Instead of caring for an individual cancer patient, I’m now trying to help fix the system at large. If we fix the system, we can greatly reduce the suffering and death from cancer and other terrible diseases such as Alzheimer’s disease.
— Andrew C. von Eschenbach, MD
At the end of the day, I’m still a kid from South Philly,” Andrew C. von Eschenbach, MD, former Director of the National Cancer Institute (NCI) and Commissioner of the U.S. Food and Drug Administration (FDA), told The ASCO Post. Dr. von Eschenbach is the product of a closely knit yet culturally diverse household that valued caring, striving, and, above all, integrity. His father was a German-American tool and die maker, and his mother was Italian American. He grew up in a tough inner-city neighborhood. “I was the first one on both sides of my parents’ families who went to college. My parents made many sacrifices because they wanted my brother and me to reach our full potential. It was a passionate household. We argued over everything, including whether Joe DiMaggio was the greatest centerfielder of all time. But at the end of the day, we came away loving each other,” said Dr. von Eschenbach. He added, “My father was the consummate German craftsman; it was all about pride and precision. He stayed with every task, small or large, until it was perfect. That philosophy would later inform the way I approached surgery.”
When asked about early influences that helped shape his career path, Dr. von Eschenbach was quick to reply, “My Jesuit education was the most transformative part of my life. I went to a Catholic grade school run by nuns, and they ruled with an iron fist. Fortunately, I passed the high school entrance exam to St. Joseph’s Preparatory School. In fact I was the only kid from my grade school to get accepted. It was a Jesuit school, and I think my first motivation to go there was to spite the nuns,” said Dr. von Eschenbach.
He continued, “After graduating from St. Joseph’s Preparatory, I went on to St. Joseph’s University. It wasn’t my first choice. I actually had my heart set on going to West Point, but I was disqualified after the admissions board discovered that I suffered from migraine headaches.”
Dr. von Eschenbach explained that he entered St. Joseph’s as an electronic physics major on a work co-op with RCA doing computer science but in his first year spent a bit too much time in the old neighborhood, playing cards and hanging out on the corner. The Dean of Freshmen, a Jesuit priest, believed in him and allowed him to enter the pre-med program on a conditional term. “My dad and I had a lot of heart-to-heart talks over the summer. So, I began pre-med with renewed enthusiasm and wound up Class President and at the top of my class academically. I went from there, on to Georgetown Medical School,” said Dr. von Eschenbach.
He noted that the 12 years of Jesuit schooling was life-changing. “The Jesuits didn’t tell me what I was supposed to do with my life, but their formative instruction helped me develop purpose in my life’s choices. The experience also gave me the realization that to those to whom much is given, much is expected.”
Path to Medicine
After receiving his medical degree from Georgetown University School of Medicine in 1967, Dr. von Eschenbach served in the U.S. Navy Medical Corps from 1968 to 1971, during the Vietnam War. “I loved being a naval medical officer. I was assigned to Washington, DC, and seeing the sacrifice that our servicemen and their families made was inspiring. I was a general medical officer, and much of my job centered on trying to aid the healing process.”
He commented that the experience he got in the Navy served as a solid foundation as he entered his residency at Pennsylvania Hospital in Philadelphia in general surgery and urology. “I was really passionate about surgery, especially urology, which was filled with intricate procedures. I had a fantastic residency experience with the best mentor, but I became especially focused on oncology. I was intellectually fascinated by cancer and truly wanted to do something about the suffering and death caused by the disease,” said Dr. von Eschenbach, adding, “So that’s why I ventured into urologic oncology.”
Dr. von Eschenbach had planned to do his oncology fellowship at Memorial Sloan Kettering Cancer Center, but his wife, Madelyn, wasn’t thrilled about rearing their four children in a Manhattan apartment. Serendipitously, a University of Pennsylvania professor of Dr. von Eschenbach's who had gone down to Houston to head the urology department at the medical school suggested that he apply for a fellowship at The University of Texas MD Anderson Cancer Center.
“The annual American Urological Association meeting was in Dallas, so after the meeting I went to Houston to see MD Anderson Cancer Center and was literally bowled over by the experience. I applied for a fellowship position and was accepted. So, we packed up the kids and moved to Texas, telling everyone back home in Philly that we’d be back in a year,” said Dr. von Eschenbach.
