Transcript clinical/translational research - UNC School of Medicine

Welcome
to
UNC
Hematology/Onc
ology!
Interview Day






Morning presentations
3 Interviews
Research Presentations with lunch
Tour
Last interview
Wrapup
UNC and Chapel Hill
•
•
•
•
•
Oldest public university in the US
“Exceptional” Comprehensive Cancer Center
Gillings School of Public Health #2
Eshelman School of Pharmacy #1
#7 in NIH funding in 2013
• Classic University setting within
triangle of small gentrified city
(Durham) and state capital
• “Foodiest” small town in
America (CH), small city in
America (Durham)
UNC Hematology / Oncology



~ 60 faculty, 18 fellows

Oncologic subspecialties

Classical Hematology
UNC Lineberger

“Exceptional” ranking from NCI

Largest research entity at UNC
McAllister Heart Institute

Thrombosis/hemostasis/vascular research

International leadership
UNC Hematology / Oncology
Create and Apply Knowledge
Research
~ 305 publications last year
(40% first or last author)
$0
2002
2004
2006
2008
2010
$21,835,102
$29,367,175
$5,000,000
$23,064,732
$30,242,400
$10,000,000
$22,602,467
$29,792,274
$15,000,000
$18,836,235
$24,002,928
$20,000,000
$17,284,899
$22,554,760
$25,000,000
$20,788,036
$26,730,283
$30,000,000
$12,614,473
$16,303,802
125,000 Patient visits
4,500 New patients / year
650 on therapeutic trials
$35,000,000
$9,003,689
$11,555,508
Clinical care
2012
2013
2014
Missions of the UNC
Hematology/Oncology Fellowship
Program
•
•
To provide outstanding clinical training
To provide outstanding research opportunities
•
•
•
•
•
Basic Science
Translational
Clinical
Health Services
For fellows to have successful careers in
hematology/oncology
Fellowship Program Structure
Fellowship
education
committee*
Associate Program Director:
Billy Kim
Fellowship Director
Alice Ma
UNC graduate
medical education
Associate Program Director:
Frances Collichio
*Consists of 2 members from each class, program directors,
Lisa Carey, Tom Shea, Nigel Key, Bill Wood, Autumn McRee,
Chad Pecot, Matt Milowsky, Brandi Reeves, and Matt Foster
American Board of Internal
Medicine Requirements
Board
Months in
Training
Clinical
Months
Continuity
clinic A
Oncology
24
12B
24 months
BM Bx
Chemotherapy
CVC
Hematology
24
12
24 months
BM Bx
Chemotherapy
CVC
Peripheral blood
smear, apheresis
Both
36
18
C
Procedures
36 months
A: ½ day per week
B: 50% of the time outpatient months
C: 12 months neoplastic dz and 6 months non-neoplastic heme
ABIM Alternate Pathways




Geriatrics and Medical Oncology
Pediatric Hematology/Oncology and Adult
Hematology or Oncology
Infectious Diseases and Medical Oncology
ABIM research pathway
First year
Clinical and inpatient focus
Inpatient
Consult
Malignant
Heme
BMT
2
2
Coag
Solid
Tumors
Total 3
Clinic
Elective
Benign
Heme
Solid
Tumor
Elective/S
elective
1
1
3
Electives: solid tumor clinics, transfusion medicine, hematopathology,
inpatient solid tumor oncology, outpatient BMT,
palliative care (required 2 weeks) etc
Vacation: 4 weeks
Fellowship tracks
Fellows select
career pathway
in late first, early
second year
Basic Science
Research track
Clinical and
translational
research track
Health
outcomes
research track
Clinical track
Outpatient
Year
Continuity clinic
1St year
6-month rotating blocks (GI,breast)
2nd year
Four 6 month rotating blocks (malignant heme,
benign heme, lung and GU)
3rd year research track
0.5 day in clinic of interest
2nd or 3rd year clinical track B
5 month blocks of outpatient clinics per year
A : Rotations defined as : thoracic, breast, GU, GI, melanoma, head and neck
B: Clinical track fellows will have 0.5 day in one clinic of interest (e.g. GI) and then rotate
through the areas (breast, thoracic, etc) for more prolonged exposure
Research Training
• NC TraCS (North Carolina Translational and
Clinical Sciences Institute)
– MSCR (Masters of Science in Clinical Research)
• 2 year degree program training individuals to be principal
investigators and collaborators in clinical/translational
research
– TCRC (Translational and Clinical Research Curriculum)
• 2 year non-degree program providing training in
biostatistics, epidemiology and career development skills.
