Dr. Frederick Pei Li (May 7, 1940 – June 12, 2015)

In 1967, Dr. Li, Dr. Fraumeni and Dr. Miller were chatting socially at the NIH. In the course of conversation, a particular family popped up.  This family had three small children who had soft tissue sarcomas, a very rare type of tumor. When Dr. Li talked to the family more, they found other cancers in the family too, such as breast cancer.

In a time where genetics and cancer weren’t often mentioned in the same conversation, Dr. Li was one of the groundbreaking clinicians who brought it to the table.  He was one of the rare souls whose passion for research was only tempered by the compassion he showed for the families he met. I’ve often wondered if it was difficult to have such a devastating cancer syndrome bear his name. Yet without the time and work he dedicated to families with TP53 mutations, we would still be wondering why our families were cursed with cancer.

Dr. Li was an epidemiologist and approached LFS with this discerning eye. In 1987, he gave a keynote address in Japan at the Princess Takamatsu Cancer Research Fund Symposium. He discussed LFS and the series of events that lead to the identification of this hereditary cancer syndrome,

“The disorder affects only a few families and has almost no public health impact. The reason is that several major forms of childhood cancer are involved and that another component, breast cancer is the commonest neoplasm in many parts of the world. Our approach is to study the rare, but hopefully informative, families with this cancer syndrome to gain new insights into genetic mechanisms involved in breast cancer and childhood neoplasms in general.”

Dr. Li realized something very important about not only cancer, but LFS. He did not see the rarity of LFS as a problem, but rather a key to finding out important pieces of the cancer puzzle. He treated patients with  respect and kindness.

In 1994, I got a letter from Dr. Li with my husband’s test results. We both spoke with Dr. Li at that time. He was very kind and took the time to answer all of our questions. I asked him what this meant for our daughter and he told us essentially there was a 50/50 chance of her having the syndrome. He gave us his phone number and said to call anytime. After my husband died I called to get information about predictive testing for my teenage daughter. They offered to have us come to Dana-Farber for testing and genetic counseling if we chose to do that. That was the last time I spoke with Dr. Li, he was a very caring man. -Roberta

15 years ago after having lost my husband and young daughter to cancer my only remaining daughter was diagnosed with advanced breast cancer..we went to Duke, they suspected LFS. Radiation would give her a sarcoma, her father had died from liposarcoma, and chemotherapy would give her leukemia…So they pretty much said this cancer is not survivable and if we treat her then the new cancer would probably kill her sooner than the breast cancer.. I found both Dr. Li and Dr.Fraumeni, spoke to them both and Dr Li said treatment might very well cause a new cancer or not…you have to optimally treat the cancer you have. She had bilateraI masectomy, radiation, chemo, and herceptin. 15 years later she is doing great…Thanks to Dr. Li we have enjoyed 15 years and hope to have 50 more. -Pat

I called his office when my wife and son were diagnosed and asked for him. The receptionist immediately got him on the phone. He was supportive of us, and spoke with Vanderbilt Hospital about my son’s care. We got a card from him some years later, encouraging us and saying that he wouldn’t quit until he found a solution. A great man whose contributions can never be measured. -Jeff

The LFS community is lucky to have had such a great champion for our cause. Living LFS sends our kindest regards to his family, friends and colleagues as they mourn the loss of this wonderful man.

References

https://www.bostonglobe.com/metro/2015/06/16/frederick-researcher-who-helped-establish-genetic-cancer-link-dies/2hMlQ5XUBExUxWB4uqvb1H/story.html

http://www.hsph.harvard.edu/news/features/in-memoriam-fred-li-pioneer-of-population-cancer-genetics/

http://www.nytimes.com/2015/06/22/health/frederick-p-li-who-proved-a-genetic-cancer-link-dies-at-75.html?_r=0

Patient experiences printed with permission from members of the LFS Support Group.


Gray Matter- Brain Tumors in LFS

In 1969, Dr. Frederick Li was having a casual conversation with a couple of colleagues at the National Cancer Institute. He became intrigued by hearing of a family who had 3 young patients with rare soft tissue sarcomas. This cancer was so rare- it was estimated at the time only 1 person per 100,000 would be expected to develop it. Upon further examination, Dr. Li noticed other cancers in family members. Dr Li and Dr. Joseph Fraumeni examined charts in 17 different hospitals across the US to see if there was a link between these sarcomas and a family history of cancer.  They found 24 families, 151 family members who fit into this group. Each family had a member who developed sarcoma before age 45 and at least 2 other relatives with cancer before age 45. Only 10% of cancers are expected to develop in this age group. Close to 60% of the cancers were breast and sarcomas. 14 patients were found to have brain tumors. The syndrome was temporarily referred to as Sarcoma, Breast, Leukemia, Adrenocortical Carcinoma Syndrome. SBLA.

