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An Interview Profile summarizes this individual’s role, specialization, and contributions to MD Anderson.

A Table of Contents shows the range of topics covered in each interview session: each chapter title links to a chapter summary.

Chapter Summaries describe the specific topics treated in each section; each summary links to the corresponding recording so you can listen to the chapter.

Here is a link to the full transcript so you may browse and search. (link)

 

 

 

 

Interview Profile

 

Submitted: 24 July 2017

Interview Information:

Two sessions: 10 February 2017, 16 February 2017
Total approximate duration:  Three hours, fifteen minutes
Interviewer: Tacey A. Rosolowski, Ph.D.

 

To supporting materials, please contact:

Javier Garza, MSIS, jjgarza@mdanderson.org

 

About the Interview Subject:

Dr. Buzdar (b. 1 January 1945, Nishtar, Pakistan) came to MD Anderson in 1974 as second-year Fellow in Medicine (Oncology).  He joined the faculty as a Faculty Associate in Medicine (Medical Breast Service), Department of Medicine the following year.  At the time of the interview, Dr. Buzdar is Professor of Medicine and Internist in the Department of Breast Medical Oncology in the Division of Cancer Medicine.  Since 2016 he has held the Edward Rotan Distinguished Professorship in Cancer Research.  Since 2010 he has served as Vice President, Clinical Research.

 

Major Topics Covered:

Personal background and education

Research: adjuvant treatments for breast cancer

Department of Breast Medical Oncology

MD Anderson research culture, evolution of

Office of Clinical Research: IRBs and regulatory oversight

Clinical Effectiveness Committee: MD Anderson algorithms of care

Electronic Medical Records 

 

About transcript and transcription

This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than conforming to written standards).

The interview subject has been given the opportunity to review the transcript and make changes: any substantial departures from the audio file are indicated with brackets [ ].

In addition, the Archives may have redacted portions of the transcript and audio file in compliance with HIPAA and/or interview subject requests.

The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.


Table of Contents

 

Interview Session One: 10 February 2017

 

A Family Tradition in Medicine; Attracted to the Medical Mentality
Chapter 01 / Educational Path

 

The Advantages of Moving to Texas and to MD Anderson
Chapter 02 / Joining MD Anderson/Coming to Texas

 

Undertaking Breast Cancer Research When the Field was Young
Chapter 03 / The Researcher

 

A Philosophy of Clinical Research (and Its Early Controversies)
Chapter 04 / Overview

 

IRBs and a Few Words about the Growth of Multi-disciplinary Care
Chapter 05 / Building the Institution

 

Research on Hormone-Dependent Breast Cancers  
Chapter 06 / The Researcher

 

VP of Clinical Research
Chapter 07 / An Institutional Unit

 

A Serious Accident and a Major Change in Perspective
Chapter 08 / Building the Institution

 

 

 

Interview Session Two: 

 

Early Research: Changing the Natural History of Breast Cancer
Chapter 09 / The Researcher

 

Research in Breast Medical Oncology: Pushing Against Medical Conservatism
Chapter 10 / MD Anderson History

 

Endocrine Treatments for Breast Cancer
Chapter 11 / The Researcher

 

The Evolution of Tumor Registries at MD Anderson
Chapter 12 / Building the Institution

 

Additional Research Studies: HER2/neu Breast Cancer; Taxanes
Chapter 13 / The Researcher

 

Research Nurses at MD Anderson
Chapter 14 / Building the Institution

 

Electronic Medical Records at MD Anderson, Yesterday and Today
Chapter 15 / Building the Institution

 

The New Committee on Drug Side Effects
Chapter 16 / Building the Institution

 

 


 

 

Chapter Summaries

 

 

Interview Session One: 10 February 2017 (listen/read)

 

Chapter 00A
Interview Identifier (listen/read)

 

Chapter 01 (Educational Path)
A Family Tradition in Medicine; Attracted to the Medical Mentality (listen/read)

 

 

Topics Covered

  • Personal Background
  • Inspirations to Practice Science/Medicine
  • Influences from People and Life Experiences

Dr. Buzdar begins this chapter by explaining that his father, who was in banking, wanted all his children to become physicians (and they did enter medicine).  He explains that the educational system in Pakistan was based on the British system, and he entered the science track in eighth grade.  He recounts inspiring scenes from science classes.  He also explains that his college and medical school experiences were unique, as he attended the 200 year old Nishtar Medical College, Multan, Pakistan [MB,BS, 1967], where he received a high quality education.  Dr. Buzdar notes his own qualities of curiosity, his intellectual interest in medicine, and his interest in “looking for things for tomorrow.”

