Benchtop to Bedside | A Conversation with Dr. Gary Schwartz, the New Leader of the Case Comprehensive Cancer Center

First director with privileges at both University Hospitals, Cleveland Clinic

UH Seidman Cancer Update | August 2023

The new Director of the Case Comprehensive Cancer Center (Case CCC) comes to Cleveland from New York City, where he was Chief of Hematology and Oncology at Columbia University for nearly a decade and Deputy Director of the Herbert Irving Comprehensive Cancer Center since 2016. Gary Schwartz, MD, spent 30 years working extensively in early drug development with benchtop to bedside research in gastrointestinal cancers, melanoma and sarcoma. He also conducted several translational clinical trials during his years as Chief of the Melanoma and Sarcoma Service at Memorial Sloan-Kettering Cancer Center.

Gary Schwartz, MD

Dr. Schwartz has received numerous awards for his research, teaching and mentorship. He succeeds Stanton Gerson, MD, now Dean of the School of Medicine at Case Western Reserve University, a UH oncologist who led the Center for 20 years.

Learn more about Dr. Schwartz’s vision to establish Case CCC as a highly innovative clinical translational research center that will transform the field of cancer medicine.

What interested you specifically in this position in Cleveland?

I’ve seen great changes in cancer medicine over the last 30 years that I’ve been practicing. While at Columbia I was able to enlarge a small cancer program that I think reflected the needs of the community in northern Manhattan. We increased from 12,000 to 60,000 patients, from 12 faculty to over 100 faculty. The overriding goal was a patient-centric approach to cancer medicine, which is something I particularly focus on. I think patient care should be the center of everything we do. The goal should be how to best use basic science to optimize the future of cancer care. I reached a ceiling at Columbia. After 10 years I felt I had achieved everything that I could there.

Being a cancer center director has always been my dream job. And the Case Comprehensive Cancer Center is extraordinary. It was the first cancer center in the country to get the “exceptional” ranking from the National Cancer Institute (NCI); the highest ranking before then had been “outstanding.” So when I received a call from the outgoing director and dean of CWRU’s School of Medicine, Dr. Stan Gerson, I knew that I was being considered for an exceptional cancer program, one of the top five in the country. And when you get a call like that, you know, you just don't turn it down. You want to hear more.

You’re the first director of the Case Comprehensive Cancer Center to have privileges at both UH and the Cleveland Clinic. What could this mean for the consortia, since we’re one of the few comprehensive centers with competing hospitals involved?

Case Comprehensive Cancer Center is an NCI-designated consortia consisting of two major hospitals, University Hospitals and Cleveland Clinic, and Case Western Reserve University, all of which are truly outstanding centers of excellence. We link the three organizations in a unified effort to understand the causes and progression of cancer and to use that understanding to develop treatments and reduce the likelihood that the 4 million people in 15 counties we serve will develop cancer and suffer from its consequences. We advocate and provide funding for research, shared resources and training. Being a consortium allows us to do far more than if we acted individually.

I'm here to represent all of cancer medicine – and all the people of Cleveland. It doesn’t matter whether you're a Case CCC member seeing patients at UH or Cleveland Clinic. The goals are the same: the cure and prevention of cancer. I think by establishing a presence at Cleveland Clinic, which has never been done before by the Case CCC Director, I am making it clear that I'm here representing everybody, and I don't want anybody to feel that I am favoring one hospital over another. I will eventually see patients at UH as well. That's in process. I've been participating in tumor boards at both UH and Cleveland Clinic. I'm a doctor involved in the care of patients with rare cancers, such as sarcoma and rare forms of melanoma. So even though I haven't officially started seeing patients at UH, I've started integrating myself into the program, and the goal here again is to really establish a presence as Case CCC Director.

Seeing patients at both institutions clearly sends a message that I'm here to be a director for all patients in Cleveland, to represent both hospitals and also have an established position within the university. And it gives me a perspective on how best to integrate the clinical medicine with the science.

My goal as Cancer Center Director is to ensure the rapid translation of basic science into the clinic. I think that's most easily achieved by actually seeing patients at both institutions.

Do you see Metro joining the consortia at some point?

I’ve visited and have gotten to know as many people as possible at MetroHealth in March, before I officially started my job.

Metro has amazing scientists doing high-impact translational medicine. I am very impressed with the quality of its science and its cellular therapy program. To be a Comprehensive Cancer Center, the NCI requires a high number of patients enrolled in clinical trials. COVID-19 caused a big drop in patient participation in clinical trials, and Metro was hit particularly hard. While many of Metro’s physician-scientists who meet the membership criteria are Case CCC members, we’ve decided to defer Metro’s participation as a full partner in the consortium until it can raise the patient accrual numbers and become an active clinical trial center. With the investments they are making, I am sure they will succeed.

