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Steven J. Burakoff, MD, Director, The Tisch Cancer Institute, and the Lillian and Henry M. Stratton Professor of Cancer Medicine

WINTER 2015 www.icahn.mssm.edu/tischDIRECTOR’S REPORT

The Tisch Cancer Institute

This new initiative—under the leadership of Robert Maki, MD, PhD, FACP, Steven Ravitch Chair in Pediatric Hematology-Oncology, and Professor of Medicine, Pediatrics, and Orthopaedics—represents Mount Sinai’s first step in developing an in-depth analysis of each cancer patient. Our goal is to uncover valuable information on mutations among key driver genes and alterations to signaling pathways, which will lead to effective, individualized treatments.

The Mount Sinai Health System diagnoses more than 9,000 new cases of cancer each year. Patients with common tumors will be tested against a genetic mutation panel recognized for its ability to predict treatment outcomes for various types

Accelerating Science — Advancing Medicine

The Mount Sinai Health System will expand genomic sequencing and analysis this year, enabling oncologists to analyze a much broader population of cancer patients with the most up-to-date tools.

of cancer. While all cancers will not be tested initially, most patients with breast, colon, and lung cancer will be sequenced. The plan is to steadily grow the panel and build a sophisticated database of genomic information.

Genomic sequencing at Mount Sinai will be a collaborative effort among Dr. Maki’s team of scientists and those of Carlos Cordon-Cardo, MD, PhD, Irene Heinz Given and John LaPorte Given Professor of Pathology, and Chair of Pathology; Janina Longtine, MD, Vice Chair of Molecular Pathology and Genetics; and Eric Schadt, PhD, Jean C. and James W. Crystal Professor of Genomics, and Director of the Icahn Institute for Genomics and Multiscale Biology.

A world-class research program that promises to transform the treatment of graft-versus-host disease (GVHD)—a serious complication of bone marrow transplantation in which the donor’s immune cells attack the recipient’s body—is being led by James Ferrara, MD, DSc, Ward-Coleman Chair in Cancer Medicine, and Director of the Hematologic Malignancies Translational Research Center.

At its core is a new diagnostic test that was developed by Dr. Ferrara and a multicenter team of researchers, which predicts a patient’s response to GVHD treatment.

A New Era for Bone Marrow Transplantation

Together, these groups will quantitatively analyze and identify associations among vast amounts of data from genomic testing and electronic medical records. By examining DNA alterations in cancer, the gene sequencing initiative is expected to contribute to better care and outcomes for cancer patients across the Mount Sinai Health System.

James Ferrara, MD, DSc

Using several cutting-edge proteomic techniques, the team discovered three plasma biomarkers (TNFR1, ST2, and Reg3 alpha), which led to a grading system to calculate patient responsiveness.

“People with low-risk GVHD are often overtreated, exposing them to significant side effects, while those

with high-risk GVHD are often undertreated, allowing the disease to progress,” says Dr. Ferrara. “Our new scoring system provides for a personalized approach to transplantation so that each patient gets the right treatment at the right time.”

Equally important, the scoring system is paving the way for a new generation of clinical trials that will test investigative agents for the prevention and treatment of acute GVHD. Dr. Ferrara’s ultimate goal is to reduce mortality from the disease by 50 percent over the next ten years.

Recently, Dr. Ferrara created a consortium of ten major stem-cell transplant centers in the United States and Europe—the Mount Sinai Acute GVHD International Consortium (MAGIC)—to advance the science, which, until now, has changed little in more than 40 years. The consortium expects to launch a clinical trial later this year, making it the first to treat GVHD using the biomarker grading system.

TH E TI SC H CAN C E R I N STITUTE DIRECTOR’S REPORT | WINTER 2015

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Triple negative breast cancer is an outlier in the world of breast cancers, as it lacks the three receptors (estrogen, progesterone, and HER2), and in many cases does not respond to treatment.

At the Mount Sinai Health System, nationally renowned researcher Charles Shapiro, MD, Professor of Medicine, and Co-Director of the Dubin Breast Center at The Tisch Cancer Institute, is advancing the study of triple negative breast cancer.

“Around half of the women with early-stage triple negative breast cancer are cured with standard chemotherapy, while the other half will develop metastatic disease and die

Enlisting the Body’s Immune System in the War Against Lymphoma

Examining the Recurrence of Triple Negative Breast Cancer

An innovative new vaccine that mobilizes the body’s immune system to shrink tumors in patients with low-grade B-cell lymphoma has met with encouraging results in a clinical trial at The Tisch Cancer Institute at the Mount Sinai Health System. Of the study’s first five patients, one experienced a complete remission, another had a partial remission, and the remaining three had stable disease.

The vaccine is produced in each patient when two immune-modifying medicines are administered directly into a tumor, combined with two days of localized, low-dose radiotherapy. The first medicine mobilizes special immune cells (dendritic cells) to the tumor site, where they sample pieces of dying tumor cells after radiotherapy. The second medication activates the tumor-loaded dendritic cells, which then teach the effector arm of the immune system (T-cells) to recognize and eliminate tumor cells throughout the body.

Traditional treatments such as chemotherapy and radiation enable patients to live with low-grade B-cell lymphoma, but do not cure the disease.

“We’ve helped a lot of people, but immune-based therapy has the potential for even better outcomes,” says Joshua Brody, MD, Director

Joshua Brody, MD

Charles Shapiro, MD

within five years,” says Dr. Shapiro. “I want to gain a more thorough understanding of the differences between these breast cancers that are sensitive and resistant to chemotherapy.”

In collaboration with researchers at the Icahn Institute for Genomics and Multiscale Biology, Dr. Shapiro is currently

evaluating the gene mutations and pathways of the sensitive and resistant cancers.

“This may lead to a better understanding of the biology of triple negative breast cancer and may potentially identify new drug targets and novel therapies,” he says.

of the Lymphoma Immunotherapy Program at Icahn School of Medicine at Mount Sinai, and the first researcher to use the new dendritic cell mobilizing medicine as a treatment for lymphoma. “Our patients find this especially exciting because, in a sense, they’re creating their own anticancer therapy, as opposed to just passively receiving therapy, as with standard treatments.”

Sergei German, a patient enrolled in the trial, notes that the treatment is an “opportunity to treat lymphoma using immunotherapy without resorting to harsh chemotherapy. It’s like teaching our bodies to fight cancer the

same way they fight mumps.” The side effects, Mr. German reports, have been very mild, similar to those of a flu vaccine for which he’d typically take a pain reliever, like acetaminophen.

The Tisch Cancer Institute trial—soon to number 30 patients—is being funded by a $750,000 Clinical Investigator Award from the Damon Runyon Cancer Research Foundation. Dr. Brody recently presented the study’s preliminary data at annual meetings of the American Society of Hematology (ASH) Lymphoma Biology, the American Association for Cancer Research (AACR) Tumor Immunology, and the Society for Immunotherapy of Cancer (SITC).

In addition to his translational research, Dr. Shapiro serves as Director of Survivorship at The Tisch Cancer Institute, where he is drawing upon his extensive background in cancer survivorship to build a comprehensive program at Mount Sinai.

“I am very excited about developing the Cancer Survivorship Program throughout the Mount Sinai Health System,” says Dr. Shapiro. “There were nearly 14.5 million cancer survivors in the United States in 2014, and that number is expected to increase to 19 million by 2024. That is a testimony to our success in early detection by cancer screening, improved treatments, and supportive care. Equally important is addressing the consequences of cancer treatment and empowering survivors to chart their own paths to optimal health and well-being.”