What’s the best way to spend $2 billion?
That’s the pleasant problem facing oncology expert Brian Druker, M.D., as he stewards what is thought to be the largest donation ever made to an educational institute. The massive sum has been gifted to the Knight Cancer Institute (KCI) at Oregon Health & Science University (OSHU) from Nike co-founder Phil Knight and his wife Penny.
“It’s a breathtaking number,” Druker told Fierce Biotech at his KCI office in Portland, featuring a view of the Tilikum Crossing Bridge spanning the Willamette River.
The immense donation, announced Aug. 14, will fuel a steady cash flow over the next 10 years, with about $200 million to be paid out each year depending on the KCI’s needs, Druker explained.
As the KCI’s leader, Druker’s laundry list of priorities for the new funding includes building a new outpatient facility, supporting world-class cancer research, and hiring new faculty and clinical support staff.
The ultimate goal, in short, is to give cancer patients the best possible care with the latest cutting-edge treatments, Druker said—and for the KCI to ascend as the country’s premier cancer center.
But when it comes to securing such an eye-popping gift, and then spending it effectively, the devil is in the details. And as Druker will readily admit, this $2 billion windfall almost didn’t come through at all. First, big changes had to be made to the structure of the KCI itself.
Independence day
Druker joined OHSU in 1993 and became cancer research royalty just several years later with his studies of imatinib in chronic myelogenous leukemia (CML). The targeted small molecule was approved by the FDA for CML in 2001 as Novartis’ Gleevec and is now included on the World Health Organization’s "List of Essential Medicines."
Druker became director of the KCI—then called the OHSU Cancer Institute—in 2007, right before Phil and Penny Knight donated their first gift in 2008.
“He gave us $100 million at the depths of the recession,” Druker said, recalling instructions to go out and “bring talent to Oregon.”
The Knights followed up with a $500 million challenge grant announced in 2013, which OHSU successfully matched in 2015 to bring in a total of $1 billion.
But when discussions began over a year ago for an even bigger gift, one that would eclipse all the Knights’ previous philanthropy, Druker himself told the billionaires that he wasn’t sure OHSU was the best place for their money anymore.
The university bureaucracy had become stifling, Druker said, and OHSU has struggled with financial losses, layoffs and low faculty morale in recent years.
Druker highlighted the KCI’s lack of control over its own hiring as a particularly vexing concern. He recalled coaxing a talented computational biologist from Harvard to join the KCI’s faculty, only for the OHSU administrators to offer a salary that was 25% what Harvard paid him.
“He was gracious and wrote back and said, ‘Is this a mistake?‘ instead of what he probably was thinking," Druker said.
“Those are the sorts of bureaucratic hurdles I was dealing with,” Druker added. “If we're going to recruit the best and brightest in talent, we need to be able to set a competitive pay scale, instead of sending it over the wall to an HR group that doesn't understand what the going rates for computational scientists are.”
Things became so bad that Druker actually stepped down as the KCI’s director in December 2024, telling staff that the organization had “lost sight of what is crucial and forgotten our mission.” He remained at the KCI as an investigator running his lab and seeing patients and also maintained his close relationship with the Knights despite no longer running the institute.
When OHSU appointed Shereef Elnahal, M.D., former U.S. undersecretary for health at the Department of Veterans Affairs, as the organization's new president in June, Druker began to revisit the idea of a new Knight gift—if the KCI could be given more freedom alongside it. Druker had previously considered turning the KCI into a self-governing entity, he said, and now the time seemed right to make the leap.
With $2 billion from the Knights in hand, the KCI will have its own board of directors, while still being nestled within OHSU. Druker is back as president of the new-look institute, which he says will now be able to make its own decisions on critical issues like hiring.
“Aligning authority with responsibility was essential for a gift this size,” Druker said.
It's essential that the center has some autonomy while still maintaining ties with OHSU and its hospitals, support staff and medical school, Druker explained, adding that OHSU will also be represented on the KCI’s board.
It may seem surprising that Druker originally discouraged the Knights from giving his institute more money, but he thinks his candor ultimately increased his credibility in their eyes. After all, Phil Knight—founder of the world’s largest athletic apparel company and former track star for the University of Oregon—has a bit of a competitive streak and wouldn’t want to invest money into an organization that is ill-equipped to deploy it.
In fact, Nike’s influence runs throughout the KCI; the building’s layout takes inspiration from the company’s corporate campus, and the institute’s short but snappy motto “Give Cancer Hell” holds a familiar to-the-point inspiration as seen in Nike's "Just Do It."
