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Va. Institutions taking leadership roles in treatment and research

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by Marjolijn Bijlefeld and Robert Burke


At the heart of the cancer center now rising near Hampton University is a powerful and rare medical tool. It is a cyclotron, a device weighing more than 200 tons that can accelerate atoms to nearly light speed, creating a proton beam that kills cancer cells with pinpoint accuracy.

This is not experimental technology, just very expensive. The Hampton University Proton Therapy Institute — which broke ground last August and will begin treating patients in 2010 — will cost an estimated $225 million and be just the sixth center in the country. “Bringing it to Virginia is going to ease human misery and save human lives,” says Hampton President William Harvey, who calls the project “my baby” and has been the driving force behind it. “I’ve kind of lived and breathed this thing for three years now,” he says.

Hampton’s proton therapy project is one of several innovative approaches to cancer treatment being used at universities and hospitals across Virginia. Besides the high-priced proton project, research is under way at George Mason University that could help doctors choose which medicines are best for blocking cancer growth, and a new radiation-delivery system is available at Carilion Clinic in Roanoke.

According to the Virginia Cancer Registry, cancer kills about 13,500 people in the commonwealth each year. The cancer death rate is dropping slightly here, according to the registry’s most recent data, but Virginia’s rate is still slightly higher than the national average. There have been big gains — cases of prostate cancer, for example, dropped nearly 6 percent between 2000 and 2004, and breast cancer declined 3 percent during the same period. But there’s still much to do: Only two Virginia localities — Fairfax and Arlington counties — met a federal goal of reducing the annual cancer death rate to below 160 per 100,000 people.

Here is a sampling of what some Virginia institutions are doing to fight cancer.

Proton Therapy Institute

Proton therapy differs from conventional photon-radiation therapy in that its energy can be targeted at the tumor itself and away from surrounding healthy tissue. That means fewer side effects and lets physicians use radiation therapy against hard-to-reach tumors, such as those in the head and neck, eyes, liver or prostate, says Cynthia Keppel, the scientific and technical director at the Hampton University Proton Therapy Institute. “The golden thing you want is something that’s noninvasive, that people won’t feel and it won’t make them sick, and that can go anywhere in the body, unlike surgery,” she says. “That’s what this is.”

The world’s first proton therapy center opened at Loma Linda University Medical Center in California in 1990. Since then three others have been built in the U.S., in Massachusetts, Indiana and Texas, and a fifth will open at the University of Pennsylvania next year. The Hampton center is 98,000 square feet and will employ about 120 people. Keppel says major insurance companies cover the procedure, and university officials predict it will treat more than 2,000 people a year. Roughly 60 percent are expected to be victims of prostate cancer, which Harvey notes strikes black men disproportionately.

After learning about proton therapy about three years ago, Harvey moved to win state approval for the project and began fundraising. Though Hampton does not have a medical school, Harvey says it “has been involved in cancer research for several decades, and to expand to cancer treatment is almost a natural evolution.” Hampton is getting help from radiation oncologists from the Eastern Virginia Medical School in Norfolk. Plus, Sentara Healthcare, also based in Norfolk, is providing $2 million for the project.

Money for most of the project is being raised through the sale of tax-exempt bonds, Harvey says. But he also hopes to get a significant share of public funds — $10 million from Virginia, and $50 million from the federal government. So far, though, neither sum is guaranteed.

Harvey argues that other proton centers have received similar support. Gov. Tim Kaine recommended $1 million in funding in the state’s budget proposal, but the General Assembly cut that amount in half in the final budget. Harvey is frustrated but says the center will be completed no matter what. “I don’t know anybody who has not been touched by cancer. Why our legislators don’t quite get it, I don’t know,” he says.

GMU’s cancer roadblock
No two cancers are alike, says Chip Petricoin, a cancer researcher at George Mason University. The secret to blocking cancer growth is learning exactly how the proteins that drive cell growth grow inside each tumor. In the past three years, Petricoin, a former researcher at the Food and Drug Administration, and fellow researcher Lance Liotta, a former chief of pathology at the National Cancer Institute, have developed a way to map that growth. What they hope to do next is match that information with the class of drugs — called targeted inhibitors — that can block protein growth. Right now, there are about a dozen such drugs, but doctors don’t know which ones to use, “We’re trying to take the guessing out,” says Petricoin.

This is especially valuable when fighting secondary cancers that have spread from the original tumor, because stopping secondary growth could require a different drug, he adds. The GMU researchers are planning a clinical trial for later this year with Novartis, maker of Gleevec, a medicine that “turns off” specific proteins in cancer cells and is used to fight a type of leukemia. Partner Inova Health Systems will provide the clinical support and infrastructure for the trial, which will test whether the drug can help patients with advanced liver cancer that has spread to other sites.  “Our scientific intent is to try to apply these technologies to patients who have the least amount of hope,” says Petricoin.  “What better population to help first?”

In 2006 Petricoin and Liotta launched a company, called Theranos tics Health, based on their technology. Theranostics is defined as combining a diagnostic test to define a patient’s illness with a targeted drug therapy based on the test results. Located in Rockville, Md., the company has nine employees, and its founders have big plans. In a few years, Petricoin says, “there might be 40, 50 or 60” targeted inhibitors. “Companies like Theranostics are going to have an important, and even dominant, role in determining which drug to give a patient.”

