‘The BEST Is Yet
to Come’

Sylvester Comprehensive Cancer Center’s NCI designation sets the stage for powerful new scientific advances and clinical therapies

Applause filled the tent as NCI’s Dr. Robert Croyle called Sylvester a “crown jewel in the war on cancer.”

While many knew what would be announced, there was a discernible excitement among the invitees who included Sen. Rick Scott and Rep. Donna Shalala. On July 29, faculty and staff joined civic and University leaders on the Schoninger Research Quadrangle to celebrate Sylvester Comprehensive Cancer Center receiving the long-awaited National Cancer Institute designation for its groundbreaking scientific and clinical research.

Sylvester is now the only NCI-designated cancer center in South Florida, and one of only 71 in the nation.

“This is a truly exceptional accomplishment,” said Robert Croyle, Ph.D., director of the NCI’s Division of Cancer Control and Population Sciences, speaking at the ceremony. “NCI centers are the crown jewels of the nation’s war on cancer, and the standards are very high. It takes years of preparation and work, with strong leadership from the University, the state and the community. We are looking forward to the new scientific advances and therapies you will provide.”

No one at the ceremony was prouder than Stephen D. Nimer, M.D., Sylvester’s director. When Dr. Nimer joined Sylvester in 2012, he was determined to build a nationally recognized center for cancer care, research and medical education.

“I became a physician to help people,” Dr. Nimer said. “In medical school at the University of Chicago, I had an inspirational teacher, Dr. Janet Rowley, a genetics researcher who recognized the role of the Philadelphia chromosome in leukemia. As soon as I started caring for patients with leukemia, I was hooked. I could look at a patient’s blood on a microscope slide and then figure out what was wrong with that patient.”

Today, Dr. Nimer remains passionate about finding better treatments for leukemia and the many other types of cancers.

“I feel very privileged to be a cancer researcher and physician,” he said. “For me, giving new hope to the 7,000 to 8,000 new patients a year we see at Sylvester is incredibly rewarding.”

UM President Julio Frenk congratulates Sylvester Director Dr. Stephen D. Nimer at the podium.

Sylvester researchers and clinicians gather in a celebratory circle.

Changing the culture

It took six years of painstaking teamwork before Dr. Nimer was ready to apply for the NCI designation, which is based principally on research, community outreach and education. One of his early steps was to reorganize and expand Sylvester’s basic science and clinical research programs.

“When I first got here, many investigators worked in silos,” he said. “We changed the culture to one of collaboration, and that has improved everyone’s work.”

Dr. Nimer recruited talented researchers, clinicians and educators who shared his vision of teamwork and commitment to science.

“Our physician-scientists have been invited to present key research findings at the major national meetings,” he said. “We also have a strong international outreach program, teaching and training oncologists throughout Latin America and the Caribbean.”

In September 2018, Dr. Nimer and his leadership team formally submitted a 1,300-page application to the National Cancer Institute detailing Sylvester’s research, clinical care, community initiatives and more. Together, they conducted 12 seven-hour rehearsals in preparation for the NCI site visit in January, which included a number of presentations and intensive interviews.

Sylvester’s research has led to breakthrough discoveries, supported by the expertise and technologies provided by the cancer center’s shared resources and clinical research services.

“The commitment to excellence, collaborations across disciplines and expertise were readily apparent to the NCI,” Dr. Nimer said. “As part of the Miller School and the University of Miami, we have put together a group of people from different disciplines who are working extremely well together.”

On the financial side, Sylvester’s research programs have received a growing level of support from very competitive federal and state grants, research contracts and philanthropic contributions. That financial support played a vital role in achieving the NCI designation.

“One of the key elements was our level of grant funding,” Dr. Nimer said. “Today, we have more than $30 million in peer-reviewed funding, compared with $9.9 million in 2014. That is a truly astonishing performance, because these grants are very difficult to obtain.”

