Nearly 80 million Americans — one out of every four people — are infected with the human papillomavirus, and more than 31,000 will be diagnosed with an HPV-related cancer this year. Despite the availability of a vaccine to prevent the infections that cause these cancers, HPV vaccination remains low in the United States.
The UAB Comprehensive Cancer Center has partnered with 69 other National Cancer Institute-designated cancer centers to issue a statement urging for increased HPV vaccination and screening to eliminate HPV-related cancers, starting with cervical cancer. These institutions collectively recognize insufficient vaccination as a public health threat and call upon the nations’ health care providers, parents and adolescents to take advantage of this rare opportunity to eliminate several different types of cancer in men and women.
“We have the opportunity to eliminate multiple HPV-related cancers beginning with cervical cancer,” said Michael Birrer, M.D., Ph.D., director of the UAB Comprehensive Cancer Center. “To accomplish this goal, we need to utilize our most important tool — HPV vaccination. We hope our collective action as NCI-designated cancer centers will educate and motivate the public and highlight this tremendous opportunity we have to eliminate a preventable cancer.”
Vaccination rates remain significantly lower than other recommended adolescent vaccines in the United States. According 2016 data from the Centers for Disease Control, less than 50 percent of girls and 38 percent of boys completed the recommended vaccine series. Research shows there are a number of barriers to overcome to improve vaccination rates, including a lack of strong recommendations from physicians, and parents’ not being properly informed that this vaccine protects against several types of cancer in men and women. HPV causes multiple cancers, including cervical, anal, oropharyngeal (middle throat) and other genital cancers.
UAB Division of Gynecologic Oncology and senior medical officer for the cancer service line at the UAB Comprehensive Cancer Center, has tested several HPV vaccines. He was one of the first to test Gardasil, the first U.S. Food and Drug Administration-approved vaccine for the prevention of cervical cancer and genital warts. Huh was a lead author with a multinational study of a new nine-valent HPV vaccine that has even further potential to dramatically reduce rates of cervical cancer and perhaps eliminate cervical cancer screening altogether.UAB has been at the forefront of conducting groundbreaking cancer research, especially in developing the HPV vaccine. Warner Huh, M.D., director of the
“There is no question that the vaccine works,” Huh said. “We now have a second-generation vaccine that protects against 90 percent of the HPV that are associated with cervical cancer. This vaccine can literally eradicate the majority of cervical cancer, if given widely and appropriately.
“We need health care providers to stand with us and recommend the HPV vaccine. Parents can join with us by asking their doctors about the vaccination.”
HPV experts from the nation’s top cancer centers, including the UAB Comprehensive Cancer Center, along with partners from the NCI, CDC and the American Cancer Society, are meeting June 7-8 in Salt Lake City to discuss a path forward to eliminating cancers caused by HPV, including ways to reduce barriers to vaccination, as well as share education and training strategies to improve vaccination rates.
“In addition to being at the forefront of research, the UAB Cancer Center along with multiple stakeholders across the state established the Alabama HPV Vaccination Coalition, which has been a model for other states across the country,” said Isabel Scarinci, Ph.D., professor in the UAB Division of Preventive Medicine and associate director for Globalization and Cancer at the UAB Comprehensive Cancer Center.
“This movement is no longer just in the hands of the medical community, as cervical cancer screening and vaccination discoveries are already in existence,” she said. “There are many socio-economic and cultural reasons that stand in the way of adherence. But I am optimistic that we can legitimately move the needle as the scientific, public and private sectors combine efforts and expertise, with Alabama’s being one of the leaders in this effort.”
This is the third year that all NCI-designated cancer centers have come together to issue a national call to action. All 70 cancer centers unanimously share the goal of sending a powerful message to parents, adolescents and health care providers about the importance of HPV vaccination for the elimination of HPV-related cancers.
Lisa Chappell enjoys the summer sun, spending time outside and relaxing on the Coosa River at her Gadsden residence. Now, after being diagnosed with melanoma in 2015, she is much more cautious about her outdoor habits.
