People with advanced urothelial cancers — most of whom have bladder cancer — now have a new first-line treatment that will extend their survival for the first time in almost 40 years. The new treatment, approved by the Food and Drug Administration (FDA) on December 15, combines pembrolizumab, an immunotherapy agent, with enfortumab vedotin, an antibody drug conjugate.
The FDA had previously approved the drug combination in April for people who are ineligible for cisplatin-containing chemotherapy, a much smaller group of people. Bladder cancer is the fifth most common cancer.
Data from a phase three clinical trial, presented at the European Society of Medical Oncologists in October, showed that the experimental therapy nearly doubled the median survival to 31.5 months, compared to an average survival of just 16.5 months in the standard chemotherapy arm. Progression-free survival also doubled.
Furthermore, a slowing of the progression rate after 18 months in almost 40% of the experimental arm suggests that some people may live much longer. Historically, only 5% of advanced bladder cancer patients survived five years.
by D'Ann George, program development coordinator, Duke Cancer Institute Development (Dec. 8, 2023)
THE "BEFORE" PHOTO Fifteen men volunteered to shear their whiskers for the cause, including five firemen from Morrisville, several Duke clinicians, a bartender from Fullsteam, and a retired police detective from New York City.
FESTIVE Bob Young, in the holiday spirit, at Beer and Beards for Bros
This year’s Beer and Beards for Bros, held for the first time since 2019, raised nearly $10,000 for research at the Duke Cancer Institute Center for Prostate and Urologic Cancers. By all appearances, the event, held at Fullsteam Brewery on Dec. 1, raised even more fun than funds.
The 15 men who volunteered to shear their whiskers for the cause included five firemen from Morrisville, several Duke employees, a bartender from Fullsteam, dads with adorable children clinging to them, and a retired detective from the New York City Police Department, who was the first to part with his mustache.
Even the auctioneer, Sam Poley, got into the action and bid off his own beard. Poley said he volunteered his time and talent in memory of his late father, who was treated for prostate cancer at Duke.
Mohawks, Leopard Skins, and Pink Flamingos
Auction winners directed a team of stylists from the Arrow “guaranteed shorter hair” barbershop on how they wanted the men shaved. Their crowning achievement came when one of the firemen incentivized the audience to bid higher by agreeing to “go full mohawk.”
Before the night was over, all of the men shamelessly shed their street clothes to don frippery chosen by auction winners from a table of costumes.
The bartender, who sported the thickest, blackest beard of them all, looked jarring in his blonde curly wig and white bedazzled frock.
Travis Henry, MD, a Duke radiologist, dressed as a fluffy bear. Medical oncologist Mike Harrison, MD, wore a shirt emblazoned with giant pink flamingos and a red headband attached to a messy blonde wig.
But the highest bid — almost $2,000 — went to Raj Gupta, MD, a DCI radiologist who sported a leopard coat and a white mink scarf. His dashing ensemble was chosen by his two young daughters, who placed the winning bid.
Police Officer Wins “Most Hilarious” Contest
The NYPD detective, Bob Young, struggled to squeeze into a strapless, red sparkly dress with a blue-and-white starred petticoat, which he topped off with reindeer antlers embellished with multi-colored Christmas lights.
Young easily won the prize for “most hilarious.” But the sequins did not stop him from kicking off the event with a moving speech about why prostate cancer research and excellent clinical care mean so much to him.
First Responders and Genitourinary Cancers
"People usually get prostate cancer in their 60s, but the 9/11 responders were getting it in their 30s and 40s,” said Young.
As president of the 50135 club, a benevolent association for retired police officers in Raleigh, Young said that "Beer and Beards for Bros" was the first charitable event that he has attended since the pandemic.
Likewise, the five firemen who attended said that the shave-off was their first post-pandemic philanthropic event. Nick Young, president of the association, heard about the event from his fiancé, Sarah Omwenga, RN, an oncology nurse at Duke.
Young said that testicular, thyroid, and throat cancer are prevalent among firefighters due to the chemical exposures they face on the job.
“We’re coming back next year,” said the elder Young. “And we’re bringing friends. There are 120 retired policemen in my club. And 20 of them have cancer. I want the ones with prostate cancer to be seen at Duke.”
From the Archives
Daniel George, MD, visits Pedro Williams barbershop for a complimentary shave down before growing out his facial hair in November. (photo from 2015)
FLASHBACK: In 2012, Michael Harrison, MD, Andrew Armstong, MD, MSc, Dan George, MD, and Judd Moul, MD, pose following their November grow out.
