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When Max Wicha, M.D., was starting his career, oncology did not come highly recommended.
"When I first got into this field about 40 years ago, I went for advice to someone who was very senior in medicine. I said I want to go into cancer research and become an oncologist. They looked at me and said, 'Why would you want to waste your life on that? We're not going to make progress against cancer. It's the least scientific of any discipline. Go into some other field where you can really use science,'" Wicha recalled.
"Of course, that turned out to be completely wrong."
In fact, Wicha, the Madeline and Sidney Forbes Professor of Oncology and founding director of the Rogel Cancer Center, jumped into the discipline just as it was taking off. He reflects on the evolution of the field, in this interview, originally published in the Rogel Cancer Center’s Illuminate magazine.
When you were getting started, were you surprised by your mentor's criticism of the field?
Wicha: What they said in a sense was true. Forty years ago, there was a tremendous disconnect between research to understand the biology of cancer and the clinical practice of oncology. The clinical care had very little to do with the science that was brewing in the laboratory.
Initially, when chemotherapy was developed, medical oncologists thought if we find the right combination of chemotherapy, we can cure most patients with cancer. That turned out to be naïve, and there was a lot of discouragement among clinicians when their clinical trials didn’t improve outcomes.
At the same time, basic scientists were coming up with dramatic results in the laboratory, with the first discoveries of oncogenes and tumor suppressor genes.
The basic scientists were saying, “Look, we're starting to understand what cancer is.” But if you went to the clinic, you didn’t see any impact. That was the dichotomy of the field.
How did the National Cancer Act, which was signed in 1971, and the beginning of nationally designated cancer centers start to change this?
Wicha: To make a fundamental impact, we knew we had to take the basic research and figure out how it leads to improvements for patients — not just make discoveries in the laboratory.
Cancer centers became a lot of the engine for cancer research and cancer discovery, which propelled us into the dramatic impact we see now. It’s because of this marriage of basic research, clinical research and what we now call translational research.
When you were tasked with creating a cancer center at the University of Michigan, how did this landscape influence your approach?
Wicha: The challenge was how to get these groups to merge and talk to each other. On the clinical side, we had people in each discipline treating patients in different ways. Not only did they not talk to the basic laboratory scientists, but even more challenging, they didn't talk to each other.
In my own field of breast cancer, a woman then would have to visit multiple specialists, sometimes getting contradictory opinions. It could take more than a month. Patients would say, “Why don't you put your heads together.” Of course, that was the right advice.
When we started organizing our cancer center, which opened in 1986, we decided to experiment with a multidisciplinary breast clinic. We organized either the first or second multidisciplinary clinic in the country. It was a success right from the beginning. Now of course everyone does it.
Then when we started organizing a cancer center, I thought the way to do this was around multidisciplinary programs for each type of cancer. It allowed us for the first time to bring together active teams of people from different disciplines who work on a particular cancer.
It enabled us to start introducing basic scientists to clinicians and move to a more scientific approach to treat patients.
The basic scientists were saying, 'Look, we're starting to understand what cancer is.' But if you went to the clinic, you didn’t see any impact. That was the dichotomy of the field."
--Max Wicha, M.D.
Where are we now in the progress against cancer?
Wicha: It's completely flipped around. Right now, cancer is the most scientific discipline. It's the best example of basic research discoveries changing clinical care.
Melanoma is a good example. First, we developed molecular targeted therapies based on specific mutations in the tumor. But even more successful has been the use of immune stimulators. Here's a disease that was completely fatal. Now, about 60% of patients see a very significant benefit from immunotherapy. Even more exciting, for a percentage of patients, the melanoma isn't coming back. We might for the first time really be thinking of cures of cancer.
In my field of breast cancer, we’ve developed so many different treatments that often we can turn metastatic cancers into chronic diseases. I have patients who have had metastatic breast cancer for over 20 years.
The trick now is to understand what’s different about the exceptional responders and get more patients into that realm. And the real challenge is going to be how to apply this to tumors where we haven't made much progress, like pancreas cancer and brain tumors.
I will almost guarantee you that progress in those areas won't be by accident but by studying the basic biology of those cancers and then applying new ideas based on that.
Are you glad you decided to go into oncology after all?
Wicha: Personally, it's been such a privilege, and I've been so fortunate to have been in oncology during this phase when it went from a primitive discipline to being a scientific discipline making huge advances.
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