Those preliminary studies [with cisplatin] truly show the value of doing trials with novel and untested agents. In order to move the clinical benefits forward, you can’t settle for the status quo.
— Lawrence H. Einhorn, MD
Lawrence H. Einhorn, MD, grew up in Dayton, Ohio, in a time and place that he describes as pleasant and community-oriented. Throughout his distinguished career, Dr. Einhorn has maintained strong roots in the Midwest. “After finishing high school, I did my undergrad at Indiana University and went to medical school at the University of Iowa; I did my medical internship and residency at Indiana University. I left Indiana for a fellowship in Houston at MD Anderson, which is the only time I’ve escaped from the Midwest,” said Dr. Einhorn, adding, “I joined the faculty at Indiana University in 1973, and I’ve been here ever since.”
A Father’s Influence
Dr. Einhorn’s father was a doctor whose office was attached to the family’s home. “[He] was a family practitioner, which is sort of anachronistic in today’s world. He knew his patients at a level that’s hard to put into today’s perspective. By the time I reached high school, I knew I wanted to become a doctor,” said Dr. Einhorn. He stressed that his father’s practice had a profound influence on his worldview of medicine. “There was a TV show during that era called Marcus Welby, M.D., and our home had that same feel to it. My father was sort of the prototypical beloved country doctor. Not that Dayton was a small town, but everyone in the neighborhood knew my father. It was a very different environment in medicine from today. Patients paid my father what they could afford. He didn’t have a backroom staff doing coding and billing,” said Dr. Einhorn.
He continued, “During my internship and residency at Indiana University, I was focused on internal medicine and cardiology, actually with the thought of joining my father’s practice after graduating. But he developed cardiac disease and wasn’t able to continue his practice, so that door closed.”
Seduced by Oncology
During his internship Dr. Einhorn did an elective in hematology/oncology. “I was really seduced by oncology, fascinated by the future that was just beginning to explode, full of new advances and scientific knowledge. And I wanted to be a part of it,” said Dr. Einhorn.
He continued, “I had very little oncology experience before going to MD Anderson for my fellowship. Remember, it was 1972, and at that time there were relatively few accredited places to receive oncology training. You had Memorial Sloan-Kettering, Dana-Farber, Roswell Park, and the NCI—those were about the only options.”
He explained that when he arrived at MD Anderson for his fellowship, there were two separate oncology programs, the Department of Medical Oncology and the Department of Developmental Therapeutics, which was run by Dr. Emil Freireich. “Developmental Therapeutics was the far more fascinating of the two, so I worked in Dr. Freireich’s department,” said Dr. Einhorn.
Return to Indiana University
Fellowships are often the seeding ground where specialty interests are planted in young oncologists. Not so for Dr. Einhorn. “I doubt if I saw more than two testicular cancer patients at MD Anderson during my entire fellowship because most testes cancer patients were seen by Dr. Mel Samuels in the separate medical oncology program. After my fellowship, the two programs merged,” said Dr. Einhorn
“When I returned to Indiana University in 1973 to join the faculty, I had lots of experience in many different clinical scenarios but no experience in testicular cancer. During that relatively early period in oncology, most doctors worked on a range of cancers, rather than focusing on a few select disease sites,” said Dr. Einhorn
Dr. Einhorn said that he was interested in working on chemosensitive diseases such as leukemia, small cell lung cancer, and testicular cancer rather than those that were not. “I had the good fortune of joining a university that had a world-renowned urologic oncologic surgeon on staff, Dr. John Donohue. Because of his reputation, large numbers of patients came to Indiana from across the country for surgical management of testicular cancer,” said Dr. Einhorn, adding, “So the patients that were not surgically cured became candidates for chemotherapy. Anyone can have an idea, but if you don’t have the patients to study the idea, it simply becomes an academic exercise.”
Practice-changing Research in Testicular Cancer
With a steady influx of testicular cancer patients, Dr. Einhorn took his ideas and turned them into practice-changing therapies. In 1974, he began initial studies in chemotherapy in testicular cancer with cisplatin, which was an experimental drug at the time. “Those preliminary studies truly show the value of doing trials with novel and untested agents. In order to move the clinical benefits forward, you can’t settle for the status quo,” said Dr. Einhorn.
In his first phase II trial, Dr. Einhorn and colleagues added cisplatin to vinblastine plus bleomycin, both of which were on the market. “The results were quite amazing. In fact, I think it was one of the first times when a regimen became a standard of care based on a single phase II study,” said Dr. Einhorn.
Over the next few decades, Dr. Einhorn led a series of clinical trials that showed we could significantly reduce the toxicity of cisplatin and its duration. “It was a time of fruitful experimentation during which we sought to cure patients who were not cured during their first round of therapy. We also learned how to use antiemetic medications. And most of these advances were largely the result of the initial breakthrough with cisplatin,” said Dr. Einhorn.
A Typical Week
After more than 4 decades of groundbreaking research and clinical work at Indiana University, Dr. Einhorn shows no sign of slowing down. “On Mondays at 8 AM, we have a bone marrow transplant service for testes cancer patients receiving high-dose chemotherapy. It’s a rare disease, but we have 10 patients who failed prior regimens and came to our institution for treatment. That takes a good part of the morning, and then I see scattered off-scheduled patients until the afternoon, when I do rounds with a Fellow,” said Dr. Einhorn.
Monday doesn’t end after rounds; Dr. Einhorn presides over a teaching conference until early evening. Tuesdays are filled with caring for patients with testicular cancer. “Wednesdays are very different. It’s my all-day lung cancer clinic. I tell my wife that on Mondays and Tuesdays after caring for testicular patients, I leave the clinic energized. But after a day with lung cancer patients, because of the grimness of the disease, Wednesdays are very heart-heavy,” commented Dr. Einhorn.
What’s the rest of the week like? More full days of clinics, research, and teaching.
Asked why a doctor of his stature has remained at one university for an entire career, Dr. Einhorn responded, “Well, as you can imagine, I’ve had many offers for exciting positions over the years. But for my family and me, this is just the right place to be; we love the city and the lifestyle it provides. Also, I’m fortunate to be part of an academic environment that has allowed me the freedom and backing to pursue my work.”
What does Dr. Einhorn do for relaxation? “I play a pretty good game of tennis, and I like the arts. Naturally, I have to travel to meetings and give lectures. But I always like coming back to Indianapolis. Family and work are my greatest pleasures.”
“It’s a curious thing in life. Often, the secret to success is to find things that you’re good at and keep doing them. I’m lucky that I found those things. I never had the desire to become a director of a cancer center. I don’t enjoy things that come with a title—I want to care for patients and conduct research and teach bright young doctors,” said Dr. Einhorn. ■