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Lifesaving research, precision medicine, and access to the latest trials and technology are just a few reasons why Sylvester Comprehensive Cancer Center Director Dr. Stephen Nimer is bullish about scoring South Florida’s first and only National Cancer Institute designation.
Cristina Espinal was an energetic 14-year-old in Colombia who noticed a strange bump on her leg. Carolina Williams, a fit 27-year-old Dallas schoolteacher, woke one morning so bloated she couldn’t button her pants. Miami mortgage broker Eddy Fernandez, an athletic 44-year-old, began needing to nap between meetings. For Matilde Rasco Torres, 68, walking and gardening around her Miami home suddenly became such a chore she thought she had heart problems.
Though strangers to one another, these four individuals share a common bond: they were all diagnosed with cancer, received treatment at the University of Miami Miller School of Medicine’s Sylvester Comprehensive Cancer Center and have since returned to active lifestyles.
Stephen D. Nimer, Sylvester’s director, says stories like theirs should change the way people in South Florida, and elsewhere, are thinking about cancer—and where to go to have it treated. His outlook is upbeat.
“We are making great strides,” he says. “In the past two years, the Food and Drug Administration has approved 25 to 30 new drugs for treating cancer. We are turning cancer into more of a chronic disease, so people can live with cancer. We are also beginning to cure some cancers that we were never able to cure before—and that’s the real promise.”
Much of that promise comes from an approach gaining national recognition: precision medicine. Highlighted in President Barack Obama’s State of the Union address, precision medicine centers on healthcare that is tailored to each patient based on genetic makeup. Sylvester scientists and physicians recognize that each person’s cancer is different at the molecular or genetic level and will respond differently to specific treatments that attack those unique mutations. Using sophisticated genetic testing, Sylvester physicians are able to determine that mutation and offer patients a customized approach to treatment that may be far more effective than the traditional approach of grouping cancers and treatments based on location in the body.
Nimer was one of the world’s premier leukemia and stem cell transplant researchers and clinicians at New York’s famed Memorial Sloan-Kettering Cancer Center when he came to UM in 2012, drawn by a promise that he would have the support needed to gain a National Cancer Institute (NCI) designation for Sylvester.
“President [Donna E.] Shalala and Dean [Pascal J.] Goldschmidt described their commitment to taking Sylvester to the next level,” he says, “and I realized that I could have a huge impact on the lives of the patients who come here. The notion is that we can be an amazingly patient-centric cancer center while doing research that matters—research whose ultimate goal is to bring discoveries in the laboratory to patients as quickly as possible.” That combination of clinical empathy, dedication to science and commitment to the community is what Dean Goldschmidt sees as the cancer center’s strength.
“Sylvester is unique in South Florida in that our extraordinary physicians and scientists are collaborating every day to develop new therapies, improve those already in use and get them all to our patients as quickly as possible,” he says. “Bringing that research to the people in our region means our patients receive the most advanced university-based cancer care without leaving home.”
Now, Sylvester, South Florida’s sole academic cancer center, is gearing up to apply for NCI designation in 2017. The designation would mean that Sylvester’s work in basic laboratory research; clinical research; and prevention, control and population-based research are of the highest quality and meet prescribed NCI standards. It would also mean Sylvester has demonstrated substantial transdisciplinary research across those areas.
“In research, the way to show that you work together is to publish together,” explains Nimer. “The research itself takes a couple of years and then it takes about a year to get it published, so we’re moving quickly.”
Community impact is also crucial to demonstrate. “Part of that is how many people are on clinical trials,” says Nimer. “Over the past 30 months, our enrollment into clinical trials that involve testing cancer therapies has increased substantially, by roughly 40 to 50 percent each year.”
The NCI designation is more than a prestigious label. It helps the best centers become even better by unlocking doors to additional federal funding and research partnerships. Even the prospect of designation can attract top researchers. These days, a savvy generation of patients asks about NCI designation when weighing treatment options.
