SCCA Network News, Issue 20 Fall 2013
In this issue:
- Network in the Community
- Cytoreductive Surgery for Metastatic Kidney Cancer
- Columbia Basin Hematology & Oncology
- Eric Gamboa, MD
- Confluence Health
- SCCA Expands Cancer Care to North Seattle
- Edmond Marzbani, MD
- Clinical Trial Opportunities
Relay for Life – Olympic Medical Cancer Center
In partnership, Seattle Cancer Care Alliance (SCCA) and Olympic Medical Cancer Center (OMCC) proudly sponsored this year’s Relay for Life event in Sequim on August 9. Leaders from both organizations attended the opening ceremonies, along with members of OMCC staff.
Over 50 employees and family members participated in the event as part of the OMCC Cancer Warrior Team. The team raised $1,800 for the American Cancer Society’s patient support programs at OMCC including Look Good Feel Better, Reach to Recovery, and Road to Recovery, as well as the wig program and health manager programs.
Par Tee Golf Classic - Skagit Valley Hospital
On June 28, 152 golfers played in the 10th Annual Par Tee Golf Classic, at the Skagit Golf & Country Club in Burlington, Wash. SCCA helped sponsor the event and provided pilsner glasses and golf towels to all participants.
This year’s event raised a record gross $61,214 with proceeds benefiting Skagit Valley Hospital’s Cancer Care Patient Assistance Fund and the Special Observation Cardiac Recovery remodel project.
To cut or not to cut? Cytoreductive nephrectomy, or removal of the tumor-bearing kidney, may benefit survival outcomes for men and women with newly diagnosed metastatic kidney cancer. But the surgery can be morbid and delay the start of medical therapies. Not all kidney cancer patients should undergo cytoreductive nephrectomy, so community physicians often turn to our university-based faculty to determine the best treatment course for their hardest-to-treat patients.
SCCA urologist John L. Gore, MD, MS and medical oncologist Scott S. Tykodi, MD, PhD are offering continuing medical education on this topic throughout the Pacific Northwest this fall.
Approximately 65,000 new kidney cancer cases will be diagnosed in 2013, and 13,680 patients will die from their kidney cancers. About 20 percent of kidney cancer patients have distant metastases at diagnosis. Historically, immunotherapy with interferon-alpha or interleukin-2 had been the mainstays of kidney cancer therapy. More recently, the development of targeted therapies has substantially changed the treatment approach for most patients with kidney cancer. These therapies affect the cancer’s ability to grow new blood vessels, a key mechanism by which kidney cancers grow.
“Predominantly, good performance status patients do better with nephrectomy followed by either immune therapy using high-dose interleukin-2 or using the newer targeted agents,” Tykodi stated. “And most studies of targeted kidney agents are based heavily on nephrectomized patients. Nephrectomy doesn’t appear to be beneficial for poor risk patients.”
Cytoreductive nephrectomy helps palliate local symptoms such as pain or recurrent hematuria associated with the primary tumor and obviates concerns about progression of the main tumor if left in place. Randomized studies have also shown improvement in patient survival rates when treatment includes cytoreductive nephrectomy followed by systemic therapy with interferon.
Though interferon-alpha is no longer commonly used, the potential therapeutic benefit of the addition of surgery to treatment for metastatic kidney cancer, and is one of several that Gore and Tykodi use to represent the benefits of cytoreductive nephrectomy. Ongoing trials will evaluate whether the survival benefit seen with interferon-alpha also applies to newer targeted therapies. The biological explanation for better survival associated with cytoreductive nephrectomy surgery is not well understood. Nephrectomy may remove endogenous pro-angiogenic proteins such as vascular endothelial growth factor (VEGF) that could promote tumor growth and metastases and/or affect response to subsequent anti-VEGF therapy. Nephrectomy may also help relieve immune suppression mediated by large tumor bulk.
SCCA continues to offer immunotherapy with high-dose interleukin-2 to select patients with metastatic kidney cancer. Interleukin-2 treatment can result in a complete response for a small percentage of kidney cancer patients and is invariably combined with cytoreductive nephrectomy. Patients who qualify for this combined treatment would have excellent performance status. Poor risk metastatic kidney cancer would not be treated with this regimen.
