SHATTERING THE GLASS BEAKER - Women Past and Present Have Played Key Roles at Fox Chase
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BROADENING THE CONVERSATION ABOUT CANCER | WINTER/SPRING 2020
SHATTERING THE
GLASS BEAKER
Women Past and Present Have Played
Key Roles at Fox Chase
FORWARD THINKING
P R E S I D E N T ’ S M E S S A G E
MAKING THE UNCOMMON COMMON
F
or many of us, cancer is Chase a culture and a leader who
something familiar. It has helped fuel their drive to contrib-
touched us in some way, ute meaningfully to our under-
whether personally, in our standing of cancer and to achieve
families, or amongst our greatness through their own career
friends or colleagues. One might accomplishments.
consider it a common thing, but to With the help of new drugs
face it takes uncommon strength called immune checkpoint inhib-
and exceptional insight. itors, we are seeing success treat-
Fox Chase Cancer Center is a ing patients in ways we haven’t be-
place where uncommon things fore. In these pages, we share how
happen. Within our institution ongoing research is increasing our
are people who are extraordi- knowledge of the complexities of
nary—patients who carry on the human immune system and
boldly through the seemingly im- how to harness its power to kill donors, and the entire Fox Chase
possible and clinicians, scientists, cancer. In some cases, the positive family, and we look forward to
and staff who do the exceptional to effects of immune checkpoint in- new collaborations on the hori-
help them prevail. hibitor drugs last months to years. zon that will help us get closer to
Our cover story in this issue There is still much work to do. more breakthroughs. Our story
of Forward highlights the role of Right now, only a small number of continues.
women in science, particularly patients’ cancers respond to such
within our Center. In doing so, drugs, but the results give new
it also showcases Fox Chase’s hope for the future.
longstanding inclusion of different It is an exciting time for us at
voices and new ideas in the pursuit Fox Chase. As we have done for
of great science and medicine. decades, we continue to ask new
These female trailblazers exercised questions, test new ideas, and dis-
ingenuity and held close a dedi- cover new ways. We have tremen- Richard I. Fisher, MD
cation to discovery, finding at Fox dous support from our patients, PRESIDENT AND CEO
Forward
EDITORIAL ADVISORY BOARD Joshua E. Meyer, MD Christopher W. McNichol FORWARD magazine is published
Associate Professor, Donald E. Morel, Jr., PhD twice a year for friends of Fox Chase
Judith L. Bachman, MSN, RN, CNAA Cancer Center by the communications
Chief Operating Officer Radiation Oncology Leon O. Moulder, Jr. department of Fox Chase. One of the
WINTER/SPRING 2020
Ryan O’Neill-Moon Donna L. Skerrett, MD leading cancer research and treatment
Jennifer Barsky Reese, PhD centers in the United States, Fox Chase
Assistant Professor, Cancer Prevention Director of Marketing
Patrick McGee LEADERSHIP FOUNDATION BOARD was founded in 1904 as one of the
Editor and Control Program Amanda Purdy, PhD OF DIRECTORS nation’s first cancer hospitals, and
Richard I. Fisher, MD Director, Academic Affairs was among the first institutions to be
Sarah Hughes President and
J. Robert Beck, MD Donald E. Morel, Jr., PhD Chair designated a National Cancer Institute
Editorial Assistant Chief Executive Officer
Chief Academic and Administrative Officer Rosalia Viterbo, MD, FACS, Louis E. Della Penna, Sr. Vice Chair Comprehensive Cancer Center in 1974.
George Beschen Associate Professor, William J. Federici Fox Chase joined Temple University Health
B&G Design Studios Jeremy Moore Department of Surgical Oncology System in 2012.
Design Senior Director of Individual Giving Richard I. Fisher, MD
Senior Director of
Communications Richard J. Bleicher, MD, FACS, BOARD OF DIRECTORS Edward A. Glickman Temple Health refers to the health,
Brilliant Graphics Lewis F. Gould Jr. education and research activities carried
Printing Attending Surgeon, Lewis F. Gould, Jr. Chair
Patrick McGee Thomas W. Hofmann out by the affiliates of Temple University
Breast Cancer Program Leader Health System (TUHS) and by The Lewis
Fox Chase Publications Manager John M. Daly, MD Barbara Ilsen
Lisa Broida Bailey Mary B. Daly, MD, PhD Katz School Temple University School
Cancer Center Inquiries: Margot Wallace Keith of Medicine. TUHS neither provides nor
Cover Director of Donor Relations Ronald R. Donatucci Geoffrey Kent
editor@fccc.edu controls the provision of health care. All
Carolyn Y. Fang, PhD William J. Federici Dan Levin health care is provided by its member
Contributors:
Coleader, Cancer Prevention Edward A. Glickman Philip E. Lippincott organizations or independent health care
Jill Horne providers affiliated with TUHS member
and Control Lon R. Greenberg Solomon C. Luo, MD
COLIN LENTON
organizations. Each TUHS member
On the Cover: Chemist Mary Adelia Bennett (left) working in
Erica A. Golemis, PhD Kimberly D. Hagerich David G. Marshall organization is owned and operated
a lab in 1935. Lori Rink (right), an assistant professor in the Thomas W. Hofmann
Molecular Therapeutics Program, in her lab in 2019. Deputy Chief Scientific Officer Edward J. Roach pursuant to its governing documents.
Larry R. Kaiser, MD Lindy Snider
Anne Jadwin, MSN, RN, AOCN, NE-BC Margot Wallace Keith
Chief Nursing Officer
Thomas R. Tritton, PhD 333 Cottman Avenue,
Robert H. LeFever Philadelphia, PA 19111-2497
Shawn Kleitz Solomon C. Luo, MD foxchase.org
Chief Development Officer David G. Marshall 1-888-FOX-CHASE
Forward WINTER/SPRING 2020
CONTENTS
F E AT U R E S
6 Shattering the Glass Beaker
Women researchers have long played a key role
at Fox Chase Cancer Center. As early as 1946,
four of 10 laboratory heads were women. To
this day, female researchers and physicians who
bridge the gap between the laboratory and the
clinic have continued to play a vital role.
14 Picking the Lock
Cancer can evade the body’s immune system
by tricking it into thinking that cancer cells
are normal. A newer class of drugs called check-
point inhibitors help the immune system
overcome this deception and attack cancerous
cells. The results have been impressive, but the
drugs do not work for all patients.
18 The Unknown Patient
When most people hear the words “breast
cancer,” they think of women, not men. But even
though they are far fewer in number, men do
get breast cancer. The men who have struggled
with diagnosis and treatment say it can be an
isolating experience.
