Chapter: 07 Research on Chemotherapy and Anti-Fungal Therapy

Chapter: 07 Research on Chemotherapy and Anti-Fungal Therapy

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In this segment, Dr. Bodey first sketches the causes of death in cancer patients, noting that 47% of patients would die from infections. He notes that the work he conducted with others at the NCI and at MD Anderson helped improve this figure, and they determined that early intervention was very important. He then talks about his work on a study of “late-intensification chemotherapy” then moves on to sketch his studies of many types of infection and techniques for protecting patients from infection. Much of this information, he notes, came from the Protected Environment studies, adapted to help patients in ordinary hospital situations. ;

Dr. Bodey then returns to the topic of chemotherapy, noting that the work originated at the NIH and studies conducted by J Freireich. Dr. Bodey had clinical responsibility for patients with acute leukemia and Dr. Freireich was responsible for the drug regimen. Once at MD Anderson, Dr. Bodey was also involved in analyzing data. Dr. Bodey talks about a controversial but successful four-drug combination that Dr. Freireich proposed. He also speaks about the successful Adriamycin studies. ;

Dr. Bodey states that, in his research career, he was very gratified to work with Dr. Freireich and make progress against leukemia as well as infectious diseases.

Identifier

BodeyGP_02_20130626_C07

Publication Date

6-26-2013

City

Houston, Texas

Topics Covered

The Interview Subject's Story - The ResearcheThe Researcher The Clinician Discovery and Success Overview Definitions, Explanations, Translations Patients Patients, Treatment, and Survivors Character, Values, Beliefs, Talents Portraits

Transcript

Gerald P. Bodey Sr., MD:

Here is an important study. I think we may have already touched on this one—the cause of death in cancer patients.

Tacey Ann Rosolowski, PhD:

Oh, interesting. Okay.

Gerald P. Bodey Sr., MD:

We studied 816 cancer patients who underwent an autopsy. Forty-seven percent of them died of infections, organ failures in twenty-five percent. The most common fatal infections were pneumonia, septicemia, and peritonitis. The majority of infections were E. coli, Pseudomonas, and Klebsiella.

Tacey Ann Rosolowski, PhD:

Now, when you said 47%, was that 47% percent of the patients died of infections?

Gerald P. Bodey Sr., MD:

Yes, 47%. Yes.

Tacey Ann Rosolowski, PhD:

That’s amazing. That’s an amazing statistic. So after all of your work on the various antibiotics and antifungals, how did you have an impact on that figure, do you think? Were you able to get it down below that 47%?

Gerald P. Bodey Sr., MD:

The treatment of infections improved considerably over the years, because one of the first things that was demonstrated—and I think we were the ones that were largely responsible for presenting that—was the fact that you started treating these patients who were neutropenic with antibiotics when they developed fever, not waiting until you had culture results back. If you waited until the results of the cultures came back, some of them were already dead. So that was a very important aspect that evolved from a lot of this work. This one here is the causes of death in cancer patients. We went over some of that. I’m not going to repeat that again.

Tacey Ann Rosolowski, PhD:

Let me just pause the recorder for a minute while you’re looking. (End of Audio 4 Session 2)

Gerald P. Bodey Sr., MD:

This is an interesting study. This is Dr. Freireich’s.

Tacey Ann Rosolowski, PhD:

Okay. So you said this is a particularly interesting study. Why?

Gerald P. Bodey Sr., MD:

Because we had twenty-nine patients who were in complete remission of acute leukemia for at least one year and received what we call “late intensification therapy.” We came back to see if we could have a major impact. After that, then they received no more chemotherapy. Fourteen patients were still in remission when this was written, but I don’t know how long that was.

Tacey Ann Rosolowski, PhD:

Now, was this a chemo study or a study of the infections?

Gerald P. Bodey Sr., MD:

No, this was a chemotherapy study.

Tacey Ann Rosolowski, PhD:

A chemotherapy study. I see.

Gerald P. Bodey Sr., MD:

The length—fourteen patients—the length of remission was at least sixty weeks after the late intensification, with a median period of time of ninety-eight weeks. For the control group, it was only forty-four weeks. So that had a—

Tacey Ann Rosolowski, PhD:

So what exactly was the treatment that was being studied there? I wasn’t clear on that part.

Gerald P. Bodey Sr., MD:

I’m not sure. I’m sure it’s written in here somewhere. We had two different regimens, depending on—that were used. I don’t know that we need to go into that so much. But it was standard chemotherapy for acute leukemia. It wasn’t something unique. It was regimens that we were using in leukemia patients. What was unique was coming along at that point—after they had been in remission for a while—and giving them an intensive course of therapy to see if we could then lengthen the duration of their remissions. And we were able to demonstrate that.

