Karlee Steele was diagnosed with an aggressive type of melanoma in 2015. Within weeks of the skin cancer forming, it spread to the lymph nodes under her right arm and looked like it might be deadly.
Doctors in Austin initially "said to me, 'OK, well, here's what you got. Here's what's going on,'" Steele said. "'You're probably not going to lose your hair.' But I was like, 'I don't give a damn about losing my hair. Are you kidding me? I give a damn about losing my life.'"
Steele went to MD Anderson Cancer Center in Houston, where she would undergo surgery to remove the tumor on her lymph nodes. Before treatment, the tumor doubled in size every 10 days. While there, she also got involved with a clinical trial for an immunotherapy drug created by Jim Allison, who leads the immunotherapy program at MD Anderson. He receives funding for his research from the Cancer Prevention and Research Institute of Texas, a state organization that has become an international leader in the field in less than a decade since its creation.
After MD Anderson's aggressive treatment and Allison's drug, Steele has been cancer free for four and a half years, she said.
Next month, Texas voters decide on Proposition 6, a $3 billion bond for CPRIT to continue funding grants and other cancer research initiatives. It would be an extension of the institute's existing $3 billion bond, which voters approved in 2007. That money is expected to run out in 2021.
In the years since opening in 2009, the institute — which was plagued during its first few years by a scandal involving mismanagement and poor oversight of spending — helped create over 100,000 jobs in the state, invested in 1,500 research initiatives and kickstarted 132 clinical drug trials, the organization says. On top of that, the institute has a special focus on cancer prevention, in contrast to the federal government, which primarily focuses on research for treating the disease. Experts credit this focus on prevention, such as grant-funded cancer screenings, with helping lower the state's cancer mortality rate by 8% between 2011 and 2016.
"So advance [CPRIT] 12 years," and the cancer research advancements could be even more revolutionary, Steele said. "If we're not contributing to this $3 billion now, what happens to Texas' [efforts]? We're so large, and we're on the forefront that it's almost like you can't not fund it."
Former State Rep. John Zerwas, R-Richmond, has seen how radically cancer can change someone's life. In less than two years, he lost his wife and both parents to three forms of the disease that 40% of Americans will be diagnosed with in their lifetimes.
So when it came time to consider extending funding for CPRIT, it wasn't even a question for him to spearhead the efforts.
"I may not have been touched [by cancer] a whole lot prior to that time, but I certainly had a full dose in 2012 and 2013," said Zerwas, who left his seat three weeks ago for a job at the University of Texas System. "The everyday person, if they haven't been touched yet by it, somehow in their circle of family and friends will be touched by it."
There are more than 100 types of cancer, each requiring unique treatments.
Allison, who was brought to MD Anderson from Memorial Sloan Kettering Cancer Center in New York in 2012 in part by a $10 million grant from CPRIT, won the 2018 Nobel prize for physiology and medicine. He won the award for creating a drug that enhances the immune system's ability to fight cancer on its own. It was the same treatment that saved Steele's life.
Allison said the CPRIT funding meant he no longer had to worry about battling for highly competitive grants from the National Institutes of Health.
"Having lived in Texas for a long time and turned to Texas Legislature over these decades, I was surprised that they would pass such a thing, to be honest," Allison said. The stability CPRIT brought also made progressing his work much easier. Federal grants "are fiercely competitive, so it just makes it very difficult to to take on a project that would take more than the cycle of a grant, which is usually three years or something. That really keeps you from taking the long view on" research, he said.
However, in a state that prides itself on having a balanced budget, taking on billions in debt through bonds isn't something that usually attracts a lot of support from Texas Republicans, Zerwas acknowledged. He said CPRIT 12 years ago represented the state's desire to take bold steps in promoting business, science and technology.
The resolution that created CPRIT's latest bond request passed unanimously in the Senate and sailed through the House, 132-14, with two present, not voting. Its few critics primarily expressed concerns over the mismanagement and improper spending scandal that dogged the agency in 2013, leading to the resignations of several executives. One of them was also indicted but later acquitted.
"While well-intentioned, CPRIT has not been a good steward of taxpayer dollars and cancer research is not a core function of government," the hardline conservative group Empower Texans wrote in its voter guide for the constitutional election.
But Zerwas said changes to the executive team of CPRIT, including the hiring of CEO Wayne Roberts, have resulted in better management and improved vetting of grant proposals since the scandal.
"When you're dealing with the size of these grants and distributions and it being public money and, in fact, money that you're issuing debt, you can't be too careful about that," Zerwas said. "They went through that, and they've emerged even stronger."
Medical research can be a lucrative area that leads many research institutes to be self-sufficient, but Zerwas, an anesthesiologist, said CPRIT's focus on doing base-level research, which is necessary but often not as profitable, means it needs occasional state support to stay on the leading edge.
Roberts said the agency, if Proposition 6 passes, is looking at spending the next 10 years expanding its areas of focus, including looking into childhood cancers — which are rare, making drugs for them incredibly expensive to research and produce — as well as Texas-focused issues like the state's high incidence of liver cancer.
"If we don't get it, we run out of money," Roberts said. But he added, "If we're fortunate enough to be reauthorized on Nov. 5, we will be taking a very deep dive at this point in time and delving into those and other opportunities."
CPRIT, as a state agency, cannot advocate during the upcoming election. Roberts said he worried about low turnout being something that could kill the proposition, but a recent poll suggests widespread support for the ballot measure, and the American Cancer Society Cancer Action Network said it is working to promote grassroots efforts in support of CPRIT, too.
"The first 10 years was — it was a jumpstart," Zerwas said. "It demonstrated that if we invest money and we bring the brightest minds to the state of Texas and we immerse them in the culture that we have in terms of treatment of cancer ... we're going to make some discoveries, and we're going to find some cures and treatments for some of these very elusive diseases out there."
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Disclosure: MD Anderson Cancer Center, the University of Texas System and the American Cancer Society Cancer Action Network have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.
Correction: An earlier version of this story misstated the surname of Wayne Roberts. This story was also updated to provide more clarity on Karlee Steele's surgery.