Dr. Richard “Rick” Van Etten was a medical resident when researchers first identified a genetic abnormality in a human cancer. The flawed chromosome created fusion between two genes, causing production of an atypical protein in leukemic cells.
“This was very exciting to me, because I was convinced this protein might be the direct cause of leukemia,” says Van Etten, director of the Chao Family Comprehensive Cancer Center at UC Irvine Medical Center.
The discovery prompted him to specialize in hematology, the study of blood and blood diseases, in the lab of Nobel laureate David Baltimore at the Massachusetts Institute of Technology. “My hunch was correct,” Van Etten says. “We went on to prove that this protein caused the leukemia.”
His research on chronic myeloid leukemia led to the development of the current treatment for it with drugs such as Gleevec that target the abnormal protein. Before this, the deadly disease could be cured only through a bone marrow transplant.
Targeting tumor cells with pharmaceuticals, rather than blasting all cells with chemotherapy, is the future of cancer treatment, Van Etten says. He plans to establish a formal experimental therapeutics program at the Chao center that gives more Orange County residents access to new cancer drugs through participation in early-phase clinical trials.
“We’re taking diseases that used to be fatal and turning them into treatable conditions,” Van Etten says. “More cancer drugs were approved last year than in the previous three years combined. It’s an extraordinary and exciting time to be doing cancer research and taking care of patients.”
Van Etten came to UC Irvine last October from the Cancer Center at Tufts Medical Center in Boston, where – as the director – he launched a similar experimental therapeutics program. “I’m just re-creating that here,” he says.
A hematologist and oncologist, Van Etten specializes in blood cancers – leukemia, myeloma and lymphoma – affecting the production and functioning of blood cells, which develop from stem cells in bone marrow.
UC Irvine is home to one of only 41 National Cancer Institute-designated comprehensive cancer centers in the country. Comprehensive centers conduct research, encourage prevention and offer treatment.
The designation – the NCI’s highest – means that the Chao center, in Orange, has assets that community hospitals and other cancer facilities might not have, such as the ability to translate the latest scientific research into treatments and cures. It also means the center can better manage difficult and unusual cases.
“I think a lot of people don’t even know they have an NCI cancer center here. It’s a precious thing,” Van Etten says. “It’s just an amazing resource that I think is being underutilized.”
The Chao center’s NCI designation is, in part, what lured him to UC Irvine. “There was the structure and the commitment of the administration here to put cancer as a priority,” he says.
As a comprehensive cancer center, Chao is receiving grants totaling $10 million to $12 million over five years. Maintaining that designation, which is up for renewal in 2015, is one of Van Etten’s main concerns.
Bone marrow transplant program
Within two years, Van Etten also aims to re-establish the bone marrow transplant program, which ended at UC Irvine about a decade ago. “We had a transplant program here, and it never achieved the volume of patients needed to flourish,” he says.
Right now, the Chao center refers patients needing the procedure to UCLA’s Jonsson Comprehensive Cancer Center or the City of Hope in Duarte.
“Having a transplant program is part of having a full-fledged program in blood cancer,” Van Etten says. UC Irvine is aided by the fact that its partner, CHOC Children’s Hospital, already performs these transplants with children and has experience in blood banking and processing stem cells.
Dr. Leonard Sender, head of the Adolescent & Young Adult Treatment Program at CHOC’s cancer institute, is also director of clinical operations and program development at the Chao center. “He’s a world-renowned transplanter,” Van Etten says.
Transplants can cure people who have diseases such as aplastic anemia, in which the bone marrow doesn’t make enough new blood cells. People with this condition have life-threatening low cell counts and become dependent on transfusions for red blood cells, which last a week, and platelets, which last three months.
But neutrophils, one of the most important kinds of infection-fighting white blood cells, can’t be transfused because they last only 12 hours. People with aplastic anemia need a transplant or will likely develop a fatal infection.
These patients are matched with a sibling or an unrelated donor from a bone marrow registry. Transplantation is the treatment for bone marrow failure and the cure for some bone marrow cancers, Van Etten says.
Serving the community
“The biggest thing I want to do is extend the benefits of the NCI center to the citizens of Orange County in a way that hasn’t been done before,” Van Etten says.
The Chao center’s service area is primarily Orange County and some of southern Los Angeles County and the Inland Empire. About 12,000 people annually are diagnosed with cancer in Orange County, according to the California Cancer Registry. About 4,200 county residents per year die of cancer.
The top three diagnosed cancers in the county, respectively, are breast, prostate and lung. They make up nearly half of the cancers in Orange County, according to the California Cancer Registry. Also, greater sun exposure makes skin and related cancers more prevalent in Orange County than in other areas of the country.
In a year, 140 to 150 adults in Orange County are diagnosed with acute leukemia. “That’s a disease that I personally believe is best cared for in an academic medical center, because it’s a potentially lethal disease that requires very intensive treatment, often with transplant as part of the equation,” Van Etten says.
“We don’t want to replace community oncology care,” he notes. But with relapsing or hard-to-manage cancers, UC Irvine has a role to play. “We have the experts. We have access to the latest treatments,” he says. “I see us partnering with the community for shared treatment plans.”