Cancer Center credentialed to  use Bexxar

Christiana Care has acquired a new weapon in its arsenal to battle non-Hodgkin�s lymphoma (NHL), or lymphatic cancer. The Nuclear Medicine Department recently became credentialed to use Bexxar, a new radioimmunotherapy (RIT) agent that has been shown to be useful in treating NHL.

This is exciting news, as we�re the only health care facility in Delaware that performs radioim-munotherapy,� comments Timothy A. Manzone, M.D., Associate Medical Director of Nuclear Medicine.  

How Rit works
RIT is a cancer treatment method that uses antibodies to carry radioisotopes to tumors. RIT agents exploit the radiation sensitivity of lymphoma, and the targeting power of monoclonal antibodies. In many lymphomas, a specific antigen called CD-20 is expressed on the surface of the patient�s cancerous B-cells, which is a type of white blood cell. When RIT agents are injected into a patient, they attach to this antigen. This activates the immune system, and destroys some of the lymphoma cells. The radioactive isotope then kills other neighboring cells. Used in conjunction with other treat-ments, RIT can potentially increase survival by producing long remis-sion in patients.

Among patients who respond well to RIT, many have quite long-term remissions,� says Dr. Manzone. Right now there is no cure for lymphoma, but it can be treated with chemotherapy, radiation or an antibody called Rituxan in an effort to cause the cancer to go into remission. Any time you can produce a remission or a longer lasting remission, it is considered a victory. Sometimes, physicians manage their patients� lymphoma by helping them along from one remission to the next.�

Using both agents
So far, two RIT agents have been approved for treating lymphoma. The first, Zevalin, was approved by the FDA in 2002. Our Nuclear Medicine Department has treated over a dozen patients with Zevalin. The second RIT agent, Bexxar, was approved in June 2003. Christiana Care is now able to use either agent in its RIT program.

Because RIT with agents like Zevalin or Bexxar is precise�delivering radiation to the cancer cells�the adjacent surrounding tissue is unaffected, which reduces side effects. In addition, treatment with RIT agents is often easier for patients to tolerate than conven-tional chemotherapy. Clinical studies are ongoing at a number of hospitals using RIT in various stages and types of lymphoma.

We are excited about this because lymphoma is increasing in incidence, particularly in older patients,� says Dr. Manzone. Once considered a rare disease, NHL is now the fifth most common cancer in the United States. We are proud to add Bexxar to our RIT program and hope we will be able to offer RIT to more patients who could benefit,� Dr. Manzone says.

Delaware leaps ahead in decreasing cancer

Delaware�s rate of improvement for cancer mortality now leads the country, with a drop of more than 12 deaths per 100,000 statewide from 1980-2003, according to the Delaware Division of Public Health. Colorectal cancer incidence in Delaware also decreased significantly, from 64.1 per 100,000 from 1990-1994 to 56.7 per 100,000 from 1999-2003. The Division of Public Health released the figures on July 14.

The number of Delawareans age 50 and older receiving screening for colorectal cancer is on the rise. Data from the 2005 Behavioral Risk Factor Surveillance Survey (BRFSS), conducted by the Division of Public Health, indicate significant gains in preventing and identifying cancer.

According to BRFSS, 75 percent of Delawareans age 50 and older had undergone colorectal screening at least once. There was a 61.6 percent increase in the number of African Americans who reported ever having a colorectal cancer screening, from 39.6 percent in 1999 to 64 percent in 2005. It is encouraging to note that 42 percent of African Americans who reported ever having had a colonoscopy had done so within the last year.

Caucasians who received screening also increased from 45.3 percent in 1999 to 69.3 percent in 2005. Additionally, 90 percent of those who had not undergone a colonoscopy were aware of the test.

Delaware�s rate of improvement for cancer mortality is great news for succeeding generations here because the trend will continue due to programs funded by the State and the efforts of committee members of the Delaware Cancer Consortium as well as all the hard working individuals in the field,� remarks Nicholas J. Petrelli, M.D., Bank of American endowed medical director of the Helen F. Graham Cancer Center.

I�m also convinced that part of this trend is the result of the extraordinary efforts of the physicians and research nurses who participate in the NCI Clinical Trials Program at Christiana Care and the Helen F. Graham Cancer Center. All of the above described programs are models for the rest of the nation.�

Christiana Care Community Clinical Oncology Program featured in National Cancer Institute's NCI Cancer Bulletin

Delaware cancer rates decline, thanks in part to Christiana Care�s leadership

A new report from the Delaware Cancer Consortium says cancer rates are declining faster in Delaware than they are in the nation, and attributes some of this success to a statewide cancer control effort led by Christiana Care�s Helen F. Graham Cancer Center.

