Our Multispecialty Approach

LUNG CANCER MATTERST H E J O H N S H O P K I N S K I M M E L C A N C E R C E N T E R

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Our MultispecialtyApproachWhat It Means and Why It's Better

2019/2020

THE JOHNS HOPKINS KIMMEL CANCER CENTER 1

Our MultidisciplinaryApproach

At most hospitals around the country, diagnosis and treatment revolve aroundthe care team, with a series of visits with medical, surgical and radiation oncologists and other specialists at different locations. Numerous appointmentsfor tests, care decisions and treatments are spread out over time. However, at theKimmel Cancer Center’s Thoracic Oncology Multidisciplinary Clinic, located onthe Johns Hopkins Bayview Medical Center campus, providers follow an opposingmodel in which the care team revolves around the patient in one central location.

What It Means andWhy It’s Better

THE JOHNS HOPKINS KIMMEL CANCER CENTER 32 LUNG CANCER MATTERS

The 70-year -old retiree from southBend, Indiana, couldn’t pinpoint any-thing specifically wrong, except for apersistent cough. The nurse practi-tioner at her doctor’s office told herthat it was probably viral, so Butkeradidn’t worry. But after about a month,her regular physician suggested gettingan X-ray of her lungs.

“I said, ‘Wait, do you think Ihave lung cancer? Is this a joke?’” sheremembers. “But he said, ‘Better safethan sorry.’”

When she got home later thatafternoon, her husband, eddie, mether in the kitchen. With a stunnedlook, he told Butkera that her doctorhad called to say that there was amass on her lung. A biopsy soon after-ward confirmed that it was cancer.

Although more than 234,000people are diagnosed with lung cancereach year in the U.s.—making this thesecond most common cancer in bothmen and women—they don’t all receivethe same model of care. At most hospi-tals around the country, diagnosis andtreatment revolve around the careteam, with a series of visits with med-ical, surgical and radiation oncologistsand other specialists at different loca-tions. numerous appointments fortests, care decisions and treatmentsare spread out over time. However, atthe Kimmel Cancer Center’s ThoracicOncology Multidisciplinary Clinic on

the same test because of a lack of com-munication. even paying for parkingrepeatedly added to the hassle.

“I’d look into the eyes of these pa-tients and see people who were scaredto death about their cancer diagnosisand worried that we were extending thisworry with each additional appointment,”he remembers. “Our approach is to takeall those different appointments andbottle them up into a single clinic visit."

To make that idea a reality, Halesand his colleagues in thoracic oncologyneeded to design a completely newkind of cancer treatment space.Rather than having medical, surgicaland radiation oncologists in three dif-ferent locations, they were co-locatedat the same site. Their nurses—alongwith the technicians who perform imaging and other diagnostic testsand all their equipment—also neededto share the same setting.

Additionally, Hales says, at JohnsHopkins, much like most large hospitals,funds run through separate departments.To make a shared space like he’d envi-sioned, several departments needed topool their resources—a mundane butconsequential undertaking.

After years of planning, Hales andcolleagues who had been scatteredacross The Johns Hopkins Hospitalcampus moved into their new combinedspace on the Johns Hopkins Baviewcampus in 2015. It was just in time forButkera’s first appointment in decem-ber of that year.

A Patient GuideAfter Butkera recovered from the initialshock of her diagnosis, she called each of her children to let them know whatwas happening—including her daughter,Jessica, an attorney who lives in Baltimore and has worked with JohnsHopkins. Jessica and her friends helpedButkera connect with Peggy Lang, anurse practitioner and Thoracic Oncol-ogy Multidiscipinary Clinic coordinator.

“I talked with Peggy on a Tuesday,and she asked how soon we could getthere,” Butkera remembers. “Wewere in the car on Wednesday.”

Lang is usually the first contactthat patients make at the clinic, and

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the Johns Hopkins Bayview campus—where Butkera receives her care—providers follow an opposing model inwhich the care team revolves aroundthe patient in one central location.

This new model hasn’t just easedthe lung cancer journey for Butkeraand other patients—studies show that it is also lengthening lives whilecutting health care costs.

Building a Better Clinic Radiation oncologist Russell Hales,director of the Thoracic Oncology Multidisciplinary Program, based atthe Kimmel Cancer Center on theJohns Hopkins Bayview campus, saysthat he got the idea to start the clinic in 2011, during his first year at the Kimmel Cancer Center.

As a downstream provider whotypically sees patients after they’vealready seen several other membersof the care team, he’d often meet pa-tients at the peak of frustration andstress. Many had already been throughnumerous appointments to see otherspecialists one by one over the courseof months, with a bevy of diagnostictests done on different days. Informa-tion about their condition was doledout piecemeal as each test was com-pleted. Providers sometimes gaveconflicting information or repeated

her work starts before patients everarrive. she gathers all necessaryrecords from other providers and determines and schedules tests andimaging patients still need.

The clinic offers initial visits fornew patients once a week, starting at9 a.m. When patients first arrive, theymeet with a resident, fellow or an-other nurse practitioner to take a de-tailed history and perform a physicalexam, a process that takes about anhour. Then, around 10 a.m., Langleads an educational session for pa-tients and whoever came with them—often a spouse or an adult child.

Butkera had both eddie and Jessica with her on that first clinicday. she remembers feeling numb asLang gave her and five other patients atwo-hour tutorial on what they’d needto know about lung cancer, includingrisk factors for the disease, how stag-ing works, how cancer can spreadfrom its primary site, how differenttreatments work and why nutrition isimportant, among other topics.

Patients are given a lot of infor-mation, says Lang, but many find it em-powering. “The more they know, theless there is to fear. There’s also cama-raderie in meeting other patients withthe same diagnosis,” she says. “I like tothink that I’m making a very difficultsituation better. Many times, patientsjust need someone to talk to, someoneto explain it, and they need to hear itwith compassion and understanding.”

All in a Day’s WorkAfter the education session, all the pa-tients head to lunch together as a group —an opportunity for them to get to knoweach other better and make contactsfor support—while the care team leapsinto action at the clinic. After spendingtime reviewing each patient’s chart be-forehand, they’ll spend the next hourdeciding on the best care to recommendto each patient, explains Josephine“Joy” Feliciano, medical director ofthe Thoracic Oncology Program.

It’s a meeting akin to the tumorboards that many cancer centers holdusually once a week, in which everymember of the care team—doctors,nurses and other care providers in-volved in the treatment—discussevery aspect of each patient’s condi-tion to come up with a plan. Ratherthan talk about patients who visiteddays ago—the practice at many othercancer centers—Kimmel Cancer Cen-ter experts discuss the patients seenat the clinic that same day.

“We’re not just discussing thetreatments that they’ll need for thatstage of cancer, but what other re-sources we’ll need to enlist for eachpatient based on what we know aboutthem—their medical history, socialhistory, their life circumstances—be-cause treatment isn’t just about thecancer itself,” Feliciano says. “It’s abouthow this patient might need rides tochemo or that one might need us to

coordinate care with their cardiolo-gist because they have a pacemaker.”

Once the doctors conclude theirmeeting, it’s time to meet with patients.Medical oncologists, surgical oncolo-gists and radiation oncologists, or anycombination of these three, see eachpatient and discuss their recommen-dations for the next steps.

