In the season 3 finale episode of On the Edge of Breakthrough: Voices of Cancer Research, Dr. Monty Pal welcomes Wesley Yip, M.D., Assistant Professor, Division of Urology and Urologic Oncology, Department of Surgery at City of Hope. The conversation delves into Dr. Yip’s innovative work investigating the role of the microbiome in kidney cancer, the rigorous protocols required for scientific discovery and the promise of microbiome modulation to improve patient outcomes. He discusses the importance of mentorship, collaboration, and building multidisciplinary teams, as well as the challenges and rewards of balancing clinical practice, research, and family life.
In the season 3 finale episode of On the Edge of Breakthrough: Voices of Cancer Research, Dr. Monty Pal welcomes Wesley Yip, M.D., Assistant Professor, Division of Urology and Urologic Oncology, Department of Surgery at City of Hope.
The duo explores Dr. Yip’s career journey sparked by an early inspiration in his father’s urology practice to the cutting-edge urological oncology and microbiome research he now leads.
The conversation delves into Dr. Yip’s innovative work investigating the role of the microbiome in kidney cancer, the rigorous protocols required for scientific discovery and the promise of microbiome modulation to improve patient outcomes. He discusses the importance of mentorship, collaboration, and building multidisciplinary teams, as well as the challenges and rewards of balancing clinical practice, research, and family life.
Beyond his scientific achievements, Dr. Yip reflects on the value of asking for help, the power of saying “no” to stay focused on long-term goals, and his commitment to mentoring the next generation of cancer researchers. He shares advice for aspiring surgeon-scientists on embracing collaboration, seeking guidance, and pursuing personalized approaches at the edge of breakthrough.
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Presented by City of Hope: www.CityOfHope.org
Dr. Monty Pal (00:00):
I'm Dr. Monty Pal from City of Hope, and this is On the Edge of Breakthrough, Voices of Cancer Research. Each episode, we bring you the minds behind the science, the stories behind the data, and the breakthroughs that could change everything. Let's dive in. Welcome, everyone. Today, I'm delighted to have a very dear friend and colleague, Dr. Wesley Yip. Wes is a terrific surgeon scientist, assistant professor in the Department of Surgery here at City of Hope. Uh, he has an illustrious career thus far. He went to Columbia for undergrad, uh, did his residency and medical school training at USC, then went off to Memorial Sloan Kettering for his fellowship, and now is here with us at City of Hope. Wes, welcome to the program. Thank you so much fory happy to be here. Yeah, you got it. Well, uh, this is like talking to family here.
(00:50)
You and I have gotten really close really fast since you started here at City of Hope. But I wanna take you back to the very beginning. So you're essentially playing out a dream that I have of one day having my kids come and work with me or at least join the same field, right? Your dad is a very, very prominent urologist in our community, Felix Yip. What was it like growing up with him?
Dr. Wesley Yip (01:09):
Uh, well, growing up with my dad was, um, not what urology, I guess, turned out to be, uh, in a good way because he worked eight days a week, seven days a night, uh, seven nights a week. Um, he still pretty much works that, that hard. And so when I saw what he was doing, I didn't really think that I could do that, that was for me. Um, but then I did spend my summers here at City of Hope as an undergrad student. I saw the group here, uh, David Josephson, Tim Wilson, and Clayton Laub, my boss now. Uh, what they were doing, um, I saw a lot of robotic surgery, a lot of these cutting, cutting edge breakthroughs for surgical techniques, and that was really what inspired me to then go into urological oncology later on. So I did start here and then ended up circling back here.
(01:48)
That's so awesome this was back in hih school that you were actually on the city of Hope Campus. Uh, as an undergrad student. So I spent my summers. I would come back here as an undergrad student.
Dr. Monty Pal (01:55):
Yeah. And that was a really sort of pivotal time, wasn't it, in surgery, right? I mean, I think that robotic surgery had been around for, you know, a, a reasonable period, but I think that's really when City of Hope was hitting its stride and really becoming a leader in robotics. Isn't that right?
Dr. Wesley Yip (02:08):
Yeah, only a couple places really worldwide in the early 2000s were doing it. Later 2000 specialized centers like here. And then it really took off in 2010s, but I think City of Hope was one of the pioneers for that, yes.
Dr. Monty Pal (02:19):
Got it. Now, I'm gonna share something with the audience that I'm sure they don't know, which is that I actually went to college with your older brother. Yeah. Right? Kyle. Uh, this is so wild. So as many of you know, I did this program where you start college early and Kyle and I started at Cal State Los Angeles when we were both 13. So my history with the Yip family goes way, way back, way, way back. I hope so.
