Better Together: The St. Jude Comprehensive Cancer Center

Pretend you’re the most incredible trumpet player in the world. You live in a neighborhood next to the country’s top pianist, bassist and drummer.

Any one of you can thrill an audience. But as a quartet, you can make even richer music by learning and playing off each other’s strengths.

Now say that instead of a trumpet player, you’re a cancer biologist. And instead of a quartet, you have an orchestra consisting of a world-leading oncologist, a pathologist, a geneticist, and dozens of other top experts in cancer research and treatment. Every one of you leads a stellar individual research program. But how do you blend your talents in a symphony that takes on childhood cancer as a whole?

You do it through the St. Jude Comprehensive Cancer Center.

Perfect harmony

As the only National Cancer Institute (NCI)–designated Comprehensive Cancer Center dedicated solely to children, the St. Jude Comprehensive Cancer Center is deliberately designed to foster collaboration among high achievers across the hospital.

Marking the success of this approach, the center recently earned a second consecutive “exceptional” ranking — the highest possible distinction — from the NCI, once again distinguishing St. Jude as one of the nation’s elite cancer research institutions.

Because St. Jude is a pediatric specialty hospital focused on cancer and other life-threatening diseases in children, its Cancer Center differs from most, as it is completely integrated into the fabric of the entire organization.

“Cancer is remarkably complex,” says Charles Roberts, MD, PhD, director of the center. “To beat it, we need collaboration. NCI-designated Cancer Centers bring together oncologists, surgeons, pathologists and many other scientists to focus on a shared problem.

“We ask, ‘What are the critical issues we want to attack? What are children dying from? Where is the opportunity for greatest impact?’ After identifying the most pressing problems and greatest opportunities, we develop a collaborative strategy to address them.”

From lab to bedside to the world

Five Cancer Center research programs, led by world-renowned experts and composed of investigators from diverse disciplines, drive progress in key areas: blood cancers, brain tumors, solid tumors, basic cancer biology and childhood cancer survivorship. These individuals meet regularly to exchange ideas and are supported by shared resources and seed funding for promising research.

“There’s a natural opportunity for cross-pollination,” notes Victor Santana, MD. As senior vice president of St. Jude Clinical Trials Administration and the center’s associate director for clinical research, his responsibility is to oversee all clinical trials at St. Jude.

“Although my clinical duties are in the solid tumor group, I have interactions with investigators across all the Cancer Center programs,” he says.

St. Jude research, spanning the spectrum from lab to clinic, turns scientific discoveries into innovative clinical trials that give young patients the best chance of healthy adulthoods.

“Because of the remarkable science coming out of our programs, we enroll a lot of patients on studies; in fact, 98 percent take part in clinical trials during their time at St. Jude,” Santana says. “This offers patients the opportunity to improve their outcomes and care — and to feel they’re advancing science and helping others.”

To share knowledge and advance cures, the center’s members also collaborate extensively with other NCI Cancer Centers; help train the next generation of cancer researchers; and educate the community about cancer, cancer prevention and healthy living. A core team led by Dana Wallace, associate director for Cancer Center administration, organizes regular meetings, seminars and events for members.

“An NCI Cancer Center is meant to be a whole greater than the sum of its parts,” she says. “Our job is to make sure that happens. It’s awesome to see the great collaborative science that comes out of these discussions.”

An exceptional center

The St. Jude Cancer Center was established in 1977 when the hospital received its first Cancer Center Support Grant from the NCI. Funded by the NCI ever since, the center earned comprehensive status in 2007 and its first exceptional rating in 2013.

Every five years, the center must renew its NCI grant funding and designation. During the most recent cycle, Roberts, Wallace and groups throughout the center began preparations 18 months in advance. A 2,300-page application was followed by a full-day, on-site visit by NCI reviewers.

The result? As well as a second consecutive “exceptional” rating, the center earned its best numerical score to date.

“I honestly could not be prouder of the incredible team of Cancer Center members, leaders and staff that made this achievement possible,” Roberts says.

National treasure

Renewal years are a valuable time to pause and reflect on the center’s direction and contributions at a national level.

“It was a tremendous honor for the center to be called a ‘national treasure’ by the reviewers, and the fact that our score is the best it’s ever been shows our impact,” Santana says. “Going through the review process also allows investigators and leadership to identify areas where we can work together even better.”

The review process is constructive, says Charles Mullighan, MBBS, MD, who co-leads the Hematological Malignancies Program with oncologist Ching-Hon Pui, MD.

“We looked back on what we’ve accomplished over the last five years,” Mullighan says, “but now are thinking about where we’re headed, and planning strategically about areas where we need to grow our research efforts and expand our treatment programs.”

Unique responsibility

Fifty-five percent of pediatric cancer cases are caused by genetic changes that are never seen in adult cancers. This recent discovery, led by center member Jinghui Zhang, PhD, working with scientists from the NCI, the Children’s Oncology Group and other centers, underscores the importance of pediatric-focused research efforts.

“In these cases, the old model of developing drugs first for adults and then moving them down to children just won’t work,” Roberts says.

St. Jude has a responsibility to develop new cures especially made for children, he says.

Examples of key breakthroughs made possible through Cancer Center collaborations include increasing survival rates for acute lymphoblastic leukemia to 94 percent; creating a better immunotherapy that doubled the rate of treatment response in children with high-risk neuroblastoma; and launching the first clinical trial for medulloblastoma, a common childhood brain tumor, that matches treatments to the molecular features of individual patients’ tumors.

“The strength and the innovation of the basic science, and how that science gets translated into clinical trials, allow St. Jude to have real impact on patients’ lives,” Santana says.

Planning for tomorrow

Now that most young cancer patients survive their disease, research to help alleviate the long-term side effects of cancer treatment is essential.

“It’s important to look at the entire continuum, from diagnosis to survivorship,” Santana says. “Our Cancer Center does that exceptionally well.”

To more rapidly advance progress, Cancer Center members have also taken the lead on other large-scale projects in new or innovative areas.

“The center has become the vehicle for strategic planning related to childhood cancer,” Mullighan says.

“Some of the most forward-looking initiatives have been launched through direction and vision from the center — such as, how will we expand our efforts in immunotherapy? How do we best position ourselves for precision medicine? What does the next generation of clinical trials look like?

“It’s the natural home for those questions, because you can rapidly pull together the key people from the Cancer Center to get new initiatives off the ground,” he continues.

Unparalleled mission

Roberts says it’s a compelling time to be a cancer researcher.

“We still have a long way to go, but thanks to emerging technologies, we now have a better understanding of cancer and therapies — and thus have the opportunity to advance cures for children more rapidly than ever before,” he says.

And just as science moves the Cancer Center forward, the hospital’s mission provides the inspiration.

“It’s being in the clinic and seeing a 7-year-old who was playing soccer two days earlier, but then finds out his bruises weren’t from soccer but from leukemia; or a toddler who was meeting all of her milestones, but now she’s battling for her life,” says Roberts, who is also a practicing pediatric oncologist and scientist.

“There’s nothing that brings more motivation and drive.”