Are there any particular grants right now that members of the Center are working on which you find interesting?

The train derailment and its aftermath in East Palestine in February was clearly a devastating event for that part of the Ohio Valley. The question was how Case CCC could best get involved with the community to look at cancer risk over time, because that was one of their concerns. We looked at a variety of funding opportunities but would have had to wait upwards of 10 months. Fortunately, the NCI has quick-release funding for cancer-related environmental disasters that impact at-risk populations, but we had to work quickly. I didn’t start here until April 1 and this grant was due April 7, so the Case CCC’s Population and Cancer Prevention group and I started writing in March. We put together a rather robust program to monitor blood and tissue of residents in East Palestine, looking at effects of toxins on normal DNA over time.

There are many components to the program, and we did not want to raise the cancer flag and cause anxiety. So first our leadership met repeatedly with community leaders in East Palestine, who were very interested in a program to help monitor cancer risk over time. Next we decided the proposal would be stronger if it included other cancer centers in Ohio and Pennsylvania with Case CCC taking the lead.

The team set up booths at county fairs to administer a survey to potential participants. The survey collects information about lifestyle and health because, clearly, there are many reasons for cancer other than environmental toxin exposure – such as quality of life, obesity and smoking – so these need to be a factor. If a person is eligible for the study, they will provide DNA samples through hair or nail clippings that can be monitored over time. A van will visit the community to collect blood. We plan to be in East Palestine for a long time to come.

Our hope is that the pilot funding for the East Palestine study will produce enough data that can be used in larger applications. In my opinion, this speaks to what a cancer center should do: engage in the community. It also demonstrates how quickly we came together as a cancer center and how we united with other cancer centers to address a major medical concern for a population in our state that was asking for help.

We also are concerned with health disparities. Black men are 40 percent more likely to get prostate cancer than white men, and they get it at a younger age. Case CCC established a program, predating me, that trains barbers about prostate cancer so they can make their customers aware of the risk. So far, 17 barbers in the Cleveland community have taken the classes and they play awareness videos in their shops. We hope this encourages men to get screened for early prostate cancer and seek care quickly.

What’s your perspective on funding for cancer research in the United States? What’s working well, and what needs to improve?

It's still very competitive. I think the NCI budget is always constrained. When I started in cancer medicine, you could submit a grant, and if you were in the top 25 percent you could pretty much get funding. Today, with the restrictions in the federal budget, you have to be in the top 8 to 9 percent. If you're a new investigator, you’re given a little leeway. Some of the great cancer research is not being funded because of this very competitive environment. It leads to frustration and a rapid departure of scientists and physicians from the cancer medicine field.

Industry has become a big pull for cancer medicine basic scientists and physicians. There's a lot of instability in industry, but it looks attractive, especially for physician-scientists who feel they won't have to worry about RVUs and patient quotas to sustain their clinical practices while getting protected time to do the basic and translational medicine that's critical for academic advancement.

Also, industry can offer higher salaries. In the pre-COVID days, industry often involved a lot of travel, and to me that was always a negative as it was tough on the family. But now with Zoom, you can be in the office and have a meeting with someone in Europe or Asia at any time of the day. You don’t have to leave home, so travel is no longer a negative.

The pull towards industry has created an almost existential crisis in medicine in which we are desperate to retain high-quality faculty that want to do impactful benchtop to bedside clinical translational research. I’m very worried about ensuring that we have a cadre of talented young investigators who will be the foundation of our cancer medicine field. We're trying to be competitive in terms of bringing in high-quality scientists and physicians, and it's going to require having competitive salaries, providing them up start-up dollars so their laboratory efforts are being supported. We’re really trying to be attractive and to bring the very best and brightest to Cleveland.

At least from my perspective, that isn’t hard to do because Cleveland's a beautiful city. There are a lot of social and cultural opportunities here as well. It's a great place to raise a family, cost of living is less expensive. So I think there are ways to promote the program. But I think ultimately it's going to be the great science that pulls people here.

What do you see as the next big thing – the emerging therapies?

