In advance of World Cancer Day, Global Washington interviewed Dr. Tom Uldrick, the new deputy head of Global Oncology at Fred Hutch.
What led you to research the intersection of cancer and HIV/AIDS?
I did my medical training in New York City during the period when antiretroviral therapy was revolutionizing medicine. During my premed years, it worked in a large HIV organization and observed firsthand how advances in science could alter the course of an epidemic. During my residency and fellowship at Columbia University, I was inspired by many great mentors and leaders in the field of HIV and cancer, including Scott Hammer, Riccardo Dalla-Favera, Wafaa El-Sadr, Al Neugut, and Salim and Quarraisha Abdool Karim. My fellowship culminated in a Kaposi sarcoma research project in South Africa – that was the start of my research career in the field of HIV and cancer.
What inspired you to pursue this research initially, and what keeps you passionate about the research?
My initial research interests were based on understanding the molecular mechanisms related to how HIV increased the risk of B-cell lymphomas. I developed a protocol at an American Association for Cancer Research-American Society of Clinical Oncology workshop to evaluate the effects of epigenetic modulation of a protein called BCL-6, which is a master transcription factor in certain types of lymphoma common in people with HIV. From this entry, I became more broadly interested in the links between immune dysregulation caused by HIV, and development of cancer. My passion for this line of inquiry led me to move to the National Cancer Institute after fellowship to focus my efforts on clinical investigation in the field. At the NCI, I was inspired by mentors such as Robert Yarchoan, Elaine Jaffe, Wyndham Wilson and Denise Whitby. Over the past years, I have been fortunate to be able to contribute to and lead exciting studies that have better characterized immune abnormalities in people living with HIV and cancer and are contributing to the development of high impact new treatments for HIV, Kaposi sarcoma and certain lymphomas.
Many people aren’t aware of the links between HIV and cancer. How do you characterize these associations and how have they changed over the past decade?
Along with infections, Kaposi sarcoma and lymphoma were harbingers of the HIV epidemic. Although treatment for HIV decreases cancer risk substantially, with people living longer on anti-HIV therapy, cancer has become a leading cause of death in the greater than 37 million people living with HIV globally. There are seven major types of cancers that are strongly associated with HIV: Kaposi sarcoma, lymphomas, cervical cancer, lung cancer, anal cancer, liver cancer and head and neck cancers. In Uganda, cervical cancer is the most commonly diagnosed cancer and is also the leading cause of cancer-related death. On World Cancer Day, it is important to remember that many of these cancers are preventable or curable, and that the largest burden of these cancers is occurring among the 25+ million women and men living with HIV in sub-Saharan Africa.
As Deputy Head of Fred Hutch’s Global Oncology program, what are some of your goals for the program?
Seventy percent of cancers worldwide occur in low- and middle-income countries and there is a large divide in cancer outcomes between low- and high-income countries. Through our partnership with the Uganda Cancer Institute (UCI), and the Fred Hutch investment in the UCI-Fred Hutch Cancer Centre, Global Oncology is uniquely positioned to conduct cutting-edge, sophisticated cancer research that impacts the lives of people in Uganda and informs better approaches to cancer care around the world. As deputy head, my goals are to build human and infrastructure capacity to conduct world class clinical and population-based studies. I work closely with the program head, Hootie Warren, to integrate cutting-edge laboratory techniques into all of our research projects in order to dissect the unique environmental and genomic factors that may influence cancer in another setting. Ultimately, our goals are to conduct research that informs affordable approaches to accurate prevention and diagnosis of cancer, meaningful improvements in treatment, and leads to novel discoveries that improve our understanding of cancer.
How do your previous professional experiences in New York, South Africa and then the National Cancer Institute shape how you approach your current role?
Throughout my career, I have increasingly grown to appreciate team science, focused around provocative questions that address important public health issues. This often requires developing new collaborations and thinking outside the box. I have always enjoyed working at the intersection of virology, immunology and cancer – and my experiences to date in this research space continue to inform my personal research interest. At the same time, clinical research is complex, and both Columbia University and the NCI provided amazing environments for learning about clinical research from soup to nuts. I plan to apply this practical experience to build a global oncology clinical trials unit that provides opportunities to junior Ugandan trainees and is a resource for other academic partners.