Leading through innovation
The Consortium�s report, titled, "Turning Commitment Into Action: Year Two Accomplishments," shows that�based on five-year, age-adjusted averages (from 1992-1996 and 1998-2002)�the Delaware cancer incidence rate has fallen nearly five times faster (by 5.1 percent) than the drop in the U.S. estimated rate (1.5 percent). The same holds true for the cancer death rate, which has fallen 11.7 percent in Delaware (compared with 6.3 percent nationally).

"Through the work of the Delaware Cancer Consortium, and other statewide initiatives, the Christiana Care Helen F. Graham Cancer Center is helping all of the people of our state reduce the risk of getting and dying from cancer," says Nicholas J. Petrelli, M.D., MBNA-endowed medical director. "What�s more, we are committed to closing the gap in access to cancer treatment and prevention services for minorities and those who are uninsured and underinsured in our community."

Legwork to stop cancer
Through programs such as Screening for Life and Champions of Change, Christiana Care is working closely with the Delaware Division of Public Health to help hundreds of uninsured or underinsured Delawareans learn about and access screening for breast, colon and cervical cancer. Last year, Christiana Care�s nurse screening coordinators helped 113 individuals access colon screening services and enrolled those who were without insurance into the Screening for Life program. Through the Avon Helping Hands for Breast Health Network, Christiana Care has reached more than 1,500 women annually with information about the importance of early detection of breast cancer, enrolled nearly 1,000 women annually and has referred almost the same number for mammograms and clinical breast exams.

Christiana Care medical oncologist Stephen S. Grubbs, M.D., chairs the Consortium�s Colorectal Cancer Committee, whose members include Nora Katurakes, RN, MSN, OCN, manager of Christiana Care�s Community Health Outreach and Education program. For more information about how to access cancer screening services, call 302-765-4161.

1,000th ELCAP study participant screened

HELEN F. GRAHAM CANCER CENTER ASSISTS IN STUDY

Christiana Care�s Helen F. Graham Cancer Center is working to save more lives from lung cancer. Since 2003, the Center has taken part in a research study called the International Early Lung Cancer Action Project (ELCAP). The study uses a new type of spiral CT scanner to look for early signs of lung cancer, when it is most treatable. On March 29 our 1,000th participant was screened.

Top recruitersThoracic surgeon Tom Bauer, M.D., leads the study at Christiana Care with assistance from study coordinator Barbara Marconi, RN, BSN, OCN and research nurse Angela Steele-Tilton, RN, OCN. James Lally, M.D., is the lead radiologist on the project and with Sharon Gould, M.D., has volunteered to read the CT scans.

Our team is delivering cutting edge clinical research to the people of Delaware in an effort to improve survival and quality of life for smokers who are destined to get lung cancer,� explains Nicholas J. Petrelli, M.D., MBNA-endowed medical director of the Helen F. Graham Cancer Center. This is a project that was long overdue in our state, for the health of both present and future generations.�

One of few select sites
Christiana Care is the only center in the Delaware Valley to participate in ELCAP. In study recruitment we are ranked 12th out of only 40 participating sites worldwide. So far, several cases of lung cancer (75 percent in the early stage) and multiple other cancers (esophageal, breast, kidney) as well as heart disease have been uncovered among participants in this important screening program.

Who can participate?
Eligible participants are age 40 or older with a history of smoking at least a pack of cigarettes a day for 20 years (or the equivalent). Help to quit smoking is available.For more information about the ELCAP study, contact study coordinator Barb Marconi, RN, BSN, OCN, at the Helen F. Graham Cancer Center at 302-623-5227 (Dial 302-62ELCAP).

Prostate cancer patients do better with advanced radiation therapy

RESULTS TO BE PRESENTED AT NATIONAL MEETING

When the latest technologies are employed to their fullest potential, men who suffer from prostate cancer can expect better outcomes with fewer side effects. Christiana Care�s radiation oncology team has confirmed this by examining five years of clinical outcomes among their prostate cancer patients.

National recognition
The message here is that advanced therapies are being introduced at Christiana Care with incredible cure rates for both favorable and high-risk patients,� says Adam Raben, M.D., radiation oncologist at the Helen F. Graham Cancer Center. Dr. Raben will present the team�s findings in two peer-reviewed papers and a poster session at the American Radium Society�s 88th Annual Meeting in Hawaii, May 6-10.

Targeting radiation therapy
Intensity Modulated Radiation Therapy (IMRT) is rapidly replacing standard, three-dimensional conformal radiation therapy (3D-CRT) to treat many cancers, including prostate cancer. With IMRT, increasingly higher doses of radiation can be targeted directly to cancer cells without harming healthy tissues. Studies have shown that higher radiation doses can improve the chances for curing prostate cancer.

