Tipping the Scale

By Sharon Tregaskis

On the 14th floor of NewYork-Presbyterian’s Herbert Irving Pavilion, dozens of hematology-oncology patients receive infusions from a bustling team of nurses and medical techs. That is not the case just a few floors below, where a new chemotherapy unit opened in June. In this new unit on the ninth floor are just nine patient bays—most with a picturesque river view. Two RNs perform every blood draw, monitor every infusion, collect every sample, and monitor each patient’s vital signs.

It is more than the scale that distinguishes this new unit from the one a few floors above. Just a few strides from the nurses’ station, a full-time scientist in a dedicated laboratory processes every patient sample before placing it in a cryopreservation unit across the hall for distribution to drug companies and collaborating investigators at academic medical centers around the world. Unlike the routinized drug protocols dispensed on the 14th floor, every treatment administered on the ninth floor is still under development, early in the extensive vetting process for Food and Drug Administration approval. Most of the compounds received by each patient in this unit—the Adult Research Infusion Unit—have been confirmed only in petri dishes and laboratory animals and are being tested for the first time in humans.

Already, patients participating in some 100 trials have begun receiving their medications here; over time, administrators anticipate the number of trials will grow to 300. “To do these early-phase cancer trials properly, you need a dedicated team—doctors, nurses, and research staff who know how to conduct these complex trials, ensure that the experimental therapies are administered such that patient safety is always prioritized, manage novel side effects, and make sure patients have a full understanding of their treatment plan,” says unit director Richard D. Carvajal, MD, an expert in drug development who was recruited from Memorial Sloan Kettering Cancer Center to develop a phase 1 clinical trial program at Columbia University Medical Center. “In the clinical and treatment research space we’ve developed that is centralized on the ninth floor of NewYork-Presbyterian’s Herbert Irving Pavilion, patient care on early-phase clinical trials can now happen in a patient-oriented seamless fashion. This unit gives our patients at Columbia University Medical Center access to the most promising, most innovative therapies that are not available at most other cancer centers in the country or the world. And even though these are first-in-man trials, with the integration of routine deep molecular profiling and appropriate patient selection, these novel therapies can provide meaningful, durable benefit to our patients.”

Dr. Carvajal, who joined the center in November 2014, is among a large number of new faculty recruits advancing translational medicine at P&S, transforming the medical center campus, and changing the landscape of health care delivery throughout New York City and its suburbs. Beyond their sheer number—some 200 in 2014-15 alone—the new recruits exemplify a sea change at P&S, as the medical school, ColumbiaDoctors, and NewYork-Presbyterian collaborate to furnish the research, patient care, and infrastructure support needed to propel the scientific and clinical pursuits of new faculty. The appointments span clinical and basic science disciplines, including orthopedics, ophthalmology, genomic medicine, and translational immunology.

“Strategic recruitment is the No. 1 priority for the medical center,” says Lee Goldman, MD, P&S dean and chief executive of Columbia University Medical Center, whose strategic planning initiative has been developed in partnership with NewYork-Presbyterian Hospital administrators. “This has been a very good year, but it is just the beginning.”

When Jack Cioffi, MD, left the West Coast—Devers Eye Institute and Oregon Health & Science University—in 2012 to join P&S as the Edward S. Harkness Professor and Chair of Ophthalmology, he had a bit of trepidation about his new responsibility to recruit colleagues to Manhattan. Three years later, he says, he should not have worried. Now also president of ColumbiaDoctors, the University’s multispecialty faculty practice organization of 1,400 clinicians, he has hired more than a dozen new faculty for his own department. Other departments have enjoyed similar recruitment successes, including the Department of Orthopedic Surgery, which has recruited three senior spine surgeons from St. Louis. “Great begets great,” says Dr. Cioffi, who now oversees ColumbiaDoctors’ expansion to new clinical space in Tarrytown, N.Y. “At Columbia we believe we should lead and when we decide to do something new, we should be the best in the world.”

