Dr. Scott Okuno is an Oncologist at the Mayo Clinic in Rochester, Minnesota, where he treats patients who have sarcoma. He works with a team of people who have different specialties, “a good group of people,” who are “learning all the time” and who put their knowledge together to decide how best to treat patients.

He is a Professor of Oncology, and in his academic research, he collaborates with physicians across the Midwest to design studies that will help doctors find better treatments for their patients. Dr. Okuno also serves in the Rein in Sarcoma Advisory Board, and in the Board of Directors.

Setting the Course

Dr. Scott Okuno grew up in Prospect Heights, Illinois. He went to St. Olaf College, and tells us: “there I met a gal who was from a small town in Minnesota, Kasson. We fell in love. We got married.” So, after completing medical school in Illinois, Dr. Okuno and his wife moved back to Southeast Minnesota to be near her home town. Dr. Okuno completed his Residency at Mayo, and also his Fellowship in Hematology and Oncology. He joined the Mayo Clinic staff in 1996 and has worked there ever since.

Scott Okuno, MDDr. Okuno knew “somewhere along the way” that he wanted to be a doctor. Being “engaged with people” interested him. In a sense he continued the family profession, as his dad was a pathologist and his mother a nurse.

When Dr. Okuno began working at the Mayo Clinic, he joined practice with a senior physician who was an expert in sarcomas. There was a need for a new doctor to train with this physician for several years, then carry on in his place. Dr. Okuno took on this role. As he began treating sarcoma patients, he started liking this work more and more.

At Mayo, an oncologist like Dr. Okuno does not treat patients alone. There is a team of people, a good group of people, who get to know each other and work together. The doctors have different specialties, and they put their knowledge together to decide on the best treatment for their patients. It’s a “happy environment,” which makes him want to stay. Every week, every day, he learns more. He says, “we’re learning all the time.”

A Goal for Sarcoma Treatment

For sarcoma, what doctors would really like to learn is better treatment options. It is hard to conduct clinical studies in sarcoma, because there are so few people who get the disease and there are so many variations within the disease. Sarcoma is not just one cancer, and the different types respond to medicines differently. But the Mayo doctors, along with other major academic centers in the Midwest – including Rein in Sarcoma partner University of Minnesota – are collaborating to design studies that will provide useful new information more quickly. By pooling their resources and sharing patient information, they can get answers more effectively.

Joining with the Rein in Sarcoma Foundation

Dr. Okuno was introduced to Rein in Sarcoma’s work when he got a call from Dr. Keith Skubitz, asking him to review proposals for the research grants being awarded by RIS. He was interested to read about all these projects. At about the same time, he received a request to meet with RIS President Pete Wyckoff, to discuss a more active role for him and his colleagues. One wintry day Pete did drive down, with sarcoma survivor Kevin O’Keefe, and the three men talked

Dr. Okuno also was encouraged by two patients who had been touched by RIS. He realized that doctors alone “can’t do it all.” Doctors are able to see their patients for a half hour or an hour, and in that short touch point must discuss a potentially life-threatening illness or body-altering experience. Patients then must go home to live and function within their families and communities. There is a need for an organization to connect these patients and their families with good information and with others who have faced the same things.

He found RIS to be passionate, organized, and focused on an important message. He has consulted with the Red Flags team to provide accurate medical information. In July 2014, he attended his first-ever Party in the Park. “What a beautiful event,” he says. The weather was awesome, the crowd was great, and the memorials and luminary readings provided touching moments.

A Hope for the Future

Working with his Mayo team, and in collaboration with others, Dr. Okuno would like to continue conducting the research studies that may improve outcomes for sarcoma patients. And here is a goal we all can embrace.

University of Minnesota Associate Professor and orthopedic surgeon Christian Ogilvie chose medicine so he could practice science, while working directly with people. He likes teaching people, educating patients. And he likes to fix things. He appreciates the chance to make a big difference in someone’s life, in a moment. To restore them, perhaps, to what they could do before.

Dr. Ogilvie has been a great asset for RIS. He has embraced our education mission: teaching residents about sarcomas, speaking to medical students through the RIS Maudlin Sarcoma Scholars Program. Dr. Ogilvie has also served in the RIS Board of Directors.

Family Beginnings

Christian Ogilvie’s father was a doctor. A spine surgeon, who spent years at the University of Minnesota and operated on many people with scoliosis. Even as a high school student, Dr. Ogilvie was drawn to the chance for sudden change. To take a crooked spine and make it straight, all in one setting.

In college, Dr. Ogilvie had the opportunity to do service work. He found it “really rewarding to work directly with people,” and he wanted to include this type of feeling with his professional work. He liked science, and decided medicine would be a great career. He returned to Minnesota to attend medical school here, at the University.

