From the Desk of Dr. Louis M. Weiner

Only 19 years old, she came to the United States on a boat, leaving behind a country ravaged by years of war and by a peace that was nearly as awful. Passing by the Statue of Liberty, a symbol that defines the better parts of this great nation’s values and character, I wonder if she pondered the irony that a similar boat had been turned away from America’s shores, only a few years earlier, dooming its desperate refugees to savage, unimaginable fates. She did not yet know enough English to read those ennobling words, “Give me your tired, your poor, your huddled masses…” In post-war America, she was very different – a member of a religious minority, with virtually no comprehension of English, no understanding of American values, history or culture. In a still insular America, she was a foreigner.

My mother’s parents sent her to the USA on a student visa to spend time with family in Youngstown, Ohio. Post-war Europe was dangerous and desperate. Vigilante justice was admixed with a healthy ration of persistent antisemitism. Having spent four years in hiding during the war, my mother’s very existence, to say nothing of her full potential, was in danger.

Youngstown was not then (and is not now) anybody’s idea of paradise, but after years of hell, it was a godsend for my mother. While there, her cousin Sally used her visit as a pretext to visit the big city – Pittsburgh – so they could go to a party with college students on the eve of the Penn State – University of Pittsburgh annual football game. My father, a Penn State student and World War II veteran, was at that party, and they hit it off. The rest of the story is, in a very real way, my history.

They had a whirlwind courtship, but when the six-month visa was up my mom had to return to Belgium for two years before she could return to marry my father. She returned, they married and started a family. The INS officers assigned to shadow her as a resident alien during the McCarthy era actually were very helpful; one of them used to help my mother hoist my baby carriage up the stairs from the street to our apartment. In my suburban Philadelphia elementary school my brother and I were the only children with an exotic, foreign-born mother. Hard to believe…

But times change. A few years later she got a letter from the INS wondering why she had not yet applied for citizenship. The United States was asking her to become an American citizen! So she did, and my brother and I were forced to don hideous seersucker suits to be with her and my father as she proudly took the oath as a citizen of this wonderful nation.

The America I love accepted that young foreigner. Because of that act, I exist, as does any of the good I have done in my life. Because of that act, my children and grandchildren have had the gift of life with the attendant freedom to dream big and make this world a better place. The America I love made this happen.

I have had the great privilege of working with countless talented physicians, scientists and staff here at Georgetown and elsewhere during the course of my career. Many of these wonderful people have been foreign nationals. Just this past week I found myself at my lab meeting, marveling at our remarkable ethnic, cultural and religious diversity – with everyone working to together with a shared focus on defeating cancer – the ultimate terrorist. I am proud to work with each one of them, and with all of my colleagues from around the world. I intend to continue working with them, always hearing my mother’s voice, silenced by death but living within me, reminding me, “Louis, what’s right is right.”

Let’s keep that in mind as we go about our work and our lives.

In other news, members of the Ruesch Center for the Cure of Gastrointestinal Cancers made the most of this year’s ASCO Gastrointestinal Cancers Symposium held January 19-21 in San Francisco. Mohamed E. Salem, MD, gave an oral presentation, “Molecular variances between rectal and left-sided colon cancers“, which was written about here. Salem was also quoted in Healio Gastroenterology and appeared in this video. Two poster presentations featured research from summer student groups led by A. Ruth He, MD, PhD, and Keith Unger, MD. The Ruesch Center also organized successful meetings with GI Cancer Alliance Network, the GI Cancers Alliance and the PARP working group.

Harriet and I took a long-planned weekend out of town to celebrate our wedding anniversary and have a delayed celebration of her birthday. Depending upon what one seeks in life, the timing was either abysmal or fortuitous. An inauguration is always filled with excitement, but it sure sounds as if the Women’s March added a whole new dramatic dimension to the events of the past few days. Each of the two components provided a profoundly important example of American democracy in action. All in all, I think we were better off being on our relaxing little vacation.

Last week was truncated by the MLK holiday, and then by our Thursday departure. But there was still plenty of work to do. My most memorable event was a Tuesday evening meeting of Friends of Lombardi, a group of younger supporters of the cancer center. They are our future, and their commitment to our cause is quite remarkable. I want to share a story I told them because it really exemplifies our commitments to both precision cancer medicine and immunotherapy.

In October I saw a new patient, sent to me from an oncologist at St. Mary’s Hospital, one of our Medstar Georgetown Cancer Institute affiliates. This 48 year old woman saw her dentist for a growth in her mouth and was found to have a neurendocrine tumor thought to be of gastrointestinal origin. It was removed and she then received proton radiation therapy at the University of Maryland. Unfortunately, she developed metastatic disease to the lungs and the liver, and was sent to me for a consultation.