Fullsteam Brewery 726 Rigsbee Ave Durham, NC United States
Everardo Macias, PhD, assistant professor in the Department of Pathology, assistant research professor in the Department of Cell Biology, and a member of the Duke Cancer Institute.
Supporters of the 2023 Tackle Cancer Tailgate, including clinicians, cancer survivors, and community members, enjoyed fine weather and great camaraderie for the tailgate and football game. Though the Duke Blue Devils lost to the Fighting Irish of Notre Dame on Sept. 30, the research support was a giant win for our patients, present and future.
On September 29, community members, including cancer survivors and caregivers, learned about the latest clinical advances in the treatment of kidney, prostate, and bladder cancers during a live discussion among faculty/oncologists from the Duke Cancer Institute Center for Prostate & Urologic Cancers.
Speakers included: William Berry, MD; Daniel George, MD; Michael Harrison, MD; Zach Reitman, MD, PhD; Ankeet Shah, MD; Michael Abern, MD; Andrew Armstrong, MD, MSc; Ryan Fecteau, MD, PhD; Christopher Hoimes, DO; Shahla Bari, MBBS; and Hannah McManus, MD.
In a special session of the symposium William Berry, MD, was celebrated for his five-decade career in Medicine — beginning and ending at Duke — and interviewed by George. Berry, a DCI medical oncologist specializing in treating bladder, kidney, prostate, and testicular cancer, joined Duke on January 1, 1974, and will officially retire on Dec. 31, 2023. He earned his MD at Duke in 1973.
Together, the 2023 Duke Cancer Institute Center for Prostate & Urologic Cancers Symposium (9/29/23) and Tackle Cancer Tailgate (9/30/23) raised $64,000 for prostate and urologic cancer research.
This slide was shown as part of a tribute to William Berry, MD, to illustrate Duke in the 1970s when he began his medical career.
Angelo Moore, PhD, MSN, RN, NE-BC, director of the DCI Community Outreach, Engagement, and Equity program Office of Health Equity, has been named a Fellow of the American Academy of Nursing (AAN). Moore, along with four other nurses at Duke, is among 253 new fellows selected from across 40 states, the District of Columbia, and 13 countries.Beyond one's achievements within the nursing profession, fellows are recognized for "engaging with health leaders nationally and globally to improve health and achieve health equity by impacting policy through nursing leadership, innovation, and science."As a U.S. Army Non-Commissioned Officer, Moore served during three Gulf War campaigns. After subsequently attending, then graduating from Winston-Salem State University, he joined the U.S. Army Nurse Corps. All told, he served more than 25 years on active duty in multiple leadership roles from Germany to Hawaii — earning several service medals, commendation medals, service ribbons, and three bronze service stars. During this time Moore also completed a master’s degree and a doctorate degree in nursing.Moore retired from the U.S. Army in 2015 as a Lieutenant Colonel, but his service continued in civilian life with his commitment to serve historically underserved communities in the U.S.Moore joined DCI in May 2019. He oversees, coordinates, and helps design DCI's community impact-projects to reduce disparities in cancer outcomes for patients across North Carolina and beyond.LEARN MORE about OHE's latest projectsRead this 2020 profile of Moore: "In Service to Others: On the Battlefield & In the Community."The Academy will induct the new class of fellows during its annual Health Policy Conference in October. With this honor comes the Fellow of the American Academy of Nursing "FAAN" credential.The other Duke inductees are: Mariam Kayle, PhD, RN, CCNs; Mitchell Knisely, PhD, RN, ACNS-BC, PMGT-BC; Staci Reynolds, PhD, RN, ACNS-BC, CCRN, CNRN, SCRN, CPHQ; Ryan Shaw, PhD, RN, ACHIP.
Duke Cancer Institute Blog
Nadine Barrett, PhD, provides strategic direction for the Men’s Health Initiative.
When Nadine Barrett, PhD, was 15, she and her mother traveled from their home in Wimbledon, England to New York City and ended up staying; making a home in Brooklyn. They were immigrants seeking “new opportunities to advance their education and career,” Barrett said, and undocumented.
“We lived in Wimbledon, and were of one the few black families in the area,” said Barrett. “I came to Brooklyn and saw so much diversity and a strong representation of black people, essentially, people who look like me in the community. I thought, 'This is fabulous.'”
But the novelty of a new life in America quickly wore off.
Barrett’s mom, who had been a district nurse in England, could not practice in the America because of her immigration status. As result, she had to initially accept low-paying jobs outside of her professional experience, until she received her green card and was able to practice as a geriatric nurse, a career she held for 30 years.
Barrett enrolled in Lafayette High School, which though integrated in the classroom, was far from integrated on the playground — “Italian white students on one side, black and Puerto Rican students on the other.”