• https://tracs.unc.edu/index.php/services/education/translati
onal-and-clinical-research-curriculum
• K12 programs
– For senior trainees and junior faculty in basic or
translational research in hematology or oncology
Research Support
• Early Grants
–
–
–
–
Hematology T32 (coagulation and BMT immunology)
Other Institutional T32 awards
Health Behavior/Health Outcomes
T32-like Institutional Funding for well-qualified
research track fellow
• Later Grants
– K12 for senior fellows/junior faculty
– KL2
– BIRCWH
• Other
– Foundational Grants
– NIH Loan Repayment
Planning the Path to Research Independence….
Fellowship
Faculty
1
2
3
4
X
X
X
(X)
(X)
T32/NRSA
K12
(Institutional)
K08 or K23 or R21
(Individual)
RO1 or other
(Individual)
X
X
5
6
7
8
9
10
X
X
X
X
X
X
X
X
(X)
X
X
X
X
(X)
(X)
X
X
Tyler Buckner
• Combined Peds heme onc/Med Heme
Fellowship
• Interest: Patient Reported Outcomes in
Hemophilia, especially pain
• ASH CRTI 2012
• MSCR
• Clinical Instructor July 2014
• Assistant Professor at University of Colorado
Tyler Buckner
• Grants
– T32 Hematology 2011-2
– Cecil Sheps Health Services Research 2012-3
– Hemostasis and Thrombosis Research Society / Novo Nordisk Clinical
Fellowship Award in Hemophilia and Rare Bleeding Disorders. 2013-14
– National Hemophilia Foundation – Baxter Clinical Fellowship. 2013-15;
$100,000/yr
– Observational Study of Postoperative Deep Venous Thrombosis (DVT) in
Hemophilics Undergoing Major Orthopedic Surgery. Investigator initiated
study, Nigel Key (PI). Baxter Healthcare Corporation. 2014-16; $10,000/yr
(salary support)
– National Institutes of Health Clinical Research Loan Repayment Program.
2014-16; Repayment of 25% of total medical education loan debt each
year for 2 years
Tyler Buckner
•
Buckner T, Amin C, Esserman D, and Key NS. African-Americans have a higher rate
of proximal deep venous thrombosis at presentation. Thrombosis Research.
2010;126:e246-e2474.
•
Buckner T, Key NS. Clinician Update: Venous thrombosis in blacks. Circulation.
2012;125(6):837-9.
•
Buckner T, et al. Complete spontaneous remission of diffuse large B-cell lymphoma
of the maxillary sinus after concurrent infections. Clin Lymphoma Myeloma Leuk.
2012 Dec;12(6):455-8. Epub 2012 Sep 29.
•
Buckner TW, et al. Patterns of symptoms and functional impairments in children
with cancer. Pediatr Blood Cancer. 2014 Jul;61(7):1282-8. Epub 2014 Mar 15.
•
Buckner TW, Ataga KI. Evidence-based mini-review: Does hydroxyurea prevent
pulmonary complications of sickle cell disease? Submitted for review to: American
Society of Hematology 2014 Annual Meeting Education Program Jul 2014.
•
Buckner TW, Nielsen BI, Key NS, Ma A. Factor VIII inhibitory antibody in a patient
with combined factor V / factor VIII deficiency. Submitted for review to:
Haemophilia Aug 2014
Satish Gopal
• Combined ID/Oncology Fellowship 2009-2012
• Interest: AIDs related malignancies in Sub-Saharan Africa
• Clinical Assistant Professor 2013
• Awards:
– Bristol Myers-Squibb Virology Fellows Research Training
Program Award 2011
– UNC Lineberger Clinical Fellows Award 2012
– Fogarty Global Health Fellows Award 2012
– AIDS Malignancy Consortium Fellow (inaugural year) 2013
– North Carolina Cancer Hospital Endowment Award 2013
Satish Gopal
• Grants
– UNC Lineberger and CFAR Developmental Research Awards. Characterizing a
large cohort of HIV-associated lymphoma in the CNICS network and
examining correlates of clinical outcomes. 2012– NIH/FIC K01TW009488. Developing a prospective clinical cohort of
histopathologically characterized lymphoma patients in Malawi . 2012-7.
– UNC Lineberger and CFAR HIV Malignancies Pilot Award. Epstein-Barr virus and
Kaposi sarcoma-associated herpesvirus in HIV-associated non-Hodgkin
lymphoma (NHL) in Malawi . 2013-4.
