A Coast-to-Coast Road to an Illustrious Career in Radiation Oncology
The sophisticated technology of today, such as 3D imaging and high-tech targeted radiation therapies, would seem impossible to conceive of when I was a resident in the 1970s. And as [Department Chair], I’ve had the privilege to oversee the growth and development of these therapies that have translated into remarkable increases in patient survival and quality of life.
—Richard Hoppe, MD
Nationally regarded radiation oncologist and lymphoma expert Richard Hoppe, MD, was reared in Seaford, a small town hugging the South Shore of Long Island, New York. “I grew up in the early part of Long Island’s suburban sprawl, and my childhood was a fairly typical experience for that time,” recalled Dr. Hoppe.
Asked about early influences that steered him toward a career in medicine, Dr. Hoppe explained, “When I was in the third grade, I wound up in the hospital with appendicitis and I had a very good hospital experience. And as a kid, I was impressed by our family physician who would do house calls when we were sick. My parents had a layperson’s medical textbook at home that I used to spend hours pouring over. So, those combined experiences help develop my early interest in the sciences.”
Dr. Hoppe cited a very solid high school experience as another foundation for his career in medicine. “I had terrific teachers, not just in the science and math departments, but throughout every level of the learning process. Looking back, it seems like from an early age, becoming a doctor was always on my radar,” he said.
Dr. Hoppe continued, “I went to Cornell as an undergrad, which was a popular choice for kids from Long Island; it was far enough from home to get that feeling of independence, yet it wasn’t on the other side of the continent. I majored in what was initially called zoology, but later renamed biological sciences. It was a track that pre-med students would take.”
The undergraduate experience at Cornell offered a rich environment for the intellectually inquisitive pre-med student, and Dr. Hoppe dove into diverse courses ranging from British literature to Southeast Asian politics. “I did pretty well in Cornell, capping it off during my senior year when I met my future wife on a blind date,” he said.
An Academic Career Path
After graduating from Cornell in 1967, Dr. Hoppe applied to several top medical schools in the Northeast, eventually deciding on Cornell University Medical School. “My wife and I got married after my first year of medical school and we moved into the married student housing. At the time, my wife was pursing a BA at Columbia. She began working while I was still a student,” said Dr. Hoppe.
“[After medical school,] I figured that I’d go into some subspecialty in internal medicine, perhaps neurology or gastrointestinal medicine, but there was nothing I was passionately drawn to,” said Dr. Hoppe. “I got an opportunity to do a special summer program with an anatomy professor who was working on computer-aided instruction. Remember, this was at a time when we used Fortran and punch cards. The program didn’t go very far but being part of it stimulated my decision to work in an academic environment,” he said.
Introduction to Radiation Oncology
At the end of medical school, Dr. Hoppe still had not decided on which field or medical specialty he wanted to pursue. “For medical students in the East, doing a residency in California was enticing. I was working as a subintern at New York Hospital, and the doctor I was working with was a Stanford Medical School grad. He said that if I wanted to check out the West, I should go to Stanford, and he gave me the phone number of Les Zatz, a professor in radiology. I called Dr. Zatz and he said, ‘Yeah, sure, come on out.’ Things were pretty informal at that time,” explained Dr. Hoppe.
As his departure date neared, Dr. Hoppe, who had never traveled west of the Mississippi, found himself overwhelmed at having to leave his wife back in New York. “A few days before leaving, my mother-in-law mentioned that her cousin’s son was in medicine somewhere in California. She said she’d put me in touch with him. Well, his name was Svi Fuks and he was on the faculty in the Radiology Department at Stanford,” said Dr. Hoppe.
He continued, “I contacted Dr. Fuks. He was a great guy. He picked me up at the airport let me sleep on his couch until I found a room. The elective course in radiology didn’t start for a couple of weeks so the administrator suggested that I spend the interim in radiation oncology therapy with Dr. Fuks. Radiation therapy was in its early stages and very few medical students had that kind of opportunity, especially at Stanford, whose faculty were the giants in the field. That experience really turned me on to radiation oncology.”
After his elective at Stanford, Dr. Hoppe returned to New York. “I decided that I really needed to be sure if radiation oncology was for me, so I took my next elective at Memorial Sloan Kettering in radiation therapy. I actually may have been the first medical student to do an elective in radiation therapy at Sloan Kettering. Working there sealed my decision. There were so many new modalities being looked at. It was an exciting time to begin a career in oncology,” said Dr. Hoppe.
The Move West
Following his elective, Dr. Hoppe did an internship in medicine at North Shore Hospital-Memorial Hospital program. “During my internship, I applied to MD Anderson and Stanford University School of Medicine along with several other radiation oncology programs. I was accepted by Stanford and given my great experience there it seemed like a natural fit for my career path,” said Dr. Hoppe.
