by Alicia Di Rado For a cancer patient, making the best treatment choices can be tough; but when the cancer is a rare one, the lack of knowledge and advanced therapies to battle the disease can mean even more frustration.
Syma Iqbal, M.D., battles that void through clinical research and clinical trial development.
Iqbal, assistant professor of medicine, recently joined the medical oncology faculty at the USC/Norris Comprehensive Cancer Center. She specializes in gastrointestinal cancers: an array of malignancies spanning from the esophagus to the rectum.
Besides common cancers such as colon tumors, Iqbal also investigates rare, intractable malignancies within the digestive system.
Last year, Iqbal developed a clinical trial for the Southwest Oncology Group for the treatment of gall bladder cancer and cholangiocarcinoma, or carcinoma of the bile duct. This thin tube carries bile from the liver and gallbladder to the small intestine, where bile breaks down fat in food.
Doctors only diagnose about 3,000 new bile duct cancers and 6,000 to 7,000 new gallbladder cancers in the United States annually. But because Latinos run a higher risk of gallbladder cancer than others, and so many Latinos live in Southern California, Iqbal and the gastrointestinal oncology team see two to four new cases every month-a surprisingly large number.
"There is a need to develop better therapies in this area, given the high incidence in our patient population. This is a good environment to conduct trials and offer innovative therapy," Iqbal says.
The clinical trial, set to officially open early in 2002, will test the use of the chemotherapy drugs gemzitabine (Gemzar) and capecitabine (Xeloda) for both cancers. It also will look at certain genetic markers in patients' tumors to find out which chemotherapy drugs work best in patients with key genetic characteristics.
This is just one of numerous clinical trials to investigate genetic markers, Iqbal's area of interest.
A 1995 graduate of the Keck School of Medicine, Iqbal returned to USC for a fellowship in 2000 and began writing clinical trials with Heinz-Josef Lenz, M.D., associate professor of medicine and USC/Norris gastrointestinal oncology director. Lenz identifies and tests molecular markers that may predict in individual patients whether tumors are vulnerable to chemotherapy drugs.
"Dr. Lenz has been an excellent mentor to me," Iqbal says. "He is motivating and innovative. He is passionate about what he does and the work is on the cutting edge."
By offering clinical trials and treatment strategies based on molecular markers, USC/Norris provides a service unavailable in the community, Iqbal says.
"We are currently using this drug combination in treating patients while waiting for the trial to open, and have seen good responses," she says. "I received a phone call from an extremely ill patient whom we put on the regimen, and now she's doing very well."
Iqbal also plans to pursue clinical trials on predictors of response to intra-arterial chemotherapy for the liver cancer hepatoma-a treatment offered by John Daniels, M.D., associate professor of oncology-as well as for treatment of breast and esophageal cancers.
Since childhood, science has surrounded Iqbal, whose father runs a small biotech firm. "I washed beakers in his lab in junior high," laughs Iqbal. "I've kind of done it all."
Today, she not only conducts clinical research, but also sees patients at USC/Norris and LAC+USC Medical Center two days a week. In addition to Lenz, she credits USC/Norris's Christy Russell, M.D., and Alexandra Levine, M.D., as female role models that galvanized her drive to pursue oncology.
Explains Iqbal: "I've always thought the treatment of cancer was the greatest application of medicine."