Chapter 13: Research with Chinese Partners at Fudan University Shanghai Cancer Center

Authors

Lorenzo Cohen PhD, The University of Texas MD Anderson Cancer Center
Tacey A. Rosolowski PhD, The University of Texas MD Anderson Cancer Center

Files

Description

In this chapter, Dr. Cohen talks about the turn his research took when he began to build a research partnership with Fudan University Shanghai Cancer Center [now a Global Academic Partners sister institution]. He first explains that he was interested in partnering with institutions that offered a combination of western and traditional treatments and details why Fudan was a good choice.

Next, Dr. Cohen talks about three clinical trials set up at Fudan, looking at natural products, acupuncture and chi quong. He talks about the results of the studies and the impact on Fudan University.

Identifier

CohenL_03_20160824_C13

Publication Date

7-24-2016

Publisher

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

City

Houston, Texas

Interview Session

Lorenzo Cohen, PhD, Oral History Interview, July 24, 2016

Topics Covered

The Interview Subject's Story - The Researcher; The Researcher; Building/Transforming the Institution; Understanding Cancer, the History of Science, Cancer Research; Professional Path; Overview; Definitions, Explanations, Translations; Research, Care, and Education; Research; Patients; Patients, Treatment, Survivors; Cancer and Disease; Professional Practice; The Professional at Work; Collaborations; Cultural/Social Influences; Global Issues "“Cancer, Health, Medicine

Transcript

Lorenzo Cohen, PhD:

