AS SEPTEMBER IS NATIONAL Ovarian Cancer and Prostate Cancer Awareness Month, COMMERCE presents this special section, which features the latest advances in treatment and disease management, as well as patient success stories. While medicine has come a long way, ovarian cancer ranks fifth as the cause of cancer death in women and prostate cancer is the second leading cause of cancer death in men, according to the American Cancer Society. What follows are treatment updates and real-life experiences of the medical professionals serving on the front lines against these deadly forms of cancer.
Atlantic Health System, Morristown Medical Center, Overlook Medical Center
By Nana E. Tchabo, M.D., FACOG, Gynecologic Oncology, Carol G. Simon Cancer Center
Ovarian cancer is the leading cause of mortality among gynecologic malignancies. Unfortunately, the majority of cases are diagnosed at an advanced stage. Despite an initial response, most of these patients develop a recurrence and subsequent resistance to chemo-therapy. I am a Gynecologic Oncologist at the Atlantic Health System Carol G. Simon Cancer Center at Morristown Medical Center and Overlook Medical Center. Over the past nine years, it has been my sincere honor and pleasure to participate in the care of many remarkable patients, including Marilyn Thorne. Mrs. Thorne is an 87-year-old female with stage IIIC BRCA negative ovarian cancer who had optimal cytoreductive surgery on Sept. 23, 2015. She completed six cycles of dose dense Docetaxel and monthly Carboplatin with dose reductions in May 2016. She tolerated therapy well and has been without evidence of recurrent disease. She continues to play and teach piano, swim, and be an ever-present matriarch to a loving and nurturing family. Her husband of 67 years attends every one of her surveillance appointments and their love and commitment to one another is palpable. She continues to inspire me to investigate novel therapeutics.
Bayonne Medical Center, CarePoint Health
By Devrajan Iyengar, M.D., Chairman, Oncology Dept., Cancer Liaison Physician
For Diane Billingsley of Bayonne, 2004 and 2005 were stressful years. The bloodwork her primary doctor ordered uncovered fibroid tumors, which necessitated a hysterectomy. The surgery was successful, and all but one of the tumors were benign. However, that one tumor also indicated something else: the possibility of ovarian cancer. She was in an advanced stage. I ordered six months of chemotherapy during the first half of 2005, knowing that two thirds of women with Billingsley’s diagnosis—even with successful chemotherapy— will not survive, succumbing to a relapse of that cancer or a related one within the next three to five years. But 13 years later, Billingsley, now 75, is cancer free and enjoying life. She credits the accurate diagnosis, quick action and teamwork of her Bayonne Medical Center-affiliated physicians.
Englewood Health, Englewood Hospital
By Mazyar Ghanaat, M.D., Director, Urologic Oncology
Over the past two or three decades, a combination of technological advancements and increased knowledge have allowed not only for the improvement in detection of prostate cancer, but also a decrease in overtreatment of the disease. One of the major additions to the field is the multiparametric MRI, which led to the creation of the MRI/ultrasound fusion biopsy. Random systematic biopsies of the past can miss some harmful tumors and, in some cases, detect inconsequential, low- grade cancers. MRI fusion biopsies combine MRI findings with real-time ultrasound images and allow for precise targeting of suspicious areas. Studies have proven this technique improves our ability to detect and localize significant prostate cancer. Our goal is to use this technology to eliminate needless surgeries, invasive tests, wasted efforts and allow us to more accurately inform our patients about their options. At Englewood Health, we perform the systematic biopsy in conjunction with the new, targeted fusion biopsy to optimize effective cancer treatment.
Hackensack University Medical Center, Hackensack Meridian Health
By Michael Stifelman, M.D., Chair of Urology; Director of Robotic Surgery, Urologic Oncology, John Theurer Cancer Center; Professor and Chair of Urology, Hackensack Meridian School of Medicine at Seton Hall University
Hackensack University Medical Center’s Urology Department leads the way in the comprehensive treatment of prostate cancer, offering patients a range of options including advanced diagnostics and radiotherapy, innovative gene therapy and robotic surgery. The Prostate Cancer Program at John Theurer Cancer Center is one of New Jersey’s largest and features a multidisciplinary team that employs the latest advances to develop personalized treatment plans. Several factors place Hackensack in a leadership role in treating prostate cancer, including fusion guided biopsies that combine MRI and ultrasound imaging to more precisely detect the disease and pinpoint areas for treatment; active surveillance, which leverages genomic testing, to closely monitor cases that do not require immediate treatment; focal therapy that uses targeted techniques—such as cryosurgery or high-intensity ultrasound—to destroy cancer within the gland while sparing healthy tissue; immunotherapy, including the only state approved Advanta-Gene therapy trial designed to harness the body’s immune system in fighting the cancer in patients undergoing radiation or on active surveillance; and robotic surgery, which lessens pain, blood loss and recovery time. More than 5,000 robotic prostate surgeries were performed at the center over the last decade.
