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Massey and U.Va. centers seek ‘comprehensive’ designation

Higher designations for U.Va., VCU cancer centers could benefit patients

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Print this page by Marjolijn Bijlefeld and Robert Burke

Two years ago Richard Moran helped develop and bring to market a new drug called pemetrexed, a powerful weapon against a very common type of lung cancer. Discovering a new cancer drug is a big accomplishment in itself, but Moran — a researcher at VCU’s Massey Cancer Center in Richmond — isn’t finished.

He has since teamed with other cancer experts at VCU and elsewhere and developed a potential new use for pemetrexed. It might work against even the most aggressive breast cancer cells, too, when combined with a second drug, sorafenib. Moran is hoping that clinical trials soon can begin with breast cancer patients, possibly this spring. “Right now we’re looking to find ways of enhancing what we have,” he says.

Massey is one of two locations in Virginia designated as “cancer centers” by the Bethesda, Md.-based National Cancer Institute, part of the U.S. National Institutes of Health. The second is the University of Virginia Cancer Center. There are just 66 NCI cancer centers in the country. The designation and NCI support grants go to cancer centers that have records of excellence in cancer research, treatment and community outreach.

But Massey and U.Va.’s cancer center are seeking an even higher designation — they want to become NCI-designated “comprehensive” cancer centers. Forty of the 66 cancer centers in the U.S. have the comprehensive designation, and none are in Virginia. Backers of the effort say that if they’re successful, the change will improve the quality of cancer treatment and help translate the benefits of research done in the state into more treatment options for Virginians. U.Va. plans to ask for the comprehensive designation when it applies for NCI grant funding in three years. Massey is working now to get the higher NCI designation, with a review taking place this spring.

NCI cancer centers get a substantial amount of funding — Massey and the U.Va. center got close to $20 million each in NCI money last year — which helps them bring in experts in a range of cancer specialties and give them space to work. The new therapies that Moran and others have developed “are sort of the essence of what an NCI cancer center does,” says Dr. Gordon Ginder, director of the Massey Cancer Center. “It really leads to new ways of looking at problems and new ways to develop treatments.”
Top-tier research

In general, comprehensive cancer centers are exactly what the name suggests. They have top-tier researchers, state-of-the-art facilities and the resources to take clinical research into the communities they serve. The directors of both centers say that too often the advances produced by cancer researchers here are used to support trials done somewhere else. They’d rather see population-based studies done in Virginia.

According to a presentation last fall for the Joint Commission on Health Care, about 15 percent of patients at comprehensive cancer centers are taking part in clinical trials of the newest treatments. At U.Va. that number currently is 6 percent, and at Massey it’s 11 percent. “Those are the kinds of activities that distinguish a regular NCI-designated cancer center from a comprehensive cancer center,” says Dr. Michael Weber, director of the U.Va. center. His center already works with hospitals far from Charlottesville, such as Johnston Memorial Hospital in Abingdon, which opened a new cancer-treatment center in 2007. “We would like to have people from Southwest Virginia be able to be in our U.Va. clinical trials and not have to drive to Charlottesville every day. That would be goal number one,” Weber says.

Getting the comprehensive center designation depends a lot on its peer-review process, which looks at a wide range of things, including the quality of the institution’s cancer research and its impact. There’s no checklist from NCI, “because each institute is different,” Weber says. But broadening the reach of cancer care is a key benchmark, so the two cancer centers are working together to develop a statewide Virginia Cancer Network.

Weber says U.Va. recently spent $500,000 to buy a clinical trials management software system, the same kind VCU purchased two years earlier, so that people getting care at one of the centers can take part in clinical trials at either school. That move effectively creates a larger pool of potential candidates for clinical trials, which Weber says can help speed up the pace of research. “There are lots of trials that take three years to complete just because there aren’t that many people enrolling in them, and if we could cut that [time] in half that would be a big step forward,” he says.

Funding is an issue, and advocates of expanding cancer research have been pushing for more state support for years. State funding this year was $1.55 million for U.Va.’s center and $1.96 million for Massey. The coming budget year has a big increase for both: U.Va. will get $3 million, while the Massey center will get $5 million. Weber isn’t sure why his center got less. VCU’s funding level came as part of Gov. Bob McDonnell’s budget recommendations, while U.Va.’s amount was set by General Assembly budget negotiators. “I really think there should be parity” in funding levels, he says.

More state money 

Both Weber and Ginder want the state to keep the money flowing in the coming years — a one-time infusion of cash isn’t enough to sustain the effort. A study released last fall by the Joint Commission on Health Care made the same point. Weber and Ginder will be making that appeal to state legislators when work on the next budget begins in earnest next fall. “I’m hopeful that by the time November comes we’ll be able to show them some real progress that will give them confidence that they’re not throwing money at a problem that never gets solved,” Weber says.

A study released in February by U.Va.’s Weldon Cooper Center for Public Service includes estimates for the economic impact of increased funding for the school’s cancer center. A $5 million annual boost in funding could help the cancer center reach comprehensive status, which would open the door to extra funding from the NIH, foundation and philanthropic sources and pharmaceutical companies.

It would also help more Virginians get their cancer treatment closer to home. About 1,500 state residents travel outside Virginia each year to receive clinical cancer care. If Virginia were able to keep a modest 20 percent of those patients in state, it would produce an economic stimulus of about $12 million a year, the report says.

The rate of cancer in Virginia is about 452 cases per 100,000 people, which is slightly under the national average, according to recent data from the American Cancer Society. Cancer is the second-leading cause of death in the U.S., responsible for about 23 percent, second only to heart diseases. In Virginia last year about 36,410 people were diagnosed with cancer, and more than 14,000 died.

Ginder and Weber have seen research breakthroughs produced at their cancer centers turn up in clinical trials at comprehensive centers elsewhere. Virginia is essentially exporting the raw materials that could produce better care for cancer patients here and potentially launch private-sector companies. “There’s just absolutely no reason why those trials should be opening in Florida and California and Massachusetts, and not Virginia,” Weber says.

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