As Hoosier Cancer Research Network celebrates our 30th anniversary, we acknowledge another significant milestone: the 40th anniversary of the discovery of the cure for testicular cancer by HCRN co-founder and board member, Lawrence H. Einhorn, MD.

Dr. Einhorn joined the Indiana University School of Medicine in 1973, just one year before his groundbreaking discovery testing the platinum-based drug Cisplatin with two additional drugs. He continues to serve as Distinguished Professor and Livestrong Foundation Professor of Oncology at the IU School of Medicine.

The following conversation with Dr. Einhorn introduces a new series of interviews with HCRN co-founders, who share their perspectives on the organization’s founding, development, and history, and on advances in cancer research. We thank each of our co-founders for their vision to create a vibrant academic-community partnership to advance cancer research in the State of Indiana and beyond.

How did you and the Indiana University School of Medicine mark the 40th anniversary of the discovery of the cure for testicular cancer?

Dr. Einhorn: Indiana University and our development office put together an event, to my surprise. We had a lot of patients come from a long distance. It was 40 years ago in October that we treated the very first patient with platinum when it was a very experimental drug in testis cancer, knowing the severe toxicity that would be seen but really having no idea what it would do therapeutically, and especially whether it would have any durable responses. When you use a toxic drug that causes a lot of side effects and you get a two-month remission, it’s hardly worthwhile. But obviously the reason we’re having the 40-year anniversary is that it really turned out to be a miracle drug for testicular cancer and just revolutionized the cure rate for patients with metastatic disease.

Do you recall when you first knew you were on to a game-changing discovery?

Dr. Einhorn: As a young oncologist, you tend to be enthusiastic about every new drug that you’re trying. It becomes more sobering as you get older and see how many drugs failed to produce meaningful durable remissions. But when we first started out with platinum combination chemotherapy we were seeing spectacular responses to the point that our radiologist who was so used to seeing patients come back three weeks later with increased size and number of pulmonary metastases actually called me up and wanted to know what we were treating these patients with, because as a radiologist he had seen these tumors melting away. Within the first couple of months when we had our first five or six patients, we were seeing something pretty spectacular. But again, you don’t know whether those are durable remissions, and it wasn’t until we had a significant number of patients out beyond a year that we realized that we were whispering the word cure and thought that we might actually be able to move the needle forward because prior to platinum the cure rate was five to ten percent of these patients.

What are the differences in the way research was conducted 40 years ago compared to today?

Dr. Einhorn: There’s a night and day difference. The studies we did here with platinum at Indiana University 40 years ago, I could never do that today. First of all, we wrote up a protocol, we got the drugs from the NCI, and two weeks later we started our first patient. It would be a year later before we would start our first patients today. Secondly, this was in-patient therapy with an experimental drug. No insurance company would have covered it. It would have been for the wealthy only who could afford to self pay. Thirdly, because it’s such a toxic drug, as soon as we had a side effect with an experimental drug, the IRB would have shut the protocol down and waited another 6 months. And fourthly, we would have been inundated with serious adverse event reactions, sending them to the IRB.

These are things today that need to be done; you don’t want someone being a maverick out there. But it was much easier 40 years ago.

Most importantly, when we do a clinical trial today, it’s very expensive. A huge amount of financial resources are required, often funded by either a grant or by a drug company. We did these platinum studies on a shoestring budget. There was no drug company support. We had no grant. We just did it. We could never do that today.

Every year that goes by there are more hurdles and barriers to doing things. The research machinery that we have in place right now is elegant and sophisticated, but it’s also burdensome.

What do you love about Indiana University, the IU School of Medicine, and the IU Simon Cancer Center?

Dr. Einhorn: As a medical oncologist in the areas that I deal with, testis cancer and lung cancer, you need to have collaboration with other medical oncologists, but also with surgical oncologists, radiation oncologists, and pathology. And in testis cancer, we’ve always had what I would argue are the best urological surgical oncologists in the world, first with John Donohue, and now with Richard Foster. In lung cancer and for our testis cancer patients that need surgery in the lung, there’s no one better in the country than Ken Kesler. Many NCI cancer centers send patients to Dr. Kesler for his surgical expertise. In pathology, we see several patients a year where we turn things around dramatically because of a change in the pathology report. Tom Ulbright is recognized as the leading pathologist in the country in germ cell tumors. It would be impossible for me to have this type of cadre of co-investigators at any other institution.

How did the idea for Hoosier Cancer Research Network come about? What was the need, what was the vision, and how has that vision been implemented over the years?

