Networked and competent in the fight against cancer

Networked and competent in the fight against cancerThe goal sounds simple, but the path is demanding: It is about nothing less than the "best possible cancer care in Schleswig-Holstein," as Prof. Nikolas von Bubnoff formulates. In this sense, those responsible want to make progress with the University Cancer Center Schleswig-Holstein (UCCSH), which includes all oncology facilities of the University Hospital Schleswig-Holstein (UKSH) with locations in Kiel and Lubeck – and also wants to build up a sustainable network for excellent cancer medicine in the whole of the north.

The UCCSH office is located under the roof of the Karl Lennert Cancer Center in Kiel. Source: UKSH

Excellence in oncology has a tradition at UKSH. Sometimes it can also be traced back to names: Prof. von Bubnoff, for example, received in 2021 together with his Freiburg colleague Prof. Robert Zeiser the German Cancer Award, which is considered one of the highest honors in oncology. In this particular case, the prize honors the duo's efforts to develop a new procedure in the treatment of so-called graft-versus-host disease, which often occurs after stem cell transplantation in acute leukemia and causes severe complications. This example alone shows how comprehensively networked the subject of oncology is, both in terms of content and location. And exactly this realization follows the UCCSH founded in the middle of 2021. "Innovative and in accordance with the latest state of science" is the aim under this organizational umbrella, in order to actually help each and every person affected as comprehensively as possible, explains Prof. von Bubnoff, who is the Director of the Clinic for Hematology and Oncology at the UKSH in Lubeck, Germany.

Also on the board of the new University Cancer Center are prof. Claudia Baldus, Vice Dean and Director of the Department of Internal Medicine II for Hematology and Oncology at UKSH in Kiel and her colleague Prof. Anne Letsch, Head of the Internal Oncology and Oncology Center in Kiel, Germany. Together with Dr. Thorsten Schweizer, who as Managing Director has mainly coordinating tasks, the two female physicians and the male physician form the well-rehearsed team of the UCCSH Board of Directors.

From basic research to the bedside

More important than the functions are, of course, the contents, which on the one hand are as diverse as the facets of the disease cancer, and on the other hand can nevertheless be formulated as central concerns. "A particular concern of the UCCSH is to optimize the connection between clinical research and basic research and thus to make new approaches in cancer therapy rapidly available to patients," states Prof. Claudia Baldus the perhaps most important generic term. To ensure that this concern is lived out, the UCCSH promotes joint study strategies and, among other things, is creating a register that records the studies available for patients with cancer and makes this data available in a clear and easily understandable form to both the treating physicians and those affected throughout Schleswig-Holstein. The registry is linked to an online search function (https://www).quickqueck.The new UCCSH website will provide an easy way to find current studies outside of UKSH. "This can be an incredible help in selecting the most appropriate therapy," emphasizes Prof. Anne Letsch, thinking above all of special studies that deal with very rare or very advanced cancers. "In everyday therapeutic practice, you first have to know that such studies exist and which patients might be suitable for them," she points out the value of such a study database. Prof. Anne Letsch has been appointed Head of Internal Oncology. of the Oncology Center in Kiel. Anne Letsch is head of the Department of Internal Oncology. of the Oncology Center in Kiel.

Cooperation with Hamburg brings further impetus

In order to create more synergies, especially for rare disease situations, as well as to bundle and strengthen activities, the UCCSH is already in close exchange with the UCCH, the University Cancer Center Hamburg. Together, the UCCH, which has been established as a CCC for years, and the UCCSH want to submit an application as a Comprehensive Cancer Center (CCC) North – Hamburg Schleswig-Holstein in 2024 and thus achieve recognition as a university CCC consortium funded by German Cancer Aid. Until then, there are still quite a few development-. Harmonization steps necessary. One thing is certain, however, according to Prof. von Bubnoff, that a "very, very important development" is underway. After all, this covers a large region with seven million people and creates a research and therapy landscape that is "considerably more than the sum of its parts". Similarly, the basic construct of the UCCSH is. In the meantime, a network has been established that reaches from the Medical Association of Schleswig-Holstein to the Schleswig-Holstein state ministries and to the Schleswig-Holstein Cancer Society and bundles many cooperations with practices, practice centers and non-university clinics into one network. In order to develop in a common direction despite all the diversity, the UCCSH network advisory board started its work a few days ago. His task: to keep an eye on the big picture and also to live the philosophy that it is not a matter of competing, but of working in a complementary way for seriously ill people. In view of the dynamics that the UCCSH, which will soon also be united with Hamburg, is developing, Prof. Nikolas von Bubnoff a real atmosphere of departure. "It's a lot of fun for everyone involved," he says happily He is convinced that patients will benefit from this, not least of all.

