MEMORIAL HERMANN

WINTER 2017 On Making the Breast Cancer Treatment Decision: A Personal Story

Leigh Rozelle found the lump purely by accident, just three days before Christmas. As she crossed her arms, she felt a golf ball- size knot on the outer side of her left breast. “My family practitioner was able to squeeze me into her schedule the very next day,” says Rozelle, who is 38. “When she examined my breast, she was concerned and asked me if I had time to see a breast surgeon the following morning if she could get me in.” The breast surgeon was Liz Lee, M.D., who is affiliated with Memorial Hermann Memorial City Medical Center. “Dr. Lee did an ultrasound and told me the lump was slightly larger than 3 centimeters in diameter,” Rozelle says. “She wanted to move quickly and sent me to the breast center for a mammogram and biopsy the following day. And that’s how I spent my Christmas Eve.” Four days later on Dec. 28, 2015, she heard her diagnosis: stage 1A, grade 3 ductal carcinoma in situ with some invasive components. Grade 3 and 4 tumors tend to grow rapidly – much faster than Leigh Rozelle on her first and last day of chemotherapy treatment at Memorial Hermann Memorial City lower grade tumors. She also learned Medical Center. Leigh was diagnosed with breast cancer in December 2015, and received all of her that her particular cancer was triple treatment at Memorial Hermann. negative – characterized by the absence of three receptors known to fuel most aggressive, they typically respond to mastectomy – and had a scare in the breast cancers: estrogen receptors (ER), chemotherapy. The diagnosis gave her a process,” Rozelle says. “On the MRI they progesterone receptors (PR) and human glimpse into the future. found patches in my right breast, which epidermal growth factor receptor 2 The multidisciplinary Breast Cancer were biopsied and identified as dense (HER2). Although triple-negative breast Tumor Board at Memorial Hermann tissue, not tumors. Then I had lots cancers do not respond to receptor- Memorial City met to discuss Rozelle’s of questions: If I do a mastectomy and targeted treatment and tend to be more case and agreed that surgery was the Treatment Decision continues on page 2 best first course of action, followed by chemotherapy. In January, she met DIGITAL VERSION Frankie Ann Holmes, M.D., a medical To receive the Memorial Hermann Cancer oncologist affiliated with the hospital. Journal via email, please sign up online at “I was struggling with what type of memorialhermann.org/cancerjournal. surgery to have – lumpectomy or SURVIVORSHIP

Treatment Decision continued from page 1 these challenges before treatment.” then need radiation, will that delay Prior to surgery, Rozelle saw Emilia reconstruction? How will I know if I Dewi, OTR, O.T.D., CLT, an occupational need radiation? I learned that they could therapist and certified lymphedema remove a few lymph nodes to make sure therapist at TIRR Memorial Hermann that the cancer hadn’t spread. We did that Outpatient Rehabilitation-Memorial on Feb. 1, 2016, in the left arm. Luckily City. Dewi evaluated her and took all five lymph nodes were negative and I measurements for a compression sleeve, would not need radiation. But the tumor which encourages the movement of was growing, and because of the size, I Leigh and her support system on her last day lymph through the body and discourages felt that a lumpectomy would leave my of chemotherapy. pooling of lymph in the arm. breast lopsided. I was dealing with “After the mastectomy, I had four something aggressive and I wanted to prehabilitation,” Dr. Holmes says. “When drains and couldn’t do a whole lot of take aggressive action. I had faith in we see cancer patients, we’re very aware exercising but I could do some light Dr. Lee. In the end I decided to move that they have lives beyond diagnosis and stretching,” Rozelle says. “Once the forward with a mastectomy, and then treatment. Patients who have mastectomy drains were out, I went back to continue decided on a double mastectomy because and lymph node dissection, as Leigh did, therapy before I started chemotherapy.” I’m young and want peace of mind.” will lose some range of motion in the arm She saw Emilia twice a week for about a Dr. Holmes referred Rozelle for and shoulder on the affected side and also month, working primarily on improving prehabilitation – occupational therapy in be at risk for lymphedema. If a patient is range of motion in her shoulder. advance of mastectomy to optimize the deconditioned before chemotherapy, an “As it turns out, I didn’t have a lot of outcome and help improve quality of life exercise program can help with fatigue swelling,” she says. “I was aware of it, but after treatment. “I’m a big believer in during treatment. We can address all of it was nothing anyone else would notice.

IN THIS ISSUE

SURVIVORSHIP 1-3 BRCA1/2 and Other Genes Associated with EXCELLENCE IN CANCER CARE 13-14 Breast and Ovarian Cancer: The Importance On Making the Breast Cancer Treatment of Genetic Testing Memorial Hermann Launches a South Region Decision: A Personal Story Lung Program Focused on Early Detection Early Detection of Gastrointestinal Cancers A NOTE FROM LEADERSHIP 3 With Advanced Endoscopic Techniques and Memorial Hermann Cancer Centers Teamwork Greater Heights Breast Care Center ADVANCES IN CANCER TREATMENT 4-9 Digital Tomosynthesis Improves Early PERSPECTIVES ON RESEARCH 9-12 COMMUNITY OUTREACH 14-17 Detection of Breast Cancer An Adjuvant Therapy, Plerixafor, Shows Memorial Hermann Offers Free Cancer Promise in the Treatment of Glioblastoma Funds Raised at the Memorial Hermann Screenings to Northeast Community Multiforme Foundation’s Annual Razzle Dazzle Luncheon Bringing Cancer Awareness to the Workplace Bring Advanced Biopsy Technology to A Patient Benefits From Participation in a Memorial City Clinical Trial of a New Treatment for Relapsed Community Partner Spotlight: Ovarcome Ovarian Cancer Video-Assisted Thoracic Surgery Gives Memorial Hermann Goes Pink for Breast Patients a Minimally Invasive Option for Lung Ongoing Clinical Trials Cancer Awareness Month Cancer Surgery VOLUNTEER SPOTLIGHT 12-13 EXPERTS ON THE PODIUM 18 Memorial Hermann Breast Care Centers Offer Superior Care Across the City Clara Cook Lambert: From Cancer Patient to BY THE NUMBERS 18 Energetic Volunteer MEMORIAL HERMANN WELCOMES PROFILE IN CARING 13 NEW TEAM MEMBERS 18-19 William Velasquez, M.D.: On the Front Line of Cancer Care

2 MEMORIAL HERMANN CANCER JOURNAL Emilia got me started early with a sleeve that they were going to recommend apy. “No matter how much I prepared to help prevent full-blown lymphedema.” chemotherapy, but that it was my choice and took charge of things, there were Rozelle prepared for chemotherapy as whether to have it,” she says. “I was bad days, so I was happy to be done with diligently as she had prepared her home surprised. I’ve been blessed with good chemotherapy. A lot of friends and family for life after mastectomy. “I read what to doctors, including my reconstructive came to celebrate my last day, and all the expect of chemotherapy but avoided the surgeon, Dr. Rafi Bidros. He’s phenom- nurses came out to wish me well. I have horror stories. I focused on things I could enal. As a team they have it down to a a lot of good support and a lot of people do around the home to make my life easier. really good science.” praying for me at different churches, and The preparations were comforting and Rozelle finished chemotherapy in I know that this is just a season in my gave me a sense of being in control.” mid-August and had her reconstructive life. It will pass.” u Early on, Dr. Lee emphasized Rozelle’s surgery in November after giving herself role in treatment planning. “She told me a chance to bounce back from chemother­

A NOTE FROM LEADERSHIP

Everyone at some and there was very little treatment for fall Memorial Hermann rallied together point is touched by breast cancer at the time. My grand­ as a system to spread the message of cancer. Whether mother was the very example of a loving prevention and early detection, in it’s a loved one or and generous spirit. She always went out particular, regarding breast and lung a personal diagno­ of her way to love and serve her family, cancer. It is our hope that by maintaining sis, we will all friends and neighbors. It is my privilege Memorial Hermann’s strong presence in encounter cancer to have been influenced by her and the community, we will continue the at some point in motivated to continue her legacy of caring. fight against cancer through screenings, our lifetime. From our dedicated nurse navigators, prevention, education and outreach, For those of us who help guide patients through every because at Memorial Hermann, you’ll who have spent careers in the fight against step of their journey, to our expert never fight cancer alone. cancer, we feel a deep connection to each affiliated physicians, who are committed and every one of our patients as we help to providing high-quality cancer care, it Sandra Miller, M.H.S.M., RN, NE-BC them along their cancer journey. For me is everyone’s mission to be there when Senior Vice President this connection comes as a result of the our patients need us most. Oncology Service Line inspiration of my grandmother who had As reflected in this edition of the breast cancer. It was in the late 1960s Memorial Hermann Cancer Journal, this

