SARAH SURGENOR's Weblog

 

Jan 17 2020

50 Years

Greetings from Florida, where I am attending the annual Breast Cancer Think Tank. I just listened to a fascinating talk on targeting mitochondrial metabolism driven by ERRalpha. My first exposure to serious science was at a lab during my undergraduate years, where we studied mitochondrial respiration in cardiac mitochondria. Ironically, the laboratory pavilion was named in honor of a surgeon who had operated on my grandfather, for whom I am named, who died before I was born.

Here I am, 50 years later, learning new insights into how mitochondrial targets can be exploited for cancer therapy. What a journey! I have been so lucky to bear witness to these advances.

Our meeting ends on Friday evening, when I speak about our work on understanding mechanisms of resistance to antibody-initiated immune attack. Harriet and I then head up to Tampa, where after visiting with friends over the weekend I will be doing fundraising meetings for Lombardi. Accordingly, I will miss Monday evening’s event at the Kennedy Center commemorating Martin Luther King Jr. Day.

Tying together these two threads, 50 years and the MLK remembrance, is a very big anniversary.

2020 marks an important milestone for our cancer center as we celebrate Georgetown Lombardi’s 50th anniversary. Georgetown Lombardi Comprehensive Cancer Center was established in 1970 at Georgetown University Hospital. The next year President Richard Nixon signed the National Cancer Act, launching the National Cancer Program, and in 1974, Georgetown Lombardi became one of the first in the nation to carry the coveted distinction as a National Cancer Institute designated Comprehensive Cancer Center. Today we remain the only such cancer center in Washington.

Throughout the year, you will notice that our communications will carry our commemorative anniversary logo and we will be highlighting our achievements of the last 50 years at various junctures.

On Friday, an informative insert about Georgetown Lombardi was published in the Washington Business Journal highlighting what we have achieved and also our plans for the future.

Given that this weekend is designated to honor the legacy of Dr. Martin Luther King Jr., I’m reminded that while recognizing achievement is important, there is much work to be done going forward. This is especially true in closing the health disparities gap that remains strong in the District where we have some of the highest cancer incidence and death rates in the country. Georgetown Lombardi remains deeply committed to having a role in defining, and redefining, strategies to mitigate this seemingly intractable challenge.

Clearly, there are many hurdles still to cross as we trudge on, but we do so standing on a foundation built here at Lombardi over the last 50 years and in partnership with researchers and clinicians around the world.

The last 50 years have been remarkable, but what’s to come will be genuinely breathtaking, due to the work we do and the impact that work will have.

Have a wonderful week.

Lou

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Jan 12 2020

Recovery Mode

Greetings on a Sunday evening from Florida. I am attending a research meeting this week, to be followed by a series of fundraising meetings in the Tampa area for Georgetown. I can’t say I am disappointed to leave the DC area for a week or so in January, though it was pretty warm when Harriet and I boarded the plane this morning.

The meeting comes at an opportune time, since I was really knocked for a loop by my sinusitis and cough. I pretty much rested earlier in the week, but was able to get stuff done at home and then at work. I had an active clinic on Thursday, and then took a day trip up to Hackensack on Friday for some CCSG consortium-based meetings. After being placed on a Medrol Dose Pack earlier in the week I finally began to improve and now only cough when I have to speak a lot. I expect to fully recover over the coming week – finally. The meeting is organized like a Gordon Conference – with plenty of work to do but time set aside every afternoon for a bit of relaxation. It’s just what the doctor ordered!

I will be sorry to miss the Georgetown Kennedy Center Martin Luther King event on Monday, and especially sorry to miss the ceremony honoring Sharon Levy and Karen Howenstein when they receive the President’s Excellence Awards for Staff and AAP Members. We have so many exceptional colleagues. For example, Sharon has long been indispensable to the success of the CRMO and more recently the CCSG. In her role as CCSG administrator and Associate Director for Administration she really makes the Cancer Center tick. Congratulations, Sharon and Karen as well!

Have a great week.

Lou

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Jan 06 2020

Happy New Year!

