Dean Page and Randall Holcombe, M.D., M.B.A., the new Director of the UVM Cancer Center, talk about the lure of complexity and problem-solving in research, clinical care, and administration.

In the few short months since he joined the University of Vermont Cancer Center as its director, Randall Holcombe, M.D., M.B.A., has drawn on four decades of experience—most recently leading the University of Hawai'i Cancer Center to full NCI redesignation—to plan the next chapter of cancer research and care in Vermont. Shortly after assuming the new J. Walter Juckett Chair in Cancer Research this fall, Dr. Holcombe joined Dean Richard L. Page, M.D., for a wide-ranging discussion of these plans.

 

Richard L. Page: Randy, to start off our discussion, I’d say: Why cancer? What prompted you to devote your life to researching cancer and providing care to those who have it?

Randall Holcombe: Well, I knew that I was going to be an academic physician. I was interested in science. And what really turned me on was immunology and the immune system. And as I went through residency training, I had thoughts of perhaps focusing on rheumatology or infectious disease or hematology and oncology. All of them seem to have some overlap with the immune system. And I really found taking care of cancer patients very fulfilling. And that’s what led me in the direction of hematology-oncology.

RLP: And what about the immune system was exciting for you?


RH: Its complexity. At the time, we didn’t understand very much about the immune system. We didn’t know how to modulate it effectively. I thought there was a lot of opportunity for research to improve our understanding of what was really a critical but not well-understood component of the human systems. I love that challenge.

RLP: Complexity is attractive.

RH: Absolutely. It stimulates thinking. And I think that’s what we should do as physician-scientists. We should think and solve problems. 

RLP: And immunology, especially seemed like a “black box” back then, and the great challenge was sorting it out.

RH: Now we know a lot more. And now, it’s become a mainstay of treatment for patients with cancer and hematologic disorders. So that knowledge that people have gained over the last 40 years has now led to breakthrough therapies for the patients that I see every day.

RLP: That’s interesting. You liked immunology, initially in its relationship to infectious disease, but you decided to pursue hematology/oncology when it became clear that immunology might help us treat cancer.

RH: When I began my work, there was a relatively small number of people working on the immunology and cancer connection. They were a minority that was shunned by most oncologists and hematologists. But I thought there was something to it—that it was an area that I thought would be interesting to study. It led to some research projects that were focused on the immunology of cancer. We were using an immunostimulatory agent at the time for patients with colon cancer. And I set up a clinical trial, which I had the fortunate opportunity to be able to do nationally through the Southwest Oncology Group, studying the immunologic response for patients receiving this medication. And it was a good start, I think, to my career.

RLP: And the gastro-intestinal aspect that you’re now well known for, was your engagement serendipity—since there was a GI immunologic cancer study going on that sent you in that direction?

RH: Essentially, yes. I was initially trained as a hematologist, not an oncologist. Now, I practice as a gastrointestinal oncologist. But I was studying immunology in my laboratory. I had a K23 award from the NIH to support my research activities. And that was focused on immunology. Then I started doing immunology for colon cancer patients. And, essentially, I was then told that I would be the colon cancer doctor because there was not another colon cancer doctor around, and I must know something about colon cancer, because I
was doing laboratory research related to it. So I became a GI oncologist at that time.

RLP: And that’s a perfect combination of being attracted to a field and then finding how to grow and develop within it.

RH: And I think as a junior faculty member, you shouldn’t be too rigid about what you want to study. Because sometimes there are opportunities that are just slightly outside of what you thought you were going to focus on, and those are opportunities that you have to seize, and you have to go with them. And that’s just how it turned out for me.

 

RLP: In more recent years you’ve been involved in non-basic research. 
How did you make that transition to the work you do now?

RH: Well, again, that’s something that just sort of happened. I ran a lab as what you would call a traditional physician scientist for about 30 years. And I studied signaling pathways related to colon cancer in the laboratory. I think we did a good job. We had a number of different funding mechanisms to help support our work. We published lots of papers. And when I went to Mount Sinai Medical Center, I was put in charge of the clinical cancer program in addition to running my lab. I had two jobs—a clinical leadership job as well as a laboratory focus.

