Barr Program Impact Statements
Blocking Key Drivers of Cancer Cell Growth
Chronic lymphocytic leukemia (CLL) causes a slow increase in white blood cells called B lymphocytes, or B cells. Cancer cells spread through the blood and bone marrow, and can also affect the lymph nodes or other organs such as the liver and spleen. CLL eventually causes the bone marrow to fail. Funded by the Claudia Adams Barr Program in 2007, Cathy Wu, MD, used powerful DNA sequencing to identify five genes that are abnormal in CLL. The numerous genetic flaws uncovered by this study offered clues to the biological underpinnings of CLL, paving the way for novel targeted treatments that hone in on the unique genetic features of each tumor.
Identifying Novel Treatments
Although recent treatment advances benefit many patients with leukemia and lymphoma, some tumors develop resistance to treatment. Claudia Adams Barr Program funding in 2008 and 2013 has allowed David Weinstock, MD, (who has also been a runner/fundraiser on the Dana-Farber Marathon Challenge team) to use powerful new technologies to identify new potential targets and the alterations linked to resistance. His discovery of the mechanism through which an altered gene drives a form of leukemia has already led to clinical trials testing of a drug that may target this alteration.
Emerging Therapy for AML
With support from the Claudia Adams Barr Program in 2015, Julia Etchin, PhD, is studying a protein called exportin1, or XPO1, as an attractive, new target for acute myeloid leukemia (AML) therapy. Selinexor (KPT-330), an investigational drug that targets XPO1, has produced promising results in patients with AML in early clinical testing. Dr. Etchin found that selinexor destroys both rapidly-dividing AML cells and treatment-resistant leukemia stem cells, while sparing normal blood cells.
New Treatment Opportunities
For six years during the 1998-2004 timeframe, Rosalind Segal, MD, PhD, parlayed Claudia Adams Barr Program funding into the discovery that a genetic pathway called "Notch" is consistently damaged in brain tumors. Drugs already existed for other diseases to target Notch, and exciting clinical trials are exploring opportunities to use these drugs for people with brain cancers. This has the potential to significantly improve survival for these devastating cancers.
Discovering New Treatments
Myles Brown, MD, used Claudia Adams Barr Program funding in 2002-2003 to make the first genome-wide map of all genes that estrogen controls. This has enabled scientists for the first time to understand why certain drugs have been so effective in treating breast cancer, including the marked improvement in survival for women whose breast cancers respond to tamoxifen and other drugs that block estrogen. Building on this work, Dr. Brown continues to investigate the mechanistic underpinnings of hormone-positive cancers and how to expand treatment options for patients whose tumors do not respond to tamoxifen.
Inhibiting Cancer Cell Growth
Jean Zhao's Claudia Adams Barr Program funding in 2004 allowed her to systematically test a large number of proteins for their effects on breast cancer growth. She identified the specific, cancer-driving roles of various alterations to the PI3K protein, including PI3KCA. Based on these findings, drug companies have developed PIK3CA inhibitors that are being tested in clinical trials of breast and other cancers. Dr. Zhao also continues to explore the use of PI3K inhibitors in combination with other breast cancer drugs.
New Function for BRCA1
Since they were first identified in the early 1990s, genes in the BRCA family have been the focus of intense research because of the increased risk of breast cancer they cause when abnormal. With support from the Claudia Adams Barr Program in 2015, Elodie Hatchi, PhD, has shed new light on one of the ways that BRCA1 functions at a molecular level. Dr. Hatchi’s unprecedented work is the first to identify and outline the relationship between BRCA1 and unusual DNA structures, as well as the role this interaction may play in driving the formation of breast cancer cells.
PI3K Inhibitor Resistance
The most frequently mutated gene in breast cancer is PIK3CA which controls cell growth. A type of targeted therapy called a PI3K inhibitor should treat cancer cells that have PIK3CA mutations, yet these drugs have not yet proven to be clinically successful. With support from the Claudia Adams Barr Program in 2015, Xiuning Le, MD, PhD, is conducting research to determine which mutations may cause resistance to PI3K inhibitors and is generating data to determine if and how targeted therapies can be combined with PI3K inhibitors to boost their overall effect. Dr. Le and her colleagues completed a large genomic screen, which identified several abnormalities most likely to be involved in resistance to PI3K inhibitors. Some of these abnormalities may be manipulated to restore sensitivity of breast cancers to PI3K inhibitors.
New Drugs to Trigger Cancer Cell Death
All living cells contain "executioner proteins" that help to control the growth of normal cells. Cancer cells can sometimes prevent activation of these proteins, enabling them to replicate uncontrollably. Claudia Adams Barr Program in 2008 empowered Loren Walensky, MD, PhD, to generate novel compounds that bind to these proteins in cancer cells, reactivating their "executioner" function and triggering cell death. By integrating chemistry, biology, and cancer medicine, this work has created groundbreaking new therapies for multiple types of cancer, many of which no longer respond to conventional therapies. One of these is now in clinical trials at Dana-Farber and elsewhere.
