making a advances - uw health
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AdvancesUniversity of Wisconsin Carbone Cancer Center
Winter 2015uwhealth.org/cancer
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When Dennis Bricco
underwent radiation
treatment at UW Hospital this
past September, he became
one of the first patients in
the country to have a tumor
treated with the newest version
of radiotherapy technology.
Bricco, 58, is in his fourth
year of traveling from his
Shawano County home to the
UW Carbone Cancer Center
in Madison for treatment of
metastatic colorectal cancer.
He’s undergone surgery,
cryoablation, and treatment
with tiny radioactive glass
spheres that were infused into
his liver.
Before the September
treatments, his radiation
oncologist Dr. Michael Bassetti
talked with him about the
possible advantages and
disadvantages of having
radiation therapy in the
nation’s second ViewRay™
system.
Bricco recalls the actual
therapy as no big deal.
“It felt like a bite from the
smallest bee in the whole wide
world,’’ he says. “They make it
so you’re really comfortable in
there.”
But for Dr. Bassetti, the
treatment view of Bricco’s liver
tumor was unparalleled. Unlike
current technology, which
uses CT scans to picture the
tumor before treatment begins,
the newest technology uses
real-time magnetic resonance
imaging (MRI) to guide the
radiotherapy.
“For the first time we are able
to see a patient’s tumors and
internal organs in real time, as
we are treating the patient,’’
says Bassetti, assistant
professor of human oncology.
Physicians at UW Health
are using this technology
for complex patients, such
as Bricco, who have tumors
that move as they are being
treated. Generally, these are
tumors in the lung, liver, GI
tract and thorax.
Bricco’s medical oncologist
Dr. Sam Lubner says he
appreciates Dr. Bassetti’s
expertise in using this new
radiotherapy application.
“For Dennis, and people like
him who are living longer and
better with their cancer, we
need to work as a team and
apply tools like these where
they are best used,’’ Lubner
says. “Dennis has had multiple
invasive treatments to his
liver. A precise, non-invasive
treatment is exactly what we
needed for Dennis, and I was
thrilled that Dr. Bassetti and his
colleagues brought it up as an
option.”
The real-time technology gives
clinicians the ability to clearly
see the target tumor and
monitor where the radiation
dose is being delivered. During
treatment, the system scans
the patient’s anatomy and
adjusts for motion in real time,
delivering the radiation dose
only when the tumor is located
exactly where it should be.
If the tumor moves beyond
the pre-defined area, the
beam automatically pauses,
resuming when the target
moves back into the area.
“One of the key advantages is
that this technology allows us
to ’view and gate’ the radiation
delivery in real time, so we
are less likely to injure normal
tissue while delivering full dose
to the tumor,’’ says Dr. Paul
Harari, chair of the department
of human oncology.
While the patient is on the
treatment table, this system
can quickly compare the pre-
treatment MRI image to the
planning image and predict
the dose to be delivered. With
this information, clinicians
can determine whether organ
motion or other changes in the
patient’s anatomy might result
in sub-optimal treatment. After
consulting with the physician,
the plan can be adapted to
re-optimize the dose in several
minutes.
The continuous imaging
throughout the treatment
allows the shape of the beam
to be adapted as needed
to deliver the prescribed
treatment. And over the
course of therapy as the
patient loses weight, the tumor
changes shape or the patient’s
anatomy shifts from day to
day –physicians can adjust the
radiation treatment to these
changes.
In fact, the physicians are
amazed by what they have
seen.
“We are pulling up the blinds
on some things we have never
seen before,’’ says Harari.
“We’re seeing dynamic motion
in anatomic structures that we
did not previously envision to
have motion.”
The medical physics
researcher team, led by Dr.
John Bayouth, professor of
human oncology, say it’s
exciting to finally be able to
see the tissues as they are
being treated.
“This technology has
tremendous potential,’’ he
says. “As researchers, we’re
only beginning to imagine the
questions we can ask with it.”
It’s still early days for the
ViewRay system, which had its
third system recently go online
at UCLA. But Bassetti says the
UW team is developing clinical
protocols to track data from
patients like Bricco to see how
their outcomes compare with
conventional non-MRI based
treatments.
