publication date: Jan. 29, 2021

Conversation with The Cancer Letter

Ed Kim tells us about building a $1 billion City of Hope campus in Orange County

Edward-Kim2

Edward S. Kim, MD, MBA

Physician-in-chief, City of Hope Orange County

Vice physician-in-chief for City of Hope National Medical Center

 

In his previous job, in North Carolina, Edward S. Kim helped build a cancer program where there was none.

In his current job, in Southern California, he is putting together the research and cancer care infrastructure for a $1 billion cancer center in Irvine.

“It is a unique opportunity. You are very familiar with the work that Derek [Raghavan] and myself did in North Carolina, and that was taking a community-based not-for-profit healthcare system, and building a network that was academically-leaning, but not really within an academic system. So, we built that type of system and connected a network.” Kim, who late last year became senior vice president and vice physician-in-chief at City of Hope and physician-in-chief at COH Orange County, said to The Cancer Letter.

Before joining City of Hope, Kim was chair of Solid Tumor Oncology and Investigational Therapeutics, the Donald S. Kim Distinguished Chair for Cancer Research, and medical director of the Clinical Trials Office at the Levine Cancer Institute, Atrium Health, in Charlotte, NC, and a professor of medicine at the University of North Carolina, Chapel Hill.

Prior to Levine, Kim was an associate professor in the Department of Thoracic/Head and Neck Medical Oncology at MD Anderson Cancer Center.

“City of Hope is an entirely new and different challenge,” Kim said. “It is a phenomenal cancer center, really been focused on humanitarianism, and really treating the entire patient, and driving research.

“Their innovation and research have been exceptional, with synthetic insulin and CAR T, and the way they’ve been able to be a leader there,” Kim said. “They are now trying to be a new leader in establishing a second campus. There are some examples out there—maybe Mayo Clinic—but these are not campuses that are in proximity.

“If you triangulate Mayo Clinic [Florida and Arizona], they are the furthest distance away from Rochester.

“This is really to expand the services, the footprint of City of Hope in California, and to go into a county, Orange County, which has 3.2 million people, which has some very good hospitals and centers. However, 20% of current residents diagnosed with cancer still leave the region for care. The objective is to bring advanced care closer to home,” Kim said.

When completed, City of Hope will operate two cancer campuses in its four-county primary service area. The other academic cancer center in Orange County, the Chao Family Comprehensive Cancer Center, is a part of UC Irvine. Academic cancer centers in greater Los Angeles area include UCLA Jonsson Comprehensive Cancer Center, USC Norris Comprehensive Cancer Center, and Cedars-Sinai Samuel Oschin Cancer Center.

“We are ready to work with people in Orange County, whether it’s other healthcare systems or providers, businesses, technology, and the community. We are trying to elevate the overall level of care and develop the future model of healthcare delivery,” Kim said.

“How big of an impact can we have in a community—and, again, community seems like a small word for 3.2 million people—to put a very scientifically-driven, clinically excellent center, such as City of Hope, but also make sure we’re connected to a regional network in Orange County, so that we’re truly being inclusive, not only in our care patterns and the delivery of care, but also the research that we want to bring to folks?”

City of Hope has opened doors at its Newport Beach location in January as the initial phase of its plans to invest $1 billion, funded in part by philanthropy, to develop and operate a regional cancer care network featuring a world-class cancer center in Irvine.

The planned 11-acre Irvine campus will house a comprehensive cancer center opening in 2022 that will offer specialized cancer care, phase 1-3 clinical trials, precision medicine, and early detection and prevention programs. The City of Hope specialty hospital in Orange County is expected to open on the campus in 2025, Kim said.

“Having two campuses will be unique,” Robert Stone, president and CEO of City of Hope, said to The Cancer Letter when the project was first announced in June 2019 (The Cancer Letter, June 28, 2019).

“I think it’s incumbent upon all NCI-designated cancer centers to not just be disruptive with their research, but also to disrupt the way those innovations get to patients,” Stone said at the time.

“The network that we have developed will be disruptive, because we will take the innovative care we offer at our cancer center and make it available in the communities where more and more patients, due to healthcare reform and geography, are receiving their care.”

