Extraordinary Care Is the Mission of the John Theurer Cancer Center

This Month's Featured Institution:

John Theurer Cancer Center

The John Theurer Cancer Center at Hackensack University Medical Center in New Jersey has been a leader in the diagnosis, treatment, management, and prevention of cancer for more than 30 years. Last year alone it prepared close to 300,000 inpatient and outpatient chemotherapy sessions. And the Center enrolls far more patients in clinical trials than the national average—16% of the Center’s patients participated in some type of research protocol.

The Center’s mission, simply put by Andrew Pecora, MD, chairman and executive administrative director of the cancer center, is to provide patients with extraordinary care. Accomplishing that mission, he said, involves 5 key components: access to multidisciplinary, specialized care teams; care that is innovative; care that is personalized; exceeding patient expectations; and the demonstration of superior outcomes. “These are not just words for us,” Pecora said. “This is actually what we do. We have 14 divisions in the Cancer Center that provide multidisciplinary, specialized care.” Every effort is taken to ensure that this care is supplied at a very high level.

Dan Smith, MD, is vice chairman of the Center and chief of its gynecologic oncology division. He explained that when it comes to treating cancer, there are guidelines to follow—standards of care established by agencies such as the National Cancer Institute and professional alliances like the National Comprehensive Cancer Network. Smith said being innovative means further defining that standard of care to be in a position to care for patients who fail an initial treatment plan.

“If our standard of care were perfect, we probably wouldn’t need to innovate or develop new programs,” Smith said. “Since it’s not, I think that innovation is a way of looking for a better outcome for your patients.”

One of those innovations in gynecologic surgery is the use of the daVinci Surgical System, or robotic surgery. Smith explains that he experienced the daVinci system firsthand 4 years ago during his own prostate surgery. After that, he and his colleagues wondered, “Why aren’t we doing this for women?” Since then, there has been growing demand by patients for robotic surgery. Nevertheless, controversy exists concerning the cost and effectiveness of the system.

“Information [on long-term survival] is not going to come out for quite a while,” Smith said. “But what we do see is that patients are in the hospital 1 night instead of 5. They don’t need to be transfused, they don’t get wound infections, and they go back to work sooner. I would say there’s not one person who doesn’t want [their surgery] done with a robot.”

Cancer center surgeons nationwide are responding to the call. Smith said the John Theurer Cancer Center has more than 50 surgeons trained to use the daVinci system, and all the surgeons are actively involved in training other physicians. “If you are a resident in obstetrics and gynecology now and are not being trained in robotic use, you’re going to be doing pap smears,” said Smith, “because you can do almost every operation, in my opinion, better with a robot.”

Innovation in radiation oncology

division to department

Anthony Ingenito, MD, a radiation oncologist and researcher, was recently named the founding chairman of the Center’s newly elevated Department of Radiation Oncology. Ingenito explained that this specialty was previously known as the Division of Oncology, and he said the transition from encompasses more than a word.

“It gives us some more independence, I think, operationally…and somewhat more autonomy to be creative in developing new protocols for treatment. I believe that’s the most successful way that we can proceed in order to offer our patients the best possible care,” Ingenito said. One area the department is focusing on is expanding the application of intensity modulated radiation therapy and developing and integrating a comprehensive imageguided radiation therapy (IGRT) program to target tumors more precisely in the body. Ingenito said IGRT enables surgeons to account for organ motion and to make corrections in real time to ensure that radiation is reaching the tumor and not healthy tissue.

“These technologies have already shown a decrease in many of the common side effects that are often experienced by patients,” Ingenito said. “This adaptive therapy, as we call it, is in a constant state of evolution.”

April saw another step in that evolution, with the unveiling by Varian Medical Systems of the most advanced technology available to deliver radiation therapy for cancer care. The John Theurer Cancer Center, which is partnering with Varian, will be one of a handful of institutions countrywide using this new technology. “It’s very exciting to obtain this breakthrough technology,” said Ingenito.

Science immunology research

The Center’s division of research has been focusing on learning what changes at the molecular level lead to cancer, why they happen, and how they progress to disease. Some of the most exciting basic research being done at present involves unraveling the biology of graft-versus-host disease (GVHD), a common and potentially fatal complication of stem cell transplantation. Robert Korngold, PhD, chairman of the division of research, said GVHD has been a problem for years but that research has made some promising inroads.

“The gold standard that everyone is looking for are ways to separate out the graft-versus-host cells from those that could be beneficial in getting rid of the tumor,” he explained. “That’s very difficult, because there is overlap in that population. But there are also some tumorspecific cells that would not cause GVHD and could attack the tumor cells, and that’s what we’re looking to find.”