Tacey Ann Rosolowski, PhD:

Let me just read the title of that—

Gerald P. Bodey Sr., MD:

That’s Dr. Freireich’s, not mine.

Tacey Ann Rosolowski, PhD:

Okay. But you’re listed as first author on this paper.

Gerald P. Bodey Sr., MD:

I am?

Tacey Ann Rosolowski, PhD:

You are.

Gerald P. Bodey Sr., MD:

Well, I did a lot of the writing.

Tacey Ann Rosolowski, PhD:

“Late Intensification Therapy for Acute Leukemia in Remission, Chemotherapy, and Immunotherapy.” The authors are Gerald Bodey, Emil J Freireich, Ed Gehan, Kenneth McCredie, Victorio Rodriguez, Jordan Gutterman, and Andrew Burgess.

Gerald P. Bodey Sr., MD:

Well, that was et al., but I’m sure that Dr. Freireich gets the credit for it, not me. That was his idea. I just did some—a lot of the work. I don’t know. It’s amazing how much of that was stuff—the infection and prophylaxis stuff, it’s getting boring now. We did all sorts of stuff—comparing different kinds of soaps.

Tacey Ann Rosolowski, PhD:

What was the soap that you studied that went on the market afterwards?

Gerald P. Bodey Sr., MD:

I’m not sure I can even tell you that anymore.

Tacey Ann Rosolowski, PhD:

Was it one of those pHisoHex/pHisoderm things?

Gerald P. Bodey Sr., MD:

No. I really don’t remember anymore what particular one it was.

Tacey Ann Rosolowski, PhD:

So this was—all this work in the laminar airflow rooms was really groundbreaking in the sense that you were quantifying all kinds of stuff, just seeing what you could influence.

Gerald P. Bodey Sr., MD:

Yes. We recognized—the oldest is the—well, this was done to try to learn as much as we could on how we could keep the patient from being exposed to possible infection. I didn’t realize this was all infection stuff, but here’s the one paper we did studying fungal infections. But I didn’t know if I really did—this is not a terribly informative paper.

Tacey Ann Rosolowski, PhD:

Tell me, Dr. Bodey, I know you said last time that it was determined that given the expense of running and maintaining the protected environment and laminar airflow rooms that MD Anderson decided it wasn’t worth operating and that the benefits were not commensurate to the expense of running them. So what I’m wondering is with all this work that you did to quantify infections and how you could influence them, did you discover things that would be applicable outside of the airflow rooms?

Gerald P. Bodey Sr., MD:

To a certain extent, yes, trying to maintain the level of contamination, things like that, but certainly not anything to level of the quantitative approaches. Some of the—I mean, some of the agents that we used, maybe the soaps or something, might have been used then in other patients, but there was quite a dramatic difference between being in those units and being out in the ward. I think that they actually had some impact on the air flow. They didn’t have laminar airflow, but they have filtered air in the rooms. The whole laminar airflow program was stopped after I retired or when I was at least pretty much retired, so I wasn’t really heavily involved in what went on after that.

Tacey Ann Rosolowski, PhD:

Now, I know you weren’t able to—

Gerald P. Bodey Sr., MD:

Do you have a copy of this paper?

Tacey Ann Rosolowski, PhD:

“Fever in Neutropenia, The Early Years,” I do not.

Gerald P. Bodey Sr., MD:

It’s awfully long, twenty-one pages of published material. I don’t know how we can—it’s kind of long to make a copy of, unless you really want it badly. My copy machine is slow.

Tacey Ann Rosolowski, PhD:

Slow, yeah. Well, the other thing I could do is take it with me and mail it back to you.

Gerald P. Bodey Sr., MD:

Well then, if you’d like to do that, yeah.

Tacey Ann Rosolowski, PhD:

Sure. That would be great. I will just make a note to copy and return.

Gerald P. Bodey Sr., MD:

Now, I don’t know how much all—what else you’d like to have. I mean, this is—

Tacey Ann Rosolowski, PhD:

Well, let me just make that note. I mean, I’d like to hear about—I know you don’t have papers in front of you, but I’d like to hear about the work that you have done. That doesn’t go with this? This is another thing? Okay.

Gerald P. Bodey Sr., MD:

That belongs with another—

Tacey Ann Rosolowski, PhD:

Some of your reasons for getting involved in the chemotherapy work and maybe the big themes of the research that you did in that area.