This single-day approach is highlyunusual in cancer care, explains Hales,where patients generally have to visitdoctors at different sites. All the aspectsof this first clinic visit—including theexam, education session, lunch andtumor board meeting—unquestionablymake for a long day.

“But patients get to leave in a daywith a plan that would have takenweeks to develop elsewhere,” says Hales.“We pride ourselves on that long daybecause so much gets accomplished.”

All the Experts TogetherTests revealed that Butkera’s tumorwas situated in a way that would makesurgery challenging. The cancer hadalso spread to tissue near her hip. sheand her husband nicknamed it “thefloater.” Her care team recommendedcombined therapy with chemotherapyand radiation. soon after that initialappointment, she started treatment.

Thoracic surgeons are preparedfor challenging scenarios like Butkera’s.“A high proportion of our patients re-ceive treatment before surgery, but our

Dina Lansey

Peggy Lang, N.P.

Julie Brahmer, M.D.

Joy Feliciano, M.D.

In November 2015,Frances Butkera just didn’t feel like herself.


outcomes are as good as everywhereelse, despite the complexity,” saysRichard Battafarano, director of gen-eral thoracic surgery and a member ofthe multidisciplinary team.

After the initial diagnosis andplanning, treatments and follow-up ap-pointments also continue at the Kim-mel Cancer Center on the JohnsHopkins Bayview campus. Having allthe experts together helps facilitatetreatment discussions, explains Hales.“If a scan reveals that a patient’s cancerhas returned, I can consult with my col-leagues in medical oncology to discussstarting chemotherapy right away, asopposed to waiting a week or longer toget a new appointment on the books,”he says. Working in the same physicalspace also influences clinician-scien-tists’ research programs, spurring newquestions and plans for studies.

“It allows each member of thecare team to work together moreseamlessly,” says nurse RamseyValenti, who works with Hales. Al-though specialties may vary amongnurses, she says, “we’re all in two-sec-ond walking distance to each other.”That close proximity helps them learnmore about each patient—such aswhich days each patient needschemotherapy or bloodwork, orwhich ones are candidates for surgeryand need follow-up—allowing them todeliver unified information to patientsand work together to improve care.

Patients also appreciate theshort distance from one treatment areato the other, Hales adds. “If patientsare getting chemotherapy and radia-tion on the same day, they’ll walk 200feet from one area to the next, insteadof from one building to the next.”

The ProofAlthough Hales and colleagues knew thisnew model worked for Kimmel CancerCenter patients, they wanted objectivedata that provided evidence for othermedical institutions to show this modelwas an investment worth making. He andhis colleagues put the clinic to the test toquantify the increased value for patientsand the health care system.

“Value is a buzzword in medicinethese days, and increasing value can

4 LUNG CANCER MATTERS

mean one of two things—improvingcare at the same cost or reducing costfor the same level of care,” he says.

Two years ago, Hales and col-leagues presented data at the Ameri-can society of Radiation Oncology(AsTRO) meeting, comparing theoutcomes of lung cancer patients whoreceived care through the multidisci-plinary clinic with patients who re-ceived their care outside of theclinic—either in the years just beforethe clinic opened or with individualproviders through a more traditionalcare model. Their findings showedthat one-year survival at the clinic was82 percent, compared with 64 percentfor patients treated outside the clinic.

Last year, Johns Hopkins radia-tion oncologist Ranh Voong presentedadditional data at the AsTRO meeting,showing that the clinic provides a costsavings of 30 percent over traditionalcare—presumably because patients receive more streamlined planningand treatment, avoiding unnecessary appointments and tests.

“You don’t see this magnitude ofimprovement in some of the newerdrugs coming out, and it’s even moresignificant because patients and thehealth care system are saving money,”says Hales.

Butkera says her treatment has in-volved several twists and turns. she’s hadtwo courses of chemotherapy and radia-tion over the past three years, and she re-turns to the Kimmel Cancer Center forfollow-up care to receive new scans everythree months. In the meantime, she’sseen her daughter get married, watchedher grandchildren grow and celebratedher 48th wedding anniversary—none ofwhich she believes would be possiblewithout the care she’s received.

“I can’t say enough about thedoctors, nurses, technicians andeveryone at the clinic,” she says.

“They’ve made a really bad,scary situation much more bearable.”WEB EXCLUSIVE: Lung Cancer surgery with dr. Benjamin Levy and dr.stephen Broderick: http://bit.ly/2CmDYke

Expert Surgeons At Johns Hopkins and other medical centers across the country, outcomes fromlung cancer surgeries are getting better and better, say thoracic surgeons StephenBroderick and Richard Battafarano. That’s largely due to changing philosophiesand approaches, they add. For example, about 75 percent of surgeries for early-stage lung cancer now take place in a minimally invasive fashion.

“We don’t hesitate to use an open approach when necessary,” says Broderick. “But when possible, a minimally invasive approach leads to less pain,a shorter length of stay and improved outcomes.”

In the Kimmel Cancer Center, Broderick, Battafarano and thoracicsurgeons Errol Bush, Malcolm Brock, Jinny Ha and Stephen Yang aredeveloping better techniques, such as operations after patients have alreadybeen pretreated with chemotherapy or immunotherapy, to advance therapyand improve outcomes for the most complicated cases.

Interventional PulmonologyInterventional pulmonology is a relatively new subspeciality of pulmonarymedicine. But it’s already making huge strides in diagnosing patients earlier and

boosting survival, say Johns Hopkinsinterventional pulmonologists Lonny Yarmus,David Feller-Kopman, Hans Lee and AndrewLerner. Each of these specialists is helping todevelop new technology or protocols thatcontinue to improve patient care.

For example, Yarmus is currently the princi-pal investigator for two clinical studies. One is amulticenter prospective clinical trial that’s inves-tigating electrom agnetic navigation—a type ofGPS for the lungs—to help locate small nodulesfor biopsy. Another trial is helping to develop ahand-held device that analyzes a patient’s breathfor lung cancer biomarkers. A third trial, led byLee, is combining bronchoscopy with genetic

information from patients to stratify the cancer risk of lung nodules.“Each of these efforts is aimed at earlier identification, earlier diagnosis

and earlier treatment, which lead to higher survival,” Yarmus says.Johns Hopkins is also one of the top centers for endobronchial ultrasound,

helping develop consensus statements that are guiding the field, adds Feller-Kopman. “It’s not a rare technique anymore, but performing it well is veryimportant,” he says. “We have long been leaders in this area.”

“Every year, there are newer and newer techniques and technology,” addsLerner. “Each advance is helping us provide even better care for our patients.”

Locations in the National Capital RegionOver the past decade, the Kimmel Cancer Center has grown, with locations now inthe national capital region at Sibley Memorial Hospital and Suburban Hospital.Despite this growth, our experts remain committed to maintaining the team

approach, says lung cancer expertBenjamin Levy, clinical director ofmedical oncology at Sibley. Radiationoncologists Jean Wright, who directsthe Breast Cancer Program and treatsthoracic malignancies at the KimmelCancer Center at Sibley, and StephenGreco, who directs the Department ofRadiation Oncology at Suburban

Hospital, say they meet twice a week.Wright and Greco join colleagues based at the Johns Hopkins Bayview and

East Baltimore locations for tumor boards, using video conferencing technology.The groups discuss the best care for patients. “We’ve developed a more unifiedapproach across these different sites,” says Greco. For example, interventionalpulmonologist Andrew Lerner, who performs procedures at Sibley, attends Sub-urban’s tumor boards to share his expertise on diagnosis, staging and treatments.

