Distinction in Research (Basic, Clinical or Translational)
Students who pursue a distinction in research at Dell Med work with faculty to design and implement a project in research from options spanning the spectrum of research at The University of Texas at Austin, a tier-one research university.
MIHAILO’S GOAL THIS YEAR
“I’m hoping to find some new treatments for colon cancer, both to reduce its mortality rate but also to minimize the need for particularly difficult cancer treatments like surgery or chemotherapy.”
Three years ago, Mihailo "Misha" Miljanic was teaching high school chemistry. Originally from New Jersey, he came to Texas with Teach for America and quickly noticed the symptoms of larger public health issues surrounding the Dallas high school where he taught.
This year, he will help discover treatments for one of the deadliest cancers in the United States.
“When you’re a teacher, there are a lot of problems that you can’t really tackle on your own — things like drugs and violence,” Miljanic says. “When Dell Med was opening, I was drawn to its community focus, and the expectation that we as medical students would take on broader health issues.”
Entering Dell Med’s Growth Year with a year of clinical clerkships under his belt and a budding interest in radiation oncology, he sought a way to combine both cancer research and immunotherapy (using the body’s own immune system to fight disease) into his work.
Miljanic found an immediate opportunity with the LIVESTRONG Cancer Institutes of the Dell Medical School. Taking advantage of the research distinction option, he is partnering with the institutes’ team on a study to test immunotherapy drug combinations to improve treatment of colon cancer — which, up until now, has primarily been treated through surgery or chemotherapy.
One of Miljanic’s mentors at the institutes, Carla Van Den Berg, PharmD, encouraged him to apply for the competitive Paul Calabresi Medical Student Fellowship — a grant given to only one U.S. med student per year by the Pharmaceutical Research and Manufacturers of America Foundation to pursue clinical pharmacology research. Miljanic was awarded the 2018 fellowship, and will be supported in his pursuits this year as a result.
“Misha’s work is an example of how medical students can make an impact right away,” says S. Gail Eckhardt, M.D., director of the LIVESTRONG Cancer Institutes and lead author of the study. “Colon cancer is a deadly disease and advances in immunotherapy will likely be the key to better, safer treatment options.”
Mihailo Miljanic spent countless hours at the lab bench last semester, and that work is paying off.
Of the several drug combinations Miljanic and his mentors tested for effectiveness against colon cancer cells, one emerged as a promising opportunity to increase immunotherapy options. The combination is having the exact effect he and his team hoped for: Not only did the cocktail kill cancer cells more effectively, but tumors the team tested began to express receptors that make the cells more obvious to a person’s own immune system.
“An important aspect of Misha’s work is that it’s translational, and is based on observations from real patients in clinical settings who have a need for these treatments — it’s not just based on academic curiosity,” says Anna Capasso, M.D., Ph.D., assistant professor in the departments of Oncology and Internal Medicine, and one of Miljanic’s mentors. “Translational research is meant to address demonstrated needs, and projects can ideally move from bench to bedside back to the bench, and so forth, in pursuit of filling the gaps we see in health care.”
So what’s next? Miljanic will begin testing the drug combination in 3-D organoids, which are masses of cells that represent an organ’s structure more realistically than individual cells in a petri dish do. And if the drugs work there, Miljanic and his team will move forward with animal models — the next step on the way to clinical trials.
Meanwhile, Miljanic is working on an interprofessional education (IPE) group project with two other Teach for America alumni. In 2017, he and classmates Anatoli Berezovsky and Francisco Barrios founded the Dell Med chapter of the Health Career Academy, a national organization in which medical students mentor local high school students. This spring, Miljanic, Berezovsky and Barrios will work with the program’s 90 students to conduct a health fair at Travis High School, where the high schoolers themselves will present on health issues they find to be most pressing in their own communities — anything from cancer to diabetes to environmental health.
“One thing I’ve taken from my teaching experience is just how much students are really capable of,” Miljanic says. “We’re hoping this project helps these students realize that they can take steps to effect change in their own community’s health.”
Imagine you’ve been diagnosed with cancer. Traditionally, this means months or years of treatment — surgery, chemotherapy, radiation or a combination of these. Sometimes treatment plans work as expected. Sometimes they don’t.
Now, imagine that within weeks after your diagnosis, your oncologist knows exactly how a particular drug combination will affect your cancer. With the technology that Mihailo Miljanic is using to test immunotherapy drugs this year, that vision could become a reality.
He’s progressed from testing the drugs in cell lines to three-dimensional organoids to animal models in just nine short months, and the organoids in particular give him hope for personalized cancer treatment in the future.
“There have actually been some samples coming in recently of patients who haven't started treatment yet, so we might be able to figure out which drugs work for them before they even begin treatments,” Miljanic says. “Organoids, like the organic human body, are diverse, so they can be harder to work with because the data is messier. But they mimic what happens to people much more closely, so it’s really exciting technology.”
The drugs are proving to be as effective as his team hoped — moving the project ever closer to human clinical trials — and he’s begun to share his work at national conferences alongside researchers from major cancer centers: He gave an oral presentation at the American Society of Clinical Oncology annual meeting in Chicago this spring.
Mihailo Miljanic has put in the hours. Now it’s time for results.
As he concluded the spring semester, Miljanic’s tests of a colon cancer drug combination, conducted under the direction of his mentors at the LIVESTRONG Cancer Institutes, progressed from 3-D organoids to mouse models. The data are looking good so far, he says — and if it continues to bear out, clinical trials for the novel drug combo won’t be far off.
As the project progressed this spring, Miljanic began presenting his findings alongside oncologists from across the country, delivering an oral presentation at the American Society of Clinical Oncology conference and a poster presentation at the American Association for Cancer Research annual meeting. He’s also working alongside other researchers to submit multiple papers to academic journals in hopes of contributing his findings to the body of work on immunotherapy.
Mihailo Miljanic, who is finishing his 3rd year at @DellMedSchool presenting his research at the 2019 @ASCO annual meeting in Chicago! pic.twitter.com/nt9sdVmgiK— S. Gail Eckhardt (@SGailEckhardt) June 1, 2019
Miljanic has wrapped up his role at the cancer institutes for the year, but he’ll stay in touch with his mentors to monitor the performance of the drug combo in mice. As he concludes his primary care clerkship at CommUnityCare’s David Powell Health Center and moves into his fourth-year away rotations in radiation oncology, he’s more sure than ever of his path to becoming a radiation oncologist.
The third year was an incredible experience,” Miljanic says. “I was able to dive into research full-time for the first time in my life, and was able to do so for an entire year under the direction of amazing mentors. They’ve have shown me what an impact this type of translational research can make, for oncology patients in particular.”