2024 Karnofsky Award winner Lillian Siu talks about her career in phase I studies, ctDNA, and her mentor’s “evil red pencil”

To date, Michael P. Link has the unique honor of being the only pediatric oncologist to have served as president of the American Society of Clinical Oncology. Link, who is the Lydia J. Lee Professor in Pediatric Oncology at Stanford University, appeared on the Cancer History Project Podcast in conversation with Paul Goldberg, co-editor of the Cancer History Project and editor and publisher of The Cancer Letter.In honor of Childhood Cancer Awareness Month, Link revisits what drew him to pediatric oncology, his auspicious mentors, his 2011-2012 ASCO Presidential term—and his concerns about what he’s seeing in oncology today.Over the course of his career, Link has seen a childhood cancer cure rate increase from a mere 40% to closer to 90%. But he’s concerned about how the field of oncology is being impacted today.In his 2012 Presidential address, Link said:“There is another lesson from our children—that an ounce of prevention is worth a pound of cure. This is a lesson not just from pediatric oncology, but from pediatrics in general. Prevention strategy through immunization has proven to be one of the greatest triumphs of pediatrics and of modern medicine. Rather than diagnosing and treating diphtheria, widespread immunization simply eliminated it as a health problem in North America. The near eradication of measles, polio, and serious infections from H Influenzae is a similar triumph.”He expressed shock about how things have changed in 2025. “I'm a pediatrician, so here I am and they have measles? I mean really, measles in 2025? How is that possible?” Link said. “I never thought I'd be in a position where I have to talk to people about measles and polio and chickenpox as a threat... And measles, it's a matter of how serious your illness is going to be, and if you're immunocompromised it's life threatening.”Other concerns from his time as ASCO President have reemerged—or never really gone away.In 2012, Link said, “But all this newfound insight into these diseases and their treatment is only as good as our ability to deliver what we know. The current chemotherapy shortage is emblematic of the precarious nature of the path between the discovery and the delivery of our most exciting new findings.”Speaking on the podcast, Link called this an issue of “whack-a-mole”—where new drugs go into shortage on a regular basis. “Can you believe that here we are in whatever year it is, 20-whenever the next shortage is going to come and we don't have access to this?”A transcript of this conversation, along with an archive of related content, is available on the Cancer History Project: https://cancerhistoryproject.com/article/michael-link-podcast/ 

As an oncology nurse practitioner at NCI’s Clinical Center and wife of FDA’s Richard Pazdur, Mary Pazdur knew cancer drug development inside and out. When she was diagnosed with ovarian cancer, she and Rick got to know “the other side of the stethoscope.” In his 25 year career at FDA, Rick has shaped the FDA approach to drug approval, setting forth a set of criteria accepted by drug companies, academics and NCI. And for 16 years, Mary was by his side, with compassion, intuition, and practicality. She was described by one colleague as having a “combination of efficiency and great humanity, [...] compassion and strength.” This interview with Rick and Mary Pazdur was recorded in 2015, a few months before she died, and was conducted by Ellen Stovall, three-time cancer survivor and pioneering patient advocate, on behalf of the National Coalition for Cancer Survivorship. Stovall also died a few months later—in January 2016—from cardiac complications due to her cancer treatments.This episode is accompanied by a robust archive about Rick and Mary Pazdur, as well as further reading about Ellen Stovall. Read more at https://cancerhistoryproject.com/article/rick-and-mary-pazdur/ 

Melvin J. Silverstein, now Medical Director of Hoag Breast Center and the Gross Family Foundation Endowed Chair in Oncoplastic Breast Surgery at USC, sat down with Stacy Wentworth, radiation oncologist and medical historian, to reflect on his career.Silverstein founded the Van Nuys Breast Center in 1979. As he saw more and more and more patients with what was only recently coming to be known as ductal carcinoma in situ (DCIS), he wrote the first major textbook on the disease and developed the Van Nuys Classification for Ductal Carcinoma in Situ of the Breast as well as the USC Van Nuys Prognostic Index.Wentworth asked Silverstein about a time when his science was challenged by the medical establishment. At the time, most surgeons favored treating DCIS just like aggressive, invasive breast cancers, with mastectomy and radiation.Silverstein wasn’t so sure about that. He felt that, in some cases, radiation wasn’t necessary.Silverstein debated against radiation oncologists at conferences for years, and his arguments stirred up visceral responses, he recalls.“Pro-radiation therapy were all the radiation oncologists from academic centers. That was Jay Harris, who was I guess my arch rival in this. He once, after one of these talks, came up to me, smiled at me and said, ‘You're killing patients.’ Which broke my heart,” Silverstein said. “It was a terrible thing. He said to me after not giving radiation therapy, but it turns out in the long run, everybody's come on board. And clearly now it's 25, 30 years later, some people have finally agreed that they all don't need it.”Recent trial results have confirmed Silverstein’s analysis that not all patients with DCIS need radiation.Today, Silverstein runs the USC breast fellowship program, which has an emphasis on oncoplastic surgery—the first of its kind.Read more at https://cancerhistoryproject.com/article/melvin-silverstein/

