From Clinician-Scientist to Cancer Center Builder | Samir Khleif (Part 2/4)

Intro - 00:00:06: Welcome to The Biotech Startups Podcast by Excedr. Join us as we speak with first-time founders, serial entrepreneurs, and experienced investors about the challenges and triumphs of running a biotech startup from pre-seed to IPO with your host, Jon Chee. In our last episode, Samir Khleif shared how growing up as a refugee shaped his worldview, why education was central to his family, and how early leadership experiences laid the groundwork for a future in science and medicine. If you missed it, check out part one. In part two, Samir picks up the story at the National Cancer Institute Institute where he bridged basic research and clinical care and discovered his calling as a clinician scientist. He also shares how that mindset shaped his approach to translational medicine and set the stage for building a world-class cancer center from the ground up.

Jon Chee - 00:01:07: Now you're at NCI, and you land there. Talk a little bit about, like, your early days there and kind of your journey through NCI.

Samir Khleif - 00:01:15: NCI was really great. And one of those things that how even I got to NCI because there was no books of where to apply except one book that tells you where to apply, but NCI was not part of the book. Yeah. Really, I wanted to go to NCI. So I picked up the phone and I called NCI. It's like, you know,

Samir Khleif - 00:01:34: I'm a 100% coming, like, so why are you calling me? Right? Yeah. And then somebody transferred me to another person and then another person and another person. And finally, somebody picks up the phone and said, look. I'm looking to apply for a fellowship. And she said, I believe the fellowship time for application is done. And then, lo and behold, it was, and I applied. So, anyway, so that was a different story. But NCI was really great. I mean, NCI, again, is one of the major fundamental, and, again, NIH all, fundamental organizations that this country had developed that is unmatched. Not only unmatched in the world, but it's unmatched even in anything that this country developed, to be honest. The amount of progress to human life and health that NIH has put forward over the past many years is something that is fundamental. And this is an institution that has to continue and has to be supported, and it has to be expanded even. So MCI was really great. I had a great group of colleagues. The amount of knowledge that you gain from the attendings and researchers that are there is unmatched by any level. People are highly experts in their area of expertise. But more importantly, because it's NIH and because it's government, people are there for one purpose: to do what they love to do. And all of them are highly, highly sophisticated scientists, very accomplished, and most of them started things that never started outside. So but because of that, then you are really amongst collection of brains that are great. And you can not only do your research, you learn also oncology, but also if you need anything, it's it's a matter of walking few steps, knocking on somebody's door and say, look. I'm looking for to understand or learn this. What do you think? So, yeah, NCI was fabulous, as in my fellowship, and I've learned a lot. I've learned how to do research in real way continuously. I've learned how to do clinical research, also not only basic research. And as a clinician, I would say I developed my early formative year of being the definition of a clinician scientist, which means both a person who can do basic research, learn how to do basic research, and explore ideas in basic research, but also how to translate this into clinical trials. And this is what I tried to do in my years during fellowship is to try to combine this. Because you look backward and say, what are the knowledge that I collected? And if I did medical school and now I'm doing research, is it possible to combine them? And and few people do that. Now some people decide, no. I'm just gonna go and do basic research. Right? Some people decide, no. I'm just gonna do clinical research. But I decided really to utilize everything I had to be able to do both, to do the research in the lab and then translate it into clinic and conduct clinical trials. So and that was that was very fulfilling by all measures. It was great because you can do things in the lab and then see patients receiving that treatment and some benefit from it. And, again, in an environment of NCI that is built to encourage research and built on the principles and the foundations of medical exploration. So I I can't tell you how wonderful that experience was, at least during my fellowship.

Jon Chee - 00:05:13: Very cool. And it sound like you had a very unique kinda like Venn diagram practice and philosophy. Would you say that, like, these are broad strokes, but the basic research and then the clinical research folks are siloed, and there needs to be more folks who kind of are able to bridge the gap?

