Inside the Tulane Cancer Center
Spring 2002 Newsletter
Headlines in this Issue
Lung Cancer Program Offers Full Spectrum of Care
Introducing the Tulane Cancer Center Scarf
SELECT Prostate Cancer Prevention Study Launched
Clinical Trials for AIDS Malignancy Patients
NFL Gridiron Glamour Benefits Tulane Cancer Center
Benefits of Art Therapy for Cancer Patients
Immunity to Cancer? Dendritic Cells May Hold the Answer
A Message from the Director
Welcome to new faculty member Marshall Schorin, M.D.
Accolades: Faculty honors and awards
Index to all archived issues
Index to archived articles by topic
Editorial Staff & Contacts


Tulane's Lung Cancer Program:
Offering Our Patients the Full Spectrum of Care
It happens every Monday at noon in the Tulane Cancer Center Comprehensive Clinic. A sea of white coats fills a conference room. It's a gathering of medical experts, the only dedicated Lung Tumor Board in the area. Pathologists, radiologists, pulmonologists, medical and radiation oncologists, thoracic surgeons, and often referring community physicians come together to discuss the most effective course of action for every new Tulane lung cancer patient. That's the strength of multidisciplinary care -- multiple expert opinions in one place, in one visit. But that's only one facet of Tulane's Lung Program. From groundbreaking basic and clinical research to cancer prevention and education efforts to minimally invasive diagnosis and early intervention to state-of-the-art treatment options to sensitive, respectful palliation, Tulane's Lung Cancer Program leads all others in the Gulf South region in offering the entire spectrum of patient-centered care.

Minimally Invasive Diagnosis / Treatment Options
"We can often offer our patients answers without surgery," said Kevin Kovitz, M.D., associate professor of Medicine in the Section of Pulmonary Diseases, Critical Care and Environmental Medicine and director of Interventional Pulmonology and Medical Critical Care at Tulane. Translation -- no incision. "When others cut to examine lymph nodes near the airway, we can now use endobronchial ultrasound to more precisely pinpoint the nodes," said Dr. Kovitz. In fact, Tulane recently performed the first endobronchial ultrasound procedure in the state. "We also have a longstanding successful experience using transbronchial needle aspiration (inserting a fine needle through a bronchoscope, puncturing the airway wall and taking representative cells from the nearby node) for rapid, painless outpatient biopsies, and ultrasound enhances this approach," he said. With access to such leading-edge equipment and techniques, the focus on minimally invasive diagnosis, staging, and treatments can be maintained at Tulane like nowhere else in the region. "By far, we have the largest experience with pulmonary lasers and stents in the area, and one of the largest in the country," said Dr. Kovitz. Stents, small props used to keep the airway open for cancer patients whose tumors are obstructing or completely blocking the passage of air, can be placed quickly and easily through the use of a bronchoscope, relieving symptoms and often precluding the need for ventilators. "Eighty to ninety percent of the patients with advanced disease who come to us on ventilators are typically off their ventilators within 24 hours and often back home with their families within 48," said Dr. Kovitz. This is a radical departure from other programs where similar patients might spend several weeks on a ventilator, with only a small percentage coming off at all. The steady goal is to improve quality of life while exploring all treatment options available.

Dr. Kovitz performs a stent removal

A Solid Foundation in Basic and Clinical Research
Of course, these treatment options wouldn't be available without the groundbreaking basic and clinical research that forms the other arm of the Tulane Lung Cancer Program. Tulane has one of the most active pulmonary research groups in the Gulf South. "A sturdy foundation in basic science right here at Tulane is what allows our clinicians to be able to offer new and innovative treatments to our patients," said Arnold R. Brody, Ph.D., professor of Pathology and chief of the Lung Biology Program at Tulane. This group of approximately 30 researchers, supported by a $2.6 million Health Excellence Fund grant, performs independent investigations into the causes of lung cancer. "Right now, we're looking at the mechanism by which inhaled agents cause lung cancer," said Dr. Brody. This involves first developing a viable mouse model lacking specific tumor suppressor genes so that a predictable pattern of lung cancer develops. "Once the mouse model has been established, we can then use our exposure facilities to expose these mice to known carcinogens, like tobacco smoke, asbestos, or combinations of carcinogenic agents, in order to understand how lung cancers develop." Dr. Brody's team is also looking into gene therapy approaches to manipulate cancers as they develop or to prevent them from developing in the first place.

