This is an audience favorite episode. Dr. Yuman Fong shares insights on AI, robotics, the future of surgical oncology, plus his groundbreaking work in oncolytic viruses and the importance of mentorship.
This is an audience favorite episode. Dr. Monty Pal sits down with Yuman Fong, M.D., an internationally renowned surgical oncologist and Chair of Surgery at City of Hope, to explore the leading-edge innovations shaping the future of surgical oncology.
Dr. Fong shares his incredible journey from studying medieval literature to being one of the first-ever surgeons to conduct surgery in space. They discuss the evolution of oncolytic viruses, the role of AI in cancer surgery, and how remote robotic surgical procedures are transforming patient care worldwide. Dr. Fong also shares his insights on balancing an intense surgical career with family life, mentorship, and finding passions outside the operating room.
Don’t miss this fascinating conversation about the future of cancer care, where groundbreaking science meets human connection. Subscribe via the links below to listen now.
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Presented by City of Hope: www.CityOfHope.org
Voiceover [00:00:00]:
Welcome to on the Edge of Breakthrough, where hope meets innovation in the fight against cancer.
Dr. Pal [00:00:18]:
Hi, I'm Dr. Monty Pal. I'm a medical oncologist at City of Hope, and I'm really excited to bring to you on the Edge of Breakthrough voices of cancer Research. We're going to be bringing some of our best, best researchers to the table to discuss exciting findings from their laboratories, from their research programs, and really get some great perspectives on what their plans are for the future. Welcome to today's podcast. I gotta tell you, you've heard of the Dos Equis Man, but I guarantee that I'm actually sitting next to the most interesting man alive, Dr. Yumen Fong.
Dr. Monty Pal [00:00:50]:
Yumen. Welcome to the program.
Dr. Yuman Fong [00:00:52]:
Oh, thank you very much for inviting me.
Dr. Monty Pal [00:00:53]:
And congratulations. Ten years at City of Hope now, right?
Dr. Yuman Fong [00:00:56]:
Oh, yeah, it's such a great 10 years. I look back, right, because these anniversaries, 5 years, 10 years, 20 years matter. And as I thought back, it's been such a transformation at institution, but it's also been a great opportunity for me and my department and so really appreciate having been here 10 years.
Dr. Monty Pal [00:01:16]:
Oh, yeah. And we're definitely going to get back to your time here at City of Hope, but I want to start right at the foundation of everything. Right? So, you know, you actually were a medieval history major in college, is that right?
Dr. Yuman Fong [00:01:27]:
Medieval literature.
Dr. Monty Pal [00:01:28]:
Tell us more about this.
Dr. Yuman Fong [00:01:29]:
Oh, listen, I had a amazing mentor in college freshman year, and I was sitting with him and I said, how did you win the Nobel Prize? And he said, I only do things that are important. And then he turned to me and he said, you know, you're going to do science the rest of your life. Shouldn't you do something in your first three, four years in college that is different? And. And with that single conversation, I had some of the best advice, which is to go explore. And linguistics and medieval poetry was interesting to me. How did epic poets remember thousands of lines? Okay, and then why does certain sound patterns only happen and some patterns never happen? And so again, I had an opportunity to go study very different things. But help me think.
Dr. Monty Pal [00:02:14]:
So, so take us from there to a career in medicine. What was the intersect between the two?
Dr. Yuman Fong [00:02:18]:
Well, I was already admitted to medical school. I was at the seven year med program at Brown.
Dr. Monty Pal [00:02:22]:
Oh, okay.
Dr. Yuman Fong [00:02:23]:
Yeah.
Dr. Monty Pal [00:02:23]:
Okay.
Dr. Yuman Fong [00:02:24]:
So that's why, again, I knew I was gonna go do medicine, I was gonna do surgery, and that was never an issue.
Dr. Monty Pal [00:02:30]:
And so surgery was your calling from the get go, huh?
Dr. Yuman Fong [00:02:32]:
Yes. I still remember all. When I was young, I would think My hands, are they big enough, Are they small enough? You know? Cause I didn't know what would make a good surgeon. And I didn't realize that that's not what makes a good surgeon. And, and always wanted to be a surgeon. So I was very young.
