Inside the Tulane Cancer Center: Spring 1997

- Inside the Tulane Cancer Center: Spring 1997

Spring 1997

Headlines in this Issue:
A Message from the Director
Scientific Education / an AIDS Advantage: The AIDS-Related Task Force
Staying Connected: Community Outreach
Gideon Outreach ... Friends for Life ... Fashion Show ... Survivors Day ... Sports for Life

Research: Making a Difference

Disease Management Teams: More Options for Patients
Tulane Cancer Center: Seamless Care
New Clinical Protocols at TCC

AT A GLANCE:
1997 Calendar of Events
Breast Cancer Seminar Series
Comings and Goings
Recent Honors and Awards

Index to all archived issues
Index to archived articles by topic
Editorial Staff & Contacts

A Message from the Director

Roy S. Weiner, M.D.
Director, Tulane Cancer Center

With the opening of our new Comprehensive Clinic, TCC patients and their families will have access to a health care resource that is new and unique in this region. The new Center's design creates a physical environment and organizational structure tailored to meet each patient's need. Specifically, the Comprehensive Clinic will integrate cancer diagnostic and treatment services and provide a single location from which to coordinate all cancer care. The 20,000 square foot facility (it covers one square block) located at 150 South Liberty will house multi-disciplinary clinics, an infusion center for outpatient chemotherapy, a pharmacy, a laboratory, radiation therapy suites, a patient resource library, a video conferencing center, and minor procedure rooms. The Patricia Trost Friedler Cancer Counseling Center will be relocated to the new center and will provide convenient family support and counseling services. In short, the constellation of services will provide one-stop shopping for Cancer Center patients.

In concert with the physical integration, the model of care will offer a complementary union of function for both staff and support systems. Within the new Comprehensive Clinic, TCC physicians, nurses, social workers and patients support staff will offer care that is comprehensive, multi-disciplinary, well coordinated, and most importantly, centered on the needs of the patient and the patient's family.

Our focus on patient need and patient convenience within our academic cancer center unique in the Gulf South. Our patients will benefit from our "academic engine" driven by our expert physicians and surgeons, and from our advanced technologies for diagnosis and treatment without sacrificing warmth and convenience. Our new Cancer Center is scheduled to open in July of this year. With its opening, we will demonstrated that our model of coordinated interdisciplinary care can indeed provide our patients with excellent and satisfying service while providing our faculty with the opportunity to teach, to discover, and to translate scientific discovery to improve health outcomes.

Scientific Education

An AIDS Advantage: The AIDS-Related Task Force Scientific notice of AIDS (Acquired Immune-Deficiency Syndrome) began with a patient who died in St. Louis, Missouri, nearly three decades ago. But that patient, know as Robert R., did not die of AIDS. He died of Kaposi's Sarcoma, a condition in which wells that make up the blood vessels multiply uncontrollably. Today, the AIDS-Related Task Force of the Tulane Cancer Center is seeking clues among a special group of lesions that occur most frequently in these patients.

Kaposi's Sarcoma (KS) is one of several malignancies that are more frequent or more aggressive in patients with weakened immune systems, such as those with AIDS or with suppressed immune response as part of organ transplant procedures. At its peak, KS appeared in as many as a third of HIV-infected men, though seldom in infected women. In HIV-infected women, cervical cancer threatens with greater frequency and often fatally.

The correlation of these and other malignancies with immune deficiency offers the task force a key with which to unlock the maze of mechanism from which cancer arises. The presence of the AIDS Clinical Trials Unit, jointly operated by Tulane and LSU, offers an unusually large concentration of clinical contexts in which to study the problem, as do the various specialty clinics, such as dermatology, hemophilia, and obstetrics and gynecology, that also identify and treat AIDS patients.

Task Force chair Cindy Morris, Assistant Professor of pathology, says, "Anyone involved in AIDS research is, in a sense, part of the task force. All are invited."

One clue to the relationship of immune system mechanisms and cancer is found in the recent decline of KS. Larry Millikan, professor and chair of dermatology, and Morris speculate that the retroviral treatments AIDS patients now receive may also affect KS, though exactly how is not yet clear. One possibility, says Millikan, is that a herpes virus, newly associated with KS, may be affected. Or, the newer drugs may interfere with virus to virus interaction. Researchers agree that several factors must combine in the development of cancers.

