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BUILDING On STRENGTH 2013 Annual Report Multidisciplinary Clinical Teams + Patient Navigation + Genetic Counseling + Clinical Research + Clinical Education + Integrative Medicine + Patient Support and Education + Innovative Clinical Trials Center + Survivor Celebrations + Community Outreach Contents 1 Baylor Dallas Leadership: Building on Strength Medical Director’s Letter 2 2013 Cancer Committee Membership 3 Baylor Charles A. Sammons Cancer Center at Dallas 5 Areas of Focus Blood and Marrow Transplant Program Innovative Clinical Trials Center Colon Cancer Genetics: Lynch Syndrome BUILDING On STRENGTH 13 Cancer Center Highlights Community Events/Outreach • Mobile Mammography Program • American Cancer Society • Virginia R. Cvetko Patient Education and Support Center Site-Tumor Conferences Clinical Research Coordination Patient Navigation Cancer Genetics Program 23 Patient Spotlight: Teri Rodgers 25 Cancer Registry 29 Patient Outcome Studies Cancer research studies on the campus of Baylor University Medical Center at Dallas are conducted through Baylor Research Institute, Texas Oncology, and US Oncology. Each reviews, approves, and conducts clinical trials independently. Their clinical trials are listed together, in this publication, for the convenience of patients and physicians. • Acute Myelogenous Leukemia at Baylor Charles A. Sammons Cancer Center from 2010 to 2012 • Radiation Treatment for Glioblastoma Multiforme: The Baylor Charles A. Sammons Cancer Center Experience, 2010 to 2012 37 Cancer Center Publications 41 Campus and Area Maps 43 Contact Information 3410 Worth St. Dallas, TX 75246 1.800.4BAYLOR 214.820.3535 BaylorHealth.com/DallasCancer Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community, or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center, or Baylor Health Care System. © 2014 Baylor Health Care System. All rights reserved. Photographs may include models or actors and may not represent actual patients. SAMMONS_444_2014 SC 1 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 2 Letter from Leadership Cancer Committee Members Over the past several years, our annual reports have concentrated on building. We have built physical facili- Required Members: Research Coordinator) W. Scott Webster, MD ties including the Baylor Charles A. Sammons Cancer at Dallas which opened in March 2011, and in 2012, John T. Preskitt, Sr., MD, Chair [Surgery] Kathleen Shuey, MS, RN, AOCN, Barry N. Wilcox, MD the Baylor T. Boone Pickens Cancer Hospital. In addition to our advanced facilities, we continue to build (Cancer Registry Quality Coordinator) APRN BC [Oncology Nurse] Laith Abushahin, MD (House Staff hope through innovative treatment opportunities and outstanding patient support. Erin Bowman, MD [Radiology] Sheryl Walker, CGC [Genetics] Representative) B. Scott Cheek, MD [Radiation Oncology] Kathy Thomas Welch, LMSW Sarah Swineford McFadden, MD Peter A. Dysert, II, MD [Pathology] (Social Work) (House Staff Representative) In 2013, we continued to build, but not so much with bricks and mortar, but building on our strengths. The Blood and Marrow Transplant Program celebrated 30 years of providing curative treatment opportunities and “In 2013, we continued to build, but Leah Zhrebker, MD (House Staff Robert L. Fine, MD [Palliative Care] Representative) E. Colin Koon, MD, PhD [Cancer Liaison Other Members: Physician] Carlos Becerra, MD Carolyn M. Matthews, MD (Quality Yvonne Coyle, MD Invited to Attend: Improvement Coordinator) Karen L. Fink, MD Patrick Allgood, RN, BSN Robert G. Mennel, MD [Medical Oncology] James W. Fleshman, MD Anna Barber Site-Tumor conferences, a mainstay of our academic approach to multidisciplinary treatment planning, have Amy J. Wilson, MD [Rehabilitation] JaNeene Jones, RN, FACHE Jane Dempster, RN, MBA expanded and new conferences centered around pancreatic and colorectal cancer were added. Scientific Johanna Bennoch, RN, CPHQ [Performance Ronald C. Jones, MD Ann Giddens, ACS publications in peer-reviewed journals continued to rise and have doubled in the past five years. Improvement/Quality Management] Kartik Konduri, MD Kimberlee Hanna, RN, BSN, OCN, Pam Carnevale, MHA (Cvetko Center/ Z. H. Lieberman, MD CHPN There has been growth in the cancer genetics program with expansion of the genetics counseling program Community Outreach Coordinator) Alan M. Miller, MD, PhD John McWhorter, President BUMC with additional counselors, more cancers covered and expansion to other Baylor facilities. In addition, our Sylvia Coats [Cancer Program Administrator] John C. O’Brien, MD Nolan Ngo, PharmD stellar patient navigation program continues to serve more patients every year. Michelle Murray, PhD (Psychosocial Services John E. Pippen, Jr., MD, FACP Lynn Randolph, VP Nursing Coordinator) Charles T. Richardson, MD Taryn Pemberton, Marketing Throughout the following pages you will read of how the Baylor Charles A. Sammons Cancer Center at Janet Reynolds, CTR [CTR] (Cancer Raphaelle Vallera, MD Laura Siciliano, RN, CTR Dallas is building on these and other strengths to provide more options and hope to those with cancer. Conference Coordinator) Estil A. Vance, III, MD Julie Smith, Marketing Cheryl Sampson, CCRP, MBA (Clinical David L. Watkins, MD performed the 5000th transplant since the program’s inception. Clinical trials opportunities increased with the opening in September of the Swim Across America Innovative Clinical Trials Center. With the generous support of the Swim Across America organization, we can now offer more patients the opportunity to participate in clinical trials of advanced investigational therapies including targeted and immunotherapies. Alan M. Miller, MD, PhD Chief of Oncology, Baylor Health Care System Medical Director, Baylor Charles A. Sammons Cancer Center at Dallas not so much with bricks and mortar, but building on our strengths.” BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 4 3 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH Baylor Charles A. Sammons Cancer Center at Dallas Baylor Charles A. Sammons Cancer Center at Dallas offers treat- For nearly four decades, Baylor Charles in McKinney and Carrollton also offer ment for all forms of cancer, with particular emphasis on lung, A. Sammons Cancer Center has provided oncology services and are expected to pancreas, colon, breast, prostate, and gynecologic cancers. quality clinical care, advanced technology, carry the Baylor Charles A. Sammons Physicians on the medical staff of Baylor Sammons Cancer and clinical research to patients, along Cancer Center name in the future. Center at Dallas also have special expertise in treating blood and with comprehensive support services and bone marrow cancers such as leukemia, lymphoma and myeloma. programs for patients and their families. With the opening of the 10-story outpa- Baylor T. Boone Pickens Cancer Hospital Baylor offers a full spectrum of oncology services, from education tient treatment facility and integration with This is the first dedicated cancer hospital to advanced treatment options and rehabilitation programs. Baylor T. Boone Pickens Cancer Hospital in North Texas and only the second in Specialists and staff work diligently to treat patients in an environ- in Dallas, it is now the largest outpatient the state. This 96-bed, 175,000-square- ment filled with compassionate, quality care by using effective cancer center in North Texas. Annually, foot facility has been specially designed methods in prevention, diagnostic, and treatment. more than 90,000 cancer visits occur at to provide a place of healing, calming, Baylor Sammons Cancer Center at Dallas, and spirituality. A skybridge connects the Depending on the type of cancer and the needs of each and more than 800 people participate in inpatient hospital to the many outpatient individual patient, both standard and innovative treatment options research trials. services of Baylor Sammons Cancer Center at Dallas. Larger rooms enable are available. Therapies include blood and marrow transplantation, Baylor Charles A. Sammons Cancer Center Network patient families and caregivers to have ablation for liver cancer, and ultrasound-guided transperineal Seven facilities across Baylor Health Care givers have access to two areas in the radioactive seed implants. Scientists at Baylor Sammons Cancer System carry the Baylor Charles A. hospital for showering, washing clothes, Center perform extensive cancer research, and support services Sammons Cancer Center name as part working or relaxing. like the Cvetko Patient Education Center, Ernie’s Appearance of the system’s focus to bring patients Center, and the Healing Environment Program help Baylor throughout North Texas quality clinical Sammons Cancer Center treat the whole patient. care and advanced technology. Facilities surgery, chemotherapy, immunotherapy, radiation, CyberKnife® and Gamma Knife® radiosurgery, monoclonal antibodies, thermal their own space, and families and care- 5 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 6 5 Areas of Focus 2013 + Blood and Marrow Transplant Program: Curative Cell Research Celebrating more than 30 years and At Baylor University Medical Center at Healing Power 5,000 transplants, the Blood and Mar- Dallas, the BMT team is performing a About 70 percent of individuals requiring a stem cell transplant row Transplant (BMT) Program at Baylor study comparing the use of umbilical are not able to find a suitable match in their family. Through Charles A. Sammons Cancer Center at cord blood versus conventional marrow the BMT program’s research efforts, patients have access to Dallas, is one of the leading blood and or peripheral blood stem cell transplants. donated cord blood units that have been frozen and stored for marrow programs in the state of Texas, The stem cells in cord blood have a rare transplantation. “Not long ago, cord blood was discarded,” and has grown into one of the largest and capacity to repair bone marrow and boost says Dr. Pineiro. “It is incredible that today it can be utilized to most comprehensive in the nation. Led immune system recovery. “The patient’s perform life-saving procedures.” by Edward Agura, MD, medical direc- diseased bone marrow with cancer is tor, our BMT program continues to move completely eliminated with