– NIH/NHLBI U01HL117659. Sickle Cell Disease in Malawi. 2013-8
– NIH/NCI R21CA180815 . Molecular profiling of HIV-associated lymphoma in
the US and Malawi. 2013-5
– UNC Lineberger and CFAR Developmental Research Awards . A pilot clinical
trial of R-CHOP in Malawi. 2013– NIH/NCI U54CA190152. Addressing herpesvirus-associated cancers through
the UNC-Malawi Cancer Consortium. 2014-
Satish Gopal
• Selected Publications
– Gopal Et al, Clinical presentation, treatment, and outcome among 65
patients with HIV-associated lymphoma treated at the University of North
Carolina, 2000-2010. AIDS Res Hum Retroviruses 2012
– Gopal, et al, Importance of concurrent CART in HIV-associated lymphoma.
Blood 2012
– Gopal et al, Meeting the challenge of hematologic malignancies in subSaharan Africa. Blood 2012
– Gopal et al, Association of early HIV viremia with mortality after HIVassociated lymphoma. AIDS 2013
– Gopal et al, Temporal trends in presentation and survival for HIVassociated lymphoma in the combination antiretroviral therapy era. J Natl
Cancer Inst 2013
– Gopal et al, Early experience after developing a pathology laboratory in
Malawi, with emphasis on cancer diagnoses. PLoS One 2013
– Gopal et al, Lymphoma Immune Reconstitution Inflammatory Syndrome in
the Center for AIDS Research Network of Integrated Clinical Systems
Cohort. Clin Infect Dis 2014
– Gopal et al, Multicentric Castleman Disease in Malawi. Lancet 2014
– Gopal, et al, Moving forward in HIV-associated cancer. J Clin Oncol 2014
Katie Reeder-Hayes
•
•
•
•
•
•
•
MBA in Health Care Mgmt pre-med school
Fellowship in Medical Oncology 2007-2010
Interest: Health Disparities in Breast Cancer
Clinical Instructor 2010-2011
MSCR 2008-10
Clinical Assistant Professor 2011
Awards:
– Outstanding Fellow Award, North
Carolina Oncology Association , 2011
– ASCO Merit Award for Outstanding
Abstract by a Fellow 2012
Katie Reeder-Hayes
• Grants
– Sheps CeAgency for Healthcare Research and Quality T32 in Comparative
Effectiveness Research 2010-12
– Cecil Sheps Health Services Research 2012-3
– 5K12HD001441-12 University of North Carolina Building Interdisciplinary
Careers in Womens Health (BIRCWH) Career Development Program 20122015
– Agency for Healthcare Research and Quality HHSA290200710056I Genomic
Testing for Risk of Recurrent Cancer 2012-4
– National Institutes of Health Loan Repayment Program Award 2013-5
– UNC Translational and Clinical Sciences Institute Pilot Grant in Comparative
Efficacy. Comparative Effectiveness and Toxicity of Trastuzumab-Based
Chemotherapies in Older Women with Breast Cancer 2014-5
– ACS Mentored Research Scholar Grant . Improving Endocrine Therapy
Utilization in Racially Diverse Populations . 2014-8
•
Publications
Katie Reeder-Hayes
– Reeder-Hayes K, et al, Clinical Trials in Triple Negative Breast Cancer. Breast Disease. 2010
– Reeder-Hayes KE. A Piece of My Mind: Way Back When. Journal of the American Medical
Association. 2011
– Reeder-Hayes KE, et al. Racial disparities in initiation of adjuvant endocrine therapy of early
breast cancer. Breast Cancer Res Treat. 2014
– Reeder-Hayes KE, Carey LA. How Low Should We Go? The Search for Balance in Management of
Small Human Epidermal Growth Factor Receptor 2-Positive Breast Cancers. J Clin Oncol. 2014
– Reeder-Hayes KE, et al. Comparative effectiveness of follow-up imaging modalities in pancreatic
cancer. Journal of Comparative Effectiveness Research. 2014
– Green AK, Reeder-Hayes K, Corty R, Basch E, Milowsky MI, Dusetzina SB, Bennett AV, and Wood
WA. The Project Data Sphere initiative: Accelerating Cancer Research by Sharing Data.
Oncologist. 2015 May;20(5):464-e20.
– Angela Green A, Corty R, Wood W, Meeneghan M, Reeder-Hayes KE, Basch E, Milowsky M,
Dusetzina SB. Comparative Effectiveness of Mitoxantrone Plus Prednisone Versus Prednisone
Alone in Metastatic Castrate-Resistant Prostate Cancer After Docetaxel Failure. Oncologist. 2015
May;20(5):516-22
– Tichy JR, Deal AM, Anders CK, Reeder-Hayes KE, Carey LA. Race, Response to Chemotherapy,
and Outcome within Clinical Breast Cancer Subtypes. Oncologist. 2015 May;20(5):464-e20.
