matter what.”
car and begin new partnerships that can last a lifetime. I will do this work, and the people in these 27 counties will see myself and the COE team frequently. We are living in a complicated time, with the COVID pandemic and renewed attention to addressing racism. Do you see this as an opportunity to gain momentum for change? Absolutely, there’s a lot of great momentum. Everybody’s talking about racism, discrimination, eliminating disparities and increasing opportunities for inclusion. However, I’m very cautious, you know, because the way that it has been handled — by all of us — might put us even more apart. Everybody wants to do something, but we need to be careful and sensitive on how to do this with an open mind. It takes time to understand and eliminate the roots of racism and discrimination. We must do it differently. We cannot repeat the same old
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actions and attitudes that have brought us here. And it’s not about me. I have heard people say, “Oh, now that Paula is here and all these other efforts are in place …” No, we do not want to hear that. It’s your job. It’s Dr. Jonathan Friedberg’s job. It’s the job of all of Wilmot’s employees, faculty, and trainees. We must build on the work already underway at the University. There are centers and departments addressing health disparities, and we must all work together. This is how we begin having an impact. I don’t have the solution. I wish, I wish I had that power as I have been working in this field for years. Here is a call for all of us — independent of your position or attitudes and beliefs about cancer disparities and their roots — to focus on eliminating unfair disparities faced by underrepresented minority communities. I can facilitate. If we decide to do a really in-depth social climate assessment of discrimination, microagression and racism — pushing us out of our comfort zone — this could be a first step. That will tell us where we are, as well as where Wilmot or each department is. I think it’s a wonderful way to begin. But it takes time, it takes resources and it takes motivation to grow understanding on these issues. At Wilmot, we have already committed to improve the health of Black communities and cancer outcomes for Black patients. Our plans include convening a Black Community Cancer Coalition to work directly with Wilmot director Jonathan Friedberg and our team in Community Outreach, Engagement and Disparities to address racial inequity in cancer incidence, prevention and access to Wilmot through culturally tailored interventions. We have also committed to improving representation of Black clinicians and scientists at Wilmot and better supporting Black residents, fellows and post-docs. We are developing a pipeline for Black high school students interested in addressing the disparities affecting Black communities.
mind, that everything happened smoothly, following step by step and we’ll do A, B and C. It was more of a discovery over time. Since my teen years in Brazil when I was reading Paulo Freire, I just kept falling in love with the opportunity to eliminate injustices in the health care setting, and that kept me away from clinical care. I started out interested in being a psychologist — not a clinical psychologist, but a social psychologist — because I have always been interested in the context, in social issues and social justice. I was influenced by the social justice movements
in Brazil in the ’60s and the establishment of the universal health care system in a country with 220 million people spread over 3 million square miles. When I came to the U.S. to the University of California, Davis, I came in thinking that I was going to be working on an intervention study. I ended up working on an epidemiological study, the Sacramento Area Latino Study on Aging (SALSA). In that study, we identified Zip codes with high concentration of Latinos older than 65 and then we would go door to door. As we identified eligible Latinos, we would
Wilmot Cancer Institute’s catchment area includes 27 counties in upstate New York
How did you find your passion for addressing disparities and focusing on population health research? I wish I could tell you that I had a plan in This heat map of New York state shows hot spots in red in Wilmot’s catchment area where high smoking rates are prevalent. 14 find us on Facebook, Twitter and Instagram
complete a comprehensive assessment from specimen collection all the way to the social and behavioral measures implied in cognitive decline. My job was working closely with the outreach team, as well writing my dissertation. The study was set up as a longitudinal cohort study, and I fell in love with the methods in epidemiology as an opportunity to understand why Latinos have higher risk for cognitive decline. My mentors Dr. Mary Haan and Dr. Carolyn Aldwyn aligned my path. After that, I went to Brazil where I implemented the first epidemiological assessment of older adults similar to the SALSA study.
I learned a lot about smoking cessation in rural America, and then I started applying that with my mentors among Latinos, adding the community-based approach and mobile tools to improve the reach. So, it happened again by accident. I think I have some skills for finding lemons and turning them into lemonade! More than anything, with my mentors in Kansas, Dr. Ellerbeck and Dr. Kimber Richter, I have found my reason to come to work every day, alongside communities, motivated to face what is next.
COVID era, and our team is learning to be creative.
