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UPMC Announces $2B Investment to Build 3 Digitally Based Specialty Hospitals Backed by World-Leading Innovative, Translational Science

New patient-focused cancer, heart and transplant, vision and rehabilitation hospitals augment mental health, pediatric and women’s specialty care

UPMC today announced a bold plan to transform patient care with three leading-edge, new specialty hospitals that will offer next-generation treatments in patient-focused, technology-enhanced settings unique to health care. Backed by a $2 billion investment from UPMC, the all-new UPMC Heart and Transplant Hospital, UPMC Hillman Cancer Hospital and UPMC Vision and Rehabilitation Hospital will add to UPMC’s complement of advanced specialty care at Magee-Womens Hospital, Western Psychiatric Institute and Clinic, and Children’s Hospital of Pittsburgh.

“UPMC is recognized around the world for pioneering treatments that are backed by groundbreaking research in an unparalleled care network,” said Jeffrey A. Romoff, president and chief executive officer, UPMC. “Our transformative vision will make available the most innovative treatments for cancer, heart disease, transplantation, diseases of aging, vision restoration and rehabilitation, among many others. Working in partnership with the University of Pittsburgh Schools of the Health Sciences, we will radically change health care as we know it to provide personalized, effective and compassionate care. At core, these digitally based specialty hospitals are the expression of our cutting-edge translational science creating treatments and cures for the most devastating diseases.

“We are also pleased to announce that Microsoft will collaborate with UPMC in designing these ‘digital hospitals of the future.’ Building on our existing research collaboration with Microsoft and its Azure cloud platform, we will apply technology in ways that will transform what today is often a disjointed and needlessly complex experience for patients and clinicians,” said Romoff. “UPMC and Microsoft will have more to share in the coming months.”
The UPMC Vision and Rehabilitation Hospital, on the UPMC Mercy campus, is expected to open in 2020 to offer advanced clinical vision care. Clinicians and researchers at the new hospital will pursue promising new research for vision restoration and diseases of the eye, and offer technology-assisted rehabilitation services that restore mobility for patients with wide-ranging physical and cognitive challenges.The all-new hospitals will be situated on the campuses of UPMC’s Mercy, Presbyterian and Shadyside hospitals. Designs for the UPMC Heart and Transplant Hospital and the UPMC Hillman Cancer Hospital will be selected in an international design competition.

Patients of the UPMC Hillman Cancer Center, a name that is synonymous with unmatched excellence in cancer care, and the only National Cancer Institute-designated Comprehensive Cancer Center in the region, will receive specialized treatment in the new UPMC Hillman Cancer Hospital, located on the UPMC Shadyside campus. The facility is expected to open in 2022.

Building on UPMC’s legacy in organ transplantation, the UPMC Heart and Transplant Hospital in the heart of Oakland on the UPMC Presbyterian campus will provide the highest caliber organ transplantation and cardiac procedures available anywhere in the world.

“Tomorrow’s UPMC, we are confident, will not only be best-in-class,” said G. Nicholas Beckwith, III, chairperson, UPMC Board of Directors. “It will, in fact, have created a class virtually unto itself.”

The $2 billion investment is in addition to UPMC’s annual capital commitments of nearly $1 billion and will result in no increase in inpatient beds.

About UPMC’s Specialty Hospitals:

UPMC Heart and Transplant Hospital at UPMC Presbyterian

  • Home of Thomas E. Starzl, M.D., the “father of transplantation,” and these transplant firsts:
    • World’s first pediatric heart-liver transplant: 1984
    • World’s first heart-liver-kidney transplant: 1989
    • First medical center to discharge a patient on a ventricular assist device: 1990
  • Performed more than 19,500 total transplants and over 2,000 lung transplants, the most of any lung transplant program in the U.S.
  • One of the most experienced liver transplant programs in the country and a leader in living donor liver transplantation
  • Nationally ranked by U.S. News & World Report for cardiology and heart surgery for the last 10 years*
  • Location of the nation’s first LIVE (Less Invasive Ventricular Enhancement) surgery to repair the heart after severe heart attacks
  • Second center in the world to surpass 3,000 cardiothoracic transplants
  • One of only a few programs in the country with heart transplant recipients now nearing or beyond 30-years post-transplant

