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UCSF Department of Medicine Department UCSF and Apatient SCROLL TO LAST PAGE FOR ARTICLE UCSF Department of Medicine FRONTIERS OF MEDICINE ISSUE 24 / SPRING 2017 CONTENTS Unleashing the Army Within 1 From the Chair 2 Alumni Profile: 3 Dr. Margaret Callahan The Parker Institute 8 for Cancer Immunotherapy Faculty Profile: 9 Dr. Lawrence Fong New Department 10 Chair Profile: Dr. Robert M. Wachter Appointments 11 Donor Profile: 12 Peter Michael Foundation Oncologist Lawrence Fong, MD (center), who co-leads the UCSF Cancer Immunotherapy Clinic, consults with Gabriel N. Mannis, MD (left), Cancer Immunotherapy and a patient. Unleashing the Army Within What if the human body possessed a powerful weapon against cancer, honed by millions of years of evolution? That’s the idea behind immunotherapy, one of the most promising new approaches to fighting cancer. Instead of directly trying to poison cancer cells with chemotherapy, immunotherapy boosts the body’s own immune system to attack cancer cells – the same way it kills viruses and bacteria. Long before cancer immunotherapy made headlines by helping former President Jimmy Carter achieve remission from metastatic melanoma – a disease which often kills people within months – UCSF Department of Medicine faculty members had been working to translate an intriguing idea into remarkably potent therapies. “Cancer immunotherapy has been something that people have thought about for decades, but the real excitement now is we’ve made the transition from pre-clinical studies and animal models to actually treating patients,” said oncologist Lawrence Fong, MD, Efim Guzik Distinguished Professor in Cancer Biology. He co-leads the UCSF Cancer Immunotherapeutics Program, established in April 2016, which includes both a clinic that offers the latest immunotherapy drugs to patients through continued on page 4 UCSF DEPARTMENT OF MEDICINE UCSF DEPARTMENT Editorial Advisory Board: From the Chair Robert M. Wachter, MD Suzanne Kawahara Olivia Herbert The Changing Face of Eileen Murphy Maria Novelero Cancer Treatment Frontiers of Medicine is published by the Department of Medicine at the In 1971, President Richard Nixon boldly declared a national “War on Cancer.” University of California, San Francisco Nearly half a century since that declaration, the war has proved to be one of WRITER/EDITOR: Elizabeth Chur attrition. While there have been small victories, fundamental outcomes have not DESIGN: Laura Myers Design improved very much. Why? Despite the war, until recently our understanding of PHOTOGRAPHY: A Day in Your Life Photography, cancer was relatively primitive, and our weapons – primarily chemotherapy, Noah Berger, Getty Images (for Parker Media), radiation and surgery – have obvious limits. Elisabeth Fall, UC San Francisco In the past few years, we’ve turned a corner in this tragic and costly war. While in most of medicine the promise of precision medicine is just that, a Contact Us: For mailing list corrections and additions, promise, in oncology it feels very real. Our deepening understanding of the or to find out how you can support our work, molecular underpinnings of cancer has created opportunities to develop new please contact: kinds of targeted therapies. UCSF Department of Medicine In this issue we profile some Box 0248, San Francisco, CA 94143-0248 of the superb UCSF scientists (415) 476-5618 and clinicians who are tackling [email protected] cancer with new molecular tools, ©2017 The Regents of the University of California including those designed to unleash the power of the immune system. I am pleased that the The Department of Medicine work has attracted a number of is the largest of the 28 academic generous donors, including departments of the UCSF School Internet pioneer Sean Parker, of Medicine and is comprised of whose Parker Institute for Cancer the following Divisions: Immunotherapy is accelerating President Richard Nixon research in this exciting area. signing the National Cancer Act of 1971 Cardiology Not only is the science evolving, but the new knowledge calls into Clinical Pharmacology question our organizational model for cancer. In the old days, cancer was defined by the organ in which the Endocrinology/Metabolism malignancy originated. And so there were lung cancers, Experimental Medicine colon cancers, breast cancers and prostate cancers, each with its own natural history, workup, prognosis, Gastroenterology treatment options and specialists. With our new discoveries and therapeutic General Internal Medicine armamentarium, does this organ-based grouping still Geriatrics represent the best organizational structure? Perhaps cancers should be organized by their genetic defect, or by Hematology/Oncology their potential susceptibility to a given class of therapies. At UCSF, we are asking these hard questions, and coming HIV/AIDS up with novel answers. Today, patients with many different Robert M. Wachter, MD Hospital Medicine cancer types (as viewed through the traditional organ- system lens) might see Larry Fong and his colleagues in Infectious