A Leader in the Revolution: Michael B. Atkins Is Giant of Cancer Care in Melanoma

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Partner | Cancer Centers | <b>Georgetown Lombardi Comprehensive Cancer Center</b>

“I don’t intend to rest on any laurels as thereis still much more to be done.”

At the very start of his medical career more than 40 years ago, when most oncologists only hoped to turn cancer into a chronic disease, Michael B. Atkins, MD, had a different goal: He was looking for a cure.

A tall order for sure, and a seemingly insurmountable one when the cancer in question was melanoma. “The cancer that gives cancer a bad name,” as Atkins called it. Melanoma affected people young and old, spread rapidly and widely, and at that time, killed 90% of patients with metastatic disease within 2 years.

“Few oncologists wanted to take care of it,” said Atkins, who has served as deputy director of the Georgetown Lombardi Comprehensive Cancer Center since 2012. “So many lives lost, motherless children, fatherless families, really a lot of tragedy, and few wanted to be involved with it.”

Atkins believed immunotherapy would make all the difference. His earliest research involved recombinant human interleukin-2 (IL-2) and lymphokine-activated killer cells. Atkins’ “eureka” moment came when a 28-year-old man with metastatic melanoma treated with the protocol returned weeks later for a checkup. His neck was swollen with a goiter and blood work showed he’d developed hypothyroidism. But his tumors were gone.

“That suggested to me that the treatment was working by stimulating immunity against the tumors,” Atkins recalled. Although this type of response was relatively rare, occurring in only 10% of patients, it served as proof of principle that the immune system, if properly activated, could eliminate the last cancer cell, producing a cure.

Atkins said his experience with IL-2 proved that cytokine-based immunotherapy could be curative. Investigators spent the next 20 years trying to develop regimens that either improved the cure rate or reduced the toxicity—and, failing in those regards—later trying to identify those who would benefit the most from immunotherapy. This led to the observation that some patients had immune cells that recognized the tumor cell but could not kill those tumor cells because of unknown factors in the tumor microenvironment.

The breakthrough came from the work of James P. Allison, PhD, the 2014 Giants of Cancer Care® award winner for Scientific Advances, and Tasuku Honjo, MD, PhD, who shared the 2018 Nobel Prize in Medicine for discovering that immune “checkpoint” proteins prevented tumor-specific T cells from being fully activated. Those inhibitory checkpoints, CTLA-4 and PD-1, put the brakes on the immune response. The development and application of antibodies against those checkpoints—pembrolizumab (Keytruda), nivolumab (Opdivo), and ipilimumab (Yervoy)— unleashed the immune system to kill tumor cells.

Atkins and colleagues at Yale University, Memorial Sloan Kettering Cancer Center, and the University of Pittsburgh wanted to see how dual checkpoint blockade with antibodies against both PD-1 and CTLA-4 would affect melanoma progression. The nivolumab/ipilimumab combination induced extended treatment-free melanoma remissions in more than 50% of patients. Today, it is the standard of care for not just melanoma, but also for patients with kidney cancer, non–small cell lung cancer, mesothelioma, and other diseases.

“Immunotherapy has turned my melanoma clinic from a place of fear and suffering to a veritable travel agency, as patients are finishing their treatments and returning to their precancer lives,” said Atkins, also the Scholl Chair in Medical Oncology at Georgetown University Medical Center. “They’ve been given a second chance at life, and they’re pursuing it with gusto.”

Atkins is modest about his own contributions, but his clinical and translational research efforts in melanoma and kidney cancers and immune, anti-angiogenic, and targeted therapies have uncovered critical biology of these diseases that have led to more than 20 FDA-approved treatments. Still, he wants to do more.

“I would say being a giant in melanoma may seem like being a big fish in a small pond, but the impact we’ve had on oncology in general has been enormous,” said Atkins, who’s still excited to go to work after all these years. “I truly believe we are in the midst of nothing short of a revolution in cancer therapy. Progress in immunotherapy is not just changing the way we care for patients with many cancers, but the very way we think about cancer.”

The Less-Successful Brother

Atkins grew up in Milwaukee’s North Shore suburbs, the third of 5 children. His twin brother, Edward, claimed the second spot, arriving in the world 13 minutes earlier. Edward also became a doctor, focusing on anesthesiology. He retired about 2 decades ago.

“My parents always thought of me as being the less-successful one since I’m still working,” Atkins explained.

His father, Julius, a Navy veteran, completed law school and then worked in real estate development. Atkins’ mother, Mildred, was one of the first women to earn an engineering degree from the University of Wisconsin. Her November 2020 obituary noted that she and her husband shared with their children “their belief that hard work, passion, and commitment made any goal achievable.”

Atkins describes a happy childhood, living next to a man-made lake with friends nearby, winters spent ice skating, and summers filled with water sports. At one point, he considered becoming a professional water skier.

“I figured I wasn’t going to make it, but I still love being out on the water,” he said.

He chose to attend Tufts University in Medford, Massachusetts, as an undergrad, making him an outlier in a family thick with degrees from the University of Wisconsin. He wasn’t sure of his academic or career paths, but something his father said before dropping him off at the airport for his first flight to Boston stuck with him.

“He said, ‘You know, if I had to do it over again, I might have been a doctor instead of a lawyer,’ ” Atkins recalled. “I always loved science and I loved interacting with people—and being a doctor has been a way to do both.”

Tufts didn’t have a waterskiing team, so Atkins joined the Jumbos swim team. Being a college athlete taught him a lot about time management and teamwork.

“It has been very important to me to have functioning teams...where everybody gets recognized for their contributions and has an opportunity to lead specific efforts rather than one person getting all the glory.”

