UF Health MedMatters

UF Health Cancer Center Roadmap 2022

As we settle into 2022, it is useful to reflect on the considerable progress the University of Florida Health Cancer Center has made in the last few years and the steps we have taken toward National Cancer Institute designation, while also considering the path ahead.Johnathan Licht, MD

The UF Health Cancer Center continues to grow, now boasting nearly 300 members from 11 colleges and 62 departments. This is notable because few cancer centers look beyond their colleges of medicine, whereas our approach has always been to take advantage of the entire University of Florida in order to solve the problem of cancer.

Since coming aboard as the Cancer Center’s director in 2015, I have built upon the foundation laid by my predecessors, Stratford May, Jr., MD, PhD, and Paul Okunieff, MD, in restructuring our research programs, assembling an executive committee, developing a strategic plan and recruiting more than 50 Cancer Center members into our robust prevention, population science, basic science and clinical science programs.

In 2018, we presented our programs to our External Advisory Board and to the National Cancer Institute and got the go-ahead to apply for Cancer Center Support Grant submission and become NCI designated. The Center applied in 2019 and received an impact score of 31; it was noted that we are poised to have a major impact on cancer in the state of Florida. Nevertheless, despite this favorable score — a score that, in the past, granted other centers funding — the NCI decided not to fund us. They challenged us to do even better, so we got to work enhancing our institutional commitment by increasing investments and engagement in community outreach, enhancing our education and training programs, and increasing recruitment of clinical investigators and cancer population scientists.

We consulted with Cancer Center senior leadership, our External Advisory Board and David R. Nelson, MD, senior vice president for health affairs at UF and president of UF Health, and decided to resubmit as an A1 Application, which would make us the only center, to our knowledge, to submit a revised application. In December, we met with the NCI Office of Cancer Centers and received their enthusiastic go-ahead to submit the reapplication in May 2022.

UF Achievements

Meanwhile, the University of Florida has not been standing still. As you know, the university’s performance has positioned UF among the nation’s top five ranked public universities, according to the 2022 U.S. News & World Report Best Colleges rankings. UF is the premier research institution in the state of Florida — and, with over $200 million per year, the leading NIH-funded research institution. Additionally, after integrating with Scripps Florida, which has its own robust NIH funding, including NCI funding, UF will be a $250 million research enterprise from the NIH alone. Another new development is the ongoing integration of the Villages and Leesburg hospitals; our Center is looking forward to new cancer outreach and research opportunities in those locations.

UF recently committed to making artificial intelligence the centerpiece of a major, long-term initiative. The university has partnered with NVIDIA, which has resulted in HiPerGator, higher education’s most powerful AI supercomputer and a workforce training program that will jumpstart the next generation of discovery and innovation. This will be headquartered in Malachowsky Hall for Data Science & Information Technology, which is currently under construction. The Cancer Center is involved in recruitment across multiple colleges in the AI space; we recently launched a Cancer AI Working Group and hosted the AI Day for Cancer Research and Scientific Retreat for Prediction Model Developments with Statistical, AI and Mathematical Approaches.

UF Health Cancer Center Achievements

We have been working hard to apply the feedback received from our 2019 Cancer Center Support Grant application.

This year, I will be working closely with David R. Nelson, MD and other UF Health leaders to develop a cancer service line that will coordinate cancer services across multiple departments and divisions. The Cancer Center has also appointed Disease Site Group leaders. We recruited Merry Jennifer Markham, MD, FACP, chief of the division of hematology and oncology in the College of Medicine and associate director for medical affairs at the Cancer Center. We augmented hematology/oncology fellowship recruitment, emphasizing research, and recruited a number of new clinical trial-oriented faculty — supporting the clinical research efforts of a number of other critical units such as Radiation Oncology and Surgical Oncology.

Our marketing for cancer services emphasizes clinical research and Thomas J. George, MD, associate director for clinical research, has been working to expand our clinical research network. Meanwhile, our Clinical Research Office basically wrote the book on how to maintain clinical trial enrollments and engagement during the height of shut-downs for COVID-19. Additionally, we expanded and renovated the research infusion space in the UF Health Medical Oncology — Davis Cancer Pavilion, worked with the hospital system to increase mammographic access, and implemented a genomics module in the electronic health record, or EPIC.