Welcome to 2020. I trust you all had a wonderful holiday break. I did, though I continue to battle with an annoying but certainly not dangerous case of chronic sinusitis. I was scheduled to fly to Tucson on Sunday for meetings at the University of Arizona Cancer Center. But discretion was the better part of valor so I will see my internist on Monday instead.

We have a lot of work to do in 2020, but we have a good head of steam heading into the year. Over the past two weeks we concluded the successful recruitments of three outstanding investigators who will join us over the next few months. You will hear more about them in the coming months.

Now for some cough suppressants!

Have a great week.

Lou

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Dec 15 2019

Last Blog of 2019

This will be my last blog of 2019. It has been an eventful year, both professionally and personally. In work, we received CCSG approval as a consortium, are in active recruitment mode and have been working very hard to reorganize our science. At home, Harriet and I welcomed our sixth grandchild and spent a lot of time at the beach.

We are heading into 2020, which will be a momentous year as we continue to move forward, all of us with an eye on the upcoming 2020 elections. The political drama is quite real and will have important impacts on the future directions of cancer research. I am sure many of us will keep more than a casual eye on the happenings here in DC. However, cancer remains my major focus, and I intend to do everything in my power to assure that Lombardi continues to make transformative progress.

We are knee deep into the holidays, and I want to wish each and every one of you a Merry Christmas, Happy Chanukah, Happy Kwanzaa and a joyous, productive and healthy new year. Happy New Year!

Lou

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Dec 08 2019

Remembering a Colleague and Friend

Greetings on a chilly but seasonable Sunday evening. We entertained friends from Philly this weekend and spent part of the day at Glenstone Museum in Potomac. It is an idiosyncratic but very beautiful museum that houses a most impressive collection of modern art. I had always assumed that the many rules and constraints on the visitor experience at the former location of the Barnes Foundation just outside of Philadelphia was the premier example of an unwelcoming environment for art appreciation, but Glenstone is now the undisputed champion. It is a marvelous but somewhat cold experience, well worth at least one visit if you like modern art.

Last week was very busy, including a formal site visit of the Department of Oncology at Thomas Jefferson University in Philadelphia, but the event that I certainly will remember with sadness is the death of our colleague and friend, Eliot Rosen. Eliot passed away on Wednesday evening, two weeks following surgery for a glioblastoma that had been diagnosed in August. As many of you know, he had experienced a stroke a few years ago, ultimately leading to his retirement. Eliot was a former co-leader and member of Lombardi’s Molecular Oncology program, and a very successful and productive scientist with an interest in regulating sensitivity to ionizing radiation. He was a radiation oncologist who found his calling in science. A thoughtful contrarian by nature, Eliot loved nothing more than a good political debate. I did not usually agree with him, but respected his opinions and learned from him as well. Even though he was no longer actively involved in our community’s day to day activities, his passing leaves behind a hole that cannot be filled. He will be missed.

I have rarely had busier days than I did on Thursday and Friday. It did not help that my upper respiratory infection had morphed into a sinus infection. It was a long day: My Thursday afternoon clinic was unusually busy, so I was about a half hour late for the GUMC Community Meeting. I then decamped to visit a patient in the Medical ICU and scooted up to E503 to participate in the last half hour of the Immunotherapy Interest Group, which featured presentations from our New Jersey colleagues. Along the way, I was able to stop by the GWIM reception. Congratulations to all those who were honored especially our own Eleni Tousimis, who received the Karen Gale Karen Gale Outstanding Achievement Award and Catherine Lai who received the Eisenberg Early Career Development Award.

Friday was even busier. Following two morning meetings at MedStar Washington Hospital Center, I hustled over to the Omni Shoreham Hotel to deliver brief remarks at the well attended and highly successful annual Ruesch Center Symposium, which was highlighted by a John Marshall sighting. I then hurried back to my car and returned to Georgetown in time to catch the first half of Grand Rounds, which were presented by Cliff Hudis, the CEO of ASCO. I then hurried off to the Lombardi Clinic, picked up my white coat and headed up the the Pediatrics Unit to be interviewed by ESPN for its annual Jimmy Valvano commemoration; ESPN and the V Foundation are great champions for cancer research. I then moved back to the Research Building to join in the luncheon with Dr. Hudis. After that, I had a few meetings (including a visit to the ENT suite to be examined and get treatment for my sinusitis), and then dragged myself home. Fortunately, I feel better and look forward to a productive work week as we head into the holidays. It will be a busy week for all of us, but don’t forget that our annual holiday party will be held on Tuesday evening, starting with cocktails in the Lombardi building, and then crawling over to the Leavey Center for the rest of the party. I hope to see you there!

