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Curiosity, money, and a mother's anguish help inspire neuroendocrine cancer research
By Debra Ruder
Matthew Kulke, MD, (left) and Ramesh Shivdasani, MD, PhD, discuss their findings.
Ramesh Shivdasani, MD, PhD, has something under his microscope to show his Dana-Farber colleague Matthew Kulke, MD.
The pink-and-purple blotches on the stained slide are not merely cancerous cells removed during surgery and frozen for research. When combined with information about this patient's health history and the cells' DNA, the slide may offer another clue about a family of rare and little-understood cancers.
Neuroendocrine tumors, which arise in hormone-making cells throughout the body, have brought together these two physician-scientists — one focused on laboratory discoveries (Shivdasani), the other on clinical care (Kulke) — in an alliance that would have pleased Institute founder Sidney Farber, MD, who sought to bridge "patient bed and laboratory bench" in the quest to combat cancer.
Although this kind of collaboration is occurring more and more at Dana-Farber, it often takes a few sparks to ignite. In this case, the fuel took several forms, namely, recent advances in genetically targeted therapies, several hundred cooperative patients, financial gifts from private sources, and a mutual interest in the digestive tract, where these cancers most often lurk.
"Matt [Kulke] has collected probably the most comprehensive neuroendocrine cancer database in the world, including tumor specimens, blood and urine samples, and clinical information, that may be used to understand the biology of the disease and design better therapies," says Shivdasani, who set up a laboratory specifically for this kind of translational work.
"Matt [Kulke] has collected probably the most comprehensive neuroendocrine cancer database in the world … that may be used to understand the biology of the disease and design better therapies."
—Ramesh Shivdasani, MD, PhD
The pair, teaming with colleagues at Dana-Farber and its affiliates, has already made inroads in understanding the causes of these illnesses, which include carcinoid cancer and pancreatic endocrine cancer. Powered by recent knowledge about the genetic and biological behavior of neuroendocrine cells, Kulke and others have tested new combinations of drugs, among them angiogenic inhibitors that thwart the development of blood vessels around tumors.
An estimated 3,000-5,000 new cases of neuroendocrine tumors are diagnosed in the United States each year, many of them in the gastrointestinal tract, but some in the lungs and other organs. By contrast, more than 234,000 new prostate cancer diagnoses are expected nationally this year. Neuroendocrine cancers often grow slowly, are adept at outsmarting conventional chemotherapy, and are usually fatal when diagnosed at a late stage.
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