In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
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Chapter 08: Brain Tumor Research: Translational Studies in Progress and the NCI Study Section
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Yung sketches his other research activities on glioblastoma. He first talks about his activities with the NCI and other groups focused on developing clinical, translational studies of brain cancer. He talks about the challenges of setting up such studies. Dr. Yung next talks about his clinical trials with the drug, BKM 120. He explains how this study also demonstrates the difficultly of attracting attention to a "small cancer" and how MD Anderson can partner with drug companies.
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Chapter 09: The Challenges of Glioblastoma; MD Anderson's Moon Shot Program; No Low-Hanging Fruit for Neuro-Oncology Research
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung explains the challenges that glioblastoma presents to the researcher then sketches the work he is doing to build collaboration among the brain tumor community. He notes that Dr. Charles A. LeMaistre [Oral History Interview] started the Brain Tumor Group, now the largest in the country and the world. Dr. Yung next talks about MD Anderson's Moon Shots Program, now expanding to include more than the six cancers. He talks about the structure of the Moon Shots program and evaluates the lessons learned from its early years. He notes the aim of the Program to focus on "low hanging fruit" that can lead quickly to treatment advances, and explains that there are no such quick remedies on the horizon for treating glioblastoma.
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Chapter 10: Creating a New Department of Neuro-Oncology in 1983
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Yung tells the history of the Neuro-oncology Department from 1983 to 1988. The Department was formed around the same time as the structural reorganization of MD Anderson according to a division system. Dr. Yung talks about the autonomy that the Department was given within this new system. He notes the functions of the new Department: provide neuro consults, manage the Brain Tumor Clinic and Pain Management Section, and provide psychiatry services. Dr. Yung notes that his vision from the beginning was to build brain tumor research. He talks about milestones: the creation of the Brain Tumor Clinic, then the Fellowship Program, and the Department's growing patient load and reputation. Dr. Yung then explains that he and others created joint meetings and rounds cutting across departmental and division boundaries. He also explains that he took advantage of this collaboration to work with the NCI's Cancer Therapy Evaluation Program to develop clinical trials. Members of the Department joined the Brain Tumor Committee within the Radiation Therapy Oncology Group.
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Chapter 11: Creating Networks for Clinical Trials
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung begins this chapter by observing that, in 1988, the new Department had expanded and Dr. Field was ready to retire. Dr. LeMaistre wanted to expand neuro services and recruited Dr. Leaven to chair Neuro-Oncology and provided him with a large package to expand the research and clinical operations. Dr. Yung notes that he was still continuing to run his own research. He also took advantage of the NCI's desire to stimulate brain tumor research and he created a network of institutions for running Phase I clinical trials. He describes what he did to create the consortia under NCI guidelines and the lessons learned as the networks were reorganized. Dr. Yung observes that this project resulted in the NCI adding pediatric brain tumors to clinical trials. He explains that brain tumors are the second most common cancers in children. He also provides an overview of the limited array of drugs available for treating brain cancers, with focus now moving from cytotoxic agents to targeted therapies and immunotherapies. He notes that as the Department grew, there were more opportunities to take advantage of patient philanthropy to support research.
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Chapter 12: Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung explains that in 1990, Neuro-Surgery became a department and Dr. Raymond Sawaya [Oral History Interview] was recruited to head it. He describes the period of expansion that began for both departments at that time. Dr. Yung gives examples of research in Neuro-Oncology and their ties to the institution's status as a comprehensive cancer center. Dr. Yung explains Dr. John Mendelsohn's [Oral History Interview] continued support the combined activities of Neuro-Oncology and Neuro-Surgery, known as the Brain Tumor Program. He stresses that he and Dr. Sawaya shared a commitment to building multi-disciplinary research and care initiatives and he describes the "blessing" for this group that faculty work well together. He describes his goals at the time and his continued commitment to work with Neurosurgery and related fields to develop a cohesive program in patient care and research. He talks about collaborative projects, including development of an oncolytic virus -a rare example of a successful brain tumor drug.
