We treat colorectal cancer (colon and rectal), esophageal cancer, stomach (gastric) cancer, anal cancer, liver cancer, pancreatic cancer, bile duct cancer (cholangiocarcinoma), gallbladder cancer, and neuroendocrine cancer. Our physicians specialize in the treatment of aggressive and complex GI cancers.
Patients with GI cancers benefit from our refined approaches to risk assessment, advances to improve responses to existing treatments, and the development of more effective treatments. The best approach depends on the tumor type, stage, and personal goals.
Our Gastrointestinal Cancer disease group is advancing translational research to bring about new treatments, improve the effectiveness of current treatments, and prevent or lessen treatment side effects.
Our physician-scientists are working to identify mechanisms of sensitivity, resistance, and toxicity to anti-cancer therapies.
Peter Allen, MD runs a laboratory focusing on translational research in the realm of pancreatic disease and cancer. The main focus of the laboratory is studying a cystic precursor lesion of pancreatic adenocarcinoma called Intraductal Papillary Mucinous Neoplasm (IPMN). These cysts can occur in the main pancreatic duct as well as in the branch ducts of the pancreas. These lesions may be present in as many as 10% of people over the age of 70 years and this pathway is presumed to account for 15-20% of pancreatic cancer. Study of this disease affords us the opportunity to potentially prevent pancreatic cancer and gives us insight into the progression to pancreatic cancer.
Gerald Blobe, MD, Ph.D., is the lead physician-scientist for preclinical research.
David Hsu, MD, Ph.D. (Hsu Lab); Michael Morse, MD; Brent Hanks, MD, Ph.D. (Hanks Lab); and Nicholas Devito, MD (Hanks Lab); are engaged in translational research. Andrew Nixon, PhD (Phase 1 Biomarker Laboratory) is engaged in translational research.
Michael Morse, MD, and H. Kim Lyerly, MD, are leading preclinical and translational research into potential cancer vaccines.
Michael Morse and Gayathri Devi, Ph.D., are leading research into therapies to kill cancer cells by enhancing the body’s immune response.
The Hanks Lab, led by Brent Hanks, MD, Ph.D., works to develop novel strategies to enhance the efficacy of checkpoint inhibitors and vaccine immunotherapy while also developing predictive biomarkers to better guide the management of cancer patients with immunotherapeutic agents. The lab's work in gastrointestinal cancers is currently focused on understanding the mechanisms behind immune tolerance and immunotherapy resistance.
The Hsu Lab, led by David Hsu, MD, Ph.D., is working on the identification, characterization, and validation of novel drug targets for colorectal cancer and other GI cancers and is engaged in defining the role of epigenetic profiling of colorectal cancer in drug resistance and the immune system.
Michael Lidsky, MD leads the Hepatic Artery Infusion (HAI) team at Duke, a rapidly growing program to deliver high-dose chemotherapy directly to the liver for patients with advanced primary and secondary liver cancers. HAI entails the surgical implantation of a subcutaneous pump with a catheter that is inserted into the hepatic arterial system, allowing for the delivery of high-dose chemotherapy directly to the liver, typically given concurrently with systemic therapy.
The Phase 1 Biomarker Laboratory, directed by Andrew Nixon, Ph.D., has been appointed as a Molecular Reference Laboratory for the Alliance oncology cooperative group, a national clinical trial research group sponsored by the National Cancer Institute.
Clinical and Correlative Research
Our experienced team of physician-scientists, nurses, and in-patient staff as well as specialists is engaged in protocol development and clinical trial registration.
Our clinical research focuses on and is led by:
Esophageal/GE/gastric cancer (Hope Uronis, MD)
Hepatobiliary cancers (Michael Morse, MD and Caron Jia, MD, PhD)
Neuroendocrine cancer (Michael Morse, MD)
Pancreatic cancer (James Abbruzzese, MD, and Niharika Mettu, MD)
Colorectal cancer (John Strickler, MD, and David Hsu, MD, PhD
Health Services Research
We collaborate in health services research with Duke University’s Margolis Center for Health Policy, Duke Forge (Health Data Science Center), Fuqua School of Business, and the Sanford School of Public Policy.
