Summer 2015 - Dana-Farber/Brigham and Women`s Cancer Center

Oncology
Advances
Summer 2015
Page 2
PD-1 Inhibitor Trials Target Gastrointestinal Cancers, Span Many Cancer Types in
Combination Studies
Immunotherapy trials at Dana-Farber/Brigham and Women’s
Cancer Center using PD-1 inhibitors have expanded to include
studies for several gastrointestinal cancers and combination
studies spanning a wide range of cancers.
Page 4
New Study Finds Many Patients Choose Mastectomy, Despite Eligibility for
Breast Conserving Therapy
At the American Surgical Association’s 135th Annual Meeting,
Mehra Golshan, MD, a breast surgeon at Brigham and Women’s
Hospital and Medical Director of International Oncology Programs
at Dana-Farber/Brigham and Women’s Cancer Center, presented
findings of a multicenter study evaluating the impact of neoadjuvant
chemotherapy in Stage II-III triple negative breast cancer on eligibility for breast conserving surgery and breast conservation rates.
Page 5
New Clinic Studies Innovative Approaches to Prevent the Progression of Blood
Cancer in Patients with Precursor Conditions
The new Blood Cancer Prevention of Progression Clinic is
designed to enhance the understanding of the progression and
clonal evolution of blood cancers in order to provide targeted
approaches to prevent the development of blood cancers in
patients with precursor conditions.
Page 6
Thyroid Cancer Center Focuses on Targeted Therapy, Tailored Approaches to
Evaluation and Treatment
The multidisciplinary team in the new Thyroid Cancer Center
is employing novel approaches to the evaluation, diagnosis,
treatment, and management of all forms of thyroid cancer, as
well as nodular disease.
Page 7
Now Available: Next Day Access for New Patients in Boston
2 | Oncology Advances
PD-1 Inhibitor Trials Target Gastrointestinal Cancers, Span Many Cancer Types in
Combination Studies
Immunotherapy trials at Dana-Farber/Brigham and Women’s
Cancer Center using PD-1 inhibitors have expanded to include
studies for several gastrointestinal cancers and combination
studies spanning a wide range of cancers.
of gastric cancers. An earlier phase study of PD-1 inhibition
across a range of cancers also showed specific benefit in patients with gastric cancer.
The Center for Immuno-Oncology at Dana-Farber/Brigham
and Women’s Cancer Center, led by Director F. Stephen Hodi,
Jr., MD, and Clinical Director Patrick A. Ott, MD, PhD, offers
more than 20 early phase immunotherapy trials using a variety
of approaches. Dr. Hodi and Dr. Ott also collaborate with disease center leaders at Dana-Farber/Brigham and Women’s
Cancer Center to initiate immunotherapy trials in cancers
where immunotherapy has not traditionally been used.
A New Approach for Gastrointestinal Cancers
The Gastrointestinal Cancer Center at Dana-Farber/Brigham
and Women’s Cancer Center is currently enrolling patients in
a phase II trial of the PD-1 inhibitor pembrolizumab for patients
with metastatic gastric or gastroesophageal junction
adenocarcinoma who have progressed on at least two prior
chemotherapy regimens, including trastuzumab. Charles
Fuchs, MD, MPH, Director of the Gastrointestinal Cancer
Center, is the site Principal Investigator of this study, which is
based on previous demonstration of efficacy in earlier studies
of PD-1 inhibition in gastric cancer. For more information regarding this trial, please contact Christopher Graham, RN, at
(617) 632-5960.
The Center is expected to open numerous additional trials
using pembrolizumab in the fall of 2015, including first line and
second line therapy for patients with gastrointestinal cancers.
Another study will combine pembrolizumab with ramucirumab, a monoclonal antibody VEGFR-2 antagonist that was
approved after demonstrating a survival benefit in advanced
gastric cancer in a separate study led by Dr. Fuchs (Lancet.
2014 Jan 4;383(9911):31-9.).
“Immunotherapy represents an entirely new way to treat gastrointestinal cancers, but our approach to this treatment is
based on scientific evidence of target mutations in these cancers,” said Dr. Fuchs.
