New Mexico, Texas, Kansas, Oklahoma, Arkansas, Louisiana, Missouri, Alabama, Georgia, Florida, South Carolina, and North Carolina, make up the Southern Division of the National Cancer Institute Cooperative Human Tissue Network's Southern Division. Duke University is the headquarters of the Southern Division.
The NCI CHTN: Supporting Cancer Research for 35 Years, Changing Patients' Lives
Published
The Cooperative Human Tissue Network was created by the National Cancer Institute in 1987 to support a coordinated national effort to collect and distribute high-quality, pathologist-validated human tissues for cancer research.
Since then, the network has expanded to provide different types of tissue samples, blood and body fluid samples, immunohistologic and molecular sample preparations, tissue microarrays, and clinical datasets inclusive of biomarkers and molecular testing. From inception through the end of 2021, the network has distributed 1,375,041 bio-specimens. It served 889 active investigators in 2021.
In a new article in Molecular Cancer Therapeutics, CHTN Southern Division leader Shannon McCall, MD (corresponding author), together with the other 5 CHTN Division leaders and NCI staff, breaks down the advances of the past 15 years, including the shift from molecular biomarker testing of individual genes to panels of hundreds of genes to the increased use of whole-exome and whole-genome sequencing, and steps they are taking to optimize the representation of communities among the distributed biospecimens.
Duke has been the CHTN Southern Division Headquarters since 2019.
This division encompasses the states of North Carolina, South Carolina, Georgia, Florida, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, Kansas, Texas, and New Mexico. Operational and scientific highlights of the CHTN Southern Division (page 7 of the review) include: the Frameshift Molecular Registry of Tumors and leading-edge technologies like whole-slide imaging, nucleic acid extraction, digital spatial profiling/transcriptomics via the NanoString GeoMx platform, multiplexed IHC stains for standard immune markers, and more.
Bringing together cutting-edge science and multidisciplinary collaboration, the Duke Molecular Tumor Board (MTB) is transforming cancer care at Duke and beyond.A collaboration between Duke Cancer Institute and the Duke University Department of Pathology, the MTB was established to ensure patients with advanced or metastatic solid tumors receive evidence-based precision therapies and clinical trial access. Since launching in 2017, the MTB has reviewed over 18,000 patient cases.Genomic data is integrated into a centralized database known as PathPrime. Every molecular testing report across the Duke system is reviewed, with as many as 100 cases evaluated weekly.Select cases are then discussed in a weekly meeting attended by a multidisciplinary team of around 40 experts, including pathologists, genetic counselors, pharmacists, oncologists, surgeons, and clinical trials staff.“It’s a robust discussion about cases where we share knowledge,” said medical oncologist John Strickler, MD, leader of the MTB. “Our goal is to ensure that each patient receives the most informed, up-to-date treatment recommendations possible.”For patients, the MTB also offers a level of personalized care that goes beyond standard practice. Unlike traditional systems where genomic data may be buried in medical records, the MTB ensures results are accessible, actionable, and continuously reviewed. As new therapies and trials emerge, eligible patients can be flagged by the PathPrime system and their physicians notified — sometimes within hours of an FDA approval.“Because the patient is seen at Duke and has their profiling done at Duke, we’re able to provide that concierge-level precision cancer medicine support,” Strickler said.Looking Forward & Expanding Access Beyond DukeIn 2024, Duke launched a two-year partnership with Eli Lilly and Company and the National Comprehensive Cancer Network to address disparities in molecular testing in rural communities. Through this initiative, patients at smaller, non-Duke hospitals that are staffed by Duke physicians and part of the Duke Cancer Network can consent to have their data reviewed by the MTB. This effort is on track to include 500 patients by the end of the first two years, significantly expanding access to precision medicine.“In the community setting, timely testing is happening less frequently, and patients are not getting access to precision cancer medicine therapies or trials in the same way that academic center patients are,” Strickler said. “The Molecular Tumor Board has established a relationship with these hospitals so those patients can access our precision cancer medicine services.”Duke is also pioneering new approaches to accelerate diagnosis and treatment. One such innovation is a pre-diagnosis testing program for lung cancer, designed to ensure genomic results are available at the patient’s first clinical visit by pairing molecular profiling with diagnostic biopsies. This minimizes delays and avoids unexpected costs for patients.Plans are underway to deploy a digital molecular navigator powered by artificial intelligence. This tool will streamline patient identification and support rapid testing, helping match patients to FDA-approved therapies or clinical trials as quickly as possible.Strickler credits the MTB’s success to support from the DCI and key external sponsors.“This is a commitment by the DCI to ensure that we are offering the highest level of support,” he said. “This level of teamwork and collaboration by highly specialized thought leaders across multiple disciplines is not something that is easily reproducible.”
