Fred Hutchinson Cancer Research Center and Uganda Cancer Institute join forces to advance research and treatment of infection-related cancers

Fred Hutchinson Cancer Research Center, based in Seattle, Wash., USA, has forged an innovative collaboration with the Uganda Cancer Institute, based in Kampala. Together they are spearheading cutting-edge research on cancers in the developing world with a special focus on infectious disease-related cancers. The collaboration will concentrate on developing new models for the delivery of cancer care in resource-limited settings, and training the next generation of health care providers and researchers in infection-related cancers relevant to both sub-Saharan Africa and the United States.

On Oct. 4, 2011, the Hutchinson Center ushered in the next phase of this joint effort by breaking ground on a state-of-the-art, integrated cancer training and treatment facility in Kampala.

When completed, the Uganda Cancer Institute/Fred Hutchinson Cancer Research Center Clinic and Training Institute will significantly increase patient access to cancer diagnosis and treatment while furthering study of cancers in Uganda. One of the initial goals of the program is to investigate the role that infections, such as HIV and Epstein-Barr virus, have on the development of cancers such as Kaposi sarcoma, the most common cancer among Ugandan adults, and Burkitt lymphoma, the most common life-threatening malignancy among Ugandan children.

Cancer increasingly is recognized as a health threat to individuals in both resource-rich and resource-poor regions. In the United States, is it widely known that cancer is the second leading cause of death; one of every four deaths is attributable to cancer. In low- and middle-income countries, cancer kills more people annually than HIV, tuberculosis and malaria combined. However, cancer is largely neglected as an urgent global health issue. The UCI/Hutchinson Center Cancer Alliance, which is the name of the collaboration between the Hutchinson Center and the Uganda Cancer Institute, seeks to reduce the morbidity and mortality due to cancer around the world through research, clinical care improvements and training.

The alliance is ideally positioned to provide American and Ugandan physician scientists with in-depth training in the treatment of infection-related malignancies, which account for nearly 25 percent of cancer cases worldwide and disproportionately impact low-resource settings and countries hit hard by the HIV pandemic. HIV and other infectious diseases have increased Uganda’s cancer rates, a trend that threatens to undermine the young and productive segment of the nation’s population. Hutchinson Center researchers hope to uncover new infectious causes of cancer, develop new ways to prevent infection-associated cancers (such as through the development of new vaccines) and new ways to treat such cancers with antibiotic or antiviral drugs, avoiding the need for chemotherapy.

The relationship between the Hutchinson Center and the Uganda Cancer Institute—the site of several landmark cancer discoveries—dates back to 2004 and the UCI/Hutchinson Center Cancer Alliance was established formally in 2008. The program builds on an innovative research approach, which draws data from a setting where the disease burden is exceptionally high, while reinforcing the Hutchinson Center’s commitment to reduce cancer-related suffering and death in both resource-rich and resource-poor regions.

In 2008, Uganda had just one oncologist who treated more than 10,000 patients a year. Today, specialized training sponsored by the Hutchinson Center has increased the number of practicing oncologists in Uganda fivefold by 2011 and tenfold by 2012, a milestone that will play a key role in achieving the goal of increasing survival rates for common infection-caused cancers from 10 percent to 90 percent over the next three years.

Infections, including HIV, fuel cancer in East Africa and Uganda

East Africa has among the highest burdens of infection-related cancers worldwide. These cancers include Kaposi sarcoma and Burkitt lymphoma, alongside liver, cervical and gastric malignancies. Uganda, with a population of 34 million, has a very high cancer rate that is fueled largely by the HIV epidemic. More than 1.2 million Ugandans are living with HIV/AIDS. According to the U.S. National Cancer Institute, people infected with HIV are several thousand times more likely than uninfected people to be diagnosed with Kaposi sarcoma and at least 70 times more likely to be diagnosed with non-Hodgkin lymphoma. HIV-positive women are at least five times more likely to be diagnosed with cervical cancer, which is caused by the human papillomavirus.

While the advent of effective antiretroviral therapy has dramatically improved AIDS survival rates, HIV-positive individuals are still vulnerable and succumb to secondary diseases, such as cancer, due to the lack of effective diagnosis and treatment.

In Uganda, researchers have determined the following:

• Six of the 10 most common cancers are associated with infections.
• Kaposi sarcoma is the most common cancer in adult Ugandan men; 75 percent of these cases can be treated for less than $800.
• Human herpesvirus 8, the primary cause of Kaposi sarcoma, is a common cancer-related infection in women, infecting more than 80 percent of the Ugandan population.
• Non-Hodgkin lymphoma is the fourth most common cancer in Uganda and one of the most common to develop in HIV-infected individuals. The majority of these cases are caused by infection with Epstein-Barr virus, which was first discovered in tumor tissue obtained from a child with lymphoma in Uganda.
• Since the advent of HIV, Hodgkin lymphoma has become increasingly common, with a 30 percent annual increase in incidence in the last 15 years in Uganda.

Childhood cancers: improving low survival rates

Burkitt lymphoma, which was first identified in 1958 in Uganda by Sir Denis Burkitt and is caused by the Epstein-Barr virus, is a potentially fatal and disfiguring malignancy and the most common cancer diagnosis among Ugandan children. The first use of combination chemotherapy in world was used to treat Burkitt lymphoma and initiated by Uganda Cancer Institute physicians in conjunction with the National Cancer Institute at the U.S. National Institutes of Health. This approach is now the most widely utilized therapy for cancer.

