Four interview sessions: 20 March 2014, 7 May 2014, 18 June 2014, 7 July 2014
Total approximate duration: six hours and five minutes
Interviewer: Tacey A. Rosolowski, Ph.D.
For a CV, biosketch, and other support materials, contact:
Javier Garza, Archivist, Research Medical Library
About the Interview Subject:
Dr. Wai-Kwan Alfred Yung, M.D (b. 8 April 1948, Hong Kong) joined MD Anderson in 1981 as an Assistant Professor in the Neuro-Oncology Section. Dr. Yung established his reputation with work on chromosomal heterogeneity in tumors and its effect on drug sensitivity, shifting to translational studies looking at the role of epidermal growth factors in determining drug effectiveness.He has served as Chair of that Department since 1999. He also serves as Co-Director (of the Brain Tumor Center. He holds the Margaret & Ben Love Chair in Clinical Cancer in Honor of Dr. Charles A. LeMaistre.
Major Topics Covered:
Personal and educational background; faith; challenges of intercultural assimilation
Evolution of research on glioblastom from study of chromosomal patterns to investigation of genes and genetic/molecular mechanisms
Research design for difficult cancers
History of Neuro-Oncology services and research at MD Anderson
History of the Department of Neuro-Oncology
The Brain Tumor Center: collaborative relationships and shared resources with Neuro-Oncology, Neuro-Surgery, Neuro-Pathology, neuro-imaging and other support fields
Change at MD Anderson under three MD Anderson presidents
The Moon Shots
Building organizations and collaborations for glioblastoma research
Experiences as a cancer patient and impact on professional life
About 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: 20 March 2014
Education and Family in Hong Kong
Segment 01 / Personal Background
Medical Education and Laboratory Research Solidifies an Interest in Molecular Analysis
Segment 02 / Educational Path
Developing a Brain Tumor Clinic at MD Anderson
Segment 03 / Building the Institution
A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties
Segment 04 / Institutional Change
Interview Session Two: 7 May 2014
Stepping Down as Chair of Neuro-Oncology
Segment 05 / The Administrator
Looking at Chromosomal Patterns in Brain Tumors; Chromosomal Heterogeneity, Chemo-Sensitivity, and EGFR
Segment 06 / The Researcher
Research Pathways and Research Issues that Emerge from EGFR Work
Segment 07 / The Researcher
Brain Tumor Research: Translational Studies in Progress and the NCI Study Section
Segment 08 / The Researcher
Interview Session Three: 18 June 2014
Creating a New Department of Neuro-Oncology in 1983
Segment 10 / Building the Institution
Creating Networks for Clinical Trials
Segment 11 / The Researcher
Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery
Segment 12 / Building the Institution
Interview Session Four: 7 July 2014
Focusing on Work, Faith, and Hope During Cancer Treatment
Segment 13 / The Patient
Building the Advanced Practice Nurse Program
Segment 14 / The Administrator
The Collaborative Ependymoma Research Network (CERN); Funding Research
Segment 15 / Professional Service beyond MD Anderson
The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee
Segment 17 / Professional Service beyond MD Anderson
Key Periods of Change at MD Anderson
Segment 18 / Institutional Change
Stepping Down as Chair; Accomplishments in Perspective; A Sunday School Teacher
Segment 19 / View on Career and Accomplishments
Interview Session One: 20 March 2014 (listen/read)
Interview Identifier (listen/read)
Segment 01 (Personal Background)
Education and Family in Hong Kong (listen/read)
Dr. Yung talks about his family background, education, and the challenges of growing up in Hong Kong during the recovery period in the aftermath of World War II.
He first explains that his parents came to Hong Kong from China during the War. He describes the family’s financial situation and the strong work ethic he gained by working in his father’s business.
Dr. Yung explains the educational system in Hong Kong. He talks about the origin and growth of his faith. He talks about meeting his wife, Susie Yung, in high school.
Dr. Yung next recounts his early educational experiences under the British style, “pyramid” system education in Hong Kong and notes his transfer from a community school to the Jesuit-run Wah Yen College, a “vigorous” and well-funded school where all the teaching was in English. He notes that he became interested in medicine while he was in high school. Dr. Yung recounts how he came to the United States for college.
Segment 02 (Educational Path)
Medical Education and Laboratory Research Solidifies an Interest in Molecular Analysis (listen/read)
In this segment, Dr. Yung talks about his college and medical education and his interest in working at MD Anderson.
He begins with his arrival in the United States to attend college at the University of Minnesota (f 1968), a “defining moment” in his life, because of the culture shock.
Dr. Yung notes that he began as a sophomore and that his research career began during his undergraduate years as he worked on a project that gave him an interested in cancer: he quantified radiation damage to tissue with different types of radiation.
