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Surgical Oncology. In addition, MD Anderson pancreatic cancer surgeons have led multiple clinical trials, with the coordinated goals of maximizing patient survival as well as quality of life. These trials have helped surgeons understand how to improve delivery of existing pre- and post-operative drug and radiation therapy regimes and have tested the efficacy of new therapeutics. Surgeons have also studied ways to optimize each patient’s condition prior to surgery, and have evaluated clinical, molecular, and genetic information in an attempt to create individualized patient-centric treatment algorithms that employ surgery at the time most likely to lead to a favorable therapeutic outcome. “If you can identify the genetic makeup that forms the cancer, you can better determine how aggressive that tumor is and the best way to treat it,” says Jean-Nicholas Vauthey, M.D., professor of Surgical Oncology. Melanoma research and prevention Surgical Oncology researchers are evaluating and perfecting surgical care across 16,000 square feet of lab space and with over 200 active studies. Through these investigations, they expect to improve survival, shorten recovery times, and minimize treatment-related side effects for cancer patients. Jeffrey E. Gershenwald, M.D., professor of Surgical Oncology, is leading multidisciplinary efforts to advance personalized medicine and targeted therapies for patients with melanoma. In 2017, he served as chair of the AJCC Melanoma Expert Panel’s efforts to change melanoma staging after studying a database of more than 40,000 patients worldwide. This revised staging system will guide melanoma patient treatment, provide better prognostic estimates, and refine stratification of patients entering clinical trials. The revision was a part of the recently released “American Joint Committee Cancer Eighth Edition Cancer Staging Manual,” for which Gershenwald served as expert panel leader. Gershenwald’s work is closely linked to that of Surgical Oncology associate professor Jennifer Wargo, M.D., who is leading award-winning research on the microenvironment surrounding certain tumors, specifically how the intestinal microbiome, or bacteria in the gut, helps determine tumor growth and responses to certain cancer treatments, including immunotherapies. Wargo and her lab team are dedicated to conducting basic research on melanoma and the microbiome and coordinating those efforts with other organizations. Recently they looked at immunotherapy checkpoint blockade in melanoma patients by examining fecal microbiome samples. Immune profiling suggested enhanced systemic and antitumor immunity in responding patients with a favorable gut microbiome, as well as in germ-free mice receiving fecal transplants from responding patients. Together, these data have important implications for the treatment of melanoma patients with immune checkpoint inhibitors. “While our findings in this study and others are compelling, we also appreciate that there is a lot of work still left to be done. Our results and those of others indicate that the microbiome could potentially be modulated to enhance the efficacy of immune checkpoint blockade therapies, though this must be carefully tested in the context of clinical trials,” Wargo says. Last, Wargo’s lab is working to improve patient survival in a randomized Phase II clinical trial using novel molecularly targeted therapy delivered before and after surgery. The trial finished early due to the dramatic nature of the results, which demonstrated that neoadjuvant plus adjuvant dabrafenib and trametinib significantly improved Division of Surgery | Surgical Outcomes FY18 41 event-free survival versus standard of care in the enrolled patients. The results immediately resulted in a change in the standard of care in favor of neoadjuvant (preoperative) therapy for such patients. Both Wargo and Gershenwald, along with Michael Davies, M.D., Ph.D., chair of Melanoma Medical Oncology, are actively involved in MD Anderson’s Melanoma Moon Shot, an effort to dramatically reduce melanoma deaths. The Moon Shot is not only focused on identifying new and improved ways of treating melanoma, but also on preventing melanoma from ever starting. Gershenwald partnered with several colleagues in Poland in a multidisciplinary effort contributing to national legislation that restricts indoor tanning use for minors under 18. “We worked with melanoma colleagues in Poland and requested data from their cancer registry. Remarkably, we learned that between 2005 and 2015, melanoma rates nearly doubled in women under age 45,” says Gershenwald, medical director of the Ben Love/El Paso Corporation Melanoma and Skin Center at MD Anderson. “From there, we shared significant scientific evidence about the dangers of indoor tanning and the potential impact of public policies aimed at reducing skin cancer risk in youth with the Polish health ministry and other governmental officials and presidential staff.” The MD Anderson team was recognized for this collaboration by the Chancellery of the President of the Republic of Poland, and in November 2017, a bill prohibiting the use of tanning beds by minors was signed into law and was enacted nationwide in Poland in early 2018. The Polish law is based on similar legislation that was passed in Texas in 2013. MD Anderson surgical and medical oncologists and
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