Latest / Becker’s Healthcare Podcast / Advancing Cancer Care Through AI, Access and Precision Medicine with Dr. Richard Barakat

Transcript

Advancing Cancer Care Through AI, Access and Precision Medicine with Dr. Richard Barakat · Becker’s Healthcare Podcast

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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - Hello. Thank you so much for tuning into
• 0:53
  - the Becker's Oncology Leadership podcast.
• 0:56
  - I'm Elizabeth Gregerson,
• 0:58
  - a reporter here at Becker's. And today, I'm
• 1:00
  - talking to doctor Richard Barakat from Northwell Health.
• 1:04
  - Doctor Barakat is physician in chief and executive
• 1:07
  - director of Northwell Cancer Institute.
• 1:10
  - Thank you so much for taking the time
• 1:12
  - to speak with me today.
• 1:13
  - Thank you, elizabeth. I thank you for having
• 1:15
  - me Absolutely. And before I dive into all
• 1:17
  - my questions for you, I'd love it If
• 1:19
  - you could share a bit about your background
• 1:21
  - and your roles at northwell for our listeners
• 1:24
  - Sure, so, I have been at northwell now
• 1:27
  - for almost nine years
• 1:29
  - prior to that, I spent thirty years at
• 1:31
  - Memorial Sloan Kettering Cancer Center where I was
• 1:33
  - chief of the gynecology
• 1:34
  - service and ultimately deputy physician in chief.
• 1:38
  - But I've, been thrilled with the transition to
• 1:40
  - Northwell,
• 1:41
  - which
• 1:43
  - people should know is the the largest cancer
• 1:45
  - provider in New York.
• 1:46
  - We care for more than twenty four thousand
• 1:49
  - newly diagnosed cancer patients per year, and we
• 1:52
  - do that over the 14 cancer centers that
• 1:55
  - are distributed throughout our system.
• 1:58
  - Perfect. Thank
• 1:59
  - just kick off our conversation with just hearing
• 2:02
  - what is your biggest priority right now,
• 2:05
  - for Northwell and the Cancer Institute today?
• 2:08
  - Because of the size of our catchment area
• 2:11
  - and the,
• 2:13
  - diverse nature of the patients that we care
• 2:15
  - for,
• 2:16
  - I think our biggest priority
• 2:18
  - is making sure that we're standardizing
• 2:21
  - care throughout the system,
• 2:22
  - that we're ensuring
• 2:24
  - the quality of care that we deliver,
• 2:26
  - and perhaps most importantly,
• 2:29
  - that we are bringing
• 2:30
  - cutting edge
• 2:32
  - novel therapies
• 2:33
  - to all of the patients within our system.
• 2:36
  - One of the amazing things about,
• 2:38
  - the Northwell catchment area is that we have
• 2:40
  - a large number
• 2:42
  - of underserved patients and minority patients in our
• 2:44
  - system. We actually have approximately forty percent of
• 2:47
  - our patients have government insurance,
• 2:50
  - and we wanna make sure that patients
• 2:52
  - who who really have issues that prevent them
• 2:55
  - from getting those novel therapies, perhaps their social
• 2:58
  - issues, lack of transportation or or financial issues,
• 3:02
  - from getting to academic centers,
• 3:05
  - in
• 3:06
  - in the city, comprehensive
• 3:08
  - cancer centers in in New York, for example.
• 3:10
  - We wanna make sure that those patients get
• 3:13
  - the most advanced therapies
• 3:15
  - right in their backyard.
• 3:18
  - Absolutely. And are there any pressures that you
• 3:21
  - feel cancer centers
• 3:23
  - or maybe even just oncology service lines are
• 3:26
  - facing right now that maybe aren't getting talked
• 3:29
  - about enough? Could it be that access issue,
• 3:31
  - or is there anything
• 3:32
  - else?
• 3:33
  - Well, I I think there's many pressures. I
• 3:36
  - think health care systems on the whole are
• 3:39
  - seeing a great deal of headwinds, and the
• 3:41
  - financial headwinds has to do with
• 3:44
  - with declining
• 3:45
  - reimbursements that we're seeing,
• 3:47
  - from payers.
