by Lori Oliwenstein
Derek Raghavan's is a career in translation. With an almost palpable zeal, he strives to find the best ways to metamorphose concepts born atop a lab bench into therapies available to the patients who need them.
"I view my job at USC as being predominantly to act as an interface-to bring together lab scientists and clinical scientists so that both can do the best work possible," he says.
He is a man uniquely qualified to do just that. With M.D. and Ph.D. degrees, the physician-scientist has often traveled both literally and conceptually from lab bench to patient bedside. And in his many roles at the Keck School of Medicine of USC, he is simply continuing that journey-not only by doing hands-on clinical research, but also by mentoring other physician-scientists and giving them the freedom to look at cancer from both the molecular level and the human perspective. He is professor of medicine and urology, chief of the division of oncology and associate director for clinical research at the USC/Norris Comprehensive Cancer Center.
It is a point of view-or, more accurately, a series of viewpoints-that Raghavan himself has managed to maintain throughout his career. Educated and trained in Australia-where he was born and raised-as well as in Britain and the United States, he spent six years as chief of the departments of solid tumor oncology and investigational therapeutics at the Roswell Park Cancer Institute in Buffalo, New York. During that time he was twice named among the "Best Doctors in America" for his work in medical oncology, specifically urologic and lung cancers.
While at Roswell, Raghavan did a lot of basic scientific research. For instance, he explored the use of a new anticancer drug that had been used for pancreatic cancer-gemcitabine - for use in bladder cancer. "It's a very effective, gentle drug for bladder cancer," he says. "It has become the standard of treatment for that disease since we first published on it in 1996." More recently, he has been concentrating his efforts in a clinical setting, working with a drug called DPPE, which, when paired with a Food and Drug Administration-approved drug called mitoxantrone, seems to make the approved drug work better. "It's improving the quality of life and causing cancers to shrink in about two-thirds of patients we treat for prostate cancer," says Raghavan. This study is being done in collaboration with Lorne Brandes, M.D., in Canada. Brandes, who pioneered the use of DPPE, has been collaborating in its clinical development with Raghavan and his team for the past two years.
Raghavan's ability to pick out the useful, worthwhile drugs from the countless pharmaceuticals being tested has continued to serve him and his patients well since his arrival at USC in 1997. It has also served him well as a member of the FDA Oncology Drug Advisory Committee, which is responsible for deciding "what new drugs get into America," he explains. But what truly distinguishes Derek Raghavan is his ability to look at the patients these drugs are used on as individuals rather than medical case studies.
This is a man who believes that translational medicine means more than getting new drugs to patients. It also means getting people to understand the role they themselves can play in preventing cancer or in getting the best medical care possible. Raghavan is one of those rare scientists who understand the role of the media in getting that message out. Indeed, he has spent the past three years as the chair of the public relations committee of the American Society of Clinical Oncology, or ASCO. In that role, he has helped countless reporters not only translate the information disseminated at ASCO's annual meeting, but to put that information in perspective.
Raghavan is also a man with strong, educated opinions-opinions he is unafraid to express. "I can't think of anything more valuable than to cut cancer rates by removing the ability to get addicted to cigarette smoking," he told Ladies Home Journal last November. And to The NewsHour with Jim Lehrer he declared, "If I could control the health care budget and was given one option to reduce the cancer in the nation and in the world, I would do just one thing, and that is, I would stop people from smoking."
Raghavan is doing his best to spread that message-and to make sure that the fruits of all these years of research reach all members of society, rather than just a privileged few. Indeed, it is in his work with the community-in translating science into action, medical cases into human faces-that Raghavan truly shines. "I think it's important to develop a global approach to patient care," he explains.
To that end, he is currently working to put together a program at LAC+USC Medical Center that would work to improve the standard of care for testicular cancer in Latino patients. "It's still a developing story," he admits, "but what we're trying to do is to increase patient education to improve the sorts of results we get." To find the best way to do that, he is putting together a randomized trial in which patients will all receive the same high quality of care, but in which one group will be assigned a Spanish-speaking nurse who will follow their care throughout the course of their illness. The nurse will make sure the patients understand what the doctors tell them, help them to comply with medication regimens, work with them to schedule necessary appointments and follow up to ensure they keep those appointments.
In addition, Raghavan is working to encourage other faculty members to get involved in similar studies. For instance, Heinz-Josef Lenz, M.D., associate professor of medicine at the Keck School and director of gastrointestinal oncology at USC/Norris, is currently looking at the enzymes that alter drug metabolism in Latinos. And both Raghavan and Alexandra Levine, M.D., chief of hematology and medical director of the USC/Norris Hospital, are working with Oscar Streeter, Jr., M.D., associate professor and chief of radiation oncology, to take USC's expertise in cancer and HIV to the streets of South Los Angeles, Hawthorne and Inglewood. Funded by the California Centinela Community Foundation, Streeter's program will send a project coordinator into the community to find out what cancer and HIV services are offered and what services are missing - and then try to fill those needs. The project will also characterize the demography of cancer within the region-a culturally diverse 10-by-10-mile swath -with the help of the USC-based Cancer Surveillance Project, which tracks cancer cases in the county.
"We have such a diverse racial population in Los Angeles," says Raghavan. "It's projects like these that allow us to improve-to tailor-treatments to different population groups."
But Raghavan's interest in diverse populations goes beyond race. "I think it's important to work with all people who don't just seem to fit perfectly into the routine facilities of the medical community because of special problems or considerations," he says. That is indeed true of a population that is of particular interest to Raghavan-a population that makes up almost two-thirds of the cancer patients in this country, the elderly.
This is a population, says Raghavan, for which cancer care has yet to be optimized. For instance, he says, the elderly have long been left out of cancer trials. In the past, that was because the National Cancer Institute (NCI) required a cut-off age of between 60 and 70 for most trials of cancer therapies, to protect the elderly from the toxic effects of strong drugs.
But in recent years it has become apparent that many of the elderly are in better shape than they used to be-in good enough shape, certainly, to handle the downsides of experimental drugs. And they are eager to try to attain the promise inherent in such drugs-the promise of a longer, better life.
"We must reach out to our patients as the Baby Boomers age," says Raghavan. "Since cancer is a disease of aging, we will have a growing number of them as patients. We won't be able to say to these patients, 'We can give you only another year or two of life.' That won't fly."
The NCI agrees; they no longer set a limit on age in clinical trials. If you fit the criteria, you can participate.
But the problem, notes Raghavan, is that the elderly are not participating. According to a study in the New England Journal of Medicine from the Southwest Oncology Group-a cooperative research group in which Raghavan is currently a principal investigator-63 percent of all cancer patients are over 65, but only 25 percent of them are in cancer clinical trials. What this means is that physicians remain unclear as to the best way to treat these patients.
That, says Raghavan, is clearly unacceptable. And so he has embarked on a study funded by the Estelle, Abe, and Marjorie Sanders California Foundation to rectify the situation. The gift will allow Raghavan to look at both established and new chemotherapeutic agents for older patients with prostate cancer who have failed initial attempts at treatment.
"The Norris is getting to be known for our program for older patients," he adds. "This study is going to help us to treat them even better."
One might think that with all his endeavors, Derek Raghavan would fast run out of steam. On the contrary, he says, it invigorates him.
"Setting a fast pace is something I like to do," says Raghavan with a smile, "and that fits perfectly with the style of our whole group at the Norris." And that is a good thing for the patients at the USC/Norris, who are relying on him to bring them a better quality of care as quickly as he can-to race a cure from bench to bedside, to take pain and fear and turn them into hope for the future. A career in translation, indeed.