Leading Cancer Researcher Dr. Michael Caligiuri On Coming Breakthroughs in Cancer Therapies

Michael Caligiuri

[Music]

Mark Masselli: This is Conversations on Healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret we are counting down to open enrollment for the
online insurance marketplace. For people who wa nt to sign up for insurance
coverage under the Affordable Care Act , i t's fair to say that after several years of
relatively stable open enrollment experiences we are kicking off things this time
around with a lot of confusion.

Margaret Flinter: While a w hole lot of confusion Mark . S o let's start with a few
important specifics President Trump has reduce d the amount of time allotted for
the open enrollment period from three months down to six weeks and he's also
practically eliminated the budget for market ing the health insurance marketplaces
around the country . Here in our home state of Connecticut where there is pretty
robust support for the Affordable Care Act consumers are getting a lot of
messaging about open enrollment not so much in many states wher e there has
been a very little support.

Mark Masselli: President has been switching his stance on a number of issues
saying he was canceling the cost - sharing reduction payments to insurers to help
lower out - of - pocket costs for consumers . Now no one is s ure what he is going to
do next.

Margaret Flinter: Meanwhile of course we come back to our first point
consumers are understandably confused as well.

Mark Masselli: So we encourage everyone to enroll and here in Connecticut and
in those states with the ir own insurance marketplaces they need to check in with
their state insurance sites but for consumers and most other states just go to
healthcare.gov and you should find the information you need.

Margaret Flinter: The healthcare.gov site has a pretty ea sy to follow checklist
that can help guide you as you prepare to enroll you and your family.

Mark Masselli: All it takes is one serious diagnosis such as cancer for instance
to cost uninsured patients hundreds of thousands of dollars that could lead to
f inancial devastation. So remember to make sure that you get coverage for you
and your family during this open enrollment period.

Margaret Flinter: Well Mark , speaking of cancer , we ’ re seeing some exciting new
developments with targeted therapies and tha t ’s something that our guest today
knows well Dr. Michael Caligiuri is President of the American Association for
Cancer Research and there are some exciting new trends in cancer research

Michael Caligiuri

and treatments that look very promising.

Mark Masselli: Lori Robert son also stops by the Managing Editor factcheck.org
but no matter what the topic you can hear all of our shows by going to
CHCradio.com.

Margaret Flinter: And as always if you have comments please email us at
[email protected] or find us on Facebook or T witter because we love to
hear from you . We’ll get to our interview with Dr. Michael Caligiuri in just a
moment.

Mark Masselli: But first , here's our producer Marianne O’Hare with this week’s
Headline News.

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Marianne O’Hare: I am Marianne O’Ha re with these Healthcare Headlines.
Whiplash that ’s how one healthcare pundit from Kaiser health news describes
the current scenario around health policy in Washington after months of
intermittent reprieves the President abruptly announced recently that h e was
cutting off the cost - sharing reduction subsidies to insurers. Subsidies that help
lower costs for low and middle income Americans buying insurance in the
marketplaces . Then came a last - minute bipartisan deal to stabilize the markets .
Democratic Se n ator Patty Murray and Republican Lamar Alexander offering this
compromise bill in an effort to keep the market stable for the short term. The
President said first he was for it the next day he was against it and now Senate
Majority Leader Mitch McConnell one of the most ardent opponents of the
Affordable Care Act said he might support the bipartisan measure or at least
bring it to the floor for a vote , b ut only if the President gives a clear signal about
what kind of bill he might sign . One thing is cert ain if there is no action to
preserve the CSR payments into the next year consumers will pay more.
Meanwhile house speaker Paul Ryan has said he will not support the bipartisan
measure. So chances of it passing look a little sketchy at the moment still a t
least 60 senators have indicated they would support it . S ome of the nation's
governors are letting the President know what they think of his efforts to
sabotage Obamacare Nevada's Republican Gov. Brian Sandoval's outline who
will be harmed by the Presid ent's actions. He says it's going to hurt people , kids
families, he says it will hurt people with mental health issues and veterans.
Sandoval is President of the National Governors Association.

