You’ve just marked your first year as Physician-in-Chief. What has it been like?
This has been a year of getting acquainted — or reacquainted — with Memorial Sloan Kettering. Over the course of these first 12 months, I’ve met a tremendous number of people from every part of the institution and have learned about the workings of its clinical operations. I spent a lot of time with our department chairs and visited virtually all our treatment facilities, both in Manhattan and in our regional network. It’s been a wonderful experience, and my most indelible impression is that you have to live in this place to see how great it is.
You mentioned our patient-care facilities, so let’s begin there.
A good place to start!
This was the year in which we laid out the vision and strategic planning for our sites. My colleagues and I spent a great deal of time thinking about how to achieve even better clinical integration across all our locations, and I include in this not only our network sites on Long Island and in New Jersey and Westchester County, but also our Manhattan facilities.
Central to realizing these plans has been the appointment of [former Chief of the Gynecology Service] Richard Barakat to the newly created position of Deputy Physician-in-Chief for the Memorial Sloan Kettering Regional Care Network and Alliances. Dr. Barakat will lead the network, expanding its presence throughout the New York metropolitan area and building relationships with medical institutions outside the region. He’ll also lead the effort to fully implement and expand the recently announced Memorial Sloan Kettering Cancer Alliance.
The MSK Cancer Alliance is an unprecedented undertaking with Hartford HealthCare (HHC), a multihospital healthcare system in Connecticut, and represents a sea change in Memorial Sloan Kettering’s clinical enterprise.
Yes, it does. But first you need to know that about 80 percent of cancer care in the United States is delivered in community settings and that cancer advances can take years to reach patients. Many of these patients also lack access to sophisticated genetic tests and clinical trials. The MSK Cancer Alliance, of which HHC is the first member, is creating a new model to address the challenges of providing high-quality cancer care to many more patients. HHC is in fact the model on which the Alliance will grow.
I also want to put it into an important and more all-encompassing context, which is clinical research. During 2013, we embarked on a major restructuring of our clinical research operations, and Alliance members will play a key role in this. In order to continue our clinical research mission and make it even more robust, we need larger patient populations. Almost every important advance in cancer treatment has come about as a result of clinical trials — and to conduct effective trials you need many patients to participate.
Early in my tenure, we appointed [medical oncologist] Paul Sabbatini as Deputy Physician-in-Chief for Clinical Research, and he’s been doing a tremendous job of streamlining and accelerating our clinical trial process. We now have two Institutional Review Boards, doubling our capacity to do clinical trial reviews. As a result, we’ve seen remarkable decreases in the time between the review and the approval of clinical trial protocols — down from 200 to 90 days. And we are also seeing an increase in clinical trials with more patients participating.
I’m deeply grateful to Dr. Sabbatini and to everyone who has contributed so much to these efforts, including Collette Houston [Executive Director of Clinical Research Operations] and her colleagues in the Office of Clinical Research.
There is another point I’d like to make about the MSK Cancer Alliance and our growing network of regional sites, and it’s this: If you want to extend the best care in the world, the best protocols, the best surgical procedures, and so on, you cannot do it from an ivory tower in Manhattan. Our mission is to improve the lives of people with cancer, and to do that, we have to be out there. We need to be a force in the community, to have a presence, an influence, and to make certain our innovations get to patients.
During your first year at Memorial Sloan Kettering a number of new “virtual” centers were established to foster collaborations among clinical investigators and scientists, with the aim of actually bringing novel therapies to patients. Can you talk about this?
My “big” answer is that I believe Memorial Sloan Kettering is becoming a real engine of execution of new ideas that will transform patients’ lives.
More specifically, the new centers are part of a larger vision to develop and bring treatments to patients that were not available before — indeed, that didn’t exist before.
First — with the participation of our gifted pathologists — we have massively expanded our tumor sequencing program. In the past year, we have sequenced more than 10,000 patient tumors. That’s an incredible tour de force. In order to design tumor-specific treatments, we must know what is happening within individual cancers, and tumor profiling is fundamental to this
We have also appointed [physician-scientist] Richard Carvajal Director of Developmental Therapeutics and have established the Marie-Josée and Henry R. Kravis Center for Molecular Oncology (CMO) under the leadership of [physician-scientist] David Solit. The major goal of cancer research in the years ahead will be to integrate molecular and clinical information in order to develop precision treatments, and the CMO will be the first program in the country to span the full range of activities required to translate molecular insights into clinical innovations.
The Center for Mechanism-Based Therapy (CMBT), led by [physician-scientist] Neal Rosen, is another important virtual center. In 2013 we reinvigorated the CMBT, and it has become the forum in which ideas from the lab are being brought into the clinic. We’ve launched a weekly CMBT conference, for example, where clinical investigators are coming together with scientists and biotechnology companies to discuss how to develop and advance new therapies.
And with generous support from [Memorial Sloan Kettering Board member] David Rubinstein, we’ve established the Pancreatic Cancer Research Center, headed by [surgeon and cell biologist] Steven Leach, an expert in pancreas cancer and a recent recruit from Johns Hopkins. This is part of a transforming effort at Memorial Sloan Kettering to rigorously address the more “difficult” cancers — the cancers that have proved most treatment-resistant.
Improving patient access to Memorial Sloan Kettering has also been one of your priorities.
It has. And we’ve made great progress over the past year. As everyone knows, these are challenging times for the medical community generally. But at Memorial Sloan Kettering, despite these challenges — which include space constraints — we’ve been able to improve patient access. Several initiatives spanning the entire institution have resulted in shortening the time between a call from a patient or caregiver seeking an appointment and when that patient can see one of our physicians.
Looking ahead to your second year, what will be on your mind?
Interestingly, I think this next year will partly be one of turning my attention back to some of Memorial Sloan Kettering’s core values. Of course, I will continue to focus on clinical excellence — we are who we are because we have the best people anywhere: the best physicians, nurses, and support staff. They are all superb professionals.
Yet in our focus on research and drive to identify new cancer treatments, we can miss important moments with the patients in our care. During 2014 I want to work with my
colleagues to make certain we deliver the best, most compassionate patient care
Broader picture, how do you see the state of cancer research and treatment now and as we move into the future?
I can tell you that I’ve been doing this for many years and I’ve never seen the acceleration of progress that I see today. While it’s difficult to make predictions — and cancer is anything but simple — I will point to just a few major advances that have deepened our understanding of cancer biology and are changing the way we think about treating these diseases.
For the first time we have the capacity to sequence tumors in real time and identify actionable mutations [mutations that can be targeted with drugs]. For the first time we have the ability to investigate the complex patterns of feedback in cellular signaling pathways that drive the growth of cancer, and this has opened the gates for us to explore new combination therapies. For the first time, we have proof that harnessing a person’s immune system to fight cancer actually works.
On top of that, there are extraordinary and continuing developments in surgery, in radiation oncology, in molecular imaging and nanotechnology. And this is only the tip of the iceberg.
Let me put it another way: If someone went away to a deserted island at the start of 2013 and came back now, they would be amazed. And it would take them more than a year to catch up.
As I begin my second year here, I personally couldn’t be more enthusiastic about the future. Memorial Sloan Kettering is an energizing and inspiring institution and I feel both excited and privileged to play a part in our communal efforts to conquer cancer.