This interview with Walter Lawrence Jr. was conducted in 2020, when Lawrence was 95 years old and director emeritus of VCU Massey Cancer Center. Lawrence died one year later, on Nov. 9, 2021.Lawrence was one of the founders of the field of surgical oncology, setting up the first-ever university-based division of surgical oncology at what later became VCU Massey Comprehensive Cancer Center, in Richmond, Virginia. He served as director of VCU Massey from 1975 to 1988, during which time the cancer center earned NCI designation.Lawrence spoke with Paul Goldberg, editor and publisher of The Cancer Letter, and Robert Winn, director of VCU. “The thing that was exciting about the National Cancer Act, which I think was one of the best things President Nixon did, among things that weren’t so good, was that it did bring the federal government into the funding of various kinds of research,” Lawrence said.Lawrence saw promise in the National Cancer Act, and earning the Cancer Center designation from NCI in 1975 allowed VCU, then called the Medical College of Virginia, to become systematically involved in clinical trials.“Randomized clinical trials were the only way we had of really improving patient cancer care—things like the one that Bernie Fisher in Pittsburgh started, the National Surgical Adjuvant Breast and Bowel Project,” Lawrence said.Read more and explore related archives at https://cancerhistoryproject.com/article/walter-lawrence-podcast/

In this episode, Susan Ellenberg, emerita professor of biostatistics, medical ethics, and health policy at the University of Pennsylvania Perelman School of Medicine, describes her lifelong love of mathematics, how she accidentally became a biostatistician, and her well-rounded career in clinical trial design and analysis. As a child, Ellenberg was fascinated by a mathematical puzzle. John is twice Mary's age when John was Mary's age. When Mary will be John's age, the sum of their ages will be 63. How old are John and Mary? Ellenberg occasionally chipped away at the question by randomly plugging in numbers, but she soon discovered another way to approach it. “When I got to high school algebra, I learned that there was an actual way to solve this problem. I was so excited I knew how to do it,” Ellenberg said. That enthusiasm, combined with her college entrance exam math scores—which topped her graduating class, despite not being in the math honors program—led her to become a math teacher. But Ellenberg soon put her career on hold so she and her husband could start their young family. However, when Ellenberg was pregnant with her first child, a friend asked if she could help with computer programming for a project under the eminent biostatistician Jerome Cornfield. That job led to Ellenberg earning a PhD in mathematical statistics and having a career in clinical trial design and analysis. She has held positions at the Emmes Clinical Research Organization, NIH, and FDA. She also worked with activists during the AIDS epidemic and has combatted misinformation about vaccine safety. Eventually, though, she took a job in academia and returned to her first passion: teaching. “I said I would teach a class on clinical trials, which I did all the years until I became emeritus,” Ellenberg said. “I really enjoyed doing that, [going] back to my original love of teaching.” Ellenberg spoke with McKenzie Prillaman, reporter at The Cancer Letter. A transcript of this conversation appears on the Cancer History Project.

To mark Hispanic Heritage Month, in this episode, six cancer experts discuss Latino representation in clinical trials, translational research, and healthcare professions. Hispanic and Latino people comprise nearly 20% of the U.S. population, but less than 6% of physicians nationwide identify as Hispanic. “The pipeline issue continues to be a huge issue for us,” said Amelie Ramirez, of UT Health San Antonio and Mays Cancer Center. “As our population continues to grow, in terms of the Latino population, we definitely need more [Latino physicians].” Since trust plays a huge role in recruiting participants, the dearth of Latinos in health care affects clinical trials and translational research, said Cruz-Correa, of the University of Puerto Rico and PanOncology Trials. “For our patients, for our communities, language is still important—that concordance between the physician that is telling you about the study and the patient’s background.” Still, it’s important to remember that Latinos are a very diverse group, who speak languages other than Spanish, said Carvajal-Carmona, of UC Davis. Latino people of the myriad ethnicities throughout the Americas have a variety of histories, cultures, and cancer risk factors, he said. And for Latino professionals in oncology, it’s vital to continue making their presence known, said Edith Perez, of Mayo Clinic. “We are part of the population. We are part of the intellectual minds that exist in this nation. And we're here to help lead and collaborate.” Panelists included: Moderator: Ruben Mesa, president, Atrium Health Levine Cancer; executive director, Atrium Health Wake Forest Baptist Comprehensive Cancer Center Luis Carvajal-Carmona, professor, Auburn Community Cancer Endowed Chair in Basic Science, associate vice chancellor for the Office of Academic Diversity, University of California, Davis Marcia Cruz-Correa, lead investigator and director, Clinical & Translational Research, University of Puerto Rico Comprehensive Cancer Center; chief medical officer, PanOncology Trials; professor of medicine and biochemistry, University of Puerto Rico School of Medicine Edith Perez, professor emeritus, Mayo Clinic Amelie Ramirez, professor, director of the Institute for Health Promotion Research, and chair of the Department of Population Health Sciences, UT Health San Antonio; associate director of cancer outreach and engagement, Mays Cancer Center Yolanda Sanchez, director and CEO, University of New Mexico Comprehensive Cancer Center A transcript of this conversation is available on the ⁠Cancer History Project⁠.