high doses of Unlike adult hematopoietic — or blood-forming — stem cells, research forward to improve outcomes chemotherapy and sometimes radiation, cord blood stem cells are young, flexible cells that can easily for those affected by blood cancers and or a combination of the two,” says Luis develop into different blood cell types that perform specialized deficiencies for which bone marrow trans- Pineiro, MD, FACP, a hematologic oncolo- tasks. For people with blood cancers such as leukemia, lym- plantation may provide lifesaving treat- gist on the medical staff at Baylor Dallas. phoma and myeloma, an infusion of cord blood stem cells can ment. “If a patient comes to us today for “Healthy stem cells from a donor will regenerate bone marrow following cancer therapy. For individu- a bone marrow transplant, there is almost repopulate the bone marrow. In the case als with inherited disorders of red blood cell production, such no reason we cannot find a donor for him of inherited deficiencies, the ‘deficient’ as sickle cell anemia or thalassemia, cord blood stem cells can or her,” says Dr. Agura. cells will be replenished by the healthy replace defective cells with a genetically normal counterpart, transplanted donor cells.” thus restoring red-cell function: the delivery of vital oxygen to the body. In immune deficiency disease, cord blood stem cells help fend off infections and diseases by replacing defective white blood cells with their healthy counterparts. “If a patient comes to us today for a bone marrow transplant, there is almost no reason we cannot find a donor for him or her.” - Dr. Agura Cherysee Daniels, Cancer Survivor and Dr. Edward Agura, MD 7 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 8 Areas of Focus 2013 + Blood and Marrow Transplant Program: Curative Cell Research Flexible Fit For a transplant to be successful, the human leukocyte antigen (HLA) markers in the donor’s stem cells must match those of the recipient. Because cord blood stem cells are better able to adapt themselves to a patient’s body, there is less chance of immunologic side effects such as rejection or graft-versus host disease. “When used for transplantation these cells are more tolerant, and therefore less likely to get ‘activated’ when exposed to their new environment in the recipient. The end result is less rejection and less graft-versus-host reaction,” says Dr. Pineiro. “Since we expect to see less immunologic activation, we can then use ‘less than perfect’ matches for transplantation. This has increased the number of patients in which stem cell transplant is feasible.” Program Highlights • More than 5000 transplantations performed since the program’s inception in 1983. • Texas’ first unrelated donor bone marrow transplanta Although cord blood contains fewer stem cells than a marrow or tion was performed by the transplant physicians on the blood stem cell transplant, Baylor researchers are able to com- medical staff at Baylor Charles A. Sammons Cancer bine cord blood products from multiple donors, thereby increasing the number of stem cells infused and providing faster recovery of blood counts. Center at Dallas in 1988. • Continuously accredited by the Foundation for the Accreditation of Cellular Therapy (FACT) since 1998. • Among an elite group of facilities designated as a Center for Excellence in most major insurance networks for meeting strict quality of care standards. 9 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH Areas of Focus 2013 + Innovative Clinical Trials Center: Moving Cancer Care Forward BUILDING BUILDINGOn OnSTRENGTH STRENGTH| | Baylor BaylorCharles CharlesA.A.Sammons SammonsCancer CancerCenter CenteratatDallas Dallas 10 9 on June 7, 2013, the ICTC WAS OFFICIALLY named the Swim Across America Innovative Clinical Trials Center at Baylor Charles A. Sammons Cancer Center at Dallas. The first open-water swim, held in June announced on June 7, 2013, the day Baylor Charles A. Sammons Cancer Center at Dallas boasts a 2011 at Lake Ray Hubbard in Rockwall, before the open-water swim. 6,375-square-foot facility, the Swim Across America Innovative Texas, was the beginning of a four-year Clinical Trials Center (ICTC), offering patients better access to commitment to the ICTC, with the goal Under the leadership of Carlos Becerra, a wide range of new research and treatment options. The ICTC of raising in excess of $1 million during MD, medical director of the ICTC, the expands the already extensive program of cancer clinical trials those four years to benefit the phase 1 center plans to use the expanding knowl- offered at Baylor Sammons Cancer Center. clinical trials program. SAA-Dallas is likely edge about the biology and genetics of to exceed that goal with the third swim cancer in exploring novel treatments for With the cost of bringing a new drug to market currently hover- in June 2013 bringing the total amount patients with hard-to-treat cancers. Says ing around $1 billion, or more, phase 1 clinical trials at the ICTC raised to $950,000. “We hope and Dr. Becerra, “in the past, for breast cancer continue, in part, due to funding sponsors from pharmaceutical anticipate that this commitment will be or colon cancer, as examples, we treated or biotechnology companies; however, for those agents without a extended for many, many more years to everyone the same. Now, as we dissect sponsor, other funding must be found to run the clinical trials. An come,” says Watters. tumors at the molecular genetic level, we Recognizing the critical importance of phase 1 trials, have learned that colon or breast cancer ideal match was found for the ICTC when Swim Across America (SAA), a national organization that holds swim-related events to In recognition of the support and dedica- can be subdivided into different types of raise funds supporting cancer research, prevention and treat- tion of SAA-Dallas, the ICTC has been disease that need to be treated differently. ment, came forward with an offer to support the center. According named the Swim Across America In- This gives us the knowledge to be smart- to Daniel Watters, chairman of the SAA-Dallas committee and a novative Clinical Trials Center at Baylor er in treating our patients, using specific member of the 1988 U.S. Olympic swim team, SAA-Dallas chose Charles A. Sammons Cancer Center at drugs to shut down specific pathways.” to support the ICTC at Baylor Sammons Cancer Center at Dallas Dallas. The naming was officially after an intensive search for “the best of the best” in terms of cancer research and treatment in North Texas. 11 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 12 Areas of Focus 2013 + Colon Cancer Genetics: Lynch Syndrome Because of current genetic research, physicians now have Boland’s theory about a genetic link, working with entire families,” Dr. Boland the tools to identify specific genetic mutations passed down Henry T. Lynch, MD, had published says. “Then, we are able to alter how through families that are responsible for a large number of papers to support just that. In one of his Lynch affects a person and their rela- colon cancers. “The current estimate is that one in 350 people own papers, Dr. Boland named the con- tives.” has one of these genetic mutations,” says C. Richard Boland, nection “Lynch syndrome.” Genetic counseling at Baylor Charles A. MD, chief of gastroenterology and a physician on the medical staff at Baylor University Medical Center at Dallas. The Today, researchers have not only con- Sammons Cancer Center at Dallas can condition is called Lynch syndrome, and knowing its genetic firmed that Lynch syndrome is surpris- help identify patients who are at risk of roots gives people the chance to protect themselves and their ingly common, but they’ve identified how developing colon cancer as a result of a families from the cancers it can cause. the mutations lead to cancer. Research genetic mutation. Board-certified genetic also shows that, among people with counselors help patients understand Experts estimate that three out of every 100 colon cancers Lynch syndrome, the chance of having their diagnosis, the inheritance pattern, are caused by Lynch syndrome. Screening is critical because colorectal cancer is 70 percent in men and the recommended screening and colorectal cancer is the third most common cancer – about and 40 percent in women. Women also prevention options. 150,000 Americans are diagnosed annually. It’s also the third have a 40 percent chance of having most deadly, claiming about 50,000 lives each year, according endometrial cancers (in the lining of the to the American Cancer Society. uterus), plus smaller risks of having a variety of other cancers. Also, a child When Dr. Boland first theorized that inherited genes were the of someone with the condition has a 50 cause, he did not have to go far to find a family to study. “My percent chance of having it, a fact that father first got colon cancer when he was in his mid-20s,” he leads to large clusters of affected says. “Ten out of 13 of his siblings had cancer of some kind. So relatives, as in Dr. Boland’s family. “Once for me, this is personal.” Though few others supported Dr. we identify one person with it, we end up 13 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 14 Cancer Center Highlights + Community Events/Outreach: Baylor Health Care System Mobile Mammography Program Getting an annual mammogram is important, but life sometimes locations in the fall of 2013. The mobile gets in the way of keeping that potentially lifesaving appoint- machine enables women to have quality ment. “Women often don’t take the time to take care of their breast screening at a location convenient health like they should,” says Sherry Fox, mobile account for them. The bus serves patients with executive at Baylor University Medical Center at Dallas. “By two changing rooms with direct access to making mammograms convenient and efficient though, they’re the mammography area assuring conve- much more likely to follow through.” Baylor Dallas’ Darlene G. nience and privacy. The mobile program Cass Women’s Imaging Center Mobile Mammography aims can serve up to 50 women per day and to do just that. The 41-foot coach is staffed by two women, the vehicle is equipped with internet including a certified mammographer, and travels to businesses, capabilities to sync patient data with the churches, school districts and corporations to bring mammog- hospital. raphy services to women right where they are. “The mobile program features digital The specially-designed bus equipped with three-dimensional mammography that includes Computer breast imaging technology began making regular stops at key Assisted Detection (CAD), an application that scans the patient’s screening mammogram to identify suspicious features that may warrant a second review by the radiologist,” says Ethel Randall, director of breast imaging for Baylor Health Care System’s Baylor Charles A. Sammons Cancer Center. “Digital mammography technology also provides faster processing times and the ability to store images electronically. 