Korngold said the Center’s researchers have been working with an approach that uses T-cell receptor DNA analysis to look at the T cells from the donor and how they might respond to both the recipient and the recipient’s tumor. Research has been focused on identifying subsets of cells that can be eliminated from the donor population to reduce the risk of the patient developing GVHD.

“We published data on that in 2008,” said Korngold, “and are moving ahead in looking to perform a clinical trial. Hopefully, within the next 2 years, we will be able to start that trial.”

Tumor bank and outcomes tracking

Andre Goy, MD, MS, a hematologist/oncologist, is deputy director of the John Theurer Cancer Center. He was instrumental in developing a Tumor Bank at the Center, where samples of cells, tissue, and other anatomical structures are stored and analyzed for research purposes. According to Goy, the bank currently has received more than 1300 patient consents.

“The goal is to try to identify signatures that will tell us that one patient will do very well with standard therapy, while another patient should receive something different; something innovative,” said Goy. “It’s very important to try to tailor the treatment based not on how the cells look, but how the cells are wired. That’s really the future of rational therapeutics,” he added.

It is important to track treatment results, and the Center is in the process of building a system that will be able to track outcomes for every single patient who comes to the Center and show how various subsets of patients are doing. The system should be operational by the end of 2010, and Goy said it would mark an important step forward at the John Theurer Cancer Center.

“We want to be able to say at any given time that our patients, let’s say 3 years from now, those who have lymphoma [and are being treated] with drug XYZ are doing better than [patients] 3 years ago,” Goy said. “And then you create hypotheses to develop the next clinical trial. That’s where the field is going, and it’s very exciting.”

A new center

Plans are under way to build a freestanding cancer center that will centralize all divisions and the physicians, nurses, and other cancer specialists currently scattered among various buildings. The goal is to move into the new center by the end of 2010.

“It’s going to be a major endeavor, considering we’re among the top 10 providers of cancer services in the country by volume,” Pecora said. “That will be a significant challenge.” Meeting that challenge, however, will come with significant benefits.

“Having everyone in one building will make it so much easier to communicate in real time while seeing patients,” Ingenito said. “It makes [providing care and treatment] so much more of a userfriendly process, which, I think, only improves overall patient care.”

Goy echoed those sentiments. “The best way to do a multidisciplinary approach is to make everything extremely multidisciplinary. The core of our mission is to make the patient experience better. Cancer is so disruptive in someone’s life, so we have to be cognizant that patients have to have a better experience.”

Ed Rabinowitz is a veteran healthcare journalist based in Bangor, Pennsylvania.

Clinical Trials

Ongoing trials at the John Theurer Cancer Center

Phase II: Study of Carfilzomib in Relapsed Multiple Myeloma

This open-label, single-arm trial is being led by David Siegel, MD, PhD. The purpose is to evaluate the best overall response rate (ORR), safety, and tolerability of carfilzomib in ~155 evaluable patients with relapsed multiple myeloma. Patients must have received prior treatment with bortezomib and either thalidomide or lenalidomide and be refractory to their last treatment.

JTCC ID: PX-171-004

ClinicalTrials.gov ID: NCT00530816

Contact: Laura McBride, RN, at (201) 336-8020

Phase I: HGS-1029 in Relapsed/ Refractory Lymphoid Malignancies

This interventional trial is being led by Andre Goy, MD, MS, to evaluate the safety, tolerability, and pharmacokinetics of HGS-1029 in patients with relapsed/refractory B-cell neoplasms (chronic lymphocytic leukemia/small cell lymphocytic lymphoma, or non-Hodgkin lymphoma).

JTCC ID: HGS1029-C1080

ClinicalTrials.gov ID: NCT01013818

Contact: Judith Smith, RN, at (201) 996-5078

Phase I: Gene Expression Signature as a Biomarker for Response/Resistance to BCR-ABL Inhibitors

Stuart Goldberg, MD, is leading this trial, which seeks to determine whether a gene expression signature changes in response to treatment with BCR-ABL inhibitors in patients with Philadelphia chromosome—positive (Ph+) chronic myelogenous leukemia in the blast phase or with Ph+ acute lymphocytic leukemia.

JTCC ID: 2009_558, 098

ClinicalTrials.gov ID: NCT00860535

Contact: Sora Limor, RN, at (201) 336-8598

Phase IB/II: Carfilzomib in Relapsed Solid Tumors and Multiple Myeloma

This 2-part trial is being led by Robert Alter, MD. Phase I will evaluate the safety and tolerability of carfilzomib in patients with relapsed solid tumors or relapsed/refractory multiple myeloma. Phase II will evaluate ORR after 4 cycles of carfilzomib in patients with relapsed solid tumors or newly diagnosed multiple myeloma.

Protocol ID: PX-171-007

ClinicalTrials.gov ID: NCT00531284

Contact: Diane Den Bleyker at (201) 336-8066

Promoting Innovation