UF Shands Cancer Center superstars combine forces to zap cancer

BIFF! BAM!

POWWWWWWWW!

The scene: It's spring 1995, in a quiet laboratory along a nondescript corridor within the Health Science Center. A scientist in a white lab coat stoops over his work, facing the malignant menace in the Petri dish before him. Time is of the essence. The cells are reproducing. Can this neoplastic nemesis be stopped?!

Shortly after cell biologist Stephen Sugrue arrived on campus 10 years ago, he set out to do an experiment that involved rapidly multiplying cells in a lab dish, then abruptly halting their growth.

Stopping the cells in their tracks required a chemical he assumed would be within easy reach on his lab shelf. But finding it required a bit of a scientific scavenger hunt, one that today represents for him the giant leaps the UF Shands Cancer Center has made since then.

"I came down from Harvard from the cell biology department," recalled Sugrue, Ph.D., now associate director of basic science for the Cancer Center and chairman of the medical school's department of anatomy and cell biology.

"There every lab would have such reagents. Here it took me two or three days to find somebody who had a reagent to do a cell-cycle block. It was like borrowing a cup of sugar!"

In those days, researchers studying how cancer cells proliferate and spread were virtually nonexistent at UF, as was National Cancer Institute funding-a couple of grants totaled a paltry $500,000.

"We started from ground zero and we needed to build," he said. "The Cancer Center existed on paper but really didn't have any substance to it."

Today the landscape looks far different. There is no shortage of the reagents Sugrue needed a decade ago. Furthermore, a brand-new $85 million, 280,000-square-foot Cancer & Genetics Research Complex has been added to house those bottles and the expanding number of people who use them.

The Cancer Center has come alive.

That's in large part thanks to a cadre of scientists who have marshaled their forces in the fight against cancer. Like their caped comic book counterparts, these researchers rely on strength and speed to battle their foe, a disease that claims the lives of millions every year. No superhuman abilities here-just plain old scientific skill, technology and sheer people power to propel them forward.

Money also has helped. The overall institutional investment in cancer in the past decade has been simply astounding-in excess of $600 million. Consider, too, the cancer extramural research base, which has grown from $3.7 million to $24.6 million in just seven years. And for the first time in the institution's history, administrators say, UF has in place fundamental bench research in cancer that will yield advances at the patient's bedside. To further that effort, a critical mass of scientists has been assembled, bolstered by a flood of new faculty recruits: In the past year alone, 25 cancer researchers have come on board.

The list goes on: Last month, UF's Proton Therapy Institute-one of only five in the nation-treated its first patient. And by 2009, the Shands at UF Cancer Hospital will have sprung up along Southwest Archer Road.

"We expect to be major contributors to ending the long-fought war on cancer," said W. Stratford May, M.D., Ph.D., Cancer Center director. "We plan to grow our cancer operation through research and clinical trials. That's what I envision the Cancer Center being able to do-to provide the infrastructure, the support, the colleagues and all of the backup needed to develop a new therapy and bring it into testing in the clinical arena for the potential benefit of patients. That's our job."

Able to build tall buildings

Building up the research effort to support the overall cancer initiative has been a key thrust for UF scientists.

"When I arrived here, there were pockets of excellence in both laboratory science as well as clinical investigation but no coordinated effort, and we didn't have any synergies between one individual and another individual's efforts," said John Wingard, M.D., the Cancer Center's deputy director for the Gainesville campus. "When the institution made a decision to recruit a new Cancer Center director, Dr. May, and to put resources behind coordinating both the research and the clinical efforts, we for the first time had the opportunity to blend those in new ways that made the effort more than any one individual's efforts. Over the last five years or so, we've spent an enormous amount of time recruiting new investigators to our campus with a cancer focus and also encouraging individuals in other disciplines that were tangential to cancer to try to turn that focus more toward the cancer research effort.

"And of course this big push over the last few years has been enormously facilitated by the new (Cancer & Genetics) research building, where these individuals who had been scattered across campus now are on a day-to-day basis rubbing elbows and talking about common research problems or technical issues, so they can draw on each other's ideas," he added.

Information gleaned in the lab can then be used to identify new targets for novel therapies that can be tested clinically. Researchers in pharmacology and therapeutics, for example, have done groundbreaking work on an enzyme that is active in stimulating cancer cell growth, May said, opening new avenues for drug development.

As science changes, research opportunities expand, too, often in unexpected ways. The Cancer Center is pouring resources into epigenetics, a promising field involving the molecules that package a cell's genome.

Much of that work will go on in the new building, home to half the cancer-focused researchers on campus. And while it's a focal point, "our bright new shining star on campus for cancer and genetics research," Sugrue said, the cancer research initiative is much bigger than that. Researchers still populate the Academic Research and Medical Science buildings, offices within the College of Dentistry and a multitude of departments on main campus.

Meanwhile, UF researchers continue to pioneer new treatments. In July, physicians treated eight patients with the Trilogy Tx medical linear accelerator. They were the first ever to receive this form of noninvasive, image-guided radiosurgery, which targets tumors with precisely focused radiation.

Other notable initiatives include the planned cancer hospital facility, which will provide the latest technology and high-quality care. Clinicians now scattered throughout the existing hospital system will be able to work in an interdisciplinary fashion more easily, Wingard said.

