arkansas

Clinical Trial Promising for Ovarian Cancer Treatment

Jan. 18, 2017 | Eighteen years ago, Gail Clayton received news that changed her life. Looking back, she says finding out she had breast cancer marked the beginning of new perspectives.

“When I was first diagnosed with cancer, it wasn’t the end of life as so many people think. To me, it was the beginning of life.”

Clayton and her husband, Raymond, have been married 46 years. He calls UAMS one of Arkansas’ best kept secrets.

“I don’t think people realize how amazing this institution is,” Clayton said. “You become friends with your doctors and nurses. It takes a village and I believe that village is right within these walls at UAMS.

She had breast cancer twice and was recently diagnosed with ovarian cancer. That prompted Clayton’s oncologist, Laura Hutchins, M.D., to refer her to gynecologic oncologist Kristin Zorn, M.D.

“Anytime we see a patient with a new diagnosis of cancer in the ovaries, fallopian tubes or the peritoneum (the internal lining of the abdomen), we think of a possible hereditary source for that cancer,” Zorn said.

Clayton and Zorn discussed genetic counseling and ultimately found Clayton had a mutation in one of the BRCA genes, commonly known as the breast cancer genes. Every person is born with the BRCA1 and BRCA2 genes, but women who inherit mutations of the genes have an increased chance of developing breast, ovarian, and other cancers.

Researchers’ knowledge about these genetic mutations has helped lead to development of a new class of drugs known as PARP inhibitors.

“PARP inhibitors capitalize on the genetic defect that’s already present in people who carry one of these mutations,” Zorn said. “It helps to kill the cancer cells that are accumulating DNA damage.”

There are three types of PARP inhibitors that have been FDA-approved over the past few years: olaparib, rucaparib and niraparib. Clayton is a part of a clinical trial that includes her taking olaparib.

“With PARP inhibitors, we first focused on people who carry a BRCA or similar mutation. We’re now finding many patients with ovarian cancer who do not have a mutation are responding to the drugs.”

Another advantage of this new class of drugs is that they can be taken orally rather than through intravenous infusion, making it more convenient for patients. This works especially well for Clayton who spends a great deal of her time seeing the world.

“If someone says go, we pack a bag and go.”

Since her first diagnosis, Clayton says she takes nothing for granted and began living in a way she may not have if not for the illness. She and Raymond Clayton have made lots of memories abroad. Sometimes their adult son Randy joins them.

“We’ve been to the Baltic States, Russia, Berlin, Sweden…”

She’s responded well to the clinical trial and shows no indications of slowing down.

“…England, Paris, the Caribbean, Ireland. It’s been a journey.”

“Part of the reason I’m so passionate about practicing at a place like UAMS, is that it helps us bring cutting-edge therapies to our patients,” Zorn said. “Sometimes we’re talking about a surgical advance, sometimes we’re talking about an advance in treatment.”

Zorn says genetic counseling and testing has become a standard of care in some of the most common gynecological cancers.

“While many parts of the country are having trouble keeping up with the change in the standard of care, UAMS has a genetic counselor embedded in our clinic so that we can accomplish that.”

“The way I see it,” said Clayton, “Even if the clinical trial didn’t work for me, maybe it would work for someone else. I’m grateful for the strides scientists have made in treating this disease.”

This clinical trial was developed through the NRG Oncology cooperative trial group of the National Cancer Institute. The only access to this trial in Arkansas is at UAMS.

All Slots for Prestigious Neuro-Oncology Fellowship Filled by UAMS Residents

June 13, 2017 | Two residents from the University of Arkansas for Medical Sciences (UAMS) have been selected for a prestigious fellowship in neuro-oncology administered jointly by the Johns Hopkins University School of Medicine and the National Institutes of Health Neuro-Oncology Branch.

A maximum of two fellows per year are selected for the program, and this year, both are from UAMS.

Carlos Romo, M.D., co-chief resident physician; and Orwa Aboud, M.D., Ph.D., will complete their residencies in the Department of Neurology in the UAMS College of Medicine in June and begin their fellowships in July.