Take, for example, that trio of spine surgeons. Together, MDs Larry Lenke, Daniel Riew, and Ronald Lehman will establish a comprehensive spine hospital at NewYork-Presbyterian/Allen and also will treat patients at Columbia University Medical Center. William Levine, MD, chair of the Department of Orthopedic Surgery, orchestrated the recruitment of the spine doctors, who will join the strong group of orthopedic and neurosurgery spine doctors already at Columbia. “I wanted to recruit the one person in the world with the cachet to bridge multiple subspecialties like orthopedics, neurosurgery, anesthesia, podiatry, and pain management,” says Dr. Levine. “If done right, this has so many tentacles that reach into so many domains at NewYork-Presbyterian and Columbia University Medical Center.” Larry Lenke was that person. With his current practice partners, Dr. Riew and Dr. Lehman, also being recruited by several top medical centers, Dr. Levine decided to invite all three to move together to found a new hospital. “It’s my first recruitment as chair,” admits Dr. Levine, who became chair in 2014. “I’ve set a pretty high standard.”

Beyond seeing to the recruitment of key support personnel to accompany the faculty, Dr. Levine worked with NewYork-Presbyterian administrators to leverage underutilized space in the Allen Hospital to provide state-of-the-art surgical facilities to accommodate all six Columbia spine surgeons in orthopedic surgery. When the spine hospital opens, says Dr. Levine, patients will benefit from efficiencies that will speed their treatment and recuperation. The second phase of the plan includes additional operating rooms that can accommodate spine surgeons from both orthopedic surgery and neurosurgery.

The orthopedic surgeons are joining an already strong group of renowned neurosurgeons who form the Spine Center: Paul C. McCormick, MD, director; Michael G. Kaiser, MD, associate director; Donald O. Quest, MD; Peter D. Angevine, MD; Alfred T. Ogden, MD; Christopher E. Mandigo, MD; and Marc L. Otten, MD.

The Columbia Spine Health Initiative outpatient service will be based at ColumbiaDoctors Midtown. “We already have a spectacular orthopedics department, as well as neurology, neurological surgery, rehabilitation & regenerative medicine, and the relevant ancillary departments—anesthesiology, radiology, and internal medicine,” says Dr. Cioffi. “They’ll all benefit.”

Dr. Carvajal says the prospect for collaboration was a key inducement when Gary Schwartz, MD, chief of hematology-oncology (himself a recent recruit from Memorial Sloan Kettering Cancer Center, in early 2014), approached him about founding the early-phase clinical research program. “What drew me here was the opportunity to translate the incredible science being conducted at Columbia, which represents the most cutting edge research in cancer biology and therapeutics, to the clinic and bring these promising therapies to our patients.” The list of potential collaborators was rich and deep, says Dr. Carvajal. “The basic science research in cancer genetics, epigenetics, translational immunology, informatics, imaging, and computational biology is incredibly strong at P&S.”

For basic scientists, the reverse is also true, says Megan Sykes, MD, who came to P&S in 2010 after 19 years at Harvard. “One of the great things about being here is how anxious people are on the clinical side to understand the diseases that they’re working on, to understand the immunology better, and to have that whole scientific dimension of understanding and being on the cutting edge of new therapies,” she says. As founding director of the Columbia Center for Translational Immunology, Dr. Sykes was high on the list of prospective collaborators for several of Dr. Schwartz’s hemonc recruits. Says Dr. Carvajal: “Figuring out the key molecular nodes and immunological processes we need to target in animal models and bringing that back to the clinic is an incredible opportunity.”

