| Clinical
Studies
Recruitment into clinical trials from all USC/Norris Comprehensive Cancer Center affiliated hospitals is strong with more than 1,327 cases being recruited in the last year. Patient recruitment is represented by study type as follows:
In house 45%, In House (Peer Review) 18%, SWOG 9%, other cooperative groups – 2%, Industry 16%, Consortium USC – 5%, Consortium – not USC 2%, and CTSU 3%.
Drs. Russell, Garcia, Spicer, Tripathy and Daniels undertake breast cancer treatment and research, with an expansion of clinical trials and an increased focus on chemoprevention strategies for breast cancer. The GI team is developing strategies of clinical research for gastrointestinal cancers (Drs. Lenz, Iqbal and El-Khoueiry), with an emphasis on molecular correlates of tumor responsiveness and of the familial clustering of gastrointestinal cancer. An active program of research and treatment of genitourinary cancers was initiated by Drs. Quinn, Goldkorn, Dorff, Pinski and Hu, with specific programs of new drug development and multidisciplinary management. Multidisciplinary management has been a governing theme in the clinical trial programs that have been developed for lung cancer and head and neck malignancies by Dr. Barbara Gitlitz and neuro-oncologic tumors by Dr. Helen Gu.
Each of these teams has been developed to allow maximum synergy with staff members from other clinical units, including surgical oncology, radiation oncology and urology, as well as an expanded translational interface with the scientists of the Cancer Center and the School of Pharmacy.
LAC+USC Medical Center
Inpatients are seen by the Consult Team throughout the hospital. Patients receiving chemotherapy on Ward 7B or in the Infusion Center are seen by the Chemo Consult Team
Major components of the clinical activities of the Division were undertaken at LAC+USC Medical Center. Traditionally, an inpatient unit and Infusion Center provides the bulk of treatment to hospitalized patients and outpatients requiring specialized daily treatment or daily visits. In view of escalating drug costs, treatment protocols with industry support have been initiated that have provided some of the cytotoxic agents and marrow stimulating agents used in cancer treatment.
The GI, GU, Solid tumor and Women’s Sections of the Division rotate and provide daily attending rounds on consult patients.
The management of non-hematologic malignancies has evolved towards an outpatient service, a greater proportion of the clinical census has been managed in the Outpatient Clinics, with inpatient care predominantly directed towards patients who are less robust, with intercurrent medical disorders, more advanced tumors or requiring more complex and lengthy treatment regimens. Faculty members staffed three clinics per week, with allocation of patients being predicated on tumor type. This specialization has allowed a greater focus of resources and concentration of areas of clinical expertise. Particular emphasis is placed on treatment programs for breast cancer (integrating programs of the Southwest Oncology Group, availability of new anticancer agents and development of novel therapeutic strategies), gastrointestinal malignancy (with a more recent emphasis on biochemical targeting of anticancer therapy, and in particular strategies directed towards thymidylate synthase) and lung cancer (with particular emphasis on the assessment and development of the role of novel taxane compounds and other new cytotoxics).
Because of the specific nature of modern oncological practice and the absence of accepted standards of care for many advanced malignancies (traditionally with poor prognosis), the application of novel treatment strategies has been crucial to the successful management of patients with metastatic cancer, thus achieving total integration of clinical and clinical research practice. Funds generated from clinical trials and from the USC/Norris Comprehensive Cancer Center have covered costs of correlative laboratory testing programs fully, and have allowed a clearer understanding of the mechanisms of success and failure of therapy. A particularly important program, directed towards improving the care of Hispanic patients, has addressed a previously undescribed metabolic abnormality that appears to correlate with enhanced toxicity from certain cytotoxic agents. Similarly, in association with the routine clinical management programs for testicular cancer, a program of assessment has been initiated (sponsored by the Cancer Center) to investigate an unusual pattern of failure of chemotherapy for Hispanic patients with testicular cancer. An interactive research and treatment program for the development of new anticancer agents, funded by the National Cancer Institute, and conducted by a consortium of USC, City of Hope National Medical Center and University of California-Davis, has made novel compounds available to the patients treated in the hospitals of the USC Health Sciences Campus. This program has included components of Phase I testing (assessment of correct dose and definition of toxicity profiles of new compounds) and Phase II trials (assessing the anticancer effectiveness of these agents). Specific attempts have been made to expand the utilization of the GCRC for Phase I and pharmacologic studies of novel anticancer agents.
USC/Norris Cancer Hospital
The Division’s faculty care for patients in their field of expertise at the USC/Norris Cancer Hospital.
USC University Hospital: The Division sees tumor specific patients on a consultative basis. There is presently no facility for the delivery of cytotoxic treatment. However, attending faculty provide consultative services upon request for the full gamut of tumor types, interacting with clinical services from the full range of other disciplines. Seamless transfer of patients between UH and the USC/Norris Cancer Hospital has been effected, allowing full access to services of chemotherapy and radiotherapy for patients with cancer at UH. Similarly, the Transitional Care Center of UH has been used to assist in the rehabilitation and post-acute care management of patients from the USC/Norris Cancer Hospital.
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