An inside look.

Learn more about cancer research activities at the UW.

Radiation Oncology

The UW Department of Human Oncology provides radiation oncology services that employ many of the most advanced cancer treatment technologies available in the world. Guiding these technologies are expert radiation oncology physicians and medical physicists along with a core of highly experienced dosimetry and therapy staff whose unifying goal is to deliver the highest standard of cancer care.

Our treatment capabilities include conventional and MRI-guided motion management to track tumors during treatment delivery; GYN, breast and prostate brachytherapy; spine, liver, prostate and lung stereotactic body radiation therapy (SBRT); image-guided intensity modulated radiotherapy; Y-90 selective internal radiotherapy for liver tumors; Ra-223 systemic radioisotope therapy for cancers involving bone, and total body radiotherapy. Our facilities include advanced Tomotherapy units, state-of-the-art linear accelerators, a ViewRay MRI-guided radiation therapy system and two modern brachytherapy suites equipped with a mobile CT scanner.

Our radiation oncology faculty and staff strongly believe that the best care is delivered when a multidisciplinary team collaborates to guide treatment recommendations. Thus, our faculty participate in a wide spectrum of multidisciplinary clinics and tumor boards, including a molecular tumor board that seeks to individualize and customize treatment to most effectively target each tumor.

As an academic center and member of the UW Carbone Cancer Center, a National Cancer Institute-designated Comprehensive Cancer Center, our clinical and laboratory investigators continually explore innovative, promising therapies that seek to improve the effectiveness of cancer treatments.

Cancer Biology

Researchers in the Department of Human Oncology pursue basic and translational cancer research with a common goal: to improve knowledge about how cancer cells grow and spread so as to eradicate cancer in the future.

Our basic cancer researchers explore the molecular building blocks that enable cancer cells to develop and spread.

Our translational cancer researchers collaborate closely with the basic biologists to translate promising new discoveries into clinical trials in animals and humans.

We know that the ultimate goal of curing cancer benefits greatly when we train the best and brightest minds of the next generation. Therefore, our program emphasizes rigorous training for young cancer researchers of the future, both in the laboratory and in the clinic.

Medical Physics

The Department of Human Oncology (DHO) medical physics group is comprised of highly skilled physicists who provide state of the art clinical service, teaching, and research expertise in Radiation Oncology. The field of Medical Physics is a broad-based discipline that encompasses physical principles with applications in biology and medicine. As the technologies to image and treat human disease are complex, medical physicists often work “behind the scenes” to provide expertise. This work supports physicians to provide sophisticated and personalized treatments for each patient. Medical physicists are engaged in the development and implementation of novel technologies and treatment techniques, all designed to improve patient outcome.

DHO has state-of-the-art medical imaging and treatment delivery technology, including High Dose Rate brachytherapy and Tomotherapy programs that have long held national and international reputations for excellence.  UW researchers have pioneered discovery and development of many leading technologies that have shaped the field of Radiation Oncology. In addition to leading edge technologies for current treatment, we are developing new strengths in adaptive radiation therapy and MRI guided radiation therapy for the future.

The educational activities of the medical physics group support the training of medical residents, physics residents, graduate students, dosimetry students, and radiation therapy technology students. These trainees participate in a range of clinical procedures to learn fundamentals of the technologies and clinical problems we encounter each day.

Identifying New and Novel Targets to Attack Cancer

On the 3rd floor of the Wisconsin Institute of Medical Research (WIMR), the offices of Drs. Deric Wheeler and Randall Kimple are equipped with two large dry erase boards covered in notes and equations. Wheeler and Dr. Kimple run independent laboratories in addition to collaborating with one another in order to maximize the potential impact of their respective cancer research activities. The notes scrawled across the boards are remnants of their weekly ‘chalk talks’ – an important element of their collaborative research investigating the manipulation of specialized proteins that may confer resistance to treatments for head and neck cancer and other common tumors.