John Bayouth, PhD, Paul Harari, MD and Michael Bassetti, MD, of the UW Department of Human Oncology, are members
of the team introducing a new MRI-guided form of radiation therapy at the UW Carbone Cancer Center.
UW Second in Nation to IntroduceNew Radiation Oncology Technology
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]
Please help us update our mailing list. If you have
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Making a Difference
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The 2nd annual “Mad-City Pond Hockey Championships” was
held the weekend of Jan. 23-25 at Vilas Park Pond in Madison.
The event brought together more than 50 teams with over 400
people participating in men’s, women’s and co-ed divisions in the
tournament. Proceeds of $3,000 from a raffle, silent auction and
concessions went to benefit UWCCC’s pancreatic cancer research
fund. The event’s co-organizers, Brad Mastenbrook and Rich
Kerns, already have begun planning for the 2016 event.
Lisa Delmore, assistant general manager (left) and Michelle Zuelke,
general manager (right) of Tanger Outlets Wisconsin Dells, WI
recently donated more than $25,000 to support breast cancer
research. Tanger Outlets raised this money at their annual Pink
Partini event held last October.
LEARN MORE
Watch a video about the ViewRay™ system by visiting uwhealth.org/viewray
Peggy Zimdars, breast cancer survivor, has “grounds for celebration”
and she hopes to encourage others to brew up needed support for
the UW Carbone Cancer Center.
“I was diagnosed with breast cancer in 2005. In less than a week, I went
from hearing I had a perfect mammogram, to my physician wondering if
she felt an edge, to waking up from surgery and realizing my diagnosis,”
said Peggy. “My surgery was at another facility so I did not receive any
cancer information until the day I began chemotherapy at the UWCC.
Arriving with many questions and concerns, I was reassured by the
oncology team who listened, answered our questions, and with concern
for each family member, helped us adjust to a new “normal” with both
quality care and concern for me as an individual.”
Peggy and her husband, John thought 10 years since diagnosis was
“Grounds for Celebration,” which made them think of coffee, which led
to how they wanted to celebrate.
According to Peggy, “Our goal is to purchase up to 1000 coffee pillows
from Door County Coffee for the UWCCC. If each person who receives
a coffee pillow would host a coffee for 10 people and each of the 10
individuals would donate $10 to the UWCCC, each coffee pillow would
raise $100, with the potential to raise thousands of dollars together.”
Individuals and families might choose to celebrate with the coffee
together, rather than hosting a coffee and donate $100 per coffee packet
to the UWCCC. If 100 cancer survivors could engage 10 people who
would each host coffee for 10 friends who each donated $10, then
$100,000 could be raised.
If individuals are interested in learning more about how they can receive
coffee pillows and host their own “Grounds for Celebration,” please
contact Peggy at [email protected] or 608-233-8546.
Grounds for Celebration: A Unique Coffee Fundraiser That is Percolating
D r. Howard Bailey has been named
director of the University of Wisconsin
Carbone Cancer Center effective April 1, 2015.
A professor of medicine at the UW School of
Medicine and Public Health, Bailey is a medical
oncologist who specializes in gynecologic and
soft-tissue cancers and cancer prevention.
He had served as interim director of the UW
Carbone Cancer Center since September 2013.
“The Carbone Cancer Center embodies the
spirit of what this university accomplishes for
our state,” said Dr. Robert Golden, dean of the
UW School of Medicine and Public Health. “Its
researchers make important discoveries that
lead to better treatments; its clinicians deliver
those treatments to patients; and both educate
a wide range of health professionals and
scientists who will move the field forward in the
future. Howard has excelled in all roles and it
is my great privilege to have him move into the
top leadership role at this jewel in our campus
crown.”
“It is an incredible honor and privilege to be
named director of Wisconsin’s only NIH-
designated Comprehensive Cancer Center,”
said Dr. Bailey. “The UW Carbone Cancer
Center continues to be Wisconsin’s leader in
advancing discovery through basic, clinical and
population cancer research while translating
this knowledge into quality care for those
affected by cancer.”
Bailey, who worked under and alongside Dr.
