Georgetown University’s Newspaper of Record since 1920

The Hoya

Georgetown University’s Newspaper of Record since 1920

The Hoya

Georgetown University’s Newspaper of Record since 1920

The Hoya

On the Cutting Edge: Inside the Lombardi Cancer Center

A 10-year-old boy is suffering from severe leg pain. After a few dead-end diagnoses, his doctor orders a CT scan and the results are bad – the scan reveals a tumor in his thigh bone. After further testing, the doctor confirms that the boy has Ewing’s sarcoma, a very rare bone cancer most common among children and teenagers.

The boy faces a grim outlook and a series of debilitating treatments: Intensive chemotherapy, radiation therapy and surgery are his only options for attempting an unlikely recovery. Even if he survives, he might never be able to walk again.

Scientists and physicians at the Georgetown University Lombardi Comprehensive Cancer Center recently developed a drug that effectively stops the growth of Ewing’s sarcoma, however. Since the disease is so rare, most pharmaceutical companies were not interested in producing such a drug, according to Louis Weiner, the center’s director. But Jeffrey Toretsky, a pediatric oncologist and associate professor at the center, found that the disease has a genetic abnormality called EWS/FLI-1, which forms as a result of a translocation, or a “jumping,” of chromosome pieces.

It was the beginning of a breakthrough.

Toretsky joined Milton Brown, director of the Lombardi Center’s drug discovery program, to identify a molecule that blocked the effect of the EWS/FLI-1 gene – making feasible the new drug, which will soon be available to patients in clinics.

Weiner points to this as the sort of advanced research that could catapult the center into the ranks of the top research and treatment facilities in the nation.

Since he was recruited and appointed director in 2007 by Howard Federoff, executive vice president for health sciences at Georgetown UniversityMedical Center, Weiner has worked to reorganize research and develop new initiatives to maximize the center’s progress fighting diseases like Ewing’s sarcoma. The Lombardi Center has the distinction of being the only comprehensive cancer center in D.C. accredited by the National Cancer Institute; the center has been noted for a globally acclaimed breast cancer program, the development of the HPV vaccine – which helps to prevent cervical cancer – and its well-regarded research divisions.

But Weiner believes the key to further growth and improvement lies in interdisciplinary research.

“I believe firmly that progress occurs when disciplines collide. At the interfaces of two disciplines is where you can get novel perspectives and observations and skill sets that can help energize fields of research,” Weiner said.

**Breaking Socioeconomic Barriers**

When Weiner first came to Georgetown from the Fox Chase Cancer Center in Philadelphia, he wanted to make the challenges of improving health in minority groups and addressing health disparities in the D.C. area two of Lombardi’s major institutional priorities.

“When I got here to D.C., I was impressed by and struck by the very high rate of breast cancer death and cancer mortality and incidence in [D.C.],” Weiner said. “While Georgetown has always rightfully thought of itself as a world-class university and as a university that reaches out to the world, here we are in our own city, facing this huge challenge of health disparities.”

Weiner hired Lucile Adams-Campbell, former director of the Howard University Cancer Center, as the Lombardi Center’s new associate director for minority health and disparities. He then spearheaded the creation of another enterprise, the Capital Breast Care Center.

“[The CBCC] is devoted to providing mammography free of charge to anybody, regardless of her ability to pay or to have insurance to cover her expenses,” Weiner said.

Weiner said he believes Georgetown is an inspiring place to make meaningful contributions to global health challenges.

“One of the things I love about Georgetown is that it always fights above its weight – it always makes a disproportionate impact whenever it tries to do something, and it’s our goal to live up to that legacy and help to find new standards of excellence by really making a difference on minority health and health disparities in the District and the surrounding areas,” Weiner said.

John Marshall, chief of the hematology/oncology division, associate director for clinical care and leader of the center’s Developmental Therapeutics Program, lauded MedStar Health for its work in facilitating collaborative research, particularly in coordinating access to clinical trials through D.C. and Baltimore. MedStar Health took over Georgetown University Hospital after the university sold it in 2000 after years of deficits.

**Promoting Personalized Medicine**

Approaches to research have grown more sophisticated at the Lombardi Center over the past few years, according to Marshall.

