Inside the Tulane Cancer Center
December 2003 Newsletter
Headlines in this Issue
Letter Campaign Reaches Out to Patients
LCRC Board Chairman Honored
Dr. Erik Flemington Explores Links Between Epstein-Barr Virus and Cancer
Recap: Key to the Cure 2003
Dedicated Oncology Social Worker Makes a Difference
Tulane Researchers Honored for Drug Discovery Efforts
A Message from the Director
Accolades: Faculty honors and awards
Index to all archived issues
Index to archived articles by topic
Editorial Staff & Contacts

Looking for a way to make a difference this holiday season?
Please consider a donation to our Patient Relief Fund as an alternative to gift-giving.
And remember that our cancer awareness silk necktie and scarf make great gifts while supporting cancer research.

Keeping Our Patients Informed: Letter Campaign Addresses Media Blitz
Patients are Urged to Consult Their Physicians to Discuss Options More Fully
Many of Tulane Cancer Center's breast cancer patients recently received a letter from Roy S. Weiner, M.D., Director of the Tulane Cancer Center, in response to headlines regarding the results of an international clinical research trial on an inhibitor of estrogen production and the new choices this drug may offer some of them. The results of this important trial were published in the November 6 issue of the New England Journal of Medicine (Goss PE, et al.: A randomized trial of letrozole in postmenopausal women after five years of tamoxifen therapy for early-stage breast cancer. NEJM, 349:1793-1802, 2003) and were widely reported in the popular media. "The results of this study may open the possibility of additional therapy options for some of our breast cancer patients," said Melissa Brammer, M.D., a member of Tulane's Multidisciplinary Breast Cancer Team, which endorsed the letter campaign. In addition to Drs. Weiner and Brammer, the Team includes Drs. Ralph Corsetti, William McKinnon, David Jansen, Ellen Zakris, and clinical psychologist Tim Pearman. "We felt it was important to respond to the headlines quickly and to encourage our patients to contact their physicians to discuss more fully the risk/benefits ratio and whether this option is right for them," said Brammer.

The Study
Beginning in 1998, a total of 5,187 women were enrolled in this international clinical trial, led by the National Cancer Institute of Canada Clinical Trials Group on behalf of several cooperative groups and a pharmaceutical company. Previous clinical trials had shown that in hormone-dependent breast cancer, five years of tamoxifen therapy given after surgery prolonged disease-free and overall survival. Tamoxifen blocks estrogen receptors in tumor cells. After five years, however, continued treatment with tamoxifen had not been shown to be beneficial. This placebo-controlled trial investigated whether postmenopausal women with estrogen-receptor-positive tumors who had completed five years of tamoxifen therapy might also benefit from an additional five years of treatment with an aromatase inhibitor, which acts by inhibiting the synthesis of estrogen. This study is important, because each year hundreds of thousands of women worldwide finish five years of adjuvant tamoxifen therapy. Recently, the study reached a point at which the results could be reviewed for the first time, and the Data Safety Monitoring Committee (DSMC), an independent committee responsible for protecting the interests of the women enrolled in the trial, recommended that the findings be made public, the study participants and their physicians be told the results, and that women who had received placebo be given the opportunity to cross over to aromatase inhibitor therapy. The study's preliminary results had shown that breast cancer returned much less often in the women receiving the aromatase inhibitor compared to those on placebo. There were 75 cases of recurrence of breast cancer in women taking the aromatase inhibitor compared to 132 cases among women taking the placebo. Overall, women on the study who took the aromatase inhibitor had 43% fewer recurrences of their breast cancer than those who took placebo. The reductions in the recurrence of cancer included fewer cancers in major organs, in the breast and surrounding area in which the original cancer occurred, and in the opposite breast. There were also fewer deaths (30 versus 42) in women taking the aromatase inhibitor.

Side Effects
Despite the positive results, the study also found that the aromatase inhibitor caused some side effects that should be considered. Study participants who took the aromatase inhibitor experienced slightly more hot flashes, joint and muscle pains than the placebo group, but less frequent vaginal bleeding. Slightly more women taking the aromatase inhibitor reported osteoporosis and new bone fractures (3.6%) than women taking placebo (2.9%), and some experienced slight increases in their cholesterol levels. However, the medication seemed generally acceptable to most patients, as only 4.5% of women taking the aromatase inhibitor stopped the medication due to side effects, whereas 3.6% taking the placebo did so. It must also be pointed out that the study was stopped early, and few women had yet received the full five years of aromatase inhibitor therapy; therefore, we may not yet fully understand the long-term toxicities of this drug.