Samir Khleif - 00:05:31: The answer to that is yes. This is why a place like NIH or NCI is a phenomenally great place to learn how to develop both because this institution has been built on the premise that basic research and clinical outlets is one. And as a matter of fact, one of the things that you see when you go into NIH is how the basic research laboratories are next to the clinic, which is great. And most of the people there that are doing research are also basic scientists. So it really an environment that teaches you how to think in a way that is merged. So I think that trained me to when we do basic research, when we do fundamental discoveries, and this is what we're doing now and this is what we reach this level, is to have in mind how could this eventually be translated into patient benefit. Now I'm not saying again, I'm not saying that the fundamental basic research by itself is not valuable. It's more than valuable. Right? And many people do it in a unbelievable way. The way I have grown up in the field is not only to discover basic science findings, but also to have in mind always in the back of my mind, not only, okay, I'm going to discover this molecule or we're gonna discover this mechanism, but then immediately during that discovery and with the team is how can we translate this mechanism or this discovery into a potential drug or an approach that could be given to patients. And I think those four years, at least four or five years formation that I had during my fellowship at NCI really formulated that in me in the presence of brilliant people around me and how you do that. So I I developed my first protocol when I was a second or third year second year fellow, which was like a cancer vaccine protocol, which was again, cancer vaccine was not even on the map. It was starting to develop. So this is why I would say those years were forming years in really learning how to do research, conducting very valuable research, but more importantly, how to merge my two personalities together, my two things that I've learned during the years together and make it one.

Jon Chee - 00:07:51: Very cool. And I think it was around this time, I believe, you got involved with the FDA and also the King Hussein Cancer Center. I guess, chronologically, how did that kind of

Samir Khleif - 00:08:04: So I was at NCI. I finished my fellowship, and I started on the faculty at NCI, on the staff. And then within that period, after I finished my fellowship and I was on the faculty, I think, two or three years later or four years later, this King Hussein Cancer Center started where the king of Jordan, King Hussein, was being treated at Mayo and the National Cancer Institute and, and the presidents were involved in that. And he wanted to build a cancer center in Jordan so that how it was. He asked the president or the NCI director to see if they can find someone to go to Jordan. That was when I was asked by the NCI director if I would be willing to go to Jordan and develop the cancer center.

Jon Chee - 00:08:52: Very cool. So were you splitting time, or did you end up relocating back to Jordan?

Samir Khleif - 00:08:57: No. I actually relocated in Jordan. I was sent by NIH by HHS to Jordan, and I was there as a diplomat with the US embassy. And I relocated there, but this is why I smiled when you said you're splitting your attack. I kept my research operation at NCI. So I was developing the cancer center, and I was meeting with the lab on Skype. Yeah. Skype. So that was Yeah. Yeah. And but I was going back and forth twice a month. Oh. But my main residence was there on-site to develop a cancer center.

Jon Chee - 00:09:36: Very cool. I mean, that's like a talk about a new big initiative. Can you talk about launching a cancer center?

Samir Khleif - 00:09:42: Yeah. I mean, look. This was really an unbelievable experience. It's a really beautiful experience. So there was a cancer center. The cancer center was not functioning very well. The king of Jordan asked the president if he can find someone to go and really develop it from the ground up. So I've done assessment to the cancer center over few months, and we identified the gaps. Also, there was a a chairman of the board there who's a princess, princess Gita was really phenomenal, and she was involved in this that time. It because it took us time to decide to go. But then when I started working there, I used to tell people, I I wake up in the morning with dreams that are I'm on a ship with six six-million hole in it, and I was running from one hole to another to just cuff. Yeah. It was an amazing experience, really, very great experience. It was a a complete restructuring, reforming, and rebuilding the center. I was helped tremendously by the team that I recruited most of them from The US to be with me. I was helped tremendously by the people that were there and, of course, by the board, the government, and his majesty, the king. So the the beginning, Jon, what we wanted to do is to really develop the cancer centers to a level to become a cancer center at a level of US cancer centers. So the idea was how I can do that. Going there by myself I mean, again, NCI said go. I said, find out.

Jon Chee - 00:11:12: Figure it out. Figure it out.

