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Shedding Some Sunlight on the Cancer Center Situation Down San Antonio Way

Rosenthal, Eric T. Special Correspondent

doi: 10.1097/
Eric Rosenthal reports

For years the cancer center entity that has existed in San Antonio, Texas, has been an enigma to many of those who've tried to figure out exactly what the relationship has been between the Cancer Therapy & Research Center (CTRC), the University of Texas Health Science Center at San Antonio (UTHSCSA), and the largely perceived Potemkin village-like San Antonio Cancer Institute (SACI).

This situation became somewhat more transparent in December when CTRC officially entered the University of Texas Health Science system and the SACI façade was retired.

For some three decades the most visible common denominator in San Antonio's cancer community had been Charles A. Coltman Jr., MD, longtime and former Professor in the Department of Medicine at UTHSCSA; President and CEO of the CTRC; Director of SACI; Chairman of the Southwest Oncology Group (SWOG), and Co-chair and Co-founder of the San Antonio Breast Cancer Symposium (SABCS).

Dr. Coltman is currently President Emeritus of CTRC and Chairman Emeritus of SWOG and will serve either as Co-chair or in an emeritus advisory position with SABCS for this year's meeting in December (see accompanying story).

Last month, he retired fully from SWOG after 44 years and will have two fellowship programs established in his honor.

The cancer research and treatment dynasty that had existed during a large part of the last quarter of the 20th century was partially dismantled by the National Cancer Institute in 2000 when NCI requested that the leadership of the CTRC and SACI be separated.

Dr. Coltman remained President and CEO of CTRC until retiring and assuming emeritus status at the end of 2004, and was succeeded by Karen K. Fields, MD, in January 2005.

However, SACI did not immediately seek a permanent director and was headed by a series of interim directors, until Tyler J. Curiel, MD, MPH, was recruited from Katrina-battered Tulane University School of Medicine in August 2006 to become SACI Director, CTRC Director of Cancer Research, and Assistant Dean at UTHSCSA.



Then in mid-November a news release was jointly issued by a San Antonio-based public relations agency and UTHSCSA announcing CTRC's merger with UTHSCSA in December pending approval by the UT System Board of Regents, which was granted on December 6.

The release offered reporters interviews with only CTRC Chairman of the Board Mark E. Watson Jr. or Francisco G. Cigarroa, MD, President of the Health Science Center, and bypassed any CTRC administrative, medical, or scientific spokespeople.

Requests for background information or comment were also refused by several individuals involved in the San Antonio cancer community.

OT contacted Mr. Watson, who was referred to in the release as the owner of the Diamond K Ranch, which is described on its Web site as a 5,000-acre working ranch north of San Antonio with exclusive, personally guided wildlife hunts, as well as fishing and photography.

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Eliminating Confusion

When asked about the confusing relationship among the various cancer and academic entities, Mr. Watson chuckled and said, “I think there's been a lot of justification for the confusion and one of the things we're really excited about coming out of this merger is eliminating all that.”

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The center's assets are a gift by the CTRC Board of Directors to the university—“probably the largest gift they've ever received,” Mr. Watson said. “It's probably about a $150 million gift, and the university is going to take over the management and the direction of the CTRC, but the identity will remain the same, very much like M. D. Anderson.”

Details of the deal were more fully described in an article in the San Antonio Express-News by Don Finley, who reported that the UT System would pay approximately $14 million for the CTRC's land, buildings, and equipment and that CTRC will use the money to pay off debt related to those assets.

“In return, the CTRC Foundation, a separate organization that manages the CTRC's $74 million endowment, will pay the health science center $10 million at the completion of the deal, $8 million after one year, and $6 million after two years,” the Express-News article said. “Afterward, the foundation will contribute each year at least $1.9 million or 5% of its fund balance, whichever is greater.”

Mr. Watson said during his November interview with OT that the effective date of the merger would be December 17, and that Dr. Fields had been offered a tenured professorship at UT but hadn't said yet if she would accept it.

Dr. Fields declined to be interviewed and wouldn't comment when I saw her during the San Antonio Breast Cancer Symposium days before the merger date. However, on Dec. 17, coincidently the day following the end of the breast cancer meeting, Dr. Curiel, who had just been appointed Director of the new entity—CTRC at UTHSCSA—told OT in what he said was his first official call from his new office that Dr. Fields had “declined to accept the position with UTHSCSA as well as any position in the restructured cancer center.”