Paul Carbone, for whom the cancer center is
named, has been an active cancer clinician
and researcher since joining the faculty of the
University of Wisconsin-Madison in 1994. He
has led the development of three different
state- and nationwide clinical research networks
to expand access to cutting-edge research
for patients. In 2011, he was appointed to the
national committee which reviews all National
Cancer Institute-designated Cancer Centers
and is currently the national chair of the
American Society of Clinical Oncology’s Cancer
Prevention Committee. An expert on drug and
nutrient development for cancer prevention and
treatment, he has directed or participated in
more than 100 cancer clinical trials examining
agents for preventing or treating malignancies.
He graduated from medical school at the
University of North Dakota and completed
his internship and residency at Southwestern
Michigan Area Health Education Center
in Kalamazoo, Michigan. He completed
fellowships in medical oncology and oncologic
research at the UW Carbone Cancer Center.
Howard Bailey named Cancer Center director
A S K T H E E X P E R T
Please visit uwhealth.org/cancerevents for more details on all events.
I t is easy to speculate that had the McArdle Laboratory’s
Howard Temin worked today, his lab would be struggling.
After all, his Nobel Prize-winning work focused on a curious
virus that caused cancer not in people, but in chickens.
This year UW-Madison’s McArdle Laboratory for Cancer
Research celebrates its 75th anniversary, reflecting on a
rich history as one of the first and most heralded basic
cancer research institutes in the world. Breakthroughs from
McArdle include Elizabeth and Jim Miller’s finding that many
chemicals cause cancer through mutating genes; Charlie
Heidelberg’s discovery of 5-FU, a wildly successful and still
heavily used chemotherapeutic drug; and Howard Temin’s
1975 discovery of reverse transcriptase, a finding that led to
a profound sea-change in scientific dogma and, ultimately,
the development of potent anti-HIV drugs that have saved
millions of lives across the globe.
But more importantly, we look forward to the next 75 years
of basic research progress that will yield the next generation
of cancer cures and therapeutic strategies. Moreover,
the recent relocation of McArdle from central campus to
the Wisconsin Institutes for Medical Research provides
additional impetus toward moving basic advances more
quickly from the bench to the bedside.
And it is an exciting time. Scientists now have the tools
needed to generate a comprehensive understanding of
the root causes of cancer, integrating studies of systems
biology, genetics, metabolism, and protein chemistry with
increasingly relevant tissue and small animal models. We
can now screen millions of compounds for anticancer
activity, and determine modes of action with increasing
speed and precision. Non-invasive imaging strategies are
under development to directly monitor tumor progression
in people and at high resolution. We are learning the
biomarkers and gene signatures that define specific
cancers, fueling a revolution in personalized, low toxicity
anticancer therapeutics. And we are learning to manipulate
the immune system in ways that augment the body’s natural
anticancer defenses. One day we may find that the cure is,
in fact, within ourselves.
But despite these advances, it is also a time of great
anxiety in science. We face crucial challenges, in particular
the severe constriction to federal funding for basic cancer
research. Even the most successful labs are cutting
projects, in particular “high risk – high reward” endeavors
that could yield unexpected, game-changing anticancer
strategies. In lock step, we lose Wisconsin’s best and
brightest young scientists for want of opportunity.
In celebrating McArdle’s 75 years, we emphasize the
need to remember that “basic” means “discovery”; and
that discovery requires that we support exploration of the
unknown and sometimes unconventional, e.g., Temin’s
chicken viruses. It’s my hope that we can reinvigorate
investment in basic science funding through the National
Institutes of Health, the National Science Foundation, and
philanthropic endeavors, and thus help pave the way for 75
more years of breathtaking basic cancer research progress
in Wisconsin.
Nathan Sherer, PhD, is an assistant professor
of molecular virology and oncology at the
McArdle Laboratory for Cancer Research, the
basic research arm of the UW Carbone Cancer
Center. He is a recent recipient of a Shaw
Science Award. The annual award supports
emerging investigators with innovative ideas in
biochemistry, biological sciences and cancer
research. Such awards are critical for young
researchers working to establish their labs
and develop early data that will allow them to
compete for larger nationally-funded grants.
With approximately 22,000 diagnoses annually in the United
States, ovarian cancer isn’t among the most commonly
occurring cancers. Yet, the mortality rate for women who
have ovarian cancer hovers above 60 percent.
