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Patient with melanoma receives tumor-infiltrating lymphocyte therapy

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Vanderbilt-Ingram Cancer Center has treated its first patient in a newly launched therapy program that magnifies the power of a person’s natural defense system against tumors. 

Tumor-infiltrating lymphocyte (TIL) therapy involves isolating the white blood cells from a tumor after it is surgically removed, expanding the magnitude of those cells in a laboratory, and then infusing them back into the patient to elicit a more powerful counterattack. The highly personalized treatment is currently approved for patients with advanced stages of melanoma whose tumors have grown despite immunotherapies and/or targeted therapies. 

The patient who received the therapy in late January has melanoma that has spread to the bone, abdomen, liver and brain despite multiple lines of other treatments. A team of clinicians harvested white blood cells from a tumor in the patient’s liver, then shipped them to a laboratory where they were supercharged before being infused back into the patient, who is being monitored. Additional patients are scheduled to receive TIL therapy. Vanderbilt-Ingram launched the program as a standard of care service line after previously treating patients with TIL therapy in clinical trials. 

“The mission of Vanderbilt Health is to get treatments that are cutting-edge to the patients who need them the most,” said Olalekan Oluwole, MBBS, MPH, associate professor of Medicine and a hematologist who specializes in cellular therapies. “Some of these patients have exhausted prior standard of care options.” 

About a third of patients who receive TIL therapy respond to it. 

“On the surface that doesn’t sound like a lot, but the great thing about TIL therapy is when it does work, it can lead to long-term durable response. It can keep right on working for years or even indefinitely,” said Douglas Johnson, MD, MSCI, professor of Medicine and clinical director of melanoma, who holds the Susan and Luke Simons Directorship. 

Establishing the TIL program required assembling a team of multidisciplinary clinicians trained to handle the care needs of patients while simultaneously handling the logistics of getting their white blood cells shipped to a laboratory. 

Sarah Moseley, BSN, RN, the coordinator for immune effector cell and gene therapy patient care, led that process. She described the process of navigating care for patients who receive TIL therapy, which involves surgeons, oncologists, hematologists and specialized nurses. 

“I am with the patient from start to finish,” Moseley said. “Once a patient is identified by Dr. Johnson, he immediately gets me involved. The patient has to be approved by our cell therapy team and our surgery team as well as Dr. Johnson to make sure that they’re a good candidate. The next step is the insurance process, which is probably the hardest part because this is a new and expensive therapy. It is a detailed process involving our financial team, our managed care team and us nurses as well.” 

The nurses serving as patient care coordinators also include Leslie Mader, BSN, RN, OCN, and Brittney Baer, BSN, RN.  

“I or one of my nurse colleagues go to the surgery, and we transport the specimen from the operating room to the processing lab, where a courier picks it up,” Moseley said. “Without the specimen, there is no product for the therapy. It has to be done quickly, and it must be done right every time. Then we get the patients set up for cell infusion after about five to six weeks.” 

The launch of the TIL program is the latest achievement in cellular therapies for Vanderbilt-Ingram, which is an international leader in the field. The cancer center offered clinical trials for therapies, which became standards of care, most notably CAR-T, which is shorthand for chimeric antigen receptor T-cell therapy. Vanderbilt-Ingram established an outpatient protocol for patients to receive CAR-T and treats more patients with this immunotherapy than any other provider in the state. It is offering clinical trials to expand the treatment for additional types of cancer and to make it more easily accessible to patients. 

“The launch of our TIL program represents a natural and important evolution of Vanderbilt-Ingram’s leadership in cellular therapy,” said Ben Ho Park, MD, PhD, the Benjamin F. Byrd Jr. Professor of Oncology, professor of Medicine and director of Vanderbilt-Ingram Cancer Center. “Building on the infrastructure, clinical expertise and multidisciplinary coordination established through our CAR-T program, we are now able to offer another highly personalized immunotherapy to patients with otherwise limited options. Our goal is not only to deliver these complex therapies safely and effectively, but also to continue advancing the science so that more patients, across more cancer types, can benefit in the years ahead.” 