Atkins met Susan Crockin the first day of freshman orientation, and they quickly became a couple. As college graduation loomed, both knew they wanted to attend postsecondary schools, him for medicine and her for law, but the big question was where? Atkins’ parents wanted him to join his brother at the University of Wisconsin School of Medicine and Public Health. Crockin’s parents wanted her to move closer to their Virginia home.

Their solution? Tufts University School of Medicine for him, making him a “double Jumbo,” and Northeastern University School of Law for her. “We decided to stay in Boston,” Atkins said. “Then we stayed 40 years.”

Oncology Presents a Continual Challenge

Atkins was immediately drawn to oncology. He’d enjoyed cell biology classes as an undergraduate, and “cancer was really just applied cell biology.”“I wanted to be in a field with patients who really cared about their disease, who would come to their appointments and do what you asked them to do. You weren’t just a nuisance; these were serious health issues that they cared deeply about, and you were responsible for managing them,” he said. “I also wanted to be in a field that was a challenge, where most of the problems hadn’t been solved and there was a lot of room for advances. I wanted to be continually challenged throughout my career. Oncology met all of those criteria.”

Atkins became interested in immunotherapy while a medical student. He began working on immune-based cancer treatments for patients before he’d even done his oncology fellowship. He was inspired by the work being done by John M. Kirkwood, MD, at the University of Pittsburgh and Steven A. Rosenberg, MD, PhD, now at the National Cancer Institute (NCI). Both men are now Giants of Cancer Care®.

James W. Mier, MD, a recently retired associate professor of Harvard Medical School, was one of Atkins’ earliest mentors and later a close colleague.

"It’s important for someone who is a clinician interested in doing translational research to have a laboratory partner to bounce ideas off, to provide preliminary data for clinical trials, write grants with, and do the correlative studies for translational research,” Atkins said. “Jim Mier was that for me for 30-plus years.”

The first 2 decades of Atkins’ career were buoyed by research grants, allowing him to divide his time between the lab and the clinic. The losses outweighed the successes, making each win all the sweeter. And that 28-year-old patient with metastatic melanoma who was part of Atkins’ eureka moment? He’s now in his 60s.

“He was newly married and had no children when we treated him. Now he’s a grandfather. It shows you the impact of potentially curative therapy,” Atkins said. “When things were really bleak, when we were helping less than 10% of patients, we’d do things like count their offspring to remind ourselves we were making a difference.”

The World Beyond Melanoma

Atkins spent almost his entire adult life in Boston. He and Susan raised 3 children there while he worked at Tufts Medical Center and then Beth Israel Deaconess Medical Center (BIDMC) and played a leading role in multiple collaborative research projects. He led the Cytokine Working Group from 1992 to 2008, co-led the first NCI Melanoma Specialized Programs of Research Excellence (SPORE) grant, led the Dana-Farber/Harvard Cancer Center Kidney Cancer Program and the first Kidney Cancer SPORE grant, and founded and co-led the Melanoma Research Foundation Breakthrough Consortium.

He also established and led the BIDMC Cancer Center’s cutaneous and biologic therapy programs, was president of the Society for Immunotherapy of Cancer, codeveloped a new staging system for melanoma, served as coeditor of the Cutaneous Melanoma textbook, and continues to edit the melanoma chapters for UpToDate (the electronic medical textbook).

In 2012, Atkins made a major career and life change, moving to Washington, DC, to become deputy director of Georgetown Lombardi Comprehensive Cancer Center.

Atkins has continued his melanoma, kidney cancer, and immunotherapy research. He began work on dual checkpoint blockade and now leads the DREAMseq trial (NCT02224781), comparing the sequence of targeted therapy followed by dual checkpoint blockade versus the reverse sequence in patients with metastatic BRAF-mutant melanoma.

He’s also looking at the combination in patients with brain metastases, exploring developing biomarkers for response and toxicity with the regimen and when it is safe to stop treatment.

Most recently, Atkins joined the NCI’s Investigational Drug Steering Committee Immunotherapy Task Force.

“I’m looking at ways to be helpful, focusing on novel aspects like identifying biomarkers for response and safely stopping treatments and trying to figure out the prerequisites for successful combination regimens that will improve outcomes while maintaining the curative potential of immunotherapy,” Atkins said.

While preparing to leave Boston, Atkins compiled a list of 22 “Atkins’ Aphorisms” to remind himself of the important lessons he’d learned over time. They can also serve as guidelines for younger physicians. Among his lessons:

  • The secret to good patient care is caring about the patient. Put yourself in their shoes, and try to make recommendations you would be comfortable receiving.
  • Clap for others. People like applause. Support your staff, and look for opportunities to support their careers. You will benefit in the reflected light of their accomplishments.
  • You need to work for people you respect and who respect you. Your bosses should want to help you succeed, not just protect their own status.

Atkins has proven that he lives these words, particularly the one about how good patient care starts with caring for the patient. When Atkins was officially named the Dr Scholl Chair in Medical Oncology at Georgetown in 2017, Lombardi Comprehensive Cancer Center Director Louis M. Weiner, MD, shared his favorite story about Atkins, whom he’d met at Tufts when he was a fellow and Atkins was a resident.

Weiner said that Atkins was vacationing in Florida when he bumped into a former patient. Years earlier, he had treated the man for melanoma with one of the first immunotherapy drugs.

Atkins’ treatment had cured the man, and he wanted to introduce the doctor to his son. The boy was born after the man finished therapy. “This is the impact that greatness has on our society,” Weiner said. “This is the impact of great and innovative work.”

When Atkins addressed the crowd upon receiving the Dr Scholl Chair, he introduced former patients as “not just cancer survivors but thrivers.” He pledged to keep looking for a cure for today’s patients and future patients.

“I don’t intend to rest on any laurels as there is still much more to be done,” he promised.