A year into your new role, what are you most proud of? And what do you hope the program will achieve in the next year?
I am most proud of leading a team that has developed an innovative curative treatment protocol for diffuse large B-cell lymphoma and Burkitt lymphoma. This project has led the Global Oncology program to design a treatment that we hypothesize will be safe and improve survival by greater than 30 percent, recruit talented Ugandan oncologists and nurses, pioneer new international regulatory processes, develop important new partnerships, and build our laboratory and IT capacity. We anticipate the first patient will be on study by Spring 2019! We will be focusing on this study over the coming year as a model for future studies. At the same time, we continue to lay the groundwork for additional studies in other important diseases such as breast cancer and Kaposi sarcoma.
What are some of the challenges of treating cancer in Uganda and in other resource-constrained settings?
Two of the biggest challenges are limited resources for pathology and too few oncology doctors. Cancer care depends on an accurate diagnosis. A Global Oncology faculty member, Manoj Menon, along with a Ugandan physician-scientist trained at the Fred Hutch, Nixon Niyonzima, are studying innovative approaches to the accurate diagnosis of breast cancer using molecular techniques. We also have several initiatives to improve the diagnosis of blood cancers in children and adults and are working with the Burkitt’s Lymphoma Fund for Africa to help build capacity for flow cytometry [a technology used to analyze the characteristics of cells or particles]. Fred Hutch has also been heavily involved in training Ugandan oncologists, and in 2018, in partnership with the University of Washington and the UCI, we launched a new Adult Hematology Oncology fellowship. The fellowship program, led by John Harlan from University of Washington and Abrahams Omading from the Uganda Cancer Institute, together with the research training program, led by GO faculty member Warren Phipps, are helping to train the next generation of oncology leaders in East Africa.
Central to Fred Hutch’s Global Oncology program is its partnership with the Uganda Cancer Institute. How does partnership, both locally and globally, play a role in the work the team does?
The partnership with the UCI is central to our work in Uganda. It is based on a shared vision of promoting research and building capacity. Jackson Orem, Executive Director of the UCI, is our key partner in the collaboration. He serves as both an investigator on many of our research projects and our primary partner in the governance of the UCI-Fred Hutch Cancer Center. Meaningful partnership is critical to developing a sustainable cancer program, and the UCI-Fred Hutch partnership is recognized and supported by the Ugandan Ministry of Health, which is dedicated to improving cancer outcomes in Uganda.
You wear many hats—caring for patients, serving as principal investigator on several clinical studies, and helping lead Fred Hutch’s Global Oncology program. Walk us through a typical day in your life.
Working with researchers 9,000 miles and 10 time zones away means my day usually starts with 6 am phone calls with collaborators and staff in Kampala; our team in Uganda is comprised of approximately 60 research, administrative and operational staff. My major current projects include a large project evaluating cervical dysplasia, a form of pre-cancer, being conducted in collaboration with Corey Casper and Lisa Frenkel. Cervical cancer is a leading cause of preventable death in Uganda, and last year we screened close to 5,000 women for cervical cancer, and the research team is aiming to understand why HIV increases the risk of cervical cancer. The second is an upcoming study in lymphoma, which is the second most common cancer in children and young adults in Uganda. After catching up with Uganda, when I am on service, I take care of leukemia and lymphoma patients at the University of Washington through the early afternoon. I then spend the late afternoon at Fred Hutch meeting with scientific collaborators and the Seattle-based research teams, developing new projects and evaluating data from ongoing research. On Wednesday evening, I participate in a tumor board teleconference led by Hootie Warren in Seattle and Abrahams Omading in Kampala.
What have you found to be unique or different about working in Seattle?
I have found the research environment at the Fred Hutch invigorating. Fred Hutch is a smaller and more nimble organization than where I trained and the level of collegiality and support for new ideas is very rewarding. Also, the global health community in Seattle is unparalleled. Although I had done international research before, meeting people in the global health field has been one of the highlights of working in Seattle.
What do you do in your spare time?
I am an avid runner, and so you frequently may find me running around Queen Anne, Lake Union or on the Burke-Gilman Trail. I also love skiing, and I am excited about the opportunities to explore skiing in the Pacific Northwest.