Dr. Wesley Yip (02:54):
Um, so what I really liked about, um, what I got to see from him is what urology was. It's not that well known in medical school. So a lot of students find out about a little bit later on, um, and then sometimes they'll choose other paths because they didn't really find it early enough. Had a little bit of an earlier exposure, was able to see that's a combination of surgery and medicine. You follow your patients for really most of their lifetime. You help out with a lot of really quality of life changing, um, disease states for them, or in the cancer setting, it's often curative. So that's what I really appreciated about it and, and led me to wanna pursue it further.
Dr. Monty Pal (03:25):
Oh, that's very cool. A- and so, you know, of course, after getting into residency at USC for urology, which is, which is no joke, I mean, that's a difficult program to match into. You then went off to a very prestigious program in urologic oncology training, specifically at Sloan Kettering. So tell us about that pathway for you and how that was influenced.
Dr. Wesley Yip (03:42):
Sure. So, um, as a student at USC, I got to see the group there, um, all the big cases that they were doing, how high volume it was, how proud people were to be a USC trained urologist, and also a lot of my colleagues here are USC trained as well. Um, so very high volume, uh, surgical group there. And then what I wanted to then do was learn a little bit more about the science behind cancer, clinical trial design, a lot of the translational research, which is why I wanted to do fellowship at Memorial Sloan Kettering. So I went off to New York, um, back there for a couple more years. Had a dedicated research here in the Jonathan Coleman lab, so a lot of, uh, upper tract urothelial carcinoma work. Um, and also, uh, with the bladder group, um, I was really seeing how we would dive deeper into tumors.
(04:24)
So pretty much every tumor that was removed there ended up going to some type of genomic sequencing or single cell RNA sequencing, bulk RNA sequencing. Things after that from tissue or urine or blood, we sent off our metabolomics, and we really went into these tumors to try to figure out more the tumor microenvironment and go beyond some of these clinical factors that we would know about. That's what I spent most of my
Dr. Monty Pal (04:44):
Research here doing. That's awesome. That's awesome. And, and I remember sort of seeing that work come to fruition. I'd see you at AUA, the American Urologic Association meetings at SUO, the Society of Urologic Oncology. These are sort of big meetings in our, our respective spaces, more, more surgically oriented where you can showcase your research. And I remember seeing you on multiple podia. And it was really at that time that me and Clayton Lau, who, as you'd mentioned, is our chief of urology and Kevin Chan, who runs our bladder cancer program, we kind of put our heads together and we said to ourselves, "We really want Wes." I mean, he's super productive at this early stage in his career. He comes with sort of great references from all of our surgical colleagues who knew him from USC. Um, but I wanna hear from you, from your side.
(05:25)
I still remember having, you know, these recruitment lunches and dinners with you ahead of you joining us at City of Hope. I'm sure you had plenty of options coming out of the illustrious training that you had. What was it that sort of sold you on our campus versus others? So,
Dr. Wesley Yip (05:38):
Um, actually something you might not have shared that much before is kind of this, um, what had happened when I was looking for a job option. And I would say that, you know, not just being on this podcast because of you, but really being at City Hope is because of you after reaching out to me, I remember after GUASCO. So I presented on, uh, the neoadjuvant chemotherapy for Upper Tract trial and afterwards I got a DM in my Twitter inbox from you that was, I think it said, "Hey, bro, do you have time to talk?" And I had your phone number in there. And I was so excited, I screenshotted it because I felt like, "This might be something for my future." Uh, ended up really being because I'm here now. And, uh, I interviewed at a bunch of places, yes. I was looking for a surgeon scientist position somewhere.
(06:17)
Um, somewhere would have a lot of good mentorship, you had to build a career. And, um, I had one interview, um, at AUA that didn't go as I expected to, and I was actually pretty disappointed by it. Um, I felt like they didn't really know that much about me or what I wanted to do, not much of a plan of fostering an environment that I could thrive in. I actually called my dad and my wife right afterwards and I was like, "You know, that wasn't what I expected. I really thought that was gonna be it and that wasn't." And then about an hour later, I sat down with you, Clayton Lau and Kevin Chan, and you knew everything about me, everything I've done already, all these things about my CV, um, how to build up a career for me. And it was like this personalized plan that was presented to me of career development.
(06:57)
And it was really impressive. And it was just, you know, an hour later that I had this, it was complete opposite. And I was like, "Wow, you know, I think this is where I wanna be. " This multidisciplinary group that, um, is really trying to build up an environment that I can grow in and, um, uh, protect my time and then help with my academic goals.
