They lead groundbreaking clinical trials using new radiation oncology therapies for pancreas, brain, pediatric, prostate, lung, and head and neck cancer. They search for novel treatments for breast and colon cancer, and for metastatic disease. They are consulted by other experts in the field, serve as editors of medical journals and textbooks and prepare the physicians of tomorrow as faculty members of Florida International University’s Herbert Wertheim College of Medicine.
They are the world-class Radiation Oncology Department at Baptist Health Miami Cancer Institute.
For cancer patients, having an experienced team means sophisticated and individualized treatment that is focused on extending lives and improving quality of life. It also means that experts develop and guide clinical trials that are leading to breakthroughs and life-saving treatments for some of the most complex and difficult-to-treat cancers.
Minesh P. Mehta, M.D., deputy director and chief of radiation oncology at Baptist Health Miami Cancer Institute
“The research at Miami Cancer Institute represents areas of great unmet medical need,” said Minesh P. Mehta, M.D., deputy director and chief of radiation oncology at Miami Cancer Institute. “Our physician-investigators are focusing on cutting-edge technologies and combinatorial therapies in radiation oncology, unified in our forward-looking mission to provide the best possible care to cancer patients.”
Rupesh Kotecha, M.D., radiation oncologist, chief of radiosurgery and director of the Central Nervous System Metastasis Program at Baptist Health Miami Cancer Institute.
Among the research is a first-in-world brain metastasis trial being led by radiation oncologist Rupesh Kotecha, M.D., chief of radiosurgery and director of the Central Nervous System Metastasis Program at Miami Cancer Institute. The ADORATION study is using the medication Azeliragon in combination with stereotactic radiosurgery to fight metastatic brain cancer.
In the U.S. each year, between 200,000 and 300,000 patients are diagnosed with brain metastasis — cancer that has spread to the brain from elsewhere in the body. It is a particularly difficult cancer to treat.
“The ADORATION trial offers an exciting new combinatorial regimen,” Dr. Kotecha said. “In patients with brain metastasis treated with radiotherapy, it has the potential to overcome cancer’s resistance pathways and improve response rates. It also has the promise of protecting against inflammation and preserving neurocognitive function.”
Michael Chuong, M.D., lead physician for the MRI-guided radiation program and medical director of the Department of Radiation Oncology at Baptist Health Miami Cancer Institute.
Michael Chuong, M.D., the lead physician for the MRI-guided radiation program and medical director of Miami Cancer Institute’s Department of Radiation Oncology, co-led an international multicenter trial for patients with inoperable pancreatic cancer. In the Phase II SMART trial, physicians used noninvasive MRI technology that delivers very high ablative radiation doses to eradicate pancreatic tumors in only five outpatient sessions.
Some 64,000 people a year are diagnosed with pancreatic cancer in the U.S., and because most cases are not caught until they are at an advanced stage, treatment options are limited. Most patients are not candidates for potentially curative surgery at the time they are diagnosed.
In the SMART trial, with MRI-guided stereotactic ablative body radiation therapy, 53.6 percent of patients with inoperable pancreatic cancer were still alive after two years. In comparison, just 20 percent of patients who receive chemotherapy and standard radiation therapy are expected to live at least two years after diagnosis.
“Treatment is exceptionally well-tolerated and patients report that the high-dose radiation therapy does not negatively impact their quality of life,” Dr. Chuong said. Many of the radiation planning and delivery techniques developed at Miami Cancer Institute are now being adopted by other cancer centers.
The team of stellar medical physicists, Andrew Wroe and Alonso Gutierrez, together with Drs. Kotecha and Mehta, recently developed and patented a novel technique of delivering proton therapy for recurrent tumors, known as temporally modulated pulsed proton re-irradiation. Based on initial dramatic responses in heavily pre-treated patients, the first formal clinical trial in the world has been launched.
In addition, Institute physics researchers, in collaboration with the University of Iowa and University of Wisconsin-Madison, have developed and tested a prototype device called the Dynamic Collimation System, which when used during pencil beam scanning proton therapy improves the target dose and reduces the dose to associated healthy tissue and critical structures.
Other radiosurgery trials being led by the radiation oncology team at Miami Cancer Institute include:
A Phase I trial of trastuzumab deruxtecan with stereotactic radiosurgery in patients with brain metastases from HER-2-positive breast cancer to effectively shrink or eliminate brain tumors. Led by Manmeet Ahluwalia, M.D., deputy director, chief scientific officer, and chief of medical oncology at Miami Cancer Institute, and Fernandez Family Foundation Endowed Chair in Cancer Research, this trial combines the sophisticated radiosurgery delivery platforms at the Institute with targeted therapeutics in a multi-institutional trial.
A Phase III trial of stereotactic radiosurgery with or without tumor treating fields (TTFields) for patients with one to 10 brain metastases from non-small cell lung cancer to delay disease relapse. Initial findings of the international METIS (EF-25) trial, presented at the American Society of Clinical Oncology meeting in June by Dr. Mehta, co-principal investigator, showed that the median time to intracranial progression with best supportive care was 11.3 months, while the median time to intracranial progression with best supportive care plus TTFields was 21.9 months. TTFields are electrical signals delivered non-invasively to the tumor site through transducer arrays attached to the scalp.
The Breast Reirradiation After Second Ipsilateral Lumpectomy (BRASIL) trial for patients who have a new or recurrent second breast cancer event and wish to undergo repeat lumpectomy and reirradiation rather than have a mastectomy. Led by radiation oncologist Youssef Zeidan, M.D., with Lynn Cancer Institute, the study will assess the feasibility and safety of repeat breast radiation.
Two studies for patients with HPV-related oropharyngeal cancers. Both assess treatment response. One, available through the Memorial Sloan Kettering Cancer Center alliance, utilizes a special PET-CT, while the other uses a blood test. Principal investigator Noah Kalman, M.D., said the goal is to determine mid-treatment whether patients can complete treatment sooner, maintaining excellent disease control while reducing radiation toxicities.
The LUNAAR study, which is testing the anti-tumor activity of a combination therapy for patients with metastatic hormone-resistant prostate cancer and being led by principal investigator Rohan Garje, M.D. Eligible patients require a positive PSMA PET scan and should have previously received and progressed through both taxane-based chemotherapy, as well as androgen receptor pathway inhibitor therapies such as enzalutamide, darolutamide or apalutamide, said sub-principal investigator Adeel Kaiser, M.D.
The Radiation Oncology team, which also includes experienced radiation oncology physicists and medical dosimetrists, is increasingly represented at the most significant industry meetings, serving as faculty, presenting their research findings and leading and moderating educational sessions. At the upcoming American Society for Radiation Oncology (ASTRO) annual meeting, the researchers are scheduled to give three oral and six poster presentations in addition to hosting four educational sessions.
It’s not just its research that makes Miami Cancer Institute unique. From a technology standpoint, it is the only center in the world to offer all of the latest radiation therapy modalities in one setting. It is home to South Florida’s first Proton Therapy Center and at the Particle Therapy Cooperative Group (PTCOG) meeting in Singapore recently, the team gave a number of presentations on proton therapy topics.
“We are fortunate to have the most sophisticated technology at our fingertips,” Dr. Mehta said. “But, in addition to being high-tech, we are also high touch. Our providers are compassionate and caring. We are here to personalize care for every patient and to change the landscape of cancer care today.”
