This K24 application is to support my career development as I build a translational research program. I am an associate professor, seeing patients with melanoma and renal cell carcinoma. I mentor junior faculty and clinical fellows and run an R-01 funded research laboratory, conducting biomarker studies and pre-clinical drug testing experiments in these two diseases. I have a busy clinical practice and actively enroll patients on clinical trials. Given the increased incidence of metastatic melanoma and the high frequency of brain metastases (BrMs) in this population, there is urgent need for new approaches to this problem, as most clinical trials exclude BrMs patients, and their therapeutic options are exceedingly limited. I recently assembled a group of clinical and basic science researchers that focus on BrMs, and my vision (and long term goal) is to develop a brain metastasis research center at Yale. My short term goal is to conduct our first two BrMs-specific protocols and to generate preclinical data for future trials. To accomplish my goals, I need additional protected time to conduct these studies and mentor junior clinicians to participate these efforts. My proposed career development plan includes both acquisition of new skills and a plan for increased mentorship of junior faculty and clinical fellows. The former involves formal training such as a didactic statistics course and informal training in animal experiments and additional training in development of phase I trials. In addition to mentorship of fellows, I will mentor junior faculty, including two current mentees and two new hires. I will participate in specific mentorship activities at Yale supported by the CTSA grant, including advisory committees and lectures. The underlying premise of this proposal is that drug penetration through the leaky vessels found in BrMs can be superior to typical BBB penetration. We further hypothesize that use of combinations of local therapies and molecular targeted therapies selected based on individual tumor characteristics will result in improved survival of patients wit BrMs, similar to patients with other visceral metastases. Finally, manipulation of brain immunity might be a means of treating brain metastases.
My first aim i ncludes the first neoadjuvant clinical trial using a targeted therapy (vemurafenib) and innovative surgical approaches to treat patients with brain metastases not amenable to gamma-knife therapy. Predictive biomarker studies will be incorporated, complimented by lab-based endeavors to train mentees in conducting pre-clinical drug sensitivity studies with an emphasis on BrMs, with the goal of developing a pipeline of drugs to be studied in future BrM trials.
In aim 2, I will mentor a junior faculty clinician in conducting a clinical trial of an antibody against an immune-checkpoint inhibitory molecule (PD-1), and development of a panel of predictive biomarkers.

Public Health Relevance

Studies aimed at improving treatments for the ever-increasing population of patients with melanoma brain metastasis are inadequate, and there are not enough oncologists trained in conducting this type of patient oriented research. We therefore need to facilitate mentorship of junior clinicians to conduct both clinical and laboratory-based investigations. This award will enable the principal investigator to do these types of studies and will provide protected time for mentoring clinical fellows and junior faculty.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24CA172123-02
Application #
8692684
Study Section
Subcommittee B - Comprehensiveness (NCI)
Program Officer
Lim, Susan E
Project Start
2013-07-01
Project End
2018-06-30
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
2
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Yale University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
New Haven
State
CT
Country
United States
Zip Code
06510
Jilaveanu, Lucia B; Puligandla, Maneka; Weiss, Sarah A et al. (2018) Tumor Microvessel Density as a Prognostic Marker in High-Risk Renal Cell Carcinoma Patients Treated on ECOG-ACRIN E2805. Clin Cancer Res 24:217-223
Ueno, Daiki; Xie, Zuoquan; Boeke, Marta et al. (2018) Genomic Heterogeneity and the Small Renal Mass. Clin Cancer Res 24:4137-4144
Kluger, Harriet M; Zito, Christopher R; Turcu, Gabriela et al. (2017) PD-L1 Studies Across Tumor Types, Its Differential Expression and Predictive Value in Patients Treated with Immune Checkpoint Inhibitors. Clin Cancer Res 23:4270-4279
Weiss, Sarah A; Kluger, Harriet M (2017) From the Guest Editors: Recent Advances and Evolving Challenges in Treating Unresectable Melanoma. Cancer J 23:1-2
Cohen, Justine V; Alomari, Ahmed K; Vortmeyer, Alexander O et al. (2016) Melanoma Brain Metastasis Pseudoprogression after Pembrolizumab Treatment. Cancer Immunol Res 4:179-82
Bi, Mark; Zhao, Siming; Said, Jonathan W et al. (2016) Genomic characterization of sarcomatoid transformation in clear cell renal cell carcinoma. Proc Natl Acad Sci U S A 113:2170-5
Cohen, Justine V; Kluger, Harriet M (2016) Systemic Immunotherapy for the Treatment of Brain Metastases. Front Oncol 6:49
Goldberg, Sarah B; Gettinger, Scott N; Mahajan, Amit et al. (2016) Pembrolizumab for patients with melanoma or non-small-cell lung cancer and untreated brain metastases: early analysis of a non-randomised, open-label, phase 2 trial. Lancet Oncol 17:976-983
Alomari, Ahmed K; Cohen, Justine; Vortmeyer, Alexander O et al. (2016) Possible Interaction of Anti-PD-1 Therapy with the Effects of Radiosurgery on Brain Metastases. Cancer Immunol Res 4:481-7
Kluger, Harriet M; Zito, Christopher R; Barr, Meaghan L et al. (2015) Characterization of PD-L1 Expression and Associated T-cell Infiltrates in Metastatic Melanoma Samples from Variable Anatomic Sites. Clin Cancer Res 21:3052-60

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