At Columbia Basin Hematology and Oncology (CBHO), nurse practitioners (NPs) have become an increasingly important part of the core medical team. A shortage of medical oncologists is developing, and the demands on physician time have become more intense. At CBHO, the role of nurse practitioners has evolved to include a wide range of duties, freeing up physician time for new patients and complex problems.
Traditionally, NPs have served only two functions in oncology care: seeing routine follow-ups and performing basic procedures. But as their competence and confidence have increased, NPs have proven their ability to add value in unique ways and are becoming vital to CBHO’s ability to provide palliative care, clinical trials, urgent care, extended hours, and hospital medicine.
Lynne Allen, a certified oncology NP, spends most of her time acting as hospitalist for our practice. She sees and admits our patients and provides oncology input in the hospital setting. This increases patient safety and comfort by ensuring continuity of care, and also makes it possible for a patient’s oncologist to maintain contact without having to take time from each day to make rounds. Lynne does not currently admit patients through the emergency department, but we anticipate that she will eventually. We are currently training other NPs to work as hospitalists and our goal is to have a hospitalist available to care for our hospitalized patients at all times.
As more NPs enter the field of oncology, their role will continue to expand. If the expansion is carefully planned, it will improve patient care and allow physicians to focus on the aspects of care for which they are uniquely trained.
Columbia Basin Hematology & Oncology
Eric Gamboa, MD is a medical oncologist and hematologist at CBHO. He treats a wide variety of solid tumors and hematologic malignancies, but has a special interest in the treatment of patients with gynecologic and genitourinary malignancies.
Gamboa received his medical degree from the University of the Philippines in 2003. He completed his residency in internal medicine at Akron General Medical Center and was appointed chief resident in his third year. He went on to pursue a fellowship in hematology and medical oncology at St. Luke’s Roosevelt Hospital, an affiliate of Columbia University in New York. His work has appeared in the Journal of Clinical Oncology, Clinical Colorectal Cancer, and Clinical Lymphoma, Myeloma & Leukemia. He has presented papers on his work at the scientific meetings of the American College of Physicians and the American Society of Hematology.
As the son of a breast cancer survivor, Gamboa approaches his work with concern for the personal and emotional well-being of his patients. His philosophy of patient care was perhaps best expressed by a patient who wrote to him, “Thank you for taking care of my wellness, and not just my illness.”
Formed in 2013, Confluence Health is an affiliation between Wenatchee Valley Medical Center and Central Washington Hospital. An integrated rural health care delivery system, Confluence Health includes two hospitals providing multi-specialty care with over 30 service lines, and primary care in 10 communities across North Central Washington. There are over 225 physicians and 100 advanced practice clinicians that serve an area of approximately 12,000 square miles and cover nearly every corner of the region.
The Confluence Health Cancer Program offers a full range of medical services and a multidisciplinary team approach to patient care. We provide state-of-the-art pre-treatment evaluation, staging, treatment, and clinical follow-up for several hundred patients each year. Our cancer program includes medical oncology, radiation oncology, nurse navigators, surgery, survivorship programs, and palliative care, as well as outreach and infusion services provided in Omak and Moses Lake.
In early September, Seattle Cancer Care Alliance (SCCA) opened a medical oncology clinic at UW Medicine’s Northwest Hospital & Medical Center in North Seattle. This clinic joins SCCA Radiation Oncology at Northwest Hospital and Seattle Cancer Care Alliance Proton Therapy, A ProCure Center, located on the same campus, providing comprehensive cancer care and access to leading-edge cancer treatments and clinical studies to North Seattle residents.
SCCA Medical Oncology
UW Medicine physicians treat patients at SCCA Medical Oncology at Northwest Hospital just as they do at the SCCA clinic at South Lake Union. Services include an onsite pharmacy, laboratory, diagnostic services, and infusion, physical therapy, nutrition counseling, with patient navigator assistance available. Lymphedema therapy, pain management, as well as support groups, classes, and a free hat and wig bank are available to patients.
