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Medical oncologist Heather Parsons, MD, MPH, witnessed how cancer affects the entire family when her younger sister was diagnosed with lymphoma as a young adult. It’s an experience that helped her understand what cancer patients and their loved ones go through during their treatments. Depending on the progression of the illness and how the patient responds to treatment, they often work with the same oncology team for months or even years. Years later, her sister now thriving, Parsons remembers her sister’s diagnosis and treatment as a challenging time for her family.
Parsons’ desire to help improve that experience for patients and their families led her to specialize in oncology, specifically breast cancer treatment and research. She joined Fred Hutch Cancer Center last month as program head of the Breast Oncology Program. She is also an associate professor in the Fred Hutch Clinical Research Division and an associate professor in the Division of Hematology and Oncology at the University of Washington School of Medicine.
Previously a physician at Dana Farber Cancer Center in Boston, Parsons treated breast cancer patients and conducted research on new ways to test a person’s blood for signs of cancer, both to understand how cancers change over time and to help guide choices for therapy. Parsons plans to continue that research at Fred Hutch.
In recognition of her significant achievements to date, Parsons was awarded the Maudslien Endowed Chair in Breast Cancer Precision Oncology Research.
“I'm very humbled and honored by this endowed chair, and it feels like a mandate to both be able to lead this breast cancer program and to develop the science that I've been working on from my time in Boston,” Parsons said. “I’m looking forward to leading this group of really incredible breast cancer researchers and doctors to help reduce the burden of breast cancer on our patients and in the world.”
Parsons will split her time between leading research at Fred Hutch and patient care at the Sloan Clinic.
“It’s wonderful to welcome Heather to Fred Hutch as the new program head in Breast Oncology,” said Fred Hutch President Thomas J. Lynch Jr., MD, holder of the Raisbeck Endowed Chair. "Her dual commitment to compassionate patient care and innovative research embodies the heart of our mission. With her leadership, we look forward to elevating clinical excellence and driving transformative progress in breast cancer research."
Finding cancer’s clues in unexpected places
Parsons’ research focuses on a type of cancer marker called circulating tumor DNA (ctDNA) that can be detected in a person’s blood. Similar to how fetal DNA can be detected in a mother’s circulating blood several weeks after conception, ctDNA tests identify a cancer tumor’s genetic code by finding it in the plasma (the liquid portion of blood that does not contain cells) of cancer patients.
The exciting thing about this type of test is that “it offers this opportunity to be able to take a sample of the cancer by just taking a small sample of blood,” Parsons explained. “That sample can be used for everything from trying to understand whether a person has cancer, all the way to understanding what kinds of treatments might address their cancer.”
Plasma-based ctDNA testing can allow a patient’s care team to watch the cancer over time by detecting changes in the ctDNA, from early detection to determining genetic specificities that could help direct targeted, personalized treatments.
For some cancers, a needle biopsy is not possible due to the size or location of the primary tumor. Plasma-based ctDNA testing has the potential to detect cancers early when no other screening tests exist.
For breast cancer, ctDNA screening can help identify qualities of the tumor that might make it receptive to some treatments and not others. For example, the ctDNA of a patient whose tumor displays HER2 (human epidermal growth factor receptor 2), a molecule found on the surface of some breast cancer cells that can be targeted by specific interventions, will look different in a ctDNA screening when compared to a patient whose tumor does not have these receptors.
“That sort of personalization and tailoring of the therapy for the individual patient in front of you isn't something that we've been able to do historically,” said Parsons. “We've had to use inferences from large clinical trials, including thousands of patients, and then use probabilistic models to guide therapy. So I hope that we can really provide tailored therapy for each person who comes in with these kinds of tests. And that may extend also to the advanced cancer setting.”
Looking for tumor DNA in blood: One part of a bigger cancer story
The ctDNA testing that Parsons and her team are developing is part of a larger innovation in cancer care that has begun to revolutionize how a patient’s tumors can be detected, tracked over time, and treated effectively. Liquid biopsies are a range of tests that use bodily fluids, such as blood or urine, to detect cancer cells instead of relying on solid tumor biopsies. While some look for small pieces of DNA shed by tumor cells — the ctDNA that Parsons works with — other tests look for entire cancer cells, known as circulating tumor cells (CTCs).
Due to the range of liquid biopsies available today, it can be complicated for a provider to understand the specificity of the test they are ordering. Some types of liquid biopsies, Parsons said, are not appropriate for some patients.
“One of the important things to understand about these liquid biopsy tests is that they are many different kinds of tests,” said Parsons. “And so they're asking many different types of questions. You have to know the question you're asking about the cancer before you order the specific test.”
For example, a generalized test that looks for ctDNA in a patient who has been treated and is currently in remission could generate misleading data if another change in the genetic makeup of white blood cells after treatment is misread as an unnatural change in that cell population that could mistakenly suggest a relapse. This makes the science behind the tests even more crucial.
Certain kinds of liquid biopsies could indicate “very common mutations or alterations in the DNA of the white blood cells, and so that could cause a false positive,” Parsons explained. As always, the key for patients in learning how best to utilize these types of tests is to talk directly with their oncologist for specific recommendations.
A move from Boston to the Pacific Northwest
With the Boston area an outstanding place for professional development in cancer care and life sciences research, it would have been understandable had Parsons decided to stay at Dana Farber for the duration of her career. Moving cross-country to a new location, especially with family members in tow, is a major decision. What made that decision easier for Parsons and her family was Fred Hutch’s reputation as a leader in the cancer care community.
“This opportunity was difficult to pass up,” Parsons said. “Fred Hutch is an incredible organization that has such a long and storied history of cancer research. We have such a committed group of breast cancer oncologists. I love being able to be a bridge between laboratory science and the clinic. I saw this opportunity as one where I could help our group to be that bridge.”
In addition to delving into her work building her lab and treating patients, she noted that she’s looking forward to spending time outdoors getting to know the Seattle area with her family.
Endowed chair provides career-defining support
Parsons’ appointment comes with reliable financial support as a result of the Maudslien Endowed Chair. The support allows her to plan decades into the future, structuring new experiments to build on her early success with ctDNA screening tests.
“I hope in the next 10 years that we might be able to take a person with very high risk of developing breast cancer and do a blood test on that person that might tell them they do or don't have cancer,” said Parsons. “That could be incredibly reassuring for a patient, or a flag indicating a need for additional workup and potential therapy, which could help them do better in the long term.”
Within the same timeframe or earlier, Parsons also expressed hope that ctDNA testing could be utilized to evaluate blood samples from a patient who has already been diagnosed with cancer. “We might be able to guide therapy based on the results of the liquid biopsy — either to escalate therapy because maybe we see from the blood test that we might need to change or add additional therapies, or we might even be able to say, ‘Actually, you don't need any more therapy.’”
“We deeply appreciate the commitment that our endowed chair funders have made to the legacy of Fred Hutch,” said Senior Vice President and Director of the Clinical Research Division Sara Hurvitz, MD, a breast cancer expert herself, and holder of the Smith Family Endowed Chair in Women's Health. “I look forward to the innovations and advancements in breast cancer research that Dr. Parsons and her team will work to develop with the support of this endowed chair.”