• 3:48
  - It has to, do with the payer mix.
• 3:50
  - You know, obviously, when you deal with a
• 3:52
  - lot of patients who have government insurance,
• 3:55
  - those challenges, faces with reimbursement.
• 3:58
  - I think the other challenges, as you said,
• 4:00
  - are access,
• 4:01
  - getting patients
• 4:03
  - to get the best care possible. One of
• 4:04
  - the things that we've done at the Northwell
• 4:06
  - Cancer Institute
• 4:08
  - is we've instituted
• 4:09
  - what we think is a best in class
• 4:12
  - navigation program.
• 4:14
  - So we basically tie,
• 4:17
  - every new cancer patient to a navigator, usually
• 4:20
  - a nurse navigator,
• 4:21
  - who sticks with that patient for the course
• 4:23
  - of their treatment.
• 4:25
  - I think that is so critical for any
• 4:27
  - patient. It's enough to deal with the diagnosis
• 4:30
  - of cancer, let alone try to figure out
• 4:32
  - all the appointments you need to make, all
• 4:34
  - the doctors you need to see. So those
• 4:36
  - navigators hold those patients' hand throughout their treatment
• 4:40
  - journey. I think it's important for all patients,
• 4:42
  - but I think it's especially important,
• 4:45
  - for patients of lower socioeconomic
• 4:47
  - status who don't have the resources
• 4:49
  - and the support system
• 4:51
  - to get to those treatments that, they deserve.
• 4:55
  - And, we currently are navigating over 20,000
• 4:59
  - patients.
• 5:00
  - So I think it's it's really
• 5:02
  - critical
• 5:03
  - that we provide those services for our patients.
• 5:06
  - Absolutely. And I and I feel like that's
• 5:08
  - just an added layer of access. Right? It's
• 5:10
  - not just the physical or the geographic
• 5:12
  - access. It's it's how to navigate all those
• 5:15
  - things that,
• 5:16
  - those nurse navigators can help with. Yes. Absolutely.
• 5:20
  - Kind of shifting from
• 5:22
  - the hand holding of a real person, I'd
• 5:24
  - love to touch on AI,
• 5:27
  - which I know is probably the opposite,
• 5:30
  - frame of mind when we're talking about nurse
• 5:32
  - navigators. But we couldn't, you know, have a
• 5:34
  - health care podcast without talking about the influence
• 5:37
  - of AI right now. I'd love to know
• 5:39
  - kind of your mindset,
• 5:42
  - how you're navigating, whether that's safety concerns or
• 5:45
  - integrating it into care, if you feel like
• 5:47
  - it's genuinely
• 5:49
  - changing things, or is it more hype?
• 5:52
  - How are you feeling about it right now?
• 5:55
  - I think it's such an important and such
• 5:57
  - a timely issue. In fact,
• 5:59
  - we hold a cancer conference annually called Frontiers
• 6:03
  - in Cancer. Mhmm. This year,
• 6:06
  - the entire meeting was on
• 6:08
  - AI and cancer,
• 6:10
  - and we had world class experts,
• 6:12
  - on AI and cancer. And it's it,
• 6:16
  - it
• 6:17
  - does extend it to the entire gamut of
• 6:18
  - treatment, everything from early diagnosis,
• 6:22
  - picking up lesions that perhaps the human eye
• 6:24
  - could miss. As as, you know, AI does
• 6:27
  - have a role in
• 6:29
  - avoiding mislesions in in mammography,
• 6:33
  - enhancing,
• 6:34
  - what the doctors do and making sure that
• 6:36
  - lesions are missed.
• 6:38
  - We talked about
• 6:40
  - using AI to look at CAT scans. We
• 6:42
  - do have a a program where we've developed
• 6:45
  - software to look at large language models
• 6:47
  - to see if there were findings on a
• 6:49
  - CAT scan that a busy clinician may just
• 6:53
  - have missed. Maybe a small lesion in the
• 6:54
  - pancreas, and they thought, oh, this probably isn't
• 6:57
  - important. This might be a a little cyst.