Diseases the UCSF Cancer Immunotherapy Clinic. Those with a given genetic profile might see Pamela Munster and her colleagues in the BRCA research clinic. Nephrology The progress is dizzying, and we are committed to marrying scientific advances Occupational and with fresh thinking about care delivery. Our goal is to make it as easy as possible Environmental Medicine for patients to access the best treatments, to participate in cutting-edge clinical trials and to speed the discoveries we need to finally win the War on Cancer. Prevention Science Sincerely, Pulmonary, Critical Care, Allergy and Sleep Medicine Robert M. Wachter, MD Professor and Chair, Department of Medicine Rheumatology Holly Smith Distinguished Professor in Science and Medicine Lynne and Marc Benioff Endowed Chair in Hospital Medicine 2 medicine.ucsf.edu Alumni Profile: Dr. Margaret Callahan ‘We Can Offer Patients Hope’ When UCSF resident alumna Margaret Callahan, MD, PhD, began her medical oncology fellowship in 2009, treatment options for patients with metastatic melanoma were dismal. Only a tiny fraction of patients responded to therapies, and most died within months. That landscape soon changed dramatically with the emergence of cancer immunotherapy – which has been particularly effective in melanoma patients, for reasons that are not yet understood. UCSF DEPARTMENT OF MEDICINE OF DEPARTMENT UCSF “The conversations we have with patients today are very different,” said Callahan, now an assistant attending in the Melanoma and Immunotherapeutics Service at Memorial Sloan Kettering Cancer Center in New York, where she also completed her fellowship. “Today we have some really good options, and it’s very likely we’ll find a therapy that works for you. We can offer patients hope, and we have the drugs and the data to back it up. Many patients I treated during my UCSF resident alumna Margaret Callahan, MD, PhD, leads clinical trials of new immunotherapy fellowship are cancer-free or cancer- drugs at Memorial Sloan Kettering Cancer Center in New York. controlled – four, five, six years later.” Callahan first learned about cancer immunotherapy in the early 2000s, That’s served me well in so many and kindness that convinced me that she when she was just starting her joint different avenues.” would be a terrific clinical oncologist,” MD-PhD program at the University She also appreciated career said Hollander. “In a very short time, she of Connecticut. “I was all set to go guidance from Harry Hollander, MD, has made major contributions to the into genetics, but I heard a talk on director of the residency program. immunotherapy revolution which has immunotherapy and thought, ‘This is Because she planned to complete a swept over oncology.” so cool!’” she said. “There were a lot research-oriented fellowship, Callahan As a faculty member at Memorial of people who didn’t think it was “fast-tracked” through residency – Sloan Kettering, Callahan leads clinical such a great idea, but I saw that if we compressing her clinical training into trials of new immunotherapy drugs and could understand the immune system two years rather than the usual three, combinations, and actively pursues many better, we could mold it into a tool and adding an extra research year to research questions. “I’d like to know why to fight cancer.” her fellowship. That required her to immunotherapy works for one patient but apply for fellowships just three months not another, and what we can do to Asking the Next Question into her internship year. improve activity and make side effects “Dr. Hollander sat down with me easier to tolerate,” said Callahan. “How She earned her PhD in immunology early on, and made sure I was reflecting can we improve our understanding of our along with her medical degree, then on decisions for my career pathway,” patients’ immune systems so we can chose UCSF for her internal medicine said Callahan. “He also helped me get better deliver therapies that work? No residency. “My experience at UCSF was all my paperwork in, and enabled me to one therapy will be the magic cure for all really foundational, and the skill sets I have time to interview on the East Coast cancers, but there is lots of room to got there are imprinted on me,” said during my intern year, when I didn’t have improve what immunotherapy can Callahan. “The program did a very a lot of control over my schedule. Those deliver.” good job of teaching residents to ask things aren’t small at all.” Callahan is married to Joseph Grosso, the next question. If something about a “Maggie had all the intellectual PhD, a cancer researcher. Together they diagnosis doesn’t fit, we learned to energy one finds in top physician- have a young daughter, Olivia. n ask what else could possibly explain it. scientists, coupled with the compassion 3 Immunotherapy immunotherapy harness the notion that you can uncloak cancer. UCSF has continued from front page worked in this area for a long time.” clinical trials, as well as a laboratory that studies each patient’s response Bringing Immunotherapy to to these agents.
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