PATRICK J. LOEHRER, Sr. MD
Director, Indiana University Melvin and Bren Simon Cancer Center
H.H. Gregg Professor of Oncology
Associate Dean for Cancer Research, Indiana University School of Medicine
As Center Director Pat Loehrer tells it, the IU Simon Cancer Center owes its very existence to the Walther Cancer Institute. “It was Walther’s mission to establish Indiana University as a National Cancer Institute-designated cancer center, and they accomplished that goal. They provided seed funding and capital for growth; Walther was the initial catalyst that brought in the outstanding talent we have now,” Loehrer says.
In 1992, the Indiana University Cancer Center was established with an NCI planning grant. In 1999, thanks in large part to the efforts of the Walther Cancer Foundation, IU’s center earned the coveted NCI designation, which it has maintained continuously ever since. In 2006, in honor of Melvin and Bren Simon’s philanthropy, the center was renamed the Indiana University Melvin and Bren Simon Cancer Center (IUSCC). Pat Loehrer, MD, has led the center since 2010.
Today, medical scientists and clinicians at the IUSCC dedicate their lives to eliminating the burden of cancer on the citizens of Indiana, through outstanding research and patient care, screening and prevention, and a renewed focus on palliative care.
Precision oncology and bioinformatics
Thanks to medical science, many cancers now are curable and many more have become more like a chronic illness than an inevitably rapidly fatal diagnosis. But treatments have become increasingly complex. Each form of cancer has a unique protocol. Even within cancer types, treatments for individuals need to be unique, given a patient’s genetic makeup — and the genetic makeup of their tumor, a makeup that changes over time adding to the complexity.
“We need to understand the wiring that makes a cancer cell grow,” Loehrer says. “The more we learn about cancer-growth at the molecular level, the more complicated we realize it is. There are thousands of different genes that come together in unique ways to make different proteins. In many types of adult cancers, scores if not hundreds of mutations occur which makes the root causes of carcinogenesis, drug resistance or metastasis difficult at best. It is truly like finding the needle in the haystack. In reality, in each patient with cancer, there are commonly several different “needles” we need to find.”
As a result, Loehrer explains, discovering cancer treatments requires sophisticated modeling — and a lot of it. “We need more elegant patient avatars, or cancer avatars, from which we take some cancerous tissue from patients. We grow the tumors outside the body, test some drugs against these tumors, and see what genes are up-regulated or down-regulated. This inventory is the first step in designing a more comprehensive and strategic approach for combination therapy for patients with advanced disease.”
The amount of data produced by such work is enormous, and analyzing it requires the specialized skill of data scientists. Fortunately, just an hour north, a group of data scientists exists at Purdue University, known nationally for its expertise in engineering and bioinformatics. Given the state of cancer research, work that requires both medical scientists and data scientists, it is fitting that Indiana’s two NCI-designated cancer centers should discover treatments for cancer together.
In 2015, the Walther Cancer Foundation funded a three-year, $2M joint effort between the IU Simon Cancer Center and Purdue’s Cancer Research Center. IU provides the patients and the data. Purdue provides algorithms and analysis.
Together, researchers from both centers established a shared resource, a database that enables clinical data to be analyzed —and thus, applied — with much greater speed and efficiency.
“We take information from the hospital and the clinics, about how the patient is feeling, their symptoms, and we tie it to a database and link it with molecular data. So now we have outcomes that can be linked with the clinical data, and with that we can come up with more precise treatment options and in some cases, prevent serious side effects of treatment,” Loehrer says. “It is the next generation of cancer treatment.”
“Our ability to make rapid advances requires collaborations,” Loehrer says. “Often, we can do the work within our own institutions, but increasingly, Walther has been interested in supporting projects that bring Indiana’s three research universities together. We at IU also feel very strongly about collaborative research efforts.”
Indeed, “team science” is a core value that the Walther Cancer Foundation and the IU Simon Cancer Center share. Team science means tackling a specific problem with a group of researchers from a variety of disciplines — from whichever academic field is necessary — even if they are from other institutions or outside conventional biologic science disciplines.
“I believe that the relationship between Purdue and IU is as close as any two NCI-designated cancer centers in the country,” says Loehrer. “This perhaps is a reflection on the leadership of Tim Ratliff and myself. We both really love working with each other.”
