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As James K. McCloskey II, MD, begins the next chapter of his career as chief of the Division of Leukemia at John Theurer Cancer Center at Hackensack University Medical Center.
As James K. McCloskey II, MD, begins the next chapter of his career as chief of the Division of Leukemia at John Theurer Cancer Center (JTCC) at Hackensack University Medical Center, he is in awe of how much the institution—and the leukemia treatment paradigm overall—has evolved since he joined 7 years ago.
“Things are changing incredibly rapidly,” McCloskey reflected, “and I'm just very grateful to be a part of that.”
McCloskey, who will continue in his role as director for the Program for Myeloproliferative Neoplasms at JTCC, previously served as interim chief in the Division of Leukemia. Prior to joining JTCC, he was chief fellow in the Department of Hematology and Oncology at Georgetown University Hospital, which was where he also completed his residency.
With goals of continuing to foster collaboration between JTCC and community physicians, and boosting clinical trial options across hematologic malignancies, McCloskey’s time as chief will be anything but lackluster.
In an interview with OncLive, McCloskey shared his plans for the first 100 days as chief in the Division of Leukemia at JTCC, ongoing research efforts that are being made at the center, and what it’s like holding down the fort during the coronavirus disease 2019 (COVID-19) pandemic.
McCloskey: The first thing that I thought about was just how flattered I was to be recognized. It's very meaningful to be recognized in this way. I think that I always have felt very lucky to be part of such an incredible team. Caring for patients with leukemia is never easy. [A leukemia diagnosis] is an incredibly hard journey for our patients. However, it also takes a lot on a day-to-day basis, as the provider, and we are really fortunate to have a team of [professionals] that get up every day to do this. I am just very fortunate to have colleagues that I think of as family and friends, and I know our patients feel that way, too.
The other thing that I thought of was how much things have changed since I came to Hackensack. Seven years ago, when I finished my fellowship at Georgetown University Lombardi Comprehensive Cancer Center, my mentor at the time, who was a very senior lymphoma physician, asked me, “Why do you want to do leukemia? Leukemia hasn't changed since I was a fellow.” I realized, when I was thinking about this today, that [treatment] has changed entirely in the past 7 years. Since 2017, we've had 9 new drugs approved for acute myeloid leukemia (AML); 7 of those [agents] were studied here in our division. Three new therapies [have also emerged] in acute lymphoblastic leukemia (ALL).
I'm very fortunate that the program [has been up and] running. I have been the interim chief for a couple of years now, so a lot of the foundation is already there. One of the backbones of what I've tried to build here, and what I hope to continue to build in the future, is this program that is very collaborative. The most important collaboration that I think we encounter on a day-to-day basis is our collaboration with the community. Hackensack University Medical Center’s John Theurer Cancer Center has always been a place where local community providers can reach out to for input.
I always say, “I'm not smart enough to be a community oncologist, because I haven't treated breast cancer since I was a fellow.” I know a lot about a very little bit of oncology. We need to continue to prioritize our relationship with community providers—especially in our current era of oral oncolytics. An increasing number of patients are able to be treated [by community physicians] closer to home, so they don't need to come here for every visit.
Hopefully, I hope to continue to build this collaboration where patients can come here for an opinion, or their referring physician can call [us or] my cell phone, and we can work together to care for patients closer to home. That way, they're plugged in, and we can also ensure that when we have a clinical trial that's available for [a patient], we can get them on it.
[Additionally], we would like to have a clinical trial for every patient, at every point during their treatment; this is a continued focus. In AML, things were mixed up a bit with all the drug approvals, and that caused us to go back to the drawing board and look at some studies […] since, really, the standard of care has changed entirely in the past year.
My goal is to continue to build upon that, and we are really looking at growing our [myelofibrosis neoplasm] program more, as well. We have a lot of exciting trials in the pipeline for that disease space as well.
We have several clinical trials that are open at the moment. Of particular interest, one of the trials we're most excited about is looking at the use of natural killer cells for minimal residual disease (MRD) eradication. Hopefully, in the future, this will be a treatment that could be used particularly as a bridge to transplant or an interim treatment for patients before they undergo allogeneic stem cell transplant. We certainly know that the presence of MRD predicts for a greater likelihood of relapse.
