History

Origins of the Oncology Division

The Division of Oncology is the newest division of the Department of Medicine. It was the vision of the late Dr. Stanley Korsmeyer (June 8, 1951 - March 31, 2005) who sought to expand both clinical and translational programs in hematologic and solid tumor malignancies at Washington University School of Medicine. Drs. Korsmeyer, Tim Ley and John Atkinson joined together to establish and build these programs in 1994. They established two separate divisions that emerged from the need to expand the clinical activities that were, up until that time, a part of the division of Hematology-Oncology. The two divisions were called Medical Oncology and Bone Marrow Transplant (BMT), and two chiefs were recruited to start up these new divisions.

Daniel Ihde, MD, a nationally recognized expert in lung cancer, was recruited from the National Cancer Institute, where he held the position of Deputy Director, to become the new Chief of the Division of Medical Oncology. John DiPersio, MD, PhD, a physician-scientist focusing on leukemia and transplantation biology, was recruited from the University of Rochester to become the new Chief of the Division of Bone Marrow Transplant. The combined faculty in both divisions numbered only eight, two in BMT and six in Medical Oncology. Over the next three years there was significant growth of clinical care and clinical and translational research programs in both divisions. Dr. Ihde helped recruit medical oncologists and, with Drs. DiPersio (BMT) and Stuart Kornfeld (Hematology), expanded the hematology-oncology fellowship program and promoted fellows to faculty positions within the two divisions. In 1997, Dr. Ihde moved to the Moffit Cancer Center in Tampa, Florida, and Dr. DiPersio was appointed the interim Chief of the Division of Medical Oncology. In 1999, after the appointment of Kenneth Polonsky, MD, as the new Chairman of Medicine, Dr. DiPersio was named Chief, Division of Oncology, which consolidated the Divisions of BMT and Medical Oncology into one division. Robert Barczewski, MBA, CMPE, after working for fourteen years in the Department of Medicine Business Office, was picked to be the first Administrator of the two divisions, and he continues to serve as Director of Business Operations for the Division of Oncology.

 

Expansion of the Cancer Program

Over the ensuing decade, the Division of Oncology has experienced unprecedented growth in numbers of faculty and national visibility and has excelled both clinically and scientifically. The division has recruited over 80 faculty and has a staff that now exceeds 400. The division has been divided into four sections. These include two clinical/translational research sections (BMT & Leukemia and Medical Oncology) and two basic science sections (Stem Cell Biology and Molecular Oncology). Each section is led by world class and internationally recognized experts including Tim Ley, MD (Stem Cell Biology); Lee Ratner, MD, PhD (Molecular Oncology); Matthew Ellis, MD, PhD (Medical Oncology); and Peter Westervelt MD, PhD (BMT & Leukemia). The Section of Molecular Oncology was developed in close collaboration with the Department of Cell Biology and Physiology. The Medicine and Cell Biology researchers occupy adjacent space on the fifth floor of the McDonnell Sciences Research Building. Recruitment and research activities are coordinated across the Departments.

With the support of the Chairman of Medicine (Dr. Kenneth Polonsky) and the Dean of the School of Medicine (Drs. William Peck and Lawrence Shapiro), the Division of Oncology has grown to over 70 faculty that focus in diverse research areas of basic and translational/clinical cancer biology and cancer care. Forty-five of the current faculty were recruited from outside institutions, ensuring a healthy degree of outbreeding and intellectual diversity.

 

Education & Career Development

The division has continued to support the education and career development of fellows and junior faculty. We have recruited 19 faculty who either trained at Washington University or trained here and were junior faculty members at other institutions prior to returning to Washington University. We have also lost some faculty who either trained with us or started their faculty career with us and have assumed major leadership roles elsewhere. We are particularly proud that many of these trainees and junior faculty have developed international reputations during their time in the Division of Oncology and have assumed major leadership roles at other institutions, including:

  • Chief of Hematology (Hanna Khoury, MD, Emory University)
  • Director of Transfusion Medicine (Lawrence Goodnough, MD, Stanford University)
  • Directors of BMT Programs (Steve Devine, MD, Ohio State University, and Randy Brown, MD, University of Kentucky)
  • Director of Institute of Personalized Medicine (Howard McLeod, PhD, University of North Carolina)
  • Director of Institute of Regenerative Medicine (Jan Nolta, PhD, University of California - Davis)
  • Director of Phase I Program (Joanne Mortimer, MD, City of Hope)
  • Deputy Director of Cancer Center (Paula Fracasso, MD, PhD, University of Virginia)
  • Associate Members (James Hseih, MD, PhD, and Emily Cheng, PhD, Memorial Sloan Kettering Cancer Institute)

We have continued to train and recruit the best and the brightest who will play major roles as thought leaders in cancer care and cancer biology either here or at other outstanding Cancer Centers around the country.

 

Research Accomplishments & Highlights

The first planning grant for the Washington University National Cancer Institute (NCI)-Designated Cancer Center was funded in 1996. Formal NCI designation was awarded in 2000 and the Siteman Cancer Center (SCC) received Comprehensive Cancer Center status when it was renewed in 2004. By 2010, the SCC had become one of the largest cancer centers in the country, with over 7,000 new cancer patients cared for each year. The Division of Oncology has played a major role in the growth and development of the SCC, both clinically and scientifically. Of the 1,200 new patients placed on therapeutic clinical trials in the past year in the Siteman Cancer Center, the Oncology Division was responsible for over 1,050 accruals. The division has contributed to many advances in our care of cancer patients and the biology of their diseases. These advances include novel therapeutics and clinical interventions in both solid tumor and hematologic malignancies as well as understanding the genetics and genomics of cancer cells. In fact, members of the Division of Oncology, in collaboration with members of the Washington University Genome Center, were the first to complete the full DNA sequences of the first cancer genomes for patients with acute myelogenous leukemia (Ley, Nature 2008) and breast cancer (Ellis, Nature 2010). Members of the Division of Oncology are leaders in national and international efforts (through NCI and NHRGI-funded projects) to fully decode mutations associated with initiation and progression of cancers, both hematologic and solid tumor. We were the first to identify highly recurrent somatic mutations in AML using an unbiased approach of whole genome sequencing (Mardis and Ley, N Engl J Med 2009) and have pioneered many new approaches to permit cost-effective and comprehensive genetic and epigenetic analysis of cancer cells in the future.

In addition to our basic science strengths in AML and breast cancer genomics, we have also great strengths in:

  • Immunotherapy (Gerald P. Linette, MD, PhD, and Beatriz M. Carreno, PhD)
  • Gene therapy (Mark S. Sands, PhD, and DiPersio)
  • Stem cell-stromal niche interactions (Daniel C. Link, MD)
  • Preleukemic syndromes (Timothy A. Graubert, MD, and Matthew J. Walter, MD)
  • Myeloma biology and genetics (Michael H. Tomasson, MD, Ravi Vij, MD, and Katherine N. Weilbaecher, MD)
  • Transplantation biology and models of graft vs. host disease (DiPersio, Ley, Todd A. Fehniger, MD, PhD, Michael P. Rettig, PhD, and Peter Westervelt, MD, PhD)
  • Osteoblast biology (Weilbaecher, Ratner, Link)
  • HIV and HTLV-associated oncogenesis (Ratner)
  • Cell death (Cheng)
  • Ribosomal biogenesis (Jason D. Weber, PhD)
  • Hox gene and MLL biology (Hsieh)
  • T cell and NK cell biology (Ley, Fehniger, Linette and Carreno)
  • Breast cancer signaling and biology (Weilbaecher, Ellis, Loren S. Michel, MD, Ron Bose, MD, PhD, and Cynthia X. Ma, MD, PhD)

Clinical research strengths include:

  • Experimental therapeutics of solid and “liquid” malignancies (Joel Picus, MD, A. Craig Lockhart, MD, Benjamin R. Tan, Jr., MD, Andrea Wang-Gillam, MD, PhD, Geoffrey L. Uy, MD, Amanda F. Cashen, MD, Ramaswamy Govindan, MD, and Westervelt)
  • Clinical and translational studies in normal and leukemic stem cell trafficking (Link, Rettig, Uy and DiPersio)
  • Novel drugs and approaches to lymphoma patients (Nancy L. Bartlett, MD, Cashen, Nina D. Wagner-Johnston, MD, and Kenneth R. Carson, MD)

Our clinical and translational investigators play major leadership roles in several cooperative groups and funding agencies including:

  • Cancer and Leukemia Group B (Bartlett, Ellis, Govindan, Picus)
  • American College of Surgeons Oncology Group (Ellis, Govindan)
  • AIDS Malignancy Consortium (Ratner)
  • NCI Phase II Consortium (Douglas R. Adkins, MD)
  • BMT Clinical Trials Network (Westervelt, DiPersio)
  • American Society of Hematology (Ley, DiPersio and Link)
  • Leukemia and Lymphoma Society (Graubert and Camille N. Abboud, MD)
  • TCGA (Ley, Graubert, Tomasson, Vij and DiPersio)

Currently the division has one member elected to the Institute of Medicine (Ley), nine faculty elected to the “Young Turks”/American Society of Clinical Investigation (Ley, Ratner, DiPersio, Graubert, Tomasson, Weilbaecher, Link, Cheng, and Hsieh), and two faculty are members of the Association of American Physicians (Ley and Ratner.)

