A publication of the J A M E S G R A H A M BROWN CANCER CENTER

FALL 2009

DISCOVERIES

Dr. Anthony Dragun

and the Breast Care

Multidisciplinary Team

Embrace Today’s

Advances and Look

Ahead to Tomorrow

Dear Friends,

Nearly every day headlines across the country use words like “downturn,” “freeze,” “slowdown,”and “reduction” to describe industries from manufacturing to banking to health care.

While we are not immune from the effects of the financial times, none of those words describethe vibrant growth in research, clinical care, and capital improvement we are enjoying at theJames Graham Brown Cancer Center. Even in the midst of these trying economic times, wecontinue to renew our commitment to our mission each day – a commitment that drives ourcontinued success.

Allow me to share with you just a few examples of these recent successes:

The University of Louisville recently opened the Clinical and Translational ResearchBuilding (CTRB), a $143 million, 285,000+ square foot facility located just behind theBrown Cancer Center housing laboratory space for research that has potential for clinicaland translational applications, particularly cancer research. The CTRB offers our researchteams flexible and adaptable state-of-the-art biomedical research facilities, designed topromote interdisciplinary collaboration between scientists. Its core laboratories includeflow cytometry, micro-array, advanced diagnostic imaging services and tumor bank.

A study supporting the use of transgenic plants in HIV prevention was published byKenneth Palmer, PhD, associate professor of pharmacology and toxicology and seniorscientist in the James Graham Brown Cancer Center working at the Owensboro CancerResearch Program (OCRP). The study indicates that growing large quantities of theprotein griffithsin in Nicotiana benthamiana—a close relative of tobacco—offers anaffordable, preventative measure for HIV. This work highlights our work at the OCRP,strengthens our partnerships with Kentucky BioProcessing and Intrucept Biomedicine,LLC, and offers hope to communities ravaged by HIV all over the world.

The University of Louisville established two endowed chairs, the Auerbach FamilyEndowed Chair and the Dr. Renato LaRocca Endowed Chair in Oncology Social Work, toaddress the needs of cancer patients beyond treatment of the physical disease. Thesechairs, the first residing in the Brown Cancer Center and the second in the Raymond A.Kent School of Social Work, will both support the cancer center’s commitment toadvance research and treatment for the whole patient.

The Brain Tumor Clinic, our latest multidisciplinary clinic, saw its first patients in thesummer of 2009 under the leadership of UofL School of Medicine Dean Edward C. Halperin,MD. The Brain Tumor Clinic is the latest example of our commitment to clinical excellencethrough cross-disciplinary teamwork.

The Brown was the first in the region to introduce Contura, a new clinical innovation inAccelerated Partial Breast Irradiation. This new tool gives more patients in our Breast CareMultidisciplinary Clinic yet another option to more aggressively target the treatment of cancerwith fewer side effects and vastly reduced damage to surrounding healthy tissue.

As always, I am amazed at what we continue to accomplish through teamwork, vision, andcommitment to excellence. Please read on to learn more about how the Brown Cancer Centercontinues to change the cancer landscape in Kentucky and beyond.

Donald M. Miller, MD, PhDDirector of the James Graham Brown Cancer Center

2A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

Discoveries is publishedfor the friends, faculty andstaff of the James GrahamBrown Cancer Center.

DiscoveriesBrown Cancer Center, 2nd Floor529 S. Jackson StreetLouisville, KY 40202www.browncancercenter.org

EditorCraig Fairfield

ContributorsTom FougerousseKathy KeadleDiane KonzenAlbert LeggettMarion Whelan

letter from the director

INSIDE THIS ISSUE...

8page

4page

12page

15page

COVER STORYNew Options & Team Approachto Breast Cancer Treatment

ARTICLES

New HIV Drug

The Elite 8

Rebecca’s Story

3FALL 2009

welcome...

Swapna Kartha Chandran, MD, has joined the Brown CancerCenter’s Head and Neck Multidisciplinary Clinic. Board-certifiedin otolaryngology, Dr. Chandran received her undergraduatedegree at the University of Chicago and her MD at theUniversity of Louisville. She completed two fellowships, the firstin laryngology/professional voice care and professional voicedisorders at Drexel University, and the second in pediatricotolaryngology at the Alfred I. DuPont Hospital for Children inWilmington. Among her numerous awards are the Banas andRose Cohen Compassionate Service Award from the Universityof Louisville School of Medicine, and the Seymour R. CohenAward for Pediatric and Neurolaryngology from the AmericanLaryngological Association.

Jarod A. Little, MD, has joined theBrown Cancer Center’s Head and NeckMultidisciplinary Clinic. Dr. Little received hisundergraduate degree at Baylor Universitybefore earning his MD at the University ofTexas, Houston. He completed his residencyin otolaryngology and his fellowship in plasticand reconstructive surgery at the Universityof Louisville.

