Pushing the Envelope in Search of a Cure

In a box, ready to be unpacked in his new office, are all the things patients have given Robert L. Coleman, MD, over the years. They include a jug of beer from a brewery in Arkansas, a golden ship from Kuwait, bottles from Serbia, art and books, and even a signed picture of Weird Al Yankovic.

These items from patients are expressions of themselves, said Coleman, who joined The US Oncology Network earlier this year as chief scientific officer. Previously, he was the Ann Rife Cox Chair in Gynecology at The University of Texas MD Anderson Cancer Center and executive director for the MD Anderson Cancer Network Research Program.

“I had one patient who came from Wyoming and was scared to fly,” he said. “She and her husband would drive, sometimes on motorcycles, from Laramie, Wyoming, to Houston, Texas. She told me I should be driving a Corvette, so she gave me a scale model of a 1987 Gold Corvette.”

The model and the many other items are memories of the journeys Coleman has shared with his patients and their families. Clinicians often get focused on the mechanics of cancer and the strategy for treatment, which can often be impersonal.

“This is about the human part, and that human connection is what makes it all worthwhile,” he said.

Coleman’s focus is very much on his patients. He believes it is an honor to be with them through their journey. “It’s a privilege to experience joy and sorrow with patients. There are ups and downs, and I have been able to, hopefully, bring some joy and hope to that process.”

Coleman has had close and emotional relationships with patients throughout the years. While many patients with cervix and endometrial cancer, his specialty, are cured, those who have died have made an impact on him.

“I can remember vividly many times coming into a room with patients and their families with hopeful expectations and telling them not only did their treatment not work, but there is nothing else. Those moments are so hard,” he said. “But it is an unbelievable opportunity to gain perspective, and you become a better person.”

Patients, Coleman said, have much to teach clinicians. When physicians are making choices based on published data, they are translating population-based data to an individual, but there is a lot of fallacy in that, he said. Patient-level data can be much different from the population-based experience.

“What we don’t know is whether the patient sitting in front of us is going to be that person who responds to therapy,” he said. “I tell patients when we look at the data together that this is the best available therapy for you today.”

When there are opportunities in clinical research, it is the clinician’s role to help patients understand why trials are being offered, he said, adding that he believes it is the responsibility of all clinicians, whether in clinical care or research, to not be satisfied with the current standard of care.

Increasing Access to Clinical Trials

That is why Coleman, a highly regarded ovarian cancer investigator, decided to join US Oncology Research in The Woodlands, Texas, in the middle of the coronavirus disease 2019 (COVID-19) pandemic. “I had always wanted to broaden the engagement in clinical research. There is a large proportion of patients who never really get access to clinical trials,” he said.

Coleman started at US Oncology Research, part of The US Oncology Network, on March 31 and is currently working remotely. He leads one of the largest community-based research site management organizations in the country, managing more than 400 active clinical trials at any given time. His role includes developing and expanding the infrastructure to make participation in clinical trials more accessible to all physicians and patients in the research network.

At the same time, Coleman, who has been a gynecologic oncologist since 1993, is in the process of setting up a private practice with a former trainee.

As a people person, Coleman has found it challenging to start a new position remotely. He misses face-to-face interaction.

“I like to get to know my team in a personal way, and doing that all remotely is strange,” he said. “You can do Zoom videos, but not everyone has their video on and you can’t read body language. We do the best we can.”

Coleman has also been working to get to know the more than 1350 physicians in The US Oncology Research network, which includes approximately 70 unique practices and more than 480 sites of care.

Over the past 20 years, US Oncology Research has enrolled more than 82,000 patients in more than 1600 trials, playing a role in more than 100 FDA-approved cancer therapies. Coleman joked that he has 4 big priorities for his role at US Oncology and that all 4 involve clinical trial accrual. His aim is to work with clinicians who want to do research, helping them implement processes and enroll patients.

“My goals are to look at the speed bumps for activation, enrollment, and conduct of these clinical trials and keep them as low as possible, as well as increase the efficiency of these trials,” he said. “I also want to engage our pharma sponsors and our investigators who want to do investigator-initiated work in a way that we can expeditiously deliver high-quality data to answer clinically important questions.

Coleman said his move to US Oncology Research expands on the work he had done at MD Anderson Cancer Center, where he spent the past 3 years developing a network of research sites. He was part of an outreach effort to build cancer networks associated with the university that could bring quality research and clinical trials to their communities. “It’s been extremely gratifying and super exciting to help build programs from scratch in some cases and augment them in others.”