18
D E PA R T M E N T S
26 MAKING A DIFFERENCE: Feet First to Kick Cancer
2 FOCUS: Around Campus In 2009, a group of friends and sports enthusiasts
Fox Chase Nurse Travels to Mozambique for started an annual kickball tournament to fund
Volunteer Work | High School Students Create cancer research. Since then, the Kicking Cancer
Art to Highlight the Cancer Journey of Patients Foundation has raised $375,000.
22 CLOSE-UP: Patient Perspective: 28 REVIEW: News of Note
Faith to Fall Back On Special Events | Honors & Awards | Notable
Angela Shammo found out she had breast cancer Accomplishments
when she was 40 years old and the mother of four
young children. But her faith and excellent 32 REWIND: Hugh Creech: A Fox Chase
medical care got her through. Family Story
Organic chemist Hugh John Creech came to Fox
24 CLOSE-UP: Faculty Perspective: Chase Cancer Center in 1945 and would go on to
A Family of Physicians have a long, distinguished career in pioneering
Mariusz Wasik grew up in Poland as the child of work developing and testing chemotherapy drugs.
CLINT BLOWERS
two physicians. He went to medical school, where His wife also worked at Fox Chase as a researcher,
he met his wife, who is also a doctor. And one of and his son served as a medical oncologist at the
his two daughters is a nurse practitioner. center.
WINTER/SPRING 2020 FOX CHASE FORWARD 1
FOCUS
A R O U N D C A M P U S
FOX CHASE NURSE TRAVELS TO MOZAMBIQUE
FOR VOLUNTEER WORK
A
lthough based in
Philadelphia, Fox Chase
Cancer Center has a global
reputation, a fact borne
out by its many partner-
ships with other cancer centers and
researchers around the world. But
that global reach also extends to vol-
unteer work. Recently, registered
nurse Dana Adamson traveled to
Mozambique with a group of nurses
to provide medical services.
They traveled to Macadeira,
a small rural community, with
a group organized by Nurses for
Africa, which is located in the
“They were unable to
give us anything back,
so instead they prayed
for us. It was extremely
memorable.”
— DANA ADAMSON,
FOX CHASE REGISTERED NURSE
United States but partners with
Hands at Work, a local group of
mission workers in Africa.
The nurses hosted two days
of clinics which involved vital
signs, assessments, and wound
care; people were also prescribed the community.” Fox Chase nurse Dana Adamson with
medications by nurses from more On their other days there, some of the children she met on her
volunteer trip to Mozambique.
developed areas of Mozambique. Adamson said, the nurses did a
During those two days they saw day of teaching for both the care
over 700 people, Adamson said. workers, who are women in the were able to thank the care workers
PHOTO COURTESY OF DANA ADAMSON
According to Hands at Work, community that take care of their in the community for their work
there is “no shortage of challeng- own family plus other families, by giving them large bags of rice,
es” in Macadeira. “Hunger and and the children. They taught two liters of oil, and a bag of salt,
starvation are prevalent, as are hand washing, hygiene, nutrition, things that are extremely difficult
the risks of HIV/AIDS and malar- wound care, seizure care, and for them to even purchase.
ia. Abuse in relationships between burn care. They also distributed “They were unable to give us
husbands and wives and between soap, toothbrushes, toothpaste, anything back, so instead they
parents and children has fostered and other items. prayed for us. It was extremely
a spirit of brokenness throughout On the last day of the trip, they memorable,” Adamson said.
2 FOX CHASE FORWARD WINTER/SPRING 2020
HIGH SCHOOL STUDENTS CREATE ART TO
HIGHLIGHT THE CANCER JOURNEY OF PATIENTS
G
etting diagnosed and through artwork. Helen Gordon, circumstances.”
treated for cancer is easily director of Volunteer Services and Tennent art teacher Rena
the most difficult event co-chair of the art committee, Friedant helped guide the
someone can go through helped get the project approved students through their artis-
in their life. Some patients and implemented. tic journey with help from the
try to understand their struggle Yannuzzi used paper tape on
through words or music. And matboard to depict patient Lainie
sometimes, art created by others Sykes’s place of tranquility.
“While facing cancer,
can play a role. Serrano chose clay as her medium she had a vision
Beyond the Canvas grew out of an and created a large vase depicting of purpose and
outreach effort by Amanda Purdy, various scenes representing the
director of Academic Affairs, and story of patient Judy Bernstein. never lost sight of
Glenn Rall, chief academic officer, Serrano then painted the three that through foggy
at Fox Chase Cancer Center. sides of the vase to illustrate vari-
The CentennialX Student ous aspects of Bernstein’s journey.
circumstances.”
Design program was created by One painting featured the sun — D I R AYA S E R R A N O ,
Ignacio Jayo, a science teacher at shining through clouds. STUDENT ARTIST
William Tennent High School in “The sun shining light behind
Warminster. the clouds represents her ability to Doylestown Art Studio, which
After meeting with Fox Chase shine through cloudy situations,” provided the students with space
staff, two honors art students Serrano wrote of the painting to create the art. When their
at Tennent, Diraya Serrano and and Bernstein’s positive attitude. pieces were done, Serrano and
Tyler Yannuzzi, were chosen to “While facing cancer, she had Yannuzzi were able to showcase
meet with cancer patients and a vision of purpose and never their work at the Women’s Center
interpret the patient journey lost sight of that through foggy at Fox Chase.
THOMAS STEPHANO
WINTER/SPRING 2020 FOX CHASE FORWARD 3
FOCUS
S C I E N C E
GENOMIC DIFFERENCES IN COLORECTAL CANCER
IN YOUNGER PATIENTS MAY HAVE TREATMENT
IMPLICATIONS
T
he incidence of colorectal molecular carcinogenesis affect- Officer and co-leader of the
cancer (CRC) continues to ing genes relevant to treatment Molecular Therapeutics Program
increase in adults under decision-making. Erica Golemis, and other col-
age 50, in contrast to The paper, which was published leagues concluded that, while
stable rates of late-onset in Clinical Cancer Research, is similar overall, there were signif-
disease. To determine if the rise the most comprehensive analy- icant differences in several genes
in early-onset disease reflects a sis of the genomic landscape in relevant to the biology of early-on-
distinct profile of somatic driver young-onset CRC cancer patients set cancer. These differences may
mutations, researchers at Fox that has been reported to date, an- impact response to therapy in
Chase Cancer Center have com- alyzing mutations in over 18,000 young versus old patients.
pared the genomic landscape CRC patients.
of CRC in younger patients to Joshua E. Meyer of the
that in older patients. Their Department of Radiation “Our new study pro-
analysis found differences in Oncology, Deputy Chief Science vides more evidence
that young-onset
colorectal cancers
may arise from
different processes
from those diagnosed
in older patients.”
