Bid to become NCI cancer center nears completion

For the last two years the medical center has been reorganizing, retooling and expanding its facilities and support services for cancer research and treatment in preparation for its bid to join an exclusive club: It is looking to be designated a National Cancer Institute Comprehensive Cancer Center.

What is at stake is more than a bit of added prestige. Winning the NCI approval opens the door to hundreds of millions of dollars to fund cancer facilities and programs—equal to roughly 20 percent of the total that Stanford cancer researchers received this year. And having the NCI designation would also likely lead to more patients being referred to Stanford for treatment and to participate in studies.

"When doctors think about referring cancer patients on the West Coast we want Stanford to be the first place that comes to mind," said Irving Weissman, MD, the Virginia and DK Ludwig Professor for Clinical Investigation in Cancer Research, who is leading the application process and is slated to be the center's first director.

Weissman said the school will submit its application to the NCI in October, and he is optimistic that Stanford will join the elite group of 39 institutions that are already NCI-designated comprehensive cancer centers.

Indeed, the biggest changes needed for Stanford to win approval are already in place. Most notably it's been one year since the opening of the Stanford's new cancer center building, which was a major step toward achieving the support infrastructure for research that the NCI requires.

New building brings benefitsThe benefits of the new cancer center building are apparent to the patients who go there. On any given day, they may enjoy the meditation room and Zen garden or perhaps take advantage of the cyber café to sip some tea while checking their e-mail.

But just as important is the building's new and roomier space for the medical school's Cancer Clinical Trials Office, which is responsible for providing critical administrative support for the trials of new drugs and treatments.

Before the new building opened, the clinical trials office was located in a separate building from the doctors and scientists who were running these investigations. "We have a lot more interactions with faculty now because we see them regularly," said Miriam Bischoff, the clinical trial office's associate director.

Moving into the new cancer center building not only gave oncologists better access to her office's existing services, Bischoff added, but it also paved the way for her office to expand to meet the requirements to become an NCI-approved comprehensive cancer research institution.

Among these requirements were an improved database system for monitoring ongoing clinical trials. Stanford chose a system that is already being used by a consortium of nine other NCI-designated cancer centers. "We've talked to other people in the consortium using this tool, and they say it's making their administrative procedures more efficient," said George Fisher, MD, PhD, associate professor of medicine and also the director of the clinical trials office.

Although having a database doesn't change the number of trials Stanford can support, it does mean that people running the trials can more easily track individual research participants and monitor dangerous side effects from a trial. In the past each researcher maintained trial data on personal computers, posing greater risks to patient privacy than the new system. Information about trial accrual and status will also be easier to monitor and report to the NCI, another requirement for being an NCI comprehensive cancer center.

"Because of the ease with which our multidisciplinary teams now interact, access to our many cutting-edge research protocols has been greatly enhanced," said Steven Leibel, MD, medical director of the cancer center. That's good news both for patients, who have a better chance of being referred into clinical trials, and for researchers hoping to fill their trials and carry out groundbreaking research.

More money, more patients The advantages of being a designated center should not be overstated. Stanford investigators currently receive significant grants for research from the NCI, and, even if Stanford received the NCI designation, these investigators would continue to apply for and receive NCI funds as they have done in the past.

But one change that would result from winning NCI recognition is that these investigators would be able to apply for additional grants that are only available to faculty at designated centers.

Another difference is that the NCI would refer patients to Stanford for cancer treatment, not to mention more referrals from other doctors as a result of the prestige associated with the designation.

Winning acceptance would be the culmination of the effort launched two years ago by Karl Blume, MD, professor of medicine, emeritus, and then passed on to Weissman. While the school had tried in the past to achieve the designation, the efforts had never come to fruition.

Changing the organization The undertaking demands that the medical school structure its research and services in new ways, beyond the opening of the new cancer center building and the changes to the clinical trials office.

As part of the grant application, Stanford has designated nine major programs to support cancer research, as well as dedicating school-wide resources to support such work. The school has also partnered with the Northern California Cancer Center—a nonprofit cancer research and information center—which will add to the medical school's ability to carry out population and epidemiological research required by the NCI.

While these organizational and networking efforts are demanding, they have benefits above and beyond winning the NCI stamp of approval. "Becoming an NCI comprehensive cancer center organizes essential core and shared services that enable both basic and clinical investigators to carry out leading edge research," Philip Pizzo, dean of the School of Medicine, said.

In the meantime, the school continues to put the finishing touches on the procedures needed to win the NCI designation.

Only last month, the medical school instituted a new system for approving cancer-related clinical trials, in keeping with NCI requirements. Now trials must pass through an internal scientific review in addition to the school's institutional review board, or IRB, which is responsible for making sure clinical trials protect patients' rights.

The chair of the new review committee, Sandra Horning, MD, professor of medicine, said that the added input is meant to provide more peer review and enhance the quality of research at Stanford. Ideally, this review will take place at the same time as the IRB does its evaluation to keep the process as efficient as possible, she said.

And the added review will ensure that the clinical trials taking place do not overlap, needlessly splitting eligible patients between competing trials. Leibel said this review would keep medical center resources directed toward trials that are of the highest quality.

All of these changes put Stanford in a strong position to receive the NCI's comprehensive cancer center designation, according to Weissman. With that stamp of approval, he added, Stanford will be poised to be the "Sloan-Kettering of the West," a reference to the highly-regarded cancer hospital in New York City.