“Unfortunately, patients often recur or relapse after initial cancer treatment, and our goal is to identify how we might overcome resistance to treatment as well as increase the effectiveness of the initial treatments,” Dr. Wheeler said of the theme behind the research.

Their current project focuses on an oncogenic tyrosine kinase known as AXL. The Wheeler laboratory identified AXL as an important molecular target influencing response and resistance to common treatment approaches using radiation and the drug cetuximab. They found that removal of AXL from tumor cell lines led to an increased sensitivity to cetuximab and radiation, an observation with exciting potential implications for future cancer therapies.

“The main question we will pursue is whether inhibiting the activity of AXL can lessen resistance to certain cancer therapeutics as well as radiation and thereby increase their value for cancer patients,” Dr. Wheeler explained. In recent years AXL has become a molecular target of interest for a variety of cancer types including ovarian, breast, and lung.

We both believe that in the next few years there is a real potential to better understand how manipulation of AXL could benefit cancer patients in the clinical setting,” Dr. Kimple said.

While both Dr. Kimple and Dr. Wheeler maintain their own research teams and interests, their laboratories collaborate very effectively together. This linkage of basic scientist (Dr. Wheeler) with physician-scientist (Dr. Kimple) brings together a valuable combination of perspectives to tackle challenging problems.

“The more we encourage talented cancer researchers like Wheeler and Kimple to work together and challenge one another, the more good things will happen,” says Department of Human Oncology Chairman Dr. Paul Harari. “Their complementary expertise is powerful, and they have the potential to open important new doors of research discovery.”

In addition to the advantages of having a basic scientist and physician-scientist working together, Dr. Wheeler and Dr. Kimple maintain connections with researchers from outside institutions, including groups from Chicago, California, and several international centers as well as pharmaceutical companies developing promising new drugs. This expanded network allows for an increased patient volume, a larger data set and publication base, and many sources of expertise for advancing the research.

“You need this sort of collaboration with top experts across the field to make the best progress in cancer research. Having a good team helps move things forward more effectively. We have the opportunity to build an important story about the role of AXL in cancer therapy for the future,” Dr. Wheeler said.

Dr. Kimple and Dr. Wheeler have recently published two research articles detailing their AXL findings in high profile cancer research journals. They are hopeful that their work will enable the development of new clinical trials within the next several years. In the meantime, they will continue to use their “chalk talk” brainstorming sessions to discuss potential new molecular targets and treatment approaches that may benefit future cancer patients.

Breast Imaging: From Cancer Screen to Precision Medicine

-This article originally appeared on UW Health news, written by Silke Schmidt-

Since 1927, mammography, a special form of X-ray breast imaging, has helped diagnose and screen for breast cancer—by catching a tumor early with a mammogram, it can often be treated effectively before spreading to other organs.

But with President Obama announcing his precision medicine initiative in January 2015, breast imaging is becoming an increasingly important tool for cancer treatment as well.

“Imaging can help us tailor the treatment to the exact biological properties of a tumor,” says Amy Fowler, MD, PhD, an assistant professor of radiology at the UW Carbone Cancer Center. “This may not only reduce the risk of cancer recurrence at the primary site, but also the risk of metastases.”

A prime example for precision medicine is Fowler’s research toward improving the success rate of hormone (endocrine) therapy after the surgical removal of a breast tumor.

The typical path from cancer detection to surgery starts with a mammogram followed by a biopsy-based diagnosis that classifies the tumor as hormone-receptor-positive or -negative. About 70 percent of newly diagnosed cancers are positive, meaning they may respond to hormone therapy.

In the future, Fowler hopes that these 70 percent of patients will receive a short course of hormone therapy right after the biopsy, before the surgery is performed, to evaluate the tumor’s response.

“We will inject a radioactively labeled compound into the patient’s vein,” Fowler explains. “About an hour after the injection, we will obtain an image of the tumor’s uptake of that compound with positron emission tomography (PET), using equipment similar to the more familiar computer tomography (CT) machine.”

