Giselle Sholler is the Chair of the Neuroblastoma and Medulloblastoma Translational Research Consortium (NMTRC) and the Director of the Hayworth Innovative Therapeutic Clinic at Helen DeVos Children’s Hospital. The NMTRC is a group of 15 pediatric hospitals across the U.S, plus the American University in Beirut, Lebanon, and Hospital La Timone in Marseilles, France. We sat down recently with Dr. Sholler to talk about to role of precision medicine in her work and how it impacts patients.
Intel: What are the challenges of pediatric oncology and how do you tackle those challenges?
Sholler: As a pediatric oncologist, one of the most challenging times is when we’re faced with a child who is not responding to standard therapy and we want to figure out how we can treat this patient. How can we bring hope to that family? A project that we are working on in collaboration with TGen, Dell and Intel has brought that hope to these families.
Intel: What is the program?
Sholler: When a child has an incurable pediatric cancer, we a take a needle biopsy and send it to TGen where the DNA and RNA sequencing occurs. When ready, that information comes back to the Consortium. Through a significant amount of analysis of the genomic information, we’re able to look at what drugs might target specific mutations or pathways. On a virtual tumor board, we have 15 hospitals across the U.S. and now two international hospitals in Lebanon and France that come together and discuss the patient’s case with the bioinformatics team from TGen. Everyone is trying to understand that patient and with the help of pharmacists create individualized treatment plans for that patient so that patient can have a therapy available to them that might result in a response for their tumor.
Intel: Why is precision medicine important?
Sholler: Precision medicine is about using the genomic information data form a patient’s tumor to identify which drugs not only will work, but which ones may not work on that patient’s specific cancer. With precision medicine, we can identify the right treatment for a patient. We’re not saying chemotherapy is bad, but for many of our patients chemotherapy is attacking every rapidly dividing cell and leaves our children with a lot of long term side effects. My hope for the future is that as we can target patients more specifically with the correct medications, we can alleviate some of the side effects that we’re seeing in our patients. Half our children with neuroblastoma have hearing loss and need hearing aids for the rest of their lives. They have heart conditions, kidney conditions, liver conditions that we’d like to see if we can avoid in the future.
Intel: How does the collaboration work to speed the process?
Sholler: The collaboration with Dell and Intel has been critical to making this entire project possible. The grant from Dell to fund this entire program over the last four years has been unparalleled in pediatric cancer. The computer power has also been vital to the success. Three years ago we were doing only RNA expression profile and it took two months; now, we’re doing RNA sequencing and DNA exomes completely and it takes less than two weeks to get the answers for our patients. The data transfer and networking used to entail shipping hard drives a few years ago. Now, we can send a tumor sample from Lebanon to TGen, complete the sequence in a few days and have a report for the tumor board a few days after that. It’s just been amazing to see the speed and accuracy improve for profiling.
Intel: Anything else?
Sholler: Another very critical piece that Dell has helped provide is the physician portal. Physicians are able to work together across the country, and across the world, and have access to patient records. The database now has grown and grown. When we do see patients, we can also pull up previous patients with similar sequencing or similar profiles, or treated with similar drugs, and see what was used in treatment. And how did they do? What was the outcome? We’re learning more and more with every patient and it doesn’t matter where we live anymore. Everything’s virtual online. It’s just been incredible.