15 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 16 Cancer Center Highlights + Community Events/Outreach: Taking Cancer Information and Screening to the Community Virginia R. Cvetko Patient Education and Support Center American Cancer Society American Cancer Society knows how Through the Patient Navigation Program, The American Cancer Society is the only Cancer education and support are two vital components in one’s Baylor Sammons Cancer Center facilities The American Cancer Society has been an important each and every birthday can be. patient navigators provide free and organization offering cancer patients and cancer journey. Baylor Charles A. Sammons Cancer Center host several cancer education events, free incredible supporter of Baylor Sammons In May of 2013, the Society celebrated confidential support and guidance to all their families around-the-clock guidance boasts a beautiful patient education and support center named screenings and participate in many health Cancer Center at Dallas to deliver lifesaving its 100th birthday – one-hundred years of patients and their caregivers during their and support through their toll-free line, in honor of one of our former patients, Virginia R. Cvetko. The fairs throughout the community. In 2013, results. Together, we are a relentless force saving lives and twenty years supporting cancer journey. 1-800-227-2345 and at www.cancer.org. Cvetko Center provides many disease-specific education and 34 community education/outreach events fighting cancer. American Cancer Society Baylor hospitals. In the last two decades support programs to help patients and their caregivers under- were held and were attended by a total of representatives collaborate with oncology the Society has contributed to a 20% stand and navigate the physical, emotional and spiritual chal- nearly 3,700 participants. staff to deliver support, and serve on the decline in cancer death rates in the US. lenges of fighting cancer. cancer committee to help provide re- Last year the Society and Baylor hospitals sources to fulfill the Commission on Cancer reached over 2,100 patients with more standards for cancer care. than 6,000 programs and services, that’s 1-in-4 cancer patients treated at Baylor In 2013, the American Cancer Society Together, • Amyloid Support North Texas: Quarterly we are a receiving valuable services by the Society served 1,026 patients with 3,148 services Disease-Specific Support Groups • Bladder/Kidney Cancer Support Group: Monthly • Breast Cancer Support Group:Monthly relentless • Carcinoid Cancer Texas Survivors: Monthly at Baylor University Medical Center at Dal- Patients at Baylor University Medical las. Patients received weekly support from Center at Dallas are able to receive the Society’s ACS Day representative and guidance on Society programs, includ- all newly diagnosed patients received a ing the Reach To Recovery® program Personal Health Manager kit from the for those coping with their breast cancer Society which provides personalized experience. Female patients may also get information on their specific cancer type, involved in the Look Good Feel Better® as well as helping patients and caregivers program, dedicated to improving the • Prostate Cancer Education and Support Group: Monthly keep appointments, test results and pre- self-esteem and quality of life of people • Waldenstrom’s Macroglobulinemia Support Group: Bimonthly scriptions organized throughout treatment. undergoing treatment. • Young Adult Cancer Survivors: Bimonthly As the official sponsor of birthdays, the force fighting • Colon Cancer Support Group: Monthly • Graft-Versus-Host Disease Support Group: Quarterly • Gynecological Cancer Support Group: Every other Monday • Lung Cancer Education Support Group: Monthly • North Texas Myeloma Support Group: Monthly • Ovarian Cancer Support Group: Every other Monday cancer. • Oral and Head and Neck CancermSupport Group: Monthly 17 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 18 Cancer Center Highlights + Virginia R. Cvetko Patient Education and Support Center Free Community Screenings circus style performance group. The high- Young Adult Cancer Survivors’ Summit Baylor Sammons Cancer Center at Dallas hosted a head and light of the reunion was when John King In an effort to better meet the needs of neck cancer screening on April 27 followed by a skin cancer a leukemia survivor from Bossier City, young adult cancer survivors (YACS), the screening conducted on May 11. In all, a total of 38 patients Louisiana met his blood donor match, Young Adult Cancer Survivors’ Coalition received abnormal results and were contacted by a member Camila Bresciani who traveled from Dubai hosted the annual Down with Cancer, Up of our patient navigation team to facilitate an appointment to meet the man her donation saved. with Survival YACS Summit in April at the with a member of our medical staff. Through the Be The Match® National University of Texas at Arlington. Marrow Donor Program database, Camilia This year’s event featured keynote speak- Community Outreach Events was identified as a perfect match for Mr. ers: Heidi Adams, a young adult cancer On October 6, women from throughout Dallas gathered to King, enabling him to receive his life sav- survivor, author and president and CEO of take a proactive stand against breast and ovarian cancers at ing transplant on June 6, 2012. Critical Mass along with Karen Albritton, MD, a researcher specializing in young this year’s Sole Sisters™ event held at Tower Club Dallas. This health & beauty boot camp event promotes Baylor Charles A. Sammons Cancer adult cancers at Cook Children’s Medical good health/fitness practices and early detection. More than Center at Dallas hosted a lighted vigil Center at Fort Worth. Event attendees 100 women enjoyed spa treatments, group workout classes as part of a national campaign to raise participated in interactive breakout ses- and health/beauty consultations. A special highlight of the awareness for lung cancer on November sions covering topics such as: nutrition, event was an interactive discussion panel covering genetics, 14, 2013. Dallas joined more than 100 caregiving and building emotional support. prevention/screening, integrative medicine and survivorship. communities across the nation in host- Ivana Hall, Miss Texas 2013 served as event emcee. ing a Shine a Light on Lung Cancer Vigil in collaboration with the Lung Cancer More than 100 survivors and their families attended the Alliance. The purpose of this vigil was Blood and Marrow Transplant Reunion: Cirque du Celebra- designed to provide hope, support and tion, on September 29, 2013. Attendees enjoyed carnival compassion to the thousands who are style games, treats and were entertained by Circus Freaks, a diagnosed with lung cancer. 19 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 20 Cancer Center Highlights + Site-Tumor Conferences the interventional radiologist or surgeon held 350 site-specific tumor conferences Exposure to interesting and problematic cases: in 2013, where more than 1500 patients The conferences are a clearing-house for the same images may point out that the were discussed. Nearly 8,000 physicians, the most interesting and difficult cases procedure to get the tissue may be much trainees, nurses and allied health staff seen at Baylor. In this one place a health more involved than originally thought and attended these conferences focusing care professional can learn about every fraught with significant risk for the patient. on malignancies in Bone & Soft Tissue, aspect of a patient’s case, the pathology, This could change the whole care of the Breast, Chest, Colorectal, Endocrine, GI, the radiological findings, the genetics, the patient. Baylor Sammons Cancer Center at Dallas sitting in the same room and looking at Gynecology, Head & Neck, Liver, Neuro- social impediments to the therapy, etc. Oncology, Pancreas, Skin, Urology and The whole book of business about the pa- Hematopoietic Diseases. Education leading ultimately to better patient care: ease teaches everyone about the disease. tient’s problem is presented in one venue. It has tremendous value and efficiency of These conferences have all levels of train- patient care. Value of Tumor Conferences by Robert G. Mennel, MD time for the health care practitioner. ees from students to staff and all disci- The value of the tumor conferences can presented that apply to this patient’s disEducation and discussion lead to better plines from general surgeons to Professional camaraderie: genetic counselors. Interpreting X-rays In this era of increasing ways of commu- be summed up in 4 benefits: Insight into other disciplines’ thought processes towards the same problem: with a radiologist teaches the other disci- nication (Emails, tweets, webinars, etc) [1] Exposure to interesting and Different disciplines, by virtue of their plines how to interpret X-rays, what is the but decreasing depth of communication, problematic cases training, approach the same problem from best X-ray to order, and the problems the these conferences put everyone in the [2] Insight into other disciplines’ thought different angles. For example the patholo- radiologist faces in interpreting the film. same room, face to face, to engage in processes towards the same problem gist and medical oncologist may need The same is true for anatomic patholo- education and friendly professional ban- [3] Education, leading ultimately to better more tissue for a diagnosis and think gists, molecular pathologists, surgeons, tering that builds the ties