Mr. Watson said that he expected about 90% of the CTRC's 440 employees to be retained under the UT system after the merger, with some loss due to duplication of some administrative jobs. He also mentioned that CTRC's chief operating officer had recently resigned.

He said the merger was motivated by what's best for the patient: “San Antonio is the seventh largest city in the United States and we should have the finest cancer center in the world in San Antonio and we feel this is a significant step in that direction,” he said.

“We feel that our trade territory is not just San Antonio and Bexar County but all of south Texas and northern Mexico. We're as close to Monterey, Mexico as we are to Dallas. People in south Texas and Mexico feel very much at home in San Antonio—much more so than if they had to go to Houston, Baltimore, or New York City.

“This is something that's a long time coming, but I'll tell you I made it happen as quickly as I could, and I'm really thrilled and I feel the scientists we have here are absolutely elated, and it will improve our competitiveness when we are out encouraging world-class scientists to come to San Antonio,” he said, also citing the importance of Texas's recently passed Proposition 15 that will provide cancer research centers with $3 billion over the next 10 years under the statewide Cancer Prevention and Research Institute of Texas.

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Reverse Brain Drain

CTRC can use the help to reverse what had been a brain drain, with the loss of several prominent faculty members during the last decade.

In the late-1990s Institute for Drug Development (IDD) founder Daniel D. Von Hoff, MD, left for the Arizona Cancer Center, where he served as Director, and C. Kent Osborne, MD, took his research group to the greener pastures of Houston's Baylor College of Medicine, becoming Director of its cancer center in 2005, which received NCI designation in 2007.

In 2006, Peter Ravdin, MD, PhD, founder of Adjuvant! Online, left to become Research Professor of Biostatistics at M. D. Anderson, and in early 2007, Anthony W. Tolcher, MD, head of IDD, and several of his top staff left CTRC in what was described by the San Antonio Express-News article as “a dispute with Fields and Curiel” to start South Texas Accelerated Research Therapeutics, a company created to conduct Phase I cancer drug studies.

Figure. Dea

Figure. Dea

CTRC, which opened in 1974 and formed the amorphous SACI entity in 1990 with UTHSCSA, earned its NCI designation in 1991 and comprehensive cancer center status in 1996, only to lose the comprehensive designation in 2002.

The merger should help the Center rebuild its critical mass, which began when Dr. Curiel was recruited less than a year and a half ago.

During a telephone interview with William L. Henrich, MD, Dean of UTHSCSA School of Medicine, and Vice President for Medical Affairs, Dr. Henrich said that CTRC had always been affiliated with the health science center in one way or another.

“When I arrived [in spring 2006] there were several affiliation agreements that needed to be signed. The arrangement between CTRC and HSC needed to be codified. So that was undertaken and done.

“SACI was created largely to be the organization that knitted the CTRC and HSC together,” he said. “In essence you had the nonprofit CTRC and its Institute for Drug Development, and its entities now joined to the HSC in a very formal way.

“We recruited Tyler Curiel to be cancer center head of SACI, and a new head of hematology/oncology, Francis J. Giles, MD, MB, from M. D. Anderson to be part of the new program.”

He said that earlier this year CTRC leadership approached the health science center leadership about a possible merger and discussions were held intermittently over about eight months.

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‘Asset Transfer’

The merger would make CTRC a health component in the University of Texas system, and Dr. Henrich talked about the paperwork involved in transferring employees over to the state payroll, and said the deal was called an asset transfer, meaning that the buildings, equipment, and holdings of CTRC were transferred to the university.

He added that Dr. Curiel would report up through his (dean and VP medical affairs) office and said, “To be candid as an administrator, I think that when CTRC and HSC were two institutions united under SACI it made it more difficult for the leadership in both institutions to be in full and complete communication.

“It wasn't that people were trying not to be in communication, it's just that they were two entities and there were efforts to bring us closer together but they could never be fully successful unless both were joined in the same institution, and now they are.”

He said there's reason for optimism for the success of the new venture because with the University of Texas backing and the single entity the complicated structure of SACI becomes a lot clearer, and “becomes a lot less dense than it was before.

“From my own selfish point of view—the parochial point of view of an administrator as the dean of the school—it's going to make our jobs in building a first-rate cancer center much easier administratively,” he said.

