A PUBLICATION FOR FRIENDS OF DUKE COMPREHENSIVE CANCER CENTER

DukeComprehensive CancerCenter Summer 2002 notes New Breast Cancer Therapy Boosts Drugs’ Effects, Dramatically Shrinks Tumors by Becky Levine

Kimberly Blackwell, MD and Ellen L. Jones, MD

atients of Dr. Kimberly into normal tissues over a period (heat therapy) together with Second, heat increases the rate Blackwell jokingly call their of three or four weeks—long chemotherapy and fat liposomes of a drug’s uptake into the cancer P treatment table the “booby enough for the liver and spleen in patients with newly diagnosed, cell itself, through mechanisms Jacuzzi.” The name may be a bit to blunt its toxic side effects. large and invasive breast tumors. that are not well understood. Heat crass, but then, a close brush with In several cases, the treatment While hyperthermia has long also increases oxygen levels within mortality entitles these women to has remarkably destroyed all been known to boost the effects the tumor, oxygen being critical to call the life-saving contraption visible signs of the tumor. In of radiation therapy, its ability to the proper functioning of many whatever they want. others, the treatment has saved enhance a tumor’s response to chemotherapy agents, including All humor aside, they have come women’s breasts from surgical drugs encased in liposomes is just those in the current trial. And to the Duke Comprehensive removal. In every case, it has being explored in humans. finally, heat amplifies the level of Cancer Center with the earnest halted the tumor from growing, Already, the Duke researchers DNA damage that chemotherapy hope of preserving their lives, if said Blackwell, a Duke medical have shown that traditional inflicts upon the cell by inhibiting not their breasts, from the ravages oncologist who runs the protocol chemotherapy agents, which have enzymes that normally repair of deadly breast cancers—termed with a team of a dozen colleagues. little effect on cancer in mice, are such DNA damage. “inflammatory” and “locally The results are far more dramatic highly effective in mice when Hyperthermia, however, is not advanced” tumors—that often resist than any of the team envisioned, encapsulated in liposomes and the only powerhouse in this new traditional treatments. Sixty to 70 based on their pre-clinical studies, heated, said Mark Dewhirst, PhD, treatment equation, said Dewhirst. percent of its victims do not survive said Blackwell, who presented their director of the hyperthermia Liposomes themselves are quite past five years. Twenty-one women phase I clinical trial data on May 18 program at Duke. beneficial to patients because their came to Duke for a unique phase I at the American Society of Clinical Simple as it appears, heat trig- unique formulation reduces the trial in search of better odds. Oncology in Orlando. Twenty-one gers a series of complex events amount of drugs that enter the Propped on pillows and sere- women with newly diagnosed that are critical to the tumor’s heart, nerves and other critical naded by the music of their choice, breast cancers participated in the demise, said Dewhirst, whose tissues, where they could cause the women lie upon a massage- 12-week hyperthermia trial, funded decades of animal research gave substantial harm. like table for one hour as radio by the National Cancer Institute. rise to the current trial. First, heat- The liposomal hyperthermia frequency energy warms their “Encapsulating the chemother- ing the breast draws liposomes out combination appears to be quite breasts, which lie in a sunken pool apy inside of liposomes enables of the bloodstream and directly to effective thus far. Results show of water. The heat triggers the us to deliver 30 times more the site of the tumor, thus concen- the combined therapy has halted chemotherapy they have just chemotherapy than we normally trating the drug-packed liposomes tumor growth in all women and received to settle inside the tumor, could to the tumor site, without where they are needed the most. has at least partially shrunk tumors where it trickles out of its protec- poisoning the rest of the body,” “A tumor’s blood vessels are in half the women. Eleven percent tive coating—a tiny fat bubble said Blackwell. “Heat also boosts much leakier than normal blood of women have had complete called a liposome—and attacks the drugs’ potency by interfering vessels,” Dewhirst said. “Heat pulls pathologic responses, meaning no the tumor’s genetic machinery. with mechanisms that control a the blood vessels apart even more cancer was found in the breast The body’s normal tissues cancer cell’s ability to replicate.” than usual, allowing tiny particles tissue upon analyzing its surgical remain unheated, so the drug is The only clinical trial of its kind —such as liposomes—to leak remains. Thirty-three percent of not preferentially delivered there. in the nation, Blackwell said it is out and pool into the tumor’s patients had complete clinical Hence, the drugs slowly leak out the first to combine “hyperthermia” interstitial spaces.” responses, meaning visible signs of Continued on page 8

DUKE COMPREHENSIVE CANCER CENTER Darell D. Bigner, MD, PhD, Stepping Down named Director pro tempore Michael Colvin, MD, arell D. Bigner, MD, PhD, announced in January has been named Director pro tempore of the Duke . his decision to step down D O Comprehensive Cancer Center as from the directorship in order to national search for a new director return full time to cancer research. takes place. Bigner is the Edwin L. Colvin had been director of the Jones, Jr. and Lucille Finch Jones Duke Comprehensive Cancer Center Cancer Research Professor of for more than six years. Pathology, Chief of the Division of In 1995, Colvin became the third Basic Science and Investigative director of the Duke Comprehensive Pathology, and Director of the Preuss Darell D. Bigner, MD, PhD Cancer Center. He was recruited to Laboratory for Brain Tumor Duke after a 34-year career at Johns Research. He was Deputy Director of the Cancer Center. Hopkins, where he was chief of the Dr. Bigner came to Duke in 1963 as a medical student and has remained internationally recognized Division of Pharmacology and for the past 38 years. He is considered the leading authority on brain tumors, Experimental Therapeutics. and has directed the neuro-oncology program for the past 25 years, building it into the largest and most successful of its type in the world. Under his Colvin is one of the country’s truly