within this can- that this would be a minor procedure of medical oncologists, and radiation cer center. This camaraderie may be the very little risk for the patient. However, oncologists. Having the scientific studies major benefit of our tumor conferences. patient care [4] Professional camaraderie. INSIGHT CASE-SOLVING EDUCATION CAMARADERIE 21 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 22 Cancer Center Highlights + Clinical Oncology Research Coordination (CORC) Office Patient Navigation Clinical Oncology Research Coordination (CORC) Office SOCRD is a central location where information from all of these patients, investigators, and sponsors. In At Baylor Charles A. Sammons Cancer nurses that partner with patients and their community. In 2013, we screened 109 The Clinical Oncology Research Coordination Office underwent sources can be stored, validated, and accessed for feasibility August 2013, M.Y. Levy, MD, became the Center at Dallas, we understand the over- families to serve as an advocate, guide, individuals and found 38 of them to be a major change in April of 2013 when Angelia Drake, MSN, RN, and future research. medical director of Hematological Malig- whelming nature of a cancer diagnosis. and resource through cancer treatment at risk for either skin cancer or head and nancies of the ICTC. Thanks to Dr. Levy Understanding and following complex and recovery. neck cancer. To make sure those at-risk and Dr. Carlos Becerra, medical director treatment recommendations can be diffi- assumed the role of director. In addition to being responsible for this system-wide office she also supervises the Division of Currently, Drake and her staff are re-vamping the infrastructure Surgical Oncology and the development of the Surgical Oncol- and processes in the department to accommodate the rapid of Heme Malignancies, there has been a ogy Clinical Research Database or SOCRD. SOCRD is a meta- expansion of clinical trials in Baylor Health Care System. While registry where multiple databases are connected from the tumor individuals are connected with a physician cult for both the cancer patient and family Our patient navigation team also works on staff at Baylor as quickly as possible, big increase in the number of phase I and members. This is why every family that very closely with our Virginia R. Cvetko patient navigators will call each person to focusing on continuing the growth of these trials, as well as II trials being offered through the clinic. walks through our doors has access to a Patient Education and Support Center. facilitate setting up an appointment with registry data imports, multi-disciplinary tumor conferences, trials in the Innovative Clinical Trials Center (ICTC), the depart- At present, oncology clinical trials are patient navigator. Our patient navigation Free cancer screenings are one of many the appropriate provider. investigator-initiated clinical trials, pathology, and radiology. ment is maintaining its focus on providing quality and service to being conducted at the Dallas, Fort Worth, team is a group of dedicated registered resources our Cvetko Center offers to the and Irving campuses. CORC hopes to expand to more of the Baylor Health Care 400 2011- 2013 Patient Accruals to Baylor Clinical Oncology Trials 350 301 Patient Accruals 300 System hospitals in the near future. The 339 expanded network of locations for clini- 2011 2012 250 2013 number of clinical trials and the number of • Answer questions and address patient concerns patients enrolled in the trials. • Educate and empower patients to make an informed decision • Work with a multi-disciplinary team of doctors to provide 200 136 150 66 37 33 efficient, timely, and quality care 121 100 50 Patient Navigators: cal trials should result in growth of the 45 37 120 4 1 2 56 50 29 14 • Assist patient and family members with finding appropriate 90 85 80 80 6 11 8 resources 35 34 21 0 Breast Chest GI GU Gyn Head and Neck Healthy Donors Hemotology Neuro Other Skin • Explore and assist with financial resources 23 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 24 Patient Profile + Teri Rodgers : Melanoma – Immunotherapy – Interleukin II In 2007, 38 year-old Teri Rodgers was live past the end of the year. He advised wasn’t the standard of care. It was risky, it In thinking about her experience, Rodg- district. She enjoys every day with her In addition to working full time, Rodgers leading an active, normal life. She was us to get our affairs in order.” was aggressive, it was cutting edge.” ers isn’t shy about her feelings. “I love husband and children and she says enjoys traveling, spending time with her Baylor. I have been to multiple hospitals every day she remembers how far she family, gardening, cooking and having and her family have come and how friends over to her home. “I love the feel blessed they are. and sound of a house full of friends and a wife, mother of a four-year old and a seven-year-old and working full-time as Rodgers was shocked and couldn’t un- Rodgers treatment regimen was intense. and cancer care facilities and Baylor is an elementary school assistant principal derstand why she had cancer. There was She spent one week in the intensive care number 1. Everyone – the secretaries, in Arlington, Texas. An autumn day in Oc- no history of melanoma in her family and unit, received treatment consisting of the nurses, the physicians, the lab tech- tober would change her life and the lives the only cancer she knew of was when two doses twice a day, recovered, had nicians, they knew my children by name. of her family, forever. her grandmother dealt with lymphoma. scans to check the size of the tumor, then They became my family and they treated “The ‘C’ word was a heavy blow, but I scheduled another week in the ICU to me as family as well.” “I felt a lump under my left arm pit,” knew I didn’t have an option, that I had repeat the process. This was repeated remembers Rodgers. “At first, I brushed it to do everything I could to survive and over four cycles. Rodgers says she was In 2009, Rodgers’ scans revealed off, not thinking much about it. After a few work to stay alive. I wanted aggressive fortunate that her body was able to toler- another tumor. She began a two-year weeks, when it hadn’t gone away, I began treatments, so we followed the old adage ate the aggressive therapy. clinical trial testing another form of to worry. I saw my physician who referred about the squeaky wheel getting the oil. me to an oncologist in Arlington. I’ll never We were squeaky, calling, emailing, show- “I was scanned every month, CT scans Sammons Cancer Center at Dallas. forget the day he told me I had a golf ball ing up at physicians’ offices. I worked and PET scans,” recalls Rodgers. “I Today, she has been cancer free for two sized tumor that was stage 3-4 melanoma with my oncologist to locate a melanoma could see each time we scanned that the with no external spot. The first thing that specialist. We found Baylor Charles A. ran through my mind was, OK, it was skin “I’m living proof that family and the memories that are being “I’ve always had a servant’s heart and made,” she says. immunotherapy a willingness to help others, but now I works and that have a real life battle and I’m committed “Being in remission is a new place for to being a living testimony to share with me because for the past several years others and help them fight for what they I’ve been living and dealing with cancer,” want or aspire to become. Unfortunately, Rodgers admits. “I’m living proof that there’s a lot of grief and struggle in our immunotherapy works and that there can at the end of world. Yet I get to share my success be hope and a light at the end of the tun- story and hopefully encourage others nel. The research continues to identify the tunnel.” along their journey. The gift of life is new treatment options. Whatever we can years. Rodgers credits her physicians precious and I don’t ever want to take do to increase the research, increase the tumors were shrinking. It didn’t happen and the clinical trials offered through it for granted. I’ve lost several friends opportunities for new clinical trials to Sammons Cancer Center at Dallas. After immediately, but the tumor decreased a Baylor Institute for Immunology along this journey and I know that I am occur and increase the other outcomes cancer. But, after extensive tests, we real- evaluating my health history and health centimeter here and a centimeter there. Research for her remarkable recovery. here for a reason. I don’t ever want to to increase the survival rate and have ized the prognosis was dire. The oncolo- status, my doctor recommended immuno- After the four rounds of Interluken II, we miss out on an opportunity God has put more survivors, then I’m all for it!” gist told us there was only a 20% chance therapy using high dose Interleukin II. This finally got to a no evidence of disease Rodgers has taken a new position as a of surviving and that I probably wouldn’t was seven years ago and immunotherapy status.” school counselor in a smaller school immunotherapy at Baylor Charles A. there can be hope and a light me here for.” 25 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH CoC State of Texas Performance Rate Oncology Quality Metrics 2012 NCDB Target Cancer Registry + summary of 2012 : cancer registry data BHCS ALL FACILITIES BY SITE 2012 BUMC BMCP BASMC BMCG BMCI BMCG BMCW BMCC Oral Cavity 80 72 75 5 4 11 2 2 Digestive System 586 83 147 100 84 71 36 21 Respiratory System 229 31 104 116 56 58 17 20 Blood/Bone Marrow 141 12 21 30 15 15 1 5 Bone 13 10 8 2 1 1 0 0 Connective/ Soft 35 19 12 2 2 1 0 0 Tissue Skin Breast Cancer 2010 & Prior 2012 Forward CoC Census Region (West) Performance Rate All CoC Programs Performance Rate Diagnosis Year 2011 (CoC) Baylor University Medical Center Performance Rate *2009 *2010 *2011 *2012 Post Breast Conserving Surgery Irradiation: Radiation therapy is administered within 1 year (365 days) of diagnosis for women under age 70 and receiving breast conserving surgery for breast cancer (Accountability Measure) NCDB, CoC, NQF, NAPBC 90% 90% 86.8% 88.8% 91.8% 97.2% 95% 95.6% 95.6% Adjuvant Chemotherapy: Combination chemotherapy is considered or administered within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cNoMo, or Stage II or III