Posts

Precision Medicine Clinic

New Markey clinic gives patients access to latest cancer treatments

In its ongoing efforts to offer Kentuckians the latest, most innovative cancer treatments available, the UK Markey Cancer Center recently launched the Precision Medicine Clinic, a new space dedicated to providing patients with increased access to Phase I and Phase II clinical trials.

Before a new drug can be approved by the Food and Drug Administration for widespread use, it must first be proven safe and effective in clinical trials. When patients are enrolled in Phase I trials, they are often among the first people to receive a promising new drug or treatment. Phase II trials build on the information gathered in a Phase I trial and often compare its efficacy with the current standard treatment for that specific cancer.

Many of the early-phase clinical trials offered at the Precision Medicine Clinic will be investigator-initiated trials from Markey physician-scientists, as well as national clinical trials sponsored by the National Cancer Institute and Early Therapeutic Clinical Trials Network. Leading-edge trials like these are not usually available to patients treated outside an NCI-designated cancer center such as Markey.

Understanding cancer in Kentucky

Markey’s Molecular Tumor Board, which launched in November 2016, is providing ongoing guidance for the types of clinical trials the Precision Medicine Clinic will facilitate. As the tumor board members learn more about the types of mutations causing cancer in here in Kentucky and the region, new trials can be designed to target those specific mutations.

“Cancer treatment has traditionally been based on tumor types, but with more data obtained from genetic analyses, we are using that information to target specific mutations,” said Markey Director Dr. Mark Evers. “The more data we gather through the Molecular Tumor Board, the more precise therapies we’ll be able to offer through clinical trials at the Precision Medicine Clinic.”

A team of research experts

The Precision Medicine Clinic is directed by clinical pharmacologist Jill Kolesar, PharmD, a professor in the UK College of Pharmacy and a nationally known expert in oncology pharmacogenomics, alongside medical oncologist Dr. Susanne Arnold and surgical oncologist Dr. Rachel Miller. All have extensive experience in clinical trial implementation.

Additionally, the clinic employs a staff of multidisciplinary experts who have a high level of experience with research, including chemotherapy nurses, pharmacists, and research nurses. Cancer patients who are enrolled in early-phase clinical trials will receive much of their care in this new space.

Located on the second floor of UK Albert B. Chandler Hospital Pavilion H, the Precision Medicine Clinic includes two exam rooms and four infusion chairs. Kolesar anticipates the clinic will see up to six patients a day and about 300 new patients each year.

Helping patients across the Commonwealth

The clinic will receive many internal referrals from UK HealthCare physicians, but community physicians from across the Commonwealth will also be able to refer patients to Markey for these unique trials and treatment options.

“The Precision Medicine Clinic provides trials that aren’t available anywhere else in Kentucky,” Kolesar said. “It truly benefits the entire state by providing access to the newest cancer treatments. Referring community physicians will be able to keep their patients here in Kentucky instead of sending them to other facilities far from home.”


Next steps:

  • Get to know Dr. Kolesar and find out why she is so passionate about cancer research.
  • Markey is Kentucky’s only NCI-designated cancer center, providing world-class cancer care right here in the Commonwealth. Learn more about why patients choose Markey for their cancer treatment.
During the third annual Appalachian Research Day, UK researchers revealed the insights of their studies aimed at addressing health problems of rural Ky.

Appalachian Research Day addresses rural health issues

Inviting researchers to “come sit on the porch” and share their findings with community members, the UK Center for Excellence in Rural Health (CERH) hosted its third annual Appalachian Research Day in Hazard, Ky., on May 24.

Rural Appalachian communities experience some of the most severe health disparities in the nation, and community-based research is an effective method to identify problems and develop collaborative, effective solutions.

This type of engaged research begins at the local level, built on the foundation of relationships with individuals, neighborhoods and groups who have common questions and concerns. And for many researchers at UK and partner institutions, the CERH is an indispensable resource for conducting community-based research. It provides local connections, infrastructure, dedicated research personnel and a team of community health workers, called Kentucky Homeplace, who engage participants and gather data.

