Archive

Curators Versus Cancer

UConn Foundation
UConn Foundation

6 min read

If the genetic code is like a book, then a mutation is like a typo. Some typos are meaningless. Others have such dramatic consequences for a book, or a life, that the error alone could have an entire novel written about it.

Cancer mutations are like that. As oncology moves toward precision medicine – the idea that if we knew exactly which genetic mutations make a particular cancer tick, we could pick exactly the right treatments – oncologists have to keep up with an ever-expanding library of mutations and the drugs that might foil them. The number of cancer research papers published increases every year; there were about 35,000 published in 2015 just in the U.S. It’s far more than any one person can keep up with.

A new collaboration between UConn Health and The Jackson Laboratory (JAX) hopes to help oncologists find the right treatments by keeping up with research for them – and using the institutions’ combined expertise in cancer treatment, molecular biology, and genetics to improve patient outcomes for cancers that currently don’t have good treatments. In the same way that a university has research librarians who keep up with the literature in specific fields, JAX has experts who keep up with cancer gene and drug research, even studies that are ongoing and not yet published. JAX already successfully connects these experts with doctors in the Maine Cancer Genomics Initiative, a philanthropy-funded statewide precision medicine program. UConn Health and JAX hope to expand the concept and demonstrate its feasibility more widely.

In the same way that a university has research librarians who keep up with the literature in specific fields, JAX has experts who keep up with cancer gene and drug research, even studies that are ongoing and not yet published.

Bull’s Eye Treatment

Samples of tumor slices used for DNA sequencing to help physicians find appropriate treatment based on genes in the tumors. (Kristin Wallace/UConn Health Photo)
Samples of tumor slices used for DNA sequencing to help physicians find appropriate treatment based on genes in the tumors. August 20, 2018. (Kristin Wallace/UConn Health Photo)

Imagine that a patient has surgery or a needle biopsy to diagnose a tumor. It’s a particularly ugly tumor, the surgeon, oncologist, and pathologist all agree. Invasive, spreading, and perhaps this isn’t the first time this patient has had to come in for cancer surgery. The tumor is sampled and sent for genetic testing. In about two weeks, the results come back: there are three genetic variants in the tumor that might be drug targets.

“The goal is to define the optimal treatment regimen for each individual patient” who may not have good options otherwise, says Dr. Ketan R. Bulsara, chief of neurosurgery at UConn Health and one of the principal investigators on the project.

The report is intended to be a standalone reference an oncologist can use to inform a treatment plan. But if the oncologist is unfamiliar with one of the mutations identified in the report or just wants more information, they can request that a genomic tumor board be convened. The board is composed of surgeons, pathologists, and molecular oncologists who act as external advisors, sharing their opinions with the oncologist. In just 15 minutes, the oncologist can get a wealth of expert opinion to combine with their own expertise and judgment. In the end, the oncologist and patient decide on the best treatment, based on all the available information.
“In a multidisciplinary fashion, doctors and scientists work hand in hand in this with one common goal: identify the best treatment regimen for that particular patient’s pathology,” Bulsara says.

The focus is always on the patient. But behind the scenes, there’s an entire team of researchers whose work goes into the genetic tumor report. Scientists at JAX Clinical Laboratory sequence the tumor’s genetic code and report information on more than 200 cancer-related genes. The genes were picked because they are associated with both malignancy and potential drug treatments. Any mutations or variants in these genes might be a clue to the cancer’s weakness. Or a red herring.

“A typical tumor might have 2,000 mutations. Not all of them really matter,” says Andrey Antov, the program director for the Maine Cancer Genome Initiative at JAX. Finding the key mutations that matter, the two or ten or twenty that could possibly inform treatment and a better outcome for the patient, is the job of the clinical genomic curators.

Personal Librarians

The clinical genomic curators are specialists in fields such as molecular oncology and oncological pharmacology. They’re dedicated to keeping up with the literature on cancer genes and the drugs that target them. More and more of these drug-gene connections are being discovered every day. It’s exciting, but the sheer volume of papers can be overwhelming. Navigating that ocean of scientific papers is the medical curators’ full-time job. They’re like librarians curating a Boston Public Library-size collection of genes and drugs with no cross references in the card catalog and only an imperfect search function. The hope is that just as a good librarian’s knowledge of the subject matter can unearth texts a researcher would never otherwise find, a medical curator’s grasp of oncological genetics and pharmacology can identify potential treatments that would otherwise remain obscure.

