Robert J. Mayer, MD; Erica L. Mayer, MD, MPH; Kathy D. Miller, MD


June 12, 2014

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Kathy D. Miller, MD: Hi. I am Kathy Miller, Associate Professor of Medicine at the Indiana University School of Medicine in Indianapolis. Welcome to a special Medscape Oncology profile.

This morning, I am speaking with 2 colleagues and friends. Dr. Robert Mayer is Stephen B. Kay Family Professor of Medicine at Harvard Medical School and Faculty Vice President for Academic Affairs at the Dana-Farber Cancer Institute in Boston. Bob is also a past President of American Society of Clinical Oncology (ASCO®). His daughter, Dr. Erica L. Mayer, is Assistant Professor of Medicine at the Harvard Medical School and Senior Physician at the Susan F. Smith Center for Women's Cancers, also at the Dana-Farber Cancer Institute in Boston. Welcome to both of you.

This year at ASCO, being the 50th anniversary of the organization, there has been a lot of reflection about the history of the field and the history of the organization itself -- and a look forward to what the next 50 years might bring. With 2 oncologists in the same family, I thought it might be interesting to get a sense of that history and the trajectory as you two might discuss it around the dinner table.

Bob, let's start with you. Do you recall your first ASCO meeting?

ASCO: A 40-Year View

Robert J. Mayer, MD: I came to my first ASCO meeting in 1974, when I was at the National Cancer Institute (NCI). The meeting was in the Rice Hotel in Houston, which does not exist anymore. The meeting was held in an average-size hotel ballroom. Imagine, over ASCO's 50 years -- what has happened with the organization is just mind-boggling.

Dr. Miller: When you think back to that first meeting, what was the big news, the big practice-changing results that were shared?

Dr. R. Mayer: I don't remember exactly, but I will tell you that the next year, which was the second meeting I went to (in Toronto), was the year that somebody you know very well -- Larry Einhorn -- presented the testicular cancer data on cisplatin plus vinblastine plus bleomycin (PVB),[1] which certainly was practice-changing. We all went around high-fiving; we were doing something and it was great.

Dr. Miller: Chemotherapy will fix this problem.

Dr. R. Mayer: That's right.

Dr. Miller: Have there been some disappointments along the way?

Dr. R. Mayer: There are always disappointments. The old adage of an investigator is, "If everything is working well, something is not right, because nothing is ever perfect." Yes, there were negative trials. There were missiles that went into the air that did not land in the proper manner. Even at this meeting, there are adjuvant studies that did not pan out in your area of breast cancer[2] and in the area of hepatocellular cancer.[3]

Things that should work did not necessarily work; from 1974 to 2014, what it has taught me is the critical importance of doing a properly conducted clinical trial and not assuming that people and diseases are the same as they appear in the laboratory or in laboratory models. That is why we are clinical oncologists.

From Dad's Presentation Slides to Her Own

Dr. Miller: Erica, oncology has truly been a part of your entire life. Do you recall your first ASCO?

Erica L. Mayer, MD, MPH: My first ASCO meeting was when my father was President of ASCO, and it was in Los Angeles. My experience of ASCO was very different from what it is now, as a participant and faculty member.

At that time, I was a family member, and it was great fun and exciting. I remember becoming a little nervous getting ready for the presidential address, and a lot of practice sessions with Kodachrome slides at home. I came to ASCO a few times as a medical student, still getting a taste of what the meeting was about and being impressed each year by how it kept getting bigger and more exciting.

Now, my role at ASCO is very different but still very exciting. It is always so impressive to walk in the first day and see thousands of people, all gathered here together from around the world to do the same thing.

Dr. R. Mayer: I remember that first meeting that you came to. You were impressed with ASCO, but you were also impressed with the suite that the President of ASCO was given.

Dr. E. Mayer: As is every family of the ASCO President.

Dr. Miller: It is still a fabulous honor to be the President. Do you aspire for your daughter to be President of ASCO someday?

Dr. R. Mayer: We all have fantasies, I suppose. I am just very proud of all the things that she has done.

Erica may not remember. She was a medical student at a meeting in New Orleans, and we started to go to different places because she had different interests. Then she was a fellow at a meeting in Atlanta, and she was already in the breast cancer track, if you will, and now I watch her participate in the Leadership Development Program, as Chair of the Breast Cancer component of the Education Committee, and on the Communications Committee.

It's a real thrill to sit in the back of the room and listen to her speak. You never know what will happen.I just want to be sure that I am around to see it.

From Sick Patients to Cancer Survivors

Dr. Miller: Erica, your perspective is different from that of some other oncologists of our generation. You were introduced to the field much earlier in life because of the experiences that you shared with your father. As an oncologist practicing independently now, what things about that role caught you by surprise, that you did not expect from what you had seen with your father?

Dr. E. Mayer: Two present trends are quite different from the world of oncology that I was exposed to as a child. I heard about when my dad was a trainee and how incredibly sick cancer patients were and how cancer took peoples' lives, not infrequently. It was a really difficult place to be. Today, in the world of breast cancer, most of my patients are cancer survivors.

