Keck Medicine of USC
For decades, medical schools have taught doctors that the best way to treat cancer and metastatic progression is to memorize a list of tumors and their typical migration patterns. Metastasis is the development of malignant tumor growths elsewhere from the primary site of cancer.
“This is akin to back in the days when weather reporting depended solely on a barometer and experience,” said Jorge Nieva, an associate professor of clinical medicine at the Keck School of Medicine of USC and co-author of a new study. “Medical students are taught very fundamental cancer progression patterns. What the modeling does is it brings the sort of complexity of modern-day weather forecasting to trying to understand where tumors go, when they go and how they get to that location. This type of mathematical modeling is wholeheartedly different from what most medical students learn today.”
The study, published online Oct. 21 in the journal npj Breast Cancer, a Nature Partner Journal, looked at 25 years of data regarding 446 breast cancer patients at Memorial Sloan Kettering Cancer Center. It focused on a subgroup of women who were diagnosed with localized disease but later relapsed with metastatic disease.
The model shows that cancer metastasis is neither random nor unpredictable. Survival depends significantly on the location of the first metastatic site or “spatiotemporal patterns.” In other words, USC researchers uncovered a framework to explain how tumor cells circulate through a patient’s bloodstream over time to settle in various organs. The path varies depending on tumor makeup and treatment decisions.
“There’s nothing like this in the cancer world; there’s nothing really like this in the disease progression community even though the techniques are well-developed in other contexts,” said Paul Newton, lead author of the study and an aerospace and mechanical engineering professor in the USC Viterbi School of Engineering. “Our long-term goal is to build comprehensive predictive computational simulations of metastatic cancer. Ultimately what we want to do is tailor those models to individual patients using their individual characteristics.”
The framework USC researchers built combines scattered data points doctors are already collecting in order to produce an understandable, comprehensive cancer map. The system design is comparable to information Google collects to predict Web surfing patterns and to determine PageRank.
“If somebody is reading about breast cancer on Wikipedia, the likelihood that she is going to jump to a lung cancer page or a bone cancer page is much higher than the likelihood of her jumping to the Costco website,” said Newton, who is also a professor at the Norris Comprehensive Cancer Center in the Keck School of Medicine of USC as well as professor of mathematics. “These probabilities of jumping from one page to another are not all equal. Where you jump to next depends strongly on where you currently are. This observation lies at the heart of our model.”
Chances of survival
Breast cancer patients die when tumors have colonized an average of four metastatic sites, the study found. Women had the poorest chances of long-term survival if they had more than two initial metastatic locations; they fared much better if migrating tumor cells first landed on one organ.
Roughly 35 percent of breast cancer patients developed first metastasis to the bone, while less than 5 percent contracted their first metastasis in the brain, Newton said. The five-year survival of the bone group is more than 90 percent, whereas the brain group had survival characteristics of 20 percent or less, he said.
Peter Kuhn, senior author of the study, explained further.
“If you have breast cancer with metastasis to the bone and your next metastasis is the liver, you are likely to die from that,” said Kuhn, Dean’s Professor of Biological Sciences and professor of medicine, biomedical engineering, and aerospace, and mechanical engineering in the USC Dana and David Dornslife College of Letters, Arts and Sciences. “If you have breast cancer with metastasis to the bone and the next metastasis is in the lung, you are unlikely to die from that. Instead, the disease is going to spread further first.”
Expanding the cancer treatment team
The study’s results led the researchers to further define the words “spreaders” and “sponges” to describe metastasis, a nomenclature that eventually could inform medical teams how best to deliver personalized therapy plans.
“A spreader is a site that is likely the source of new disease,” Kuhn said. “Hence you need to avoid spreaders or eliminate the disease if it shows up at a spreader site. At a sponge site, one might just manage or stabilize. Of course if you could eliminate all of it, you would. But if you have multiple metastasis, one would attempt to stabilize the sponge but eliminate the spreader.”
Bone, chest wall and mammary lymph nodes were spreader sites in the patients sampled. Lungs, distant lymph nodes and liver were sponge sites.
The future of cancer care could be squads consisting of a biologist, a mathematician, a physicist and a computer programmer to complement the current medical teams, Newton said.
USC is working on a convergent science initiative that provides a collaborative environment for cancer experts. Construction of the USC Michelson Center for Convergent Bioscience broke ground in October 2014. It will eventually be the largest building on USC’s University Park Campus.
