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Story of a CU Anschutz-driven breakthrough

Nichol Miller and family

Under the sunny skies that return to Portland, Ore., every summer, Nichol Miller is enjoying a life of family and purpose. The mother of three soaks in the milestones of graduations, weddings and anniversaries as well as the simple pleasures of seeing her kids head off to school and her husband come home from work.

All this seemed improbable just a few years ago – even impossible. Stricken with an aggressive soft-tissue sarcoma that started in her hip flexor and quickly spread to her lungs, Miller traveled to Denver to participate in a clinical trial of an experimental therapy.

She called it her “hail Mary.”

Breakthrough in the making

At the CU Cancer Center at the CU Anschutz Medical Campus Miller met Robert Doebele, MD, PhD, associate professor of medicine, CU School of Medicine, who had found – thanks to an immortal cell line donated by another cancer patient – the abnormal gene NTRK1 in the cancer of that patient, who also happened to be a mother of three children.

Doebele’s discovery set the stage for a breakthrough therapy.

Nichol Miller and Robert Doebele
Nichol with Dr. Robert Doebele at the CU Cancer Center after undergoing the successful clinical trial drug for her aggressive cancer in 2015.

“The finding of an NTRK1 gene fusion in the lung cancer patient made me want to develop a therapy for patients with this type of genetic mutation as none had existed beforehand,” he said. “This led my lab to perform a number of experiments demonstrating that this gene was cancer-causing and, importantly, that cancer cells with this gene could be inhibited with a selective TRK inhibitor called ARRY-470, now better known as larotrectinib.”

When Miller arrived at the CU Cancer Center, breathing was almost impossible without five litres of oxygen per minute. Put on the targeted-therapy drug in spring 2015, called LOXO-101 at the time and taken orally as a pill, Miller showed immediate improvement.

FDA approves targeted-therapy drug

Miller still takes the drug, now commercially known as Vitrakvi, on cycles that start every 28 days. During the cycles ­– she’s currently on her 56th – Miller takes the pill twice a day, and will continue doing so for the rest of her life.

She and her family celebrated when the Food and Drug Administration (FDA) approved Vitrakvi last November.

Early on in the development of targeted therapies, Doebele said, researchers saw examples of cancers such as EGFR mutation-positive lung cancer in which mutations seemed to occur in only one type of cancer, or that perhaps a therapy would only work on a mutation when it was found in certain types of cancer.

“When we started planning the clinical trial (of LOXO-101) I had the idea, based on data from our laboratory showing that lung, colon and leukemia cells responded to therapy as long as they had the right genetic fusion in an NTRK gene, that we should include any tumor type as long as it had an NTRK gene fusion,” Doebele said.

Drug attacks the genetic markers in cancer

Because Miller’s tumors had this specific gene fusion, the therapy had the desired effect: her lung tumors began to shrink and disappear and tumor markers in her blood showed dramatic declines. The drug works by targeting the proteins that are abnormally turned on by a gene fusion event. It essentially kills the cancer or stops it from growing.

“The term is ‘tumor agnostic,’ and that’s part of what’s unique about this drug,” Miller said. “It’s not linked to a particular cancer, or where a cancer is found in the body, but linked instead to the genetic markers in the cancer.”

Now her life is marked by milestones.

‘Lab saved my life’

This spring, Miller, 46, got to see her oldest son get decked out for prom and then graduate from high school. For her birthday in March, she and her husband enjoyed a week in Florida – the first time in 18 years of marriage they vacationed without their children.

Nichol Miller is now a cancer patient advocate, frequently speaking in her home state of Oregon as well as during a recent trip to Denver. Here, she is pictured with fellow presenters at an Oregon Health & Science University panel. Pictured from left: Lara Davis, MD; Miller; Summer Gibbs, PhD; and Shannon McWeeney, PhD.

“I wouldn’t be talking to you without (the clinical trial at the Cancer Center),” she said. “It was huge. It was my miracle. It gets easier with time, but I still think about how close I came (to dying), and it makes you appreciate everything so much more and gives you a lot more patience.”

Miller likes to say “the lab saved my life” because she gives full credit to the important cancer studies being performed by researchers at the CU Cancer Center as well as, closer to her home, the Oregon Health & Science University. The gene mutation found in her cancer is very rare; only 1 to 3 percent of all solid cancers have the NTRK1 mutation.

“I wouldn’t be here without the all the work of the researchers and the doctors who are trying to solve the cancer puzzle.” – Nichol Miller

“I wouldn’t be here without the all the work of the researchers and the doctors who are trying to solve the cancer puzzle,” she said. “The genetic testing that found my alteration is incredibly important because the chances of finding something are rare, but for that one person it’s life or death. It’s a new way of looking at cancer.”

When physicians do genetic testing on a patient, Doebele said, they look not only for a specific mutation, such as NTRK, but rather a host of other rare genetic events that may already have, or may soon have, effective therapies.

A standout clinical trial

The clinical trial he administered to Miller stood out for a number of reasons. A key part was the 46-year-old mother who had never smoked but, by 2012, had developed metastatic lung cancer. Unfortunately, at the time there were no drugs available that could treat her illness. Before she died, the woman gave Doebele a sample of her tumor to grow an immortal cell line that could be used for further research and to test drugs against this type of cancer.

