Sunday, November 29, 2015         

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Michele Carbone

A challenging local economy isn't stopping this native of Italy from turning Hawaii's Cancer Research Center into a world-class facility

By Vicki Viotti


Michele Carbone, director of the Cancer Research Center of Hawaii, has acquired a reputation for a love of cooking -- but for now, the production he's overseeing with the most relish is not a dish at all but the building that's finally under construction near his offices and lab in Kakaako.

Ground was broken in October on the $140 million project and in a few weeks the foundation will be poured, roughly a month ahead of schedule. At this pace, Carbone said, there's some hope of a late 2012 opening.

But at least by early 2013, Carbone and his staff can finally realize a dream of a full-scale facility that will allow them to leave behind the University of Hawaii-Manoa center's scattered labs and offices at its rented Lauhala Street building, Gold Bond Building and UH School of Medicine.

Before taking the helm in September 2009, Carbone's focus was on research into mesothelioma, the kind of cancer linked to asbestos. Now he's building new partnerships with Honolulu cancer specialists and luring new experts on cancers known to afflict people here in particular, helped in part by a grant issued under the American Recovery and Reinvestment Act (ARRA), also known as stimulus funds.

At 50, Carbone feels settled in Hawaii, a place that seemed instantly familiar when he first came in 2006 to take a UH-Manoa faculty position. To explain that move, he pulled out a poster of an idyllic beach scene. It looked just like Waimea Bay.

"Exactly!" he exclaimed. "But this is Calabria (in Italy). This is my beach. This is where I grew up.

"The fact is, if I want to live in the United States, the closest place to my house is this," Carbone added. "Also, the mentality of people here and the way they are is much more similar to the south of Italy than anywhere else."

Question: What will the new facilities have that will enhance what the Cancer Research Center can do for Hawaii?

Answer: The Lauhala cancer center is too small to host all of us, and at the same time we are too small to be a cancer center. The NCI (National Cancer Institute) expects a cancer center to have a larger number of researchers and physicians, and the critical mass here is too small. So the NCI told us we need to at least double up in size or we cannot continue to be an NCI-designated cancer center. So really, there was no option but to build another facility.

Q: How important is the NCI designation?

A: It's a kind of accreditation. There are only 65 in the United States of America. You have to go through a very tough process of peer review. It comes with a grant from the NCI that, of course, is very important. But also it gives you access to resources that only cancer centers have access to. For example: Last year we got two ARRA grants for a total of $2.6 million, and only an NCI-designated cancer center could compete for that.

So, on one end it's a stamp of excellence that assures people that they are dealing with something that has been vetted by a very strict peer-review process and at the same time gives us access to resources that otherwise we would never have. And then there is a third part, and that's the prestige. Many top researchers-investigators would be very difficult to recruit or to keep in a cancer center if it was not an NCI-designated cancer center.

Q: What is the purpose of the ARRA grants?

A: These grants were assigned, one, to (liver specialist) Linda Wong ... Hawaii has the highest incidence of liver cancer in the United States. It's a record we don't like, and we would like to lose it. But unfortunately, we are not only the first one, but the second one has less than half of what we have. So the incidence here is extremely higher than anywhere else. Linda is the surgeon who treats almost all people with liver cancer. So we have used the ARRA grants to build a liver cancer team around Linda for the purpose of developing preventive approaches first in novel therapeutic approaches ... Breast cancer, women who are Hawaiian, Hawaiian ethnic descent, have a much worse prognosis when they have advanced breast cancer than women of any other ethnic group. Now, why is that? Clayton Chong is a physician-oncologist at Queen's (Medical Center); Clayton is the one who made the observation and then linked it to some possible oncogene (potentially cancer-causing gene) alterations; he's the recipient of the other ARRA grant. So we have used this grant to build a team of researchers around Clayton to see if we can address the issue: Why is it that women of Hawaiian descent have a worse prognosis, and what we can do about it?

Q: How far will that money carry you?

A: You have to look at it as kind of seed money. It will last for another year, and hopefully out of the work that has been performed these two years, then these things will be able to generate grant funding that would allow them to grow.

Q: More generally, what benefits will the patients of Hawaii see from the development of the cancer center?

A. Whatever advance is made in cancer research benefits everybody, including the people of Hawaii.

Then, as we discussed, there are certain types of problems that are peculiar to Hawaii. ... So either you study them here or you forget about it -- second thing.

The third thing is that now the cancer center is working together with the hospitals.

Q: How does that consortium work?

A: One problem we have had here is being able to attract top-quality physicians and academic physicians. You are not going to attract top academic physicians unless they can work in an academic environment. The university doesn't have a hospital; the hospitals do not have a university. How do you fix it? You fix it the way that we did; we formed a consortium.

Let me give you an example to explain myself. I have hired now, for example, Amy Powers. Amy Powers was (the pathologist) in charge of the blood bank at Beth Israel, one of the Harvard hospitals -- not a bad place to be. I wanted to hire her here. I could not have hired her here because we do not have a hospital. Still, she would not have gone to work in a hospital if she could not work in a university. On top of that, I couldn't have afforded her salary, because as a state university, we could not pay what a physician makes. So what we did is I hired Amy 50 percent; the other 50 percent is Queen's. Queen's needed very much somebody who had expertise, but did not have the possibility to recruit her by itself without the academic support in it. ... Queen's gets the cutting-edge clinical pathology experience that it needed, and we brought her here.

Q: So you've enabled a partnership that shares resources?

A: Kind of the Switzerland that helps everybody to go along, yes. ... Another benefit is the money. Besides this building that is now being built, the state gives us $2.4 million a year in funds; that's what we receive. We bring in about $31 million in grants. About 90 percent of the money is spent here in the islands. It gives jobs to a lot of people. It gives opportunities to a lot of people. We have some very bright kids here. ... They need to be working in good places, with good investigators.

Q: There have been years of battles for funding at the Legislature. Do you feel more secure of the support you'll get?

A: The world has changed, and so you need to do business in a different way, ... because if you do not evolve, you collapse like the Soviet Union. ... Definitely what we need to do, which is the next important, critical step, is to engage the society of Honolulu. This cancer center historically has been the one that has brought in less fundraising than any cancer center in the United States. But Honolulu is ranked, what, the 11th top city in the United States? ... So the capacity's here, and there is a huge disproportion between the capacity and the fundraising that the cancer center has done. ... We need to show we are good, because if you are a philanthropist and you want to donate your money, you want to be sure that your money is donated in a place where it makes a difference.

And, therefore, many philanthropists here are donating to Sloan-Kettering in New York, and the Anderson Cancer Centers. So we need to convince them that we are doing cutting-edge cancer research here, and in fact they don't need to be sending their philanthropy money to New York, that they can spend it here.

But the capacity here exists, so there is a tremendous potential for growth. Now, we have gone from the $300,000-$400,000 average the cancer center had done for the years before I was director; last year we closed at $3.1 million. ... It's not bad. It's still way low compared to what other cancer centers make, but now we are not so low.

Q: How have you settled in here? Wasn't the critique originally that you didn't come with administrative experience?

A: Since they couldn't find anything else, they said 'administrative experience.' (Laughs) It's true for any type of job, right? Until you have had that job, you didn't have experience. So if that were true, you should never have a job.

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