What if in the next few years patients with cancer in their lungs or blood could sit in a chair, get an infusion of their own modified cells to wipe out their cancer and go home?
Cancer researchers and doctors around the country are working on it — not only replacing rounds of toxic chemotherapy with the most advanced immunotherapies but also making the cutting edge treatments more readily accessible and even comfortable.
A big piece of the effort locally starts coming together Friday when the University of Maryland Medical Center breaks ground on a new $219 million cancer center.
The Roslyn and Leonard Stoler Center for Advanced Medicine will rise in front of the downtown Baltimore hospital and house the Marlene and Stewart Greenebaum Comprehensive Cancer Center. It’s slated to open in 2025.
Dr. Kevin Cullen, director of the Greenebaum Cancer Center, said the new center was designed in anticipation of medical advances and patient needs.
“We’ll be able to offer a bone marrow transplant, for example, in an extended-stay environment. You stay for treatment and go home and come back the next day,” Cullen said ahead of the groundbreaking. “We don’t have that capability now.”
Cullen said the center already is among the first in the region to offer some immunotherapy treatments that will only expand.
The building and research at the University of Maryland School of Medicine, which will jointly operate the center with the hospital, are made possible in part by state and federal “moonshot” investments and funding from the American Cancer Society and others with a goal of developing better therapies, and even cures, for more types of cancer — the No. 2 killer in the United States with 600,000 deaths expected this year.
Fundraising for the Maryland center began in 2018 when Baltimore auto dealer Len Stoler and his wife, Roslyn, gave $25 million toward the 198,000-square-foot building to enable treatment of thousands of patients a year.
The 9-story metal and glass building designed by the Nebraska-based architectural firm HDR will double the center’s capacity from the current building and accommodate patient visits that are estimated to rise more than 50% by 2028.
Officials anticipate serving patients with increasingly complex cancers that require multidisciplinary treatment and lengthy follow-up care. Most of the space will be devoted to inpatient and outpatient care with a new entrance and lobby for the hospital. Another 42,000 square feet will be renovated in the existing medical center.
A large portion of the new center’s start-up funding will come from a $216 million “moonshot” initiative launched by Gov. Larry Hogan, whose cancer was treated at the center. Hogan accelerated $100 million in funding for the center in next year’s budget.
At the federal level, cancer research nationwide stands to gain from a President Joe Biden initiative with a goal of cutting cancer deaths in half in the next 25 years and improving life for survivors.
Congress already has allocated about $1.6 billion to expand research into genetic mutations found in different cancers, develop vaccines to prevent cancer, deploy new diagnostic tools to find cancers sooner and close disparities in rates of disease.
A big and promising front in those treatments focuses on immunotherapies, which train people’s own immune systems to target and kill cancer cells.
Keeping momentum will require more funding and attention, said Dr. Arif Kamal, an oncologist and chief patient officer at the American Cancer Society.
The National Cancer Institute, the largest funder of cancer research, can only accept one in 10 of the research applications it receives, Kamal said.
“When receiving funding has a 90% chance of not working out, promising scientists can be deterred, and we face the threat of them leaving the field and their potential groundbreaking discoveries never coming to light,” he said.
The cancer society has contributed more than $133 million in Maryland for research over the years, with the University of Maryland hospitals and university receiving $23.8 million.
Kamal said it’s an “exciting and promising time” in cancer care, and doctors have increased ability to treat more types of cancers in less damaging ways.
He cited several kinds of immunotherapies, such as checkpoint inhibitors, which block proteins that stop the immune system from attacking cancer. There is also CAR T-cell therapy, which involves taking T-cells from a patient’s blood and training them to attach to tumor cells before being given back to patients via viruses.
The Maryland cancer center was the first in the Maryland-Washington, D.C.-Virginia region to offer CAR T-cell therapy to treat lymphoma, a blood cancer, after having been involved in trials to show its effectiveness.
The FDA recently approved it to treat lymphoma in patients whose chemotherapy failed once rather than multiple times, giving patients earlier access, said Dr. Aaron Rapoport, director of the transplant and cellular therapy program at the Maryland cancer center.
In all, the University of Maryland center is using the treatment on 250 patients.
“More than half of those patients had no other option and are likely cured of their cancer,” Rapoport said. “This turned out to be highly effective for patients, and we were one of the leading centers demonstrating that.”
Rapoport said there are many other advances in the works at Maryland and elsewhere, and some are likely to be available by the time the new cancer center opens in 2025. They also may be given in outpatient settings rather than involving hospital stays.
To prepare for that, the new center will feature an expanded outpatient center for bone marrow transplants and other immunotherapies. A cell-processing laboratory that handles patients’ blood will be on site. There also will be an urgent care area where cancer patients can go instead of the emergency room.
Such additions were among the changes made with input from medical and other staff and the community, said Cullen, the center’s director.
The expanded patient care areas will supplement research areas largely housed nearby in the hospital.
That research will press on during construction, and will involve collaborations with other institutions including Johns Hopkins Medicine.
Dr. William Nelson, director of Hopkins’ Sidney Kimmel Comprehensive Cancer Center, said institutions have long shared their work to make advances.
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In the 1970s, researchers looked at what could kill cancer in a lab dish and determined “how much of that stuff we could get into a person without too much collateral damage,” Nelson said.
It cured some cancer but also damaged other organs, made hair fall out and made people feel sick, he said.
Today doctors have and are developing new tools: They can inventory gene defects in cancer patients, target specific gene defects with therapies, improve the technology to better diagnose cancer and determine which drugs will or won’t work on specific patients. And that’s on top of new immunotherapies.
Nelson said Hopkins, Maryland and other institutions need to figure out how to seize opportunities like government moonshot and private dollars to build on progress. Collaboration is one big way.
Hopkins scientists recently announced they were awarded $8 million for novel cancer research. It’s part of a $50 million award from the Break Through Cancer research foundation to five top cancer centers that will work together on cures for pancreatic, ovarian and brain cancers.
They hope to accelerate research like scientists did with the mRNA vaccines against COVID-19 in less than a year. Then they need to ensure any new treatments are delivered as comfortably and equitably as possible.
“Take a disease like breast cancer. You never need to be in the hospital overnight, for a mammogram, biopsy, lumpectomy, chemo, hormonal therapy,” Nelson said. “People have lives to live. Go get in, get seen and get back to work or home. That’s the future.”