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Cancer at the crossroads

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Friday, June 01, 2007

{safe_alt_text}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.

{safe_alt_text} 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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