Another Trip, Another Conference

I recently had the pleasure of attending the 14th annual meeting of the Connective Tissue Oncology Society in London. This was the kind of medical conference I like the most. It was small, with ample opportunity to meet colleagues from around the world. More importantly, the presentations were first rate, and I learned a lot from my time there.



CTOS, as the group is called, has grown dramatically in the past few years, both in numbers and in the quality of the research. My first CTOS meeting, two years ago in Venice, was smaller and many of the papers presented were good… but not great. This year, there were 30% more attendees, and the quality of the work presented has improved dramatically as well.

CTOS is truly an international and interdisciplinary organization, embodying what I believe is truly necessary for the advancement of care for patients with sarcomas. The organization has members from Europe, Asia, Australia, North America, and the Middle East. Sitting in the same conference room listening to the same presentations were radiologists, surgeons, orthopedists, radiation oncologists, medical oncologists, pediatric oncologists, pathologists, nurses, and patient advocates. These interactions, across international boundries and across the boundries of medical disciplines, are vital for progress in caring for patients with rare diseases.

My favorite session captured that spirit perfectly. Entitled “Bone Sarcomas 2 - Surgery and Molecular Biology,” this session included talks on surgical techniques for rebuilding limbs after resection of large tumors as well as two talks on the application of cutting edge molecular biological techniques to understanding the biology of these tumors. I can honestly say I’ve never experienced anything quite like that.

All work and no play makes Jack a dull boy, so I managed to spend some time sightseeing. It was typical London weather – overcast, misty, and cool, but I enjoyed it anyway.

Next year? Miami!

Related Posts:

Back to the Future: Another Meeting in Denver

Osteosarcoma Symposium in Houston

Children's Oncology Group: A Meeting of the Minds in Denver, CO

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Back to the Future: Another Meeting in Denver

Last week I attended the annual meeting of the Children’s Oncology Group. Like last year, the meeting was held in Denver, Colorado. The Children’s Oncology Group is the organization that coordinates the majority of clinical research into childhood cancer in North America. We conduct clinical trials ranging from early Phase I studies of brand new drugs through Phase III trials designed to optimize the treatment of children with a wide variety of cancers.

Unfortunately, this year I was only able to attend part of the meeting. I did get to spend a full day attending various meetings related to ongoing and upcoming bone cancer-related clinical trials. It was an exciting day because we are entering the era I spoke about as “the future” when I was interviewing for medical schools back in the 1980’s – the era of “molecular medicine.” All of the upcoming studies under discussion involved the use of at least one drug that works differently from traditional chemotherapy. Drugs that target specific biological differences between normal cells and cancer cells. These drugs have tremendous potential to improve our treatment of children (and adults) with cancer by being more effective and having fewer side effects. As George Allen, the coach of my favorite football team when I was a kid, used to say, “The future is now.”

Like last year, I also took some time to relax while I was out west. Last year, I wandered around Denver, but this year I rented a car and explored the mountains. South of Denver, west of Colorado Springs, lies Pikes Peak, which already had snow at the summit.

Nearby were the amazing rock formations of Garden of the Gods.

Needless to say, the scenery was stunning, and my little camera doesn’t begin to do it justice.

I can’t wait to get back there for a vacation, when I can really spend time in the Rockies and enjoy it all.

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Children's Oncology Group: A Meeting of the Minds in Denver, CO

What’s New in Cancer Research?

Why do there seem to be so many

cows at the conferences I go to?

I just got back a couple of days ago from Chicago, where I attended the annual meeting of the American Society of Clinical Oncology (ASCO). This is an enormous meeting, attracting over 30,000 participants from across the country and around the world. All of the specialties involved in cancer care are represented – surgeons, medical oncologists, pediatric oncologists, radiation oncologists, social workers, psychiatrists, orthopedists, and others.

The annual meeting is an opportunity for researchers from around the world to present their findings to each other. I thought it might be interesting to discuss some of the interesting presentations about sarcomas that I saw:

Better Treatment for Ewing’s Sarcoma
One of the most exciting talks at the meeting (at least, for me) was Dr. Womer’s presentation of the results of the last Children’s Oncology Group clinical trial for patients with localized Ewing’s sarcoma. In this study, patients were randomly assigned to receive the same chemotherapy (cycles of vincristine/doxorubicin/cyclophosphamide alternating with cycles of ifosfamide/etoposide) every 3 weeks or every 2 weeks. The question was whether chemotherapy works better given closer together (time intensive), or whether there would be too many side effects. Well, the results are in, and time intensive chemotherapy works! The patients who received the chemotherapy every 2 weeks had a 78% 4-year event-free survival rate, compared with 70% for the patients treated at the standard 3 week interval. Although this improvement was limited to patients younger than 18 years old, this is probably because there were too few older patients to evaluate.

