Dan Gold is founder of Favrille, a biopharmaceutical company focused on research, development and commercialization of therapies for the treatment of cancer and other diseases of the immune system.

It’s not all bikinis and wet suits anymore. Torrey Pines has stepped up its dress code to include lab coats and security coded badges on the mesa up the bluffs. Working to turn the tide against cancer, technology companies and their scientists have made San Diego a leader in scientific research.

“When you look at Torrey Pines Mesa, you are literally looking at the cutting edge of science,” says Joe Panetta, president and CEO of Biocom, San Diego’s biotechnology industry association. “Between Scripps, Salk, the Burnham Institute and UCSD, the sheer volume of academic research and technology being generated is staggering. We’ve actually implemented a capital development initiative to help out-of-town venture capitalists realize the great opportunities down here, and it has done really well. “Several new firms have opened San Diego offices, and we’ve seen two of the biggest biotechs, Amgen and Biogen Idec, set up their venture funds here in San Diego. The research environment on the mesa isn’t like anywhere else in the world, except maybe the National Institutes of Health in Bethesda.”

The No. 1 leading product for cancer treatment is Rituxan, a treatment for non-Hodgkin’s lymphoma that was developed in 1997 here by Idec. Although Idec since has been acquired by Biogen in Boston, its research core remains in San Diego.

Showing new signs of laboratory success in the fight against cancer is Favrille, a biopharmaceutical focused on the research, development and commercialization of targeted immunotherapies for the treatment of cancer and other diseases of the immune system. Favrille is in Phase 3 clinical trial on its lead product FavId, a personalized vaccine for the treatment of indolent B-cell non-Hodgkin’s lymphoma. “This is a different approach than any other vaccine because we start with a bit of the patient’s own tumor from which we clone the genes for a very specific target that we will then convert back into protein and re-administer to the patient as a therapeutic vaccine,” says Dan Gold, Favrille founder and chief scientific officer. “It’s absolutely customized. The product we make cannot be used on any other patient other than the one from which we got the biopsy.”

Cancer is still justifiably feared, but no longer a certain death penalty. “Many cancers are still fatal, although over the last decade we’ve made incredible strides in managing patients with cancer and actually curing, in certain disease stages, patients,” Gold says. “As a field, we’ve made great strides, but there is a much longer road to go until we are satisfied. If we can manage the patient with good quality of life, that’s a major accomplishment that wasn’t available years ago.”

Taking Science To Patients

Dr. Joanne Mortimer, executive director of UCSD Cancer Center, says the center treats the whole patient and studies the disease.

As science progresses, local hospitals are participating in more clinical trials, bringing to the effort state-of-the-art equipment. It is in managing these programs, and others, where the top-notch care and treatment offered at centers such as the Rebecca and John Moores UCSD Cancer Center, the Cancer Institute at Sharp Memorial Hospital and programs at Scripps and Kaiser hospitals step in.

At UCSD, the research and clinical care are centralized at the Rebecca and John Moores UCSD Cancer Center in La Jolla. The new building allows for the consolidation of the center’s extensive clinical, research, education and community outreach programs. The center contains clinical space that is comfortable and welcoming for patients; modern laboratories to support research that advances prevention, diagnosis and treatment of malignancy; and areas dedicated to patient support and education. Inpatient care like surgery and bone marrow transplantation are still delivered at UCSD’s two hospitals: the Medical Center in Hillcrest and Thornton Hospital in La Jolla.

The nearly 300 physicians and scientists affiliated with the cancer center have access to technology like robotic surgery for prostate cancer, the region’s first all-digital breast imaging center, and the Varian Trilogy linear accelerator, the most advanced radiation oncology equipment in the region. The image-guided system gives doctors the option of delivering radiation to tumors traditionally (in small daily doses over a period of weeks) or stereotactically (in higher doses to smaller tumors over a shorter period of time).

As a teaching hospital, UCSD makes regular use of its medical students and research trainees. One such arrangement invites resident trainees from San Diego Hospice to work in a palliative care program, a treatment that affords relief from a problem, but not a cure. “The whole premise of a comprehensive cancer center is that we treat the whole patient and study the disease; they are not exclusive,” says Dr. Joanne Mortimer, medical director of the cancer center. “When we treat the patient, we hopefully are utilizing some of these new agents, some of which have been developed from basic research ideas that were identified at UCSD.” A research tower at the center can house seven to 12 independent teams. In addition, UCSD works with area companies on outside research and trials. “(La Jolla) is a wonderful place to be because we sit in this biotech area,” Mortimer says. “We have a number of clinical trials in many different diseases right now that are testing new agents. It varies by cancer, but the whole basis of the biotech industry is that, unlike chemotherapy that basically just kills cells that divide fast, these agents are targeted to the way the cancer grows and spreads. That means there are less side effects for the patient.”

