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Improving the Lives of Patients With Cancer Is Richard L. Schilsky’s Lifelong Mission


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Richard L. Schilsky, MD, FACP, FSCT, FASCO

Richard L. Schilsky, MD, FACP, FSCT, FASCO

In 2009, as Richard L. Schilsky, MD, FACP, FSCT, FASCO, was preparing his Presidential Address for that year’s ASCO Annual Meeting, he came across his 6th grade essay titled “My Ambition,” which foretold with eerie specificity the career path he would follow over the next 6 decades. In the paper, Dr. Schilsky wrote that he hoped to enter the field of medical research, “searching for cures to diseases such as cancer and leukemia.” 

“I was startled to see that not only did I say in my essay that I wanted to be a doctor, I said that I wanted to be a medical researcher, so I could make discoveries that would help people with serious disease and not just deal with conditions like broken bones. How I got that insight, I don’t know,” said Dr. Schilsky.

Several years after Dr. Schilsky wrote that essay, although he didn’t realize it at the time, his professional trajectory in oncology was set when his maternal grandmother, Mary Cohen, was diagnosed with breast cancer. Through her illness, he witnessed firsthand the devastating effects the disease and treatment had on patients. 

“At that time, treatments for breast cancer weren’t very good, and she had a difficult time,” remembered Dr. Schilsky. “She had a radical mastectomy and scorching radiation therapy, which left her burned and scarred. Several years later, cancer developed in the other breast, followed by painful bone and brain metastases, and she died in a nursing home in a very unpleasant way.” The experience left such an indelible impression on Dr. Schilsky, he has carried it throughout his career as a reminder to put patients’ concerns first in any treatment decision.

In the 6th grade, Dr. Schilsky declared his desire to enter the field of medicine to search for cures for “cancer and leukemia,” in his essay “My Ambition.”

Star Student

Born in New York City on June 6, 1950, Dr. Schilsky was a precocious student. He excelled in math and science in grade school and was accepted into Stuyvesant High School, one of New York’s most prestigious high schools. He later graduated cum laude with a degree in biology from the University of Pennsylvania in 1971 and with honors from the University of Chicago Pritzker School of Medicine in 1975. Dr. Schilsky’s love of science and math may have been inherent, but it was nurtured by his parents, Shirley and Murray, who were determined to see their son succeed.

“Neither of my parents had gone to college, and to them the absolute pinnacle of success was to raise their son to be a doctor. I’m sure a lot of that influence rubbed off on me. Plus, I really liked the subject matter, so aiming for a career in medicine wasn’t a difficult choice,” said Dr. Schilsky. 

Turning Points

In addition to his grandmother’s illness, a confluence of several other seminal events during Dr. -Schilsky’s medical school years led him to a career in oncology and a specialty in gastrointestinal (GI) cancers. Returning to New York during summer recess after completing his first year at the University of Chicago Pritzker School of Medicine, Dr. Schilsky received a stipend from the American College of Radiology to spend time in the Department of Radiation Oncology at New York University Medical Center, one of the city’s premier private hospitals, and Bellevue Hospital, the oldest public hospital in the United States. 

Dr. Schilsky’s maternal grandparents, Mary and Sam Cohen. Mary Cohen’s diagnosis of breast cancer in the mid-1960s was a catalyst for Dr. Schilsky’s determination to forge a career in oncology.

The experience of talking with patients with cancer and working alongside the radiation oncologists treating them convinced Dr. Schilsky to join the field of oncology and initially put him on the path to a specialty in radiation oncology. It wasn’t until his third year in medical school, while doing rotations in internal medicine, that he detoured from that plan.

“I fell in love with internal medicine because of its problem-solving aspect and the long-term relationships internists have with their patients,” said Dr. Schilsky. He also credits his mentor at the University of Chicago, the late John E. Ultmann, MD, with inspiring him to pursue a career in oncology. Dr. Ultmann encouraged him to apply for an oncology fellowship at the National Cancer Institute (NCI), which he did before graduating from medical school. Although accepted into the NCI’s fellowship program, Dr. Schilsky first had to complete his internal medicine training at The University of Texas Southwestern Medical Center in Dallas. 

Dr. Schilsky’s parents, Shirley and Murray Schilsky, nurtured their son’s love of science and math and were determined to see him succeed in medicine.

