Bioscience

Scottsdale Healthcare takes on ambitious agenda to advance personalized medicine

July 26, 2006

By Flinn Foundation

A couple of years ago, a doctor at an internationally renowned medical center called up Dr. Daniel Von Hoff, director of the translational drug development division for the Translational Genomics Research Institute (TGen) in Phoenix. The doctor was about to operate on a woman with a rare tumor.

“She told me, ‘Dan, I’m going to take this tumor out, but this patient doesn’t want chemotherapy. We need to find something that has a chance of helping her,'” Von Hoff said.

Prior to arriving in Arizona, Von Hoff had become well known within scientific circles for building a research center in San Antonio that focused on finding new therapies for individuals with advanced cancer, and he was about to launch a similar center in Scottsdale.

Stacks of files regarding the patient’s history poured into Von Hoff’s office, and he spent night after night laboring over them. Using TGen’s technology, he was able to identify a potential therapeutic target. The patient transferred her care to Scottsdale Healthcare, where she was placed on a clinical trial for an experimental drug.

Von Hoff, who is now also the chief science officer for Scottsdale Clinical Research Institute (SCRI), calls this woman’s story an example of what personalized medicine can do for someone. But the story also stands for much more—it is representative of the larger ambitions of the hospital that works with Von Hoff and his team.

Six years ago, Scottsdale Healthcare administrators were revising their hospital system’s vision. After visiting the Web sites of pharmaceutical companies and high tech companies, they found themselves increasingly drawn to the concept of personalized healthcare and medicine.

“We’re in an era of consumerism where people are much savvier of their healthcare services,” said Thomas Sadvary, chief executive officer of Scottsdale Healthcare. “Our vision of personalized healthcare allows us to really distinguish ourselves in meeting the needs of patients.”

Although meeting those needs would strictly entail offering better traditional care services, such as nursing and physical therapy; Scottsdale Healthcare also decided to dive into research.

“Research is about innovative technology and drugs that we will have access to in order to improve how we can personalize the healthcare for the people who come here,” Sadvary said.

Without its own established research base to draw from, Scottsdale Healthcare has begun to carve out its own niche through partnerships and innovative programs that create opportunities for its doctors to engage in research.

As a result, the hospital has become a center for clinical research, where institutions from around the state come together with the aim of translating research as quickly as possible into improved patient care.

SCRI was launched in 2005, yet already it has partnerships with the Arizona Cancer Center, TGen, the International Genomics Consortium, University of Arizona’s College of Nursing, and Arizona State University’s College of Nursing. Sadvary said the institute also plans to develop partnerships with ASU’s Biodesign Institute, as well as with hospitals around the state.

For a hospital system that prides itself on its patient care, research has become as central as its wig shop and beauty parlor, yoga room, and chapel at the Virginia G. Piper Cancer Center—located at Scottsdale Healthcare and the current Phoenix home of the Arizona Cancer Center.

“Research expertise combined with clinical care expertise is a perfect mix to provide absolutely the best care to our patients, now and in the future,” said Susan Brown, associate vice president for oncology services at Scottsdale Healthcare.%pagebreak%

Scottsdale Healthcare, by bringing new treatments and individualized therapy to the East Valley, is aggressively investing in its vision: Setting the standard for excellence in personalized healthcare. And it is not going at it alone; instead it is bringing in partners who can enhance what Brown says Scottsdale Healthcare already does best: patient care.

It is all part of the spirit of collaboration that has propelled Arizona so far in the biosciences in such a short time, and that has distinguished the state on the national stage.

“Cancer is the enemy,” Von Hoff said. “Not each other.”

New therapies brought to the bedside

Community hospitals historically do not engage in research, said Ed Moticka, director of research at Scottsdale Healthcare, a locally-based community hospital system with three campuses and some 5,700 employees.

“I came from the Midwest where if a community hospital couldn’t make money on something, they didn’t do it. And research is really not a moneymaker for a hospital,” he said. “The hospitals here are unique. They all have this feeling that research is an important thing for them to be doing.”

As important as cancer research is to Scottsdale Healthcare, for a long time it was not on the hospital’s radar screen. It was not until 1999—when the Arizona Cancer Center in Tucson approached them with a partnership opportunity—that the blip first appeared.

At the time, Von Hoff was director of the cancer center, which had no Phoenix office. As a result, about 100 patients and a doctor traveled back and forth between the two cities for access to experimental treatments. Von Hoff and other cancer center officials realized that it needed to have a place in the Valley.