According to the Over the past year, our physician screening. Our hope is that the use of American Cancer steering committee, in partnership with this tool, along with guidance from Society, a man’s Memorial Hermann oncology leadership, our expert affiliated providers and lifetime risk has made significant progress in expanding navigation team, will allow for early of dying from cancer prevention and early detection detection and better overall survival cancer is 1 in 4, programs. In addition to our expanded outcomes. and for a woman, Low-Dose CT Lung Cancer Screening Thank you for being on this journey that chance is 1 in program, we have also increased access to with us and entrusting your patients 5. As physicians cutting-edge tomosynthesis mammogram with our care. Together, we are fighting who see cancer technology at our facilities throughout cancer one patient at a time. every day, we know a person’s best chance Greater Houston. Memorial Hermann is at beating this disease is through early also encouraging any patient that walks Ron J. Karni, M.D. detection. It is up to us to spread aware­ through our doors to utilize a new Chair, Physician Strategic Steering ness and to continually educate our screening self-assessment tool to help Committee community on their risk factors and what determine whether he or she is due for Oncology Service Line screening options are available to them. a breast, lung, colon or prostate cancer

WINTER 2017 3 ADVANCES IN CANCER TREATMENT Digital Tomosynthesis Improves Early Detection of Breast Cancer

In 2011, Memorial Hermann was the of low-dose exposures that are mathemati­ first hospital system in the southern part cally processed into 1-millimeter slices “TOMOSYNTHESIS MAKES IT EASIER TO of Texas to introduce a new, leading- that visualize breast tissue in three DISTINGUISH BETWEEN DENSE TISSUE AND edge digital technology that improves dimensions, removing spatial ambiguity. MALIGNANCIES, AND ALLOWS radiologists’ ability to detect smaller “Digital breast tomosynthesis takes a RADIOLOGISTS TO LOOK AT ISOLATED AREAS tumors at the earliest stages of breast sweep through the breast, allowing us to OF THE BREAST IN GREATER DETAIL. WE cancer, especially in women with dense see several slices and reducing the FIND CANCERS THAT MIGHT NOT BE FOUND breasts. Today, digital breast tomosyn­ possibility of a malignancy being hidden by ON TRADITIONAL 2-D IMAGING.” thesis is available at 15 Memorial overlapping tissue caused by compression,” - ANNE C. KUSHWAHA, M.D. Hermann locations around the city. says Dr. Kushwaha, an associate professor “Digital tomosynthesis creates a in the department of Diagnostic Radiology density, yearly mammograms should highly focused 3-D image of the breast at The University of Texas MD Anderson start at age 40, or earlier in the case of a that aids in detection of small tumors Cancer Center. “Dense breast tissue can very high risk of breast cancer or the earlier than traditional mammograms, look similar to cancer on a mammogram. presence of a known mutation in either which is especially important for women Tomosynthesis makes it easier to the BRCA1 or BRCA2 gene. There is no with dense breast tissue,” says Anne C. distinguish between dense tissue and consensus on when women should cease Kushwaha, M.D., a diagnostic radiologist malignancies, and allows radiologists to annual mammograms. Most physicians at Memorial Hermann Breast Care Center- look at isolated areas of the breast in recommend continuing screening Upper Kirby, Memorial Hermann Breast greater detail. We find cancers that mammograms as long as the woman is Care Center-Southwest and Memorial might not be found on traditional 2-D healthy. Hermann Bobetta Lindig Breast Care imaging. In addition, tomosynthesis has The American College of Radiology Center-Memorial City. “Radiologists been shown to reduce the number of endorses breast tomosynthesis, saying examine mammograms to rank tissue false positives resulting in fewer women recently, “Better sensitivity will likely density in four categories: almost entirely being called back for more tests.” translate into more lives saved.” The fatty (category 1), scattered areas of There’s another issue for women with technology is available at Memorial fibro-glandular tissue (category 2), dense breasts: They have double the Hermann Breast Care Centers at Memorial heterogeneously dense (category 3), and cancer risk compared to the average, Hermann Memorial City Medical Center, extremely dense (category 4). Women similar to the risk associated with a Memorial Hermann Katy Hospital, with any breast density beyond fatty family history of breast cancer. The topic Memorial Hermann Southeast Hospital, tissue, which includes those in categories is currently under investigation. Memorial Hermann Greater Heights 2 through 4, should get digital tomosyn­ Although cancer may be more difficult Hospital, Memorial Hermann Sugar Land thesis. This is 90 percent of women.” to spot on traditional mammograms, Hospital, Memorial Hermann Southwest Fat appears dark on mammograms, they are the only exam proven to lower Hospital, Memorial Hermann The while fibro-glandular tissue and cancers mortality in women. “Mammograms Woodlands Hospital, Memorial Hermann appear white. Because it’s difficult to see detect early signs of cancer, including Northeast Hospital, Sienna Convenient white on white, malignant masses may be calcifications that can’t be felt during a Care Center, Cypress Breast Care Center, obscured by fibro-glandular tissue when manual breast exam,” Dr. Kushwaha says. CyFair Imaging Center, South Katy viewed with traditional 2-D mammog­ “Women with heterogeneously dense or Imaging Center, Pearland Imaging raphy. This is called masking; some extremely dense breasts can request an Center, Victory Women’s Imaging cancers may be hidden by the overlying ultrasound for additional screening, as it Center and Upper Kirby Breast Center. tissue and not detectable to the has been shown to increase the number For more information about breast radiologist. of cancers detected. For women with a cancer screening, visit memorial­ Tomosynthesis can be performed at the lifetime risk of breast cancer greater than hermann.org/imaging-and-diagnostics/ same time as traditional mammograms 20 percent, an annual MRI is recom­ breast-care-centers. u to boost accuracy. Much like computed mended in addition to mammography.” tomography, tomosynthesis takes a series Regardless of a woman’s breast

4 MEMORIAL HERMANN CANCER JOURNAL Funds Raised at the Memorial Hermann Foundation’s Annual Razzle Dazzle Luncheon Bring Advanced Biopsy Technology to Memorial City

A Hologic Affirm™ Prone Biopsy System an assistant professor in the department – the first in use in Texas – is the newest of Diagnostic Radiology at The University high-tech addition at the Bobetta Lindig of Texas MD Anderson Cancer Center Breast Care Center at Memorial Hermann and medical director of the West Memorial City Medical Center. The Division of MD Anderson Breast Care unit was purchased with funds raised by with Memorial Hermann. “Before the community members through the Hologic, we could see small tumors at Memorial Hermann Foundation’s their earliest stages using tomosynthesis Annual Razzle Dazzle Breast Cancer but had no way to biopsy them in a way Awareness Luncheon. that was comfortable for women. In addition to superior image quality, the new system improves the biopsy experience by allowing women to remain more relaxed in a prone position.” Keynote speaker, author and breast cancer The Hologic Affirm system’s C-arm survivor Elin Hilderbrand. provides 360-degree breast access, allowing the radiologist to move the ensuring that the Memorial Hermann biopsy needle without having to move the Health System remains at the forefront Hologic Affirm™ Prone Biopsy System at Memorial patient or the mammography machine. of medicine. “Philanthropy allows us to Hermann Memorial City Medical Center. “Traditionally we’ve only been able to have that margin of excellence,” Voss perform biopsies on two-dimensional says. “In a system as large as ours, many The Hologic system is the only findings with the patient face down, great programs vie for new technology. dedicated prone stereotactic biopsy using mammography as a guide,” Dr. Philanthropy helps us stay on the cutting system with both 2-D and 3-D imaging. Cohen says. “With the new system we edge. The women who attend the Razzle “For the first time we can comfortably can locate the area easily, and if we need Dazzle Luncheon do so out of a desire to and accurately biopsy lesions seen only to approach it from the side or from a find better ways to diagnose and treat with 3-D digital breast tomosynthesis, different angle, we can do it by making a breast cancer. Anyone who visits the which allows us to visualize very thin few adjustments to the computer system.” Bobetta Lindig Breast Care Center can slices of tissue and find tumors that Julie Voss, interim CEO for the see the difference that contributions otherwise might remain hidden,” says Memorial Hermann Foundation, points from the community have made.” breast radiologist Ethan Cohen, M.D., to the importance of philanthropy in At the Seventh Annual Razzle Dazzle luncheon held Oct. 6, 2016, community members raised more than $400,000 in support of the Lindig Breast Care Center. u

Only 30 percent of breast centers in the United States have 3-D digital breast tomosynthesis, even though the technology has been approved for use since 2011. Tomosynthesis is available at 15 Memorial Hermann locations throughout Greater Houston. For more information, visit memorialhermann. org/imaging-and-diagnostics/breast- Mayor Pro Tem Ellen Cohen, Kristina Somerville, Hallie Vanderhider, Leigh Rozelle, Mary Ann McKeithan care-centers. and Julie Voss at Razzle Dazzle.