For Pamela Kreeger, a University of Wisconsin-Madison assistant
professor of biomedical engineering, that number is needlessly high.
Kreeger is among a group of exceptionally forward-thinking researchers
to receive a 2014 New Innovator Award from the National Institutes
of Health. And with funding of nearly $2.3 million, she is studying
what factors cause ovarian cancer cells to progress from their origin
in a woman’s fallopian tube through the ovaries and on to metastatic
sites—where they become resistant to chemotherapy drugs.
“When we look at most cancers, we focus on gene mutations and how
they impact the cells’ behavior, and then that’s the drug target,” she
says. “Cancer is somewhat clonal, so early mutations tend to replicate
throughout the tumor. But some cancers don’t show this clear pattern
of mutated genes for clinicians to target.”
That’s the case with ovarian cancer, according to a 2011 study of the
disease by The Cancer Genome Atlas (TCGA) Research Network.
Nearly all ovarian cancers have a mutation in the gene TP53—a gene
that encodes a tumor suppressor protein that normally prevents cancer
development, and is very difficult to target therapeutically.
However, ovarian cancer cells also tend to have increased or
decreased copies of genes—rather than mutations in the genes
themselves. “So, the proteins are all potentially there and may function
in the normal way, but their relative levels are skewed,” says Kreeger.
“Ovarian cancer patients have a common mutation and then a
proteomic mess.”
As a result of this pattern, Kreeger’s hypothesis is that the genetic
mutation is less of a factor in the cancer’s spread than is protein
expression, which is the way in which proteins are made, regulated
and modified in cells. “What the TP53 mutation sets up is the genomic
instability where we see changes in the levels of proteins,” she says.
“I’m trying to figure out what we can target as a result of this variation.”
Kreeger’s research will draw on her unique background and expertise
in three seemingly different areas: ovarian cancer biology, biomimetic
culture development, and using systems biology models to analyze
quantitative data. For this project, she is developing in vitro culture
systems to mimic ovarian cancer cells’ spread through a woman’s
body, and how they develop resistance to chemotherapy.
Using these models, she and her students will examine how cells with
different protein expression patterns will behave and then, drawing on
Kreeger’s expertise in developing computer models, they will simulate
how multiple variables impact cell decisions and influence tumor
progression. “Progress in treating ovarian cancer over the last 30 years
has been flat,” she says. “One reason is that the disease is nearly
universally diagnosed too late—so understanding ovarian cancer’s early
stages might lead to new screens for the disease, as well as potential
treatments.”
Kreeger hopes researchers can use her tools and approach in their
efforts to understand progression in other cancer types, because many
tumors have both genetic mutations and quantitative protein variations
in their cell networks.
As an engineer, she brings a unique skillset to addressing a
multifaceted biological challenge. And she says that UW-Madison’s
culture of transdisciplinary collaboration is key to her research.
“Wisconsin is the kind of environment in which people can take on this
high-risk, high-reward research because of the intellectual openness
here,” says Kreeger. “People talk to each other, and they naturally
want to collaborate. They want to see if there’s a way to do it better
by working together. It’s just a part of our culture and what makes
Wisconsin a fantastic place to do research.”
Understanding How Ovarian Cancer Spreads
Subway Promotion!
April 1-15, 2015
Participating Subway locations in Dane County
Donate $1 or more at the register after eating at
Subway
Visit uwhealth.org/subway if you can’t eat out
during this time period.