Dr. Monty Pal [00:02:47]:
What makes a good surgeon?
Dr. Yuman Fong [00:02:49]:
Decisions. And I say to my fellows, it's about choosing the right patient, it's about choosing the right operation, it's about choosing the right time to do the right operation.
Dr. Monty Pal [00:02:58]:
Got it. I mean, you've had such an illustrious career. So tell us about the surgeon scientist role that you've taken on over time and how that evolved.
Dr. Yuman Fong [00:03:05]:
So I was in training at Cornell, and those were kind of golden times on York Avenue, which is where Cornell University is in New York City. And that's because at that time it was very clear that the reason people got sick from infection was not just the bacteria or the viruses. It was really that the body overreacted and made a new class of proteins called cytokines. And I knew that at Rockefeller University they were working hard on this. And so I joined a group that discovered tumor necrosis vector. And then suddenly science was not just textbook, was not just, you know, things that you read about and you were taught. Science was what we invented and very exciting times. And so I was part of the group that also tried to cure sepsis with TNF antibodies.
Dr. Yuman Fong [00:03:53]:
And so as you know, if we gave an antibody to tumor necrosis factor, suddenly interleukin 1 didn't fire, interleukin 6 didn't fire. All of those bad cytokines that killed people in the first few days after bad infections didn't fire. And so we thought we would be able to give it to human being, rescue them from dying from infection. Turned out by the time we were ready to give it, it was already triggered. But all of those antibodies now are amazing parts of medicine to go treat inflammation, chronic inflammation. So, you know, when you think about arthritis and how anti TNF antibodies now have changed the world, and when you think about other inflammatory diseases, it's been amazing.
Dr. Monty Pal [00:04:37]:
You know, from a scientific perspective, I think these days I really think of you in the context of so many things, but one element in particular is oncolytic viruses. That's something that I think your lab has become really world renowned for. So how did that focus sort of evolve? Was it from your days of memorial or beyond that?
Dr. Yuman Fong [00:04:52]:
Just like many things, it's serendipity that usually brings about progress. So I was sitting at my lab bench at Rockefeller University and it Turned out in the same room were some very, very remarkable human beings. Okay. Bruce Beutler was over there onto my right. And to my left was Michael Brownlee, who is one of the best diabetologists in the world. And one afternoon I was chatting with Michael, and he said, you know, I have a friend who is working on these viruses that kill cancer. Maybe you should. We should have a chat.
Dr. Yuman Fong [00:05:22]:
And it was that one introduction and that got me into the field. And so again, the whole idea of this is that can we find or make a virus that infects only cancer and kills cancer? And so. And from there, we've come to human trials, and we are very hopeful where that will bring us.
Dr. Monty Pal [00:05:39]:
You know, it's amazing when I think about virology, microbiology in general. You know, when I entered into this field in oncology, I thought I'd really be separating myself from it, but frankly, it's coming so full circle, right, with the role of the microbiome in cancer, something I'm very interested in virology, something that's really, I think, been a big essential part of your laboratory development. You know, I'll tell you, it inspired me so much that I actually started tutoring the microbes section of my kids Science Olympiad.
Dr. Yuman Fong [00:06:03]:
Oh, my goodness.
Dr. Monty Pal [00:06:04]:
I think this was the wave of the future. I said to my son and my little daughter, I said, gosh, you know, microbes are going to be an essential part of medicine down the line. If you want to go into medicine, you better know them.
Dr. Yuman Fong [00:06:13]:
Oh, I think it's so right. And so that's why when people go, oh, should I go do molecular biology? I go, well, that's fine as how we read out things and how we direct things. But think about the core biologies, okay? And that's how things grow, how microorganisms grow, how we live in synergy with our microorganisms. And then how do we exploit microorganisms to kill cancer? Okay. Or whatever disease? So, you know, again, people always come up and say, how do you go and find a virus that kills cancer? And I go, listen, nature does it all the time where it makes a virus that only does one thing. So when you think about hepatitis, viruses only infects the liver.
Dr. Monty Pal [00:06:52]:
Yeah.
Dr. Yuman Fong [00:06:53]:
So you go, how does that happen? Meningitis virus only infects the brain. Right. So the idea that we can actually have a virus that only infects cancer and kills cancer, not far fetched, okay? And so that's what we're working on. And that's. We have some Very good candidates now in human trials. So.
