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Robert J. Mayer, MD, who helped the field of oncology develop while conducting groundbreaking research, was honored in the Gastrointestinal Cancer category with a 2015 Giants of Cancer Care® award, a program that OncLive developed to recognize leaders in the field.
Robert J. Mayer, MD
Oncology and hematology arguably attracts more research funding, more media attention, and more talented minds than any other medical specialty—but that wasn’t always the case. When Robert J. Mayer, MD, graduated from Harvard Medical School in 1969, the profession was just emerging from its infancy. Its training programs were still a work-in-progress, and it struggled to attract top researchers.
Thousands of people deserve some of the credit for changing that reality, but Mayer deserves a particularly significant share. He has, like all Giants of Cancer Care®, published important papers. Indeed, Mayer’s research has helped create standards of care for leukemias and gastrointestinal cancers.
Perhaps more importantly, though, Mayer has spent much of his career working to improve and expand the entire field of oncology and hematology. He was a key architect of one of the first postgraduate training programs in cancer, a tireless worker for the development of professional groups such as the American Society of Clinical Oncology (ASCO), a catalyst for the increased specialization among cancer doctors, and a mentor to hundreds of young physicians from institutions all around the world. He was, in other words, a driving force in the professionalization of an entire specialty.
“Bob has a commitment, not only to cancer patients and cancer research, but to the field of oncology itself. He is just one of life’s natural mentors, and he has mentored individuals at his own and at other institutions,” said Alan P. Venook, MD, the Madden Family Distinguished Professor of Medical Oncology and Translational Research at the University of California, San Francisco.
“I first met him when a flight cancellation stranded us both at Frankfurt Airport on the way back from a conference where I’d done a small presentation. He was already well known and I was just a very junior researcher. He introduced himself and we spent the day looking for a way home while we talked about my research and my interests.
A Commitment to Mentoring
Within a week of returning to San Francisco, he had appointed me to a committee. He basically mentored me from across the country. He gave me the opportunity to do truly meaningful work far faster than I could have done otherwise, and he has done the same for a number of accomplished researchers.”Mayer’s commitment to mentoring may stem from the difference between his years as a college undergraduate and his years as a medical student. During the former, Mayer developed a deep and lasting relationship with a faculty adviser who helped him make the most of his time inside and outside the classroom. During the latter, Mayer’s adviser left a few months into his first year, and the school did not replace him. Mayer overcame that challenge, but he had always been unusually bright and energetic. Born to Jewish immigrants who fled Nazi Germany for Long Island in the late 1930s, Mayer decided at an early age to follow in his father’s footsteps and become a doctor. He graduated first in his high school class and went on to be a standout undergraduate at Williams College before moving on to Harvard Medical School and a residency at Mount Sinai Hospital in New York. He then took a fellowship at the National Cancer Institute (NCI), both because it was then the world’s leading center of cancer research and because the job fulfilled military obligations that might otherwise have sent him to Vietnam.
Mayer says he learned more about medicine in a few years at the NCI than he did in all his prior medical training. He was soon, however, on his way back to Boston, when Emil Frei III, MD, offered him a job at a new cancer center that Harvard was building. It was only a 1-year fellowship, but Mayer so enjoyed working at what would come to be known as the Dana-Farber Cancer Institute that he has stayed for an extra 40 years (and counting).
“The NCI was a wonderful place to treat patients and do research, but it had no ties to any medical school and it trained no residents, so it was really missing most of the teaching component that had been integral to academic medicine for more than a century,” Mayer said.
A Growing Field
“What’s more, virtually none of the academic centers with medical schools and residency plans had programs focused on oncology and that’s what Dr Frei wanted to create at Harvard and Farber. I believed it was vitally important to teach doctors far more about cancer than they were learning, so I very much wanted to be a part of that effort.”It is hard to imagine now how quickly the field of cancer medicine has grown over the past several decades. Another Giants of Cancer Care® winner, Emil J. Freireich, MD, DSc, recalled that as late as the 1940s, the entire medical school curriculum on systemic cancer could be boiled down to a few sentences: there is no treatment; just keep your patients comfortable. In addition, less than 20 years elapsed between Sidney Farber’s discovery of the first antifolate treatment in the late 1940s and the first treatment that could cure some cases of acute lymphoblastic leukemia (ALL). Less than 30 years elapsed between Farber’s breakthrough experiment and the development of a broad spectrum of treatments for many more malignancies.