Keeping Up With Technology

The Cancer Institute at Sharp Memorial Hospital combines surgery, general cancer care and radiation therapy in one setting at the Sharp Memorial Outpatient Pavilion. Patients visit the pavilion for initial evaluations, second opinions, consultations, treatments, special procedures, case management and follow-up care. Uniting all outpatient services under a single roof makes it convenient for patients who are able to have the majority of their care and physicians in one location. “It allows for an ease of teamwork and communication,” says Dr. Geoffrey Weinstein, medical director of radiation oncology at Sharp Memorial. “The environment makes it easy for patients to come and go for treatment with the sense that they are being treated as individuals. We’ve got different hallways, so depending on what a patient is going to do, it allows for a sense of privacy.”

Ancillary treatment offered at the pavilion include dietitians, social workers and patient liaisons. “It’s a five-star experience,” Weinstein says.

The cancer institute has recently invested $5 million in new technologies to benefit patients and is the first in San Diego to purchase the da Vinci Surgical System and Novalis Shaped Beam Surgery System. The da Vinci consists of an ergonomically designed surgeon’s console and a patient-side cart with four interactive robotic arms. Powered by robotic technology, the surgeon’s hand movements are translated into precise movements to the arms. The surgeon operates while seated at a console viewing a 3-D image of the surgical field. Novalis is a treatment device for patients undergoing non-invasive stereotactic radiosurgery or fractionated stereotactic radiotherapy. This applies a high dose of radiation to a precise target during a single treatment session. This virtually painless treatment is usually performed on an outpatient basis. Sharp is the only hospital in San Diego with either of these machines. “It’s amazing,” Weinstein says of having these machines to use. “These pieces of equipment are just incredible in their capabilities. They are able to provide precise treatment that wasn’t available a decade ago.”

Memorial isn’t the only Sharp hospital keeping up with technology. Sharp Grossmont is the region’s only designated TomoTherapy Treatment Center. The TomoTherapy Hi-Art System is a new concept in the delivery of radiation therapy. As the patient lies on the treatment table, it targets tumors through a thin radiation beam that rotates 360 degrees around the patient as the patient is moved through the beam. Each day prior to the delivery of the radiation, a CT scan of the patient is obtained to ensure that the tumor is accurately targeted.

In the South County, Sharp Chula Vista Medical Center has the only certified Community Hospital Cancer Program. Sharp Chula Vista treats more patients with cancer than any other South Bay hospital and has the region’s only linear accelerator for radiation therapy. Next year, Sharp Chula Vista expects to break ground on a 10,000-square-foot Cancer Treatment Center. The hospital will spend more than $4 million to equip the center with two linear accelerators, new stereotactic radiosurgery technology, additional diagnostic and treatment capabilities, on-site support services such as infusion therapy, nutrition counseling, social services and a patient resource library.

Scripps Spreads Its Care

Dr. William Stanton, associate medical director of Scripps Cancer Center.

With five campuses throughout the county, “the Scripps Health system cares for more cancer patients than any other system,” says Dr. William Stanton, associate medical director of Scripps Cancer Center. “The fact that we care for so many folks in so many locations dictates one of our developmental strategies. One of the distinguishing features of our cancer center is that we try to bring most cancer care into the communities in San Diego where patients can seek care near their homes, for minimal travel and for maximum support from family, friends and their primary physician.”

The Scripps Cancer Center is a composite of two major institutions: Scripps Health, which has five regional hospitals, and the Scripps Research Institute in Torrey Pines. “We have a scientific arm and a lot of care to provide,” Stanton says.

Dr. James Mason, director of clinical oncology research at Scripps Cancer Center.

Among the most innovative treatment at Scripps in the last two years is the use of umbilical cord blood transplants. “Typically these are used in adult patients who have acute leukemia, cancer of the bone marrow,” explains Dr. James Mason, director of clinical oncology research and director of Scripps Blood and Marrow Transplant program. “With conventional chemotherapy, the cure rate for adult patients with acute leukemia is less than 30 percent. With transplants we can often do better. The trouble is that most adults do not have a donor. Only about 25 percent of siblings will be a match.” As a result of its success, Scripps has become a national marrow donor program transplant center and is an umbilical cord blood center. The most difficult part in this program, Mason says, is that people are not aware of this process and don’t know to donate the cord blood. “This is a waste product in the United States. Typically the cord blood is just thrown away to medical waste after the baby is born.” Efforts are starting to develop cord blood banks.

To cover all of its patients’ needs, Scripps decided about four years ago to concentrate on four programmatic areas in its cancer program: patient care, patient support services, active commitment to clinical research and cancer control.

With about 3,000 newly diagnosed cancer patients a year, the need for nurses is great. Scripps has developed a core system of advance-practice nurses who provide bedside nurses with certification and up-to-date training on new technologies. This has evolved into a national nursing symposium on oncologic nursing.

Patient support services, which include social workers and nurse educators, provide education and program information to patients. Recently added is a men’s general cancer support group.

