As the words “Tampa” and “innovation” become increasingly intertwined, look for Dr. Alan List and the team at Moffitt Cancer Center to be leading the charge toward the future of healthcare.
Besides serving as Moffitt’s president and chief executive, Dr. List is also an actively publishing researcher with a focus on bone marrow diseases. He says he sees a clear connection between his two roles.
“As a researcher, you’re always a student, which is what I love,” Dr. List says. “As CEO, I approach it the same way. It’s becoming a student of how to engage your workforce and how to lead them best.”
Recently Dr. List has helped encourage Moffitt team members to stay on the cutting edge of immunotherapy, which he calls one of the most exciting areas of cancer research in the last five years. In immunotherapy, the body’s own immune cells, called T-cells, are removed and genetically engineered to recognize and target cancer cells. The modified T-cells are then reinserted into the body, where they fight the tumor and grow new T-cells. Current trials of this therapy are underway to treat patients who have not responded to any other treatment.
“It’s incredibly effective,” List says. “The overall response rate in these people is around 65 percent to 70 percent, and complete response is in the range of 40 to 50 percent.”
To accommodate the pace and scope of researchers’ discoveries, Moffitt will soon embark on a 10-year growth plan to add more labs, faculty offices and hospital beds, among other additions. Dr. List hopes the city’s overall growth attracts more companies, like Bristol Myers-Squibb and Johnson & Johnson, that can take advantage of Moffitt’s innovations.
“Particularly because of M2Gen [Moffitt’s health informatics startup] and all their success and growth in cellular informatics for cancer, as well as immunotherapy, I think we have an opportunity to really help to grow that biotech cluster for Tampa Bay,” Dr. List says.
Q&A with Dr. Alan List, President and CEO of Moffitt Cancer Center
When you earned your medical degree, you could have chosen to practice any kind of medicine. Why did you choose oncology and hematology?
I didn’t make that decision in medical school. In fact, I had no exposure to hematology or oncology in medical school. It really wasn’t until I was an intern and resident [that I made the decision]. I figured that out [at the Good Samaritan Medical Center] in Arizona. At that point in time, our residency had different rotations. There was a gastrointestinal floor, there was a pulmonary floor, and there was a hematology-oncology floor.
Hem-onc was the one where the patients were the most inspiring. They were so grateful for anything you could do for them. This was back in 1980, and we thought we had some good drugs, but it was nothing compared to what we have now. Patients were facing their own mortality, and they were the most gracious people you could ever meet and truly inspiring.
I had a background in research. When I was in college, I did my bachelor’s and my master’s together in four years, so I did a lot of research, and I did research in medical school. I thought, this is a place I could make a difference in applying research. But the hematology specifically, I had a hematologist there who really became my mentor. What I loved about it was, not only do you serve as the clinician as a hematologist — you look at the blood smear, you look at the pathology, you do the bone marrows and you read the bone marrow [biopsies] yourself — you are a clinician who actually knows the patient’s history, and looking at the pathology you had more insight than any pathologist ever could. In my training at Vanderbilt in hematology, a hematologist read all the bone marrows; wasn’t a pathologist.
Lastly, if you want to do research, you can access the malignancy at any time. That’s the advantage of hematology over oncology, at least in bone marrow diseases, which I was interested in. You can access that and then do research in your lab. I’d say those were the primary factors.
Besides serving as Moffitt’s president and CEO, you are also an actively publishing, award-winning researcher. How do you balance your work on both the business and scientific sides of Moffitt’s mission to prevent and cure cancer?
As a research institution, we’re all about innovation. As a researcher, you’re always a student, which is what I love. I love finding new ideas, changing things and seeing if we can do things better. As CEO, I approach it the same way. When I was taking over this [position], it took me about a year to get my arms around everything that we needed to do. But we are very strategic. We have a strategic plan that we work on for five years at a time. It’s really about doing research for that. It’s becoming a student of how to engage your workforce and how to lead them best. We’re in a difficult situation now in the last eight years — since the approval of the Affordable Care Act — where there’s decrease in reimbursement, at least on the clinical side. We had to position ourselves to weather that and still be productive and successful and to serve our mission. I think we’ve done that very well by engaging the workforce and training everyone in process excellence and getting them all involved. The strategic margin management is a great example of that. We engage everybody to find projects where we can improve efficiencies, decrease waste and so on, and it’s been a big success.
Regarding how to manage it all, you have a lot of good people to work with. All of my executive vice presidents are incredibly effective, and they’re all great leaders. Surrounding yourself with the best people you can is probably the best strategy I can think of.