Anything we can do to improve the outcomes of those patients—especially considering that many of these folks are older, frailer, and not able necessarily to receive an intensive conditioning regimen—would be very promising. We are excited to be participating in this study, which is accruing now.
For patients with AML, we also have the BioSight study. [This study comprises] a new pro drug of cytarabine for patients who are older or maybe not quite fit enough for induction. We have had a lot of success with that study; we are excited about outcomes with that agent. It will hopefully not only open up the possibility of more tolerable therapies for these patients, but it also might [serve as a] backbone for future combination studies, as well. We really do have a host of trials for almost every disease space.
There are so many people. First of all, the most important person that I work with every day is my colleague, Jamie Lynn Koprivnikar, MD. She really is at my side all the time; we do all of this together. She is just an incredible, brilliant provider and we are great friends. I am very lucky to have her with me every step of the way.
Michele Lyne Donato, MD, and Andre Goy, MD, both have been great mentors to me. They are always there when I need advice and are always there to provide support. Stuart Goldberg, MD, really built this program. We all owe him so much, because he built this program from the ground up. I have to admit, I stepped into a program that was already running quite robustly. I'm taking over for Stefan Faderl, MD, who left us a couple of years ago, but who changed the way that I [clinically] approach patients with leukemia.
The challenging thing in leukemia is that it's not appropriate to take a one-size-fits-all approach. What I tried to do is find the right therapy for each patient, based on their biology, their disease, and the characteristics of disease at presentation, but also their own personal goals. We have many options [available]. Part of the decision for [treatment] is: What does that patient want? What does quality of life mean [to them]? Where do they want to receive their therapy? What kind of support do they have at home? We try to consider all those factors to find the right therapy for each patient who comes in the door.
There is another thing that I really do think is key to our success here. What is so unique is that we work so closely with our transplant program. When you talk to other providers, at either larger or smaller institutions, it isn't always so cohesive. Sometimes feels like [they have] very separate divisions. While we're separate here, we really do work in tandem to try to ensure that from the day that [we] see [a patient], we're planning the right initial therapy, and we're considering the role of transplant and starting that workup early; this is really crucial to potentially capturing that window for which a patient might be able to go to transplant.
That allows us to be a lot more successful. By having a transplant program across the hall, we are able to easily shave off a 30-day window for individuals undergoing induction to get them moving toward transplant.
One of my goals is to continue to build on these relationships. One of the most important relationships we have established is our one with Georgetown. We run 2 very different programs, [and we are 2] very different institutions. We are [in the midst of] building the foundation of a program, where many of the basic science applications for our research will be performed there.
Catherine Lai, MD, is the director of the Leukemia Program down at Georgetown. We are also working to build [upon] the transplant program down there, so hopefully, that will continue. We are currently working on some investigator-initiated trials that are being written for both institutions. The future will be a very strong clinical and scientific collaboration between both of our institutions.
It has been a crazy 6 months, to say the least. For us, when this pandemic hit, I remember, during all the [virtual] meetings, each division had a very different outlook on how this was going to impact them and how they were going to approach things.
For us, for the most part, especially if you consider acute leukemias, we really view these as oncologic emergencies. Our priority was to ensure that we did not allow for significant delays in care or access to treatment because these are often rapidly [progressing], and even fatal, hematologic malignancies. I am very proud of how our institution handled a pandemic; we never really shut [the center] down. Our doors were always open; we always maintained an inpatient floor and the leukemia and transplant teams worked very closely to quickly manage protocols to help us improve safety.
From just the first week that we had a patient identified in New Jersey, we adopted universal masking, which has clearly improved the safety of both our providers and our patients. We continue to screen patients on a regular basis in terms of symptoms or exposures before they enter the building. All patients are being screened prior to admission. Especially in the Division of Leukemia—knock on wood—we've had very few issues with COVID-19, and no nosocomial events. We have managed to stay open and provide care to patients safely.