Article Category: Clinical

Siteman Cancer Center named among top U.S. cancer centers

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine has been named among the top cancer centers nationally by U.S. News & World Report. The recognition is part of the overall ranking of Barnes-Jewish and Washington University, which are No. 18 on the news magazine’s 2020-21 “Best Hospitals” list, released today.

Siteman was named No. 11 in cancer care, based on a review of 899 hospitals. Health-care facilities are chosen largely on patient outcomes and other data and a national survey of physicians.

In addition to their national rankings, Siteman and Barnes-Jewish each were ranked No. 1 in the St. Louis region and No. 1 in Missouri in their respective categories.

“Being recognized as one of the nation’s top cancer programs is an honor,” said Timothy J. Eberlein, MD, Siteman’s director and the Spencer T. and Ann W. Olin Distinguished Professor and head of the Department of Surgery at the School of Medicine. “More importantly, it speaks to the extraordinary care we provide to our patients, care that’s built on one of the top cancer research programs anywhere.”

Siteman’s “Best Hospitals” listing follows recent recognition by the National Cancer Institute (NCI), the principal federal agency for cancer research and training. Based on the NCI’s review of Siteman research programs, the cancer center received the agency’s highest possible rating, “Exceptional.”

Siteman is Missouri and southern Illinois’ only NCI-designated Comprehensive Cancer Center and the only cancer center in that area to be nationally ranked by U.S. News & World Report. The cancer center treats more than 75,000 patients, including 12,000 newly diagnosed patients, every year. Care is provided at six locations in the St. Louis region: on the Washington University Medical Campus and at Northwest HealthCare, part of Christian Hospital; Barnes-Jewish St. Peters Hospital; Barnes-Jewish West County Hospital; Siteman Cancer Center-South County; and Memorial Hospital East in Shiloh, Ill. Siteman also partners with Siteman Kids at St. Louis Children’s Hospital in the treatment of pediatric patients. The facilities all are affiliated with BJC HealthCare.

Barnes-Jewish Hospital and its Washington University physician partners also are part of U.S. News & World Report’s top 20 honor roll of hospitals that excel in complex specialty care.

To determine its rankings, U.S. News & World reviews 16 specialties. Rankings for 12 of them, including cancer, are based on a mathematical model combining mortality rate for particularly challenging cases, patient experience and other data, as well as on the expert opinions of specialized physicians nationally. Learn more about the methodology here.

The 2020-21 “Best Hospitals for Cancer” list is available at https://health.usnews.com/best-hospitals/rankings/cancer. Rankings also will appear in U.S. News & World Report’s “Best Hospitals 2021” guidebook, available Oct. 6.

New gene-altering treatment offered for blood cancers

Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis is one of the first centers nationwide to offer a new immunotherapy that targets certain blood cancers. Newly approved by the Food and Drug Administration (FDA) for types of advanced non-Hodgkin lymphoma in adults, the CAR-T cell therapy harnesses a patient’s own immune system to fight cancer.

Washington University doctors and researchers were involved in clinical trials that led to the FDA approval of the new CAR-T cell therapy, called Yescarta, and are working to develop other immunotherapies that attack cancer.

“This is the beginning of a new era of cancer therapy,” said Washington University oncologist Armin Ghobadi, MD, an assistant professor of medicine at the School of Medicine who treats patients at Siteman. “With CAR-T cell therapy, we can take patients’ own cells and turn them into a powerful weapon to attack cancer. It’s a highly personalized, innovative therapy and one we hope also will prove to be effective against many different types of cancer.”

At the heart of the new therapy are the immune system’s T cells, which typically fight off disease. In cancer patients, T cells lose the ability to recognize and attack cancer cells. CAR-T cell therapy involves extracting a patient’s own T cells and genetically altering – or supercharging – those cells to home in on cancer cells and destroy them.

The first cancers to be treated with CAR-T cell therapy include advanced lymphomas in adults and acute lymphoblastic leukemia (ALL) in children. CAR-T cell therapy for pediatric ALL was approved by the FDA at the end of August and is available through Siteman Kids at St. Louis Children’s Hospital. These cancers are characterized by the production of too many B cells, a type of white blood cell that is also a part of the immune system.

