Chapter 13: A History of the Brain Tumor Institute
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Description
Here Dr. Sawaya tells the story of MD Anderson’s Brain Tumor Institute. He begins by noting that the multi-disciplinary Brain Tumor Program is one of the top three programs in the country and that it is the product of three decades of accumulated development. The story begins, he says, when Dr. Victor Levine was recruited from the University of California San Francisco to head the Department of Neuro-Oncoloy and brought with him an initial vision of a multi-disciplinary program with basic and translational research. In the mid-nineties, Dr. Levine secured the first program project grant from the NCI to study the molecular biology of gliomas. Dr. Sawaya describes the significance of that grant for MD Anderson and then goes on to talk about Dr. Peter Steck’s work on the genetics of brain tumors. This work led to the discovery (1997) of the tumor suppressor gene, PTEN –a major discovery that “crowned the project program effort.” Over the course of this time building research, Dr. Sawaya and Dr. Levine were also hiring clinical faculty, among them medical oncologists and neurooncologists. Dr. Sawaya created the largest brain tumor surgery department in the country and expanded neuropathology and neuroradiology as well.
Dr. Sawaya then explains that Dr. Levine was asked to step down, “a significant change.” Dr. Sawaya’s next move (1998) was to propose to Dr. John Mendelsohn that all the neuro-related activities be housed in a single brick and mortar location. He explains why Dr. Mendelsohn rejected this proposal, allowing Dr. Sawaya (2001) to lead the multi-disciplinary effort of the brain tumor program, including giving him permission to raise dedicated funds. Dr. Sawaya describes the composition and activities of the Brain Tumor Institute Executive Committee, which has had monthly meetings for the last 12 years.
Dr. Sawaya explains that the presidential permission to fundraise allows the Brain Tumor Institute to establish a premiere class tissue bank. He eplains that validation of the tissue bank came when the NCI decided to perform genetic studies of five cancers and selected the MD Anderson Tissue Bank to provide the samples of glioblastoma. Dr. Sawaya then explain how he worked with Development to identify donors. In the process he gives an overview of how Development presents possible projects to donors to secure their support.
Dr. Sawaya next explains that funding for the Brain Tumor Institute initiatives is never funneled to individual research programs but is used to build core facilities for research, including the Animal Core, the Tissue Bank, specialized equipment, and other shared resources. He then notes that when the Mitchell Building was constructed, he was given permission to consolidate all the research laboratories in one place (2005). He explains the key role that new-hire Dr. Oliver Bogler played in organizing research in the new location and in securing the SPORE grant for brain tumors. He talks about the difficulties that neurosurgery had in getting this kind of grant and how Dr. Bogler was able to “get them back on track” so MD Anderson could be a “major player” in brain research. Dr. Sawaya then summarizes the evolution of the Brain Tumor Institute and what it required.
Identifier
SawayaR_03_20130625_C13
Publication Date
7-16-2013
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - Building the InstitutionThe Administrator; Institutional Mission and Values; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Philanthropy, Fundraising, Giving to MDACC; MD Anderson Impact; Beyond the Institution; Devices, Drugs, Procedures; The Administrator; Understanding the Institution; The Institution and Finances; The Business of MD Anderson
Transcript
Tacey Ann Rosolowski, PhD:
Let me resume, and I will put the identifier on. This is
Tacey Ann Rosolowski, PhD:
, and today is July 16, 2013. The time is 1:38, and I am in the faculty center at MD Anderson in the Department of Neurosurgery, and this is my third session with Dr. Raymond Sawaya. Thank you, Dr. Sawaya, again for participating in this.
Raymond Sawaya, MD:
My pleasure.
Tacey Ann Rosolowski, PhD:
And we were strategizing a little bit earlier about where to start this third session and talked about how the Brain Tumor Institute is an interesting history to tell. So you became head of that in 2001, and if you’d give me the tale of how that institute came into being.
Raymond Sawaya, MD:
So there is a nice development of our brain tumor program, and I would like to fast forward to today to say that our multidisciplinary brain tumor program at MD Anderson is one of the top three in the country. UCSF—the University of California, San Francisco—Duke, and MD Anderson are viewed as having the three top brain tumor programs in the country. So clearly the development that led us to this point is quite significant.
Tacey Ann Rosolowski, PhD:
And what makes it part of the top three? What are the qualities?
