Mokenge P. Malafa

Mokenge P. Malafa, is a surgical oncologist and a lead researcher at the Moffitt Cancer Center in Tampa, Florida. He is the Chair of that center's gastrointestinal oncology department, and the leader for its GI tumor program. Malafa's most notable contributions to the field are his research into the anticancer molecular actions of Vitamin E as a form of chemoprevention  and his involvement in the first robotic Whipple Surgery (a.k.a. a pancreaticoduodenectomy) in the state of Florida in 2012 (offered through the Moffitt Institute for Robotic Cancer Surgery). Malafa was also a major player in the Florida Initiative for Quality Cancer Care from 2009 to 2011, publishing many evidence based studies as well as NCCN clinical practice guidelines on best practices for the medical and psychosocial treatment of oncology patients. Malafa's research is funded by the National Institute of Health (NIH)

Education & certification
Malafa was born in 1958 to imigrent parents stationed in Lagos, Nigeria. Malafa grew up in a small English speaking viliage in Cameroon, where a Catholic missionary inspired him to "dream big" and instilled in him a compassion for the sick and an interest in medicine. He attended a boarding school in Pairs before traveling to America to pursue his pre-medical education at the University of Wisconsin Green Bay.

Malafa received his B.S. in Human Adaptability from the University of Wisconsin–Green Bay in 1982, and his M.D. from the University of Wisconsin Medical School, Madison, Wisconsin in 1986. His postgraduate training consisted of a residency in general surgery at the Medical College of Ohio in Toledo, and a clinical surgical oncology fellowship at City of Hope National Medical Center, Duarte, California, completed in 1994. While there, he also served as a research fellow in Molecular Genetics through the Beckman Research Institute's department of molecular genetics at City of Hope.

Following his education, Malafa served as a faculty member at Southern Illinois University School of Medicine in Springfield, Illinois (1994-2002) and accepted his position as at H. Lee Moffitt Cancer Center in 2002.

Malafa was board certified through the American Board of Surgery in March 1992, and recertified in October 2000. He is currently licensed to practice in the state of Florida.

Surgeries
M.P. Malafa is a general surgeon who performs a variety of operations through Moffitt Cancer Center's Gastrointestinal (GI) division. He is particularly noteworthy for his use of the da Vinci Surgical System to perform Florida's first set of robotic Whipple surgeries in 2012.

Moffitt describes Malafa's special surgical expertise as including:


 * Pancreatic Cancer and Tumors
 * Hepatocellular Carcinoma and other Liver tumors
 * Colon and Rectal Cancer
 * Gastrointestinal Stromal Tumors
 * Small Bowel Tumors
 * Carcinoids and Neuroendocrine Tumors

Clinical Trials are also listed as an expertise. Malafa performs clinical trials in translational medicine through the NIH and other granting agencies (see "Research").

Robotic Whipple surgery
In 2012 Malafa performed some of the first robotic Whipple surgeries in Florida, using the da Vinci Surgical System. The benefits of this robotic surgery include smaller incisions, higher precision, less bleeding, and a shorter recovery time.

Research
Malafa conducts research regarding genetic oncology and its translational potential for cancer treatment and prevention. His major areas of research include the role of vitamin E signaling pathways and biomarkers in pancreatic cancer, the use of Vitamin E succinate (VES) as a cancer preventative (specifically for pancreatic and colorectal cancer) and quality of cancer care.

Vitamin E and cancer prevention
Malafa began publishing research on pancreatic cancer in 2006, but had begun research into the use of vitamin E succinate (VES) as a cancer preventative as early as 2000, primarily through Moffitt Cancer Center and an R01 grant from the NIH. The research has also been funded by awards from the charitable foundations, the United States Department of Defense, and the state's Bankhead-Coley Cancer Research Program.

Malafa's early, pre-clinical research demonstrated that vitamin E succinate promoted breast cancer tumor dormancy, inhibited melanoma growth in mice, inhibited colon cancer liver metasteses in a mice model, and inhibited melanoma angiogenesis.

This research was continued by a group at Moffitt and in 2006 they published a study showing that vitamin E succinate down regulates oncogenic RAS signaling. By this time it was apparent that, despite the promise of its preventative uses, vitamin E succinate was not orally bioavailable. The group turned to studying vitamin E tocotrienols which were, for this reason.

In 2011, the group published results of a study which found that the most bioactive tocotrienol (a family already known to inhibit chemoresistant cell activity), d-tocotrienol, was able to "significantly enhanc[e] the efficacy of gemcitabine to inhibit pancreatic cancer growth" by suppressing the expression of NF-kB transcriptional targets (which act as "crucial regulator[s] of cell survival in pancreatic cancer").

A follow up randomized control mouse-model study (2013) tested the chemopreventive activity of d-tocotrienol (extracted from palm fruit) by comparing three groups of LSL-Kras(G12D/+);Pdx-1-Cre pancreatic cancer mice: (i) non treated; (ii) vehicle, and (iii) d-tocotrienol (200 mg/kg × 2/day, PO). Results showed increased median survival from onset (8.5 mo - 9.7 mo - 11.1 mo), significant suppression of mouse pancreatic intraepithelial neoplasm (mPanIN) progression, and inhibited mutant Kras-driven pathways; additionally, none of the treated mice harbored invasive cancer (compared to 10% and 8% in groups i and ii).

