Don't tell Robert Bast that there's a divide between basic research and clinical impact. As vice president for translational research at MD Anderson Cancer Center, Bast practices the kind of bench-to-bedside work that he says exemplifies science at the institute. As a clinician, he treats patients with breast and ovarian cancer; in his lab of about a dozen people, he studies cell growth regulation and imprinted tumor suppressor genes, among other things.
MD Anderson was founded in 1941 as part of the University of Texas system. Thirty years later, it became one of the first three nationally designated Comprehensive Cancer Centers thanks to the National Cancer Act. Today, it is one of 39 such designated cancer centers across the US. According to MD Anderson, nearly 700,000 patients have received care at the center since its inception.
Part of Bast's job is to "facilitate moving new ideas and new drugs from the laboratory to the clinic," and he says it's just as important to complete the loop by bringing clinical "information back to the laboratory."
To that end, MD Anderson has established a career training program for both "physician-scientists" and "clinician-investigators" — scientists and clinicians who are encouraged to spend time on the other side of the fence. The center's program targets 20 of its "best and brightest young faculty," says Bast. Those people get two mentors — one a clinician and one a scientist — and spend as much as 80 percent of their time for five years working "in the laboratory on clinically relevant programs," he adds. By the end of the first three years, these faculty members are expected to have submitted a significant grant proposal. So far, Bast says, at least 70 percent of the participants have been awarded grant funding. "We hope to get that to 100 percent," he says.
Funding is something everyone has to keep in mind, and MD Anderson has been successful with its internal grant initiative that puts scientists in a better position to win federal funding as their research matures. "We have provided grants of $250,000 internally" to support early stage research projects consisting of multiple investigators for a few years, Bast says. Ultimately, the concept helps the whole institute: Bast contends that the center's track record in securing major grants is boosted by this seed funding program, which helps researchers gather the preliminary data needed to solidify a bigger, later-stage grant proposal.
With physicians and scientists so well versed in bench and bedside life, it makes sense that MD Anderson has one of the highest rates of patient participation in clinical trials. In the US, about four percent of adults with cancer are enrolled in these trials; at this cancer center, the fraction is much more substantial — 30 percent is not uncommon, and certain groups, such as leukemia, have even higher rates. That gives patients access to the most cutting-edge treatments out there, Bast says; it's also a critical step to validating the hundreds of cancer drugs in development around the world.
Collaboration is key
Just as Bast works to make sure clinicians and scientists both feel comfortable in each other's realms, collaboration between research programs and even with external institutions is encouraged at MD Anderson.
Anil Sood, who has a research appointment in the cancer biology department and a clinical appointment in the gynecologic oncology program, is working to find new, more efficient ways to deliver siRNA as a possible treatment for cancer. That research is occurring in collaboration with colleagues from the experimental therapeutics department, and Sood says that results are promising. "Realistically, I think we are about eight or nine months away from starting this in clinical trials," he adds. Sood joined MD Anderson six years ago, and at the time he really wasn't looking to move from his post at the University of Iowa. But he was impressed by the concentration of cancer specialists in one institution. "The intellectual pool as a whole is enormous," he says. "It covers the entire spectrum, all the way from human clinical trials to preclinical studies to doing work at the single-cell level. The amount of work that goes into cancer research is absolutely phenomenal."
Bast says that teamwork is a crucial part of the attack on cancer, and in that spirit MD Anderson has established multidisciplinary groups for each of the major types of cancer, such as breast, lung, colon, and so forth. Laboratory scientists work with surgeons, pathologists, diagnostic imagers, and other specialists to provide as much expertise as possible.
The teamwork concept got an extra boost when MD Anderson recently expanded, adding six buildings to its campus, each one dedicated to a particular program. The metastasis building has been around the longest; the basic research program is part of the immunology building. "Each one of these is basically an experiment to see if we can get people together physically" to improve research and patient treatment, Bast says. He adds that having people from various backgrounds all working toward the same goal is furthered by such factors as serendipitous interactions in the cafeteria, or people in open lab space realizing that their research fits nicely with someone else's. Shared resources, of course, are another path to promoting this. Bast says MD Anderson has more than 20 such facilities, ranging from flow cytometry to DNA sequencing to animal imaging and even clinical trials.
Friends in pharma
Beyond the collaborations within MD Anderson, though, one key to the institute's success has been its model of partnering with outside organizations — both other academic institutions and pharmaceutical or biotech companies. Alliances formed in the past few years, Bast says, include agreements with AstraZeneca, GlaxoSmithKline, and others that take care of IP concerns in such a way that "we can take on new projects within a day." In those partnerships, MD Anderson participants meet with their pharma counterparts every six months to find out about new drugs coming through the pipeline, Bast says. "We think that that's a model for how we might facilitate the translation of promising drugs from the laboratory to the clinic," he adds.
Sood says that while most of his partnerships are with other academic institutions, "we certainly have close collaborations with biotech companies as well. … For the small companies, we bring both the clinical knowledge [and] expertise as well as the animal models or biological assays that we have established," he says. "They have novel technologies that they are trying to bring to cancer."
MD Anderson Cancer Center
Host: University of Texas system
President: John Mendelsohn is president of the executive committee that oversees the cancer center.
Began: MD Anderson was formed in 1941 and became one of the first three Comprehensive Cancer Centers as designated by the National Cancer Act of 1971.
Staff: The institute employs some 16,000 people, including more than 1,300 faculty members.
Funding: Much of MD Anderson's funding comes from the National Cancer Institute, where it has won more awards than any other institution. In 2006, the center invested more than $410 million in research. As the NIH budget has grown lean, the state of Texas established a $300 million kitty to serve as matching funds for the cancer center.
Core facilities: The center has more than 20 core labs, ranging from gene sequencing to flow cytometry to animal imaging to clinical trials.
Patients: Nearly 80,000 patients are expected to receive care at MD Anderson this year, and 27,000 of them will be new patients. The center boasts a much higher rate of patients who enroll in clinical trials than the US national average; in 2006, 11,000 patients participated in some kind of research trial.