Samir Khleif - 00:11:14: Figure it out. So it wasn't it wasn't like, okay. Fine. Yeah. Well. Yeah. Yeah. I I think I developed it based on multiple different principles. One is to develop a nucleus of experts around me. So I had to hire really good, talented, brilliant people that are, again, from the region, Jordanian, Palestinian, whoever, and bring them all together and put them around. And second, depend on the great minds that exist there. So it was not a straightforward process. Right? Because you need to really take everything, put it out, and develop from the ground up. So we did. We actually worked, and, plus, I started a lot of connections with institutions in The US. Of course, the NCI was there to help if if needed, and it was a very, very interesting and learning and growing process. It took us three years, and we got the center from where it was to an institution that got accredited by the Joint Commission Cool. Which is the same accreditation process that goes into US. And it became the best cancer center in The Middle East, and it became the referral cancer center for seven countries. So it was really amazing. The minister of health at that time mentioned to our HHS secretary that single handedly, the project lifted Jordan health care, the whole national health care system in logs. So after we got it accredited, multiple other institution got accredited just because they start learning, and we started teaching how to do it. So, yeah, it was a very great I mean, I I'll be happy to answer any questions specific, but it was a very, very good experience, very rewarding experience. And before we went there, a lot of the people that used to be able to leave the country to get cancer care used to leave. Majority of people did not have an outlet for cancer care. The mortality rate for kids with leukemia was extremely high. Within a year and a half, it became cure rate almost remission almost ninety, ninety plus percent. And some of the other diseases therapy was not available. Now very rarely anybody leaves the country to get care because they all get care there. Plus, as I mentioned, seven other countries send people there. I mean, the patients. So

Jon Chee - 00:13:45: That's amazing. I think about this broadly speaking, like, how do you start something from scratch in a region? Like, I I I maybe take I'll take it out of, like, the kind of cancer center domain. But, like, when I think about, like, what makes Silicon Valley Silicon Valley and, like, how do you recreate those kinds of areas and regions, it's such a multifaceted, multivariate initiative. Because, like, you talk about, like, there's, like, you gotta have governmental support. You gotta have the talent. You gotta, like, raise the bar enough to the point where it's just like, okay. We got a good foundation, and then we can work from there. When you think about the success of the King Hussein Cancer Center, if there were, like, some key pillars, like, obviously, it sounds like personnel is very important. What were the the key pillars to standing it up and getting to the point of accreditation?

Samir Khleif - 00:14:34: That's a great question. And I'll tell you, it definitely has major pillars that you might think of or not think of. So one is clear talent nucleus. You can't do it by yourself. There's no way that you can do it by yourself. So clear talent nucleus that you have to put together. Second, you need to build support because this is a change in culture, and change in culture requires support because people will fight you.

Jon Chee - 00:15:02: Yeah. Yep.

Samir Khleif - 00:15:04: So that's very important. But it is critical, though, for this particular point is to explain why you're doing what you're doing. Because you cannot just go there and do it and say, this is how I think about it. And more importantly, Jon, is to show the benefit of it. Now you're gonna have lots of naysayers, right, when you do any change in culture. I'm not talking about that particular project in general, but these are the things that you learn and and you use in in your career when you move forward. But you need to do things that, one, explain why you're doing what you're doing, and second, do it fast, by the way. Yeah. Very fast Yeah. Before people know how to respond to it. Yep. And then show the benefit and explain the benefit and highlight and market the benefit. This third pillar is usually when you do these kind of things, the naysayers are way more than the naysayers. Like, how are you thinking that you're gonna be doing this? Why did you even waste your time and go there to do that? I've heard that again and again and again. Actually, his majesty the king, once he had an interview on television sometimes, and he was that gesture. And Arabic says, like, no. Because everybody would tell it, no. That doesn't work. That doesn't work. But that's the case. So but I'm not saying about that particular issue. Any project you do in life, that's usual case. Like, are you sure you wanna do something like this? So the third pillar is really listen to your capability, ability, and more importantly to your heart and those kind of things. If you can do it, just do it. Don't listen to the naysayers, and don't let anyone tell you that you cannot do this thing, especially if you're putting your mind to it. And then the fourth thing is make sure that people that you're working with absolutely understand and appreciate the mission. These are four very critical points that to build something from the ground up and more importantly, if you wanna build it with a change of culture, which is more difficult, is that these are critical factors. Have expertise, explain what you're doing, get the people on the mission, and believe in the mission. And by the way, those that don't believe in the mission, they should not be there. You keep those that believe in the mission. And then finally, don't let people put you down.

