February 6, 2019

UAMS Researchers, Clinicians and Patients Collaborate to Advance Cancer Research

The past two decades have seen unparalleled advances in cancer therapies. Where patients with many types of cancer were once given a grim prognosis, many now go on to live long and productive lives.

These life-extending treatments are undoubtedly blessings for patients and their families, adding years to their time together and offering them the chance to remain active and functioning members of society.

However, while these research advances have positively impacted thousands, there are countless others with advanced-stage or complex disease for which a research breakthrough has yet to emerge.

These are the people who inspire researchers like UAMS’ Alan Tackett, Ph.D., to push forward in search of new and better ways to prevent, diagnose and treat cancer.

Tackett’s focus on metastatic melanoma is particularly vital, as about 91,270 Americans – including 670 Arkansans – were diagnosed with the deadly form of skin cancer in 2018. While not all of these cases will metastasize, or move to other areas of the body, for those that do, treatment options are limited and often unsuccessful.

While new immunotherapies, such as the drugs Keytruda and Opdivo, show tremendous promise for many patients, others fail to receive the same favorable outcome. Immunotherapy uses drugs to stimulate a patient’s own immune system to recognize and destroy cancer cells.

“About half of metastatic melanoma patients become cancer free with the use of immunotherapy. While that’s a significant and intriguing advancement, we are interested in finding out why the other half of patients don’t respond in the same way,” said Tackett, professor of biochemistry and molecular biology in the UAMS College of Medicine.

To that end, Tackett’s team utilizes a new collaborative system developed at UAMS for the sole purpose of providing scientists with the fresh tissue specimens needed to advance their research.

Before this online system was established in 2017, Tackett and other UAMS researchers were limited to the use of archived tissue specimens stored in the UAMS Tissue Biorepository and Procurement Service (TBAPS).

Moving Research Forward

Housed in the UAMS Winthrop P. Rockefeller Cancer Institute, TBAPS provides researchers with a mechanism for collecting, processing and storing tissue specimens needed for research purposes. While the facility’s archived tissue samples are a valuable resource for many projects, the ability for Tackett to receive fresh specimens taken immediately from the operating room to be assessed by a clinical pathologist and then transported to his lab in the UAMS Biomedical Research Center increases his capabilities exponentially.

“Getting fresh tissue out of surgery and into our lab very quickly is key. This gives us the ability to sort it into individual cell populations and analyze it in ways that are difficult to do with older, fixated tissue,” he said.

Tackett’s research relies on the use of metastatic melanoma tissue removed during surgery at UAMS Medical Center. While melanoma sometimes metastasizes to an inoperable part of the body, such as the brain, it spreads in other patients to areas of the skin, where it can be surgically removed. In these cases, Tackett relies on surgical oncologists, such as J. Camilo Barreto, M.D., to identify appropriate patients, gain their consent to donate tissue and ensure it is provided fresh to Tackett’s lab.

“When I have a melanoma patient whose tissue could be beneficial in research, I will either determine if that patient has already consented to donate or speak to them about their interest in doing so. If they consent, I contact Dr. Tackett in advance of the surgery, so he is prepared to receive the sample,” said Barreto, assistant professor of surgery in the UAMS College of Medicine.

To further facilitate this process, de-identified patient information is entered into a password-protected program alerting researchers of upcoming surgeries that could result in valuable tissue samples.

“Surgeons are the primary source for tissue samples, so we have a unique opportunity to collaborate with scientists and help facilitate research,” Barreto said.

This digital system, which was developed at UAMS, is not commonly found at other academic medical centers, but plays an essential role in the advancement of cancer research.

“This service has been highly impactful for my lab, and puts us in an excellent position to be competitive on a national level for grant funding,” said Tackett, who holds the Scharlau Family Endowed Chair in Cancer Research at UAMS.

The Consent Process

New patients at the UAMS Cancer Institute are approached in the early stages of treatment about their interest in becoming a research partner by donating a portion of their surgically removed tumor, or other specimen, such as blood or urine, either at that time or any time in the future.

If a portion of tissue is donated to research, it never affects a patient’s level of care, impedes the ability of pathologists to properly diagnosis their disease, or alters any methods or techniques used by the surgeon, said Mindy Gibbons, a registered nurse practitioner and TBAPS clinical services manager.

The procurement of donated tumor tissue does not require any type of additional procedure, but simply makes use of a portion of the tissue that was removed during the normal surgical process. Patients who agree to donate blood, however, have an extra vial drawn during their routine blood draw procedure.

Those who are interested in participating in research are told about the process, safety measures and potential long-term benefits for future patients.

“Through research, we attempt to gain knowledge about how cancer behaves and to find better targets for more effective therapies down the line. Patients who are willing to donate their tissue are a vital part of this process,” Barreto said.

For the patient, the risk of any harm from participation in research is extremely low.

All personal information is de-identified throughout the process, and the research team has no idea from whom the tumor sample was removed.

“We go over a series of questions and explain everything thoroughly to the patients, so they completely understand what is involved. Participation in research is voluntary, and patients can call us at any time to withdraw their lifetime UAMS consent if they change their mind,” Gibbons said.

In addition to the collaboration between scientists, surgeons and patients, other key members of the team include the pathologists who initially handle the tissue and confirm the patient’s diagnosis and the medical oncologists who treat the patient and monitor their outcome.

It is this joint effort that ensures research findings will continue to advance and push the boundaries of what was previously thought possible for patients with cancer.

“It’s not only about receiving the fresh tissue samples. It’s also about this important clinical interaction. Working together throughout this process, we gain a better idea of how to design or improve therapies for patients, which is our ultimate goal,” Tackett said.