On October 1, the American Cancer Society (ACS) Cancer Action Network (CAN) along with presenting sponsors University of Colorado Cancer Center and UCHealth hosted more than a hundred leaders from business, education, government, and research communities to answer an interesting question: What do a highly successful new treatment against leukemia stem cells, a new way to point the immune system at pediatric cancer cells, and new understanding of how Medicare expansion affects cancer outcomes have in common? The answer: All three are born in Colorado. Due in part to new investments in infrastructure and the recruitment of top talent, combined with a climate of collaboration and innovation, CU Cancer Center researchers are at the forefront of discoveries and initiatives that are driving a golden age of cancer prevention, research, and care.
Delivering quick welcome messages were representatives from the offices of Senator Michael Bennet, Senator Cory Gardner, and Representative Jason Crow, along with RJ Ours, Colorado Government Relations Director for ACS CAN. Attendees included John J. Reily, Jr., MD, Dean of the University of Colorado School of Medicine, and Don Elliman, Chancellor of the University of Colorado Anschutz Medical Campus.
“We’re working today to strengthen Colorado’s network of people collaborating to fight cancer so that you have the new tools and resources to accelerate the pace of discovery during this significant period of change, opportunity, and promise to end cancer as a health problem,” Ours said, setting the tone.
Leading the morning’s program was CU Cancer Center Director, Richard Schulick, MD, who spoke about the burden of cancer, the strategies we use to attack it, and the activities across the CU Cancer Center consortium to develop new strategies for cancer prevention, early detection, treatment, education, and access to care.
“I’m here not only as the cancer center director, but as the son of two parents who developed cancer during their lifetimes. My passion comes from very personal experience,” Schulick said. “What is our goal? For the people in this room, the goal is to eradicate the pain and suffering from cancer.”
Despite a 26 percent reduction in the death rate of people diagnosed with cancer over the previous 25 years, there remains a long way to go toward Schulick’s goal. In the next decade, cancer is set to overtake heart disease as the leading cause of death in the United States. About 1.7 million Americans will be diagnosed with dangerous cancer this year, and 600,000 will pass from the disease, over 8,000 in Colorado alone. Lifetime cancer risk is about 40 percent and the risk of dying from cancer is about 20 percent.
“I can’t imagine a more pressing problem we need to deal with a society, a research institution, and as a community,” Schulick said.
In addition to innovative, new treatments, Schulick says many gains will come from learning to better use existing treatments. For example, the traditional workflow of cancer care starts with a primary care physician, who refers a patient to an oncology specialist, who may send the patient a week later for diagnostic imaging, then a week later to consult with a surgeon, who sends the patient to a radiologist, etc. – all of which results in many appointments over the course of weeks or months just to decide on a course of care. Instead, at CU Cancer Center care partners, patients may be seen in “multidisciplinary clinics.”
“It’s a better model for taking care of cancer patients,” Schulick says. “They come in the morning, get a physical exam and any needed imaging, see a nutritionist, a pain specialist, etc. Then all the doctors and specialists meet from noon to one and go over everything, typically with 30 or more people in the room. Everyone is there, they all weigh in and argue about the best treatment plan. Then the whole team meets with the patient, all at the same time. In one day, everything is done, the whole treatment plan laid out. Patients love this and their families love it even more.”
Now a major goal is to expand access to the best cancer care to patients outside the Denver metro area.
“We’re trying to make the very best care available to every citizen in Colorado and surrounding states, no matter where they live. It’s no good if we have all the best therapies and clinical trials concentrated only on this campus – that doesn’t do any good for a lot of people who can’t get here. So we have to spread our ability to care for these patients,” Schulick says.
The second presentation highlighted this need for additional services to reach Colorado’s rural and underserved populations.
Cathy Bradley, PhD, CU Cancer Center deputy director, pointed out that the lung cancer survival rate for patients living in the Front Range is 70 percent, while the survival rate for Coloradoans living in rural and high-poverty areas is only 55 percent. Likewise, rates of HPV vaccination that can effectively prevent cervical cancer are 45 percent in Colorado as a whole, but only 28 percent in rural areas.
“These disparities are wider than they are elsewhere,” Bradley says. “Our white population does better than whites nationally, while our Hispanics do worse than Hispanics nationally. And the Colorado youth vaping rate is four times the national average.”
Bradley also pointed out the benefit in focusing on cancer prevention, pointing out that while $500,000 could help 3,000 people become non-smokers, or screen 700 people for lung cancer, or screen 1,200 people for colon cancer, the same amount of money is only enough to treat 4-8 people with advanced cancers.
Until recently, one of the worst of these advanced cancer was acute myeloid leukemia (AML).
“AML is an absolute monster of a disease, one of the most aggressive forms of cancer known to man. Until a couple years ago, they never would have invited someone like me to a breakfast like this: I would have been too depressing. That’s all changed in the last couple years,” says Daniel A. Pollyea, MD, MS, the Robert H. Allen Endowed Chair in Hematology Research and clinical director of Leukemia Services at the CU School of Medicine.
Based on CU Cancer Center basic science, Pollyea and colleagues have built a hematology program specifically focused on targeting leukemia stem cells.
“It’s population of cells that can’t be killed with chemo and that causes relapse,” Pollyea says. “We believed that if we could kill leukemia stem cells, maybe we could even cure the disease.”