UPMC Hillman Cancer Hospital at UPMC Shadyside

  • Consistently ranked by U.S. News & World Report as having one of the best cancer programs in America*
  • The only nationally ranked cancer program in the region, and the only National Cancer Institute-designated Comprehensive Cancer Center in the region
  • Among the largest integrated community cancer networks in the U.S., providing world-class care and clinical research to more than 110,000 patients a year at over 60 locations
  • Allows patients to begin treatment plans and receive follow-up care after surgery in their own communities thanks to the UPMC Hillman Cancer Center network
  • Where patients seek comprehensive care, second opinions and clinical trials on rare cancers and the most challenging medical cases
  • Employs the latest innovative technologies, including intensity-modulated radiation therapy, treatments using RapidArc®, TrueBeam™ STx, CyberKnife®M6™, and PET–CT planning, which was pioneered by UPMC physicians

UPMC Vision and Rehabilitation Hospital at UPMC Mercy

  • UPMC Eye Center directed by world-renowned expert in vision therapies and developer of interventions, such as stem cell implantation, gene therapy, innovative pharmacologic approaches and the artificial retina
  • Leading research initiatives for vision restoration techniques, including age-related macular degeneration
  • Ranked one of the top ophthalmology programs in the U.S. by Ophthalmology Times for delivery of patient care
  • World-class ophthalmologists available to patients outside of Pittsburgh with real-time image transmission and video display through UPMC’s teleophthalmology program
  • Largest rehabilitation network in western Pennsylvania, and one of the largest in the U.S., treating 4,678 inpatients and 72,000 outpatients in the past year
  • Rehabilitation outcomes consistently better than national averages in the areas of patient independence, efficiency and discharge to the community
  • Implementing innovative early mobility initiatives for ICU patients to reduce the risk of delirium, muscle loss, ventilator-associated pneumonia and psychological distress
  • Clinical research to enable individuals with severe spinal cord injuries to control robotic arms with the brain and re-experience the sense of touch with brain-computer interfaces
  • Leading groundbreaking rehabilitation efforts for cancer patients, who need interdisciplinary rehabilitation because of the cancer itself or the treatment

Children’s Hospital of Pittsburgh of UPMC

  • Ranked on U.S. News & World Report’s Honor Roll of America’s Best Children’s Hospitals for eight consecutive years
  • Served patients and families from all 50 states and 50+ countries in the past five years with advanced specialty care
  • Nation’s first pediatric transplant center, performing more than 3,300 transplants
  • Heart Institute has one of the lowest overall four-year surgical mortality rates in the nation among all high-volume programs with a mortality rate under 2 percent
  • Heart Institute awarded a 3-Star rating by the Society of Thoracic Surgeons (2012-2016), one of only 11 programs to receive this distinction
  • First pediatric hospital in the nation recognized by HIMSS for its early adoption of electronic health records and technology to improve patient outcomes
  • Telemedicine consultation and care management programs provided globally with hospitals in Brazil, Colombia and Serbia, and nationally in Florida and Virginia

Western Psychiatric Institute and Clinic of UPMC

  • One of the top 12 hospitals in the nation for psychiatric care, according to U.S. News & World Report*
  • Leading recipient in National Institutes of Health psychiatry research funding
  • Only Center for Interventional Psychiatry and Behavioral Health Intensive Care Unit in the region
  • Award-winning specialty programs in child and adolescent bipolar disorders and adolescent suicide prevention
  • Nationally recognized by the Human Rights Campaign Foundation for LGBTQ health care equality
  • National pace-setter in the integration of behavioral health services in medical clinics
  • Centers for excellence in the diagnosis and treatment of addiction disorders
  • Ranked in the top 10 psychiatry resident training programs in the nation
  • Leading clinical psychology internship program in the country
  • One of the nation’s first and largest academic-affiliated telepsychiatry programs, averaging more than 12,000 consults a year

Magee-Womens Hospital of UPMC

  • Specialized expertise in women’s health across the lifespan, including prenatal and postnatal health, mid-life and menopausal services, and end-of-life care
  • One of the busiest obstetrics programs in the country, with nearly 10,000 babies born each year
  • Treats more than 1,500 seriously or critically ill babies each year in the highest volume neonatal intensive care unit in Pennsylvania and one of the largest in the country
  • Collaborates with Magee-Womens Research Institute, one of the largest research institutes in the U.S. devoted exclusively to women’s health research
  • One of the first teaching facilities recognized as a National Center of Excellence in Women’s Health by the U.S. Department of Health and Human Services
  • Offers women comprehensive and compassionate outpatient care for opioid addiction in a first-of-its-kind Pregnancy Recovery Center
  • One of the busiest clinical sites in the country for women’s cancer including nurses, doctors and support programs all focused on women’s cancer
  • Blend of clinical expertise and innovative research dedicated to breast cancer prevention and treatment ensures patients receive the most comprehensive breast care available

*U.S. News & World Report rankings are based on UPMC Presbyterian Shadyside data.

