While patients with lung cancer are living longer

than before, more progress is essential because

many patients still succumb to the disease. Inves-

tigators in the Thoracic Oncology Program at

the NYU Cancer Institute — led by Harvey Pass,

MD, Professor of Surgery and Cardiothoracic

Surgery and Director, Division of Thoracic Sur-

gery and Thoracic Oncology, and Abraham

Chachoua, MD, Jay and Isabel Fine Associate

Professor of Oncology — are delineating the

pathways of lung carcinogenesis, pioneering the

exploration of biomarkers to detect the disease

in its earliest stages, and leading clinical trials of

new treatments for patients with all stages of

lung cancer.

Their efforts were greatly enhanced with the

recent $1.1 million gift from NYU Langone

Medical Center Trustee E. John Rosenwald, Jr.

and his wife, Patricia Rosenwald, to support lung

cancer research at the NYUCI. Mrs. Rosenwald

received treatment for lung cancer at NYU Lan-

You may have heard about the human genome,

the library of some 25,000 genes that dictate the

development of our bodies and the processes

within. But that’s not the end of the story — in

fact, it’s just the beginning, the tip of the iceberg.

Many chemical carcinogens directly damage

DNA, leading to cancer. There is growing evi-

dence, however, that some environmental expo-

sures cause cancer by turning genes on and off.

At the same time, researchers are learning how

to replicate this power by turning off bad genes

and turning on good ones using promising anti-

cancer drugs.

The field is called epigenetics (also called

epigenomics), and it’s one that the National

Institutes of Health (NIH) has made a priority

in its research portfolio, announcing in January

2008 its decision to allocate some $190 million

over five years to support investigations related

The NYUCI Thoracic Oncology Program: The Machine Driving the Discovery

continued on page 7

continued on page 4

NYU Cancer Institute

Harvey Pass, MD, and Margaret Huflejt, PhD, are evalu-ating a novel means of identifying biomarkers that couldserve as early indicators of lung cancer development.

Max Costa, PhD, is studying epi-genetic changes in people atincreased risk of cancer due toenvironmental exposures such asnickel and arsenic.

Genes Under SiegeNYUCI Scientists Study Epigenetics to Understand Cancer Development and Improve Treatment

IN THIS ISSUE

2 Director's Message

3 Goldstein Gift

6 Young Adults with Cancer FaceUnique Issues

8 Rajni Kannan’s Personal Crusade

9 Spring Health Quiz

10 Hormone ChangesDuring CancerTreatment

11 Events Calendar

newsSpring/Summer 2010

gone Medical Center; her cancer was found

early, thanks to periodic CT scans. “Lung cancer

has touched our lives and was successfully treat-

ed at NYU. When we were making a gift, it was

natural to aim our philanthropy at the program

that was most significant in our lives,” says

3184W1 4/28/10 5:25 AM Page 1

Although breast and prostate cancers remain the two most common cancers in the United

States, lung cancer is the leading cause of death from cancer for both men and women. While

the majority of lung cancers are caused by smoking, others are associated with occupational

exposures. And still others arise with no identifiable cause.

The NYU Cancer Institute has built a robust program to study the origins of lung can-

cer, pinpoint markers that may signal increased risk or its earliest stages of development, and

evaluate new drugs and treatment regimens for

patients diagnosed with the disease. I’d like to thank

NYU Langone Medical Center Trustee E. John

Rosenwald, Jr. and his wife, Patricia Rosenwald, who

generously contributed $1.1 million to support our

lung cancer research program, which you can read

about in this issue.

You may have been hearing the word “epigenet-

ics” more in the popular press these days. In fact, it

made the cover of TIME magazine last January.

While it’s true that some people have an increased

risk of cancer because of a genetic mutation they

inherited from one of their parents, many cancers

may be caused by DNA alterations — “epigenetic

changes”— that change the expression of genes but

do not alter the sequence itself. Epigenetic changes

may occur during our lifetimes, sometimes as a result of environmental exposures.

NYUCI investigators are collaborating to study such epigenetic changes and how they

may lead to cancer. Moreover, investigators are looking at how these changes occur and using

this knowledge to devise and assess drugs that work by inducing epigenetic changes that are

not favorable for cancer cell growth. Several of their efforts are described in this issue.

Our community education program continues to bring the latest news from cancer

research and advocacy to all of you. One such recent presentation focused on hormonal

changes that may occur during or as a result of cancer treatment. Another event armed

young adult cancer survivors with practical information to empower them as they move on

with their lives.

Finally, I’d like to note the story on page 8 about one of our nurse practitioners, Rajni

Kannan, who cares for patients with melanoma. She sees all too often the damage that

tanning beds can inflict on young patients, and is speaking out for stronger tanning bed

regulations.

Staff members like Ms. Kannan exemplify who we are at the NYU Cancer Institute: a

team of dedicated and compassionate individuals who work tirelessly not only to give our

own patients the very best care, but also to bring cancer awareness to others in our commu-

nity to reduce the burden of this disease. I’d like to take this moment to thank NYUCI staff

for all you do to care for our patients and to further the knowledge of cancer in our great

city and around the world.

Message from the Director

Disclaimer: The medical information provided is foreducational purposes only. It is not intended or impliedto be a substitute for professional medical advice.Always consult your physician or healthcare providerprior to starting any new treatment or with anyquestions you may have regarding a medical condition.

