Cristina Espinal was an energetic 14-year-old in Colombia who noticed a strange bump on her leg. Carolina Williams, a fit 27-year-old Dallas schoolteacher, woke one morning so bloated she couldn’t button her pants. Miami mortgage broker Eddy Fernandez, an athletic 44-year-old, began needing to nap between meetings. For Matilde Rasco Torres, 68, walking and gardening around her Miami home suddenly became such a chore she thought she had heart problems.

Though strangers to one another, these four individuals share a common bond: They were all diagnosed with cancer, received treatment at the University of Miami Miller School of Medicine’s Sylvester Comprehensive Cancer Center, and have since returned to active lifestyles.

Stephen D. Nimer, Sylvester’s director, says stories like theirs should change the way people in South Florida, and elsewhere, are thinking about cancer—and where to go to have it treated. His outlook is upbeat.

“We are making great strides,” he says. “In the past two years, the Food and Drug Adminis-tration has approved 25 to 30 new drugs for treating cancer. We are turning cancer into more of a chronic disease, so people can live with cancer. We are also beginning to cure some cancers that we were never able to cure before—and that’s the real promise.”

Nimer was one of the world’s premier leukemia and stem cell transplant researchers and clinicians at New York’s famed Memorial Sloan-Kettering Cancer Center when he came to UM in 2012, drawn by a promise that he would have the support needed to gain a National Cancer Institute (NCI) designation for Sylvester.

“President [Donna E.] Shalala and Dean [Pascal J.] Goldschmidt described their commitment to taking Sylvester to the next level,” he says, “and I realized that I could have a huge impact on the lives of the patients who come here. The notion is that we can be an amazingly patient-centric cancer center while doing research that matters—research whose ultimate goal is to bring discoveries in the laboratory to patients as quickly as possible.”

That combination of clinical empathy, a dedication to science, and a commitment to the community is what Dean Goldschmidt sees as the cancer center’s strength.

“Sylvester is unique in South Florida in that our extraordinary physicians and scientists are collaborating every day to develop new therapies, improve those already in use, and get them all to our patients as quickly as possible,” he says. “Bringing that research to the people in our region means our patients receive the most advanced university-based cancer care without leaving home.”

Now Sylvester, South Florida’s sole academic cancer center, is gearing up to apply for NCI designation in 2017. The designation would mean that Sylvester’s work in basic laboratory research; clinical research; and prevention, control, and population-based research is of the highest quality and meets prescribed NCI standards. It would also mean Sylvester has demonstrated substantial transdisciplinary research across those areas.

“In research, the way to show that you work together is to publish together,” explains Nimer. “The research itself takes a couple of years, and then it takes about a year to get it published, so we’re moving quickly.”

Community impact is also crucial to demonstrate. “Part of that is how many people are on clinical trials,” says Nimer, who is also a professor of medicine, biochemistry, and molecular biology at the Miller School. “Over the past 30 months, our enrollment onto clinical trials that involve testing cancer therapies has increased substantially, by roughly 40 to 50 percent each year.”

The NCI designation is more than a prestigious label. It helps the best centers become even better by unlocking doors to additional federal funding and research partnerships. Even the prospect of designation can attract top researchers. These days a savvy generation of patients asks about NCI designation when weighing treatment options.

The halo effect spreads farther still. The Washington Economics Group estimates that the NCI designation for Sylvester would have a $1.2 billion impact on South Florida’s economy over five years and create 200 high-quality jobs.

Those numbers are not lost on Governor Rick Scott and the Florida Legislature, who recently approved a five-year, $300 million budget to support cancer research throughout the state. Of that, Sylvester will receive at least $16 million annually. The funding, which is already helping Nimer hire another 20 to 30 top physicians and researchers, is a significant and deliberate assist in the NCI application process.

“Currently there are 41 NCI-designated comprehensive cancer centers in the U.S.,” Nimer says. “Florida, with a population of more than 19 million—we’re now the third-largest state by that measure—should have three. Instead, we have one—and it’s not in densely populated South Florida. New York, which our state just surpassed in population, has six.”

