John Theurer Cancer Center at Hackensack University Medical Center: Providing Extraordinary Care to the Community

John Theurer Cancer Center

at Hackensack University Medical Center

Year after year, the John Theurer Cancer Center (JTCC) harnesses the newest technologies and retains world-class oncologists, nurses, and scientists to fulfill its mission of delivering extraordinary care to patients in the community. In January 2011, the cancer center opened a new patient-centric facility in northern New Jersey that provides personalized, innovative, and multidisciplinary care across 14 specialized cancer divisions. JTCC, part of Hackensack University Medical Center, had 87,200 outpatient visits and 5400 new patients in 2011. The volume and diversity of this patient population provides a unique opportunity for JTCC to enroll participants in the 200 clinical trials being conducted at any given time at the cancer center.

In the past year, JTCC has been a part of cutting-edge clinical research that has helped to establish its national reputation as one of the largest and most comprehensive cancer centers in the United States. JTCC was one of the institutions involved in determining the complete genomic portrait of multiple myeloma, which was subsequently published in the journal Nature. In September 2011, JTCC became one of the first hospital sites in the country to enroll patients in the Multiple Myeloma Research Foundation’s personalized medicine initiative, which includes studies on biomarkers and targeted drug development. Research like this helped JTCC to earn the distinction of being ranked among the top 50 cancer centers in the country by US News & World Report—the only cancer center in New Jersey with this designation.

Robert Korngold, PhD

Translational Research

In 1978, Robert Korngold, PhD, demonstrated that mature T cells in donor bone marrow were responsible for causing graft-versus-host disease (GVHD) after bone marrow transplantation. GVHD is a disorder in which newly transplanted cells attack the recipient’s body from within. This landmark study had a significant impact on the future of clinical treatment for patients undergoing transplantation.

Today, Korngold is the chief of the Division of Research at JTCC, where that translational research has led to remarkable discoveries that are nearing the clinical trial stage. Along with his colleague, Thea Friedman, PhD, Korngold’s lab is focusing on research that examines the role of T cells in GVHD. By studying a potential donor’s T cells and distinguishing between which cells could cause GVHD and which ones have antitumor activity, researchers can determine which donors would be suitable matches for blood cancer patients undergoing hematopoietic stem cell transplantation. In addition, “that would allow us to also guide therapy where we could eliminate those T cells that might cause GVHD, give the remaining cells back to the patient, and hopefully have a safer result as an end product,” Korngold said. “This would theoretically eliminate GVHD as a complication.”

In October of last year, JTCC also began enrolling patients in a clinical trial designed to promote regulatory T cells by treatment with cyclophosphamide and sirolimus in patients with steroid-refractory GVHD. The immune suppression that follows salvage treatment for GVHD leads to very poor outcomes because of high infection rates. The goal of the trial is to find a more targeted approach based on the promotion and stabilization of regulatory T cells to control GVHD without the high level of immunosuppression usually seen in these patients.

By working closely with the transplantation team at JTCC, Korngold has had the support and resources needed to transform his research from something observed in a lab to something that will have the potential to end GVHD and save lives.

“In order to do this research, we needed patient samples that we couldn’t get elsewhere,” Korngold said. “It would have been difficult to do this [research] at other institutions.”

Tissue Bank

With thousands of cancer patients passing through the doors of JTCC each year, there is tremendous potential to learn from each individual case and use that knowledge to develop better treatment options for future patients. The center’s growing tissue bank program stores tissue, blood, and bone marrow samples from patients who have undergone biopsies, surgery, or other procedures in an effort to study the underlying genetics responsible for the formation of those tumors.

John Theurer Cancer Center Timeline

1983

1989

1995

2000

2006

NCI designates program a “Clinical Community Oncology Program,” allowing HUMC to participate in national cancer trials

Andrew L. Pecora, MD, joins the HUMC staff as director of the adult stem cell program

HUMC adds the Institute for Radiosurgery

HUMC opens the state-of-the-art David Joseph Jurist Research Center for Tomorrow’s Children

JTCC launches its Tumor and Tissue Bank

1981

1987

1995

2001

2006

Hackensack University Medical Center (HUMC) receives NCI grant to start a hospital oncology program

HUMC establishes Tomorrows Children’s Institute for Cancer and Blood Disorders and Adult Oncology programs

The Institute for Breast Care opens, offering all diagnostic services in one location

John Theurer Cancer Center (JTCC) is created and Andrew L. Pecora, MD, is named chairman and director

JTCC collaborates with NCI on joint clinical research program to develop innovative treatment approaches

Continued below

K. Stephen Suh, PhD

K. Stephen Suh, PhD, is the director of the Genomics and Biomarkers Program and manages scientific activities of the Tissue Bank. The Tissue Bank takes the tissue samples collected from patients over the years and analyzes specimens of interest to create a molecular signature of the genes, proteins, and tissues that make up a particular tumor. The goal of the research is to identify key biomarkers that can be used to develop more accurate and less invasive diagnostic techniques, early detection of multiple human cancer types, and targeted treatment options to achieve personalized medicine.

With approximately 5400 new cancer patients coming through its doors each year, JTCC scientists have a great opportunity to collect tissue samples from a wide variety of tumor types. “To be located in a highly populated region like this really gives us the potential of creating a high-quality tumor bank with a large quantity of biospecimens,” Suh said.

