14 Remembering Gianni Bonadonna BY KURT SAMSON ianni Bonadonna, in previously un- MD, whose revo- treated women.” oncology-times.com lutionary research Bonadonna’s • in combina- proposed regimen Gtion adjuvant chemotherapy of CMF and then helped transform the treat- CMFP was found ment of both breast cancer to be very active in and Hodgkin lymphoma, died achieving remis- Sept. 7, in Italy, at the age of sion of disease, 81. Canellos said. “Dr. His research has helped re- DeVita and I were October 25, 2015 duce morbidity and mortality in the process of • for millions of patients after compiling our data introducing adjuvant therapy for review by the at a time when radiotherapy leadership and we and radical mastectomies were hoped to use it to standard practice. keep early breast A widely revered, beloved, cancer from me- charismatic, and internation- tastasizing. At that ally acclaimed investigator, time, however, the Bonadonna published over Gianni Bonadonna, MD (1934-2015) centers and other Oncology Times 550 papers and received nu- U.S. oncology merous awards for his revolutionizing Vincent DeVita groups were reluctant to participate.” work. Until his death he chaired the In an interview, DeVita, Director of Today, adjuvant chemotherapy is a Committee on Prospective Clinical the National Cancer Institute from standard practice in treating breast can- Trials at the Istituto Nazionale dei 1980 to 1988 and now the Amy and cer recurrence and metastases in many Tumori in Milan. Joseph Perella Professor of Medicine women undergoing therapy. Although his early findings on the and Medical Oncology at Yale Cancer potential of early adjuvant therapies Center, remembered working with were not initially embraced by the Bonadonna in the early years: “I first The Early Years oncology community in general, in the met him when he spent a week with us Gianni Bonadonna was born on July decades since, his and others’ research at the NCI Medicine Branch in 1969 28, 1934, in Milan. After he gradu- helped establish combination regimens going over the CMF protocol we had ated from the University of Milan in that are today considered the optimal developed and modifying it for use 1959 with a degree in Medicine and approach for treating many of these as adjuvant chemotherapy in breast Surgery he studied in the U.S. between cancers. cancer. 1961 and 1964. During his postdoc- In 1972, Dr. Bonadonna and his col- “No one in this country would touch toral training from 1961 to 1964 he leagues published preliminary findings it at the time, but Gianni adopted it was a research fellow at Memorial in early trials among Hodgkin’s patients and ran the trial in Italy, with the NCI Sloan Kettering Cancer Center, in at Italian institute using a new combi- providing support. That 1976 trial, New York. After returning to Italy nation chemotherapy regimen called published in NEJM, rocketed him to he joined the Istituto Nazionale dei ABVD (doxorubicin [Adriamycin], fame.” Tumori of Milano, where he stayed for bleomycin, vinblastine, and dacarba- the rest of his life. In 1976 he became zine). They determined that ABVD was the Director of Medical Oncology and more effective than the MOPP regimen George Canellos in 1991 became the Head of Cancer (mustargen, oncovin, procarbazine, George P. Canellos, MD, the William Medicine at the Milan institute. and prednisone), then the standard Rosenberg Professor of Medicine at His work in adjuvent therapy for combination. Harvard Medical School, who prac- breast cancer and Hodgkin’s disease Developed in the 1960s at the U.S. tices at Dana-Farber Cancer Institute, included the first trials of doxuru- National Cancer Institute by research- also recalled those days. At the time bicin, bleomycin, and epirubicin. In ers that included Vincent T. DeVita, Jr., he was a clinical associate at the NCI, subsequent years he was awarded MD. MOPP was the first combination and from 1975 to 1995, he was Chief many national and international chemotherapy regimen to result in high of Dana-Farber’s Division of Medical honors. success rates in Hodgkin’s disease and Oncology; a former Editor-in-Chief other blood cancers. of the Journal of Clinical Oncology In 1973, Bonadonna and his and a past president of the American Breast Cancer Award colleagues published a groundbreak- Society of Clinical Oncology, Canellos and Lecture ing study in the New England Journal is currently a senior physician at In recognition of his many contri- of Medicine that