Nichol and Marc Miller
Nichol and her husband, Marc, take in the sunset at the Snake River gorge in Twin Falls, Idaho, on their return trip home from the clinical trial in Aurora in 2015. “We knew the drug was working,” Nichol says.

Her donation ended up helping another young mother, Miller, and potentially countless patients in the future.

“Her sacrifice and forethought is something I’m so grateful for,” Miller said of the patient who donated her cells. “I know that’s something people are working on at a national level – to make it easier for people to donate genetic material for research. There’s a lot of valuable information that just goes into the incinerator.”

And that’s another part of Miller’s clinical trial that stands out.

It shows how an understanding of cancer biology can reveal genetic markers which are tested in human tumors, thereby accelerating potential therapies to target the cancers, Doebele said. “We identified NTRK1 in lung cancer in 2012, published the initial laboratory findings in 2013 and 2014 and had started the trial by early 2014 with an FDA approval only a few years later in 2018.”

‘There’s always hope’

For Miller, telling her story and furthering the cause of genetic testing is now a big part of her purpose. She recently returned to Denver as a featured speaker at the “Stupid Cancer” conference, and she frequently shares her story at other venues as a patient advocate.

“My story is unique, and it’s a good story for giving people hope,” Miller said. “I read a lot of survivor stories and they’re what kept me going – knowing there’s always hope.”

Mainly, she’s joyful to share in the life of her family, and seeing her teenagers grow into healthy and happy adults.

“Ultimately, I’d like my children to grow up into a world where there is no longer a fear of cancer,” Miller said. “It doesn’t have to be a death sentence.”

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Tanning industry uses promos, cheap prices to lure adolescents and young adults

Woman laying in tanning bed

It’s well-known that cigarette smoking causes cancer and as a result, prices and advertising are closely regulated to discourage youth from starting.  But another cancer risk, indoor tanning, shown to cause melanoma, lags in regulation.

Researchers at the Colorado School of Public Health have found that the tanning industry uses marketing strategies that appeal to adolescents and young adults, including unlimited tanning packages, discounts, and even offering free tanning when paired with other services like an apartment rental or gym membership.

“This study highlights the fact that a lot of businesses out there are providing this service at a low cost which removes a barrier to adolescents and young adults,” said Nancy Asdigian, lead author of the study and a research associate in the Department of Community and Behavioral Health at the Colorado School of Public Health. “Young people who want to tan do so when they can afford it and don’t when they can’t.  The industry capitalizes on this with the strategies they use to price and promote this risk behavior.”

The study was published this week in the Journal of Public Health Policy.

According to the Global Burden of Disease Study, about 352,000 people worldwide were diagnosed with potentially deadly melanoma in 2015. That includes 81,000 cases in the U.S.

High profile public health and policy efforts along with state age restrictions have helped decrease the prevalence of indoor tanning among youth, but the study said levels remain  `unacceptably high.’

The researchers posed as customers and contacted tanning facilities in Akron, Ohio, Denver, Colorado, Austin, Texas, Boston, Massachusetts, Portland, Oregon and Pittsburgh, Pennsylvania. These cities were selected because they represent a variety of climate and geography as well as a range of stringency of state indoor tanning laws.

Of the 94 tanning places they contacted, 54 were primary tanning salons, and 40 were ‘secondary facilities’ that offered indoor tanning secondary to some other service like hair styling or physical fitness.

The study found that indoor tanning was free at 35 percent of secondary facilities. Nearly all apartments with tanning offered it free compared to 12 percent of gyms. Free tanning was most common in Austin.

Nearly all primary tanning salons offered time-limited price reductions.

“Many provide promos geared toward young adults. They offer packages that incentivize more frequent tanning. The more you use them the cheaper tanning becomes,” Asdigian said. “Everyone wants to get their money’s worth. When you buy a ski pass, you want to ski as much as possible.” In some cases, an individual tanning session could cost as little as $1 if the customer buys an unlimited monthly plan and uses it frequently.

Some countries, including Brazil and Australia, have banned indoor tanning salons altogether. The U.S. imposed a 10% tax on indoor tanning in 2010 and 19 states and the District of Columbia have enacted complete bans on indoor tanning for those under age 18.

But few of these policies have focused on the advertising, promotions or pricing practices of these facilities.

“A next step is to work with policymakers to restrict the use of discounts and deals to lure customers,” said Lori Crane, PhD, MPH, the study’s senior author and professor at the Colorado School of Public Health.

Another strategy would be to eliminate tanning provided in apartment complexes and fitness centers where tanning services are often free and less likely to be licensed and inspected by local regulators.

Asdigian said it’s important to understand the connection between pricing and the use of indoor tanning.

“In this study we described the costs and promotions,” she said. “An important question to answer is how variability in pricing impacts behavior. Establishing that link is an important step.”

The study co-authors include: Yang Lui; Joni A. Mayer; Gery P. Guy and L. Miriam Dickinson.