In 2016, Moffitt renewed its designation as a National Cancer Institute Comprehensive Cancer Center and was also named the No. 6 cancer hospital in the country by U.S. News & World Report. As Moffitt’s leader, how do you motivate and encourage your fellow team members to consistently give their all to fight cancer?
It begins, I think, with the right mission, and I think we’re very fortunate. We’re a standalone cancer institute with one mission — to contribute to the prevention and cure of cancer. You can ask anybody here, any staff member, and they can recite the mission statement.
I think, secondly, we’re team-based. If you’re on the research side, we are team-based because we feel like we can accelerate discovery and the translation of our discoveries more effectively and quickly. But also [we’re team-based] on the clinical side. There is no department of medicine here. There’s no department of surgery like you would see in a standard university, or matrix, cancer center. Our clinical departments are all disease-based. We surround the patients in each department with faculty who practice different disciplines but all with one focus, and that is their specific disease. For example, gastrointestinal oncology — you’ll have surgeons that just do surgery for esophageal and gastric [cancer] or pancreatic biliary cancer or colon cancer. There are medical oncologists that are focused on the same thing and leading trials in those areas — like gastroenterologists and radiation oncologists that are experts in just GI cancers. You bring all those disciplines together so they’re all contributing at the same time. That team-based approach I think really helps.
But I think to really have an engaged workforce, there has to be communication. It starts with communication. We try to do that. We want everybody to know what’s going on from month to month, from week to week. We also have to have all of them involved to be as productive as possible. So I think strategic margin management was a great example of that. We’ve been educating the workforce for the last four years or longer. They were ready when we launched strategic margin management, then, to be able to contribute projects and help with the bottom line. When you’re trying to eliminate waste and improve efficiencies, that’s not something that you can do from the top down. That has to be from the bottom up. Those are the people that can see those opportunities. I think being visible and holding people accountable is the other part of it. And I think we’ve prioritized all of those things over the last four years, since I’ve been CEO.
What treatments or innovations at Moffitt are you most excited about right now?
We have a lot of new licensing agreements that are coming on board, and I think they’ll be exciting. But I think the most exciting thing right now by far is immunotherapy, specifically what we call the CAR T-cells, which are the chimeric antigen receptor engineered T-cells.
T-cells are our immune cells, and the cancer cells arise because they cloak themselves from the immune cells. That tolerance to the tumor allows them to grow. What CAR T-cells are all about are taking those T-cells out and genetically engineering them so they’re no longer blinded and can recognize the tumor, putting in a new target receptor so it can recognize the target and specifically target that malignancy, and putting in some additional genetic material that activates the T-cells and grows them so you get billions of T-cells back.
It’s incredibly effective. Dr. Fred Locke has led most of those trials here. He’s gotten a lot of exposure lately on the major networks and on the evening news because of the most recent trials that he’s led, particularly in refractory lymphoma. These are people who are not candidates even for transplant because they won’t respond to anything to get them into minimal disease state. These are people who, this is their last opportunity, and their median survival is around six months or less. The overall response rate in these people is around 65 percent to 70 percent, and complete response is in the range of 40 to 50 percent. [The results] are durable, and they’re lasting. These people may actually be cured by this type of therapy. That I think is the most exciting [innovation].
[This research] began in B-cell lymphomas and also in B-cell acute leukemia, what we call acute lymphoblastic leukemia, or ALL. I think that was the low-hanging fruit because you can live without your B-cells, but you can’t live without your stem cells. Targeting a disease like what I’m focused on, myelodysplastic syndrome, where it’s derived from your normal stem cells, finding that unique antigen is a critical piece for CAR T-cells to be applied — also then characterizing what limits their effectiveness so you can address that as well. I think we have one of the strongest immunology and cell therapy programs in the nation. Our cell therapy lab is one of the few places in the country, maybe two or three in the country, that can do all of these things — generate CAR T-cells and tumor-infiltrating lymphocytes, dendritic cell therapy, all types of cell therapy. Because of that, right now we have two contracts where we’re making all the CAR T-cells for companies so they can deliver them for all their trials nationally. I think that’s probably the most exciting area I’d say for cancer in general in the last five years.
Moffitt is already an integral part of Tampa’s economy and a member of Innovation Place [formerly the Tampa Innovation Alliance]. How do you see Moffitt fitting into the overall picture of the massive growth the city is about to undergo?
