Blasting cancer with 120 drugs? Why FIU and a Miami children’s hospital tried it

Eight-year-old Logan Jenner might not be here right now if it weren’t for his little sister Mary.

Mary was born two weeks early in October 2019. But for Logan — then 3 and diagnosed with acute myeloid leukemia and in need of a bone marrow transplant — she arrived just in time.

“She was our miracle baby,” said their mom, Diana Jenner, 35. “And the first thing I asked when she was born was, ‘What is her blood type?’ ”

Mary was Logan’s “100%” match, his parents said. The December transplant was a success. And Logan went into remission.

“It was kind of the miracle story that anybody would pray for ... the younger sibling was the one who saved his life,” said Michael Jenner, 38, Logan’s dad. “We were great for an entire year and then this Cinderella story kind of fell apart.”

On Feb. 2, 2021, a day before the Miami-Dade family would celebrate Mom’s birthday, doctors confirmed: The cancer was back.

The 5-year-old began chemotherapy immediately. And his parents were told about a new clinical trial underway at Nicklaus Children’s Hospital near South Miami. The trial, with Florida International University, was seeking to use a new, more personalized approach to treat some of the most aggressive cancers in children.

And that’s how Logan became Patient No. 13.

FIU, Nicklaus Children’s test cancer against 120 drugs

As part of the trial, which involved more than a dozen pediatric cancer patients, Logan had samples of his blood sent to an FIU lab. Researchers blasted his cancerous cells with more than 120 FDA-approved drugs. Results were then sent back to Nicklaus, ranking the effectiveness of each drug against the cancer.

The goal was to help doctors find the best available treatment, quickly, before having to pump any more drugs into Logan, according to FIU cancer researcher Diana Azzam, who led the study. The study’s results, published April 11 in the peer-reviewed medical journal Nature Medicine, found that 83% of patients who received guided treatments showed improvement.

“It’s very promising, even as .... a proof of principle,” Azzam said.” We’re showing that we can do this, we can return results back to the physician quickly, we can change the course of treatment for the patients quickly, and that’s important, especially for those children whose cancers are just getting worse day by day.”

After 33 days of treatment and a second bone marrow transplant, Logan went into remission again. And he rang the bell inside Nicklaus for the second time.

He’s now been cancer-free for more than two years.

Logan “is living proof that this approach works; it improves outcomes,” Azzam said. “We’re on the right track.”

The study, which ran from Feb. 21, 2019, through Dec. 31, 2022, used “functional precision medicine,” known as FPM, a new approach that uses drug-sensitivity testing and genomic profiling to analyze and identify which drugs would be the most effective for over a dozen pediatric cancer patients. Existing FPM studies focused on adult patients, but this FIU study focuses on children, the researcher said.

One of the reasons why cancer is so challenging to treat is because no two are the same. Each cancer has its own characteristics, even between patients diagnosed with the same type.

And while there are standard medications doctors use to treat cancer, that can sometimes involve trial and error to see which treatment works best, according to Azzam and Dr. Maggie Fader, Logan’s doctor and the director of Nicklaus Children’s pediatric sarcoma and solid tumor program. Cancer cells are constantly mutating, and just because a specific treatment worked once doesn’t mean it will work again.

Azzam’s clinical trial tried to eliminate the guesswork. And quickly.

Testing different drugs on samples of tumor tissues or blood, depending on the patient’s cancer, allowed Azzam and her team to see how the DNA of each patient’s cancer cells reacted to different drugs.

The goal? To help cancer patients “by identifying the right drug for the right patient at the right time,” Azzam said. “So basically, we develop an individualized treatment plan for each child.”

Nicklaus Children’s enrolled 23 patients in the study. One other patient was enrolled by St. Mary’s Medical Center Palm Beach Children’s Hospital and another from Oregon Health and Science University. All of the children had rare, relapsed or refractory cancers and were running out of treatment options.

Some of the children died before the study was completed. By the end of the study, 21 patients received personalized treatment plans, 19 patients had treatment plans discussed by their hospital’s molecular tumor board, and 14 patients received therapeutic intervention. Six of the children’s treatment plans were guided by the FPM approach, of which five of the kids showed improvement.

For Azzam, the study’s purpose was to see if the drug-testing results could be delivered to the hospital’s molecular tumor board within four weeks. The board is made up of experts who review and interpret molecular-profiling results to help match cancer patients with available therapies.

As part of the study, doctors still had final say on which treatment would be best for their patients. Doctors have to consider not just how effective a treatment could be against a child’s cancer, but whether the family wants the medication by IV or pills and if the insurance would cover the treatment costs.

What personalized cancer testing found?

In Logan’s case, the more personalized testing made significant findings that changed the course of his treatment.

Testing found that while his prescribed cancer treatment was working, he didn’t need to undergo a three-drug combo to get the same results. Fader adjusted the treatment and made it a two-drug combination, getting rid of a “cardiotoxic” medication that could affect his heart.

“We really did want to avoid exposing his heart to more side effects,” especially since he had already undergone treatment before with cardiotoxic medications for his previous bout with cancer, Fader said.

For Azzam, Logan’s success story holds a special place in her heart. She was even able to meet him, a rare opportunity for the researcher. Patients often remain anonymous to researchers during clinical trials.

But a 2022 Live Like Bella symposium helped bring Azzam and Logan’s mother, Diana Jenner, together.

Logan’s mom went to the symposium to get inspiration for her foundation, The Pursuit of HAPPYmess, previously known as Team Logan, which helps raise money for pediatric cancer patients. Azzam was giving a presentation about her clinical trial.

Diana Jenner rushed to meet her.

“I think my son was part of something like your study,” she told the researcher.

“Well, tell me about your son,” Azzam said.

As they talked, it became clear.

“She’s like, ‘That’s Patient 13,’ … and sure enough, he is Patient 13,” said Diana Jenner.

Azzam is now working on another clinical trial, this time involving adult and pediatric cancer patients, to gather additional data on the effectiveness of functional precision medicine to help guide cancer treatment. People can learn more about Azzam’s trials on the website of FIU’s Robert Stempel College of Public Health and Social Work.

Logan’s mom is planning to raise funds through her foundation to help families who enroll their child in Azzam’s clinical trials.

As for Logan, the second-grader is doing just fine. And it can get pretty busy in the Jenner household.

Logan plays the violin and soccer and practices martial arts. His 10-year-old brother Ashton plays basketball and the electric guitar. Mary, the 4-year-old sassy fashionista, plays violin and cello and does gymnastics.

The siblings might start a band one day. And while Logan will remain monitored to make sure his cancer doesn’t come back, he knows his family will have his back. Their support makes him “very happy,” said Logan, recalling his previous cancer treatment.

Logan, his mom said, “brings out the best in every single person in this house,” and is the “biggest lover in the family.”