outstanding cancer direction, Duke’s program obtained the first Brain Tumor Center grant for researchers, and is well known for his pioneering work with the National Institute of Neurological Diseases and Stroke, and it remains cyclophosphamide and other drugs that damage the genetic one of three programs in the nation with such a grant. material that causes cancer cells to replicate. He was one of the “The Duke Comprehensive Cancer Center is now one of the top first investigators to use very high dose of cyclophosphamide for centers for research and care in the country, and I am confident that the treatment of solid tumors, now a common practice in bone we can ensure our Cancer Center will remain a national leader as we marrow transplantation for breast cancer and other tumors. conduct the search for Mike Colvin’s successor,” Bigner said. ● During his tenure, Colvin did much to strengthen the Cancer Center. He restructured the administration and appointed leaders to oversee major areas such as basic research, clinical research, and cancer prevention, detection and control Herman Albert, Cancer research. One of Colvin’s primary goals was to develop multi- disciplinary disease-specific programs that brought together Center Benefactor, Dies physicians and scientists from different fields to look at specific erman Albert died Sunday, June 16, cancers. The Brain Tumor Center, the breast cancer program, 2002, at Duke University Medical and the thoracic oncology program are incredible examples HCenter. Last year the Alberts, who live of this approach, which enables our patients to benefit from in Purchase, NY, and Palm Beach, Fla., gave Duke’s world-class laboratory research as soon as the new $1.5 million to the Thoracic Oncology Program therapies are available. to establish the Herman and Ruth Albert Lung He also brought together collaborators to develop innova- Cancer Genomics Fund. Earlier this year, they tive therapies such as cancer vaccines and created a drug committed an additional $2 million to the fund, development program to create and test new treatments. a gift which came as a part of a $10 million He broadened the scope of the adult bone marrow transplan- commitment to the Medical Center, $8 million tation to include other diseases and add a stronger of which will create he Ruth and Herman Herman Albert immunotherapy component. Albert Eye Institute. Under his direction, the Cancer Center received an “out- Supporters of Duke with their time and resources, both Mr. and Mrs. Albert were members of Duke Cancer Center and Medical Center standing” score by the National Cancer Institute on its most Advisory Boards. recent core grant renewal and peer review. The Center was Ralph Snyderman, MD, Chancellor for Health Affairs, and CEO granted $3.5 million in support, a figure that represents a 38% of the Duke University Health System, called Herman Albert “a truly increase over previous years. great man, one of the strongest I’ve ever known. The legacy that he Colvin was committed to meeting the needs of cancer and Ruth created at Duke will live and benefit the health and lives of patients. He oversaw the expansion of the Jaycees Outpatient generations to come.” Treatment Facility and has been a staunch supporter of the Herman Albert was born on November 23, 1922. At the end of Cancer Patient Support Program, of which his wife, Macey, WWII he began his career in an entry-level position with a home- has been a volunteer since 1995. Colvin truly recognized the furnishing textile manufacturing firm in New York City. With a combi- overwhelming impact cancer has on patients and their families, nation of innovation, hard work, and calculated risk, he rose through and fought to maintain a human touch and caring interface the ranks to become CEO and owner of the company. In May, Mr. and to cancer care. Mrs. Albert were honored at a dinner at the home of Duke University President, Nannerl O. Keohane, where they received an official procla- mation approving construction of the Albert Eye Institute. Herman Albert is survived by his wife, Ruth, of Purchase and Palm Beach; a Cancer Center Notes is published quarterly by Duke Comprehensive Cancer Center daughter, Lena Albert of Santa Fe, NM; a son, Richard Albert, and wife, Office of Communications, DUMC 3828, Durham, NC 27710; Fax: 919-667-0406; Janet, of Greensboro, NC; three sisters, Belle Wang of New York, NY; E-mail: [email protected] Irene Goldberg of Englishtown, NJ; and Edith Lederman of Massapequa Darell Bigner, MD, PhD Director pro tempore, Duke Comprehensive Cancer Center Park, NY. ● Thomas B. Hadzor Executive Director, Development and Communications Lauren McFeeley Editor Contributors: Laura Ertel, Becky Levine, Nancy Oates

DCCC is designated a Comprehensive Cancer Center by the National Cancer Institute. Produced by the Office of Creative Services and Publications. Copyright © Duke University Medical Center, 2002. MCOC-3134

2 • DUKE COMPREHENSIVE CANCER CENTER Cancer Survivor of the Year

by Nancy Oates comes back, it’s like a kick in the stomach.” ast fall, after her oncologist She endured radiation treat- decided a third liver abla- ment and a new type of Ltion was unnecessary, Nancy chemotherapy, despite the dismal Emerson reviewed her latest PET prognosis for someone with a Emersonscan. “Multiple (too numerous to recurrence so soon after the origi- count) intensely abnormal” pock- nal cancer had been treated. The ets of cells were scattered through- statistics for survival gave her two out her skeleton. years to live. That was 1985. “It made me stop and say, why “I remember how out of control am I still here?” recalled Emerson. I felt,” Emerson said. “I asked God Many positive, uplifting reasons to give me something to help me could be offered why Emerson, through this.” the director of major projects and Two things happened next: She assistant director of the Duke opened the Bible and saw words Comprehensive Cancer Center’s of comfort; and she closed her Office of Development and eyes and saw a billboard with the Communications, is still here. word CANCER splashed across it. In fact, because of her tenacious “That was the first time I saw battle with various forms of cancer, the CAN in cancer,” she said. her tireless support of others strug- Emerson used that opportunity gling with the disease and her to assess her purpose in life. Over opening in its development office. justice that the tree is growing fat efforts to raise money for cancer the years, she had