Michael Milam, MD, MPH, joined theGynecologic Multidisciplinary team August 1.Dr. Milam received his MD from theUniversity of Kentucky College of Medicineand an MPH from the University of TexasSchool of Public Health in Houston.He completed an internship in obstetricsand gynecology at Barnes-Jewish MedicalCenter, Washington University in St. Louis;

a residency in obstetrics and gynecology at VanderbiltUniversity in Nashville; and a fellowship in gynecologiconcology at The University of Texas MD Anderson CancerCenter in Houston.

Kevin L. Potts, MD, also joins the Head andNeck Multidisciplinary Clinic team from aprivate practice in Louisville. Dr. Potts, boardcertified in otolaryngology, completed hisundergraduate, medical and residencytraining at the University of Louisville, wherehe served as chief otolaryngology resident.Dr. Potts received the Michael B. NolphAward for Academic Excellence, the Serge A.

Martinez Award for Outstanding Performance inOtoloaryngology, and the Resident Research Award.

NEW FACULTY

Guilherme Rabinowits, MD recently joinedthe Head and Neck Multidisciplinary team atthe Brown Cancer Center. Dr. Rabinowitsreceived his MD from the Fundacao Tecnico-Educacional Souza Marques in Rio de Janeiro.After completing his residency in radiationoncology at the Instituto Nacional de Cancer,Dr. Rabinowits completed an internship ininternal medicine at the Metro West Medical

Center in Framingham, Mass., and a residency in internalmedicine at the Lahey Clinic in Burlington, Mass. He then cameto Louisville, where he served as chief fellow in the BrownCancer Center’s hematology/oncology program.

Elizabeth C. Riley, MD, joins the LungCancer Multidisciplinary team from BethIsrael Deaconess Medical Center in Boston,where she recently completed her fellowshipin hematology/oncology. Dr. Riley receivedher undergraduate degree from DukeUniversity and MD from the University ofLouisville. She then completed herinternship and residency in internal medicine

at Beth Israel Deaconess, where she was named chief resident.Dr. Riley served as clinical fellow in medicine and instructor inmedicine at Harvard Medical School.

Kara Joyce Collins Sedoris, PhD, joinedthe Molecular Targets research program teamafter completing her postdoctoral fellowshipin cancer research at the Brown CancerCenter. Dr. Sedoris received her BA fromOhio Wesleyan University, as well as amaster’s degree and PhD in Physiology andBiophysics from the University of Louisville.She has presented at numerous national and

international meetings and has been published in several peerreviewed journals including Biochemistry and the Journal ofApplied Physiology.

Huang-Ge Zhang, MD, PhD, has joined the Brown CancerCenter’s Tumor Immunology research program team from theUniversity of Alabama at Birmingham. Dr. Zhang received hisMD from the Medical School of Inner Mongolia and his DVMfrom the Veterinary Medical School of Inner Mongoloia beforecompleting his PhD in viral immunology at Mississippi StateUniversity. He completed his postdoctoral fellowship at UABbefore joining the faculty there, where he received severalawards including the Basic Clinical and Translational ResearchAward from the Susan G. Komen Foundation and the CareerScientist Award from the VA Administration. His NIH-supportedresearch is chronicled in many publications, including theInternational Journal of Cancer, the Journal of Immunology,and the American Journal of Pathology.

A University of Louisville faculty memberat the Owensboro Cancer ResearchProgram (OCRP) published researchon March 30 supporting the use oftransgenic plants in HIV prevention.The study indicates that growing largequantities of the protein griffithsin inNicotiana benthamiana – a close relativeof tobacco – offers an affordable,preventative measure for HIV.

Kenneth Palmer, PhD, AssociateProfessor of pharmacology andtoxicology and senior scientist in theJames Graham Brown Cancer Centeris senior author of the article, “ScaleableManufacture of HIV-1 Entry InhibitorGriffithsin and Validation of its Safetyand Efficacy as a Topical MicrobicideComponent,” in the Proceedings ofthe National Academy of Sciences ofthe United States of America. Thepublished study was the result of a closecollaboration between Dr. Palmer andthe scientists who discovered the drug,led by Dr. Barry O’Keefe at the NationalCancer Institute. Two Kentuckybiotechnology companies, IntruceptBiomedicine, LLC and KentuckyBioprocessing, and scientists at DukeUniversity and the University of Londonin the United Kingdom also participatedin the study.

“This drug works by binding to sugarmolecules on the surface of HIV,preventing the virus from infecting cellsof the immune system,” Dr. O’Keefe said.“Using plants to produce griffithsin willoffer underdeveloped countries with anaffordable solution for prevention ofHIV transmission.”

According to Dr. Palmer, whenmanufactured in the form of amicrobicide gel or film for topicalapplication, the product’s selling pricecould compare to that of male condoms.

HIV research is a focus of OCRP ascontracting HIV increases risk for cancer.

The study modified the tobacco mosaicvirus to incorporate the griffithsin geneand infected more than 9,300 plants,

extracting enough griffithsin to produceabout 100,000 HIV microbicide dosesfrom the leaves. The chemical performedidentically to griffithsin produced byother methods. In a petri dish modelincorporating cervical tissue, it stronglyinhibited HIV and did not inducemarkers of inflammation; a standardanimal test confirmed it was not achemical irritant.