— JOSHUA E. MEYER,
R A D I AT I O N O N C O L O G I S T
“Colorectal cancer incidence
in younger adults has been
increasing since the mid-1980s
and mortality rates have begun
to increase among this group in
the last decade after multiple
decades of decline. Our new study
provides more evidence that
young-onset colorectal cancers
may arise from different process-
es from those diagnosed in older
patients,” Meyer said.
“Further research is needed
to determine if the differences
in gene alteration rates can be
leveraged to provide personalized
therapies for young patients with
DAN PAGE
early-onset sporadic CRC,” he
added.
4 FOX CHASE FORWARD WINTER/SPRING 2020
BRCA1 GENE REARRANGEMENTS MAY HELP
IDENTIFY PARP INHIBITOR RESISTANCE
N
ew research published in prolonging disease-free survival in mechanism that involves rear-
Nature Communications BRCA-mutated ovarian cancer, but rangement of the BRCA1 gene. The
indicates that BRCA1 eventually the majority of patients consequence of having a mutation
gene rearrangements are will develop drug resistance,” said in this domain is that it causes the
responsible for generating Neil Johnson, associate professor whole protein to become degraded.”
partially active proteins that drive in the Molecular Therapeutics pro- Johnson and postdoctoral fellow
resistance to PARP inhibitors. gram at Fox Chase Cancer Center. Yifan Wang found that when cells
Individuals with BRCA1 muta- Uncovering the biology of drug become resistant to PARP inhibi-
tions are at significantly increased resistance may enable the develop- tors, the BRCA1 gene changes the
risk for developing breast and ment of treatment strategies that way it is arranged in the chromo-
ovarian cancers. Women who prevent resistance from occurring some. That leaves behind the BRCT
develop BRCA-mutated cancer may altogether and potentially help iden- domain mutations that are causing
benefit from treatment with PARP tify which patients are most likely to the whole protein to get degraded.
inhibitors, drugs which block an benefit from PARP inhibitors. “Now, it does not get degraded.
enzyme involved in certain cell Johnson’s lab is focused on how It is stable and it can contribute to
functions, including the repair of BRCA1 mutations might develop the repair of DNA damage. Because
DNA damage. resistance. “We found that a it repairs DNA damage, it also
“PARP inhibitors have been group of BRCA1 mutations in the promotes resistance to the PARP
shown to be very effective at BRCT domain have a particular inhibitor.”
FINDINGS MAY POINT THE WAY TO MODULATING
EGFR INHIBITOR RESPONSE
U
nderstanding how tumor lung, colorectal, and brain cancer. of the Cancer Epigenetics Program.
cells become resistant to Blocking EFGR can slow the growth “Our data suggests that if we
drugs used to treat them is of cancer cells. target these epigenetic modifiers
one of the greatest challeng- Amplification is a double-edged we can dial up or down EGFR am-
es faced by cancer research- sword. Although it makes drugs plification and, in turn, modulate
ers. In a new study, researchers the associated drug response. We
from Fox Chase Cancer Center believe that this could provide a
describe how cancer cells use The researchers more homogeneous cell popula-
epigenetic mechanisms to control believe their findings tion, which might result in more
amplification of a critical cancer consistent response to drugs
gene that impacts cell proliferation
provide a basis for targeting the pathway,” Whetstine
and drug response. The researchers developing novel said. The research was published
believe the findings provide a basis drugs or combinations in Cancer Discovery.
for developing novel drugs or com- “We showed that copy num-
binations of drugs. of drugs. ber is druggable by targeting the
EGFR (human epidermal epigenetic factors involved, which
growth factor receptor) is found in targeting that gene more effective, has significant clinical impli-
normal cells and in high levels in prolonged treatment with EGFR cations. Therefore, we can turn
some types of cancer cells. EGFR inhibitors can reduce the copies of levels of copy gains up or down,
DNA amplification tends to occur EGFR, leading to drug resistance, and in return, change responses to
in hard-to-treat cancers such as said Johnathan R. Whetstine, head growth factors and drugs.”
WINTER/SPRING 2020 FOX CHASE FORWARD 5
the The lab of organic chemist Gerrit Toennies in the Wanamaker building on the Lankenau Hospital campus in 1935. Shown left to right are Peg Elliott, Toennies, Theodore Lavine, and Mary Adelia Bennett.
Women Past and Present Have Played Key Roles at Fox Chase
I
n 1989, Mary Daly came to Fox Chase Cancer Center with a medical degree and a doctorate in
epidemiology, both of which she obtained when her three children were young.
When Daly joined Fox Chase, she met Scientific Director Anna Marie Skalka, who had come
to the center in 1987. “That was pretty interesting. I mean, for a woman to be in charge of all
these men doing research,” Daly said. Unbeknownst to Daly at the time, Fox Chase had a long
history from its beginnings of women scientists playing leading roles in its labs and clinics.
In fact, as early as 1946, four of the institute’s 10 laboratory heads were women. And female re-
searchers and physicians who bridge the gap between the laboratory and the clinic have continued to
play a role in the achievements of Fox Chase to this day.
BY PATRICK McGEE
WINTER/SPRING 2020 FOX CHASE FORWARD 7
Shattering the Glass Beaker
In 1927, Stanley P. Reimann, a physician, and Frederick could only work part time while pursuing her doctorate. She
Hammett, a biologist and biochemist, founded the was also caring for an invalid mother.
Lankenau Hospital Research Institute, which later mor- Her accomplishments include many journal publications
phed into the Institute for Cancer Research before merg- throughout the 1940s and 1950s in general biochemistry.
ing with the American Oncologic Hospital. The end result Some of that work included preparation of various liver
is what is now known as Fox Chase Cancer Center. extracts that led to the isolation of vitamin B12. She was also
The two men had what seemed to be an odd premise to the recipient of the Robert McNeil Fellowship.
many of their fellow scientists and clinicians at the time: To
learn about cancer and the abnormal cell growth that define BENEFIT OF GEOGRAPHY
it, it was necessary to study the normal growth and develop-
ment of cells. They were ridiculed by many for the direction PHILADELPHIA, WHERE FOX CHASE IS LOCATED, HAS LONG
of their “so-called” cancer research. been a center for scientific and medical education and
The two did something equally unusual—they hired a research. The first medical school in the United States
number of women as researchers at a time when research opened in 1765 at the College of Philadelphia and eventual-
labs were dominated by men. ly evolved into the University of Pennsylvania’s Perelman
This history was not accidental. In 1927, Reimann laid out School of Medicine. Scientists and physicians have long
a strategy for the type of research to be done and the people used the city as a starting point or a home base for their
who would execute it. He wrote endeavors.
that the approach was “one in “The fact that a woman could
which a large problem is adopted get a PhD degree and then get a
with a diverse staff to attack the “I also thought that this job was really different than in
problem by way of various disci-
plines and techniques.”
would be a place where other parts of the world,” said
Marilyn Bailey Ogilvie, profes-
This “diverse staff” included you could flourish as a sor emeritus in the Department
a number of women researchers of the History of Science at the
who would go on to long, dis- person running a University of Oklahoma. She is
tinguished careers and become
leaders in their fields. According
small independent coeditor of “The Biographical
Dictionary of Women in Science,”
to “Growth: A History of the laboratory that explored and the author of several books on
Institute for Cancer Research,” the history of women in science.
