Planting the Seeds of Prevention - Siteman Cancer Center

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The Center for Clinical Imaging Research provides leadingedge technology and the expertise of radiologists such as Farrokh Dehdashti, MD, foreground. The center supports 185 clinical studies and produces 2,000 scans a year. Harvesting Hope Advancing New Treatments Through Clinical Research 16 The Alvin J. Siteman Cancer Center For advancing cancer care, clinical studies are the crucial bridge between idea and practice. Without them, medical scientists would have no reliable way to evaluate new therapies, and clinicians would still be caring for cancer patients as they did in the 1950s. As they cautiously usher new ideas into widespread use, clinical studies also offer patients the opportunity to receive potentially helpful treatments that would otherwise be unavailable. The breadth of Siteman Cancer Center’s clinical research program ensures that many studies to evaluate drugs, combinations of drugs, devices and techniques are under way at all times, according to Lee Ratner, MD, PhD, professor of medicine at Washington University School of Medicine and co-director of Siteman’s translational and clinical research program. More than 250 therapeutic clinical studies, also called clinical trials, are being conducted at Siteman at any moment. Every participant in these studies is carefully protected: An institutional review board made up of professional and lay members examines the details of each clinical study, and participants receive thorough explanations before signing an informed consent.
Many of the studies are institutional in origin, born out of the ideas of Siteman researchers and clinicians, and are unavailable anywhere else. Others arise from collaborations with cooperative oncology groups or institutions pursuing similar research. And a smaller number are initiated by pharmaceutical companies. Among Siteman’s promising institutional efforts are: • A study testing the efficacy of a vaccine that stimulates the immune system to identify and overcome cancer cells in late-stage melanoma • A trial of implanted radiation seeds to treat early-stage breast cancer • A Siteman-led national investigation of a chemotherapy agent for patients with Hodgkin lymphoma whose disease has come back or is difficult to treat • A vaccine study that uses a patient’s immune system to prevent the progression of metastatic breast cancer Siteman also has a number of radiology studies at the Mallinckrodt Institute of Radiology’s Center for Clinical Imaging Research (CCIR), the only facility of its kind in the nation. The center, with its full range of the latest imaging equipment, is dedicated to research. “The CCIR greatly enhances the role of imaging in clinical research,” says radiology professor Mark Mintun, MD, who spearheaded creation of the center. Siteman’s Imaging Response Assessment Team (IRAT) also promotes the use of imaging in clinical research, particularly to assess patients’ response to therapy. The IRAT, one of eight formed nationally through National Cancer Institute grants, integrates radiologists into the planning of cancer clinical studies. Clinical studies proceed in stages, beginning with phase I. “This is the point where newly developed drugs — or perhaps established drugs in new combinations or doses — are tested for the first time in people,” explains medical oncologist A. Craig Lockhart, MD, MHS, leader of Siteman’s developmental therapeutics program. Lockhart is working to expand the number of Siteman’s phase I studies to provide important alternatives to patients for whom standard therapy is either ineffective or nonexistent. Siteman’s clinical investigators make concerted efforts to recruit participants in ways that serve science and the community equally. “Study populations balanced by gender and race let us know that any medical benefit works in all PERCENT Siteman Minority Participation in Trials 20 15 10 5 0 13.74% 14.38% 15.88% 15.81% 2005 2006 2007 2008 Increasing minority participation in clinical studies is a key priority at Siteman. Improvements have come about through extensive outreach efforts. groups,” says Lannis Hall-Daniels, MD, MPH, director of radiation oncology at the Siteman Cancer Center at Barnes- Jewish St. Peters Hospital. Hall-Daniels, who leads the clinical-trials outreach team for Siteman’s Program for the Elimination of Cancer Disparities, has been instrumental in encouraging minority participation, which has increased from 13.7 percent in 2005 to 15.8 percent in 2008. To bring all available resources to bear, Ratner says the translational and clinical research program, co-directed by professor and chief of endocrine and oncologic surgery Jeffrey Moley, MD, is creating centers of excellence to focus on studies in areas of strength: breast, endometrial, gastrointestinal, lung and prostate cancer as well as leukemia. The goal, he says, is to streamline the process of designing and testing targeted therapies. www.siteman.wustl.edu 17
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