WINTER 2017 5 Video-Assisted Thoracic Surgery Gives Patients a Minimally Invasive Option for Lung Cancer Surgery

Removal of malignant lung tissue using remove a slice of lung for biopsy. With length for removal of the lobe and lymph video-assisted thoracic surgery (VATS) advances in technology and improvements node dissection. Advantages for the offers patients who qualify for the in our skill set, we can now remove lung patient are considerable, including less procedure a faster and more comfortable lobes and perform the lymph node postoperative pain by avoiding the recovery. Primarily available only at dissection thorascopically, sparing spreading of the ribs required for open leading academic hospitals such as many patients an open thoracotomy.” thoracotomy; decreased length of Memorial Hermann-Texas Medical VATS employs the same principles of hospital stay; faster overall recovery and Center, VATS for lung cancer is also anatomic resection as the open procedure, return to work; and fewer complications, offered at Memorial Hermann Southeast including individual dissection and including the need for blood transfusions. Hospital. ligation of blood vessels and bronchi. “A percentage of people, about 3 to 5 “The question has always been whether percent, develop chronic post-thoracotomy VATS provides the same long-term pain that persists along the scar line for PHILIP A. RASCOE, M.D., FACS outcomes as open thoracotomy,” Dr. more than two months following surgery, Cardiothoracic Surgeon affiliated with Memorial Hermann Rascoe says. “Recent studies have a condition that is difficult to manage,” demonstrated oncological equivalency Dr. Rascoe says. “In addition to allowing with regard to resection margins and patients to avoid the acute pain associated “VATS is an option for most small or lymph node dissection, as well as with open thoracotomy, VATS allows them peripheral lung tumors,” says Philip A. five-year survival rates. We’re basically to avoid post-thoracotomy pain syndrome. Rascoe, M.D., FACS, an associate professor doing the same operation through We don’t see the same incidence of pain in the department of Cardiothoracic and smaller incisions.” at six months to one year after VATS.” Vascular Surgery at McGovern Medical VATS allows for removal of a lung Dr. Rascoe sees patients in clinic School at UTHealth. “The standard of cancer-containing lobe through three at Memorial Hermann-Texas Medical care for treatment of lung cancer has long small incisions – two of 2 centimeters in Center and Memorial Hermann been to remove the lobe that contains the length (less than an inch), one for the Southeast Hospital. To refer a patient, tumor and all potentially affected lymph camera and the second for retraction, call 713.486.1144. u nodes. Historically, VATS was used to and a third incision of 5 centimeters in

Nineteen Memorial Hermann Locations Offer Superior Breast Care Across the City

Memorial Hermann gives women the Breast Care with Memorial Hermann, and trials also showed significant gains in best breast-care experience available at 15 sites offer 3-D breast tomosynthesis, specificity, giving radiologists the 19 Houston-area locations, combining an FDA-approved digital technology that confidence to rule out cancer and reduce advanced technology with fellowship- helps physicians detect smaller tumors callbacks. Other benefits include trained radiologists and a comfortable, at the earliest stages of breast cancer. improved lesion and margin visibility spa-like environment. Services include Tomosynthesis takes 15 successive images and the ability to accurately localize 2-D mammography, 3-D digital breast at slightly different angles across the structures in the breast. tomosynthesis, diagnostic mammography, breast, resulting in improved accuracy in Tomosynthesis is available at Memorial digital mammography, breast ultrasound screening results and better pinpointing Hermann Breast Care Centers at Memo- and breast MRI, as well as bone density of lesion location. Clinical trials using the rial Hermann Memorial City Medical scans and ultrasound, stereotactic and Dimensions 3-D system showed measur- Center, Memorial Hermann Katy Hospital, MRI breast and lymph node biopsies. able improvement in clinical performance Memorial Hermann Southeast Hospital, Fifteen locations offer MD Anderson over conventional mammography. The Memorial Hermann Greater Heights

6 MEMORIAL HERMANN CANCER JOURNAL Hospital, Memorial Hermann Sugar Land Medical Center, Memorial Hermann- The Woodlands

Hospital, Memorial Hermann Southwest Texas Medical Center, Memorial Hermann 249

Hospital, Memorial Hermann The Southwest Hospital, Memorial Hermann 1960 Cypress Willowbrook 290 45 Woodlands Hospital, Memorial Hermann Southeast Hospital, Memorial Hermann Northeast Cy-Fair 8 99 Hardy T

Northeast Hospital, Sienna Convenient Greater Heights Hospital, Memorial oll Rd. 59

Care Center, Cypress Breast Care Center, Hermann The Woodlands Hospital, 8 CyFair Imaging Center, South Katy Memorial Hermann Katy Hospital and Katy Greater Heights 10 10 Imaging Center, Pearland Imaging Memorial Hermann Sugar Land Hospital Memorial City Upper Kirby 90A

South Katy 225 Center, Victory Women’s Imaging Center – bring together a multidisciplinary tumor Pasadena G r Texas Medical Center and P ark w a Southwest y

W 59 and Upper Kirby Breast Center. board comprised of affiliated medical e s t 288 The Bobetta Lindig Breast Care Center oncologists, radiation oncologists and 8 45 Sugar Land at Memorial City recently added the surgeons who discuss care options for Sienna Pearland Southeast 6 Hologic Affirm™ Prone Biopsy System with the best possible patient outcomes. There Friendswood Breast Care Locations both 2-D and 3-D imaging, enabling are seven Nurse Navigators across the Victory Women’s radiologists to accurately biopsy lesions Memorial Hermann System who provide Imaging seen only on 3-D breast tomosynthesis additional resources to patients diagnosed with patients in a more relaxed prone with cancer. position. A breast cancer support group To refer a patient or schedule an meets monthly at that location. appointment, visit memorialhermann. Breast Care Centers at six hospitals org/imaging-and-diagnostics/breast- – Memorial Hermann Memorial City care-centers or call 877.704.8700. u

BRCA1/2 and Other Genes Associated with Breast and Ovarian Cancer: The Importance of Genetic Testing

Most cancers are not inherited. Only cancer risk, but it’s also important for about 5 percent to 10 percent of breast healthcare providers to know that there KATHRYN MRAZ, MS, CGC cancers and 10 percent to 20 percent of are at least 17 other genes that can Certified Genetic Counselor Memorial Hermann Cancer Center- ovarian cancers are hereditary, due to at increase the risk of both cancers,” says Texas Medical Center and least one genetic change that significantly Kathryn Mraz, MS, CGC, certified McGovern Medical School at UTHealth contributes to the risk of developing genetic counselor with the Cancer Risk cancer. Among the mutations – and Genetics Program at the Memorial we’ve had the capability to check for linked to both types of malignancies Hermann Cancer Center-Texas Medical large genetic deletions and duplications, – are BRCA1 and BRCA2, genes that pro- Center and McGovern Medical School at which gives us a big-picture view. duce tumor-suppressor proteins, which UTHealth. “Because we haven’t tested Compared to spell check, this is more help repair damaged DNA and play a role many of these genes for as long a period like proofreading for sense to make sure in ensuring the stability of a cell’s genetic of time as we’ve tested BRCA1/2, we that things are not out of order, and it material. When either of these genes is haven’t quantified the associated risk for picks up 10 to 15 percent for BRCA1/2 altered or fails to function correctly so many of them. Basically, predicting the carriers. Around 2012, it became a that its protein is not made, damage to risk of developing breast or ovarian combined test. So patients who had DNA can’t be repaired properly. As a cancer is no longer as simple as having negative results on a test for a BRCA1/2 result, cells are more likely to develop a mutation in either BRCA gene.” mutation in 2007 haven’t really been additional genetic alterations that can BRCA genetic testing has improved comprehensively tested.” lead to cancer. over the years. “In the early years we just Specialists at the Cancer Risk “BRCA1 and BRCA2 were first did sequencing, which is like a spell check Genetics Program see between 25 and sequenced in 1995 and 1996 and are key for genes that picks up 85 percent of the 40 patients each month, including new factors in predicting breast and ovarian mutations,” Mraz says. “Since 2008 Genetic Testing continues on page 8

WINTER 2017 7 Genetic Testing continued from page 7 helps them navigate their care. They each of these patients in our clinic. patients and those who return in follow- also address the cancer risk of family Maybe a woman just had breast surgery up. They meet with Mraz and a medical members and make recommendations and hasn’t yet made plans for ovarian oncologist to discuss cancer risk for evaluation and testing. cancer risk management, is a candidate assessment; if their personal or family “Genetics is a rapidly advancing field, for high-risk pancreatic surveillance or history is suggestive of a hereditary and we have to keep up with the litera- has family members who would benefit cancer syndrome, they are offered ture,” Mraz says. “If we find either from testing and she wants to learn more genetic testing, if available. BRCA1 or BRCA2 or a lower-risk gene to about their options. It’s a lot to deal with, They also discuss ways to help lower be mutated or not working, we follow and I help them navigate the process by cancer risk or take preventive measures National Comprehensive Cancer Network providing information. We make on a personal level. A team of experts (NCCN) recommendations for BRCA- recommendations about how to proceed so develops a personalized cancer surveil- related cancer risk in addition to consid- that they can make informed choices.” u lance plan for each patient’s needs and ering updated literature. We also follow

Genetic Counseling Testing: family member diagnosed with either the same testing or inquiring about information for a When Is It Recommended? type of cancer or related cancers – for example, family member; anyone at high risk, with or Genetic counseling can be appropriate for breast, ovarian and/or pancreatic cancer or without a known cancer susceptibility syndrome, individuals and family members who want to colon and endometrial cancer; anyone with who has questions about cancer prevention, make informed decisions to assess their risk and multiple family members with cancer; anyone screening options or treatment; and anyone who plan for the future. with more than 10 colon polyps over their is concerned about their personal or family’s Counseling is recommended for anyone with lifetime; anyone of Ashkenazi Jewish ancestry cancer risk, regardless of high-risk status. a diagnosis of cancer at age 50 or younger; with a personal or family history of breast, Physicians need to provide a referral to the anyone who has been diagnosed with two or ovarian, prostate or pancreatic cancer; anyone Cancer Risk Genetics Program at Memorial more primary cancers; anyone with a diagnosis who has previously undergone genetic testing Hermann-Texas Medical Center. Patients may of one or multiple rare cancers or discovery of a through a physician and wants to learn more also contact Kathryn (Kate) Mraz directly at rare tumor; anyone with more than one close about the results; anyone considering genetic 832.325.7206 to learn more about the process.