Relocating his family across the country for 4 years was a huge consideration, but his wife was supportive, so he accepted the residency. “My wife was pregnant at the time, due almost any day. So when we boarded the airplane the stewardess gave bit of a startled a look and my wife said, ‘Oh that’s OK, my husband’s a doctor.’” Dr. Hoppe recalled.
“Although the faculty at Stanford were all top researchers in the field of radiation oncology, they were doctors first and set an example that we carried into our own careers. Put simply, the patient came first, and they conveyed that philosophy by empathetic action at the patient’s bedside,” said Dr. Hoppe.
During his residency which began in 1972, Stanford was in the midst of a series of prospective randomized clinical trials in lymphoma led by Drs. Saul Rosenberg and Henry Kaplan. “Early in our residency, the rigor of clinical investigation was set in our minds. We participated in the care of the patients on trial, so it was a rich period when I learned about discussing randomized studies and interacting with patients,” said Dr. Hoppe.
New Opportunities Arise
As his Stanford residency drew to a close, Dr. Hoppe began searching for a position, first looking back East where his family and friends were firmly settled. However, just before his residency ended, the department chair, Dr. Malcolm Bagshaw, called to offer him a job at Stanford’s radiation oncology department. A recent faculty departure had opened a research position investigating mycosis fungoides, and Dr. Hoppe was asked to take over the program, which turned out to be a key point in the development of his academic career. “This was an important program at Stanford, and they were on the forefront of treating the disease with radiation, which was about the only effective treatment,” he said.
Dr. Hoppe explained that because mycosis fungoides is such rare disease, he quickly became a nationally regarded expert. “It opened doors and gave me the opportunity to write papers and get my name recognized in the field. The lymphoma department at Stanford was so large that I was brought on as the number three researcher behind Drs. Henry Kaplan and Eli Glatstein.”
Dr. Glatstein soon left for the National Cancer Institute, but before leaving he received a grant to study the pathologic classification systems for lymphomas. “This was an international, multi-institutional effort. Stanford was the center for aggregating the data, and I was deeply involved. The end result became The Working Formulation of Non-Hodgkin Lymphoma for Clinical Usage, which became the eligibility criteria for clinical trials,” said Dr. Hoppe, adding, “It was very important for my career, not only for name recognition, but it gave me the opportunity to meet the world leaders in lymphoma, from Clara Bloomfield to Gianni Bonadonna and from Karl Lennert to Henry Rappaport.”
Shortly after, the untimely death of Dr. Kaplan opened the door for Dr. Hoppe to become Dr. Saul Rosenberg’s senior partner. “It became a fabulous collaboration and friendship. Saul still comes to our clinic a few times a month and participates in our lymphoma conferences. Partnering with Saul was a huge part of my career’s growth path,” said Dr. Hoppe.
A Career-Defining Program
Participating in an early translational program would further advance Dr. Hoppe’s illustrious career in lymphoma research. “We used extensive large-field radiation in Hodgkin disease and saw immune system changes in certain patients. Curiously, some of these changes were the exact transformations that transplant surgeons were trying to achieve pharmacologically to get organ transplant tolerance,” said Dr. Hoppe.
This observation was taken to the laboratory and developed into mouse models for giving total lymphoid irradiation in conjunction with bone marrow transplantation. “I became involved in this research and together with Sam Strober and other colleagues we developed a number of animal models using total lymphoid irradiation, going up the scale from rats to primates. We tested different concepts of using radiation to achieve successful transplantation. Those studies came back to the clinic and eventually became a key component of Stanford’s allogeneic transplant program program using total lymphoid irradiation and anti-thymocyte globulin (TLI plus ATG), which has been, which has been a central focus of my career,” said Dr. Hoppe.
Dr. Hoppe entered medicine in the nascent days of radiation oncology when surgeons at some hospitals even defined the radiation field by drawing margins on the patient’s skin with a marker. “The sophisticated technology of today, such as 3D imaging and high-tech targeted radiation therapies, would seem impossible to conceive of when I was a resident in the 1970s. And as Chair of our department at Stanford for 19 years, I had the privilege to oversee the growth and development of these therapies that have translated into remarkable increases in patient survival and quality of life,” said Dr. Hoppe.
“Stanford has been a place of incredible enthusiasm, collaboration, and success. My days are full, from the clinic to the lab, and the lecture hall. But it’s a job I love. I’ve never not wanted to come to work on Monday,” said Dr. Hoppe, adding, “My daughter teaches math in public school and my son is a radiation oncologist on the faculty at the University of Florida Proton Therapy Center. My wife and I enjoy the cultural scene in San Francisco. I have a good life,” said Dr. Hoppe. ■