Uniting Science and Medicine: A Vision for the Case Comprehensive Cancer Center

Podcast Transcript

Dale Shepard, MD, PhD: Cancer Advances, a Cleveland Clinic Podcast for medical professionals exploring the latest innovative research and clinical advances in the field of oncology. Thank you for joining us for another episode of Cancer Advances. I'm your host, Dr. Dale Shepard, a medical oncologist here at Cleveland Clinic directing our Taussig Early Cancer Therapeutics Program and co-directing the Cleveland Clinic Sarcoma program. Today I'm happy to be joined by Dr. Gary Schwartz, the new Director of the Case Comprehensive Cancer Center. He's here today to talk to us about his vision for the Case Comprehensive Cancer Center. Welcome Gary.

Gary Schwartz, MD: Thank you Dale.

Dale Shepard, MD, PhD: Tell us a little bit about what exactly is the Case Comprehensive Cancer Center.

Gary Schwartz, MD: As a cancer center director, I've been here now about nine or 10 weeks. The question often comes up, what is the role of the Cancer Center in Cleveland and how does it work? Well, the Case Comprehensive Cancer Center, in fact is a consortium of three centers, Cleveland Clinic, which I actually am currently seeing patients at in the area of sarcoma, I work with Dr. Shepard actually in this area and I'm very excited about that partnership; university Hospital and finally Case Western Reserve University.

It's a consortium with three centers where the goal here is to bring together the very best in science and translational medicine to patients in need of the latest advances in cancer medicine and for the cancer center to be the glue in a sense that allows rapid translation from bench top to bedside across all Cleveland in which we utilize the very best in cancer medicine at both and the clinic itself.

The challenge is how best to bring two hospitals together under one cancer center program. I guess the challenge is really addressed simply by the fact that cancer is a common denominator and wherever you may sit, we've all had a patient we know with cancer, a family member with cancer, it's a unifying force and it gives a common mission. The common mission for the Cancer Center is the conquest, treatment and cure of this disease. By bringing together two amazing hospitals and one university system with one integrated science program in Cleveland, we can really make the impossible possible. We can do great things together. We have amazing science at these two centers.

The challenge is how to identify the science, how then to bring the clinicians into the discussion about the science and how to move the science from the bench top to the bedside so that all patients in Cleveland can benefit from this. Our goal is not just to benefit the patients in Cleveland, our goal is to benefit the patients in Ohio and throughout the country by this integrated collaborative research program in which the Cancer Center brings together investigators, identifies great science, looks at ways of translating that science from the bench top to the bedside and delivering it to the people with cancer in this community. Hopefully the discoveries we can make will be utilized not just by our communities, as I said before, but by people outside our community of Cleveland, in the state of Ohio and even used at a national level.

That's the goal of the Cancer Center, to make sure cancer research can go forward in a collaborative fashion within the context of two amazing hospitals and one university. That's my position here. Yes, we've made great advances in cancer medicine. We clearly have. In the last 15 or 20 years, I've been involved in cancer medicine from the very beginning of immuno-oncology. I was there for the very first patients treated with immunotherapies, I'm a melanoma doctor as well as sarcoma doctor. I've seen amazing things happen. The beauty of being the Cancer Center Director now in Cleveland is we can really make even further advances by utilizing these two amazing hospitals, great scientists, great physicians come together for a common goal. That's really the mission and that's why I'm in Cleveland to make this all happen.

Dale Shepard, MD, PhD: We're going to talk about the research parts and how we make that work and some ideas from that standpoint. If we could maybe take a little bit of a detour over and so we'd like to think about being able to treat patients in a most effective way and come up with new therapies. What about your vision of how we can be a force in Cleveland in terms of getting effective screening and prevention and getting community involvement and things like that?

Gary Schwartz, MD: Well, I think prevention is a critical part of any cancer program. In Cleveland of course we have a large, underrepresented minority population that's in need of prevention strategies. The Cleveland community, in fact, if you look at our population the median vicinity is we have a large Black neighborhood. Our whole catchment area, which involves 2.1 million people, that's a lot of people to take care of with cancer, right? 2.1 million. That's the population the Cancer Center represents. In that neighborhood the 2.1 million are underrepresented minorities about 15 percent.

