Sunday, Aug. 26, 2007 | 1:01 a.m.
Patients and researchers are partners in a life-and-death struggle at Nevada Cancer Institute, where the latest experimental drugs are tested - sometimes for the first time on humans - in dozens of clinical trials.
A valet greets guests with a smile and a hand shake, and the marbled atrium is sunlit, with a 20-foot waterfall cascading down a colorful mosaic of tiles. Tens of millions of dollars go into cancer research and drug development, but the patients are just as struck by the staff members who know them by name and keep hope at the forefront of conversations.
But the shadow of death looms amid the grandeur and science. The American Cancer Society estimates that in 2006 1.4 million people were diagnosed with cancer and 564,000 died from the disease. That's more American cancer deaths in one year than the population within Las Vegas city borders.
Every patient and every researcher has a story, a personal connection to cancer, or a way the disease has transformed their lives.
The Sun interviewed five clinical trial patients and two doctors. These are their stories.
Death is an everyday reality at Nevada Cancer Institute. Most clinical trial patients have terminal cancer. All traditional treatments have been exhausted and many have been told by doctors that there's no hope. But life is precious, so they enter uncharted waters.
Since the institute opened in September 2005 its staff has grown to 25 researchers and clinicians. The goal is to increase the number to 80 by the fifth anniversary. About 2,000 patients have been treated at the institute, and more than 300 have signed up for clinical trials.
Clinical trial patients may be weary, but they're also optimists, with hope for new drugs not yet proven effective for humans. They enter into a symbiotic relationship with scientists. Even their cancer cells are essential to progress. Cancer tissue donated by patients will be preserved on ice at the institute for decades to come, contributing to a storehouse of scientific knowledge.
Sometimes the experimental drugs knock back the cancer, but often they do not. At times like these patients know that at least they did all they could and that even in death they helped researchers gain valuable ground against the disease.
Dr. Nam Hoang Dang, chief of hematological malignancies at the institute, called patients in clinical trials "my heroes."
"They walk into the frontier without any guarantee that the treatment would work," Dang said. "What they are willing to undergo in terms of being the first to get these new drugs really opens the doors for subsequent patients."
Developing cancer drugs takes decades. Dang, for instance, plans to start in 2008 the first phase of trials for a drug he's been developing since the mid-1980s. After the drugs are proven effective in the lab, the expensive clinical trials are taken over and funded by pharmaceutical companies that hope to bring the drugs to market.
The U.S. Food and Drug Administration sets a high threshold for drugs that are approved. The institute has opened 63 trials that may be at one of three phases of development, determining whether the drugs are safe, effective for a particular cancer and improve on the current treatment.
Dr. Sunil Sharma, director of the institute's Phase I program, describes the research and clinical trials as an "incremental war on cancer."
He said the early trial stages may be experimental, but they are not dangerous. Cancer patients are closely monitored and there have been many advances in caring for them, so there is a less than 1 percent chance of serious side effects, he said.
Only a minute number of drugs that enter Phase I trials ever make it to market, Dang said.
Cancer changes so quickly, and patients are so fragile , that many research hours are spent, many hopes are dashed and many lives are lost in the pursuit of a cure.
But researchers are making progress. Dr. Nicholas Vogelzang, director of the institute, noted that in the 1960s, the overall cure rate for cancer was about 25 percent. Now it's up to 60 percent with early detection, and could hit 75 percent in another generation.
Vogelzang said he's fascinated by the ability to kill a cancer cell and prolong and improve the quality of life for patients.
Toward that end, he is driven by a dream - the "elusive hope that one of these drugs, someday, will truly eradicate cancer."
When doctors found tumors on Afriquita Peterson's lungs, they said the cancer was inoperable and terminal. A death sentence.
She wondered if she'd live to see the next Super Bowl.
Peterson doesn't look like a typical football fan. Born in the Philippines, she's a cheerful 78-year-old who stands about 5 feet tall and wears a diamond-encrusted wedding ring and earrings. She's a devout Catholic and loves rose gardening. But ask about her beloved Denver Broncos, and her eyes widen as she brags about Hall of Fame quarterback John Elway as if he's her favorite son.
This is Peterson's third bout with cancer. Tumors first appeared on her right kidney in 1990 . A year later the organ was removed, and the cancer disappeared. Breast cancer was discovered in 1997, but she's been breast cancer free since a lumpectomy and a month of radiation treatments.