Taking a cue from European research showing that retenoids improve immune-related disorders, such as psoriasis, Millikan and his group are using an oral preparation containing these substances, such as Vitamin A, to treat KS. He has previously shown positive effects by applying the compound on the surface of the skin.

Raja Mudad, assistant professor of hematology, has begun another protocol for KS. He is giving patients Taxol, a chemical originally found in the Pacific yew but now synthesized, intravenously every three weeks. He says that lesions improve markedly and patients are much more comfortable. The only negative side effect of this outpatient chemotherapy is hair loss, a small price for the regression of lesions and decrease in pain from swelling. Taxol interferes with cells' ability to multiply. Mudad is a member of the Cancer Center's lymphoma and myeloma task forces as well.

Cindy Leissinger, along with Morris, is exploring a possible genetic mutation that may protect against HIV infection. Leissinger, an Associate Professor of Medicine, has been following a large number of hemophiliacs who were exposed to HIV -- some as long as 15 years ago -- and show high levels of the virus but without succumbing to the disease itself.

"We think they have a heightened cellular immunity, an ability to contain infection. We also know that cellular immunity is important because those with dysfunctional immune systems get cancer," says Leissinger. From clinics in obstetrics and gynecology come yet more evidence of malignancies taking advantage of weakened immune systems. William "Rusty" Robinson, associate professor, says that clinic patients who are HIV positive also have a higher incidence of cervical cancer, and the disease is more aggressive, often returning after treatment. And once it becomes invasive, it is 100 percent fatal. In contrast, more than 50 percent of non-HIV infected patients with the malignancy survive.

Agreeing with Millikan and Morris about the apparent benefits of antiretroviral drugs, Robinson also points out that while a weak immune system means worse cancer, at least in the lower genital track of women, it has not yet been proven that a healthy immune function results in a weaker cancer.

Robinson, who is a researcher as well as a clinician, says, "The theory is that one of the genes associated with HIV accelerates destruction of a product that controls cellular reproduction by keeping cells from reproducing too quickly." If the gene and its products could be identified, they could be reproduced through pharmaceutical measures or addressed through gene therapy," he says.

Finding that gene, or understanding the molecular mechanism of KS, is the focus of work by Morris, who has long studied HIV replication. She says mechanisms of HIV infection and oncogenesis are very complementary. For example, "Cytokines, proteins that regulate immune response, play a huge role in HIV infection and in tumor genesis."

One thread of her work concerns understanding a gene product called Tat, which is released by HIV-infected cells and which promotes the growth of KS. Another protein Morris is studying, bc12, accelerates cell growth, and in a study of 19 HIV-related cases of cervical cancer, Robinson found bc12.

Although cervical cancer's rapid spread in HIV-infected women reduces the likelihood of early detection and effective treatment, Morris says the speed is also useful to researchers, because it is easier to see the mechanisms of the disease than in the 15 to 20 year progression typical of uninfected women.

On yet another track, Morris notes that a newly identified herpes virus, HHV8, is found in all forms of KS, whether associated with HIV or not. Further, she says, HHV8 is also associated with lymphoma.

Robert Garry, professor of immunology, supported by a $50,000 National Cancer Institute grant, is going back to tissue samples from Robert R. to see if the contain HHV8 or KS herpes virus. He will compare the old HIV virus to contemporary samples. He hopes to discover whether the virus is changing significantly, as some experts believe, or merely varying around a mean, which Garry favors. The answer to this question will help to reveal ways to interfere with its reproduction.

Leissinger says, "HIV has focused the spotlight on immunity, and we have learned more in the past ten years than in all previous years together."

The importance of the overlap of research on immune deficiency and cancer is apparent in the National Cancer Institute's requirement of an AIDS-Related program to qualify for designation as a National Cancer Center. Tulane has applied for recognition.

Robinson says, "Other places may have one element or another -- patients, clinicians, and basic scientists interested in that population -- but Tulane is one of a very few places with all of these."

by Anne Yeoman

Research:

Making a Difference

Disease Management Teams:
More Options for Patients Today most every one agrees that providing high quality health care that is satisfying to patients requires coordination and teamwork. Nowhere is this more true than in cancer care. In cancer care, high quality translates into programs for early detection and precise diagnosis coupled with ready access to the beast available treatment technologies and rehabilitation options.