Clinical Trials Results
We have many gastrointestinal cancer trials open, including for colorectal cancer and cancers of the stomach, esophagus, and other digestive organs.
Please contact the Gastrointestinal (GI) Clinical Trials Office at 919-668-1861 for more information.
Charlotte-area resident Vickie Johnson, 72, was diagnosed with colon cancer in 2018 after seeking care twice for abdominal pain. First, she was diagnosed with appendicitis and had her appendix out. Then, when her pain persisted beyond the recovery period, she received a new diagnosis. A scan at the ER showed a possible tumor. She went back to her appendix surgeon, had the mass in her colon removed, and was referred to a hospital oncologist. He referred her to a second surgeon who performed an even more aggressive surgery to remove all the remaining cancer in her colon and got her started on chemotherapy.Unfortunately, after each chemotherapy infusion she experienced severe chest pain. As she described it, “terrible spasms like I was having a heart attack.” Her oncologist didn’t have a plan b. “Finally, he said ‘I'm sorry, there's nothing I can do. We'll just test your blood every so often and get a scan every six months,’” Johnson shared. She wasn’t ready to give up, and as it turned out she didn’t need to.Johnson’s next area oncologist — Justin Favaro, MD, PhD — who'd done his medical training at Duke, brought a cardio-oncologist onboard the care team. The two providers tweaked the chemotherapy regimen she’d been on with the first oncologist; adjusting the dosage so her heart would be able to tolerate it. That worked, but successive treatments didn’t make any headway against her cancer.Johnson had begun 2019 in treatment for newly diagnosed colon cancer and ended that year with the death of her husband and progression of her cancer. During 2020, she’d endured another chemotherapy regimen but with no success. Cancer metastases remained in her liver and her lungs.Patients with metastatic colorectal cancer who have progressed on standard chemotherapy receive limited benefit from the available standard of care options. Johnson had genomic testing done and it turned out her cancer was hardwired with a KRAS G12C mutation, an alteration found in 3 to 4% of all metastatic colorectal cancer cases. Favaro said there was one more option.In the summer of 2021, he referred Johnson for enrollment in CodeBreaK 101, an early-stage clinical trial (phase 1b/2) at Duke Cancer Institute testing a new approach to treating KRAS G12C-mutated solid tumor cancers — a new KRAS G12C inhibitor drug (sotorasib) in combination with other anti-cancer therapies of choice, including FDA-approved antibodies, immunotherapy, and chemotherapy drugs. DCI was one of the first institutions worldwide to open this trial, which had launched in December 2019.Duke Cancer Institute GI medical oncologist and Associate Professor of Medicine John Strickler, MD, was Duke site principal investigator. Strickler is a colon cancer specialist who co-leads the DCI Precision Cancer Medicine and Investigational Therapeutics Research Program and the Molecular Tumor Board.Johnson said she had “no hesitation” about her decision and was grateful when she qualified for recruitment to the study under the care of Strickler.“This was the option. Nothing else was working,” Johnson recalled.
