Ruben A. Mesa is going into the new year with a massive new challenge: bring together the programs and cultures of an academic cancer center and a hybrid cancer center—and convincing NCI that the new organization should keep its elite designation.
In December, Mesa was named president and executive director of the cancer service line of Atrium Health, a job that places him at the helm of both Atrium Health Levine Cancer Institute in Charlotte, NC, and Atrium Health Wake Forest Baptist Comprehensive Cancer Center in Winston-Salem. Mesa was also named vice dean for cancer programs at Wake Forest University School of Medicine.
Last year, NCI truncated the five-year Cancer Center Support Grant held by Wake Forest Baptist as that institution was undergoing a bumpy transition of leadership—in the midst of its integration with Levine.
The duration of Wake Forest Baptist’s Cancer Center Support Grant was shortened by two years. The grant, which was originally set to run through Jan. 31, 2027, will now expire on Jan. 31, 2025.
The institution will be able to get funding for years four and five based on progress reported to NCI and based on the External Advisory Board reports (The Cancer Letter, Feb. 25, May 27, 2022).
Mesa said that, based on his conversations with NCI and the report of the EAB, the prospect of extensions looks favorable.
“Clearly, both the progress over the last year, a strong EAB report last fall, the ability to have recruited a permanent director, and having me jump in and start with both feet right away in 2023, are all strong signs of progress,” Mesa said to The Cancer Letter.
Atrium Health recently merged with another large health system, Advocate Aurora, to become the fifth largest health system—and, over time, one of the largest cancer programs—in the United States.
In addition to his administrative job, Mesa will continue to see patients.
“It’ll be modest, but I’m going to do a half-day clinic in each spot, in each of the two main hubs once a week. It’s a great way to connect with the faculty,” said Mesa, whose research is focused on myeloproliferative neoplasms. “I very much enjoy my own personal research with patients with myeloproliferative neoplasms, and clinical trials, and have some really strong colleagues in both areas. So, it’s always something I want to be involved with.”
Mesa, who is winding down his job as the executive director of the Mays Cancer Center at UT Health San Antonio MD Anderson and professor of medicine at UT Health Science Center San Antonio, will start showing up regularly in North Carolina next week.
He will assume the positions now held by Derek Raghavan, who had previously announced his mid-January 2023 retirement (The Cancer Letter, Jan. 4, 2013), and by William Blackstock, professor and chair of radiation oncology at Wake Forest University School of Medicine.
Blackstock has served as interim director of Wake Forest Baptist’s Comprehensive Cancer Center since February.
“I feel that I’ve been empowered to take this on to make it truly a multi-campus NCI Comprehensive Cancer Center that I hope preserves both the spirit of what it means to be an NCI Comprehensive Cancer Center, but also does preserve the spirit and some of the ingenuity that Derek Raghavan brought to Levine Cancer Institute as well,” Mesa said.
Recently, the institution adjusted its catchment area, Mesa said.
“It’s an area of 30 counties, including both the Winston-Salem and Charlotte area, almost 4.8 million individuals representing 27,000 new cancer cases, 43% of which are rural, 36% of which are minority with overrepresentations here for African American patients, 10% Hispanic patients—and some very historic issues of health disparities, a lot of tobacco-related mortality, and increases in mortality from lung cancer and others,” Mesa said.
Mesa said his transition period will begin in mid-January and run through the end of March. During that time, he will be splitting time between North Carolina and San Antonio.
Over the past 11 years, Mesa has led or co-led the development of six drugs that have been FDA approved for chronic leukemias. He has been the principal investigator or co-principal investigator for more than 100 cancer clinical trials, including numerous global phase III trials.
At UT Health San Antonio, Mesa, one of the first Latinos to direct an NCI-designated cancer center, led the planning and design of a new research specialty hospital to focus on cancer, integrating cancer prevention and screening practice and research activities, and expanding oversight for Greehey Children’s Cancer Research Institute, one of two institutes in the country dedicated solely to pediatric cancer research (The Cancer Letter, June 30, 2017; Oct. 2, 2020).
As one of the first Latino directors of an NCI-designated cancer center, Mesa helped implement an innovative process that has led to increased diversity among clinical trial volunteers at Mays Cancer Center (The Cancer Letter, March 11, 2022).