To meet this need, TCC has organized itself in Disease Management Teams. These teams are made up of TCC members from many disciplines. Team members include basic scientists in areas of biochemistry, genetics, and pharmacology; behavioral scientists and physicians. The goal of the teams is to transfer the latest discoveries in science to the patient's bedside in the shortest possible time. Thus, disease management teams' diagnostic options used at the TCC represent the widest array of prevention and treatment technologies available. The ability to care for patients in this special way will be greatly enhanced by the opening of the Comprehensive Clinic.

Tulane Cancer Center:
Seamless Care Discovering that a family member, a friend or even ourselves may have cancer is a frightening and sometimes devastating experience. Patients and loved ones often require much more than excellent medical care to help them cope. At the Tulane Cancer Center, we have developed unique programs and services centered around the special needs of cancer patients and their families.

Tulane currently practices in a multi-disciplinary model for many cancers. For example, a woman diagnosed with breast cancer can see her surgeon, medical oncologist, radiation oncologist, plastic surgeon and counselor in the same exam room on the same day. "Being able to talk with all your doctors at once, in the same place and then to be able to decide on a plan of care you believe is best for you, can be very comforting to a newly-diagnosed breast cancer patient and her family," says Maureen Sintich, Nurse Practitioner and manager of the TUH&C's Breast Health Program. With the opening of the new Comprehensive Clinic, this unique approach to care will be made available to all cancer patients treated at Tulane.

New Clinical Protocols at TCC

Clinical practice in oncology is currently being guided by innovative research protocols that will help improve current strategies in cancer management. Efforts are directed toward defining socioeconomic and biologic parameters that may be underlying the current ethnic disparity cancer incidence and survival. Development of outreach programs that will enhance cancer awareness are underway, with a goal of heightened cancer surveillance and early detection. These efforts will be coordinated with community physicians in an attempt to promote the integration of relevant tumor biology information into clinical practice. By establishing networks that foster community/university physician collaboration, novel therapeutic strategies developed in the laboratory may be introduced into the medical community and perhaps positively impact patient survival.

Derrick Beech, M.D. announces several clinical trials currently active at the Tulane Cancer center utilizing novel approaches in the treatment of melanoma, breast cancer, hepatocellular carcinoma, soft tissue sarcoma, and several other malignancies. An upcoming research proposal is designed to use the oral agent Temozolomide in treatment of patients with metastatic or recurrent sarcoma refractory to other therapies. This treatment is designed to combat advanced tumors that are resistant to the traditional chemotherapeutic agents. The combined efforts of members of the TCC team will hopefully heighten our current understanding of cancer progression of cancer progression where the ultimate goal is to relieve human suffering. Dr. Beech may be reached at (504) 988-5355

Rodney Davis, M.D. and Raja Mudad, M.D. announce an upcoming protocol for patients with Hormone Refractory Prostate Cancer (HRPC). It will involve the drugs Mitoxamtrone, Prednisone, and Pamidronate . Mitoxamtrone and Prednisone are used to attack tumor cells, while Pamidronate is used to strengthen the bone, decrease any complications involving bones, and possibly make the bone more resistant to invasion by cancer cells. This study also looks at using this combination of drugs to increase the patient's quality of life. Dr. Davis may be reached at (504) 988-5274 and Dr. Mudad at (504) 988-5482.

Raja Mudad, M.D. announces a Phase II study of Taxol in Kaposi's Sarcoma. The study uses the drug Taxol in patients with AIDS-related Kaposi's Sarcoma. The study is investigating the role of taxol used in previously untreated patients who have developed Kaposi's Sarcoma. Taxol seems to have good activity in the treatment of this disease. It offers good palliation with minimal toxicity. Dr. Mudad may be reached at (504) 988-5482.

Hana Safah, M.D. announces a protocol BMT 95-2, a phase II study of patients with Chronic Myelogenous Leukemia (CML). CML is caused by an uncontrollable growth of one type of white blood cell. The only current treatment for CML which provides a cure is Allogeneic Bone Marrow Transplantation, or replacement of bone marrow from another individual. If a person does not have a matched donor for Allogeneic Bone Marrow Transplant, the treatment provided by this protocol may improve chances of patient survival. Dr. Safah may be reached at (504) 599-6565.