Duke Cancer Institute physician scientist Brent Hanks, MD, PhD, has been elected to the American Society for Clinical Investigation (ASCI), one of the nation's oldest medical honor societies. The ASCIsupports the scientific efforts, educational needs, and clinical aspirations of physician-scientists to improve health.In 2019, Hanks was first recognized by ASCI with a Young Physician-Scientist Awardin 2019 — one of 35 “outstanding physician-scientists” named that year by the society.“This is a great honor demonstrating the value that Dr. Hanks’ physician-scientist colleagues place on the high quality of his laboratory work designed to understand the mechanisms of resistance to immunotherapy,” said then-Chief of the Division of Medical Oncology James L. Abbruzzese, MD FACP FASCO DSc (hon) at the time. “Dr. Hanks’ work has the potential to extend the impact of immunotherapy to diseases that have not yet been able to take advantage of this new treatment modality.” “I have a ton of respect for the mission of the ASCI and their support for the development and training of future physician scientists,” Hanks said upon receiving the Young Physician-Scientist Award. “I believe the role of the physician scientist to be critical for advancing medicine and healthcare into the future and this type of support is vital for making sure this challenging career path remains viable.” A DCI member since 2013, Hanks is an associate professor in the Department of Medicine and an assistant professor in the Department of Pharmacology and Cancer Biology.He has dedicated more than 20 years of his career to research in the fields of tumor immunology and immunotherapy. In his lab, he explores how cancers have evolved to suppress the generation of tumor antigen-specific immune responses and how to exploit that knowledge to develop more effective cancer immunotherapy strategies. He is working to develop new pharmacologic and genetic strategies to overcome immunotherapy resistance and investigating the mechanisms that contribute to some immunotherapy-associated toxicities. (READ:School of Medicine Faculty Elected to American Society for Clinical Investigation) In addition to managing an independent research lab, Hanks sees gastroesophageal and gastric cancer patients in DCI's Gastrointestinal Cancer clinic. He made the clinical shift to GI towards the end of 2023 after several years of treating patients with skin cancers, particularly melanoma and Merkel cell carcinoma, in order to address the prevalent problem of immunotherapy resistance in these patient populations.Hanks serves as associate director of Basic/Translational Research in DCI's Center of Cancer Immunotherapy.He's currently an investigator on 16 different grant projects — including in melanoma, gastroesophageal cancer, gastric cancer, immunotherapy-associated toxicities, immunotherapy resistance, immune evasion, non-small cell lung cancer, and prostate cancer — including six grants funded by the National Institutes of Health (he's PI on three, and a mentor or preceptor on the other three), one by the U.S. Department of Defense (he's PI), four by pharmaceutical companies (he's the PI on all four),and one each bythe Conquer Cancer Foundation (he's PI), American Association for Cancer Research (he's PI), Cancer Research Institute (he's PI), and Melanoma Research Foundation (he's PI).Hanks received his PhD (2004) and MD (2006) from Baylor College of Medicine, and completed both his residency in Internal Medicine (2008) and fellowship in Hematology/Oncology (2012) at Duke University School of Medicine.
THE GRADUATE Monica Bodd, MD, MTS, at her MD Graduation with Associate Dean for Student Affairs Aimee Chung, MD, her advisory dean (left); her primary Duke Surgery mentor DCI head & neck surgical oncologist Dan Rocke, MD (top right) and clinic staff; and with her proud parents on match day (bottom right).
Monica Bodd thinks a lot about the patient experience and how to make it better — both through research and clinical practice.
While earning her MD and her Masters of Theological Studies degrees at Duke, she learned from some of the best, including Thomas LeBlanc, MD, MA, MHS, Dan Rocke, MD, JD, and Walter Lee, MD, MHS, from Duke Cancer Institute, and from the Duke Divinity School, Warren Kinghorn MD, ThD, Sarah Barton OT, ThD,Susan Eastman, MDiv, PhD, and Kate Bowler, PhD.
Patient experience research in oncology is an investigation of common issues faced by people with cancer, including symptom burden, quality of life, and psychological distress, as well as how patients understand their prognosis and make decisions about their treatment through the various stages of their disease.
“The way I explain it to my friends or to my family, it’s about asking patients how they live and work through their diagnoses on a day-to-day basis, centering their perspective over the perspective of a medical record or a diagnosis or a doctor's words,” said Bodd. “There are validated and quantitative aspects to it, but it’s more about what we wouldn't necessarily capture with our big data and metrics… I believe it’s the redeeming hope for a lot of medicine.”
As Bodd was leaving Duke to begin her residency in Otolaryngology-Head & Neck Surgery at Stanford Medicine this past spring, she spoke with DCI about some of the unique projects she got to work on and co-lead as a medical student and theology student — and the wisdom and practices she’s carrying forward in her medical career from both disciplines.
