Wake Forest’s entire EAB resigns in protest as director Boris Pasche is fired

All 15 members of the External Advisory Board of the Wake Forest Baptist Comprehensive Cancer Center resigned, stating that they are also withdrawing their “endorsement for submission of the competitive renewal of the Cancer Center Support Grant.”

The Feb. 18 letter of resignation was signed by the EAB Chair Gerold Bepler, president of the Barbara Ann Karmanos Cancer Institute, on his own behalf and on behalf of all members of the committee.

The letter of resignation, which was obtained by The Cancer Letter, states that during the competitive renewal process Wake Forest leadership gave an endorsement of the center’s director Boris Pasche. 

“This endorsement included unequivocal statements of support for Dr. Pasche’s oversight of the combined Atrium-Wake Forest cancer program,” Bepler’s letter states. The two health systems are combining their operations, which span two cancer centers—one NCI-designated, the other not.

However, after the renewal of the NCI grant was finalized, the administration changed its approach to integrating the cancer programs, and Pasche was dismissed, the letter states. 

The notice of award was dated Feb. 9. Pasche was terminated on Feb. 10, with no cause cited, sources said. 

A. William Blackstock, Jr., has been named interim director. He is the chair of Radiation Oncology and a professor of cancer biology at Wake Forest. He is also a member of the NCI Cancer Centers Study Section (A). 

EABs are advisory to institutions as they prepare NCI grant applications. Their members usually include directors of other cancer centers, researchers who represent a variety of disciplines, as well as administrators.

“The EABs for cancer centers can only provide value to the center when there is openness and transparency in the process,” said one Wake Forest EAB member, who spoke on condition of not being identified by name. “In the absence of such, I believe the members felt that there was no further utility in providing guidance to the organization.” 

An en masse resignation by the EAB members is highly unusual. Withdrawal of support for renewal of the comprehensive designation—with copies of the resignation letter going to the NCI Cancer Centers Office and the NCI director—is unusual as well, several former and current cancer center directors said.

“In my experience as both a member of the NCI community for many years and active reviewer of CCSG grants, it is usual and customary for an External Advisory Board to offer its resignation with there is a change in the center director position,” Blackstock said to The Cancer Letter. “That is because EABs serve at the pleasure of the center director. This process enables new center directors to have the flexibility to create an EAB that complements their personal vision for the center and has expertise in relevant areas of scientific focus.

“As the interim director of WFBCCC, I have already talked to the chair of the EAB and members, several of whom will likely be invited to serve on the EAB under my tenure,” Blackstock said. “We have a very exciting vision for our integrated cancer center, which we are finalizing this coming week, and will very much look forward to the active engagement of our EAB in this transformative process.”

The role of the EAB is to advise the cancer center director and institutional leaders regarding program development and expansion to optimally prepare the institution for grant review by NCI. The board plays no role in bestowing the NCI designation. 

That process includes detailed review of what is usually an extensive grant application, followed by an on-site review, each conducted by a team of 12-20 cancer experts; these experts are almost always scientific or clinical leaders of other NCI-designated centers.

The grading of the institution on its commitment to the cancer center is an extremely important criterion for review in the written document and site visit. A low score on institutional commitment will sink an application in review. 

The firing of a director of a cancer center is a common occurrence. NCI doesn’t get involved in such decisions. 

Generally, if an application fails, a director can be sacked with no questions asked. If an application is successful and a change of leadership is contemplated, institutions usually wait a year or so after the award letter.  

Even in situations where knives were  sharpened for years, cancer centers don’t want to create the appearance that they weren’t truthful when they pledged to support the director during the NCI grant review—thus avoiding taking a hit on institutional commitment. 

At the same time, when change occurs, institutions want to give the new directors enough time to prepare grant applications. 

Donald “Skip” Trump, a historian of cancer centers, who has served as president and CEO at Roswell Park Cancer Institute, and, most recently, as president and executive vice president at Inova Schar Cancer Institute, described the Wake Forest EAB resignation as “unusual, and, in fact, unprecedented, in my recollection of goings on at NCI centers over many years.

“The manner in which the Atrium Wake Health managed the ‘transition’ in the cancer center director position was at best very clumsy and at worst deceptive,” Trump said to The Cancer Letter. “One would hope that AWH leaders communicated prospectively with leadership at the NCI regarding the apparent need for a change in center directors. 

“AWH leadership clearly did not communicate with the EAB chair or members, suggesting the NCI Cancer Centers Branch leaders were as surprised by the turn of events as the EAB,” he said. “This does not bode well for the immediate future of the WFBCCC as it seeks to regain its stability after what appears to have been a disruptive and clumsily managed leadership transition.”

The EAB said the resignation is not a reflection on Blackstock’s “personal or professional accomplishments, expertise, acumen, and capabilities.” According to the letter, some members of the EAB would consider returning if they see “unequivocal evidence from the health system’s senior management for support of a single, academically-driven, comprehensive and integrated cancer center (and service line) as described at the time of the CCSG renewal.”

Pasche declined to speak with a reporter.

The text of the EAB letter follows: