Reflections on the Cancer Center's First 25 Years
Max Wicha, M.D., director of the University of Michigan Comprehensive Cancer Center, reflects on the center's first 25 years and what the future may hold.
How did the Cancer Center come about?
The idea actually started on a napkin. It began at a meeting of the American Society of Clinical Oncology -- this was about 1985. At the time, I was the chief of the division of hematology/oncology and Dr. Allen Lichter was the chairman of the Department of Radiation Oncology. We started talking about creating a cancer center at the U-M. We then got together with Dr. Raymond Ruddon, chairman of Pharmacology and one of the most renowned cancer researchers on the U-M faculty at the time. In these initial discussions, we sketched out on the back of a napkin how we might establish multidisciplinary cancer programs that would bring together basic scientists, clinical scientists, radiation oncologists and surgeons.
What was the vision?
The goal of a cancer center was to design better strategies to link cutting-edge research and clinical care, and in fact, that has remained our goal throughout the last 25 years. It's both a challenge as well as a goal -- linking research to patient care and putting together multidisciplinary teams of researchers and clinicians in the most efficient way to facilitate patient care and research.
Research and care weren't integrated back then?
The U-M, in fact, does have a long-standing history of being a center for interdisciplinary research. However, in the field of cancer, much of the research, as well as cancer care, was fragmented. Most of the physicians and scientists were organized according to their departmental appointments. This sometimes accentuated a "silo" mentality that inhibited interdisciplinary research. The Cancer Center provided a structure to organize multidisciplinary and interdisciplinary research between departments and schools at the university. We felt, and still believe, that this is a better way to advance research and patient care.
What was it like at the beginning of the Cancer Center?
When we started the Cancer Center, we were scattered throughout many buildings at the Medical Center and other schools in the university. There was, in fact, no Cancer Center building. We ran the administration of the center from a trailer behind the Simpson Memorial Institute. That was it -- all we had was a trailer and a vision of what could be created in the future.
But even without a dedicated building, what was happening?
Even before we built the cancer center facility, we worked with Medical Center and departmental leaders to greatly expand the cancer research and treatment capabilities at the U-M. This included our recruitment of a number of stellar researchers, many of whom focused on moving basic research into the clinic. As a result our cancer program, which was unranked nationally, jumped into the top 20 over that decade. In fact, we have continued that trajectory and are now the No. 1 university-based cancer center in terms of National Cancer Institute grants to medical schools and No. 3 in the country for overall grants from NCI.
How is cancer research changing?
For much of the last 20 years, we thought that the most efficient way to organize cancer research was according to disease sites. We created research programs in each of these disease sites such as breast cancer, prostate cancer, colon cancer and pancreas cancer. This greatly facilitated our interdisciplinary research. However, science continues to advance and we now find that there are many similarities between cancers in different organs at the molecular and genetic level. Our challenge is now to integrate research across multiple tumor types so that we can draw from the strengths of these programs and develop specific treatments that target genetic pathways in cancer.
What are some of the current challenges?
Despite the tremendous advances in cancer research, national funding for cancer research is actually declining. As a result, only 7 percent of grants submitted to the NCI are now funded. Our core grant which funds the Cancer Center infrastructure was successfully renewed for the sixth time last year. Despite receiving an "Outstanding" priority score, however, NCI budgetary constraints have resulted in a freeze of all cancer center budgets.
The tremendous increase in cancer research technology has also been expensive. These increased expenses and great opportunities occurring in a context of decreased NIH funding means that we need to identify additional sources for research funding. One of these sources is the biotechnology and pharmaceutical industry. The Cancer Center has greatly expanded its interaction with these groups. This not only helps to support research, it helps to move discoveries into the clinic in an efficient manner. As an indication of this success, U-M Cancer Center investigators have spun-off 10 biotechnology companies, eight of which remain in Michigan. In addition to moving research forward, this helps to stimulate the local economy.
Another important source for funds to support research is philanthropy. We are privileged to have a loyal group of donors who have helped us develop our dream. We continue to work with the Health System to identify and work with major donors and in fact, to potentially attract a naming gift for the entire Cancer Center.
In the future, will oncologists be able to select a treatment based on the genetic mutations of each patient?
That is our hope. In fact, the Cancer Center is one of the leaders nationally at performing genetic analysis of individual tumors. The analyses have shown us that individual tumors may contain multiple mutations suggesting that successful cancer treatment may require the use of multiple targeted drugs. A good analogy of this is the treatment of AIDS. If you use a single drug against HIV, the virus rapidly becomes resistant. But if you use a cocktail of inhibitors, you can inhibit HIV growth turning AIDS into a chronic disease. That's what we hope to accomplish with cancer treatment. Using a combination of molecularly targeted drug inhibitors, we can either eradicate cancer or at least make cancer a chronic disease.
The NCI's most recent "Cancer Trends Progress Report" shows that the overall incidence and death rates for cancer are decreasing. Is there a danger that people will relax and say cancer is taken care of, let's move on to something else?
It is true that we are making substantial progress in the treatment of cancer. However, we also are seeing an aging population and since cancer is more common as we age, this is leading to an increase in cancer incidence. As we continue to make progress in treating other major killers such as cardiovascular disease, cancer may become the No. 1 killer of Americans over the next decade. Furthermore, although we've made great progress in treating certain cancers, progress has been significantly more limited in the treatment of other cancers -- and progress in the treatment of these cancers will depend on our continued research.
What are your dreams for the future of the Cancer Center in the next 25 years?
I would like the U-M Comprehensive Cancer Center to be seen as the place where some of the crucial breakthroughs were made that led to improved outcomes for patients with cancer. We also would like U-M to continue to enhance its reputation as a preeminent center for holistic patient center care, as well as groundbreaking research.