Community hospital experiences
Christiana Care investigators, working in collaboration with colleagues at one other cancer center in New Jersey, compared five-year clinical outcomes for 3D-CRT or IMRT. They collected data on 220 prostate cancer patients treated at their respective centers from 1998-2000 and from 2001-2004. They found that with IMRT, higher doses of radiation are feasible, safe and result in fewer side effects such as rectal bleeding or gastrointestinal problems. Outcomes compared favorably with other academic centers, demonstrating that higher doses of radiation are required to improve cure rates for all risk groups.

A second study looked at five-year results achieved with a combined form of therapy using IMRT and temporary High Dose Rate (HDR) Brachytherapy, in collaboration with the University of Colorado and Monmouth Medical Center in New Jersey. In this procedure, a protected source of high-dose radiation is implanted for a short period directly within the prostate while external radiation is also delivered using IMRT.

According to Dr. Raben, cure rates using the combined approach among 161 prostate cancer patients were outstanding and considerably higher than previously reported with other methods. The data showed a 70 percent cure rate among high-risk patients and a 90 percent rate for intermediate-risk patients with fewer than three percent reporting rectal side effects,� he says.

Dr. Raben points out that Christiana Care is one of a handful of community hospitals in the country to conduct this type of peer-reviewed research. Not only have we begun constructing our own reference source of clinical data, but now we have a great opportunity to share our findings at the national level and more importantly with our community,� he says. Patients and their families want to know that advanced technology and clinical research are resulting in improved cure rates in their own community so they can avoid travel to distant cities. Having family support and being close to home reduces the stress and burden for them during treatment.�

Nicholas J. Petrelli, M.D., nominated as president-elect of Society of Surgical Oncology

Nicholas J. Petrelli, M.D., MBNA-endowed medical director of the Helen F. Graham Cancer Center, was nominated to serve as president-elect of the Society of Surgical Oncology (SSO) for 2006-2007. Dr. Petrelli is actively involved in SSO. Currently the organization�s vice president, he served on SSO�s executive council from 2000 to 2003 and was councillor-at-large from 1992 to 1995. In addition, Dr. Petrelli is the former chair of SSO�s corporate relations and examination

committees and a past member of both the training program directors and continuing education committees. He also served on the James Ewing Foundation Board of Directors and was section editor (gastrointenstinal) for Annals of Surgical Oncology. The mission of SSO is to ensure that all cancer patients receive the highest quality, comprehensive and multimodal cancer care. The society provides a leadership role and a commitment to excellence in the broad specialty of surgery and surgical oncology.

American Cancer Society honors Nora Katurakes

Nora Katurakes, RN, MSN, OCN, received the American Cancer Society�s (ACS) Award for Excellence in Mission Delivery at the first Volunteer Leadership Conference for the Society�s South Atlantic Division. Katurakes, manager of Community Health Outreach and Education Program, received the award because "she demonstrates exceptional skill as a champion of the American Cancer Society�s goal to provide �state of the art� mission programs and services in every community," according Dawn Ward of the ACS. She has volunteered at ACS for the past eight years. As a volunteer, Katurakes facilitated free or low-cost screenings for breast, prostate, skin and colorectal cancers and was trained for the "Tell a Friend" and Breast Health Awareness programs. Katurakes is a member of the Men�s Health and Cancer Conference planning committee, which has reached more than 1,000 men and women the past four years. She adopted the ACS�s "Let�s Talk About It" program in New Castle County and hosts a quarterly cancer community forum, which reviews new programs, identifies gaps in service and meets the need for educational outreach to strengthen the community.

Vaccine studies look at new ways to treat cancer

Vaccine research is changing the way we think about how best to treat some cancers. The Helen F. Graham Cancer Center at Christiana Care is one of only a few centers in our region to offer this exciting new form of therapy. According to Michael J. Guarino, M.D., director of Christiana Care�s Pharmaceutical Research Program, Vaccine trials offer hope to patients with advanced cancers that have resisted other available treatment options. Because they are designed to target only cancer cells without harming healthy ones, these new vaccines are even more appealing to patients whose immune systems already may be compromised from repeated rounds of more traditional therapies.�

Three trials
Three separate vaccine trials are now open to patients at the Helen F. Graham Cancer Center, through the Pharmaceutical Research Program. A vaccine called IMOxine^� is being evaluated to treat patients with recurrent and advanced kidney cancer. Another under investigation is designed to activate the immune system specifically against prostate cancer cells. Men whose prostate cancer is spreading and no longer responding to hormone therapy may be eligible to receive this treatment. A third study, designed to treat lymphoma, will use each patient�s own tumor cells to make a vaccine called FavId^� that will target those cells specifically.

