Michael Pishvaian, an experienced gastrointestinal cancer specialist with expertise in targeted therapies for patients with pancreatic and advanced colorectal cancers, joined the Johns Hopkins Kimmel Cancer Center in March. Pishvaian, a Washington-area native who worked for Georgetown for many years, says he was excited to bring his talents to the program, housed at Sibley Memorial Hospital.
“Johns Hopkins represents the absolute nexus between incredible science and world-class clinical care,” says Pishvaian, who was appointed director of the gastrointestinal, developmental therapeutics and clinical research programs for Johns Hopkins’ national capital region. “Over the last 10 years, Johns Hopkins’ cancer researchers in Baltimore have become true leaders in the field of immunotherapy for different cancers, and continue to expand our understanding of how the immune system can be harnessed to fight cancers. My hope would be to build a program in parallel, developing a clinical and translational research program focused on biomarker-directed therapies for gastrointestinal cancer patients who don’t benefit from immune therapies.”
Within three to five years, he says, his group aims to have one of the premier precision medicine programs in the country, with a menu of clinical trials focused on patients and their unique biomarkers, so patients can be offered several therapy options tailored to their specific cancers.
“We’re also building a pancreatic-focused team to work in parallel with the highly successful pancreatic multidisciplinary program at the main campus in Baltimore, where there is a team of medical oncologists, surgical oncologists, radiation oncologists and gastroenterologists available to evaluate patients together to optimize and maximize the management of their cancers.”
“We have now gotten to the point that if you do a molecular test on a pancreatic tumor sample, and are able to treat the patient with appropriately targeted therapy, that you improve survival by about a year,” --Dr. Pishvaian
Gastrointestinal cancers present some challenges to physicians, says Pishvaian. First, pancreatic cancers are often identified at a later stage because the pancreas sits in a location where tumors may not cause any symptoms until they have grown or spread. Colorectal cancers are being diagnosed sooner thanks to screening colonoscopies, but they also have been developing in younger patients, for reasons not yet understood, Pishvaian says.
Pancreatic cancers are difficult to treat, in part because the cells are resistant to chemotherapy drugs and the connective tissue surrounding the pancreas in particular seems to form a barrier to therapies getting in, he says. Additionally, there’s not a very robust immune response to these cancers, so stimulating the immune system using single agent immunotherapies has not been as successful for pancreatic and colorectal cancers as for other types of cancer, “which is why the work being done in Baltimore to identify combination immunotherapy strategies is so critical,” Pishvaian says.
Pishvaian’s research has focused on the development of new therapies for gastrointestinal cancers and the identification of predictive markers of response to therapy for these cancers. This includes studying mutations in the DNA damage response and repair (DDR) pathway—defects in the way in which cells monitor and repair damaged DNA. He is a co-principal investigator on two large National Cancer Institute-funded studies: one looking at resistance to inhibitors of an enzyme called PARP (poly ADP ribose polymerase) in pancreatic cancers, and one evaluating the best models of testing cancer susceptibilities for patients with pancreatic cancer.
“We have now gotten to the point that if you do a molecular test on a pancreatic tumor sample, and are able to treat the patient with appropriately targeted therapy, that you improve survival by about a year,” he says. A research study he led on this topic was published in March in the journal Lancet Oncology.
With precision medicine, Pishvaian says, “You’re delivering what is typically less toxic therapy to a more specific subgroup of patients with pancreatic cancer, expecting a higher likelihood of showing a beneficial response to therapy.” This is because the therapy is more targeted to the root of the cancer.
Pishvaian comes to Johns Hopkins from the University of Texas MD Anderson Cancer Center in Houston, where he spent a year as co-director for clinical research at the Sheikh Ahmed Bin Zayed Al Nahyan Center for Pancreatic Cancer Research. Prior to that, he spent 12 years at Georgetown University’s Lombardi Comprehensive Cancer Center, where he directed the phase I clinical research program; served as medical director of the Clinical Research Management Office; and co-directed the Ruesch Center Pancreatic Cancer Program.
Pishvaian received a bachelor’s degree in biology from Duke University in Durham, N.C., and completed medical school and a Ph.D. program in tumor biology at Georgetown. He stayed on at Georgetown for an internship and residency in internal medicine, and a fellowship in hematology/oncology, before joining the faculty there in 2007. Pishvaian’s wife, Aline Charabaty, is clinical director of gastroenterology and director of the inflammatory bowel disease center at Sibley.