Hoosier Cancer Research Network co-founder Kenneth L. Pennington, MD, recently retired from the IU Health Goshen Center for Cancer Care after 34 years of practice in medical oncology. As a founding member of HCRN (formerly known as Hoosier Oncology Group), Dr. Pennington shared the vision to bring innovative cancer research to communities throughout Indiana and beyond.

Dr. Pennington attended medical school at the Indiana University School of Medicine and completed his residency and fellowship at Methodist Hospital in Indianapolis. He served as an investigator for the Eastern Cooperative Oncology Group and the National Surgical Adjuvant Breast and Bowel Project.

We thank Dr. Pennington for his long partnership with HCRN and for the difference he has made in the lives of countless patients over the years.

Dr. Pennington reflected on his career in the following interview with HCRN, part of a series of conversations with our co-founders.

What led you to a career in medicine and more specifically, oncology?

When I went to medical school from 1969 to 1973, I had ambitions to be a cardiologist. I went to Emory University, which at that time was a prominent, well recognized program with J. Willis Hurst as director. After my internship, I was in the Air Force for four years and planned to do further training. While I was in the Air Force, my closest friend was an optometrist. His daughter contracted acute leukemia at age 5 just as I was being transferred to Utah, and all of a sudden it occurred to me that this is what I was going to do with my life.

Talk about your medical training, including those who helped guide you along the way.

Probably the best teacher I have had, at all levels, was an English teacher named Carol Enestes who was well ahead of her time. She taught me to think critically. During my internship, the influence of Dr. Hurst was felt by every intern in the program. He’s an outstanding teacher with a dynamic personality. During my fellowship, the influence by Dr. Einhorn was quite profound on me. His personality and his way of teaching has been a very positive influence on everybody who’s gone through his program. Dr. Clarence Ehrlich in gynecology was an excellent role model. Most of my training was done at Methodist Hospital, but they were gracious enough to also include me in all of the meetings that were done on behalf of the fellows, and I formed some excellent friendships there.

Please talk about your experience as a mentor to medical students.

My first 20 years were actually in Lafayette, associated with the Arnett Clinic. At that time I did some teaching at Purdue. They have a program for medical students which at the time was only two years. I did instruction in hematology and oncology and we would occasionally have students rotate through with us. After those 20 years, I came to the Goshen campus and have been practicing since that time as part of the Goshen cancer system, which became an IU affiliate just a few years ago.

A lot of physicians early on they think that their way is always the best way, and then after you get knocked around a bit and you get a little experience behind you, you realize maybe there are some better ways to do certain things. You also have to understand that there’s latitude in how to approach a problem, but most importantly, you learn after a few years that what works for one patient may not work for another patient, and so you become much more selective about what you might choose for treatment plans and what your objectives and goals might be for an individual patient. Learning from other people as they come in with new ideas always helped me. And I often found that other people had better ideas than I did, and I always tried to adopt them. I learned from young people coming in, and hopefully someone learned a little bit from me.

What interested you in research to begin with, and as a community physician what were the obstacles that you encountered in trying to access research opportunities?

In 1982, when I started practice, essentially all research was being done at academic centers, and there weren’t many physicians from private practice involved in research. We didn’t have a vehicle by which patients could stay in the community. My personal interest was twofold. First, I think patients always get better care when they’re on a trial. Secondly, there is a personal satisfaction in being involved in what we used to call “cutting edge medicine.” I wanted to do this on behalf of my patients, but I also got a great deal of enjoyment being involved in helping create studies. The scientific pursuit is intellectually stimulating. I found that I liked going to meetings such as ASCO, and the quarterly research meetings we had at the Hoosier Oncology Group were stimulating.

Can you talk about the beginnings of Hoosier Cancer Research Network?

I felt I had to bring to the front what a lot of other people were feeling. There were several physicians in different communities who had the same feeling I did and were wondering how to go about it. When we decided to float this concept, it was eagerly accepted by many physicians because they had been thinking along the same lines, and it just took a little bit of a spark to get the fire going.

Are there any special memories you have of the physicians and staff you worked with through HCRN?

One person stands out in my mind, Sandra Turner, who was with Hoosier Oncology Group. She was right at the center of things. She had a great personality and was a very bright woman and a hard worker. She was really dedicated to the whole idea of making the Hoosier Oncology Group work. She, along with several other people, took an ownership interest in it. They weren’t just employees, and I remember the dedication of those people, especially Sandra Turner, who helped physicians actually make it work.

I remember meeting at the old Walther house several times, having the opportunity to sit at the table with other physicians and hear them introduce new ideas. We would usually have a visiting professor at our meetings.

Initially when we were rotating meetings around the state, before it became more centralized, we had a real flurry of activity. At a meeting in Lafayette, Larry (Einhorn) said after the meeting, “You know, Ken, the biggest problem may be success, because we’ve got so many people interested and so much that they want to do. Do we really have the resources to handle all of the ideas coming through?” I have never forgotten that comment, and as it turned out, we were able to handle the success.

What are some of the similarities and differences between the national cooperative groups and what you experienced with Hoosier Cancer Research Network?