Genomic Analysis of Gastric Cancer
Through The Cancer Genome Atlas (TCGA) program, medical
oncologist Adam Bass, MD, co-chaired the largest ever project
to map the genomic changes in gastric and esophageal cancers. A comprehensive genomic analysis of nearly 300 gastric
cancers, performed by TCGA researchers, was published in
Nature last year (Nature. 2014 Sep 11;513(7517):202-9.). The
study showed the amplification of JAK2, CD274 (also known
as PD-L1) and PDCD1LG2 (also known as PD-L2) in a subtype
Key features of gastric cancer subtypes. (Nature. 2014 Sep 11; 513(7517):202-9.)
Combination Therapies with PD-1 Inhibitors
In the Center for Immuno-Oncology, Dr. Hodi and Dr. Ott are
leading several trials that are combining pembrolizumab (and
other agents directed at PD-1 or PD-L1) with other therapies
for the treatment of a range of cancers in order to assess safety
and increase efficacy of treatment for these cancers. The Center features an immune assessment core for evaluation of patients on current immunotherapies and a pathology core for
identification of biomarkers and analysis of immune therapies.
Examples of current combination therapy studies in the Center
for Immuno-Oncology are:
• Phase 1 Trial of MK-3475 Plus Ziv-Aflibercept in Patients
With Advanced Solid Tumors – This study, led by international Principal Investigator F. Stephen Hodi, MD, will examine the side effects and best dose of ziv-aflibercept when
given together with pembrolizumab in treating patients with
advanced solid tumors, including metastatic melanoma,
metastatic renal cell carcinoma, recurrent colorectal cancer,
recurrent ovarian cancer, recurrent renal cell carcinoma,
stage IV ovarian cancer, stage IVA colorectal cancer, and
stage IVB colorectal cancer. For more information regarding
this trial, please contact Principal Investigator F. Stephen
Hodi, MD, at (617) 632-5053 or [email protected];
Dana-Farber/Brigham and Women’s Cancer Center | 3
• Phase I/II Clinical Trial to Study the Safety and
Tolerability of MK-3475 + Pegylated Interferon
Alfa-2b (PEG-IFN) and MK-3475 + Ipilimumab
(IPI) in Subjects With Advanced Melanoma and
Renal Cell Carcinoma (KEYNOTE 029) –This
study, led by site Principal Investigator F. Stephen
Hodi, MD, is analyzing the safety, tolerability, and
efficacy of treatment for advanced melanoma and
renal cell carcinoma using combination regimens
of pembrolizumab + pegylated interferon alfa-2b
(PegIFN-2b) and pembrolizumab + ipilimumab
(IPI). The primary hypothesis is that these combinations will be sufficiently well-tolerated to permit
continued clinical investigation. For more information regarding this trial, please contact Christopher Graham, RN, at (617) 632-5960.
“Our studies open new opportunities to patients
with cancer by specifically manipulating the patient’s
own immune system to recognize and destroy cancer. We are enabling clinicians to enroll patients in
trials of novel agents when a dedicated study of the
targeted approach for that specific cancer type is not
available,” said Dr. Hodi.
Tumor cell
IFN-γR
IFN-γ –mediated upregulation
of tumor PD-L1
PD-L1/PD-1–mediated
inhibition of tumor cell killing
MHC-I
PD-L1
T-cell
receptor
IFN-γ
PD-1
TCR
Shp-2
MHC-I
Priming and
activation of T cells
Other NFκB PI3K
CD28 B7.1
CD8ⴙ cytotoxic
T lymphocyte Shp-2
Dendritic
cell
PD-L1 B7.1
PD-1 PD-L1
B7.1 PD-L1
PD-L1
PD-1
PD-1
PD-L1
PD-1
Treg cell
PD-L1
Tumor-associated
fibroblast
M2
macrophage
Stromal PD-L1
modulation of T cells
T-cell polarization
TGF-β
PD-L2 PD-1
IL-4/13
Immune cell
modulation of T cells
TH2
T cell
PD-L2–mediated
inhibition of TH 2 T cells
Can you generate
tumor-killing T cells?
Can the T cells
get to the tumor?
Can the T cells
see the tumor?
Can the T cells
be turned off?
Can the T cells
be turned off?