There are a couple of issues. One is we have to make sure there's access. We have to make sure that members of our community are aware of what we do, who we are and how to get into the system. I think at Cleveland Clinic there's a rather seamless way to get people into the program. I've now treated patients at Cleveland Clinic. I see the access is actually pretty smooth and seamless to get people in. I think access is one issue, but we have to make people aware in the community that there are clinical research programs and clinical trials and it's really the clinical trials where we offer the latest advances in cancer medicine. There's a very deep program of cancer research and clinical trials at Cleveland Clinic and University Hospital. All this is within the context of the Case Comprehensive Cancer Center. Every clinical trial ultimately is reviewed by the cancer center before approval either at or Cleveland Clinic.

The Cancer Center is the point of entry ultimately before it enters the clinical arena itself. We need to make sure we have studies that are compelling but also need to make sure the community itself knows who we are, what we have to offer, and make sure they have access to our programs. We are trying to really increase our accruals from underrepresented minorities. Currently our represented minority representation on clinical trials is about 17 percent, which in fact exceeds the 15 percent of the whole community of 2.1 million we represent. We're actually doing okay. We're actually making progress. It's actually been building over the last six to 12 months.

There is certainly a decrease in clinical trial participation during COVID. We lost patients that just didn't want to come in. We lost support staff to run the program. Now with the resources being reinvested within the Cancer Center and at both hospitals, we're seeing a steady rise in clinical trial participation and increasing representation from an underrepresented minority community such that we're exceeding our initial benchmark of 15 percent.

Dale Shepard, MD, PhD: Could you tell us a little bit about some of the Case Comprehensive Cancer Center approaches to community outreach?

Gary Schwartz, MD: One of the programs, in fact, we've just established within the cancer center is a prostate cancer screening program. We're actually working with the barbers in Cleveland. The barbershop is a center of social gathering for the Black community. We've trained the barbers of Cleveland to have discussions with their clients about the value of prostate cancer screening because Black men have a higher mortality for prostate cancer. They get it at an earlier age starting in the forties. When they do get it it's much more aggressive, but there's no screening program, there's no access.

Now we're having discussions with the barbers and their clients. We've given educational programs and there are videos running in the barbershops in Cleveland. As a client sits there reading the magazine or waiting for their haircut then these videos are running about the value of process screening. They continue the discussion with the barber and then we have a protocol in place to consent members of the community to get a free PSA blood test, prostate cancer antigen, whether it is elevated that they would need subsequent screening and even intervention if detection of a prostate cancer became apparent. Those are some of the outreach programs we're trying into the community to make people aware of what we are, what we do and how we can be more engaged with the community.

As far as other prevention strategies, we're struggling a little bit with smoking in the community. In Cleveland smoking is, if you look at the Cleveland immediate community, nationally the rate of smoking is about 10, 11 percent now nationwide, in Cleveland it's 30 percent. One of the factors that I think motivates people to smoke is the addictive quality of nicotine, but also the addictive quality of menthol. Menthol is an addictive factor and appears that Black men and women are more susceptible to menthol and the impact on menthol on getting addicted to cigarettes than people of white color. Again, not sure why, but this is a fact. We're working with David Margolis, who is the Health Commissioner of Cleveland, to address this now on a legislative issue. Actually, as we speak, there's legislation in front of the Ohio State Legislature to address some of these issues including flavored cigarettes and vapes which are attractive to children. We're trying to legislate that, and the menthol issue is more of a challenge and how to address that.

There are healthcare issues the Cancer Center can be involved in. They in healthcare programs that prevent cancer, but they also unfortunately touch on politics, Dale. Trying to separate the politics from cancer prevention is a bit of a struggle. Like I said, I've only been here a short amount of time and we have a lot of work to do, a lot of things we can do together. I think our community needs to rally, the physicians need to rally together to make sure that these healthcare initiatives are addressed on a legislative level so we can change the way we take care of our patients and prevent cancer.

Ben Franklin said this famous statement, "An ounce of prevention is worth a pound of cure." I think that's true. He was talking about fire stations. Philadelphia in 1775 was the big issue and how to prevent them. We can take that same language today and apply it to cancer prevention. I think together we can make a big impact in the prevention field. I can think of other initiatives as well so we can make a big impact. Frankly, the investment in prevention is much cheaper than the therapeutic approach to cancer medicine. We just have to be smart, be wise, and address some of these issues on a collective level. I think together we can make a big impact in this particular area.