Have a great week.

Lou

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Dec 02 2019

On Being Human

Good morning. I hope you had a wonderful Thanksgiving Holiday. I am still feeling the warm afterglow of spending time with family and friends, and the joy of turkey dinner leftover lunches as well. Somewhat more remotely, I am deeply grateful to our great Lombardi Gala team for putting together our most successful Gala ever. Special kudos to Cristy Seth and Sharon Courtin for their diligent and highly professional leadership, making the evening as close to effortless as any high-stakes event could be. Thank you!

Last week reminded me of the enormous transformative power that every person has, and so often that power comes unexpectedly and quite wonderfully. On Monday I saw a new patient, an older gentleman from a southern state who came in for a second opinion. He is a retired attorney and veteran and is scion of a large family. If Atticus Finch was real, he might have been this man.

In the course of our conversation he asked if it mattered what kind of radiation therapy he might receive, amongst the many options. Knowing that he would not be receiving his care at a comprehensive cancer center I used a baseball analogy, explaining that while a great fastball might be the best possible pitch that can be thrown, every pitcher that makes the major leagues has one great pitch. It might be a slider, it might be a curveball, or it might indeed be a fastball. When it matters the pitcher throws his best pitch. I told him the same would be true for his radiation oncologist. My analogy resonated with his son, who mentioned that his dad was a huge baseball fan. That simple engagement pulled my patient into storytelling mode. Speaking in a rhythmic cadence, with a gentle drawl he spun a yarn about his childhood. In 1945, every man in town followed baseball games, which were not available on radio, by heading down to the local B’Nai Brith Lodge (a Jewish social organization, similar to the Elks) and would sit outside on rockers as someone with access to a telegraph feed would hold up cards telling the play by play. Well, my patient had constructed a crystal radio, and was able to listen in one night from his home to a game between his beloved Chicago Cubs and the town’s local favorite team, the St. Louis Cardinals. The Cubs improbably rallied to win dramatically in the ninth inning. He hopped on his bicycle and rode down to the lodge. Knowing that the telegraph feed was usually an inning or more behind real time, he began taunting the crowd of Cardinals fans, who responded by placing bets over the outcome of the game. Of course, he won, and rode home with a small bag containing a treasure trove of change.

His father, a judge in the town, found out about all of this the next day, and called his son into his chambers. The boy fessed up and was instructed to give back the money. Of course, he could not remember who had bet how much. So the judge decreed that the next Sunday, when they went to church, the collection plate would have an unusually large amount of change in it. As we wrapped up the visit, my patient, clearly a man of remarkable character and the product of a small town, then told me he had one major objective with respect to his disease: he wants to live long enough to vote against the current president. So much for reflexive stereotyping based upon conventional demographics…

On final note this morning, my thoughts are with Andrew Pecora, whose sister Debbie died last week. I had the privilege of attending her funeral. This woman with Down syndrome affected so many people and the filled chapel contained many tearful faces of people who remembered her remarkable impact on everybody she met. I am so glad we showed up and as a reward were reminded of the importance and value of every human life.

Lou

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Nov 18 2019

My Birds are Cooked Before Thanksgiving!

Greetings on a chilly Sunday evening. The football fortunes of both Washington and Philadelphia have been (in the case of DC) and now are, for the Eagles, basically toast. Pitchers and catchers report in about three months, though!

Please remember to attend Monday’s GUMC Convocation to celebrate the accomplishments of two special Lombardi members, the GUMC Lifetime Contribution will be presented to Dick Schlegel and the GUMC Outstanding Service Award to Carolyn Hurley, among other highlights! I will have to skip the reception that follows to host our Internal Advisory Committee meeting, which is chaired by Sandy Swain.

