When urologist Peter Carroll, MD, MPH, did his residency at UCSF 30 years ago, cancer was “a word that was whispered,” a knowledgeable patient was someone who just followed doctor’s orders and oftentimes a diagnosis wasn’t made until disease was advanced.
That’s all changed with the introduction of routine use of imaging and other screening practices, in which, for example, an asymptomatic small kidney cancer might be spotted in a patient with suspected gallstones, said Carroll, interim director and head of the prostate cancer program at UCSF Helen Diller Family Comprehensive Cancer Center and associate dean of the UCSF School of Medicine.
Peter Carroll, MD, MPH, interim director of the UCSF Helen Diller Family Comprehensive Cancer Center, stands outside the new UCSF Bakar Cancer Hospital at Mission Bay. Photo by Susan Merell
Peter Carroll as a resident at UCSF in the early 1980s. In the 30 years he's been here, Carroll says he's seen dramatic advances in the quality and precision of cancer care. Photo courtesy of Carroll
Other pivotal advances include the development of new classes of treatments that has meant some cancers could be successfully managed as a chronic disease; and the advent of the Internet and social media providing patients with a wide window into information about their condition and prospective treatments.
“We’re witnessing a sea change in the way we respond to cancer. We’ve found that surveillance rather than treatment might be the best strategy for some low-grade cancers, while using novel therapy or combinations of treatments might offer the best chance for long-term survival for patients with some advanced cancers,” he said.
From Microscopes to Molecules
Carroll said clinicians are also learning that “treatment isn’t just determined by grade, staging, size of tumor, or even its site of origin and what it looks like under a microscope in some cases.”
“Advances in molecular biology, genomics and related technologies have led to a greater understanding of cancer at the molecular level,” he noted. “If we identify the genetic and molecular variations in each patient’s cancer cells, we can tailor treatments that target the molecular underpinnings of each patient’s disease.”
Embodying this evolution in cancer management is the new 70-bed UCSF Bakar Cancer Hospital, opening Feb. 1, 2015, at Mission Bay. It will be right down the street from the UCSF Helen Diller Family Cancer Research Building, dedicated to uncovering the basic biological mechanisms of cancer.
“It will be the ‘Emerald City’ emerging from the fog in a location surrounded by dozens of biotech companies, which will promote a synergy facilitating the bench-to-bedside process of developing innovative treatments like precision medicine,” said Carroll.
Responding to Changing Demographics of Cancer
The construction of the new hospital was spurred by changing demographics, said Gerrie Shields, MBA, director of clinical services administration at the UCSF Helen Diller Comprehensive Cancer Center.
“We have an aging population and with aging comes an increased incidence of cancer. We have seen the demand for access to UCSF cancer specialists grow over the last 10 years and we expect this to continue. The opening of the new UCSF Bakar Cancer Hospital provides capacity to assure that we can meet that demand,” she said.
Running parallel with the emergence of different approaches for treating cancer, is the emergence of a different type of patient: one that “won’t settle for average” when it comes to seeking treatment and one that expects to work in tandem with their physician participating in the decision-making process, said Carroll.
These patients have found their match at UCSF, where cutting-edge research has followed breakthroughs by its eminent scientists, including Nobel prizewinners, J. Michael Bishop, MD, and Harold Varmus, MD, who discovered proto oncogenes – genes that have the potential to become cancerous – and Elizabeth Blackburn, PhD, for her work on telomeres, parts of chromosomes that impact the lifespan of cells, and play a key role in cancer.
Pushing Boundaries in Melanoma Treatment
Typical of the novel treatment tactics that have redefined cancer therapy was a tool developed at UCSF that became a game-changer for patients with a type of skin cancer called melanoma, said Boris Bastian, MD, professor of dermatology and pathology at UCSF.
Boris Bastian, MD
As a post-doc fellow working in the lab of Dan Pinkel in 1997, Bastian and others used comparative genomic hybridization, which detects gains and losses of chromosomes in cancer. This method – developed by Pinkel and colleagues – enabled the team to identify patterns of chromosomal alterations in melanoma that correlated with the site where the disease originated. This finding indicated that genetically distinct types of melanoma existed and that this heterogeneity needed to be considered in order to develop successful treatments.
“It became apparent that mutations in a gene called KIT, which could already be targeted therapeutically in other cancers, were present in some rare subtypes of melanoma, creating for the first time a route for targeted therapy,” said Bastian. “Clinical trials using KIT inhibitors are ongoing for patients with this variant of melanoma and are showing that they are effective.”
This discovery and treatment of KIT was the beginning of precision medicine in melanoma, said Bastian, who currently heads the Clinical Cancer Genomics Laboratory of the UCSF Genomic Medicine Initiative and the department of pathology, which examines tumor tissue from patients so oncologists can select the most appropriate therapies based on its genetic makeup.
Initiatives such as this one will make the new UCSF Bakar Cancer Hospital a destination for patients seeking cutting-edge treatment, according to Bastian.
“In time, we’re going to lean less on what we know from traditional clinical research and develop those treatments that are designed to the unique genetic signature of each patient’s cancer,” he said.
Cancer Care: Who’s Going Where?
When the new UCSF Bakar Cancer Hospital opens at Mission Bay, many services will move over from the Mount Zion campus, while others will remain in place. Here are some frequently asked questions about the new facilities:
Which cancer practices will move to the UCSF Mission Bay campus?
Adult practices in urologic, gynecologic, head and neck, orthopedic, and gastrointestinal and colorectal cancers will be primarily at the Gateway Medical Building at the UCSF Mission Bay campus. All inpatient and outpatient cancer services for pediatric patients will be at the UCSF Mission Bay campus. This includes the new UCSF Benioff Children’s Hospital San Francisco, a linear accelerator for radiation therapy and a pediatric outpatient chemo infusion center.
Which cancers will be treated at UCSF Bakar Cancer Hospital?
Generally the 70-bed UCSF Bakar Cancer Hospital will serve adults in the above specialties. Some same-day surgeries may take place at the UCSF Mount Zion campus.
Where will adult cancer outpatients undergo chemo infusion and radiation?
The UCSF Mission Bay campus will have an outpatient chemo infusion center. Radiation therapy will also be available there, but most adult patients will receive the treatment at the UCSF campuses of Mount Zion or Parnassus.
Will the UCSF Mission Bay campus have an Emergency Department?
The new UCSF Benioff Children’s Hospital San Francisco will have an Emergency Department to serve pediatric patients with all conditions. The Emergency Department at the UCSF Parnassus campus will continue to serve all adult patients.