Doctors will no longer have to guess, based on average treatment statistics, whether or not hormone therapy will reduce a patient’s recurrence risk after the surgery; instead, the PET image will help them predict that specific patient’s response much more precisely.

In the Breast Center, where Fowler helps care for breast cancer patients, she also screens asymptomatic women at average and increased cancer risk.

A lifetime risk exceeding 20 percent, based upon a computer model that accounts for family history and personal risk factors, makes a woman eligible for annual screening breast MRIs (magnetic resonance imaging), in addition to mammography.

The primary screening tool for women whose lifetime risk is below 20 percent is a clinical breast exam. However, the age at which a mammogram should be added to this screen is surprisingly controversial.The American College of Radiology endorses annual mammograms for all women starting at age 40 in order to save the most lives. In contrast, the U.S. Preventive Screening Task Force recommends a start age of 50 followed by a mammogram every other year.

“Recent studies show that some 6,500 additional women in this country would die from breast cancer each year if those between 40 and 49 years go unscreened and those 50 to 74 years old are only screened biennially,” Fowler says.

Another controversial topic concerns the disclosure of dense breast tissue in the letter that informs a woman of her negative mammography result.

A mammogram may miss a tumor when breast tissue is extremely dense, rather than fatty, but Fowler says there is not yet any clear guidance on the type of supplemental screening these women should receive.

Controversies aside, however, Fowler says UW Health patients can be sure of one thing: “The multidisciplinary approach to patient care that involves surgeons, medical and radiation oncologists, geneticists and imaging experts is a particular strength of UW Health. Our patients are very fortunate to have access to all of these resources in one place.”

Carbone Cancer Center to Play Key Role in Nationwide Precision-Medicine Effort

This article originally appeared on UW Health news, written by Susan Lampert Smith-

A UW Carbone Cancer Center scientist is leading part of a unique national effort to match cancers to drugs based on their genes and not on where in the body the cancers begin.

Dr. Kari Wisinski, breast-cancer oncologist, will lead one arm of the National Cancer Institute’s NCI-MATCH trial, which was announced today at the American Society for Clinical Oncology annual meeting.

The trial is for adults with a wide variety of cancers, including some rare cancers, solid tumors and lymphomas. It will begin enrolling patients in July, and will test up to 3,000 people whose cancer has stopped responding to treatment. It is part of the precision-medicine initiative announced by President Barack Obama during his State of the Union address in January.

“It’s really exciting to be at the forefront of the country’s largest trial precision- medicine effort,” says Dr. Howard Bailey, director of the Carbone Cancer Center. “This trial shows how our understanding of cancer has shifted. Cancers that seem different, such as lung cancer and melanoma, may in fact respond to the same treatment because they’re driven by the same mutation in their genes.”

People who enroll in the trial will first have a biopsy of their cancer tissue. Four labs will analyze the cancer cells, looking for 4,000 different variants across 143 genes to figure out which genetic mutation is likely driving their cancer. If the abnormality matches a drug or drug combination that targets that mutation, they will be assigned to that arm of the trial.

The trial will begin in July with about 10 treatment arms, but that number is expected to double before the end of the year as more treatment regimens are added. Overall, researchers plan to screen 3,000 people in order to match 1,000 into treatments that target their particular mutation.

Wisinski is co-chairing an arm for people whose cancers have mutations in the HER2 gene, which plays a role in certain kinds of breast and gastric cancers. But people assigned into this group will have different types of cancer that all show specific mutations in HER2. They will be treated with afatinib, a drug currently used to treat non-small cell lung cancer, which may target their cancer’s mutation.

“It is estimated these mutations are only present in less than five percent of cancers, which makes it hard to study,” Wisinski says. “But if you can group people whose cancers all show the same mutation, we can do a trial to see if a drug that targets HER2 is effective for these patients.”