With her very strong British accent, Barrett didn’t entirely fit in with either group, she said.
“The black kids didn't like me because of my accent, the white kids didn't like me because I was black,” explained Barrett. “I figured that out very quickly. I became keenly aware of how race, racism, and the social, cultural and political environment in which we live impacts our lives and our opportunities.”
Barrett has traveled far — literally and figuratively — since those days in Brooklyn.
For 20 years, she’s worked to reduce health disparities among historically underrepresented populations by increasing their access to care and research; ensuring that diverse voices and perspectives are included as stakeholders that can influence and improve community and population health, and equipping health systems and researchers with tools, resources, and strategies to effectively engage these diverse populations in the development and full participation in healthcare and research.
About a third of that time has been spent at Duke.
Part of a Special Report by Duke Cancer Institute & the Department of Pathology, Duke University School of Medicine — as featured in the 2021-22 Department of Pathology Annual Report (pdf)Oncologists today have a wider range of anti-cancer drugs to reach for, many of which target the molecular alterations believed to contribute to the cancer’s development.Comprehensive genomic profiling, also known as next-generation sequencing (NGS), is used to identify these molecular alterations. Duke Cancer Institute (DCI) oncologists partner with Duke University Health System (DUHS) Clinical Labs and private diagnostics companies to test patients at diagnosis and/or after the cancer grows or spreads.While it can vary across cancer types, increasingly, targeted therapies that can save patients from needing toxic chemotherapy are becoming available at multiple points in a patient’s cancer treatment, from first line standard of care to subsequent treatment after progression on conventional therapies.Test results are entered into a Molecular Registry of Tumors known as Frameshift MRT. This centralized informatics tool — designed, built, and coded at Duke byMichael Datto, MD, PhD, (currently the medical director of DUHS Clinical Labs and vice chair for Clinical Pathology) and Christopher Hubbard (DUHS clinical informatics architect) — helps oncologists identify if anything in their patient’s mutational profile, even extremely rare targets, can be treated with any existing targeted therapies or immunotherapies.Duke Cancer Institute has been offering its patients NGS testing since 2014. Developing Frameshift MRT three years later to organize and optimize the growing volume and complexity of data, and the subsequent formation, in early 2018, of a weekly multidisciplinary Molecular Tumor Board to review complex patient cases was a perfectly timed great leap forward.The Precision Cancer Medicine Initiative — launched in 2017 by DCI, the BioRepository & Precision Pathology Center (BRPC), and the Clinical Labs — was the critical push behind it.“It had become increasingly clear that the needs of sophisticated cancer researchers were changing across all cancer types; moving away from generic, archived, cancer-tissue samples, to fresh samples, to samples with a specific molecular abnormality,” explains Shannon McCall, MD, director of the BRPC, a DCI and Duke University School of Medicine Shared Resource housed in the Department of Pathology. “This coincided with clinical advances. Providers, including at DCI, were utilizing these broad molecular profiling assays to direct the care of cancer patients. There was a need to harness all this molecular profiling data to support both cancer research and treatment. I was totally on fire to get this started. We have so many big thinkers at Duke who said, ‘Let’s think about data and what’s possible.’”In mid-2018, Executive Director of DCI Michael Kastan, MD, PhD, a noted cancer biologist, and Chair of the Department of Pathology Jiaoti Huang, MD, PhD, a prostate cancer researcher, signed a memorandum of understanding to co-fund the staffing necessary to further support the Molecular Tumor Board — co-directed by oncologists John Strickler, MD (for solid tumor cancers), and Matthew McKinney, MD (for blood cancers) — and to manage the Frameshift MRT database. This included hiring a bioinformatician/ data analyst (Jonathan Bell, PhD) and a savvy genetics scientist (Michelle Green, PhD).Green, fresh from a position in the molecular diagnostic testing industry, joined the Duke Pathology (with salary support from DCI) in the spring of 2019 as senior research program leader of the Molecular Tumor Board and main user and manager of Frameshift MRT. She tracks promising clinical trials and new FDA drug approvals and has configured Frameshift MRT to automatically send therapy alerts to providers when their patients' molecular profiles match any known anti-cancer drug(s). This match could include drugs that are already FDA-approved, drugs that are “emerging” with strong clinical evidence, drugs that are being tested in clinical trials, or drugs that are approved or being trialed in another cancer type.Over the course of the COVID-19 pandemic, Green has made several significant changes to Frameshift MRT that make it more user-friendly, interactive, and accessible for clinicians and researchers, who can access the Frameshift MRT dashboard when logged into the Duke VPN. Green is available to train and advise.