 

 

 

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Wellness Center teaches people how to improve their health through nutrition

Cooking at CU Anschutz Health and Wellness Center

When the University of Colorado Anschutz Health and Wellness Center piloted a series of cooking classes to educate the community about the importance of nutrition and health, organizers did not expect it to grow into one of the most popular programs offered on the CU Anschutz Medical Campus.

The Culinary Medicine Series features weekly cooking demonstrations of recipes that are healthy and nutritious for those with chronic illnesses such as cardiovascular disease, diabetes and cancer.

Lisa Wingrove, RD, CSO, a registered dietitian who specializes in nutrition for oncology patients, recently led a session on how to make a butternut squash mac-and-cheese dish geared for cancer patients. She shared basic cooking techniques and other methods for cooking for those with cancer.

“When someone has cancer or is going through chemotherapy treatment, sometimes the foods they liked before are not appealing anymore because certain smells become unappetizing,” said Wingrove.

What is Culinary Medicine?

As a new evidence-based field, culinary medicine blends cooking and medicine to help people access high-quality meals that help to prevent and treat disease. The Culinary Medicine Series, created in partnership with the UCHealth Digestive Health Center, the Integrative Medicine Center and the CU School of Medicine’s Department of Internal Medicine, provides members of the Aurora community as well as faculty, staff and students of CU Anschutz with nutrition resources.

Lisa Wingrove, RD, CS
Lisa Wingrove, RD, CSO

“Many of the attendees of the classes are caregivers, patients or members of the community as well as staff or students on campus,” said Wingrove.

The concept of culinary medicine was created by John La Puma, MD, a physician who recognized a need for further nutrition education for both physicians and patients. According to La Puma, physicians need to learn how to prescribe food as medicine, and patients should become more educated about what foods can help beat disease.

“Many physicians don’t learn about   nutrition in medical school, but it is something that can help people live better with chronic illness,” explained Wingrove.

Learning about nutrition

The Culinary Medicine Series gives anyone the knowledge to eat well and provides a resource to those struggling with chronic illness. “Nutrition is an evidence-based science, so we offer recipes that are beneficial to those living with chronic illness,” she said.

According to Wingrove, the recipes taught are alternatives to classic recipes and are meant to be more palatable for those with additional dietary restrictions.

butternut squash
This butternut squash mac-and-cheese dish is geared for cancer patients.

“One of the goals of the sessions is to provide participants with alternatives while maintaining the flavor of their favorite dishes. A lot of the foods we cook include ingredients that you might already have in your kitchen,” said Wingrove.

The sessions are also intended to be interactive, giving participants opportunities to ask a dietitian questions.

“People come here who have never cooked before,” said Wingrove. “We want to make this an approachable environment where participants can feel comfortable asking us questions so they can learn new skills.”

As medicine continues to advance, so will treatment options. According to Wingrove, it will become more important to incorporate nutrition into treatment plans for patients with chronic illness.

“A lot can be gained from using nutrition as a treatment. For cancer, that means providing patients with a plant-based diet with lean proteins and helping maintain a healthy body weight,” said Wingrove.

The next class for cancer care in the Culinary Medicine Series taught by Lisa Wingrove takes place on March 12. To register, visit the series website.

For the butternut squash mac-and-cheese recipe, click here.

Guest contributor: Katherine Phillips

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What’s on the horizon of artificial intelligence and health care?

Artificial intelligence panel

The explosion of big data promises potential breakthroughs in disease treatments, but, just as in the development of new drugs, scientists and clinicians must exercise caution in how they apply algorithms and other technologies, according to a CU Anschutz panel of experts.

The discussion on “What’s on the Horizon of Artificial Intelligence (AI) and Health Care?” kicked off this year’s series of Transforming Health Care lectures at the CU Anschutz Medical Campus. About 80 people attended the session in Krugman Conference Hall on Wednesday. The panel was made up of Lawrence Hunter, PhD, director of the Computational Bioscience Program in the CU School of Medicine (SOM); Foster Goss, DO, clinical informaticist and assistant professor of Emergency Medicine; and Clay Smith, MD, director of the Blood Disorders and Cell Therapies Center at University of Colorado Hospital and associate chief, Division of Hematology, SOM.

Hunter outlined examples of how machine-learning systems are used in health care. The outcomes show mixed results: while some systems delivered illuminating data that helped clinicians, other instances revealed a machine’s inability to understand the nuances involved in, for example, a basic blood draw. “The goal is not to replace doctors, but to augment them — help them do a better job and spend less time doing boring stuff and more time on doing the things that really matter to patients,” he said.

Algorithmic snake oil?

Only 100 years ago, Hunter reminded the audience, “snake oil” was often passed off as “medicine.” Just as the Food and Drug Administration (FDA) certifies new medicines as safe and effective, the same process should apply to AI, he said. “These algorithms aren’t magic … It’s really important that we treat them the same way we treat all other aspects of medicine: make sure they’re safe and effective.”

Goss, a physician in the Emergency Department, has studied how the documentation demands of electronic health records (EHR), which are intended to improve patient outcomes, can actually create problems for physicians. In one case, he said, the large amount of “free text,” or unstructured data, in a patient’s EHR resulted in a clinician missing the man’s allergy to a particular drug.

