Download Triple Negative Breast Cancer

Insight
ON C A NCER SER V ICE S
Triple Negative
Breast Cancer
School of Medicine
UAB Insight on
CANCER SERVICES
welcome
summer 2010
The UAB Comprehensive Cancer Center is in its 40th consec-
volume 1, number 1
utive year of funding and designation as a comprehensive cancer
center by the National Cancer Institute (NCI). There are only
E d it o r i n C h i e f
Edward E. Partridge, MD
E x e cuti v e E d it o r
Emily Delzell
M a n a g i n g E d it o r
Peaches Scribner
C o n t r ibuti n g W r it e r s
Suzanne Parker
Dave Parks
Peaches Scribner
C r e ati v e Di r e ct o r
Ron Gamble
40 such designated centers in the United States, and UAB is the
only one in a six-state region that includes the Deep South states
of South Carolina, Georgia, Alabama, Mississippi, Louisiana,
and Arkansas.
This prestigious designation is awarded only to centers with
vigorous and productive cancer research programs in laboratory science, translational science, clinical science, and cancer
prevention and early detection sciences. UAB’s Comprehensive
Edward Partridge, MD
Cancer Center excels in all of these areas of research.
Because of the size of its cancer physician staff, the UAB Comprehensive Cancer Center is the
only institution in Alabama that can field teams of physicians, medical oncologists, surgical and
gynecological oncologists, and radiation oncologists that specialize, and in fact subspecialize, in
a single type of cancer. These teams are then able, through multidisciplinary evaluation, to design
a treatment plan most appropriate for ensuring optimal outcomes for patients, particularly those
with complex problems.
A r t Di r e ct o r
Jessica Huffstutler
I l l ust r ati o n
Echo Medical Media
Because our cancer physicians participate in our research programs, patients have the opportunity,
when appropriate, to receive investigational therapies well before they are available to most patients.
.In addition, an NCI-designated cancer center such as ours is able to provide services and facilities that are not typically available in the community. These services include palliative and supportive care teams and treatment programs for preserving or restoring fertility in cancer patients
before or after therapy.
.In this issue of UAB Insight on Cancer Services you can read more about our cancer research
and multidisciplinary treatment programs. The UAB Comprehensive Cancer Center is a true state
Published by the
UAB Health System
and regional resource, and we welcome the opportunity to work with the entire cancer community
to ensure the highest quality of care for all citizens.
500 22nd Street South
Birmingham, AL 35233
©2010 by The Board of Trustees
of The University of Alabama
for the University of Alabama at
Birmingham. Second class postage
Edward E. Partridge, MD, Director, UAB Comprehensive Cancer Center,
and Evalina B. Spencer Chair in Oncology
paid by UAB Bulk Mail Dept.
Postmaster: address changes to:
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On the cover: The image shows death receptor 5 (DR5) expressed on the surface of basal-like triple negative breast
cancer cells with the tigatuzumab antibody molecule bound to the DR5. Tigatuzumab is a novel treatment for basaltype triple negative breast cancer that targets the tumor itself and triggers tumor cell death.
Back cover: An isolated astrocyte, a subtype glial cell that can give rise to primary brain tumors. By permission of
Michelle L. Olsen, PhD.
6
contents
Treatment for Basal-like Triple
Negative Breast Cancer...................... 2
Advanced Options for Preserving,
Restoring Fertility................................ 3
Mouse Model Reveals Novel
Cause of Cancer................................. 4
Image-Based Oncological
Orthopaedic Surgery............................5
Expanding Applications of
Robot-Assisted Surgery...................... 6
3
5
New Therapeutic Approaches to
Brain Tumors........................................... 8
Integrated Multidisciplinary Breast
Cancer Care............................................ 9
8
Organ Transplantation for
Hepatocellular Carcinoma................ 10
Cancer Services Faculty...................... 11
UAB Ambassador Program
The Ambassador Program allows referring physicians to have complete access to their patients’ UAB records through a
secure Web portal. This innovative tool improves communication between the UAB Medicine and referring physicians,
enhancing continuity of care. To join, contact Physician Services through UAB MIST at 1.800.822.6478.
Oncology
Evolving Treatment for Basal-like
Triple Negative Breast Cancer
Investigational and Translational Therapies Show Promise
Advances in cancer genomics have
elucidated six different breast cancer
subtypes: luminal A, luminal B, human
epidermal growth factor receptor 2 positive (HER2+), normal-like, basal-like, and
claudin-low. “No targeted therapies have
been available for the treatment of basallike, normal-like, or claudin-low tumors,”
says UAB hematologist oncologist Andres
Forero, MD, director of the Clinical Protocol
and Data Management shared facility at the
UAB Comprehensive Cancer Center. Forero
is developing targeted therapies to improve
outcomes in basal-like and claudin-low
breast tumors, which usually are estrogen
receptor–negative (ER-), progesterone receptor positive (PR+), or HER2- (ie, triple
negative) breast cancers (TNBC).
Diversity in molecular variants and cellular makeup significantly affect therapeutic
options and clinical outcomes in breast
cancer patients. Endocrine-based therapy
for treatment of the slow-growing ER+
PR+ receptor luminal A and B cancers
often is very effective. The monoclonal
antibody Herceptin as a single agent or in
combination with chemotherapy in HER2+
cancers can improve clinical outcomes.
Yet chemotherapy remains the first-line
intervention for basal-like and claudin-low
breast tumors. The lack of effective targeted
therapies has made treatment of TNBC
challenging. “Identification of abnormalities
at the molecular level will allow development of target-specific therapies for triple
negative breast cancer, fulfilling the dream
of personalized breast cancer medicine,”
Forero says.
Intervention for TNBC
TNBC accounts for 15% to 25% of all
breast cancers. Historically this disease has
Breast Cancer Subtypes
Because of differences in gene expression, breast cancer may be divided into subtypes that have a different prognosis and may respond differently to therapy. The six
subtypes researchers have identified are: luminal A, luminal B, human epidermal growth
factor receptor 2 positive (HER2+), basal-like, normal-like, and claudin-low.
Luminal subtypes: Breast tumors of the luminal subtype are estrogen receptor positive (ER+). Luminal A and B tumors account for the majority of breast cancers. The
keratin expression profile is similar to that of the epithelial cells that line the lumen of
the breast ducts. Luminal A tumors carry the best prognosis of all of the subtypes, and
luminal B tumors often have a poorer prognosis.
Estrogen receptor negative (ER-) tumor subtypes: These tumors may be more
aggressive than luminal tumors. These tumors fall into two subtypes: Those that
overexpress HER2 and basal-like tumors. HER2+ types usually are ER- and PR- and HER2+.
A great proportion of basal-like tumors typically are ER-, PR-, and HER2-, leading to
the “triple negative” label. They have the worst prognosis of the subtypes. Basal-like
tumors may be associated with the BRCA 1 mutation, often occur in cancer patients,
and are frequently seen in black and Hispanic women.
Claudin-low subtype: Claudin-low breast cancers are a rare subtype characterized
poor clinical outcomes, exhibits aggressive behavior, and is prevalent in patients expressing
breast cancer gene 1 mutations. TNBC often
occurs in young, Hispanic, or black women.
Multiple new interventions under investigation show promise in patients with TNBC.
