First-year progress in MD Anderson’s Moon Shots Program

MD Anderson Cancer Center
Date: 10-18-2013


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Lisa Garvin: Welcome to Cancer Newsline, a podcast series from University of Texas MD Anderson Cancer Center. Cancer Newsline helps you stay current with the news on cancer research, diagnosis, treatment and prevention, providing the latest information on reducing your family's cancer risk. I'm your host Lisa Garvin. Today we'll be talking about MD Anderson's cancer moon shots program about to celebrate its first anniversary. Our guest today is Dr. Elizabeth Grimm. She is the Frank McGraw professor of cancer biology and also the Director and Chief Scientific Officer of the Moon Shots Program. Dr. Grimm, Moon Shots launched in September 2012, what sort of progress have we seen since then?

Dr. Elizabeth Grimm: Thank you Lisa, it's my pleasure to be here and to speak about this. I think we've had an exciting year of building, of forming team science groups unlike anything we've had a MD Anderson in the past, our groups have usually been five to ten scientists and faculty, which really has been the most we could support with the common or the current grant funding agency awards, such as spores or PO1s but with the promise of the moon shot we've been challenged to put together teams of forty or fifty to even a hundred of our faculty and researchers who try to make a team event and team approach to tackling these very serious cancers.

Lisa Garvin:  I think that people don't realize, and when we talked about building the platforms as you just discussed, getting the researchers to collaborate, I think people don't realize how important that is because in a situation like this they're often siloed, you have the researchers in the labs, you have the doctors in the clinic so this is the way to pull all of that knowledge together.

Dr. Elizabeth Grimm: Yes we are fortunate at MD Anderson that our doctors often have laboratories and the researchers are intermingled with many of the physicians in the clinical departments. So we've had a culture of sharing, it's just not been able to be effective at the large level that we're challenged now for this team science at the Moon Shots, which is intended to cover from the cancer prevention, through early detection, through treatment of advanced patients to follow the entire cancer continuum.

Lisa Garvin: And we picked these because there was the possibility for near term impact correct?

Dr. Elizabeth Grimm: Yes, yes. There was an external advisory board that came to MD Anderson last fall and reviewed, I don't know how many at this time probably thirteen to fifteen different cancers and six were chosen because they had the possibility of a near term impact, but also had an idea of approaching various parts of this cancer continuum with novel, creative, infrastructure and possibility of really new data.

Lisa Garvin: When I spoke with President DePinho about a year ago he was saying that with respect to the CLL or the Chronic Lymphocytic Leukemia moon shot we were already circling the moon.

Dr. Elizabeth Grimm: Well, I think he was speaking about the Ibrutinib project. Ibrutinib is a drug that has really showed a great promise for CLL and the leaders of this and the people that really are moving that forward are here at MD Anderson. So that is one of the Moon Shot projects that's pretty far advanced right now even.

Lisa Garvin: Part of the leukemia moon shot which is actually two diseases is also myelodysplastic syndrome, or MDS, what's going on with that moon shot?

Dr. Elizabeth Grimm: The MDS and also associated acute myeloid leukemia is a effort to well, there are two efforts excuse me one is working on trying to overcome the resistance to hypomethylating agents and this resistance is something that we find developing in many types of targeted therapies and other cancers as well. So as we make more of a personalized or molecularly targeted therapy for caners and in this case the myelodysplastic syndromes and the AML leukemia, we really need to ramp up our research and understands the mechanisms of resistance, either how to avoid them, or how to overcome them. So that's one of the major parts of this moon shot. There's a second part of this moon shot that has to do with immunotherapy using a T-cell therapy platform in which recombinant and genetically refined patients T-cells will be administered. So both of these things are very novel, very forward thinking and we have just the I think the world's best scientists here working on this.

Lisa Garvin: We also have a moon shot program for lung cancer and it sounds like they're trying to hit all cylinders there, cancer prevention, early detection and help with advanced cancer patients. What are some of the factors of the lung moon shot and how are we doing there?