Dr. Monty Pal [00:07:09]:
So, yeah, exactly. I'd love for you to expand on that a little bit, because in my mind, this is a beautiful kind of bench to bedside story that you've really shepherded from the start. So, you know, don't be humble here. Tell us a little bit about, you know, that journey for you.
Dr. Yuman Fong [00:07:20]:
Yeah. So last generation. Okay. And. Well, I'm gonna. I'm gonna even take it further back. Okay, sure. The idea that viruses could kill cancer, we've known that for a long time.
Dr. Yuman Fong [00:07:31]:
And the reason we know when human beings were vaccinated against rabies, there were certain patients with cancer where it was noticed that cancers got smaller. But back then, in the early 1900s, couldn't exploit it because we didn't understand viruses as well. Back in the early 1900s, we just couldn't exploit that knowledge because didn't know viruses very well. So in the 1920s, and it was too early then in the 1960s, people started taking all these new viruses that they discovered and try to throw it on cancer cells in sea whether it killed things and killed cancer. So around the country, there were a number of clinics that sprung up, including one at Sloan Kettering, where they gave natural viruses to kill cancer. That included everything from measles to west Nile. And it clearly killed cancer, but the toxic effects of normal viruses that existed in nature was just too high. The 1970s into the 80s, people started designing these viruses.
Dr. Yuman Fong [00:08:28]:
And that's where I came into the scene, because I was a young investigator, and we were talking about how should we redesign the virus? Should we take away that gene or insert that gene? And we had a whole generation of viruses that we gave to human beings. But we were much too slow, and we made the viruses much too weak. And that's because we were all afraid of all the things you see in movies, you know, where viruses designed to kill cancer would hurt someone. And so that whole generation, only one virus made it, and that was TVEC virus from Amgen then that was clearly able to kill skin cancer, melanoma, and kill it in a very good way. But it taught us that we needed to move faster, that viruses were safe. It also taught us that virus kill cancer not only by infecting and killing it, but also stimulating the immune system to recognize cancer. So spin far forward. Okay.
Dr. Yuman Fong [00:09:23]:
2013, I said, we need to reboot. And a number of other groups decided to do the same thing. But that's why I came to City of Hope. I came here because I said, I now know what to Go do. City of Hope has the facilities that allow me to do it. I needed a high throughput facility. I needed a production facility that whatever I made in the laboratory that's good can immediately go to human beings. But this time I said, I'm not going to try to be so smart as to design the virus.
Dr. Yuman Fong [00:09:54]:
Let's let nature do it. So I took nine vaccine strains of virus, put it into the same cell in nature. That never happens, right? Right. Viruses trade genetic material. So I isolated about 200 new viruses that never existed on earth and then I put them through high throughput screening. I threw them on all 60 of the NCI 60 cancer cell lines. Those are the 60 cell lines at the NCI National Cancer Institute screens new compounds against. I also added 30 more that I thought might work.
Dr. Yuman Fong [00:10:25]:
So 90 cell lines. And I only this time cared about viruses that killed all cancers, meaning that I wasn't trying to find a cure for liver cancer or brain cancer or skin cancer. I said, let's go find a cure for cancer. Then I took the six that killed everything and injected them into animals and said, which one is safe? So that's actually what we brought into human testing is a virus that killed almost every cancer we know in the petri dish and was enormously safe. Six logs of therapeutic index. And so that's what's in trials now. So when you think about that, that's really accelerating evolution to try to kill cancer. That's what we were trying to do.
Dr. Monty Pal [00:11:07]:
This period in particular, right around the time this podcast is airing, is just this monumental phase of growth for City of Hope. Right. I mean, we've got our Orange County Hospital opening. Right. We've actually got all these new facilities across Chicago, Atlanta and Phoenix. So a lot of work to really sort of figure out staffing for all these locations and making sure that, you know, we maintain this stellar reputation that we've got. So what's your thoughts on how to do that? Fanning out to all of these new locations and really sort of maintaining quality as we do this?