Conferring synthetic lethality to cancer cells
by inhibiting poly (ADP ribose) polymerase
(PARP) activity, PARP inhibitors in combination with chemotherapy show potential
benefits in the treatment of TNBC and other
cancer types (Cancer J. 2008;14:343-351).
Phase 2 clinical trial results evaluating BiPar
Sciences’(San Francisco, California) PARP
inhibitor, BSI-201, in patients with metastatic
TNBC were encouraging, Forero says. Until
BSI-201 receives Food and Drug Administration approval, an expanded access trial opening soon at UAB will offer patients BSI-201
in combination with chemotherapy. “If data
outcomes are validated, BSI-201 will be the
first drug approved specifically for use in triple
negative breast cancer,” he says.
Data from clinical trials of Avastin and Ixempra reveal the drugs are effective in TNBC
populations, generating interest for focused
TNBC applications. A monoclonal antibody
developed at UAB, tigatuzumab, selectively
targets death receptor 5 in tumor cells and
induces apoptosis. Preclinical studies show
basal-like cancers are particularly sensitive to
tigatuzumab-mediated cell death.
Forero and coinvestigators Tong Zhou, MD,
radiation oncologist Donald J. Buchsbaum,
PhD, and radiologist Kurt R. Zinn, DVM, PhD,
will investigate tigatuzumab and other experimental agents through a Susan G. Komen
Promise Grant cofunded by the Triple Negative
Breast Cancer Foundation. “Preclinical data of
tigatuzumab response in triple negative breast
cancer are impressive and provocative and are
as potentially exciting as Herceptin for treating HER2-sensitive cancers,” Forero says.
by mesenchymal and stem cell–associated gene expression and no expression of claudin-3, claudin-4, claudin-7, E-cadherin, epithelial cell adhesion molecule or mucin-1,
genes associated with tight junctions and cell-to-cell adhesion.
2 uab insight on Cancer Services • Summer 2010
FOR MORE Dr. Andres Forero
INFORMATION 1.800.UAB.MIST
[email protected]
Fertility Preservation
Advanced Options for Preserving,
Restoring Fertility
Methods Underutilized Despite Evolving Science, Benefits
The American Society of Clinical
Oncologists recommends clinicians advise
reproductive-aged patients that cancer
treatments pose risks to fertility: Radiation
therapy and chemotherapy can lower sperm
counts, destroy eggs, or trigger premature
menopause.
“The options for fertility preservation are
evolving constantly, and addressing this issue often helps people cope with their disease,” says G. Wright Bates Jr, MD, director
of UAB’s Division of Reproductive Endocrinology and Infertility. “Too often the
opportunity to preserve and restore fertility
is missed,” he says. Of patients preparing
for cancer treatment, <1% of women are referred to fertility specialists, and only about
10% of men are offered sperm banking.
Although sperm banking is typically
the sole simple option for men, options for
women are many and complex, and each
treatment carries its own benefits and risks.
To offer patients the most choices, it is
important for physicians to discuss fertility
preservation with them at the earliest opportunity, he says. “Physicians also should
explain all reproductive side effects of
treatment and advise patients to seek investigational treatments only at centers with
necessary expertise and protocols approved
by Institutional Review Boards [IRB].”
UAB participates in Fertile Hope, a nonprofit initiative that provides fertility information and support to cancer patients and
oncologists. The medical center also is one
of the first institutions to gain IRB approval
for tissue banking in conjunction with the
Oncofertility Consortium, a group of physicians and researchers exploring reproductive interventions for patients with cancer
and other serious diseases.
UAB’s Reproductive Endocrinology and
Infertility Services Clinic makes this care
as timely and trouble-free as possible. Men
can be seen for a sample the same day as
The image shows
intracytoplasmic sperm
injection (ICSI), which
may be required for
fertilization. ICSI is
one of several options
the UAB Division
of Reproductive
Endocrinology and
Infertility offers to
achieve pregnancy
after cancer treatment.
Inset: A human
embryo 5 days
after conception.
referral, and women are usually scheduled
within a day or two, Bates says.
Treatment Options
for Women
In vitro fertilization (IVF) followed by
embryo freezing is the most established and
successful method of fertility preservation.
It does, however, require time, expense, and
sperm availability. IVF can delay cancer
treatment, and there are concerns that hormones used to induce ovarian hyperstimulation could contribute to tumor growth.
Ovarian cryopreservation is an investigational treatment involving retrieval, freezing, and storage of ovarian tissue. The tissue
from one ovary can later be reimplanted in
the remaining ovary after cancer treatment,
with the possibility of restoring hormonal
production and fertility. This approach
may be appropriate for women who cannot
undergo the hormone treatment required
for IVF or lack the time needed for an IVF
cycle.
Cryopreservation of unfertilized oocytes
is an experimental technique requiring
ovarian stimulation but not sperm. Unfertilized eggs are retrieved and frozen for later
IVF. Immature eggs also may be retrieved
without stimulation, but maturation of these
eggs in the lab is a highly experimental
technique with only a handful of successful
pregnancies reported.
Ovarian transposition or relocation involves surgical repositioning of ovaries to
minimize radiation exposure. Transplantation can be appropriate for women undergoing pelvic radiation treatments.
Hormone supplementation can be used
to treat early menopause with premature
ovarian failure related to cancer therapies. It
is used primarily in younger women since
hormone therapy does not carry the same
risk for them as it does for older women.
FOR MORE Dr. Wright Bates
INFORMATION 1.800.UAB.MIST
[email protected]
uab insight on Cancer Services • Summer 2010 3
Hematology/Oncology
Cancer Susceptibility
Transgenic Mouse Model Reveals Novel Cause of Cancer
The genetic predisposition to colorectal cancer (CRC) that arises from
high-penetrance mutations associated with
Lynch syndrome, familial adenomatous
polyposis, and other rare syndromes is
responsible for approximately 5% of CRC.
Little is known, however, about genetic
factors that influence cancer susceptibility,
progression, or severity.
UAB hematologist oncologist Boris
C. Pasche, MD, PhD, director of the UAB
Division of Hematology and Oncology,
and Qinghua Zeng, MD, PhD, developed
an original mouse model to examine genetic factors associated with CRC and its
progression. “Using our novel transgenic
Fig. 1 reprinted with permission from Cancer Res. 2009; 69[2]:681, Fig. C.
1
mouse, we identified a new cause for
colorectal cancer in humans — a receptor
polymorphism,” Pasche says.
The signaling pathway of transforming growth factor-beta (TGF-ß) plays a
profound role in human cell growth, differentiation, angiogenesis, apoptosis, embryogenesis, homeostasis, and wound repair.
Increases or decreases in TGF-ß expression
are associated with atherosclerosis and
fibrotic kidney, liver, or lung disease. Mutations in the TGF-beta receptors (TGFBR)
1 and 2 or in their signaling pathways
can result in unrestrained cellular growth.
“We discovered TGFBR1*6A — the first
TGFBR1 mutation — associated with
cancer risk and impaired TGF-ß signaling,”
Pasche says.
Case-control population studies exploring the significance of the polymorphic
TGFBR1*6A mutation show its presence is
significantly more common in individuals
with cancer than in those without cancer (Mol Biol Rep. 2009:Nov 1. DOI
10.1007/s11033-009-9906-7). Multiple
studies have explored the relationships of
TGFBR1, impaired TGF-ß signaling, and
their association with cancer risk.