“Over the next five to 10 years, there’s going to be a big change in the way medical schools and oncologists think about disease,” he said. “I could easily see a situation 10 years down the road where a patient comes in with a particularly difficult disease. The oncologists in charge will put together a team of researchers to develop a model to forecast disease progression and determine best treatment options that they would then implement.”
Memorial Sloan Kettering Cancer Center contributed their clinical expertise and supplied the data set used in this study. The study was funded by a National Institutes of Health/National Cancer Institute Physical Sciences-Oncology Centers Transnetwork Grant. An interactive website containing the study’s diagrams are available at http://kuhn.usc.edu/breast_cancer.
by Zen Vuong]]>
Steve Chaffee loves to exercise. A former marathon runner, the Sierra Madre resident modified his routine as the years went by but he still ran every day, entered 10K runs and maintained a steady weightlifting routine. A couple of years ago he noticed he couldn’t run as long as he used to. Alarmed, he scheduled an appointment with his doctor. He was about to learn he was a candidate for a new kind of pacemaker.
“They put a heart monitor on me, and said, ‘Bad news,’” said Chaffee, 58, the director of finance for a specialty chemical manufacturing company in Pasadena. “They discovered I had atrial fibrillation, and that my heart was stopping for five seconds at a time. It was shocking. I’ve always been so healthy. I said, ‘Pacemakers are for older, sedentary people – not for me!’”
He knew people who had pacemakers. The devices are visible through clothing, and at the beach he’d never be able to hide it. Then he was referred to Keck Medicine of USC cardiologist Rahul Doshi, MD, who told him he was a candidate for the Nanostim, a leadless pacemaker that is implanted in the heart.
“The Nanostim is for patients like Steve who need pacing for atrial fibrillation, and for other patients such as those who have vascular access issues or have a history of infection,” said Doshi, director of electrophysiology and associate professor of medicine at the Keck School of Medicine of USC. “It’s a dramatic, game-changing technology in the field of cardiac pacing, and will lead to further refinements to make it available to an expanded patient population.”
More than 4 million Americans, typically over the age of 60, experience irregular heartbeat, also known as arrhythmia, that may lead to serious complications including stroke, breathing problems or loss of consciousness. Many arrhythmias, including atrial fibrillation, are detected only when medical tests are done.
Keck Medicine of USC was the first medical center in Southern California to perform a Nanostim implant, in 2014. Since then, 15 of the pacemakers have been implanted at Keck Medicine of USC. The Nanostim is one of two leadless pacemakers currently being studied in clinical trials nationwide. Keck Medicine of USC is part of a multi-center clinical trial that ended in September 2015, with a continued access study beginning immediately after. A post-market approval application was submitted this year to the federal Food and Drug Administration (FDA) by St. Jude Medical, the device manufacturer.
Traditional pacemakers, designed to steady irregular heartbeat, are about the size of a drink coaster. They are implanted in a pocket under the skin to the left of the heart and attached to the heart with leads. The battery-driven Nanostim is under an inch long and fits inside the heart’s right ventricle. It is implanted under local anesthetic in a minimally invasive procedure that typically lasts an hour. The device is delivered to the heart via catheter through the groin. The catheter is guided with the help of X-ray.
Chaffee was initially wary of the procedure – “I dragged my feet,” he said. After speaking to a fellow congregant at his church who said he’d had the procedure, he decided to go ahead, and was surprised by his recovery.
“We’re talking days, not weeks or months,” he said. “I’ve had zero effect from the procedure. Unless you told me I had (the implant), I wouldn’t know it’s there.”
Two months after the implant, he entered a 5K race, and a 10K three months after that.
“I’m thrilled to do these races and pretend I’m an Olympian,” he said with a chuckle. “I think I’m younger than I am.”
That’s another example of The Keck Effect – applying the very latest treatments to help patients do the things they enjoy most.
By Leslie Ridgeway]]>
The USC Center for Health Systems Innovation (CHSI) will focus on turning research and education into measurable and sustainable improvements in outcomes and experience for patients and staff. It will be led by Executive Director Carol Peden, MD, MPH, a professor in the Department of Anesthesiology at the Keck School of Medicine of USC.