I returned to DC late Friday after a productive fundraising trip in San Francisco. I then received our preliminary letter from our EAC, which made many useful suggestions regarding our recruitment plans and program structure. I will be discussing these at our next Faculty Sector meeting and hope all faculty will attend.

I am looking forward to a week without travel, and hope you have a good week as we head into the homestretch before Thanksgiving.

Lou

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Nov 10 2019

Has the War on Cancer Gone Too Far?

Sunday’s New York Times Book Review section contains a review by Henry Marsh entitled, “Has the War on Cancer Gone Too Far?” Dr. Marsh, a neurosurgeon, reviews a book by a Columbia oncologist, Dr. Azra Raza, recounting the tragic death of her husband to cancer, who suffered greatly during the course of his illness and therapy. I have not yet read this book but look forward to doing so. But something about this review touched a nerve and demanded my response.

Dr. Marsh recycles a reliable old chestnut, “Why should you never give an oncologist a screwdriver? The Answer: Because they will open the coffin and carry on treating the patient.” It is not the oncology I practice and it is not the oncologic practice I have seen evolve over the past 35 years. How might Dr. Marsh feel if I gently reminded him that neurosurgery for gliobastoma multiforme, a deadly brain cancer, is almost never curative yet is routinely performed?

Dr. Raza, whose personal ordeal demands our empathy and respect, is described as stating that most chemotherapy does not work for patients with metastatic disease, and researchers attempting to solve this dreaded Emperor of All Maladies are guilty of hubris. Try telling that to the millions of Americans whose cancers have been cured since the signing of the National Cancer Act; since 1971 cancer cure rates have jumped from about 50% to about 70%. That’s a lot of lives saved, purely driven by advances in cancer research. These apparently smug researchers have not only increased cure rates but have cured increasing numbers of metastatic cancers and are converting others into chronic, albeit eventual deadly illnesses that permit patients to live meaningful lives. These people receive the gift of life that permits them to meet sweet life objectives such as the marriage of a loved one or the ineffable joy of meeting a first grandchild. Who are we to minimize the impact of these advances? There is no reason to believe that this path of progress will fade, as bumpy as it may be.

Certainly some oncologists get swept away by their determination to “do everything” but most are all too aware of their limitations and the importance of letting go at the right point. However, that right point is not always so evident, and this is not the fault of greedy oncologists, evil big pharma or an American obsession with eternal life. Sometimes people just want to live, even when confronted with awful, scary facts. They don’t work for us, we work for them, and the work is not easy.

Several years ago I wrote about one of my favorite patients, a nonagenarian from Germany who had survived the Auschwitz death camp along with his wife of more than 70 years. I had been treating him for several years, always mindful of his age, but he was quite sturdy and wanted me to try anything reasonable. Finally, I had run out of treatment options, and for the first time he was starting to really feel the impact of his cancer. I spent an hour with my patient and his wife, explaining why I believed it was important to consider hospice, reminding them of the profound privilege I had felt to be his doctor.

He chose hospice, and I made a call to his wife shortly after he died. She was curiously cool with me, but I discounted her behavior as a reaction to her grief. Then I got a note from his son, blistering me for “abandoning” his parents, stating that his grieving mother felt betrayed. I was shocked and deeply saddened, and spoke with him too. To this day I don’t know what more I could have done. I suspect that my patient and his wife felt that they could beat anything, having survived Auschwitz, and saw in me, the son of a Holocaust survivor, their perfect partner. In retrospect they would have preferred he die with chemotherapy drugs coursing through his veins, even though it would have been the wrong thing to do. He wanted to die fighting.

In no way do I advocate that every patient refuse to let go, with the assistance of their oncologists. Rather, I want to point out that this is complex stuff. Nobody should be treated with toxic agents when those agents have no chance to be helpful. However, our patients’ voices need to be heard, and they need to hear from us when palliative measures such as hospice represent the best course of action.

I must admit that I do bristle at the notion that cancer research, in all its complexity represents hubris and wastes resources and hope. Research cures cancer, and every life saved keeps one more sacred flame lit. Those flames light our path toward a time when the Emperor has been reduced to a ragged pauper.

Have a good week.