Currently, CAR-T therapy for adults with non-Hodgkin lymphoma is available only to patients whose cancer has not responded to standard treatments — including chemotherapy and bone marrow transplantation. Kite Pharma, a Gilead company, developed the new treatment.

Clinical trials of CAR-T therapy have shown what doctors have called remarkable remission rates among children with ALL and adults with lymphomas and multiple myeloma. In patients whose disease has not responded to standard therapies or has relapsed, CAR-T therapy has achieved from 40 to 80 percent remission rates. Some patients have remained in remission for several years.

“The availability of this new treatment offers a novel and very effective option for patients whose choices were once limited to joining a clinical trial of an investigational drug or entering hospice care,” Ghobadi said.


These modified T cells have been dubbed CAR-T cells, which stands for chimeric antigen receptor T cells.
A patient’s T cells are isolated from the blood and modified in a way that lets the T cells specifically home in on the type of cell affected by the cancer. These modified T cells have been dubbed CAR-T cells, which stands for chimeric antigen receptor T cells. Once a CAR-T cell finds its target, it behaves as any T cell should — triggering a chain of reactions that destroys the target cell. HUY MACH



If cancerous cells find ways to fly under the radar of immune surveillance, the new therapy renders these cancers visible again.

“The immune system can’t always see cancer cells as threats — the T cells are sometimes blind to them,” said John F. DiPersio, MD, PhD, the Virginia E. and Sam J. Golman Professor of Medicine in Oncology and director of the Division of Oncology at the School of Medicine and deputy director of Siteman Cancer Center. “By modifying these T cells, we tell them what to look for. Now they can go right to the leukemia or lymphoma and eliminate the cancerous cells.”

Over decades, an extensive body of research gradually has revealed the details of what many types of cancers look like on the cell surface. And in this new therapy, that information is, in a sense, programmed into the T cell. A patient’s T cells are isolated from the blood and modified in a way that lets the T cells specifically home in on the type of cell affected by the cancer. These modified T cells have been dubbed CAR-T cells, which stands for chimeric antigen receptor T cells.

Once a CAR-T cell finds its target, it behaves as any T cell should — triggering a chain of reactions that destroys the target cell. CAR-T cells often are referred to as a living drug because they expand their numbers dramatically once in the bloodstream. And like other T cells, they remember what their targets look like, sometimes long after the offending cells have been eradicated. While long-term data is still being gathered, there is evidence that some CAR-T cells may maintain their active surveillance and ramp up again in response to cancer recurrence. The fact that CAR-T cells can be given different programming, locking them on to different cell surface features, suggests the strategy could be expanded to other cancers.

But because the therapy induces a heightened immune response, there can be a range of side effects, from fever and shortness of breath to kidney failure and seizures. Many of the side effects are manageable, but some are severe and a few can be life-threatening, which is why the first centers selected to administer the new therapy are those with extensive expertise in treating blood cancers. That expertise includes long histories of success in bone marrow transplantation and management of the sometimes severe side effects of that similarly intensive, but standard, therapy for many blood cancers.

“The toxicities of bone marrow transplantation and CAR-T cells are completely different, but we are well-equipped to manage both,” DiPersio said. “We have approved therapies we can give to counter one of the primary side effects of CAR-T cells called cytokine release syndrome, which causes symptoms like low blood pressure, high fevers, chills, swelling and kidney failure. Some patients who receive CAR-T therapies also can experience life-threatening neurologic toxicities that we are still working to understand.”

Washington University doctors at Siteman also are evaluating CAR-T cell therapy in a clinical trial for leukemia and soon will begin a trial in patients with multiple myeloma, another type of blood cancer, and ovarian cancer. Clinical trials currently available for sarcoma, a cancer of bones and connective tissue; lung cancer; and melanoma, a skin cancer, involve therapies very similar to CAR-T cell therapy.

For more information about CAR-T cell therapy, patients should visit siteman.wustl.edu or call toll free 800-600-3606.