UPMC-Developed Genetic Test Successfully Detects Some Asymptomatic Pancreatic Cancers

A genetic test developed at UPMC proved highly sensitive at determining which pancreatic cysts are most likely to be associated with one of the most aggressive types of pancreatic cancer, UPMC and University of Pittsburgh School of Medicine scientists reported in Gut, the journal of the British Society of Gastroenterology.

The successful results are a critical step toward a precision medicine approach to detecting and treating pancreatic cancer, which has one of the lowest survival rates of all cancers.

Pancreatic cysts — small pockets of fluid in the pancreas — are increasingly detected on medical scans by happenstance. For the most part, the cysts are benign. But because some can progress to pancreatic cancer, doctors must determine whether it is surgically necessary to remove the cysts.

“On the one hand, you never want to subject a patient to unneeded surgery. But survival rates for pancreatic cancer are much better if it is caught before symptoms arise, so you also don’t want to ignore an early warning sign,” said lead author Aatur D. Singhi, MD, PhD, a surgical pathologist in the UPMC Division of Anatomic Pathology. “This rapid, sensitive test will be useful in guiding physicians on which patients would most benefit from surgery.”

Singhi and his team at UPMC developed PancreaSeq®, which requires a small amount of fluid removed from the cyst to test for 10 different tumor genes associated with pancreatic cancer. It was the first such prospective study, testing pancreatic cysts before surgery, rather than analyzing cysts after surgery as had been done by previous efforts.

The study, funded in part by the Pancreatic Cancer Action Network and The National Pancreas Foundation, also was the first to evaluate a test that employed a more sensitive genetic sequencing method called next-generation sequencing and the first to be performed in a certified and accredited clinical laboratory as opposed to a research setting.

“This was important to us,” said Singhi. “If PancreaSeq is going to be used to make clinical decisions, then it needed to be evaluated in a clinical setting in real time, with all the pressures that go with a clinical diagnosis.”

In this analysis phase, the test was not intended to be used as the sole factor in determining whether to remove the cyst or not, so doctors relied on current guidelines when deciding on a course of treatment. A total of 595 patients were tested, and the team followed up with analysis of surgically removed cysts, available for 102 of the patients, to evaluate the accuracy of the test.

The study showed that with 100 percent accuracy, PancreaSeq correctly classified every patient in the evaluation group who had intraductal papillary mucinous neoplasm (IPMN) — a common precursor to pancreatic cancer — based on the presence of mutations in two genes, KRAS and GNAS. Furthermore, by analyzing mutations in three additional genes, the test also identified the cysts that would eventually progress to being cancerous lesions, also with 100 percent accuracy. test was less accurate for the less prevalent pancreatic cyst type called mucinous cystic neoplasm (MCN) — catching only 30 percent of the cases. Importantly, PancreaSeq did not identify any false positives in either cyst type, making it a highly specific test.

The researchers noted that the results could be biased by choice of which patients had their cysts surgically removed, but plan to monitor those who did not have their cysts removed to continue evaluation of the test’s reliability. An improved version of PancreaSeq that incorporates additional tumor genes associated with pancreatic cancer currently is undergoing rigorous clinical testing, according to Singhi. In the future, the team notes, clinical guidelines will need to be revisited to explore incorporating tests like PancreaSeq.

The PancreaSeq test currently is available to patients and ordered through UPMC.

Marina N. Nikiforova, MD, is the senior author on this study. Additional authors are Kevin McGrath, MD, Randall E. Brand, MD, Asif Khalid, MD, Herbert J. Zeh, MD, Jennifer S. Chennat, MD, Kenneth E. Fasanella, MD, Georgios I. Papachristou, MD, PhD, Adam Slivka, MD, PhD, David L. Bartlett, MD, Anil K. Dasyam, MD, Melissa Hogg, MD, Kenneth K. Lee, MD, James Wallis Marsh, MD, Sara E. Monaco, MD, N. Paul Ohori, MD, James F. Pingpank, MD, Allan Tsung, MD, Amer H. Zureikat, MD, and Abigail I. Wald, PhD, all of Pitt or UPMC, or both.

