publication date: Aug. 6, 2019
Conversation with The Cancer Letter
Indiana University Simon Cancer Center becomes 51st NCI-designated comprehensive cancer center
Indiana University Melvin and Bren Simon Cancer Center
Indiana University Distinguished Professor
H. H. Gregg Professor of Oncology
The Indiana University Melvin and Bren Simon Cancer Center has achieved comprehensive status—becoming the only NCI-designated comprehensive cancer center in Indiana.
“We are very proud,” said Patrick Loehrer, director of IUSCC, Indiana University Distinguished Professor, associate dean for cancer research, H. H. Gregg Professor of Oncology, and professor of medicine at IU School of Medicine. “The last time a Midwest institution received comprehensive status was 11 years ago for the University of Chicago.”
The cancer center received an “outstanding” rating by NCI reviewers and was awarded a five-year, $13.8 million grant that supports the center’s research programs and shared facilities. That marks an increase of 43 percent from the previous five-year funding period.
NCI Acting Director Douglas Lowy announced the designation Aug. 6 at Indiana University.
“Designated cancer centers are recognized for their state-of-the-art research programs and strong commitment to delivering cutting-edge cancer treatment for patients,” Lowy said in a statement. “They are at the core of the nation’s cancer research effort.”
The comprehensive designation comes with IUSCC’s second Cancer Center Support Grant renewal, after Loehrer and his team recruited 32 faculty over the past five years and invested in the cancer center’s population science programs.
“This has been our goal since I became director. In our first venture five years ago, we thought we were close,” Loehrer said to The Cancer Letter. “Over the last several years, we have made a conscientious effort to make a stronger case for comprehensiveness.
“In terms of our total commitment to the cancer center, it has been millions of dollars that have been involved. Our development office has brought our current total endowment close to $100 million through philanthropic support. A large proportion lie in endowed chairs used for mid- to senior-level recruits. Institutionally, we secure about $3 million to $4 million a year through philanthropic efforts.”
IUSCC now has nearly 250 researchers, who altogether hold 459 grants that total more than $60 million in external funding.
“We’re very involved with really promulgating clinical research, so we’ve had a twofold increase in our number of investigator-initiated grants,” Loehrer said. “We’ve had over a threefold increase in our multi-PI grants—a 47% increase in our NCI funding, and a 40% increase in funding per our members. Also, 17% of our publications have an impact factor greater than 10.
“I believe all of these factors contributed to convincing the site visitors that we were an outstanding institution. Our score went from 30 to 22—an eight-point improvement—of which we’re very proud. It further underscores the depth and breadth of our research.”
In addition to recognizing the center’s laboratory and clinical research, NCI reviewers said IUSCC has “very well-designed community outreach efforts to serve the needs” of the state of Indiana. This includes initiatives to increase HPV vaccination rates, as well as developing, testing and disseminating interventions to increase screenings for breast, cervical and colorectal cancer in racially diverse and rural populations in Indiana.
Also, reviewers commended the cancer center’s work in western Kenya—in partnership with Moi University, IUSCC helped fund and establish the Chandaria Cancer and Chronic Diseases Center.
“Our work in Kenya, I think, is very important,” Loehrer said. “It’s come along extraordinarily well. When I first visited Eldoret 15 years ago, there were just maybe a couple of hundred patients seen and they had basically no standardized treatment.
“Today, we’re seeing about 800 patients a month in our cancer clinics now. We are screening about 1,000 women a month for cervical and breast cancer screening. We’ve opened a $5.5 million cancer and chronic care building.”
Will IUSCC henceforth be known as the IU Simon Comprehensive Cancer Center?
“I love that. That’s part of the discussion—what are we going to call ourselves?” Loehrer said. “We are basically going to have an all-cancer-center retreat in the next couple of months, and we have our strategic plan in place. But we want to go over this with all of the membership and redefine our direction of where we’re headed.”
Loehrer spoke with Matthew Ong, a reporter with The Cancer Letter.
Congratulations! This makes you the only cancer center to have a comprehensive designation in Indiana, right?
How long have you been working on it?
This is a 20-year journey. We’ve been an NCI designated center since 1999, and I’ve been director of the cancer center for nine years. I succeeded Steve Williams, the founding director, who unfortunately succumbed to melanoma a decade ago.
How long did it take to get the comprehensive designation?
I guess I’ll wait another 30 years for The Comprehensive Cancer Letter…
Well actually, this has been our goal since I became director. This was my second CCSG renewal. In our first venture five years ago, we thought we were close. Over the last several years, we have made a conscientious effort to make a stronger case for comprehensiveness.
What goes into making the case for the reviewers at NCI that IUSCC deserves comprehensive designation?
