Two interview sessions: 16 September 2013, 16 October 2013
Total approximate duration: 3 hours 10 minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Medical oncologist Waun Ki Hong, MD (b. 13 August 1942, Cheung Pyung [near Seoul], Republic of Korea) came to MD Anderson in 1984 as a full professor to serve as Chief of the Section of Head and Neck Medical Oncology. Dr. Hong’s research has had a translational focus, beginning with his studies of Vitamin A derivatives and publication of the first demonstration that a chemical product could reverse the course of cancer. He specializes in head/neck and lung cancers, with research focus in the areas of molecular therapeutics, cancer prevention, organ preservation, and personalized targeted therapy.
Dr. Hong he chaired the Department of Thoracic/Head and Neck Medical Oncology from 1993 until August 2013. Since 2001 he has served as Head of the Division of Cancer Medicine.
Shortly after the completion of these interview sessions, he was named to the National Academy of Science.
Major Topics Covered:
Personal and educational background; military experience
Research: organ preservation (especially of the larynx), studies of leukoplakias, Vitamin A, chemoprevention, and personalized, targeted therapy; multi-disciplinary approaches to diseases of the aero-digestive system
Approaches to research design, team science, translational research
The Department of Thoracic and Head and Neck Medical Oncology: organization, fellowship program, creating an environment for excellence
The Division of Cancer Medicine
MD Anderson growth; the presidents
Leadership; leading teams, fostering collaboration
A note on transcription and the transcript:
This interview had been transcribed according to oral history best practices to preserve the conversational quality of spoken language (rather than editing it 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.
Interview Session One: 16 September 2013
Experiences of War and Emigration
Chapter 01 / Personal Background
Choosing to Specialize in Cancer Research and Treatment
Chapter 02 / Professional Path
New Fields and the Discovery of Vitamin A’s Role in Chemoprevention
Chapter 03 / The Researcher
Recruited by Irwin Krakoff; Research and Program-Development Skills
Chapter 04 / Joining MD Anderson/Coming to Texas
A Chemoprevention Study and Reflections on Research, Team Science, and Clinical Trials
Chapter 05 / The Researcher
Early Larynx Preservation and Current Work on Targeted Therapy
Chapter 06 / The Researcher
Interview Session Two: 16 October 2013
Bold Research: Opening the Field of Personalized Therapy
Chapter 07 / The Researcher
Administration: Focusing on Collaboration and Education
Chapter 08 / The Administrator
The Department of Thoracic and Head and Neck Medical Oncology: Reorganization; A New Fellowship Program
Chapter 09 / The Administrator
Head of the Division of Cancer Medicine
Chapter 10 / The Administrator
How Research Has Changed; the Future of the Division of Cancer Medicine
Chapter 11 / Overview
Administrative Roles; On the MD Anderson Presidents; Looking Ahead to Retirement
Chapter 12 / The Administrator
Interview Session One: 16 September 2013 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Personal Background)
Experiences of War and Emigration (listen/read)
In this Chapter , Dr. Hong talks about key experiences in his homeland of South Korea. He explains that in his family of seven children, his oldest brother became a prominent bio-scientist and served as his mentor and “a second father,” who went to the United States for his Ph.D. training, returning to inspire the young Waun Ki Hong.
[The recorder is pause for approximately 10 minutes.]
Dr. Hong next talks about the impact of living in a country where here experienced three wars: the Second World War, the Korean War, and the Vietnam War, during which he served in the Korean Air force as a flight surgeon. Seeing the devastation of war, he explains, instilled in him the spirit of service and collaboration. His military experience helped him establish his own sense of discipline and accountability, the capacity for team effort and respect for chains of command.
Dr. Hong explains that when his military service ended (in 1970), he came to the United States for an internship. He says that arriving as an immigrant was a challenge, but he is “an eccentric and doesn’t play it safe. He then explains why he was only able get an internship at a community hospital.
[The recorder is paused for about 11 minutes.]
