Tulane Cancer Center's Multifocal Mission: Teaching, Research, and Patient Care

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In post-Katrina New Orleans, Louisiana, people refer to their return home and the revival of the city as “being back.” Today, the human spirit is thriving in the Big Easy’s resurrected communities and New Orleans is growing. The Tulane Cancer Center (TCC) at Tulane University Medical School has been the beneficiary of some of that growth.

“I’ve been places that were growing and places that were shrinking, and people want to be where things are growing,” said Prescott Deininger, PhD, director of TCC and the Brown Foundation Regents Distinguished Chair in Molecular Cancer Pharmacology. “It creates opportunity, it creates excitement. We’re certainly experiencing that. Our clinical program is bigger than it has ever been before.” Keeping up with the growth has required a range of renovations at the institution and 30 to 40 additions to TCC’s faculty.

A focused mission

how

TCC has a three-pronged mission that focuses on teaching, research, and patient care. Deininger described the interdependent relationship between these three elements. In conducting research, TCC’s clinicians teach students to research. The main point of the research is to develop better treatments. This requires a solid patient base, which relies on having physicians see patients and identify problem areas. This, in turn, leads to additional research to find solutions.

“One of our most critical goals is to bring more clinically oriented people together with our more laboratory-type people and see whether we can increase the value of both of their efforts,” Deininger said. “We want to have the basic scientists come up with new therapies that the clinicians can use and have the clinicians help teach us where the therapeutic problems are.” Deininger believes fostering communication through this open channel be- tween different realms is vital to its success.

One benefit of an academic medical center is its team approach to patient care rather than relying on the perspective of a lone physician. Researchers at the Center attend in-house tumor boards, where clinicians present cases and discuss the best diagnostic and treatment options. Deininger said this benefits physicians as well as patients. “[Physicians are] seeing things before they’re out in the journals. They’re able to understand what the problems are with the studies, as well as the strengths of the studies. It gives them a much more balanced view.”

Everything at TCC is about synergy—between departments, ideas, and people. Deininger explained how this concept factors into hiring decisions. “When we hire people, we keep in mind the faculty we already have, and we make sure we’re hiring people who synergize well with one another,” Deininger said. He singled out TCC’s prostate cancer program as an example of what happens when the facility’s mission comes to fruition. “We have great surgeons, a wonderful oncologist, and a group of young researchers who can now interact. That’s been very exciting as we learn to grow.”

Novel clinical trial

One reason for TCC’s excitement stems from its participation in a novel phase III randomized clinical trial investigating Alpharadin in late-stage prostate cancer. Oliver Sartor, MD, Piltz Professor of Cancer Research in the departments of medicine and urology at Tulane University School of Medicine, is principal investigator for the trial’s North American arm and was instrumental in shaping its design. Sartor said the multinational study plans to accrue 750 patients across more than 100 centers globally. TCC is the first designated trial site in the United States, making Sartor the first oncologist in the nation able to treat patients with this experimental therapy. As a result, patients from North Carolina to Washington state have contacted TCC to express interest in enrolling in the trial.

“To be able to offer patients the possibility of participating in a trial with a new therapeutic agent, and to know that this agent has a reasonable chance of working, is a very gratifying opportunity for me,” Sartor said. He added that his goal is not just to offer patients a new therapeutic option, but to take part in a trial he hopes will bring a new therapeutic opportunity to patients around the world.

Alpharadin appears to target and destroy cancer cells in the bone while sparing healthy bone marrow tissue, Sartor said. A randomized phase II trial in Europe produced “very provocative overall survival results,” he said, and expressed strong optimism about the phase III study. “Many of the cancer treatments we use today have the potential to be quite toxic. One of the exciting elements about this particular new treatment option is that the toxicity [of Alpharadin] appears to be very low in the preliminary human trials.”

Sartor believes if the phase III study has a positive outcome for the endpoint of overall survival, regulatory approval of Alpharadin in the United States and Europe will follow. “This compound could make a significant difference for the large number of men whose cancer has spread to the bones,” he said. “Patients most often die as a consequence of the metastases, not the primary cancer,” said Sartor, noting how challenging it is to prevent cancer from metastasizing and controlling metastases.

Moving research forward

In December 2009, Tulane University was the beneficiary of more good news, receiving approximately $11.1 million in federal funding to continue a successful mentorship program that supports the next generation of promising cancer genetics researchers. The National Institutes of Health is providing the bulk of the funding ($10.5 million) as a Center of Biomedical Research Excellence (COBRE) grant. This will fund projects for 5 junior faculty members. The mentees are matched with a team of senior scientists who guide their research progress and career development. The remaining $600,000 consists of a supplement grant from the American Recovery and Reinvestment Act. The grant supports a translational project from one additional mentee—Bridgette Collins-Burow, MD, PhD, whose clinical study is in response to discoveries at TCC’s own laboratories. This is an excellent illustration of the TCC mission in action and demonstrates the value of the academic medical center model.

