New Approach To Cancer Treatment May Hold Key To Patients’ Live
Long Beach Memorial Medical Center’s Robert A. Nagourney, M.D., Tests Potential Drugs In Laboratory
By Barbara Crane
Contributing Writer
Long Beach Business Journal
December 2003
“Columbus knew the world was round, but it took him 20 years to get the three ships he needed to prove it to everyone else,” says Robert A. Nagourney, M.D.
That’s an interesting fact, but why is a noted cancer researcher, respected physician and newly named director of the Malcolm C. Todd, M.D. Cancer Institute talking about Columbus? Because he is challenging the accepted cancer treatments just as the Italian explorer challenged the accepted geography of his time. And the three ships that Columbus sailed across the seas? For Dr. Nagourney, these could represent his reputation in the medical community; his laboratory studies, for which he recently received funding; and the position Memorial Medical Center currently holds in the nation.
The second largest hospital on the West Coast, Long Beach Memorial Medical Center has won national recognition for its cancer programs. HCIA, Inc., a national research organization based in Washington, D.C., named the hospital as Los Angeles’s best cancer program. Nagourney says, “I couldn’t do what I’m doing at Johns Hopkins, Harvard or UCLA. What you need is a center that’s large enough to make its own way – and a good idea.”
The “good idea” is a new approach to cancer treatment that Nagourney began formulating 20 years ago: the idea that you could, as he says, “test cancer in a test tube.” That hope had been dashed in the 1970s when researchers tried to stop cancer cells from replicating by subjecting them to various drugs. They found that although cancer cells did stop growing in the test tube, when the same drugs were used in human beings, the expected positive results in patient recovery did not occur.
Nagourney looked at the research and found a correlation that others had missed: the number of cells that died in the test tube corresponded to the number that died in the patient. Later, he understood that cell replication was not the problem. Cells are “born” at the same steady rate in both healthy people and people with cancer; it takes three months for them to divide and produce new cells. Cancer cells, however, refuse to die at that same steady rate. They continue to live and multiply until they ultimately overwhelm the normal cells. The problem is not overgrowth, but underdeath, he explains.
Recognizing that the fundamental difference between cancer cells and normal cells was the death rate, Nagourney focused his laboratory on drugs that killed human cells in the test tube. This enabled him to test a variety of drugs and combinations of drugs in a laboratory setting rather than subjecting a patient to a series of toxic drug experiments. Nagourney says, “When I realized that you could do this, and it wasn’t reported in the scientific literature, I couldn’t trust the scientific literature any more. I became wedded to what works, and not wedded to dogma.”
A Laboratory Model Points The Way
Nagourney’s plan, which is now coming to fruition, is guided by a laboratory model based on data from 1,600 peer-reviewed patient experiences published in the medical literature. He says, “The model is highly effective in predicting cancer outcomes.” A positive finding in the laboratory is generally associated with a positive outcome for the patient. He’s confident that he can take Memorial Medical Center patients with “uncertain expectations and make their expectations demonstrably better,” for the cancers that are studied in the protocol: pancreatic, colorectal, gastric and non-small cell lung cancer. Moreover, the protocol will enable physicians to learn from the cancers.
Patients newly diagnosed with these cancers can participate in the clinical trials currently being conducted by Nagourney’s laboratory at Long Beach Memorial Medical Center. “They will be referred to a participating physician and will take part in a registered clinical trial within the guidelines of the Federal Drug Administration,” he says. He is conducting the clinical trial at cost, and the Memorial Medical Center Foundation is funding the data analysis. His goals include doubling the response rate to drug therapies and improving the quality and duration of the patient’s life. He has already seen some success.
The Place To Be
Memorial Medical Center plays an important role in this drama. Nagourney and other physicians who are pioneering new treatments have a degree of independence they might not have at smaller or less progressive hospitals. By the same token, if the hospital were on the campus of an academic medical center, a physician might be more of a cog in the wheel, having to execute a more standard protocol. In contrast, Nagourney often initiates new protocols, which then go through the traditional approval process, enabling him to pursue his research in the manner he thinks will be most fruitful.
Long Beach also seems like the place to be. Nagourney says, “It has a burgeoning economy, a mixed population, a large number of businesses, hotels and restaurants and a busy airport.” Many of his patients use the Long Beach Airport; one commutes regularly from Cincinnati to be treated by the physician.
Better Path To Drug Development
Nagourney believes his method may also assist in the development of cancer therapies. As it now stands, the theory underlying drug development is upside down, he says. “If the cancer cell stops growing, we say the drug works. But it doesn’t. [Patients don’t get well.] Imagine if you had a correct model and you designed a drug for that model.”
Here’s how it might work: the human genome project allows scientists to better examine the molecular basis of cancer. For some specific cancers, targeted therapies go after a particular feature – a genetic abnormality – of a person’s cancer cells. Nagourney cites an example of the success of Gleevec®, the commercial name for a product made by Novartis Pharmaceutical, which has been used successfully with thousands of patients who have chronic myelogenous leukemia.
While thousands of people may develop this type of leukemia in a year, the most common cancers, like those of the breast, lung and prostate, show up in hundreds of thousands of people each year. In these cancers not one but many genetic elements “get broken,” he explains. It takes 11 years and $800 million to develop a new cancer drug. The problem becomes, how do you go from an interesting compound to making cancer patients well faster and at less cost. Nagourney believes that his approach can contribute here as well. Because genes, proteins and environmental factors all determine the cancer’s progression, if you can match treatments to patients with more certainty, you can achieve a better understanding of the cancer and streamline drug development.
New Facility For Cancer Institute
Nagourney’s research comes at a critical time for Long Beach Memorial Medical Center. In six months, it will break ground on its 100,000-square-foot Malcolm C. Todd, M.D. Cancer Institute. Named for the late Long Beach Memorial surgeon, American Medical Association chairman and physician advisor to five U.S. presidents, the center will occupy the north end of the medical center’s campus. Nagourney was recently named the institute’s medical director. “The facility will bring comprehensive and innovative prevention, screening, diagnosis, treatment, clinical research and education to one location,” says Nagourney.
“Cancer has become a chronic outpatient disease,” says Cathy Copy, the institute’s executive director. Therefore, it makes sense to build a center where patients can find all their outpatient services in one place. City of Hope and the Norris Cancer Hospital are analogous institutions but they treat cancer patients only. “It would be difficult to find a full service hospital like Memorial Medical Center with such a specialized cancer center,” Copy says. The institute is being built using private funds that include money raised from hospital operations and private philanthropy.
Among other services, the institute will house the Memorial Breast Center, one of the largest in the country, which screens and treats 40,000 people yearly. The new facility will enable the hospital to increase the number of people being served, important because a growing number of patients come from outside the City of Long Beach. The center will also house outpatient services for children. Children needing inpatient care will continue to be served by the Jonathan Jaques Children’s Cancer Center within Long Beach Memorial’s Miller Children’s Hospital.
The American Cancer Institute estimates that 40 percent of all people will experience a cancer diagnosis in their lifetime. Within Los Angeles County 53,000 people are not getting their care at one of the top 10 centers. “Getting a first opinion at one of these centers can make a difference in your recovery,” Copy says. The Todd Cancer Institute has already attracted some of the nation’s leaders in research and treatment. A new facility will make its highly-ranked services more accessible to the public.
|