OHSU's $1 billion goal: Fewer cancer deaths, better treatment

By Lynne Terry | The Oregonian/OregonLive | December 17, 2015 | See Original Here

It started with a question.

Nike's co-founder Phil Knight was getting a progress report on his latest donation to Oregon Health & Science University. Dr. Brian Druker, director of the Knight Cancer Institute, had done just about everything he'd promised with the $100 million gift, hiring renown researchers and top-notch teams. But Knight pushed for more.

What else do you want to accomplish? he asked.

Druker had pondered that question. But hearing it from Knight in the spring of 2013 inspired Druker and his team to think bigger.

They fleshed out a plan for a research center focused on identifying cancer early, when it's most treatable. Most research targets advanced stages of the disease. An early detection center would fill a vacuum and could save countless lives.

But it would need a mountain of money.

The economy: OHSU's investment in early detection cancer research will create an economic windfall, with more jobs, spending and public revenue.
The patient: Ken Zeidman is a poster child for how new cancer drugs save lives.

Druker, OHSU President Dr. Joe Robertson and Keith Todd, head of OHSU's foundation, shared the plan with Knight that summer. In a small conference room at Nike's headquarters, a towering poster of basketball superstar Michael Jordan on the wall, they discussed details.

They told Knight they would deepen their focus on unraveling cancer at a molecular level and try to identify early indicators of lethal tumors, distinguishing ones less likely to kill, to spare patients unnecessary procedures and treatments. They would hire rock star scientists and create a research hub. They would expand clinical trials.

It would cost $1 billion, they said.

Knight asked a few questions and that was that.

"It was a daunting ask of anyone," Todd said.

But Knight came through, announcing at an OHSU donors dinner later that summer that he and his wife, Penny, would give $500 million if the university raised as much in two years.

With that goal reached this year, Druker now must fulfill his promise. He has 10 years to succeed.

"My hope is that when people talk about places that have an impact against cancer that we're right at the top of that list," Druker said. "When people talk about Portland they'll say: 'Oh, that's where cancer really met its match.'"

Building on earlier success

Druker, a slim, long-legged man with a mild manner, speaks in grand terms, pledging to cure cancer. Though politicians and researchers have been promising that for decades, he's got a track record to back it up.

His research led to Gleevec, a treatment for chronic myeloid leukemia. It was the first drug to attack cancer at a molecular level instead of bombarding cells with toxic chemicals. It's turned chronic myeloid leukemia from a death sentence into a manageable condition.

Ken Zeidman, a 59-year-old Portland real estate investor, is among many patients who've benefited. When he got the diagnosis in 2001, he'd been married three months.

He and his wife were terrified.

Zeidman has suffered with Crohn's disease, an inflammatory bowel condition, since he was a kid. He didn't want to go through chemotherapy. A bone marrow transplant was not a good option, either.

Druker put him on Gleevec, which kicked his cancer into remission. Late last year, Zeidman went off the daily pills.

"Not to have to take the drugs anymore," Zeidman said, "it's awesome."

The drug inspired a new field of targeted cancer therapies.

"It opened up people's eyes to how you could approach cancer," Druker said. "We want to do the same thing with early detection."

First of a kind

For nearly 15 years, the National Cancer Institute has led a group of researchers focused on early detection. The Early Detection Research Network has identified five biological characteristics, or biomarkers, to detect ovarian, prostate and liver cancer.

"It's the biggest effort that I'm aware of," said Dr. Barry Kramer, director of cancer prevention at the National Cancer Institute.

The network has developed a better prostate-specific antigen test, or PSA, to determine whether the patient needs a biopsy to check for prostate cancer. But Druker said that's not enough.

"We want to have something that accurately tells us whether a man needs to have his prostate removed or radiated," Druker said. "Even with a slightly better PSA we're not going to get there."

OHSU's early detection center will look beyond single biomarkers to try to gain a deeper understanding of what distinguishes a nonlethal growth from a lethal one. That could involve identifying biomarkers that lead to new cancer tests based on blood, images, saliva or urine.

"If we understand what it is that distinguishes a lethal cancer, that will allow us to develop the tools to detect them at the stage when they actually need to be treated," Druker said. "Now it's being done piecemeal and not in an organized fashion."

Few institutions have access to $1 billion.

One exception is the University of Texas MD Anderson Cancer Center in Houston. It's one of the largest research, treatment and prevention cancer centers in the world. In 2011, it completed a $1.2 billion fundraising goal. About $200 million was spent on construction and the rest has been spread among various programs, including precision cancer medicine, gene analysis, clinical trials and cancer therapies.