As he continues to get settled at US Oncology Research, he’s taking advantage of temporarily working from home by cooking more often and spending a little more time with his family, which includes his wife, 6 children, and 4 grandchildren. “I also love playing guitar,” he said. “My guitar-playing days now are primarily at church on Sunday. I try to work out 5 to 7 days a week, and that is really important for my mental health.”

Research Is How We Cure Cancer

Coleman believes research is a critical component of cancer care, saying clinicians must continue pushing for safer, more effective treatments. “You have to have faith in the standard of care, but until we’ve cured everybody, you can’t be comfortable with the standard of care. I’m trying to find out ways that we can increase the potential [for] cure for patients.”

In fact, clinical research raises the global health benefit for patients with cancer. Patients who participate in clinical trials and patients who are treated in centers that have clinical trials tend to do better overall, he said.

Coleman’s passion for gynecologic oncology and research is just as evident as his devotion to patients. While still in medical school at Creighton University School of Medicine in Omaha, Nebraska, and during his residency at Northwestern University Medical Center in Chicago, Illinois, Coleman found the rotations through medical oncology and OB/GYN to be amazing experiences. “I loved all of the subspecialties, but I really hit the sweet spot when I got to mix oncology and gynecology in 1 specialty.”

Gynecologic oncology, he said, is unique because it is multidisciplinary and incorporates surgery as well as medical therapy. “I’ve been very fortunate in my research career, having been the lead investigator on several trials that have brought new drugs for patients that are actively in use today,” Coleman added. “That is particularly gratifying because those particular trials have made a difference to countless numbers of patients.”

He is best known for his work on novel therapies, such as the incorporation of PARP inhibitors and surgical approaches into the paradigm for ovarian cancer. Coleman is credited with more than 500 publications, and he has contributed to many book chapters and edited and written 6 books.

He was the principal investigator for the phase 3 ARIEL3 trial, evaluating maintenance therapy with rucaparib (Rubraca) in patients with platinum-sensitive recurrent ovarian cancer. Based on data from this trial, the FDA approved rucaparib in April 2018 for the maintenance treatment of adult patients with recurrent epithelial ovarian, fallopian tube, or primary peritoneal cancer who are in a complete or partial response to platinum-based chemotherapy.

Coleman also led the VELIA trial, the results of which showed that carboplatin plus paclitaxel and veliparib (ABT-888) followed by veliparib maintenance therapy led to significantly longer progression-free survival for newly diagnosed patients with high-grade ovarian cancer.

His research, however, extends beyond drug development. Coleman has been involved in studies of lymphatic mapping for gynecologic malignancies and more recently studied the role of surgery in patients with ovarian cancer who have recurrent disease, concluding that surgery did not provide a benefit.

Pushing the Envelope

Coleman pointed out that research doesn’t happen in a vacuum. It requires not only passion but also people working in collaboration who are willing to push the envelope. He cited a colleague from MD Anderson Cancer Center, Anil K. Sood, MD, vice chair for translational research in the Departments of Gynecologic Oncology and Cancer Biology, as one such collaborator.

Once a year, Sood asks his students to present an out-of-the-box research project. One of the fellows wanted to look at dogs that can smell cancer and whether there were hydrocarbons in the breath of patients that are representative of the cancer population. “We were able to identify the specific chemicals, and we developed a prototype machine that would do spectral analysis of what people were breathing. That was one of those really cool things. This was a kid [who asked] a question and a mentor who gave him the opportunity. It turned out to be a viable hypothesis and is still being evaluated,” Coleman said.

Coleman also had the opportunity, both as a medical student at Creighton University and later as a faculty member, to work with the late Henry T. Lynch, MD, who changed the way the world looked at cancer. Lynch was the founder and director of the Hereditary Cancer Center at Creighton University, and he helped launch the modern era of precision medicine in oncology by identifying the strain of hereditary nonpolyposis colon cancer now known as Lynch syndrome.

Patients with Lynch syndrome have genetic predisposition to certain cancers, including stomach, small intestine, liver, gallbladder, brain, and skin. Lynch discovered the hereditary basis for cancer and his research on hereditary breast and ovarian cancers eventually helped lead to the identification of BRCA mutations, which can serve as a therapeutic target. In 2019, Lynch was honored with a Giants of Cancer Care® award for his work.“

Lynch was instrumental in not only helping me learn his craft, but also learning how to be a mentor,” Coleman said. “He was a visionary, and he was OK with taking the risk in a new area of research.”

Research, Coleman said, is about persistently asking how to make things better in the areas of systemic care, screening, early prevention, diagnostics, and therapeutics. “I ask, ‘How can I understand more about the biology, and how can I move the needle?’ I hope that is something that stays with people—asking the question gets people to think about new ways to approach a problem.”