Sweet Home Chicago is home not just to the ASCO Annual Meeting but also five medical school-affiliated cancer centers that have accomplished many breakthroughs in the treatment and understanding of cancer.

"We don't get the press here in Chicago that other regions do, but that doesn't mean we don't do innovative things," said Patrick Stiff, MD, Professor of Oncology at Loyola University Stritch School of Medicine and Director of Loyola's Cardinal Bernardin Cancer Center, located just outside Chicago in Maywood, Illinois.

Loyola and Chicago's other academic cancer centers-Northwestern University, Rush University, University of Chicago, and University of Illinois at Chicago-have helped advance oncology in many ways. From the University of Chicago alone, researchers have included one of the fathers of chemotherapy (the late Leon O. Jacobson, MD), one of the fathers of hormone therapy (the late Charles B. Huggins, MD), and the discoverer of chromosomal translocations in cancer (Janet Rowley, MD, Professor of Medicine, Molecular Genetics, and Cell Biology).

"It's hard to think of one institution with three faculty members who had such an impact on cancer," said Richard L. Schilsky, MD, Professor of Medicine and Deputy Director of the University of Chicago Comprehensive Cancer Center. "Their work has manifested itself in many breakthroughs in cancer treatment."

In testing nitrogen mustard in patients with lymphoma in 1943, Dr. Jacobson showed for arguably the first time (researchers at Yale University, New Haven, Connecticut, also are considered pioneers of chemotherapy) that chemotherapy worked in humans. According to Dr. Schilsky, Dr. Huggins "essentially opened up the field of hormone research" by showing in 1941 that prostate tumors regressed after castration; he won a Nobel Prize for his work. In 1972 Dr. Rowley identified chromosome abnormalities in chronic myelogenous leukemia followed by the discovery of other chromosomal abnormalities in acute myeloid leukemias.

"She turned around the thinking of cancer to be a fundamentally genetic problem. In many ways, Dr. Rowley's work provided the basis for targeted therapy," Dr. Schilsky commented.

Many of the cancer advances achieved in Chicago have been in treating breast, lung, and hematologic cancers, and more specifically, in bone marrow transplants.

Breast Cancer

The discovery of the estrogen receptor in 1958 by University of Chicago researcher Elwood Jensen, PhD, revolutionized the treatment of breast cancer, many believe. His finding made it possible to measure whether a woman's breast cancer was estrogen-receptor positive and would respond to hormonal therapy.

"Until then, we removed everyone's ovaries if they were premenopausal and had metastatic disease," said Janet Wolter, MD, Professor Emeritus of Internal Medicine with Rush University Medical Center. (Dr. Wolter, a pioneer in breast cancer treatment, is profiled on the following page.)

Lung Cancer

In the early 1980s, Rush University Medical Center was one of the original centers to use combined radiation therapy and chemotherapy before lung resection for treatment of stage III non-small cell lung cancer, said L. Penfield Faber, MD, Rush University Surgery Professor and Vice Chairman, Department of Cardiovascular-Thoracic Surgery. Initial studies showed this approach might improve survival. Since then, this combined-modality therapy has doubled the 5-year survival rate compared with other treatments, studies show.

"Now for patients with advanced lung cancer, we can give them some hope," Dr. Faber said.

With his partner, the late Robert J. Jensik, MD, Dr. Faber was one of the earliest U.S. advocates for doing tissue-sparing sleeve lobectomy, which was invented in England. The procedure uses anastomoses, after removal of a cancerous lobe of the lung, to reconnect the remaining lobe and bronchial segment.

Hematologic Cancers

Among the most important advances in treating cancers of the blood are targeted therapies, including monoclonal antibodies. Northwestern University conducted proof-of-concept clinical trials of monoclonal antibodies in the 1980s, said Steven T. Rosen, MD, Professor of Medicine and Director of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.

"The use of chemoimmunotherapy for non-Hodgkin lymphoma and chronic lymphocytic leukemia has improved cure rates without a significant increase in toxicity," Dr. Rosen said.
University investigators also participated in pioneering studies of the treatment of hairy cell leukemia with 2-chlorodeoxyadenosine (Leustatin), which can induce long-term remission, according to Dr. Rosen.

"We have probably made the greatest impact [in oncology by testing] drugs that became standard treatments, which have improved quality of life and prolonged survival," he added. As examples, he cited medications to treat cutaneous T-cell lymphoma, including alemtuzumab (Campath), denileukin diftitox (Ontak), and vorinostat (Zolinza).

Bone Marrow Transplants

Both Northwestern and Loyola reportedly have among the largest stem cell transplant programs in Illinois, annually helping hundreds patients with hematologic cancers and other life-threatening diseases.

Researchers at Loyola's cancer center in March 2000 became the first to successfully transplant bone marrow cells grown outside the body, Dr. Stiff said. "From as little as a tablespoon of bone marrow, we were able to do an entire transplant," he said.
Loyola, according to Dr. Stiff, is a leader in nonembryonic stem cell research using umbilical cord blood. The research team is trying to magnify the number of umbilical cord stem cells grown in vitro, because the number of these cells is limited in cord blood.

The advantage of cord blood stem cells is that human leukocyte antigens (HLA) do not need to match a patient as closely as donated bone marrow. Thanks to cord blood transplants and creation of the National Marrow Donor Program's unrelated donor registry, Dr. Stiff said it is possible to cure many patients who could not otherwise find a suitable donor.

"If you had leukemia in 1985 and needed a bone marrow transplant, the chance of coming to transplant was one in three," Dr. Stiff said. "Now we can find a donor for 90% of patients. It may be a cord blood donor. We've come a long way."

Current Efforts

Chicago's cancer centers have helped the field of oncology move forward. They continue to perform important clinical and basic science studies that they hope will improve cancer care. Two of the centers, Northwestern and University of Chicago, have the state's only National Cancer Institute-designated comprehensive cancer research centers.

Besides doing their own research, the five cancer centers often collaborate with each other through regional oncology consortia.

Dr. Stiff said, "We work together on research, we collaborate on the phone, and we refer patients to each other. We would rather work together to improve outcomes than fight about who's better."

ASCO has committed to host the Annual Meeting in Chicago for the next 10 years.