The SSO Young Investigator Award in surgical oncology promotes and recognizes translational or clinical research that advances innovative ideas and concepts designed to improve health outcomes through advances in the delivery of cancer-related care. The 2019 recipient, Georgia Beasley, MD, Duke University, received the Award for her research topic, “Comprehensive Immunologic Profiling of the Sentinel Node to Optimize Care for Patients with Melanoma.” SSO spoke with Dr. Beasley about her research and this award.
Q. Please describe your research hypothesis.
A. My research hypothesis is based on a few different concepts. First, a very common surgery that most melanoma surgeons do is sentinel lymph node biopsy. As I’ve been doing these procedures, I was thinking that we could learn a lot more from looking at these lymph nodes rather than if there is a tumor or not and that there is an opportunity for discovery using these lymph nodes. Secondly, we also now have an approved adjuvant therapy for patients who have tumor in their lymph nodes, although it is not entirely clear who should receive adjuvant therapy. Finally, since there are a lot people looking at metastatic disease and how that interplays with the immune system, I decided to take a unique approach by looking at earlier stage disease and one where I have access to the tissue. I also work with an immunologist and we were talking about what we could learn from the lymph nodes. And so, my hypothesis is, “Could we use the results of the lymph nodes to help us stratify who should get adjuvant therapy, as well as what else we can learn beyond just tumor in node?”
We decided to do gene expression using nanostring technology. This is a new way to do gene expression, which does not require PRC amplification and it can be done quite efficiently and effectively on paraffin tissue. Since we have all types of stored tissue, we went back and pulled several sentinel node positive and negative slides and ran the gene expression. We looked at immune-related genes and while it is a very small group, we found some interesting differences between patients that had tumor in their lymph nodes and those who did not. Independent of tumor status, we found genes that were highly differentially expressed between patients who went on to do poorly or went on to do well and that was independent of if there was tumor there or not.
To validate these findings, we needed to run more tissue samples and this proposal will help facilitate additional processing. The second phase is about not just doing whole gene analysis on the slide. There is a new technology available called digital spatial profiling where you can examine regions of interest on the slide and only do the protein expression for that area. I’m really interested in looking at the spatial distribution of the immune cells and how they may be different in a lymphoid with cancer and without. For instance, we think B-cells that are present may be contributing to an immune tolerized environment and so the immune signaling going on may be different when B-cells may be in close proximity to the tumor. That is just one example, but there are other types of immune cells in the lymph node and we will be able to conduct an analysis based on the basis of cell type.
Q. What research leading up to the development of your proposal has influenced your study?
A. A lot of people have done different types of research where they have selected one or two genes or signaling pathways to examine in the lymph nodes. I also collaborate with people here at Duke who use digital spatial profiling and nanostring technology related to their own projects. As I listened to them talk about their work, I thought about how I could use this in my project. I was also influenced by research happening here in breast cancer and I thought I could apply it to my own research hypothesis.
Q. What do you plan to do with the with the data and are you able to think about the next step and what you might learn?
A. The technology is very expensive and the YIA will cover 5 – 10 samples. I’m hoping that we demonstrate feasibility and that we get a lot of data back. And, with the few samples that we try, we generate a significant volume of data that will allow us to receive additional funding to continue the research.
Q. How did you learn about the SSO’s YIA award?
A. I have been going to the Annual Cancer Symposium since I was a 4th year medical student and I’ve been involved with my mentorship. I received the SSO emails and within the department others would forward me information. Also, the division chief, Peter Allen, MD won the award as a young investigator and I was encouraged to apply for it by him.
I want to emphasize how grateful and thankful I am to have received this award. I’ve been mentored by many SSO members at different institutions and they are just as much a part of this – Keith Delman, MD, Jonathan Zager, MD, Douglas Tyler, MD and also John Thompson, MD from Australia who are all very interested in moving the field forward. They’ve always treated me as a colleague even though I’m just starting out.