Welcome back. If you can please take your seats. Looking forward to the next panel around some of the clinical advances that have been made over the past 50 years by virtue of the National Cancer act. You know, as a former nci director, you know that one of your greatest assets and some of your best friends are those heroes who agree to become Cancer Center directors, because they have to deal with the complexity of everything from supporting basic research on one end of the spectrum to all the way to the other end of the spectrum with regard to training, clinical research, cancer prevention, et cetera. Being a director is a challenge. Were very fortunate today to have with us to chair this next panel dr. Steve rosen who was the for 24 years the director of the robert h lauri and is the head of the Beckman Research center at city of hope. He has a distinguished career as a medical oncologist and particularly addressing himself now to much of the academic progress thats being made, having published over 400 articles himself and is currently the editor in chief of the series Cancer Treatment and research. We are very fortunate to have him lead this conversation as it relates to the progress thats occurred in the Clinical Care of patients. He will introduce his distinguished panel. Steve, thank you for being willing to do this. Thank you, andy. Good morning, everyone. Welcome. We have three renounced panelists, experts in their field, thought leaders. Each in a distinct area. Im going to introduce them briefly and then im going to ask them to answer a series of questions. And then were going to open it to the audience. Hopefully, have a thoughtful period of communication. About all the issues that we are dealing with. First im going to introduce dr. Peter bistus. Peter is a surgical oncologist specializing in gastrointestinal cancer and has received numerous outstanding Teaching Awards at the institution. Thank you, peter. Dr. Lori pierce is academic Faculty Affairs at the university of michigan. A radiation oncologist, figured in Breast Cancer research, member of the National Academy of medicine and the 57th president of the American Society of clinical oncology. Welcome. And dr. Steven group, the director of the cancer and Therapy Program and medical director of the cell and Gene Therapy Laboratory at Childrens Hospital of philadelphia. A Pediatric Oncologist and leading figure in cancer immunotherapeutics. Join me in welcoming this distinguished group. [ applause ] the first question for you, what do you feel is the most profound legacy of the National Cancer act . We will start with you, peter and go to lori and steve. Well, thats the topic of the whole session in many ways. I think probably among the many contributions that we all see now and are discussing is the ability to bring clinicians and researchers togetherclinicians researchers together in ways that no one imagined at the time, creating opportunities for discovery. Bringing them together to understand common problems, and then to create solutions that were now seeing. And we are benefitting patients and saving lives. And i think it really took a Cancer Research coordinated National Effort and were really seeing 50 years of progress as a result. Do you have one example in your mind that would lend itself to this team work . I think a lot of the work that we have seen in targeted therapies where youre understanding the molecular basis for cancer, youre understanding targets and youre developing drugs against those targets and moving an entire field forward, we now know targeted therapy is an excellent example. So i can answer this in a very general way and a very specific way. I think about what i do every day when i see patients. I see mrs. Smith, i can take the clinical information, and derive a treatment recommendation based on her tumor. Thats all possible because of the National Cancer act. Everything that we do is so different and it is because of the National Cancer act. And now we can do, based upon the specifics of mrs. Smiths cancer. And then from a specific standpoint, i think it is the creation of National Clinical trials network. Clinical trials change everything. Thats how we move the needle. Thats how we improve what we do for patients. Offering patients the best therapy, thats what we inspire to be able to offer patients, the best possible treatments with Clinical Trials. You can take a therapy, a drive similar to what we heard in the first panel, and process that in phase one trials and try to find the best dose, and in faze three and be able to compare the new therapies to whatever the standard of care is. And that is how we move the needle. I think this is all possible because of the advancements of the National Cancer act. The first session was so fascinating for me. What i sigh is again the theme of bringing everything together. Often nasa tries to justify some of what it does by saying look at all of this cool technology, which i think is the greatest thing in the world, but multiply that by 10,000 for the cancer act, and i think that bringing all of these folks together, all of this basic science, looking at dr. Baltimore, looking at the script case and realizing that you need a reverse script case to make the thing that i work with which is a antigen receptor to work. Make t cells do what they want. We heard dr. Alison talk about waking up t cells for their natural ability to kill tumor cells and we force them to be able to