Dr. Luke Nordquist opened a medical clinic in west Omaha dedicated mainly to prostate cancer about three years ago as a slew of new drugs emerged to fight the disease.
Today, Nordquist sees 300 patients a month, most with prostate cancer, the leading cancer among men.
His Urology Cancer Center is rare in its focus and in its commitment to test and use the latest drugs that have been approved or are being investigated through clinical trials. Besides Nordquist's clinic, a California oncologist who has a prostate cancer clinic could name only one other private, community-based clinic that deals strictly with that disease, and it's in Virginia.
It's unusual for an oncologist to focus on one form of cancer, especially a specialist outside academic medical centers. But one expert called it a positive step because 80 percent of cancer patients receive their care from community providers.
“I feel like a fish going against the stream here,” said Nordquist, whose Urology Cancer Center is near 176th Street and West Center Road.
Nordquist considers prostate cancer's threat to be underestimated. Although many cases are cured by surgery, radiation or other therapies, prostate cancer is still the second-leading cause of death among cancers in men, killing close to 30,000 a year, the American Cancer Society reported in 2013. About 240,000 new cases are reported each year.
Prostate cancer is widely perceived as an old man's disease, but Nordquist said 20 percent of his patients are 40 to 60 years of age. Many of them have prostate cancer that has advanced into the bones or elsewhere in the body, which at one time was a death sentence. Today's new drugs and drug combinations may not cure patients, Nordquist said, but they may add years of quality life.
Dr. Mark Scholz, the California oncologist who specializes in prostate cancer, agreed that many people don't respect prostate cancer's might. “It's sort of the neglected disease, even though it's the most common cancer in men,” he said.
Ken Reinke of Columbus, Neb., was diagnosed with prostate cancer in April 2012, then learned that it had advanced to his bladder and bones. He underwent bladder surgery shortly after that.
Reinke, 43, and his wife had just had a baby boy in January 2012, and the discovery of cancer rocked them.
“It was kind of shocking,” said Reinke, a production coordinator at a manufacturing plant, “but I've always been a pretty positive person.”
Reinke saw Nordquist at the encouragement of his urologist. “There's a lot of research he's involved in,” Reinke said. Reinke currently is on Provenge, a drug that is given three times intravenously, and Xtandi, capsules that block testosterone, the fuel for prostate cancer.
So far, Reinke said, he appears to be doing OK and continues to work at his job.
Nordquist has patients involved in, or is recruiting patients for, more than 25 studies. Most of those studies are prostate cancer trials and most are funded by pharmaceutical companies. The companies provide the drugs to the patients at no charge and compensate Nordquist for enrolling patients and generating data. Even after FDA approval is given for some drugs, patients may continue to receive the drugs for free for follow-up purposes.
Nordquist isn't the only cancer specialist doing clinical studies, and academic medical centers, such as the University of Nebraska Medical Center and Creighton University, typically engage in trials. UNMC is involved in about 20 clinical trials involving the organs in which Nordquist specializes (some of his patients have kidney, bladder or testicular cancers), Creighton about seven.
Nordquist said he is set up to enroll patients in clinical trials and can do so with little delay. He employs about 10 staff members to work on the research, generating data, doing quality control and performing other tasks.
Nordquist said pharmaceutical companies have developed excellent medications over the past 10 years to stimulate immune systems, block testosterone or target cancerous areas. Some of these are game-changers, such as a new injection called Xofigo that sends radiation right to cancer tumors in the bones.
He said that as of late 2013, he had more patients on Xofigo than any other clinic in the world. Bayer HealthCare Pharmaceuticals, which markets Xofigo, declined to comment. But other drug companies said Nordquist has been among the leaders in the country in enrolling patients in studies involving their products.
Dendreon Corp. reported two years ago that Nordquist and a doctor in Nevada had enrolled more patients in a Provenge study than any other cancer specialist in the nation. Tokai Pharmaceuticals said Nordquist is the third-leading enroller of patients in trials of another prostate cancer drug, galeterone.
The American Society of Clinical Oncologists last year named Nordquist's clinic one of seven recipients of its Clinical Trials Participation Awards. Dr. Richard Schilsky, chief medical officer of the society, said providers submit applications, and the awards go to clinics that conduct quality research and enroll many patients.
Schilsky said most medical oncologists treat many kinds of cancer, such as breast, lung, colon and prostate cancer.
It's important that community providers such as Nordquist engage in trials, he said, so patients have access to new drugs and so that new treatments can be tested and advanced.
Nordquist said most of his patients are referred to him by urologists. One of those, Dr. Jon Morton of the Urology Center in Omaha, spends about one day a week in Nordquist's clinic working on cases with Nordquist. They are ”continuing to make baby steps” against cancer, Morton said.
Michael Simmonds, a 66-year-old Omaha businessman who has downsized a chain that once totaled more than 80 restaurants, has battled kidney cancer for 11 years. He has had surgeries, drugs and other therapies.
“Yes, it's obscenely expensive,” he said.
His cancer has spread to his spine, brain, liver and other spots. He's fighting for his life. So, he said, “You try stuff.”
He began seeing Nordquist three or four years ago, Simmonds said, because “he's aggressive, willing to try things outside the box to keep people alive.”
Nevertheless, Simmonds said the cost of drugs such as Provenge, a total of more than $90,000 for three infusions of the drug, is outlandish. This is especially true, Simmonds said, when initial studies found the drug to have a median survival benefit of only about four additional months. The FDA approved the drug in 2010.
Nordquist said four months is hardly an accurate reflection of what Provenge can do. The Provenge trial in many cases involved men at the very end of the line, who had failed previous treatments, he said. When used for healthier patients, Nordquist said, the survival benefit is far better.
Nordquist hailed tremendous progress through the drugs with which he works. “The downside is that they're usually much more expensive,” he acknowledged.
Nordquist, 44, said a family friend played a role in influencing his career choice. Nordquist's father had a wrecker service in Beresford, S.D., and helped a man named Dr. Wallace Graham when he had car trouble in the vicinity. Graham had been President Truman's physician and was living in the Kansas City area. Graham became friends with the Nordquists and Luke began considering medicine.
Luke Nordquist obtained bachelor's, pharmacy and medical degrees at Creighton. He did a cancer fellowship at Memorial Sloan-Kettering Cancer Center in New York.
He practiced at Nebraska Cancer Specialists in Omaha before breaking away to start his own clinic, spending about $4 million, he said, to buy and renovate the space once occupied by a restaurant. His clinic includes photographs of Nordquist on a bicycle, Nordquist with New York Yankees Joe Torre and Yogi Berra, and a photo of Dr. Wallace Graham.
His younger brother, Jeremy, is a state senator who represents an Omaha district.
Ken Robus, 70, of southeast Iowa, was diagnosed with prostate cancer that had moved into his bones about eight years ago. A University of Iowa physician eventually referred Robus to Nordquist because the Omaha cancer specialist had a certain drug in a trial. The drug, now called Zytiga, which shuts down testosterone, was approved by the FDA in 2011.
Robus, a retired farmer, said he has had good results with Zytiga and is “feeling good.” His wife, Pam, said: “We really feel that if he hadn't gotten on the experimental drug, he might not be here or he might not be in as good of shape.”
Last fall, Nordquist's office celebrated with Robus. He had been on Zytiga 50 months. Nordquist's staff gave Robus a trophy.