The latest tumors appeared on her lungs in 2005, although doctors say it's likely a reemergence of the kidney cancer. She was desperate to find a cure.
"I didn't have any hope anymore," she said.
She went to see a doctor in San Diego and heard great news - her best chances might be down the road from her home in Henderson , with Dr. Nicholas Vogelzang, director of Nevada Cancer Institute. The San Diego doctor had trained under Vogelzang and said he taught him everything he knew.
Peterson says Vogelzang always has new plans for her treatment. She was in two clinical trials that were not successful - the first made her nauseated, and she still wears a "Raquel Welch" wig after losing her hair. But she is in her third, taking a Phase III drug, taken in pill form once a day.
And she's now on a high. Recent blood tests are positive, and the tumor is shrinking, although doctors say that initial success in a clinical trial does not always mean a positive long - term outcome.
They gave Peterson a 20 percent chance of surviving when she was diagnosed two years ago. She has faith she'll beat the odds, but knows that even if she doesn't , she'll have contributed to cancer research.
"If I don't make it, this clinical trial will probably help the future people," she said. "That's how they discover medicine. I hope and pray that God will give the scientists the intelligence to find a cure for all cancers. That would be really, really wonderful."
Meanwhile, she and her friends and family continue to pray for healing.
"I'm hoping I'll be here a while longer - next Super Bowl is coming!"
It took a cancer diagnosis for Oscar Foger to realize that cancer is not always a death sentence.
"Cancer is just a doom word," said Foger, 66, a retired miner at the Nevada Test Site . "It's just the end of the road for you, more or less. Anybody who's had cancer, you just figure that's the end. Most times you go to the doctor and that's your worst scenario."
In January doctors found cancer in Foger's left kidney. He blames radiation from the Test Site for the cancer. A month later the kidney was removed, and doctors told him the cancer was gone. Foger says he's one of the lucky ones.
Today he wears a "Battle Born Laborers 872 union" hat. Cancer didn't slow his union activities. He never suffered intense pain and still can exercise five times a week. When it comes to his daily routine, cancer "hasn't affected my life a bit," he said.
But his outlook on cancer and life has changed deeply.
"Up until you have it, we even take life for granted, and I'm one that can attest to it," Foger said. "We get up every day feeling good and doing well. Every day is going to be a sunny day. But it's just not so. Life is not just about all them good times. Sooner or later you're going to run into something, and then the thing is that you have somebody who can go through that with you."
Foger has found an important support network at Nevada Cancer Institute, where he's involved in a clinical trial. He receives 15-minute drug infusions every Wednesday for six months to ensure the cancer never returns.
He was blessed to have doctors spot and remove his cancer early, he said. In contrast, he knows much younger men who are dying of cancer, and that's what inspires him to do the clinical trial. His eyes well with tears and his voice falters when he speaks of younger people suffering from the disease.
"The little thing I'm going through, if it will be worth anything ... can help these young people," Foger said. "Being my age, I'm heading out of here anyway."
The institute has been a place of security through the illness, Foger said. It's such a beautiful place it uplifts spirits, he said, and when you walk in the door you're part of the family.
"I just want to believe that I'm going to go on and live my life until God sees fit for something else," Foger said. "I wake up with that thought every morning."
You'll have to excuse Norman Laefer for injecting conversations about his health with gallows humor. He had his first heart bypass operation at 42, the second at 55 , and now he's fighting lymphoma - cancer of the blood.
The bad heart did not come as a surprise. Laefer said his father and uncles died in their 40s or 50s because of cardiac problems.
"I picked the wrong parents, obviously," Laefer quipped.
Laefer, 67, said his cancer diagnosis in 2003 was a shock, but because the doctors chose not to treat it immediately, he did not see it as a problem.
"When you've had two bypass operations you're just playing a game of which is going to get you first, either my heart or the lymphoma, and we're looking at probably a five-year time frame for both," Laefer said. "So far I seem to be beating the odds."
Laefer describes 2004 to 2006 as his "two years of hell." Lymphoma weakens the immune system, and he was struck with opportunistic illnesses that capitalized on his vulnerability.
First he came down with shingles - "was lucky enough to get it twice, most people don't."
Then he had pneumonia, pneumococcal meningitis - an inflammation or infection of the membranes covering the brain and spinal cord - and cellulitis, a skin infection.
Doctors were out of good options to treat the lymphoma, so Laefer had high hopes for a clinical trial at Nevada Cancer Institute. But at first, the drug company that sponsored the trial turned him down because it wanted candidates who would put their drug in the most positive light, he said. His doctors fought for him, and the company relented.