Multidisciplinary programs

The passion for finding better ways of diagnosing and treating cancer is shared by Sylvester’s scientists, who were grouped into three multidisciplinary research programs for the grant applications.

“We looked at our research strengths and the unique population diversity of our South Florida community,” Dr. Nimer said. “That led us to three areas where we can apply our expertise and share that knowledge with our NCI colleagues across the country.”

Sylvester’s Cancer Control Program looks at reducing the incidence of cancer and its impact on patients in the region.

“When I joined Sylvester, I wanted to understand why so many women from Haiti were dying from cervical cancer, a treatable disease,” said Erin Kobetz, Ph.D., M.P.H., one of the program’s co-leaders, who was recently named the University of Miami’s co-vice provost for research. Dr. Kobetz, who is also professor of medicine and Sylvester’s associate director for population science and cancer disparity, said, “That led me into community-based, participatory research aimed at improving the quality of life for the people who live here. South Florida is thought to represent the future demographic of the United States, and our cancer control programs can serve as models for the nation.”

For example, Sylvester’s Firefighter Cancer Initiative, which has received funding from the state since it was launched in 2015, has worked to figure out why firefighters are at increased risk of developing and dying of cancer, and to identify methods for reducing risk. Led by a team of scientists, health care practitioners, and occupational health and safety experts, the initiative uses community engagement approaches to ensure that firefighters are represented in all aspects of program planning. It has inspired a national dialogue by reducing exposure to carcinogens through education and by implementing evidence-based methods. More than 4,000 decontamination kits are being used by firefighters across Florida to help them clean up after responding to a call.

The NCI designation will open the door to further research funding, collaborative studies with other leading academic centers and new life for patients.

The Cancer Epigenetics Program studies modifications to gene structure that occur due to aging, the environment, nutrition and other factors. “Very few centers have programs dedicated to epigenetics, which is like the software that runs on the cell’s genetic hardware,” said Maria Figueroa, M.D., one of the program’s co-leaders. “We are just at the beginning stages of learning how to edit or reprogram that software to correct mutations or metabolic problems that can lead to cancer.”

Dr. Figueroa, an associate professor of human genetics, trained as a hematologist in Argentina and found she had a passion for cancer research. In New York, she would read genomics and bioinformatics books while riding the subway to her office.

“I learned to keep studying the cancer process until you can find the solution, even if it is hidden deep in the cell,” she said. For instance, Dr. Figueroa led a recent study that found that epigenetic changes to blood-forming stem cells as people age may contribute to acute myeloid leukemia and possibly other blood cancers.

Sylvester’s Tumor Biology Program takes a broad, integrated perspective into cellular interactions within the complex biological landscape of tumors.

“With our diverse minority populations, the incidence of some tumors is higher than average,” said Wael El-Rifai, M.D., Ph.D., one of the program’s co-leaders, who is also professor of surgery and associate vice chair of the Department of Surgery. “We want to understand the mechanisms of tumor initiation and progression. This step is critical for developing a personalized treatment approach based on the characteristics of the tumor in each patient.”

Early in his career as a cancer geneticist, Dr. El-Rifai became concerned with the increasing global cancer burden. That led him into the field of research on gastric and esophageal cancers, which affect more than one million people every year worldwide. By understanding the biology and behavior of tumor cells, he strives to make a difference in the lives of cancer patients.

“We are only looking in one direction — toward the future,” said Dr. Stephen D. Nimer.

— Photograph by Jeffery Salter

A strategic plan for the future

WITH SYLVESTER BEGINNING THE NEXT PHASE of its journey, Dr. Nimer and the leadership team have identified new research, clinical care and outreach initiatives.

At Sylvester’s annual faculty retreat in May, Dr. Nimer presented a five-year strategic plan with three key themes: increase the social and translational focus of the center’s research programs, develop and grow shared research resources, and launch a developmental therapeutics program.

