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UCSF Helen Diller Family
Comprehensive Cancer Center
2015 Cancer Showcase Report
A State of the Science on Cancer
A cancer is as unique as the individual life it threatens. The disease is driven by each cancer’s unique genomic
fingerprint and is experienced in ways that are profoundly personal. At UCSF’s Helen Diller Family Comprehensive
Cancer Center, we are engaged as never before at every level of the disease – from the micro-details of individual
genes to the big picture of the patient’s experience.
At the 2015 Cancer Showcase, 30 of our basic, clinical, and population
scientists shared their progress in a wide range of areas, from big data
to quality of life. We’ve communicated these advances in the pages that
follow. Each session was remarkable, and taken together, they describe the
state of cancer science – and it is compelling indeed.
Whether in our search for new therapies or our efforts to enhance care,
people will continue to be at the heart of our mission. We are going to
look at the whole experience of the UCSF cancer patient – from his or
her first visit, hopefully through cure and survivorship; and if not, then
through ending their journey with dignity. As one example of many steps
being taken toward enhancing the patient experience, we are introducing
palliative care earlier and more comprehensively in cancer care.
To hasten the time it takes to get discoveries out of the lab and to our patients, we are developing integrated teams
focused on specific diseases. These teams will combine our deep disciplinary strengths in fields such as cellular
and molecular biology, population science, and computational biology to give us an unprecedented breadth of
perspective. From there we will create rapid, systematic steps from the lab to the bedside and back again to hone
and translate our discoveries into safe and effective treatments.
Central to our vision is the Precision Cancer Medicine Building. This 170,000-square-foot facility, to be constructed
at Mission Bay, will allow us to be at the forefront of what has now become a national priority with President Barack
Obama’s announcement of the Precision Medicine Initiative.
We also are developing an innovative Center for BRCA Research with an integrated patient clinic. It will be the
culmination of my long-sought goal of creating a comprehensive research and treatment approach for BRCAmutation carriers. The center will be a microcosm of our overarching strategy to bring basic research through
translation and into the clinic as quickly and as accessibly as possible.
Please page ahead for a sense of where we are and where we are headed. As you read, know that we owe our place
at the very top of the field of cancer research and care to those whose generosity helped get us here, and who we
regard as true partners in the future.
Many thanks,
Alan Ashworth, PhD, FRS
President, Helen Diller Family Comprehensive Cancer Center
Cancer Genomics
Likewise, they can search the database for patients with
• Boris Bastian, MD, PhD
the best care options and outcomes. In this way, the
• Kristen McCaleb, PhD
database, or knowledge network, becomes a continually
Cancer genome sequencing reveals which gene
similar genetic profiles to their own patients’ to determine
evolving, virtual clinical trial of cancer care.
mutations are associated with which cancers – such
UCSF, already a leader in the field, has roles on statewide
as breast cancer’s link to the BRCA gene mutation
and national precision medicine initiatives that will help it
or leukemia’s link to the BCR-ABL mutation – and
accelerate the study of cancer genomics and translate
provides insight into related mutations that may cause
those findings seamlessly from the research community
cancers in different parts of the body. Through UCSF’s
into patient care.
Cancer Genetics and Prevention Program, the largest
such center in Northern California, genomic testing
can provide lifesaving preventive options for children in
families with a history of cancer.
UCSF launched the Genomic Medicine Initiative
two years ago with the goal of building a powerful
infrastructure and electronic medical record system to
serve as the linchpin of its precision medicine effort. In
partnership with software company Syapse, UCSF is
creating a sophisticated database for clinicians to record
Developing New
Cancer Drugs
• Steven DuBois, MD
• Frank McCormick, PhD, FRS, DSc
• Pamela Munster, MD
• Jeffrey Wolf, MD
patient data, genomic testing and analysis, treatment
Basic and clinician scientists at UCSF have been at the
plans, and outcomes.
forefront of drug discovery for decades and have great
Incorporated into the software is the “UCSF 500,” a
panel of 500 gene mutations implicated in cancer and
catalogued by UCSF oncologists. Physicians continually
upload their patients’ data to share their treatment
strategies and outcomes.
insight into the changing nature of the endeavor over
time. The sequencing of the genome confirmed that
genes were driving the mutations that caused cancer.