Dr. Yuman Fong [00:11:36]:
It's Orange county. It's really a direct extension of us. Okay. And so in surgery, we sort of thought of that as just our same group of faculty. And we're going to have folks that will go back and forth or I have related programs that talk day to day with one another. Elsewhere, it's going to be a little harder. Okay. And Atlanta's a long ways, Chicago's a long ways and Phoenix.
Dr. Yuman Fong [00:12:02]:
But again, the mechanisms now we have put in place to help with that and I'm very involved in the recruitment in all three places of surgeons. And we are looking at how to go make sure the quality is good, that the programming is leaning towards the future. And so, again, my big model is more cures, less invasive. And for solid tumors, as you know, a surgeon is a very essential part of cure for almost every solid tumor, except for cell.
Dr. Monty Pal [00:12:32]:
Okay, of course.
Dr. Yuman Fong [00:12:33]:
And so I now need to put good surgeons in all these places and then make sure we all work together and be heading towards the future, which is less and less invasive therapies, and so very exciting times. But we'll have some challenges before we get there.
Dr. Monty Pal [00:12:51]:
So this all begs the question of an area scientifically that I know you're very interested in, which is remote surgery. Right. Maybe we could talk a little bit about just the general principle first. I mean, for the audience that may not be familiar, what is remote surgery?
Dr. Yuman Fong [00:13:05]:
So in the 20th century, remote surgery is not possible. Right. In order to do surgery, you have to cut someone open and you have to put your hands in whatever cavity is. Do the work. In the 21st century, life has changed a bit. And that's because robotic surgery is here now. We can actually reach into human beings with 8 millimeter incisions, have a computer stand between us and what's inside, and control the tools to go do the work. Right now, we sit in the corner of the same operating room as the patient, but down the line, does that have to happen? Okay, could we sit next door where we could have our masks off, have a cup of coffee so that if we're thirsty, we don't need to scrub out and go someplace else? Or can we do it from here to Orange county if it turns out the best expert is here and not down in Orange County? And beyond that, there's the mentoring.
Dr. Yuman Fong [00:14:02]:
Okay. Is if someone has questions in the operating room, they now will call for a peer to come and see what they think. And oftentimes that means somebody, if it's in the middle of night, driving in, waiting, 10, 20, 30, 40 minutes to come to the operating room and give an opinion that may last five minutes in the future. I don't think that's what's going to happen. I think it's somebody we'll have a console where they are and be able to look in and give an opinion immediately. For the surgeon in the operating room that just needs an additional opinion, or if it is that we need a vascular surgeon and it was unanticipated, we may not need to wait an hour and that's because that's really tough if somebody's having a major bleed to wait an hour for a vascular surgeon to show up. I think that down the line, the vascular surgeon may be able to reach in from where they are on their consoles within minutes to go and fix something. So I think life is going to change, and how we go and formulate that is going to be really, really important.
Dr. Monty Pal [00:15:06]:
See, you're getting me to think about this from a different perspective, because I think you're referring to it at this point, at least, as more of an assistive technology. So, you know, surgeon's in trouble and someone sort of jumps in and helps. If I'm framing this correctly, what about the potential to independently do surgery remotely? Is that something that you might see in the foreseeable future?
Dr. Yuman Fong [00:15:25]:
It's already happening.
Dr. Monty Pal [00:15:26]:
Really? Really.
Dr. Yuman Fong [00:15:27]:
I didn't realize that in other parts of the world. In China, for example, they are already doing remote urologic surgery from one place to the other, thousands of miles away.
Dr. Monty Pal [00:15:36]:
You're kidding.
Dr. Yuman Fong [00:15:37]:
That's because the regulatory aspects are totally different. And so over a 5G network, they're willing to go do that because there are no government regulations against it or for it. Okay. In America, it's going to be a little tougher. And. And the whole idea there is that if you were in Inner Mongolia and there's no expert in robotic kidney surgery, can you get somebody from Tsingtao who's really, really good at it to go do the work when the person in Tsingtao doesn't want to live in Inner Mongolia? Okay. And so can that just be scheduled so that once a month or once a week, two or three operations happen, and the patients don't need to travel thousands of miles away? So that's already happening. But I think it's gonna be more and more complex operations.