Dale Shepard, MD, PhD: If we shift back to the therapeutic part, unfortunately cancer still does exist, and it impacts a lot of people. When you talked about outreach and we really have a huge footprint in northeast Ohio between the institutions involved in the Case Comprehensive Cancer Center, how do we raise awareness? How do we get more people involved to consider clinical trials as the standard of care? How do we use the partnership in this Case Comprehensive Cancer Center to spread that word?

Gary Schwartz, MD: Well, I think we need to make sure we have great science [inaudible 00:12:24] our patients. We have great laboratory programs both at Cleveland Clinic and UH within the Cancer Center. We need to be better at communicating across the campus. A good example, for example, I was in a meeting about two weeks ago, invited to a hematology meeting and I told the group I don't do leukemia, but they really wanted me to participate and listen to what they're doing. One of the investigators showed a zebra fish and you go, well zebra fish is a way to develop cancers and to test drugs. He says, "I think we have Ewing's sarcoma in a zebrafish." I said, you're kidding me? Ewing's in a zebrafish, unheard of."

I'm a sarcoma doctor like you and I spent several years trying to develop an Ewing's mouse model. Unfortunately, Ewing's, the EWS/FLI1 translocation is embryonic lethal so I never got beyond a third generation of developing a mouse model. He showed me a tank. This tank is full of fish, literally with a bone sarcoma, under the microscope here's small blue round cells, EWS/FLI1 positive. Sure enough, at Cleveland Clinic within the Cancer Center, we now have an Ewing's positive zebrafish model.

Now what does that mean? Well, you can test 10,000, 20,000 drugs, Dale. You can do things that no one else can do. Forget the mice. You don't need mice. You can grow the little zebrafish in 960061 plates, and you can sprinkle little drugs on top of them. Now you can look at all sorts of new drugs and may kill Ewing's. It might be the very next therapy. We have Peter Anderson at Cleveland Clinic working with Tim Chan, our head of immuno-oncology developing a vaccine for Ewing's sarcoma. Nowhere else in the world does that happen. It's happening here in Cleveland.

We need to get the message out what we can do. I think we're too quiet. I don't know. Maybe we don't brag enough. We don't pound our chests and say, "Look at all the great things in Cleveland." I'm a New Yorker. We always pound our chest and show ourselves off maybe the Cleveland way from quieter or more. We don't want to brag. I'm good. Okay. I can develop a Cleveland approach to things too. There's also a part of me who's a New Yorker who wants to get out and promote us and tell us what great things we're doing and how Cleveland is the place to come for great cancer medicine. In the last two weeks, I've been here nine or 10 now, I can identify new things that we can do in the field of cancer that could be transformative.

I don't know if that answers your question, but one of my roles as Cancer Center Director for Case is to make people aware of what we do that. There's the lab group, they just didn't know, it's all leukemia. I got it. Okay. Here it is a leukemia laboratory developing something that's extraordinary. Now we have to get it out of the lab into the clinic. Now we've got to do the drug testing and make sure we can identify drugs and begin to test them so you and I as clinicians can begin to do the clinical research. It's the excitement of clinical research that is going to bring people to the Case Comprehensive Cancer Center.

We got to get the message out. We're doing things differently and we're doing it with excitement and innovation that's going to change the field of cancer medicine. That's the message. We get that message out people will flock to Cleveland; people will be lining up with the door to come to us Dale and not just sarcoma. I'm talking about the field of cancer medicine. That's my goal. That's the vision to elevate cancer medicine, to elevate cancer research, make the impossible possible, make people aware of what we're doing here and draw them into our clinical research program. That'll be the sign of success.

Dale Shepard, MD, PhD: That's fantastic because it's again about awareness. It's awareness of what groups are doing on each side of the street and letting everyone else in the world know what we're doing. Those are both important. How about the educational piece? What are the collaborations that you see as being strong, being necessary? What would you like to see from an educational standpoint between the two institutions?

Gary Schwartz, MD: I think there are multiple ways to approach cancer medicine. I think, again, with the great body of scientists who are in UH and Cleveland Clinic, the clinicians who can really develop translational medicine. We have an obligation to educate the next generation of clinicians, of physician scientists as a big part of the cancer center program. We do have a couple of programs. For example, we have something called the K12 that identifies a promising junior faculty in the field of cancer medicine, both MDs and MD PhD, to develop careers.