So that's the kind of -- you know, trying to really incorporate these mind/body practices within the standard of care, alongside radiation, or alongside chemo, embedded within medical procedures, etc. Just to shift for a little bit to another area that's taken up a significant portion of my career is the work we have done with our colleagues at the Fudan University Shanghai Cancer Center, which is a sister institution in Shanghai, China. So in -- I believe it was in 2002, the National Center for Complementary and Alternative Medicine, which has since changed its name to National Center of Integrative Medicine and Health, released an RFA for international centers of excellence, pairing a US institution with a foreign institution in the country that had a very strong indigenous medical culture -- for example, Ayurvedic medicine from India; traditional Chinese medicine from China; Kampō in Japan, if you were interested, but I don't think anyone submitted grants; homeopathy; Curanderismo from Central and South America; Native American medicine. So these are intact medical systems from other cultures that have their own diagnosing, prescribing, you know, their whole philosophy of medicine that's very different from our Western view of medicine. So when that RFA came out... That RFA came out, like, right around the same time that I took over as, you know, kind of formally the director of the Integrated Medicine Program, and the Integrated Medicine Program was founded, you know, in 2002. And I was lobbied by MD Anderson colleagues from China, from India, from Japan, and from Korea, to pick their country, and that, you know, they had relationships with such-and-such a hospital, and, you know, "I want you to, you know, go on and work with them. And so I already had kind of started the relationship with my colleagues in India, in the area of yoga. And I can't remember the exact RFA, but, you know, they -- and NCI joined on, as well, even though it was an NCCAM RFA -- NCI, National Cancer Institute. And they, meaning NCI, I knew was very interested in the natural product side of this, and everyone was interested in the natural product side of this. And I hadn't gotten that involved in any research in that area of natural product drug development. It's really drug development, preclinical, phase one, phase two. [] So early in 2003, I went to China, and went to a number of different institutions set up primarily by Dr. Zhingxing Liao, who's now -- who continues to be at MD Anderson, professor in Radiation Oncology, who specializes in lung cancer. And she had colleagues at Fudan, as well as in Hunan, and I went to Beijing, as well, and essentially interviewed and was interviewed by, you know, these different individuals. All these hospitals, as essentially every hospital in China has, they're either a traditional Chinese medicine hospital that has conventional medicine, or they're a conventional medicine hospital that also has traditional Chinese medicine. And the traditional Chinese medicine hospitals that had a little conventional medicine were too uncontrolled. You know, they had, you know, literally -- when they were weighing out the herbs, they held scales up in the air. There was newspapers all over the tables. There was herbs literally all over the table, all over the floor, just because of the speed that they needed to go through to, you know, put these formulas together. There wasn't a lot of care and precision that we would need in the West. Now, frankly, the -- you know, when you're boiling up some of these herbs, you know, if there's a little extra pinch of that or this, you know, it's all a hot water extract, so it's probably not going to make a huge difference clinically, but for research purposes we needed something that was a little cleaner. I also went to Korea around that time, and during this first trip, when I went to China, my wife came with me, because I knew if we were -- if I was going to actually submit this grant and embark on this not that I, you know, presupposed that I would be successful, but, you know, starting an international collaboration to form a center was going to be a big investment of my time, and I was certainly going to be there a lot, and she had the opportunity to come with me, as you know. [] So in -- so we -- so I chose the Fudan University Shanghai Cancer Center. Their name wasn't that at the time, and they weren't a sister institution at the time, but we had close relationships already formed. And it's partly because the president of the hospital was trained here in radiation oncology, so Dr. Liao was very close friends with Dr. Jiang, the president. He modeled his hospital on MD Anderson. You know, they changed their name to kind of follow the MD Anderson name, right? Shanghai University, Fudan University Shanghai Cancer Center, right? MD Anderson Cancer Center. They used to be called Cancer Hospital, and we used to be called Cancer Hospital. So, you know, a lot of parallels there. And, you know, again, it was a Western hospital doing conventional treatment, similar stature and size as MD Anderson, their traditional Chinese medicine pharmacy was immaculate, everything weighed and put in little packets, and, you know, very, very well done. And there was a department of traditional Chinese medicine that was very interested in particular in natural products research. So we designed a study -- the initial grant was an R21, which is just two years to allow the centers to start to work together and to develop a plan of what they would do for the subsequent competition two years later, which was a U19 grant, which is a center grant where the institutes -- the -- have a little more say than your standard center grant, like a P01, but the same kind of concept. So I learned about traditional Chinese medicine very quickly, read Dr. Ted Kaptchuk's wonderful book called The Web That Has No Weaver, read it actually on the plane flight over my first time to China. Fell in love with Shanghai, as my wife, Alison, did, as well, just this crazy, you know, urban city on steroids that was just going through this crazy development during that time, and continues today. But that was really where it was starting to accelerate, in 2002, 2003. And extremely Western. And it was really just a juxtaposition of living in Houston -- we both grew up in Toronto, which is a vibrant city, and there's people on the streets all the time, and you're walking everywhere, and then we land in Houston, where, you know, it looks like, you know, the air raid signal just went off and everyone's hiding inside and you never see anyone in the street, and if you see somebody walking on the street you say, "That's weird, somebody's on the street,and then you think, that's weird that I think it's weird that somebody's walking on the street.

Tacey A. Rosolowski, PhD:

Did -- I don't know if I told you, but when I -- during the time when I was housesitting for you guys, I would often walk up to the library, or I would, you know, walk up to Starbucks or... I actually had people slow down and ask me if I needed help, because... (laughter)

Lorenzo Cohen, PhD:

Yeah, so that's it. That's, like... That's sort of the perfect --

Tacey A. Rosolowski, PhD:

Very car culture, yeah.

Lorenzo Cohen, PhD:

