Clinical Trials

Dr. Roy Jensen: At The University of Kansas Cancer Center, we are always looking for ways to develop new therapies, improve quality of life, and discover more cures for cancer. Clinical trials play an essential role in helping the millions of Americans who are diagnosed with cancer each year. Clinical trials are research studies that involve people and test new ways to prevent, detect, diagnose, or treat diseases. Nearly all cancer treatments used today were studied and made available to patients through clinical trials. As the only National Cancer Institute-Designated Cancer Center in the region, we offer a wide range of leading-edge trials that are not available anywhere else. By participating in a clinical trial, you have access to potentially effective treatments not available elsewhere. Talk to your doctor to see if a clinical trial is right for you.

Roy Jensen: Welcome to Bench to Bedside, a weekly series of live conversations about recent advances in cancer from the research bench to treatment at the patient's bedside. I am Dr. Roy Jensen, director of the University of Kansas Cancer Center. My guest today is Dr. Joaquina Baranda, who is a medical oncologist at the University of Kansas Cancer Center. Today, we are talking about clinical trials. Clinical trials are research studies that involve people. Often, a clinical trial is used to learn if a new treatment and/or has less harmful side effects than standard treatments. Clinical trials are one of the final stages of a long research process. The process often begins in a laboratory where scientists first develop and test new ideas.

recording: [crosstalk 00:01:18].

Roy Jensen: Nearly all of the tried-and-true cancer drugs available to you today exist because of the past patients who participated in clinical trials. Dr. Baranda, tell us about your role at the University of Kansas Cancer Center.

Joaquina B.: Yeah. Thanks, Roy. Thank you for the invitation today to be with you. It's an honor. Yes. I'm a medical oncologist and a physician-scientist. Just like some doctors in large academic cancer centers, I get to wear a number of hats in the cancer center. Just to give you an idea of how I spend my week, I have of clinic at our Westwood Cancer Center Campus where I see patients with gastrointestinal cancers, like colon cancer, stomach cancer, esophageal cancer, pancreas cancer. But most of my time is actually spent at our clinical research center down the street on Fairway where I join a team of highly dedicated doctors, nurses, pharmacists, basic scientists with a common mission of taking care of patients on clinical trials in order to improve the outcome of our patients with cancer.

recording: [crosstalk 00:02:48].

Roy Jensen: How do clinical trials actually work?

Joaquina B.: Clinical trials are research studies that are based most of the time on the discoveries in the laboratory. These discoveries are based on the questions we have in the clinic so that if, for instance, we're seeing certain treatments that are not very satisfactory, we go to our basic scientists. They come up with many discoveries in the laboratories with potential to answer some of these questions, such as, "What would be a better treatment for certain cancer?" We don't do clinical trials on all of those discoveries, but we choose discoveries with the highest potential that would result in the greatest impact in the care of our patients. Then a protocol or a treatment plan is written. This is a very well-written document that guides everybody taking care of our patients on clinical trials to make sure that all the precautions are in place, to ensure safety, the highest level of safety that is possible, with the highest potential for it to work against their cancer. Some trials are done in order to prevent cancer or diagnose cancer at an earlier stage, but the majority of our trials I do are mainly on using novel treatments in order to find better approaches to how we treat cancer nowadays. As you know, even if we have major advances now in cancer treatment, we are actually not satisfied yet. We are not there yet because there are still obviously patients who are dying from the cancer. However, in the last decade or two, with better understanding of cancer in its very molecular level, clinical trials have actually improved. In the past, when we talk about phase I clinical trials, we're talking about testing a drug that has a potential to work, but we test it on a large number of patients. Back then, we were looking for very small benefit. Now, because we understand cancer better using information from the laboratory, looking at molecular changes or mutations in the genes, we can now target those changes. Therefore, the drugs we use have higher potential in treating a smaller group of patients, and therefore, early-phase or phase I trials are now done quicker so that drugs become more available to patients with cancer in general faster than usual. So it's very exciting.

Roy Jensen: Yeah. What types of cancer patients are eligible for clinical trials?