hormone receptor negative breast cancer (Accountability Measure) NCDB, CoC, NQF, NAPBC 90% 90% 90% 90.5% 92.5% 96.6% 94.3% 96% 96% Adjuvant Hormonal Therapy: Tamoxifen or third generation aromatase inhibitor is considered or administered within 1 year (365 days) of diagnosis for women with AJCC T1cNoMo, or Stage II or III hormone receptor positive breast cancer (Accountability Measure) NCDB, CoC, NQF, NAPBC 90% 90% 86.1% 87.1% 90.3% 94.9% 91.7% 95.1% 95.1% Adjuvant Chemotherapy: Adjuvant chemotherapy is considered or administered within 4 months (120 days) of diagnosis to patients under age 80 with AJCC III (lymph node positive) colon cancer (Accountability Measure) NCDB, CoC, NQF 90% 90% 88.5% 89.4% 90.6% 89.3% 92.6% 95.2% 95.2% Surgical Resection Includes at Least 12 Lymph Nodes: At least 12 regional lymph nodes are removed and pathologically examined for resected colon cancer (Surveillance Measure) NCDB, CoC, NQF 80% 80% 90.5% 89% 87.8% 97.4% 97.2% 95.9% 95.9% NCDB, CoC, NQF 90% 90% 91.6% 90.6% 91.8% 100% 100% 100% 100% Colorectal Cancer 91 88 37 5 1 4 2 0 Breast 593 231 340 154 91 90 75 23 Female Genital 207 10 116 19 7 32 4 1 Male Genital 163 24 47 33 2 27 2 1 Urinary System 186 38 40 27 6 45 21 4 Brain/CNS 149 13 26 31 13 14 8 4 Endocrine/Thyroid 151 30 87 20 20 15 4 4 Lymphatic System 107 25 49 37 15 22 8 9 Unknown Primary 51 18 8 10 4 10 9 3 Other/Ill-Defined 11 2 9 1 1 4 0 0 Total 2793 706 1126 592 322 420 189 97 Rectal Cancer Radiation Therapy for Rectal Cancer: Radiation therapy is considered or administered within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathological AJCC T4NoMo or Stage III receiving surgical resection of rectal cancer (Surveillance Measure)Connect/Soft Tissue *Source: American College of Surgeons National Cancer Data Base 27 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 28 Baylor University Medical Center Dallas: Analytic/non Analytic Cases Diagnosed 2012 Primary Site Total Ananalytic Nonanalytic Male Female In Situ Local Regional Distant NA/Unknown 4050 2811 1239 1810 2240 150 1345 775 795 985 124 5 51 4 2 62 83 3 36 2 0 42 41 2 15 2 2 20 81 2 33 3 2 41 43 3 18 1 0 21 1 0 1 0 0 0 32 2 18 0 0 12 62 1 25 3 1 32 11 0 3 1 0 7 18 2 4 0 1 11 Digestive System Esophagus Stomach Colon Rectum Anus/Anal Canal Liver Pancreas Other 796 31 43 174 136 8 221 127 56 592 21 30 113 110 4 178 88 48 204 10 13 61 26 4 43 39 8 498 29 26 97 87 5 167 58 29 298 2 17 77 49 3 54 69 27 6 1 0 0 2 0 0 2 1 260 8 3 38 44 5 128 22 12 233 7 17 61 43 1 52 37 15 158 4 11 45 21 0 15 46 16 139 11 12 30 26 2 26 20 12 Respiratory System Nasal/Sinus Larynx Lung/Bronchus Other 386 3 34 346 3 233 1 18 212 2 153 2 16 134 1 206 1 28 175 2 180 2 6 171 1 2 0 1 1 0 62 0 8 53 1 77 3 12 62 0 163 0 5 158 0 82 0 8 72 2 Blood & Bone Marrow Leukemia Multiple Myeloma Other 266 160 87 19 143 92 44 7 123 68 43 12 148 86 50 12 118 74 37 7 0 0 0 0 6 1 5 0 1 1 0 0 238 141 78 19 21 17 4 0 Bone 18 13 5 8 10 0 7 7 1 Connect/Soft Tissue 47 34 13 23 24 0 28 8 134 124 10 94 89 5 40 35 5 79 72 7 55 52 3 8 8 0 58 54 4 30 29 1 All Sites Oral Cavity Lip Tongue Oropharynx Hypopharynx Other Skin Melanoma Other Primary Site Total Analytic Nonanalytic Male Female In Situ Local Regional Distant NA/Unknown Breast 806 595 211 5 801 99 371 170 35 131 Female Genital Cervix Uteri Corpus Uteri Ovary Vulva Other 261 39 141 54 17 10 207 22 127 40 12 6 54 17 14 14 5 4 0 0 0 0 0 0 261 39 141 54 17 10 3 0 0 0 3 0 115 7 92 4 9 3 63 13 31 10 5 4 39 3 9 27 0 0 41 16 9 13 0 3 Male Genital Prostate Testis Other 277 267 9 1 163 157 5 1 114 110 4 0 277 267 9 1 0 0 0 0 0 0 0 0 144 141 2 1 34 34 0 0 21 16 5 0 78 76 2 0 Urinary System Bladder Kidney/Renal Other 233 76 150 7 189 65 119 5 44 11 31 2 161 57 99 5 72 19 51 2 31 29 0 2 129 34 91 4 23 3 20 0 27 1 25 1 23 9 14 0 Brain & CNS Brain (Benign) Brain (Malignant) Other 229 15 77 137 147 10 32 105 82 5 45 32 89 9 40 40 140 6 37 97 0 0 0 0 39 0 39 0 2 0 2 0 2 0 2 0 186 15 34 137 Endocrine Thyroid Other 198 129 69 152 106 46 46 23 23 80 41 39 118 88 30 0 0 0 60 59 1 45 45 0 7 6 1 86 19 67 3 Lymphatic System Hodgkin’s Disease Non-Hodgkin’s 186 24 162 104 9 95 82 15 67 105 13 92 81 11 70 0 0 0 31 2 29 19 5 14 74 9 65 62 8 54 6 5 Unknown Primary 73 52 21 42 31 0 0 0 1 72 10 10 0 28 23 5 Other/Ill-Defined 16 10 6 8 8 0 3 1 2 10 Data Source: Electronic Registry System, Baylor Health Care System Cancer Registry This report INCLUDES CA in-situ cervix cases, squamous and basal cell skin cases, and intraepithelial neoplasia cases phoma/myeloma category. 29 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 30 Table 1. Prognostic Value of Cytogenetics Patient Outcome Studies + Prognostic Group 5-year Survival Mutation Favorable 65% t(8;21)(q22;q22) inv(16)(p13.1q22) Acute Myelogenous Leukemia at Baylor Charles A. Sammons Cancer Center from 2010 to 2012 t(16;16)(p13.1;q22) t(15;17)(q22;q21) Normal karyotype with mutated CEPBA, or mutated NPM1 without FLT-3 Background According to the American Cancer Society, in 2012 there was an estimated 13,780 new cases of acute myelogenous blood or bone marrow occurring de novo or in a patient with a prior diagnosis of myelodysplastic syndrome or myeloproliferative neoplasm. In the setting of 41%, and 14%, respectively. Table 1 lists the mutations related to each prognostic group. Classification among risk groups provides information regarding treatment Normal AML diagnosis, cytogenetic analysis is evaluation. While conventional cytogenet- miaNet. These guidelines, in addition to +8 considered mandatory as part of the ic studies are considered mandatory, mo- the frequently updated NCCN guidelines, +21 diagnostic evaluation. Cytogenetic abnor- lecular cytogenetic studies are optional. serve as a reference and guide for the +22 malities are present in approximately 55% In non-study patients who have AML with published from the international Leuke- Intermediate 41% leukemia (AML) and 10,200 deaths. While specific genetic abnormalities, however, response in addition to survival. Those diagnosis and risk stratification of newly del(7q) of adult AML cases, and they provide the normal cytogenetics (CN-AML), testing the 5-year relative survival of patients the requirement for a blast count of 20% classified as favorable show complete diagnosed cases of AML. del(9q) most important prognostic information. for mutations in the NPM1, CEBPA, or Abnormal (11q23) Additionally, they allow, in cases of t(8;21), FLT3 genes is not currently considered Complex cytogenetics t(15;17), inv(16), or t(16;16), the AML diag- mandatory, but it is recommended. -5 diagnosed with AML is only 24%, there are large differences in patients’ prognoses, which are influenced by patientspecific factors and perhaps most importantly the genetics of the disease. While AML was initially classified by the French-American-British system, which used cell morphology and cytochemical or more does not apply. These specific response rates to treatment of 90%, while Adverse 14% have a complete response rate of approxi- Current Recommendations and Practice Guidelines nosis to be made with <20% blasts in the Traditionally classified as intermediate mately 60%. Based on the previous guidelines, mor- del(5q) peripheral blood or bone marrow aspirate. risk, the CN-AML group includes approxi- t(15;17)(q22;q12). In addition to the WHO phologic assessment of blood and bone -7 As the results of the karyotype are the mately 40% to 45% of young adults with classification Among patients with normal cytogenet- marrow smears using Wright-Giemsa Abnormal 3q strongest prognostic factor for predicting AML. Identifying the presence of these ics, or those considered to be at inter- stains and assessment of the bone mar- response to therapy and overall survival, particular mutations has provided further mediate risk, a more detailed analysis row aspirate remain fundamental to should include all blast forms with the In addition to morphologic assessment, recommendations suggest that a mini- prognostic information and allowed for exception of erythroblasts, though in the immunophenotyping using multiparam- mutations include t(8;21)(q22;q22), inv(16) (p13.1q22) or t(16;16)(p13.1;q22), and acute promyelocytic leukemia (APL) with system for AML, the international European LeukemiaNet (ELN) guidelines for those in the adverse or unfavorable group stains to categorize the disease, a newer reporting genetic alterations in AML were for the presence of molecular markers is the routine diagnostic workup for AML. mum of 20 metaphase cells be analyzed stratification within the intermediate-risk classification system developed by the published recently, further delineating needed. Examination of the FLT-3, NPM1, Specifically, when evaluating blood and case of pure erythroid leukemia these eter flow cytometry or immunohistochem- to define an abnormal karyotype, and that group to intermediate-I and intermediate- World Health Organization (WHO) that AML patients based on genetics as well CEPBA, RUNX1, MLL, and EVI1 genes bone marrow smears, it is recommended should be counted. In addition to the istry is also essential in new AML diagno- this cell number is mandatorily assessed II. Evaluation for the presence of specific incorporates genetic studies is now used. as age. allows further risk stratification among the that 200 leukocytes be counted on blood assessment of blood and bone marrow ses for determination of cell lineage, with before diagnosing a normal karyotype. isolated mutations has also allowed for prognostic group, potentially influencing smears and 500 nucleated cells counted aspirate smears, assessment of a bone a preference towards use of flow cytom- For cases with inadequate or failed movement among risk groups. Isolated treatment and treatment response. Due on bone marrow aspirate smears contain- marrow trephine biopsy may provide valu- etry. While consensus data do not give cytogenetic analyses, fluorescence in mutations of the NPM1 and CEBPA to the significant progress that has been ing adequate spicules. With the exception able information regarding cellularity, cell a specific cutoff point for considering a situ hybridization (FISH) may be used for genes offers a favorable prognosis as- made in identifying these molecular mark- of cases with t(8;21), t(15;17), inv(16), or maturation, and bone marrow stroma; specific