Diminished TGFBR1 expression
2
has been observed in multiple
types of cancer including prostate, breast, and CRC.
Cancerous polyps in mice (Fig. 1) and in humans
(Fig. 2) have similar features.
Colorectal Cancer
Susceptibility Factor
Genetic studies suggest approximately 20% to 30% of
CRC is inherited. The relationship among the inherited forms
of CRC, disease severity, susceptibility, and clinical outcome is
unclear. “To delineate the causal
relationship between decreased
TGFBR1 signaling and colorectal
cancer, we created a knock-out
4 uab insight on Cancer Services • Summer 2010
mouse model enabling us to manipulate
TGFBR1 expression,” Pasche says.
“Data demonstrate decreased TGFBR1
signaling plays a role in adenocarcinoma
formation and is associated with increased
susceptibility to colorectal tumor development,” he says.
A subsequent case-control study of
TGFB1 expression in humans suggests that
individuals with constitutively decreased
expression of the TGFBR1 gene quantitatively have a significantly increased
risk for development of CRC (Science.
2008;321[5]:1361-1365).
“Decreased TGFBR1 expression may account for approximately 10% of colorectal
cancer and represents the most commonly
inherited cause of the disease yet discovered,” Pasche says.
Additional animal and human studies
are exploring the role of TGF-ß function in
non–small cell lung cancer and pancreatic
and other cancers. A UAB Comprehensive
Cancer Center project is screening individuals to examine links between TGF-ß function and cancer susceptibility. Potentially
TGFBR1 mutations and pathway variant
tests may be used to develop genetic
screens to assess cancer susceptibility.
“The TGFBR1 mouse model studies and
subsequent TGFBR1 human case-control
studies epitomize a unique, correlative discovery between mouse data and the subsequent discovery of causative disease factors
in humans,” Pasche says.
FOR MORE Dr. Boris Pasche
INFORMATION 1.800.UAB.MIST
[email protected]
Orthopaedic Surgery
Image-Based Oncological
Orthopaedic Surgery
Navigation-Assisted Tumor Resection
Computer surgical navigation technology recently has garnered tremendous interest
from many surgical subspecialties. Orthopaedic
surgeons are using this technology in joint
reconstruction and pelvic trauma. Fusing
multiple imaging modalities such as X-ray,
computerized tomography (CT), magnetic
resonance imaging, and positron emission
tomography generates a three-dimensional
(3D) multimodal image for real-time use.
Surgeons use 3D fusion images as a virtual
reality guide to optimize surgical precision.
Recent developments in computer software
allow integration of such 3D radiographic
data with intraoperative surgical navigation
systems. “Intraoperative computer navigation enhances a surgeon’s ability to work
with complex anatomical architecture,” says
UAB orthopaedic surgeon Herrick J. Siegel,
MD. “Using 3D fusion images allows me to
develop a highly specific, detailed preoperative plan and execute that plan with great accuracy,” he says.
Siegel combines 3D image fusion technology with computer-assisted navigation during
orthopaedic tumor resection and reconstruction procedures involving the pelvis and lower
extremities. Upper extremity techniques are
in developmental stages, and initial trials are
planned for 2010, he says.
Currently fewer than 10 medical centers
nationwide use these advanced technologies
for musculoskeletal tumor resection, and
Siegel is the only surgeon in the South using
image fusion and computer-assisted surgical
navigation during orthopaedic oncological
procedures.
This integrated approach can provide
precise measurements during total joint replacement, direct screw placement to repair
complex pelvic or sacral fractures, and help
surgeons avoid injuries to neural foramina or
nerve roots.
In a musculoskeletal oncology setting Siegel uses the technology to determine surgical
approach and tumor volume, outline tumor
margins to the millimeter, and determine
measurements for allografts or prosthetic
devices. The tools enhance tumor resection
and subsequent reconstruction in areas with
extensive bone loss, and in anatomically
challenging areas in the hip, pelvis, and, in
the near future, the shoulder or scapula.
“The technology yields accurate tumor
resection while minimizing bone loss and
soft tissue dissection,” he says. It also can
be used to preserve pelvic structures in
patients with metastatic disease involving
extensive pelvic bone loss and in planning
for custom implants.
Intraoperatively, the navigation software
uses strategically placed anatomical markers
to annotate patient anatomy and generate a
virtual image. Aligning intraoperative virtual
images with preoperative radiographic data
allows surgeons to implement surgical plans
accurately and reliably. “I can execute precise cuts and determine measurements down
to a millimeter for reconstructive intervention,” Siegel says.
The integrated modalities benefit both
patient and surgeon, he says. Although
probe placement extends operative time by
minimal periods, surgeons achieve appropriate tumor margins and execute precisely
guided cuts. Patients experience a shortened
recovery and less postoperative pain and
retain better function.
“Patients want to sit, walk, work, and play
with their kids again,” Siegel says. “This
new technology optimizes surgical accuracy
and helps us achieve functional goals. With
surgery, not only can we remove cancerous
tissue, we also can enhance patient’s mobility and quality of life.” FOR MORE Dr. Herrick Siegel
INFORMATION 1.800.UAB.MIST
[email protected]
2
1
Fig. 1. A cross section of the CT/
positron emission tomography (PET)
fusion image at the resection level
above the hip. Lack of uptake on
the PET images at the planned
resection level helped determine
the tumor-free bone resection.
Fig. 2. A 3D bone tumor model
reconstructed from the CT angiogram and MRI data sets. Virtual
markings are colorized and used to
guide bone resections as well as
placement of screws and implants
for reconstruction.
uab insight on Cancer Services • Summer 2010 5
Surgical Oncology
Expanding Applications of
Robot-Assisted Surgery for Cancer
For nearly a decade UAB surgical oncologists have used robot-assisted surgical
techniques to treat cancer, most prolifically
urologic and gynecologic tumors. UAB
surgeons use robot-assisted surgery for
more services than any other US medical
center, according to Intuitive Surgical, Inc.
(Sunnyvale, California), manufacturer of the
da Vinci Surgical System. In 2006, UAB became the first hospital in Alabama to apply
the technology to women’s pelvic cancers.
A robotic approach now is UAB’s standard of care for prostatectomy and hysterectomy, and surgeons increasingly are turning
their attention to treatment of head and neck,
thoracic, gastrointestinal, and rectal cancers.
The robotic surgical system combines
benefits of open and laparoscopic approach1
B
Intuitive Surgical’s da Vinci robot endowrist
instruments (Fig. 1) and surgeon’s control of the
instruments at the console (Fig. 2).
©2010 Intuitive Surgical, Inc.
2
es in a minimally invasive platform, providing improved flexibility and visualization in
addition to miniaturization of instruments.
Functional outcomes are purported to be
equal to or better than those achieved with
current standards of care. Port access and
small incisions result in minimal blood loss
and scarring, less pain and trauma to surrounding tissue, and shorter hospital stays
and recovery.
These optimistic reports are largely
anecdotal and most studies are based on
small populations and short-term outcomes.
Initial oncological outcomes look favorable
in some applications, but formal, long-term
data is lacking.
“We are cautiously optimistic about the
robot’s potential,” says UAB surgical oncologist Martin J. Heslin, MD. “To define
benefits for patients in both oncologic and
functional outcomes, we must follow the
dictates of evidence-based medicine, which
requires prospective, long-range, randomized trials.”
