A Gifted Leader Who Broadened Investigative Work in Oncology

OncologyLive, Vol. 20/No. 15, Volume 20, Issue 15

A 2018 Giants of Cancer Care award for Community Outreach, Education, and Cancer Policy, Richard L. Schilsky, MD, built a scaffolding upon which new trials were launched into emerging areas of oncology investigation. His work has led to new standards in cancer care, particularly in breast cancer, and along the way he has furthered the careers of many successful and talented oncologists and investigators.

Richard L. Schilsky, MD

From an early age, Richard L. Schilsky, MD, had no doubt that he would pursue a career in medicine. In fact, he put it in writing in a sixth-grade assignment that asked students to describe the kind of work they wanted to do. “It was titled ‘My Ambition,’” he recalled. “There’s a line in there about how I wanted to be more than a physician. I wanted to be a medical researcher so that I could discover new things that would help people. Looking back, I think it was pretty amazing that in the sixth grade, I had that goal in mind already and could distinguish between the 2 career paths.”

Currently the chief medical officer of the American Society of Clinical Oncology (ASCO), a post he is the first to occupy, Schilsky, has served as chair of the Cancer and Leukemia Group B (CALGB), as well as director of the Comprehensive Cancer Research Center and associate dean of the Biological Sciences Division at the University of Chicago in Illinois.

At the time Schilsky took over, CALGB was a narrowly focused cooperative. It had achieved significant milestones in developing a systematic approach to clinical trials that led to meaningful gains in medical knowledge, particularly for patients with leukemia, but Schilsky worked to broaden its perspective so that it could address emerging needs in the field of oncology.

“I’ve always felt that part of the success of being a leader is to have a vision, know where you want the organization to go, and find the best people to help move it in that direction,” he said. Schilsky did exactly that. Through his insight into human capabilities and leadership strengths, he was able to not only turn his visions into reality but also choose the right people to build on what he started.

Broadening Geriatric Oncology

In the 1990s, Schilsky knew that as the population aged, older individuals would bear most of the cancer burden. He also saw geriatric oncology as an emerging field. Putting two and two together, Schilsky formed the Cancer in the Elderly Committee at CALGB and paired a well-known geriatrician, Harvey J. Cohen, MD, with a well-known medical oncologist, Hyman Muss, MD. “That turned out to be a match made in heaven. Those guys then worked together for the next 20 years and carved out the field of geriatric oncology,” Schilsky said. “Almost every current leader in that field passed through that committee in their career development, and the field is now recognized as an important cross-disciplinary specialty.”

With Schilsky at the helm, CALGB went on to develop programs in clinical pharmacology and pharmacogenetics. From his days at the University of Chicago, Schilsky had been interested in studying how patients metabolized drugs differently and how that contributed to outcomes. For this, Schilsky drew on the talents of Mark J. Ratain, MD, a longtime colleague. Ratain, an expert in pharmacology, was also interested in pharmacogenetics.

“We started collecting a sample of normal blood from every patient in every CALGB randomized clinical trial, and as we were able to see the patient outcomes, we were able to also see whether there was a patient group that had far more toxicity than anyone else or far less,” Schilsky said. Those outliers made it possible to understand how differences in genetic makeup influenced drug metabolism, which helped broaden the field of cancer pharmacogenetics.

Other activities at CALGB during his tenure also contributed to understanding and developing new standards of care. An important randomized trial during the late 1980s debunked the value of high-dose chemotherapy and bone marrow transplant for treating breast cancer. In addition, the research efforts that blossomed under Schilsky’s leadership led to approvals of key oncologics, of which the lifetime researcher and medical oncologist is especially proud.

Following developmental work by James F. Holland, MD, at the Icahn School of Medicine at Mount Sinai in New York, New York, CALGB did a pivotal phase III trial of azacytidine that led to FDA approval of the drug for patients with myelodysplastic syndrome. A study of paclitaxel as part of an adjuvant chemotherapy regimen for breast cancer led to approval of the drug for that indication; similarly, FDA approval followed a CALGB trial of lenalidomide (Revlimid) after bone marrow transplant for patients with multiple myeloma. Most recently, a CALGB study begun under Schilsky’s tenure led to FDA approval of midostaurin (Rydapt) for treatment of acute myeloid leukemia with an FLT3 mutation.

