14 U A B C O M P R E H E N S I V E C A N C E R C E N T E R

mutated and seem to prevent leukemia cells from dying. The Cancer Center is conducting a study, the first in leukemia patients and only second in humans, with a small molecule that binds to a protein called MDM2 and reactivates another protein called p53. That second protein, p53, is known as the protector of the genome. If a cell has something go wrong with it, p53 is respon- sible for the cell dying so that it doesn t progress into cancer. The Cancer Center treated the first patient in the United States with that drug, and while it has only shown some modest activity using a low dose, Dr. Erba is excited about the potential of killing cancer cells by blocking the signals that keep those cells from dying.

One of the pathways that lead to the development of leukemia is through a molecule called FLT3, which is a protein on the surface of bone marrow cells. FLT3 binds a molecule that signals the cells (white blood cells, red blood cells and platelets) to proliferate, which is a necessary process that must be controlled.

Unfortunately, about 25 percent of leukemia patients have mutations in this FLT3 protein. So because they no longer need the signal, the cells are always growing, Dr. Erba says. A number of drugs have been developed to turn off that FLT3 activity, and we re working with an industry sponsor to bring that drug here to UAB to treat patients with acute myeloid leukemia.

Dr. Erba and his team are also conducting inpatient studies to determine if newer forms of chemotherapy are actually beneficial to acute leukemia patients compared to the standard therapeutic options traditionally used. Our response rates among acute leukemia patients are high with chemotherapy, as many, depending on the patient s age and leukemia type, have a 75 to 90 percent chance of going into remission, he says. Unfortunately the treat- ments we have today are incredibly toxic, so we lose some people from the toxicity of these therapies. The other big problem is the remissions are not durable. Even with post- remission treatment, including bone marrow transplants, the disease may come back. The reason I m so active in clinical investigation is that there is a lot that we still need to do.

A Higher Calling In addition to his clinical work, Dr. Erba spends a

great deal of time handling various administrative tasks. Juggling those activities keeps his days full, Dr. Erba says. And my nights and my weekends, he adds with a laugh.

Outside of the clinic, Dr. Erba enjoys running, ten- nis, hiking and spending time with his wife Amanda, a research nurse in the UAB Center for Palliative Care. They are the parents of five children: Claire, a senior at the University of Michigan; Madeleine, a first-year stu- dent at the University of Illinois College of Veterinary Medicine; Abigail, studying to be a teacher in Michagan; Alexis, studying at a local community col- lege; and Jake, soon to be a freshman at the University of Michigan.

About six months ago, my wife and I both realized that Birmingham feels like home now, Dr. Erba says. I love Birmingham, but the one thing I don t like is the summers. It just gets too hot and humid!

While his job can be both time-consuming and challenging, Dr. Erba takes a humanistic, faith-based approach to what he does. All of our lives are finite, and we don t know what plan the Lord has for each of us, he says. I approach my job believing that I m part of that plan, and it s a gift and blessing to be so involved in other people s lives and to touch them in that way.

Dr. Erba believes that while it is great to share in the patient triumphs, it is equally important to share when things do not go well. As a physician, I think a very important part of my role here is not in just developing the next cure for leukemia, which I hope we do here at UAB, but to support patients and their families even when there are no other therapeutic options. That s what we re called to do: give the best overall care to our patients.

Dr. Erba adds: There can be days that are very tough, but it s quite an honor to be included in what s going to be a part of everyone s life. That s something physicians have to be able to do. I really believe that s what keeps me going. I feel that I was called to do this.

There can be

days that are

very tough,

but it s quite

an honor to

be included in

what s going

to be a part of

everyone s life.

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