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To develop a vaccine, doctors use thriving cancer cells taken from the patient, cells culled from either a tumor or the blood. They must identify proteins in the tumor cells known as polypeptides; such proteins are common in many cancers. Then the doctors will manufacture a vaccine that contains those proteins but that can also be identified immediately by the body's immune system.
The hope, explains Abel, who has followed but not conducted research in vaccines, is to "paint" prominent targets on cells that stimulate a ferocious immune-system response and to inject the patient with such cells. The immune system, recognizing and reacting to the vaccine, will then destroy anycell that carries a similar marking or target, thus killing the cancer.
For some patients whose tumors or conditions do not produce sufficient cells to create vaccines from their own bodies, researchers can also produce synthetic proteins, made in the lab from amino acids.
Early studies suggest sometimes significant promise. In the case of CancerVax, a vaccine still about two years shy of FDA approval, the survival rate of patients is about 40 percent. Only about 16.5 percent of those who endure traditional chemotherapy for the same lymphatic cancers survive.
But some doctors are already referring to CancerVax as "steam engine technology," because it is made from whole cells and not the tiny proteins doctors have more recently learned to isolate and define. They theorize it is less precise and less effective than protein-based vaccines will be.
No clinical proof exists that vaccines either prolong survival or cure cancer, only that they can help the body produce promising antibodies. But that proof is likely to come, Abel believes. "Five years, or maybe ten, and the science will be much more refined," he says. "[Cancer vaccines] will be used much more commonly."
In addition to building upon existing cancer-vaccine research, the trials at Holy Cross will have an advantage no other such experiment can now boast: a direct link with the NCI.
The Telesynergy Center is the heart of this effort. In this conference room on the first floor of Holy Cross, doctors in Fort Lauderdale and Bethesda will simultaneously examine patients, study high-resolution displays of medical tests, and control microscopes and cameras from either room. In a single examination, they will be able to focus the full force of the government's best medical minds on a given case. Patients selected for a trial will be examined at a station in the room, which also contains the expensive Telesynergy equipment and a round table with chairs for the medical team.
Only patients selected for clinical trials will benefit from the almost unheard-of consultation of 15 to 20 highly educated doctors. These professionals can draw from a distressingly large pool of potential candidates. In Broward County, doctors this year will diagnose nearly 10 percent of all new cancer cases in Florida, about 9000 people, according to the American Cancer Society. With an estimated 88,000 new cases in the state this year, Florida ranks second behind California for the highest incidence of the disease. Almost 40,000 Floridians will die from cancer in 2000, a majority from lung cancer, breast cancer, pancreatic cancer, or prostate cancer. African-Americans suffer higher mortality rates than whites because their cancers are often detected later, doctors say, and can thus prove more difficult to treat.
For patients at Holy Cross, entry into a clinical trial could alter those grim statistics. Research doctors at NCI, in turn, will gain valuable research data from patient reactions to the vaccines. "One of their problems in the past has been a lack of patients," Abel points out. "They've had the researchers, they've had the research, and now they're seeking a broader patient base. As it is now, only about 2 percent of Americans receiving treatment are engaged in clinical trials."
The "Partnership in Science," as NCI describes it, is happening at Holy Cross first in part because of the successful lobbying of Abel and two colleagues, oncologists Leonard Seigel and Martin Gutierrez. The three doctors are the point men of the venture, which also benefited from good timing, says Maureen Mann, executive director of the cancer center. "We had the doctors who had spent time [at the NCI], and we asked at the right time, so it was partly luck and partly our own ambition."
When Holy Cross decided to beef up its cancer center a couple of years ago, administrators followed the advice of the hospital oncologists and sought guidance from the NCI. Coincidentally, says Mann, NCI researchers were searching for ways to introduce new patients into their program of clinical trials.
NCI looked at other hospitals, including cancer centers in California. Then its managers performed a due-diligence analysis of Holy Cross. They found a successful hospital with an established cancer center and a growing population of patients. But NCI did require some changes: Hospital administrators would have to acquire $250,000 of telecommunications equipment and add a new wing to the cancer center. The soon-to-be-completed wing will provide beds to accommodate patients entering the clinical trials.
Abel keeps an aerial photo of Harvard Medical School, his alma mater, framed on his wall. He uses the picture one day to explain his own compulsion to help create the partnership between NCI and Holy Cross.