Raymond Sawaya, MD:
It’s obviously not one factor. And so it’s a cumulative effect of the number of faculty involved, of the patient care level of expertise provided, the true multidisciplinary aspect of it, which goes from surgery to medical to radiation to pathology, the level of research and the level of funding that we receive that is competitive funding—peer-reviewed funding. That also puts a program in the higher tier. And so all that has happened in our program over the last thirty years. And that’s why I was going to fast forward to say after all these years of development we have reached that level of premier category. So it started, as I mentioned in a previous time, with Dr. Victor Levin coming from UCSF to head neuro-oncology in 1988 and my starting the neurosurgery department here in 1990. And so Victor Levine played an important role by providing the initial vision for the program—a true multidisciplinary vision and a very strong emphasis on basic and translational research. And to that end, he was the driving force behind establishing or obtaining our first program project grant, which was a big grant—multi-million dollar grant from NCI—to study the molecular biology of gliomas. These are primary brain tumors. And so by getting that grant, we really were being accepted as a strong program nationally.
Tacey Ann Rosolowski, PhD:
And when did the department receive that grant?
Raymond Sawaya, MD:
This was in the mid-‘90s. And part of that grant was the study of the genetics of brain tumors. And Dr. Peter Steck, who is a basic scientist in the Department of Neuro-Oncology, had a focus on finding out what mutations in brain tumors are occurring that have led or are leading to the development of the most malignant form of brain tumor—the glioblastoma. And this resulted, with the help of the program project grant, to him discovering a mutation in a suppressor gene that was not known up to that point. And that turned out to be a major discovery. That gene now is called PTEN. And he discovered that gene working in animal models of human brain tumors, and finding out where—on what chromosome—are we missing a gene in those tumors that are growing in those mice. And he identified that on chromosome 10, and the same month he published his paper, the group at Columbia published another paper exactly showing the same discovery. So this was a really major, major discovery that was made in 1997. It did crown this program project effort, showing that not only are we able to compete to bring in high-dollar, big grants from NIH, but that that work is leading to some of the most important discoveries in cancer research. PTEN now is a key, key player as a mutation in several cancers, not only brain.
Tacey Ann Rosolowski, PhD:
Are there ways in which that discovery influenced care?
Raymond Sawaya, MD:
Only in the sense that it will lead to development of new drugs—drugs that target where this mutation has occurred, because there is a cascade—an important kinase that affects the cell growth that is blocked by PTEN. And since PTEN is getting mutated, this cascade of events is not being restrained. And so many drugs now are focusing on this cascade to see—and there are a couple, two or three, different areas where we can block that. It’s very, very difficult. So there is a lot of effort going on in this research. And it very likely will take more than one drug to be able to block that, because it’s a very, very powerful cascade of events. So that really is an early history of the development of our program, but one that is very encouraging, because it showed that we are capable as a group of very major developments. So the strategy then was to, along with the research development, to bring in the faculty on the clinical side. So Victor then was hiring medical oncologists—medical neuro-oncologists. And he expanded his department to being the largest in the country. I have, likewise, expanded my neurosurgical recruitment, as we spoke previously. Now we have by far the largest brain tumor neurosurgery department in the country. We’ve also, because of the increased number of patients and surgeries—we have expanded our Neuropathology Department from one to four neuropathologists. Neuroradiology also expanded tremendously. There was only one neuroradiologist in the early ‘90s, and now we have sixteen neuroradiologists at MD Anderson—something unbelievable. With that also is the technology. We have many more MRI scans, CAT scans, we have the intraoperative MRI, and the technology that goes along with that. As you see, gradually but rapidly we have grown the entire program and part of that was also patients coming in and we needing more man power and more faculty. In the late ‘90s, Dr. Levine was asked to step down. You know—it is not clear all the specifics of what led to that, but this was a significant change for our program, because I viewed Victor as a true leader. Many refer to him as the grandfather or neuro-oncology, because he really established the role of chemotherapy in treating brain tumors. There was nothing related to that before he did so over in San Francisco before he came here. So that was risking to create a vacuum in our program, and I got very worried about this. So I became very proactive with—at the time Dr. Mendelsohn was the president—in ’98 I proposed to him to combine all the neuro-related services at MD Anderson under one umbrella in the form of an institute or division—something