Clinicians with the cellular therapy team built the TIL program on the foundation of the CAR-T program. However, there are major differences between these treatment modalities. With CAR-T, immune cells are reengineered to attack cancer from the T cells in a patient’s blood. With TIL therapy, white blood cells are taken from a patient’s tumor and are then multiplied so they can stage a better counterattack against cancer. 

Currently, CAR-T is approved by the Food and Drug Administration only for certain blood cancers. TIL therapy is approved only for advanced melanoma when patients have not responded to other treatments. However, clinical trials are underway to expand the therapies for other types of cancers.  

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Vanderbilt Health celebrates milestone for novel histotripsy procedure 

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Vanderbilt Health recently performed its 100th histotripsy, a noninvasive procedure in which highly focused ultrasound waves are directed at liver tumors to destroy cancer without ever making an incision. 

The recipient, Aaron Davis of Cleveland, Tennessee, had just celebrated his 52nd birthday days before the procedure and was surrounded in the Vanderbilt University Hospital operating room by a surgical team he’s come to greatly admire. 

Sekhar Padmanabhan, MD, assistant professor of Surgery, performed the procedure, in which a tub of water held over Davis’ abdomen served as the medium through which the ultrasound waves passed. In histotripsy, the focused ultrasound energy causes small gas bubbles in the tissue to rapidly expand and contract. This process forms a “bubble cloud,” forcing the targeted tumors to be liquified while avoiding damage to other tissue. 

“Histotripsy is a novel procedure, but one that shows a great deal of promise,” said Padmanabhan. “Thanks to generous philanthropic support, we’re building a world-class program to continue offering this technology to patients who can benefit from a noninvasive surgical option that yields excellent results.”  

Vanderbilt-Ingram Cancer Center is among the first institutions to offer histotripsy. Appealing to patients for its noninvasive nature, it avoids many of the traditional drawbacks of surgeries that use incisions, including pain management. 

“When I had my liver resection, that was some of the worst pain I’ve ever felt in my life,” said Davis. “And I’m allergic to many pain medications, too. Being able to get put to sleep for surgery and wake up without the pain of having my abdomen cut open changes everything.” 

Davis had previously been in Padmanabhan’s care to receive a hepatic artery infusion pump, which successfully delivered high doses of chemotherapy to his liver while minimizing toxicity to the rest of his body. And although the cancer returned, Davis knew he was in good hands with Padmanabhan and Kristen Ciombor, MD, MSCI, associate professor of Medicine in the Division of Hematology and Oncology, who eventually helped him settle on histotripsy as the best option to treat his latest recurrence of cancer. 

“The doctors at Vanderbilt-Ingram Cancer Center changed my life,” said Davis. “Having a care team who knew exactly what I needed and recognized that a newer procedure could help me has given me hope that I can continue fighting cancer.” 

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Wife of cholangiocarcinoma patient makes gift in honor of husband

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Kristen Ciombor, MD, MSCI, left, with Sallie Bailey (courtesy/Sallie Bailey)

When Sallie Bailey’s husband, John Bailey, was diagnosed with cholangiocarcinoma (bile duct cancer) in July 2018, the news came as a shock. Just months earlier, his physical appearance showed no difference.

The first sign was subtle: jaundice in one eye. The jaundice quickly spread throughout John’s entire body, the point at which he and Sallie met with Benjamin Womack, MD, associate professor of Clinical Medicine. Despite the care of Womack, Patrick Yachimski, MD, MPH, professor of Medicine, and Kristen Ciombor, MD, MSCI, associate professor of Medicine, John passed away in November 2018, only four months after his diagnosis.

“Until the jaundice appeared, there were no symptoms,” Sallie recalls. “It’s a silent disease, and by the time it’s detected, it’s often too late.”