It was Scottsdale Healthcare, Von Hoff said, that stepped up to the plate, raising $30 million for the cause and providing a home for the center. Other groups offered their support as well.

“The Virginia G. Piper Charitable Trust and Stardust Foundation have been particularly generous,” said John Ferree, president of the Scottsdale Healthcare Foundation.

Since then, Scottsdale Healthcare has been designated by the National Cancer Institute as an official site for the Tucson-based Arizona Cancer Center.

The hospital system dedicated the new center in 2001, and in 2002 the Virginia G. Piper Cancer Center began offering to Valley cancer patients access to phase I clinical trials.

“We set up a unique program where medical oncologists in the Valley were invited to work at Scottsdale Healthcare and the Arizona Cancer Center provided experimental drugs to treat cancer,” said David Alberts, current director of the Arizona Cancer Center who was one of the physicians who trained Dr. Von Hoff.

Most experimental drugs are in the early phases of development, either in phase I or phase II clinical trials, where researchers are still determining toxicity, dosage, and which cancers specifically to target. Institutions can only get access to them through research and experimental protocols. Because of its partnership with the Arizona Cancer Center, Scottsdale Healthcare is a clinical outlet for the latest experimental therapies. Hundreds of patients come into the clinic every year for access to them, including close to 100 who fly in to Scottsdale from other parts of the country.

“To do phase I clinical trials in a community hospital setting is pretty unique in the country, and we have been doing those for several years,” Brown said. %pagebreak%

Ask Von Hoff about the experimental drugs that have been made available to patients at Scottsdale Healthcare, and he will run through lists of them—like Abraxane, a drug recently approved by the Food and Drug Administration for women with advanced breast cancer.

But perhaps the best example of what these new therapies mean for patients in the Valley is told through another one of Von Hoff’s stories.

This one began two years ago at Thanksgiving. A man arrived at the Virginia G. Piper Cancer Center with very aggressive stomach cancer. Von Hoff and the man’s doctor, who works at the center, started him on a new treatment regimen that few people in the country had tried. The man’s disease completely disappeared by the next Thanksgiving.

“Community oncologists working together with experimental therapeutic oncologists is very special,” Von Hoff said. “And this patient knew it.”

Two years later the man’s cancer reappeared, and no treatment worked anymore. Von Hoff went to the patient at the very end to apologize for not being able to do anymore.

“I wish you could have seen him smile,” Von Hoff said. “He said ‘don’t apologize, you gave me two years. I didn’t expect any of this. I got to go fishing with my son.'”

Individualized therapies

According to Brown, the importance of Scottsdale Healthcare’s role as a clinical research center cannot be overstated.

“There are so many drugs in the pipeline and so few places in which to test them, and that is really slowing up the ability to bring new drugs to patients,” Brown said. “There is a great need particularly in cancer to provide a clinical research site.”

Five years ago Scottsdale Healthcare directed itself towards filling that gap, and now it is moving into another area in which there is a need for a clinical research outlet—personalized medicine.

Less than one year ago, Scottsdale Healthcare established an alliance with TGen, earning the designation as the institute’s primary clinical research outlet.

This alliance brought Von Hoff permanently into Scottsdale Healthcare’s hospital system and also led to the creation of the Pancreatic Cancer Center and the Genomics Medicine and Individual Therapy Center. The Pancreatic Cancer Center is an extension of Von Hoff’s research; pancreatic cancer has been his specialty for many years.

The Genomics Medicine and Individual Therapy Center is what many are touting as the future of personalized medicine. The center will be a joint effort by TGen and Scottsdale Healthcare to utilize all available knowledge of a patient and their advanced cancer in order to select the most effective therapy.

The difference is in the approach, and in having the right tools for the job all under one collaborative roof.

“This is a very different, very aggressive attack on disease,” Von Hoff said.

There are three billion base pairs in our DNA. According to Von Hoff, within those three billion base pairs, researchers, to find the right therapy for cancer patients, need to seek out the six changes that cause cancer.

In its relationship with Scottsdale Healthcare, TGen provides the oncologists the opportunity to conquer such a challenge with access to the latest genomic technology, such as microarrays, chips, supercomputers, and others means for examining a patients’ tumors for molecular targets.

Von Hoff and his research partner based at SCRI, Dr. Mitesh Borad, a genomics medicine scholar with TGen, use the information provided by TGen’s technology to treat the tumors with more specialized therapeutics that could have fewer side effects.

