CC-31963-12 A · 2012-08-30 · samples from patients with pancreas, liver, and other gastrointestinal cancers. ... MD, PhD – Professor of Oncology and Medicine at the University

AdvancesUniversity of Wisconsin Carbone Cancer CenterAdvances

Summer 2012uwhealth.org/cancer

Making a Difference

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Mail this form to: UW Carbone Cancer Center 600 Highland Avenue, K4/646 Madison, WI 53792-6164

You can also donate online by visiting uwhealth.org/cancerdonation Please call (608) 263-0160 with questions.

600 Highland Ave., K4/658Madison, WI 53792-6164

n Advances is published semi-annually by the University of Wisconsin Carbone Cancer Center (UWCCC), a National Cancer Institute-designated comprehensive cancer center.

n For patient services at the UWCCC, please contact Cancer Connect, (800) 622-8922 or (608) 262-5223 or e-mail [email protected].

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Wisconsin's only comprehensive cancer center as designated by the National Cancer Institute

Amy Formella, breast cancer survivor (pictured) raised more than

$3,900 from Concert for a Cure for Cancer held in Stevens Point on

May 19, 2012. Thank you Amy for raising much needed funds for

breast cancer research at the UWCCC!

The third annual 5k Pardeeville High School run/walk was held in early

May, raising more than $16,000 for the UW Carbone Cancer Center.

This year’s event was the most successful event organized by the

Pardeeville High School student council members.

The UW Carbone Cancer Center (UWCCC) is proud to announce the creation of a Cancer Genomics

initiative. With the help of a generous $500,000 anonymous donation to the Amitabha Fund, this program will focus on identifying common cancer-causing gene mutations. The study of these human DNA mutations will allow clinicians to identify and target therapy focused on specific genes to inhibit cancer growth.

This initiative includes pilot and clinical studies for lung cancer patients using a state-of-the-art DNA sequencer.

A cancer genomics task force has been created within the UWCCC to bring together experts in translational and basic genetics research to streamline development of novel targeted cancer treatments.

Jill Kolesar, PharmD, a UWCCC member of the task force, says the sequencer, called the “Ion Torrent” is set up to identify hundreds of specific mutations within the human genome that may contribute to lung cancer development. Down the road, she hopes to use the sequencer for other cancer types with the ultimate goal of identifying the disease before it fully develops anywhere in the body.

This is an exciting time to be part of cancer genomics research,” says Kolesar. “With the help of this donation and others like it, we have the ability to offer a unique service to patients across Wisconsin,” she adds, “all while making important discoveries in detection and treatment.”

In the coming months, the service will be available to participants throughout the state via the UWCCC-sponsored Wisconsin Oncology Network.

UWCCC Cancer Genomics Initiative:

Studying DNA For Cancer Clues

All Hands On DeckTo Improve Pancreatic Cancer Outcomes

A hallmark of the UW Carbone Cancer Center (UWCCC) is the

link between doctors and scientists in a common mission. Translating research between the lab and the clinic results in unique discoveries of the human condition and better options for patients.

When UWCCC researcher W. John Kao, PhD, surveys the field of pancreatic cancer research, he sees a lot of potential for improvement. Currently, the survival rate for those with pancreatic cancer stands at about 6% beyond five years, compared to more than 90% for breast and prostate cancers. Kao, a distinguished professor in the UW department of Biomedical Engineering and associate dean of International Studies, who also has appointments in the UW school of Pharmacy and the UW department of Surgery, wants that to change.

By examining closely the composition of pancreatic tumors, Kao is determining how each facet of this complicated cancer functions.

Pancreatic tumors are difficult to treat because they are surrounded by layers of dense stromal cells. These cells, which serve as connective tissue, can often act as a tumor’s first line of defense and aid in its growth. In the pancreas, stromal cells can make up to 90% of the actual tumor volume,

creating an almost impenetrable wall protecting the cancer cells, and a huge obstacle for any drug designed to kill the cancer cells within.

“If we can get past that first line of defense,” says Kao, “then we have a much better chance of discovering which drugs are effective in treating the cancer cells themselves.”

The solution, he says, is to deliver a “one-two punch” of drugs using tiny nanocarriers the size of a single molecule to first break down the huge wall of stromal cells, then destroy the cancer cells at the center of the disease.

