TGen Talks Live: Driving Change and Innovation in Cancer Research and Treatment
Karie Dozer [00:00:04] I'm Karie Dozer and this is TGen Talks. Cancer continues to be the second most common cause of death in the United States, with a total of nearly 2 million diagnoses every year. In this episode of TGen Talks, recorded in front of a live studio audience in Phenix, we take a look at how genomic information is leading to better and earlier diagnoses and treatments for all kinds of cancer. The collaboration between city of Hope and TGen is proving to be a mighty weapon in the fight against cancer right here in Arizona. As clinicians who treat cancer are better informing their laboratory counterparts and in turn, the laboratory is helping guide clinicians. And we welcome all of you to a very dressed up version of TGen Talks. We're here to talk about driving change and innovation in cancer research. And we're doing it with two very important and special guests. Doctor Alan Bryce, who's chief clinical officer at city of Hope Cancer Center Phenix and professor of molecular medicine at TGen, and Doctor Jeffrey Trent, who is the founder and president and research director at TGen. We're here to have a conversation about cancer, because for many people, there's nothing more important. There's no one in this room. There's no one watching listening who hasn't been touched personally. And I think we all have the same questions with all of this research that's been happening at TGen and at research institutes around the world. Why are we still where we are with the fight against cancer?
Dr. Jeffrey Trent [00:01:31] Well, I think one of the really discouraging parts, but I'll turn it around and say encouraging as well, is that despite there being over 200 subtypes of cancer, increasingly we're not just able to bring, treatment options, but cures for a great number. But unfortunately, one of the things that the genome project is health going block is just that each one of those cancer types, like breast or prostate or melanoma or pancreas cancer, usually is made up of a series of different subtypes. Those that, are still under a microscope were what can be recognized as breast or ovary or melanoma. But when we use the lens of genomics, it helps us to subdivide those. So we're looking at. Literally hundreds of different challenges, but we're making progress every day.
Karie Dozer [00:02:35] Doctor Bryce, you're in a slightly different position every day. You're more of a clinician. Tell me a little bit about your perspective on the search for answers and what it is that you do.
Dr. Alan Bryce [00:02:44] Yeah. There's no question we've made tremendous progress in the last five years. The last ten, the last 20. Cancer care today is entirely different than what it was a generation ago. So, you know, the truth is we're curing a lot of cancers we never did before. We're helping patients live better lives lived longer lives than ever before. But to your point, we have a long ways to go. All right. There's still too many people dying of cancer. There's still too many people suffering from, from this family of diseases. So there's a lot of research left to be done. And that's why, you know, these relationships between, cancer centers, between, laboratory research researchers and clinicians are so important, because there is a long way yet to go.
Karie Dozer [00:03:40] The relationship between TGen and City of Hope is not brand new. It began several years ago. But what is it that you will be doing here in Phenix? What is your new mission?
Dr. Alan Bryce [00:03:49] Well, I've been in Phenix 12 years, but I'm new to city, so to be sure, I, have been doing cancer research for. You know, I suppose you could go back to college. I mean, you know, 25 years now, I've been involved in cancer research, but here in town I've been involved with TGen for over 12 years now. And. You know what the Human Genome Project and the genomic, abilities and insights that TGen have brought allow us to do, is to really dissect down the individual patient's cancer, to a level that we couldn't do before we had these tools. We all know people who seem to have the same thing going on. Two people get a cancer diagnosis, and one does really, really well, and the treatments work great, and they don't seem to get any side effects. And the other person gets a lot of side effects, or the cancer seems to be resistant. And you know, what that reflects is the fact that even though we put the same label on it, we say it's breast cancer or colon cancer or something. You know, patients can take very different paths. And it's because the underlying genetics of those cancer cells between those patients are entirely different. So that's what we're now able to really get down into, with the work at TGen and with this technology of genomic sequencing to really understand that, you know, the most intricate level possible, what's going on precisely with this patient's cancer.
