October 30, 2000

As a young boy, Pramod Srivastava was admonished by his father for buying a cheap ruler. "I am not rich enough to buy you cheap things," his father said. "Next time, buy a ruler that will last and not need to be replaced again."

That message is one Srivastava recalled while talking about what is needed to advance the cancer program at the Health Center. Srivastava, who is a professor of immunotherapy and director of the Center for Immunotherapy of Cancer and Infectious Diseases, says the proper investments will help the Health Center significantly change the cancer landscape in the state and the region.

As part of its strategic planning process, the Health Center has identified signature programs to link areas of research and clinical excellence. These signature programs are in Genetics/Immun ology and Cancer, the Brain and Human Behavior, Bone Biology and Musculoskeletal Diseases, and Connecticut Health.

The cancer initiative is led by Srivastava and Giles Whalen, associate professor of surgery. Whalen, who specializes in gastrointest inal cancers and endocrine tumors, has been at the Health Center for seven years. He is excited about the opportunities in genetic analysis and translational research to improve the clinical care of cancer, especially those cancers that have been resistant to traditional treatments. "With our strength in basic science we can improve the health of the people of Connecticut by moving this science to the clinical arena as soon as possible," he says.

Whalen and Srivastava have concentrated on current strengths and programs that make the Health Center different from other area health care providers, as well as what needs to be done to move the cancer initiative forward and improve its focus. They have also looked at ways to reinforce the bond between academic priorities and clinical programs.

During the past several months they have met with almost every Health Center scientist connected to cancer research and every clinician involved in cancer patient care. In doing so, they have discussed the challenges, opportunities and investment necessary to build a stronger cancer program by linking research excellence with clinical excellence. Collectively, they have recommended several actions and are considering others, which will be presented to the strategic plan steering committee and ultimately to the Health Affairs Committee of the Board of Trustees.

These recommendations take into account the Health Center's long-standing clinical and research expertise and link basic science research in areas such as imaging, genetics, immunology, and genomics to clinical and translational research in adoptive immunotherapy, gene transfer, cancer screening and epidemiology/populat ion research, among others. They build upon nationally and regionally recognized clinical expertise in areas like breast, prostate, gastroenterological and gynecological cancers, and in bone marrow transplantation.

The initial recommendations focus on areas where advances and innovations in cancer are occurring. Two such areas are immunotherapy and anti-angiogenesis. Immunotherapy includes a new approach to treating cancer that Srivastava has developed, a cancer vaccine. The vaccine, which utilizes proteins from patients' tumors, is in clinical trials and has shown promising results thus far. Anti-angiogenesis, which Timothy Hla in the Center for Vascular Biology is developing, works by "starving" cancer through elimination of the blood supply to tumors. "This process is highly developable and marketable," says Srivastava, "and translational research is the next step in the process to extend the research."

Another recommendation is to establish a group of central information processing centers. Srivastava says that reconfiguring and strengthenin g current capabilities in areas such as pathology and diagnostic screening would make it easier for faculty conducting cancer clinical trials. By analyzing and "fingerprinting" tumors at the molecular level, Health Center researchers will be closer to their goal of predicting the behavior of tumors and their potential response to treatment. An integral component of this recommendation, says Whalen, is the establishment and integration of databases to capture information generated by these central processing groups.

Srivastava and Whalen have also proposed improving the ways in which cancer care intersects with other services.

"When a cancer patient is seen at the Health Center, we want to assure that that individual is able to move smoothly and effortlessly though our system, from the minute they call to make an appointment through all of their clinical interactions," says Whalen. "Even improving computer system interactions between departments can greatly benefit patients, by cutting down on the time for medical information to get from one physician to another."

Srivastava and Whalen stress that recruitment of both junior and senior level faculty is essential to the success of this Health Center strategic initiative. They say faculty members with expertise in cancer are needed in areas such as medical oncology and radiology. Some recruitment efforts have begun, exemplified by the recent arrival of Mandeep Dhami, an oncologist/hemat ologist who recently joined the University Cancer Center on a part-time basis. Additional faculty in various disciplines may be needed, as the volume of cancer patients increases. This assessment will be ongoing, as the program advances.

Recommendations for the structure of the Cancer Center's senior level program leadership have not yet been finalized. Various models are currently under discussion.

"The cost to implement these recommendations, while substantial, is not extraordinary," says Srivastava, "the initial investment will allow us to leverage our existing infrastructure. We can't afford a cheap ruler."

Wendy Soneson