Next, Dr. Yung talks about how his decision to focus on neurology and attend medical school at the University of Chicago, where he kept working on his own research. He talks about his residency and his fellowship at Memorial Sloan Kettering, where he framed his primary research interests: “How do we go from chromosome analysis to molecular analysis?”
Segment 03 (Building the Institution)
Developing a Brain Tumor Clinic at MD Anderson (listen/read)
In this segment, Dr. Yung talks about his first impressions of MD Anderson and his early efforts to develop the neurology offerings at the institution.
He begins by explaining his decision to come to MD Anderson (in 1981) after his fellowship at Memorial Sloan-Kettering. MD Anderson contacted him because the institution needed a neurologist to handle neuro consults. Dr. Yung describes the neurological complications that he would see normally see during consults and explains why he wanted to start the first designated brain tumor clinic at MD Anderson to treat complications and offer but care for primary tumors.
Dr. Yung notes that he wanted to continue his research at MD Anderson. He established his laboratory at the Medical School, but relocated to MD Anderson in 1983.
Segment 04 (Institutional Change)
A Reputation For Experimentation and the Impact of Shifting to a Division System in the Eighties (listen/read)
Dr. Yung connects MD Anderson’s reputation for radical research in the 1980s to the move to reorganize the institution by Divisions in order to foster collaboration.
He sets context by noting that MD Anderson struggled with a reputation for experimenting on people as well as with limits imposed on its growth.
Dr. Yung explains how in 1982 the second president, Dr. Charles LeMaistre, reorganized the institution according to a division system to foster collaboration between departments and services and created a more systematic environment for promoting clinical research. The division system also fostered a more systematic approach to patient care and more structure in services by focusing on disease type.
Dr. Yung next explains that, with that administrative reorganization, many new faculty were hired to provide a platform to enhance the quality of research and research driven patient care.
Segment 05 (The Administrator)
Stepping Down as Chair of Neuro-Oncology (listen/read)
The recorder is started during a conversation in progress. Dr. Yung offers brief comments on his decision to step down as Chair of Neuro-oncology. (He stepped into the role as interim chair in 1999 and became permanent chair in 2002.)
Interview Identifier (listen/read)
Segment 06 (The Researcher)
Looking at Chromosomal Patterns in Brain Tumors; Chromosomal Heterogeneity, Chemo-Sensitivity, and EGFR (listen/read)
Dr. Yung discusses the evolution of his research, beginning with work on chromosomal patterns at Memorial Sloan-Kettering in the late 70s. He sets this work in the context of the science at that time and its development into the entirely new field of genomic medicine.
Next he explains the evolution of his work to include epidermal growth factor receptors (EPGR) and their importance in cells, discussing connections to work of other MD Anderson faculty. He describes the relationship of the gene to kinase and EGFR functions.
He then talks about his shift into translational research since 1997. Dr. Yung then sketches the history of translational research at MD Anderson, noting that in the Eighties and Nineties, the institution became a forerunner in applying translational research to clinical questions.
Segment 07 (The Researcher)
Research Pathways and Research Issues that Emerge from EGFR Work (listen/read)
In this segment, Dr. Yung talks about the research paths that evolved from his work on EGFR, though he has been unsuccessful so far in discovering how to render glioblastoma sensitive to the receptor. He goes on to describe the lines of research that have opened up and also discusses controversies that have arisen around the issue of sequencing the cancer genome. He notes that MD Anderson is one of the suppliers of tissue to The Cancer Genome Atlas project –and he is involved in this. Dr. Yung also explains how the body of knowledge growing from this project and the International Cancer Genome Continuum has influenced how researchers look at tumors.
Dr. Yung explains that the fundamental question is Can we understand the evolution of a tumor? He notes the special technical and ethical difficulties that arise with examining brain tumors.
Segment 08 (The Researcher)
Brain Tumor Research: Translational Studies in Progress and the NCI Study Section (listen/read)
In this segment, Dr. Yung sketches his other research activities on glioblastoma. He first talks about his activities with the NCI and other groups focused on developing clinical, translational studies of brain cancer. He talks about the challenges of setting up such studies.
Dr. Yung next talks about his clinical trials with the drug, BKM 120. He explains how this study also demonstrates the difficultly of attracting attention to a “small cancer” and how MD Anderson can partner with drug companies.
Segment 09 (The Researcher)
The Challenges of Glioblastoma; MD Anderson’s Moon Shot Program; No Low-Hanging Fruit for Neuro-Oncology Research (listen/read)
Dr. Yung explains the challenges that glioblastoma presents to the researcher then sketches the work he is doing to build collaboration among the brain tumor community. He notes that Dr. Charles A. LeMaistre [Oral History Interview] started the Brain Tumor Group, now the largest in the country and the world.