that could strengthen our program by combining all these elements instead of being a virtual center to create a real center. This was a difficult period of time for Dr. Mendelsohn. He had come here in ’96 —in September of ’96. So it was less than two years since he was here. There were some controversies that he faced at the time with Enron going bankrupt. And he was on the board of Enron, so that was a concern that he may be personally affected. He also was involved with the ImClone Company that was in New York, and there were inside trader issues. That didn’t affect him, but it was his drug and there were fears that he may be affected by what’s going on there. And so—I’m mentioning all these issues—he ended up not being affected by any of this except that it clearly was on his mind when he was the president. And for me to come to him with a proposal that one may consider revolutionary or that would really change how we do business at MD Anderson, that really requires a president to be much more able to focus on these matters. And the timing was not good. So as a result of this, he wasn’t agreeable to what I proposed, although he did recognize that my proposal had a lot of strength in it and a lot of merit. But he would not agree to it. I reacted to that decision somewhat in a negative way. Part of that was looking to leave and go somewhere else. And I did interview—in fact, Dr. Mendelsohn knew that I looked at the cancer center in Salt Lake City, Utah, because the director of the cancer center there is a personal friend of his, Dr. Joe Simone. And so, of course, the two have talked, and John knew that I was looking to go somewhere else. As a result of that, he eventually allowed me to lead the effort of the multidisciplinary brain tumor program and to also create a priority fund for fundraising for brain tumors. Because the brain tumor program was not among his priorities for fundraising at MD Anderson. Without the president’s permission, you cannot really do that. So this then got me into the role where in 2001, I put together an executive committee for the brain tumor program that is, of course, multidisciplinary. As my co-director, I had the acting chairman of neuro-oncology at the time, Dr. Al Yung. Al became the permanent chair in 2002. And as an interesting aside, last week he announced that he was stepping down as chairman after ten plus years. So with Al being my co-director for the brain tumor program, we had several members representing neuro-oncology, neurosurgery, neuropathology, radiation oncology, and the research side of the house. And we have had monthly meetings for the last 12 years. We meet monthly to review the progress, look at recruitment, look at programmatic expansion. So we have had a very, very productive—part of that in 2001, and because we were allowed to do fundraising, I committed funds to establishing a first-class tissue bank. And for that, we hired two full-time technicians whose job was to get tissues from the operating room to the neuropathologist, where the tissue is divided, allocated, and provided for research. That effort turned out to have been a major development, because when NCI chose to do the TCGA—The Cancer Genome Atlas Project, they picked three cancers to begin with. And glioblastoma was one of the three cancers. And our brain tumor tissue bank was selected as the source of tissues for the NCI to analyze the genome of these cancers. So there was ovarian, lung, and glioblastoma—were the three first cancers picked by NCI. One of them is glioblastoma, and the source of the glioblastoma was our tissue bank. So that investment in our tissue bank and in making it top quality and certainly containing large, large numbers of samples because of the volume of cases we do here led to that selection. So clearly it was a major development, and we continued that support to this day.
Tacey Ann Rosolowski, PhD:
I was curious about the fundraising activities that you undertook to fund that initiative.
Raymond Sawaya, MD:
Yes. Then we started working with the development office and gave them a number of research projects and ideas that they could—because they meet with donors. Of course, there are some donors that we recognize and let the development officer know that Mr. or Mrs. Such-and-such had a good experience with us and expressed interest in supporting our program. But frequently, you don’t know that. You don’t even know which of your patients might be potential donors because—you know—we don’t ask them every time we see a patient. That would be inappropriate, but when the patient or the family bring up, “What can I do for you? Thank you for your care. I would be glad to support your program.” Whenever they tell you that, then obviously that opens a door. Then we have a development officer, who is a professional expert in this field, then approach the family. Once there is some specific research, then we would meet with them and tell them about it. But frequently, they also meet independently with donors and potential donors. And they give them a menu of activities. So if the brain program is not part of that menu then we’re not likely to get anything. Well, it is—it has become because Dr. Mendelsohn directed—we were approached a number of times by individuals who would like to support brain tumor research. And that’s how we’ve been able to raise several million dollars over the years.
Tacey Ann Rosolowski, PhD:
And money very well spent.