Early Detection of Gastrointestinal Cancers With Advanced Endoscopic Techniques and Teamwork

At the Ertan Digestive Disease Center, at UTHealth and is director of advanced cancers, double-balloon endoscopy for affiliated gastroenterologists use state- endoscopy at the Ertan Digestive Disease diagnosis of small bowel tumors, and of-the-art endoscopic technology for the Center at Memorial Hermann-Texas chromoendoscopy for the diagnosis of detection and treatment of gastrointestinal Medical Center. “We start the process by early colon cancers. (GI) cancers. If cancer is diagnosed, performing all diagnostic procedures Gastroenterologists work in close close collaboration across disciplines within the same week of referral. Our collaboration with their medical oncol- ensures that a medical oncologist sees patients have access to a comprehensive ogy, pathology and surgical oncology the patient the same day. range of technology under one roof – colleagues to provide quality care in a an advantage available only at select timely fashion. “A cytopathologist is endoscopic centers in the United States.” available during each EUS-guided NIRAV THOSANI, M.D., M.H.A. Director of Advanced Endoscopy Advanced endoscopic technology at biopsy to review the sample and provide Ertan Digestive Disease Center the Ertan Center includes volumetric an immediate diagnosis, a patient benefit Memorial Hermann-Texas Medical Center laser endomicroscopy (VLE) for early available only at specialized centers,” detection of esophageal cancer within Dr. Thosani says. “This practice pre- “We get our patients into the system Barrett’s esophagus, endoscopic ultra- vents unnecessary repeat procedures very quickly,” says Nirav Thosani, M.D., sound (EUS) with elastography for due to inadequate sampling of the tumor, M.H.A., who holds the Atilla Ertan Chair detection and staging of various GI and it also ensures that patients receive in Gastroenterology, Hepatology and cancers, cholangioscopy and pancreatos- timely care.” Nutrition at McGovern Medical School copy for detection of pancreaticobiliary Affiliated medical oncologist Julie

8 MEMORIAL HERMANN CANCER JOURNAL Rowe, M.D., and her partner Putao Cen, it very convenient. We educate patients M.D., see patients soon after a biopsy at on what to expect of their treatment, and Join gastroenterology specialists from the Memorial Hermann Cancer Center- have a dedicated GI team that includes McGovern Medical School at UTHealth Texas Medical Center, where radiology physicians, nurses and medical assistants affilated with Memorial Hermann-Texas Medical Center on Feb. 11 for the 2017 scans and treatments are scheduled to as well as a genetic counselor and Gastroenterology and Hepatology Symposium, assure a plan of care is quickly identified. oncology-certified pharmacists. Each Frontiers in Gastrointestinal and Liver Disease. Nutritionists and social workers are also case is reviewed by a multidisciplinary The symposium will take an in-depth look available to provide assistance. gastrointestinal tumor board.” at the latest advancements in technology, Affiliated gastroenterologists at the controversial topics, and treatments of GI Ertan Center perform minimally and liver disease. For more information and JULIE ROWE, M.D. to register, visit www.memorialhermann.org/ Affiliated Medical Oncologist invasive endoscopic procedures such as gi-symposium. Memorial Hermann Cancer Center- radiofrequency ablation of Barrett’s Texas Medical Center esophagus as well as pancreaticobiliary tumors, endoscopic mucosal resection require additional care, they have the “The service we provide patients is and endoscopic submucosal dissection full support of a top-ranked hospital unique in that they have access to every for treatment of early GI cancers. “These in the Texas Medical Center. Our goal is provider they’ll need once they’re in our diagnostic and therapeutic procedures to provide excellence in clinical care system,” Dr. Rowe says. “The fact that are performed by less than 2 percent with compassion, grounded in cutting- we’re all located on the same floor in the of gastroenterologists in the Houston edge research in gastroenterology and Memorial Hermann Medical Plaza makes area,” Dr. Thosani says. “If patients hepatolog y.” u

PERSPECTIVES ON RESEARCH An Adjuvant Therapy, Plerixafor, Shows Promise in the Treatment of Glioblastoma Multiforme

In late summer of 2013, a 66-year-old the same as we once had about other vessels that supply the tumor. However, man living in Panama developed vision diseases that are now curable. The after treatment, there’s an increase in difficulties, a persistent right-sided propensity of the tumor to recur and the tumor cavity of a factor known as headache and memory loss for recent cause death has long been a difficult stromal derived factor 1 (SDF-1), the events. When a CT of the brain per- oncological problem, especially when cognate ligand of the CXCR4 receptor,” he formed in Panama City revealed a large viewed in light of the intensity of the says. “This increase produces mobiliza- right temporal occipital tumor, the treatment. As researchers, we continue tion of CXCR4 + myeloid cells from the patient sought care in Houston, where to seek treatments that will produce bone marrow and the circulatory system. he was diagnosed with glioblastoma good responses, with an eye toward Once these cells attracted by the SDF-1 multiforme (GBM), a tumor notorious developing a cure.” recolonize the tumor cavity, they produce for its poor prognosis and short clinical secondary blood vessels (vasculogenesis) history. The average length of survival ADAN RIOS, M.D. that renourish the dying tumor. We following diagnosis is 12 to 15 months. Associate Professor, Division of Oncology, hypothesized that, if we treated our McGovern Medical School at UTHealth “It’s almost a given that patients who Medical Oncologist, Memorial Hermann- patients in a similar manner as was done receive the standard-of-care treatment Texas Medical Center in the animal model and could block for GBM – maximal resection of the these cells to keep them from rescuing tumor, intensive radiation therapy and In a case report published in May 2016 the tumor, either the cancer would be chemotherapy with temozolomide – will in Oncoscience,1 Dr. Rios and other cured or the period of response to the suffer a relapse,” says Adan Rios, M.D., authors at McGovern Medical School therapy would be increased significantly. an associate professor in the division of reported the results of adding plerixafor Rather than seeking a new treatment Oncology at McGovern Medical School at to the standard-of-care regimen as an that might do a better job of destroying UTHealth and a member of the medical adjuvant therapy. “Preclinical studies in the tumor itself, patients with GBM may staff at Memorial Hermann-Texas Medical a human xenograft animal model2 have benefit more from a therapy that allows Center. “As a result, there is a generalized shown us that the standard-of-care treat- the standard treatment to continue its very fatalistic attitude toward GBM, much ment kills the tumor cells and the blood Plerixafor continues on page 10

WINTER 2017 9 Plerixafor continued from page 9 inherent in reporting only one case, but standard-of-care treatment for glioblas- course and destroy the tumor without given the natural history of GBM, the toma may just need a tweak,” he adds. being subverted by the vessel-saving cells.” duration of the patient’s response “In a disease notorious for fatal outcomes, That therapy may be plerixafor, an deserves attention,” Dr. Rios says. “To any intervention that gives a patient immunostimulant used to mobilize our knowledge, he is the first patient longer life is worthy of further clinical hematopoietic stem cells into the treated with an adjuvant regimen exploration.” u bloodstream in cancer patients. When involving a combination of chemothera- the patient from Panama had completed py plus inhibitors of metabolic pathways 1 Rios A, Hsu SH, Blanco A, Buryanek J, Day AL, his first 12 months of adjuvant treatment – and more significantly, plerixafor, an McGuire MF, Brown RE. Durable response of with plerixafor, his adjuvant regimen of agent that specifically inhibits vasculo- glioblastoma to adjuvant therapy consisting of temozolomide and lapatinib were discon- genesis. Clinical observations of a disease temozolomide and a weekly dose of AMD3100 tinued. At the time of this publication, with a very poor prognosis don’t require (plerixafor), a CXCR4 inhibitor, together with he was 36 months out from diagnosis a large number of cases to demonstrate lapatinib, metformin and niacinamide. – more than double the average life the effectiveness of a particular approach. Oncoscience. 2016 May; (3)5-6:156-63. expectancy. His plerixafor regimen has The fact that our patient had a positive 2 Kioi M., Vogel H, Schultz G, Hoffman RM, been changed from weekly to once a response – plus the positive results of Harsh GR, Brown JM. Inhibition of vasculogen- month, and he continues on metformin studies in an animal model – makes esis, but not angiogenesis, prevents the and niacinamide, without clinical or adjuvant treatment with plerixafor of recurrence of glioblastoma after irradiation in radiological evidence of relapse. great interest to us.” mice. J. Clin. Invest. 2010;120(3):694-705. “We recognize the limitations “It’s really exciting to think that the

