Cancer | Mount Sinai Today

What You Should Know About Gynecologic Cancers

Updated on Jun 30, 2022 | BFWHRI, Gynecologic Cancer, Women's Health

In September 2019, we met with Stephanie Blank, MD, Blavatnik Family Women’s Health Research Institute faculty member, to discuss gynecologic cancers in recognition of Gynecologic Cancer Awareness Month. Dr. Blank is a Professor of Obstetrics, Gynecology, and Reproductive Science at the Icahn School of Medicine at Mount Sinai, as well as Director of Gynecologic Oncology for the Mount Sinai Health System. She practices at the Mount Sinai Blavatnik Family – Chelsea Medical Center, where she leads the Women’s Cancer Program. Dr. Blank has also been recently elected as the President of the Society of Gynecologic Oncology.

Dr. Blank primarily focuses on caring for women with ovarian, uterine, and cervical cancer and those who are at an increased genetic risk for these gynecologic cancers. Her current research focuses on the significance of genetics on cancer risk management, including BRCA variants, as well as making genetic testing accessible to those at risk.

In our video Q&A, Dr. Blank discussed screening recommendations and methods for gynecologic cancers; risk factors and symptoms of gynecologic cancers; her role as a gynecologic oncologist; and what she first tells her patients when they are diagnosed with a gynecologic cancer. Dr. Blank assures her patients that “the treatment for all these diseases is really moving forward” and “we can help a lot of women.”

For Gynecologic Cancer Awareness Month, Mount Sinai held a health fair at the Guggenheim Pavilion to educate staff and patients on how to understand symptoms and risk factors in order to make proper health care decisions. Representatives from Woman to Woman, a network at Mount Sinai of volunteer survivors of gynecologic cancers who provide one-on-one support and education to women currently in treatment, attended. Guidance from women who understand the grueling situation a woman with a gynecologic cancer is in could help emotionally support the patient in conjunction with her treatment.

Thank you to the women of Woman to Woman and Dr. Blank for your exceptional work!

Examining the Effects of Immunotherapy on Cancer

Updated on Jun 30, 2022 | Cancer, Featured, Research

From left: Thomas Marron, MD, PhD; Adeeb Rahman, PhD, Associate Professor, Genetics and Genomic Sciences; and Miriam Merad, MD, PhD

Using a collection of sophisticated single-cell technologies, scientists at the Mount Sinai Health System have launched an early-stage clinical trial that examines the effects of immunotherapy on hepatocellular carcinoma, non-small-cell lung cancer, and head and neck squamous cell carcinoma.

Four to six weeks before a tumor is resected, the researchers administer a neoadjuvant immunotherapy, cemiplimab, and study its effects. As soon as the tumor is removed, they continue to analyze the fresh tissue for a month or more to observe mechanisms of resistance and response. The Phase 1 trial is sponsored by Regeneron Pharmaceuticals, Inc.

“With the technologies available to us at The Tisch Cancer Institute and Mount Sinai’s Human Immune Monitoring Center, we are able to investigate at an unprecedented depth how these immune therapies are changing the microenvironment within the tumor,” says Thomas Marron, MD, PhD, Assistant Professor of Medicine (Hematology and Medical Oncology), Icahn School of Medicine at Mount Sinai, and Principal Investigator of the study. “This trial enables us to analyze fresh tissue immediately after resection—instead of the preserved tissue typically obtained in trials—to observe the dynamic changes that occurred.”

The study is enrolling multiple small cohorts of 21 patients. One goal is to determine which cancer patients will benefit from cemiplimab, and, more specifically, how cemiplimab can be more effective by combining it with chemotherapy and/or other novel immunotherapies. Cemiplimab was previously studied at Mount Sinai in liver and lung cancer patients and has been approved by the U.S. Food and Drug Administration for patients with metastatic cutaneous squamous cell carcinoma. The compound works by inhibiting the interaction between PD-L1, a protein on the surface of tumor cells, and PD-1, the protein on the surface of T cells, and restoring the immune system’s ability to recognize and kill cancer cells.