As Puerto Rico continues to reel from the after effects o f hurricane Maria there
are looming new health threats as much of the island remains without electricity
or running water , more people are resorting to bathing in and drinking from
contaminated wells and water sources. The numbers of illnesses and deaths
related to tainted water are on the rise .

Michael Caligiuri

I am Marianne O'Hare with these healthcare headlines.

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Mark Masselli: We are speaking today with Michael Caligiuri , President of the
American Association for Cancer Research which represents 37 , 000 cance r
researchers in ove r 100 countries. Dr. Caligiuri is a professor of Molecular
Virology , Immunology and Medical Genetics, at Ohio State University School of
Medicine and he is director of the Ohio State University Comprehensive Cancer
Center and CEO of th e Arthur G . James Cancer Hospital and the Richard J .
Solove Research Institute. He is President of the Society of Natural Immunity
and Chair of the Institute of Medicine's National Cancer Policy Forum . Dr.
Caligiuri earned his bachelor's degree from SUNY Buffalo and his master’s in
medical degree from Stanford University. He completed his medical residency in
internal medicine at Brigham and Women's Hospital and Harvard Medical
School . Dr. Caligiuri welcome to Conversations on Healthcare .

Dr. Michael C aligiuri: Thank you happy to be here.

Mark Masselli: Your organization just released its annual report on the state of
cancer research and some causes for optimism cancer death rates are down in
this country about 35% in children and down 25% in adults since 1991 and yet
660,000 Americans are still expected to die from cancer related causes in 2017.
I wonder if you could share with our listeners give us an overview of where we
are on the war on cancer.

Dr. Michael Caligiuri: Well I would say great pro gress but a lot more to do . I
think the biggest thing we have learned is that for any one cancer let's say colon
cancer there are actually a multitude of causes and that is w h ere the complexity
comes in . S o no one single treatment is going to work in eve ry particular colon
cancer that’s a big breakthrough moment in the last say 10 to 15 years. We all
know people today living successfully with cancer or curative cancer. So in many
instances what we are doing is we are turning cancer into chronic disease there's
a number of cancers including lung cancer actually, leukemias lymphomas where
they are now treated with a pill and it becomes a chronic disease for years where
death sentence was imminent within months. So we still have challenges , we
still have t o figure out the multitude of causes, but what’s promising is it seems
as we figure out the cause of a particular subset of cancer patients we can come
up with a medicine that can target it with a lot less toxicity than traditional
chemotherapy.

Margaret Flinter: Well Dr. Caligiuri , you know , we were thinking and preparing
for today that it's been close to 50 years since Pres ident Nixon declare d his war
on cancer and last year of course Vice President Joe Biden creating the
moonshot for cancer after losin g his son to brain cancer. This new effort which
you are contributing to is predicated on the fact that cancer is not based on just

Michael Caligiuri

one cause , we ’ ve all stood and are really of the results of the mapping of the
human genome in 2004 . S o tell us more about this half - century of cancer
research both in terms of breakthroughs on causes and the potential cures you
referenced.

Dr. Michael Caligiuri: It's almost without exception that for every type of cancer
we've had some phenomenally important breakthroughs that have helped us
improve that rate of death from cancer. About 20 years ago , we discovered the
gene that causes colon cancer in about 5% of people [inaudible 00:08:18 ]
develop ed a test where we can find that in a colon cancer. In this particular type
it's passed on to the family 50% rate so if you have this particular gene 50% of
your brothers and sisters would all have this gene. We can now detect that on a
simple glass slide and then with a simple blood test we can determine who's
carrying the gene . A nd while they have a 80 to 90% chance of getting colon
cancer on ce we see you carry that she we start routine colonoscopies at the age
about 25 and you're never going to get that colon cancer. So there's an example
where we have had a breakthrough disc overy and actually had very meaningful
impact. We actually did a study collected 3 , 000 colon cancers identified
hundreds of people that carry the gene and they’ll never get colon cancer that
study cost us $4 million to do but it saved the state of Ohio $4 0 million. So if we
invest the 4 million we save 40 million and hundred and hundreds years of lives.

