DEPARTMENT OF NEUROSURGERY TO REFERRING PHYSICIANS AND SPECIALISTS

For consultations and referrals with physicians at UNC Neurosurgery at Chapel Hill: New Patient Referrals Contact: Shama Turrentine Direct Line: (919) 843-4609 Fax: (919) 966-6627 Return/Follow-up Appointments ADULT CLINIC 1350 Raleigh Road/Hwy 54 Chapel Hill, NC 27517 Direct Line: (919) 957-6855 Fax: (919) 843-6520 PEDIATRIC CLINIC N.C. Children s Hospital 101 Manning Drive Chapel Hill, NC 27514 Direct Line: (919) 966-1401 Fax: (919) 843-6520 For consultations and referrals in area communities: Pinehurst Clinic 5 First Village Drive Pinehurst, NC 28374 Tel: (910) 295-0215 Fax: (910) 215-2649 Fayetteville Clinic 3650 Cape Center Drive Fayetteville, NC 28304 Tel: (910) 484-9802 Fax: (910) 484-2342 High Point Regional Health/UNC Health Care High Point Regional Health 404 Westwood Avenue, Suite 201 High Point, NC 27262 Tel: (336) 884-1800 Fax: (336) 884-1814 Administrative Office 170 Manning Drive Campus Box 7060 Chapel Hill NC 27599 Phone: (919) 966-1374 SPOTLIGHT ON: COLLABORATION IN NEURO-ONCOLOGY VOL. 3 ISSUE 1 FROM THE UNC DEPARTMENT OF NEUROSURGERY TO REFERRING PHYSICIANS AND SPECIALISTS Collaboration. That s a hallmark of the care we bring to all of our neurosurgery patients, especially when they need neuro-oncology care. This specialty area is the focus of this issue of our newsletter. UNC Neurosurgery brings together a remarkably broad and diverse group of specialists with many of our services not available anywhere else in the state. Our Neuro-Oncology Program, Brain Metastasis Clinic and endocrinology-pituitary experts are examples. Working with our neurosurgeons, these and other experts perform skull-base surgery and treat patients who have rare conditions, all here in the Research Triangle Region of the state. In addition to these specialists, we also offer clinical trials, working collaboratively with other experts from across the country. All of these services are supported by the tremendous, science-based research of the Lineberger Cancer Center where, in over a dozen labs, hundreds of researchers are performing exciting, meaningful brain tumor research, hoping that the next wave of treatment will come from their work. For your patients needing Neuro-Oncology care, we ve highlighted in this issue a few of our areas of expertise. We welcome your questions about your patients and how we can assist both them and you. Sincerely, Matthew G. Ewend, MD, FACS Van L. Weatherspoon, Jr. Eminent Distinguished Professor and Chair UNC Department of Neurosurgery

NEURO-ONCOLOGY: Approaching Rare Tumors with Extraordinary Resources Our multidisciplinary team at UNC-Chapel Hill, NC, collaborates to treat patients with a variety of neuro-oncology diseases. We ve highlighted FOUR MAIN CATEGORIES, so that you can evaluate your patients for possible referral. 1 Brain Tumor Program: Experts make up our multi-disciplinary team Neuro-oncology is not a specialty that every hospital has, says Jing Wu, MD, PH.D, neuro-oncologist, Assistant Professor and Co-Director of the UNC Brain Tumor Program. She joined the UNC medical staff in 2010 after completing a fellowship at MD Anderson. It s important that area physicians know about our services and the clinical trials we re involved in. For some trials, ours is the only site in the state. (See Clinical Trials, p.3) Physicians who are most likely to refer to the Brain Tumor Program are neurosurgeons and neurologists, but it s not uncommon for ER or primary care physicians to refer patients, as well, especially if they find a brain or spinal tumor through imaging. Once a patient reaches us, we remain in close communication with the referring physicians, Dr. Wu says. I keep them in the loop mainly through personal phone calls to update them or when there s a major decision to be made. That relationship is important to us. The neuro-oncology team at UNC also maintains close ties to internal specialists and sub-specialists, such as neuropsychologists, neuropathologists and others. We work closely with them and with the patient, so the patient can meet with everyone in as few trips as possible, she says. The nature of this specialty is teamwork. The neuro-oncology team at UNC maintains close ties to internal specialists and sub-specialists, such as neuropsychologists, neuropathologists, as well as to each patient s primary care physician. Some members of the team: Matthew G. Ewend, MD Neurosurgeon Jing Wu, MD, PhD Neuro-Oncologist Lindsay Thorp, FNP-BC Sharon S. Cush, RN, OCN Sonja Henretty, RN Nurse Navigator These specialists are part of a multi-disciplinary team that includes neuro-oncology, radiation oncology, neuropathology, neuro-imaging, neuropsychiatry and supportive care. page 2 The brain tumor conference meets every Friday morning. S M T W T F xx S x x