“This is about bridging the gap between innovation and implementation, to deliver health care safely, effectively and efficiently, while ensuring the best possible patient and staff experience,” Peden said. “The center will focus on a very practical approach. We will use the wealth of resources across the university, harnessing the knowledge and skills of many of USC’s schools to better design and deliver care.”
The center will facilitate faculty-led research projects and create new interdisciplinary programs in health care quality improvement. By January 2017, the CHSI will establish fellowships in health systems innovation for medical and non-medical graduate students.
Peden, an anesthesiologist and intensive care physician, joined Keck Medicine of USC in September from the United Kingdom, where she gained extensive experience in leading local and national improvement projects. She is a believer in data for improvement and developed a national database for emergency surgery outcomes. Peden chaired the executive board of Global Comparators, a group of 44 of the world’s leading institutions that share data for improvement.
Peden said her commitment to improving care across health systems stemmed from her clinical work as a physician.
“Through my work as an intensive care doctor, I sometimes saw critically ill patients in whom a simple step earlier in their pathway could have prevented disease progression,” she recalled. “The enormous challenge of recovering from critical illness for the patient and their family could have been avoided. I started to think about the whole system of health care more.”
CHSI developed from a partnership among several USC schools, including the Viterbi School of Engineering, the Pacific Center for Health Policy and Ethics, along with the faculty in anesthesiology. Peden plans to build on these relationships and foster further partnerships across USC to envision, design and develop new ways of caring, and to provide the strategy and tools to ensure successful delivery in the complex environment of health care.
“CHSI’s strength will be the academic input from USC, but the center will be of real relevance to the health system,” Peden said. “It will be integrated into patient care and dedicated to improving the experience for everyone in the health system, both our patients and our staff.”
Peden was previously associate medical director for NHS England, responsible for clinical quality for 13.5 million people. Her expertise in improvement was developed as a fellow at the Institute for Healthcare Improvement (IHI) in Boston. She has also developed improvement and leadership courses for institutions such as the University of Oxford and University College London.
by Douglas Morino]]>
The device, a Covaris M220, uses high frequency sound waves to shatter DNA that is gently resting in a water bath, an important step in the process that scientists are using to piece together clues about what drives cancer cells to grow uncontrollably.
Mike Bozick, a 1960 graduate of the USC Marshall School of Business, and his wife, Bobbie, own a grape, citrus and vegetable company based in Riverside County. Their children, Nicholas Bozick and Cynthia Bozick Beteta, are both USC graduates who now work for the family business in Mecca, CA.
The Bozicks devotion to USC Norris includes hosting of a recurring cancer research event that has been held for many years at the Indian Wells Country Club near Palm Springs.
“We are extremely honored and grateful to Mike and Bobbie Bozick for their belief in our efforts to conquer cancer and provide compassionate care to our patients,” said Stephen B. Gruber, MD, PhD, MPH, the director of USC Norris.
The Genes, Environment and Melanoma Project is led by Gruber. Research scientists Kevin J. McDonnell, MD, PhD, Asaf Maoz, MD, and Marilena Melas, a PhD student, will process samples from more than 600 melanoma patients who previously contributed melanoma biopsies and shared their sun exposure history with the USC investigators.
Melanoma is the deadliest type of skin cancer, and more than 73,000 Americans are expected to be diagnosed with melanoma this year. About 10,000 will die from the disease.
by Carmy Peters]]>
With a growing senior population – 10,000 baby boomers turn 65 every day – the early detection of eye diseases such as glaucoma and AMD can lead to the prevention of blindness. The CDC reports more than 26 million Americans over age 40 suffer from various eye diseases and according to Prevent Blindness America, the annual cost of adult vision problems in the U.S. exceeds $51 billion annually.
The USC Eye Institute has been involved in the clinical trials for the XEN implantable device for open-angle glaucoma patients for the last several years. Presenting the latest results of human clinical trials, Rohit Varma, MD, MPH and director of the USC Eye Institute, will showcase how the implantable gelatin device dramatically reduces pressure in the eye. Over the course of one year, the intraocular pressure (IOP) in the study participants was reduced 44 percent and IOP medications were reduced 65 percent. The gelatin stent is currently available in Europe and is expected to be approved by the FDA for U.S. patients next year.
