Steven Rosen, M.D., was just 37 when he became a cancer center director. In this episode of "On the Edge of Breakthrough," the emeritus director of the City of Hope® Cancer Center Duarte, reflects on a career spanning research, patient care and cancer center leadership. He shares how early work with monoclonal antibodies shaped his research and how he eventually brought that leadership experience to City of Hope.
Why would a leader who was at the helm of a national cancer center still maintain a practice of approximately 500 patients? Dr. Rosen explains why caring for patients remains central to his work and describes how treatment for lymphoma and chronic lymphocytic leukemia has been transformed by advances including CAR T cell therapy.
In the lab, Dr. Rosen’s work has ranged from a myeloma cell line that helped advance modern therapies to new treatments now being studied for acute myeloid leukemia and other blood cancers. After decades in cancer research, he remains optimistic about the field, pointing to earlier detection, prevention and increasingly effective treatments as advances that continue to change what a cancer diagnosis can mean for patients.
Beyond medicine, Dr. Rosen is also a published poet and songwriter, a reminder that behind the breakthroughs is someone who brings both scientific rigor and imagination to the way he sees the world.
Tune in to hear why he believes the best may still be ahead.
On the Edge of Breakthrough: All Episodes
Full Transcript
Dr. Monty Pal:
I think the field has evolved so dramatically in the last decade where more knowledge has been gained in months than had been gained in previous decades that you see that we're gonna be conquering one disease after the other. And some of the profound advances we've had in blood cancers, and I see it now being applied to the other disease areas.
Dr. Steven Rosen:
Mm.
Dr. Monty Pal:
Um, you know, it used to be that we could dissect one pathway at a time. Now with artificial intelligence, you can do 10,000 pathways at once. It's astounding.
Dr. Steven Rosen:
I'm Dr. Monty Pal from City of Hope, and this is On the Edge of Breakthrough: Voices of Cancer Research. Each episode, we bring you the minds behind the science, the stories behind the data, and the breakthroughs that could change everything. Let's dive in. Welcome everyone. I am so excited to have our guest today. This is incredibly special. Our emeritus director of the Cancer Center, Dr. Steven Rosen, is joining us. Dr. Rosen has incredible accolades through the fields of lymphoma, hematologic malignancies, and actually ran our cancer center here at City of Hope for many years. And we're so thrilled to have you on the show today. Steve, may I call you that?
Dr. Monty Pal:
Of course, Monty. Can I call you Monty?
Dr. Steven Rosen:
<laugh> Indeed, indeed. Well, I, I have such a reverence for everything you've done in your career. And I, I actually wanted to start at the very beginning. You spent a lot of time in Chicago. Are you from the Midwest originally?
Dr. Monty Pal:
No. But first I want to say this is my honor to be here. And, uh, I have such great, great admiration for you. Uh, so to me, this is a privilege.
Dr. Steven Rosen:
Oh, I appreciate that. Thanks.
Dr. Monty Pal:
So I was born in Brooklyn, New York, actually about seven blocks from Ebbets Field where the Dodgers played. Uh, when I was eight, we moved to Queens. Um, my mother was a school teacher and my father, uh, at the time was sort of a blue collar worker. He had served in World War II, didn't go to college. And the community I lived in was predominantly the city workers. It was right at the edge of Queens and Long Island. And so if you were gonna be a city worker, you had to live within the five boroughs. And so we had a lot of policemen, firefighters, postal workers, school teachers.
Dr. Steven Rosen:
That's wild. And, and you gotta tell me this path towards medicine. Is it anything that you rejected early on?
Dr. Monty Pal:
No, not at all. It's, uh, actually all a circumstance. So I, I went to an inner city public high school. We were bussed. We were the first group to be bused into the, um, uh, high school area. Um, and then a friend whose brother had gone to Northwestern, uh, he, uh, convinced me that I should go to Northwestern with him. In part, I was a good athlete in high school. I was actually, believe it or not, the best running back in Queens, New York in 1969. And my father had this image of my being, um, a, uh, college athlete and, and also I was a good student. So I went to Northwestern and it was during the Vietnam War and it was on the quarter system, uh, during, during the last quarter. Uh, there was campus unrest across the country. Uh, the school had closed.
We didn't know whether it would reopen. Okay. Um, my roommate was pre-med. My friend from New York was pre-med. I had no idea what I wanted to do, but I went with them to hear about the expansion of a program, which was called the six years honor medical program where you go two years to college and then right to medical school. I just signed in. Turned out I had very good grades. I didn't realize I had such good, good grades compared to others. And like three days later, they interviewed me for medical school, no tests, nothing. And like the next week they told me I was accepted to medical school.
Dr. Steven Rosen:
So this is this famed six year program at Northwestern, right? And this was the inaugural year for it?
Dr. Monty Pal:
No, it was probably, I don't know, fourth or fifth year.
Dr. Steven Rosen:
Got it.
Dr. Monty Pal:
Um, and I don't know how many slots were added. It was a handful. And, uh, then after the second year, I was supposed to go to medical school.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And now I'm 18 years old and I know you were a kid when you, you went, um, but I was very immature in, in New York City. If you had any aptitude, you would skip the grade because the, the schools were overcrowded. And so I just wasn't ready. Uh, so I talked to my parents and my mother said, "Why don't you ask them if you can spend another year in college and then decide?" And so I spent another year in college taking a English course, economics course, something in biology and a laboratory.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And the laboratory experience transformed my life. Uh, and then I ended up going to medical school and stayed for residency and ultimately did a fellowship at the National Cancer Institute.
Dr. Steven Rosen:
Yeah, indeed. And that was really a, I would say a glorious time at the NCI where they were making really pivotal discoveries. Can you tell us a little bit about your time there?
Dr. Monty Pal:
Oh, well, the technology to make monoclonal antibodies had just been developed by doctors Kohler and Milstein in 1975. So I arrived in 1979 and my project is to make monoclonal antibodies against lung cancer antigens. And so I learned that skill and that served me well because all my initial grants were making monoclonal antibodies against, uh, different targets. Uh, and the group I was with were focused on lung cancer, um, multiple myeloma and on cutaneous lymphomas.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And so that was a natural for me when I left and ultimately went back to Northwestern. My laboratory research was in lung cancer, uh, but I was seeing patients with cutaneous lymphomas and myeloma. And back then there was limited therapeutic options. And so
Dr. Steven Rosen:
We
Dr. Monty Pal:
Were in the infancy of establishing the field.
Dr. Steven Rosen:
No, I have to say, I mean, when folks look at this illustrious CV, one of the things that stands out right from the get-go is this short amount of time in which you, you start on faculty at Northwestern and then assume the directorship of the cancer center there. I mean, walk us through that timeline. In my mind, I, I've never seen anything like it.
Dr. Monty Pal:
Uh, so it was a strange, again, group of occurrences. I started at the Veterans Hospital and I was there for about six years, uh, but I always had a laboratory at Northwestern. And I gave a lecture in North Dakota as a favor for a friend whose wife had just delivered.
Dr. Steven Rosen:
In North Dakota. Okay.
Dr. Monty Pal:
And came back and there were some physicians who were abusing their VA privileges at the time, I think at the University of Pennsylvania. And so the, the federal government had a national investigation of whether VA physicians were abusing their privileges. And it turned out that I had not signed a day of absence at the VA even though I was working 100 hours a week and never even occurred to me. And I, um, also had gotten awards for mentoring, et cetera. And the next thing I know, the federal government is investigating me to see why I took a day off and went to North Dakota. And turned out Eli Lilly had given some honorarium that I never saw anybody from Eli Lilly, but it went through the North Dakota Medic- Medical Association. So I, I then met with the attorneys from the federal government. I, they said, "You shouldn't have done this." I said, "I didn't know what I was, uh, breaking any rules."
Dr. Steven Rosen:
Sure.
Dr. Monty Pal:
And I was so offended by what happened. I walked out of that meeting. I went across the street to the head of medicine at Northwestern. I said, "This is my last day at the VA."
Dr. Steven Rosen:
Wow.
Dr. Monty Pal:
And my last day working for the federal government, I'd had previous experience with the federal government in the post office, the Department of Immigration, the NIH.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And this was the final draw. And, uh, so obviously they wanted me to stay at Northwestern. I was one of the few people who had grants and was a clinician, and so I switched over to Northwestern full-time, which was across the street at the time.
Dr. Steven Rosen:
No kidding.
Dr. Monty Pal:
But, uh, what happened then, Northwestern had a NCI Comprehensive Cancer Center grant because they had recruited the acting director of the NCI to come to Northwestern. And in some way, he finagled that they would get the grant when he came, but they lost it immediately.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And so at that point, I wasn't aware of even the possibility. I wasn't the head of a department or a division. I was just a clinician scientist. Uh, but they tried to recruit a distinguished figure, a national figure, and they didn't want to put up resources, so no one wanted to come. So about that time, I was given the opportunity to go to the University of Wisconsin in Milwaukee - Okay. As a division chief. And for me, it was just to earn more money to support a family. And I was gonna go, and then the Dean who had, I'd never met with, learned of the fact that I had some grants, I was a clinician, and he asked me if, if I would be the acting head of the cancer center. I was 37. I'd never balanced a checkbook. And I was gonna do it. But then I called my mentor from the NCI, Paul Bun, who was already a cancer center director at University of Colorado.
And I told him of the circumstance and he said, "Don't do it. You'll destroy your career, plus you can't compete for the grant."
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. "In order to get the grant back to Northwestern, you have to have the position. You can't be acting." And so I went back to the Dean and he though about it and he said, "Okay, I'll give you a contract and in three years, uh, we'll decide whether the contract is renewed."
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
So then I have to get to work to get the grant back. And so I go on the committees, I make some site visits, I learn what you need to do. And at that point, we recompete the grant and we get it.
Dr. Steven Rosen:
Wow.
Dr. Monty Pal:
So it was amazing. I think it was just all, uh, personal connections. People liked us, we liked them.
Dr. Steven Rosen:
And just for our audience, this is not a simple, straightforward 12 pager to the NIH. This is a thousand plus page grant application.
Dr. Monty Pal:
And, and, uh, it was the largest grant that Northwestern had at the time. And the first one I wrote the whole thing myself. Ironically, uh, seven grants later, I didn't write a single word, I just edited. But, um, at that point, I went back to the dean and I said, "We got the grant back and I'd like to renew my contract." And he said to me, "No, you've proven yourself. Now you're like all the other chairman. I can fire you whenever I want." <laugh> So it was cute. But that was the beginning. And so I stayed for 25 years as the cancer center director.
Dr. Steven Rosen:
That is remarkable. And that's one of the longest trajectories of any cancer center director, right? I mean, that's incredible.
