Working Together to Beat Endometrial Cancer

It seems appropriate that Paul Goodfellow, PhD, and David Cohn, MD, will work together to lead the new, statewide clinical cancer initiative aimed at improving the outcome for endometrial cancer patients.

Working together to beat cancer is nothing new for this determined duo, whose initial collaboration dates back to 1998 and the first day of Dr. Cohn’s fellowship in Dr. Goodfellow’s lab at Washington University in St. Louis.

“Paul said, ‘we’re going on a field trip,’” said Dr. Cohn, now the director of gynecologic oncology at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James).

This field trip (which also included a geneticist) was to meet with a family that had a history of what appeared to be a genetic syndrome that was causing multiple cases of colon and endometrial cancer.

“Sure enough, it was Lynch syndrome,” said Dr. Goodfellow, a geneticist now with the OSUCCC – James Molecular Biology and Cancer Genetics Program.

As their careers progressed, with Dr. Goodfellow running a lab and Dr. Cohn in the clinic, the two kept in touch on a professional and personal basis. They worked together on a Specialized Program of Research Excellence (SPORE) grant from the National Cancer Institute (NCI) that Dr. Goodfellow received in 2009.

“I had such a strong belief in David and this was an opportunity to add value to the SPORE,” Dr. Goodfellow said of why he invited Dr. Cohn and the OSUCCC – James to join the study that was focused on improving the detection and treatment of endometrial cancer, a cancer of the lining of the uterus that is the most common gynecological cancer.

When there was an opportunity at the OSUCCC – James in 2012, Dr. Cohn vouched for the importance of Dr. Goodfellow’s research, leading to his recruitment.

“The James is an extraordinary place,” Dr. Goodfellow said.

Together, they will lead The Ohio Prevention and Treatment of Endometrial Cancer (OPTEC) project and continue their work to help patients with Lynch syndrome and endometrial cancer. The study is funded with $1 million from Pelotonia and aims to recruit up to 700 Ohio women with endometrial cancer from at least 25 partner hospitals in Ohio.

These women will be screened for Lynch syndrome and other inherited genetic mutations that are linked to an increased risk for endometrial, colon, stomach and ovarian cancer. Learning if a woman has Lynch syndrome will lead to similar tests for family members and regular screenings for those that have this inherited mutation. This knowledge and the screenings will prevent colon cancer, catch endometrial cancer in the very early stages and save a lot of lives.

The OPTEC program will also take tumor samples from patients. These samples will undergo molecular profiling to identify the best treatment approach for each patient. For example, many women with endometrial cancer could benefit from anti-PD-1 drugs.

These drugs help the body’s immune system detect and attack the endometrial cancer cells.

“We will channel these patients into clinical trials that demonstrates the efficacy of the drugs,” Dr. Cohn said.

About 27 percent of patients with endometrial cancer will benefit from anti-PD-1 drugs, Dr. Goodfellow said. “This is a real opportunity to improve the treatment options for a disease in which most of the therapies are less effective than desired,” he added.

Endometrial cancer is one of the few types of cancer in which the number of cases and the mortality rate are on the rise, Dr. Cohn said, adding a national increase in the obesity rate is the primary reason.

More than 61,000 women are diagnosed with endometrial cancer annually in the United States, with more than 17 percent of patients dying of the disease. About 5 percent of all women with endometrial cancer have inherited Lynch syndrome, and each of their children has a 50 percent chance of inheriting the mutation. The lifetime risk for endometrial cancer in a woman with Lynch syndrome is 50 percent, which is 10 times higher than a woman without Lynch syndrome. Women with Lynch syndrome have an even higher risk for colon cancer than they do for endometrial cancer.

A similar program at the OSUCCC – James, the Ohio Colorectal Cancer Prevention Initiative (OCCPI), preceded OPTEC. This statewide program screened thousands of colon cancer patients and their family members for Lynch syndrome. The next step was endometrial cancer, the second-most common form of cancer caused by Lynch syndrome. Colon cancer is the most common.

“I think of this as closing the circle,” Dr. Goodfellow said of OPTEC.

Dr. Goodfellow and Dr. Cohn are such effective collaborators for several reasons.

“Paul has a unique ability to understand clinical medicine,” Dr. Cohn said. “He can relate to what we do and help us interpret science in the clinical setting to benefit our patients.”

Toss in Dr. Cohn’s understanding of how a lab works, first acquired during his year in Dr. Goodfellow’s lab, and you have a scientist who understands what goes on in the clinic (Dr. Goodfellow), and a clinician and division head (Dr. Cohn) who understands what goes on in a lab. Then spend some time with the two, and it’s obvious they enjoy each other’s company.

Dr. Goodfellow and Dr. Cohn are determined to improve the treatment options and outcomes for cancer patients. It’s why they do what they do, and they believe OPTEC is a big step in this direction.

“I’ve learned over the years to manage my expectations,” Dr. Goodfellow said. “Most things don’t work out and the advances are incremental. But, I’ve had enough successes to keep me hungry and if we can see this through and make this happen, the outcome will be really good.”

Dr. Goodfellow said OCCPI and OPTEC could become the models for regional or even national testing programs that will screen thousands more cancer patients for Lynch syndrome.

Dr. Cohn believes OPTEC will help the women he treats at the OSUCCC – James.

“One of the hardest things for me is to see a patient with ovarian or endometrial cancer, review their family history and see clearly (before genetic testing) that Lynch syndrome is there,” he said.

Knowing this would have meant more screenings, earlier detection and better outcomes.

“I look at it as a missed opportunity,” Dr. Cohn said. “And if we can use OPTEC to identify these patients early on, that’s really powerful.”