Lou

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Oct 28 2019

EAB Season

I am standing in the lobby of a theatre showing the premiere of our nephew’s film, “The Nomads” at the Philadelphia Film Festival. This caps an eventful week that started with the 2-day  AACI meeting in Washington, where we learned about the evolving cancer center guidelines and caught up with old friends as well.

Wednesday was highlighted by our quarterly meeting of the MedStar Georgetown Cancer Institute, where we heard great updates on our Network-wide efforts in lung cancer screening and tobacco cessation. On Thursday morning I participated in the thesis committee meeting of Allison Fitzgerald, an MD/PhD student in my lab as her project evolves and deepens. I then “shuffled off to Buffalo” for the Roswell Park EAB meeting on Thursday evening and Friday. I got home Friday night and was ready for a rest! I worked a bit on my R01 renewal, and kicked back a bit on Saturday, with dinner at a friend’s house.

Sunday was highlighted by our drive to Philly, punctuated by two stops in Baltimore to see our kids and grandchildren – we watched the Eagles game in two different houses! At least they won pretty easily.

No rest for the weary; we are in EAB season. I head up to Minneapolis on Tuesday for the University of Minnesota EAB, and then we host our own EAC on Sunday and Monday. Then, perhaps a rest…

Have a great week.

Lou

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Oct 20 2019

Remembering a Giant

Well, I guess it was important to eat into the drought. Too bad it had to happen on a weekend. I am gearing up for a busy week highlighted by the annual American Association of Cancer Institutes meeting here in DC. It’s a great opportunity to network and to hear about what our colleagues are doing.

Harriet and I had a quick trip to New York this past weekend for the annual Hackensack Meridian Health Gala, which featured a performance by the famed singer John Legend. It was quite the event, replete with a Cirque du Soleil type of pole-based acrobatics at the entry to the event. No, this was not a participatory exercise! It was a wonderful experience, and they raised a lot of money.

While we were gone I learned of the death of cancer research legend Bernard Fisher (Bernie, to anybody who knew him or had heard of him) at the age of 101 years old. He is rightly famed for his groundbreaking work in breast cancer research and therapy, and he leaves behind a nearly unparalleled legacy of impact. I had met him, but did not know him as well as some of my colleagues, like Sandy Swain. He had lived a full life, but it is a mark of his enduring impact that he will be sorely missed, as a world that contains Bernie Fisher is always the better for it, no matter his age.

When he was a young surgeon, the standard of care was a mutilating radical or modified radical mastectomy. Many women who endured such burdens nonetheless succumbed to metastatic disease. His work has led to the progressive reduction in the extent of surgery, the introduction of radiation therapy in conjunction with surgery and the establishment of adjuvant therapy as a standard of care that reduces relapses and death in women at high risk of disease recurrence. Bernie’s leadership improved not only the survival but also the quality of life for millions of women, and has laid the groundwork for continued progress. What a legacy!

It should be noted that these accomplishments did not occur accompanied by the trail of garlands he encountered late in his career. Each innovation met resistance from those entrenched in the old ways, and he had to overcome deeply held surgical adherence to the tenets of more extensive surgery. Some years ago, a rogue researcher in the NCI cooperative group he chaired (then known as the NSABP) falsified clinical trial data, leading to Fisher’s removal as chair of that group. Many in the cancer research community properly felt he had been scapegoated. I will never forget an ASCO plenary session where he was introduced to comment on a breast cancer presentation at the height of this particular controversy. Such was the reverence and appreciation for him and his accomplishments that the entire hall of cancer specialists, more than 10,000 strong, rose as one to give him the most rousing and prolonged standing ovation I have ever been part of at a scientific meeting. It was an inspiring moment, because we knew the score, and wanted both he and his oppressors to know it.

Historians frequently debate whether the man or woman makes the times or if the opposite is true. Had Bernie Fisher never lived I suspect many of his accomplishments would have occurred anyway, but perhaps not at the same pace. Here’s what I do know; the man defined the times, and we are the better for it. May he rest in peace, knowing that he achieved perhaps the highest calling to which any of us could aspire; he left the world better than he found it.

Have a great week.

Lou

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