Social and molecular cancer epidemiologist Tomi Akinyemiju, PhD, associate director ofthe Duke Cancer Institute Community Outreach, Engagement, and Equity (COEE) program, is one of four recipients of a 2023 Michelle P. Winn Inclusive Excellence Award from the Duke University School of Medicine.
Akinyemiju is an associate professor in the Department of Population Health Sciences and associate research professor of Global Health, Duke Global Health Institute. She is also an instructor in the Duke Department of Obstetrics and Gynecology, Clinical Science Departments.
The Michelle P. Winn Inclusive Excellence Award recognizes individuals who have made significant contributions to diversity and inclusion within the School of Medicine community. Nominees should exemplify excellence, innovation, and leadership in helping to create a more diverse and inclusive environment.
Duke Cancer Institute Blog
When Eleanor Scott Bell needed cancer care her doctor sent her to see Duke Cancer Network doctors at Gibson Cancer Center in Lumberton, close to where she grew up as a member of the Lumbee Tribe of North Carolina, "People of the Dark Water."
Eleanor Scott Bell, 79, was born and raised in Lumberton, the capital of Robeson County in North Carolina.One of her earliest memories is of picking tobacco to supplement the family income. They were a family of nine with a large extended family — part of the Lumbee Tribeof NC, "People of the Dark Water."“My daddy was in construction. He did brickwork, but he let us work with the local farmers. I started when I was probably 9 years old standing up on a cinder block handing tobacco to my momma,” she said.Her first full-time job, once she turned 18, was at a local linen supply company. She began working for Temptation Hosiery Mills in Lumberton — maker of L’eggs pantyhose and other Hanes products — after it opened in 1974. Her sister Carolynworked at the large Converse factory in Lumberton, which had opened in a former B.F. Goodrich tire manufacturing facility in 1972 to makeChuck Taylor All-Star shoesand other sneaker styles.In 1970, Eleanor Scott married Travis Bell, also a member of the Lumbee community.In 1977, the couple moved out of their single trailer in a Lumberton mobile home park and bought land and a double-wide further north in St. Pauls — a “Small Town with a Big Heart” located closer to the Fort Bragg U.S. Army base where Travisworked as a barber.St. Pauls and Lumberton were part of the late 19th/early 20th-century textile boom that created mill communities across the Piedmont region of the state. The communities’ prosperity really took off in the 1940s when a big textile corporation purchased several area cotton mills. By 1953, North Carolina was a manufacturing powerhouse,leading the nation in hosiery production.Textiles (including hosiery, clothing, and footwear) were woven into the fabric of many lives in the region. But beginning in the mid-1980s and through the 1990s production shifted to Latin America, China, and Southeast Asia — leaving thousands of workers, including in the Lumberton area, jobless. As noted in theOur Statemagazine article“Heart & Soles,”“if you grew up in the Piedmont in the half-century prior to the mid-’90s, chances are good that someone in your family — your grandfather or grandmother, your mom or dad, your aunts or uncles, your siblings or cousins — worked in a hosiery mill.These days it’s common to find mentions of Temptation Hosiery (bought by the Sara Lee Corporation, then closed in 1994), Kaiser Roth Mills, Converse (whichclosed their Lumberton plant in 2001), and other prominent factories of that era inThe Robesoniannewspaper obituary pages.In 1980, at the age of 37,Eleanor Bell was forced to resign from Temptation for medical reasons. She had developed rheumatoid arthritis in her legs at around age 35 and stayed active — working and attending church on a regular basis — for as long as she could. But after undergoing surgery on her legs,her ankles then hips started “giving out.” She began using a walker, and one day fell and broke her knees. In 1999, she started using a wheelchair off and on to get around and in 2007, at age 64, became a full-time wheelchair user.Her churchprocured her a bed with a remote control that helps lift her up and out of the bed into her electric wheelchair each morning, which has allowed her to stay active.
