The University of Kentucky Markey Cancer Center is providing some of the most revolutionary treatments and sophisticated surgeries available to those with hepatobiliary cancers.
LEXINGTON During discussions of cancer, it is often asked with optimism, “What if one day they developed a vaccine?” Now this concept is no longer just wishful thinking. An mRNA vaccine for pancreatic cancer, developed by BioNTech, recently entered Phase II trials. The vaccine, which is composed of individually sequenced RNA molecules, is not geared to prevent pancreatic cancer but rather induce a more effective response among patients by enabling their immune cells to recognize specific cancer cell neoantigens. And Lexington will prove a pivotal place in the testing process.
Pioneers in Pancreatic Cancer
With Joseph Kim, MD, at the helm—as the chief of surgical oncology of the University of Kentucky (UK) Markey Cancer Center (MCC)—UK will be instrumental as one of hospitals chosen to participate in the clinical trials. After a stringent selection process, UK joined the ranks as one of only 17 institutions to conduct the trial. According to Kim, “We recruited our first patient in September for this clinical trial, and so we’re excited. I think it’s a reflection of how our program has grown and the excellence that it’s already achieved. We have grown a very large pancreatic cancer program. We have shown that we can successfully enroll and recruit patients.” Kim recognizes that, even though the mRNA vaccine is one of the most revolutionary occurrences in recent medicine, many outside of the oncology specialty are still not aware of its existence. This is the case with many cancer breakthroughs. He points out, “The field of oncology is so fast moving. I would surmise most physicians who are not in the field of oncology wouldn’t know about the mRNA vaccines. And yet, they’ve been published in our biggest medical journal, the New England Journal of Medicine.”
Providing revolutionary care is one of the hallmarks of the UK Markey Cancer Center. One of Kim’s specialty surgeries is the HIPEC (hyperthermic intraperitoneal chemotherapy) also known as “hot chemotherapy.” HIPEC is most often performed to treat colon and appendiceal cancers. As a two-part surgery, it involves cytoreductive surgery to remove any existing tumors followed by the process of filling the abdominal cavity with the hot chemo. Kim explains, “You’re going to set the clock back to zero. You’re going to remove all the disease and hope that if the clock starts running again, it will run really slowly. We give patients more time by resetting that clock.”
Because of their ability to perform surgeries like HIPEC, the MCC receives referrals from throughout the state of Kentucky—from Paducah to Pikeville. Due to UK’s innovative offerings, it is not uncommon to see patients from other states as well. Kim states, “We provide the most sophisticated, advanced therapies that are available at the best hospitals. Sometimes patients feel like they need to leave the state to get advanced therapies when it’s right here in their backyard.”
Surgeons Heal with Their Hands
While studying at Loyola University’s Stritch School of Medicine in Chicago, Kim determined surgery was the proper path. He states, “When I was in medical school, I decided that general surgery was the career I wanted because you could directly help and heal patients with your hands, rather than treating them with medications to heal them of their illnesses.”
After medical school, Kim entered a residency in general surgery at the University of Cincinnati, followed by a clinical and research fellowship in surgical oncology at the John Wayne Cancer Institute in Santa Monica, California. “Surgical oncology was technically challenging, fascinating, demanding, and I had great mentors. I think all of those together led me to this career path,” says Kim. Though surgical oncologists can specialize in several different areas—breast, skin, and soft tissue—Kim chose to focus on hepatobiliary surgery to treat disorders of the biliary system, which includes the liver, pancreas, gall bladder and bile duct.
Kim went on to hold surgical oncology leadership positions at the State University of New York at Stony Brook and City of Hope National Cancer Center outside Los Angeles, California before being recruited by the University of Kentucky to serve as chief in 2018.
All in a Day’s Work
As chief, Kim oversees a broad range of administrative and leadership responsibilities, including identifying issues in the surgical oncology division, developing strategies for programmatic growth, facilitating meetings, participating in tumor boards, research, and outreach. To ensure the most comprehensive care for patients, UK takes a collaborative approach using a multidisciplinary model. Kim often works in tandem with a medical oncologist, radiation oncologist, and other relevant medical subspecialties.
Along with his above-mentioned duties, Kim still has one day of full clinic per week along with a minimum of one day of operating. His commitment to accommodating every clinic patient who requires an operation means that, on average, he spends two or three days in the surgical suite, which he relishes. Kim says, “My love in medicine was surgery, I think it would be a vastly different position were I not able to do operations.”
Having the Difficult Conversations
One of the more emotional aspects of Kim’s job is to inform patients of their diagnosis, especially when they have not been previously alerted that they have cancer. He elaborates, “It is sometimes difficult when patients are referred to us and the referring physicians are relying on us to break the news, because the patient is completely caught off guard. They’re not prepared. When people receive the initial diagnosis of a cancer, they need time to process, to let it sink in, to go through the various emotions that everybody needs to go through.” Kim encounters a similar scenario with patients who have been prematurely told that surgery is an option for them, when further evaluation reveals it is not.
On the flipside are patients who find out their cancer is operable. Kim states, “When patients come to the office and know about their cancer diagnosis, everybody has the hope that we can do surgery. There’s elation…there’s joy, when I tell them, ‘This is removable with surgery.’”
Challenges of Comorbidities
The greatest challenge Kim has encountered since coming to UK is navigating the widespread comorbidities that exist among his
“We provide the most sophisticated advanced therapies that are available at the best hospitals.” — Joseph Kim, MD
patient population, who are typically 70 and older. Unfortunately, in Kentucky, conditions such as obesity, heart disease, and diabetes are incredibly common and often coupled with effects of long-term smoking. According to Kim, “I feel the patient population here in Kentucky is more complicated than my patient populations in New York and Los Angeles because of the comorbidities.” Kim notes the reasons are multifactorial and involve genetics, diet, and environmental exposures, whether those be smoking or coal related.
He explains, “There are parts of Kentucky, especially in Appalachia, that have the highest rates of GI cancers in the country and some of the worst outcomes, and so we do have an extremely vulnerable population here in Kentucky.”
Despite his multitude of accomplishments, one of Kim’s greatest sources of satisfaction is in seeing complex patients with comorbidities and/or advanced age successfully undergo treatment and go back to their families and lives. He recently performed a pancreaticoduodenectomy—one of their most involved operations—on an 88-year-old patient with pancreatic cancer. The procedure, known as the Whipple, involves removing the head of the pancreas along with the first section of the small intestine, the bile duct, and the gallbladder. The results were surprisingly satisfactory.
Kim shares, “There’s a huge level of satisfaction that I get when I can successfully complete that operation, remove that tumor, and have the opportunity and ability to cure patients of their disease. So that is a tremendous level of satisfaction that’s hard to replicate in any facet of life.”
He adds, “From a physician standpoint, I feel like I have become a better surgeon being able to safely and effectively take care of all of these patients.”