 

Chapter 02 (Joining MD Anderson/Coming to Texas)
The Advantages of Moving to Texas and to MD Anderson (listen/read)

 

Topics Covered

  • The Researcher
  • Joining MD Anderson
  • Personal Background
  • Professional Path
  • Funny Stories

Dr. Buzdar begins by talking about how he came to leave New England (where his wife, Barbara, was very happy) and come to Houston.  He explains that there was an unexpected opening at MD Anderson, and called Dr. Schullenberger to follow up.

Dr. Buzdar then sketches his evolving research focus within the Breast Cancer Section.  He explains that, at the time, there was little that could be done for breast cancer patients as oncology was in its infancy.  He talks about the dramatic results achieved when he and Dr. Gabriel Hortobagyi [oral history interview] developed the 3-drug combination of 5-flourouracil, Adriamycin and cyclophosphamide for use in patients with metastatic breast cancer, resulting in cancers shrinking in 75% of patients.  The combination was then used for adjuvant therapy.

Dr. Buzdar talks about controversy over using aggressive chemo therapy with severe side effects, noting that the study was blocked by other disciplines when it came up for review in the IRB.

 

Chapter 03 (The Researcher)
Undertaking Breast Cancer Research When the Field was Young  (listen/read)

 

Topics Covered

  • The Researcher
  • Research
  • Discovery and Success
  • Healing, Hope, and the Promise of Research
  • Multi-disciplinary Approaches
  • MD Anderson Impact; MD Anderson Impact
  • Overview
  • Definitions, Explanations, Translations
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Obstacles, Challenges
  • Institutional Politics
  • Controversy
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care

In this chapter, Dr. Buzdar sketches his evolving research focus within the Breast Cancer Section.  He explains that, at the time, there was little that could be done for breast cancer patients as oncology was in its infancy.  He talks about the dramatic results achieved when he and Dr. Gabriel Hortobagyi [oral history interview] developed the 3-drug combination of 5-flourouracil, Adriamycin and cyclophosphamide for use in patients with metastatic breast cancer, resulting in cancers shrinking in 75% of patients.  The combination was then used for adjuvant therapy.

Dr. Buzdar talks about controversy over using aggressive chemo therapy with severe side effects, noting that the study was blocked by other disciplines when it came up for review in the IRB.

 

Chapter 04 (Overview)
A Philosophy of Clinical Research (and Its Early Controversies) (listen/read)

 

Topics Covered

  • The Researcher
  • Research
  • Discovery and Success
  • Healing, Hope, and the Promise of Research
  • MD Anderson Impact; MD Anderson Impact
  • Institutional Politics
  • Controversy
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Ethics
  • Research
  • Multi-disciplinary Approaches

Dr. Buzdar first sets his philosophy of clinical research in the context of his early work on aggressive chemotherapies.  He says that a principle investigator should always be honest with the patient.

[The recorder is paused.]

The “gold standard,” he says, is full information. 

[The recorder is paused.]

Dr. Buzdar notes that there was almost a “cult” attitude at the time that the best procedure was to push more drugs at higher doses, without evidence that this had an impact on outcomes.  He notes that he was chair of the institutional review board at the time.

He then notes that MD Anderson was the first institution to add taxanes to the FAC regimen, a combination that is still standard of care.

 

Chapter 05 (Building the Institution)
IRBs and a Few Words about the Growth of Multi-disciplinary Care (listen/read)

 

Topics Covered

  • The Researcher
  • Research
  • Overview
  • MD Anderson Impact; MD Anderson Impact
  • Institutional Processes
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Patients; Patients, Treatment, Survivors
  • Ethics
  • Understanding the Institution
  • Research

Dr. Buzdar begins this chapter with an explanation of why ethical review boards (the first IRBs) were established after the Second World War.  MD Anderson was in the forefront of the movement, and established the first ethics committee in 1966.  Dr. Buzdar served on the IRB for a decade.