Many HIV entry inhibitors are biologicalmolecules, making them virtuallyimpossible to produce by a purelychemical process and requiring synthesisby living organisms. In comparison withcell-culture based manufacturingprocesses, plant-based manufacturingof biologicals offer significant costsavings by reducing the need forexpensive infrastructure for growingorganisms to produce the protein, andalso provide the economies of scaleoffered by agricultural production.

Kentucky BioProcessing, whichspecializes in the expression, extraction

and purification of proteins and otherhigh value products from plants, willmanufacture proteins for the drug forfuture clinical trials. �

preventative drug for HIVMANUFACTURED IN PLANTS READY TO BEGIN CLINICAL DEVELOPMENT

4A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

Dr. Kenneth Palmer

led the study indicating

that growing large

quantities of the protein

griffithsin in Nicotiana

benthamiana – a close

relative of tobacco –

offers an affordable,

preventative measure

for HIV.

The new UofL Clinical and Translational Research Building (CTRB) on Hancock Street is

humming with activity. More than 40 members of the Brown Cancer Center faculty, plus

their students, assistants, technicians and other staff members are in the process of moving

into the 285,000 square foot building.

The CTRB is a flexible and adaptable state-of-the-art biomedical research facility and is

designed to promote collaboration between scientists working in the building. At full

occupancy, the $143 million facility will house as many as 650 principal investigators,

junior investigators, research assistants, fellows and support staff.

Initial programs will include:

Structural Biology Program, Biostatistics and Core Facilities(Drs. Chaires, Cunningham, Ghim, Jenson, Lane, Rai, Rodu, Trent,

Ye and Zacharias)

Prevention & Control Program including Pharmacology& Toxicology members, and Tumor Immunobiology Program(Drs. Bodduluri, Gercel-Taylor, Hein, Jala, Kakar, Kidd, Lillard,

McGregor, Milam, Singh, States, Taylor, Yan and Zhang)

Molecular Targets Program and UofL labs of the Owensboro faculty(Drs. Bates, Chesney, Clark, Clem, Donninger, Eaton, H. Hao, C. Li, Miller, Mitchell, Sedoris,

Telang, Wattenberg and Zhou; and the researchers from Owensboro - Drs. Davis, Matoba, Palmer, and Sankar)

CLINICAL & TRANSLATIONAL RESEARCH BUILDING GOES LIVE

UofL establishes two endowed chairsTO ADDRESS THE PSYCHO-SOCIAL SIDE OF CANCER

The CTRB is designed to meet LEED certificationfrom the U.S. Green Building Council.

5FALL 2009

A diagnosis of cancer often will send apatient into a spiral of depression, painand hopelessness. The University ofLouisville will be addressing this issuethrough the establishment of theAuerbach Family Endowed Chairat the Brown Cancer Center and theDr. Renato LaRocca Endowed Chairin Oncology Social Work at the UofLRaymond A. Kent School of Social Work.

The holder of the Auerbach Family Chairwill be a psychologist or psychiatrist whowill research the impact of psychosocialcancer care and will develop a teachingprogram for medical students and othersthat focuses on the psychosocial needsof patients. The chair will be expectedto strengthen partnerships withother support service organizationsthat provide cancer support for thewhole family.

“This endowment will allow us to recruita world-class clinician who specializes inpsychosocial aspects of cancer and whoembraces our collaborative, multidiscipli-

nary approach to care,” says Donald M.Miller, MD, PhD, Director of the BrownCancer Center.

Sy Pearson Auerbach, MD, anemeritus assistant clinical professor oforthopedic surgery at UofL says hedecided to make this donation followingmany of his family members’ longstruggles with cancer, including thatof his late wife, Minx.

Oncology social workers serve as patientadvocates, providing answers, guidanceand support. They connect cancerpatients and their families to communityresources, including physicians, financialaid, local and government agencies andsupport groups. The Dr. Renato LaRoccaEndowed Chair in Oncology Social Workwill train social workers on the uniqueaspects of cancer care related issues.

“We don’t know of another (social work)program in the nation that focuses oncancer patients; we want to fill thatvoid,” said Terry Singer, dean of the Kent

School of Social Work at UofL. “Throughthis chair, we will create a state-of-the-arttraining and research program targetedat this very vulnerable population.”

Local cancer medicine specialistRenato LaRocca, MD, recognized theneed for helping his patients navigatingtheir way through the maze of emotionsand health care systems associated witha cancer diagnosis. The result was hisleading the effort to establish thenation’s first known endowed chair inoncology social work.

“A cancer diagnosis immediately impactspatients and generates a tremendousamount of emotional and technicalneeds,” Dr. LaRocca said. “I don’tknow of any formal program in theUnited States, let alone the world, thatresearches the topic or that specificallyeducates and trains social workers in thisarena. There is a tremendous need in ourcommunity and beyond and I can’t thinkof a better place than UofL to lead theway in this new specialty area.” �

6A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

Every year since the Brown CancerCenter’s Mobile Mammography Unitbegan coming to her work, Pam Reashad had her annual mammogramperformed during a quick break from herduties at Brown Forman. It had becomeroutine; almost an afterthought,although her own mother’s breast cancermore than a decade before made herappreciate the convenience.