Dr. Monty Pal (07:14):
That's awesome. Well, I'm, I'm so glad we were able to sell you on, on us here. I mean, it was, it was frankly an easy decision for us to make. We, we really wanted you to come here bad and obviously we're, we're thrilled that you signed on. You know, so since coming here, you have been insanely productive, insanely productive. And I, I think this is by any measure, whether it comes to, you know, what you've done clinically, what it's, what you've done from the standpoint of research and so forth. Before we get into the nitty-gritty of what it is that you've actually accomplished here, I want you to maybe give us a couple of lessons learned. And, and it can be mistakes as much as, you know, good things that you've accomplished to date, you know, in your first couple of years here on junior faculty, what do you have advice for young surgeon scientists?
(07:54)
The
Dr. Wesley Yip (07:54):
Biggest one is not being afraid to ask for help, I think, and any level of things. So I think a lot of times we see these big studies and trials, we see the first author, the last author and soon they just did everything. And then finding out more about how these things work, they have huge teams behind them and, you know, they, they ask for help. They have other people to help them with these things. And I think just for a long time, I was afraid to ask to send out a cold email to just talk to someone and say, "Hey, can you help me with this? " And then more and more I would do that and found out that people are very collaborative and happy to help and engaging them. So not trying to do it alone is one of the biggest things, um, that I learned here.
(08:29)
And the second thing, um, I think is also making sure that everything that I agree to is something that I can do, so I don't wanna promise something I can't deliver. And I think that's important too for long-term relationships also. If someone asks me to do something and I don't do it, they're not gonna ask me again. So it's okay to say no. It feels hard to, especially as a younger either trainee or young investigator to say no, but sometimes you have to be realistic about what you can handle and what you can deliver.
Dr. Monty Pal (08:53):
Yeah. No, I, I think that's actually terrific advice. And I think that advice evolves over the years. That second bit, I'm gonna focus in on that because I will say when I meet with residents and when I meet with medical students, to them, I often say, "You gotta say yes to everything, right?" Yeah. You know, I think that at that particular stage and career, you really do have to spend the nights and weekends and what have you, really sort of cranking so that you can get the elements on your CV you need to get to the next stage. I think by the time you get to our phase as junior faculty, senior faculty, et cetera, you know, you can really spend so much time focused on things that are really gonna do nothing to really sort of boost your CV, to boost your bio sketch, et cetera.
(09:33)
Um, and so being discriminating here is incredibly helpful. So if I can dive a little bit deeper into that, and I'm happy to share my perspectives too, how do you decide on what's important, what's not?
Dr. Wesley Yip (09:44):
So to clarify also, I do agree with you in college and medical school residency, fellowship, I did say yes to everything.
(10:21)
Does this make sense to me? " And sometimes they'll offer a different perspective. Well, they'll say, you know, "Sounds great, probably not gonna pan out anything in five years, or a different role." You might not get anything in three years, and then it's gonna explode, and you're gonna have so much there. So even though no one will really know about it for a little bit of time, you're gonna feel like you're working so hard and not really bearing fruit, once it does though, it will really blossom and you'll get so much more out of it. I think those senior perspectives are what help guide junior investigators to say, "This is a good idea, this is not ... You don't know that this is a good idea, but you should do it, " and help guide that way.
Dr. Monty Pal (10:51):
Uh, you know, that, you've hit the nail on the head there with looking at that four, five-year horizon. You know, I'm actually mentoring this year in the ASCO leadership development program, and, you know, one new element that I brought to the curriculum is to say to all of my mentees within this group, "Look, let's sit down, let's come up with a 10-year plan." And every move that you make along the continuum, let's make sure that it's done with some degree of intentionality, right? So if you're gonna do a review paper, right, let's make sure it's a part of that 10-year plan. If you're gonna sit here and do a podcast, right, you know, that also has to be a part in some way, shape or form of that 10-year plan. These are all investments of your time. You don't wanna get too distracted because if you're not focused on one overarching goal, right, that you're trying to get to in your career, i- it's, it's really gonna take you in, in various directions that are unrelated to where you wanna be down the line.
(11:37)
So, so brilliantly said, you know, y- you'd mentioned looking sort of forward at potential derivatives from projects, right? And one thing that I really see as being an example of that is the stuff that you're doing in the microbiome space, right? It's something that is gonna take a while to mature indeed, but once it does, I think there's gonna be an explosion of data, right? So tell the audience a little bit about what you've done in that space today, where it's sort of headed. Sure, sure. So,
Dr. Wesley Yip (12:04):
Um, part of the kind of impetus for this was looking at, uh, so at Memorial Stone Kettering, we took all the tumors and I mentioned already, we did single cell RNA sequencing, bulk RNA, RNA sequencing. Um, but then a lot of these meetings that we, we go to, some other investigators from other fields have, you know, pointed out, well, there's a lot more interaction than just that than just these cells, that there's actually not a sterile environment. There's all these microbiota that are part of it too. And then there's other papers coming out that if you alter that gut microbiome or within the intratemoral microbiome, there's changes that, uh, can then lead to, um, really significant clinical outcomes. So with that in mind, we wanted to look in kidney cancer well, is that into play as well? Uh, there's been several large studies, um, looking at gut microbiome modulation for kidney cancer with clinical effects, but not really understanding the deeper mechanisms.
