Duke Sarcoma Center Leadership: David Kirsch, MD, PhD, Co-Leader; Brian Brigman, MD, PhD, Director; Richard Riedel, MD, Associate Director of Clinical Research. (photo by Brian Strickland)
New Duke Sarcoma Center Announced
Published
From the Duke Cancer Institute archives. Content may be out of date.
Brian Brigman, MD, PhD, Director, Duke Sarcoma Center, presents a case at the tumor board, with (pictured at left) Nicole Larrier, MD, and Pam Pennigar, FNP, MSN, and Associate Director of Clinical Research at the Center, Richard Riedel, MD, and Center Co-leader David Kirsch, MD, PhD. (photo by Brian Strickland)
The Duke Cancer Institute is excited to announce the establishment of the Duke Sarcoma Center, a center of excellence for sarcoma treatment and research.
Spearheaded by orthopedic surgical oncologist and professor of Orthopedic Surgery and Pediatrics, Brian E. Brigman, MD, PhD, the Center is the natural outgrowth of DCI’s Sarcoma Disease Group — a program recognized for innovative personalized treatment grounded in state-of-the-art clinical and basic-science research and committed to training the next generation of sarcoma clinicians and scientists.
“Care for sarcoma patients has gone on for decades at Duke, but over the last 15 years or so, our specialized team has really grown into a national leader in this area. The Duke Sarcoma Center is a recognition of this accomplishment and a new beginning of even better care, research, and training at Duke,” says Brigman.
(at right) Director of the Duke Sarcoma Center Brian Brigman, MD, PhD (Orthopaedic Surgery) discusses a case with Center co-leader David Kirsch, MD, PhD (Radiation Oncology). (photo by Brian Strickland)
The multidisciplinary team is comprised of 35 specialists — physicians, physician assistants, nurses, and researchers across the disciplines of orthopedic surgery, surgical oncology, medical oncology, pediatric oncology, radiation oncology, radiology, neurosurgery, and pathology.
“We see more than 900 new patients in the Duke Cancer Institute’s Sarcoma Clinic per year across all specialties and are actively caring for more than 2000 patients. The majority are in active treatment or long-term-follow up or survivorship,” notes Brigman. “Sarcomas may be rare cancers, but they’re not rare for us. With our experience comes greater expertise.”
EXPERTISE IN MOTION AT DUKE & IN THE COMMUNITY Duke Sarcoma Center Co-Leader David Kirsch, MD, PhD, consults with Nicole Larrier, MD, MS, an associate professor of Radiation Oncology. Kirsch and Larrier are the only DCI radiation oncologists affiliated with the Center. Both work out of the Duke Cancer Center Sarcoma Clinic. Larrier also sees patients at the Maria Parham Cancer Center in Henderson, NC, which is part of the Duke Cancer Network. (photo by Brian Strickland)
Sarcomas are cancers that affect the supporting tissue of the body. They can occur in bone, muscle, fat, or other tissues.
According to the American Cancer Society, about 3,910 new cases of cancer in the bones and joints and an estimated 13,190 new cases of soft tissue sarcomawill be diagnosed in adults and children this year. An estimated 2,100 people are expected to die from bone and joint sarcoma and 5,130 from soft tissue sarcoma.
That’s about 17,000-plus diagnoses and 7,000-plus deaths too many.
“Because they occur anywhere in the body, can affect people of any age, and have more than 100 different subtypes, they are very challenging to diagnose and cure,” Brigman explains. “This work requires a true team approach. There’s ample evidence to suggest that patient outcomes are better when they’re treated by an integrated subspecialized sarcoma team.”
Notably, in addition to adults, the Center treats a significant number of pediatric sarcoma patients. All five pediatric sarcoma specialists affiliated with the Center (Lars Wagner, MD, Corinne Linardic, MD, PhD, David Van Mater, MD, PhD, Michael Deel, MD and Susan Kreissman, MD) have clinics at Duke Children’s Health Center in Durham.
UP TO THE CHALLENGE DCI medical oncology nurse practitioner Jenny Phillips, FNP-C, sees patients with bone and soft tissue sarcomas — a rare and often challenging diagnosis.
Diagnostic testing offered at the Center includes the use of chest X-ray, cross-axial imaging with MRI or CT imaging, nuclear medicine imaging with bone scan or PET imaging, and ultrasound- or CT scan-guided needle biopsies.
Patient cases are discussed weekly at a multidisciplinary sarcoma tumor board (a meeting of sarcoma specialists) where imaging and pathology are reviewed, and consensus is built around building the best treatment for an individual patient.
The team offers the latest treatment options to preserve healthy tissue and bone, including comprehensive limb-sparing surgeries to avoid the need for amputation, and radiation therapy that reduces potential damage to surrounding tissue and organs by targeting the tumor directly or the tumor site (before or following surgical removal). Radiation therapy modalities include intensity- modulated radiation therapy, intraoperative radiotherapy, and brachytherapy. Chemotherapy may also be deployed depending on the patient’s specific diagnosis, anticipated risks versus benefits, and other factors.