Dr. Monty Pal:
Oh, I am the longest for sure. Yeah. Uh, because I've done it seven times, the core grant renewal, five at Northwestern and two at the City of Hope.
Dr. Steven Rosen:
Oh my gosh, that is just amazing. That's amazing. And you know, I, I think you took Northwestern really to, you know, sort of the next level, right, in oncology. I mean, it's risen to, you know, substantial prominence thanks to your efforts there. Tell us about the process of program building there. I'm definitely gonna ask you about City of Hope shortly, but what was it like being a young cancer center director, right, you know, new in the role and, and trying to take a department that, you know, perhaps was, you know, struggling a little bit to one that was nationally respected?
Dr. Monty Pal:
So I, I knew from the start I would have to have the support of all the department chairman.
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. That was essential. And so I went and I met with every single one.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And they were much older, much more experienced. And I talked to each of them about the necessity for them to be advocates and for me to learn from them and that I would respect all of the input and, and they were wonderful. They all supported me. And then probably the most important thing I did was to take the L train up to Evanston.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
Because Evanston, uh, even though they had phenomenal science at the university campus, it wasn't incorporated into the medical center. And I knew in order to recompete that grant, I needed that science.
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. And so I went up and I met with a distinguished scientist. Name was Susan Peter. She ultimately went to the NIH and she said, "You're the first person from the medical school who ever came up to talk to me." And, and so she embraced that and, and she had all of her colleagues who became dear friends of mine participate. And I, uh, had the associate director for basic science was on the Evanston campus. Uh, his name was Doug Engel, and he is still at the University of Michigan, uh, renowned developmental biologist. And it just all came together. And it was very much like what we have at City of Hope, a family environment where everyone pulled for each other.
Dr. Steven Rosen:
Yeah, that's incredible. You know, the logistics of that are challenging. I know Evanston, my dad actually, uh, had his first landing spot from India at Northwestern, in fact, and he studied geography there of, of all things. Um, but in any case, getting two campuses that are so geographically disparate to function together must have been, you know, quite a challenge, I would imagine, right?
Dr. Monty Pal:
Mm-hmm. <affirmative>. And it, it was never ideal. Uh, ironically, one of the blessings of COVID was the fact we all do now virtual communication. It doesn't matter where you are. In fact, uh, when I came to City of Hope and when we ultimately acquired TGEN, which is in, you know, Phoenix, Arizona, the issue is, well, do you really talk to each other? Do you really dialogue? And now it's pretty trivial because we all dialogue because of the virtual communication. But, uh, historically, it was challenging.
Dr. Steven Rosen:
Absolutely. And, and we're gonna get to City of Hope now. You know, it must have been a real, you know, sort of challenge for us to pull you from this very successful position at Northwestern over to our campus. What was sort of the draw for you to come out to Los Angeles?
Dr. Monty Pal:
So I had been the cancer center director for 25 years at Northwestern. Um, we had just successfully recompeted the core grant and did very, very well. Um, the dean at the time, who's still the dean at Northwestern, uh, I, I would say I would struggle working under him. He wasn't the, the same type of personality that I was. And I, I decided I didn't wanna continue as the cancer center director. And it's a cute story. Uh, we had our external advisory board meeting.
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. I told everybody that I was not gonna continue as cancer center director, but I wasn't gonna announce it for about six weeks. So keep it to yourself.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
Everyone leaves. I go to the restroom. My cell phone goes off and it's Alexandra Levine who's at that point, uh, the physician in chief at City of Hope.
Dr. Steven Rosen:
Right.
Dr. Monty Pal:
And she's, "I just heard a rumor that you're stepping down as cancer center director at Northwestern."
Dr. Steven Rosen:
Well, that was fast.
Dr. Monty Pal:
It wasn't even five minutes after everyone walked out. And she said, "We're, uh, searching for a provost and we can't come to a consensus on, uh, the recruitment. And so we would love for you to come out and take a look at the position." And at the time, three of my four kids were living out in LA.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And so it seemed like a, a natural opportunity. And, and then, um, came out, visited, thought, uh, that there was great potential. Uh, City of Hope needed a lot at that point. Uh, but I was familiar with developing Northwestern, so it didn't seem like a, a, uh, difficult challenge. And that's where some renowned figures here at the time, Steve Foreman, who I always say if there's, uh, Mount Rushmore in our field, he's one of the four faces. And Art Riggs was here, you know, great scientist. Uh, Robert Stone then flew to Chicago to meet with me. We hit it off and, and he offered me the opportunity.
Dr. Steven Rosen:
That is so incredible. What a great story. So this, this all transpired very quickly, you know, after you landed here at City of Hope. What were some of the similarities? What were some of the differences in terms of the structure of, you know, a sort of university-based organization like Northwestern versus City of Hope?
Dr. Monty Pal:
City of Hope had the benefit of the total focus of our activities was cancer. Uh, obviously we have great strengths in diabetes. And in fact, I think few know that there are more, uh, important discoveries in diabetes at City of Hope than anywhere else in the nation. Indeed,
Dr. Steven Rosen:
Yeah.
Dr. Monty Pal:
It's quite remarkable. Um, you know, the mechanism of action of insulin, the structure of the insulin receptor, human insulin, uh, even some aspects of, uh, transplantation, uh, re- related to, uh, pancreatic islets is all, uh, City of Hope and it continues. And, and it's really, uh, Art Riggs's legacy, what, what he accomplished. Uh, but the fact that the focus was cancer and you could build around that, uh, to me was very intriguing and exciting. And Robert Stone, to his credit, gave me enormous resources to recruit because that was the critical issue to get the talent.
Dr. Steven Rosen:
And you pulled in some incredible folks. Why don't you just give us a sampling of some of the prominent physicians that you brought into the City of Hopeful?
Dr. Monty Pal:
Well, the first recruit was Yuman Fong, who, uh, was at the time at Sloan Kettering, the head of hepatobiliary surgery. And it's a cute story again. Uh, I asked Alexandra Levine who were the candidates for the head of surgery because that recruitment had started and she said some names and mom was Yuman and it was intriguing to me. So I asked the head of surgical oncology at Northwestern if he was starting a surgical oncology program, who would you recruit? He gave me some names and I said, "What about Yuman Fong?" He said, "Oh, he's a superstar, but he'll never leave Sloan Kettering."
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. So that's all I had to hear. So then, uh, Yuman and I met at O'Hare, had breakfast. He was going one way, I was going the other way, and just fell in love with the fellow. And, uh, he was the first recruit. And obviously, you know how successful Yuman's, uh, been.
Dr. Steven Rosen:
Indeed. Indeed. He's really taken our surgical oncology program to new heights. You know, it's amazing how he's actually now brought up a generation of terrific surgeons and, uh, continues to, I think, you know, recruit aggressively int his department.
Dr. Monty Pal:
Unbelievable. Then the next Ravi Salgia, uh, I, when I was at Northwestern, I wanted to recruit Ravi from the University of Chicago to Northwestern.
Dr. Steven Rosen:
Oh, okay.
Dr. Monty Pal:
But I didn't have the right position, the right resources. So when I came here, uh, Ravi was another important, uh, recruit. And, uh, probably, um, so there are so many, but Mike probably was one of the more transformative figures that we recruited here. He had been the cancer center director at, um, Ohio State, and I heard a rumor that he was unhappy and we're, we were friends. And I called him up and I said, "Is it true that you're looking for another opportunity?" And he said, "Yes." And so I went to Robert Stone. I said, "This is the fellow you have to recruit to succeed Alexander Levine." And it happened and yeah.
Dr. Steven Rosen:
And these are just household names on oncology. Ravi Salgio is my boss in medical oncology and he's been a tremendous leader within our group. Mike Colgary's made seminal contributions on the hematologic malignancies as well. Um, it really, but thank you, uh, first of all for recruiting all these terrific folks. You know, I wanna shift gears a little bit and talk about some of the amazing contributions that you've made from a research perspective. Uh, everybody knows you for your work in the cutaneous T-cell lymphoma domain. And I think it's really been in, in recent years, you know, shifting towards drug development thanks to, you know, some of the elements that we have here at City of Hope. Is that fair?
Dr. Monty Pal:
It, it is. Uh, so my original research, as I mentioned, was making monoclonal antibodies. And in addition, uh, we did one of the first trials in the nation injecting patients with monoclonal antibodies. Uh, back then they were murine. So these were mouse proteins. Okay. And we had them radio labeled and we actually, uh, were targeting CD5, which is overexpressed in cutaneous T-cell lymphomas, but also in CLL and small cell lymphoma. So in the trial, it was fascinating. The patients who had the B-cell malignancies, uh, when we injected the murine antibodies, they didn't develop a human antibody response to them.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
But the patients with the cutaneous T-cell lymphomas, and we saw some dramatic responses, even towards the end of their life, they would develop whopping human anti-mouse antibody responses.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
So you couldn't retreat. Huh. So I said, "Well, I have to make human monoclonal antibodies." So the way to do it, the way you make these antibodies, you have to have a myeloma cell line. The, um, mouse antibodies are made with mouse myeloma lines. So I needed a human myeloma line in my mind to make the human monoclonals. And I had a patient who had a pleural effusion that needed to be drained, and we found malignant cells in the effusion.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And the cell lines, there were very few cell lines back then, there were myeloma cell lines from humans. Uh, if it's in a fluid space, you have much more success than if you're trying to grow it from a bone marrow or from other areas. Yeah. It's profoundly different. So we created the cell line with the though of making human antibodies, published it. And ironically, about that time, Art Riggs at City of Hope developed the technology to humanize proteins.
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. First human insulin, and then it led to all the human antibodies from Genentech. So Rituxan, Herceptin, Avastin, and that's where City of Hope got all the royalties from Art's work and Art himself became very successful as a result of that. So I no longer needed that myeloma line to make human proteins. So, uh, a fellow at MD Anderson was studying how glucocorticoids kill cancer cells. And back then, the treatment of myeloma was an alkylating agent and steroids.
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
<affirmative>. And so we started to collaborate and then he shortly thereafter left, uh, academics for whatever reason. And so I started to do part of my research in the area of myeloma. And those cell lines, believe it or not, for 20 years, I didn't realize Northwestern
Dr. Steven Rosen:
Had,
Dr. Monty Pal:
Uh, patented the cell lines. And we had an agreement that academic labs could get it for free.
Dr. Steven Rosen:
Hmm.
Dr. Monty Pal:
But they would license it to companies. So for 20 years, nothing happens. And then about
Dr. Steven Rosen:
20
Dr. Monty Pal:
Years ago, I start getting royalty checks to this day because of the companies that have used it to make all the modern therapies in myeloma. Oh, no kidding.