A Patient Benefits From Participation in a Clinical Trial of a New Treatment for Relapsed Ovarian Cancer

Not long ago, Donna and her boyfriend tion in either the BRCA1 or BRCA2 gene. cancer in 1979 during her third pregnancy, made a 3,000-mile road trip across the The drug is olaparib, which stops an she underwent a mastectomy at the age country to sightsee and visit family enzyme called PARP (poly [adenosine of 33, a week after the birth of her daughter. members. Thanks to her participation in diphosphate-ribose] polymerase) from Both her mother and her mother’s sister a clinical trial under way at Memorial working. “In normal cells when a strand were treated for breast cancer; because Hermann-Texas Medical Center, she was of DNA is damaged, PARP helps to repair of her family history she decided to able to travel while continuing chemo- it,” says Joseph Lucci III, M.D., site undergo a second mastectomy a year therapy with a new drug for women who principal investigator for the trial and a later. She remained cancer free until have relapsed ovarian cancer. To be professor in the department of Obstetrics, 2011, when she was diagnosed with eligible for the trial, patients must have Gynecology and Reproductive Sciences primary peritoneal cancer, a relatively responded to previous platinum-based at McGovern Medical School at UTHealth. rare malignancy that develops most chemotherapy and have a harmful muta- “The BRCA1 and BRCA2 genes produce commonly in women and is a close tumor-suppressing proteins, providing relative of epithelial ovarian cancer. another way to repair damaged DNA; cancer cells that do not have these proteins due to mutation in the genes are unable JOSEPH A. LUCCI III, M.D. Director, Division of Gynecologic Oncology to repair themselves. When both ways of McGovern Medical School at UTHealth repairing damaged DNA are not working, cancer cells die, which makes olaparib of clinical interest for the treatment of Donna started chemotherapy in 2011, women with advanced BRCA-mutated finishing three rounds followed by a ovarian cancer.” hysterectomy. After the surgery, she Donna is among the women to benefit underwent another five rounds that “(Donna is) a delightful person who’s very active from the tumor-blocking effects of reduced her score on the Cancer Antigen and continues to live her life.” - Joseph A. Lucci olaparib, which is marketed under the 125 test (CA 125) – used to look for early III, M.D. name Lynparza™. Diagnosed with breast New Treatment continues on page 12

10 MEMORIAL HERMANN CANCER JOURNAL Ongoing Clinical Trials

TRIAL NAME DESCRIPTION

Prospective international observational cohort This multicenter observational study is investigating the long-term safety and clinical outcomes of ZALTRAP non-comparative study describing the safety in combination with FOLFIRI as a standard-of-care treatment. Approximately 1,000 adults with metastatic and effectiveness of ZALTRAP® administered colorectal cancer who have failed treatment with an oxaliplatin-based regimen will be enrolled at sites across in combination with FOLFIRI for the treatment the country, with 24 to be enrolled at the Houston site. of patients with metastatic colorectal Lead Physician: Julie Rowe, M.D. cancer in current clinical practice: A Post- Authorisation Safety Study (PASS) Contact: Christine Marie Kent, 832.325.6515, [email protected]

A Phase III, Randomized, Open-Label, Multi- Researchers are evaluating the use of Abraxane® (nab-paclitaxel) as a maintenance treatment in non-small Center, Safety and Efficacy Study to Evaluate cell lung cancer (NSCLC) patients, after response or stable disease with nab-paclitaxel plus carboplatin, in the nab-Paclitaxel (Abraxane) as Maintenance areas of safety, efficacy and progression-free survival. The study will enroll about 540 male and female adults Treatment After Induction With Nab-Paclitaxel with stage IIIB or IV squamous cell NSCLC, with 6 to be enrolled at the Houston study site. Plus Carboplatin in Subjects With Squamous Lead Physician: Syed Jafri, M.D. Cell Non-Small Cell Lung Cancer (NSCLC) Contact: Christine Marie Kent, 832.325.6515, [email protected]

A Randomized, Placebo Controlled Phase This Phase 2B/3 trial will determine whether the addition of ABT-414 to concomitant radiotherapy and 2b/3 Study of ABT-414 With Concurrent temozolomide plus adjuvant temozolomide prolongs progression-free survival (PFS) and overall survival time Chemoradiation and Adjuvant Temozolomide in (OS) among subjects with newly diagnosed glioblastoma multiforme (GBM) harboring EGFR amplification. Subjects With Newly Diagnosed Glioblastoma Lead Physician: Sigmund Hsu, M.D. (GBM) With Epidermal Growth Factor Receptor (EGFR) Amplification Contact: Guangrong Lu (Greg), 713.704.7100, [email protected]

A Phase III, Open Label, Randomised, In this multicenter trial, investigators are determining the efficacy of olaparib versus physician’s choice Controlled, Multi-Centre Study to Assess the single-agent chemotherapy (weekly paclitaxel, topotecan, pegylated liposomal doxorubicin, or gemcitabine) in Efficacy and Safety of Olaparib Monotherapy subjects with relapsed ovarian cancer. Efficacy is measured by assessment of progression-free survival (PFS) versus Physician’s Choice Single Agent using blinded independent central review (BICR). Adult females with relapsed ovarian cancer possessing the Chemotherapy in the Treatment of Platinum BRCA1 or BRCA2 mutation and have received at least 2 prior platinum-based chemo regimens are eligible to Sensitive Relapsed Ovarian Cancer in Patients take part. Overall, 411 subjects from 100 sites in 15 countries will be enrolled. Carrying Germline BRCA1/2 Mutations Lead Physician: Joseph A. Lucci III, M.D. Contact: Dr. Sonia Robazetti, 713.500.6382, [email protected]

A Randomized Phase II Study Comparing Investigators are determining whether treatment with higher doses of testosterone will improve radiographic Bipolar Androgen Therapy vs. Enzalutamide progression-free survival compared to enzalutamide in men with metastatic castrate-resistant prostate cancer in Asymptomatic Men With Castration (CRPC) post-treatment with abiraterone. This site will enroll 10 asymptomatic men with metastatic CRPC Resistant Metastatic Prostate Cancer: with no disease-related symptoms who have been treated with continuous ADT and have progressed after The TRANSFORMER Trial (Testosterone treatment with abiraterone. All subjects will be screened for insurance that covers enzalutamide in case they Revival Abolishes Negative Symptoms, are randomized to that treatment arm. Fosters Objective Response and Modulates Lead Physician: Robert J. Amato, M.D. Enzalutamide Resistance) Contact: Christine Marie Kent, 832.325.6515, [email protected]

A Phase 3 Placebo-Controlled Study of In this Phase 3 placebo-controlled, randomized study, researchers are determining the efficacy and tolerability Carboplatin/Paclitaxel With or Without of veliparib in combination with carboplatin and paclitaxel as continuation maintenance therapy in subjects Concurrent and Continuation Maintenance with untreated Stage III or IV high-grade serous epithelial ovarian, fallopian tube or primary peritoneal cancer. Veliparib (PARP inhibitor) in Subjects With This site will enroll 20 women (ages 18 and older) who have had no prior systemic therapy. Previously Untreated Stages III or IV High- Lead Physician: Elizabeth Nugent, M.D. Grade Serous Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer Contact: Dr. Sonia Robazetti, 713.500.6382, [email protected]

Evaluation of Safety and Efficacy of Investigators are assessing the safety and maximally tolerated electroporation field strengths in combination Electrochemotherapy in the Treatment of with chemotherapy (gemcitabine and nab-paclitaxel) treatments for patients with locally advanced Pancreatic Adenocarcinoma unresectable pancreatic adenocarcinoma, and to examine and describe treatment changes of the tumor and surrounding stroma. Twenty-four male and female adults (ages 18 years and older) with Stage II or III pancreatic adenocarcinoma that is locally advanced or borderline resectable will be enrolled at this site. Lead Physician: Derek West, M.D. Contact: Karen Parker Swaby, 713.704.2842, [email protected]