At that point- there was a definite suspected genetic link. It was years later that a germline mutation in the p53 tumor suppressor gene was identified and the syndrome was named after the 2 young clinical researcher’s who traveled the country looking for clues. For decades, p53 and it’s roles in cancer have been researched. Each new discovery seems to open more doors to new pathways, treatment potentials and control of errant cancer.

Most of the Core LFS cancers behave badly. They are angry, they don’t respond well to therapy and they crowd out the healthy needed cells. Brain tumors are known for their aggressive nature in LFS. It is estimated that 13% of tumors in LFS before age 45 are brain tumors. The majority of those tumors are astrocytomas. In 2002, an examination of the roles of p53 in various brain neoplasms helped illuminate one of the roots of the problem. Cellular studies revealed that when wild type(functioning) p53 was expressed in brain tumor cells- it suppressed the aberrant growth. On the other hand- when there was a loss of p53 function(as there is in mutant p53) the cells immortalized- they kept growing and growing and growing. Mouse studies show that inactivation of p53 correlates with the beginning of tumor formation. There is also a noticeable relationship between p53 and the aggressiveness of brain tumors. Mutant p53 plays a role in the progression of cells from low grade to high grade cancer and p53 status is used to determine prognosis.  What does this mean for people with germline p53 mutation? Routine screening for brain tumors- promotes the chance of catching tumors early, before they progress to  high grade tumors.

10 years ago, Cara, a young woman in her early 20’s was diagnosed with a malignant brain tumor. At a time where most young adults her age were discovering independence, Cara was just trying to survive.  She then found out, on top of having a brain tumor, she had Li Fraumeni Syndrome. As she learned- having a brain tumor was a scary proposition- having a brain tumor with LFS has lots of grey areas.

Having LFS with a brain tumor is completely different for a mutant. I didn’t even know I had LFS when I was diagnosed with a malignant brain tumor. My oncologist expected it was something hereditary. I was lucky that my tumor was removed all the way and after I saw the geneticist it was agreed that not having chemo and radiation was the best idea since I did have LFS. While I was lucky that tumor was removed completely, having LFS has made it very different for me in the after effects. I have dystonia(as the result of a medical mistake) and seizures-which are caused from having the brain tumor. Most people with dystonia have Baclofin pumps in the spine to help control pain from dystonia and helps with some contractions. But since I have LFS,  I have to have MRIs every 6 months and since electrodes from a pump are magnetic, I can’t have the pump. Being a mutant has also meant that when my seizures are really bad or out of control, myself or my family have to decide if a CT scan is worth the radiation risk to find out if another tumor is present…it’s always a hard decision. 

And then there’s worrying. When I have a terrible headache, is the brain tumor back? Should I not use a cell phone? Will I die from a brain tumor and not know I had a brain tumor…or die from a seizure? My risk for a brain tumor coming back is pretty strong, considering I have LFS and my tumor type often does reappear. There’s always the voice of: Did I make the right decision to not have chemo or radiation? Will I regret it later? Having a brain tumor is never easy, but even more uneasy is having brain cancer and not knowing if your decisions on how to treat your cancer will harm you with other cancers or keep you alive only to die from another cancer. That’s a very harsh way to look at it, but unfortunately that is how I see it most of the time, especially since my second cancer diagnosis. 

My advice to another brain tumor patient with LFS would be to get multiple opinions on everything from the pathology of the brain cancer to all treatments out there to what other treatments are out there. Don’t just do what a doctor tells you is right, if you don’t feel right about it. Be comfortable with what treatment you are or are not doing. Seek the advice of people that have been in your shoes before. Have a strong support system, whether that is your family, friends or people online. They will matter most, both when it comes to brain tumors and when it comes to LFS.

Cara’s picks for Information and Support:

American Brain Tumor Association
Blankets for Brains
The Sam Fund
Stupid Cancer

Li, F.P and Fraumeni, J.F. Jr. Soft-Tissue Sarcomas, breast cancer and other neoplasms: a family syndrome? Ann. Intern. Med., 71-747-752, 1969

Li FP. Keynote lecture. The familial syndrome of sarcomas and other neoplasms. Princess Takamatsu Symp. 1987;18:243-9. Review.

Sakar, C. p53 in Brain Tumors: Basic Science Illuminates Clinical Oncology. Indian J. Hum. Gen 2002;8:52-9.