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You are the 12th National Cancer Institute (NCI) Director in its 64 year history. Is there anything you'd like to say by way of an introductory statement:

Dr. von Eschenbach: I am extremely honored and excited to accept this important role. My approach and attitude coming to this position is not that of 'I have an agenda and I've decided what all the answers are going to be.' Just the opposite is true. I'm coming to this role to promote the "we" in the NCI. I intend to access all the expertise from this great institute of knowledge and experience and from experts throughout the community in order for us to work collaboratively and collectively towards a comprehensive solution to the problem of cancer. I intend to listen and learn so that from this process "we" will define an ongoing successful agenda. I value the full dimension of research along with the translation of research discovery into effective interventions. It's a process that's already underway at the NCI and a process I will accentuate and accelerate.

Are there any major, overall goals you'd like to achieve during your tenure at NCI?

Dr. von Eschenbach: I have told former NCI Director Richard Klausner that I am coming to the NCI to complement the previous Directors, and I mean that as both complement and compliment. I compliment them for the tremendous accomplishments and progress the NCI has achieved under their leadership. Since the passage of the National Cancer Act 30 years ago, we have made great progress in our scientific understanding of the biology of cancer. We have much more to learn about this complex disease, but the National Cancer Institute has been responsible for many of these accomplishments. At the same time, I see a responsibility to complement what's gone before by building on that foundation. Our emerging understanding of cancer at the genetic, molecular, and cellular levels opens up enormous opportunity to alter disease processes at each level. The paradigm that I grew up with as an oncologist was to 'find cancer and kill it'. Now we can look forward to not only eradicating cancer, but to 'target and control it' by modulating and altering the behavior of cancer. Our goal should be to accelerate the evolution of this exciting new paradigm, leading to biology-based interventions to detect, treat, and prevent cancers.

The decoding of the human genome and the burgeoning field of proteomics hold the promise of treating cancer differently from one patient to the next. How do you see cancer research evolving to meet patient needs in the 21st Century?

Dr. von Eschenbach: Initially we approached cancer as a single disease. Then it became apparent that cancers behave quite differently depending on organ site. When I began my career in oncology in the seventies, the NCI was at the forefront of promoting organ site programs. Due to progress since then, we are beginning to understand cancer at a more fundamental level -- at a genetic and molecular level. So we will be able to further define a tumor that arises in the breast or in the prostate by its genetic and molecular fingerprint. Beyond just the site of the origin of the tumor, these genetic and molecular profiles will determine our interventions. We will be applying and combining agents for detection, treatment, or prevention that are directed to unique targets in the malignant process. From a pharmaceutical or biotechnology perspective, the development of a drug will be based on a target and that target may be present on a subset of tumors from a variety of organ sites.

For example, STI-571 was developed against a molecular target present in some leukemias, but clinical trials are now underway in other diverse tumors in which this drug can be effective, such as stromal tumors of the stomach and prostate cancer. The recognition that tumors which are diverse with regard to their site of origin can share common molecular pathways will cause us to realign our approach to drug development and clinical delivery.

You've been through treatment for cancer yourself twice. Do you feel this experience has influenced you in your roles as cancer researcher and administrator?

Dr. von Eschenbach: Clearly having cancer has affected me, however I don't think you have to be a cancer patient to be a compassionate oncologist or a researcher passionate about a cure. Developing cancer did not make me more compassionate or more passionate, but rather gave me more of a sense of urgency. I initially made the decision to be an oncologist because, intellectually, the mysteries of cancer fascinated me the most. But then during my urology residency, my dad was diagnosed with prostate cancer and later, as I was practicing oncology full-time in the clinic, I witnessed first-hand cancer's tremendous everyday toll in human suffering. Being a cancer physician requires caring and dedication. Being a cancer patient brings with it a deep sense of urgency about eradicating this disease. It is important to not just solve the problem, but to solve it as quickly as possible, because every day that we don't is another day that people suffer and die. So I appreciate the balance between being careful, meticulous, and precise in our research, but at the same time I will drive this process with a sense of urgency. I will always maintain that the cancer patient is at the center of what we're doing. Ultimately, what we accomplish will be measured in terms of people living or dying or suffering or not.

One of your areas of clinical experience has been in urologic oncology. What lessons do you expect to take from this field that may be helpful in the evolution of various programs at the National Cancer Institute?