“The XEN implantable device is a game-changer when it comes to treating glaucoma, especially for seniors,” said Dr. Varma. “There is currently no cure for the 3 million American seniors who are diagnosed with glaucoma and with no warning signs 50 percent of those with glaucoma do not realize they have it,” he continued. “Detecting glaucoma early through an annual eye exam and having new interventions such as this minimally invasive surgical gel stent is the next step in reducing blindness.”
Click here to watch Dr. Varma discuss the minimally invasive Xen gel stent.
Age-related macular degeneration
According to the CDC, 1.8 million people over age 40 are affected by age-related macular degeneration (AMD). The USC Eye Institute’s Andrew A. Moshfeghi, MD, MBA, will present research on the promising role of L-DOPA medication to delay or prevent the onset of AMD. The study has shown participants taking L-DOPA, originally used for Parkinson’s disease, restless leg syndrome and other movement disorders, are less likely to develop AMD or it develops years later than those not taking the drug. This study also shows the promise of Precision Medicine using electronic medical records (EMRs) as the original study results were confirmed in a larger data set of 87 million patients. In a separate session, Dr. Moshfeghi will also present research on the latest techniques in intraviteral injections for wet AMD to increase safety and efficacy.
In addition, Dr. Varma will present his research on the impact of dry AMD on reading speed and in macular degeneration patients. The reduction in reading speed can significantly impact the life quality of AMD patients making activities such as reading medical forms, legal documents or even watching TV more difficult.
Click here to watch Dr. Moshfeghi discuss L-DOPA and its effects on AMD.
On the opposite end of the age spectrum, Dr. Varma will be one of 10 experts on the “Myopia Matters!” panel debating the causes of the global increase in childhood myopia. He points to research and statistics on near-work and low light activity for the alarming increase.
In China 60 years ago 10-20 percent of the youth population were near-sighted, today it is 90 percent and in Singapore 96 percent of 19-year-old men have myopia. While the U.S. increase is less dramatic, the number of American children with near-sightedness has doubled over the last 50 years.
The global phenomenon can be linked to an increase in indoor, low light, near-work activity. Although there is a genetic predisposition for myopia in East Asian cultures, some research shows children in China are spending up to 12 hours a day in near-work – activities that also have significant impact on the increase in myopia. Children in the U.S. spend less time than their Chinese counterparts – up to nine hours daily – but the impact is the same result of increasing near-sightedness at earlier ages.
“Children today spend many more hours in near-work and low light activity rather than spending more time outdoors where distant vision and natural light helps eyes to shape normally as spherical instead of the oblong or egg-shaped that we are currently seeing,” said Dr. Varma. “In addition to improving childhood vision health, more outdoor activity and less time spent on video games, computers, smartphones and tablets will also potentially help reduce the increase we have seen in childhood obesity.“
by Sherri Snelling]]>
USC Eye Institute patient Terry Byland became the first person in the world to have two retinal prostheses – one in each eye – and his progress regaining some sight signals hope for people going blind from Retinitis pigmentosa.
“I just can’t get over what I can see, and all the things I’ve seen so far,” said Byland, the 66 year-old resident of Riverside, Calif.
The reason: the Argus II Retinal Prosthesis system, the first FDA-approved implanted device to re-establish some sight in blind patients, giving them the ability to perceive images and movement.
Like most people diagnosed with Retinitis pigmentosa, Byland experienced gradual blindness, going completely dark at the age of 45, when his youngest son was just five years old. He had to retire from the job he loved, selling power tools.
“It’s one thing to give up driving, but it’s another thing to give up your work,” Byland said. “My co-workers were like a second family. I struggled with depression and mood swings. It’s paralyzing to lose your sight.”
Byland was part of the clinical trial for the original prosthesis, Argus I, from 2004 to 2010. His right eye was implanted with a 16-electrode retinal prosthesis on June 23, 2004.
“That study gave me a sense of worth,” said Byland. “The biggest thing for me was to see how far we could go before we hit that wall. The prosthesis allows more independence. And the more independent you are, the happier you are.”
An Eye Toward the Future
“Terry is a true pioneer,” said Mark Humayun, MD, PhD, co-inventor of the device, who holds joint appointments at the Keck School of Medicine of USC and the USC Viterbi School of Engineering. “His work with the first-generation implant helped our team develop the FDA-approved Argus II. For him to enjoy the benefit of this smaller, better device is gratifying.”