Dr. Einhorn: Before what then was the Hoosier Oncology Group started, there was a friendly and sometimes contentious arrangement between non-academic and academic oncologists. Most of the community oncologists were extremely bright and highly motivated, but were not necessarily doing research protocols. Research protocols are very time-consuming and, even back then, somewhat expensive. There was a need for patients to stay in their own community rather than traveling long distances to Indianapolis or any other tertiary care center. If you require this incredibly aggressive surgery from people like Ken Kesler or Richard Foster, that’s different. But as far as injecting drugs or putting someone on an oral chemotherapy agent, that can be done equally well at the community as well as at an academic center.

So this started when Ken Pennington, a community oncologist in Lafayette, Indiana, and I had lunch together. I was giving a talk at Purdue, and he was bemoaning the fact that he loved doing research but you just can’t do it at the community. On the other hand, patients don’t necessarily want to travel to the university, and we jointly decided, why can’t we do this as a community-based cooperative group. We were fortunate to get non-NCI funding for doing this. The first year and a half this was just a meet-and-greet, bringing in an outside speaker and talking about common needs. Then during the second year of the Hoosier Oncology Group, we put together disease-oriented committees and started making protocols. We were fortunate to have Pat Loehrer take over leadership. And Pat was able to bring people together at the community level and the academic level without any animus.

It’s changed quite a bit from its early iteration. Pat Loehrer had the vision to not have Indiana University be the only research base, so now we have the Big Ten Cancer Research Consortium, and the sophistication of clinical trials and the amount of scientific knowledge that’s available is greatly different than it was when the Hoosier Cancer Research Network was first formed. It’s been a model that other groups have tried to emulate here in the United States, too. We’ve done studies that I think would have been difficult to do in the national cooperative group setting.

Looking across the organization’s 30-year history, are there any special anecdotes or memories that you’d like to share?

Dr. Einhorn: The best thing is just getting everybody together, because idea generation doesn’t come from a university hospital. It comes equally well for anyone that’s dealing with cancer as a physician. Also, what we get with the community physicians is common sense. You might have a brilliant idea, but then you realize you can’t implement it. You just can’t treat people with this type of regimen or bring them back and forth in this type of format. So, it’s been very educational for us at the academic center, and I think it’s been wonderful at the community center to have them present papers at national meetings, to be involved in research where they’re just not asked to be the 100th institution putting one or two patients on a trial, but being involved on the ground floor of starting a protocol, writing up a protocol, and carrying it to fruition.

We’ve had protocols that have changed the way diseases are treated, and we take great pride in that, just as the national cooperative groups do. So it’s been a social, political, academic and scientific success, and it’s done phenomenally better than probably Ken Pennington and I would have dreamed when we had that lunch together.

We’re also very fortunate that the late Dr. Joseph Walther provided seed funding for this organization. We did not want to rely upon drug company studies, unless they were initiated by investigators. So we needed to have some corpus of funding in order to get the organization started, and with the Walther Cancer Institute’s vision and generosity, we were able to do this. I don’t think we would have been able to carry out our mission without that type of funding.

As you look ahead, what opportunities might drive HCRN’s continued progress?

Dr. Einhorn: The field of cancer research has changed as we’ve moved toward genomic-based analysis and personalized medicine. We look at what is a genomic abnormality of a cancer, what drives the pathogenesis and spread of disease, and work to develop an individual drug that is usually not a chemotherapy drug, that can block that pathway. So the science is far more sophisticated than it was 40 years ago when we started these studies with platinum. We have a lot more academic collaboration because of the Big Ten network.

Hoosier Cancer Research Network can do novel studies, we can be more facile than the national cooperative groups. We can get things started and completed. And we can negotiate well for studies with promising molecules that come out at Big Ten laboratories or at the NCI, as well as investigator-initiated trials.

What brings you the greatest hope in your work as a researcher?

Dr. Einhorn: Every year when we go to the national meetings of the American Society of Clinical Oncology, there are exciting new presentations. They come from all over the world. Today, there is not a single type of metastatic cancer that we cannot treat and palliate and prolong survival. Forty years ago, that would have been unthinkable. The science has really outpaced the disease. But again, cure has been elusive, unlike a disease like testis cancer.

I help to run our fellowship program at Indiana University, and I always tell our fellows when they start out July 1 that they should pat themselves on the back for choosing such an exciting career. It was exciting 40 years ago and it’s even more exciting now.

Hoosier Cancer Research Network (formerly known as Hoosier Oncology Group) conducts innovative cancer research in collaboration with academic and community physicians and scientists across the United States. The organization provides comprehensive clinical trial management and support, from conception through publication. Created in 1984 as a program of the Walther Cancer Institute, Hoosier Cancer Research Network became an independent nonprofit clinical research organization in 2007. Since its founding, Hoosier Cancer Research Network has initiated more than 150 trials in a variety of cancer types and supportive care, resulting in more than 300 publications. More than 4,400 patients have participated in Hoosier Cancer Research Network clinical trials.