2000s Translational bench-to-bedside research continues to be the hallmark of our Cancer Center. Breakthroughs in research and clinical care is facilitated by two new Cancer Research buildings, and our Center is renamed in honor of philanthropist Sidney Kimmel.

In 2008, William G. Nelson, M.D., Ph.D., became the third and current director of the Kimmel Cancer Center.

He has overseen significant expansions in the physical footprint of the Kimmel Cancer Center, moving most cancer care to the outpatient setting and opening satellite locations throughout the National Capital Region. The expansions included the addition of the Skip Viragh Outpatient Cancer Building, the Kimmel Cancer Center at Sibley Memorial Hospital in Washington, D.C., the Johns Hopkins Proton Therapy Center, and the Kimmel Cancer Center at Johns Hopkins Bayview Medical Center. He also added cancer services at Johns Hopkins Health Care & Surgery Center — Green Spring Station in Baltimore County and at Suburban Hospital in Montgomery County.

The treatment of cancer as an outpatient would have been unthinkable when our Center opened its doors in 1977. It is a testament to the progress that has been made over the last 50 years.

“In the future, as cancer evolves further into a disease managed through drug and outpatient treatments, I expect the Center’s expanded locations to provide convenient, local treatment instead of requiring people to visit central locations,” says Nelson.

The number of people who work for the growing Kimmel Cancer Center and who come to us for treatment has also greatly increased. Today, the Center has 285 full-time faculty, 349 nurses and more than 500 support staff members. There are more than 90,000 patient visits and 9,000 new patients seen across all Kimmel Cancer Center locations in a year.

Nelson also broadened and restructured clinical services and research programs. The Skip Viragh Center for Pancreas Cancer Clinical Research and Patient Care, the Ludwig Center, the Lung Cancer Center of Excellence, the Colorectal Cancer Patient Care and Research Center of Excellence, two Precision Medicine Centers of Excellence, one for prostate cancer and another for pancreatic cancer, the Greenberg Bladder Cancer Institute, the Bloomberg~Kimmel Institute for Cancer Immunotherapy, and the Convergence Institute opened. To address higher death rates among minorities and other underserved populations in Maryland, he established the Community Outreach and Engagement and Diversity and Inclusion in Clinical Research programs.

With emerging discoveries in genetics, epigenetics and immunotherapy showing that cancer cell growth and behavior was less about where it occurred in the body and more about the instruction manual that is contained within cancer and surrounding cells, Nelson reorganized Kimmel Cancer Center research programs to enhance the understanding of how cancer develops, grows and spreads.

He integrated studies of specific cancer types into existing programs in cancer genetics and epigenetics, cancer immunology, new drug and drug target development, cancer prevention and control, cancer imaging at the molecular and functional level of cancer cells, and blood cancers and bone marrow transplant. He also added a new program to research cancer invasion and metastasis, aimed at better understanding the leading cause of cancer deaths — the lethal spread of cancer from the place in the body it originated to other tissues and organs.

The restructuring deepened the understanding of the basic biology of cancer within the context of translational — bench-to-bedside — research to develop better prevention, detection and treatment strategies.

“The hope, the ultimate goal, is that we’re going to eradicate the ability of cancer to threaten your life and its quality, and ensure that treatment isn’t a drag on your life and happiness,” says Nelson.

He incorporated the multidisciplinary model — commonly referred to at the Kimmel Cancer Center as the multi-D clinics — into the treatment of all cancer types. The multi-D clinics, pioneered first in prostate cancer and pancreatic cancer, bring together all of the experts involved in treating a patient with cancer to develop the best treatment plan.

“What people need when they hear the words ‘I think you have cancer,’ is an answer and a plan,” says Nelson. “The multidisciplinary clinics bring together surgeons, medical oncologists, pathologists, radiation oncologists, nurses — any specialist involved in the treatment of a specific cancer — all working together to the benefit of the patient.”

With the shift of most cancer care to the outpatient setting and more cancer therapies coming in pill form, Nelson also proposed a new paradigm for drug discovery to address the high rate of cancer drug failure. To illustrate the problem, he explained that in 2008 alone, the year he became director, there were 750 cancer drugs in clinical trials, with less than 5% of them ever ultimately performing well enough to get approved for cancer treatment.

“Pharmaceutical companies estimate it costs them about $1 billion to discover, develop and get a cancer drug FDA approved. These costs are passed on to people with the disease in the form of high costs for treatments. I believed our Cancer Center could be a part of the solution. We have the drug discovery engine that could help pick the winners from the losers before large sums of money are spent, and we did it,” says Nelson. “Kimmel Cancer Center research led to the first FDA approval of a drug across all cancer types based on a specific biomarker that our researchers discovered and then later determined could pinpoint pretty successfully who would respond to a type of immunotherapy drug. We will continue to look for these kinds of opportunities.”

Inspired by his own experience at Johns Hopkins, Nelson also gathered together the entire brain trust of Johns Hopkins in the fight against cancer. He refers to himself as “homegrown,” as he went to medical school and graduate school at Johns Hopkins and completed his residency and fellowship here. 

“I have never delivered any health care of any kind as anything other than a Johns Hopkins physician,” he said. “By being around the institution for so long, I’ve ended up a professor in six departments, and this helps me bring people together across Johns Hopkins. It gave me a good sense of how great we can be when we work together across departments.”

