The Best Cancer Care in Colorado Keeps Getting Better

Step by Step

Colorado oncologists are saving more lives than ever before, while researchers continue to search for ways to save everyone.

During World War II, the U.S. Army began probing mustard gas’ various poisons, looking for deadlier weapons. But among the harmful chemical ingredients, researchers discovered nitrogen mustard, a compound that, miraculously, seemed to slow lymphoma. Eventually, doctors figured out a way to deploy nitrogen mustard and similar so-called alkylating agents to damage the DNA of cancer cells, and in 1956, methotrexate, one ingredient of what’s now the standard chemotherapy cocktail, helped lead to the first recorded cure of metastatic cancer.

The drive to build on past discoveries continues today as cancer treatments become more specific to individual patients, resulting in improved outcomes and reduced side effects. “Our knowledge of basic science, biology, and biochemistry is what’s fueling the successes that we’re seeing in the clinic,” says Dr. Gerald Falchook, a Denver-based medical oncologist and the director of the Sarah Cannon Research Institute at HealthOne. “When I started this work 15 years ago, we could test for eight genes to figure out which treatment to give the patient. We thought that was incredible,” Falchook says. “Now, we can test for over 300 genes with a fraction of the tissue that we needed before, and we do it in a fraction of the time.”

Home to the University of Colorado Cancer Center and the Western States Cancer Research program (two National Cancer Institute–affiliated research organizations) as well as a thriving bioscience industry, the Centennial State is pioneering many of the advancements that are improving outcomes all over the globe. At the same time, a fundraising boom has bankrolled Colorado hospitals’ implementation of technologies that are prolonging and saving lives here and now. “Having all of those people in one spot means that there’s a lot of science going on here,” Falchook says, “which means we can really be successful and change people’s lives.”

On the following pages, we detail the tangible ways the Centennial State’s health care industry has improved treatments for cancer patients, including multidisciplinary care, cutting-edge diagnostics, and tumor-excising lasers. But we also go inside laboratories to peek at the future of oncology. “If I told you I think this research boom will level off, that would be because I have a lack of imagination,” Falchook says. “There have been times along the way, even in the last 15 years, where it seemed like there was some technology barrier we couldn’t get over, and then someone figured out how to get over that barrier…. I think inflection points are where we see the science take off and get better and move forward.”

28%: Decline in cancer mortality rate in Colorado from 2002 to 2019.

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Centers of Attention

Local hospitals have recently unveiled (or will soon debut) oncology hubs stocked with the latest cancer-fighting hardware.

Sarah Cannon Research Institute at Presbyterian/St. Luke’s Medical Center and Swedish Medical Center

Denver (Presbyterian/St. Luke’s) and Englewood (Swedish)

Opening: February 2023 (Presbyterian/St. Luke’s) and fall 2023 (Swedish)
Why it was needed: Previously, both HealthOne hospitals’ oncology services were scattered, meaning patients had to visit one building to see their doctors, another to receive treatment, and another to access support, such as fertility planning and art therapy.
How it will help: Presbyterian/St. Luke’s and Swedish consolidated all cancer care into single buildings at each campus, investing $20 million in the former’s existing facility and adding a 162,000-square-foot center to the latter.

University of Colorado Anschutz Katy O. and Paul M. Rady Esophageal and Gastric Center of Excellence

Aurora

Opening: December 2022
Why it was needed: Esophageal cancer remains one of the most deadly forms of the disease, with a five-year survival rate of less than 20 percent.
Why it was needed: The center’s eponymous donors gave $20 million to, in part, establish an innovation fund, which founding chair Dr. Sachin Wani, a professor of gastroenterology and hepatology at CU Anschutz, will use to fund research grants. The gift will also pay for the recruitment of elite doctors and researchers, an expansion of CU Cancer Center’s clinical trials, and more screenings.

Lutheran Medical Center Comprehensive Breast Cancer Center

Wheat Ridge

Opening: July 2023
Why it was needed: The breast cancer incident rate in Colorado (130.4 per 100,000 people, excluding in situ cases, in which the cancer has not spread beyond the milk ducts) is slightly higher than the national average and has steadily risen over the past two decades.
Why it was needed: Lutheran’s patients will continue to have access to 3D mammography, which is 40 percent better at detecting cancer than traditional mammograms. The center will also dedicate an entire unit to breast biopsies to provide more accurate and timely results.

