Joseph Califano named director of UCSD Moores Cancer Center

There’s nothing like a deadline to make sure you get done what you need to get done.”

Joseph A. Califano III, a head and neck surgeon scientist, was named director of Moores Cancer Center at UC San Diego Health, an NCI-designated Comprehensive Cancer Center that serves San Diego County. 

Califano, the physician-in-chief at Moores, was selected to succeed Scott M. Lippman, who announced a year ago that he would be transitioning to associate vice chancellor for cancer research for UCSD after serving as director of Moores for more than 11 years. (The Cancer Letter, Dec. 3, 2021).

Califano’s appointment was announced Nov. 14, and he started work as director on Nov. 16. The Moores Cancer Center Support Grant was due in May 2023, but with the change of PIs, the submission date has been moved back to May 2024.

“I think it’s a golden opportunity actually to have a leadership transition,” Califano said to The Cancer Letter. “And although it probably is a little bit time-compressed, [and] we would love to have as much time as we need to do this in a leisurely fashion, I think there’s nothing like a deadline to make sure you really get done what you need to get done and force you to really do those things you need to do to prepare for a grant like this. 

“I think it’s actually kind of nice, because it makes you get the job done and make sure you do the right things prior to a submission.”

Moores is a consortium cancer center that, in addition to UCSD, includes LaJolla Institute for Immunology and San Diego State University. San Diego County, the fifth most populous county in the U.S., has a “minority majority” population, which means that Latino, Asian Pacific Islander, and Black San Diegans outnumber white San Diegans. The demographics of the Moores catchment area are reflected in its clinical trials accruals—and in the UC San Diego Cancer Care vision of “One Mission, One Program, 19 Locations,” which see 2,300 analytic cases annually, and which are expanding geographically throughout the region, Califano said. 

Transcending population differences, Califano said all cancer centers are facing a similar set of challenges. 

“As academic medical centers, we have a tripartite mission. We need to take care of the educational mission. It’s critically important to make sure we have a sustainable healthcare enterprise. We have to make sure we provide high-quality research, provide new discoveries, and at the same time competing against health systems that don’t have those missions,” Califano said.

“So, we just need to be better at it than other folks are. We can’t just simply say, ‘Well, we’re really expensive, and that’s just how it’s going to go, and that’s how we’re going to have to do that.’ That’s not going to work. 

“So, we need to work on making sure we keep those core missions alive, healthy, vibrant and growing while still becoming more efficient and better in terms of our delivery of health care, both to underserved communities and communities in need, as well as communities that perhaps don’t have as much need.”

Califano’s clinical expertise includes minimally invasive treatment of tumors of the mouth, throat and head and neck, and he has served on the NCI Head and Neck Steering Committee. At UCSD, he directs a laboratory that investigates the molecular and biological basis of head and neck cancer. 

He will be transitioning from his roles  as director of the Hanna and Mark Gleiberman Head and Neck Cancer Center and co-leader of the Structural and Functional Genomics Program.

Prior to joining UCSD in 2015, Califano was a professor in the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins School of Medicine. He completed a fellowship in head and neck surgical oncology at Memorial Sloan Kettering Cancer Center and a residency in otolaryngology-head and neck surgery at Hopkins. He earned his medical degree from Harvard Medical School.

Lippman, who recruited Califano, will lead—together with Ludmil B. Alexandrov—the PreCancer Genome Atlas, a transformative effort to map the molecular, cellular and structural characteristics of premalignant lesions and how they evolve into invasive cancers.

Catriona Jamieson, Koman Family Presidential Endowed Chair in Cancer Research in the UC San Diego School of Medicine, has recently stepped down from her position as deputy director at Moores to lead the new UC San Diego Sanford Stem Cell Institute. Philanthropist T. Denny Sanford established the institute with a $150 million gift, following on his $100 million gift to the Sanford Stem Cell Clinical Center. Jamieson will continue as co-program leader for the Hematological Malignancies Research Program at Moores.