Mark Masselli: Well I think the United States has something to be proud of that
we had a government effort to fund medical and scientific research for d ecades.
I think recently there's been concern that ranking is slipping away what if you
could just talk a little bit about the impact in US funding as we compared others
around the world.

Dr. Michael Caligiuri: So we have been the leader and you're righ t it is slipping
because for the last 15 years the NIH has been flat funded by congress. So
we ’ re getting about $ 0 .75 or $ 0 .80 on every dollar that’s invested , in which that a
number of young investigators who would've been funded had left the field and
t hat's where we all suffer as a society because it's really the young minds that
need to come along and they are the ones with the energy that make those great
discoveries and the consequences are not good for the field in cancer and any
other diseases , but the good news is that through organizations like the
American Association for Cancer Research and about three or 400 others the
rally for medical research we ’ re rallying for the last five years our legislators. So
I'm happy to say that a bit ago we got a two billion - dollar increase in the 30 billion
or so that the NIH spen ds on research , what we would really like to see is just an
3 - 4% increase every year. And I think it was Mary Lasker who once said , “ if you
think research is expensive try disease. ” We are spending about 30 billion a year
on research , but these diseases are costing us well over half a trillion dollars a
year. So it pays to invest in research.

Margaret Flinter: Well Dr. Caligiuri you yourself are a specialist in

Michael Caligiuri

immunotherapies and th eir power to trigger the bodies on cancer fighting
response . W e had Director Dr . Francis Collins on the show who oversaw the
human genome project and we have entirely new bodies of research underway
based on genomic discoveries . Talk to us about some of these emerging trends.

Dr. Michael Caligiuri: Once we understood that there are so many different types
of cancer. It became apparent to us that I'm not in a have enough patience to
studying my own institution. I'm actually going to need hundreds of th ousands of
patients to find the 50 or 60 that have not only colon cancer but colon cancer by
this particular cause or lung cancer by this [inaudible 11:40] . S o that led to
another realization that we have to share it to create progress , you order a book
o n Amazon Mice and M e n what happens in two minutes you get what you like of
mice and men you ’d like these three books. So we are building the Amazon for
cancer now one is project GENIE the AACR has coalesced the genome s from all
over the world putting them into a single language and answering them in to a
public database actually being loaded into a public database w h ere researchers
have access to that data . I think immunotherapy mentioned that one of the
things we've learned the way the cancer works is oft en the way an army will work
right and wants to get through enemy line . A nd so what cancer does is it actually
secretes molecule that put the immune system asleep then it can just walk right
through the enemy line . And recently we have learn ed your molec ules to call
checkpoints we have developed checkpoint inhibitors and it discovers the enemy
right with the ir myth [PH] and can attack it and kill it we are not targeting tumor
actually. We are simply waking up the immune system . T here will be several
dec ades of research on how the immune system can destroy cancer but clearly
there are palpable results at this point. I call it the fifth dimension of cancer
therapy there was first surgery then radiation then chemo then targeted drugs
and now immunotherapy very, very exciting progress.

Mark Masselli: We are speaking today with Dr. Michael A. Caligiuri President of
the American Association for Cancer Research, Dr. Caligiuri is a professor of
molecular virology immunology and medical genetics at Ohio State U niversity
School of Medicine . Dr. Caligiuri I wanted to pull the thread on a quote Mary
Lasker if you think research is expensive try disease. The cost and burden for
treatment is incredibly high , some $90 billion in 2014 are there any cost
controlling t echniques out there or anything that you all are promoting?

Dr. Michael Caligiuri: One is we need more funding for prevention research ,
personally I believe the cure to cancer is prevention . W e are ultimately we will
have the tools to know who was going to get cancer and then develop the
behavioral and pharmacological things that we need to do to prevent that cancer.
For example wouldn’t it be great if we knew from the time of birth who is going to
be addicted to smoking . S o that’s ultimately w h ere we are going you know
smoking for example is a huge , huge cause of cancer lung cancer by far
surpasses all other cancers. So more research on smoking cessation , more
activity at the policy level , and how can we further curb the tobacco industry. It's

Michael Caligiuri

very , very expensive to develop drugs techniques and surgery and radiotherapy
immunotherapy , the real cost is you say is the burden of the disease . S o AACR
is putting great efforts into prevention behavioral research health disparities all of
the things that ca n lead to a lower instance of cancer and if you don’t have
cancer it's not going to cost us much.