Strengths at both UKSH locations

A major keyword here is translational medicine, which means the transfer of findings from research into clinical studies and ultimately into practice. "The faster and more reliably this works, the more it benefits those suffering from cancer," explains Prof. Anne Letsch. For example, the unprecedented transparency and coordination of the activities of individuals under the UCCSH umbrella makes it possible better than ever to develop new therapies that promise greater prospects than standard treatment, he said. The UKSH has particular strengths in Lubeck as well as in Kiel. One focus in Kiel is on cancer immunotherapy, explains Prof. Letsch, and explains the special feature of this therapy, namely activating the body's own immune system against cancer cells and thus using this itself as a therapy. Cellular immunotherapy, which uses the body's own cells – CAR-T cells – modified outside the body as weapons against cancer, is particularly promising. This technique has been used on this campus since the summer of 2019 for certain B-cell leukemias or lymphomas and, more recently, for myelomas that affect the hematopoietic system. According to Prof. Baldus, the experience with this very expensive therapy so far has been quite positive. Baldus, but it is proving to be a great challenge to identify in advance those patients who actually respond particularly well to it. What is needed is more research and more experience, i.e. exactly what the UCCSH stands for. However, the expert believes that such efforts could be worthwhile and speaks of a "very exciting field" that could one day bring great progress not only for the treatment of cancer, but also for other inflammatory diseases.

Prof. Claudia Baldus is Vice Dean and Director of the Clinic for Internal Medicine II for Hematology and Oncology at the UKSH in Kiel.

Deciphering cancer cells in detail

Differentiated in specific areas, but unified in principles, that is also a principle of the UCCSH. All parties involved are committed to the principle of guideline-based therapy, so that patients can rely on the same standards regardless of where they live. Of course, this does not preclude certain treatments from being carried out in a specially qualified center, but further care can then take place in the patient's familiar environment. One example of treatments that are only possible at certain facilities is the cellular immunotherapy practiced in Kiel, another is precision oncology, which is a hallmark of the Lubeck campus. Precision oncology is essentially about comprehensively genetically sequencing the cells affected by cancer, i.e. decoding their blueprint. Are you dealing with mutations or do certain signaling pathways show up that are behind unchecked cell proliferation? The aim is to answer such questions, explains Prof. von Bubnoff. von Bubnoff, who estimates that in about 80 percent of the cases analyzed in this way, individual therapy recommendations emerge. This opens up new treatment options, especially for patients with limited treatment options or rare tumors. According to von Bubnoff, it is important to integrate this activity into a comprehensive range of counseling services for those affected and the medical staff treating them, so that the individual therapy concepts can also be implemented and accompanied.

Focus on the whole person

It is gratifying that, despite the still young history of the UCCSH, a quarter of the patients now come on the recommendation of cooperation partners outside the two locations of the University Hospital. Networking thus works, especially since there are hardly any practical hurdles and often therapies are only recommended or started at UCCSH and can subsequently be undertaken close to home. Individualized and at the same time supported by a nationwide database – this is how the national network Genomic Medicine (nNGM) operates as an example of forward-looking concepts in oncology. UCCSH has also recently become an nNGM network center. With the help of broad molecular diagnostics, lung cancer is to be diagnosed as accurately as possible in order to derive recommendations for treatment. Large data sets compiled according to uniform criteria then make it possible, for example, even in the case of very rare forms of this disease, to benefit from the experience of others and to achieve the best possible treatment, explains Prof. Letsch. With all the importance of medical therapy. Diagnostics moves the UCCSH at the same time the whole person into the focus. With all the importance of medical therapy. Diagnostics moves the UCCSH at the same time the whole person into the focus. The social service, physiotherapy, sports and exercise therapy, nutritional counseling, psychological support and many other offers within the UCCSH and the network are intended to contribute to "people being able to live well with this disease," is how the doctor from Kiel formulates the major concern. And those responsible at both sites are pleased that this goal can be achieved more and more effectively – despite the fact that the fight against cancer is still far from being won.

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