Local Research With Global Implications & The IU Oncologist Behind It

“I’m a geek at heart. The coolest day is when you have new data and are the first human to know it. And then you hope that data will make a difference.” –Dr. Bryan Schneider

Dr. Bryan Schneider is a Komen Hero.

As a practicing breast cancer oncologist and breast cancer researcher, Dr. Schneider is combining two areas of expertise into one superpower: helping figure out how to save patients’ quality of life with individualized chemotherapy treatment.

More background on our hero: Dr. Schneider is also an associate professor of medicine at the IU Simon Cancer Center and holds department appointments in Hematology/Oncology, Clinical Pharmacology and Medical & Molecular Genetics. He is a member of the international Komen Scientific Advisory Council and a recipient of the Komen Promise Award. For a full list of degrees, accolades, publications and different ways he seeks to make the world better for cancer patients, you can read his bio.

Another interesting fact is that Dr. Schneider is only 38. That’s not to undermine his authority or accomplishments; it’s to underscore them. Being so well-known in this field, you would imagine someone older and more formal – on the contrary, he looks even younger than his age and is extremely approachable, accessible and intelligent.

His fascination with oncology began at age 10 after his grandmother was diagnosed with cancer and he kept her company during treatments until she lost her battle. While the doctors weren’t sure what type of cancer it was, he knew he wanted to study the disease. He did his fellowship at the IU School of Medicine, which inspired him to take his oncology specialty a step further after training under his mentor - Dr. George Sledge – who specializes in breast cancer.

“Very few people have the opportunity to think their work makes a difference,” Schneider said. “I feel like I owe it to others to use my skills because of all the opportunities I’ve had.”

Dr. Schneider now divides his skills into two parts:

1. Patient Care (25 to 30 patients per day), which can be up to a 12-hour work day.

2. Research, which is eight hours in the lab and more when he gets home at night.

While his research is the focus of this article, Dr. Schneider notes that the patient care is what gets him through the long hours in the lab.

“I get to work with lovely and amazing women, and they’re a constant reminder to me that we are not where we need to be in terms of treatment,” Schneider said. “Those days working with patients are the ones that provide a lot of fuel for the other days.”

To find out more about Dr. Schneider – like his family, favorite hobbies, guilty pleasures and love for South Beach – see the bottom of this article.

THE STUDY

 

The technical name for this research is “genetic associations with taxane-induced neuropathy by genome-wide association study (GWAS) in E5103.”

In layman’s terms: this is part of a larger initiative – a clinical trial – to identify parts of the DNA (genetic biomarkers) that can indicate whether a patient is more susceptible to certain side effects from specific chemotherapy drugs. While his particular study focuses on neuropathy as a side effect (numbness or pain in the hands and feet), future work will be performed to identify the DNA biomarkers that can predispose a patient to two other common conditions stemming from treatment: high blood pressure and congestive heart failure.

THE DNA MATERIALS

While Dr. Schneider is only studying the blood from patients enrolled in the E5103 clinical trial for the study that is focus of this article, his other studies have analyzed DNA strands with everything from patient-approved medical data, blood draws, breast tissue from the Komen Tissue Bank and/or breast cancer cells.

Whenever a study requires breast cancer cells, the cells are stored in a fluid filled with nutrients to keep them intact, as they become very fragile once they’re removed from the body and put into a different environment. These cells are not contagious – if you touched or ingested them for some accidental or odd reason, your immune system would recognize and attack them as foreign cells regardless of whether they were cancerous or non-cancerous since they came from someone with completely different DNA. What allows cells to turn cancerous and spread is that the cancer cells are enough like your own body that the immune system doesn’t know to – and can’t – fight them. Chemotherapy treatments are designed to kill off any rapidly growing cells in your body, which includes some healthy cells that also grow fast, like hair follicles and the digestive tract, resulting in hair loss, nausea and mouth sores.

WHY THE STUDY IS BEING DONE

Some chemotherapy patients suffer from the short- or long-term side effects of neuropathy, while others suffer none at all. These differing biological reactions are what prompted Dr. Schneider to pursue the study – to find out which DNA (genetic biomarkers) indicate increased susceptibility to neuropathy when interacting with certain chemotherapy drugs.