Another goal of the study is to identify biomarkers in human tissue and blood that will be able to predict who will respond to immunotherapy, since so many patients do not respond to anti-PD-1 therapy. “We really need to find the ideal patients to treat so we don’t unnecessarily expose those who won’t respond to the toxicity of immune therapies,” says Dr. Marron, who is also Assistant Director of Early Phase and Immunotherapy Clinical Trials at Mount Sinai. “There’s also a financial issue at stake for patients and society in general in using expensive drugs that are not improving outcomes.”

Dr. Marron and his team are using several powerful new technologies to help them with their work. These include immune mapping and monitoring technologies such as mass cytometry (CyTOF), a flow-cytometry-like technology that allows them to see up to 50 proteins on each cell so they can identify the cell type and classify the maturation and activation status of the cell, along with some of the regulatory “on/off” checkpoints.

CITE-Seq (Cellular Indexing of Transcriptomes and Epitopes by Sequencing) is another platform that provides an even higher resolution view of each individual cell within the tumor. This technology combines the capabilities of CyTOF and single-cell RNA sequencing to characterize both the RNA and protein in each cell.

A third technology is known as Multiple Ion Beam Imaging (MIBI), a unique form of immunohistochemistry that allows scientists, for the first time, to unravel the spatial architecture of tumors in order to better understand the mechanisms through which the immune system is infiltrating the tumor and is being hijacked by the tumor.

“For 10 years, we’ve been building the Human Immune Monitoring Center into one of the leading platforms in the world for investigating the role of the immune system in human disease, and using that knowledge to design novel, immune-based therapies,” says Miriam Merad, MD, PhD, Director of the Center, and Professor of Oncological Sciences, and Medicine, Icahn School of Medicine at Mount Sinai.

Drawing on a highly specialized team of clinicians, immunologists, mathematicians, physicists, and surgeons, the Human Immune Monitoring Center is currently involved in more than 45 federal- and foundation-funded research programs in fields such as cancer, autoimmune disease, inflammatory bowel disease, allergies, and neurodegenerative disease.

Novel Cancer Immunotherapies Show Promise

Updated on Jun 30, 2022 | Cancer, Featured, Research

A PET-CT scan indicates one patient’s partial response to the in situ vaccination after six months. as shown in pre-vaccine, left, and six months post-vaccine.

Researchers at the Icahn School of Medicine at Mount Sinai are pioneering two novel approaches to cancer immunotherapy that are promising for patients with non-Hodgkin lymphoma and other solid tumors, which have been stubbornly resistant to therapies such as checkpoint blockade.

One new approach is an in situ vaccination that worked so well in patients with advanced-stage lymphoma that it is now undergoing trials for breast cancer, as well as head and neck cancers. The other therapy captures the synergy of checkpoint blockade and stem cell transplantation in the form of a highly promising treatment known as immunotransplant. Joshua Brody, MD, Director of the Lymphoma Immunotherapy Program and Assistant Professor of Medicine (Hematology and Medical Oncology) at The Tisch Cancer Institute at Mount Sinai, is the lead investigator for both therapies.

The In Situ Vaccination

This vaccination approach involves injecting immune stimulants directly into a single tumor site, which “teaches” the immune system to recognize and destroy cancer cells at that site and throughout the body. “We’re teaching dendritic cells—the generals of the immune system army—to specifically recognize tumor antigens, which then instruct the T cells, the immune system’s soldiers, to go forth and kill the cancer cells while sparing non-cancer cells,” says Dr. Brody.

As reported in the April 2019 issue of Nature Medicine, this therapy involves several steps that begin with injection of a small molecule that calls the dendritic cells to action, followed by low-dose radiation to kill the tumor cells. These dying cells, in turn, release antigens into the immune system that are recognized by the dendritic cells and presented to the T cells as part of the “coaching” process.

The results were encouraging among a cohort of 11 patients with non-Hodgkin lymphoma. In earlier tests with lab mice, the vaccine was able to cure about 40 percent of lymphoma tumors, Dr. Brody says. When combined with checkpoint blockade, the cure rate nearly doubled. Dr. Brody reports that when testing the therapy in patients, “We saw some who had profound regressions of their entire tumor burden. After treating one site, tumors throughout the body melted away.”

The next step in the development of the vaccine began last spring when Mount Sinai began recruiting patients for a clinical trial that combines the vaccine therapy with checkpoint blockade—a widely used treatment that effectively removes the brakes from T cells so they are free to attack cancer cells. This trial will target lymphomas, as well as breast cancer and head and neck cancers.