Dr. von Eschenbach: The field of urologic oncology has been interesting as a model system for many of the fundamental problems of cancer. The origin of cancer is genetic but the behavior of a cancer cell is influenced by its environment. This dynamic is responsible for the tremendous variability we encounter among patients with even the same type of tumor. The tumor that I have specialized in, prostate cancer, is one of the most interesting models of diverse behavior. Prostate cancer is the most prevalent malignant transformation that occurs in men, and for most it remains a relatively innocuous disease throughout life, but for a subset of men it's a vicious disease and the second leading cause of male cancer death. One of our major research challenges is to not only understand the origin of cancer, but the basis of its virulence. As a fourth year medical student I knew prostate cancer cells could cause bone cells to produce blastic lesions. Research is now revealing that organ site-specific cell-to-cell interaction, such as between prostate cancer cells and bone cells, is critical to the metastatic cascade. Thus, prostate cancer is an important model for metastasis. Research that helps us understand this critical interplay between tumor and environment can lead us to innovative ways of controlling the metastases responsible for the lethal phenotype of cancer.

As a clinical oncologist, I am convinced that successful management of these complex tumors must involve interdisciplinary collaborative care, and that we cannot solve this complex problem without research. I learned these lessons early and they have been my mantra. We study tumors in the laboratory, but a cancer evolves in a patient, and that patient can alter the outcome of that cancer.

So, while endeavoring to prolong the lives of cancer patients, we cannot overlook the importance of assuring their quality of life. Among others, nutrition, pain control, fatigue management, and emotional support are essential to the patient's reaction to cancer and much study is needed to understand these elements.

So you're talking about a real bench to bedside approach?

Dr. von Eschenbach: Exactly. Discovery and delivery. But we must come to think of discovery and delivery as a continuous rather than a linear process. It is critical that we apply discoveries in the laboratory to the clinic, but I believe it is equally important to bring observations from the clinic and bedside to the laboratory for elucidation. This will be even more important as we move further into a new era of biologic interventions. Monitoring and measuring the expression of biologic interventions in the patient in real time will add a great deal more information to help guide therapy than relying just on measurement of tumor shrinkage and patient survival. Monitoring of the molecular pathways that regulate the tumor's growth and behavior allows the basic researcher and the clinical researcher to work much more closely together to refine and improve cancer therapy.

You've served in important leadership capacities for both the American Cancer Society and the National Dialogue on Cancer. How do you see these and other such organizations interacting with the NCI, and what can NCI do to foster good relations with these and other cancer support organizations?

Dr. von Eschenbach: The role that the NCI has played in what we may call the National Cancer Agenda has been crucial and can even be thought of as the keystone. The NCI plays a critically important part in fostering research and promoting the delivery of state-of-the-art care. Increasingly, many other organizations and agencies are playing essential roles, especially in delivery of care. The Food and Drug Administration, CDC, CMS (formerly HCFA), state agencies, and health care delivery systems and providers, are essential to insure an ultimate solution to the problem of cancer. The NCI can't provide for everything that is required for a successful National Cancer Agenda, but it must play a key leadership role in making sure the agenda is fulfilled. Cooperation, collaboration, and integration are very important and the NCI will continue to forge creative partnerships with many other organizations at the federal, state, and local levels as well as pharmaceutical and biotechnology companies, cancer survivor groups, and non-governmental groups like the American Cancer Society, the American Association for Cancer Research, the American Society of Clinical Oncology, and others.

Unlike a number of former NCI Directors, you've had no formal Federal government employment. How do you think your experience as a government official will differ from your experience in the academic sector?

Dr. von Eschenbach: Although I've not been at NCI, I've spent many years at M.D. Anderson Cancer Center, a state institution, which is a part of the University of Texas. I do have an understanding of a governmental system and its rules, regulations, and processes. I am blessed by the fact that I'm surrounded by people at the NCI who understand the system exceedingly well. Deputy Director Alan Rabson, M.D., has been at NCI for 46 years and is invaluable to have at my side. I also have an Executive Committee made up of individuals with great experience and I'm looking forward to working and interacting with them.

One of the most important tasks of the NCI Director is creating a balanced research portfolio. What are your thoughts on the best ways to achieve balance?

Dr. von Eschenbach: A balanced portfolio must be developed with careful deliberation and consultation. If you think of successful portfolio management from a financial perspective, you set goals and targets and then partner with the best financial advisors you can find to successfully manage each aspect of the portfolio. In addition to its own talented staff, the NCI is fortunate to have key advisors that can oversee the portfolio, such as the National Cancer Advisory Board, the Board of Scientific Advisors, and the Board of Scientific Counselors. In addition, an array of experts in the community are devoted to seeing the NCI succeed in its mission. The portfolio is in good hands and as director I will continue to partner with talent and great minds in cancer to formulate and manage our investments in research.

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