Daniel Nussbaum, MD, assistant professor, Department of Surgery, Division of Surgical Oncology,is one of 12 young surgeons nationwide to be selected by the National Institutes of Health/National Cancer Institute for the2023 Early-Stage Surgeon Scientist Program (ESSP).Thispilot program brings together surgeon scientists from across the U.S.; building cohorts that will be trained together for up to three years per cohort.ESSP participants are funded through either an administrative supplement to the grantee’sNCI-designated Cancer Center Support Grant (P30)(of which Duke Cancer Institute is a recipient) orComprehensive Partnerships to Advance Cancer Health Equity (CPACHE; U54)to one of the institutions serving underserved health disparity populations and underrepresented students.Nussbaum is also one of four faculty members at Duke to have beenselected to receive a 2023 Physician-Scientist “Strong Start” award.According to the Duke University School of Medicine, the awards program, funded with a gift from the Nanaline H. Duke Fund, supports promising early-career physician-scientists at Duke as they develop independent research programs. Each recipient will receive $75,000 annually for three years to support their research programs.The Strong Start program is administered by the School of Medicine’s Office for Physician-Scientist Development (OPSD) and integrates with other physician-scientist development programs including the Medical Scientist Training Program (MD-PhD students) and the Lefkowitz Society (clinical residents and fellows). Nussbaum, who's a member of theLefkowitz Society,has been an assistant professor of Surgery and a Duke Cancer Institute member since 2021. Previous to Duke, he completed his Surgical Oncology Fellowship at Memorial Sloan-Kettering Cancer Center (2019 - 2021) and a General Surgery Residency at Duke (2011-2019).He earned his MD from the University of Southern California in 2011.The "Strong Start" award will support his research project: "Deciphering Mechanisms of Hepatic Immunity Governing Pancreatic Cancer Liver Metastasis." Nussbaum will be working under thejointmentorship ofPeter Allen, MD, and H. Kim Lyerly, MD, and with collaborators/co-mentors Erika Crosby, PhD, Zachary Hartman, PhD, Joshua Snyder, PhD, and Christopher Counter, PhD.
In a global phase 1/2 clinical trial, sotorasib as a monotherapy “demonstrated meaningful anticancer activity in patients with heavily pre-treated KRAS G12C–mutated advanced pancreatic cancer,” says John Strickler, MD, site principal investigator forCodeBreaK 100and lead author of an article published by theNew England Journal of Medicinelast month on the study results. "It's the largest dataset so far evaluating a KRAS G12C inhibitor in these patients, whose therapeutic options are limited."
Pancreatic cancer has an overall5-year survival rate of 11.5%.
Sotorasib works by targeting the KRAS G12C mutation, which occurs in approximately 1 to 2% of pancreatic cancers.In this study, which evaluated its safety and efficacy as a monotherapy, sotorasib was well tolerated with no side effects that led to treatment discontinuation. The median progression-free survival was four months and the median overall survival was 6.9 months.
“These data support further exploration of sotorasib either alone or with other therapies in this patient population with high unmet medical need,” said Strickler, a Duke GI medical oncologist, associate professor of Medicine, and co-leader of the Molecular Tumor Board and Precision Cancer Medicine and Investigational Therapeutics Research Program at DCI.
Sotorasib is alreadyapproved to treatadult patients with KRAS G12C‑mutated locally advanced or metastatic non‑small cell lung cancer who have received at least one prior systemic therapy. The mutationis much more common in non-small cell lung cancer, where it occurs in 13% ofcases, or 1 in 8 patients with non-small cell lung cancer.
Duke Cancer Institute Blog
Duke Cancer Institute Executive Director Michael B. Kastan, MD, PhD, presents medical student Priya Alagesan, BS, with the Robert and Barbara Bell Award For Basic Science Cancer Research at the 2022 DCI Scientific Retreat.