“We now have a full multidisciplinary team so we can offer our patients thebest care, regardless of location,” says Wright.

SPECIALTY CARE

Richard Battafarano, M.D., Ph.D.

Ranh Voong, M.D.

Jarushka Naidoo,M.B.B.Ch.

Russell Hales, M.D.

Feller-Kopman, M.D. Lee, M.D.

Lerner , M.D. Yarmus, D.O.

Lerner, Wright, Levy, Greco, Broderick


cancer, which typically develops inthe bronchioles—the small, branch-like airways in the lungs. When themedical director for the secret service,a former Johns Hopkins doctor,learned of the diagnosis, he sentshurer to the Johns Hopkins KimmelCancer Center.

shurer opted for treatment atthe Kimmel Cancer Center’s sibleyMemorial Hospital location in Wash-ington, d.C., as it was closest to wherehe lived and worked, under the care ofLevy, a thoracic cancer expert andclinical director of medical oncology.

The lung cancer had alreadyspread, so surgery was not a treatmentoption, but Levy gave shurer hopefrom the onset. “dr. Levy said, ‘We havegood treatments. There are things wecan do,’ and that was huge. I felt likewe could put up a fight,” says shurer.

Among the first things Levy didwas order genetic testing of shurer’scancer and found it was among the 15to 20 percent or so of non-small celllung cancers that contain mutationsin a gene known as eGFR. Although,the gene alteration actually fuels thegrowth of the cancer, it is also a targetfor treatments with drugs that slow orstop the cancer by blocking the gene.

The gene mutations that sup-port cancer growth and spread canalso be its Achilles’ heel. drugs thatinterfere with the genes are calledtargeted therapies and are a promis-ing and relatively new kind of cancertherapy. Unlike standard chemother-apy, which directly but somewhat in-discriminately kills rapidly dividingcells—cancer cells and normal cells—targeted therapies work by interfer-ing with an unchecked mechanismthat fuels the cancer to start, growand spread. shutting down thatmechanism can slow or stop thegrowth and spread of cancer cells. Ofcourse, targeted therapies only workif the cancer has the target, and forshurer, that was the case.

He was treated with an eFGR-blocking drug called afatinib—one pilltaken orally every day—and for al-most two years, it kept his cancer incheck. Radiation oncologist Jean

Wright also treated some of shurer’stumors with radiation therapy to alle-viate pain caused by the cancer.

In March 2017, on a scale of 1 to10, shurer classified his pain as a 9.“After three weeks of radiation with dr.Wright, it was a 3,” he says.

Levy understands advancedcancer and how it can turn the tables

to become resistant to treatment, sohe was always developing multipleplans to go after shurer’s cancer. Withadvanced cancers like shurer’s, it’s un-likely that treatment will make himcancer-free, but they can hold the can-cer in check, keeping it from growing,essentially converting it to a chronicstate that patients can live with.

“even when things were goinggreat, he was always looking for waysto improve our position or to shiftcourse if things started going the otherway,” says shurer.

That was the case in October2018, just a few weeks after his Medalof Honor ceremony, when a CT scanrevealed the cancer was growingagain. The first eGFR inhibitorknocked the cancer back quite a bitand held it in check for 19 months, soLevy plans to use a newer and betteriteration of the drug to stabilizeshurer’s cancer once again. If newerversions of the drug don’t work, hehas several other treatment optionshe is considering, including the possi-bility of a clinical trial. He hadshurer’s cancer studied again to iden-tify any new mutations that might beamenable to other targeted therapies.

“Of course, I’m not excited thatthe cancer is progressing again, but Idon’t have any question that dr. Levyhas three, four or five plans ready togo,” says shurer. “If the first one doesn’twork, he’ll move to the next one.”

There are currently four eGFRinhibitors that are FdA approved foradvanced lung cancers like shurer’s.There are also other gene mutationsthat respond to targeted therapies.

“new gene mutations that can-cers acquire over time, called resist-ant mutations, may make targetedtherapies stop working, but fortu-nately, have led to the development ofnext-generation targeted therapiesthat may be effective,” says Levy.“While historically, immunotherapy,like checkpoint inhibitors, has notworked in most patients with eGFRmutations, ongoing clinical trials areevaluating newer immunotherapeu-tic approaches that are promising.Other drugs, called antiangiogenesisagents, that cut off the blood supplythat nourishes tumors also workagainst some lung adenocarcinomas,including eGFR mutation patients.”

Cancer seems an unthinkablycruel reality for someone who has al-ready sacrificed so much. still, thehusband and father of two young boysremains fixed on the future. In thoseinevitable moments of despair, hecredits his wife, friends and medicalteam for helping to keep him positive,focused and determined.

special Forces military traininghelps. “You don’t get a Medal ofHonor because things went well foryou that day,” says shurer. He saysfacing adversity and life and death inhis military service helped preparehim emotionally for his cancer battle.

“When I was overseas, I saw howlife could just be taken away in the blinkof an eye. I have friends who didn’tcome home. I’ve had to fight cancer forthe last two years, but I’m still with myfamily. I’m still enjoying things. I’mthankful for that,” shurer says.

He remains confident in the ex-pertise of Levy, Wright, nurse practi-tioner Rasheda Persinger and all ofthe Kimmel Cancer Center at sibleyexperts who provide his cancer care.

“They take great care of us everytime we’re there. They listen to us,and we appreciate that,” says shurer.“They have our complete trust. Weare in this fight together.”


U.s. Army special Forces veteranRonald shurer is no stranger to toughbattles. The Green Beret and seniormedic was awarded the Medal of Honorin 2018—the country’s highest militaryhonor—for fighting for more than anhour to reach and care for members ofhis unit when attacked by 200 enemyfighters during the Battle of shok Valleyin Afghanistan on April 6, 2008.

In March 2017, shurer unexpect-edly found himself on a new kind ofbattlefield, facing a sneak attack by adifferent kind of enemy—lung cancer.

The battle is longer and themethods different, but the strategy is

a bit similar, as 40-year-old shurerworks with his Johns Hopkins Kim-mel Cancer Center oncologist BenLevy to monitor the enemy and adjustthe attack to defeat as many of the in-vading cancer cells as possible.

“In a lot of respects, I’m ap-proaching cancer in the same way Iapproached my Army missions, rely-ing on gains and surrounding myselfwith great people,” says shurer.

He was diagnosed two years agoafter ongoing hip and back painturned out to be spreading cancer.

After leaving the Army in 2009,shurer became a member of the se-

cret service, a job that often requiredcarrying heavy gear.

“I distinctly remember hikingthrough Yosemite national Park withthe Obama family and my back seizedup a lot,” says shurer, who was withthe former first family as part of itssecret service detail.

He was carrying a lot of gear, andthis combined with the physical demandsof his years of military service seemedto point to some type of muscular in-jury. It made sense to shurer, and fora time, he got some relief with chiro-practic care. Unfortunately, the painremained and worsened over time.