The City of Hope cancer campus is located on a former U.S. Air Force base in the Great Park neighborhood of Orange County. The 11-acre campus, which includes a 190,000-square-foot building, is part of FivePoint Gateway in Irvine, a 73-acre commercial section of the neighborhood.

The Irvine campus is part of a parcel being developed by FivePoint Holdings.

 

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

 

Paul Goldberg:

Can you tell me what you what your new job is?

Edward S. Kim:

My official position is physician-in-chief of City of Hope Orange County, and my other position is vice physician-in-chief for City of Hope National Medical Center.

I’ll be overseeing the clinical and research development of Orange County—that’s our network, with a main campus in Irvine, with both an outpatient and an inpatient hospital, and then we will have several regional sites in Orange County.

 

PG:

Can we back up and talk about City of Hope becoming a two-campus cancer center?

ESK:

Yes. Just as you’re saying.

I should mention, Paul, that I am working really closely with Annette Walker, our president of Orange County. She is the lead administrator, and I’m the lead medical position. It’s a great partnership.

It is a unique opportunity. You are very familiar with the work that Derek [Raghavan] and myself did in North Carolina, and that was taking a community-based not-for-profit healthcare system, and building a network that was academically-leaning, but not really within an academic system.

So, we built that type of system and connected a network (The Cancer Letter, Jan. 4, 2013).

City of Hope is an entirely new and different challenge.

It is a phenomenal cancer center, really been focused on humanitarianism, and really treating the entire patient, and driving research. Their innovation and research have really been exceptional, with synthetic insulin and CAR T, and the way they’ve really been able to be a leader there.

We will now be a leader in establishing a second campus. There are some examples out there, maybe Mayo Clinic, but these are not campuses that are in proximity. If you triangulate Mayo Clinic [Florida and Arizona], they are the furthest distance away from Rochester.

This is really to expand the services, the footprint of City of Hope in California, and to go into a county, Orange County, which has 3.2 million people, which has some very good hospitals and centers. However, 20% of current residents diagnosed with cancer still leave the region for care. The objective is to bring advanced care closer to home.

We are ready to work with people in Orange County, whether it’s other healthcare systems or providers. We are trying to elevate the overall level of care and delivery—I want to develop the future of healthcare delivery.

How big of an impact can we have in a community—and, again, community seems like a small word for 3.2 million people—to put a very scientifically-driven, clinically excellent center, such as City of Hope, but also make sure we’re connected to a regional network in Orange County, so that we’re truly being inclusive, not only in our care patterns and the delivery of care, but also the research that we want to bring to folks?

People should not have to travel to find research, we want the research to find them, to work with technology partners in Orange County, which is a Silicon Valley type environment, with lots of innovation and people with lots of ideas.

What is the delivery of care, that patient experience looks like, if we want to predict 20 years down the road?

This is what I feel our challenge and our goal is, and I’m taking those cues from our system leadership like [COH President and CEO] Robert Stone and [President and Physician in Chief, City of Hope National Medical Center] Mike Caligiuri.

Irvine-

City of Hope Orange County. – Photo courtesy of CIty of Hope.

 

PG:

How far is this from being built right now, how far are you from opening the doors?

ESK:

The outpatient portion of the cancer center, which is the outpatient portion, is projected to open in mid-to late 2022 right now.

 

PG:

So you’ve got two years of construction.

ESK:

Yes. And then the hospital, which will be the inpatient portion, right now estimation is 2025, but that’s a little far off to give too many specific numbers.

 

PG:

So, you are in the design phase; right?

ESK:

Yes. They’ve broken ground, they are retrofitting an office building that was on the campus, so again, one of the unique aspects of this whole project is that it’s a collaboration with FivePoint, the developer who owns 120 plus acres on the Great Park in Irvine.

We have 11 acres on that land, and part of this vision is that not only will we build a campus to help treat patients in that region, but we will also be working closely with our partners there to help develop Great Park to be an ecosystem of connected health, wellness, technology, innovation. As that entire property develops, we will be in step with them, developing, and placing our healthcare staff in that region.

It offers many possibilities to include technology for people who may be living in Great Park and in Orange County, to start following people longitudinally, through monitoring technology, so that we can help them be healthier, help detect cancer earlier, maybe identify those who are at higher risk. Cancer covers the entire spectrum of people who are healthy, but high-risk, all the way through treatments, and then to those we cure. We need to follow them long-term for survivorship, and make sure we keep cancer away.