Each mutation identified by the genetic panel might require 10 to 20 scientific publications to understand. Once the curators have a handle on the variants’ significance, the clinical laboratory decides which two or three should be described in the report to the oncologist.

illustration of books in a library cart

Sifting the information down to something relevant and digestible is the ultimate goal.

“Today, all this information is disorganized and may not all be in the oncologist’s head. We’re trying to bring it together,” says Jens Rueter, medical director for the Maine Cancer Genomics Initiative.

The ideal outcome of a tumor genetic analysis would be to identify a mutation such as the HER2 gene that is turned on in the most aggressive breast cancers. HER2 is responsible for the cancer’s malignancy. But it’s also the cancer’s Achilles’ heel. Once drugs were developed to block the HER2 protein, survival rates climbed sharply.

The goal of the Maine Cancer Genomics Initiative is to enable oncologists to identify other drug-gene connections as potent as the ones found for HER2. Although more and more of these drug-gene connections are being discovered, it remains difficult to provide a patient with access to these drugs. Many of them are only available if a patient participates in a clinical trial. And often, there are barriers to accessing clinical trials, and getting drugs off-label is the only way to get patients to treatments. That’s another benefit that Antov, Bulsara, and Rueter hope UConn Health’s collaboration with JAX will bring.

Positive Outcomes

Ultimately, the researchers hope to demonstrate that this approach leads to better outcomes for patients. During the past year more than 350 patients and 70 oncology practitioners (more than 80 percent of the Maine oncology community) enrolled in the Maine Cancer Genomics Initiative study protocol. A few patients have already been offered a targeted treatment through a trial or a compassionate drug access program as a result of enrollment in the program. And Maine health care professionals have logged more than 1,200 certified education hours through 35 genomic tumor boards, online modules, and annual forums held by JAX.

So far, five patients have done this at UConn Health within the last two months. Generous donors have given enough to fund 20 more.

“We hope to get funding for at least 100 patients to show the feasibility of this approach,” Bulsara says. “We want to show we can do this reliably, and that it reliably improves patient care.”

UConn Health already has the infrastructure to do this, in particular a biorepository for tumors set up by Neag Cancer Center director Dr. Pramod Srivastava and pathologist Dr. Melinda Sanders. With that foundation and support from UConn Medical School dean Dr. Bruce Liang and UConn Health CEO Dr. Andrew Agwunobi, the program was piloted in the Department of Surgery by Bulsara, its chief of neurosurgery, with support from Department of Surgery chairman Dr. David McFadden, hematology, and oncology chief Dr. Susan Tannenbaum, anatomical pathology chief Dr. Qian Wu, and JAX Clinical Laboratory director Honey Reddi.

If the UConn Health–JAX initiative does prove its feasibility, the approach will continue to spread and become a standard of care.

The hope is that just as a good librarian’s knowledge of the subject matter can unearth texts a researcher would never otherwise find, a medical curator’s grasp of oncological genetics and pharmacology can identify potential treatments that would otherwise remain obscure.

More oncologists could have access to the library of knowledge and advice of a genetic tumor board, and more cancer patients could benefit from longer, healthier lives.

 

This story first appeared in the Fall 2018 issue of UConn Health Journal. For more stories on UConn Health research and clinical innovations, visit healthjournal.uconn.edu.

Gifts to the Neag Comprehensive Cancer Center Fund support all facets of the Carole and Ray Neag Comprehensive Cancer Center at UConn Health—from innovative approaches to personalized patient care to groundbreaking faculty research.

Support the Neag Comprehensive Cancer Center Fund

Related Posts

Chemotherapy Suite Named After Advocate for Cancer Patients

Chemotherapy Suite Named After Advocate for Cancer Patients

Read More
Gift from Neags Supports Cancer Research and Treatment

Gift from Neags Supports Cancer Research and Treatment

Read More
UConn Honors Heroes in Fight Against Cancer

UConn Honors Heroes in Fight Against Cancer

Read More

UConn Foundation Wins CASE Bronze Circle of Excellence Award

Tiffany Ventura Thiele
Tiffany Ventura Thiele

< 1 min read

 

The UConn Foundation’s video featuring UConn student-athlete and cancer survivor Ryan Radue recently received international recognition.