Mesa spoke with Paul Goldberg, editor and publisher of The Cancer Letter.
A recording of the conversation is available here.
Paul Goldberg: Well, Dr. Mesa, first of all, Happy New Year.
Ruben Mesa: Happy New Year.
And happy new challenge. What’s happening in North Carolina?
RM: Well, really excited to be starting going back and forth next week. This was a really a unique opportunity.
I’ve been now at the Mays Cancer Center for almost six years, and it’s been a phenomenal trajectory. It’s a wonderful institution. We’ve grown funding, we’ve grown by membership, we’re building a cancer-focused hospital. We’ve got the cancer center renewed.
We have really built a strong focus on advancing the science of cancer in Latinos, with wonderful colleagues such as Dr. Amelie Ramirez. We’ve built a cancer service line, I think we are having a great impact.
So, why the move? Well, the move I think is really about opportunity. I’m confident that the Mays Cancer Center is on a tremendous trajectory to achieve comprehensive status as an NCI cancer center, and I know that they’ll recruit a strong successor, and I’m going to be a resource to that successor.
But the move, I think, was about opportunity.
I visited, and I had strong relationships with both the Wake Forest Baptist Comprehensive Cancer Center, the legacy center in Winston-Salem, as well, having gone and visited as a visiting faculty to the Levine Cancer Institute back in 2018.
I know Derek Raghavan well; many wonderful colleagues there. I’ve been tremendously impressed by the scale of the operation, the tremendous patient-centeredness, the wonderful clinical trials, outreach to the community.
So, when this opportunity to try to bring together the integration of all of these elements, the legacy Wake Forest Baptist Comprehensive Cancer Center, the tremendous Levine Cancer Institute, and all of its regional sites, and the opportunities of Atrium Health, which is a very large health system, now merged with Advocate Aurora to become the fifth largest health system in the United States, I thought that the ability to have an impact was really tremendous.
One, the opportunity to really be on the ground floor in building a culture and shared mission between two wonderful cancer centers, and really make them function as one ,and bring some of the experience I’d had from Mayo Clinic on what a multi-campus, but integrated NCI Comprehensive Cancer Center can look like.
What’s really interesting is this is clearly of great interest to people who read The Cancer Letter, because I looked at the end-of-last-year’s numbers, and the stories that we wrote about Wake Forest and this merger were number one, squarely.
So, there’s something here that is extraordinarily important, because here you have two very different cultures. One of them is Levine, which is visionary and different, and it’s Derek’s creative genius that created that.
And the other is a very, sort of, traditional Comprehensive Cancer Center. They merge them. They do fit or don’t fit. They obviously didn’t fit together in an easy and harmonious way, so they need somebody visionary who can bring this together.
That’s why you’re here; right? So, how are you going to do this? What do you see…
Or am I wrong? Actually, I could be wrong in the characterization here.
RM: So, first, I think some of the controversy at first really was what was the plan going to be?
And over this past year, I think there has been a lot of self-reflection, discussion, planning, and work toward integration, led by Dr. William Blackstock, who’s been the interim director at Wake Forest, working hand-in-glove with Derek around how do these two things integrate.
And I think a lot of progress has been made that’s been validated by the external advisory board, now led by Dr. Ed Chu, the director at Einstein—so a lot of progress.
From my end, as I visited with folks from both campuses, I think the core things that matter really are the same. These are strong teams of individuals who care deeply about making a difference in cancer, who care about great patient care, who care about wonderful clinical trials, who care about how we advance the science of cancer.
Now, I think one of the things that’s really special about this opportunity is that there are some things that I think really fit in a very strong complimentary way.
For example, Wake Forest has had tremendous investigators in cancer prevention and control, with prevention and screening with the NCORP research base, and view that [as an] extension into Charlotte and into the Atrium Health system.
In cancer prevention, screening, drug development there are huge opportunities.
It is a cultural lift, bringing together two organizations.
The organization has been integrating in parallel.
So, first, there’s going to be an additional campus of the Wake Forest Medical School in Charlotte as an additional academic hub.
