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Exploring the Promise of Immunotherapy THE FIR ST LINE of defense any patient has against cancer is his or her own immune system. That's why Steven Katz, MD, has devoted much of his professional life to researching ways to use the human immune system to more effectively fight the disease. Dr. Katz is the Director of Surgical Immunotherapy at the Roger Williams Cancer Center and heads up a nationally renowned research program that truly sets this facility apart from any other in the region. "Immunotherapy is essentially a series of maneuvers or manipulations of the immune system that we can use to turn the immune system back on," Dr. Katz explains. "Alternatively, we actually have the capacity to manufacture a very specific and powerful immune response that we can deliver to the patient. "What we do at Roger Williams, which very few centers in the world are capable of doing right now, is re-engineering through genetic reprogramming a patient's T cells. We can actually take these cells out of the patient, reprogram them in our production facility and then infuse them back into the patient armed with very specific molecules or proteins that enable them to locate, bind to, recognize and destroy the cancer cells." The leading-edge capabilities that immunotherapy offers attract patients from all across the country, and as far afield as India and China, to the Providence cancer center that some might think would be overshadowed by better-known facilities in Boston. Dr. Espat, for one, gets great satisfaction from reminding people just how far ahead of more celebrated research facilities Dr. Katz and his team really are. "Every once in a while," Dr. Espat says, "I'll get an email from someone who says, 'Hey, did you see what Harvard did, or the University of Utah did? Because they were just in the news about it.' And I'll say 'Yeah, we've been doing that for four years, and we've been running phase 1 and 1b clinical trials for four years.'" Both physicians agree that immunotherapy is no magic bullet, merely another tool they can offer in the ongoing fight against cancer. "We often speak about the three pillars of cancer therapy," says Dr. Katz. "The three main pillars have traditionally been surgery, chemotherapy and radiation therapy. We see immunotherapy as being the fourth pillar now." " D r. E s p a t i s t h e C h a i r of Su rger y, a nd I'm t he Cha i r of Medicine, a nd I think the mes- sage should go out to the primar y care doctors that we actua lly see patients. We feel what t hey 're feeling. Prior chairs of medicine here didn't see patients, they just made policies without being in the trenches." " The traditiona l depa r tment leadership across t he countr y is evolving out of the practice," a g rees Dr. Espat. " The admin- i s t r a t i v e c o m p o n e n t s , t h e policy component s, t hey t a ke the majority of the time for most other department heads. If you go a ny where in the countr y you'll f ind the cha ir of medicine a nd the chair of surgery are rarely the ones who have the busiest patient schedu les. I t hin k we ca n cat- egorica lly state that Dr. Armenio is the busiest medica l oncologist in this faci lit y, a nd I'm a mong the busiest surgeons." B ot h phy sicia n s a g ree t hat t his direct involvement in t he d a y- t o - d a y c a r e o f p a t i e n t s a l lo w s t h e m t o m a k e b e t t e r decisions as depa r tment cha irs that, in turn, a llows the center to ta ke bet ter ca re of patients, perhaps bet ter tha n a ny other facilit y in the state. "The cancer program at Roger W i l l i a m s of fer s a f u l l a r r a y of t reat ment options i n a col- laborat ive, mu lt id i scipl i na r y manner where the most qualified specia lists in the oncolog y f ield are able to communicate because they 're litera lly 25 linea r ya rds from each other," Dr. Espat says. T h e R o g e r W i l l i a m s C a n c e r C e n t e r i s a n a f f i l i - a t e o f C h a r t e r C A R E He a l t h Par tne rs , R hod e Island's f irst C o o r d i n a t e d R e g i o n a l C a r e health system . For more infor- m at i o n , o r to re fe r a pat i e nt , please visit weknowcancer.org or call 401- 456-2077. ■ 2 0C O V E R F E A T U R E Steven Katz, MD, Director of Surgical Immunotherapy at Roger Williams, researches how to best utilize the body's T cells in the fight against cancer. 2 0