To do this, Kao and his team mimic the essential elements of a pancreas outside of the body. Cole Drifka, a graduate student in Kao’s lab, designed a microfluidic system that places the cancer cells and the stromal cells of a pancreatic tumor side-by-side in a space the size of a microscope slide.

First, pancreatic cancer cells taken from actual patients are inserted into each side of the slide. On one side, drugs expected to break down the stromal cell barrier are tested for effectiveness; on the other, the impact of drugs on the actual cancer is analyzed. “If we can find a drug combination that can destroy the whole tumor using our microchannel,” Drifka explains, “it increases the

likelihood of success when we move on to clinical trials.”

Testing the viability of different treatments in vitro, or outside of the body, means scientists in Kao’s lab can work faster for better results. Using live cells extracted from actual pancreatic cancer patients is the key to making this laboratory experiment imitate the conditions of a pancreas inside the body.

Sharon Weber, MD, Medical Director, Surgical Oncology, helps provide cancer cells for Kao’s lab. For almost 10 years, Weber’s group has collected tissue samples from patients with pancreas, liver, and other gastrointestinal cancers.

Collaborating with Kao gives Weber and her team a hand in evaluating new types of therapies and gives Kao a perspective of someone who treats patients face-to-face.

This kind of cooperation between the lab and the clinic, according to Weber, is essential if treatment of pancreatic cancer is to advance. “There is an ongoing need for translational scientists to look at actual cancer tissue from patients to better understand how tumors arise and grow,” she adds.

Joe Vanderloop, a former pancreatic cancer patient, readily agreed to donate to the tissue bank from which Weber

and Kao use in their studies. “When I hear that there are new treatments on the horizon,”says Vanderloop, “it makes me feel good knowing I participated in some way.”

Live tissue samples similar to those from Vanderloop are processed by the UWCCC Translational Science Biocore, a service designed to further streamline the process and ensure quality for testing.

“The tissue sample he provides helps us find better cures,” observes Weber, “and gives patients like Vanderloop a meaningful role in the discovery process and those down the road a better chance at survival.”

Kao maintains that this partnership is a kind of poetic justice for the patients who don’t survive to fully know the impact of their participation in the tissue bank. “A piece of those affected is still here fighting pancreatic cancer on their behalf,” he notes.

With the help of Kao, Weber, and the whole UWCCC pancreatic cancer team, many who have endured this disease are now keeping the doorway between the lab and the clinic wide open, transforming the potential for improved outcomes into the reality of survival.

BUIldINg PArtNerShIPS: the UWCCC Pancreatic Cancer task Force

In 2012, pancreatic cancer deaths are expected to top 37,000, making it one of the leading causes of cancer deaths in the U.S. Despite this fact, scientists and clinicians are optimistic about the future treatment for this deadly disease.

The Pancreatic Cancer Task Force is designed to raise awareness of pancreatic cancer and funds to support the highest quality research.

To maximize breakthroughs occurring at the UWCCC, the task force seeks to build an endowment to support fundamental discoveries, novel drug screening and development, and translational research to make pancreatic cancer survivorship the new norm.

To learn more about the Pancreatic Cancer Task Force, contact James Listug at (608) 263-3309 or [email protected]

Researcher W. John Kao, PhD (right) and graduate student in Kao’s lab, Cole Drifka, examine a microfluidic channel, designed to mimic the conditions of a pancreatic tumor outside of the body.

Sharon Weber, MD, Medical Director, Surgical Oncology and W. John Kao, PhD, are working together to improve pancreatic cancer outcomes.

Friday, Oct. 19, 2012Madison Marriott West, 1313 John Q. Hammons Drive, Middleton, WI

Confirmed Keynote Speakers:Personalized Cancer Care, Oncogeriatric Edition: How Do We Do It?Martine Extermann, MD, PhD – Professor of Oncology and Medicine at the University of South Florida, Senior Adult Oncology Program at the Moffitt Cancer Center, Tampa, FL

Embedding Geriatrics and Palliative Care Within Oncology: The SOCARE Experience at the University of ChicagoWilliam Dale, MD, PhD – Associate Professor of Medicine; Chief, Geriatrics and Palliative Medicine, University of Chicago; Director, SOCARE Clinic

Hearing is Part of the Cure: Letting the Cancer Patient Tell Their StoryBen Merens – Talk show host of “At Issue” with Ben Merens, Ideas Network of Wisconsin Public Radio

The 80/20 Rule: Improving Health, Not Just HealthcareKaren Timberlake, JD - Director, Population Health Institute, UW School of Medicine and Public Health

Visit uwhealth.org/puzzle to register or for more information.