Dr. Yuman Fong [00:16:23]:
Okay. And it's gonna be more than just operations. Because imagine if somebody has a stroke and goes into a community hospital, you have an hour to save the brain. And so your choices are gonna be, if there's no interventional stroke radiologist, that you're gonna transfer the patient, and in that transfer, there may be permanent sequelae or death. Okay? So if you actually had a remote robot that can. That could be plugged in by a technician, and your remote stroke radiologist can work from the stroke center and suck out the clot in the brain and save the brain, probably would say yes and sign the consent. Okay. And so there are going to be many, many work scenarios like that that will work.
Dr. Yuman Fong [00:17:10]:
Right now, though, here at the City of Hope, we are partnering with others to go and try to set up for the regulatory hurdles to be overcome, the communications hurdles would be overcome, and the technical hurdles to be overcome. And so, again, working very hard on this with many colleagues around the country.
Dr. Monty Pal [00:17:29]:
And I'm just putting my clinical trial hat on here. Right. Is this something that needs to be formally tested? Would you have a trial looking at remote surgery versus on site surgery? Or is this something that might get approved through different mechanisms?
Dr. Yuman Fong [00:17:42]:
I don't think it'll be a randomized trial. Okay. I think right now where we are is we need to prove that we can have communication setups that allow us to transmit data in. In great fidelity and with no interruption. Okay. And with. And with high security. So that's all being set up now.
Dr. Yuman Fong [00:18:00]:
And then we need to say which robots might we use and what are the workflows that we might do. And then we just have to prove that it is safe and routinely safe. And, and. And that there are very little likelihood that a catastrophe can happen. And so all those are. Are fascinating. In fact, we did a really interesting experiment early in the year. We actually, we, as a US Mirror robots, Silvato and.
Dr. Yuman Fong [00:18:28]:
And many other groups out there, we sent a robot up into the International Space Station.
Dr. Monty Pal [00:18:32]:
I heard about this. I heard about this.
Dr. Yuman Fong [00:18:34]:
And on Super Bowl Sunday, I actually got to operate from Earth and do simulated surgery on the space station. That was so much fun. Wow. Yeah. And so that was just a proof of principle. We'll have many more experiments like that that actually show on Earth what we can do. And I am absolutely convinced that operating from one side of America to the other will have very little lag and will have very little delay and risk. And at some point, we're gonna go and have that as one of the workflows.
Dr. Monty Pal [00:19:09]:
Awesome. And it seems to me as though with our expansion, that's the perfect testing ground for this.
Dr. Yuman Fong [00:19:12]:
Right.
Dr. Monty Pal [00:19:13]:
With your surgeons that you hire in Atlanta and Chicago, you know, having perhaps an expert either at that site or at our site, really navigating things, mentoring the junior faculty. It could be an amazing way forward. Right?
Dr. Yuman Fong [00:19:24]:
Amazing way forward. And so think about this. We have some folks that are really good at taking out just part of the kidney as a therapy for kidney cancer. Right? Sure. Most institutions take out the whole kidney. Saving part of the kidney is really important because many of those individuals get kidney cancers on the other side. Okay. And so imagine if a handful of the really great experts in doing partial nephrectomy can actually do this to many sites around the country.
Dr. Yuman Fong [00:19:55]:
And the fallback in those institutions is really to do a total nephrectomy. Okay. And. And if there's somebody, a good surgeon in the room. But now you're doing a lesser operation that might be better for the patient, I can see that as a highly desirable workflow.
Dr. Monty Pal [00:20:12]:
I love that. I love keeping those nephrons. Right. I love keeping those nephrons. That's a good idea.
Dr. Yuman Fong [00:20:17]:
Yeah. But think about harvesting for a kidney, harvest for transplant.
Dr. Monty Pal [00:20:24]:
Okay. Okay.
Dr. Yuman Fong [00:20:25]:
Would you want the person who did it robotically 2000 times, or would you, like, want the person who did it 10 times?
Dr. Monty Pal [00:20:32]:
Oh, gosh, yeah. Easy choice. Easy choice. Right.
Dr. Yuman Fong [00:20:35]:
And I don't care if that person who's done it 2000 times is 100 miles from me or a thousand miles from me, because it's not, you know, his experience will still probably trumpet for me as the person I want.