• 6:59
  - And when we go back,
• 7:01
  - we are able to pick up lesions that
• 7:03
  - should have been looked at, and we actually
• 7:05
  - were able to detect some early cancers. And
• 7:08
  - and disease like pancreatic cancer, you absolutely
• 7:12
  - want to do that. But AI is going
• 7:14
  - to to be involved in the entire spectrum
• 7:16
  - of treatment. We use AI for clinical trials
• 7:20
  - matching.
• 7:21
  - First of all,
• 7:22
  - there are so many clinical
• 7:25
  - trials available to doctors.
• 7:27
  - The medical literature changes so quickly. How can
• 7:30
  - any one
• 7:32
  - individual practitioner
• 7:34
  - know about every single study out there? Does
• 7:36
  - everyone have the time to look at all
• 7:39
  - the important journals, make sure that they're on
• 7:41
  - top of everything?
• 7:42
  - That's why we attend national meetings to hear
• 7:45
  - what the state of the science is. So
• 7:47
  - AI is absolutely
• 7:48
  - going to enhance
• 7:50
  - how we treat patients because we will use
• 7:53
  - AI to make sure that we're providing the
• 7:55
  - best treatment for patients, and I'll give you
• 7:57
  - an example about that.
• 7:59
  - AI should absolutely be incorporated
• 8:02
  - into tumor boards. Tumor boards are critical to
• 8:05
  - the treatment of cancer patients. That's where we
• 8:08
  - gather the clan, the surgeons, the radiation
• 8:11
  - oncologists, the medical oncologists, the pathologists,
• 8:14
  - the radiologists,
• 8:16
  - and we present our complicated patients.
• 8:18
  - And we talk about the patients. And And
• 8:21
  - then, basically, the way tumor boards work is
• 8:23
  - that the clinicians in the room start talking
• 8:26
  - about it. And, well, there was a study
• 8:28
  - published,
• 8:29
  - six months ago in this journal which showed
• 8:31
  - that this is the best treatment. So you're
• 8:33
  - really just relying
• 8:34
  - on the memory of the people in the
• 8:36
  - room.
• 8:37
  - And it and sometimes
• 8:39
  - some people have a larger voice than others.
• 8:41
  - Perhaps if you're a leader on the service,
• 8:43
  - you might make your opinion and then people
• 8:46
  - might be a little hesitant to go against
• 8:48
  - that opinion. You know, the boss is is
• 8:50
  - saying this. Well, what if we took that
• 8:51
  - out of the hands
• 8:53
  - of just people sitting in a room and
• 8:55
  - we used AI to come up with what
• 8:57
  - they what AI thinks is the correct treatment?
• 9:01
  - Then the focus of the tumor board shifts
• 9:04
  - from trying to remember
• 9:05
  - what is the best treatment or what you
• 9:07
  - think you've read recently or what studies have
• 9:10
  - been presented.
• 9:11
  - AI puts that all together and synthesizes it.
• 9:14
  - But then in the room, you talk about
• 9:17
  - what AI has come up with, and I
• 9:19
  - think that is is very important. We're actively
• 9:22
  - using software,
• 9:24
  - AI to,
• 9:26
  - to highlight what clinical trials are available for
• 9:29
  - patients. Again, doctors can't keep up on every
• 9:31
  - single clinical trial, but if you can take
• 9:34
  - the data on patients before you see them
• 9:36
  - in clinic and you know that this is
• 9:38
  - a clinical trial that matches to them, why
• 9:41
  - is that important?
