As New Leaders Rise at SCRI, the Mission Remains: Bringing Clinical Trials Where Patients Live

As he sits down for a conversation, David R. Spigel, MD, is surrounded by blank walls that might suggest his recent arrival. But although Spigel has just taken the helm as president and chief medical officer of Sarah Cannon Research Institute (SCRI), he is hardly a stranger.

Spigel arrived in 2003, a decade after the cancer center first opened in Nashville, Tennessee, a year before a partnership with HCA Healthcare launched the modern SCRI, and some 6 years after Howard A. “Skip” Burris III, MD, started a one-of-a-kind drug development program.^1,2 These early steps laid the groundwork for a research organization that has conducted more than 850 first-in-human trials, including those that have led to FDA approval of most cancer drugs over the past decade.³

With Burris’ retirement in December 2025 (see related article), Spigel and other longtime physician leaders at SCRI assumed new roles in January 2026:

Melissa L. Johnson, MD, is now chief scientific officer while retaining leadership of lung cancer research, and Erika P. Hamilton, MD, is now chief development officer, late phase, while remaining the lead in breast cancer research. Vivek Subbiah, MD, who joined SCRI in October 2022, will continue as chief of early phase drug development.¹

In separate interviews with The American Journal of Managed Care® (AJMC®), Spigel, Hamilton, and Johnson described how the excitement in cancer research and changes in the oncology ecosystem make SCRI’s work more important than ever, as it ensures clinical trial access for patients no matter where they live.

The science is abundant. Johnson described a recent meeting with Hans Lee, MD, who in the past year became SCRI’s director of myeloma research, and learning the connections between the amazing strides in that blood cancer and what is happening in her own lab. Hamilton shared how genomic platform technology available for every trial site allows a nurse, “with a touch of a button,” to ask which patients have a PI3K alteration—and thus could be eligible to take part in a trial for a new PI3K inhibitor.

“To me, it’s the most exciting time—not because of my position, but in cancer research, we’ve had great progress,” said Spigel, who previously served as chief scientific officer. He has witnessed leaps in the understanding of genomics in oncology, a revolution in the use of targeted therapies over the past 15 years, and a similar one over the past decade with immunotherapy.
Spigel discussed what has happened with KRAS inhibition as an example: a target once considered “undruggable” now has 2 approved KRAS G12C inhibitors in non–small cell lung cancer and colorectal cancer.^4,5 Last year, the American Association for Cancer Research meeting highlighted progress with RAS(ON) therapies, which address challenges of resistance.⁶ Virginia Cancer Specialists, part of The US Oncology Network, will enroll patients in a phase 3 trial for one of these therapies, daraxonrasib (Revolution Medicines), at the community level.⁷

“In the next year,” Spigel said, “we expect to have therapies for pancreatic cancer and for colorectal cancer that target RAS(ON)—that’s groundbreaking. We’ve never had anything like that in pancreatic cancer.”

Community Access as the Core Mission

Spigel’s example highlights SCRI’s central mission: bringing state-of-the-art trials that were once only available in academic centers to community practices, so patients can access them without driving long distances.

Founded in 1993 as a “bridge” between academic and community practice,⁸ SCRI takes its name from Sarah Cannon, a patient with breast cancer who was better known to Nashville’s Grand Ole Opry fans by her stage name, Minnie Pearl. Cannon had been successfully treated for breast cancer in the 1980s and allowed her name to be used for the new center before her death in 1996.⁹

The idea of bringing trials to where patients are is popular today. But Burris challenged the status quo when he opened the first phase 1 drug development program outside an academic center in 1997. “While there are many more programs now,” he told OncLive® in 2015, “it was exciting to be a part of the team that stepped out to show that phase 1 research could be done if you had the right support system in place.”¹⁰

Today, through its contract research organization, SCRI reaches 1300 physicians and more than 3400 patients in clinical trials each year, all in community settings instead of academic centers.³ Its reach expanded in 2022 when it formed a strategic partnership with McKesson and The US Oncology Network, a move that created ties with large community practices such as Texas Oncology and Rocky Mountain Cancer Centers.¹¹

Bringing clinical trials into the community is what drew Johnson to SCRI 11 years ago.

“I remember thinking that in order to be a good clinical investigator, I needed to work at a place where the work was fast paced enough and the volume was high enough that I would gain a skill set in a relatively short time period,” she said. “But the truth is the majority of patients in the US are treated at community centers,” with the National Cancer Institute putting the percentage as high as 80%.¹²

“I understand where that desire comes from. It helps patients to be cared for by their loved ones. It helps them go home and sleep in their own bed at night…and not spend money that they don’t have,” Johnson continued. “It’s just being realistic and meeting patients where they are, which as health care providers we try to do all the time.”

Yet access to trials remains a challenge in the United States, Hamilton said. There are large areas of the country with no clinical trial access within a 50-mile radius. “We certainly could get into a debate of whether driving 50 miles for a clinical trial is even doable for the average American,” she said. “Our goal at Sarah Cannon is to have clinical trials—the latest cancer options—for patients in the communities where they live.