“If I counted up, there were 5 or 6 drugs that got an expanded or initial FDA approval based on CALGB studies that were conducted during my time as the group chair,” Schilsky said. “If I were a pharma executive who had successfully brought 5 or 6 drugs to market during my time, that’d be a pretty good track record, and I think it’s a darn good record for a cooperative group.”

Although Schilsky went on to fulfill the ambition expressed in his school essay, many formative experiences cut and shaped the direction of his career, honing him into the scientist—leader he became. The first cut was perhaps the most painful. In the mid-to-late 1960s, his grandmother, with whom he was very close, developed breast cancer, first in 1 breast and some years later in the other. In those days, the treatment then was crude compared with current standards. “She was treated both times with radical mastectomy followed by chest wall radiation, and both were brutal and cosmetically disfiguring,” he said. There were recurrences, bone metastases, fractures, and brain metastases. Schilsky’s grandmother suffered greatly in her last days. “Watching her go through that, it seemed to me that there could be a better way,” he recalled.

School Days

Schilsky earned his undergraduate degree at the University of Pennsylvania in Philadelphia and then attended the University of Chicago Pritzker School of Medicine. Prior to his second year there, he won a stipend to follow a radiation oncologist on his rounds at New York University Medical Center. “The only thing I was able to do was talk with and listen to the patients and observe the doctor, but that was also a very influential time in my own career development—just hearing the stories of the patients, many of whom presented with locally advanced cancer, which was painful and disfiguring, and, of course, the radiation therapy was for the purposes of palliating their symptoms,” Schilsky said. “It wasn’t likely to be curative in most cases. I was taken by the impact of cancer on the lives of these people.”

He returned to medical school convinced that he wanted to be a radiation oncologist, and he even landed a research project studying clinical charts for clues to radiation’s effectiveness in preventing recurrence of sarcoma in the extremities after amputation. Schilsky described that as a rewarding experience, but during internal medicine rotations in his third year, his focus changed once more.

“I really fell in love with internal medicine and the focus on diagnosis and problem solving, along with the long-term relationships with patients that was typical of the way that internists work,” he said. Thus, medical oncology became his career choice.

Schilsky had the great fortune to study under John E. Ultmann, MD, a pioneer in the teaching of compassionate care who also developed treatments for Hodgkin disease and non-Hodgkin lymphoma. Ultmann urged Schilsky to consider further training at the National Cancer Institute (NCI). Schilsky successfully applied for a fellowship and, following his 2-year residency at Parkland Memorial Hospital in Dallas, Texas, began as a clinical associate in the NCI’s Medicine Branch.

The Fruits of a Career

Either by design or by accident, encounters with Schilsky stimulated many sharp and eager young minds to pursue careers in medicine.

“I’ve always enjoyed interacting with students and trainees at every level,” he said. “One of the most gratifying things is to see so many of these former trainees in positions of leadership in their own institutions around the country and even around the world. People stop me all the time at meetings and say, ‘Hey, you were my attending physician on my oncology service’ or ‘I attended a lecture you gave’ or ‘You were my group leader at a course, and it made all the difference to me.’ Someone said almost those very words at a reception at the [2018] ASCO meeting. A young man came up to me and said, ‘You were the group leader at my Vail course—which was a course on clinical research methods—and it totally changed my career path,’ and that was almost 20 years ago. To hear those things coming back at you is immensely gratifying.”

As chief medical officer of ASCO, Schilsky continues to pursue the activities that have defined his achievements of the past 4 decades. His passion for research is reflected in ASCO’s Targeted Agent and Profiling Utilization Registry (TAPUR) trial. Its rationale originated from the recognition that different tumor types with similar mutations may respond to drugs that are approved just for limited indications. ASCO wanted to track the genomic profiling of cancers by collecting data on treatment and outcomes from physicians. The way to do this, Schilsky and others decided, was to incentivize doctors to share information by providing a source for the drugs oncologists needed.

In his leisure time, the New York City native likes to watch sports, visit the theater, and spend time with his wife, Cynthia, an oncology nurse by training whom he met as a third-year medical student.

“She was a nurse [who was] working on the inpatient hematology-oncology service. We then had a bit of a long-distance courtship. I went to Dallas, she went to Seattle. We finally were able to get back together when we completed our respective trainings,” Schilsky recalled.

“She gave me the ultimatum: ‘We’re getting married or I’m out of here.’” They got married, and the rest is progeny. The couple have 2 daughters and 2 grandchildren.