• 9:42
  - We know that the best outcomes
• 9:44
  - in cancer clinical care
• 9:46
  - are for patients who are enrolled on clinical
• 9:49
  - trials, and I think AI will absolutely
• 9:52
  - have a role in that. And, again, with
• 9:54
  - screening and early diagnosis,
• 9:56
  - AI is gonna be used more and more
• 9:58
  - in in CT scans. And, of course, you'll
• 10:01
  - need doctors,
• 10:02
  - to confirm things or to review things, but
• 10:04
  - the key with AI is we wanna make
• 10:06
  - sure that we're not missing things that could
• 10:09
  - really change the way,
• 10:11
  - that
• 10:12
  - treatments
• 10:13
  - are are presented or are posed. Finally,
• 10:16
  - there's a huge explosion of AI in genomics.
• 10:20
  - And just trying to understand all of the
• 10:22
  - mutations that are occurring in tumors, what the
• 10:24
  - significance of those mutations are, So we had
• 10:27
  - some really incredible scientists at our conference
• 10:30
  - talking about how AI was being used to
• 10:33
  - enhance,
• 10:34
  - to understand,
• 10:36
  - tumor biology and and and what mutations are
• 10:38
  - actually driving the cancer and how these patients
• 10:40
  - can be treated.
• 10:41
  - So there's a whole spectrum of way where
• 10:44
  - AIs were sort of in the infancy, but
• 10:46
  - not really.
• 10:47
  - I think it's just gonna take on a
• 10:49
  - bigger and bigger role, and it will be
• 10:51
  - a critical role.
• 10:53
  - Nobody's being replaced. This is a team effort.
• 10:55
  - This is doctors, nurses,
• 10:57
  - staff, and and AI all working together to
• 11:00
  - make sure that patients have the best possible
• 11:02
  - outcomes.
• 11:04
  - Absolutely. And I I loved what you said
• 11:06
  - about we're kind of in the infancy because
• 11:08
  - it feels like we are, but it also
• 11:09
  - feels like it's happening so fast
• 11:12
  - Right. That,
• 11:13
  - it's hard to say it's the infancy when
• 11:15
  - it it like you said, there's so many
• 11:17
  - different ways it's being used, and it's all
• 11:19
  - occurring so quickly.
• 11:21
  - Yeah. Exactly.
• 11:23
  - Feel like I I could do a whole
• 11:24
  - podcast episode with you just talking about the
• 11:27
  - AI conference.
• 11:28
  - But I'd love to to kind of
• 11:31
  - focus on the leadership aspect of oncology for
• 11:35
  - a minute here.
• 11:36
  - What challenge do you think
• 11:39
  - the next generation of oncology leaders
• 11:42
  - will need to focus on, will need to
• 11:44
  - try to solve that the field isn't fully
• 11:47
  - tackling
• 11:47
  - right now?
• 11:49
  - I think with all of the headwinds that
• 11:52
  - we're facing,
• 11:53
  - in health care you know, again, we talked
• 11:55
  - a little bit about the reimbursement from payers,
• 11:57
  - reimbursement from government,
• 11:59
  - federal funding,
• 12:01
  - for, grant funding,
• 12:03
  - that supports
• 12:04
  - the innovative cutting edge. I think we're all
• 12:07
  - going to have to learn
• 12:08
  - to do
• 12:10
  - more with less.
• 12:12
  - I think that's the challenge for the future.
• 12:14
  - I don't think,
• 12:16
  - you know, some institutions in the past had
• 12:18
  - the luxury of largesse,
• 12:20
  - a lot of funds to be able to
• 12:21
  - do research. Research is expensive.
• 12:24
  - And I think
• 12:25
  - continuing to foster
• 12:28
  - research and support
• 12:30
  - young people who want to focus primarily on
• 12:33
  - research, well, you know, what generates revenue for
• 12:36
  - healthcare systems is the doctors taking care of
• 12:38
  - patients and whether it's,
• 12:40
  - surgery or radiation treatments or,
• 12:43
  - you know, or infusional therapy. That's what generates
• 12:46
  - revenue.