Siteman Cancer Center opens expanded St. Charles County facility

Siteman Cancer Center will open its newly expanded and renovated outpatient facility at Barnes-Jewish St. Peters Hospital in St. Charles County on May 1.

The expansion nearly doubles the facility’s size, to 37,000 square feet. With the larger capacity, additional physicians will be available to see patients in newly added exam and treatment rooms.

The facility offers access to the same advanced treatments, including more than 500 clinical trials, available at Siteman’s other satellite locations in the region and on the Washington University Medical Campus at Barnes-Jewish Hospital.

“Recognized among the best cancer centers in the country by U.S. News & World Report, Siteman Cancer Center offers highly advanced care,” said Timothy J. Eberlein, MD, Siteman’s director and the Spencer T. and Ann W. Olin Distinguished Professor at Washington University School of Medicine in St. Louis. “Our patients deserve the best, and with additional Washington University physicians and new facilities, we can continue providing exceptional care closer to where patients live.”

The multidisciplinary, coordinated care provided by Washington University radiation oncologists, medical oncologists and surgeons at Siteman-St. Peters helps to ensure that patients can see as many as three physicians in one visit. This team approach also means a patient’s treatment plan can be determined in one visit with a team of nationally recognized cancer specialists.

Located near Mexico and Jungermann roads on the campus of Barnes-Jewish St. Peters Hospital, the newly expanded facility provides:

  • Five medical oncologists to serve patients, up from three.
  • An increase in medical oncology exam rooms to 16, from eight.
  • An increase in chemotherapy infusion chairs to 32, from 11.
  • 28 chemotherapy infusion bays and four private infusion rooms.
  • An increase in radiation oncology rooms to seven, from four.
  • Two state-of-the-art linear accelerators with a wide range of treatment capabilities, including stereotactic body radiation therapy and stereotactic radiosurgery, which deliver precisely targeted radiation to tumors in the body or brain.
  • More space for Washington University surgeons to consult with patients.

“At Siteman-St. Peters, we offer our patients nationally recognized care in a community hospital setting,” said John DiPersio, MD, PhD, Siteman’s deputy director and the Virginia E. and Sam J. Golman Professor of Medicine at the School of Medicine. “With access to hundreds of clinical trials, advanced technology and world-class care, patients don’t have to choose between the two.”

With the unique needs of cancer patients in mind, planners at Washington University and Barnes-Jewish St. Peters Hospital defined several guiding principles for the facility’s design and expansion, striving to provide an atmosphere that promotes trust, instills calm, conveys respect, ensures quality and offers inspiration.

“Patients don’t need to choose between world-class care and the comfort and convenience of a community hospital setting,” said Chris Watts, president of Barnes-Jewish St. Peters Hospital. “With this new and expanded facility, residents of St. Charles County and the region can have both.”

Ravi Vij, MD, is medical oncology director and Lannis Hall, MD, is director of radiation oncology at the St. Peters facility. Kelly Tschannen is nurse manager and Diane Foglesong is radiation oncology manager.

CORE10 Architecture and Christner Inc. were the external and interior architects, respectively, for the $13.1 million project. Pillar Design Group Inc. and Glasper Professional Services Inc. were the structural and civil engineers, respectively. William Tao & Associates handled mechanical, electric, plumbing and fire engineering. Kadean Construction Co. managed construction. Barnes-Jewish St. Peters Hospital, part of BJC HealthCare, contributed $10.6 million to the expansion, with the School of Medicine providing the additional funds.

The facility’s address is 150 Entrance Way, St. Peters, MO 63376 (map). For more information about the new location, visit its website.

Siteman’s other locations are:

  • Washington University Medical Center in St. Louis, where Barnes-Jewish Hospital’s Parkview Tower now under construction will include private, inpatient rooms for Siteman patients.
  • Barnes-Jewish West County Hospital in Creve Coeur.
  • Siteman Cancer Center-South County, near Interstate 55 and Butler Hill Road.