built a success- “It gave me an opportunity to and sturdy in the too-shady spot. research, Coping magazine named ful career, pulling together experi- raise money to beat this disease, as “That holly was not supposed Emerson its “Cancer Survivor of ence in real estate, advertising and well as see more cancer patients and to live in that spot, and it is thriv- the Year.” banking to become a bank senior give them hope and encouragement ing,” she said. “That’s an example Each year, the magazine searches vice president. After the cancer by my experience,” she said. for cancer patients: Don’t be worldwide for someone whose story recurred, she took a yearlong leave Part of the operating expenses swayed by statistics.” of trumping the disease will give of absence to share her cancer for the Duke Cancer Patient Emerson had to remind herself hope to others. Emerson’s husband, experiences with others. She con- Support Center comes from of that when cancer returned a John, leafing through a copy of the tacted Rachel Schanberg who had donors. While chairwoman of the third time, invading her liver and magazine in a clinic waiting room, recently begun the Duke Cancer advisory board, Emerson came up jumping from different places thought his wife would be a good Patient Support Program. Despite with a new fund-raising idea: the along her spine to her ribs, pelvis, candidate, so nominated her. The the pain of cancer and the side Tree of Hope. One of her first legs, arms and skull. So far this magazine’s editors agreed. Emerson’s effects of treatment, Emerson projects as a staff member was to year she’s had 10 tumors removed picture graced the cover of the commuted daily from her home make it a reality. from her liver by the ablation January/February 2002 issue, and her in Graham to volunteer. Last year, the Tree of Hope technique that uses radio fre- recovery story was the main feature. At the end of the year, she raised more than $30,000. People quency to pummel the tumors Emerson was first diagnosed with went back to the bank under the make donations to put a light on into oblivion. She starting a breast cancer in 1982, three years condition that she be given a half the tree in memory or in honor of new chemotherapy, and she still after her doctor brushed aside her day each week to continue her someone. At the start of the winter works full time. reports of symptoms and assured volunteer work at Duke. She holidays, donors and others gather “I feel I have a mission, not a Emerson she had nothing to worry also joined the support program’s for a tree-lighting ceremony, and a job,” she said. “I have an opportu- about. By the time the cancer was advisory board and later became strong supporter of the program or nity to help find a cure for this confirmed, it had spread to six its chairwoman. someone who’s been an inspiration stuff. If it wasn’t for individual lymph nodes. After a mastectomy Duke’s Comprehensive Cancer to the patients is honored. support, we would never have and seven months of chemotherapy, Center was one of the first eight Emerson envisioned the Tree of made the progress we have in Emerson went on with her life. cancer treatment and research Hope as a large holly tree, but cancer research.” Three years later, the cancer clinics established in the country Duke gardeners said the spot for Indeed, she’s seen many had crept back and spread to her after Congress declared war on the tree, in front of the Morris strides in cancer treatments in spine. The recurrence was worse cancer in 1972. There are now 41 Cancer Clinic in the Duke Clinics the past 20 years. than the original diagnosis. such centers nationwide. Duke’s is Building, was too shady for holly. When she was first diagnosed, “It’s a real shock when you hear ranked among the top 10. Emerson settled for a pine tree the cancer was a death knell. Friends you have cancer,” she said. “But In 1990, Duke administrators gardeners recommended, but a year would stop calling because they when you’ve fought it and it contacted Emerson about an and a half later, she noticed the didn’t know what to say. Now, tree was turning brown. she’s gone so far beyond the Hour of Power She called the gardeners and statistics that she doesn’t know On Sunday, June 9, Nancy traveled to Garden Grove, California, for an interview said, “Look, the Tree of Hope is what her prognosis is, she said. with Dr. Robert Schuller at a service in the Crystal Cathedral. The conversation was dying, and we can’t have that.” “We all are going to die some- taped for a later television broadcast on The Hour of Power, international television Once again, she asked for a holly time,” she said, and told of a program that emanates from the weekly worship services at the Crystal Cathedral tree, and once again let herself be cancer survivor who was killed and is viewed by 50 million people worldwide. talked into another pine. Two in a car accident. “I can become To read more about Nancy’s story, and to access a streaming video of years later, it, too, began to fail. bitter or better. I’d rather be She asked a third time for the remembered as a positive, her appearance, visit http://www.hourofpower.org/interviews/nancy. holly, and this time the gardeners uplifting person than someone emerson.html. relented. Emerson calls it poetic swamped in disease.” ●

DUKE COMPREHENSIVE CANCER CENTER • 3 RResearchesearchnotes HIGH-PROGESTIN PILL REDUCES RISK TUMOR SIZE DOESN’T EQUAL SEVERITY It’s been known for years that taking oral contraceptives can dramat- A fundamental assumption of lung cancer screening is that small ically reduce a woman’s risk of developing ovarian cancer. Most tumors are less likely to have metastasized—spreading to other experts believe the protective effect comes from limiting ovulation. organs—than large tumors. But a new study by Duke researchers Now, however, Duke researchers have found that progestin levels shows that size does not necessarily indicate the severity of cancer. in birth control pills may be just as important. The authors of the study caution physicians who have begun to use After reanalyzing data from an existing study, the researchers computed tomography (CT) scans for screening and early lung cancer found that pills with higher levels of progestin are associated with detection not to assume that small tumors represent early-stage cancers. greater reduction of risk of ovarian cancer than those with lower They advise physicians against the widespread use of CT scans for screen- progestin