What is the SMMART program?
SMMART stands for Serial Measurements of Molecular and Architectural Responses to Therapy. It is the flagship project of the Knight Cancer Institute’s new Precision Oncology program.
The goal of the SMMART program is to develop new treatments for cancer that last longer (are more durable) and allow better quality of life (are more tolerable) for patients with advanced disease.
In particular, the goal is to understand why chemotherapies often stop working, and to develop new treatments that will stop cancers from becoming resistant to cancer drugs.
The main focus of SMMART is helping individuals who have triple-negative breast cancer defeat their cancers. But the same research methods and approach are applicable to other cancers, such as prostate cancer, pancreatic cancer, and acute myeloid leukemia, and we are studying these cancers also.
Many features of the SMMART program are unique:
- There is a deep research component associated with the clinical trials in SMMART. The data that will be measured is extensive.
- The patients are followed longitudinally, which in this case means that they are monitored before, during and after being given study treatments to assess how they are doing and how well the treatments are working.
- The treatments are tailored to each individual patient in the study. This means that if you are a patient enrolled in this study, the drugs you receive will be prescribed according to the characteristics of your cancer and your genetics.
- A novel combination of drugs out of a pool of 33 FDA-approved drugs will be prescribed for each patient, rather than a single drug or usual combinations that are routinely prescribed.
- Adaptive treatment in real time. We tailor our therapy for each individual patient, then re-evaluate, and change the prescription during the trial according to changes we see in the patient’s response.
The SMMART program is led by Gordon Mills, M.D., Ph.D., Joe Gray, Ph.D., and Raymond Bergan, M.D.
The SMMART staff is comprised hundreds of scientists, including physician-scientists, clinicians, sample and imaging processing experts, data scientists, pharmacists, radiology, programmers and lab scientists.
Joe Gray, Ph.D.
SMMART Cancer Biology and Analytics Lead
Raymond C. Bergan, M.D.
SMMART Clinical Lead
Annette Kolodzie, J.D., Ph.D.
SMMART Assistant Director
Brett Johnson, Ph.D.
Scientific Program Manager
Precision Oncology Assistant Director
Tara Macey, Ph.D.
Drug Acquisition Specialist
Swapnil Parmar, M.B.B.S., M.P.H.
Clinical Program Manager
Jamie Keck, Ph.D.
Clinical Genomics Specialist
Souraya Mitri, Ph.D., M.A.
Senior Clinical Research Coordinator
Clinical Research Coordinator
Zahi Mitri, M.D., M.S.
Breast Cancer Clinical Lead
Joshi Alumkal, M.D.
Prostate Cancer Clinical Lead
Uma Borate, M.D., M.S.
Acute Myeloid Leukemia (AML) Clinical Lead
Charles D. Lopez, M.D., Ph.D.
Pancreatic Cancer Clinical Lead
- OHSU Knight Cancer Institute Throws Out Old System Of Clinical Trials, by Kristian Foden-Vencil, Oregon Public Broadcasting, March 21, 2019.
- Making cancer a rare disease: The subclassification of cancer is challenging research and treatment efforts, by Markian Hawryluk. The Bend Bulletin, March 8, 2019.
- Making history every day. OHSU Onward, February 29, 2019.
- How a new OHSU Knight Cancer program could eliminate trial and error in drug treatments, by Elizabeth Hayes. The Portland Business Journal, November 19, 2018.
- Making cancer clinical trials SMMART, by Joe Rojas-Burke. OHSU News, November 16, 2018.
- KIYATEC Adds Oregon Health & Science University to Study to Predict Response to Cancer Therapy Prior to Treatment. KIYATEC, Inc., press release, also on Marketwatch. February 6, 2019
- Zahi I. Mitri, Swapnil Parmar, Brett Johnson, Annette Kolodzie, Jamie M. Keck, Max Morris, Alexander R. Guimaraes, Brooke R. Beckett, Uma Borate, Charles D. Lopez, Kathleen A. Kemmer, Joshi J. Alumkal, Tomasz M. Beer, Christopher L. Corless, Gordon B. Mills, Joe W. Gray and Raymond C. Bergan. Implementing a comprehensive translational oncology platform: from molecular testing to actionability. Journal of Translational Medicine (2018) 16:358. https://doi.org/10.1186/s12967-018-1733-y
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Frequently asked questions
Precision medicine or precision oncology means treating a person's cancer according to the genetics of that individual's cancer.
This is important because there are many types of cancers, and a cancer that someone has can also change over time, for example, adapting to become resistant to drugs.
This characteristic of cancers often cause a chemotherapy drug that initially works to stop working.
SMMART's goal is to discover and tailor treatments for each individual patient, in anticipation of a cancer's ability to change and resist treatments. The treatments prescribed are updated over time so that they remain effective.
SMMART stands for Serial Measurements of Molecular and Architectural Responses to Therapy. We call it this because we take repeated, or serial, measurements from each patient, over time. The serial measurements allow us to best understand each patient's cancer in great detail, and also to best individualize the treatments we prescribe for each patient.
A tumor board is panel of experts that meets to review and discuss the imaging and lab results for a patient's cancer biopsy. Together, they determine what treatments will be prescribed for that patient's case. For the most challenging cases at OHSU, tumor boards meet as often as every two weeks.
In the SMMART clinical trials, two tumor boards meet every other week to discuss findings and work together to recommend the best treatment approach for each patient.
In SMMART, the two tumor boards who review your case include a clinical board, or one comprised of doctors an scientists with specific clinical expertise in cancer medicine, and another that discusses mechanisms of resistance, comprised of researchers who know the most about how the drugs work in terms of genetic and cellular mechanisms.
Unlike other clinical trials, which are usually designed to make simple comparisons or analyses, SMMART is designed to be as comprehensive as possible about understanding and treating your cancer.
This includes taking biopsies more than once, if necessary, and also taking blood samples weekly, then doing extensive testing on the blood and tissue samples.
The repeated measurements will allow us to best understand why and how the drugs are working or not working as hoped, and whether the treatment can be better optimized.
- Imaging of various types, including at very high resolutions (electron microscopy) so that even the smallest (microscopic) features of individual cancer cells can be assessed.
- Omic profiling, or the full determination of the exact composition of your cancer's DNA, RNA, proteins and other biomolecular information. This is known as omics because it is the composite knowledge of all the following types of analyses:
- DNA profiling is known as genomics.
- RNA profiling is known as transcriptomics.
- Protein profiling is known as proteomics.
- The analysis of modifications to the DNA, which help turn genes on and off, or affect gene expression, is known as epigenomics.
- Biomarker assessment from the patient blood samples. Because biomarkers yield information about a cancer without requiring more than a blood sample, they are valuable because they are a less invasive way to assess how a treatment is working. Fewer biomarkers tend to mean the cancer is dying. No biomarkers may mean the cancer is gone or almost gone. Learn more about biomarkers.
Read more about:
- Patient information about breast cancer, including understanding breast cancer, its treatment, the breast cancer team, breast cancer services, and patient resources at OHSU.
- The OHSU Breast Center, which offers comprehensive breast health services by top medical specialists using the latest medical technology.
- The Knight Cancer Institute is at the forefront of research into promising new cancer treatments. Learn more about:
- Precision medicine at OHSU.
- Scientists at our Cancer Early Detection Advanced Research Center, or CEDAR, are finding new ways to identify cancer when it’s most treatable. The center is in our Knight Cancer Research Building, which was designed to encourage collaboration among hundreds of researchers.