“We’re doing this now because we realized we have pretty much reached a plateau,” Von Hoff said. “We’re treating all the patients with a particular disease, and a few respond, but others don’t. And then it takes an enormous amount of effort–which is obviously incredibly warranted–and resources, to find a treatment that works.”%pagebreak%

Borad and Von Hoff spend at least two to three hours with each patient during a visit, and they say they need more help. Scottsdale Healthcare already has plans to bring two more research physicians on board as soon as August.

“There’s a lot of work to be done,” Brown said. “Around 2,300 new cancer cases come to Scottsdale Healthcare each year, and we have standard treatments for 2,000, and then for the rest we need new, unknown treatments to save their lives.”

Brown said Scottsdale Healthcare is committed to investing in a future of personalized medicine, already with about 90 percent of its cancer research devoted to targeted therapies.

Additionally, SCRI, directed by Von Hoff, is the lead institution on a large scale investigation of targeted therapy. It is one of two trials initiated since the inception of the institute–a number that Von Hoff expects to top 50 by the end of the year.

The targeted therapy study will focus on patients who have progressed on all therapies. Doctors at Scottsdale Healthcare will biopsy the patients’ tumors and then send them to labs at TGen to find molecular targets.

A successful targeted therapy pilot trial was run throughout the country last year, and this time around it is Scottsdale Healthcare that is leading the study.

“This is show time for studying individualized therapy,” Von Hoff said. “And this hospital will be the spot for it.”

Building and expanding a research base

Another piece of Scottsdale Healthcare’s cancer research is found on the ground floor of its headquarters: the Arizona Cancer Center’s cancer prevention programs, which are run by three faculty members and more than a dozen research staff.

“Being on the ground floor is symbolic because prevention is the basis,” Von Hoff said. “The best way to cure cancer is not to get it in the first place.”

Right now the Scottsdale site of the Arizona Cancer Center is helping to run a colon cancer prevention effort. The 1,600 person statewide study, supported by the National Cancer Institute and the Arizona Cancer Center, is testing selenium as a preventing agent for colon polyps.

There is also a soon to be activated skin cancer prevention program at Scottsdale Healthcare, which is utilizing topically applied drugs that could dissolve lesions that are precursors for melanoma, Alberts said. This is a part of a comprehensive skin cancer prevention program in Tucson and Scottsdale that includes early childhood educational curriculum.

While cancer is the central component of SCRI’s research focus, the institute has also begun to expand into other niche areas such as diabetes, cardiology, trauma, and orthopedics. There are 100 studies currently being conducted through SCRI, Moticka said.

There are around 20 different cardiology studies and phase I cardiac drug trials at Scottsdale Healthcare, and in August the hospital will open a diabetes center on its Shea campus. The center will have both an education component and a research component.

One of the first diabetes research projects involves a group called TrialNet, of which SCRI is the only participating Arizona institution, according to Moticka. TrialNet is an NIH-funded program that will enroll relatives of people with Type I diabetes and test them for the presence of biomarkers that can help researchers assess an individual’s likelihood of developing the disease.

Also, Sadvary said that Scottsdale Healthcare is working to develop an infrastructure for its hospital and medical staff members to conduct clinical research by providing them with resources and support.

“If we can help them do research, we hope it not only makes them want to stay here, but it also sharpens their skills, and that translates into better patient care,” Sadvary said.%pagebreak%

In addition, in keeping with its concern with holistic patient care, Scottsdale Healthcare has ambitious plans for nursing research.

“Our goal is to become as well known as the City of Hope [a leading California biomedical research and treatment center] for nursing research in oncology,” said Peggy Reiley, senior vice president of Scottsdale Healthcare.

To accomplish this, Scottsdale Healthcare has set up partnerships with ASU and UA that create nursing research chairs. Anna Schwartz was the first person selected from ASU and has been doing research on the importance of exercise in achieving better outcomes in cancer patients.

The importance of nursing research, Reiley said, is that personal healthcare is not just about treatment of a disease but the post-treatment and the management of side affects, which is where nurses come in.

“In many ways what we need to be thinking of is interdisciplinary with nurses, pharmacists, physical therapists, physicians, and others involved in patient care,” she said. “It’s not just about medical care, it’s truly about the holistic care of the patients and their families.”

And in the end, that holistic patient care is what Scottsdale Healthcare’s investment in research is all about.

“If there’s something to characterize the Virginia G. Piper Cancer Center, we want it to be the care,” Von Hoff said. “You can’t do clinical investigations without the caring.”