How Elbow Grease and Inspiration Forged a Winning Career

OncologyLive, Vol. 19/No. 4, Volume 19, Issue 4

He was once laughed at for pouring his talent into the “reviled” field of oncology, but Larry Norton, MD, said he was driven by his passion to learn about cancer.

Larry Norton, MD

He was once laughed at for pouring his talent into the “reviled” field of oncology, but Larry Norton, MD, said he was driven by his passion to learn about cancer. In fact, even now, seldom do his thoughts or actions stray far from the problem of how to cure this disease. “There’s a constant churn of activity toward making a difference— my own research, teaching, taking care of patients,” said Norton, who is deputy physician in chief for breast cancer at Memorial Sloan Kettering (MSK) Cancer Center, New York, New York, where he also serves as medical director of the Evelyn H. Lauder Breast Center.

His dedication moves full speed ahead almost all of the time, and when Norton is not engaged in fighting the battle against cancer, he is a husband and father who unwinds by hiking in Vermont, skiing with his wife, and going to the theater. He is also very passionate about music.

The Aha Moment

Norton, who is conservatory trained, was initially interested in becoming a professional musician. He can play multiple instuments, from the keyboard to the guitar to woodwinds. In 2010, he even hit the stage for a duet with Sir Elton John at a breast cancer charity event. Elton played the piano, Norton the harmonica—a performance the celebrated oncologist and musical talent says he will never forget.As a youth, Norton knew the extremes of environment that New York has to offer. He lived in the Bronx, the poorest borough of New York City, and Valley Stream, a suburb of wealthy Nassau County in Long Island. His father was a journalist and his mother a secretary. Somehow, the bug for medicine flourished in the younger generation. His sister became a pediatric radiologist and is now retired. But before medicine even crossed his mind, Norton earned a living as a truck driver by delivering fishing tackle.

When the 1960s arrived, Norton was a struggling musician. He grew his hair long and could be found playing the bongos and saxophone in Greenwich Village. The Vietnam War was raging in the background. It was then that the study of medicine attracted Norton, and he nourished that interest by going to college. He did not serve in Vietnam, but during the war he did serve in the US Public Health Service after finishing medical school.

It was during a summer rotation at Roswell Park Memorial Institute in Buffalo, New York, when he was taken under the wing of William Regelson, MD, that something happened that made Norton decide that oncology was the right choice for him. “I was just a college student at the time and [Regelson] said to me, ‘I want to show you something,’ and he brought me to see a patient who had a pelvic tumor that had erupted through the pelvis up to the skin. It was this big, ugly, horrible-looking cancer. Bleeding, smelly—really the kind of nightmare that cancer can be,” Norton recalled.

Over that summer, Norton watched the tumor melt away under Regelson’s care. The patient’s skin closed and healed. She was able to be discharged and treated at an outpatient facility.

A Pioneering Moment

“I thought it was the most magical thing I had ever seen in my life,” Norton said. “It was like I saw this monster that was devouring this patient and a medicine—carefully chosen to work in this setting—was making this obviously fatal process just go away. Everything about that experience was something that I knew I had to do, and that convinced me that I belonged in medicine and not in music. The fact is that it was the great science, the great clinical thinking, and Regelson’s intuition—I mean everything good about the world was in that one case. And that was my revelation.”When Norton entered the field of oncology, it was overshadowed by pessimism. Few believed that oncology would become a promising branch of medicine unto itself. In medical school, Norton’s mentor once said to him, “Larry, you’re so good with your hands. You belong in surgery. It’s surgery that really helps people. You don’t want to get involved in drug treatment of cancer. It’s never going to go anywhere. We can’t kill cancer with drugs.”

But Norton said he was encouraged by the pioneering spirit of some of the founding doctors of the field, such as Emil “Tom” Frei III, James Holland, Vincent DeVita Jr, and Paul Carbone, who trained him and made the field of oncology more and more attractive to him. “Oncologists are very special people. You’re dealing with very severe illness and it’s not always a success, but you’re always dedicated to making things better,” said Norton. “We are making progress faster and faster.”