Compounding the math is the intersection of disease and demography in the Sunshine State. Though No. 3 in overall population, Florida has the nation’s highest percentage of residents over 65—17 percent according to the U.S. Census Bureau—and seniors are cancer’s most frequent targets. The American Cancer Society estimates that Florida will report 114,560 new cancer diagnoses and 42,740 cancer deaths (both No. 2 nationally) for 2014. The Florida Cancer Data System, housed at Sylvester since 1978, projects that around 60 percent of those diagnoses and 70 percent of the deaths will be of people 65 and older.

Nimer likens leading Sylvester to running a basketball team, and his strategy is similar: Recruit the best players and focus on your best plays. In just two years, he hired nearly 50 top physicians and scientists from leading institutions, mixing them in with the star players he’d inherited to achieve wins as quickly as possible.

His “best plays” strategy is based on the recognition that cancer is not one but 100 different diseases and that Sylvester’s wins hinge on a realistic playbook.

“We have to get very good at a few things first, then add on, as opposed to having 20 different programs, all of which are getting a little bit better,” he says.

Nimer’s choices include leukemia, lymphoma, and myeloma; sarcoma; genito-urinary cancers (prostate, kidney, and bladder); tumors of the eye and brain; gastrointestinal cancers; head and neck cancers, which includes lung cancer; and breast cancer.

He points out that Sylvester already offers world-class treatment in several of those areas and is achieving five-year survival outcomes that are significantly better than the national average for acute myeloid leukemia (54 vs. 21 percent), late-stage breast cancer (61 vs. 44 percent), and early- and late-stage colon cancer (90 vs. 73 percent and 42 vs. 33 percent, respectively).

“Sylvester’s better outcomes are due, in part, to the fact that we have super-specialized doctors,” says Nimer. “We’re also smaller than some of the other cancer centers, so it’s a little easier to pay attention to all the right details, avoid making any mistakes, and make sure patients are treated optimally.”

It may offer little comfort for people who have already lost loved ones, but the statistical truth is that the battle against cancer is slowly being won. In raw numbers, new diagnoses and deaths continue to grow, but that’s because the U.S. population continues to grow, and with it an increasingly large percentage of seniors. According to American Cancer Society statistics, the average five-year survival rate for all cancers, races, and ages in the U.S. has risen from 49 percent in the 1970s to 68 percent today. Those numbers bear out what Nimer has seen in his own clinical practice.

“Multiple myeloma, a disease I treat, is a great example,” he says. “If you developed it 10 years ago, your average life expectancy was three or four years. Now it’s five to eight years, so it has doubled in a decade. While that’s clearly not good enough, it is important progress, especially because the treatments have become much less difficult.”

There are also more cancer survivors than ever before—14.5 million, according to the American Cancer Society—a number expected to exceed 19 million by 2024.

To speed translational results, Sylvester has begun research collaborations with Memorial Sloan-Kettering, Nimer’s former institution, and with the giant University of Texas MD Anderson Cancer Center in Houston, from which a number of his star recruits have been drawn. Inside the Miller School, Sylvester is working with the Diabetes Research Institute, the Interdisciplinary Stem Cell Institute, the Department of Neurological Surgery, and the John P. Hussman Institute for Human Genomics. The Miller School’s Dr. John T. Macdonald Foundation Department of Human Genetics now includes the newly created Cancer Epigenetics and Genomics Program. Elsewhere within UM, Sylvester is teaming up with the School of Nursing and Health Studies and the School of Communication to improve its health disparities outreach programs and messaging to affected populations.

Sylvester is also expanding its service regionally by opening satellite clinics, most recently in the Broward County cities of Plantation, Hollywood, and Coral Springs. Still to come is The Lennar Foundation Medical Center, a large outpatient facility slated to open in 2016 on the Coral Gables campus.

Nimer says he enjoys his role at the helm of all these transformative initiatives. “Leadership positions give you a wonderful way to help others,” he says. “It’s a great responsibility, but we’re gearing up to do great things.”

Departing from his earlier basketball imagery, Nimer concludes, “We want to be thought of as the Tiffany’s of cancer care. When you come here, you know you will get a wonderful product.”

Robert S. Benchley is senior editor at the University of Miami Miller School of Medicine.

Surgeon J. David Pitcher and one of his young patients, Lazaro Cordero, arrive at the Dolphins Cycling Challenge finish line.

A Wheel
Good Cause

Dolphins Cycling Challenge
spins gold out of asphalt to help cure cancer.