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Treatment Through Time

An abbreviated history of fighting the Big C.

3000 B.C.E.: In the earliest known depiction of cancer treatment, an ancient Egyptian textbook depicts breast tumors being removed by a cauterization tool called a fire drill.

1895: German engineer Wilhelm Conrad Röntgen discovers the X-ray. Within three years, Swedish physicians Tor Stenbeck and Tage Sjogren describe using X-ray radiation therapy to cure skin cancers.

1923: Greek physician Dr. George Papanikolaou invents a screening test for cervical cancers, which becomes known as the Pap smear.

1960: U.S. doctors use methotrexate to bring about long-term remissions and cures in children with leukemia.

2010: The Food and Drug Administration (FDA) approves sipuleucel-T for metastatic prostate cancer, making it the first cancer immunotherapy to hit the market.

2017: Two tests that identify specific genes in tumors get the go-ahead from the FDA, allowing doctors to better target treatments to those cancers’ vulnerabilities.

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Outside City Limits

For rural Coloradans, traveling to Denver for cancer treatment is incredibly inconvenient. Thankfully, cutting-edge care is spreading to less populous parts of the state.

Fighting cancer is a tough task, but people living in Denver have long been able to count on having the best weapons for the battle within a few minutes’ reach. That hasn’t been the case for rural Coloradans, who sometimes have had to make long treks to Denver or Salt Lake City to receive appropriate care. “You really don’t want to get in a car after a heavy dose of chemotherapy,” says Chris Thomas, president and CEO of Community Hospital in Grand Junction, “and drive hours back home.”

For Coloradans living on the Western Slope and in the southern part of the state, care that had typically only been available in urban areas is finally making its way to the countryside. Thomas’ Community Hospital, for example, will soon realize a long-held ambition: opening the $54 million James Pulsipher Regional Cancer Center. The 130,000-square-foot building will not only house all of Community Hospital’s cancer offerings—from its nine oncologists to genetic counseling to clinical trials to a survivorship program—but it was also built for the latest technology, literally. Its floors were poured incredibly thick so that they could host a linear accelerator, a machine that focuses beams of radiation so precisely that they hit a patient’s tumor but none of the healthy cells. The center’s thick floors were necessary to ensure the powerful rays don’t harm people working below. “This is a huge step forward for us, and it means Grand Junction is getting care just like you would get in Denver or in Salt Lake City,” says Thomas, who expects Pulsipher to welcome its first patients in January.

Parkview Medical Center in Pueblo got its own linear accelerator, the first in southern Colorado, when it opened the Parkview Comprehensive Cancer Center in October 2022. But Dr. Suraj Singh, medical director of Parkview’s radiation oncology department, is equally excited about the guiding principle behind the 47,000-square-foot building’s design. “At those big academic centers up in Denver,” Singh says, “multidisciplinary care is the way oncology is going.” For good reason: A 2017 study in the Journal of Clinical Pathways shows that patients felt their care improved by five to eight percent when providers worked across departments to help them heal.

Prior to the Cancer Center’s debut, Parkview’s oncology offices were spread out, with patients forced to shuttle themselves among oncologists, radiologists, and other services. Now they are all in one building, which has been more convenient for patients and beneficial to doctors, who are able to consult with one another before delivering diagnoses. “Not everyone lives within 20 minutes of Denver,” Singh says. “We know that all Coloradans deserve that same high-quality care no matter where they live.” Today, they’re much closer to receiving it.

20%: Percentage of the U.S. population that is estimated to live in rural areas, while only three percent of oncologists practice there, according to the National Cancer Institute.

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Smart CAR-T’s New Road

Researchers have discovered a way to put our own bodies to work battling cancer. Called chimeric antigen receptor T-cell, or CAR-T, therapy, the process involves programming a patient’s immune system to seek out malignant cells and destroy them and has been proven effective against blood cancers such as leukemia. Now doctors are hoping to expand its uses to diffuse intrinsic pontine gliomas (DIPG), a rare yet aggressive childhood tumor that typically kills within nine to 11 months of diagnosis. Dr. Jean Mulcahy Levy and research professor Sujatha Venkataraman, both of Children’s Hospital Colorado and the University of Colorado School of Medicine, are developing a “smart” CAR-T therapy that has the potential not only to extend life expectancies but also to eradicate DIPG entirely.

