John Carpten: City of Hope’s national strategy drew me to this opportunity

John Carpten, when he was named director of the City of Hope Comprehensive Cancer Center in April, took over a massive, newly formed national oncology network—the first of its kind.

Roughly a year before Carpten was named director, City of Hope’s acquired Cancer Treatment Centers of America in a $390 million deal. In February, City of Hope retired the CTCA brand, its former locations becoming City of Hope Atlanta, City of Hope Chicago, and City of Hope Phoenix (The Cancer Letter, Feb 3, 2023; Feb 4, Jan 21, 2022). 

Carpten is also chair of the National Cancer Advisory Board.

“If there is anything that keeps me up at night, it’s what are the areas that we can focus on to increase the pace of the integration?” Carpten said in a conversation with The Cancer Letter. “We don’t want this to take a long time. We want this to happen quickly.”

The national reach of the City of Hope network was one of the reasons Carpten was excited to take this job, he said.

“As we think about building out the system across Los Angeles, Orange County, Arizona, Greater Atlanta, and Greater Chicago, I think we have to ensure that research is at the foundation of the integration,” Carpten said. “I think it will be a huge draw to continue to recruit exceptional clinical faculty—across the system. But we also think it creates major opportunities for population sciences, basic sciences, and translational research as well.

“It’s City of Hope’s national strategy that drew me to this opportunity.”

When Carpten began his role at City of Hope, there were four Black directors of NCI-designated cancer centers. Last month, Taofeek K. Owonikoko was named director of the University of Maryland Greenebaum Comprehensive Cancer Center, bringing the number of Black directors to five. 

“The CCSG, as you know, requires a very specific component, which is the Plan to Enhance Diversity, or PED, and it is now a required component, similar to the Cancer Research Training and Education Coordination (CRTEC) component of the CCSG,” Carpten said. “I think my appointment, or my hiring as cancer center director and chief scientific officer, speaks to City of Hope’s current and future commitments in this area.”

The political climate, specifically the recent Supreme Court decision on affirmative action in college admissions, is unlikely to prevent City of Hope from centering DEI and fostering inclusive excellence, Carpten said.

“It’s all about excellence from my standpoint,” Carpten said. “And I’m always identifying the individual who is excellent and the individual who is most likely to be successful in a given position. And I don’t think that there always has to be a policy to achieve that. I have a number of colleagues who have maintained incredibly diverse teams, who are beyond excellent and exceptional. And did it without a policy. Strategy, yes. Policy, maybe not so much.”

The recent events cannot be taken out of their historical context, Carpten said. 

“First of all, we didn’t get here for no reason,” Carpten said. “History can’t be forgotten, and a lot of the issues we face are rooted in history. Historically in America, opportunities have not been provided or made available equitably. That history can’t simply be forgotten. But I think I’ve always come from the standpoint that there’s no reason to separate excellence from diversity.”

DEI efforts must extend beyond opportunity, Carpten said. 

“I also feel that once an opportunity is provided, we have to ensure that the culture and work environment are equitable and conducive to ensure career development from an inclusive standpoint,” Carpten said. “I actually think that, in many cases, that’s where we fail. So, we still have a lot of work to do to continue to grow the pipelines, but to also make sure that career development plans are created in ways to ensure that everyone has a fair chance to advance.

“DEI is really, really important. It’s front and center to everything that we’re hoping to achieve at City of Hope.”

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

Paul Goldberg: First of all, Dr. Carpten, congratulations. Running City of Hope’s science and research is one of the great jobs in oncology.

John D. Carpten: Thanks, Paul. Without a doubt, it’s an honor, and I’m humbled, and I look forward to serving our faculty and our staff and working with them to bring to bear the best care we possibly can to our patients.

What is your vision in this new position? What will happen in the Carpten years that wasn’t happening in the Rosen years, or the Friedman years?

