Pre-Cancer Atlas: Plotting a course to intercept cancer

The route a cancer takes from its earliest stages to advanced disease is a long and winding road. Often, the first mutations or changes that send a normal cell on the path toward cancer occur decades before any diagnosis could be made.

Fortunately, our immune systems are able to recognize and eliminate most of these “pre-cancers” before we ever know they existed. However, some pre-cancers can evade detection, enabling them to continue down the road to become malignant cancers.

Researchers have begun to realize that if we can better understand the path between pre-cancer and cancer, we may be able to intervene before any damage is done. This is the idea behind an emerging field called cancer interception.

With the hopes of saving more lives, a new MD Anderson initiative aims to discover new avenues for cancer interception by generating a comprehensive biological roadmap of pre-cancer development – a Pre-Cancer Atlas.

“Our vision is to develop this atlas so that we can identify actionable targets for intercepting pre-cancers,” says Eduardo Vilar-Sanchez, M.D., Ph.D., co-director of the Pre-Cancer Atlas project. “We have a very clear translational mandate to implement new trials for cancer interception.”

Deep dive into pre-cancers

To generate this map, Vilar-Sanchez and Anirban Maitra, M.B.B.S., are leading teams of researchers to perform comprehensive analyses of early pre-cancer samples, including abnormal cells as well as surrounding healthy tissue and immune cells.

Analyzing this mix of cells is important for understanding the dynamic interactions that allow pre-cancers to develop or not, explains Maitra.

“A lot of what we know about cancer development is a two-step, if you will, between the tumor and the microenvironment surrounding it. They each talk to one another, they co-opt one another,” he says.

Researchers are studying pre-cancerous tissue samples from patients, collected with the help of MD Anderson’s Adaptive Patient-Oriented Longitudinal Learning and Optimization (APOLLO) platform.

Using single-cell sequencing technology, scientists can analyze samples at the level of individual cells to develop a comprehensive picture of pre-cancer biology. With time, they will be able to identify the subtle, early changes occurring and, in turn, targets for therapeutic intervention.

Driven by team science

A broad team of researchers and clinicians are working together to make the Pre-Cancer Atlas a reality.

“We want to be the national leaders in this space,” says Vilar-Sanchez. “So, we have assembled teams of disease site experts from across MD Anderson, and we are working collaboratively to develop an efficient framework for carrying out this work.”

That framework is built upon infrastructure already created at MD Anderson, such as the APOLLO platform and the single-cell sequencing core. Together, they’ll enable a harmonious process for sample collection, processing and analysis.

The initiative also is supported by MD Anderson’s Moon Shots Program®, a collaborative effort to accelerate scientific discoveries into clinical advances that save patients’ lives.

All of these pieces coming together are essential for the success of this endeavor, explains Vilar-Sanchez, and are why a project like this can only be done at a place like MD Anderson.

The initiative is focused on an initial subset of pre-cancers, with plans to expand to additional areas in the future. Current projects are investigating:

• Cancers driven by microsatellite instability (MSI), including colorectal and endometrial cancers
• Pancreatic cancer
• Lung cancer

Potential for profound impact

While the initiative has only recently launched, there is excitement about where it could lead.

Based on discoveries from the Pre-Cancer Atlas, researchers hope to perform clinical trials to evaluate new treatments for individuals with early pre-cancers. These could include targeted therapies, immune checkpoint inhibitors or even cancer vaccines used to intercept pre-cancers and stop them before symptoms even develop.

“If we can intercept cancer, we can have a tremendous impact on long-term survival,” says Maitra. “But to be able to do that, you have to understand what is going on. That is our fundamental goal.”

Refer a patient to MD Anderson online or by calling 1-877-632-6789.