Deininger described the COBRE grant as a “tremendous tool” for TCC. “You have to meet certain standards to receive this grant, and it forces us to think about those standards—to make sure we’re making the appropriate mentoring and communication available to all of our faculty.”

Deininger and Sartor are mentors in the program. Sartor, a full professor for 20 years, said his decades of experience have taught him a great deal about prostate cancer. He has also learned a lot about the research process, publishing data, and acquiring grants. Sartor said assisting promising young colleagues in their efforts to conduct successful research is rewarding.

“As a mentor, I can help them ask questions because I understand the disease,” Sartor said. “I can help with the hypothesis and help with the data interpretation. It’s something that is very gratifying to do.”

Ilana S. Fortgang, MD, assistant professor of clinical pediatrics and head of the section of pediatric gastroenterology at Tulane, is a mentee in the program under Deininger. She characterized the value of being in the program as “priceless,” adding that it was a great honor to be selected as a mentee.

Fortgang is investigating the development of colon cancer in the context of chronic inflammation and said one benefit of being a mentee is that it gives you “a couple of years of being funded, protected, and nurtured.” She said her project has been deemed meritorious, and the program allows her to move forward with the project and receive assistance from a great cohort of scientists. It also keeps the “wolves” at bay, she said. “It’s marvelous,” said Fortang. “It’s being protected and maximizing the chances for success.”

Challenges ahead

As TCC’s growth continues, Deininger said one challenge is for TCC to carve out a specific niche. This involves identifying TCC’s strengths and determining how to invest and maximize those strengths rather than doing a bit of everything. Deininger feels TCC is in an opportune position to look at health disparities among minority populations.

Said Deininger, “In New Orleans, half of the population is African American, and we already have tremendous involvement of African Americans in our clinical trials. That’s a real resource, nationally.” Deininger said he is as eager to discover the particular problems African American patients with cancer face and identify things TCC can do more effectively to address those problems. “That would be a special niche for us in the cancer center world,” he said.

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

Clinical Trials

A selection of Tulane Cancer Center Clinical Trials

Phase III Study of Alpharadin (Radium 223) in Symptomatic Hormone Refractory Prostate Cancer withBone Metastases

With this phase III, double-blind, randomized, multi-dose clinical trial, Oliver Sartor, MD, becomes the first US oncologist to offer patients with advanced prostate cancer that has metastasized to the bones the novel agent Alpharadin. This injectable treatment based on the radioactive bone-seeking substance radium-223, demonstrated promising overall survival and low toxicity in a phase II trial. Algeta ASA is sponsoring the study, which will recruit patients from more than 100 sites throughout more than 20 countries.

TCC ID: BC106

ClinicalTrials.gov ID: NCT00699751

Contact: E-mail osartor@tulane.edu or call (504) 988-7869

Using Effective Provider-Patient Communication to Improve Cancer Screening Among Patients withLow Health Literacy

This study, led by Eboni Price-Haywood, MD, MPH, at Tulane is designed to teach primary care physicians various techniques for effective cancer risk communication with patients whose health literacy is low. This is an especially vulnerable population, and the study will assess whether this training improves these patients’ cancer screening behaviors. The study is funded by the Harold Amos Medical Faculty Development Award through the Robert Wood Johnson Foundation.

Contact: E-mail eprice@tulane.edu

ERB-B4 Expression after Treatment with HDAC Inhibitor in ER+, Tamoxifen Refractory Breast Cancer

Bridgette Collins-Burow, MD, PhD, is lead investigator for this pilot study, which aims to understand the molecular mechanisms of acquired endocrine resistance in breast cancer. The primary objective is to assess the expression level of ER B-B4 before and after treatment with the HDAC inhibitor panobinostat in women whose tumors have demonstrated resistance to tamoxifen. Tulane is conducting this nonrandomized, single-arm proof of principle trial with support from Novartis and the Louisiana Board of Regents.

TCC ID: CLBH589BUS46T

ClinicalTrials.gov ID: NCT00993642

Contact: E-mail bcollin1@tulane.edu or wjohnso@tulane.edu

To learn about other open clinical trials at Tulane Cancer Center, contact the Center’s Office of Clinical Research at (866) 357-2140 or ocr@tulane.edu.