Califano spoke with Paul Goldberg, editor and publisher of The Cancer Letter. A video recording of the conversation is available here. 

Dr. Califano, congratulations, first of all, on getting this job.

Joseph A. Califano III: Well, thank you very much. It’s a pleasure and it’s a pleasure to chat with you.

When is your first day?

JAC: My first day is tomorrow, actually. In fact, I’m on vacation right now, but I’m returning from vacation tomorrow morning, so I officially start tomorrow.

Tomorrow being Nov. 16, so people will read it on Friday. I am guessing here­—but your name suggests that an interest in public health runs in the family. Is this correct? If it’s wrong, there’s an egg on my face.

JAC: That’s correct. My father also goes by the same name. Joseph Califano had a variety of jobs in public service, so certainly public service does run in our family, and that’s probably part of the reason why I enjoy service jobs and leadership jobs that serve the public good. I think you’re quite right. That is how I view this job, this position in particular—as a public service.

Well, we’re talking about your father, who was the Health Education and Welfare (HEW) Secretary, famously.

JAC: Correct. He was the secretary of HEW, but he actually also served in the Kennedy and Johnson administrations as well, and a variety of other public service roles. In fact, his most recent role was to run a foundation associated with academic institutions on addiction and solving the addiction crisis in the United States. So, he has really made public service part of his life’s work in many different ways.

Public health is really what I was referring to. Your job is a public health job right now—as well as public service.

JAC: You are absolutely correct. It’s interesting, the University of California, San Diego, is a public institution and dedicated to serving the public good, not just in health, but in all other academic and service roles as a public university in Southern California.

Certainly, as a health system, UC San Diego Health is dedicated to serving the entire county.

As a cancer center director and as a NCI-designated cancer center, our catchment is San Diego County, so we have, through multiple different mechanisms, a primary role to serve the public good in San Diego County, both as an NCI-designated Comprehensive Cancer Center, but also as a health system and a public university.

That’s nice, because that makes that a very congruent mission. They align very well.

I always do this. I probably should stop at some point, but it’s really the same question I ask every time I talk with a new cancer center director. Joe Simone used to say “When you’ve seen one cancer center, you’ve seen one cancer center.” What is Moores? How is it different from all the others?

JAC: I think I alluded to this a little bit initially, when I said that we are tremendously aligned in terms of our service as a public university and as an NCI-designated comprehensive cancer center.

San Diego County is quite diverse. First of all, it’s a majority minority county, and that diversity is something that we strive to serve both as a health system, but also as an NCI designated comprehensive cancer center.

We are the only academic cancer center and the only academic health system in San Diego County, so that brings a significant responsibility, not just in terms of direct service to patients, but also in terms of performing research that really addresses the needs of our county, and addresses the needs of our patients and communities.

Then, finally, there’s a real educational mission associated with that. As the sole academic cancer program, really our mission is to make sure we educate not just our community, all our stakeholders, but actually all the other physicians and care providers in our region as well.

Then, San Diego is really a fairly unique area as well. As you know, it’s one of the top biotech hubs in the country. The culture at UC San Diego is really one of not just doing superb science—as you know, its reputation has been built on incredible both biomedical sciences and engineering—but also because there’s this vibrant community that immediately translates these findings to clinical applications and to direct application. So that culture is pretty unique.

I don’t think I’ve found that, personally, to this degree, in any health system or academic medical system I’ve served in over my career.

It makes it very dynamic, very exciting, and also immensely practical. I think the quote we always tell folks is about 30% of UC San Diego faculty have patents or startups, which is an incredibly high amount. It really shows in the culture that people really want to take what they learn and what they investigate and directly apply it to clinical application.

The other unique thing about our environment is the entire collaborative nature of the biomedical enterprise. As you know, we have two consortium partners, San Diego State University, which really has incredible expertise in population science and the La Jolla Institute of Immunology, which is an extraordinary immunology institute. These consortium partners and the collaborations we have with these two partners is really a significant synergistic added value to our particular cancer center.

