Giulio F. Draetta, M.D., Ph.D., director of the Institute For Applied Cancer Science and co-leader of the Moon Shots program at The University Of Texas MD Anderson Cancer Center, sat down with William F. McKeon, executive vice president and chief strategy and operating officer of the Texas Medical Center, to discuss his dynamic career and how the Moon Shots program hopes to accelerate rapid development of new research and treatment protocols for some of the most devastating cancers.
Q | What part of Italy are you from?
A | I was born in Naples and lived there until I was 27. I am the eldest of three brothers, and I am the only one who entered a career in the sciences. My middle brother was a hospital administrator and my youngest brother is a violinist. We are very different—we all went in very different directions.
Q | When did you discover your passion for the sciences?
A | It wasn’t early on. In middle school, I excelled in English and Italian literature and Latin. I think it was during my third year of high school that I had this fantastic chemistry professor who really made me think twice about my original plan to attend medical school.
She was an amazing role model who got students excited about chemistry and biochemistry, and she made me consider becoming a chemist instead of a physician. Ultimately, I found a renewed passion for medical school and was considering psychiatry.
I explored a number of options and opportunities while I was in medical school. In Italy, at the time, you could really build your own curriculum, so I was adding classes in neurophysiology and related sciences and psychiatry and so on. Somewhere in my studies, I enrolled in courses in biochemistry and cell biology. These classes in particular had amazing, dynamic professors, and I really loved the coursework, and it piqued my interest in bench research.
I was fortunate to be given an internship in a laboratory to explore this idea of being a research scientist more in depth. At the time, it was possible to continue your medical studies while working in a lab, and I considered this opportunity such a privilege that I stayed on until I completed my medical degree and clinical training in emergency medicine.
After I completed my residency, I decided to come to the United States to sort out where I wanted to go with my career, working as a Fogarty Fellow at the National Institutes of Health (NIH). One of my mentors in medical school had trained at the NIH, and he had been very encouraging about what an interesting time it was because there were many physicians and physician-scientists who had gone there to avoid the draft for Vietnam. This influx of M.D.s, who were choosing civil service as research scientists, were doing pioneering work and really pushing the medical sciences to new horizons. The opportunities I found here cemented my decision to apply my medical training to the sciences and focus on medical research.
Q | How was the transition from Italy to the United States, culturally speaking? Were there challenges after being trained in Italy and then moving directly to the NIH?
A | Well, I was somewhat surprised to come here and realize that my studies in British English had not quite prepared me to speak ‘American,’ but I was able to come up to speed with regard to the language quickly. More than feeling challenged by the transition, I would say I actually felt more overwhelmed, but in a very positive way. It was incredible for me to see how welcoming this nation was. In fact, this has been my impression throughout my career: how welcoming the country, and in particular the scientific community, is of foreign nationals from every corner of the globe. Religion, accent, culture—they are all welcomed and embraced. The international presence and integration in this country and in our scientific communities is such a striking contrast to what is going on right now in other parts of the world, and it’s something I have always respected about the U.S. Just in my little lab at the NIH, I shared a bay with a scientist from New Zealand, one from France, an American, and me from Italy—it was a very exciting atmosphere.
Another astonishing aspect of moving to the U.S., for me, was the immense resources of the NIH. You really felt the obligation to do something impactful because you had no excuses to not do well. And then the culture, the environment at that time, was such that there were Nobel Prize winners just walking around campus. From that standpoint, it was actually rather overpowering, but inspiring at the same time.
Q | You have had a very unique career path that has traversed both industry and academia.
A | Yes, after spending my first eight years in the United States, I decided to accept an offer in Heidelberg, Germany, at a very prestigious center, the European Microbiology Laboratory. My family and I stayed there for about four years. Toward the end of the third year I went to London to give a talk, and my former advisor from a laboratory in New York was also there. He mentioned that he’d been approached by a venture capital group about the idea of starting a company. I had no idea what the company would be, but I was intrigued by the premise, which was to start thinking about curing cancer by blocking the cell division cycle. I engaged in multiple discussions with this team, and we put together a plan and started to really think about an entry point and how the company would be shaped at the time. There was, of course, tremendous interest in the eukaryotic cell division cycle at the time, but the vast majority of labs were using model organisms like yeast, sea urchins or clams—organisms where the spawning cycles were very fast—for their research. The community of scientists using mammalian cells to explore cell division was actually quite small at the time, so the only way to get a company focused on designing drugs to target the cell cycle was to find an individual who could drive this kind of research. My wife and I had discussed the fact that we wanted to go back to America, and the sooner the better, so when they offered me this opportunity, I have to admit I jumped pretty quickly. I didn’t really over-analyze it, and I would say that I have acted similarly at other decision points throughout my career, finding great excitement in new opportunities and being quick to seize them.
After my first four years with this company, Mitotix, I realized that the environment was limiting to some extent because all four of our major projects had been partnered with large pharma, and the focus had really shifted to later-stage drug discovery and development and further away from innovation, which was really my passion. Fortunately, right as I was feeling the urge to move on, I was presented with another opportunity with the opening of the European Institute of Oncology in Milan. This was an opportunity to go back to Italy after many years, and that’s what we did. We kept the children in the American system by putting them into the American schools in Milan, and we spent the next 10 years there.
