In an experimental treatment to direct the immune system to target prostate cancer, all of a patients blood is filtered three times to gather a half-cup of cells so potent theyre known as master cell gardens. Then, a growth factor is added to the cells so theyll target the cancer, and the cells are put back into the patients body.


In another clinical trial, patients who have head and neck cancers are given a virus, Onyx-15, that causes their cells to make a copy of a gene that normally suppresses cancer, but which their bodies are no longer making.


In a third trial, patients receive a vaccine intended to stimulate the bodys immune system to attack a target within pancreatic cancer cells.


All three studies are national in scope, but Cancer Care Northwest PS, of Spokane, administered the therapies here to patients enrolled in the first and third study and still is doing so in the second study.


To take part in the pancreatic-cancer study, three patients traveled to Spokane from California. Usually, patients travel in the other direction to participate in leading-edge medical studies, but Cancer Care Northwests research setting meets the rigors of a university research hospital even though it isnt in an academic setting, which is what the pancreatic-cancer study had called for.


The medication that the three patients received here is at least two or three times better than any other compound that you have out there and enables Cancer Care to provide cutting-edge hope, says Dr. Bruce Cutter, Cancer Cares president.


He calls Onyx-15, used in the head- and neck-cancer study, hot, and Dr. Stephen Anthony, who heads Cancer Cares research department, says the experimental medication is stuff we really hoped to get. Anthony adds that in the prostate-cancer study, Cancer Care handled the blood filtering and administration of the growth factor additive to 11 of the 120 patients, or about 9 percent, in a national study that will be published soon.


The three research trials are among more than 100 cancer studies being performed in the research department at Cancer Cares clinic at 605 E. Holland. The clinic is one of three the medical practice operates here.


Cancer Care soon will add an eighth full-time member to its research department, which also has one part-time employee. That staffing level is a far cry from when Rose Miller, a registered nurse whos the departments research manager, was hired in 1998 to work two days a week to help launch the department.


Cancer Cares research staff doesnt include Anthony or the practices 13soon to be 16other oncologists, who are the lead physicians here in the studies. Dr. Ryan Holbrook, a surgical oncologist, and Dr. Elizabeth Grosen, a gynocologic oncologist, both of Spokane, will join Cancer Care on Sept. 1, as will Dr. Melanie Schneider, a gynocologic oncologist with the Yale University School of Medicine, Cutter says. He says that the practices oncologists carry out their research efforts in addition to their work with patients as full-time clinicians.


Cancer Care is one of few community-based sitesand is perhaps the only community-based site in Washington statewhere Phase I and Phase II clinical trials are conducted routinely, Cutter says. Such studies typically are carried out in a university research hospital, Cutter says.


In Phase I trials, a drug that has completed laboratory and animal testing is given to humans so researchers can study the correct dose and the drugs side effects and learn how its metabolized in the body. In Phase II trials, researchers answer such questions as how the drug works and what cancers its effective against. Cancer Cares research capabilities have been enhanced by its affiliation with Houston-based U.S. Oncology, which is a joint-venture partner in the Spokane practice, Cutter says.


U.S. Oncology claims that through its affiliations with community-based oncology practices, it has a research network of more than 850 oncologists at 330 locations. Cancer Care Northwest, however, is one of just five U.S. Oncology research locations that do Phase I and Phase II clinical trials, Miller says.


Though research isnt a profit center for Cancer Careand is often a loss center, Cutter saysit enables the Spokane medical practice to:


Offer patients cutting-edge experimental treatments here, giving hope to people who have life-threatening diseases. Says Anthony, I just dont see how you can be in the cancer field and not be involved in clinical research. Every patient who comes in here has to be looked at as a potential participant in a clinical trial. Still, while its estimated that up to half of all cancer patients could qualify for experimental treatments, were lucky to hit 10 percent, and thats when were trying really, really hard, Anthony says.


