Building on Our Strengths


William Evans, PharmD
“There are few places in the world where basic science and patient care
are as well integrated as they are at St. Jude. We have incredible people
and incredible support from the public, which give us the resources we
need to be like no other place—to try things that other places can’t try.”


Promise talks with Dr. William E. Evans, St. Jude director and CEO, about the hospital’s achievements and future direction.


You’ve worked at St. Jude for many years, beginning as a student. What have been some of the most significant changes?

It’s easy to say how much the campus and the organization have grown in size, but I think the most impressive aspects have been the quality of people we’ve been able to recruit and retain, the quality of the programs we’ve built, and the importance St. Jude has assumed on a global scale. In spite of our physical growth, we’ve worked hard to retain the feel of a relatively small place and our culture of compassion, collaboration, innovation and quality. People know each other; they work together: they interact and innovate. It was a major achievement that this did not change while we were growing. Sustaining these interactions and collaborations is why our productivity and creativity remain exceptional.


What sets St. Jude apart from other research institutions?

There are few places in the world where basic science and patient care are as well integrated as they are at St. Jude. We have incredible people and incredible support from the public, which give us the resources we need to be like no other place—to try things that other places can’t try. We place great importance on doctors and scientists knowing each other and working together. It’s an intrinsic part of our culture, and we design our facilities and infrastructure to facilitate this. For a scientist who’s working at that interface of patient care and research, there isn’t a better place to do that kind of work than here.

At most other academic medical centers, the biochemists, pharmacologists and geneticists are on one side of campus, and the hospital and doctors are on the other side of campus. Often, those groups rarely meet or intersect. Whereas at St. Jude, week in and week out, we focus on how we can integrate the scientists, doctors, patients and staff. This is one thing that attracted me to St. Jude in 1976 and a major reason, beyond our mission, that has kept me here for my entire career.


How does St. Jude foster that integration?

Dr. Don Pinkel, the first director at St. Jude, basically said, “We’re going to organize everything around the patient—so the science needs to connect to the patients, and the patients and doctors need to connect to the scientists.” In the last 20 years, the entire scientific community has moved toward that model, which is called translational research. St. Jude was doing this before these buzzwords were created.

We’ve continued to do things to make the interaction between doctors and scientists a natural one and to keep that small-institution feel. We often place laboratory research in the same building as patient care or clinics. In our newest building, for example, the proton therapy center, Surgery and the ICU are going to be in the same building as research labs. In that way, many of our buildings are a microcosm of the greater campus, which focuses on people working in collaboration. This also enriches the environment for those doing pure basic science that may be many steps removed from translation, because every day they see the ultimate benefactors of their fundamental discoveries, our patients.


How will St. Jude remain on the cutting edge of research going forward?

It has been interesting to see how much technology has evolved in the last decade—how that technology has accelerated science, changed the scale of research we can do, and accelerated the pace at which we can understand what causes childhood cancer and how better to treat it. It’s hard to imagine what things are going to be like in 10 years, because it’s moving so quickly. An organization has to move quickly while staying focused and remaining committed to quality. For St. Jude, it’s not just how fast we do it; it’s how well we do it. It’s not how big we are; it’s how much better we are at doing things. By keeping that attitude first and foremost, St. Jude will continue to be the best at what it does.


What is the future of genetics research?

Dr. William Evans with a St. Jude patient

Cracking the G-gnome
“There’s a little ceramic gnome on my desk, with a crack on his hat, which is emblazoned with the letter “G,” Evans says. “Brennan Simkins and his father, Turner, came into my office one day and gave it to me. They said, ‘Thanks for all the work you’re doing to crack the G-gnome.’ To me, that clever little memento is a reminder that our patients and families know about what we’re doing in the laboratories. They know how important it is to integrate the treatment with the science, and they understand the importance of our Pediatric Cancer Genome Project. It is patients and parents like these who constantly remind us of the importance of the work we’re doing and their partnership in this grand endeavor.”

Genetics research will continue to accelerate; sequencing DNA and other interrogations of DNA will become faster, less expensive and more robust. It is going to become increasingly automated. The real challenge is going to be interpreting the onslaught of data. We’re now generating data in days what used to take years to generate. The greatest power comes from integrating all of the different genomic technologies with our patient outcomes to understand what is driving childhood cancers and what is influencing treatment response. Our challenge is to translate the power of genomics into better treatment, and we are doing that. We are also harnessing these technologies in our gene therapy program, making remarkable advances against several genetic diseases, like hemophilia and immunodeficiencies.


What will it take to meet our goal of pushing childhood cancer survival rates to 90 percent in the next decade?

It is going to take new medications as well as new treatment strategies. But it’s not all going to be medications. Some of it is going to be immunotherapy and other biological therapies. It will be improved surgery; more targeted radiation therapy, such as proton therapy; and better support-ive care.

We will continue to use genetics as a diagnostic to personalize therapy based on the DNA in the cancer cells and also the normal DNA that children inherit from their parents. These differences affect how children respond to drugs and other treatments.

Discovering what happens in the genome to make a normal cell become a cancer cell is the path to finding better treatments and pushing overall cure rates for childhood cancers beyond 90 percent. It’s going to be a challenge, but we are already there in leukemia. There are still some cancers—some forms of brain tumors, some solid tumors—where overall cure rates are still around 50 percent. We need major advances and discoveries that will lead to new treatments, new drugs and new approaches. It’s going to happen, and St. Jude is going to lead the way.


What gives you the most inspiration for your work here?

I think the most inspiration comes from the patients and their treatments getting better—not only improvements in cure rates, but reducing the burdens of treatment. That’s why the work that goes on here is so important: We’re trying to tip the scale in favor of better success and less toxicity in treatment, to not only improve cure rates but enhance quality of life for childhood cancer survivors. That’s why treatment of all childhood cancers—even acute lymphoblastic leukemia, with its 90 percent cure rate—must be further improved.

The more we know about what causes these cancers and what determines response to treatment, the better chance we have of improving both cure rates and quality of life for children with cancer.

 

 


Abridged from Promise, Spring 2014

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