Immunotransplant Therapy

While PD-1 blockade has been effective for some lymphoma patients, its ability to help those with non-Hodgkin lymphoma has been more challenging. Even anti-PD-1/anti-CTLA4 dual checkpoint blockade has yielded limited efficacy, perhaps due to insufficient T cell activation.

Recently, Dr. Brody and his team found that combining immunotherapy and stem cell transplantation may be beneficial. In this first-of-its-kind approach, reported in Cancer Discovery, the researchers were able to increase the cancer-killing immune response tenfold when tested in the lab, making it effective against not just non-Hodgkin lymphoma but also melanoma and lung cancer.

“In the lab, immunotransplant either prolonged survival greatly compared to immunotherapy alone or actually cured a significant portion of mice with melanoma and lung cancer,” Dr. Brody says.

Immunotransplant works through the principle of homeostatic proliferation: when T cells are put into an empty organism or body, they become activated and begin to wildly multiply. In immunotransplant, T cells are withdrawn from the blood through apheresis, clearing the way for their reintroduction as infused immune cells. As they proliferate, these reinvigorated T cells build the immune system back up, become activated, and enable checkpoint blockade to achieve its full cancer-fighting potential.

The fact that checkpoint blockade has become the standard of care for treating melanoma, kidney cancer, lung cancer, and other diseases underscores the promise of immunotransplant. “We’ve shown we can increase the power of checkpoint blockade immunotherapy to prolong survival and induce cures in aggressive cancers, and that means not just lymphomas but solid tumor types,” says Dr. Brody.

Gynecologic Cancer Awareness Health Fair

Oct 21, 2019 | Cancer, Community

Rachel You, BSN, RN, left, and Hanna Cho, BSN, RN.

More than 500 participants learned about self-care and cancer risk factors at the Gynecologic Cancer Awareness Health Fair in Guggenheim Pavilion. The event, on Thursday, September 19, was sponsored by Women’s Services at The Mount Sinai Hospital and included nutrition tips, music, spiritual care, yoga, and information about support groups. This year, about 100,000 cases of gynecologic cancer will be diagnosed in the United States, says Godsfavour Guillet, BSN, RN, Nurse Manager, who organized the fair with the Women’s Health team on Klingenstein Pavilion 4.

Stephanie V. Blank, MD, Director of Gynecologic Oncology, Mount Sinai Health System, and Director, Women’s Cancer Program at the Blavatnik Family – Chelsea Medical Center at Mount Sinai, says, “By learning about symptoms, and measures that can reduce risk, you can empower yourself to make health decisions that can literally save your life.”

The nursing team from Klingenstein Pavilion 4 organized the event. Front row, from left, Jennifer Winborne, Assistant Director; Rachel You, BSN, RN; Godsfavour Guillet, BSN, RN, Nurse Manager; Petrina James, BSN, RN; and Hanna Cho, BSN, RN. Back row, from left: Justin Lyttleton, Business Associate; Ali Karim, Patient Care Associate; Diandra Mitchell, Patient Care Associate; Micaela Cruz, BSN; Vereen Gouldburne, BSN; Irena Durkovic, BSN; Monique Bartholomew, Patient Care Associate; and Erin Figueroa, MSN, RN, Senior Director.

Study Links Dust at Ground Zero to Prostate Cancer

Sep 9, 2019 | Featured, Prostate Cancer

Eighteen years after the September 11 attacks, Mount Sinai Health System researchers have found a higher incidence of prostate cancer among the World Trade Center (WTC) first responders than other populations, suggesting that chronic inflammation can facilitate the development of prostate cancer.

Emanuela Taioli, MD, PhD; and William Oh, MD

The most recent findings, published in June in Molecular Cancer Research, were led by Emanuela Taioli, MD, PhD, Director of the Institute for Translational Epidemiology and Associate Director for Population Science at The Tisch Cancer Institute; and William Oh, MD, Chief of the Division of Hematology and Medical Oncology at the Icahn School of Medicine at Mount Sinai, and Deputy Director of The Tisch Cancer Institute.

“Our research supports the first line of evidence that acute World Trade Center dust exposure through inhalation can profoundly disturb gene expression and immune cell infiltration in the prostate,” says Dr. Taioli.