Then finally, San Diego has some amazing other research institutes as well, including the Scripps Research Institute and the Sanford Burnham Prebys , that really have fairly free collaborations, so it makes this a very fertile and rich environment.

What about community outreach and engagement? What is the special needs of this community?

JAC: As I mentioned, San Diego State University and our collaborators there, as well as our folks who are focused on population science, community outreach, and engagement at UCSD—have a very vibrant partnership.

So, particularly for us in our locations down south and in South San Diego, and particularly along the border, there’s real need and for community outreach and engagement, particularly in these populations that really don’t get enough service in terms of access to health care. But in particular, it’s also access to expert cancer care; right?

So, we have some really unique partnerships where we actually, for example, we have a partnership where we serve Hispanic women with triple-negative breast cancer, but do complex genomic analysis, using some of our expertise from our computational scientists to try to figure out not only what’s really going on in that particular disease, but also in a culturally relevant context, so we can make sure we break down those barriers to make sure those populations get access to really high-end care.

And I think it’s actually fairly exciting, because we have long-standing partnerships with community health centers, particularly around San Diego and South San Diego. And to make sure that we get that access, so that we can serve those communities where they live and work, is the important thing that we need to do. So, that’s not just part of our mission as a cancer center, part of our strategic plan as a cancer center, but also part of our health systems mission as well.

So, the ability to have some unified strategic planning around that is really a luxury that we benefit from. We have health system leaders who are very, very cognizant of the mission of UC San Diego Health to serve those communities. And that works very well with our cancer center’s mission to really do significant community outreach and engagement, and figure out how to execute really expert care in the communities that we serve, make sure that care finds its way to those communities rather than making those folks travel to get that care.

So, your CCSG was due in May next year, and you’ve been given the new date, which is another year. So, what are you going to do in the next 17 months?

JAC: Work very, very hard.

But focusing on what needs to be done…. By that I mean the transition from being the physician-in-chief to being cancer center director.

JAC: Well, so certainly now there is a lot of work to be done, of course, and I’ve been very fortunate that my predecessor, Scott Lippman and Deputy Director Cat Jamieson have really, really done a lot of work in preparation already.

And I’ve been part of that as the co-lead for the Structural and Functional Genomics Program.

But I think we will initiate strategic planning prior to our external advisory board meeting this coming spring. And we’ll do that in a somewhat accelerated fashion. But at any time, I think, when you have leadership transition, it’s a really wonderful opportunity to engage the entire community, to understand what their goals and needs are, see all of our stakeholders, where they are, and what they are looking forward to, and also get a chance to unify people around the specific themes and names that we want to accomplish in the next cycle.

So, I think it’s a golden opportunity actually to have a leadership transition. And although it probably is a little bit time-compressed, we would love to have as much time as we need to do this in a leisurely fashion, I think there’s nothing like a deadline to make sure you really get done what you need to get done and force you to really do those things you need to do to prepare for a grant like this.

So, in some ways, I think, yes, it’s a time pressure, but in other words, I think it’s actually kind of nice, because it makes you get the job done and make sure you do the right things prior to a submission.

What will you do that makes the place yours? What are the fingerprints? What are the thumbprints you’re putting on the place?

JAC: It’s funny. I think when you first kind of opened this conversation that we’re having, you talked about a public service and a public trust, and really a cancer center in this context, we are the only Comprehensive Cancer Center in our region.

We really serve the entire county. We really have a public trust. This is part of what we owe the community, and the community is really our stakeholder in a very big way. When I say community, I mean everything from our populations throughout the entire county, to our scientific community, to our patients, and to all of our investigators. I do think we need to prepare for some of the challenges and some of the opportunities. There’s tremendous opportunities to leverage the incredible science and incredible investigation that we have to really do groundbreaking work.

The quote we always tell folks is about 30% of UC San Diego faculty have patents or startups, which is an incredibly high amount. It really shows in the culture that people really want to take what they learn and what they investigate and directly apply it to clinical application. 