Over the past six years, we have received $123 million of support due to philanthropy, the NCI Cancer Centers Act and funds from University of Florida. In the next six years, we anticipate a 35% increase with augmented funds from the state, philanthropy and notably from the university. This is a major step in addressing critiques from the Site Visit team.

About a quarter of this year’s fiscal budget went toward faculty recruitments and commitments. Ten percent of our budget goes to leveraging and supporting grants, such as augmenting funding to our PO1 on tumor virology, led by Rolf Renne, PhD, associate director for basic sciences, and the U54 Partnership for health care disparities led by Diana Wilkie, PhD, RN, FAAN. About 7% goes toward the subsidizing of Shared Resources, including Biostatistics and Quantitative Sciences supervised by Ji-Hyun Lee, DrPH, and NextGen Sequencing and Flow Cytometry and Confocal Microscopy, overseen by Steven Madore, PhD, associate director for shared resources. The Clinical Research Office, which comprises approximately 27% of the operating budget, requires this infusion of resources due to the complexity and risk of cancer research and concomitant extensive and regulatory requirements. About 5% of our budget is used to protect clinical investigator time and we see this growing in the coming years.

Previously, we presented a rather limited description of our philanthropic activities to the NCI. Recently, UF Health Development secured a $1 million estate gift and Dan Hoffman came aboard as our new senior director of development; he was preceded by Patrick Henry, acting director of development, who obtained a $7 million estate gift. The Cancer Center endowment has a market value of nearly $60 million, some of which is donor-directed and some of which is fungible. David R. Nelson, MD, has agreed that I will be co-signing on future cancer gifts and their use. In the near future, resources will become available with the integration of Scripps Florida to fund joint programs between that will include substantial money for cancer research investigation.

The need for space to grow our programs in the next several years has been addressed by the development of the Adam Michael Rosen Neuro-oncology Laboratory by Duane Mitchell, MD, PhD, associate director for innovation and discovery, and his colleagues as well as more space in the Basic Science Building and Malachowsky Hall. Additionally, a new translational research building will break ground in the next two years, wherein a quarter of the space will be allocated for cancer research — particularly in the microbiome and metabolomics.

Clinical Translation

The Cancer Center supports the career development of a number of physician scientists directly and indirectly. Some of the clinically trained investigators now undertaking bench-based research include Ryan M. Thomas, MD; Maryam Rahman, MD; and Elias Sayour, MD, PhD, who recently converted his KOA to an R37. Paul Castillo Caro, MD, has a KL2 grant funded by the Cancer Center and Bently P. Doonan, MD, an oncology fellow with a master’s degree in immunology, moved into an 80% research position.

In the past two years, we have recruited nine new clinical investigators from excellent institutions in a variety of tumor types to round out our programs in therapeutic and population-based clinical research programs. They work monthly with our former division director, Carmen J. Allegra, MD, and Thomas J. George, MD, our associate director for clinical research, on a think tank to develop investigator-initiated trials run by Erin Monari, PhD, CCRP, assistant director of project management and network operation. This has led to a number of concepts — many have been approved but are awaiting funding sources. Three are currently open:

Phase II Study Using Tazemetostat in Patients with Recurrent/Refractory and/or Metastatic Malignant Peripheral Nerve Sheath Tumors (NCT04917042)

Activated 8/12/2021

PI: Joanne Lagmay, MD

A Phase II Randomized Therapeutic Optimization for Refractory Metastatic Cancers Using ctDNA(RAPID1 Trial; NCT04786600)

Activated 8/18/2021

Co-PIs: Sherise Rogers, MD and Carmen Allegra, MD

Utilizes Microbiome Cancer Biobank

Atezolizumab Plus Tivozanib in Immunologically Cold Tumor Types (IMMCO-1 Trial; NCT05000294)