• 12:47
  - So how can we have those clinician scientists
• 12:50
  - be supported
• 12:51
  - who are making the discoveries, generating the investigator
• 12:55
  - initiated trials
• 12:56
  - to bring novel therapies? So it's really about
• 13:00
  - wisely using resources, I think,
• 13:03
  - learning how we can do more with less,
• 13:06
  - what things do are a must have, what
• 13:08
  - things may not be necessary,
• 13:10
  - how do we have to learn to become
• 13:12
  - more efficient
• 13:13
  - in the way we do things, How do
• 13:15
  - we appropriately use physician extenders
• 13:18
  - practicing at the top of their license? You
• 13:21
  - know, we did a lot of things when
• 13:23
  - we weren't as worried about the financial headwinds,
• 13:26
  - and I'll I'll speak to my own way
• 13:28
  - of practicing as a gynecologic oncologist.
• 13:30
  - I was seeing patients
• 13:32
  - fifteen years after I had operated on them
• 13:34
  - on a regular basis.
• 13:36
  - That's not the best model.
• 13:38
  - The best model is to see patients
• 13:40
  - in the acute period after they're diagnosed,
• 13:43
  - and then we have to get better at
• 13:46
  - transitions of care. And that's where survivorship
• 13:49
  - comes in.
• 13:50
  - Survivorship starts the minute you're diagnosed,
• 13:53
  - and it extends all the way, through the
• 13:56
  - entire,
• 13:57
  - continuum of care.
• 13:59
  - We have to be more,
• 14:01
  - efficient in getting patients transferred. Patients have comorbidities.
• 14:04
  - They come in with diseases like diabetes or
• 14:08
  - heart disease,
• 14:09
  - or or lung disease or kidney disease, and
• 14:12
  - they also develop toxicities of therapy. So we
• 14:15
  - need to get patients to see the right
• 14:17
  - doctors,
• 14:18
  - as quickly as possible, but we also need
• 14:21
  - to transition their care,
• 14:23
  - to whether it's nurse practitioners or physicians that
• 14:27
  - can see patients who would say, okay, no,
• 14:29
  - this patient had this diagnosis.
• 14:30
  - We know they need a mammogram,
• 14:33
  - alternating with an MRI of the breast every
• 14:35
  - six months. We know that they need these
• 14:38
  - tumor walkers drawn, for example.
• 14:40
  - We need to make that
• 14:42
  - transition of care as soon as appropriate
• 14:45
  - so that the doctors that are there to
• 14:47
  - see the new patients and take care of
• 14:49
  - the needs of the new patients
• 14:52
  - can be more efficient in in getting those
• 14:54
  - patients in, getting them seen in a timely
• 14:56
  - manner, treating them, and allowing the patients who
• 14:59
  - are doing better because they're now moving on
• 15:02
  - in their treatment course.
• 15:04
  - It's much more important that we focus on
• 15:07
  - survivorship
• 15:09
  - and and and focus on the comorbidities,
• 15:12
  - that these patients have as well as the
• 15:14
  - toxicities of treatment and the symptoms that they
• 15:17
  - develop, from those treatments. So I think, to
• 15:20
  - me, that's one of the biggest challenges that
• 15:23
  - the future is going to face,
• 15:25
  - learning
• 15:26
  - to become more efficient, learning to do more
• 15:28
  - with less, not to increase the workload and
• 15:31
  - cause burnout, but just to make everyone more
• 15:35
  - efficient.
• 15:36
  - We are doing so many things that we
• 15:37
  - don't need to be doing. One of the
• 15:39
  - things that's going to help us in the
• 15:41
  - Northwell system with our 28 hospitals and our
• 15:44
  - 14 cancer centers is we're now we're in
• 15:46
  - the latest stages
• 15:48
  - of complete conversion to Epic as our electronic
• 15:52
  - health care record.
• 15:54
  - And I think about that as a very,
• 15:56
  - very powerful tool to make sure that our
• 15:59
  - entire system is integrated.
• 16:01
  - All of our cancer centers are integrated.
• 16:03
  - All of our health care providers are integrated,
• 16:06
  - and that system is really going to allow
• 16:09
  - AI to flourish.
• 16:10
  - You know, now that we're all on one
• 16:12
  - electronic
• 16:13
  - health record. So really, really excited about how
• 16:16
  - that is going to make us more efficient.
