These researchers have dedicated their careers to finding new treatments and cures for people with cancer.
Fortunately, their family found Michael Kinnaman, MD, a Conquer Cancer-funded researcher. Dr. Kinnaman was there for Calum every step of the way.
In this interview, Dr. Kinnaman discusses the relationship between his Conquer Cancer-funded research and Calum’s care and what fuels his passion for pediatric cancer care and research. He also shares some favorite memories of working with Calum and the lifesaving impact a single idea can have.
What memories stand out most to you about caring for Calum and his family?
MK: Calum is one of those kids who defines the word resilient. He has a bright personality that lights up a room. The staff were always excited to see him. He’s calm, collected, and outgoing, which isn’t always common for children that age with cancer.
Calum is also very funny. I remember when his parents got him a joke book. Every time Calum would visit the clinic for treatment, he always came prepared with a new joke, and that speaks to where he was at: not worrying much about what the treatment was going to be, or whether they were going to draw blood. He was just like, “Alright, time to share my latest jokes!”
Caring for Calum and his family reminded me why I entered the field of pediatric oncology. He regularly brought a smile to my face. I got to know Caitlin and her husband, Mike, really well. Calum’s family was a positive beacon of hope and a reminder that things can go well. It was nice to work with such a kind and loving family—and especially Calum, who is so resilient and smart. As an oncologist, you almost feel sad as the years go on, and clinical visits are spaced further and further apart, but ultimately, you’re genuinely happy for your patients who survive. It was a real pleasure and honor to get to know the Murray family.
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Could you provide more details about your approach to Calum’s treatment for ALL?
MK: These days, more than 90% of patients with leukemia will likely reach remission. When research advances treatment to that point, we start considering ways to scale back therapies and make treatment more tolerable for patients. This is especially important for patients with blood cancers, since treatments for these diseases can be particularly taxing both physically and emotionally.
At the time Calum was treated, the standard of care for targeting ALL was three years for boys and two years for girls. The treatment we recommended for Calum was informed by the latest ALL study at the time, because it showed the best patient outcomes and was the most up-to-date way of targeting ALL. However, towards the end of Calum’s course of care, a new study emerged focused on ways to safely and effectively reduce treatment, including the time spent in it. We pulled from some of this promising research to tailor Calum’s treatment, and he benefited from the progress made in previous studies. Fortunately for Calum, with his risk factor being average, we had a winning formula that would give us a great chance of success based on prior research.
How did you come to focus on pediatric oncology research?
MK: While on rotations in medical school, I really enjoyed caring for kids. Many of them were often smiling and having fun, even when faced with tough diseases and illnesses. Pediatric oncology provides an opportunity to develop uniquely meaningful relationships with patients and their families. I enjoy really getting to know the families over time. The field also requires you to know a little bit of everything. You’re not just an oncologist; you also have to think like a general practitioner, an infectious disease clinician, a family medicine specialist, and so on.
Most pediatric oncology training programs require about two years of research. This offers a great chance to immerse yourself in that world by identifying a question and figuring out the best way to answer it. The hope is that you have a key takeaway or tangible outcome that could help patients, perhaps by providing new scientific knowledge or maybe shining light on new treatment approaches. During my training, I launched a study, learned new skills, and really came to enjoy the research process. I took what I was seeing in the clinic and tried to figure out how I could answer questions using different techniques, patient samples, and similar resources.
In what ways have you and/or loved ones been affected by cancer, and how did these experiences shape your approach to cancer research and clinical care?
MK: Witnessing my own loved ones go through cancer has shaped my approach to caring for patients and helped me to better understand their perspectives. My mother-in-law was diagnosed with Hodgkin lymphoma. Her initial diagnosis and subsequent treatment were eye-opening experiences for me. She was initially on the fence about whether she wanted to pursue treatment and was terrified of the toxicities that come along with it. But she wanted to be around to watch her grandchildren grow up, so she overcame her fear and pushed forward through treatment.
Through supporting my mother-in-law through treatment, I noticed some things you hear about but may not always appreciate when you’re an oncologist. For example, when you have a scan and you’re waiting for results, that time between the scan and when you receive the results can be filled with anxiety. Being on the other side was helpful for me in considering what it’s like to be a patient: sitting in the waiting room, waiting for results, long days in the clinic, dealing with toxicities. Thankfully, my mother-in-law’s now five years in remission. I believe navigating this experience from the patient side of things really helped me to become a better doctor and researcher.