Dr. Elizabeth Grimm: Well, the lung is really our largest moon shot effort and you are right it spans the entire cancer continuum of prevention, early detection and treatment for the patients who have the disease and I have to say this is one of the two instances in which we are studying patients tumors that have incredible numbers of mutations that serve as targets for a variety of different drugs and in both the lung, as well as in melanoma, which is known for even having more mutations in the cancer, melanoma I think is number one with mutation numbers in the individual type or an individual patient and then lung cancer is close to that. These are the carcinogen driven cancers and so they have many, many mutations caused by these carcinogens. And because of that, and I'll go back to lung now, there are a variety of types of lung cancer, probably hundreds of types of lung cancer and each one of these may need a different drug. So the beauty of the therapy part of the lung cancer is that they're trying to identify each mutation and test each drug so they're going through every drug that has a known genetic target. And we'll test every patient for these mutations and match them up and this will be the first time that patients had available such a spectrum of agents and have available such target sequencing efforts performed. So that is really novel and that approach is also something that's going into one of the melanoma projects as well, to look for these mutations, match them up with targets that are already approved drugs, sometimes from other cancers even, and then we'll need also as I mentioned with the AML drug, we need to target the mechanisms of resistance because we will find these resistance pathways coming up very quickly. But all of that is part of the plan

Lisa Garvin: And since moon shots launched in October of 2012, we have seen lung cancer screening become available to a select population in that year. What sorts of things can we do with lung screening to improve that or expand that program?

Dr. Elizabeth Grimm: Well, part of our early detection project in lung cancer is to look for a molecular marker in a serum of patients and we'll be following the CT, the newly approved method for early detection that if you're fortunate to have the insurance and all of the things you can to have this done, we will be comparing markers in the patients serum and a propionic approach to the results found on the CT scan and hopefully then we will develop a blood test and that would be a dream come true to have a blood test for early detection of any cancer, particularly lung cancer. So this is one of the long term big projects that we have.

Lisa Garvin: Melanoma is another moon shot. This is an equal opportunity disease; it affects everybody across the globe. I know a big part of the melanoma moon shot is community outreach and education.

Dr. Elizabeth Grimm: Yes

Lisa Garvin: So what sort of efforts are we doing to get out there and let people know about sun safety?
Dr. Grimm: Yes, we've been very active in the prevention field and this year have been most active in cancer control, helping the legislature in Texas understand how deadly sun exposure is, particularly tanning booths. So already we feel like we've had a victory in leading the prevention of melanoma by supporting the effort that was passed in our state legislature. So now 18 year olds and under age people are not allowed to go into the tanning booths at all. And this is the beginning, there are a couple of other states I believe that have passed such legislation but we're certainly the largest and we would love the export this to other states as well. We also have a lot of education efforts that have been ongoing but they've been smaller efforts, they've been from individual grants and this moon shot provides the opportunity to expand this and to do a larger effort and to take this into hundreds of schools and really get evidence based methods for preventing melanoma.

Lisa Garvin: Because I think out of the moon shots that we have melanoma is easily the most preventable cancer of all of the moon shots.

Dr. Elizabeth Grimm:  Probably, probably safe to say. UV light is a carcinogen just like tobacco smoke is a carcinogen. So to avoid that in excess is something that would be very helpful to reduce melanoma.

Lisa Garvin: One of our other moon shot programs is focusing on prostate cancer, obviously a very common cancer in men. What sorts of things are going on there? I know there have been some issues with the baseline PSA testing and other early detection methods. So what sort of things are we looking at in the prostate moon shot?

Dr. Elizabeth Grimm: The prostate moon shot has several aspects of identifying new molecular pathways and new markers. So PSA has really not proven to have the specificity needed to identify patients who will die from prostate cancer and so a lot of the work is trying to identify these markers, to understand the mechanisms of the androgen inhibition and to try to understand which patients would respond to that. So there's a lot of marker and mechanism work planned in that moon shot.

Lisa Garvin: So our last moon shot combined two very rare cancers with a genetic basis, high grade serous ovarian cancer and also triple negative breast cancer. First of all, why were these two combined? Was it because of the genetic situation?

Dr. Elizabeth Grimm: Yes, these are rather rare genetically driven cancers but they were selected because we have at MD Anderson the largest history of treating these patients, or the longest history of treating these patients and we have archived material that needs to be interrogated and the molecular basis of these cancers really needs to be studied and as we found that in breast cancer the survival has increased dramatically over the last decade for most common kinds of breast cancer but some of the subtypes such as the triple negative is extremely deadly, remains deadly and there's nothing on the horizon for it at present. So I think that it's very important that we put our efforts for research for this and then the serous ovarian cancer is also a hormonally driven cancer, also there's nothing to treat it, it has a lot in common with the triple negative breast and therefore the teams got together to form a women's cancer exploration group that is studying not only the mechanisms of these cancers, drugs that might be useful in these cancers, or immunotherapies for these cancers, as well as reaching out to the community to try to identify these patients before the cancers progress to a very lethal end stage which can happen rapidly.

Lisa Garvin: Even though we're focusing on two rare cancers for breast and ovarian, the results that we get from the moon shot should be applicable to other types of cancer.