• 16:19
  - And we have many other examples.
• 16:21
  - You know, in the future,
• 16:23
  - the model of patients coming in and waiting
• 16:25
  - for hours has to end. You know, we
• 16:27
  - use software
• 16:28
  - to really streamline our infusion centers to smooth
• 16:32
  - out the schedule. So we're not seeing it
• 16:33
  - very slow in the morning and then this
• 16:35
  - peak in the afternoon where everyone's waiting for
• 16:37
  - hours.
• 16:38
  - That cannot happen anymore.
• 16:40
  - We have to focus on the patient experience.
• 16:43
  - We have to get them in and out
• 16:45
  - in a timely manner.
• 16:46
  - We have to give them a seamless,
• 16:49
  - process
• 16:50
  - where their,
• 16:52
  - their appointments are made online, where they can
• 16:55
  - get their follow-up appointments made. The days of
• 16:57
  - everyone sitting around in a large crowded waiting
• 17:00
  - room, getting called out by name, getting taken
• 17:04
  - back, then having to wait online again to
• 17:06
  - get a follow-up appointment.
• 17:08
  - For the future, the patient experience has to
• 17:10
  - be seamless and much more efficient as well.
• 17:12
  - So I think efficiency, efficiency, efficiency.
• 17:16
  - Absolutely. And I I just feel like your
• 17:19
  - answer just touches on what a pleasure it
• 17:21
  - is to speak with you, doctor Barakat, because
• 17:23
  - I feel like our conversation ranged from just,
• 17:25
  - you know, using AI to find lesions earlier
• 17:29
  - to then survivorship
• 17:30
  - and everything in between. So I'm just so
• 17:32
  - grateful that our listeners have the chance to
• 17:34
  - get to hear
• 17:36
  - your insights. With my last question, though, I'd
• 17:39
  - love to look to the future and just
• 17:42
  - what
• 17:42
  - you see on the horizon that's giving you
• 17:45
  - hope for the
• 17:47
  - cancer care oncology space right now?
• 17:51
  - You know, the field of genomics and genetics
• 17:54
  - is exploding.
• 17:55
  - And, you know, just profiling our patients,
• 17:59
  - seeing what mutations are driving their cancer, if
• 18:01
  - it's an actionable,
• 18:03
  - mutation,
• 18:04
  - there's a drug available, treating those patients. That's
• 18:07
  - made the big difference. That's seen the improvement,
• 18:10
  - that we're seeing in lung cancer.
• 18:13
  - Look at the exciting news
• 18:15
  - about, the doubling of survival, that's seen in
• 18:17
  - in pancreatic cancer with the RAS inhibitors.
• 18:22
  - That's where the future is. The future is
• 18:26
  - discovering
• 18:26
  - novel therapies,
• 18:28
  - treating patients with precision medicine, but remembering
• 18:33
  - that personalized medicine
• 18:35
  - means that we can get that 80 year
• 18:37
  - old diabetic who doesn't have a car to
• 18:40
  - get the best treatment possible,
• 18:42
  - to get the single mom,
• 18:44
  - with three kids who doesn't have time to
• 18:46
  - drive,
• 18:47
  - long distances
• 18:49
  - to get the best,
• 18:50
  - possible treatment.
• 18:52
  - So I think the future is,
• 18:54
  - when we talk about precision medicine,
• 18:56
  - making sure that we understand that it's personalized
• 18:59
  - medicine, not just finding a mutation,
• 19:01
  - but making sure that all patients can have
• 19:04
  - access to those kind of novel novel therapies
• 19:07
  - because we know
• 19:08
  - that outcomes are better on cancer clinical trials,
• 19:11
  - which is what I love about the START
• 19:13
  - program,
• 19:14
  - the joint venture that the Northwell,
• 19:16
  - health system has with START. Again, they are
• 19:19
  - the largest provider of phase one trials in
• 19:21
  - the country, over 1,000.