Antigen
priming
T-cell
trafficking
Peptide-MHC
expression
Inhibitory
cytokines
PD-L1 expression
on tumor cells
© 2012 American Association for Cancer Research
Charles Fuchs, MD, MPH
Director,
Gastrointestinal Cancer Center,
Dana-Farber/Brigham and Women’s Cancer Center
F. Stephen Hodi, Jr., MD
Director,
Center for Immuno-Oncology,
Director, Melanoma Center,
Dana-Farber/Brigham and Women’s Cancer Center
Patrick A. Ott, MD, PhD
Clinical Director,
Center for Immuno-Oncology,
Clinical Director, Melanoma Center,
Dana-Farber/Brigham and Women’s Cancer Center
Tumor immunology and the PD-L1/PD-1 pathway. (Clin Cancer Res. 18(24):6580-7.)
Refer a Patient to the Center for Immuno-Oncology
For more information or consultation, please call 1-877-332-4294 to
speak with one of our experienced referral coordinators. We now
offer next business day access for first appointments at our main
campus in Boston.
Leaders in Cancer Treatment and Research
1-877-DFCI-BWH • www.dfbwcc.org
(1-877-332-4294)
4 | Oncology Advances
New Study Finds Many Patients Choose Mastectomy, Despite Eligibility for Breast
Conserving Therapy
At the American Surgical Association’s 135th Annual Meeting
in April 2015, Mehra Golshan, MD, a breast surgeon at
Brigham and Women’s Hospital and Medical Director of International Oncology Programs at Dana-Farber/Brigham and
Women’s Cancer Center,, presented findings of a multicenter
study evaluating the impact of neoadjuvant chemotherapy in
Stage II-III triple negative breast cancer on eligibility for breast
conserving surgery and breast conservation rates (Ann Surg.
2015 Jul 28; E-pub ahead of print).
Figure 2
“Neoadjuvant systemic therapy is often used to induce tumor
regression and enable breast conserving therapy in patients
with breast cancer who were to have a mastectomy if they had
surgery first,” said Dr. Golshan, who is lead author of the study.
“Our goal in this study was to quantify this benefit.”
Alliance for Clinical Trials in Oncology Companion Study
As part of a surgical companion study to CALGB 40603 (Figure 1), the treating surgeons prospectively evaluated breast
conserving therapy (BCT) candidacy before and after neoadjuvant systemic therapy (NST) using clinical and radiographic
information. Surgery was performed at surgeon and patient
discretion. The presence of genetic mutations was not considered. The researchers measured:
Among these patients, 70 percent chose BCT, which was successful in 94 percent of cases. Of the patients who were not
initially eligible for BCT prior to NST, 42 percent converted to
BCT eligibility. Of these patients, 68 percent chose BCT with
a 91 percent success rate (Figure 3, back cover).
• Conversion from BCT ineligibility to BCT eligibility;
A Range of Significant Results
• Surgical choices in BCT candidates;
• Rates of successful BCT with tumor-free margins.
Among 404 patients who were assessable for surgical outcomes, 54 percent were BCT candidates prior to NST. After
NST, 90 percent remained candidates for BCT (Figure 2).
The study led to substantial findings, including:
• 31 percent of patients who were eligible for BCT still chose
mastectomy;
• 42 percent of patients who were initially deemed ineligible
for BCT were found to be eligible following neoadjuvant
systemic therapy. Conversion was highest among patients
who received NST with carboplatin, bevacizumab, or both;
Figure 1
• 47 percent of patients in the study overall underwent BCT,
compared with 75 percent of patients with similar tumor
types in a recent German study (von Minckwitz et al.);
continued on back cover
Mehra Golshan, MD
Breast Surgeon, Brigham and Women’s Hospital;
Medical Director, International Oncology Programs,
Dana-Farber/Brigham and Women’s Cancer Center
Dana-Farber/Brigham and Women’s Cancer Center | 5
New Clinic Studies Innovative Approaches to Prevent the Progression of Blood Cancer in
Patients with Precursor Conditions
The new Blood Cancer Prevention of Progression Clinic is an
extensive research program designed to better understand
the progression and clonal evolution of blood cancers in order
to provide targeted approaches to prevent the development
of blood cancers in patients with precursor conditions. These
conditions include monoclonal B cell lymphocytosis (MBL),
monoclonal gammopathy of undetermined significance
(MGUS), and early cases of myelodysplastic syndromes (MDS)
and myeloproliferative neoplasms (MPN).