Imaging to explore his escalat-ing hip pain revealed a fracture, butthe worst news came when additionalimaging revealed the fracture wascaused by cancer that had spreadthroughout his body.

The diagnosis was the most ad-vanced stage of adenocarcinoma ofthe lung, a type of non-small cell lung

Lessons fromTwo BattlefieldsA Military Hero Confronts Advanced Lung Cancer

[Profile]

Deputy Defense Secretary Patrick M. Shanahaninducts Medal of Honor recipient, former Army Staff Sgt. Ronald Shurer into the Hall of Heroes at the Pentagon.

THE JOHNS HOPKINS KIMMEL CANCER CENTER 98 LUNG CANCER MATTERS

[Community Care]

Breaking Down Barriers toLung Cancer Treatment

toring them regularly,” Feliciano says.“If not, they may not be undergoingroutine screening for lung cancer ormay not be evaluated early enough,when they start to have symptoms.”

People who lack access to pri-mary care are also unlikely to un-dergo screening for lung cancer, evenif their risk for developing the diseaseis elevated—if they smoke, for exam-ple, or have been exposed to certainchemicals in the workplace.

Taken together, these factorsadd up, resulting in patients who areless likely to receive stage-appropri-ate evaluation and therapy. Felicianois working to improve the delivery ofcancer care throughout the wholetimeline of the disease.

Representation in Clinical TrialsAfrican Americans and other under-served and minority populations areunderrepresented in clinical trials ofnew treatments. Working with patientnavigators, Feliciano hopes to identifymore patients with lung cancer in thearea who are eligible for studies butmay be unaware of the promising newtreatment options being studied. shealso is collaborating with Dina Lansey,assistant director of diversity and inclusion in clinical research, to see ifher patients can be included in a study

to determine if providing free trans-portation or parking has a positive impact on clinical trial participation.

Lack of Social Support and Access to Resources“something that can make a huge im-pact for these patients is having supportfrom social workers and counselors,”says Feliciano. “It’s not just the cancerthey’re dealing with. It’s many issues athome. Lung cancer is really a diseasethat affects the whole family at manylevels. There is a lot of room for im-provement for resources to be directedto those who need them most.”

Feliciano works with social workers and navigators to make sure that a whole range of needs are addressed and met, including trans-portation needs—often a main con-cern—and ensuring that prescriptionsare filled and taken. “These interven-tions may seem simple, but they may impact whether or not a patientcompletes their treatment,” she says.

CostFeliciano and colleagues are looking athow the costs of cancer care impact pa-tients. The cost of drugs; lost wagesfrom missed work; treatment for sideeffects, such as nausea and pain; andthe cost of parking and transportationcan add up to what feels like an insur-

mountable burden. It is possible this “fi-nancial toxicity” from cancer care mayimpact patient choices and ultimatelyoutcomes from their disease as well.

“There are so many costs thatproviders are unaware of and don’ttake into account,” says Feliciano.“Our goal is to understand thesebarriers to care so that we can dobetter for our patients.”

With all these efforts, the Kim-mel Cancer Center is dedicated tofinding innovative ways to break downbarriers so that all patients with lung cancer have access to thesupport and treatment they need tosurvive and thrive.

differences in the health status of vari-ous groups of people are known ashealth disparities, and they are becom-ing a focus of attention among healthcare providers. Factors such as race,ethnicity, immigrant status, disability,sex or gender, sexual orientation, geog-raphy and income can all impact howillness and disease affects someone.

Like many illnesses, lung cancerdoes not discriminate. It is known todisproportionately affect specificpopulations, with differences in theincidence, treatments, and outcomes,such as survival. For example, the

American Cancer society reports thatblack men are at roughly 20 percenthigher risk of lung cancer than whitemen—even if they don’t smoke.

Through various clinical and academic research efforts, pilot proj-ects, and support from the Wayne K.Curry Lung Cancer disparity Aware-ness Fund and P.J. Aldridge Founda-tion, Joy Feliciano, Johns HopkinsKimmel Cancer Center lung cancerexpert, is working to break down thebarriers within populations who ex-perience health disparities.

Access to Care and Care DeliveryAll along the way, these patients facehurdles to optimal care for their disease.The problem starts even before they arediagnosed, with a lack of access to pri-mary care physicians or not being underthe care of a primary care physician.These doctors are very important be-cause they are often the clinicians whofirst suspect the presence of cancer.

“People may not have primarycare physicians to whom they canbring their complaint or who is moni-

FACTORS SUCH AS RACE,

ETHNICITY, IMMIGRANT STATUS,

DISABILITY, SEX OR GENDER,

SEXUAL ORIENTATION,

GEOGRAPHY AND INCOME

CAN ALL IMPACT HOW

ILLNESS AND DISEASE

AFFECTS SOMEONE.

Patient Vyrlena Choyce and Dr. Joy Feliciano

Surviving and Thriving: DarleneStewart, a patient of Feliciano's, is a retired teacher and a two-time cancer survivor. She battledbreast cancer in her 20s. Now, sheis combating advanced lung can-cer, receiving a drug that targetsa gene mutation in her cancer.The targeted therapy has kept hercancer in check for the last sixyears. “I love the Kimmel CancerCenter and Dr. Feliciano. Itdoesn’t even feel like we’re com-ing for a doctor’s appointment. I feel great, and I have so muchfun when I see her,” says Stewart.


Patrick Personne was not surprisedwhen his doctor told him he had lungcancer. The 62-year-old had been asmoker for more than 40 years, so whenhe began feeling ill and developed anagging cough, lung cancer certainlycame to mind. What did surprise him,however, was learning about a new typeof treatment called immunotherapy.

“To me, lung cancer meant I wasgoing to die. I thought I was done,” recalls Personne. The avid motorcy-cle rider began planning his farewellride, a trip to Patagonia, Argentina.

His doctor encouraged him to goto the Johns Hopkins Kimmel CancerCenter. “He told me, ‘They are thebest in the country,’” says Personne.He met with thoracic surgeon StephenYang and lung cancer expert PatrickForde within days of his diagnosis andenrolled in a clinical trial using im-munotherapy before surgery.

“When I was first diagnosed andsaw the X-ray, there was this hugeblack spot on my lung. After just twotreatments with the immunotherapy,


Lung cancer expert Julie Brahmer ledthe landmark clinical trials that helpedearn FdA approval for the immunother-apy drugs nivolumab and pembrolizumabin lung cancer.

nivolumab (Opdivo) is now FdAapproved for treatment of advancednon-small cell lung cancer in patientswhose cancers progress on standardtherapy, and pembrolizumab(Keytruda) became the first im-munotherapy to gain FdA approval asthe first-line treatment for non-smallcell lung cancer patients whose cancercells have a lot of a Pd-L1 protein.Pembrolizumab works so well in thisPd-L1 subset of lung cancer patients—extending survival well beyond whatchemotherapy was able to do—that thesepatients can now forgo chemotherapyand start with immunotherapy. A first-line combination of chemotherapy andpembrolizumab was also approved forpatients with advanced lung cancer,making it the second FdA-approvedimmunotherapy combination.

