JUNE 2007: SPECIAL REPORT, THE FUTURE OF HEALTH CARE
Cancer at the crossroads
The OHSU Cancer Institute is celebrating its 10th year as part
of the National Cancer Institute’s elite network and
renewing its goal: nothing less than a cure.
By Christina
Williams
Grover Bagby has a spring in his step as he strides through the
cancer institute’s new lab space at Oregon Health &
Science University.
He raves about the layout: Faculty offices are perched nearby
and the conference room around the corner will provide a ready
room for discussing recent discoveries.
He raves about the view: From the 14th floor of the new Center
for Health and Healing in Portland’s South Waterfront,
lab occupants look south down the Willamette River for a view
that’s more rural idyll than riverfront urban.
And he raves about the technology: A microarray scanner that
can read 35,000 genes at once coughs up a goldmine of data that
medical researchers such as Bagby, who turns 65 in July, were
only able to dream about earlier in their careers.
“This is why I’m glad I’m retiring back to
my lab,” says Bagby, bouncing slightly on the balls of
his feet while he shows off the equipment. “These are the
kinds of experiments I’ve wanted to do all my
life.”
Bagby may be giddy at the prospect of giving up his post as
director of the OHSU Cancer Institute, but while he starts
madly writing grants and ramping up his research on Fanconi
anemia, the institute he nurtured into existence will move
forward under new leadership. And the pressure is on:
OHSU’s headliner success — the development of
Gleevec, arguably the most important innovation in
cancer-treatment history — is a hard act to follow.
At a time when cancer research is leveraging new technology to
inch ever closer to understanding and eventually eradicating
what those in the business call “the cancer
problem,” the OHSU Cancer Institute, small in scale but
mighty in reputation, must seize the opportunity — and
raise the money — to make its quest for a cancer cure pay
off for the state.
It’s fitting that Brian Druker, the boyish scientist who
catapulted to fame with his Gleevec discovery, is the one
who’s been tapped for institute leadership. Because
Druker’s goals — for himself, for OHSU and for
Oregon — are steep. He wants nothing less than to cure
cancer and to make the state a shining example of how cancer
treatment and prevention ties into economic prosperity.
Dr. Brian Druker holds
promise in his hand: Gleevec, a drug he developed that is
used to treat myeloid leukemia and stomach
cancer.
PHOTO BY LEAH
NASH
|
BORN AS THE OREGON CANCER CENTER in 1991, what became known as
the OHSU Cancer Institute received its blessing from the
National Cancer Institute in 1997. It’s the only
designated cancer center between Seattle and Sacramento. With
the designation — one of 61 nationwide — comes
money, an annual grant from the federally funded NCI to help
pay for research and operations.
OHSU falls short of getting the NCI’s
“comprehensive cancer center” designation because
of its historical lack of public outreach about cancer
prevention and treatment. But a new affiliation with public
health workers at Kaiser Permanente and a ramp-up of community
outreach makes both Druker and Bagby pretty confident that OHSU
will snare that comprehensive moniker when NCI next reviews
applications and makes its designations in 2009.
As the new director, Druker will oversee that prickly process,
which comes up every five years in the life of a NCI cancer
center. Once the application is submitted, NCI sends out a
peer-review group of a couple dozen officials from other cancer
centers, each with incentive to find fault with their
competition. The NCI grants that come along with the
designations vary in size from $1.5 million to $12 million per
year, depending on the size of the institution and the amount
of research going on there.
OHSU weighs in at the bottom end of the NCI funding scale, yet
its achievements at the cancer institute are world-class.
“They’re one of the best because they have
capitalized on very strong science with a major impact on the
clinical world,” says Joseph Simone, an Atlanta-based
consultant for cancer centers after several decades running
them.
Simone says that among cancer centers of similar size and
setup, OHSU sits on the top of the heap in part because
research by Druker — there are others, but Druker is the
headliner — is internationally recognized. And the fact
that OHSU has been able to hang on to Druker since his catapult
to fame bodes well for the institute’s future.
“Druker has had more job offers than Marilyn
Monroe,” Simone says. “He’s such a hot
commodity.”
Druker snared a $2.5 million research grant from the Jeld-Wen
Foundation in 2001, was named a Howard Hughes Medical
Investigator in 2002 (a title that comes with up to $1 million
a year in research funds) and was elected to the National
Academy of Sciences in May. Druker has been the
institute’s fundraising star, tirelessly chatting up
potential donors and sharing his infectious enthusiasm for the
search for cancer’s cure.
And in a world where research grants submitted to the National
Institutes of Health are being funded in dwindling numbers any
advantage is worth having. Most cancer centers —
including OHSU’s — are supported largely by private
philanthropy.
The cancer institute brought in $6 million in philanthropic
contributions last year. Of that, close to $3 million was
designated to a specific cancer research fund; about $720,000
was raised specifically for the Center for Cancer Cell
Signaling, a new lab for Druker and fellow cell-signaling
expert John Scott in the Biomedical Research Building; and
$600,000 went to fund faculty endowments.
