South Florida's Sylvester Comprehensive Cancer Center: Hitting Its Stride

The Sylvester Comprehensive Cancer Center (SCCC), part of the University of Miami Health System, first opened its doors in 1992. Over the years, the SCCC has become the hub of cancer research in the region. And though the center has experienced periods of major development during the past decade, interim director Joseph Rosenblatt, MD, said that the SCCC has truly hit its stride within the past 5 years.

"The goal of [the SCCC] is to provide outstanding primary and tertiary cancer services, and serve as a regional resource for cancer clinicians and their patients," Rosenblatt said. "We also aim to expeditiously secure the National Cancer Institute's [NCI] designation through the development of cutting-edge research programs that relate to the unique diversity and challenges posed by the population that we serve." Earning the distinction of a NCI designation would identify the SCCC as one of the country's 66 Cancer Centers recognized for scientific excellence. In addition, all NCI-designated Cancer Centers received financial support from NCI grants for important new discoveries in cancer prevention, diagnosis, and treatment.

Rosenblatt continued, "As a [cancer] center, [the SCCC has] been able to make some real contributions, both on the prognostic and therapeutic side in viral and nonviral lymphomas. Our location provides unique opportunities and we are doing our best to capitalize on them."

Geographic Opportunity

The SCCC is uniquely located "where the Third World brushes against the First World: right at the opening to the Caribbean Basin and Latin America," said Rosenblatt. A large number of the SCCC's patients come from this geographic region. So the SCCC and its 2 satellite clinics see patients with a wide variety of malignancies--particularly lymphomas and cervical cancer--that are linked to viruses.

"Due to the demographics and the prevalence of HIV and HPV in the environment, we have mounted a substantial program in the viral malignancies," said Rosenblatt. "Our program is focused on the link between viruses and malignancy, and how can that link be exploited."

Understanding viral malignancies is important to the overall fight against cancer. Glen Barber, PhD, the Eugenia J. Dodson Chair in Cancer Research and the associate director of basic science at the SCCC, indicated that 15% to 20% of cancers may be associated with viral infection. Barber explained that some cancers may be antagonized through the presence of a virus in the cancer cell. "Viral association," said Barber, "provides opportunity for diagnosis, prevention, and (in some cases) treatment through exploiting the biology of the viruses themselves and our innate and adaptive immune response."

"Many types of leukemias and lymphomas may be linked with herpes viruses," Barber explained. "Cervical cancer, for example, is associated almost 100% with human papillomavirus. Adult T-cell leukemia corresponds almost 100% with the presence of human T-cell lymphotropic virus. And there is emerging evidence implicating viruses in prostate cancer."

Barber also explained that viruses make very good targets because they are proteins--specifically, nonhuman proteins. He said, "That means that if we find a drug that targets a viral protein important in pathogenesis, we may selectively affect cancers without interfering with normal cellular proteins and pathways that regulate cell growth and differentiation."

Through ongoing research, Barber and his colleagues at the SCCC are now designing therapeutics that target specific viruses. "By targeting the virus and shutting down its ability to replicate itself, we can inhibit its ability to keep the cancer cell alive." The goal, he said, is to implement new therapeutic strategies to target these viruses. In fact, the SCCC hopes to initiate several clinical trials in 2011 for the treatment of viral-associated malignant diseases.

Transforming Transplantation

Another area of growth at the center is the bone marrow transplant program. Krishna Komanduri, MD, head of this program and coleader of its tumor immunobiology program, came to the SCCC in 2008 from the MD Anderson Cancer Center in Houston, Texas, and has made great strides in transforming and expanding the center's bone marrow transplant program. Although it is still in the early stages of its transformation, Komanduri described the program's significant growth within the past few years.

"We performed approximately 75 transplants in 2010, whereas we did about 45 transplants the year before I arrived [in 2007]," said Komanduri. He noted that the number of allogeneic transplants (ie, transplants from donors) has also increased, more than doubling over the last 3 years.

"If you look at [cancer] centers across the country, most are growing on average about 20% to 30% over a 4-year period," Komanduri said. "So, we've had a dramatic increase in the numbers of patients being transplanted at our center."

The new Ambulatory Treatment Center at the SCCC has contributed to the growth of the transplant program. The Ambulatory Treatment Center opened in May 2010 and provides intensive outpatient and follow-up care for stem cell transplant patients who are highly vulnerable to infection. The outpatient center has 5 dedicated exam rooms where patients can receive a routine examination; receive blood product transfusions, which are often required in the early post-transplantation period; or receive infusion-based therapies of IV medications.

To further enhance the patient experience, the SCCC has changed other aspects of its care delivery model to include a dedicated nurse practitioner to the post-transplant clinic so that patients can receive treatment without always having to see their primary clinic physician.

In addition to these enhancements in outpatient services, the SCCC is completing construction of a state-of-the-art in-patient transplant unit at the University of Miami Hospital and Clinics (UMHC), the center's in-patient hospital.

"We are well into the process of moving the in-patient transplant program to Sylvester," Komanduri said. "Patients will then receive the entire spectrum of care in one building. Patients will be evaluated for transplant [and] will have their inpatient transplant stay and post-transplant care at the [SCCC]/UMHC, which is a significant change in location and the model of care."

Novel Technology

Translating research from the bench to the bedside in the areas of prostate, bladder, and kidney cancers can help the SCCC achieve its NCI designation. Richard J. Cote, MD, leader of the Genitourinary Malignancies Program, has made strides toward that goal by securing a grant from the State of Florida to pursue prostate cancer research. Cote, who is also chair of the pathology department, explained that the grant supports 3 projects that focus on how prostate cancers progress, how prostate cancers metastasize, and how interventions that employ novel therapies or combinations of therapies are used.

"We have formulated a biomedical nanoscience program here at [the SCCC]," said Cote, who is also director of that program. "We have developed a very novel technology to capture and characterize circulating tumor cells. The technologies that we've been developing, which allow us to capture these tumor cells in a way that is much more efficient--using a more general mechanism than any other previous technologies have allowed--are really beginning to make an impact. We are already applying these technologies in the area of prostate cancer analysis, specifically looking at patients who are being treated for metastatic prostate cancer."

For those patients who have no clinical evidence of metastasis, the SCCC researchers are trying to determine whether these technologies can detect early metastasis to help identify patients who may actually need more therapy than they would otherwise have received. It is a proactive response to treating cancer, Cote said, and a good example of moving toward more personalized medicine.

The developments thus far have been exciting."The progress that we've made in these areas has really been startling," Cote said. He continued, "And we have a number of technologies that have the real potential to be used in clinical situations, are already being used in clinical trials, and have the possibility of actually transforming how we manage patients with cancer and other diseases. There is a great deal of excitement and enthusiasm in this area."

Putting It All Together

The combination of the SCCC's geographic location, transplantation programs, ambulatory center, and innovative research has positioned it as a center that can provide the community with exceptional cancer care for future generations.