Brahmer’s clinical studiestested anti-Pd-1 therapy in a varietyof advanced cancers, including non-small cell lung cancer. she and the re-search team discovered that Pd-L1was expressed in human lung cancercells and highly elevated when com-

pared with normal cells. The remark-able activity of anti-Pd-1 in a smallnumber of lung cancer patients provedwhat Johns Hopkins Kimmel CancerCenter immunologists long believed—if understood, the immune systemcould be used to fight any cancer.

now, a new clinical trial led byPatrick Forde, in collaboration withsurgeons Richard Battafarano,Stephen Broderick and Stephen Yang,may have uncovered evidence that—insome patients—immunotherapy shouldstart even sooner. Forde’s trial was thefirst to study anti-Pd-1 immunotherapybefore surgery. After just four weeksand two doses, all the patients had im-mune cells rushing to their tumors, andnine saw significant or complete reduc-tion in the size of their tumors.

In this small study of 21 lungcancer patients with operable tumors,nine patients had a 90 percent or morereduction in tumor size. Forde andcolleagues believe the immunotherapy

prompted an aggressive immune at-tack against the cancers.

“These findings suggest that thetiming of immunotherapy may be criti-cal to successful cancer treatment inpeople whose lung cancers are opera-ble,” says Forde.

He plans additional studies to seeif they can extend this immune re-sponse to more patients by giving alonger course of anti-Pd-1 or giving itin combination with other checkpointinhibitors before surgery.

All these studies are aimed atPd-1 and a related partner protein on

tumor cells called Pd-L1. Pd-1 is whatimmunology experts call an immunecheckpoint. Checkpoints are mole-cules on the surface of T cells and natu-ral regulators of the immune responsethat cancer cells use to avoid immunerecognition and attack. drugs such asnivolumab and pembrolizumab blockcheckpoints and signal the immunesystem to attack cancer cells.

Laboratory research and earlyclinical trials point to Pd-1 as one ofthe strongest influencers of an immuneresponse to cancer identified so far.

nivolumab has produced thelongest follow-up to date of an immunecheckpoint inhibitor. “Five-year overallsurvival quadrupled in non-small celllung cancer, compared with what wewould expect from chemotherapy,”says Brahmer, director of the ThoracicCenter of excellence and theBloomberg~Kimmel Institute for Cancer Immunotherapy lung cancerimmunotherapy program.

“Based on these data, I think wecan shorten the amount of time patientsare treated. But we need to identify thosepatients who develop immune memory,”says Brahmer. “I think we can safely saynot all patients need indefinite treat-ment. We want to personalize therapy.We are continuing to look for biomarkersfor response and long-term control.”

The Promise of Immunotherapy

[Clinical Trials]

it disappeared. It was like magic,” saysPersonne.

What he thought was going tobe his last ride turned out to be a newbeginning. His rides have become ametaphor for his triumph over lungcancer.

“I’ve traveled from the end of theworld to the top of the world!” saysPersonne.

Before he left for his trip, hecreated a website where people followhis progress and donate to Forde’sresearch. The ride raised more than$10,000.

“I am grateful, and I wanted to

do something good. I think dr. Fordeis incredible,” says Personne. “I’veseen many, many doctors throughoutmy life, and there is no one like him.”Personne feels certain that the im-munotherapy Forde treated him withsaved his life.

Personne also makes a personalgift in his two grandchildren’s nameseach year on their birthdays. “I thoughtthis would be much more beneficialthan giving them another toy,” he says.

Three years later, his cancer re-mains in check and, although he tradedhis motorcycle for a motor home, hestill enjoys traveling the world.

A WILD RIDE[Life Lessons]

Five healthy habits that can help support your wellness duringand after treatment include:1. STOP SMOKING2. EAT WELL3. BE ACTIVE4. ENLIST SUPPORT5. MANAGE YOUR CAREWhether it’s you or a caregiver who’schampioning your cancer care, it’simportant to have someone whois advocating for your needs. Thisincludes communicating with yourcancer care team, coordinating ap-pointments, and keeping track ofsymptoms and side effects.

“When I was first diagnosed and saw the X-ray, there was this huge black spot on my lung.After just two treatments with the immunotherapy, it disappeared. It was like magic.”

CANCER DRUGS ARE HELPING TO BLOCK CHECKPOINTS AND SIGNALING THE IMMUNE SYSTEM TO ATTACK CANCER CELLS. AS A RESULT, THEY ARE HELPING TO SHORTEN THE AMOUNT OF TIME PATIENTS ARE TREATED.

Julie Brahmer, M.D.

Patrick Forde, M.B.B.Ch.

SU2C-LUNGevity Foundation-Amer-ican Lung Association Lung CancerInterception Dream Team: Julie

Brahmer, M.d., and in-terventional pulmo-nologist DavidFeller-Kopman, M.d.,are among the investi-gators on the multi-in-stitutional grant aimed

at developing new ways to interceptlung cancer—the leading cancer killer—before it progresses to an advancedstage. The dream Team brings togetherscientists and clinicians from manyfields of lung cancer research, fromprevention through early detectionand treatment. The goal of the dreamTeam’s project, called InTIMe, forIntercept Lung Cancer ThroughImmune Imaging and Molecularevaluation, is to use state-of-the-arttechnologies to understand genetics,immunology, radiological imaging,and treatment response in patientswith abnormal, precancerous lungtissue that puts them at high risk ofdeveloping lung cancer. Among theteam’s priorities are creation of amolecular atlas of precancers of thelung, development of two diagnostictools that can be directly applied in theclinic for simple yet accurate detectionof early lung cancer and new tests toidentify which individuals are mostlikely to benefit from a number oftreatment strategies, including emerg-ing immunotherapies.

Immunotherapy Before Surgery: Theanti-Pd-1 immunecheckpoint blockernivolumab, given to

early-stage lung cancer patients before


A NeW CLASS OF cancer-fighting drugscalled checkpoint inhibitors is offeringhope to patients with several kinds ofsolid tumors, particularly lung cancerand melanoma. The medications,which work by spurring the body’s im-mune system to attack tumor cells, pro-long life in roughly 20 percent ofpeople who take them.

Why some patients do well butothers fail to improve is a mystery,but emerging evidence suggests thatat least some of the reason may liewith the trillion-odd bacteria thatmake up the body’s microbiome.

Researchers at the Johns HopkinsKimmel Cancer Center andBloomberg~Kimmel Institute forCancer Immunotherapy are studying

how the microbiome—the menagerieof germs that live in the gastrointesti-nal tract and other organ systems, in-cluding the lungs and skin—mayinteract with checkpoint inhibitors in ways that both make thedrugs stronger and that potentiallyweaken their effectiveness. Theirgoals are to identify which strains ofbacteria sit on which side ofthe ledger and, if possible, totweak a patient’s microbiomein ways that make the cancerdrugs even more potent.

Infectious disease and microbiome expertCindy Sears is leading theresearch effort. “We’re trying to attack on multiplefronts,” says sears.

Research in the areahas heated up recently, withseveral publications showing thatgroups of bacteria may alter the func-tion of immune cells in ways that in-tersect with the function ofcheckpoint inhibitors. some experi-ments found that a greater abundancein the gut of certain species of bacteriawas associated with a stronger responseto the drugs. Others showed the oppo-site—species of microbes that, whenpresent, were linked to a poor responseto the immunotherapy drugs.