The Council for Advancement and Support of Education (CASE), headquartered in Washington, D.C., with members around the world, awarded a Bronze Circle of Excellence Award in Best Fundraising Video, Long, to the UConn Foundation.

The seven-minute video features the journey of Ryan Radue, a relief pitcher and graduate student, who discovered he had cancer in his knee and neck. The video, produced by Foundation Marketing and Communications staff member Jennifer Huber and filmmaker Jeffrey Teitler, details his battle against cancer while undergoing treatment at the Carole and Ray Neag Comprehensive Cancer Center at UConn Health in Farmington. Now cancer-free, Radue has helped raise support for research and patient care at UConn Health.

“We’re honored that Ryan allowed us to share his courageous story with the world,” said Josh Newton, president and CEO, UConn Foundation. “His perseverance in fighting this deadly disease has been an inspiration to us all. While we’re honored to receive this award, it is most important that people hear Ryan’s story of strength and survival.”

The Council for Advancement and Support of Education is one of the largest international associations of education institutions, serving more than 3,670 universities, colleges, schools, and related organizations in more than 82 countries. CASE is the leading resource for professional development, information and standards in the fields of education fundraising, communications, marketing and alumni relations.

Watch Ryan’s story here or support the Carole and Ray Neag Comprehensive Cancer Center here.

Become An Ambassador
Connect with fellow Huskies
Don't miss out on alumni events and more

Related Posts

Law School Foundation Makes Strategic Move to Join UConn Foundation

Law School Foundation Makes Strategic Move to Join UConn Foundation

Read More
UConn to Align Alumni Efforts Within Foundation (UConn Today)

UConn to Align Alumni Efforts Within Foundation (UConn Today)

Read More
UConn Foundation Receives $40,000 Grant from Newman’s Own Foundation

UConn Foundation Receives $40,000 Grant from Newman’s Own Foundation

Read More

Former FVL star Radue ready to launch comeback

UConn Foundation
UConn Foundation

< 1 min read

By Tim Froberg, USA Today Network-Wisconsin
This article was originally published on Post-Crescent.

The hair is coming back and so is the fastball.

The latter will serve Ryan Radue well the remainder of his collegiate baseball career at the University of Connecticut.

When he does return to the mound, Radue may see the sport differently.

He’s endured enough off the field to know that must-win games don’t really exist. But there are must-win situations in life, and he’s winning a personal battle against the ultimate opponent.

Read the rest of the story on Post-Crescent.

Become An Ambassador
Connect with fellow Huskies
Don't miss out on alumni events and more

Related Posts

Former All-American Caron Butler Makes Gift to Basketball Center at UConn

Former All-American Caron Butler Makes Gift to Basketball Center at UConn

Read More
UConn Community Unites To Help Pitcher Ryan Radue Beat Cancer

UConn Community Unites To Help Pitcher Ryan Radue Beat Cancer

Read More
Hygienist-Turned-Dentist and Student Star in Radio Spots

Hygienist-Turned-Dentist and Student Star in Radio Spots

Read More

Chemotherapy Suite Named After Advocate for Cancer Patients

Grace Merritt
Grace Merritt

4 min read

When cancer patients step into the chemotherapy area at the UConn Health Outpatient Pavilion, they may be reminded of a cozy library at a four-star hotel.

The waiting area is lined with floor-to-ceiling, cherry bookshelves loaded with 1,800 books. Carpeted and painted in soothing greys and creams, the room has two couches and is dotted with rose-colored, upholstered chairs.

In the infusion area, they’ll find an open design with a nurse’s station in the center surrounded by a mix of bays offering patients a choice of private, semi-private and open infusion spaces for chemotherapy, depending on their mood.

These design touches are due to input from Maryann dePreaux Walmsley, a cancer patient herself, who wanted to make the chemotherapy—and other infusion treatment—experience a little more pleasant for patients and their caregivers.