kill tumor cells. These are all Unexpected Technology thats came out of basic science research, handed off to the clinical programs, and then the thing that excites me most at this moment in addition to being able to provide transformational therapies to patients, but we talk about bench to bedside. Thats our mantra. Thats what we want to do. Now there is bedside to bench. So you have patients, kids in our hospital, theyre having transforming responses to brand new fields of medicine whether or not it is immunotherapies, or with many other therapies, and you can take their cells right back to the lab with incredible techniques developed by the basic signists to look, interrogate and see what is happening so you can understand these things in a rapid fashion, none of which would have been possible without the infrastructure and focus on cancer. I think the speed was outstanding as well. They would often say that were now at a point where were actually finding that we can bring therapies to patients in a reasonable period of time with the anticipation that therapy will work. The next question within your area of expertise, what do you feel are the most significant advances in the last 50 years. Maybe well start with you, steve, on this one. All right, you know, a certain level of bias, you know i think that immunotherapy is incredibly exciting. It is relatively new in the last 50 years of development. But the idea that we may actual i will be able to go chemo free for so many more of our patients, and spare them the experience, the notion that in the future we could possibly do that for our patients is incredibly exciting and i think both sides of the ak sisz provide that potential. And you know, i remember hearing early on from mentors that why are you thinking about the immune system and cancer, they have nothing to do with each other and of course they have profound things to do with each other. So the idea that t cells can have an impact is one of the more important discoveries. Sue, wearing my radiation oncology hat and thinking 50 years ago, i would have understood that everything is cobolt, and the view from the front and the back. Fastforward now how we can advance to the point where we can vary the accelerations, we can do modulated radiation. We have radio bands where you can take a compound and target it specifically to a tumor and give the radiation directly to that tumor. Looking at the biology side of things, assessing what genes make them radio resistance. And it addresses the areas of existence, its just an explosion of what we can do. And then i guess wearing my Breast Cancer had, going 50 years ago where i think the majority of women probably still would have been treated with a radical mactectomy, and now we have lumpectomy and we have subsequently learned because of Clinical Trials that radiation will reduce the risk of local occurrence but it translates to a modest survival advantage and knowing from a systemic point of view, looking at how therapies have now changed, the history of the Natural History of the disease from a very untreatable cancer to a treatable cancer. And from a surgery perspective, aspects of radiation and where were learning that sometimes less is more. That if we can assess the potential outcome from a certain cancer that perhaps some of them dont need have radiation and we can spare radiation for those and for those that have highly aggressive disease they could have more radiation. And were looking now at molecular profiles. And so it is changing significantly both from a radiation perspective and Breast Cancer perspective. What im hearing between both of us is hurt people less and get better outcomes. We have kids that have their whole lives ahead of them and we want to make sure those are healthy lives and we see often theyre not. Theyre survivors, which is fantastic, but they pay a price. Also combining the technology with the biology is fascinating how it comes together. It comes together beautifully in radiology. I think in many ways what youre hearing is part of the fusion of the forces of physics, engineering, and medicine. And that has created Proton Therapy in the radiation and oncology world and lead to minimally invasive and robotic surgery. So along the themes of less is more has hemmed to revolutionize surgery. And it has been applied to patients with cancer in innovative ways it is a minimally invasive approach. And they have a huge impact on patients overtime and that we see every day today. I think looking into the future among the things that we have been talking about one thing we should focus on is cellar therapy which is a brand new need is just opening up now and as we see in the past, the treatment has been infusions and pills and now were moving to genetically modified cells in patients. Its not a bill, its not a compound, by it opens up a brand new path way for Cancer Treatment. And blood cancers are blessed to lead that activity. I have about 300 active patients right now, and no one has died in three years. And it has been a game changer with what you can accomplish with patients. Next, how can we advance cancer prevention. Thises that been an issue since i have been in training, and its a period of passion and we start and stop. When youre voted as president , youre asked to decide what your theme will be, and i chose a theme of equity. I did it at a time before george floyd, before the pandemic, and i wondered if it would be welcomed by the