At the moment, the research isin early days, sears says, with manyquestions remaining unanswered.Which species of microbes are mostimportant in the interaction, and howthey alter the way the body processes

the cancer drugs, is unclear. “One possibility is that there is

priming, or education, of the immunesystem that either enhances or inhibitsthe capacity of the cells to respond tothe tumor,” sears says. In other words,the presence of certain bacteria in theintestines conditions the immune sys-tem the way regular exercise strength-ens muscles. When checkpointinhibitors unlock the power of the im-mune system, it’s better prepared tofight off cancer. Alternatively, exposureto certain strains of bacteria may sapthe immune system, crippling T cellsso that they’re unable to rally that defense.

Another possibility is that proteins that the bacteria in the gutmake are similar to those producedby cancer cells. “In this idea, the pa-tient’s immune system first developsan immune response to one or more bacterial proteins,” sears says. “Whenthe tumor is treated with checkpoint

blockade, the immunesystem is released to at-tack the tumor using theantibodies against bacter-ial proteins that ‘mimic’tumor proteins.”

Lung cancer expertJarushka Naidoo is col-laborating with sears onthe project. she is helpingcollect samples of bacteriafrom patients being treatedwith immunotherapy, tak-

ing swabs from stool, fluid from thelungs—which have their own micro-biome—the mouth and urine. UsingdnA profiling, they’ll catalog all of theorganisms present and try to build aprofile of which ones are linked to agood response to the drugs and whichappear to hinder their effectiveness.

Although the research is still inits early stages, sears says she hopes thework will lead to the development oftherapies—such as a “microbe cocktail”or even a vaccine—that will boost theimmune response in cancer patientswho receive immunotherapy. “Wewant these drugs to work for most patients, not just a small percentageof them,” she says.

A‘Pesty’SolutionHow the Bugs We Livewith Could Help FightLung Cancer

surgery, caused major tumor regres-sion, an increase in anti-tumor T cellsthat remained after surgery and re-sulted in fewer relapses. The study, re-ported in theNew England Journal ofMedicine and led by Patrick Forde,M.B.B.Ch., in collaboration with sur-geons Stephen Broderick, M.d.,Richard Batafarano, M.d., Ph.d., andStephen Yang, M.d., and experts in theBloomberg~Kimmel Institute for CancerImmunotherapy, also found that thenumber of gene mutations in the tumorcorrelated closely with response to treat-ment and was a potential predictivemarker for future studies. stand Up toCancer, LUnGevity, Bristol-Myerssquibb, Lung Cancer Foundation ofAmerica, the MacMillan Foundation, thedr. Miriam and sheldon G. AdelsonMedical Research Foundation, and thenational Institutes of Health wereamong the funders. Broderick is cur-rently serving on a steering committeefor a multicenter global prospective ran-domized trial of immunotherapy beforesurgery combined with chemotherapy inearly-stage non-small cell lung cancer. WEB EXCLUSIVE: Listen to dr. Forde explain the researchbit.ly/2QuHmim

Understanding HowRadiation HeightensImmune Response: Anew study will decipherhow stereotacticablative radiotherapy

(sABR) heightens the immuneresponse against cancer. sABR is ahighly focused, intense dose ofradiation treatment. It is very effectiveagainst lung cancer alone, and whenpaired with immune checkpointinhibitors, which release brakes oncancer-fighting immune cells, it can

result in even better control of tumorsin some patients. How checkpointinhibitors work is well understood, buthow radiation therapy impacts theimmune system is not, says radiationoncologist Ranh Voong, M.D. A 10-patient study, led by Voong and funded by the Lung Cancer ResearchFoundation, will examine biopsysamples obtained from patients beforeand after sABR treatment to betterunderstand the effect radiationtreatment has on immune cells, so thatphysicians will know how best tocombine it with immunotherapy toachieve optimal responses in patients.

Immunotherapy Resistance: An in-depth genetic analysis on tumor samplesfrom patients before treatment with im-munotherapy and again when the treat-ment stopped working led researchersVictor Velculescu, M.d., Ph.d., ValsamoAnagnostou, M.d., Ph.d., and KellieSmith, Ph.d., to uncover a key way can-cers become resistant to immunother-apy drugs known as checkpointinhibitors. Their genetic analysis, pub-lished in Cancer Discovery, revealed thatcancers get rid of genetic cues that flagthe cell for destruction by the immunesystem. When the cancer cells shedthese mutations, they discard the evi-dence that would normally lead them tobe recognized by the body’s protectiveimmune cells. They are investigatinghow broadly the process occurs in lungand other cancer types to develop newways to improve current cancer im-munotherapies. Julie Brahmer, M.d.,Patrick Forde, M.B.B.Ch., and JarushkaNaidoo, M.B.B.Ch., also collaborated onthis research. LUnGevity and stand UpTo Cancer were among the funders.

Trending Research news

CATALYST

12 LUNG CANCER MATTERS • 2019

MICROBIOME REFERS TO THE COMMUNITY OFBACTERIA THAT LIVE INUS AND ON US. THELARGE AND COMPLEXSOCIETY HAS SIGNIFICANTEFFECTS ON IMMUNITY,INCLUDING IMMUNE RESPONSES THAT ACTU-ALLY PROMOTE CANCERDEVELOPMENT AND INTERFERE WITH HOWCANCERS RESPOND TOIMMUNOTHERAPY.

Feller-Kopman

Yang

Voong

Cindy Sears, M.D.

[Cancer-fighting drugs]

Continued on page 14


levels, but some have more severe ef-fects. Treatment includes oral corticos-teroids, and, for severe problems, hospitalizations may be necessary.

How are you educating patients aboutimmunotherapy side effects?Our patients come from all over thecountry. They could end up in emer-gency rooms or offices with doctors whodo not understand patients’ symptomsor mistake them for infections and pro-vide incorrect treatment with devastat-ing consequences. To prevent this, all ofour immunotherapy patients are given awallet card to carry with them at alltimes to share with any doctor they see.The card says, “I’m on immunotherapy.Please contact my oncologist.” The cardprovides contact information and thename of the drug or drugs patients are

on. We also have a patient hotline, pagerand email system.

What about doctors?With support from the Cole Founda-tion, I am attending national cancermeetings with a Bloomberg~Kimmel In-stitute nurse to educate other doctors,and working with organizations like thenational Comprehensive Cancer net-work, of which I am a member, to sharewhat we have learned and to establishstandards for managing immunother-apy side effects. Julie Brahmer is co-chair of the toxicity guidelinescommittees of the American society ofClinical Oncology, national Compre-hensive Cancer network and the soci-ety for the Immunotherapy of Cancer.We are also working on a web-basedcourse for doctors.