In 2008, however, Ms. Reas received acall for follow-up to a suspicious readingof her annual screening. She reported tothe cancer center for an ultrasound withbiopsy, and learned that she did, indeed,have breast cancer.

“The radiologist was very understand-ing,” Ms. Reas said. “I was so apprecia-tive of the time she spent with me.”

Ms. Reas was one of more than 4,600women screened by the state-of-the-arttechnology offered by the MobileMammography Unit in 2008.

“In all, the Brown Cancer Center’smammography program screensaround 9,000 women a year,” explainedLaura Fry, program director. “Ourmammography outreach programaccounts for well over half that number.We feel great about reaching womenwho may find it easy to postponeimportant screenings by makingscreenings more convenient. We feeleven better about reaching women whomay not otherwise have access or oppor-tunity to have a regular mammogram.”

The Mobile Mammography Unit is busynearly every day of the year at locationsthroughout Louisville, surroundingcounties, and beyond.

BUSINESSES PROMOTE HEALTH

In addition to the partnership withBrown Forman which facilitatedPam’s regular screening, the mobilemammography program has othercorporate partner clients across the areawho feel the program is a great way topromote employee health (see sidebar).

"The Mobile Mammography Unitprovided by the James Graham BrownCancer Center has been a valuable toolin Papa John's ‘Campaign for BetterHealth,’ at our corporate campus,” saidAnnette Calhoun, senior director forbenefits at Papa John's International, Inc.“We've been extremely satisfied with themobile mammography unit and so haveour team members. We book to capacityeach time we schedule the unit to comeon campus."

mobile mammography EXPANDS CANCER CENTER’S REACH

Breast cancer survivor Pam Reas visits

the Brown Cancer Center's Mobile

Mammography Unit, where her cancer

was first detected.

7FALL 2009

In addition to the long list of Louisville-based corporations that benefit frommobile mammography, the van makesregular trips to more rural-basedbusinesses as well. American Greetingsin Bardstown and Nationwide Uniformsin LaRue County have both enjoyed along-standing partnership with theBrown Cancer Center.

COMMUNITY OUTREACH ISKEY TO REACHING UNDER-SERVED POPULATIONS

While annual trips to area businesses area large part of the outreach program, itis the visits to area churches, rural healthdepartments, extension offices and thestate fair that make the most impact.

“For many patients we see at communityevents, there is a significant distrust ofthe health care system and a fear of ahospital setting,” Laura Fry said.“Meeting patients on their ‘home turf’provides a level of comfort that makesthe screening process less intimidating.”

As an additional comfort, the centerbrings interpreters to promotecommunication when visiting areaswith a significant Hispanic population.

“We try to do whatever we can to makesure that the women we see can askquestions and have them thoroughlyanswered,” Ms. Fry continued.

The mammography outreach programworks closely with the Louisville MetroDepartment of Health, Kentucky CancerProgram, and the Louisville/JeffersonCounty Partnership in Cancer Control toidentify and connect with populationsthat may most benefit from mobilemammography.

A new community outreach programthat began last year under the leadershipof Kentucky First Lady Jane Beshear is“Horses and Hope”.

Along with a highly successful awarenesscampaign run through each ofKentucky’s race tracks during activemeets, the Brown Cancer CenterMobile Mammography Unit providesmammograms on the “backside” of eachtrack for horse industry workers and theirfamilies, many of whom are uninsured orunderinsured.

BEST TECHNOLOGYAVAILABLE – ON WHEELSOR OFF

The Brown’s Mobile MammographyUnit features the same advanced digitalmammography services offered at theJames Graham Brown Cancer Center’sBreast Care Center. In fact, the BrownCancer Center’s unit was among the firstin the country to offer digital imaging.This advanced technology providesdramatically improved image contrast inall tissue, even denser breasts. Patientsbenefit from reduced exposure times,improved imaging, and a morecomfortable exam.

In addition, the digital images areprovided instantly to the technicianand, when wireless is available, to thephysicians of University RadiologyAssociates, eliminating time that maybe wasted when available physiciansmust wait for films to be delivered.

EARLY DETECTION MEANSIMPROVED RESULTS

Today, former cancer patient Pam Reas isenjoying a cancer-free life, although herfollow-up treatment still requires twomammography screenings a year.

“From the day we got my diagnosis – onour 20th wedding anniversary – I’ve feltthat all the education and support Ineeded was provided at the BrownCancer Center,” she said. “My husband,Greg, always felt welcomed, and weknew that any of my physicians wouldgive us all the time we needed duringclinic.