Byland’s left eye was implanted with the new 60-electrode Argus II on June 22, 2015 – almost 11 years to the day from the first implant – by Lisa Olmos de Koo, MD at the USC Eye Institute.
“Once the Argus II was activated, I was immediately able to see what it took the original device more than two years to let me see,” said Byland.
“The Argus II uses software that we can upgrade as we go,” said Olmos de Koo. “So, as there are new innovations in image processing technology, we can continue to introduce new features that might help improve the way a patient can see in the future.”
A Collaboration Between Medicine and Engineering
The Argus II helps patients recognize large letters, locate the position of objects and more. It restores some visual capabilities for patients whose blindness is caused by Retinitis pigmentosa (RP), an inherited retinal degenerative disease that affects about 100,000 people nationwide.
The system includes a small video camera mounted on a pair of eyeglasses, a video processing unit that transforms images from the camera into wirelessly-transmitted electronic signals, and an implanted retinal prosthesis (artificial retina) to stimulate visual neurons. The receiver sends signals to the retina that travel through the optic nerve to the brain, where they can be interpreted as a visual picture.
The external device runs on rechargeable battery packs with each battery pack providing four to six hours of operation. Byland wears it as often as he can, especially when he goes out. The more that he wears it, the more he is able to see. Though he has a retinal prosthesis in each eye, he can only use one at a time.
The Argus II is manufactured by Sylmar, Calif.-based Second Sight, and is the result of a close collaboration among Keck School of Medicine of USC, USC Eye Institute and USC Viterbi School of Engineering. It is available to qualified patients at the Keck Medical Center of USC.
Byland celebrated his 29th anniversary with wife Sue within days of getting the Argus II implant. He is hopeful.
“I am looking forward to the progression of seeing more,” said Byland.
by Meg Aldrich]]>
In all, more than 2,000 viewers from about 60 countries registered to participate in the event, which included surgeries performed in countries that also included Sweden, Belgium, Italy, France, Great Britain, Egypt, Brazil, India, South Korea and Australia.
At USC, the first surgery was performed by Inderbir S. Gill, MD, whose pioneering robotic “zero-ischemia” partial nephrectomy was broadcast live from Operating Room 15-16 on the fourth floor at Keck Hospital of USC. Gill is founding executive director of the USC Institute of Urology and chairman and professor, Catherine and Joseph Aresty Department of Urology at the Keck School of Medicine of USC.
Later that morning, Mihir Desai, MD, performed a robotic radical cystectomy with intracorporeal orthotopic neobladder. Desai is professor of urology and director of urological robotic surgery at the Keck School.
For both procedures, the USC robotics team has the world’s preeminent experience. The surgeons narrated the procedures for viewers who watched via an online link, and they answered questions via Skype and on social media.
Later that evening, a four-hour studio session was held in Aresty Auditorium to further discuss robotic surgeries. The studio session featured lectures by Gill, Desai and by Andrew Hung, assistant professor of clinical urology, as well as Andre Abreu, a clinical fellow in urology. Professor of Clinical Urology Rene Sotelo presented his session via Skype while traveling to Miami.
Organizers included Microsoft and the European Association of Urology.
by Les Dunseith]]>
To honor Breast Cancer Awareness Month, a team of physicians and staff from Keck Medicine of USC joined cancer survivors on the field during the Oct. 24 USC Trojan football game against Utah.
During the break at the end of the first quarter of play, a video about breast cancer was played on the giant video screen inside the Coliseum and the crowd recognized a group of doctors and their patients on the field with a standing ovation.
It was an “awesome moment,” said one of the organizers, Nick Cartan, director of business development for USC Sports Properties.
Earlier on game day, two Keck Medicine of USC physicians, Stephen F. Sener and Christy A. Russell, were interviewed during a pre-game segment on ESPN710 by announcers John Jackson and Steve Mason. The doctors spoke about breast cancer awareness, treatment and prevention options.
In all, about 100 people from USC showed their support during the event by wearing special black or pink shirts adorned with the pink ribbon logo that is associated with the fight against breast cancer. The commemorative t-shirts are available for sale at USC bookstores.]]>
Rene Sotelo, MD, joined the USC staff on Aug. 3 as professor of clinical urology at the USC Institute of Urology, just a few days after performing a robotic prostatectomy in Bogota, Colombia, on Oscar Iván Zuluaga, an economist who was the nominee of the Democratic Center political party in the 2014 presidential election.