Urology and Gynecology
After a decade of refinement, prostatectomy remains the most common cancerrelated robotic application. Most series
indicate the approach is safe and effective.
Functional outcomes compare favorably
with open prostatectomy, and oncologic outcomes also appear good. When compared
with radiation therapy, robotic-assisted prostatectomy produces similar survival rates.
UAB urological surgeon J. Erik Busby,
MD, performs as many as 200 robotic procedures annually, including laparoscopicassisted robotic prostatectomy, cystoprostatectomy, and partial nephrectomy. Patient
selection is based on prior surgeries and
extent of disease. Functional outcomes,
including continence and potency, are
equivalent to open approaches, while blood
loss and recovery rates are significantly improved. Most importantly, cure rates remain
as good as with open approaches.
6 uab insight on Cancer Services • Summer 2010
Despite much expectation and some
initial evidence that a robotic approach provides earlier return of sexual function and
improved continence, those expectations do
not yet hold up to scrutiny. “The literature
concerning these outcomes is mixed. The
truth is patients get better outcomes with
experienced surgeons — outcomes as good
as with the open approach, but with more
rapid recovery and decreased blood loss,”
Busby says.
UAB’s robot-assisted gynecological surgeries include hysterectomy, hysterectomy
with pelvis and para-aortic lymph node dissection, radical hysterectomy, and oophorectomy. UAB surgeons perform more than 300
robotic gynecological surgeries a year and
have largely stopped using standard laparoscopy for hysterectomy, says gynecologic oncologist Warner K. Huh, MD, who now uses
the robotic approach for more than 75% of
patients. “We have not studied postoperative pain formally, but I am convinced it is
substantially less than with laparoscopy,”
Huh says. Patients often go home within 24
hours and may not require narcotics, and
recovery time is reduced from 2 months to 2
to 4 weeks.
Otolaryngology
UAB otolaryngologist William R. Carroll,
MD, was the first in the South to use robotics to treat pharyngeal and tongue-base tumors. “We now are using robotic techniques
in select cases to remove oropharyngeal
and supraglottic and laryngeal cancers.” In
traditional surgery, removal of these tumors
necessitates lip-splitting mandibulotomy that
may result in poor cosmesis, speech, and
swallowing. Patients for whom the robotic
approach is appropriate may not require
long-term feeding tubes or tracheotomy
tubes, and they benefit from a shorter hospital stay and recovery time.
Carroll and UAB otolaryngologist J. Scott
Magnuson, MD, have played a robust role
in feasibility studies of transoral robotic
Surgical Oncology
surgery (TORS). A recent study found
TORS to be an “emerging alternative” with
acceptable functional outcomes and low
morbidity (Otolaryngol Head Neck Surg.
2009;141[2]:166-171). In a second study,
UAB surgeons determined TORS feasible
and safe for resection of select head and
neck tumors (T1-T4 lesions) in the oral cavity, oropharynx, hypopharynx, and larynx,
with good preservation of swallow function
(Arch Otolaryngol Head Neck Surg.
2009;135[4]:397-401). Carroll and Mag-
nuson emphasize the studies do not confirm
oncologic or functional superiority to any
standard treatment. In their experience-more
than 100 surgeries-hospitalization is shorter
and return to function is quicker with TORS
than with open procedures.
Thoracic Surgery
UAB thoracic surgeon Robert J. Cerfolio,
MD, a longtime adherent of open lobectomy
versus video-assisted thorascopic surgery
(VATS), is intrigued by positive functional
outcomes, particularly with regard to nerve
impingement, he has observed with robotic
surgery. He is pursuing a robotic program
for thoracic tumors and is 1 of only 14 surgeons in the world doing completely portal
robotic lung resections and lobectomy.
A robotic approach is ideal, Cerfolio says,
for tumors in the mediastinum, such as thymoma, or thymus removal for patients with
myasthenia gravis, but the robotic approach to
thoracic tumors is in its infancy. Validated data
from well-constructed multi-institutional
studies are lacking and research is needed to
confirm anecdotal data, he says.
“Our experience with the da Vinci system
for lung cancer has been nothing short of
spectacular,” Cerfolio says. “We have experienced more complete nodal dissection and
easier vessel dissection, with less surgeon
hand and arm pain. The 3D visualization
of the robot is unparalleled; it’s even better
than with open procedures because of the
magnification.”
One advantage of port access is that it
potentially avoids a crush injury to the intercostal nerve that frequently results from
more invasive procedures or from the VATS
camera that often can torque the nerve, says
Cerfolio, who is known internationally for
his postthoracotomy pain reduction technique, which avoids intercostal nerve injury
(Ann Thorac Surg. 2008;85:1901-1907).
“With the rib-, nerve-, and muscle-sparing
technique developed at UAB, we provide
a complete and safe operation with open
lobectomy — removal of all lymph nodes
and palpation of the lung — with little
pain. However, it still spreads the ribs and
cuts some muscle.” After performing more
than 80 robotic surgeries he feels oncologic
principles all are maintained with robotic
lobectomy which avoids muscle cutting or rib
spreading.
“Based on my objective assessment of
pain scores, I find patients experience less
pain after robotic surgery than with VATS,
need fewer narcotics, and return to work
sooner,” he says.
The robot role in metasectomy is a concern, he says, because “we cannot palpate
the lung for nodules not seen on CT or PET/
CT. With minimally invasive approaches
such as VATS and robotics, it is easy to miss
nodules in nonresected pulmonary lobes.”
Radiographic scans may suggest the other
lobes are normal, but Cerfolio’s research
has shown that lung palpation finds nodules
15% of the time (J Thorac Cardiovasc
Surg. 2008;135[2]:261-268) and (Eur J
Cardiothorac Surg. 2009;35:786-791).
Half of those nodules are malignant, he says.
Open thoracotomy offers the advantage of
lung palpation. “This is a big question with
the robotic approach. Without palpation, we
know we may be missing nodules, but our
own studies suggest they may have no clinical significance, even if malignant.” He is
following patients closely who undergo robotic procedures to discover how oncologic
outcomes compare with open procedures
and VATS.
General Surgery
General surgery has been slow to embrace
robotics, either because existing laparoscopic
techniques are straightforward and effective
or because some procedures are too complex
to attempt robotically. Nevertheless, the
robotic approach does offer advantages, and
general surgeons are applying it to various
procedures. “Some aspects of laparoscopic
surgery complement robotic procedures, so
hybridization of techniques may be the end
result for many general surgeons,” Heslin
says.
“The intracorporeal dexterity the robot
provides is far superior to laparoscopy,” he
says, “and coupled with superior visualization, it makes sewing in small places much
easier.” Robot-assisted surgical techniques
are most effective, he says, in procedures that
require advanced suturing and good visualization in narrow spaces, such as the pelvis.
Heslin has performed robotic low anterior
resection, splenic-preserving distal pancreatectomy, partial gastrectomy, adrenalectomy,
and abdominal perineal resection for rectal
cancer. “Despite the hype, we do not yet
know if postoperative pain is less, if length
of stay is shorter, or if recovery is faster, than
with current minimally invasive approaches.”
He aims to concentrate on select robotic procedures to methodically establish efficient,
effective protocols and procedures.
Heslin’s foci are rectal tumors and adrenal tumors — lower anterior resection and
adrenalectomy. “We will collect as much
data as we can, step back, and assess outcomes of open approaches and laparoscopic
approaches. The question to ask is ‘Will it
translate to improved survival and improved
quality of life?’”