Jon Chee - 00:17:32: That's amazing because, like, I was, like, thinking about that too. I I love the also the, like, the the the sub tip of go fast, like because I think change management and, like, managing culture is, like, it's an art and a science. It's like it can be really hard and but it can make or break it or any it can make or break any initiative. So I love hearing that, especially with something so ambitious as starting a cancer center. The tenants stay true. I can see that in company building as well. And it reminds me that you you're talking about, like, how your father had the kind of logical why behind the what. It carries all the way.

Samir Khleif - 00:18:10: But this is what I'm saying. All these kind of things that you take on the way, it helps you a lot. One thing, though, that is critical in building any institution, including starting with Kinkosan Cancer Center, is appreciating what you don't know. This is critical because you don't know what you don't know. And the mitigation to that is, one, to hire the best people that they know way, way more than you do in anything. And second, to make sure that you knock on every door to ask questions. Just ask. Yeah. Before I went to build a cancer center, I actually rotated on 12 cancer centers in The US and talked with the directors of those cancer centers. Most of them are my friends, but I took a flight Yeah. Went there. I went to Seattle. I went to Mississippi. I went to New York. So I literally met with every cancer center that I know and just brainstormed with them. Right? Because you will learn. So the lesson is get the best people, but more importantly, knock on doors and ask questions even if you don't know what to ask. Just get people to talk because you will discover lots of things that you will learn, and then you can start building on top of them. Right? But that's really critical.

Jon Chee - 00:19:25: That's so cool. That's freaking awesome. I love that kind of mentality because I think you can always take it's like I saw Osmosis. You can kind of just, like, take learnings wherever, and then you start figuring out what aspects of this might work in Jordan versus, you know, in New York versus Seattle. There's, like, there's different cultures, like, also as well in the Pacific Northwest versus, like, in, like, New York City so that you you know, those are different. But that sounds like an awesome journey, and it sounds like as, you know, this thing has now stood up and it's, like, improved health care, like, multiples. When did you know it was time to leave, and did you know what was up next after that?

Samir Khleif - 00:20:01: So my intent was two things. One, to build a team, and, really, the team there is just amazing. So I had the best team that you can ever have, and I felt that the team is there. But most important thing from my perspective was that we needed to get the accreditation, the joint commission accreditation. So we got the joint commission accreditation in, I think, March, and I left in March of that year. The reason is because two things. One, it is not the accreditation the process was. It wasn't meant to be getting that piece of paper. It's developing the process. It's the journey to it. It's for people to understand, learn, and realize what it takes to build and maintain a quality health care institution. So every single employee was engaged with that process on purpose, and that was my intent. Right? We engaged literally every single employee. We had weekly meetings. We had monthly all hand meetings all about this process just for people to understand that a high level health care institution delivery system require that mentality. So it was like as if you're taking an IV every day with that process. So my job or my intent was, if I get this accreditation, I can hit three birds in one stone. One, people learn the process and more importantly, absorbed it, and finally got something that recognized that that is it. The second is when you get that, you need to maintain it every three years. And if you don't maintain it, it's a big problem. But people now know that it needs to be maintained. Third, during that process, the leadership that was there evolved to the degree that they became really a team, and there were leaders, and there were people to take over that are really great. And they probably did a much better job than I did, but they're fantastic. So I think these are the three principles. The last one, evolved as we go. But, again, the process involving them, putting them in leadership position to reach a level because there is a goal. Right? There's a goal. You need to catch that goal and get a check. It's not like, okay. Great. We built a team. So this is why that accreditation was important because it taught everyone what it means, and it put the center at a place where it cannot go down now. It has to be maintained. Of course, they were able to take it even more up because they have that capability. They have the spirit, and they're fantastic. But that was my intent, and this is what happened. So it was a period of detail to build it and do it, and I had from the beginning, I thought, at least, we were thinking of three years. And I wanted to accomplish that in three years, and that was exactly what's the case. So we were able to accomplish in three years and and then moved on.

Jon Chee - 00:23:00: Sounds like a very busy three years.