“I am blessed to have a supportivehusband, a wonderful daughter, Hailey,and fantastic extended family, friendsand co-workers,” she continued. “I wasalso blessed by the support and careI received at the Brown; care that beganin a van just outside my office.” �

Corporate PartnersAmerican GreetingsAnthemBA Merchant ServicesBrown FormanHorseshoe CasinoCitiGroupCourier JournalGeneral ElectricHumanaKCIWKelloggsLarue County Extension OfficeLouisville Water CompanyLouisville Gas & ElectricMetropolitan Sewer DistrictNational City BankNationwide UniformsPapa Johns InternationalPassport Insurance CompanyPublishers PrintingSHPSSud-ChemieTyson FoodsUofL HospitalUPSYUM! Brands

Metro Council SponsoredCommunity ScreeningsCouncilwoman Welch, Blessed TeresaCouncilwoman Butler, Salvation ArmyCouncilmen Benson, Kramer, and Engel, Glen Ridge

Health CampusCouncilwoman Green, Highland ParkCouncilwoman Flood, St. LukeCouncilmen Fleming, Stuckel, and Downard,

Lyndon City HallCouncilwoman Ward-Pugh, Clifton CenterCouncilman Blackwell, Beechland Baptist

2009 Community ScreeningsHillebrand HouseAntioch ChurchUrban LeagueAppointment w/ Life ChurchJunior LeagueCrum's Lane ElementaryJewish Community CenterGreencastle BaptistForest TabernaclePresbyterian Community CenterFaith Presbyterian ChurchPresbyterian SeminaryMother's Day ScreeningMost Blessed SacramentSt. BernadetteSt. RitaCaanan Christian ChurchGreater Friendship BaptistBoat People SOSFern Creek Christian ChurchBerrytown Community CenterIroquois Shopping CenterSun Valley Community CenterRace for the CureSt. CatherineWomen of Vision (Central HS)SW YMCAJ-town Baptist ChurchVFW MiddletownFirst GesthsemaneBritthavenShivley City Council

Health DepartmentsGreen River Health DeptLouisville Metro Health Dept

Portland FHCEast Broadway FHCFairdale FHCSouthwest FHCIroquois FHCPark DuValle Health ClinicNewburg Health Clinic

Bullitt County Health DeptLexington-Fayette Co. Health Dept. (Keeneland)Green River Health Dept. (Ellis Park)

MOBILE MAMMOGRAPHY

“She didn’t want her elderly mother to

know she had cancer; didn’t want her

to worry,” Anthony Dragun, MD, said

of one recent patient who decided to

undergo a lumpectomy with partial

breast irradiation using the new

multi-channel Contura balloon

catheter. This method, which is available

regionally only at the James Graham

Brown Cancer Center, reduced her

treatment time from six weeks to just

five days, and allowed her to get back

to her normal routine quickly, sparing

her mother from worry.

This story is just one example of how

Dr. Dragun, Anees Chagpar, MD, and

the other talented members of the

Breast Care Multidisciplinary team at the

James Graham Brown Cancer Center are

combining groundbreaking research

with the latest technology to provide the

best treatment options for each patient.

It is also a perfect illustration of what

inspired Dr. Dragun to pursue medicine,

and his specialty of radiation oncology in

particular – the opportunity to be both

scientist and physician, and a passion

for finding minimally invasive ways to

effectively treat cancer.

Early Call

When he was 12 or 13, as he recalls,

Dr. Dragun was afforded a unique

opportunity. His mother, who was a

licensed dietician at the time, decided

to go back to school and pursue her

medical degree. One of her professors at

the Hahnemann University School of

Medicine in Philadelphia (now the

Drexel School of Medicine), Luther

Brady, MD, was a pioneer in the

emerging field of radiation oncology.

Dr. Brady’s passion for combining

science and clinical care inspired both

mother and son. His influence,

combined with that of Barbara Hoopes,

PhD, who mentored Dragun while he

completed his undergraduate work in

molecular biology at Colgate University

in New York, convinced Dragun that

cancer would be his field. Not

surprisingly, he chose Hahnemann

University for his medical studies where

he was reunited with Dr. Brady,

completing the circle.

After an internship at Crozer-Chester

Medical Center at Temple University,

Dr. Dragun began a residency at the

Medical University of South Carolina

(MUSC) where he met the visionary

Joseph “Buddy” Jenrette, MD, chairman

of radiation oncology. MUSC was one of

five beta test sites for a new device – a

catheter used to administer radiation

directly to breast cancer tumor sites

following a lumpectomy.

Research DrivesAdvances in Care

Dr. Jenrette believed that this new

approach, called Accelerated Partial

Breast Irradiation (APBI), would be

a dramatic step toward shortening

treatment times and minimizing risk

to healthy tissue. He assigned

Dr. Dragun to collect the data, and,

with participation from other MUSC

colleagues, they began publishing

their findings.

APBI quickly proved effective, and

popular with patients. It provided

results comparable to mastectomy and

shortened treatment time from six weeks

to just five days – which was especially

important for patients who had to travel

long distances for treatment.

The most recent innovation in APBI,

called Contura, improves on previous

technology by incorporating multiple

channels into the catheter. This allows

more precise control of dosage and

direction, making the procedure

available to women with smaller

breasts, tumors closer to the surface

and other complications.

new options AND TEAM APPROACH TO BREAST CANCER TREATMENT

8A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

“The give-and-take is whatmakes the difference.”

Anees Chagpar, MDSurgical Oncologist

9FALL 2009

“As a medical professional, it is myresponsibility to be on the front lines;to educate the people who rely on me;to make sure they know about the latestand most effective therapies.”