What’s the most exciting aspect of the work that you do? It’s just the people coming with you around that vision, that mission, because you’re talking about joining forces to make a difference with disenfranchised groups that have been oppressed and kept outside the latest and greatest science, the prevention of cancer and cure of cancer, for example. You offer a little tiny window of opportunity to be closer to that empowerment, and the How have you managed in this excitement created around that is the path pandemic to do a job that’s all about to change happening at Wilmot. being in the community? This feeds me. It feeds me daily with the How did you get into tobacco I think when you have this passion for opportunity to work and to eliminate small cessation research? community and you have developed trust barriers that are not right, that are not fair, In 2001, we moved to Kansas. I had a and sustainable community partnership that are not acceptable. Just open that little PhD, I spoke English and, like most Latino over the years, you can transfer that to window and wow, people just start coming immigrants, despite their education and virtual platforms. It does not stop you from through with you, and you begin to think degrees, I ended up working in the cleaning growing partnerships and collaborations. The about priorities together. industry. I just wanted to get a job. You core values and principles are the same — know, I had the worst experiences in the empowerment together with communities, When you’re not focused on your interviews at academic centers during that practice, and collaboration. It feels almost work, what do you like to do? time. People would ask where are your legal the same as before. I’m all about family time. Keeping a papers to ensure you’re documented. It was People are getting very excited across multicultural environment with multiple a humbling time as my family and I faced the 27 counties to be part of Willmot. I think languages and cultures around the table at bias, discrimination and racism towards we are sharing a much-needed mission and our home by Lake Ontario is key for us. I Latinos. These experiences made us reflective a vision to address social determinants and like to entertain, cook and bake frequently, and maybe more sensitive to these issues. cancer disparities in the catchment area. Our and make sure the family have what they A friend of a Brazilian friend introduced mission is to reduce the burden of cancer need to keep growing together toward me to someone at the University of Kansas and eliminate cancer disparities through our shared family ways of life. We love Medical Center Department of Preventive robust, bi-directional communication with animals and exotic animals. We have four Medicine and Public Health. They had a diverse communities across the catchment dogs — including an English mastiff, a St. postdoc opportunity to work in a rural area. Bernard and tiny Chihuahuas — four cats, smoking cessation randomized clinical We’ve had an overwhelmingly positive four snakes (two Brazilian boas,of course), a trial with Dr. Edward Ellerbeck. I knew very response. Wilmot Community Outreach, tarantula, and a soon-to-come Vietnamese little about smoking cessation, but after a Engagement and Disparities organized a mini pig. We’re also waiting for our Maine year working in the cleaning industry, that community cancer action council meeting, coon. We play with them every night. That is sounded like a sweet opportunity. and more than 50 community members our unwind routine that leads us to another I got fascinated because smoking is showed up. They had never met us, and they day. an area where there are clinical practice stayed with us for three hours. guidelines to treat tobacco and nicotine But this work can also be hard during dependence, but the clinical guidelines the pandemic. We want to continue to have not reached the communities who be culturally and linguistically sensitive to need them the most, such as Latinos — communities’ preferences, and that might particularly Puerto Ricans — and the Black not be working virtually. You probably need community. Both have faced tobacco-related to spend more time before and after the disparities influencing their outcomes. I meeting getting to know people and hearing joined a team interested in understanding things that might not be shared in the virtual why and designing interventions. scenario. So I recognize the challenges in the
Wilmot Cancer Institute
Wilmot Science Moves out of the Lab into a Clinical Trial By Leslie Orr
Laura Calvi, M.D., achieved what a lot of translational researchers only dream of: For years, she made important discoveries in the lab, but then she was able to turn the project into a clinical trial, where it has begun to benefit patients. “It’s an amazing accomplishment to get this far,” says Calvi, a co-leader of Wilmot Cancer Institute’s Cancer Microenvironment research program. Many researchers, of course, intend for their basic science to eventually help patients. But the process can get derailed during the years it takes to develop goals, run experiments, publish the results, and then design and fund clinical trials. Sometimes good ideas don’t pan out, or funding is lost, or the scientist gets pulled in other directions. In this case, though, a strong team approach made it happen. Calvi emphasized that moving the laboratory project into the clinical trial required a close collaboration with many Wilmot clinician-scientists, including Jane Liesveld, M.D.; Jason Mendler, M.D., Ph.D.; Michael Becker, M.D.; Frank Akwaa, M.D.; and Melissa Loh, MBBCh. “This project represents a huge success,” Calvi says. “To hand off a concept to a clinical team that can run a study — it’s really, really difficult, but we’ve done it.” Wilmot has several homegrown translational research projects in the pipeline — for instance, a clinical trial for
glioblastoma, a type of brain cancer, is on the horizon, based on years of collaborative work done by Nimish Mohile, M.D., and Mark Noble, Ph.D. But Calvi’s case represents the most recent win. She took a series of discoveries about blood-forming and bone-forming stem cells in the bone marrow and created an innovative treatment idea for myelodysplastic syndrome (MDS). MDS is a type of blood cancer that morphs into leukemia in about one-third of patients. A disease of aging, it occurs when blood cells in the bone marrow are defective (dysplastic) and cannot make healthy blood. As a result, patients with MDS usually require frequent blood transfusions. In her clinical trial, Calvi combined an osteoporosis drug called abaloparatide, which builds bone and can also expand
Laura Calvi, M.D.
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Bob Coombs, shown here at a visit in February, prior to COVID-19, is part of a clinical trial of a new treatment for myelodysplastic syndrome.
healthy blood cells, with another drug, bevacizumab, which blocks a growth factor common in many cancers. The goal, Calvi says, was to improve the environment for healthy blood stem cells and crowd out budding cancer cells. Bob Coombs, 71, of Penfield, was among the first to volunteer for this trial. “I was fortunate that my disease was discovered before it got really bad,” Coombs says. “That put me in a good position to help medical science. I was eager to help. I was under no illusions that this could be a cure, but at least we’ll advance knowledge.” Calvi’s interests have centered on understanding how all of the tissues and cells in the bone marrow microenvironment contribute to MDS and other blood cancers. This approach is different from that of other scientists across the U.S., who are more focused on the malignancy itself. She believes that improving the health of the blood supply and the entire bone
marrow environment is key to reducing the risk of worsening MDS and leukemia. As it turned out, Coombs’ health improved considerably while he was taking the experimental two-drug combination. His need for blood transfusions dropped from every two weeks to every six weeks. “To go six weeks without a transfusion was pretty awesome,” says the retired software engineer and former town justice in Prattsburgh, Steuben County. Coombs lived in a rural area an hour south of Rochester for most of his life but recently moved to the Rochester suburbs to be closer to his daughter. So far, all patients in the clinical trial have tolerated the treatment well, Calvi says. The phase 1 study was designed to measure safety, but the team also collected bone marrow samples and is analyzing data on the medications’ effectiveness. When the trial is complete and if the results are promising, Calvi and her team
will seek National Institutes of Health funding for a larger clinical study. The project bolsters three of Wilmot’s major research strengths: blood cancer investigation and treatment, an expertise in cancer and aging, and a growing understanding of how best to serve a predominantly aging population in Rochester and the surrounding upstate New York region. Coombs says he was honored to be able to help improve medicine through clinical research. “We need to give,” he says. “The world is a better place for it.” The Mangurian Fund provided the support to purchase the study drugs, which have already been approved by the U.S. Food and Drug Administration. Calvi also received early support from the University of Rochester Clinical and Translational Science Institute.