But to compete with iconic cancer centers like MD Anderson in Houston, Dana-Farber in Boston and Memorial Sloan Kettering in New York City, catchy slogans aren’t enough. When it comes to research and care, Druker already has ideas for how the KCI can use $2 billion to break the mold.
Shattering the illusion
On OHSU’s main campus, there’s a bench featuring a version of historian Daniel Boorstin's famous quote: “The obstacle to discovery is the illusion of knowledge.” In recruiting new faculty, Druker wants to prioritize scientists who are never satisfied with the status quo.
“I want somebody who's always curious,” he said. “‘Is there something better out there? Is there something that I'm missing, or something else we could be doing?‘”
Druker sees the KCI as a leader in three key areas of oncology, focuses he wants to triple down on with the help of the Knights’ new gift.
The first is the same field in which he originally made a name for himself: precision oncology.
Targeted therapies have now gone beyond homing in on a specific cancer feature, Druker explained, but have expanded to consider the microenvironment the tumor lives within inside the body.
“If you sequence a patient's cancer, that gives you about 15% of the data,” Druker said. With new insights into gene expression, protein levels, immune response and more, “we're getting maybe to 50% of the data.”
A key focus of the KCI will be unlocking the remaining 50% of missing data through basic research on different cancer types, along with making sure that the knowledge scientists generate is properly used in patient care.
Another priority is early detection of cancer, which Druker attributes to Gleevec’s success.
“For 25 years, I've given talks about imatinib, and I said there were two things that were important about it. No. 1, we matched the right patient with the right drug,” Druker said. Second, “We treated early in the course of the disease.”
The KCI is home to an initiative called the Cancer Early Detection Advanced Research Center, or CEDAR, which the organization “will continue to support and thrive,” Druker said.
The third pillar of the KCI’s research renaissance builds from early detection to early interception: recognizing when a patient is at elevated risk of developing cancer and administering treatments to lower that risk before the disease ever develops. Druker compared this work to the prevention of heart attacks with statins, or the use of Pap smears to identify precancerous cells in the cervix.
With enough research advances, Druker believes doctors may one day understand what external factors—like smoking—are doing in the body to promote cancer and how to treat those effects to lower risk.
“We know after 20 years, the risk of lung cancer is close to normal” once someone stops smoking, Druker said. “What if I could do that in five years?”
While such advances may be far off, Druker envisions that the $2 billion gift will help fertilize a research ecosystem at the KCI that fruits new innovations for generations to come.
When he speaks to younger researchers, Druker tells them they need to “finish the job we started.”
“‘I'm going to be gone, but you need to finish it,‘” he said. “And if we can bring those people here and help them get to that next level, that would be amazing.”
Bringing it home
New cancer treatments developed by KCI scientists will be just one component of a pioneering care model that the institute is launching, Druker explained. Some of the Knights’ gift will go toward hiring social workers, financial advisors and other staff who will help patients deal with all the other ways a cancer diagnosis can upend life.
“If we provide those services and match the best treatments with the best support, we're going to get the best outcomes,” Druker said.
But in order for the KCI’s experimental therapies to reach a broader patient pool, they will need to be translated into commercial products. Here, the importance of the KCI’s continued relationship with OHSU really shines.
“Our new president, Dr. Elnahal, has made intellectual property and spinouts and getting things commercialized from our research a top priority,” Druker said. “We want to make sure that the research that we do here gets patented and commercialized and becomes potential opportunities for startups, either here or elsewhere.”
Should those startups stay local, the Knights’ gift will strengthen Portland’s place in the biotech world, Liisa Bozinovic, executive director of the Oregon Bioscience Association, told Fierce.
“A gift like that really positions OHSU as a national leader in cancer research,” Bozinovic said. “In doing that, it just naturally strengthens Portland's role in the bioscience space.”
And, while it’s easy to contrast such a large private donation—bigger even than Michael Bloomberg’s $1.8 billion gift to Johns Hopkins University in 2018—with the current crisis of federal research funding being slashed, Druker notes that philanthropy will never be able to replace the collective funding power of taxpayers. At around $48 billion, the annual budget of the National Institutes of Health alone is 24 times that of the KCI’s record-breaking gift, which will be paid out over a decade.
“I do hope that Phil and Penny's generosity has inspired other philanthropists, but I don't see that as a replacement for the federal government's investment in making this the envy of the world for biomedical research,” Druker said.
“What Phil Knight said when he announced the $500 million challenge was, let's keep the miracles coming,” Druker added. “We need that to be an investment from both the federal government and from philanthropy.”