Across the nation, patient participation in clinical trials can be less than 1 percent. Scripps aims for 6 percent participation and has a centralized scientific review board that looks over every proposal to be sure the trial is scientifically valid. Scripps has nurses that go through patient files to identify qualified participants. Clinical trials allow patients to be active in research through national cooperative groups as well as with The Scripps Research Institute. Currently in Phase 1 is a trial between TSRI and an institute in Palo Alto researching a rare cell detector that allows a look into the blood of cancer patients to detect unusual or rare malignant cells. “We are going to be investigating how that might be used to assess whether a patient needs more treatment,” Stanton says. “This is really at the cutting edge.”

Dr. Joan Kroener, oncologist and director of the breast cancer conference at Scripps.

Dr. Joan Kroener, oncologist and director of the multidisciplinary breast cancer conference, is committed to doing clinical research. “I’m not a laboratory researcher; I’m a clinician,” she says. “I see patients. One of the ways we’ve been able to improve our ability to treat breast cancer is large studies have been done in the United States and Canada taking patients and comparing state-of-the-art treatment to a new treatment we think might be better. It’s the courage of people to do big trials and the courage of the patients to participate that leads to making major progress in a field like breast cancer.”

Finally, Scripps concentrates on cancer control, prevention and early detection. Early detection in many cases leads to a cure. Breast cancer, a common malignancy and frequently diagnosed, is one of those cases where the cancer can be eradicated if caught early. “Happily we cure a lot of breast cancer so the death rate is not as high as lung cancer, but there are more cases of breast cancer,” Kroener says.

Breast cancer may be treated multiple ways by multiple specialists. Generally all patients have surgery, many will have radiation therapy, and a large portion will be seen by an oncologist and treated with additional medications. The multidisciplinary breast cancer conference puts pathologists, radiologists, surgeons, radiation therapists, oncologists and patient coordinators in the same room to review a patient’s case. “One of the big advantages of a closed system like this is all the doctors are in the same place, with the same chart and the same information,” Kroener says. “It really helps that everybody has the same view of what is going on.”

To assist patients through all of this, Scripps Memorial Hospital La Jolla and Scripps Mercy Hospital are starting a nurse concierge service this year, which already is in place at Scripps Clinic and Scripps Green. This means cancer patients will have a dedicated nurse who will assist them in coordinating doctor appointments with outpatient radiation treatments, MRI and CT scans.

Kaiser Researches For A Better Quality Of Life

Research at Kaiser Permanente is not only a part of the organization’s mission, it provides health plan members with access to new technologies and medicines. In Southern California, Kaiser recruits study subjects from within the Kaiser Foundation Health Plan’s 3.2 million members; in San Diego, from nearly 500,000 members.

Clinical research project experience — from the smallest pilot studies to drug trials to outcomes and quality of life analysis — stretches from Phase II to Phase IV and beyond, encompassing post-marketing analysis. Kaiser investigators are all practicing physicians in the more than 26 therapeutic areas of research. More than 300 articles per year from Kaiser Permanente investigators in Southern California are published in peer-reviewed journals. The Southern California Permanente Clinical Trials program is a comprehensive research organization and the only one of its kind that can offer all services of a commercial research organization with the credibility and expertise of practicing physicians.

Kaiser Permanente Medical Center offers cancer prevention, education, detection and treatment to its nearly 500,000 San Diego members but it’s particularly pleased by its participation in the nearly 2,000 investigations and clinical trials throughout the country. In San Diego, Kaiser Permanente research for cancer screening methods and clinical trials for cancer prevention and treatment continue with 30 to 35 trials in a range of malignancies.

One promising study involves FavId and Kaiser’s Dr. Jonathan Polikoff. “The majority of our trials derive from the (National Cancer Institute) sponsored cooperative research groups,” Polikoff says. “We do partner with pharmaceutical firms when an experimental agent appears to hold particular promise. I am particularly interested in novel approaches such as targeted agents and vaccines.”

That is why Polikoff is so excited about Favrille’s FavId. “Favrille has developed a technique to manufacture individualized patient vaccines using a small amount of biopsy tissue utilizing DNA technology,” he says. “Their technique has a high success rate in producing the vaccine within a three month time interval. Patients receive a standard therapy (Rituxan) and those who respond or have stable disease then receive active vaccine or placebo vaccine monthly. The vaccine is relatively nontoxic so patients can continue with a normal lifestyle. Patients who receive placebo vaccine can receive their active manufactured vaccine when they progress. The trial is done in this fashion (randomized and placebo controlled) in an attempt to prove this type of vaccine is effective, with the goal of FDA approval.

“Trial participation is very important to develop new cancer therapeutics that will be less toxic and more effective than traditional chemotherapy,” Polikoff says. “Though there is no guarantee FavId will work, I feel the work the sponsoring company Favrille has done to date has maximized the chances for success. They have created a rational product in an efficient manner and designed their trial with the highest ethical standards. I feel very comfortable offering this trial to my follicular lymphoma patients.”

In health care, nothing can substitute for early detection and treatment. But with the area’s researchers, biotechs and hospitals keeping up with, and in some cases inventing, the latest and greatest in cancer technology, San Diego is at the forefront of this life-saving effort.