Issue No. 19 / November 2008

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In this issue

3 Map of U.S. cancer centerstissue collection sites

4 Dr. Petrelli explains The Cancer Genome Atlas project goals and what it means to the Helen F.Graham Cancer Center and cancer care in Delaware

The Helen F. Graham Cancer Center Joins NCI’s CancerGenome Atlas Project to Speed Cancer Research

cancerupdateThe National Institutes of Health (NIH) has selectedthe Helen F. Graham Cancer Center at Christiana Careto participate in The Cancer Genome Atlas (TCGA)project, a ground breaking, federally funded effort toaccelerate cancer research to find new cures. The $4.6million, four-year research subcontract to the Helen F.Graham Cancer Center was awarded by the NationalCancer Institute (NCI) and the National HumanGenome Research Institute (NHGRI).

Personalized medicine“We are right on the cutting edge of cancer research,”says Nicholas Petrelli, M.D., Bank of Americaendowed medical director of the Helen F. Graham

Cancer Center. “The cancer genome atlas project will help establish medicine where patients’diagnoses and treatments for cancer will be based on their own genetic profiles.”

Using the latest genetic technologies, a broad cross-section of the cancer research organizations and individuals are collaboratively working to develop a comprehensive catalog-an atlas-of the manygenomic changes that occur in three specific cancers.Data will be placed into a public database for use bythe international cancer research community.

Critical resourceThe vital role for the Helen F. Graham Cancer Centeris to collect, store and share tissue and hold samplesfor cancer research at other sites.

“The excellence of clinical care, the spectrum ofpatients treated, and the Helen F. Graham Cancer

Some members of the teamthat helped put the CGAPgrant together include;Nicholas Petrelli, M.D.,Brenda Rabeno, Gary Witkin,M.D., Pat Swanson, BeverlyWilson, Pat Grusenmeyer,ScD, FACHE. Missing from the photo are; JerryCastellano, Pharm D. CIP,Richard Dashefsky and Mary Iacocca, M.D.

“We are right on the cutting edge of

cancer research. The cancer genome

atlas project will help establish medicine

where patients’ diagnoses and treat-

ments for cancer will be based on their

own genetic profiles.”

— NICHOLAS PETRELLI, M.D.Bank of America endowed medicaldirector of the Helen F. Graham CancerCenter at Christiana Care

Center’s commitment to quality bio banking—which is anintegral part of the NCI Community Cancer Center Programplan—offer extraordinary opportunities for synergiesbetween cancer care in local communities where more than80 percent of cancer care is delivered and cutting edge science,” says Carolyn Compton, M.D., Ph.D., director of theOffice of Bio repositories and Bio specimen Research (OBBR)that manages genome atlas project. “These synergies will provide benefits to cancer patients on many levels.”

Genetic trail blazingThe Cancer Genome Atlas project is initially focusing oncancers of the brain (glioblastoma multiforme or GBM), the lung (squamous cell of the lung) and ovarian (serouscystadenocarcinoma of the ovary). These cancers, whichgenerally have a poor prognosis, account for more than258,480 cancer cases each year. “The contribution of high-quality tissue samples to translational research will transform cancer medicine and improve outcomes forpatients,” Dr. Compton explains. “Patient biospecimens and the molecules in them fuel the research and productdevelopment necessary to realize the dream of molecular

medicine – to better treat cancer.These molecules hold the secrets of the biologic and pathologicprocesses that we need to under-stand and control cancer.”

Early results from the atlas pilotdescribe the discovery of newgenetic mutations and other typesof DNA alterations present inGBM, including resistance to acommon chemotherapy drug. This discovery could impact theway doctors diagnose and treat

brain cancer in the future. The Cancer Genome AtlasResearch Network, (October 23, 2008). Comprehensivegenomic characterization defines human glioblastoma genes and core pathways. Nature, 455, 1061-68.