Dr. Steven Rosen:
Wow.
Dr. Monty Pal:
Where the survival went from two to three years when I was a fellow to now the average survival for myeloma is about a decade and many patients out, 15, 20 years, some cured.
Dr. Steven Rosen:
Wow.
Dr. Monty Pal:
And so it's, that was very rewarding. Uh, when I came to City of Hope, I gotten into, uh, experimental therapeutics, uh, but it really flourished when I came here, uh, because of all of the shared resource facilities and the fact that we had GMP facilities that you could take small molecules, biologics to patients.
Dr. Steven Rosen:
And this is a very unique resource, right? Most cancer centers don't have their own GMP or good manufacturing practice facility on site, right?
Dr. Monty Pal:
I think there's a handful at best, and I don't think any have the spectrum of the shared, uh, facilities that we have here at, at City of Hope. Um, the other thing that we had that was a great advantage for me at City of Hope is grant writers, because it's very hard to find the time to put together grants and all the extraneous material that comes together. So I started to get more grants, uh, than I'd ever have before at Northwestern to support, uh, the research. And, uh, uh, the, the lab, uh, fortunately did very well and, and, uh, one of the therapeutics is in the clinic here right now. Uh, Amanda Blackman's leading that project. It's a nucleoside analog that's RNA directed, uh, that we had initially NCI funding to do correlative studies and the Rising Tide foundation to support the clinical trial.
Dr. Steven Rosen:
Awesome.
Dr. Monty Pal:
And it's, um, a molecule that looks like a piece of RNA. It's actually a chloradenosine.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
So it enters the cell, gets triphosphorylated to look like ATP with this modification. ATP levels decline. It incorporates an RNA and it's a chain terminator.
Dr. Steven Rosen:
Hmm.
Dr. Monty Pal:
And it also affects RNA methylation and, uh, leukemic cells are exquisitely sensitive, uh, to it. I see. And so we did the phase one trial and now we have a trial, uh, that combines it with decitabine and venetoclax in AML. Oh, very cool. And it's a dose escalation. Yeah. So I think the next, uh, dose or the dose after will start to get to the therapeutic level. Uh, the other projects in the lab, uh, one has led to a biotech company, Slam Bio and, uh, knock on wood, I hope we're in the clinic in the fall.
Dr. Steven Rosen:
Okay. Uh, so this - Tell us about that, the product.
Dr. Monty Pal:
So this was started as a collaboration, uh, with the Weitzman Institute.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
Uh, the SLAM family of proteins are signaling molecules on the surface of blood elements that regulate the body's immune response. And there's already an antibody in the clinic against SLAM7 for myeloma.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
So we now have a humanized antibody against, uh, SLAM5, and, uh, the antibody, uh, against SLAM5 is an antibody drug conjugate now, uh, attached to exitecan. It's a topoisomerase inhibitor. Okay. And, uh, the preclinical, uh, results are just, uh, so exciting. And, um, if it holds up in the clinic, it ha - would have efficacy against all lymphomas, the, the targets overexpressed in all lymphomas, uh, as well as all leukemias, AML, ALL, T and B cell, ALL. Uh, it's even expressed on the Reed-Sternberg cells and Hodgkin's. Oh,
Dr. Steven Rosen:
Wow.
Dr. Monty Pal:
Uh, it's expressed on, uh, isolated, uh, normal blood elements. So I think, uh, the toxicity profile should be very acceptable. And, uh, we're gonna start with the cutaneous T-cell lymphomas in a phase one trial and then expand into AML and high risk MDS. Um, and then we'll see where, where it evolves. Uh, it also is a molecule that's overexpressed in the immunosuppressive microenvironment of all cancers.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And so, uh, some of our original publications with the group from the Weitzman using a mirroring antibody, um, in a mouse model, uh, we were able to show you can effectively treat a variety of blood cancers, but also triple negative breast cancer.
Dr. Steven Rosen:
So some solid tumors. Uh, you,
Dr. Monty Pal:
You're treating as a checkpoint inhibitor.
Dr. Steven Rosen:
Got it.
Dr. Monty Pal:
So we don't, so even though that's not the, uh, initial focus of our work, it has potential there as well.
Dr. Steven Rosen:
Oh, that's so neat. Wow. Interesting. I didn't realize that sort of translation of the solid tumor space. That's fascinating. Steve, you're in this niche field, you know, that some might consider of cutaneous T-cell lymphomas. It's a rare diagnosis, um, challenging to treat, uh, for many sort of day-to-day oncology providers. What makes City of Hope unique in delivering opinions for some of these rare entities?
Dr. Monty Pal:
So, so it's the team care. That's what is so remarkable about City of Hope. In the cutaneous T-cell lymphomas, I'm in the clinic with two of the leading dermatologists in the nation. One happens to be also dermatopathologist, uh, Kristin Kwerfeld. And, uh, Courtney Johnson is the other, uh, dermatologist, uh, trained at Hopkins just joined us. It's fantastic. And then I have Christina Poe, who's a leading figure in T-cell lymphomas with me. So we're dialoguing constantly. Uh, for the patients I see with the other lymphomas and with chronic lymphocytic leukemia, uh, we meet every Tuesday, all the experts, and we present every single new patient. And so you get the opinion of 12 of the leading figures in the field. And I always tell my patients when I see them that this is what I feel, but that I'm gonna present you the f - next week to the group, and if there's any controversy or if people feel differently, then I'll share that with you.
And patients say, "Oh my God, that I've come to see you, but the reality is I'm getting the advice of all these giants in the field."
Dr. Steven Rosen:
It's gotta be nice to have that reassurance, right? Uh, from the patient's perspective. I always enjoy that in the GU side as well where, you know, we focus on kidney, bladder and prostate cancer, but any complex decision gets made with the assistance of the whole team.
Dr. Monty Pal:
Also, the clinical trials. The fact that we have all the latest therapies here, it's remarkable. And, you know, in the CAR-T space, we've done over 2,000 CAR Ts and, you know, this is the most advanced immunotherapy that you can apply, and it's been a breakthrough in, uh, the lymphomas and chronic lymphocytic leukemia.
Dr. Steven Rosen:
I didn't realize there was over 2,000. You started to, you know, engage with our CAR T-cell group for trials in kidney cancer, um, a- and the breadth of expertise there is just, it's so refreshing for me, you know, who's relatively new to the field, to have that backup of folks who really know how to manage some of these very complicated therapies. Y- you know, one of the things that I've always been impressed with is that, you know, you maintain a very busy clinical practice. I think many folks might, you know, look at someone in a cancer center d- director's role and make the assumption that now it's, you know, always pen to paper, writing grants, et cetera, you know, patient care really becomes secondary, but never the case for you, right? You've always maintained a, a pretty busy clinical practice.
Dr. Monty Pal:
I have 500 patients right now.
Dr. Steven Rosen:
Oh my gosh. Yeah. And, uh,
Dr. Monty Pal:
The only one in the hospital is postsurgical issue, uh, unrelated to the lymphoma treatment.
Dr. Steven Rosen:
Yeah. Tell us about that. Has that always been sort of the central tenant of your career, just maintaining patient care alongside these very, very sort of large and time-consuming administrative roles?
Dr. Monty Pal:
That's my passion. I love it. Um, it, my patients become my family. I'm just like you. Uh, it just, uh, is so rewarding. It's a blessing. And, uh, with that comes the obligation to do everything you can to help those individuals.
Dr. Steven Rosen:
Yeah. Y- you know, a- as I reflect on, you know, some of your achievements, what always sort of stands out more recently... Learn these, you know, incredible lifetime achievement awards, you know, that you received. Giants of cancer care, you know, is one of them. Uh, uh, one issued from the Israel Fund, uh, Israelson Fund, which, uh, you know, again, rewards some of the work that you've done, you know, jointly between the US and Israel. Um, you're getting actually an award at this ASCO meeting in just a couple of days in Chicago, right? Um, you know, a- as you sort of accumulate those awards and sort of look back, you know, what is it that you think makes you tick? What makes Steve Rosen really show up every day to work his hardest at the cancer center?
Dr. Monty Pal:
Yeah, there's a great quote from Fellini who says, "There's no end, there's no beginning. There's only the infinite passion of life."
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
And to me, it's just get up every day, enjoy it. It's a blessing. Uh, it's so fulfilling. Uh, you know, you, you experience it every day like I do. It's just, you're surrounded by people, uh, that embrace what they do. They wanna do things that'll benefit humanity. And they, you see the compassion, the empathy, the caring, and then when you take care of a large group of patients, it, it, it's just so interesting to see the different aspects of individuals life and what they do and what brings pleasure and, and City of Hope, the diversity is, is something that I relish. Uh, it just, you, you see people with every background, uh, who come here to make a better life.
Dr. Steven Rosen:
Yeah. Oh, I, I, I've gotta say I agree with so many of those sentiments. I do think the patient care aspect is really what, you know, makes a lot of folks like us tick, right? Indeed brings us back to work every day with a big smile on our face. Um, one of the big challenges I think nowadays is, uh, for folks entering into the field, right, you know, just balancing the pressures. I guess this has always been the case of, of home life, of administrative work, of, of clinical care, you know, perhaps, you know, because of what folks are facing with the electronic medical record and so forth, some of those burdens might be increasing to some extent. Uh, what's your advice to folks who are entering into the field right now who wanna really sort of blaze a path similar to yours?
Dr. Monty Pal:
Well, I do think, uh, for a variety of reasons, you have to be very focused.
Dr. Steven Rosen:
Mm-hmm.
Dr. Monty Pal:
Uh, I had the luxury of dabbling in many areas that that's no longer the case.
Dr. Steven Rosen:
Okay.
Dr. Monty Pal:
So what I advise young faculty is, uh, become known for something so that every time there's a meeting in your field, if this topic is gonna be discussed, you're the person they wanna talk to.
Dr. Steven Rosen:
Yeah.
Dr. Monty Pal:
And, and, you know, whether it's the microbiome or the microenvironment or select aspect of that, I think that's, uh, would be my advice at, at this juncture.
Dr. Steven Rosen:
And, and not to be, you know, controversial here, but what if you picked the wrong field there? Is, uh, is it, you know, worth, you know, having sort of several areas of focus, um, or do you think that that singular focus is really what academicians need nowadays to thrive?
Dr. Monty Pal:
I, I do think that you need a focus. Now, you could evolve. You may find that this looks like a dead end, but if you still have the energy and the creativity, it may evolve from there. Um, but it, it is challenging to, uh, be known in two or three areas and, uh, really to be able to get competitive grants and to get the recognition.
