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Andrew von Eschenbach: New Director of the National Cancer Institute

Director, University of Wisconsin Medical School Surgical Oncology Director, The Oncologist

Those of us with a strong belief in a guiding power are frequently known to express a confidence in supreme direction regarding the appearance on center-stage of "the right person for the time." So it is with the President's recent appointment of Andrew von Eschenbach, M.D. as the new director of the National Cancer Institute (NCI).

Andrew von Eschenbach, M.D.

Under Dr. Klausner's superb leadership, the NCI was able to restore its position as the leader of the nation's cancer research agenda [1]. Dr. Klausner's vision took full advantage of the scientific revolution under way in molecular biology and genetics and successfully positioned the cancer research community to begin the exciting post-genome era of scientific application to the diagnosis and treatment of cancer.

Dr. von Eschenbach brings a broad experience as a cancer surgeon, a very clear vision of the power of the new knowledge that cancer is a disease of altered genes, and a palpable passion for the rapid application of discovery to the immediate benefit of our patients. He has had an appropriate number of years to grow and mature as an academic leader at one of the nation's premier cancer centers. These years of dedicated service to his patients and his own personal experience as a cancer survivor have had a major influence on his life and his decision to accept the President's call to duty.

Dr. von Eschenbach is one of the most passionate and sensitive men whom I have had the privilege of knowing. His high moral standards and the integrity with which he conducts his life are examples for all of us. His personal values and the strength of his character are readily apparent when he talks about the cancer problem and shares his vision for what we must do to continue the momentum in cancer research.

When I suggested that he is the "right man for the time," I had in mind the paradigm shift that is just beginning in oncology. The truly remarkable achievement of the Human Genome Project and the resulting logarithmic growth in the science of this disease in areas of genomics, proteomics, and functional biology have set the stage for this new era. Dr. von Eschenbach will need to shepherd us through these changing times. We will need to reevaluate how we train in our various disciplines. Future oncologists whether they be a medical, surgical, or radiation specialist will of necessity need to be heavily grounded in cancer biology. A patient's diagnosis of cancer will no longer be focused on its anatomic and histologic descriptives but will instead be a detailed analysis of the tumor's molecular alterations—a genetic fingerprint specific for the patient and the patient's cancer.

In this new era, intervention will not always be solely focused on eradication but will be designed to address specific molecular targets. As a result, treatment will almost always be less toxic than classic chemotherapy. The goal will be to modulate the tumor toward chronicity. Identification of risk, introduction of new screening tools, and ultimate cancer prevention will be the goals of cancer physicians. More than ever our efforts in research, application, and patient care will need to be multidisciplinary.

The NCI and its leadership along with the nation's NCI-designated cancer centers will be challenged by the rapidity and sheer volume of new molecular therapies, diagnostics, and preventives that need to be evaluated in phase I and II clinical trials. We have no choice but to find novel and innovative ways in which to speed up the process of evaluation. We will need to develop the clinical trials infrastructure to support this new era.

It is reassuring that Dr. von Eschenbach clearly understands the challenges ahead. It is also comforting to know that he sees the urgency, that he has the experience, the political connections, and a gift for communicating the story and the issues. "For it is not the cry, but the flight of the wild duck, that leads the flock to fly and follow" (Chinese saying). We are in good hands.

John E. Niederhuber Director University of Wisconsin Medical School Surgical Oncology Editor, The Oncologist

REFERENCES

1. Chabner BA. NCI in the post-Klausner era. The Oncologist 2001;6:484–485.[Free Full Text]

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