 

PG:

How much of what you will be doing will be clinical alone, on this campus, or will there be clinical and basic research? Will basic research stay on Duarte campus?

ESK:

There will be some things that should stay in Duarte.

They have great manufacturing facilities and have clearly established a real pattern and talent for that. The goal, ultimately, is that it is one enterprise, the City of Hope. When you say, “A novel phase I study opens at City of Hope,” it’s not going to be, “Well is it open at Orange County, or is it only open in Duarte?”

It will be open at City of Hope, the enterprise, and that will be inclusive of Orange County and the main campus.

To answer your question about basic research, right now, the planning has included to be clinical services, but I fully expect that we are going to have clinical trials available there that are phase I through phase III.

We will want to have services like CAR T, and perhaps autologous BMT, and I could see a future where we would have research labs there as well, Paul, because, you know, part of the keys to figuring out cancer, unlocking it, is to collect biospecimens, study people’s genomes.

The more talent you can put into a system, into City of Hope, where we have laboratory researchers and innovation in the lab that moves into the clinic, and then the clinic is able to then make sure that it is accessible by the different represented populations.

That is our real goal in Orange County—to be accessible, cutting-edge and inclusive.

 

PG:

Just thinking back to last time I sat around in your office, you were doing the exact same thing at Levine, in Charlotte.

ESK:

That was about eight years ago. I was at MD Anderson from 1999 to 2012, and then 2012 to 2020 in Charlotte.

Well, we were building a network. The difference was we weren’t an academic system. We are a clinical hospital, and what we had to build was some of that academic prowess. We were able to do that successfully.

Working with Derek Raghavan, we were able to make research available in 26 sites across North and South Carolina. It was rewarding and a joy to work with him and be part of Levine Cancer Institute.

I think the City of Hope Orange County vision allows me to combine experience at MD Anderson, which was a lot of innovative precision-based research with BATTLE, and really growing academic muscle there, understanding the culture of an academic center, and then going to Levine, where there was no academic center, we had to build it, in the community, understanding the need, the challenges of delivering sophisticated care, expertise, and offering services like clinical trials, genomic testing, specimen collection, in a standardized manner across the community, on the front lines.

These are the two training areas where I’ve spent the last two decades. Now, I will try to take these experiences and not just make them additive, but magnify insights from both in Orange County to support City of Hope and elevate the entire enterprise.

 

PG:

Plus, you picked up an MBA degree.

ESK:

Yes, I got one of those. I’m a Tar Heel now (University of North Carolina Keenan-Flagler School of Business).

 

PG:

Speaking of which, how does the market look, how do you see your catchment area in terms of research, and also market, in terms of other competitors—there are several: there’s UC Irvine, there’s UCLA, there’s USC, there is Cedars-Sinai. How does it all configure, and how do you know you have room to expand in that market?

ESK:

It’s a competitive market, because there are other very good health systems and universities.

There’s 3.2 million people, so it’s still a big market.

When I was in Houston, working at MD Anderson and working in the Texas Medical Center, we had neighbors right next to us, across the street, that were different health systems.

My belief is that the most important thing is that, and I’ll quote Annette Walker on this, “The competition is cancer.”

We are trying to reduce the incidence of cancer, help patients live longer and better, a life without cancer becoming cancer-free. We’re willing to work with anyone in that region, partner with them, support them, and really be part of the team in Orange County that can deliver the best care to these patients.

That being said, again, when I moved to Charlotte, North Carolina, everyone told me, “Well, you’ve got Duke, you’ve got UNC, you’ve got Wake Forest, you’ve got MUSC.”

My attitude, Paul, has always been, yes, we have a common goal, which is to eradicate cancer and help the people. Personally, whenever I embark on a project, the goals are always against myself.

None of us can control what anyone else does as far as other healthcare systems, other universities. My focus has always been, what WE are doing, what is City of Hope is doing now in Orange County—that’s my focus.

The goals that we set are internal, because we want to be the best we can be, because that’s the only way that we’ll be able to deliver the best care, the best access, the best inclusive research, to the people in Orange County.