As you know, the guidelines for comprehensiveness is to show excellence in basic, clinical and population research, and to also demonstrate inter-programmatic collaborations. And so, we focused on those areas.
Additionally, the reviewers pay particular attention to the impact of outreach and engagement especially in population science. We have, I believe, done an extraordinary job in that area. I’m very proud of our leaders of our Cancer Prevention and Control Program, Drs. Susan Rawl and Todd Skaar, and of Dr. Victoria Champion, who is the associate director of population science and community engagement. The CPC program got an outstanding rating and we were very, very pleased.
How will the comprehensive designation empower your work and mission in Indiana?
This is a continuum. So, our researchers who have been working incredibly hard will continue to do so. This designation bolsters them with a sense of confidence and much deserved respect, if you will. It acknowledges their hard work. With this designation, we now sit at the roundtable of other elite cancer centers in the country.
It is my hope that this designation will leverage additional support to help advance our activities to further impact the burden of cancer for all patients in Indiana and beyond.
How much did you have to spend to develop IUSCC into a comprehensive-level institution?
That’s a good question. I’m going to guess that we probably spent north of $100,000 on this, just for the grant preparation itself. In terms of our total commitment to the cancer center, it has been millions of dollars that have been involved.
Our development office has brought our current total endowment close to $100 million through philanthropic support. A large proportion lie in endowed chairs used for mid- to senior-level recruits. Institutionally, we secure about $3 million to $4 million a year through philanthropic efforts.
Did you have to engage in intensive recruitment over the past five years or more?
Yes, indeed. The job of the cancer director primarily is for fundraising and for recruitment. And then at home, our job is to make the lives of our researchers better, by trying to improve their shared resources and helping with pilot projects. We recruited 32 new cancer center members over the past five years.
In that recruitment process, which disciplines did you focus on growing?
We put a particular emphasis on population science, because that was one of the areas we believed would help us secure comprehensive status. About five years ago, we recruited Dr. Jiali Han to be the founding director of the Department of Epidemiology at the IU Fairbanks School of Public Health. He’s a cancer epidemiologist who came from Harvard, and he brought gravitas to that position.
We also recruited Dr. Lois Travis, who has done work with survivorship, particularly in the testis population, which builds upon the work of Larry Einhorn here, who is the world’s preeminent clinical researcher for testis cancer.
We have worked on developing the pharmacogenomics program. We worked with the university to create a university-wide Precision Health Initiative (PHI), which is a $120 million investment towards precision medicine encompassing cancer, neurodegenerative disease and regenerative medicine. PHI is the first recipient of the IU Grand Challenges program.
Within the PHI, we have prospective cohorts for triple negative breast cancer, which is one of the most common cancers in Indiana, for multiple myeloma, in which we have a very strong myeloma program, and for pediatric sarcomas. The PHI has several pillars, which includes Chemical Biology and Biotherapeutics; Genomic Medicine; Data and Informatics; and Cell, Gene and Immune Therapy.
The key elements of the Precision Health Initiative are led by researchers from the cancer center, which is now actually integrated into the fabric of the university’s precision medicine program. Obviously, these themes have great ties with cancer, but precision medicine fits across other diseases like Alzheimer’s, diabetes, and other non-communicable chronic diseases—our efforts have helped shape the direction for the university.
What sets IU Simon Cancer Center apart from other cancer centers in the region?
There are a number of areas that I think the IU Simon Cancer Center is known for. Obviously, our clinical work has been incredibly strong. Dr. Larry Einhorn and his apostles over the last several decades have basically transformed the most common cause of death in young men—testicular cancer.
In the 1970s, it was about a 5% cure rate, and now it’s 95%, and it’s because of a plethora of trials that he has led or influenced. This provided for a strong platform for clinical research. In many ways, we are the cradle of cooperative groups. In the early 1980s, we created a research organization called the Hoosier Oncology Group, now known as the Hoosier Cancer Research Network (HCRN), which has more than 200 sites around the globe. This initially was set up with an academic community partnership that has now mostly consisted of linkages with academic centers.
Together with Steve Rosen [then director of the cancer center at Northwestern], we established the Big Ten Cancer Research Consortium, which uses the HCRN as its administrative source. We have 13 of the 14 Big Ten institutions as members. The Big Ten has the largest number of NCI-designated cancer centers of any athletic conference in the country, and it focuses on largely the Midwest—cancer centers working together to do clinical and translational research.
We’ve also created the AMPATH Oncology Program, which links numerous North American institutions with Moi University and Moi Teaching Referral Hospital in western Kenya. And this is considered by many a model for global oncology. So, from a clinical research perspective, I think we’re incredibly strong.
