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About Ewing Sarcoma

Ewing sarcoma survival rates have reached a plateau in recent decades – overall the five-year survival rate is just 60%. Survival rates for patients with metastatic disease or who relapse are much lower. This plateau suggests that conventional treatment regimens have reached the limit of their efficacy and underscores the need to develop new or improved therapies. Development of such therapies might also avoid or mitigate the adverse side effects of conventional chemotherapy.

The Nick Currey Fund is currently supporting five research projects aimed at improving outcomes for children diagnosed with Ewing sarcoma.

Jeffrey Toretsky, MD Associate Professor Lombardi Comprehensive Cancer Center Georgetown University

In a study being conducted at Georgetown University's Lombardi Comprehensive Cancer Center since September 2010, a small molecule drug specific to Ewing Sarcoma is being developed. The project is looking at how combinations of a drug specific to Ewing Sarcoma, YK-4-279, and current cancer therapies interact synergistically. The findings from the study will help inform how the drug may be used as a therapy. Furthermore, the study may help define how YK-4-279 works inside Ewing sarcoma cells.

Stephen Lessnick, MD Jon and Karen Huntsman Presidential Professor in Cancer Research Director, Center for Children's Cancer Research at Huntsman Cancer Institute University of Utah

Julia Bridge, MD Professor, Pathology, Pediatrics, and Orthopaedic Surgery Associate Director, Clinical Cytogenetics Director, Sarcoma Rearrangement Testing for Molecular Diagnostics University of Nebraska Medical Center

Based on data suggesting that alterations in two specific genes, p53 and pl6, may help predict future outcomes for patients with Ewing sarcoma, Drs. Stephen Lessnick and Julia Bridge are evaluating how often 2 specific genes are altered in a large cohort of tumor specimens, and whether these alterations predict patient outcomes. As part of the study, the investigators will also "amplify" tumor DNA to allow them to study the genes and create an important resource for other investigators studying this disease. If this study supports the idea that p53 and/or pl6 alterations can predict patient outcome, these tests might then be incorporated in future clinical trials for patients with Ewing sarcoma.

Elizabeth Lawlor, MD Russell G. Adderley Professor of Pediatric Oncology Associate Professor, Pediatrics and Pathology University of Michigan

Dr. Lawlor's lab previously identified that Ewing sarcoma cells survive when deprived of oxygen. Dr. Lawlor and colleagues discovered that suppression of the potassium ion channel Kv1.5 is, at least in part, responsible for this abnormal cell survival. Kv1.5 is a type of protein in cells that moves potassium out of cells. Therefore, Dr. Lawlor hypothesizes that restoring expression of the Kv1.5 channel in Ewing sarcoma cells may inhibit their resistance to cell death and lead to better outcomes for patients. Dr. Lawlor and her team will study both normal and cancer cells to understand Kv1.5 channel suppression in Ewing sarcoma. Cell death under conditions of stress requires potassium ions move out of the cell, which is often blocked in cancer, leading to abnormal cell survival. Understanding how this response is disrupted in Ewing sarcoma can lead to tools to reactivate it and ultimately prevent survival of the most therapy-resistant cells and thereby prevent tumor relapse.

Joshua Schiffman, MD Assistant Professor Division of Pediatric Hematology/Oncology University of Utah

Using microarray technology, Dr. Schiffman and his colleagues retrospectively examined archived tissue samples from 40 patients at the University of Utah, including tissue from patients who had both relapsed and metastatic disease. A gene called CEBPB was found to be amplified in many patients - instead of the normal two copies of the chromosome, there were as many as 11. Further research identified seven other chromosomal regions in Ewing sarcoma patients in which amplification or missing genes occurred. Those with changes in gene copy numbers are called Multifactor Copy Number (MCN)-positive and those without changes are called MCN-negative. In comparing the findings to the patients' clinical outcomes it was found that patients who were MCN-negative had a 100% survival rate over 12 years, compared to a 41% survival rate over 12 years for those patients who were MCN-positive.

The study is being expanded to examine tissue samples from across the country and determine if findings can be validated. If they are, it may lead to a change in protocol treatment for patients with Ewing sarcoma as tumors could be examined at diagnosis and therapy adjusted based on the MCN status of individual patient tumors.

Statistician Funding

Bringing together data from multiple Ewing sarcoma studies with the hopes of funding overarching information to develop targeted treatments, the Nick Currey Fund is funding statisticians working on five projects.

1. Expert pathologists have examined tumor tissue from hundreds of patients enrolled in clinical trials in the last two decades and are linking this data to the clinical outcomes of patients to determine if any particular features are related to outcomes.
2. Assembling data from three studies of newly-diagnosed patients with Ewing sarcoma, statisticians are trying to determine not only if the age of diagnosis, race, and gender affect treatment outcomes and side effects, but also if interrelationships between these and other established factors increase risk of disease progression.
3. The statistician is integrating data from a series of trials and conducting analyses to examine the effects of various surgical characteristics on disease outcomes and complications of surgery.
4. The presence of EWS-FLi1 in blood and bone marrow samples is believed to serve as a marker for recurrence of Ewing sarcoma. To test this hypothesis, serial blood and bone marrow specimens from patients enrolled in a specific COG study were analyzed at the National Cancer Institute. Those results will be integrated into the dataset of another study to determine their prognostic significance.
5. Statisticians are assembling and analyzing treatment and complication data related to rare tumor sites in Ewing sarcoma patients, such as the spine and skull. This information will be published and serve as a treatment guide for clinicians who are often presented with these rare cases only once or twice in their entire careers.

For more information please contact NickCurreyFund@CureSearch.org.