Forget the lions and giraffes. What really has Raymond N. DuBois, M.D., Ph.D., excited about his recent trip to South Africa is his passion for changing how research is done so that doctors will have more options for their patients.
That’s what drew him to South Africa to speak at the American Association for Cancer Research International Conference on the new frontiers in cancer research. It’s why he has rubbed elbows with the likes of Katie Couric and other celebrities who raise awareness for the nonprofit group Stand Up To Cancer. An ardent supporter of the group’s mission, DuBois has served in various roles since its inception. By focusing on raising funds to accelerate the pace of the most innovative and promising research, Stand Up To Cancer offers innovative ways to bypass traditional administrative red tape to get new therapies to patients faster.
The following Q&A highlights DuBois’s advocacy efforts and sheds light on some of the most exciting changes when searching for the elusive cure to cancer.
Q: Is the AACR conference something you usually go to?
This is the first time the AACR has ever had a conference in South Africa. I am a past president of the organization and served on the organizing committee for the meeting, so that’s how I got involved. We had a large number of people sign up to attend the meeting, including African students, researchers and postdoctoral fellows from the University of Cape Town, as well as from several adjoining countries like Ghana and Nigeria.
Q: What were the highlights?
We tried to cover all the hot areas in cancer research and the new developments, including the more personalized approaches being used in precision oncology. We talked a lot about public health and how to prevent cervical cancer and other cancers caused by viruses and other infectious agents. I chaired a session on colon cancer, a disease where they are seeing an increase in the number of people affected. The room was completely packed. Physicians in Africa typically have not had long-term experience with colorectal cancer, because traditionally it hasn’t been a significant cause of cancer in Africa. Now the larger cities in Africa are sporting fast-food restaurant chains like McDonald's and KFC, and doctors are seeing more patients with colorectal cancer. The attendees asked great questions about the latest treatments and screening guidelines.
Q: Was there anything surprising you took away from the conference?
I think the biggest surprise was the extent of the lack of resources on the continent of Africa. For example, in many African countries there are very few machines like CT, MRI and PET scanners or LINACs to administer radiation oncology treatments. So there is no way doctors can treat all the patients who would benefit from this technology. Because of infrastructure problems, patients don’t have access to some of the more modern diagnostic and treatment regimens that we in the West take for granted. In the U.S., almost anyone who needs to can get screened for colon cancer through colonoscopy, but many African patients don’t have access to that kind of sophisticated screening.
Q: How does having a global perspective help?
I think it’s important to observe the lack of uniformity in cancer incidence across the globe and to investigate why that might be so. For example, for such a densely populated country, India has very low numbers of patients with colorectal cancer. The diet in certain parts of India contains significant amounts of fiber and vegetables rich in anti-inflammatory components like curcumin. This seems to have an impact on reducing cancer incidence.
We can learn so much more if we exchange information across cultures and countries. A lot of the early work on lymphoma, especially Burkitt's lymphoma, was done in Africa. Dr. Burkitt was a public health officer from Ireland who was sent to Africa and began working on the cause of a form of lymphoma that was devastating to the local population. He did a lot of really important work that led to understanding the etiology of some forms of lymphoma. It turned out this work couldn’t have been done anywhere except Africa, even though this lymphoma affects people on every continent.
Q: What was your presentation about?
I presented our work on the role of inflammation and inflammatory mediators in colorectal cancer. We discovered some regulatory pathways that are playing a role in setting up an immune tolerance in colorectal cancer that are related to inflammation. The audience was interested in the fact that aspirin and non-steroidal inflammatory drugs can reduce the risk of colorectal cancer by up to 40 to 50 percent. Even in Africa, aspirin is reasonably cheap and could be used widely under a health care provider’s supervision. Attendees asked lots of questions about dosages and indications for usage, because aspirin and other anti-inflammatory drugs could be immediately prescribed to reduce risk, even in an under-resourced country.
Q: Are there people here who aren’t aware of that?
Some people are aware of the protective effects of aspirin, but it’s not widely known. The U.S. Preventive Services Task Force has recommended it for people who are at high risk for heart disease and colorectal cancer. So it’s out there, but I don’t think all general practitioners are up to speed in how it could be used in our population. There are concerns about the side effects of aspirin, because its use does increase bleeding risks and can cause gastrointestinal toxicity.
Q: Speaking of colorectal cancer, what are plans to raise awareness in March?
Katie Couric is one respected celebrity who has made it her mission to raise awareness of the importance of colorectal screening, and she has several campaigns slated for the month of March to encourage people to get screened. For the vast majority of the population, a colonoscopy will detect precancerous polyps, which the doctor can remove before they ever mutate into cancer. It’s a fantastic preventive cure. In addition to Katie, Stand Up To Cancer has launched a social media awareness campaign in which various celebrities tout the importance of preventive screening. Here at MUSC and across South Carolina, we are joining in the campaign to encourage our citizens to get screened. As one part of that, MUSC has decided to provide access to a large “colon” on campus that you can actually walk through and see what a polyp looks like.
Q: Why are you drawn to the Stand Up To Cancer group?
Stand Up To Cancer, as begun by its early dynamic and undaunted founders, has been working since its beginning in 2008 to move the dial on accelerating cancer research. Over these nine years, the organization has made quite remarkable progress, and scientists on the “dream teams” – collaborative task forces comprised of top researchers from different institutions who come together to develop new and improved approaches to cancer – have made some significant progress.