– Meleth S, Reeder-Hayes K, Ashok M, Clark R, Funkhouser W, Wines R, Hill C, Shanahan E,
McClure E, Burson K, Coker-Schwimmer M, Garge N, Jonas DE. Technology Assessment of
Molecular Pathology Testing for the Estimation of Prognosis for Common Cancers. Rockville
(MD): Agency for Healthcare Research and Quality (US); 2014 May.
Fellow’s career choices
Academic
Private
Industry
Gov
Unknown
1995-2009
22
23
2
1
1
2010-16
22
18
Geographic Distribution
“BENIGN” OR “CLASSICAL”
HEMATOLOGY AT UNC
The Hemostasis and Thrombosis Program
• Comprehensive Hemophilia Treatment Center (est. 1977)
• 6 physicians, 3 clinical nurses, 1 research nurse, 3 research
coordinators, 1 social worker, 1 pharmacist
• Currently follows ≈250 adults, ≈100 children with
hemophilia, several hundred vWD
• ≈20 new thrombosis patients/week
• Multi-disciplinary HHT Clinic
The Sickle Cell
Program
• Inaugurated 1980
• 2 physicians, 2 physician extenders, 1 social
worker, 2 research coordinators, 2 administrative
personnel
• Currently follows ≈350 adults and ≈225 children
• NIH-funded “Excellence in Hemoglobinopathies”
UO1 2013-2018
Hematology ‘Firsts’ at UNC
• 1947: Hemophilia dog colony founded by Kenneth
Brinkhous MD
• 1952: Invention of the APTT
• 1956: Discovery of factor X (‘Stuart Prower factor’)
• 1962: Development of the first FVIII concentrate
• 1972: Separation of plasma FVIII from VWF
• 1978: Center for Thrombosis and Hemostasis founded
by Harold Roberts, MD
• 1987: First human trial of recombinant clotting factor (rFVIII)
• 1989: First administration of rFVIIa in the US
• 1991: Isolation of vitamin K carboxylase
• 1994: Elucidation of the mechanism of action of rFVIIa
• 1997: First mouse model of hemophilia B
• 2004: Identification of the gene for Vitamin K epoxide reductase
Hematology T32 Training Grant
• Continuously funded since 1975
• An estimated 95 previous T32 scholars,
(including 1 Nobel Laureate!)
• Clinical or bench research in benign
hematology – 5 slots
Career Paths in Benign Hematology
1. ‘Traditional’ RO1 investigator
- Clinical research
- Basic research
2. Clinician, with additional focus:
- Educator
- Hemostasis/thrombosis/vascular medicine
- Transfusion medicine/red cell disorders
Clinical / Translational
Research at UNC:
Opportunities for Fellows
Clinical / Translational Research as a Fellow: Your
Goals
• Complete the project(s) within your time frame
– Ok to be part of an ongoing project (finish one, start the next)
• Identify at least one mentor
• Create a coherent body of work - “who are you?”
• Have fun ….
Outcomes
Treatment trials
Novel approaches to diagnosis or therapy
Correlative studies on tumor samples or blood
UNC Landscape
• #7 in NIH funding in the country in 2014
• Opportunities –
– 33 MD division members with a track record of working
with fellows and clinical role
– 6 PhD members with collaborative roles (esp benign
heme)
– 350 LCCC members (“Exceptional”)
• Longstanding emphasis and focus on team
science
– #2 SPH in country across street, multiple joint
appointments/collaborations
– #1 SOP in country “ “ “
– Training grant opportunities across this landscape
General Approach
• Two phenotypes:
– Testing the waters - e.g. database mining
– Jumping in!