Reimann’s confidence in the abili- creative ideas.” Another unique thing was that
ties of women as researchers “was women researchers at Fox Chase
— ERICA GOLEMIS, DEPUTY CHIEF
perhaps one of the major factors were being paid the same as their
SCIENCE OFFICE, FOX CHASE
that contributed to his success in male counterparts. In a 1985
CANCER CENTER
spreading knowledge of cancer interview, Patterson said, “There
and in weathering the many crises was no discrimination whatsoever.
PREVIOUS PAGE: PHOTO COURTESY OF FOX CHASE CANCER CENTER ARCHIVES
he encountered in establishing Salaries were the same.”
the Lankenau Hospital Research Institute on a firm footing.” Ogilvie said that pay equity is “very surprising” for its
The history was written by Elizabeth Patterson, who was time. She also noted that generally, once women got into the
recruited by Reimann in 1944 after earning her doctorate at laboratory, they trained other women to do the same work.
Bryn Mawr College. “That’s the pattern that I’ve seen,” she said. That pattern of
handing scientific knowledge down would recur throughout
REIMANN’S FIRST ASSISTANT the history of Fox Chase, with one generation of women
researchers passing their knowledge along to the next.
THE FIRST RESEARCHER THAT REIMANN HIRED WAS MARY As the staff continued to grow, more women were brought
Adelia Bennett, who became his assistant. She started on board, including Grace Medes, who earned her doctorate
working part time with him in 1921, and he encour- in zoology at Bryn Mawr in 1916. Before coming to the insti-
aged her to pursue graduate studies at the University of tute in 1932, she taught at Vassar and Wellesley and was an as-
Pennsylvania, where she received a doctorate in physiolog- sistant professor of medicine at the University of Minnesota,
ical chemistry in 1926. where she became known for her work in biochemistry.
“Dr. Bennett’s early years at the laboratory in some ways Despite her credentials, Reimann had a hard time con-
mirror the stresses of women scientists to obtain their vincing his colleague Hammett to take her on, and he was
academic degrees and their independence at that time,” not helped much by the negative feedback he was getting
Patterson wrote. Bennett lived on very little money since she from some of her colleagues at Minnesota. One wrote that
8 FOX CHASE FORWARD WINTER/SPRING 2020Margie Clapper (left), deputy chief science officer, and Mary Daly career in which she developed mouse models that allowed
(right), director of the Risk Assessment Program, discuss the scientists to identify links between development and cancer
genesis of colorectal cancer in this 2009 photo.
(see “Seeking Answers to Big Questions,” page 10).
although she was “a worker and cooperative,” she was also BRIDGING THE GAP
“eccentric as all hell.”
But Reimann remained undaunted, and wrote to AS RESEARCHERS LIKE GLUSKER AND MINTZ WORKED IN
Hammett that Medes wanted to work at the institute the confines of their labs, others like Daly were working
because she believed “we are doing the best work in the to bridge the gap between the research lab and the clinic.
country.” He went on to press his case in a later letter to After earning her doctorate from the University of North
Hammett: “I just know we are going to get much good work Carolina at Chapel Hill (UNC), Daly got a job in public
from Grace Medes…. I shall back her to the limit.” health, but became frustrated because she realized she
Once again, Reimann was on the mark, as Medes went on didn’t understand the diseases she was studying. “I knew
to a long and distinguished career, culminating in 1955 with how to design the studies and do the statistics, but I didn’t
the Garvan Medal (now the Garvan-Olin Medal) from the know the physiology of those diseases. So I figured at this
American Chemical Society for her work. She and Reimann point I had to go to medical school,” she said. Daly received
co-authored a book, “Normal Growth and Cancer.” her medical degree from UNC as well.
During Medes’ late career at Fox Chase, two other female After an oncology fellowship, she knew she wanted to in-
PHOTO COURTESY OF FOX CHASE CANCER CENTER
researchers appeared on the scene who would play a key role tegrate her oncology and public health experience. “There
in groundbreaking work. One, Jenny Pickworth Glusker, weren’t many jobs that matched my vision. That is, I didn’t
arrived in 1956 after training with a Nobel Prize-winning want to be someone who just did clinical trials in medicine.
scientist (see “A Way to Continue Working,” page 13). In I wanted to bring in my epidemiology experience and look
1960 geneticist Beatrice Mintz began a long and illustrious at prevention.”
She was brought to Fox Chase as the associate director of
the Cancer Control Science Program by a pioneer in preven-
Read More About Women in Science
To read full-length profiles of women in science and tion, Paul Engstrom. She also brought her interest in genetics
research at Fox Chase Cancer Center, go to with her. “I started a makeshift genetics high-risk program,
www.foxchase.org/about-us/history/women-science. probably a year or two after coming here. It eventually blos-
somed into what is now the department of clinical genetics.”
WINTER/SPRING 2020 FOX CHASE FORWARD 9Shattering the Glass Beaker
ALREADY AN ACCOMPLISHED CAREER
BY THE TIME SHE ARRIVED AT FOX CHASE, THE WOMAN
who had impressed Daly so much, Ann Skalka, already had
an accomplished career. She spent 18 years at the Roche
Institute of Molecular Biology, a basic research institu-
tion funded by the pharmaceutical company Hoffmann-
LaRoche. She started as an assistant professor, immediately
after postdoctoral training with Nobel laureate Alfred
Hershey, and eventually rose to assistant vice president and
head of the department of molecular oncology.
Skalka’s parents were immigrants who worked at a produc-
tion plant for the pharmaceutical company Pfizer located in
Williamsburg, Brooklyn. Pfizer offered part-time summer
jobs to the children of employees, and that is how Skalka was
first exposed to a working laboratory while in high school. The
SEEKING ANSWERS group she was assisting was experimenting with the use of
various plant materials as possible screens for drug toxicities.
to the BIG QUESTIONS In a short memoir that was published in the scientific
journal Annual Review of Virology, Skalka wrote that during
Geneticist Beatrice Mintz came to Fox Chase in 1960 that time she “discovered that science could be fun and sci-
with a doctorate in zoology from the University of Iowa, entists could be both interesting and kind.” In an interview,
time spent teaching at the University of Chicago, and an she said her career benefitted by being in large urban areas
interest in asking what she called “big questions.” In her like New York and Philadelphia, where the idea of a woman
research, she developed mouse models that allowed sci-
scientist did not seem as foreign as it may have in other
entists to identify links between development and cancer.
parts of the country.