UAB surgeons agree: Robot-assisted
minimally invasive surgery offers tremendous potential for patients, but an objective,
evidence-based perspective is needed to
avoid overstating benefits. Ultimately, surgical decisions, like all health care choices,
must weigh patients’ individual comorbidities and type and stage of malignancy
against surgeons’ experience and technological options.
FOR MORE Surgical Oncology
INFORMATION 1.800.UAB.MIST
[email protected]
uab insight on Cancer Services • Summer 2010 7
Neuro-Oncology
Brain Tumors: New
Therapeutic Approaches
UAB Part of National Brain Tumor Consortium
Malignant gliomas are the most
common central nervous system tumors,
accounting for approximately 17,000 to
20,000 new cases each year in the United
States and nearly as many deaths. In spite
of investigators’ best efforts during the
last 20 years, progress in the treatment
of gliomas has been slow. The advent of
novel targeted drugs and oncolytic viruses,
however, has increased survival of patients
with malignant glioma who are undergoing specific treatment protocols.
UAB’s Neuro-Oncology Program is
nationally and internationally known for
bringing novel therapies into the clinic to
provide patients access to cutting-edge
trials aimed at increasing survival while
maintaining quality of life.
UAB is a member of the American
Brain Tumor Consortium (ABTC), an elite
group of US research institutions that receive National Institute of Health and National Cancer Institute (NCI) funding for
treatment trials of agents not yet widely
available.
ABTC’s 16 premier medical institutions
have access to a large number of adult patients with primary brain tumors; extensive
clinical and laboratory resources; outstanding expertise in oncology, pharmacology,
drug development, neurosurgery, and
neuropathology; and biostatistics and data
management expertise.
Consortium members
share human brain tumor
specimens and clinical and
laboratory data to conduct
high-quality, clinically relevant, peer-reviewed brain
tumor research. Investigators at member institutions
also are researching the
basic biology of primary
brain tumors and neuropharmacology of new
therapies.
UAB scientists and consortium clinicians concentrate their efforts on earlyphase clinical trials of
new drugs, specifically for
high-grade gliomas, says
UAB radiation oncologist
John Fiveash, MD. “Collaboration among ABTC
institutions fosters innovative, efficient translational
work and feeds an ongoing
The image shows the integrin receptor with the approaching cilengitide molecule about to bind. Cilengitide is a novel treatment for gliomas pipeline of cancer treatments,” he says.
that targets both endothelial cells and the tumor itself and triggers
tumor cell apoptosis.
8 uab insight on Cancer Services • Summer 2010
Under ABTC funding UAB neurologist
Louis B. Nabors, MD, introduced cilengitide, a novel treatment for glioblastomas
that inhibits endothelial cell migration and
survival and tumor cell invasion. Nabors is
the lead North American investigator on an
international phase 3 study of patients with
newly diagnosed malignant gliomas. That
trial, which began in March 2010, along
with UAB’s other pioneering work on cilengitide exemplifies the medical center’s
translational research efforts.
“In a relatively short time, UAB ushered
cilengitide from its development in the lab
to the current phase 3 study,” Nabors says.
“The ABTC infrastructure energizes early
research phases and paves the way for
large international trials.”
Another breakthrough drug being studied at UAB under ABTC protocols is AT101. This drug inhibits B-cell lymphoma-2
family proteins, anti-apoptotic proteins that
when overexpressed interfere with conventional cancer treatment. A phase 2 clinical
trial showed the drug stimulated apoptosis
and halted cancer progression in patients
with glioblastoma multiforme (J Clin Oncol. 2009;27[15S]).
Treatments on the Horizon
UAB is an international leader in oncolytic viral therapy, and its experts have
enrolled more patients in trials of oncolytic
herpes simplex virus, adenovirus, and most
recently, reovirus, than any other institution in the world.
In addition, the UAB Neuro-Oncology
Program receives funding under a NCI
Specialized Program of Research Excellence (SPORE) grant. This SPORE gives
grant holders access to novel agents produced by member institutions. Through
this program, UAB researchers are developing a novel antiglioma vaccine protocol
that will open for patient enrollment within
the year.
FOR MORE
INFORMATION
Dr. John Fiveash
Dr. Louis Nabors
1.800.UAB.MIST
[email protected]
Oncology
Integrated Multidisciplinary
Breast Cancer Care
Personalized, Integrated Care Model
Breast cancer treatment and intervention is multimodal. Patient treatment options involve various intervention choices
offered by multiple care providers. More
than a decade ago, UAB breast care physicians came together to ensure streamlined,
personalized patient care, creating the
Breast Health Center and Interdisciplinary
Breast Cancer Clinic (IDBC).
“All patients have to make treatment
choices,” says surgical oncologist Helen
Krontiras, MD, codirector of the UAB
Breast Health Center. “To help patients
evaluate their options as efficiently as possible, the breast cancer clinic gives them
the opportunity to meet with all physicians
involved in treatment in one visit,” she says.
“This is important because in most circumstances treatment plans for breast cancer involve multiple disciplines. We discuss
surgical choices, breast conservation versus
mastectomy, radiation therapy options, and
whether chemotherapy and hormonal or
endocrine therapy is necessary,” she says.
In 2009, more than 400 new breast cancer
patients from the Southeast benefitted from
UAB’s state-of-the-art treatment facilities
and services, which provide preventive
intervention, risk assessment (including genetic risk), screening and evaluation, nutritional, emotional, and financial counseling,
and expanded care options. “Many women
referred to us for a second opinion opt to
continue their breast cancer care at UAB,”
Krontiras says.
Integrated Services Ensure
Optimal Care
UAB has implemented a new model of
care, the Integrated Multidisciplinary Cancer
Care Program (IMCCP), which coordinates
specialty physician visits. “This model gives
patients efficient, timely access to our
cancer treatment programs,” Krontiras
says. IMCCP staff schedule appointments for IDBC patients within 2 weeks
of the initial physician referral. The IMCCP is active in treatment programs for
gynecologic cancers, leukemia and lymphoma, otolaryngologic, gastrointestinal,
neuro-oncologic, urologic, lung, and
breast cancers.
IMCCP nursing coordinators specializing in breast health streamline
patient visits by gathering extensive
preappointment information. “Gathering
prerequisite test results and pathology
and imaging reports before appointments
allows physicians to offer patients recommendations immediately,” Krontiras says.
A multidisciplinary physician team meets
to review patients’ diagnostic images and
pathology reports, discuss therapeutic
options, and develop a treatment plan.
A unified, personalized plan using the
most advanced, patient-tailored options,
including potential clinical trial participation, is then presented to each woman.
IMCCP Patient Navigators guide patients through the UAB Medicine system,
assist with transportation and insurance
queries, establish community and social
services, locate health care information,
and connect patients with support groups.
“Heart disease may take the lives of
more women than breast cancer, but breast
cancer is a greater fear for most women,”
Krontiras says. Patient access to highly
specialized physicians, the most advanced
therapeutic options, clinical trial participation, and volunteer support provide
women a powerful ally against that fear.
UAB Breast Health
Center Volunteers
Provide Support
Several lay volunteer groups share
time and experience with patients at
the UAB Breast Health Center. Angel
Squad, Patient Navigator, and Reach
to Recovery group members undergo
instruction to fulfill Occupational Safety
& Health Administration and The Kirklin
Clinic© (TKC) training requirements before working with patients.