Joaquina B.: Again, trials are different. They vary from trial to trial, depending on the goals or objectives of the trial. There is what we call eligibility criteria. That is a list or a guideline, a list what kinds of patients we want to be treated in that clinical trial. It is based on safety, so we would look for patients with specific blood tests that are normal in order to protect those patients who have the potential to, for instance, be affected by a drug that has the potential to affect a certain organ system. But I would say, talk to your doctor, and talk to your research contact in order to find out whether you would be eligible for a certain trial or not.

Roy Jensen: And they can always call the CRC to see we have a trial available, right?

Joaquina B.: Absolutely.

Roy Jensen: At any given time, we have probably around 150 trials that are open, so-called interventional treatment trial. Can you tell us what are the unique aspects about the trials that we offer at the KU Cancer Center?

Joaquina B.: Yeah. The clinical research center is something unique to our cancer center. The vision is so that our patients don't have to travel thousands of miles to get novel treatments. We want to do phase I trials at the CRC in order for our community to have access to these novel agents. To tell you frankly, some of the trials that we participate, we actually have safety calls from investigators throughout the nation from large cancer centers. We share information of observations we have on patients on certain clinical trials. They share their information. There's actually a true exchange of ideas and information that I think leads to patient safety and moving the trials faster with those collaborations. We also have what we call IIT program here where our physician-scientists are able to collaborate with our basic scientists and figure out the best way to do clinical trials so that we can marry the answers from the laboratory to the clinics by performing high-impact clinical trials.

Roy Jensen: In terms of patient benefit, what are the advantages to patients in terms of participating in a clinical trial?

Joaquina B.: These novel treatments that we give in clinical trials are not commercially available. By participating in some of these early-phase clinical trials, the patients are able to access these treatments that we have. As you know, some of the cancers we have do not have standard treatments, or, if they have standard treatments, they are of marginal benefit. Therefore, one benefit is to try a new drug that you cannot otherwise access, but you can access it through a clinical trial. The other is that you are able to exercise your right to choose what kind of treatment you want, how your care would ... you would like it to look like. One major thing is you're actually giving valuable contribution to cancer research by doing that.

Roy Jensen: In terms of misconceptions about clinical trials that you hear out in the community, could you tell us a little bit about some of those issues?

Joaquina B.: Sure. When I talk to patients about participating in clinical trials, one of the questions they have is, "Am I going to get placebo?" Placebo is a sugar pill that does not have any effect or treatment effect. Most trials actually do not have placebo. Most trials, if they have different treatment arms or different assignments of treatment, will have a standard treatment versus a standard treatment plus the new drug or a novel therapy. If there is a placebo arm, you will know if there's a placebo arm. But most of the time, the placebo is combined with a standard of care treatment.

Roy Jensen: If you're just joining us, we're talking about clinical trials. Cameron Poindexter is here in the studio to take your questions. Remember to share this link with people you think may benefit from this discussion and use the hashtag #BenchToBedside. A common concern of patients is that they will stop receiving standard of cancer and only receive the treatment being tested in the clinical trial. Would you address that concern, Dr. Baranda?

Joaquina B.: Yeah. If there is a standard of care for a particular disease or a particular cancer, that standard of care will not be repelled. As I said, most of the time, you will receive the standard of care plus the novel treatment. The other part of this, which is important, the care of our patients, is continuing supportive care, best supportive care. When we do clinical trials, the nurses and the doctors taking care of the patients in clinical trials try everything they can to maximize giving all the supportive measures. Pain management, psychosocial support, nutrition ... Those are quite critical in taking care of patients with cancer in general.

Roy Jensen: One of the things that one of my mentors, David Johnson, taught me is that, even for patients who are receiving standard of care that are on a clinical trial, their outcomes tend to be better than patients getting standard of care that are off of a clinical trial. His theory on that was that patients are being monitored very closely on the trial. They're assured that they always get their drug on time at the right dose, and they're constantly monitoring side effects. Frankly, it's just a higher level of care when you're on a clinical trial, so the patients do better. Do you have any thoughts on that?