SCCA Radiation Oncology
SCCA Radiation Oncology treats adult patients for any primary cancer, including breast, colon, lung, and prostate cancer. A new Elekta Synergy linear accelerator with electron and photon capability was installed in 2010. The facility uses a 16-slice, wide-bore GE LightSpeed CT simulator to target tumors and minimize damage to healthy tissue, the Philips Healthcare medical dosimetry treatment planning system, and Elekta MOSAIQ electronic medical record software.
SCCA Proton Therapy
SCCA Proton Therapy, A ProCure Center opened last March. An advanced form of radiation treatment, proton therapy can be calibrated with great precision to selectively kill cancer cells. Over the past seven months, proton therapy at SCCA has been used to treat a steady stream of patients including those with central nervous system cancers (adults and children), prostate and other genitourinary cancers, lung, and recently liver cancer.
There are 12 proton therapy centers across the country. “Our disease experts are working toward identifying the cancer patients who will benefit the most from proton radiotherapy, often developing comparative treatment plans for both protons and conventional X-rays to identify the best treatment for each patient,” said associate medical director Ramesh Rengan, MD, PhD.
In many cases SCCA radiation oncologists have the option to treat patients with traditional X-ray (photon) treatment or with proton therapy. Rengan explains that often it isn’t clear whether patients would be better served with protons or photons, so comparative planning is used to model both options. If, during the comparative planning process, it is discovered that protons do not provide a meaningful benefit, SCCA radiation oncologists will recommend X-ray therapy. “Our goal is for the patient to be treated with the optimal modality for their cancer, whether that is X-rays or protons. The comparative planning process helps us ensure that this happens. We then discuss with the referring physician the best way to deliver this care to the patient. It is not unusual for us to find X-rays to be equivalent and to recommend photons,” Rengan said.
Patients who clearly benefit from proton therapy include those with tumors near critical structures and those who require re-irradiation after initial treatment with X-rays. Oftentimes, these patients cannot be re-treated safely with conventional X-rays or photons because of excess dose to healthy tissue. For these patients, protons may offer the only therapeutic option for treatment.
Physicians referring patients to an SCCA clinic at Northwest Hospital will receive copies of consultation notes as well as copies of post-treatment summaries. SCCA physicians frequently have personal contact with referring providers as part of the treatment decision-making process. Normal follow-up occurs for patients four to six weeks after treatment is finished, according to follow-up algorithms. But who the patient ultimately sees for the follow-up visit(s) is determined with the referring provider.
SCCA Medical Oncology at Northwest Hospital
p: (206) 368-5800
SCCA Radiation Oncology at Northwest Hospital
p: (206) 368-5808
SCCA Proton Therapy, A ProCure Center
p: (877) 897-7628
SCCA Medical Oncology at Northwest Hospital
Initially, Edmond Marzbani, MD medical director for SCCA Medical Oncology at UW Medicine’s Northwest Hospital & Medical Center, wanted to pursue a research-based career. After spending time in the laboratory, he realized something else altogether. “I found it difficult at times to trace the consequences of my work to the cure of human disease,” he said. “The connections were, at times, frustratingly abstract and this led me to pursue medical training.”
Unfortunately, similar to most, Marzbani has had cancer affect his friends and family members and these experiences helped inform his decision to pursue a career in oncology. “Early in medical school, I recognized the strong bond that oncologists often have with their patients and patients’ families, and this had a great appeal to me,” he said.
Marzbani spent much of the research portion of his fellowship as part of the University of Washington’s Tumor Vaccine Group with a focus on clinical research and translational science. His focus there involved investigating the efficacy of a vaccine directed against HER-2/neu for the prevention and treatment of high risk breast cancer. “I hope to continue my collaboration with the Tumor Vaccine Group and other SCCA-based research groups by facilitating high priority clinical trials at the Northwest Hospital site,” he said. “While my focus is providing expert oncology care, I think it is important to offer high quality clinical trials when appropriate.”
In his lifetime, Marzbani, like all oncologists, hopes to see the eradication of cancer. “This will require improvements both in the early prevention and diagnosis of cancer,” he said. “I also anticipate there will be a shift from toxic chemotherapy to well tolerated\ targeted therapies in the next 10 years, which will certainly improve the quality of life of patients receiving treatment. The SCCA clinic at Northwest Hospital will be at the forefront of using these new therapies as they are approved.”
Outside of work, Marzbani enjoys reading fiction, playing guitar, songwriting, and long-distance running.
