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The Power of Personalized Medicine Advancing Cancer Care Through Personalized Expertise in a Wide Range Medicine of Cancers 2017 ANNUAL REPORT Patient- Centered, Compassionate Care Personalized medicine is no longer just the future of medicine, it is here. Our NorthShore Kellogg Cancer Center patients benefit from individualized treatment plans and the most sophisticated genomic and tumor analysis that directs therapy to one’s own “personal” tumor characteristics. And just as important as DNA, we personalize treatment based on each individual’s and each family’s needs, attending to nutritional, psychological, financial, and social needs. At the NorthShore University HealthSystem (NorthShore) Kellogg Cancer Center, we are truly dedicated to improving patient outcomes. We come together in teams of specialty trained physicians, nurses and healthcare professionals with the most advanced technology and expertise, all working to provide the best possible care to individual patients. From the quickly evolving world of immunotherapy, which we have made a priority and conducted a vast array of clinical trials, to surgical enhancements including robotic pancreatic cancer surgery, we ensure that our patients have access to the latest and most effective therapies. As both a teaching and research-driven program, we are set apart from many other healthcare institutions. We are further differentiated by our close partnership with the University of Chicago Pritzker School of Medicine and its basic science faculty. We also are distinguished by our clinical affiliation with the Mayo Clinic, which allows us expedited consultations with Mayo Clinic physicians on particularly complex cases. NorthShore is certified by the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) as a premier medical provider for practicing the highest standards for quality cancer care. The Commission on Cancer has continuously accredited NorthShore as an Academic Comprehensive Cancer Program since 1981. Dr. David J. Winchester (left) and Dr. Bruce Brockstein Kellogg Cancer Center has also been designated by Blue Cross Blue Shield of Illinois as a Blue Distinction Center for Complex and Rare Cancers. The Blue Distinction program identifies hospitals with proven expertise in delivering specialty care. These accomplishments validate the team’s approach and underscore the quality, compassionate cancer care patients receive. We are committed to quality as a basic tenet, leveraging more of our resources this year to ensuring optimal patient outcomes. Philanthropic support is essential to maintain our commitment to the comprehensive care that supports patients and their families through the challenging times that can follow a cancer diagnosis. On behalf of the many patients we are privileged to serve, we are so grateful for the continued generosity of our donors. We are pleased to share some of the highlights of personalized care at the Kellogg Cancer Center with this report. Bruce Brockstein, MD David J. Winchester, MD Medical Director Chairman, NorthShore Cancer Committee NorthShore Kellogg Cancer Center Associate Director for Surgical Specialties, Head, Division of Hematology/Oncology Kellogg Cancer Center Kellogg-Scanlon Chair of Oncology Board of Directors, David P. Winchester, MD, Chair of Surgical Oncology ARane Ddsei vBrivlsueieo C nSo homife pHladen aAyls,t shao nCc iIaanrtdeio eSnpe ernvdiceen Ct Loricpeonrasetieo no,f ath Me uBtluuael CLreogsasl Quality Cancer Care: Recognizing Excellence For more information, visit northshore.org/cancer or call (847) 570-2112 The Power of Personalized Medicine: Advancing Cancer Care Kellogg Cancer Center—Experience and Innovation At Kellogg Cancer Center, we have been ahead of or kept pace with national trends in research and clinical use of novel and lifesaving immunotherapy drugs and other advanced treatment options. For more than a century, NorthShore has conducted patient-centered translational research that has resulted in improved clinical care. We have built a distinguished record of cancer care in part because of our focus on improving care through discovery. With an institution-wide focus on personalized medicine, we are now working to even further advance patient care—preventing, predicting and treating cancers with individually tailored care. Pushing the Boundaries of Immunotherapy NorthShore has been actively involved in im- gastroenterology, dermatology, primary care toxicity” utilizing structured education and munotherapy treatment and trials for de- medicine and internal medicine residency) routine involvement of our patient financial cades. With the advent in 2011 of clinical on the scientific basis, clinical uses and, im- advocates. (See “Financial Toxicity Quality use of breakthrough checkpoint inhibitor portantly, the side effect management of Improvement Initiative” on page 2.) Finally, we drugs (ipilimumab first, with several others these drugs. have continued to ramp up our clinical and following since 2014), our implementation of translational research projects in the field of We have implemented a formalized program this treatment modality has been compre- immunotherapy, which has already resulted aimed at minimizing our patients’ “financial hensive, timely and ahead of the curve. in several publications.  