Carilion’s CyberKnife

Last summer, Betty Woolwine, 57, a secretary in the special education department of Roanoke County Schools, sat grim-faced when she heard the news. Her doctor told her that her cancer had returned for a fifth time. Since the initial diagnosis of rectal colon cancer in 1996, she had undergone four surgeries, massive doses of radiation and a year of chemotherapy that left her with a permanent colostomy bag and a left side of her body “that has taken a beating.” During the past decade, her cancer reappeared in the same location, then metastasized to her lungs. Last summer, doctors found a tumor on her left rib.

“My options were an invasive surgery that involved chemotherapy and the risk that I’d lose my left lung and need to be on oxygen for the rest of my life — or a new treatment called CyberKnife,” she says. CyberKnife features a linear accelerator — the radiation source — mounted on a movable robotic arm and uses image-guidance technology to deliver radiation to precisely targeted tumors, shielding normal body tissue from radiation. The Carilion Roanoke Memorial Hospital, where Woolwine was treated, became the first hospital in Virginia to implement CyberKnife technology in November 2005. A second hospital, Virginia Hospital Center in Arlington, acquired the technology last November.
To Woolwine, the prospect of more surgery, radiation and chemotherapy treatments was so discouraging that she opted for the $49,000 CyberKnife treatment, even though her health insurer refused to pay because it considers the treatment to be experimental. Family and friends and the hospital worked with her to pay for the procedure.
She underwent three treatments in early August, and “there’s no comparison. I kept thinking it can’t work because it’s too easy. The staff was wonderful explaining the process; the machine wasn’t intimidating and it didn’t hurt.” After her previous cancer surgeries, Woolwine was out of work for at least six weeks, plus additional time as needed because of illness and nausea associated with chemotherapy. After the CyberKnife treatment, which did not require additional chemotherapy, she took two weeks off “more because I needed the time to fight the insurance company and to come to grips with my fifth reoccurrence of cancer. But I felt great.”

Palliative care at VCU

In a fight with a life-threatening illness, having a doctor who won’t quit seems like a good thing. But if it’s a losing fight, somebody needs to say so, says Dr. Thomas Smith, founder and director of the Thomas Palliative Care Unit at Virginia Commonwealth University’s Massey Cancer Center.
“It’s really hard for doctors, including me, to look somebody in the eye and say, ‘I’m sorry, but we really can’t fix your disease.’ And it’s hard for patients to accept that. And yet it’s so critically important,” he says. “If you’ve got six weeks or six months to live, you’d like to live that to the fullest. And part of that comes from understanding how much time you really have.”

Palliative care begins with that kind of honest dialogue between patients, family members and physicians. What it can lead to, Smith says, is more effective treatment of symptoms, including pain management. “We’ve shown that we can improve the symptoms of most people by about 50 percent in two days, because basically that’s what we do. We pay attention to symptoms,” he says. Palliative care can also halve the financial costs of dying, he says, by avoiding needless medical therapies done only because “that’s what the doctors and patients knew to do.”

VCU’s Massey Center is a national leader in palliative care. It’s one of six sites nationwide designed as a pallia tive-care training center by the New York City-based Center to Advance Palliative Care. Massey’s Thomas center, which opened in 2000, has 11 beds and admits about 500 people annually.  It also does about 1,800 consultations within the health system every year, Smith says, and has an outpatient clinic one day a week. Its rooms offer a more comfortable and home-like space where families can gather, cook meals, and even bring in pets.
Palliative care is catching on. About 70 percent of hospitals with more than 200 beds have a palliative care program today, up from “essentially zero percent 10 years ago,” Smith says. Smaller hospitals and medical centers rely on consultations from larger hospitals.

The Massey Center helped launch the Virginia Initiative for Palliative Care, through which health-care providers, chaplains and social workers can get training for dealing with end-of-life issues. Dr. James Franko, medical director of general medicine and hospitalist services at the Carilion Medical Center in Roanoke, went through the training under Smith in 2006. It’s especially valuable for hospitalists — physicians who work exclusively in hospitals — because they frequently deal with dying patients. “There’s not a lot of training for that in medical school or residency programs,” Franko says. Oftentimes doctors are reluctant to try a palliative approach because “many times physicians think of the patient’s death as their own personal failure, when it’s not the case at all. It’s just the natural progression of the disease.”
Carilion now has a palliative care doctor on staff, he says. When doctors understand palliative care, they can care for their patients even if they can’t save them, he says. Such as the “death rattle” — the gurgling sound sometimes heard in a dying person’s last breaths, which is always upsetting for family members. The right medications can prevent those fluids from building up, he says. “There’s always something we can do,” Franko says. “We can comfort, and there’s something we can do to make the patient comfortable, to make the loved ones comfortable.”

University of Virginia begins constructionon new cancer clinic

The University of Virginia Medical Center is building a $74 million outpatient cancer clinic.
Construction began on the 150,000-square-foot Emily Couric Clinical Cancer Center in April in Charlottesville. The five-story center is named for the late Emily Couric, a Virginia state senator who died in 2001 after a long battle with pancreatic cancer. She was the sister of CBS News anchor Katie Couric. The cancer center is scheduled for completion in 2011. U.Va. gets about 41,000 outpatient visits a year, one-third of which involve patients traveling at least 100 miles. The new building is part of an overall expansion of the U.Va. Health System. Other plans include construction of a 72-bed tower, a new children’s hospital and a 40-bed long-term, acute-care facility.


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