The fellowship provides advanced training for neurosurgeons, radiation therapists, medical and pediatric oncologists and neurologists to prepare them for academic careers in neuro-oncology. The experience is tailored individually to the needs of the fellow. Both Romo and Aboud will spend three years expanding both their research and clinical experience through courses, research projects, mentoring and clinical rotations.

“It is extremely prestigious for us to have not just one of the two, but both,” said Robert L. “Lee” Archer, M.D., professor and interim chairman of the Department of Neurology. “Their selection says a lot about the level of residents we are producing. Dr. Romo and Dr. Aboud have done outstanding work during their time here, and I would also like to credit their adviser, Dr. Shirley Ong, and our residency director, Dr. Kinshuk Sahaya, for contributing to their success.”

Ong, M.D., said that both have unique skillsets to offer their patients and expand the future of neuro-oncology.

“There are very few good neuro-oncology fellowship training programs in the U.S., and they are extremely competitive,” Ong said. “Neuro-oncology is a small field and requires hard work and a strong fortitude, and I had zero hesitation in recommending Drs. Aboud and Romo to the Johns Hopkins/NIH fellowship program. I know they will represent UAMS well.”

Romo is from Aguascalientes, Mexico, and earned his medical degree at Tec de Monterrey in Monterrey, Mexico. Sahaya, M.D., described him as a dynamic and multifaceted resident whose teaching ability is appreciated by students and faculty alike. For example, Romo helped Sahaya redesign part of the neurology residency curriculum. Ong described him as a leader who sets goals and accomplishes them.

Romo said his time at UAMS exposed him to a wide variety of patients, especially because of UAMS’ partnerships with Arkansas Children’s Hospital and the Central Arkansas Veterans Healthcare System. He is looking forward to expanding his experiences even further.

“This fellowship, unlike any other in the country, provides the fellows with access to two different institutions that are leaders in the field,” Romo said. “Faculty members at Johns Hopkins and NIH are recognized worldwide for their contributions in the area of neuro-oncology. NIH also offers opportunities for collaboration between basic and clinical scientists, and particularly among scientists across other disciplines. This collaboration creates a nurturing environment for the development of ideas that can improve outcomes for patients with cancer of the nervous system.”

Aboud is from Swaida, Syria. He attended medical school at the University of Damascus in Syria and graduate school at UAMS. Sahaya described him as an outstanding resident and researcher and a skilled physician. He is a great team leader who is loved by colleagues, faculty, students and patients alike. His research is already garnering him top honors. Ong said Aboud is extremely compassionate and goes above-and-beyond with his patients.

Aboud said that early in his neurology residency, he took part in a neuro-oncology rotation that exposed him to how big the impact of basic and clinical research can be on patients’ treatment options and quality of life. He values the fact that both the UAMS residency and the NIH/Johns Hopkins fellowship give him both research and clinical exposure.

“The field of neuro-oncology is about giving patients options for a better quality of life, longer survival, and, hopefully, a cure,” Aboud said. “In preparation for my career as a neuro-oncologist, this training is essential to gain a broad knowledge of the science of brain tumor development and the scientific strategies used in the development of the next generation of treatment. As a clinician scientist, my goal is to achieve a more immediate and positive impact on my patients’ lives.”

The UAMS Neurology Residency is a four-year program open to students who already have a medical degree and are looking for advanced training in neurology. Residents can then move on to become practicing neurologists or pursue additional specialized training through fellowships, like Romo and Aboud.

“Both are very different in their interests and approach, and they exemplify the diversity of our learning approach, both culturally and academically,” Sahaya said. “It’s our goal to provide a supportive environment for our residents where they can both learn the essentials and develop their own interests while we assist them in that process. We support our residents in all career choices, from general to specialized neurology. These two are just another example of the careers we hope to nurture with our residency.”

For more information, visit neurology.uams.edu.

Inherited Cancer Risk Leads Travel Blogger to Choose Mastectomy

April 14, 2017 | Lesley Murphy is accustomed to waking up in exotic locations. From snow-covered Finland to the beaches of Bali, this 29-year-old professional blogger spends more than 300 days a year documenting her travels to vacation destinations around the world.

“My number one goal is inspiring travel and showing people that if they get out of their comfort zones, they can make the world a better place,” she said.