Dr. Monty Pal [00:20:50]:
Absolutely, absolutely. You know, on another topic, I mean, I think one thing you've done really well in is really integrating with a number of international societies within surgery. So tell me about some of the experiences, experiences there that have maybe been the most meaningful for you.
Dr. Yuman Fong [00:21:04]:
So surgery back in the early 1900s, okay. The way surgeons learned is that they would finish their training and then they would take a European tour. They would actually get on a plane, go to Europe, and travel around for six months to all the famous clinics to see what people were doing and try to bring it back to their practice. Okay. I still think that is a great, great thing. Even though the Internet's wonderful, it's been shortening all the paths to learning. I still think that young people should travel, see the places that are doing the most innovative work. And so from that standpoint, I've been pushing my young people to travel and do that.
Dr. Yuman Fong [00:21:43]:
But that's what international societies allow us to do. And what they do in Europe and Asia and America are sometimes a little bit different. And going to the meetings that are in Asia looking at robotic surgery, the goals and what's accepted as practice is oftentimes very, very different. Robotic thyroid surgery is huge in Asia because Asian patients form what we call keloids. And so if you make a little incision in a young person's neck, there could be a terrible scar that could then be considered deforming and have social consequences, whereas in America, it's a little bit different. Most of the scars disappear in the neck. And so that's why, if you want to see the greatest thyroid surgery robotically, you need to go to Asia. And so, again, partnering with our international societies now, we've been doing very well, but we're also now pushing to bring more of the national society presence here to City of Hope.
Dr. Yuman Fong [00:22:50]:
So this coming year, the Society for Asian Academic Surgeons has allowed us to host their meeting.
Dr. Monty Pal [00:22:55]:
Oh, great.
Dr. Yuman Fong [00:22:56]:
And the Clinical Robotic Surgery association, which is the oldest robotic surgery association, has also allowed us to host their meeting here this year.
Dr. Monty Pal [00:23:06]:
So this is going to be at City of Hope.
Dr. Yuman Fong [00:23:08]:
City of Hope.
Dr. Monty Pal [00:23:08]:
Amazing.
Dr. Yuman Fong [00:23:09]:
Both meetings. And so looking forward to that.
Dr. Monty Pal [00:23:11]:
Yeah. I mean, I always think about you and the future scape of, you know, oncology, surgery, et cetera. You know, the one thing that looms over all of us. Right. Is AI. Is AI. And I know that's something that you must have been thinking about for a long time. AI and surgery, what.
Dr. Monty Pal [00:23:27]:
What's next for it?
Dr. Yuman Fong [00:23:28]:
Oh, well, AI's been in surgery a long time, and, you know, again, people go, oh, what's about to happen to AI? Go, well, what's been happening? We have a lot of instruments in the operating room that are completely controlled by the computer. Okay. When we go seal something with coagulation, we have now very smart instruments that know exactly when it's sealed perfect, without charring and without overburning and tell us. And then we'll cut the piece of tissue and allow us to do amazing surgery. That's part of what is allowing us to get people home so fast. Okay. But as you know, one of the big projects we have is really trying to do major surgeries robotically and send people home very quickly. And so we just published a paper.
Dr. Yuman Fong [00:24:11]:
307 outpatient liver surgeries and outpatient liver surgery.
Dr. Monty Pal [00:24:15]:
Really? Okay.
Dr. Yuman Fong [00:24:16]:
Meaning less than 24 hours. So Medicare considers anything less than 24 hours as outpatient.
Dr. Monty Pal [00:24:22]:
Okay.
Dr. Yuman Fong [00:24:22]:
And. And here it is where 30 years ago, when we started really doing liver surgery, it would be that the patients would be in the ICU for two, three days, and they would be in the hospital for like, 15, 20 days. Now we're sending them home the same day or the next morning. So one of the things that's helping us from AI is actually analyzing what happens to them when they're home. Meaning we send them home with trackers.
Dr. Monty Pal [00:24:46]:
Okay.
Dr. Yuman Fong [00:24:47]:
Yeah. And that's because there are three ways to track people, if you really think about it. There's physiologic ways you could track folks. Okay. And meaning blood pressure, pulse rate, what their weights are, and all of those things. There is patient reported symptomatology, where they tell you, I have anxiety, I have pain, I am not of good quality of life. Then lastly, there are activity trackers where we can actually track how far they walk, how far they're from their home, how many times they make it more than 100ft from their home in a single day. So we're now trying to have the computers after we gather all this data, what actually matters.
