Cancer Fighter

One of the newest elements in the Kakaako waterfront’s changing skyline is a terracotta-and-green tower that, Dr. Brian Issell hopes, will help to accelerate Hawaii’s progress in the fight against one of the world’s dread diseases.

It’s the new home of the University of Hawaii Cancer Center, a research institute that, Issell said, is an essential if Hawaii wants its residents to have access to the best cancer treatments, including clinical trials of developing drugs, without boarding an airplane.

"People in Hawaii deserve to have top-quality care without the need to go, except in very unusual circumstances, to a mainland center," said Issell, who is the center’s associate director of clinical and translational research.

"Translational research" is a concept that’s key to the success of the overall mission: creating a cancer infrastructure in Hawaii, in which advances in research is translated to treatment in clinics (for more on the clinical aspect, see story on page F4).

The UH Cancer Center, first established in 1981, was previously known as the Cancer Research Center of Hawaii. It now operates out of quarters at Lauhala Street near The Queen’s Medical Center, the UH John A. Burns School of Medicine and office space in the Gold Bond Building. That scattered existence should end once construction of the new home is finished sometime this fall.

And last week, while crews continued their work building out the interior structure beneath the glassy facade, a VIP group surveyed the scene with interest. What made these observers very important is that they came from the National Cancer Institute, the federal agency that issues grants to research programs that it approves.

The renewal of that approval — the Hawaii institution’s official designation as an NCI cancer center — is what’s at stake here. Issell, the center’s associ- ate director of clinical and translational research, said everyone hopes to hear back from NCI in a few months.

The UH Cancer Center has held its NCI designation since 1996, but in its previous periodic review, a few red flags appeared, not the least of them its lack of an adequate campus to house its research and administration.

It was the risk of losing the designation that lit a fire beneath the state to get the new center, years on its to-do list, built at last. Planning picked up speed in 2009, when Dr. Michele Carbone took over as director and M.R.C. Greenwood became UH president.

"When I arrived here in 2009, the Cancer Center project was one of the highest priorities both for me and the regents," Greenwood said. "This is a state that needs its own cancer center, and this state is valuable to the rest of the nation because we have populations to do clinical trials that are not as available elsewhere."

Every Monday for about a year, roughly until mid-2010, Greenwood, Carbone and others met to coordinate the center’s planning, the meetings becoming monthly once the project got under way in earnest. Greenwood said she’s proud of the team’s fundraising achievement, breaking the $10 million mark in philanthropic donations to the project, being built at a total cost of about $140 million.

Among the other concerns that the NCI raised was the need to attract a full complement of researchers — "academic physicians," as Carbone described them in a Star-Advertiser interviewer a year ago.

"You are not going to attract top academic physicians unless they can work in an academic environment," said Carbone at the time. "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."

The Hawaii Cancer Consortium, founded in February 2010, now includes the UH Cancer Center, Queen’s, Hawaii Pacific Health, Kuakini Medical Center and the medical school; officials say it’s open to other Hawaii hospitals as well. It operates as a 501(c)3 not-for-profit corporation with a mechanism for coordinated care: a centralized institutional review board that enables treatment and prevention approaches to be implemented in a timely way.

The consortium also will do strategic planning, according to its mission statement, "providing strategic, team-oriented approaches for advancing the academic and clinical oncology programs within a single, operationally -efficient enterprise."

All of this, officials hope, will assuage any concerns the NCI team has about the center’s ability to deliver on what Issell considers the bottom-line issue: "the best science."

"All these scientists — clinician scientists throughout the country, the best — come out to review us," he said. "And they want to make sure, to have that designation that you have the best science."

Hawaii has biodiversity, he said, everything from plants to corals that may yield promising chemical components. Issell himself has done early-stage research work on the Hawaiian plant noni, examples of and some of its varied species that could yield the next anti-cancer drug.

"The most effective drugs in cancer have actually come from natural products," he added. "You’ve probably heard of taxol. It comes from the yew tree. The other important drugs that have really saved so many lives, particularly children and young adults with Hodgkins disease and lymphoma and leukemia, are from the periwinkle plant, the vinca, vincristine and vinblastine."

Hawaii scientists believe that the islands also have something important to offer in its ethnic diversity as an asset in clinical trials. Issell cited the statistic that 75 percent of the population are non-Caucasian minorities.

"We developed a cohesive clinical trials program," he said. "We call it a minority-based CCOP (community clinical oncology program) because of our special population.

"This gave us the opportunity to access all the clinical trials," he said. "Basically, where we’re very different, which I think is a unique advantage, is we don’t have a tertiary referral hospital, we don’t have a university-run hospital. We actually work through really excellent community hospitals. It’s all community-based.

"To me that means we can actually take research discoveries into community applications so much faster, because the majority of cancer care in our country, by far the majority, is done through community," he said. "And the trouble is, there’s always that disconnect."

A "tertiary referral" hospital — a large specialized institution, often university-affiliated, such as the University of Texas MD Cancer Center — often will make a discovery and then draw a selection of patients for the clinical trials, Issell said.

"You get a selection of only certain types of patients, certain characteristics," he added. "First of all, they have to be economically able to go. And usually it’s the more motivated people.

"We’ll do discoveries in that setting, but what’s right for the majority of the people? We’ll say, ‘Is it generalizable to the majority of people that have cancer in our country?’

"So we (in Hawaii) have a better idea because we’re doing it in that setting to start off with," he said. "We have the engagement right at the start."