Because Milan was yet another international city, we were part of an international community there, too, and that was incredibly exciting. And then from an Italian perspective—Italy is so different, we felt like we were learning about a region that we never interacted with before. So people, culture, habits, food—it was completely strange to us. In Milan, they eat a lot of rice, but in the south and in Naples, you only eat rice if you’re sick. We eat pasta. So we learned to eat risotto, and we discovered all of these beautiful things and this wonderful food. Also, Milan is so central, you can drive to Switzerland, you can drive to France, to Austria. Because it’s a commercial city, it’s full of interesting people, and we made a lot of friends through the American school. There were some journalists and people like us who had been traveling the world and wanted to keep their children in the American system, so it was really enriching for the children and they made some of their best friends there.
While I was in Milan, I was approached to be a consultant for a pharmaceutical company that had really been building their oncology franchise, Pharmacia. Initially this was presented as a local job, and they said I could keep my laboratory, so it seemed like a win-win situation for me to keep my research program alive and simultaneously fully immerse myself in this consultantship to learn the business of drug discovery. I accepted the job and within a year we had acquired yet another company in San Francisco and then merged with another. I started to spend most of my life on an airplane. It was a really intense time in my career, butitpaidoffinabigway.Wehadan incredible portfolio of products, but because of that, we were targeted by Pfizer. I stayed on through the Pfizer acquisition, but unfortunately I was charged with the dismissal of some of the sites. Then Merck came knocking at my door and offered me the opportunity to go to Boston and lead their oncology group. We all moved back to America again, and I had five groups within Merck in Tsukuba, Japan; Pennsylvania; Seattle; Rome and Boston.
Q | What eventually brought you to MD Anderson?
A | I left Merck when it closed all of its sites but one. I really didn’t see the opportunity to be able to contribute. I want to stay in early innovation and discovery, and so once you start to narrow down your early-phase pipeline and limit your activities to clinical development, that’s simply not my area. It’s not my passion.
I had an offer to join another large pharmaceutical company, but, frankly, I didn’t want to be in a situation where I had to spend time consolidating sites again. So, instead, I took the opportunity to go to Dana-Farber, which ultimately led to MD Anderson. We came here and discovered Houston. It is a really special place. It is an incredible community and very down-to-earth. The doctors here are incredibly generous in volunteering hours to talk about science and talk about solutions for the patients and to engage in collaborative efforts. And outside of these walls as well, we find colleagues to be generous with their time and knowledge. I haven’t seen this anywhere else.
Q | One of the most exciting initiatives in the world is Moon Shots. As co-director of this program, can you explain what makes it both unique and promising?
A | We have seen interesting advances in cancer for 40 years, and it’s getting better and better in terms of our ability to understand the disease. What’s really missing is our ability to take action on our knowledge to develop remedies. For us, we can articulate things that, from a process standpoint, define what we want to do. First, we want to intervene by working on prevention. There are measures that can be taken, but we don’t see adequate dissemination of existing knowledge and policy implementation to favor adoption of these preventative measures. Our own policy at MD Anderson to hire only non-smokers is an important opportunity to encourage prevention. Within my own group I have Europeans, Chinese—smoking is much more prevalent in those countries—and people are stopping smoking. To me, this is a success because there is such a clear connection. HPV vaccinations are another great example. So many cancers are clearly HPV or virally mediated, and now tools are emerging to dramatically reduce the incidence of these tumors.
We also want to intervene on disease in the clinic. Part of that is to make clinical trials far more informative. We’re trying to enable a knowledge system that allows us to really learn from our patients in real time. We are using digital health approaches, which frankly are equivalent to approaches that are being used by the Walmarts of the world, to predict trends in terms of whether we buy more tomato sauce or fresh tomatoes, to enable us to make the best decision for the patient and to disseminate knowledge. MD Anderson is an incredible engine for generation of best practices that are now being adopted by local hospitals throughout Texas, the nation and the world. Twenty-five percent of patients coming to us are misdiagnosed, so we have to reassess the nature of their disease. In some cases, we have dramatic impact. I was just talking to a friend of mine who told me about a patient who came in with a diagnosis of gastric cancer. The chances of surviving gastric cancer are limited, but it turned out that it was lymphoma. It was spreading around the stomach and the patient is now in total remission. There are all these opportunities to intervene clinically in real time. We need to disseminate the knowledge we develop.
Another goal of the Moon Shots Program is to create a multidisciplinary culture. We don’t just have scientists around. Or just clinicians. We have both, and most importantly we have hired specialists in disciplines that are normally only represented in industry and the private sector. And now, as we build out our Moon Shots platforms and various resources throughout the institution, we increasingly have tremendous translational medicine capabilities. Bringing the full spectrum of drug discovery—from basic research through deep biology and onto drug development and clinical studies—under one roof and with a united purpose, is extremely powerful. We need the experts in all of these areas and, most critically, we need them to intersect, intentionally and humbly, to think, to learn, and to commit to making a difference for our patients. Part of this is making sure we have the right incentives in place, so that contribution is measured by clinical impact, not by arbitrary metrics or numbers.
Last, but very important, is the ‘fast kill’ concept. This is about looking at all of the advanced things that have merit and being able to make tough decisions when you develop a diagnostic or therapeutic. It’s a rigorous prioritization approach to leverage anything that is actionable now and could show us a way forward. We really hope the Moon Shots Program could enable some
of these concepts. If it limited itself to identifying high-priority areas for research and then funding research in just those areas, it may miss opportunities, especially some with short-term impact. I think there are a lot of things we could do if we simply acted on this.
Q | Any closing thoughts?
A | My wife sees me as excited today as when I started my post-doc at Cold Spring Harbor Laboratory. She says she’s never seen me as excited. I think that’s really wonderful.
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