John was more than a patient at Vanderbilt-Ingram Cancer Center. He was a man with a passion for good food and wine. A talented chef, he worked in San Francisco, Chicago, France, and Washington, D.C., before retiring from professional kitchens. Even then, he continued creating memorable meals for family and friends and sought out locally owned restaurants and new wines to enjoy. His welcoming smile made everyone feel special, and he loved traveling, especially to California wine country.

After moving to Nashville in 2011, Sallie and John chose Vanderbilt Health for their care because they valued being part of a teaching hospital. That decision connected them to a team of experts who provided compassionate care during an incredibly difficult time. Sallie’s experience inspired her to take action. Today, she supports research led by Ciombor and Yachimski, hoping to help scientists detect cholangiocarcinoma earlier and slow its progression.

“Ultimately, I hope researchers will find a way to treat the cancer so that it isn’t a death sentence,” Sallie says. “Dr. Yachimski and Dr. Ciombor have both told me their goal is to work themselves out of a job. I admire and support that goal.”

Through her gifts, Sallie honors John’s legacy in a deeply meaningful way. Her support helps researchers pursue earlier detection methods, develop treatments that slow disease progression, and improve quality of life for patients. It also fuels innovation in clinical trials and provides hope for families facing rare cancers like cholangiocarcinoma. Every contribution moves science closer to a future where this diagnosis is no longer a death sentence.

“Particularly for a rare tumor type such as cholangiocarcinoma, contributions like Sallie’s propel our understanding of the molecular underpinnings of these tumors forward and set the stage for future therapeutic advances,” Ciombor said. “Philanthropic support such as Sallie’s provides critical resources at a time when patients with cancer need better treatment options more than ever.”

Learn more about supporting cancer research and making a gift by clicking here. When making a gift, please write in the comment field that you’d like your donation to support cholangiocarcinoma initiatives.

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Clinical trial led by Vanderbilt Health seeks to refine lung cancer biopsy standards

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Vanderbilt Health investigators have received a grant from AstraZeneca to lead a multisite, randomized controlled trial aimed at refining the standard of care when using robotic bronchoscopy combined with three-dimensional imaging to obtain lung samples for malignancy assessment and gene sequencing.

“Recent advances in minimally invasive bronchoscopic techniques have improved the diagnostic yield, particularly for peripheral pulmonary lesions, and in the recent VERITAS trial, we demonstrated that navigational bronchoscopy can achieve a diagnostic accuracy of around 79%,” said Fabien Maldonado, MD, MSc, professor of Medicine and Thoracic Surgery and director of Interventional Pulmonology at Vanderbilt Health. “That is statistically comparable to transthoracic needle biopsy, which is around 74% accurate.”

Fabien Maldonado, MD, MSc
Fabien Maldonado, MD, MSc

“Because of the proven success of navigational bronchoscopy, we now want to determine whether or not the rapid, on-site evaluation (ROSE) of biopsy material remains a necessary step. We’ll test the hypothesis that this advanced bronchoscopy procedure done without ROSE guidance is non-inferior to bronchoscopy with ROSE. This could have immediate patient care implications, potentially shortening procedure time, improving specimen quality and avoiding complications from additional, unnecessary biopsies.”

ROSE has been the standard of care for decades in navigational bronchoscopy, but it adds time, cost and may paradoxically result in lower quality specimens. It can also lead to complications from unnecessary biopsies motivated by unclear intraprocedural results. With modern techniques such as robotic bronchoscopy with cone-beam CT technology, which is rapidly becoming the standard of care, the need for ROSE needs to be studied, said Maldonado, who holds the Pierre Massion Directorship in Lung Cancer Research.

The development of better biopsy approaches is driven by the fact that lung cancer kills more than 130,000 Americans annually, and survival depends on early diagnosis, which requires biopsy to be definitive. Current approaches make accurate biopsy challenging or even impossible for many hard-to-reach lesions.

These modern bronchoscopy techniques extend the range of bronchoscopes and the ability to access lesions reliably and safely throughout the lung, including in the peripheral zone, said study co-investigator Rafael Paez, MD, MSCI, assistant professor of Medicine in the Division of Allergy, Pulmonary and Critical Care Medicine.