NYU Cancer Institute news

NYU Cancer Institute Board of Directors

Lori W. FinkChair

Ellen BannerSusan Block CasdinRoberta GreenbergJames M. KennyKenneth G. LangoneThomas H. LeeSandra MeyerEdward J. MinskoffShlomo PerlLaurie PerlmutterAmanda PullingerStanley B. ShopkornJoseph SteinbergBrian Walter

NYU Cancer Institute

William L. Carroll, MDDirector

Lauren E. HackettExecutive Director for Administration

Owen A. O’Connor, MD, PhDDeputy Director, Clinical Research and Cancer Treatment

Michele Pagano, MDDeputy Director, Basic Sciences

Associate DirectorsJohn Curtin, MDAcademic Affairs and Education

Silvia Formenti, MDClinical Research

Richard B. Hayes, DDS, PhDPopulation Sciences

Angel Pellicer, MDShared Resources

Mark Philips, MDBasic Research

Robert Schneider, PhDTranslational Research

James L. Speyer, MDClinical and Hospital Operations

Community Outreach and EducationDeborah Axelrod, MDMedical Director

Claudia AyashAdministrative Director

Danielle IavaroneSenior Coordinator

Rachael RennichProgram Associate

NYU Cancer Institute News Editorial Board

Deborah Axelrod, MDClaudia AyashStephanie V. Blank, MDMargo BloomWilliam L. Carroll, MDSteven GogelLauren E. HackettDanielle IavaroneMichelle Krogsgaard, PhD, MScMichele Pagano, MDMark Philips, MDRachael RennichFreya Schnabel, MDMarjorie ShafferJames L. Speyer, MD

Vice President for Communications &Public Affairs, NYU Langone Medical CenterDeborah Loeb Boren

www.nyuci.org

William L. Carroll, MD

Julie and Edward J. Minskoff Professor of Pediatrics

Professor of Pathology

Director, NYU Cancer Institute

3184W1 4/22/10 9:12 AM Page 2

NYU Cancer Institute news 3

Arlene and Arnold Goldstein, longtime

supporters of NYU Langone Medical Cen-

ter, have made a generous $1 million gift

to the NYU Cancer Institute to support a

breast cancer registry. The project is

designed to help investigators better

understand factors that influence the

development of the disease, response to

treatment, and long-term outcome.

The findings of the research will

advance the care of women diagnosed and

treated with breast cancer. Data generated

by the research could also lead to the

development of novel approaches for

identifying and monitoring women who

are most likely to develop the disease, with

the goal of finding it in its earliest, most

curable stages or even reducing breast can-

cer risk. The registry is directed by Freya

Schnabel, MD, Professor of Surgery, who

treated Mrs. Goldstein for breast cancer in

2009.

Both Mr. and Mrs. Goldstein were

very impressed with the care she received

at the NYUCI. “Arlene was overwhelmed

by the personal care and concern for her

well-being offered to her,” says Mr. Gold-

stein. “We could both see it was very gen-

uine. The NYU Cancer Institute staff are

like family.” When Dr. Schnabel told them

about the registry, Mrs. Goldstein liked the

idea of helping other women with breast

cancer by supporting the program.

Through this initiative, every person

who has breast cancer treatment at the

NYUCI and consents to the protocol will

be enrolled in the registry, along with de-

identified information about her medical

and family history, details of her cancer,

methods of treatment, and her outcome.

The program will enable investigators to

track women who are suspected of having

or are proven to have a genetic predisposi-

tion to breast cancer. This information

will allow them to understand the unique

issues of this patient population and assess

the possible benefits of risk-reducing

interventions. The registry data have the

potential to transform clinical practice

and frame public policy.

The Goldsteins’ contribution will also

support interactive educational programs

for healthcare providers and the public

through The Arlene and Arnold Goldstein

Seminars in Breast Cancer. Dr. Schnabel

plans to engage other physicians in an

educational dialogue throughout the

duration of the project.

“The Goldsteins’ gift supports a criti-

cal initiative that we need to look at

patient outcomes in a sophisticated way,”

says Dr. Schnabel. “It allows us to trans-

form every encounter we have with every

breast cancer patient into an opportunity

to learn something new. We’re going to

learn everything we can about our patients

and watch what happens over time. That’s

the best laboratory in the world.” ■

referrals • 212-731-5000

The NYU Cancer Institute honors the memory and commit-

ment of June Newmark, a member of our Board of Directors

since 2006 who passed away in February. Ms. Newmark was a

generous supporter of NYU Langone Medical Center, found-

ing the Ella and Saul Newmark Cancer Research Fund for the

study of women’s cancers in 1998 in honor of her parents. An

accomplished artist and wise investor, Ms. Newmark gra-

ciously supported various institutions in New York City

focusing on art, education, and medicine. As an artist, she

specialized in creating collages and paintings. Her work has

been exhibited at the Weill Cornell Medical College Library,

and a collage she once sent to President John F. Kennedy was

later displayed in the Kennedy Library. Her remarkable giving and support have enabled

us to make significant strides in the diagnosis and treatment of cancer in women, and

we will miss her presence.

Goldstein Gift Supports Breast Cancer Registry

Arlene and Arnold Goldstein

June Newmark

How You Can HelpDonations to the NYU Cancer Institutecan bring us closer to our goal ofdefeating cancer. Each gift — no matterwhat its size — furthers our researchefforts, enhances our clinical services, and expands our community programsso that we may help more people over-come this illness. You can give online atwww.nyuci.org, where you can:

• Create your own personal fundraisingpage

• Make an unrestricted gift• Direct your gift to fund a particular area• Honor your doctor, nurse, or loved one

Contributions can also be sent to:NYU Cancer InstituteNYU Langone Medical CenterOffice of DevelopmentOne Park Avenue, 17th FloorNew York, NY 10016

For more information, please contactMargo Bloom at 212-404-3638(margo.bloom@nyumc.org)

3184W1 4/22/10 9:12 AM Page 3

Mr. Rosenwald, Vice Chairman Emeritus at

J.P. Morgan. “We were impressed with the

team at the NYU Cancer Institute and are

truly excited about their work.”

“Our Thoracic Oncology Program is

unique in this city because the research

component is really blended in. Our basic

science and clinical investigators collabo-

rate as a team, talking on a regular basis

about what is going on in our labs and in

clinical trials,” explains Dr. Pass. “We are

the machine that drives the discovery and

the validation of novel biomarker and

therapeutic target molecules.”

The NYU Lung Cancer Biomarker CenterDr. Pass and William Rom, MD, Sol and

Judith Bergstein Professor of Medicine,

lead NYUCI’s participation in the National

Cancer Institute-funded Early Detection

Research Network — a national multicen-

ter effort to help accelerate the discovery

and evaluation of novel biomarkers for

detecting lung cancer early and identifying

people at increased risk for the disease. The

NYU Lung Cancer Biomarker Center,

established ten years ago, facilitates the

clinical validation and application of bio-

markers through this network and its own

investigations.