-- example. So we immediately fell -- we're foodies, and the food is just, you know, sensational. You know, they had the same kind of obsession with food that, you know, my Italian culture has, and so I just loved it. So, you know, I would go -- so during those first two years, you know, I went about three times a year, usually in two-week stints, always had this sort of, like, army of people that I went with, including Dr. Liao, Dr. Joseph Chang, who's anesthesiologist and acupuncturist, was one of the key folks, as well, to help make this relationship a success. He ended up actually marrying one of the anesthesiologists from there, and she's now here at MD Anderson, during our times over there, and stuff happening behind the scenes that I didn't know about. (laughter) And so we designed three clinical trials, a study in three areas: so one was natural products; one was acupuncture; and one was Qigong -- you know, mind/body. So the Qigong we used a similar model that we did here with the yoga study that was successful, of incorporating into radiation, so they would get the Qigong, or they would get the usual care. Acupuncture was the study for treating prolonged ileus after surgery for abdominal surgery, which was a study we'd also done here, so trying to replicate it there, grabbing low-hanging fruit. And then the natural products area was a little more challenging where to start, and we started with a product called huachansu, which is the extract from a toxic toad, which has been used in traditional Chinese medicine for centuries, and there was a company that makes an oral formulation, and an IV formulation, and it's, you know, speaking to -- every hospital that we spoke to, it is part of their formula for liver cancer, for pancreatic cancer, and other cancers, but those two cancers were really the specialty of my colleagues in the traditional Chinese medicine department. So we actually, you know, started those three clinical trials in the first two years. Nobody else out of the eleven grants that were awarded actually started a clinical trial, and, in fact, we finished two of them, as part of the first grant -- the Qigong study we didn't finish -- and continued it when we submitted the U19. We were actually successful in getting the U19 funded, which was for a subsequent four years, and then did a phase two of the huachansu study, did an acupuncture study for xerostomia, and then we did a follow-up acupuncture for xerostomia. So over the course of the R21 and the U19, we conducted seven clinical trials in Shanghai, and, as you know, we had the luxury of, with John Mendelsohn's support, who was super supportive, of spending six months living in Shanghai, which should've been a full year -- and in hindsight, it should've been a full year, but... [] So that was -- I mean, I could spend two hours talking about everything that went on in China, and the politics, and around Qigong, and translation issues, and people having to leave a meeting to go to the Communist Party meeting, you know, in the auditorium, and if you weren't part of the Communist party you were going to be, you know, passed over for chairmanship, and so it was, you know, just -- it was so difficult, and so rewarding to do that kind of research. Because at that point I was actually already kind of bored with my career here. You know, I kind of... You know, I'd already been very successful in getting R01s, and publishing in at least, you know, what you could call the top-tier oncology journals -- JCO, etc. And I thought, well, you know, more of this. You know, I've already done this, moving on kind of thing.

Tacey A. Rosolowski, PhD:

Open a restaurant, right? (laughter)

Lorenzo Cohen, PhD:

Yeah, I mean, so going to China and having to work with people who don't even speak English and have a totally different sensibility, and, I mean, it was the challenge that I kind of needed at that time, and I kind of hadn't seen, you know, exactly where I should be, let's say, putting my efforts and not focusing on the short-term excitement of getting grants funded and that kind of thing. So...

Tacey A. Rosolowski, PhD:

So what were your big decisions coming out of that experience?

Lorenzo Cohen, PhD:

Well, so what was the most successful in a, I guess, conventional sense of positive studies, like clearly positive studies, was the acupuncture research for the radiation-induced xerostomia. So that led to us applying for and being successful in -- successful to a degree that we got a perfect score on the R01, which up until then I'd actually never really heard of, and since then I've heard of other perfect scores, but this was kind of early when the NIH shifted their -- the way they scored grants, and we got a perfect score to do a multicenter trial of acupuncture for radiation-induced xerostomia. So this was another four years, so this is now, you know, going on -- you know, my first trip was 2002, 2003. We're now 2016 and we've just finished recruiting the last patients on that R01. So, you know, the relationship has waned, partly because we've subsequently tried to get funding from the NIH to continue the radiation-induced xerostomia research by going and doing more neuroscience, and we haven't been successful. So I'm not sure where the relationship will go, if it'll go anywhere. We have continued the huachansu research, the toxic toad venom, with the company through sponsored research agreements. So, you know, if you look at all the centers that were funded, there was only three funded. I think... I think you can say ours was, under all measures, probably the most successful, but one of the measures of success is, one, now that traditional Chinese medicine department does a ton of research, and actually with companies like Bayer and other companies. As part of this -- again, I could do a whole two hours just on this center -- you know, we brought the nurses over here. Every nurse who worked on the study had to spend three months at MD Anderson to be trained under our nurses, work with the phase one program, do all the trainings that nurses went through. All the doctors had to come here and spend at least a month, do our IRB, human subjects. That hospital, when we first started, didn't have an IRB. Now they have an IRB, they do scientific review. I mean, it's parallel. It's -- everything is parallel. What was I going to say? Oh, so we're continuing the huachansu research, not with the hospital but with the company, to develop an extract from this toxic toad that will be more potent -- oral, ideally, because the IV formulation's not reasonable to do in the West, where you have to have an injection, an IV drip every day for 14 days. Right? That's... I mean, they do a lot of inpatient treatment. We don't.

