Targeting Women’s Cancers
words by mary ann littell / photographs by john emerson
Bernadette Cracchiolo, MD,
ASSOCIATE PROFESSOR, OBSTETRICS, GYNECOLOGY AND
WOMEN’S HEALTH AT UMDNJ-NEW JERSEY MEDICAL
SCHOOL (NJMS), WITH PATIENT
Griselda Malave (Standing)
hen 45-year-old Griselda Malave began experiencing vaginal bleeding in April 2005, she did not assume the worst. “I thought it was an early sign of menopause,” she says.
The bleeding lasted for months, accompanied at times by severe back pain. “I didn’t see a doctor because I had no health insurance,” she says. “I didn’t know where to turn.”
With her husband’s help, she went to a social services agency to obtain Medicaid coverage, then saw a doctor at a clinic near her home in Jersey City. She received grim news: She had Stage II cervical cancer. “The doctor could tell I had cancer even before doing the biopsy,” she says. “When she told me the tumor was as large as a baby’s head, I cried.” Malave was referred to Bernadette Cracchiolo, MD.
As director of the Division of Gynecologic Oncology at NJMS, Cracchiolo provides high-quality care for women with gynecologic cancers. “Many of our patients don’t have regular Pap tests,” she says. “So by the time we see them, they have advanced disease. However, many of them can get long-term cures with the proper treatment.”
When Malave first visited Cracchiolo’s office in May 2006, the physician found that the tumor, eight centimeters in size, had not spread outside the cervix. “There is no benefit to surgically removing this type of advanced cervical cancer,” explains Cracchiolo. She asked Malave to consider participating in a Phase III clinical trial that combined the study drug tirapazamine with standard therapy. “I decided to go for it,” says Malave.
The study protocol specified that patients would receive either the standard therapy (radiation plus cisplatin), or standard therapy plus tirapazamine. Malave later found out she was part of the group receiving the study drug, which was administered intravenously on an out-patient basis at UMDNJ-University Hospital (UH). By the time she finished treatment in August 2006, her tumor had shrunk to two centimeters in size. Over time, it disappeared, and today, there is no evidence of recurrence.
According to the American Cancer Society, cervical cancer mortality has dropped 70 percent in the last 50 years. However, cervical cancer rates are highest among minorities and the poor, and most invasive cervical cancer is found in women who haven’t had regular Pap smears. “Cervical cancer is the primary cancer we treat,” says Cracchiolo. “We see between 40 and 60 patients a year — a phenomenal number. Someone in private practice may see a dozen cases or less.”
THE TUMOR BOARD MEETS BI-WEEKLY
TO REVIEW CASES AND DETERMINE
TREATMENT FOR PATIENTS. MEMBERS OF THE TUMOR BOARD:
(TOP, LEFT TO RIGHT)
DOLLY RAZDAN, MD, MARGARETTE BRYAN, MD, BERNADETTE CRACCHIOLO, MD, KAREN HOUCK, MD, DEBRA HELLER, MD
JULIA LUTZ, APN, SUE WALTHER, APN, MARIA CUNHA, APN
Cracchiolo is the principal investigator for several clinical trial protocols for uterine, ovarian and cervical cancer. “Unfortunately, underserved populations have less access to subspecialty care, and only 1 to 2 percent of cancer patients in clinical trials are minorities,” she says.
Before attending medical school, the physician worked in San Francisco as a project assistant for a field study on heterosexual HIV transmission. She finds the link between clinical trials and public health compelling. “In both disciplines, you’re treating populations, so you have a greater chance to make a difference,” she says. During medical school she earned a master’s degree in public health, and came to NJMS after completing a fellowship in gynecologic oncology at Yale. As a clinical researcher, high on her to-do list was boosting clinical trials at UH. To that end, she applied for and gained acceptance as an affiliate member of the Gynecologic Oncology Group (GOG), an NCI-funded organization that runs approved protocols. “The trials we’re running here are the same ones you’ll get at the top comprehensive cancer centers,” she says. Another study she is overseeing is a Phase III trial for Stage III or IV endometrial cancer. Patients are randomized into two groups, with one receiving chemotherapy agents carboplatin and paclitaxel and the other a combination of doxorubicin, cisplatin and paclitaxel.
Cracchiolo has also established a bi-weekly tumor board, which includes medical oncologist Margarette Bryan, MD, radiation oncologist Dolly Razdan, MD, and gynecologic pathologist Debra Heller, MD, “one of the few double board-certified physicians on our staff. We discuss all new patients, any recurrences, and patients who have experienced toxicity. We decide which protocol would be best. We talk about their family situations and whether they will be able to follow protocol instructions and return for follow-up. This is where we make all our treatment decisions.” Nurse-practitioner Julia Lutz performs initial physicals and follow-up visits and monitors patient care, while palliative care specialist Sue Walther counsels terminal patients.
Her days are busy — sometimes too busy — with patient care, teaching and research. She recently gained a partner, Karen Houck, MD, who comes to NJMS via Morristown Memorial Hospital, to help address the growing need for services. Houck specializes in advanced laparoscopy. “Our specialty is very unique in that we’re pelvic surgeons,” says Cracchiolo. “Depending on how the cancer spreads, sometimes that also includes bladder and urologic surgery as well as gastrointestinal surgery.”
Another facet of Cracchiolo’s care is palliative practice. She recently became board-certified in palliative care “because so much of our work is late-stage, and there is treatment even when a cure is not possible. This changes the focus of care to emphasize quality of life rather than length of life.”
The physician focuses on the positive. “Research shows that subspecialty services in gynecologic oncology improve quality of life and translate into longer survival,” she says.