Dr. Yung next talks about MD Anderson’s Moon Shots Program, now expanding to include more than the six cancers. He talks about the structure of the Moon Shots program and evaluates the lessons learned from its early years. He notes the aim of the Program to focus on “low hanging fruit” that can lead quickly to treatment advances, and explains that there are no such quick remedies on the horizon for treating glioblastoma.
Interview Identifier (listen/read)
Segment 10 (Building the Institution)
Creating a New Department of Neuro-Oncology in 1983 (listen/read)
In this segment, Dr. Yung tells the history of the Neuro-oncology Department from 1983 to 1988. The Department was formed around the same time as the structural reorganization of MD Anderson according to a division system. Dr. Yung talks about the autonomy that the Department was given within this new system. He notes the functions of the new Department: provide neuro consults, manage the Brain Tumor Clinic and Pain Management Section, and provide psychiatry services. Dr. Yung notes that his vision from the beginning was to build brain tumor research. He talks about milestones: the creation of the Brain Tumor Clinic, then the Fellowship Program, and the Department’s growing patient load and reputation.
Dr. Yung then explains that he and others created joint meetings and rounds cutting across departmental and division boundaries. He also explains that he took advantage of this collaboration to work with the NCI’s Cancer Therapy Evaluation Program to develop clinical trials. Members of the Department joined the Brain Tumor Committee within the Radiation Therapy Oncology Group.
Segment 11 (The Researcher)
Creating Networks for Clinical Trials (listen/read)
Dr. Yung begins this segment by observing that, in 1988, the new Department had expanded and Dr. Field was ready to retire. Dr. LeMaistre wanted to expand neuro services and recruited Dr. Leaven to chair Neuro-Oncology and provided him with a large package to expand the research and clinical operations.
Dr. Yung notes that he was still continuing to run his own research. He also took advantage of the NCI’s desire to stimulate brain tumor research and he created a network of institutions for running Phase I clinical trials. He describes what he did to create the consortia under NCI guidelines and the lessons learned as the networks were reorganized. Dr. Yung observes that this project resulted in the NCI adding pediatric brain tumors to clinical trials. He explains that brain tumors are the second most common cancers in children. He also provides an overview of the limited array of drugs available for treating brain cancers, with focus now moving from cytotoxic agents to targeted therapies and immunotherapies. He notes that as the Department grew, there were more opportunities to take advantage of patient philanthropy to support research.
Segment 12 (Building the Institution)
Becoming Chair of Neuro-Oncology and Developing Collaborations with Neuro-Surgery (listen/read)
Dr. Yung explains that in 1990, Neuro-Surgery became a department and Dr. Raymond Sawaya [Oral History Interview] was recruited to head it. He describes the period of expansion that began for both departments at that time. Dr. Yung gives examples of research in Neuro-Oncology and their ties to the institution’s status as a comprehensive cancer center.
Dr. Yung explains Dr. John Mendelsohn’s [Oral History Interview] continued support the combined activities of Neuro-Oncology and Neuro-Surgery, known as the Brain Tumor Program. He stresses that he and Dr. Sawaya shared a commitment to building multi-disciplinary research and care initiatives and he describes the “blessing” for this group that faculty work well together.
Next, Dr. Yung talks about his cancer diagnosis and treatment, and his decision to accept Dr. Mendelsohn’s request that he take on the role as ad interim chair. He describes his goals at the time and his continued commitment to work with Neurosurgery and related fields to develop a cohesive program in patient care and research. He talks about collaborative projects, including development of an oncolytic virus –a rare example of a successful brain tumor drug.
Interview Identifier (listen/read)
Segment 13 (The Patient)
Focusing on Work, Faith, and Hope During Cancer Treatment (listen/read)
In this segment, Dr. Yung talks about his experiences as a patient after his 1999 diagnosis with a rare bladder cancer.
He sketches the medical dimensions of the disease, the slow process of diagnosing it, and his choice to have chemotherapy followed by radical surgery. He talks about his faith and his choice to have treatment at MD Anderson and have a true patient experience, not special treatment for an MD or VIP. Dr. Yung observes that his patient experiences have made him a better caregiver and advisor to the department when changes to the clinics and care deliver are planned.
Dr. Yung talks about the different ways patients cope with a cancer diagnosis. He notes the special case of brain cancer patients, who lose cognitive function and their independence. Dr. Yung says that he advises patients that accepting their diagnosis early will help them avoid depression and other complications.
Dr. Yung notes that he took on the Chairmanship of the Department of Neuro-oncology during his treatment. He felt he had been given extra time to use for his department. He lists the projects he wanted to push forward.
Segment 14 (The Administrator)
Building the Advanced Practice Nurse Program (listen/read)
In this segment, Dr. Yung talks about the expansion of the Advanced Practice Nurse program once he became department chair. He first notes how important support staff are to extending clinical care and then explains why he elected to expand APNs in particular. Dr. Young says that most institutions do not have the rich resource of nurses that MD Anderson has: research nurses, APNs, clinic nurses, and in-patient nurses. He sketches the roles that the APN services in assisting patients’ caregivers and building quality of life for patients.