- ECOG E3F05: Phase III Study of Radiation Therapy with or without Temozolomide for Symptomatic or Progressive Low-Grade Gliomas www.seattlecca.org/clinical-trials/braincancer- NCT00978458.cfm
- RTOG 0834/EORTC 26053_22054: Phase III Trial on Concurrent and Adjuvant Temozolomide Chemotherapy in Non-1p/19q Deleted Anaplastic Glioma. The CATNON Intergroup Trial www.seattlecca.org/clinical-trials/brain-NCT00626990.cfm
- RTOG 1205: Randomized Phase II Trial of Concurrent Bevacizumab and Re-Irradiation Versus Bevacizumab Alone as Treatment for Recurrent Glioblastoma www.seattlecca.org/clinical-trials/glioblastoma-NCT01730950.cfm
- RTOG 1005: A Phase III Trial of Accelerated Whole Breast Irradiation with Hypofractionation Plus Concurrent Boost Versus Standard Whole Breast Irradiation Plus Sequential Boost for Early-Stage Breast Cancer www.seattlecca.org/clinical-trials/breastcancer- NCT01349322.cfm
- FHCRC 6628: Combined Targeted Therapies for Triple Negative Advanced Breast Cancer—A Phase II Trial of Weekly Nab-Paclitaxel and Bevacizumab Followed by Maintenance Targeted Therapy with Bevacizumab and Erlotinib www.seattlecca.org/clinical-trials/breastcancer- NCT00733408.cfm
- UW School of Nursing: Helping Her Heal, A Program for Spouses of Women with Breast Cancer Contact: Mary Ellen Shands, RN, MN at (206) 685-0837 or firstname.lastname@example.org.
- RTOG 1010: A Phase III Trial Evaluating the Addition of Trastuzumab to Trimodality Treatment of HER2- Overexpressing Esophageal Adenocarcinoma www.seattlecca.org/clinical-trials/esophageal-NCT01196390.cfm
- RTOG 0926: A Phase II Protocol for Patients with Stage TI Bladder Cancer to Evaluate Selective Bladder Preserving Treatment by Radiation Therapy Concurrent with Radiosensitizing Chemotherapy Following a Thorough Transurethral Surgical Re-Staging www.seattlecca.org/clinical-trials/bladder-cancer-NCT00981656.cfm
- RTOG 0534: A Phase III Trial of Short Term Androgen Deprivation with Pelvic Lymph Node or Prostate Bed Only Radiotherapy (SPPORT) in Prostate Cancer Patients with a Rising PSA After Radical Prostatectomy www.seattlecca.org/clinical-trials/prostatecancer-NCT00567580.cfm
Head & Neck
- RTOG 0920: A Phase III Study of Postoperative Radiation Therapy (IMRT) +/- Cetuximab for Locally Advanced Resected Head and Neck Cancer www.seattlecca.org/clinical-trials/headneck-cancer- NCT01311063.cfm
- Spectrum Protocol SPI-ZEV-11-301: A Phase III, Open-Label, Multicenter, Randomized Study of Sequential Zevalin (ibritumomab tiuxetan) versus Observation in Patients at Least 60 Years of Age with Newly Diagnosed Diffuse Large B-cell Lymphoma in PET-negative Complete Remission After R-CHOP or R-CHOP-like Therapy (ZEST) www.seattlecca.org/clinical-trials/Lymphoma-NCT01510184.cfm
- Endocyte EC-FV-06: A Randomized Double-Blind Phase III Trial Comparing EC145 and Pegylated Liposomal Doxorubicin (Pld/Doxil®/Caelyx®) in Combination Versus PLD in Subjects with Platinum-Resistant Ovarian Cancer www.seattlecca.org/clinical-trials/gyncancer-NCT01170650.cfm
- FHCRC 7159: Advanced PET/CT Imaging for Clinical Trials
- UW School of Nursing: Enhancing Connections Telephone Program Nurses at the University of Washington School of Nursing are studying the effectiveness of an educational program for mothers with a recent diagnosis of breast cancer and who have an 8-12 year old child. This program is available at no charge. Contact: Mary Ellen Shands, RN, MN at (206) 685-0837 or email@example.com.