“We know that we can bring high-quality clinical trials,” she continued. “We’ve shown this historically, year over year, without sacrificing rigor or safety, and we know that disparities occur when the latest options are only offered in select cities and academic centers.”

Spigel, Johnson, and Hamilton say bringing clinical trials to community practices achieves several things: It boosts enrollment. It opens trials up to patients of more varied socioeconomic strata. It allows patients to stay near support systems, increasing their odds of sticking with the study.

Adapting Trials to Real-World Practice
Bringing trials into the community may mean having conversations with pharmaceutical sponsors about doing things differently, Johnson said. Offering centralized support helps, too. Last year, SCRI and McKesson launched Clinical Trial Central Screener as a resource to practices across The US Oncology Network; this service provides research nurses and clinical trial coordinators and uses McKesson’s Genospace precision medicine technology, acquired in 2022 from SCRI, to integrate genomic data into the trial selection process.¹³

Johnson said other centralized services can create trial opportunities, such as STAR (Selected Trials for Accelerated Rollout). This protocol for very rare mutations permits a trial site to be opened within 2 weeks if a patient with a specific mutation under study is identified.¹⁴

“That’s a good example of what we need more of—just-in-time opportunities,” Johnson said. The administrative burden does not fall on the small site, which would lack the staff to handle it alone. With rare mutations, she said, “we never know where we are going to find them, so we have to be agile, to be able to open a trial quickly.”

Similarly, pharmaceutical companies might be asked to adjust protocols for blood work when dealing with small sites that are only open 8 hours a day.

Many factors go into deciding which trials will be offered, and one of Johnson’s tasks will be developing those site-specific research priorities. “Once we know the doctors who work at different sites, we can assess capabilities for research. And what is possible in a small practice may be more than what’s possible in a big practice that’s very spread out, where patients have to commute a great distance,” she said.

Accelerating Innovation Through Technology
Technology plays a big role in allowing SCRI to provide support to community practices, starting with Accelero, its clinical trial operations model.¹⁵ Hamilton has a lead role ensuring Accelero’s reach helps site partners streamline each phase of the trial life cycle, from site activation to data collection.

Both Hamilton and Spigel highlighted Accelero’s role in making higher-performing drug development sites more efficient by automating data flows and speeding the process of getting answers to trial sponsors. “Our goal was to tackle some of the core challenges that all our sites experience with clinical trials, with manual data burdens, by standardizing some of these workflows,” Hamilton said.

The process features “EMR to EDC” transfer, meaning clinical trial data flows directly from the patient’s electronic medical record (EMR) to the trial’s electronic data capture (EDC) system—trimming timelines, eliminating errors, and reducing the need for additional staff at the community practice.

“Labs and vital signs are automatically going from the EMR into the EDC, so site staff doesn’t have to manually put that in,” Hamilton said; thus, staff members are free for other tasks.

What about the impact of artificial intelligence (AI)?

“AI is this big box that can mean a lot of different things,” Hamilton said. “And to be quite honest, it’s a little bit scary.” She described how today’s physicians see it all—from patients who ask ChatGPT for medical advice to AI-driven tools that offer the possibility of support, both in practice and in research.

“AI can help make trials more efficient and more representative by improving site selection, by identifying eligible patients earlier, by streamlining data collection and reducing administrative burden,” Hamilton said. “When applied thoughtfully, technology really can help trials run closer to the way care is actually delivered. That’s really important—the goal of technology isn’t for technology’s sake. It’s really for better access, better efficiency, and faster translation of research into real-world impact.”

Spigel concurred, as he also sees multiple ways that AI could shrink the time it takes to deliver trial results. New AI tools may draw better road maps in the hunt for new targets by offering more guidance in cancer signaling and resistance. In both direct care and research, he said, AI is yielding advances in imaging and pathology when used alongside manual interpretation of scans.
“AI will accelerate how we diagnose people—how we diagnose what stage they’re in, and of course, how we select therapies for them,” Spigel said. He predicted that in some cases, AI could shave days, if not weeks, off treatment planning—by catching something on a scan or matching a patient with a clinical trial that might have been overlooked.

Opportunity and Challenges in Uncertain Times
SCRI operates clinical trials funded by pharmaceutical sponsors, so it is not directly affected by shifting priorities from the nation’s capital. But the cuts in academia are still felt. “Our colleagues in academia, who we partner with on these trials, are struggling. Their teams are being thinned out; their resources are being limited, so our collaboration is challenged by that,” Spigel said.

“There are more new drugs coming out than ever. This is the challenge for us,” he said. “They all have to be studied to understand their efficacy and safety. And Sarah Cannon is perfectly positioned to help with that challenge.

“Like it or not,” he continued, “a lot of drugs are coming out of China, and the innovation out of China is challenging us to see if those drugs help in Western populations.”