• Laboratory or clinical trial setting
• Health services / outcomes research
• ~ 400 researchers in Heme / Onc
• Alphabet soup programs for formal training - MSCR,
MPH, TraCS…
Example:
BREAST CANCER
Hy Muss
Geriatric Oncology
Lisa Carey
Biomarkers
Claire Dees
Drug Development
Katie Reeder-Hayes
Health Services
& Outcomes
Carey Anders
Brain metastases
Trevor Jolly
Geriatric Oncology
Recent Clinical /
Translational Breast
Cancer Publications
Led by Fellows
J Natl Compr Canc Netw. 2013 Sep 1
Example: GU CANCER
Tracy Rose
GU Cancer
Clinical Trials and
outcomes
Young Whang
Prostate Cancer
Ethan Basch
Health Services &
Outcomes
Matt Milowsky
Bladder Cancer
GU Clinical Trials
Paul Godley
Prostate Cancer
Disparities, Outcomes
Billy Kim
Translational Research
Recent Clinical GU
Manuscripts Led by
Fellows
Etc, Etc…
Finding Your Research Niche
Clinical
trials
Translational
research
Health
Services
research
1st year – conferences, seminars, informal chats with faculty
Learning
the ropes
1st-2nd year – Ongoing talks with Dr. Stinchcombe
Facilitated discussions with relevant faculty
Recommendations for specific training program
Getting
attached
and funded
3rd (?4th) year - MAGIC
Summary
• UNC provides a rich resource for “clinical”
research
– Division of > 60 faculty, > ½ do clinical research of
some kind
– Clinical / Translational / Health services research
– Myriad training grants and support
• Goals for fellows training in clinical research:
– Develop a portfolio
– Differentiate yourself
– Develop the skills to run your own program
Research Orientation to the
Lineberger Comprehensive Cancer
Center
NORMAN E. SHARPLESS, MD
Director, Lineberger Comprehensive Cancer Center
Wellcome Distinguished Professor Of Cancer Research
Departments Of Medicine And Genetics
UNC Lineberger:
NC’S PUBLIC COMPREHENSIVE CANCER
CENTER.
MATRIX CANCER CENTER EMBEDDED IN
UNC-CH.
AREAS OF FOCUS
Basic Research
Population Sciences Research
Clinical and Translational Research
Dissemination and outreach in NC
Economic Development
Clinical Excellence
Facilities
Lineberger Bldg: 79,000 nsf
NC Cancer Hospital
Clinical space increased 3-fold
Research space: clinical trials unit,
Protocol office, PK/PD Lab
New Hillsborough Hospital
40 new inpatient beds
Marsico Hall: 22,000 nsf
(Opened 2014)
Cancer Genomics: National Leadership
LCCC 1108 –UNCseq
Over 1,900 patients consented
28 tumor types
10,000 samples
>100 trillion bases
--Hoadley, Cell, 2014
CHUCK PEROU,
KATIE HOADLEY
NEIL HAYES
https://www.youtube.com/watch?v=Y9HumO20GKc
Discovering Cancer Drugs
CENTER FOR INTEGRATIVE CHEMICAL BIOLOGY
AND DRUG DISCOVERY (CICBDD)
Many Cancer Projects:
• Mer Inhibitors for Pediatric Leukemia
• IDH1 Inhibitors for Glioma, Leukemia
• >$14M in funded proposals
Science Focus:
• Chemical Biology of Chromatin Regulation
• 55+ publications: Nature Chemical Biology, PNAS, Cell,
Science
• 2 Oncology start-ups with LCCC founders
Ongoing Expansion:
• New recruitment: Jeff Aubé (U of K), Tim Willson (GSK)
• Leveraging $100M gift to Eshelman School of Pharmacy
STEPHEN FRYE (MT)
CICBDD DIRECTOR
Studying Cancer in the Mouse
COLLABORATIVE CROSS
• 80+ publications since 2011
• Example:
Pardo-Manuel de Villena et al.,
Nature Genetics, 2015
MOUSE PHASE I UNIT
•
•
•
•
•
•
50+ partners in academia and industry
40+ publications (e.g. Cell, Nature, Cancer Cell, Cancer Disco.)
32 funded grant proposals: $25M
5,000 cages for serial housing
Small animal imaging (PET/CT, Optical, MRI, U/S)
Pharmacokinetics and Pharmacodynamic Monitoring
Sharpless et al., Cell 2013
Kinoming
In progress trials in melanoma, lung, lymphoma and breast cancer
FUNDING: NCI R01, Komen, MRA, LLS, V Foundation, Lustgarten
LISA CAREY
GARY JOHNSON
STERGIOS MOSCHOS
2014 CANCER CLINICAL
INVESTIGATOR TEAM
LEADERSHIP AWARDEE
Cellular Immunotherapy Program
Developed the sixth CAR-T cell program in
the United States
cGMP facility built and functioning off
HWY 54 on Quadrangle Boulevard
Two CAR-T cell trials currently open at
UNC
Developing novel murine
approaches to
CD30-CAR therapy after autologous SCT CAR
understanding efficacy in
for patients with relapsed/refractory
solid tumors
Hodgkin and anaplastic large cell
Identification of
lymphoma
neoantigens from SNV,
CD30-CAR therapy for R/R patients not translocations and spliced
variants
undergoing autograft
Plans for CAR therapy with suicide gene for ALL and
NCI RO1 x 3, LLS, NCI
CAR therapy for myeloma in 2017 Support
SPORE, UCRF
LCCC Entrepreneurship
Growth in NCI Funding
Annual NCI funding (in $M)
$65
$60
UNC
Top 30 Average
$55
$50
$45
2014 NCI FUNDING:
Stanford
$55M
Michigan $54M
Wash U
$42M
Duke
$34M
UNC
$58M
(6th among matrix cancer
centers)
$40
http://report.nih.gov/award/index
University Cancer Research Fund
Funded $351M for cancer research through 20082014 (with $44M in FY2015).