Gerald P. Bodey Sr., MD:

Well, it all came about because—I think I mentioned to you the last time—one of my friends, Dr. Charles Mengel who went to Johns Hopkins, his father was our family physician. He talked me into applying for a position at the National Cancer Institute. That’s how I got started in it. Of course, then I was assigned to the leukemia service, so I was working under Dr. Freireich. And Dr. Freireich is a brilliant man. He just created an environment where we found things to do that interested us. So I had—and then I stayed on—well, I was there for three years. Then I just got interested in it. Then of course, our clinical responsibilities were the entire ward, taking care of these patients with acute leukemia. So that’s how I got in it all with acute leukemia. Actually, the infections were really kind of secondary to the primary, which was treating these patients for leukemia. I wasn’t really knowledgeable about antitumor agents and all that. That was Dr. Freireich’s responsibility—was to come up with the chemotherapy regimens. We just were giving them to the patients. We might be involved in the analysis of the results and that sort of thing, but they were his derivations, to a lesser extent, I guess, Dr. Frei too. But it was primarily him. He ran the leukemia service. We actually had two floors, one for children and one for adults.

Tacey Ann Rosolowski, PhD:

And this was at the NIH?

Gerald P. Bodey Sr., MD:

NIH—National Cancer Institute—yeah. So that’s how I got involved. I got involved in some of the chemotherapy work as well. I was analyzing data and that sort of thing.

Tacey Ann Rosolowski, PhD:

So you served a support role. You were not pairing drugs or doing any of those kinds of things?

Gerald P. Bodey Sr., MD:

No. That was his responsibility. When I came down here, I had more. But even here, he was always the over—oversight with acute leukemia and some other areas as well. I often worked very closely with him. I don’t know that I ever developed a chemotherapy regimen solely on my own. Maybe I did, but not very often. That was his doings. Then I would be involved in carrying them out and so forth.

Tacey Ann Rosolowski, PhD:

Was there a particular—any particular study that stands out for you right now that you recall as being either particularly interesting to you or significant?

Gerald P. Bodey Sr., MD:

Well, one of them was when he decided to develop a four-drug combination to treat acute leukemia. I mean, that was unheard of at that time. You usually were using only one. Some of us were somewhat skeptical about the wisdom of doing something like that, but it turned out to be very effective, and the remission rate was higher in those patients. The duration of remission was longer. So it was a major advance, actually.

Tacey Ann Rosolowski, PhD:

How did the patient tolerate it?

Gerald P. Bodey Sr., MD:

The drugs were selected on the basis of their activity but also their toxicities so that we didn’t have overlapping toxicities. As we used them, we got to learn what concentrations or doses they could tolerate.

Tacey Ann Rosolowski, PhD:

Now, as you were treating patients, for example, on that study, you were also handling the infectious disease side of it as well?

Gerald P. Bodey Sr., MD:

Yes.

Tacey Ann Rosolowski, PhD:

Were there some patients who were in two studies at once? I mean, how did you manage that?

Gerald P. Bodey Sr., MD:

Well, there were a lot of patients who were on a chemotherapy regimen and also getting involved in an antibiotic study. That was very common, yeah.

Tacey Ann Rosolowski, PhD:

Any other of the chemo studies that stand out in your mind?

Gerald P. Bodey Sr., MD:

We did so many of them. I’d have to really think for—you know—to pick one out as opposed to another. But there were obviously advances. Adriamycin, I guess, is one drug that would stand out as being particularly effective. To be quite honest with you, I don’t know what they’re using right now.

Tacey Ann Rosolowski, PhD:

Is there anything else that you’d like to say—more about the research that you’ve done?

Gerald P. Bodey Sr., MD:

I don’t know.

Tacey Ann Rosolowski, PhD:

When you look back at the research that you’ve done, what are you really pleased that you focused on, or what are you really proud to have accomplished?

Gerald P. Bodey Sr., MD:

The thing I’m most pleased with was that I had the opportunity to work with Dr. Freireich all these years. I mean, we’re very good friends, and I have very high regard and respect for him. I was grateful to have the opportunity of working with him because we were making progresses and treating leukemia as well as infections. It was a real pleasure to work with him. See what I have here? I have all these papers, up to—I don’t know—800 and something, but it’s only the first page, not too much help.

Tacey Ann Rosolowski, PhD:

That’s okay. I mean, I think we’ve hit the big themes, and certainly with a solid bibliography people can do supplementary research.

Gerald P. Bodey Sr., MD:

Well, you’re welcome to take this along with you as long as you bring it back to me, because it’s the only one I have. It’s a pretty heavy book.

Tacey Ann Rosolowski, PhD:

That’s okay. I think actually Javier gave me a list of abstracts. So they could be—I can find those on my end too.

Gerald P. Bodey Sr., MD:

Oh, you can? Okay.

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Chapter: 07 Research on Chemotherapy and Anti-Fungal Therapy

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