Better Cures, Better Care

On a recent trip to Washington, D.C., USC Dornsife’s Peter Kuhn was sitting in a restaurant when a server walked up to him and said simply, “Thank you for saving my mother’s life,” before walking away.

“I think that’s a pretty amazing testament to the far-reaching impacts of Peter’s work and the countless lives he has touched with his research,” USC Dornsife Dean Steve Kay told the packed audience gathered at Joyce J. Cammilleri Hall, inside the Dornsife Neuroscience Pavilion, on Jan. 26.

“Peter’s goal is to find and obliterate every tumor cell in a patient’s body — an innovation that will potentially revolutionize the success rate of cancer treatments, while at the same time minimize side effects,” Kay said in his introductory remarks.  

Kuhn, Dean’s Professor of Biological Sciences, recently arrived at USC Dornsife from The Scripps Research Institute in La Jolla, California. Having published more than 180 articles and filed 16 patents, he founded the company Epic Sciences in 2008 to bring his personalized cancer detection and treatment innovations to the market.

At USC, Kuhn also serves as associate director of The Bridge@USC. Directed by Provost Professor of Biological Sciences and Chemistry Raymond Stevens, the institute focuses on bringing scientists, engineers, physicians and visual artists together to research alternative treatments for a wide array of human diseases and conditions.

In his Dean’s Special Lecture titled “Convergent Science; Life Sciences and Engineering in Oncology,” Kuhn discussed his “no cell left behind” approach to detecting and characterizing circulating tumor cells (CTCs) in the blood. First identified in the 1860s, CTCs are cells that have broken off from a primary tumor, ruthlessly seeking out new areas of the body to set up camp and plant the seeds for new tumors to take root.

Kuhn, who holds a joint appointment at Keck School of Medicine of USC, is developing strategies to attack CTCs before the cancer can fully metastasize.

His research focuses on biological transition points as they pertain to cancer treatment. His findings may provide the link between an individual cancer patient’s biology and how he or she will be treated for a particular disease.

A biological transition point is the initial, instigating change that occurs when a cancer shifts from benign to malignant, from local to distant or from treatment-sensitive to treatment-resistant. Medicine is limited currently to treating the corresponding clinical transition point — the time at which this change is first detected due to an amassed population of changed cells.

The audience learned how Kuhn employs physical science and biological methods to study the factors that affect biological transition points in order to improve clinical decision-making and mitigate the damage caused by delayed clinical detection. By studying changes occurring within individual tumor cells, within patients’ organ systems and within populations of patients to chart the dynamic course of cancer evolution, he is working to better predict and thus better treat this ever-changing disease.

“The beauty of the bloodstream is that it’s a super highway that connects the entire body,” Kuhn said. “A cancer cell that breaks away from the primary tumor gets exposed to the whole body through the circulatory system in just one minute — the time it takes for blood to circulate.” Kuhn decided to exploit that “super highway,” in the belief that analyzing cancer cells in the blood can be a complement to traditional imaging techniques that provide information about only the tissue parts of tumors.

Kuhn has garnered international distinction for devising a way to test for cancer cells in the blood through what he refers to as “a liquid biopsy.” In addition to being less costly and uncomfortable for patients, tests Kuhn and his colleagues are developing may also be more sensitive and effective at identifying CTCs than any of their existing competitors.  

Kuhn cited the example of a 60 year-old patient with Stage IV prostate cancer who died despite undergoing treatment. Analyzing blood drawn at different stages of his treatment showed that while chemotherapy had done little to change the disease, three weeks of targeted therapy succeeded in wiping out most of it. However, a resistant clone later developed under therapeutic pressure, leading to the resurgence of the cancer and the patient’s eventual death.

“We just didn’t know when to stop and do something different,’ Kuhn said. “We know from other diseases like chronic myelogenous leukemia (CML) and HIV that if these blood tests had been done in real time as part of clinical practice, we would have had an opportunity to detect the emergence of resistance early and intervene.

Kuhn’s research also focuses on developing the ability to use quantitative data to evaluate the likelihood of a primary tumor spreading to other organs. “This will allow oncologists to understand individual patients in the context of all patients,” Kuhn said.

With the World Health Organization’s prediction that cancer cases will soar over the next 20 years, Kuhn cautioned that we need to accept that most humans will be diagnosed with cancer but not necessarily die from the disease.

“What’s going to change in the future is that we’re going to know about it,” he said. “We need to know about it with the level of precision to understand whether it’s necessary and useful to intervene.”

Using the example of prostate cancer, which is not fatal for 85 percent of men affected, Kuhn said, “We need to figure out who are the 15 percent who will die, and who are the 85 percent who will not. We need to find the cases we need to act on and become comfortable with not doing anything about the ones we don’t.

“Finding the disease at every single time point of a patient’s lifetime, the ability to find an individual cancer cell, characterizing that cancer cell and as many others as it takes to understand the disease in that patient, and then executing on that in terms of fighting it, is one part of matching the treatment to the patient,” Kuhn said.

As a second step in supporting patients through this journey, Kuhn advocates preparing patients for treatment through optimizing human performance using quantitative measures. This is in addition to qualitative measures long-used by physicians.

Kuhn cited celebrated USC Dornsife alumnus Louis Zamperini, a war hero and Olympic athlete, who set a national collegiate record for running a mile in four minutes and eight seconds. Kuhn noted that the six years of hard training it took Zamperini to achieve that record also helped him to survive 47 days at sea when his Air Force bomber went down in the Pacific during World War II.

“Relentless training of the mind and the body is an absolute necessity for survival in the harshest of circumstances,” Kuhn said. “Being a cancer patient is a harsh journey. If we think about training recommendations for a cancer patient, what do we as a scientific community provide to patients in terms of how they should prepare for therapy?”

The answer, according to Kuhn, is sadly very little. He noted that 61 percent of women with breast cancer end up in the emergency room during their first year after diagnosis or following their first course of chemotherapy.

“This is mostly because of fever, infections, low cell counts or dehydration. However, if we figured out how to create performance optimization for cancer patients, we could predict and perhaps avoid these problems, resulting in better treatment outcomes,” he said. “What if we could rehydrate, reactivate and rehabilitate before the emergency room is even necessary? We believe this ability to assess and improve human performance will play a huge role in patient outcomes.

“I think by working together, by converging across disciplines, we can answer these questions for every individual patient and that really has to be our goal.”