With a significant expansion of researcher-driven clinical trials and a sharp focus on the region’s distinct healthcare needs, Penn State Cancer Institute (PSCI) is bringing the latest in cancer treatments to central Pennsylvania.
PSCI’s enhanced research initiatives enable physicians to refer patients locally, reaffirming Penn State Health Milton S. Hershey Medical Center’s dedication to ensuring that patients need not travel to Philadelphia, Pittsburgh or Baltimore for state-of-the-art care. Diane Hershock, MD, PhD, medical director of the Clinical Trials Office and director of the Phase One Program at PSCI, is overseeing this expansion.
“We’ve been broadening our clinical trials program the past several years to better serve our unique population of patients. In addition, we collaborate on research with other respected institutions,” Dr. Hershock says, noting that PSCI is pursuing National Cancer Institute designation. “Through these efforts, we are able to provide patients in central Pennsylvania access to world-class clinical trials. Our goal is to lead the way in cancer research, with many novel concepts and agents originating at Penn State Cancer Institute.”
A major objective of this multiyear effort has been to support more researcher-driven initiatives. When Dr. Hershock joined the Clinical Trials Office as medical director in 2016, pharmaceutical-sponsored studies accounted for a large portion of its open trials, she says. Currently, open trials at PSCI are on track to exceed 100 by midyear and will continue to grow in 2020 — with up to half of the trials investigator-initiated.
To meet those goals, the Clinical Trials Office is expanding personnel by about a third, to 50 staff members, and Dr. Hershock is recruiting faculty. However, as the region’s only tertiary care center and research institution, Milton S. Hershey Medical Center is already unique in its commitment to advancing cancer treatment.
“There are approximately 27 clinicians currently working on clinical trials,” Dr. Hershock says. “In addition, we have many researchers at the bench who are involved in some sort of clinical research both at the Hershey and University Park campuses.”
In furthering PSCI’s clinical trials program, Dr. Hershock and her colleagues identified work its researchers had already done that merited further study.
“Some of our own physicians were finding other pathways with currently marketed drugs that could be beneficial,” she says, “so we started empowering those investigators to write trials that were coming out of their labs or to initiate approaches that had not been attempted by pharmaceutical companies.”
She notes that several promising drugs now in the pipeline at Hershey Medical Center were developed there. One comes from the lab of Charles Smith, PhD, who has been studying sphingosine kinase involvement in gastrointestinal cancers and neuroblastomas. Smith developed a sphingosine kinase inhibitor that is currently in Phase 2 clinical trials.
“We are also planning to open his trial here at PSCI in hepatocellular cancer in the next few months,” Dr. Hershock adds.
She anticipates that many of PSCI’s clinical trials will evolve from the laboratories of its Mechanisms of Carcinogenesis and Experimental Therapeutics program, which essentially functions as a discovery unit or think tank.
“The program provides agents or pathways we can take into clinical trials, or we can look at laboratory correlates of things we currently have in clinical trials,” she says.
PSCI’s participation in multi-institutional collaborations such as the Big Ten Cancer Research Consortium offers another valuable avenue for development of life-extending and quality-of-life-enhancing treatments. Through these relationships, researchers gain rapid access to novel agents as well as existing drugs that they can combine with other treatments in new ways, Dr. Hershock explains.
Targeting Regional Health Needs
A key focus of clinical trials involving PSCI scientists is the tailoring of research to diseases prevalent in central Pennsylvania. Among these are lung, cutaneous skin cancers including melanoma and Merkel cell tumors, hematologic malignancies as well as hematologic malignancies eventually treated with a bone marrow transplant, and genitourinary cancers.
“As our 28-county catchment area covers a diverse group of patients, we are evaluating cancer patterns in specific areas,” Dr. Hershock says. “Our goal is to provide appropriate clinical trials to meet the needs of those patients.”
Reading has a large Hispanic population, for example, and according to the U.S. Department of Health and Human Services Office of Minority Health, Hispanic women are 60 percent more likely than non-Hispanic white women to be diagnosed with cervical cancer and 30 percent more likely to die from it. Given cervical cancer’s association with human papillomavirus (HPV), a major focus of the clinical trials program is HPV-driven malignancies.
“We have physician investigators and basic researchers working on novel pathways to treat or prevent HPV-driven cancers,” Dr. Hershock says. “We anticipate that this work will be practice-changing.”
“In addition to developing this strategy, we hope this novel construct may be used in conjunction with allogeneic stem cell transplant for potential curative intent in this difficult disease,” she says.
“We have a very strong commitment from Penn State as well as other funding sources to build a world-class, clinical and translational research-focused Cancer Institute.”
— Diane Hershock, MD, PhD, medical director of the Clinical Trials Office, Penn State Cancer Institute
An internationally recognized cancer virologist at PSCI, Craig Meyers, PhD, studies the biology and mechanisms of action of HPV and helped develop existing HPV vaccines. Dr. Hershock says Meyers’ research has fueled Penn State Health’s clinical strength in treating HPV-driven disease, particularly head and neck cancer.
Physician scientists at PSCI are studying aggressive HPV-driven head and neck tumors in patients who may or may not have a remote smoking history, to understand why these cancers are less curable than most HPV-related head and neck cancers.
“Once this research is validated, we may be able to develop an assay or test to determine which patients may have a more aggressive variant,” Dr. Hershock says. “We hope this will ultimately lead to novel agents in the treatment of HPV-induced head and neck cancers.”
As it develops new investigative pathways in many of its clinical areas, PSCI is also building on its robust immunotherapy and hematologic malignancy programs.
Because PSCI’s catchment area includes a larger-than-average number of cutaneous cancers, particularly melanoma, for which immunotherapy has become a vital part of treatment, PSCI’s labs and clinical investigators are studying patterns of resistance that evolve from those cancers and looking for pathways to overcome that resistance, Dr. Hershock says.
Similarly, the institute’s hematologic malignancy program is further developing innovative therapies, such as CAR-T technology for acute myeloid leukemia. This is a groundbreaking approach to treatment, as current CAR-T is used for lymphoma as well as acute lymphocytic leukemia and is being investigated in multiple myeloma, Dr. Hershock notes.
Advanced Treatments Close to Home
Transforming PSCI into a world-class hub for oncology research has been an ambitious project requiring vision and commitment. While Dr. Hershock plays a strategic role, she credits the institutional support of Penn State University, the collaborative efforts of researchers throughout the Penn State system and the leadership of PSCI Director Raymond J. Hohl, MD, PhD. Ultimately, she adds, their combined focus is on the people of central Pennsylvania, who need ready access to the most advanced cancer treatments.
To help meet cancer patients where they are, Dr. Hershock says, PSCI collaborates closely with Mount Nittany Health and Penn State Health St. Joseph Cancer Center and has established community practices in the Harrisburg-Lancaster-York area.
“Our patients are challenged with dealing with a cancer diagnosis, and we can offer them cutting-edge treatment close to home,” she says. “We are committed to providing novel treatments, interventions such as exercise, psychosocial trials that may enhance outcomes and prevention strategies to address the needs of our unique population. Our investigators and clinicians work as a seamless team to develop drugs that are not only practice-changing but provide hope to our patients, who deserve a chance at a cure.”
For more information, visit cancer.psu.edu/research.