Anthony E. Dragan, MDRadiation Oncologist

10A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

Team Provides Critical Eyeand Human Touch

While the technology is impressive, the

team approach to treatment is the real

key for patients. At a recent meeting of

the Breast Care Multidisciplinary team,

more than a dozen people with a variety

of specialties and expertise discussed

each case. They considered the obvious –

medical histories, pathology and tumor

sites, for example; but they also talked

about the less obvious but equally

important considerations. What is the

patient’s family situation? Do they have

the support they need to successfully

complete a particular course of

treatment?

By asking these less-conventional

questions and bringing a wide variety

of expertise to the table, the team is able

to make better determinations about

treatment.

“The give-and-take is what makes the

difference,” Dr. Chagpar, a surgical

oncologist, notes. “It is far more

productive to gather a team around a

table to discuss every situation than it is

to pass charts around a building or try to

talk to peers on the phone.”

As the primary surgeon on the team,

Dr. Chagpar is often the first to meet

with a patient. She sees her role as that

of counselor and facilitator.

“When I see a patient, I discuss all of the

Surgical Oncologist: Anees Chagpar, MD

Radiation Oncologist: Anthony Dragun, MD

Medical Oncologists: Dharamvir Jain,MDCarolina Salvador, MD

Pathologist: Sunati Sahoo, MD

Breast Radiologists: Lane Roland, MDSara Mizuguchi, MD

Behavioral Psychologist: Jessica Lehman, PhD

Psychiatrist: Rebecca Tamas, MD

Nurse Coordinator: Barb Kruse, RN, OCN, M.Ed

Breast Care Nurse: Ellen Galbraith, RN

Resource Center: Barb Steele, RN

Social Worker: Amy Thorn, MSW

Chaplain: Kathy Costanza

THE BREAST CAREMULTIDISCIPLINARY TEAM INCLUDES:

11FALL 2009

surgical options with her. We discuss

the advantages and disadvantages of

different choices,” she said. “The

management of breast cancer, however,

goes beyond surgery alone. Patients

benefit from the culmination of the

expertise of a wide array of specialists

that make up the multidisciplinary team

working together with her to achieve

optimal results.”

For many breast cancer patients, Contura

seems to be the answer.

“The accelerated treatment time seems

to be the driver for many people,”

Dr. Dragun notes. “Patients who would

have chosen a radical mastectomy before

because they couldn’t spend months

traveling back and forth for treatment

now have another option. We are very

happy that we can make that possible.”

While Contura is a breakthrough,

Dr. Dragun, Dr. Chagpar and the rest of

the Breast Care Multidisciplinary team

are constantly working toward better

solutions. Soon, they expect to have even

more advanced therapies available. And

when they do, the process will continue.

”As a medical professional, it is my

responsibility to be on the front lines,

to educate the people who rely on me,

to make sure they know about the

latest and most effective therapies,”

Dr. Dragun says. “My goal, and the

goal of the team, is to help every patient

understand all of their options and to

guide them toward the one that best

suits their situation.” �

“We launched on September 6, 2002,”multidisciplinary clinic coordinatorLiz Wilson remembers.

After several months of planning and stilla bit of apprehension, the Brown CancerCenter Head and Neck MultidisciplinaryClinic welcomed its first patients on aFriday morning.

Seven years later, the staff remembersthat day as one that changed the courseof the development of clinical care at thecancer center forever.

“It was a groundbreaking approach foran ENT surgeon, a radiation oncologist,a medical oncologist, and a dentaloncologist along with a speechpathologist, social workers and nursesto review cases and plan and monitortreatment strategies together,”Ms. Wilson said. “Seven years and1,200 patients later, we are a finely oiledmachine that can fully concentrate onthe patient rather than the process.”

Today, the team approach is the goldstandard of care at the Brown CancerCenter, which has developed dedicatedmultidisciplinary teams for the treatmentof breast, gastrointestinal, genitourinary,gynecologic, head and neck, lung,melanoma, and, as of 2009, brain andspine cancers. (See “Brain Tumor ClinicOpens at Brown” on page 14.)

While each clinic operates independentlyand with variations on the theme,all value a team approach to thediagnosis, treatment, and post-treatmentrecovery from cancer.

“In a community medicine setting, acancer patient’s treatment plan will likelybe navigated by whichever physician thepatient sees first,” explains Barb Kruse,associate director of multidisciplinaryclinics. “In our clinics, physicians andhealth professionals work together,shelve egos, and consult with oneanother to develop an individual planthat best suits each patient.

“The culture change has been reallyquite extraordinary.”

New Culture – New Identity

According to Ms. Kruse, the multi-disciplinary system has opened doorsand created opportunities that no oneanticipated in 2002.

“We have grown from competing withcommunity medicine providers tocompeting with other top-tier regionalcancer centers such as Vanderbilt andIndiana University,” she said. “We are a

leader in counseling patients seeking asecond opinion.

“The physicians and health professionalson each team feel ownership in the teamand in the plan for each patient. I believethat feeling of commitment is evident topatients who come through our doors.”