I think we need to go further than that. We need to strengthen our fellowship program. In fact, I think we need to go into colleges. I think we need to go into high schools. We have summer programs. In fact, I just talked to a bunch of kids from inner city Cleveland from high school who were identified in a program who are spending their summers here in the laboratory learning about research and cancer. Our hope is that by developing programs like this, that'll raise interest, enthusiasm and excitement about cancer research starting in the high school level, especially among our most underrepresented members of our community, who we'd love to increase that percentage of in our programs and recruit ultimate faculty from underrepresented minority populations by starting at the very beginning of training programs, high school, college, undergraduate. We can begin to attract people to Case and into cancer medicine as a whole.

It's a continuum. I think you need to start early. I think by the time people get to medical school or beyond, they've already made commitments to what they want to do. I'm hoping the science at Case and the programs we offer through the Cancer Center can really engage younger members of our community to want to pursue fields in cancer or cancer research. That's one of the things we do through the Cancer Center is provide those opportunities to fund those initiatives and to bring as many people into our community as possible and hope that one day they'll be sitting in a chair like this presenting a podcast, working with you and saying they started at Case as a high school student or a college student doing great cancer research and the field of cancer medicine.

Dale Shepard, MD, PhD: That's excellent. You've only been here for a short period of time. You certainly relayed the excitement for the zebrafish model, which is outstanding. What are the things so far that you have seen as most exciting about the collaboration and the Case Comprehensive Cancer Center, and where do you see that we need to do the most work?

Gary Schwartz, MD: Well, I think we have come together as a center, and I think everybody sees great promise in cancer medicine. I still think we need to work on the consortium. I think it is a challenge for people to understand what the consortium's about. I think that it is to the benefit of the cancer community to have a centralized program within the Cancer Center. We are designated as comprehensive, which is a unique program. I remind people that the cancer centers are ranked on a level of good to outstanding. Seven years ago, they added a new ranking called Exceptional. Exceptional is Exceptional. My predecessor, Stan Gerson, who is now the Dean of the Medical School, was leading the program at the time, and he was the first center in the whole country to get an exceptional ranking. Very few centers have actually achieved the level of exceptional.

That's what I'm sitting at. I'm sitting in the chair of my predecessor who achieved an exceptional ranking in the Comprehensive Cancer program, comprehensive because we engage the community. We're not just focused on our labs; we're engaged in bringing the community in and making sure that everybody's represented in this large cancer community. I think we have to really understand that our goal is really to be agnostic to hospital. That's a challenge in a community we have two hospitals that do tend to compete with each other, but I think the commonality is cancer. You have to see it that way.

My goal is to ensure that everybody gets a say. Everybody's represented. The best science emerges from the programs, both the UH and Cleveland Clinic. All these programs are supported by the Cancer Center. We have an investment in every cancer program. Our Cancer Center supports it. The Cancer Center is a unifying force that brings everybody together. My goal is to reinforce that. My goal is to make sure that people feel they're part of a Cancer Center, feel they're part of a commonality, a common goal of cancer cure so we continue to achieve excellence and we can continue to be considered exceptional across the country.

That's what the Cancer Center can bring something truly exceptional to Cleveland. It's going to require a unified program, a sense of oneness, a sense of togetherness that we can all come together for this common goal. That's really what I hope to focus on, to ensure and reinforce that vision for the Case Comprehensive Cancer Center.

Dale Shepard, MD, PhD: Sounds fantastic. I've been fortunate to get to work with you clinically and as you've started here and look forward to working with you to help out in the years to come. We'll look forward to that New York attitude to spread the word.

Gary Schwartz, MD: I'm going to do it with more of a Midwest approach.

Dale Shepard, MD, PhD: Well, we'll look forward to it. I appreciate you being with us and telling us about your visions.

Gary Schwartz, MD: Thank you, Dale.

Dale Shepard, MD, PhD: To make a direct online referral to our Taussig Cancer Institute, complete our online cancer patient referral form by visiting clevelandclinic.org/cancerpatientreferrals. You will receive confirmation once the appointment is scheduled. This concludes this episode of Cancer Advances. You'll find additional podcast episodes on our website, clevelandclinic.org/canceradvancespodcast. Subscribe to the podcast on iTunes, Google Play, Spotify, SoundCloud, or wherever you listen to podcasts. Don't forget, you can access real time updates from Cleveland Clinic's Cancer Center experts on our Consult QD website at consultqd.clevelandclinic.org/cancer. Thank you for listening. Please join us again soon.