Institutional impact:
• Recruitment/Retention >180 faculty
• Major investment – genomics, NGS and
bioinformatics
• Built population and hospital cohorts
• Created informatics and big data infrastructure
• Developed therapeutics, devices and diagnostics
https://unclineberger.org/ucrf/ucrf-annualreports/UCRFLegislativeReport2014FINAL.pdf
• Statewide outreach and network support
In 2014, the UCRF funding created 2,250 NC jobs and generated
$333M in economic impact
Division of Hematology/Oncology Members
There are eleven divisional members who have space and
or resource commitment for laboratory work in the
Lineberger Cancer Center
• Also a much larger number of PhD investigators in the Cancer
Center who have trained MD/MD PhD fellows
There are four divisional investigators with laboratorybased research in the Carolina Cardiovascular Biology
Center
Ned Sharpless MD
• Studies the CDKN2a tumor
suppressor locus
• Genetic models of cancer using
mice
• Novel Drug Discovery and
Commercialization thereof
• Pathways important in
melanoma growth and
therapeutic targets
• Cancer genetics and genomics
Oncology Fellow
Jonathan Serody MD
• Evaluations of the role of
migratory proteins during
GVHD
• Interactions of immune and
stromal cells and their roles
in tumor growth
• Generation of clinical tumor Th17-mediated lung inflammation and
GVHD
Manuscripts in press with Ben
vaccines against solid tumors
Vincent in JNCI, JCI x 2
Oncology Fellow
D. Neil Hayes MD MPH
• Interested in correlating
clinical outcomes with genetic
mutations and epigenetic
changes in patients with
tumors of the aerodigestive
tract
• Leader of The Cancer Genome
Atlas (TCGA) group evaluating
panel of multiple tumors for
genetic changes and how
these affect downstream
pathway activity
William Kim MD
• CLINICAL/TRANSLATIONAL RESEARCH
• Cancer genomics (TCGA)
• Discovery of luminal and basal
molecular subtypes of bladder cancer
• Genetic models of cancer using mice
• Immunotherapy/immunogenomics
• Tumor hypoxia and angiogenesis
Oncology Fellow
Nigel Mackman PhD
• Laboratory focuses on the role
of tissue factor, coagulation
proteases and protease
activated receptors in
hemostasis, thrombosis and
inflammation.
• They have generated a variety of
novel mouse lines and study
mechanisms of thrombosis in
cancer, the role of the clotting
cascade in viral infections and in
cardiac injury.
Hematology Fellow
Faculty Who Have Mentored MD Fellows in
the Basic Sciences in the Cancer Center
Individual
Mentor
Shannon Penland/Jessica Fu/**Patrick
Dillon/**Hanna Sanoff
Ned Sharpless
**Ben Vincent, **Jay Coghill/**Hank van
Deventer/Judy Ng-Cashin
Jon Serody
David Chism, Mingqing Li **Autumn
Jackson, **Tracy Rose
Billy Kim
Jeremiah Boles
Nigel Mackman
**Brandi Reeves
Rafal Pawlinski
*Current fellows
**Academic Faculty Members
LCCC Core Facilities
Animal models, Animal experiments and protocols, and
Histopathology
Genomics and Bioinformatics
• Human and mouse microarrays, expression data from RNA from
any source, custom arrays
• Massive parallel sequencing (4 platforms on campus; Illumina,
454, PacBio and Ion Torrent)
Flow Cytometry
Proteomics
Tissue Procurement
Why MD Fellows:
• Fellows better at making the work clinically
relevant.
• Fellows easier to fund.
• Fellows good at bureaucracy needed for
human studies.
• LCCC scientists will be enthusiastic about
working with you!
Questions?
Opportunities for Training in
Population Research
UNC Hematology/Oncology Training
Program
Paul Godley, MD, PhD
UNC Cancer Research Training
Programs
Cancer Control
Education
Program
NRSA Training Program
in
Health Services Research
Cancer Care
Quality
Training Program
UNC Cancer Research Training
Programs
Cancer Care
Quality
Training Program
Why a Cancer Care Quality Training Program?