Dr. Steven Rosen:
Yeah.
Dr. Monty Pal:
It's just a reality.
Dr. Steven Rosen:
I, I think that makes a lot of sense. You know, it really is hard to compete, you know, at the level of getting R01s and other, you know, competitive grants unless you really have some designated expertise in an area, right? Y- you know, and to that end, you know, what advice are, are you giving, you know, your kids or young folks who are entering into the field of medicine? I, I've heard, you know, some of our colleagues that are turning, you know, their, their kids, grandkids away from going into the medical field. Do you have any sage advice, uh, given your illustrious career?
Dr. Monty Pal:
No. All four of my children, uh, did not enter the medical field, so - Okay. It wasn't because of a lack of exposure, but there was just no interest there. Um, and they're very happy, so I -
Dr. Steven Rosen:
Yeah.
Dr. Monty Pal:
Yeah.
Dr. Steven Rosen:
It, it is, yeah, I guess that makes sense. It is important to, I guess, give that guidance to follow your passions and so forth. Medicine requires that, I think, right? Doesn't it, uh -
Dr. Monty Pal:
Yeah.
Dr. Steven Rosen:
Really thrive in the field.
Dr. Monty Pal:
You have one life and, and, you know, enjoy it. Um, and I don't think, uh, that you f - have to, uh, feel that the only way this is a meaningful life is if you do X, Y, or Z. I mean, it's like, you know, people say if, uh, a door closes and other opens and so.
Dr. Steven Rosen:
Indeed. Indeed. Yeah. And, and, you know, I wanted to shift gears a little bit too and talk about City of Hope's expansion into other regions of the country. This is something I think that's quite unique amongst cancer centers. Y- you know, certainly I've heard of other centers having, you know, sort of some expansion within their regional areas. I think what City of Hope is doing now with, uh, moving to Chicago, Atlanta, and Phoenix, uh, with our, you know, brand new center in Irvine, I think a lot of these elements are quite unique. What is your sort of forecast for how this is gonna play out?
Dr. Monty Pal:
Hopefully s- success. Um, I feel that the clinical trials component's gonna be the most important in terms of having a national network. Uh, there may be other aspects in terms of having large databases, uh, that other institutions can't have. Uh, but the clinical trials piece may be the most unique. And I know pharma, um, has been very excited about the potential of doing trials on a national scale with diverse populations, with, with City of Hope as a partner.
Dr. Steven Rosen:
Yeah. No, I think a lot of us are really excited about the potential for taking Trial X that's previously opened in Duarte and doing it, you know, three, four times as fast by engaging our colleagues from around the country. There's no doubt about that. Yeah. And, and, and really impressed some of the folks that we've recruited to lead some of these centers. You know, Walt Stadler, uh, from, you know, the University of Chicago joined us recently to head our Chicago site, Alan Bryce, uh, leads our center, uh, at the University of Arizona with lots of experience from the Mayo Clinic. Um, and, and it really is, you know, kind of a, an all-star cast, I think, that we've gotten to lead these centers moving forward. So, so certainly a positive note. Y- you know, now that we've hit on a lot of academic themes, I wanted to talk about some of your pursuits outside of medicine, which I think are, you know, just as fascinating.
Um, you know, you shared with me some of your poetry, you shared with me some of your music. How big a role do those sort of extracurricular elements play in your day-to-day life?
Dr. Monty Pal:
Uh, day-to-day, not much. But, um, there are moments, it goes in streaks. So the poetry, I have two anthologies. I'm proud of both. Uh, one is heartfelt reflections, uh, and the other one is called The Next Journey. Uh, both are translated into Spanish.
Dr. Steven Rosen:
No kidding.
Dr. Monty Pal:
Yeah. So it's by the sister of a patient of many years who happened to be a professor of Latin studies. And she loved the poetry, so she translated it all, uh, for me. Uh, the music has, uh, been a bl- blessing in the later years of my life. It, it, again, it was a fluke. It was a woman who sat next to me at a medical meeting on the big island of Hawaii. She was there with her partner who was in the pharmaceutical industry, and everyone was talking medicine and science. And so to be polite, I asked what she did and, and she said, "Well, she's an aspiring, um, singer, performer, and she's writing music." And I said, "Oh, if you have anything you wanna share, please send it to me." And about a year or two later, she sends a song, and I though her voice was intriguing, uh, and I decided I would try and write music for her.
And so it, it turned into a album, 15 songs. Uh, it's gotten good publicity, and she's working on our second album right now. I gave her another 30 songs.
Dr. Steven Rosen:
Oh, wow.
Dr. Monty Pal:
And, uh, and we had our first concert, uh, a few months ago, and it went very well, and so.
Dr. Steven Rosen:
Oh, that's, that's so brilliant. You know, Rena and I had a chance, my wife, uh, and I had a chance to sample some of your music at our home not too long ago, and I though it was just incredible. Uh, I've gotta ask you, I mean, I'm sure music always draws from personal experiences. Does, does patient care ever sort of blend into the music, you know, times, trying times with patients? Does that ever sort of wind its way into either your poetry or, or lyrics that you write?
Dr. Monty Pal:
Mm, not that often. Um, if, the poetry in particular, it's much more either romance, philosophy, uh, unique individuals who I've, was inspired by that I would write about. Uh, not so much medicine or patient, though there are a few, uh, that have a, a medical tinge to them. The music, not at all.
Dr. Steven Rosen:
Got it.
Dr. Monty Pal:
Not at all.
Dr. Steven Rosen:
Got
Dr. Monty Pal:
It.
Dr. Steven Rosen:
Yeah. Yeah, no, I,
Dr. Monty Pal:
I can,
Dr. Steven Rosen:
I can -
Dr. Monty Pal:
And the poetry doesn't rhyme. Uh, the music has a lot of rhyme to it because it just sounds better, so.
Dr. Steven Rosen:
Of course, of course. I found music to be such an important release. My son who's, you know, 13 and I love rocking out in the garage. I play a little guitar and piano. He's, he's great on the drums, so that's turned into -
Dr. Monty Pal:
Well, you play a, play a little bit more than a little bit of, uh, guitar. You're very talented. <laugh> You're very modest because you are, uh, a great musician. I've seen you perform.
Dr. Steven Rosen:
Oh, thank you. Thank you. Um, yeah, no, I mean, this has just been incredible. You, you know, Steve, one of the things that we always do on this podcast is we wrap up by asking, uh, a question pertaining to our title, which is On the Edge of Breakthrough: Voices of Cancer Research. What does on the edge of breakthrough mean to you?
Dr. Monty Pal:
Well, I think the field has evolved so dramatically in the last decade where more knowledge has been gained in months than had been gained in previous decades that you see that we're gonna be conquering one disease after the other. And some of the profound advances we've had in blood cancers, and I can honestly say every single patient I see, because I do a restrict number of types of blood cancers, uh, some of the lymphomas and chronic lymphocytic leukemia, cutaneous lymphomas, in general, patients do well with the, and I see it now being applied to the other disease areas.
Dr. Steven Rosen:
Mm.
Dr. Monty Pal:
Um, you know, it used to be that we could dissect one pathway at a time. Now with artificial intelligence, you can do 10,000 pathways at once. It's astounding. And so, um, I, I think that, not that we'll ever eliminate cancer, but I think our ability to detect it early, uh, to prevent it, uh, to cure a significant portion of, of patients i- is on the horizon.
Dr. Steven Rosen:
Amazing. Well, Steve, this has just been an incredible conversation. I'll probably keep you here as hostage for hours in this seat, but thank you so much for -
Dr. Monty Pal:
I would like to talk to you for hours. <laugh> Yeah.
