Summer 2013

Grace Mbabazi, UCI patient
By Ignacio Lobos



Uganda, a country of 34 million people, is one of the world’s poorest nations, with nearly 40 percent of the population living on less than $2 per day.

On top of the poverty, Ugandans live in a tropical climate that harbors major life-threatening infectious diseases, such as malaria, HIV and tuberculosis.

There’s also cancer—particularly infection-related cancer, with six of the 10 most common cancers directly connected to viral and bacterial infections. The human papillomavirus (HPV) is common in the region, contributing to one of the highest burdens of cervical cancer cases worldwide.

Viruses also lead to lesser-known cancers such as Kaposi sarcoma, which affects mostly adults; and Burkitt lymphoma, whose tumors are caused by the Epstein-Barr virus. Endemic throughout tropical Africa, Burkitt lymphoma is the most common pediatric cancer in Uganda.

Issaac Muwanguzi, UCI patient
Issaac Muwanguzi, UCI patient

And yet, there’s not even a word for cancer in many of the Ugandan tribal languages. Those who watch their children battling Burkitt lymphoma only see its grotesque results: massive tumors that deform necks, faces and bellies. The “swellings,” they call them.

But something remarkable is happening in Uganda. Two researchers from vastly different continents have forged a partnership that brought their cancer research institutions together to conduct breakthrough research on infection-related cancers. As they go about their work, they’re saving lives.

Working together in the capital city of Kampala, Fred Hutch’s Dr. Corey Casper and the Uganda Cancer Institute’s Dr. Jackson Orem are keenly aware that they share ambitious goals.

The partnership, formed in 2004 and known as the UCI/Hutchinson Center Cancer Alliance, is conducting innovative infection-related cancer research, training a new generation of clinicians and researchers, and enhancing cancer treatment for adults and children.

“There’s the prospect for discovering new causes of cancer, maybe new infections that we do not know anything about that are unique to environments like the one in Africa,” said Orem, director of UCI. “We know that close to 35 percent of cancers in the developing countries and in Africa may be related to infection, and we may be underestimating. There may be even many other viruses out there yet to be discovered.”

That makes Uganda a suitable place for Fred Hutch to conduct its research. With world-leading research programs in both cancer and infectious disease and unparalleled experiences with international research collaborations, Fred Hutch’s unique partnership with the Uganda Cancer Institute is already paying dividends.

Fred Hutch has trained a dozen Ugandan cancer specialists, who are now back in their country working to alleviate the cancer burden. The partnership has conducted 25 research studies with more than 7,000 Ugandans. It has yielded a new diagnostic test being used in Uganda and Seattle to better diagnose the presence of EBV and help determine if patients are at higher risk of lymphoma.

The UCI/Hutchinson Center Alliance has collaboratively developed a treatment protocol for Burkitt lymphoma. Led by the program’s Managing Director Erica Sessle, this project will treat all children with Burkitt lymphoma at the UCI with a set of standardized care guidelines.

It is hoped that the program’s coordinated, holistic approach — which includes a trained team of experts, standard chemotherapy, pain medication, food and transportation— will result in a doubling of overall survival for these children.

Also, based on his experiences in Uganda, Casper is studying more cost-effective treatment options that could be used in the U.S., where the cost of cancer treatment is skyrocketing.

Casper, who spends several months a year in Uganda leading the collaboration, points to the pharmacy as an indicator 
of change.

“I was looking through my photos, and I have a photo of the pharmacy stock in 2005. On the shelf there were maybe two vials of Vincristine, just a little bit of Methotrexate and a little bit of Adriamycin [all chemotherapy drugs to treat cancer], and now when you look at the shelves, there’s a fully-stocked pharmacy. That’s an amazing change,” he said.

Most importantly, more patients than ever are going home—cured from their infection-related cancers. If the UCI was once the place where cancer patients went to die, it’s now a beacon of hope.

The goal of increasing survival rates of Burkitt lymphoma patients at the UCI from 30 percent to 90 percent in the next three years may seem daunting.

But it’s a treatable disease and by American standards, incredibly affordable. In Uganda, it takes less than $1,000 to cure a child of Burkitt lymphoma.

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