Karie Dozer [00:05:17] TGen has been around for 20 years, and your researchers and your scientists have been in the lab working that entire time. City of Hope has been around more than 110 years. How did this marriage come about? How did you find that you had something to offer one another? And what was that?
Dr. Jeffrey Trent [00:05:32] Well, City of Hope, as you said, over 110 years old, the 20 years of TGen really came at the end of the completion of that first genome and really the opening of the door to use that information to treat a patient sitting in front of us today, where most of our effort has been in that that focus of understanding those intricate, specific, personalized changes that each patient has and we want to identify. City of Hope spent most of its effort building today's most successful programs, using our immune system to treat our cancer, cell-based therapies, transplants … the best transplant center in the United States the last 17 years at the national level. So this opportunity six years ago really began to, for the first time, think about aligning a program that they had built in using our own immune system with the genomic information that we have and unifying those in a way that could try to deliver benefit for the patients sitting in front of us today.
Karie Dozer [00:06:48] What are those city of Hope headlines? A hospital that's been around 110 years has to have achieved some amazing things. What should people know about city of Hope that they might not?
Dr. Alan Bryce [00:06:57] City of Hope as a proud history. And I'm frankly very excited about the fact that we have it here in Arizona. You know, I grew up in Southern California, so I always knew of this institution. But if we trace it back, you know, city of Hope started as one of the original sanatoriums for TB hospitals, for the city of Los Angeles. You know, it was at the end of the train tracks and a mile beyond, right? Because you had to keep those hospitals, you know, at a distance. And then as TB got under control and it wasn't the burden that it once was, you know, city of Hope had a foundation of being very community oriented, being very research focused and innovative and forward thinking, in a way that that wasn't necessarily the norm, right, 100 years ago. And so, you know, we trace that history and some of the highlights would include the first development of synthetic insulin, right. The backbone of diabetes treatment that came from city of Hope. One of the nation's earliest leading transplant centers, and that tradition continues today. The development of the technology behind all the antibody therapies we use today. So the technology behind drugs like her stepped in for breast cancer, toxin for lymphoma, Avastin for so many cancers. All of that was city of Hope technology. So city of Hope is one of the nation's historic cancer centers. So bringing that to Arizona, marrying that with TGen, I really think the marriage with TGen and bringing that genomic expertise, is going to be one of the next big leaps forward for city of Hope.
Karie Dozer [00:08:25] So this relationship between Jen and City of Hope, while is relatively newer, you two, your paths have crossed in the past. So you've worked together even while you were with different organizations.
Dr. Jeffrey Trent [00:08:37] You know? So clearly cancer is the enemy, not institutions that are out to really try to do something in an advanced way across this. And one of the organization that's been successful in bringing together scientists is Stand Up to Cancer. And where I first really began to get to know Doctor Bryce, was, when I was privileged along with, head of phase one clinical trials at Yale University, path Russo to become the head of the melanoma dream team. And that allowed us, a very large grant, about 20 some million dollars to say we would launch the first FDA supervised trial, the first that would actually marry that genomic information with treatment options. And at that time, Doctor Bryce was at the Mayo Clinic, and we, enlisted him as one of the senior, physicians and other physician in the room. Doctor Alex, secure work. Was also a key part to that program as well.
Karie Dozer [00:09:44] So it's a misnomer that this hospital competes with that hospital that competes with someone in another state to find a particular treatment for a particular cancer.
Dr. Jeffrey Trent [00:09:54] It's not a misnomer. We compete made it to being first is incredibly important in science and the ball in football. You know, I mean it's no question we're competitive. But where cancer equalizes the playing field is we none of us are smart enough or large enough or good enough or have the individual type of tools that are required to beat this monster. So I think it forces collaboration. And the other. There's nothing more satisfying than feeling that you make a discovery, but then it's used by others broadly across the country, across the world. And that's where city of Hope is allowed to engender scale. What it does here in Arizona nationally.
