Surgeons in this section provide the most up-to-date care for breast and endocrine system diseases, melanoma and sarcoma. Faculty seek to advance treatment through leading-edge research. With one of the largest endocrine surgery practices in the country, surgeons also offer expertise in thyroid cancer, adrenal tumors and hyperparathyroidism. Surgical oncologists provide care at Siteman Cancer Center, offering clinical trials that evaluate new therapies. The section provides clinical and research opportunities for general surgery residents, and offers a breast disease fellowship.
Section of Surgical Oncology | 2020 Annual Report
Surgical Oncology faculty lead a multidisciplinary team at the Breast Health Center who diagnose and treat women with breast cancer. Clinical trials advance patient care in breast cancer through innovative technologies, endocrine therapies and personalized cancer vaccines.
Breast surgeon Julie Margenthaler, MD, Professor of Surgery, is Principal Investigator in a clinical trial to improve the visibility of cancer cells at the margin of the tissue removed in breast cancer surgery. The trial, which is a collaborative effort with Professor of Radiology Samuel Achilefu, PhD, from the Mallinckrodt Institute of Radiology, uses Cancer Vision Goggles and a contrast agent called LS301—both developed at the School of Medicine—to obtain real- time intraoperative visualization of breast cancer during surgery.
“The underlying hypothesis is that the accurate detection of all cancer cells highlighted by LS301 during surgery will reduce the number of breast cancer patients with margin positivity to less than 5%, compared to the current surgical paradigm of greater than 20%,” says Margenthaler, President-Elect of the American Society of Breast Surgeons. The group hopes to extend this trial into other solid tumors, including melanoma and pancreatic cancer.
For women ages 70 or older with ER+ tumors and good prognosis (low Ki67 scores), surgery as a definitive treatment may not be necessary. A clinical trial led by Professor of Surgery Rebecca Aft, MD, PhD, investigates whether neoadjuvant endocrine therapies provide adequate local and systemic control of breast cancer for this subpopulation of patients. The trial measures information on patients receiving endocrine therapies using the Functional Assessment of Cancer Therapy – Breast (FACT-B) questionnaire, and analyzes archival tissue to measure risk of recurrence. The results of this trial may lead to a new standard of care for elderly women with good prognosis ER+ tumors.
Vice Chair for Research and Professor of Surgery William Gillanders, MD, has initiated clinical trials combining personalized neoantigen vaccines with current treatment options to prevent recurrence of triple negative breast cancer (TNBC). In this National Institutes of Health-funded research, Gillanders studies immune response to these vaccines, hypothesizing that enhancing T cell response to neoantigens can improve outcomes in patients with TNBC.
Cancer vaccine research extends to include clinical trials in pancreas cancer. In collaboration with the SPORE in pancreatic cancer, Gillanders is evaluating the safety and immunogenicity of a neoantigen DNA vaccine strategy in pancreatic cancer patients following surgical resection and adjuvant chemotherapy.
As clinical trials continue to advance treatment in breast and other cancers, surgeons at the School of Medicine are at the forefront of providing the best individualized patient care.
2020 Highlights
CLINICAL
Katherine Glover-Collins, MD, PhD, brings expertise in breast cancer surgery to Christian Hospital and Siteman Cancer Center North St. Louis County. Glover-Collins is a fellowship-trained breast surgeon with research experience in genetic mutations linked to breast cancer. Many women in North County are diagnosed with late-stage breast cancers due to health disparities in their community. She is addressing these disparities by promoting mammography screening, access to funds for underinsured women and comprehensive cancer care. “If you are a breast cancer patient, you can receive all of the care that you need,” Glover-Collins says. “From surgery to medical oncology and radiation therapy, patients can receive the same excellent care in North County.”
RESEARCH
Surgical oncologists are performing novel research to transform cancer care through scientific discovery. Assistant Professor of Surgical Oncology Beth Helmink, MD, PhD, leads a research laboratory focused on immune response to cancer therapies. Immunotherapies are an important form of cancer treatment, but can trigger autoimmune response in patients. Helmink’s research aims to target this immune response to fight cancer while reducing its impact on the patient’s overall health. Endocrine surgeon Taylor Brown, MD, MHS, researches the deadliest form of thyroid cancer—anaplastic thyroid carcinoma. For his ongoing research, Brown was awarded a research grant from the American Association of Endocrine Surgeons and the Thyroid Cancer Survivors’ Association.
EDUCATION
Endocrine surgeon T.K. Pandian, MD, MPH, is now Rotation Director for Surgical Oncology Medical Student Education. Pandian is developing new initiatives to increase feedback and evaluation of medical students during rotations, as well as a clinical immersion experience in Surgical Oncology. “This is an opportunity to globally immerse medical students in the clinical environment,” Pandian says. To further his goals as a surgeon-educator, Pandian joined the Teaching Scholars Program, a 12-month certificate program designed to enhance knowledge and skills, and develop future leaders in healthcare education with a focus on educational scholarship and curriculum development.
A better understanding of how tumors progress to metastasis could lead to improved methods of diagnosis and treatments of cancer that has spread to other organs, such as the liver or brain.
Two recently published studies outline colorectal cancer evolution from primary tumor to metastasis. These studies are the culmination of cross-disciplinary research between the labs of co-senior authors, Chief of Surgical Oncology Ryan Fields, MD, and Assistant Director of the McDonnell Genome Institute Christopher Maher, PhD.
The first study, published in Nature Communications, led to the discovery of 150 long noncoding RNAs that may contribute to metastasis.
This study analyzed normal tissue, colon tumors and metastatic tumors from the
same patient, finding that a molecule called RAMS11 was associated with metastatic tumor progression and resistance to chemotherapy. Using CRISPR gene editing technology, the researchers turned off RAMS11 in colorectal cancer cells, which caused the cells to become less aggressive.
“There is a significant unmet need in clinical oncology to identify new markers of cancer that can reliably predict and stratify low- and high-risk patients,” Fields says. “This will allow oncologists to move from ‘one size fits all’ to a ‘personalized and precision-based’ approach that will reserve aggressive and higher risk treatments to those who need it most, sparing those who do not need it the unnecessary side effects. We hope to explore further the ability of RAMS11 and other biomarkers to do just that.”
The second study, published in Science Advances, sequences the genome of nearly 100 tumor samples collected from 11 patients with metastatic colorectal cancer who underwent treatments at Siteman Cancer Center. The researchers detailed the heterogeneity of these tumors and reconstructed how the cancer evolved in these patients.
These findings will impact future strategies to target, and ultimately inhibit, the progression of metastases.
“Tumor heterogeneity is a challenge in treatment of advanced colorectal cancer,” Fields says. “The more complex the tumors are, the more difficult to treat them.”
These two companion studies provide novel insights into the biology of colorectal cancer. The ongoing work of Fields and Maher will further explore and validate these findings and may lead to novel diagnostics and therapeutics in solid tumors.