In fact, a recent review of secondopinions offered for breast cancerpatients showed that more than

12A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

“In our clinics,physiciansand healthprofessionalswork together,shelve egos,and consult withone anotherto develop anindividual planthat best suitseach patient.”

Barb KruseAssociate Director ofMultidisciplinary Clinics

the elite 8SEVEN YEARS AFTER THE FIRST CLINIC OPENED, THE BROWN CANCER CENTERLAUNCHES ITS EIGHTH MULTIDISCIPLINARY CLINIC AND LOOKS EXPECTANTLYTO THE FUTURE

13FALL 2009

80 percent of patients entering thesystem for a second opinion chose toreceive care at the cancer center’s BreastCare Clinic. That kind of ownership ispresent in each of the center’s clinics.

“Each of our multidisciplinary teams hasa unique and dedicated group ofphysicians,” said Brown Cancer CenterDirector Donald Miller, MD, PhD.“Each team has a dedicated radiologist,pathologist, and oncologist. We’veadded three full-time social workers toensure quality of service to each team.We’ve also recruited a psychiatrist whoconferences each month with our nursecoordinators to discuss any patientpsychiatric needs.

“The clinical culture has shifted tobecome highly customer-service orient-ed, which is a more pleasant environ-ment for our professionals to work in.”

The cross-specialty cooperation has alsobeen a benefit to health professionalsthroughout the community and beyond.

The structure has supported theaccreditation of continuing education

credit for various team meetings, andseveral teams have annual or biannualeducational conferences that feature notonly Brown Cancer Center faculty, butcancer leaders from around the world.These conferences give the Brown teamthe opportunity to learn from and withcolleagues from across the region,strengthening ties and potential referralnetworks.

Clinical research is active and vibrantthroughout the clinics. “The multidisci-plinary setting makes our clinicalresearch better,” Dr. Miller said. “Ourclinical researchers have vibrant andactive clinical settings in which to workcreatively.” Dedicated clinical trialresearch nurses serve in each clinicconference and match qualifying patientswith available trials in consultation withthe entire team. This immediateconsideration of emerging treatmentadvances is an obvious benefit toBrown Cancer Center patients.

Clinical Evolution

The research and education-richenvironment also allows for clinics to

grow and evolve in their approach tobest serve patients with the latestdevelopments.

For instance, the Head and Neck Clinichas grown to heavily consider, alongwith eradication of the cancer, thequality-of-life impact of each viabletreatment option.

“Head and neck cancers and theirtraditional treatments can be disfiguringand can drastically affect communicationand self-care,” Liz Wilson explains.“Working with each patient, we discussthese issues and work toward organpreservation whenever possible, withoutlosing focus on the extension of aquality life.”

This slight shift in focus has resulted inpromising results, with low rates ofcancer recurrence and high marks forquality of life.

“We continue to work with our patientsafter cancer treatment has ended, asmany need a variety of therapies toachieve full recovery,” Ms. Wilsoncontinues. “The continuity of care that

Dedicated clinical research nurses, such as Charita Weathers and Stacy Baum, work with multidisciplinary teams tomatch qualifying patient volunteers to the latest clinical trials.

includes speech pathologists and othersurges everyone on the team to look ateach case through both a short and along lens.”

Looking Ahead

Never one to rest on past accomplish-ments, Dr. Miller continues to lookforward to the next stages ofmultidisciplinary care.

“We are working with members fromacross our clinic teams to work out howthey can work together and learn fromeach other more effectively even as eachteam continues to hone its own work,”he said. “In addition, we will continueto look across the spectrum of cancersand the unique needs of our regionalhealth landscape to identify newmultidisciplinary opportunities. �

14A publication of the J A M E S G R A H A M BROWN CANCER CENTERDiscoveries................

ELITE 8 continued...

The latest addition to the Brown Cancer Center multidisciplinaryclinical service is the Brain Tumor Clinic, which saw its first patients inthe summer of 2009.

According to Edward C. Halperin, MD, clinicradiation oncologist and dean of the UofLSchool of Medicine, Kentucky’s dire healthstatistics called for a specialized clinic fortumors of the brain and spine.

“Nationally, roughly half of all brain tumorsare metastasized cancers from the lung,breast or melanoma,” Dr. Halperin explains.“Kentucky has the highest adult smoking ratein the country, along with the lowest lung

cancer survival and high rates of both breast cancer and melanomas.”

Dr. Halperin explains that, in Kentucky, brain tumors metastasizedfrom other cancers outnumber primary brain tumors ten to one,accounting for 30 percent of cancer-related deaths.

“With the focused care of a multidisciplinary team, we can make adifference in the quality and longevity of life for many patients fromacross the region,” he said.

Like other Brown Cancer Center multidisciplinary teams, the BrainTumor Clinic weaves together the expertise of health professionals fromacross the spectrum, including neurosurgery, neurology, radiationoncology, medical oncology, neuroradiology, pathology, nursing, socialwork, and psychology.

In all, approximately 15 health care professionals are actively involvedin reviewing and mapping a treatment plan for each case.

