Grant will advance adrenal cancer research with colleagues in Brazil

The road to understanding the physiology of adrenal cancer has been a long one, stretching many years and some 5,100 miles. That’s the distance between Michigan Medicine and the Faculdade de Medicina da Universidade de Sao Paulo (FMUSP), Brazil’s top medical school, where researchers have been partnering with UMMS colleagues for years to study the rare disease.

From left: MD-PhD student Dipika Mohan, Research Investigator Antonio Lerario, and Professor of Internal Medicine Gary Hammer.

A recent grant continues that collaboration, aiming to identify biomarkers that could help doctors tailor their treatment plans to the respective tumor. After more than a decade of lab work, the new project moves the research much closer to the patients, according to Gary Hammer, UMMS Millie Schembechler Professor of Adrenal Cancer, who has spearheaded the research with FMUSP.

“The aim to come up with usable protocols that will help doctors stratify patients into different treatment groups,” said Hammer, MD, PhD. “Protocols are already being discussed to potentially enroll patients in local, national and international trials. For our world in adrenal cancer research, that is a big step forward.”

Adrenocortical carcinoma is often undiagnosed until the late stages, making it difficult to treat. But the disease’s rarity impedes meaningful research; it impacts only about one or two in every million people.

“For us, the biggest challenge is getting enough patient samples to conduct a study of any real value,” Hammer said. “That’s what makes international collaboration so critical to progress.”

In Brazil, adrenal cancer is more prevalent – that is, slightly less uncommon – compared to other countries. FMUSP is affiliated with the largest hospital system in South America and home to some of world’s foremost experts on the disease. Funded by a grant from the U-M Comprehensive Cancer Center with additional resources from FMUSP, the new joint study uses patient tumor samples from both institutions to identify biomarkers that could help stratify future patients.

The work builds on prior joint research conducted as part of the NIH-funded The Cancer Genome Atlas Project (TCGA), which mapped the molecular genetics of many types of cancers, including adrenal cancer. The Atlas study, published last May in Cancer Cell, showed among other things that adrenocortical carcinoma tumors can be broadly categorized into three sub-types with three different outcomes: good, fair and poor.

While the Atlas project relied on complex sequencing, the new study will test a simplified assay to look for three biomarkers the researchers think are associated with the three tumor types.

“We’re using a pretty routine test. The benefit of our assay is that it can be completed within 48 hours,” said Dipika Mohan, a UMMS MD-PhD student in Hammer’s lab who spent a month in Sao Paulo this fall on the project. “Our study can help us identify which patients really need aggressive treatment and when they should receive it.”

The team has about tumor 50 samples from each institution to collect, test, and compare against the respective clinical records for each patient. Antonio Lerario, MD, PhD, a graduate of FMUSP and now a research investigator in Hammer’s lab, worked directly with some of the Brazilian patients who provided samples for the study.

“That makes it very personal for me because I spent so much time taking care of them,” Lerario said. “Those samples are a gift those patients provided to us, and hopefully we can use that gift to turn around and help others in the future.”