However, part of the Tissue Bank’s mission extends beyond just collecting and storing samples for research. Suh said patients must be educated about the importance of studying tissue from tumors so that they understand that the opportunity to study and experiment with tissue samples can lead to future discoveries in cancer research and treatment.

A big part of that education has been incorporated into JTCC’s patient education process, which now includes a description of the Tissue Bank program on all patient consent forms. It is important that patients understand that providing samples to the tissue bank does not require them to undergo an additional procedure. However, patients must give their consent to allow the Tissue Bank to collect and store tissues for scientific research. There is a limited window of time in which the samples can be collected, and Suh explained that JTCC is focusing on patient education as a way to promote and expand its Tissue Bank program.

Scott Rowley, MD

Blood and Marrow Stem Cell Transplantation Program

JTCC is home to the only stem cell transplantation program in New Jersey approved by the National Marrow Donor Program, a global transplant network that connects more than 450 leading centers worldwide and ensures patients and donors receive high-quality care. Led by Scott Rowley, MD, chief of the Division of Stem Cell Transplantation and director of the Adult Blood and Marrow Transplantation Program, the JTCC stem cell transplantation program is 1 of the 10 largest in the country. The center’s transplant program performs autologous, allogeneic, and umbilical cord stem cell transplants for more than 250 patients with cancer or blood disorders each year. In August 2011, the program reached a milestone in that it performed its 4000th stem cell transplant. At the 53rd Annual Meeting of the American Society of Hematology in December, the results of 938 consecutive allogeneic and autologous hematopoietic stem cell transplants were presented, showing that the center is capable of collecting long-term survival data over a large consecutive series.

“There are very few [stem cell transplantation] programs in the country that have treated that number of patients,” Rowley said, noting that most centers that have similar programs treat less than 100 patients. “It puts us among a small group of centers that are the most active in this field.”

“

There are very few [stem cell transplantation] programs in the country that have treated that number of patients. It puts us among a small group of centers that are the most active in this field.”

—Scott Rowley, MD

JTCC has more than 50 clinical trials underway related to stem cell transplantation. In a trial that’s currently recruiting patients, Rowley and his team are studying whether related donors are at a higher risk for acute medical and psychological toxicity compared with patients who receive hematopoietic stem cell transplants from unrelated donors.

John Theurer Cancer Center Timeline Continued

2010 (August)

2011 (March)

2011 (April)

2011 (August)

Bernard Park, MD, world leader in robotic video-assisted thoracic surgery lobectomy, joins as Co- Chief of Thoracic Oncology

JTCC researchers joined colleagues from 20 research institutions to publish the first complete genomic portrait of multiple myeloma in Nature

Andre Goy, MD, MS, is named chairman and director of JTCC. Dr Pecora assumed role of Chief Innovations Officer, Professor and Vice President of Cancer Services at HUMC

Adult Blood and Marrow Stem Cell Transplantation Program performs its 4000th stem cell transplant

2009 (September)

2011 (January)

2011 (March)

2011 (July)

2011 (September)

Brought together more than 1000 cancer survivors and caregivers for the first annual Celebrating Life and Liberty event

JTCC opens a new $130-million, 155,000-square-foot building, bringing together 14 specialized divisions with research and auxiliary oncology services

JTCC is the only cancer center in New Jersey where patients with prostate cancer can find the complete capabilities of Provenge in one center

Ranked among the top 50 in US News & World Report for the first time

One of the first clinical sites enrolling patients in the MMRF’s landmark personalized medicine initiative

A Collaborative Effort

When the John Theurer Cancer Center at Hackensack University Medical Center was established more than 30 years ago, patient services and research facilities were spread across various locations throughout the hospital and the surrounding community.

In January 2011, that all changed when a $130-million, 155,000-square-foot comprehensive cancer facility was opened to bring research and patient care—2 aspects of the facility that have always been closely aligned—together in a stateof- the-art, 5-floor facility.

With dozens of trials and hundreds of enrolled patients, the growing oncology program has benefited from the new, stand-alone facility, where doctors, researchers, nurses, and patients have an easier time navigating through the clinical trials.

The nursing team that handles the research program at JTCC come from a number of different backgrounds. Danielle Blair, RN, research coordinator for the gastrointestinal, skin, and sarcoma programs, worked as an infusion nurse before joining the research program. Blair said that drugs like Erbitux and Avastin—now standards of care for different forms of cancer—were in clinical trials at JTCC when she began.

“There are so many new cancer drugs now and so many studies that we’ve conducted here at JTCC that have since gotten approved and changed the course of treatment for patients,” Blair said. “It’s so nice to have treatments we can offer patients that they may not have had any other options for before.”

The facility has not only brought patients and their caregivers closer, but it’s also helped to further develop the sense of collaboration and camaraderie among the staff. While the research and clinical teams are separate, working side-byside allows information to be shared among the staff so that every decision is made with as many voices being heard as possible.

“It’s a very team-oriented approach,” said Laura McBride, RN, research coordinator of the Multiple Myeloma Division at JTCC. “Once you are a part of a team, and you are a vital part of that team, and you are asked for your input and what you’re seeing with that patient, you truly end up changing the lives of a lot of patients.”

It is this collaboration that helps promote innovation and allows the entire oncology care team to provide the multidisciplinary, patient-centric care that lives up to the JTCC standard of delivering extraordinary care for every patient.