The Advanced Robotic Techniques and Rapid Onsite Evaluation for Minimally Invasive Diagnosis and Next-Generation Sequencing (ARTEMIS) trial will be conducted at Vanderbilt Health and nine other United States medical centers. Expected enrollment will be 440 adults who are scheduled for a navigational bronchoscopy for the evaluation of a pulmonary lesion. Participants will be randomized to have the procedure with the addition of ROSE or to have the procedure without ROSE.

The primary objective is to assess the diagnostic yield of robotic bronchoscopy with and without ROSE for peripheral lung lesions. A secondary objective is to compare the adequacy of malignant tissue samples for next-generation sequencing (NGS) between the two intervention strategies.

ROSE involves the immediate microscopic assessment of biopsy specimens, typically performed by a cytotechnologist or cytopathologist, to confirm the adequacy of biopsy samples obtained during a bronchoscopy for the diagnosis of malignancy. This has also been an important step in the past to ensure sufficient tissue is obtained for NGS to identify genetic mutations to guide treatment decisions, said Maldonado.

A 2023 Rapid On-site Evaluation Practice Variability Appraisal survey of interventional pulmonologists revealed significant variation in ROSE utilization. Of the 137 respondents, 88% reported ROSE availability, while time constraints (28%), availability of cytology (22%) and scheduling conflicts (20%) were the most reported barriers to ROSE utilization.

“Additional motivation for determining if ROSE use and non-ROSE use yield similar outcomes during diagnostic procedures is that ROSE is historically poorly reimbursed and uses considerable hospital resources,” Maldonado said. “Our findings will guide interventional pulmonologists in optimizing workflow and technology during robotic bronchoscopy, aiming to maintain the nearly 80% diagnostic yield seen in trials like VERITAS, thus improving patient care as we evaluate pulmonary lesions.”

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Guide published for outpatient cancer treatment with bispecific antibodies

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Hematologists with Vanderbilt-Ingram Cancer Center have published strategies for implementing outpatient treatment programs for bispecific antibodies, an immunotherapy that can cause adverse reactions.

The recommendations, published recently in JCO Oncology Practice, detail a comprehensive overview of the potential risks, treatment options for dealing with reactions, prophylactic protocols to prevent them from occurring, and the roles of an interdisciplinary care team within an outpatient program. The team at Vanderbilt-Ingram has expertise in outpatient care models for immunotherapy treatment because Vanderbilt-Ingram was among the first in the nation to establish outpatient protocols for another personalized immunotherapy, CAR-T.

Bispecific antibodies (BsAb) utilize engineered antibodies, molecular spikes, which bind to both cancer cells and immune cells, activating a patient’s T cells to attack hematologic malignancies. With CAR-T (chimeric antigen receptor T-cell therapy), T cells are harvested from a patient, then reengineered to recognize and destroy cancer cells before being infused back into the patient’s body. Both therapies can elicit strong immune responses with complications that pose risks, including cytokine release syndrome, a potentially life-threatening reaction that can damage healthy tissues and organs.

For this reason, the BsAb and CAR-T therapies typically require inpatient monitoring, which can be an economic and logistical burden for both patients and hospitals.

“Bispecific antibodies are a major advance in the field of cancer immunotherapy,” said the article’s corresponding author, Bhagirathbhai Dholaria, MBBS, associate professor of Medicine. “This class of drugs is available off the shelf, which makes them ideal for utilization in the community settings. In this article, we have provided a comprehensive framework to establish an outpatient bispecific antibodies program, especially for community practices, which do not have an already established CAR-T program. Our strategy has the potential to greatly reduce the logistical and financial burden during step-up dosing of bispecific antibodies while maintaining safety of the patients.”

The protocols suggested are for seven BsAb therapies that have been approved by the Food and Drug Administration for non-Hodgkin lymphoma and multiple myeloma. They address potential complications, including cytokine release syndrome, infections, cytopenia, tumor flare reactions, and immune effector cell-mediated neurotoxicity syndrome.