In another case, speech-recognition technology — commonly used by clinicians when dictating information into an EHR — took a doctor’s “missed-her-period” comment on a patient and translated the menstrual “period” into a simple punctuation mark. So, when the patient had a complication, her subsequent physician misread the woman’s condition and prescribed a drug that’s dangerous to pregnant women.

Developing AI tools

Goss, along with colleagues, is working to develop an AI tool that can detect errors before they are entered into the electronic record. They are also working on a standardized knowledge base of allergies and reactions, which could be applied in an easily-found fashion in the EHR.

He is also working on a universal tool to help clinicians quickly identify all information in the EHR that’s relevant to a patient’s presented condition. The goal is to ensure that clinicians can make the right care decision at the right moment.

‘Medical errors are the third-leading cause of death behind heart disease and cancer. I think artificial intelligence has tremendous potential to actually improve the safety of the care we provide our patients.’ – Foster Goss, DO

“Right now, medical errors are the third-leading cause of death behind heart disease and cancer,” Goss said. “So, I think artificial intelligence has tremendous potential to actually improve the safety of the care we provide our patients.”

Meanwhile, Smith and a large team of personalized-medicine experts are researching ways to improve therapies for acute myeloid leukemia (AML), a disease that went decades without a significant advance in treatment, and other blood disorders.

Progress was recently made on a novel new therapy, fueled by combining clinical data with new information about cancer cells, and the campus continues to make great strides in other areas of personalized medicine.

Team sport

Chancellor Don Elliman and others here have had the foresight to build such an environment, a compass where we can marry this data together, and then layer on top of it the tools that allow people to analyze the data, visualize the data, and then hopefully give us quick and accurate answers,” Smith said.

Smith noted that the marriage of data and health care knowledge is a “team sport” and requires a diverse group of experts, which exists in spades at CU Anschutz. “That’s the key for all this moving forward,” he said. “This is not an electronic-record problem, it’s not a statistics problem, it’s not a doctor problem. It’s a problem that’s only going to be addressed effectively by a big team of people who have all of these disciplines and can work well together.”

The panel answered questions from the audience, including a query on ways the campus should incorporate AI training into its health care curricula. Hunter said the curricula should be agile enough to adapt to the fast-changing technological environment. As a baseline, the curricula should educate students about the errors that may occur in AI. Beyond that, he said, the curricula could offer, for interested students, a deeper dive into the theories behind AI.

“I do think there is a baseline that ought to end up in the curriculum,” Hunter said. “We don’t have that yet.”

All of the panelists agreed that, ultimately, human capabilities and machine-based technologies must be married in complementary fashion. It’s an exciting time, they said, and the health care advancements will be for the better, but they will arrive incrementally.

“When we have these cool new technologies, we have to figure out where do they actually help in medicine?” Hunter said. “Where are the places we know we could do better, and is there a technology that could help us?”

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After a ‘Lazarus’-like response to treatments, Shavvi is back to shredding guitar, loving life

Pumping iron. Shredding guitar. Hiking the mountains. Working in information technology. For Shuvanzan Dwa, the start of his 30s was a daily exercise in the things he loved.

Everything changed, however, when the young man began to notice a pain in his pelvis. The nagging ache persisted, and he figured it was a byproduct of weight lifting, possibly a muscle tear. One spring day while Shuvanzan (who goes by Shavvi) was at home, the pain intensified and he suddenly experienced gastro-intestinal bleeding. He called 911 and within hours was diagnosed with a mass in his pelvis.

Shavvi Dwa on guitar
Shavvi Dwa performs during a recent gig in Denver.

It turned out to be a rare form of sarcoma, and it was growing aggressively. “I thought, ‘No way, that can’t be,’” he said. “I was a fit guy. I ate a healthy diet. Didn’t smoke and hardly ever drank.”

The prognosis immediately got worse. The physicians at a south metro-area hospital administered radiation and chemo treatments. When Shavvi had a severe reaction to the latter, being left so weak he could barely walk, his family got the shocking news that his condition was terminal.

In a matter of days, however, he rallied and began to feel a bit better. Still, the prognosis he received from the physicians was bleak, and it continues to haunts him: You have weeks or possibly days to live, and we can’t do anything more. You should spend the rest of your days with your family.

‘This can’t be happening’

Shavvi was recommended to hospice, and his thoughts swirled: I want to go running. I want to go hiking. I want to be playing my guitar. They must be mistaken; this can’t be happening.

A friend offered a suggestion that, yet again, changed everything: “You should look at the CU Anschutz Medical Campus. They do research and clinical trials.”

He quickly got an appointment with Victor Villalobos, MD, PhD, director of the Sarcoma Medical Oncology team in the CU Cancer Center. Considering what Villalobos knew about Dwa’s case, “I was expecting him to be wheeled in,” the oncologist said, “but he walked in the room and looked super healthy.”

Leery after the serious reaction he’d already suffered from chemo, Shavvi initially opted to hold off for a month when he heard Villalobos’s recommendation for a chemo treatment. “At the end of June, Dr. V scheduled a scan and said, ‘It’s not as bad as when you were diagnosed, but the tumors are growing.” The sarcoma was in his liver and lungs.