Chapter 02 (Professional Path)
Choosing to Specialize in Cancer Research and Treatment (listen/read)
After explaining why his internship at Lebanon Hospital in New York was disappointing, Dr. Hong describes his move to the Veterans Affairs Hospital in Boston, Massachusetts. He talks about cross-cultural adjustments. He also explains that he saw many cancer patients in Boston and decided to work on smoking related cancer. He was, at the time, thinking about cancer treatment from a new perspective (which would create an entirely new field), as he was not approaching head and neck cancer as a surgeon. He describes his next move to Memorial Sloan-Kettering in New York, where he was part of a top fellowship program and met “good people,” among them Dr. Irwin Krakoff, who would later come to MD Anderson and serve a role in recruiting Dr. Hong for that institution. Dr. Hong next traces his move back to Boston, where he joined the faculty of the Veterans Affairs Hospital as an assistant professor (1975-1984). Dr. Hong was the only medical oncologist on staff, and he describes how he was able to prove himself able to build a medical oncology program. Dr. Hong also states that he was “lucky” because the drug Cisplatin had become available, and he was able to obtain and test the drug on head and neck patients –he was one of the first individuals to treat head and neck patients with chemotherapy and the first to demonstrate its effectiveness in preserving the larynx. He explains that the human motive of preserving patients’ ability to speak and swallow motivated him. Dr. Hong tells a story about his connection to George H.W. Bush.
Chapter 03 (Professional Path)
New Fields and the Discovery of Vitamin A’s Role in Chemoprevention (listen/read)
Dr. Hong first describes the trial that demonstrated chemo’s effectiveness for patients of head and neck cancer. (One group was given the standard treatment of surgery and radio therapy and the second treated with chemotherapy and radiation therapy.) Dr. Hong then explains the process by which academic medicine came to recognize medical oncology as a subspecialty. He then explains that many head and neck patients develop second cancers. He defines leukoplakias, the white patches or pre-cancerous lesions that appear in smokers. He explains that he learned about leukoplakias from head and neck surgeons and that these lesions are also associated with Vitamin A deficiencies, a connection that led him to use Vitamin A and its derivatives as chemoprevention agents. Dr. Hong describes the first trials in which patients with leukoplakias were treated with high dose retinoic acid (synthetic Vitamin A) vs. a placebo, yielding a sixty percent response in the former group. This demonstrated for the first time that a chemical treatment could reverse a cancer process. Dr. Hong explains the implications of this discovery as well as how retinoic acid works with cell mechanisms. He also notes that toxicity effects associated with high doses of retinoic acid.
Chapter 04 (Joining MD Anderson/Coming to Texas)
Recruited by Irwin Krakoff; Building Research Teams (listen/read)
Dr. Hong begins by describing how he became acquainted with Dr. Irwin Krakoff while he was in Boston. When Dr. Krakoff became head of the Division of Medicine at MD Anderson, he saw the institution’s need for head and neck medical oncology and recruited Dr. Hong. Dr. Hong explains that he had reached the limit of what he could do at the Boston Veterans Affairs Hospital, and that MD Anderson was the right place to advance the field by involving more basic and translational research. Dr. Hong describes MD Anderson in 1984 when he arrive collaborative and committed to patient care, with many resources and good faculty. He saw the need, however, to integrate biology and the basic sciences more fully into clinical care.
Dr. Hong next reflects on how he was able to build sophisticated research teams by reaching out to people. He notes that he was very effective at winning peer reviewed grants, and states that he advocates scientific research that asks bold questions.
Chapter 05 (The Researcher)
A Chemoprevention Study and Reflections on Research, Team Science, and Clinical Trials (listen/read)
Dr. Hong begins by discussing the first project he undertook after coming to MD Anderson –a study of the biology and chemoprevention of head and neck cancer funded by an NCI Program Project R01 grant. This was a fifteen-year project of almost twenty million dollars that clarified the genetic processes of head and neck pre-cancers and cancers.
Dr. Hong summarizes the personal qualities he has drawn on to create his research projects: talent, passion, and curiosity. He notes that his research areas –organ preservation, chemoprevention, and personalized, targeted therapy—are all difficult areas that present obstacles. He stresses the importance of supportive collaborators, funds, and posing “bold, impactful questions.” He notes that complex studies take time to unfold and require patience, stubborness, and the ability to encourage and sustain the energy of collaborators.