We’re all excited about the growth and what’s going to be happening downtown as well. Even though we’re Florida’s cancer center, created by a state statute with a mission for the state and all of the Southeast, Tampa’s our home, and that’s where a significant portion of our patients come from. The way I see what’s happening downtown, there’s a vision for that about healthy living. I think that aligns exactly with what we’re all about. Ideally we don’t want to be treating cancer; we want to be preventing it. We have some of the best researchers in the world. We have active outreach programs, and we have talked about possibly having some other opportunities downtown for healthy living, genetic screenings and interpretation to prepare people for how to manage things, other types of cancer screenings and diagnostics. We’re very much involved in outreach throughout the community, and I think we’d like to do it even more.
I think the other thing is that now we’re looking at opportunities not just to license [technologies] but to bring companies here to work with us on with some of our new licensing agreements. We’d like to help generate and grow the biotech community. We’re very fortunate now to have Bristol Myers-Squibb’s support services here [in Tampa, along with] Angen, Johnson & Johnson, so we’re beginning to form a cluster. Lion Pharmaceuticals moved from California to here because of our strength in immunotherapy, and that’s what they’re involved in. I do think we have an opportunity to really be a hub for growing some of that biotech industry. Particularly I think because of M2Gen [Moffitt’s health informatics startup] and all their success and growth that’s occurring right now in cancer informatics and cellular informatics for cancer as well as immunotherapy. I think we have an opportunity to really help to grow that cluster for Tampa Bay.
What’s next for Moffitt Cancer Center?
I’d say right now it’s all about growth. We have run out of laboratory space. Moffitt Research Center (MRC) is over 30 years old now, and we cannot even add a hood. Someone wanted to add a hood to their lab, and we couldn’t because it couldn’t handle the electrical load. We’re out of space for research and laboratories, and that building is beyond its lifespan. We’re out of office space for all our clinicians that are working here. We’ve had to cannibalize a lot of clinical area to use for office space.
Lastly, we mentioned CAR T-cells, and we expect that [treatment] to get approved by Kite [Pharma, a pharmaceutical company focused on immunotherapy], which are trials that we’ve led here in the Southeast, probably this summer. At a minimum, over the next several years, it could be 300 to 400 patients a year that need that [treatment] just in Florida alone. We’re going to be probably the only site in Florida that can begin with that. That’s about almost the size that we see in transplant, and they have to be managed like in a transplant setting, so we need more transplant beds. We actually need more hospital beds.
Over the next 10 years, I think we have a growth plan that we’re going to need. We’re going to begin building a new clinical support building on the south side of the hospital so we can have more faculty offices, space for clinical laboratories, pathology, and so on. That’ll allow us to convert some of the space that we have for the faculty right now into clinic space and more hospital beds, and we can add another 10 transplant beds as well. Also we’re planning, as soon as we have the final signatures from the state, we have an agreement with the University [of South Florida] to tear down the USF Eye Institute [currently attached to the MRC] and build a new tower there. When that’s done, sometime in the next 10 years, we’ll tear down the MRC and build a new research tower there. Our goal is to keep this campus here on Magnolia [Drive, on USF’s campus] an acute care and research campus and continue to grow over on the McKinley [Drive] campus and add more outpatient facilities over there and even perhaps some of our offices and support services as well.
Overall, in the next 10 years, we’re probably adding another 500 to 600 more faculty and support services, particularly on the research side, so there’s a lot of growth. Our growth has just been enormous over the last several years, and it’s just shocking, the demand for our services. This year alone, our new patient admissions are up more than 20 percent, which is phenomenal. The year before that, it was 12 percent. The year before that it was 8 percent. It’s on a pace that we cannot sustain. We can’t grow fast enough. And these patients come not just from all over Florida — they come from every county in Florida, every state in the country and over 100 countries around the world. We are a major international center, so they come from all over. It’s imperative for us to raise the funds we need to be able to grow as much as we need to provide those services.
Who in the Tampa Bay community do you admire professionally?
I think that there’s a lot of people, and that’s the hard part. One thing I love about Tampa Bay is that it’s the friendliest place I’ve ever lived, and it’s the most inviting community. Everybody wants to get you involved. But I have to highlight two people. One of those is Mayor Buckhorn. Bob has been phenomenal in seeing his vision through, and it began with some mayors even before him, but for the downtown and the Riverwalk area, that’s just become phenomenal and aligns beautifully with what the plans are for downtown, the city and the county. Of course the other one is Jeff Vinik. Jeff came here as an investor, coming here because he invested in the Lightning. But, talk about someone who likes research, he learned how to be a developer and changed his whole career around with his commitment to the community. He’s not just investing and building, he’s investing in the community itself. He and [his wife], Penny, you couldn’t find more humble individuals. They’re fantastic people.
What is your proudest accomplishment up to this point?
My daughter, McKenzie. She’s just fantastic. She is a very productive student and probably one of the most engaging young individuals that I know. My wife, Kim, and I are very proud of her.