The Angel Squad, originally coordinated by a breast cancer survivor, works
with UAB nursing staff to provide women
compassionate support. Volunteers
offer refreshments, reading materials,
and a friendly presence in the Breast
Health Center.
American Cancer Society (ACS)
Patient Navigators help women and
their families negotiate and access appropriate resources provided through
the ACS, which operates a library on
the second floor of TKC that houses
educational pamphlets and materials
about cancer.
ACS Reach to Recovery volunteers
provide hands-on support and information on topics ranging from what to
expect following breast cancer surgery
to living with a prosthesis to how to
perform exercises that aid in postsurgi-
FOR MORE Dr. Helen Krontiras
INFORMATION 1.800.UAB.MIST
cal recovery.
[email protected]
uab insight on Cancer Services • Summer 2010 9
Oncology/Transplantation
Organ Transplantation for
Hepatocellular Carcinoma
An Innovative Approach
Oncologic resection is not a viable
option for many patients with hepatocellular carcinoma (HCC). Tumor excision
can compromise hepatic function and lead
to liver failure. Acuity of hepatic disease,
tumor size, and tumor location limit the
number of patients with HCC who are
eligible for resection. “For individuals
who have nonresectable HCC and meet
specific criteria, liver transplantation [LT]
is the gold standard,” say UAB transplantation surgeons Devin E. Eckhoff, MD,
director of the Division of Transplant
Surgery, and Derek A. DuBay, MD. Studies indicate 5-year survival rates following
LT for HCC exceed 70% (Hepatology.
2001;33[6]:1394-1403).
“Potential recipients with HCC undergo
routine transplantation screening,” Eckhoff
says. Criteria evaluated include tumor size,
number, and the extent of vascularization.
“In individuals with HCC, the presence of
vascular invasion and metastatic or extra
hepatic disease precludes consideration for
transplant,” he says.
Bridge to Transplantation
Multiple factors, including disease severity, blood type, body size, and availability
of organs, affect transplantation wait times.
An epidemic incidence of hepatitis C has
increased the number of patients on LT
lists, lengthening wait time for donor livers. In addition, transplantation physicians
may recommend a watchful waiting period
for patients with aggressive disease whose
tumor load exceeds current criteria for LT
consideration. Several therapeutic options
can be used to reduce tumor size or slow
disease progression during observational
interims or while patients wait for compatible organs.
Liver-directed therapies enable select
patients to meet LT criteria. “Using locoregional therapy [LRT] downstaging protocols
prior to liver transplant to stabilize hepatic
disease or inhibit tumor growth is a recent
trend in HCC transplantation,” DuBay says.
“Bridge therapies are tailored to pretransplant patient needs for tumor reduction and
disease management.”
Transarterial chemoembolizaton (TACE),
radiofrequency ablation (RFA), and external beam radiation therapy (EBRT) impede
tumor growth and can act as bridge therapies. TACE administration of ethiodized
oil in combination with patient-specific
chemotherapy can effectively downstage
patients, qualifying them for LT (Ann
Surg. 2008;248[4]:617-625). “TACE is
well tolerated, effective, and requires only
a 1-day hospitalization,” DuBay says.
A novel hyperfractionated liver radiotherapy protocol used at UAB shortens
the 6 weeks of conventional radiation to 3
applications during a 2-week period. This
EBRT protocol spares surrounding hepatic
tissue and can target tumors adjacent to
vascular structures. Percutaneous RFA
achieves locoregional tumor control, especially in HCC tumors <3 cm.
Developing therapies for use in LRT
include drug-eluting beads that bring chemotherapeutic agents directly to tumors and
microspheres labeled with yttrium-90 that
deliver large local radiation doses and minimize exposure to uninvolved hepatic tissue.
“In select HCC patients, a tailored treatment plan that involves administration of
locoregional therapy along with vigilant
surveillance is key to giving individuals
time to meet criteria for liver transplant,”
Eckhoff says.
FOR MORE
INFORMATION
10 uab insight on Cancer Servicess • Summer 2010
Dr. Devin Eckhoff
Dr. Derek DuBay
1.800.UAB.MIST
[email protected]
Pre-intervention: Patient with hepatitis
C-induced cirrhosis with a 3 cm HCC. The
patient has normal liver function.
TACE: HCC treated with transarterial
chemoembolization. Lipodiol accumulates
in the tumor.
TACE-RFA: Embolized tumor definitively
treated with percutaneous ablation (note
dark halo around tumor indicating ablated
tumor plus rim of uninvolved tumor margin).
Cancer Services Faculty
UAB Cancer Services Faculty
The UAB Comprehensive Cancer Center is home to more than 300 clinicians and researchers, many of whom are internationally and nationally recognized for their expertise in the basic sciences and specialty and subspecialty areas of medical and
surgical oncology. This unique team offers the full range of advanced and investigational therapies, allowing them to tailor
highly individualized treatment plans for each patient.
CLINICAL/RESEARCH
FACULTY
Bone Marrow Transplant
Donna E. Salzman, MD
William P. Vaughan, MD
Breast Cancer: Medical Oncology
John T. Carpenter Jr, MD
Carla I. Falkson, MD
Andres Forero, MD
Breast Cancer:
Radiation Oncology