How cancer vaccines work
Cancer vaccines are designed to energize the body�s natural defenses against invading cancer cells. Most of the time cancer cells grow under the radar, without attracting much attention from the immune system. Vaccines are designed to change that. Most vaccines are injected into the bloodstream and target cells that belong to a specific type of cancer, such as prostate cancer cells, kidney cancer cells, or lymphoma cells. The vaccines contain bits of proteins called antigens that are either made synthetically or derived from a patient�s own cancer cells, as in the case of the lymphoma vaccine now under investigation. When the antigens enter the bloodstream they bind to the surface of the cancer cells, signaling the immune system for attention and exposing the cells to attack. The immune system responds by making antibodies that can hone in on those signals and destroy the cells.

For more information about ongoing vaccine clinical trials at the Helen F. Graham Cancer Center, contact Celeste Cordrey, RN, Pharmaceutical Clinical Trials coordinator, at 302-733-6269.

National study targets melanoma
Patients with metastatic melanoma may be eligible to participate in a national clinical trial, sponsored by the Eastern Cooperative Oncology Group (ECOG-1602) to evaluate four different vaccines designed to stimulate the immune system against melanoma tumor cells. The ECOG trial is funded by the National Cancer Institute and is open to patients at the Helen F. Graham Cancer Center through participation in the Christiana Care Delaware Community Clinical Oncology Program, for which Medical Oncologist Stephen Grubbs, M.D., serves as principal investigator. For more information about the melanoma vaccine trial, contact the Cancer Research Office at 302-733-6227.

Helen F. Graham Cancer Center will help test new cancer vaccine

LYMPHOMA PATIENTS WILL RECEIVE PERSONALIZED� TREATMENTS

Chuck Porter, 57, of Hockessin, remembers July 4, 2000, as the day he almost didn�t make it home. He had started his five-mile run just like every other day, but soon the energy began to drain from his limbs as from an open tap, forcing him to the curb for a breather. Not long afterward, his doctor diagnosed follicular or indolent, non-Hodgkin�s lymphoma, a slowgrowing cancer of the immune system that until now has had no cure.

Promising new study
There is hope for Porter and more than 56,000 Americans like him diagnosed each year with non- Hodgkin�s lymphoma. Christiana Care�s pharmaceutical research program at the Helen F. Graham Cancer Center is helping to test a new vaccine designed to signal the body�s natural defenses to destroy invading cancer cells. The vaccine (FavId��) will be made by Favrille, Inc., a pharmaceutical company based in San Diego, CA, and tested at multiple centers nationwide as part an FDA-approved, Phase III clinical trial. Christiana Care is one of only a few centers offering this trial in our region.

We�ve learned from previous studies that every person�s lymphoma cells are unique,� explains Michael J. Guarino, M.D., director of Christiana Care�s Oncology Pharmaceutical Trials Program, What is so exciting about this approach is that each batch of vaccine will be custom made from an individual�s own lymphoma cells and designed to target those cells specifically.�

Going on the offense
Lymphoma attacks the tissues and organs in the body that produce, store and carry white blood cells
that fight infections and other diseases. Most patients with non- Hodgkin�s lymphoma respond to chemotherapy combined with rituxamab, an approved drug that helps shrink their tumors. But with
follicular tumors, recurrence of their cancer is almost guaranteed.

According to Nicholas J. Petrelli, MBNA-endowed medical director of the Helen F. Graham Cancer Center, This pharmaceutical trial for a �personalized� vaccine against lymphoma is one more example of how our cancer program continues to lead in the search for new and better treatments for all types of cancer. Patients do not have to leave the state of Delaware to get cuttingedge cancer care,� Dr. Petrelli says.

Study regimen
All study participants will have a biopsy or sampling of their lymphoma tissue to make the study vaccine. All will receive standard treatment for their lymphoma. Half also will be randomly assigned to receive the vaccine monthly for at least six months. Those randomly assigned to the control group that does not get the vaccine may later go on to receive it in a companion trial. As for Porter, he hopes the lymphoma vaccine will knock out his cancer for good. At the very least this treatment could offer a better chance at sustained remission,� he says, but I�m ready to go for the brass ring. I won�t stop trying to be one of the first people cured of this disease.�

For more information about participating in the lymphoma vaccine clinical trial, contact clinical research nurse Kathy Oertel, RN, OCN, in the Cancer Research Office at 302-733-6227.

Back to Top