Chappell noticed a mole on her upper thigh had changed color and immediately visited her dermatologist. She was quickly advised to visit doctors at the University of Alabama at Birmingham, where she met with Carlo Contreras, M.D., assistant professor in the Division of Surgical Oncology and associate scientist with the UAB Comprehensive Cancer Center. Chappell met all the criteria for persons who are at risk for developing melanoma — red hair, light skin tone and chronic sun exposure.
“I was scared because I have a history of cancer in my family,” Chappell said.
Melanoma is highly capable of spreading and can be deadly rapidly if not treated.
Skin moles are very common, and fortunately the vast majority of skin moles do not transform into melanoma. Melanoma often appears as an enlarging skin mole, either flat or raised. Moles containing melanoma are usually darkly pigmented, but can take on a variety of colors. In addition to rapid growth, moles with an asymmetrical shape or irregular borders are also concerning. Overall, new or changing moles should be examined by a dermatologist, surgeon or primary care physician.
“You should see a doctor if you are concerned that a lesion is changing, is newly symptomatic or is non-healing,” Phillips said. “If you have a first-degree relative with melanoma or you have many dark moles, it’s a good idea to have a baseline skin exam by a dermatologist.”
Chappell’s mole was removed, and after testing, results showed that the melanoma had unfortunately spread to her lymph nodes. Contreras suggested a minimally invasive type of lymph node removal for her melanoma in the groin and in the pelvis. This unique operation is one Contreras developed at UAB’s Comprehensive Cancer Center and is not offered anywhere else in Alabama.
“The traditional operation for Lisa would have involved about a 12-inch incision that starts in the abdomen, goes over the groin and ends in the upper part of the thigh,” Contreras said. “The traditional operation usually involves a three- or four-day hospital stay and a considerable recovery period of several weeks at home.”
Contreras’ minimally invasive approach uses six small, laparoscopic incisions, and patients can usually go home the next morning. The recovery at home is much quicker, meaning patients can get back to doing the things they love earlier, or they can start chemotherapy earlier if that is part of their regimen.
“The recovery was great for me,” Chappell said. “I was only in the hospital for one night. I don’t like to take pain pills, and this procedure didn’t really leave me all that sore.”
Chappell says she now takes all the necessary precautions — like wearing sunscreen with a SPF value of 30 or higher every day and wearing a hat and sunglasses — to ensure she doesn’t have to have another scare.
“I still love relaxing by the river, but now I always reapply sunscreen and make sure I’m doing things the right way,” she said.
Doctors in the Division of Surgical Oncology are committed to providing personalized, comprehensive care for patients with a broad array of benign and malignant tumors, often working in collaboration with other departments across UAB’s medical campus to guide patients through the surgical decision-making process and provide innovative, advanced diagnostic and therapeutic options.
When watching the Mississippi State softball team take the field this spring, it would be tough to tell that freshman outfielder Alex Wilcox is actively undergoing chemotherapy treatment. The 18-year-old Brantley, Alabama, native has been battling ovarian cancer since December 2015, juggling her Division I softball commitments and chemotherapy regimens at the University of Alabama at Birmingham with unmatched resiliency.
It started when Wilcox, a junior in high school at the time, felt abnormal pain in her side. She chalked it up to appendicitis; but after being rushed to the nearest emergency room, she and her family knew something was not right. Their suspicions were confirmed when the pain Wilcox was experiencing was diagnosed as ovarian cancer, specifically granulosa cell tumor of the ovary.
“You hear people say this, but you never think something like that will happen to you,” Wilcox said. “I had heard a lot about other cancers over my lifetime; but I didn’t know much about ovarian cancer at all, let alone that it could develop in girls my age.”
After she was referred to UAB’s Division of Gynecologic Oncology, Wilcox’s care and treatment plan began with a surgery to remove her tumor, and rounds of chemotherapy and surgeries to follow. All the while, Wilcox was still making strides on the softball field, inking her commitment to the Mississippi State softball team in fall of 2016 while in the throes of intense treatment.
Now, two years after her initial diagnosis, Wilcox is living out her dream by taking the field each week with the Bulldogs in Starkville. Her treatment has been personalized to enable her to compete if she is up to it, but her care team at UAB credits her ability to play to her unparalleled tenacity.