Dr. Elizabeth Grimm: It's possible, it's really possible. As we're finding different drivers, different pathways, different mutations in all the other cancers, the drugs that would be developed or the approaches for therapy that would be developed for these women's cancers certainly could be considered if these same markers and pathways are expressed there and I would not be surprised if there would be other cancers that might have some use for the agents that we would develop in these rare women's cancers.

Lisa Garvin: So even though we're focusing on eight cancers, via six moon shots, the results from this can have a wide impact.

Dr. Elizabeth Grimm: Absolutely, absolutely, there's no doubt about that.

Lisa Garvin: I know that supercomputing is being used to crunch a lot of this data to help us reach these discoveries faster.

Dr. Elizabeth Grimm: In the next year, I believe we'll be putting lots of data into our data warehouse and our results, various computer banks and we will need supercomputing to analyze all of this. The field has grown so fast, the possibilities are so tremendous that it really is impossible for one person's mind to put every factor together about a patient not who will have just reams and reams of data. If it were a patient pages of a book it might be the whole encyclopedia Britannica where you can think of from your youth if you had that in a hard copy. And so it's just impossible I think for physicians ultimately to get all of that data together in one spot. So we hope to train computers to learn the algorithms that work in the first patients that are treated and then by this continuous learning the computers should be able to be more efficient in searching through the data that might help other patients.

Lisa Garvin: I think part of the underlying message of the moon shots is when it's going to jump the barrier from research to clinical care. I'm going to ask you to look into your crystal ball and it may be a little bit hazy but when do you think we might start to see this translate from the lab to the bedside?

Dr. Elizabeth Grimm: Well, we already have trials such as the Ibrutinib trial that are in the clinic and I think we're doing this now. So depending on the particular cancer and depending on the particular progression of the diseases it could be short term. Now some of the others and some of the prevention techniques or prevention approaches excuse me will be long term. And we know that cancers take twenty to thirty years to develop in some cases. The case of melanoma childhood sun exposure may not develop into a melanoma until the patient is fifty or sixty. So the prevention efforts are definitely long term. But the therapy efforts could be quite rapid and we just know in cancer research to expect the unexpected so we're very hopeful this could happen in some of these instances very soon.

Lisa Garvin: Do you feel like the moon shots program in and of itself was the only way to kind of kick start this process? I mean we've been trying to cure cancer since 1941 here at MD Anderson but what is it about the moon shots that's really going to help us reach that goal?

Dr. Elizabeth Grimm: My view is that it's the large teams that have been formed and have been charged with working together, we're cutting boundaries, we're eliminated silos, people from different departments and different divisions who have different reporting structures, are all now charged with working together, they hope to achieve much more than they would have in their smaller groups and I see this happening already. We're coming up with ideas and we're being funding is being raised that can support this massive effort, that's another part, we really have not had enough funding to support these large groups, to work together, to meet together, to use the resources or to obtain the resources that they need to do such large scale work.

Lisa Garvin: And I do know that you know we are facing as all cancer centers are declining federal funding for research grants so we kind of have to fill in that gap.

Dr. Elizabeth Grimm: Absolutely, absolutely so it's never been a very lucrative business to be in cancer research, there's never been enough money. As a career cancer research I dream every time I think about writing a grant, or write a grant I dream all of the possibilities then I have to cut it down to what the grant may afford. So you know I sit around dreaming boy if I had this I could do that and this is now the opportunity for some of these researchers to really try to live that dream.

Lisa Garvin: So what has donor support meant for the moon shots program?

Dr. Elizabeth Grimm: The donor support has meant everything. It has enabled the groups to be formed, it has enabled the platforms to get started and I'd like to say that this first year we've had over thirteen hundred individual donations. It has added up to getting us off the ground and great ideas are moving forward and we're just very grateful for that.

Lisa Garvin: So in closing Dr. Grimm, we've got moon shots for eight diseases, is there a future for more moon shots?

Dr. Elizabeth Grimm: I think so Lisa actually we had a tough competition narrowing it down to these eight diseases, six moon shots and there are quite a number that are eager to join this, it will take a little bit more philanthropy, it will take a little bit more preliminary data and I don't think we can start them right away but certainly it would be our dream to bring in other disease sites that we haven't mentioned today. So I'm very hopeful we can do that as well.

Lisa Garvin: Great, thank you very much for the moon shots update. If you have questions about anything you've heard today on Cancer News Line contact ask MD Anderson at 1-877-MDA-6789 or online at MD Thank you for listening to this episode of Cancer News Line. Tune in for the next podcast in our series.

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