HonorHealth Research Institute (HRI) in Scottsdale, AZ, is a nonprofit health system serving 1.6 million individuals in the greater Phoenix area. The network includes 5 acute-care hospitals, an extensive medical group, outpatient surgery centers, a cancer care network, a clinical research institute, medical education, a foundation, and community services, and has approximately 11,500 employees, 3700 affiliated physicians, and 3100 volunteers.
HRI conducts research on innovative treatments, pharmaceuticals, and medical devices that are promising for cancer and other diseases (eg, heart disease, trauma, and obesity-related medical conditions). The eminent researchers at HRI collaborate with other expert investigators from the University of Arizona, Arizona State University, Translational Genomics Research Institute, Stand Up To Cancer, Mayo Clinic, and other academic sites.
The Oncology Nurse-APN/PA (TON) spoke with Gayle Jameson, MSN, ACNP-BC, AOCN, Director, Supportive Care Division, Virginia G. Piper Cancer Center, Scottsdale, AZ, about her role in conducting cancer research at HRI. Ms Jameson has been a nurse practitioner involved in cancer care since the late 1970s. In 2006, she joined Daniel D. Von Hoff, MD, FACP, Physician in Chief and Director, Translational Research, Translational Genomics Research Institute, and past President, American Association for Cancer Research, to conduct cancer research, and her role has evolved as a clinical investigator in cancer drug development and supportive care studies since that time.
TON: Tell us about your work at HRI.
Gayle Jameson: I am a nurse practitioner and an associate investigator at HRI. As an advanced practice nurse, my role is rather unique as my responsibilities include writing new drug protocols, leading studies as principal investigator, and caring for the patients enrolled in clinical trials. I also have the privilege to present the research findings at national meetings, and to publish the trial results. I am fortunate to be part of a group of highly dedicated oncology researchers and clinicians, as well as a talented multidisciplinary team, who help support our patients.
Approximately 11 years ago, I came to HRI (previously called Scottsdale Healthcare) to work with Dr Von Hoff. At that time, there were 5 clinical trials underway at our institution. We have grown significantly, and in 2017 we have >70 ongoing cancer clinical trials.
TON: What kind of research are you conducting?
Ms Jameson: The focus of our clinic includes phase 1 research, pancreatic cancer, malignancies in women, supportive care, and early cancer detection. We also support investigator-initiated trials, and I am a principal investigator on 2 of our current studies. In addition, we have experience with new drugs, from first-in-human phase 1 clinical trials through to FDA approval.
TON: What are some drugs you studied that have gone on to receive FDA approval?
Ms Jameson: We worked on vismodegib, treating the first patient in the world with this novel hedgehog signaling pathway–targeting agent. It was approved by the FDA in 2012 for the treatment of patients with advanced or inoperable basal-cell cancer, a disfiguring and potentially lethal disease. Working with Dr Von Hoff and our team, we developed the phase 1/2 and 3 trials of nab-paclitaxel plus gemcitabine, approved by the FDA in 2013 as a first-line treatment for patients with pancreatic cancer; the phase 3 study demonstrated improved survival compared with standard-of-care gemcitabine alone. I was also our site principal investigator on the phase 3 trial of irinotecan liposome injection, approved in 2015 for the second-line treatment of patients with pancreatic cancer.
Dr Von Hoff and I designed a triplet combination of nab-paclitaxel and gemcitabine plus cisplatin. The preclinical rationale is that pancreatic cancer cells have trouble with DNA repair, and are sensitive to cisplatin. In this study, we saw a dramatic and rapid response in many of the first 24 evaluable patients with stage IV adenocarcinoma of the pancreas. Overall response rate—which is yet to be published—was 71%. In addition, overall survival was a median of 16.5 months, exceeding the best median survival reported for approved therapy (11.1 months). Nine patients are still alive, and 2 have crossed the 3-year mark. We recognize that this was a small study, and plans are underway to expand this trial to further evaluate response. I presented these results at the 2017 American Society of Clinical Oncology Gastrointestinal Cancers Symposium.
TON: What is the biggest reward of your job?
Ms Jameson: My biggest reward is seeing patients with pancreatic cancer do well and have their symptoms improve. We are not just focused on our patients living longer, but also on improving their quality of life. My greatest joy is witnessing patients living longer with control of their disease, and sometimes achieving normalcy and even returning to work.
TON: What is your biggest frustration?
Ms Jameson: Most patients still die of pancreatic cancer, and it is frustrating and very sad when we lose them to this dreadful disease. Our vision is to improve patient outcomes, and we are confident that a cure is on the horizon. For example, in 1970, almost all young men with testicular cancer died. Then, Larry Einhorn, MD, Distinguished Professor, Indiana University School of Medicine, Indianapolis, developed an effective chemotherapy regimen, and now the cure rate is >90%.
Pancreatic cancer is a complex disease; the tumor has multiple mutations and is challenging to treat. However, rapidly evolving science has provided understanding of the biology and microenvironment of the tumor, and new treatment strategies give us great hope. Our patients, and those who have passed, continue to motivate us to find a cure.
TON: What else are you excited about right now in cancer research?
Ms Jameson: I am excited about patient empowerment and the growing awareness of the urgent need for research in pancreatic (and other less common) cancers. I am honored to participate on the Scientific Advisory Board of Let’s Win, a patient advocacy organization founded in 2015. The mission of Let’s Win is a bit unique, as it offers hope to patients with pancreatic cancer by providing cutting-edge information on advances and scientific research in the field. We want to get the word out that there is hope, and that new treatment options are available, including information about clinical trials. The Let’s Win website (http://letswinpc.org) is reliable and science-driven. The organization goes beyond patient education to patient empowerment.
We can control symptoms and knock back this disease in many patients, and our goal is to expand the number of those who receive help from new treatments.
Another important point to share with patients, families, and the medical community is that the National Comprehensive Cancer Network website recommends clinical trials as an important choice of treatment for patients with any stage of pancreatic cancer.
Although we have made progress in new standard-of-care options, these do not cure most patients’ disease. Only approximately 5% of adults diagnosed with cancer enroll in clinical trials, and we want to improve that. A major goal of Let’s Win is to increase the participation rate of patients with pancreatic cancer in clinical trials.
TON: What would you do if you won the lottery?
Ms Jameson: Exactly what I am doing now. Science is exploding, and I want to be a part of the advances being made that will not only improve treatment for our patients, but also enable early detection, and, ultimately, prevention. I suspect that I would use at least a portion of the winnings to fund clinical research. I love my work and am blessed to be a member of a dedicated team of nurses who do a great job educating patients and managing their symptoms. We are part of a larger multidisciplinary team, as it truly “takes a village” to effectively care for these patients.