Activated: 10/6/2021

Co-PIs: Jonathan Chatzkel, MD and Brian Ramnaraign, MD

Cancer Control and Population Sciences

Another noted opportunity for improvement of our Center was that Elizabeth A. Shenkman, PhD, who previously led both our population sciences and community outreach and engagement efforts, had a very large portfolio. In response, and to further diversify the research themes and scope of our population sciences efforts, we recruited Dejana Braithwaite, PhD, from Georgetown Lombardi Comprehensive Cancer Center into the role of associate director for population sciences. Dr. Braithwaite has an outstanding background, including a PhD from the University of Cambridge and postdoctoral training with Robert A. Hiatt, MD, PhD — a founder of the cancer control and population science programs at the NCI and beyond. Dr. Shenkman has now been able to focus her energies on outreach and engagement.

We redesigned the Cancer Control and Population Sciences research program to study the cancer burden across the patient journey, from genetic epidemiology and etiology; risk factor mitigation, including cancer communications; new screening efforts; implementation science, to confirm treatments are getting to patients in real-world settings; and studying secondary effects, survivorship and palliation in the field of symptom science.

Additionally, we have recruited five new clinicians who are engaged in population science and survivorship studies: Wayne Brisbane, MD, Raymond Mailhot, MD, and Oluwadamilola Oladeru, MD, are interested in toxicities of radiation; Jesus C. Fabregas, MD, is interested in disparities; and Naykky Singh Ospina, MD, is interested in the potential over-diagnosis of thyroid cancer.

Community Outreach and Engagement

Our Community Outreach and Engagement office is designed to have bidirectional conversations with our community to better understand the cancer burden in our catchment area and to meet their needs, in terms of prevention, screening, financial implications and the long-term outcomes of cancer.

Our catchment area is largely rural, with many small towns and several small cities such as Gainesville, Ocala and Tallahassee. It is characterized by many counties with high rates of persistent poverty, an aging population, particularly in the retirement communities in south Florida, and a large number of people who have no health insurance. Our highest mortality tumor, lung cancer, has the highest incidence and highest mortality in the United States. The cancer burden in our catchment area is largely borne by the non-Hispanic white population, which is, on average, 10 years older than Black or Hispanic individuals. This implies there are great opportunities to screen and prevent cancer in the younger population groups. Our region is additionally characterized by the highest cancer burden in the state, with cancer being the leading cause of death. Our counties have high rates of advanced-stage cancer due to the lack of health care access, lack of screening and increased risk factors such as cigarette smoking and obesity.

Priority Cancers

We have characterized breast, brain, colorectal, human papillomavirus-related, leukemia and lung cancers as our priority cancers for the catchment area. These were chosen either because of their high incidence and mortality, such as lung cancer, or because we have specialized programs addressing them, such as leukemia, where we have an outstanding hematopoietic stem cell program, or where there has been a large investment in making UF a destination for care and research, such as brain cancer. Our priority cancers also include highly preventable cancers that are affected by low rates of screening and vaccination in our region, such as HPV-related cancers.

Addressing the Catchment Area Burden

Some of our achievements that address the catchment area burden of cancer include participation and leadership in the Center for International Blood and Marrow Transplant Research and the development of BCXL degraders, a proto-oncogene developed by Daohong Zhou, MD, that is not just inhibited by the drug but actually degraded and eliminated from the cancer cell, stopping tumor growth.

Policymakers such as Ramzi Salloum, PhD, and others in the Cancer Control and Population Sciences research program, helped inform our county’s decision to raise the tobacco-buying age to 21, and the entire state has followed suit.

In colorectal cancer research, Janice Krieger, PhD, co-leader of the Cancer Control and Population Sciences research program, Melissa Vilaro, PhD, and others are using customized avatars to communicate and engage patients in screening and prevention behaviors as part of an innovative cancer communications program. W. Greg Sawyer, PhD, is using 3D printings of tumors to study tumor immune system interactions ex vivo.

Project CONTINUITY is a direct response to the community’s need for screening. This was informed and inspired by our Community Advisory Board to increase screening, link patients to care and resources, and to provide counseling and engagement. If we screen and identify new cases of cancer, we can get people into care. This is being performed by our office of Community Outreach and Engagement, with locations in Gainesville, led by Sarah Szurek, PhD, and by LaTrina Massey, MPH, in Tallahassee — as well as throughout the catchment area and beyond.