Patients may attend conference meetings — increasing their owneducation about their diagnosis, and giving the team the opportunityto work with the patient in developing a strategy.

“A patient may check in for an initial work-up at 9 a.m., meet withthe conference at 11 a.m., and have the group decision by earlyafternoon,” Halperin explained. “By the time a patient leaves theclinic, he or she will have had the opportunity to meet and askquestions of physicians and health professionals on the team withouthaving to make multiple trips or appointments.”

The Brain Tumor Clinic, still in its early months, is seeing a handful ofpatients. However, Dr. Halperin’s experience as a member of the DukeUniversity Brain Tumor Clinic leads him to expect the clinic to growto roughly 150 new cases per year when it reaches maturity.

BRAIN TUMOR CLINIC OPENS AT BROWN

Members of the Genitourinary Multidisciplinary Clinic, led byDr. Damian Laber (center), discuss treatment options.

An Alaskan woman with a rare eyecancer; a baby bottle nipple with the tipfilled with lead; and the personal touchof the UofL Department of RadiationOncology. All these things combined toequal another James Graham BrownCancer Center success story.

After drug therapy at Duke Universityfailed to help, Rebecca Hinsberger, whohas lived for thirty years in Alaska, calledthe James Graham Brown Cancer Center.She had heard of the specialized work inradiation oncology performed there byUofL School of Medicine Dean EdwardHalperin, MD.

A bacterial infection in Ms. Hinsberger’seyes had turned into conjunctivallymphoma. The tumors covered someof the white of her eyes, folding onto theinside of the eyelids.

“Every case is different,” Dr. Halperinexplains. “The tumor is never in exactlythe same location. The stakes are veryhigh. Shielding is very complicated.If the lenses are exposed to even a smallamount of radiation it increases thechances of cataract formation.”

“I went to two other radiationoncologists, but they didn’t havespecial equipment to protect my eyes,”Ms. Hinsberger notes.

At the Brown Cancer Center, lead shieldsare made to the specifications of eachpatient. For the eye lens itself,Dr. Halperin has used a drinking strawfilled with lead positioned above the eye.However, concerned about the rigidnature of the straw, Brown CancerCenter Chief of Physics Michael Mills,PhD, used his imagination to create anew approach.

“Occasionally we have to be clever,”says Dr. Mills. “I stopped at Walgreenson the way home from work andlooked over the selection of babybottle nipples.”

He learned that baby bottle nipplescome in an assortment of sizes and,as it happened, the largest available waswhat was needed. He filled the tip ofthe nipple he had chosen with lead, and,after some rigorous testing, found thatthe nipple protected just the rightamount of tissue.

Dean Halperin says using a nipple alsohas a safety benefit.

“If the patient were to be startled, orjump, the nipple’s pliability allows it togive as needed.”

After two visits to Louisville fortreatment, Ms. Hinsberger’s eyesightis intact and the cancer appears tobe gone.

Although thrilled with the results,Dr. Mills was a little amused by the

attention paid to this case, which wasthe focus of a report on WAVE-3, theLouisville NBC affiliate, and was alsopicked up in more than a dozen othercities around the country.

“We do creative little things like this allthe time,” Dr. Mills said with a smile. �

15FALL 2009

Rebecca’s story

Watch Rebecca’s story at www.browncancercenter.org

Cancer SurvivorRebecca Hinsberger

J A M E S G R A H A MBROWN CANCER CENTER529 South Jackson StreetLouisville, KY 40202

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PAIDLOUISVILLE, KYPERMIT NO 879

mark your calendar... WHAT MAKES THE BROWNCANCER CENTER DIFFERENT?

The James Graham Brown Cancer Center

at the University of Louisville is an academic

cancer center. Our physician-scientists are on

the forefront of cancer treatment discoveries,

and they bring this knowledge to patient

treatment and care.

Our mission is to generate new knowledge

relating to the nature of cancer, and to

create new and more effective approaches

to prevention, diagnosis and therapy,

while delivering medical advances with

compassion and respect to cancer patients

throughout our region.

How can I donate?

You may make a tax-deductible gift by

visiting www.browncancercenter.org.To learn more about how you can support

the work of the James Graham Brown

Cancer Center, please contact Kelly Wesley,Director of Development, at 502-562-4642or kelly.wesley@louisville.edu.

w w w . b r o w n c a n c e r c e n t e r . o r g

For more information about any of these events, please call 502-562-8021.

Or, visit www.browncancercenter.org for additional information regarding all

upcoming events and classes at the Mint Jubilee Cancer Resource Center.

10/20 Mobile Mammography screening - YMCA - Southwest Family Branch

10/24 Mobile Mammography screening - Baptist Church of Jeffersontown

10/26 Mobile Mammography screening - The Clifton Center

10/29 Horses and Hope special event - Keeneland

11/11 Minds Behind the Cure Brown Cancer Center Tour - Clinical

11/14 Horses and Hope special event - Churchill Downs

11/23 Horses and Hope Mobile Mammography screening -Churchill Downs

2/5 Horses and Hope Mobile Mammography screening - Turfway

4/30 Horses and Hope special event - Churchill Downs - Oaks