 

PG:

I guess another thought here is, what kind of people are you going to be recruiting now, and how soon will you start?

ESK:

We have one site open, a regional site that’s actually opened before the cancer center. It’s in Newport Beach. There are four physicians there, three medical oncologists and a surgeon. It’s really the first step in how the entire Orange County network will look.

It is a mixed model in that there are four people, who are based there at Newport Beach. What they’ve done is also had three or four of the disease site experts come down through Newport Beach as well.

Monty Pal, for instance, has a clinic there that he goes to several times a month. Also, we have Amrita Krishnan, Tanya Siddiqi, and Ravi Salgia, who have been going there for a while.

What that has done is really create a closeness between the faculty who are based there and the experts on the Duarte campus.

What we are planning in Orange County is, again, a combination of that. We need to have high-skilled, excellent physicians and nurses who know the community.

There will be some strategic partnerships that we will want to have within Orange County, but also, we want to recruit national-level experts in disease sites, and especially those will probably be more baseded on the Irvine campus.

They’ll all be working together with the Duarte campus as a single enterprise, so if we hire a person who is a national leader in GI cancers, they will work in the GI section for City of Hope, they will be City of Hope faculty members. However, they will be based in Orange County.

Again, it speaks to the overriding theme that this is the City of Hope. The City of Hope is not just now one place. It’s where Sam Golter put up the two tents 100 plus years ago, and said, we are going to help people with TB. Please come here and we will offer science and healing. That’s why we are the City of Hope, and how he helped people and their families and really try to be very humanistic to them, treating the mind, body and soul.

We started with TB, and then transitioned to cancer, because the architect for the building was a young man who came down with leukemia and died. Our founders turned to cancer care because, after tuberculosis subsided, we were presented with a new need for expert treatments and research. That’s where the shift went to cancer. It’s a devastating disease that was on the rise. We need to help patients, we need to treat them, and we need to drive the research.

I’m basing my work on the principles that Sam Golter published and espoused—we’re taking those same concepts and we’re going to apply them to the next generation of what City of Hope can become.

 

PG:

You are going to be hiring a whole lot of people, presumably.

ESK:

If we consider the network, and we consider that we’ll need surgical oncologists, radiation oncologists, medical oncologists, medical specialties, APPs, nurses, pharmacists, we’ll need people who can do supportive care, genetics, precision medicine. I don’t know what a “whole lot” looks like, I certainly don’t want to over-hire, as you know, but we will need expertise.

I think, Paul, we’ve got a lot of great expertise on the main campus, so the trick, and the key will be to hire people strategically, but also utilize our talent within the system as well.

That would include telehealth, because the world has changed now with COVID, so using digital services and connectivity is crucial. It is unprecedented, the way medicine has been delivered, compared to any other time in our history.

 

PG:

Actually, how impacted was City of Hope by COVID?

ESK:

Like a lot of cancer specialty places, there were people who didn’t want to come in for their wellness checks and their screening, and that’s really where cancer in general has been impacted.

We know that the incidence of cancer is not going down, but we’ve seen the number of cases go down, and I think we’ve seen that because people are staying away from the screening exams.

Overall, when you have cancer and you need to be treated, you need to continue to get those treatments. I think there’s been much less impact at City of Hope, because we implemented the highest safety standards and let patients know it was safe to return. I think everybody dropped a little, but just not the magnitudes of those primary care or internal medicine, or those other areas.

 

PG:

You’ve caught up though, right…

ESK:

Yes—catching up fast. Everybody’s going to feel a little bit of something this year, but unfortunately in oncology, there just isn’t much you can do to delay when you have patients who have cancer.

 

PG:

What led to your decision to leave North Carolina, because you seemed like a happy guy there?

ESK:

It’s a great place, Levine Cancer Institute.

We’ve really built that into something special and something I’m very proud of, and have lots of fond memories. I have a great friend in Derek Raghavan and many of my chiefs that I hired there.

Paul, I can tell you, I’ve never aspired to live in California. I’m a Midwestern kid, and Texas.

Let me start with City of Hope—it’s a very special institution. It really intrigues me, the way it was created, and the people there. Arti Hurria was a very close friend of mine. She was a symbolic person who embodied what City of Hope is all about (The Cancer Letter, Nov. 9, 2018).

