Dr. Cora Sternberg is an American oncologist who trained at the Memorial
Sloan Kettering Cancer Center in New York and was the Chief of Medical
Oncology in one of Italy’s largest public hospitals in Rome. She sought
to maintain the highest level of patient care through clinical research
and education in Italy. Research funding has been a serious problem for
many Italian scientists, creating a widely acknowledged “brain drain”
among researchers who leave to find funding for their work in other
countries, most notably the United States. Funds often go to only a few
Italian research centers.
For this reason, Dr. Sternberg founded
the Samuel and Barbara Sternberg Cancer Research Foundation –ONLUS (in
her parents’ names) which was recognized by the Italian government in
2004. Since then, she has been raising funds on her own, with the help
of her patients and friends, to support cancer care and research in
Italy.
Dr. Sternberg is highly respected internationally for her
scientific and organizational capacities. For this reason, she was an
elected Officer to the Executive Board of the European Organization for
Research and Treatment of Cancer (EORTC), has been nominated by the
American Society of Clinical Oncology (ASCO) to chair their scientific
programs and was responsible for Genitourinary Cancer education for the
European Society of Medical oncology (ESMO) for many years. In November
2018, she transferred to become the Clinical Director of the Englander
Institute for Precision Medicine and full Professor of Medicine at Weill
Cornell University in New York.
Dr. Sternberg believes that this
foundation can make a difference in Italy and worldwide and that she
has the track record, reputation, and energy to prove it.
Dr.
Sternberg has made significant contributions to the treatment of cancer,
particularly genitourinary cancers. She is best known for her seminal
work performed at Memorial Sloan Kettering Cancer Center in New York in
developing the M-VAC chemotherapy regimen. This has become the gold
standard of treatment for more than 20 years for bladder and urothelial
cancers and has saved lives and decreased pain and suffering in patients
worldwide. Since then, Dr. Sternberg has become internationally
recognized for her research in bladder preservation in patients with
muscle infiltrating bladder cancer who would otherwise have had to
remove their bladders.
Dr. Sternberg has made significant
contributions to the treatment of cancer, particularly genitourinary
cancers. She has been responsible for developing chemotherapy regimens
in bladder cancer that are today considered the standard of care
worldwide, M-VAC and High dose or dose dense M-VAC (HD-MVAC, DD-MVAC).
HD-M-VAC is primarily used in the neo adjuvant setting and is currently
the subject of a SWOG ongoing study and was presented as superior to GC
therapy at ESMO in 2021.
While at San Camillo, she has published
on behalf of the EORTC and several large cooperative groups, the largest
randomized adjuvant chemotherapy bladder cancer trial to date.
“Immediate Versus Deferred Chemotherapy after Radical Cystectomy in
Patients with pT3-pT4 or N+ M0 Urothelial Carcinoma of the Bladder
(EORTC 30994): An Intergroup, Open-Label, Randomised Phase 3 Trial. This
trial demonstrated the value of adjuvant chemotherapy after cystectomy.
A meta-analysis showed that overall, there is an OS benefit of
immediate adjuvant chemotherapy, especially with cisplatin-based
combination therapy. She has taken part in a recent international
collaborative update with the MRC in an individual patient
meta-analysis, has corroborated these results.
At San Camillo,
together with investigators in her department, Dr. Sternberg has
collaborated with the RISC (Retrospective International Study of Cancers
of the Urothelial Tract) investigators to create a large data base
(n=3024). Several publications have emerged, also from Rome, Italy using
his database on neoadjuvant vs. adjuvant chemotherapy.
San
Camillo was the highest contributor to the SAUL study, an extended
access program of atezolizumab, a fully humanized, engineered monoclonal
antibody of IgG1 isotype against the protein programmed cell
death-ligand 1 (PD-L1) in patients who have received prior chemotherapy
and who were ineligible for the prior registration studies (poor real
function, inflammatory disease etc), demonstrating that this regimen can
be safely administered to these patients.
Dr. Sternberg was an
author on the practice changing phase III study of Pembrolizumab as 2nd
line therapy after failure of platinum-based therapy vs chemotherapy
(investigator’s choice). Urothelial Cancer patients have also now
started receiving second-line treatment with immunotherapeutic agents.
We have been part of this study in Italy at San Camillo Hospital, the
KEYNOTE-045 trial and have recently studied a patient with an
exceptional response to immunotherapy. The patient received treatment
for 2 years per the protocol and was monitored using serial CT scans.
