“Hurry up, Dr. Von Hoff,” exclaimed the wife of a cancer patient. “I need to get him to lunch at Kentucky Fried Chicken at 11:30, and it’s already 11:15.”
Startled, Daniel Von Hoff, M.D., looked at his charts and discovered something most unusual — his patient had gained 17 pounds. Due to the progression of their disease, pancreatic cancer patients develop fatty food intolerance; they definitely don’t gain weight. What was happening here?
The answer was gemcitabine, one of the few drugs currently approved by the Food and Drug Administration for the treatment of pancreatic cancer. Dr. Von Hoff ran the initial clinical trial with gemcitabine, now marketed by Eli Lilly. This anticancer agent has also shown promise in treating patients with lung, ovarian, and breast cancer. But until that fateful day in the clinic, no one, including Von Hoff, knew the full potential of the drug.
“Nobody else with pancreatic cancer had ever gained weight on this,” Von Hoff recalls of his KFC patient, “and so it had to be that the drug was working.” He went to the FDA to pursue further clinical trials that eventually proved him correct. Gemcitabine is now part of the oncologist’s arsenal against pancreatic cancer.
A Knack for Developing Drugs
The story sounds extraordinary. Yet gemcitabine is more the rule than the exception in Dr. Von Hoff’s career. His journey to becoming the director of the Arizona Cancer Center in 1999 began decades earlier, crisscrossing the country. From his roots in Wisconsin, Von Hoff completed medical school at Columbia University, a residency at the University of California at San Francisco, and an oncology fellowship at the National Cancer Institute (NCI) near Washington, D.C. He then spent 20 years in Texas, where he directed the Institute for Drug Development at the Cancer Therapy and Research Center, the clinical division of the San Antonio Cancer Institute. He was also a professor of medical oncology at the University of Texas Health Science Center at San Antonio (UTHSCSA).
Von Hoff has helped more than 120 anticancer drugs move from bench to bedside, the result of a drive for excellence that was fostered early in his training at Columbia under the influence of Dr. Houston Merritt. A giant in the field of medicine, Merritt took a young protégée with him to the front row of a ceremony to receive the Lasker Award — a medical honor on par with the Nobel Prize. “He showed me what excellence was in clinical research,” Von Hoff says. “That excellence is what got me interested. I saw these people take things from scratch, get them into patients, and make a difference. How could you not want to follow that pattern?”
As his training continued, he began to develop ideas of his own, eventually focusing his efforts on combating a disease that killed 30,000 Americans last year. “The first patient I ever took care of as an oncology specialist had pancreatic cancer,” he recalls, “and I watched this wonderful man die very quickly.”
Once Von Hoff established his own lab as an assistant professor at UTHSCSA, he brought all available resources to bear on the problem, including a drug screening system that tested new anticancer drugs for their efficacy against pancreatic cancer. “We took drugs made by anyone, anywhere,” he notes. “I would take anything anyone would give me.”
While in Texas, Von Hoff established a successful drug development institute and a company called Ilex Oncology, currently traded on NASDAQ (ILXO). Content in San Antonio, he had no plans to relocate—until the day he received a phone call from an old friend, Dr. Sydney Salmon, then the director of the Arizona Cancer Center
Arizona-Bound
Von Hoff first met Salmon as a fellow at NCI, and what began as an exchange of ideas developed into a lifelong mentoring relationship. Tragically, that friendship would be cut short by Salmon’s death from pancreatic cancer in 1999. Before he passed away, Salmon left a request with Von Hoff. “Syd called to tell me he had pancreatic cancer and to ask if I would come out and help keep the dream alive of a cancer center in Arizona,” says Von Hoff. “It was a friend calling, and so I stepped up to the plate.”
Today, Von Hoff is busy heading an organization designated as one of only 39 comprehensive cancer centers by the NCI. “I’m glad I came,” he says. “I found very good science here and really terrific people. This is a place receptive to good ideas.” Von Hoff’s faith was confirmed when a recent NCI site visit garnered the Cancer Center the coveted rank of “excellent.”