As a land-grant university, UF has offices in all 67 counties of Florida and we use this resource. For example, Michael Gutter, PhD, is working to increase access to telemedicine services and link patients to care at these county extension offices, which became particularly important during the pandemic.

The UF Health Cancer Center in the Years Ahead

The specific aims of the UF Health Cancer Center are to:

  1. Conduct innovative research
  2. Synergize research across UF
  3. Address the cancer burden of our catchment area
  4. Train future cancer researchers

Leadership

In recent years, the Cancer Center’s leadership team has undergone exciting changes. Dejana Braithwaite, PhD, joined our Executive Leadership team as associate director for population sciences and became co-leader of the Cancer Control and Population Sciences research program. Duane Mitchell, MD, PhD, moved from research program leader to associate director for innovation and discovery — and at the same time, he became Director of the Clinical and Translational Science Institute, which demonstrates our commitment to collaborate with the CTSI. Elias Sayour, MD, PhD, who is creating innovative RNA nanoparticle vaccines for tumor immunization, assumed the role of co-leader of the Cancer Therapeutics and Host Response research program along with Christian Jobin, PhD Lizi Wu, PhD, a noted molecular genetics and microbiology researcher, has co-led our Mechanisms of Oncogenesis research program since 2020, along with Daohong Zhou, MD.

Research Programs

Our transdisciplinary research programs, organized by associate directors Rolf Renne, PhD, and Dejana Braithwaite, PhD, include the Mechanisms of Oncogenesis research program with its emphasis on genetic and epigenetic changes in cancer, the role of noncoding RNAs and RNA biology in cancer, and DNA tumor biology.

The Cancer Therapeutics and Host Response research program translates discoveries into clinical trials with a focus on the microbiome and inflammation, tumor immunity and novel small molecule compounds as cancer therapeutics.

The Cancer Control and Population Sciences research program has been redesigned with an emphasis on precision public health, looking at individual patient engagement through avatars as well as big data, and understanding health trends using the OneFlorida database. There is a focus on cancer and aging as well as cancer health disparities, whether they are based on cultural, biological, environmental or socioeconomic factors.

Cancer Research Training and Education

Our Center is pleased to have received an American Cancer Society Institutional Research Grant specifically to fund early-stage investigators.

Dietmar Siemann, PhD, associate director for education and training, successfully applied for and received the only team-based interdisciplinary training program in the NCI portfolio. Under the direction of Dr. Siemann, Andrew Judge, PhD, and Lizi Wu, PhD, and the Team-based Interdisciplinary Cancer Research Training (TICaRT) program will provide pre- and postdoctoral trainees from a broad range of disciplines the opportunity to develop interdisciplinary skills in cancer research and experience with transdisciplinary approaches.

Dr. Siemann and Elias Sayour, MD, PhD. have also submitted a T32 grant in pediatric cancer immunotherapy coupled with interconnected training in translational oncology that spans multiple disciplines, departments and colleges.

The NCI is now mandating that every Cancer Center develop a plan to increase equity and inclusion in the cancer research workforce, which we anticipated by supporting the development of the CARE² Health Equity Center at UF partnership with Florida Agricultural and Mechanical University, a historically black college, and the University of Southern California, in which projects in cancer health disparities, shared resources, and outreach and educational cores support the careers of minorities in cancer research. The Center also developed the Diversity Post-baccalaureate Research Education Program, of DPREP, in which five students from historically Black and Hispanic serving Institutions are embedded in our laboratories for a year. We intend to expand this across additional minority-serving institutions and rural colleges. We look forward to tracking the outcomes of these individuals as they move into further stages in their career.

Strategic Plan

To formalize our plans for NCI designation and beyond, John Wingard, MD, deputy director of the UF Health Cancer Center, led the development of our first strategic plan, “Vision 2022.” In accordance with this plan, Cancer Center’s leadership defined our catchment area, its burden and chose priority cancers to attack.