Wilmot Cancer Institute
Sometimes Tumors Vanish, but Improvements Still Needed for CAR T-Cell Immunotherapy Wilmot Poised to Lead Research and Treatment to Improve Access, Results By Leslie Orr
Patrick Reagan, M.D., looks at the data on his computer screen and a rare grin spreads across his face. His most recent study results for patients with end-stage mantle cell lymphoma show that an eye-popping 93 percent responded to the latest iteration of CAR T-cell treatment. He’s not the only one smiling. Oncologists at the Wilmot Cancer Institute and across the U.S., and their grateful patients, are seeing the benefits of one of the most exciting new cancer treatments to emerge in recent years. CAR T-cell therapy is based on an old idea — that the immune system can be super-charged to attack tumors — and thanks to modern technology and a series of new discoveries, it’s showing more promise than ever. “It’s a miracle in a lot of ways,” says Nicole Zaleski-Conine, 47, an Irondequoit mother of five who underwent CAR T-cell therapy in 2018. “But it’s also science, and doctors, and research and amazing medicine.” Zaleski-Conine was near death when she received the treatment but remains cancer-free two years later, under Reagan’s care. CAR T-cell therapy was originally designed for blood cancers. The earliest versions were used to treat pediatric leukemia. Now, adults like Zaleski-Conine, who have a relentless form of diffuse large B-cell lymphoma, may qualify for CAR T-cell therapy when their disease progresses despite standard aggressive treatment. on Facebook, Facebook,Twitter Twitterand andInstagram Instagram 18 find us on
A nurse prepares to infuse CAR T-cells that have been engineered to treat lymphoma.
More recently, as with Reagan’s mantle cell lymphoma study, researchers have been expanding the playbook to other types of blood cancer with success. “We certainly don’t have other treatments that are as effective in patients who have already exhausted most other options,” Reagan says. Nationally, approximately 80 percent of patients improve immediately after receiving CAR T-cell therapy, says Reagan, who leads Wilmot’s program to administer the treatment. Nearly 50 percent of those patients have a complete response, which means their tumors vanish within three months. Approximately 40 percent stay well for two years or longer, Reagan says, citing national data. These individuals likely would have succumbed to their cancer within weeks or months had they not received CAR T-cell therapy. Instead, they are not only alive, but they’re healthy and productive. Zaleski-Conine is the 13th of more than 60 individuals who have received the treatment at Wilmot. The positive response rates locally mirror the national data, Reagan says. But as he looks beyond the triumphs to
what is still needed, Reagan’s grin fades. “We have a lot to learn to make the treatment safer and more effective,” he says. “Keep in mind that, ultimately, 60% of patients who get CARs are not going to respond the way we’d like them to with durable remissions, and there are still many people who are ineligible because of other medical problems.”
a person’s weakened body can’t withstand the severe immune reaction, known as a cytokine storm, that occurs, leading occasionally to fatal complications. “We have a long way to go,” Reagan says.
Science and Safety
One of the most dangerous features of a “living drug” like CAR T-cell therapy, is that it cannot be withdrawn from the patient once it’s infused into the veins, says URMC immunotherapy expert Minsoo Kim, Ph.D. In contrast, if a person develops a serious side effect from other types of cancer treatment, such as chemotherapy, the treatment can be stopped. For this reason, Kim maintains that it’s critical to control the activity of the billions of laboratory-modified immune cells after The barriers to treatment can be they’re injected into a cancer-burdened heartbreaking: Some individuals with blood body. cancers and a life expectancy of six months The treatment works like this: A patient’s or less either aren’t eligible for the therapy white blood cells (T cells), which fight off or they don’t live long enough to receive infection and other invaders, are collected the treatment because their fast-moving and sent to a manufacturing facility to be disease outpaces the approximately two genetically reprogrammed and expanded. weeks it takes to fully develop the cells and The U.S. Food and Drug Administration administer CAR T-cell therapy. In some cases, has approved a handful of biotech and
Wilmot Cancer Institute
The Next Frontier
was the senior co-author of a highimpact study published earlier this year in the New England Journal of Medicine Jonathan Friedberg, M.D., M.M.Sc., — the clinical trial with the astounding director of Wilmot and a worldwide 93-percent response rate. In that small lymphoma expert, is the reason why group (74 patients) with relapsed mantle the cancer center was chosen back in cell lymphoma, an aggressive disease, 83 2016 as one of the first in the nation to percent survived and did well for a year after evaluate CAR T-cell therapy in diffuse large the treatment. This compares to a 10-to-20 B-cell lymphoma. Wilmot is still “pushing frontiers,” he says, and will continue to lead percent success rate for chemotherapy in as scientists learn more about the treatment. patients in the same situation. Wilmot is expanding its CAR T-cell Reagan and Kim also see promise in Minsoo Kim, Ph.D. combining CAR T cells with other cancer toolbox. It now offers a CAR T-cell clinical treatments. And manufacturers are speeding trial for children and young adults up to age pharmaceutical companies to produce 21 with acute lymphocytic leukemia (ALL), up the 10-to-17 days it takes to genetically CAR T-cell therapy, which is designed to led by Kristen O’Dwyer, M.D.; and Reagan modify a patient’s immune cells. Data attach to the CD19 protein that sits on the is planning studies for chronic lymphocytic suggest that even modest upgrades in the surface of some blood cancer cells. After leukemia (CLL) and other slower-growing timeframe could impact survival. the manufacturing process, the T cells are lymphomas. Another major push is around safety, shipped back to the cancer center and A longer-term goal is to retool CAR T-cells infused into the patient intravenously, where Reagan says. By design, CAR T-cells stir up to target solid tumors such as breast, brain a powerful immune response, resulting in they begin to hunt down cancer. and lung. So far, it’s been more difficult for In 2018, the FDA approved the treatment dangerous inflammation. Patients experience the super-charged immune cells to infiltrate for adults with certain types of non-Hodgkin fever and flu-like symptoms, rapid heart solid tumors, which have more diverse and rate, low blood pressure, heart problems lymphoma, and in 2019 it approved a variable gene mutations. But Friedberg and trouble breathing. About 30 percent second CAR T-cell drug for diffuse large remains confident that investigators will of individuals also develop short-lived B-cell lymphoma. The treatment comes figure out how to overcome the problem. with strict eligibility criteria for patients and but frightening neurological toxicities: “In