Program members have recruited

nearly 1,200 people over age 50 from the

tri-state area, including people at risk for

lung cancer who have at least a 20-pack-

year smoking history, with or without

workplace exposure to asbestos. These

individuals include workers from Consoli-

dated Edison (who has provided funding

for the study) who have known asbestos

exposure, as well as other patients. Partici-

pants in a control population (those not at

increased risk for lung cancer) include

never-smokers over age 50 and ex-smokers

with less than a 20-pack-year smoking his-

tory who quit at least five years prior to

entering the study.

Individuals complete a questionnaire,

undergo lung function testing and spiral

chest CT scanning, and provide blood and

sputum samples. For patients undergoing

lung biopsy or surgery, tissue samples are

collected and banked. The researchers are

following the study participants to see who

develops lung cancer and to correlate their

findings with the questionnaire results,

imaging tests, and analysis of tissue, blood,

and sputum samples.

The goal is to use the information

gleaned from the study to learn more

about who is most likely to get lung cancer

and to identify biomarkers that may signal

which patients with lung nodules found in

imaging studies require additional treat-

ment. So far, 52 percent of participants

have been found to have lung nodules

more than 4 mm in diameter; 24 of them

had lung cancer, one had an asbestos-relat-

ed cancer called mesothelioma, and anoth-

er had a lymphoma.

NYUCI investigators are collaborating

with a number of biotechnology compa-

nies and other universities to develop and

validate biomarkers (proteins and genes)

in the blood that may signal which patients

with lung nodules should continue to have

periodic CT scans, which should have sur-

gery, and which may need less aggressive

monitoring. “We can’t keep repeating CT

scans in all of these patients because of the

high cost and the radiation exposure

involved,” says Dr. Rom. “If we had a

serum biomarker, it would guide us beau-

tifully.”

A New PlatformNinety-two percent of patients diagnosed

with stage I lung cancer are still alive five

years later, but only a quarter of patients

have their lung cancers detected at this

early stage. NYUCI investigators are evalu-

ating a novel means of detecting the cancer

early through what could ultimately be a

simple blood test.

Margaret Huflejt, PhD, Assistant Pro-

fessor of Cardiothoracic Surgery, has devel-

oped a unique cancer diagnostic approach

that utilizes a “printed glycan array.” This

novel high-throughput platform contains

286 synthetic molecules (glycans) that are

sugars often expressed on the surfaces of

lung cells, including abnormal sugars pro-

4 NYU Cancer Institute news www.nyuci.org

NYUCI investigators are assessing a "printed glycan array" for evaluating lung cancer risk.

The NYUCI Thoracic Oncology Program continued from page 1

3184W1 4/28/10 5:25 AM Page 4

NYU Cancer Institute news 5

duced by lung cancer cells in response to

changes induced by the cancer process.

Researchers can measure antibodies

against these abnormal glycans in the

blood of people with mesothelioma or

lung adenocarcinoma or those at risk for

these diseases. This test could also be a tool

for identifying new therapeutic targets.

“We are developing this array as a

global way of looking at molecules that

may serve as very early markers to tell us

something is wrong inside lung cells,”

explains Dr. Pass, who is collaborating with

Dr. Huflejt on this project. “This informa-

tion can tell us if someone is at risk for the

mesothelioma or lung cancer, or if some-

one who already has the disease is likely to

do poorly and may need more aggressive

therapy.”

Because lung adenocarcinoma is the

most common cell type in nonsmokers,

the array could also potentially be used to

identify which nonsmokers are most at risk

for lung cancer. Toward this goal, the

NYUCI is partnering with the Canary

Foundation, a non-profit group “dedicated

to the goal of identifying cancer early

through a simple blood test and then iso-

lating it with imaging.”

NYUCI investigators are also on a

hunt for early detection biomarkers in the

breath of people with lung cancer and

those at risk for the disease. The research is

based on the premise that dogs have been

known to be able to distinguish between

people with and without cancer by

smelling their breath.

Other NYU investigators are studying

how lung cancer develops. Moon-Shong

Tang, PhD, Professor of Environmental

Medicine, Pathology, and Medicine, is

exploring DNA adducts (pieces of DNA

linked to cancer-causing substances) on

the p53 and KRAS genes (which are com-

monly mutated in lung cancer patients) to

see if these adducts cause the mutations

associated with lung cancer development.

Novel Drugs and Drug CombinationsLed by Marc Ballas, MD, Assistant Profes-

sor of Medicine, and Dr. Chachoua,

NYUCI investigators are conducting a

number of clinical trials evaluating new

chemotherapy agents and new combina-

tions of existing anticancer drugs to fine-

tune treatment and optimize the outcome

of patients with lung cancer. Studies are

available for patients with non-small cell

lung cancers (NSCLC) and small cell lung

cancers, those whose disease is surgically

removable and whose disease is not, and

people who’ve never had treatment as well

as those whose disease has progressed

despite therapy.

Several of the studies are assessing tar-

geted therapies that zero in on specific

receptors on cancer cells. “We’re learning

that different types of lung cancer respond

to different drugs, depending on the profile

of the tumor,” explains Dr. Ballas.

