
Chapter 06: Early Larynx Preservation and Current Work on Targeted Therapy
Files
Loading...
Description
Dr. Hong begins with a story of his uphill battle to initiate a pilot study of larynx preservation in the 1980s. The project was eventually funded by the VA Cooperative Studies Program [certificate mentioned]. The results of the landmark study were published in the New England Journal of Medicine in 1998. Next, he talks about the BATTLE Project (Biomarker Based Approaches of Targeted Therapy for Lung Cancer Elimination Project (BATTLE –funded by Defense Dept.). With this study he has moved into personalized treatments based on genetic studies that address multiple pathways leading to many different molecular subtypes of cancer. He talks about the challenges this landmark study presents. [There is a brief interruption near the end of this session.]
Identifier
HongWK_01_20130916_C06
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; The Researcher; The Clinician; Discovery and Success; Overview; Definitions, Explanations, Translations; On Research and Researchers; The Administrator; Multi-disciplinary Approaches; Collaborations; The Professional at Work; Professional Practice; Obstacles, Challenges; Patients; Patients, Treatment, Survivors
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
Waun Ki Hong, MD:
It’s interesting. In 1982, I had a good idea at this time. I wanted to do the study that oral organ preservation—larynx preservation trials—through the Boston Head and Neck Group. So I was quite curious and nobody listened to me. So I went to the Dana-Farber Cancer Institute. I met Emil Frei. He was the one proponent of neoadjuvant chemotherapy. Then I got to know him so he knew that my work was—I said, “Dr. Frei, you’ve got to help me do this trial through the Boston group.” So he was very kind and organized some dinner meeting at (???) (inaudible). Then I presented my pilot study, and about a dozen people showed up, and we had some interesting discussions. Then the follow up meeting was scheduled and nobody showed up, except for Frei and I. Then I think I was referred to a team for the Boston group. So I didn’t give it up. And then I went to National Cancer Institute. And Frei was at the time director of the CTEP. The Cancer Treatment Evaluation Program was what was used at Memorial Sloan-Kettering, which was my attending. Then I proposed the same study—randomized study. And he really liked that idea, and he was the one that helped me to develop the initial pilot study. But NCI was not interested to fund. So that’s two strikes. And then I didn’t give it up, so I went to the VA Cooperative Group.
Tacey Ann Rosolowski, PhD:
So this is the certificate of appreciation?
Waun Ki Hong, MD:
This is for a new strategy to preserve the larynx in the treatment of advanced laryngeal cancer. So I convinced the VA Cooperative Study program, and they funded about $3.2 million. The point I think you’re asking is how I did that—stubbornness. I went to Boston Head and Neck Group, that failed, NCI failed, and then I was successful at the VA Cooperative Study Program. It turns out to be a really landmark trial. And we published the paper in the New England Journal of Medicine in 1991. So I think that team science at that time, again, was not like these days.
Tacey Ann Rosolowski, PhD:
It sounds like, too, at that time since it doesn’t sound like there were as many mechanisms to set it up you had to be really, really persistent about finding those supporters—one of those keys that you mentioned earlier.
Waun Ki Hong, MD:
It was fairly junior with this. Now I think there’s some more sitting here—the then the (???) (inaudible) cancer. People—if I say something people listen now. But at the time, I wasn’t.
Tacey Ann Rosolowski, PhD:
Just out of curiosity, since team science is becoming so much more important, is that changing the culture of medicine in academic institutions at least?
Waun Ki Hong, MD:
Yes, that is true. And I think especially in the cancer field. We are better together than separate. Working together you can really answer questions more quickly. Otherwise, it would take a longer time. And MD now is also, in a public way, recognized more and more for team science. Again, when you talk about team science, so many people are involved. I think you have to really lay out clearly the credit. Even though you are the main person or architect that develops some research project—to articulate that research project, you have to have troops. And you have to figure out how to recognize the individual people to share the same credit.
Tacey Ann Rosolowski, PhD:
In addition to—we’ve got about five minutes left. Is that okay? You want to stop at 3 o’clock?
Waun Ki Hong, MD:
Sure.