For a while now, I've been discussing the need for Stand Up To Cancer to get more involved in cancer prevention. The organization has decided to support two areas of research on prevention that include pancreatic and lung cancer. It is accepting applications for research projects from teams to work on finding better approaches to prevent those two cancers, which continue to be some of the most difficult cancers to treat once they take hold in the body.
Q: What’s your role in Stand Up To Cancer?
I have worked with them a long time in different capacities. I’m on the scientific advisory board, and I was a member of the executive management team. One of the things I’m chairing now is the Catalyst program. Stand Up To Cancer has teamed up with several drug companies that have provided quite a bit of support – about $40 to $50 million – to fund projects where unique combinations of drugs can be used that wouldn’t normally be considered. This is being done in small trials to see if they have an impact and then rapidly ramped up to larger trials for combinations of drugs that look to be effective.
The initial projects included the combination of a targeted therapy with an immunotherapy agent, as well as chemotherapy, radiation therapy or immunotherapy combinations that aren’t normally evaluated. I have to say, the Catalyst program is something I am extremely excited about and honored to be involved in. We really are bringing people together who normally would be in competition with each other. This could result in life-saving treatments for patients.
If we can get unique treatments developed faster, it’s really going help the patients in the long run. The problem with immunotherapy is that it only works in 15 to 20 percent of the patients. This program was developed in an attempt to find out why it’s not working in some situations and try to overcome resistance to therapy.
Q: Why can Stand Up To Cancer do this better than other groups?
Stand Up To Cancer has given up any intellectual property rights that are developed from this research. So for Stand Up, the goal has never been about making a profit. This has removed some of the red tape that inhibits progress in these kinds of innovative trials.
There are some companies that won’t participate, because they may be concerned about intellectual property issues. So far, we have gotten some outstanding applications and are in the process of launching those trials. Everybody is really excited about this program, including several pharmaceutical leaders.
The other thing that makes Stand Up To Cancer unique is that it has been able to attract not only a host of stars and celebrities as its spokespeople, but it also has drawn to its ranks a cadre of distinguished scientists and world-renowned scholars, including Phil Sharp, Ph.D., from the Massachusetts Institute of Technology, who’s a Nobel Laureate and has helped lead the scientific advisory board. Some of the dream team leaders read like a “Who’s Who” in cancer research.
Q: Why take the time to participate, given your busy schedule?
It has taught me that working collaboratively between groups, you can have a much broader and deeper impact than working alone. Part of the whole reason Stand Up To Cancer was developed was to create these dream teams from all over the world to attack a specific problem using the best and brightest people possible. We really have made headway that I don’t think would have been possible without this collaborative approach.
They may not understand the intricacies of cancer and molecular biology, but the people running Stand Up To Cancer are able to corral massive resources through their Hollywood connections, which has led to four telethon events that were broadcast on all the standard channels, and collaborations with organizations like Major League Baseball and MasterCard. There’s no way an academic group could have garnered these kinds of collaborations.
Q: Why aren’t we closer to having a cure for cancer?
We do have cures for some cancers. For childhood leukemia, we have made a lot of progress. Melanoma has really come a long way with the development of immunotherapy. Twenty percent of those patients are in very long-term remission because of new checkpoint inhibitor treatment.
We have much more powerful techniques now using genomic approaches, and our ability to dissect the immune system is amazing. It will take more research to improve our success. I know the public doesn’t want to hear that, but cancer is such a complex disease. Many people think of cancer as one disease, but it actually consists of several hundred diseases, and they all don’t respond the same way to treatment. We need to better understand how to classify cancer more accurately.
Q: What Stand Up To Cancer initiative are you most excited about?
It will be interesting to see what happens with this lung and pancreatic cancer prevention program. Those are the two areas that Stand Up To Cancer wanted to focus on initially in the area of prevention, but I think that’s going to inspire efforts in other types of cancer, and hopefully, future efforts will be more focused on public health screening, early detection and understanding the biology of pre-malignant disease. And, again, the Catalyst program is bursting with possibilities for making a major impact.
Q: You balance running your research lab of 10 to 12 people and being dean of MUSC’s College of Medicine. Why is it important for you to do both?
I have always been very interested in and excited about research. I get a lot of personal satisfaction from it, and I know it makes a difference. It also enables me to understand what a lot of our research faculty are going through in terms of getting protocols approved, getting grant applications written and navigating the bureaucratic process. I think I have a much better appreciation for all the things they must do to keep their research active.
One of the things I introduced here was that at every one of our basic science chair meetings, one of our faculty members gives a 20-minute research presentation about the most exciting things happening in his or her research lab. That gives us drive, because it reminds us why we are here and what we’re all about.
Q: Where are we in the fight against cancer?
Cancer is a devastating disease. One in two American men and one in three American women will be diagnosed with cancer during their lifetime. But 30 years ago, a cancer diagnosis was often a death sentence. Now, many more people are surviving it. We have over 15 million survivors and are learning a lot more about the nature of this disease.
There are some really exciting developments in immunotherapy. Through recent developments with immunotherapy, and hopefully some of the new combinations that are being evaluated in the Catalyst program, we should develop more effective treatments. It is also important to remember that almost 50 percent of cancers can be prevented if we focus more on diet, exercise, avoiding sun exposure and avoiding tobacco use. We have spent too little effort on prevention through our government and public awareness, and hopefully, with recent efforts with Stand Up To Cancer, we can have better impact there.