• 19:23
  - And our 14 infusion base on Long Island,
• 19:25
  - another 14 that we're building
• 19:27
  - in the city,
• 19:29
  - will give us 28 phase one infusion base.
• 19:32
  - And I think that's exciting because
• 19:34
  - we our goal is to become the largest
• 19:36
  - provider of phase one trials in the area,
• 19:39
  - but getting those phase one trials to the,
• 19:43
  - patients who classically haven't received them. You know,
• 19:45
  - if you look, the American Association of Cancer
• 19:48
  - Research published a pooled analysis
• 19:51
  - of all of the patients
• 19:52
  - enrolled on phase one trials.
• 19:55
  - Sixteen percent of the population is is black,
• 19:57
  - thirteen percent is Hispanic. And if you look
• 19:59
  - at the number of patients on phase one
• 20:01
  - trials, I think it was almost zero for
• 20:04
  - Hispanics and a very small percentage for African
• 20:07
  - Americans. So we wanna make sure that everybody
• 20:09
  - gets those trials. There's other more exciting developments
• 20:13
  - happening.
• 20:14
  - Northwell in conjunction with Cold Spring Harbor Laboratory,
• 20:16
  - a partner that we're moving towards applying to
• 20:19
  - become an NCI designated,
• 20:21
  - cancer consortium,
• 20:24
  - built together an organoid facility. And these are,
• 20:28
  - these are this is really fantastic. This is
• 20:31
  - where you biopsy the patient's tumor and then
• 20:33
  - grow it in a gel. And you really
• 20:35
  - have an avatar
• 20:37
  - of the patient's tumor that's growing.
• 20:39
  - So instead of giving a patient a drug
• 20:42
  - and trying to see if they respond to
• 20:44
  - the drug, we can put 50 drugs
• 20:46
  - and see what happens,
• 20:48
  - in,
• 20:49
  - in vitro with that patient's tumor. So So
• 20:52
  - it's literally an avatar of the patient's tumor
• 20:55
  - so that you can select the best treatment.
• 20:58
  - And the final thing I'll say is that
• 20:59
  - we wanna go beyond phase one trials. We're
• 21:02
  - developing a phase zero unit.
• 21:04
  - A phase zero unit is where you treat
• 21:06
  - a patient with experimental therapy, but you do
• 21:09
  - real time biopsies
• 21:10
  - so that they're getting biopsied along their treatment
• 21:13
  - course so that you're seeing in real time
• 21:17
  - what's happening to the tumor microenvironment,
• 21:19
  - what's happening to the cancer,
• 21:21
  - how are things changing in real time
• 21:24
  - as the patient is getting treatment. Those are
• 21:26
  - what phase zero trials are all about. So
• 21:29
  - I think the future,
• 21:30
  - the explosion
• 21:31
  - in genomics,
• 21:33
  - is really going to drive improved outcomes.
• 21:36
  - That excites me. I think,
• 21:39
  - the explosion in artificial intelligence, the specialist, relates
• 21:43
  - to early
• 21:44
  - diagnosis
• 21:45
  - and screening. I think these are the things
• 21:47
  - that are gonna have a major, major impact
• 21:49
  - on cancer outcomes.
• 21:52
  - Perfect. That is so exciting. I I look
• 21:54
  - forward to being able to share with our
• 21:56
  - listeners more about all those discoveries coming out
• 21:59
  - of Northwell. And, again, I just wanna thank
• 22:01
  - you so much for coming on the podcast
• 22:03
  - and and sharing your expertise,
• 22:05
  - with our audience.
• 22:06
  - You are most welcome, Elizabeth. Great speaking with
• 22:09
  - you again.
• 22:10
  - And thank you to our listeners for tuning
• 22:12
  - into Becker's Oncology Leadership podcast.
• 22:15
  - I invite you to check out even more
• 22:17
  - Becker's Health Care podcasts
• 22:18
  - at beckerspodcasts.com.
• 22:21
  - Thank you again to doctor Barakat for joining
• 22:23
  - me, and thank you again to our listeners
• 22:25
  - for tuning in.