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"We're gathering the best talent to offer the best care and do this in a coordinated fashion," says Athanassios (Ethan) Argiris, M.D., professor and Chief of the Division of Hematology/ Oncology at the UT School of Medicine. "As a National Cancer Institute-designated center, CTRC also offers innovative therapies through participation in clinical tri- als, giving patients access to the best new therapies of tomorrow. Alongside our Institute for Drug Development, we're providing care beyond the current national standards." Following the DNA In CTRC's operating room, infusion center and radiation suite, information gathered from a patient's pathology report guides the team's decisions. As Steve Weitman, M.D., Ph.D., professor and Director of the Institute for Drug Development (IDD) at the CTRC, explains, the medical community's expanding knowledge of cancer genomics stems from the observation of overexpressed genes and DNA abnormalities occurring frequently with particular cancers. Once identified, the genes become targets, and specialists are able to learn the most effective methods of treating these abnormalities. "In the past, we've taken the one-size- fits-all approach. As we get further and further in improving our understanding of cancer genomics, we're beginning to tailor the therapy more and more for specific types of genetic abnormalities, so patients are treated based on their own genetic profiles," Dr. Weitman says. "Again, historically, a patient would come in with cancer X and be given drug Y. Now, the patient may come in with cancer X, and we'll look through a whole variety of different therapies to try to identify the best therapy based on the genetic profile of the patient's tumor." For lung cancers, the Thoracic Oncology Clinic looks for ALK and epidermal growth factor receptor mutations in order to match these with new, targeted therapies. Often, chemotherapy is paired with radiation therapy. According to Chul Ha, M.D., professor and Chair of the Department of Radiation Oncology, about 60% of patients undergo radiation treat- ment — be it brachytherapy, conventional external beam radiotherapy or intensity- modulated radiation therapy — either during initial treatment or later should the disease reoccur. "When we see a patient with very early stage lung cancer, the option of radiation treatment in the form of stereotactic body radiation therapy is discussed with the patient, along with the surgical option," says Dr. Ha. "It's a state-of-the-art, evolving treatment option." Collaborative Care In the application of brachytherapy, Dr. Ha can collaborate with Daniel T. DeArmond, M.D., a thoracic surgeon and CTRC's Daniel DeArmond, M.D., thoracic surgeon, and Ethan Argiris, M.D., Chief, Division of Hematology/Oncology THERE FROM THE START AT THE CORE of the Cancer Therapy & Research Center's (CTRC's) ability to test its DNA-centric approach to advancing care is the Institute for Drug Development (IDD). The research arm of CTRC serves as ground zero for numerous new compounds that target specific, DNA-identified tumor receptors. Typically, once a new agent has received clearance for initial investigation, the team at IDD looks to determine the most appropriate dosage and gauge the presence of adverse side effects, and searches for early signals of antitumor activity. These trials — in which clinicians observe the first human exposure to the drugs — are instrumental in each drug's progression toward general use in patient care, as well as the further development of cancer genomics. "We are recognized throughout the world for our involvement in phase I clini- cal studies," says Steve Weitman, M.D., Ph.D., professor and Director of the IDD. "We've noted that about 15 of the most recently approved drugs in oncology started here at the institute. These are drugs we worked on very early on that made their way through the development pathways to reach the Food and Drug Administration for final approval." Steve Weitman, M.D., Ph.D., Director of CTRC's Institute for Drug Development MDNEWS.COM ■ MD NEWS San Antonio | 7