What Does This Mean for our Patients?
"Tulane Cancer Center's Multidisciplinary Breast Cancer Team anticipated that several of our patients would have questions about the impact of this new information on their care," said Dr. Weiner. "The results of this trial are important, but individual factors must be considered. That's why we wanted to communicate directly to our breast cancer patients who might qualify for this new treatment option and urge them to contact their physicians to learn more about what these results might mean for them." It's all part of an overall effort by the Tulane Cancer Center to recognize that our patients are often confronted with information in the media which may or may not impact their care. "It's our job as their cancer care team not only to acknowledge some of the issues they may be hearing about in the media," said Dr. Weiner, "but to also make ourselves available for counsel and to encourage them to contact us so that we can help them to weigh the risks and the benefits in order to decide whether new treatment options are right for them. It's something we plan to do more often as new inroads are made in the fight for a cure and more information about these advances becomes widely available." To learn more about aromatase inhibitor therapy, call the Tulane Cancer Center at 988-6300 and make an appointment with your physician. For more information on the results of the study, visit the New England Journal of Medicine website at www.nejm.org or contact the National Cancer Institute at 1-800-422-6237 or www.cancer.gov. For an overview of the women's cancers program at Tulane Cancer Center, visit our website at www.canceriscurable.com.
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External Scientific Advisory Board Chair Honored
Dr. Harold Moses, Director of the Vanderbilt-Ingram Cancer Center and chair of the External Scientific Advisory Board for the Louisiana Cancer Research Consortium, has been elected into the Institute of Medicine of the National Academies. Moses joins 1,382 active members of the elite group of scientists, who are called upon for independent analysis and recommendations on issues related to human health. Individuals are elected to the Institute on the basis of professional achievement and demonstrated interest, concern and involvement with problems and critical issues that affect the health of the public. Moses is internationally known for his cancer research in growth factors, particularly transforming growth factor-beta, which Moses' team discovered as the first growth factor to act as both a cell growth stimulator and suppressor under different circumstances. Moses was named chair of the External Scientific Advisory Board (ESAB) for the Louisiana Cancer Research Consortium last year. ESAB members are charged with providing direction and offering counsel to the Consortium's senior leadership as joint research programs are developed, new faculty recruitment goals are established, and joint infrastructure is planned. The Louisiana Cancer Research Consortium recently broke ground on a $40 million, 150,000-sq.-ft. research facility located in the biotechnology corridor of downtown New Orleans. "Dr. Moses' election into the Institute of Medicine is a tremendous honor for him and the Louisiana Cancer Research Consortium," said Roy S. Weiner, M.D., Director of the Tulane Cancer Center. "We are fortunate to be able to benefit from the experience and expertise of a scientist of his caliber."
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Dr. Erik Flemington Explores Links Between Epstein-Barr Virus and Cancer
More than 90% of us live our lives day to day playing host to a latent form of the Epstein-Barr virus (EBV). In most of us, this virus is inactive and unnoticeable; however, in some others, it has been linked to the development of a number of diseases, including several cancers. Erik K. Flemington, Ph.D., Associate Professor of Pathology at Tulane University Health Sciences Center, and his team of researchers are trying to better understand the mechanisms by which EBV promotes tumor growth and how to eradicate EBV-associated tumors. EBV is a member of the herpes virus family and is most frequently associated with infectious mononucleosis. It is spread chiefly through the transfer of saliva, giving rise to the nickname "the kissing disease." Most of us become infected with EBV initially as young children, but do not become noticeably ill. Those who become exposed during or after adolescence, however, have a greater than 50% chance of contracting mononucleosis. Once infected, the virus remains in the body, usually in a latent, inactive form. "In fact, most individuals walk around without even knowing they've ever been exposed," said Flemington. But, when the virus is present in conjunction with genetic alterations, it can cause cancer, especially in those with compromised immune systems. These genetic alterations can be inherited or can be caused by exposure to environmental agents. EBV has been associated with Hodgkins disease, Burkitt's lymphoma, nasopharyngeal carcinoma, breast cancer and a certain percentage of gastric carcinomas. "EBV basically creates a number of proteins that causes tumor cells to proliferate while at the same time preventing the immune system from attacking and killing the infected tumor cells," said Flemington. His laboratory is developing a new technique using double-stranded RNA molecules called siRNA to block EBV protein expression and inhibit tumor growth and survival. This technique has possible therapeutic potential because it only targets EBV-infected cells. "The key is specificity," said Dr. Flemington. "We only want to block EBV gene expression, which will theoretically impact tumor survival without affecting normal tissue, and this technique shows promise."