Samir Khleif - 00:23:02: Like, that is No. No. It was an amazing three years. Yeah. No. Not not

Jon Chee - 00:23:06: not in a bad connotation. Not in

Samir Khleif - 00:23:08: a bad Absolutely. It was an amazing amazing three years. But, again, it was all those three years that are up and down and some naysayers and some people. But that's part of a process. That's part of a process when you build something that's completely new, that's completely against the grain, that's completely unusual, and sometimes you step on foot. You know? That that's not Yeah.

Jon Chee - 00:23:28: Because it's life. That's life.

Samir Khleif - 00:23:30: That's life. Exactly. But but the good news is that at the end of a process, you see a product. Right? You see that product. And, again, the proof in the pudding. The center now is really the best place or the best health care institution in The Middle East, so one of the best in the world.

Jon Chee - 00:23:46: And two things that stood out to me is you know? And I I'm still working on this. Standing up organizations where, like, if I were to, like, step back for a moment where people can just take it to the next level even without me there, I think our team is like I'm continuously trying to empower, empower, empower the next kind of guard of the company as young employees come in. How do we train them up, get them to the point where they can start running with it and being creative? And I can imagine it was a similar exercise at the cancer centers. It's like, okay. You guys know the process. You know the fundamentals, and now it's your time to carry the torch and run with it. So there's, like, so many lessons that when it comes to building a self-propagating organization initiative about, like, empowering and teaching folks how to run the process and then get creative with it on top. And the other aspect that kinda stood out to me is not only explaining the why behind the what, but it's, like, showing it, like, literally showing the impact. Because I think sometimes, especially as organizations get larger, you can start to lose sight of the impact because there's, like, multiple degrees of separation. And then you start to feel like, how am I even connected to this kind of, you know, three degrees of separation? But it's always important as leaders to, like, bring it back and be like, hey. This was because you did this.

Samir Khleif - 00:25:06: Very important. Jon, very important. That's critical, actually. This is why in every institution that I led, we have those meetings that you show people what their effort led to. That is really critical because that would link their hard work to a product, and it means progress. The other thing is the the first point that you mentioned is those talented people. I mean, this is one of those things that you really need to be courageous when you lead institutions like that. Right? Because there are cultures. How can you change the culture into a meritocracy culture rather into hello, can you take my cousin? Yeah. Yeah. Yeah. Yeah. So these are the things, and there are ways that that you develop as you go. You invent as you go. There's no book. Right? There's no book that you say, okay. Well, where's that? Tell Yeah. How to do that. Yeah. To invent those techniques and you make techniques to make sure that only people are hired based on meritocracy. You're not gonna offend anyone. But by the way, yes, he can definitely apply or she can definitely apply, but there's this process of doing a test at the beginning. And then if they pass that test, then they'll go into interviews, and those interviews are done in separate rooms. And so all these kind of things that says, it's not my fault. It's just so these are the things that you embed within those kind of things to be able to reach the level where you just mentioned, which is that first thing is to have those best people that can carry it further because that's critical.

Jon Chee - 00:26:39: Very cool.

Outro - 00:26:41: Thanks for listening to this episode of The Biotech Startups Podcast with Samir Khleif. In part three, Samir shares what it was like leading a national reform effort at the FDA, building new oncology programs in Georgia, and navigating the shift from government to academia. He also talks about recruiting mission-driven talent, spinning out IP for the first time, and how one scientific breakthrough and mindset shift led to the founding of Georgia Georgiamune. If you're enjoying the series, follow the show, leave us a review, and share it with a friend. See you next time. The Biotech Startups podcast is produced by Excedr. Don't want to miss an episode? Search for The Biotech Startups Podcast wherever you get your podcasts and click subscribe. Excedr provides research labs with equipment leases on founder-friendly terms to support paths to exceptional outcomes. To learn more, visit our website, www.excedr.com. On behalf of the team here at Excedr, thanks for listening. The biotech startups podcast provides general insights into the life science sector through the experiences of its guests. The use of information on this podcast or materials linked from the podcast is at the user's own risk. The views expressed by the participants are their own and are not the views of Excedr or sponsors. No reference to any product, service, or company in the podcast is an endorsement by Excedr or its guests.