Scientific discoveries drive advancements in the clinic, so a significant portion of Von Hoff’s time is devoted to laboratory activities. As part of the Center’s leadership team, he is involved with administrative coordination ranging from fundraising and community outreach to scientific networking and development. The Center’s role in Arizona’s securing of the International Genomics Consortium (IGC) and the Translational Genomics Research Institute (TGen) underscores Von Hoff’s ability to promote collaboration.
Though proud of the Center’s strong research reputation, Von Hoff’s primary commitment is to its oncology patients. “I try to keep as much focus on patient care issues as possible because I believe that’s where the strength of investigators come from,” he says. While acknowledging the importance of superior administration, he is quick to remind you of his underlying focal point: “My heart is at the bedside and the bench.”
Von Hoff is equally direct when it comes to articulating his vision for the Arizona Cancer Center. “I want us to prevent and cure the disease,” he says. “That’s our mission. It’s very clear.” This perspective, shared by the basic and clinical scientists of the Cancer Center, has led to exciting developments that are helping to make this dream a reality.
The Role of Prevention
“The best way to cure cancer is to not get it in the first place,” Von Hoff says. The Cancer Center is home to some of the best projects in cancer prevention in the country. Dr. Anna Giuliano is making strides with a vaccine against Human Papillomavirus (HPV), the chief causative agent of cervical cancer. Dr. David Alberts has played a key role in the evolution of understanding colon cancer and the importance of early detection of colon polyps. Skin and prostate cancer prevention trials are also moving forward.
The genetic basis for tumor development has been well established, and several investigators at the Center — including Dr. Bernard Futscher and Dr. Laurence Hurley — have made groundbreaking contributions to the understanding of these processes. In addition, investigators such as Dr. Garth Powis continue the development of new anticancer agents. A compound known as PX-12, developed by Powis, is currently in phase I clinical trials.
An Arizona Collaboration
One of Von Hoff’s goals is to ensure that the Arizona Cancer Center lives up to the geographic reference in its name. He believes that the Center’s stellar showing in national evaluations reflects statewide strengths. Recent developments in the Phoenix area are helping to advance his goal. Arizona Cancer Center clinical trials are now being conducted through the Virginia Piper Cancer Center at Scottsdale Healthcare. Patients who would once have had to drive to Tucson for treatment can now be seen in Phoenix while still remaining under the umbrella of the Arizona Cancer Center. “This isn’t an outreach,” Von Hoff says. “This is a major statewide effort. We don’t have any geographic boundaries and we’re not going to have any. That’s my job. All new therapies should be available to all patients.”
In addition, plans are in place for a statewide initiative called “TargetNow,” a cooperative enterprise among the three state universities, IGC, and TGen. As Von Hoff says, “The goal is to detect the targets, or patterns of targets, in patient tumors, and then treat them accordingly — rather than, for example, taking a new breast cancer drug and trying it in everyone.” TargetNow would make Arizona a proof-of-principle contributor, showing that it is possible to profile a disease and create an individualized course of treatment.
The goal matches the unique strengths of cancer research in Arizona. Two separate but synergistic elements provide the promise of great things to come. “You see, we’ve got great strength in target detection between the Cancer Center, IGC, and TGen,” Von Hoff explains. He then cites more than 30 pharmaceutical agents in clinical trials in the state. “We’re one of the few places in the universe that can match target and treatment. That’s what we’re going to be emphasizing to make a difference in both therapeutics and prevention.”
The progressive integration of tailored therapy and a continual emphasis on prevention may well be the combination that makes cancer, in Von Hoff’s words, “a chronic disease twenty years from now, or maybe even a thing of the past.” Under his direction, the Arizona Cancer Center will continue to be a vital force in this progression and a symbol of excellence in the ongoing development of the biosciences in Arizona.