Wisconsin Institutes for Medical Research
Tours
April 14, 2015: 5:00-7:00 pm
Tour labs and meet leading UWCCC researchers
Contact Janie Winston,
Free Oral Head and Neck Cancer Screening
April 17, 2015
UW Hospital and Clinics, Madison
Contact Heather Geye, [email protected]
Bulldog Stomp 5K Cancer Run-Walk
May 2, 2015
Pardeeville High School, Pardeeville
phsrunwalk.com
Brain Tumors: Frontiers in Care and
Caregiving
May 2, 2015
Free workshop for people living with a malignant,
benign or metastaic brain tumor, their families
and caregivers
Health Sciences Learning Center, Madison
Contact Ranee Williams-Toycen,
[email protected] or (608) 265-8584
Carbone’s Pedaling for Pancreas
May 9, 2015
Verona Hometown USA Park
Contact James Listug,
uwhealth.org/pedaling
The Feature at PGA West
May 13-15, 2015
PGA West, La Quinta, CA
Contact Ty Trbovich, [email protected]
Aly’s Honky Tonk Hustle
May 16, 2015
McFarland High School, McFarland
Contact Ariel Arneson, (608) 572-0282
alyshonkytonkhustle.com
Ride for Research
June 6-7, 2015
Wabeno
Contact John Newton,
widualsportriders.org
Andy North and Friends
June 7-8, 2015
Edgewater Hotel, Madison (dinner)
Maple Bluff Golf Country Club (golf)
Contact Janie Winston, (608) 262-1032 or Amy
Manecke, (608) 262-6967
andynorthandfriends.com
Tomorrow’s Hope Walk Fest
July 17-18, 2015
Jefferson County Fairgrounds, Jefferson
Contact Barb Endl, [email protected]
Tomorrowshope.org
Be the Cure
July 18, 2015
Contact Nancy Thorne Cahill, (608) 852-5147
CC-41438-14
Basic Cancer Research at UW-Madison: The Next 75 Years
M A R K Y O U R C A L E N D A R S
Nathan Sherer, PhD
Updates in
Clinical Trials
What are clinical trials?
Clinical trials are research studies conducted to find better ways to
prevent, diagnose and treat cancer. Clinical trials involve people who
volunteer to participate.
Patients at the UW Carbone Cancer Center are often among the first in
the world to have access to promising new treatments through clinical
trials. The UW Carbone Cancer Center typically has more than 250
clinical trials available for participation.
As more people participate in clinical trials at the UWCCC, cancer
researchers can more rapidly answer critical questions that will lead to
better treatment and prevention options.
Central Neck Dissection (CND) in Patients With Clinical Node
Negative Thyroid Cancer
Thyroid cancer is usually treated with the complete surgical removal of
the thyroid gland, but due to concerns that the cancer may recur in the
future, lymph nodes in the central part of the neck with no evidence
of metastasis may also be surgically removed. Unfortunately, the
additional lymph node surgery may be associated with increased risks
for complications such as inadequate calcium, problems with voice
function, swallowing deficits, and generally diminished quality of life.
Current practice standards at UW offer patients a total thyroidectomy.
At many other major academic centers, however, a prophylactic CND
is the standard of care. Because the risks of complications are poorly
defined, Dr. Rebecca Sippel and Nadine Connor are conducting a
phase II randomized clinical trial that will compare clinical recurrence
rates and complication levels in patients with papillary thyroid cancer
who have thyroid gland removal alone to those who receive thyroid
gland removal plus lymph node surgery in the central neck.
Breast Cancer
Researchers at UWCCC are increasingly recommending ‘neoadjuvant’
approaches for the treatment of breast cancer. Traditionally, new
cancer treatments take years to replace or improve current therapies.
To test new drugs quickly and safely, physicians are now using the
neoadjuvant approach, where standard therapies in association with
new medicines are given before breast surgery. This allows doctors
and patients to immediately see how well treatment is working, and
offers the possibility of minimally invasive surgery. Two new studies
using this approach will soon be available at UWCCC. One is testing
veliparib, a targeted drug that turns off the enzyme PARP. Certain
types of breast cancer rely on PARP to grow, so this medicine aims to
increase the effect of standard chemotherapy. A second clinical trial
will evaluate eribulin, a newer type of chemotherapy as a replacement
for the standard drug, Taxol. These studies will help grow our
understanding about how to customize and personalize breast cancer
treatments.
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
“Progress in treating ovarian cancer over the last 30 years has been flat.”
Have You Visited Our New Cancer Nutrition Website?Make sure to visit and bookmark our new cancer nutrition website, uwhealth.org/cancernutrition
Our website offers the following:
■ New, delicious, healthy recipes every month
■ An opportunity to ask one of our dietitians a question
■ Unique modules to learn more about nutrition and cancer
■ A schedule of classes and lectures
■ Links to national resources
600 Highland Ave., K4/658Madison, WI 53792-6164
Winter 2015 Issue Inside:- Check out our nutrition website!
- Learn more about “Grounds for Celebration”
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Advances