In this episode, Lawrence Phillips, an endocrinologist at Emory Clinic, a professor at Emory University School of Medicine, and medical director of the Clinical Studies Center at the Atlanta VA Medical Center, discusses pushing through lung cancer to continue doing what he loves—seeing patients, teaching, and conducting research. Something odd turned up in one of Phillips’s routine health screenings in 2008. A radiologist who was examining Phillips’s CT scan images to look at his coronary arteries noticed a mass in his left lung. Phillips had previously been told not to worry about the mass because it wasn’t growing. “Well, that’s not true,” Phillips recalled the radiologist saying. The tumor had, indeed, grown. Three days later, Phillips had it removed via segmentectomy. He thought his lung cancer was over and done with. But in 2014, his surgery scar had started to change. It lit up in a PET scan. So, Phillips had a lobectomy, after which he learned he had an EGFR mutation. Eventually, Phillips began a treatment regimen gefitinib, which he still takes today. He is currently free of evidence of disease. Phillips spoke with Deborah Doroshow, associate professor of medicine at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai. A transcript of this conversation is available on the Cancer History Project.

In this episode, stay-at-home mom Christy Erickson discusses how she went from a roundabout lung cancer diagnosis to riding a motorcycle and competing in strongman competitions. Erickson wasn’t worried about lung cancer when she was younger. Breast cancer had a stronghold on her family tree. Her mom died from it when Erickson was seven years old. She took preventative measures for breast cancer, including a mastectomy. But a few years later, in 2006, scans for an unrelated health issue revealed spots all over Erickson’s lungs. Her biopsy came back negative for cancer at the time. But 10 years later, she was diagnosed with stage 4 EGFR-positive lung cancer. Receiving that news after dedicating years to prevention measures pushed Erickson down an emotional spiral. But her condition stabilized with osimertinib. “I sort of hit this point where I thought, 'Well, I'm still here and I'm relatively healthy. If I'm not dying, I want to go live,’” she said. Erickson spoke with Deborah Doroshow, assistant professor of medicine, hematology, and medical oncology at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai. A transcript of this conversation is available on the Cancer History Project.

In this episode, 2024 David Karnofsky Memorial Award winner Lillian L. Siu reviews her career developing novel therapies in the phase I setting, the evolution of her field, and her mentor’s dreaded “evil red pencil.” Siu was among the first scientists to read out the signals of safety, pharmacology, and preliminary efficacy of therapeutic agents that ushered in a new era of cancer therapy. She has been involved in the early development of over 50 drugs and has focused on ways to improve efficiency and scientific relevance of clinical trials. Over the course of her career as a phase I clinical trialist, Siu watched as the field moved away from using “maximum tolerated dose,” the growing need for early-phase efficacy data, and the emergence of intermediate biomarkers. After a nearly 30-year-long career, Siu’s advice for young oncologists is simple: Don’t give up. “Learn from every mistake or every challenge and rise above it and be tenacious,” Siu said. “Be persistent, because there’s never an end that is a bad ending. It is always a good ending if you put enough effort in it. Maybe not entirely the way you want it, but at least if you put in the effort, something will return to you that is worth your effort. I truly believe in that, and certainly I see that in my career. “I don’t only have positive results, I have very often negative results, but it’s fun. Learning from your mistakes is half of the fun, and cherish that kind of moment to learn from it.” Siu spoke with Jacquelyn Cobb, reporter with The Cancer Letter. A transcript of the conversation appears on The Cancer History Project.

Something felt wrong during one of Morhaf Al Achkar’s regular runs on the treadmill in late 2016. He started gasping for breath. “It became really hard to run,” he said. “That sudden development of shortness of breath alarmed me.” Being a family physician in Indiana at the time, he asked a resident at the clinic where he worked to listen to his lungs. “There’s no air moving on the left side of your chest—that doesn’t seem right,” Al Achkar recalled hearing from the resident. A few weeks later, Al Achkar received devastating news: he had stage 4 ALK-positive lung cancer. He estimated that he would live for just another six to 10 months. But today—nearly eight years after his devastating diagnosis—Al Achkar is still working, now primarily as a researcher and educator. Al Achkar spoke with Deborah Doroshow, assistant professor of medicine, hematology, and medical oncology at the Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai. A transcript of this conversation is available on the Cancer History Project.