Childhood cancer meets its match: Q&A with Diana Azzam

Cancer researcher Diana Azzam is an assistant professor and director of doctoral programs in the department of environmental health sciences in the Robert Stempel College of Public Health & Social Work. Azzam’s lab – comprised of postdoctoral researchers, technicians, graduate and undergraduate students – conducts research in two main areas: individualized treatments for cancer patients who have exhausted standard of care, and investigation of cancer stem cells and how exposure to environmental toxins like arsenic can lead to cancer.

How do you create individualized treatments for cancer patients?

It’s a collaboration between the patient’s physician and my lab. We perform high-throughput functional drug testing, testing hundreds of FDA-approved drugs on the tumor sample that we receive from the hospital. From this testing, we derive drug response profiles efficacies and share this data with the physicians at participating hospitals. We provide the physicians with a list of the most effective drugs as well as those that are ineffective.

What do the data show so far?

Our feasibility studies funded by the Florida Department of Health Live Like Bella Pediatric Cancer Research Initiative have generated very promising results. We found that children with advanced cancers who were guided by functional drug testing and genomic profiling have improved survival compared to those patients who did not go through our functional drug testing and genomics.

What's next?

It’s exciting. We are very grateful to have received a $2 million appropriation from the State of Florida to acquire state-of-the-art robotic instrumentation that will allow the lab to become the first CLIA-certified lab dedicated to functional cancer drug testing in Florida. This will enable us to scale up the process of drug testing and, hopefully, provide this functional drug testing platform to all cancer patients.

Do you see a time where this might be the treatment of choice rather than a treatment of last resort?

Ideally, we want to use drug testing in patients that are newly diagnosed because this will avoid the toxic effects of trial and error. But in order for us to get to that point, we need to generate data from large-scale clinical trials that will prove that drug testing correlates with improved outcomes.

You discovered something interesting in your feasibility studies at Nicklaus Children's Hospital.

We observed that minority populations have different genomics and respond to FDA-approved drugs differently than each other and White patients. Based on that data, I became a project lead on an NIMHD-funded study as part of FIU’s Research Center in Minority Institutions led by Eric Wagner to reduce health disparities in childhood cancer patients from minority populations. We will identify biomarkers that are specifically expressed in minority populations and also identify targeted drugs that may work within these groups. I’m particularly pleased that we will be providing functional precision medicine clinical trials to children with cancers that come from minority populations. These patients often don’t have access to these clinical trials.

Tell us about your work with cancer STEM cells.

This is a population of cells that are responsible for therapy resistance and metastasis. My work in this area is focused on understanding what they rely on to survive and how they are resistant to standard radiation and chemotherapies. We’re also exploring how they arise. If we understand that, we will be able to design combination therapies that will selectively target the most therapy-resistant cells in tumors.