JDC: A great question, Paul. I’d like to acknowledge Dr. Steven Rosen’s remarkable leadership as City of Hope’s previous cancer center director, and its first chief scientific officer. I look forward to building on Steve’s great accomplishments and the solid foundation he built. 

And to your question, my overarching vision is to begin to craft the cancer center of the future—not necessarily the cancer center of 2025—but what will an NCI-designated Comprehensive Cancer Center look like in 2035?

And I think that the national model that’s been developed at City of Hope is one of the first steps, and, of course, this is a differentiator from the previous leadership as we think about being able to distribute high-quality healthcare innovations across this national integrated clinical and scientific framework.

To me, that’s the ultimate vision.

Also, we are aligning with the national priorities as set forth by the National Cancer Plan under the NCI director, Dr. Bertagnolli. So, we think about early detection, smarter treatments, and achieving health equity.

We think that having this national, integrated, cancer-focused biomedical system will provide us with access to a really large and very diverse patient population that we can impact, and not only with just high-quality standard of care, but, of course, also with all the amazing healthcare innovation, for instance, through the incredible clinical trials platform that’s currently in place at City of Hope.

Also, we are undoubtedly entering a data era. And so, I think that this model will allow us to create massive datasets that we can mine for new discoveries.

So, in a nutshell, that’s how I’m thinking about my current role: to craft this new, national, distributed model and this national system to support clinical care and research for a broad and diverse population of patients.

JDC: It’s a great question. It’s a massive integration; just considering the clinical system integration. My primary role as cancer center director and chief scientific officer is to ensure that research is at the foundation of the integration.

As we think about building out the system across Los Angeles, Orange County, Arizona, Greater Atlanta, and Greater Chicago, I think we have to ensure that research is at the foundation of the integration.

Of course, when we talk about research, we are considering clinical trials as one of the primary areas.

And I think it will be a huge draw to continue to recruit exceptional clinical faculty—across the system. But we also think it creates major opportunities for population sciences, basic sciences, and translational research as well.

So, my role is to ensure that research is front and center and to work with the other system executive leaders to build an integrated strategic plan that supports clinical systems integration, as well as all of the research integration.

And specifically to your question about AccessHope, that, of course, is another national platform that City of Hope established that, as you mentioned, provides expert cancer consultation from faculty at City of Hope and several other NCI-designated cancer centers to employers in support of people covered by their health plans with cancer diagnoses. 

It’s City of Hope’s national strategy that drew me to this opportunity. 

How do former CTCA patients count toward your Cancer Center Support Grant (CCSG); or is that different?

JDC: Currently, our CCSG includes the cancer center in Duarte and our Southern California network sites that are on our license where clinical trials are available for patients. We have, of course, a large referral network as well around this area, so the patients can be referred to these hub sites to participate in clinical trials.

And then we have the Lennar Foundation Cancer Center in Orange County, which was just recently opened, about a year-and-a-half or so ago. Overall, there are about 58,000 patients that are in our denominator.

Eventually, once the integration is complete, we may be able to include patients across the national network into the denominator, given all necessary considerations. Either way, our goal is to include City of Hope Chicago, Atlanta, and Phoenix patients in more clinical trials as we continue our integration efforts. This is especially important since larger and more diverse clinical trial populations are better for research and, ultimately, patient impact. 

How many patients are in the catchment area and in City of Hope Chicago, Atlanta, and Phoenix?

JDC: In our fiscal year 2023, City of Hope sites in Greater Chicago, Atlanta, and Phoenix cared for about 30,000 patients. And in California, there were about 114,000 patients.

How many staff members do you have?

JDC: The system-wide number is more than 11,000 employees across the City of Hope system, which includes more than 650 physicians and more than 1,000 scientists and researchers.

I know this kind of predates you a little bit, but how was the decision made to retire the CTCA brand? I am asking because it’s a well-known brand.

JDC: City of Hope is building a national, integrated cancer care and research system. It is important to have one unifying name and a name that leverages the robust academic reputation that City of Hope has. 