Questions? Call Katie Arendt, (608) 263-0160 or e-mail [email protected]

11th Annual Symposium • Advances in Multidisciplinary Cancer Care

Putting the Puzzle Pieces Together:cancer in aging america

Updates in

Clinical TrialsA S K T H E E X P E R T

M A R K Y O U R C A L E N D A R S

Rudy’s Road TripBenefit for UW Carbone Cancer CenterAugust 18, 2012, Waunakeerudysroadtrip.com

VFW Car ShowBenefit for breast cancer programAugust 25, 2012, Madison Contact Terry Olson at [email protected]

Rock for a Good CauseBenefit for UW Carbone Cancer CenterAugust 25, 2012, High Noon Saloon, MadisonContact: Justin Hartman, [email protected]

Jewel of an Evening A gathering to honor and remember those affected by gynecologic cancersSeptember 7, 2012, MadisonContact Katie Arendt, (608) 263-0160

Carbone’s Passion for FashionFashion show to benefit UW Carbone Cancer Center September 13, 2012, Madison Contact Janie Winston, (608) 262-1032uwhealth.org/passion

MPPOA & AMPS Charity Golf OutingBenefit for UW Carbone Cancer CenterSeptember 14, 2012, Madison Contact Cindy Buechner at [email protected] or Lori Chalecki at [email protected]

Maher’s Halfway Leprechaun LeapSeptember 15, 2012, Beaver DamBenefit for prostate cancer programContact Melissa Maher, [email protected] or (815) 355-3376

Run with Wolfes Run/WalkSeptember 16, 2012, Menomonee Falls Benefits brain cancer research in memory of Eric WolfeContact: Cara Olson (262) 703-0705 or [email protected]

Scramble for a Cure Golf OutingBenefit for breast cancer programSeptember 26, 2012, ElkhornContact Bill Rogers, (262) 723-5722

Sparkle of HopeBenefit for gynecologic cancer programOctober 2, 2012, Madison Contact Katie Arendt, (608) 263-0160 uwhealth.org/sparkle

Pink Partini Party Benefit for breast cancer program October 5, 2012 Tanger Outlet Mall, Wisconsin DellsContact Janie Winston, (608) 262-1032 uwhealth.org/partini

From Munich to Madison: A Beer & Wine TastingBenefit for UW Carbone Cancer CenterOctober 12, 2012, Madison Contact Janie Winston, (608) 262-1032uwhealth.org/munich

11th Annual Fall Cancer ConferenceEducation conference focused on cancer and agingOctober 19, 2012, MiddletonMore details: uwhealth.org/puzzle or contactKatie Arendt, (608) 263-0160

Restaino & Associates Halloween PartyPartial proceeds to benefit UW Carbone Cancer Center October 25, 2012, Madison(608) 395-3102 or e-mail [email protected]

Please visit uwhealth.org/cancerevents for more details on all events listed.

Prostate Cancer Advanced prostate cancer commonly presents as metastasis to bone,

which makes it difficult to determine response to treatment. As a result,

the development of new drugs in this disease has relied on measuring

progression of cancer (instead of response to treatment), which may subject

a patient to ineffective therapies for longer periods of time. Drs. Glenn Liu

and Robert Jeraj are leading a trial within the Prostate Cancer Clinical Trials

Consortium in which they will determine the repeatability and responsiveness

of NaF PET/CT in patients with metastatic castrate-resistant prostate

cancer to bone who will be treated with either docetaxel chemotherapy or

androgen receptor-directed agents. The results of this study will allow us

to understand the performance characteristics of NaF PET/CT and identify

imaging biomarkers of treatment response that will eventually benefit patients

and quicken the drug development process. Funded by a Prostate Cancer

Foundation Creativity Award, as well as a PCF Mazzone Challenge Award,

the UWCCC will lead this multi-institutional effort, which includes the National

Cancer Institute and Memorial Sloan Kettering Cancer Center.