People will stay in the trial as long as their tumors are shrinking or their cancer is not progressing. If their cancer does not have a mutation that is included in the trial, their genomic analysis will be sent to their personal doctors at no cost to them, in hopes another trial could help them.

The trial is called NCI-MATCH, which stands for Molecular Analysis for Therapy Choice. It was co-developed by the National Cancer Institute (NCI), part of the National Institutes of Health, and the ECOG-ACRIN Cancer Research Group. UW Carbone Cancer Center is part of the National Clinical Trials Network, a partner in the trials.

Two Promising Anti-Cancer Drugs Found to Work Better With Radiation

-This article originally appeared on UW Health news, written by Sarah Perdue-

Madison, Wisconsin – Giving cancer cells a double hit with radiation and certain drugs could lead to better patient outcomes at lower radiation doses, according to two studies by UW Carbone Cancer Center scientists.

During treatment, radiation is directed at tumors with the goal of lethally damaging the dividing cancer cells. But some cancer cells survive, and nearby healthy cells can also be affected, leading to unwanted side effects.

“The goal is to identify new molecular targeting drugs that might increase the effectiveness of radiation and possibly diminish the amount of radiation needed,” said Dr. Paul Harari, senior author of the studies. “These two studies bring cutting-edge molecular drug growth inhibitors to the forefront, with the hope that several years down the road they can be used in the clinic in combination with radiation to benefit cancer patients.”

“Combining radiation with targeted therapies is not a new approach, but that is where treatment is heading,” said Dr. Shyhmin Huang, a lead author of the studies. What is unique in this work is that the researchers were looking at drugs that reduce the ability of cells to recover from radiation damage, hoping the double hit to cancer cells would prevent them from surviving. “These particular drugs can link beautifully with radiation treatment because they affect DNA damage and repair,” Harari said.

In one case, they looked at a drug that promotes the activity of the anti-growth protein p53, a molecule that normally signals severely damaged cells to stop growing but is blocked from working in many different cancer types. In a second paper, they focused on a drug that targets two crucial proteins of the EGFR family that are overactive in various poor-prognosis head and neck cancers.

In both cell-culture tests and mouse models, they found that administering the combination of either drug with radiation treatment was more effective at curbing cancer cell growth, through a variety of growth inhibition or even cell-death mechanisms, than either treatment alone. As lead author Lauryn Werner puts it, “radiation is putting on the gas, and the inhibitor drugs are removing the brakes. They synergize nicely.”

Both drugs are currently in phase I/II clinical trials to test their safety and early efficacy, and Harari expects that future trials could include combinations with radiation therapy.

Both articles were published in the September 2015 issue of the journal Molecular Cancer Therapeutics and chosen by the journal as featured articles.

MRI-guided Radiotherapy at UW

In 2014, the University of Wisconsin Hospital and Department of Human Oncology initiated cancer treatments with the first-in-the-world MRI-guided radiation therapy technology, the ViewRay MRIdian system. Over 100 patients have been treated at UW to date with this powerful new technique. Only 3 centers in the world currently offer this technology (University of Wisconsin, Wash U and UCLA), however the incorporation of MRI-guided radiotherapy is anticipated to grow substantially around the world in the coming years.

Combining real-time MRI scanning with IMRT radiation delivery using a single machine enables unprecedented precision in daily treatment verification and opportunities for adaptive treatments. The ability to see each patient’s tumor and surrounding organs throughout the course of their radiation treatment delivery is exceptionally unique. To date, patients with cancers involving the lung, liver, GI tract and thorax have been the primary focus at UW in light of the significant tumor motion that can occur with breathing for these sites. Additional tumor types are anticipated to commence treatment as further experience is gained with this sophisticated technology. The primary objectives are to increase the precision of radiation delivery to the tumor and diminish radiation exposure to surrounding normal tissues. The early experience has been remarkably favorable.