Margaret Flinter: Well Dr. Caligiuri kind of reading my mind there on this issue of
prevention through regular screening thinking about the opportunities th at we
have in primary care I think of colon cancer or cervical cancer and I can tell you
as primary care providers, it is a very heavy lift to get those rates of screening
and to get people to engage with this . Now what’s the conversation about the
role o f primary care especially in the health disparities issue?

Dr. Michael Caligiuri : Health disparity is a huge problem. If you look at some of
the disease s like prostate cancer and breast cancer, we have a higher death rate
in for example the African - Amer ican population , twice as high for prostate
cancer, and about 40% higher in breast cancer for African - American men and
women respectively. It's multiprong, it access to care, there is all sorts of
barriers. So to your point, Margaret, we can have all the guidelines in the world,
but if we can't implement an effective strategy to incentivize people to adhere to
these what I call behavioral modifications to lower the risk and beating cancer.
For example , raising the price of cigarettes, it's clearly have b een shown to help
keep people from smoking, we ’ve got to develop policies, effective policies that
will allow us raise the price of cigarette s to incentivize those people to participate
in the effective screening that already exist. And personally I feel that physical
incentive should be big part of it, again with the principle that this may cost a little
money to get people to the primary care physicians, they don’t know what we are
saving.

Mark Masselli: No, you are absolutely right , and I know our own Weizmann
Institute has worked with Yale University ran a randomized trial looking at the
financial incentives for folks, the Medicaid population for tobacco cessation. You
know I want to pivot and talk about a word that seems to be growing more
prevalent and that's collaboration and you formed your own partnership
collaboration called ORIEN and the American Association of Cancer
Researchers also have a similar effort the GENIE Project. Share with our
listeners this much broader approach to trying to get at this vaccine problem.

Dr. Michael Caligiuri : It's the realization that hey , we are all collecting these
genomes in different languages , so the AACR put the money into collecting these
genomes, putting them through a filter into a common language, and they are
making it accessible to the research world. ORIEN stands for the Oncology
Research Information Exchange Network , so again a network of cancer centers
and community hospital that have agreed to share their patient data in a HIPAA
compliant fashion , so that we could find those smaller cohorts of patients who are
identical not only at the disease type, but actually at the molecular and the stage

Michael Caligiuri

and the race like patients like me. And we started this about three years ago and
within two and half yea rs, we got 17 cancer centers across this country. We
have 200,000 patients who are consented , and they consent to three things, you
can follow me for my lifetime , you can do what you need to do it with my t issue
and you can contact me if you have somethin g for me. And we realized this is
what patients want, they want their data shared, and they want it shared in a
meaningful way that brings them results in a faster better way. I'll be announcing
a collaboration between ORIEN and Project GENIE underrepres ented minorities
and making sure that both operations are doing their best to collect tumor
samples from minorities who are literally underrepresented in these various
efforts.

Margaret Flinter: We have been speaking today with Dr. Michael Caligiuri ,
Pre sident of the American Association for Cancer Research which represents
35,000 cancer researchers in over 100 countries. You can learn more about
their work by going to the www.accr.org and you can follow his work on T witter at
OhioStateMed # MichaelCaliguri. Dr. Caligiuri , thank you for the work you are
doing, and thank you for joining us on Conversation on Healthcare today.

Dr. Michael Caligiuri : Well, it's been my great pleasure. Thanks for all that you
do.

[Music ]

Mark Masselli: At Conversations on Healthcare , we want our audience to be
truly in the know when it comes to the facts about Healthcare reform and policy.
Lori Robertson is an award - winning journalist and managing editor of
FactCheck.org, a nonpartisa n, nonprofit consumer advocate for voters that aim to
reduce the level of deception in U.S. politics. Lori, what have you got for us this
week?

