Emerging Issues in Cancer Control:

The Perspective from

The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

Martin D. Abeloff, M.D.

Director – SKCCC

November 12, 2003

A Comprehensive CancerCenter Designated by theNational Cancer Institute

N ICCCC

THE SIDNEY KIMMEL COMPREHENSIVE CANCER CENTER

AT JOHNS HOPKINS

Mission To decrease the mortality and morbidity from

cancer To excel in cutting edge basic, clinical and

translational research

To provide the full range of highest quality, affordable, preventive, diagnostic, and therapeutic services

To be a leader in education To demonstrate respect and provide support

for faculty and staff while fulfilling the Center’s mission

Research AccomplishmentsThe Sidney Kimmel Comprehensive

Cancer Center at Johns Hopkins

Elucidation of the molecular steps in the development of colon cancer

Identification of markers of risk for development of cancer

Therapies for prevention of cancer

Research AccomplishmentsThe Sidney Kimmel Comprehensive Cancer

Center at Johns Hopkins - (continued)

Discovery and development of new anti-cancer therapies including drugs, vaccines, and bone marrow transplantation

New approaches to supportive and palliative care

Cancer Center Membership by Departments (253 Members*/27 Depts.)

Medicine4%

Rad Onc3%

Other10%

Oncology39%

Public Health8%

Pathology14%

Surgery17%

Radiology5%

Other includes: Anes, Bio Eng, Comp Med, Derm, Microbio, Mol Bio, Neur, Peds, Pharm, Phy, Radiol, SON

*18 Pending

NormalSmall

Adenoma CancerLargeAdenoma

Metastasis

APC/-catenin

TGF-RII/Smad4 p53K-Ras PRL-3

Chromosomal or Microsatellite

InstabilityVogelgram – early detection

30 to 40 years

Problems with DetectingAPC Mutations in Fecal DNA

1. Human DNA small fraction of fecal DNA

2. APC mutations are heterogeneous

3. Mutant APC genes <1% of WT genes

4. Contaminants in feces

Problems Comparison with widely used screening tests

Mammography

Sensitivity

75-88%

Specificity

83-98%Pap Smear

65-80%

90-98%

PSA 40-60% 88-94%

APC/fecal DNA 70% >99%

CA Cancer J Clin 2003;53:5-26

Decrease in UK and USA Breast Cancer Deaths from 1987 to 1997

Decrease in death rate per 100,000 women (Age Group)

20-49 50-69 70-79 UK 22% 22% 12% USA 19% 18% 9%

“This substantial reduction in national mortality rates has come not from a single research breakthrough but from the careful evaluation and adoption of many interventions, each responsible on its own for only a moderate reduction in breast cancer mortality”

Peto et al:Lancet 2000:355:1822

Trends in Breast Cancer in Five-Year Survival Rates (%) by Race and Year of

Diagnosis 1974-1998

1974-76 1983-85 1992-98

White 75 79 88

African-American 63 63 73

All Races 75 78 86

Key Factors Leading to Changes in Management of Breast Cancer

Marked increase in understanding of biology of breast cancer (molecular and cellular biology)

Development of clinical research centers, networks, infrastructure, and methodologies

Improvements and innovations in surgery and radiation therapy

New drugs and combinations: cytotoxic, endocrine, targeted biologic therapies

Patient autonomy Patient advocacy movement

The Future of CancerResearch and Care

Greater emphasis on prevention

Changes in life style – nutrition, exercise,

tobacco, alcohol

Chemoprevention

Screening and early detection

Molecular markers

Molecular imaging

Molecular targeting of cancer as basis of therapy and prevention

The Future of CancerResearch and Care (cont.)

Multimodality therapy will continue to be central theme

Incremental gains Not simply a biomedical challenge –

Societal imperatives! Integration with State initiatives in

particular the State cancer plan

MD Cancer Plan Chapter 13:

Cervix Cancer

Objective 6 Conduct a follow-back study to determine

factors that contribute to women developing or dying from invasive cervical cancer….

Establish and maintain mechanisms to monitor the proportion of cervical cancer cases and deaths attributable to failures of detection….

CRF Research Grants atThe Sidney Kimmel Comprehensive Cancer

Center at Johns Hopkins

Connie Trimble: Center for Cervical Studies– Proportion without timely screening– HPV status follow-up– Case management– Vaccine development

Kristen Kjeruff: Racial Disparities among Cervical Cancer Patients– Patient characteristics– Treatment outcomes

MD Cancer Plan Chapter 8Environmental Health and Cancer

Objective 2 – Improve data collection and carcinogen exposure assessment

Objective 3 – Enhance collaboration between academic research institutions and State and local public health departments

CRF Research Grants atThe Sidney Kimmel Comprehensive Cancer

Center at Johns Hopkins

Tim Buckley and Tom Burke: Cancer Prevention in Maryland through Risk Characterization– Identify environment-related cancers– Quantify human risk from monitoring data– Test correlations and calculate environmental

contribution to cancer occurrence– Tracking projects with MD health officials underway

Anthony Alberg: The Joint Influence of Active and Passive Smoking on Cancer Incidence– Quantification of active and passive smoking risks in a

western MD population