Chromosomal Rearrangements and Cancer
Some cancers are caused when a piece of one chromosome breaks off and joins another. The resulting molecules are called chromosomal rearrangements and they occur very frequently in childhood cancers. With funding from the Claudia Adams Barr Program in 2015, Tovah Day, PhD, is studying how chromosomal rearrangements form. She conducted a screen of several hundred genes to determine which are involved in the formation of chromosomal rearrangements. She identified a handful of genes and focused on one, PARP3, which promotes the formation of these rearrangements. Dr. Day and her colleagues have shown that drug-like small molecules can inhibit PARP3 activity and prevent the formation of chromosomal rearrangements.
Models for Gastroesophageal Cancer
Gastroesophageal cancers (GEC) are a group of genetically complex diseases that affect the stomach and esophagus. A primary barrier to the development of effective treatments for GEC is the lack of robust research models—such as cell lines and mouse models—in which to study these cancers. With funding from the Claudia Adams Barr Program in 2015, Eirini Pectasides, MD, PhD, is using a revolutionary new technology called CRISPR to generate mouse models that more faithfully represent human GEC tumor biology.
Preventing Liver Cancer
Liver cancer is extremely difficult to treat. One approach to liver cancer might be to prevent it from occurring in the first place. With support from the Claudia Adams Barr Program in 2015, Wolfram Goessling, MD, PhD, is studying how cirrhotic liver tissue activates signals that cause liver cells to make nutrients, particularly nitrogen and glucose, that can fuel tumor growth. This process occurs before detectable cancer even arises, offering an opportunity to prevent liver cells from ever becoming cancerous.
Enabling Meaningful Analysis of Massive Databases
The Human Genome Project and DNA technology in general have provided the important tools needed to uncover and treat the genetic abnormalities that cause cancer. Since there are three billion units of DNA in the genome and an unknown number of ways that their functions are controlled, the technologies used for research on the genetics of cancer are creating a tsunami of data. Awarded Claudia Adams Barr Program funding in 2005, Shirley (Xiaole) Liu, PhD, conducted groundbreaking research to provide a way to manage that data. Scientists around the world are now using Dr. Liu’s "open source" techniques, uncovering new pathways toward cancer development that can be targeted by novel and effective therapies.
Enabling New Drug Development for Many Cancers
The Kinome Project, with initial Claudia Adams Barr Program funding in 1997, discovered mutations in a family of genes called "kinases" that prevent cell growth stimulators from being turned off, resulting in cancer cells that replicate uncontrollably. These discoveries by William Sellers, MD, and his colleagues led directly to the development of targeted drugs used by patients worldwide for the treatment of multiple cancers, including lung cancer, leukemia, and melanoma. Examples include Tarceva and Vemurafenib, which improve survival in subsets of people with lung cancer and melanoma, respectively. This work has become the model for personalized medicine in cancer treatment and is widely credited for helping transform the approach that pharmaceutical companies use for drug development.
Metabolism and Cancer
Bruce Spiegelman, PhD, supported by the Claudia Adams Barr Program in 2005 and again in 2009, has made critical discoveries about the links between obesity, metabolism, inflammation, and the development and progression of cancer. For instance, Dr. Spiegelman identified the proteins that control fat activation and may thereby play a role in driving cancer cachexia, a significant, involuntary weight loss that affects approximately half of all cancer patients and can negatively impact treatment.
New Ways to Activate the Immune System
An important area of cancer research asks why the human body's defense systems do not always attack and destroy tumors as they form. Funded by the Claudia Adams Barr Program in 1998, Glenn Dranoff, MD, discovered complex regulatory pathways in the human immune system that cancers exploit in order to escape destruction. Reversal of these effects can lead to the development of vaccines against cancer, like Provenge for prostate cancer. This research has also enabled the development of immune-activating drugs such as ipilimumab, which showed striking effects in melanoma in a trial led by Dana-Farber scientists and is now approved by the Food and Drug Administration for treatment.
The recent development of immunotherapies—drugs that leverage the power of the immune system to fight cancer—has opened up an array of promising new treatment approaches. With the support of the Claudia Adams Barr Program in 2015, Kai Wucherpfennig, MD, PhD, is using the latest technology to study neoantigen-specific T-cells. Neoantigens are substances that the immune system has never seen before and identifies as foreign, triggering the T-cells to attack. Dr. Wucherpfennig and his colleagues are studying how neoantigen-specific T-cell response changes in response to immunotherapy.