And really, we have people who are already doing that, but it’s really straightforward to imagine how we can accelerate that by making those linkages even tighter between our clinicians, our clinician scientists, and our incredible basic scientists, and then move that out to our community environments through really extraordinary team that’s really been working hard in developing our community outreach and engagement and our population science expertise.

UC San Diego is also just recently started its School of Public Health. That’s an extraordinary benefit, and a lot of resources can be brought to bear. We recently obtained an incredible gift for a Sanford Stem Cell Institute, also an incredible resource that can be leveraged for growth in the cancer center.

In fact, most of the majority of that institute is really going to be dedicated to novel cancer-oriented research. So, there’s a lot of opportunities to go ahead and grow this enterprise in that way. But if I had to say what I would hope a legacy would be for my carrying the torch for this great institution over the next phase of its development, it would be two things.

One is to make sure that we take those incredible discoveries and move them out into the community. And I mean that community, not just in San Diego County, but really throughout the country, as many of them already are, but to really make sure that that pipeline is well refined and make sure we do that in a way that’s works with our culture, which is to rapidly translate things into actual drugs and discoveries and products that get to the market.

The second thing, I think, which is a challenge that’s facing all of us, really, who are working in health care, is that our healthcare environment is changing in terms of how payers reimburse us, and how we integrate with that changing payer mix and make sure we take care of our communities that are perhaps under-resourced, and make sure that we can actually take care of the people we’re supposed to take care of is going to be a challenge.

Health care is just going to be difficult in terms of providing care in a highly integrated health system, to make sure we can provide expert care in that context and still provide it efficiently at a reasonable cost. And I do think that will provide stresses for academic medical centers.

There’s just no way to get around it. As academic medical centers, we have a tripartite mission. We need to take care of the educational mission. It’s critically important, to make sure we have a sustainable healthcare enterprise. We have to make sure we provide high-quality research, provide new discoveries, and at the same time competing against health systems that don’t have those missions.

So, we just need to be better at it than other folks are. We can’t just simply say, “Well, we’re really expensive, and that’s just how it’s going to go, and that’s how we’re going to have to do that.”

That’s not going to work. So, we need to work on making sure we keep those core missions alive, healthy, vibrant and growing while still becoming more efficient and better in terms of our delivery of health care, both to underserved communities and communities in need, as well as communities that perhaps maybe don’t have as much need.

Where do you see room for improvement? Is it on the clinical side? Is it on the basic science side? Is it on the population science side? Where’s the place where you really need to focus to make it the best it can be? I mean, you’re a clinician.

JAC: Well, it’s interesting. You say I’m a clinician, but remember I started my career as a translational scientist. So, was a translational scientist for decades before I entered leadership roles, leading clinical services.

So, I still have an active lab and that’s still deriving incredible satisfaction from looking at raw data, and that’s probably one of my most favorite times of my week when I actually get to sit down with my postdocs and actually wade through experiments.

So, to be honest with you, the trajectory of the institution has been so incredible over the past few years, I mean, the growth, both in terms of the research enterprise, in terms of clinical enterprise, has been unrelenting. And in terms of our population science, the growth has been extraordinary as well. And I can name other areas, including precancer initiatives, immunology and immunotherapy, cell therapeutics—all of those have really grown simultaneously.

So, I don’t view it so much as where does the emphasis need to be? It’s making sure that the accelerated growth in all these areas is coordinated and mutually synergistic, because I think the enterprise itself is simply growing, no matter what anybody else will do with it.

It’s a matter of making sure that this is done on coordinated fashion that everybody can really benefit from each other’s success. And that’s actually a very happy place to be. I think that’s why this is such an exciting job, because really there’s no area that isn’t growing and developing and moving forward.

So you’re really talking system. I’m just wondering if there’s any area where Moores is the place to go. For example, head and neck cancer.

JAC: Well, I mean trying to be as humble as I can be, I think Moores already is the place to go for head and neck cancer, as I think it’s for several other disease sites as well.