“Appalachian Research Day is an important and exciting day for us each year at the UK Center of Excellence in Rural Health. It is an opportunity for us to provide research updates to our community about relevant issues that affect all of us,” said Fran Feltner, director of the CERH. “Appalachian Research Day is also an opportunity for dialogue with community members to discuss what we can come up with together to better our lives in Appalachia.”

This year’s event, which was held at Hazard Community and Technical College to accommodate the growing number of participants, included Hazard Mayor Jimmy Lindon and Perry County Judge-Executive Scott Alexander, who both made remarks during lunch. Also present were Andrea Begley, field office representative for U.S. Congressman Hal Rogers, and Jenna Meyer of the U.S. Centers for Disease Control and Prevention, who is on special assignment in Eastern Kentucky for the Shaping Our Appalachian Region (SOAR) initiative.

Research insights in cancer, addiction, nutrition

Featured presentations reported findings from five health research studies conducted with Appalachian communities:

  • Dr. Susanne Arnold, associate director of clinical translation at the UK Markey Cancer Center, presented her research examining the interrelated causes of lung cancer and how to combat them. She reported that lung cancer risk has environmental, physical and molecular causes, some of which can be prevented.
  • Nancy Schoenberg, PhD, associate dean for research of the UK College of Public Health and Marion Pearsall Professor of Behavioral Science in the UK College of Medicine, studies the health of grandfamilies in Appalachia. Her recent study with rural adults over age 65 found that half of them struggled to make ends meet and experienced many physical health problems.
  • Dr. Judith Feinberg, professor in the Department of Behavioral Medicine & Psychiatry at West Virginia University School of Medicine, studies behavioral medicine and psychiatry. She presented her research on addiction as a chronic, relapsing brain disease, reporting that syringe services programs (SSPs) operate under the principles of harm reduction and have been shown to offer significant protection for people injecting drugs, including lower risk of HIV infection.
  • Jarod T. Giger, PhD, of the UK colleges of social work, medicine and public health, studies child well-being in Eastern Kentucky. In a recent study, he found that children in three Eastern Kentucky counties reported relatively high amounts of electronic health literacy but low amounts of overall life satisfaction and affective and psychological well-being.
  • Omopé Carter Daboiku is an Appalachian foodways scholar who leads workshops that operate on an emotional level to help participants understand that adapting family recipes to healthier versions doesn’t disrespect one’s ancestors. Her work incorporates nostalgic attachment to food memories, with the understanding that the relationships these memories invoke can make it difficult to prepare healthier food.

Next steps:

molecular tumor board

Watch: Our new TV spot highlights precision cancer care at Markey

Our new TV spot tells the exciting story of how the UK Markey Cancer Center is using precision medicine to target cancer treatment to patients’ unique cancer cells. Watch the video below and learn more about how we’re harnessing the power of advanced medicine to find the best treatment for each patient.

Treating cancer at the molecular level

The future of cancer treatment is fighting the disease at the level of an individual gene, breaking down a diagnosis by analyzing each patient’s unique genetic characteristics. At Markey, our Molecular Tumor Board is leading this fight, bringing personalized, precision medicine to patients across Kentucky.

The Molecular Tumor Board, which is made up of more than a dozen leading clinicians and scientists, meets monthly to review individual cancer cases from across the Commonwealth, diving deep into patients’ genetic information, then collectively tailoring a precision treatment specifically for them.

Tailoring a precision treatment

Dr. Jill Kolesar

Dr. Jill Kolesar

“It’s well accepted that cancer is chiefly a genetic disorder,” says Dr. Jill Kolesar, a founding member and co-director of Markey’s Molecular Tumor Board. “The first genome that was sequenced took 13 years and $2.7 billion dollars. Now we can sequence a genome in an afternoon.”