The commitment that Robert Stone and their board are making is really a serious commitment. That was actually the first thing that I said, “Okay, maybe I should look at this a little closer.” Because you just don’t see this every day, or even once in several decades, where a center like this, like City of Hope, wants to be this ambitious and grow. This is going to be the largest expansion in the history of their center.

I’m very flattered and humbled, actually, that they thought I was the right person for this job. I’m really excited to be a part of developing, envisioning what the future of a healthcare delivery model could be in Orange County, and how that could affect City of Hope, the enterprise.

Paul, it’s like one of the things where I think my ambition is also something that I can’t control myself.

I seem to like to build new things. Now we have two data points on my timeline over the last 20 years.

 

PG:

One’s a lot.

ESK:

Orange County is such a great place. The people there, the breadth of this, I mean 3.2 million in a county. Look at the type of impact we can make!

Maybe we’ll get there and maybe we won’t, but all I know is that I’m going to try my best, I’m going to try to use every skill that I have, that I’ve acquired, that I’ve learned from people, whether it was from Waun Ki Hong, and Fadlo Khuri at MD Anderson, all the way up to Derek Raghavan, to now, learning from Mike Caligiuri, Steve Rosen, Steve Forman, Robert Stone, president and chief executive officer for City of Hope and then from Annette Walker.

We just need to make sure we step back and say, “How can we make this really the next generation, the next level of care delivery, of taking care of people?”

That could include: How are we going to connect more with patients when they’re at home? How can we engage them to be more active in screening and genetics?

I think the key to how we’re going to fight cancer, is how can we implement prevention and chemoprevention within a community. Providing the access, being inclusive, and also—by the way—we have some of the world’s expertise in CAR T or cellular therapy, in phase I clinical trials.

Patients will access these services close to your home with the confidence that City of Hope is taking care of them.

That’s just what’s really cool and exciting to me. I want to work with the experts and try to translate that into growing their programs, expanding their breadth, and thinking outside the box. That’s the hardest part to do when you’ve been at a place for a long time. It’s hard to go outside the box and say, “How are we going to reinvent ourselves?”

Well, here, the invention is going to occur.

 

PG:

You’re seeing so many cancer centers becoming the delivery machines for big health systems. Here is a freestanding cancer center, truly a freestanding cancer center, just growing, and not becoming part of a health system. That’s a different model.

ESK:

It is going the other way around—in the neighborhood, rather than the traditional way. Totally agree with you there.

People do it the other way, absolutely. That was the experience going from Anderson to Carolinas, now Atrium, with Levine.

Now, we’re going to see if we can take that academic center of excellence and now create the delivery system that really can impact the community. It hasn’t been done that way, you know?

 

PG:

Are you going to learn to surf?

ESK:

Well you know Paul, I’ll share with you, the first time I ever visited City of Hope, I’d never actually set foot in campus previously. I went down in July 2020 with my family, because we just wanted to spend time there, and we had never really spent time in Orange County. I booked us four surfing lessons during that trip.

The four of us went out in our wetsuits. I have a photo too, I can probably send you.

DrKim

Left to right, Edward S. Kim and his wife Florence, daughter Elyssa, and son, Alex.

 

PG:

We’ll run it.

ESK:

It was awesome.

My 19-year-old daughter Elyssa, 15-year-old son Alex, and my wife Florence—we’re all pretty athletic.

But who were the two people who wanted to go out after we’d surfed for three, four hours the first day? You know who wanted to go out the next day? My wife and my son.

They said, “We think we’re going to go rent boards tomorrow. Where should we go?”

I said “Okay, let’s just have another lesson.”

We had another group lesson at a different part of the beach, so all four of us went out again, for the second consecutive day, and I’ll tell you, Paul, everybody was standing up after the first day, then on the second day we were riding ten-foot waves, and my son and my daughter were out there, just loving it—but I’m just not in shape to surf for four hours two days in a row, which is what I learned.

But it was fun.

My kids, I could tell, really were having fun there. It gave me comfort that, although we hadn’t worked out details and I was still interviewing, I felt that this place could definitely be a home for the Kim family. Experiencing something new and challenging like surfing was definitely a part of that.

 

PG:

Thank you for talking with me. That’s an inspirational story.

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