The Next Step in Cancer Research
by Ruth SoRelle, M.P.H.
Dr. C. Kent Osborne does not understand why people are surprised that Baylor College of Medicine is seeking National Cancer Institute designation as a comprehensive cancer center.
They should be asking why it is not already one.
"If you add up all the cancer funding our researchers have, it would rank us 15th among the current 60 NCI-designated cancer centers. And our funding goes up each year," he said.
As director of the BCM Cancer Center, Osborne knows that the drive to obtain that NCI designation has two goals—better patient care for everyone treated by BCM physicians and even better research.
That means private patients to be seen in the Baylor Clinic and at St. Luke's Episcopal Hospital, veterans at the Michael E. DeBakey Veterans Affairs Medical Center, the working poor at Ben Taub General Hospital and the youngsters at Texas Children's Hospital.
"Our mission is to join all the cancer activities at Baylor College of Medicine and its affiliated institutions to further reduce cancer mortality," said Osborne.
Texas and even Houston could be considered underserved. The state has only two comprehensive cancer centers, and Houston has only one. Some cities in the Northeast have two and three.
Osborne and his colleagues have grouped the many cancer-related research activities at BCM into eight programs that include breast cancer, prostate cancer, cell and gene therapy, pediatric oncology, nuclear receptors, cancer biology, molecular carcinogenesis, and cancer prevention. The BCM Cancer Center is also home to various shared resources that provide essential services that allow cancer researchers to accomplish their goals.
One innovative program in cancer control outreach and health disparities, headed by BCM Professor of Medicine
Dr. Amelie Ramirez, seeks ways to encourage more participation in cancer research by ethnic and racial minorities while building coalitions to educate communities about cancer and its prevention.
Osborne also hopes to expand programs at BCM in gastrointestinal cancer, lung cancer, hematologic malignancies in adults (leukemia and lymphoma), genitourinary cancer (outside the already strong prostate program), molecular imaging, biomedical use of nanotechnology, stem cell biology as well as studies of DNA repair.
Research "at the bench" is the key to understanding the cancer puzzle, said Dr. Bert O'Malley, chair of the BCM department of molecular and cellular biology and associate director for basic research at the BCM Cancer Center.
"You cannot fix a car if you don't understand how it works," he said. "When we understand what goes wrong in cancer, we will understand so much about everything from aging to metabolism. If I look at everything in our department, 98 percent of it would apply to cancer."
The journey from laboratory to bench to bedside is becoming faster, and a comprehensive cancer center will make it even easier he said.
"In 15 years, we will have made a huge jump in therapy in breast cancer and prostate cancer," he said. "Most of it will have come out of basic science."
It is clinical research, however that continues to offer more immediate hope for many patients, who look to studies of new drugs and therapies that result in remission of their disease and even cures.
Baylor's various hospital affiliations offer an "ideal mix "of different kinds of populations for such studies.
 Timothy Thompson, Ph.D.
Freedom to think...
"I'm getting too old for this," mutters an exhausted urology professor Dr. Timothy Thompson as he arrives to work on a particularly sweltering July morning. The cause of his fatigue is not his job as a prostate cancer researcher, which he loves, but rather the "academic lobbying" he has had to do in Washington, D.C. to preserve funding for his Specialized Program of Research Excellence (SPORE).
As one of the top-ranked SPORE programs in the country, Thompson's team aims to harness the body's biological weapons to trigger an immune response against any cancer that escapes the prostate gland. By no means are they taking the easy route.
"We push forward original and very innovative concepts and capture a lot of ideas that otherwise may not ever be tested clinically and may not ever have a chance to really benefit any patients," Thompson says.
Thompson's academic office could easily be mistaken for that of a high school teacher. The small room has a few windows and a picture of his son as an infant but is otherwise austere, unless stacks of papers and piles of journals qualify as decoration. He says the freedom of creative thinking afforded at Baylor has made him feel as though he has never had a real job. Reclining in his chair with his feet propped up on his desk, he acts like it, too.
"I enjoy free-thinking and new ideas," says Thompson, sounding every bit like he is still in college. "That's the joy of science."
