Scientists are making gains despite obstacles

SECOND OF THREE PARTS

University of Hawaii researchers believe they are on the cusp of significant breakthroughs in the development of anti-cancer drugs that could extend the life span of patients while bringing much-needed revenue to the UH Cancer Center.

Among the center’s current research, scientists are studying chemical compounds that stop the growth of brain tumors and breast cancer cells, a combination of titanium and gold that destroys kidney cancer cells and a drug that can be injected into the bladder to kill the disease.

The Cancer Center’s goal is to get its research into clinical trials, where the efficacy of potential drugs and treatments can be studied first in animals, then in humans and ultimately approved by the U.S. Food and Drug Administration for commercial use. There are roughly 150 clinical trials at the National Cancer Institute-designated center at any given time — half pediatric and half adult studies.

“The issue is getting the word out to patients and doctors in the community that we have clinical trials here. Some may not know that despite our efforts to inform them,” said Charles Rosser, professor and director of the center’s clinical trials office. Ongoing studies are posted at uhcancercenter.org.

Clinical trials also have been stymied by a lack of state support, internal division within the organization and government rules and regulations that prevent researchers from bringing cancer cells and animal test subjects into Hawaii in a timely manner, he said.

“Hawaii has certain laws in which you can’t readily get access to cells or animals. It takes us over a year to do it, and it’s very likely that someone at UCLA will get the same idea,” Rosser said. “By that time our novel idea isn’t so novel anymore. When something like that happens, it puts biomedical research at a disadvantage.”

Hawaii is one of the few NCI centers that doesn’t have its own university hospital where researchers can conduct studies and generate revenue from treating patients. Instead, the UH Cancer Center collaborates with the Queen’s Medical Center, Hawaii Pacific Health, Kuakini Medical Center and UH Manoa’s John A. Burns School of Medicine — known as the UH Cancer Consortium — and community oncologists to get its research into trials. The hospitals invest $2.2 million annually to help with the recruitment of investigators and startup laboratory costs.

“We’re probably one of the smallest NCI cancer centers competing with people like MD Anderson,” Rosser said. “We’re small not only in terms of researchers, but in the number of clinical trials. Most NCI centers near 300 trials. The goal isn’t necessarily to do more; the goal is to better serve the people here in Hawaii.”

It typically takes up to 10 years from discovery to getting a potential drug into the clinical trials phase and more than $100 million to finance it through FDA approval, he said.

More than 6,000 Hawaii residents are diagnosed with an invasive cancer each year, and more than 2,000 will die from the disease annually. The number of people affected by cancer is projected to grow as the population ages, with nearly every person in the state facing a cancer diagnosis, either personally or within their family, at some point in their life.

Typically, 80 percent of cancers lend themselves to traditional treatments, while the other 20 percent do not respond.

“There are 1,400 patients who really do not respond well to traditional treatments. This is where the clinical research provides potential value,” said Art Ushijima, Queen’s chief executive officer. “There’s 200 different types of cancers, so there’s no one treatment that will cure every cancer that emerges in a person. The value then of cancer research is when you can provide these novel treatments for patients.”

Much of the cancer center’s research focuses on Hawaii’s diverse population and studies specific to higher-risk populations, including Native Hawaiians, Pacific islanders and Asians. Researchers have found that certain cancers are more aggressive in different patient populations, such as breast cancer in Native Hawaiian women.

One of the organization’s substantial contributions to cancer research internationally has been the creation of a so-called multiethnic cohort started in the 1990s. The Cancer Center followed the group of ethnically diverse Hawaii patients for more than 20 years, tracking their food, lifestyle choices and whether they develop health problems such as cancer. The study led to insights into how genetics and nutrition interact to determine cancer risk.

“Because Hawaii is so diverse, we’re like a special microcosm of studying how ethnicity affects your cancer risk combined with environment,” said professor Joe Ramos, director of the cancer biology program. “It’s not only about clinical trials or approved drugs. People around the world access this research.”

Out of the 152 patients in these studies, the typical cure rate — five years or longer with no sign of cancer — ranges from 20 percent to 40 percent.

“Trials used to be very broad. Now they’re very targeted,” Rosser said. “Years ago we would give blanket chemotherapy that would kill everything — bad and good cells. Now we have a way to find out what’s making bad cells bad and give them drugs specifically for that. Clinical trials have cured cancer. That’s ultimately what we’re looking for.”

UH CANCER CENTER’S RESEARCH BREAKTHROUGHS

Multiethnic cohort

The Cancer Center has followed a group of ethnically diverse Hawaii patients for more than 20 years, tracking their food, lifestyle choices and whether they develop health problems such as cancer. The study led to insights into how genetics and nutrition interact to determine cancer risk.

E-cigarette prevalence

UH researchers were among the first to investigate the health effects of electronic cigarette use. They uncovered a growing public health problem in Hawaii high schools, with local teens using e-cigarettes at nearly triple the rate of mainland teens.

Prediabetic indicators

The Cancer Center has discovered markers that identify whether a person is prediabetic by measuring the fatty acids in their blood, which could allow physicians to warn patients years before the onset of diabetes to change their lifestyle and potentially avoid the chronic disease.

Detecting colorectal cancer

Researchers found six genetic variants associated with an increased risk of colorectal cancer as part of a large international study that will help identify individuals who should be prioritized for colonoscopy screening to find tumors earlier and increase patient survival.

Discovery of cancer mutation

Researchers were among the first to identify a new cancer syndrome caused by mutations in the protein Bap1, associated with a higher incidence of mesothelioma, melanoma, renal carcinoma and other cancers. It is the focus of several new lines of research to better diagnose and treat cancers.

New bladder cancer drug

The new drug is expected to be more effective for patients with nonmuscle invasive bladder cancer, the most common type of the bladder disease.

Compounds to fight brain and breast cancers

Researchers have discovered two chemical compounds that effectively stop the growth of brain cancer cells and breast tumors, opening the way for potential new drugs to be developed. The targeted treatments are less toxic and could give cancer patients a better quality of life.

Compound to fight kidney cancer

Researchers developed a promising metal-based compound of titanium and gold that destroys kidney cancer cells while leaving normal cells unharmed. The findings might provide a new way of treating kidney cancer, opening the potential for more potent and less toxic therapies that would give cancer patients a better quality of life.

Source: University of Hawaii Cancer Center