Holy Name Medical Center
By Sharyn N. Lewin, M.D., FACS, FACOG, Director, Division of Gynecologic Oncology, Patricia Lynch Cancer Center
At the Patricia Lynch Cancer Center at Holy Name Medical Center, our gynecologic oncologists treat patients with cancer by focusing on the unique medical and emotional needs of each woman. We know all of our patients personally and spend time with them going over the best treatment plan for them. We use advanced technology—such as the daVinci® robotic surgical system and minimally invasive procedures—to perform complex surgery for ovarian cancer and related conditions. We also use targeted therapies that help stop cancer cells from growing, and HIPEC, which delivers heated chemotherapy directly to cancer cells in the abdomen. Research has shown that HIPEC often achieves better results than traditional IV therapy. Many of our patients participate in clinical trials that offer them innovative new treatments. At the Cancer Center our entire team follows our patients for the rest of their lives so that we can help them improve their quality of life. We encourage them to use integrative therapies, such as acupuncture, massage, and nutrition therapy, which help patients feel and heal better. We also advise patients who are at high risk for developing ovarian cancer and other related cancers to consider genetic testing and counseling for themselves and their family members so that they can take steps to prevent the disease.
Jefferson Health—New Jersey
By Robin Wilson-Smith, M.D., Medical Director, Gynecologic Oncology Services, Sidney Kimmel Cancer Center
Ovarian cancer is the leading cause of gynecologic cancer death in women. More than 22,000 women in the United States are diagnosed annually with ovarian cancer. Unfortunately, more than 14,000 of these women will die, largely because ovarian cancer often shows no signs, and goes undiagnosed until it has progressed to an advanced stage. To significantly improve the currently unfavorable prognosis of women diagnosed with advanced stage ovarian cancer, the development of new treatment methods is imperative. In recent years, there have been significant advancements in cancer treatment for gynecologic cancers. Immunotherapy is a treatment that uses the body’s own immune system to help fight cancer. It is currently being used to target specific genetic alterations in tumors, which results in helping the immune system eliminate the cancerous tumor. Specific treatment combinations using immunotherapy are being studied in clinical trials. Some of the combinations have been successful in treating other types of cancer, which may make them promising options in the treatment of ovarian cancer, as well.
Jersey Shore University Medical Center, Hackensack Meridian Health
By Verda Hicks, M.D., FACS, FACOG, Chief, Gynecologic Oncology; Medical Director, Gynecologic Oncology, Hackensack Meridian Health Cancer Care in Monmouth, Ocean and Middlesex Counties
Identifying women who are at high risk for certain reproductive system cancers can be a critical piece of information gained during genetic testing. At Jersey Shore University Medical Center, women will now have access to a new one-stop clinic for assessment of risk for ovarian, breast or fallopian tube cancers, as well as associated intestinal malignancies. Cancer specialists at Jersey Shore University Medical Center are opening a specialty clinic this fall, combining their joint expertise in the areas of gynecologic, breast and gastro-intestinal cancers. This coordinated approach provides a standard of care, assessment and management techniques for screening and, if indicated, prophylactic services. Should a cancer be identified, the team is then able to provide immediate counseling and planning for treatment. For individuals who may develop cancer, these experts take a multifaceted approach to treating gynecologic cancers in a holistic environment, which enables the team to provide customized solutions for cancers that will benefit each patient’s physical and emotional recovery. Through collaboration with a highly skilled multidisciplinary team—and the patient—a comprehensive and personalized treatment plan is created. Treatment options include chemotherapy, radiation delivered by state-of-the-art technology systems and advanced surgical procedures.
