Advancing Cancer Care at the Clinical Center
The parking garage in the new Mark O. Hatfield Clinical Research Center is a speed bump-free zone - less likely, by that design, to intensify nausea in chemotherapy patients. Down to such details that improve patients' quality of life, the new center is the embodiment of lessons learned from the decades-long union of compassionate patient care and cutting-edge scientific research.
Since its opening more than 50 years ago, the NIH clinical center has played a singular role in advancing cancer care. A mark of this success is the NCI's pioneering work in immunotherapy - boosting the body's own cancer-fighting potential. In the 1980s, NCI Surgery Branch Chief Dr. Steven Rosenberg and his team were largely responsible for advancing the treatment of metastatic melanoma and kidney cancer using the immune system-booster interleukin-2 (IL-2). Known as the grandfather of immunotherapeutics, IL-2 stimulates the continued growth of T cells in the body, generating response rates of 15 to 20 percent for advanced melanoma and kidney cancers. It continues to be part of the standard of care for these cancers.
Today the groundbreaking work in this area continues. Dr. Jeffrey Schlom and his colleagues in the Laboratory of Tumor Immunology and Biology, for instance, have had early success with novel recombinant vaccines to treat gastrointestinal, prostate, and lung cancers. The vaccines equip the immune system to attack tumor cells it would otherwise not recognize as a threat to the body. "This is not only a completely different approach to treating cancer, but one that has the potential to be virtually free of deadly side effects," Dr. Schlom says.
Meanwhile, Dr. Rosenberg is teaming with others in CCR to convert interleukins and other cytokines with antitumor activity into the tools of another therapeutic line of attack called adoptive immunotherapy. This novel approach uses drugs, gene therapy, and cell transfer to more effectively coax the body's own immune system into action to combat cancer.
NCI research in the clinical center also is focusing on lymphoma - the annual incidence of which has almost doubled over the last 35 years. Dr. Wyndham Wilson and his colleagues in the Experimental Transplantation and Immunology Branch have produced promising results with a five-agent chemotherapy regimen called EPOCH. In early trials, EPOCH yielded a cure rate of 80 percent for the most common adult type of non-Hodgkin's lymphoma, diffuse large B-cell lymphoma (DLBCL). Cure rates with standard therapy are approximately 50 percent.
"These results are based on 12 years of work we have been doing here, building from basic scientific principles," says Dr. Wilson. Because of this success, his team is planning to launch a randomized phase III international clinical trial to compare pharmacodynamic dosing of the EPOCH-regimen agents with standard therapy against DLBCL.
NCI clinical center research is not focused solely on treatment. Researchers from the Division of Epidemiology and Genetics are fueling advances in prevention and early detection through the Family Studies program - a multidisciplinary research model established 30 years ago, long before the term "team science" entered the medical lexicon. It employs clinicians, epidemiologists, geneticists, and biologists in a collaborative manner, and has set the stage for today's molecular epidemiology research.
Major familial cancer syndromes have been identified through this effort, such as Li-Fraumeni, hereditary breast and ovarian cancer, and hereditary melanoma. Current initiatives for early detection and prevention include a familial melanoma risk-lowering study and trials to test a novel screening tool and risk-reducing surgery to prevent ovarian cancer in high-risk women. "These types of trials are not likely to be funded through a traditional grant mechanism," says Genetic Epidemiology Branch Chief Dr. Peggy Tucker, "and the clinical center forms the infrastructure, onsite collaborative efforts, free evaluation and care, and patient travel activities from which these high-risk, high-impact studies can be run."
Important changes in the delivery of care also have been ushered into practice as a result of NCI work in the clinical center, including the first outpatient clinic for administering chemotherapy, the first outpatient care centers, and the first day hospital - each of which are now standard components at many cancer centers - as well as the first oncology nurses' training program.
For oncology nurses, says Caryn Steakley, CCR deputy clinical director and a registered nurse, the clinical center offers real opportunities to make a difference. "Imagine," she says, "being able to teach patients about research studies and their role as study subjects, participating in developing approaches to symptom management to improve patient outcomes, and connecting with patients and families to improve the health of the nation."