Yale Cancer Center: Innovation Abounds in New Facilities

In 1974 the National Cancer Institute designated Yale Cancer Center as one of the country's inaugural comprehensive cancer centers. That was a major step forward for the facility that today remains the only comprehensive center in southern New England. Yet, the advancements continue (see "Timeline of Cancer Developments at Yale-New Haven Medical Center").

In 2009 the Center's teaching hospital affiliate opened Smilow Cancer Hospital at Yale-New Haven, bringing all the components of worldclass cancer care under one roof. A year later the center launched its Tumor Profiling Lab and a new Cancer Biology Institute. But the Center's focus is not just on the "new"; the focus is innovation--a commitment to bringing tomorrow's cancer treatments and cures to patients today.

Smilow Cancer Hospital at Yale-New Haven

Smilow Cancer Hospital treats more cancer patients than any other hospital in Connecticut. The staff is committed to providing a steadfast focus on patient- and family-centered care, making sure each patient has a positive experience within the center. In addition to state-of-the-art medical care, the facility boasts several unique physical features, including a rooftop healing garden (complete with trees, shrubs, plants, a small stream, benches, and panoramic views of New Haven), a two-story glass lobby with a terrazzo floor, a granite water wall, terracotta walls, and maple woodwork. Plus, a special boutique offers a unique array of services (eg, This Month's Featured Institution: Yale cancer center Innovation Abounds in New Facilities breast prostheses, makeup/fashion/hair advice, relaxation CDs, billing services for major insurers, etc) that help cancer patients deal with the side effects of healing.

Building on the scientific traditions of Yale University, Smilow's physicians are dedicated to interdisciplinary cancer research in basic science, translational research, and prevention and control. A team from one of Smilow's 12 cancer programs is available to discuss each patient's diagnosis and therapy options, resulting in the development of a unique, comprehensive treatment plan for each patient, which can include a combination of surgery, medical oncology, radiation oncology, or conservative monitoring.

A leader in personalized cancer care, Smilow employs innovative tumor-profiling techniques that guide treatment decisions based on gene mutations. Through research and clinical trials, scientists and physicians are learning how to identify the specific genes that are abnormal in any given patient's cancer. "We want to profile our patients' cancers for as many of those abnormalities as we can, and then use drugs or other therapies to treat them," says Thomas Lynch Jr, MD, director of Yale Cancer Center and Smilow's Physician-in-Chief.

Tumor Profiling Lab

Jeffrey Sklar, MD, PhD, who heads up operations for the new Tumor Profiling Lab, notes that the facility reflects a growing recognition of the value of analyzing tumors for mutations in order to predict the likelihood of patient response or resistance to various drugs. The lab, which began accepting patient samples for analysis in August 2010, consists of a senior PhD staff member responsible for the daily operations, a pathologist to oversee clinical matters associated with the lab, and a lab technician who performs most of the test procedures. The technology being used in the lab, a TaqMan Array system, or what Sklar refers to as a "non-off-the-shelf approach," amplifies DNA from tissue samples and simultaneously interrogates the DNA for the presence of mutations in a single closed-tube step.

"All of these technologies involve DNA amplification by polymerase chain reaction (PCR), and the bane of PCR reactions in a clinical lab doing the same amplifications of samples day after day is cross-contamination of tests," says Sklar. Benefits of the TaqMan Array system are its speed and that physicians don't need to transfer material from one tube to another site. "We minimize the potential for contamination because everything is done in a sealed chamber," Sklar explains. "We don't remove any DNA that has been amplified from that chamber, and the analysis and amplification are done simultaneously within that chamber."

The technology, through new advances that will be released in the upcoming months, will permit detection of 1 in 10,000 cells as tumor cells. "This is a great boon," notes Sklar, who explains that heretofore, special purification procedures needed to be performed to enrich the tumor cells within a sample. "That's difficult and laborious, and these new advances will obviate that whole step. We will be able to work with very impure tumor specimens."

The lab is currently focused on lung, melanoma, and colon tumor samples, with the intent to eventually look at all cancer types. "I think this is the ultimate in personalized medicine," says Sklar. "We're genotyping the patient's tumor so we can fit the therapy precisely to the tumor on a caseby- case basis."

Cancer Biology Institute

Finally, the new Cancer Biology Institute at Yale will bring together a diverse group of scientists to focus on complementary areas of research in cancer biology. The Institute's primary goal is to pinpoint the root molecular causes of cancer, identify new molecular targets, and develop new drug treatments to contain or even eradicate them.

"In order to have an excellent cancer hospital and excellent patient treatment, you need a foundation of good science," says Joseph Schlessinger, PhD, who has been appointed the founding director of the Institute. A worldrenown leader in the field of signal transduction, Schlessinger notes that, "While we have several good people who do cancer research at Yale, we need more of them. [The new institute] will increase the breadth and the depth of the different scientists who are doing research--excellent research that will allow people to be trained, more teachers to teach, and bring cutting-edge science to allow the latest and most advanced therapies to be incorporated into our hospital."

In addition to his appointment as founding director of the Institute, Schlessinger retains his position as Professor and Chair of Yale's Department of Pharmacology. He also plans to remain active with his own research. "I am trying to understand fundamental, basic processes that govern and control the process of cell proliferation," Schlessinger explains. "Some of these processes become altered by mutations in cancer, and this is how cancer emerges. I have pinpointed such changes over the past 30 years, and was able to understand how the changes cause cancer."

Schlessinger says he will likely hire one or two more people who are doing similar research, and notes that they will be "younger than I am so they can continue in this field after I go." Even so, the 65-year-old does not expect to take his leave any time soon. "When I reach the point where I'm no longer productive, I will leave. But this is certainly not the case today."

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Ed Rabinowitz is a veteran healthcare journalist based in Upper Mount Bethel Township, Pennsylvania.