And certainly I think you’re right; certainly when you have an environment where you are growing and expanding despite all the challenges, I think the answer is to make sure that you’re growing in a coordinated fashion.

For example, Moores has historically had extraordinary expertise in hematologic malignancy. And one of the great legacies of Scott Lippman, the prior director, is he’s really developed solid tumor and solid tumor therapeutics significantly. And I think that can be continued, absolutely. There still can be more growth in solid tumor therapeutics.

I think our population science and the cancer control programs are extraordinary. We have really amazing leaders, but I think they’re just starting that growth journey, and they can continue to do that.

Certainly we have incredible computational biology group that’s absolutely world-class, but that there’s plenty of headroom to grow there. And certainly, from an immunotherapy and immunology point of view, particularly with our collaboration with LaJolla Institute, I think that’s extraordinary as well.

But immunotherapy is really just in its infancy in cancer therapeutics. We’re really just starting. I know we think we’ve already arrived, but we really haven’t. So, I think to double down and really expand that is important, as well as with our cell biology and pharmacology departments, which are extraordinary. Our engineering has been untouched. So, we have an incredible engineering school and we do leverage some of the expertise from engineering in our cancer center, but I think there’s plenty more opportunity to do that as well.

And I think it’s important to make sure that we can accelerate where we have our strengths, and these are where we have our strengths.

Yeah. Speaking of engineering, that seems to be a big issue right now with ARPA-H. This is probably too nebulous a question, but where does science and engineering begin? And what are the opportunities for a cancer center in this?

JAC: Well, so it’s a great question, because it’s fairly pervasive.

So, certainly from a technological point of view, certainly in terms of imaging sciences, there’s significant opportunities to expand. So, I’ll give you a concrete example. We have investigators who are using ratiometric peptides that are preferentially cleaved, both in neural structures and in cancers, to do real-time intraoperative imaging.

And that requires a number of things. 

One is it requires the actual biology to produce the molecules that can be cleaved selectively in cancer cells or in supporting Schwann cells, and can be cleaved and actually fluoresce in real-time. But, it also requires a computational expertise to be able to switch the imaging that one is looking at intraoperatively to switch between a bright field image and a fluorescent image, and then superimpose them in real-time and be able to provide that technology.

So, engineering can interface with biology, and ideally, this should really be a seamless fusion, as in, for example, in that project.

But, there are different kinds of options. There are very small ways to measure things. There are wearable technologies. There are ways to go ahead and look at specific nanomotors that can actually do real-time fluorescent imaging, deliver therapy. There’s just an enormous amount of applications.

We tend to, at least in our institution, have those work concurrently with a lot of our biologic investigation, but I think that’ll increase. And in fact, we do have some mechanisms, particularly through the university itself, where we’ve actually specifically encouraged collaboration between our engineering departments and our biologic investigators.

What about multi-cancer tests, for example, do they worry you that this is going to open up a Pandora’s box where you’re basically chasing a lab finding for a whole lot of people?

JAC: Well, I think that’s a question that we’re all wrestling with; right? There’s a lot of effort being used to support multi-cancer detection tests, perhaps a modality for cancer detection.

And of course, the litmus test for efficacy of those tests is a reduction in cancer-related mortality. And that’s a very challenging bar to achieve. And we know there’s plenty of other detection tests, or early detection tests, or cancer screening tests, that are in use that have been able to do that, but others that have been significantly challenged.

But I think we do have to be rigorous. I think we have to accept the fact that in order for us to support a test for cancer we need to see that it has an outcome in cancer-related mortality that actually makes a difference for patients.

And, as you know, that is a key fundamental threshold that’s rigorous. So, it’ll be interesting. Those studies are certainly underway in the U.K., and we know that’s important.

What I do think is, perhaps, a more topical concern for me is that we know that tumor sequencing itself actually makes a significant difference in terms of therapeutic choice for lung and multiple other tumors.