We also formulated research programs and shared resources; reformed our Clinical Research Office to increase interventional accruals and clinical trials; developed a T32 training grant and American Cancer Society institutional research grant; and established an office of Community Outreach and Engagement and a Citizen Scientist Program, where we educate members of our community about cancer science and embed them in our research programs. We are also developing a plan to enhance diversity.

Our 2022-2027 Strategic Plan will be finalized by March 2022 after consultation with a number of stakeholders including our Community Advisory Board, research program members and our leadership. At our center-wide membership retreat on Feb. 1, we will further discuss our strategic goals and codify them as we move forward with NCI designation.

Space to Expand

The Cancer Center has adequate space to expand our programs across campus, including in the Cancer and Genetics Research Complex, the Basic Science Building and the upcoming translational research building — which will break ground in 2023. Malachowsky Hall, which is under construction, will eventually house members of our Cancer Control and Population Sciences research program.

In 2018, the Cancer Center renovated the UF Health Medical Oncology — Davis Cancer Pavilion and created a $1.3 million research infusion space to allow for earlier phase clinical trials. This has supported around 115 trials and 320 treatment accruals. The Adam Michael Rosen Neuro-Oncology Laboratory opened in 2021, housing our brain tumor immunotherapy group with additional room for expansion.

Governance and Advisory Structure

The UF Health Cancer Center has weekly executive committee meetings augmented by a monthly senior leadership meeting with our program and Disease Site Group leaders. Additionally, we have quarterly meetings with our Community Advisory, who maintain critical bidirectional communication between the community and the cancer research community. Lastly, our External Advisory Board meets and gives us direct advice every year.

COVID Response

An important metric to the NCI and our colleagues is the Center’s response to COVID-19. We excelled in this regard, developing cancer communication studies, studying the outcomes of hydroxychloroquine and holding a number of webinars to educate our community about the impact of coronavirus on cancer prevention and care.

Clinical Research Office

Our clinical research progress has been excellent. The UF Health Cancer Center Clinical Research Office, led by Administrative Director Alison Ivey, RN, MS, MBA, OCN, CCRP, currently manages more than 250 clinical trials. These are developed by the tumor-specific Disease Site Groups and reviewed for scientific impact by the Scientific Review and Monitoring Committee led by Chair Paul Crispen, MD. In 2020, 12% of our reported cases were on treatment clinical trials. When we compare our six-year journey, in 2016, we had 138 interventional tumor treatment accruals to trials and this nearly tripled to 400 in 2018. COVID-19 presented challenges, but we reached close to 300 accruals by the end of 2021.

Non-tumor treatment trials such as prevention, intervention or pain relief-intervention studies have also increased over time, though again were impacted in 2021. Overall, however, we have increased in all parameters over the past six years.

Recruitment

The Cancer Center has played a leading role in expanding membership with more than 50 new recruits — with 40 coming from outside the institution and a spectrum of partnering colleges and departments. Over 40% of these recruits are women and nearly 20% are from underrepresented minority groups.

These recruits have received nearly $30 million of Cancer Center support matched by the university. About $10 million of that support has been spent by these faculty recruits thus far, which resulted in an enormous return on investment: more than $46 million in new peer-reviewed funding.

This further resulted in hundreds of publications with strong collaborative statistics and many interventional and observational accruals to clinical studies.

Diversity

The UF Health Cancer Center promotes a culture of inclusion, diversity, equity, access and justice through our patient care, research, training and engagement with the communities we serve.

We recognize that the diversity of our workforce is a work in progress. While our students are more female than male and our cancer patients are slightly more male than female, our faculty across the university is about 40% female and our Cancer Center members are about 30% female. We have a diverse student body at the University of Florida, with nearly 20% Hispanic and 6% Black —but faculty are underrepresented, with Black and Hispanic faculty together representing less than 10% of Center members.

The UF Health Cancer Center is dedicated to creating a culture of inclusion and diversity and is doing this in several ways: 1) by increasing the throughput of people from underrepresented minority groups and women in research and training. 2) through partnerships with historically black universities, such as our U54 CARE² partnership with Florida Agricultural and Mechanical University and the University of Southern California and 3) a yearlong diversity post baccalaureate research education program that aims to work with predominately Black and Hispanic populations and rural colleges and universities.

