First Long Island Investors was honored to have Dr. Richard Barakat speak to clients at our recent Thought Leadership Breakfast.  Dr. Barakat is Physician-in-Chief and Director of the Northwell Health Cancer Institute and Senior Vice President of Cancer Services at Northwell Health. Prior to joining Northwell Health, Dr. Barakat spent almost three decades at Memorial Sloan Kettering Cancer Center, serving as Head of Gynecology Cancer Services for 14 years before becoming the leader of the organization’s entire network. Dr. Barakat helped standardize practices across different locations and organizations, ensuring patients would have convenient access to cancer care without the need to travel to Manhattan. His successful integration and leadership put him on the radar of Northwell Health, which was in need of a physician-in-chief who could help expand the Cancer Institute’s programs and services.

Dr. Barakat began the conversation by shedding light on the brutal facts of cancer:

• In 2018, 9.6 million deaths were caused by cancer and 18.1 million new cases were reported globally.
• In the US alone, there will be approximately 1.7 million new cases this year and 600,000 deaths.
• One out of every eight women and one out of every ten males are diagnosed with some form of cancer in their lifetime.
• A third of cancer cases are either lung, breast or colorectal
• A third of cancer related deaths could be eliminated by dietary and lifestyle changes.
• Currently, there are 10.9 million cancer survivors in the US, and the cost of cancer is expected to reach $173 billion by 2020.

The conversation shifted to the treatment of cancer with a focus on the advancements being made in the treatment and quality of life care.  Three areas of research are being emphasized at Northwell: precision medicine, immunotherapy, and CAR-T therapy.

Precision medicine is an approach where doctors treat patients based on a genetic understanding of the disease.  All cancers have a genetic basis which can differ from patient to patient, even in the same affected organ.  Tests can be conducted to determine which mutation is responsible for the cancer’s origin.  Precision medicine involves the creation of drugs that target these mutations. This method is agnostic to the type of cancer and treatment is based on the cancer mutation rather than the tumor histology. One form of treatment in precision medicine is a PARP inhibitor. PARP is a protein found in our cells that helps damaged DNA repair itself. The inhibitor stops PARP proteins in cancer cells from repairing the cancer cells and the cells die off.

Immunotherapy treatments either help the immune system attack the cancer directly or stimulate the immune system in a targeted way. Cancer cells develop proteins that attach to and block the proteins on our body’s T-cells, the cells that defend our body from infectious germs and diseases.  One form of immunotherapy is the use of checkpoint inhibitors.  Some cancer cells make high levels of proteins. These can switch off T-cells, when they should really be attacking the cancer cells. Checkpoint inhibitor drugs stop the proteins on the cancer cells from switching off T-cells. This turns the immune system back on and the T-cells are able to find and attack the cancer cells.  The drawback to checkpoint inhibitors is that the drugs are very potent with strong potential side effects.

CAR-T therapy, or chimeric antigen receptor T-Cell Therapy, is a treatment that alters T-cells to make them more effective at fighting cancer cells. CAR-T therapies induces complete remission in approximately 80% of patients. This therapy has been extremely effective for patients with leukemia and lymphoma. While effective, the therapy has been too expensive for many, costing near $400,000. Fortunately, Medicare is now covering treatment nationwide when it is administered at health care facilities enrolled in an FDA-mandated safety program requiring special training on handling side effects.  

Dr. Barakat stated that recently the FDA has approved 13 new targeted therapies within precision medicine, 5 new checkpoint inhibitors, and the first adoptive cell immunotherapy. These are promising steps.  An issue raised by Dr. Barakat was the insufficient attention given to survivorship post –cancer.  More than 18% of the United States’ GDP is spent on health care (the highest of any developed country and the most per capita), yet our life expectancy is well below many countries. A primary reason for this is a lack of access to premier medicine around the country. Many of the country’s best hospitals and institutes are highly concentrated in certain areas leaving few choices for patients who are not fortunate enough to live in close proximity to dedicated cancer institutes.

For many, historically the best treatment available is in New York City.  Traveling from Long Island into the city may not be a viable option for ill patients. Dr. Barakat believes Northwell is creating a leading Cancer institute on Long Island to help combat this issue.  He cited that they are in the process of replacing Lenox Hill Hospital in NYC with a state-of-the-art 450 bed acute care hospital of the future.  Northwell is also improving the quality and scope of cancer services delivered in its Long Island facilities. Dr. Barakat also pointed to Northwell’s ability to treat pregnant patients suffering from cancer at its Center for Cancer, Pregnancy and Reproduction, one of the nation’s first cancer programs dedicated specifically to pregnant women. 41,000 births occur at the Northwell location and one in every thousand pregnant women will be diagnosed with cancer.  “No other center exists in the New York area that can offer this scope of services with experts working seamlessly together,” Barakat said.

Dr. Barakat brought a profound and stimulating conversation to clients that unearthed many oversights of cancer while sharing the encouraging advancements and steps being taken to fight off one of the world’s most deadly diseases.