It was during his training at the NCI, from 1977 to 1980, that Dr. Schilsky made his decision to specialize in GI cancers. “I was mentored by Bruce A. Chabner, MD, who was Head of the Clinical Pharmacology Branch at the NCI, and I was interested in learning more about how drugs worked and doing research in pharmacology and drug development. If you were interested in new drug development, GI cancers offered a good patient population to enroll in phase I and phase II trials to investigate new drugs, because there were so few standard-of-care treatment options for patients at that time,” said Dr. Schilsky. 

It was also during his fellowship at the NCI that he made his first major contribution to the treatment of cancer, which changed the standard of care for patients prescribed the then experimental chemotherapy drug cisplatin. After receiving a call from a patient with ovarian cancer enrolled in a clinical study of the drug, complaining that she was shaking all over, Dr. Schilsky ordered blood tests to determine the cause and found that her magnesium levels were so low, they were nearly undetectable. After giving the patient magnesium supplements, the problem subsided, and she rapidly improved. But the question remained, why were her magnesium levels so low?

“I consulted with some of the experts at the National Institutes of Health, and we hypothesized that cisplatin, which could damage the kidneys, was causing the kidneys to lose magnesium in the urine,” said Dr. Schilsky. To test their theory, Dr. Schilsky and his colleagues launched a clinical trial, which proved that low magnesium was a side effect of cisplatin. Their finding1 was published in the Annals of Internal Medicine in 1979 and led to the now routine practice of providing magnesium supplementation to patients being treated with cisplatin.

A Serendipitous Turn 

Following 4 years at the NCI, Dr. Schilsky was anxious to return to the Midwest and raise his young daughter in a less urban environment. He accepted an offer as Assistant Professor in the Department of Internal Medicine, Division of Hematology/Oncology at the University of Missouri–Columbia School of Medicine, and almost immediately encountered unexpected challenges. 

“Within my first year, both the Chairman of the Department of Medicine, who had hired me, and the Head of the Division of Hematology/Oncology, who had recruited me to the position, left the university, and I was floundering,” recalled Dr. Schilsky. “I began looking for other opportunities, and 3 years later, in 1984, I was offered the position of Director of a new phase I investigational drug program at the University of Chicago, which was what I really wanted to do. So I moved back to Chicago.”

I fell in love with internal medicine because of its problem-solving aspect and the long-term relationships internists have with their patients.
— Richard L. Schilsky, MD, FACP, FSCT, FASCO

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Despite Dr. Schilsky’s misgivings about his tenure at the University of Missouri, he admits his time there and his friendship with colleague Michael C. Perry, MD (an oncologist and member of the Cancer and Leukemia Group B [CALGB], now called the Alliance), led to professional opportunities he could never have anticipated. In the fall of 1982, at Dr. Perry’s suggestion, Dr. Schilsky attended his first CALGB meeting, and 13 years later he was elected Chairman of the group. 

He presided over CALGB from 1995 to 2010, and during that period, the group oversaw the launch of a series of clinical studies in such diverse cancers as multiple myeloma, breast cancer, myelodysplastic syndromes (MDS), acute myeloid leukemia, kidney cancer, and childhood T-cell leukemia/lymphoma, which led to U.S. Food and Drug Administration (FDA) approval of six drugs in the treatment of those diseases, including lenalidomide (Revlimid) for myeloma, paclitaxel for adjuvant therapy for breast cancer, azacitidine for MDS, bevacizumab (Avastin) for kidney cancer, nelarabine (Arranon) for childhood T-cell leukemia/lymphoma, and midostaurin (Rydapt) for FLT3-mutated acute myeloid leukemia.

“This experience taught me that no matter how bad you think your career is going, there could always be some good that comes out of it. My career seemed to be going off the rails, and then I got this incredible opportunity to be involved in CALGB, which became such an important part of my career for many years. It’s a good lesson for every young person starting out in a career,” said Dr. Schilsky.

Transitioning From Clinician to ASCO Executive

Another pivotal career-altering chance came in 2008, when Dr. Schilsky began his tenure as President of ASCO. An ASCO member since 1980 (with 2018 marking his 39th consecutive year in attendance at the ASCO Annual Meeting), being ASCO President gave Dr. Schilsky exposure to a variety of issues plaguing oncologists and a venue to help solve some of those problems. 

After nearly 30 years at the University of Chicago, in positions ranging from Director of the Cancer Research Center and Associate Dean for Clinical Research to Chief of the Section of Hematology/Oncology, Dr. Schilsky was becoming restless and looking for another opportunity to contribute to cancer care and research. That opportunity came in 2012, when he received a call from then ASCO Chief Executive Officer Allen S. Lichter, MD, FASCO, asking if Dr. Schilsky would consider assuming the Society’s newly created position of Chief Medical Officer.