(12:51)
So we thought, well, let's look deeper. Let's look actually in the tumors, let's look in the gut, what are the changes in microbiome there? What are we finding? And then what can we, how can we answer, uh, questions from there and design the next generation of trials? So what we're doing is looking at stool microbiome samples from patients who are undergoing kidney surgery. Then when the kidney is actually removed, we're taking samples from the tumor itself, uh, different parts of the tumor itself, and also the regular, uh, normal kidney tissue, looking at what kind of different microbiome we find in the different parts of the tumor and outside, and then how that might have effect on tumor
Dr. Monty Pal (13:22):
Genesis. That, that's awesome. And, you know, I've seen this data before and, you know, the big challenge with the, these intratumoral microbiome studies is exactly what, you know, many might expect, right? You have somebody in the lab who's trying to slice and dice a tissue, and whatever bacteria sitting on that scalpel or the microtome or what have you, right, that may actually taint the specimen. Um, you know, the, you might actually have factors related to the environment. For instance, maybe you have some non-sterile conditions that you have present after you process the tissue that could affect things. How are you kind of controlling for that in your study? So
Dr. Wesley Yip (13:56):
We cut out a lot of those middle man steps. So originally when we wrote the product call, people said, "Okay, so after it's all said and done, it's handed over, put it in a bucket, then pass the pathology, they sequence it and they do their thing, then you can have the tissue." And we said, "You can't do that because at that point it's way too contaminated." So we changed our protocol with agreement with pathology and everyone else in the department that once the specimen comes out, immediately a sterile true cut device is gonna use to sample the tissue, uh, flash frozen and then sent off to the lab. So we cut out all the steps of handling where all the tissue can be contaminated. And then we're using the regular normal tissue to be able to act as a control to see, well, what's normally in the kidney tissue anyways?
(14:33)
Um, and then how that, how does that differ in the, uh, the tumor tissue?
Dr. Monty Pal (14:36):
You know, I think this project is coming exactly at the right time. So we have obviously a new president at City of Hope Marcel Vanderbrink, who comes with a lot of great leadership experience, but also is just world renowned for his work in the microbiome space. And he brought with him from MD Anderson, somebody that I hope to get on this program soon, Rob Jenk, um, who also is well reputed for the stuff that he's done with respect to the microbiome. So Rob set up this core facility over here that I think is gonna have very unique capabilities to do some of this stuff with real finesse. So looking at the intratomoral microbiome, et cetera. You know, we've also had this longstanding partnership now with TGEN, which is a city of hope subsidiary, and they have a site up in Flagstaff, Arizona, not at their main hub in Phoenix, which we've been working with for years to do stool microbiome assessments, et cetera.
(15:21)
It's been a really wonderful relationship. So I think you're, you're really at the right place at the right time when it comes to microbiome research here.
Dr. Wesley Yip (15:29):
Yeah, I think so too. And Dr. Jenk has helped us with our protocol to refine it. It's really been to point out steps along the way that he said, "That's not a good idea over there. You're gonna run into problems here. Have you thought about sequencing in this way? Should we do shotgun, 16S, should we do both? How do they compare? What's gonna come down the line?" And so he's gotten, um, a really great perspective on making sure that we're more efficient in what we're doing, so we don't just collect a bunch of samples that then, you know, aren't gonna really bear fruit later on.
Dr. Monty Pal (15:54):
You know, you've, you've kind of inspired me. I've heard sort of rumblings about your protocol, of course, over the years. And so I actually spoke to Irene Kang and Jennifer Sang, who are, uh, terrific breast cancer medical oncologists and surgeons, respectively, based at our city of Hopeland our campus. And so I've encouraged them to actually develop protocol, and we've got a little bit of funding behind it now to actually do the same intratumoral assessment and breast tissue. And do you envision this is kind of a paradigm we could look at across many other cancer type- any solid tumor or even liquid tumor, but mostly solid tumor,
Dr. Wesley Yip (16:22):
It would be feasible to do that.