marker to be positive, expression detection of gene rearrangements. sociated with higher complete response ers and their role in pathogenesis, new t(16;16), the diagnosis of AML through however, expert panel recommendations of specific markers in >20% of leukemic recommendations have been developed morphologic assessment requires the consider this evaluation optional, except cells is commonly used. in the setting of a “dry tap,” where no material is obtained in the biopsy. This system, most recently updated in 2008, combines the traditional clinical features, morphologic features, and immunophenotypic criteria with cytogenetic and molecular analyses. Based on the WHO categorization of myeloid neo- Cytogenetic information not only influences the classification of AML but also provides important prognostic information regarding remission rates, risk of relapse, and overall survival. Patients with favor- plasms, AML is defined as the presence able, intermediate, or adverse cytogenet- that define general practice guidelines for presence of a blood or marrow leukemic of 20% or more blasts in the peripheral ics have 5-year survival rates of 65%, the diagnosis of AML, the most recent blast count of at least 20%. Blast counts For all patients with a new or suspected rates, reduced relapse risk, and longer Based on expert panel recommendations, overall survival. In comparison, mutations blood and marrow specimens should be of the FLT3 gene, whether present as a collected routinely for molecular genetics single mutation or in combination, are 31 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 32 Table 3. Results Table 2. Patient Demographics considered intermediate-I risk, conferring Review and documentation of a patient’s Center, a tertiary referral center in Dallas. of presentation, with a mean of 33.1% Years 2010 2011 2012 Total Years poorer prognosis due to inferior disease- performance status, comorbidities, basic Cases were identified through our tumor (range, 0–95%). Total patients Diagnostic CBC 25252777 2010 (n = 25) 2011 (n = 25) 2012 (n = 27) free survival and overall survival rates. blood counts and chemistry profile, registry and then reviewed for demo- All cases had histologic evaluation of the Age, years Mutations in KIT, have also been noted to coagulation studies, hepatitis and HIV graphic information, initial laboratory bone marrow accompanied by flow cyto- 18 to 60 9 11 17 37 (48%) be of prognostic significance in patients testing, chest x-ray and electrocardiogram, assessments and pathologic evaluations metric analysis. The mean blast percent- 61 to 65 2 5 4 11 (14%) with t(8;21)(q22;q22) or inv(16)(p13.1q22) . and transplant assessment should all be performed at presentation, as well as age in the bone marrow was 60% (range, >65 14 9 6 29 (38%) Among this specific patient population a performed based on standard guidelines cytogenetic and molecular studies per- 9%–98%). Conventional cytogenetic Sex mutation of KIT is associated with a worse and expert panel recommendations. formed. The mean age of patients in our analysis was completed in 74 patients Male 14 13 17 44 (57%) prognosis changing the risk status from Documentation of these various factors to cohort was 58 years (range, 20–83 years). (96%). Based on results of conventional Female 11 12 10 33 (43%) favorable to intermediate. determine higher risk is important, as age Males represented 57% of the patients. cytogenetics, 17 patients (22%) were Comorbidities >60 years and medical comorbidities, Fourteen patients, or 18%, had a history given a prognostic classification of favor- Prior malignancy 9 3 2 14 (18%) specifically diabetes, coronary artery of prior malignancy. Diabetes mellitus was able, 34 patients (44%) were classified as Diabetes 5 6 6 17 (22%) Favorable risk 3 7 Intermediate risk 13 8 Adverse risk 8 10 Not done 1 0 2 3 4 9 (11.6%) Molecular Cytogenetics performed 1 2 2 5 (6.4%) Yes No Testing for the presence of additional fusion genes via reverse transcriptase- disease, and chronic obstructive pulmo- the most common comorbidity present in intermediate risk, and 23 patients (30%) Coronary artery disease polymerase chain reaction, such as nary disease, have been associated with 17 patients (22%), followed by coronary were classified as adverse; 3 patients Chronic obstructive pulmonary disease RUNX1-RUNX1T1, CBFB-MYH11, adverse prognostic outcomes. Among artery disease in 9 patients (11.6%) and were not classified. DEK-NUP214, and PML-RARA, can be treatment guidelines, age >60 is associ- chronic obstructive pulmonary disease in performed, but these tests are presently ated with higher prevalence of other 5 patients (6.4%). Demographic informa- considered optional, although recent unfavorable factors, such that this is tion is summarized in Table 2. alterations in the WHO classification have considered a division point for therapeutic categorized these as individual entities. recommendations. Patients considered Additional studies for mutations in the White blood cells 30.8 33.8 43.1 4.0-11.0 (1000/μL) (0.5–163.2) (0.8–212.0) (0.8–212.0) Hemoglobin (g/dL) 8.7 8.7 8.4 12.0-17.0 (3.6-12.0) (6.3–10.5) (6.4–11.6) Platelets (K/μL) 59.5 48.2 54 140-400 (7-150) (6–203) (12–217) Risk Group by Karyotype Total 20 23 5 2 7 13 5 2 findings correlated with conventional HLA typing performed HLA typing at presentation was complet- mation. Overall, complete cytogenetic cytogenetics, which demonstrated the ed in 38 patients (49%). Of those patients evaluation was performed in 98.6% of presence of t(15;17)(q22;q21) consistent Yes No in the intermediate and adverse risk our patients. For the single patient who with a diagnosis of APL. Overall, patients Laboratory results are summarized in categories 58.8% and 56.5%, respec- did not have cytogenetic evaluation, the with APL accounted for 11% of our new potential candidates for allogeneic stem Table 3. All patients had a complete tively were tested, and of those below age reason is not clear, as charts were not AML diagnoses. specific genes WT1, RUNX1, MLL, KIT, cell transplant should have HLA typing blood count at initial presentation. The 60, 60% had HLA testing at presentation reviewed for treatment or survival data. RAS, TP53, TET2, and IDH1 for prognos- performed at diagnosis, along with typing mean white blood cell count was 35.9 (Table 4). tic assessment are currently considered of their first-degree relatives, an assess- K/uL (range, 0.5–349 K/uL). All patients investigational and only advised for use in ment of key importance particularly in except one were anemic at presentation, Conventional cytogenetic evaluation is clinical trials. patients with adverse cytogenetics. with mean hemoglobin levels of 8.6 g/dL considered standard in the diagnosis (range, 3.6–12.0 g/dL). Thrombocytopenia and workup of new cases of AML. In our was present at presentation in 72 patients and genetic studies to establish a diag- Acute Myelogenous Leukemia at Baylor Sammons Cancer Center nosis of AML, several additional tests and FFrom February 2010 to December 2012, assessments should be performed as a 77 new cases of AML were diagnosed standard in the initial patient evaluation. at Baylor Charles A. Sammons Cancer 13 11 12 14 17 (22%) 34 (44%) 23 (30%) 3 (4%) 23 66 (86%) 4 11 (14%) the necessary diagnostic genetic infor- In addition to bone marrow examination Normal values 14 13 38 (49%) 39 (51%) Table 4. Performance of HLA typing by risk group and age HLA TypingYesNo Risk Group Four patients had inv(16)(p13.1;q22) by Favorable Risk 5 12 Optional/Investigational Studies conventional cytogenetics. In three of Intermediate Risk 20 14 Additional molecular cytogenetic evalu- these patients, molecular cytogenetics Adverse Risk 13 10 ation via FISH was performed in 66 pa- was performed, and all demonstrated Age tients (85.7%). The presence of the PML/ the presence of the CBFB-MYH11 gene <60 years 21 14 cohort, conventional cytogenetics was RARA gene rearrangement was identi- rearrangement. Patients with inv(16) >60 years 17 25 (93.5%) and the mean platelet count was performed in only 96% of the patients; fied in eleven patients. Of those eleven (p13.1;q22) accounted for 5.2% of our 53.9 K/uL (range, 6–217 K/uL). The pres- however, of the three patients without patients, all but one had conventional new AML diagnoses. ence of blasts in the peripheral blood was conventional cytogenetics, molecular cy- cytogenetic evaluation. Of the remain- also assessed in all patients at the time togenetics was performed in two, giving ing ten patients, molecular cytogenetic Mutations in the RUNX1 gene were 33 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 34 detected in nine patients by molecular isolated NPM1 mutations, while seven tional cytogenetics performed and 20 cally, these mutation analyses were only acterized by a variety of genetic and ease while avoiding unnecessary genetic cytogenetics. Three of the nine patients patients had mutations of both NPM1 and had molecular cytogenetics. In 2011 of considered of prognostic significance, molecular mutations with the potential evaluations which come at increased cost. had the gene rearrangement RUNX1- FLT-3. This additional information obtained 25 new AML cases 24 had conventional and therefore were only recommended as to significantly impact diagnosis, choice Reflex testing has been adopted at Baylor RUNX1T1, which was consistent with the by mutation analysis allowed for the cytogenetic analysis and 23 had molecu- an optional assessment in patients with of therapy, response to treatment, and University Medical Center for specific conventional cytogenetic finding of t(8;21) reclassification of the five patients with an lar cytogenetic evaluation. The results CN-AML. Among our patient cohort 24 survival. For these reasons, a thorough types of lung, colon and uterine cancer (q22;q22) in two of the patients. Muta- isolated NPM1 mutation from the inter- were again similar in 2012 with 21 of 22 patients had a normal karyotype war- diagnostic evaluation establishing an and is being discussed for several others. tions in RUNX1 were present in 11.7% of mediate risk group to the favorable risk patients having conventional cytogenetics ranting further mutation analyses for the accurate diagnosis and classification for our patient cohort, with 2.6% occurring