Dr. Steven Rosen:
Thanks so much for being here. Thanks for tuning in to On the Edge of Breakthrough. See you next time for more insights from the front lines of cancer research and care.No. I, I, I came up playing basketball. Basketball is a contact sport, Monte, even though people don't realize that, at least the way I played it with two left feet. And I played pretty late here at City of Hope. We're on our, our campus. And we used to have a basketball league here. And I played with scientists, mostly scientists, a few physicians. Dr. Monty Pal: Okay. Robert Stone: And it took me a while to realize they play for keeps. And I wanted to say during the up and down, I'm not deciding budgets today. You can take it easy. And they play for keeps. And I, I tore a ligament in my, uh, ankle and that kind of ended my career. Dr. Monty Pal: So I, I remember this game on the south end of campus. It was. And it was pretty vigorous. I, I do remember that. I tried playing once, uh, and once and only. That was it for me. Robert Stone: So I was told stories and, and our strat And the story I got from multiple people on multiple occasions about that basketball game on the South Side on Blacktop, remember it's outside - I do. Yeah. On Blacktop was that I should just be thankful that by the time I joined and started playing, Art Riggs had stopped playing. Because Art, who is, is I believe City of Hope's most renowned scientist - Indeed. In the 110 years was an aggressive basketball player. Dr. Monty Pal: No kidding. And this is, you know, potentially a future Nobel Laureate. I mean, he's an incredible guy. Well, he should have been. Yeah. He Robert Stone: Should have been already Dr. Monty Pal: In Nobel Laureate. Absolutely. Well, well, you know, Robert, let me just ask you, you know, one thing that you have always made time for in the years that I've known you is family. You know, you've got a wonderful family. Tell us a little bit about that. You know, your, your, your daughter's in medical school now at UCLA, which is my alma mater, which is super exciting. Robert Stone: Yeah. It's why she did it. I said, you know, any place that Dr. Pal went is good enough to know. Um, yeah. So I've been married 30 years. Uh, I, I remember that, both that anniversary and my service anniversary at City of Hope because they happened in the same month. That's Dr. Monty Pal: Right. It's 30 Robert Stone: Year time. Dr. Monty Pal: City of Hope, Robert Stone: Right? September of 1996. I, I got married to a wonderful woman, Charlotte, who is, uh, as the years go by, 30 years ago I told you we can't be closer. And as each year goes by, I have the pleasure of, of getting closer and closer. And I married up, which is just a wonderful... I know, Rena, you did the same. Indeed. So we, we share that. Indeed. Yeah. Um, and we have two kids. Our eldest Ellie is, uh, finishing her first year of medical school at UCLA, which we love because she went to undergrad at Emory in Atlanta. So she was gone for four, for five years because she took a gap year. And our son Thomas, uh, is a junior at Chapman University here in Orange. Dr. Monty Pal: Oh, phenomenal. So both close by, I imagine you get to stay in close touch over that time. Robert Stone: Yeah. For, for reasons you'd appreciate more than I perhaps would, Monty. Apparently first year of medical school doesn't leave a ton of time - Fair enough. To get together with your parents. But we do get to see her quite often, much more than when she was in Atlanta. And, um, so yeah, it's great. Dr. Monty Pal: Phenomenal, phenomenal. Uh, you know, we are gonna talk about City of Hope now. And I wanna start with what initially brought you to the campus. You know, it's been 20 years here for me, 30 years for you. Um, I could talk for hours about, you know, how I was sort of linked originally to the campus. I wanna hear how you were originally brought to our, our illustrious institution. Robert Stone: Yeah. So, um, it, for me, with the benefit of 30 years of hindsight, that, that story leads me to conclude luck plays a lot into history for, for people. I, um, I lucked into coming to City of Hope. Uh, I turned down the offer to interview twice. Really? Yeah. Yeah. So I, I'm a lawyer by training. And, um, I went to work in a firm downtown Los Angeles right out of law school. And a partner that I had worked with there, uh, went out and started his own firm and asked me to join him. So I was one of three people to start a firm and I, and I left that first firm. In the meantime, a couple years later, a part, another partner at the same firm had become City of Hope's first general counsel in its 86, then 86 year history. And he asked me to come and be the second full-time lawyer in the office. And I knew of City of Hope. I grew up in Whittier, which is just, you know, a few miles away, 20 minutes away from the campus here. Um, so I knew of City of Hope, but I didn't know anybody that had, had benefited from our services. And I thought I was happy doing what I was doing. I had a lot of responsibility. I was, um, learning every day. I was intellectually curious and I kept going, but I, so I said no. And then he said, "I'll buy you lunch in the cafeteria if you'll come and interview." Okay. And so l- lucky piece number one is I'm here because of hospital food. So that, that's a, that's a true story. Luck number two is I came and I met wonderful people. I mean, I, I still can remember who I met with. I could list names that for everybody in the institution that's been here a long time, they would resonate with from Jack Kovach to Marsha As. I mean, you, to Alan Shubin, you just go right down the line. But I still wasn't sold on coming. And I took a tour of the campus and it looked very different 30 years ago than it looks today. Um, and I came around towards the front, what was then the fountain, took a, took, took a right hand turn heading towards the front entrance. And the building on my right now is the Briskin, uh, Clinical Research Center. Was then the pediatric bone marrow transplant unit. And out in front of me was a, a nurse pulling, literally pulling a red wagon. And in the red wagon was a kid who had no hair. I, I, to this day, 30 years later, can't tell you if the child, uh, was a boy or a girl, probably four or five years old. Beautiful blue skies, uh, Sunday day. And the kid's just smiling. I was having a great day. And you can tell that was evidence of what City of Hope can do for people. I still wasn't sold. It wasn't until I looked to the right of, of that young pediatric patient. And a step behind pushing an IV pole was clearly his or her mother. And she's silently sobbing. And to this day, Monty, I don't know if she was crying because, um, her child clearly was go - undergoing transplant or if she was crying because her child had been undergoing transplant and now was outside and starting to enjoy the day like a, a, a, every kid should. But it was that mom that sold me on City of Hope. Never spoke to her. Never said anything. Wish I had. Um, but that's how I ended up coming here. Dr. Monty Pal: Well, what a beautiful story. And, and, and certainly, you know, I think that I understand that transition towards a role here that carries so much, so much meaning. Uh, you know, your role at City of Hope has evolved so much. You know, initially, as you've mentioned, the office of General Counsel, um, then towards strategy and now of course to, you know, president and CEO of the hospital. Tell me a little bit more about, you know, that, that transition for you. How, how did you migrate through these positions, um, and take on this role that's, you know, so sort of, uh, I would say grand within the hospital and, and command so much direction? Robert Stone: Well, so if you think back, so I went to the University of Chicago for law school. And I went to law school because I had been a political science major as a, an undergrad. And at that time you either taught, I didn't really want to teach, or you went to law school. And it wasn't that I had a passion for the law, but the law taught me how to structure thinking, how to put pieces together, um, to figure out, well, if in, in our case now, if something's happening in the clinical care arena over here and something else happening in research over here, how do they impact each other and how do we put them together? And what I found when I came was a, I, I wouldn't have told you I had a natural curiosity at the time because I didn't even think that way. But I clearly, looking back, had a natural curiosity. This was a place that was caring. It was much smaller. We had about 2,500 employees just here on the Duarte campus, not what we've become. And I got to get involved in all kinds of things. And ultimately that led to the next job, to the next job, to the next job. And the, the two places that had the biggest shifts for me were on, uh, in 2009, if you can think back that far. Dr. Monty Pal: Yeah. Robert Stone: President Obama had just been elected. Dr. Monty Pal: Okay. Robert Stone: So, and just been inaugurated. So we knew healthcare reform was coming, but we didn't know what it was going to look like. And I went to the then CEO, Mike Friedman, who I'd worked for, for, uh, quite a while at that point, about five years. And said, you know, Mike, I think I want to do something else and, and expand. And I went into strategy and Mike was, uh, gracious enough to give me that opportunity. So that was the big move. I, I moved out of the law. I haven't practiced law since our, our general counsel, Kristen O'Callaghan will tell you at the few times now when I opine on legal issues, she'll say, okay, leave it to the expert. I love Kristen. Yeah. Um, uh, we don't. And then when I became CEO, uh, I was announced in 2013. We had a board meeting in the room next door to where we're, we're talking right now. And at the time, my belief was that the organization would put, would hire, go out and hire a physician, probably a physician scientist for the role of CEO. Mike, uh, Friedman, who I'm very close to to this day, was a physician scientist. Dr. Monty Pal: Sure. Robert Stone: And he, uh, he believed strongly, as close as we were, that it should be a physician. There were 54 comprehensive cancer centers at the time. Everyone was led by a physician or a scientist. Okay. And I had set up meetings with faculty members and others for our board the following week to, um, interview and start the process for choosing the next CEO. Board had their quarterly meeting, took two to three hours in executive session, came out, then board chair and an immediate past chair asked me to come over. We sat down and they said, "We're gonna make you CEO." And, um, that was the other big change. Dr. Monty Pal: Well, I, I think it's a brilliant decision. You've done amazing things for the campus. And we've had periods of explosive, explosive growth since then, which I wanna highlight in just a moment. But, but tell me a little bit first about leadership, leadership style. You know, everybody comes to the position, um, at the helm of a cancer center or business or any institution with a certain philosophy. Tell us about yours. Robert Stone: Well, so you started the conversation, uh, early about basketball and about athletics. And, and for good teams, you play a role. I mean, that, that goal in, in athletics was winning. Our goal here is how do we help patients win? The competition is cancer. And so my, I started my leadership style and it stayed true as a true, um, north for me is it's not about one person. I, I had the benefits, the same benefit you've had in your time here. Um, We were, we, as I said, we were smaller and we had one campus. I got to watch Art Riggs. I got to watch Steve Foreman. Um, part of the story I left out, uh, when I arrived is that one of the guys who had been CEO for 30 something years before me, a guy by the name of Ben Horowitz and a couple of other, uh, long time employees, Manny Feinman, Isadore Familion, they were still around. They were in their 80s. But that group from Art to Steve to Ben to Man - in their own ways, they taught me what it meant in this context to be humble, to demand excellence and to put something bigger than yourself in the middle. And as we've grown, I've tried to live with those, by those principles throughout. I was taught a lesson very early on, uh, Monty. Um, I was new. It had to be in my first year or two. I, I was still in my 20s when I came. And I sat down first time, so probably the first year with Steve Foreman. And Steve Foreman, as I'm sure everybody knows, is the most incredible physician. If I have a family member who not just has cancer, has any disease, I'm asking Steve to do. Dr. Monty Pal: No. Robert Stone: That's how, how fabulous he is. And I, but I didn't know him then. And we sat down so humble. He's undoubtedly, he's wearing a sweater then. I think it's probably the same sweater he's wearing now. Sure. And he said, "So I was here when we built the transplant program and here's what my research interests are and here's where the program stands. What are you an expert in? " And, and I swallowed hard and it, and it really did, was an early teaching of you need to have the right attitude to be a leader. You also have to demand excellence of yourself and of those around you because if you're going to get excellent people, they're going to motivate themselves to do that. Yeah. Dr. Monty Pal: That makes perfect sense. And I've got to ask you, and this builds on your experience with Steve. You, you know, you've presided over this, uh, array of department chairs, all of whom are luminaries, uh, Ravi Salgia, Yuman Fong, others. Uh, what is, uh, what does it take to really sort of corral a bunch of these brilliant minds oftentimes with, you know, differing thoughts on, you know, what direction to take departments in or the institution in? Robert Stone: So a couple of things it takes. One, um, I, I mentioned a few minutes ago that I actually believe now more firmly than I did 13, 14 years ago that not being a physician or a scientist is a real advantage because I walk in with a deep, deep appreciation for what, not just our chairs, our chiefs, our faculty, what they bring that I could never bring and that most can't. What you, what you