For the first time since 2019, the Duke Cancer Institute Scientific Retreat was held in person with a full program followed by a poster session and mingling. Held on December 2, 2022, the retreat attracted around 90 faculty, staff, and trainees (students, residents, fellows, postdocs, etc.).There was also a virtual option, which an additional 184 individuals took advantage of — whether out of convenience or caution during a season of rising Covid-19, Flu, and RSV infections.“Good afternoon, everybody. It's a pleasure to welcome you to the ninth annual Duke Cancer Institute Scientific Retreat. It's wonderful to be able to be in person again. I know this is a hybrid meeting, so we don't have everyone here. Maybe 15% of the audience is in person — but this is better than zero," said Executive Director of Duke Cancer Institute and host of the event Michael B. Kastan, MD, PhD. "We have a wonderful afternoon planned with selections of the top abstracts from each of the Cancer Center programs, a faculty presentation by Dr. Epplein that we're very much looking forward to, and then our keynote speaker for the Colvin lecture, Peggy Goodell from Baylor will be wrapping up the afternoon prior to the poster session.”Commemorations of DCI's 50th Anniversary as a National Cancer Institute-designated Comprehensive Cancer Center were in evidence in nearly every presenter’s PowerPoint — emphasizing their pride in the tremendous impact of current and former DCI investigators and clinicians on cancer research and patient care in the U.S. and around the world.Seven DCI Trainee Members — one from each of DCI's seven basic, clinical, and translational National Cancer Institute-Designated Research Programs — were selected by program leaders and the scientific review committee to present their research at the retreat. (Previous to the retreat all trainees were invited to submit, for oral-presentation consideration, an abstract on their research project).Six of the trainees received a $1,000 award from the DCI and the trainee with the most innovative basic-science research project, as is customary at the annual retreat, received the Robert and Barbara Bell Basic Science Cancer Research Award in the amount of $5,000.Each trainee was introduced by either their mentor or a research-program faculty leader and took questions after their presentation. Between affirmations, friendly critiques, probing questions, and ideas for further exploration, there was no debating that the learning was infectious.In three presentations, the learnings were literally “infectious.”Meira Epplein, PhD, MS, MA—co-leader with Katherine Garman, MD,of the National Cancer Institute-designated DCI Cancer Risk, Detection and Interception Research Program (CRDI) — plus two of seven top trainees addressed, each from different angles, the bacterial and viral associations with and molecular drivers of gastric cancer, and potential strategies for both treating it and stopping its development before it starts.Other topics of the afternoon included:a patient experience study on barriers and facilitators to care in Black patients with newly diagnosed leukemia (specifically AML);a pathology/immunochemistry computational mapping study — deep learning — to characterize the features of the immune micro-environment landscape;novel approaches for: targeting fusion-driven rhabdomyosarcomas; targeting glioblastoma stem cells, otherwise known as brain-tumor initiating cells; and making breast cancer more receptive to treatment with immunotherapies by using targeted therapy/vaccinationand a review, by the keynote speaker, of the mechanisms that regulate hematopoietic stem cells and how they go awry in blood cancersGastric Cancer in Focus
Duke Cancer Institute Blog
Pat Smith (center) with her daughters Claibourne and Christine.
In 2016, when Pat Smith first felt a lump on her thigh, she didn't think much about it. But a “just-in-case” MRI led to a biopsy, and then her doctor told her it was a leiomyosarcoma — an aggressive, cancerous tumor.
Smith, who lives in Florida, had never heard of a leiomyosarcoma, and for good reason. They are rare, as are all sarcomas (soft tissue cancers). Leiomyosarcomas grow in the smooth muscles, which are in the hollow organs of the body, such as the intestines, stomach, bladder, and blood vessels.
Smith had gone to the appointment alone because she wasn’t expecting her biopsy results so soon. Stunned, she went home to tell her husband, Randy, and to call her three adult children. Her son impressed upon her that because leiomyosarcomas are so rare, she should get treatment at a center that sees a lot of these types of tumors. Then she remembered that her good friend Andrea Erwin is retired from Duke University and volunteers at Duke Cancer Center. Erwin arranged for someone from Duke to call her that same afternoon.
