Issue link: https://tmcpulse.uberflip.com/i/686754
t m c » p u l s e | j u n e 2 0 1 6 12 While I was in Milan, I was approached to be a consultant for a pharmaceutical company that had really been building their oncology franchise, Pharmacia. Initially this was presented as a local job, and they said I could keep my laboratory, so it seemed like a win-win situation for me to keep my research program alive and simul- taneously fully immerse myself in this consultantship to learn the business of drug discovery. I accepted the job and within a year we had acquired yet another company in San Francisco and then merged with another. I started to spend most of my life on an airplane. It was a really intense time in my career, but it paid off in a big way. We had an incredible portfolio of products, but because of that, we were targeted by Pfizer. I stayed on through the Pfizer acquisition, but unfortunately I was charged with the dismissal of some of the sites. Then Merck came knocking at my door and offered me the oppor- tunity to go to Boston and lead their oncology group. We all moved back to America again, and I had five groups within Merck in Tsukuba, Japan; Pennsylvania; Seattle; Rome and Boston. Q | What eventually brought you to MD Anderson? A | I left Merck when it closed all of its sites but one. I really didn't see the opportunity to be able to contribute. I want to stay in early innovation and dis- covery, and so once you start to narrow down your early-phase pipeline and limit your activities to clinical develop- ment, that's simply not my area. It's not my passion. I had an offer to join another large pharmaceutical company, but, frankly, I didn't want to be in a situation where I had to spend time consolidating sites again. So, instead, I took the oppor- tunity to go to Dana-Farber, which ultimately led to MD Anderson. We came here and discovered Houston. It is a really special place. It is an incredible community and very down-to-earth. The doctors here are incredibly gener- ous in volunteering hours to talk about science and talk about solutions for the patients and to engage in collaborative efforts. And outside of these walls as well, we find colleagues to be generous with their time and knowledge. I haven't seen this anywhere else. Q | One of the most exciting initiatives in the world is Moon Shots. As co-director of this program, can you explain what makes it both unique and promising? A | We have seen interesting advances in cancer for 40 years, and it's getting better and better in terms of our ability to understand the disease. What's really missing is our ability to take action on our knowledge to develop remedies. For us, we can articulate things that, from a process standpoint, define what we want to do. First, we want to intervene by working on prevention. There are measures that can be taken, but we don't see adequate dissemination of existing knowledge and policy imple- mentation to favor adoption of these preventative measures. Our own policy at MD Anderson to hire only non- smokers is an important opportunity to encourage prevention. Within my own group I have Europeans, Chinese— smoking is much more prevalent in those countries—and people are stop- ping smoking. To me, this is a success because there is such a clear connec- tion. HPV vaccinations are another great example. So many cancers are clearly HPV or virally mediated, and now tools are emerging to dramatically reduce the incidence of these tumors. We also want to intervene on disease in the clinic. Part of that is to make clinical trials far more informa- tive. We're trying to enable a knowledge system that allows us to really learn from our patients in real time. We are using digital health approaches, which frankly are equivalent to approaches that are being used by the Walmarts of the world, to predict trends in terms of whether we buy more tomato sauce or fresh tomatoes, to enable us to make the best decision for the patient and to disseminate knowledge. MD Anderson is an incredible engine for generation of best practices that are now being adopted by local hospitals through- out Texas, the nation and the world. Twenty-five percent of patients coming to us are misdiagnosed, so we have to reassess the nature of their disease. In some cases, we have dramatic impact. I was just talking to a friend of mine who told me about a patient who came in with a diagnosis of gastric cancer. The chances of surviving gastric cancer are limited, but it turned out that it was lymphoma. It was spreading around the stomach and the patient is now in total remission. There are all these opportunities to intervene clinically in real time. We need to disseminate the knowledge we develop. Another goal of the Moon Shots Program is to create a multidisciplinary culture. We don't just have scientists around. Or just clinicians. We have both, and most importantly we have hired specialists in disciplines that are normally only represented in industry and the private sector. And now, as we build out our Moon Shots platforms and various resources throughout the institution, we increasingly have tremendous translational medicine capabilities. Bringing the full spec- trum of drug discovery—from basic research through deep biology and onto drug development and clinical studies—under one roof and with a united purpose, is extremely powerful. We need the experts in all of these areas and, most critically, we need them to intersect, intentionally and humbly, to think, to learn, and to commit to mak- ing a difference for our patients. Part of this is making sure we have the right incentives in place, so that contribution is measured by clinical impact, not by arbitrary metrics or numbers. Last, but very important, is the 'fast kill' concept. This is about looking at all of the advanced things that have merit and being able to make tough deci- sions when you develop a diagnostic or therapeutic. It's a rigorous prioritization approach to leverage anything that is actionable now and could show us a way forward. We really hope the Moon Shots Program could enable some of these concepts. If it limited itself to identifying high-priority areas for research and then funding research in just those areas, it may miss opportu- nities, especially some with short-term impact. I think there are a lot of things we could do if we simply acted on this. Q | Any closing thoughts? A | My wife sees me as excited today as when I started my post-doc at Cold Spring Harbor Laboratory. She says she's never seen me as excited. I think that's really wonderful. We need the experts in all of these areas and, most critically, we need them to intersect, intentionally and humbly, to think, to learn, and to commit to making a dierence for our patients.