publication date: Feb. 8, 2019

Conversation with The Cancer Letter

NYU receives NCI Comprehensive Cancer Center designation

BenjaminNeel_2-5-15_ 300 dpi

Benjamin G. Neel

Director,

Laura and Isaac Perlmutter Cancer Center, NYU Langone Health

 

The Laura and Isaac Perlmutter Cancer Center at NYU Langone Health received the Comprehensive Cancer Center designation from NCI.

The announcement was made Feb. 6. Now, NCI has 50 comprehensive cancer centers across the U.S., three of them in New York City.  The city also has two clinical cancer centers.

When Benjamin G. Neel accepted the job of director of the cancer center in 2014, he promised to attain the comprehensive designation after two five-year cycles. Since he took the job at mid-cycle, this would have been 2023.

“It’s five years ahead of when we planned to do it. I promised the Perlmutters and the dean [Robert I. Grossman, dean and CEO of NYU Langone] that we would get comprehensive status in five years, but my friend Kwok Wong, in a different context in a meeting said, ‘You should go big or go home,’” Neel said to The Cancer Letter.

To meet this challenge—or for that matter just to stay afloat—Neel had to recruit an entire level of leadership, and do it rapidly.

“When I came here, there was an unprecedented number of vacancies in the leadership positions,” Neel said. “That was both a challenge and a tremendous opportunity, because you don’t usually get this kind of situation. We had the kind of leadership vacancies that you usually would see in a place that was starting out and was trying to grow into a designated cancer center.

“We were, actually, lucky that we were able to fill so many of these positions and get a lot of improvement early. And so, I felt that it was worth taking a shot at comprehensive. I felt we’d give it our best shot, and by the time we actually put the grant together and read it and everything, I felt that we deserved comprehensive status for the grant. But I think up until then, it was a 50/50 chance. And I also felt that regardless of what the site visit team said, we were a comprehensive cancer center.”

NYU was among the first cancer centers to receive NCI-designation and comprehensive status, but lost it in the 1990s, regaining the clinical cancer center designation in 2003.

Since NYU received an overall “outstanding” rating, it will receive a little over $2.35 million in new funding each year (direct costs) for its research programs, shared resources, educational and community outreach activities.

This adds up to nearly $20 million for the five-year grant. This represents a 51 percent increase from our last grant, one of the largest increases to any cancer center, NYU officials said.

 

Neel spoke with Paul Goldberg, editor and publisher of The Cancer Letter.

 

Paul Goldberg:

First, congratulations on the designation.

Benjamin Neel:

Thank you. It was a long haul, but, you know, everybody’s pretty happy, so it makes it worthwhile.

 

PG:

There’s an often-made, often-quoted observation that once you’ve seen one cancer center, you’ve seen one cancer center.

BN:

That’s probably true. It’s a good observation.

 

PG:

Well, what is your center like, how is it different from all the others?

BN:

I think what’s really the big story here is that when I came here, we had a unique opportunity in that we were an NCI-designated cancer center, and we’re embedded in a major medical center.

But, on the other hand, when I came here, there was an unprecedented number of vacancies in the leadership positions, pretty much unprecedented for a designated cancer center.

That was both a challenge and a tremendous opportunity, because you don’t usually get this kind of situation. We had the kind of leadership vacancies that you usually would see in a place that was starting out and was trying to grow into a designated cancer center.

And that, plus the $50 million gift from the Perlmutters, gave us the opportunity to rapidly reshape the cancer center almost from the ground up. We were in some ways a new cancer center, and, also, we were coming from the standpoint where we’re already designated and embedded in a very rich medical school that had a lot of strengths in the discovery or basic science areas.

It’s literally no exaggeration that the entire leadership team was changed in the three years before the grant. New deputy director, a new associate director, new associate directors, of basic translational, population sciences—basically every single leadership position.

And I would say, I don’t remember if it’s half or a little bit more than half of the program co-directors. We’re basically a new cancer center, and at the same time, we’re starting from the standpoint of a designated cancer center.

That’s the big story here, and it’s in the context of similar changes that were going on in advance of that for about five years at the medical school, where the medical school has gone from a solid middle-tier medical school to a medical school that’s ranked third in the country.

I think the story that makes us different than others is that we’re a turnaround story, or a transformation story, an entirely new cancer center from where we were four years ago.

And I think that that was an unusual combination of circumstances that allowed that to happen.

 

PG:

How did you do it?