Examples of lung cancer clinical trials

available at the NYUCI include:

➤ ECOG 1505: comparing four differentcisplatin-based chemotherapy regimenswith and without bevacizumab (Avastin®)in patients with stage I-III NSCLC that hasbeen surgically removed

➤ 07–306 GSK: evaluating a vaccine

called MAGE-A3 for patients with stageIB-IIIA NSCLC that has been surgicallyremoved and whose tumors express thetarget protein MAGE-A3; patients receivethe vaccine in addition to any plannedchemotherapy to see if it can furtherreduce the risk of cancer recurrence

➤ RTOG 0617: assessing high-dose versuslow-dose radiation therapy plus carbo-platin/paclitaxel with or without cetux-imab in patients with stage III lung cancer

➤ RTOG 08-027: a study of stereotacticradiosurgery for stage I lung cancer pa-tients whose disease can be surgically re-moved but who don’t want to have surgery

➤ 08–756 Imclone: initial therapy withcarboplatin/paclitaxel plus a new investiga-tional drug called IMC 1121B (a humanantibody that interferes with the signalsgoverning the growth of blood vessels thatfeed a tumor) in patients with metastaticNSCLC

➤ ECOG 1508: a study of patients withsmall cell lung cancer comparing the cur-rent standard regimen versus the same reg-imen plus an investigational drug that is a“hedgehog inhibitor” (which interfereswith cancer cell growth and maturation),versus the standard regimen plus an inves-tigational “insulin growth factor antibody”(which interferes with cancer cell growthand division)

“We’ve made tremendous advances in

the treatment of advanced lung cancer, and

we’ve learned how specific chemotherapy

drugs work in specific settings, which is

very exciting,” concludes Dr. Ballas. “The

new trials of targeted therapies are very

promising and may help us learn how to

extend survival, and even manage lung can-

cer the same way we treat chronic diseases

such as diabetes and hypertension.” ■

People who are interested in participating in

the NYU Lung Cancer Biomarker Center

clinical trial may contact Ellen Eylers, RN,

Research Nurse, at 212-263-6126. For infor-

mation about clinical trials of lung cancer

treatments, call Genevieve Breeze, RN, at

212-731-5637.

referrals • 212-731-5000

The NYUCI is part of a national multicenter effort

to help accelerate the discovery and evaluation of

novel biomarkers for detecting lung cancer early and

identifying people at increased risk for the disease.

3184W1 4/22/10 9:12 AM Page 5

6 NYU Cancer Institute news www.nyuci.org

The young adult years can be filled with

promise: preparing for a new career, look-

ing for a first job, renting a first apart-

ment, getting married, starting a family. A

diagnosis of cancer can throw a serious

wrench into the works, sidelining personal

and career plans and filling a person with

uncertainty about the future. Some 70,000

young adults in the United States between

the ages of 15 and 40 face those quan-

daries each year when they learn they have

cancer.

That’s exactly what happened to

Matthew Zachary, who at age 21 was

studying at SUNY-Binghamton in 1995

for a career as a concert pianist when he

began to experience problems with his left

hand. The cause: a brain tumor called

medulloblastoma, which was successfully

treated, but which detoured Mr. Zachary’s

music career.

Instead he began a career in advertis-

ing and information technology, all the

while slowly regaining use of his left hand

— enough to release two acclaimed

albums by the fifth anniversary of his

diagnosis. Noticing the dearth of informa-

tion for young adults about cancer, and

feeling that physicians were less educated

about cancer in this age group than in

younger and older patients, Mr. Zachary

became increasingly active in the cancer

advocacy community. In 2004 he founded

a group called Steps for Living, which

became the I’m Too Young for This Can-

cer Foundation in 2007 (i[2]y for short).

He now leads i[2]y full-time.

“Our mission is to empower young

adults with cancer to get their lives back,

to redeem themselves and not become vic-

tims,” says Mr. Zachary. The i[2]y Web site

frequently encourages survivors to “get

busy living.”

He joined fellow cancer survivor and

advocate Curt Balch and NYU social

worker Leora Lowenthal, LCSW, MPA, at a

seminar hosted by the NYUCI in February

called Insurance Boot Camp for Young

Adults Affected by Cancer.

Mr. Balch was in a similar position in

2002, when he was diagnosed with stage

III testicular cancer at 23. He was an

Infantry Officer in the U.S. Army at the

time, with every intention of being a

career military officer. “I was deeply con-

fused,” he recalls. “I thought I had figured

out what I was going to do with my life,

and I had to change paths.” He was grant-

ed an honorable discharge from the Army

and relied on his economics degree from

Colgate University to become a financial

advisor.

Today he works full-time for a major

financial firm, and also donates his skills

to educate other young adults with cancer

about the unique issues they may face and

how to address them. These include:

➤ denial of medical, life, or disabilityinsurance due to a cancer history

➤ gaps in employment history due totime off for cancer treatment

➤ discrimination by prospective employ-

ers who fear that the survivor may experi-ence a recurrence

➤ discrimination by current employerswho may not be aware of their legalrequirement to give employees time off fortreatment or reasonable on-the-jobaccommodations when needed

“Concerns linger for us as young adult

cancer survivors that a relapse could destroy

everything we worked so hard to build back

up,” says Mr. Balch. He encourages young

adult cancer survivors to speak with their

hospital social workers to get referrals to

financial advice resources, and to their

workplace benefits coordinators to under-

stand their rights as an employee with can-

cer. His top pieces of advice are:

➤ Understand the Family Medical LeaveAct: employers with 50 or more employ-ees in a 75-mile radius must grant an eli-gible employee up to a total of 12 work-weeks of unpaid leave during a 12-monthperiod if the employee cannot workbecause of a serious medical condition, orif the employee must take off work to carefor an immediate family member with aserious medical condition. Employeesworking at companies with fewer than 50staff members may still be eligible to taketime off for medical reasons under theAmericans with Disabilities Act or NewYork State and City Human Rights Laws.

➤ Understand your right to reasonableaccommodations under the Americanswith Disabilities Act: employees may beable to negotiate flexible work hours, workspace alterations, writing aids, and otheraccommodations to ensure they can per-form the essential functions of their jobs.

➤ Ensure that your financial needs aremet: see a financial advisor for guidance.

➤ Understand your work benefits: seeyour human resources representative. ■

For more information, visit the i[2]y Web

site at www.i2y.com.

Young Adults with Cancer Face Unique Issues

3184W1 4/22/10 9:12 AM Page 6

to gene regulation. Because there is huge

variability in epigenetic changes from one

individual to another, and even within dif-

ferent tissues in the same individual, the

field offers an enormous array of research

opportunities. The NIH noted that epige-

netics will build upon our new knowledge

of the human genome, and help us better

understand the role of the environment in

regulating genes that protect our health or

make us more susceptible to disease.