Dr. Flemington's team is also conducting fundamental molecular research on the virus itself. They are trying to understand more fully what makes EBV switch from the latent, tumorigenic phase, during which tumor cells proliferate, to a lytic phase, during which the virus actively replicates while in the process killing the infected cell. "The goal, therefore, is to get EBV to switch to the lytic phase in the tumor cells," said Flemington. "In order to do this, however, we need a better understanding of the factors that control this regulatory switch."

Dr. Flemington was recently awarded a grant by the National Institutes of Health, and he was one of twelve Tulane researchers honored at the recent Mauvernay Research Excellence Seminar and Award presentation.

diagram
Understanding how EBV latency associated gene expression leads to tumorigenesis will aid in the development of drugs that may reverse the function of these genes. Similarly, investigation into how the lytic program leads to cell growth arrest and apoptosis may allow researchers to mimic and/or stimulate this naturally occurring pathway in anti-tumor strategies.

Flemington Lab Personnel and Projects
Qinyan Yin, Post-doctoral Fellow, Pathology Zhen Lin, Graduate Student, Molecular and Cellular Biology Graduate Program Kendra Jupiter, Graduate Student, Molecular and Cellular Biology Graduate Program Tara Arrowood, Rotating Graduate Student, Molecular and Cellular Biology Graduate Program
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Community Involvement is Key at "Key to the Cure" 2003
key logo A new name. A new logo. A new color scheme. Many things were new at this year's charity shopping fundraiser at Saks Fifth Avenue New Orleans, but one thing remained the same - the energy and enthusiasm of Tulane Cancer Center's supporters, who turned out en masse on Wednesday, September 17, to give the four-day event a proper New Orleans-style kickoff. Key to the Cure is a nationwide fundraising initiative of Saks Fifth Avenue held simultaneously at all 61 Saks locations over the same four-day period. Each store chooses a local beneficiary to receive the proceeds from the event -- 2% of sales over the four days. For the third year in a row, Saks New Orleans partnered with the Tulane Cancer Center, directing all local event proceeds to Tulane researchers working to better understand and ultimately cure female cancers. This year's effort, dubbed Key to the Cure, attracted approximately 2,500 shoppers to the Kickoff Gala, a new event record! As they've come to expect, guests were treated to an incredible array of hors d'oeuvres provided by 28 local restaurants and caterers; an incomparable beverage menu concocted once again by Glazer's Companies of Louisiana; and fabulous musical entertainment compliments of Dr. Michael White and his Original Liberty Jazz Band, Los Hombres Calientes, and Kim Prevost and Bill Solley. A new twist this year was the festive welcome provided shoppers entering from The Shops at Canal Place by dance troupe Ole Flamenco Ole.

Event co-chairs Julie Murphy (left) and Patricia Brinson (right) recognize and thank the event's top sponsors.

How did we do? This year's event is expected to once again generate well over $100,000 for cancer research at Tulane. Combine this total with the $42,000 raised in 2001 and the $105,000 raised last year, and the event's overall impact over three years totals nearly $250,000! And every penny of this total is at work in the fight against cancer right here in New Orleans. A large portion of the proceeds from this year's event was generated by a raffle of donated items, many by cancer survivors or the families of local cancer patients. An annual feature of this fundraiser, this year's raffle included a record 33 items and added well over $9,000 to the bottom line! Many thanks are due Pam Ryan, former event co-chair and this year's Raffle Subcommittee chair, as well as Mayor C. Ray Nagin and his team at City Hall. Several members of the mayor's staff became involved in planning the event this year and were responsible for accumulating over $1,500 in additional raffle ticket sales! The Mayor and his wife were also kind enough to serve as honorary co-chairs of this year's event, along with Mrs. Bertie Deming Smith, a long-time supporter and friend. It's obvious that this year's success would not have been possible without the hard work and dedication of our massive team of community supporters. "Words alone cannot express my appreciation for the dedication of our volunteer committee, chaired flawlessly this year by Julie Murphy and Patricia Brinson; our 102 corporate, foundation, and individual sponsors; and our incredibly generous restaurant participants and raffle donors," said Roy S. Weiner, M.D., Director of the Tulane Cancer Center. "They have made an immeasurable contribution to both the success of this event and to what our team is trying to accomplish. They are all active partners in our cancer research, and they have my heartfelt gratitude for all they have done for Tulane and the entire New Orleans community."