do, Monty, you, you're an inspiration for me. What you do, um, I couldn't replicate. But what I can do is create an environment that allows you to even be more successful. You'd be successful no matter what you did. Yuman Fong, Ravi, Robbie Selgia, um, Eileen Smith, uh, they would all be successful no matter what. I can help create an organizational infrastructure that allows that talent to, to come out. So that's one, is a deep appreciation. Two, I learned a lesson, a leadership lesson very early. I don't think I was CEO. Okay. In fact, I know I wasn't. Uh, maybe I'd just been named. And we had a chair of the medical staff, um, a surgeon name of Fred Granis. Oh, I Dr. Monty Pal: Remember Fred. Robert Stone: And Fred, for reasons I couldn't, we, we've become actually pretty close. But at the time, Fred thought I had done some things wrong and Fred was not shy at telling people that I had not, had done some things wrong. And we sat down to talk and he paid me ultimately years later and I got it secondhand. The greatest compliment I think a leader who's tr - who's working with faculty and trying to unleash faculty could ever receive. He told a group that there were things he agreed that I did. There were things he disagreed, but that he always knew where I stood and that I was always honest with him. And I think that part of faculty members are brilliant. There's a challenge sometimes faculty members have, which is when you become so specialized in your work, you can become narrow and not see the whole, the whole field. Um, my job is to help you see the whole field as a leader and part of that is delivering messages that help. And part of that is delivering messages that you don't necessarily like, but having that dialogue around it. Dr. Monty Pal: Brilliant. And, and you know, I, I wanna assure our audience this is not hyperbole. Every time, Robert, that I've ever passed you in the hallway, two questions come to mind, right? Ev- every time I've passed you, you've asked me, Monty, are you happy? And Monty, what can I do for you? And that means the world to me. I brag about this all the time as I go to visit colleagues at other cancer centers, many of them, you know, have never met their CEO. Uh, it's just wonderful to have this rapport and relationship that, that we do. And it seems to pervade much of our faculty. So thank you for that. Robert Stone: Thank, thank you, Monty. I think of it this way. Um, I had a nurse who was leading a joint commission survey some years ago who I was sitting down with and getting the, the, the results, which were very positive. And she said, "Just remember, oncology is a tough business and it's tough emotion. It's very rewarding, but it's tough." And I tell people, I've told you I think this, um, you have to find what gives you energy. What up... Not every day is gonna be smooth sailing. And in fact, characters formed on those days that aren't. And part of our sacred mission is actually for those, for those, um, days that aren't good and the people lose their battle. What, one of the things that gives me energy is knowing and helping our faculty. So if I was listing the, the handful of things that really, when I'm having a day that, you know, you wanna pull your hair out, things aren't going right, I get uplifted by coming and talking to you. And, and the only thing you could have said that was more flattering is I'll give you the, the advice for next time. Dr. Monty Pal: Sure. Robert Stone: Is how are you, are you happy? Um, what can I do for you? And how's Rena doing? Dr. Monty Pal: Oh, there you go. Robert Stone: Because there's an aspect of the fact that if your wife walked into the studio right now, I would know her and give her a hug. And if my wife walked into the studio right now, you would know her and give her a hug. It, it's not a job. It's a calling and it's about family. So that's very uplifting for me. Dr. Monty Pal: Oh, indeed. Indeed. Y- you know, Robert, I wanna shift gears and talk a little bit about what's changed at City of Him. I just don't even know where to start. You know, you've been here for 30 years, a decade and a half at the helm of the institution. Um, and you've overseen so many changes. I think the perhaps most prominent change in many folks' minds is this massive expansion that we've had. Uh, and we can talk about this in the context of this new beautiful center we have in Irvine. I've had the good fortune of actually practicing there and I just absolutely love it. Uh, we have new sites in Chicago, Atlanta and Phoenix, which I, I think are really led by some of the, the best experts in oncology in the country. Um, tell us about, you know, what sort of took us from, uh, the singular entity focused here in Duarte, California to this really sort of nationwide enterprise. What was the philosophy and driving force behind that? Robert Stone: So I don't think I've told part of this story publicly. So you're, you're gonna get the first. Okay. All right. You've worn me down, Monty. Um, the context is I see right now in other health organizations reaction to, um, the health environment, to consolidation, to all of the changes, almost with a strategy that, well, size is gonna overcome all and there's growth for growth's sake. I fundamentally disagree with that. I think that if you're not well run and you don't have a mission purpose, getting bigger just exacerbates your problems, not makes it easier. So it wasn't the idea that we woke up one day and said, "Let's just grow and we'll have more voice if we're bigger." It's true we have more voice, uh, when we go to advocate, uh, nationally than we did because we spent, but that wasn't the goal. Back, I, I said that in 2009 after President Obama had been inaugurated and I changed jobs, there were conversations in the quiet halls, some in this building, um, but in the boardroom, in the senior leadership room that said, "Okay, we're seeing consolidation." It came right around the time we had, there's a large well respected medical group in Los Angeles that was sending us a number I remember was like 40 transplant patients a year. Mm-hmm. Okay. Not insubstantial. And they went, one year they gave, sent 40, the next year they sent one. Dr. Monty Pal: Hmm. Robert Stone: And the only thing that changed is they were bought by another health system and all of their transplants went to the other health system except the one was the spouse of the managing partner who made sure that his wife got the care that she needed. Interesting. And so we were having the dialogue of can a then niche player, just cancer, survive going forward in an environment where you're seeing consolidation and the payer landscape is changing? And we, we ultimately decided yes, um, we would and that we would lean into that, um, cancer only focus because while I'm very proud of our diabetes work, it's really diabetes research. We're not a primary care place for diabetes patients. Sure. Um, it really was about the cancer at the time, cancer at the time. And if you fast forward from 09 to, you know, 2016, 2017 when the growth really started happening, by that time it became clear because people were talking about access and access in, in the environment meant you have insurance. It didn't mean you have access to great care. Dr. Monty Pal: Right. Robert Stone: And we started with a model. We formed our medical foundation, which was our partnership with our physicians back in 2011, 2010, 2011. And we started growing in Southern California and we did that for two reasons. We grew so that we believed if patients didn't have to travel to Duarte, um, they, they shouldn't have to, then get great care to home. And that we could create an infrastructure where care could be delivered in the community and still have the access to the experts and the subspecialists in what at the time was just Duarte. And that led us to grow Southern California, which is now 31 sites. Mm-hmm. Um, it led us to go into Orange County, uh, and make a bet in Orange County, which was seen as risky at the time because there are a lot of institutions providing cancer in Orange County, but we though that focus could make us do, have an advantage in focusing and helping cancer patients. And then that led to the CTCA acquisition to, uh, forming a company called Access Hope, which was designed not for us to provide the care, but make sure our experts did. And, and it, it ultimately, you know this as well as I do, four out of every five cancer patients in this country don't have access to a comprehensive cancer center. Yep. They get their care elsewhere. And if all of the comprehensive cancer centers were, had the ability to remove all barriers to access, we couldn't collectively make a dent in that 80% statistic. So we're gonna forget about those people. And as you see so much innovation happening in science, um, that gap gets wider because the care is more exciting. The care, the possibilities are more exciting. Um, you just have to figure out a way to make access available. Dr. Monty Pal: Indeed. Indeed. You know, I'll go back to a time when I was the only geomedical oncologist on our campus, but I never felt alone. This was more than a decade ago and our, our group has grown immensely since then. Never felt alone because I always had those partnerships with colleagues in Pasadena or colleagues in our upland site or colleagues out in Corona. And it meant so much to be able to, you know, really sort of have that, uh, group related force associated with my program just by having all these wonderful colleagues spread out through Southern California. And, you know, it's great to have those guys out in Chicago and Atlanta and Phoenix to partner up as well. Robert Stone: Yeah. Well, think of it this way, Monty, and, and I wish I, I was quick enough to come up with an example other than you because you, people are gonna that I'm only agreed to come on or you had me on so I could compliment you. I appreciate that. But it's, yeah, it's, it's really true. I, I was speaking recently on a, on a panel and I said something that I kind of wish I didn't say. And I'm gonna exacerbate it because I'm gonna say it again here. Let's hear it. Which is I, I told a patient, I said, "If you have to choose, cancer patient has to choose between somebody who is excellent, expertise in your cancer and somebody who's nice to you. If you had to choose, choose the expert." Okay? Dr. Monty Pal: Yeah. Robert Stone: Most patients understand and choose the nice person. And I absolutely believe what, what is our model can be replicated pieces of it by others. We're actually pushing to have it replicated by others. But the piece that's hardest to replicate is we don't, at City of Hope, you don't have to choose between an expert in your cancer and somebody who's gonna treat you with respect and see you as a person and not see you as just a number. And you do that better than anybody. And if you think about that expansion and you talk about your colleagues, whether it's in Upland, Santa Clarita, or it's in Irvine or Atlanta or Phoenix, at too many cancer centers, there is a pervasive thought of I'm the expert. Did you see my, my CV? And did you see what I've published? Dr. Monty Pal: Sure. Robert Stone: So I'm here to help you, but send, you know, if you have a tough case, you can send them to me. I think that's backwards and we're not gona solve the problems in this country of access if we don't do what you do. I would be willing to bet those doctors in those sites have come to rely on you as, as much a counselor and advisor to them as it is, as somebody who can help Take care physically with one of their patients. And that's the infrastructure we have to set up. Dr. Monty Pal: So, so, so let's talk about the secret sauce, right? There's this unique mix that we have, because I fully agree with you. We've got, in my mind, you know, some of the top physicians in oncology by their CV, but also folks that you would just, you know, love to grab dinner with, you know, people that are just at their core fundamentally nice people. And it is really the best mix in my opinion for our patients. You know, City of Hope grows and grows. I think we've been able to do it so far, but you tell me, what's been our, um, formula for this? How do we keep that secret sauce alive as we expand? Robert Stone: So there are a number of answers to that. Let me, let me take it a couple of paths. One, um, all of us who are working here today are incredibly fortunate to have come and, and stand on the shoulders of giants. And I know that that's a saying that many places, but that history is true here and you live it every day. I, I go back, have something that was put together right after World War II from one of our leaders and it was called the, uh, it was a philosophy, right? The articles of, of faith, of what do we stand for? And it talks about each individual who comes into our care is an individual and deserves to be treated with kindness, love and compassion. Think about how few organizations have codified that much less can go back, you know, 100 years for that. And, and when you have the Art Riggs and the Steve Foremans and the others, they attract people who have those ethos. And so part of the secret sauce starts with what are the ethos of the people that come here? And, and it's almost like your, your, um, sports questions earlier. If you wanna have a championship sports team, look to how your star players operate. And if your star players operate like they're entitled, you're never gonna win. If they operate as if they are one of a broader team, you have a chance. That's, that's where it starts for me for City of Hope. Two, the fact that we're able to focus on cancer means we can approach a world renowned expert, Dr. Monte Pal, as an example, and say, Monty, you don't have to worry about how our football team is doing this year or how much money we're gonna put into undergraduate education. Um, you don't have to worry actually that as you're trying to provide great care and create the breakthroughs in the next generation of therapies that those happen siloed or separately. Too many cancer centers, the health system is separated from the, the medical school and separated from the research. Our secret sauce is to bring that together and to keep