Clinical trials are also often an option for pediatric and adult patients with sarcomas.
“We have a strong record of developing innovative clinical trials and research studies at Duke and are dedicated to accelerating, into the clinic, those research discoveries with translational potential,” says associate professor of Medicine and practicing medical oncologist Richard F. Riedel, MD, the Duke Sarcoma Center’s associate director of Clinical Research. “Our goal is to try and have a clinical trial option for every patient who walks through the door.”
Translational Research
OPTIONS: ONE SIZE DOES NOT FIT ALL (at right) DCI medical oncologist Richard Riedel, MD, reviews a case before the tumor board with Duke pathologist William Jeck, MD (back left) having queued up a slide. Riedel is an associate professor of Medicine, and Associate Director of Clinical Research at the Duke Sarcoma Center. “Our goal is to try and have a clinical trial option for every patient who walks through the door," he says.
David G. Kirsch, MD, PhD, the Barbara Levine University Distinguished Professor and vice chair for Basic & Translational Research in the Department of Radiation Oncology, is co-leader of the Duke Sarcoma Center. He sees patients as a radiation oncologist and also runs a research lab — the Kirsch Lab — focused on developing better treatments and understanding how sarcomas develop and spread.
Duke oncologist and veterinarian Will Eward, MD, DVM, (right) with N.C. State University veterinary oncologist Steven Suter and canine osteosarcoma patient "Deuce" in 2018.
“Although our current treatments cure some patients with sarcomas, these therapies fail in too many patients. At the Duke Sarcoma Center, we have a critical mass of investigators funded by the NIH and foundations who are focused on understanding the mechanisms of sarcoma development, metastasis, and developing novel treatments for sarcomas,” says Kirsch. “Our goal is to not only make impactful discoveries in the lab but translate them to new treatments for sarcoma patients in the clinic.”
Some of the clinician-scientists and researchers affiliated with the Duke Sarcoma Center also play an active role in the DCI Comparative Oncology program, which leverages research and resources across species to ensure the development of new diagnostics and therapies for naturally occurring cancers, including bone and soft-tissue sarcomas.
Led by orthopedic surgical oncologist William Eward, DVM, MD — an expert in treating pediatric, adult, canine, and other mammalian sarcomas — Comparative Oncology brings together researchers, medical doctors, and veterinarians at Duke, NC State University's College of Veterinary Medicine, and the Triangle Veterinary Referral Hospital to defeat the common enemy of cancer.
HAIR GOALS Richard Riedel, MD, and Brian Brigman, MD, PhD, show their team spirit with yellow ribbons & "hair."
Community engagement is an important pillar of the team’s mission.
This includes planned public symposia on sarcoma treatment and research and the traditional Strike Out for Sarcoma run/walk event, an annual event that brings together patients and families, friends and caregivers, survivors, providers, and the local community to raise awareness and research support for the program.
This article was updated on April 26, 2022, to update the number of Center members -- from 25 to 35.
For many people with lung cancer, the disease doesn’t stay confined to the lungs. Up to half of patients with non-small cell lung cancer, and as many as 80 percent of patients with small cell lung cancer, develop brain metastases throughout the course of their illness. These diagnoses can significantly affect quality of life, treatment options, and long-term outcomes.At Duke Cancer Institute (DCI), Laura Alder, MD, deputy director of medical oncology for the Duke Center for Brain and Spine Metastasis, is working to change how patients with brain metastases are represented in clinical research and, ultimately, how they are treated.Alder’s clinical and research career centers on two closely related priorities: lung cancer and brain metastases. After completing her fellowship at Duke, she joined the faculty and became deeply involved in multidisciplinary efforts to improve care for patients whose cancer has spread to the brain or spine.“Brain metastases have a huge impact on a patient’s trajectory,” Alder said. “They affect quality of life, treatment decisions, and outcomes in very meaningful ways.”Clinical trials often represent the most promising treatment option for patients with advanced cancer, offering access to therapies that are not yet widely available. However, Alder notes that trial eligibility criteria have traditionally been narrow.“There’s been a longstanding concern that patients with brain metastases wouldn’t do well on clinical trials or could confound the results,” Alder said. “As a result, many trials exclude these patients entirely.”To address this gap, Alder collaborated with a multidisciplinary group of researchers on a publication focused on improving clinical trial inclusion for patients with lung cancer and brain metastases. The work, published recently in Lung Cancer, builds on decades of research led by Paul Sperduto, MD, PhD, adjunct professor in the Duke Department of Radiation Oncology, who developed the Graded Prognostic Assessment (GPA).The GPA is a validated tool used to estimate survival in patients with brain metastases by accounting for factors such as age, performance status, disease burden, and tumor biology. For non-small cell lung cancer, the tool incorporates modern biomarkers, including genetic driver mutations, which can influence response to targeted immunotherapies.Paired with the eligibility quotient (EQ), which helps estimate conditional survival, these tools paint a more accurate and individualized picture of prognosis, one that challenges outdated assumptions.