Overview of the Second Annual
Joint Cancer Conference
of the Florida Universities
February 26-28, 1998
Orlando, Florida
A unique educational experience was enjoyed by more than 300 health
care providers from throughout the United States at the Joint Cancer Conference of the
Florida Universities in February 1998. Motivated by Florida’s special populations and
needs as they relate to cancer care and delivery, the three universities in the state of
Florida -- the University of Florida, the University of South Florida, and the University
of Miami -- joined together to offer three days of small and large didactic group
discussion and interactive sessions on the latest advances in cancer diagnosis and
treatment. The codirectors of the conference designed the plenary sessions to address
issues in cancer that relate to all specialists and tumor types, while the parallel
sessions were designed for detailed discussions of specific tumor types. An interactive
computer system was used during the last two days of the conference to poll audience
knowledge base, attitudes, and opinions on therapy.
The conference began with a keynote speaker on Thursday, February
26, 1998. Samuel Wells, MD, recently named to become Executive Director of the American
College of Surgeons, addressed the assembly on tumor susceptibility genes. He emphasized
that cancer develops and progresses as a result of an accumulation of genetic mutations,
and tumor susceptibility gene mutations play a role by their loss of function to
negatively regulate cell growth. He reviewed the evidence and application of the
retinoblastoma gene not only in its role in causing this childhood tumor, but also in its
expanding role in other malignancies. Marcia Moore, MD, Director of the University of
Virginia High-Risk Breast Clinic, followed with a discussion of the role of genetic
counseling in patients and families identified with these inherited cancer syndromes. She
stated that even though this type of service may not be profitable to a cancer center, the
service is invaluable as clinicians struggle with the proper role of genetic testing. With
an emphasis on patient selection for testing, confidentiality, and counseling, successful
services may be incorporated into the care of the patient and medical center operations.
Eric Rowinsky, MD, the Director of Clinical Research at the
Institute of Drug Development in San Antonio, Texas, discussed paclitaxel and other
natural products. He also illustrated how the drug screening process has changed over the
last couple of years so that the NCI has shifted its screen from a tumor-type-based screen
into a molecular-target-based screen. For example, paclitaxel’s activity was
initially identified by the random screening of natural substances (eg, plants, marine
organisms) but eventually led to the discovery of two subcellular targets for therapeutic
development, topoisomerase I and tubulin polymerization. Isaiah Fidler, DVM, PhD, followed
with a scholarly address on host-tumor interactions. He emphasized a line of research
involving the role of angiogenesis in the development of cancer metastases. Tumors smaller
than 1 to 2 mm can receive nutrients by diffusion, but growth beyond this stage requires
new blood vessel growth. This induction of angiogenesis is mediated by both host and tumor
molecules, and the balance between factors that stimulate or inhibit this process
ultimately determines the growth of the metastatic focus. These factors are then targets
for drug therapy, and already interferon-alfa is being used in clinical trials to try to
down-regulate or inhibit angiogenesis. In a lighter moment, Dr Fidler asserted that since
the conference was being held at Walt Disney World, he should receive a special award
since he cured more mice of cancer than Walt Disney himself.
Continuing with the highlights of the plenary sessions, Richard
Assoian, PhD, from the Sylvester Comprehensive Cancer Center, delivered a lecture on
signal transduction pathways in growth control and oncogenesis that could be easily
understood by the clinicians in attendance. Dr Assoian and his colleagues have studied a
class of nuclear enzymes called cyclin-dependent kinases that are recognized to be
increasingly important in cell cycle control. Mutations in these enzyme systems lead to
unregulated growth and cancer. Edward Trapido, ScD, also from the Sylvester Cancer Center,
reviewed the epidemiology of cancer in the state of Florida. Prostate cancer is the most
common cancer in men, while breast cancer accounts for 30% of all cancer diagnoses among
women in Florida. Some cancers vary in rates throughout the state, which may be a result
of etiologic exposures. Melanoma incidence in particular is rising in Florida.