This is a very unusual situation. I had no idea what to suggest. So, I ordered molecular profiling through Caris. As you may know, Lombardi is the lead institution of the Caris Centers of Excellence, which is overseen by John Marshall. The Caris molecular profile entails targeted sequencing of nearly 600 genes, with additional immunohistochemistry tests performed to provide a comprehensive molecular fingerprint of the cancer. It turned out that her malignancy had a high mutation burden, and also expressed high levels of PD-L1, an immune checkpoint. Armed with this information, I recommended that she receive therapy with an antibody targeting either PD-L1 or PD1. We were prepared to offer her therapy on a clinical trial but she wished to be treated closer to home, and the information we had obtained was sufficient for her insurer to approve an anti-PD1 antibody therapy for her. A CT scan obtained as a baseline study demonstrated significant worsening compared with four months earlier. So, she started anti-PD1 therapy in October.

She was scheduled to see me for an interval visit in January, but called, asking why she needed to come since she felt fine and her CT scan showed improvement. Indeed, her CT scan is improved, and a woman with an otherwise very limited life expectancy now has a second chance at a long life. People who respond to these agents tend to do very well for a long time. My only regret in not seeing her in January was that I could not break into a bit of victory dance to celebrate her encouraging outcome. In another era (i.e., only a few years ago) she would have been consigned to palliative chemotherapy that likely would have had little benefit for her, and she would have lost her life. I cannot begin to convey how honored and humbled I am to be a part of the transformation of cancer medicine in a way that helps people like this patient live with hope.

This case illustrates the promise of precision cancer medicine, the transformative power of effective immunotherapy and the value of having a broad cancer network that assures world class therapy for patients wherever they live.

One final note: Jan Blancato has been organizing a wonderful class, entitled “Translational Oncology Class Spring 2017”. It is a great way for scientists to learn about the clinical challenges and opportunities that can and should inform our science. The class meets on Mondays from 10:30 a.m. to 12:00 p.m. in Research Building W302. This week’s talk on Monday, January 23 is about cancer survivorship by Jamie Holloway, PhD, a graduate of the tumor biology program and a breast cancer survivor and advocate. On Monday, January 30, Jay Zeck, MD, GUMC breast pathologist, will discuss the steps of surgical pathology and explain the breast cancer pathology report. Check it out!

Have a great week.

Is it cold enough for you? Compared to the frozen tundra of Lambeau Field in Green Bay, where teams not based in DC or Philly played a football game, today our cold snap is a relative thaw. But, now that we’ve had our first snowfall, I for one hope it is our last for the year.

Last week saw a gradual ramping up of work, and this week promises to be very busy. We have tickets for Monday night’s Georgetown game against St. John’s, and hope to go if I can get out of work on time. It will be a busy Monday. We received initial feedback from our cancer center’s External Advisory Committee, and will be going through it in great detail at our Executive Committee and Program Leaders meetings, with the goal of using it as our guide as we commence our planning for our CCSG renewal application. We have a lot of work to do!

Have a great week.

Happy New Year! I hope your holidays were wonderful and restorative.

I am back at work, caught up, rested, refreshed and finally freed of the upper respiratory infection that tormented so many of us in December. We pretty much had a “stay-cation” these past 10 days, spending time with friends and family in DC, Philly and Baltimore. As is our Christmas week custom, Harriet and I saw a bunch of movies – this year, it was ‘LaLa Land’, ‘Moonshine’, ‘Lion’ and ‘Manchester by the Sea’. We also watched a funny action movie, ‘Nice Guys’ at home on New Year’s Eve with Ken and Sarah, who spent the night at our place. There is nothing like watching a cartoon ball drop at 7:30 pm on New Year’s Eve so our grandchildren Ella and Eli can also ring in the new year before going to sleep!

Each movie was wonderful in its own way. ‘LaLa Land’ was clearly the most fun, and as an old movie buff and lover of classic Hollywood musicals, I was really happy to have seen it. “Moonlight’ is the type of great movie that grows on you over time – its plot is anything but formulaic, but it is so raw and real it is hard to not be swept up by its narrative. ‘Lion’ was a pleasant surprise – wonderfully evocative and very moving. ‘Manchester by the Sea’ is brilliantly acted but a bit too relentless in its misery for my personal taste. And, if you like stylish, witty action thrillers, ‘Nice Guys’ is worth a Netflix rental. There are a few more movies we’d like to see, and hope to get to them over the next few weeks. I had expected to see ‘Rogue One’ with Isaac, who is a Star Wars freak, but he would rather see it when it comes out on Netflix for some reason. So, I’ll wait, along with him.

2017 promises to be a very busy and exciting year for our work here at the cancer center. First and foremost it will be time to begin assembling the competitive renewal of our CCSG, which is due in May 2018. It’s a huge amount of work that involves many of us, but it also is an exciting way to think deeply and rigorously about who we are, where we are at this moment in time, and where we want to be five or six years from now. In its own excruciating way, it is an exhilarating process.

I wish you happiness and success in everything you do in the coming year.