Staying Connected: Community Outreach

Gideon Christian Fellowship Church
Early Detection of Cancer Educational Session
In collaboration with the Gideon Christian Fellowship Church Ministry, the Tulane Cancer Center sponsored an informational session on Saturday, April 26. The program included display areas providing educational materials on cancer and the early detection of cancer, and a dynamic lecture on cancer incidence and detection, focusing on African-American women's and men's health issues. Dr. Rodney Davis and Dr. Suzette Cullins held classroom sessions focusing on prostate cancer and breast cancer.

Friends for Life Program Celebrates its First Anniversary
On April 28, the Breast Cancer Fund and the Tulane Cancer Center celebrated the first anniversary of the Friends for Life program with a champagne toast reception in the J. Bennett Johnston Health and Environmental Research Building. Friends for life is a personal support system that helps

	remind women friends to perform monthly breast self-exams & get regular mammograms.
	remind men friends to get regular screenings for testicular and prostate cancer
	educate members on other screening tests that might be appropriate for their age, lifestyle, and medical history.

All men and women are invited to join and anyone can be a Friend for Life. Call 1 (800) 588-5800
Remember, cancer is curable ... and can be prevented.

"A Tribute to Breast Cancer Survivors and Other Heroes"
On May 9, The Breast Cancer Fund hosted its inaugural New Orleans "Tribute to Breast Cancer Survivors and Other Heroes" Luncheon and Fashion Show to benefit the Tulane Cancer Center and the Louisiana Breast Cancer Task Force.

The tribute honored Maria Burkhardt and Helen Malin for their inspiring activism, and Dr. William M.P. McKinnon for his exceptional care. The runway featured models who have faced breast cancer, and their New Orleans celebrity escorts. Fashions were provided by JC Penney.
Ms. Jenny Winstead takes the stage, on the arm of Frankie Ford.

National Cancer Survivors Day
Tulane Cancer Center is demonstrating its commitment to cancer survivors by celebrating National Cancer Survivors Day 1997 as a national supporter on June 1 in New Orleans' Survivors Plaza on Poydras Street. Thanks to recent advances in research, treatment, and early detection, ten million Americans are alive today after a diagnosis of cancer. TCC celebrates cancer survivorship and reaffirms our nation's commitment to conquering cancer by research, treatment, and patient education.

Sports for Life Program
In conjunction with Prostate Cancer Awareness Month, on September 6 Tulane University and the Tulane Cancer Center are sponsoring "Sports for Life", a community awareness event focusing on prostate cancer and the importance of annual screening. The goal of the Sports for Life event is to increase community knowledge and awareness of this disease, and to increase participation in annual prostate screening by promoting a day of sporting events. Funds raised from this event will be utilized for prostate cancer research at Tulane Cancer Center.

Upcoming Events

May 18, 1997: The Louisiana Breast cancer Task Force's third annual Conquer Breast Cancer 5K Run/Walk

May 28, 1997: Senior Friends National Health & Fitness Day Fair (Tulane, Lakeside, Lakeland) at the Treasure Chest Casino, first floor, Kenner, Louisiana. Please contact Ms. Linda Skidmore at (504) 988-5868.

June 1, 1997: National Cancer Survivors Day

October 17, 1997 Grand Opening Celebration
Tulane Cancer Center Comprehensive Clinic
Contact: Angela Latino, TCC, (504) 599-6592

September, 1997
Sports For Life Tournament
Teaming Up Against Prostate Cancer
Contact: Bettina Beech, Dr.P.H., TCC, (504) 988-2181

Breast Cancer Seminar Series

5:30-6:30 pm at the Uptown Square Clinic
200 Broadway, Suite 230, New Orleans
Free and open to the public
For further information, please contact The Professionals
at 1 (800) 588-5800

May 15, 1997: Psychosexual Rehabilitation for Breast Cancer Patients
Dr. Griselda Gutnisky and Dr. Rusty Robinson
Psychosexual rehabilitation after treatment for breast cancer, for women experiencing loss of intimacy, feeling unattractive, or experiencing dryness or pain. For further information please call Brenda at (504) 988-5405.