Jennifer F. De Los Santos, MD
Kimberly S. Keene, MD
Ruby F. Meredith, MD, PhD
Christopher D. Willey, MD, PhD
Breast Cancer: Surgery
Kirby I. Bland, MD
Helen Krontiras, MD
Marshall M. Urist, MD
Dermatology
Craig A. Elmets, MD
Conway C. Huang, MD
S. Lauren C. Hughey, MD
Fertility Preservation
G. Wright Bates, MD
Gastroenterology and
Hepatology
Mohamad A. Eloubeidi, MD
M. Charles Wilcox Jr, MD
Gynecologic Oncology
Ronald D. Alvarez, MD
J. Maxwell Austin Jr, MD
Mack N. Barnes III, MD
Warner K. Huh, MD
Charles N. Landen Jr, MD
Michael Straughn Jr, MD
Head and Neck Oncology
William R. Carroll, MD
Artemus J. Cox III, MD
J. Scott Magnuson, MD
Glenn E. Peters, MD
Head & Neck Oncology:
Reconstruction
Eben L. Rosenthal, MD
Head and Neck Oncology:
Larynx
Paul F. Castellanos, MD
Lung/Thoracic/Pulmonary
William C. Bailey, MD
Gerald B. Belopolsky, MD
Robert J. Cerfolio, MD
Mark T. Dransfield, MD
Douglas J. Minnich, MD
Medical Oncology
Diego A De Idiaquez Ba’kula, MD
Naresh Bellam, MD
Graeme B. Bolger, MD
Robert M. Conry, MD
Mollie R. DeShazo, MD
Kevin W. Harris, MD, PhD
Lee M. Hilliard, MD
Richard D. Lopez, MD
Lisle M. Nabell, MD
Steven Newman, MD
Boris C. Pasche, MD, PhD
James A. Posey III, MD
Francisco Robert, MD
Mansoor N. Saleh, MD
Tina E. Wood, MD
Medical Oncology: Geriatrics
Patricia S. Goode, MD
Medical Oncology:
Infectious Diseases
Paul A. Goepfert, MD
Michael S. Saag, MD
Richard J. Whitley, MD
Medical Oncology:
Leukemia/Lymphoma
Randall S. Davis, MD
James M. Foran, MD
Neuro-Oncology
Hassan Fathallah-Shaykh, MD,
PhD
Xiaosi (Stan) Han, MD
Louis B. Nabors III, MD
Neuro-Oncology: Neurosurgery
Barton L. Guthrie, MD
James M. Markert Jr, MD, MPH
Kristen Riley, MD
Alyssa T. Reddy, MD
Ray Watts, MD
Kimberly F. Whelan, MD
Pediatric Oncology: Genetics
Bruce R. Korf, MD, PhD
Radiation Oncology
James A. Bonner, MD
O. Lee Burnett, MD
Michael Dobelbower, MD
John B. Fiveash, MD
Rojyman Jacob, MD
Robert Y. Kim, MD
Sharon A. Spencer, MD
Eddy Yang, MD
Surgery: General/GI
Jamie A. Cannon, MD
John D. Christein, MD
Jayleen Grams, MD
Mary T. Hawn, MD
Melanie Morris, MD
John Porterfield, MD
Richard Stahl, MD
Orthopaedic Oncology
Herrick J. Siegel, MD
Surgery: Liver
Derek DuBay, MD
Devin E. Eckhoff, MD
Palliative and Supportive Care
Heather Herrington, MD
Elizabeth A. Kvale, MD
Christine S. Ritchie, MD
Rodney O. Tucker, MD
Surgical Oncology: GI/Other
J. Pablo Arnoletti, MD
Martin J. Heslin, MD
John Porterfield, MD
Thomas Wang, MD, PhD
Pediatric Oncology
Roger L. Berkow, MD
Kevin A. Cassady, MD
David A. Randolph, MD
Urology
James E. Bryant, MD
J. Erik Busby, MD
Rizk El-Galley, MD
uab insight on Cancer Services • Summer 2010 11
Cancer Services Faculty
UAB Cancer Services Faculty
Research Faculty
Cancer Cell Biology
Devin Michael Absher, PhD
David M. Bedwell, PhD
Susan L. Bellis, PhD
Etty (Tika) N. Benveniste, PhD
Mary-Ann Bjornsti, PhD
Scott W. Blume, MD
Chenbei Chang, PhD
Yabing Chen, PhD
Igor N. Chesnokov, PhD
Gregory A. Clines, MD, PhD
Michael R. Crowley, PhD
Peter J. Detloff, PhD
Kevin F. Dybvig, PhD
Xu Feng, PhD
Stuart J. Frank, MD
Lisa M. Guay-Woodford, MD
Omar Hameed, MD
John L. Hartman, MD
N. Patrick Higgins, PhD
Susan K. Hollingshead, PhD
Douglas R. Hurst, PhD
Amjad Javed, PhD
Robert A. Kesterson, PhD
R. Jack Lancaster, PhD
Aimee L. Landar, PhD
Elliot J. Lefkowitz, PhD
Shawn Edward Levy, PhD
Yonghe Li, PhD
Lin Fang-Tsyr, MD, PhD
He-Ping Ma, MD
Jin-Biao Ma, PhD
Mary B. MacDougall, PhD
Richard B. Marchase, PhD
Jay M. McDonald, MD
Joseph L. Messina, PhD
Michael A. Miller, PhD
James A. Mobley, PhD
Joanne E. Murphy-Ullrich, PhD
Jan Novak, MSc, PhD
Susan E. Nozell, PhD
Rakesh Patel Pravinchandra,
PhD
Kirill M. Popov, PhD
Joseph G. Pressey, MD
E. Shyam P. Reddy, PhD
Susan M. Lobo Ruppert, PhD
Thomas M. Ryan, PhD
Ralph D. Sanderson, PhD
David Schneider, PhD
Katri S. Selander, MD, PhD
Rosa A. Serra, PhD
Yuhua Song, PhD
Elizabeth S. Sztul, PhD
John Anthony Thompson, PhD
Sunnie R. Thompson, PhD
Trygve O. Tollefsbol, PhD
Timothy M. Townes, PhD
Charles L. Turnbough Jr, PhD
Patrick K. Umeda, PhD
Robert C. A. M. van
Waardenburg, PhD
Hengbin Wang, PhD
Jianbo Wang, PhD
Danny R. Welch, PhD
Bo Xu, MD, PhD
Zhi-Xiang Xu, MD, PhD
Yang Yang, MD, PhD
Bradley K. Yoder, PhD
Karina Jin Yoon, PhD
Majd Zayzafoon, MD, PhD
Qinghua Zeng, MD, PhD
Chemoprevention
Mohammad Athar, PhD
Stephen Barnes, PhD
Pi-Ling Chang, PhD
Dale A. Dickinson, PhD
Ada Elgavish, PhD
Isao Eto, PhD
William E. Grizzle, MD, PhD
Clinton J. Grubbs, PhD
Robert W. Hardy, PhD
Donald L. Hill, PhD
12 uab insight on Cancer Services • Summer 2010
Karen E. Iles, PhD
Santosh K. Katiyar, PhD
Natalia Y. Kedishvili, PhD
Helen Kim, PhD
Coral A. Lamartiniere, PhD
Donald D. Muccio, PhD
Gary A. Piazza, PhD
Jeevan K. Prasain, PhD
Nabiha Yusuf, PhD
Cancer Control/
Population Sciences
Brahim Aissani, PhD
David B. Allison, PhD
Jamy D. Ard, MD
Donna K. Arnett, MSPH, PhD
Andres Azuero, PhD
William C. Bailey, MD
Monica L. Baskin, PhD
Daniel S. Blumenthal, MD, MPH
Molly Bray, PhD
C. Michael Brooks, EdD
Kathryn L. Burgio, PhD
Eric Chamot, MD, PhD
Myra A. Crawford, PhD
Karen L. Cropsey, PsyD
Elizabeth S. Delzell, MSPH SD
Wendy Demark-Wahnefried, PhD
Renee A. Desmond, DVM, PhD
Jose R. Fernandez, PhD
Mona N. Fouad, MD, MPH
Frank A. Franklin, MPh, PhD, MD
Ellen M. Funkhouser, DrPH
Diane M. Grimley, PhD
Youngshook Han, PhD
Angela Jukkala, PhD, RN
Richard A. Kaslow, MD, MPH
Meredith L. Kilgore, PhD