the future,” Friedberg says, “as requires heightened training for the medical headaches, forgetfulness, confusion, new CAR T-cell products come into the seizures, and coma. team. marketplace, they will be less toxic and will “Somebody who’s really confused Last year, the National Cancer Institute include treatments for earlier stages of blood or lethargic and possibly on a ventilator awarded Kim $2 million to investigate cancers and other types of tumors. And we’re presents a lot of other risks beyond the the roots of CAR T-cell side effects and poised to be ready to take advantage and cancer or the treatment,” Reagan says. to improve its delivery toward tumors. lead the nation.” “Most people who experience serious side His co-principal investigators are Reagan effects get better in about a week but it’s and Richard Waugh, Ph.D., a University of very hard on the family. We talk about this Rochester biomedical engineering expert. leading up to the treatment but it’s still fairly Kim is most interested in the way CAR T shocking to see.” cells act immediately after they get into the Wilmot has been working with several bloodstream. Rather than heading straight U.S. biotech companies such as Kite, for cancer, the modified T cells lodge in the Novartis and Juno Therapeutics, to develop lungs, liver, and other major organs for a CARs with fewer side effects. The goal is to few days. While there, Kim says, the CARs make the treatment suitable for patients erroneously recognize non-cancer cells as who have disqualifying, underlying health the enemy and attack healthy tissue. This conditions. complicates the body’s immune response. Reagan understands the changing “Can we inject fewer CAR T-cells to landscape as well as anyone. He is part of minimize the side effects?” Kim wonders. “If we can figure out how the CARs initially the U.S. CAR T-Cell Consortium, a group of 17 leading cancer centers that share respond, we believe we can ‘direct’ them and analyze the latest data, and conduct - Minsoo Kim, Ph.D. better toward the intended target.” innovative clinical studies. “It’s an exciting time,” Kim says, “and we As part of the consortium, Reagan have a great team here at Wilmot.”
“It’s an exciting time and we have a great team here at Wilmot.”
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“RESEARCH AND AMAZING MEDICINE” In the autumn of 2017, Nicole Zaleski-Conine was a 44-year-old mother of five living in Irondequoit, working as a hairdresser, helping her husband run a business, and spending a lot of time on sports fields, shuttling some of her children to practices and games. She felt something odd in her stomach and chalked it up to lingering effects from three hernia surgeries in two years. Night sweats came next, but she believed they were from peri-menopausal hot flashes and spending time in a busy, hot, hair salon. By the end of December, her symptoms worsened dramatically by the day. The definitive cancer diagnosis came in January 2018: follicular lymphoma that transformed into diffuse large B-cell lymphoma. “Initially I thought: Phew! Lymphoma,” Zaleski-Conine recalls. “This is totally beatable.” But things did not go as she had hoped. After the first chemotherapy treatment, she suffered from tumor lysis syndrome, an emergency that occurs when a large number of cancer cells die quickly and flood the bloodstream with toxins. She survived a stint in the ICU at UR Medicine’s Strong Memorial Hospital and went on to receive more chemo. After each treatment, however, the disease would return within days. “I started realizing how serious this was,” she says. “But I never let myself think beyond the idea that there will always be something new to try.” Sure enough, as her standard treatments were failing, the U.S. Food and Drug Administration approved CAR T-cell treatment for diffuse large B-cell lymphoma. Her oncologist, Carla Casulo, M.D., a blood cancer specialist at Wilmot, was on board and worked
collaboratively with Patrick Reagan, M.D., Wilmot’s CAR T-cell specialist. “I was terrified,” Zaleski-Conine says. “Very few humans had been through the treatment and I had no one to talk to. But I had no other options, so I went for it. Either that, or give up on life.” The next days were difficult. The care team filtered ZaleskiConine’s T-cells from her immune system and shipped them to a special laboratory in California, operated by Kite Pharma. Scientists genetically engineered the cells to recognize a protein that’s associated with B-cell lymphoma. This process takes about two weeks. Meanwhile, back in Rochester, Zaleski-Conine became so gravely ill that her doctors worried she would not make it. But she hung on and received the infusion on May 29, 2018 — a day shy of her 45th birthday. As her immune system responded, she predictably suffered from many expected side effects. But she challenged herself to recover by walking every day and digging into her competitive spirit as she worked through rehabilitation. In one month, the cancer had disappeared, and today, she remains stable. She is grateful for “research and amazing medicine.” “It’s very simple — there is no way to possibly pay back and thank everyone at Wilmot,” Zaleski-Conine says. “If I hit the lotto, I would send every doctor and nurse who helped me on a great vacation… I was someone who was having intense treatment and nothing was working, and then I get this new therapy and all of a sudden my tumors are gone.” “And now,” she says, “I’m watching my kids grow up.”
Nicole Zaleski-Conine, in the poncho, with her husband and children. Wilmot Cancer Institute
THE DOCTOR IS A PATIENT
Patrick Brophy, M.D., underwent CAR T-cell therapy in 2018.
Patrick Brophy, M.D., physician-in-chief at UR Medicine Golisano Children’s Hospital, says he never looked at his own medical chart. But he knew his health was declining rapidly. Brophy suffered from a relapse of mantle cell lymphoma, and standard therapy was not working. His luck changed as he became eligible for a groundbreaking clinical study evaluating CAR T-cell therapy in this type of blood cancer. It was the first clinical trial of its kind in the nation, and the Wilmot Cancer Institute had a significant role in the study, with Patrick Reagan, M.D., at the helm. Cancer is never welcome, but his encounter with Wilmot was serendipitous, Brophy says. Brophy’s initial diagnosis occurred in 2016 in Iowa, while he was a pediatric leader at University of Iowa. After aggressive treatment there, he had a period of remission and during that time was recruited to the University of Rochester as the William H. Eilinger Professor and Chair of the Department of Pediatrics. Within a year of moving to upstate New York, though, his cancer returned — but being in Rochester allowed him to receive care from a worldrenowned lymphoma specialist, Jonathan Friedberg, M.D., M.M.Sc., Wilmot’s director. “Cosmic debris got me to Rochester,” Brophy says. “Had I not been here, I wouldn’t have had the opportunity for this treatment. Now I’m able to take a step back and understand that the science is remarkable and the leadership team here is amazing.” During his CAR T-cell therapy, Brophy’s immune system went into extreme overdrive and he became so ill that it was “touch and go” for many days, he says.