Dr. Yuman Fong [00:25:27]:
Okay. And it's totally fascinating data coming in and helping us triage next generation patients that go home really quick.
Dr. Monty Pal [00:25:35]:
Yeah, absolutely. Well, I gotta say, now that we've geeked out on the science a little bit. Right? Yeah. I'm going to shift gears and talk about something I know that you and I are very passionate about. And that's music. Music is a huge part of my life. You know, I play a little.
Dr. Yuman Fong [00:25:48]:
We're going to use the studio to play some music someday.
Dr. Monty Pal [00:25:51]:
The acoustics are amazing, aren't they? They're really good. We should definitely bring our instruments in here. So, you know, as you know, I play a little piano and guitar on the side with my son who's a drummer. You have an amazing studio at home, don't you? Tell us about this.
Dr. Yuman Fong [00:26:03]:
Well, it's not so amazing in the sense of the trappings. Okay.
Dr. Monty Pal [00:26:08]:
Okay.
Dr. Yuman Fong [00:26:08]:
Yeah.
Dr. Monty Pal [00:26:09]:
Okay.
Dr. Yuman Fong [00:26:09]:
And what is amazing is that, you know, we as a family get to play. I have a family group called Feng Shui. You need a family group name. Okay. And this is how my kids and I are still bonding. Okay. And so every holiday when everybody comes in, we play music. And.
Dr. Yuman Fong [00:26:30]:
And it's been a very wonderful part of my life is growing up with music and my kids growing up with music and I'm still trying to learn new instruments and I've now come to realize I cannot learn some instruments.
Dr. Monty Pal [00:26:44]:
I was going to ask you who plays what, but I have a sense you might play everything. What is your.
Dr. Yuman Fong [00:26:48]:
I do mostly string instruments, so my favorite is the viola and the electric bass. And so those two I'm pretty good at. And. And then, you know, I have, I. I have kids who are. Are keyboard people. I have kids who are brass people and have kids. I have a son in law who plays guitar.
Dr. Yuman Fong [00:27:07]:
But most important is that I have a son in law who's a drummer. Okay. You absolutely need a drummer.
Dr. Monty Pal [00:27:11]:
Yes.
Dr. Yuman Fong [00:27:12]:
And then my granddaughter is two years old and starting to play the drums.
Dr. Monty Pal [00:27:16]:
I love it. I love it. Yeah. No, I couldn't agree with you more. My son, the drummer, he. He definitely keeps time for us. It's so critical. So critical.
Dr. Monty Pal [00:27:24]:
Even Question for you. So the title of this podcast is on the Edge of Breakthrough. Right. What does that mean to you?
Dr. Yuman Fong [00:27:33]:
Cure for cancer.
Dr. Monty Pal [00:27:35]:
Okay.
Dr. Yuman Fong [00:27:37]:
But let me frame that, because in stage one and two, we've already done it.
Dr. Monty Pal [00:27:43]:
Right?
Dr. Yuman Fong [00:27:43]:
Haven't we?
Dr. Monty Pal [00:27:44]:
Yeah.
Dr. Yuman Fong [00:27:44]:
And that's the thing that people don't get. Stage one and two cancer. We have already cured cancer. We can find cancer in stage one and two and get people to come for treatment at good places. We've already cured cancer. It is that we see stage three and four, and particularly at stage four. Right. It's kind of hard.
Dr. Yuman Fong [00:28:02]:
So in what I work on, which is liver surgery, stage four, colon cancer in the liver, we now cure 40%. Okay. And that's something that nobody thought was possible. Okay. When we first started really doing it in the 1980s, everybody would make fun of us. Okay. They would go, why are you doing this? And. And then there's still parts of the country I go to where they go, why are you doing this? So again, it's really stage three and four.
Dr. Yuman Fong [00:28:29]:
What are we going to go do? And every incremental step, I hope that the next step will be a giant step because we make little progress. Fine. But every now and then, a big step happens. Right. Checkpoint inhibitors. Okay. Targeted therapies for lung cancer. Amazing.