Dr. Buzdar then talks about the power of the IRB, which operates as an independent and final authority in determining whether a protocol can proceed.  He gives an example of immunotherapy trials using CAR T cells [chimeric antigen receptor T cells], a treatment that has very serious side effects, leading in some cases to death.  Dr. Buzdar describes the unique (in the nation) initiative that MD Anderson has undertaken to monitor and treat these patients for side effects.  He notes the value of immunotherapy for patients who are resistant to every other known treatment.

Dr. Buzdar also explains that the immunotherapy protocols represent efforts in multidisciplinary care and research.  This, he says, is MD Anderson’s unique system.  He describes how multidisciplinary care works and how it gives rise to research.  This has also necessitated a move away from the traditional axiom, “do no harm,” he states.

 

Chapter 06 (The Researcher)
Research on Hormone-Dependent Breast Cancers (listen/read)

 

Topics Covered

  • The Researcher
  • Research
  • Multi-disciplinary Approaches
  • Overview;
  • Definitions, Explanations, Translations
  • Discovery and Success
  • Healing, Hope, and the Promise of Research
  • MD Anderson Impact; MD Anderson Impact
  • Controversy
  • Ethics
  • Research

In this chapter, Dr. Buzdar talks about his work on the effectiveness of anti-estrogens in shrinking cancers.  He led the research, he explains, on aromatase inhibitors that block estrogen production.  After skepticism, this work led to new therapies that became standard of care.

Dr. Buzdar talks about his collaboration with Dr. Gabriel Hortobagyi.  He notes that accepting the challenge of collaboration is an important first step in doing multidisciplinary research.

 

Chapter 07 (An Institutional Unit)
VP of Clinical Research (listen/read)

 

Topics Covered

  • Building/Transforming the Institution
  • MD Anderson History
  • MD Anderson Culture
  • Ethics
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Education; On Education
  • Overview
  • Definitions, Explanations, Translations
  • This is MD Anderson

In this chapter, Dr. Buzdar talks about his role as Vice President of Clinical Research, an office that oversees five IRBs.  He notes that in the mid-eighties, there was one IRB with a tiny office and one secretary; now he has three hundred people working under him. 

[The recorder is paused.]

He explains that the office has a dual role, to oversee clinical research and ensure compliance with federal regulations, and to educate faculty and personnel about regulations.

[The recorder is paused.]

Dr. Buzdar stresses that patients come to MD Anderson because of the innovative research conducted and to have access to clinical trials, and research remains a primary part of the institution’s mission.  He then offers examples of his Office’s role in preserving transparency in the process protocol approval process.  He notes that investigators are impatient to get their protocols underway, and the Office is involved in educating them about the complex processes that have to unfold in order for this to happen prior to and after approval (which involves many legal documents). 

 

Chapter 08 (Building the Institution)
The Clinical Effectiveness Committee and the MD Anderson Algorithms of Care (listen/read)

 

Topics Covered

  • Building/Transforming the Institution;
  • Multi-disciplinary Approaches
  • Growth and/or Change
  • Discovery and Success
  • Healing, Hope, and the Promise of Research;           
  • Patients; Patients, Treatment, Survivors
  • MD Anderson Impact; MD Anderson Impact

Dr. Buzdar chaired the Clinical Effectiveness Committee from 2007 to 2014, and in this chapter he talks about the committee’s role in “spelling out patient care.”

[The recorder is paused.]

The purpose of the Committee’s activities was and is to develop the MD Anderson approach for disease management from start to finish, for every disease site, based on evidence.  A primary downstream use of this information is to define the rationale behind care to insurance companies.  Dr. Buzdar explains that the algorithms were developed by disease center experts, who present their findings to the committee.  They are then approved as the institutional standard of care.

Dr. Buzdar notes that Medicare has used the MD Anderson model as a national standard.  There is also a series of publications based on the algorithms.  He explains that the Committee is still in existence and continues to develop and refine the algorithms in real time.  There are yearly reviews of all algorithms and there may be immediate reviews in response to a new study or treatment innovation.