Molecular Imaging in Myelodysplastic Syndrome (MDS)Myelodysplastic syndrome (MDS) is a disease of the bone marrow that

causes anemia (low red cell count), neutropenia (low white cell count), and/

or thrombocytopenia (low platelet count). Some patients with MDS are at

risk of developing acute leukemia. There are FDA-approved therapies such

as 5-azacytidine, decitabine, and lenalidomide that can be used to improve

patient blood counts and reduce the risk of developing leukemia. However,

it can be difficult to tell whether a patient will ultimately respond to a specific

therapy. Therefore, it would be useful to have a biomarker or imaging

test early in the treatment course that could predict whether a patient will

have good results from treatment, or whether another therapy should be

prescribed. Hematology, medical physics, and nuclear medicine researchers

at the UW have published results showing that a non-invasive imaging

technique called fluorothymidine positron emission tomography (FLT-PET)

could be an early marker for treatment response in aggressive acute myeloid

leukemia. The research group is opening a study to investigate this imaging

technique in patients with MDS being treated with 5-azacytidine.

HO10417 is a pilot clinical study that is designed to explore whether

FLT-PET imaging could be an early marker of response in patients being

treated for MDS. The study aims to enroll five patients with MDS for whom

5-azacytidine is standard therapy. Patients will undergo 3 FLT-PET scans:

one scan prior to treatment, a second scan after the first month of treatment,

and a third scan after the fourth month of treatment. Ryan Mattison, MD, the

study’s principal investigator states, “Patients who are helped by medications

such as 5-azacytidine often require several months of treatment before it is

shown that their disease will ultimately improve. It would be clinically useful

to have a test that shows early on, within the first month, who will be helped

by treatment and who will not. Then, those patients unlikely to benefit can

be treated in other ways. Such an imaging tool also has the potential to

improve the drug development process by helping us to visualize response

to new medications.

For more information about these and other clinical trials at the UW Carbone Cancer Center, contact Cancer Connect, (800) 622-8922 or (608) 262-5223 in the Madison area.

A complete listing of clinical trials at the UWCCC is also available on our website, uwhealth.org/cancertrials

the fourth annual Andy North and Friends event raised more than

$1 million (gross) for the UW Carbone Cancer Center on June 3 and 4.

More than 650 people attended a dinner at the Kalahari Resort and 160 people

participated in a golf outing at Trappers Turn in Wisconsin Dells. North and a host

of sports celebrities including Green Bay Packers quarterback Aaron Rodgers,

Hall of Famer Robin Yount, pro golfer Sherri Steinhauer and ESPN Monday Night

Football play-by-play announcer Mike Tirico were among those participating in the

event to raise funds and awareness.

Since the event was started in 2009, Andy North and Friends has raised more than

$3 million for the Andy North fund at the cancer center. For more details about the

2013 event, please visit: andynorthandfriends.com.

raises more than $1 million

you just received news that you have cancer, or that your

cancer has not responded to recent treatment. Your mind is

reeling. Your doctor has multiple treatment options available.

But your doctor wants YOU to decide.

You worry: How can I possibly know what’s best? How do I make

sense of these statistics – these risks? How can I make THE

RIGHT decision?

For some, being involved in the decision is empowering.

For others, it’s anxiety provoking. For many, it’s a bit of both.

But anxiety interferes with critical thinking. So the emotional

situation of hearing you have cancer is actually not ideal for

decision-making. You may rush to a decision just to make one.

Or avoid a second opinion for fear of hearing worse news.

But it is critical to take time to look at the situation from all sides.

Here are some tips:

TAKE TiME

Decide with your doctor how much time you can take to decide.

Use that time. Get a second opinion. Talk about your options and

concerns with people you trust – family, friends and professionals.

Cancer psychologists can also help in treatment decision-making.

BE iNFORMED

Understand your cancer and treatment options. What is the

expectation of treatment: cure, control or symptom relief?

ANALYzE BENEFiTS VERSUS RiSKS

Potential risks come from treatment side effects, the impact

on your life, and the loss of opportunities offered by treatment

options you do not choose.

Understand the possible side effects and how common they are.

Learn what can be done to manage side effects if they occur.

Exactly what side effects you are willing to tolerate may depend

on what benefits treatment offers.

How will treatment affect your life? Will you need time off work?

Will your family role change? How will treatment affect your daily

life; the things you enjoy most? Are costs involved? If you have

other health conditions, how will treatment affect them?

Treatments affect everyone’s lives differently. Your personal goals

and values impact what treatments are best for you.