The authors noted that while outpatient programs for CAR-T were established before bispecific antibodies, CAR-T poses higher risks for adverse reactions. Their recommendations prioritize early recognition and intervention for these complications, particularly in the first cycle of treatment with BsAb when most cytokine release syndrome events are likely to occur.

The paper provides an infrastructure and workflow guide for how clinicians can work with patients to implement monitoring and address care needs. They also stress the importance of educating both patients and family/friend caregivers about proper protocols for remote monitoring.

The article’s additional authors are Kian Rahbari, MD, and Raul del Toro Mijares, MD, Kathryn Kennedy, RN, Leslie Mader, RN, Salyka Sengsayadeth, MD, Reena Jayani-Kosarzycki, MD, James Jerkins, MD, Andrew Jallouk, MD, Tae Kon Kim, MD, Shakthi Bhaskar, MD, Vivek Patel, MD, Brittney Baer, RN, Sarah Moseley, RN, David Morgan, MD, Bipin Savani, MD, Adetola Kassim, MD, Muhamed Baljevic, MD, and Olalekan Oluwole, MD.

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Patients with clonal hematopoiesis have increased heart disease risk following cancer treatment 

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About 1 in 5 patients with cancer who undergo genetic testing are incidentally found to have mutations in their blood called clonal hematopoiesis of indeterminate potential (CHIP). A study from Vanderbilt Health researchers reveals that it puts them at increased risk for heart disease following cancer treatment.

The findings, published Jan. 8 in JAMA Oncology, support the potential benefits of screening patients for CHIP before they undergo cancer treatment so they can be more closely monitored for heart complications. CHIP is a condition, not a disease, characterized by age-related variants in blood stem cells, and it is typically asymptomatic.

The researchers were able to determine which patients had CHIP by using Vanderbilt Health’s biorepository, BioVU, to link electronic health records with whole-genome sequencing data. They compared the cardiovascular health outcomes of the patients with CHIP to outcomes of patients without the condition. All the patients had been diagnosed with solid tumors, and none had heart failure, ischemic heart disease or arrhythmia before undergoing cancer treatment.

Over a 10-year period following treatment, patients with CHIP had a significantly higher incidence of heart failure (20.3% versus 14.5%) and ischemic cardiovascular disease (25.3% versus 18.5%). The effect was amplified in patients who received more intensive chemotherapy.

“We frequently find CHIP in patients with cancer, but previously we did not consider this to be an important result for their care. We now know that these patients are at higher risk of heart disease and would likely benefit from including cardiologists in their care team,” said the study’s corresponding author, Alexander Bick, MD, PhD, associate professor of Medicine, holder of the Edward Claiborne Stahlman Chair, and director of the Division of Genetic Medicine and Clinical Pharmacology.

The patients received chemotherapy, radiotherapy, immunotherapy, or a combination of the treatments. Cardiovascular disease is the leading cause of noncancer deaths among cancer survivors.

The researchers analyzed data from 8,004 patients, and 549 of them were identified with CHIP. To their knowledge, the study is the largest to date evaluating the association between CHIP and cardiovascular disease in patients with solid tumors who underwent cancer treatment. Most patients with CHIP were male (54% versus 45%) and had hypertension (78% versus 69%) compared to patients without the condition.

The clinical implications of the study are that there may be value in testing patients for CHIP prior to cancer treatment to stratify risk and tailor monitoring for cardiovascular diseases and offering early cardio-oncology consultations as well as consideration of cardioprotective strategies.  

The researchers received support from the National Institutes of Health (grants DP5OD029586 and T32GM007347). The sequencing of 250,000 individuals who have donated samples to BioVU has been funded by the Alliance for Genomic Discovery.

The study’s first authors are Derek Shyr, PhD, and Yash Pershad. The study was jointly supervised by Bick and Leo Luo, MD, assistant professor of Radiation Oncology at Vanderbilt Health.