“In the majority of cases, there are no effective disease-modifying therapies available for patients with precursor conditions
to blood cancers,” said Irene Ghobrial, MD, Co-Principal Investigator of the Clinic. “We are left waiting until the patient’s
condition progresses to initiate treatment.”
Experts in the Clinic are aiming to:
• Promote earlier detection of precursor conditions;
• Identify patients that are most likely to progress in order to
focus treatment in this patient population;
• Deliver targeted intervention, including the use of shortened duration of therapy with newer agents with low toxicity, to eliminate disease before symptoms appear.
with age and is associated with an increased risk of hematologic malignancy. Current studies in the Clinic include:
• Phase II Trial of Combination Elotuzumab and Lenalidomide +/- Dexamethasone in High-risk Smoldering
Multiple Myeloma – This research study will determine the
proportion of high-risk smoldering multiple myeloma patients who are progression free at two years after receiving
elotuzumab and lenalidomide+/- dexamethasone combination therapy. For more information regarding this trial,
please contact Principal Investigator Irene Ghobrial, MD, at
[email protected];
• Study of Precursor Hematological Malignancies to Assess
the Relationship between Molecular Events of Progression
and Clinical Outcomes – This national observational study,
led by Principal Investigator Irene Ghobrial, MD, is identifying molecular changes in cells of patients with precursor
hematological malignancies using patients' bone marrow,
blood, buccal swab or mouthwash, lymph node, urine, or
other specimens. The study will link the participants’ molecular alterations with clinical information that has been generated during the course of clinical care in a large database
with a goal to capture data on at least 10,000 patients. For
more information regarding this trial, contact Adriana Perilla
Glen at (617) 582-8664.
“Prevention is the best way to eradicate disease,” said Robert
Soiffer, MD, Co-Principal Investigator of the Clinic and Chief
of the Division of Hematologic Malignancies at DanaFarber/Brigham and Women’s Cancer Center. “This clinic has
the potential to change the trajectory of many blood cancers.”
Robert Soiffer, MD
Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic;
Chief, Division of Hematologic Malignancies;
Co-Chief, Adult Stem Cell Transplantation Program;
Dana-Farber/Brigham and Women’s Cancer Center
Irene Ghobrial, MD, and colleagues have established the Blood Cancer Prevention of
Progression Clinic to better understand the evolution of blood cancers in order to
provide targeted preventive treatment for patients.
Clonal Hematopoiesis
Co-Principal Investigators Benjamin Ebert, MD, PhD, and
David P. Steensma, MD, recently defined and outlined the nature and prevalence of clonal hematopoiesis of indeterminate
potential (CHIP), which is characterized by acquisition of somatic mutations that drive clonal expansion in the absence of
cytopenias and dysplastic hematopoiesis (NEJM. 2014 Dec
10; Blood. 2015 July 2;126(1).) CHIP increases in prevalence
Irene Ghobrial, MD
Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic;
Medical Oncologist,
Jerome Lipper Multiple Myeloma Center,
Dana-Farber/Brigham and Women’s Cancer Center
Benjamin Ebert, MD, PhD
Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic;
Medical Oncologist,
Center for Hematologic Malignancies,
Dana-Farber/Brigham and Women’s Cancer Center
David P. Steensma, MD
Co-Principal Investigator, Blood Cancer Prevention of Progression Clinic;
Medical Oncologist,
Adult Leukemia Program,
Dana-Farber/Brigham and Women’s Cancer Center
6 | Oncology Advances
Thyroid Cancer Center Focuses on Targeted Therapy, Tailored Approaches to
Evaluation and Treatment
The multidisciplinary team in the new Thyroid Cancer Center
at Dana-Farber/Brigham and Women’s Cancer Center, led by
Director Jochen Lorch, MD, is employing novel approaches to
the evaluation, diagnosis, treatment, and management of all
forms of thyroid cancer, as well as nodular disease.
“Our Center delivers comprehensive evaluation and care using
tailored approaches for each patient, from assessment of nodules and surgical treatment to targeted therapy for metastatic
thyroid cancer,” said Dr. Lorch.
Molecular and Genetic Analysis
A variety of advanced techniques are employed to evaluate
thyroid nodular disease, confirm a new thyroid cancer diagnosis, or assess recurrent or malignant disease. Endocrinologists
and cytopathologists in the Center are leaders in the use of
diagnostic molecular markers, including gene expression classification and gene mutation panels, to enhance the accuracy
in distinguishing between benign or malignant disease. The
team’s ongoing research into molecular analysis also is helping
to better determine which patients require radioactive iodine
or are at high risk for recurrence and to appropriately modify
treatment decisions.