The patient has been free of disease for over 6 years and is currently
off all therapy and is followed by colleagues in Milan.
The
utilization of immune checkpoint inhibitors (ICIs) will only increase
for UC, and as such, understanding the molecular mechanisms of response
to immunotherapy is essential for developing more effective treatments
for UC patients. Bagaev et al. previously reported the development and
utilization of a Molecular Functional (MF) Portrait to dissect genomic
and transcriptomic features of tumors, including bladder cancer.
Therefore, we comprehensively characterized the patient’s tumor and
tumor microenvironment (TME) using the MF Portrait. Briefly, the
analysis showed the presence of the APOBEC signature, a high TMB, and
the ATM mutation in the patient’s tumor. Our integrated genomic and
transcriptomic analysis revealed important insights that can eventually
lead to the development of clinically useful biomarkers. In June 2022 we
have submitted a manuscript on this exceptional responder with Italian
and American authorship.
Patients with muscle invasive bladder
cancer are usually treated with platinum-based chemotherapy and radical
cystectomy. We have patients who have undergone chemotherapy in Italy at
San Camillo and at the Vincenzo Pansadoro Foundation who have had a
complete response to chemotherapy on subsequent Transurethral resection
of then bladder (TURB). We have collected these cases and reviewed their
pathology and are planning to study them with clinical whole genome
sequencing (cWGS), RNA sequencing and spatial transcriptomics, to map
the spatial architecture of the cells and how it talks to and interacts
with its surroundings. These cases will be compared to cases who have
undergone cisplatin-based chemotherapy and radical cystectomy and have
still had muscle invasive disease after chemotherapy. We will try to
detect differences in those who respond well to chemotherapy, in theory
being able to avoid chemotherapy in those who do not respond.
While
at San Camillo, Dr. Sternberg has been a Principal Investigator on the
Javelin Bladder 100 trial with avelumab maintenance therapy that has
changed clinical practice guidelines worldwide in patients who have
responded to first line platin based combination therapy. She has also
been on the steering committee and recently published the STRONG study
with durvalumab, a monoclonal antibody that targets programmed cell
death-1 ligand 1 (PD-L1), in pre-treated bladder cancer patients. Dr.
Sternberg is on the steering committee of a study with Sacituzumab
Govitecan (anti-Trop-2-SN-38 ADC), a first-in-class antibody-drug
conjugate. This work has also recently been published and this drug now
has accelerated approval in the US.
Dr. Sternberg has established
a collaboration with the Bladder Cancer Advocacy Network (BCAN) and the
Hoosier Cancer Oncology Group to perform whole genome sequencing (WGS)
on their large cohort of bladder cancer patients.
She is actively
involved in treating patients with both early and advanced prostate
cancers with new and experimental therapies. She has been intimately
involved in developing studies that have led to the registration of
abiraterone acetate and enzalutamide, as well as other novel therapies
for prostate cancer. Abiraterone was approved in the USA the day after
the FDA inspection at San Camillo in Italy. She is the Principal
investigator and senior author of the PROSPER phase III study of
enzalutamide in patients with non-metastatic castration resistant
prostate cancer (M0 CRPC), published in the NEJM and approved by the FDA
and EMA due its decrease of > 70% in metastases free survival that
was associated with a statistically significant 27% reduction in the
risk of death, a clear improvement in overall survival, improvement in
QoL and decrease in the time for the need of other antineoplastic
therapy. This is an important practice changing study!
While at
San Camillo, the team participated in the COMIT I cabozantanib study (a
small molecule inhibitor of the tyrosine kinases c-Met and VEGFR2). They
have studied the combination of abiraterone and an AKT inhibitor,
ipatasertib that was published in the Lancet. Dr. Sternberg was on the
steering committee for the CARD study, which established sequencing in
mCRPC.
She has also been instrumental in developing darolutamide,
a novel AR inhibitor for patients with prostate cancer. The ARASENS
triplet therapy for patients with metastatic hormone sensitive prostate
cancer is a practice changing study that was published in the New
England Journal of Medicine.
While at San Camillo, her team
collaborated with investigators at the John’s Hopkins University to
validate a test for ARV-7 splice variants in circulating tumor cells
(CTCs) in patients with CRPC and worked closely with them on several
academic studies.
Dr. Sternberg is currently conduction a study on the Molecular Basis of Lineage Plasticity and AR-Independent Prostate.