Her work, for which she received numerous awards,
also allowed scientists to explore the biology of cancer Skalka went on to get a doctorate in microbiology from
over an animal’s lifetime. She is widely recognized as New York University Medical School and become inter-
a pioneer in the field of developmental genetics and its nationally known for contributions to understanding how
relation to cancer biology. retroviruses replicate and insert their genetic material into
“Dr. Mintz’s scientific insights have led to new direc- the host genome. Although the most well-known retrovirus,
tions in developmental cancer biology and genetics,” HIV, causes AIDS, many retroviruses cause cancer in ani-
Margaret Foti, chief executive officer of the American mals and some cause cancer in humans. Skalka’s work has
Association for Cancer Research, said in 2012 when greatly informed the study and treatment of both diseases.
Mintz received the organization’s award for Lifetime
Achievement in Cancer Research. “Her groundbreaking
RECOGNIZED ROLE MODELS
work has helped shape our understanding of stem cell
behavior and the tumor microenvironment in cancer, and
A YEAR BEFORE SKALKA CAME TO FOX CHASE, MARGIE
has provided scientists with important tools to study the
many types of cancer.” Clapper arrived, fresh from getting her doctorate in genet-
In 2011, Mintz was awarded the 6th Annual Szent- ics and cell biology from the University of Connecticut at
Györgyi Prize for Progress in Cancer Research from the Storrs. Clapper grew up on a dairy farm in upstate New York
National Foundation for Cancer Research. The organiza- and was intrigued by the intricacies of biological systems
tion said it awarded the prize for her discoveries of the early in life. Her undergraduate laboratory experience at the
PHOTO COURTESY OF FOX CHASE CANCER CENTER
relationship between development and cancer, which State University of New York at Oneonta shaped her future
were based on her development of various mouse models career path.
of cancer. Her work has enabled the study of cancer and After completing the requirements for veterinary school,
other genetic diseases in whole organisms.
she instead accepted a research opportunity as a technician
“This was the first successful work of its kind,” Mintz
in the laboratory of Norman Klein at UConn. Klein, focused
said in a 2009 interview regarding work with mouse em-
bryos. “Very few labs at the time were attempting to per- on identifying the causes of abnormal embryonic develop-
form experiments on mammalian embryos. That required ment, quickly recognized her potential and encouraged her to
new technology. I came from a do-it-yourself family—you enter the doctorate program. Her work revealed that anticon-
didn’t buy things that you could make—and I enjoyed the vulsants can induce birth defects in the offspring of mothers
fact that I had to work out everything myself.” with epilepsy. In 1986, she began to apply her drug-related
expertise to cancer as the first postdoctoral fellow in the
10 FOX CHASE FORWARD WINTER/SPRING 2020Ann Skalka, who came to Fox Chase in 1987 with nearly 20 years lead clinical studies that help advance therapeutic options
of experience as a cancer researcher, focuses on the link between for patients.
retroviruses and cancer.
In addition to clinical studies, von Mehren is very in-
volved in translational research with a laboratory-based
newly formed Pharmacology Department at Fox Chase and partner. Originally joining Fox Chase in 1993 for a fel-
has remained a leading researcher at the institution. lowship in medical oncology, von Mehren is now physi-
“With the opening of the Phase I clinical unit adjacent to cian director for the Clinical Trials Office and associate
our lab came unique opportunities to test new experimental director for clinical research. One of the several forms of
therapies in patients with advanced-stage disease,” said cancer she has done research on is gastrointestinal stro-
Clapper. “Our ability to obtain biological specimens in real mal tumors (GIST).
time from these courageous patients—literally bench to bed- Some of that research is a collaboration with Lori Rink,
side—is an early example of what we now know as transla- an assistant professor in the Molecular Therapeutics
tional research.” Program. Rink, who got her doctorate in molecular biology
According to Clapper, it helped to have internationally at Temple University, came to Fox Chase in 2006 and
recognized role models like Glusker and Mintz already here has stayed to focus her research on GIST, a rare can-
when she arrived. “The message from all of them was that cer, and Gleevec, a drug approved by the Food and Drug
you have to work hard and stick up for what you believe,” said Administration in 2002 to treat GIST.
Clapper, who was recently named the Samuel M.V. Hamilton Prior to Gleevec, the only option for patients with GIST
PHOTO COURTESY OF FOX CHASE CANCER CENTER
Chair in Cancer Prevention. She has also been co-leader of was surgery, so the drug has changed the lives of many
the Cancer Prevention and Control program for the past patients. But for most, it eventually stops working, and
decade and is a deputy chief science officer. Rink and von Mehren want to understand why. They have
received large grants to investigate the problem and have
CLINICAL AND TRANSLATIONAL RESEARCH also identified genetic markers that could predict how pa-
tients will respond to Gleevec. They are also investigating
ALTHOUGH MUCH RESEARCH AT FOX CHASE IS LABORA- using a combination of drugs to attack GIST.
tory- based, the mission of a comprehensive cancer center Prior to working with von Mehren, Rink had another
also embraces clinical research across multiple areas of on- mentor, but he took a position elsewhere, just as Rink re-
cology. Respected faculty, including Elin R. Sigurdson, Lori ceived a prestigious five-year grant. The first two years of
Goldstein, Elizabeth Plimack, and Margaret von Mehren, the grant required a mentor for training, so Rink turned
WINTER/SPRING 2020 FOX CHASE FORWARD 11Shattering the Glass Beaker
to von Mehren and Erica Golemis, chair of the Molecular Sanjeevani Arora of the Cancer Prevention and Control Program
is researching the effectiveness of treatments for colorectal cancer.
Therapeutics Program. She is shown here at the microscope used to identify the Philadelphia
“I’m very grateful for both of them because you wonder chromosome at Fox Chase in 1959, the first conclusive evidence
what you’re going to do next once the person you’ve trained linking cancer and genetics.
under has left,” she said. “Meg was very supportive and
said, ‘I’m happy to stand in there as your mentor. I know that cause aggressive tumor growth, as well as research
you can do this.’ She had a strong belief that I could eventu- aimed at improving the use of clinical agents that can selec-
ally run the lab.” Rink now has two graduate students and a tively target tumors.
postdoctoral fellow in her lab. In her time at Fox Chase, Golemis has worked with dozens
Rink said she feels very lucky having successful scien- of graduate students, postdoctoral fellows, and clinical fellows.
tists such as von Mehren and Golemis in her corner. “I get Golemis said she was attracted to Fox Chase because it seemed
two different perspectives, that clinical perspective from like it had a very collegial environment, where time spent PHOTO COURTESY OF FOX CHASE CANCER CENTER (CARDONI)
Meg, which is really, really important for a translational mentoring the next generation of scientists would be valued.