potency, regardless of estrogen content, duration of use, ing and early detection of lung cancer until further data become available. and latency. Non-users of oral contraceptives appeared to be at “Our study found no statistically significant relationship between the greater risk of ovarian cancer than women who took oral contracep- size of small tumors and the stage of cancer,” said Dr. Edward F. Patz, Jr., tives, regardless of formulation. professor of radiology. Lead investigator Joellen Schildkraut, PhD, cautions that more The study found that patients with a primary lesion that is three cen- studies are needed, and that high doses of the hormone are associated timeters or smaller in diameter will have an approximately 80 to 85 per- with increased breast cancer and heart disease risk. However, she cent chance of having stage I (early) lung cancer and an approximately pointed out, improving prevention is critical: “Ovarian cancer is 10 percent chance of having stage IV (most advanced) lung cancer, usually detected at a late stage, when not a lot can be done in terms regardless of tumor size at detection. For of treatment.” Study details appeared in the January 2002 Journal of that reason, Patz advises against the wide- the National Cancer Institute. ● spread use of CT scans for screening and early detection of lung cancer until further data become available. LOSS OF TASTE AND SMELL CAN In recent years, low-dose “spiral” CT scans—in which an imaging machine COMPROMISE SUCCESS rotates rapidly around the body taking more Cancer patients who experience taste and smell loss because of the than 100 images in sequence—have been disease and its treatments are at high risk for weight loss and nutri- proposed as a potential method to screen tional deficits that can compromise their overall treatment success, for lung cancer. Proponents of CT scans Edward F. Patz, Jr., MD according to a small study of 33 lung cancer patients at Duke. have argued that these scans could detect While not all cancer patients lose weight with the disease, those smaller lesions not visible with chest X-rays, that these smaller tumors who do so tend to have a poorer prognosis for treatment outcome represented an early stage of cancer and detecting them would lead to and long-term survival, said Jennifer Garst, MD, a study author and reduced lung cancer mortality, the Duke researchers said. assistant professor of oncology. “Our study emphasizes the fact that size alone does not appear to deter- Thus, finding ways to prevent weight loss and nutritional deficits mine a cancer’s metastatic potential and ultimate stage distribution,” the is critical to helping patients respond more effectively to treatments researchers wrote. “While it is reassuring to believe there is a size threshold and even live longer, she said. The scientists are now continuing below which there is minimal or reduced risk of a tumor having metasta- the study to explore the whether the addition of flavor-enhancing sized, and thus that lung cancer screening can reduce mortality, there is no powders, derived from actual foods such as cheese, bacon, garlic conclusive data to support this notion. Early detection with imaging alone and fruits, can improve the patients’ appetite. may not be enough to impact the natural course of lung cancer.” ● “Weight loss has long been a hallmark of cancer, but it has been considered an inevitable byproduct of the disease process and chemotherapy drugs, rather than as a treatable symptom that can INITIAL STUDY SHOWS SAFETY AND affect outcomes,” said co-author Susan Schiffman, PhD, professor of medical psychology. BIOACTIVITY OF CANCER VACCINE More than just a nuisance, taste and smell deficits have been A new phase I clinical trial of a prostate cancer vaccine developed at Duke associated with reduced levels of key immune system cells, such as has shown that the vaccine made from the patient’s own dendritic cells T-cells and B-cells, in elderly patients tested at Duke, said Schiffman. causes no adverse side effects. More importantly, the trials indicate that In the study of 33 lung cancer patients undergoing chemotherapy, the vaccine is able to boost the patient’s immune system to fight cancer. the Duke researchers assessed the patients’ own perceptions of their “This is the first study that has data on the safety and immunological taste and smell deficits, then scored their ability to detect and recog- efficacy of this type of cancer vaccine,” said Johannes Vieweg, MD, an nize odors and flavors presented to them in a laboratory. Patients associate professor of urology and assistant professor of immunology at who reported the lowest degree of taste and smell ability, and who Duke University Medical Center and senior investigator in the study. scored the lowest on the psychophysical measurements, also experi- “And while this work was done in prostate cancer patients, we believe this enced the most weight loss, body-mass loss and nutritional deficits. method may prove to work in most cancers, not just prostate cancer.” Half the patients were then given powdered flavor enhancers— Dendritic cells are white blood cells that activate the immune system extracts of natural foods combined with amino acids—that strengthen by capturing antigens—substances that trigger an immune response, such the smell and taste of foods. All patients received nutritional advice as against a virus, bacteria or tumor—and presenting them to the body’s and worksheets explaining what foods help alleviate dry mouth, killer cells, called “T-cells.” The vaccine created in the Duke study intro- constipation, diarrhea and other side effects of treatments. duces genetic information from a prostate cancer patient’s own dendritic The researcher’s hypothesis is that patients who receive the flavor cells, in the form of RNA from prostate-specific antigen (PSA). This enhancers will lose less weight and will show higher immune status antigen is secreted by the prostate gland and is elevated in some forms at their eight-month checkup than patients who do not receive the of prostate cancer. Once the dendritic cells use the RNA to produce and flavor enhancers. present the PSA antigen, they are injected back under the patient’s skin “As oncologists, we can become so focused on the medical treat- and activate the T-cells to attack tumors. ments of the disease that we overlook the importance of factors like In the trial, 13 men with metastatic prostate cancer were given three weight loss and nutritional status. Both of these factors have a huge escalating doses of the vaccine. Overall, the vaccine was well tolerated, impact on quality of life and long-term survival,” said Garst. ● reported Vieweg and his colleagues. Four subjects had low-grade fevers and flu-like symptoms, and four patients had inflammation at the site of the injection that subsided after two to three days. “Patients responded well to the vaccine because we are using materials from their own body to create a vaccine that is designed just for them,” said Vieweg. ● 4 • DUKE COMPREHENSIVE CANCER CENTER Caring House

