Pew-Stewart Scholar Works to Stop Blood Cancer Before It Develops
Dr. Alexander Bick studies how to better detect, treat, and even prevent the disease
With disease screening and new drugs, Dr. Alexander Bick hopes to slow or even halt blood cancer progression. A decade ago, the 2022 Pew-Stewart Scholar for Cancer Research and a team of scientists discovered clonal hematopoiesis, a precancerous condition that forms due to age-related mutations in blood cells that can lead to blood cancer. This discovery is paving the way for researchers to detect blood cancer even before it develops.
Dr. Bick, now director of Vanderbilt University Medical Center’s Division of Genetic Medicine, is leading research into clonal hematopoiesis, investigating what causes blood cancer progression and how drug development can transform patient outcomes.
This interview has been edited for length and clarity.
Your lab studies “pre-blood cancers.” What does this mean?
Long before you get colon cancer, you'll get a colon polyp, or you might have a small breast lump before you get breast cancer. We call this “precancer” because these early abnormalities often progress to become cancer. Some individuals also have these precancers in their blood. As people age, the cells that make up our blood can acquire mutations that cause blood stem cells—the precursors of all blood cells—to grow and expand and, sometimes, develop into cancer.
How common is this condition?
Unlike with other precancers, only a small population of people with blood precancer actually go on to develop the disease. To put it in perspective, about 10% of people over the age of 60 have one of these blood precancers, but less than one in 10,000 people—or just under 0.01%—will develop blood cancer.
Do we regularly screen people for blood precancer?
Not yet, but that's one near-term implication of this research. Our lab is trying to develop tools that help us determine who, when, and how to screen people. For example, should everyone get screened every year? Should we screen people once they turn 65?
In addition to screening, what else is your lab exploring?
Our team is trying to understand why only some people develop blood precancer, and then why a small fraction of these cases transforms into blood cancer. We’re asking all these questions with the ultimate goal of attempting to prevent cancer before it happens.
Are there any existing treatments for blood precancer?
Unfortunately, no. Right now, we know that certain mutations are worse than others and that some people with this condition are at a higher risk of having it progress to blood cancer. But when it comes to recommending different lifestyle choices or offering treatment, we don't have a lot to tell patients with this precancer.
How could your research inform new drugs?
One of our goals is to create treatments that could prevent or slow the development of precancer into blood cancer. That’s really what we're at the cutting edge of trying to discover: Are there existing drugs that we can repurpose or new drugs we can develop to stop cancer progression before it starts?
So the idea is that we could prevent blood cancer before it happens?
Exactly. When we treat patients who have high cholesterol with a cholesterol-lowering drug like a statin, our goal, essentially, is to prevent heart disease before you have a heart attack. With cancer, we spend a lot of time treating patients after they have a diagnosis. What’s so exciting about our work is that we could find pathways and, ultimately, treatments for high-risk patients before they develop blood cancer.
Any recent work you want to highlight?
One exciting study that we've done in the past year, with support from the Pew-Stewart Scholars Program, has been to look at people who have multiple blood samples over time to explore how different medications affect clonal hematopoiesis progression. These people take drugs for other conditions, such as diabetes, heart disease, or gout. We've started to see promising patterns showing that certain very common medicines seem to slow the growth of these clones.
You’re a physician-scientist—you treat patients and you conduct research. How does this inform your work?
It’s an incredible privilege to take care of patients who have these kinds of mutations in the clinic. Our research group can take blood samples from patients I treat back to the lab for research. And then it also works the other way: We might have an observation in the lab that I can take back to my patients to inform their care. Being able to quickly move some of that knowledge—things that we're actually finding in the lab—back to help patients is incredibly gratifying.
Sounds like you’re passionate about all these efforts.
Absolutely. And I want to emphasize how important this research is for the many, many people who have this condition. The science that we're doing in these labs is very close to reaching patients’ lives and preventing people from having a terrible disease. Right now, having blood cancer is incredibly challenging. Supporting this kind of scientific research transforms how we're able to make a difference in patient lives.
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