The treatment that Pollyea was able to offer to Colorado patients through clinical trials in 2015 earned FDA approval in 2018.
“Patients here were essentially getting a treatment of the future, kind of time traveling years into the future to get a therapy that wasn’t available then. That’s what so incredible about being a clinician who works in research – the hope we could deliver a treatment of the future to a patient today,” Pollyea says.
Now new trials at CU Cancer Center are refining Pollyea’s treatment and showing that targeting cancer stem cells may have applications for more people with AML and perhaps even beyond leukemia.
“At other places, it can be like, ‘We’ve never done this before so we’re not going to do it now.’ Here at CU, it’s more like, ‘We’ve never done that before so let’s figure out how to make it happen,’” Pollyea says.
One of these new things we are just figuring out is how to make happen is engineering a patient’s own T cells to attack cancer, which is the specialty of the morning’s third speaker, Terry Fry, MD, CU Cancer Center investigator and co-director of the Human Immunology and Immunotherapy Initiative at Children’s Hospital Colorado.
“I was happy with my career at the National Institutes of Health,” Fry says. “I had developed a good team, and when Lia Gore [of CU Cancer Center and Children’s Hospital Colorado] called me to take a look, it was sort of a, ‘Oh, okay, I’ll take a look.’ But from my first visit, it was pretty clear that Colorado was the place I wanted to be to develop the next generation of immunotherapy.”
The first generation of immunotherapies was developed more than a century ago, when a doctor named William Coley noticed that some cancer patients who developed infections actually had better cancer outcomes – in rare cases, an activated immune system would attack tumor tissue. Then radiation and chemotherapy showed more promise, and anti-cancer immunotherapy went on the back burner for many decades. Terry Fry is a pioneer in the generation of scientists who revived the idea, often despite naysaying by many in the research community who thought it would never pan out.
“I just heard Jimmy Carter is celebrating his 95th birthday today. He was one of the first recipients of immunotherapy for brain cancer,” Fry says.
But while Jimmy Carter’s treatment was meant to remove a kind of braking system that kept the immune system from attacking cancer, Fry specializes in the design and testing of treatments that engineer the body’s immune system T cells to recognize and attack cancer cells.
“I’ve been privileged to be part of a field called genetically modified T cell therapy, or CAR-T cell therapy. Fifteen or twenty years ago, nobody would have ever thought that it would be possible to take T cells from patients, genetically modify them to see proteins on the surface of cancer cells, and then reinfuse them as a drug to target cancer,” he says.
Still, major challenges remain for CAR-T therapy. Despite being able to induce remission in 80 percent of pediatric patients with B-cell leukemia, about 50 percent will relapse within the first year.
“I certainly don’t feel like we’re done,” Fry says. “This is a therapy that is very, very new for us in the field of cancer treatment, and we still need to improve induction rate, durability, and the ability to deliver the treatment safely.”
Another challenge for CAR-T therapy is cost, an issue brought up by the first question delivered to the panel by a parent whose daughter had been treated at UCHealth University of Colorado Hospital.
“For a long time, the whole conversation was about therapy success, and now people are starting to talk about the challenge of access,” Fry says. “The cost of CAR-T is about three or four-hundred thousand per treatment, so it’s a real challenge that we need to figure out. One thing being discussed is that the standard treatment is chemo and bone marrow transplant, which costs more than $500K and we pay for that now. If we can do this therapy the right way, there’s a possibility it could replace another expensive therapy. Also, a lot of work is being done to bring down the cost of these treatments.”
The next question asked about research into the rising rate of colorectal cancer diagnosed in adults below age 50.
“Right now, in my inbox is data describing Colorado rates of colorectal cancer in people under 50,” says Cathy Bradley. “It’s something we’re aware of as a problem and is just starting to get attention nationally.”
Schulick pointed out that the American Cancer Society is leading a push to lower the recommended age to start colorectal cancer screening from 50 to 45. “The question is what’s the cost and what are the lives saved,” Schulick says, “but I think there’s enough evidence now to lower the screening age. Another frontier is genetic risk. The idea is that maybe if you have a certain panel of genes, you have your first colonoscopy at age 20 or 30 or 40. I think the frontiers are being pushed and we’re learning more about genetics and risk factors and how to implement screening that saves lives.”
Additional questions focused on how federal policies may affect cancer research, including a proposal to increase annual NIH funding by $6 billion, and how Medicare expansion has affected cancer outcomes.
“In a study funded by the ACS, we looked at states that expanded Medicare and those that did not, and found that with far more low income women being screened, there were fewer late-stage diagnoses, and longer survival,” says Bradley. “Also, the availability of medications through Medicaid meant that more were people taking medicines as directed, and more people staying in the workforce.”
These federal policies that affect cancer research and care may seem abstract, but the ACS closed the morning by offering two ways to get involved now: First, ACS Ambassador Martha Cox suggested signing the ACS petition to increase cancer research funding; second, Cox suggested becoming a member of the ACS Cancer Action Network.
Despite significant progress against cancer, there remains much more to do. Right now, here in Colorado, we are at an absolute epicenter of research aimed at the disease. Events like this morning’s ACS research breakfast ensure that everyone in the community of people who care about cancer is aware of the great opportunity and also the great responsibility we have to continue powering this push toward a day when suffering from cancer is no more.