• Cancer care quality is not as good as it could be
• Patterns of underuse, overuse, and misuse exist for all forms
of cancer…across care continuum
• Improving cancer care quality requires a multidisciplinary
approach
• Aim:
– Train clinician and non-clinician scientists to work in
multidisciplinary research teams to improve the cancer care
quality across the cancer care continuum
What Kind of Training?
• A specialized curriculum that involves:
– Coursework (include 3 new courses designed for this
program)
– A journal club
– An immersion experience in tumor board meetings
– Training in the responsible conduct of research
– Occasional special seminars and lectures
• Hands-on research experience in multidisciplinary research
teams focused on cancer care quality, with mentoring
provided by experienced faculty members from diverse
disciplines.
• Career development experiences that enhance professional
skills and build professional networks.
Potential Quality Problems across the
Cancer Care Continuum
Risk Assessment
Age
Family Hx
Exposure Hx
Genetics
Lifestyle
Screening HX
Primary Prevention
Lifestyle counseling
Chemoprevention
Detection
Screening
(Asymptomatic)
Appropriate
testing (Symptomatic)
Failure to Identify
Need to Screen or
Counsel
Primary Prevention
Failure
Failure in Access
to Care
Failure in
Detection
Failure to Screen
Cancer or Precursor
Treatment
Recurrence
Surveillance
End-of-Life Care
Imaging
Biopsy
Repeat Exams
Lab tests
Other procedures
Excision
Surgery
Radiation
Adjuvant
Chemo
Palliation
Testing
Follow-up
Care
Palliation
Survivorship
Care
Palliative
Care
Advanced
Care
Planning
Bereavement
Support
Failure during
Diagnostic
Evaluation
Failure of
Treatment
Failure in
Surveillance
Failure in Care
Diagnosis
Failure during
Follow-up of
Abnormal Result
Failure during
Follow-up of
Diagnostic or
Treatment Plan
Failure to Followup Surveillance
Plan
Failure to Access
Care
POTENTIAL FAILURES DURING THE PROCESS OF CANCER CARE
Adapted from Zapka et al. (2003)
Evidence of quality problems in cancer care available on request ([email protected])
UNC Cancer Research Training Programs
NRSA Training Program
in
Health Services Research
Cancer Care
Quality
Training Program
Post-Doctoral Training Program in Health
Services Research
• The postdoctoral program is intended to provide advanced,
specialized training in the methods of health services
research
• Trainees will gain experience in applying research methods
to the systematic analysis and evaluation of health care
services and health policy issues. The emphasis of the
training program is the organization, financing, utilization,
quality and evaluation of personal health care services and
public policies for ensuring access to such services.
Post-Doctoral Training Program in Health
Services Research
• The postdoctoral program is intended to provide advanced,
specialized training in the methods of health services research
• Trainees will gain experience in applying research methods to
the systematic analysis and evaluation of health care services
and health policy issues
– aging, disablement and long-term care; health workforce
policies and programs; health care organization; medical
practice and health care outcomes; child health services;
health care economics and finance; health disparities; rural
heath care; mental health services; preventive health
services; and heath policy analysis.
• Trainees may elect to pursue one of several degrees through
the UNC-CH School of Public Health as part of their training
program.
UNC Cancer Research Training Programs
Cancer Control
Education
Program
NRSA Training Program
in
Health Services Research
Cancer Care
Quality
Training Program
Cancer Control Education Program
• The CCEP trains pre- and postdoctoral fellows for careers as independent
investigators in interdisciplinary and collaborative cancer prevention and
control research.
• The UNC Lineberger Comprehensive Cancer Center and the University of
North Carolina at Chapel Hill constitute an ideal setting for a training
program in cancer prevention and control that emphasizes multidisciplinary,
collaborative research.
– Established, well-funded scientific research programs in Cancer
Prevention and Control and Cancer Epidemiology
– Core resources established to support the population sciences (Rapid
Case Ascertainment, High-Throughput Genotyping, Dissemination);
– Other core resources that support the population sciences as well as
other research (Biostatistics, Tissue Procurement, Oncology Clinical
Protocol Office) and
– A developmental/seed grants program dedicated to cancer prevention
and control/cancer epidemiology.
Patient-Oriented Research Training Programs
NC TraCS Institute
CTSA KL2 Program
(K12)
Paul Calabresi Career
Development Award
for Clinical Oncology
(K12)
Mentored PatientOriented Research
Career Development
Award (Parent K23)
NIH Research Grants
(R01, R03, R21)
You are a newly-trained clinician
transitioning to more advanced
support mechanisms, e.g., K08
and K23.
