Alliance Research Not Limited by Private-Sector Restraints
By Annette M. Boyle
BETHESDA, MD – In celebration of its second anniversary, the John P. Murtha Cancer Center at the Walter Reed National Military Medical Center, announced plans to substantially expand its partnerships with the National Cancer Institute and the Uniformed Services University of the Health Sciences to bring more resources to cancer research and treatment.
The announcement came in December as part of the celebration of the second anniversary of the center, which was formed in 2011 through the integration of research arms of the Walter Reed Army Medical Center, the National Naval Medical Center, Malcolm Grow Medical Clinic and the U.S. Military Cancer Institute.
“The Murtha Cancer Center represents the compilation of the tremendous capabilities of Army and Navy Medicine,” Army Col. Craig Shriver, MD, director of the Murtha Cancer Center said last month. “Now, with the Uniformed Services University of the Health Sciences, the National Cancer Institute and all services, we will move forward as three federal organizations in one unity of effort to fight cancer.”
Shriver sees Murtha, the only DoD-designated cancer center of excellence, as a natural and necessary component of the MHS.
“Cancer is a readiness issue. If any person is out, it impairs the unit,” he noted. Further, cancer affects potential recruits, servicemembers and veterans, as “some cancers are being diagnosed at younger ages nationally, and certain cancers disproportionately affect warriors and veterans, including prostate cancer, melanoma and breast cancer.”
Joining forces with USUHS and NCI takes Murtha’s battle against cancer to a new level, Shriver said, explaining, “By leveraging the assets of these three federal health organizations, we are increasing the research and clinical capabilities for military and civilian patients, while decreasing costs to the government.”
Murtha has already posted an impressive record of achievements and created unique research opportunities for all members of the new partnership. For example, Murtha has the only DoD biorepository accredited by the College of American Pathologists. One of only 23 accredited biorepositories in the country, it contains 65,000 de-identified human tissue and blood samples from 8,000 properly consented patients that can be used to help researchers at NCI, USUHS and elsewhere identify molecular changes in cancer patients.
“The biobank’s resources are very important tools for cancer research,” said Mary Lou Cutler, PhD, director of the molecular and cell biology graduate education program at USUHS. Many members of the faculty at the medical and nursing school at USUHS have particular expertise in clinical studies of cancer, she noted, and will advance the collaboration by utilizing the biobank in their research.
In a lung screening program run jointly with the VA, published results show a 15% improvement in survival rates for patients treated at Murtha, compared with national Surveillance, Epidemiology and End Results (SEER) Program outcomes, said Shriver. The screening program also identified more than twice as many early cases of lung cancer as the National Lung Screening Trial. More remarkably, 50% of the Murtha-screened patients who started a smoking cessation program stopped smoking, he added.
Lung cancer has long been a concern for the military and VA because of historically high rates of smoking among military forces as well as Agent Orange exposure among Vietnam veterans, according to Shriver. Rising rates of smokeless tobacco use have increased awareness of other tobacco-related cancers, such as those of the mouth, tongue, cheek, stomach, pancreas and esophagus.
With servicemembers using smokeless tobacco at five times the rate of the general population, Shriver said he plans to use the unique abilities of the alliance to find out more about how that form of tobacco affects users.
“Among deployed military, in particular, the use of smokeless tobacco is rampant, and we don’t understand a lot about it yet. We will be rolling out a program to military bases with the USUHS dental school to get a file specimen from a cheek swab of young servicemen and women at their annual dental check-up. Then we can see early changes in DNA and institute a cessation program,” Shriver told U.S. Medicine.
Breast cancer has been another area of focus for Murtha. Shriver noted that a recent study showed that patients with breast cancer treated at the center had a 20% better survival rate than the national average. The alliance is now tackling triple negative breast cancer, one of the most difficult to treat forms of breast cancer and one that hits young black women particularly hard.
The collaboration provides distinct advantages for prostate researcher Shiv Srivastava, PhD, co-director of the Center for Prostate Disease Research and a professor of surgery at USUHS. “Our patient population is ethnically diverse, with 20% of our patients African-American. That gives us a unique opportunity to study the disease” in various subgroups,” he said, and offers extensive training and collaboration opportunities.
Together, the organizations will be studying an immunotherapy for prostate cancer developed at NCI that combines a therapeutic vaccine with a checkpoint inhibitor for men with intermediate to high risk of the cancer. The study will include clinical follow-up and tissue analysis when treatment concludes. The research also will tap into the 20 years’ worth of tissue samples from men diagnosed with prostate cancer.
“That will enable us to answer questions we could not address otherwise and to look for early markers that may predict which cancers are indolent versus more progressive,” Srivastava said.
For NCI, the greatest benefits of partnering with Murtha are the expanded patient base and integration with a large team of experienced physicians, according to William Dahut, MD, head of the prostate cancer clinical research section at NCI.
“At our clinical center, we don’t treat as many patients as other hospitals, so it’s beneficial to our patients to have the incredible expertise and passion of the clinicians at Murtha. The commitment to research at Murtha and USUHS and the dedication of skilled physicians you find here cannot be mirrored anywhere else,” he said.
Because of the federal agency structure, the alliance “has the opportunity to move the field in ways others find more challenging,” Dahut added. “We are not in a situation where we bill our patients or make decisions based on reimbursement issues.” Patients who have volunteered for military service also show greater willingness to be involved in clinical trials and advance research, he said.
“This is a great time in history to bring together the resources of Walter Reed and the tremendous researchers at NCI and USUHS and recommit to breaking down administrative boundaries to deliver the best value to tax payers,” Shriver said. “Together, there is no limit to what we can do.”