As it turned out, Duke has a team of 25 specialists focused on sarcomas. Smith had an appointment scheduled in two weeks with David Kirsch, MD, Barbara Levine University Distinguished Professor, and Brian Brigman, MD, professor of orthopaedic surgery, and other providers.
“The greatest thing is that when I met each one of them, no one rushed me,” Smith said. “And they all said, ‘What do you know about your particular type of tumor?’ And they all explained it, and it was like they had all the time in the world,” Smith said.
When she was first diagnosed, she remembers thinking “Why me?” Then she prayed about it. “I said to myself, ‘Pat, God has this. You’ve found a great place to go, and they’re going to take care of you, and you’re going to have a positive attitude.’”
Smith started keeping a “blessings list,” naming all the positive things about her cancer experience. “You really can meet a lot of great people,” Smith said. “I’m originally from North Carolina, and I have connected with old friends.”
Smith had radiation every day for several weeks, staying with her friend Andrea. A month later, she had surgery.
She is now considered cancer free, though doctors at Duke watch her closely. Every three months, she has a CT scan of her lungs, because that’s where this tumor tends to spread. She also has a yearly MRI of her leg. Smith prefers to come to Duke for those screenings.
“I chose to come back to Duke because this is the best place to take care of me,” she said during a visit to Duke Cancer Center. “I walk in that front door down there, and I feel this peace wash over me.”
Since her diagnosis, Smith has welcomed two grandchildren, and she enjoys taking them to the beach. In November 2022, she and her husband, Randy, will celebrate 40 years of marriage.
Pancreatic cancer is one of the most challenging types because it is most often diagnosed in the late stages, when surgery isn’t possible. In 2022, the five-year survival rate for the disease is 11%, a slight increase from last year, according to the American Cancer Society.
To make outcomes better, researchers around the world are trying to find a marker from blood or some other bodily fluid that would reliably diagnose pancreatic cancer in its early stages, said Jim Abbruzzese, MD, Duke Cancer Institute Distinguished Professor of Medical Oncology. Abbruzzese sees promise in a test that has been studied in the lab of Chris Counter, PhD, George Barth Geller Distinguished Professor of Pharmacology. Abbruzzese and hematology/oncology fellow Ryne Ramaker, MD, PhD, are beginning work to translate it to patients.
Counter’s lab tries to capture the moment when a normal cell progresses to a tumor, then study it. Even in a cancer with lots of successful treatment options, like melanoma, the best bet is still finding the disease early, said Counter, whose mother-in-law Linda Woolfenden died of melanoma. It’s even more important in a challenging disease like pancreatic cancer.
Siqi Li, PhD, now a Damon Runyan fellow at Fred Hutchinson Cancer Research Center, was a PhD student in Counter’s lab when she became intrigued by a method called maximum-depth sequencing, which was developed by researchers in the lab of Evgeny Nudler, PhD, at New York University to detect mutations that lead to antibiotic resistance in bacteria.
“Siqi saw the parallels between bacteria and cancer, and she was very interested in using this assay in mammals,” Counter said. “So she adapted this assay with the help of the lab of Dr. David McAlpine here at Duke for the mammalian genome to capture mutations causing cancer.”
Counter’s team found that this technology captures mutations that are too few and far between to be detected by traditional next-generation gene sequencing. “The assay was so sensitive, that Siqi was able to detect a cancer-causing mutation a week after mice were exposed to an environmental carcinogen,” Counter said. The team published results of this work in 2020 in the journal Nature Communications and in 2022 in the journal eLife. The studies were supported in part by a Duke Cancer Institute pilot grant, a program sustained by donor funds.
The test holds promise not only because of its sensitivity, but also because it’s specific to KRAS, a gene commonly mutated in pancreatic cancer, Abruzzese said.