A Keen Mind and a Daring Spirit Propel Kantarjian's Many Discoveries in Leukemia Therapy

Published: Thursday, Jan 08, 2015
Hagop M. Kantarjian, MD

Hagop M. Kantarjian, MD

Hagop M. Kantarjian, MD, has built the nation’s largest clinical leukemia practice, in part to ensure that leukemia studies are completed efficiently and in a timely manner. This helped him become one of the most productive clinical translational cancer researchers of all time.

“My clinic is my research laboratory, and nearly every patient is participating in a study,” he said. “The goal is to give patients something better than current standards of care and then, when the regimens we devise become standards of care, to look for regimens that are even better.”

This attitude has revolutionized the treatment of many types of leukemia, extending the lives not only of many thousands who have come to the leukemia program at MD Anderson Cancer Center in Houston, Texas, but also of millions who have received care elsewhere.

Kantarjian spent decades developing the new research protocols that transformed chronic myeloid leukemia (CML) from a death sentence to a manageable condition. He helped create the hyper-cyclophosphamide, vincristine, doxorubicin, and dexamethasone (hyper-CVAD) regimen for treating acute lymphocytic leukemia (ALL) in adults. He found lifesaving uses for drugs that had been abandoned, important medications such as clofarabine (Clolar) and decitabine (Dacogen). He pioneered the use of epigenetic therapy in leukemia.

In all, Kantarjian has authored or coauthored more than 1200 peer-reviewed articles, many of them describing breakthrough studies that rank among the most important in the history of leukemia research.

Photographic, Encyclopedic Memory

Why has Kantarjian achieved so much success? Colleagues say it starts with remarkable mental talents.

“He has a photographic, encyclopedic memory unlike any other I’ve ever encountered. He can absorb huge quantities of information and remember it all forever,” said another giant of cancer research, Emil J. Freireich, MD.

According to Freireich, who helped invent the very idea of combination chemotherapy, Kantarjian’s incredible facility for acquiring, storing, and retrieving knowledge helps his protégé in two key ways.

First, it gives Kantarjian a deep understanding of leukemia, and that understanding helps direct his research in fruitful directions. If some study from 1972 suggests an interesting possible follow-up for work that was just published yesterday, Kantarjian knows it, because he remembers the study from 1972.

Second, and more important, Kantarjian’s breadth of knowledge makes him a natural leader of large teams. He knows enough about every specialty to manage specialists, and he knows enough about how different specialties mesh to combine their efforts effectively.

“He isn’t a lab researcher at all,” Freireich said. “He does his research in his head. Then he assembles the proper team for the project and keeps that team running efficiently—all while he’s managing half a dozen other research teams and running his department. It’s an incredible talent, and it makes him more productive than any traditional researcher could ever be.”

Kantarjian gives a different explanation for his success. He says that he owes much of it to the lessons he learned from mentors such as Freireich, Michael J. Keating, MB, BS, and Kenneth B. McCredie, MD.

Chief among those lessons was to ignore tradition, challenge every idea, and dare to seek improvement.

Indeed, Kantarjian said, this is the ethos that permeates MD Anderson and made his career possible.

“Most places expect deference based on seniority or prestige or tradition. Anderson expects the opposite. From the day I arrived, they encouraged me to question the assertions of the most senior people,” said Kantarjian, who expects the same from his youngest researchers. “Even if new ideas prove wrong—and most of them do—they are the only possible path to improvement, so you must keep investigating them. Nothing is ever good enough.”

Tinkering

Shortly after his arrival at MD Anderson, a young Kantarjian helped to run some of the first studies that employed interferon against CML. The team discovered, in relatively short order, chemo-interferon regimens that significantly improved upon existing standards of care, but Kantarjian kept on experimenting.

He spent years tinkering with different medications, in different doses, on different schedules—eking out little gain after little gain and waiting for the next big jump.

That jump came years later when Kantarjian helped develop treatment protocols for first-generation kinase inhibitors such as imatinib (Gleevec). The next leap followed a few years after that, when he did the same for second-generation kinase inhibitors that are the current standard of care.


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