By Robert C. Jones Jr.
Photo by David Sutta

At mile 26, J. David Pitcher Jr.’s 6-foot 3-inch frame ached beyond description. The Miller School of Medicine orthopaedic surgeon had completed four marathons in 2012, but the metaphorical expression, “hitting the wall”—used by most endurance athletes to describe the point at which glycogen stores in the liver and muscles are depleted, ushering in fatigue and energy loss—didn’t even come close to describing what he felt on this early-November Sunday as he neared the end of a 30-mile bike ride. Despite the pain, Pitcher pressed on, downing three bottles of water and a Gatorade to replenish his energy stores. With two miles to go, he picked up the pace and soon entered the 75,000-seat Sun Life Stadium in Miami Gardens—his destination—to the applause of hundreds. Of those who crossed the finish line at the end of the 2012 Dolphins Cycling Challenge, Pitcher stood out. He’d pedaled his recumbent bicycle from Fort Lauderdale to Miami while towing in a custom buggy all 165 pounds of his 17-year-old patient Lazaro Cordero, who lost his left leg to bone cancer.“A chauffeur is never more important than his passenger,” Pitcher told Cordero at one point during their trek.

Outfitted in cycling jerseys, the duo joined nearly 1,500 others who rode to raise funds for lifesaving research and treatment programs for the school’s Sylvester Comprehensive Cancer Center. The 2012 fundraising total of $2.2 million is believed to be the largest single-event donation made by any NFL team and one of the biggest in Sylvester’s history.

“From the survivors who participated to those who rode for loved ones, it was a big success in supporting cancer research at Sylvester,” says Miller School Dean Pascal J. Goldschmidt, who rode through three South Florida counties to complete the DCC’s full 170-mile route. “It’s this commitment that propels our work to save more lives.”

Former Miami Dolphins tight end Jim “Mad Dog” Mandich helped start the fundraiser three years ago while he was battling bile duct cancer, a disease that took his life in April 2011 at the age of 62.

Ridership has more than doubled each year since the launch.

The third annual ride began on Saturday, November 3, 2012, with cyclists setting out from Sun Life in the cool air of an early-morning darkness that eventually gave way to clear skies and warm temperatures. Some completed a 30-mile journey to Miami Beach; others, like Goldschmidt, cycled on to West Palm Beach, where they stayed overnight before riding back to Miami.

Day two’s climactic conclusion resembled the Champs-Élysées finish at the Tour de France, with a multitude of cyclists entering Sun Life Stadium along a path lined with cheering spectators, a jumbo screen displaying each arrival.

Members of the TriCanes, a UM club that competes in triathlons, were among the first finishers, completing the West Palm Beach-to-Miami journey at a brisk 20-mile-per-hour pace. Each rode for a family member or friend who had either passed away from or is undergoing treatment for cancer.

John Labriola, 22, a meteorology and math major from New Jersey, rode for his aunt Jennifer, who died from complications of cancer last August. Engineering major Maggie Ricciuti, 19, was thinking of the aunt whose ovarian cancer is now one year in remission. Finance major Monte Eiseman, 20, rode for his grandparents, both of whom died of the disease.

Luis Cardona, 23, rode for his late grandfather Pacho, who had prostate cancer, and for his uncle Jesus, who is undergoing treatment for brain cancer.

“Cancer runs in my family, so riding in the challenge was important to me,” says Cardona, an industrial engineering and economics major who graduates in May but plans to return for the 2013 challenge.

For the second year in a row, the Sunday finale at Sun Life Stadium was held in conjunction with Sylvester’s Cancer Survivors Day, a gathering of people from all walks of life who have defeated cancer with the help of Sylvester physicians. Among them, sitting with her husband, was Joan Scheiner, chair of Sylvester’s Board of Governors and a 16-year survivor of leiomyosarcoma, a rare cancer of the soft tissue. “I felt like my world had stopped and was spinning out of control,” says the 61-year-old, recounting the day she received her diagnosis. “But from the very beginning, I knew that I was going to make it if I found the right doctors.”

The Miller School’s Pasquale Benedetto, professor of medicine, became her oncologist. “I put my trust and faith in him,” Scheiner says. After undergoing chemotherapy and enduring several surgeries, she is cancer-free.

“Our partnership with the Dolphins has created not only funds but also enormous awareness of the world-class cancer center we have right here in Miami,” Scheiner adds. “And when you’re sick, there’s no place like home.”

