Serial Measurements of Molecular and Architectural Responses to Therapy (SMMART) program

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. 

Our team

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.

Headshot of Gordon Mills

Gordon B. Mills, M.D., Ph.D.,
SMMART Program Director
Faculty Profile
Read more about Dr. Mills

Headshot of Joe Gray

Joe Gray, Ph.D.
SMMART Cancer Biology and Analytics Lead
Faculty Profile

Headshot of Raymond Bergan

Raymond C. Bergan, M.D.
SMMART Clinical Lead
Faculty Profile

Headshot of Annette Kolodzie

Annette Kolodzie, J.D., Ph.D.
SMMART Assistant Director

Headshot of Brett Johnson

Brett Johnson, Ph.D.
Scientific Program Manager
 

Headshot of Rochelle Williams-Belizaire

Rochelle Williams-Belizaire
Precision Oncology Assistant Director

Headshot of Tara Macey

Tara Macey, Ph.D.
Drug Acquisition Specialist

Headshot of Swapnil Parmar

Swapnil Parmar, M.B.B.S., M.P.H.
Clinical Program Manager

Headshot of Jamie Keck

Jamie Keck, Ph.D.
Clinical Genomics Specialist
 

Headshot of Souraya Mitri

Souraya Mitri, Ph.D., M.A.
Data Manager
mitris@ohsu.edu

Headshot of Jennifer Laverdure

Jennifer Laverdure
Data Steward 
 

Headshot of Kiara Siex

Kiara Siex
Senior Clinical Research Coordinator
 

Headshot of Ana Olson

Ana Olson
Clinical Research Coordinator

Taylor Kelley, casual headshot photo, smiling

Taylor Kelley
Clinical Research Coordinator

Nicholas Van Marter, headshot photo, smiling

Nicholas Van Marter
Research Assistant 1 (Data Abstractor)

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Becky Goodford
Research Assistant 1

Headshot of Zahi Mitri

Zahi Mitri, M.D., M.S.
Breast Cancer Clinical Lead
Faculty Profile

Headshot of Joshi Alumkal

Joshi Alumkal, M.D.
Prostate Cancer Clinical Lead
Faculty Profile

Headshot of Uma Borate

Uma Borate, M.D., M.S.
Acute Myeloid Leukemia (AML) Clinical Lead
Faculty Profile

Headshot of Charles Lopez

Charles D. Lopez, M.D., Ph.D.
Pancreatic Cancer Clinical Lead
Faculty Profile

Headshot of Christopher Corless

Christopher L. Corless, M.D., Ph.D.
Executive Director, Knight Diagnostic Laboratories
Director, Knight BioLibrary
Faculty Profile

Publications

News stories

Research articles

Contact

For more information please email
SMMART@ohsu.edu

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.

You can learn more about the history of precision medicine at OHSU, and read more about precision oncology at the National Institute of Health. 

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. 

Official study information about the SMMART clinical trial is available through the Knight Cancer Institute's clinical research database page about the SMMART clinical study

For more information, contact Swapnil Parmar, parmar@ohsu.edu, or 503-494-9642.

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.

Measurements include:

  • 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.

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