Chapter 16: MD Anderson's

Title

Chapter 16: MD Anderson's "Horizonally-Organized" Brain Tumor Center

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Description

In this chapter, Dr. Yung focuses on the Brain Tumor Center, created via the working relationships and shared resources that link sixty members from Neur-oncology, Neuro-surgery, Imaging, Neuro-pathology and other services. Dr. Yung explains that these working relationships enable neuro-focused members to get individual and multi-investigator funding, and that the SPORE grant is "a triumph of the Brain Tumor Center." Dr. Yung next comments on the difficulties of formalizing the Brain Tumor Center as a self-contained unit within MD Anderson. (This discussion refers to the fact that the head of Neuro-Surgery, Dr. Raymond Sawaya, is an advocate of such independent status. Dr. Sawaya discusses this at length in his oral history interview.) Dr. Yung cites the enormous cost of running an independent Center, given the expense of the technology required. Dr. Yung says that the Brain Tumor Center will enter a new phase when a new chairman of Neuro-Oncology replaces him. He also feels that the Center currently offers a solid platform to expand immunotherapy with a new emphasis on T-cell function.

Identifier

YungWKA_04_20140707_C16

Publication Date

7-7-2014

Publisher

The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center

City

Houston, Texas

Topics Covered

The University of Texas MD Anderson Cancer Center - Building the Institution; The Administrator; Institutional Processes; Devices, Drugs, Procedures; MD Anderson Culture; Building/Transforming the Institution; Multi-disciplinary Approaches; Growth and/or Change; Obstacles, Challenges; Controversy; Understanding the Institution; Technology and R&D

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

Tacey Ann Rosolowski, PhD:

Well, I wanted to ask you too about the Brain Tumor Center, which is something that we’ve mentioned from time to time because you’ve been the co-director of the Brain Tumor Center from --- since 2001. And we sort of mentioned it a bit along the way but we haven’t really talked about what the Brain Center means and what it encompasses, so if you could tell me a bit about that.

Wai-Kwan Alfred Yung, MD:

Well the Brain Tumor Center basically is a, you know, horizontal organization bringing the department together.

Tacey Ann Rosolowski, PhD:

And this is with the Department of Neurosurgery?

Wai-Kwan Alfred Yung, MD:

2 Department of Neuro-Oncology, Department of Neurosurgery, and Department of Radiation Oncology with this brain group there and imaging --- predominately imaging with the neuro-imagers. That --- Because the well-defined department is the Department of Neurosurgery and Department of Neuro-Oncology. These two departments all focus on brain tumors, so we are the anchor departments for the center. But we cannot be a Brain Tumor Center without support from radiation, without support from radiology, without support from pathology and also laboratory researchers. So we have these people all working together under the umbrella of the Brain Tumor Center. And we --- we basically kind of started you know and we said now we are going to work together so that we can synergize each other and combine resources so --- and also --- and combine resources and synergize our talents so that we do not go off on a tangent and we need to do things as a group. And --- and I think we have done very well since we work together very well as a group. This has probably about more than 60 members in it and we work together to --- to --- to help each other to get individual investigator funding as well as combined multi-center --- multi-investigator funding like we are able to get the SPORE. I think that getting the SPORE is a triumph of the Brain Tumor Center coming together and we also --- it becomes a --- a program under the cancer program, --- you know, it’s a clinical program under the cancer program and --- and support the cancer program. We get a outstanding rating you know. And we work together to develop drugs and the --- the viral program is also an outcome of collaborative effort among neuro-oncologists, basic scientists, and neurosurgeons. All three groups working together to really promote the oncolytic virus program.

Tacey Ann Rosolowski, PhD:

Is the Brain Tumor Center and, you know, the thinking behind it, does that represent a special culture at MD Anderson, do you think? I mean, it --- does it have unique qualities?

