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Vince Devita: the View from the Top

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Vince Devita: the View from the Top Masterpiece Vince DeVita: the view from the top ➜ Interview by Chistine Haran As director of the NCI between 1980 and 1988, Vince DeVita was a Commander in Chief of America’s War on Cancer. He has little time for those who now criticise the plan of attack – or the outcome. But he warns that if we are to win the battles in the molecular arena, we will need to fight on an altogether grander scale. Disillusionment with the speed of Did the War on Cancer succeed? progress in finding a cure for cancer VINCE DEVITA You hear and read that the War has led some people to question the on Cancer failed, but actually it did everything it vision of the 1971 National Cancer Act was supposed to do. It supported basic research and the way it was interpreted as some handsomely. It has now spent about $50 billion sort of quasi-military campaign. Did on research, of which 80% has gone into basic you get it right? research. It set up applications programmes – VINCE DEVITA We had a very straightforward the EORTC [European Organisation for mandate to support basic research and the Research and Treatment of Cancer] and US application of the results of the research to clinical trials programmes. And what’s happened reduce the incidence and the morbidity and to the incidence and morbidity and mortality of mortality from cancer. cancer? The incidence of cancer in this country Period. End of story. What was so controversial started dropping in 1990 and has continued to about it? The National Institutes of Health drop every year since, and so has mortality. And [which include the National Cancer Institute] the morbidity from cancer, comparing 1971 to had never been involved in applications before. 2005, is like night and day. In fact they considered their job to be basic In 1971 when the Cancer Act was passed, a research, and the applications were done some- woman with breast cancer, for example, had a where else. radical mastectomy and the breast was removed, That is why the Cancer Act was very controver- all the muscle was removed and all you had was sial and everybody was against it, and if it wasn’t a thin layer of skin over ribs. Then women would for the fact that [advocate and philanthropist] get irradiated on top of that and their arms Mary Lasker was so politically powerful it would would swell up and neither the surgery nor the never have passed. radiation did enough to cure the patient. 38 ■ CANCER WORLD ■ MAY-JUNE 2005 Masterpiece “I think the War on Cancer has been a resounding success, and I’m very pleased to have led it” Nowadays you can have a lumpectomy and radi- How did the NCI evolve under your ation therapy with a very good cosmetic effect, leadership? and you get adjuvant chemotherapy. Mortality VINCE DEVITA When I became director in 1980, has dropped in this country and survival has we created the cancer programme, as it was increased. Even though it’s very difficult for a described in the Cancer Act. We reorganised the patient to be diagnosed with breast cancer and Institute so that it reflected treatment and pre- go through treatment, it’s nowhere near as diffi- vention, and then we reorganised the treatment cult as it was back then. division. When I had taken over as director of So every benchmark of the mandate has been the Division of Cancer Treatment in 1974, the hit and it’s been hit in some places in Europe as treatment division didn’t have all the treatment well. I think the War on Cancer has been a programmes in it. Drug development, for exam- resounding success, and I’m very pleased to ple, was in the treatment division, but supervi- have led it. sion for all the clinical cooperative groups was in CANCER WORLD ■ MAY-JUNE 2005 ■ 39 Masterpiece “The whole ideal of the Cancer Act was to get these things going all over the world” another division. So if you wanted to make the What do you see as some of the more translation of a drug and put it in clinical trials, important recent contributions from you had to go through another group of people. European oncologists? We put all the treatment programmes together VINCE DEVITA The best work in Hodgkin’s dis- where they belonged. ease now is done in the German lymphoma We also created the PDQ, the information system study group. We have so many private doctors in [for patients and health professionals]. We set up this country who use yesterday’s therapy that it’s 11 bi-national agreements with European coun- very hard to get them to put patients on tomor- tries. We used the vehicle of cancer research to row’s protocols. The Germans do it. They put open up pathways to various countries, such as thousands of patients with Hodgkin’s disease the Soviet Union. It was a frenzied time. into a study, and all the major questions in Hodgkin’s disease are going to be answered by Was there any collaboration with Europe? the German study group. There have also been VINCE DEVITA In the beginning there was very lit- drugs of European origin; there’s been good syn- tle going on in Europe. So when the Cancer Act ergy in drug development. was passed there was a provision that Europeans But the Europeans still don’t even come close to could apply for grants through the National the US in terms of funding. The NIH budget is Cancer Institute. Thanks to people like Umberto $26 bn a year. That probably exceeds the cancer Veronesi and Gianni Bonadonna in Italy and research budget of the rest of the world. We’re still Henry Tagnon in Brussels, we had a receptive the major defenders of the health of the world. audience. So we set up the original grant for the They may not like me to say that but that’s true. EORTC. In Brussels, we also established a cen- tre for drug screening, so our drug development How did you decide what research to programmes could access European cancer drug fund in the early days of the War on candidates. We provided money to the Istituto Cancer? Nazionale Tumori in Italy for a biostatistical cen- VINCE DEVITA We did a lot of research con- tre and for the CMF [cyclophosphamide, tracts, which were very controversial. They were methotrexate, fluorouracil] clinical trials. and are a dirty word in science. The reason peo- We did a lot in the beginning and the Europeans ple love grants is that if you’re an investigator have done very well since. I think it’s an impor- and you get an idea, you write a grant applica- tant story because the whole ideal of the Cancer tion and you submit it to the government. It’s Act was just that: to get these things going all peer reviewed by scientists independent of you over the world, because what you learn in and you get a score. If the score is good enough, Europe is going to be applicable in the United you get support. A research contract is some- States and vice versa. body sitting at the NCI saying “I think we ought “We’re still the major defenders of the health of the world. They may not like me to say that but it’s true” 40 ■ CANCER WORLD ■ MAY-JUNE 2005 Masterpiece At a hearing of the President’s Cancer Panel, at the Columbia University Cancer Center. Though already director of the NCI, DeVita (second from right) is a relative youngster “You need $20m mobilised from five institutions, with the research directed by a major scientist” to look for viruses in cancer and we’re going to call ‘goal-directed’ research. With all of the tools put in $50 million,” and we’ll ask who wants to we have available now, you can address almost apply for it. The fact of the matter is we did a any major question in the cancer field. We’re study, which we never published, looking at the exactly where we wanted to be. But this will major advances in science. We asked a small require that we mobilise very large numbers of group of people to identify 15 areas where there resources. had been major advances and then we looked at So instead of doing a project in an individual lab the funding. What we found out was that every for $200,000, what you need is $20 million instrument that we used to support research was worth of resources mobilised from five different represented: research contracts, grants, cooper- institutions, and have the research directed ative groups, and so forth. So it was fallacious to by someone who is a major scientist in that par- think that one mechanism could support ticular area. research then and it’s even more fallacious now. The mechanisms for supporting the new kind of research just aren’t there and need to be assem- What do you think about the way bled on a project by project basis, which is very research is funded today? inefficient. So there really needs to be re-think- VINCE DEVITA Science has moved from the era ing of how we spend money to support dominated by individual scientists to what we research. CANCER WORLD ■ MAY-JUNE 2005 ■ 41 Masterpiece “The more specific a new targeted drug is against a target, the less effect it has against a cancer by itself” Are clinical investigators getting the who is making the translation from the lab.
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