June 26, 1997: Topic to be confirmed
William McKinnon

July 24, 1997: Healing Touch
Sharon Lewis

Comings and Goings

Welcome....

Angela Latino will support the TCC in her efforts as Executive Secretary and News/Features Editor. She joins the TCC staff after leaving her post as Director of Twin Cities Business & Community Relations for the University of Minnesota Alumni Association. Angela is a graduate and former staff member of Tulane University (Uptown Campus).

Jane Johnson recently joined the TCC staff as Community Outreach Program Coordinator. Before assuming this role, Jane completed an internship in the Public Relations Department for the Tulane Medical Center, and an internship with Channel 4 WWL-TV.

Goodbye....

Although we will miss her, the TCC would like to wish congratulations to Maria Bryer-Ash, the "voice" of the Bone Marrow Transplant program. Maria was the executive secretary to Dr. Miller, the program director for close to three years. During that time she organized the weekly transplant conferences and special programs, and was one of the planners of the first patient reunion in January 1996. Her wonderful personality and amazing efficiency will be missed by all in the Cancer Center. We wish the best to her, Michael, and Faith in their new home in Memphis.

Recent Honors and Awards

	Griselda Gutnisky, M.D., was elected to fellowship in the American Psychiatric Association. The election is a recognition of her outstanding abilities, talents and contributions to psychiatry.
	Steven Hill, Ph.D. was recently awarded two National Institute of Health-National Cancer Institute (NIH-NCI) research grants. The first is entitled, Neuroendocrine Influences on Mammary Cancer with a grant amount of $470,000, and the second is entitled, "Melatonin-Estrogen-response pathway for Breast cancer", amounting to $390,000.
	Laura Levy, Ph.D.: Recently published papers: Importance of a c-Myb binding site for lymphomagenesis by the retrovirus SL3-3. Nieves A., Levy LS, and Lenz J. Journal of Virology, February 1997 The feline leukemia virus long terminal repeat contains a potent genetic determinant of T-cell lymphomagenicity. Pantginis J, Beaty RM, Levy LS, and Lenz J. Accepted for publication in the Journal of Virology Speaker and participant at the National Cancer Institute, Bethesda, Maryland workshop entitled, "Biology of AIDS Lymphoma", March 7-9, 1997. Lab poster presentation at the National AIDS Malignancy Conference, National Cancer Institute, Bethesda, Maryland, April 28-30, 1997. Title is "Pathobiology of SIV-associated lymphoma in the rhesus macaque: Incidence of multiple viral infection in tumors."
	Graduate student Eric McGary was awarded the Norman Rogers Award, the Halsey Award (Pharmacology), and the Schlegel Award. He has successfully defended his Ph.D. thesis, and is also graduating from Medical School. Eric has been accepted to complete his medical residency at The Scripps Clinic & Research Foundation, and The Scripps Institute in La Jolla, California.
	Alan M. Miller, Ph.D., M.D. has been appointed to serve as Deputy Director of the Tulane Cancer Center
	Julie Sullivan, a graduate student in Anatomy and the Cancer Center, was awarded the American Association of Anatomy's outstanding dissertation award entitled, "Analysis of the Upstream Regulation of the Estrogen Receptor Gene in ER-positive and ER-negative Breast Cancer Cell Lines."
	Roy Weiner, M.D. has been: appointed by the governor of the State of Louisiana to the Louisiana Lung and Cancer Trust Fund Board. appointed chairman of the American Association of Cancer Research Media Relations Committee. appointed to serve on Columbia's Physician Oncology Advisory Board. elected to the Louisiana Oncology Society Board of Directors.
	James R. Yates, CHE, MBA, MSPH was a speaker at Delgado Community College in New Orleans, Occupational Therapy Student Seminar entitled "Managed Health Care: What Care Givers Need to Know," March 26, 1997.
	Congratulations to the members of the Tulane Pediatric Hematology/Oncology Section for the success of their SMILE (Student Make It a Little Easier) program. Through SMILE, about fifty medical student volunteers help children with cancer, and their families, by serving as big buddies.