Changing these new locations to City of Hope is about much more than rebranding. It’s about our commitment to developing a unifying culture of “One City of Hope” across our national network for the benefit of cancer patients. 

JDC: I totally get his point. But I also think it depends on how one would define precision medicine, the history of precision medicine, where did it even come from.

It all started with the framework of genomic medicine, which started in, I would probably say 2000.

I remember we had, arguably, the first genomic medicine symposium at National Human Genome Research Institute when I was an early-stage investigator at NIH.

How do we use the genome? How do we apply the genome to human health, with the genome being the measurement of sorts. That could be inherited disease, but of course, our group was focusing on cancer, and so we were exploring how to utilize genetic or genomic data generated in the laboratory to improve human health or the practice of medicine.

That’s where it started.

Over time, we began to include other parameters, but it still boiled down to whether it was gene expression profiling or cancer mutations to determine whether specific mutation profiles are associated with therapeutic response.

That’s where it started, and I believe it was Harold Varmus who coined the phrase “precision medicine.”

We were both there.

JDC: Now, the word “precision,” from my perspective, is about data points. The more data points you have, the more precise you can be.

In terms of precision medicine, I think about it from the standpoint that we don’t have all of the information or all of the data points.

So, when I think about health equity from a precision medicine or genomic medicine standpoint, my main issue is that the vast majority of genomic or molecular data has been generated from individuals of largely European descent. 

Once an opportunity is provided, we have to ensure that the culture and work environment are equitable and conducive to ensure career development from an inclusive standpoint. I actually think that, in many cases, that’s where we fail.

It could be at least 70%, if not 80% of the data. So, what does that mean? As biomarkers are developed, the question becomes, will that information generalize for individuals across other racial and ethnic groups or ancestral populations?

I co-wrote a chapter in the AACR Cancer Disparities Progress Report 2021, and the chapter was titled “Imprecision of Precision Medicine.”

The point being that we don’t have all the data points, so the overall approach may not be very precise. I do think that over time, this whole concept of precision medicine has changed some to include a lot more parameters, including the social determinants of health and various other types of data or data points. But even with that, we still have a lot to learn.

I mean, barring disparities, and even from a basic cancer genomic standpoint, we see patients who might have the same mutation, and that mutation might be associated with a very specific targeted therapy, yet everyone with that same mutation may not respond the same. 

So, I still think that overall, the approach is still somewhat imprecise. The hope is that the more we learn, the more data points we feed into the model, where ultimately it becomes more accurate and precise. But we have to make sure that we are collecting data in an inclusive way.

Well, what you’re saying is that if precision medicine is done precisely, i.e., more inclusively, then you would agree with Winn’s view.

JDC: Yes. 

Ultimately, to some degree his standpoint also reflects that fact that concepts like precision medicine can exacerbate disparities if the cost of generating the data that’s required becomes too high—essentially if everyone doesn’t get access.

And he also talked about the concept of individualized. And, of course, if we are approaching care from an individualized standpoint, then all individuals should be treated equitably. So, I get his point.

Yes. Can we talk more about DEI? How does that fit into your vision for City of Hope?

JDC: DEI is incredibly important. From the standpoint of the cancer center, Paul, we have two components. We are a national cancer care system and so, of course, we have a system-level executive leader for DEI, Angela Talton. 

But the CCSG, as you know, requires a very specific component, which is the Plan to Enhance Diversity, or PED, and it is now a required component, similar to the cancer research training and education coordination (CRTEC) component of the CCSG.

And it has to be represented at the associate director level.

So, there’s the requirements of the CCSG, and then there’s our system-level work in DEI.

And I think my appointment, or my hiring as cancer center director and chief scientific officer, speaks to City of Hope’s current and future commitments in this area.

I’ve had a long track record enhancing and improving diversity in biomedical research throughout my career at all levels, from early trainees all the way up through faculty, tenure-track faculty.