 

Bone Marrow Transplantation & Leukemia

Starting with two bone marrow transplant/leukemia/lymphoma specialists and six medical oncologists in 1994, the divisions under Drs. Ihde and DiPersio began to recruit specialists and identify promising fellows to build the clinical and clinical research program. In 1994, BMT faculty performed approximately 30 transplants. The faculty, under the leadership of Peter Westervelt, has now grown to include seven “full-time” clinical transplant/leukemia/myeloma physicians and another six physician-scientists who provide regular support to a burgeoning inpatient program. The BMT Program has grown from 30 transplants per year and 10 inpatient transplant beds in 1994 to approximately 400 transplants per year and 90 inpatient transplant and leukemia beds. Our program has performed over 5,000 bone marrow and stem cell transplants since its inception, making it one of the top five programs in the country. The BMT faculty care for over 1,200 new patients per year and performed over 110 unrelated allogeneic transplants in the last 12 months, making it the fifth largest transplant program in the world. In addition, the BMT & Leukemia faculty provide care to a very large population of patients with acute leukemia, multiple myeloma, and various other hematologic malignancies. The combined BMT and Medical Oncology Sections see approximately 300 patients per day in the outpatient offices of the SCC. The Division of Oncology (both BMT and Medical Oncology) had over 85,000 patient contacts last year.

BMT’s clinical research program has also been extremely successful, currently offering patients over 40 clinical trials, accruing over 260 patients to therapeutic clinical trials in 2010. Many of the translational and clinical research studies conducted by the BMT & Leukemia faculty are institutional studies that are funded not only bytheNationalInstitutesofHealth,butalsobyagencies such as the Leukemia and Lymphoma Society.

 

Medical Oncology

Medical Oncology has also grown explosively over the past 10 years. There are now over 25 faculty who subspecialize in every cancer type from neuro-oncology to breast, gastro-intestinal, genito-urinary, and thoracic oncology. In 2010, these physicians saw 4,000 new patients at three Siteman Cancer Center outpatient locations, including the Center for Advanced Medicine, Barnes West County, and Barnes St. Peters offices. All three centers offer their patients clinical trials at very convenient locations. A fourth SCC outpatient office in South County will be open soon.

Many members of this section are national leaders and leading researchers in their areas of expertise. From the genomics of breast cancer to the development of novel therapeutic interventions in patients with solid tumors and lymphomas, members of the Medical Oncology faculty have designed, written and conducted novel institutional and multi-institutional clinical trials with strong basic correlative science. Over 250 clinical trials are currently open and available to our patients through the Section of Medical Oncology. Our faculty, who enrolled over 750 patients to therapeutic clinical trials in the last 12 months, wrote nearly 40% of these studies. To support this extensive clinical research program, the division employs over 55 Clinical Research Associates (CRAs) to manage clinical trials conducted by the combined faculty in the Sections of BMT & Leukemia and Medical Oncology.

 

The Hematology-Oncology Fellowship Program

The Hematology-Oncology Fellowship Program was overseen and built over the years by Drs. Stuart Kornfeld and Joel Picus. In 2008, Dr. Picus assumed management of the program, assisted by Hematology Division Chief, Dr. Evan Sadler. Currently, the program is managed by Douglas Adkins (Director, Oncology Division) and Morey Blinder (Associate Director, Hematology Division). The program has grown to include twenty fellows, including several in a non-accredited program focusing on bone marrow transplantation and breast cancer research. We are proud that many of our past fellows have gone on to very successful clinical and research careers within our program and at other academic institutions.

 

The Future

Although the Division of Oncology is one of the newer member divisions of the Department of Medicine, it has grown to substantial size and national and international prominence over the last 15 years. With a healthy mix of physician-scientists and basic researchers, coupled with continued development and recruitment of talented junior physician-scientists, the division looks forward to a future, which will ensure its continued major role in the growth and national visibility of the Department of Medicine.

 

[Text written by John F. DiPersio for the Department of Medicine Centennial Celebration, September, 2010]

Stanley J. Korsmeyer

Stanley J. Korsmeyer

Daniel C. Ihde

Daniel C. Ihde

John F. DiPersio

John F. DiPersio