Dr. Hong notes that to open up a field, a researcher must do something new. He recalls a joke: If you are too smart, you can’t do research, and notes the importance of knowing how to articulate good questions. He touches on the challenge of clinical trials and gives an example of the time frames involved in getting clinical results.
Dr. Hong explains that collaborations with talented colleagues are only successful if one shares common goals and recognizes individual contributions. He also stresses the importance of sharing resources and credit to build trust with collaborators. Dr. Hong then makes a few comments on the increase in team science since the 1980s.
Chapter 06 (The Researcher)
Early Larynx Preservation and Current Work on Targeted Therapy (listen/read)
Dr. Hong begins with a story of his uphill battle to initiate a pilot study of larynx preservation in the 1980s. The project was eventually funded by the VA Cooperative Studies Program [certificate mentioned]. The results of the landmark study were published in the New England Journal of Medicine in 1998. Next he talks about the BATTLE Project (Biomarker Based Approaches of Targeted Therapy for Lung Cancer Elimination Project (BATTLE –funded by Defense Dept.). With this study he has moved into personalized treatments based on genetic studies that address multiple pathways leading to many different molecular subtypes of cancer. He talks about the challenges this landmark study presents. [There is a brief interruption near the end of this session.]
Interview Identifier (listen/read)
Chapter 07 (The Researcher)
Bold Research: Opening the Field of Personalized Therapy (listen/read)
[Note: At the beginning of this Chapter Dr. Hong refers to “my file”: this is a PowerPoint presentation that is available as a supplement to this interview.]
In response to a question about his strategy of asking “bold” research questions, Dr. Hong speaks in detail about his third area of bold research –personalized, targeted therapy. He defines personalized therapy and returns to a discussion of the BATTLE trials discussed in Chapter 7 (Biomarker Based Approaches of Targeted Therapy for Lung Cancer Elimination Project). Dr. Hong describes the trials’ central hypothesis: by acquiring genetic information about a tumor, one can identify what drives the cancer and then hijack it, therefore blocking cancer. He notes that colleagues were very skeptical when he developed the study, but the published results opened up the new field of personalized therapy at an institutional, national, and global level. Dr. Hong notes that he takes a lot of pride in taking this approach from an idea to a force that galvanized an entire field. He believes that this approach can make an impact on cancer science and treatment of cancer at all stages of the disease.
Dr. Hong then notes that as the Institute for Personalized Therapy was being founded, the results of the BATTLE trial gave confirmation that the approach was sound. Dr. Hong explains that personalized therapy requires a different paradigm of treatment and new research modalities based in genomic medicine and he then gives reasons why people were skeptical of the approach at first. He also notes that this approach is fundamentally multi-disciplinary and lists the disciplines that collaborate.
Dr. Hong next speaks briefly about team science –an approach essential to personalized, targeted therapy. He then lists his contributions to cancer science.
Chapter 08 (The Administrator)
Administration: Focusing on Collaboration and Education (listen/read)
Dr. Hong notes that he came to MD Anderson in 1984 to capitalize on research opportunities, but discovered that research was not as collaborative nor as transitionally based as he had expected. He was one of the first researchers to actively reach out to people and also to develop the program projects. In his administrative roles, he actively developed a culture of collaboration: the successes he had with research designed in this way insured that “collaboration was contagious,” with people following the research template he designed.
Dr. Hong also explains that education was also part of the developing culture of collaboration. He names some fellows who have gone on to important leadership positions in the field. He also lists important collaborators with his own projects.
Chapter 09 (The Administrator)
The Department of Thoracic and Head and Neck Medical Oncology: Reorganization; A New Fellowship Program (listen/read)
Dr. Hong explains the reorganization that integrated the sections of Head and Neck Medical Oncology and Thoracic into a single Department. Dr. Hong headed the section of Head and Neck from ’84 – ’93. Thoracic was included in that section in ’87. The section became a department in ’94 and Dr. Hong was chair until 2001. He explains that he was brought in to head the Section of Head and Neck because of his work on lung and head and neck cancers. Since these were specific to aero-digestive cancers, it made sense to bring in Thoracic. Dr. Hong explains that he developed clinical and research programs. He specifies the links between that integrated these specialties, making it clear that they should be identified as a single unit. (He acknowledges that some physicians still have reservations about sharing their patients, even at MD Anderson.) Trans-disciplinary research depends on a culture of collaboration, which also attracts younger researchers. He notes that the Department of Thoracic and Head and Neck Medical Oncology has been particularly effective at stimulating research. He lists the awards program begun six or seven years ago. Awards to faculty, instructors, fellows, and staff are listed in the annual reports.