Raymond Sawaya, MD:
And so exactly. Now that brings me back to the executive committee. So my plan was this money was not to support individual research programs, because that’s the individual’s responsibility to raise their own money. But we have created a core facility for research. And by core, that means every researcher in our program has access to that core, and if there are pieces of equipment—some of them are quite expensive—that are needed for that research that will benefit most, then we use those funds that we have to spend. The tissue bank is to help everybody. The animal core facility—we have an animal core where we make the tumors grow in animals to test drugs or test different approaches. That also is beneficial to everyone. So we do that. Along with the development of the brain tumor program was the great news that we received from Dr. Kripke that we were going to be able to consolidate all our research laboratories in one place. Because, as you could imagine, each of our areas were growing independently and separately, even though we were collaborating. But physically the growth occurred over many years, and so we were in different buildings—Neurosurgery, Neuro-Oncology, Neuropathology, Radiation Oncology—each of us was in a different area and different building of MD Anderson. When the Mitchell Building, the Basic Science Research Building—BSRB—Mitchell Building on Bertner was being planned, we had put a request to the chief academic officer’s office—at the time it was Dr. Kripke—to allow us to be housed in that new research building. This was phenomenal, because it’s state of the art. It opened in 2005—March 2005. And I was able to then recruit a basic scientist who studied brain tumors. I had a position in neurosurgery, but the idea was that that person will be the director of all the research laboratories that will be there. And he happened to have been recruited in ’05, and when he moved here the labs had just opened. He was able to organize the entire floor. We had about twenty principal investigators. These are faculty studying brain tumors. And about 100 people working on that floor. To this day we still have that. So that person that I hired, his name is Oliver Bogler. So Oliver played two, I would say, major roles. And his impact is and will be long lasting. The first one was indeed to organize all the laboratories, to help mentor, administer the floor, the research needs, the core, et cetera. But the second very important accomplishment was he helped us get the SPORE grant for brain tumors. There were only two other SPORE’s in the country for studying brain tumors. We had tried to get one, and if I can back up a little bit—I told you about the PO1 that we had in the mid-‘90s that finished around ’98. Between ’98 and 2005, that seven years, our group tried several times to get a PO1, either to renew this old one or to get a new one. And we were not successful. We were just—it’s so hard to get these big, big grants. Then when the SPORE programs came up and became existing, we tried a couple times. And it took Oliver Bogler’s effort to organize our SPORE application. He is very meticulous. He is very careful. He writes well. And we got that one funded. It got funded in ’08. And it’s now in its fifth year, and we have the renewal—we sent it in, and there is a very strong probability it will be funded. So really this put us back on track to be one of the solid brain tumor programs that have national recognition with major funding, such as a SPORE grant.
Tacey Ann Rosolowski, PhD:
What is the level of funding for the SPORE grant?
Raymond Sawaya, MD:
We’re talking about $13 million. It’s big. It’s big.
Tacey Ann Rosolowski, PhD:
That’s 3-0 or 1-3?
Raymond Sawaya, MD:
It’s 1-3.
Tacey Ann Rosolowski, PhD:
One-three, okay, thirteen.
Raymond Sawaya, MD:
Thirteen over five years. So it’s outstanding. So that’s the influence of Oliver. Then of course in 2010, he was proposed a position as vice president for Global Oncology and he was selected among several candidates who applied. Obviously, he could not maintain his role as the director of the research lab, so we ended up—we went through a transition, and we have now Dr. Fueyo, Juan Fueyo, who is the current director. And Juan is doing a great job, but we certainly miss Oliver. So as you see, we’ve gone from a small program to a much larger program through integration of all our activities, through development of the research in faculty and in space. That’s also integrated into getting major grants and therefore recognition of our excellence by the national peer review system. And so that required coordination, leadership, to keep everybody somewhat in line. And we’ve had many retreats. In fact, one of the retreats was when Dr. DePinho had just arrived. It was in November 2011. He had been here only one month. We had an all-day retreat, and he sat through the entire retreat and was so impressed that he said at the end of the day that we had tremendous breadth and depth to our program. And this was very pleasing to hear, because in many ways he was an outsider. He came from Boston. And he may have known about some of our program, but certainly not the entire—and having sat through the whole day of very major presentations and discussions, he was able to formulate an opinion on that.
Recommended Citation
Sawaya, Raymond MD and Rosolowski, Tacey A. PhD, "Chapter 13: A History of the Brain Tumor Institute" (2013). Interview Chapters. 1549.
https://openworks.mdanderson.org/mchv_interviewchapters/1549
Conditions Governing Access
Open