Making the teamCenters selected to participate as tissue collection sites wentthrough an extensive three-phase evaluation that included asite-visit from NCI reviewers. “We met NCI’s strict scientificand technical requirements, demonstrating our ability toenroll significant numbers of patients in research clinical trials and to collect and process the required numbers ofhigh quality tissue samples,” says Patrick Grusenmeyer,Sc.D., FACHE, cancer program vice president. According toSenior Counsel Richard Dashefsky, “Our selection by NCI

is as much a testament to the strict legal and ethical standards we follow as it is to our scientific capabilities.”

Other U.S. cancer centers serving as tissue collection sitesinclude:• Duke University• Emory University School of Medicine• Memorial Sloan-Kettering Cancer Center• The University of Pittsburgh• Henry Ford Hospital System• Mayo Clinic• Gynecologic Oncology Group Tissue Bank• MD Anderson Cancer Center• The University of California at San Francisco

Medical Center• Cedars-Sinai Medical Center• University Hospitals Case Medical Center• University of Florida• Washington University

High clinical trial participationThe Cancer Genome Atlas scientists will extract both DNAand RNA (part of the unique genetic material that carriesinstructions for how a person’s body develops and func-tions) from each tissue specimen. When deprived of normalblood supply, this tissue degrades rapidly, necessitating theneed for speed in collecting and preserving the tissue. Infact, the tissue procurement team will have less than 20minutes to collect, process, and flash freeze each specimenin liquid nitrogen. Each sample must be confirmed for diagnosis and viability by the pathologist. “Our selection asone of the few sites to participate in TCGA shows we havedemonstrated this is a process we can do very well,” saysGary Witkin, M.D., chair of the pathology department. “We are in for a lot of hard work, but everyone is excitedand up for the challenge of contributing to an incrediblyvaluable effort for the future of cancer research.”

2 Christiana Care Health System

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CAROLYN COMPTON, M.D.,PH.D., director of the Officeof Biorepositories andBiospecimen Research(OBBR)

“We met NCI’s strict scientific and

technical requirements, demonstrat-

ing our ability to enroll significant

numbers of patients in research

clinical trials and to collect and

process the required numbers of

high quality tissue samples.”

— PATRICK GRUSENMEYER, SC.D., FACHE, vice president of the Helen F. Graham Cancer Center at Christiana Care

Cancer Update 3

“The Christiana Care IRB has worked

closely with the members of the research

team to assure a detailed review of the

research protocol and procedures for

informed consent so that potential

research participants will be able to

make an educated decision about being

part of this important project.”

— JERRY CASTELLANO, PHARM.D., CIP, corporate director, Helen F. Graham Cancer Center at Christiana Care

Collecting, storing and sharing tissue and bloodsamples for research“This is a real ‘go live’ moment for all of us who have beenbanking research tissue for the last five to six years,” sayspathologist, Mary V. Iacocca, M.D., medical director of theTissue Procurement Center at Christiana Hospital. “It is certainly a feather in the cap of the Helen F. Graham CancerCenter and a tribute to the leadership of Dr. Petrelli, thatour tissue collection and banking program is judged to be on par with NIH standards.” What is more, she adds,“Patients who agree to participate can feel confident thattheir tissue specimen will be used immediately for studiesthat could potentially benefit others in the future with thesame type of cancer.”

“The processes are in place to support TCGA in the collection of ovarian, lung and brain cancers,” says BrendaRabeno, MT, MBA, manager of the tissue procurement center. “Right now we are streamlining our procedures tomaximize specimen viability. We expect to start collectingspecimens from patients with other types of cancer as theaward period progresses, she added noting that the awardwill fund the eventual hiring of nine individuals including

research nurses and technicians to meet the increaseddemand.

Dr. Petrelli cited Christiana Care thoracic, gynecologic and neurosurgeons, plus operating room personnel undersupervision of Jackie Crawford, RN, BSN, PCC., as important partners in procuring tissues.

