From the Desk of Dr. Louis M. Weiner

Having just returned from vacation I had a lot of catching up to do last week. But, there were some memorable moments. First of all, on Monday we had our annual Men’s Event at Morton’s on Connecticut Avenue. There was a record turnout, and while we don’t yet know the final tally in terms of money raised, we almost certainly set a record. The evening started with a briefing on prostate cancer by Sean Collins and me, followed by a cocktail reception and a wonderful meal, and then a live auction. It was great fun. I got to sit at a table headed by Cliff Alexander, one of the event’s co-founders, and found myself sitting next to a retired lawyer who, as luck would have it, literally grew up a couple of blocks from me in the Philly suburbs. It was great fun to talk about the old neighborhood. More importantly, it was wonderful to be surrounded by so many people who are dedicated to our cause.

After a very busy couple of days, I drove down to Charlottesville on Wednesday afternoon to participate in the Georgetown University Executive Committee retreat. We visited Monticello for a fascinating and important in-depth tour with the staff, which included historians, archeologists and preservationists.

We also spent an afternoon learning more about Generation Z, whose older members are now of college age. For those of you who have lost track of generational definitions, here you go: Baby Boomers (1945-1964), Gen X (1965-1981), Gen Y – known by most of us as Millennials (1982-1995), and Gen Y (1996-2015). I don’t know what comes next, but I predict the Greek alphabet may soon come into play. According to our guests, each generation has its own cultural touchstones. Gen Z has never known a world without smart phones, laptops and iPads. Obviously, this changes the ways they interact socially. It changes the ways they learn. Gen Z is less into drugs, but more into LARPing (you can look it up). Gen Z is incredibly tolerant with respect to race, gender identification and sexuality. Apparently when they meet each other, one of the key questions they ask is “What’s your pronoun?”  Any answer is just fine with them. Of course, it is too soon to know if these attributes reflect durable changes or are simply transitory; we baby boomers once fancied ourselves as the Woodstock generation, and ultimately became our parents, more or less. Perhaps youth is just another curable disease, treated best by time. Hopefully, the unassuming tolerance of this youngest generation will endure. That would be nice. But I don’t know about LARPing…

Have a great week.

I hope you had a good week. I spent mine at Bethany Beach with my extended family. We had a wonderful time, and I feel refreshed and ready to get back to work. One of the great things about family beach vacations is the wonderful rhythm of paradoxically action-packed yet lazy days that blend together – wonderful nothings that create gauzy memories and unbreakable bonds. However, a few mornings ago our oldest son Ken took a run on the beach and came across a 35 foot long, 35 ton whale that had washed up onto the shore the night before. Apparently this magnificent creature had been killed by a boat’s propeller blade and had probably been dead for about two weeks.

The body was cordoned off and officials (with the help of volunteers) set about doing an autopsy and preparing for disposal of the carcass. Needless to say, one does not move a behemoth easily. In the end the body was buried on the beach. It was a sad, massive undertaking, and it got me thinking about the destructive potential of modernity, which in this case felled one of nature’s noblest creatures. In paradox, as technology changes, there are good and bad consequences, often unintended.

What does this have to do with cancer research and clinical care? At first glance, not much. But, clinical care, now so technology-dependent and algorithmic, too frequently involves physician/patient interactions where the doctor sits at a computer, with only cursory interactions with the patient sitting before him or her. Has clinical care actually improved? The answer is undoubtedly yes, since cancer cure rates and survivals have improved. But technology, like the whale, has the potential to be blind to its destination. There is certain finesse to balancing the metaphorical propeller in front of us with the sonar technology that saves. In the end, a patient is a person, just as the whale is a creature. Even as treatment is not perfect, it is important to see the life of the patient beyond disease.

Just as in medicine, technology has utterly transformed cancer research. In general, this transformation has been for the better, but I suggest you check out the classic Watson and Crick paper describing the structure of DNA (Nature. 1953 Apr 25;171(4356):737-8.). One page; one figure… It would never be sent out for review by any modern journal editor. To get a paper published today we need immense data sets, gargantuan teams, and enough figures and tables (to say nothing of supplementary data) to populate an entire issue of Nature in the early 1950s. Is this progress? Yes, but a paper describing simple, rigorous experiments is as endangered as a whale in the midst of an armada. There is room for both technology and scientific intuition in science (indeed, they are complementary and essential). There is much that technology has done, and despite its potential for error, there is always room for research and exploration to improve the lives of many. Whales die, but whales can also be saved.

Have a great week.

Greetings on a lovely Sunday evening. We got to our rented house for a week at the beach with our family a few hours ago. The sun is shining, and the ocean is shimmering in the distance. One of our grandchildren is having a tantrum. Life could not be more perfect.

The week was highlighted by a number of activities regarding the MedStar Georgetown Cancer Network. I have found this work to be stimulating and very important. I look forward to sharing the details with you as the structure unfolds. I also was delighted to meet new people in the context of our advancement activities. Since Donald Dunn arrived I have been introduced to more people and have laid more groundwork for future philanthropy than at any time since I arrived at Georgetown. It has been very exciting and rewarding.

All that remains between me and watching the sunset is completion of this blog. See you later, and have a great week.

The flood of exciting results coming out of this weekend’s ASCO meeting is a powerful reminder that research and discovery are making a difference in the lives of people with cancer. Lombardi is well represented, as always. Immunotherapy continues to be a star of the show. For example, the combination of nivolumab (anti-PD1) and ipilumumab (anti-CTLA4) has important anti-tumor activity in small cell lung cancer, which has seen no major advances in over 25 years. An anti-CD38 antibody shows significant clinical activity in multiple myeloma. There is progress in molecularly targeted therapies as well, and evidence is beginning to emerge that the overall strategy indeed improves outcomes. There is even progress in adenocarcinoma of the pancreas, one of the diseases that gives cancer a bad name. Simply combining the standard agents gemcitabine and capecitabine yields significantly better survival in the adjuvant setting compared with gemcitabine alone.

Over the past several months, that progress has been demonstrated in a very personal manner. One of my elderly relatives was diagnosed with myelofibrosis, which is caused by JAK/STAT or calreticulin mutations, and leads to progressive fibrosis of the bone marrow. This causes anemia, pancytopenias and until recently was a very difficult to treat, accelerated chronic illness with a relatively short life expectancy. Individuals afflicted with this disease are typically tortured by relentless pruritus (itching) that is extremely difficult to treat. Lest you think that pruritus is a trivial toxicity, think about itching that robs you of sleep and sanity. It is no fun.

When my relative’s pruritus worsened, even as his hemoglobin rose and stabilized after treatment with recombinant erythropoietin, he commenced therapy with low, twice-daily oral doses of ruxolitinib, a JAK/STAT inhibitor. One week later his pruritus had nearly resolved. He is likely to do well for quite a while, and his disease is likely to remain controlled so he can maintain his active lifestyle. This is a small miracle – a reprieve – that could not have happened without the fundamental and translational research that led to the development of an important drug that relieves suffering and prolongs survival.

ASCO is a reminder that our work has broad impact that manifests itself in very particular ways, one person at a time. It reminds me of Lombardi’s Vision Statement of having local focus and global impact. Keep up the great work, and have a wonderful week.