Technology Guides Immunotherapy:There are trillions of T cells within the

human body. each onehas the ability to see adifferent biochemicalsignature. Kellie Smith,Ph.d., is focusing ondeveloping new T cell

receptor-based immunologic analysisand applying these technologies to lungcancer. smith and Franck Housseau,Ph.d., both swim Across Americainvestigators, invented a sensitive testto detect anti-tumor T cells, recentlyreported on in Cancer ImmunologyResearch. This technique, calledMAnAFesT, has the capacity to scourimmense amounts of data to reveal theunique biochemical signatures in eachpatient’s cancer that alert the specificimmune cells T cells in that patient’scancer. The technology can be used toguide therapy, helping oncologistspersonalize immunotherapies by usingdrugs that will unleash an immuneattack against individual cancers.Valsamo “elsa” Anagnostou, M.d.,Ph.d., Julie Brahmer, M.d., PatrickForde, M.B.B.Ch., Kristen Marrone,M.d., and Jarushka Naidoo, M.B.B.Ch.,collaborated on this research. Fundersincluded the Bloomberg~KimmelInstitute for Cancer Immunotherapy,Bloomberg Philanthropies, and nIHCancer Center support Grant, the LungCancer Foundation of America/International Association for the studyof Lung Cancer, stand Up To Cancer,the Mark Foundation for Cancer Research, the eastern Cooperative Oncology Group-American College ofRadiology Imaging network and theMacMillan Foundation.

Test Monitors Treatment Response:A study, funded by swim Across America,will explore an innovative combinationof genomic and immune analyses toprovide a basis for novel molecular ap-proaches to identify patients most likelyto respond to immunotherapy withcheckpoint inhibitors. The project, ledby Valsamo “elsa” Anagnostou, M.d.,Ph.d., will also help identify patientswho will develop resistance to immunecheckpoint blockade. The long-term

goal is the development of a predictivetest to assess responses to cancerimmunotherapy in real time. The testcould lead to tailored cancer immunotherapy strategies and novel approaches to clinical trial design. Anagnostou is a LUNGevity Career De-velopment Award and MacMillan Path-way to Independence Award recipientand a Swim Across America Scholar.

New Drug Combo: Jarushka Naidoo,M.B.B.Ch., will oversee a clinical trial

combining two epige-netic drugs with immunotherapy forpatients with non-small-cell lung cancer.The clinical trial, co-led

by Stephen Baylin, M.D., is one of 10stand Up To Cancer (sU2C) Catalystclinical trial projects. The inauguralsU2C Catalyst projects will explorenew uses for an array of powerful medicines from three sU2C Catalystcharter supporters and six otherpharmaceutical companies.

Addressing Treatment Resistance inSmall Cell Lung Can-cer: Kimmel CancerCenter researchers re-ceived a $3.1 milliongrant from the nationalInstitutes of Health tostudy the resistance oflimited stage small celllung cancer to a combi-nation of chemotherapyand radiation therapy.Christine Hann, M.d.,

Ph.d., and Phuoc Tran, M.d., Ph.d., areamong the researchers who will leadthe project expected to have a directimpact on the causes and possible treat-ment for chemoradiation resistance in

small cell lung cancer. Chemotherapy isthe most common treatment for smallcell lung cancer, but radiation therapy isfrequently used in combination withchemotherapy when the tumor is con-fined to the lung and other areas insidethe chest. Most patients respond to ini-tial treatment, but the return of the dis-ease due to chemoradiation resistanceis almost universal. The researchers ex-pect this research to provide a broaderunderstanding of chemoradiation re-sistance in other cancers as well, point-ing to new ways to target treatmentresistance.

Lung Cancer at Sibley-Web exclusive:Kimmel Cancer Center director

William Nelson, M.d.,Ph.d., talks with BenLevy, M.d., clinical di-rector of medical on-cology at sibleyMemorial Hospital,

about new treatments for lung cancerpatients and the growing cancer centerat sibley. bit.ly/2CTfTmQ

Julie Brahmer Receives MultipleHonors: Julie Brahmer, M.d., waselected to the International Associa-tion for the study of Lung Cancerboard of directors and was also fea-tured on the cover of Chesapeake Physi-cian magazine for her work inadvancing lung cancer therapies. shealso was honored by the Baltimore Ori-oles, with its Birdland Community He-roes Award, which recognizes thosewho inspire others through charity andcommunity service. she wasnominated by LUnGevity, which alsohonored Brahmer with its Face of HopeAward, for those who recognize theneeds of and actively make a differencefor people living with lung cancer.

Managing Side Effects of ImmunotherapyA Conversation with Jarushka Naidoo

What do patients and doctors need toknow about immunotherapy side effects?The Johns Hopkins Kimmel CancerCenter’s Bloomberg~Kimmel Institutefor Cancer Immunotherapy is leadingthe way and setting national standardsfor recognizing and managing im-munotherapy side effects. These sideeffects can present with a wide range ofsymptoms, so their management re-quires the cooperation of many ex-perts. We have assembled a group ofspecialists for every part of the bodythat has the potential for adverse reac-tions to immunotherapy, and they areon call for us 24/7. It is important fordoctors and patients to call right awayif they experience any symptoms, evenif they believe them to be minor.

What types of side effects should doctors and patients look for?Patients can experience side effectsthat include anything that ends in –itis.They are typically ones that involve in-flammation, such as colitis (inflamma-tion of the colon) and the worst of them,pneumonitis (inflammation of thelungs). These types of side effects aren’tunexpected when taking medicines thattinker with the immune system, and in-flammation is considered an immune-related biochemical process. Aside frominflammation-related side effects, fa-tigue often tops the list of side effects.some patients also experience low thy-roid hormone levels. A new patientstudy is exploring a connection be-tween immunotherapy and the devel-opment of inflammatory arthritis.

The toxic effects of immunother-apy drugs can occur anytime during apatient’s treatment, even after patientsstop taking the drugs. If side effectsoccur, they are typically at low-grade

WE HAVE ASSEMBLED A GROUP OF SPECIALISTS FOR EVERY PART OFTHE BODY THAT HAS THE POTENTIAL FOR ADVERSE REACTIONS TO IMMUNOTHERAPY, AND THEY ARE ON CALL FOR US 24/7.

Immunotherapy is a promising new therapy that activates the immune system to attackcancer cells. It has a completely different side effect profile than chemotherapy, and thathas caught some physicians off guard. doctors—including emergency room physicians,dermatologists and gastroenterologists—need to learn about immunotherapy.

Hann

Tran

Smith

Levy

Naidoo

Jarushka Naidoo, M.B.B.Ch.

Continued from previous page


some complications. “The clinic wasclosing, but our nurse practitioner,Amy, stayed with us, consulting withthe necessary experts to get us the answers we needed,” says Matt. “shestayed late and waited for all of theexperts to look at the test results soshe could give us a plan to get usthrough the holiday weekend.”

To make their patient careaward idea a reality, the Holmans de-cided to reach out to the InternationalAssociation for the study of Lung Can-cer (IAsLC), which supports research

through young investigator awards.IAsLC Foundation representativesagreed that a caregiver award wasneeded, and working with Marilyn andMatt, they established the IAsLCFoundation Cancer Team Award. Mar-ilyn, an artist and elementary schoolteacher, designed the award. Hann,Hales, Vance and Rodavia were amongthe inaugural recipients.

“The truth is, if drs. Hann andHales, and all of the other doctors andnurses had not provided such excep-tional patient care, this award wouldnot exist,” says Matt.

