The sarcoma program is a collaboration of physicians, researchers, and their patients. It ranks as one of the top sarcoma research and treatment programs in the nation.

Three years ago, Ruth Bachman had a strange lump on her left wrist for several weeks. Thinking that it might be a touch of arthritis or a sports-related injury, she finally made an appointment at a sports medicine clinic with the first available doctor. He referred her to Denis Clohisy, M.D., a professor of orthopedic surgery at the University of Minnesota and a researcher with the University's Cancer Center. She soon learned that the lump was a sarcoma, a fairly rare cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

As cancers go, sarcoma is a bit of an orphan. Only about 8,700 people are diagnosed with sarcoma in the U.S. each year, compared to more than 200,000 cases of breast cancer. In fact, many physicians never see even one case of sarcoma in their career. But, as a National Cancer Institute-designated Comprehensive Cancer Center with a wide range of sarcoma expertise, the University of Minnesota Cancer Center is a hub for sarcoma research and treatment. Physicians there see as many as 100 new sarcoma cases each year with the patients ranging from age 6 months to 100 years. Consequently, the physicians offer a rare level of expertise in sarcoma.

That's why Bachman put her trust in the University's sarcoma team. An avid cook, traveler, and soon-to-be grandmother, Bachman was a "lefty" and could not imagine life without her left hand. But chemotherapy failed to shrink the tumor, and ultimately, amputating her left hand was the most viable alternative. That was in 2003. Today, Bachman remains an avid cook and traveler, plus she is now grandmother of two. She also adds another description of herself to that list: "sarcoma survivor."

"Denis Clohisy was the best person to go through the journey with," she says. (Read more about Ruth Bachman's experience as a cancer survivor.)

One site, many experts

But there were many more people on Bachman's "team" than Clohisy. Collaboration is one of the defining features of sarcoma research and treatment at the University. Surgeons, pathologists, pediatric and adult oncologists, radiation therapists, and radiologists meet weekly to discuss each patient's case and decide the best approach for treatment.

This system fosters the "cross pollination" of the expertise of physicians who work with all types of cancer, not just sarcoma. As a group they treat several hundred tumors every year. This tradition of collaboration dates to the 1970s when Roby Thompson, M.D., professor of orthopedic surgery and associate dean for clinical affairs at the University's Medical School, led the sarcoma program.

Clohisy explains that in other settings, the course of treatment for a sarcoma would likely take place in different locations with different doctors working independently. "At the University, we work as a team to identify the unique characteristics of the individual patient, tailor the treatment to the patient, and provide the treatment in one location." Having these specialists at one site also simplifies the logistics for patients, particularly for those living outside the Twin Cities area and traveling to the University for treatment.

Research based on experience

So much clinical experience leads to extremely focused, patient-centered research. Says Clohisy, "As we gain real-life understanding of what's really happening to patients, we ask, 'What improved approaches can we develop to better understand what causes the problem and stop it?'"

This questioning and critical thinking applies to both clinical research on humans and basic research in the laboratory. "It's unusual for a sarcoma team to do both clinical and basic research," says Clohisy. "Besides the University, there are only two or three other places in the U.S. that do that."

Edward Cheng, M.D., professor of orthopedic surgery, focuses on clinical research. Cheng spends about 80 percent of his time performing surgery and 20 percent doing research. He is conducting clinical trials to develop an alternative to the lengthy time required to evaluate new sarcoma treatments, typically five to 10 years. He says, "Instead of using survivorship as the 'gold standard' of success, we're investigating the effectiveness of using patients' PET scans after chemotherapy as the benchmark for determining the success of treatment." He hopes to use before and after scans as a much faster way to screen newer treatments, such as molecularly targeted therapies.

Cheng also chairs the research committee of the Musculoskeletal Tumor Society (www.msts.org), a national organization dedicated to advancing the science of orthopedic oncology and enhancing patient care. In that capacity, he is working to foster coordination of clinical research between research centers across the country.

"Because there are so few cases of sarcoma, we need to cooperate to conduct more studies and gain more information to better serve our patients," he says. This cooperation has now been recognized with the opening of the first national clinical trial focusing on a rare bone cancer, chondrosarcoma, jointly sponsored by the Southwest Oncology and American College of Surgeons Oncology Groups, with Cheng as one of two principal investigators leading the multi-center trial.

Beyond the clinic

On the basic research side, Cancer Center researchers are investigating molecular drug treatments targeted directly at tumors. Using what's called the "Trojan Horse" approach, Clohisy's research team is exploring a method to deliver normal cells engineered to contain a cancer-killing enzyme directly into a sarcoma tumor. The treatment was successful in mouse experiments, and the results will be published in the prestigious journal Cancer Research.

"As we gain real-life understanding of what's really happening to patients, we ask, 'What improved approaches can we develop to better understand what causes the problem and stop it?'"
— Denis Clohisy, M.D.

Again, such research would not be possible without the collective expertise and experience of other Cancer Center researchers. For example, Cancer Center researcher Paul Orchard, M.D., who also is an associate professor in the University's Department of Pediatrics, designed the gene used in Clohisy's study. Such research also draws upon the Cancer Center's resources for researchers in tissue procurement, mouse genetics, and bioinformatics. This crossover collaboration illustrates one of the requirements of being an NCI-designated Comprehensive Cancer Center. According to the NCI, the University of Minnesota Cancer Center and the 38 other cancer centers in the nation that hold that designation "are characterized by scientific excellence and the capability to integrate a diversity of research approaches to focus on the problem of cancer."

Furthermore, the Cancer Center encourages this type of research collaboration and innovation by annually sponsoring the "Brainstorm Awards." Researchers can apply for these awards, which range from $25,000 to $50,000, to use for conducting new research projects. Similarly, a cooperative effort between the Children's Cancer Center Research Fund, Karen Wycoff Rein in Sarcoma Fund (see related article), and the Roby Thompson Chair in Musculoskeletal Oncology awards $50,000 to University researchers in medical or non-medical fields to fund sarcoma research.

Yet, despite the potential of such creative cancer research, the focus always goes back to one thing: "Patients come first," says Clohisy. "That's the guiding principle."

People like Ruth Bachman and hundreds of others are grateful for the treatment they receive at the University, but the University is also grateful to them. The care of each patient by physicians at the University increases the level of understanding of sarcoma and bestpossible treatments. And that leads to enhanced care for sarcoma patients everywhere.

Dr. Clohisy holds the Roby Thompson Chair in Musculoskeletal Oncology at the University of Minnesota and he is a member of the Cancer Progression and Metastasis Research Program, which is led by James McCarthy, Ph.D. Dr. Cheng holds the Mairs Family Chair in Muscoloskeletal Oncology. Both physicians also are members of University of Minnesota Physicians and on staff at the University of Minnesota Medical Center, Fairview. To learn more about the research and treatment of sarcoma at the University of Minnesota, visit www.sarcoma.umn.edu or contact the Information Line at ccinfo@umn.edu, 612-624-2620 or toll-free in Minnesota, Iowa, Wisconsin and the Dakotas at 1-888-CANCER MN (1-888-226-2376).

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This article was originally published in the University of Minnesota Cancer Center 2006 Annual Report (PDF).