Dr. Monty Pal (16:23):
Yeah. Yeah, absolutely. I think back to the rigor that needs to happen with these types of studies, there was a paper that was published several years ago and top tier journal that actually looked at a fungal organism called malicesia that seemed to induce pancreatic cancer, uh, based on its presence in the tumoral milieu, right? And, you know, that paper was retracted. So I do think that moving forward, we're gonna have to really make sure that we look at all of these particular efforts with tons and tons of scientific rigor, have all the right controls in place and so forth. It's, it's super important. Um, you know, so that's, that's happening on the discovery side, right? But you've also got some really interesting things in the hopper that I'm aware of, uh, related to clinical trials moving forward. And I, I have to tell you, Wes, I've dreamed of the day when we could have a real surgeon scientist in the urology program to help guide some of these efforts.
(17:12)
So it's one of the many reasons I'm grateful you're here. Um, and you actually got an ASCO Career Development Award for this, which is the first time actually somebody from our institution's gotten one of these, so we're, we're super proud of you. But tell us about the, the project that the ASCO CDA is funding.
Dr. Wesley Yip (17:27):
Oh, sure, sure. So, uh, something I'm very, uh, proud about, also because my mentor is you
(18:08)
A lot of times for these higher grade, higher risk tumors, despite having a major operation, that might come back. And it's very unsettling for patients to hear that. They think, "Well, I went through surgery. I mean, it's gone. Why would this come back?" So there's this big recurrence risk, and so now a standard of care is utilizing adjuvant pembrolizumab to try to reduce that recurrence risk. Some patients, despite receiving that, will still recur. Um, and so we wanted to see how can we reduce that recurrence rate further and can we do it with something that's not necessarily pharmaceutical or like a medication in the traditional sense or some chemotherapy. And part of that was talking to patients. So a lot of these big meetings, we have really great patient advocates, so one of them, Laura's fellow really helped me with this. So I talked to her about this protocol and what are patients looking for?
(18:51)
Other ways to help improve their outcomes that are not just, you know, medication. Um, so then we looked at microbiomemodulation, that's how it all ties together. Um, you've had two, uh, bigger papers before showing that, um, adding CBM 588 to, um, kidney cancer regimens can improve outcomes. And those were in the metastatic kidney cancer setting, never looked at it in the adjuvant setting. So we wanted to see, well, if we actually add CBM 588 to, uh, pembrolizumab in the adjuvant setting, can we improve their outcomes there? And maybe this gut microbiome modulation will help them. And so that's what the basis of the grant is, and it's going through the IRB now and hopefully
Dr. Monty Pal (19:26):
Should be open soon. I, I love it. You've really been able to kind of get this underway, I would say in record time. So I'm, I'm super excited about that. I will say too, there's so many funny stories embedded. I remember getting that call from you in Japan, right, where, where you're with your wife on vacation. Um, and I was in Europe at a laundromat of all places, right? My family was out there, we were spending a week, I wanna say in Paris, and I was actually washing their clothes while we were chatting. So
Dr. Wesley Yip (20:01):
Right, right. As,
Dr. Monty Pal (20:01):
As you recall, I think you needed a letter of recommendation- Yes. ... for this grant. And we were right down to the wire, literally just like a buzzer beater minutes before the grant deadline submission. And had I not had an online subscription, right, for wifi on the plane that I was on, I actually don't think I would've been able to get that letter for you in on time. Yeah. So, so thank you.
Dr. Wesley Yip (20:21):
Well, and thank you too. I mean, on that, actually it kind of goes back to being not afraid, uh, or not being afraid of asking for help or, or favors.
Dr. Monty Pal (20:29):
And I know there's so many buzzer beaters when it comes to these grants and there are probably so many, uh, really wonderful stories around how it all comes together at the last minute. So I'm gonna start probing my guests on this program about that in a little bit more detail.
Dr. Wesley Yip (20:41):
Yeah. I think it's good for people to also see that, um, you know, you see a lot of people with big grants and you don't know what happened behind the scenes, how much effort it took. Um, and another thing when we, we're talking about what's it like for junior investigators is, um, you know, no one sees a list of how many grants didn't make it. So I think you said when you started, it was like a five to one ratio of ones that you would apply. And now for me, it's more like a 10 to one ratio, but as long as I have the one,
Dr. Monty Pal (21:07):
Uh, you know, not reviewed and, but just take one. I, I think you're knocking it out of the park, honestly. You, you're doing a great job. Y- you know, I, I did sort of ask about sort of future planning, right? So, you know, there's this sort of career focus that you've built on the microbiome. How about clinically? Uh, what is it that you're most interested in seeing as a physician here at City of Hope? Um, so
Dr. Wesley Yip (21:27):
Really kind of narrowing down a geo oncology practice here. Um, while we do do a lot of minimally invasive robotic surgery here, we also do a lot of big open cases too. And so overall, um, mainly kidney, um, bladder, upper tract, urothelial carcinoma are the main focuses, but still doing prostate cancer testis and some adrenal masses as well. Very long term though, I think is kind of personalizing things more. Um, so, you know, one of the studies that we're looking for at, in, uh, in high risk prostateate cancer is men who have BRCA12 mutations and high risk prostate cancer. And then can we actually add in a new adjuvant therapy that's a little bit more personalized for them that, that can improve their outcomes later on? So I think going beyond offering surgery to these patients, but more perioperative, what else can we do and more specific to them?