To schedule an appointment at any Siteman facility, call 314-747-7222 or 800-600-3606 toll-free from 8 a.m. to 4:30 p.m. weekdays, or visit siteman.wustl.edu.

A complete toolkit for brain-tumor treatment

Every week, the brain tumor and neuro-oncology program at the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine holds a tumor board meeting.

Attending are specialists in the field of brain-tumor diagnosis and treatment: neurosurgeons, neuro-oncologists, neuro-radiation oncologists, endocrinologists and neuro-intensivists, as well as representatives from psychology, neurology, genetics, hematology, pathology and nursing.

“The tumor board uses a collaborative approach to determine the best options for each patient with a brain tumor, whether benign, malignant or metastatic,” says Mary Spencer, executive director of neuroscience and orthopedic surgery. “Rather than relying on set protocols that may not prove effective, we tailor our patients’ care to their tumor characteristics.”

“Siteman’s program offers the most current surgical, medical and radiation therapies available, as well as opportunities to enroll in more than 35 clinical trials,” says Kaci Dannatt, oncology program manager. “More than 57 expert physicians, researchers and nurses specializing in treating brain tumors participate in the program.”

Targeting tumors, reducing risks

Washington University neurosurgeons at Barnes-Jewish Hospital have contributed to the success of the neuro-oncology program by using imaging technologies that improve the ability to see and remove tumors, while minimizing surgical risks to healthy brain tissue. Both functional magnetic resonance imaging (fMRI) and intraoperative MRI (iMRI) are part of this brain-mapping toolkit.

“Our neurosurgeons were among the first to use iMRI,” Spencer says. “Having worked on more than 1,600 cases, these specialists have gained considerable expertise in using iMRI for optimal resection of gliomas, pituitary skull-base tumors and spinal tumors, including metastases from lung and breast cancers.”

As a brain tumor is removed and cerebrospinal fluid drained, the initial fMRI becomes inaccurate for distinguishing tumor margins. Real-time iMRI gives neurosurgeons the updated information needed to complete the surgery. Siteman Cancer Center specialists also were among the first in the nation to use an MRI-guided, high-intensity laser probe to treat brain tumors that could not be removed with conventional surgery. In this procedure, heat from the laser kills cancer cells deep within the brain while minimizing damage to surrounding brain tissue, says neurosurgeon Eric Leuthardt, MD, who helped pioneer the minimally invasive laser procedure. The technique was first approved by the Food and Drug Administration (FDA) in 2009.

An unexpected result

Use of the laser probe recently led a team of neurosurgeons to a promising discovery: The technology can be used to penetrate the blood-brain barrier. This unexpected finding was made during a pilot study of 14 patients with glioblastomas who underwent minimally invasive laser surgery to treat the recurrence of their tumors.

“The laser killed tumor cells, which we anticipated,” says Leuthardt. “But, surprisingly, while reviewing MRI scans of our patients, we noticed changes near the former tumor site that looked consistent with the breakdown of the blood-brain barrier.”

In fact, Leuthardt and colleagues found that the laser treatment kept the blood-brain barrier open for approximately four to six weeks, providing a therapeutic window of opportunity to deliver chemotherapy drugs to the patients. Previous successful attempts by other groups to breach the barrier resulted in only modest benefits or were only successful for a short period of time—about 24 hours, not long enough for chemotherapy to be consistently delivered.

“Our finding is critical because most chemotherapy drugs can’t get past the brain’s protective barrier, which greatly limits treatment options for patients with brain tumors,” says Leuthardt, who also directs the Department of Neurosurgery’s Brain Laser Center and the Center for Innovation in Neuroscience and Technology.

“We are closely following patients in the trial. Early results indicate they are doing much better on average, in terms of survival and clinical outcomes, than what we would expect,” Leuthardt says. He notes the need for caution, however; additional patients need to be evaluated before conclusions can be drawn. Nevertheless, he adds, “we are hopeful this technology will open new avenues to treating these devastating brain tumors that cause great suffering for patients and their families.”