Participate in the search for cures for cancer. The only way were going to get better is to do the studies and do the documentation, Cutter says. This is how cancer treatment progresses.


Integrate research into its system of care. Cutter notes that the practices researchers are right down the hall. Theyre not somewhere else. You dont have to go anywhere to see them. You can go see them and ask them a question. That helps Cancer Cares entire staff keep up with advances in cancer treatment, he says.


As well, Cutter says, Cancer Cares research work keeps health-care dollars in the Spokane area and should help Spokane in its drive to be recognized as a leading medical research center.


In all, the medical practice has brought more than 400 patients into cancer-research studies in the last four years, and its still following some 200 of those patients.


Cancer Cares North Side clinic includes a clean room used only for research patients. The room has a ventilation system that turns over the air 10 times an hour; a minus 80 degrees (Centigrade) freezer; a hooded drug-mixing station; and a security-monitoring system.


Cancer Cares oncologists bring individual strengths to the practices research effort. Anthony serves on U.S. Oncologys national scientific advisory committee, is the lead physician for all of U.S. Oncology on one study, and has written six clinical trials, including one thats under review currently. He also has published articles on gene therapy and cancer drug resistance, and maintains a science link with the Dartmouth Medical School, where he works with a former mentor and a lab to do research into pharmacology and toxicology.


Dr. Greg Swanson is a member of the Southwest Oncology Group, which designs and carries out national clinical trials on prostate cancer, and also is a member of the Pediatric Oncology Group and the National Surgical Adjuvant Breast and Bowel Project. He currently is an investigator on five national prostate-cancer studies and has authored a clinical trial, which is under review, to combine the drug taxotere with radiation in treating prostate cancer.


Dr. John Caton Jr., was one of nine co-authors of a recent article in the New England Journal of Medicine on the benefits of removing a cancerous kidney over drug therapy alone, and is a former director of the Southwest Oncology Group.


The hours that Cancer Cares oncologists spend on research can mount up until they consume 20 percent to 30 percent of all of the time a physician devotes to his or her work, Anthony says. Its a lot of time; you dont bill for that, he says. On top of all this, we are committed to some type of individual research.


Not all of the research done at Cancer Care is to combat cancer after it has set in. Two current studies are preventive.


In one, vitamin E and selenium are being given to men in an attempt to keep them from getting prostate cancer. In another, women who are at high risk of getting breast cancer are being given raloxifene. The study attempts to weigh whether that drug is better than the medication tamoxifen in preventing, with limited side effects, breast cancer in high-risk women.


In addition to Miller and two other registered nurses, Cancer Cares research staff includes five data coordinators who track the qualifying of patients for studies and the meeting of study requirements.


Research staff members screen patients to find study candidates, makes sure all baseline studies and testssuch as blood work, CT scans, bone scans, electrocardiograms, and othersare performed to satisfy the eligibility criteria, and even do such things as arrange for hotel rooms for patients when necessary.


Everything is documented, and thats a lot of information. Miller guesses that by the end of a cancer study, an average patient file is 10 inches thick.


A key factor in getting research done is accrual of patients, and to find patients here, Cancer Care sets up meetings with Spokane-area physicians in different specialties.


Research staff members often become close to the patientsand inevitably, some patients die from their disease while theyre participating in a study, which is hard for the research staff. Anthony says, though, that participating in a clinical trial can provide palliative care for patients and their families. He says the widow of one research patient wrote to say, It meant so much to him to be able to participate in the trial. He knew he had done everything he could. His quality of life was better for having participated. Says Miller, To be able to get the people through it is the big reward.


For the cancer researchers, another big reward comes when the FDA approves for general use a drug theyve worked on in clinical trials. Since 1995, staff members at Cancer Care and its predecessor, Spokane Oncology Hematology, have taken part in the development of seven anticancer drugs. To Spokane Valley native Miller, The opportunity to participate in something like that in your own hometown is amazing.