Recently, however, the Arkansas native took a detour from her globetrotting lifestyle to focus on a very different subject — her future health. About three years ago, Lesley was living in Argentina when she received the call that her mother, Martha Murphy, was diagnosed with breast cancer. With no history of breast cancer in her family, the diagnosis came as a shock.

“It was my first year living abroad, and I felt so far away,” Lesley said. “It was a wash of emotions. You never want to hear the words ‘mom’ and ‘cancer’ in the same sentence.”

Martha Murphy, who was living in Fort Smith at the time, felt a lump in her breast before scheduling a mammogram in early March 2014. After it was confirmed she had stage 1 breast cancer, Martha immediately sought the advice of her next-door neighbor, who happened to be an oncologist. He recommended genetic testing to determine if she might have a mutation of one of the BRCA genes, commonly known as the breast cancer genes.

While every person is born with the BRCA1 and BRCA2 genes, women who inherit mutations of the genes have up to an 80 percent chance of developing breast cancer by age 70. If Martha tested positive for a gene mutation, it would mean her three adult daughters had the potential for it as well.

“My doctor in Fort Smith ordered the genetic test on the same day I was diagnosed, but it took a few days to receive the results,” Martha said.

The morning after her diagnosis, Martha decided she wanted to seek a second opinion at UAMS, Arkansas’ only academic health sciences center. After a reassuring visit on March 21 with breast surgeon V. Suzanne Klimberg, M.D., director of the Breast Cancer Program at the UAMS Winthrop P. Rockefeller Cancer Institute, Martha scheduled a double mastectomy for 10 days later.

Her breast reconstruction surgery was completed at UAMS in August, followed by an oophorectomy to remove her ovaries in September. A BRCA gene mutation also can increase a woman’s risk of developing ovarian cancer.

“When I look back, this experience was just a blip on my radar. While it was happening, I was in the midst of helping my eldest daughter plan her wedding. I didn’t have time to focus on myself, so I’m terribly blessed that I didn’t have any complications or need any chemo or radiation,” Martha said.

Klimberg also is a professor of surgery and pathology in the UAMS College of Medicine and director of the Division of Breast Surgical Oncology.

Martha received the results of her genetic test prior to her visit with Klimberg and was surprised to discover she did indeed carry the BRCA2 gene mutation. She immediately knew that she wanted her daughters to be tested as well.

“I told them, this is what we’re going to do. They needed to know if they had the gene mutation, so they could make informed decisions about their future,” Martha said.

Each child of a parent — mother or father — who carries a mutation in one of the BRCA genes has a 50 percent chance of inheriting the mutation.

Martha’s eldest daughter, Lauren, and youngest, Jordan, both underwent testing at the UAMS Cancer Genetics Clinic and received mixed results.

“After Jordan’s test came back negative, we were hopeful they all would,” Martha said.

That would not be the case, as Lauren’s results were soon found to be positive for her mom’s BRCA2 mutation. The UAMS Cancer Institute is home to the only clinical cancer genetics team in Arkansas. Although any doctor can order genetic testing — which is conducted using a blood or saliva sample — UAMS has the only board-certified geneticists and genetic counselors in the state who can diagnose rare syndromes and manage complex cancer syndromes, of which there are more than 50.

As for Lesley, finding time for the genetic screening was a challenge in itself. Because she was living in South America, did not have domestic insurance, and was launching her career as a travel blogger, the sense of urgency wasn’t strong.

“I would be in Arkansas for two days and then gone for a month, so there was never any time to schedule it. Two years went by before I was home for an extended time. That’s when Mom encouraged me to get it done,” said Lesley, who initially gained fame as a contestant on season 17 of ABC’s “The Bachelor.”

When her genetic test came back positive for the BRCA2 gene mutation, Lesley knew she had some choices to make. She looked to Kent McKelvey, M.D., director of Cancer and Adult Genetics Services, and the UAMS Cancer Genetics Clinic staff for guidance.

“Each person ultimately has to make the choices that are best for themselves and their families. We are here to help people understand the evidence and options and guide them to make the best informed decisions,” said McKelvey, who also is associate professor in the UAMS College of Medicine Division of Genetics.

For Lesley, those choices were to undergo breast cancer screenings every six months in an attempt to catch any tumors in their earliest stages or have a preventive double mastectomy, followed by reconstruction. With her travel career in full swing, Lesley said the choice was clear.

