Working Together to Build a Program: Multiple Myeloma Care at the UW Carbone Cancer Center
When it comes to multiple myeloma patient care and research, the UW Carbone Cancer Center’s bench to bedside is not unique – all comprehensive cancer centers take this approach.
What is unique? Carbone Cancer Center’s relatively small size has actually been a boon to collaboration, allowing a diverse group of physicians and researchers to create a formidable team. Together, they have made great strides in multiple myeloma research and care, with even more on the horizon.
“Many larger universities really struggle to get people from different disciplines together,” said Natalie Callander, MD, a hematologist at the Cancer Center who specializes in treating multiple myeloma patients. “Here, we have PhDs and physicians and pathologists working together, and our different viewpoints enhance everything we do.”
Multiple myeloma is a blood cancer that affects 30,000 new patients each year. For most patients, there is no cure; chemotherapy and bone marrow transplants can lead to remissions, the lengths of which vary based on the number of prior treatments and how a patient responded. Not even ten years ago, the median survival was five years. Today, it is around nine years.
“That’s very good news, but myeloma drugs are very expensive,” Callander said. “I’m interested in, how do you treat patients in an effective but cost effective way?”
Prior to 2003, there was little research happening at the Carbone Cancer Center on the disease. However, several generous and forward-looking patients with myeloma established the Trillium Fund to support myeloma research. Callander arrived in 2004 and was introduced to Cancer Center members Shigeki Miyamoto, PhD, Alan Rapraeger, PhD and Peiman Hematti, MD. Callander said none of them were specifically working on multiple myeloma at the time, but they were conducting research that was closely linked to the disease.
“Shigeki was originally studying a breast cancer pathway that is dysregulated in 90 percent of myelomas,” Callander said. “Alan had for years been studying a signaling protein called syndecan-1, which turns out to be on nearly every myeloma cell, and Peiman had expertise in stem cells and macrophages. We sat down and said, ‘Let’s pool our strengths and see what we can come up with.’”
Ten years ago, the team developed what turned out to be a game-changing plan: the development of a myeloma tissue bank. In typical tissue donations, patients consent to donate biopsy tissue beyond what is needed for their treatment and diagnosis. For the myeloma bank, patients generously consent to a second, painful bone marrow biopsy. This second tissue sample is then made available to Carbone Cancer Center researchers and linked to patients’ clinical outcomes.
“That was gold for us,” Miyamoto said. “With patient samples, we can learn how they are so different from patient to patient, which we cannot do nearly as well with established cell lines in the lab.”
Miyamoto uses these samples to investigate how the tumor microenvironment influences cancer development and progression. He has found that the non-cancerous, healthy cells that interact with the myeloma cells contribute to chemotherapy resistance. He and Cancer Center member Dave Beebe, PhD have developed a microfluidics device that mimics the tumor microenvironment. They can test drug combinations on tissue samples and predict, in a matter of days, which next therapy is likely to benefit the patient.
Both the team approach and access to the myeloma tissue bank contributed to bringing Fotis Asimakopoulos, MD, PhD, to the Carbone Cancer Center in 2010. He is a physician scientist who treats and studies multiple myeloma.
“I came to UW because I could clearly see the potential for great work and rapid progress,” Asimakopoulos said.
Asimakopoulos brought with him more invaluable resources: a mouse model of multiple myeloma, the expertise to work with it and a research focus on cancer immunotherapy. His group is looking for ways to mobilize the immune system to attack cancer cells. They also want to understand why cancer cells are protected from chemotherapy, which complements Miyamoto’s work on drug resistance.
In addition to lab research, Callander, Asimakopoulos and their newest colleague, Dr. Aric Hall, lead of the Cancer Center's myeloma clinical research team. That team develops their own clinical trials and partners with other cancer centers or pharmaceutical companies to bring national clinical trials to Wisconsin. These trials give patients access to breakthrough treatments, helping advance multiple myeloma patient care.
“I’m thrilled to be at UW,” Callander said. “We really feel like we’ve built something special here.”
Date Published: 09/07/2017