"Cancer affects so many of us personally as well as professionally," said Shands HealthCare CEO Tim Goldfarb. "The Shands at UF Cancer Hospital will allow us to blend the science of medicine with the art of healing in a specially designed space."

And last month, a Cocoa Beach man with prostate cancer became the first patient to undergo treatment at the new 98,000-square-foot, $125 million UF Proton Therapy Institute, the first time this advanced form of radiation therapy has been offered in the Southeast. The therapy has a high rate of success in curing prostate cancer and malignancies of the brain, lung, head and neck, eye, cervix, gastrointestinal tract, bones and soft tissues, with minimal side effects.

"We are determined to offer patients in Florida and the Southeast the best possible treatment options, whether it be proton therapy, conventional radiation therapy, surgery or chemotherapy," said Nancy Mendenhall, the institute's medical director. "We do believe that protons will occupy a very important place among the armamentarium of cancer weapons. We are also poised to become a center for both clinical and basic research that will increase our understanding of basic disease processes and improve cancer treatments."

Cancer crusaders

The development of five cancer-focused research programs has helped fuel recruiting in cell signaling and apoptosis; cancer genetics, epigenetics and tumor virology; stem cells, vasculogenesis and cancer; experimental therapeutics; and cancer prevention, control and population research.

Since 1999, the university has hired 71 new faculty members whose work addresses cancer, 51 in Gainesville and 20 in Jacksonville. Those efforts will continue, with a focus on translational researchers who can bridge basic science with clinical work. Additional hiring will take place in medical oncology and in subspecialties of cancer care, such as urology, thoracic surgery and neurooncology, May said.

The recent arrival of Johannes Vieweg, M.D., has been heralded as one example of the center's emphasis on attracting top scientists and clinicians. Much of Vieweg's research focuses on the development and early clinical testing of new immunotherapies for cancers of the genitourinary tract, including prostate cancer. A new Good Manufacturing Practices facility also is under construction; it will provide engineered cells and small molecules required for vaccine-based clinical trials and will produce new stem cell-based therapies.

Meanwhile, the Cancer Center continues the search to fill two key clinical leadership positions, a chief medical oncologist with solid tumor expertise for the Gainesville campus and a deputy director for the cancer program in Jacksonville. Such individuals happen to be in short supply.

"It's a problem that every university center faces, and we're not unique to that," Wingard said. "For a number of years, many of the trainees, when they complete their fellowship, go into private practice. What we are trying to do with our fellowship program is to emphasize the pursuit of scholarly interests. We're hoping to grow our own oncologists from our own trainees."

X-ray visionaries

So where to go from here? Cancer Center administrators say they will build on existing strengths, which include a world-class bone marrow transplant program, the surgical and radiation oncology programs and significantly enhanced capabilities in epigenetics.

Robert Nuss, senior associate dean and associate vice president for health affairs at the Health Science Center-Jacksonville, said the center's structure as a joint campus initiative also is a plus. And because of Jacksonville's huge patient base, it will be a key component in clinical trials development.

"I think the sum of the parts is greater than each one alone, clearly," Nuss said. "I think that's the key advantage of this opportunity, to allow us to be successful utilizing the strengths of both campuses."

The development of a Health Science Center-wide clinical trials office-a common resource for the coordination of research studies and contract negotiation-is another recent achievement, Wingard said, and replaces the fragmented approach of the past. In the past 12 months, 684 patients entered clinical trials at UF. In contrast, in fiscal year 2002 only 337 subjects were enrolled in trials.

Challenges lie ahead. As the number of patients grows, the outpatient clinics and the oncology staff need to expand to accommodate them, he said. And the availability of future research funding remains a concern.

"The federal government has traditionally been the major funding mechanism for cancer research, and there are concerns with where those dollars will come from in the future because of cutbacks," said Joe Woelkers, the center's chief administrative officer. "That, to me, is our biggest risk. I also know we're seeing reimbursement for cancer care being reduced by Medicare and other insurance carriers, and that's a trend I think is going to continue. We're going to have to find a way to be more economically efficient but continue to provide the highest quality of care for our patients."

Cancer Center administrators also seek to become one of 60 NCI-designated comprehensive cancer centers, a quest complicated by current federal funding constraints, said Joseph Simone, associate vice president of health affairs for cancer programs. The NCI grant would provide a few million dollars annually for core facilities, recruitment and seed money for research.

"More important than the money is that you are now in an elite club, and it has an impact on your ability to recruit people, it has an impact on your standing in the university environment, and it has an impact on your standing in the national cancer community," Simone said.

Wingard likes to think back to a year ago, when program leaders gave a presentation to the UFSCC internal advisory board, articulating their vision, their accomplishments, recruitment efforts and plans to strengthen programs and collaborative research.

"For me that was an important turning point for the Cancer Center," he said. "In the past, it seemed that only a couple of individuals had a vision of what was to be accomplished; it was then that I saw that the vision was embraced by a wider circle of leaders who over time will shape the future of the Cancer Center. Buildings and money are important facilitators of progress, but shared vision and broad leadership are much more powerful agents of change. These changes are now happening and are perhaps the most notable accomplishments of the Cancer Center to date."