Before and during medical school, Dr. Ogilvie worked in Dr. Clohisy’s lab. Through this work he became interested in tumors. Although he considered pediatric medical oncology for a time, ultimately Dr. Ogilvie wanted to “intervene directly.” He liked performing surgical procedures, and he wanted to take the cancer out. So he took his residency in Orthopaedic Surgery, then a fellowship in Musculoskeletal Tumor Surgery at the University of Toronto.

Geography

Upon completion, Dr. Ogilvie moved to the University of Pennsylvania, where he was an Assistant Professor and a surgeon. He developed a busy practice, focused on tumors. In one single year, he saw 400 individual cancer patients.

When Dr. Clohisy was becoming Chair of the Orthopaedic Surgery Department at the University, he called to recruit Dr. Ogilvie back to Minnesota. In 2009, Dr. Ogilvie returned. He had met his wife here, and the two of them felt this was a good place to raise children.

At Minnesota, Dr. Ogilvie’s practice still involves tumors. He focuses on sarcoma, but does other things as well, including major trauma. He drew many connections between the two. Like sarcomas, fractures can occur anywhere in the body. Both trauma surgery and sarcoma surgery may involve bones and joints. And, you will not be surprised to hear that trauma surgery calls to Dr. Ogilvie because it offers the chance to take a crooked, broken bone and straighten it out, all in one setting; to place a plate on it; to help it heal.

You may be surprised to learn that unlike many other tissues in the body, bone really can heal. Cleanly, completely, and without a lot of scar tissue getting in the way of good function. If the conditions are right, if you give it enough time, bone will replace itself and be almost like new. Often, people can go back to doing just about everything they were doing before, because their bone will go back to doing what it was doing before.

Education

Medical students and residents may not get much education about sarcomas, even today. Through his practice, Dr. Ogilvie has seen the patients who don’t get diagnosed. Sometimes, an incomplete surgery by a non-cancer specialist will require a second revision surgery, bigger than it would have needed to be.

Dr. Ogilvie talks to people about sarcomas. He has presented at Grand Rounds for medical students twice, through the Wyckoff Sarcoma Scholar program, and expects to do this again. He speaks to orthopedic residents about sarcomas, since people will show up in their offices with lumps and bumps and pains. Most will be benign and harmless, but some will be cancer. He wants people to consider the cancer, before they cut.

What is hard?

The hardest thing about Dr. Ogilvie’s job “is probably telling someone their kid has cancer. That’s difficult.” The parents are kind of helpless, and they have so many questions. Most times, they worry a lot. The second hardest thing? Telling someone they have metastatic disease. The third? Telling someone they have cancer.

It is rewarding, though, when you have the ability to tell people you can take out the cancer and they’ll be fine. When you can “educate them a little bit, make some plans” and attack the tumor. Or when a person has pain from cancer in their bone, and has trouble walking, and surgery can help them feel better. When you can “help out with the quality of life.”

There are lots of opportunities for constructive outcomes. Sometimes, these come in surprising forms. Allowing someone to go home, for even a few days, may be a victory.

We are thankful that Dr. Ogilvie has decided to embrace these challenges, here.

By Christin Garcia

It can be really hard to love sarcoma cells when you’re a cancer patient. Yet your future may depend on scientists finding them fascinating. Meet University of Minnesota Professor and tumor biologist Amy Skubitz, who finds cancer cells to be the most interesting in the human body. We can embrace this interest, as she has focused her talents on discovering better ways for doctors to find, predict and stop cancer cells. Often working in collaboration with others at the University, including her husband oncologist Keith Skubitz, Dr. Amy Skubitz has received more than one RIS grant award. What is it about cancer cells? What does a tumor biologist really do? And how can your tumor cells be used to improve cancer treatments?

Amy Skubitz’ parents were scientists. When it came time for her to choose a college major, she combined their backgrounds in biology and chemistry, taking a major in biochemistry. What she really loved was working in the lab, with hands-on and off-beat procedures, some so delicate that a single human fingerprint could change the results. She loved the quantitative data analysis, too, that followed this work. So she pursued a PhD in Pharmacology and Experimental Therapeutics from the Johns Hopkins University and completed postdoctoral work in Laboratory Medicine and Pathology at the University of Minnesota. Now a Professor in that department, Dr. Skubitz spends her days preparing grant funding applications, conducting scientific research, writing scientific papers, and mentoring graduate and undergraduate students who work in the labs.

