‘The treatment has to be personalized because patients are not a statistic’
Jonathan C. Trent, M.D., Ph.D., was on his way to becoming a chemist when he was struck with the desire to pursue medical school. His passion for researching new cancer-fighting drugs in the lab inspired him to want to treat patients.
Since his grandmother died of cancer, specializing in oncology was also personal. But Trent never abandoned his love for lab research, and his combined expertise has made him one of the most recognized sarcoma specialists and investigators in the U.S.
Since joining the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine in September 2011, the professor of medicine and Co-Director of the Musculoskeletal Center, Sarcoma Medical Research Program, has led an award-winning team that has made breakthroughs in gene discovery and leads one of the first human trials for a drug treatment for chondrosarcoma.
While sarcomas are rare cancers, Trent’s dedication to providing individualized precision medicine has given hope to many patients, including those with a type of sarcoma known as gastrointestinal stromal tumor.
“We aim to give patients the best care possible, because if you’re the one with chondrosarcoma, the disease is not rare to you,” Trent said. “And since I see over 20 sarcoma patients a clinic day, it’s also not rare to me. There are patients suffering from these diseases who need access to these novel clinical trials.”
The Oklahoma native and champion for precision medicine chats with Medical Communications about sarcoma, Sylvester’s mission, his latest research and his longtime affinity for brewing beer.
What attracted you to Sylvester Comprehensive Cancer Center?
Prior to coming to Sylvester, I was at the MD Anderson Cancer Center at the University of Texas. I came here to expand the sarcoma program. I was attracted to Sylvester because of its potential, long-term vision and the interest in becoming an NCI designated cancer center.
We have one of the best sarcoma programs in the country. Our aim is to become the best program. We want to provide the best level of care to sarcoma patients. We don’t want South Florida patients to feel like they have to travel to another city when we have one of the best sarcoma programs in the country.
When did you realize that you wanted to be a doctor?
I guess when I was an undergraduate doing research. I loved working in the lab at the bench with the goal of finding new medications to fight cancer, and that seemed to have led me toward taking the next steps of going to medical school and getting the knowledge and know-how to care for patients with cancer. But I never lost my love of science and chemistry, so I enrolled in a seven-year M.D./Ph.D. program at the University of Texas Health Science Center.
What inspired you to specialize in oncology?
My grandmother died of cancer and I was fairly close to her. And when I was a chemistry major as an undergrad, my research was focused on designed biological agents that could act as chemo therapy and kill cancer cells. I found this to be important and very interesting academically.
How is sarcoma different from other cancers?
It is a rare collection of over 200 types of bone and soft tissue cancers, and since it’s so rare many patients seek out a Center of Excellence. A lot of patients I see are motivated and interested in coming to a cancer center with a nationally and internationally recognized sarcoma program like at Sylvester. Because of the strength of the program, we get patients from all over the world, including Australia, Turkey, Alaska, the Caribbean, South America and throughout the United States.
What’s your approach to treatment?
Sarcomas are rare diseases, and our philosophy is that we take care of patients no matter how common or rare their tumor. We aim to give patients the best care possible because if you’re the one with sarcoma, the disease is not rare to you. And since I see over 20 sarcoma patients a clinic day, it’s also not rare to me. There are patients suffering from these diseases who need access to these novel clinical trials.
In the world of oncology we take care of cancer patients and the honest truth is that some of these patients don’t survive. However, when I see a new sarcoma patient, my philosophical approach is of optimism. Some patients with stage four metastatic sarcoma do survive their cancer and they are long-time survivors. I have some patients who have been in remission for 15 years and that’s proof that we have to keep providing novel, individualized care.
What have been some of your most notable breakthroughs?
One of our amazing pathologists, Dr. Andrew Rosenberg, played a pivotal role in describing a gene mutation called IDH (isocitrate dehydrogenases) in chondrosarcoma. He found that it expressed very frequently, or 70 percent in a cancer called chondrosarcoma. With that finding, we were able to investigate the mutation and cell lines in the lab and we described an IDH inhibitor that could prevent those cells from forming colonies and migrating, which is extremely encouraging.
Sylvester is one of the only sites that’s conducting four of the first human trials to test the inhibitor, with hematological malignancies and solid tumors. We also have two of the few chondrosarcoma patients in the world enrolled in a study.
Can you explain the concept of precision medicine?
Precision medicine is critical to the optimal care of patients and has always been our approach in sarcoma. You have to first figure out which type of sarcoma a patient has, and that often takes molecular tests to identify a gene mutation and input from a pathologist, a radiologist and a surgeon. There are quite a few steps to devising the best approach for a patient, but the treatment has to be personalized because patients are not a statistic.
Precision medicine can also be described as an extra step in personalized medicine that heavily focuses on understanding the molecular changes that are causing the cancer.
How has cancer treatment evolved in the past decade or so?
We’re fortunate that there have been a number of pharmaceutical breakthroughs in the past 10-15 years that truly improve patient outcomes. As a result, we now have a number of therapies that can be matched to a specific cancer and genetic mutation. For instance, a patient with a gastrointestinal stromal tumor, the most common sarcoma of the gastrointestinal tract, will get tested for the KIT gene mutation. If it’s in exon 11 region of that gene, we treat it with 400 milligrams of imatinib a day. If the mutation lies in the exon 9 region, we treat them with 800 milligrams a day. The mutations can be any number of places, but whether it’s in the RAF gene or elsewhere, we treat them with the matching inhibitor.
Ten years ago we also didn’t have the capability to test for these gene mutations that are driving the cancers.
Are patients always in your thoughts?
They are in my thoughts 24-7. You always want to help your patients. I have patients who are running out of therapy who need to be placed in a clinical trial. We have patients who we can cure if they are treated correctly, and we can’t afford to make a mistake. So we’re always triple checking, second guessing. All of our patients get discussed at a multidisciplinary level at a weekly meeting with 15 specialists.
What are some of your hobbies outside of medicine?
Spending time with my family is number one. We like to do things outdoors. I also brew beer. It’s a hobby that started 26 years ago while I was a poor graduate student and realized it was cheaper to make my own. Since moving to Florida I’ve started experimenting with different additives such as coconut and ginger.