The Scope E-Newsletter January 2010 Gerard and Carlson Advance Oral Cancer Research Through Retrospective Study

While breast cancer research has led to advancements in treatment options and increased survival rates over the past 15 years, oral cancer research has made little progress. Oral cancers, represented by squamous cell carcinoma, are the tenth most common cancers in the United States, and even higher in East Tennessee due to smoking and other social habits such as the use of smokeless tobacco.

David Gerard, PhD, Professor of Oral and Maxillofacial Surgery and Director of Research; and Eric Carlson, DMD, MD, FACS, Professor and Chairman of the Department of Oral and Maxillofacial Surgery, want to improve the survivability associated with oral cancer by being able to predict a cancer's biologic behavior with subsequent targeted therapy. They have designed a study in an attempt to identify a "genetic signature" for oral cancers that behave in different ways. After two pilot studies, the investigators discovered that oral squamous cell carcinoma may behave in one of three ways: the cancer remains isolated to the oral cavity without regional lymph node or distant metastatic spread despite the potential for bone invasion; the cancer spreads quickly to regional lymph nodes in the neck; or the cancer spreads to the lymph nodes in the neck as well as distant organs.

Using evidence collected from more than 200 operated cases of oral cancer with long-term follow-up of patients, the investigators will examine the genetic profile of these cancers and look for mutations in patients who had a recurrence of their cancer. Their goal is to identify genetic profiles of cancers that will permit surgical procedures and adjuvant therapy based on a predicted biologic behavior of the cancer.

In addition to studying oral cancers, Drs. Gerard and Carlson are studying a novel biomaterial made from hydroxyapatite, a naturally-occurring mineral found in bone and other hard tissues, as a bone replacement material, in collaboration with Oak Ridge National Laboratory. The novel material is produced by bacteria in culture, and therefore the calcium/phosphorus ratio can be modified by varying culture conditions to imitate the ratio found in human bone. This material has the potential to act as a bridge in bone defects and then stimulate the bone-growth process.

The Oral and Maxillofacial Surgery researchers have designed a third study that has the potential to improve outcomes for their patients who receive bisphosphonate therapy. Bisphosphonate medications are commonly used to treat patients with osteoporosis and metastatic cancer, including multiple myeloma, breast and prostate cancer. These patients who undergo oral surgical procedures may develop bisphophonate-related osteonecrosis of the jaw (BRONJ), or death of jawbone. Drs. Gerard and Carlson are looking at ways to override the negative effects on bisphosphonate treatment on bone activity.

"The integration of effort of clinicians and basic science researchers presents an exciting opportunity to make clinically meaningful conclusions in translational research performed in an academic medical center," Dr. Carlson said. "My hope is that my work with Dr. Gerard will one day result in my ability to more effectively manage cancer patients in my surgical practice."