CAR T-cells for Renal Cell Carcinoma
With funding from the Claudia Adams Barr Program in 2015, Wayne Marasco, MD, PhD, is studying an emerging immunotherapy in which disease-fighting T-cells are genetically engineered to carry chimeric antigen receptors (CARs) on their surface, enabling T-cells to recognize specific targets on cancer cells. Called CAR T-cells, these modified immune cells attack and destroy cancer cells. This treatment has demonstrated success in leukemia and lymphoma, but has not yet proven to be effective in solid tumors. Dr. Marasco is applying this therapy to renal cell carcinoma (kidney cancer).
Discovery of an Important Mutation
The Claudia Adams Barr Program provided initial funding in 2002 to Matthew Meyerson, MD, PhD, who discovered mutations in the EGFR protein in certain lung cancer tumors. This critical finding helped lead to the development of an array of drugs that target EGFR, changing the landscape of lung cancer care. Today, these drugs are being used successfully across the world to help people with cancers that were previously untreatable. Dr. Meyerson ran the Boston Marathon® in 2011 as a member of the Dana-Farber Marathon Challenge fundraising team.
New Treatments for Drug-Resistant Cancers
One of the difficult problems facing oncologists is that tumors often become resistant to therapies. One promising area of cancer therapeutics is using chemistry to design and create new classes of compounds that bind to and inhibit the growth of cancer cells that have become drug-resistant. In 2006, Michael Eck, MD, PhD, and Nathanael Gray, PhD, received Claudia Adams Barr Program funding to uncover structural characteristics of cancer cells and to develop compounds that attach themselves to these structures in a way that inhibits their growth. This work is leading to the development of new drugs that are effective against resistant cancers. For example, they identified ways to overcome resistance to EGFR inhibitors. Pharmaceutical companies quickly developed new drugs based on their work, and one of these drugs was shown to improve the survival of people with lung cancer who have developed resistance to older EGFR inhibitors.
Hydroxychloroquine is a drug that inhibits "autophagy," a process that enables cells to break down and eliminate structures such as damaged cell membranes. Cancer cells use autophagy to survive in the presence of cancer therapies. Alec Kimmelman, MD, PhD, with Claudia Adams Barr Program support in 2009, discovered that autophagy is turned on at all times in pancreatic cancer cells, suggesting that pancreas tumors are highly dependent on autophagy and therefore good candidates for autophagy-inhibiting treatments. These treatments were found to be very effective in mouse models, and Dr. Kimmelman is testing this strategy in current clinical trials.
Neuroblastoma in Children: New Treatment
While recent advances have improved survival for children with neuroblastoma, some forms of this disease continue to present serious treatment challenges. With Claudia Adams Barr Program support in 2007, Rani George, MD, PhD, was the first to discover that neuroblastoma tumors often contain a mutation in the ALK gene. Since then, Dr. George and her team have initiated preclinical studies and clinical trials to test ALK inhibitors in combination with other therapies, which could ultimately result in new treatments for children with neuroblastoma.
New Target in Pediatric Brain Tumors
Recent progress in genetic technologies has allowed researchers to learn more about the mutations that are specific to pediatric brain tumors. Mutations that affect histones, the spools around which DNA winds, are not common in adult tumors but are often found in pediatric brain tumors. This suggests that drugs that target these genetic abnormalities in histones could present a more effective approach to treating pediatric brain tumors. With support from the Claudia Adams Barr Program in 2015, Brendan Price, PhD, is leading research to develop cell lines that contain the specific histone mutations found in pediatric high grade gliomas.
Optimizing Treatment of Early Stage Cancers
We now know that not all tumors are alike, and that treatment strategies need to be based on the unique molecular characteristics of each cancer—not just the site where tumors originate. Funded by the Claudia Adams Barr Program in 1996, Todd Golub, MD, performed one of the first molecular classifications of tumors, which are now used by oncologists around the world to personalize treatment decisions and deliver targeted therapies for people with cancer. For example, gene expression is now used routinely to help determine which people with breast cancer are most likely to relapse after surgery and therefore need additional treatment.
Determining When to Use Chemotherapy
Typically, if cells become sufficiently damaged or abnormal, they self-destruct in a process known as apoptosis before they can cause any harm. Cancer cells, which bear many abnormalities, have ways to escape this death sentence through "antideath" proteins. Anthony Letai, MD, PhD, used Claudia Adams Barr Program funds in 2005 to develop a powerful test to determine whether a patient's specific cancer cells will be destroyed by chemotherapy, thereby enabling the selection of the most appropriate cancer treatment. Dr. Letai is currently working to confirm the efficacy of this test, with the ultimate goal of making it available for a range of different types of cancer.