Tulane is also leading the way in the clinical research arena. Our clinical research infrastrucutre, consisting of core faculty researchers as well as an active network of twelve community-based practices, provides wide access to a broad menu of innovative clinical trials to patients throughout the Gulf South region. "The constant focus of our clinical research effort is to improve the curability of lung cancer," said Raja Mudad, M.D., associate professor and associate section chief of Hematology and Medical Oncology and director of Hematology-Oncology at Veterans Administration Medical Center in New Orleans. Dr. Mudad recently presented the results of his innovative study of 23 patients with stage III lung cancer using new combinations of radiation with chemotherapy at the 12th International Congress of Anti-Cancer Treatment in Paris. This study, the results of which have been submitted for publication, has been expanded to accrue patients nationwide by the National Cancer Institute's Southwest Oncology Group, with Dr. Mudad serving as the national principal investigator.

Other Lung Cancer Program clinical trials offered now at Tulane include a test of an oral medication, Iressa, in combination with chemotherapy (study S0023). "We're attempting to discover whether this combination improves results for patients who have failed all other forms of therapy," said Dr. Mudad. And Lucien A. Nedzi, M.D., assistant professor of Radiation Oncolgy and an expert in intensity-modulated radiation therapy (IMRT), is the only radiation oncologist in the area who will soon be offering trials which combine IMRT with chemotherapy to lung cancer patients. IMRT will allow Dr. Nedzi to increase the dosage of radiation to very specific areas (i.e., areas which are thicker than others) of a tumor.

Psychological and Palliative Care
Another benefit for patients of the Tulane Lung Cancer Program is the psychological care accessible to them through the Patricia Trost Friedler Cancer Counseling Center (PTFCCC). A diagnosis of cancer is truly a life-altering event. Timothy Pearman, Ph.D., director of the PTFCCC, offers patients access to a wealth of informational resources regarding their diagnosis, as well as the psychological support needed to successfully complete treatment and rehabilitation at the Tulane Cancer Center Comprehensive Clinic. Despite efforts to improve the curability of lung cancer, it remains the leading cause of cancer deaths in both men and women in the United States. "There are some patients with advanced disease for whom there is no cure. These patients require sensitive palliation," said Dr. Kovitz. "The goal of our palliative care program is to explore all treatment options available for managing the patient's symptoms while never losing sight of the importance of quality of life issues. We want to allow our patients to go home and be with their families rather than end their lives in a hospital on a machine." From the lab bench to the bedside, Tulane's Lung Cancer Program meets the needs of our patients and their families every step of the way. At the end of the day, however, it's what our patients think that matters most. "Our patients like us," said Dr. Kovitz. "We welcome them as mature, responsible adults who participate in their own care. We work with our patients, bring our research to bear, offer them the opinions of a great number of experts, as well as access to the full gamut of therapies, simple to complex, all in one location. And through it all, we never lose sight of the individual."
Tulane's Lung Cancer Team personifies the multidisciplinary approach.

Introducing A Gift That Gives Back....For the Ladies!
Two years ago, the Tulane Cancer Center teamed up with the Department of Urology to introduce an innovative approach to raising awareness of prostate cancer and funds for prostate cancer research at Tulane -- the prostate cancer necktie! Since its introduction sales of this tie at the Tulane University bookstores and via the Tulane Cancer Center web site have raised valuable funds for Tulane's prostate cancer research program. While the necktie program gives men an opportunity to accessorize and show support for cancer research, it quickly became apparent that there was a need for a similar fashion accessory with meaning for women. And so, the Tulane Cancer Center scarf was born.