scientist, but also, some of the nitty gritty in terms of what “I also thought that this would be a place where you could
methods or analyses to use from Erica.” flourish as a person running a small independent laborato-
Golemis has a long history of working with up- and-com- ry that explored creative ideas,” she said. She was also im-
ing researchers. She arrived in 1993 following an under- pressed by Skalka, who was the scientific director when she
graduate degree at Bryn Mawr College, a doctorate from the was first hired. “I thought Ann Skalka was a fantastically
Massachusetts Institute of Technology, and postdoctoral inspirational leader, a brilliant scientist, and a role model.”
training in molecular biology and genetics at Massachusetts
General Hospital and Harvard Medical School. THE NEXT GENERATION
In addition to being a deputy chief science officer and
leader of the Molecular Therapeutics Program, she is also FOX CHASE HAS NEVER RESTED ON ITS LAURELS AND ITS
the William Wikoff Smith Chair in Cancer Research. She is commitment to women in science remains. While the
well known for her work in studying errors in cell signaling institution recognizes the numerous challenges women
12 FOX CHASE FORWARD WINTER/SPRING 2020face, it has implemented important programs, including
guest lectures led by women, scientific colloquiums with
strong women representatives, mentorship programs, ac-
ademic interest groups, and career development events.
Director of Academic Affairs Amanda Purdy oversees a
training program that is noteworthy for its gender and
ethnic diversity.
Among the newest members of the Fox Chase faculty, and
one of the beneficiaries of those programs, is Sanjeevani
Arora, an assistant professor in the Cancer Prevention and
Control Program. She thinks as highly of Golemis as
Golemis does of Skalka. After her previous mentor left
Fox Chase, Arora began working with Golemis. “If not
“Dr. Bennett’s early
years at the laboratory
in some ways mirror the A WAY TO CONTINUE
stresses of women WORKING
scientists to obtain their Jenny Pickworth Glusker was born in Birmingham,
England. Both her parents were doctors. After several
academic degrees and years of practicing medicine and having three children,
Glusker’s mother Jane stayed home to raise them. When
their independence she wanted to return to practice, the system in place in
at that time.”
England at that time would not allow her to compete with
other doctors in the area.
— FROM “GROWTH: A HISTORY OF THE
“She was very frustrated that she could not continue with
a career that she had put so much energy into,” Glusker
INSTITUTE FOR CANCER RESEARCH”
wrote in a memoir that she penned for the American
Crystallographic Association, an organization she once
served as president. “For this reason, I decided that I would
find a way to continue working, even if I had children.”
for her encouragement, I don’t think I would be doing
She did that and much more.
what I’m doing. I think she saw something in me and
Glusker went to Somerville College, one of the wom-
really helped me move forward.” en’s colleges at Oxford. The person who interviewed her
One aspect of Arora’s research focuses on ways to for admission to the program and who she would do her
determine the effectiveness of treatments for colorectal graduate work with was Dorothy Hodgkin, who would
cancer, with the ultimate goal of more individualized go on to win the Nobel Prize in Chemistry in 1964 for
treatment and preventing some patients from being confirming the structure of penicillin and determining the
treated unnecessarily. Clapper is one of her mentors for structure of vitamin B12.
that research. Following a postdoctoral fellowship with Nobel prize
PHOTO COURTESY OF FOX CHASE CANCER CENTER
In addition to her work in the lab, Arora also founded chemist Linus Pauling at the California Institute of
a professional development and networking group for Technology, Glusker came to Fox Chase Cancer Center in
1956 after being hired by Stanley P. Reimann, one of the
women in science at Fox Chase in 2013. The group invites
founders of Fox Chase. “There were quite a lot of women
speakers in to discuss their career paths and challenges.
that he brought along,” Glusker said. “He went out of his
“There are challenges that I’ve faced when I’ve worked way to make me feel welcome.”
on projects, and it’s been hard to move things forward During her time at Fox Chase, Glusker’s work with X-ray
sometimes. But having the right kind of mentorship has crystallography included the determination of the struc-
helped,” Arora said. tures of numerous antitumor agents and chemical carcin-
For Arora and her many female colleagues on the Fox ogens, as well as investigating the structures and possible
Chase faculty, respect for facing such challenges is certainly mechanisms of action of several biological enzymes.
well deserved.
WINTER/SPRING 2020 FOX CHASE FORWARD 13PICKING
THE
CHECKPOINT INHIBITORS HELP IMMUNE
SYSTEM IN CANCER BATTLE
J
ohn Lens, 76, a retired teacher from New Jersey, does
not know many of the details of the immunotherapy
treatment he underwent for his Stage 4 urothelial
cancer, upper urinary tract cancer that had begun to
spread to his kidney. He leaves that to his wife, Iride.
What he does know is that the drug, an immune checkpoint
inhibitor called pembrolizumab, and his team at Fox Chase
Cancer Center, saved his life.
“They deserve a Nobel Prize,” he said.
As a matter of fact, an American and a Japanese research-
er shared the 2018 Nobel Prize in Physiology or Medicine for
their discovery of cancer therapy by inhibition of negative
immune regulation. Their work directly led to the devel-
opment of the class of drugs called checkpoint inhibitors,
of which pembrolizumab (Keytruda) is one, which have
significantly improved the treatment of a variety of cancers
over the last decade.
BY LEAH LAWRENCE
ILLUSTRATION BY BRIAN STAUFFER
14 FOX CHASE FORWARD WINTER/SPRING 2020Picking the Lock
“We all have an immune system, and its job is to recognize immunotherapy as a cure for bladder cancer.”
and kill certain things in the body, such as infections or can- After an exhaustive search, their doctor found one trial for
cers,” said Daniel M. Geynisman, a medical oncologist at Fox John’s rare type of cancer at Fox Chase.
Chase who specializes in genitourinary cancers. “One of the The trial was called KEYNOTE-052 and it investigated the
hallmarks of cancer growth is that some cancers are able to use of pembrolizumab in patients with bladder cancer who
evade the immune system.” were ineligible to receive a typical standard-of-care chemo-
The body’s immune system has mechanisms that tell it to therapy called cisplatin.
shut off or lock the door when a “job” is complete and there is “In order to receive cisplatin, you have to have good
no more work to be done. Cancers can take advantage of that kidney function, and with one kidney left, John’s function
system by giving off similar signals. was not adequate to receive that drug,” said Matthew R.
