Cancer care is a readiness mission, and that guided discussions as the John P. Murtha Cancer Center (MCC) at Walter Reed National Military Medical Center, the Department of War’s only Center of Excellence for Cancer Care and Research, hosted its Blood Cancer Summit recently at the hospital.

The summit brought together experts, caregivers, and researchers addressing emerging research and treatment advances in blood cancer across the Military Health System (MHS).

“We’ve been the Center of Excellence for Cancer Care and Research since 2012,” said Dr. Craig Shriver, director of the MCC and MCC Research Program at the Uniformed Services University (USU). “The key that makes this all work is command support [from Walter Reed and USU].”

Walter Reed Director U.S. Navy Capt. (Dr.) Melissa Austin agreed, emphasizing that cancer care directly supports readiness across the MHS. “You sometimes have to explain to people why we do cancer care in the {MHS],” she said.

Austin explained that Walter Reed’s core mission is casualty reception. “Cancer care within the MHS is probably the best way to keep the entire care team ready to do our jobs when the next conflict comes,” she added.

“We don’t do a lot of invasive surgery because much of the world has gone to minimally invasive surgery,” Austin continued. “But that’s not what we’re doing when we’re in a deployed setting. We’re transfusing blood. We’re managing complex medication, metabolic derangements, [and] multi-systems issues. [Cancer care] teaches people to think critically and at a high level just like we have to do when we have complex poly-trauma.”

“[Cancer and its treatment] simulate things like burns to the entire system that we’re going to have to treat in a conflict,” Austin added. “Wounds we haven’t seen since World War II are going to come back to us, so it’s vital that the team stays ready.”

“So, if you think of the reason why the MHS exists – casualty reception, [then cancer care] is directly relevant,” Austin continued. “It keeps the team at the top of its skill set, and it is the most complex care we can bring into this building [Walter Reed].”

Austin also highlighted Walter Reed’s robust hematology/oncology research program, which includes 18 open, actively enrolling clinical trials conducted in collaboration with other health-care systems, such as Veterans Affairs (VA).

“We’re also developing the first military CAR-T treatment program to treat hematologic malignancies in the MHS,” said Austin.

U.S. Air Force Lt. Col. (Dr.) Christin DeStefano, program director for hematology/oncology and an organizer for the blood cancer summit, explained CAR-T, or Chimeric Antigen Receptor T-cell therapy, is a personalized immunotherapy that genetically modifies a patient's own immune T-cells to recognize and attack cancer. Austin added that Walter Reed also performs autologous stem cell transplants for blood cancers like multiple myeloma and lymphoma.

“We do things [at Walter Reed] that are not done anyplace else within the MHS,” Austin added. “Why? Because it keeps us sharp, it provides the best possible care for our patients, and it causes people to want to come to Walter Reed, and that’s what we want.”

Topics discussed during the summit included lymphoma incidence in the military, combination targeted therapy in relapsed Diffuse Large B-cell Lymphoma (DLBCL), updates in follicular and Hodgkin lymphoma, and the pathophysiology and treatment of myeloproliferative neoplasm (MPNs).

CANCER INCIDENCE

Kimberly Robins, a cancer epidemiologist at MCC, explained that cancer incidence tracks the number of cancer cases diagnosed in a population over time. She noted that occupational hazards, demographics (age, sex, race/ethnicity), lifestyle factors (physical activity, tobacco use, obesity, diet), and genetics can influence cancer risk. “The MHS provides universal access to care,” Robins stated, adding cancers among MHS beneficiaries are often detected earlier because of the military’s requirement for routine health exams, and some military occupations may increase risk for some cancers.

DLBCL

Dr. Christopher Melani, of the National Cancer Institute, explained his team has developed a combination targeted therapy in relapsed DLBCL, a blood cancer of the immune system that can spread from the lymphatic system to bone marrow and other organs. “We showed that multiple targeted agents could be concurrently administered safely and with an acceptable side-effect profile in adult patients of all ages with relapsed or refractory DLBCL. Our study also showed that simultaneous targeting of multiple survival pathways is potentially curative in specific molecular subtypes of relapsed or refractory DLBCL.”

FOLLICULAR LYMPHOMA, HODGKIN LYMPHOMA

Dr. Joseph Roswarski, of Georgetown University Hospital, shared updates in follicular and Hodgkin lymphoma focused on targeted agents, drug combinations, bispecific antibodies, and CAR-T therapy, along with future directions for earlier intervention and patient-centric care.

Dr. Nicholas Burwick, of the VA Puget Sound Health Care System, discussed pathophysiology and myeloproliferative neoplasms (MPNs). He previously collaborated with DeStefano on research examining cancer risk among veterans exposed to environmental and occupational hazards. They stated in the study, “Military members are expected to go in harm's way if needed and endure potentially harsh conditions or toxic exposures during training and deployments. For example, Vietnam War Veterans were potentially exposed to Agent Orange, and Persian Gulf War Veterans were potentially exposed to oil well fire smoke, pesticides, chemical warfare, pyridostigmine bromide among other toxins.” This is why research needs to continue to determine if there is a link between certain military occupations, deployments and cancer, they added.

Dr. Clifton Mo, of the Dana Farber Cancer Institute, discussed updates in multiple myeloma including advances in immunotherapy, including promising results for bispecific antibodies, novel CAR-T cell therapies, new combination therapies, and radioimmunotherapy.

According to Shriver more than 1,500 active-duty service members are diagnosed with cancer annually. “This is among the healthiest, generally young, and most active members of the nation’s population. Every one of them is important to the military and warfighter readiness. When we lose one to treatment for a while, or [the service member] has to be transitioned out of the military, it impacts readiness,” he said.