Such significant advances in technology have helped spur precision medicine, but have also created large quantities of genetic information, Kolesar said. It’s up to the Molecular Tumor Board to interpret that vast amount of data and apply it to an individual’s cancer diagnosis and treatment.

Dr. Susanne Arnold

Dr. Susanne Arnold

Medical oncologist Dr. Susanne Arnold, Markey’s associate director for clinical translation and member of the Molecular Tumor Board, is helping lead this individualized approach to cancer treatment. A precision approach to diagnosis and analysis is the future of care, she said.

“You take a biopsy and do the genomic analysis, called next-generation sequencing, which helps us understand exactly what happened with that cell that resulted in cancer,” she explained.

But what might sound like a routine test in modern medicine is much more remarkable in these particular cases.

“Molecular medicine is actually discovering the information about a unique cancer in a specific person at a precise point in time,” she said. “Pinpointing this allows us to understand why it happened, why our treatment did or didn’t work, and how we can potentially stop (the cancer).”

In short, these tests allow for a remarkably detailed understanding of what goes wrong in cancerous cells. And that sort of comprehensive knowledge helps the tumor board choose the best treatment from among the many options available at Markey.

How the molecular tumor board works

Markey’s Molecular Tumor Board is not the first of its kind, but it is the first in Kentucky. And that’s significant, given the unprecedented rates of cancer across the state, most notably in the rural, eastern parts of Kentucky.

With the board meeting twice monthly, oncologists across the state can reach out for a recommendation for therapy based on their patient’s molecular signature.

There are more than a dozen scientific specialties represented on the board, and more than 300 years of experience in total. All of this is applied to a single patient as cases are presented to the board, and the inclusion of each patient’s own physician in the process ensures an intimate understanding of that patient’s condition and outlook.

Each patient’s cancer will be tested for all genetic mutations that are known to cause cancer, regardless of what type of tumor the patient has. The tumor board then uses the results of that test to choose possible treatment options that target the genetic mutations. Each mutation is evaluated for FDA-approved therapies for the patient’s tumor type, FDA-approved off-label therapies and any clinical trials available related to the patient’s specific mutations.

Taking into consideration the available treatment options, the Molecular Tumor Board will make a recommendation based on the best possible outcome for the patient.

For a single patient, for all of Kentucky

As more tumor boards are established across the country and more cases are reviewed, a bank of information will be available to doctors to help them determine the best course of action for patients with similar cases.

“Everything we discover is designed to help you, and by sharing this information in an anonymous way, it can help people across the country suffering with cancer. We’re all being connected through this process, and that’s a beautiful, beautiful story to tell,” Arnold said. “Imagine you are ‘Anne’ from Pikeville, Kentucky, but behind you is your doctor, the Markey Cancer Center, other NCI-designated cancer centers, the National Cancer Institute … and ‘John’ in New York City, who has the same mutation as you. The six degrees of separation suddenly disappear, and ideally you each benefit from the experience of the other.”

Dr. Mark Evers

Dr. Mark Evers

That is the crux of Markey’s ambitions: an individualized approach to each patient, but on a large scale. In an open letter released at the end of 2016, Dr. Mark Evers, director of Markey, made public a goal of the organization: to significantly reduce cancer incidence and mortality across the state, and the region, by the year 2020. It’s a lofty aspiration, but initiatives like the Molecular Tumor Board position Markey for success.

As Kolesar said, “When researchers and clinicians at the Markey Cancer Center decide something is going to benefit patients, like the Molecular Tumor Board, they say, ‘Let’s do it.’”

This team spirit spans the entire organization. Kolesar noted the collegiality and support for accomplishing goals at UK HealthCare.

“Dr. Evers, says, ‘You just tell me what you need, and we’ll make it happen, because that’s what we think the patients of Kentucky need,’” she said.

Such sweeping change, especially when it comes to issues as complicated and extensive as healthcare, rarely happens quickly. But a series of small successes, over time, can have an enormous ripple effect. The experts who make up the Molecular Tumor Board understand this, and it’s their reason for participating in and offering their time to such programs.