 

Interview Session Two: 6 February 2017 (listen/read)
 

Chapter 00B
Interview Identifier (listen/read)

 

Chapter 09 (The Researcher)
Early Research: Changing the Natural History of Breast Cancer (listen/read)

 

Topics Covered

  • Discovery and Success
  • The Researcher
  • MD Anderson Impact; MD Anderson Impact
  • Devices, Drugs, Procedures
  • Multi-disciplinary Approaches
  • Controversy
  • Controversies
  • Research
  • Survivors, Survivorship; Patients, Treatment, Survivors
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Ethics

In this chapter, Dr. Buzdar talks about his first studies of combination chemotherapy that he conducted with Dr. Gabriel Hortobagyi and that successfully “changed the natural history of breast cancer.”  He discusses a first study of patients with recurring breast cancer in one or two places, noting that 25%-30% of the patients treated in the seventies are still alive today.  He explains that the success of the treatment meant that the research team never conducted a randomized trial.

He discusses the next study of combination chemotherapy given to patients with inflammatory carcinoma of the breast.  He explains how skeptical individuals were of the success of the trail, both within and outside the institution.  He talks about the controversy surrounding aggressive chemotherapeutic treatments.

 

Chapter 10 (MD Anderson History)
Research in Breast Medical Oncology: Pushing Against Medical Conservatism (listen/read)

 

Topics Covered

  • Discovery and Success
  • MD Anderson History
  • MD Anderson Snapshot
  • MD Anderson Culture
  • Multi-disciplinary Approaches;
  • Controversy
  • Research
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Portraits

Dr. Buzdar begins this chapter by describing the overall culture of medical conservatism he and others faced as they conducted studies with chemotherapy.  He talks about the innovations led by J Freireich and Emil Frei in the Department of Developmental Therapeutics, and that it took a while to convince others in the institution about the value of combination treatments and aggressive treatments.

Next, Dr. Buzdar sketches a picture of how small Breast Medical Oncology was when it began, occupying only a hallway with pull-down desks to write on.

Despite such small beginnings, he points out, MD Anderson research had great impact on the natural history of breast cancer; he cites the publication of a recent book on MD Anderson treatments for the disease.

Dr. Buzdar also cites the influence of R. Lee Clark on this research, noting that he instituted the policy of keeping comprehensive data on patients (following a patient to the end of his/her life, if possible).  He describes Dr. Clark as “down to earth” and tells a story about sleeping in Dr. Clark’s office.

 

Chapter 11 (The Researcher)
Endocrine Treatments for Breast Cancer (listen/read)

 

Topics Covered

  • Discovery and Success
  • MD Anderson History
  • MD Anderson Snapshot
  • MD Anderson Culture
  • Controversy
  • Research
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Technology and R&D

In this chapter, Dr. Buzdar talks about research that developed in the aftermath of the discovery of Tamoxifen and hormone dependent cancers.  He was the principle investigator on a national blinded study of the effectiveness of the aromatase inhibitor, anastrozole, which was eventually approved by the FDA and approved globally based on his work.

Next, Dr. Buzdar talks about the origin of research into the link between hormones and cancer.  He notes his collaboration with endocrinologist Dr. Najib Saaman. He explains the impact that advancing technology has had on the study of tissues.

 

Chapter 12 (Building the Institution)
The Evolution of Tumor Registries at MD Anderson (listen/read)

 

Topics Covered

  • Discovery and Success
  • MD Anderson History
  • Controversy
  • Research
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Technology and R&D
  • Institutional Processes
  • Devices, Drugs, Procedures
  • Building/Transforming the Institution

In this chapter, Dr. Buzdar explains how tumor registries have evolved at the institution.  Originally there were many registries associated with departments, but now there are two.  Dr. Buzdar participated in a group to advocate for an institutional bank which was activated on 31 January 2017.  He explains that all patients are now asked if they will donate tissue to the bank.  He talks about the “clear environment” conditions maintained at the registry and why this is important.  Another bank, in existence for two or three years, preserves samples of metastatic disease collected sequentially from a patient as the disease evolves.

Dr. Buzdar sketches the controversy around creating these institutional banks.  He also talks about the evolution of the methods for analyzing tissues and how they are subject to government regulations when used in research studies.  He also stresses that the primary purpose of the banks is patient care: to preserve tissue for use in treating the patient who donated the sample.