The PD-1, PD-L1 and CTLA-4 checkpoint inhibitors are now approved for use in nine Immunotherapy different cancer types, and we have imple- Number of Patients Treated, 2011–2017 mented these treatments promptly for all nine. We have treated more than 490 unique 250 patients—more than 350 in the last two years—with these potentially lifesaving medications, with an expected sharper increase 200 in the number of patients next year. As these medicines work by a very different mecha- 150 nism and have side effects unique from other cancer treatments, we have imple- 100 mented several key programs to maximize access for our patients and optimize quality outcomes. 50 Over the course of 2017, we implemented a joint educational program with two medical 0 2011 2012 2013 2014 2015 2016 Annualized oncologists and an oncology pharmacist. 2017 Together, they educate Kellogg Cancer Patients 7 15 19 21 83 163 193 Center staff as well as vital collaborators in other departments (emergency medicine, radiology, endocrinology, rheumatology, For more information, visit northshore.org/cancer or call (847) 570-2112 Page 1 Center for Medical Genetics Financial Toxicity Quality Improvement Initiative Our Center for Medical Genetics is one of the larg- Cancer therapy in general and newer immunotherapy agents in particular can est and busiest adult genetic counseling centers be exceedingly expensive, and even patients with good insurance are now at nationwide and incorporates genomic information risk for financial toxicity. A team of NorthShore cancer clinicians and allied pro- with the latest genetic technology and information fessionals led by Thomas Hensing, MD, conducted a quality initiative aimed at to provide personalized care and achieve the best developing resources to mitigate financial risk and exposure to financial toxicity outcomes for individual patients. for oncology patients. Pharmacogenomics Part of the American Society of Clinical Oncology (ASCO) Quality Training Program, the pilot program focused on immune checkpoint inhibitors and NorthShore’s Pharmacogenomics Clinic is one of patient education of financial risks at the time of informed consent. only a few in the country that pre-emptively provide Financial toxicity (FTOX) can exacerbate disparities in cancer care and lead to genetic testing to help predict how patients will clinically relevant adverse health outcomes including health-related quality of life, respond to certain medications. Led by Mark symptom burden, adherence and survival. The project resulted in a revised prior Dunnenberger, PharmD, the clinic is an important authorization process that is now in place at Kellogg Cancer Center. The team resource for cancer patients. Currently there are also concluded that FTOX and treatment disparities should continue to be clinical decision-support tools for 72 drugs and monitored closely.  10 genes embedded in the Epic medical record system, up from just three drugs and two genes in The proportion of patients The revised prior authorization 2015. This unique resource is a benefit to patients receiving information about process increased the here and beyond as research efforts continue to financial risk and available proportion of patients starting expand knowledge. The pharmacogenomics team cancer center financial support treatment after confirmation published three papers last year.  services increased from of prior authorization from 0% to 53% 50% to 94% . . Program for Personalized Cancer Care NorthShore’s Program for Personalized personalized care, including experience Cancer Care (PPCC) is dedicated to im- of physicians and patients for genetic proving quality of care by offering proac- testing and cancer screening behaviors. tive and totally personalized cancer care, In addition to Genetic Risk Score, we are from individualized cancer prevention taking a leadership role in proposing a and screening strategies to customized comprehensive approach that combines treatment modalities of localized cancer, Genetic Risk Score and high-penetrance and targeted cancer therapy of advanced genes (HPGs) for inherited cancer risk cancer. Dr. Peter Hulick, Medical Director, Center for Personalized assessment. The PPCC team developed Medicine Development of a novel model, the Pyra- a targeted next-generation sequencing mid Model for Personalized Cancer Care panel to effectively implement this ap- Center for enables our commitment to individualized proach for discovery and translational re- Personalized Medicine care and is based on the principle that search. Using this panel, we found both personalized medicine should not be lim- pathogenic mutations in HPGs and high Under the direction of Peter Hulick, MD, NorthShore’s ited to treatment. The Pyramid Model Genetic Risk Score can predict risk for Center for Personalized Medicine brings together contains four tiers: (1) screening and pre- lethal prostate cancer (results published multispecialty experts and provides transforma- vention, (2) diagnosis, (3) early-stage dis- in the New England Journal of Medicine tional patient care based on genetic information, ease and (4) late-stage disease. and European Urology). We also found including personalized clinics in eight medical spe- that germline (inborn) mutations in HPGs The PPCC team developed a Genetic cialties. The Center strives to bring personalized predict grade reclassification of patients Risk Score tool to assess an individual’s medicine to the frontlines of care as quickly and ef- undergoing active surveillance. inherited risk of various types of cancer fectively as possible—and in treating cancer, it spans based on multiple cancer risk-associated To ensure that patients outside of the spectrum from cancer risk in the healthy individ- genetic variants or single nucleotide poly- NorthShore can access our novel inher- ual to the treatment of the most advanced cancers. morphisms (SNPs). An ongoing Genetic ited risk assessment tool, we success- The Center is building the infrastructure to offer Risk Score trial is recruiting NorthShore fully established a strategic partnership cancer risk/genetic assessment at the primary care patients through their primary care physi- with Ambry Genetics, a leading medical level throughout the entire NorthShore system to cians to provide Genetic Risk Score of genetic testing company. Members of meet expanding demands of genomics based colorectal cancer as well as breast (female the PPCC have published more than medicine. While personalized approaches take patients) and prostate (male patients) for 30 peer-reviewed manuscripts in high- place for each cancer patient, our specific per- personalized screening recommendation. impact journals, including the New England sonalized cancer clinic offers consultations for the The trial will evaluate practical aspects of Journal of Medicine and JAMA.  assessment of optimal treatment for the most implementing genomic information for difficult cases based on cancer genetics.  Page 2 For more information, visit northshore.org/cancer or call (847) 570-2112 Pathology and Expertise in a Wide Laboratory Medicine More than 70 percent of treatment deci- Range of Cancers sions are based on laboratory results. NorthShore’s team of experts has been a leader in using advanced tumor diagnostics and DNA analysis to personalize patient care. The ability to conduct sophisticated laboratory testing in-house means quicker and more accurate diagnosis and treat- Breast Oncology ment recommendations for our patients. The majority of all “actionable” mutations NorthShore’s comprehensive, collaborative expression in breast cancers and axillary and genetic variants are tested for in- breast program is one of the largest aca- nodes. house, allowing for the rapid initiation of ap- demic, multispecialty practices in the state propriate therapy.  of Illinois, and patients with breast cancer Major recruitments include a new fellowship- represent the largest percentage of Kellogg trained, full-time breast surgeon, Katherine Cancer Center patients. A focus on preven- Kopkash, MD, who is joining our program as 50-Gene “Hotspot” tion and early detection is at the core of our Director of Breast Oncoplastic Surgery and program, and robust research activities con- will start a robotic mastectomy program. A Cancer Panel tinue to distinguish our efforts and enhance new breast medical oncologist, Poornima patient care. Kellogg Cancer Center’s ad- Saha, MD, who completed her hematology Leaders in state-of-the-art next-genera- vanced, personalized care is accredited by oncology fellowship at the University of tion sequencing (NGS), we have expand- the American College of Surgeons’ National Chicago, has joined the Kellogg Cancer ed our capabilities around the 50 Gene or Accreditation Program for Breast Centers Center team to lead our strong breast can- “Hotspot” cancer panel and are now (NAPBC), and our fellowship-trained special- cer clinical trial program. able to obtain additional gene amplifica- ists continue to serve in leadership roles. All tion and translocation information. three breast centers feature the latest tech- Anatomic pathologist Megan Sullivan, MD, funded by a NorthShore research pilot Our molecular diagnostic lab’s unique nology, including 3-D mammography. award, is conducting research to examine in-house sequencing capability allows us Among the many new initiatives and high- cell-free DNA in breast cancer patients un- to rapidly look at large genomic regions lights from last year is a new research dergoing neoadjuvant chemotherapy. targeting almost 3,000 possible variants study examining a Genetic Risk Score for involved in cancer. A new partnership David J. Winchester, MD, currently serves risk prediction in women undergoing annual with PierianDx expands our reporting to on the AJCC 8th edition breast staging mammograms in our high-risk breast clinic. include current clinical trials and up-to- committee and will help launch the new Katharine Yao, MD, along with a breast the-minute treatment options, all linked to staging manual both at NorthShore and cancer genomics research fellow, funded NorthShore’s Electronic Medical Record. nationally. Dr. Pesce has developed a by the Harold and Jane Perlman Family All advanced-stage lung and colon can- Foundation, are studying genomic profiles of breast ultrasound-guided core biopsy cer patients now undergo this genomic women with contralateral breast cancer. module for resident teaching in the testing. In addition, we use this panel for Grainger Center for Simulation and Innova- many other tumor sites—including brain, Catherine Pesce, MD, initiated a radioac- tion. Dr. Yao is the program chair of the melanoma and thyroid, where we are tive seed localization program and is also American Society of Breast Surgeons beginning to use the advanced testing to conducting research to examine HER2/neu meeting in 2018 in Orlando, Florida.  