Since the joint effort in bioinformatics began in 2015, researchers have completed more than 100 projects. “It’s really been a terrific endeavor,” Loehrer says. “A uniquely successful experiment that absolutely would not have happened without the Walther Cancer Foundation’s trust and support.”
Detecting counterfeit chemo
Team science also solves health problems, including cancer, in developing countries. A prime example is in Eldoret, Kenya, where the Academic Model Providing Access to Healthcare, or AMPATH program, thrives. There, at the Moi University Teaching and Referral Hospital, healthcare professionals from American universities work with local doctors to improve the lives of people in the region.
Started by Indiana University physicians in 2001 as a way to halt the HIV pandemic, AMPATH has become a holistic healthcare program. Among its services is an oncology clinic, with which Loehrer has been involved for more than a decade.
In Kenya, Loehrer was intrigued by a simple, inexpensive tool for detecting counterfeit drugs. It was developed by a Notre Dame scientist, Marya Lieberman, working in a Purdue-coordinated pharmacology program in Eldoret, Kenya. Counterfeit medicines are a ubiquitous problem in low-income countries, which depend on affordable, generic formulations of antibiotics, anti-retrovirals, and anti-malarials — all targets for counterfeiters.
The “paper analytical device,” or PAD, is about the size of a playing card. “You take a little bit of the drug, a drop of water, and within minutes the filter paper will turn color, indicating whether or not the medicine is counterfeit,” Loehrer explains.
With funding from Walther, Loehrer is working with Dr. Lieberman to spearhead a similar project for detecting counterfeit chemotherapy drugs. The Notre Dame chemist is now working with researchers at Purdue, examining chemo drugs commonly used in Kenya and creating a device to detect counterfeits. It’s called the ChemoPAD.
“If we can pull this off, and our collaborators are very confident we can, this will have impact around the world,” Loehrer says.
A model for supportive oncology
In the spirit of Joe Walther’s desire to recognize and care for the overall well-being of cancer patients and their families, the Walther Cancer Foundation is facilitating the creation of a supportive oncology program at the IUSCC.
Two Walther-endowed chairs enable development of national models for palliative care, symptom management, and for addressing personal and practical problems faced by cancer patients and their families.
The survivorship research program, also established by Walther, examines and tracks the side effects of cancer treatments. “Side effects occur in patients differently, mainly due to genetic makeup,” Loehrer says. He explains that in time, oncologists at IUSCC will be able to use a patient’s genetic markers to predict the side effects that specific cancer treatments will cause in an individual patient and thereby develop strategies to avoid or at least mitigate them.
“It is an exciting time,” Loehrer says. The future for cancer patients looks brighter than ever, and much of the progress made by the IU Simon Cancer Center is due to the Walther Cancer Foundation. “In Indiana,” Loehrer says, “The Walther Cancer Foundation is one of the best friends that most cancer patients have never met.”
About Patrick Loehrer
Patrick Loehrer, MD, is Director of the Indiana University Melvin and Bren Simon Cancer Center and the H.H. Gregg Professor of Oncology and Associate Dean for Cancer Research at the Indiana University School of Medicine.
Loehrer is a specialist in a variety of cancers, including cancers of the testis, bladder, colon, pancreas and, most notably, the thymus gland. His work has led to the approval of ifosfamide for the treatment of testicular cancer, and he helped develop therapies for the treatment of several malignancies, including thymoma and cancer of the bladder, colon and pancreas.
More than 30 years ago, he founded the Hoosier Oncology Group, recently renamed the Hoosier Cancer Research Network. The network, the administrative home of the Big Ten Cancer Research Consortium, has created an international network of 130 academic and community institutions dedicated to turning clinical research into patient treatments.
Dr. Loehrer has received numerous awards, including the Flick Family Fund Award, the American Cancer Society Fellowship, the American Cancer Society Junior Faculty Award, the Glenn Irwin Experience Excellence Award, the ECOG Young Investigator Award, the Danielson Award, the Collaborator of the Year Award from the Walther Cancer Institute, and the W. George Pinnell Award. He has received the Outstanding Mechanical Engineering Award and the Distinguished Engineering Award from Purdue University. Dr. Loehrer received the Special Recognition Award from the American Society of Clinical Oncology (ASCO), and in 2017, he received the inaugural Allen S. Lichter Visionary Leadership Award from ASCO.