“Taking this position felt right, because I knew ASCO well and knew the impact I could make,” said Dr. Schilsky. “I came into the position with a blank slate, and it’s been an exciting 5 years since then.”

Dr. Schilsky surrounded by his wife, Cynthia, and daughters, Meredith (left) and Allison (right).

Dr. Schilsky is filling that blank slate with the creation of innovative clinical trials never before attempted by ASCO—most notably the Targeted Agent and Profiling Utilization Registry (TAPUR) Study, a basket trial he launched in 2016. The purpose of this nonrandomized clinical trial is to identify potential signals of drug activity in patients with advanced cancer and a potentially actionable genomic alteration. The drugs included in -TAPUR are targeted therapies that have already been FDA-approved for other indications. Currently, more than 1,000 patients have been treated with a TAPUR Study drug at 113 sites across 20 states. 

“We are trying to test whether drugs already FDA-approved and used outside of their indication to target a specific genomic alteration are effective,” said Dr. Schilsky. For example, a phase II TAPUR study is evaluating palbociclib (Ibrance), an FDA-approved treatment for metastatic breast cancer, in patients with pancreatic cancer and gallbladder or bile duct cancer with CDKN2A alterations. The first results from this investigation showed that palbociclib has no clinical activity in these cancers2—a critical finding, said Dr. Schilsky, even though the result was negative.

Taking this position felt right, because I knew ASCO well, and I knew the impact I could make. I came into the position with a blank slate, and it’s been an exciting 5 years since then.
— Richard L. Schilsky, MD, FACP, FSCT, FASCO

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“Even a negative result is important because we are trying to determine whether drugs already on the market are effective in other indications. A negative result that informs physicians they shouldn’t be doing something is just as valuable as a positive result,” said Dr. Schilsky. “Interestingly, in other TAPUR cohorts of patients with lung cancer, head and neck cancer, and ovarian cancer with the same CDKN2A alteration, palbociclib is showing preliminary signs of activity, so that’s gratifying.”

In January 2017, Dr. Schilsky led the ASCO launch of its Center for Research and Analytics. The program aims to make a variety of ASCO data assets available to the oncology community and provide consultation and support for research and analysis.

Although Dr. Schilsky admits he misses treating patients and teaching medical students, the transition to an executive position with ASCO has been seamless—and worth the tradeoff. “I miss the interaction I had with patients but not the bureaucracy of functioning as a physician in today’s climate. I also miss the academic environment and the exposure to medical trainees. On the other hand, I’m working in a very exciting place, at a very exciting time, and with wonderful colleagues. It doesn’t get much better than this,” said Dr. Schilsky. 

Reflecting on the Past and Future

In addition to a stellar career in oncology, Dr. Schilsky has had a gratifying personal life as well. Married to his wife, Cynthia, for 41 years, the couple has two daughters and two grandchildren. At age 68, Dr. Schilsky shows no signs of slowing down and is hopeful about the future

My life has worked out well, and it’s been a remarkably satisfying career so far. There is still work to be done, and I’m not ready to quit doing it yet.
— Richard L. Schilsky, MD, FACP, FSCT, FASCO

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of oncology care and the advancements in treatment that will allow more durable remissions and cures for patients with cancer. As he looks over his long career and reflects on his achievements, Dr. Schilsky is satisfied with a life well lived and excited about the future.

“I wouldn’t change anything in my life. It hasn’t always been easy, and there have been challenges along the way. But my life has worked out well, and it’s been a remarkably satisfying career so far. There is still work to be done, and I’m not ready to quit doing it yet,” said Dr. Schilsky. ■

DISCLOSURE: Dr. Schilsky’s institution has received research funding from AstraZeneca, Bayer, Bristol-Myers Squibb, Genentech/Roche, Merck, and Pfizer.

REFERENCES

1. Schilsky RL, Anderson T: Hypomagnesemia and renal magnesium wasting in patients receiving cisplatin. Ann Intern Med 90:929-931, 1979.

2. Baghdadi TA, Halabi S, Garrett-Mayer E, et al: Palbociclib in patients with pancreatic cancer and gallbladder or bile duct cancer with CDKN2A alterations: Results from the Targeted Agent and Profiling Utilization Registry (TAPUR) Study. 2018 ASCO Annual Meeting. Abstract 2532. Presented June 4, 2018.


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