There is integration along all the key areas in healthcare, with cancer being clearly, what I have been tasked with integrating and bringing together as one team, but in others, whether it be cardiology, or musculoskeletal, or others.
Additionally, there is a new dean that is joining this month from Duke, Dr. Ebony Boulware, who was the PI of the Duke CTSI, who focuses on chronic disease and health disparities, and she’s going to be a tremendous colleague and a close partner.
Obviously, one of my roles is as her vice dean for cancer programs for the School of Medicine—so [I will be] working hand-in-glove with her as to how we integrate these efforts across really that whole region.
We’ve worked as a cancer center, they’ve done efforts to reflect on what is the catchment area of this new, integrated, unified cancer center. And it’s been adjusted.
It’s an area of 30 counties, including both the Winston-Salem and Charlotte area, almost 4.8 million individuals representing 27,000 new cancer cases, 43% of which are rural, 36% of which are minority with overrepresentations here for African American patients, 10% Hispanic patients—and some very historic issues of health disparities, a lot of tobacco-related mortality, and increases in mortality from lung cancer and others.
It certainly is part of the region that very much was a central tobacco-growing region, with Winston-Salem having been a historic base of those sorts of activities.
So, I think although it clearly created a lot of interest, and in some ways angst and kind of a challenging year as things progressed, I think it has both tremendous trajectory, because of the leadership that’s occurred over this past year.
And, certainly, I feel that I’ve been empowered to take this on to make it truly a multi-campus NCI Comprehensive Cancer Center that I hope preserves both the spirit of what it means to be an NCI Comprehensive Cancer Center, but also does preserve the spirit and some of the ingenuity that Derek Raghavan brought to Levine Cancer Institute as well.
Well, you’ve got till Jan. 31, 2025, with the possibilities of extension if the EAB loves what you are doing, and if the NCI loves what you are doing. You kind of need to impress both of them. What have the communications been so far with the NCI and with the EAB on this?
RM: So, the communications have been very favorable.
The center, both years four and five of the grant, are kind of pending, depending upon progress toward integration as well as, really, the support of the EAB and the NCI that the center is making great progress, that it really is functioning as one center, that it’s really making an impact.
I think those conversations are favorable.
I’m strongly hopeful that we will be successful in restoration of that funding for years four and five, to give us the full five-year arc to both deepen our impact to be able to continue to modify our strategic plan, to make the full use of the opportunity that we have, to further flesh out our team, and really make use of the opportunity.
One of those key opportunities, how is this cancer center going to be unique? This unified cancer center takes advantage of a concept, really, across our system, which is the academic, learning health system. How does one kind of go bench to system and system to bench? How do you take observations and really apply them at scale?
And then, on the flip side, how do you learn from things at scale, from data in large populations, from a complex community care tied to academic hubs, and then be able to apply that back in the questions that are being asked, whether they be in cancer biology, in health disparities, in prevention and screening, or others?
So, I’m hopeful we will have that full five-year arc to develop as a unified enterprise cancer center over this time, and then hopefully successfully renew as an NCI Comprehensive Cancer Center.
That seems to be a possibility, you would think, because if your EAB goes to bat and makes sure that happens for you, then NCI would probably say Yes.
RM: Certainly, the trajectory—and this is both with my direct conversations with Henry Ciolino, the leader of the NCI Cancer Centers Program, as well as our EAB—all of that looks very favorable.
Clearly, both the progress over the last year, a strong EAB report last fall, the ability to have recruited a permanent director, and having me jump in and start with both feet right away in 2023, are all strong signs of progress.
What about the catchment area? Let’s return to that for a moment, because you mentioned that’s 30 counties now. What was it before for each of these centers, and how did the catchment area situation change and when?
RM: So, the catchment area has evolved over this past year.
I can’t speak with great authority as to exactly what it looked like before, but it has been narrowed.
I believe it was 38 counties at the time of their prior renewal. It certainly has become more concentrated to that region in North Carolina and northern South Carolina.
I think there had been some further regions in Virginia that had been prior part of the catchment area. It has been tightened a bit, reflecting the opportunity with setting a threshold of where 91% of new cancer cases are coming now for the combined system, as well as the counties where they’re having both an impact as well as the patients that they serve.