oncology community. Oh my gosh. This was the time for the equity. And i chose because because were all canter people and were all aware of the outcomes. You think of black males and prostate cancer. There is a 100 mortality increase. Black women have a 40 more mortality rate for Breast Cancer. You think of hispanic kids, adolescents, higher risk of leukemia compared to whites. You think of native americans having a higher incident of gi cancers, liver cancers, and the list just goes on. I thought that equity would be the right decision. And during the year we were able to put forward a lot of initiatives. And we increased that as well. And one of the things that we focused on was increasing, needing to increase, a diverse workforce. And we all know that the number of minorities in oncology is woefully low. Much less than the percent of patients that are minorities that we serve. So were working on a way to increase the pipeline. Having had more minority oncologists. Were working on an initiative with accc to community to increase minority participation in Clinical Trials. We talked about how important the Clinical Trials are and if you look at the percentage of minoriies in a Clinical Trial, it is around 3 to 5 . And we know that is the way to move the needle. And so many times we heard people say we just cant get the patients to go on Clinical Trials. The problem is not the patient, it is us. We need to create an infrastructure to remove the barriers that patients have and that institutions have so that patients can go on Clinical Trials. We have a pilot looking at a tool that institutions can do a selfassessment and look at various stages for enrolling patients. You see how many patients come into your Cancer Center and you see how few are offered a Clinical Trial. What are the barriers presenting to those patients. The bottom shrine that if youre looking at new studies including a very recent one, published in the jnci last year. Once you ask a patient cancer to go in a study, whether or not theyre white or black, the same percentage goes, it makes to difference what race they are. We have to get things to the point where they are offered a Clinical Trial and the selfassessment study will hopefully open some eyes. Every institution has different barriers. And another initiative is to increase awareness of the social determinants of help. You know we need things along the full con tin wum. Prevention, treatment, and if we can prevent a cancer that is better than treating a cancer. And i applaud all of the work that the nci is do and we need all hands on deck. I think it is symbolic that we are addressing this question at this session. And america is at a cross roads right now driven by george floyd, by so many things happening in our society. And you see corporate boards moving to esg goals, institutions embracing dei in their strategic plans, and a massive change in front of us. I could not personally be more excited about what were seeing. It creates real opportunities for us to come together as an community to have an impact and to think about the importance of the policy issues. When we look at the behaviors of health, and the structural issues in american medicine and health polt si where for whatever set of reasons and circumstances insurance is linked to employment and this is a fundamental flaw that underpins many of the access challenges that we see in america right now. Its not a mistake that other developed countries have made. Were not in the top ten in the world. While we have unbelievable outcomes that were discussing in our oncology, when we look at other aspects of Public Health like longevity, thicks like instant mortality rate or Maternal Mortality rate in childbirth, we have a long way to go. Addressing these will focus on important policy issues in washington that would really help to change the landscape for americans. Youre talking about policy issues and i think a great example is the clinical treatment act. So to give a little bit of background, for medicare patients and private insurance patients, if they enrolled in a Clinical Care trial theyre routine care costs would be covered. Getting xrays and things like that, medicaid were the only people that didnt have a routine care cost. They needed that covered. But that was a rock that had not been picked up and a lot of work by friends of Cancer Research and many groups said this has to change, and im happy to say that as of january of 2022 it will change. But this was a classic example of disadvantaging a population that needed it the most. And the irony is that people were not on a Clinical Trial into it is a disincentive for the poorest patients, the ones that probably needed it the most. So looking the policies and taking the time to actually scrutinize policy thats have been in place for awhile that probably need to be reassessed and changed. It is so very important that we all do that. I want to build on something that lori said that i think is very important. Those of us in the field and work in centers like the university of michigan, we have a degree of cognitivi dissonance. When i talk about our commitment to the clinic that we have, they are wildly enthusiastic about what were doing for the underserved in our own county. Theyre raising their hands and this is a reflection of the moral distress that is present right now. Steve, from your perspective as a Pediatric Oncologist . It goes hand in hand. When you look at these