Were there any unique activities or pastimes that Calum liked to partake in while undergoing treatment?
MK: I’ll never forget walking into Calum’s hospital room to find him reading a comic book about superheroes who are fighting off leukemia. From seeing Calum flip through that book, I recall the superhero’s job was to “eliminate the leukemic lymphoblast.” It was such an interesting and beautiful way for a pediatric patient to learn more about their disease and what they’re going through, especially in a way that’s not scary. It kind of introduced medical terms in a way that could help Calum understand the bigger picture of what’s going on. And there are not many similar resources out there for pediatric patients, so it was quite unique to see Calum really take to it.
Additionally, Calum and his mom would record weekly videos where he’d say, ‘Happy Friday, everyone!’ and a message like ‘Today, we’re doing XYZ.’ He was undergoing treatment—maybe not always feeling his best, often losing his hair, and yet he was still making these videos on a weekly basis. Those are the things that stick out most to me from Calum’s time in treatment.
Your Conquer Cancer-funded research focused on metastatic osteosarcoma, but often, research for one type of cancer can influence progress in other areas of cancer care. Can you explain more about your research?
MK: ALL is the most common type of childhood cancer, and it’s also a notable example of vital progress made in oncology research.
In the 1940s, children with ALL received a single type of chemotherapy, but researchers quickly learned they needed more than one line of treatment to effectively target the disease. In the 1950s, investigators tried the same approach with two drugs, and still most patients faced recurrence.
In the 1960s, ‘70s, and ‘80s, researchers tested three- and four-drug regimens and began lengthening the time of treatment. By the 1990s, over successive clinical trials, scientists found an ideal treatment strategy, with more than 90 percent of patients with ALL surviving long-term. In other words, ALL went from being one of the most fatal types of cancer to being a disease that the vast majority of children survive.
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Patients with osteosarcoma, however, aren’t as fortunate. Only 60 to 70 percent of patients with this disease survive, even when given similar treatments to patients with ALL. Investigating these differences in outcomes is one of the key focuses of my research. I’m attempting to answer a simple question with regards to osteosarcoma: How does cancer evolve from when you’re first diagnosed to when it comes back?
It’s an evolutionary question. Charles Darwin’s theories, including survival of the fittest, can be useful principles that apply to better understanding and targeting cancer cells. The goal when treating any patient, whether it’s osteosarcoma, ALL, or any type of cancer, is to make that person’s unique cancer cells go extinct.
Can you summarize the key takeaways from your research, and the implications for improving pediatric cancer care?
MK: Most patients with osteosarcoma start off with nearly 99 percent of their tumor cells being sensitive to chemotherapy. However, a small population of cancer cells are resistant to chemotherapy. By the time we remove the tumor after the first strike of intensive treatment, these stubborn cells dominate what remains of the disease. They also make up the majority of cells when cancer recurs. So, you start with a small population of chemo-resistant tumor cells, but they’re the ones that dominate at relapse.
My research revealed a unique feature about those chemo-resistant cells: Some of the genes in these tumors had multiple copies of themselves and were hyperactive, which leads to rapid cell growth and division. When you look at these osteosarcoma cells, they’re often identifiable by this resistant feature.
With these findings, we began to understand the unique characteristics of what drives chemotherapy resistance on a genetic level. There’s still a lot more work to be done in this space, but my Conquer Cancer-funded research helped us to develop a fundamental understanding that we didn’t have with osteosarcoma before.
If there was one thing you could share with a potential donor about the importance of funding cancer research, what would it be?
MK: It just takes one idea to have a huge impact. I don’t think there’s a better investment of your money or your time than supporting oncologists who want to break into the field of cancer research. I deeply appreciate Conquer Cancer’s special interest in funding early-career investigators. Looking at research advances over the past 10 to 20 years, they can all be traced back to people who had promising ideas. Most cancer research needs some kind of funding, and investing in just one research idea is all it takes to have a huge impact.
Learn more about Calum’s story by listening to the Your Stories podcast featuring his mother, Caitlin Murray: “Big Time Adulting: Kids, Cancer, and a Lesson in Laughter.”
Disclosure: At the time of Calum’s treatment, Dr. Michael Kinnaman worked at Memorial Sloan Kettering Cancer Center. Dr. Kinnaman now works at Regeneron Pharmaceuticals.