 Sharon Plon, M.D., Ph.D.
A foot in two courts...
Dr. Sharon Plon's career could be a roadmap for bridging gaps between disciplines and fields in medicine.
She came to Baylor College of Medicine because the newly established Texas Children's Cancer Center gave her the opportunity to bring together her two professional loves—medical genetics and cancer research. She runs both adult and pediatric cancer genetics clinics, where she advises patients with concerns about their cancer risk.
Take the problem of colon cancer.
Most patients she sees in the adult genetic clinic at the Baylor Clinic are referred for breast cancer – mainly because physicians and patients recognized the potential for a genetic predisposition. Yet colon cancer can also be inherited.
"We have done studies at BCM showing that people are more likely to be screened for breast cancer than colon cancer—even when there is a family history of colon cancer," she said.
Plon directs clinics at Baylor Clinic, Texas Children's Cancer Center, and a combined adult and pediatric clinic at the Vannie E. Cook Jr. Children's Cancer and Hematology Clinic in McAllen. In each, she spends time with both patient and their family.
"The patient's treatment directly affects other family members," she said. "Parents of pediatric cancer patients want to know their risk of having other children with cancer and the risk to the child's siblings. The parents themselves could face increased cancer risks."
"Often, the biggest impact of what we do is on the other family members," said Plon.
 David G. Poplack, M.D.
No matter what...
Walk through the Texas Children's Cancer Center on any given day and you might see a ballerina from the Houston Ballet standing en pointe, or a violinist performing for a rapt group of youngsters.
At a table nearby, children draw pictures as part of an Arts-in-Medicine program while mothers chat and nurses help with an IV.
It's a tableau Dr. David Poplack could hardly have envisioned in 1993 when BCM President Dr. Ralph Feigin and Texas Children's Hospital President Mark Wallace asked him to leave the National Institutes of Health to build the best pediatric hematology/oncology program in the nation.
"That was music to my ears," said Poplack.
Today, there are 87 faculty members, over 500 employees and 26 different laboratories, all doing work related to childhood cancer and blood diseases. The Center also pursues nearly 300 innovative studies and has "more new agent clinical trials in progress than many drug companies."
Texas Children's Cancer Center is also home to one of the largest pediatric hematology/oncology fellowship programs in the country, and partners with The University of Texas M.D. Anderson Cancer Center in a Childhood Cancer Epidemiology and Prevention program. In McAllen, Texas, the Center operates the Vannie E. Cook Jr. Children's Cancer Clinic, Long-Term Survivor Clinic, and Cancer Genetics Clinic.
"We have a philosophy," said Poplack. "It is not enough to simply to give the correct chemotherapy. We must provide outstanding psychosocial support. We embrace our patients and their families and are with them throughout their cancer experience, no matter what they need, no matter the outcome."
 Richard Elledge, M.D.
Doing the right thing...
Fighting cancer is not a Lone Ranger activity. It involves many medical disciplines, health care providers and a lot of communication.
Dr. Richard Elledge, medical director of the Breast Care Center at Baylor College of Medicine and The Methodist Hospital and associate professor of medicine at BCM, is passionate about this team approach.
"That's why patients come to the Breast Center," he said. "They often remark that our care is both personalized and seamless."
The Breast Center provides prevention, genetic evaluation, diagnosis, treatment and psychosocial support services, and offers imaging, chemotherapy, specialty nurses, clinical research staff, a genetic counselor, psychologists, as well as physicians from multiple specialties including medical oncologists. The team also includes a surgeon, a plastic surgeon, and a breast pathologist.
"We have all of that together in one place," said Elledge. "We did it because it was the right thing to do. Published studies also show that women who receive their care at multidisciplinary breast centers have a lower risk of the cancer coming back and higher cure rates."
The Center also conducts studies of treatments and drugs in patients, an important part of developing new strategies for a difficult disease. Since the Center opened in 1999, it has run 40 different studies—15 to 20 of which remain open to patients.
"It creates new knowledge. It is the only way to improve the care of women with breast cancer," he said.
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