Found in Translation

Wafik El-Deiry is feeling cautiously optimistic. As the new associate director for translational research at Penn State Hershey Cancer Institute (PSHCI), he is charged with furthering the impact of personalized medicine at the region’s only comprehensive cancer center. One way to do that, it turns out, involves counting.

“People generally don’t die from their primary tumor,” explains El-Deiry. “Cancer cells detach from the primary cancer site and travel throughout the body, forming new tumors and causing metastatic disease.” These circulating tumor cells, or CTCs, can be found in extremely small numbers in the bloodstream. Recent research has shown that by capturing and counting each cancer cell present in a vial of blood before patients begin chemotherapy—and at intervals during treatment—oncologists can gain a more accurate picture of how metastatic breast, prostate or colorectal cancers are responding to therapies.

This kind of knowledge is key to tailoring treatments to each patient’s specific needs, El-Deiry notes. “The number of CTCs a patient has in one 7.5 ml of blood is significant. If a patient with advanced cancer has fewer than three circulating cells, their survival is twice as long as those with more than three cells.”

man looking at image projected by microscope
Ken Smith

Wafik El-Deiry

Knowing the CTC number aids both in predicting survival and in assessing treatment benefit, he adds. “If we see that a patient isn’t responding to one chemotherapeutic agent, we can change our approach and use another modality. The earlier we know that, the better.”

Another advantage? Current methods for monitoring patients with metastatic cancer—including radiology studies, such as CT scans and ultrasounds; surgical biopsies and bone marrow aspiration—are typically painful, expensive, and detrimental to the patient’s quality of life. “Getting a tumor biopsy before and after therapy is the more difficult route,” says El-Deiry, “compared with a blood test that is a relatively simple and much less invasive way to track the quality and quantity of cancer cells in a person’s body.”

Adds El-Deiry, with evident excitement, “When treating advanced cancers, we need to look for all available information about the specific tumor. Tumor cell analysis, including—but not limited to—CTCs, is rapidly becoming part of a new standard of care for the diagnosis and treatment of this disease.”

From Bench to Bedside

Defining a new standard of care for cancer patients is precisely what senior leaders at PSHCI had in mind when they recruited El-Deiry from the University of Pennsylvania in March of 2010. His reputation preceded him: Among the top 40 most-cited researchers of the 1990s, he is also one of “America’s Top Oncologists,” an American Cancer Society Research Professor, an elected member of the Association of American Physicians, and editor-in-chief of the journal Cancer Biology and Therapy. With a prestigious career in full swing, what was it about the opportunities at PSHCI that drew him to the position?

vial of blood held by hand wearing latex glove
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Today, cutting-edge work in cancer medicine is happening at the interface between clinic and lab.

“A person comes to a certain stage in their professional life when they think of what they’d like to accomplish,” explains El-Deiry. “What really impressed me about Penn State was the major institutional commitment to cancer on this campus as well as a genuinely collegial environment. I felt like I needed to move on to the next stage of my career, work in a collaborative environment and actively guide the best ideas from the laboratory to the clinic. Being at PSHCI allows me to do that very effectively.”

Cancer medicine is in the midst of a paradigm shift, El-Deiry observes. Today, cutting-edge work is happening at the interface between clinic and lab. “Ideally, basic research will be brought into the practice of medicine, and clinical outcomes will feed back into basic research—but this all depends on open lines of communication between researchers and clinicians, as well as a commitment that this is of paramount importance to our mission,” he says.

PSHCI’s new home—the award-winning, four-story, 178,000-square-foot Cancer Center facility, completed in 2009— was designed with this type of communication in mind. Research labs are connected to the main hospital and Penn State College of Medicine to encourage collaboration between patient treatment and cancer research. “Physicians and scientists are closely and regularly interacting,” says El-Deiry, “and what’s more, not all pharmacology departments are interested in cancer, but this one is. Multidisciplinary interactions and collaborations are a necessary cornerstone for successful research as well as for clinical care. Our radiation oncology and surgical oncology are interested in being involved in translational research, and this is an important strength.”

The ability to form strategic partnerships with scientists at Penn State’s other campuses is another asset. “In the Experimental Therapeutics Program, our scientists have been awarded several grants from the National Cancer Institute in the area of nanotechnology. These projects, developed with leading researchers at University Park, are aimed at delivering new cancer treatments to individual cancer cells.”

A Personal Approach

All this interdisciplinary collaboration feeds into PSHCI’s ability to develop and practice personalized medicine, says El-Deiry. “An important aspect of that process is the clinical trial,” he clarifies. Carefully conducted clinical trials are the fastest and safest way to test the efficacy of a new device or drug and demonstrate that new treatments actually work to help people. “We’re fortunate to be in a place that isn’t already saturated with clinical trials that compete with each other for patients,” he adds. “We’re constantly improving our portfolio of clinical trials and want the new treatments to be known and appreciated in the community. We want to continue to make new treatments available for patients especially in those situations when they have no other options.”

hand of doctor holding hand of patient
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No two cancer patients are the same. What works for one patient might not be the right avenue for another, says El-Deiry.

The Institute’s growing number of affiliate relationships with hospitals and health systems across Pennsylvania—including Mount Nittany Medical Center in State College, St. Joseph Medical Center in Reading, Lewistown Hospital, and the Wyoming Valley Health Care System in the Wilkes-Barre/Scranton area—will increase convenient access to clinical trials. “This is the only major academic medical center between Philadelphia and Pittsburgh,” says El-Deiry. “The reality is that patients with cancer in this region no longer have to go to the middle of Manhattan or to Philadelphia or Baltimore to access new diagnostic and therapeutic methods. We’re bringing the best care and new treatments to them right here.”

Novel approaches such as CTC analysis are being tested in clinical trials on an ongoing basis. “I’ve seen some institutions, especially overseas, adopt a philosophy of not doing trials,” El-Deiry says. “Their attitude is 'We’re waiting for other centers to work out the details and then we’ll use the treatments that are developed elsewhere.’” But cancer patients deserve better, he adds. “Our vice dean of the College of Medicine, Daniel Notterman, expresses our institution’s vision well when he asks, ‘How can we harness all the knowledge we have for patient benefit?’”

Ultimately, El-Deiry reflects, personalized medicine just makes sense. No two cancer patients are the same. What works for one patient might not be the right avenue for another. “The more we know about the specific enemy we’re fighting, the better,” he says. “For instance, by employing genetic testing, physicians at PSHCI are individualizing treatment plans for each patient, using just those chemotherapeutic agents that will be most effective in reducing the tumor size and treating the patient’s cancer. Gene mutations tell us what the likelihood is that a particular patient’s tumor will or will not respond to targeted treatment therapies. Genetic tools can also be used to assess a patient’s risk of cancer recurrence.”

“Our task,” El-Deiry concludes, “is to draw upon all the resources of Penn State in order to translate basic discoveries into new treatment approaches, discover better drugs at the right doses, and see more successful outcomes for the people of Pennsylvania who entrust us with their care.”

Wafik El-Deiry, M.D., Ph.D., is the Rose Dunlap Professor and Chief of Hematology/Oncology, Associate Director of Translational Research at Penn State Milton S. Hershey Medical Center, Penn State Hershey Cancer Institute. He can be reached at weldeiry@hmc.psu.edu.

Last Updated February 22, 2012