We are working with our various colleges and departments to change how we recruit faculty and trainees, using diversity advisors to ensure bias training is inculcated into all faculty on recruitment and search committees and to identify candidates outside of the traditional, rather closed networks.

In the coming weeks, we’ll be commissioning a new diversity committee consisting of members of various races, genders, ethnicities and sexual orientations to address diversifying our research workforce. We are actively curating our membership to identify emerging leaders and place an increasing number of women and underrepresented minority members into leadership positions across the Cancer Center.

Transdisciplinary Collaboration and Coordination

Each of our three cancer research programs and program leaders have nearly $10 million per year of peer-reviewed cancer funding. When we add non-peer-reviewed, we have over $30 million of total funding with high rates of collaborative publications within and across programs.

We have more than 50 new recruits across multiple colleges and departments spread across our three research programs. These recruits have been quite productive, bringing in peer-reviewed funding, including from the NCI, and contributing nearly 500 new publications. Our publication output has grown, nearly doubling over the past six years and remaining highly collaborative. We’re working with the CTSI to measure how well clinical scientists are interacting with other types of scientists. We’re systematically working to increase collaborations between clinically facing and non-clinically-facing scientists.

Our Cancer Center members manage complex multi-institutional grants. We have 39 multi-PI grants, including 22 from the NCI. Our members are taking increasing roles in national research organizations, such as PCORI, NRG Oncology, Precision Promise, ASCO, CIBMTR, Children’s Oncology Group, PBTC, the Blood and Marrow Transplant Clinical Trials Network and others.

Funding

Our peer-reviewed funding has increased by $6 million since we last applied for NCI designation. It is now over $30 million per year with a high rate of 42% from the NCI. When we fully integrate Scripps Florida in 2022, this will result in over $35 million of peer-reviewed funding. In this regard, the Cancer Center is in the upper third of the NCI-funded centers and has more research funding than many centers previously designated. Our total funding, including industry sponsorship of research and clinical trials, is approaching $40 million per year.

Team Science Commitment

Our institutional commitment includes a culture in which we support clinical researchers to be promoted and recognized for their contribution to teams and enrollment to clinical trials. Half of those recruited into clinical research tracks have been promoted over the past decade. The compensation plan will also be adjusted in the coming year to incentivize clinical research engagement by clinical faculty. We have 14 new clinician scientists who have been recruited in the past three years alone.

Our institutional commitment includes expanded research space, increased resources and a new guarantee of support for clinical research faculty — with a floor of $3 million a year to support such efforts. Over the next several years, the Center will have an increased direct cost return and new funds for recruitment.

Where Do We Go from Here?

Cancer Center leadership is currently drafting our second Cancer Center Support Grant application, which is being organized by Robert Houlihan, DHA, associate director, administration. Our External Advisory Board will workshop the grant early this year, and we are on track to submit the application in May 2022 with an anticipated site visit in the fall of 2022. We hope to receive notice of the award in the first quarter of 2023 and the NCI-designation and CCSG would begin in April 2023.

Henry P. Ciolino, PhD, director of the NCI Office of Cancer Centers, reviewed our progress on an official pre-grant submission Zoom visit. He was impressed with the gains the Cancer Center has made over the past three years and is looking forward to receiving our revised Canter Center Support Grant application.

These accomplishments and more are all made possible by you — the UF and UF Health faculty, staff, students, health professionals and administrators — who are dedicated to preventing, detecting, treating and ultimately curing cancer. I look forward to all we will accomplish together this year.

Jonathan D. Licht, MD

Director

University of Florida Health Cancer Center

About UF Health Shands Hospital

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University of Florida Health Shands Hospital has been recognized among the nation’s best hospitals in seven adult medical specialties. Overall, UF Health Shands Hospital was recognized as one of the best hospitals in Florida. In addition to being ranked among the nation’s top 50 hospitals in seven specialties, UF Health Shands Hospital also was listed as “high performing” in seven specialties, including abdominal aortic aneurysm repair, colon cancer surgery, COPD, heart failure, lung cancer surgery, neurology & neurosurgery and orthopaedics.