Dr. Monty Pal (22:12):
Yeah. Yeah, I think that makes a lot of sense. That, that is a, that's a tough study, isn't it? If I can be totally frank. I mean, getting these DNA damage repair mutations, BRCA1, BRCA2 tested for ahead of surgery, it's just not really part of the current paradigm, right, in prostate cancer therapy. So how are you going about outreach for this? You're the city of Hope PI on this trial. Mm-hmm. I understand it. So what, what sort of efforts are you making to make sure that patients get gene testing before they roll into your prostate cancer clinic?
Dr. Wesley Yip (22:41):
Right. So the workflow typically is man gets a biopsy, finds out they have high risk prostate cancer. We offer them genetic testing, and that gap in time is difficult. So we've tried to switch it more so to look at our men who already know have these mutations and offer screening to them earlier on because they're at higher risk, um, and kind of, uh, more personalizing our high risk cancer clinic.
Dr. Monty Pal (23:01):
Okay. That makes a lot of sense. And, you know, one of the people that I fully intend to have on this program is Joanne Jeter, who's, uh, the interim chief of our clinical cancer genetics division. Mm-hmm. And I know that she's got a GU focus, a focus on kidney, bladder, prostate cancer. I know she'd be really instrumental in, in sort of bringing some of these patients forward so that they have an opportunity to participate in studies like this.
Dr. Wesley Yip (23:21):
Yeah. We've worked closely with her. Uh, she has the patrol study open here. We're also working on with, uh, men with BRCA12 mutations and others. And then also with her actually as a VHL alliance. So we're looking more at building up our VHL program here for kidney tumors, um, and helping manage these patients as well.
Dr. Monty Pal (23:37):
That, that's a great idea. You know, I would say it's City of Hope because we're, you know, what one might call a tertiary quaternary center, right? We, we get all of these extremely rare varieties of cancer. And I think we're probably best suited in our area to deal with these, frankly. Um, but having specific programs, VHL programs, you'd mentioned, which is a, a relatively rare but important mutation in kidney cancer, uh, developing programs around BRCA1, BRCA2, two well-known mutations, but perhaps more airtime in breast cancer than in prostate cancer. I think that's really key. So definitely, uh, kudos to you for those sorts of efforts.
Dr. Wesley Yip (24:11):
Thank you. I mean, it's part of the multidisciplinary environment here. I mean, these people are available to work with. It's not inter-institution. It's all on campus. So I think that's the big thing.
Dr. Monty Pal (24:19):
That absolutely is very cool. You know, one other neat thing that, that I, frankly, I've done and you're, you're really sort of, uh, taking the baton on is bringing some scholars from outside of, not just City of Hope, not just outside of Los Angeles area, but from around the world and bringing them to City of Hope to participate in our research. Um, and I have been super impressed with somebody that you've shepherded, uh, named Salvador Jaime Casas. So tell us a little bit about him.
Dr. Wesley Yip (24:44):
Uh, so Salvador Jaime Casas is really outstanding. Um, well, he's a medical graduate from Mexico and he's applying to urology residency. Um, he has been, uh, you know, really the major reason why I can be productive. Uh, he helps me out with everything that I do in my research program in the intramural microbiome program. He actually was really one of the leads in getting all the paperwork done for that, writing the protocol and helping me set up all these meetings with the workflow and then even just kind of being a boot on the ground. So he's helping me collect the tissue, shuttle over to the lab and work at all the kinks in the workflow. So he's really doing everything in that regard. Um, beyond just that study, I mean, he has a lot of clinical research projects. He's presenting all over at all these conferences.
(25:23)
I'm running out of startup funds to, you know, send him to all these places, but it's important for him to get out there.
Dr. Monty Pal (25:29):
One, one of the things I really appreciate about your style with him is that, and this is the same focus that I have when I bring my trainees on board, you're always looking to kind of getting to, them to that next phase, right, in life and training, et cetera. So Salvador came here with a very sort of overtly stated goal of getting into a solid urology residency program, right? And so, you know, you've helped him build some connections at the University of Michigan where he is right now, freezing his buns off in Ann Arbor, right?