“Immunotherapy using checkpoint inhibitors is de- Zibelman, a medical oncologist at Fox Chase who enrolled
signed to reinvigorate the immune system by blocking John in the trial.
those signals and reminding the body to attack the cancer,” The trial would ultimately lead to Food and Drug
Geynisman said. Administration approval of pembrolizumab for patients like
John with locally advanced or metastatic urothelial cancer
who could not handle cisplatin. Of the participating patients,
FINDING A TARGET
T
about 29 percent saw their disease respond to the treatment,
he first checkpoint inhibitor for cancer was approved but it is not yet known how long that effect will last.
in the United States in 2011. Ipilimumab (Yervoy) If John had not enrolled in the trial at Fox Chase, he would
targets a switch on immune cells called CTLA-4. This have begun chemotherapy that day in June 2016, getting in-
first approval was based on a clinical trial that showed fusions every two to three weeks for as long as it seemed to be
the drug extended the life of patients with metastatic controlling his cancer, Zibelman said. If his cancer stopped
melanoma by about four months. It was the first drug to ever responding, he would have been switched to a different
extend the survival of patients with metastatic melanoma. chemotherapy.
Pembrolizumab targets a different pathway on immune “After first-line treatment, there weren’t clear approved
and tumor cells called PD-1/PD-L1. Pembrolizumab and a chemotherapy options for patients like John,” Zibelman said.
multitude of other PD-1/PD-L1 inhibitors are now available to “The chances of benefit of the drugs we used were low, in the
treat nearly a dozen types of cancer. 10 percent to 20 percent range, and the average survival was
John was lucky enough to be the last person enrolled in a about one year.”
clinical trial testing pembrolizumab in his type of cancer, Instead, John received two years of pembrolizumab
gaining him access to the drug before it was approved in 2017. through the clinical trial and elected to continue treatment
Seemingly healthy, John was on a school trip to Costa Rica for another year after the drug was approved. Now, more than
in January 2016 with his wife and some of her students when three years from his diagnosis, John’s scans show no evidence
he first noticed blood in his urine. Upon returning home, he of active disease.
scheduled an appointment with his urologist, who performed
a urine lab test. He was diagnosed with upper urinary tract
TOO GOOD TO BE TRUE?
P
cancer that had begun to spread to his kidney.
John immediately underwent surgery to remove one of his eople like John are among the lucky ones though,
kidneys and ureters, the tube that passes urine from the kid- Geynisman pointed out. The number of people whose
ney to the bladder. “After the surgery they told us, ‘Everything disease will respond to checkpoint inhibitors varies
looks great!” Iride Lens recalled. depending on the type of cancer, as well as a variety of
The PET scan at John’s follow-up visit in June 2016 other disease and patient characteristics.
revealed, however, that his cancer had spread to his lymph “It varies greatly, but I would say on average about a quarter
nodes and appeared aggressive. It was Stage 4. of patients eligible for treatment will respond,” Geynisman
They were devastated by the diagnosis but buckled down said. “It is still only a minority.”
and began to do as much research as they could. Then they For example, in advanced non-small cell lung cancer,
saw a question on the cover of Time magazine that caught recent data from another trial of pembrolizumab showed that
their attention: “What if your immune system could be taught about 23 percent of patients who received no prior treatment
to kill cancer?” That story focused on the promise and chal- responded and were still alive five years after diagnosis.
lenges of immunotherapy. “In lung cancer, we have never had this type of data for clin-
“Soon after, we had an appointment with our local oncolo- ical efficacy at five years,” said Hossein Borghaei, a medical
gist to have a port put in so that John could begin chemother- oncologist at Fox Chase. In fact, prior to the immunotherapy
apy,” Iride said. “While we were there, we asked the doctor era, the five-year survival rate for non-small cell lung cancer
if there was any doctor or hospital nearby working with was closer to five percent.
16 FOX CHASE FORWARD WINTER/SPRING 2020“IT IS GOING TO TAKE US LONGER TO TOXICITIES AND COST
T
he types of side effects that occur with che-
TRULY BE ABLE TO MANIPULATE THE motherapy differ from those associated with
IMMUNE SYSTEM IN FAVOR OF GETTING immune checkpoint inhibitors, but Geynisman
stressed that it is important to remember that
RID OF CANCER WITHOUT CAUSING A some side effects, even sometimes fatal side
LOT OF SIDE EFFECTS, BUT EVERYBODY effects, can occur.
“As the immune system gets activated to attack the can-
SHOULD STAY TUNED. IT IS GOING TO cer, it can get confused and attack normal, healthy body
GET EVEN MORE EXCITING IN THE parts as well,” Geynisman said. “This can include anything
from the skin to the thyroid, to major organs like the lungs
NEXT FIVE TO 10 YEARS.” or liver.”
In some cases, these immune-related adverse events
— HOSSEIN BORGHAEI, MEDICAL ONCOLOGIST
can be mild and can be managed with only observation or
treatments like topical creams for rash.
But not every type of cancer is responding to immune However, in some patients these side effects can be
checkpoint inhibitors the way that lung and urothelial can- severe. There have been cases of inflammation of the heart
cers are. There is probably a combination of factors, mainly where high-dose steroids and other immunomodulatory
related to the type of tumor and the particular patient, that drugs had to be administered quickly. Research has also
affect how well these drugs work. shown that some of these immune-related events can occur
Despite only a small percentage of patients responding, the months to years after people have stopped taking immuno-
reason many researchers are so excited about immune check- therapy drugs, so patients who take the drugs need to keep
point inhibitors is that of those patients that do respond, the an eye out for such delayed side effects.
responses are durable and can last months to years. That is Currently available checkpoint inhibitors can have a
why there is so much research being done to help identify price tag averaging about $150,000 a year. The amount a
people who will respond and to find ways that may allow more patient pays will vary depending on whether or not they
people to respond. have health insurance and on the type of insurance. “These
drugs are extraordinarily expensive,” Geynisman said,
emphasizing that cost is a generally underemphasized and
SEARCHING FOR CLUES
B
understudied question.
orghaei and colleagues Edna Cukierman and John, who elected to stay on pembrolizumab for an ad-
Kerry S. Campbell codirect the Immune Monitoring ditional year after the clinical trial, said his treatment was
Facility for Immunotherapy at Fox Chase. Staff at covered by Medicare and supplementary insurance he had
the facility work with scientists and clinicians to from being a teacher.
perform studies called immune phenotyping on Some patients are kept on the drugs indefinitely,
blood, bone marrow, tumor, or lymph node samples taken Zibelman said. “Because each clinical trial testing these
from patients with cancer. types of drugs was slightly different, no one knows the
“We can look at samples taken before treatment, during answer to how long patients need to stay on them.”
treatment, and after treatment to see whether a patient’s Slowly, researchers are beginning to think that when
immune system has been activated,” said Campbell. immune checkpoint inhibitors are successful, people can
For example, in patients assigned to immune checkpoint likely try to stop taking them. In cases where people have
inhibitors, one thing scientists are trying to figure out is had to stop immunotherapy treatment because of im-
how to identify patients that will respond prior to starting mune-related side effects, many continued to respond even
the treatment. “It would also be useful to know if there are after treatment was stopped, Zibelman said. “We are only
immune checkpoint molecules other than CTLA-4 or PD-1/ beginning to ask those questions,” he added.