Brain Tumor Center Featured on “60 Minutes” Celebrates n April 7, the Brain tell the story of the many people Tumor Center at Duke being helped by brain tumor th Owas featured on the CBS research and medical care at Duke. news program, “60 Minutes.” The The show offered a touching center is the largest and most portrayal of the center, and the successful program of its type in patients and families who, after the nation and currently treats coming to Duke, have found more than 1,900 pediatric and hope. The response has been phe- adult patients with brain tumors nomenal—in the week following 10 who have come to Duke from all the show, more than 2,000 over the world. e-mails and hundreds of phone The special double-length story calls flooded the Brain Tumor profiled three patients as they pro- Center from all around the world. gressed through their treatment Every message received a reply. and follow up appointments at the We are extremely proud of the Brain Tumor Center. Doctors work being done at the Brain Henry Friedman, Allan Friedman, Tumor Center and are pleased Darell Bigner, and several staff that the producers of “60 members were featured in inter- Minutes” chose to highlight views and footage that helped to this outstanding program. ●

Nielsen Shares Story aring House has been the The convenient and well- best treatment I possibly equipped facility allows cancer at Power of Knowledge C could have received.This patients and family members is more than just a place to stay; to concentrate on their treat- n May 7, inspirational Communicating with doctors it is a haven from the rest of the ments, because the stresses of breast cancer survivor in the U.S. 11,600 miles away, world. A safe place where every- living away from home are O and author Jerri Nielsen, and with the support of a team one around you understands what greatly reduced. Each of the M.D., who performed surgery on of South Pole scientists and you are going through. Both the 18 bedrooms has a television, her own breast cancer tumor engineers, Nielsen was able physical and the mental side effects telephone, and private bath. while stranded in Antarctica, was to perform a biopsy on her own of treatment. Just to be able to see Guests can gather around the the keynote speaker at the second breast and set up a chemotherapy smiles that welcome you home is piano in the two-story great annual Power of Knowledge semi- regime using airlifted supplies. worth everything. room, or borrow books and nar. Nielsen was presented with Her story is now a best-selling magazines from the fully stocked a Jonquils award at the event, novel titled Icebound: A These words from a former library. Exercise equipment and an honor given to distinguished Doctor’s Incredible Battle for guest are just one example of computers are available in the individuals and organizations that Survival at the South Pole. A the heartfelt praise that Caring hobby room. Three fully have made significant contribu- copy of the book was given to House has received in its ten equipped kitchen units allow tions in the fight against cancer the first 400 attending, courtesy years of providing a home- guests to prepare their own During the winter of 1999, of Aventis Pharmaceuticals. away-from-home for cancer meals at any time day or night, when Dr. Nielsen was medic- The event raised more than patients. Since opening on July and the dining room and on-duty at the Amundsen- $22,000 for the Duke Cancer 20, 1992, Caring House has screened porch overlook a water Scott South Pole Station, she Patient Support Program. ● served more than 1800 patients garden. Van service to and from discovered a lump in her breast. and their caregivers. the Cancer Center is provided. The idea for Caring House A devoted staff and dedicated began in 1984 when six Durham volunteers provide a strong Ladies Home Journal women—Barbara Booth, foundation for the home. In Frankie DuBose, Susie Leaming fact, volunteers Ann Barlow, Honors “Best Docs” Huffines, Pat Joklik, Bunny Arlene Corrigan, Carolyn Davis Kerns, and Martha Uzzle— and Bill Townsend have been were looking for a project to giving of their time since the ancer Center physicians (Breast Specialist, Plastic Surgery) assist patients at the Duke facility opened ten years ago. have been recognized for • Herbert Kim Lyerly, MD Comprehensive Cancer Center. “I’m always struck by the fact C excellence by a leading (Breast Specialist, Surgery) After hearing an oncology social that guests often remark when women’s magazine. The Ladies • Leonard Prosnitz, MD (Breast worker discuss the need for a checking out, ‘Oh, I hate to Home Journal list of “Best Specialist, Radiation Oncology) residence for adults receiving leave. This is my second home, Doctors for Women Coast to • Michael Zenn, MD (Breast outpatient treatment for cancer, my second family,” notes Barlow. Coast” includes more doctors Specialist, Plastic Surgery). the six friends decided to create a “I’m proud to be a part of this from Duke than from any other home in Durham for adult cancer special place.” medical center in the Southeast The physicians were chosen by patients and their families. In a To contact Caring House, region. The five Cancer Center a team that asked physicians joint effort with the Cancer Center, call 919-490-5449. ● members included in the list were: in each area to identify highly $1.9 million was raised to con- • Andrew Berchuck, MD skilled, exceptional doctors. The struct and furnish Caring House. (Gynecologic Oncology) list was published in the April •Gregory Georgiade, MD 2002 issue of the magazine. ● DUKE COMPREHENSIVE CANCER CENTER • 5 Developmentnotes A Record Day for Angels One Lap for Hope he 9th annual Angels Among Us 5K and Family Fun Walk netted o raise funds for the Brain Tumor Center at Duke, Richard an incredible $354,000 to support the Brain Tumor Center at LaScala, chair of the Brain Tumor