Rutgers Cancer Institute of New Jersey
By Lorna Rodriguez, M.D., Ph.D., Chief of Gynecologic Oncology; Professor of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School
A patient of mine, Dee Sparacio, was diagnosed with stage IIIB ovarian cancer in 2005. She underwent a hysterectomy and had chemotherapy as part of her treatment, and she also took part in a phase I clinical trial at Rutgers Cancer Institute of New Jersey to determine the effectiveness of the trace mineral selenium on ovarian cancer. The cancer recurred in 2008, and Mrs. Sparacio underwent surgery followed by chemotherapy. She finished treatment in 2009 and has been cancer free since. This former high school teacher is now a patient advocate who helps educate others about ovarian cancer. It has been more than a decade since this patient took part in the selenium clinical trial. Science has rapidly advanced since then. Along with high-tech advances such as robotic surgery offered at Rutgers Cancer Institute, in conjunction with Robert Wood Johnson University Hospital (an RWJBarnabas Health facility), cutting-edge treatments in the form of vaccine and immunotherapy and precision medicine clinical trials are helping patients with advanced stage ovarian and other cancers have treatment alternatives they didn’t have 10 or 12 years ago.
Saint Barnabas Medical Center, RWJBarnabas Health
By Alison Grann, M.D., Chair, Dept. of Radiation Oncology
The department of radiation oncology at Saint Barnabas Medical Center (SBMC) treats patients using the most advanced technology. With the addition of CyberKnife, the world’s first and only robotic radiosurgery system, we can treat prostate cancer patients with laser-like precision in five treatments, instead of 40-45 treatments with conventional therapy. CyberKnife is painless, safe and effective. The reduction in treatment time is because of its ability to target the tumor in real time with continual image guidance, while delivering a high dose safely. Additionally, the Radiation Oncology Department at SBMC is the first hospital in the area to utilize the SpaceOAR® System for prostate cancer patients. While radiation treatment has become more targeted, one of the biggest risks of radiation therapy of the prostate is injury to the rectum due to its proximity. The SpaceOAR® System is a temporary hydrogel spacer that’s injected between the rectum and prostate to increase the area between the two. The gel doesn’t interfere with treatment but acts as a barrier. It re-mains in place for up to six months, after which it’s reabsorbed into the body. The SpaceOAR® has been found in clinical trials to reduce damage to the rectum and minimize other side effects.
Saint Peter’s University Hospital
By Gopal Desai, M.D., Chair, Radiation Oncology
Chester Janusz was a lifelong educator who was enjoying retirement with his wife Priscilla. The two led an active lifestyle which included frequent travel, especially a love for cruising. Blessed with good health for most of his life, Chester was “a bit shocked” to learn he had prostate cancer. His urologist referred him to me. After reviewing Mr. Janusz’s medical history, I felt strongly that he was a candidate for CyberKnife® Robotic Stereotactic Radiosurgery. CyberKnife delivers beams of high-dose radiation with pinpoint accuracy in a manner that minimizes damage to surrounding healthy tissue. Its popularity with patients is due to the fact that it offers a non-invasive option, allowing individuals to avoid surgery. The procedure is also painless, without side effects and is performed in only five treatments rather than the traditional 40 treatments. After receiving three treatments (out of the required five), Chester turned to me and asked if I could be sure the procedure was working because he was not experiencing any pain or discomfort. My response was that it was in fact working, something that I was able to confirm after seeing that his PSA (prostate-specific antigen) levels had begun to decrease. Since concluding treatment, I am pleased to report that Chester has resumed his regular activities.
Valley-Mount Sinai Comprehensive Cancer Care
By Ephrain S. Casper, M.D., Chief Medical Officer
The latest advances for the diagnoses and treatment of prostate cancer include a new radiation treatment option for selected patients called stereotactic body radiotherapy (SBRT). Prostate SBRT involves the delivery of a complete course of radiation therapy in just five short treatments, allowing patients to continue their normal activities without the interruption of a traditional nine-week course of treatment. Clinical trials have demonstrated excellent results in terms of disease control with very low risks of long-term, treatment-related side effects. In addition, patients receiving radiation therapy for prostate cancer are now being offered an innovative new technology called SpaceOAR® hydrogel. The gel-like material temporarily moves the rectal wall away from the prostate during radiation therapy, decreasing the amount of radiation that the patient’s rectum receives during prostate treatments, which can reduce complications associated with radiation therapy. We are also proud to offer a new technology that allows for more a more precise diagnosis of prostate cancer. It’s called fusion-guided biopsy; and Valley is proud to offer the UroNav Fusion Biopsy System to its patients. This system fuses pre-biopsy MRI images of the prostate with ultrasound-guided biopsy images in real time, so that suspicious areas can be precisely targeted.