He started taking a Phase III drug developed in East Germany that's being tested for approval in the United States.
"After the first round, two consecutive days of chemo, it did such a fabulous job I wound up in the hospital," Laefer said. "The number of dead cancer cells flooded my kidneys, and they shut down. I wound up doing three days of dialysis."
The drug worked too well, so the dosage was cut to 75 percent to ease the strain on the kidneys. Within months Laefer was cancer-free. His life, which had been consumed by pain and sickness, returned to something approaching routine. He and his wife just returned from a trip to France, something he'd always imagined they would do in retirement.
Unlike many patients who are in the drug trials, Laefer says he isn't doing it for altruistic reasons. "I'm a really private person and I tend to be fairly self-centered, my wife will probably agree," Laefer said. "If it benefits anyone else, great. But that's not why I'm here."
He marvels that there are so few places in the country where such potentially life-saving drug trials are available. He chokes up when he considers that he probably would not be alive if it were not for the institute.
"It's amazing, after all the hospital stays , I get a lot more emotional," he said. "I used to have a much harder shell."
His colleagues warn him to keep his distance. It's too difficult to get close to cancer patients. The specter of death is too real.
But there are patients whose names Dr. Nam Hoang Dang will never forget.
He remembers being at the deathbed of a young patient with ovarian cancer a dozen years ago . Before she died, she reminded her husband to close the window of the house when he got home.
"There are times when I close the window and I think of her," Dang said.
His voice halts. He's crying.
Dang, 44, realized he wanted to be a doctor when he was a child in Vietnam at the height of the war. His mother was a pharmacist and his father a math professor, and the family lived on a main thoroughfare in Saigon.
Every day, he saw people with limbs lost from the war. Every night, trucks laden with coffins of soldiers would drive down his street.
"When you are a kid growing up it becomes part of your life," he said of his visions of the war. "You notice right away that, wow, health is important."
Dang's family fled Vietnam in 1975 and as a boy he learned English from sports talk radio. Now his rapid-fire speech is laced with analogies, comparing the rate of research success to baseball batting averages and the two general types of cancer - liquid and solid - to foreign and domestic cars.
He became an American immigrant success story, graduating with honors from Harvard Medical School and pioneering T-cell lymphoma research.
About half of lymphoma patients can be cured or have their cancer sent into remission, as long as they get the right treatment from the start, he said.
The fact that many patients die of cancer is something he sees as a challenge, not a burden. A perpetual optimist, he says a researcher has to have a positive mind-set because so many scientific ideas don't work.
He got into cancer research because so much was unknown. It was a "big black box, a death sentence, and I wanted to have the most impact possible," Dang said.
He's driven by the passion for research and curing patients, and said he thinks about experiments all the time, even while in the shower or in his car.
"These patients come to me with their lives, and when they die I feel I've failed them," Dang said. "I know you can't save everybody, but my patients come to me as their last hope."
Dr. Sunil Sharma became a cancer specialist to explore an "uncharted frontier."
Sharma, who directs Nevada Cancer Institute's Phase I clinical trial program, said few advances against cancer had been made when he was in medical school in India, his home country. He realized that the scientific progress in the 21st century would be made in the area of cancer research.
The institute is offering something new to Nevada, he said. Most of the patients are local, and his work with people who may have "no other options" is "extremely rejuvenating - the best thing someone can do," Sharma said.
But it also can be difficult emotionally.
"It helps that we're in the business trying to provide a newer treatment and trying to provide hope," Sharma said. "I don't think every person can be an oncologist. It requires special skills. One has to be able to deliver hope and bad news and empathy all at the same time."
The institute is one of three facilities in the world to introduce an innovative drug, BEZ. Made by Novartis, the drug , in pill form, targets solid-tumor cancers by blocking a pathway that regulates cell growth. The focused approach is much less harmful to patients than chemotherapy, which attacks all cells.
The clinical trials are extremely experimental, but show promise in about 60 percent of patients, although the threshold for getting drugs to market is higher, Sharma said.
Sharma said his focus is always on making the patient better, although he freely admits he's doing research in the process. Most patients find it gratifying that their treatment is fulfilling a greater purpose, he said.
"You would think that patients who have cancer, who have no other options, would be primarily self-obsessed and obsessed with their own disease," Sharma said. "But it turns out they are very altruistic and giving. They want to help other people."
