Chapter 14: Developmental Therapeutics in the Midst of Opposition to Systemic Treatment of Cancer

Title

Chapter 14: Developmental Therapeutics in the Midst of Opposition to Systemic Treatment of Cancer

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Description

In this chapter, Dr. Freireich talk about the Department of Developmental Therapeutics amid opposition to systemic treatment of cancer, the development of the immunotherapy program, and animosity among different departments and personalities at MD Anderson.

Identifier

FreireicEJ_02_20010730_C14

Publication Date

7-30-2001

Publisher

The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

Building the Institution; The Professional at Work; Understanding the Institution; Discovery and Success; MD Anderson Culture; The Business of MD Anderson; The Institution and Finances; Working Environment; Growth and/or Change; Leadership; Obstacles, Challenges; Institutional Politics; Controversy; Critical Perspectives on MD Anderson; MD Anderson History; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care; Patients, Treatment, Survivors; Ethics

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 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

Emil J Freireich, MD

We didn't give up. Even though we had nothing, we kept trying to build. The way Dr. Frei and I built our department was, since nothing was given, we had to create it. Dr. Clark, to his credit, if he couldn't give it to you, he would not interfere with you creating your own resources. Since we knew Dr. Zubrod at the NCI and knew about the granting mechanism, we aggressively pursued grants. We got a grant for our platelet transfusion support, and we got a grant for our infectious disease support.

Lesley Brunet, MA

You had a lot of grants.

Emil J Freireich, MD

Dr. Clark moved a temporary building from his ranch to the parking lot, and that was our office and laboratory space for Dr. Loo and Dr. Ho. Nothing came from MD Anderson. Everything in DT was created with federal money. When I was fired as head of DT by Dr. Irwin Krakoff in 1983, over DT's 17 years, our overhead exceeded our state budget every year. We never got a dollar from Dr. Clark or the state of Texas. Our department was built entirely with federal money, private money, and money from drug companies. That was our goal. That's what Clark wanted us to do. Our job was to build MD Anderson, not to bleed it. He had gotten as much as he could. We were supposed to add resources, and we did.

So we had this clinical research center. Dr. Clark said, "Okay, Freireich, you can run that," and he gave us 3 West for our research patients. We recruited Gerald Bodey, since retired, and he became head of our infectious disease program. Joe Sinkovics used to be the infectious disease expert, but Dr. Clark came to me and said, "Well, Alexanian and Sinkovics have requested that they come out of your department and go back to Medicine." Okay, so we were back to ground zero. Sinkovics hated Gerald Bodey because he was good. Sinkovics was okay, but not good. We hired Evan Hersh, and Hersh was in charge of our immunotherapy program. He's now at University of Arizona. Hersh has been gone for probably 5 years, maybe 10. Bodey retired maybe 4 or 5 years ago. It was not a voluntary retirement. There were forces. When people leave, there's always pushing and pulling. There's an opportunity, but there's got to be trouble at home or you don't leave. We had Bodey, Hersh, Loo, Ho, Frei, and Freireich. We had some grants, and we had to expand our program. We had started a reverse isolation research at the NCI, so we got a grant from NCI, and we bought 2 life islands. We convinced Dr. Clark to modify 2 rooms on 3 West to make them germ-free rooms. Our immunotherapy program was booming. We were doing BCG vaccination. Our chemotherapy program was booming. We were attracting adults with leukemia. We didn't have any beds here, so we leased beds from Hermann Hospital and started a unit over there. Eventually we leased space in the Center Pavilion Hospital, when they converted it to a hospital from an apartment building. It's now been torn down, of course.

Lesley Brunet, MA

So at Hermann, they didn't have Anderson patients there before?

Emil J Freireich, MD

When we were here there were zero. However, we did have a unit, and they agreed to lease it to us. Joe Boyd worked out a contract, and we had something like 11 beds. We put our patients over there, and we cared for them.

Lesley Brunet, MA

They were adults or pediatric?

Emil J Freireich, MD

They were adults. I was out of pediatrics. From '65 on, pediatrics is history. I have nothing to do with it. So we started to build, but we were creating a lot of animosity. Everybody in Medicine despised us. We started the first adjuvant chemotherapy for breast cancer. We did the first studies with Adriamycin, which was developed initially in Italy. We got the drug, we began to do studies here, and we found it very active in breast cancer. Jeff Gottlieb was here at the time, in the cooperative group. We said, "If it worked in leukemia, why shouldn't it work in breast cancer?" Adriamycin had an 80 percent objective response rate in breast cancer. We said, "Okay. So you get women with Stage III disease. They have a 90 percent chance of dying of metastatic cancer. You do an operation, and then what? Then you radiate the hell out of them. Well, what good does the radiation do when they're going to die of metastases? They need systemic therapy. We have good systemic therapy." We developed our solid tumor practice again. No referrals from Dr. Howe in MD Anderson. If a doctor in Texas calls up MD Anderson and says, "I have a patient," it goes to Medicine. If they call me, they go to DT. If they call Frei, they go to DT. We developed our own practice in Texas. No patients came from them. They never sent us any patients. As a matter of fact, that's the reason Cliff Howe finally got fired.