Advisory Board, and TDuke as a record number of participants ran, walked, and wheeled TDr. Greg Hulka, assistant professor in the Division of their way through the Duke campus to raise money to combat brain and Otolaryngology, competed in the automobile endurance race One spinal cord tumors. This is the most money raised at a Cancer Center event Lap of America from May 3 - 11. The pair, who named their team One to date, and nearly three times what the event brought in just three years ago. Lap for Hope, logged 6,500 miles and competed in 17 races in nine Grateful thanks goes to an incredible group of families, friends and raceways throughout the United States. They dodged snow in Buffalo, school groups, traveling from as far away as Iowa and Maryland, who tornadoes in Oklahoma, forest fires in New Mexico, and plowed formed teams in honor or memory of loved ones. Their commitment to through a Texas rainstorm to place 35th among 83 teams. finding a cure for brain tumors was truly inspirational, and their dedica- In the early 1970s, legendary automotive journalist Brock Yates created tion and incredible energy have made the event into what it is today. the Cannonball Sea-to-Shining-Sea Memorial Trophy Dash, a race from Together, the top ten fundraising teams brought in more than $242,000. New York City to Redondo Beach, California. After five successful They were: Team Epperson from Atlanta; Team Kramer from Maryland; events, Brock set out to create a motorsports event that was accessible Team Kate from Emerald Isle, NC; the Justin Carney Team from to the average citizen. And so, in 1984, the first Cannonball One Lap Northern VA; the Mangum Explorers from Bahama, NC; the Chris of America was run. Since then, the event has evolved into what Cash Team from Durham, NC; Jasper’s Team/Kerr Vance Academy from it is today: Nearly twenty-four hours a day driving with time Henderson, NC; Survivor Iowa from Capital City, Iowa; West Lake trial competitions on racetracks throughout the country. Middle School from “Some may think of this Apex, NC; and the as an extreme way of gener- Hoepucky Warriors ating new sponsors for the from Greensboro, NC. Center,” LaScala said. “Greg A fantastic group of and I are convinced that volunteers worked tire- Duke’s research, clinical, lessly to make the day surgical, patient and family a tremendous success. support professionals are the Carolina Builders and pivotal ream in the fight to Schering Plough were conquer brain and spinal this year’s top “corpo- tumors.” The One Lap for This year’s top fundraising team, Team Epperson from rate angels” with their Hope team plans to compete Atlanta, Georgia, raised $52,015 in memory of Jeff Epperson. generous donations. ● in the 2003 event. ● The One Lap for the Hope team car. Swim, Bike and Run for Hope Singer Shares Message n Saturday, September 14, the Duke with Students Comprehensive Cancer Center, the ONorth Carolina Jaycees, and Set-Up, his spring, Leslie Nuchow, singer, songwriter, and activist from Inc. (a triathlon production company) will Brooklyn, New York, shared her anti-smoking message with join forces to host The Duke Blue Devil Tstudents at Rogers-Herr Middle School in Durham, NC. Duke’s iron-distance triathlon. There are less than Thoracic Oncology Program and Ortho Biotech sponsored the ten triathlons of this type in the United appearance, which was the first in a series of events aimed specifically States, none of which are hosted by and at teenagers in an effort to curtail youth smoking habits. fully benefit a non-profit organization. In 1997, Nuchow, who has appeared on national television including This history-making event for the state will bring top triathletes from MTV, VH1 and NBC’s “Dateline,” was approached to participate in a throughout the world to compete in the grueling seventeen-hour event. high-profile promotion run by the Virginia Slims cigarette company. Governor Mike Easley and LeRoy Walker are honorary chairs and Jaycees In keeping with her belief that music has the power to heal and chapters throughout North Carolina will come together to provide the should not be used to harm, she rejected their offer and instead founded base of volunteer support. Sponsors to date include NBC-17, Inside Out Virginia SLAM!, an organization committed to exposing corporate Sports, Hammer Gel, the Millennium Hotel, Overtons, Zone Perfect, deception and exploitation. Leslie also started SLAM! Records, a record Click Culture and Budweiser. label devoted to targeting industries or organizations which hurt The Duke Blue Devil consists of a 2.4-mile swim at Beaver Dam humanity, and SLAM!ing them with the healing power of music. in Falls Lake, a 112-mile double loop bike ride, and concludes with a “I think music is one of the most powerful healing forces on the planet,” 26.2-mile point-to-point marathon ending on the west campus of Duke Nuchow said at the concert. “I do not feel that way about cigarettes.” University. A finish-line celebration will include live entertainment, On November 16th, the Thoracic Oncology Program will sponsor a food, beverages and various activities lasting until the final finishers “Teens Fighting Cancer” Block Party for area teens. The event will arrive by midnight. have anti-smoking information and raise money for lung cancer Half of the proceeds from this event will support research and research at the Duke Comprehensive Cancer Center. Visit www. innovative projects at the Duke Comprehensive Cancer Center. teensfightingcancer.org for more information.● The remaining half of the proceeds will help construct Hope Lodge, a 30-suite pediatric housing facility for bone marrow and stem cell Other Event News… transplant patients and their caregivers. The inaugural Tee Off Against Colon Cancer, the brainchild of the nurses in There are many ways in which you can be a part of this great event. Duke’s GI Endoscopy Unit, raised funds for community awareness of the Volunteers are needed. There’s room for participants, both individuals importance of early colon cancer screenings… On May 4, Rainbow of Heroes and relay teams, as well. Or come on out to the finish line party and walk participants braved stormy weather to raise money for the Pediatric help cheer for the triathletes! Bone Marrow and Stem Cell Transplant Family Support Program… More than For more information, visit www.dukebluedevil.org, or call Dorrys McArdle $207,000 was raised at the Joann Gaddy Grimes Bike and Walk to Fight at 919-667-2616. ● Cancer on May 18. This year, a 5K walk through beautiful Hagan-Stone Park in Greensboro, NC was added to the day’s festivities…

