Expectations are high for Nevada Cancer Institute

Friday, Nov. 14, 2003 | 6:57 a.m.

WEEKEND EDITION

Nov. 15 - 16, 2003

If everything comes together as Heather Murren visualizes, most Nevadans who travel out of state for specialized cancer treatment eventually will no longer have to do so.

Instead, they would visit a state-of-the-art research clinic in Summerlin with colorful furnishings, eye-catching sculptures and a level of concierge service for patients that is normally reserved for high-rollers on the Strip.

The fledgling Nevada Cancer Institute that she and husband James Murren have launched is being designed to supplement existing cancer care in the Las Vegas Valley. The institute intends to do this by developing and testing potential treatment and prevention alternatives that are not otherwise available through the standard care provided by local doctors and hospitals.

If the Murrens are correct, the institute will also help create a biomedical research industry in Las Vegas. It would be an industry complete with pharmaceutical companies and the greatest concentration of scientific minds Nevada has ever known.

"If we can rally around a certain issue such as cancer, we will have a much larger voice," Heather Murren said. "Any time you can create a critical mass of research, other things will follow. We feel the stars are lining up the right way for us and that we're bringing in the right people at the right time."

Those lofty dreams will not come cheaply for Heather, the institute's energetic president, and James, who is MGM MIRAGE president, chief financial officer and treasurer. The Murrens -- both Wall Street veterans who know plenty about high finance -- are looking to raise $50 million for a three-story, 140,000-square-foot nonprofit outpatient cancer center that they hope to open at Town Center Drive and Interstate 215 by early 2005.

They're already more than 40 percent toward their goal, having raised more than $20 million in cash and in-kind donations -- including free land, architectural services and public relations.

And they're going about their fund-raising with pizzazz. None other than CNN talk show host Larry King is set to serve as emcee Thursday during a sold out "Rock for the Cure" event at the Siegfried & Roy Theatre at The Mirage. Featured will be a live performance by the Eagles rock group and an auction -- one item up for grabs is a day as a boxing promoter, accompanied by former heavyweight champion George Foreman.

Already, many of the valley's most influential people have made financial donations to the institute. The event committee for the fund-raiser contains many of the biggest names in the gaming and development communities.

It would be difficult for any medical institution in the valley to match the Nevada Cancer Institute's gaming support. Its major financial contributors include International Game Technology Chairman Emeritus Chuck Mathewson, MGM MIRAGE Chairman and Chief Executive Terry Lanni, Harrah's Entertainment Inc. Chairman Philip Satre, Kirk Kerkorian's Lincy Foundation, casino builder Marnell Corrao Associates, William McBeath, president of The Mirage, and Timothy Poster, part of a company buying the Golden Nugget resorts in Las Vegas and Laughlin.

Entertainers Roy Horn -- who is being treated at UCLA Medical Center for severe injuries he suffered when he was bitten by a tiger during a performance last month -- and Siegfried Fischbacher and boxing promoter Bob Arum also are on the fund-raiser's event committee list.

James Murren said the level of financial support for the institute has exceeded his dreams.

"I would say it has been extremely overwhelming," he said. "The level of support is greater than we expected. If there was not a need for this institute, no amount of work could have generated the type of support we have received."

Currently, most local residents who have cancer go to valley oncologists who specialize either in drug treatments such as chemotherapy, radiation treatments or surgeries. Skin cancers often can be treated in a doctor's office but more complex cancer surgeries occur in local hospitals.

Dr. Dan Curtis, a radiation oncologist who is past president and current vice president of the 67-member Nevada Oncology Society, estimated that 75 to 85 percent of all local cancer patients rely on the standard care that can be found in Southern Nevada. Standard care means treatments that have already been medically approved and are widely accepted.

"Some patients may want to enter special clinical tests because the general treatment isn't doing as well as expected," Curtis said.

This is an example of where the cancer institute would enter the picture.

As an outpatient research clinic, the institute would be designed to supplement standard care. That means that a person who has cancer would still go to a community oncologist first. If the standard care wasn't working or if the patient would like to try alternative treatments, that patient would be considered a candidate to attend the institute.

"The level of standard care in Nevada is excellent," William Murphy, the cancer institute's director of basic research, said. "But when everything fails, what are your options? That's why you need a pipeline to research options."