You have completed specialty or subspecialty training and are seeking
salary and research support for a
full-time supervised career
development experience in patientoriented research
University of North Carolina
Adult and Pediatric
Bone Marrow and Stem Cell
Transplant Program
Program History
•
Over 2000 HCTs performed since November 1992
•
1/3 allogeneic and 2/3 autologous
•
Stem cell sources: Bone Marrow, PBSC, & UCB
•
1992/1995: NMDP Bone Marrow Collection and Transplant Center
for URDs
•
BCBS and United Resource (Optum) Centers of Excellence
•
2005, 2008, 2011: FACT Accreditation for both adult and pediatric
patients
•
NIH/L&LS/SBC Study Sections & CCSG Core Grant Site Reviews
•
Over 120 articles published and numerous national presentations
Program History
•
2010-14: Dr. Thomas Shea elected to role of Chair of the
CIBMTR Executive Committee & Scientific Advisory Board
•
2011: Dr. Kimberly Kasow elected NMDP Council Officer VicePresident from a Transplant Center
•
2012: UNCH identified as one of only 14 “overperformimg”
CIBMTR centers with OS > 2 SDs above expected for allografts
•
2012: CTN consortium site with OSU, UCSF, RPCI, and VCU
•
2014: Certificate of Need obtained for new 24-bed BMTU
Adult Faculty
•
Thomas C. Shea, Program Director, Professor; clinical research in
stem cell mobilization, auto and allo grafting
•
Jon Serody, Thomas Professor; NIH funded investigator in
chemokines and pre-clinical models of GVHD; Director of
Hematologic Malignancy and Immunotherapy Programs (former
UNC Fellow)
•
Jay Coghill, Assistant Professor; L&LS / NCI funded laboratory
investigator in cell homing and GVHD (former UNC Fellow)
Adult Faculty
•
Paul Armistead, Assistant Professor; NCI funded investigator
studying MRD and identification of minor alleles that are
important in GVHD and GVT effects
•
William Wood, Assistant Professor, NCI funded investigator in
outcomes research and effects of exercise (former UNC Fellow)
•
Katarzyna Jamieson, Associate Professor, clinical research in
leukemia and BMT
•
Marci Riches, Associate Professor, clinical research in and BMT
•
7 adult NP/PAs
220
Total BMT Transplants 2009-2013
200
184
182
180
170
Total Transplants
160
148
140
122
120
121
121
Auto
92
100
80
102
Allo
80
60
40
63
20
42
56
68
61
0
2009
2010
2011
2012
2013
UNC PROJECT-MALAWI
CURRENT HEME-ONC ACTIVITIES
Malawi country profile
•
Population ~15.3 million
(NC ~9.7)
•
Surface area ~45,700 square miles
(NC ~48,600)
•
Life expectancy 56 years
(US 78 years)
•
Annual GDP per capita 318 USD
(US 47,199)
•
Human Development Index rank 171
out of 187 countries
(US 4)
•
•
HIV prevalence 11% in 2009
Severely limited cancer facilities
–
–
–
–
–
No RT
4 pathologists
2 clinical oncologists
2 hematologists
1 medical oncologist
MALAWI
United Nations
UN Development Program
UNAIDS
UNC Project-Malawi
•
•
•
•
•
•
•
•
>20-year collaboration between UNC and
Malawi Ministry of Health, established in
1991
Based in the capital Lilongwe at Kamuzu
Central Hospital (KCH)
1000-bed public tertiary care hospital
1 of 2 national teaching hospitals serving a
catchment area of 4-5 million people
>350 employees, 40,000 square-feet,
extensive community engagement
Longstanding involvement of UNC IGHID,
Lineberger, Surgery, Women’s Health,
Gillings School of Global Public Health
Training site for Fogarty AIDS International
Training and Research Program
Clinical trial site for protocols
implemented through numerous
multinational NIH-sponsored networks
(ACTG, HPTN, IMPAACT, CHAVI, AMC)
Malawi National Cancer Registry (n = 18,946; 2007-2010)
Men
Women
Msyamboza et al, BMC Res Notes 2012
KCH Pathology Laboratory
•
•
•
•
•
•
•
UNC Project-Malawi and KCH
collaboration
200,000 USD renovations and
installation of new equipment
Aperio virtual microscopy system
installed for long-distance virtual
consultation
Operational since July 2011
Specimen review provided by Prof.
George Liomba
Immunohistochemical staining
implemented
>10,000 specimens reviewed to date
Gopal et al, Lancet Oncol 2013; Gopal et al, PLOS ONE 2013; Montgomery et al, USCAP 2015
KCH Pathology
Laboratory
Jul 2011-Feb 2013
Gopal et al, Lancet Oncol 2013; Gopal et al, PLOS ONE 2013; Montgomery et al, USCAP 2015