6 • DUKE COMPREHENSIVE CANCER CENTER “Jill’sDaughter’s Experience Ordeal” Spurs Family to Help Other Children with Brain Tumors

By Laura Ertel When the Dawkins family returned home, they had to n January 11, 2002, decide where to continue Jill’s Johnny Dawkins picked treatment. They were relieved to Oup a birthday cake for his find that Duke, right in their own daughter, who turned eleven that backyard, was home to the lead- day. Joyous events like this are ing Brain Tumor Center in the the kind the Dawkins family world. For nearly a year, Jill could only dream about in underwent chemotherapy treat- October 1994, when they found ments under the supervision of themselves in the midst of a pediatric neuro-oncologist and parent’s worst nightmare. co-chair of Duke’s Brain Tumor “Jill’s ordeal,” as her father calls Center, Dr. Henry Friedman. it, began that month while Afterwards, regular MRIs were Johnny and Donna Dawkins were used to monitor her condition, vacationing in Arizona. Their and things looked good …until two children, Jay and Jill, were July 1999, when doctors discov- staying with their grandparents ered several new tumors. The Dawkins Family back home in Fayetteville, North So Jill’s ordeal continued in Carolina. Checking in regularly, 1999, first with surgery at Duke to the couple learned that Jill, then remove the three brain tumors, Together, the two families Dr. Friedman’s labs at Duke three, had begun vomiting and and then with six weeks of daily launched the Hope for Kids Golf are making great strides.” staggering when she walked. radiation for the eight-year-old. Tournament, “in memory of “Unrestricted research funds Donna’s parents took Jill to her The family lived near Duke for Margaret and in honor of Jill,” such as those raised by the pediatrician on October 6. The two months, and Jill saw a tutor Dawkins notes. The tournament, Dawkinses’ golf tournament are doctor detected tremendous pres- at Duke Hospital to continue her held every fall since 1996 at the invaluable,” notes Dr. Bigner, the sure in the back of Jill’s eyes and studies. Finally, in November Gates Four Country Club in Edwin L. Jones, Jr. and Lucille sent her to the local hospital for 1999, Jill returned home and got Fayetteville, draws over one hun- Finch Jones Cancer Research an immediate CT scan. A few the green light to return to school. dred golfers from the community, Professor of Pathology, who leads terrifying hours later, the grand- During the frequent visits to family, and friends. This past year, research for Duke’s Brain Tumor parents were signing consent Duke, the Dawkinses got to know the Kiwanis Club co-sponsored Program. “They allow us to obtain forms at Cape Fear Valley Medical many other families with children the event with the families. the preliminary data for new ideas Center: Jill would undergo emer- battling brain tumors, and Johnny Dawkins finds two things and cancer treatments that are gency brain surgery to remove a was invited to join the Duke rewarding about running the necessary to then submit applica- tumor—an ependymoma— Brain Tumor Program Board of annual event: “Number one, tions for the highly competitive, attached to her brain stem. Advisors. Fundraising was part of seeing folks having a good time, but large federal grants available Without the surgery, the little girl the assignment, so the Dawkins because this tournament makes from institutions like NIH.” might not survive the night. family decided to start a golf tour- each participant feel good about Jill, now a thriving fifth grader, A helpless Johnny and Donna nament to raise money for the themselves, knowing that plays a central role at each Hope learned the news while calling in program. As a group health and they’re making a difference. for Kids tournament, driving from a truck stop in Holbrook, long-term care insurance broker, Number two is actually handing around in a golf cart to meet par- Arizona (250 miles from Phoenix) commercial real estate manager, Dr. [Darell] Bigner [deputy direc- ticipants and take pictures with and frantically made flight plans and past chairman of the tor of the Duke Comprehensive them, and helping her parents and sped to the airport to get to Fayetteville Chamber of Cancer Center] the check and present the check to Dr. Bigner their daughter’s side. They would Commerce—not to mention a knowing that this money is at tournament’s end. “She has a leave everything they had with lifetime resident of Fayetteville, going to be put to the best use big time,” says her proud dad. them at the Bellrock Inn in son of the city’s late mayor J.L. to help other kids fight this Jill is currently doing “outstand- Sedona, Arizona. Their brother- Dawkins, and a mayoral candidate dreaded disease.” ing,” Dawkins reports. “Of course, in-law, Jim Caison, would be himself—Dawkins figured he had The money raised from the we thank the Lord every day. But responsible for flying home with the connections to make the tournament—about $90,000 in we also have fun. We know that the golf clubs and luggage event a success. six years—goes to brain tumor life is precious and we try not to for four. Johnny, Donna, and Everyone in the Dawkins research at the Cancer Center. waste any of it.” Johnny’s sister, Dawn Caison, flew family got into the act—parents, “Our goal is to put brain tumor That’s a lesson you learn through the night—praying and grandparents, siblings, aunts and research scientists out of business when your daughter goes crying all the way—and got to uncles, in-laws—to plan the by finding a cure for cancer,” through this kind of ordeal. the hospital soon after Jill’s nine- new tournament and make it a Dawkins states matter-of-factly. The 2002 Hope for Kids and-a-half hour surgery was com- success. The Dawkinses joined “There are over a hundred tournament is scheduled for pleted. By morning, Donna and forces with the Harris family, different types of brain tumors, September 26. Please call Johnny were holding Jill’s hands lifelong family friends who lost unfortunately, and they all have Ellen Stainback at 919-667-2603 in the recovery room, and they three-year-old Margaret to the different ways of acting. So it’s for more information. ● never left her side through several same ependymoma tumor at about probably going to be a long trying days in the hospital. the time Jill was first diagnosed. process, but Dr. Bigner’s and