Other Vanderbilt Health authors on the study are Ashwin Kishtagari, MD, Robert Corty, MD, PhD, Eric Shinohara, MD, MSCI, Ben Ho Park, MD, PhD, and Brett Heimlich, MD, PhD.

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Study identifies potential target for blood cancer treatment, prevention

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A multi-institutional research team that included genomic scientists from Vanderbilt Health has identified a potential target for blood cancer prevention and treatment.

Their report, published Jan. 1 in the journal Science, could lead to new treatments for blood cancers, which kill an estimated 23,540 people in the United States every year.

The research team, led by scientists from Boston Children’s Hospital, Dana-Farber Cancer Institute, the Broad Institute of MIT and Harvard, and Memorial Sloan Kettering Cancer Center, found that the protein Musashi-2 (MSI2) is essential for the function of blood-forming stem cells.

High levels of MSI2 can support the unchecked growth of abnormal stem cells, a precancerous condition known as clonal hematopoiesis of indeterminate potential, or CHIP.

The researchers used a genome-wide association study (GWAS) meta-analysis to identify a haplotype, or inherited grouping of genomic variants, which reduces MSI2 expression, thereby protecting against CHIP.

To validate these findings in humans, Alexander Bick, MD, PhD, Yash Pershad, and colleagues leveraged Vanderbilt Health’s DNA biobank, BioVU, the world’s largest repository of genetic material linked to de-identified electronic health records based at a single academic center.

By analyzing a unique longitudinal cohort of 3,000 patients with genetic sequencing performed approximately six years apart, the Vanderbilt Health team tested whether a variant which reduced the expression of MSI2 protected against the expansion of precancerous mutations.

Patients who carried the protective variant had precancerous clones that grew significantly more slowly than those without the variant. In many of these patients, the abnormal cells were transient; that is, they disappeared entirely over the study period rather than expanding into cancer.

“Most genetic studies only provide information from a snapshot in time, but the longitudinal samples in BioVU allowed us to study the mutations over six years,” noted Pershad, an MD/PhD student in the Bick lab, who with Bick is among the paper’s co-authors.

“We could clearly see that in people with the protective variant, precancerous clones behaved fundamentally differently than we expected — they shrunk or disappeared rather than expanding and becoming cancer,” Pershad said.

While CHIP results from somatic (acquired) blood stem cell mutations, this protection against it is inherited. This human genetic evidence suggests a potential way to prevent blood cancer by targeting MSI2 through small molecule inhibition or genome editing.

“More broadly,” the researchers concluded, “we provide an example of how resilience to cancer can arise through inherited genetic variation, motivating the search for other natural pathways that could be leveraged to prevent or treat malignancy.”

Bick, the Edward Claiborne Stahlman Professor, associate professor of Medicine, and director of the Division of Genetic Medicine and Clinical Pharmacology at Vanderbilt Health, is internationally known for his research on the genetics of blood disorders.

His research is supported in part by National Institutes of Health grants DP5OD029586, R01AG088657 and R01AG083736, a Burroughs Wellcome Fund Career Award, a Pew-Stewart Scholar for Cancer Research award, and a Hevolution/AFAR New Investigator Award in Aging Biology and Geroscience Research.

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Lucy Spalluto and Jennifer Lewis awarded $1 million lung cancer screening grant

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Vanderbilt Health’s Lucy Spalluto, MD, MPH, professor of Radiology and Radiological Sciences, and Jennifer Lewis, MD, assistant professor of Medicine in the Division of Hematology and Oncology, have received a grant from AstraZeneca to understand and improve veteran access to mobile lung cancer screening.

Lucy Spalluto, MD, MPH

The study, “REACHing veterans at high risk for lung cancer outside the guidelines and through mobile screening,” will receive approximately $1 million in total grant funding over a four-year period. As explained by Spalluto and Lewis, lung cancer is the leading cause of cancer death in the United States, with incidence higher in veterans compared to the civilian population.

“Improving access to lung cancer screening for a broader population, including those who live in rural areas, through mobile services can increase the early detection of lung cancer and improve lung cancer outcomes,” Spalluto says. “The REACH study explores the impact of mobile lung cancer screening in the Veterans Health Administration. An important component of the REACH study is understanding veterans’ perspectives of mobile screening.”

