The Portland VA Medical Center is one of 12 sites chosen to receive additional funding to enroll more veterans with cancer into research studies, offering Oregon veterans better access to cutting-edge medications and treatments.

The program will be jointly managed by the Department of Veterans Affairs and the National Cancer Institute for as long as three years.

The VA runs clinical trials for cancer and other diseases at about 100 sites across the nation. But facilities often face challenges launching or participating in externally funded trials because of the difficulty outside partners face in navigating the VA system. The new effort will provide funding for VA facilities to build the infrastructure needed to participate in more trials. That could include funding for clinical staff to enroll veterans and manage their participation in the research studies, assist with paperwork, submit tissue samples or record treatment and safety data.

“This could give (veterans) potential access to the same types of clinical trials that the rest of the population has,” said Dr. Cora Calomeni, an oncologist with the St. Charles Cancer Center in Bend. “That might have been a little more difficult for them through the VA system, just because of how the VA is set up.”

The timing for Oregon veterans couldn’t be better.

“What’s happening now is that we are in a revolution in medicine,” Calomeni said. “There are so many new drugs being developed.”

Cancer researchers are pioneering promising treatments that target specific molecules involved in the growth and spread of cancer cells or that marshal the immune system to fight tumors.

“What we’re seeing here are some of the biggest developments that have occurred in 40 to 50 years, since the advent of chemotherapy itself,” said Dr. Mark Garzotto, a urologist with Oregon Health & Science University and the Portland VA. “The benefits that we’re beginning to see with these new drugs are not incremental, they are substantial.”

Some of those new treatments are designed for very specific types of cancers that only affect a small subset of patients. Including veterans in those clinical trials could help researchers find the minimum number of patients needed to conduct a meaningful study.

Studies show that cancer patients have better outcomes when they participate in clinical trials. Some of the newly discovered treatments and drugs have been available to patients five to 10 years earlier through clinical trials.

“We’re giving veterans the opportunity to be on the leading edge of extremely promising drugs,” Garzotto said. “We’re talking about ones that give significant improvement in longevity but also quality of life.”

Academic hospitals, such as OHSU, have traditionally affiliated with VA medical centers with whom they shared faculty and conducted research studies.

But in recent decades, bureaucratic hurdles have made shared clinical trials much more difficult.

“The regulatory processes were duplicative between the university and the VA,” said Dr. Charles Blanke, an oncologist at OHSU. “You had to double your effort, and sometimes you had to quadruple it.”

The Portland VA has offered veterans access to clinical trials for decades, but has relied on OHSU to run the trials.

“What this grant does, is it provides program infrastructure so that we can have our very own base of operations within the VA,” Garzotto said. “We can tailor our program to specifically meet the needs of the veterans.”

For example, a large percentage of the veterans seen at the Portland VA are Vietnam veterans, whose exposure to the chemical defoliant Agent Orange puts them at risk for more aggressive forms of prostate cancer.

“I’ve really been focused on trying to get trials that address the most aggressive cancers in prostate cancer,” Garzotto said. “We’ll definitely continue to do that with the trials available with the NCI.”

Veterans are more likely to smoke than the general population, so have high rates of lung cancer. Many are affected by post-traumatic stress, which can make participation within a clinical trial more challenging. Veterans are more likely to have certain types of cancer based on their various exposures during service.

“These aren’t the kind of cancers your community doctors are going to see on a regular basis because they don’t have the concentration of veterans within their practices,” Garzotto said.

Central Oregon vets would likely to have to travel to Portland to participate in these trials, although Garzotto said the center is working ways to enroll more vets from rural areas east of the Cascades. The Portland VA center has a cancer care navigation team that can help veterans get the best available treatments regardless of where they live.

Blanke says over time as clinical trials have become more difficult to conduct within the VA system, many VA researchers lost interest and funding was cut, leading to “a loss of culture of research.” In 2014, when he became chairman of a global cancer clinical trials network based at OHSU, the 28 VA centers in the network were enrolling only three veterans a year into clinical trials. Over the past three years, the network and its charity arm have given $25,000 grants to build research infrastructure to 14 VA centers, including the Portland location. That boosted the number of veterans enrolled to 48 last year.

“It doesn’t sound like a ton, but it is,” Blanke said. “Clearly, it’s the right direction. I think we proved and the NCI believed that you could change the whole lack of culture of research with dedicated support.”

— Reporter: 541-633-2162, mhawryluk@bendbulletin.com

20757315