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Dr. Lau is head of the Molecular Neuro-oncology Laboratory and the Cancer Genomics Program at Texas Children's Cancer Center. Dr. Lau’s many research interests include the molecular biology of pediatric brain and bone tumors, and the clinical applications of genomics. Because the phenotype and clinical behavior of every tumor is determined by the underlying genetic alterations, Dr. Lau hypothesizes that comprehensive genetic profiling is a systematic and unbiased approach to recognize tumor subtypes.
What is the focus of your research? “My research team and I are focused on one of the most pressing clinical needs in pediatric neuro-oncology, which is to identify genetic markers that can be used to design risk-based therapy. We want to create therapies that are intensive enough to optimize survival in our patients who are at high risk for relapse, but we also must develop therapies that minimize toxicity in low-risk patients.”
What specific types of tumors do you research? “I focus most of my attention on pediatric brain tumors, which are among the most challenging of all types of pediatric cancers to treat. While the overall survival rate for children with cancer is more than 75%, only half of all children diagnosed with a brain tumor will survive. We seek to identify new and reliable prognostic markers in pediatric brain tumors by using some of the most powerful genomic technologies currently available, including gene expression profiling, comparative genomic hybridization (CGH), spectral karyotyping (SKY), and allelotyping. By integrating these powerful techniques, we are developing a molecular classification system for pediatric brain tumors that can be used to stratify patients more accurately. This system will allow us to ensure that children with brain tumors receive the most effective yet least toxic therapy possible.”
Is this research applicable to other types of pediatric cancers? “Absolutely. In both pediatric and adult cancers, we will soon provide a diagnosis based on the genetic profile of the individual patient's tumor, rather than on the location and physical characteristics of their cancer. We are currently establishing a molecular classification for osteosarcoma, medulloblastoma, ependymona, low-grade glioma and intra-cranial germ cell tumors by using high throughput genomic technologies, such as gene expression profiling, comparative genomic hybridization, spectral karyotyping, and genotyping based on polymorphic markers scanning, as well as proteomics.”
What else are you researching? “I am also interested in the genetic regulation of normal brain development and its role in the pathogenesis of brain tumors. In my laboratory, we are also studying the molecular mechanisms that cause each patient to respond differently to the various chemotherapeutic agents used in treating pediatric cancers. This information will also enable to us to better tailor our therapies to the individual patient, thereby increasing the survival rate and decreasing the toxicity.
Do you have a specific goal? "In 1993, I returned to Houston from Boston, where I had received my Ph.D. and M.D. degrees. Like many Harvard alumni, I submitted a short essay to school’s alumni magazine in which I described my dream for the future. I still have that dream today, 13 years later. My dream is of a not-too-distant future when children with cancer will be diagnosed with 100% accuracy. I dream of children with cancer being cured of their disease by taking pills at home, rather than having to come and stay in the hospital for therapy. Children and adolescents will no longer be devastated by disfiguring surgeries that leave permanent scars, both physical and emotional. I dream of treating cancer with medications that are so specifically targeted against cancer cells that there will be minimal side effects because the normal cells are spared. Children will not turn bald when they receive treatment for cancer. There will be no more nausea and vomiting, low blood counts requiring blood transfusions, or fever requiring prolonged hospitalizations. Children will not be deprived of the opportunity to develop to their fullest potential because they cannot reach their normal height after radiation to the brain or because they have hearing loss or memory loss or other neurocognitive deficits. I dream of the day when we can customize cancer therapy for each patient based on the unique characteristics of the patient’s cancer and the body’s ability to tolerate the medication. I dream of the day when we can tell if the therapy is working by a simple blood test, instead of waiting three months for a CT or MRI scan. I dream of the day when we can use a simple screening test for early detection and prevention of all cancers."
Do you really think these dreams can be realized? “With the incredible technologies made available as a result of the Human Genome Project, we have made great strides in understanding the genetic changes that underlie the malignant behavior of cancers. We can design specific therapies that target these genetic changes. In the Cancer Genomics Program at Texas Children’s Cancer Center, we have more than 20 researchers working very hard to make use of these genomic technologies to solve the mysteries of various types of cancers. And we see a glimpse of hope in the future based on our first findings. For example, we can now predict which children with osteosarcoma, the most common bone tumor of childhood, will do well with standard therapy even before we start treatment. We can also predict which children will develop metastasis elsewhere in the body in the future and therefore may benefit from more intensive therapy upfront. In collaboration with other investigators, we have discovered that children with the most common form of brain tumor can have 100% chance of survival if the activity of a certain gene is suppressed. The implication of this finding is that we could potentially back off on the aggressive therapy with this group of patients in order to minimize the long-term side effects of therapy without compromising the child’s chance of survival. These were all merely dreams 13 years ago, and they are slowly but surely becoming reality. So you can see why this is not necessarily just a dream anymore, and why I am so optimistic about the future of pediatric oncology. I believe we can reach the goal set forth by the director of the National Cancer Institute to eliminate suffering and death due to cancer by 2015. But we are in a race against time. The longer it takes for us to make these discoveries, the more children will succumb to their disease." What challenges do you foresee in realizing your dream? "We cannot win this race alone. The incredible technologies that enable us to crack the cancer code are also incredibly expensive. With the National Cancer Institute having no net increase in their budget for the second year in a row, we are able to launch very few new initiatives. In order to maintain the momentum of our discovery process and to initiate new projects to test new ideas, we are increasingly dependent on support from philanthropy and private foundations. It warms my heart when I see so many people in the community who care, even though they may not be impacted directly or indirectly by a child who is afflicted with this dreadful disease."