Dr. Patrick Hwu became CEO of the Moffitt Cancer Center in November. He took over at a crucial time for the Tampa, Fla., organization, which saw several leaders resign in late 2019 due to concerns over conflicts of interest regarding research being conducted in China. He wants to make Moffitt a leader in cell therapy. And in late January, Pasco County officials approved a $25 million incentive and financing deal for Moffitt to build on a 775-acre site. It includes infrastructure improvements, as well as waiving nearly $800,000 in permit fees. Hwu spoke with Modern Healthcare Managing Editor Matthew Weinstock about his plans for Moffitt, as well as the impact of COVID-19 on cancer care. The following is an edited transcript.
MH: Coming into an organization that’s gone through a bit of turmoil, are there things that you had to address right away or since it was almost a year after the turnover, had some of that taken care of itself?
Hwu: A lot of it had settled down already, but the bottom line is we need to help cancer patients. We still have 45,000 deaths a year in Florida, 600,000 in America and over 10 million globally, although that’s probably an underestimate. If we focus everyone on trying to cut down the number of deaths from cancer, everything aligns. Because that, in the end, is what we want—to prevent cancer and cure all these patients, and I think it’s possible.
MH: What are some of your priorities?
Hwu: It’s very straightforward actually. We have to implement in 2021 all of things we know are effective to prevent, treat and cure cancer patients. So we need to have widespread implementation, which includes building additional centers where we can take care of more patients. The second thing we have to do is come up with better therapies and better ways to prevent cancer. In doing both of those things, I think we can really decrease these deaths over the years and so that’s really our only goal.
People used to tell me, “Isn’t it depressing taking care of advanced melanoma patients,” because my own clinic would turn over every six months. But now over half of my patients are doing well for many, many years because of the advances that we’ve made in targeted therapy and immunotherapy.
MH: One of the things you’ve talked about growing at Moffitt is cell therapy. Can you talk a little bit about what that might mean both for Moffitt and for cancer care broadly?
Hwu: Our immune systems are incredible. In fact, that’s what’s going to turn us around from COVID—stimulating the body’s immune system.
We’ve evolved cells called lymphocytes that go around the body and try to protect against viruses, but we’ve also learned to trigger them against cancer. So when we get these immune cells, lymphocytes, touching the cancer cell they can do what I call the kiss of death, where they secrete proteins that cause the holes in the cancer membrane itself, and the cancer itself blows up. Then the immune cell goes to another cancer cell, does the kiss of death, and does the same thing.
We’ve learned to grow these immune cells out of the body, grow them to large numbers, give them back to patients, (which) causes the tumors to regress.
We’ve also learned to grow cells and put in genes, like CAR T-cell genes, chimeric antigen receptor genes, to help them recognize those tumor cells to cause that kiss of death. That’s a technology that we started years ago, in the early ‘90s … when I was at the National Cancer Institute. And it’s really been fun for me to see this now approved by the Food and Drug Administration for some lymphomas.
MH: Moffitt is also expanding its physical presence. You recently got approval from Pasco County, which is putting in about $25 million in incentives, for a new project. What are you looking to do there?
Hwu: It’s a 775-acre plot of land, which we’re very excited about. It’s a growing area and a growing community, and more and more we have to take our care out to patients. So this is going to be an important facility. We’re going to start with an outpatient facility to provide care in the clinic, and infusions, radiology, radiation. But we also hope to do some very novel kinds of treatment as well, such as carbon ion therapy, which is even the next level above proton therapy where you take a carbon ion, which is six protons, and hit it against the cancer. It should be much more effective and less toxic. We’re really excited by that. Pasco County is now helping us by putting in the interstate exchanges so it’s very easy to get to and from the (Tampa) airport.
MH: We’ve seen in other cases, including the Mayo Clinic, backlash when these large taxpayer financial incentives come into play. Have you heard any of that from people in Pasco County?
Hwu: (There’s been) nothing but positive feedback from everybody. They’re very excited that we’ve chosen to go in there and expand. We think it’ll ultimately result in over 14,000 jobs in the area, so it’s going to build all sorts of industries. And it will also help with the biotech entrepreneurship community.
MH: Switching to the COVID-19 pandemic, we’ve been seeing reports that patients are skipping some of their screenings, including for some cancers. What level of concern do you have on that front?
Hwu: Initially we were seeing that—people did not want to come in. But then we really got on top of this and we explained to everybody that Moffitt Cancer Center, we’re probably the safest environment on the planet. Everyone gets screened, we’re all wearing masks, and we’ve had very low numbers of infections here at Moffitt. And I think cancer patients, in general, are more careful to begin with. So we’ve been able to get our activity back up to pre-COVID numbers.
We’re also working with our communications team to make sure patients know that they need to get their mammograms, they need to get their colonoscopies, because the earlier we can catch their cancers, the more curable they are. Just because there’s COVID, cancer does not stop, so it’s really important that we get people to follow through on their appointments and their screenings.
MH: And for a lot of cancer care, you can’t rely on telehealth as heavily as other disciplines have, right?
Hwu: Absolutely. At the same time, we’re using a lot of telemedicine. What telemedicine is really helpful with is in between visits. They might have to come in to get an infusion or to be seen, or examined or for surgery, but in between, we could do some things on telemedicine and we’ve just scratched the surface of this.
The other area it can help is when the patient first calls us, we can get a much better idea (about their concerns), so the first appointment is much more efficient. We have a lot of the paperwork done and we have a lot of the screening done, we know exactly what we need to do for them initially. We’ve had some positive learnings.
MH: Regarding the vaccine, what are you seeing in terms of patients getting vaccinated and do you feel like we know enough about the impact those vaccines might have on cancer patients?
Hwu: First, I want to point out that the COVID vaccine was developed through cancer research. It was first a cancer vaccine. (BioNTech CEO Dr.) Ugur Sahin … was a cancer researcher. He was designing vaccines against cancer and then quickly flipped that to COVID when this became an issue, so it’s not a new platform. People say, “Oh, I don’t know about a new platform.” Well, we’ve been giving this kind of RNA vaccine to cancer patients in clinical trials for years. We know it’s safe. I know that it’s going to be safe in cancer patients. We’ve immunized over 5,000 cancer patients here.
The question is whether it is effective. Now that’s an important question and hasn’t been totally answered. At Moffitt, we’ve drawn blood samples on over 600 patients to try to answer this question. We’ve taken their blood so we can understand their development of antibodies, which is what neutralizes the COVID virus. We’re going to take it before (their vaccination); four weeks after their first vaccine we’re going to take another sample. Four weeks after the second vaccine we’re going to take another sample. And we’re going to look at six months, 12 months, 24 months, just to make sure that it’s still working. We’ll be able to define those populations.
What I predict is that some patients, especially if they’ve had their cancer a number of years ago, will be just like the non-cancer population. But others, especially the ones who are having disorders like leukemia or lymphoma—disease of the immune system or they got Rituxan or CD19 CAR-T where they’re knocking out the B cells that make the antibodies—they may have lesser of a response and may need a third, or a fourth, vaccine to boost that up to levels that will protect them against COVID.
MH: When do you expect to start seeing some of that data roll out?
Hwu: Two to three months. I want to get that information as quickly as possible because it’s possible we’ll need to pull back some of those patients and say, “Hey, you need vaccine number three or vaccine number four.” So that’s why I’ve urged the teams to try to get that data almost in real time. And we’ll try to get this published just as quickly as possible, so everybody knows how to deal with this in their cancer patients.