She was a patient consultant on the design of the treatment area, which opened June 12 in the Carole and Ray Neag Comprehensive Cancer in the UConn Health Outpatient Pavilion, the 300,000-square-foot new home of ambulatory services, including UConn Health’s leading centers for cancer, spine/neurosurgery, and healthy aging.

Unfortunately, dePreaux Walmsley never got to see the new library and suite she helped design. She died in April 2014 at age 52 after fighting cancer for four years.

Tom and Maryann Walmsley.
Tom and Maryann dePreaux Walmsley.

To commemorate her vision and advocacy, her husband, Tom Walmsley, recently gave a large monetary donation to name The Maryann dePreaux Walmsley Cancer Center Library in her memory.

“She thought it would be nice if patients had a library here so they can grab a book or an iPad and be entertained for a few hours. That might not be anything to cure their cancer, but anything to make an unpleasant experience a little more tolerable is worth it,” Tom Walmsley ’82 said.

The gift supports the construction of the library and is part of Bioscience Connecticut, which includes the construction of the Outpatient Pavilion, a new hospital tower, and the renovation of John Dempsey Hospital.

dePreaux Walmsley was a warm, smart, dynamic businesswoman who not only fought her cancer valiantly, but was an advocate for other cancer patients.

“Even at the end of her life she was thinking about what she could do make patients’ experience better,” said her doctor, Molly Brewer, professor and chairman of the UConn Health obstetrics and gynecology department.

dePreaux Walmsley also organized a team for the annual Run/Walk to Break the Silence on Ovarian Cancer and volunteered as a committee member of the UConn Cancer Research Golf Tournament.

Petite, pretty, and thoughtful, dePreaux Walmsley was an avid knitter and golfer who loved to travel and would talk about her exotic trips to Tahiti, Bora Bora, and China. She loved to entertain and always put her family first, said Tom Walmsley, who is second vice president of Bond & Financial Products at Travelers Insurance.

Tom and Maryann’s friends and coworkers conducted book drives at Cigna and Travelers, where they collected 2,500 books and funds for several iPads. Tom Walmsley stocked the shelves with most of the books, saving some to replenish the shelves in the future.

In addition to the library, the design also includes dePreaux Walmsley’s suggestion to make the chemo area have more of an open concept space. “One of the things she wanted was she felt it was important to have an area where patients could converse if they wanted,” said Nurse Manager Susan Chelllis. “There are patients who really benefit from talking to each other, so having an open area for them to talk was important. But on days they didn’t feel well or wanted privacy, they can go to the private areas.”

Tom Trutter, associate vice president of campus planning, design, and construction, said her suggestion led to several changes in the design and ultimately improved the atmosphere in the center and made it more comfortable.

“Maryann’s gift will make possible a creative and positive healing environment for cancer patients within the Neag Comprehensive Cancer Center at UConn Health,” said Josh Newton, president and CEO of the UConn Foundation.

Maryann’s daughter, Nicole Nehmer, said her mother was always an advocate, despite being so ill.
“She took after my grandmother,” Nehmer said. “She always liked to get involved and make sure people had a voice.”

Nehmer said dePreaux Walmsley was a terrific role model and managed to balance raising a daughter, being a wife, taking classes, and working full-time as an investment managing director at Cigna. dePreaux Walmsley earned her executive MBA from UConn in 1989.

“They say you can’t have it all, but she did,” Nehmer said. “She was truly an amazing role model to me and my friends. “She not only balanced them all, but she excelled at all of them.”

Naming the library after her is a fitting tribute, Nehmer said. “It’s a testament to her legacy, leaving her stamp as she tried to overcome her disease,” she said.

 

If you’d like to find out more about naming opportunities at UConn Health, please call (860) 486-4524.

Become An Ambassador
Connect with fellow Huskies
Don't miss out on alumni events and more

Related Posts

Curators Versus Cancer

Curators Versus Cancer

Read More
Gift from Neags Supports Cancer Research and Treatment

Gift from Neags Supports Cancer Research and Treatment

Read More
UConn Alumna Cares for COVID Patients at Children’s Hospital

UConn Alumna Cares for COVID Patients at Children’s Hospital

Read More