Wai-Kwan Alfred Yung, MD:

Not really. I think, you know, if you think about it it is a multidisciplinary approach to the cancer problem. I think is brain tumor may be more unique and that we, not the medical oncologist, not the neurosurgeon, not the radiation can really go independently to really create something for the patient. You know the treatment is so ________ () --- the treatment is so you know much dependent on all three things. You know you have to have good surgery, you have to have good radiation therapy, and you have to have good chemotherapy and all three things can be intermixed. So all three group of people really have to make --- work together to make advances. So we may be more dependent on each other if you want to build up --- if you want to build up strength as opposed to breast cancer. Breast cancer you can say, you know, there’s a lot of chemotherapy that we can do with it. But on the other hand nowadays, you know, if we don’t put the surgeon and the radiation doctor and the chemotherapy together in breast cancer they cannot make big advances either. You know? I think whether we call it a program, a breast cancer program, a brain tumor program, a lung cancer program or we call it the lung cancer center, breast cancer center, or brain tumor center, it is a multidisciplinary concept. Clinical and research people working together. It is a collaborative approach. It takes a village. We cannot go independent together. There is so much interdependency. For us to really make I think a center approach or a program approach is the only way to go so we can bring all the talents together.

Tacey Ann Rosolowski, PhD:

And you’re co-director is Ray Sawaya, M.D?

Wai-Kwan Alfred Yung, MD:

Yeah. The question is how much of an independent infrastructure and mini structure that you want to create for the center or how loose a structure do you want, like many medical school or medical center they more use major loosely put together center or you know if we want to be more ri --- more --- more formal and say now not only you work together, administratively, you’re together. You know the director gets to hire all the people and gets to control all the machinery. That’s --- That’s the definition _______ ().

Tacey Ann Rosolowski, PhD:

And what’s your view of that? I mean I interviewed Dr. Sawaya and he, you know, provided his perspective on that. What’s your perspective on what that might look like and what the pros and cons are of independent administration?

Wai-Kwan Alfred Yung, MD:

I think it depends on where you are. I mean if you are able --- if you are able to --- I think, of course, it is --- It would be wonderful if you have --- if we can have an independent center you know independent center you know that the center controls the building and controls everything so. But on the other hand financially it is a very big undertaking, you know. So there is pros and cons to that approach you know es --- especially for the support. I mean if you think about radiation therapy, you know, can we administer and own our own radiation machine for brain and then lung own their own radiation machine, breast own their and split up our radiation department into 10-15 subgroup to house under each --- each unit. It becomes very costly. So we have to really look at this --- all these finance models. It’s easier for us to group our neurosurgeons and neuro-oncologists, you know, together because we don’t need to handle big machines, but when you have to handle big machines like radiation --- big machines like radiology the --- the financial model needs to be carefully thought out whether the --- this is economical.

Tacey Ann Rosolowski, PhD:

:5Is there anything else you want to say about the Brain Tumor Center and maybe its future? Big directions that are being undertaken at this point?

Wai-Kwan Alfred Yung, MD:

Well at --- at this point I mean the mixed levels. Presently I’m waiting for a --- a new chairman to come in to expand the group. I think it is time for us to bring in new talents to go into the next level. And --- and we have all the bells and whistles --- bells and whistles to do it and --- and I think we are pretty well set in terms of expanding the brain tumor program in a direction of the institution. You know not only to --- to put a lot more emphasis on immunotherapy and immunology which I think you know even though it has been employed for brain tumor treatment but I think the --- the --- the --- the new age of the emphasis of the T cel --- emphasis on T cell function you know is going to bring that into a new level also as opposed to the old --- the old way of depending on vaccine. Vaccine is not going to make a major impact other than you know coming back to look at this new --- the new knowledge of activating the T cell and that’s how the brain tumor Moon Shots is pushing.

Tacey Ann Rosolowski, PhD:

Now the brain tumor Moon Shot, has that become a reality?

Wai-Kwan Alfred Yung, MD:

Not yet.

Tacey Ann Rosolowski, PhD:

Not yet. That’s what I thought I remembered from our last sessions but they’re putting it together.

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