(26:14)
Um, and when I had a conversation with you about it, you said, "Well, you know what? That's what he's here for. He's here to actually go out, get these experiences and do what he needs to do to get to the next phase in training." So I, I appreciate that. I will say it's actually very early in your career to develop that sort of philosophy. So what's, what's at the root of it?
Dr. Wesley Yip (26:31):
Um, I think that's what other people, my mentors, like you, taught me, you know, looking ahead and what's really more important beyond just the day-to-day thing and looking ahead. So I think that's
Dr. Monty Pal (26:40):
What I was trained to do. Yeah. Well, we've got our fingers and toes crossed for him, I know, for the urology match. And that comes up really early, right, January? Yeah, it's a little bit earlier on than the rest of them. Okay, got it. Well, that's super exciting. So I've, I've talked a lot about 10-year plans and so forth, and we've touched on a lot of your research projects. So if I had to ask you explicitly, where do you anticipate being 10 years from now, how would you respond to that?
Dr. Wesley Yip (27:03):
I'd be here, and there'd be a young junior investigator next to me, and I'd be interviewing them about, you know, how I help them bring their career up, I think. Oh, that's
Dr. Monty Pal (27:11):
Amazing. What, what a great answer. Yeah, I love that. And, and just in terms of that divide between clinic and research, uh, how do you see that panning out over time?
Dr. Wesley Yip (27:20):
So right now I'm a fifty fifty split, which is really, really great for me to be able to still maintain my clinical practice. It's hard for surgeons to go less than 50. Uh, some are able to do it, but just kind of keeping up the reps and making sure you have enough volume, uh, to maintain your practice, 50% is, is ideal, I think. Um, and that's been a lot of support from the surgery department. So Dr. Fong, Dr. Emanfon, the overall chair has been very clear in protecting my time. And, uh, when he interviewed me originally, and that was one of the things that we talked about is what do I need to be successful? And I said protected time, and he was very clear, "Well, here it is. You get this, use it and, you know, work hard and make sure you do something with it.
(27:55)
" Um, but I've talked to other people at other institutions that don't get that where they say, "Oh, we want a surgeon scientist, here's 10% protected time," which is really nothing or 20%. Um, but Dr. Fong has been instrumental in making sure that I have that protected time to keep up an academic surgeon scientist career. So help to maintain about 50% of my clinical practice, um, you know, mainly oncology. The other 50%, um, more of what we're doing now, these perioperative clinical trials, and then really kind of, um, getting a lot of the translational endpoints, um, growing from there. So not just the clinical outcomes, but what we're doing with the specimens that we bank from all these studies, and then how we have the next phase of therapies that we can use. Um, so, you know, for these adjuvant trials, for example, we have these studies looking at adjuvant pembrolizumab with microbiome modulation, but at the same time in parallel, we're taking, uh, blood in stool samples from patients who are undergoing adjuvant pembrolizumab as a standard of care, and then also not receiving any therapy, just kind of in a surveillance arm to then see in these patients what happens when they're not, you know, getting other things.
(28:55)
That gives us a baseline to then see, well, are we missing something that can help develop the next set of therapies that we can treat them with? Are there certain types of T cells that are exhausted or not, um, or can we reinvigorate them or what else can we do to, um, to help these patients? And I think that's kind of the very longer term that will be in the background for a while, but then, you know, many years down the line will bear
Dr. Monty Pal (29:16):
More fruit. Makes sense, makes sense. I'm gonna shift gears in a big way here and talk about personal life. So my wife Rena and I had dinner with you and your wife, Sarah, um, you know, a couple months ago, which was just a ton of fun, right? And, and she's actually on staff here, right? Yes.
Dr. Wesley Yip (29:31):
Um, so talk about my wife a little bit because I'm very proud of her. So she's a pediatric anesthesiologist. Uh, we met in training, so at USC when we were residents together, and then during my fifth year of residency, because hers was four years, she did her pediatrics, uh, fellowship at Children's Hospital Los Angeles, and then she moved to, uh, New York with me so I could do my fellowship there. And so she was on staff at Cornell. And then we were figuring out what we were gonna do long-term, you know, I said, "Well, I made you move to New York, we can go anywhere." Um, and And she's still, she's from Southern California, but she likes the weather here. She's actually from Illinois. Oh, wow. It's cold. Um, and then this, uh, City of Hope job opened up even before I started my process.
(30:10)
And she was like, "Well, maybe I should consider doing this. " So she ended up interviewing, um, and liked the culture there. Um, really liked the anesthesia team here, who as surgeons were very close with having a good relationship with. Um, but yeah, she actually preceded me at City of
Dr. Monty Pal (30:21):
Hope. Oh, that's too funny. And, and how is that dynamic working together? Do you ever cross paths in the operating room?