WINTER 2017 11 New Treatment continued from page 10 with limited access to women with BRCA blood cell count, which can happen with signs of ovarian cancer in women at very mutations who have failed other forms of olaparib, and had a transfusion, but in high risk – to the normal range. She chemotherapy,” says Dr. Lucci, who is general she has tolerated the drug well completed chemotherapy in April 2012. director of the division of Gynecologic with minimal side effects and much less A year later the cancer recurred, and she Oncology at McGovern Medical School. toxicity than any of the other chemother- underwent another six rounds of chemo- “Through the trial, they don’t have to apy drugs she’s taken in the past. She’s a therapy under the care of Dr. Lucci. fail as many drugs before being able to delightful person who’s very active and In 2015, when her cancer recurred, he access olaparib in tablet form. Participants continues to live her life.” offered her the opportunity to enroll in come in to the office once a month, which Dr. Lucci points out that limited the clinical trial of olaparib. Approved in allows us to assess their response and therapies are available for patients with capsule form by the FDA for the treatment monitor any side effects. It’s a good BRCA-mutated ovarian cancer. “Olaparib of women with advanced BRCA-mutated choice for patients who want to maintain is the only commercially available PARP ovarian cancer, the current study is their lifestyles and activities.” inhibitor, but others are coming on the evaluating an experimental tablet form Participants remain in the trial as market,” he says. “Currently the drug is of the drug administered at a different long as they continue to have a positive restricted to patients with germline dose. Approximately 411 patients will response – until progression or toxicity. mutations – any detectable and heritable take part in the study in 15 countries “Donna responded quickly to the medica- variation in the lineage of germ cells. worldwide. Donna, who is 70, was tion – her CA 125 was normal by January In the future, we expect it to become enrolled in September 2015. – and she has maintained that response,” more available and in broader use, which “Olaparib is commercially available Dr. Lucci says. “She developed a low red is good news for these patients.” u

VOLUNTEER SPOTLIGHT Clara Cook Lambert: From Cancer Patient to Energetic Volunteer

For the past three and a half years, Clara Cook Lambert has spent every Thursday morning volunteering at the Memorial Hermann Cancer Center-Greater Heights. A few years before that, she was a cancer patient herself, coping with the same physical and emotional challenges facing the people she now supports. “When you say, ‘Hi, my name is Clara, I’m a lung cancer survivor and I’ve been out seven years,’ patients are very happy to see you,” says Lambert, who radiates high spirits and positive my antibiotics and steroids, I was as surgeon affiliated with Memorial energy when she introduces herself to good as gold. When my ENT retired, I Hermann Greater Heights Hospital. At patients in her Survivor T-shirt. “These started going to a different doctor who the time Lambert was still smoking. people are scared, just like I was, and didn’t believe in steroids. When I still “Dr. Macris told me he wouldn’t they need someone who’s been through had a problem after my second round of take me into surgery until I’d stopped it to talk to and cheer them on.” antibiotics, he told me he thought there smoking for two weeks,” Lambert says. Like many malignancies, Lambert’s was something else going on and ordered “I said to myself, he wants two weeks so cancer was an incidental finding. “I have a chest X-ray.” I’m giving him three. Three weeks from allergies that caused a variety of tempo- The X-ray revealed a mass in her right the day I quit we went into surgery. When rary illnesses and saw my ENT about every lung, and the ENT referred her to Michael I woke up, they told me I had cancer.” six months,” she says. “As long as I took P. Macris, M.D., a thoracic and vascular Over the course of 35 radiation

12 MEMORIAL HERMANN CANCER JOURNAL sessions and six chemotherapy sessions, him helping patients overcome cancer at children and five grandchildren. the staff at the Cancer Center got to know Oncology Consultants of Houston, in the Dr. Velasquez approaches his profession Lambert. Impressed by her positive group’s practice located on the campus of with care, concern and empathy. “Many energy and attitude, they asked her to Memorial Hermann Southwest Hospital. of our patients have very serious illnesses,” come back as a volunteer. A native of Lima, Peru, Dr. Velasquez he says. “They are desperate when they “I did, but it took me a couple of years,” received his medical degree at San Marcos come to us, or have serious concerns she says. “For me it was hard to come University in his hometown, and then about their lives and the consequences of back right away because of the emotional chose to come to the United States for treatment. Our first step is to eliminate side of the experience. When I was done, training. “The training in this country any physical or emotional suffering. Then I just wanted to be far away from there.” is unsurpassed,” he says. we consider survival. In this setting, Today, as a member of the Memorial compassion is the operative word. As a Hermann Cancer Center team, Lambert practice, we play close attention to detail. has nothing but good things to say about WILLIAM VELASQUEZ, M.D. We do good oncology quietly, without Affiliated Medical Oncologist her experience. “Every one of our patients Memorial Hermann Southwest Hospital making a big noise about it.” u is important to us,” she says. “There’s an intensity of purpose and a feeling that EXCELLENCE IN CANCER CARE we can do what we do better than anyone He completed his residency in internal else. We want to go above and beyond the medicine at Memorial Hospital in normal protocol with the sole purpose of Worchester, Massachusetts, in 1973, Memorial Hermann being the very best. As a patient I felt like and went on to complete a hematology Launches a South I was getting the best care I could have fellowship at the University of Cincinnati Region Lung Program gotten anywhere in the world. When I in 1975. When he had the opportunity to tell patients that, it’s the absolute truth. begin a fellowship in medical oncology Focused on Early I’ve lived it.” at The University of Texas MD Anderson Detection When she’s not volunteering, Lambert, Cancer Center, he relocated to Houston. who is 70, stays busy as a real estate agent Following completion of the fellowship, Lung cancer, both small cell and non- and helps people organize their lives he was offered a position as staff physician small cell, is the second most common through her image consulting company, at the cancer hospital, where he advanced cancer in both men and women, after Clarafications. Indefatigable, she recently to associate professor of medicine and prostate cancer in men and breast cancer married John W. Perkins, whom she met remained until 1992. He was recruited to in women. Only skin cancer is more through an online dating service. the University of St. Louis as a professor common, according to the American “At the Cancer Center, everybody of medicine and served as deputy chief of Cancer Society. For patients at high risk brings skills to the table and mine happen the hematology/oncology unit at St. of developing lung cancer, Memorial to be as a former patient,” she says. Louis University Hospital until 1997. Hermann now offers Low-Dose Computed “When you’re healing, you need positive An offer from The University of Texas Tomography (LDCT), an effective energy and I like to provide that. It’s a Medical Branch at Galveston brought him screening tool, at multiple locations ride, but when you get to the end and back to Texas, where he served as chair throughout the Greater Houston area. your patients walk away, you hug them of the department of Hematology/Oncology In conjunction with the screening and then you miss them terribly.” u until 2001. Following private practice for program, Memorial Hermann recently three years at Texas Oncology, he joined launched a South Region Lung Program PROFILE IN CARING Oncology Consultants, P.A., in 2005. for cancer patients, with a multidisciplinary Within the discipline of medical oncol- lung tumor board and a dedicated William Velasquez, M.D.: ogy, Dr. Velasquez has a special interest Oncology Nurse Navigator serving in leukemia, lymphoma and myeloma. Memorial Hermann Southeast Hospital, On the Front Line of An active researcher, he has published Memorial Hermann Southwest Hospital, Cancer Care nearly 200 articles and abstracts in Memorial Hermann Sugar Land Hospital, peer-reviewed journals. He is a member Memorial Hermann Pearland Hospital As a young man, William Velasquez was of the Institutional Review Board at and Memorial Hermann-Texas Medical attracted to medicine for the opportunity The University of Texas Health Science Center. “From screening through diagno- it gave him to use deductive reasoning Center (UTHealth) at Houston and the sis, treatment and survivorship, we work to find solutions to problems – and the Memorial Hermann Health System. with patients individually to help them excitement that accompanies the discov- In his spare time, Dr. Velasquez plays overcome barriers to healthcare access ery and sharing of new knowledge in tennis and soccer. He is also devoted to and ensure as positive an experience as ways that help others. Today, you’ll find his family, which includes two grown Excellence in Cancer Care continues on page 14