“What Alex has gone through is nothing short of remarkable, and she is surrounded by teams both here at UAB and at Mississippi State that are working to keep her healthy and able to live out her dream of competing at the highest level,” said Warner K. Huh, M.D., director of UAB’s Division of Gynecology Oncology and Wilcox’s oncologist. “Her involvement as an athlete has given us tangible goals to meet, but her drive and spirit are really what have made the difference. I’ve never worked with a patient before who has the type of bravery and patience that Alex has.”
While ovarian cancer tends to be uncommon in young women and teenagers, Wilcox’s particular cancer is incredibly rare.
According to the American Cancer Society, 22,240 women will be diagnosed with ovarian cancer in 2018. Ovarian cancer is often known as the “silent killer,” as many of its symptoms tend to be ones that women experience as nonspecific symptoms or with menstruation, but Huh wants women to understand that paying attention to their own bodies can be the best detector.
“Women may experience symptoms like bloating, cramping or nausea regularly; but it’s when it turns chronic that there is an indicator that something is not right. Women are the only ones who can judge their symptoms and know when they are experiencing a legitimate bodily change, so we encourage them to always speak up and seek clinical advice if something doesn’t appear right — it could be what saves their life.”
For Wilcox, going through her cancer at this phase in her life has not been easy; but having strong teams behind her has made all the difference. The softball team at Mississippi State has even launched a campaign in her honor appropriately titled “No One Fights Alone,” wearing special teal team jerseys each week to shed light on ovarian cancer and in support of her fight, a campaign that her care team at UAB have also rallied behind.
“Since day one of treatment, my care team at UAB has shot everything to me straight and outlined how we are going to work through this together, just as my teammates have supported me during this time on and off the field,” Wilcox said. “Whether I’ve been able to play or had to watch from the sidelines, all of my teams have made the difference and made me realize that I really am not fighting this alone.”
When Cieasha Jones, 13, attended Wednesday’s 10,000th robotic surgery milestone event at the University of Alabama at Birmingham, she had no idea she would have the opportunity to experience one-on-one simulated surgical training with renowned UAB surgeons.
But that is exactly what happened for Cieasha, an eighth-grader at Oak Mountain Middle School. She has aspired to be a surgeon since she was a young girl, but Cieasha also has a passion for robotics. In fact, she is a member of Oak Mountain’s world championship robotics team. When her mother, Cieara Jones, R.N., a nurse in UAB’s Cardiovascular Intensive Care Unit, saw an email about the robotic surgery event at UAB, she thought Cieasha would enjoy attending and learning how her two passions could collide in the real world.
“I checked my email and saw that this event was taking place and thought ‘there’s no harm in going,’” Cieara said. “I’m just trying to find ways to help Cieasha on this journey and thought seeing firsthand what robotic surgery is about would be a neat experience.”
After the event concluded, Cieasha tested the Intuitive Surgical daVinci simulator when Kenneth Kim, M.D., associate professor in the School of Medicine’s Division of Gynecologic Oncology and director of Robotic Surgical Education and Training, struck up a conversation about her passion. From there, he pulled her aside to walk her through individualized simulated training and teach her along the way how robotic surgery works.
“It was amazing [to replicate robotic surgery],” Cieasha said. “I sort of knew that robotics played a role in surgery, but I didn’t realize it had this big an impact. This was a great experience that I never thought I would be able to get.”
With Kim’s assistance, Cieasha was able to use the daVinci surgery simulator to conduct a virtual hysterectomy, with other Department of Surgery surgeons like John Porterfield, M.D., associate professor and director of UAB’s General Surgery Residency Program, watching along and coaching her through the computer-generated procedure.
“It was easy teaching her, as she has an intuitive knack and feel for this and has the hand-eye coordination already,” said Kim, a member of UAB’s Comprehensive Cancer Center. “She is young, but age doesn’t matter if you have the right talent. It’s our job as educators to identify where trainees are and bring them to where they need to be. She already has the hand-eye down, so she has a leg up.”