Spigel believes the United States can innovate—and with newer strategies can meet or exceed what is coming out of China. “So, the competition from China is both helpful for us directly, because those drugs are being tested in American populations, but it’s also challenging us to innovate ourselves and see if we can catch up, so to speak. So, it’s exciting—and it’s busy.”

Thus, in some ways, the time has never been better to have a clinical trial network rooted in community oncology. That doesn’t mean it is easy; both Spigel and Johnson say community oncologists are busier than ever, and taking on trials can be a lift. On the plus side, Johnson said, research does offer new revenue in a time of declining reimbursement.

“Patient volumes are probably more than they’ve ever had before. And diseases are more complicated,” Spigel said. “Where it used to be, with breast cancer, lung cancer, or colon cancer, there’s only so many ways you treat them; now each of those disease areas requires very in-depth conversations and testing.

“It’s very sophisticated treatment planning—and that’s good. Doctors who’ve been doing this awhile find themselves in a very complex care environment right now. It’s hard to be an expert in every disease and do that efficiently.”
So, where does research fit in? Said Spigel, “That’s our job, to make research easy for patients and families and providers. But it’s a challenge.”

References
1. SCRI announces the appointments of leaders David Spigel, MD, Melissa Johnson, MD, and Erika Hamilton, MD, in new and expanded roles. News release. Sarah Cannon Research Institute. October 5, 2025. Accessed January 12, 2026. https://www.scri.com/news/scri-announces-the-appointments-of-leaders-david-spigel-melissa-johnson-and-erika-hamilton
2. Meet President Howard “Skip” Burris, MD. Sarah Cannon Research Institute. February 22, 2022. Accessed January 12, 2026. https://www.scri.com/news/meet-skip-burris/
3. Advancing cancer therapies for patients. Sarah Cannon Research Institute. Accessed January 12, 2026. https://www.scri.com/about-us/
4. Sotorasib (oral route). Mayo Clinic. Updated January 1, 2026. Accessed February 2, 2026. https://www.mayoclinic.org/drugs-supplements/sotorasib-oral-route/description/drg-20516741
5. Adagrasib (oral route). Mayo Clinic. Updated January 1, 2026. Accessed February 2, 2026. https://www.mayoclinic.org/drugs-supplements/adagrasib-oral-route/description/drg-20543702
6. Caffrey M. Addressing KRAS resistance, RAS(ON) therapies find limelight at AACR. AJMC. May 5, 2025. Accessed February 1, 2026. https://www.ajmc.com/view/addressing-kras-resistance-ras-on-therapies-find-limelight-at-aacr
7. Study of daraxonrasib (RMC-6236) in patients with resected pancreatic ductal adenocarcinoma (PDAC) (RASolute 304). ClinicalTrials.gov. Updated January 29, 2026. Accessed February 1, 2026. https://clinicaltrials.gov/study/NCT07252232
8. Sarah Cannon Research Institute founders feature: Dr. John Hainsworth & Dr. Anthony Greco. Cancer History Project. August 4, 2022. Accessed February 2, 2026. https://cancerhistoryproject.com/people/sarah-cannon-research-institute-founders-feature-dr-john-hainsworth-dr-anthony-greco/
9. Sarah Cannon: the name & the story. Cancer History Project. April 28, 2022. Accessed February 2, 2022. https://cancerhistoryproject.com/institutions/sarah-cannon-the-name-the-story
10. A trendsetter in oncology drug field draws inspiration from patients. OncLive. 2015;16(8): August 5, 2015. Accessed February 2, 2026. https://www.onclive.com/view/burris-moved-from-military-to-front-lines-of-drug-development
11. McKesson and HCA Healthcare announce plans to form an oncology research joint venture to advance cancer care and increase access to oncology clinical research. News release. HCA Healthcare. June 23, 2022. Accessed February 2, 2026. https://investor.hcahealthcare.com/news/news-details/2022/McKesson-and-HCA-Healthcare-Announce-Plans-to-Form-an-Oncology-Research-Joint-Venture-to-Advance-Cancer-Care-and-Increase-Access-to-Oncology-Clinical-Research/
12. Bringing research to the community to reduce cancer disparities. National Cancer Institute. September 21, 2017. Accessed February 1, 2026. https://www.cancer.gov/research/areas/disparities/chanita-hughes-halbert-clinical-trials-community-access
13. Lander E, McKenzie A, Patel K. Integrating technology with expert oversight can simplify clinical trial enrollment. Targeted Oncology. September 30, 2025. Accessed February 1, 2026. https://www.targetedonc.com/view/integrating-technology-with-expert-oversight-can-simplify-clinical-trial-enrollment
14. US Oncology research enrolls 2,900 patients in leading-edge clinical trials in 12 months. News release. The US Oncology Network. April 25, 2017. Accessed February 1, 2026. https://usoncology.com/news/us-oncology-research-enrolls-2900-patients-in-leading-edge-clinical-trials-in-twelve-months/
15. Accelero. Sarah Cannon Research Institute. Accessed February 1, 2026. https://www.scri.com/partners/accelero/