help predict malignancies in common thyroid nodules. Testing will be expanded to leukemia and lymphoma patients this year. We plan to expand our capabilities to broader panels and include molecular biomarkers in the coming year. Performing these tests in-house means significantly faster results and quicker treatment for our patients. NorthShore’s advanced instrumentation also enables our lab professionals to accurately analyze very small samples from fine-needle biopsies, sparing our patients from undergoing more invasive procedures. These sophisticated genomic tests drive personalized care and improve patient outcomes.  Dr. Katharine Yao, Chief of Surgical Oncology For more information, visit northshore.org/cancer or call (847) 570-2112 Page 3 Prostate/Genitourinary Cancer The Genitourinary Oncology Program at screening and now uses a prostate cancer research group and others have validated Kellogg Cancer Center offers the latest inherited cancer panel (ICP) test developed that these gene mutations significantly in- treatments for patients with advanced ma- by our physician-scientists in collaboration crease the risk of prostate cancer and lethal lignancies and is also focused on early de- with Ambry Genetics. The blood test can disease. In addition, the new blood test also tection and risk stratification. The prostate provide information on whether a man car- provides a Genetic Risk Score. The Genetic cancer program for localized disease has ries gene mutations that are associated with Risk Score test documents information on made tremendous progress over the past increased prostate cancer susceptibility and an individual’s inherited risk of developing year and is the prototypical program for per- aggressive disease. prostate cancer. The higher a man’s Genetic sonalized medicine at NorthShore. Risk Score, the higher likelihood that he will Determining whether a man is a carrier of be diagnosed with prostate cancer and The program aims to identify men who gene mutations within BRCA1/2 and ATM is aggressive disease throughout his lifetime. would most benefit from prostate cancer particularly important as findings from our Together, the results of this genetic test can identify which men are most likely to benefit Active Surveillance Prostate Cancer from screening and certain treatments. In addition, we also provide access to ad- 66 455 103 ditional genomic tests that can be used after a tissue diagnosis of prostate cancer has been determined. The results of these Average age Total number enrolled Total number of patients tests (e.g., Oncotype DX, Prolaris and at enrollment progressed/treated Decipher) can further help guide treatment decisions including active surveillance, sur- Caucasian: 368 57 on gery or radiation. These are some of the African- Confirmation Biopsy many tests we are using in urology to American: 25 improve and personalize prostate cancer Asian: 6 46 on care. Within the past year, our team of Other: 56 Surveillance Biopsy clinical urologists and researchers has published more than 25 publications in peer-reviewed journals.  Gynecologic Oncology Intensive international research efforts and and the combined experience of gyneco- associated with the fight against cancer. advances in surgery, chemotherapy and logical oncologists, geneticists, radiologists, Our palliative care initiatives are being spear- novel biological agents over the past decade radiation oncologists, pathologists and criti- headed by Elena Moore, MD, in collabora- are leading to improved outcomes in women cal support services, including psychosocial tion with the NorthShore palliative care and with gynecologic cancers, including higher oncology, integrative medicine and nutrition. hospice teams. This has included both clini- cure rates. The Division of Gynecologic We leverage the latest technology and in- cal initiatives as well as research as we seek Oncology has been at the forefront of novative techniques with robotic surgery to mitigate the side effects/toxicity and progress, supporting an aggressive clinical and other minimally invasive procedures symptoms associated with gynecologic and research program aimed at preven- through our minimally invasive program, cancer and its treatment. Dr. Moore is the tion, early detection, improved treatment which is among the most active in gyneco- principal investigator of a study evaluating and survivorship for ovarian, uterine and logic oncology in the Chicago area. the impact on quality of life and survival of other women’s cancers. Led by Gustavo The outstanding quality of care provided by early involvement of the palliative care team Rodriguez, MD, Matthews Family Chair of the Division has been recognized by third in women with gynecologic cancers. She Gynecologic Oncology Research, the Division parties including Press Ganey, with scores was also the recipient of a departmental sees patients at all four NorthShore Hospitals that