WINTER 2017 13 Excellence in Cancer Care continued from page 13 Mielcarek says. “If the screen is positive, To maintain accreditation, centers must possible,” says Deidra Teoh, RN, OCN, who she talks to the physician who ordered it undergo an onsite review every three years. has been an Oncology Nurse Navigator and helps navigate the patient through since 2011 and rejoined Memorial the healthcare system.” Hermann in July 2016. “We’re pleased to Patients who have a physician order offer patients an innovative way to get for a screen may call the screening answers to their questions about their location nearest them to schedule the personal care based on opinions from a test, or schedule online at www.memori- large multidisciplinary team of physicians alhermann.org/lungcancer. u representing three hospitals.” COMMUNITY OUTREACH Pulmonologists, thoracic surgeons, Memorial Hermann medical oncologists, radiation oncolo- gists and pathologists who specialize in Cancer Centers Memorial Hermann lung malignancies come together on the Offers Free Cancer first and third Tuesdays of the month to All eight Memorial Hermann Cancer Screenings to Northeast review cases and recommend treatment Centers are accredited by the American plans. The meeting location for the College of Surgeons Commission on Community tumor board rotates through the three Cancer (ACoS CoC). Only 25 percent of hospitals on a quarterly basis, with Inter- hospitals across the country have received Throughout the year, Memorial Hermann net access for specialists whose clinic this special recognition. This approval Cancer Centers host free cancer screen- and surgery schedules prohibit travel to means our Centers meet national ings for the community. On Sept. 17, another hospital. standards that have been established to affiliated physicians at Memorial The South Region Lung Program is a ensure cancer patients receive the best Hermann Cancer Center – Northeast pilot for future expansion of a solid lung care. Commission accreditation is given conducted screenings for breast, prostate tumor program at Memorial Hermann only after a thorough onsite evaluation and lung cancer. hospitals across the city. “The strength process and performance review. To In total, 69 screenings were performed. in this approach is the large number of maintain approval, our Centers undergo Out of the nine patients pre-screened for physicians who bring their expertise to an onsite review every three years. their lung cancer risk, 3 qualified to bear in discussions of pulmonary cancer receive a low-dose CT (LDCT) screening. cases,” says Melissa Mielcarek, director One patient returned for screening and of business development at Memorial presented with Category 3 nodules. Hermann Southwest Hospital. “At base­ Thirty-six patients were screened for line, we’ll have at least three physicians prostate cancer, of which 5 came back from each campus involved on a case, with abnormal results and were referred giving patients the benefits of great for follow-up. Twenty-four patients had a depth and expertise, as well as the breast exam, 15 of which followed up with opportunity to have their cases viewed Memorial Hermann mammograms that all came back normal. from many different angles.” Greater Heights Breast Memorial Hermann Cancer Centers The focus of the program is on early throughout the Greater Houston area detection. In 2015, Memorial Hermann Care Center will host additional community cancer performed more than 250 low-dose screenings in the spring, with more infor- computed tomography (LDCT) lung The Breast Care Center at Memorial mation to be announced in early 2017. cancer screenings at Imaging Centers Hermann Greater Heights Hospital is across the Memorial Hermann Health accredited by the American College of Bringing Cancer System. LDCT screenings are available Surgeons’ National Accreditation Program at multiple locations throughout Greater for Breast Centers (NAPBC). NAPBC Awareness to the Houston. Lung nurse navigators are accreditation is granted only to those Workplace available to assist patients with schedul- centers that have voluntarily committed ing, physician referrals and follow-up to provide the best in breast cancer diagno- In October, Memorial Hermann Cancer for abnormal findings. sis and treatment and are able to comply Centers rallied together to host a series of A physician order is required for an with established NAPBC standards. Each cancer awareness health fairs at various LDCT lung screening. “When a physician center must undergo a rigorous evalua- companies across Greater Houston. In orders a lung screen, Deidra is notified tion and review of its performance and partnership with Memorial Hermann to call the patient and track results,” compliance with the NAPBC standards. Employer Solutions, employees at

14 MEMORIAL HERMANN CANCER JOURNAL it is late stage, making it much more “There are times when patients have difficult to treat. to choose between medications and food. “I didn’t know anything about ovarian Ovarcome makes that decision a little cancer,” Sen recalls. “[My mother] had easier,” Brown said. “I had a patient call symptoms for years, but we weren’t me after receiving a care package, educated enough to know what it was.” thrilled because she used the grocery After her mother passed away, Sen gift card and only had to pay $5 out-of- says it was as if a new path illuminated in pocket for groceries that week. She front of her. commented that it assisted her greatly in The team from Memorial Hermann Cancer “I decided it was my life’s calling to being able to afford other necessities.” Center-Greater Heights at Comcast’s employee make other people aware of this disease, cancer awareness fair. and to make sure no one else would have to be in my shoes.” Friedkin Group, Comcast, Humble Independent School District, Shell Deer Park, Schlumberger and the Houston Zoo were able to take advantage of Memorial Hermann’s cancer expertise. In addition to presentations by affiliated physicians on cancer awareness, risks, and screenings, those in attendance were able to have questions answered by our Oncology Memorial Hermann Oncology Nurse Navigators Nurse Navigators, find out if they were supporting Ovarcome’s annual conference. due for a cancer screening, schedule mammograms, learn about an anti-can- OvarCare packages include gift cards cer diet and lifestyle from our dietitian, to cover gas and grocery expenses, a and hear about the prevention, detection, Runsi Sen with Elizabeth Nugent, M.D., a $200 financial grant, $50 towards a treatment and survivorship programs gynecological oncologist affiliated with Memorial cancer wellness boutique and spa, and that Memorial Hermann offers. Hermann. the option to take advantage of a health More than 700 people cumulatively restoration consultation. In September, attended these events, and are now It was then that Sen established Ovarcome also began piloting a new one step closer to understanding their Ovarcome, a nonprofit organization that program called OvarEmbrace, which cancer risk and taking greater strides in dedicates its time and resources to raise provides care packages to patients who prevention and early detection. awareness for ovarian cancer. In addition have just finished chemotherapy. Runsi to its awareness and outreach initiatives, says it’s just another way of celebrating Ovarcome raises funds for clinical the end of a patient’s treatment. Community Partner research and provides financial assistance Sen credits the organization’s success Spotlight: Ovarcome to underprivileged patients through its to hard work and support from the ovarian OvarCare program. cancer community, saying “we are abso- In 2009, Runsi Sen found herself having To date, the organization has given lutely blessed with the encouragement, to make a tough decision: whether to over $30,000 in financial assistance to support, collaboration and faith we have continue her job in corporate America, or ovarian cancer patients in partnership received.” Ovarcome’s reach has ex- take a leap of faith and pursue something with 17 hospitals in 6 states, and com- panded internationally in recent years, she never thought she would be passionate mitted to over $100,000 to ovarian where their work is focused on general about – the fight against cancer. cancer research. ovarian cancer awareness and sponsoring One of Ovarcome’s hospital partners chemotherapy costs in India and Africa. is Memorial Hermann Health System, Patients eligible to receive an OvarCare RUNSI SEN which Sen says has been a “big friend and package must have an ovarian cancer Founder and President/CEO Ovarcome champion” over the years. Sylvia Brown, diagnosis, be in active treatment, meet M.S., RN, OCN, CNL, Oncology Nurse financial eligibility guidelines, and Navigator at Memorial Hermann Cancer provide income verification documenta- Just 11 months earlier, Sen’s mother Center-Texas Medical Center, sees tion. For more information on Ovarcome had been diagnosed with ovarian cancer, firsthand the impact that Ovarcome’s and to access the OvarCare application, a disease that often goes undetected until programs have on patients. please visit www.ovarcome.org/ovarcare.

WINTER 2017 15 Memorial Hermann Goes Pink for Breast Cancer Awareness Month

According to the American Cancer Society, 1 in 8 women will develop breast cancer in her lifetime. In order to spread the message about the importance of early detection and prevention, Memorial Hermann hospitals across the system hosted fundraisers, participated in community events, and painted the town pink as part of October’s National Breast Cancer Awareness Month. For more information on Memorial Hermann’s Memorial Hermann-Texas Medical Center Breast Cancer Awareness month activities, including links to news articles and blog posts, please visit memorialhermann.org/ cancer/breast-cancer-awareness-month.

Memorial Hermann Southwest Hospital Memorial Hermann-Texas Medical Center

Memorial Hermann The Woodlands Hospital Memorial Hermann-Texas Medical Center

Memorial Hermann Katy Hospital Memorial Hermann Memorial City Medical Center Memorial Hermann Pearland Hospital

Memorial Hermann Southwest Hospital Memorial Hermann Southwest Hospital Memorial Hermann Southwest Hospital

16 MEMORIAL HERMANN CANCER JOURNAL The 2016 planning committee for Memorial Hermann The Woodlands Hospital’s annual In The Pink of Health fundraiser

Memorial Hermann Greater Heights Hospital Memorial Hermann Southwest Hospital

Memorial Hermann Northeast Hospital at its Memorial Hermann-Texas Medical Center annual In The Pink of Health fundraiser

Memorial Hermann-Texas Medical Center Memorial Hermann The Woodlands Hospital Memorial Hermann Sugar Land Hospital

Memorial Hermann Greater Heights Hospital Memorial Hermann Cypress

WINTER 2017 17 EXPERTS ON THE PODIUM Memorial Hermann-Texas Medical localization systems, partial breast Center. Women’s Health and Prevention. irradiation, Gamma Knife® and LINAC- Shelita Anderson, M.B.A., B.S.N., RN, Presentation at Schlumberger, Houston, based radiosurgery, prostate low dose- OCN, Memorial Hermann Greater Texas, October 2016. rate brachytherapy and high dose-rate Heights Hospital. Antineoplastics for the Kelly S. Dempsey, M.D., Breast Center brachytherapy for prostate, gynecological Non-Oncology Nurse. Presentation at of Southwest Surgical. Breast Exams, and breast cancers, as well as pediatric Memorial Hermann Sugar Land Hospital, Risk Assessment, and Myths. Presentation malignancies. Sugar Land, Texas, July 2016. at Schlumberger, Sugar Land, Texas, Dr. Khwaja earned his M.D. and October 2016. Ph.D. at the Mayo Clinic in Rochester, Minnesota, through the Mayo Clinic