Neuro-Oncology Researcher at Children’s Hospital of Pittsburgh of UPMC Receives Grant from St. Baldrick’s Foundation

PrintGary Kohanbash, PhD, a neuro-oncology researcher at Children’s Hospital of Pittsburgh of UPMC, has been awarded a scholar grant of $298,000 from the St. Baldrick’s Foundation, a volunteer-driven charity dedicated to raising money for childhood cancer research.

These grants provide resources to institutions to conduct more research and enroll more children in ongoing clinical trials. Kohanbash and his team will look at improving immunotherapy for ependymomas, the third most common kind of brain tumor in children.

“As a scientist and a father, I am driven to help save kids from brain cancers, so I am very excited about the potential of immunotherapy. Unimaginable advances within the last 10 years are enabling us to create new, safer and more effective treatments,” said Kohanbash, who also is an assistant professor of neurological surgery at the University of Pittsburgh School of Medicine. “With this funding from the St. Baldrick’s Foundation, I am hopeful that we can bridge the gap between lab research and clinical care for kids with ependymomas.”

Kohanbash’s team has identified three peptides that might activate immune cells to specifically fight one of the more lethal types of ependymoma. He will be testing these peptides in the lab and also is looking at how immunotherapy could help fight all six types of ependymoma that affect kids.

“We are thrilled Dr. Kohanbash is receiving this grant based on his experience and accomplishments in the field of brain tumor immunology and his ongoing work to translate findings from the lab into promising treatments for children with ependymomas,” said Ian Pollack, MD, chief, Pediatric Neurosurgery, Children’s Hospital.

The grant is supported by the St. Baldrick’s Henry Cermak Fund for Pediatric Cancer Research.

For more information, please visit www.chp.edu.

Topical Therapy for Radiation-Induced Skin Damage Shows Promising Results

A team of University of Pittsburgh researchers has demonstrated that a newly developed topical therapy applied before or after radiation exposure prevents skin damage in both animal and human models.

The results, published online in the Journal of Investigative Dermatology, are expected to accelerate efforts that will lead to clinical studies and licensing of the technology, said Louis Falo, MD, chairman of the Department of Dermatology at the Pitt School of Medicine and corresponding author for the study.

The skin is the largest human organ and protects the body from physical, chemical and environmental exposures. Radiation-induced skin damage ranges from photo-aging and ultraviolet sun exposure to radiation dermatitis, a treatment-limiting condition caused by radiation therapy; and skin radiation syndrome, a frequently fatal consequence of exposures from nuclear accidents.

Dr. Falo teamed with Joel Greenberger, MD, professor and chair of the Department of Radiation Oncology, and Peter Wipf, PhD, Distinguished University Professor of Chemistry, in 2008. Drs. Greenberger and Wipf were exploring treatments to mitigate radiation poisoning caused by an accident at a nuclear power facility or from a so-called “dirty bomb” device. Together, they determined that the approaches being developed and investigated at Pitt could potentially benefit the approximately 1 million people annually in the U.S. who undergo radiation therapy to the skin for breast, head and neck, and other cancers.

“During the course of radiation therapy, patients can develop irritating and painful skin burns that can lead to dangerous infections and diminished quality of life,” Dr. Falo said. “Sometimes the burns are so severe that patients must stop their treatment regimen. Our results show that topical treatment with this therapeutic agent prevents skin damage at the source.”

Dr. Wipf’s lab developed the molecule that targets the formation of oxidative free radicals in the cell’s mitochondria, thereby preventing inflammation and cell death.

“This provides for potentially improved treatment options for patients undergoing radiation therapy with the prospect for more simplified treatment regimens and reduced concern about quality of life post-treatment,” he said. Dr. Wipf’s former student, Joshua Pierce, PhD, who now operates his own lab at North Carolina State University, is credited with synthesizing the molecule, named JP4-039.

Dr. Falo said he is optimistic about the therapy’s performance in clinical trials because the treatment appears to be effective in a model that uses human skin obtained from cosmetic procedures.

Looking beyond treating radiation therapy, he and his team are pursuing further studies of the molecule’s ability to reduce skin damage from sun exposure, including sunburns and the molecular changes that lead to skin cancer, as well as cosmetic applications to prevent skin changes caused by the oxidative stress that is associated with normal skin aging.