While working at Ground Zero, the first responders did not wear protective gear and were exposed to dust particles composed of volatile organic compounds from jet fuel, as well as asbestos, benzene, silica, glass fibers, polychlorinated biphenyls, polychlorinated dibenzofurans, and dioxins from the collapsed buildings. Given the fine particulate nature of the WTC dust, the researchers hypothesize that the toxins entered the blood through the lungs and eventually reached the prostate and other distal organs.

“The results of this study support our hypothesis that exposure to the dust at the World Trade Center caused chronic changes in the body,” says Dr. Oh. “The long-lasting inflammatory effect in the prostate revealed in our study calls for further investigation as to the effect of this exposure in other organs, such as the kidney or thyroid, or the central nervous system.”

In 2018, Dr. Taioli led a study published in the European Journal of Cancer Prevention, which reported that responders who spent more time working at Ground Zero and had a higher exposure to the dust cloud that formed after the WTC buildings collapsed, had more advanced stages of prostate cancer—stages III and IV—representing tumor invasion. Interestingly, the 2018 study found that at the beginning of their service at the WTC, the responders were mostly nonsmokers of diverse ethnic backgrounds who were considerably healthier than the general population and at lower risk for cancer.

According to the recent 2019 report, approximately 20 percent of human cancers are thought to be caused by chronic infection or inflammatory states, and chronically unresolved inflammation is related to increased risk of malignant disease. When tested in the laboratory, the toxic dust was shown to induce the secretion of cytokines— small proteins involved in modulating responses to inflammation infection, cancer, and trauma.

Mount Sinai runs the largest World Trade Center Health Program Clinical Center of Excellence in the New York metropolitan region, with 25,000 patients who have consented to participate in research. A biobank of more than 600 cancer samples from first responders has helped lay the groundwork for Mount Sinai’s WTC research findings.

Dr. Taioli says the latest research raises additional questions about whether air pollution, in general, causes an inflammatory response in people. “This work has larger implications for the population exposed to environmental particulates, such as emissions from motor vehicles, industrial processes, power generation, and the household combustion of solid fuel,” she says. “Inflammation could be the common pathway driving an increase in cancer occurrence.”

Push-Up Challenge Brings Awareness to Prostate Health

Updated on Jun 30, 2022 | Community, Prostate Cancer

More than 120 Mount Sinai Health System faculty and staff completed more than 6,000 push-ups at the recent fourth annual Push-Up for Prostate Cancer Challenge held in Guggenheim Pavilion. The event, which commemorated Prostate Cancer Awareness Month in September, challenged each individual to complete 29 pushups in honor of the 29,000 men who die from prostate cancer in the United States each year.

“This very important event reflects Mount Sinai’s commitment to prostate cancer,” said Dennis S. Charney, MD, Anne and Joel Ehrenkranz Dean, Icahn School of Medicine at Mount Sinai, and President for Academic Affairs, Mount Sinai Health System, who kicked off the challenge by completing 96 push-ups.

Dr. Tewari, left, and Dr. Charney, far right, with winner John Mendez.

Dr. Tewari, left, and Dr. Charney, far right, with winner Daphne Semet, MBA.

Dr. Tewari, left, and Dr. Charney, far right, with The Mount Sinai Hospital Urology team.

The first-place team trophy was awarded to the Department of Urology at The Mount Sinai Hospital, which completed 775 push-ups. Individual awards were given to the top male and female, as well as to the individual who completed the most modified push-ups. First place honors were given to John Mendez, Customer Service Representative, Department of Plastic and Reconstructive Surgery (male, 101 pushups); Daphne Semet, MBA, Vice Chair of Administration and Finance, Department of Pathology, Molecular and Cell-Based Medicine (female, 102 push-ups); and Mena Singh, MPA, Senior Accountant, Department of Finance (modified-style, 106 push-ups).

Push-Up Challenge Brings Awareness to Prostate Health The program also offered information about prostate cancer and provided cancer screenings and risk consultations. “Prostate cancer is one of the most common cancers, but it does not produce any symptoms, and the only way you can go after it is by being proactive,” said Ash Tewari, MBBS, MCh, the Kyung Hyun Kim, MD Chair in Urology, Mount Sinai Health System, who led the event.

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