For years a UF surgeon and a UF engineering professor have put their heads together on a project to develop innovative ways to diagnose and treat cancer.
Stephen Grobmyer, MD, and Brij Moudgil, EngScD, are working in the promising field of nanotechnology – the design and engineering of objects composed of particles 10,000 times smaller than the diameter of a human hair.
“The current tools cannot see a tiny change in cells when the disease is just developing,” said Moudgil, director of UF’s Particle Engineering Research Center. “We’ll design a nanoparticle that will have functionalities to take to a specific site in the body. When a light shines on it, it will glow so a doctor can see what’s going on there.”
Crossing departmental and college lines to explore new ways of thinking has paid off for Moudgil and Grobmyer. But their work can only go so far. Once they develop and perfect their nanotechnology applications, there’s no guarantee they’ll be able to accurately point the particles to the cancer.
That’s where researchers in Tampa studying novel approaches to diagnostic imaging of cancer come into the multidisciplinary picture. Robert Gillies, PhD, director of molecular and functional imaging at the H. Lee Moffitt Cancer Center and Research Institute, and colleagues have developed ligands, or binding molecules, that target cancer. The Moffitt research into multivariate targeting could be the key to finding the right spot on the cancer cells at which to aim UF’s nanoparticles.
There should be no reason for anyone to leave the state for cancer care.
– William Dalton, MD, PhD, director and CEO of the Moffitt Cancer Center.
“If we combine their technology in targeting with our technology in nanoparticles, we create a unique strength,” said Grobmyer, a surgical oncologist. “There is tremendous potential.”
It is that potential that led leaders from the University of Florida, the College of Medicine and Shands HealthCare to enter into a partnership with Moffitt, a Tampa-based NCI-designated cancer center. With the UF Shands Cancer Center and Moffitt Cancer Center working as allies, the state of Florida is poised to become a leader in scientific discoveries for cancer research, treatment and prevention, says William Dalton, MD, PhD, director and CEO of the Moffitt Cancer Center.
“The ultimate outcome (of the partnership) will be better care, better research and higher recognition for Florida in the area of cancer research and enhanced care,” Dalton said. “There should be no reason for anyone to leave the state for cancer care.”
Under the arrangement, the parties will look for opportunities to collaborate across the spectrum of patient care, research and educational activities.
“It’s one thing for the leaders to be excited, but things will really begin to happen when the faculty embrace the partnership,” Dalton said. “They are excited at the prospect, and it is our job to make sure the environment nurtures these interactions.”
Working with the National Cancer Institute, Moffitt will seek to integrate the UF and Shands cancer program into Moffitt’s NCI designation, held by only 39 cancer centers nationwide. Inclusion should give UF scientists more opportunities at garnering NCI grants for collaborative projects with Moffitt investigators – a concept favored by the National Cancer Institute.
“We think there are potential advantages for all partners in these arrangements,” explained Linda Weiss, chief of the Cancer Centers Branch of the NCI. “They integrate complementary and supplementary research strengths of multiple institutions, making the whole stronger.”
A Total Approach
Shands and the College of Medicine also intend to incorporate many of Moffitt’s Total Cancer Care practices into their treatment regimen to address the growing need for long-term care plans based on cutting-edge research and information technology. The Total Cancer Care model follows patients through each step of their journey – from screening to diagnosis and treatment. Physicians develop multidisciplinary teams, conduct clinical trials and create survivorship plans in an overall effort to focus on the individual, not the disease.
One component of patient-centered care is developing treatments specific to individuals by using information stored in their “molecular fingerprints.”
“This will ultimately lead to a radical new way of practicing medicine,” Dalton said, “one that creates individualized treatments for cancer patients based on cancer biomarkers specific to their tumor types.”
Shands and UF will enroll patients in a TCC clinical study that collects tumor and blood samples that are analyzed for cancer biomarkers of each individual tumor. The program is projected to be the single largest data collection of its kind in the country.
“This marriage of molecular data with clinical outcomes is just the beginning and it’s an ambitious long-term project,” said Dr. Timothy Yeatman, executive vice president of translational research at Moffitt. “It is well worth it – eventually leading to improved outcomes, population-based matching of patients with new drugs and the development of targeted, personalized cancer treatments for patients.”
A cancer diagnosis can not only be frightening, it can be time-consuming and confusing. Patients are often required to travel and coordinate visits from one specialist to another during the course of diagnosis, treatment and postsurgical care.
Historically, at Shands and most other hospitals around the country, cancer patients have visited each of a series of specialists individually, often in separate locations. At Moffitt, coordinated care is offered, and all the doctors work in the same office, making it easier for patients to access services and get a complete understanding of their course of treatment.
Another component of patient-centered care is a strong emphasis on multidisciplinary teams of physicians who work together to focus resources and varied expertise on an individual for long-term health care.