Even as she took on new collaborators this past year in response to the expansion of other departments, Dr. Sykes mounted an ambitious recruitment effort of her own, her hopes pinned on extending a fruitful research partnership of more than three decades. On July 1, Dr. Sykes’ former mentor, David Sachs, MD, and their long-time research partner, Kazuhiko Yamada, MD, resigned their Harvard faculty appointments for posts at P&S. Together, the three scientists have invested a century in pursuit of solutions to the shortage of human donor organs that currently impedes transplantation medicine. While stem cells, bioscaffolds, and 3-D printers offer the possibility of laboratory-grown replacements to make up for the shortage, another option long considered and debated is xenotransplantation the use of living tissues harvested from other species. Dr. Sykes, Dr. Yamada, and Dr. Sachs have set their sights on specially bred pigs as a source for whole organs.

Over the past four decades, Dr. Sachs has bred a herd of miniaturized pigs whose identical genetics and human scale promise the possibility of a new source of replacement organs for human patients. “Dr. Sachs, Dr. Yamada, and I have believed from the beginning that for xenotransplantation to work, we have to induce immune tolerance in the recipient,” says Dr. Sykes. “You can’t just expect a pig organ to be accepted with immunosuppressing drugs the way we do with human organ transplants; there’s a broader and stronger immune response when the donor is a pig.” To succeed, the team must discover the keys to induced immune tolerance, insights that hold promise for bone marrow transplants, cancer immunotherapy (where the immune system could be kickstarted to fight malignancy), and type 1 diabetes. By bringing Dr. Sachs and Dr. Yamada to P&S, Columbia is also protecting the intellectual legacy embodied in Dr. Sachs’ research herd. (Though Columbia will have custody of the pigs, they will remain at an animal research facility in Massachusetts.) Already, Dr. Sykes has a team of graduate students and postdoc fellows ready to expand the group’s investigations. “Now we’re in the position to make the ideal pig to induce tolerance,” says Dr. Sykes. “It’s a huge opportunity.”

https://www.youtube.com/watch?v=jE9_TTzQPas

Jean C. Emond, MD, executive director of Columbia’s Transplant Initiative, also recruited outcomes researcher Onur Baser, PhD, to the Department of Surgery. Dr. Baser, editor-in-chief of the Journal of Health Economics and Outcomes Research, has a PhD in economics. His research interests include unwarranted variations in health care as well as comparative effectiveness research.

Much of the current wave of recruitment boils down to a model for faculty expansion piloted by Donald Landry, MD, PhD, physician-in-chief of NYP/Columbia and chair of the Department of Medicine, when Dr. Sykes was recruited in 2010. “I wanted to bring someone into the Department of Medicine who would lead in an area of science that would cut through all of the divisions of medicine, touching cardiology, pulmonary, gastroenterology, and the corresponding divisions in surgery, pediatrics, pathology,” says Dr. Landry. “The thought was to recruit in particular areas that would unite the various elements of the university and also bring us closer to the hospital.” The basic science behind transplant immunology, subsumed under the even broader umbrella of translational immunology, was an obvious prospect for bridging disciplines, and Dr. Landry began explaining his vision to his counterparts in surgery, pediatrics, pathology, and microbiology/immunology, as well as the leadership of the Herbert Irving Comprehensive Cancer Center and the Naomi Berrie Diabetes Center.

In two decades at the National Institutes of Health and at Harvard Medical School, Dr. Sykes had pioneered paired organ and bone marrow transplantation to eliminate the need for immune-suppressing drugs. Her name quickly rose to the top of Dr. Landry’s list of exemplars in the field of transplant immunology. All he had to do was partner with the hospital, university administrators, and P&S Dean Goldman to furnish the infrastructure for her success, and with this partnership the barriers vanished. “I promised her—and we delivered—20,000 square feet of space, the reopening of a specialized large animal research facility, expansion of a GMP cell therapy facility, and the build-out of an ultra-clean mouse unit in the comparative medicine facility. She also needed a clinical bone marrow transplant unit, so the hospital committed to building a $25 million bone marrow facility,” he says. “All of these elements within the university and hospital came together, and, as predicted, recruits of the highest quality attract others of the highest quality, who in turn draw others.”