The team completed the study of everolimus, which is being
presented for FDA approval for appropriate patients with thyroid cancer. An investigator-initiated study of MLN0128, a new
mTOR inhibitor, will soon become available for patients with
anaplastic thyroid cancer and aggressive differentiated thyroid
cancer. Tumor tissue sampling performed as part of the studies
is linked with sequencing data to allow researchers to correlate
clinical response with genetic information. A separate phase II
study of the tyrosine kinase inhibitor (TKI) regorafenib is expected to open in fall 2015 as second or third line therapy for
patients with metastatic medullary thyroid cancer.
Histologic Findings and Computed Tomographic (CT) Scans in a
Patient with Metastatic Anaplastic Thyroid Carcinoma.
Thyroid Cancer Center endocrinologist Erik K. Alexander, MD,
Chief of the Thyroid Section within the Division of Endocrinology, Diabetes and Hypertension at Brigham and Women’s
Hospital (BWH), is a member of a panel of the American Thyroid Association that establishes guidelines for the management of thyroid nodules and thyroid cancer care. He was the
lead author of a recent multicenter study published in the New
England Journal of Medicine (N Engl J Med 2012; 367:705715) that found that patients with cytologically indeterminate
nodules on fine needle aspiration that are benign according
to gene-expression classification should be considered for a
more conservative approach to management.
Innovative Targeted Approaches for Advanced Thyroid Cancers
Medical oncologists in the Center have introduced innovative
trials of targeted therapies for patients with advanced thyroid
cancer. Dr. Lorch and Nikhil Wagle, MD, led a recently published study that outlined response and acquired resistance to
the mTOR inhibitor everolimus in a 57-year-old patient with
metastatic anaplastic thyroid cancer (N Engl J Med 2014;371:
1426-33.). The patient had a near-complete response for 18
months before her disease progressed. As part of the study,
whole exome sequencing was performed on samples of the
pre-treatment and resistant tumors, demonstrating the mechanisms of cancer response and resistance.
Hematoxylin and eosin staining of a total-thyroidectomy specimen (Panel A, top)
shows anaplastic thyroid carcinoma; MIB-1 staining (Panel A, bottom) reveals the
high proliferative rate of the tumor. A histologic section (hematoxylin and eosin) of
an enlarged mediastinal lymph node, obtained after 18 months of a response to
everolimus monotherapy, shows recurrent thyroid carcinoma (Panel B). Axial CT
scans of the chest show a right-sided hilar mass (arrow) before treatment with
everolimus (Panel C), 6 months after treatment initiation (Panel D), and at the time
of everolimus resistance, 18 months after treatment initiation (Panel E).
(N Engl J Med. 2014; 371:1426-33.)
Dana-Farber/Brigham and Women’s Cancer Center | 7
Optimizing Surgical Outcomes
Francis D. Moore, Jr., MD, Chief of the BWH Division of General and GI Surgery, leads a team of endocrine surgeons in the
Center who perform more than 600 thyroid and thyroid-related procedures each year using advanced techniques. Internationally recognized for the development of team-driven
protocols and checklists that have influenced surgery worldwide, the surgeons have reduced the rate of surgical complications to far below national averages for recurrent laryngeal
nerve injury, one percent for bleeding, and two percent for
parathyroid gland dysfunction.
Innovative surgical developments include the use of the Advanced Multimodality Image Guided Operating (AMIGO)
Suite at Brigham and Women’s Hospital for select patients with
thyroid and parathyroid tumors. In the AMIGO suite, surgeons
employ real-time imaging and 3D models to enhance navigation to identify small tumors, confirm complete resection, and
avoid injury to key nerves and blood vessels. Endocrine surgeon Daniel T. Ruan, MD, was the first to utilize this technology
during neck surgery and the first to describe MRI imaging of
the recurrent laryngeal nerve during a thyroidectomy (N Engl
J Med 2015; 373:96-98). Injury to this important nerve during
thyroid and parathyroid surgery can result in vocal cord
paralysis, leading to problems with speech, swallowing, and
breathing.