We’re all born with 46 chromosomes

containing the DNA blueprint for our bod-

ies. But epigenetics is what makes your brain

a brain and your liver a liver, and not some

other organ. At the NYUCI, researchers are

exploring epigenetic changes resulting from

carcinogenic environmental exposures

around the world, and developing and eval-

uating novel anticancer drugs that work by

regulating gene activity.

“Epigenetics is related to the structure

of DNA in a complex fashion,” says Richard

Hayes, DDS, PhD, Associate Director for

Population Sciences at the NYU Cancer

Institute and Director of the Division of

Epidemiology in the Department of Envi-

ronmental Medicine at NYU School of

Medicine. “As we learn how to kill or rereg-

ulate cells with aberrant behavior by inter-

fering with epigenetic processes, we can cre-

ate new targets for cancer therapies.”

Lining Up at the WellIn a search for clean drinking water in the

1970s, the Army Corps of Engineers dug

new wells for the people of Bangladesh. But

high levels of arsenic contaminated many of

the wells, leading to elevated rates of skin

cancer among residents. Today contaminat-

ed wells are marked with a flag, leading to

long lines behind the uncontaminated wells

as people wait to obtain their daily ration of

clean water. But some choose not to wait

and continue to drink the water from the

tainted wells.

“We know that cancer is a disease of

epigenetic changes,” says Max Costa, PhD,

the Fred Wild Professor and Chair of Envi-

ronmental Medicine, Professor of Pharma-

cology, and Director of NYU’s Nelson Insti-

tute of Environmental Medicine. “Epigenet-

ics is like a computer program telling the

genome what to do. It tells it what’s going to

happen, when it’s going to happen, and how

it’s going to happen. There’s almost no dis-

ease that doesn’t have epigenetics as some

part of it.”

He is collaborating with researchers at

Columbia University to study epigenetic

changes in the white blood cells of people in

Bangladesh to see how those who have not

been exposed to arsenic differ from those

who have. The results will glean insights

into the molecular mechanisms through

which arsenic causes skin cancer.

Dr. Costa and his colleagues have been

collaborating with investigators at Princeton

University to explore the epigenetic changes

caused by arsenic and nickel (a particulate

component of air pollution). Princeton has

the only lab in the world that offers a form

of mass spectrometry that can be used to

study how “histones” are modified. Histones

are spool-like proteins that package DNA

neatly into chromosomes, and the modifi-

cation of histone tails forms the basis of

epigenetic changes.

Methyl groups (a carbon atom attached

to three hydrogen atoms) can attach to the

histones, coiling them tighter (turning genes

off) or uncoiling them (turning genes on).

Enzymes called demethylases remove methyl

groups from the histones, but metals such

as arsenic and nickel may bind to these

enzymes and inactivate them.

Nickel refining is still big business in

China, exposing workers to levels that raise

their risk of lung cancer fourfold. Dr. Costa

and his colleagues have received permission

from the Chinese government to obtain

samples of blood and mouth tissue from

nickel refinery workers in China for analy-

sis. They are also studying white blood cells

from foundry workers in Brescia, Italy

exposed to both nickel and arsenic. The

investigators will compare epigenetic

changes in white blood cells from exposed

and unexposed people.

They’ve already found that nickel inac-

tivates a tumor suppressor gene, which nor-

mally puts the brakes on rampant cell

CHROMOSOME

DNA

HISTONE TAIL

HISTONE TAIL

DNA accessible, gene turned on

DNA hidden, gene turned off

HISTONE

GENE

METHYL GROUP

CHEMICALTAG

The epigenome can mark DNA in two ways that play a role in turning genes off or on. The first occurswhen chemical tags called “methyl groups” attach to the backbone of a DNA molecule. The second occurswhen chemical tags attach to the tails of histones.

Genes Under Siege continued from page 1

NYU Cancer Institute news 7referrals • 212-731-5000

continued on page 8

3184W1 4/22/10 9:12 AM Page 7

8 NYU Cancer Institute news www.nyuci.org

Reserving a limousine and ordering a cor-

sage have become staples of pre-prom

preparations for high school seniors

around the country. But there’s one more

ritual that many prom-going girls have

added to their lists: visits to their local

tanning salons. It’s a trend that has grown

in popularity over the years — and not

just at prom time, but all year long.

And it’s a disturbing trend. Last year

the World Health Organization announced

that it reclassified tanning beds to its highest

cancer risk category —“carcinogenic to

humans”— the same classification as tobac-

co, asbestos, and uranium. Studies have

linked these ultraviolet radiation-emitting

beds to melanoma, with people under age

30 who use them having up to a 75 per-

cent increased risk. And according to the

American Cancer Society, melanoma rates

among young women (ages 15–34) have

been rising at an alarming 3.8 percent per

year since 1995.

Rajni Kannan knows about the prob-

lem all too well, and is working with gov-

ernment officials to advocate for stronger

warnings and restrictions

for tanning beds. As an

Adult Nurse Practitioner

at the NYU Cancer Insti-

tute who works with

melanoma patients, she

has witnessed the prob-

lem firsthand.

She describes a young

woman in her 20s who

frequently used tanning

beds before cheerleading

competitions and before

prom when she was in

high school, and who is

now battling stage III

melanoma. “She’s a cute young girl who is

spending the majority of her 20s having

surgeries and getting treatment for

melanoma, instead of enjoying the life that

young women her age should be enjoy-

ing,” says Ms. Kannan.

She had attended a seminar teaching

her how to become a nurse advocate,

and this past January was sitting with

U.S. Reps. Carolyn Maloney (D-NY) and

Charlie Dent (R-PA), the editor-in-chief of

Cosmopolitan magazine (a staunch advo-

cate of safe sun approaches), and others at

a press conference announcing the intro-

duction of the Tanning Bed Cancer Con-

trol Act before Congress. The bill seeks to

expand the U.S. Food and Drug Adminis-

tration’s regulation of tanning beds from

their current Class I medical device clas-

sification (those that pose minimal harm,

Rajni Kannan’s Personal Crusade

NYUCI Adult Nurse Practitioner Rajni Kannan is advocating for strongerwarnings and restrictions for tanning beds.

growth, but when inactivated can lead to

cancer. They also discovered that nickel dis-

rupts iron levels in cells, altering demeth-

ylases by interfering with cell signaling

pathways. As a result, cancer cells learn to

live with little or no oxygen, enabling them

to grow and multiply unabated.

