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Expanding fight against cancer

Moffitt seeks more room for a project to unlock the disease’s secrets.

By LISA GREENE, Times Staff Writer
Published October 25, 2006

ADVERTISEMENT [Times photo: Daniel Wallace]

TAMPA — This is how Dr. William Dalton envisions fighting cancer five years from now:

Somewhere in Florida, says Dalton, CEO of the H. Lee Moffitt Cancer Center & Research Institute in Tampa, a young woman will get breast cancer. She’s only 35, from, perhaps, Titusville, and her cancer is fairly advanced. It has spread to three of her lymph nodes. She’ll need chemotherapy.

If she were diagnosed today, her doctor would have to choose among about nine drugs. And for many breast tumors, those choices would be based as much on guesswork and doctors’ personal preferences as on solid medical evidence.

If her doctor makes the right choice, the Titusville woman could have a good chance of beating her cancer. The wrong one, and she might die.

But five years into the future, Dalton hopes the Titusville woman’s doctor will be able to turn to Moffitt for answers. He’s hoping that by then, an ambitious $80-million project  will start to show results. The plan is one of the driving forces behind Moffitt’s recent interest in expanding to a second site.

Moffitt’s plan, called “Total Cancer Care,” is a step toward more individualized treatment of cancer patients. The center has started collecting medical histories and tissue samples from cancer patients across Florida — from both Moffitt patients and those at 16 hospitals affiliated with Moffitt.

The center aims to build a huge tissue bank, with samples from thousands of patients. So far, about 2,000 patients have agreed to donate.

For now, those samples are being used for research.

But Dalton hopes that in as little as five years, they might be helping patients. By then, he wants to have tissue samples and medical histories for 25,000 to 30,000 people. To protect their privacy, their names won’t be in the database and researchers won’t be able to identify them.

Dalton envisions the Titusville woman’s doctor asking Moffitt researchers to compare samples of her breast cancer tumor to those of other patients.

“The physician in Titusville can say, 'How many patients look like mine, from a molecular point of view?’ ” Dalton said.

Researchers will look at other tumor samples — not just  actual tumors, but computer analyses of the genetics of each tumor. Researchers will compare one tumor’s genes to another, discovering differences that are invisible even under a microscope.

Suppose the Titusville doctor finds 100 other patients in the databank with tumors similar to the one that has attacked his patient. He’ll ask: “What were the therapies used to treat these patients?” Dalton said. “Who did best with what therapy?”

Researchers across the country preserve tumor samples in wax. Far fewer quick-freeze them to preserve genetic material, as Moffitt is doing. And fewer still have consent from patients to allow the tissue to be broadly used for genomic research, said Dr. Robert Penny, chief operating officer and chief medical officer of the nonprofit International Genomics Consortium.

Penny could think of only three such tissue banks being developed in the United States: Moffitt’s; his consortium, whose partners include Moffitt, the Mayo Clinic and Johns Hopkins University; and the National Institutes of Health’s Cancer Genome Atlas project.

“Moffitt recognizes the value in being able to capture this incredible resource from patients,’’ Penny said. “The vision of what Moffitt is doing is extraordinary.”

New therapy ideas

Dalton and Dr. Timothy Yeatman, director of Total Cancer Care and Moffitt’s associate center director for translational research, also envision using the databank in other ways.

By looking at how databank tumor cells are different from normal cells, researchers could get ideas for which cell components to target with new drugs.

Or researchers might be able, by comparing so many tumors, to find abnormal proteins that circulate in blood when someone has cancer. Such proteins could be used to help screen for certain cancers.

All this research takes money. Moffitt has raised about $15-million and plans to use donations, federal grants and other funds to pay the rest.

It also takes space. Moffitt, which this month celebrates its 20th anniversary, has expanded rapidly. Even though it opened a $186-million clinic expansion and state-of-the-art research tower just three years ago, it’s running out of room.

The tower, the Vincent A. Stabile Research Building, already is 80 percent full. The hospital’s clinic has another expansion opening in February — and it’s expected to be full when it opens.

In the 20 years since it opened, Moffitt has grown from 364,000 square feet to 1.3-million, increased its research funding from zero to $54-million and gone from treating fewer than 10,000 outpatients a year to treating more than 210,000.

But Moffitt has nowhere else to build on its campus at the University of South Florida. That’s why Moffitt officials have looked at other sites, including in the Wiregrass Ranch area of southeastern Pasco County. They’re also looking in Hillsborough County.

Whatever the final choice is, it needs to be close to Moffitt and have enough room for long-term expansion, Dalton said.

Speed is vital

But for now, research is focused at Moffitt, where scientists already are collecting tissue from patients. So far, almost every patient asked has consented to give tumor tissues to Moffitt for research, even though it may never benefit them personally.

When tumors are removed in surgery, they are rushed to a pathology lab deep in the hospital. As soon as they arrive, researchers take tissue needed to diagnose the patient’s condition.

If extra tissue is left, it can be used for research. Researchers separate the tissue, preserving some in wax, and freezing more in liquid nitrogen.

If tissue isn’t frozen within 15 minutes of being removed from the patient, the genetic material starts to degrade. It won’t be as useful to researchers.

Moffitt researchers are averaging five to 10 minutes from removal to freezing, said Dr. Tyron Hoover, medical director of Total Cancer Care and Moffitt’s tissue core program.

“That’s the most critical step in the whole process,’’ Hoover said.

Frozen tumor samples are placed into tiny tubes, then into metal boxes, 100 tubes to a box. The boxes, in turn, go into metal canisters, which are then stored in a 4-foot high vat. The vat is cooled with liquid nitrogen to negative  292 Fahrenheit.

Genetic material is later extracted from tumor cells and put on a chip. Using a laser and computer analysis, researchers can see which genes in a tumor are active, then look for patterns to compare tumors.

Within a few years, researchers hope to use those comparisons to recommend treatments. In time, Dalton hopes, to save that woman from Titusville.

[Last modified October 25, 2006, 06:18:49]