While Cieasha has many years to go before she can become a surgeon, she is committed and dedicated to her dream. When asked if this experience motivated her even more to pursue a career in medicine, Cieasha replied, “Absolutely. It is set in stone.”
A team of physicians and scientists from the UAB Comprehensive Cancer Center will present some of the latest advances in cancer research to more than 32,000 oncology professionals from all over the world during the annual meeting of the American Society of Clinical Oncology in Chicago from June 1-5.
UAB Cancer Center investigators are authors on 56 abstracts accepted by ASCO for the annual meeting. Many UAB presentations will deliver discoveries expanding on the reach of precision medicine. Topics range from new drug combination therapies to investigator initiated pilot studies that show promising outcomes. Cancer Center members who are lead authors include Rebecca Arend M.D., gynecologic oncology; Luciano Costa, M.D., multiple myeloma; Andres Forero, M.D., breast cancer and lymphoma; Ravi Paluri, M.D., gastrointestinal cancers and tumor biology; Erica Stringer-Reasor, M.D.,breast cancer; Grant Williams, M.D. gastrointestinal cancers and outcomes for geriatric cancer survivors; and Eddy Shih-Hsin Yang M.D., Ph.D., precision oncology and tumor profiling.
This year, Smita Bhatia, M.D., MPH, director of the UAB School of Medicine’s Institute for Cancer Outcomes and Survivorship, will be named a Fellow of ASCO. This distinction recognizes ASCO members for their extraordinary volunteer service, dedication, and commitment to ASCO.
Additionally, Gabrielle Rocque, M.D., has been named the chair of the ASCO Quality of Care Committee. She will also serve on the editorial board of ASCO’s Journal of Oncology Practice.
Detailed information on all UAB abstracts is online — search University of Alabama at Birmingham.
This April, the University of Alabama at Birmingham surpassed the 10,000 robotic surgeries mark, a feat that helps make UAB the leader in robotic surgery volume in the country. For surgeons within UAB Medicine, a collaborative spirit and the willingness to work together across many disciplines helped push the hospital over this incredible milestone and into a new frontier of surgery.
“Surpassing 10,000 robotic surgeries is reflective of a joint commitment made by many surgeons and hospital administrators alike to demonstrate UAB’s mission pillars, from education to innovation, community engagement to patient care,” said Jeffrey Nix, M.D., assistant professor in UAB’s Department of Urology and associate scientist at the UAB Comprehensive Cancer Center. “We are constantly thinking through how as a team we can continue to enhance patient experiences and make innovative strides in our respective fields, which ultimately reflects back on UAB as a leading health care provider.”
At UAB, robotic surgery is a cornerstone in many disciplines, including urology, cardiothoracic surgery, gynecologic oncology, general surgery, otolaryngology, head and neck surgery, endocrine surgery, and surgical oncology, as well as women’s reproductive health. Rather than focusing efforts on select specialties, the well-rounded approach promotes cross-collaboration among surgeons and has helped UAB push the envelope with technology to provide patients unmatched minimally invasive, quality surgical care.
“What makes our approach unique is that a patient may need to have rectal surgery, while at the same time part of his bladder may need to be removed,” Nix said. “Instead of having to have two surgeries that require separate and challenging recovery periods, we can complete both in one surgery through minimally invasive methods that speed up recovery time, cause less pain and leave minimal scaring. Across departments, we are constantly communicating and working together to deliver the best care possible.”
In reaching the 10,000 surgeries, UAB surgeons have gone beyond just performance to make lasting impacts on the field and future of robotic surgery. For instance, William Carroll, M.D., chair of UAB’s Department of Otolaryngology and senior scientist at the UAB Comprehensive Cancer Center notes that the department has been pivotal in the support of head and neck cancer robotic surgeries, as data collected at UAB were used by the FDA to grant approval for robotic surgeries of the head and neck specifically. Renowned surgeons like Robert Cerfolio, M.D., former chief of Thoracic Surgery at UAB, have helped to develop guidelines and standards that have and will continue to influence the field as we know it.