We’ve had a number of areas of innovation—Dr. Wade Clapp and his colleagues have the first and only pathway driven in pediatrics in the country focused on NF1 and RAS signaling. We have the only normal tissue bank for breast tissue in the world, the Komen Tissue Bank, which has well over 5,000 specimens.
Hal Broxmeyer, one of our researchers, is, as far as I know, the first and only PhD to be president of ASH. He was a pioneer in umbilical cord transplant and has spent a career researching stem cells, in particularly hematopoiesis. He most recently has underscored the importance of hypoxia in the collection and analysis of in-vivo studies. Everything that we have studied with pathways—in terms of what we study in the laboratory—may be turned upside down, because we have not been previously studying them in the physiologic conditions of hypoxia, and he’s leading that effort.
One final point is our work in symptom science and how we have integrated precision medicine. Not only do we have a precision medicine tumor board that serves the university, but we have several outreach sites now in the rural parts of the state in which they call in on a weekly basis and we discuss this, but we’ve also used pharmacogenomics to help us understand the selective toxicity of patients with these drugs.
Dr. Bryan Schneider is leading the first trial looking at pharmacogenomic markers that help predict the neurotoxicity of African American women using taxanes and breast cancer. This is a trial that’s just opened up in the ECOG-ACRIN Cancer Research Group. It’s the first trial of its kind, focusing in on understanding why African Americans may have greater toxicity with paclitaxel, but also seeing whether an alternative taxane (i.e. taxotere) can actually have improved outcomes in these patients because of better tolerability and compliance.
We’ve chatted about this previously—the NCI reviewers, obviously, commended IUSCC for its work in Kenya. What did the reviewers say?
They very much praised our work, because of the vision of our cancer center to decrease the burden of cancer in Indiana, but also beyond. Our work in Kenya, I think, is very important.
I personally would love to see global oncology become much more woven into the fabric of comprehensive cancer centers. The vast majority of cancer centers in the country are involved in global research, to some degree.
To the best of my knowledge, there is not currently a cancer center in the country now that has a scientific program focused on global oncology in the NCI Core Grant. But all of us are doing work in those areas, so my hope is that it will help serve as a stimulus to make this work much more common and cohesive with the cancer centers around the country.
What’s the latest from AMPATH at Eldoret in Kenya? How is the program coming along?
It’s come along extraordinarily well. When I first visited Eldoret 15 years ago, there were just maybe a couple of hundred patients seen and they had basically no standardized treatment. Today, we’re seeing about 800 patients a month in our cancer clinics now. We are screening about 1,000 women a month for cervical and breast cancer screening. We’ve opened a $5.5 million cancer and chronic care building.
And I’m delighted to say that we now finally have approval from the government of Kenya and the International Atomic Energy Agency, so we’re expecting radiation therapy equipment to be delivered this fall with the first patient treated either the end of this year or the beginning of next year.
That’s been something I’ve been looking forward to for the past 15 years. And this will be the first radiation unit serving the public sector in western Kenya, which has a catchment area of around 20 million people, so we’re very excited about that.
What are your plans and next steps for IUSCC? Or, should I say, IUSCCC?
I love that. That’s part of the discussion—what are we going to call ourselves? There are formal announcements of this to the public today, on Aug. 6. Dr. Douglas Lowy, who’s the acting director of the NCI, is here to make the announcement. We’re very excited about that.
We are basically going to have an all-cancer-center retreat in the next couple of months, and we have our strategic plan in place. But we want to go over this with all of the membership and redefine our direction of where we’re headed.
I think, again, we’re very keen to focus on a number of different areas, including building on prevention, early detection, and population health, and focusing on biology to bedside research—again, our theme of precision medicine and not only with the understanding of the biology of tumors, but also through pharmacogenomics. And finally, a big pillar for us is health care disparities and survivorship and symptom science.
Were there any specific improvements—in NCI grant funding, perhaps—that led to an increase in your score?
I’m glad you asked that question. We’re very involved with really promulgating clinical research, so we’ve had a twofold increase in our number of investigator-initiated grants. We’ve had over a threefold increase in our multi-PI grants—a 47% increase in our NCI funding, and a 40% increase in funding per our members. Also, 17% of our publications have an impact factor greater than 10.
I believe all of these factors contributed to convincing the site visitors that we were an outstanding institution. Our score went from 30 to 22—an eight-point improvement—of which we’re very proud. It further underscores the depth and breadth of our research.
Right, which makes you the 51st NCI-designated comprehensive cancer center.
Yes. We are very proud. The last time a Midwest institution received comprehensive status was 11 years ago for the University of Chicago.