Segment 15 (Professional Service beyond MD Anderson)
The Collaborative Ependymoma Research Network (CERN); Funding Research (listen/read)
Dr. Yung describes his efforts to support research into the rare cancer, ependymoma and talks about the challenges of funding innovative research in a time of fiscal conservatism.
He begins by giving an overview of the four types of brain cancers then recounts how the Collaborative Ependymoma Research Network (CERN) and now serves as model for using private funds to fund research.
Next Dr. Yung offers his perspective on the conservatism of government funding of research versus private systems that can take risks. Innovative clinical trials require collaboration of government, the drug industry, and private foundations. Dr. Yung then describes a plan now being implemented to bring these forces together to look at the molecular characteristics of different types of glioblastoma to determine which drugs might target them, sharing the financial risk of running the trials. He notes that this approach has some features in common with MD Anderson’s Moon Shots Program.
Segment 16 (Building the Institution)
MD Anderson’s “Horizonally-Organized” Brain Tumor Center (listen/read)
In this segment, Dr. Yung focuses on the Brain Tumor Center, created via the working relationships and shared resources that link sixty members from Neur-oncology, Neuro-surgery, Imaging, Neuro-pathology and other services. Dr. Yung explains that these working relationships enable neuro-focused members to get individual and multi-investigator funding, and that the SPORE grant is “a triumph of the Brain Tumor Center.”
Dr. Yung next comments on the difficulties of formalizing the Brain Tumor Center as a self-contained unit within MD Anderson. (This discussion refers to the fact that the head of Neuro-Surgery, Dr. Raymond Sawaya, is an advocate of such independent status. Dr. Sawaya discusses this at length in his oral history interview.) Dr. Yung cites the enormous cost of running an independent Center, given the expense of the technology required.
Dr. Yung says that the Brain Tumor Center will enter a new phase when a new chairman of Neuro-Oncology replaces him. He also feels that the Center currently offers a solid platform to expand immunotherapy with a new emphasis on T-cell function.
Segment 17 (Professional Service beyond MD Anderson)
The Defeat Glioblastoma Initiative and the NCI Brain Malignancy Steering Committee (listen/read)
Dr. Yung first describes the The Defeat Glioblastoma Initiative, an inter-institutional collaboration he has established between UCSD, UCLA, Memorial Sloan-Kettering Cancer Center, and MD Anderson to address glioblastoma. He notes that the Initiative is poised to expand and add international collaborators.
Dr. Yung next describes his service on the NCI Brain Malignancy Steering Committee, set up in 2001 response to the request from National Institute of Medicine to provide more review of applications for research funds. The aim is to identify high-value concepts, prevent duplication of efforts, and create collaborations. Dr. Yung explains that this committee’s role reflects the new reality of team science and limited resources.
Dr. Yung then comments on the challenges of creating collaborations between scientists who originally thought they would run projects independently.
Segment 18 (Institutional Change)
Key Periods of Change at MD Anderson (listen/read)
Dr. Yung offers his perspectives on periods when MD Anderson has undergone large changes.
He first discusses Dr. Charles LeMaistre’s role in handling the HMO crisis in the early nineties. He next talks about Dr. John Mendelsohn’s in setting the institution on “an upswing” of growth and corporatization. He describes how hard it is to manage growth so the institution remains true to its mission of delivering research-driven care, rather than deviating and increasing patient care to generate income to sustain the institution. He notes the pressure and debates that come each year with requests to see more patients, cut back on expenses.
Dr. Yung then talks about Dr. Ronald DePinho, who came in “with a good heart and an insightful” view of how to elevate MD Anderson to a position of making an impact on specific cancers. He explains that Dr. DePinho has brought in necessary change, notable addressing complacency and a lack of productivity among the faculty. He says that Dr. DePinho has yet to address the need for investment in infrastructure for clinical research.
Segment 19 (View on Career and Accomplishments;)
Stepping Down as Chair; Accomplishments in Perspective; A Sunday School Teacher (listen/read)
Dr. Yung begins this segment by sketching the activities he will focus on after stepping down as chair. He next says that he is gratified to see how the Department has grown under his leadership, particularly in the areas of research and psychiatry. He talks about initiatives that have not advanced sufficiently, notable training of physician-scientists and providing a culture for their success. He shares what he would like the department to achieve in the next ten years, notably advances in brain metastasis.
Finally, Dr. Yung talks about teaching adult “Sunday school” classes at his church, where he trains the next generation of church leaders. Dr. Yung says that his own faith enters into his work with patients, whom he encourages to have hope.