Lori Robertson: President Donald Trump has claimed that under the Affordable
Care Act insurance companies hav e “taken advantage of this country" made a
fortune. He said he stopped that by ending payments for cost - sharing subsidies
on the ACA marketplace s. That’s misleading at best for several reasons. Health
insurance companies have made money an increase in n et income of 46% from
2015 to 2016 according to a report from the company A.M. Best, but that was in
spite of not because of the ACA marketplaces. And A.M. Best Associate Director
told CNNMoney that insurers lost millions and millions on Obama Care. The
National Association of Insurance Commissioners sen t us data showing that
insurers reported an underwriting los s of 4.7 billion in 2016 on the individual
market which would include plans sold on and off the ACA marketplaces.

Trump pointed to the increased stock prices of four companies but two of them
Humana and Aetna pulled out of the ACA marketplaces for 2018 and a third
company Anthem pulled out of some states and counties. Also the ACA limits

Michael Caligiuri

the amount of profit insurers can make, at least 80% of pre miums must go
toward covering health costs. The rest can go toward administrative costs,
profits, marketing and salaries. If insurers don't meet th ose requirements they
have to issue rebates to consumer. Insurers should actually do well because of
Obama Care millions of people have gained insurance and some companies
have succeeded where others have withdrawn, but insurers say they've had to
increase premiums as Trump has reminded voters in order to cover the cost of a
sicker pool of consumers than expec ted.

th
On October 12 , the Trump Administration announced it was immediately cutting
off payments to insurers for the cost - sharing subsidies. These are separate from
the premium tax credits that lower the cost of premiums for those who qualify.
Under the ACA, insurance companies are required to sell policies with lower out -
of - pocket cost s to those earning between 100% and 250% of the federal poverty
level and buying plans o n the ACA marketplaces. The government then sends
the cost - sharing subsidy payment s to the insurers reimbursing them for the cost
of the discounted coverage. Many insurers sub mitted higher premium increases
for 2018 because they were uncertain whether the Trump Administration would
continue the subsidies .

And that’s my fact check fo r this week, I am Lori Robertson, Managing Editor of
FactCheck.org.

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Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the Univers ity of Pennsylvania. If you have a fact that you would like
checked, e - mail us at www.chcradio.com , we will have FactCheck.org’s, Lori
Robertson, check it out for you here on Conversations on Healthcare.

Mark Mass elli: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities into everyday lives. For all the people
in the world without limbs acquiring prosthetics can be costly and out of reach.
It's especially challeng ing to make prosthetics for children since they are in
constant state of growth. Rochester Institute of Technology Scientist Dr. John
Schul l stumbled upon a clever and affordable solution provided online Open
Source templates to anyone, anywhere in the wo rld who has access to a 3 D
printer and provide prosthetic hands for next to nothing.

Dr. John Schull : I have made this Google Map snapshot . If you have a 3 D
printer and you would like to help, put yourself on this map and if you know
someone who needs t he hand, put yourself on those map.

Mark Masselli: So he founded the eNABLE network which has massed
thousands of volunteer makers providing cheap but functional prosthetics for

Michael Caligiuri

children in need.

Dr. John Schul l : We know that we have delivered about 80 0 hand devices and
we suspect that is comparable number have been downloaded by the people we
can ’t track because we put all of our design on the Internet.

Mark Masselli: The movement has grown so rapidly the simple limb designs
have become more sophisti cated as recipients of the prosthetic devices provide
feedback for designers to make more efficient devices.

Dr. John Schul l : We are still working on individual finger movements. These
things grip or un - grip that’s all they do so there are much less fun ctional than our
biological and then they are also less functional than a fancy m y o electric hand .
But for kids it's huge because those expensive devices are typically out of reach
for children who would outgrow them, and our hands don't even pretend to lo ok
like regular hands, they look like superhero, iron man hands and for that very
reason they are very popular with kids.

Mark Masselli: eNABLE , a global collaborative network of Open Source designs
linking makers with 3 D printers to provide low - cost pro sthetic limbs to children
and adults around the world. Now that's a bright idea.

[Music]

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthca re broadcast from WESU at Wesleyan University,
streaming live at www.wesufm.org and brought to you by the Community Health
Center.