When Amit Tirosh, MD came to the United States in 2015 to be a senior endocrinologist at the National Institutes of Health (NIH), he began a journey that will lead full circle when he returns to Israel this summer to establish and lead a new neuroendocrine tumor center at Sheba Medical Center at Tel HaShomer, Israel’s largest hospital, in the Tel Aviv District. As an NIH Post-doctoral Fellow he has focused his research on different aspects of neuroendocrine tumors (NETs) and syndromes associated with NETs, including von Hippel-Lindau (VHL) and multiple endocrine neoplasia (MEN) type 1.
Most recently, Dr. Tirosh’s work was recognized for excellence by the Endocrine Society. Dr. Tirosh was awarded a travel grant to attend ENDO, the Society’s Annual Meeting and Expo. Travel grants are given to “outstanding abstracts submitted by graduate or medical students, in-training post-doctoral or clinical fellows, or new faculty who have been accepted to present their research” during the Endocrine Society’s annual meeting, held in March, 2018 in Chicago, Illinois. The poster, for which Dr. Tirosh is first author and was the presenting author, “Oncogene Panel Sequencing Analysis May Discover New Targetable Genetic Mutations in Patients with Advanced Neuroendocrine Tumors,” was chosen as a winner of the Presidential Poster Competition.
The research on which the poster was based was a prospective study of mutation-targeted therapy in patients with advanced gastroenteropancreatic (GEP-NET) neuroendocrine tumors. Prospective studies watch for outcomes during the study period and relate this to other factors such as suspected risk or protection factor(s). Dr. Tirosh and his colleagues at the NIH analyzed data from the study of NET patients who were on one of two second-line medical treatments following no reaction to somatostatin analogs (octreotide or lanreotide). The second-line treatments were everolimus, an mTOR inhibitor, and sunitinib, a tyrosine kinase inhibitor. Both of these drugs have shown tumor response in NET patients.
Dr. Tirosh at ENDO 2018, the annual meeting and expo of the Endocrinology Society, with the poster for which he was a winner of the Presidential Poster Competition.
Dr. Tirosh and colleagues were researching whether or not there are actionable mutations, a DNA change that, if detected in a patient’s tumor may be used to select a specific treatment. Actionable mutation based approach, is widely used in oncology, and would possibly affect a patient’s response to treatment. While they determined that “selective mutation analysis for directing treatment in patients with advanced GEP-NET identified very few actionable mutations” they did identify a number of mutations in genes that were not necessarily identified with NETs previously that can help characterize NET tumors in a way that best matches medication for those patients. This will require additional research but was a very positive outcome of the study.
Dr. Tirosh has also been actively involved in the NIH study of Gallium-68 DOTATATE PET/CT scanning of NET patients. In March 2018, the journal Gastroenterology published “Prognostic Utility of Total 68Ga-DOTATE-Avid Tumor Volume in Patients with Neuroendocrine Tumors,” a paper by Dr. Tirosh and colleagues at the NIH, examining how Gallium-68 DOTATATE PET/CT could predict progression-free survival (PFS) and disease-specific mortality in NET patients. They concluded that this scan, approved by the FDA in June 2016, was very useful as a prognostic tool for patients with neuroendocrine tumors, by accurately measuring the total tumor volumes.
Where will Dr. Tirosh focus his research in the coming years? Bioinformatics, an interdisciplinary field of science, that combines computer science and biology to analyze and interpret biological data, is of particular interest. He also believes that medicine is going in the direction of precision medicine, matching specific treatments to patients. Dr. Tirosh explains that “comprehensive genetic characterization of the tumor may help match the best management plan for patients” and emphasizes that “it is important to determine which interventions and at which timing, will give the best outcomes.”
Most importantly, Dr. Tirosh stresses that while he loves research, “I am a clinician more than anything else and am focused on giving the best care possible to NET patients.”
Thanks for all you do for NET patients, Dr. Tirosh, and wishing you the best in your new NET clinic in Israel!
