Sometimes an opportunity comes along that's too good to pass up, even though taking it will mean some serious tradeoffs.
This past summer, Mace L. Rothenberg, MD, was introduced to a deal he felt he couldn't refuse—to lead worldwide development of new cancer drugs in a newly restructured oncology business unit at Pfizer, which claims to be the world's largest research-based biomedical and pharmaceutical company.
Shortly before his December 1 start date as Senior Vice President of Clinical Development and Medical Affairs for Oncology, Dr. Rothenberg discussed his transition from academia to industry with OT while he was still Ingram Professor of Cancer Research at Vanderbilt-Ingram Cancer Center.
“I had been contacted over the years with various opportunities and never pursued any of them. But there was something about this position that seemed different, so I asked for more information and I realized this was a unique opportunity that would be the senior-most position focused just on oncology,” he said.
“It would allow me to benefit from the substantial resources of Pfizer to help guide development of a really top-rate portfolio of compounds on a worldwide basis. That struck me as being very different from any position I ever heard of before in the industry.”
Dr. Rothenberg had been contacted by Garry Nicholson, Senior Vice President and General Manager of Pfizer's Oncology Business Unit, who had joined the company earlier in 2008 after spending years at Eli Lilly leading its US and then global oncology businesses.
Pfizer announced last fall that it was shifting its research focus away from heart disease and obesity to concentrate more on cancer and Alzheimer's disease, which the company said offer the possibility of greater profits and more treatment improvements.
Irinotecan, Oxaliplatin, Gemcitabine
With his substantial track record in drug development for more than a decade, Dr. Rothenberg was a likely recruit. He was involved in the development and subsequent FDA approval of two colorectal cancer drugs: originally Upjohn's and now Pfizer's irinotecan (CPT-11, Camptosar) in 1996 when he was on the faculty of the University of Texas Health Science Center in San Antonio and Executive Director of the Southwest Oncology Group; and oxaliplatin (Eloxatin) for Sanofi-Aventis in 2002 while he was at Vanderbilt-Ingram.
He also helped develop Lilly's gemcitabine (Gemzar) in 1996 for pancreatic cancer.
But Dr. Rothenberg has been more than a medical researcher; he's been a dedicated teacher, editor, and physician—receiving the American Cancer Society's Lane W. Adams Quality of Life Award in 2008 as one of the nation's top cancer caregivers, and serving on the editorial boards of the Journal of Clinical Oncology, Clinical Cancer Research, Clinical Colorectal Cancer and Investigational New Drugs, and Journal of Anticancer Agents.
“The more I learned about the position, the more I realized this was not so much a departure from what I'd been doing but really was a next logical step in my career, because for the past 23 years I've been focused on new drug development in oncology on a patient-by-patient, trial-by-trial basis,” he explained.
“And I've had a wonderful experience and am very proud that the work I've done has actually led to the development and approval of several drugs and improved cancer care for patients around the world. But I realized this position allowed me to do that but on a larger scale, working with a portfolio of compounds and clinical trials around the world.”
Taking Own Advice
He said he found it interesting that sometimes when we give advice to someone else, “we suddenly find ourselves in a situation where we have to take our own advice,” adding he often lectured about careers in oncology and happened to see one of the related slides when he was making his decision to join Pfizer.
He said he often told others they should really have an idea of what they want to do in their careers, what they want to accomplish, and how they are going to get there.
“But you also have to be open to new and unexpected opportunities that may not have been in that plan. You need to give yourself permission to think about how this opportunity may be unique and might be really a wonderful chance to move forward in a different manner but yet be able to accomplish the goals you set for yourself.”
Dr. Rothenberg said that giving up patient care was a very difficult aspect of his decision since he very much enjoyed patient care and patient interaction as well as interacting with fellows and residents while overseeing them in clinical and clinical research settings.
Weighing What You Get & What You Give Up
“One of the things I realized was that with a big move there are things you get and things you give up, and you have to weigh those two elements. I also realized that if I've done a good job in the last 20-plus years in training residents and fellows, then there are people who will be every bit as good if not better [than me] in caring for patients.
“You also have to look at this as life in the old growth forest where there are times when the big trees have to be cut down to allow the sun to shine on the younger trees allowing them to grow, and I see this as an opportunity for them to step up.
“I know the departure of any senior faculty member from any institution is difficult and people wonder if it's a sign of something ominous, but it really isn't; it's more the natural order of things, and if an institution has been successful in developing the careers of faculty members, then other individuals will have the opportunity to take the next step up.
“Senior people should leave for the right reasons, such as taking a position where they can contribute more on a larger stage. The reaction I've gotten from people [at Vanderbilt-Ingram] is they've just been wonderful and I couldn't ask for a better group of colleagues and collaborators and friends.”