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The CAR T cells were infused on Oct. 1, 2018, and the next day his temperature soared to 105 degrees. By day four he was really struggling with confusion — “and suddenly, in the hospital room while talking to my wife, I just blanked.” He slipped into a coma due to the treatment’s toxic impact on the brain and he doesn’t remember a thing until he woke up two weeks later in the intensive care unit at UR Medicine’s Strong Memorial Hospital. “I was awake but I couldn’t move my arms or legs,” he recalls. “My kidneys had shut down, too, and I was put on dialysis. When I was being intubated in the ICU, apparently, I bit down so hard on the bite block that I lost my front teeth. And because I couldn’t move for so long, I lost muscle mass and 70 pounds. It was quite hard on my wife and my family.” In fact, Brophy was in the hospital for 56 days. He improved dramatically through hard work and rehabilitation, and was able to come home for Christmas of 2018. He has remained stable ever since, and keeps himself busy at work and active outside with golfing, hiking, skiing and skating — and hanging out with his two young-adult sons. “You have to have belief in something, that there is a future,” Brophy says. “You can’t change what’s going on but you can get lost real quick without hope.” “In my job I see a lot of bad things — like when families lose kids — and I watch how it never goes away and how they power through life,” he adds. “This has made me think: What do I value? It’s an old adage but it’s really about family and friends. Being there and being present. That’s something I’m focused on a lot more.”
FINALLY, A MILESTONE TO CELEBRATE Maxine and Dave Wilson finish each other’s sentences. They feel that would be the end of cancer, but again the disease returned. blessed to have each other, given what Maxine has been through. “That one really knocked us down,” Dave Wilson says. “We She was unexpectedly diagnosed with non-Hodgkin lymphoma mistakenly thought the stem cell transplant made us good-to-go, in 2009 at age 57. It was discovered during routine blood work forever.” for a primary care visit, and she had been feeling well. “The word Sousou told them there was still another option: CAR T-cell ‘cancer,’ it just blew me away,” says the Syracuse woman. “But therapy. He urged them to return to Wilmot, and to meet Patrick I just decided to live with it, pray about it, and after that first Reagan, M.D., a CAR T-cell specialist, and Anna Morrison, R.N., treatment, they said I was fine.” OCN, who would become their new care team. The Wilsons agreed, But Maxine Wilson’s bout with cancer was far from over. She and said it was a “wonderful” decision. endured four recurrences during the next several years. Each time, Maxine Wilson received the treatment in the summer of 2018 the disease came back within one year of completing treatment. and experienced some expected but severe neurological side effects. Much of that time the couple was living in Georgia. At one point, Initially, she didn’t recognize her husband or her doctors, and that she went for a work-up at was frightening, especially Emory University’s cancer for Dave. But a week later, center, and doctors there the symptoms eased. She discovered she also had recalls the happy day when cold agglutinin disease, her mother and sisters came a rare type of anemia. to visit at Wilmot, and she When a person with this knew who they were. condition is exposed to She has been cancercold temperatures, it can free for two years — her cause the immune system longest period of remission to mistakenly attack healthy ever. red blood cells. “I’m a new person!’ Those were difficult says the 70-year-old retiree. times. “I wanted to get any “I had many up-andtreatment I needed, to go down days,” Maxine Wilson on with life. I was a willing says. “But I got my strength patient.” from praying to the Lord, The couple admits and I went on with my life.” they get anxious around Dave Wilson interjects: every new follow-up test “It wasn’t that simple. with Sousou, but Maxine Chemo was so devastating Wilson says she’s in good to her… it was not a cake spirits and Sousou is Maxine Wilson, at home in Syracuse, is grateful for CAR T-cell treatment walk, it was very tough pleased about the two-year at Wilmot. stuff.” milestone. She agrees and recalls The past several months that she became depressed. “I would think, ‘Why is this happening coping with the coronavirus pandemic have been manageable to me?’” compared to cancer, she says. The couple protects their health by In 2015, they decided to return to their native upstate New York, staying home unless it’s absolutely necessary to go out, masked and despite the cold weather. Maxine Wilson missed her mother, who gloved. She calls her mother, who is in her 90s, every evening. She lives in Auburn, and the Wilsons looked forward to being closer to also talks frequently with her sisters and other family via WhatsApp, children and grandchildren in New York City. and tries to stay active by doing housework. And her beloved Dave Aggressive cancer treatments continued under the care of her is always by her side. Syracuse oncologist, Tarek Sousou, M.D. In 2016, he recommended “We get cabin fever,” she says, “but we’re fine.” a stem-cell transplant at the Wilmot Cancer Institute. She hoped
Wilmot Cancer Institute
UR Awarded $29 Million for National Leadership in Cancer Control Research UR Medicine’s Wilmot Cancer Institute is continuing its practice-changing research into cancer side-effects and symptom management with a coveted $29 million grant from the National Cancer Institute. The award is the largest single grant currently funded at the University of Rochester Medical Center. The NCI selected Wilmot’s Cancer Prevention and Control research program as a hub for the National Community Oncology Research Program or NCORP. As such, the Wilmot team is charged with designing and managing clinical studies to be carried out at oncology clinics at more than 1,000 NCORP affiliates in 44 states, the District of Columbia, Puerto Rico and Guam. The grant not only honors longstanding research strength, but assures that the Wilmot Cancer Prevention and Control program remains a leader for tackling issues of great concern to patients — nausea
and chemo brain, neuropathy, fatigue, fitness, and the use of supplements to quell common chemotherapy side effects and symptoms related to cancer and its treatments. With nearly 17 million cancer survivors in the U.S., which is an estimated 5 percent of the entire population, improving the lives of patients and survivors is a top priority, said co-Principal Investigators Gary Morrow, Ph.D., M.S., and Karen Mustian, Ph.D., M.P.H. Both are Dean’s Professors in the UR Department of Surgery, and leaders at Wilmot. “It’s always been our mantra to help good people through lousy times,” Morrow said. “This new funding allows us to seamlessly continue our work while extending the mission to reach even more people on a national scale and throughout Rochester and the upstate New York region.” Wilmot was one of seven cancer centers chosen as an NCORP research base, and this year’s awards cover the largest geographic area in NCORP’s history. “Receiving the NCORP award places us at the epicenter of all scientific ideas in this growing and vital field of research,” Mustian said. “The clinical trials carried out through the NCORP program end up changing how oncology is practiced in
Gary Morrow, Ph.D., M.S.