Dr. Victor Villalobos
Victor Villalobos, MD, PhD

Villalobos put him on an intense regimen of chemotherapy, and the response was immediate. “The type of cancer he has is usually very resistant to chemo, but his behaved very differently,” he said. “He was literally like Lazarus, like he was resurrected. Shavvi had a dramatic response and was back to work, weight lifting and playing guitar soon after.”

That was two years ago.

Family, fan support

Shavvi, who recently underwent yet another cycle of chemotherapy (cycles usually last five days), is originally from Nepal. He was the lone member of his family living in Colorado, but after the diagnosis in spring 2017, his parents and sister moved here from Houston and New York, respectively.

The many people thrilled to see his recovery include the fans of KasthaMandap, the local rock band in which Shavvi plays guitar and sings. In February, KasthaMandap (a historical reference to Kathmandu) opened a show for Nepal Idols, and in August, Shavvi performed as the solo opener for Bipul Chettri & The Travelling Band, a well-known Nepalese group, at Cervantes Ballroom in Denver. “When we get an offer for a gig and I’m not fatigued, I always say, ‘Let’s do it!’” he said.

When Shavvi checks in for periodic chemo treatments at University of Colorado Hospital, he spends his days working on his computer or watching TV. The extensive World Cup soccer coverage brightened one of his five-day treatment cycles last summer.

Coordinated care

Shavvi Dwa on computer
Shavvi Dwa works on his computer during a chemotherapy cycle at UCHealth’s University of Colorado Hospital.

Lindsay Thurman, MD, assistant director of the oncology hospitalist service, said patients can get “pretty down from having to give up a week of their life, sitting in the hospital and getting chemo.”

But that’s not the case with Shavvi, she said. “He always rolls with it, always has a positive attitude. He’s easy-going and will let us know if something doesn’t seem right.”

Cancer Center patients receive multidisciplinary, one-stop-shop care. They see specialists in all medical disciplines at once rather than having multiple appointments. This coordinated care extends to the inpatient oncology service at UCHealth’s University of Colorado Hospital.

“Our goal is to ensure our patients get a consistent, clear message on their prognosis and treatment plan — no matter if they’re on the inpatient side or if they’re in the Cancer Center clinic,” said Thurman, who is also an assistant professor of Hospital Medicine in the CU School of Medicine.

Shavvi admits he’s had some ups and downs over the past two years. He recalls the shock of looking in the mirror after completing one of his first rounds of intensive chemo. “When you’re a body builder, you look in the mirror to see if your muscles are toning,” he said. “Everything tone-wise was gone in a month or so. I thought, ‘This can’t be me.’ It was really hard.”

CONCERT T-SHIRT

Shavvi designed a T-shirt shirt to wear on stage. On the front it reads …

Tumors in my Body / Music in my Soul / Guitar in my Hand / Love in my Heart / Strength, Hope & / Courage in my Mind!

… and on the back: #ShavviStrong / #StrongerthanSarcoma / #CancerWarrior

Undeterred, Shavvi returned to his lifting regimen at the gym. Earlier this year, however, he eased off a bit when the lung tumor caused a bout of fluid buildup.

Mostly, though, he’s a good-natured, hard-working and hard-rocking guy. Shavvi always enjoys his interactions with Villalobos and the rest of his CU Anschutz medical team.

“I like the way Dr. V communicates. He explains everything really well,” he said. “If he decides to change medications, he explains what’s happening and why we should give it a try. It gives me a boost. It took a while for this all to sink in, but now, hey, I’m here and I’m able to do the things I love to do.”

Shavvi T-shirt
The T-shirt Shavvi designed for his concert performances.

Villalobos said sarcomas make up only 1 percent of all cancers. Although a cure has yet to be discovered for Shavvi’s sarcoma, the Cancer Center is constantly offering patients clinical trial options and the most cutting-edge therapies. “The center is bringing in national leaders on clinical therapy protocols,” Villalobos said. “We have internationally recognized programs for basically every cancer type.”

Back to rockin’

Villalobos will review how Shavvi responded to his last chemo cycle and then assess the next treatment steps. While developing cures for cancer is the ultimate goal, he said, “more likely we’ll be able to treat the disease and hold it at bay, essentially changing cancer from terminal to chronic disease like diabetes.”

With love in his heart, and strength, hope and courage in his mind, Shavvi, now 32, is the kind of patient who responds well to treatment. Sarcoma be damned. This #CancerWarrior is back to rockin’ and living life to its fullest.

Editor’s note: Photos in hospital room taken by Matt Kaskavitch, director of digital engagement, Office of Communications.

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Pancreatic cancer patient featured in State of the Campus video

When Karen Possehl was diagnosed with Stage IV pancreatic cancer that had spread to her liver, she went to the Mayo Clinic for a consultation that ended in heartbreak and disappointment. Then Possehl came to the University of Colorado Cancer Center to meet with Richard Schulick, MD. Watch the video to find out what happened next.