DUKE COMPREHENSIVE CANCER CENTER • 7 Cancer Centernotes New Therapy TopsTamoxifen letrozole quite different from current cancer is vital for several reasons, breast cancer patients, said Ellis. therapies like tamoxifen and Ellis said. If researchers can identify These larger studies should other, more toxic chemotherapies, which women express these pro- provide abundant data to confirm Ellis said. teins in their cancer cells, they can or refute letrozole’s effects. Ellis cautioned that, while his use them as biological “markers” to The study was funded by results are highly significant, they predict which women will respond Novartis Pharmaceuticals Corp., must be replicated in larger and to a given cancer treatment. which manufactures letrozole. more standard types of studies. For example, women whose Ellis is a consultant for The current study design was tumors made or “expressed” either Novartis, and a member of their Matt Ellis, MD unique because it examined the of these proteins (ErbB-1 or ErbB-2) speakers’ bureau. drugs’ ability to shrink tumors appeared to be largely resistant to Joining Ellis in the study before women had surgery to the effects of tamoxifen, the study were researchers from Univer- by Becky Levine remove their tumors rather than showed. Letrozole, however, was sitaets Frauen-und Poliklinik, after surgery, as is commonly very effective in these types of Hamburg, Germany; Instituto new cancer drug called done to eradicate any undetected tumors, shrinking them in 88 Valenciano de Oncologia, letrozole worked better cancer cells. Also, the sample size percent of women. Valencia, Spain; Institut Bergonie, Aat shrinking breast cancer of 324 women is not large enough Several upcoming studies will Bordeaux, France; and West tumors than did the front-line upon which to base a change in compare letrozole’s effects to General Hospital, Edinburgh, breast cancer drug tamoxifen routine clinical practice, he said. tamoxifen in larger numbers of United Kingdom. ● among a group of postmenopausal Letrozole works by depriving the women with estrogen-positive tumor of estrogen. Specifically, New Therapy, continued from page 1 tumors, according to a study letrozole inhibits an enzyme called coordinated by Dr. Matt Ellis, aromatase, which converts the male the tumor could no longer be detected, and 17 percent of patients were clinical director of the Breast hormone androgen into the female converted from mastectomy candidates to lumpectomy candidates. Cancer Program at the Duke hormone estrogen. Women taking Hyperthermia treatment begins with a traditional infusion of chemo- Comprehensive Cancer Center. letrozole, therefore, make almost no therapy, followed by a CT scan of the breast to pinpoint the tumor’s precise Sixty percent of women taking estrogen at all. Without estrogen, location. Next, a plastic tube or “catheter” is placed inside the tumor, in letrozole (trade name Femara®) tumor cells that rely on the hor- which doctors place a thermometer to monitor the tumor’s temperature showed tumor shrinkage after four mone for growth cannot divide and during hyperthermia. Patients then lie on a one-of-a kind treatment table, months on the drug, whereas 41 do not continue to grow. with their affected breast lying in a pool of salt water. Sophisticated software percent of women taking tamoxifen Tamoxifen has a very different delivers radio frequency energy through the water and directly to the breast. showed tumor shrinkage. Patients mechanism of action. It binds Following four hyperthermia treatment sessions over several months, taking letrozole also underwent to small sites in the cancer cell radiation oncologists measure the tumor shrinkage and recommend the fewer mastectomies (complete called estrogen “receptors” and least invasive type of surgery to remove their patients’ tumors. Surgery is breast removal) than women who blocks estrogen from docking followed by additional chemotherapy and radiation to kill any undetected were taking tamoxifen. there. The receptors, plugged cancer cells in the breast and surrounding tissue. Moreover, letrozole actually up with tamoxifen instead of “We use the best and newest agents up front, then the standard and slowed the rate of cell division— estrogen, initiate a different traditional treatments at the tail end,” Blackwell said. “It’s like a and hence, tumor growth—better sequence of events than they guarantee policy to ensure that the patients receive every possible than tamoxifen did, according to would in the presence of estrogen. benefit we have to offer them.” ● cellular studies conducted on the However, tamoxifen’s presence actual tumors. on the receptor still triggers some “We are very excited by letro- estrogen-regulated genes to exert zole’s potential because it appears their influence within the cell, SUPPORT GROUPS to block the growth-promoting albeit in ways not fully understood. The Duke Cancer Patient Support Program sponsors many cancer effects of estrogen within cancer This effect may blunt the effective- support groups. For complete, up-to-date information about these cells better than tamoxifen does,” ness of tamoxifen against some groups, please call 919-684-4497. said Ellis. “Estrogen is involved breast cancers. in up to 80 percent of all breast Ellis says letrozole’s ability to cancers, so blocking its effects is completely block estrogen from the vital to successful treatment.” cell is, in part, responsible for its NON-PROFIT ORG. “Although our results are prelim- apparent benefits over tamoxifen U.S. POSTAGE inary, letrozole appears to block in some women. PAID estrogen more effectively than does In addition, he said, tamoxifen DUMC 3828 • Durham, NC 27710 DURHAM, NC tamoxifen, suggesting that letro- allows two other proteins—called PERMIT NO. 60 zole may work for women whose ErbB-1 and ErbB-2—to amplify the tumors are relatively resistant to growth-promoting effects of estro- tamoxifen,” said Ellis. gen inside the cell. Letrozole, on Letrozole could even replace the the other hand, nullifies the action more toxic chemotherapy drugs in of these proteins because they rely some patients, or it could be taken on the estrogen receptor being together with other non-cytotoxic stimulated to exert their action. drugs like Herceptin for maximum Knowing how the ErbB-1 and effect, the researchers theorize. Its ErbB-2 proteins interact with the distinct mechanism of action makes estrogen receptor to promote

8 • DUKE COMPREHENSIVE CANCER CENTER