Additional authors on this study are Rhonda M. Brand, PhD, Michael W. Epperly, PhD, J. Mark Stottlemyer, BS, Xiang Gao, PhD, Erin M. Skoda, PhD, Song Li, MD, PhD, Saiful Huq, PhD, and Valerian E. Kagan, PhD, D.Sc, all of Pitt.

This research was funded by National Institute of General Medical Sciences grants P50 GM067082 and U19-A1068021, and National Institute of Allergy and Infectious Diseases grant 1RC1AI081284, and the Coulter Foundation.

UPCI-Tested Immunotherapy Prolongs Life, Reduces Side Effects and Improves Quality of Life

The immunotherapy nivolumab significantly increases survival and causes fewer adverse side-effects in patients with recurrent head and neck cancer, according to a randomized trial co-led by investigators at the University of Pittsburgh Cancer Institute (UPCI), partners with UPMC CancerCenter.

The results of the international CheckMate-141 phase III clinical trial were reported Sunday in the New England Journal of Medicine, following preliminary presentations at the annual American Society of Clinical Oncology and American Association for Cancer Research meetings earlier this year. Patients on nivolumab were doing so much better than those receiving standard therapy that the trial was stopped early to allow all patients to receive it.

“Due to our clinical trial, anti-PD-1 therapies like nivolumab are now the recommended treatment for patients with this very difficult, devastating cancer,” said lead author and trial co-chair Robert Ferris, MD, PhD, UPMC Endowed Professor, and chief of the Division of Head and Neck Surgery and co-leader of the Cancer Immunology Program at UPCI.

Worldwide, more than 600,000 cases of squamous-cell carcinoma of the head and neck are diagnosed annually, and the cancer recurs in more than half the patients within three years. The cancer typically returns because it has evaded the immune system and become resistant to chemotherapy.

Alcohol and tobacco use are the two main risk factors for head and neck cancers. Infection with the human papillomavirus (HPV) also is a risk factor, and rates of head and neck cancer attributable to HPV infection have increased 250 percent over the past several decades.

Nivolumab, which belongs to a class of drugs known as immunotherapeutics, enables the body’s immune system to destroy cancer cells. It currently is approved to treat certain types of cancers, including melanoma and lung cancer.

The CheckMate-141 trial enrolled 361 patients receiving care at 64 locations worldwide for recurrent head and neck cancer that had progressed within six months of chemotherapy. From June 2014 through August 2015, the researchers randomly assigned 240 patients to receive nivolumab and 121 to receive standard therapy, which consisted of one of three chemotherapy drugs.

On average, the patients on nivolumab survived 7.5 months, versus 5.1 months for the patients on standard therapy. At one year, 36 percent of the nivolumab patients were still living, compared with 16.6 percent of the standard-care patients.

Additionally, only 13.1 percent of the patients receiving nivolumab suffered serious, quality-of-life-disrupting side effects of the treatment, compared with 35.1 percent of those receiving standard therapy.

“It is wonderful news that we have a new, better option for patients with recurrent head and neck cancer,” said Dr. Ferris. “But for the vast majority of patients, nivolumab isn’t a cure and more research is needed to find one. Perhaps even more important, we need to prevent this cancer from ever occurring. We have to help people to stop smoking or chewing tobacco, and encourage them to never start. We also need to continue to encourage children to be vaccinated against HPV.”

The trial’s other co-chair is Maura Gillison, MD, PhD, from Ohio State University. Additional US institutions that participated in the trial include University of Texas MD Anderson Cancer Center, Stanford Cancer Institute, University of Chicago, University of Michigan, Emory University, Dana-Farber Cancer Institute and Bristol-Myers Squibb.

International collaborators are located at Centre Leon Berard, Centre Antoine Lacassagne, and Institut Gustave Roussy, all in France; Fondazione IRCCS Istituto Nazionale Tumori, in Italy; The Institute of Cancer Research, in the United Kingdom; University Hospital Essen, in Germany; Hospital Universitario 12 de Octubre, in Spain; University Hospital Zurich, in Switzerland; and National Cancer Center Hospital East and Kobe University Hospital, both in Japan.

The trial was funded by Bristol-Myers Squibb, which is now seeking US Food and Drug Administration approval for the use of nivolumab in head and neck carcinoma.

UPMC’s Dr. Stanley Marks Honored with Endowed Chair in His Name to Recruit Cancer Leaders

Stanley Marks, MD, a leading UPMC oncologist and advocate for cancer patients throughout the western Pennsylvania region, was honored by UPMC and his medical partners at Oncology Hematology Association (OHA) through the establishment of the Stanley M. Marks – OHA Endowed Chair in Hematology/Oncology Leadership.