are at the top for the NorthShore Innovation Grant to critically evaluate che- and brings together a collaborative team that Medical Group and in the top 5 percentile motherapeutic approaches for women employs a multidisciplinary approach to nationally as compared to peers. with advanced ovarian cancer. treating women with malignant or premalig- A major emphasis of the Division in the past Our newest partner, Mary Tilley Jenkins nant conditions of the gynecologic tract. year has been the development of a robust Vogel, MD, has now fully integrated clinical The Division’s mission is to provide compre- survivorship program, spearheaded by services throughout the NorthShore system, hensive and compassionate care to patients Carolyn Kirschner, MD. The goal of the program but with a special focus on expanding ac- while performing basic and clinical research is to enhance the quality of life of our patients cess and care at NorthShore Glenbrook that will make a significant impact in our and their families by helping them address Hospital. She has initiated clinical studies community and beyond. and overcome the many physical, psycho- with a focus on pharmacologic prevention of Patients benefit from the collaborative care logical, social and economic challenges endometrial cancer.  Page 4 For more information, visit northshore.org/cancer or call (847) 570-2112 Gastrointestinal Oncology Colorectal Cancer Program embolization of tumor vasculature, radio- offers personalized risk-reduction strategies, frequency ablation and Yttrium-90 perfu- including lifestyle modifications. Kellogg Cancer Center’s multidisciplinary sion of the liver. These techniques are team leverages collective expertise and the Innovative research is a key component of minimally invasive and either supplement latest technology to offer individually our GI program. We participate in a number current multimodality approaches or replace focused treatment to all patients with colo- of national and international studies, ensur- older, more invasive therapies. Radiation rectal cancer. Our collaborative approach ing that our patients have access to cutting- therapy and nuclear medicine are able to ensures outstanding care for rarer or more edge research and novel treatment options. offer all of the latest techniques, as the situ- complicated cases and is facilitated by mul- Our collaboration with our academic partner, ation requires, including stereotactic body tidisciplinary clinics at both NorthShore the University of Chicago Pritzker School of radiation therapy and the many varieties of Evanston and Glenbrook Hospitals where Medicine, significantly enhances our research targeted radioactive particle infusion. patients can see experts from gastroenterol- efforts and facilitates access to an even ogy, medical oncology and surgery all in Medical oncology is increasingly moving broader range of studies. one location. Our Kellogg Cancer Center away from a “one size fits all” approach to an Sophisticated technology plays an increas- team is supported by psychosocial oncolo- anatomical and molecularly based treatment ingly critical role in diagnosing and treating gy, integrative medicine, specially trained paradigm that ensures that effective therapy is benign and malignant tumors in the colon pharmacists, nurses, nutritionists and more, chosen right from the start. All new patients and rectum. Endoscopic ultrasound exami- providing comprehensive and seamless care. are presented in a multidisciplinary confer- nations and dedicated MRIs are very valu- ence prior to starting therapy, ensuring that Leaders in minimally invasive surgical able tools that have become indispensible in all the latest options are considered. techniques, NorthShore surgeons perform advanced diagnostics and therapeutics. laparoscopic procedures on most patients. Our program continues to emphasize pre- Newer instruments and techniques now We are one of only a few centers in the vention and early detection and offers a make the removal of early-stage cancers Chicago area using minimally invasive and high-risk colorectal cancer clinic for patients without surgery a definite possibility, and robotic approaches to manage liver resec- who have a family history or other high-risk this option is carefully weighed in all appro- tions, a not-uncommon problem in colorec- health history. Specialists in medical genet- priate situations. tal cancer. Our experienced surgeons con- ics meet with patients and families in this Hepatopancreatobiliary Program tinue to push the boundaries of innovative clinic and help coordinate personalized technology, including scarless, or transanal screening plans based on individual medical The Hepatopancreatobiliary (HPB) Program and transoral procedures. and family history. A special Women’s GI experienced continued growth in the clinical Cancer Risk and Prevention Center coun- realm with the implementation of minimally Interventional Radiology offers a full spec- sels women about their individual risk and invasive pancreaticoduodenectomy (robotic- trum of therapeutic interventions, including assisted) surgery and the addition of two new oncologists to NorthShore. Our physician-scientists continue to participate at national meetings and are involved in that publication of a number of