Designed by Alexa Pulitzer of the Randa Tie Corporation, Tulane Cancer Center's ladies scarf is both beautiful and meaningful. "We wanted the ladies who purchased or received this scarf as a gift to wear it," said Pulitzer. The 100% silk scarf is hand finished and measures 10" x 48". It is available in two color schemes-Tulane green and blue with gray highlights, and wine and gray with beige highlights. Layered artistically over its colorful background, the scarf incorporates several of the architectural elements found at the LaSalle Street entrance to the original Medical School building and on the bronze doors mounted in Tulane's Rudolf Matas Medical Library. A brief description of the symbolism incorporated into the fabric and its significance to Tulane is included with each scarf purchased.

We are offering our scarf as a "thank you" for your tax-deductible donation of $50 or more to the Tulane Cancer Center Research Fund. We also continue to offer our ties as a "thank you" for your tax-deductible donation of $50 or more to our Prostate Cancer Research Fund. You can make your donations by calling Keadren Green at the Tulane Cancer Center, (504) 988-6064, or by sending a check (made payable to the Tulane Cancer Center) to 1430 Tulane Avenue, SL-68, New Orleans, Louisiana, 70112, attention: Keadren Green.

The Tulane Cancer Center is Seeking a Few SELECT Men
to Take Part in Largest-Ever Prostate Cancer Prevention Study
Can two common over-the-counter dietary supplements actually help prevent prostate cancer? That's what a new study launched recently by the National Cancer Institute and available through the Southwest Oncology Group (SWOG) will attempt to discover.

The Tulane Cancer Center, a SWOG member site, is looking for a few healthy men age 55 and older (African-American men age 50 and older) for the largest-ever prostate cancer prevention study. The Selenium and Vitamin E Cancer Prevention Trial, or SELECT, seeks to learn if these two dietary supplements can protect against prostate cancer, the second most common form of cancer in men after skin cancer.

Selenium and vitamin E, both naturally occurring nutrients, are antioxidants, capable of neutralizing toxins known as "free radicals" that might otherwise damage the genetic material of cells, possibly leading to cancer. These nutrients were chosen for study because of the results of two other large cancer prevention trials. A 1996 study on the effects of selenium on nonmelanoma skin cancer found that selenium did not reduce skin cancer but did decrease the incidence of prostate cancer in men by more than 60 percent. A 1998 study of vitamin E and beta carotene's effect on lung cancer showed 32 percent fewer new cases of prostate cancer among those who took vitamin E. "SELECT is the first study designed to look directly at the effects of vitamin E and selenium, both separately and together, in preventing prostate cancer," said Rodney Davis, M.D., the study's principal investigator at Tulane. "When SELECT is finished, we will know more about whether these supplements can prevent prostate cancer, and this information will benefit our sons, grandsons, and future generations."

Men may be able to participate in SELECT if they:
  1. are age 55 or older (age 50 or older for African-American men),
  2. have never had prostate cancer and have not had any other cancer, except nonmelanoma skin cancer, in the last five years,
  3. are generally in good health. African-American men are eligible at age 50 rather than age 55 because they tend to get prostate cancer earlier. And, since African-American men have the highest incidence of prostate cancer in the world, they are especially encouraged to consider joining this trial. Men enrolling in the study will fill out a questionnaire on their diet and past dietary supplement use. Participants will then be randomly assigned by a national computer-based selection process to one of four groups and will take two capsules daily: one group will take 200 micrograms of selenium daily plus a placebo; another group will take 400 milligrams of vitamin E daily along with a placebo; a third group will take both selenium and vitamin E, and a final group will be given two placebos. During the study, participants will be evaluated every six months for seven to 12 years, depending on when they join. Men who join SELECT will not need to change their diet in any way, but they must stop taking any supplements they buy themselves that contain selenium or vitamin E. If participants wish to take a multivitamin, the study coordinator will provide, without charge, a specially formulated one that does not contain selenium or vitamin E.