Every one of his 48 partners at OHA, a UPMC-owned practice, financially committed to create this chair, which also was supported by UPMC, for a total of $2.2 million.

The permanent endowment will support the recruitment and retention of outstanding leaders in the University of Pittsburgh Division of Hematology/Oncology. It also will help to train professionals devoted to research and improved treatments for patients.

Dr. Marks has directed and overseen the continued growth and success of the UPMC CancerCenter, a partner with the University of Pittsburgh Cancer Institute and now one of the largest cancer care networks in the nation.

“None of this would have been possible without the support of my colleagues and UPMC,” said Dr. Marks. “This endowment will enable us to recruit a medical and scientific star, ultimately leading to better care for our patients.”

Added Barry Lembersky, MD, “Through his decades-long leadership of OHA and the UPMC CancerCenter, Stan has made a significant impact on cancer care and research in our region and beyond. All of the physicians in OHA wish to honor his outstanding contributions and provide a legacy to benefit patients for generations to come.”

Dr. Marks serves as chairman of UPMC CancerCenter, chief of the Division of Hematology and Oncology at UPMC Shadyside, and as a clinical professor of medicine at the University of Pittsburgh School Of Medicine. He also has been named consistently as one of the “Top Physicians in Pittsburgh” and “Best Doctors of America” in hematology and medical oncology by Best Doctors®.

UPCI Secures Federal Contract For Up To $10M in Preclinical Cancer Drug Development Work

The University of Pittsburgh Cancer Institute (UPCI), partner with UPMC CancerCenter, secured a highly prestigious contract from the National Cancer Institute (NCI) to perform preclinical research crucial to the development of new cancer drugs. This commitment could bring up to $10 million in research projects to UPCI over the next five years.

The contract cements UPCI’s role in all five stages of NCI’s drug development process, with UPCI researchers now holding funding mechanisms in drug screening, preclinical research, and Phase I, II and III clinical trials.

“It is exceedingly rare for an academic cancer institute to have funding in every one of these NCI drug development stages,” said Nancy E. Davidson, MD, director of UPCI. “By being involved in every stage of NCI drug development, UPCI is able to truly consider and understand each part, bringing extra knowledge and value to every cancer drug research project we perform. Contracts like this are a crucial part of how we get the best therapies to our patients.”

Julie Eiseman, PhD, DABT, professor of pharmacology and chemical biology, and Jan Beumer, PharmD, PhD, DABT, associate professor of pharmaceutical sciences and medicine, both of UPCI, are co-principal investigators on the new NCI preclinical research contract. They also hold a previous NCI preclinical contract, which will conclude next year.

Under the new preclinical contract, UPCI will perform the research necessary to collect drug pharmacology data and determine the most efficacious routes and doses of proposed cancer drugs so that they can be used in human clinical trials.

“What sets UPCI apart is that we provide an added value by being able to think outside the box,” said Dr. Beumer, who also is co-principal investigator on the NCI phase I clinical trial grant at UPCI. “We can connect these preclinical studies with the clinical trials that will follow and make suggestions to help both phases be as efficient and effective as possible.”

The researchers do not yet know specifically what potential drugs they’ll be investigating or which cancers they’ll ultimately be intended to tackle.

“That’s what we help to determine,” said. Dr. Eiseman. “In the past we’ve evaluated potential drugs for use in cancers of the colon, breast, pancreas, and head and neck, among others. It’s a team effort. No one person could develop these therapies alone.”

The Contract Number is HHSN2612016000221; the NCI Control Number is N02CM-2016-00022.

‘Starving’ Immune Cell Discovery Points to Cancer Immunotherapy-Boosting Strategies

The microenvironment that supports a cancerous tumor also starves the immune cells that the body sends in to destroy the cancer, University of Pittsburgh Cancer Institute (UPCI) scientists revealed in a discovery that holds the potential to significantly boost the performance of breakthrough immunotherapy drugs.

The UPCI team showed that when immune T cells enter the tumor microenvironment, their mitochondria—which act as mini-factories inside cells, making energy and crucial reagents a cell needs to survive—begin to shrink and disappear, indicating that the T cell is out of fuel and can’t do its tumor-destroying job. The finding, reported online today and scheduled for next week’s issue of the journal Immunity, opens the door to several potential clinical approaches that could help keep T cells functioning and boost the body’s ability to fight cancer.