5280: Why hasn’t CAR-T been effective on DIPG tumors in the past?
Sujatha Venkataraman: CAR-T is engineered to identify antigens, which are present on cancer cells, and kill those cells. This is an effective way to treat blood cancers but not solid tumors like DIPG, because the antigens on solid tumors are also present on normal cells. So our white blood cells can’t differentiate between them and would kill normal cells, too.

How is your therapy different?
Venkataraman: What we did was identify two antigens that are present on solid tumor cells but aren’t expressed on normal cells. If the CAR-T cell finds only one antigen on a cell, it leaves it alone. We call it “smart” because it knows where to go.

Does it work?
Venkataraman: We treated DIPG-bearing mice with this therapy, and it completely cleared the tumor. Without treatment, mice live only 30 to 40 days. These mice survived for more than 200 days, which is how long they usually live when they’re healthy. That’s an unprecedented increase in survival. We’re now collaborating with other centers that can validate our results. After that, we’ll get approval for clinical trials.
Dr. Jean Mulcahy Levy: We’re probably looking at a few years before this gets into patients.

What are your expectations?
Mulcahy Levy: I would say the goal for this therapy is not prolongation, it’s a cure. Even if a recurrence of the cancer happens, we can give the therapy again.

Could this therapy be expanded to treat more types of solid tumors?
Venkataraman: Different tumors express different antigens. Our current research is just focused on DIPG, but the smart CAR-T therapy can be altered to look for and kill different pairs of antigens, meaning this could eventually treat all kinds of solid tumors.

What’s it like working together on this?
Mulcahy Levy: Our offices are right next to each other, so we sit and talk and run ideas past each other. It’s funny: The smart CAR-T therapy works best because we’ve identified those two antigens together to make it work, and that’s how I see us. In our field, just chatting in the hallway lets us build ideas off each other. That’s where science happens.

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Lock and Key

Cancer screenings can feel like medical roulette, but proposed legislation could force insurance companies in Colorado to cover a more precise method.

As far as diagnostics go, the typical blood test you get during your yearly physical is good for indicating that something is wrong—just not what is wrong. A high amount of white blood cells, for example, could be a sign of a tumor, but it could just as easily mean that you’re pregnant. That’s why doctors perform other exams, such as CT scans or biopsies, before they can clear a patient or deliver a cancer diagnosis. More screenings mean more time, money, and anxiety. Enter biomarker testing, a specialized form of blood exam that can identify the genes and proteins that are specific to certain cancers.

Originally developed about 30 years ago and popularized in the early 2000s, biomarker tests not only pinpoint malignancies, but they also help doctors select targeted treatments. Dr. Karng Log, an oncologist with Intermountain Healthcare in Golden, compares standard chemotherapy to a battering ram: Doctors inject patients with a stew of chemicals and hope that one or more of the poisons kills the cancer. It’s often effective, yet it reaps unintended damage—such as nausea, fatigue, and hair loss—in the process.

Biomarker exams allow doctors to reduce the chemical load. If, say, the test reveals that a patient’s colorectal cancer possesses a KRAS mutation, doctors know that the chemotherapy drugs Erbitux or Vectibix will probably be most effective. “The example I like to give is of a lock and a key,” Log says. “If you’re trying to get into a house and you have a keychain with tons of keys, you need to figure out which one will unlock the door. Biomarker testing lets us figure out which key we need to go in.”

The catch? Biomarker testing is much pricier than a standard blood exam, running $1,700 on average for folks who are underinsured or don’t have insurance, according to the National Conference of State Legislatures. Although most insurers cover at least some variations of the screening, members of the Colorado House of Representatives introduced a bill this past session that would have forced insurers to pay for every kind of biomarker exam. (Colorado would’ve become the fifth state to approve such a bill, behind Arizona, Illinois, Louisiana, and Rhode Island.) The legislation didn’t make it out of the Appropriations Committee, but its sponsors hope to take it up again next year. Until then, Coloradans can only hope providers’ fees aren’t too rich for their patients’ blood.