    More than 400 sites across the United States, Puerto Rico, and Canada are recruiting a total of 32,400 men for this study. The goal is to recruit 600 men locally. The Tulane Cancer Center is joined by the Ochsner Cancer Institute and LSU's Stanley S. Scott Cancer Center to make it easy to enter the SELECT trial in New Orleans.

    Once a month, Tulane Cancer Center offers free prostate cancer screenings. For more information on our screening program or joining the SELECT study, visit the Tulane Cancer Center web site at www.canceriscurable.com or call Betty Jurisich, R.N., oncology research nurse specialist, at (504) 988-6450. The Tulane Department of Urology also offers an informational website, http://www.som.tulane.edu/departments/urology/pc.htm, which gives information about prostate health, testing and treatment options.

    SELECT fact sheet: http://www.som.tulane.edu/cancer/select.html

    Clinical Trials for AIDS Malignancy Patients
    Patients with AIDS-associated malignancies are often ineligible to participate in clinical trials for investigational cancer therapies because of their HIV. However, a grant funded by the National Institutes of Health, AIDS-Associated Malignancies Clinical Trials Consortium (AMC) offers Tulane's AIDS cancer patients alternatives. Ellen L. Zakris, M.D., associate professor of clinical Radiology, chief of Radiation Oncology, and director of Radiation Oncology Programs at Charity Hospital MCLNO and Tulane Hospital & Clinic, is principal investigator on this grant which supports several clinical trials for investigational therapies to treat AIDS patients with Kaposi's sarcoma, as well as trials for treating AIDS-associated lymphomas and solid tumors.

    There are currently six open studies at Tulane. "These clinical trials are important because they offer both the patient and the caretakers the opportunity to jointly learn how to treat the disease better," said Dr. Zakris. "It's all part of our ongoing effort to improve overall care for this patient population." Dr. Zakris (see biosketch) is also to be a co-principal investigator on an AMC protocol under development entitled Combined Modality Therapy for Anal Carcinoma in HIV Infected Patients: A Randomized Phase II Trial Evaluating the Role of Amifostine. For more information on clinical trials currently open see our clinical trials page, including trials for AIDS-associated malignancies
    Ellen L. Zakris, M.D.

    Patricia Trost Friedler Cancer Counseling Center
    "Art.Rage.Us" Exhibit Suggests Healing Power of Artistic Expression
    The Newcomb Art Gallery is hosting an exhibition entitled "Art.Rage.Us: the Art and Outrage of Breast Cancer" through June 16, 2002. Organized by The Breast Cancer Fund, the exhibit is a collection of paintings, drawings, sculpture, poetry, essays, and journals created by women who have been diagnosed with breast cancer and has been described as a very powerful show.

    "Recent articles on art therapy have suggested that non-verbal expression may be excellent for helping patients deal with emotional conflicts and feelings about life and death," said Timothy Pearman, Ph.D., assistant professor of Psychiatry and Neurology and director of the Patricia Trost Friedler Cancer Counseling Center at the Tulane Cancer Center. "I also think it can be especially helpful for patients who may not be comfortable expressing their emotions verbally."

    In response to the public health crisis of breast cancer, The Breast Cancer Fund identifies -- and advocates for elimination of -- the environmental and other preventable causes of the disease. For more information on The Breast Cancer Fund, contact them in San Francisco toll-free at (866) 760-TBCF. Contact the Patricia Trost Friedler Cancer Counseling Center at (504) 988-6313

    Throughout the run of the exhibition, several programs are planned at the Newcomb Gallery to highlight recent developments in the prevention, diagnosis, and treatment of breast cancer. For more information, contact Stacy Lafleur, program coordinator, at 862-8000, ext. 2406. Kay Minto, Nike of Mastectomy, (c)1998 Art.Rage.Us.,
    The Art and Outrage of Breast Cancer, a project of The Breast Cancer Fund
    Used with permission.