Charlotte-area resident Vickie Johnson, 72, was diagnosed with colon cancer in 2018 after seeking care twice for abdominal pain. First, she was diagnosed with appendicitis and had her appendix out. Then, when her pain persisted beyond the recovery period, she received a new diagnosis. A scan at the ER showed a possible tumor. She went back to her appendix surgeon, had the mass in her colon removed, and was referred to a hospital oncologist. He referred her to a second surgeon who performed an even more aggressive surgery to remove all the remaining cancer in her colon and got her started on chemotherapy.Unfortunately, after each chemotherapy infusion she experienced severe chest pain. As she described it, “terrible spasms like I was having a heart attack.” Her oncologist didn’t have a plan b. “Finally, he said ‘I'm sorry, there's nothing I can do. We'll just test your blood every so often and get a scan every six months,’” Johnson shared. She wasn’t ready to give up, and as it turned out she didn’t need to.Johnson’s next area oncologist — Justin Favaro, MD, PhD — who'd done his medical training at Duke, brought a cardio-oncologist onboard the care team. The two providers tweaked the chemotherapy regimen she’d been on with the first oncologist; adjusting the dosage so her heart would be able to tolerate it. That worked, but successive treatments didn’t make any headway against her cancer.Johnson had begun 2019 in treatment for newly diagnosed colon cancer and ended that year with the death of her husband and progression of her cancer. During 2020, she’d endured another chemotherapy regimen but with no success. Cancer metastases remained in her liver and her lungs.Patients with metastatic colorectal cancer who have progressed on standard chemotherapy receive limited benefit from the available standard of care options. Johnson had genomic testing done and it turned out her cancer was hardwired with a KRAS G12C mutation, an alteration found in 3 to 4% of all metastatic colorectal cancer cases. Favaro said there was one more option.In the summer of 2021, he referred Johnson for enrollment in CodeBreaK 101, an early-stage clinical trial (phase 1b/2) at Duke Cancer Institute testing a new approach to treating KRAS G12C-mutated solid tumor cancers — a new KRAS G12C inhibitor drug (sotorasib) in combination with other anti-cancer therapies of choice, including FDA-approved antibodies, immunotherapy, and chemotherapy drugs. DCI was one of the first institutions worldwide to open this trial, which had launched in December 2019.Duke Cancer Institute GI medical oncologist and Associate Professor of Medicine John Strickler, MD, was Duke site principal investigator. Strickler is a colon cancer specialist who co-leads the DCI Precision Cancer Medicine and Investigational Therapeutics Research Program and the Molecular Tumor Board.Johnson said she had “no hesitation” about her decision and was grateful when she qualified for recruitment to the study under the care of Strickler.“This was the option. Nothing else was working,” Johnson recalled.