Levine, not having pursued NCI designation in and of itself, did not have a defined NCI-type catchment area. But they were very active in their community in a range of ways, including things such as lung cancer screening.
One very innovative piece that Dr. Raghavan and colleagues had developed is something called The Lung Bus, where they have a bus that can do low-dose CT screening for lung cancer that goes in various regions, including, I believe, to the Catawba Nation, where they did significantly increase the rates of lung cancer screening.
So, some really innovative things that they had done, and, again, over this past year, they have been working to create really one COE-type effort across the unified enterprise cancer center.
Okay. So, basically, you’ve shrunk the number of counties, because Levine really was, their idea of catchment area was fluid.
RM: In terms of counties, yes. In terms of the number of patients—an increase, because of really the population density around Charlotte and reflective what the opportunity is of the combined cancer center.
Together, as a center, it has over 25 venues of care, over 300-350 cancer care providers, does over 400 stem cell and CAR T therapies a year, over 20,000 new cancer cases, almost a thousand treatment accruals.
So, a bit more concentrated, but highly impactful.
I know you may not even have the answer to this, but is this the largest cancer center or one of the largest in the United States now?
RM: In terms of where it would rank, that I don’t have the data for comparison, but I would think, in terms of scale and impact, certainly, would be one of the largest, without question—and in terms of the number of sites, providers, and new cancer cases.
And, certainly most important from my end, I really hope—n terms of impact.
I’m hopeful that, again, we will be able to pilot things on a small scale, then be able to test them at a much larger scale across the system, and then be able to extend them further out into both the system and, really, across the U.S.
One additional piece of this—and it’s a piece that is evolving—is the merger of Atrium Health with Advocate Aurora. That is a recent piece.
The merger completed its process just a couple weeks ago, in December, and what the exact plan will evolve in cancer, and, certainly, I, as the cancer center director, will be intimately involved with that.
We’ve been visiting with Dr. Jim Weese, who is the service line leader for Advocate Aurora.
That is a very significant system in Illinois and Wisconsin, again caring for almost a little over 20,000 cancer cases between them—between Wisconsin and Illinois.
We envision many short-term opportunities as it relates to data. Opportunities in terms of efforts in health disparities, potentially decentralized clinical trials and other pieces.
So, that part evolving. But the opportunities, as you can imagine, are enormous. Even the data, an opportunity to learn from over 40,000 new cancer cases per year is really very significant.
So, basically that may very well be the largest, with the merger. What’s the timeline for your involvement in that merger? Does it even exist yet? Because I just see this as something so monumental.
It’s like you’re in the middle of one monumental task, and here’s another one—looming.
RM: That is more incremental.
With the merger process, again, they have worked on more front-office operations, but already are ongoing in terms of supply chain. You can imagine, from our end, opportunities in terms of chemotherapy, drug acquisition or shared contracts. So, there’s more of those pieces to start.
The granularity of what that’s going to look like in a service line like cancer is evolving, but the opportunities are many.
My first task, of course, is very North Carolina-focused, but, clearly, I view that over time as a huge additional opportunity.
To quote Joe Simone, “When you’ve seen one cancer center, you’ve seen one cancer center.”
I quote Joe Simone often.
This is just huge, and different… How would you summarize it?
How is this different from all the other centers?
RM: Well, you are right that every center—having had a chance to visit many, either as a site visitor or on EAB or as a visitor or a friend—is different.
I think the very unique piece for this, is truly a strong academic cancer center with two hubs in Winston-Salem and Charlotte, with many regional sites, but tied to a very large integrated academic health system that opens up a tremendous amount of opportunities.
We realize that making a difference in cancer is both about what we do for cancer patients, but everything what we do really for the general public to help prevent or screen cancer to begin with.
Or how we really care for the large number of growing cancer survivors and all of the health issues that they really have with them.
I think what’s going to be one of the unique things about this center is that core of cancer expertise, cancer biology, cancer prevention and screening, and population science research—for the ability to both learn from the system, but also to extend opportunities across the system.
I’ll use an example, they had had a very successful trial ongoing that called mPATH that was a shared decision-making colon cancer screening trial that they have been doing at Wake Forest for a number of years, with tens of thousands of patients enrolled, again, hoping to increase uptake of colonoscopy and other cancer screening.