2 UNC Brain Metastasis Specialty Clinic One of the most unique clinics in the state is UNC s Brain Metastasis Specialty Clinic. It provides care for complex patients that few other facilities provide, in part because it brings together experts from across disciplines. It was the multi-disciplinary aspect of patient care that brought me here from a research facility, says radiation oncologist Timothy M. Zagar, MD, who is a co-director of the UNC Brain Metastasis Specialty Clinic. I work closely here with specialists in other disciplines to treat patients for whom other facilities might provide only palliative care. CHALLENGES IN BRAIN CANCER Treating brain cancer most effectively involves an understanding of how best to cross the blood-brain barrier, and the UNC team is in a unique position to bring patients novel options for care. One of the greatest challenges of delivering drugs to the brain is the brain itself, says Carey Anders, MD, hematologist/ oncologist and a Co-Director of the Clinic. It has a very protective nature. But we re able to use novel drugs to penetrate the blood-brain barrier, and we re actively developing and evaluating new protocols in clinical trials. In addition to drugs, the team s neurosurgical techniques are also very refined, she says. For example, UNC is one of only five facilities in NC and the only one in the Triangle using the CyberKnife. PATIENT REFERRALS Physicians most likely to refer patients to the Brain Metastasis Specialty Clinic are those who treat breast, melanoma and lung cancers, as well as general oncologists. During one visit, patients meet with a neurosurgeon, radiation oncologist and medical oncologist all together. We have a very coordinated approach to evaluation and treatment for each patient, Dr. Anders says. We re also deliberate in keeping in contact with each patient s referring physician. Co-Directors of the UNC Brain Metastasis Specialty Clinic: Matthew G. Ewend, MD Neurosurgeon Carey K. Anders, MD Hematologist/Oncologist Timothy M. Zagar, MD Radiation Oncologist Clinic Contact: Lauria Theme; lthemes@unch.unc.edu; (919)445-5543 Photo courtesy of Mark Kostich ACCESS TO CLINICAL TRIALS, RESEARCH FOR NEURO-ONCOLOGY The field of neuro-oncology is today at the stage of hypothesis-driven clinical trials, where teams work to incorporate molecular markers to evaluate different responses to treatment, says Jing Wu, MD, PH.D, a neurooncologist at UNC Medical Center. This will eventually lead to personalized treatment. Having access to basic research, as we do here, is a blessing for our neuro-oncology patients, says Dr. Wu. She also has a Ph.D. in neuroscience, therefore bridging the fields of clinical practice and research. Having strong ties to multifacility collaborations is the direction for this field. For neuro-oncology alone, UNC is active in three clinical trial organizations, giving patients access to promising experimental treatments, in addition to proven standards of care. Each time I open up a trial, I inform our local physicians, so they can evaluate whether a patient might be a candidate, Dr. Wu says. UNC participates in these neurosurgery-related collaboratives: Brain Tumor Trials Collaborative (BTTC): UNC is one of only 23 facilities in this collaborative, and the only one in N.C. The Alliance of Clinical Trials in Oncology, which includes nearly 10,000 cancer specialists across the United States and Canada. Collaborative Ependymoma Research Network (CERN) for a rare type of primary brain or spinal cord tumor. UNC is one of only 18 members of the network, and the only one in N.C. page 3

3 PEDIATRIC BRAIN TUMORS When a child has a brain tumor, experts at UNC know that their physician, parents and family want information quickly. We offer significant resources for families and children, for emotional, financial, social and educational concerns, says UNC pediatric neurosurgeon Scott W. Elton, MD, FAAP, Clinical Professor and Director of Pediatric Neurosurgery for UNC s Department of Neurosurgery. We can share with them the significant advancements in care, both surgically and medically. For example, UNC neurosurgeons can now access previously inaccessible tumors, Dr. Elton says. For each patient, the experts at UNC collaborate with national experts with the Children s Oncology Group. Referring physicians often a pediatrician or emergency room physician have several ways to reach us: Call Pediatric Neuro-oncology directly: (919)966-0000 Shama Benton, New Patient Coordinator: (919)843-4609 Stuart H. Gold, MD, Pediatric Hematologist/Oncologist: (919)966-1178 Timothy Gershon, MD, PhD, Pediatric Neurologist: (919)966-3618 Patient Transfer Center: (919)843-1920 or 1-800-806-1968 UNC Computer-based Directory: http://findadoc.unchealthcare.org. For more information about UNC Pediatric Neurosurgery, see the 2nd quarter 2013 issue of this newsletter. Exciting Clinical Trial Allows Toddler to Hear UNC Neurosurgery was part of the first clinical trail in the country to implant an auditory brain stem device that allowed a child born without cochlear nerves in either ear to hear. Threeyear-old Grayson Clamp was completely deaf until the surgery in the spring. Watch a video of the toddler as he hears his father s voice for the first time. Search the web for brain stem implant, UNC. page 4