In its fight to cure cancer, the institute's basic laboratory research will focus on two areas: treatment, with a heavy emphasis on drug development and testing; and prevention, including an examination of the roles stress, diet and smoking play in the creation of malignant tumors. Genetic studies will be a big part of this research.

Lab researchers will either develop their own drugs or help test experimental drugs that have been made by pharmaceutical companies but have not yet been approved by the U.S. Food and Drug Administration. The researchers will want to know how certain chemicals react with tumors.

Murphy, who will also retain his position as an immunology professor at the University of Nevada, Reno, is particularly excited about the prevention aspect of the research.

"We're going to look at the relationship between stress and how it affects cancer," he said. "We'll look at alternative approaches to relieving stress."

The institute, at least initially, will emphasize drug development as opposed to other forms of cancer research.

Drug development

"Drug development will be our focus because that is what the state of Nevada needs most," Heather Murren said.

The National Cancer Institute, which provides federal research funding, wants drug development to be speeded up, she said. The Nevada institute, which initially will be smaller in scale than many other cancer centers, believes it will have an advantage in drug development because its researchers will be better able to communicate with each other than would be the case in larger, more bureaucratic research facilities.

"Developing huge laboratories is an expensive undertaking," Heather Murren said. "With drug development you can do it on a much smaller scale."

As the institute's director of translational research, it will be up to Giuseppe Pizzorno to decide how to best use the laboratory research so that it can benefit patients. Pizzorno, who will also retain his position as a professor at Yale University's Pediatric Pharmacology Unit, said it's possible that a combination of experimental treatments would be recommended for specific patients.

One thing institute researchers will want to know is how proposed treatments will interact with the biological compounds known as proteins that help sustain human life.

"We have 30,000 proteins in the human body and all can be targets for cancer or other diseases," Pizzorno said. "We may only know about the impacts on 1,000 proteins. There are a large number of targets we don't know about."

The experimental treatments will be tried on the patients through the institute's clinical research program, which will be directed by Dr. John Murren, James' older brother and a Yale University oncologist. John Murren, who will also retain his positions as director of the lung cancer unit at the Yale Cancer Center in New Haven, Conn., and as chief of the Yale Medical Oncology Outpatient Clinic, said the cancer institute will offer four phases of clinical drug tests.

Patients who have not found any suitable treatments through standard community care and are out of options are the ones most likely to go through the initial phases of testing. The purpose of the clinical tests is to determine whether the drugs work or whether they are better than existing treatments used in standard care.

"It's a phenomenal time in the field of cancer research," Dr. Murren said. "There are close to 400 agents that are being evaluated as possible new therapies."

Because the institute is being designed to handle only outpatient services, it is not anticipated that any surgeries would occur there. Cancer surgeries would still be performed at local hospitals and patients could still be treated by their own oncologists while receiving the institute's experimental services.

Murphy said the interaction between the institute's staff and the patient's oncologist will be a key to the success of the institute's program.

"You want to go to the physician who has been working with the patient on the front lines," he said.

The Nevada institute, its supporters say, will help change the face of medicine locally within five years of its opening. With a planned staff of 150 researchers and administrators, the center also has the potential to attract scientists for research in other medical fields simply because laboratory and clinical professionals tend to gravitate to communities where they can collaborate and share expensive equipment.

Institute researchers will have access to multi-million-dollar machines with the ability to track molecules within the body of a cancer patient to test the interaction of an experimental drug with that person's tumors.

Labs in Nevada

And center administrators already are negotiating with pharmaceutical and biotechnology companies to have them open labs in Nevada to work with the institute on joint research projects.

"In Las Vegas you're dealing with a city that is exploding with growth and there is a tremendous need for research to be there," Murphy said. "There's a lot of excitement from the researchers I've talked with about Las Vegas' potential. You can make a difference there from the ground up if you're a clinician.

"When you have research infrastructure it becomes more cost effective to share research equipment. You establish critical mass. You have a place where researchers can speak the same language. And federal dollars come in and it spurs on more research."

A separate effort is under way by the city of Las Vegas to bring a branch of the multi-faceted Cleveland Clinic health center downtown. The Las Vegas City Council is scheduled on Dec. 3 to consider spending about $300,000 on a consultant to study the feasibility of bringing the clinic to the valley. Cancer happens to be one of the center's research specialties but its other areas of expertise include cardiology, neurology, gynecology and geriatrics.

"We're always looking for diversification of our economy," City Manager Doug Selby said. "The Cleveland Clinic could be the impetus for that diversification."