“Immunotherapy to stimulate the body’s immune system has increasingly become the way we treat people with aggressive cancers. It’s effective for a subset of patients, but the truth is that only about 20 to 40 percent of patients will respond to the treatment, and it is still unclear why,” said senior author Greg M. Delgoffe, PhD, assistant professor of immunology and member of the Tumor Microenvironment Center at UPCI, partner with UPMC CancerCenter. “It’s a huge question in the cancer immunotherapy field, and we think we’ve found a big part of the answer.”

As tumors grow, they build a microenvironment, which develops its own blood supply and keeps the tumor thriving, protected and voraciously consuming all available nutrients.

When T cells enter the microenvironment, it’s as if they’re “automobiles that suddenly had the emergency brake applied; they can’t keep driving,” explained Dr. Delgoffe. Immunotherapies, like those that target negative regulators on the T cell surface, take these brakes off. “However, what we’re discovering in many cases is that even though the brakes have been taken off, there isn’t any fuel in the tank,” Dr. Delgoffe said. Or—in scientific terms—the lack of mitochondria in the tumor-infiltrating T cells keeps them from functioning.

“This is an exciting discovery because we already have various strategies to ‘fill the fuel tank’ and support T cell function in the tumor microenvironment,” said Dr. Delgoffe.

In laboratory experiments and tests with mice, Dr. Delgoffe and his team found that when they boosted the mitochondria in the T cells, they were better able to clear the tumor.

Dr. Delgoffe is partnering with other scientists to test various mitochondria-boosting strategies, including using drugs that already have proven safe in humans, such as those for type 2 diabetes, to stimulate T cell metabolism. He’s also working with existing immunotherapy studies to further modify the T cells so that their metabolism functions better in the tumor microenvironment.

Additional authors on this research are Nicole E. Scharping, BSc, Ashley V. Menk, BSc, Rebecca S. Moreci, BA, Ryan D. Whetstone, MS, PhD, Rebekah E. Dadey, BS, Simon C. Watkins, PhD, and Robert L. Ferris, MD, PhD, all of Pitt.

This work was supported in part by Sidney Kimmel Foundation for Cancer Research grant SKF-015-039 and National Institutes of Health grants 1S10OD016236-01, P50 CA097190 (UPCI Head and Neck Specialized Program of Research Excellence (SPORE)) and P50CA121973 (UPCI Skin Cancer SPORE).

Advertising by US Cancer Centers Soars Over Past Decade, New Analysis Shows

Cancer centers promoting their services dramatically increased their advertising spending from 2005 to 2014, with the bulk of the spending by for-profit organizations, according to the results of a study published Monday.

Researchers at Indiana University (IU) School of Medicine and the University of Pittsburgh School of Medicine and Graduate School of Public Health reported that 890 cancer centers spent $173 million for advertising in 2014, and just 20 centers accounted for 86 percent of the spending.

One company, Cancer Treatment Centers of America, a for-profit firm with a national network of five hospitals, spent $101.7 million, 59 percent of the total. In contrast, 25 of the nation’s 60 National Cancer Institute (NCI)-designated cancer centers spent no money on advertising, and of those that did, half spent less than $4,000, the authors said.

Of the 20 centers that accounted for the bulk of spending, five were for-profit institutions, 17 were Commission on Cancer-accredited and nine were NCI-designated centers.

The report was published Monday by the journal JAMA Internal Medicine.

“Spending on cancer center advertising has more than tripled since 2005, and a small percent of cancer centers are responsible for the majority of spending. Patients should be aware that cancer centers that spend the most on advertising may not necessarily provide the highest quality of cancer care,” said study first author Laura Vater, MPH, a fourth-year medical student at the IU School of Medicine.

Additional work is needed to better understand how advertising may affect the cost and quality of care, she said.

In a 2014 study published in the Annals of Internal Medicine, Vater and colleagues analyzed the content of cancer center advertising and concluded that “clinical advertisements by cancer centers frequently promote cancer therapy with emotional appeals that evoke hope and fear while rarely providing information about risks, benefits, costs or insurance availability.”

For the new study, the researchers used data from Kantar Media, an agency that tracks advertising and calculates expenditures. They obtained data for television, magazine, radio, newspaper, billboard and internet advertising. The expenditures were adjusted to 2014 U.S. dollars using the Consumer Price Index.

The researchers also identified the centers that were NCI-designated, accredited by the Commission on Cancer, were not-for-profit versus for-profit organizations, and by location.