With the first riders rolling in, she walked toward the stadium tunnel, as she has every year, to welcome them. “I never thought I’d see my kids grow to be men,” says Scheiner, who has two sons and two granddaughters. “In most other places, just being a doctor would be enough. But at Sylvester, their commitment runs deep. It’s a true partnership.”

Breast cancer survivor Annie Anderson, a kindergarten teacher for Miami-Dade Public Schools, and her daughters, Adrienne and Rashauna, also watched the riders enter the stadium. “We wanted to celebrate our mom’s recovery in hopes that someday there’ll be a cure,” says Adrienne.

“Someday” may be closer than she and others would believe. DCC funds will give a boost to research that has already resulted in significant findings. Last year a team of Sylvester breast cancer experts participating in a multicenter study of breast tumors discovered the existence of four main breast cancer classes—a discovery that could lead to more targeted therapies.

In other recent studies, a research team that included Sylvester’s new director, Stephen D. Nimer, identified a gene responsible for a subtype of childhood leukemia and found that the signaling protein Akt, implicated in a number of human cancers, can also impair the growth of blood-forming stem cells that develop into cancers like leukemia.

Recruited last year from Memorial Sloan-Kettering Cancer Center, Nimer was among those who rode in the DCC to benefit Sylvester, which has set “an aggressive agenda that,” Nimer explains, “will allow us to develop and expand our clinical programs and recruit more outstanding physicians and scientists devoted to research.”

“We’ve been very fortunate over the years to have great support from the Sylvester family,” he adds. “The Pap Corps is a big group of supporters who work tirelessly to raise money for us, and we’re fortunate that we now have the Dolphins Cycling Challenge as well.”

For surgeon Pitcher, the challenge is a way to bear his young patient’s burden. As a 10-year-old boy in Cuba, Cordero was diagnosed with osteosarcoma, the most common malignant bone tumor in kids. Surgeons operated, but he lost so much muscle in his left leg that he needed crutches to walk. By the time Cordero came under Pitcher’s care after arriving in the U.S. years later, the leg had to be amputated.

“Osteosarcoma has an overall survivorship of about 65 percent, and only 20 percent without chemotherapy,” Pitcher notes. “Each person who survives it has a rare story. Each health care provider involved in their story is forever changed. It’s as simple as that. I’m changed by my patients. If I could take their place, I would—I see that sentiment in the eyes and hearts of their fathers, mothers, brothers, and sisters too. And it has rubbed off onto me. If it rubs off onto another from me, bless the Lord for that. It’s what we’ve trained for and been created for.”

Today Cordero, a student at South Dade High School, is cancer free. As he and Pitcher biked from Fort Lauderdale to Miami, they discussed the path—from diagnosis and sadness to treatment and renewed hope—that brought them to this point.

“We talked about the kids in Cuba with his kind of tumor who didn’t make it, and how he wished they could be part of the race and the excitement,” Pitcher recounts. “We talked about how God had given him another chance and what he was going to do with that chance. We talked about his parents and the sacrifices they made for him. We talked as brothers, as father and son, as friends on the same journey.”

The idea to ride in the DCC while pulling one of his patients came weeks before the event, somewhere near the Mason-Dixon line. As Pitcher pedaled his recumbent from Maryland into Pennsylvania, he towed his wife, Pam, who’d been injured while training for their planned tour of the Great Allegheny Passage Trail.

“Person after person commented on what a great thing we were doing,” Pitcher recalls. “Pam kept saying she’d rather be pedaling, but eventually she realized that it’s a great opportunity to bear another’s burdens. It was then that we thought perhaps we could turn something bad into something good.”

Pitcher and Cordero just made the DCC entry deadline.

“It was a long, tough ride,” says Cordero, “but Dr. Pitcher made it easy, telling a lot of jokes to keep up my spirits.”

Nimer, the Sylvester director, says each cancer patient is unique. “We have to understand the patient’s individual cancer, and then we have to understand the impact on the patient. Some of this involves the highest technology—proteomics, genomics—and the other part involves the simplest technology, which is listening to the patient.”

Pitcher describes his patient as “a young man with a bright future and all the world ahead of him.”
Cordero agrees. With his new prosthetic leg, received after the DCC, he plans to return for the 2013 event—this time riding his own bicycle.