Current Neuro-Oncology CLINICAL TRIALS at UNC Neurosurgery For complete details about the studies and patient eligibility, please contact our Study Coordinator Becky Lynch, (919) 843-7112, becky_lynch@med.unc.edu. NEWLY DIAGNOSED GLIOMA DCVax(R)-L (also called DCVax-Brain): For patients with newly diagnosed Glioblastoma. Purpose: Evaluate the effectiveness of a therapy that uses a patient s own tumor cells and white blood cells in addition to standard therapy. (Must be enrolled in the trial prior to surgery.) BTTC11-01: Randomized, Double-Blind, Placebo- Controlled Trial of Lacosamide for Seizure Prophylaxis in Patients with High-Grade Gliomas. Purpose: To assess the efficacy of prophylactic administration of the anti-epileptic drug lacosamide. RECURRENT GLIOMA BTTC 09-01: A phase I-II trial utililizing everolimus and sorafenib in patients with recurrent intracranial malignant glioma. Purpose: To establish effective therapies at recurrence and improve on current clinical results in patients with glioblastoma. BTTC11-02: BTTC11-02: Phase I/II Adaptive Randomized Trial of Bevacizumab versus Bevacizumab plus Vorinostat in Adults with Recurrent Glioblastoma. Purpose: Evaluate the efficacy of the drug bevacizumab versus bevacizumab plus vorinostat. 2B3-101-CR-001: An open label, Phase I/IIa, dose escalating study of 2B3-101 in patients with solid tumors and brain metastases or recurrent malignant glioma. Purpose: Explore the preliminary antitumor activity of 2B3-101 as single agent in patients with recurrent malignant glioma, as well as in patients with various forms of breast cancer with brain metastases, patients with SCLC and brain metastasis, patients with melanoma and brain mets and in combination with trastuzumab in HER2+ breast cancer patients with brain mets. BRAIN METASTASIS 2B3-101-CR-001 (See description, above.) N107-C: A cooperative group, Alliance study comparing whole brain radiotherapy to stereotactic radiosurgery in patients with 1-4 metastatic brain lesions. Purpose: Evaluate overall survival as well as quality of life and neurocognitive function LCCC 1025: A Phase II study evaluating the efficacy and tolerability of everolimus (RAD001) in combination with trastuzumab and vinorelbine in the treatment of progressive HER2-positive breast cancer brain metastases. Purpose: To investigate the intracranial efficacy of the mtor inhibitor everolimus (RAD001) in combination with vinorelbine and trastuzumab in the setting of HER2-positive breast cancer brain metastases. RESEARCH, NON-THERAPEUTIC STUDIES LCCC1308: Engineering reprogrammed patient-derived neural stem cells for novel malignant glioma therapy a tissue study utilizing skin samples from patients with malignant glioma. Purpose: Goal is to estimate the proportion of patient biopsies that can be converted into fibroblast cells, and to estimate the proportion of fibroblast lines that can be converted into neural stem cells. LCCC 1108: Genetic study of cancer patients to create rapid genetic profiling to support treatment decisions. Purpose: Develop a tumor molecular analysis program that can support treatment decisions. page 5

Administrative Office 170 Manning Drive Campus Box 7060 Chapel Hill NC 27599 Phone: (919) 966-1374 VOL. 3 ISSUE 1 FEB 2014 4 New Neuro-Endocrinologist Treats Skull-Base Pituitary Tumors In the fall of 2012, UNC Neurosurgery began creating a Pituitary Center of Excellence to treat patients with rare tumors. To that end, we brought neuro-endocrinologist Julie Sharpless, MD, to serve as our first Director of the new UNC Multidisciplinary Pituitary Adenoma Program. I work closely with our neurosurgeons and with referring physicians to treat our patients, she says. Because of the endocrine consequences related to hormones, the rarity of the disease and patients need for lifelong care for the condition, it s important to have a center of excellence like this. DEPARTMENT HIGHLIGHTS We welcome our new Pediatric Nurse, Melody Watral, MSN, RN, CPNP-PC, CPON, as well as our new Pediatric Administrative Assistant, Susan Cochran. Now follow us on Twitter! @UNCNeurosurgery Contact UNC Neurosurgery with questions or referrals, and watch for a future newsletter with more complete information about this exciting, unique program. Dr. Sharpless and Dr. Matt Ewend hold Pituitary Tumor Conferences once a month. page 6