Another unique aspect of UAB’s robotic surgery division includes one-of-a-kind training to which only UAB residents have exposure. In noticing that most residents had access to robotic training only once a year if at all, Kenneth Kim, M.D., associate professor in the Division of Gynecologic Oncology, was tasked with revamping the existing robotic surgery training curriculum.
“Surgery in its basic form is a combination of skill and technique, used in a logical fashion to complete a surgery safely and successfully,” Kim said. “It’s critical that, in addition to learning the ‘how’ of procedure basics, residents are learning the ‘how’ in surgical tools and techniques. The how — in conjunction with consistent simulation to training — is what enables residents to become comfortable with and proficient in robotic surgery.”
Kim’s revisions to the gynecologic resident training gave residents one-on-one training sessions with him on a quarterly basis. Through this, he was able to track data over a year’s time and quantifiably show that, with individualized attention, his residents’ skillsets improved tremendously — enough to convince Intuitive Surgical, the maker of the daVinci Surgical System, to provide UAB with its own robotic surgery simulator with updated and exclusive simulation software that will be used to train residents across multiple surgical disciplines.
With a shared mindset that resident education needed to have a strong focus on robotic surgery training, surgeons across many fields have come together to work toward a common goal of advancing curriculum for residents of all years and specialties.
“We pride ourselves on being early adopters and innovators, and knew it was critical to change the theory that robotic surgery should be used exclusively by chief surgeons,” said John Porterfield, M.D., associate professor and director of UAB’s General Surgery Residency Program. “We wanted to give our residents the tools and time to familiarize themselves with the robot and training as often as possible, which has set UAB’s residents apart nationwide in terms of comfort and skill in robotic surgery specific to their fields. We have been able to prove that the extra attention our residents are given has helped UAB lead the way in a responsible manner that ultimately benefits our patients and the quality of care they receive.”
Porterfield also attributes UAB’s success in reaching the 10,000 robotic surgery milestone to the joint relationship between surgeons and hospital administrators.
“We have found a great balance where surgeons and hospital administrators have mutual understandings about each other’s interests so that, ultimately, our patients are the ones who benefit most at the end of the day,” Porterfield said. “The ‘rising tide floats all boats’ mindset has enabled all involved with robotic surgery to leave a legacy and frame groundwork that will continue to leverage UAB’s innovative offerings to patients on a local to international scale.”
UAB surgeons feel a particular responsibility to continue to serve as leaders in the field. Knowing that ongoing research, technological advances and collaborating are keys to success, Nix says working together to meet quantifiable goals and training the next wave of surgeons at the highest level will continue to give UAB a competitive edge.
“At the end of the day, we are committed to increasing surgery volumes while simultaneously increasing positive patient outcomes,” Nix said. “We are confident that our continued successes will keep UAB’s name synonymous with top robotic surgery care, and hope that we can continue to lead by example in our next 10,000 surgeries.”
Warner K. Huh, M.D., an internationally respected gynecologic oncologist at UAB Medicine, was appointed senior medical officer for the cancer service line at the UAB Comprehensive Cancer Center.
Michael J. Birrer, M.D., Ph.D., director of the Comprehensive Cancer Center, says “It is a great pleasure to work with Dr. Warner Huh as the physician leader of the UAB cancer service line. Dr. Huh will assist in the design implementation and operation of the cancer service line, which is critical to the future success of the cancer center and the care of our patients.”
Dr. Huh’s appointment is effective immediately. “It’s truly an honor and a privilege to be a part of the leadership team for cancer care at UAB. This institution has a longstanding, rich, and productive history in the area of cancer treatment and research,” Dr. Huh says. “It’s important to remember that UAB was one of the very first NCI Comprehensive Cancer Centers in the U.S. Given the current needs of our patients and the considerable future impact cancer will have on our population, it’s imperative that we continue to grow and develop a world-class cancer program that will provide superlative, compassionate care and serve as the standard bearer for the region.”
Dr. Huh’s new responsibilities will be in addition to his current roles as professor and vice chair of Gynecology; director of the Division of Gynecologic Oncology; the Margaret Cameron Spain Endowed Chair in the Department of Obstetrics and Gynecology; professor in the Department of Surgery; professor in the Department of Epidemiology at the UAB School of Public Health; and senior scientist at the UAB Comprehensive Cancer Center.