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13%

Glioblastoma patients who reached the five-year mark after receiving DCVax-L, an immunotherapy injection co-developed by Dr. Michael Pearlman of HealthOne’s Swedish Medical Center. Pearlman partnered with hospitals in four countries to treat 331 patients, and though the results of the clinical trial might appear disappointing, the doc is thrilled with the outcome. Why? Because the five-year mark currently sits at 6.9 percent, a number that has remained unchanged for decades. DCVax-L delivered the largest increase in survival rates in 20 years, an accomplishment Pearlman says is “simply extraordinary.”

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The Little Guys

Although Boston and San Francisco are regarded as the cancer-fighting capitals of the U.S. biotech and pharmaceutical industries, metro Denver’s contributions to the cause shouldn’t be overlooked. Here, four local companies that could be on the verge of developing the next big things—or already have.

Vona Oncology

Location: Aurora
Year founded: 2018

Not only is Vona small (it employs only 10 people), its wonder drug is, too. VDX-111 is made of tiny molecules that can enter cells more easily and is aimed at treating triple-negative breast cancer, an aggressive form of the disease. Early tests have been promising: VDX-111 reduced tumors in mice by 80 percent with minimal side effects and is expected to enter the clinical trial phase in 18 to 24 months.

Foresight Diagnostics

Location: Aurora
Year founded: 2020

Foresight’s blood tests track the genomic differences between cancer cells and healthy cells and are sensitive enough to detect cancers below one part per million DNA fragments, lower than current liquid biopsy exams. Bottom line: Foresight spots a cancer relapse about 200 days before existing diagnostics do. No wonder the company has raised more than $70 million and is on the verge of FDA approval.

Biodesix

Location: Boulder
Year founded: 2006

Biodesix manufactures two blood exams, Nodify Lung and IQLung. The former determines a patient’s risk for lung cancer as well as whether a suspicious mass is benign or not. The latter can identify gene mutations, allowing a care team to pick the best individualized cancer treatment. Both are already being used by independent practices, a multistate hospital network, and “everywhere in between,” says Kieran O’Kane, Biodesix’s chief commercial officer.

AIGene

Location: Aurora
Year founded: 2019

Currently, a patient receiving treatment must wait three to six months before a CT scan is able to detect whether a tumor is shrinking—i.e., whether the therapy is working. AIGene, on the other hand, charts changes in DNA and could provide feedback in hours. The technology is years away from reaching the market, but it’s promising enough to have warranted a $250,000 grant from Colorado’s Office of Economic Development and International Trade this past May.

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Easing the Toll on Your Ticker

Cardio-oncologists are beginning to understand cancer’s impact on your heart—and how to mitigate the damage.

The field of cardio-oncology isn’t new; it’s simply new to you. In the past, physicians in the specialty were confined mainly to research facilities, where they studied cancer’s effects on the body’s beating center. Among their discoveries: Cancer survivors have a greater chance of developing heart disease because of the powerful drug treatments that coursed through their veins. Today, cardio-oncologists are finally putting their homework into practice. Dr. Chris Fine is the only cardio-oncologist at Denver’s National Jewish Health and one of fewer than 100 cardio-oncologists in the country who have been board-certified by the International Cardio-Oncology Society. Fine has begun collaborating with cancer care teams to monitor patients’ cardiovascular systems and recommend ways to protect their hearts. That might mean avoiding certain cancer drugs, such as anthracyclines, which can cause left ventricle dysfunction and even congestive heart failure. Fine’s most important task, however, is educating his peers. Many primary care physicians still don’t realize that their 20-year-old cancer-surviving patient might have the heart of a much older person. “We’re just now starting to see ourselves trickle down to work with the actual community itself,” Fine says, “which is where I think we’re most needed.”

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Sko Buffs

Coach Prime might be getting all the attention on campus these days, but researchers at the University of Colorado Boulder deserve a share of the spotlight for their recent contributions to cancer care.

Stellar Cells

Stem cells are essentially blank slates—raw materials that can replace malfunctioning cells that cause cancer. Manufacturing them is difficult, though, because Earth’s gravity can ruin entire batches of the fragile specimens scientists grow in labs. So last year, NASA awarded BioServe Space Technologies, a University of Colorado Boulder research program, a $3.3 million grant to figure out a way to produce stem cells in a more forgiving atmosphere: space. The project is set to launch to the International Space Station, where astronauts will use BioServe’s complex bioreactor to try to accomplish the mission, on August 2.