Tacey A. Rosolowski, PhD:

What does the venom extract actually do?

Lorenzo Cohen, PhD:

So Dr. Peiying Yang, who's a preclinical associate professor in the Integrated Medicine program does all the preclinical research in this area, and it's a cardiac glycoside, and, you know, she's kind of mapped all the mechanisms behind why huachansu works, and it's a very encouraging product, and very potent. And, in fact, the company that was a small company in Anhui Province that -- who we were working with, they were subsequently bought by the largest natural products company in China during this whole relationship, and it's -- there's no question in my mind it's partly due to all this attention that huachansu was getting in the West. When we published the first paper, there was actually a -- I was living in China at that time, and they did a big -- NBC did a big national story on huachansu -- well, big meaning, you know, two- or three-minute clip on, you know, the work that we were doing there. So...

Tacey A. Rosolowski, PhD:

But, I mean, what -- how is it used? What is the effect that it has on the body or cancer?

Lorenzo Cohen, PhD:

You mean mechanism, or does it work?

Tacey A. Rosolowski, PhD:

No, I mean... No, I'm accepting the fact that it works. I'm just --

Lorenzo Cohen, PhD:

Well, no, no, we don't even know if it works. They use it, though, all --

Tacey A. Rosolowski, PhD:

But I mean -- but I'd be -- but what -- how does it affect a patient? What are the results in a patient? Does it make the cancer go away? Does it shrink a tumor? I mean --

Lorenzo Cohen, PhD:

I don't know. So, I mean, our phase two trial wasn't successful. It was randomized. You know, Gemcitabine for advanced pancreatic cancer patients -- everyone got Gemcitabine with or without huachansu, and the huachansu didn't seem to add to it, but, you know, there's a lot of reasons why that probably didn't work, and actually John Mendelsohn said, "You know, in hindsight -- and hindsight's easy -- you probably should've done huachansu against Gemcitabine, and you may have shown that huachansu is as good as Gemcitabine. But Razelle Kurzrock, who helped with the first phase one study, used to be head of our phase one program, who's now at UCSD, she's like, "Well, Gemcitabine's not even a good drug. So we're kind of in a murky, not great world. You know, they use it, and the company continues to fund research in a number of different areas. It's not part of the Western pharmacopeia, because there isn't good enough evidence yet that it works, and from our perspective we needed to make, and will continue to work with the company to make, a better product. So during this experience, I had learned a lot about, you know, as my crash course in drug development and preclinical research and, you know, the FDA, and INDs, and phase one, phase two, phase three clinical trials. So how are we doing on time?

Tacey A. Rosolowski, PhD:

It's ten minutes after 10:00.

Lorenzo Cohen, PhD:

Oh, okay, we have time. So...

Recommended Citation

Cohen, Lorenzo PhD and Rosolowski, Tacey A. PhD, "Chapter 13: Research with Chinese Partners at Fudan University Shanghai Cancer Center" (2016). Interview Chapters. 632.
https://openworks.mdanderson.org/mchv_interviewchapters/632

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