Patients who develop cardiac side effects from traditional cancer therapies will now have a new place to receive specialized treatment at the University of Alabama at Birmingham.
The new cardio-oncology program at UAB is the only one of its kind in Birmingham and northeast Alabama. Although the number of cancer survivors continues to grow, cardiovascular disease is the second leading cause of death in survivorship. The cardio-oncology program works closely with UAB oncologists, cancer survivorship programs and cancer rehabilitation specialists to return survivors to a high quality of life and improve the cardiac outcomes.
“Through a detailed history and innovative techniques such as strain echocardiography, cardiac MRI, angiography, nuclear imaging and cardiac biomarkers, we identify cancer patients at high risk for cardiovascular complications and work to minimize potential cardiotoxicity,” said Carrie Lenneman, M.D., associate professor in the Division of Cardiovascular Disease.
Heart disease, cancer and strokes continue to be the highest causes of death in the state of Alabama. Through the use of cardioprotective medications and close monitoring, patients can keep receiving necessary chemotherapeutic agents while minimizing their risk for developing heart disease.
“Heart disease in cancer survivors is the second leading cause of death behind recurrent cancer, thus cardio-oncology programs are well-suited to helping cancer survivors,” said Riem Hawi, M.D., assistant professor in the Division of Cardiovascular Disease.The cardio-oncology program also focuses on cancer survivors with modifiable risk factors or pre-existing cardiac disease. The goal is to provide comprehensive care focused on maintenance or prevention of cardiovascular disease with incorporation of healthy lifestyle factors and medical treatment.
Lenneman says pairing cardiology and oncology is unique, but the need for this program is important.
When a patient is diagnosed with cancer, the patient needs timely coordination or care. The cardio-oncology clinics help facilitate timely cardiac evaluation and cardiovascular diagnostic testing. Lenneman says opening the cardio-oncology clinics has decreased wait times to nine days for cancer patients to see a cardiovascular specialist, with many patients seen the same day to facilitate coordination of multiple visits or out-of-state referrals.
Lenneman says the new clinic is just the first step in helping cancer patients with cardiovascular health needs.
“Down the road, we would like to develop collaborative research in UAB cardio-oncology emphasizing improved cardiovascular surveillance in cancer patients,” Lenneman said. “Additionally, we would like to expand the number of locations we hold clinics and implement telemedicine to decrease the burden of long travel times and coordination of care.”
The clinic is open in the afternoon every Tuesday, Wednesday and Thursday at The Kirklin Clinic and every other Tuesday and Friday morning at the Birmingham VA Hospital. To learn more, visit the official UAB Medicine website.
In March of 2018, Peoples was diagnosed with acute leukemia, a type of blood and bone marrow cancer. With leukemia, the bone marrow produces too many white blood cells, which typically fight infections. The disease progresses rapidly and creates immature blood cells, crowding out other healthy blood cells that may collect in the blood, bone marrow and lymph tissue. Acute leukemia can be extremely draining on the person affected, causing fatigue, infections, persistent weakness, and aching bones and joints.
Peoples has been hospitalized for nearly two months since her diagnosis, and by her side each day of the journey has been her partner of 11 years, Lovie Ivory.
“He’s my rock,” Peoples said. “Since this journey started, he’s done everything. I wouldn’t be able to be on this side without him.”
Although Ivory asked Peoples to marry him many times throughout their relationship, Peoples never thought the time was right until a short time before her diagnosis.
“I got to a point where I felt like it was time, and then I was diagnosed with leukemia,” Peoples said. “I told Lovie, after this was all over, I would marry him.”
That’s when UAB’s nurses stepped in.
“I asked the nurses if they had people who get married in the hospital, and I asked them to look into it for me,” Peoples said. “From there, it just blew up. They started doing all these different things for me, and then they asked if I wanted to have a blessing of our relationship today.”