BN:

How did I do it? It’s hard to summarize.

First of all, I’m very fortunate in the sense that I had spent eight years in Toronto, at Princess Margaret Cancer Centre, so I had actually seen firsthand what a really strong clinical research operation looked like. In Toronto, we had world-class clinical trials in phase I and phase II in the drug development program.

And, at the same time, we had a strong basic science environment. So I had some ideas in advance about what needed to be done here at NYU.

When I came to Toronto, my clinical colleagues there were very skeptical about having a basic scientist come in as the research director, because I think that there was sort of a tension between the clinical side and the research side there.

And I rapidly realized that the operation actually starts from the clinical side, and then the clinical engine or the clinical operation helps support the basic science, not the other way around.

And I think that many of my basic science colleagues haven’t benefited from that insight when they take a job like this, or maybe they don’t know much about the clinical side.

When I came here, I looked at the landscape. We spent about six months having a relatively truncated strategic planning process. When I was in Toronto, we took a year to do that, because we had more time.

But here, with the impending cancer center grant, and also with the need to really fill the leadership positions, there was just an incredible assortment of problems. The clinical trial operation was really embryonic and dysfunctional. We were short-handed in multiple areas. We didn’t have these leadership positions filled. We had to make these decisions reasonably quickly.

And my general feeling is that cancer centers should have full service teams in major disease areas, where you have basic science translation to the clinic and then back, and population research, too.

When I came here, melanoma was the only area that was even close to being a full service or a fully integrated program, where you go bench to bedside and back, and even that wasn’t that strong. And then we had these leadership vacancies.

I think it’s important to figure out what your exact priorities are, and my priorities were twofold.

One was to fill those leadership positions, and the other one was to build three to five full-service bench-to-bedside-to-bench clinical research translational teams.

I’m a big football fan, so this has been a very good week for me, because I’m a Patriots fan.

It’s been a good week all along: Patriots win the Super Bowl, $75 million gift [to PCC], and then the comprehensive cancer center designation, all in four days.

That’s pretty good.

I know from football, in the 70s and 80s, when I was growing up, that there were two major strategies for football teams to develop.

One was the Washington Redskins, which is you draft by position. And the other one was the Dallas Cowboys, and they were always, you take the best athlete. And I felt that that was a faulty distinction for building great cancer centers and even great football teams, and that the answer was somewhere in the middle.

Since we had all these leadership vacancies, like head of hem/onc and head of med/onc and head of neuro/onc and head of gyn/onc, deputy director.

And so, I felt we should go after the best player available for those positions, and then have that help weight the decision on which disease areas to build, with some weighting from the research that was already here.

When we got Alec Kimmelman as head of radiation oncology, and we already had Dafna Bar-Sagi and George Miller and several other people here who were RAS experts, it seemed like pancreas cancer would be an obvious area to try to build strength in.

And then we were able to get Diane Simeone [associate director, translational research] to come from Michigan, and Paul Oberstein from Columbia, to complement Deirdre Cohen, who was already here in medical oncology to fill out the team.

And then we got Kwok-Kin Wong from the Farber as head of hem/onc. We already had a good young researcher here in lung cancer.

We have a lot of lung cancer patients, who were coming to see Abe Chachoua, a great lung cancer doc. We went out and got initially Leena Gandhi, and then she was successful and went to Lilly, and we recruited Vamsidhar “Vamsi” Velcheti to be head of thoracic medical oncology. And then we went and got Robert Cerfolio from Alabama, who’s a really extremely busy thoracic surgeon, robotic surgeon.

That was sort of the general strategy that we used: get the best player available for the leadership positions, and then use that to inform the areas that we’re going to grow our center in.

That’s actually the cancer center, not the [NCI] grant. Okay? I’ve always viewed grants as different from the enterprise. They are a part of the enterprise, but the grant is only a small part of the reinvigoration of the Perlmutter Cancer Center.

In terms of the grant itself, then, you have to add on additional considerations that have to do with, as you know, the vagaries of cancer center grants, like promoting collaborations, having the best cores.

And so, there I felt that doing the same thing over and over again, and expecting a different outcome is generally not a good strategy in any area of life. And this place had tried to get comprehensive status multiple times after it lost it in the ‘90s, and, basically, it was the same people doing it.

I felt that we needed to shake up the leadership and get a bunch of young people and new people involved, and I also felt it was important that we partner—every program have one basic scientist and one clinical person.