PD-L1 that appear on cells during treatment that can be Research on immune checkpoint inhibitors and other
used as targets for future immunotherapies or combina- immunotherapies is exploding. “We are only just begin-
tions of immunotherapies,” Campbell said. ning to appreciate the complexity of the immune system
In addition to identifying patients who will respond to and its relationship to tumor progression,” Borghaei said.
immune checkpoint inhibitors, this type of research could “It is going to take us longer to truly be able to manipulate
also identify those who will not. This information could help the immune system in favor of getting rid of cancer with-
clinicians to move patients to more effective therapies sooner out causing a lot of side effects, but everybody should stay
in the course of their treatment and spare them any possible tuned. It is going to get even more exciting in the next five
side effects of immunotherapy. to 10 years.”
WINTER/SPRING 2020 FOX CHASE FORWARD 17Male Breast Cancer Can Be An Isolating Experience
W
hen people hear the words “breast cancer,” they likely envision
pink ribbons. Maybe they think about a woman they know who had
the disease. Maybe they are “that” woman. Chances are, however,
they don’t think about men.
But last year, about 2,700 American men experienced something like
what happened to Thomas Spoltore. Right after Christmas in 2017, the
then-72-year-old barber was showering when he noticed what he thought
was a pimple on the right side of his chest.
He decided to ignore it, figuring it would go away. But as the days and
weeks passed, it didn’t. It got bigger. Spoltore’s wife suggested he see his
family doctor, who recommended further consultation. Spoltore made an
appointment at Fox Chase Cancer Center. A mammogram and ultrasound
confirmed he had breast cancer.
“My initial reaction was shock,” Spoltore said. “I truly did think the odds
were in my favor and there would not be a cancer diagnosis. It was hard to talk
about initially, since I was not aware of anyone I knew with male breast cancer.”
BY ABBEY J. PORTER
PHOTO ILLUSTRATION BY CLINT BLOWERS
18 FOX CHASE FORWARD WINTER/SPRING 2020The Unknown Patient
While men don’t have breasts in the same sense that women
do, everyone—male and female—has breast cells and tissue
“Men and their health care
that can become cancerous. Breast cancer in men is relatively providers need to know that they
rare: Only 1 in 1,000 men will be diagnosed with the disease,
versus 130 in 1,000 women. Breast cancer in men usually are at risk for developing breast
develops as a hard lump beneath the nipple and areola.
Most cases of breast cancer in men are infiltrating ductal
cancer and they need to be
carcinoma, or IDC, in which cells in and around the milk vigilant for new breast
ducts (yes, men also have milk ducts) begin to invade sur-
rounding tissue. Breast cancer carries a higher mortality symptoms and changes.”
rate in men than in women, partly because men are less — ALLISON A . AGGON, SURGICAL ONCOLOGIST
likely to suspect a lump of being cancerous, which can cause
a delay in treatment.
That was the case with Spoltore, who waited a month or of a protein (HER2) that makes cancer spread quickly.
more before seeing a doctor about the growth on his chest. Trastuzumab (Herceptin) is one of the drugs that has been
Once he had been diagnosed, Fox Chase surgical oncologist approved to treat breast cancer that has spread to other areas
Allison A. Aggon gave him a choice: have the tumor removed of the body. It stops HER2 from making cancer cells grow.
and undergo radiation, or have a mastectomy. Spoltore opted
NEW ATTITUDES, NEW OPTIONS
I
for the mastectomy.
t used to be that male breast cancer patients were nearly
TREATMENT AT A GLANCE
T
always given a mastectomy. But attitudes toward, and
he large number of female breast cancer patients options for, the treatment of breast cancer in men have
has allowed for extensive study of the disease—and changed in recent years, noted Richard J. Bleicher, a surgical
its treatment—in women. However, the disease has oncologist and leader of the Breast Cancer Program.
not been studied much in men because of the relatively small The attitude used to be that there was “no value in saving
number of male patients. “Historically, we’ve always extrap- what little breast a man has,” Bleicher said. “Men would wind
olated our experiences with women to treat men,” said Mary up with a scar across the chest.” Recently, however, a trend
Daly, a medical oncologist specializing in genetics. “But there has developed, at Fox Chase and elsewhere, to conserve the
very well could be differences in responses to chemotherapy breast in male patients.
agents that we really don’t know.” Bleicher said that when it comes to caring for breast cancer
With that said, treatments for male and female breast can- patients, survival is the primary goal. “Regardless of whether
cer patients are generally the same. Many men benefit from a you’re male or female, the number one priority is to get rid of
combination of approaches, such as: the tumor and maximize survival. Number two is to maximize
SURGERY: Options consist of a mastectomy, in which the the cosmetic outcome.”
entire breast is removed, or breast-conserving surgery, also Bleicher said that for male patients, the survival rates for
called a lumpectomy, in which just the tumor is taken out. lumpectomy plus radiation or chemotherapy are on par with
RADIATION THERAPY: Patients may have treatment those for mastectomy. And for many, the former may be pref-
with radioactive rays or particles after surgery to help kill off erable. That’s because, generally speaking, men care about
any cancer cells that were missed. If the cancer is inoperable, what they look like posttreatment.
radiation may be the primary treatment. “Men do have the desire to have a cosmetically less disrup-
CHEMOTHERAPY: With this treatment, the patient is tive outcome,” Bleicher said. “Men care if there’s a cosmetic
given drugs, either orally or by injection, that attack the can- difference, if the nipple and areola are removed.” Although
cer cells. He may have chemotherapy after surgery to lower the breast does not hold the same sexual significance for men
the risk of the cancer coming back. For men with advanced that it does for women, “there needs to be a recognition that
cancer or cancer that has spread to other parts of the body, men are cosmetically aware, in many cases, and they also
chemotherapy may be the primary treatment. don’t want disfigurement,” he added.
HORMONE THERAPY: Some types of breast cancer need He minimizes cosmetic deformity in his patients using
certain hormones to grow. Hormone therapy blocks the oncoplastic techniques, surgical approaches that combine ad-
effects of those hormones, stopping the growth of the cancer. vanced plastic surgery with surgical oncology. For instance, if
It’s often more successful in men than in women because a large lumpectomy is required that will leave the breast dis-
more men, about 90 percent, have hormone-receptor-posi- torted, the remaining tissue is sculpted to realign the nipple
tive cancer. For men with advanced cancer, hormone therapy and areola and restore a natural appearance to the breast. The
may be the primary treatment. opposite breast is also modified to create symmetry. In the
TARGETED THERAPY: Some men have an excess end, it’s often difficult to tell that the patient ever had surgery.
20 FOX CHASE FORWARD WINTER/SPRING 2020You can also read