important studies. A vital aspect of the program is the HPB multidisciplinary conference attended by specialists from diagnostic and interventional radiology, pathology, oncology, gastroenterology, hepatology and surgery, meeting weekly to present and discuss spe- cialized treatment plans for patients with complex hepatic and pancreatic disease. The HPB multidisciplinary clinic takes place immediately following the conference. Patients are often seen by medical oncologists, surgeons, hepatologists and gastroenterologists at the same clinic visit and in the same clinic space, assisted by dedicated nurse navigators. This has also facilitated integration of a personalized medicine approach into treatment planning and research participation. Genetic and molecular analysis is frequently a part of the discussion—and if the results are complex, they are presented and reviewed at our dedicated molecular medicine tumor board. Patients may also be referred for counseling in our Department of Medical Dr. Mark Talamonti, the Stanton and Margaret Rogers Palmer Chair of Surgery, is a leader in advanced robotic technology for minimally invasive procedures for patients with pancreatic cancer. Genetics.  For more information, visit northshore.org/cancer or call (847) 570-2112 Page 5 Thoracic Oncology The multidisciplinary Thoracic Oncology Program (TOP) continues have been expanded to the Lake County region by the effort of inter- to expand clinical capabilities and pursue both translational and ventional pulmonologist Keenan Hawkins, MD. clinical outcomes research, improving care for our patients and TOP continues to develop a robust research program. Our transla- contributing to the broader understanding and treatment of tho- tional program has expanded the clinical trials menu with the ultimate racic malignancies. goal of having a clinical trial opportunity for all patients in our program. Our Lung Cancer Screening Program, with a digital health com- Novel immunotherapy strategies are a focus, and Thomas Hensing, ponent through our Electronic Medical Record (EMR) system, is MD, Co-Director of TOP, is leading a national multicenter clinical trial designed to coordinate patient care throughout our system and op- investigating the optimal sequencing of immunotherapy with standard erates under the guidance of a multidisciplinary committee group led chemotherapy in patients with advanced non-small cell lung cancer. by Neil Freedman, MD, Division Chief for Pulmonary and Critical Our clinical research database and biobank have grown and, through Care Medicine. a collaborative partnership with the University of Chicago, have been used to support translational research initiatives on immune check- TOP, in collaboration with our colleagues in pathology, uses our ad- points and acquired chemotherapy resistance. vanced molecular diagnostic capabilities, expanding our next-generation sequencing platform to help identify the ever-growing list of Our thoracic surgeons, Ki Wan Kim, MD, Interim-Chief of Division of potentially treatable molecular alterations. This has greatly improved Thoracic Surgery and Co-Director of TOP, and Seth Krantz, MD, are our ability to provide personalized treatment recommendations for not only providing the highest quality surgical care utilizing minimally our patients. All new patients are reviewed by our multidisciplinary invasive surgical approaches for thoracic malignancies, but also ac- thoracic oncology tumor board, which is comprised of medical on- tively pursuing clinical research. A clinical outcomes research program in cologists, thoracic surgeons, radiation oncologists, pathologists and thoracic surgery has been productive using the National Cancer Data- radiologists, ensuring the coordination of care and a timely, efficient base (NCDB); Surveillance, Epidemiology, and End Results (SEER) data- and complete diagnostic and therapeutic evaluation. base, and The Society of Thoracic Surgeons General Thoracic Surgery The access and availability of cutting-edge diagnostic tools such as Database (STS-GTSD). These activities have led to multiple presenta- navigational bronchoscopy and endobronchoscopic ultrasound tions at national meetings and publications in peer-reviewed journals.  Dr. M. Jaffer Asif, pulmonary disease specialist Dr. Stacy Raviv, pulmonary Dr. Keenan Hawkins, Director of the new Advanced Pulmonary Diagnostics Program and respiratory therapist Tracy Bingham, RCP. disease specialist Advanced Pulmonary Diagnostics pulmonary disease. The program also advances NorthShore’s commitment to lung cancer screening and early cancer detection. Thoracic oncology patients benefit from NorthShore’s new Advanced The Advanced Pulmonary Diagnostics Program includes Stacy Pulmonary Diagnostics Program, which offers state-of-the-art, minimally Raviv, MD, and M. Jaffer Asif, DO, at NorthShore’s Evanston and invasive procedures enabling cancer detection, advanced diagnosis Glenbrook campuses where a range of advanced pulmonary and assistance with development of personalized treatment plans. diagnostic procedures are also available. Together, the phy- Keenan Hawkins, MD, serves as the inaugural director of the program, sicians of the program contribute to an environment of uniform which is based at NorthShore Highland Park Hospital and is among the and uninterrupted care for patients throughout the NorthShore first in northern Illinois to offer a comprehensive array of advanced diag- healthcare system in need of advanced diagnostic broncho- nostic, minimally invasive procedures aimed at the management of scopic procedures.  