“By understanding the genetic makeup of our patients and their tumors, we can then help to direct their therapy,” Evers said.

The future of advanced medicine

Treatment options at UK HealthCare are more abundant than ever before. The Early Therapeutics Clinical Trials Center focuses on increasing patient access to phase I and phase II clinical trials will also have a major impact for Markey patients.

“[Previously,] if patients in Kentucky needed an earlier-phase clinical trial, they would have to go out of state,” said Kolesar, explaining the advantage of the initiative.

These early-phase studies can offer patients new treatment avenues for cancers that have proved difficult to target using standard therapies. Essentially, it allows Markey to participate in the development of new and novel treatments while offering patients first access.

Being at the forefront of medicine means incredible discovery, but for every breakthrough, there are new unknowns. This uncharted territory is a product of advancement and a reason for optimism.

“Do we have a therapy for every gene that’s broken? No. But we do have therapies for genes that are broken in non-small cell lung cancer, melanoma, breast cancer, colon cancer and a growing list every day. They are defined by their gene signature and by the gene that’s broken. That’s called targeted therapy,” Arnold said.

The hope is that this sort of targeting can be applied to all types of cancer, and Markey’s patients could be among the first to benefit.

“The Power of Advanced Medicine” is more than a slogan. It’s a guiding principle and a reminder that UK HealthCare prioritizes discovery in the name of our patients.


Next steps:

  • Markey is Kentucky’s only NCI-designated cancer center, providing world-class cancer care right here in the Commonwealth. Learn more about why patients choose Markey for their cancer treatment. For a second opinion or appointment, call Markey at 859-257-4488 or 866-340-4488 (toll free).
  • Learn more about the power of advanced medicine at UK HealthCare.
Making the Rounds with Dr. Susanne Arnold

Meet oncologist Susanne Arnold, second-generation doctor and proud Kentuckian

Making the RoundsOur featured provider in this week’s Making the Rounds is Dr. Susanne Arnold, an oncologist at the UK Markey Cancer Center who treats patients with lung cancer and head and neck cancer.

Dr. Arnold is particularly interested in early therapies for cancer and leads several clinical trials at Markey.

How did you become interested in medicine?

My first memories of my life were going with my dad to the hospital because he was a doctor. And that’s how I first became interested in medicine. He was the director of the Center on Aging here for over 25 years and so I have great pride in being a second-generation doctor here at the University of Kentucky.

And even deeper than that is my love of Kentucky, because I’m an eighth-generation Kentuckian and my children are ninth-generation Kentuckians. So serving Kentucky in the little area that I can make a difference – which is in cancer care, where we have some of the biggest health disparities and highest mortality rates – is a real calling to me.

What is your patient care philosophy?

Cancer is really scary, and when you think about how you care for someone with cancer, you have to think about what their goals are first and foremost. I try to put the patient in the center and say, ‘What are your goals? How are we going to help you live your life with cancer and hopefully past the time that you have cancer?’

What characteristic do you most admire in other people?

In my patients, I admire courage because they have to face so many things and they face it so much more courageously than I feel like I would. In others, I admire those who are genuine and care about people.

If you could meet any person from history, who would it be?

I always have wanted to go back in time and see what the heck Stonehenge is really about. That seems really weird, but it’s such a wild thing. I’d love to know why it’s there. What the heck were they doing? I don’t know that I’d want to meet the Stonehenge caveman, but I would love to see that.

And I would love to meet J.R.R. Tolkien because I love his books.

How would your friends describe you?

Nerdy and that I work too hard. I hope people think of me as a kind person and that I’m generous.


Watch our video interview with Dr. Arnold, where she discusses what types of patients she sees at Markey.


Next steps:

  • Learn more about clinical trials at Markey, where our experts are advancing cancer care and giving patients access to the latest treatment options.
  • If you’ve been diagnosed with any form of head and neck cancer or lung cancer, our specialized treatment teams are here to help. Learn more about the leading-edge, personalized care we provide.