More recently, the recruitment of David Goldstein, PhD, founding director of the Institute for Genomic Medicine, followed a similar model. Dr. Goldman and Steven J. Corwin, MD, CEO of NewYork-Presbyterian, empaneled a committee chaired by Tom Maniatis, chair of biochemistry & molecular biophysics, that recruited Dr. Goldstein. The committee’s charge: Identify exceptional scientists whose recruitment could be transformational. “Imagine,” says Dr. Landry, “if we asked department chairs to look around the country, not think about their priorities, and look at people for their excellence and consider whether, if those people were in our departments, we would be delighted.”

That’s precisely the approach now utilized across Columbia to boost the number of women and minorities who join the faculty each year. “Columbia clearly aspires to be the greatest destination for world-class scholars,” says Dennis Mitchell, DDS, MPH, the University’s vice provost for faculty diversity and inclusion. “We cannot achieve that aspiration without realizing our core values of inclusion and excellence. P&S has completely embraced that vision, making diversity a fundamental goal.” To facilitate an out-of-the-box focus on intellectual excellence, the Columbia provost established a competitive program, the Provost’s Office Funding for Faculty Recruitments from Underrepresented Groups. Each dean submits a list of potential hires and a university-level review committee identifies the most eminent scholars to receive funding. Anne L. Taylor, MD, vice dean for academic affairs at P&S and senior vice president for faculty affairs and career development at CUMC, coordinates the medical school’s participation.

Through the program, P&S has consistently led in receiving support for recruitment of faculty from underrepresented groups, including Laura Landweber, PhD, professor of ecology and evolutionary biology at Princeton (her entire lab will move to Columbia next year), and Edward Owusu-Ansah, PhD, who joined the Department of Physiology & Cellular Biophysics from Harvard University.

Another recruit through the provost’s program is Adam M. Sonabend, MD, former chief resident and research fellow in neurosurgery, who has joined the Department of Neurological Surgery faculty to expand the department’s neuro-oncology program. Dr. Sonabend, a graduate of the National Autonomous University of Mexico Faculty of Medicine, will focus on brain tumor surgery and run a brain tumor research laboratory at the cancer center.

Dr. Goldman is the only Columbia dean, so far, who has committed to matching funds provided by the provost’s diversity initiative, which targets tenure and tenure-track faculty. “He has encouraged his department chairs to scour the nation and the world to find the very best,” says Dr. Mitchell.

Perhaps the most powerful example of growth at P&S over the past year has been in the Department of Medicine’s hematology and oncology division, augmented recently by the latest gift from Herbert and Florence Irving to establish a $50 million research fund, create seven new endowed professorships, and expand the Irving Scholars research program. In his first 18 months as division chief, Dr. Schwartz hired not only Dr. Carvajal but also five other faculty. Two are recruits from the National Cancer Institute: Antonio Tito Fojo, MD, PhD, an expert in neuroendocrine tumors, who will serve as chief of cancer medicine at the James J. Peters VA Medical Center in the Bronx and build a clinical trials program there, and Susan Bates, MD, whose research investigates molecular therapeutics for metastatic brain tumors. The others are Naiyer Rizvi, MD, who joined Columbia in January from Memorial Sloan Kettering Cancer Center and directs a new program in thoracic oncology and immunotherapeutics in medical oncology; Ran Reshef, MD, a physician-scientist recruited from the University of Pennsylvania for his expertise on immunotherapy and cellular therapy; and clinician-scientist Yvonne Saenger, MD, recruited from Mount Sinai for her expertise in the use of immunotherapeutics to fight melanoma.

As the faculty roster expands, applications for residencies, fellowships, and slots in the MD-PhD program have picked up as well. Even the oncology curriculum for medical students has been overhauled. “I sometimes wake up and pinch myself,” says Dr. Schwartz. “This has been an exceptional opportunity to bring together basic scientists and clinicians to make the clinical care we offer the best in the city of New York, if not the country.”