Isolating the particular gene that drove specific cancers
led to lifesaving drug discoveries. Yet as the field has
progressed, researchers
have found that few cancers
have just one driver. Tumors
can grow over two to three
decades, acquiring as many as
40 different mutations. Trying
to figure out which mutations
drive the disease is far more
complicated than once
thought. Consequently, the
next wave of cancer treatment
is combination therapy –
agents that boost a patient’s
Frank McCormick, PhD, FRS, DSc
Boris Bastian, MD, PhD
immune response coupled with drugs that bombard the
cancer itself.
In UCSF’s Developmental Therapeutics program,
clinician-scientists go back and forth between their
clinics and labs to develop drugs for their patients who
have run out of options. They sequence the DNA of the
patients for inherited cancer-causing mutations, and then
Enhancing Quality
of Life for Cancer
Patients, Survivors,
and Their Families
• Susan Chang, MD
• Lee-may Chen, MD
• Michael Rabow, MD
Treating cancer once meant choosing between quality
or quantity of life. But this is no longer true, according
to researchers at the UCSF Helen Diller Family
Comprehensive Cancer Center.
Cancer treatment at UCSF now routinely incorporates
palliative care, a range of services designed to address
mental, emotional, and spiritual symptoms and maintain
quality of life while simultaneously administering the best
UCSF Chancellor Sam Hawgood’s opening remarks
sequence their tumors for precise targets. If a patient’s
tumor becomes resistant to a therapy, the clinicianscientists head back to the lab to find the next target,
while looking closely at the tumor environment for new
immunotherapy options.
oncologic treatments available.
The cancer center offers palliative care through several
multidisciplinary teams and services, including symptom
management, psycho-oncology, social work, spiritual
care, and caregiver support. These services provide help
with pain, fatigue, depression, insomnia, anxiety, and
spiritual issues, all integrated into regular oncologic care.
A great number of drugs are under development at
Family members and caregivers also can get training
UCSF, adding to a long list of our successes, including
and support.
sipuleucel-T, the first FDA-approved cancer vaccine, and
ipilimumab, the first FDA-approved immune checkpoint
inhibitor. UCSF scientists also are hard at work on a
new therapy for Ewing’s sarcoma, a rare pediatric bone
cancer. While the current treatment is effective, its side
Research, while still in its early stages, demonstrates
that patients who receive palliative care at the time
of diagnosis feel better, have less pain, and are likely to
live longer.
effects are debilitating as the cured former patients age.
As one of the nation’s pioneers in palliative care, UCSF is
Efforts are underway to change dosage and delivery
striving to make this level of care available for all cancer
methods, in addition to looking for substitute drugs to
patients, whether their disease is life-threatening or not,
solve the issue. Scientists at UCSF also are adding drug
to help them live as long and as well as possible. UCSF
candidates with great potential for success for myeloma,
researchers give credit to patients and their families for
an adult bone cancer.
their invaluable feedback along the way. These dynamic
relationships between UCSF practitioners and patient
They note an increase in the use of drug cocktails in
families have led to higher touch, more comprehensive,
cancer, where as many as three therapies compensate
and lasting clinical care programs.
for each other’s shortcomings. The researchers spoke
of a therapy cocktail that shrunk tumors in only about
The New Generation
of Cancer
Researchers:
What’s on the
Horizon for Us?
12 percent of patients, but for one, it has kept cancer
at bay for three years. Now researchers seek to answer
why, in hopes that the solution will lead to a more broadbased cure.
Another trend cited was the national shortfall in
funding for early-career researchers like themselves.
Consequently, young investigators all over the country
take significant time away from their research to pursue
grants. Funding from endowments proves most valuable
in allowing them to return to their work. Often, donor
support equates to “seed grants,” funding research that
• Chloe Atreya, MD, PhD
enables younger researchers to collect enough primary
• Trever Bivona, MD, PhD
data to then apply for federal and other grants.
• Adam De Smith, PhD
• Kyle Walsh, PhD
UCSF’s young cancer researchers see promising
trends on the horizon. First is an unprecedented level
of collaboration among universities. Increasingly, large
The Perils of OverDiagnosing Cancer
grants are awarded to multiple institutions, featuring
as many as 40 authors across various universities
• Matthew Cooperberg, MD, MPH
and disciplines.
