Archive for March, 2012

 

Mar 25 2012

Planes, Trains and Automobiles

by at 10:20 pm

This was a week with a lot of long days. I had a work-related dinner on Monday evening (a recruitment). Then it was off to Union Station for an 8 am train to New York, where I serve on the Advisory Board of the Israeli Cancer Research Fund, which distributes money to Israeli grantees.

From there I went to Hackensack University Medical Center to be introduced at the HUMC annual meeting. I then was whisked off to Newark for an 8 pm flight to Boston – which left promptly at 12:30 am, when the crew finally arrived from San Francisco. There is not a lot to do in that airport other than to eat in an airport facsimile of a New Jersey diner (I have a more than passing familiarity with such establishments from my high school years), but at least I got some work done.

After getting into my hotel at 2 am and catching a bit of sleep followed by a brief workout, my meeting started at 8 am and ran all day. I got home later that evening.

Thursday was only slightly less hectic. My first meeting started at 8 am, where Miriam Markowitz briefed the Medical Center leadership about plans to improve security. The plans are quite comprehensive, and clearly reflect a close collaboration between the Medical Center and the University’s Department of Public Safety. I had a busy afternoon clinic, and then hustled off to attend the Hope Connections for Cancer Support (formerly the Wellness Community) annual gala at the World Bank. Liza Marshall, one of the program’s co-chairs, presented an award to             Lombardi for our contributions to the mission of their wonderful organization, which offers a wide variety of complementary services to cancer patients and their families. I was honored to accept the award on behalf of Lombardi. The beautiful vase we received will be displayed prominently in the Lombardi clinic lobby.

On Sunday morning Harriet and I attended the Scope it Out 5K, sponsored by Chris4Life Colon Cancer Foundation, to raise awareness about colon cancer screening. Mike Sapienza, who leads Chris4Life, has done a remarkable job – the 5K walk attracted about 3,500 runners and walkers.

Lombardi and its team had a great representation, including Mike Pishvaian (who fielded questions from people about screening and other colon health issues) and Patrick Jackson (who came out to run in the event). I should note that this foundation has committed more than $1 million to support the Ruesch Center’s work, and we are incredibly grateful for that support.

Christian Conant did a great job of organizing Lombardi’s efforts, ably assisted by Carol Pribulka and Lauren Wolkoff – and they arranged for the availability of nifty little pedometers for interested participants. Harriet and I walked the 5K route, and finished the 3.3 miles in 56 minutes. I then was asked to make a few remarks at the event following the race. I noted that this is one of the cancers that is easily curable because it usually can be prevented by screening studies such as colonoscopy, using approved guidelines based on age and risk. This is one disease where prevention is possible, and thus every advanced cancer is a particular tragedy.

As the program unfolded, I was struck that it highlighted a large number of young people who had been diagnosed with colon cancer, which typically occurs in people who are older. This made me think of a 20-year-old college student I first saw about eight years ago, when she was diagnosed with a colon cancer and a synchronous, solitary liver metastasis. Genetic testing showed no predisposing conditions such as HNPCC, and there was no family history. She had appropriate surgeries to remove her primary tumor and the metastatic disease, and then I administered six months of adjuvant chemotherapy. She finished college and went to work in her father’s business, and resumed her habit of being the life of every party, any party. She was incredibly sweet and vivacious.

Two years went by, and then a CT scan of the chest showed two tiny nodules in the right lung. The nodules grew, and I arranged for her to undergo thoracoscopic resection of the areas of concern. They showed adenocarcinoma, consistent with a colonic primary. I recommended additional chemotherapy. Engaged at that point, she and her fiancee’ wanted to know about issues such as  the impact of treatment on fertility; I was worried about her survival, and actually met with her fiancee’ at his request and with her permission to give him candid information about her prognosis – which was not good. We determined that she was likely to retain her fertility, and he was determined to see it through with her. So, she received an additional six months of chemotherapy. Then we began watching her, waiting for the other shoe to drop.

Our fears were not realized. They got married, and she is now five years out following the completion of her second round of chemotherapy. And, at the end of last year I received a message, with a picture of their beautiful new baby. I still get goose bumps when I think about it.

This is such a great story. Using all the tools at our disposal, a young woman with a terrible cancer was cured, and now has a chance to live a full and long life. Moreover, by curing her we have enabled the creation of a new life, with perhaps more to come. Now, think about future generations of this growing family, and about how many new lives will be created and impacted just because we did not give up on this young woman with a bad disease. Now, think about what might happen if we prevent such cancers, and develop better treatments for those who are afflicted. And then, do the math.

Now you know why I walked on a cool, misty Sunday morning to help raise awareness of colon cancer. because every saved life means so much, not only for today, but for the future.

Have a good week.