It is also pouring money into early detection but not on the same scale as OHSU.

"We had a different approach," said Dr. John Mendelson, former president of the center who oversaw the capital campaign. "I don't know of a program that's putting this amount of money in such a focused way into this particular question."

Common and lethal cancers

When Druker says he plans to cure cancer what he really means is that he wants it to become a manageable disease, like a common infection, that people don't fear.

He wants fewer to die.

phil knight.JPGNike co-founder Phil Knight and his wife donated $500 million to OHSU's early detection cancer research center.

The center will target common cancers, including breast, colon, prostate and lung cancer. It will also focus on other tumors, like ovarian and pancreatic cancer, that are often lethal because they are caught late. Researchers will work on rare cancers as well if that helps them understand the molecular abnormalities that cause cancer cells to multiply and spread.

The center will collaborate with others, including the Early Detection Research Network. This week, OHSU announced a formal arrangement with Cancer Research UK, a global leader in the field, to accelerate early detection research.

Still, Oregonians should not expect quick results.

Scientific advances happen incrementally, on stepping stones of discovery. Clinical trials are long affairs, with therapies checked for safety and then efficacy among increasingly larger numbers of patients. Developing a successful cancer drug can take years and gobble up hundreds of millions of dollars.

It's been four years since MD Anderson completed its capital campaign. The center boosted its faculty of scientists and added support staff. Those new hires have helped advance research, but the money has not yet produced any major breakthroughs.

"There are no Gleevecs yet," Mendelsohn said. "No drug has ever been developed in four years."

Though Druker can't predict specific results, the OHSU plan calls for more clinical trials.

"We want to bring in more people with deep expertise who are able to develop clinical trials and work with pharmaceutical companies to bring these trials to patients," said Steve Stadum, chief operating officer of the Knight Cancer Institute.

The trials won't be limited to early detection work either, he said.

The budget includes hiring 20 to 25 physicians plus support staff to work on the clinical side. That will mean more trials for patients even beyond the metro area. This year, the Knight Cancer Institute had more than 650 patients in clinical trials, with nearly 20 percent from out of state and over half living outside Multnomah County.

Top-tier scientists

The biggest chunk of the OHSU campaign – $550 million – is earmarked for early detection research. That money will pay for 20 to 30 senior scientists and their teams, people like Joe Gray and Paul Spellman.

Gray, a physicist and engineer, is working with Intel on a number of projects, including a digital cloud for cancer data from institutions across the country. That effort could unlock a wealth of data for research.

When OHSU hired Gray away from the Lawrence Berkeley National Laboratory in the San Francisco Bay Area in 2010, he was already an international star. Spellman, a scientist who worked on mapping the cancer genome, came with him.

The $1 billion is expected to be a big lure for others like them, offering lucrative salaries without the grind of grant writing. Science depends on grants. But federal funds have shrunk and the competition is stiff.

Grants aren't as crucial when you have $1 billion to spend. The money will give the early detection researchers freedom to experiment and even fail.

"That's how you innovate," Druker said.

The Knight Cancer Institute is far from being the biggest cancer center in the country. MD Anderson has a faculty of about 1,500, with more than 1,300 at Memorial Sloan Kettering Cancer Center in New York. About 275 are affiliated with the Knight Cancer Institute.

But the $1 billion will elevate its status, experts say.

"This kind of gift is transformational," said Dr. Thomas Lynch, head of the Massachusetts General Physicians Organization and former leader of the Yale Cancer Center.

Brain power matters

OHSU's $1 billion investment will add to the region's brain trust, with top scientists bringing their families, contributing to the arts, culture and community.

The money also will pay for visiting professors as well as conferences, drawing experts from around the globe.

"That helps the reputation of your city," said Tom Potiowsky, chair of the Economics Department at Portland State University.

It could entice young scientists to pick cancer research because of the opportunities at the Knight Cancer Institute. They might move to Portland. Others could follow.

"Eventually what will happen is you create a place where everyone will want to go even when the billion dollars has been spent because it becomes an appealing place," said Lynch of the Massachusetts group. "Once you have critical mass, everyone wants to be in Portland."

While Druker will be looking for early wins from the research, he's committed to the long haul.

"Ultimately, we're going to measure our success in how many lives we've saved," he said.

-- Lynne Terry