Overall, the OHSU Cancer Institute’s annual operations
budget is $5 million (about 20% of which is covered by the NIH)
and sponsored research projects bring in $129 million.
The question Simone has, though, is what Druker and OHSU will
do with its resources. “The biggest challenge is going to
the next level,” Simone says. “You can’t
stand still. You’re either going up or you’re going
down.”
WHEN BRIAN DRUKER FIRST ARRIVED IN OREGON he flew in from the
Bay Area on one of those magical winter days when the sky is
crystalline and it looks like you can touch the mountains. He
came for a job interview with one Grover Bagby, who was just in
the process of establishing a cancer institute at OHSU.
“It was just Grover and a vision,” Druker recalls.
“It was an opportunity to get in on the ground
floor.”
Druker did, arriving at OHSU from the Dana Farber Cancer
Institute at Harvard in 1993. In 1998 he started working with a
promising compound that would turn off the signal of abnormal
cancer-causing proteins, shutting down the progression of
chronic myeloid leukemia. The result was Gleevec, produced by
the Swiss drug giant Novartis as the first targeted cancer
therapy. The hoopla that followed prompted Wired magazine to feature Druker
in a 2003 article that proclaimed “The End of Cancer (as
we know it)” and Druker was celebrated as
Portland’s favorite son.
But while Gleevec was a great public relations success for
OHSU and Druker has used his fame to raise money for more
research, no royalties from Novartis’
multi-billion-dollar sales of the drug came back to Druker or
to OHSU.
Despite Druker’s development work, Novartis retained the
patent on the compound that became Gleevec and OHSU failed to
negotiate any rights to the drug.
While the lack of financial payoff has rankled and embarrassed
many administrators — OHSU’s tech transfer office
now works closely with the cancer institute in order to make
sure that the next time there’s a breakthrough, more of
the intellectual property is protected and more money will come
back to the school — it doesn’t bother Druker much
at all.
What was earth shattering about Gleevec is that it changes the
game in cancer treatment by illuminating how the disease
operates at the cellular level and targeting only the molecules
that are causing the problem.
But Druker isn’t satisfied. “We can control the
disease, but we can’t stop it. Why can’t we kill
every last cell?” he says. “Long-term control is
fantastic but, ask a diabetic, they’d rather be cured.
We’re committed to being very persistent.”
Druker would also like to see Oregon taking a lead in cancer
prevention and treatment. “Oregon has a unique
opportunity in health care. The state has always been a leader
in getting more coverage to more people. What if we set
standards for appropriate screening for cancer and provided
coverage for it? Is it worth it to lower the mortality rate
from cancer? OHSU has the opportunity to drive that. Not only
would it make Oregon a better place to live but every business
in the state would benefit.”
A new cancer institute director fixated on finding a cure and
bringing down mortality rates statewide is a strong marquee to
gather under, but to really make progress OHSU must have
cutting-edge research going on in several areas.
The departure this month of Craig Nichols, the testicular
cancer specialist famous for treating cyclist Lance Armstrong,
is a blow to the institute: A link to a cancer-surviving sports
legend is tough to lose.
But OHSU has deep talent. Tomasz Beer is having success in
using vitamin D to help treat prostate cancer. Mark Garzotto,
director of urological oncology, made national headlines
earlier this year for his work in helping doctors identify the
more deadly strains of prostate cancer. OHSU also has leading
research in breast, head and neck, and colorectal cancer. But
it will be incumbent upon Druker to further deepen the
bench.
The institute currently counts 138 affiliated researchers, but
the reality is they are spread throughout OHSU, hailing from
departments such as surgery, oncology and biochemistry. But in
addition to shiny labs with nice views, the new OHSU building
on the South Waterfront consolidates many of the operations of
the institute, including radiation oncology, medical oncology,
surgical oncology, social work and genetic counseling, in one
patient-friendly place. On the seventh floor, patients receive
chemotherapy in cushy chairs and a wide-open setting so they
can talk to each other.
Bagby, who lobbied for the multi-disciplinary center, says
it’s unambiguously better for the patient and is
effective for getting doctors out of their silo mentality. The
consolidation marks a trend among cancer centers around the
country and the new digs should be a good recruiting tool for
Druker to build his anti-cancer army. But Druker is more likely
to talk about how seeing patients is so integral to his own
research.
What he still needs, though, is the money to arm them, and he
becomes easily frustrated by the difficulties in finding it,
pointing out that the NIH is only funding one in 10 research
proposals, compared to one in three a few years ago. The
National Cancer Institute’s budget was whittled from
$4.79 billion in 2006 to $4.75 billion in 2007.
“This should be a time that we’re doubling,
quadrupling our investment in cancer research,” Druker
says. “We’re in an era where the pace of progress
is brisk. This is when we get the payoff.”
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