Photo Credit

The Genetics of Rhabdomyosarcoma
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma of children and adolescents. There are several different types of RMS based on microscopic appearance, but the two most common types are called “alveolar” and “embryonal.” These types refer to the microscopic appearance of the tumors (alveolar because the tumor resembles the alveoli, or airspaces, of the lungs; embryonal because the tumor looks like very immature muscle cells). It has long been known that alveolar RMS is characterized by chromosomal translocations (where a piece of one chromosome is “swapped” for a piece of another one), but embryonal RMS is not. Dr. Barr presented data showing that embryonal RMS are characterized by specific changes in chromosome 11 instead.

Interestingly, not all alveolar RMS has these chromosomal translocations, and 63% of those that do not, instead have the same chromosome 11 changes seen in embryonal RMS. A detailed genetic analysis also showed that by this test, so-called “translocation negative” alveolar RMS appears to be more similar to embryonal RMS than to “translocation positive” tumors. This raises the possibility that, in the future, we may do away with tumor descriptions based on microscopic appearance in exchange for genetic descriptions that probably more closely reflect the underlying causes and behavior of the tumors.

Alveolar RhabdomyosarcomaPhoto Credit

Synovial Sarcoma
One of the more rare types of sarcoma we treat is called synovial sarcoma. Doctors from the Rizzoli Institute in Italy looked back over the records of 250 synovial sarcoma patients treated there since the 1970’s to try to learn more about this rare disease. They presented some very important findings: 1) radiation therapy improves survival in patients with localized disease, but chemotherapy did not; 2) some patients relapse very late (more than 5 years from the end of treatment), suggesting that we need to follow these patients for a very long time; 3) patients who have a local relapse are often cured with further treatment, and it did not seem to matter whether this was a rapid relapse or a late relapse. This is an important study because it is the largest report on a single series of synovial sarcoma patients treated at a single institution.

Samarium to treat Osteosarcoma
Finally, I had the honor of presenting the results of my Phase I study of samarium-153 for the treatment of patients with osteosarcoma metastatic to bones. Samarium-153 is a radioactive agent that targets bone lesions. Because it was a Phase I study, the goal was to identify a dose of the drug we could give that would allow patients to recover safely and quickly from the side effects. Not only did we find what that dose is, but we also showed that this drug could be given to patients who had a LOT of previous treatment, and they had no more side effects than patients who had not been treated at all. Our next step will be to figure out how best to integrate this drug into treatment regimens based on chemotherapy, and hopefully one day this will be an important addition to our arsenal of therapies for osteosarcoma patients.

Unfortunately, my schedule did not allow me to make it to the presentation of the data regarding vitamin D and breast cancer, but you can read more about that study here.

Related Posts:
Vitamin D and Breast Cancer
Osteosarcoma Symposium in Houston
Children's Oncology Group Meeting
Medicine from the Sea

Upcoming Conference on the Medical Care of People with Lower Limb Amputations

This is somewhat late notice, but Physicians for Peace is organizing and hosting a conference April 11-12, 2008 in Norfolk, VA entitled, "Collaborative Practice and Research to Improve Functional Outcomes for Amputees." Discussion will focus on the issues facing medical professionals who take care of people who have had lower extremity amputations. It should be a valuable experience. For more information, take a look here and contact conferencesupport@tpti.com.

OMG! Cancer Conferences for Young Adults

I've attended and participated in many conferences about cancer. Most of them have been venues for medical professionals to present and discuss research, so it’s not surprising that they are not well-attended by patients.

Fortunately, the Leukemia & Lymphoma Society, and the I'm Too Young For This! Cancer Foundation are sponsoring two upcoming (free) conferences in New York for and about adolescent and young adult cancer patients.

The first is on April 10th and is a one-day educational workshop called 'Cancer in the Young Adult' in New York City. Go here for further details and registration information.

The second is on May 3rd and is for all 'cancer survivors aged 18 - 40'. It is taking place at Onondaga Community College in Syracuse, NY. The keynote speaker at the Syracuse conference is Matthew Zachary, the founder/executive director of the I'm Too Young For This! Cancer Foundation. Registration will open this week, so be sure to check back to their site as space is limited.