Neuropathy can be a nuisance at best and debilitating at worst. It is the interruption of signals to the body parts farthest from the brain, which also happen to be ones we use most: our hands and feet. The resulting numbness or pain can make it very difficult for a patient to do everyday tasks like typing, grasping, buttoning clothes, cooking or walking. Sometimes this is temporary and passes after treatment, but for others it lasts the rest of their lives.

Knowing in advance that you have an increased chance for neuropathy if you select a particular chemotherapy drug can mean the difference in more informed decision making, better treatment and ultimately a higher quality of life as a survivor.

THE INITIAL FINDINGS

Dr. Schneider and his colleagues are currently two years in to this five-year study funded by Komen Research Grant dollars.

So far, the team has already discovered multiple genes that can be used to predict susceptibility to neuropathy, but one in particular has been identified as the best indicator to date: the RWDD3 gene.

There are three combinations of the RWDD3 gene, each comprised of two bases – one base from the mother’s side, one base from the father’s side.

A common “base” is called “wild-type” an uncommon strand is called “SNP” (pronounced “snip”). The below chart shows the initial finding on the probability that a patient’s RWDD3 gene combination would result in neuropathy when paired with a particular chemotherapy (in this case, paclitaxel):

• Combo #1 – If you have 2 common bases, you only have a 27% chance of neuropathy.
• Combo #2 – If you have 1 base and 1 SNP, you have a 40% chance of neuropathy.
• Combo #3 – If you have 2 SNPs, you have up to a 60% chance of neuropathy.

What this would mean if you were a patient is that your oncologist could look at your RWDD3 gene and discuss the likelihood of you getting neuropathy as a side effect from a treatment option with paclitaxel.

FUTURE OF THE STUDY

The next steps in this study are to:

• Repeat and hopefully validate the initial findings (the probabilities listed above).
• Test more genes to see if there are any other and possibly even better genetic indicators than the RWDD3.
• Determine whether the ability to base treatment on genetic indicators matters to patients. As part of the Komen Promise Award, a primary outcome of this study is to provide tools for doctors and patients to make more informed decisions about treatment.

This process might seem tedious to some, but Dr. Schneider still gets excited about it, even though he’s had to explain the study many times over the past several years.

“I’m a geek at heart,” Schneider said. “The coolest day is when you have new data and are the first human to know it. And then you hope that data will make a difference.”

While this is a breast cancer study, the tie between genetic biomarkers and certain chemotherapy drugs has even larger implications across different types of cancer.

For physicians, this could provide an opportunity to deliver more successful chemotherapy treatments while maintaining the highest quality of life and health possible for their patients.

For pharmaceutical companies, this could help their researchers better understand the role certain biomarkers play in how a patient’s body responds to their drugs, which can in turn help them improve the development and testing processes for new treatments.

For patients, this could eventually assist individuals with all cancer types in weighing the cost-benefit of selecting certain chemotherapy treatments, taking a more active role in discussing treatment options with their physician and also mentally preparing themselves for the likelihood of certain side effects.

More About The Komen Hero

When he’s not saving the world, Dr. Schneider is home with his wife, Kim – a pediatrician – and his 18-month-old son, Cole Matthew.

Mid-Day Energy Boosters: Coffee and PB&J protein bars

Favorite Book: “Outliers: The Story of Success” by Malcolm Gladwell, which is about how some people become so good at what they do (like Bill Gates), exploring how they think and how they’re frequently at the right place at the right time.

Guilty Pleasures: While he is very disciplined and describes himself as “no fun,” when he wants to completely relax, he goes to Barnes & Noble to treat himself to books, a caramel latte and Rice Krispy Treat.

Last Movie He Saw In Theater: Harry Potter & The Deathly Hallows (he does not have a favorite movie candy because of the non-Barnes & Noble self-discipline thing)

Non-Medical Magazine Subscriptions: Sports Illustrated

On the DVR: Pardon The Interruption and Around the Horn (both on ESPN)

Favorite Local Restaurant: St. Elmo’s Steakhouse

Favorite Travel Spots: In the winter, it’s South Beach in Miami, because that’s where one of his best friends / former med school roommate did fellowship training and he came became addicted to the warm weather, beaches and cuisine. In the summer, it’s Boston, because he’s had to travel there a lot for collaborations with Massachusetts “Mass” General Hospital and loves the history, rich culture, sights and food.