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Dedicated Oncology Social Worker Makes a Difference
"A cancer diagnosis is devastating in so many ways," said Sue Wilson, LCSW, Tulane Cancer Center's licensed oncology social worker. "It literally puts each patient on a bumpy path he or she has never had to navigate before. I can't take away the bumps, but it's my job to help make some of them smaller." Wilson works closely with Timothy Pearman, Ph.D., Clinical Assistant Professor of Psychiatry & Neurology and Director of the Patricia Trost Friedler Cancer Counseling Center, in order to address some of the many issues cancer patients have to face.

Sue Wilson, LCSW, and Timothy Pearman, Ph.D.
"Transportation to and from treatments, how to pay for prescription medications, how to arrange work schedules around treatments or apply for disability, housing for family members or caregivers while treatment is delivered....These day-to-day issues can become overwhelming considerations at a time when our patients need to be concentrating on making themselves better," said Wilson. "I try to be a problem-solver for them." She connects patients to the community resources, both local and national, that can assist them. "There isn't a whole lot out there, but we are very thankful for what is," said Wilson, "and we are eager to help our patients find it." For instance, many pharmaceutical companies have programs providing medications to cancer patients at reduced costs. The local Ronald McDonald House offers housing and transportation for family members seeing pediatric patients through cancer treatments in the New Orleans area. The American Cancer Society also provides a few nights of free or reduced housing for family members assisting patients receiving treatment and will soon open the Hope Lodge for adult patients with cancer and their families. "The Hope Lodge will be similar to the Ronald McDonald House concept," said Wilson, "and will be a tremendous resource for our patients in the near future."

Tulane Cancer Center's Patient Relief Fund is an in-house resource Wilson can use to help. "This Fund was set up to help our patients in need meet unexpected expenses associated with their care at Tulane," said Roy S. Weiner, M.D., Director of the Tulane Cancer Center. "It is often the only source available to our social worker to solve an urgent problem for our patients." Wilson has drawn from this fund to help patients facing eviction with rental assistance; she has also provided assistance with transportation, meals, short-term housing, and other emergency situations.

In addition to being a patient advocate, Wilson also counsels patients and family members, helps provide them with equipment they might need in the home during their treatment and rehabilitation, and helps solve discharge planning issues like hospice or home health care. Wilson and Pearman also see all of the bone marrow transplant patients prior to their procedures in order to assess the emotional, family, financial and support issues crucial to a transplant's success. "There is some overlap in what we are qualified to do," said Pearman, "so we work closely together to coordinate and maximize the services we are able to provide our patients."
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Tulane Researchers Honored for Cancer Drug Discovery Efforts
Charles S. Hemenway, M.D., Ph.D., was recently named the Mauvernay Research Excellence Scholar for his research into new treatments for childhood leukemia. Hemenway, Associate Professor of Pediatric Hematology-Oncology and contributing member of the Tulane Cancer Center, was awarded a $5,000 prize as well as an etched crystal tribute commemorating this honor, and he delivered the Mauvernay Scholar address, Rational Development of an Inhibitor of t(4;11) Leukemia, at the Inaugural Mauvernay Research Excellence Seminar, held October 17 at Tulane University Health Sciences Center.
Eleven other Tulane faculty researchers each received $500 prizes and presented their research (see full details) in poster format at the symposium. Established by Tulane University with support from Debiopharm S.A., a Swiss drug development company, the Mauvernay Research Excellence Seminar provides a forum for the exchange of ideas and information on the latest research accomplishments at Tulane that may lead to the discovery of new therapeutic agents for cancer treatment. "I am extremely proud of the quality research being conducted by Tulane scientists who are on the front lines in the battle against cancer," said Roy S. Weiner, M.D., Director of the Tulane Cancer Center. "Each of the honorees is a credit not only to the university but to science." In addition to Hemenway and the Tulane faculty poster presenters, invited speakers at the seminar included Carl H. June, M.D. of the University of Pennsylvania School of Medicine; Michael B. Kastan, M.D., Ph.D. of St. Jude Children's Research Hospital; Donald P. McDonnell, Ph.D. of Duke University Medical Center; and Donald Small, M.D., Ph.D. of Johns Hopkins University.
Charles S. Hemenway, M.D., Ph.D., Mauvernay Research Excellence Scholar 2003, lower row, center, with fellow honorees.
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A Message from the Director
Roy S. Weiner, M.D.
Director of the Tulane Cancer Center
I want to devote this letter to our Tulane Cancer Center faculty. Please refer to the Accolades section in which we highlight some of the noteworthy accomplishments of our faculty members. In this issue, as in many of the previous issues, we are limited by space in listing all the accomplishments for which our faculty have been lauded. Each member of the TCC is exceptional in his or her devotion to our mission of improving health by discovering new ways to prevent, diagnose and treat cancer. Moreover, our faculty are equally devoted to the broader mission of the Health Sciences Center, which includes teaching future health care professionals, training the new generation of researchers and practitioners, and reaching out to our community. For some background information, the TCC is a matrix center. In a matrix center, each TCC member is also a full participant in a classical department of the university and contributes to the "home" department's teaching, service, and research responsibilities. The TCC provides a "focal point" of cancer, expanded opportunities for research collaboration, enhanced opportunities for service, and highly specialized teaching. The TCC also provides resources over and above those provided by the departments to enhance its members' productivity in all cancer related activities. Our TCC faculty members are busy, talented, and productive.