Young-il Kim, PhD
Connie L. Kohler, DrPH
Andrzej Kulczycki, PhD
Cora E. Lewis, MD, MSPH
Rui-Ming Liu, MD, PhD
Julie L. Locher, PhD
Avi Madan-Swain, PhD
Upender Manne, PhD
Michelle Y. Martin, PhD
M. Patrick McNees, PhD
Karen M. Meneses, PhD, RN
Ludwine M. Messiaen, PhD
Timothy R. Nagy, PhD
Timothy J. Ness, MD, PhD
Groesbeck P. Parham, MD
Edward E. Partridge, MD
Dorothy W. Pekmezi, PhD
Sharina D. Person, PhD
Chandrika J. Piyathilake, PhD
Joshua S. Richman, MD, PhD
Nalini Sathiakumar, MD, DrPH
Isabel C. Scarinci, PhD, MPH
James M. Shikany, DrPH
Sadeep Shrestha, MS, MSH,
PhD
Seng-jaw Soong, PhD
Diane C. Tucker, PhD
Laura Kelly Vaughan, PhD
John W. Waterbor, MD, MS,
DrPH
O. Dale Williams, MD, MPH, PhD
Lesa L. Woodby, MPH, PhD
Yingkui Yang, MD, PhD
Nengjun Yi, PhD
Zhiying You, PhD, MD
Kui Zhang, PhD
Experimental Therapeutic
Edward Acosta, PharmD
Stephen G. Aller, PhD
Michael T. Azure, PhD
Melissa F. Baird, MD, PhD
Scott W. Ballinger, PhD
J. Edwin Blalock, PhD
Margaret S. BrandweinGensler, MD
Ivan A. Brezovich, PhD
Christie G. Brouillette, PhD
Cancer Services Faculty
UAB Cancer Services Faculty
Wayne J. Brouillette, PhD
Alan B. Cantor, PhD
Steven L. Carroll, MD, PhD
Andrew J. Carroll, PhD
Robert P. Castleberry, MD
Debasish Chattopadhyay, PhD
Herbert C. Cheung, PhD
Champion C. S. Deivanayagam,
PhD
Lawrence J. DeLucas, OD, PhD
Patricia DeVilliers, DDS, MS
William E. Dismukes, MD
Jun Duan, PhD
Mahmoud H. el Kouni, PhD
Gabriel A. Elgavish, PhD
Maaike Everts, PhD
Charles N. Falany, PhD
Andrey Frolov, MD, PhD
Andra R. Frost, MD
Gregory S. Gorman, PhD
David E. Graves, PhD
Thomas H. Howard, MD
Kenneth L. Hoyt, PhD
Conway C. Huang, MD
Racquel Innis-Shelton, MD
Jacob Rojymon, MD
Martin R. Johnson, PhD
Rakesh Kapoor, PhD
Hyunki Kim, PhD
Jennifer R. King, PharmD
Christopher A. Klug, PhD
Wilson Blaine Knight, PhD
N. Rama Krishna, PhD
Yufeng Li, MS, PhD
L. Keith Lloyd, MD
Albert F. LoBuglio, MD
Aaron L. Lucius, PhD
Marina S. Manuvakhova, PhD
Sreelatha Meleth, PhD
Desiree E. Morgan, MD
Richard M. Myers, PhD
Sthanam V. L. Narayana, PhD
Thian C. Ng, PhD
Patsy G. Oliver, PhD
Robert A. Oster, PhD
William B. Parker, PhD
Peter E. Prevelige Jr, PhD
Zhican Qu, PhD
Kevin P. Raisch, PhD
Vishnu V. B. Reddy, MD
Matthew B. Renfrow, PhD
Robert C. Reynolds, PhD
Ahmad Safavy, PhD
Paul W. Sanders, MD
John A. Secrist III, PhD
Jere P. Segrest, MD, PhD
Bingdong Sha, PhD
Craig D. Smith, PhD
Jeffrey B. Smith, PhD
Eric J. Sorscher, MD
J. Michael Straughn, MD
Stephen R. Stricker, PharmD
Arabella B. Tilden, PhD
Dmitry G. Vassylyev, PhD
Sadanandan E. Velu, PhD
Mark R. Walter, PhD
Wen Wan, MD, PhD
Pengfei Wang, PhD
Raymond G. Watts, MD
Krister Wennerberg, PhD
Xizeng Wu, PhD
Ruiwen Zhang, MD, PhD
Kurt R. Zinn, DVM, PhD
Neuro-Oncology
Dale J. Benos, PhD
Markus Bredel, MD, PhD
Michael Brenner, PhD
Gregory Kane Friedman, MD
G. Yancey Gillespie, PhD
Corinne E. Griguer, PhD
Peter H. King, MD
Lawrence S. Lamb, PhD
Cheryl Ann Palmer, MD
Kevin A. Roth, MD, PhD
Harald W. Sontheimer, PhD
Susan E. Spiller, MD
Esther Azungwe Suswam, PhD
Jianming Tang, DVM, PhD
Scott M. Wilson, PhD
Other
John R. Baker, PhD
John C. Chatham, DPhil
Kent T. Keyser, PhD
Radiation Oncology
Prem Pareek, PhD
Richard Popple, PhD
Tumor Immunology
Mary Ann Accavitti-Loper, PhD
T. Prescott Atkinson, MD, PhD
Scott R. Barnum, PhD
David E. Briles, PhD
Donald J. Buchsbaum, PhD
R. Pat Bucy, MD, PhD
Peter D. Burrows, PhD
David D. Chaplin, MD, PhD
Joseph H. Chewning, MD
James F. Collawn, PhD
Jeffrey C. Edberg, PhD
Vithal K. Ghanta, PhD
Laurie E. Harrington, PhD
Zdenek Hel, PhD
Louis B. Justement, PhD
Janusz H. S. Kabarowski, PhD
Sergey Kaliberov, MD, PhD
John F. Kearney, PhD
Robert P. Kimberly, MD
Hiromi Kubagawa, MD
Robinna G. Lorenz, MD, PhD
Jiri F. Mestecky, MD, PhD
Suzanne M. Michalek, PhD
John D. Mountz, DMD, PhD
Moon H. Nahm, MD
David G. Pritchard, PhD
Harry W. Schroeder Jr, MD, PhD
Sui Shen, PhD
Phillip D. Smith, MD
Theresa V. Strong, PhD
Laura Timares, PhD
Casey T. Weaver, MD
Douglas A. Weigent, PhD
Hui Xu, PhD
Allan J. Zajac, PhD
Tong Zhou, MD
Virology
Mary Ballestas, PhD
Suresh B. Boppana, MD
William J. Britt, MD
Elizabeth E. Brown, PhD, MPH
Louise T. Chow, PhD
David T. Curiel, MD, PhD
Igor P. Dmitriev, PhD
Ilya V. Frolov, PhD
Elena I. Frolova, PhD
Patricia N. Fultz, PhD
John W. Gnann, MD
Beatrice H. Hahn, MD
John C. Kappes, PhD
Earl R. Kern, PhD
David W. Kimberlin, MD
Ming Luo, PhD
Casey D. Morrow, PhD
Peter G. Pappas, MD
Jacqueline N. Parker, PhD
Robert F. Pass, MD
Alexander V. Pereboev, MD, PhD
Selvarangan Ponnazhagan, PhD
Mark N. Prichard, PhD
Debra C. Quenelle, DVM, PhD
Jamil S. Saad, PhD
Jesus F. Salazar-Gonzalez, PhD
George M. Shaw, MD, PhD
Gene P. Siegal, MD, PhD
Wayne M. Sullender, MD
Hongju Wu, PhD
uab insight on Cancer Services • Summer 2010 13
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I n si d e u a b i n s i g h t o n C AN C E R S E R V I C E S
Expanding Applications of Robot-Assisted Surgery
Image-Based Oncological
Orthopaedic Surgery
6
5
New Therapeutic Approaches to Brain Tumors
8
uab r e f e r r a l s
To refer a patient to the UAB Comprehensive Cancer Center, schedule appointments, or arrange for transport of patients
24 hours a day, 7 days a week, contact UAB MIST at 1.800.822.6478.
For more information about cancer services at UAB visit the UAB Cancer Services Web page at uabmedicine.org/cancer.
For more information about UAB Medicine, visit uabmedicine.org.