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Norris Cotton Director Praises Research, Collaboration Efforts

  • Norris Cotton Cancer Center director Steven Leach answers a question about mentoring during a gathering with Geisel School of Medicine students along with Sandra Wong, chair of surgery at the school and Dartmouth-Hitchcock and Gabriel Brooks, an oncologist at the hospital in Lebanon, N.H., on Feb. 9, 2018. (Valley News - Geoff Hansen) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

  • Julian Devlin, a cancer survivor from Hanover, lets his daughter, Isabel, 2, sit on his bike after he completed the Prouty's 100-mile route on Saturday, July 8, 2017, at Richmond Middle School in Hanover, N.H. (Valley News - Jovelle Tamayo) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.



Valley News Staff Writer
Saturday, February 10, 2018

Lebanon — It’s been about five months since Dr. Steven Leach left the Sloan Kettering Cancer Center in New York City to take the reins of the Norris Cotton Cancer Center, and he’s struck by two things: The Upper Valley is a close-knit community that seems to suit him, and Norris Cotton is a relatively small institution where collaboration seems to thrive.

Relocating to rural New England has worked out well personally. Leach, 57, enjoys such recreational pursuits as cycling, fly-fishing and skiing.

“New York was great,” Leach said in an interview earlier this month at his office on the campus of Dartmouth-Hitchcock Medical Center in Lebanon. But, “almost every aspect in terms of quality of life is better in the Upper Valley.”

And taking the helm of Norris Cotton promises to deliver professional rewards.

Leach says that the sort of collaboration that he believes is fostered by the small size of Norris Cotton and its supporting institutions, Dartmouth-Hitchcock and Dartmouth College, is key to scientific discovery. It’s also crucial to translating those discoveries to improvements in patient care, said Leach, a surgical oncologist who directed pancreatic cancer research at Sloan Kettering.

Norris Cotton, one of 49 National Cancer Institute-designated comprehensive cancer centers in the country and the only one east of Buffalo, N.Y. and north of Boston, spans 21 disciplines at D-H, Dartmouth, Thayer, Geisel School of Medicine and Tuck School of Business, Leach said.

Researchers at bigger universities tend to be isolated from each other, but here in the Upper Valley, he said, “Any evening at the Co-op you could have a Dartmouth faculty meeting.”

Before Sloan Kettering, Leach worked at Johns Hopkins University and Vanderbilt Cancer Center, and did his training at Yale and MD Anderson Cancer Center in Texas. He earned a medical degree from Emory University and an undergraduate degree from Princeton.

His interests and training exemplify the value of crossing disciplines to solve tough problems, said Lynn Matrisian, who worked with Leach at Vanderbilt and now serves as the chief science officer of the Washington, D.C.-based Pancreatic Cancer Action Network, where Leach serves on the scientific medical advisory board.

Though Leach initially trained as a surgical oncologist, he went on to specialize in pancreatic cancer surgery and research.

“When he went to Hopkins he really

started to develop a real research career,” Matrisian said. It’s “unusual in my mind for a surgeon to do that.”

Prouty Tumult

Leach brings his collaborative approach to Norris Cotton following a tumultuous period for the cancer center. Its former director Mark Israel, after leaving the post in 2016, sued D-H on the grounds that D-H fired him in an act of illegal retaliation after he objected to the diversion of $6 million — including $1.6 million raised through The Prouty, the organization’s signature fundraiser — away from cancer research and patient support and toward operational expenses.

After Grafton County Superior Court Judge Lawrence MacLeod Jr. dismissed the case last September, Israel, who continues to be a member of the faculty at Geisel, said he plans to pursue his case in arbitration.

In a letter early last year, Thomas Donovan, the director of the Charitable Trusts Unit in the New Hampshire Attorney General’s Office, concluded that D-H was within its rights in 2015 when it spent money from donors on salaries, equipment and occupancy costs associated with research.

After Donovan issued that letter, Chris Amos, then interim director of the cancer center, and Shelley Gilbert, then-chairwoman of the board of Friends of the Norris Cotton Cancer Center, wrote a Valley News op-ed that pledged that donations to the organization will be spent to “advance cancer research, improve cancer treatment protocols, develop strategies for cancer prevention (or) provide supportive services for patients with cancer and their families.”

Leach, who biked 50 miles in last year’s Prouty, said Norris Cotton is dependent on philanthropy for half of its $10 million operating budget, which excludes clinical operations. Norris Cotton sees another $50 million in grants and contract funding each year for cancer research. 

Questions about how Norris Cotton spends donated dollars — some $3 million of the charitable donations come from the annual Prouty fundraiser — still come up in Leach’s conversations with supporters, but he says he reassures them that their money will be well spent.

“We’ve moved beyond all of the events that were the source of any controversy,” he said. “All of the money (has been) restored in full to the cancer center. I know that because we’re luckily able to use the funds.”

He noted that he is currently recruiting new faculty and employees using the restored money, and the new joint operating agreement between Dartmouth and D-H eliminates any ambiguities that led up to the allegations about the misuse of funds.

Israel, who took a job heading the New York City-based Israel Cancer Research Fund last month, said that while he remains on the Geisel faculty until June 2019 he will do what he can to help Norris Cotton and Leach.

He described Leach as a “lovely guy” and a “strong scientist,” and said, “I really wish him luck.”

Dr. Gary Stein, the director of the University of Vermont Cancer Center, said he doesn’t view the leadership change at Norris Cotton as a significant shift.

“I don’t think there is anything to be repaired,” said Stein, whose cancer center often collaborates with Norris Cotton. “I think what we’re looking at is moving forward.”