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Mar 18 2012

Help our Avon Walk Team Meet its Goal

by at 10:12 pm

What a terrific weekend! While Saturday was a bit overcast, Sunday was about as good as it gets. In the morning I decided to go hit some golf balls at Haines Point, forgetting that the cherry blossoms and the Park Police had other ideas in mind. So, I scooted out to Potomac, and thoroughly humiliated myself in front of a group of perfect strangers at the Falls Road Golf Course and Driving Range, most of whom had never witnessed such a putrid exhibition of shotmaking. So, nothing has changed, and all of my “winter swing thoughts” turned out to be hallucinations. Oh well, now I’ll have to wait until next winter to feel good about my game.

On Sunday afternoon I accompanied Harriet to the Atheneaum in Alexandria to attend the opening reception for the Botanical Art Society National Capital Region’s Art Show. Harriet was Exhibit Chair, so I was delighted to meet the exhibiting artists and be her guest. At one point I stepped onto the sidewalk to check out the NCAA tournament basketball scores (I picked Kentucky to go all the way, though I had hoped that Georgetown would at least get to the Sweet 16 this year). So, while hunched over looking at the scores, I heard a familiar voice, but one that was out of context, as it belonged to a “St. Baldrick’s bald” Ray Mitchell, who had been checking out the exhibit. Small world!

As always, last week flew by, marked by the usual torrents of meetings, attending the funeral of one of my patients, and three consecutive evenings out on work-related dinners. We have a lot of good stuff going on in the lab, and I look forward to sharing some of the work we are doing when it’s my turn to give a research update in a couple of weeks.

On Wednesday, after returning from the funeral, I attended the Research America Celebration at Mellon Hall, where one of the honorees was Margaret Foti, CEO of the American Association of Cancer Research. Marge has been a good friend, and more importantly a dynamic and effective leader of the AACR for many years. I was delighted to be able to honor her accomplishments.

On Thursday, a small group went out to dinner with the lead candidate for a major clinical and clinical research position at Lombardi; Mike Atkins was in town, and joined us at dinner. Then on Friday evening Harriet and I attended a reception for the lead candidate for Chief of Surgical Oncology at the home of Lynt and Gloria Bowles-Johnson.

Saturday brought an opportunity to catch up a bit on sleep, and we drove up to Baltimore to visit our grandson. All in all, a full week.

One reminder; Lombardi’s CBCC team is doing a great job gearing up for the Avon Walk for Breast Cancer, which will be held on May 5-6, 2012. Jeanne Mandelblatt and the team of 44 walkers are currently in second place in fundraising for the walk, but need everybody’s participation and support. Some of the walkers have not yet been able to raise any money, and won’t be able to walk if they don’t meet the minimum requirement. I met recently with Marc Hurlbert from the Avon Foundation, and you can be sure that he mentioned our efforts on behalf of the walk on several occasions! So, all the hard work is definitely noticed. Please come out to walk if you can, cheer if you can’t walk, or support one or more of the walkers if you cannot walk or cheer. More information can be found here, or visit the team’s fundraising page here. Congratulations and good luck to Jeanne and the whole team!

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Mar 11 2012

A Jam Packed Weekend

by at 11:36 pm

I just don’t know where the time flies.

This past Thursday I participated in two really interesting meetings. As I have mentioned previously, we have been discussing a formal relationship with Hackensack University Medical Center (HUMC), with an initial emphasis on a HUMC-based bone marrow transplantation program based at Georgetown University Hospital. The purpose of the morning-long meeting was to discuss opportunities for more broadly based cancer center interactions. We discussed how to expand existing clinical trials, how to build new collaborative clinical trials and how to address regulatory and protocol management issues.

We were fortunate that our incoming deputy director, Mike Atkins, was able to fly in for the meeting, and we all benefited from his deep understanding of network-related clinical trial relationships. All in all, it was a very productive meeting. Mike Pishvaiain made a brief appearance, but was simultaneously engaged in a very well-received “Doctors Speak Out” panel discussion with John Marshall and Bruce Luxon on gastrointestinal cancers.

Later that day, I concluded a truncated clinic and traveled up to NCI for a meeting of a small group of extramural immunologists with Harold Varmus and a few other NCI senior leaders to discuss ways to take advantage of recent major clinical advances in cancer immunotherapy. Dr. Varmus was deeply engaged and encouraging. I did make the point that the remarkable results with ipilumumab (anti-CTLA4 Ig) and PD1 antibodies in diverse cancers make it clear that our field will be judged for how effectively these exciting results can be incorporated into clinical care and utilized as platforms for exciting new combination treatment strategies. We are fortunate that Mike Atkins has been at the forefront of developing these agents, and we can expect to make important contributions in the future.

The work highlight on Friday clearly was the ACS Young Investigator Symposium, which featured talks by John Deeken, Roxanne Jensen, Lixin Mi, Ayesha Shajahan and Huei-Ting Tsai. The symposium clearly was indicative of the depth and quality of our emerging researchers. Congratulations to all speakers and participants, and thanks to all who have mentored these outstanding young scientists!