SHELITA ANDERSON, M.B.A, B.S.N., RN, OCN Medical Scientist Training Program. SHARIQ KHWAJA, M.D., PH.D. System Oncology Director of Nursing Affiliated Radiation Oncologist After his internship in internal medicine Memorial Hermann-Texas Medical Center, at Parkland Memorial Hospital/The Memorial City and Katy University of Texas Southwestern Kate Mahan, M.S.S.W., LMSW, OSW-C, Medical Center in Dallas, he went on to Memorial Hermann Northeast Hospital. Shariq Khwaja, M.D., Ph.D., McGovern complete his radiation oncology residency Coping with Work Stress. Presentation Medical School at UTHealth. Cancer at Barnes Jewish Hospital/Washington at Canopy – A Cancer Survivorship Screening and Early Detection. Presenta- University School of Medicine in St. Center at Memorial Hermann The tion at Friedkin Group, Houston, Texas, Louis, Missouri. Woodlands. July 2016. October 2016. Dr. Khwaja is the co-author of articles published in the International Journal of MEMORIAL HERMANN WELCOMES Radiation Oncology•Biology•Physics; DEIDRA TEOH, M.S.N., RN, OCN Cancer Medicine; Otology & Neurotology; Lung Oncology Nurse Navigator South Region Shariq Khwaja, M.D., Ph.D., has joined Clinical Breast Cancer; American McGovern Medical School at UTHealth Journal of Clinical Oncology; and and is an affiliated radiation oncologist Journal of Clinical Investigation, among Deidra Teoh, M.S.N., RN, OCN, with Memorial Hermann Cancer Centers other journals. Memorial Hermann Oncology Service at the Texas Medical Center, Katy and Arechia Gaines, B.S.N., RN, has joined Line. Low-Dose CT Screening for Lung Memorial City Medical Center. Dr. Memorial Hermann as a Community Cancer. Mended Hearts Support Group at Khwaja practices radiation oncology with Outreach Specialist at Memorial Hermann Memorial Hermann Southwest Hospital, clinical interests in intensity-modulated Memorial City Medical Center. Arechia Houston, Texas, September 2016. radiation therapy, image-guided and oversees the Lindig Family Cancer Sylvia L. Brown, M.S., RN, OCN, CNL, adaptive radiation therapy, advanced Resource Center and all of its survivor-

BY THE NUMBERS

BREAST CANCER 423 LUNG CANCER 121 Inpatient stays for breast Patients received radiation 2,374 cancer 1,194 therapy Number of breast cancer Number of lung cancer patients seen in 2015 233 patients seen in 2015 109 Patients received radiation Patients received chemo­ 116,921 therapy 301 therapy Number of screening mam- Number of low-dose CT mograms performed 103 (LDCT) screenings for lung 6 Patients received chemo­ cancer performed Clinical trials related to 1,221 therapy lung cancer Patients diagnosed with 93 breast cancer following an 6 Lung cancer surgeries 119 abnormal mammogram and/ Clinical trials related to performed Patients enrolled in lung or ultrasound breast cancer 609 cancer clinical trials 813 26 Inpatient stays for lung Breast cancer surgeries Patients enrolled in breast cancer performed cancer clinical trials

18 MEMORIAL HERMANN CANCER JOURNAL nurse at the Aberdeen Royal Infirmary.

ARECHIA GAINES, B.S.N., RN Although new to this role, Carol has ALLA VARGO , AART(R), RDMS, M.B.A., M.H.A. Community Outreach Specialist been with the Memorial Hermann Regional Director, Oncology Service Line Memorial Hermann – Memorial City Medical North Region Center Health System since 2009, where she served as a supplemental staff nurse at Memorial Hermann Cancer Center - ship and patient programs. She received Texas Medical Center, as well as the Memorial Hermann Greater Heights her Bachelor of Science in Nursing from supplemental oncology nurse at Memorial Hospital for over 20 years, most recently The University of Texas Medical Branch Hermann Cancer Center - Northeast. as the Patient Care Director for Special in Galveston, Texas, and her Bachelor of Deidra Teoh, M.S.N., RN, OCN, is Projects. In her new role, Shelita will Science in Health Administration from Memorial Hermann’s new Lung Oncology provide support for oncology nursing Texas Southern University in Houston. Nurse Navigator - South Region. Deidra and the oncology service line through Prior to joining Memorial Hermann, received her Master of Science in Nurse collaboration across the entire Memorial Arechia served as a staff nurse in Education from the University of Hermann Health System. hematology/oncology at Texas Children’s Houston - Victoria, and her Bachelor of Alla has been promoted to Regional Hospital. She is a certified pediatric Science in Nursing from Prairie View Director, Oncology Service Line - North chemotherapy and biotherapy provider. A&M University. As the Lung Oncology Region. Alla has been with the Memorial Nurse Navigator, Deidra is responsible Hermann Health System for over 25 years, for providing support and education to and transitions from her previous role as CAROL KIRTON, B.S.N., RN, OCN lung cancer patients, from screening the Director of Business Development Oncology Nurse Navigator Memorial Hermann Cancer Center – Northeast through treatment and into survivorship. for Oncology Services and Administrative She coordinates care across five of Director, Inpatient Imaging Services at Memorial Hermann’s hospitals, as well Memorial Hermann - Memorial City Memorial Hermann welcomes Carol as the first regional lung tumor board. Medical Center. In her new role, Alla is Kirton, B.S.N., RN, OCN, as the Oncology Please join us in congratulating responsible for leading, directing, and Nurse Navigator at Memorial Hermann Shelita Anderson, M.B.A., B.S.N., RN, OCN, supporting strategic and operational Cancer Center - Northeast. Of British and Alla Vargo, AART(R), RDMS, M.B.A., initiatives for the service line by working descent, Carol earned her Bachelor of M.H.A., on their recent promotions in collaboration with hospital leadership, Science in Nursing at the University of within Memorial Hermann’s Oncology regional administration, management Dundee in Dundee, Scotland, and her Service Line. teams and medical staff. Diploma in Adult Nursing at Robert Shelita has been promoted to the Gordon University in Aberdeen, Scotland. System Oncology Director of Nursing. Upon graduation, she worked as a staff Before this transition, Shelita served at

ABOUT MEMORIAL HERMANN’S CANCER CARE

Memorial Hermann offers the entire Children’s Memorial Hermann Hospital, Care Center has been granted full, continuum of cancer care – prevention, Memorial Hermann Mischer Neurosci- three-year accreditation by the education, screening, diagnosis, ence Institute at the Texas Medical National Accreditation Program for treatment, survivorship and rehabili- Center, TIRR Memorial Hermann and Breast Centers. tation. We do more than provide UTHealth, patients can be confident To refer a patient or schedule an trusted medical care - we’re helping that oncology specialists are working appointment, call the Memorial patients navigate their entire cancer together to ensure the best possible Hermann Cancer Center nearest you: journey by caring for their physical, outcome for their cancer treatment. social emotional and spiritual needs. At Memorial Hermann, we enable Memorial City 713.242.3500 Patients can take advantage of cancer patients with the tools and resources Northeast 281.540.7905 services in their own neighborhood needed to fight cancer close to home Greater Heights 713.867.4668 through our convenient network, when home is where they want to be. Katy 281.644.7000 which includes eight Cancer Centers, All Memorial Hermann Cancer TIRRSoutheast is a registered 281.929.4200 trademark of TIRR Foundation. 19 breast care locations, 10 acute care Centers are accredited by the American Southwest 713.456.4028 hospitals and dozens of other affiliated College of Surgeons Commission on Texas Medical Center 713.704.3961 programs. Through partnerships with Cancer, and the Greater Heights Breast The Woodlands 713.897.5655

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7737 Southwest Freeway Houston, TX 77074 memorialhermann.org/cancer

MEMORIAL HERMANN CANCER CENTER LOCATIONS

Memorial City Southeast 925 Gessner Rd. 11920 Astoria Blvd. Houston, TX 77024 Suite 100 Northeast 713.242.3500 Houston, TX 77089 281.929.4200 Northeast 18960 Memorial North Southwest Humble, TX 77338 7600 Beechnut St. 281.540.7905 Houston, TX 77074 713.456.4028 Greater Heights 1635 North Loop West Texas Medical Center Houston, TX 77008 6400 Fannin St. 713.867.4668 Suite 2900 Houston, TX 77030 Katy 713.704.3961 23900 Katy Fwy. Katy, TX 77494 The Woodlands 281.644.7000 920 Medical Plaza Dr. Suite 100 Shenandoah, TX 77380

713.897.5655 Memorial Hermann Cancer Centers

The Memorial Hermann Cancer Journal is Sandra Miller, M.H.S.M., RN, NE-BC, Material in this publication may not be reproduced published four times a year by Memorial Hermann Senior Vice President, Oncology Service Line in whole or part without permission from Memorial Health System. Please direct your comments or Ron J. Karni, M.D., Chair, Physician Strategic Hermann Health System. suggestions to Editor, Memorial Hermann Cancer Steering Committee, Oncology Service Line Winter 2017 Journal, Memorial Hermann Memorial City Tower, 929 Gessner Rd., Suite 2548, Houston, TX 77024, Sunnye Owens-Garrett, Director of Marketing, 713.242.4490. Oncology To receive the Memorial Hermann Cancer Melissa Gilbert, Editor and Contributing Writer Journal via email, please sign up online at Karen Kephart, Writer memorialhermann.org/cancerjournal. Steve Stanley, Designer

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