ONcology Rounds

Vanderbilt Researcher Lands SU2C Grant

John T. Wilson, PhD, assistant professor of Chemical and Biomolecular Engineering and of Biomedical Engineering at Vanderbilt University, has received an Innovative Research Grant from Stand Up To Cancer (SU2C). Wilson is among 10 early-career scientists to receive the grant awards focused on immuno-oncology.

Wilson, who is also a member of Vanderbilt-Ingram Cancer Center, is trying to determine how a "cold" tumor that does not respond to immunotherapies can be reprogrammed into a "hot" tumor that is recognizable by the immune system.

Cancer immunotherapy harnesses a patient's own immune system to attack cancer cells with minimal damage to surrounding tissue while also training the immune system to remember how to kill the cancer cells if they return. New checkpoint inhibitor drugs work by reactivating the immune system's T cells to recognize cancer cells. However, many patients do not completely respond to these therapies.

Wilson said there are two reasons for this lack of response: 1) patients have nonimmunogenic or "cold" tumors that evade recognition by T cells, and 2) some patients lack a sufficient number of the correct type of anti-tumor T cells necessary to efficiently destroy tumors. He plans to develop "smart" nanoparticles loaded with a small molecule that will act on inflammatory pathways to transform "cold" tumors into "hot" ones. Wilson also plans to load the nanoparticles with tumor antigens to better train T cells to recognize and attack cancer cells.

"We are combining multiple approaches, using state-of-the-art bioengineering, mouse tumor models, and a series of advanced proteomics and immunology tools," Wilson said. "If successful, this research has the potential to positively impact patient outcomes by developing a versatile, safe, and scalable drug-delivery platform for personalized immunotherapy."

One Child's Cure Raises Hopes For Pediatric Soft Tissue Cancers

The word to describe Tucker Williams is joy. "He is happy, fun, active, and an extremely strong little boy," said his mother, Jessica. Just 14 months ago she might not have described her son this way.

At that time, just two months old, Tucker went from being a typical newborn to a child in need of serious medical care. He went from eating six ounces of food to nearly nothing. "I knew his eating patterns, and when he refused to eat and began sleeping more than usual, I knew something was wrong. Cancer never crossed our minds," his mother recalled.

Admitted to The Children's Hospital at TriStar Centennial, a large cancerous abdominal mass was discovered located deep near Tucker's diaphragm. Haydar Frangoul, MD, a pediatric hematology/oncology physician, was assigned to the case.

"Tucker's diagnosis was Rhabdomyosarcoma, a common cancer of the soft tissue that affects nearly 350 children each year," said Frangoul. "The difficulty with Tucker's case was the location of the tumor. It was deep within his body and comprehensive treatment would require a three-prong approach: chemotherapy, surgery, and radiation."

Almost two-thirds of Pediatric Rhabdomyosarcoma cases are diagnosed in children under six years of age, which makes standard care practices a bit more challenging," explained Frangoul. "Surgery and chemotherapy are acceptable for a child this age but large doses of radiation - the amount needed to achieve the highest rate of cure - can result in significant long term side effects for infants."

To counteract this, Frangoul and a team of physicians employed a more targeted approach to therapy. Stephen Morrow, MD, pediatric surgeon at The Children's Hospital and Andrew Kennedy, MD, from Sara Cannon, pinpointed areas where Tucker needed radiation and placed catheters to deliver radiation close to the tumor site. "This targeted approach was a first for our hospital and certainly in this region," said Kennedy. "Delivering radiation with accuracy allowed us to avoid damaging Tucker's organs near the tumor site."

Today Tucker is in full remission with a chance to grow and enjoy his childhood. "We've been so fortunate to have the privilege of treating him," said Frangoul.

New Prostate Screening Recommendation for Older Men

Last month a federal task force has changed its recommendation about prostate cancer screening for some older men. The United States Preventive Services Task Force (USPSTF) now recommends that men between the ages of 55 to 69 consult with their physicians about getting routine screening blood tests to detect prostate cancer.

In 2012 the task force recommended against routine screening with prostate specific antigen (PSA) tests for men of any age because the risk of complications from treatment appeared to outweigh the benefits of routine screening.

However, following that recommendation, a 2015 study led by Vanderbilt University Medical Center (VUMC) investigators found new diagnoses of prostate cancer in the U.S. declined 28 percent in the year following the draft recommendation against routine PSA screening. The VUMC investigators suggested that withholding screening might result in failure to detect higher-risk cancers during the window of time when the cancer is most likely to be cured. Timely treatment of intermediate and high-risk localized disease is associated with superior overall survival, disease-specific survival and decreased spread of the disease to other locations in the body.

The VUMC research and other studies helped contribute to the revised USPSTF guidelines. "This is a major about-face for the USPSTF that brings them into agreement with most other major professional societies. Patients need to discuss screening with their doctors and decide if this is the right thing for them," said David Penson, MD, MPH, Hamilton and Howd Professor of Urologic Oncology and chair of the Department of Urologic Surgery at VUMC.