“Because of my schedule, I didn’t foresee the twice-yearly screenings as a realistic option. While it may sound drastic to some people, having the surgery was definitely the best option for me,” she said.

The fact that Lesley was able to learn about her gene mutation and make the best choice for herself provides a sense of freedom and empowerment, McKelvey said.

“Given her active career and the fact that she gave this decision serious consideration, her choice to have elective surgery makes perfect sense,” he said.

Following the double mastectomy with UAMS breast surgeon Daniela Ochoa, M.D., Lesley’s risk of developing breast cancer will be reduced by about 95 percent. Nothing can eliminate the risk entirely, McKelvey said, however, surgery is the most effective strategy to dramatically reduce her risk of breast cancer and eliminate any future need for screenings. Ochoa is a professor of surgery in the UAMS College of Medicine Division of Breast Surgical Oncology.

Because of her public image and large social media following, Lesley chose to document her experience on social media channels including Instagram, Facebook, Twitter and Snapchat.

“I saw this as a way to educate people and encourage them to be more knowledgeable about their own personal health decisions,” she said.

After a four-week break from traveling following her April mastectomy, Lesley will hit the road again in May, this time with Mom by her side.

“The doctors think I’ll be fine to travel by then, but she’ll be there for support if I need it,” Lesley said.

She will return to UAMS in late summer to complete her breast reconstruction process under the direction of plastic surgeon Eric J. Wright, M.D., associate professor in the UAMS College of Medicine Division of Plastic and Reconstructive Surgery.

Then, it’s back on a plane to her next destination. “I will always travel. I don’t know what my career will eventually evolve into, but travel is definitely what I’m passionate about and what makes me happy,” Lesley said.

Promise to Patient Inspires UAMS Doctor to run Half Marathon

March 13, 2017 | When Nikhil Meena, M.D., crossed the finish line of his first half marathon March 5, his patient, the late Joe Cook, symbolically crossed it with him.

Cook, who died of lung cancer July 2, 2016, had taken up long-distance running about a year earlier after watching several friends enjoy the sport.

“Joe was always an active person and did some running when he was younger, but he didn’t start running half marathons until he was in his 60s,” said his wife, Marilyn Cook.

Cook had recently completed Conway’s Soaring Wings Half Marathon in October 2016 when he started to experience shortness of breath. A diagnosis of stage 4 lung cancer soon followed, and he began treatment at the UAMS Winthrop P. Rockefeller Cancer Institute. Meena, an interventional pulmonologist, was a member of Cook’s treatment team.

A 26-year employee of UAMS, Cook embarked on his second career at the academic health sciences center following 20 years in the U.S. Air Force. While at UAMS, he held positions in the College of Nursing, the College of Medicine Department of Psychiatry and Jackson T. Stephens Spine & Neurosciences Institute, where he served as administrator at the time of his death.

“When Mr. Cook came to his appointments, our topic of conversation would always turn to his love of running. He was hoping to run in the 2016 Little Rock Half Marathon but had to postpone that due to his cancer diagnosis,” said Meena, assistant professor in the UAMS College of Medicine Department of Internal Medicine.

During one of their visits, Cook asked Meena if he would consider joining him in running the 2017 half marathon. Although he had never attempted long-distance running, Meena accepted Cook’s challenge and promised to run with him in the upcoming race. As his treatment progressed throughout the spring, Cook appeared to show improvement and their race plans progressed. In early summer, however, Cook’s cancer stopped responding to treatment. He was admitted to the ICU at UAMS Medical Center, where he died a short time later.

“Dr. Meena made it a point to visit Joe when he was in the ICU. They had such a good relationship. He tried so hard to help Joe fight the cancer,” said Marilyn Cook.

After Cook’s passing, Meena was determined to live up to his promise. He contacted Little Rock Marathon officials about the possibility of running the half marathon in Cook’s memory. It was decided that he could wear two runners’ bibs, one for himself and one for Cook. He also would receive two medals, one of which he presented to Marilyn Cook at the finish line.

“After they told me I could run the half marathon for Mr. Cook, I started training in December. This may be my first and last half marathon, but I’m happy to honor my promise and earn one last medal for him,” Meena said.