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Chapter 13: Focusing on Work, Faith, and Hope During Cancer Treatment
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Yung talks about his experiences as a patient after his 1999 diagnosis with a rare bladder cancer. He sketches the medical dimensions of the disease, the slow process of diagnosing it, and his choice to have chemotherapy followed by radical surgery. He talks about his faith and his choice to have treatment at MD Anderson and have a true patient experience, not special treatment for an MD or VIP. Dr. Yung observes that his patient experiences have made him a better caregiver and advisor to the department when changes to the clinics and care deliver are planned. Dr. Yung talks about the different ways patients cope with a cancer diagnosis. He notes the special case of brain cancer patients, who lose cognitive function and their independence. Dr. Yung says that he advises patients that accepting their diagnosis early will help them avoid depression and other complications. Dr. Yung notes that he took on the Chairmanship of the Department of Neuro-oncology during his treatment. He felt he had been given extra time to use for his department. He lists the projects he wanted to push forward.
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Chapter 14: Building the Advanced Practice Nurse Program
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
In this chapter, Dr. Yung talks about the expansion of the Advanced Practice Nurse program once he became department chair. He first notes how important support staff are to extending clinical care and then explains why he elected to expand APNs in particular. Dr. Young says that most institutions do not have the rich resource of nurses that MD Anderson has: research nurses, APNs, clinic nurses, and in-patient nurses. He sketches the roles that the APN services in assisting patients' caregivers and building quality of life for patients.
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Chapter 15: The Collaborative Ependymoma Research Network (CERN); Funding Research
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung describes his efforts to support research into the rare cancer, ependymoma and talks about the challenges of funding innovative research in a time of fiscal conservatism. He begins by giving an overview of the four types of brain cancers then recounts how the Collaborative Ependymoma Research Network (CERN) and now serves as model for using private funds to fund research. Next Dr. Yung offers his perspective on the conservatism of government funding of research versus private systems that can take risks. Innovative clinical trials require collaboration of government, the drug industry, and private foundations. Dr. Yung then describes a plan now being implemented to bring these forces together to look at the molecular characteristics of different types of glioblastoma to determine which drugs might target them, sharing the financial risk of running the trials. He notes that this approach has some features in common with MD Anderson's Moon Shots Program.
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Chapter 16: MD Anderson's "Horizonally-Organized" Brain Tumor Center
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
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.
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Chapter 17: The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung first describes the The Defeat Glioblastoma Initiative, an inter-institutional collaboration he has established between UCSD, UCLA, Memorial Sloan-Kettering Cancer Center, and MD Anderson to address glioblastoma. He notes that the Initiative is poised to expand and add international collaborators. Dr. Yung next describes his service on the NCI Brain Malignancy Steering Committee, set up in 2001 response to the request from National Institute of Medicine to provide more review of applications for research funds. The aim is to identify high-value concepts, prevent duplication of efforts, and create collaborations. Dr. Yung explains that this committee's role reflects the new reality of team science and limited resources. Dr. Yung then comments on the challenges of creating collaborations between scientists who originally thought they would run projects independently.
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Chapter 18: Key Periods of Change at MD Anderson
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung offers his perspectives on periods when MD Anderson has undergone large changes. He first discusses Dr. Charles LeMaistre's role in handling the HMO crisis in the early nineties. He next talks about Dr. John Mendelsohn's in setting the institution on "an upswing" of growth and corporatization. He describes how hard it is to manage growth so the institution remains true to its mission of delivering research-driven care, rather than deviating and increasing patient care to generate income to sustain the institution. He notes the pressure and debates that come each year with requests to see more patients, cut back on expenses. Dr. Yung then talks about Dr. Ronald DePinho, who came in "with a good heart and an insightful" view of how to elevate MD Anderson to a position of making an impact on specific cancers. He explains that Dr. DePinho has brought in necessary change, notable addressing complacency and a lack of productivity among the faculty. He says that Dr. DePinho has yet to address the need for investment in infrastructure for clinical research.
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Chapter 19: Stepping Down as Chair; Accomplishments in Perspective; A Sunday School Teacher
Wai-Kwan Alfred Yung MD and Tacey A. Rosolowski PhD
Dr. Yung begins this chapter by sketching the activities he will focus on after stepping down as chair. He next says that he is gratified to see how the Department has grown under his leadership, particularly in the areas of research and psychiatry. He talks about initiatives that have not advanced sufficiently, notable training of physician-scientists and providing a culture for their success. He shares what he would like the department to achieve in the next ten years, notably advances in brain metastasis. Finally, Dr. Yung talks about teaching adult "Sunday school" classes at his church, where he trains the next generation of church leaders. Dr. Yung says that his own faith enters into his work with patients, whom he encourages to have hope.