Karie Dozer [00:10:45] Let's talk about the Phenix marketplace, the Arizona marketplace and what this partnership means to accessibility. How much more hopeful should someone in an Arizona be today when they receive a cancer diagnosis, knowing that this partnership exists and that there are now city of Hope cancer centers all over Phenix, all over the Phenix area?
Dr. Alan Bryce [00:11:07] Absolutely. I mean, as we know, Arizona is a young state, right? 48 state. Phenix is a young city, really wasn't on the national map as a major city. And until, you know, just a generation ago, right now, we have the fifth biggest city in the country. But because we're so young, it also means we don't have the same, you know, highly developed institutions that you'd expect for a city of this size. And, you know, and the reality is that's also true in our medical community. You know, we don't have the big historic, you know, nationally recognized large hospitals in the same way that say, Boston or Philadelphia or even a San Diego or a Seattle do. So city of Hope is really going to be able to bring that level of nationally recognized, research driven, cutting edge cancer care, to the greater population of Arizona. That's the mission. You know, that's why I've come to city of Hope. That's the task that's been given to us is to say the people of Arizona need this level of cancer care. We need to build this, for this state. And then, you know, having TJ in that depth of expertise and all that research, gives us an amazing foundation to build on to really deliver the most cutting-edge, world-class cancer care for, for Arizona.
Karie Dozer [00:12:27] What does it mean? Not for that patients. They may drive by a City of Oak Cancer Center, see it for the first time, notice it for the first time, and think that their first call might be to somebody here. Instead of googling who's the best expert in another town to treat their particular cancer carrier.
Dr. Jeffrey Trent [00:12:46] You know, we know local research benefits local patients first. And so that idea of advanced cancer care, we need more of it in Arizona. We need more of it in our city. We have some excellent examples in various areas of treatment of cancer. All of us still, can benefit from really beginning to layer in additional shots on goals, especially because, again, it's so difficult, to, to be at that point when you're looking in the eyes of a patient and really don't have unique options to offer to them next. So having options that are new today and are on the way for tomorrow, you know, that's worth living for.
Karie Dozer [00:13:37] How many patients are treated at city of Hope for cancer today?
Dr. Alan Bryce [00:13:42] It's on the order of 150,000 unique patients a year nationwide. Now, we absolutely expect that to grow with growth in Phenix. And that's the whole spectrum of cancers, right? From, from blood cancers and leukemias through to resting colon cancer from young to old. So really, as I say, one of the nation's, historic and large and great cancer centers you mentioned.
Karie Dozer [00:14:08] You mention pre- Human Genome Project obviously, and post, TGen being on the post side and City of Hope being on the pre- side, treating people with cancer. Why is genomics, simply put, so important in treating cancer? For most people they think of a cancer diagnosis as cancers its own category. Why are genomics so important?
Dr. Alan Bryce [00:14:26] I mean, fundamentally cancer is a genetic disease, right? So it's the normal healthy human cell that's mutated to become that. So the driver of the cause of cancer, one way or the other, whether it's, simple natural processes of a cell mutating, whether it's because of environmental conditions, you know, tobacco exposure, UV light, whatnot, viruses, whether it's because of a genetic predisposition that a patient inherited right from their parents. At the end of the day, the root cause of cancer is genetic mutation. To make a good cell go bad. So when we are able to do genomics now, we're able to understand in that cancer cell, what is it that went bad? How is this cancer cell different from the healthy cell that it used to be? And that gets us down in the root causes. It allows us as researchers to try to find new answers. Right. Understanding the cause points us to solutions. But then also on the clinical side. You know, when I look at a genome, I understand much more deeply what's going on with that cancer. Oftentimes, I'll change my treatment approach based upon having looked at the genome, because I have a much better idea of where the cancer is going. Right. It's really about kind of a level of detail and depth of understanding.