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A passion for improving cancer detection

A first-generation college student who lost her grandmother to ovarian cancer, Jazmyn Mosqueda aspires to become a cancer researcher. She took a big step in that direction this summer as one of 37 applicants chosen for the prestigious Cancer Research Summer Fellowship (CRSF) program through the University of Colorado Cancer Center.

Founded in 1987, the CRSF program pairs young scientists with more than 50 faculty preceptors at the CU Anschutz and CU Boulder campuses, as well as National Jewish Health and the Veteran Affairs Medical Center. Fellows are chosen through stringent selection by a panel of 18 faculty members. For 2018, only 37 fellows were chosen out of 221 applications, a success rate of only 17 percent. When it comes to choosing fellows, Jill Penafiel, education manager, cautioned that good grades alone won’t make the cut. She elaborated that work ethic, character references, and passion for cancer research are key for successful applications.

Within the first week, fellows attend orientation and submit written project goals. The remainder of the 10-week fellowship is devoted to research, with weekly events and faculty lectures including different cancer sites and personalized medicine.

For her research project, Mosqueda worked under the mentorship of Matthew Sikora, PhD, in the Department of Pathology. The Sikora lab studies lobular breast cancer, a relatively rare type of the disease. “Lobular breast cancer has good biomarkers but generally poor outcomes — this research may improve treatment options for lobular breast cancer patients,” said Mosqueda, a senior majoring in biology and Spanish at the University of Northern Colorado.

Matthew Sikora and Jazmyn Mosqueda evaluate data
Matthew Sikora, PhD, assistant professor in pathology, looks on as Cancer Research Summer Fellow Jazmyn Mosqueda evaluates her data.

Invigorates project

Sikora said the Cancer Research Summer Fellows infuse additional energy into the research taking place on the CU Anschutz Medical Campus. “It has been great having Jazmyn in the lab,” he said. “I love getting young scientists excited about research. It helps us, too, since the energy and new questions that undergraduates bring can really invigorate a project.”

Mosqueda’s summer research has centered on understanding new roles for a protein called int/Wingless 4 (Wnt4) that enables breast cancer cell growth and survival. Although she expressed that research in general is hard, Mosqueda focused instead on the satisfaction that comes the first time an experiment is successful. Having lost her paternal grandmother to ovarian cancer before she was born, Mosqueda said her family history inspired a passion for improving early cancer detection. She hopes to attend graduate school in cancer biology after she graduates in May.

As a first-generation college student, Mosqueda talked about her project with her family, which has improved her science communication skills. “I think it’s important to be able to explain to someone who doesn’t have a scientific background or isn’t educated in the hard sciences, because that’s ideally what physicians should be able to do for their patients,” noted Mosqueda. As the first time away from her native Greeley, Mosqueda continued, “I think my family is proud. But my mom misses me.”

Stepping stone

Mosqueda feels that the summer fellowship makes her a more competitive candidate when applying to grad school. Penafiel echoes this sentiment and said, “The fellowship is a great stepping stone for aspiring medical students or grad students.” Penafiel expressed the gratification that she gets from the success stories, adding, “It’s wonderful to see students go on to do great things.”

Mosqueda added, “I’m grateful and thankful for the opportunity to experience something like this.”

The nationwide fellowship program ended in early August with a public poster session where many fellows’ families were in attendance. The CRSF program is managed by John Tentler, PhD, associate director for education, and Jill Penafiel.

Guest Contributor: Shawna Matthews, a postdoc at CU Anschutz.

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A RaCAS boom: Annual research showcase breaks two-decade record

Students welcome at RaCAS
Joe Pham and Diana Lee, work-study employees of the Experiential Learning Center, greet RaCAS participants in raucous fashion.

Celebrating research from the sciences to the humanities, the 21st annual Research and Creative Activities Symposium (RaCAS) primed creative minds and broke records this year, as more than 500 participants and viewers from the University of Colorado Denver and Anschutz Medical Campus joined in the event.

A record 238 student presentations infused two floors of the Student Commons Building at CU Denver with passionate inquiry on April 27, delving into topics from cancer treatments to virtual learning tools. Under the guidance of a new director, it was the largest RaCAS turnout ever in the research showcase’s two decades.

“That was one of my goals when I took this job,” said Lindsey Hamilton, director of Undergraduate Research and Creative Activities, who accepted the reins as RaCAS director on Jan. 1. “I wanted to bring more awareness to the research that’s taking place on our campuses and change the impression of RaCAS to be more inclusive of all scholarly work.”

Rather than focusing solely on outstanding completed research, Hamilton and crew advertised heavily that projects in progress and of all levels were welcome. “This is a great opportunity to practice presentation,” Hamilton said. “We told them communicating their work was a learning experience and a critical component to their education. And it worked. We had a great turnout.”

For the first time, RaCAS involved student- rather than faculty-organized mini-symposiums, with a record 15 participants. Hamilton also added an Emerging Scholar award to the honoree list, acknowledging the work of 19 students.

Student with poster
Kathleen Nguyen presents her poster project on an innovative nanoparticle therapy aimed at improving detection and treatment of bladder cancer. She won a People’s Choice award for her presentation.

