Dr. Philip Lupo
|
When Philip Lupo, MD, MPH, was diagnosed with melanoma, it changed his life — and his career path. Now, he’s a genetic epidemiologist at Texas Children’s working to answer questions like what makes a child more likely to develop, and how a child’s genetics influences their treatment. Learn more about his COG committee’s exciting research.
SUBMITTED PHOTOS
|
Philip Lupo, PhD, MPH, is a genetic epidemiologist who leads the COG Epidemiology Committee. He is also the Endowed Chair in Molecular Epidemiology at Texas Children’s Hospital and the Director of the Epidemiology and Population Sciences Program at Texas Children’s Cancer and Hematology Center.
Philip Lupo was fresh out of college with degrees in biology and political science. He figured he’d work for a few years before going to graduate school. Then he was diagnosed with melanoma.
“Like everybody when they’re diagnosed with cancer, I wondered ‘why did this happen?’” he says. “And that question ultimately pointed me toward a career in epidemiology.”
He beat melanoma, then got Masters in Public Health and a PhD in epidemiology. Along the way, he learned about the collaborative atmosphere of pediatric cancer research and the impact it could have, and never looked back.
Now, he is the chair of COG’s epidemiology committee. We spent some time with Dr. Lupo to learn about the epidemiology committee’s current priorities and how they support all of the disease areas.
Philip Lupo was fresh out of college with degrees in biology and political science. He figured he’d work for a few years before going to graduate school. Then he was diagnosed with melanoma.
“Like everybody when they’re diagnosed with cancer, I wondered ‘why did this happen?’” he says. “And that question ultimately pointed me toward a career in epidemiology.”
He beat melanoma, then got Masters in Public Health and a PhD in epidemiology. Along the way, he learned about the collaborative atmosphere of pediatric cancer research and the impact it could have, and never looked back.
Now, he is the chair of COG’s epidemiology committee. We spent some time with Dr. Lupo to learn about the epidemiology committee’s current priorities and how they support all of the disease areas.
|
What exactly is a genetic epidemiologist?
Epidemiologists study diseases with the goal of better understanding who is at higher risk for a disease and what factors make a person more likely to develop a disease. So, for example, we see higher rates of skin cancer among fair-skinned people with light hair, and we know that smoking increases a person’s risk for lung cancer. Our goals are to better identify and understand these types of patterns, and ultimately lower the number of people who develop a disease or prevent disease altogether. |
Dr. Lupo
|
As a genetic epidemiologist, I’m really interested in how genes can predict who will develop cancer. It’s easy to think “I’ve got this gene, but what can I really do about it?” Better understanding how certain genes increase the risk of cancer can help us recommend earlier or more frequent screening to catch cancers early if they do develop, which can improve outcomes. And now we have some therapies that can actually target genes, and potentially lower the risk of cancer.
Can you tell us more about the epidemiology committee at COG? What do you do?
Broadly, our committee is working to understand why kids develop cancer, how they’ll respond to treatment and how they’ll do in the long term. Doing this work through COG and with Project:EveryChild, COG’s biorepository, is one of the few ways this work is possible.
Any child who is seen at any of the 220 COG institutions in the world can give consent for people like me to reach out, enroll them in the study and collect information through questionnaires and samples. We can then look for correlations between genetics and who had the best responses to treatment, and as well as how various patients do years after treatment.
Can you tell us more about the epidemiology committee at COG? What do you do?
Broadly, our committee is working to understand why kids develop cancer, how they’ll respond to treatment and how they’ll do in the long term. Doing this work through COG and with Project:EveryChild, COG’s biorepository, is one of the few ways this work is possible.
Any child who is seen at any of the 220 COG institutions in the world can give consent for people like me to reach out, enroll them in the study and collect information through questionnaires and samples. We can then look for correlations between genetics and who had the best responses to treatment, and as well as how various patients do years after treatment.
|
What are some of the most exciting projects your committee is working on?
One of our biggest studies is the Genetics of Embryonal and Alveolar Rhabdomyosarcoma Study (GEARS). We’re trying to understand why children develop rhabdomyosarcoma (a pediatric cancer that starts in the bones and soft tissue). We started by collecting questionnaire data and studying biological samples from kids with this cancer. We ask questions like what do these kids have in common genetically? And what’s genetically different between them and kids that don’t have rhabdomyosarcoma? So far, we’ve made some important findings such as about 8% of kids with rhabdomyosarcoma have a cancer predisposition syndrome, which is a genetic disorder that makes a person more likely to develop cancer. This information can help with not only understanding why a child develops cancer, but also could direct families toward genetic screenings to understand if other family members are at risk. |
Abby Dedic
More than a decade after Abby’s cancer treatment, she and her family were invited to join the Genetics of Embryonal and Alveolar Rhabdomyosarcoma Study (GEARS). They quickly said yes to helping oncologists and researchers learn more about the unique characteristics of the rare cancer she had and lay the foundation for better treatments. |
Through Project:EveryChild, we’re also working to better understand why children with Down syndrome are significantly more likely to develop acute leukemia than children without Down syndrome.
Third, which I’m particularly excited about, is a new study called ORIGen (Outcomes and Health Risks among Individuals with Genetic Predispositions to Cancer). The ORIGen study builds on the Molecular Characterization Initiative (MCI), a COG initiative, overseen by Diana Thomas, MD, PhD and Elaine Mardis, PhD, at Nationwide Children’s.
Since it opened in 2022, MCI has been providing highly detailed information about the biology of a tumor and of the patient’s genetics.