If you end up attending either conference, I'd love to hear about it!

Osteosarcoma Symposium in Houston

Earlier this month, I had the distinct honor of participating in an international osteosarcoma symposium organized by one of the pioneers of our field, Dr. Norman Jaffe. Entitled “Progress from the Past, Prospects for the Future,” the meeting took place at MD Anderson Cancer Center in Houston, TX. Participants included surgeons, oncologists, radiologists, radiation oncologists, pathologists and laboratory scientists from around the world, as well as patients, parents, and patient advocates.



Dr. Jaffe asked me to speak about the possible role of immunotherapy in osteosarcoma treatment. It was an honor to have been invited, and it was a pleasure to be given the opportunity to discuss my thoughts on what the future of osteosarcoma therapy might include.

So what happened? Dr. Bruland, from Norway, gave an excellent presentation on his work demonstrating that small deposits of osteosarcoma cells might lie dormant in patients’ bone marrow, and that these cells might play a key role in disease relapse. Osteosarcoma is not thought of as a disease that typically involves bone marrow, so if true, this could change the way we go about hunting for sites of disease in our patients as well as changing our understanding of how cancer cells survive therapy to cause relapse.

Dr. Gorlick, from Montefiore Hospital in the Bronx, provided a comprehensive overview of the basic biology of osteosarcoma, providing a framework for future laboratory research that might one day yield new targeted therapies. Dr. Hughes, from our host institution, MD Anderson, discussed his work on one particular biological pathway (called the Notch signaling pathway) that might be important for the development of metastatic disease. There are already drugs available that target this pathway, so the prospect of intervening in this process is tantalizingly close.

Another highlight of the trip for me was the opportunity to see relatives of some of my patients and their families in a context outside of the Pediatric Oncology Clinic.

(everything is bigger in texas!)

Of course, no trip is all work and no play. I’ve never been to Houston, so I tried to squeeze in time to explore the city. I got to visit the (very avant-garde) Contemporary Arts Museum, as well as the sculpture garden across from the Fine Arts Museum (thankfully on a bright sunny day).

(a piece from the sculpture garden)

And the sushi at Azuma was incredible. If you’re ever in Houston, I highly recommend it!

The proceedings of this symposium will be published by Springer in the very near future for those of you who are interested in learning more.

(psychedelic cow guarding the Texas Children's Hospital)

Children’s Oncology Group: A meeting of the minds in Denver, CO

Last week I had the pleasure of attending the meeting of the Children’s Oncology Group in Denver, Colorado. This is the umbrella organization of pediatric oncologists in the US and Canada. Together, we conduct clinical trials to figure out what is the best treatment for each type of cancer that kids get. Once a year, we all get together to discuss the result of our trials to date and to discuss the plans we have for future trials.

There were more than 10,000 people at the conference in Denver, CO, including physicians, nurses, data managers, and administrators. It was a great pleasure to see my friends and colleagues once again and to hear the updates about the progress we have made since last year. I took some pictures while I was there… pretty silly ones, but really, if you had to choose between posed pictures and silly pictures, what would you choose?

The first picture is from the lobby of the Adam’s Mark Hotel in downtown Denver. They had these lovely horses that were guarding us (and I, for one, was glad to be guarded).
These horses, I assume, guarded more than just us….



Every morning we were served a wonderful breakfast of coffee, pastries, and fruit. This allowed us the opportunity to socialize in a relative unformatted atmosphere. This is a very important function of the meeting – being able to network and form connections from one institution to another.



Of course, it wasn’t all work... what business trip is? They left us time to relax, because all work and no play makes Jack… OK… maybe none of use are like that, but we certainly need a break now and again. I spent one afternoon walking through the city, and happily discovered that Denver is not at all what I expected. I tried to take pictures, but that day I only had my cell phone camera with me, and that lens doesn’t do the scenery justice at all. So instead, I have a picture of the Colorado state capitol building, which I also thought was lovely. I caught it on a great day, with bright sunshine to reflect off the gold dome.



Like all trips, though, this one quickly drew to a close, and just in time - the day after I left, it snowed 4 inches! Now, for the residents of Denver, that is probably no big deal, but here in Baltimore, 4 inches of show shuts down the city for the day.

On an unrelated note, it seems mine is not the only medical blog to originate at Johns Hopkins. My colleague Lillie Shockney writes a blog for Yahoo! called Breast Cancer Chronicles. It’s really quite good, which makes sense given her role here as administrative director of the Johns Hopkins Avon Foundation Breast Center and a breast cancer survivor.