Amy Skubitz seeks excitement in her work. She was drawn to the idea of “discovering something that nobody else knew.” The field continues to change dramatically, as new technology allows new opportunities and much quicker results. Information that used to take weeks to get can now be delivered overnight. The same aspects that make tumor cells dangerous in the body make them fascinating in the lab. Normal cells “don’t do much.” Put them in a lab environment, and they will multiply a couple of times and then just sit there. Cancer cells “grow, multiply, spread out, and move.” They reach out and try to grab things. Through special time-lapse photography, scientists can watch dramatic shifts that happen overnight.

The trick for helping patients is to identify better ways for doctors to identify cancer, predict how it will behave in the body, and stop it from growing. During her career, Dr. Skubitz has pursued many different paths to these results. In the beginning, she wanted to do cancer research. Of all diseases, this is the one that seemed like such a big problem. “So many people have had cancer, or know someone who has had it,” she said. But her first work in graduate school was with parasites, after she became involved with a Johns Hopkins lab that was trying to find targets for vaccines that could prevent worm infections that plague people in foreign countries. When she came to the University of Minnesota in 1984, Dr. Skubitz was able to find work using similar technologies to evaluate potential new treatments for cancer. She has been working with cancer cells ever since.

Amy Skubitz came to RIS through her leadership of the Cancer Center Tissue Procurement Facility, which began in about 1995. Before then, after pathologists had finished testing the tumors that were removed from patients through biopsy or surgery, the extra tissue was thrown away. At the same time, researchers were having a hard time finding enough tissue samples to do their work. Dr. Skubitz led the Facility effort, which asked patients to agree that their leftover tumor tissue could be used by scientists, then to have that tissue cataloged and stored for research use. Eventually, University researchers had access to information about all the different genes that were contained in over fifteen hundred tumors. This allowed them to look for profiles or signatures that might be important to cancer growth or movement in the body. If important genes could be identified, this could lead to tests that would help doctors identify tumors or predict their behavior. It also could lead to treatments that block tumor growth or spread in the body. Amy was interested in the opportunities for ovarian cancer, which had been a focus of her work for many years.

Her husband, oncologist Keith Skubitz, was interested in the possibilities for sarcoma. One person’s sarcoma tumor can have many different-looking areas, so it can be hard for a pathologist to tell if a tumor really is sarcoma, and which kind it is, based only on the small tissue samples taken before surgery. Getting the diagnosis right is really important, however, so patients without sarcoma are not exposed to toxic treatments but patients with sarcoma get the best available treatments for their cancer type. Many sarcoma tumors are really aggressive, but some are not. Again, the best treatment could depend on knowing which is which. And, as you may understand all too well, there is a serious need for better sarcoma treatments to be developed.

Ultimately, Drs. Amy and Keith Skubitz ended up working together. They stayed up late many nights “in a locked room” at home, after their kids went to bed, reading lists of genes to each other and deciding which may be important. With their first RIS grant, they took this work one step further, testing to see if the genes they had thought were important for an aggressive form of fibromatosis actually appeared to play a role in tumor growth in the body. With fine assistance from pathologist Dr. Carlos Manivel, they were able to confirm that the genes they had identified did seem important. This work continues, and they hope to apply a new technology that will allow much smaller tumor samples to be evaluated, in a much quicker and cost-effective way.

In 2010, the RIS grant was for work related to the prevailing scientific theory that a small and constant percentage of “cancer stem cells” within a tumor are the ones that actually make cancers dangerous to people, because they drive the spread of tumors throughout the body and are not killed by commonly used chemotherapies. This work also was designed to test chemotherapies against these cancer stem cells, to see if any of the drugs had an effect on the cells. This work also continues.

It was difficult to end my conversation with Amy Skubitz. She speaks quickly and with great enthusiasm, conveying incredible depth and complexity in an accessible way. I expect she could talk about science for hours, nonstop. In many ways, she has been talking about science for a lifetime. To learn more, you may find her biography and select publications, including many publications related to her work with sarcoma, through the Laboratory Medicine and Pathology website.

By Christin Garcia

University of Minnesota Professor and medical oncologist Keith Skubitz has been treating people with sarcoma cancer for over 20 years. Maybe, he is your doctor. What he really seems passionate about is finding ways for science to help doctors deliver better treatments to their patients. This can mean anything from more effective drugs to portable pumps, which allow patients to take their chemo home.

Dr. Skubitz received his medical degree from the Johns Hopkins University, then completed his Internal Medicine training at the University of Minnesota. He took a fellowship in Clinical Pharmacology at Johns Hopkins and returned to Minnesota for his fellowship in Medical Oncology. Here he has stayed. Since 1988, Dr. Skubitz has led the University of Minnesota’s medical oncology treatment efforts for adult sarcoma patients.

