Medical Oncology
James Griffin, MD, Chair
Mission and Organization of Medical Oncology
The Department of Medical Oncology is committed to improving the diagnosis and treatment of adult patients with cancer. To meet this mission, we engage in a broad range of basic research, clinical research, patient care, and teaching. The chair of the department, James D. Griffin, MD, is an expert on the causes and treatments of acute and chronic myeloid leukemias. He oversees the research efforts of the department and the clinical care delivered by medical oncologists in the 12 disease centers at DFCI and the six medical oncology inpatient services at Brigham and Women's Hospital through the Dana-Farber/Brigham and Women's Cancer Center.
Divisions and Disease Centers
The faculty of the department is organized into seven divisions, each led by a division chief: Molecular and Cellular Oncology (Myles Brown, MD); Solid Tumor Oncology (Philip Kantoff, MD); Hematologic Malignancies (Robert Soiffer, MD); Hematologic Neoplasia (Kenneth Anderson, MD); Psychosocial Oncology and Palliative Care (Susan Block, MD); General Oncology (Lawrence Shulman, MD); and Population Sciences (Jane Weeks, MD). The division chiefs play key roles in departmental operations, planning, promotions, recruitment, and administration; they are joined by Robert Mayer, MD, vice chair for Academic Affairs; Edwin Alyea, MD, chief of Inpatient Operations; and Eric Winer, MD, chief of Ambulatory Operations.
Clinical care and clinical trials are conducted in 12 disease centers: Bone and Sarcoma Oncology, Cancer Genetics, Cutaneous Oncology and Mohs Surgery, Gastrointestinal Oncology, the Gillette Center for Women's Cancers (breast and gynecologic oncology), Head and Neck Oncology, Hematologic Oncology, the Lank Center for Genitourinary Oncology, the Carole M. and Philip L. Lowe Center for Thoracic Oncology, Neuro-Oncology, Phase I Experimental Therapeutics, and Psychosocial Oncology. In addition to providing clinical care and conducting clinical research, the disease centers are the focus of teaching for the 14 first-year clinical oncology fellows at Dana-Farber/Partners CancerCare. Clinical care and research of other departments — including Radiation Oncology, Nursing Oncology, and Surgical Oncology — also take place within the centers. Each of the disease centers is headed by a physician with a national reputation as a leader in the treatment of that cancer, and these disease center directors are responsible for coordinating the mission of the centers. The number of patients receiving care and entering clinical trials at Dana-Farber has increased several fold over the last five years. Recently recruited physicians include Phillip Friedlander, MD, PhD, Sue Berlin, DO, Jennifer Brown, MD, PhD, Martha Wadleigh, MD, Lori Wirth, MD, Paul Marcoux, MD, Eric Jacobsen, MD, Jan Drappatz, MD, Pankaj Bhargava, MD, Suzanne George, MD, and Irene Ghobrial, MD.
Clinical and Basic Cancer Research
Clinical research is central to the department and the disease centers. DFCI currently has more than 400 open clinical trials and accrues more than 2,500 patients to therapeutic trials each year in addition to several thousand patients to nontherapeutic clinical protocols. Disease center members play a major role in Dana-Farber/Harvard Cancer Center programs and in national cooperative group trials, such as the Cancer and Leukemia Group B (CALGB). Through the efforts of Lee Nadler, MD, the Institute has opened an eight-bed outpatient research chemotherapy unit, in which the most sophisticated clinical trials can be conducted, with an emphasis on "first-into-human" studies that have the potential to move the boundaries of oncology care. Similarly, efforts are under way to expand the infrastructure of clinical research, provide a mechanism to train the next generation of clinical investigators, and support clinical trials with dedicated laboratory space for determining trial endpoints and measuring novel biomarkers.
The department has 40 independent research laboratories, primarily focused on disease- and patient-oriented cancer research. Recent recruits include Anthony Letai, MD, PhD, Matthew Freedman, MD, Kwok-Kin Wong, MD, Holly Prigerson, PhD, Andrea Gurmankin Levy, PhD, Vish Viswanath, PhD, Christopher Lathan, MD, Pasi Jänne, MD, PhD, Levi Garraway, MD, (recruited for 2006) and others. The department has added a number of other laboratory and clinical investigators to the junior faculty through promotions. Most disease centers have succeeded in obtaining National Cancer Institute Specialized Programs of Research Excellence (SPORE) awards, NIH Program Project grants, or Center of Excellence awards to support basic and clinical research in their areas of interest. In 2005, DFCI investigators participated in seven different NCI SPORE awards.