And as I became more and more involved in the delivery of cancer care, that’s what I got excited about. I started writing grants related to health sciences research, focused on cancer care delivery. One day I was sitting in my office and I had two grants to write. One was related to the lab research, and one was related to the health services research that I was doing. And I kept writing the latter, the health services research grant, and I could never get around to going back to writing the lab grant.

I realized at that point that I just didn’t have the bandwidth to do both at the level of excellence. And so I made that decision to close my lab. It was a really difficult decision at the time, because it was an essential part of me. Then I went and obtained an MBA to help me in the efforts that I was directing related to the conduct of the cancer program on the clinical side of things at Mount Sinai.
Rendering of the firestone building
Holcome
Randall F. Holcombe, M.D., M.B.A.

University of Vermont

  • Professor of Medicine and Director, University of Vermont Cancer Center
  • Chief, Division of Hematology/Oncology
  • J. Walter Juckett Chair in Cancer Research

University of Hawai’i

  • Professor of Medicine,  John A. Burns School of Medicine
  • Director, University of Hawai’i Cancer Center

Mount Sinai School of Medicine and Mount Sinai Health System (N.Y.)

  • Professor of Medicine (2010-2016)
  • Director, GI Medical Oncology (2010-2016)
  • Medical Director, Ruttenberg Treatment Center (2010-2016)
  • Director, Clinical Cancer Affairs (2010-2013)
  • Deputy Director, The Tisch Cancer Center (2011-2016)
  • Chief Medical Officer-Cancer (2013-2016)
  • Associate Director for Clinical Affairs, The Tisch Cancer Center (2010)

UC Irvine School of Medicine Chao Family Comprehensive Cancer Center, UCI Medical Center

  • Professor of Medicine (2006-2010)
  • Associate Professor of Medicine (1997-2006)
  • Chief, Division of Hematology/Oncology (1997-2010)
  • Associate Director for Clinical Research  (1997-2010)
  • Director, Office of Clinical Research and Trials (2006-2010)
  • Associate Vice Chancellor for Research (2008-2010)

LSU School of Medicine

  • Associate Professor of Medicine (1993-1997) 
  • Assistant Professor of Medicine (1989-1993)

Education & Training

  • Duke University, B.A. Zoology & Chemistry, 1979
  • University of Medicine and Dentistry of N.J.  –New Jersey Medical School, M.D., 1983
  • Zicklin School of Business, Baruch College, M.B.A., 2015
  • Resident Physician, Brigham & Women’s Hospital, Boston, MA 1983-1986
  • Chief Medical Resident, West Roxbury Veterans Administration Hospital, Boston, Mass., 1986
  • Research/Clinical Fellow in Medicine (Hematology/Oncology), Brigham & Women’s Hospital, 1986-1989
  • Research Fellow in Medicine, Harvard and Research Fellow in Genetics, Harvard Medical School, 1986-1988
  • Clinical Fellow in Medicine (Hematology/Oncology), Harvard Medical School, 1988-1989


“We want to bring the outcomes for the rural population up to those that we see in an urban population.” – Randall Holcombe, M.D., M.B.A.

RLP: Now let’s fast forward a bit to your going to Hawai'i. What can you say about that move?

RH: I think every organization I’ve joined has needed some assistance in getting over the hump and building to a level of excellence. And I love doing that. Even Mount Sinai, which is a huge name in healthcare, had a undeveloped academic hematology-oncology program when I went there—surprisingly so. They have so many great programs there. But oncology wasn’t one that had had a lot of focus before.