COMMUNiCATE WiTH YOUR DOCTOR

Ongoing communication with your doctor can help at each step

of decision-making, from first hearing about options, to clarifying

information and discussing concerns as you evaluate choices,

to stating treatment preferences, including goals and what you

are willing to tolerate. Continue communication about treatment

progress. Re-evaluate options and make changes as needed.

REMEMBER YOU CAN CHANGE YOUR MiND

Sometimes it helps to think about choices in steps. When you

make a choice, you are only agreeing to the first step, with the

option to decide whether to continue next. For example, if you

choose chemotherapy, you agree to take it one time. Then you

have the choice whether to take it the next time. It is okay to

change your mind during treatment.

Remember, there is no 100% right or wrong answer. Regardless

of the outcome, you are likely to feel better about your choice if

you take time to consider what’s important to you and choose

according to those goals and values.

Lori DuBenske, PhD, a cancer psychologist

at the UW Carbone Cancer Center, provides

psychotherapy to patients and family members.

She also conducts research with the UW Center

for Health Enhancement Systems Studies

(CHESS), examining ways to use technology to

enhance cancer patient, caregiver and clinician

communication to improve the cancer experience.Lori L. DuBenske, PhD

Making tough Cancer decisions: There’s Often No ‘Right’ Answer

and Friendsand Friends

AndyNorth

AndyNorth

Front Row: Mike Tirico, Chris Roderick, Bob Murphy, Billy Andrade, Sherri Steinhauer, Paul Molitor. Back Row: Bo Ryan, Aaron Rodgers, Andy North, Tom Weiskopf, Adam Burish, Terry Gannon, Bo Van Pelt, Scott Van Pelt

1. The majority of melanomas occur from a changing mole. TRUE OR FALSE

2. Melanomas always have dark discoloration. TRUE OR FALSE

3. Sunscreen with an SPF of 30 is twice as strong as one with SPF 15. TRUE OR FALSE

4. If a melanoma has spread to lymph nodes, the lung is the internal organ that has the higher risk of getting involved next. TRUE OR FALSE

5. There are identified risk factors for developing melanoma. TRUE OR FALSE

6. Melanomas are only found on skin surfaces that are exposed to the sun. TRUE OR FALSE

7. Early diagnosis is important for a melanoma patient. TRUE OR FALSE

8. A shave biopsy is the best approach for a skin lesion suspected of being a melanoma. TRUE OR FALSE

9. Melanoma is usually curable once spread to distant sites. TRUE OR FALSE

10. Clinical features of a skin lesion can help identify melanomas. TRUE OR FALSE

ANSWERS:

1. FALSE. More than half of melanomas develop de novo which means that they develop on the normal skin without a mole.

2. FALSE. A small subset of melanomas does not have brown or dark pigmentation. They are called amelanotic melanoma.

3. FALSE. SPF 30 blocks about 96.7% sun rays while SPF 15 blocks 93.3%. By doing the same math, SPF 50 blocks 98% and SPF 100 blocks 99%. Therefore, one gets marginal benefit after the SPF number is higher than 30.

4. TRUE

5. TRUE. Risk factors for melanoma include a positive personal or family history of melanoma, multiple atypical or dysplastic nevi, light complexion, history of blistering sunburns, and use of tanning beds.

6. FALSE. Melanoma can be found on any skin surface including areas with little or no history of sun exposure, mucous membranes, in the eyes, or as metastatic disease without a clear primary site.

7. TRUE. Early diagnosis is critical to patient outcome. Even melanomas with one millimeter of thickness at the time of diagnosis carry a risk of recurrence and death. Therefore, the clinician should have a low threshold for the evaluation and removal of changing lesions.

8. FALSE. Ideally, a suspect lesion should be removed by excisional biopsy including elliptical or punch biopsy. The full thickness of the questioned lesion needs to be included in this initial biopsy.

9. FALSE. New insights are critically needed to achieve durable benefit for patients with metastatic melanoma, as this cancer is usually incurable once metastatic to distant sites.

10. TRUE. Clinical features that help guide early identification include the “A, B, C, D and E’s”:

“A” asymmetry “B” irregular or notched borders “C” irregular distribution of color “D” diameter of 6 mm or greater “E” new elevation, erosion or ulceration

M e l a n o M a :TEST YOUR KNOWLEDGE