“This became the foundation of all the new trials we developed, to stage the disease and then develop therapies or approaches for each of the different stages,” said Durie. “This strategy has become a mainstay in terms of everyone’s approach to cancer treatment.”
Durie generated another medical “first” nearly a decade later, when he collaborated with Salmon to develop a stem cell assay that involved growing myeloma cells, and then trying to wipe them out with different drugs.4
Such a test had never been used in cancer before.
“This technique was subsequently picked up by the NCI and used as a national screening technique for all cancers to test drugs,” said Durie, referring to the National Cancer Institute. “We ended up having an annual, international stem cell conference in Tucson, and people would come from all over the world to learn about this.”
In 2006, Durie and colleagues contributed yet another technique for measuring the success of myeloma treatment when they published an updated version of the uniform response criteria authored by the European Group for Blood and Bone Marrow Transplant/International Bone Marrow Transplant Registry. Durie’s system included new categories—stringent complete response and very good partial response—that made it easier to quantitate patients’ responses to therapy, and thus to compare the effectiveness of drugs. His team also made other changes, including a new emphasis on time to event and duration of response as critical endpoints.5
“The FDA now uses this system across all kinds of cancers to assess whether they’re going to approve a new drug,” Durie said.
He further helped to set FDA standards by determining that patients with multiple myeloma who have failed every available therapy will typically live another three to six months.6
“This establishes something called an unmet need criterion
,” Durie said. “If the FDA is going to approve a new drug for myeloma, the drug has to fill an unmet need, meaning it will generate an improvement over that three-to-six month lifespan by a significant percentage. It turns out this is key if you want to make progress toward developing a new drug.”
Looking Beyond His Village
Durie grew up in North Berwick, a Scottish fishing town that was home to about 2000 people but no traffic lights. His father worked at the railway station and his mother as a nanny to the local doctor’s children.
While Durie knew the doctor and his partner fairly well, he didn’t consider following in their footsteps until he sat down with his mother to discuss his future. Since Durie was excellent at math and science, his mother asked him to consider what he could do with those skills.
“I started to think that, although I would need to continue my education, becoming a doctor could mean I’d always have a job doing something I was interested in, and actually helping people,” he said. “The other aspect was that, coming from this none-too-prosperous family, the possibility of having a job and being able to survive financially on a regular basis was attractive.”
But not everyone had faith that Durie would make good on his plans. “There was a lot of question among different family members as to whether I would get through medical school,” he said. “I had the grades, but they said ‘Could he be a doctor?’ There was a lot of speculation about that.”
As it turned out, the speculation was unnecessary.
Durie had no problem graduating from the University of Edinburgh Medical School in 1966, and then training for a year at the Royal Infirmary there.
Still, when he considered his prospects for practicing medicine in the United Kingdom, the outlook seemed grim.
“You need to wait for someone to die to get their job in the UK system,” he said. “I saw everyone waiting for jobs and decided that maybe the answer was to try something different. Not too many had done this at the time, but I decided I just would leave.”
Durie secured a fellowship at the Mayo Clinic in Rochester, Minnesota, first attending Wayne State University for part of a year to get the necessary US clinical training.
“I loved it because it represented a freedom of expression,” he said of Mayo. “The idea that I could work and get promotions and be able to do well if I did things properly was very, very exciting.”
It was his experience at Mayo, where he worked in cellular immunology, that inspired Durie’s interest in myeloma. He was influenced by his mentor there, Robert A. Kyle, MD, a prominent myeloma researcher.
“The other part was that I loved looking down a microscope, so, as a researcher, blood diseases were fantastic,” Durie recalled. “Studying cells under the microscope was a whole world for me.”
As his fellowship drew to an end, Durie learned that Salmon would be taking a position at the University of Arizona, and that junior research jobs were open. He applied and Salmon chose him, launching his two-decade association with the university. In 1981, Durie was named a full professor, and he stayed on through 1992.