Jennifer Lewis, MD
Jennifer Lewis, MD

Screening for lung cancer with low-dose CT scans is an effective strategy to detect lung cancer early and improve mortality. However, this screening is widely underutilized, including in the Veterans Health Administration. Veterans living in rural areas are less likely to be screened for lung cancer, and individuals living in rural areas have higher mortality from lung cancer compared to those who live in nonrural areas.

In response to the low screening and high mortality rates, the VA’s Midsouth Veterans Integrated Service Network has partnered with the VA Lung Precision Oncology Program to offer mobile lung cancer screening to better reach veterans who reside in rural areas. Spalluto and Lewis have been awarded the REACH grant through AstraZeneca to understand the reach of mobile lung cancer screening among veterans within and outside current screening eligibility criteria, as well as veterans’ experiences with mobile lung cancer screening.

This work is particularly pertinent to veterans who may have been exposed to war-related chemical, waste and other similar smoke inhalation.

“Exposures that veterans have had because of their military service, such as Agent Orange and burn pits, may place them at high risk for lung cancer,” Lewis explains. “This study will help us understand how many veterans are eligible for lung cancer screening not only based on age and smoking history, but also other important risk factors, such as family history, personal history of cancer, diagnosis of COPD and military environmental exposures. These data will be critical for VA leadership.”

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Interim data reported for multiple myeloma off-the-shelf CAR-T therapy  

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Interim results from an ongoin​​g Phase 1 clinical trial for an off-the-shelf CAR-T therapy indicate that no dose-limiting toxicities or severe cytokine release syndrome instances occurred in an early and limited cohort of patients. 

The results were reported in Nature Communications on Nov. 24. Vanderbilt-Ingram Cancer Center accrued the most patients nationwide for the clinical trial for P-BCMA-ALLO1 – a chimeric antigen receptor T cell therapy (CAR-T) derived from healthy donors’ white blood cells. Currently, all CAR-T therapies approved by the U.S. Food and Drug Administration are autologous or made individually from each patient’s own reengineered T cells. An off-the-shelf or allogenic therapy derived from healthy donors would expedite the manufacture of this immunotherapy and make it readily available to patients, allowing them to start treatment sooner and expanding access to those patients not healthy enough for their own T cells to be reengineered. 

T​​he results reported in the Nature Communications study include​ data​ from 11 patients who received enhanced lymphodepletion, which is short-course chemotherapy to reduce the number of lymphocytes and create a favorable environment for the CAR-T therapy. Clinical analyses of patient responses and additional enrollment continue in the ongoing phase 1 trial. 

“P-BCM-ALLO1 differs from other CAR T-cell products due to the non-viral vector gene editing technology used during manufacturing. This approach allows P-BCMA-ALLO1 to retain T-cell memory phenotype compared with an activated T-cell phenotype common with CAR-T products using a viral-vector,” said Bhagirathbhai Dholaria, MBBS, associate professor of Medicine at Vanderbilt University Medical Center, who is leading the clinical trial at VUMC and is one of the study’s lead authors. 

P-BCMA-ALLO1 has exhibited characteristics that are crucial for CAR-T therapy because it is typically a one-and-done treatment. The study’s authors noted that the therapy had an optimal potency profile characterized by a strong memory phenotype and significant proliferative capacity. They stated that it “functions as a prodrug, conferring multipotency to rapid expansion and control of the tumor.” 

The interim results do not include enough data to make determinations about clinical efficacy of P-BCMA-ALLO1 because of the limited number of participant responses analyzed at this point, but Dholaria has observed positive results in individual patients. 

​​​​​“I have observed remarkable response rates in heavily pre-treated multiple myeloma with minimal cytokine release syndrome or neurological side effects,” he said. “In this study, I have also treated patients who have previously failed autologous CAR-T therapies or bi-specific antibodies. The ongoing study will help determine optimal cell dose and conditioning regimen for P-BCMA ALLO1.” 