Today, under his leadership, the Kimmel Cancer Center spans 35 Johns Hopkins departments and five schools.

The Kimmel Cancer Center represents a broad number of disciplines, with cellular biology, structural biology and DNA research playing roles alongside engineering and computer sciences. Researchers are working to understand how proteins that disrupt cancers can be tucked into drugs and to apply artificial intelligence (AI) tools toward managing cancer gene data — which can number in the billions — speeding research and discoveries, he says.

Nelson also ushered in the era of precision medicine, tailoring research, screening, detection and new therapies to what has been revealed about the unique molecular and cellular characteristics of cancers.

“Our research showed that people carry genetic vulnerabilities that they inherit from their parents, and about 15% of all cancers occur in people who seem to have these genetic predispositions. It doesn’t mean they’re fated to get cancer, just that they are more susceptible to getting a cancer. What is newer are tests for some of these genes that predict increased risk for cancer among the general populations so that we can use early detection and screening strategies to intervene and diagnose people at the very earliest stage,” says Nelson.

This means, he says, that our experts can determine who is not as likely to develop cancer and economize our use of screening tests. In terms of therapy, gene alterations and cancers may predict which treatments will be successful and which will not.

With precision medicine, Nelson set a new direction for the Kimmel Cancer Center, moving it away from a model in which patients are seen for the first time when they experience symptoms and toward one that detects, manages and many times eradicates cancers before patients even know they have them. This new model, he says, preserves health by preventing cancers very accurately, predicting who will get them, and personalizing screening and therapy to each individual.

“We are beginning to use our scientific discoveries to determine which treatments and screening interventions will work best for each patient, and just as important, we are using this knowledge to spare patients the risk and adverse effects of treatment and procedures that will not work,” says Nelson. 

In many ways, the accomplishments and direction of his leadership to date have been guided by his overarching goal to use science to improve the benefits of cancer therapy and reduce its ill effects by “getting the right treatments to the right patients at the right time.” This iconic phrase for which Nelson has become known is at the heart of precision (individualized) medicine.

“Over the next decades, the discoveries and developments in treatments will be enhanced by the vast influx of AI-influenced data that will help Kimmel Cancer Center physicians and researchers further tailor treatments on the individual level,” he says.

With this long list of accomplishments, it’s hard to imagine that Nelson had not set out to become a doctor. He was a soccer standout and chemistry major at Yale University, and planned to study law. A summer job in the laboratory of a cell biologist looking for molecular biomarkers of a rare skin disorder called ichthyosis changed his mind. 

“There were clinical trials of some new drugs, and I was in contact with many of the participants. I was struck by how well they understood their disease and their reason for joining the trial. They knew it was an experimental therapy that may not help them, but could help others. That’s when I decided I wanted to be a physician,” says Nelson.

For most of his career, his research and clinical interests have been focused on prostate cancer.

“When I started in oncology, men were commonly diagnosed at an advanced stage. We had some limited success with treatments, but death rates were far too high,” says Nelson. “Since that time, we’ve gotten PSA (prostate specific antigen), a blood test that made it possible to diagnose men far earlier, so they could benefit from surgery and radiation. We’ve also developed new treatments. That allowed us to cut prostate cancer death rates almost in half over the last 30 years.”

He’d like to see similar progress made against all cancers, and he believes the Kimmel Cancer Center has the talent to make that goal a reality.

“This place is special,” says Nelson. “I’ve been a researcher trying to invent new treatments and take them into the clinic. I’ve been a clinician working directly with people with cancer. I understand the promise and limitations before us, and I think the time is right to really take some major shots that can transform the cancer problem.”

Once of those “shots,” he says, has to be in cancer prevention.

“There are about 1.4 million new cases of cancer each year, and this number is expected to increase as our population ages. Cancer is a major health concern, not just in the United States but worldwide. I believe we can prevent people from having some of these devastating diseases,” says Nelson. “When we look at screening and early detection that we already do — Pap smear, mammography, colonoscopy, PSA — their use leads to improvements in survival and treatments that are far less deforming and have fewer side effects.”

Nelson is also optimistic about laboratory discoveries in prevention that he believes may be able to both stop a cancer from developing and treat cancer. He has stewarded efforts to address behaviors and other underlying causes of cancer, such as chronic inflammation and infection, and directed research and resources to help minorities and other underserved populations that suffer disproportionately higher rates of cancer deaths. Part of this effort includes increasing minority participation in clinical trials.

Building upon the accomplishments of his predecessors, Nelson says the Kimmel Cancer Center remains true to its founding as a place that uses science to improve the care of patients. The labs are no longer physically adjacent to patient rooms, but they remain adjacent in spirit and practice, and this translational research remains at the core of the Kimmel Cancer Center.

“I believe nearly every challenge facing the field of cancer medicine can be solved through translational research,” says Nelson.

This expertise in translational research is what makes the Kimmel Cancer Center so special, he says, adding that he wouldn’t want to be a director at any other cancer center.

“The major difference at a place like the Kimmel Cancer Center is that the state of the art is just the starting point of what we can offer. That kind of treatment opportunity — the latest, plus some — is what we have and always will deliver,” says Nelson. “There is so much we have accomplished here already, but I believe there is much more we can do. This is a great place to be, and the right time to be here. We have tremendous opportunities.”