Why should we be concerned about

nickel and arsenic exposures in other coun-

tries? Says Dr. Costa, “Elucidating the roots

of cancer induced by these chemicals may

help us identify targets for new therapies, or

even preventive approaches.”

Taking It to the ClinicDr. Costa is working with Owen A. O’Con-

nor, MD, PhD, Deputy Director for Clinical

Research and Cancer Treatment and Direc-

tor of the Division of Hematologic Malig-

nancies and Medical Oncology in the NYU

Cancer Institute, to develop and assess “epi-

genetic agents” that interfere with enzymes

called histone deacetylases (HDAC) and a

protein called BCL6, which are involved in

certain types of lymphoma.

“The potential of epigenetics is spectac-

ular,” says Dr. O’Connor. “The idea of turn-

ing off bad genes and turning on good ones

sounds like science fiction, but we are

already doing it. By understanding the biolo-

gy of cancer, we can use epigenetic strategies

to learn how to modulate that biology in the

right therapeutic direction.”

Epigenetic drugs are already on the

market and in clinical use. Dr. O’Connor

was part of the team who developed an

HDAC inhibitor called vorinostat (marketed

as Zolinza®), which is approved for the

treatment of cutaneous T-cell lymphoma

(CTCL). Two other drugs — romidepsin

(Istodax®) for CTCL and valproate

(Depakote®) for seizures — also work by

inhibiting HDAC.

Investigators are assessing new combi-

nations of epigenetic agents and other

drugs, primarily in hematologic cancers

such as lymphoma and leukemia. For exam-

ple, the NYUCI is conducting a clinical trial

to evaluate vorinostat plus bortezomib

(Velcade®, which is approved for multiple

myeloma and mantle cell lymphoma) in

patients with multiple myeloma that has

become resistant to bortezomib. The ration-

ale is that vorinostat acts on the pathway

through which a myeloma cell develops

resistance to bortezomib, restoring sensitivi-

ty to the cancer-killing effects of bortezomib.

In another approach, vorinostat is

being combined with a vitamin called nia-

cinamide. Vorinostat turns off a cancer-

Genes Under Siege continued from page 7

3184W1 4/28/10 5:25 AM Page 8

NYU Cancer Institute news 9referrals • 212-731-5000

equivalent to Bands-Aids® and tongue

depressors) to a higher-level classification

which would place the beds on par with

tobacco and alcohol.

The new classification would require

tanning salons to post warnings more

conspicuously; current warnings are post-

ed on the machines themselves, and are

not always easily visible. The bill also seeks

performance standards that restrict the

strength of the ultraviolet rays emitted

and the amount of time a consumer

should remain in the bed. In March, Ms.

Kannan spoke before Congress in support

of the bill. “Each patient has a face and a

story. With education and better regula-

tion, we can save lives,” she says.

“Rajni’s dynamic involvement in

changing healthcare policy not only

demonstrates her personal mission to

impact the outcome of melanoma

patients, but also reflects the NYUCI

melanoma program’s commitment to

melanoma awareness and prevention on a

national level,” adds Anna Pavlick, DO,

Associate Professor of Medicine and Der-

matology. “We are very proud to have her

on our team.” ■

causing oncogene, while niacinamide turns

on a tumor-suppressing gene. The combina-

tion is under evaluation at the NYUCI in

patients with diffuse large B-cell lymphoma

whose disease persists despite up to ten

prior regimens of chemotherapy.

“This approach represents the ultimate

in tailored and targeted therapies, where we

are combining epigenetic agents and exploit-

ing their effects on various proteins in a way

that turns off bad genes and turns on good

genes,” Dr. O’Connor explains. “Once we can

sort out how best to combine these classes of

drugs, we can rationally use them to sensitize

cancer cells to conventional chemotherapy

and hopefully design more effective and less

toxic approaches to cancer treatment.” ■

To learn more about epigenetics, read the NIH

fact sheet at www.genome.gov/27532724.

Does alcohol cause cancer? Can losing weight

reduce your cancer risk? Are artificial sweeteners

bad news? Take this quiz to test your knowledge

of cancer fact versus fiction!

1. True or False: There is no association between

alcohol and cancer.

2. True or False: NutraSweet® (aspartame) causes

cancer.

3. True or False: Vitamin D may possibly reduce

the risk of certain cancers.

4. True or False: There is no link between obesity

and cancer risk.

5. True or False: Consuming only organic foods can

lower cancer risk.

6. True or False: Physical activity lowers the risk of

developing certain cancers.

Answers:

1. False.Alcohol increases the risk of developing cancers of the mouth,

throat, larynx, esophagus, liver, and breast, and may elevate colorectal can-

cer risk. If you drink alcohol, you should limit your intake to no more than

two drinks per day for men and one drink per day for women.

2. False.To date there is no evidence demonstrating a link between aspar-

tame and an increased risk of cancer.

3.True. There is a growing body of evidence from studies of large groups of

people that vitamin D may be helpful against some types of cancer, includ-

ing cancers of the colon, prostate, and breast. However, more research is

necessary to identify the optimal levels of intake and blood levels of vitamin

D required to reduce cancer risk.

4. False.Being overweight or obese has been associated with an elevated

risk of cancers of the breast (among women after menopause), colon,

endometrium, esophagus, and kidney, and possibly other sites as well.

Achieving and maintaining a healthy weight can not only lower your cancer

risk, but your risk of cardiovascular disease and diabetes as well.

5. False.To date, there are no studies suggesting that organic foods (which

are produced without pesticides or genetic modifications) are more effec-

tive for reducing cancer risk than foods produced by other methods.

