Making Oncology His Path: An Interview With Ezra E.W. Cohen, MD

Beth Fand Incollingo @fandincollingo
Published: Tuesday, Nov 15, 2011
Dr. Ezra Cohen
Ezra E.W. Cohen, MD

He traded a rewarding family practice for a career researching head and neck cancers.

Ezra E. W. Cohen, MD, had achieved his childhood dream. He was a doctor in a small Canadian town, treating families for nearly any health issue that cropped up—the flu, injuries, childbirth. On hand for milestones both happy and sorrowful, the physician was forging a special relationship with his patients, and he cherished it.

So his wife was surprised one night when Cohen told her he wanted to leave family practice and become an oncologist.

“I was a small-town doctor for almost two years, and I realized that it didn’t stimulate me in the way that I needed,” said Cohen, 45. “I was also doing some palliative care at the time and was involved with a lot of oncology patients. Clearly, we were not winning the battle, and what I began asking myself was not how to take care of these patients, but why— why does this person get that type of cancer, why does this cancer behave the way it does, and what can we do about that?”

To alter the course of his career, Cohen knew he’d have to pursue another internship and residency. It would mean a lifestyle change for a family that had gotten comfortable in Orillia, Ontario, where their home overlooked a lake.

But Cohen’s wife never flinched. “She was, from day one, completely supportive,” Cohen recalled. “She said, ‘If you feel strongly about this, then this is what you’ve got to do.’”

That support helped shepherd Cohen through a journey that brought him to the United States and transformed the doctor into a leading expert on head, neck, lung, esophageal, thyroid, and salivary gland cancers, and in the development of novel, molecularly targeted therapies for those diseases. His laboratory and clinical research interests also include radiation therapy for non-small cell lung cancer and squamous cell carcinoma of the head and neck, especially ways to combine radiotherapy with novel agents.

As a physician and translational researcher at the University of Chicago Medical Center, Cohen has focused on epidermal growth factor receptor (EGFR) inhibitors, such as gefitinib (Iressa). Cohen and his laboratory colleagues discovered that gefitinib was most effective in patients who developed a rash after treatment, indicating a genetic and pharmacokinetic interaction.

“You had to achieve a certain level of exposure for this drug to be effective, and also there are people who are genetically susceptible to this rash and whose tumors are susceptible to respond to this agent,” Cohen said. “The relationship between the development of the rash and the benefit of these drugs is true not just of this drug, but of every EGFR inhibitor out there in every cancer in which these have been tried.”

Out of that understanding branched several areas of research for Cohen: the mechanism of resistance to EGFR inhibitors, newly identified signaling pathways and the study of agents that might shut them down, toxicity and the genetics related to that toxicity, and why some individuals get the rash and some do not.

Having been the lead investigator of phase I studies of sorafenib and axitinib, Cohen is seeking an answer for patients with thyroid cancer, as well. The discovery that these patients respond very well to drugs that inhibit vascular endothelial growth factor receptor 2 (VEGFR2) has been upheld in phase III studies and, Cohen hopes, will soon be an FDA-approved use for such treatments.

Risk Factors Pose Challenges

At the University of Chicago Medical Center, Cohen serves as associate professor in the Section of Hematology/Oncology, co-director of the Head and Neck Cancer Program, and director of the Hematology/ Oncology Fellowship Program. He spends about 30% of his time seeing patients and managing their care, another 30% designing and running clinical trials and doing administrative work, and the remainder conducting research in his lab.

Since beginning his work with head and neck cancers in 1996, Cohen has found himself responding to a growing change in the demographics of his patients, whose risk factors differ from those prevalent in many other forms of cancer.

The patients these days often are in their 40s and 50s, a decade younger than those he previously treated and, as nonsmokers and nondrinkers, they lack 2 typical risk factors for cancer. Perhaps most importantly, these patients have contracted the sexually transmitted human papillomavirus (HPV), which can cause oral pharynx cancer.

An increase in oral sexual behaviors, coupled with a decrease in smoking, is contributing to a soon-anticipated dominance of HPV-positive oral cancers, likely just the beginning of an epidemic, Cohen said. In general, patients with HPV-positive oral pharynx cancer have a far better prognosis than patients with the disease who do not have HPV— and that has created an interesting scientific challenge for Cohen.

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