Funding the Best

The Borstein family’s gift bolsters Saint John’s Cancer Institute’s melanoma program.

When the Borstein Family Foundation chose to provide a major gift to support melanoma research at Saint John’s Cancer Institute, the decision was based partly upon recognition of the institute’s groundbreaking work in combatting the most aggressive and dangerous form of skin cancer, which causes 7,000 deaths each year in the U.S. Saint John’s “has one of the best-known programs in the world,” explains family patriarch Alan Borstein, who says the family was also attracted to the institute’s efficient scale and lack of excessive bureaucracy, which enables it to move more quickly in its work than some of the larger, university-based medical research centers that the foundation also supports. “Saint John’s is a different story,” Borstein says. “Los Angeles has world-class hospitals, but one of the problems with having that is you’ve got the bureaucracy that unfortunately grows up around major hospitals.

Saint John’s is not overly bureaucratic. That makes for a more direct and personalized experience. ”The new gift is the family’s latest donation in 15 years’ worth of contributions to the institute. But there was also a personal motivation. Alan Borstein says that both he and his wife, Brenda, “have some personal experience, unfortunately, with melanoma.” He shares that in both their cases, the cancer was caught early by their dermatologists and successfully treated. In recognition of the family’s contribution, the Saint John’s research effort has been renamed the Borstein Family Melanoma Program. “The Borstein family has been a loyal and generous friend to Saint John’s for many years,” says Robert O. Klein, president and chief executive officer of the Saint John’s Health Center Foundation. “We applaud the Borsteins for their thorough and thoughtful philanthropy, and we thank them for making it possible for us to do even greater work to mitigate a dangerous disease. ”The Borstein family’s gift will help fund research to explore the spatial immune characterization of tumors, says Maria L. Ascierto, PhD, director of translational immunology at the Saint John’s Cancer Institute. These studies focus on how the environment of the tumor may influence its growth. The research is considered “the next frontier in gaining insight into immunotherapeutic success or failure and will lead to the development of better-informed treatment strategies,” Dr. Ascierto says.

Alan Borstein, a New Jersey native who came to California in the 1960s, is chairman of Borstein Enterprises, a real estate development and investment company. He’s also a founding member of the Center for Real Estate Development at his alma mater, the Massachusetts Institute of Technology. He also serves as a board member of the University of Southern California’s Lusk Center for Real Estate. Borstein and his wife are cofounders of the family’s 20-year-old foundation, whose mission includes supporting the advancement of medical research and care and providing educational opportunities. In addition to gifts to major health institutions such as Cedars-Sinai Medical Center, City of Hope and UCLA-Mattel Children’s Hospital, in recent years the foundation has provided grants to social service organizations such as the Los Angeles Regional Food Bank and the Los Angeles Jewish Home, according to the foundation website.

The Borsteins’ three sons also are involved with the family’s foundation. Eric Borstein is the owner of EB Ventures, a real estate development company. He is also a member of the Saint John’s Health Center Foundation board of trustees. Craig Borstein, a member of the family foundation’s board of trustees, is president of the income properties division at Borstein Enterprises. Loren Borstein, who is also a board member, is president of Borstein Enterprises.

The Borsteins’ approach to philanthropy focuses on carefully choosing institutions where their donations can move the needle the most, Alan Borstein explains. “We have to limit our donations and emphasize being impactful. ”The family saw that sort of opportunity in the melanoma research effort at Saint John’s, which was launched in 1991.

The program’s founder and early leader, the late Donald L. Morton, MD, is renowned for devising a procedure called the sentinel node biopsy, which enabled doctors to determine whether the melanoma has spread beyond the primary tumor into the patient’s lymphatic system. Prior to Dr. Morton’s development of the procedure, surgeons treating melanoma routinely had to remove all of a patient’s lymph nodes as a precaution, explains Richard Essner, MD, director of surgical oncology and codirector of the melanoma and cutaneous oncology research program at the institute. He oversees the research program along with Kim Margolin, MD, who serves as medical director of the melanoma program. But that often became unnecessary.

“A study that was performed at Saint John’s and completed with the help of other research institutions around the world, demonstrated that you don’t have to take out all the secondary lymph nodes—just taking out the node with the cancer is all you need to do,” Dr. Essner says. As a result, sentinel node biopsies have eliminated unnecessary surgeries, reduced patient suffering and, in the process, also saves the nation’s health care system an estimated $3.8 billion each year in costs. The melanoma program has been involved in other advances that have helped improve the survival rate for melanoma, even as the incidence of the disease has risen. “In the last 10 years, we’ve seen significant gains in understanding of the immune system and development of immunotherapy,” Dr. Essner says.

Today about 70% of patients are cured by excision of their tumor. Another 30% see a recurrence. While new treatments have improved their survival rate, about half of the patients with recurrences—15% of the total cases—still ultimately die of the disease, according to Dr. Essner. One of the most frustrating problems for doctors is that once they diagnose patients with melanoma, they can’t predict which patients will relapse, Dr. Essner says. If they had that prognosticative ability, those patients might be targeted for more aggressive treatment from the start. And while immunotherapy has shown benefits for melanoma patients, doctors aren’t yet able to target it as precisely as they would like.

At present, “immunotherapy works by turning off the brakes in your immune system, to allow it to attack the melanoma,” Dr. Essner says. “That explains partly why the drugs are not universally successful, because they only turn off one of the system’s brakes. It may be that there are multiple breaks that need to be shut off so that you can attack the melanoma cancer cells in particular.

”To make matters more complicated, that process may work differently in various individuals. “That’s why some people get a great response—the cancer will disappear, and they’ll do amazing. Other people get no response—you give them the drugs, and nothing happens with their cancers.

Others get a mixed response, in which some tumors grow and others shrink.” It may also be that not all the tumors are the same, he adds. Targeted therapy, in which a drug exploits a genetic mutation that’s found in about half of melanoma cases to turn off cell growth, has also shown some value. “But unfortunately, these drugs are less successful because the cancer cells can learn how to evade it,” Dr. Essner says.

Those are all important research areas where the Borstein Family Melanoma Program might make an important contribution and help even more patients survive the disease. Some of the studies supported by the Borstein funding, for example, may seek to use fragments of genetic material in blood and tissue samples to predict which patients are likely to have their tumors return so they can be given different treatments. Other work may investigate deficits in immune function that make immunotherapy less effective and to try to get a better understanding of how immune cells enter tumors, in order to guide therapy.

Dr. Essner says that the financial impact of the Borstein family’s gift could pay significant dividends well into the future. That’s because some of the money will be used to fund early-stage research and produce results that, in turn, could attract additional backers. “To get grants from the big funding agencies, like the National Institutes of Health and some large foundations, you need to have preliminary data to submit,” Dr. Essner says. “You can have a great idea, but unless you have some data to support it, you’re never going to get funded.

The Borstein family grant allows us to continue to work on some of these seed projects and allows us time to create data that we can use to get this other funding. ”That’s all in keeping with the Borsteins’ objective of helping win the war against melanoma. “You always have a hope of eliminating a disease in one form or another—making the treatment safer and quicker,” Alan Borstein explains. “There’s an awful lot of research to be done.”

“The Borstein family grant allows us to continue to work on some of these seed projects and allows us time to create data that we can use to get this other funding.”