Page 6 For more information, visit northshore.org/cancer or call (847) 570-2112 Neuro-Oncology Hematology and Hematologic Malignancies The Division of Neuro-Oncology cares for a The Hematologic Malignancy Program at wide variety of patients, including those with NorthShore offers the latest care for patients primary brain and spine tumors, meningiomas, with acute and chronic leukemia, myeloma, central nervous system (CNS) lymphoma, meta- Hodgkin and non-Hodgkin lymphoma. Led static tumors, paraneoplastic syndromes and by Lynne Kaminer, MD, Virginia and James neurologic complications of cancer. We col- Cozad Chair of Hematology/Oncology, the laborate closely with Medical Oncology on the program features four full-time hematolo- latter two categories. We see patients at all gists and three additional physicians three Kellogg Cancer Centers. whose practice is focused on hematology. The team sees patients at all four North- Neuro-oncologist Heather Leeper, MD, joined Shore Hospitals and our Ambulatory Care our team this year, after serving as the direc- Center in Gurnee. Close collaboration with tor of Neuro-Oncology at Advocate Health hematopathologists and a multidisciplinary System. She previously completed a neuro- conference to review cases, lymph node and oncology fellowship at Mayo Clinic. Dr. Leeper bone marrow specimens, and treatment sees patients at Evanston and Highland Park Hospitals, and our Lincolnshire office. Ryan plans are key elements of our program. The Dr. Lynne Kaminer, Virginia and James Cozad Chair of hematopoietic stem cell program for myelo- Hematology/Oncology Merrell, MD, sees patients at Evanston and ma and lymphoma continues to grow and Glenbrook Hospitals. evolve and was reaccredited by the Foundation for the Accreditation of Cellular Therapy We work closely with Neurosurgery, and (FACT). The continued use of the new, multicolored channeled flow cytometer allows more Julian Bailes, MD, Chair of the Department of precise characterization of immunophenotype of tumors. Neurosurgery, Arlene and Marshall Bennett We have the ability to use an initial sample as a baseline to look for and detect minimal residual and Joseph A. Tarkington, MD Chair of Neuro- disease post therapy, which allows for more precise decisions regarding ongoing mainte- surgery, serves as our primary brain tumor nance therapy, or to predict early relapse and allow for early intervention. We continue to neurosurgeon. Dr. Bailes continues to use ad- develop specific multigene panels with molecular pathology to identify mutations associated vanced neurosurgical techniques, including with specific malignancies to guide therapeutic decisions. We analyze molecular features of the NICO system, to improve the extent of tumors to enable more precise therapy and can identify subgroups that are at higher or lower surgical removal of brain tumors and de- risk or have specific mutations to facilitate therapeutic treatment decisions. Among the new crease the length of hospitalization. NICO in- studies that opened this year are several that address specific molecular mutations in both volves an endoscopic port that creates an acute myeloid leukemia and myelodysplastic syndromes.  easier path through the brain and allows greater removal of tumors. It preserves the Head and Neck Oncology tissue better, allowing for enhanced tissue analysis. We also use the Synaptive system, a sophisticated brain-mapping system that A collaborative team of experts in otolaryn- The approval of immune targeted therapies allows the neurosurgeon to avoid harming gology/head and neck surgery, radiation (pembrolizumab and nivolumab) for use in vital structures in the brain. Ricky Wong, MD, oncology and medical oncology—as well recurrent/metastatic head and neck cancers is another key member of the team who pro- as plastic and reconstructive surgery, den- has given medical oncologists the ability vides expertise in skull base tumors and offers tal medicine, physical medicine and reha- to provide patients a chance at long-term additional minimally invasive innovative sur- bilitation, psychosocial oncology, nutrition, remission. We were among the first in the geries including “eyebrow” surgery, removing physical therapy, diagnostic and interven- area to offer this treatment in structured tumors through a tiny incision near the brow. tional radiology, pathology, nursing, and clinical trials, and now in FDA-approved more—come together in NorthShore’s head available medications. Our program offers the most cutting-edge and neck cancer (HNC) group. clinical trials. We currently have three trials for Robust research continues, including ongoing gliomas and will soon be adding two addition- The HNC Program welcomed Cheryl Nocon, translation projects in genomic profiling of al glioma trials and one for meningiomas. One MD, to the team in an exciting year. Dr. Nocon aggressive cutaneous squamous cell carci- of the glioma trials for newly diagnosed glio- completed a fellowship in head and neck