Chapter 05: A Chemoprevention Study and Reflections on Research, Team Science, and Clinical Trials
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Dr. Hong begins by discussing the first project he undertook after coming to MD Anderson –a study of the biology and chemoprevention of head and neck cancer funded by an NCI Program Project R01 grant. This was a fifteen-year project of almost twenty million dollars that clarified the genetic processes of head and neck pre-cancers and cancers.
Dr. Hong summarizes the personal qualities he has drawn on to create his research projects: talent, passion, and curiosity. He notes that his research areas –organ preservation, chemoprevention, and personalized, targeted therapy—are all difficult areas that present obstacles. He stresses the importance of supportive collaborators, funds, and posing “bold, impactful questions.” He notes that complex studies take time to unfold and require patience, stubborness, and the ability to encourage and sustain the energy of collaborators.
Dr. Hong notes that to open up a field, a researcher must do something new. He recalls a joke: If you are too smart, you can’t do research, and notes the importance of knowing how to articulate good questions. He touches on the challenge of clinical trials and gives an example of the time frames involved in getting clinical results.
Dr. Hong explains that collaborations with talented colleagues are only successful if one shares common goals and recognizes individual contributions. He also stresses the importance of sharing resources and credit to build trust with collaborators. Dr. Hong then makes a few comments on the increase in team science since the 1980s.
Identifier
HongWK_01_20130916_C05
Publication Date
9-16-2013
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Waun Ki Hong, MD, Oral History Interview, September 16, 2013
Topics Covered
The Interview Subject's Story - The Researcher; OverviewDefinitions, Explanations, Translations; The Researcher; The Clinician; On Research and Researchers; On Leadership; The Administrator; Multi-disciplinary Approaches; Collaborations; The Professional at Work; Professional Practice
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
Tacey Ann Rosolowski, PhD:
Tell me about the evolution of that. I mean, when you first arrived in ’84, what were some of the first projects you undertook with these new collaborations you put in place?
Waun Ki Hong, MD:
This project was biology and chemoprevention of head and neck cancer. So to do this successfully the prevention research became—you have to understand the biology of the disease. That’s the first priority.
Tacey Ann Rosolowski, PhD:
So how was that project funded, and how long did it last?
Waun Ki Hong, MD:
That was funded by the National Cancer Institute through the program project—through the program projectRO1 grant. It lasted almost fifteen years. I think we obtained almost $20 million for that.
Tacey Ann Rosolowski, PhD:
Can you tell me before you go on—can you tell me some of the results of that? What were some of those answers to the bold questions?
Waun Ki Hong, MD:
Obviously, it’s all the results in all the multiple projects that have been published on understanding genetic processes of head and neck cancer development, retinoid as a differentiation mechanism, and also identifying some high-risk individuals who are predisposed to develop the head and neck cancers. Also, using some combined agents in the treatment of the far advanced pre-cancerous lesions.
Tacey Ann Rosolowski, PhD:
So really this was very comprehensive.
Waun Ki Hong, MD:
Oh, yes. Genotypic and phenotypic—the change of the pre-cancerous lesion after treatment. I think that kind of highlighted so many important discoveries. I think the most important thing is understanding the biology—the biology of pre-cancer and the biology of the cancer.
Tacey Ann Rosolowski, PhD:
Why is that so important?
Waun Ki Hong, MD:
Well, if you understand the biology you can basically—that is understanding the strengths and weakness of the enemy. You understand what the strengths of the enemy are, and then you can target that.
Tacey Ann Rosolowski, PhD:
One thing I didn’t ask you about when we were talking about your education and the early part of your career is your training to do research and designing research studies. Where do you feel you gathered the most experience and information to do that well? Designing research—how did you get the skills to do that?
Waun Ki Hong, MD:
That’s a good question. I think it is from the spontaneous leadership. I didn’t take any extra courses. I didn’t take any extra training. It was just a motivation and a talent, and then a passion and through curiosity.
Tacey Ann Rosolowski, PhD:
Is there a way that you would characterize—how would you characterize your approach to a question? You said to ask bold questions, because otherwise you won’t get answers that really are significant in a field. Is there a way that you—you know—as you think about your own approach, how would you describe it?
Waun Ki Hong, MD:
I think that’s an interesting question. I’ve been very lucky. I always say that. I’ve been recognized as more than I deserve during my career. So if you—I think you read some of my studies already—there are three important areas I feel like I made some small contributions. One is in the oral organ preservation, like laryngeal preservation. The other one is in chemoprevention. The third one is—I’m not sure you’ve heard about this—the BATTLE trial (Biomarker Based Approaches of Targeted Therapy for Lung Cancer Elimination Project (funded by Defense Dept.).
Tacey Ann Rosolowski, PhD:
I’m sorry?
Waun Ki Hong, MD:
BATTLE trial.
Tacey Ann Rosolowski, PhD:
Oh, yes. I wanted to ask you about that.
Waun Ki Hong, MD:
Yes, it was personalized. I’ll get to that. All those three areas are difficult. All three areas are very difficult to conduct studies.
Tacey Ann Rosolowski, PhD:
Why? Why are they particularly challenging?