And that’s something that it maybe doesn’t get as much press, because it’s a little bit less sexy, but it really makes a difference. And particularly for our populations that have perhaps less access to more expert care, we kind of view that as an equity issue, that our populations that perhaps don’t have access to the latest and greatest thought in terms of how we treat cancer patients don’t get as much sequencing done when they should, and they need to in order to do effective treatment selection.

My predecessor, Scott Lippman, has been working very hard, as have all the University of California Cancer Center directors, to really get support for governmental payers to pay for tumor sequencing for patients who have cancers that can benefit, and for which this has really become standard of care to understand, for example, EGFR mutation status for lung cancer.

We really need to make sure that we provide that truly standard of care for all of our patients, really across the U.S., quite frankly.

I think that’s probably the question that really gnaws at me more than our multi cancer detection test efficacious?

We’ll eventually get that answer, but we now know that tumor sequencing is part of our standard of care. We should just accept that and make sure that our payers can pay for that so our patients don’t have to pay out of pocket, particularly when they don’t have the resources to do that.

JAC: Well, it’s very funny.

I think any time there’s a leadership transition, people always try to read tea leaves into what the new leader will do and how they will affect the institution. And I think particularly when you are in an institution and you take a new leadership role, there’s a tremendous seductive air to maybe thinking that you actually know the institution well, and that you already know what to do. And I think really that’s something to be resisted.

I think one really has to take every new leadership opportunity and look at it with fresh eyes, and really, in some sense, try to remember that you really don’t know the institution as well as you think you do, and take some time to get to know it.

So, as you mentioned, as soon as you become a cancer center director, people want to know immediately exactly what you want to do and try to figure out just exactly what the plan is going to be. But I think it’s worth taking some time to really go ahead and listen, particularly more importantly, if you’ve been in an institution, because I think you need to listen, you need to understand what all your stakeholders really want, what they’re really thinking about.

And it’s more than just a five- or 10-minute conversation. It really requires some time to understand the institution with fresh eyes.

So, I’ve tried to resist making my own individual plans without listening to stakeholders.

And I’ve learned throughout the years that really it’s a much richer experience and the institution does a lot better, and I learn a lot more. And we end up being much more productive if we take a little time to listen and understand where everybody is and what everybody’s needs are.

So, I push back against that idea that somehow I would… Immediately, what I wanted to do with the cancer center, I think one actually has to really hold that thought in advance and think very hard and listen, listen, listen, listen.

So the past is not the future, but I guess maybe there’s another way of asking it. This should have been my first question. Why did you apply for this job?

JAC: Oh, I applied for the job, because one of my greatest joys is to help teams achieve more than they ever thought they could as a team.

I get more and more excited about helping the achievements of others, and really watching that flower and watching teams do well. And I’ve just found that to be extraordinarily fun, and it brings me great joy. I think also it’s just an extraordinary opportunity to really serve an important role for a very large community that has real need.

San Diego County is a wonderful place. It’s got significant health challenges, significant challenges in terms of cancer, in terms of its broad and diverse population, with a variety of opportunities to access high quality health care. And it’s really an extraordinary opportunity to make a huge difference for a population of 3.7 million people. Just an extraordinary opportunity to help an enormous amount of people. So, that makes it irresistible.

Oh yeah. Is there any question I forgot to ask? Anything you want to bring up?

JAC: No, I think it’s just I have to be honest, it’s just tremendously exciting to really have an opportunity to work with such an incredible institution.

I’m continually impressed and surprised with just how extraordinary a place it is that I work. And it’s kind of fun. I’ve been there for seven years. Not a day goes by when I don’t realize that somebody’s doing something absolutely extraordinary I didn’t know about, and I’m learning something new.

And I think that’s an incredibly attractive thing about a place that’s in a significant growth trajectory and really moving forward on all cylinders. Just really, it’s an exciting place to work and you learn something every day, and I wouldn’t trade that for the world.

Well, thank you so much. This sounds really exciting.