    Can We Manipulate the Immune System to Fight Cancer?
    Dendritic Cells May Hold the Answer
    "There is good evidence that each of us creates cancerous cells in our bodies throughout our lifetimes," said Tyler J. Curiel, M.D., associate professor of Medicine and chief of the Section of Hematology and Medical Oncology. "When this happens, a properly functioning immune system identifies the mutated cells as foreign invaders and kills them."

    When cancerous cells are not destroyed by the immune system, they can multiply and grow into tumors. Why does the immune system fail to reject cancer cells in these cases? To find the answer, you have to start at "ground zero" of the immune response -- the dendritic cell (DC). "These are the cells that put the immune system into motion," said Dr. Curiel. There are three known kinds of DCs. Two of them are known as "good" DCs and include DC1s; it's their job to turn the immune system on and generate killer T cells to attack invaders. "For the past 20 years, most research into cancer immunity was targeted at these fundamental immune cells," said Dr. Curiel, "while little attention has been given to the third kind of DC, known as DC2s, which were only positively identified within the past few years."

    For Dr. Curiel, in order to understand tumor growth, two basic questions needed answering: 1) Do tumors do something to keep DC1s from activating anti-tumor immunity? and 2) Do DC2s have anything to do with tumor immunity? To find the answers, Dr. Curiel and his colleagues did something no one had done before them -- they looked inside an actual human tumor. "Most researchers were looking at tumors in mice or at cells grown in Petri dishes," said Dr. Curiel. "We wanted to find a way to look into the human tumor itself to see what was going on." They collected a fluid called ascites from the abdomens of patients with ovarian cancer. This fluid is produced by the tumor and contains the tumor and immune cells. What they found was surprising. "We found DC2s," said Dr. Curiel, "not the DC1s we were expecting!"

    Dr. Curiel and his colleagues theorized that the tumor was making a factor to attract DC2s and then protect them in the harsh tumor environment. Subsequent laboratory work confirmed that ovarian cancer cells made a protein that attracted DC2s and protected them. Further, the DC2s in the tumor prevented anti-tumor immunity from developing. "It seemed the tumor had a vested interest in this process," said Dr. Curiel. "DC1 precursor cells were probably being attracted to the tumor, but the tumor was not allowing them to develop into mature DC1 cells that would make a good anti-tumor response. Instead, the tumor made additional factors that pushed these potential DC1s down another pathway so that they were prevented from mounting an anti-tumor response, while attracting DC2s and reprogramming them to suppress immunity." This led Dr. Curiel's team to the conclusion that the current technology for tumor immunotherapy wasn't going to work. Rather than build up DC1s, which is the current strategy, he thinks that we need to find a way to understand how DC2s get into tumors and how the tumor protects them so that we can find a way to turn them off. "It's similar in theory to mine sweepers clearing a field so that the soldiers can come in and do their jobs," mused Dr. Curiel. "The DC2s are the mines. If we can sweep them away, or turn them off, the DC1s can come in and create the proper immune response." This work was published in the December 2001 issue of the prestigious journal Nature Medicine, along with lead author Dr. Weiping Zou, also here at Tulane.

    Dr. Curiel and his team are now using a mouse model to study a drug that will block DC2s from entering tumors and getting the protection signal from the tumor. While it sounds promising, he warns that "manipulating the immune system could have side effects we're not yet aware of." Still, he is cautiously optimistic that this new approach to tumor immunotherapy "holds great promise." Dr. Joan Cheng from Tulane is now contributing clinical specimens to further these investigations. Other members of the Curiel tumor team include Dr. Mansour Zadeh, Ph.D., and Dr. Matthew E. Burow, Ph.D., both assistant professors in the Section of Hematology and Medical Oncology. "We are fortunate to have many skilled and dedicated collaborators both here at Tulane and around the world. Without their help we would never get so much accomplished so quickly," Dr. Curiel adds.