Bringing together cutting-edge science and multidisciplinary collaboration, the Duke Molecular Tumor Board (MTB) is transforming cancer care at Duke and beyond.A collaboration between Duke Cancer Institute and the Duke University Department of Pathology, the MTB was established to ensure patients with advanced or metastatic solid tumors receive evidence-based precision therapies and clinical trial access. Since launching in 2017, the MTB has reviewed over 18,000 patient cases.Genomic data is integrated into a centralized database known as PathPrime. Every molecular testing report across the Duke system is reviewed, with as many as 100 cases evaluated weekly.Select cases are then discussed in a weekly meeting attended by a multidisciplinary team of around 40 experts, including pathologists, genetic counselors, pharmacists, oncologists, surgeons, and clinical trials staff.“It’s a robust discussion about cases where we share knowledge,” said medical oncologist John Strickler, MD, leader of the MTB. “Our goal is to ensure that each patient receives the most informed, up-to-date treatment recommendations possible.”For patients, the MTB also offers a level of personalized care that goes beyond standard practice. Unlike traditional systems where genomic data may be buried in medical records, the MTB ensures results are accessible, actionable, and continuously reviewed. As new therapies and trials emerge, eligible patients can be flagged by the PathPrime system and their physicians notified — sometimes within hours of an FDA approval.“Because the patient is seen at Duke and has their profiling done at Duke, we’re able to provide that concierge-level precision cancer medicine support,” Strickler said.Looking Forward & Expanding Access Beyond DukeIn 2024, Duke launched a two-year partnership with Eli Lilly and Company and the National Comprehensive Cancer Network to address disparities in molecular testing in rural communities. Through this initiative, patients at smaller, non-Duke hospitals that are staffed by Duke physicians and part of the Duke Cancer Network can consent to have their data reviewed by the MTB. This effort is on track to include 500 patients by the end of the first two years, significantly expanding access to precision medicine.“In the community setting, timely testing is happening less frequently, and patients are not getting access to precision cancer medicine therapies or trials in the same way that academic center patients are,” Strickler said. “The Molecular Tumor Board has established a relationship with these hospitals so those patients can access our precision cancer medicine services.”Duke is also pioneering new approaches to accelerate diagnosis and treatment. One such innovation is a pre-diagnosis testing program for lung cancer, designed to ensure genomic results are available at the patient’s first clinical visit by pairing molecular profiling with diagnostic biopsies. This minimizes delays and avoids unexpected costs for patients.Plans are underway to deploy a digital molecular navigator powered by artificial intelligence. This tool will streamline patient identification and support rapid testing, helping match patients to FDA-approved therapies or clinical trials as quickly as possible.Strickler credits the MTB’s success to support from the DCI and key external sponsors.“This is a commitment by the DCI to ensure that we are offering the highest level of support,” he said. “This level of teamwork and collaboration by highly specialized thought leaders across multiple disciplines is not something that is easily reproducible.”
Charlotte-area resident Vickie Johnson, 72, was diagnosed with colon cancer in 2018 after seeking care twice for abdominal pain. First, she was diagnosed with appendicitis and had her appendix out. Then, when her pain persisted beyond the recovery period, she received a new diagnosis. A scan at the ER showed a possible tumor. She went back to her appendix surgeon, had the mass in her colon removed, and was referred to a hospital oncologist. He referred her to a second surgeon who performed an even more aggressive surgery to remove all the remaining cancer in her colon and got her started on chemotherapy.Unfortunately, after each chemotherapy infusion she experienced severe chest pain. As she described it, “terrible spasms like I was having a heart attack.” Her oncologist didn’t have a plan b. “Finally, he said ‘I'm sorry, there's nothing I can do. We'll just test your blood every so often and get a scan every six months,’” Johnson shared. She wasn’t ready to give up, and as it turned out she didn’t need to.Johnson’s next area oncologist — Justin Favaro, MD, PhD — who'd done his medical training at Duke, brought a cardio-oncologist onboard the care team. The two providers tweaked the chemotherapy regimen she’d been on with the first oncologist; adjusting the dosage so her heart would be able to tolerate it. That worked, but successive treatments didn’t make any headway against her cancer.Johnson had begun 2019 in treatment for newly diagnosed colon cancer and ended that year with the death of her husband and progression of her cancer. During 2020, she’d endured another chemotherapy regimen but with no success. Cancer metastases remained in her liver and her lungs.Patients with metastatic colorectal cancer who have progressed on standard chemotherapy receive limited benefit from the available standard of care options. Johnson had genomic testing done and it turned out her cancer was hardwired with a KRAS G12C mutation, an alteration found in 3 to 4% of all metastatic colorectal cancer cases. Favaro said there was one more option.In the summer of 2021, he referred Johnson for enrollment in CodeBreaK 101, an early-stage clinical trial (phase 1b/2) at Duke Cancer Institute testing a new approach to treating KRAS G12C-mutated solid tumor cancers — a new KRAS G12C inhibitor drug (sotorasib) in combination with other anti-cancer therapies of choice, including FDA-approved antibodies, immunotherapy, and chemotherapy drugs. DCI was one of the first institutions worldwide to open this trial, which had launched in December 2019.Duke Cancer Institute GI medical oncologist and Associate Professor of Medicine John Strickler, MD, was Duke site principal investigator. Strickler is a colon cancer specialist who co-leads the DCI Precision Cancer Medicine and Investigational Therapeutics Research Program and the Molecular Tumor Board.Johnson said she had “no hesitation” about her decision and was grateful when she qualified for recruitment to the study under the care of Strickler.“This was the option. Nothing else was working,” Johnson recalled.
