John A. Burns School of Medicine (JABSOM) Alumnus Stephen Chun (Class of 2010) is co-author of an intriguing new research paper. Published in Cancer Biology and Therapy, the paper describes research which reports that Aspirin Improves Outcome in High Risk Prostate Cancer Patients Treated with Radiation Therapy.
In addition to JABSOM, Dr. Chun also earned degrees from Punahou School and Georgetown University. He completed the Doris Duke Clinical Research Fellowship at the University of Iowa, and currently is a Resident in Radiation Oncology at the University of Texas at Southwestern Medical Center. He answered a few questions about his work for his JABSOM Alma Mater.
JABSOM: Stephen, You were the recipient of the 2010 JABSOM Po`okela No`i Award in Research and the 2009 National American College of Physicians Research Competition Winner, so we expected great things from you! We hear you are first co-author of a new paper that breaks new ground in the possible theraputic use of aspirin in prostate cancer. Can you describe the research?
In a retrospective analysis of all patients treated at UT Southwestern for high-risk prostate cancer, we have found that aspirin use is significantly associated with reduced metastatic disease, improved PSA control, and prolonged overall survival. This is the first study showing an overall survival benefit associated with aspirin in prostate cancer patients who have the highest-risk disease such as Gleason 9-10 tumors.
JABSOM: Why is this important?
Prostate cancer is the most common male malignancy in the United States and 20-30% of prostate cancer cases have high-risk features where there is a 30% chance of dying of cancer in spite of best medical treatment. Identification of novel approaches to improve biochemical control and development of metastatic disease is critical to improve cancer-specific and overall survival in high-risk prostate cancer.
Our study showing aspirin to be associated with improved overall survival in high-risk prostate cancer is important because lives could be saved. An aspirin costs pennies at Costco, and could represent a cost-effective way to improve outcomes in high-risk prostate cancer. However, before recommending routine aspirin use for prostate cancer, a prospective randomized clinical trial is needed to confirm our findings. Patients should talk to their doctor being starting any aspirin regimen, and keep in mind that there remains insufficient evidence presently to advocate routine aspirin use for prostate cancer patients.
JABSOM: What’s the next step in the process?
The next step is to determine through prospective investigator-initiated clinical trial whether routine aspirin use is warranted for high-risk prostate cancer with overall survival being the primary endpoint or goal. This will potentially confirm or refute the findings of our study.
JABSOM: What at JABSOM (and who) inspired you to pursue research?
I was very lucky to have multiple mentors who encouraged me to pursue research at JABSOM. Dr. Edwin Cadman who was my PBL tutor was my most important mentor who steered me towards biomedical research and oncology. Dr. Cadman pushed me to do the Doris Duke Clinical Research Fellowship at the University of Iowa in 2007, and introduced me to Dr. Peter Bryant-Greenwood and Dr. Ralph Shohet, who have mentored me substantially. I still keep in touch regularly with Dr. Cadman and visited him recently with Dr. William Haning. I would encourage anyone in the Oregon area to visit him, as he enjoys visitors.
Dr. Chun, you’ve been studying while working as a physician since you earned your MD at JABSOM four full years since JABSOM. What’s the toughest part of your average day?
The toughest part of oncology is telling a patient that we have exhausted our ability to help them with radiation therapy. Anyone can shoot radiation at a tumor, but deciding when toxicity exceeds benefit is one of the most difficult and important decisions in Radiation Oncology. This does not at all mean giving up on a patient. Rather, it means we must find other ways to help them in their fight against cancer.
What’s the most inspiring part of your average day?
What thrills me most is seeing long-term survivors of advanced metastatic cancer. Seeing 20-year survivors of metastatic cancer is becoming increasingly common with advances in surgery, chemotherapy, and radiation therapy. These patients should be an inspiration to all the patients and physicians.
We just finished our Biomedical Research Symposium. Whatʻs your advice to budding researchers here at the University of Hawai`i?
Persistence and hard work. Nine of 10 ideas I have never see publication (probably because I’m just not very smart or efficient). The things that I have published represent a tiny minority of what I have worked on or thought of. However, there is so much we don’t know in medicine, that with hard work, you’re bound to stumble across something eventually, and that’s the fun of it.
For the M.D. students, I would also emphasize that patient care is the number one priority– which JABSOM has always emphasized very well. I try to learn everything that I can about every patient to provide them the best care possible, and develop ideas that may help other patients. Research and science is about improving the art of medicine and patient care. I cannot emphasize enough that patients are always our foremost responsibility and priority.