“What we see is that many of these patients actually have very good overall survival,” Alder said. “Our therapies are better, more precise, and more effective than ever before.”Alder said advances in imaging, MRI surveillance, and radiation techniques, such as stereotactic radiosurgery (SRS), also make it possible to closely monitor and manage brain metastases during treatment. These innovations further support the safe inclusion of these patients in trials.At Duke, efforts to improve clinical trial inclusivity extend beyond a single publication. Through the Duke Center for Brain and Spine Metastasis, clinicians and researchers regularly collaborate with pharmaceutical partners, advocate at national conferences, and engage in ongoing dialogue with industry leaders.“This has been a mission for many of us for years,” Alder said. “At every meeting, every podium, we’re making the case that these patients need to be included because that’s where the unmet need is.”Encouragingly, progress is being made. National organizations such as the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO), along with the U.S. Food and Drug Administration (FDA), have increasingly emphasized the importance of broader eligibility criteria in cancer trials.Alder hopes the framework outlined in the publication will be used prospectively in future trials, helping demonstrate that inclusion of patients with brain metastases is both safe and beneficial.“Our patients are living longer than ever before,” she says. “They deserve clinical trials that reflect the reality of their disease and give us the data we need to keep making progress.”
For many people with lung cancer, the disease doesn’t stay confined to the lungs. Up to half of patients with non-small cell lung cancer, and as many as 80 percent of patients with small cell lung cancer, develop brain metastases throughout the course of their illness. These diagnoses can significantly affect quality of life, treatment options, and long-term outcomes.At Duke Cancer Institute (DCI), Laura Alder, MD, deputy director of medical oncology for the Duke Center for Brain and Spine Metastasis, is working to change how patients with brain metastases are represented in clinical research and, ultimately, how they are treated.Alder’s clinical and research career centers on two closely related priorities: lung cancer and brain metastases. After completing her fellowship at Duke, she joined the faculty and became deeply involved in multidisciplinary efforts to improve care for patients whose cancer has spread to the brain or spine.“Brain metastases have a huge impact on a patient’s trajectory,” Alder said. “They affect quality of life, treatment decisions, and outcomes in very meaningful ways.”Clinical trials often represent the most promising treatment option for patients with advanced cancer, offering access to therapies that are not yet widely available. However, Alder notes that trial eligibility criteria have traditionally been narrow.“There’s been a longstanding concern that patients with brain metastases wouldn’t do well on clinical trials or could confound the results,” Alder said. “As a result, many trials exclude these patients entirely.”To address this gap, Alder collaborated with a multidisciplinary group of researchers on a publication focused on improving clinical trial inclusion for patients with lung cancer and brain metastases. The work, published recently in Lung Cancer, builds on decades of research led by Paul Sperduto, MD, PhD, adjunct professor in the Duke Department of Radiation Oncology, who developed the Graded Prognostic Assessment (GPA).The GPA is a validated tool used to estimate survival in patients with brain metastases by accounting for factors such as age, performance status, disease burden, and tumor biology. For non-small cell lung cancer, the tool incorporates modern biomarkers, including genetic driver mutations, which can influence response to targeted immunotherapies.Paired with the eligibility quotient (EQ), which helps estimate conditional survival, these tools paint a more accurate and individualized picture of prognosis, one that challenges outdated assumptions.“What we see is that many of these patients actually have very good overall survival,” Alder said. “Our therapies are better, more precise, and more effective than ever before.”Alder said advances in imaging, MRI surveillance, and radiation techniques, such as stereotactic radiosurgery (SRS), also make it possible to closely monitor and manage brain metastases during treatment. These innovations further support the safe inclusion of these patients in trials.At Duke, efforts to improve clinical trial inclusivity extend beyond a single publication. Through the Duke Center for Brain and Spine Metastasis, clinicians and researchers regularly collaborate with pharmaceutical partners, advocate at national conferences, and engage in ongoing dialogue with industry leaders.“This has been a mission for many of us for years,” Alder said. “At every meeting, every podium, we’re making the case that these patients need to be included because that’s where the unmet need is.”Encouragingly, progress is being made. National organizations such as the American Society of Clinical Oncology (ASCO) and the European Society for Medical Oncology (ESMO), along with the U.S. Food and Drug Administration (FDA), have increasingly emphasized the importance of broader eligibility criteria in cancer trials.Alder hopes the framework outlined in the publication will be used prospectively in future trials, helping demonstrate that inclusion of patients with brain metastases is both safe and beneficial.“Our patients are living longer than ever before,” she says. “They deserve clinical trials that reflect the reality of their disease and give us the data we need to keep making progress.”
