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You are here: Home: BCU 8| 2002: Editor's Note
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Editor’s Note |
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| Meet the Professor |
““I love my work. I’m surrounded by incredibly
talented people who constantly challenge me — and I
challenge them. We have a great group, and we're really excited
about our work, because it’s the most exciting time
in the history of oncology. I’ve also been fortunate
enough to receive a number of awards, and those were all very
nice. I was thrilled and honored, but the greatest reward
I ever received was the Christmas after trastuzumab was approved.
Melody Cobleigh — who participated in the registration
trial and was the second leading accruer — asked her
patients to write a one-page note to me about what it meant
to have been on the trial and to have benefited from the study
and respond. And so I got these personal notes from women
whom I’d never seen, I’ll never know, I’ve
never met, talking about how we had impacted their lives.
It was very moving — it brought me to tears. And it
showed that while this is very interesting science, it goes
way beyond that. If you can make things work, you really do
impact people’s lives.”
— Dennis J Slamon, MD, PhD |
The Breast Cancer Update series has provided me with the privilege
of interviewing many “movers and shakers” in the oncology
research leader community. My main mission is to ask questions that
are not covered in journal articles or meeting presentations. By
representing the practicing oncologist, I particularly want to push
my interviewees to move away from standard algorithms and to tell
us how they treat their own patients outside of a protocol setting.
My other main objective is to have these research leaders predict
what we might expect in the future, as data from ongoing clinical
trials mature.
In 14 years of producing this series, I’ve had the opportunity
to speak with many of the legendary figures in breast cancer clinical
research, including Bernie Fisher, Gabriel Hortobagyi, Richard Peto,
Michael Baum and Larry Norton. These leaders are united in a commitment
to the application of the scientific method to improve patient care.
They also maintain very close ties to preclinical research and often
attempt to differentiate the hype from the hope of laboratory findings.
Because of their extensive knowledge and true love of their work,
most of these visionaries can, and do, speak passionately for hours
on the subject of breast cancer clinical research. The depth of
their insight always makes it very challenging to edit down these
interviews. To offset this “problem”, we are launching
what we intend to be a regular annual feature — a special
edition with an in-depth interview with a research leader who has
played a crucial role in shaping the current breast cancer management
paradigm.
The focus of our first “Legends in Oncology” program
is Dr Dennis Slamon, whose pioneering laboratory and clinical research
on the natural history and management of HER2-positive breast cancer
has ushered in a new era of targeted biologic treatment. Like most
visionary leaders, Dr Slamon unflinchingly “tells it like
it is.” In the enclosed program, he criticizes the designs
of the two major adjuvant trastuzumab trials (NSABP B-31 and NCCTG-N9831)
for including anthracyclines in all of the randomization arms. He
also recounts, without apology, his nonprotocol use of adjuvant
trastuzumab, a practice that most research leaders interviewed for
this series do not support.
Dr Slamon also believes that FISH should be routinely utilized
to assess a patient’s HER2 status, calling the standard IHC
assay archaic and ill advised. He predicts that the combination
of a platinum agent, a taxane and trastuzumab will soon be standard
therapy in the adjuvant and first-line metastatic setting for HER2-positive
disease. A recent report by Dr Nicholas Robert* suggests that the
second half of Dr Slamon’s prediction is being borne by the
initial results from a U.S. Oncology trial in the metastatic setting.
Last year during an interview at the San Antonio Breast Cancer
Symposium, Michael Baum made one of my favorite and most-frequently
cited comments in this audio series. Mike had just stunned a packed
auditorium with the initial results from the ATAC adjuvant trial,
which demonstrated an advantage for anastrozole compared to tamoxifen.
Hours later, as he and I explored the clinical implications of these
groundbreaking but early results, he shrugged and said, “There
are always periods of uncertainty in the evolution of science and
medicine.”
Oncologists in clinical practice know that one productive way
to face these “periods of uncertainty” is to obtain
numerous perspectives, and determine areas of consensus and disagreement
about the application of clinical trial results to patient care.
However, we also need people like Dennis Slamon to challenge our
conventional beliefs and make us think “outside of the box.”
—Neil Love, MD
*Robert N et al. Phase III comparative study of trastuzumab
and paclitaxel with and without carboplatin in patients with HER-2/neu
positive advanced breast cancer. Breast Cancer Res Treat
2002;Abstract
35.
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