Raymond Bergan, M.D., is an internationally regarded cancer researcher who joined OHSU as head of hematology and medical oncology in the School of Medicine and as associate director of medical oncology for the OHSU Knight Cancer Institute. He is also a practicing clinician who sees patients at OHSU and the Veterans Administration Portland Health Care System.
What brought you to OHSU?
My decision to leave Northwestern University and come to OHSU was two-fold. The opportunity to lead the Hematology & Medical Oncology Division was a big draw but I came in large part because of what OHSU is doing for the field. I’m a medical oncologist and have been in drug discovery and therapeutics – that’s my area of focus. I had been at Northwestern for a long time and got to a point where I asked myself “What do I want to do with the rest of my career?” A career I’ve spent helping patients, developing better therapeutics for patients, and I could see where the field was going – toward precision medicine and personalized therapy. So I thought “Do I want to stay [at Northwestern] and wait for the new guidelines to come out or do I want to go and help shape and define those guidelines? I wanted to help move that science forward and felt this was the right place because of what OHSU was doing for cancer, providing a visionary way forward as objectively measured by the Knight Challenge. It’s not about the money per se but about the tools and capabilities it affords and how OHSU is using the money that is significant.
What is the focus of your research?
I came to this division because I thought it had huge potential for further advancing therapeutics. What our group does scientifically is to understand why cancer cells move and therapeutically inhibiting that process. The example I often use is, say a woman discovers a lump in her breast and it turns out to be breast cancer. If it’s just that lump, it’s easy to treat and cure using a local therapy such as surgery or radiation or sometimes chemotherapy; if that cancer hasn’t moved, the woman is cured. If, however, that cancer has moved throughout her body, we can treat it but we can’t cure it. The analogy for breast is true for most cancers. The leading cause of death from cancer is metastatic cancer. So how does that cancer go from the original point and move throughout the body? What kills patients is that process of cell movement, so if you can block that process, you can cure people.
There are many things that are attractive about focusing on motility as a therapeutic target. Until recently, no one had actually been able to do it. But we have. We were the first group to successfully therapeutically target pathways in humans that act to inhibit that process. To clarify, we’ve inhibited a pathway inside cells that’s an important driver of that process. We have not yet shown that we can stop cancer cells from moving in patients and thus have not yet demonstrated benefit to patients. So this is the focus of our laboratory. We’re starting out with prostate cancer, but the research isn’t necessarily limited to that. The overall aim is to discover what regulates and controls cell movement or transformation to a metastatic phenotype and then what part of that process can be therapeutically targeted. We’ve taken agents from bench into clinic through phase II trials, and now we’re putting a lot of effort into discovery of a novel class of agents and moving that forward. This is what’s nearest and dearest to my heart in terms of what our group is working on.
Linked to that, I’m also involved in early phase clinical trials. I have a long history in the field of chemo-prevention. At Northwestern, I put together–and served as PI for over a decade–one of only five National Cancer Institute-funded early phase chemoprevention consortia groups. I built the group to 19 institutions, including two in China, and ran a variety of clinical trials. Early phase trials are what you would consider “go – no go” trials for larger, expensive and potentially risky trials. If you have a promising agent and you’ve run it through a Phase I trial and are confident the drug isn’t toxic, you go to the next phase to see if it does anything of use. If it’s an effective chemoprevention agent acting as expected, you would run a trial in humans looking at target cells in the target tissue in the body to see if you get a response. The outcomes of these early stage trials have molecular endpoints that allow you to say, yes, this is worth further investigation because we know that a certain dose given to a targeted cohort exerts the pharmacologic effect we want in the exact organ we want to target. Tamoxifen is an example of a very successful chemoprevention drug that blocks the actions of estrogen, which is effective against tumors that require estrogen to grow.
But say you developed a drug and in early trials, you didn’t get the response you’d anticipated. We wouldn’t just throw the drug out. We would look at it closely and ask “is it a bad drug? Did we not administer the correct dose?” We might be able to rescue the drug if we find it was a case of bad formulation or we didn’t administer the drug properly. So that’s the purpose of this consortium – to run these types of trials which are very complex and require experts in a particular cancer type or methodology, etc. A single research group or institution can’t cover all those bases which is why a consortium is needed. When I came here I had to give up my leadership of the group, which was probably the hardest thing I’ve ever had to do professionally. Ultimately, the award is made to the institution, so it stayed at Northwestern. But I’m still heavily involved. When I came here, I made OHSU a site and I’m now chair of the Eastern Cooperative Oncology Group Prevention Committee.
I’m passionately committed to this work. I think the way we’re going to have the biggest impact on cancer is in early detection and early intervention.
What do you do when you’re not at work?
I love Portland. I knew nothing about it prior to coming here other than having read a few things. There’s so much about it that reminds me of home. I grew up in a rural area of upstate New York in a small town, and I spent a lot of time in the woods when I was young. Here I walk to work and when I’m done working, I’m running on a wooded trail right outside my door. I’m happy anywhere and very much liked living in Chicago. However, Chicago is a large city, and it would take you a long time to get out of it. Here, you have a real city with a downtown that’s vibrant, but you can get out of town in half an hour. I’m also currently learning Chinese, I read a lot of biographies, and I have three wonderful kids that I love spending time with.