6. True.Getting regular exercise can reduce the risk of colon and breast

cancers. And it does not have to be vigorous; daily walking can be quite

beneficial.

Source: American Cancer Society

Spring Health Quiz: Fact versus Fiction

3184W1 4/28/10 5:25 AM Page 9

10 NYU Cancer Institute news

Depression. Anxiety. Insomnia. Lack of

libido. Many of the therapies commonly

used to treat cancer today result in hor-

monal imbalances that can produce these

symptoms, impairing patients’ quality of

life. The good news is that help is avail-

able, in the form of medication and psy-

chotherapy that can relieve or alleviate

symptoms and make patients feel better.

“In general, just having cancer can

make some people feel anxious or

depressed and experience a loss of con-

trol,” says Carol Bernstein, MD, Associate

Professor of Psychiatry at NYU School of

Medicine. “But there is no reason to suffer.

There are treatments available to help

patients feel better.”

Dr. Bernstein spoke in January with

Andrew McCullough, MD, Associate Pro-

fessor of Urology, and Samantha M. Dun-

ham, MD, Assistant Professor of Obstet-

rics and Gynecology, at a presentation

hosted by the NYUCI that addressed hor-

monal changes during cancer treatment.

Such changes can result from hormonal

therapies as well as other treatments such

as surgery, chemotherapy, and radiation

therapy.

Hormonal therapies are most com-

monly used for the treatment of breast

and prostate cancers. Women with breast

cancer may receive tamoxifen or ralox-

ifene to reduce the risk of breast cancer

recurrence; both drugs interfere with

estrogen activity. Women taking these

drugs may experience menopause-like

symptoms such as hot flashes, vaginal dry-

ness, pain on intercourse, mood swings,

and weight gain. These symptoms may

also be brought upon by surgery to

remove the ovaries, certain chemotherapy

drugs, and radiation therapy to the pelvis.

Some men with prostate cancer, par-

ticularly those with advanced-stage dis-

ease, may receive therapies that lower can-

cer-fueling testosterone. Examples include

leuprolide and goserelin. While these

drugs have been shown to be effective for

shrinking prostate tumors, the lowered

testosterone levels they produce may cause

a loss of libido, depression, sluggishness,

and even occasional menopause-like

symptoms such as hot flashes. Certain

chemotherapy agents can also reduce

testosterone levels, generating these symp-

toms.

About a quarter of all people with

cancer are likely to feel depressed enough

at some point in the course of their dis-

ease to warrant evaluation and treatment.

Higher rates of depression are observed in

patients being treated for pancreatic,

breast, and lung cancers. Many patients

complain of cognitive impairment, such as

memory lapses and trouble concentrating.

Patients experiencing symptoms of

hormonal changes are encouraged to

speak to the physician who is overseeing

their cancer treatment. As for the choice

of therapy, “that’s a discussion between

the doctor and the patient,” says Dr. Bern-

stein. “It’s important to give people with

cancer a choice, since they may already be

feeling like they have so little control over

what is going on in their bodies.”

Some patients feel more comfortable

starting with medication, while others

may opt for psychotherapy first. Com-

monly used medications include:

➤ antidepressants, some of which havebeen shown not only to help with depres-sion but also relieve symptoms such as hotflashes and night sweats

➤ psychostimulants, which may promotea sense of well-being, decrease fatigue, andimprove cognitive abilities

➤ anti-anxiety drugs

➤ hormone replacement therapy forwomen who are eligible (may not beappropriate for women with breast orgynecologic cancers)

➤ testosterone replacement therapy formen who do not have prostate cancer

Supportive therapeutic approaches that

help many patients include:

➤ individual psychotherapy

➤ group therapy or support groups

➤ online self-help groups, thoughpatients are encouraged to speak to theirphysicians for recommendations aboutreputable Web sites

➤ exercises to improve cognition, such asdoing crossword puzzles or learning a newlanguage

➤ sex and couples therapy for patientsconcerned about their libido

➤ relaxation techniques such as yoga, taichi, and meditation

“You don’t have to go it alone,” con-

cludes Dr. Bernstein. “Help is out there if

you need it.” ■

Hormone Changes During Cancer Treatment?You Don’t Have to Go It Alone

www.nyuci.org

3184W1 4/22/10 9:12 AM Page 10

Registration is required for all events, and seating may be limited. Please call 212-263-2266 or e-mail NYUCIcommunityprograms@nyumc.org for more information and to register, unless otherwise noted.

events calendar

referrals • 212-731-5000

PANCREATIC CANCER LUNCHTIME AWARENESS PROGRAM

Thursday, May 13, 11:00 AM – 12:30 PM, Location A*Description: The exact cause of pancreatic cancer is still largely unknown,but certain factors are known to increase risk, such as age, gender, race, ciga-rette smoking, diet, environment, and family history. But risk factors do nottell us everything. Having a risk factor, or even several risk factors, does notmean that you will get the disease. And some people who get the disease donot have any known risk factors. Learn the latest facts about pancreatic canceras well as recent advances.

Presenters: Howard Hochster, MD, Elliot Newman, MD, Rebecca Yee, MS,CGC (certified genetic counselor), Kimberly Johnke, LMSW, Manager, Publicand Patient Information, The Lustgarten Foundation

A healthy lunch will be provided after the program. This program is co-sponsored with The Lustgarten Foundation, whose mission is to advance sci-entific and medical research related to the diagnosis, treatment, cure, and pre-vention of pancreatic cancer.

GYNECOLOGIC CANCER FOUNDATION’SOVARIAN CANCER SURVIVORS COURSE

Saturday, May 15, 9:00 AM – 4:00 PM, Location A*Description: The Gynecologic Cancer Foundation is pleased to offer thisfree course for all ovarian cancer survivors, friends, family members, andothers who are interested in hearing about ovarian cancer research andpatient care. Experts will share new information about the disease, includ-ing screening and early detection, symptoms, genetics, and clinical trials.Registration/check-in begins at 8:00 AM. Registration for the course willalso be available online at www.wcn.org.