Joaquina B.: Yeah, absolutely. I totally agree with that because, just like what I said, these protocols are well written to maximize safety of our patients. Therefore, we do closer monitoring of toxicities, including laboratory tests. One of the things that we tell our patients when they're participating in clinical trial is that you probably will have more frequent visits. You may have more blood tests than you would otherwise get if you were not on a clinical trial. Some patients, however, have concerns that those visits and exams, including CAT scans, may not be covered by their insurance. In fact, most clinical trials are not associated with added out-of-pocket cost because the standard of care procedures, like blood tests and CAT scans, if you were to get that if you were not on a clinical trial, would be covered generally by your insurance. Those that are considered outside the standard of care are actually generally paid for within the clinical trials. I would like to assure patients that, most of the time, that is usually figured out very well by our study teams and our financial counselors.

Roy Jensen: What about safety concerns? How is safety monitored during the clinical trial?

Joaquina B.: Yeah. A lot of these drugs that we use, we have information and knowledge as to what are the likely side effects associated with these drugs. However, because these drugs are being tested in humans not for too long of a time, we do added blood tests and added visits, as I said. In addition to that, it's actually a team effort. The oversight is incredible when you are on a clinical trial. As I said, you are not the only one taking care of patients. It's a team of doctors, study coordinators. Plus, we do have, as I said, safety calls among the network of doctors doing the same clinical trials.

Roy Jensen: How can patients learn more about clinical trial opportunities that may benefit them?

Joaquina B.: Yeah. One one-stop website is the clinicaltrials.gov. Patients can go into that site, and they can find many clinical trials on different kinds of cancer and different places where they can access those. But they can go to our website also, the University of Kansas Cancer Center website. There is a link there where they could clink, and they will find contact information there.

Roy Jensen: If you're just joining us, we're talking about clinical trials. Cameron Poindexter is here in the studio to take your questions. I believe we have might have gotten a question. Cameron?

Cameron P.: Yes, we do. We have a question from Olivia Francos. If a patient may benefit from a clinical trial, do you recommend that most of them get involved in their specific cancer as applicable? Are there any downsides?

Joaquina B.: Thank you for that question, Olivia. The first part of that question is whether they should contact somebody for that specific cancer. The good thing about clinical trial nowadays is that the clinical trials are done in a way that they put the different cohorts that we say, groups of patients, into disease-specific cancers. For instance, we're testing drug X. We would have different groups of patients where some will have non-small cell lung cancer, for instance. Some will have breast cancer in the same clinical trial. That is in an effort to find a signal of how active that treatment is, faster. I would suggest that, even early on, at the time of your diagnosis, you don't have to wait until you have exhaust all the standard treatments available for you. I would say at the time of diagnosis, you should always ask your doctors for available clinical trials for the cancer that you have and perhaps for the molecular changes that your cancer have. The second part of that question is the downside. Whether or not you're in a clinical trial, cancer treatment, unfortunately, has downside. That is these drugs and side effects. However, again, you are very closely monitored. Well, even at the time that these protocols are written, again, they are written in a way to protect the patient. The patient is the center of it all. We want to make sure that the patient is safe and the patient gets benefit from the treatment.

Roy Jensen: You and I got to participate in an event last week that was a celebration of our clinical trials office. We had some very special guests there. Could you tell us a little bit about that event, Dr. Baranda?

Joaquina B.: Yeah. Because of your leadership and the hard work of the people in clinical research center led by Dr. Steve Williamson, we were able to achieve a milestone where we enrolled 100 patients in 2017 in our early-phase program. It's a major milestone because I have been at KU for a long time, and that's the first time that we have seen that number of patients enrolled. We are totally indebted to every patient who participated in the clinical trial. We did have two guest speakers who are patients of ours who described incredible experience they had while they were in the clinical trials. I would suggest that you guys look for those video. I think they may be available. We are just indebted to the patients who participate in these trials.

Roy Jensen: What would you like to say to patients who are considering a clinical trial?

Joaquina B.: Clinical trials are a major tool in the fight against cancer. We're not done with this fight yet. I think we should continue this partnership, and I think we will get there pretty soon where cancer, hopefully, will be a thing of the past.