Spending in all advertising categories grew from 2005 to 2014, led by television where $37 million was spent in 2005, rising to a peak of $107 million in 2011. Television spending declined somewhat after that, but still stood at $87 million in 2014. Print media spending rose from $11 million to $34 million. In a time when internet advertising was growing, cancer center online ads were among them—internet display advertisements rose from $300,000 in 2005 to $9 million in 2014.

“More work is needed to understand the effects of cancer center advertising on the web, as more and more people search for health information online,” said senior author Yael Schenker, MD, assistant professor in the Pitt School of Medicine. “One concern is that when advertisements are listed at the top of internet search results, patients may have trouble finding and recognizing good information.”

After Cancer Treatment Centers of America, the two biggest advertisers in 2014 were MD Anderson Cancer Center, which spent $13.9 million, and Memorial Sloan Kettering Cancer Center at $9.1 million.

The authors noted that the expenditure calculations could be low because advertising in cancer-specific magazines was not included, nor was advertising by affiliated organizations designed to encourage charitable donations.

The research was supported by a National Institutes of Health grant KL2TR000146 and by a University of Pittsburgh Department of Medicine Junior Scholar Award.

In addition to Vater and Dr. Schenker, researchers contributing to the study were Julie M. Donohue, PhD, of the University of Pittsburgh Graduate School of Public Health, and Seo Young Park, PhD, of the University of Pittsburgh Department of Medicine.

CMS Selects UPMC Oncologists and UPMC Health Plan to Participate in New ‘Oncology Care Model’ Pilot

UPMC CancerCenter oncologists and the UPMC Health Plan have been selected as one of nearly 200 physician group practices and 17 health insurance companies to participate in an innovative federal program designed to enhance quality and coordination of care for cancer patients, while lowering costs.

The five-year Oncology Care Model (OCM) pilot payment project, overseen by the Centers for Medicare and Medicaid Services (CMS), aims to align physician incentives with improvements in the effectiveness and efficiency of cancer care delivery.  As part of CMS’s broader move to pay physicians for “value” instead of volume, the program aims to reduce unnecessary hospitalizations and emergency room visits by helping patients with improved coordination of and access to key services.

The participating UPMC practice, Oncology Hematology Associates (OHA), is one of the largest integrated community networks of cancer care specialists in the country, providing the latest advances in cancer prevention, detection, diagnosis and treatment. OHA has more than 19 sites throughout western Pennsylvania and has over 168,000 patient visits a year.

“As one of the largest integrated health care provider-payer systems in the country, UPMC has been a leader in developing new models of accountable, patient-focused care,” said Peter Ellis, M.D., deputy director for clinical services at UPMC CancerCenter. “By taking part in this pilot, we believe that UPMC CancerCenter can also play a leading role in developing a model for affordable, high-quality cancer care that can be replicated across the country.”

The UPMC Health Plan is supporting the new model through its own incentives and support services, part of a systemwide effort to transform the delivery of care.

“The UPMC Health Plan, as part of an integrated delivery system, is committed to partnering with CMS to demonstrate how value-based cancer care can improve quality and effectiveness for our members,” said Stephen Perkins, MD, chief medical officer of commercial and Medicare services for the UPMC Health Plan.

Cancer is one of the most common diseases in the United States, with more than 1.6 million individuals receiving a cancer diagnosis each year. According to CMS, a large majority of those diagnosed are over 65 and are Medicare beneficiaries.

To participate in the OCM, oncology providers and insurers must meet multiple requirements, including robust patient navigation, advanced use of an electronic health record, round-the-clock access to clinicians and enhanced outcomes reporting.

The UPMC CancerCenter already meets the majority of the requirements and is enhancing programs to ensure patients receive well-coordinated cancer care. Every cancer patient will receive a detailed cancer care plan to guide his or her treatment. This will cover diagnosis, treatment goals, quality-of-life considerations, care coordination and psychosocial concerns. Following treatment, patients will be provided a survivorship care plan, which includes a summary of treatment delivered and ongoing care, schedules for future visits and testing, as well as management of treatment-related effects. OHA is also improving a nurse triage function and implementing additional management tools to reduce unnecessary hospitalizations and emergency room visits.

The names of the practices and payers participating in the OCM, and more information about the model, can be found on the model’s website: http://innovation.cms.gov/initiatives/Oncology-Care/. The Oncology Care Model begins on July 1 and runs through June 30, 2021.

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