The standards for academic recognition are and have been peer review and peer recognition. Thus, when a faculty member has a novel idea to pursue in the research laboratory, he or she must submit a grant proposal seeking the funds necessary to perform the research. When the request for funds is submitted to the National Institutes of Health, the American Cancer Society, the Research Grant Section of the Department of Defense, the National Science Foundation or some other major source of cancer research funds, the proposal is reviewed by a committee of 20 or more scientists with specialized knowledge in the field in question. The review sessions are held two to four times each year, depending on the agency. As many as 60 grants may be reviewed during each two- or three-day review session. Each grant is reviewed in detail by at least three scientific experts who have no conflict of interest. The grant is also read by each member of the panel (called a Study Section). The strengths and weaknesses of each proposal are discussed in depth. A three-digit score is assigned to each grant with "1.00" usually being the best and "5.00" being the least meritorious of those grants worthy of a score. In addition to the quality of the science, the research environment, ethical issues, and significance are considered and scored. Each of the members of the Study Section assign a score. The scores are averaged and then weighted by the scoring history of the Study Section in question. The scored grants are ranked, and they are funded in rank order until the available funds are exhausted. The reviewers take their responsibility very seriously. They in fact shape the science of the nation. When our faculty members serve as members of Study Sections or Site Visit Teams, it is another indication of the value placed on their judgement and opinion by their scientific peers.

Likewise, the peer review process operates in selecting research papers for publication. The results of research are prepared for publication by the researchers. The research papers are highly stylized so that the hypothesis studied, the methods used, the results obtained, and the interpretation of the results are presented in such a way that scientists can understand the results, assess their significance, and use them as a basis for confirmation, refutation, or extension of knowledge. The submitted papers are reviewed by members of a journal's editorial board-again working scientists who are expert in the subject matter of the submitted paper, who have no conflict of interest, and who are charged with the responsibility of assuring that the papers published are of the quality established by the journal for publication. Each submitted paper is usually reviewed by at least two reviewers and then submitted to an associate editor with recommendations for acceptance, rejection, acceptance with modification or resubmission after revision. Over the years, each scientific discipline has developed a hierarchy of journals varying in prestige. One measure of prestige is the "selectivity" of the journal, i.e. the number of papers actually published compared to the number submitted. Thus, like the prestigious granting agencies listed above, there are prestigious journals such as Nature, Science, Cell, Cancer Research, Journal of Clinical Oncology, Blood, New England Journal of Medicine, and several others in which publication connotes special merit. When our faculty are called upon to serve on editorial boards or review papers, it is an indication that their peers place high value on their expertise and their judgement.

Invitations to speak or present data at scholarly meetings are another indicator of peer recognition. Planners of national or regional meetings of scholarly societies select the content of their meetings by peer review. The meetings are an opportunity for scientists to present and discuss new data, some of which may not yet be mature enough to withstand the rigors of peer-reviewed publication. Valuable insight is gained by exposing these data to discussion and critique in the atmosphere of a scientific meeting. New research directions are often identified and new collaborations frequently forged at these meetings. The presence of our TCC faculty at these regional, national, and international meetings is a measure of their reputation among their peers and is of tremendous value to the mission of the Cancer Center. Participating as a Chair of a scientific session or as a member of the organizing committee is a special distinction conferred by their peers.

As you read this issue of our newsletter, please share my pride in our Cancer Center faculty. Also, please understand that our listing of Accolades is limited by space and by the inherent modesty of our TCC faculty members. These outstanding people are busy teaching, pursuing research, keeping abreast of their field, caring for patients, serving our university, guiding the direction of our Cancer Center, and serving the scientific community as reviewers and speakers. Melanie Cross is very persuasive in her request for Accolades for each. Our faculty members are, however, often too busy or too modest to provide the information that would make our listing more complete.
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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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