Dr. Hong also talks about the Department’s Fellowship program designed to cultivate more young medical oncology researchers. Dr. Hong himself created the Advanced Scholar Program that allows a fellow to extend his or her fellowship period for one year to focus completely on research. He explains why this period is so important for a researcher’s maturation. Dr. Hong also talks about the time, mentorship, and support that physician-scientists need to be successful.
Chapter 10 (The Administrator)
Head of the Division of Cancer Medicine (listen/read)
Dr. Hong explains that he had no real interest in heading the Division of Cancer Medicine, but he was drafted into the role by the Department chairs (after an external search produced no viable candidates), and their choice was approved by Dr. John Mendelsohn. He took the job out of a sense of obligation to the institution (and took it without an increase in pay). The position allowed him additional opportunities for impact and Dr. Hong explains his commitment to helping departments in the Divison build their team research program. He talks about the process of achieving aligned action among seventeen departments and lists some of the key players in implementing his programs. Dr. Hong next list his accomplishments in the Division: improved quality of the faculty; increased transparency among the departments; raising the bar for research; improved patient care; building the fellowship program; the creation of the Advanced Scholar Program.
Chapter 11 (Overview)
How Research Has Changed; the Future of the Division of Cancer Medicine (listen/read)
Dr. Hong next comments on how the environment and requirements for conducting research have changed, creating “an unprecedented time for translational research.” He observes that one must be opportunistic to survive in the current research landscape. He sees his role as one of inspiring the faculty to open up to the new era of science and research. Dr. Hong then observes that faculty need access to resources to implement their research. With grant monies shrinking, competition is keen, though the NCI and NIH are both encouraging multi-investigator studies more now than in the past.
Dr. Hong observes that he is nearing retirement and he looks ahead to what is next for the Division of Cancer Medicine. The Division needs a person with passion and great intellectual capacity, he says.
Dr. Hong notes that he continues with his work on chemoprevention and personalized therapy. He uses a football metaphor to explain how he sees his research accomplishments: “I don’t want to take the credit,” he says. “I brought the ball to the 50-yard line.”
Chapter 12 (The Administrator)
Administrative Roles; On the MD Anderson Presidents; Looking Ahead to Retirement (listen/read)
Dr. Hong explains how he came to serve the role of Vice Provost for Clinical Research, overseeing the institution’s research and laying ground rules for working with patients. Clinical research is “very complicated and requires meticulous attention and rigorous conduct,” he observes. He reviews the range of challenges clinical trials present and also describes the lessons he learned by serving as Vice Provost. Most importantly, he became aware of how much the faculty struggles to conduct research, and his new knowledge of this influenced recommendations he made to the executive administration.
Next he offers his views on the presidents of MD Anderson. He speaks about Dr. Charles LeMaistre’s role in opening up cancer prevention. Dr. John Mendelsohn was more translational in approach: Dr. Hong notes the similarity in their approaches and backgrounds. (He quips that they play tennis together.) Dr. Hong observes that Dr. Ronald DePinho is a brilliant scientist with vision who fits the institution perfectly. He also notes that Dr. Margaret Kripke was another key leader who understand science and translational research.
Dr. Hong next discusses his role as presidential appointee (under George W. Bush) to the National Cancer Advisory Board (NCAB), a board that reviews research and makes recommendations on allocating funds. He explains process of reviewing proposals (and appeals of rejections). Dr. Hong observes that funding has been flat in the past years and he talks about the impact of this reduction of resources on research. He expresses concern that “America has been powerful and successful because of the substantial funding of research,” but this is no longer the case.
Dr. Hong briefly talks about his work with Chinese cancer institutions while he was President of the American Association for Cancer Research. In 2001 he created a travel fund to bring Chinese researchers to meetings.
Dr. Hong briefly speaks about his retirement plans. He anticipates that he will work with Dr. John Mendelsohn at the Institute for Personalized Therapy.