Lesley Brunet, MA

Were DT people doing some of the staffing in the Diagnostic Clinic?

Emil J Freireich, MD

No. Two of our fellows went to Diagnostic Clinic—Ed Middleman and Harry Price. Ed Middleman is in practice in Dallas, and Harry Price is still there. But we had nothing to do with Diagnostic Clinic. We gave adjuvant therapy to women with breast cancer. No radiation therapy. I went to a staff meeting, and Dr. Fletcher stood up in Dr. Clark's presence, and he said, "Freireich, you are a murderer." He hated chemotherapy. Radiation therapy was his life. "You're a murderer, Freireich. You're denying these women radiation to the breast." But we proved that he was wrong and we were right. Of course, adjuvant therapy in breast cancer is now the standard of care everywhere in the world. In fact, they do it for Stage II breast cancer. So Radiotherapy hated us. We also had Lillian Fuller; she was the Pat Sullivan of radiation therapy. Dr. Fletcher trusted Lillian Fuller. She took care of lymphoma. One of the first things we did was the MOPP in Hodgkin's disease and confirmed that what we had reported to NCI was correct. We did it through the cooperative group. Then, because we had Adriamycin, we developed the CHOP in our department. They were still giving Cytoxan to all the patients with Hodgkin's disease. We were giving them CHOP, and we showed that you got a 90 percent response rate and a 50 percent cure rate. We cured lymphoma.

Lesley Brunet, MA

Once you showed them that, did they continue to treat them differently, or were you able to convince them?

Emil J Freireich, MD

There was a lag of about 5 years.

Lesley Brunet, MA

That's a long lag.

Emil J Freireich, MD

Yes. It was tragic. I used to go to Shully and say, "Look. Here's our data." We used to take him out to drink. I even got drunk with him one time. "Look. Send that to your lymphoma." No, they wouldn't do it. Alexanian did the lymphoma patients.

Lesley Brunet, MA

Is there still a lag?

Emil J Freireich, MD

There's still a lag. We'll come to that later, because eventually Medicine disappears, as you know. So we got CHOP. We're getting along. Radiotherapy hates us. Medicine hates us. We invited Nikos Logothetis to dinner once, and he said, "We used to call it 'Detrimental Therapeutics.'" That's what they used to call it.

Dr. Robert Hickey was a surgeon. The surgeons hated us. Hickey called me in his office one day on a Monday. He said, "Freireich, every time I schedule a patient for surgery, all the beds are full with these goddamn terminally ill DT patients. When are you going to cut this out?" I made a deal with Dr. Hickey that whenever he wanted to admit a patient for surgery, I would move a patient to Center Pavilion Hospital. The surgeons hated us, because we were interfering with their practice. I remember J. Ballantyne, God bless him. I used to fight with all these guys. They hated me, because the treatment of cancer was local. The head and neck surgeons did surgery and radiations. I said, "We have to give them chemotherapy." J. Ballantyne used to send me patients with metastases of the brain and say, "Okay, Freireich, if you're so smart, cure this guy." I'd say, "Okay. I'll do the best I can." We'd give him this and that and everything. I had a big fight with Dick Martin once over this football player who had a sarcoma, and they did an amputation. I said, "Listen, this kid isn't cured. He needs chemotherapy." He wouldn't do it. He died of metastases. So they all hated me because I wanted to treat adjuvant to surgery all the patients with chemotherapy. They didn't want to refer them. Radiotherapists wanted to radiate them. We wanted to give chemotherapy. They hated us. The medical people hated our guts because we were ruining their lives. They had to learn all kinds of new things. Pat Sullivan hated us because we were trying to change pediatrics, and she had to give vincristine and do combinations; she had to do all these things. I discovered the intrathecal therapy for meningeal leukemia; she had to do that. She didn't want to do spinals because, "It would hurt the children." Grant Taylor, God bless him, he had to finally say, "Well, maybe the parents don't need to be in the room." So who's left that doesn't hate us? Only Dr. Clark. He doesn't hate us. Well, the Blumenschein thing comes along. That's the interesting part of the story.

Chapter 14: Developmental Therapeutics in the Midst of Opposition to Systemic Treatment of Cancer

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