Anyone who drives over the Interstate 5 bridge in Portland will see the concrete skeleton of a high-rise spouting from the bank of the Willamette River.
It may seem like just another construction site, but this one is different. It's the new home of the Knight Cancer Institute — a $1 billion dollar, home-grown effort to cure cancer.
The quest started in 2013. Nike founder Phil Knight was making a speech at a fundraising gala for Oregon Health And Science University. He was off on a tangent about how the Oregon Ducks lost a national treasure when football coach Chip Kelly left for the NFL.
But then Knight pivoted, saying he didn't want the same to happen to Brian Druker, the OHSU scientist who discovered the curative powers of the cancer drug Gleevec.
Knight said he would donate $500 million to fight cancer and keep experts such as Druker around — but only if OHSU could match it.
"If the campaign raises $499 million, we are relieved of our pledge," he said.
Within two years, the school had successfully raised $500 million. Up to then, the most it had raised for cancer in a year was $10 million.
Druker is now the director of the Knight Cancer Institute, and he says Knight's challenge was a complete surprise and a stroke of genius.
"People want to have a big goal," he said. "And curing cancer is the biggest goal you could possibly imagine."
But in the same breath, he softens the idea that OHSU teams will come up with a true single cure for cancer.
“I don’t want to entirely back away from that. But I do want people to understand that there’s nuance,” he said.
In other words, Druker doesn’t want anyone to think there is one silver bullet for cancer. Instead, he expects scientists to find many different cures because what we call "cancer" amounts to many different diseases.
He likens the search for answers to cancer to the efforts to cure infectious diseases.
“If you were diagnosed with pneumonia in the early 1900s, it was a death sentence," Druker said. "And today you think, ‘Well what antibiotic do I need?’”
He says infectious diseases were cured in many different ways. Towns introduced sewage treatment plants. They built plants to provide clean water. Milk was pasteurized to kill bacteria. Food was refrigerated.
"And then we introduced vaccines, polio vaccine, we've eradicated smallpox. And for cancer, we're going to take that same approach," Druker said.
He uses the example of leukemia, a cancer of the white blood cells. It isn't just one disease, but a dozen or more.
Druker's drug, Gleevec, increased the survival rate for one type of leukemia from 30 percent to 90 percent. It's been called a miracle drug and was one of the first personalized or precision therapies.
The work of Druker and his Gleevec team showed that if scientists could understand the biology of a disease, then they could learn how to treat it.
“If you understand what’s driving the growth of a cancer, you can target that specifically," he said. "That leads you to better responses, fewer side effects.”
Gleevec isn’t poisonous like chemotherapy. Instead, it unlocks a cancer cell’s defenses so chemotherapy drugs can penetrate to kill it. Gleevec also unleashed a whole new area for research.
But when he made his cancer pledge, Knight didn’t want to put money into areas of research that were already getting attention. Instead, he wanted to support cutting-edge research that offers the promise of a big reward but which also comes with a high risk of failure.
So they decided to focus on the early detection of cancer, said Tom Beer, the deputy director of the Knight Cancer Institute. "Early detection is compelling because we know that if we can detect a lethal cancer early, we can often cure it," Beer said. "We can often treat it with less side effects and fewer side effects than treatment of advanced cancer."
So the plan is to invest in dozens of new areas of research, rather than building on in-progress work, in the hope that one or two will bear fruit.
But the focus on early detection has critics.
"There's been some discouraging developments around problems with early detection like over diagnosis, detecting insignificant cancers, which in turn leads to unnecessary treatments and harm to patients," Beer said.
Druker says what "early detection" means to him is the development of new, cheaper and more effective tests that can easily be conducted in a doctor's office and deliver dependable results.
"If we develop some new diagnostic tests or technologies, we want to spin them out into the commercial domain, because they're going to move more quickly than we can," he said. "And that's the idea. … Patent it, and spin it out. Hopefully, we'll get some royalties back because we'll have some of the intellectual property around that. But the reality is that if it's something successful, curing more patients, diagnosing cancers earlier, that's what we really care about and that's ultimately how we're going to measure our success."
If the OHSU project works, cancer treatments will move from a "one size fits all" model to one that involves more precise prevention efforts.
"If you look at all the prevention trials that have been done, most have been a failure because it's been, 'Let's treat everyone with Vitamin A,'" Druker said. "What if only 5 percent of the population is going to benefit from Vitamin A as a cancer prevention? In a large trial, that's going to fail."
So how will people feel in 30 years when they get a cancer diagnosis?
"In my view, cancer will no longer be feared," Druker said. "But people will still get some cancers and will still die of cancers, just like people still get infections and die of infections. But it's not this mysterious death sentence that people think of it today."