In a similar way, Sharma wanted to maximize his research for the greatest good, which is part of what brought him to Nevada. There are few cancer research facilities in the United States that provide such an array of clinical trials, and he was able to start the institute's program.
"It's easy for us to find jobs," Sharma said. "The question is finding a community where you can have an impact."
Every night the battle starts when Mike Schlins lays down his head.
That's when he drives from his mind the doubt, the fear, the worry and thoughts of the disease.
"You think about the strongest thought that you can have in your head that's not about cancer," Schlins said.
He thinks about his earliest memories of holding a string of fish with his father, of woodworking, building furniture or tinkering on projects at his hotel in Glendale, Utah, four hours away from the Nevada Cancer Institute. After seven years of "hacking around with this crap," as he says, "I can do it at will."
"I'm tricking my brain into letting me go to sleep," he said.
Schlins, 60, was diagnosed with prostate cancer at age 53. A former Navy submarine navigator, high school science teacher and wrestling coach, he can sound like a bully when he talks about cancer.
"It's an opponent that has just basically gotten in my way," he said. "And you brush aside the opponent to do whatever you've got to do."
On this day he's on his way to play golf, wearing Tommy Bahama shorts, sport sandals and a Hawaiian print shirt.
His interest in science compelled him to join a Phase I clinical trial at the institute, so he could find hope for himself while advancing the fight against cancer. After just six weeks, with no side effects, the experimental drug is cutting off the nutrient supply to the cancerous growth in his prostate, he said. He calls it the "magic pill from Wonderland - a diet pill for cancer."
His mental toughness isn't unique among patients at the institute, he said. People may look feeble, he said, "but they're fighters." They want to go on living.
Their spirits are buoyed by the institute's staff, Schlins said, and a positive emotional attitude is the most important quality to beat cancer.
"That 'H-O-P-E' word is the thing," he said. "You don't see it written anywhere, but it lies within the walls of the institute."
Schlins knows he's not going to die tomorrow , so that's as far as he looks ahead. Some people live so far in the future they lose what they have at the moment, he said.
"We take for granted a hell of a lot of living that you don't think about until you get charged with the idea of thinking about dying," Schlins said. "That charge changes the perceptions you have on a daily basis."
Doctors twice told Gladys Laughlin her liver cancer would kill her.
And although the cancer has had her down , it's also renewed her zest for life.
Laughlin, 64, was first diagnosed in early 2001 and her ongoing treatments have led to surgery, chronic pain and an antibiotic-resistant infection she picked up in a hospital. At times she lost the will to live - only to have family members inspire her to fight.
The lowest point came in 2001, after she had a cancerous tumor the size of a football removed from her liver. Her oldest sister, a nurse, was helping her recover from the surgery at UCLA. Laughlin is a career educator from the tiny gambling Mecca of Laughlin, which was founded by her husband's cousin. She's accustomed to success. To achievement.
After the surgery, Laughlin's sister made her get out of bed and walk. She wanted none of it. She "was going to die anyway, so what's the point" of getting out of bed? But finally, after much prodding, with catheter and IV attached and a physical therapist holding her up with a belt, she shuffled all the way to the door - about 10 feet.
Laughlin had to remind herself that such small steps were a giant victory.
"Allowing myself to celebrate that the littlest gain was a victory was tough because I was used to doing things in a big way," Laughlin said. "It wasn't acceptable to me to do just OK, I had to do best. So if I couldn't do best I was willing to give up."
Until she came to the institute, Laughlin felt she'd been "written off" by physicians who said there was nothing they could do to help. She's dealt with the hassles and indignities of maintaining some sense of normalcy in the midst of a cancer battle. She lives with pain that, when not medicated, is like a "stabbing and grabbing" in her side - like someone's pulling her from the inside out.
But she's alive.
She says terminal cancer gave her a new mission.
"I think I'm alive for a reason and I think the reason I'm alive is because I have people to help," Laughlin said. "I have skills. I have knowledge that will help people live a better life."
A year ago Laughlin joined the Laughlin Town Advisory Board, where she works to improve social services in the burgeoning community.
Her mission extends to the institute, where she's been involved in a Phase I clinical trial since May. The treatments have been a success so far. She started the drug in May and after two infusions the eight-centimeter tumor stopped growing, and after two more it had shrunk by 9 percent.
"Every day is a present, you just open it up and say, 'Ah! This is what we're going to do today!' " Laughlin said. "It's exciting. I'm blessed."
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