I think the major differences are the ease with which you can work with a decentralized group, like HCRN. You don’t have the barriers to go through in terms of paperwork, but we’re also looking at different patient populations. The large cooperative trials are usually phase III studies and they have to go through so many layers that, sometimes, by the time they present the study and they want people to participate in it, the question may not be relevant anymore. You have a real lack of enthusiasm for putting a patient on a study that took 3 to 5 years to develop, because science is changing. With the Hoosier Cancer Research Network, you didn’t have all those layers of bureaucracy. If you had a good idea, you could get it in front of a committee, and within months you’d have a proposal written, you would have a protocol either approved or denied at the top level, and you could take it right to your IRB. Decentralization of studies is really the key, and I think that’s why groups like the Hoosier Cancer Research Network have a real role to play.

Are there certain studies that you have been involved with that stand out as particularly significant?

The research that I’ve been involved in has mostly been in a contributing role. There have been several studies in the Hoosier Oncology Group, early on especially, that I thought were really valuable. One that stands out immediately to me is when we were investigating the use of platinol and 5FU in the treatment of metastatic colon cancer. Unfortunately, that study turned out to be negative. We thought we had an active combination that would be better than the traditional 5FU, and it didn’t turn out to be that way. But that study taught me a lot. It reinforced what I had been taught, but really didn’t believe: that first impressions are not always accurate and you just can’t go on anecdotal information. You have to be honest with yourself, you have to construct trials that are realistic, and then you have to live with your results.

Now that we have more molecular markers, and we have a better understanding of the biology of cancer, if we were to go back and revisit that study, we might find that we could profile patients on a molecular characteristic that responds to treatment, whereas those who lack this particular molecular finding do not.

As you have seen developments in oncology over the years how has your perspective changed?

I learned early on from patients that even if you couldn’t achieve your goals of cure, and sometimes not even prolongation of life, if you could at least help patients adjust to their situation, if you could provide them comfort, and pay attention to them as people, you were providing them a service. Once that finally kicked in, that you’re not going to be the guy who hits the home run, that you’re going to be the person who helps them to adjust and do the best they can, it became much easier. Fortunately, starting in the late 1980s and early 1990s, the science got so much better. Technology became better. Surgery improved. Imaging studies improved. With the development of drugs like rituxan, the introduction of Gleevec for chronic lymphocytic leukemia, all of a sudden we started having a positive impact on the natural history of disease that was really quite surprising. Lately, the new drugs in myeloma and chronic lymphocytic leukemia have just been astounding. In some ways, I hate to be retiring just when things are getting hot. Yet, at the same time, over the 34 years that I’ve practiced, there has been tremendous improvement.

How has the IU Health Goshen Center for Cancer Care developed during that time?

When I came here 11 years ago, I was the second medical oncologist. We had one surgical oncologist, one radiation oncologist, and one breast surgeon. The faculty has expanded. For instance, we have three surgical oncologists and two radiation oncologists now. We now have two radiation machines, which provide pretty sophisticated treatments. We have a very good diagnostic, interventional radiology program. So, it has fleshed out in those 11 years to help us provide high-quality services to this area. There has been a real emphasis on improving access to research, so we now have a lot of trials other than just the Hoosier Cancer Research Network. Many of these are phase II, and some are phase I. We are interacting with various pharmaceutical companies to bring phase I and phase II studies to this area as well. It’s been a pleasant surprise that we’ve been able to do this in a community this size.

As you look over your career, what are a few moments that come to mind that were either milestones or challenges?

I can think of four patients right off the bat who really had an effect on me personally, about the way I looked at life, and that kept me going. And then those patients who did really, really well — the outliers who beat the odds — I think of those people. And I think of how the technology has changed. I saw my first CAT scan from an old EMI (English Musical Instruments), the same company that produced the Beatles, from McGill University when I was stationed at Plattsburgh Air Force Base and I thought, “Wow, you can look into the brain!” If I were to look at that CAT scan now, I would say, “This is awful! I can’t see anything.” The improvement in imaging has just been amazing. And then I think of the first patients that we started to treat with the new antiemetics. And they didn’t get sick. And suddenly we went from inpatient to outpatient therapy. I remember being at the American Society of Hematology when Brian Drucker presented the first studies on Gleevec and CML, and the crowd was just silent. And then the most recent data on the usefulness of Herceptin, and some of the amazing results where tumors literally melt away. Those are the moments that stand out.

What plans do you have for retirement?

I’ll probably finish some plans I have to become a master gardener. We’re going to do some traveling, which we’ve not done before. I have seven grandkids, ages 4 to 16, so we’ll continue to be as busy as we can with them. I may do some things related to the medical field, so I’ll keep my license active, but the day-to-day responsibility for cancer patients is something I’ll put behind me.

Are there any other thoughts you’d like to share?

I’m really proud to have been active with Hoosier Cancer Research Network. I’m proud to be part of something that is self-sustaining that I think serves a very important role helping provide access to new care, new drugs, and new therapies for patients, but also provides an opportunity for physicians to learn, to be creative, and to interact on a collegial basis.

As I’ve traveled around the country to different meetings, HCRN is really unique. There have been several groups nationwide that have patterned themselves after what we do. And, you know, imitation is the sincerest form of flattery.

About Hoosier Cancer Research Network

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.