It was during this transitional period in Dr. von Eschenbach’s life that his father, who had been diagnosed with prostate cancer, progressed to castration-resistant metastatic disease. “I brought him to MD Anderson for treatment. He was put on the first ever randomized national chemotherapy clinical trial for prostate cancer, but he shortly progressed to end-stage cancer and chose to go back home to family and friends in Philly. At the time, I was asked to accept a faculty position at MD Anderson, but I also faced a huge internal battle knowing that my father was going home to die. But my dad said, ‘Your mom and I worked our whole lives to give you an opportunity to do something special, and if you believe that staying here at MD Anderson helps that goal, then I want you to stay. Coming home is not going to change what’s going to happen to me.’”
Pushing the Boundaries of Oncology
Dr. von Eschenbach stayed at MD Anderson, becoming Assistant Professor in 1977, and by 1983, he was Chairman of the Urology Department. He described the MD Anderson experience thusly: “When I first walked in the door as a fellow, it was like an airport at rush hour. People were pushing gurneys with IV poles and patients with radiation tattoos on their faces, and I felt an overwhelming sense of sadness. But I only felt that way for one day, because I realized that I had the privilege to be a member of a great institution that was pushing the frontiers and changing the world of oncology.”
“For instance, I was part of an experience, over 10 or 15 years, in which a diagnosis of metastatic testicular cancer went from being a death sentence to seeing men survive and be cured. It was amazingly gratifying,” said Dr. von Eschenbach.
Dr. von Eschenbach said that during his 26-year tenure at MD Anderson, he got to see the birth of molecular medicine. “We were unlocking the secrets of the cancer cells and it became obvious that if we could fully understand the underlying mechanisms of the disease, we could strategically move forward in eliminating the majority of suffering and death due to cancer,” stressed Dr. von Eschenbach.
National Cancer Institute Tenure
Although fiercely dedicated to his work at MD Anderson, Dr. von Eschenbach wanted to make a difference on the national scale, which was made possible when he was given the opportunity to head the NCI. “Moving to the NCI was like going from boots on the ground, during which I was on the front lines of day-to-day cancer care, to being a pilot in an AWAC surveillance plane, where I got to see the whole landscape of oncology,” explained Dr. von Eschenbach.
In 2001, Dr. von Eschenbach was selected as NCI Director by President George W. Bush. Dr. von Eschenbach’s only regret was that he would have to leave his surgical career, which he was passionate about. “The day that I traded in my white coat for a suit was painful. And it still is,” said Dr. von Eschenbach. But, he added, “we have the ability within our grasp, based on the trajectory of progress, to expand our understanding of the fundamental mechanisms that give rise to our susceptibility to cancers, the early events of malignant transformation, the progression and the metastatic spread, and the ultimate death that we see all around us. Conquering cancer is doable.”
Modernizing the FDA
Four years later, Dr. von Eschenbach was in his office when the telephone rang. “It was the White House saying that there’s a problem at the FDA and the President wanted me to take over the Agency. I said that I couldn’t just walk out on the NCI, so they said fine, I could do both jobs until we find a resolution. For 6 months, I was NCI Director and Acting FDA Commissioner. It was hectic. In truth, the NCI is a well-oiled machine, but the FDA, at that time, was in a crisis of being understaffed and overburdened. That’s where I was needed, and I stayed on as a Senate-confirmed Commissioner.”
During his 3 years as FDA Commissioner, Dr. von Eschenbach employed an agenda to modernize the FDA. Under his leadership, he emphasized the FDA’s role in working with external partners to ensure quality throughout the entire life cycle of the products it regulates, while internally fostering a regulatory pathway that is transparent and efficient but still rigorous and science-led.
“As FDA Commissioner, I traveled the world, collaborating with heads of other regulatory agencies, including opening the first FDA offices outside the United States in China, India, Latin America, and Europe, and gathered incredible insights into things we hadn’t seen or appreciated yet. I had an ‘oh-my-God’ moment, realizing that if we optimize our understanding of the fundamentals of life at the genomic, molecular, and cellular levels, we’ll be able to transform our world, not just in medicine and health care, but in agriculture and the environment,” said Dr. von Eschenbach. “With the sequencing of the human genome, we turned biology into a digital science. The possibilities are endless, if we work together to seize the potential.”
Now, President of Samaritan Health Initiatives, Inc, Dr. von Eschenbach admits that he misses government work, especially the FDA, which he calls a remarkable institution loaded with talent and dedication. Asked about his current work, he replied, “I’m still trying to make a difference in peoples' lives. It was the same thing I wanted to do when I was in high school. I’m just doing it in a different way. Instead of caring for an individual cancer patient, I’m now trying to help fix the system at large. If we fix the system, we can greatly reduce the suffering and death from cancer and other terrible diseases such as Alzheimer’s disease.”
Dr. von Eschenbach, still a kid from south Philly, has been married to his childhood sweetheart, Madelyn, for 48 years. They have four children and seven grandchildren. ■