therapies that were talking about, the genetically engineered theirs are being delivered. They many times require travel, and maybe in the future they wont, but thats not today. So as an example as our center we treated our first patient in 2012 and immediately we were able to secure dollars to allow us to pay for travel and hotel rooms for patients coming to us. That helps with people, and it will only become more of a problem because i was excited to be part of the process, but at that moment it became one of the highest single cost therapeutics in history and that may not be something. We see the same pricing across the field, but were talking about 300,000 or the 500,000 for the genetically engineered products. Is that a good price . I dont know, im not a health economist. Is that something we can actually do for the number of patients . And you made the key point that this is only in blood cancer. And forgive me for saying it this way but god forbid it worked in a more solid tumor because how will we handle the costs . Are we set up for it . Can we imagine what that will cost . And we know that Cancer Therapeutics is expensive, but this issue of equity and access is something that were thinking about a lot and i will end with something we were talking about last night. And so right now there are at least two approaches. These are probably curative therapies. Theyre much less risky, theyre much easier to get. It is something that i do as a clinician most frequently. So we want to move this safer therapy, they cost over a Million Dollars a piece. Now a medically underserved population can we treat the incidence. But this are the creating equity and access costs for us for extraordinarily steve, this is such a good point if you dont mind for a second if youd dont point out that part of the future has to be a push in science and a push in access and a focus on cost. If we dont focus on cost, well be developing therapies for the 1 and that is something that we cant let go of. One of the most compelling pieces of data that we talk about is the risk of personal bankruptcy. 43 of patients will be bankrupt within two years of cancer diagnosis. It mean thats if were not focused on the cost of carry, were not able to make advances at a societal level. If i can make one more comment, if question prevent cancer, that is the most Cost Effective way forward. And if you think about all of the advances in the last 50 years a lot of them have to do with tobacco control, right . So we need to talk about social sciences and prevention nap is really a way forward. One of the pioneers said that everyone spoked b the Tobacco Industry was supporting revlg at the time, they were looking at the impact of tobacco. And he showed him this profound data and he says we have to present it and he said well get through it, and he said how do you know well get through it . And he said its because were right. Its amazing it took so long to appreciate the devastating aspects of tobacco use. Before we leave this compelling issue because it is maybe the most important at this moment, its so disheartenning to think about it, we have one of the leading figures, robert wynn that made a profound impact and it has been in the most articulate and passionate ways, has everything been covered . No, no, you can do better than that. I think first of al the basic principals of that science. So our next question is almost the antithesis. Now were dealing with the covid pandemic, what are the valuable lessons that we have learned that are relevant to cancer care and what are the positive things noise recognizing the terrible scourge of the disease and how has it changed how you provide care . I see, too, macro forces that were discussing here. The first is the pivot to virtual care. This is Cost Effective, patients love it, it has been integrated into our workflows. We did over 300,000 virtual visits and it has been a spectacular success and a silver lining. The second area they think is impactful is hybrid work. As we look at our own work, it will be permanent for a work transformation team. We have wfa. Work from anywhere. People can do data science and work from anywhere, and were working aggressively in the work transformation and we believe it will be permanent and impactful for us. I think with regards to telemid sin and telehealth we need to learn how to hospital miez that. So i think in the next few months, you know, looking at this very carefully, and other groups as well, it will be sustaining that option to continue nap will be very important. They looked at this very thing as we emerged from the pandemic, what can we take and what have we learned . We need to make Clinical Trials more pragmatic. It should not be boutique trials that everyone has to come into the Main Institution usually in a city to get those trials. We should make them more pragmatic so patients can enroll. Another point is that we need tolessen regulatory birdies. Am i setting the sage for you . That was during the pandemic and we need to exploit that. A physician working with patients, but there is a lot that im hold enough to remember the one page of informed consent when you could talk to the patient about it rather than the book that no one goes through. I would say the issue of the regulatory burg is extraordinary. I know Patient Protection is very important and much of what we are as clinical physicians dealing with terms of regulation, but the reality is that it is so