noma, and altered lipid metabolic pathways blastoma and anaplastic (grade III) gliomas is a surgical oncology and microvascular recon- in head and neck squamous cell carcinoma. collaboration between NorthShore and the structive surgery at the University of Wisconsin. We are analyzing a large database of patients University of Chicago involving a concept Her presence will continue to grow the pro- treated with chemotherapy and radiation to based on basic science research done in the gram both academically and clinically. She assess outcome and effect on the immune laboratory at the University of Chicago. We cur- has special interest in qualitative head and system. rently have a trial for newly diagnosed glioblas- neck cancer research. Our team made numerous presentations at toma patients, as well as one for recurrent Evanston Hospital became the first center national meetings and had many publica- patients involving the ABT-414 drug. ABT-414 in the Midwest to perform an innovative tions in prestigious journals. We continue is a novel antibody-drug conjugate that tar- minimally invasive procedure using a flexible with outreach efforts aimed at raising gets the epidermal growth factor receptor. robotic system. This state-of-the-art device awareness of the role of human papillomavi- We continue to work with the Gliogene group, will allow head and neck surgeons Mihir rus (HPV) in head and neck cancer and the an NIH-funded multi-institution group that Bhayani, MD, and Dr. Nocon to perform opportunity to prevent cancer with the HPV studies the epidemiology of gliomas. Several transoral tumor resections that are more vaccine in boys and girls. We also offer an publications have been generated through targeted than current robotic and transoral annual free oral cancer screening.  the studies of this group.  technologies.  For more information, visit northshore.org/cancer or call (847) 570-2112 Page 7 Melanoma and Other Skin Cancers Malignant melanoma of the skin has the molecular pathologists are uniquely posi- access to these drugs through clinical trials, fastest rising incidence of any cancer in tioned to test for this mutation, along with providing an advantage for our patients and the United States. NorthShore’s multidis- multiple less common melanoma gene early expertise for our clinicians. ciplinary Melanoma Program offers the mutations, within our own lab. This test allows New studies this year include partnerships depth and breadth of experience to use our patients to begin appropriate treatments with the University of Chicago assessing complicated new therapeutics. within days rather than weeks when the test treatment of patients whose cancers no lon- needs to be sent to a referral lab. These Whereas metastatic melanoma was previ- ger respond to nivolumab or pembrolizumab, therapies have added years to patients’ ously one of the deadliest forms of cancer, as well as an important biobanking/bio- lives. greater advances have been made in this marker study assessing correlations between disease than almost any other form of can- Melanoma has been the cancer most posi- patients’ inborn genetics, tumor genetics, cer. In the last six years, NorthShore’s tively impacted by major advances in im- stool “microbiome” and the presence of the melanoma team has had the expertise and munotherapy for cancer. The “checkpoint important “inflamed tumor phenotype” that support to bring these advances to our inhibitor” drugs ipilimumab, pembrolizumab corresponds to response to immunotherapy. patients early and safely. and nivolumab are all now approved for rou- Additionally, our Melanoma Program has tine use in advanced melanoma and have New molecularly targeted therapies are avail- provided an excellent opportunity to educate the capacity to add years to some patients’ able for the nearly 50 percent of metastatic key partners within our institution on the lives. Long-term cancer control or cure of melanoma patients whose tumors carry principles of immunotherapy and diagnosis metastatic melanoma is now possible for specific mutations in the BRAF gene. Our and assessment of side effects. The PD-1, nearly half of our patients. We had early NorthShore’s Ambulatory Care Center in Gurnee provides increased access for patients and families in Lake County. Greater Access for Patients Kellogg Cancer Center provides advanced compassionate care at our three hospital locations—Evanston, Glenbrook and Highland Park—and at our Ambulatory Care Centers in Gurnee and Skokie. We continue to expand services for our growing patient base making all phases of treatment as con- venient as possible. Five of our cancer physicians provide hematology and oncology consultations and follow-up care at NorthShore’s Gurnee Ambulatory Care Center at 7900 Rollins Road, just west of the Gurnee Mills shopping center, increasing access for patients and referring physicians in Lake County. This allows the expert consultation close to home, as well as follow-up close to home for those treated at our hospital-based Kellogg Cancer Center locations. We offer similar consultative and follow-up services at our Skokie location.  Medical Oncologist Dr. Matthew Adess with Kellogg Cancer Center nurse Diana Iacovo Page 8 For more information, visit northshore.org/cancer or call (847) 570-2112