Massachusetts General Hospital Cancer Center at forefront of team science and integrated care
In just 15 years since its formal inception, the Massachusetts General Hospital Cancer Center has evolved into an international leader in cancer research and care. At the core of this expanding enterprise is a passionate group of specialists who integrate their work across the "super-city" of MGH, renowned worldwide for medical innovation and excellence in care.
"We aim to treat the patient as a whole, providing on-site access to the various specialists required to treat and support cancer patients," says center director Daniel Haber, MD, PhD, who also heads the Cancer Genetics Program at DF/HCC. "We actively reach out to the rich environment that is so extraordinary at MGH, from the medical, surgical, radiation and pediatric oncologists who form the core of cancer care, to the experts in neurology, endocrinology, orthopedics, radiology, psychiatry and all the other superb hospital disciplines. Likewise in basic research, investigators in our Center for Cancer Research can interact with the scientists in other MGH departments, from Molecular Biology, Molecular Imaging, and Bioengineering to the newly created Thematic Centers in Genetics, Regenerative (Stem Cell) Medicine, Computational Biology, Photobiology and Systems Biology."
This open and inclusive approach in both clinical medicine and research has been accompanied by tremendous growth on both fronts. Nearly 30 percent of the 3,000 patients enrolled each year in DF/HCC’s system-wide trials are from MGH. "Our goal is to offer the best possible multi-disciplinary care in an environment that emphasizes research, " says Bruce Chabner, MD, clinical director at the MGH Cancer Center and associate director for clinical sciences at DF/HCC. "Clinical trials are shifting away from formulas based on a pathologic diagnosis and moving toward ‘targeted drug’ trials directed at a specific molecular feature of the tumor in question," says Chabner whose clinical interests are drug development and early clinical trials. Our challenge is to design trials in a way that allows us to understand why and how these new drugs work. With our colleagues in DF/HCC we are developing the infrastructure to support these new trials." Michael Seiden, MD, PhD, director of the Ovarian Cancer Disease Program of DF/HCC, is leading the translational research support effort at MGH.
Clinical care at MGH is delivered in the Yawkey Center for Outpatient Care, a center for outpatient medicine which opened last year and which includes three floors dedicated to cancer services. Specialists in all major cancer treatment modalities — medical and pediatric oncology, surgical and radiation oncology — work side by side, collaborating closely on each patient’s care. Most support services are available within the cancer clinical area, from social services and genetic counseling to a fully staffed cancer resource room and a rooftop “Healing Garden,” which is adjacent to the chemotherapy infusion suite. The Yawkey Center also houses the Francis H. Burr Proton Therapy Center, one of only three such facilities in the country, and is capable of delivering sharply focused radiation which is particularly effective in the treatment of tumors arising in the brain, the eye and spinal cord. Within six years, MGH plans to open a new inpatient tower, bridging Yawkey with the rest of the hospital, and housing several floors for inpatient oncology services and a new radiation oncology facility.
In the research arena, MGH Cancer Center’s growth can be measured by federal funding, which since 2000 has risen about 18 percent a year to today’s level of $42 million. "We have entered an era of cutbacks in federal funding and tight budgets, but our research community continues to make significant progress and compete effectively for external funding," says Deb Zelen, administrative director for research. Basic research laboratories span the breadth of the MGH campus: within the main hospital complex, across the street in the newly opened Simches Research Building and in the expansive Building 149 at the Charlestown Navy Yard. Below is a sampling of cutting-edge research now underway at the MGH Cancer Center:
- Aromatase inhibitors in breast cancer prevention. Medical oncologist and Avon Foundation Senior Scholar Paul Goss, FRCP, MB Bch, PhD, directs breast cancer research and heads a major multinational breast cancer prevention trial to see if aromatase inhibitors, which are highly effective in halting estrogen production, can reduce the occurrence of breast cancer in at-risk postmenopausal women.
- Anti-angiogenesis agents. Rakesh Jain, PhD, directs the Steele Laboratory in Radiation Oncology, exploring the ability of anti-angiogenesis agents to "renormalize" the disrupted blood supply of tumors sufficiently to allow better delivery of effective chemotherapy drugs.
- Hormonal treatment of prostate cancer. Matthew Smith, MD, PhD, is studying survivorship in prostate cancer, specifically the long-term medical complications that accompany the use of androgen-deprivation drugs in the prevention of prostate cancer and how to balance the benefits of these drugs with the associated increased risk of bone and muscle loss and cardiac complications.
- Bone marrow regeneration. David Scadden, MD, director of Hematologic Malignancies and the Center for Regenerative Medicine, has identified important interactions between bone-forming osteoblasts in the marrow and neighboring hematopoietic stem cells. This has led to a clinical trial aimed at enhancing the yield of hematopoietic stem cells in bone marrow transplantation.
- Tumor imaging and minimally invasive surgery. Among state-of-the-art imaging platforms being developed by Ralph Weissleder, MD, PhD, director of the MGH Center for Molecular Imaging and co-director of the Harvard-MIT Program in Nanotechnology, is the use of iron nanoparticles, which are visualized by MRI scanning and which are normally taken up by normal lymph nodes but not by tumor-infiltrated lymph nodes. This radiological advance may radically alter presurgical staging procedures and guide the surgeon undertaking curative treatment in prostate, breast and pancreatic cancers. In cooperative studies headed by Michael Seiden, MD, PhD, director of the DF/HCC Gynecologic Oncology Program, fluorescent probes that are visualized using specially designed laparoscopic equipment are being used to illuminate ovarian cancer cells, which line the abdominal surface and cannot be seen by standard CT or MRI scanning.
- Molecular therapeutics. A broad scale of efforts, bridging from basic to clinical research are underway within the MGH Center for Molecular Therapeutics. Jeff Settleman, PhD, with collaborators Daniel Haber MD, PhD, and Thomas Lynch MD, director of the Center for Thoracic Cancers, Thoracic Oncology, led a team that identified specific mutations in the epidermal growth factor receptor (EGFR) predicting dramatic responses of non-small-cell lung cancer to a specific inhibitor of this receptor. Laboratory research in cancer genetics, molecular signaling and drug pharmacology is now going hand in hand with early phase clinical trials designed to find additional targeted therapies for human cancer.