Selected Research Themes
A major theme of research in the department is linking knowledge of the genes that cause cancer to the discovery and testing of new therapeutics, involving both small-molecule drugs and immune approaches. For example, William Kaelin, MD, has made major advances in understanding the role of the von Hippel-Lindau gene in renal cancer; his discovery that this gene regulates expression of the vascular endothelial growth factor (VEGF) receptor has led to a clinical trial of VEGF inhibitors. Similarly, Margaret Shipp, MD, demonstrated that overexpression of protein kinase C beta is characteristic of a type of large cell lymphoma, and clinical trials with PKC-beta inhibitors are under way. Dr. Griffin and Richard Stone, MD, have been developing inhibitors of a tyrosine kinase, FLT3, which is mutated in 30% of patients with acute myeloid leukemia, and three different FLT3 inhibitors are now in clinical trials.
Dr. Anderson has been a leader in the discovery of pathways that regulate growth of multiple myeloma cells and in the testing in clinical trials of drugs that disrupt these pathways, including thalidomides and bortezomib (Velcade); his recent studies on histone deacetylase (HDAC) inhibitors will also lead to entirely novel clinical trials. In related research, our laboratories have developed several immunotherapy approaches, now in clinical trials, that range from cellular immunization with dendritic cells (Donald Kufe, MD) or autologous cancer cells modified by granulocyte-macrophage colony-stimulating factor (Glenn Dranoff, MD) to tumor antigen peptide vaccines (Jerome Ritz, MD, Drs. Nadler, Kufe, and others).
Other laboratory work in the department has contributed significantly to our understanding of the causes of cancer. Ronald DePinho, MD, has been a world leader in discovering the roles of many oncogenes and tumor suppressor genes — including INK4A, myc, hTERT, PTEN, p53, and others. Dr. DePinho, Lynda Chin, MD, and James DeCaprio, MD, are now joining forces to accelerate the discovery of therapeutic targets in multiple myeloma and pancreatic cancer by using a high-throughput approach to target identification and validation. William Sellers, MD, Levi Garraway, MD, PhD, and David C. Fisher, MD, have identified a new gene amplified in malignant melanoma that appears to play a major role as an oncogene in this disease. Drs. Sellers and Jänne, Matthew Meyerson, MD, PhD, and Bruce Johnson, MD, found that lung cancer patients with mutations in the epidermal growth factor (EGF) receptor responded to kinase inhibitors targeting this receptor — research that significantly improved our ability to use these agents in clinical care.
William Hahn, MD, PhD, continues to study how groups of oncogenes cooperate to fully transform epithelial cells, and is creating a library of short hairpin RNA reagents that can be used to suppress expression of any gene in the human genome. Kornelia Polyak, MD, PhD, is investigating the earliest events that lead to transformation of breast epithelial cells and deciphering the complex interplay between stromal cells and tumor cells. Dr. Myles Brown has developed novel ways to study estrogen receptors and their role in the transformation of breast cells.
Population scientists in the department focus on the identification of genetic risk factors for common cancers and interventional research on prevention and early detection. Investigators also are committed to community-based research to promote health and reduce cancer risk, as well as decision analysis research to examine cancer prevention and treatment strategies with respect to quality of life, cost-effectiveness, and outcomes. An expert on outcomes analysis of cancer interventions, Dr. Weeks has made important contributions to understanding the impact of therapy and decision-making in breast cancer, lung cancer, and children's cancers. Glorian Sorensen, PhD, MPH, and Karen Emmons, PhD, focus their efforts on modifying behaviors, such as smoking, that increase the risk of cancer, and have made enormous advances in this area. Several new faculty have been recruited, including Dr. Levy, who studies communications between providers and patients, and Dr. Viswanath, who studies health care communication and the media.
Overall, the Department of Medical Oncology is committed to offering compassionate care, cutting-edge clinical and basic research, and outstanding training opportunities for basic and clinical investigators.