Roy Jensen: Well, thank you, Dr. Baranda. I just want to again thank our patients that have enrolled in clinical trials at the KU Cancer Center. They are one of our greatest strengths. Frankly, without them, we could not make the progress that we've been making over the last few decades. It wasn't too long ago, back in the 1970s, when the five-year survival rate for cancer was less than 50%. Now, it's nearly 70%. All of that progress is solely attributable, or at least in large part, due to our patients being willing to enroll on clinical trials. Thank you, Dr. Baranda.

Joaquina B.: Thank you.

Roy Jensen: That's it for today. Next week, we will be talking about the fear of cancer recurrence and tips on how to manage that fear. That's right here, next Wednesday, at 10:00 AM. Good day.

Joaquina B.: Thank you.

Speaker 1: Welcome to Bench To Bedside, a weekly series of live conversations about recent advances in cancer from the research bench to treatment at the patient's bedside. And now, your host and the director of the University of Kansas Cancer Center, Dr. Roy Jensen.

Dr. Roy Jensen: Every time you make a purchase in Johnson County, you may not know it, but you are supporting cancer research in a very unique tax-supported initiative known as JCERT. JCERT stands for Johnson County Education Research Triangle authority. Hi, I'm Dr. Roy Jensen, director of the University of Kansas Cancer Center. With me, is Mary Birch, chair of the KU Cancer Center's Funding Partners Board and Cancer Center Advocate, and also Dr. Tara Lin, Medical Director of the KU Cancer Center's Clinical Trials Office. 10 years ago, a special sales tax was passed in Johnson County providing KU Cancer Center the vital resources needed to offer more clinical trials to our patients. So, Mary, you played a huge role in building the community support necessary to pass this sales tax. Could you tell us more about the JCERT initiative, how it came about, who was behind it and just...

Mary Birch: Sure. Believe it or not, the JCERT initiative was born on a tennis court with then Senate President, Dick Bond, and myself, and when we took breaks, we talked about the kinds of things that needed to happen. KU Edwards had made an effort to maybe do something because they needed to grow and add degrees. And at the same time, Olathe gave a piece of property to K State and a big study had come out about the life sciences economy in Kansas City, and the question became what is Johnson County's piece of that? So as a result, the triangle was invented. We were able to put KU and K State in the same room for a while and worked on it. We needed legislation in Topeka and that was really Kenny Wilke, the head of the tax committee, Barbara Allen, the head of the tax committee in the Senate and Dick Bond and Audrey Langworthy who supported allowing our voters to decide. And then we needed County Commission permission. That's where you and some of the others came in to talk about putting it on the ballot because they had to put it on the ballot. And then Fred Logan shared the campaign. It's probably the first campaign I know of in 40 some years of working in the community where both Missouri and Kansas participated. Bill Hall chaired the fundraising effort and raised enough money for us to do the campaign. I was kind of behind the scenes at the time. I made two, three hundred presentations to the voters because this was unique because it had never been done before. But the beauty of Johnson County is that it's always been very hopeful and it always likes a big vision, and this was a big vision. So the funding of it was I called you one day and said, "What do you need?" and we talked about the clinical center and we put it on the ballot for 1/8 cent sales tax. All you needed about five, six million dollars and that was what it raised. Today it raises a little more, which is good. And the voters bought it and they really liked it and they've been supportive. So we have ten new degrees at Edwards. We have certifications and degrees and bachelor's degrees going on at K State, and we have treated a lot of our own people for cancer since the clinical trials research center.

Dr. Roy Jensen: So Dr. Lin, you're in charge of our clinical research center down there in Fairway. Could you tell us a little bit about the purpose of that facility?

Dr. Tara Lin: So the CRC, like we've said, is really a unique resource within our cancer center and we're so grateful for the community support that makes it happen. What we do at the CRC is what we call early phase clinical trial. So these are some times brand new drugs that are being given to the first time for humans. These may be drugs that are still in early development for diseases that they weren't originally designed for. And what's incredible is that we're able, through the CRC, to give our patients the access to these innovative cutting edge treatments right here at home. In addition to conducting early phase trials from outside sponsors, the CRC is able to run and develop clinical trials for what we call investigator initiated trials. So these are ideas from KU physicians, KU scientists taking our own ideas from the laboratory, bringing it to the clinic, and making the latest and greatest available to our patients here at home. Dr. Roy Jensen: Mm-hmm (affirmative). So how does the CRC support the KU Cancer Center's mission to really conquer all cancers?