And, again, the ability to extend innovative approaches to increase screening or the effectiveness of screening across first Atrium Health, but then, really, across even a broader system, is really tremendous.
Well, can we talk about disparities separately now?
This is a huge interest of yours, you’re involved in an initiative with Rob Winn on some of this.
What can you do with disparities that you haven’t done with disparities, that’s not being done?
How can you change things?
RM: Disparities are something that remains central in my focus and something I really want to make a difference about.
And, indeed, my good friend Rob Winn and I have been chatting about some of the opportunities, with our centers being much closer to one another, over on the East, on things that we can do together in a range of ways.
I think the opportunities here are significant.
When the populations are different, and learning about both the populations and how to meet and impact the communities both of Native American nations as well as a large number of African American patients, is different and complementary in my experience in San Antonio, but the core issues are the same.
The issues of rural health disparities can be very significant.
As a center, I think that there are several key opportunities.
One is the tremendous population science that has existed through the NCORP research base in the Cancer Prevention and Control program in Winston-Salem.
And as we speak, their efforts to try to extend those efforts into Charlotte and into other regions, both in our catchment area and beyond–innovative approaches in terms of dealing with populations, expanding prevention and screening and others.
But the opportunities, as you can imagine, are enormous. Even the data, an opportunity to learn from over 40,000 new cancer cases per year is really very significant.
Two, the opportunity of decentralized clinical trials. One of my areas of passion is trying to have our clinical trials be reflective of our population.
And the limiters to those have been mainly from overcomplexity of trials, difficulties and burden in terms of travel for participation in trials, issues of trust.
Leveraging the geographic extent of the system to be able to deliver trials at greater scale with less impact from geography—from people having to travel—is an enormous possibility.
A tremendous ability in terms of tobacco cessation.
Unfortunately, having kids in their twenties, I see that there’s a resurgence of both tobacco as well as E-cigarettes, vaping and other things that again, are going to come back to haunt us.
Some of the progress we’ve made historically has been lost a little bit in the panache of smoking returning a bit for younger individuals.
That’s been a historic area of strong focus with a tobacco cessation center of excellence that has existed in Winston-Salem, and how we really extend that both across our catchment area, but really to try to decrease some of the health disparities in the region.
Certainly, tobacco has hit underrepresented communities in a disproportionate way.
So, many opportunities, but I think both the scale, the geographic spread as well as the parallel efforts of the system will go a long way.
I mentioned earlier partnering with the new dean, Ebony Boulware, that again, a strong emphasis for the system is population science, how we make a difference in populations in cancer, but also in the metabolic syndrome, in diabetes, in chronic diseases.
These things will work very much in parallel. At the system, there’s an NIH-funded aging center, a CTSI, and other natural partners that will be, I think, very strong partners in our battle against cancer.
Our readers, obviously, would love to know, what are you going to beef up, where will you be hiring?
RM: So, a lot of planned growth.
One, clearly first in population science and in cancer prevention and control; it’s already an area of strength.
We view that and informatics as strong opportunities, both in terms of the extension into Charlotte, but, really, to leverage the opportunities of the system.
Two, we’ve had strong drug development, but we are looking to add additional scientific shared resources and bring in additional investigators to truly have the full pipeline from concept of medicinal chemistry through the strong clinical trial mechanisms that we have both in Winston-Salem, in Charlotte, as well as at our regional sites as kind of a critical pieces.
There’s a couple of key recruitments that we have planned ongoing, including our AD of community outreach and engagement. That’s a key search that we are going to be launching.
Additionally, as you might imagine, this is a large, complex organization that we are building.
Again, there’s not been, historically, a deputy director at the Wake Force Baptist Comprehensive Cancer Center. I do think as the enterprise unified cancer center, one or more deputy directors may be appropriate, potentially recruiting a key partner to be based in Charlotte, to work hand-in-glove with me.
I will be practicing at both locations, but will be physically based in Winston-Salem.
So, a lot of key areas of recruitment.