“Real-time imaging during thyroid surgery can further reduce
the risk of complications, including injury to nerves and other
important structures,” said Dr. Moore.
Refer a Patient to Dana-Farber/Brigham and Women’s Cancer Center
For more information or consultation, please call 1-877-332-4294 to speak
with one of our experienced referral coordinators. We now offer next business
day access for first appointments at our main campus in Boston.
Next Day Access in Boston for New
Oncology Patients
Dana-Farber/Brigham and Women’s Cancer Center in
Boston now offers next business day access for first
appointments. To facilitate this streamlined access,
patients who are scheduled for next day access are
contacted within a few hours by an oncology nurse to
discuss their history and records.
To refer a patient, or schedule a consultation with a
member of our team, please call 1-877-332-4294.
Jochen Lorch, MD, Francis D. Moore, Jr., MD, and Erik K. Alexander, MD, employ a
multidisciplinary approach to the evaluation and treatment of patients with thyroid
cancer and nodular disease.
Jochen Lorch, MD
Director, Thyroid Cancer Center,
Dana-Farber/Brigham and Women’s Cancer Center
Erik K. Alexander, MD
Chief, Thyroid Section,
Division of Endocrinology, Diabetes and Hypertension,
Brigham and Women’s Hospital;
Endocrinologist, Thyroid Center,
Dana-Farber/Brigham and Women’s Cancer Center
Francis D. Moore, Jr., MD
Chief, Division of General and GI Surgery,
Brigham and Women’s Hospital;
Surgeon, Thyroid Cancer Center,
Dana-Farber/Brigham and Women’s Cancer Center
Daniel T. Ruan, MD
Surgical Director,
Center for Adrenal Disorders,
Brigham and Women’s Hospital;
Surgeon, Dana-Farber/Brigham and Women’s Cancer Center
See a Video of an Adrenal Tumor Surgery
Visit mdvideocenter.brighamandwomens.org to see
a video presentation of a Retroperitoneoscopic Right
Adrenalectomy performed by Daniel T. Ruan, Surgical
Director, Center for Adrenal Disorders.
New Study Finds Many Patients Choose Mastectomy,
Despite Eligibility for Breast Conserving Therapy…
Upcoming CME Courses
continued from page 4
Dana-Farber/Brigham and Women’s Cancer Center offers
CME courses that cover the latest developments in clinical research and treatments. The courses are offered in conjunction
with the Harvard Medical School Department of Continuing
Medical Education and Partners Office of Continuing Professional Development, which are both accredited by the Accreditation Council for Continuing Medical Education (ACCME) to
provide continuing medical education for physicians.
• 93 percent of patients who opted for BCT were able to
successfully undergo BCT as part of the study.
“Our study suggests that further investigation of the reasons
behind these findings is warranted,” said Dr. Golshan. “It is
important to better understand the factors that are influencing
patients’ and surgeons’ decisions to opt for mastectomy in
cases where breast conserving therapy is a viable option with
a high likelihood of success.”
Figure 3
Advances in the Management of Pancreatic and Biliary
Tumors
Saturday, October 31, 2015
Dana-Farber Cancer Institute, Boston, MA
Advances in the Treatment of Genitourinary Cancers
Saturday, November 21, 2015
Dana-Farber Cancer Institute, Boston, MA
For more information on these and other CME courses,
visit dfbwcc.org/cme.
Tari King, MD, Appointed New Chief of Breast Surgery
Dana-Farber/Brigham and Women’s
Cancer Center is pleased to announce
that Tari King, MD, has been appointed the new Chief of Breast Surgery. Dr. King has a national and
international reputation as an outstanding breast surgeon, a thoughtful
educator, a productive clinical/translational researcher, and an effective
leader. Previously, Dr. King served as
the Deputy Chief of Breast Surgical Services and Principal
Investigator of the Breast Surgery Research Laboratory at
Memorial Sloan-Kettering Cancer Center, where she was a
faculty member for more than a decade. Her research has focused on the elucidation of the molecular genetics of breast
cancer, focusing on high-risk populations, as well as on the
mechanisms involved in the progression from non-invasive to
invasive disease. Dr. King received her medical degree from
the University of Colorado Health Sciences Center. She completed her residency at the Ochsner Medical Institutions
in New Orleans and her clinical and research fellowships at
Memorial Sloan-Kettering Cancer Center.