Hawai'i needed some leadership. They had great people there. And they were doing great research. The cancer center needed someone to help organize them, lead them, get everybody on board, working toward the same mission. I thought it would be a really challenging opportunity. 
My plan in Hawai'i was to get redesignated through the National Cancer Institute, which we did, and to get the center on a stable foundation, which I think we also did. Those are the things that drew me to Hawai'i. And honestly, in many ways, those are the same things that have drawn me to Vermont. There are great people here doing really solid cancer-related research. And there are some things that need to be reorganized and worked on. And we need to get to a level of excellence in several key areas. And I think that that’s achievable.

RLP: What are those key areas?

RH: I think there are four “pillars” on which a cancer center is built. One is research. We need to do research that’s relevant to our community here in Vermont. And that research does not just include laboratory research. It includes population-based research that may be related to cancer screening, abuse of substances like tobacco and alcohol that can increase the incidence of cancer, cancer prevention, cancer care delivery, as well as clinical trials.

I also think we need to focus more as a cancer center on education and training. We’re sitting in the middle of a renowned university and we need to make sure that our cancer center educational mission meets the mission of the university overall. That involves teaching students, as well as postdocs, and mentoring of junior faculty.

A third “pillar” is community outreach. I often tell people there’s no reason for a cancer center to exist if it doesn’t serve the community where it’s located. It’s extremely critical that we have appropriate outreach to our community stakeholders, and that we get input from those community stakeholders to help inform our research directions, and also to allow us to develop appropriate interventions or programs that can help address those needs of the community.

And then the last “pillar” is clinical care. We have the opportunity here, because we have an affiliated medical center, to really connect research with the highest quality of clinical care. That’s what an academic center does. We need to take great care to not lose sight of that. We do not need to be a community-based oncology clinical program. We can be better. And we can be one that brings the most novel therapies to patients, incorporates clinical trials into the fabric of cancer care delivery, and provides sub-specialty expertise of our faculty to the benefit of patients. So, those are our four main areas, and we’ll be working on strengthening all of those.

RLP: When you say “community,” how do you define that term?

RH: Every cancer center has to define their “catchment area.” I think “impact area” is a better term, but “catchment area” is the one that the National Cancer Institute uses. Many centers define that just as “where patients come from” to their medical center. But since I think the cancer center is much broader than just a patient care delivery institution, we have been looking to define our catchment area as the whole state of Vermont, as well as northeastern New York State. So I feel strongly that our community stakeholders have to come from all of those areas.
We have been working very hard to create a new community advisory board which is truly made up of community stakeholders to give us advice and help us understand the needs of the community. We’ve been reaching out across the state. We’ve been talking with lots of underrepresented groups, including the Pride Foundation, and Americans with Disabilities organization, New American organizations, as well as more traditional community stakeholders, like the local chapters of the American Cancer Society and our Vermont Department of Health. We’re working to get a broad, connected group to help advise us. And we’ll do the best we can to try to address all of the needs for our population here.

RLP: You have shared with me that the cancer center in Hawai'i has a pretty expansive rural catchment area. And that actually prepared you, I think, in a special way to come to a state completely unlike the state of Hawai'i. Can you expand on that a bit?

RH: Sure. Vermont is one of the most rural states, obviously, in the country. And it is really vital to focus on a rural population, because we recognize now that one of the disparities in cancer outcomes is between urban and rural cancer patients. Rural cancer patients do worse, and there are lots of reasons for that. Some of it has to do with access, transportation, availability of sub-specialty providers. A lot of it has to do with socioeconomic status, as well.

I’m excited to be a cancer care delivery researcher at this time, because we can look at this population and say, “What can we do to better serve them, so that we can eliminate those disparities?” The goal is to achieve cancer health equity, which is another way of saying we’re eliminating the disparities. But really, we don’t want to just bring everybody to the middle. We want to bring the outcomes for the rural population up to those that we see in an urban population.

Hawai'i is rated around the tenth most rural state in the country. But if you eliminate the island of Oahu, where Honolulu is, which has 900,000 people in it, the rest of Hawai'i is as rural or more rural than Vermont. Many of the same issues are present in Hawai'i. They’re complicated by even worse travel problems because of distance and the nature of island geography. We’ve been doing research to try to identify some of the key factors that we might be able to improve to help rural residents with cancer in Hawai'i, and I hope to continue that research here.