The Fix Is Out

Nausica Arnoult, an assistant professor of molecular, cellular, and developmental biology at CU Boulder, has discovered a protein that is really good at repairing cancer cells—which is really bad for cancer patients. Mending damaged tumors is what allows cancer cells to spread throughout the body. However, Arnoult’s research, published in the April issue of Molecular Cell, shows that when the protein, APE2, is suppressed, malignancies sputter and die. It’s now up to other scientists to take up her research and develop therapies that would quash cancer’s Mr. Fix-It.

Cannabis Rx

After successful breast cancer surgery in 2017, Angela Bryan asked her doctors about using cannabis as a pain reliever. But because cannabis is a Schedule 1 substance and, thus, universities are not permitted to study the drug in trials, there was no data to support pot as a palliative. So Bryan, a professor of psychology and neuroscience at CU Boulder, did the research herself. Released earlier this year, Bryan’s study suggests that not only is cannabis effective at reducing pain, but it can also improve long-term cognitive function that sometimes declines because of cancer treatments.

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Ruff Comparison

At Colorado State University, a doc is writing a dog-treats-man story.

Dr. Doug Thamm works with cancer patients of all shapes, sizes, and, well, breeds. A professor of animal oncology at Colorado State University, Thamm consults for a cancer registry for dogs that allows veterinarians to upload profiles of pups that can then be analyzed by experts looking to better understand how cancer affects canines. And because cancer in dogs behaves similarly to cancer in humans, some oncology researchers have begun studying the registry to identify possible treatments for people. “Comparative oncology is a field that has rapidly expanded over the last couple of decades,” Thamm says. “Veterinary medicine can help in the cancer fight more than some might think.”

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Dismantling Disparities

University of Colorado Cancer Center is investigating new ways to bring equal treatment to all Coloradans.

When the omicron variant coursed through the United States in 2022, it affected demographics differently—but predictably. Hispanic, Native American, Black, and Asian populations recorded higher infection rates than white people during the surge, just as they had throughout the COVID-19 outbreak. Those variations laid bare the fact that the health care industry is not immune to discrimination based on race.

That includes oncology. “We see disparities not only in incidence,” says Dr. Evelinn A. Borrayo, associate director of community outreach and engagement at the CU Cancer Center, “but, more importantly, in mortality.” And although the pattern repeats itself across the world, Colorado has unique problems. To name one: Compared with other states, Hispanic residents here suffer higher rates of lung, breast, and colorectal cancers, and though they have guesses, doctors don’t know why. So, in 2020, the CU Cancer Center disbursed five grants of $100,000 each to research groups within its system to investigate how to better include all Coloradans in the services it provides.

The results, again, have been mostly predictable. For instance, Dr. Jessica McDermott, deputy associate director of diversity and inclusion in clinical research at the CU Cancer Center, found that Hispanics make up 10 percent of the head and neck cancer diagnoses in Colorado each year but only five to eight percent of such patients served annually by the CU Cancer Center. “Prevention, early detection, and great therapies don’t mean much,” says Dr. Richard Schulick, director of the CU Cancer Center, “if we’re not disseminating those things to our community.”

54%: Segment of U.S. women ages 45 and younger diagnosed with breast cancer who are Black.

By auditing representation, the center has begun to identify how it can strengthen its ties with vulnerable groups. McDermott has launched a pilot clinic called E3 (Esperanza en Español) that is staffed by bilingual and bicultural health care workers. Pediatric oncologist Dr. Lia Gore of Children’s Hospital Colorado (CHC) helped forge a partnership among CHC, Denver Health, and UCHealth to increase access to molecular testing for leukemia in metro Denver and reach more vulnerable populations. Dr. Virginia Borges, the founder and director of the Young Women’s Breast Cancer Translational Program and Clinic at the CU Cancer Center, organized interviews with people of color, Spanish speakers, and rural residents to create better educational materials about young women’s cancer.

The work is ongoing, but it’s already yielding positive results: McDermott says Hispanic participation in head and neck cancer clinical trials at the CU Cancer Center doubled from 2020 to 2022, while Gore points to a Denver Health patient who is now leukemia-free for the first time since his diagnosis. However, Dr. Tejas Patil, who specializes in hematology and thoracic oncology at UCHealth Lung Cancer Clinic and is looking into disparities in lung cancer treatments, admits the research “is going to raise more questions than answers. The solution is going to take multiple stakeholders deciding who deserves access to care.” —Spencer Campbell