Birth of ASCO
By the time Mayer returned to Boston in 1974, millions of patients who would have quickly died from their disease in years past were demanding newly developed forms of effective cancer treatment, but virtually no doctors were trained to provide them. What’s more, the Nixon administration was pouring billions of dollars into cancer research (back when $1 billion was worth more than 5 times as much as it is today), yet there were hardly any researchers who had enough experience in cancer biology to use the money wisely. Mayer launched a medical oncology fellowship program in 1975 that brought advanced cancer training not only to Dana-Farber, but also to Brigham and Women’s Hospital and Massachusetts General Hospital. He also helped design the first oncology and hematology curriculum at Harvard Medical School and define the hematology and oncology rotations for residents at all of Harvard’s hospitals.As he was doing this, Mayer was also active in supporting ASCO, the professional organization of cancer specialists. He has, in the past 40 years, held every conceivable position at ASCO. He has recruited members, shaped its system for adopting standards of care, designed educational programs for members, and raised millions of dollars. He has even headed the entire organization. In 1974, when Mayer attended his first ASCO meeting, there were only 250 members in attendance. They could all go out for a drink together in a single large bar. Today, ASCO has more than 35,000 members, and colleagues say Mayer deserves as much credit as anyone, both for the organization’s growth and for its success in disseminating best practices.
Colleagues also say that Mayer deserves praise for his skills as a clinician. “Any discussion of career achievements tends to get focused, with some justification, on things that affect large numbers of people: breakthroughs made, protégés trained, organizations built. They often don’t mention whether a great doctor was actually a great doctor, but any piece on Bob should mention that he is truly great at treating individual patients, as good as any clinician I have seen,” said George P. Canellos, MD, who ran Dana-Farber’s Division of Medical Oncology from 1975 to 1995.
“My mother-in-law had a serious blood disorder. She went to see another doctor, who was probably better than average, but he still wasn’t equipped to make a plan for managing such a complex disorder and to communicate the plan to her. She was depressed. She was confused. She was giving up hope. I told her to go see Bob, and the next time I saw her, she seemed like a new woman. She understood her situation and the plan for treating it. She was even optimistic. I asked her what had happened during her visit with Bob and she said, ‘It was like being in a downpour and having someone open an umbrella over my head.’ That’s the best description I’ve ever heard of a great clinician, and that is exactly the sort of impact Bob has on a lot of patients.”
The HiDAC Regimen
Mayer’s commitment to education, clinical care, learned societies and other interests, which range from being the associate dean for admissions at Harvard Medical School to serving as a trustee for the Boston Symphony, have not prevented him from doing significant research. To the contrary, he has spent the past 45 years publishing papers that at first ranged from basic research to trial results in both leukemia and gastrointestinal cancer and then—after Mayer decided that an increasing knowledge base demanded greater specialization— focused exclusively on gastrointestinal cancers. There are many who believe that Mayer’s very public decision to specialize persuaded many other academic physicians to do likewise and, as a result, brought increased research and treatment expertise to every tumor type.The best known of Mayer’s papers tend to be those that report on trials of new drugs and new treatment protocols. In 1994, for example, he led a group that demonstrated the efficacy of the high-dose cytarabine (HiDAC) regimen for some patients with acute myeloid leukemia (AML); that treatment is still used today in many patients who have AML. In the years since then, Mayer has conducted trials that have determined optimal postsurgical treatment for patients with cancers of the colon and rectum. He also led a recent research effort that demonstrated the effectiveness of a novel drug, TAS-102, in the treatment of refractory colorectal cancer.
Looking forward, Mayer sees a wide range of interesting research topics. He is, like nearly everyone else in the cancer world, excited about the incredible results seen with drugs that modulate the immune system, and he is interested in developing better ways to determine, in advance, which patients will respond. Indeed, much of his focus these days is on learning useful ways to differentiate gastrointestinal cancers and finding which treatments work with specific tumor subtypes.
That said, such research efforts will not crowd out his other activities.
“There are times when I think that I have spread myself too thin over the course of my career, that I might have accomplished more if I had concentrated my efforts on just a couple of fundamental activities. Most of the time, however, I feel that the variety has kept me from burning out and that each thing I do makes me better at the others. Working with patients makes me a better researcher. Doing research and editing journals keeps me up-to-date with what students need to know and how I should treat patients,” Mayer said. “There are certainly benefits that come with specialization, but there are also benefits that come with living a well-balanced life.”