Dr. Jeffrey Trent [00:15:46] You know, I would focus efforts as important as treatment with patients who have cancer diagnosed today is really where genomics has played a major role. This next decade is focused clearly on identifying cancer early at its earliest possible change. Recognize that identifying it and getting the cancer really at the earliest stages, where all of us know it's more treatable, it's, we're able to control this. So the area of early detection or what we call cancer interception, meaning just. All right, if it's started, let's find out where it's gone. Let's understand that process. We're not changing. Really? I would say effort at all from advanced patients with cancer that we see today. But I think you're going to see a an incredibly important movement for that. Jen with city of Hope will be starting such a study with 30,000 individuals over the course of the next few months to take a simple blood test that can give an answer for patients who don't have cancer, whether they actually have cancer, someplace in their body as well, even highlighting where that might be.
Karie Dozer [00:17:07] I could not happen soon enough to the researchers in the lab at to benefit more from the knowledge they gained from clinicians. Or do the clinicians gain more from the information gleaned in the laboratory, or is it it's I.
Dr. Alan Bryce [00:17:21] I don't know how you would score that right. It's actually a virtuous cycle. So we talk about traditionally the old model was bench to bedside, which means the lab bench. You discover something and we take that to the bedside. But increasingly nowadays the insights are coming from the clinic. Right. The clinician sees something they understand something. They formulate the questions. I immediately am talking to my colleagues at T Gen. They're doing the research. They're coming with more insights. We take that back to the clinic. Then we come up with the next set of questions based upon what we learned. Right. And that's the virtuous cycle. It really doesn't work. And this isn't unique to medicine. It doesn't work when people live in silos. Right. Too much of, tunnel vision around very narrow questions. We're talking about big problems. And when you're talking about bringing in this human element, right, that it's not just theoretical. So it's an absolute virtuous cycle. I always say in cancer care, cancer clinical care and research more than any other medical field are not separate. Right? Research is happening every day in the clinic. Yeah. We are learning from every patient we see. So research and clinical care absolutely go hand in hand. They cannot be separated. And that's why I think the pace of change is just getting ever quicker, because that relationship is more effective than it's ever been.
Karie Dozer [00:18:47] Sounds like city of Hope is a pretty apt name for this venture. Before we close, are there any areas, any specific areas of research that you feel Arizonans should be especially excited about?
Dr. Jeffrey Trent [00:19:00] Well, the two I could think of one I already mentioned, which is early detection. The second throw is one of the most exciting ones, and we could only do this in the combination of TJ, with city of Hope is that we, just very quickly, soon, if a cancer patient, they're diagnosed, we take a biopsy of those. And if you look through the microscope, there's plenty of cells. We call them lymphocytes. T lymphocytes are those that should be ready to kill that cancer. But they're so they're inside the cancer they got there. They just are doing their job well. Understanding the genomic information from a patient's cancer. We've been able to, work that to the point where we take those cells out and you get about 2 million. We hand them over to our colleague, said city of Hope, where they can grow that number and expand it. And the number that we give back to a patient, is about 22 billion. So we're going to go from 2 million. We expanded to 22 billion, using facilities that city of Hope has for what we call expanding ourselves. And you have to get it. And then you give that back to the patient. And the early works at this are extraordinarily exciting. So it's using your own cells in your own body, so there's not a rejection and just incredibly exciting. And we hope to open that trial sometime in the next, certainly this year. Probably before. So.
Karie Dozer [00:20:41] Well, thank you both for your time and for your work. We're certainly lucky to have you here in Phenix. That's a wrap on this TGen Talks Live. We're glad you all can be with us. And we can't wait to do it again. For more on TGen’s research, go to TGen Dot Org slash News. The Translational Genomics Research Institute, part of city of Hope, is an Arizona based nonprofit medical research institution dedicated to conducting groundbreaking research with life changing results. You can find more of these podcasts at TGen dot org slash TGen Talks, Apple and Spotify and most podcast platforms. For TGen Talks I'm Karie Dozer.