April 1, 2016:

A conversation with Theodore Lawrence, MD, PhD, director of the University of Michigan Comprehensive Cancer Center, professor and chair of the Department of Radiation Oncology, and a member of the Big Ten Cancer Research Consortium.

Q: How do you think cancer research will change in the next 10 to 20 years?

There has never been a more exciting time to do cancer research.

Over the next 10-20 years, I expect that immunotherapy will continue to advance. We’ll start to see greater clarity in patient selection and in combining immunotherapies with other therapies.

Metabolomics is another exciting area of research, and I anticipate that the biological discoveries in this area will begin to be translated into new treatments. Likewise, our growing understanding of the interaction of the microbiome with the causes and treatment of cancer will produce new ways of decreasing the toxicity and increasing the efficacy of cancer treatments.

Biostatistics and bioinformatics are already central to much of our research, and the contributions of these fields will continue to grow. We’ll see a greater emphasis and opportunity to use mobile technologies to record patient reported outcomes.

There will be challenges as well. Our increasing understanding of tumor heterogeneity means that almost all diseases are becoming “orphan” diseases. When I was a medical oncology fellow and a radiation oncology resident, lung cancer was either “small cell” or “non-small cell.” Therefore, you could design a single trial that would apply to large group of patients. Now our protocols are, for example, “erlotinib-resistant EGFR mutated lung adenocarcinoma.” That’s so much more specific of a patient population, and we expect to accrue only a few patients a year. But it’s the same effort in protocol writing and start-up. While I am excited that our outcomes continue to improve, it is certainly a challenge to our clinical trial implementation.

Q: What does translational science look like within your institution and in your collaboration with other Big Ten CRC member institutions?

Translation comes in many forms within the University of Michigan Comprehensive Cancer Center. A substantial amount of work goes on in developing new agents, some of which are now in the clinic. We also have many investigators carrying out preclinical studies of agents that are about to enter clinical trials.

We have a major translational effort in blood biomarker development, particularly for circulating tumor cells, cell free tumor DNA, microRNAs, cytokines and exosomes. Imaging plays a key role as a biomarker as well, particularly for radiation oncology, since advanced imaging techniques can reveal tumor heterogeneity that can be targeted for treatment.

The key to all of this is team work, which is fostered by our Cancer Center. In addition, we invest substantially in pilot funding for the laboratory side of translational research, as well as in support for translational clinical trials.

But we can’t do this alone, which is why collaborations such as the Big Ten Cancer Research Consortium are so valuable.

Q: In what ways is your institution involved in expanding access to clinical trials throughout the communities you serve?

We are now undertaking a major effort to move more clinical trials into the community. Certain trials are best run at our main campus, but others could be carried out in a community setting. This would allow patients to receive care closer to home but also to benefit from participating in clinical trials. This is a shift for us. We have traditionally focused on studies at our own medical campus. I expect to see significant growth in community trials in the future, in collaboration with our NCORP partners in our region.

Q: How is the Big Ten CRC unique from other research consortia in which you participate?

The Big Ten CRC provides an opportunity for us to work with other sophisticated cancer centers to perform cutting edge clinical research that cannot be carried out by a single institution. As we subdivide diseases more and more, even large institutions cannot enroll enough patients to answer key questions.

In many of these studies, it is necessary to obtain tissue to test for markers of response. This is a sophisticated process that is better supported at academic medical centers. The Big Ten CRC is unique because it brings together these elite academic medical centers that are able to carry out the most sophisticated studies – and it allows us to coordinate multi-institutional research, which means a larger, more diverse pool of patients who might enroll in trials.

Furthermore, the Big Ten CRC should provide educational opportunities for the next generation of clinical researchers by involving them in these innovative clinical trials.

About the Big Ten Cancer Research Consortium: The Big Ten Cancer Research Consortium was created in 2013 to transform the conduct of cancer research through collaborative, hypothesis-driven, highly translational oncology trials that leverage the scientific and clinical expertise of Big Ten universities. The goal of the Big Ten Cancer Research Consortium is to create a unique team-research culture to drive science rapidly from ideas to new approaches to cancer treatment. Within this innovative environment, today’s research leaders collaborate with and mentor the research leaders of tomorrow with the unified goal of improving the lives of all patients with cancer.

About the Big Ten Conference: The Big Ten Conference is an association of world-class universities whose member institutions share a common mission of research, graduate, professional and undergraduate teaching and public service. Founded in 1896, the Big Ten has sustained a comprehensive set of shared practices and policies that enforce the priority of academics in the lives of students competing in intercollegiate athletics and emphasize the values of integrity, fairness and competitiveness. The broad-based programs of the 14 Big Ten institutions will provide over $200 million in direct financial support to almost 9,500 students for more than 11,000 participation opportunities on 350 teams in 42 different sports. The Big Ten sponsors 28 official conference sports, 14 for men and 14 for women, including the addition of men’s ice hockey and men’s and women’s lacrosse since 2013. For more information, visit www.bigten.org.