Battling cancer -- which consists of hundreds of insidious and often fatal variations of diseases involving the uncontrolled growth and spread of abnormal cells -- is not a new phenomenon in Southern Nevada. Clinical research, funded in part by the National Cancer Institute, has been part of the local medical landscape for the past 20 years. Most oncologists in Las Vegas have helped test new cancer drugs through the nonprofit Southern Nevada Cancer Research Foundation or in affiliation with projects in other states.

Nevada's universities have also conducted medical-related studies. The University of Nevada, Las Vegas has had its own cancer institute since 1999 with 10 professors on board. And the statewide University of Nevada School of Medicine, with $16 million this year in mostly federal research grants used by its labs in Reno, has delved into areas such as muscle physiology, eye function, Alzheimer's disease therapies and stem cell research.

No coordination

But cancer research in Nevada is scattered with virtually no coordination among oncologists and academic researchers. And the research that does exist has been limited mostly to the later stages of drug experimentation.

Ultimately, the Nevada Cancer Institute would like to link together all the cancer research that occurs in the state. To accomplish that task, it has established affiliations with UNLV, the state medical school and UNR.

"We have been historically underfunded when it comes to health care in Nevada," biochemistry professor Stephen Carper, founder of the UNLV Cancer Institute, said. "But there's no reason that in 10 or 15 years Las Vegas couldn't be a medical mecca.

"We look forward to our partnership with the Nevada Cancer Institute. If it succeeds, it should breed more success because we would have demonstrated that you can bring high-caliber research to this state. But if it results in bringing just one more doctor to this state, it would be a rip-roaring success."

The institute also is seeking to work with as many of the state's 82 licensed oncologists as possible. One Las Vegas oncologist, Dr. John Ellerton, president of the Southern Nevada Cancer Research Foundation, also said he looks forward to working with the institute. He said the infusion of scientific researchers here could also could benefit education locally.

"There may be some overlap with what we do but I'd think we would be working together so we can do compatible things," Ellerton said. "It also would be good for the educational system. To me, building up the health sciences at UNLV would benefit the whole community."

Curtis said some of his colleagues have expressed concern that remarks they have heard from institute officials make it seem as though Southern Nevada has substandard cancer care. He defended the level of that care in Las Vegas.

Quality care

"The quality and level of care here is excellent," Curtis said. "That doesn't mean we can't provide more resources to cancer patients.

"When there's rhetoric that comes out that paints a bleak picture of care here, there will be sensitivity to that. Some of the rhetoric that has come out has caused some concern."

But Curtis said he looks forward to working with the institute and wants to know more about how it will interact with local oncologists and their patients.

"The oncology community is sitting back and waiting to see how the Nevada Cancer Institute is structured," he said. "They are open to having a cooperative relationship with the institute."

The Murrens, who moved to Las Vegas from a Connecticut farm only five years ago -- she was a highly ranked Merrill Lynch analyst and he was research director for Deutsche Bank -- weren't sure they would stay here. But once they decided to plant roots, they talked about giving something back to the community.

They turned their attention to cancer after discussing the subject with Dr. John Murren. All three have lost close relatives to cancer.

"Cancer became a very critical aspect of our lives," James Murren said. "My father contracted melanoma. By the time he found out about it, it had spread and it went to his brain. He died at age 59. It was brutal.

"He's still my hero. Much of what I do and how I conduct myself is patterned after the lessons he taught me. He was a man of high integrity who was active in his community and in his church."

Supporters of the Nevada Cancer Institute say the need for a cancer center in Las Vegas is borne out by statistics from the American Cancer Society. The statistics show that Nevada is below the national average in the number of cancer patients per 100,000 residents but above average in the number of cancer deaths. And Nevadans have much lower survival rates from various cancers after six years than is true nationally.

"We analyzed the cancer incident and survival rates in Nevada and found a missing link," James Murren said. "So we invited several directors of cancer centers to Las Vegas to tell us how to set up a comprehensive cancer center."

This is how Nevada compares with the nation as a whole:

From 1995 through 1999, cancer struck 464 Nevada men per 100,000, compared with 562.6 nationally. And 387.6 Nevada women per 100,000 were stricken with cancer, compared with 424.1 nationally.

In the same five-year period, cancer killed 263.1 Nevada men per 100,000, compared with 259.1 nationally. And cancer killed 187.6 Nevada women per 100,000, compared with 171.4 nationally. Only two states, Delaware and Maine, had higher cancer mortality rates for women.