Each year in Uganda, 600 new cases of Burkitt lymphoma present for medical attention and the average age of a child with the disease is 5. A fast-growing, malignant tumor that often develops in the jaw or abdomen, Burkitt lymphoma interferes with breathing and makes it difficult for young patients to feed adequately, which leads to malnutrition. Currently, the five-year survival rate is less than 40 percent. Hutchinson Center researchers estimate that more than 85 percent of these children could be cured for less than $600 a case.

Cancers of increasing importance around the world

While the initial focus of the collaboration was on infection-related cancers, UCI and Hutchinson Center scientists and clinicians recently have turned their attention to other types of cancer that increasingly affect people in both Uganda and the United States. Breast cancer, for example, has been recognized as a growing threat to the health of women in sub-Saharan Africa, where data suggests the disease affects younger women and is more aggressive in its clinical manifestations compared with how the disease presents in the United States. Similarly, prostate cancer is the fastest-growing malignancy in Uganda, and few of the strategies deployed to combat this cancer in resource-rich settings are applicable to care delivery models in sub-Saharan Africa.

Examples of research projects involving non-infection-related cancers include:

• Identifying novel predictors of cancer development and survival among Ugandan adults, including breast, esophageal and cervical cancer and lymphoma.
• Understanding the role of under-nutrition and specific nutritional deficiencies in the clinical manifestations and survival after diagnosis of cancer in Uganda.
• Establishing new practice guidelines for the early detection and treatment of breast cancer among Ugandan women, including increasing community breast cancer literacy and advocacy.
• Developing new methods for the diagnosis of hematologic malignancies such as chronic myelogenous leukemia, acute promyelocytic leukemia and lymphoma, which will allow for initiation of oral therapies for cancer instead of more traditional intravenous medications.

A cutting-edge facility

Upon completion of the Uganda Cancer Institute/Fred Hutchinson Cancer Research Center Clinic and Training Institute, medical training and cancer treatment in Uganda is expected improve dramatically, boosting survival rates for common infection-related cancers from 10 percent to 90 percent.

The proposed new facility will be three stories and include adult and pediatric cancer care clinics and specialized diagnostic laboratories. It will play a pivotal role in increasing cancer survival rates by:

• Boosting patient access to diagnostic technology.
• Significantly increasing the number of patients who can be treated.
• Enhancing integration of HIV treatment into cancer care.
• Improving the nutritional status of patients through nutrition research and expanded food programs.
• Enabling Hutchinson Center experts to help devise a model to deploy effective cancer care in resource-limited areas.

Training the next generation of oncologists

Capacity building is essential to empower the next generation of researchers and health care workers in both the U.S. and Africa. The lack of access to early diagnosis and treatment of malignancies has resulted in low survival rates, even for cancers that are preventable and treatable in developed countries. Training programs, based in Uganda and in Seattle, have had immediate impact:

• To date, more than 100 individuals from the Hutchinson Center and Uganda Cancer Institute have received training. Of the more than 75 Ugandan trainees, interns and fellows, 15 have traveled to Seattle to study at the Hutchinson Center. Twelve of the 25 Americans have trained in Uganda. Four additional cancer physicians and a cancer pharmacist also will be trained in Seattle in the coming year.
• The program includes training in a variety of disciplines — hematology, oncology, epidemiology, global health and HIV-associated malignancies, among others. Trainees include postgraduate and postdoctorate fellows, laboratory technicians, medical officers, research coordinators, study nurses, administrators and fiscal managers.
• This bi-directional training model could be deployed in other resource-poor areas worldwide.

Lifesaving research for today and tomorrow

Using the latest technological developments, such as genomics, proteomics, immunogenetics and molecular virology, Hutchinson Center and Uganda Cancer Institute researchers will focus on the following areas:

• Determining the risk factors for progression from chronic infection to cancer. This will allow for the development of highly effective laboratory tests to identify the less than 1 percent of individuals who are at greatest risk for infection-related cancers among the more than 70 percent of individuals worldwide who are infected with at least one infection which has the potential to cause cancer.
• Development of novel treatments for infection-related malignancies, including those that target the infectious agent, which may reduce the risk of cancer relapse.
• Development of novel approaches to cancer that can be used effectively in lower-resource settings.
• Understanding how cancer-causing infections are transmitted and acquired, with the ultimate goal of developing vaccine to prevent one-quarter of the world’s cancers.

Cancer and infection-related malignancies: on the rise in the developing world

• Cancer kills more people globally than HIV/AIDS, tuberculosis and malaria together.
• Infectious diseases are the cause of nearly one-quarter of cancer cases around the world.
• Every year, 3 million new cancer diagnoses and 1.5 million deaths worldwide are attributed to infectious disease-related malignancies.
• Seventy percent of infection-related cancer deaths occur in low- and middle-resource countries, 50 percent of which are in sub-Saharan Africa, often placing the disease burden on health systems that are least equipped to address it.
• By 2020, of the predicted 16 million new cases of cancer every year, 70 percent will be in developing countries.
• On average, more than two-thirds of cancer patients in developing countries are diagnosed at a very late stage of illness, when treatment is often least effective.
• HIV infection increases the risk of cancer between five and 4,000-fold and is leading to a second epidemic in populations with a high prevalence of HIV.

# # #

At Fred Hutchinson Cancer Research Center, our interdisciplinary teams of world-renowned scientists and humanitarians work together to prevent, diagnose and treat cancer, HIV/AIDS and other diseases. Our researchers, including three Nobel laureates, bring a relentless pursuit and passion for health, knowledge and hope to their work and to the world. For more information, please visit fhcrc.org.

MEDIA CONTACT:
Dean Forbes, Media Relations manager
dforbes@fhcrc.org
+1 206-667-2896 (desk) or +1 206-605-0311 (cell)

Additional information can be found here:
About the UCI/Hutchinson Center Cancer Alliance