terms of helping patients alleviate the side effects and symptoms that often accompany cancer and treatment. We’ll be working with doctors, patients, and advocates to decide: What are the most troublesome issues that people experience when they go through cancer care? And of those issues, where are we lacking in treatment and where are the greatest research needs?” The grant runs for six years, ending in July 2025, with the University receiving $5 million the first year and then $4.7 million or $4.8 million each year thereafter. In 2014, Wilmot received its first NCORP award for approximately $20 million; this renewal represents a $9 million increase. Wilmot and the University of Rochester have a long and successful history with NCORP and its previous incarnation, CCOP. In fact, Wilmot’s Cancer Control unit has been continuously funded with large grants for more than 30 years.
Karen Mustian, Ph.D., M.P.H. at the NCORP announcement
Wilmot Leader Earns $1.5M Grant for Breakthrough Clinical Trial David Linehan, M.D., Associate Director for Clinical Research at the Wilmot Cancer Institute, is the inaugural recipient of a $1.5 million award from Gateway for Cancer Research. Linehan is an expert investigator of pancreatic cancer, a deadly disease with a five-year survival rate of only about 9 percent. The Gateway Discovery Grant for Immunotherapy Research supports Linehan’s early-phase clinical trial combining immunotherapy with a common cocktail of drugs known as Folfirinox for treating patients with pancreatic tumors that cannot be removed. As a surgeon, much of Linehan’s research focuses on harnessing the immune system to fight 24 find us on Facebook, Twitter and Instagram
pancreas cancer. He and several collaborators also investigate how pancreatic tumors leverage surrounding non-cancer cells in their microenvironment to grow, and how to combine standard treatments with novel immune therapies and radiation, to control the disease. Linehan serves as the Seymour I. Schwartz Professor and Chair of Surgery at the University of Rochester Medical Center. The 2020 Gateway Discovery Grant in Immunotherapy Research is a collaboration between Gateway for Cancer Research and Conquer Cancer, the ASCO Foundation, as a scientific partner.
NCI Awards $3.85M to Wilmot for Collaborative Project on Aging, Cancer Three Wilmot Cancer Institute researchers received a highly valued type of National Cancer Institute award that supports team science. Known as a multi-principal investigator (MPI) award, the $3.85 million grant goes to Supriya Mohile, M.D., M.S.; Karen Mustian, Ph.D., M.P.H.; and Michelle Janelsins, Ph.D., M.P.H., as principal investigators. The trio will study a novel way to help adults who are 65 and older transition from chemotherapy to cancer survivorship. The project will study new interventions that improve function and overall health of older adults with cancer. Importantly, another major goal is to improve a patient’s ability to attend follow-up appointments
and avoid hospitalizations. The research is designed to fill an observed gap in survivorship care for this demographic, said Mohile, who founded Wilmot’s geriatric oncology clinic, one of the first in the nation. By 2040, 73 percent of survivors will be 65 or older and almost 50 percent will be 75 years or older, and yet aging-related conditions are not routinely addressed in survivorship care. The NCI funded the multi-investigator project at $770,000 per year for five years. Mohile, Mustian, and Janelsins have robust track records for groundbreaking studies in geriatric oncology, exercise oncology, and cognitive impairment related to cancer
and its treatment. The team developed a program that combines geriatric assessment — or triaging and managing physical and cognitive problems and social circumstances of geriatric oncology patients — with a realistic and tailored education plan to improve function after chemotherapy. They will conduct a randomized clinical study that enrolls patients from community oncology practices across the country. Researchers will also examine whether the new survivorship program has a positive impact on communication between cancer providers and primary care doctors and on caregiver distress or satisfaction.
Supriya Mohile, M.D., M.S.
Karen Mustian, Ph.D., M.P.H.
Michelle Janelsins, Ph.D., M.P.H.
Friedberg Named Editor-in-Chief of High-Impact Journal Wilmot Cancer Institute Director Jonathan W. Friedberg, M.D., M.M.Sc., has been appointed as the next editor-in-chief of the Journal of Clinical Oncology (JCO), the high-impact flagship journal of the American Society of Clinical Oncology (ASCO). His five-year term as JCO editor-in-chief begins in June 2021. Friedberg, the Samuel E. Durand Professor of Medicine and a clinical investigator focused on lymphoma, has served as a JCO associate editor since 2011.
As editor-in-chief, Friedberg says he plans to further improve the journal’s rapid review process and to further leverage social media as a forum for discussion around articles published in the journal. In addition, he will seek to ensure diversity at all levels of the journal, from editorial board members to published content.
Wilmot Cancer Institute
Genetic Test Results Have No Bearing on Radiation Therapy Toxicity
Sarah Kerns, Ph.D., M.P.H.
