She’s emphatic. “It’s so, so critical—no two cancers are the same!”
Dr. Gabriela Chiorean deals with pancreatic cancer, a cancer type usually kinder, surprisingly, to older people than younger ones. Like any cancer though, its severity and development differs greatly depending on both internal factors like genetic predispositions and types of metabolism and external factors like stress, diet, exercise, and toxic exposures.
Tumor tissues themselves hold many of the keys to understanding pancreatic cancer—many genetic and biomarker questions can be answered, for example, by sequencing cancer tumor cells.
“But we can’t just collect tissues without clinical data,” Chiorean explains. “You need to know what patients did in their life, when did their cancer return, why did it spread?” That’s why annotation—attaching de-identified medical records data—to collected tissue specimens is so crucial. With medical data attached to the information the tumor itself carries, clinicians and researchers know much more about why a given patient may live longer than another, what treatments might work better, and, ultimately, how to personalize cancer care.
A broad spectrum of annotated specimens helps researchers spot the differences in cancer patterns that emerge within a population. Survival profiles, exposure profiles, and toxicity profiles can be plotted, along with profiles for drug response and cancer prediction.
“It’s crucial to have these samples collected,” Chiorean says. “It’s absolutely a goldmine.”
Chiorean has poured herself into developing early screening techniques to catch those at high risk for cancer quickly. Working with biochemists, engineers and statisticians, among others, Chiorean has helped link technology to biology in clinical trials. Her studies have investigated why certain patients get cancer while their family members sharing the same environmental exposures do not.
In her work in Indiana she collected pancreatic cancer cells and blood from patients, plus specimens from healthy family members related by blood, and cells from unrelated family members (in-laws) sharing the same environment but not the same genes. Study participants also filled out extensive questionnaires about their lives. This let Chiorean peer into details about exposures, oxidative stress, DNA repair mechanisms, metabolization, and medical treatments that could impact whose cells turned cancerous and whose remained untouched.
Patients, she says, were eager to donate. Maybe not at first, when immediate treatment was their primary concern, but certainly once they understood how their blood, urine, and tissue specimens could help map cancer mechanisms and detect cancer earlier.
Her current study proposals always include requests for tumor biopsies so she has tissue specimens to work with when testing new drugs. A drug’s success depends on the drug being able to hit the correct molecular targets, and finding the right targets depends on detecting the minute molecular differences between different people.
Chiorean is a Sherlock Holmes of sorts, noticing the little details that add up to larger patterns.
“It’s how we make progress to change cancer care,” she says.
Trust, she says, is also important. Patients should feel free to ask questions about the studies that use their tissues. They should know their options and the promise and limitations of new drug developments. Study results should be given back to patients—even if the result isn’t positive, it does help advance research. “They are so empowered by the fact that they contributed,” Chiorean says.
Fairly new to FHCRC and the Puget Sound area, Chiorean is now searching locally for annotated pancreatic and GI-tissue specimens for new therapeutic trials.