“Eliminating the burden from cancer requires innovation across the research continuum, from basic research on the biology and origins of cancer, to clinical trials that test promising discoveries, to the development of novel therapies and prevention approaches,” he said. “ Sylvester will continue to build an integrated pipeline of discovery.”

Now, the NCI designation will open the door to further research funding, collaborative studies with other leading academic centers, and new life for patients.

“We are only looking in one direction — toward the future,” Dr. Nimer said. “We will never relent in our quest for cures. The best is yet to come.”

Program Cuts Firefighters’ Cancer Risk

Studies about a decade ago began showing that firefighters have higher rates of many cancers, including multiple myeloma, non- Hodgkin’s lymphoma, and prostate and testicular cancer, than the general population.

Through continued research, the reasons began to emerge: Every time firefighters respond to a fire, whether in a house, a dumpster, a car, or in wild lands, they can be exposed to an ever-increasing array of known cancer-causing agents. And due to the ingrained, tough-guy culture found in fire stations everywhere, they often don’t wear breathing masks at the site or clean up afterward, bringing the contaminants back to their station or home with them.

Sylvester responded to the challenge in 2015 by launching the Firefighter Cancer Initiative through a state of Florida appropriation. Its primary goals are to better document and understand cancer among Florida firefighters, and identify novel, evidence-based methods for reducing risk.

Firefighters are learning ways to reduce potential contamination by cancercausing agents.

— Photograph by David Sutta Photography

In June, the program’s success attracted more than 325 firefighters, scientists, researchers, and other stakeholders from seven countries to the inaugural State of the Science National Firefighter Cancer Symposium, hosted by Sylvester. Their mission was to begin developing a scientific road map for controlling and preventing cancer among firefighters.

“I haven’t seen the depth of this kind of science in one place,” said symposium co-chair Erin Kobetz, Ph.D., M.P.H., the director and principal investigator of the Firefighter Cancer Initiative. “We have leadership from across the globe, scientists and firefighters alike, here to help us think through the most challenging research questions about how we address the excess burden of cancer in the fire service.” — Maya Bell

Research Leads to Patient’s ‘Miracle’

After being diagnosed with inoperable pancreatic cancer, Irma Infante began praying for a miracle. She found one at Sylvester.

“I am so grateful to my doctors,” Infante said. “Without them, I wouldn’t be here today.”

Infante’s remarkable journey to recovery from one of the deadliest types of cancer began last year, when she turned to Alan Livingstone, M.D., the Lucille and DeWitt Daughtry Professor of Surgery. He saw that her tumor had spread outside of the pancreas, so she was not a candidate for surgery.

Pancreatic cancer survivor Irma Infante is just one of Sylvester’s “miracle patients.”

— Photograph by David Sutta Photography

“But he told me, ‘You can fight this,’” said Infante, 54. “He was a light in one of the darkest times of my life.”

Dr. Livingstone referred Infante to Peter Hosein, M.D., one of Sylvester’s principal investigators leading clinical trials for patients with liver and pancreatic cancers. After talking to Infante and her husband, Joe, Dr. Hosein learned that her maternal grandmother and aunt had died from breast cancer. Genetic testing revealed that Infante carried the BRCA gene mutation. Dr. Hosein, in collaboration with Daniel Sussman, M.D. ’02, M.S.P.H. ’11, associate professor of clinical medicine, who runs Sylvester’s GI Genetics Clinic, had recently completed a study showing that patients with the BRCA mutation had a much better chance of responding to a powerful chemotherapy combination called FOLFIRINOX.

After six months of treatment, her tumor had vanished. Dr. Hosein then recommended maintenance with an oral medication as part of an ongoing study, and she remains on that treatment today to prevent a recurrence of her disease. She and her husband were present at the NCI designation ceremony, special guests of Dr. Nimer.

“My wife is one of Sylvester’s miracle patients,” Joe Infante said. “It was cancer research, as well as great care, that made the difference.”

UNIVERSITY OF MIAMI MEDICINE
FALL 2019