The clinical trial for P-BCMA-ALLO1 is continuing to recruit participants. For more information about the clinical trial at Vanderbilt-Ingram Cancer Center, call 800-811-8480 or 615-936-5847 or email cip@vumc.org

“These are exciting times for our patients,” said Olalekan Oluwole, MBBS, MPH, associate professor of Medicine, who leads the cellular therapy research program at Vanderbilt-Ingram. “P-BCMA-ALLO1 CAR-T was engineered for the safety of patients. Furthermore, being an off-the-shelf CAR-T product meant we could get it to our patients almost immediately.” 

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Vanderbilt research community mourns loss of longtime colleague Anna Means

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Anna Means, PhD, whose 25 years of research at Vanderbilt Health advanced the understanding of early pancreatic cancer, died Nov. 28 at her sister’s home in Pelham, Alabama, following a 2023 diagnosis of brain cancer. She was 63.

A longtime collaborator of the late R. Daniel Beauchamp, MD, former chair of the Section of Surgical Sciences, in 2024 Dr. Means moved to the Department of Plastic Surgery where, as research professor of Plastic Surgery and Cell & Developmental Biology, she helped oversee development of a tissue engineering laboratory.

“Dr. Anna Means was my close friend, collaborator and colleague for over 30 years,” said Maureen Gannon, PhD, professor of Medicine in the Division of Diabetes, Endocrinology and Metabolism.

In addition to her research, Dr. Means mentored dozens of undergraduate, graduate and postdoctoral students, research staff and faculty. She was also a highly knowledgeable bird watcher, talented gardener and outdoor enthusiast. “She inspired us all with her grace and positivity and love of life,” Gannon said. “I will miss her terribly.”

An outstanding independent scientist and valued colleague, Dr. Means “was exacting and thorough in her scientific efforts and had an exceptional sense of integrity,” said Seth Karp, MD, H. William Scott Jr. Professor of Surgery and chair of the Section of Surgical Sciences. “She was highly respected across our campus and in the scientific community for her honesty, compassion and intelligence.”

A native of Ohio, Dr. Means earned her doctorate in Cell and Molecular Biology from the University of Wisconsin-Madison in 1991 and did postdoctoral work at Cornell University Medical College and Vanderbilt University before joining the Vanderbilt faculty in the Department of Surgery in 2000.

For 10 years until Dr. Beauchamp’s death in 2022, she was a close collaborator, serving as senior scientist in his lab, overseeing the work of research staff, and contributing as co-investigator and co-author to research that yielded important insights into the development of colorectal cancer.

In collaboration with other Vanderbilt faculty including Gannon and Christopher Wright, DPhil, professor of Cell & Developmental Biology, Dr. Means also led a highly productive research effort in pancreatic cancer and development of the pancreas.

She was founder and organizer of the Vanderbilt Pancreatic Cancer Researchers group, which convened a monthly research conference for basic and clinical investigators studying pancreatic cancer, and she organized the Beta Cell Interest Group, which held weekly seminars on studies related to pancreas development and function.

In 2009 Dr. Means received a Vanderbilt-Ingram Cancer Center Impact Award for her contributions to cancer research.

“At her core, Dr. Means was kindhearted, compassionate and deeply committed academically,” Karp said. “She demonstrated tireless dedication and achieved significant contributions to oncologic research as well as to the critical research and education missions of Vanderbilt. She made everyone around her better for having known, admired and worked with her.”

Dr. Means is survived by her mother, Joan Means, brothers, Christopher (Kim), Peter (Liz), and Patrick (Pam), and sisters, Michele Dragga (Chuck) and Kirsten Means.

Pending the arrangement of a memorial service in Nashville at a later date, donations in Dr. Means’ name may be made to the National Audubon Society, Friends of Radnor Lake, and Proverbs 12:10 Animal Rescue.

The post Vanderbilt research community mourns loss of longtime colleague Anna Means appeared first on VUMC News.

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