Better Patient Care

One of the first things he did was to study the possibility that chemotherapy could be delivered differently. Drugs like ifosfamide had been given to patients in one or two big infusions, over several hours in the clinic. Dr. Skubitz thought it made more sense to deliver the drug slowly, over many days, by a continuous drip. He said “you knew from high school chemistry” that this might make the drug more effective. For one thing, the long steady drip could increase the chances the drug would be there in the body, active and available to hit new cancer cells as they were turned out by the tumor, day after day. This also could lessen side effects, because people would not need to absorb so much of the drug at once.

In about 1980, new technology made this option possible. Portable pumps could deliver a slow continuous drip to patients, even while they moved around freely or stayed at home, carrying their pumps in little packs. With a colleague, Dr. Skubitz studied this method and found that it worked. They published their findings, and many other doctors have followed the same approach.

Finding Better Medicines

Dr. Skubitz says his work is “certainly very interesting,” and sometimes he and his colleagues have “very satisfying results.” It is hard, however, that the treatments don’t always work. For many patients, “eventually, they stop working.” This is a “high stress” time.

One way to improve the situation is to find better medicines. Of course, this could mean making something totally new. But it also could mean making a new match, between an existing drug and an aggressive disease. University researchers have been part of just such a solution for giant cell tumors of the bone. These tumors usually do not kill people, but they can grow aggressively and there have not been good treatment options. Doctors use surgery and radiation when possible, but good results can be hard to get and even then, the tumors often grow back. It appeared to Dr. Skubitz and his colleagues that an antibody developed for osteoporosis might target these bone tumors. A small initial study showed that the drug did help. The University now participates in a world-wide follow-up study to consider the best dose and length of time to use the drug, which is seen as a very promising treatment.

Along the way, doctors also learned more about how tumor cells “talk” to normal cells. In this disease, tumor cells make a protein that recruits normal cells to come nearby and make something – call it factor x – that the tumor itself needs to thrive and grow. The drug works by blocking this protein, interfering with the tumor’s call for normal cells. With fewer normal cells stopping by to donate factor x, the tumor can’t grow so well anymore. Sometimes, it even dies.

Using New Science

Cutting-edge science clearly motivates Dr. Skubitz. On the list of scientific articles he’s written, there are many about genes. Dr. Skubitz tries to understand what tumors are telling us through the unique collection of genetic mutations and expressions they contain. When asked if the study of genetics will turn out to be an important thing for patients, Dr. Skubitz did not hesitate. “Absolutely,” it will.

Of course, genetic work could help doctors develop more effective treatments, targeted directly at the mistakes or pathways that allow the cancer to grow and spread. Even without a cure, genetic work could help doctors predict how dangerous a cancer will be. “Absolutely, definitely” it matters to know which cancers are most likely to be dangerous. This will affect the choices doctors make about treatment. Patients with less dangerous tumors could be spared the more intensive treatments; patients facing tougher battles could receive the most aggressive options.

Just this month, Dr. Skubitz was at a national cancer conference presenting results from a study that uses genes to help doctors separate the more aggressive cancers from the less dangerous ones. This work grew from one of RIS’ first seed grants. Years ago, University researchers including Keith Skubitz and his wife Dr. Amy Skubitz received a grant to identify the genetic signatures that might help doctors predict what cancers would do. The University’s tissue bank and the RIS grant allowed them to begin. Eventually, they found gene sets that appeared to break sarcoma cancers, ovarian cancers and kidney cancers into two main groups. They did not have enough information about what happened to the patients, though, to allow them to test the idea that the two tumor groups acted differently in people. Recently, the Skubitzes collaborated with researchers in Sweden and Denmark, who did have access to good follow-up information about patients. This work confirmed the sense that different gene sets appear in tumors that are more aggressive than in those less likely to be dangerous.

Another RIS-funded project that Dr. Skubitz works with is the clinical trial designed to test whether PET scans can show us which tumors are responding to chemotherapy. This is “quite neat,” because it may suggest better measures to test drug response. Using traditional methods, it could look like “you killed it off really well,” but then sometimes the tumor comes back. Doctors believe this may be due to the survival of a select group of deadly cells, sometimes called “cancer stem cells,” which may be great at hiding from toxic drugs or blocking their effects. If doctors could tell early on which tumors are being affected by a drug, they could spare patients who are not responding by stopping the drug and could switch them sooner to a potentially more effective option.

Always Surprising

When I asked Dr. Skubitz if there was anything else he thought we should know, he said this sounded an awful lot like the “classic internal medicine question.” Do your visits end with this invitation? Apparently, from the other side of the table, it is “striking” what patients will mention in closing. The doctor may have covered four or five major problems, and “you may think you know why they’re there,” but what’s really of concern to the patient may be something that’s “not even on your radar screen.” It’s surprising what you hear.

Hopefully, most of us can be thankful that our physicians do ask us for our concerns, and will listen for the surprise.

By Christin Garcia