Genetic tests for cancer help doctors and patients figure out the best targeted therapy matched to the tumor’s mutations. But the tests leave questions hanging about radiation therapy — until now. “The new message is: You can carry on with standard of care for radiation therapy, with a few extremely rare exceptions,” said Sarah Kerns, Ph.D., M.P.H., a Wilmot
Cancer Institute investigator and expert in radiogenomics, a relatively new area of cancer research that focuses on the link between radiation therapy and genomics. Patients sometimes come to their radiation treatment consultation with genetic testing results in hand — a list of up to 50 gene mutations that may or may not have significance to their treatment plan. Some mutations are acquired by the cancer, but others are present in all cells in the body, leaving the patient concerned about whether the results mean their normal, healthy tissue might be impacted by radiation. The short answer is no, Kerns said. She was part of a nationwide group that reviewed the scientific literature and found that the mutations from conventional sequencing panels do not point to a higher risk of radiation toxicity. The findings were published by the International Journal of Radiation Oncology, Biology, Physics. The group, which was convened in
2019 by the American Society of Radiation Oncology, decided that currently no action is needed by doctors or patients. But they also urged research to continue. Kerns’ studies are focused on genomewide analysis instead of the narrower tumor-gene sequencing. The broader approach allows her to test gene mutations that occur in any gene that might be important for radiation sensitivity of normal tissue surrounding tumors. Most often, it’s the normal tissue that is damaged and results in painful and harmful side effects from radiation treatment. “Most likely, we will discover through research that much of the genetic source of treatment toxicity will be a cumulative effect of lots of small gene changes,” Kerns said. “It’s like looking for lots of needles in a haystack. But importantly, the consensus of the panel is that the mutations included in the cancer genetic tests do not, by and large, put patients at higher risk for toxicity.”
Wilmot Cancer Institute celebrates past board chair, welcomes new Dennis Wilmot is stepping down from the Wilmot Cancer Institute Advisory Board after three years as chair and 13 years on the board, and transitioning to the WCI Honorary Board. Wilmot, owner of
Dennis Wilmot 26 find us on Facebook, Twitter and Instagram
Wilmot Development Group and co-owner of REDD restaurant, led the board through the launch of Wilmot Cancer Institute’s current campaign to advance cancer care and research. Richard Yates, Of Counsel at McElroy, Deutsch, Mulvaney & Carpenter in their Corporate Transactions Group, will be the board’s new chair. “We’re very grateful for Dennis’s leadership and are excited to work with Richard on our National Cancer Institute designation efforts,” says Jonathan W. Friedberg, M.D., M.M.Sc., Wilmot Cancer Institute director The board also added four new members: R. Scott Burdett, associate real estate broker,
Flaum Management Co. Inc.; Malik Evans, business and consumer prosperity manager, ESL; Erika N. D. Stanat, partner, Harter, Secrest & Emery LLP; and Eduardo Torrado, DDS, founder, Torrado Dental.
Tailor-made for Older Adults, New Tools Improve Oncologist-Patient Relations A Wilmot Cancer Institute-led study in JAMA Oncology shows that when physicians fully appreciate the concerns of older adults with cancer, such as function and forgetfulness, it elevates patient care and satisfaction. The study is believed to be the first to assess in a randomized clinical trial whether a tool known as geriatric assessment (GA) can meaningfully influence cancer care for vulnerable older people. Many oncologists in community practices are not aware of, or do not ask their patients who are 70 or older, about living conditions, functional ability, cognition, and family support, for example. But impairments in these areas are linked to chemotherapy toxicity, an inability to complete treatment, and an overall decline in health or risk of early death, said Supriya Mohile, M.D., M.S., corresponding author
and the Philip and Marilyn Wehrheim Professor of Hematology/Oncology at the University of Rochester Medical Center. A geriatric assessment can personalize care and prompt better conversations between physicians, patients, and their families, the study found. “We’ve shown that we can modify the behavior of oncologists if they have the right tools and guidance,” said Mohile, who also co-leads the Cancer Prevention and Control research program at Wilmot. “And when oncologists are better informed about the special needs of their older adult patients,” she added, “everyone’s experience is much improved.” Mohile and co-authors suggest that a GA summary should be considered standard care for older adults with cancer, and appropriate interventions based on the
report should be used as needed. The study involved 541 older people with advanced cancer who were being treated at 31 oncology clinics across the U.S., through the UR National Cancer Institute Community Oncology Research Program (NCORP). The oncology practices either received a tailored GA assessment and summary with recommendations for the patient, or the usual alerts related to depression or cognitive impairment. Then, researchers measured patient and caregiver satisfaction with questionnaires and through audio recordings of physician visits. The Patient-Centered Outcomes Research Institute (PCORI) funded the study, as well as the NCI and National Institute of Aging.
Expanded Wilmot Locations Open in Greece and Olean This spring, Wilmot Cancer Institute opened expanded locations in Greece and Olean. Both facilities will allow patients to receive their cancer care closer to home. In Greece, Wilmot’s facility includes medical oncology and radiation oncology services. Located on Bellwood Drive, it is 3,000-square-feet larger than its previous location and features 10 exam rooms, two
private rooms, a multipurpose room which will be used for education and events, and nine infusion chairs. In Cattaraugus County, Wilmot and Jones Memorial Hospital collaborated to create an outpatient cancer care center in downtown Olean. Services at the new center will be provided by Neeta Soni, M.D., who joined Wilmot in 2019 and
has been delivering medical oncology and chemotherapy infusion services in the area since 2003. The 6,000 square-foot center is larger than Soni’s previous clinic, and it will include five exam rooms and 10 infusion chairs, as well as an educational area with computers for patients.
Left: The linear accelerator at the new Greece location. Right: Cutting the ribbon at the new Olean location.
Wilmot Cancer Institute
Cardiac Resynchronization Therapy Benefits Cancer Survivors with Heart Failure
Valentina Kutyifa, M.D., Ph.D.