• Laura Esserman, MD, MBA
They have also seen a decrease in drug development
In the 1980s, national
times over the last five or six years with the emergence
recommendations
of sophisticated molecular techniques to identify specific
emphasized rigorous
Kyle Walsh, PhD
treatments for
screening and early
specific patients.
detection as the keys
In fact, several
to reducing the rate
breakthrough
of late-stage disease
therapies for
and decreasing
lung cancer that
cancer mortality.
spent only two
While aggressive
or three years in
screening has
the development
increased early-stage
process may
detection, it has failed
be approved in
to produce a significant drop in later-stage disease and
late 2015.
morbidity rates.
Laura Esserman, MD, MBA
With the release of reports showing screening efforts
was actually ovarian. A database search of her genetic
cost the US $4 billion annually in unnecessary treatment
signature showed evidence that platinum therapy had
costs, the National Cancer Institute convened an advisory
halted the cancer in others. The “genetic re-diagnosis”
panel of the most innovative oncologists to evaluate over-
saved her life and perhaps the lives of her three children,
diagnosis. They sought out Laura Esserman, MD, MBA,
as the mutation is inheritable, and the cancer now is
to chair the panel.
treatable with a PARP inhibitor, a drug developed for
According to Esserman, considering all cancers as lethal
leads to overtreatment. Cancer is not one disease with
BRCA-related cancer by UCSF Helen Diller Family
Comprehensive Cancer Center President Alan Ashworth.
a standardized treatment. The more we know about
a cancer, the more we can avoid a “one-size-fits-all”
approach and adapt treatment to a person’s specific case
by developing targeted therapies.
Overtreatment doesn’t have to be the price of screening
the general population. Matthew Cooperberg, MD, MPH,
has identified patterns and outcomes in the diagnosis and
treatment of urological conditions that often
lead to overtreatment. He was recently recognized by
the American Urological Association for this groundbreaking research.
Atul Butte, MD, PhD
Our clinician-scientists are using biology and genetics
to drive treatment choices and reduce the possibility of
Called precision medicine (see first session on Cancer
overtreating a cancer that, though detectable, may never
Genomics), the new field incorporates not only genomic
kill. At UCSF, more personalized care and treatment
data but also environmental, lifestyle, and behavioral
options allow our practitioners to think about the entire
health information, including some delivered in real time
patient ecosystem, develop treatments specific to their
from wearable devices. As director of UCSF’s Center
biology and genetics, and provide more rational and
for Digital Health Innovation, Michael Blum, MD, helps
directed care.
incubate UCSF discoveries in the digital space, validates
existing technology, and partners with industry to create
Big Data and Cancer
new ones.
• Michael Blum, MD
will host the second largest health database in the world,
• Atul Butte, MD, PhD
with 13.6 million electronic health records. Atul Butte, MD,
• Eric Collisson, MD
PhD, director of UCSF’s Institute for Computational Health
Big data has radically changed the way medicine is
practiced at UCSF. Eric Collisson, MD, conveyed its
power with the story of a patient who was referred to
him with all the classic signs of pancreatic cancer. Yet
in sequencing her genome, Collisson found that the
patient carried the BRCA2 mutation and that her cancer
UCSF, as one of the UC system’s five medical centers,
Sciences, will spearhead UCSF’s efforts to best leverage
this invaluable resource. Virtual clinical trials, enrolling not
just across all five centers but also across the world, will
be run using highly selective patient groups, promising
more precise results at a fraction of the cost and time.
The impact on rare cancers will be profound because
clinicians will finally be able to build statistically significant
numbers of patients for trial with people participating
a 12-site clinical trial, 80 percent of participants who
from remote locations all over the world.
responded to immunotherapy were still going strong
two years later, and 15 to 20 percent who had terminal
Cancer
Immunotherapy
brought from successful mouse models into FDAapproved treatments in less than a decade.
It is not surprising that word of the success spread
quickly and led to an explosion of interest. With such
• Lawrence Fong, MD
promise, UCSF scientists are studying success rates and
• Lewis Lanier, PhD
patient response in hopes of understanding when the
Immunotherapy has
immune system can be unleashed to fully respond to the
transformed the
threat of cancer at a molecular level.
treatment approach
to cancer. Even the
language traditionally
used to describe
cancer treatment is
no longer appropriate.