Dr. Tara Lin: What we're doing at the CRC is these early phase clinical trials. And so since its inception in 2012 through now, we've treated over 500 patients on early phase and investigator initiated trials. At present, we have over 75 trials open across all disease types, so it's not just specific to any one disease. We have a lot of different trials that cover one disease type, but we also have many trials of new targeted agents where the drugs are targeting a specific mutation that might be applicable to someone with lung cancer and breast cancer and leukemia. And because of this unique facility, we're able to conduct all of those trials for all of those patients in the same place safely and completely.

Dr. Roy Jensen: If you're just joining us, we're here with Mary Burch and Dr. Tara Lin talking about the Johnson County Education Research Triangle or JCERT, which is a local sales tax that supports clinical trials. If you have any questions, post them in the comments below. Remember to share this link with people who may benefit from our discussion. Use the hashtag BenchToBedside. So, Dr. Lin, you gave us some examples of the types of clinical trials being conducted at the CRC. Could you tell us a little bit about how we leverage this facility to really provide cutting edge clinical research opportunities for our patients?

Dr. Tara Lin: I'll give you one specific example. So my disease of interest is AML, acute myeloid leukemia, and for AML we hadn't had any new treatments approved. Our original therapies are the same ones we've been using since the 1970s. Our later therapies were approved about 20 years ago and there was nothing, and through early phase clinical trials we were able to bring new treatments to our patients. But what's amazing is that in that time period, you know, we had very few advances, but in the last two years we've had eight new drugs approved for AML and we had clinical trials of every single one of those drugs available through the CRC and through our main campus. We were able to bring the latest and greatest, the most innovative treatments to our patients right here in town, long before they were FDA approved and available. So we brought the right drugs to the patients earlier. Our entire team is trained on how to use these drugs earlier because we know the side effects and we have a lot of experience with them, so we're really able to integrate these new treatments into our standard of care as soon as they're approved.

Dr. Roy Jensen: So is there anything else like the clinical research center in our region?

Dr. Tara Lin: As the only NCI designated cancer center in Kansas, we have the only dedicated phase I unit like this. And certainly in my conversations and discussions with colleagues at other cancer centers, no one's got anything like this with the level of community support that we see. In the last year we put 145 patients on early phase clinical trials and as of July 31st, we had put 150 patients on early phase clinical trials already this year. So we're already going above and beyond what we did last year and we've still got several months to go. It really just shows the way that the entire cancer field is moving towards smarter early phase clinical trials and why we feel it's so important to have those available here in town for our patients.

Dr. Roy Jensen: There's absolutely no question that under your leadership, and Joaquina Baranda and Steve Williamson, our accruals have really taken off. So I want to set the stage a little bit. Back in in 2008 there was this little thing we call the great recession and I'm quite certain that you factored that into timing of this election.

Mary Birch: Totally timed, totally planned.

Dr. Roy Jensen: Yeah. So it was like, what, six weeks after Lehman Brothers-

Mary Birch: It happened in October.

Dr. Roy Jensen: ... went bottoms up, and of course everybody wants to pass a tax initiative when their 401ks are bottoming out.

Mary Birch: Exactly.

Dr. Roy Jensen: So tell us a little bit about kind of like the climate and what this election said about Johnson County and what ... you know, you talked about their focus on the future. Tell us a little bit about that.

