Building the new James Cancer Hospital helped OSU attract a renowned sarcoma researcher

A rare and little known cancer is going under the microscope in Columbus' new Arthur G. James Cancer Hospital and Richard J. Solove Research Institute and helping to elevate the city's presence as a cancer treatment hub in the process.

The cancer is sarcoma. Striking people of all ages, it accounts for 10 percent of all pediatric solid tumors but just one percent in adults. Construction of the new James hospital helped the Ohio State University Wexner Medical Center lure a globally renowned sarcoma researcher away from MD Anderson Cancer Center in Houston last year.

"I was very fortunate. Ohio State was remarkably supportive in helping me move my entire research base from Texas to Columbus," says Raphael Pollock, the James' new chief of surgical services.

Pollock, an MD and PhD, brings with him a five-year grant from the National Institutes of Health National Cancer Institute worth $16 million. The grant is the first ever granted to a clinical trials group, the Sarcoma Alliance for Research through Collaboration, rather than to a specific cancer center or medical school.

The team he has assembled here includes just a few who followed him from Texas. In all, the sarcoma-dedicated personnel include three pathologists, three radiologists, two medical oncologists, two surgical oncologists, two orthopedic oncologists, four radiation oncologists and a half dozen researchers, most with independent funding, Pollock says.

"One of the attractions for me was the opportunity to work with a remarkable group of sarcoma experts who were already here, many of whom are younger people in need of mentorship to help their careers be developed and leadership to help these people become more visible nationally and develop large-scale research agendas," he says.

With his grant, his team and the capabilities of the new hospital, Pollock is hopeful for breakthroughs in the treatment of sarcoma patients, to whom he has dedicated 32 years of his career. When he started, about 6,000 new sarcoma patients were diagnosed annually in the United States. Now the number is over twice that. The James sees about 300 new sarcoma patients a year-many from outside Ohio-and could care for double that number in the new hospital.

"It's not that the incidence of the disease has doubled but our recognition of what constitutes the disease and our ability to tabulate and keep track of it that's improved. But it is more prevalent, therefore, than what has been previously appreciated, and all the more reason why it becomes very, very important to have dedicated teams of professionals who work together on behalf of the patients," Pollock says.

He explains that sarcoma "is a complicated disease (with) somewhere between 50 and 100 subtypes, each of which has their own basic clinical biology as well as molecular biology. It is so rare and there are so many subtypes, it has been difficult to develop research programs, because research programs in the disease are based on access to patient tissues."

While many cancers have known causes, Pollock says "99 percent of sarcomas are what we call sporadic, which is kind of a fudge term meaning we really don't know what causes them."

Part of what excites Pollock about the new James is how it has been designed with integrated research areas.

"One of the really insightful decisions in putting together the new hospital was the idea that imbedded in the patient care areas there should be research labs, and so a number of these labs are being set up.

"A critical aspect of this, harvesting tissue at the time of surgery and getting it to the research environment as quickly as possible is really important, because some of the molecules that we are studying will not remain in the tumor in their intact form if the tissue is not processed promptly…. So having laboratories such as this that are immediately accessible to the operating room is very, very important," Pollock says.

"This is something I've never seen before. It is very unique," Pollock adds, crediting David Schuller, MD, vice president of OSU medical center expansion and outreach, with the notion of integrated research labs.

James CEO Michael Caligiuri, MD, shows off one of the hospital's 14 operating rooms as he recalls how labs came to be coupled with patient care in the new James.

"Eight years ago we started planning this, not knowing what size we were going to need. It turns out that DNA sequencing of tumors-which 10 years ago took years and millions (of dollars) and a room five times as big as this OR, maybe as big as this whole floor, filled with DNA sequencers-now can be done in small labs, on a desktop, for about $3,000 in four hours. The size of these rooms that Dr. Pollock is talking about is the perfect size to do that kind of work and that's the kind of work we'll be doing on the floor.… We lucked out. We don't have a full laboratory floor, just small rooms, and it turns out that's all you need," Caligiuri says.

"The other aspect of this that is very important," Pollock says, "is the dividers between the labs and patient care areas are large ceiling-to-floor glass panels that are transparent. It enables patients to see that research is integral to their care, because it is. So if someone is donating tissue for a research program, they can see the people who are actually working with the tissue. And for the scientists in the laboratory and the technicians, they can see that the tissue they're working on comes from a patient. That's very powerful."

He adds, "From the laboratory bench to the patient bedside and back again is a really critical loop. And every time you loop through something new comes up that might potentially be useful to a patient."

During his three-plus decades of sarcoma research, Pollock's studies have revealed positive and negative aspects of sarcoma.

"We have learned much about how these tumors are able to sustain their own growth by recruiting blood vessels from the local environment and even stimulating the growth of new blood vessels as well as the genetic control of that process, which is called neovascularization.

"More recently, we have focused on mechanisms of chemo resistance in this disease, which is important because what can frequently get patients into very deep trouble is spread of tumor from the primary tumor to other sites, and the best way to control that is with a therapy that can hit all parts of the body. Yet chemotherapy doesn't work particularly well for some subtypes of sarcoma. So learning why that is the case on the molecular level, and then being in a position to potentially design, develop or deploy very specific therapies that might attack those molecular Achilles heels of the tumor is what we're trying to do now," he explains.

He envisions being able to attack what would otherwise be an inoperable tumor. "If you were able to identify the areas within the tumor particularly prone to spread elsewhere, go in and carve those out, well you have to be able to function combining robotics with interventional radiology and molecular imagining. These ORs are configured; they are big enough to be able to do that. The forward thinking that went into this facility, the ability to do these types of conjoined procedures-initially on a research basis but ultimately on behalf of patients-is at hand."

Pollock adds, "Those of us in oncology live to be able to see improvements…The home run is developing a treatment that totally changes what is the state of the art in providing therapy for a patient."