    A Message from the Director
    This Spring 2002 edition of Inside Tulane Cancer Center speaks for itself. Melanie Cross did a great job in selecting topics of greatest interest from the myriad of possibilities presented by the depth and breadth of activities at the Tulane Cancer Center. We highlighted our Lung Cancer Program because it presents every attribute of an academic approach to cancer care -- from the basic research in Dr. Brody's group to the unique clinical techniques of Drs. Kovitz and Nedzi to the nationally recognized, leading-edge clinical research of Dr. Mudad and the counseling resources led by Dr. Pearman. Moreover, lung cancer is such a common cancer in Louisiana, and relatively few patients realize how advantageous it is to receive their care in our academic environment. Our research programs in prostate cancer prevention and the treatment of cancers associated with HIV- AIDS are valuable assets to our region, worthy of broadcasting to our readership. We introduce new faculty: Tyler Curiel, M.D., who brings with him a group of scientists studying a new approach to immunotherapy, and Marshall Schorin, M.D., a senior clinical investigator in childhood leukemias.

    You will notice an expanded Accolades section in this issue. Please be aware that we have asked each of our members to select from among their many and varied professional accomplishments those of which they are most proud. You will, therefore, not only be apprised of the productivity of our Center, but will gain insight as to how our faculty value their accomplishments. You will notice a common theme of the importance of peer recognition in publication, grant funding, and participation in scholarly activities of national and international scope. The Tulane Cancer Center has an outstanding faculty and one of which we can all be proud. Enjoy this Spring 2002 edition and give us your feedback on its contents.

    Roy S. Weiner, M.D.
    Director of the Tulane Cancer Center
    ------------
    Welcome to new faculty: Marshall Schorin, M.D.
    The Tulane Cancer Center would like to welcome its latest full-time faculty member, Marshall Schorin, M.D., professor of Pediatrics, Section of Pediatric Hematology-Oncology. Dr. Schorin comes to us after having been at Ochsner and serving as a part-time faculty member in the Department of Pediatrics here at Tulane. "Dr. Schorin brings a wealth of experience in childhood leukemia," said Roy S. Weiner, M.D., director of the Tulane Cancer Center, "as well as a devoted patient following and a great deal of respect from among referring physicians in the region." Dr. Schorin will take over the role of principal investigator of Tulane's participation in the Children's Oncology Group, replacing Charles D. Scher, M.D. He brings with him longstanding collaborative relationships with colleagues at the Dana Farber Cancer Institute in Boston. "We hope to involve Dr. Schorin in our efforts to develop new investigator-initiated research by our Tulane faculty," said Dr. Weiner. "He will work closely with Dr. Scher in developing the Pediatric Hematology and Oncology group as a major regional resource for children with cancer."
    ------------
    Inside the Tulane Cancer Center is a quarterly publication of the Tulane Cancer Center, Tulane University Health Sciences Center, New Orleans.
    Executive Editor: Roy S. Weiner, M.D., Editor: Melanie N. Cross, Art Director: Kathy O. Barbazon

    Address inquiries regarding this newsletter to: Melanie N. Cross
    (504) 988-6592, fax (504) 988-6077, mcross@tulane.edu

    To inquire about cancer research and treatment programs at Tulane
    please call one of these toll-free numbers:
    (800) 588-5300 (Physicians) 24 hours a day
    (800) 588-5800 (Patients and others) 8:00 am to 8:00 pm US Central Time
    Tulane University Hospital & Clinic (http://www.tulanehospital.com)

    Tulane Cancer Center
    http://www.som.tulane.edu/cancer or http://www.canceriscurable.com
    Box SL-68, 1430 Tulane Ave., New Orleans, Louisiana 70122-2699
    (504) 988-6060, fax (504) 988-6077
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