This course is sponsored by the Gynecologic Cancer Foundation and ismade possible through sponsorship support from the NYU Cancer Instituteand the Ovarian Cancer Research Fund. For more information, please callthe Gynecologic Cancer Foundation at 312-578-1439.

WHAT YOU NEED TO KNOW ABOUT THYROID CANCER

Tuesday, May 18, 6:00 PM – 7:30 PM, Location B*Description: Thyroid cancer is the most common endocrine cancer and isone of the few cancers that has increased in incidence in recent years. Itoccurs in all age groups. This program will describe the different types ofthyroid cancer, incidence, risk factors, signs and symptoms, diagnosis, treat-ment options, and prognosis.

Presenters: David Myssiorek, MD, FACS, Kent Parks Friedman, MD, Jennifer Braemar Ogilvie, MD, FACS, Kepal Patel, MD, FACS, Rebecca M.Fenichel, MD

*Locations:

A: NYU Langone Medical Center, 550 First Avenue, Farkas Auditorium B: NYU Langone Medical Center, 550 First Avenue, Alumni Hall A

C: NYU Clinical Cancer Center, 160 East 34th Street, Room 1121 D: NYU Langone Medical Center, 550 First Avenue, Smilow Multipurpose Room

THE AMERICAN CANCER SOCIETY’S MAN TO MAN®PROSTATE CANCER EDUCATION AND SUPPORT PROGRAMDesigned to help men and their families cope with prostate cancer, Man to Man providesa comfortable setting among peers for discussion, education, and support through therecovery process. Spouses, partners, and family members are encouraged to attend.

Thursday, May 27, 5:30 PM – 7:30 PM, Location C*Topic: Complementary and Alternative Medicine for Prostate CancerPresenter: Geovanni Espinosa, ND, L.Ac, CNS, RH (AHG)

Thursday, June 10, 5:30 PM – 7:30 PM, Location C*Topic: Salvage Therapy OptionsPresenter: Stephen M. Scionti, MD

Thursday, July 22, 5:30 PM – 7:30 PM, Location C*Topic: Sexual Health and Fertility After Prostate CancerPresenter: Joseph Alukal, MD

RELAX…IT DOESN’T HURT

Tuesday, June 1, 6:00 PM – 7:30 PM, Location D*Description: Acupuncture has been used in the United States for many years as a treat-ment for chronic muscle pain. Only recently has it been tried as a remedy for other typesof pain, including cancer pain. Cancer patients who are not getting enough pain controlfrom conventional medications may be able to find relief in this ancient Chinese practice.Join us for a discussion about the history of acupuncture and the use of acupuncturewhile being treated for cancer. This program will also include a demonstration.

Presenter: Alex Moroz, MD

THE MANY FACES OF BREAST CANCERSaturday, June 19, 10:00 AM – 12:00 PM, Location A*

Description: The Many Faces of Breast Cancer is coming to New York City. Please join usfor this event, which will explore the unique needs and issues of those living with a can-cer diagnosis and provide the latest information on breast cancer. An engaging panel ofNYU Cancer Institute medical experts, breast cancer survivors, and advocates will discussissues that directly affect 2.5 million breast cancer survivors in the U.S. today, offeringinsights into the latest data surrounding treatment and key survivorship issues.

Please RSVP by calling 1-877-814-9421 or e-mailingManyFacesNewYork@zenogroupevents.com.

DAILY NEWS FREE PROSTATE CANCER SCREENING

Sunday, June 20 – Sunday, June 27Description: For screening locations and dates at the NYU Cancer Institute, please call212-263-2266 or visit www.nyuci.org. Co-sponsored by the Department of Urology.

3184W1 4/22/10 9:12 AM Page 11

The NYU Cancer Institute helps advance the care ofpatients with the most common types of cancer andblood disorders, including those of the:• Breast• Gynecologic Cancers• Gastrointestinal Tract• Genitourinary System (such as prostate cancer)• Neuro-Oncology (including brain cancer)• Lung• Head and Neck• Melanoma• Hematologic Cancers and other blood disorders• Sarcoma• Pediatric Cancers

NYU Clinical Cancer Center160 East 34th StreetNew York, NY 10016

As the principal outpatient facility of the NCI-designat-ed NYU Cancer Institute, the NYU Clinical Cancer Centerserves as home base for our patients and their care-givers. The center and its multidisciplinary team ofexperts provide convenient access to the latest treat-ment options and clinical trials, along with a variety ofprograms in cancer prevention, screening, diagnostics,genetic counseling, and supportive services.

IMPORTANT PHONE NUMBERS

New Patient Physician Referral Line 212-731-5000

Clinical Trials Information 212-263-6485

Mammography and/or Related Procedures 212-731-5002

Lucille Roberts Wellness Boutique 212-731-5198managed by Underneath It All

Lynne Cohen Breast Cancer 212-731-5452Preventive Care Program160 East 34th Street

Lynne Cohen Cancer Screening and 212-263-3198Prevention Project for High Risk WomenBellevue Hospital Center

Stephen D. Hassenfeld Children’s Center 212-263-8400for Cancer and Blood Disorders

100 Women in Hedge Funds 212-731-5345National Ovarian Cancer Early Detection Program

NYU Clinical Cancer Center 212-731-5480Support Group Information Line

Speakers Bureau & Community 212-263-8043Outreach Programs

Media Inquiries 212-404-3555

Office of Development 212-404-3640

NYULMC Office of Communications 212-404-3555

NYUCI Office of the Director 212-263-3276

215 Lexington Avenue, 15th Floor New York, NY 10016

FOR A PHYSICIAN REFERRAL , PLEASE CALL 212-731-5000

NYU Cancer Institute news IF YOU WOULD LIKE TO RECEIVE THIS NEWSLETTER, PLEASE SIGN UP FOR OUR MAILING LIST AT WWW.NYUCI.ORG.

NYU Cancer Institute newsDesign Tanya KrawciwContributing Writer Rosie FosterPhotography Gordon Cook p. 1, Cosmopolitan Magazine p. 8, istock p. 9, 10, 11

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