Relationship with Vanderbilt Started in 1982
Dr. Rothenberg first came to Vanderbilt in 1982 for his internship and residency training in internal medicine following graduation from New York University School of Medicine.
He did his medical oncology fellowship at the National Cancer Institute, and was then selected by Bruce A. Chabner, MD, to be Special Assistant to the Director of the Division of Cancer Treatment from 1988 to 1991.
His next stop was San Antonio for seven years before returning to Vanderbilt, where he also served as Director of Phase I Drug Development, Co-Leader of the Experimental Therapeutics Program, and Co-Principal Investigator of the cancer center's SPORE (Specialized Programs of Research Excellence) in Gastrointestinal Cancer.
La Jolla, NYC, New London, Milan
At Pfizer, Dr. Rothenberg's time will initially be split among facilities in La Jolla, Calif; New York City; New London, Conn.; and Milan, Italy.
His wife and son will remain in Nashville until the latter graduates from high school in 2011; his daughter is now a freshman at New York University.
Dr. Rothenberg said he plans to build relationships with academic centers so that industry and academia can share their respective strengths.
“I've been saying this for many years before this opportunity came along: Both sides have to recognize what each partner brings to the table. From academia you bring experts in the biology of a pathway or a molecule or a disease that approach it from why the cancer develops and how it progresses and goes on to kill someone; whereas industry is looking at trying to obtain and develop molecules that are particularly effective in hitting what's considered a critical pathway.
“But each one is only part of the picture. The problem is when there hasn't been adequate communication and collaboration throughout the process, when industry allows a research laboratory access to a compound only long after it has already been in clinical testing and heading toward development and approval. And yet the insights from laboratories that understand the biology of that disease could very significantly affect the direction of that drug's development.”
He noted that both sides are concerned about intellectual property when something is discovered, but that if all parties were engaged—not just the researchers and drug development people but also the respective lawyers—then the focus could be kept on what is needed to develop the drugs in a more thoughtful and expedient fashion, and that can be accomplished by collaborating at earlier points in time.
Keeping the Focus on Patients
He said that he thought his many years of patient care would ensure that he doesn't lose sight of how patients can benefit from significant new and more effective therapies.
“It's been a privilege for me to have been a part of so many people's lives during a difficult time in their lives and help them deal with end-of-life issues, and that perspective should serve me well in industry, where I'll be in the minority of people since many of the others have backgrounds instead in business or basic science or marketing.”
Coordinate with Preclinical Department
He said he plans to coordinate his clinical development effort with Pfizer's preclinical department because he's seen too many situations at other companies where the work is separate.
“The preclinical guys have a lead compound and the company makes a commitment to bring that forward into human testing, and that basically closes the book for the basic scientist. It transfers entirely to the clinical development, and that loses so much in terms of insights into how the drug works and how best to use it.
“I expect that we [he and his preclinical counterpart] will have a very interactive relationship so we are apprised about what's going on in both preclinical and clinical development so we're able to share our respective perspectives and will be able to collaborate on the design of some trials, albeit preclinical or clinical correlative studies. This will help us provide more insight into the drug's effect and help us develop that drug most efficiently.”
‘What I'll Miss’
Dr. Rothenberg said that there are a number of things he will miss in academia, such as no longer being able to keep up as a leader in GI cancers or to present the same types of talks, or attend his disease-specific meetings, or serve on advisory boards.
But he said he also realizes that the fairly autonomous structure of Pfizer's oncology unit is an attractive feature that will allow him to focus on oncology as a member of a small executive leadership team permitting him to participate in major decisions about what trials are conducted, what direction the business will move in, and what resources are used.
‘No Levels Above Mine to Get Approval to Move On’
“There won't be any levels above mine that we would have to go through to get approval to move on, and we won't be competing with other therapeutic area resources.
“Everyone talks about the new era that we've entered in terms of targeted therapies, but I think the actual implementation of that has been hampered by structural problems, resource limitations, and lack of clinical development expertise on the part of leadership.”
He said he thinks those issues have been addressed by Pfizer's new structure, and the company can implement bringing those compounds forward so they will have an impact on patients worldwide.
“Right now Pfizer Oncology is not on many people's radar screens. It doesn't have the reputation of a Genentech as being tremendously innovative in bringing breakthrough compounds forward, but that's something we can strive for in a way that depends on the things that makes Pfizer unique.
“By moving things in a new direction in the future, hopefully [people will] think of Pfizer Oncology in that same way as a leader in oncology, an innovator that's science driven and always keeping its focus on patients and patient benefits. That's the attitude I hope to see there and hope to reinforce.”