A pacemaker-like device restored heart function in a group of cancer survivors — mostly women with breast cancer — who had suffered from heart failure as a result of chemotherapy, a recent study in the Journal of the American Medical Association (JAMA) reports. The device was evaluated in a small
observational clinical trial, led by the University of Rochester Medical Center, at 12 cardio-oncology programs across the U.S., including at UR Medicine’s Wilmot Cancer Institute. Known as the MADIT-CHIC study, it was the first of its kind to assess whether cardiac resynchronization therapy (CRT) could improve heart function in patients with congestive heart failure and cardiomyopathy, an enlargement of the heart, due to chemotherapy side effects. After six months with the implanted CRT devices, the 30 patients who received cardiac resynchronization therapy experienced significant improvement. The study, which took place between 2014 and 2018, was designed to address a problem that impacts more than half of people who receive anthracycline chemotherapies. These patients are prone to heart muscle damage, and about 5 percent go into full heart failure, said the study’s principal
investigator and senior author, Valentina Kutyifa, M.D., Ph.D., associate professor of Medicine at the University of Rochester Clinical Cardiovascular Research Center. All of the trial participants did well during six months of follow-up care, Kutyifa said. “Not only did their heart function improve, but they were able to take care of themselves, enjoy life, and do just about everything they were able to do before the illness,” Kutyifa said. “It really gives hope to patients who have survived cancer.” JAMA published an editorial supporting the study and calling for a more “harmonized approach” to cardiac care for cancer survivors. Heart problems can arise early on — from six months to two years after cancer treatment — or as far as 15 to 20 years, said Eugene Storozynsky, M.D., Ph.D., who directs the Cardio-Oncology clinic at Wilmot.
NCI Funds Urban-Rural Cervical Cancer Screening Research A new University of Rochester Medical Center, Department of Emergency Medicine, study aims to reduce the screening disparity for cervical cancer, a highly preventable disease, among women in urban and rural locations. The National Cancer Institute awarded $1.5 million to David Adler, M.D., M.P,H., for a randomized clinical trial at Strong Memorial Hospital in Rochester and Noyes Memorial Hospital in Dansville, Livingston County. The focus is on women, ages 21 to 65, who are not up to date on recommended cervical cancer screenings. Many of these individuals are women of color, Adler said, but not all. Rural white women, for example, also face challenges in accessing cancer screening services. In the study, some women will be randomly placed in a group that receives motivational text messages, based on behavioral-change theory, as a way to urge 28 find us on Facebook, Twitter and Instagram
them to get screened; others will receive a standard referral for screening. Researchers will then compare the two groups and identify whether the text messages are more effective than a routine referral. Adler, a professor of Emergency Medicine, Public Health Sciences, and a Wilmot Cancer Institute investigator, said that emergency departments are an optimal environment to study disparities and reduce them. Researchers plan to enroll more than 1,400 women, who will be asked to consent to taking part in the program. “According to the CDC, the women most likely to have inadequate access to cervical cancer screening are those who use the emergency department as their source for usual medical care,” he said. “Our project aims to leverage this environment to identify women in need of screening and intervene to get them screened.”
The project represents a growing collaboration between Emergency Medicine Research and Wilmot, which draws patients from a 27-county region in upstate New York. In the future, Adler and his team plan to conduct similar studies to improve screening rates for colorectal, breast, and lung cancer. Co-investigators are Beau Abar, Ph.D., associate professor of Emergency Medicine; Nancy Wood, M.P.A., M.S., project manager, Emergency Medicine; Karen Mustian, Ph.D., M.P.H., co-leader of Wilmot’s Cancer Prevention and Control research program; Supriya Mohile, M.D., M.S., co-leader of Wilmot’s Cancer Prevention and Control research program; Adrienne Bonham, M.D., M.S., associate professor of Obstetrics and Gynecology; Kevin Fiscella, M.D., M.P.H., professor of Family Medicine; and Sydney Chamberlin, M.D., senior instructor in Emergency Medicine.
Virtual Discovery Ball Draws Real Support for Cancer Research Wilmot’s 21st annual Discovery Ball went virtual this year and raised more than $240,000 to advance care through clinical trials, drive new discoveries, and help recruit, retain, and educate world-class faculty and trainees. Originally planned for May 2, the event on June 20 featured stories of patients whose lives were changed by clinical trials and of the researchers who are looking for new treatments. Emceed by Adam Chodak, the event also included highlights of Wilmot’s accomplishments over the past year and plans to apply for National Cancer Institute designation in 2021. It featured music by singer-songwriter Elvio Fernandes, who is a member of the Grammy-nominated band Daughtry, as well as a video message from Grammy Award-winner Nile Rodgers, who underwent surgery for kidney cancer at Wilmot in 2017. “With no prior experience of a virtual event to draw upon, we tried to mirror the in-person event the best we could.
However, we were unsure of the interest we would generate,” said Wilmot Advisory Board member Keith Yeates, who chaired this year’s Discovery Ball with help from a committee that included Keith Cleary, Patrick Cunningham, Jayne DePoint, Kathy Landers, Michael Linehan, Michael Reed, Erika Stanat, and Jenny Stenzel. “We were blown away by the support we received, with 197 people signing up, about 400 attendees if you include family and friends, and close to a quarter of a million dollars raised,” Yeates said. The Wilmot Advisory Board and the Discovery Ball Committee made a pledge of over $100,000 to Wilmot as part of the event. “We extend our deep gratitude to Keith Yeates and the entire Discovery Ball committee, for all of their hard work and commitment to our mission,” said Wilmot’s director Jonathan W. Friedberg, M.D., M.M.Sc.
“We were blown away by the support we received,...”
Above: Keith Yeates At right: Wilmot board member Doug Parker tuned into the virtual Discovery Ball with family and friends.
Wilmot Cancer Institute would like to extend a sincere thank you to our special sponsors of the 2020 Discovery Ball. Your generosity has demonstrated your strong support for advancing cancer research in out community. •
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Wilmot Cancer Institute at Strong Memorial Hospital's News Magazine - 2020 V1