From 1995 through 1999, Nevada women had the nation's highest rate of lung cancer at 72.2 per 100,000, compared with 51.4 nationally. Nevada's men ranked 16th in that category at 100.8 per 100,000, well above the national average of 86.

In the same five-year period, Nevada women led the nation with 56 deaths per 100,000 from lung cancer, compared with a rate of 41 per 100,000 nationally.

Earlier this week, a report from the National Women's Law Center in Washington ranked Nevada tied for last with Kentucky in efforts to discourage women and girls from smoking. The report found that nearly 30 percent of Nevada women smoke, compared with 20.7 percent nationally.

A comparison of 17 forms of cancer, based on statistics from the cancer society and the Nevada Bureau of Health Planning and Statistics, revealed that Nevadans' survival rate after six years is below the national average in 16 of the categories and tied in the remaining category.

The most glaring differences in survival rates nationally compared with Nevada involve melanoma (89 percent to 20 percent), oral cavity cancer (56 percent to 20 percent), prostate (97 percent to 63 percent), colon and rectum (60 percent to 27 percent) and ovary (53 percent to 26 percent).

This year, an estimated 10,300 new cancer patients will be detected in Nevada, led by 1,600 new cases of prostate cancer, 1,500 new cases of lung cancer and 1,400 new cases of female breast cancer.

An estimated 4,300 Nevadans will die from cancer this year, including 1,300 from lung cancer and 500 from colon and rectum cancers.

Heather Murren estimated that 25 percent of all Nevada cancer patients leave the state for more comprehensive treatment elsewhere.

A Las Vegas cancer patient would have to travel 270 miles to reach the nearest comprehensive cancer centers in Southern California. Many Nevadans will travel 1,180 miles to the Fred Hutchinson Cancer Research Center in Seattle or longer distances back East.

"We lose a lot of people to UCLA and to Fred Hutchinson," Heather Murren said. "It could be for a couple days for a second opinion or it could be for weeks or months. It's an enormous burden on families for cancer patients to leave home."

A comprehensive cancer center, as designated by the National Cancer Institute, provides a combination of basic and clinical research, along with patient care, education and prevention programs. Such centers also can attract wide ranges of research funding.

But Heather Murren said the Nevada institute's patient areas won't look like many of the "cold" and impersonal cancer centers she has visited elsewhere. Instead, the building and the service provided will be based in large part on the hospitality standards set by the resort industry, she said.

One of the planned interior features will be a two-story waterfall.

"When you go into the building it will feel like a spa," she said.

Funds diverted

Murphy conceded that one problem confronting cancer researchers is that in the aftermath of the Sept. 11, 2001, terrorist attacks, at least $1.2 billion in federal research dollars has been diverted to the study of deadly biological agents that could be used by terrorists.

But he said that fact doesn't mean this isn't a good time to open a new cancer center.

"It's making every state more competitive now," Murphy said of the fight for cancer research funding. "That's why private funding is critical. The Nevada Cancer Institute will see to it that the state of Nevada is working together and that will give us an edge."

But designation as a comprehensive cancer center will not be a slam dunk. Heather Murren and others say it will likely take Nevada's institute 10 years to earn that status. To put itself in position to gain that designation, the institute must first hire an overall director. In its ongoing search, the institute targets possible candidates and goes after them.

"These people don't submit resumes," she said. "They're like rock stars."

Research priorities

Once hired, the director will help determine the research priorities for the institute. Lung cancer is certain to be one of those priorities because of the high rate of that disease in Nevada. But other priorities will depend on the expertise of the researchers the institute is able to recruit.

The institute already has amassed a panel of scientific advisers from around the country, including Ivy League professors, and has established an adjunct faculty of academicians from Nevada's universities, including UNLV's Carper.

Overseeing all this is a high-powered board of directors who, in addition to the Murrens, include Harrah's Satre, Stephen Cloobeck, president and chief executive of Diamond Resorts International, Nevada first lady Dema Guinn, philanthropist Jon Huntsman, founder of the Hunstman Cancer Institute at the University of Utah and chairman of the Wharton School at the University of Pennsylvania, Gary Jacobs, MGM MIRAGE executive vice president, general counsel and secretary, and Dr. Ikram Khan, a prominent Las Vegas surgeon.

"This gives a lot of credibility to the project," Carper said of the board's membership.