Also in 2013, a third study was published which "demonstrated that d-tocotrienol exerted significant cell growth inhibition pancreatic ductal cancer (PDCA) cells without affecting normal human pancreatic ductal epithelial cell growth." Additionally, "d-tocotrienol-induced growth inhibition occurred concomitantly with G(1) cell-cycle arrest and increased p27(Kip1) nuclear accumulation." Loss of nuclear p27(Kip1) expression is a known adverse prognostic factor in PDCA, and further investigation demonstrated a direct correlation between d-tocotrienol and upregulation of p27(Kip1), resulting in inhibition of PDCA cell proliferation.

The Malafa Research Lab studies "translational medicine and chemoprevention" through "experimental therapeutics." It is housed within Moffitt's GI Oncology program.

Quality of Cancer Care
Malafa helped draft the National Comprehensive Cancer Network (NCCN) clinical trial practice guidelines in oncology for hepatobiliary cancers in 2009. He also participated in drafting the NCCN's 2007 Clinical Practice Guidelines in Oncology for Pancreatic Adenocarcinoma and their 2012 updates.

M.P. Malafa published several articles specifically examining the psycho-social aspects of cancer care, covering topics such as psychosocial quality indicators for adults with cancer, performance indicators for outpatient oncology care,  suicide in patients with pancreatic cancer, the use of psychoeducational multimedia in clinical trial participation, and the physiological impact of mindfulness-based stress reduction for those with advanced stage cancer and their caregivers.

In 2009 Malafa helped form The Florida Initiative for Quality Cancer Care, "a regional project to measure and improve cancer care" in the state of Florida. The group published a series of articles detailing their results between 2009 and 2012. This research was funded by a grant from Pfizer from 2007-2011, in which Malafa was listed as a co-investigator.

Publications
Malafa has published eighty-one peer reviewed articles on a broad range of topics such as the role of specific gene signals and proteins in cancer progression and prevention, the role of vitamin E in cancer prevention, pancreatic cancer and surgery, quality of psycho-social and outpatient cancer care, breast, colon and colorectal cancer treatment and surgery, melanoma, rectal cancer, liver metastases, heptic artery infusion, heart transplantation, hepatitis B, and biopsy for papillary adenocarcinoma.

For a full list of publications visit Malafa's bio on Moffitt Cancer Center's web site.

Journal Editor/Reviewer
Malafa is on the advisory committee for the journal Cancer Control, out of Moffitt, and also provides ad-hoc reviews for:


 * Clinical Cancer Research
 * Molecular Cancer Therapeutics
 * Nutrition and Cancer
 * Genes and Nutrition
 * Pancreas
 * Cancer Research
 * Annals of Surgical Oncology

Awards
Malafa was selected for "Who's Who in Medicine and Healthcare" as a student in 1997 and received the Distinguished Alumni Award at the University of Wisconsin-Green Bay in 2012.

Malafa has won numerous awards for teaching and mentoring at various institution and levels. This includes multiple Excellence in Student Teaching, Resident Teaching, and Faculty Teaching from Southern Illinois University (1994-2002), as well as an Undergraduate Research Mentor Award from the University of South Florida in 2008. Malafa oversees clinical fellowships and provides opportunities for undergraduate research through Moffitt Cancer Center and USF.

Malafa has also been recognized for his humanistic work in the field. He received the Healthcare Foundation of New Jersey's 2000 Humanism in Medicine Award, and was nominated for the AAMC Humanism in Medicine Award in the same year.

Malafa was included in ''The Best Doctors in America: Midwest Region. 1st Edition'' published by Woodward/Wite, in 1996, and in the "Best Doctors in Tampa, Florida" from 2002–present.

Selected bibliography
Listed chronologically:
 * Malafa MP, Corman MM, Shibata D, Siegel EM, Lee JH, and Jacobsen PB. "The Florida Initiative for Quality Cancer Care: a regional project to measure and improve cancer care". Cancer Control 2009 Oct; 16(4):318-27. PMID 19910918


 * Jacobsen PB, Shibata D, Siegel EM, Lee JH, FulpWJ, Alemany C, Abesada-Terk G Jr., Brown R, Cartwright T, Faig D, Kim G, Levine R, Markham MJ, Schreiber F, Sharp P, and Malafa MP. "Evaluating the quality of psychosocial care in outpatient medical oncology settings using performance indications". Psychooncology 2011 Nov; 20(11): 1221-7. PMID 20878724


 * Husain K, Francois R, Yamauchi T, Perez M, Sebti S, and Malafa MP. "Vitamin E δ-tocotrienol augments the antitumor activity of gemcitabine and suppresses constitutive NF-κB activation in pancreatic cancer". Molecular Cancer Therapeutics 2011 Dec; 10(12):2363-72. PMID 21971120


 * Husain K, Centeno BA, Chen DT, Fulp WJ, Perez M, Zhang Lee G, Luetteke N, Hingorani SR, Sebti SM, and Malafa MP. "Prolonged survival and delayed progression of pancreatic intraepithelial neoplasia in LSL-KrasG12D/+;Pdx-1-Cre mice by vitamin E δ-tocotrienol". Carcinogenesis. 2013 Jan 23; PMID 23302291


 * Hodul PJ, Dong Y, Husain K, Pimineto JM, Chen J, Zhang A, Fracois R, Pledger WJ, Coppola D, Sebti SM, Chen DT, and Malafa MP. "Vitamin E d-tocotrienol induces p27(kip1)-dependent cell cycle arrest in pancreatic cancer cells via an E2F-1-dependent mechanism".  PLoS One. 2013 February; 8(2):e52526. PMID 23393547