pushing. And there is a, there's a humility of people that work here. There is a hunger of people that work here. Um, they want to help people. I'll tell you a quick story. Um, a couple years ago, I think I've never asked you this. Um, and we can talk offline. I think the patient that I'm about to refer to was a patient of yours. Okay? And we, we, I know many of your patients and they love you, but, but somebody stopped me. I was going into my office. It was relatively late. I was coming from meeting at 7:00, 8:00 at night. And the woman stopped me and she asked me if I worked here and I said, "Yeah, I do. " And she said, uh, "Do you, do you, are you in charge?" I said, "Well, when I ask people to do things, sometimes it happens." And she said, "Well, a year ago, I came to City of Hope because I have pancreatic cancer. And I am here today. Two things have changed my life. One, you all came up with a cocktail that, um, I'm an N of one and it was innovative. It wasn't the FDA approved it for compassion. And I'm here because you had that expertise. And second, my first moment here, I didn't know where to go. And a woman who had to be in her 20s walked me to where I needed to go and not only walked me, she gave me flowers. She happened to have flowers with her. She gave me flowers. And on the way home that night, I started crying because not only had I found a place that could give me hope for my cancer, I found a place that I wasn't gonna be alone. And h- hearing you have cancer, no matter how many people you're surrounded by often can lead you feeling alone. That ethos and the combination of it all being together I think is our secret sauce at the end of the day. Dr. Monty Pal: Indeed. Indeed. And, and, and I've heard anecdotes like this for, you know, decades now at this point and it's just so touching. And you know, I, I really know that that's something that we're gonna retain through this expansion. But as long as we're divulging details of our secret sauce - Yeah. Uh, I wonder if you can give our audience some insight on something that I think really does sort of guide the, the path of our institution and that's our strategic plan. Do you mind sharing some sort of top line elements of that? Robert Stone: Yeah. So I, I had reason to count it the other day and we're about to roll out what is the fifth multi-year strategic plan I've been involved with in my time here. And there are a couple of elements that, that you'll see Monty. Um, one, you know how many organizations, much less cancer centers, but I'll, I'll talk about cancer centers, talk about our aspirations to be the best. Our inspiration is to be number one. I mean, whatever it is. To me, the, the air of that, and it's not a lack of confidence on our part, but the air of that is it makes it about us, not about our patients. So the top line aspiration you will find in, in our strategic plan is we want to be the most trusted cancer center in the country. We want to be trusted by our patients to provide the right care, to take care of them, to as, as Steve Foreman says, hold their hand and never let it go. We want to be trusted by families of patients who are, are entrusting us to care for the patient. We want to be trusted, uh, partners in research. We want to be those that are thought of as moving the field forward. Our donors who are in this environment in particular, research funding environment in particular, our donors are going to make a huge difference pushing the field forward and allowing us to do things. So point number one is we want to be the most trusted cancer center out there. We want to make four or are making four commitments in, in so doing. Um, one, we will tackle the access problem that we've talked about. We, we've, we've been on this journey for more than a decade. That journey will continue and it's both creating a model that is even more seamless so that patients, you know, we, we're close to 200,000 patients a year, cancer patients in our system. They should have access to the expertise that they deserve no matter where they fall in the system. I've, I've said many times, cancer patients I talk to want three things. They want an expert in their cancer. They want access to a clinical trial that's relevant for them and they want to be treated with dignity. So that access both in our system and then how do we take that expertise and continue to export it to other areas, to other cancer centers? How do we support others in remembering cancer's the competition, not each other? So that's a, a commitment that we make. Two, um, this commitment to how we actually treat the patient. What's the, uh, beyond the expertise, what's the experience that they're gona have? Um, what's the supportive care element around them? How do we s - meet their psychosocial needs? How do we take care of them after they stop being a patient and go into survivorship and, and carry that? There was a, there was an interesting article last year in the Lancet. Now this didn't frame my thinking, but it really, um, put a fine tooth comb on it that talked about we're in this age of wondrous innovation. We risk, especially with AI, we risk losing the human element. City of Hope is uniquely positioned to, to define cancer care, optimal cancer care as having that human element. Third, research is, has been and will be a bedrock for the organization. We're gonna lean in, and we've started this years ago. We're gonna lean in even further to translational research that at the end of the day, we have to have urgency and speed to, uh, to turn our research into something that benefits patients. And fourth, and this has surprised me a little bit if I'm being honest. Um, the country is listening to what we collectively have to say. And I think it's because we've put cancer patients first. So in, in California we, we helped, um, uh, lead to the passage of, lead a coalition to push the passage of a cancer center bill of rights. Something called the Cancer Care Equity Act, which guarantees patients on Medi-Cal from some of the, um, most underserved communities would have access for complex cancers to the opinions that we have. We've done the same thing with the Bill of Rights in Illinois. We had the Microbiome Summit here on campus that we co-hosted with, uh, Dr. Badacharia in the, uh, director of NIH and HHS Secretary Kennedy came. There is a, an obligation on City of Hope that I believe, which is to put the patient in the, in the center and advocate for what policy decisions are being made, how they impact cancer patients. So all of those, there's a lot more. It'll be supported by some of the, fueled by some of the things that you won't be surprised at. Technology, AI is gonna change all that we do. Dr. Monty Pal: Indeed. Robert Stone: Philanthropy is a huge advantage and we're gonna lean in even further to our people and our culture and use that as, as an advantage for helping patients. Dr. Monty Pal: Well, I, I wonder if we can talk a little bit about AI and philanthropy, you know, those two elements that you just brought up. Maybe we begin with philanthropy. Kristen Patel runs a, a brilliant department there and, you know, I've had so many meaningful relationships with patients as have so many of my colleagues who just really wanna find a way to give back for the exceptional care they've received. Tell us about philanthropy and its, its role in City of Hope. Robert Stone: Well, so philanthropy, we were founded in 1913 by philanthropists. Um, so philanthropy has been with us all along, 110 years. It's changed in recent years. And it's both grateful patients, um, and people who have not been patients but who want to make a difference. Ca- cancer in a country that is polarized right now in many things. Cancer is a unifier, Monty. People, everyone, you, you speak all the time at, at events and at philanthropy events, I do as well. And occasionally I'll ask people, you know, sitting there with a thousand of your closest friends, you know, you'll ask them, raise your hand. Who here has either had cancer, had a loved one have cancer, a family member, a friend? The whole room, the hands go up. So people want to make a difference. And, and we had a, um, think of an example. So Bernie and Judy Briskin, over whom our clinical research center is named, first gift that they gave us of multiple gifts was to set up a center for multiple myeloma. And Bernie was a multiple myeloma patient. And I got to be very close to both of them. Bernie has, has passed, uh, recently. Judy is, is still going strong. And, and what Bernie said to me, we celebrated his, their gift and he pulled me aside and he said, "Look, we're giving you the gift for two reasons. One is in multiple myeloma, we, we've searched the country. There's nobody better." So he wasn't a patient of ours. Right. But he wanted the best. And he said too, "My biggest worry as somebody who, who makes donations, who's been blesed with accumulating, um, funds that I now want to use for the greater good is not that I don't worry that things won't all work. I worry they'll be wasted and that time will be wasted. And at too many places, the infrastructure is set up because it's siloed, it's incremental. It's not set up for speed. City of Hope is. " And he said, "You all, you're not, you don't run a business in the sense of you don't have shareholders. The mission is still central to what you do. It's, it's your true north. But you can apply, you do apply a discipline. And business-like principles that say, how can we help this patient fastest?" That's where I think philanthropy, you know, I think there's, there are a lot of people, a lot of wealthy people in this country who feel blessed and have raised dollars by their own two hands. They may get recognition to put their name up on a building, but we have to talk them into that. What most of them want is, are you going to make a difference and how are you going to? And so that's how philanthropy fits. That, Dr. Monty Pal: That's so true. And I have to tell you that the blessing of philanthropy, you know, in my own personal practice has been that whenever I have an idea that I want to apply to kidney cancer, you know, I, I have that, that pool of funds to just make it happen right away. You know, no waiting years for that grant or perhaps the time for that idea to pass it. It just happens immediately. Yeah. And, and, you know, onto something else that really sort of increases that efficiency. And I mentioned I was going to bring this up, AI. Yeah. And, you know, it's impossible to have a conversation like this in the future of any institution without thinking about how AI might sort of pervade into our model or help our model. Um, tell us a little bit about your perspectives on AI and, and the future of AI with City of Hope. Robert Stone: So I believe AI is gonna change everything that we do. The question is simply how fast? And what does that really mean? I, um, if we were having this conversation a year ago, I would've told you, you know, in oncology, 30 years ago in oncology we talked about how we don't need hospital beds because everything's moving to the outpatient setting. And pretty soon we're, and fast forward three decades and so much has moved to the outpatient setting and it's been replaced with new innovative therapies and all that. So you still need hospital beds. So change has been slow incoming. I would have told you a year ago that AI will move faster. My intuition is it's moving pretty fast. And I would have undersold how fast it's actually moving a, a, a year, a year ago. And so it will change how I think research, first and foremost, I think it will disrupt research more than anything else. It will disrupt how operations will, are run and how efficiently and quickly we can move through. It'll disrupt patient care and, um, uh, it'll disrupt the patient experience. And I think it's all positive. We've got to act responsibly with it. And there, there's a tension, Monty, on how much do we, you know, we're, we're an organization that discovers things. We're innovative. We got brilliant mind. How much are we going to discover ourselves? How many, uh, models are we going to train? How is our data gonna be used to fuel our research and our insights? Versus how much are we going to partner with others because together we can move faster? And I think if you keep that two things in, in front and center, that true north of how do we benefit patients the best, number one. And number two, how do we train our people and get them comfortable with using AI in appropriate and safe ways? I, I've become convinced that AI will not replace doctors. Will not. Doctors who use AI will replace doctors who don't. Dr. Monty Pal: I, I have to agree with you 110%. You know, I've, I've seen it pervade our practice and in a number of ways. Our AI department's already doing these amazing synthesis. It used to take me hours to pour through documents, uh, CT scan reports, MRI scans from patients who are coming to see us for second, third opinions. Um, and now AI has enabled me to sort of get a very succinct summary in two minutes or less. I mean, it's just remarkable. And, and I can only imagine where that's gonna take us in the future in terms of improving efficiency, right? Robert Stone: Yeah. Well, think, think of this and I, I, look, you're gonna great at this. No, you really will. Um, but it's, it's gonna be tough. I have to imagine if I was in your shoes, patient comes in, exam room closes, door closes, and they say, "Dr. Pal, I've been Googling my disease and here's what it says." Just walking them back from the misinformation and the Errors that they're making has to be a, uh, uh, something that is front of mind for you. In the future, patients are gonna be better informed and they're gonna be more right. I, I had this conversation with a physician the other day, uh, not at City of Hope who said, "Ugh, yeah, but they're gonna be wrong in all the stuff they bring in. " I think increasingly with the AI models, they're gona be right more than wrong. They just won't know how that applies to them, how the information they're having fits into what's best for them. And you're gonna have the challenge of both, uh, deciding what's best for them, what best to advise them. And you're gonna need people skills to