In front of a few family members and nursing staff, Peoples and Ivory were brought into one of UAB Hospital’s chapels and exchanged words of love, affirmation and promise to each other.“It’s easy to see patients as people,” said UAB Pastoral Care Chaplin Lauren Gilmore, who oversaw the blessing celebration. “But we treat the whole person. We wanted to give Brenda and Lovie this celebration. We celebrate even during the depths of illness and endurance, and this was a special opportunity.”
“I feel like I could live the rest of my life with her,” Ivory said. “I’m faithful to her, and it’s been scary; but I told her I am with her until the end. I knew she would be all right.”
After the blessing was over, there was one more surprise for the happy couple as Peoples’ nurses showered the couple with balloons, a cake and sparkling grape juice to cap off the celebration.
“Because of the nature of our job on this unit, we can have some pretty hard days,” said Katie Purdy, R.N., one of Peoples’ nurses in UAB’s Hematology/Oncology unit. “But we wanted to make Brenda and Lovie feel special and be able to give them the celebration they deserved.”
Peoples’ condition is improving day by day, and nurses hope she will be able to go home in the coming days. While Peoples and Ivory plan to legally wed once she is released from the hospital, UAB’s nursing staff knew what a blessing a celebration like this was and what joy it would bring to so many.
“We are thrilled to do the best for our patients and provide care from our hearts, and it is an honor to be a part of their journey together,” Purdy said.
Multiple myeloma is the second most common type of blood cancer in the United States, impacting more than 25,000 people each year and disproportionatly affecting African-American men. While patients have access to more quality treatment therapies than ever before, the disease is still regarded as an incurable condition that often leads to death for those affected.
However, researchers at the University of Alabama at Birmingham Division of Hematology and Oncology are leading and currently recruiting for a Phase II clinical trial that intends to provide newly diagonosed multiple myeloma patients an innovative treatment plan. The hope is that the therapies will eradicate the disease in a significant proportion of patients and measure disease response more accurately than ever before.
The clinical trial Monoclonal Antibody Sequential Therapy for Deep Remission in Multiple Myeloma, also known as MASTER, utilizes next generation sequencing technology to detect minimal residual disease down to a level of one cancer cell in 100,000 — or 100- to 1,000-fold more sensitive than traditional methods to evaluate response. With a goal of enrolling 82 patients, those in the trial will be treated with a combination of anti-myeloma agents and immunotherapy that have a proven record of eliminating minimal residual disease, including the drug carfilzomib and the monoclonal antibody daratumumab, agents that are currently only approved to treat patients whose disease has returned.
“I believe for the first time that we have treatments that are effective enough to make it possible to eradicate multiple myeloma definitively in a substantial proportion of patients, along with having the technology to detect that the disease has been targeted and that treatment can be stopped,” said Luciano Costa, M.D., Ph.D., scientist at the UAB Comprehensive Cancer Center, lead of the Hematologic-Malignancy Working Group, and principal investigator of the MASTER study. “That is what patients want, after all — a treatment that gives them the possibility of eliminating any trace of the myeloma without having to be on therapy for the rest of their lives. It is a bold move, but bold moves are what our patients deserve.”
This is one of the first trials in multiple myeloma to use minimal residual disease as primary endpoint and the very first one to modify therapy based on achievement of minimal residual disease eradication.
Up until now, existing therapies have been developed on trials that assigned treatment for a defined duration of time, irrespective of depth or speed of response, often followed by maintenance therapy for indefinite duration and with potentially adverse impact on risk of complications and cost. As it stands, patients with billions of cancer cells in their bodies and patients with true disease eradication will both appear to be in complete remission using current methods to measure disease response to therapy.
More than improving the results of the initial treatment, the MASTER study will treat patients for the necessary time to confirm elimination of minimal residual disease and then discontinue therapy. Patients will be monitored for relapse at the molecular level, before disease becomes again symptomatic.
In addition to UAB’s study leadership, Vanderbilt University Medical Center, Duke University, Medical College of Wisconsin, University of Wisconsin, and Oregon Health and Science University are recruiting for the trial as well.
The MASTER trial is supported by Amgen and Janseen, both with drug and financial support.