Targeting bladder cancer

“This is actually my fourth poster presentation this month,” said Kathleen Nguyen, a bioengineering undergraduate in the College of Engineering and Applied Science, who won a People’s Choice award for her presentation.

“I’ve met so many people. I think this experience is invaluable,” Nguyen said, adding that, in addition to culling connections, presenting at RaCAS and other symposiums helps inspire and prepare students for graduate school.

Looking at how nanoparticles can translate into medical uses, Nguyen highlighted a collaborative research effort in the Nanosafety and Nanotoxicology Lab in the Skaggs School of Pharmacy and Pharmaceutical Sciences. By combining gold nanorods and upconversion nanoparticles, the researchers are working on a noninvasive means of detecting and eradicating bladder cancer.

“We told them communicating their work was a learning experience and a critical component to their education. And it worked. We had a great turnout.” – Lindsey Hamilton, RaCAS director

Gold nanorods contain a property called surface plasmon resonance, Nguyen said. “Basically, that means they oscillate really fast under high-frequency lasers. So, when you shine lasers at near infrared light at these gold nanorods, they vibrate really fast and create a lot of heat, which can be utilized for thermal ablation of bladder cancer.”

By attaching upconversion nanoparticles, which will brightly fluoresce under low-frequency laser light, the aim is to detect and specifically target tumors with the complexes. “The idea is to attach these two together and insert them into the bladder in some sort of solution,” Nguyen said, explaining that the gold nanorod complexes have an anti-EGFR antibody called C225.

“It turns out that bladder cancer tumors have over expression of EGFR, so these gold nanorod complexes will only attach to the tumor,” she said. After the complex solution is allowed to sit in the patient for a short period of time, doctors would insert a catheter with a laser, detecting the tumors with low-frequency light and ablating them with high-frequency light.

Nguyen’s work is focused on how the gold nanorods could be used to activate immune responses that would detect and attack the tumor. “It’s really cool,” she said. “It’s very exciting.”

Student with poster
Angelique Dueñas stands next to her poster presentation on the educational value of 3-D embryos. Dueñas won first-place recognition for another presentation on Mapping the Body: Poetry and Anatomical Art New Student Exhibit Merges Humanities and Sciences in Higher Education Collaboration.

Bolstering embryology education

Focusing on educating future students in an area she has become passionate about but that has shown signs of declining interest, Angelique Dueñas, a master’s student in Modern Human Anatomy, presented a project weighing the value of 3-D virtual embryos in learning.

“I found it fascinating to see how we develop and why things are the way they are in our bodies,” Dueñas said, explaining her passion for embryology. After seeing a number of literature reviews on the medical curricula’s decreasing emphasis on embryology, she joined colleagues in their efforts to boost interest.

“It’s super important that medical students understand embryology,” Dueñas said. But the field has unique learning challenges. “It’s a three-dimensional subject,” she said of a fetus. “Then you add in time of a developing embryo, and it can be really challenging, especially when the classic presentation is 2-dimensional,” she said of textbook visuals.

So, her team designed 3-D printed models and virtual models and assessed their value. “You can use your mouse and look at all sides of the different organs,” Dueñas said, illustrating with a brightly colored eight-week embryo model on a computer screen. “You can click, and it will tell you what structure you are looking at,” she said, adding that the application used does have virtual-reality capabilities.

After recruiting 162 first-year medical, dental and graduate students, the researchers gave each volunteer a pre-quiz. They then assigned groups to a static pamphlet representation, a 3-D printed version and a 3-D virtual version. Then volunteers completed a post-quiz and survey.

“Students who interacted with the virtual model and the 3-D printed model seemed to increase their pre-test performance statistically significantly,” she said. “The pamphlet group did not.” Nearly 90 percent of students surveyed said they would like to see these resources in other stages and that it would enhance their understanding, Dueñas said. “They said they would even buy these resources, so it was really exciting for us.”

 

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Donors celebrated for transformational gifts

More than 430 people attended the Benefactor Recognition Dinner, a celebration of the passionate people behind philanthropic gifts to the CU Anschutz Medical Campus. The event took place in the Seawall Ballroom in the Denver Performing Arts Complex on March 29.

This year’s gathering was particularly special because, for the first time, the recognition dinner included a celebration of CU Anschutz’s partnership with University of Colorado Hospital, and an acknowledgment of how philanthropic support makes an impact all across campus. Hosts of the evening included CU President Bruce Benson and his wife, CU First Lady Marcy Benson; CU Anschutz Chancellor Don Elliman; and University of Colorado Hospital President and CEO Will Cook.

Learn more about our generous honoree benefactors in the video presentations on this page.

“Our vision at CU Anschutz is simple,” Elliman said. “We seek to rise higher among the country’s top medical destinations; to be the place where anyone who needs it can get the finest care in the world; where the science of that care is being pushed to new horizons; and where we train and prepare the health workforce of our future.”

When Cook stepped to the podium, he said, “I hope you’re getting a sense of the momentum of our campus. The tremendous promise we’re seeing realized is what drew me to the University of Colorado Hospital from UPMC (University of Pittsburgh Medical Center) 2 ½ years ago.”