Expanding capabilities in radiation and oncology

The growing expertise of Washington University neurosurgeons in treating patients with brain tumors has been matched by expanding capabilities in neuro-radiation oncology and neuro-oncology. A string of firsts highlights the growth of these modalities at Siteman Cancer Center.

In 2014, Siteman Cancer Center introduced what remains the only proton-beam technology available in Missouri and one of the few units in the region. This technology allows radiation oncologists to control radiation beams by depth, shape and radiation dose, thus enabling treatment of solid tumors—near sensitive structures or tissues—which were once considered untreatable.

Another innovation, MRI-guided radiation therapy, was approved by the FDA in 2012. Siteman Cancer Center is the first center in the world to use this advanced cancer-treatment technology. The integrated system combines radiation treatments with a continuous-MRI system, allowing a radiation-oncology team to determine whether any subtle movements to the tumor or surrounding tissue alter the delivery of radiation. A patient’s treatment plan may be adjusted immediately if changes are noted.

Brain-tumor treatment has benefited from advances made in DNA sequencing, and the Elizabeth H. and James S. McDonnell III Genome Institute at Washington University is a world leader in the field. Currently, researchers are investigating the effectiveness of personalized vaccines for brain cancer.

“These are just a few examples of how research efforts have made significant contributions to the quality of care we can offer patients with brain tumors,” says Dannatt.

Prostate cancer detection made easier—and safer

Let’s say you’re a person with a prostate, and you’ve just had that gland checked with a prostate-specific antigen (PSA) test. Results show an elevated PSA level, which may or may not mean you have cancer. What do you do next?

If you are being cared for by a Washington University urologic surgeon at Barnes-Jewish Hospital, Barnes-Jewish West County Hospital or Siteman-South County, you can take advantage of advanced technology that offers significant improvement in detecting prostate cancer, if it is present. In fact, physicians at these institutions are among the first in the United States—and the only specialists in the central Midwest—to use magnetic resonance imaging (MRI)/ultrasound fusion, a two-step biopsy process offering greater precision.

“In the past, the next recommended step for men with an elevated PSA often was to undergo an ultrasound-guided biopsy of the prostate,” says Gerald Andriole Jr., MD, a Washington University urologist at Barnes-Jewish Hospital and chief of the Division of Urologic Surgery. “While ultrasound alone allows us to see the size and shape of the prostate gland, it does not show the vast majority of prostate cancers. And a biopsy guided only by ultrasound may miss a small tumor or just graze the edge of a large one.”

Before the new technology was available—and if a tumor wasn’t found with an initial biopsy—a man often underwent multiple biopsies to determine whether cancer was causing the elevated PSA. And, generally speaking, multiple biopsies aren’t a good thing. They can be uncomfortable, and they come with the risks of excessive bleeding and sepsis, a potentially life-threatening infection.

A better scan

The first step of the MRI/ultrasound fusion process is the MRI scan. And the kind of MRI makes a difference. “We perform an MRI scan with a 3 Tesla magnet—the strongest available—which can detect cancers 3 to 4 millimeters in diameter or larger,” says Andriole. He notes that an MRI scanner with a 1 or 1.5 Tesla magnet isn’t adequate to detect such small abnormalities. “After this test, men who have an elevated PSA but no indication of cancer have the option to choose watchful waiting rather than biopsy.” In this context, “watchful waiting” means periodic PSA tests and MRIs without intrusive biopsy or further treatment.

Andriole adds, “Years of study have shown that a majority of prostate cancers are slow-growing tumors unlikely to result in death. The sensitivity of the 3 Tesla MRI scan allows us to give men a much clearer indication of the significance of their cancer.” Though in use for several years for prostate-cancer exams, the 3 Tesla MRI is a particularly powerful tool when used as part of the MRI/ultrasound fusion process. Andriole believes that a 3 Tesla MRI exam can benefit men newly identified as having an elevated PSA, as well as those with a history of persistently elevated or rising PSA for whom repeated ultrasound-guided prostate biopsies have been negative.

“A considerable number of these men may have cancer that was missed by the biopsy,” he says. “We now have the technology to identify most of those cases and help men decide the best course of treatment.”