demonstrated the Dana-Farber and Brigham and butions to cancer treatment, the effectiveness of combined chemother- Women’s Hospital, and was a major American Society of Clinical Oncology apy using CMF (cyclophosphamide, figure in the emerging field of adjuvant in 2007 established the “Gianni methotrexate, and fluorouracil) for treatment while a visiting investigator Bonadonna Breast Cancer Award and node-positive operable breast cancer. in Milan. Lecture.” This was then confirmed in a 30-year “I first got to know Dr. Bonadonna In announcing the creation of follow-up review of treated breast when he came to the National Institutes that award, ASCO then-President cancer cases, published in 2005. That of Health to see if the NCI was involved Gabriel Hortobagyi, MD, Professor study showed that CMF, especially with with adjuvant therapy for breast can- of Medicine, in the Department of the addition of prednisone (CMFP) sig- cer. Indeed, we were in the process of Breast Medical Oncology, the Nellie nificantly reduced the risk of recurrence completing a trial of combination che- B. Connally Chair in Breast Cancer, and death. motherapy for metastatic breast cancer and Program Director of the Susan 15 Oncology Times GIANNI BONADONNA to continue to lead a productive life as Continued from page 14 founder and president of the Fondazione Matthew Ellis’s Michelangelo, remarking that with his G. Komen Interdisciplinary Breast disabilities he was better able to under- Bonadonna Award Lecture Fellowship Program at the University stand the pain his patients were experi- of Texas MD Anderson Cancer encing,” DeVita said. “His approach to atthew Ellis, MD, BChir, PhD, is this year’s recipient of Center, praised Dr. Bonadonna’s many life in the face of adversity was an inspi- Mthe Gianni Bonadonna Breast Cancer Award, an honor contributions to the field of breast ration to us all. bestowed last month at the Breast Cancer Symposium. Read cancer treatment: “Without Gianni “He was a good friend, and I always • Bonadonna’s initial work in demon- enjoyed his company. We shared a love a summary of his award lecture here, online ahead of print: 10/25/15 strating the activity of chemotherapy, of opera and were both always reduced to http://bit.ly/OT-BonadonnaAward-Ellis we would not be where we are today in tears by Puccini’s music during the last terms of the management and the cure 12 minutes of the first act of La Bohème. O of breast cancer,” he said. I will miss him.” T “Bonadonna’s legacy is one of focus, persistence, passion, innovation, and creativity. That’s a tall order for most new members of our profession but clearly is a combination of attributes that make Dr. Gianni Bonadonna a role model for oncology professionals of the future.” Hodgkin’s Disease Award and Lecture His contributions to research in the field of Hodgkin lymphomas also was acknowledged by the Committee of the International Symposium on Hodgkin’s lymphoma in Cologne, Germany, where the organization created the “Gianni Bonadonna Hodgkin’s Disease Award and Lecture.” Over the course of his professional career, in addition to his many research papers, he also wrote books aimed at lay readers, as well as a book on the Sepoy revolt in India, a rebellion in 1857 against the army of the East India Company, regarded as India’s first war of independence. Unorthodox and Dedicated In the interview with OT, Canellos also talked about Bonadonna’s many interests outside of his research pursuits: “Dr. Bonadonna was a very eclectic phy- sician who enjoyed traveling to exotic places. He collected objects of art result- ing in his home being almost a museum in itself.” Similarly, DeVita said that by enthusiastically collaborating with other researchers around the world, Bonadonna gave breast cancer and Hodgkin’s disease what essentially amounted to a treatment makeover, and not just in terms of investigating adjuvant therapies: “He changed the practice of medical oncology in Italy by doing things they had not done before, like telling patients their diagnosis, and that CMF and CMFP were experimental treatments and asking patients for their informed consent. He also adopted rig- orous precepts for clinical trials. This took a great deal of courage on his part, but paid off handsomely for Italian cancer patients.” Bonadonna suffered a serious stroke in 1995, but continued to work toward improving treatment and practice. “He showed a different kind of courage; the courage of a severely disabled patient .