RLP: So, let’s talk for a minute about NCI designation. I have heard you deliver a very thoughtful explanation about cancer center excellence and NCI designation.

RH: I think what you’ve heard me say is that NCI designation is like any certification: It demonstrates the capabilities that you have and the excellence that you have in various different areas. In and of itself it can be important, but what it really represents is that you did the things you needed to do to have a robust research program, a good focus on education, extensive community outreach, great clinical care, and application of clinical trials, which is how we make progress in hematology and oncology. 

So my goal is to really build up the four pillars that we’ve already talked about, so that they are all at a level of excellence which, when we submit an application for NCI designation, will make it impossible for them not to give it to us. That’s the goal of moving forward.

And I am very appreciative of all the people who’ve been working on the cancer center previously and putting in lots of effort for that. Certainly, Dr. Gary Stein is one of our key members here. He runs a fantastic research program, which is focused on breast cancer, and he also has established ties across northern New England with a clinical and translational research grant. His contributions to the cancer center are extremely valued. And I’m very appreciative of all of the other senior faculty that have contributed in leadership roles here at the cancer center. Some of those roles will change a little bit as we move forward, and I think that people are understanding of that and are appreciative of the types of new initiatives that I’ll be implementing.

RLP: What role do you see philanthropy playing in the cancer center?

RH: An important one, definitely! No NCI Cancer Center survives without robust philanthropy. There are never enough dollars from an institution or medical center to support the research initiatives that you really want to move forward in a cancer center. Part of that is because the more successful you are, the more opportunities for great initiatives appear at your doorstep. So you need more resources to move that forward.

I think that the Firestone Building is a great opportunity, because it’s going to provide a home for shared resources, which is critically important for cancer research, and also provide new space for faculty that will be recruiting. So, we’re very pleased about the Firestone Building and looking forward to its coming online next year.

The J. Walter Juckett Foundation has been very supportive of the cancer center in the past. We’re very appreciative of that and hope that strong support continues moving forward, because that will also enable us to achieve greater goals.

We will be working with the University of Vermont Foundation to identify other sources of funding through philanthropy. And certainly, we will work to be good stewards of any funding that we bring in through that mechanism and make sure that it’s put toward really impactful research approaches that will benefit the people of Vermont. Philanthropic support helps to build programs. A transformative gift, which some cancer centers received from major donors, can move those initiatives along much faster and create greater opportunities to achieve excellence. And so, we will be looking for large gifts, but we’re also appreciative of small gifts. The bottom line is—it all helps the people who make up the cancer center to do the important work that needs to be done.  
 

Supporting a Shared Vision

With $3 million in support from a longtime major supporter of the University of Vermont Cancer Center, Randall F. Holcombe, M.D., M.B.A., was invested as the inaugural J. Walter Juckett Chair in Cancer Research in the Larner College of Medicine on November 3, 2021. The formal ceremony marked Holcombe’s stature as a national cancer care leader and the respect the Juckett Foundation holds for the Cancer Center’s mission to prevent, treat, and 
 cure cancer.

Leaders from the University of Vermont and UVM Medical Center joined special guests for the event held in the College of Medicine’s Health Science Research Facility.

The Juckett Foundation has provided decades of support to the UVM Cancer Center, helping to improve cancer outcomes for patients across Vermont and Northern New York. In establishing the Juckett Chair, the Foundation’s board of trustees has taken a major step forward in realizing their shared vision of an evolved UVM Cancer Center that has an even more significant impact on the people of this region. Juckett Foundation board member Jerome Yates, M.D., said UVM has found a dynamic new leader in Dr. Holcombe, with the experience to lead and transform the Cancer Center.    

“It’s critical in every institution to have a foundation of support for quality teachers and investigators, but also to provide some organizational stability, and that’s the hope with the J. Walter Juckett Chair,” said Yates. “It allows for time that can be devoted to building and rebuilding the Cancer Center.”