An optimistic oncologist

Prof. Hudis of Memorial Sloan-Kettering Cancer Center, said on a visit to J'lem that Israelis in the field are ‘the best of the best.’

By JUDY SIEGEL-ITZKOVICH
PROF. CLIFFORD HUDIS 370 (photo credit: Judy Siegel-Itzkovich)
PROF. CLIFFORD HUDIS 370
(photo credit: Judy Siegel-Itzkovich)
Asked whether he’s an optimist, Prof. Clifford Hudis replies without hesitation: “Of course I’m an optimist; I’m an oncologist!” xxCancers have for several years been the most common cause of death in Israel – surpassing cardiovascular disease – and most people still mistakenly regard malignancies as an inevitable death sentence. But the chief of the breast cancer medicine service at New York’s famed Memorial Sloan-Kettering Cancer Center remains upbeat.
“I chose oncology because I loved taking care of patients and confronting serious health challenges with them. I had a tremendous optimism that the field would rapidly evolve throughout my career, and I thought that would be an exciting thing to be a part of.”
The 54-year-old cancer specialist, who was born in Philadelphia and received his MD from the Medical College of Pennsylvania (now Drexel University College of Medicine), comes from a Jewish family originating in Russia and Romania. He is a professor of medicine at Weill Medical College of Cornell University in New York, president-elect of the American Society of Clinical Oncology (ASCO) and chairman of the of the Breast Cancer Research Foundation’s advisory board.
On the latest of numerous visits to Israel, Hudis was interviewed recently by The Jerusalem Post about cancer and his career. One of his stops during this visit was to see Prof. Ben Corn and his wife Dvora Corn, who founded and head Life’s Door/Tishkofet, the voluntary organization that provides emotional and spiritual support to patients and families with serious and terminal illnesses.
Hudis declared that Israeli oncologists “are the best of the best” in the field. He recognizes his Israeli counterparts as doing excellent research. “Their innovation is well known. They are always willing to try to new things, and they are very closely integrated into global oncology.”
“He has been enormously helpful at BCRF and is a great friend to Israel,” says Prof. Ephrat Levy-Lahad, director of the medical genetics department at Jerusalem’s Sha’are Zedek Medical Center, who has professional connections with Hudis. Her institute provides extensive genetic services – both clinical and laboratory, from diagnosis of embryos prior to pregnancy to identifying the hereditary basis of adult disease, including cancer.
Prof. Mary-Claire King, a world-renowned expert in genome sciences and medical genetics at Seattle’s University of Washington who first mapped BRCA1 (the genetic defect that causes early breast cancer) and frequently visits Israel, agreed: “Dr. Hudis is both a fine oncologist and a leader in breast cancer research.
Through the BCRF, he has enabled creative, important work in breast cancer. The foundation supports research in both the US and Israel. Their support has been essential to our work. I am enormously grateful to BCRF and to Dr. Hudis in particular.”
Asked to compare recovery and mortality rates for heart disease and cancer, Hudis noted: “The problem is that the conversation doesn’t work on the same level. A lot of heart disease relates to a few common processes. If you control hypertension and blood cholesterol, and if you exercise and don’t smoke, you’ve accomplished a lot. But when one talks about cancer, it’s not about one disease but many diseases.
“In oncology, we’ve made astonishing progress in many kinds, from chronic myeloid leukemia to gastroenterological sarcoma and even breast cancer. If people would only stop smoking, we’d make the same progress against lung cancer,” said Hudis. “I understand why people compare the two, but it’s like talking of apples and oranges.”
HUDIS HAD no family role models for going into medicine.
“Being a physician is a tremendous honor, [it’s] a privilege to be allowed into people’s lives and [to be] given responsibility for the most serious decisions they have to make. It’s hard not to feel this when you’re in the room to patients, even though doctors may not give voice to it,” he said.
“My parents were very strong believers in education, and they were focused on the professions for raising the quality of life in America. My mother was a public school teacher in Philadelphia. My father was born 1938, a time of turmoil between the end of the Depression and beginning of World War II. He lived in an environment of relative privilege, where kids went to college and some got to travel – but he didn’t.
“Instead, he became a self-made businessman who built something from absolutely nothing. He established a large Philadelphia wholesale food company called Quaker Valley Foods. I even worked there as a teenager. My brother and cousin now own it.”
Hudis’s wife Jane Hertzmark-Hudis is global brand president of the cosmetics company Estee Lauder, and they have two college-age sons. “I would love for them to go into medicine, but I don’t think they will,” he said.
His own decision to go into oncology “was a lucky coincidence. In 1988, I was a fellow at Memorial Sloan- Kettering. They hired a rising-star scientist named Dr. Larry Norton, and he was my mentor. I think this field is the most exciting and rapidly evolving. I felt I could translate science into something meaningful, and I enjoy helping patients and families as they go through a very scary time – expecting the worst.
“Of course, patients die of other things, including endstage kidney disease. No medical specialty escapes that. But in oncology, while there is pain and suffering and fear, I can either help to make them better or not.”
He not only treats patients but also teaches in medical school and conducts extensive breast cancer research. In June, he will become president of ASCO. He is also cochairman of the Breast Committee of the Alliance for Clinical Trials in Oncology and a member of the steering committees of the Translational Breast Cancer Research Consortium and the North American Breast Cancer Group.