in group. Four patients with CN-AML did not and 18 of 22 having molecular cytoge- NPM1, CEBPA, and FLT-3 genes, but new AML cases is of utmost importance. Our study did not evaluate how choice of association with t(8;21)(q22;q22). undergo any mutation analysis for further netic evaluation. these mutation analyses were performed Our data demonstrate that patients newly therapy or overall survival were influenced only in 18 of the 24 patients. Moreover, diagnosed with AML at Baylor University by the additional genetic and molecular risk stratification. The t(6;9)(p23;q34) DEK-NUP214 was Further investigational mutation analysis Patient evaluation and characterization these analyses were also performed in 31 Medical Center at Dallas undergo thor- evaluations, however complete informa- diagnosed in one patient by conventional was performed for the presence of the by molecular diagnostics was compared patients without CN-AML. ough diagnostic evaluation in keeping with tion allows for the most informed treatment cytogenetics. One additional patient with C-KIT mutation in 20 patients (26.0%) and from year to year with a noted increase in Based on the European LeukemiaNet current recommendations. In addition, planning. Only 49% of patients with AML multiple cytogenetic abnormalities dem- was positive in only one patient (1.3%). In use of molecular genetics from 2010 to 2010 guidelines, in addition to muta- a large portion of patients had further received upfront HLA testing, including onstrated the presence of DEK(6p23) and total, 53 patients (68.8%) underwent addi- 2012. Of newly diagnosed AML patients tion testing of the NPM1, CEBPA, and genetic and molecular evaluations, which 57% in the intermediate and high risk NUP214(9q34). tional analysis for the presence of muta- in 2010, 8% had molecular genetics FLT-3 genes, testing for the presence of although considered optional or investiga- groups, and 60% in those under 60. It tions in NPM1, CEBPA, FLT3, or C-KIT. performed. Of those cases evaluated in mutations in other genes such as KIT tional by current recommendations have should be a goal to provide HLA testing AAmong the 24 patients with a normal Also considered to be investigational, mo- 2011 and 2012, 16% and 27% of the was considered investigational. Of the prognostic significance. While this addi- as early as possible in those patients who karyotype (CN-AML) by conventional lecular genetics studies evaluating for the cases had molecular genetics performed, 20 patients who underwent KIT mutation tional useful and prognostically significant may benefit from allogeneic transplant to cytogenetics, 13 (54.2%) had further presence of fusion genes were performed respectively. Similar to cytogenetic analysis, the testing was only relevant in testing is frequently performed we did find avoid delays in identifying a donor. One molecular cytogenetic evaluation by FISH in 15 patients (19.5%): 13 patients were evaluation, rates of mutation analysis one patient. In one additional patient in that the population of people undergoing can hope that continued efforts to obtain and 20 (83%) had mutation analysis. assessed for PML/RARA and two patients over this time were fairly consistent being whom the analysis was prognostically rel- this testing needs to be more specifically all available prognostic information and Mutation analysis among patients with for BCR-ABL. Of those evaluated, eight performed in 72% of cases in 2010 and evant, testing was not performed. Overall defined. Currently, we are investigating biomarkers translate to improvements in a normal karyotype included evaluation patients demonstrated the presence of the 2011, and in 68% of cases in 2012. Per in our cohort, of the 55 patients who had having patients undergo reflex genetic treatment and patient survival. for the presence of FLT-3, which was PML/RARA fusion gene, and both analy- expert recommendations on behalf of the mutation analyses performed, 39 patients testing to better define their specific dis- performed in 19 patients (77%) and was ses for BCR-ABL were negative. European LeukemiaNet published in Jan- had testing that would not be consid- positive in 11 patients (50%); NPM1, Overall the rates of conventional and uary 2010, mutation analysis for the pres- ered standard or optional and should be performed in 17 patients (79.2%) and molecular cytogenetic evaluation of ence of mutations in the NPM1, CEBPA, restricted to investigation. positive in 12 patients (50%); and CEBPA, patients presenting to Baylor Sammons and FLT-3 genes were considered an op- performed in three patients (12.5%), all from year to year were consistent. In 2010 tional assessment at the time of diagnosis Conclusion of which were negative. Five patients had of 25 new AML patients 24 had conven- for all patients in our cohort. More specifi- AML is a heterogeneous disease char- 35 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 36 Patient Outcome Studies + Radiation Treatment for Glioblastoma Multiforme: The Baylor Charles A. Sammons Cancer Center Experience, 2010 to 2012 SAMMONS XRT • 39 PATIENTS OUTSIDE SAMMONS XRT Expired prior to recommended treatment Expired prior to recommended treatment Gliomas are tumors that arise from glia, National Comprehensive Cancer Network Results receiving less than the recommended dos- or support cells from within the central (NCCN) guidelines or enroll in clinical trials A total of 39 patients were diagnosed with age, two patients had stopped their treat- nervous system. Grade IV glioma, or to add to our knowledge base and improve GBM at Baylor Dallas from 2010 to 2012. ment and were transferred to hospice care, glioblastoma (GBM), is the most common their chances of survival. and most aggressive glioma in humans. Of these 39 patients, 37 patients had sur- while the remaining patient had whole- gery. Thirty of these 39 patients received brain radiation treatment. This patient was Refused radiation treatment Refused radiation treatment 13% (5) Unknown 10% (4) Treatment to <45 Gy 8% (3) Treatment to <45 Gy Treatment to <60 Gy 69% (27) Unfortunately, GBMs are very infiltrative, We determined how radiation treatment chemotherapy. In the remaining 9 patients, discovered to have gliomatosis cerebri, a and the median survival remains dismal at of patients at Baylor University Medical four refused chemotherapy and five died rare diffusely infiltrating glial tumor of the 14.3 months with standard therapy. Based Center at Dallas (Baylor Dallas) from 2010 prior to the recommended therapy. Among cerebral cortex, and whole-brain radiation on data from the Central Brain Tumor to 2012 compared with NCCN guidelines. those who died, one patient had Gliadel is the recommended treatment for this rare Registry of the United States, 15.6% of Treatment for GBM involves a combination wafers implanted at the time of surgery and brain tumor. all brain tumors are GBMs, and 45.2% of of surgery, radiation treatment, and che- died before planned systemic therapy. malignant brain tumors are GBMs. They motherapy. The recommended radiation Of the patients treated at the Baylor Dallas In addition to the 39 patients who received are more common in older adults and are dose for high-grade gliomas is 60 Gray in campus from 2010 to 2012, 30 patients all of their treatment at Baylor Dallas, was referred to but was never seen by Thus, for patients treated entirely or partially at Baylor Dallas, the NCCN guidelines 7% (2) 7% (2) 4% (1) 7% (2) Treatment to <60 Gy 77% (20) approximately 1.5 times more common in 1.8- to 2.0-Gray fractions. A slightly lower received radiation therapy. Among the 27 patients received some of their care Dr. Fink, so was lost to follow-up. Finally, men than women. The 5-year survival of dose of 55 to 57 Gray can be applied nine patients who did not receive radiation at Baylor Dallas from 2010 to 2012. Of these same 22 patients out of 27 who were followed regarding radiation treat- patients with GBMs is poor, normally less when the tumor volume is very large, such therapy, four declined it and five died prior these 27 patients, 24 underwent surgery received chemotherapy also received ra- ment of GBMs. When patients did not than 5%. Thus, GBMs are one of the most as in gliomatosis or grade III astrocytoma. to the recommended treatment. Of the to remove all or part of their tumor, and diation therapy. Of the 22 patients who did receive the recommended treatment, the challenging types of brain tumors to treat. For debilitated patients or the elderly, a hy- 30 patients who were treated with radia- 22 received chemotherapy. Amongthose receive radiation treatment, 20 received reason was the death of the patient or treatment of patients at Baylor With research dedicated to better under- pofractionated accelerated course of 3 to tion, 27 had up to the recommended 55 who did not receive chemotherapy, for one the full 60-Gray doses, while one received patient choice, not any decisions made by standing this disease, along with clinical 4 weeks with a total dose of 40 to 50 Gray to 60 Gray of radiation, and three patients patient it was not recommended; another a total only 32 Gray fractions, expiring their oncologist. University Medical Center at Dallas trials testing new treatments, survival is has also been found to be effective. received less than 45 Gray of total frac- patient refused treatment, two patients before the end of treatment. The remaining improving. It is important that patients tions. When the records were checked to died before they could get the recom- patient received radiation treatment, but at receive the standard of care according to determine the reason for these patients mended treatment, and the other patient an unknown dosage. Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, Baylor University Medical Center at Dallas or Baylor Health Care System. © Baylor Health Care System We determined how radiation (Baylor Dallas) from 2010 to 2012 compared with NCCN guidelines. 37 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 38 2013 List of Publications 1. Armand P, Nagler A, Weller EA, Devine SM, Avigan DE, Chen YB, Kaminski MS, Kent Holland H, Winter JN, Mason JR, Fay JW, Rizzieri DA, Hosing CM, Ball ED, Uberti JP, Lazarus HM, Mapara MY, Gregory SA, Timmerman JM, Andorsky D, Or R, Waller EK, Rotem-Yehudar R, Gordon LI (Fay JW). Disabling Immune Tolerance by Programmed Death-1 Blockade with Pidilizumab After Autologous Hematopoietic Stem-Cell Transplantation for Diffuse Large B-Cell Lymphoma: Results of an International Phase II Trial. J Clin Oncol. 