The halo effect spreads farther still. The Washington Economics Group estimates that the NCI designation for Sylvester would have a $1.2 billion impact on South Florida’s economy over five years and create 200 high-quality jobs. Those numbers are not lost on Governor Rick Scott and the Florida Legislature, who recently approved a five-year, $300 million budget to support cancer research throughout the state. Of that, Sylvester will receive at least $16 million annually. The funding, which is already helping Nimer hire another 20 to 30 top physicians and researchers, is a significant and deliberate assist in the NCI application process.
“Currently, there are 41 NCI-designated comprehensive cancer centers in the U.S.,” Nimer says. “Florida, with a population of more than 19 million—we’re now the third-largest state by that measure—should have three. Instead, we have one—and it’s not in densely populated South Florida. New York, which our state just surpassed in population, has six.”
Compounding the math is the intersection of disease and demography in the Sunshine State. Though number three in overall population, Florida has the nation’s highest percentage of residents over 65years of age (17% according to the U.S. Census Bureau) and seniors are cancer’s most frequent targets. The American Cancer Society estimates that Florida will report 114,560 new cancer diagnoses and 42,740 cancer deaths (both number two nationally) for 2014.
Nimer likens leading Sylvester to running a basketball team and his strategy is similar: recruit the best players and focus on your best plays. In nearly three years, he hired more than 50 top physicians and scientists from leading institutions, mixing them in with the star players he’d inherited to achieve wins as quickly as possible.
His “best plays” strategy is based on the recognition that cancer is not one but 100 different diseases and that Sylvester’s wins hinge on a realistic playbook. “We have to get very good at a few things first, then add on, as opposed to having 20 different programs, all of which are getting a little bit better,” he says.
Nimer’s choices include leukemia, lymphoma and myeloma; sarcoma; genito-urinary cancers (prostate, kidney and bladder); tumors of the eye and brain; gastrointestinal cancers; head and neck cancers; lung cancer; and breast cancer.
He points out that Sylvester already offers world-class treatment in several of those areas and is achieving five-year survival outcomes that are significantly better than the national average for acute myeloid leukemia (54 vs. 21 percent), late-stage breast cancer (61 vs. 44 percent) and early- and late-stage colon cancer (90 vs. 73 percent and 42 vs. 33 percent, respectively).
“Sylvester’s better outcomes are due, in part, to the fact that we have super-specialized doctors,” says Nimer. “We’re also smaller than some of the other cancer centers, so it’s a little easier to pay attention to all the right details, avoid making any mistakes and make sure patients are treated optimally.”
It may offer little comfort for people who have already lost loved ones, but the statistical truth is that the battle against cancer is slowly being won. In raw numbers, new diagnoses and deaths continue to grow, but that’s because the U.S. population continues to grow, and with it an increasingly large percentage of seniors. According to American Cancer Society statistics, the average five-year survival rate for all cancers, races and ages in the U.S. has risen from 49 percent in the 1970s to 68 percent today.
To speed up translational results, Sylvester has begun research collaborations with Memorial Sloan-Kettering, Nimer’s former institution, and with the giant University of Texas MD Anderson Cancer Center in Houston, from which a number of his star recruits have been drawn. Inside the Miller School, Sylvester is working with the Diabetes Research Institute, the Interdisciplinary Stem Cell Institute, the Department of Neurological Surgery and the John P. Hussman Institute for Human Genomics. Sylvester is also expanding its service regionally by opening satellite clinics, most recently in the Broward County cities of Plantation, Hollywood, and Coral Springs. Still to come is The Lennar Foundation Medical Center, a large outpatient facility slated to open in 2016 on the Coral Gables campus.
Nimer says he enjoys his role at the helm of all these transformative initiatives. “Leadership positions give you a wonderful way to help others,” he says. “It’s a great responsibility, but we’re gearing up to do great things.”
by Robert S. Benchley
Senior Editor at the University of Miami Miller School of Medicine