What used to be
referred to as the
“fight” against cancer
Lawrence Fong, MD
melanoma are considered cured. These drugs were
is now more likely
to be presented as
a strategic bolstering of the immune system. UCSF is
leading the way because a new generation of drugs
Now the possibility of a cancer vaccine is no longer a
distant dream but a predictable reality.
Cancer Prevention
Strategies
• June Chan, DSc
• Stacey Kenfield, DSc
• Greta Macaire, MA, RD, CSO
• Erin Van Blarigan, ScD
developed here has successfully reduced tumor size and
There’s no guarantee
eliminated clinical evidence of some cancers formerly
against cancer risk.
considered incurable.
People who eat a
Cancer confounds the immune system into complacency
and leaves the body susceptible to malignant disease.
New immunotherapy treatments awaken a patient’s
immune system, eliminate abnormal cell growth, and
build up the immune system to unleash its power.
Whether on its own or in concert with other treatments,
immunotherapy involves genetically engineering T cells
– the soldiers of the immune system – to give them the
power to attack infected cells and demobilize invading
pathogens that previously eluded them.
Normally considered untreatable, people with late-stage
melanoma rarely live more than a few months. But in
healthy diet, exercise
regularly, and never
smoke still sometimes
get cancer. However,
scientific evidence –
including some gathered
at UCSF – shows that a
healthy diet and lifestyle
June Chan, DSc
can reduce your risk
of cancer by 15 percent. Our clinician-scientists shared
prevention strategies and the evidence to back them up:
• Avoid smoking or chewing tobacco. Nearly one-third
of cancer deaths in the US result from tobacco use.
• Exercise for 30 minutes or more, at least five days
a week. Exercise in any form helps avoid cancer. If you
can’t do 30 minutes at a time, you can get the same
benefit from three 10-minute bouts during the course
of the day.
A Disproportionate
Burden of Cancer
• Rena Pasick, DrPH
• “Sitting is the new smoking.” Limit sedentary
• Eliseo Perez-Stable, MD
activities such as watching TV and working at a
• Gideon St.Helen, PhD
computer. Being sedentary increases the likelihood
• Janice Tsoh, PhD
of cancer, heart disease, obesity, diabetes, and other
diseases. Stand up and move around for a few minutes
every hour. Plan trips to the bathroom, copier, etc.,
around that schedule to limit the sedentary period.
• Limit damaging foods, including red meat, alcohol,
and foods high in sodium.
African-American men with prostate cancer have twice
the mortality of their white counterparts. Latinos are more
likely than any other US group to be uninsured. AsianAmericans account for half of all US liver cancers. These
are just a few examples of the disproportionate burden of
cancer suffered by vulnerable US populations.
• Avoid sugar-sweetened beverages, including
UCSF’s Helen Diller Family Comprehensive Cancer
soda and fruit juices, which promote weight gain
Center is a national leader in cancer disparity research
and obesity.
on the causes of these gaps, which include low income,
• Obtain nutrients from food, not supplements.
Eating a plant-based diet – fruits, vegetables, whole
grains, and legumes – increases your intake of
protective substances like dietary fiber, vitamins and
poor education, limited English proficiency, and
lack of medical insurance. Also contributing are a lack
of diversity in clinical trials and limited access to highquality care.
minerals, and phytochemicals that deter cancer
Cancer and public health experts at UCSF are developing
development, and also makes it easier to maintain a
interventions to reduce such disparities through outreach,
lower calorie intake.
education, and training. Most effective, they say, are
Research also indicates that if you are diagnosed with
cancer, a low-fat diet and vigorous physical activity – for
at least three hours a week – reduces your risk of dying
from the disease or having it recur after treatment.
collaborations with trusted community sources, such as
churches and lay health ministries, as well as counseling
and awareness campaigns to promote cancer screenings
and genetic testing among at-risk populations.
Underway through the National Cancer Institute is the
Rena Pasick, DrPH
effort to strengthen and increase diversity in the field
of cancer disparity research. Also needed are ongoing
efforts to increase understanding of the correlation
between low socioeconomic status and poor health.
© 2015 The Regents of the University of California
Minority Training Program in Cancer Disparities, a 10-year