ecancermedicalscience is delighted to welcome our first Editorial Board member from Uganda, Dr Jackson Orem.  Until recently, Dr Orem was the only oncologist in Uganda, a country home to 33 million people. He is the AIDS Clinical Trials Group (ACTG) Network’s Clinical Research Site (CRS) Leader at the Uganda Cancer Institute (UCI) in Kampala.

Orem completed his medical oncology training at Case Western Reserve University (CWRU) in Cleveland, Ohio, USA, before returning to his homeland in 2004.  Once back in Uganda, Orem became Director of the UCI in 2005. It is the only dedicated cancer treatment centre in the country.

“On specializing in oncology, again, I noticed that contrary to the prevailing opinion, cancer was common enough in Africa to warrant emphasis,” Orem says. “What, however, surprised me most was the lack of importance accorded to cancers among HIV patients in Africa, despite being the most visible face of the epidemic in Africa from the onset. This partly influenced my decision to train in oncology and to focus on treating patients with a compromised immune system.”

In Uganda alone, Orem says between 50 and 60 percent of cancers in adults are related to HIV. “Some cancers are indicator conditions of HIV/AIDS, hence, called HIV-related cancers. There is, therefore, a vicious cycle with HIV influencing cancer disease and vice versa. Early cancer diagnosis and effective treatment is needed as a starting point in breaking this cycle of disease,” Orem says. “The other group of cancers develops due to improved management of HIV. These are called non-AIDS defining cancers. Their development usually compromises gains resulting from prompt effective treatment of HIV. Early diagnosis and effective treatment of these cancers are important in improving the overall outcome for patients already on effective treatment for HIV. In both scenarios, HIV/AIDS, if not effectively treated, will lead to poor outcomes for these patients compared to those people living with HIV without cancer.”

Thus early diagnosis and treatment remain two of the biggest hurdles Orem is striving to overcome. “Few specialists have adequate knowledge for the treatment of both diseases,” he says. “HIV awareness in Uganda is very high and testing facilities are available. So there is widespread knowledge of HIV prevention. At best HIV awareness is higher than cancer awareness, and stigma to cancer is probably higher than that of HIV.” Orem hopes a partnership with the Fred Hutchinson Cancer Research Center in Seattle, Washington, USA, will eradicate the barriers to early diagnosis and treatment for HIV and cancer in Uganda. The two centers joined forces in 2004, forming the Uganda Program on Cancer and Infectious Disease (UPCID). Orem is the Co-Scientific Director. The collaboration has brought more clinicians into Uganda and led to the expansion of the existing UCI. “The Uganda Cancer Institute and the Fred Hutchinson Cancer Research Center have partnered under the UCI-Hutchinson Center Alliance to fight infection-related cancer through research training and provision of high quality care,” Orem says. “Together we are putting up a new facility with cutting edge research laboratories specializing in molecular diagnostics, immunology, pathology and clinical chemistry/hematology. There will also be an outpatient clinic capable of accommodating more than 20,000 visits annually and a training center. This will upgrade the level, the range and the quality of services offered at the UCI. The investment in this will be up to $9 million.”

The government of Uganda is also building a new inpatient facility, which will increase the current center’s capacity from 120 to 200 beds. This investment is critical as Orem says it is difficult to secure monies for cancer treatment in Uganda when compared to receiving funding for other diseases.

In addition to the clinical benefits, Orem will continue conducting important research at the upgraded site. His lab investigates novel oral chemotherapy combinations to improve cancer delivery in resource-poor settings, treatment of viral-associated malignancies and infections in cancer patients with compromised immune systems.

In 2009, Orem led the first clinical trial in Africa to explore a modified dosage of oral chemotherapy for AIDS-related non-Hodgkin lymphoma patients. This work is especially critical in Uganda as many Ugandans living with HIV die from cancerous conditions including non-Hodgkin lymphoma or Kaposi sarcoma (KS). “We are expanding our observation that oral combination chemotherapy for treating lymphoma works in low-resource settings by conducting similar studies in other African countries,” Orem says. “We are doing this under the auspices of the AIDS Malignancy Consortium (AMC) and the National Cancer Institute (NCI). We are hopeful that this idea will develop eventually into one that ACTG would be interested in for the future.”

Orem is part of the ACTG A5264 study team, which is enrolling patients in a protocol designed to understand the best way to treat HIV/AIDS-related KS in resource-limited areas of the world. While conditions for him to treat patients and conduct studies keep improving in Uganda, Orem never forgets the foe he is up against as more people die of cancer in low and middle income countries than AIDS, malaria and tuberculosis combined. He is grateful for the partnerships he has with Fred Hutchinson Cancer Research Center and the ACTG as he continues to tackle cancer and HIV in his homeland.

Source: ACTG Newsletter June 2013 Volume 2 Edition 2