interact with patients who are gonna be better informed than ever. And that's gonna be right in your sweet spot because patients that I know who, who, for whom you're their doctor, they love the interaction. They love the fact that they can talk to you and that you're not, you know, up on high telling them this is what you need to do. They're living that life and you're there to help them live it to its fullest. You're gonna succeed at places where doctors are just used to go do this. Dr. Monty Pal: And there's Robert Stone: No empathy. There's, there's very little compassion, patient. They're gonna really struggle. Dr. Monty Pal: Indeed. Indeed. I gotta agree with you there. Uh, you know, Robert, you've shared so much with me on this podcast. I'll share something with you. Uh, I grew up in Covina, which is about 15 minutes east of City of Hope. You grew up in Whittier, 15 minutes south, right? Um, and, you know, uh, as a kid, I used to drive right past City of Hope to our favorite family restaurant in Arcadia, not far away. Never knew what City of Hope was until I hit my college years and started really getting interested in oncology. Um, so back then, you know, we always used to say City of Hope itself was just a well kept secret, right? Uh, you know, since that time, we've had this massive expansion. I think we're out there. I think we're quite well known. We have these brilliant, you know, marketing campaigns led by Nisha Morris, our head of communications, which I'm, I'm really excited about. How, how do we get word out there about this exciting work that we're doing? What's your perspective on how to broadcast what we're doing so that, so that more patients are, are getting that message and, and trying to access the care that we provide here? Robert Stone: So a couple of, couple of things. One, again, it's not, it's not advertising or marketing for marketing's sake. If you, um, put the cancer patient in the center again, it means two things. One, we need to continually increase awareness of City of Hope. So not somebody who has cancer, but people know about it. The example, great example is in, in Irvine. So Irvine, as the crow flies, our campus in Irvine is, is just under 35 miles away. When we, we agreed to go down there, you know, many patients, we were averaging like three, 4,000 patients a year from Orange County who would drive up to Duarte. And we did a marketing survey of how well is City of Hope's name known in the community and would you be a f - would City of Hope be your first choice if you... And we were something like sixth, sixth or seventh on the list. I was shocked as it was. So in addition to growing the expertise and growing the, the infrastructure, we spent time getting the, the word out there. We, we, marketing, but more than marketing, it's being in the community.m. Dr. Monty Pal: It's Robert Stone: Talking to people. It's talking to leaders to patient advocacy groups. It's sharing what they can get here. Clinical trials, everybody says they have a clinical trial and you open up those. They have one. We have, you know, 800. Um, it's getting that word out. And today in Orange County, so five years later, not only are we number one, number two is half our score in Orange County. And it's part of not just thinking one path is gona do it. It starts with the expertise of you and your colleagues. It starts with the compassionate care. But it's being in the community and figuring out what does that community need. That, that's how you start raising the awareness. Dr. Monty Pal: You know, you mentioned clinical trials and I wanted to sort of round things out on that note because clinical trials are just, I mean, they're such a big part of my practice and a big part of, I, if I may say my philosophy, right? Around oncology care. Um, tell me your vision for clinical trials at City of Hope. Uh, what really makes us different in that regard? Robert Stone: Yeah. So, um, clinical trials have always been important. I mean, when, when you got here 20 years ago it was important. If we were having this conversation five years ago, it would have been important. I think it's even more important now because the standard of care things are, innovation's coming so fast. The standard of care lags so long that in many respects, the best care is not the standard of care. It can be delivered through a clinical trial and increasingly clinical trials are, um, having smaller and smaller populations they apply to. They're more and more targeted. And it's funny when I, um, suggested to our board of directors at the penultimate meeting that we agree to buy Cancer Treatment Centers of America, which has led to hospitals in Phoenix, Chicago and Atlanta. The number one reason for doing it that I gave was to create a clinical trial network that allowed trials to be available in those very distinct and spread out populations. I mean, if you think of those three populations for CTCA, Los Angeles and Irvine, 86 million people in the country live within driving distance of those. They should have access to a centralized coordinated clinical trial network. And that's what we've spent our time building and it's very unusual. And it's both partners, you know, so industry sponsored trials and investigator initiated trials that are unique to us. And we talked a few minutes ago about AI. Think about trial matching and the, the challenge that you've had over time of figuring out what trials are there and what trials are available for your patient with your patient's conditions, spec- speci- specific conditions. Um, that's where AI can help us do it. And if you couple on top of that, a belief that our job is to get a patient the best, when appropriate, the best clinical trial, whether it's our clinical trial or somebody else's, can impact lives at, at an even greater, uh, amount. Dr. Monty Pal: Well said. I mean, it's, it's such a simple formula, but such an important one in the sense that, you know, when I think about what I can do as an investigator now, say I plan a trial to evaluate new drug X with 100 patients. It might have taken me three to four years to do that here at City of Hope Duarte. Now with my colleagues, Alan Bryce and Phoenix, you know, Walt Stadler in Chicago, Kristen Higgins in Atlanta. I can do the study in half the time, you know, a third of the time. I mean, it's just incredible power, I would say. Robert Stone: Yeah. Well, think about it, Monty. You, um, it ha - it, it's an example of what I think is research as a whole at City of Hope. You shouldn't be doing research just for the sake of doing research. Dr. Monty Pal: Mm-hmm. Robert Stone: What's the impact? Whether that impact is new knowledge, whether it's getting the new knowledge out or, or a product that's gonna help people. And for clinical trials, it's hard enough to come up with what's the right clinical trial, put all the regulatory safeguards around it. But you then want to accrue as quickly as you reasonably can and safely can so that you get the learnings from it as quickly as you can. And that network of now 200,000 people almost gives us a better chance of accelerating the learning that we have. Dr. Monty Pal: Absolutely. Absolutely. Robert, this has just been a brilliant conversation. We always round out the podcast with one question. And it lends itself to our title, On the Edge of Breakthrough. We've asked every single guest this and we get brilliant different answers each time. What does On the Edge of Breakthrough mean to you? Robert Stone: Uh, so I, I, I guess that the, um, question was coming because I'd seen your other podcasts. Okay. Okay. Fair enough. Lord knows I'm way down on the list of people you wanted to talk to. So I' had a lot, I've had a huge library to, to work through. Um, I'd answer it two ways, Monty, because three ways. One way is just think back of everything we've been talking about for the last hour, because it goes to being on the edge of breakthrough, one. Two, it's a moment in time. I mean, I, I find I, I, um, was asked very early in my career of what legacy do you wanna leave? Legacy. I'm, I'm, I'm A, young, and two, um, it isn't about me, it's about the people we can help. I'm, I'm now, it's still about the people we can help. I'm not as young as I once, as I once was. Um, you'll get there someday. But I'm more appreciative of the moments in time. And if you think about the convergence of what City of Hope can offer with the talent that we have, bringing the science together with the patient care at a scale in which we're no longer the best kept secret in the San Gabriel Valley, we are nationally known. Um, and I don't mean we've, we've been nationally known for decades in the oncology space. I'm talking about everybody. People know City of Hope. So there's a specialness of that edge of breakthrough being at a moment in time. And the third thing is I think of it, um, kind of imagery I, I thought about when I, I though about the question. I think of it as a wave of catching the top of the wave and, and, you know, as a surfer on the top of the wave, the wave's curling and about to slam down and then ride out. We're not getting crushed by the wave. Cancer is getting crushed by the wave. We're at that precipice of it's about to break and we're about to be able to take our innovative discoveries, apply them to more people, be able to predict where people are most at risk, be able to find screening early, develop new therapies that are tailor-made and follow more and more people to, through survival. That's what being on the edge of breakthrough means to me. Dr. Monty Pal: Brilliant. Brilliant. Robert, I, I have to say thank you and congratulations for just leading us through this massive, massive growth over the past several decades. I mean, It, it's really been a pleasure to work with you, to work for you and, and I have to tell you, I hope I get to work with you at City of Hope for decades to come. Robert Stone: For decades, Monte. It's a deal. Thank you for having me. Dr. Monty Pal: Appreciate it. One, one of the great treasures of my career has been the opportunity to really sort of shepherd a lot of our younger faculty, uh, develop their careers as scientists, as clinicians. Um, it's a challenging environment right now. You think about, you know, for instance, the, the, the element of grants and the level of competitiveness out there right now. I do feel like we offer a good breeding ground, however, for folks that are entering into the field of oncology. Tell us about your perspective on early career scientists and, and what we can do for them at City of Hope. Robert Stone: So, so Monty, I, um, I think early career scientists are a crucial part of our future. If, if you look back, I was having this conversation. You, you know, I'm sure, uh, Dan Vonhoffit, a legend in, in the field. And we had a dinner and we were talking about this issue with about 10 people on it, uh, around the table. And Dan said to the group, he said, look, if you went back and in medicine, looked at the Nobel prizes that have been awarded and looked at the age of when, of the scientists when the work was done, you would find it disproportionately leaning to the late 20s and early 30s that there's, there's a, when you wanna be disruptive, actually being creative and being willing to try new things is important. And so early career scientists are a focal point of our strategic plan and of our, uh, where we're gonna put some money to support because it is a tough funding environment. I get asked the question, what advice would you give them? A lot. And, and I, I give them several. One, it's gona sound, um, trite, but find your passion. Don't, uh, this, this is true whether you're an early career scientist, uh, an administrator, um, find your passion because that will get you through a lot of the hard times, one. Two, I'd urge them continually lean towards translation. I, I, I think AI in many ways I said earlier that it's going to disrupt research more than anything else. You're gonna be able to write grants, you're gonna be able to identify targets in hours and days in what used to take you weeks, months and years. So the, the big change is, that's gonna change. The big advantage for early career people is figure out how that translates into really patient benefit because what places like City of Hope are always gonna have is this is the place that, that great science, that technology and that care come together for, for, for patients. So translation is one. And third, my, I, I mentioned earlier, my daughter is in medical school. And she did come home, um, for breakfast, uh, between studies, I think to get her laundry done. Okay. And, um, we were talking about medical school education. And I gave her a piece of advice that I would give early career scientists that I don't think is, is as focused in the, um medical curriculum, uh, as it could be. Don't follow the dollars, but understand how the dollars flow. So, so think about, I'll give you a, a non-scientific, uh, uh, scientist example. A physician, I can't tell you the number of times I've heard from physicians over the years, if we could just get this managed care contract, boy, somebody could get in. Have an understand - you don't have to be an expert in that, but have an understanding of how do, how does insurance work? How do patients actually have the ability to access you? What are the policy decisions that have to be made? How is research actually gonna be funded? How much, what do philanthropists want? Because one of the things I always hear from, from, or not always, often hear from early stage scientists is if I could just get philanthropy, it would help smooth out the ups and downs on grant. Absolutely true. And we have the benefit of a wonderful scientific community. My, my, um, comment to them, do you understand what philanthropists want? Not just that you have an interesting i - your idea is very interesting. Does it meet what the needs are? How will the dollars actually flow? And again, you don't chase the dollars. We have a, a pure mission than that, but you have to understand those principles or you're gonna be left not understanding why you're not getting, uh, donations, why your research isn't funded and, and why your lab is struggling. Dr. Monty Pal: Brilliant. I