Mary Birch: Well, I think that the biggest part about what happened was that recession and because we hit that point and said, "We have no idea. Will they invest in the future of this community?" They always have, with the community college, K-12, and so on, but will they invest based on degrees in research and animal health and food safety. And literally it passed by 57%. We had looked at a higher number early on, 58% which was, you know, we were joyful when that happened, but it did show that Johnson County is willing, number one, to buy into visions of the future for this county and grow its life sciences economy but, for the most part, help people be cured of cancers that we've never had that opportunity. You know, it's one of those things that the uniqueness of this is still unique today because it's not being done anywhere else. That's number one. Number two, the beauty of it is one, sales tax will continue to grow in Johnson County as we continue to grow in population, but also it's permanent and therefore it is a very safe, plannable, predictable revenue stream for the cancer center to do bricks and mortar and scientists and for K State Edwards to do degrees and K State Olathe to do degrees. So it really, I think, has had ... and we're only 10 years old, so, you know, a lot of people, "Oh my gosh, oh my gosh. What all has gotten accomplished?" A lot has gotten accomplished in a short period of time, but it's forever. And so I think that's an opportunity for Johnson County to have contributed to that piece for our community and bring in all that talent that you guys have been bringing in and that kind of thing. So it still is very positive. The thing that is worrisome is the leadership leaves, and we've had leadership from the university level that retires. We've had leaders who made this thing happen retire. So it is a job for JCERT to market itself as to the things that it's working on, but most importantly, the cancer center.

Dr. Roy Jensen: Mm-hmm (affirmative). So when I talk about JCERT to other cancer center directors across the country, they're absolutely dumbfounded that one, we even had this idea, two, that it's wildly successful, but the thing that always gets them and they just, you know, it just absolutely kills is when I point out that the election was in 2008 and they just shake their head and they say, "I can't believe this because how could the voters of Johnson County set all of that aside and just say, "You know what? We're focused on the future."" And that was, I mean, it's just incredible. So we're delighted to have you on today-

Mary Birch: Thank you. This has been wonderful.

Dr. Roy Jensen: ... and we're doing so in celebration of the fact that it's been 10 years now, which is hard-

Mary Birch: That went fast.

Dr. Roy Jensen: ... to believe, and so I want to ask both of you this question. In this last decade, what would you like our viewers to take away in terms of the lessons of JCERT, maybe for you, Mary, focusing on that, and Tara, if you could focus on what it's meant to the patients of the KU Cancer Center, and we'll start with you, Tara.

Dr. Tara Lin: I think certainly to have such an amazing level of support, an incredible facility when people come in, their jaws drop that we have a dedicated phase I unit. It's not the corner of some floor in a non-used building. That we have dedicated pharmacist to early trials, dedicated nurses to early trials, dedicated lab staff, clinical trial staff just dedicated to this initiative is really something else. And the fact that we've been able to treat so many patients over this time period and to be able to keep them at home, I think is really the most important piece of it. All of us live here. We have families and neighbors who develop cancer and we want the best treatment for them and we don't want them to have to leave Kansas City and go someplace else and have all of those extra burdens compared to what they're already going through. So to think about each one of those individuals that we've been able to touch over this time, how it extends not only to what we're doing to treat their cancer, hopefully cure their cancer, but also to allow them to be able to stay here in town with their families and neighbors and that support system is really something amazing. It makes our job so much easier when we're able to completely support that person right here at home.

Mary Birch: Yup.

Dr. Roy Jensen: So Mary, what would you say?

Mary Birch: Well, I think a couple of things. First of all, this was developed as the perfect storm. We hit tons of walls and if K State ... if Olathe hadn't given K State the land, if Edwards hadn't really worked for what they wanted, if we hadn't talked to you to say what piece is needed for NCI, none of this had happened. And at the very end-

Dr. Roy Jensen: And the Hall Family Foundation.

Mary Birch: Bingo. And the very end, we had everything set up and I was literally hysterical about the fact we couldn't find a site. We couldn't put it on the ballot without a site. We had no site and the Hall Family Foundation stepped up and said, "If the tax passes we're in and we're going to help with the facilities." And so without all of those pieces ... the legislation came close. The vote wasn't that close considering, but considering the economy it was. So I think the ability of Johnson County is to dream and that's what this was, was a dream. It's going to evolve. It's going to change as markets change and things happen and that's okay because future leaders will figure that out. On a personal basis, I'm a cancer survivor. I found my new passion when I was diagnosed and I can't think of any place better ... there isn't any place better in my world to having our people, our own people, have access to new clinical trials, to new drugs and et cetera, and to be able to capitalize on the amazing school of pharmacy we have.