The last plenary session of the second day was chaired by Albert
Einstein, Jr, MD, associate center director for Clinical Affairs at Moffitt Cancer Center,
and focused on cancer economics. This session brought together experts in the field to
speak on the evolving role of managed care, malpractice issues, and clinical guidelines
and outcome measurements in our cancer practices. The theme of the speeches, which can be
summarized by the phrase "no money, no mission," involved the struggle of
academic centers to come to grips with the pressures of the business side of oncologic
practice while fulfilling the roles of teaching and research. The talks ended with a
dazzling display of the potential for the medical uses of the Internet by Dido Franceschi,
MD, from the University of Miami. This high-tech presentation involved demonstrations from
simple matters of looking for a reference to using the Internet as an electronic medical
record.
Parallel sessions were enhanced by small group discussions for easy
exchange of information with the hope that common ground can be found to stimulate
statewide research programs. Florida has unique populations with different cancer issues,
such as the epidemic of melanoma in the state. Last year, the Florida Melanoma Trial was
launched at this conference, a phase 1 trial that examines the toxicity of a combination
of adjuvant interferon alfa and radiation therapy in the treatment of patients who have
resected gross nodal melanoma metastases. This year, the gastrointestinal parallel session
involved discussions from screening to diagnosis to treatment of the more common
malignancies.
Nursing oncology plays an important role in the care of the patient
with cancer, and the latest updates on care and issues of treatment were addressed in the
nursing parallel sessions. Skin cancer, prostate cancer, and lung cancer were topics for
discussion along with an overview of geriatric oncology, another issue affecting
Florida’s unique population.
The last day of the conference was highlighted by an interactive
session that addressed controversies in cancer management. Sharlene Weiss, PhD, from the
University of Miami, discussed the emerging acceptance and importance of alternative
therapies, led by the establishment by Congress in 1992 of the Office of Alternative
Medicine in the National Institutes of Health. She used the interactive system effectively
by initially polling the audience on their attitudes toward alternative therapies such as
acupuncture, mind-body interactions, bioelectromagnetic applications, traditional and folk
remedies, and manual healing methods. After the lecture, the speaker was able to
demonstrate a greater acceptance of these therapies.
The social program was highlighted by a reception on the first day
with the Disney characters, a "meet the professor" luncheon, and a faculty
dinner. The breaks were held in the exhibit area, a hall that included displays from the
three universities and more than 50 companies. A workshop on radioguided surgery preceded
the main conference and was attended by 50 surgeons who obtained up-to-date information on
lymphatic mapping technology for melanoma, breast, and head and neck cancer, as well as
radioguided surgery for parathyroid localization and colon cancer.
The conference would not have been possible without our corporate
sponsors. The three universities are indebted to Bristol-Myers Squibb Oncology for
partnership, Schering Oncology Biotech for gold sponsorship, Glaxo-Wellcome for silver
sponsorship, and Roche Laboratories and Novartis Oncology for platinum support. Amgen,
Chiron Therapeutics, Dupont-Merck, Hoechst Marion Roussel, and Rhône-Poulenc Rorer are
cited for copper sponsorship. We extend our thanks to them for their belief in this
education concept.
The second annual Joint Cancer Conference of the Florida
Universities illustrated how cooperation and collaboration among the three institutions
can provide an educational forum to address some of the common and unique problems with
cancer in the state. With the best minds working together, the potential for grants,
focused research, and real progress in the fight against cancer is tremendous. We look
forward to next year’s conference on January 27-30, 1999, to be held at Walt Disney
World’s Yacht & Beach Club Resort in Orlando, Fla.
Douglas Reintgen, MD
Leader, Cutaneous Oncology Program,
H. Lee Moffitt Cancer Center & Research Institute
Professor of Surgery, University of South Florida College of Medicine
Tampa, Florida
Edward M. Copeland III, MD
The Edward R. Woodward Professor and Chair
Department of Surgery
Director, Shands Cancer Center
University of Florida College of Medicine
Gainesville, Florida
W. Jarrard Goodwin, Jr, MD
Sylvester Professor and Chairman
Department of Otolaryngology
Director, Sylvester Comprehensive Cancer Center
University of Miami Hospital and Clinics
Miami, Florida
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