One thing that's coming, and we're a big part of it at University Hospitals and CWRU, is the impact on cell therapy. We have made great progress in developing agents that can activate the T-cell by targeting the immune checkpoints. The next step, which is already ongoing, is to take a patient’s own T-cell out of the body and modify them in such a way that they specifically target the cancer cell. Dr. Koen van Besien has joined UH from Weill Cornell in New York. Koen is amazing. He's head of hematology and our cell therapy program at UH. He is also working with Dr. Craig Sauter at Cleveland Clinic, who was recruited from Memorial Sloan-Kettering Cancer Center. Together they bring exceptional expertise to the entire Case CCC campus. At Case, we have very specialized facilities that make these cell therapy programs possible. Some of these reside in the newly opened Wesley Center for Immunotherapy. We have nine units – it’s like walking into NASA.

This program positions us to be the center of excellence for cell therapy across the whole country. There’s no center that I’m aware of that has this amount of GMP (good manufacturing practice) capability to build cell therapy programs, which I do think is now part of the cutting edge of cancer medicine. In solid tumors, like lung cancer, breast cancer or others, we still need to do better. It's been a challenge to make cell therapies, such as CAR T, effective in solid tumor oncology. At Case we have an extraordinary collaborative team that can actually “build” these cell products. This includes Drs. David Wald at UH Seidman Cancer Center and Tim Chan and Jos Melenhorst at Cleveland Clinic, just to name a few. We really have all the major players from across the Case campus, but there is much yet to be done.  What we’re doing here is exceptional, and I think it’s going to make a big impact.

Vaccines are coming as well. We can do a lot to treat cancer when it's in the advanced stage. But the future of cancer is starting treatments to prevent the disease in the first place. Can we introduce a vaccine program to treat high-risk, patient populations, women with high-risk BRCA 1-positive breast cancer, or men and women with high-risk colorectal cancer? How do we tackle virally mediated cancers? Can we provide unique vaccine approaches? I see us playing a bigger role in vaccine therapy. In fact, I am working with Dr. Ted Ross and his team at Cleveland Clinic to bring these types of programs to Case.

The other area of interest is rare cancers, which constitute about 20 percent of all cancers. When you get beyond colon, breast, lung and prostate, all cancers are therefore considered rare. Rare cancer research funding is scarce. This is a problem. Rare cancers affect not just older patients, but also heavily infiltrate the adolescent, young adult population – between 19 and 39 years of age. When you're in your early 20s and 30s, the last thing you're thinking about is cancer. You get a lump or a bump. You probably ignore it. You have a young family, you're working every day, so the last thing a patient in this age group is thinking about is cancer. Because of this, patients in this population with rare cancers often present with more advanced disease, and when they come for treatment they often carry a diagnosis that often is unknown or unheard of. There's often no specific therapy. This represents a huge unmet medical need. One of our missions then is to make Case CCC a center for rare malignancies and rare diseases. I'm working with a series of donors now, and we’re discussing how to build a rare cancer initiative that will engage the community of rare cancer doctors, patient advocates and scientists.

The NCI already has made investments through the Moonshot. In fact, we were in a discussion last week with representatives of the White House on how to better engage both the communities and the academic centers over this issue. We already have some amazing science going on at Case in rare cancers, especially for children. Do you know that Dr. Seth Corey at Cleveland Clinic has established a fish (a zebra fish!) that develops a rare form of childhood cancer called Ewing sarcoma. Now with this fish model we can begin to screen new drugs for the treatment and even the prevention of this disease. Similarly Dr. Alex Huang at UH has highly innovative clinical trials going on in osteogenic sarcoma, a rare bone tumor that affects children and young adults. These studies are all based on laboratory discoveries made here. We want to make rare cancers a broad-based initiative at the Case CCC, and we hope it will resonate throughout Cleveland as we develop a center of excellent for patients with rare cancers.

Where are we at with the Cancer Moonshot at this point? Has the focus shifted since it initially launched?

The NCI was given $50 million to understand the molecular biology of cancer among children. They've set up a platform by which physicians and parents of kids now submit tissue to a central repository in Columbus (Nationwide Children's Hospital) to have it analyzed for a full panel of genes and be included in research. The families get back a complete panel we call next gen sequencing. We've been discussing with leadership at the NIH how to broaden the population from only pediatric to include people ages 19 to 39.

I'm very involved in the world of rare cancers. I'm the co-chair of the Experimental Therapeutic Rare Cancer Committee of the NCI supportive cooperative group called the Alliance. This program, through clinical trials, provides new drugs to patients with rare cancers. If you have a clinical trial in a rare cancer, it would be very difficult to do this as a single center. For example, recently we completed a study in a disease called angiosarcoma, the cancer of the blood vessels. We had 300 sites participating in this trial using novel-targeted drug therapies and immunotherapy. If it wasn’t for the cooperative group, it would have taken years to complete. Rather, in this multi-center setting, we finished the study in 18 months.