Tacey Ann Rosolowski, PhD:
Okay, so I just wanted to ask you—I mean, you talked about that great big study that was established with that PRO1 grant with you first arrived. Were there other areas that you were researching, other studies that were initiated after you first came?
Waun Ki Hong, MD:
Recently it’s been the BATTLE project.
Tacey Ann Rosolowski, PhD:
And tell me about that.
Waun Ki Hong, MD:
That is a very simple idea. There’s some more—again, more personalized treatment, especially now we know that cancer is a genetic disease. And there are multiple pathways that really exist and that culminate to develop invasive cancer. So now I think there are so many new agents—targeted agents—available. Like in the old days we would look at cancer under the microscope. This is phenotypic change, this is a squamous carcinoma or adenocarcinoma. That’s still—we use it, but in terms of science and specific treatment, we need to know something more than that, which is so-called molecular cell types. And the molecular cell type means that even though the histology shows the same tumor—adenocarcinoma—but there are different drivers, cancer drivers. And the idea basically is to really identify major cancer drivers. There are a lot of genetic changes still, but many of them function as passengers. So the passengers are very innocent. If you give chemotherapy, you try to kill everyone. That’s not good. So targeted therapy is really identifying, pinpointing some target that is a cancer driver. And then the idea is how you can really hijack that cancer driver by giving the right match agent. So BATTLE means “biomarker approaches targeted therapeutic for lung cancer elimination.” So like in lung cancer patients who present with metastatic disease, they got chemotherapy, and they’re not doing well. So we did a biopsy, take out the tissue. And then identify molecular cell types. The biopsy is not easy. Analyzing biomarkers is not easy. Then based on biomarker findings, we try to match with the right agent.
Tacey Ann Rosolowski, PhD:
Why is the biopsy not easy? And why is finding the biomarker not easy?
Waun Ki Hong, MD:
Biopsies are not easy. You have to put a long needle in. It’s not easy. It’s a procedure.
Tacey Ann Rosolowski, PhD:
Is it painful for the patient, or it’s difficult to find the tumor?
Waun Ki Hong, MD:
Well, it’s expensive, too. And then the front of the needle gets the tip in the tissue, and people in the past would consider it not quite feasible. Then the biomarker—and that also is not easy because you have to have a dedicated lab. Turnaround time is about two to three weeks to get the answer, and we thought about delaying the treatment.
Tacey Ann Rosolowski, PhD:
Can I ask you why do you need a dedicated lab, and what are the biomarkers that you’re looking for?
Waun Ki Hong, MD:
Yeah, okay. When we developed that trial it was 2004. It was not really clear to certify a labCLIA Lab. We had to analyze all of the biomarkers through a dedicated fluoroscopic molecular pathology lab. Again, for us to do that, you have to have the lab, you have to have pathologists.
Tacey Ann Rosolowski, PhD:
We can close off for today.
Waun Ki Hong, MD:
So that can be quite expensive. Nonetheless, that still turned out to be a landmark trial and highly successful. Sorry I can’t talk in more detail.
Tacey Ann Rosolowski, PhD:
Absolutely, we have another appointment set up for Friday. So I can just remind you of where we left off today. Thank you very much.
Waun Ki Hong, MD:
You have all of my background CV?
Tacey Ann Rosolowski, PhD:
I have some. I do not have the CV. Maybe I can e-mail Sandra on that.
Waun Ki Hong, MD:
Oh, yes, Sandra can send that and a short biography of my research contributions.
Tacey Ann Rosolowski, PhD:
Excellent.
Waun Ki Hong, MD:
Why don’t you stop by and see her?
Tacey Ann Rosolowski, PhD:
I will do that. And let me just say for the record, I am turning off the recorder at 3 o’clock. (End of Audio Three)
Recommended Citation
Hong, Waun Ki PhD and Rosolowski, Tacey A. PhD, "Chapter 06: Early Larynx Preservation and Current Work on Targeted Therapy" (2013). Interview Chapters. 1099.
https://openworks.mdanderson.org/mchv_interviewchapters/1099
Conditions Governing Access
Open