“My research is focused on prevention of the disease, prevention of recurrence after surgery and treatment of recurrences,” he noted. The topics include the development of a wide range of novel drugs, and Hudis and has focused his BCRF-supported research on understanding the mechanisms that link diet, obesity, inflammation and breast cancer risk and outcomes.
Cancer treatment, he said, “used to encompass a few simple things – operate to remove the tumor; if this didn’t cure, radiate to control it. If that didn’t work, one gave some drugs, chemotherapy or hormone treatment.”
But in the past two decades, he explained, “we’ve begun to understand that breast cancer comprises many subtypes of cancer. It’s not because they look different, but because of the genomics of cancer. There are cancer genes. Studies help separate small subtypes of cancer, not only as an academic exercise, but because this division improves treatment. Researchers can target new drugs that they may be far less toxic. I think this will be the way to fight breast cancer and many other cancers in the years to come.”
There are, however, major changes that affect cancers.
For example, the development of Imatinib (Gleevec) for chronic myeloid leukemia – a slow-growing bone marrow cancer resulting in too many white blood cells – has saved many lives and turned it into a chronic condition.
The disease, said Hudis, is “now very well controlled.” In the US alone, there are more than 20,000 people with it, most of them adults, and nearly 5,000 new cases are diagnosed each year.
As for breast cancer, every case is tested for disease type – endocrine receptor (estrogen or progesterone receptor) positive; HER2 positive; triple negative, not positive to receptors for estrogen, progesterone or HER2; or triple positive, positive for estrogen receptors, progesterone receptors and HER2. This classification, said Hudis, gives oncologists helpful data about how the tumor acts and what kind of treatments would be more beneficial.
Radiation and surgery are very similar for these different types of breast cancer, but chemotherapy, endocrine therapy and other drugs usually differ according to the specific kind of breast cancer. Around three-quarters of all breast cancers grow in reaction to estrogen and are “ER positive,” while over six out of 10 area grow in response to progesterone and are also designated “PR positive.” Breast tumors with a large number of one type of hormonal receptors or the other are more likely to react to endocrine therapies.
In the fifth to one-quarter of malignant tumors that are called HER2-positive breast cancer; the cells produce too much of a certain kind of protein and usually grow faster and are more aggressive. For such patients, the drug Herceptin has proven to reduce significantly the risk of recurrence, and has fewer side effects than chemotherapy.
A bit under one percent of breast cancer victims are men, said Hudis. “It’s a rare disease but usually diagnosed later in men than in women. I do have some male patients; stage-for-stage, they are treated the same way women are. We are trying to see how similar or different male breast cancer is from that in women.”
Jewish women have the reputation of being at much higher risk of contracting breast cancer than the general population, Hudis said. “However, overall, Jewish women have a little more breast and ovarian cancer than non-Jews. This results from the concentration of women with the inherited BRCA1 and BRCA2 mutations. It is 1% in the general population and 2% in Jews. But there are influences besides genetic ones.”
American Jews who are included in breast cancer research tend to live in urban areas where there are academic centers. In addition, other factors are the age of first delivery, number of children one has, menstrual cycles, use of birth control, drinking alcohol and obesity.
Having an early first pregnancy, many children and early menopause are theoretically protective against breast cancer, but at the same time, women have late menopause because they are well nourished. “These are associations with risk; whether they are the cause of risk is something else,” Hudis said.
Two centuries ago, women had more babies and hoped that at least a few would survive. The breast cancer risk then was very low. Today, women cause cut the number of times they get pregnant, and they expect each child will be healthy and live a long life. So there’s a tradeoff between longevity and breast cancer risk, the oncologist explained.
CANCER PATIENTS in the US almost always get chemotherapy in outpatient facilities, a rare occurrence in Israel. He also has the feeling that palliative medicine (providing pain relief) for cancer patients is not as advanced here as in the US. All medical practitioners in the US have to have some such skills as part of board recertification spectrum of health care delivery in cancer.
Such board recertification does not exist in Israel. He also applauds the work here of Tishkofet in providing emotional and spiritual help to patients and families. In the US, chaplaincy and spiritual healing is commonly available in hospitals and clinics, but much less so here.
He is in favor of “Obamacare” for providing universal coverage for American residents.
“It can answer some problems but not everything. Many people lack health insurance, and since coverage is linked to employment, they can’t flexibly change jobs. Israelis are fortunate in having universal national health insurance since 1995,” he concluded. “You have Medicare-like medical coverage from birth to death. In the US, there are Medicare for retired people and Medicaid for the very poor. Others get private health coverage from work, but it varies from place to place. I would like to see universal care in the US, but maybe less expensive than it will be.”
Still, if an American contracts cancer, the truth is that most people get full access to treatment through Medicare or Medicaid. Only a small group have no coverage at all, said Hudis, who noted that one of the disturbing things is that patients with lower socioeconomic status and less insurance coverage are less likely to recover than the well off. “They may have to wait longer for medical care. Somehow, though, we always find a way.”
What cannot be disputed is that the US spends too little of its GDP on medical research, declared the US oncologist.
“If there were more money, the pace of discovery would surely be faster. It’s a global problem. Of the research proposals thought to have good potential, the smallest amount in history are actually being funded. That’s a terrible shame.”