I’ve been leading these efforts for the last decade, and I hope the Cleveland cancer community will become more involved in rare cancer programs and work with the Moonshot group to ensure funding for these research efforts in young children, adolescents and young adults. We need to better understand the cause of their cancers, the drivers of their malignancies, and hopefully find new therapeutics that will come out of these discoveries.

Drug shortages are a pain point for oncologists and certainly for patients. How do you see these being resolved?

We're in a crisis. I don't know if I have a solution. There's no incentive for industry to produce drugs that are now off patent. They might have one center in some part of the world where these drugs are being produced, and sometimes the quality of the production facility does not meet high-quality standards so it gets shut down. This has happened on several occasions to single facilities making a drug. This has resulted in the medical world going into complete crisis over lack of access to essential drugs.

But some of the drugs are part of our curative therapies. They've been around for over 25-30 years, and we don't have high-capacity production facilities to make them available. And then we talk about rationing a drug – the ethics of that is horrible, especially if you have curative cancers where these drugs are absolutely essential.

The focus is always on the “new” drugs, the expensive drugs, and the industry loses interest in these less attractive drugs, because there is less financial gain. The only solution that I can see is for the government to step in and be part of the production process. But can they commit resources to ensure that these facilities stay open and make sure there's money invested to provide continual access and production of the drugs? I don't think you can force industry to make the drug. Industry has been great in advancing drug therapy, but the bottom line is industry still wants to make money on a drug. My suggestion is for the government to step in and get involved and find ways to fund these types of activities.

What are your strategies to increase accruals to clinical trials?

You know, currently, the Case CCC has 4 million people in our catchment area of 15 counties. Our accruals for clinical trials are about 17 percent from underrepresented minorities, which exceeds our overall baseline numbers. Clinical trials provide our patients the latest advancements in cancer medicine. Their value to our community cannot be understated.

Looking at Cleveland city proper, the community is 50 percent Black and Hispanic. I think we need to focus on improved engagement with our community. This will only lead to increased clinical trial accruals. Through the prostate cancer screening program, we are doing this with the barber shops to communicate more effectively on prostate cancer risk, identify prostate cancer risk through a simple blood test, and provide a means for access into the medical healthcare system.

Besides your role as Director of the Case Comprehensive Cancer Center, what are you hoping to personally contribute to cancer research and discovery?

I'm looking forward to starting my day seeing patients at UH and continuing to see patients at Cleveland Clinic. I’m already participating in the tumor boards, trying to help make sure we have the best clinical trials possible. I also will have my own laboratory here, which is very focused on translational medicine in one of the rare cancers called sarcoma.

Currently there are two national clinical trials that are based on my own lab work, and one of them is a study in uterine cancer. We ran a Phase 2 study that was presented at ASCO on the combination of olaparib, the PARP inhibitor, with the chemotherapy temozolomide. Based on the highly positive results, which were just published in the Journal of Clinical Oncology, a randomized Phase 2/Phase 3 study sponsored by the NCI will now be launched nationwide. There is another study we're opening here on liposarcoma, in which patients will be treated with PD-1 checkpoint inhibitor in combination with an inhibitor of the cell cycle. Both studies will open up at UH and Cleveland Clinic within the Case CCC. I have now identified someone to help me run my laboratory, and in the next couple of months I should be back and operational.

My focus is patient-centric care. I want the university and hospitals to have the best access to the latest advances in cancer medicine. Much of it should come out of laboratory discoveries made at the Case CCC. Cleveland should be the center of discovery and, ultimately, this should be from where the latest advances in cancer medicine are made.

How are you enjoying Cleveland so far? What personal interests have you been able to pursue here when not focused on work?

I went to a Blossom concert; it was wonderful, just extraordinary really. It was an amazing evening, and I do love the symphony. We live right across from Severance Hall, so we took advantage of that in the late spring. We like the outdoors. We've been up on the Cuyahoga Valley National Park Towpath, the Ohio Erie Canal. My wife and I biked along there, we've enjoyed that.

It’s been a great experience. We've sampled the great food in Cleveland. We've been to many of the restaurants and Little Italy. And I've been to a baseball game, when the Guardians played the New York Yankees. I'm still a Yankee fan, though I could see myself becoming a Cleveland fan, as long as they’re not playing New York! I have to say, the Cleveland fans are pretty special. With the Yankees up 12-2 by the eighth inning, if this had been Yankee Stadium, three-quarters of the stadium would have been empty by that point if the Yankees were that far behind. But the fans stuck with them to the very last out. They're very dedicated, and I think it reflects the community, as a whole. There’s a true spirit here in Cleveland. And that's why I'm so glad to be here leading the Case CCC.