Dr. Buzdar gives some examples to illustrate how the tissue resources are used.  He also talks about the size of tumors and the size of samples preserved. 

 

Chapter 13 (The Researcher)
Additional Research Studies: HER2/neu Breast Cancer; Taxanes (listen/read)

 

Topics Covered

  • Discovery and Success
  • The Researcher
  • Research
  • Understanding Cancer, the History of Science, Cancer Research
  • The History of Health Care, Patient Care
  • Devices, Drugs, Procedures

Dr. Buzdar begins this chapter by talking about MD Anderson’s contributions in the 1990s to therapy for HER2/neu breast cancer.  He describes a trial with women with intact breast cancer, half of whom were given the best standard chemotherapy before surgery and half who were given the new anti-HER2/neu therapy.  He describes the dramatic result when surgeons discovered that the tumors had disappeared, even microscopic tumors, resulting in this drug’s approval as standard of care. 

Dr. Buzdar notes that the MD Anderson breast group has been on the forefront of research. He gives the example of Dr. David Hohn, who conducted the first studies of taxames in humans.  He describes the randomized trial that resulted in Taxol becoming standard of care.  He notes that now the challenge is to determine which patients will respond to which treatments.

 

Chapter 14 (Building the Institution)
Research Nurses at MD Anderson (listen/read)

 

Topics Covered

  • Discovery and Success
  • Building the Institution
  • MD Anderson History
  • Research
  • Education; On Education

Dr. Buzdar begins this chapter by noting how important transparency is when asking a patient to participate in clinical trials.  He then discusses a new, four-month training program for research nurses that was launched eight months previously (the first structured program for training research nurses).  He explains the special features of training for research nurses and their role in educating patients about clinical trials.  He sketches the history of research nurses at MD Anderson and notes that the new training program was created on the recommendation of a group of investigators.

 

Chapter 15 (Building the Institution)
Electronic Medical Records at MD Anderson, Yesterday and Today (listen/read)

 

Topics Covered

  • Building the Institution
  • MD Anderson History
  • Research
  • Devices, Drugs, Procedures
  • Multi-disciplinary Approaches
  • Patients; Patients, Treatment, Survivors
  • Technology and R&D

Dr. Buzdar begins this chapter by noting that, though MD Anderson was slow to update its electronic medical records system, it was an early adopter of the technology, developing a home-grown system, ClinicStation.  He sketches come of the issues involved with the new system, Epic, that was adopted to integrate all patient records and provide some additional features.  Dr. Buzdar gives the example of patient consent forms to participate in clinical trials: this is now fully electronic and to date fifty thousand patient consents for trials have been processed electronically.  He also explains that key elements of all the protocols in which a patient is involved is accessible through Epic.

Dr. Buzdar also explains that, at MD Anderson, each patient has always only had one medical record, not a separate set of records for ambulatory and inpatient care, as is the norm elsewhere.

 

Chapter 16 (Building the Institution)
The New Committee on Drug Side Effects (listen/read)

 

Topics Covered

  • Building the Institution
  • MD Anderson History
  • Research
  • Devices, Drugs, Procedures
  • Multi-disciplinary Approaches
  • Patients; Patients, Treatment, Survivors
  • Technology and R&D
  • Leadership
  • Discovery and Success
  • Building/Transforming the Institution
  • Multi-disciplinary Approaches

In this chapter, Dr. Buzdar explains the function of the Committee on Drug Side Effect, created six months previously, as a response to the serious [rapid and life-threatening] side effects possible with immunotherapy such as CAR T-cell therapy.  He explains the special procedures used to deliver care to these patients and the training that the teams receive to watch appropriately for signs of side effects.  He also explains that he and others are working with Informational Technology and Epic to put a red banner on these patients’ electronic medical records to alert all teams that they require special monitoring. 

Dr. Buzdar notes that all unexpected events are reported to his Office [Clinical Research].  The first immunotherapy side effect was “alarming” and he met with division heads to talk about how to manage and prevent these side effects.  They responded quickly to set up a system to manage these patients.

In the final minutes of the interview, Dr. Buzdar talks about retirement and the contributions he is pleased to have made to the institution.