The idea is that we will use the rich data from MCI to better understand why kids develop cancer and how they do after their initial treatment. So far, we’ve found that about 15% of these kids also have a genetic syndrome that likely explains their cancer diagnosis. This is a big breakthrough and we’ve never been able to study these individuals at scale. Now, we can enroll thousands of kids with and without these syndromes, and follow them over time. This can help us better understand how the syndrome impacts their long-term health, if they might develop another cancer down the road, and, if so, what we can do about it.
What are your committee’s biggest goals?
One of our biggest goals is to continue to use molecular data from MCI in our epidemiology work. There aren’t many epidemiological studies that have rich, detailed molecular information specifically for kids. Using MCI data in our epidemiology studies should lead to some significant insights that will help us understand who develops cancer and how they’ll do in the long term.
Another goal is to better understand the role of environmental factors (chemicals, air pollution, etc.) in pediatric cancer. This is challenging because a lot of times you don't know what you're exposed to or when you’re exposed to it. But our team is beginning to think about novel ways to study exposures and better understand how the environment could play a role in pediatric cancer.
Third, which I’m particularly excited about, is a new study called ORIGen (Outcomes and Health Risks among Individuals with Genetic Predispositions to Cancer). The ORIGen study builds on the Molecular Characterization Initiative (MCI), a COG initiative, overseen by Diana Thomas, MD, PhD and Elaine Mardis, PhD, at Nationwide Children’s.
Since it opened in 2022, MCI has been providing highly detailed information about the biology of a tumor and of the patient’s genetics.
The idea is that we will use the rich data from MCI to better understand why kids develop cancer and how they do after their initial treatment. So far, we’ve found that about 15% of these kids also have a genetic syndrome that likely explains their cancer diagnosis. This is a big breakthrough and we’ve never been able to study these individuals at scale. Now, we can enroll thousands of kids with and without these syndromes, and follow them over time. This can help us better understand how the syndrome impacts their long-term health, if they might develop another cancer down the road, and, if so, what we can do about it.
What are your committee’s biggest goals?
One of our biggest goals is to continue to use molecular data from MCI in our epidemiology work. There aren’t many epidemiological studies that have rich, detailed molecular information specifically for kids. Using MCI data in our epidemiology studies should lead to some significant insights that will help us understand who develops cancer and how they’ll do in the long term.
Another goal is to better understand the role of environmental factors (chemicals, air pollution, etc.) in pediatric cancer. This is challenging because a lot of times you don't know what you're exposed to or when you’re exposed to it. But our team is beginning to think about novel ways to study exposures and better understand how the environment could play a role in pediatric cancer.
Dr. Lupo is part of the Reducing Ethnic Disparities in Acute Leukemia (REDIAL) Consortium leadership team, focusing on better predicting those who have the greatest risk of poor outcomes, with a focus on improving prevention and treatment strategies for Hispanic patients. The St. Baldrick's Foundation provided funding for the initial REDIAL study in 2017 and extended the award in 2023. |
How does Project:EveryChild make your work possible?
I’m not exaggerating when I say that we could not do this kind of work without Project:EveryChild. There are so few opportunities to contact almost every child across COG’s international network diagnosed with cancer and better understand why it happened. These cancers are rare, which is good — for example, even at a large pediatric cancer center, we might only see 10 children a year with rhabdomyosarcoma. But to find meaningful epidemiological patterns, we need to study large groups. And through COG, we have been able to enroll more than 300 children diagnosed with this cancer for our epidemiologic studies. There’s no parallel to Project:EveryChild, not on childhood cancer or adult cancer either. Why is philanthropy important in your research? For so many reasons! For one, traditional funding sources are often more focused on answering specific questions rather than directing funds to build resources like Project:EveryChild. |
Same for prevention — traditional funding often goes toward studying new treatments, but there typically isn’t as much funding available for prevention studies. Philanthropy plays a crucial role in filling those gaps.
Because donors made an initial investment in Project:EveryChild through the Children’s Oncology Group Foundation, we now have an invaluable resource to answer epidemiological questions. And those answers provide the data we need to explore more research paths for specific disease areas and apply for larger, government grants. So supporting Project:EveryChild has a ripple effect and we are so grateful for our donors!
What’s one epidemiological question you’d love to answer?
Pediatric cancer is rare, but the number of children developing cancer is actually going up. It’s baffling. We’re starting to see some cancers decrease in adults, and I’d like to see the same thing happen in children. But first, we have to fully understand why this is happening.
We've made so many strides in diagnosing pediatric cancers and all of their unique characteristics. We've also made big strides in developing therapies that target cancers better and do less harm to the rest of the body. My hope is that if we can better understand why cancers happen and why more kids are getting them – we can look for ways to stop that from happening. Prevention would be the ultimate goal, because it means kids wouldn’t get sick in the first place and wouldn't have to suffer.
Because donors made an initial investment in Project:EveryChild through the Children’s Oncology Group Foundation, we now have an invaluable resource to answer epidemiological questions. And those answers provide the data we need to explore more research paths for specific disease areas and apply for larger, government grants. So supporting Project:EveryChild has a ripple effect and we are so grateful for our donors!
What’s one epidemiological question you’d love to answer?
Pediatric cancer is rare, but the number of children developing cancer is actually going up. It’s baffling. We’re starting to see some cancers decrease in adults, and I’d like to see the same thing happen in children. But first, we have to fully understand why this is happening.
We've made so many strides in diagnosing pediatric cancers and all of their unique characteristics. We've also made big strides in developing therapies that target cancers better and do less harm to the rest of the body. My hope is that if we can better understand why cancers happen and why more kids are getting them – we can look for ways to stop that from happening. Prevention would be the ultimate goal, because it means kids wouldn’t get sick in the first place and wouldn't have to suffer.