If you are going to have translational programs, you have to have people who are at least conversant in both areas. That was sort of the general strategy.

I don’t know if that’s more than you want to know, but that was the strategy…

 

PG:

This is terrific. I feel like I understand something. Actually, when I was calling a bunch of friends and asking, “Well, what do I ask Dr. Neel?” most of them said, “I’m not too sure what’s happening at NYU.” Which is sort of interesting. It’s consistent with what you were saying, is that it’s, they’re just getting to know us. Because NYU has changed quickly.

BN:

I’m starting my fifth year, but the cancer center grant went in after three years, at basically three years.

The cancer center grant went in January of last year, and that was the start of my fourth year, so I started January 2015. I would say the majority of the transformation occurred in the first three years.

It’s five years ahead of when we planned to do it.

I promised the Perlmutters and the dean that we would get comprehensive status in five years, but my friend Kwok Wong, in a different context in a meeting said, “You should go big or go home.”

We were, actually, lucky that we were able to fill so many of these positions and get a lot of improvement early.

And so, I felt that it was worth taking a shot at comprehensive. I felt we’d give it our best shot, and by the time we actually put the grant together and read it and everything, I felt that we deserved comprehensive status for the grant.

But I think up until then, it was a 50/50 chance. And I felt that regardless of what the site visit team said, we were a comprehensive cancer center. It was just good to get the endorsement of the site visit team that they agreed.

 

PG:

It kind of confirms another one of those truisms in cancer centers, which is you’re as good as the people you hire.

BN:

Well, that’s true of any enterprise.

 

PG:

It seems to be.

BN:

I think that another strategy that I learned is that I think there’s two types of people who take leadership positions, the people who always want be the best person in the institution, and the people who want people to be better than them around them in the institution.

I’m not intimidated by having smarter people than I am around me, and so, in fact, I think that that’s the way you build strength. I mean, I had John Dick and Tak Mak back in Toronto, so I can deal with people who are better than I am.

I worked next to Lou Cantley for 20 years. If you want see some ego destruction for a basic scientist, try that.

 

PG:

It’s interesting, because you are in a cancer-center-rich neighborhood. Now, there are three comprehensive cancer centers in the city alone; right?

BN:

Yes.

 

PG:

Including yours. And then two clinical. There’s a basic cancer center, Cold Spring Harbor, and then, if you want to go as far as Roswell Park, there you go.

BN:

Well, there is Rutgers, in New Jersey. They are a comprehensive cancer center. Rutgers is closer than Cold Spring Harbor. And Yale is not far, either.

 

PG:

Of course. None of it is far. I was staying within the state boundaries, but what you’re saying is more realistic. Basically, does this concentration of cancer centers present any specific challenges and opportunities?

BN:

I think that was definitely a challenge in terms of the grant, in terms of the committee. I think that there’s a natural inclination for people to think, “Well, New York already has two comprehensive cancer centers. Why do you want a third?”

But I’ll say two things about that.

One was in the context of doing the grant itself, and having to go through the catchment area exercise, it became quite clear that the catchment areas for these centers are actually quite different, and ours is clearly unique.

The other major thing that I probably should have said earlier is that the major factor that allowed us to apply for comprehensive status—and that is that something that occurred both prior to and continued through my arrival, and I take no credit for it—is the dramatic expansion of the NYU Langone Health Network.

We acquired NYU Langone Brooklyn. We have an agreement to acquire Winthrop Hospital. As of August 2019, they’ll be NYU Winthrop on Long Island. And there was just a tremendous expansion of network sites all throughout Queens and, well, mainly Brooklyn and Queens, and some on Long Island.

Whereas our catchment area in 2012 and in 2007, actually, in 2001 or ‘02; I don’t remember when, was limited to Lower Manhattan, now we serve 7.2 million lives, and our catchment area extends over four boroughs and Long Island.

Our catchment area is really that large and that deep. If you look at Mt. Sinai, Mt. Sinai really goes to Upper Manhattan, and then into Westchester, and then outward.

And then, Columbia is more on the Upper West Side and Midtown on the West Side of Manhattan, and then into Westchester, and a little bit into New Jersey. Of course, Memorial lists its catchment area as the Tri-State area, so they do overlap all of us.

But I think all of the other centers are really geographically distinct in their catchment areas. I mean, there’s some overlap, obviously, but they’re really quite separate.