A better biopsy

The “ultrasound fusion” part of the new technology comes into play for a man whose initial MRI exam reveals prostate abnormalities—a situation that may require a biopsy. Before the biopsy is performed, the information gathered during the MRI scan is uploaded to an ultrasound machine. Global positioning system (GPS) sensors attached to the ultrasound probe create a map of the prostate by fusing the MRI information with the ultrasound image. This map identifies exactly where the biopsy needle should be placed. As a result, the biopsy is much more accurately targeted compared with a biopsy performed with only ultrasound guidance.

Andriole puts it this way: “The increased specificity of the test allows us to take fewer biopsy samples and get better information. And the fewer samples taken, the less risk for complications.”

The benefit

“New technology and future improvements to it have the potential to lead us away from treatments that require removing or irradiating the whole prostate,” Andriole says. “Depending on the size and location of the cancer, we already can target specific areas of the prostate using lasers and cryoablation—applying extreme cold—to destroy tissue. And that means we may reduce debilitating side effects of treatment, such as incontinence and impotence.”

Breast cancer vaccine shows promise in small clinical trial

A breast cancer vaccine developed at Washington University School of Medicine in St. Louis is safe in patients with metastatic breast cancer, results of an early clinical trial indicate. Preliminary evidence also suggests that the vaccine primed the patients’ immune systems to attack tumor cells and helped slow the cancer’s progression.

The study appears Dec. 1 in Clinical Cancer Research.

The new vaccine causes the body’s immune system to home in on a protein called mammaglobin-A, found almost exclusively in breast tissue. The protein’s role in healthy tissue is unclear, but breast tumors express it at abnormally high levels, past research has shown.

“Being able to target mammaglobin is exciting because it is expressed broadly in up to 80 percent of breast cancers, but not at meaningful levels in other tissues,” said breast cancer surgeon and senior author William E. Gillanders, MD, professor of surgery. “In theory, this means we could treat a large number of breast cancer patients with potentially fewer side effects.

“It’s also exciting to see this work progress from identifying the importance of mammaglobin-A, to designing a therapeutic agent, manufacturing it and giving it to patients, all by investigators at Washington University,” he added.

The vaccine primes a type of white blood cell, part of the body’s adaptive immune system, to seek out and destroy cells with the mammaglobin-A protein. In the smaller proportion of breast cancer patients whose tumors do not produce mammaglobin-A, this vaccine would not be effective.

In the new study, 14 patients with metastatic breast cancer that expressed mammaglobin-A were vaccinated. The Phase 1 trial was designed mainly to assess the vaccine’s safety. According to the authors, patients experienced few side effects, reporting eight events classified as mild or moderate, including rash, tenderness at the vaccination site and mild flu-like symptoms. No severe or life-threatening side effects occurred.

Although the trial was designed to test vaccine safety, preliminary evidence indicated the vaccine slowed the cancer’s progression, even in patients who tend to have less potent immune systems because of their advanced disease and exposure to chemotherapy.

“Despite the weakened immune systems in these patients, we did observe a biologic response to the vaccine while analyzing immune cells in their blood samples,” said Gillanders, who treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University. “That’s very encouraging. We also saw preliminary evidence of improved outcome, with modestly longer progression-free survival.”

Of the 14 patients who received the vaccine, about half showed no progression of their cancer one year after receiving the vaccine. In a similar control group of 12 patients who were not vaccinated, about one-fifth showed no cancer progression at the one-year follow-up. Despite the small sample size, this difference is statistically significant.

Based on results of this study, Gillanders and his colleagues are planning a larger clinical trial to test the vaccine in newly diagnosed breast cancer patients, who, in theory, should have more robust immune systems than patients who already have undergone extensive cancer therapy.

“If we give the vaccine to patients at the beginning of treatment, the immune systems should not be compromised like in patients with metastatic disease,” Gillanders said. “We also will be able to do more informative immune monitoring than we did in this preliminary trial. Now that we have good evidence that the vaccine is safe, we think testing it in newly diagnosed patients will give us a better idea of the effectiveness of the therapy.”