August 19, 2015 | by Nancy Brands Ward
The defeat of cancer will require a team effort. Nowhere is this more necessary (or apparent) than in efforts to combat two of the most deadly forms of the disease – pancreatic cancer and triple-negative breast cancer.
It’s the approach City of Hope is taking with its newly launched multidisciplinary teams, bringing the power of collaboration to advance research into earlier diagnoses, better treatments and potential cures for patients with these and other cancers.
Both pancreatic cancer and triple-negative breast cancer are aggressive, difficult to diagnose and have limited treatment options. Pancreatic cancer represents just 3 percent of all cancer cases yet 7 percent of cancer deaths. Triple-negative breast cancer represents 10 to 20 percent of breast cancers and occurs typically in younger women and disproportionately in African-American and Hispanic women. In both diseases, survival rates at Stage 4 are dismal – only 12 months with pancreatic cancer; 18 to 24 months for triple-negative breast cancer.
The new specialized teams that City of Hope has created are offshoots of larger disease teams rolled out across the institution over the past year. Together and individually, they bring a holistic approach toward advancing knowledge and treatment of all the major tumors and blood cancers.
Building on a legacy of collaboration
Multidisciplinary collaboration is not new at City of Hope. It’s the way care has long been delivered here. What is new, however, is the breadth of collaboration on these disease teams. Each team – lung cancer, gastrointestinal cancer or lymphoma, for example – is composed of experts in the disease from surgical oncology, medical oncology, radiation oncology, radiology, pathology, nursing, pharmacology, genetics, basic science, statistics and population sciences, including cancer prevention, cancer control and quality of life.
“When you get that many people into a room, you start finding out about all the different aspects of research you might be able to piggyback onto to help advance care much faster,”said Vincent Chung, M.D., leader of the pancreatic cancer team and associate clinical professor in the Department of Medical Oncology & Therapeutics Research.
On the pancreatic cancer team, inclusion of research scientists from City of Hope’s Beckman Research Institute of City of Hope led to a “perfect collaboration” in the group’s first meeting.
Saul Priceman, Ph.D, an assistant research professor who’s investigating the use of CAR T cells against solid cancers, realized that work on patient-derived xenografts implanted in mice established by surgical oncologist and researcher Laleh Melstrom, M.D., M.S., might have an application in his own research. Future research using these xenographs could accelerate clinical translation of adoptive T cell therapy for pancreatic cancer by as much as a year and a half.
Without this group, Chung said, that "aha" moment might never have occurred. And that’s just the beginning. Other innovative therapeutic approaches to pancreatic cancer will be reviewed by the disease team as well.
While it may be years before this type of research has direct application in patient care for pancreatic cancer, clinical trials to evaluate treatments targeted to the six subtypes of triple-negative breast cancer are closer to fruition, said Yuan Yuan, M.D., Ph.D., head of the that new disease team and assistant professor in the Department of Medical Oncology & Therapeutics Research.
Triple-negative breast cancer is so called because it tests negative for expression of estrogen receptors, progesterone receptors and HER-2 receptors. That makes hormone therapy and HER-2-targeted therapy ineffective, and there is currently no proven targeted therapy. “Our goal is that regardless of the type of triple-negative breast cancer a patient has, we’ll have an experimental treatment to address it here at City of Hope,” Yuan said.
Scientists and physicians working together
Disease teams break down institutional silos that previously saw researchers working on the same cancer type but in separate departments. Now, clinicians and scientists working on a specific cancer bring their expertise to the table for regular discussions of all aspects of research, vetting ideas for studies and helping to set the direction for the research that will lead to the kind of innovative treatments that can change the course of patients’ diseases and lives.
“It's an ideal approach for an institution that is focused on speeding cancer cures and advancing knowledge,��said Steven Rosen, M.D., the Irell & Manella Cancer Center Director's Distinguished Chair, provost and chief scientific officer, as well as director of the comprehensive cancer center and Beckman Research Institute of City of Hope. “An individual doctor may be working in isolation and not realize there’s something better or that their colleagues don’t agree. Here it’s an open dialogue.”
That dialogue offers to patients the collective wisdom of nationally renowned experts on their disease – experts who, as a team, regularly discuss such concepts as best treatments, critical issues in survivorship or prevention, impediments to delivering care, or potential clinical trials for initial treatment or after relapse.
Sometimes the dialogue might lead to deciding against using a novel therapy. Other times it could lead to the possibility of an experimental treatment that a patient’s primary physician may not have been aware of previously.
Expanding access to experimental treatments is one of the goals of the new disease team structure at City of Hope, according to Ashley Baker Lee, senior vice president for research operations. And from the 62 percent increase in procedures for patients enrolled in clinical trials demonstrated over the past five months, it appears to be working.
Giving patients options not found in most places
Last year, about 16 percent of the 3,400 patients at City of Hope with newly diagnosed cancers were enrolled in clinical trials of innovative therapies. Lee believes that may be as high as 20 percent by year end: “It’s just exploded.”
Down the road, Lee said, the expectation is that disease teams will prescreen City of Hope patients upfront to discover whether there is an appropriate experimental therapy that can be included in the treatment plans for their cancers.
The power of collaboration is also evident in the uptick seen in the number of large multidisciplinary proposals for research grants submitted since the disease teams began working together.
That tells us we’re on the right track,” she said.
“Doctors love this approach,”Yuan said. “It’s a great platform to initiate collaboration – to get people’s brains together. We learn a lot.”
These multidisciplinary disease teams keep City of Hope at the forefront of cancer treatment, Rosen said, noting that, “It brings energy to our mission of transforming the future of health care by turning science into practical benefit; hope into reality.”
Learn more about becoming a patient or getting a second opinion at City of Hope by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.