At the time, Sotelo’s base of operations was in Caracas, Venezuela, which is his home country, but he had become known throughout Latin America as a leader in the use of robotic surgery to treat urologic cancers and benign conditions. Sotelo has published more than 50 peer reviewed scientific papers and 28 chapters in major urology books.
So, when Zuluaga received his diagnosis of prostate cancer, the political leader’s advisers sought out the top surgeon in that part of the world, which quickly led them to Sotelo.
“I had been traveling to Colombia and training surgeons in Colombia for many years,” Sotelo noted.
The surgery, which took place in July 2015, was particularly newsworthy in the Spanish-speaking world, and was covered by many news outlets, including an appearance by Sotelo on the Spanish-language edition of CNN.
The surgery’s result? “Now three months later, the cancer is completely extracted and Zuluaga is doing great.,” Sotelo said during an Oct. 13 interview in his new office at USC. “Just three or four weeks afterward, he was already back out doing campaign work [in his role as party chairman.]”
Although Sotelo now has a new base of operations, he will continue to be a major medical presence in Latin America, serving as an ambassador for the USC Institute of Urology and Keck School of Medicine of USC overall. His passion for surgical innovation, advancing the field, and his worldwide teaching experience coincides with and further strengthens the overall philosophy of the Keck School of Medicine of USC and its Department of Urology.
“Dr. Sotelo is the premier robotic and laparoscopic surgeon in Latin America,” said Inderbir S. Gill, chairman and professor, Catherine and Joseph Aresty Department of Urology, and executive director, USC Institute of Urology at the Keck School of Medicine of USC.
“And we have tasked him with further increasing his existing partnerships in Latin America to enhance USC’s reputation as a world-class medical enterprise,” Gill said. “In the two short months he has been here at USC, we have already seen a dramatic increase in the number of Latin American patients flying to USC Urology for advanced surgeries.”
Sotelo is excited to spread the word in Latin America about USC, but he also is looking forward to engaging with his new colleagues in Los Angeles. Sotelo is a pioneer in robotic surgery for complex urinary fistulae in females and males, for example, as well as treatment of benign prostate enlargement and inguinal lymph node dissection for cancer.
“Over time, I got a lot of experience in repairing all kinds of fistulas, which are abnormal communications between different organs and the urinary system,” Sotelo explained. Prior to joining the Keck Medicine staff, he had occasionally traveled to USC to observe and learn, and also to share his knowledge.
Gill’s pioneering work in robotic surgery for cancer has been a big part of what Sotelo refers to as his “learning network” ever since Gill was a visiting professor in Venezuela 18 years ago. Thereafter, Sotelo would observe Gill’s surgeries in person, if possible, but mostly he watched them on video to help himself learn. And he was dedicated.
Sotelo recalled an instance in which he peppered Gill with questions after he noticed a slight change in a surgical technique that he’d seen 20 times. “What happened here?” Sotelo asked Gill. “You turned your hand left or right. Why did you change it for this patient?”
Once Sotelo got his answers, he would pass along what he had learned about Gill’s techniques to others in Latin America. Over time, the relationship became increasingly reciprocal — Sotelo pioneered some techniques of his own and exchanged those discoveries with Gill.
“We are looking to Dr. Sotelo to open big doors for USC Medicine in Latin America,” Gill said. “And it’s already beginning to happen — we are already on our way!”
As, for Sotelo, coming to the United States represents a chance to work not just with Gill but with many of the best surgeons anywhere.
“USC has the best urologic team in the world,” Sotelo exclaimed. “They are always thinking of new things — 30-plus surgeons, all the best in their specialty. It’s a unique opportunity.”
It’s also an opportunity with fewer logistical and economic limitations. Soon after arriving at USC, Sotelo and Gill performed a complex robotic surgery together. In South America, Sotelo had been using an older generation of the robotic instruments.
“Here, it’s the latest technology,” Sotelo said. “To me, it’s like a dream. As Dr. Gill told me, ‘Rene, welcome to America!’”
by Les Dunseith]]>
MUST have hospital identification
RSVP Not Required
For more information, contact Robert Vance III at (323) 442-9915 or email@example.com.]]>