And, of course, the other thing to keep in mind is that Brooklyn alone is four million people. It’s the fourth largest city in the United States. I’m not a New Yorker, so I learned a lot about New York and about the geography and the populations and everything in doing this grant.

 

PG:

Whenever I talk with cancer center directors, conversation drifts to outreach and engagement these days. How is your outreach and engagement working? What’s the focus?

BN:

The two major weaknesses of the previous reviews were in the population sciences and in the outreach and engagement that came from there. I think that, again, antedating my arrival, the institution made a major commitment in the establishment of the Department of Population Health and the recruitment of several people into that entity, as well as the NYU Downtown campus established a new Department of Global Public Health, which also has several researchers in it who do cancer-oriented stuff.

For the grant, I think, our highest score was for community outreach and engagement, actually. And our major areas of engagement are in smoking policy, so for example, Donna Shelley and Scott Sherman have been very active in doing smoking-oriented population research that is translated into outreach into the communities to deliver best practices into, for example, New York Public Housing Projects, in terms of non-smoking policies.

There’s a big e-cigarette program, both here and on the Downtown campus, in terms of evaluating the benefits and risks of e-cigarettes.

We have an Asian center at NYU Medical School, and the director of our outreach and engagement effort, Chau Trinh-Shevrin, associate director for the outreach, she’s the director of that Asian center, too, and she’s done a lot of work on HPV and H. pylori. And that actually nestles in very nicely with the research here, in terms of the microbiome and its contribution to tumor immunology, and also to tumor pathogenesis.

And I should say, one other area that we really do a lot of outreach into is in the obesity area.

Brian Elbel, who’s also in our pop sci effort, has been instrumental in influencing legislation. He showed clearly in initial research that something so simple as putting water fountains in all the cafeterias in New York public schools reduces soda consumption. And that led to public policy changes.

We try to do that kind of outreach. And right now, we are actually in the midst of planning a big, new outreach effort that we are trying to obtain major philanthropic and grant support for that we are going to call Stamp Out Cancer Brooklyn.

We’ve already outlined our major strategic effort in the outreach and engagement domain for the next cycle, and it’s a new program that we want to launch sometime in the next year or so.

We’re trying to raise a lot of money for this.

 

PG:

What was the war chest? In 2015 when you came in, how much money did you think you’d have, and how much did you have?

BN:

Well, I’m not really allowed to say what my startup package was, but I can say that it was north of $100 million.

The Perlmutters gave $51 million as part of that, and then institutional and other philanthropy was more than that.

But then that was just for my initial startup package, but the institutional commitment overall for the center in terms of new building, acquiring all these hospitals, was half a billion dollars.

 

PG:

Institutional commitment was about half a billion?

BN:

What we listed in our institutional commitment was close to half a billion. And, again, because we acquired NYU Brooklyn, we built new centers, new clinical practices all throughout the boroughs and Long Island.

And also several new facilities here.  For example, the cancer center research space more than doubled.

You’ve probably heard, we just announced a $75 million anonymous gift for building a new Center for Blood Cancers. That’s actually another thing that’s happened here.

We had an elementary, embryonic bone marrow transplant program. There had been multiple attempts to try to get allogeneic transplants off the ground here, and it was multiple failures.

We’re just really fortunate to recruit Samer Al-Homsi from Michigan State, and he’s come and he’s just totally transformed bone marrow transplants.

Last year, right after we got our cancer center score, we got FACT accreditation for allo. We’re doing over 100 transplants this year. We’re going to start a new outpatient bone marrow transplant program.

Again, I don’t want to be bragging here or anything, but I think that the point I want to convey is, which again, I think is actually, unfortunately, the fact that you say it is actually validation to something I say all the time, which is I feel like in some ways Perlmutter Cancer Center is the best kept secret in New York.

I think that anything you can do to help us on that, I think that’s our major limitation. People don’t know it.

 

PG:

It’s not a secret anymore. Is there anything we’ve missed, anything you’d like to add?

BN:

No. I just want to say that I think that this is a great. I feel like the turnaround and enhancement is a great story, and I think that it’s very clear that this was due to a constellation of circumstances that included most prominently the ability to convince a number of really extremely talented and productive people to leave their institutions and take the risk of coming to New York and trying to basically rebuild a now-comprehensive cancer center on the fly.

And people like Jeff Weber, and Kwok Wong, and Diane Simeone, and also Alec Kimmelman and several others—they all took a big risk by uprooting their families from major centers to come here. And I hope that they’ve felt validated.

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