Hanover resident and cancer survivor Judy Csatari, who sits on the board of the Friends of Norris Cotton and is a member of The Prouty’s executive committee, said Leach has helped to re-energize her and other Prouty organizers after a challenging period.

From a fundraising standpoint and as a leader, Leach “understands the benefit of the personal touch,” Csatari said.

He’s made a point to get to know the cancer center’s researchers and clinicians, she said. He has volunteered to meet and train with Prouty teams, and he’s developed relationships with leaders at D-H and Dartmouth, she said.

“He’s a consummate team player,” she said.

Research Priorities

Even as he leads the cancer center, Leach will continue his own research. His New York lab wrapped up operations at the end of January, and Leach, who lives in Hanover and has two adult sons, is in the process of opening up a scaled-down version in Lebanon.

“This is a full-time job,” Leach said of his new post. “But I still love biology and still want to have a hand in it.”

Keeping a hand in the research will help him have a working knowledge of some of the challenges his fellow scientists face “and not just lead from on high here on the eighth floor.”

That will allow Leach to lead the center’s collaborative approach by example, said Matrisian, of the Pancreatic Cancer Action Network.

“Clinicians want to help patients, but basic scientists want to help patients too,” she said. “He’s the type of leader we need to bring those sides together.”

As an example of the collaboration he’s been impressed by at Norris Cotton, Leach cited the Breast Cancer Locator, which was created by a D-H surgical oncologist and engineers from the Thayer School of Engineering at Dartmouth. It is a three-dimensional printed plastic mold that guides a surgeon when removing a cancerous growth.

The goal is to improve surgeons’ accuracy, prevent the need for second surgeries and preserve the shape of the breast. The locator helped target tumors accurately in 17 out of 18 cases, according to a clinical study published last year.

Collaboration among D-H and Dartmouth researchers also resulted in advancements in immunotherapy, which works to train the body’s immune system to fight off cancer. Leach pointed to Medarex, a drug company created by Dartmouth immunologists and investors in the late 1980s that produced antibody-based cancer therapies. In 2009, the drug company Bristol Myers Squibb purchased Medarex for more than $2 billion.

Immunotherapy “provides the opportunity for a lifelong cure because of the memory that the immune system has,” Leach said.

Norris Cotton’s current work in immunotherapy is grounded in those early findings, he said.

He also highlighted the cancer center’s contribution to population-based research. Because of its location, Leach said Norris Cotton has a “unique population of patients throughout northern New England.”

As they develop new drugs, treatments and prevention efforts, Norris Cotton researchers have the opportunity to study how the region’s population accepts them. For example, Leach noted that one area of research involves creating digital tools to monitor changes in blood chemistry. But, if patients don’t have access to broadband internet services, they may not be able to utilize such tools, Leach said.

“On the research side, as we think about developing those cool new technologies, we need to be cognizant about how feasible they’ll be in a rural environment,” he said.

Personalized Care

Creating individualized treatment plans is a clinical focus at Norris Cotton, Leach said.

“Rather than invoke the traditional hierarchy (we) really want to partner with our patients,” he said.

In a technical sense, personalized cancer care now often involves genomic sequencing of tumors to better understand what kind of mutation is causing the malignancy. While Norris Cotton has provided some sequencing since 2012, it will soon be expanding that to sequence the entire genome of tumors in all patients — Norris Cotton treats 32,000 patients annually, including 3,000 with new diagnoses.

With the genetic information in hand, clinicians will then target treatment to match each mutation, Leach said. This is possible through a new data-sharing partnership with some other cancer centers, known as the Oncology Research Information Exchange Network, he said.

Another clinical change Leach is working on is a collaboration with the palliative care team at the new Jack Byrne Center for Palliative & Hospice Care to begin training all cancer providers to discuss end-of- life issues with patients at the beginning of their cancer treatment, rather than waiting until the later stage of an illness when patients may be in crisis.

“How patients want to confront the end of life is just such an individual, personal choice,” Leach said. “It really does demand conversation.”

At the same time, Leach wants to create more ways for cancer survivors to share their stories with newly diagnosed cancer patients.

Survivors are “people who know the most about what it’s like to go through a cancer diagnosis and therapy,” he said, noting that as treatment has improved, cancer has become a chronic disease for many patients.

RecruitingFor Trials and Jobs

Enrolling patients in clinical trials is an area of collaboration between Norris Cotton and UVM Cancer Center, said Stein, the UVM center’s director. The small populations in both of the Twin States necessitate this cooperation, he said.

“Clinical trials ... require patients,” he said. “The more patients, the more statistically meaningful the results are going to be.”

Because of the value of these trials in translating research into practice, one of the areas in which Leach plans to boost staffing levels is in clinical research coordinators.

But, he has been forced to temper his ambitions by the shortage of potential employees, a challenge for health care providers in the Twin States that D-H CEO Joanne Conroy has described.

It may take longer than Leach had planned to hire six new clinical research coordinators, as well as six new patient navigators, who will help guide patients through their cancer treatment, and seven or eight new faculty members, he said.

“While we hope to do it this year, it may turn into a two-year project,” he said.

Stein, for his part, said he faces the same hiring challenges. In particular, he described clinical research coordinators as “an endangered species.”

But, Stein noted that he moved to Vermont six years ago from Massachusetts and Leach just moved to Hanover from New York City.

“Sometimes, people gravitate to this type of a region,” Stein said. “You have to find the right match.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.

Clarification

The Norris Cotton Cancer Center has an operating budget of about $10 million, excluding clinical operations. About half of that comes from philanthropy, including $3 million from the annual Prouty fundraiser. In addition, Norris Cotton receives about $50 million in grants and contract funding each year for cancer research. An earlier version of this story was unclear on the size of the center’s budget.