The Helen F. Graham Cancer Center has one of the highestrates in the nation of patients participating in cancer clinicaltrials. All research involving patients and/or their datamust be approved and is monitored by the Christiana Care Institutional Review Board (IRB), a committee ofphysicians, philosophers, ethicists, nurses, clergy members,educators and community lay members who protect therights and welfare of participants in all clinical research trials conducted at Christiana Care. “The Christiana CareIRB has worked closely with the members of the researchteam to assure a detailed review of the research protocoland procedures for informed consent so that potentialresearch participants will be able to make an educated decision about being part of this important project,” saysJerry Castellano, Pharm.D. CIP, corporate director.

“This is a real ‘go live’ moment for all of us

who have been banking research tissue for

the last five to six years.”

— MARY V. IACOCCA, M.D.medical director of the Tissue Procurement Center at Christiana Hospital

University Hospitals Case Medical CenterCleveland, Ohio

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Memorial Sloan-KetteringCancer CenterNew York, New York9

Emory UniversitySchool of MedicineAtlanta, Georgia

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MD Anderson Cancer CenterHouston, Texas

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University of California atSan Francisco Medical CenterSan Francisco, California

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Mayo ClinicRochester, Minnesota

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Henry Ford Hospital SystemDetroit, Michigan

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Cedars-Sinai Medical CenterLos Angeles, California

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University of FloridaJacksonville, Florida9

Washington UniversitySt. Louis, Missouri

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University of PittsburghPittsburgh, Pennsylvania

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Duke UniversityDurham, North Carolina

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Gynecologic OncologyGroup Tissue BankColumbus, Ohio

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Map of U.S. CancerCentersTissueCollectionSites

P.O. Box 1668Wilmington, Delaware 19899

One of only 14 cancer centers in the nationselected for the National Cancer Institute

Community Cancer Centers Program.

Cancer Update is produced by Christiana Care Health System. Entire publication © Christiana Care Health System, 2008. All rights reserved. 09CANC38

Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission.

Non-Profit Org.US Postage

PAIDWilmington, DEPermit No. 357

Q. What is The Cancer Genome Atlas (TCGA) project?

A. TCGA, a National Institute ofHealth research program, seeks tocreate a genetic map of cancer inorder to understand how itbehaves. TCGA is key to creating a new generation of protocols for preventing, diagnosing andtreating cancer. The HumanGenome Project, which mappedentire human genome and was completed in 2003, laid thegroundwork for improving ourunderstanding of cancer biology.Now, with TCGA, we are taking a critical next step forward byattempting to create a comprehen-sive road map of all the geneticchanges involved in cancer.

Q. How will TCGA work?

A. Small samples of cancer and normal tissues will be collected for TCGA with permission frompatients undergoing surgery toremove their cancer. Teams ofresearchers will study and compare

the genetic material fromthese tissues along withinformation provided fromeach patient’s medical history (coded to protecttheir identity). This infor-mation, collected from thethousands of people whoparticipate, will provide importantinsight into the makeup of eachcancer and the response to differenttherapies. All of this informationwill be used to create the atlas ofgenomic changes in cancer and willbe made available to investigatorsconducing research worldwide.

Q. How will this lead to better cancer care?

A. This research is the first critical step in personalized medicine –allowing health care providers totailor diagnosis and treatment to a patient’s unique genetic profile.What we learn also will driveimproved cancer prevention strate-gies and allow us to develop betterdiagnostic tools to identify peopleat risk.

Q.What will change for Delaware patients with cancer?

A. As we provide bio specimens to the TCGA, we are also expand-

ing our Tissue Procurement Centerhere in Delaware. At the Helen F.Graham Cancer Center, our multi-disciplinary approach to treatmenthas always focused on translationalinvestigations to more quicklytranslate cancer research intopatient care. So we are increasingour support for local cancer studiesconducted through the Center forTranslational Cancer Research, acollaborative program of the HelenF. Graham Cancer Center and theUniversity of Delaware, along withthe Nemours Research Institute atthe Alfred I. duPont Hospital ForChildren and the DelawareBiotechnology Institute.

Dr. Petrelli explains The Cancer Genome Atlas projectgoals and what it means to the Helen F. Graham CancerCenter and cancer care in Delaware

www.christianacare.org 4