Waun Ki Hong, MD:
Because number one, you have to really tackle multiple obstacles. Two, you have to have a strong, supportive collaborator. Number three, you have to have a fund. Number four, it’s really very bold questions, impactful questions. And it takes such a length of time to get the answer too. To ask the correct questions, obviously, you have to have some innovations. And also you have to be stubborn. And also you have to have the capability to capture the funds, and you have to mobilize the people and teams. So I don’t know how I did it. I guess I’m a stubborn guy and people trust me. If they don’t trust, they don’t work hard. In that regard I think the—also those three areas are involved—this is important for you to know—in an opening field. It opened up the field to something new. People can do a lot of research and follow up research, confirmatory research, deliberate research. But the things that I have done are asking very fundamentally good questions that nobody has done before. So it sort of has a full frontforefront in that regard. That’s exciting. Can you have that again—if you ask that question to me and I ask you, “Maybe not.” You know—there is a joke that if you’re too smart then you cannot do research. You know that?
Tacey Ann Rosolowski, PhD:
I don’t know that joke.
Waun Ki Hong, MD:
Because they’re more calculated. So they know already the answers before you tackle it. “Oh, it’s not going to work. That’s too much. I don’tThey don't want to sweat.” And they try to work on easy subjects.
Tacey Ann Rosolowski, PhD:
That’s a wise joke—a very wise joke.
Waun Ki Hong, MD:
A guy like me, I’m not smart. I’m very stubborn.
Tacey Ann Rosolowski, PhD:
So it’s better to be stubborn than smart.
Waun Ki Hong, MD:
I think you have to have some combination. And to be innovative you have to have a certain level of inner talent. But I think the more important thing is to ask good questions. Many people ask questions, but they don’t know how to articulate their questions, and also they don’t know how to conduct—how to complete their questions. You understand what I’m saying?
Tacey Ann Rosolowski, PhD:
No, I don’t quite understand.
Waun Ki Hong, MD:
You ask questions, you have questions, but you have to formulate those questions to answer those questions. Like a clinician like me, to answer the questions you have to be able to do clinical trials. The clinical trials like I developed are very complicated. There are multiple people involved and multiple disciplines. So you have to know how to conduct a trial in a timely fashion. You understand?
Tacey Ann Rosolowski, PhD:
Uh-hunh (affirmative).
Waun Ki Hong, MD:
And then once you conduct a trial, then you’ve got to see when you can close and wrap it up to complete the trial. Then the results can be analyzed. Tacey Ann Rosolowki, PhD No one’s ever talked about the time frame of a clinical trial before. I didn’t realize that that was so key.
Waun Ki Hong, MD:
Some new drug testing takes a short period of time to get an answer. A study like this one on oral organ preservation and chemoprevention, or a BATTLE trial, takes a long time. The processes are very complicated.
Tacey Ann Rosolowski, PhD:
Can you take me through one of those complicated processes so I understand better what you’re talking about? Why is the time so critical?
Waun Ki Hong, MD:
Like in chemoprevention studies, initially you identify the patients, and you do some biopsies to understand the biology of the disease. Then you can give them some chemopreventive agent and it takes some time—three to five years—to get some answers to develop cancer. So you have to be very patient. It’s not like it’s waiting treating in metastatic cancer patients.
Tacey Ann Rosolowski, PhD:
Where it’s really fast.
Waun Ki Hong, MD:
Yeah. And the same thing with oral organ preservation too. So I don’t know how I did—if you ask me if you’re going to repeat again, I answer, “Maybe not.”
Tacey Ann Rosolowski, PhD:
Yeah. Now I suppose it would also—when you have a trial that lasts quite that long—that means you also have to manage all the people involved for a very long time as well.
Waun Ki Hong, MD:
Yeah, it’s good to put the whole people together. People can be separated, but you have to keep the people in succession. So that’s the challenge.
Tacey Ann Rosolowski, PhD:
And also—this has come out in my conversations with other people who do clinical trials and also working with basic scientists and physician scientists—that you’re working with very high intensity personalities, too. How do you get these high intensity personalities to work collaboratively? What have you found as answers to those kinds of challenges?
Waun Ki Hong, MD:
That’s a challenge. The answer—I give this from my own view—I think sharing common goals and taking time to recognize individual’s contributions. So if I ask you to do all the work for me, they are not going to be so good. They’re highly educated and well-trained people. They’re smart. They have their own agenda. Okay. Why do they have to sacrifice their time for my research project? So I think you have to share some common goals, and at the same time let the individual person carry on with recognition. Then also, share the resources. Like I was quite capable to raise some grants, and then I shared a grant. I was not only sharing a grant, it was also sharing the credit. This is not my work, this is not you, this is our work. And then people trust. So if you do all the work and then I go around and give a presentation and act like I’m the one that did all the work, then people have no respect. So I think you have to be very careful.
Tacey Ann Rosolowski, PhD:
Is there more discussion now of team science than there was, say, in the early 80s?
Waun Ki Hong, MD:
I think that’s true. We are promoting more and more team science. And again, comparing 1980 and 1990—when I developed that VA larynx trial, I was young. I was an associate professor. But I had to work with all the senior people, and I had to organize a national cooperative group. So I didn’t know how I did it.
Tacey Ann Rosolowski, PhD:
What did you learn from that process?
Waun Ki Hong, MD:
I don’t know.
Tacey Ann Rosolowski, PhD:
You’re not sure?
Recommended Citation
Hong, Waun Ki PhD and Rosolowski, Tacey A. PhD, "Chapter 05: A Chemoprevention Study and Reflections on Research, Team Science, and Clinical Trials" (2013). Interview Chapters. 1098.
https://openworks.mdanderson.org/mchv_interviewchapters/1098
Conditions Governing Access
Open