I think it’s incredibly important from various standpoints. I think one is just the diversity of ideas, the diversity of cultures. Various ideas are brought to the table when you have a more diverse group of individuals approaching a solution for a given problem.

As we think about cancer research and some of the areas where the field struggles in—for instance, increasing representation in biomedical research cohorts and increasing representation in clinical trials—it’s also been shown that with a diverse clinical workforce, you can see improvements in recruitment and involvement and participation in biomedical research.

And there are a number of studies that are currently underway, including through the Cancer Moonshot Program, to begin to collect additional data around that.

So, DEI is really, really important. It’s front and center to everything that we’re hoping to achieve at City of Hope.

What are your thoughts about the political climate? And I’m talking about the Supreme Court decision on affirmative action, specifically.

JDC: I think that’s a great question. It’s complicated and things can easily be taken out of context. But yes, we think about it a lot. 

First of all, we didn’t get here for no reason. History can’t be forgotten, and a lot of the issues we face are rooted in history. Historically in America, opportunities have not been provided or made available equitably. That history can’t simply be forgotten. But I think I’ve always come from the standpoint that there’s no reason to separate excellence from diversity.

The Supreme Court’s decision about race and college admissions; well, there’s history. I’m in California. Prop 209 dates back to 1996.

I think a lot of times we want to say diversity and equity and inclusion programs are in place to provide an advantage. 

And I’ve never thought about it that way. I think it’s all about excellence from my standpoint. And I’m always identifying the individual who is excellent and the individual who is most likely to be successful in a given position. 

And I don’t think that there always has to be a policy to achieve that. I have a number of colleagues who have maintained incredibly diverse teams, who are beyond excellent and exceptional. And did it without a policy. Strategy, yes. Policy, maybe not so much.

Now, I also feel that once an opportunity is provided, we have to ensure that the culture and work environment are equitable and conducive to ensure career development from an inclusive standpoint. I actually think that, in many cases, that’s where we fail. So, we still have a lot of work to do to continue to grow the pipelines, but to also make sure that career development plans are created in ways to ensure that everyone has a fair chance to advance.

JDC: You would think.

But what do you think is happening there?

JDC: I think if you look at the data, particularly if you look at universities and you look at faculty, if you look at gender and faculty ranks, you see a lot more equity at the junior assistant professor level. 

But as you advance to associate and full-tenured professor, you start to see the disparity that is probably at the root of the problem. We need to address issues related to advances at the faculty level. 

One question that probably our readers are most interested in is how many people are you trying to hire? Where are you recruiting? What are your targets in terms of recruitment?

JDC: Well, that’s an interesting question.

Steve [Rosen] did an amazing job in terms of expanding the faculty footprint. There were approximately 60 new faculty recruits between 2016 and 2022—exceptional, well-funded faculty members.

So, right now, we want to be very strategic about how and where we recruit. I think we want to think about national priorities, for instance, early detection. Health equity and cancer disparities are other areas that we would like to grow and expand in. Again, another national priority. 

And then I think continuing to fortify some of our strongest areas, like cell-based therapeutics and heme malignancies; we want to continue to grow in that area, because that’s one of the areas in which we differentiate. It’s my opinion that City of Hope has one of the world’s most robust cell-based therapy programs.

From my perspective, Paul, it’s not about numbers. It’s about being strategic.

Now that you’re running one of the largest cancer centers in the world, what keeps you up at night?

JDC: Oh, boy. I think someone else asked me that question recently. I think it’s pace—in terms of making sure that we’re moving, that we’re moving effectively and that we’re moving efficiently as we work on the national integration.

We don’t want this to take a long time. We want this to happen quickly.

And so, if there is anything that keeps me up at night, it’s what are the areas that we can focus on to increase the pace of the integration?

Well, that makes sense. Is there anything I forgot to ask, anything you would like to add?

JDC: I can’t think of anything. Just excited about the future and all of the amazing possibilities we have as a national cancer care system.