Norton received his bachelor’s degree with highest distinction from the University of Rochester and his medical degree from the College of Physicians and Surgeons of Columbia University. He trained in medicine and medical research at Albert Einstein College of Medicine and the National Cancer Institute (NCI).

Dose Density

Besides his work at MSK, he is a founder and scientific director of the Breast Cancer Research Foundation. Although Norton is known across the country as a top investigator in breast cancer, he said he is interested in all cancers. He studied lymphoma before breast cancer, and most recently, he conducted trials in pancreatic cancer.Based on mathematical work that he had done with Richard Simon, DSc, chief of the Biometric Research Branch at the NCI, Norton developed the concept of “dose density,” the successful application of which has proven that schedule, not just the right drug, is important in the treatment of cancer. He has also worked on genetic testing for breast cancer and the development of several effective agents, including paclitaxel (Taxol) and trastuzumab (Herceptin).

Norton has held national level titles in oncology, including chair of the Breast Committee of the NCI’s Cancer and Leukemia Group B and president of ASCO from 2001 to 2002. He also was appointed by former President Bill Clinton to serve on the National Cancer Advisory Board.

The Germ of Truth

A man of many achievements, Norton refuses to name what he feels is his greatest contribution to the field of oncology—he said that’s for other people to decide. “I’ve been involved in a lot of things that have turned out to help people,” he said. “Every single one of them was a collaborative effort. The thing that I am happiest about in my career is my contact with people my junior, who have not only worked together with me to accomplish the things that needed to be accomplished, but who have grown into substantial investigators and wonderful physicians on their own. It’s my opportunity to train that excites me the most.”There is always a new, exciting development in the oncology world, but Norton warns that neither he nor anyone else knows it all.

Two areas where oncologists are excited currently are precision medicine and immuno-oncology. Norton reminds fellow oncologists that it’s important to develop an accurate understanding of the mechanisms of these approaches. “Find the germ of the truth that’s within it,” explained Norton. “It’s how to use the drugs better with precision medicine and immuno-oncology and how to use the power of the immune system, in combination with other ways of affecting the cancer cell, by making it more amendable.”

He describes 2 natural responses to the excitement: either jumping on the bandwagon or rejecting it. Both, he said, are your enemies. One of Norton’s favorite sayings goes as follows: “It’s not the things you don’t know that get you in trouble. It’s the things you know for sure that turn out to be wrong.”

“My whole career in oncology has been dealing with the issue where everybody knows something is true that turns out not to be,” he said. “That’s what slows us down. I think people have to keep an open mind and accept new data, but be open to changes.” One of those changes is bringing the power of mathematics and chemistry into cancer, something he hopes former Vice President Joe Biden’s Cancer Moonshot program will do. Norton, who attended the summit in Washington, DC, in June 2016, said mathematicians should be engaged in the process.

“We have good engineering for airplanes, good engineering for automobiles, and good engineering for TV sets,” he said. “We don’t have good engineering for biology. We have to understand biology better from an engineering point of view, which means a mathematical point of view. I’m hoping this will be part of the Moonshot’s progress.”

The Moonshot is intended to achieve 10 years’ worth of progress in just 5 years, something Norton feels can be accomplished as long as people are willing to push forward, generate new ideas with hard work, and support creativity.

After decades of pushing for that progress himself, Norton said it isn’t credit that he’s seeking, but rather victory over cancer. “It’s seriously of less consequence to me to be the one that does it than to be there when it happens. My whole career has been focused on doing everything that I possibly can to accomplish that goal. So, it’s not just research, and it’s not just patient care; it’s not just teaching, it’s not just administration, it’s not just political activity. But it is everything that I can contribute in the time that I have on this earth to do it.”