Dr. Wesley Yip (30:27):
Uh, sometimes. So interestingly, at five years at SC for residency, we never had a case together despite her being an anesthesia resident there. No kidding. She helped, uh, give a break in the room one time, and besides that, we never really crossed paths. But here we sometimes are together.
Dr. Monty Pal (30:41):
Okay. Oh, that's very cool. And you, and you welcomed a little one recently?
Dr. Wesley Yip (30:45):
Oh, yes, yes. So we have a five month old as well. Um, so we're very excited for him and what, what he's gonna do. And his pictures are all over the urology clinic, um, and everyone loves him. They actually threw me a really nice little, um, baby shower, nice, uh, diaper cake, and I was a very nice surprise from the clinic staff.
Dr. Monty Pal (30:59):
It's, it's a good team that you've got over there indeed. I think they're a wonderful bunch. You know, and so that sort of leads me into my next sort of train of thought here around, you know, balancing family, right? I find this to be incredibly challenging, if I'm being honest with you, right? And we've had other folks on who have kind of outlined their approach to raising kids. Yuman Fong gave, I, I would say a very seasoned approach to it. You know, he's your department chair in surgery. We had Mustafa Rawuf, who's a couple years ahead of you, I would say, in terms of his, uh, academic, uh, career. Uh, and he was sharing some insights on how he interacts with his children. He's obviously a, a very talented young surgeon as well. What, what's your approach so far, realizing that you're only five months into it?
(31:38)
Right. I mean,
Dr. Wesley Yip (31:39):
Five months, it's been a lot in these five months so far. Um, one part is definitely, I think, the environment that you're in, and I think that the City of Hope environment is very encouraging for families actually. And my whole group was very supportive when the baby came of, you know, "Don't worry about your practice. We'll cover it. We'll take care of it. You know, if you have something, um, that, uh, needs covered, we'll take care of it. " And so I think I really appreciate that with my partner. So not just Clayton Lau and Kevin Chan, but Ali Zumkuala, John Yamzan, Bertramu, everyone else in the group. Um, so I wasn't sure when he was gonna arrive
(32:17)
And they said, you know, take as much time as you need. And then coming back, um, I think managing the different kind of parts of life in terms of clinical practice, academic and home, I find physical separation does work the most. I mean, I have a home office, but the home office is very much shared with everyone else. So I'll try to really sit down, look at the grant, get it ready, and then I see a tiny little head pop in the doorway.
Dr. Monty Pal (32:56):
That, that's definitely something that I found early on too. A- as much as the home office is, is a great place to be and there's certain perks to it in terms of getting a little bit more time in with family, uh, just a dedicated couple of hours at the office every now and then really is essential for productivity. Yeah.
Dr. Wesley Yip (33:11):
Yeah. And I think other people on campus do share that. Uh, there was a weekend when I was here rounding, um, it was a Saturday morning, I saw Dr. Kree, Lionel Coray, one of our amazing plastic surgeons here. I was like, "Hey, I know, what are you doing on campus?" And he's like, "If I'm here for one hour, it's seven hours at home. So I can just come here, you know, get everything done and then, and then get back home
Dr. Monty Pal (33:28):
And ... " That's great. That's great. So you, you know, one thing that we're asking all the guests who come on this program is to really sort of define what the title of our podcast means for them. So the, the title of this podcast is On the Edge of Breakthrough, right? Uh, Voices of Cancer Research here at City of Hope. What, what does on the edge of breakthrough mean to you?
Dr. Wesley Yip (33:47):
It's a really good question. Um, I think for me, and also, I guess what I've gone through in the kind of training, growth and development and over that same time period, what I've seen differently, um, in the spectrum of cancer care and what our priorities are, which also involves a lot of these big meetings like Bladder Cancer Advocacy Network, which is very patient focused, a lot of these kidney cancer meetings that have a lot of patient advocates there and hearing what they really want. Um, combining all together, I would say precision oncology for personalized medicine, and that's what we really try to do at City of Hope is kind of beyond just the numbers of this is a 65-year-old patient with a T2 this, and that's it. More so the special factors about them, what's specifically in the tumor, how can we personalize their care, and then how can we make it different for them.
Dr. Monty Pal (34:33):
That, that's great. And that seems to be entirely in alignment with your 10-year strategy, with your career development plan, which I think is just brilliant. You know, Wes, I know that you and I are gonna be working together for decades, and I look forward to listening to this podcast 10 years from now, right, and seeing how close we've come to our stated goals, but I, I have a good feeling that we're gonna get there. Thanks again for being here. I agree. Thank you so much. Thanks for tuning in to On the Edge of Breakthrough. See you next time for more insights from the front lines of cancer research and care.