At ASCO, we are focusing a lot of our attention on the health and well-being of what is now a reasonably healthy population of millions of cancer survivors in this country. It is a vastly different world from when you were at the NCI in the 1970s.

Dr. R. Mayer: Absolutely.

Dr. E. Mayer: The other thing is that we were talking about the early chemotherapy trials. In our breast cancer world now, as in many other parts of oncology, we are dissecting these tumors into smaller and smaller subgroups and developing novel targeted therapies to come up with individualized cocktails for everybody. We are not hitting cancer with a big blunt tool anymore; we are trying to do precision work and using incredibly exciting and, shall we say, sexy scientific tools (genomic profiling and all sorts of interesting things). It is very different from the one-size-fits-all approach that was in development early on.

What Hasn't Changed in Oncology?

Dr. R. Mayer: The science has changed. No question about it, but the one thing that has not changed in my 40-plus years is the humanism. It is a privilege to participate in the care, as Erica points out, of people who have life-threatening diseases.

At a meeting such as this one, very often at the end of a presentation, the speaker will thank (with humility) the courage and participation of the patients who agreed to be part of an experiment. I never forget that, because I remember in the past how desperately ill patients were. Now we are talking about fine points -- which of several different drugs we might use -- but still, it is a wonderful opportunity to really understand and bond with your patient. That is what makes oncology special to me.

Dr. Miller: Is that what drew you to the field? Thinking back to where the field was when you started -- with the really limited potential for effective therapy and with truly horrendous side effects -- it does make some young oncologists wonder, "What were you thinking?" What drew you to this field at that difficult point in its history?

Dr. R. Mayer: Because there was a need; because oncology was being defined as an entity; because I and others in my generation truly wanted to make a difference -- a difference not just for the patients, but a way of waving a flag to lead other young physicians to become oncologists, to share the passion, and to share the hope for progress, much of which has been realized.

Of course, much more needs to come, and that is the fascination of the science. Why should this happen, and why have we been unable to do more about it? So much of oncology is dealing with people in society. Why do people do things that make them more susceptible to a malignancy? Can we educate people? Can we have a positive effect?

One of the beauties of ASCO is that as it has grown and matured, it has extended to all of these different areas. It is not just chemotherapy. It is not just drug X vs drug Y, but it is the broad scope of the whole community, the welfare of our physicians, and the quality of care that we provide, and it has changed as the profession has changed. I am very proud of that.

Challenge: Keep Lowering Cancer Incidence, Mortality

Dr. Miller: As you think about the continued evolution of the profession, what are you are looking to forward to? What is the next big challenge that we as a profession need to tackle that has not been on the front burner so far?

Dr. R. Mayer: A single oncologist can't do everything, and Erica is absolutely right. The issues of survivorship; palliative care; and collaborating with family and primary care physicians to stimulate and encourage people to avoid obesity, receive vaccinations, and make sure that the ashtray is not used -- prevention, including screening -- are all within the scope of being an oncologist.

I am primarily a gastrointestinal oncologist, and the impact that endoscopic screening has had on reducing the incidence, the new cases, and the mortality caused by colon cancer (the second most common cause of cancer death in the United States) is amazing. It can happen, and it has happened in our lifetime.

Dr. Miller: Erica, we were talking earlier about the plenary session and the prostate cancer abstract.[4] It was a delightful surprise when we literally heard gasps in the audience. We do not get that sort of dramatic response very often. What is the next big advance that you are hoping to see that will get that reaction?

Dr. E. Mayer: Going back to the research lab and understanding more about the biology of cancers will allow us to design better tools and be able to take greater steps forward. In our breast cancer abstracts this year, some very exciting new tools have emerged, but we also have seen some abstracts that have led us to question what are we doing and where are we going. A continued deep partnership with the research lab and focusing on strengthening that translational bridge between lab and clinic and using that to help design our future studies is going to be very important.

Dr. Miller: I have one last question for the both of you. When you are at the kitchen table, is there someone in the family who says, "Stop with the oncology already. Can we talk about something else?"

Dr. E. Mayer: We don't talk shop at all at home. My mother and sister, neither of whom are in medicine, would prefer to talk about much more interesting subjects, such as art, music, and travel -- all that delightful stuff.

I am married to a physician, and it is very nice in our house. Even though we are not in the same field, we share the same types of highs and lows. It is very nice to have somebody in whom you can confide that way, and being at ASCO together is a special time for us because we can have our own time to talk shop.

Dr. R. Mayer: We can, but it is fair to say that when we stray and drift into those sorts of conversations at home, we are told to stop it pretty quickly.

Dr. E. Mayer: We are reprimanded.

Dr. Miller: We will not reprimand you here, but we will thank you very much for joining us. It truly has been a pleasure.

Thank you for joining us for this Medscape Oncology profile. This is Kathy Miller, reporting from ASCO 2014.


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