He added, “We’re pleased to be partnering more closely than ever with the university, as we work to rise even higher among the ranks of the country’s top destinations for health, wellness and world-class medical care.”

Elliman thanked the benefactors for their generous gifts, which help fuel the campus’s unprecedented growth. “You are a vital part of our growth and progress,” he said. “Because of you, we are in great shape and getting stronger.”

2018 honorees:

 

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Four sisters with cancer get care

Roberta Aberle and her three sisters share an unfortunate bond: cancer.

Her two oldest sisters passed away from the disease. She and one sister are still fighting the disease. All four sisters were diagnosed in their 40s or 50s, and all have received treatment through UCHealth – Aberle at the University of Colorado Cancer Center on the CU Anschutz Medical Campus and her sisters at Poudre Valley Hospital in Fort Collins.

“Our family is definitely satisfied in the care we’ve received,” said Aberle, 53, who lives in Aurora, where she can easily access treatment at CU Anschutz, “and I’m 100 percent confident in the care I’m getting right in my backyard.”

A former quality and process improvement professional for UCHealth, she now applies her skills as an advocate and resource for people with cancer. She’s spreading the word about the treatment she received from CU physicians, and her own story of cancer, far and wide.

Years of diagnoses

“Sadness took root in our family in 2005,” Aberle said. That was the year the first of her sisters, Brenda, received her cancer diagnosis.

Roberta Alberle
Roberta Alberle, CU Cancer Center patient

Brenda passed away in 2008, and a year later, sister Carol was diagnosed. Both Aberle and her oldest sister Debby got cancer diagnoses in 2012. Debby passed away six months after her diagnosis, but Aberle has survived, outliving her original prognosis by half a decade.

Aberle remembers Leap Day 2012 vividly. That was the day she went in for a quick assessment of a minor pain in her side. Despite her significant risk factors of having multiple first-degree relatives diagnosed with cancer before age 50, she never imagined a life-altering diagnosis.

“I was feeling healthy and energetic and working my dream job,” she said. “Nothing could have been going better at that time.”

She came out with a diagnosis of inoperable primary peritoneal cancer, one of the most rare and lethal forms of cancer, and recommendations to begin arranging for palliative and end-of-life care.

“I was in utter disbelief,” she said. “I had just been thinking how ill everyone in my family is and that I’m not prepared to be the person who outlives my entire family, and now I had cancer, too.”

While the disease has devastated the family, it has also mystified them. All four sisters have had reproductive cancers, but none the exact same type, and each has had a different outcome. Aberle shares the same genetic marker for cancer susceptibility with one of her sisters, but the other two sisters did not have the marker. And on top of everything, in 2015 their father was diagnosed with melanoma and lymphoma.

“Cancer has blown our family to bits,” Aberle said, “but a bit falls to the floor and we pick it up and glue it back on. It’s created a bond that can’t be broken.

A powerful treatment

Despite her family’s devastation and her own grim prognosis, Aberle was determined to fight her cancer. For the next year and a half, she underwent chemotherapy and entered clinical drug trials. Then, she received hyperthermic intraperitoneal chemotherapy (HIPEC), a rare cancer treatment that combines chemotherapy and surgery in a single procedure. The CU School of Medicine Department of Surgery is one of very few care providers in the United States that offer HIPEC.

During Aberle’s HIPEC treatment in 2013, CU surgeons opened her abdomen, removed the visible cancer cells and then doused the remaining cells with heated chemotherapy drugs. This procedure is followed by standard intraperitoneal (IP) chemotherapy. Because both HIPEC and IP techniques deliver chemotherapy directly to cancer cells in the abdomen (unlike systemic chemotherapy delivery, which circulates throughout the body), they can destroy microscopic cancer cells and has helped some patients live decades longer.

But it’s not an easy procedure for patients.

“It’s an invasive procedure, and it was a very difficult and painful recovery,” Aberle said. “I had a port inserted into my abdomen and staples up the length of my belly. Now, I have adhesions and scar tissue that still cause pain sometimes.”

Since HIPEC, Aberle’s cancer has returned, but she still believes it was the right treatment for her.

“It bought me additional time and got me farther down the path to the next available treatment,” she said. “I have no doubt in my mind that, if I had not had access to CU surgeons, I would not have survived this long.”

Survival on her own terms

Now five years into her battle with cancer, Aberle is still determined to fight the disease, and she’s grateful that the care providers at CU Anschutz continue to empower her to do that.

“My survival is 95 percent connected to the care I’m getting from the University of Colorado,” she said. “No one has ever relinquished their hope in me or objected when I say I want to keep going. It is phenomenal to be working with these doctors.”

Two years ago, Aberle took disability leave in order to devote more time and energy to conquering her cancer and to doing the things that are most important to her: spending time with loved ones and sharing her experience to help others.

“I’m not fooling myself that I’m going to live to 103,” she said. “There’s going to be a point when I want to go to palliative care and hospice, but I want to make my sure that we’ve done everything possible first. I know I’m with the right team at the CU Cancer Center, because they share in that philosophy right along with me.”

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