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Options for Cancer Treatment

Dr. Henrich said his dream was that if the citizens of San Antonio had cancer, they would have at least two, if not more, very acceptable options.

“One is that they could go to very excellent private practitioners and be seen in cancer clinics and large cancer practices in this area and be well taken care of by these practitioners, many of whom are our trainees and whom we want to work with and look forward to reaching out to them.

“The other is they could go to this new entity, this new cancer treatment and research center that we aim to become a comprehensive cancer center designated by the NCI, and in that entity they would receive first-rate multidisciplinary care bolstered by state-of-the-art facilities and research….and through the IDD offer Phase I trials to individuals whose cancers require that. That's the kind of vision I have for this entity, so it could be truly what it was designed to be when it was first created.”

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More Traditional Structure

Dr. Curiel also noted that SACI “was the entity we used to write our cancer center application that we've had in place for the last 16 years. It was a consortium structure—meaning there were two separate organizations involved. Now with the merger, CTRC becomes part of the science center and we have a more traditional NCI-designated matrix cancer center structure.”

In his former pre-merger position as SACI Director, Dr. Curiel was principal investigator on the P30 grant, Scientific Director of CTRC, and overall Director of Cancer Center Operations for SACI, and Dr. Fields was President and CEO of CTRC.

Now Dr. Curiel is CTRC Director, and Dr. Giles is the center's Deputy Director and Director of the Institute for Drug Development and Experimental Therapeutics Program, which is considered the largest oncology Phase I clinical research studies program in the world.

Tom Slaga, PhD, who was the last of SACI's interim directors, serves as Chief Scientific Officer of the new CTRC at UTHSCSA.

Dr. Curiel explained that he has expanded the three traditional research programs—Experimental Therapeutics, Cancer Prevention and Population Sciences, and Genomic Integrity and Tumor Development—to include a new program provisionally called Inflammation Immunity and Cancer.

“For several years prior to Frank Giles' arrival the Phase I program here wasn't really focused on science but drug testing, and we're now trying to strengthen the scientific component in the experimental therapeutics program to look at why people respond to therapy, why others don't, and predictors of response and failure, and we're also looking to incorporate major changes in imaging technology.

“We're one of five sites in the US whose P30 cancer grant has a supplement from the NCI's imaging program to take imaging advances into the clinic, and so we're working with the imaging program to add that into the Phase I program.”

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Preceded Merger

Dr. Curiel said that none of the fairly major changes in the scientific program were a direct result of the merger, but had preceded it and would be strengthened by it.

“We want to build our portfolio of NCI grant funding and even though we're in a very difficult climate for funding we remain highly successful and our NCI grant base has been growing for the last several years despite the budget cuts at NCI.”

The center is looking to build funding with current investigators and is actively recruiting new investigators, many of whom will be funded when they arrive, he said.

Over the next two years, he expects to recruit about 15 new junior-, middle-, and senior-level clinical scientists working in medical, surgical, and radiation oncology, some of whom will contribute to NCI funding and enrolling patients in clinical trials.

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Paying Tribute to Charles Coltman

He also paid tribute to Dr. Coltman: “He was founding father of the organization and was instrumental in getting the consortium structure put together with the Health Science Center, and wrote the original P30 application and was involved in a lot of the early dealings with NCI to make it designated.

“There's no question that Dr. Coltman was the pioneer in making all of this happen,” Dr. Curiel said. “We've retained him as President Emeritus and he's still here working here in emeritus capacity. He's quite useful to the organization, since he's a repository of prior history and has been helping us to understand some events that have occurred in the past and with the community to help us determine how we need to move forward.”

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SWOG Operations Office Remains in San Antonio

Dr. Curiel said that although SWOG headquarters had moved to Ann Arbor (where current SWOG Chairman Laurence Baker, DO, is based), the Operations Office will remain in San Antonio.

“We haven't cut any SWOG positions and the staff there will still be doing what they had been doing prior to the merger.”

He said that the new CTRC at UTHSCSA will be reversing any brain drains of the past.

“One of my direct orders when I took this job was to continue to be a successful scientist—that's part of my job description. We're looking for the best and the brightest. There's a world of opportunity here in San Antonio with the merger and Proposition 15 and the community that supports it. It's a great convergence.”

© 2008 Lippincott Williams & Wilkins, Inc.
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