Additionally, we’re going to be growing further as we refine our strategic plan in our core areas of discovery science, in neuro-oncology which is a strong area of strength, with the tremendous efforts ongoing in CNS tumors, in cancer genetics and metabolism, one of our core programs, as well as the program that we have that we partner with colleagues at Virginia Tech, which is our Signaling and Biotechnology Program.
Part of my role as cancer center director is seeing—as we grow, as we perhaps refresh or evolve—that the strategic plan had been in place at the cancer center, to make full use of the opportunity of both the expanded geography patients, faculty and resources, both in Charlotte and across the system.
What are the key scientific areas that we have the greatest opportunity to make an impact, and how do we further grow the faculty and our cancer center members to really make use of that opportunity?
So, you’ll be hiring a whole lot of people. Is what I’m hearing?
RM: Yes, yes. Clearly, I enjoy building, and this is a great building opportunity.
So, they must have given you a nice dowry.
RM: They’ve given me great support, both in terms of true core research funds, but also in terms of being able to leverage the practice hand-in-glove with our efforts.
I wear more than one hat, but one of them as president of the Enterprise Cancer Service Line, where we can look at clinical revenue hand-in-glove with our efforts in research and education to make our goals possible.
Did I hear that you’ll be actually practicing medicine, seeing patients in addition to all this?
RM: Yes, yes. It’ll be modest, but I’m going to do a half-day clinic in each spot, in each of the two main hubs once a week. It’s a great way to connect with the faculty. I very much enjoy my own personal research with patients with myeloproliferative neoplasms, and clinical trials, and have some really strong colleagues in both areas. So, it’s always something I want to be involved with.
So, you, basically, get more than 24 hours to a day; right? They give you some extra time… Yeah.
What keeps you up at nights? What worries you the most about this job right now?
RM: Well, one never underestimates the challenges that relate to coming together as a culture and timing.
But I’m confident.
I think we’re going to have the time, and we have the support. I think both of the institutional leadership as well as, really, the faculty and the staff for us to achieve what we hope to achieve.
I’ve sensed great excitement from the NCI, and our EAB, and other members across the cancer community for the opportunity.
So, although it’s going to be work, I’m confident we are going to be successful.
Dr. Raghavan is retiring; is that what’s happening?
RM: That is correct. Derek is retiring on Jan. 14, and, really, leaves an unbelievable legacy of a very unique concept and model.
But also, I have been able to see firs-hand a legacy of tremendous mentorship, of a deep caring for his faculty, of a deep patient centeredness, and well-supported holistic care, a very well articulated, supportive care systems for patients, great navigation, great engagement with the community.
He leaves a tremendous legacy as a stellar leader in cancer.
Totally visionary. What about Dr. Blackstock; is he’s staying?
RM: Yes, yes. So, Dr. Blackstock, again longstanding both cancer researcher and investigator, is the chair of radiation oncology, and will remain a critical partner and friend in this endeavor in many ways.
He has done a tremendous job during what you might imagine was a challenging year, with the reconstitution of the EAB, with really working along with Dr. Raghavan in terms of integration, of keeping folks on the team.
There’s always some stress during periods of interim leadership, and he’d done that with tremendous grace, did that very, very well, really set it up well so that I could come in as a new recruit with confidence on the strength of where I was coming.
What about Dr. [Boris] Pasche, is he staying?
RM: So, Dr. Pasche is a good friend.
He’s been a strong collaborator for the Mays Cancer Center and someone that I have tremendous respect for.
He’s still an active investigator at the cancer center, still a very active member of the programs, his own research in his company focusing on radio frequency, kind of therapeutics.
He is very innovative, and he is still very much excited about his science and I’m very excited for him and his company and what his really vision of a different modality for treating cancer, where that’s going to go.
So, he is staying?
RM: Yes.
Oh, cool. So, is there anything we have missed? Anything you’d like to touch upon? Anything I’ve neglected to ask?
RM: No, I think that was pretty comprehensive.
Well, thank you so much, and I can’t wait to continue to follow what’s happening. It’s going to be a very interesting story.
RM: Wonderful. Well, no, thank you so much for giving me this opportunity to share a little bit about the story.
It’s an exciting one. And, again, look forward to updating you on I think what will be the very special impact of this cancer center.
It certainly looks that way.