Dr. Yuman Fong [00:28:46]:
Right. And. And so right now I'm pushing really hard on cell therapies. That's because this is the time. And that's because there is a subset of patients where their native immune cells are exhausted. We now need to go engineer the cells that we could expand that target. Amazing. And send back in to go kill cancer.
Dr. Yuman Fong [00:29:11]:
And so this is also the place to do it. Right. With Steve Foreman being here and all the various folks that are great at doing cell therapies. So I am working hard on T cell therapies, whether it's TILs or CAR TS for solid tumors. When I say I, it's a royal eye. Of course. It's a giant team with us, with Steve's group with medical oncology. But I am very hopeful.
Dr. Yuman Fong [00:29:37]:
Okay. And so we're hoping a. Yeah. That we have actually a universal cartige on humans. I don't know whether you know about this.
Dr. Monty Pal [00:29:47]:
No, no. You gotta tell me more.
Dr. Yuman Fong [00:29:49]:
So we have a virus that kills cancer really well and infects almost every kind of cancer. Right. We've engineered it to express CD 19.
Dr. Monty Pal [00:29:56]:
Oh, wow. Okay. Okay.
Dr. Yuman Fong [00:29:58]:
Therefore, by sending it in, we're hoping that it will then coat the tumor with CD19, which is the protein that allow CD19 car ts to work. So theoretically, this is like a virus going in to kill cancer, but at the same time it sort of laser targets those tumors for car T cells to come. And so we're hoping to be in humans in the next 12 months.
Dr. Monty Pal [00:30:23]:
I mean, that principle for a clinician is straightforward enough, right? Because then you take all these CD19 car ts that have been so wildly effective in lymphoma and boom, you've got a direct application across the broad swath of malignancies. Right. Is that the general principle?
Dr. Yuman Fong [00:30:37]:
That is the general principle. Ok. And so the trial we are hoping to bring up and running actually doesn't care what cancer.
Dr. Monty Pal [00:30:43]:
Awesome. Awesome.
Dr. Yuman Fong [00:30:44]:
And right now we're actually in humans with the CD19 virus and blends. Ida.
Dr. Monty Pal [00:30:50]:
Oh, brilliant. Well, I can't wait to see how that pans out. That's actually super exciting. Super exciting. You know, I have to tell you, every time I sit down with you and I learn something new, I just as. As soon as I think I know everything about you, I learn something different. And I learn for our audience something very interesting that you actually just got back from a rave in London this weekend. You knew I was going to bring that up at some point.
Dr. Yuman Fong [00:31:12]:
Oh, it's both good and bad. So every two years, my wife and I pick a new sport and try it.
Dr. Monty Pal [00:31:18]:
Okay.
Dr. Yuman Fong [00:31:19]:
And if we like it, we keep going. And so one of the sports we picked up about 10 years ago that we really, really like is ballroom dancing.
Dr. Monty Pal [00:31:27]:
Okay.
Dr. Yuman Fong [00:31:28]:
So this year we were going to go and try to dance in all the continents in the world and do native dances there that related. So three weeks ago, my wife dragged me to London to dance at a rave. Okay. This was a rave in London and I hurt my knee. That's why I was limping into the studio. And so again, we are hoping this year to go dance the tango in Argentina, to go dance the salsa in Havana and to go dance the waltz in Vienna. And so that's actually on the docket this year.
Dr. Monty Pal [00:32:03]:
That's so funny. I had no idea that the rave was actually the local dance of London. But now I.
Dr. Yuman Fong [00:32:08]:
That's how I think of it.
Dr. Monty Pal [00:32:11]:
That's a good one.
Dr. Yuman Fong [00:32:12]:
Yeah.
Dr. Monty Pal [00:32:12]:
That's a good one. So I'm going to close with one question. I know I'm going to get an interesting answer to this. Where's your next trip? Where are you guys going?
Dr. Yuman Fong [00:32:18]:
To San Francisco to see my mom.
Dr. Monty Pal [00:32:20]:
Yvonne, this has been just an amazing, amazing time spent with you. Thanks so much for joining us today.
Dr. Yuman Fong [00:32:25]:
Oh, thank you very much for having me today. Thank you.