On Friday night Harriet and I attended the annual Prevent Cancer Foundation Gala at the National Building Museum. The Foundation has generously supported Georgetown Lombardi research for many years. We were joined by colleagues Marc Schwartz, Kate Taylor, Ken Tercyak and his wife, and Joe Teague and Carol Pribulka. We ran into one of our next door neighbors, and also into Sandy Swain and her husband, Steve Jones.

The evening whizzed by. Saturday was quite busy too, as it started with a breakfast meeting with Andy Pecora from HUMC to debrief the Thursday meeting and review his Friday meetings with key GUH and NCI folks who are involved in discussions to establish a joint bone marrow transplant program here at Georgetown. Then I had to go to a tailor to have a lot of my clothing altered; the combination of reduced caloric intake and increased exercise has led to gratifying results, but has wreaked havoc with my wardrobe. While this was happening our son David called to tell me his parked car had been nearly crushed by a hit-and-run driver sometime in the middle of the night. I went over to his place to assess the damages, and to say goodbye to his vehicle as it was being towed away to its final resting place. Somehow, this is going to cost me money …

The day took a better turn when we were visited by our daughter and grandson, Isaac. Isaac now speaks, runs around and tries to whack golf balls around – more proof that he has a promising future as a golfer!

On Sunday I attended a MedStar Health Research Institute Retreat in Stevensville, MD; it is very interesting to view the world of research from the perspective of a large health system. It is equally interesting to know how much interest, resource and effort is being placed into cancer research by MedStar.

After getting home and having a bite to eat, I then set about the task of vetting the more than 40 applications for cancer center-related developmental funding. My task was to assign reviewers for the many proposals. Given the high quality of the applications, I expect this to be highly competitive, and look forward to the formal review process that will occur over the next few weeks.

All this, plus we lost an hour of sleep due to Daylight Savings Time. I think it is time to get some rest.

 

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Mar 04 2012

Revisiting a Transatlantic Memory

by at 9:32 pm

I hope you enjoyed a weekend that turned out to have remarkably good weather. Harriet and I took advantage of the lovely day on Sunday to walk to the American Museum of National History; I had not been there for years. It was a really interesting few hours, and I was a bit surprised to be so moved by the exhibit showing the American flag that flew over Fort McHenry, and was the subject of the Star Spangled Banner.

I was also delighted to see an exhibit about the SS United States. Built after World War II, this ship was once the fastest and fourth largest commercial ocean liner in the world. As a child I sailed on the SS United States with my family, to meet my maternal grandparents and my extended family in Belgium. Even though I was quite young I have so many fond memories of that trip. Throughout elementary school I was known as the little boy who had been to Belgium (overseas travel was still quite exotic to residents of the Philadelphia suburbs). I must have drawn hundreds of renditions of that boat (all of them poorly) following our return. So, seeing the exhibit this weekend was like unexpectedly running into an old friend.

The work week was interesting as well. I had a productive dinner meeting with MedStar Cancer Network leadership, which continues to be developed as a clinical and clinical research enterprise. Don’t you think that MedStar’s new commercials are compelling and effective? As we roll out the Cancer Network, this type of advertising could prove to be very powerful.

Thursday was particularly memorable. I was one of the judges for Lombardi’s annual Research Day, and tried to see as many posters as possible. As was true last year, I was deeply impressed by the depth and excellence of the work done by our students and trainees. It was great fun to talk withthe poster presenters, and then to help preside over the award ceremony on Friday. Congratulations to all of the winners, and thanks to everybody who participated. I was very happy for Joe Murray, an MD/PhD student in my laboratory, who took home a prize; he has done a great job, and like everyone in my lab, he makes me look better than I really am!

On Thursday afternoon I had clinic. For those of you who have followed my recent blogs, you will remember my young patient with metastatic colon cancer. He came in for a visit, feeling better, with more energy, less abdominal cramping but continued abdominal pain requiring narcotics. He is continuing to receive chemotherapy, and will come back in a bit more than a month if all goes well, with a CT scan performed to assess his response to therapy. We are all hoping for a good report, so he can focus on his new child, and so we can move forward towards definitive surgery for his colon cancer, and perhaps, his liver metastases as well.  Once his colonic primary has been removed, we then hope to be able to add bevacizumab to his treatment regimen; this anti-VEGF antibody can cause bleeding and perforation when the colonic or rectal primary is in place.

Help me. I need better treatments for this young man, and for every other patient. Every person with cancer is important to so many people, and he is no exception. For all of their sakes, we need to act with urgency.We also need better ways to assess risk, modify lifestyles  and prevent cancer. This can only be done through research and discovery. This is what gets me out of bed every morning. How about you?

 

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