much harder, it took public highway year to get my first t cell study open. And we want today do two things with that. We could have dheen in 20 patients, but we want wanted to give it to patients. And for that we expanded the trials and its like that is not scientific, but its like i dont care thats the only way question deliver the therapy. But getting back to the pandemic, i would like to make two points, first back to rna. Now these mrna vaccines, knowing there was basically the design of the current vaccine a month into the pandemic and they got it going, it was an extraordinary success. The same with new dedication to issues of equity. So 85 come from outside of our area. Many of them have a kid with relapse leukemia. They have no immune system. We saved their life within great, here is what we need to do and at the end of the conversation and i say is everyone vaccinated, and bringing up that topic without anger is challenging. So were talking about access and also the lack of a shared understanding of what is the appropriate thing under these circumstances as well. Can i add one thing . When we look at what happened in the pandemic, it is a great advocate for team science. It is a result of teambased science. And while we want to respect and respect curiosity based science, we also want to highlight the benefits when they focus on goals that benefit society. Just the outcomes of team based science are extraordinary, and they have v to be very good at the one thing that do, but universities have not quite figured that out yet. And if we want to prosuppose team based science, we have to value that. We put forward a proposal for team based science. And i should say we take into account now. We could get down a path way here pretty quickly, but it really relates to the promotion and tenyear cry ear ya and Cancer Center environments. Once we understand what criteria should be rewarded, enhanced, and incentivized, well see teams come together sdplp so the follow up question, was moving forward, what do you fee is the most important parts in your mind . This was eluded to earlier today, i believe the biggest advances can be made by the fusion of data science and medicine right now. Its untapped, it is an area that we and others are really deeply investing in for really important reasons. We have terabytes of data, and i say all of the time, the secrets to unlock canter is in our freeders. It means team thats come from organizations like facebook and google that are fed up with really finding ways to sell more socks and get more likes and putting those people on to the cancer problem. And that, i think, is the next frontier as we see in fusion and mathematics. Youre taking the biologist, the social sciences, and putting them into Clinical Trials and having a greater pipeline of parents and if you have more patients to go on Clinical Trials, clear they is the way of the future. Were seeing more and more drop the mic moments now and i i think it is all coming together extremely well. Im going to touch on two things, fist the clinical central aspect. There is three to five account of adult patients, more than half of kids. It is a completely different circumstance. I think there is a way to have more access to Clinical Trials and it may provide more opportunity to folk thats may not have the means to necessarily get some of the most cutting edge therapeutics. The other aspect that i worry about, i dont want to end on this is cost is out of control. Were 1 to 19. And is there a way to be safer and have fewer side effects. Were going towards a circumstance and i think if we can at least cost issues, im not going to say anything different, of course, but i think that is something that we do worry about. So we have to go in a different direction. I dont think i can control the disease, and that is profound. Ten years ago i would say that this is one or two options and not knowing whether or not there will be a plan b, and now there is always a plan b, a plan c, and it is quite remarkable. Do we need to end the session . I see you patiently waiting there. I would like to open it up to audience q and a. I know we had a discussion about doing that and were going to do that right now. Those that have a question, please raise your hand and i will come to you. I want to ask the first one. The title of the panel, saying lives from hopelessness to hope. There has ban lot of talk about therapies. Can you tough on what was done,. Maybely start. Just about every patient that i take care of is doing well. Back when i was a fellow in 1979, we were focussing on lung cancer, skin lynphomas. And now the majority of patients are leaving. The cell lines that were developed back then lead to all of the profound observations now about the targets that were applying biologics, to. And it changes the way that we treat lung cancer. I have stage three testicular cancer. I just want to first thank the Nixon Foundation for the cancer act. I think that if it wasnt for such an act i probably would not be here today and i would not have two beautiful daughters and my wife here. And thank you for the doctors and the nurses. I am the exhibit here if you get a chance to see that. I wanted to ask about the Mental Health for survivors. Is there anything for people that have been hurt by chemotherapy. Were going live now to capitol hill where they are investigations price gouging by companies during the covid19 pandemic. Live coverage now on cspan 3