2013;31(33):4199-206. 2. Ashktorab H, Rahi H, Wansley D, Varma S, Shokrani B, Lee E, Daremipouran M, Laiyemo A, Goel A, Carethers JM, Brim H. Toward a comprehensive and systematic methylome signature in colorectal cancers. Epigenetics. 2013;8(8). 3. Bachanova V, Marks DI, Zhang MJ, Wang H, de Lima M, Aljurf MD, Arellano M, Artz AS, Bacher U, Cahn JY, Chen YB, Copelan EA, Drobyski WR, Gale RP, Greer JP, Gupta V, Hale GA, Kebriaei P, Lazarus HM, Lewis ID, Lewis VA, Liesveld JL, Litzow MR, Loren AW, Miller AM, Norkin M, Oran B, Pidala J, Rowe JM, Savani BN, Saber W, Vij R, Waller EK, Wiernik PH, Weisdorf DJ. Ph+ ALL patients in first complete remission have similar survival after reduced intensity and myeloablative allogeneic transplantation: Impact of tyrosine kinase inhibitor and minimal residual disease. Leukemia. 2013;28(3):658-65. 4. Barakat A, Barnes SA, Casanova MA, Stone MJ, Shuey KM, Miller AM. Advance care planning knowledge and documentation in a hospitalized cancer population. Proc (Bayl Univ Med Cent). 2013;26(4):368-372. 5. Becerra CR, Hanna N, McCollum AD, Becharm N, Timmerman RD, Dimaio M, Kesler KA, Yu M, Yan T, Choy H. A Phase II Study with Cetuximab and Radiation Therapy for Patients with Surgically Resectable Esophageal and GE Junction Carcinomas: Hoosier Oncology Group G05-92. J Thorac Oncol. 2013;8(11):1425-9. 6. Bloom CI, Graham CM, Berry MP, Rozakeas F, Redford PS, Wang Y, Xu Z, Wilkinson KA, Wilkinson RJ, Kendrick Y, Devouassoux G, Ferry T, Miyara M, Bouvry D, Dominique V, Gorochov G, Blankenship D, Saadatian M, Vanhems P, Beynon H, Vancheeswaran R, Wickremasinghe M, Chaussabel D, Banchereau J, Pascual V, Ho LP, Lipman M, O’Garra A. Transcriptional blood signatures distinguish pulmonary tuberculosis, pulmonary sarcoidosis, pneumonias and lung cancers. PLoS One. 2013;8(8):e70630. 7. Boland CR. The Mystery of Mismatch Repair Deficiency: Lynch or Lynch-like? Gastroenterology. 2013;144(5):868-70. 8. Boland CR, Lynch HT. The History of Lynch Syndrome. Fam Cancer. 2013;12(2):145-57. 9. Bredeson C, Lerademacher J, Kato K, Dipersio JF, Agura E, Devine SM, Appelbaum FR, Tomblyn MR, Laport GG, Zhu X, McCarthy PL, Ho VT, Cooke KR, Armstrong E, Smith A, Rizzo JD, Burkart JM, Pasquini MC. Prospective cohort study comparing intravenous busulfan to total body irradiation in hematopoietic cell transplantation. Blood. 2013;122(24):3871-8. 10. Brodsky JW, Jung KS, Tenenbaum S. Primary Synovial Chondromatosis of the Subtalar Joint Presenting as Ankle Instability. Foot Ankle Int. 2013;34(10):1447-50. 11. Burch M, Schneider R, Barakat A, Abushahin L, Cao Y, Ewing J, Stone MJ. Results of an educational program to promote the use of pooled instead of single-donor platelet transfusions. Proc (Bayl Univ Med Cent) 2013;26(1):3–5. 12. Butler LM, Arning E, Wang R, Bottiglieri T, Govindarajan S, Gao YT, Yuan JM. Prediagnostic levels of serum one-carbon metabolites and risk of hepatocellular carcinoma. Cancer Epidemiol Biomarkers Prev. 2013;22(10):1884-93. 13. 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FDG-PET as a predictive biomarker for therapy with everolimus in metastatic renal cell cancer. Cancer Med. 2013;2(4):545-52. 17. Cheng YS, Jordan L, Rees T, Chen HS, Oxford L, Brinkmann O, Wong D. Levels of potential oral cancer salivary mRNA biomarkers in oral cancer patients in remission and oral lichen planus patients. Clin Oral Investig. 2013 Jul 28. [Epub ahead of print] 18. Cheng YS, Jordan L, Rees T, Chen HS, Oxford L, Brinkmann O, Wong D. Errataum to: Levels of potential oral cancer salivary mRNA biomarkers in oral cancer patients in remission and oral lichen planus patients. Clin Oral Investig. 2013 Oct 31. [Epub ahead of print] 19. 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Br J Cancer. 2013;108(2):311-8. 81. Rhees J, Arnold M, Boland CR. Inversion of exons 1-7 of the MSH2 gene is a frequent cause of unexplained Lynch syndrome in one local population. Fam Cancer. 2013 Oct 11. [Epub ahead of print] 82. Ribas A, Zhang W, Chang I, Shirai K, Ern- BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 40 stoff MS, Daud A, Cowey CL, Daniels G, Seja E, O’Laco E, Glaspy JA, Chmielowski B, Hill T, Joe AK, Grippo JF. The effects of a high-fat meal on single-dose vemurafenib pharmacokinetics. J Clin Pharmacol. 2013 Dec 28. doi: 10.1002/jcph.255. [Epub ahead of print] 83. Richey SL, Hutson TE. Angiopoietins and non-vascular endothelial growth factor antiangiogenic targets in advanced renal cell carcinoma. Cancer J. 2013;19(4):307-10. 84. Robinson SD, Cooper B, Leday TV. Copper deficiency (hypocupremia) and pancytopenia late after gastric bypass surgery. Proc (Bayl Univ Med Cent). 2013;26(4):382-386. 85. Ryan CJ, Smith MR, de Bono JS, Molina A, Logothetis CJ, de Souza P, Fizazi K, Mainwaring P, Piulats JM, Ng S, Carles J, Mulders PF, Basch E, Small EJ, Saad F, Schrijvers D, Van Poppel H, Mukherjee SD, Suttmann H, Gerritsen WR, Flaig TW, George DJ, Yu EY, Efstathiou E, Pantuck A, Winquist E, Higano CS, Taplin ME, Park Y, Kheoh T, Griffin T, Scher HI, Rathkopf DE; COU-AA-302 Investigators (Hutson T). Abiraterone in metastatic prostate cancer without previous chemotherapy. N Engl J Med. 2013; 368(2):138-48. Erratum in: N Engl J Med. 2013;368(6):584. 86. Sadamori H, Yagi T, Shigeyasu K, Umeda Y, Sugihara M, Yokomichi N, Ohara T, Nishida N, Nagasaka T, Goel A, Fujiwara T. Advanced hepatocellular carcinoma with lymph node metastases showing epithelial to mesenchymal transition effectively treated with systemic chemotherapy: report of a case. Hepatol Res. 2013;43(12):136873. 87. Sanmukhani J, Satodia V, Trivedi J, Patel T, Tiwari D, Panchal B, Goel A, Tripathi CB. 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Proc (Bayl Univ Med Cent). 2013;26(2):15960. 41 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH BUILDING On STRENGTH | Baylor Charles A. Sammons Cancer Center at Dallas 42 Floyd Street Baylor College of Dentistry air P are accessible from U.S. 75 (North Central ark Roberts Hospital Parking Garage 10 Jonsson Hospital Barnett Tower Y. S ER Lot 46 Underground Parking Garage 30 (Patient/Visitor) 2nd Floor Skybridge Healing Garden Hall Street Pauline Street d. Blv Patient Drop-Off ark ir P D . lvd Valet Parking The campus is also accessible via the Cancer Center is a two-block walk. Lot 14 Lot 41 Underground Parking Garage 39 a –F XB Self Parking Medical Center station. Baylor Sammons Baylor School of Nursing RCE Baylor Tom Landry Fitness Center DOWNTOWN DALLAS Lot 13 RT H O W N T RO BE RT B .C M AL C Lot 43 Victor Street Lot 44 STATE FAIR GROUNDS I-30 Lot 42 Crutcher Street M AI L HASKEL FIRS BAYLOR SAMMONS CANCER CENTER BAYLOR UNIVERSITY MEDICAL CENTER AT DALLAS CAMPUS I-30 ink lm lco garage 4 or valet in front of the hospital. AK ME Lot 40 DL CB Ma Pickens Cancer Hospital is available in PE G COM D Self-parking for the new Baylor T. Boone N O Worth Street Bass Hall Underground Parking Garage AK O T AS ELM I-35 Center in garage 4. DART Green Line to Baylor University (Staff) H LL I-45 Baylor Charles A. Sammons Cancer Center adjacent to Baylor Sammons Cancer VE Parking Garage 6 D Self-parking is conveniently located RO TO N W Elevator to Level 3 for Skybridge Emergency Department entrance and other nearby locations. Parking Garage 5 (Patient/Visitor and Staff) AR G HALL Lot 19 Parking Garage 4 C X DART® Rail Station at Baylor Baylor Worth T. Boone Street Pickens TowerCancer Hospital IN LI DA LL H O O KE W AS OLM Valet parking is available at the front Underground Parking Garage 3 (Staff) Baylor Hamilton Heart & Vascular Hospital RO G AS MALC highway access to the medical center. Washington Avenue A map on the facing page illustrates Baylor Medical Pavilion Junius Street Junius Street LL I-35E Underground Parking Garage 8 Lot 25 FW DG . Blvd Expressway/I-45) and I-30. Hoblitzelle Hospital Truett Hospital Nussbaumer Street AS G 0 F ink– University Medical Center at Dallas, and Wadley Tower E L CBD are located on the campus of Baylor Washington Avenue Baylor T. Boone Pickens Cancer Hospital 5E . N. CENTRAL EXPY Hall Street Baylor Sammons Cancer Center and I-3 U TO AK H H N PE US 75 Gaston Aveue Gaston Avenue TZ LI I-3 Lot 9 FI AK O RT H Lot 27 VE O only) ON Lot 28 (BIR M Lot 9 LLWAY DALLAS N. TO Floyd Street Baylor Institute for Rehabilitation (BIR) W Lot 26 M LE Campus and Area Maps US 17 5 O LM X UL LU M 43 Baylor Charles A. Sammons Cancer Center at Dallas | BUILDING On STRENGTH Contact Information Referrals Baylor Sammons Cancer Center at Dallas Patient Navigation Program Physician ConsultLine 214.820.3535 1.800.9BAYLOR Administration JaNeene Jones, RN, FACHE Vice President/Oncology, Baylor Health Care System Chief Operating Officer, Baylor Sammons Cancer Center/Baylor T. Boone Pickens Cancer Hospital 214.820.2800 Alan M. Miller, MD, PhD Medical Director, Baylor Sammons Cancer Center 214.820.2881 Eric Presson, MHA, FACHE Director, Blood and Marrow Transplant/Oncology, Baylor Health Care System 214.820.7833 Support Services Gynecologic Oncology C. Allen Stringer, Jr., MD, Director 214.820.1756 A. 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O’Shaughnessy, MD, Director Cancer Genetic Program • Breast and ovarian • Gastrointestinal • • • • • • • • • • • 214.820.9600 214.820.2692 US Oncology/Texas Oncology Research Joanne L. Blum, MD, PhD, Site Leader 214.370.1000 Marketing and Public Relations 214.820.2116 Ernie’s Appearance Center 214.820.8282 • Prostheses and specialty care items for cancer patients • Nutraceuticals Sammons Events and Community Relations 214.818.8473 Screenings 214.820.6767 • Head and neck cancer (April) • Skin/melanoma (May) Smoking Cessation Program • • Dental Clinic—Oncology Outpatient Clinic 214.820.6767 Martha Foster Lung Care Center 214.820.9791 Virginia R. Cvetko Patient Education and Support Center • • 214.820.2608 Patient/family education and support programs Patient resource centers/ oncology libraries Baylor Health Care System Valet Parking 214.820.8077 Patient Transport 214.818.6400 Beating cancer 3410 Worth St. Dallas, TX 75246 1.800.4BAYLOR 214.820.3535 BaylorHealth.com/DallasCancer