In Case You Missed It: Prostate Screening at Nashville General

Kelvin A. Moses, MD, PhD, FACS is leading a screening initiative at Nashville General Hospital to reach out to men at high risk for prostate cancer.

"We want to encourage African-American men to participate because of higher incidence of prostate cancer and higher risk of high-grade cancer in black men," explained Moses, who is chief of Urology at Nashville General Hospital.

The PSCAN project, funded through the end of 2017 with a grant from Astellas Pharma US, is available at no charge to the men being screened. In addition to African-American men, Moses said other target populations include those who are uninsured, on public insurance, or who haven't been previously screened.

Upcoming Clinic Dates:

• May 15
• June 19
• August 7
• September 11
• October 23
• December 4

Moses is encouraging healthcare providers and staff members at area clinics to share information on the screening program with patients. To schedule a screening, individuals should call 615.341.4282 and ask for an appointment as part of the Prostate SCAN event.

Grant Benefits Nashville Hope Lodge

The American Cancer Society has received a $60,000 grant from the Clark Legacy Foundation to support the operation of the Nashville Hope Lodge, which provides a free, temporary place to stay for cancer patients while they are receiving treatment locally.

"If you are a cancer patient fighting for your life, the last thing you should have to worry about is where you're going to stay when receiving treatment and how you're going to pay for it," said Michele Ryan, senior manager of the Hope Lodge. "We are grateful to the Clark Legacy Foundation for their gift to fund our mission and allow our guests to focus on getting well."

In 2016, Nashville's Memorial Foundation Hope Lodge served 1,450 guests; provided 18,706 nights lodging; and offered 6,500 shuttle rides to and from treatment locally for guests from across the U.S.

The Clark Legacy Foundation is the charitable giving arm of the former CLARCOR Inc., the Franklin-based industrial filter company that was recently sold to Parker Hannifin Corp., based in Ohio.

Mark Your Calendars

Tennessee Breast Cancer Coalition (TBCC) is gearing up for the 21^st Annual Celebration of Life Golf Classic and Auction Par-TEE. The event is scheduled for Aug. 10-11 at Hermitage Golf Course. Interested golfers and volunteers should call 615.377.8777.

A Heart to Hold

Patients at Vanderbilt-Ingram Cancer Center are holding tight to hope ... and small, stuffed, fabric hearts. The "Heart to Hold" initiative is designed to provide comfort to cancer patients receiving radiation and their family members.

The project was suggested by Mark Stavas, MD, assistant professor of Radiation/Oncology and director of Supportive Radiation Services, who had received a similar fabric heart years earlier from the family of a cancer patient who died.

"After his death his wife gave me the heart that he had held as a gift in gratitude. I kept this heart for a year and a half before I started my practice. Every day I see what patients go through; transformative moments where there's nothing you can say to make it better. Sometimes you just have to sit quietly with somebody and hold the space for uncertainty, or maybe give them an object. This idea of transferrable objects, saying 'I don't know what this means but I'm here with you no matter what happens,' and having a symbol for that, is what ultimately brought this idea to fruition," Stavas said.

VICC supportive oncology nurse practitioner Rachel McDowell, APRN, who crochets, paints and sews in her spare time, started experimenting with needle felting and produced some sample hearts. "I showed these to Mark and thought it would be awesome to have them on display as a kind of encouragement to other people to make hearts for our patients," McDowell said.

Stavas commissioned artist friend Christopher Prinz to design an art installation to showcase the hearts. Next to the "Heart to Hold" display case, which now sits in the VICC lobby, visitors can pick up instruction sheets that explain how to make the hearts.

"It has an amazing power for the patient. What struck me is that patients would just hold them and grip them and squeeze them, and it was obviously a way to release some of the energy that they were having and also something they could carry with them as a constant reminder that you're not alone, that someone cares for you," McDowell said.

For more details about the Heart to Hold initiative, visit h2h-nashville.com.

Work Completed on Tennessee Oncology Corporate Headquarters Relocation

Turner Construction has completed work on the relocation of Tennessee Oncology's corporate headquarters.

Previously located within Saint Thomas' 20th Avenue West medical office building, the organization has relocated its corporate headquarters to the Midtown Medical Plaza, where Turner renovated a total of 40,000 square feet on the fourth, fifth and eighth floors. The space now houses an executive suite, conference rooms, training rooms and the medical practice's accounting, customer relations, HR and IT departments.

Turner applied lean construction methods to enhance efficiency and minimize disruption to the building's other tenants. Turner worked with design partner Gresham, Smith and Partners and project engineer Power Management Corporation on the renovation.

"It was an honor to take on and complete such an important project for Tennessee Oncology," said Kevin Williams, manager of Turner's Special Projects Division (SPD) in Nashville. "This relocation and consolidation of the practice's executive and administration functions to a new, centrally located space will enable the practice to operate more efficiently."

RELATED LINKS:
American Cancer Society Hope Lodge
TBCC
Heart to Hold Initiative