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By Michele W. Sequeira

A Menu of Brain Cancer Treatments

UNM Cancer Center Scientist developing a new personalized approach to treating glioblastoma, using Gianni Bonadonna prize

Sara Piccirillo, PhD, is passionate about finding a way to beat glioblastoma, the most aggressive type of brain cancer. Although the median survival time has doubled since the 1990s, only 6% of those with glioblastoma survive five years or more after their diagnosis. Piccirillo thinks the way to fight glioblastoma lies in what makes it different from most cancers: the extreme differences among its tumor cells.

“Glioblastoma is the most aggressive brain tumor that we know about,” she says. “There is very little in terms of effective treatment.”

Glioblastoma rarely spreads beyond the brain but it can spread rapidly within the brain. Even if it initially responds to current therapies, Piccirillo says, it usually comes back and is often resistant to those therapies when it returns.

Originally from Milan, Italy, Piccirillo came to The University of New Mexico after a multi-year stop at the University of Cambridge. She joined the UNM Department of Cell Biology & Physiology and the UNM Comprehensive Cancer Center in early August 2019. The month before, Piccirillo had won the Gianni Bonadonna prize for new drug development, which is among Italy’s most prestigious awards for young scientists. She will use the award to fund her research on glioblastoma treatment.

Piccirillo’s research focuses on a feature of glioblastoma tumors that appears to be the source of their strength. As she explains, “They are extremely heterogeneous.”

The cells in these tumors arise from multiple genetic changes, she says. Some cells may have different DNA mutations. Other cells may have extra copies of a gene. Still others may have chromosomes that have traded sections with each other. There are other types of changes as well, each of which may respond to a different treatment.

This mosaic of cells within glioblastoma tumors makes destroying them very difficult because some cells will respond to a given therapy but others won’t. And those surviving cells, Piccirillo and her team believe, can restart the tumor. Even more troubling, some therapies can make cells resistant, so that when the tumor reforms, it is even more difficult to treat.

Piccirillo wants to first develop a catalog of cellular changes and the treatments that are most effective against each one. She then wants to turn that catalog into a menu that suggests combinations of glioblastoma treatments for different combinations of changes.

The menu idea is similar to a restaurant menu that suggests having broccoli with your steak but not with your chocolate dessert; some combinations are permitted, others won’t be effective. Similarly, different people with glioblastoma might benefit from different combinations of treatments based on the changes found in their tumor cells. The menu would allow doctors to customize glioblastoma treatment to each person.

“You need to have a smart way to combine therapies,” Piccirillo says, “so that you can tackle the tumor but also avoid creating resistance.”

Piccirillo has amassed a collection of tumor samples and has begun compiling the many different cellular changes she finds within them. Once she and her team complete an initial version of the catalog, they will try different treatment combinations to find those that kill all the cancer cells. Although the treatment menu seems a long way off, Piccirillo is determined to improve the odds of beating glioblastoma.

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Sara Piccirillo, PhD, is an Assistant Professor in the Department of Cell Biology & Physiology, and holds a secondary appointment in the Department of Neurosurgery, at the UNM School of Medicine. She is a full member of the Cellular and Molecular Oncology Research Group at the UNM Comprehensive Cancer Center.

UNM Comprehensive Cancer Center

The University of New Mexico Comprehensive Cancer Center is the Official Cancer Center of New Mexico and the only National Cancer Institute-designated Cancer Center in a 500-mile radius.

Its 131 board-certified oncology specialty physicians include cancer surgeons in every specialty (abdominal, thoracic, bone and soft tissue, neurosurgery, genitourinary, gynecology, and head and neck cancers), adult and pediatric hematologists/medical oncologists, gynecologic oncologists, and radiation oncologists. They, along with more than 600 other cancer healthcare professionals (nurses, pharmacists, nutritionists, navigators, psychologists and social workers), provide treatment to 65% of New Mexico’s cancer patients from all across the state and partner with community health systems statewide to provide cancer care closer to home. They treated 13,578 patients in 105,748 ambulatory clinic visits in addition to in-patient hospitalizations at UNM Hospital.

A total of 1,610 patients participated in cancer clinical trials, including 696 patients who participated in clinical trials testing new cancer treatments that include tests of novel cancer prevention strategies and cancer genome sequencing.

The 132 cancer research scientists affiliated with the UNMCCC were awarded $34.5 million in federal and private grants and contracts for cancer research projects and published 301 high quality publications. Promoting economic development, they filed more than 30 new patents since FY16, and since 2010, have launched 11 new biotechnology start-up companies. Scientists associated with the UNMCCC Cancer Control & Disparities have conducted more than 60 statewide community-based cancer education, prevention, screening, and behavioral intervention studies involving more than 10,000 New Mexicans.

Finally, the physicians, scientists and staff have provided education and training experiences to more than 230 high school, undergraduate, graduate, and postdoctoral fellowship students in cancer research and cancer health care delivery.

Categories: Comprehensive Cancer Center