Marilyn recently passed away,but because of her and Matt's persist-ence, patients, survivors and care-givers have a way to honor andrecognize multispecialty lung cancerteams—experts in all areas of lungcancer treatment—that provide ex-ceptional care. The internationalaward helps the best of the best standout among the many lung cancerproviders and can help ease the bur-den for newly diagnosed patientsaround the world who are searchingfor the best lung cancer care.

despite being a scientist, Matt Holmanwas unsure of the best treatment planand where to go to find it when his wife,Marilyn, was diagnosed with small celllung cancer in 2016. He couldn’t imag-ine what it must be like for the manypatients and families who have no sci-ence or medical background.

“We had a lot of choices forwhere to go for treatment. I wantedto know what hospital had the bestdoctors and nurses and would pro-vide the best care for my wife,” saysHolman, a scientist at the FdA.

He did his research, and ulti-mately, he and Marilyn selected theJohns Hopkins Kimmel Cancer Cen-ter, where she was treated by lungcancer experts Christine Hann, amedical oncologist, Russell Hales, aradiation oncologist, Amy Vance, anurse practitioner, and Hanika ReyesRodavia, a clinical research nurse.

“We were extremely impressedwith the care Marilyn received,” saysHolman, so much so that they wantedto nominate the doctors and nursesfor a patient care award.

Marilyn said people asked herwhy she chose Johns Hopkins for

her treatment. Her response wassimple and direct: "Because they arethe best."

Matt volunteered to take thelead on researching potential awardsto find just the right one to acknowl-edge their Kimmel Cancer Centerlung cancer team. The problem was,when he began to look, he could notfind a single award that recognizedstellar patient care.

His search turned up plenty ofresearch awards, but nothing for pa-tient care. Thinking he must have over-looked something, he reached out tohis staff and colleagues at the FdA, butmuch to his surprise, no one knew ofan award for outstanding patient care.In the absence of an existing award,Marilyn and Matt decided to establisha new award.

They had two goals—one was torecognize and honor the KimmelCancer Center team who cared forMarilyn, but primarily to help otherlung cancer patients faced with thedaunting challenge of choosing whereto go for treatment. “We wanted tohelp others who were deciding whereto take their loved ones,” he says. The

Holmans wanted their award to serveas a guidepost for patients, helping di-rect them to compassionate and ex-pert, multispecialty, team-based care.

They were impressed with thedepth of knowledge of their KimmelCancer Center care team. “They getevery expert involved in the care oflung cancer around the table todevelop treatment plans for eachpatient,” says Matt. “It’s easy to takethat kind of specialty care for granted,but trust me, it doesn’t happeneverywhere.” Matt experienced thiswith his uncle, who he recentlydirected to the Kimmel CancerCenter, when he recognized his unclewas not getting the same level of carefor his lung cancer.

The Holmans were equally im-pressed with their care team’s will-ingness to discuss all of the optionsand share decision-making to comeup with the best path forward.

“They were so compassionate,and although we knew Marilyn wasone of many patients, it never felt thatway. They treated her like an individ-ual and were always willing to spendtime answering questions and com-municating complicated, scientificinformation in an easy-to-understandway,” says Matt.

“My wife means more to methan anyone, and we were dealingwith lung cancer. I had a long list ofquestions,” says Matt. He recalls anappointment with Hales when heasked so many questions that Marilynasked him to stop, worried they wouldannoy Hales. Far from annoyed, Haleslooked at Marilyn and said, “It’s allright. You are making decisions aboutyour health, and I want you to besure,” recalls Matt.

Another time, a few days beforeThanksgiving, Marilyn was in the out-patient clinic for a three-day series ofchemotherapy treatments. The daybefore Thanksgiving, she experienced

Patient Creates Award to Distinguish the BestLung Cancer Doctors and NursesKimmel Cancer Center team is among inaugural recipients.

THE HOLMANS WANTED THEIRAWARD TO SERVE AS A GUIDEPOSTFOR PATIENTS, HELPING DIRECTTHEM TO COMPASSIONATE ANDEXPERT, MULTISPECIALTY, TEAM-BASED CARE.

From left front, Christine Hann, M.D., Marilyn Holman, Hanika Reyes Rodavia, R.N.Back: Russell Hales, M.D., Matt Holman, Ph.D.

THRIVING ANDSURVIVING Patients, families and friends are invited to join us

in November to celebrate Lung Cancer Awareness

Month and participate in an interactive discussion

on the latest research and treatments, share

stories of survivorship, and meet our lung cancer

health care team.

Visit hopkinscancer.org or call 410-550-1711 for event details.

For more information on this and other events,please call 410-550-1711.

LUNG CANCER

Help Us Make a Differenceeach contribution to the Johns HopkinsKimmel Cancer Center makes a differ-ence in the lives of cancer patients hereat Johns Hopkins and around the world.

Our physician-scientists are leadingthe way on many of the scientificbreakthroughs in lung cancer, andyour donation will support patientcare and innovative research that istranslated to better, more effectivetreatments. We are also focusing onways to prevent cancer and supportsurvivors.

You may designate a gift to a specificfaculty member.

If you prefer not to receive fundraising communications fromthe Fund for Johns Hopkins Medicine, please contact us at 1-877-600-7783 or [email protected]. Please includeyour name and address so that we may honor your request.

To make your donation online:hopkinscancer.org and click “Make a Gift”

To mail your donation:Johns Hopkins Kimmel Cancer Center 750 e. Pratt st., suite 1700 Baltimore, Md 21202 Please note that you would like your giftto support the thoracic cancer program.

To contact our development Office: Phone: 410-361-6391Fax: 410-230-4262email: [email protected]

Visit us on the web:hopkinscancer.org

SISSY’S STORYSCULPTER SISSY FRIERSON, 81, WAS ESSENTIALLY TOLD TO GOHOME AND DIE WHEN SHE WAS DIAGNOSED WITH LUNG CANCERIN JANUARY 2016. THE TUMOR WAS WRAPPED AROUND HER PULMONARY ARTERY, WHICH CARRIES BLOOD FROM THE HEARTTO THE LUNGS.

“I KNEW I HAD TO DO SOMETHING,” SAYS SISSY, WHOLIVES IN SOUTH CAROLINA. A FRIEND RECOMMENDED SHE GOTO THE JOHNS HOPKINS KIMMEL CANCER CENTER, AND SHEFOLLOWED THAT ADVICE.

THERE, SHE MET WITH LUNG CANCER EXPERT PATRICK

FORDE AND JOINED A CLINICAL TRIAL OF THE IMMUNOTHERAPYDRUG NIVOLUMAB BEFORE SURGERY. IMMUNOTHERAPY SHRUNKTHE TUMOR, PULLING IT AWAY FROM HER PULMONARY ARTERYSO THAT IT COULD BE SURGICALLY REMOVED. HER LAST SCANSHOWED NO EVIDENCE OF CANCER.

“I WOULD NOT BE HERE TODAY IF NOT FOR THAT CLINICALTRIAL. I CANNOT SAY ENOUGH ABOUT HOW WONDERFUL THOSEDOCTORS ARE. BECAUSE OF THEM, I’VE SEEN TWO GREAT GRAND-CHILDREN BORN, AND I’VE TRAVELED TO ICELAND, HAWAII ANDROME,” SAYS SISSY. “I’M LIVING A WONDERFUL LIFE.”

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