In this model, nutritionists might work with oncologists to help boost a patient’s immune system during chemotherapy and surgeons might also share information to form a comprehensive plan for care.
UF’s Department of Neurosurgery – where nearly 600 brain tumor operations are performed each year – has been refining its patient-centered approach for years.
“We’re providing world-class, patient-centered care for patients now,” says department chair Dr. William A. Friedman. “The patient comes to one place and sees three physicians.”
Friedman says UF and Moffitt physicians are sharing best practices, and “after we gather all of that information, we will have some idea of how we can collaborate.”
UF officials aim to build on existing strengths to optimize the care of cancer patients in all treatment settings, from UF’s outpatient cancer clinics to the $338-million, 500,000-square-foot cancer hospital now under construction across the street from Shands at UF. Although it likely won’t be a one-stop treatment center for everyone, when the hospital opens next year it will offer patients a more coordinated approach to care.
“Whether we’re renovating an existing space or building a new facility, we strive to create an environment that’s welcoming and healing for our patients and visitors,” said Tim Goldfarb, Shands CEO. “The cancer hospital will serve diverse people with different needs and that’s reflected in the building’s customer-focused design. The private patient rooms, healing garden, chapel, meditation room and community room are just a few of the features that will make this a special facility.”
On the Horizon
While radiation and chemotherapy are still valuable weapons in the cancer treatment arsenal, medical scientists have long been trying to get away from treatments where the side effects are almost as devastating as the disease itself.
As scientists have learned more about the biology of cancer, they have been able to develop more precise drugs that can home in on cancerous cells and leave healthy tissues intact.
The challenge, said Johannes Vieweg, MD, the Wayne and Marti Huizenga eminent scholar chair in urology at the College of Medicine, is to develop treatments that are neither too general nor too targeted.
“Early on, we recognized that a single therapy doesn’t always cut it,” Vieweg said. “We have to broaden our repertoire.”
One of the hottest new strategies is immunotherapy, in which the patient’s own immune cells are harvested and turned into vaccines capable of embarking on search-and-destroy missions against abnormal cancer cells in the body.
Never before have patients with cancer had access to such personalized treatments.
For the past several years, teams at both UF and Moffitt have been working on immunotherapies to fight cancer.
Vieweg, who came to UF in 2006 from Duke University, is currently testing experimental vaccines for prostate cancer in phase 1 and phase 2 clinical trials. He is already collaborating with colleagues at Moffitt on this strategy and sees these relationships growing stronger with the new partnership.
“Overall, the combined Moffitt-Shands-UF program offers much more firepower to make an impact on cancer in the state of Florida and beyond than what we had before,” Vieweg says. “There is a natural synergy here that makes our programs better.”
Vieweg’s Tampa counterpart – the man at the forefront of efforts to prevent melanoma recurrence – is James Mulé, PhD,the Michael McGillicuddy endowed chair for melanoma research and executive vice president for applied research at the Moffitt Cancer Center. Mulé has devoted much of his career to basic and translational research on the development of cancer vaccines.
“We’re no longer held hostage by what Mother Nature has given us,” Mulé said. “By using clever approaches of genetic manipulation of cells, we can create more powerful vaccines. We can generate stronger immune systems in patients using the recombinant drugs that are now available.”
As research into the causes and cures of cancer becomes ever more complex, so does the importance of sharing ideas and resources.
“This partnership allows us to formalize a real connection, a real bond, through shared video conferences, shared meetings, and by learning more about the researchers at each site,” Mulé said. “It is hard to find a single institution that has all the necessary resources,” added Vieweg. “In this union with Moffitt, we can definitely leverage all of our resources into a common cause.”
Cancer patients will have access to a wider variety of clinical trials in progress at all three institutions.
“With the partnership, we have much better research collaborations because we can take advantage of our strengths,” Vieweg says. “For the first time, we can offer cancer patients in Florida what they would not get anywhere else in the world.”
Grobmyer’s patients come from all over Florida. Most of them are women who must undergo lumpectomies and mastectomies to save their lives, and the surgeon wants to develop a method that will enable him and other doctors to diagnose and treat cancer at an earlier stage.
One thing he’s had going for him is being a part of the University of Florida – a research institution with world-class laboratories in dozens of disciplines. It is also home to the country’s only comprehensive particle characterization program, just what is needed to advance the nanotechnology he thoroughly believes in.
And now, add to his firepower another team of skilled and creative scientists just two hours away in Tampa.
“The total impact of this partnership will be much greater than the sum of its parts,” said Grobmyer. “Each institution brings a unique ability to the table, and by working together and sharing our knowledge, it gives us a chance to really radically change the paradigm of how we diagnose and treat cancer.”
Ann Griswold and Melissa Thompson contributed to this report.