Dr. Roy Jensen: Once the tax passed, we went through an incredible due diligence process in terms of going and visiting the best phase I facilities across the country and getting their expertise and asking them how to design the facility and what would be their ideal setup to put a phase I program or early phase program forward. And we were able to benefit from all that advice. And you know, Steve and Tara and Joaquina have all done an incredible job of making sure that we bring a huge amount of value to our patients, and when ... you know, one of our major selling points was the fact that for all intents and purposes, Kansas City had very little access to phase I clinical trials when we got started. And that's because it takes a lot of infrastructure to do that. You have to be in a position to convince pharmaceutical companies that you have the wherewithal to put on these trials, to successfully recruit patients, that you have the clinical expertise to run the trial, that you have all the regulatory and everything else. And that's what JCERT allows us to do. You know, many cancer center directors would tell you that one of the banes of their existence is the clinical trials office because they're just an endless money sink, and frankly through the support that we get from JCERT, it's one of our brightest shining lights because we have the capacity to have absolutely one of the best clinical research programs in the country. It's solely attributable to the fact that we have JCERT, that it's predictable, it's sustainable funding, and we can really think about the future of our clinical research program and plan accordingly.

Mary Birch: It's also growing faster than what we thought it would. We were supposed to be 20 years out before you were getting $6 or $7 million. So that's really good news. I mean, it helps you at least sustain the maintenance part of it. But yeah, not just the uniqueness but really the ability to find two pieces that can work together so well and that fit Johnson County thinking, and Johnson County thinking was bold and dreaming and visionary. On one side, it's our ability to treat cancer patients right here, our own people, and within the doughnut you talk about. But secondly, it is a very large contributor to the economy of this county, which helps it continue to grow. From that perspective that brings in more sales tax to helps us help us with the clinical research center.

Dr. Tara Lin: Traditionally, phase I programs were on the East Coast and the West Coast and I'd have a patient come in and I thought they needed something that was newer and cutting edge and you would get online with them and you would look up early phase trials in their disease and you would have the conversation. Do you have any cousins on the East Coast? Do you have an old roommate who lives in Chicago or New York or San Francisco where we could send you, because there was no option within a reasonable distance for people who live in the middle of the country. And it's an accident of geography where you live and where you're born, and so it shouldn't be that only people on the East and West Coast get access to the latest cutting edge clinical trials. It's a real duty, I think, for us as physicians and cancer researchers to do everything we can to make those opportunities available for our patients at home.

Mary Birch: Exactly.

Dr. Roy Jensen: You know, one thing that we haven't talked about is that the rise of the CRC and JCERT more or less coincided with a revolution in our thinking around phase I clinical trials. And you know, back in the 1960s, 70s, 80s, even well into the 90s, most phase I trials, about the only information you got out of those was determine a dose to go further with a trial and figure out if you wanted to move ahead with that drug. This is not ... today's phase I trials are not your grandfather's phase I trials and you know, a great example is Gleevec. From the very first trial that drug was in, it put people on the path to a normal lifespan, and that is not how it used to be with phase I trials. That, I believe, increases the importance of this facility to our patients even more so because you cannot practice cutting edge, or even I would say standard of care or best in class medicine without access to a phase I clinical facility because that's where the excitement is. That's what is making progress against this disease and so we're really blessed here.

Mary Birch: Well that kind of goes back to my buy in into cancer was our trip to Seattle, Washington when you introduced us to the Fred Hutchinson Cancer Center and we were talking about Nobel laureates and what you and Dr. Hemenway had already launched a 10 year plan as to what we needed. That was kind of where I kind of figured out number one, research is an economic engine, which I had not put that together, and number two, again, the donut hole that we had gave us an opportunity here to really be able to help people deal with and survive cancer.

Dr. Roy Jensen: That's a great way to end up today's segment. So I want to thank you both. That's it for today. To learn more about clinical trials, visit kucancercenter.org/clinical trials. Join us next week at 10:00 AM for Bench To Bedside. Thanks for watching.