Sylvester Comprehensive Cancer Center

UM/Sylvester Expands Center for Cancer Prevention and Genetics and Joins Two Clinical Trials

01.20.2005

The University of Miami Sylvester Comprehensive Cancer Center is proud to announce the creation of the Center for Cancer Prevention and Genetics, expanding the use of genetic screening and counseling to predict and prevent more cancers. “It’s a paradigm shift to allow us to predict a person’s response to diseases and environments,” said Louis J. “Skip” Elsas, II, M.D., F.F.A.C.M.G., director, Division of Medical Genetics at the Leonard M. Miller School of Medicine at the University of Miami.

UM/Sylvester has offered genetic counseling for four years to patients at risk for breast and ovarian cancer, with one of the few board-certified genetic counselors in South Florida. Now, screening and counseling will increasingly be offered in other cancers, including endometrial, colorectal, thyroid, endocrine, melanoma, and sarcoma. “We’ve gotten into a variety of cancer syndromes,” said Joseph A. Lucci, III, M.D., director, Division of Gynecologic Oncology and director of the Center for Cancer Prevention and Genetics (CCPG). “We have a much more diverse service being offered to the community.”

“We can identify various gene mutations in the lab,” said Elsas. “That’s what genetics is all about, identifying and preventing disease.” Gynecologic Oncology will work closely with Medical Genetics on this expanding portfolio of screening.

Through the new CCPG, UM/Sylvester has joined two trials of the national Gynecologic Oncology Group for women at increased risk of developing ovarian cancer; GOG 190 and GOG 199. Women at increased family risk for developing ovarian cancer can come to UM/Sylvester for genetic screening. Those found to have BRCA1 and BRCA2 gene mutations, which put them at higher risk, can choose to enter GOG 199. The study has two “arms” or groups of patients – those who opt to have elective surgery to remove their ovaries and reduce their cancer risk, and those who opt for close observation instead of surgery. “There is very good published data that the surgery significantly reduces risk of both breast and ovarian cancer, especially when it’s done in pre-menopausal women,” said Talia Donenberg, M.S., C.G.C., UM/Sylvester’s board-certified genetic counselor.

Women in both groups will have a tumor marker blood test every three months. The women who do not have surgery will also have an ultrasound every year. Patients who enter the trial decide for themselves which arm to join. Also, women who opt for observation instead of surgery can change their minds and choose to have preventive surgery at any time during the five-year study.

Women who opt to have their ovaries surgically removed also become eligible for a second study, GOG 190. Half of the women who enter this study will have surgery immediately. The other half will receive the drug Fenretinide (4-HPR) for four to six months, then have surgery. Fenretinide is a retinoid, or retinoic acid analogue derived from vitamin A which has been shown to kill some tumor cells. The intent of this study is to learn whether this drug can help reduce ovarian cancer risk which it seemed to do in earlier studies. Women who enroll in GOG 190 also agree to have their ovaries entered into a tissue bank for future study.

According to the American Cancer Society, this year in the United States more than 25,000 women will be diagnosed with ovarian cancer and more than 16,000 will die, including more than 1,100 deaths in Florida. Women who are diagnosed with breast cancer are also at higher risk for developing ovarian cancer.

The Center for Cancer Prevention and Genetics will work closely with the new Miami GeneCure© Diagnostic Laboratory to lead study in the growing field of genetics in medicine.

“We will be doing a lot of the laboratory-based diagnostics on those patients identified by Dr. Lucci and his group who need to be tested based on their family histories,” said Elsas. “If they have a genetic susceptibility to developing cancer, that doesn’t say they’re going to get it, but it increases the probability that they’ll have cancer.” Also, the Braman Family Breast Cancer Institute at UM/Sylvester is in the process of recruiting a breast cancer research geneticist. “Genetics is absolutely the most important part of medicine,” said Elsas.

For more information about the Center for Cancer Prevention and Genetics, or these two clinical trials, please call (305) 243-1000.

About the GOG

The Gynecologic Oncology Group is a research cooperative made up of more than 160 institutions, including more than 50 academic medical centers and the University of Miami School of Medicine. It is supported by funding from the National Cancer Institute.

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