“Our old approach was, to liken it to a World War I analogy, to burn that field in France and hope there were bad guys in there. Our new war is a war on terrorism, and you cannot burn entire countries and expect to win the war on terror – you will not get the last cell, so to speak,” Marshall said.

In other words, when new medicine was developed, it was administered to a broad range of people in the hope that it would work on some of them. With new research and technology, Lombardi Center scientists now know that while cancers in different patients might ostensibly look the same, they might not be identical on a molecular level. This concept has fueled the creation of many different initiatives focused on personalizing medicine for patients.

Weiner’s vision for personalized medicine includes the development of the Georgetown Database of Cancer, an ongoing effort to create an integrated clinical and molecular database for all forms of cancer. Weiner said this database can connect physicians to the wide range of molecular abnormalities with information about illness likelihood, post-operative recovery and new treatments.

“Wouldn’t it be nice to give people more precise information to help them make decisions about their care?” Weiner asked.

Subha Madhavan, who was hired by Weiner as the Lombardi Center’s first director of clinical research informatics, said in January that challenges remain with the database project.

“New ideas come up when we connect the data,” Madhavan said. “But we are still in the very early phases of the project.”

Weiner also cited the database as a principal reason for his decision to come to Georgetown.

“What’s so exciting for me is when I was being recruited here, I was struck by the fact that [Federoff] and [University President John J. DeGioia] were interested in doing exactly this thing, and I was looking for a place where I could do this kind of integrated database development – so, for me, this was like a marriage made in heaven,” he said.

**Harnessing the Immune System to Fight Cancer**

arshall has been a pioneer in the development of cancer vaccines and has been collaborating with investigators from the National Cancer Institute to design clinical trials that test the ability of poxvirus-based vaccines to halt the spread of various cancers, according to Weiner.

“The idea is that you’ll introduce the gene that will code for the target that you want to raise the body’s immune response against, or the genes, because you can package multiple genes into the virus. Now that virus . is inoculated, typically under the skin, and over a period of time, [a] protein is produced by the virus, and the body sees that protein as being foreign . and it mounts an immune response against that protein,” Weiner said. “Whenever it sees that protein, if that protein is expressed by a cancer cell, it will be primed to attack that cancer cell.”

arshall has worked extensively with these viruses to identify the best one to use for cancer treatment and address matters of safety and efficiency.

“We’re talking about using your immune system to treat cancer, to try and dial up your immune system to go find cancer cells and kill them,” Marshall said. “It’s clearly capable of doing that, it just needs directing.”

arshall said this treatment work has grown extensively at the Lombardi Center.

“There’s a lot of cool science up there on the other side of the Leavey Center,” Marshall said.

**Focusing on Gastrointestinal Cancer**

Though gastrointestinal cancers are among the deadliest forms of cancer, drug discovery has not been as extensively targeted toward GI cancers.

Two weeks ago, however, the Lombardi Center announced the creation of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers, which will fund GI cancer research and specialized patient care and drug development for a range of cancers, including pancreatic, liver and esophageal cancer.

According to a university press release, Jeanne Ruesch donated $6.75 million in memory of her husband, who died of pancreatic cancer in October 2004 at the age of 64 after receiving treatment at the Lombardi Center.

“When we look at our cancer center and the expertise and the interests, we are positioned ideally to make a major impact, not a minor impact, on the outcome of GI cancer patients,” said Marshall, who treated Ruesch.

Weiner emphasized the importance of the Reusch donation to the future of the Lombardi Center.

“Catalyzed by the Ruesch gift, we’re now going to be able to really develop one of the world’s leading programs to address the problem of gastrointestinal cancers, going right from the basic laboratory into the clinic into the population and all the way out to affecting policy – so we’re immensely excited about that and very grateful to Mrs. Ruesch and her family for this magnificent donation,” Weiner said.

Weiner emphasized that the new Ruesch Center would be the Lombardi Center’s “next big enterprise.” It seems clear that enterprising spirit is hardly missing from the mission and staff of the Lombardi Center – one can only guess where that resolve will take it.

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