Lymphoma Expert and Industry Leader Sandra J. Horning, MD, Pushes the Frontiers of Drug Development and Oncology Research

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Sandra J. Horning, MD

I’m extremely excited about how the convergence of science and technology is leading us to the next frontier in cancer research and drug development. With these new possibilities comes a lot of responsibility, but the oncology community is ready to collaborate and lead the way forward.

—Sandra J. Horning, MD

Due to childhood health issues, Sandra J. Horning, MD, formed an opinion about doctors at a young age: They were good people who helped other people. By her early teens, Dr. Horning began to ponder a career in medicine, which offered the possibility of blending her love of science with a career that would benefit the lives of others. “I grew up in a small town in Iowa called Creston, and physicians were among the most respected citizens in our community. But I also found it interesting that when I went to the clinic, all of the nurses were women and the doctors were men. As a young girl, I wondered why that was so,” Dr. Horning told The ASCO Post.

Dr. Horning had no family members close or distant who worked in the medical field, so it was purely experiential knowledge that drew her into medicine. “I was the first on either side of my family to go to medical school. I think I was 14 years old when I firmly decided that I was going to be a doctor. I was an early feminist, so wanting to break into what I perceived as a male-dominated profession probably added to my desire to become a doctor,” said Dr. Horning.

She continued, “I went to the University of Iowa, and my goal in college was to learn as much about everything as possible in the humanities and other areas in the liberal arts, because I realized that once I entered medical school my studies would be narrowed to medicine. Although I was a serious student, I had a great time at college and participated in a lot of campus activities, including a sorority.”

Early Medical Career

Dr. Horning graduated from college in 3 years, earning her BA in 1971, and then worked for a year in a laboratory. “During the second half of that period in the lab, my father was diagnosed with advanced metastatic cancer. It was the first bad thing that had ever really happened in my life. Even though I wanted to be a doctor, up until then I had no experience with desperately ill people, certainly not people who were dying of a disease. My father lasted for about 6 months, which took me into the third week of medical school. It was a very important event in my life, because it altered my financial situation and made me grow up and mature very quickly. It also solidified my passion to make a difference in the world,” said Dr. Horning.

She continued on at the University of Iowa, entering the university’s medical school, where she received her MD degree in 1975. “Early on in medical school I had decided to do internal medicine, which I found more cerebral and challenging than the other options. By then I felt I needed to move on from Iowa. It had been a great experience, but I wanted to broaden my horizons, so I went to the University of Rochester in New York to do my internship and residency,” said Dr. Horning.

“I had a wonderful peer group that I really enjoyed working with. Two of my colleagues from Stanford University were among the most brilliant people I’d ever met, and during our discussions they told me about exciting research that was going on there, particularly in the areas of immunology and lymphoma research. It was also during a time when some important work was being done in cancer, such as in adjuvant therapy in breast cancer, as well as the first curative combination chemotherapies in lymphomas,” said Dr. Horning.

Several issues contributed to Dr. Horning’s next career move. “Having my father die of cancer combined with my overarching love of science and dedication to helping others made me want to be someplace that was on the cutting edge of research and discovery in the oncology field. So I decided to fulfill that dream and went to Stanford for my oncology fellowship,” said Dr. Horning. She completed her residency at Rochester University in 1978 and crossed the country, arriving at Stanford University School of Medicine later that year.

Asked if there were any mentors of note that helped shape her early career choices, Dr. Horning said, “Dr. John Bennett, who was ASCO’s 2011 recipient of the B. J. Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology and also did seminal work in the characterization/classification of acute leukemia, mentored me at the University of Rochester. He was influential in my career decisions and was very supportive along the way.”

Practice-Changing Clinical Research in Lymphoma

When Dr. Horning went to Stanford, it was at the time when monoclonal antibodies were first surfacing and hybridoma technology had just come to the forefront. There was a young investigator at Stanford named Ronald Levy, MD, who was working in this area, and Dr. Horning’s hope was to join his laboratory after she’d done a year of clinical fellowship. “However, as I was doing my training, I realized that I really enjoyed clinical research, and two individuals, ASCO Past President Dr. Saul Rosenberg and Dr. Henry Kaplan, enhanced that experience. I worked with them in the Hodgkin lymphoma clinic and was involved with patients on clinical trials.”

“During that time I became interested in the classification of lymphomas and the biology behind that work, so I decided to pursue a career in clinical investigation, working in conjunction with investigators in the laboratory,” said Dr. Horning. “Actually, my closer colleagues were in pathology, where we were doing some of the first work in lymphoma classification, understanding that lymphoma was a T-cell and B-cell lineage.”

Dr. Horning described her career arc at Stanford as multipronged. “My career at Stanford moved across parallel veins. One was working closely with colleagues in pathology as we were seeking to better understand non-Hodgkin lymphoma. I was also able to leverage the Stanford Lymphoma Database to examine the natural history of indolent disease by observing patients over a long period. I was involved in the process to characterize the lymphomas right up to my participation in the World Health Organization classification of lymphoid neoplasms,” said Dr. Horning.

She continued, “Interventional clinical investigations comprised a large part of my academic career. Eventually while working with the Eastern Cooperative Oncology Group, I was involved in two large trials, one in indolent non-Hodgkin lymphoma and the other in aggressive non-Hodgkin lymphoma, in which we integrated rituximab [Rituxan] into the standard of care. Both trials were registered as part of the package of information in a supplemental Biologics License Application for the U.S. Food and Drug Administration. What truly impressed me was how a single novel therapy changed the tenor of my clinic. Patients were being cured in unprecedented numbers, and disease progressions became fewer and farther between.”

From ASCO to Industry

During this period, Dr. Horning’s work in Hodgkin and non-Hodgkin lymphoma also centered on quality-of-life and survivorship issues, work that she carried into her ASCO presidency in 2006. “Being President of ASCO was certainly one of the highlights of my professional career. Long before I became President, ASCO was a big part of my academic life and career development. The Society is just a wonderful forum fostering collaboration on the national and international stages, and an added dimension that helps round out a career in oncology,” said Dr. Horning.

Dr. Horning commented that her presidency at ASCO helped hone her leadership and organizational skills. “The Society’s focus on policy is something that has always appealed to me because I believe that good policies can truly change the world. My presidency was focused on survivorship issues and the science behind the newly emerging targeted therapies. Under my presidency, there were also some organizational changes that I believe set the Society up for future health and success. Foremost was the search for a CEO. My legacy will probably be in finding and hiring Dr. Allen Lichter for that position, because there is unanimous agreement that Allen has done a superb job taking ASCO to the next level, said Dr. Horning.

In 2009, Dr. Horning left her position as a tenured Professor of Oncology at Stanford University School of Medicine to enter the pharmaceutical industry, taking a leadership roll at Genentech. She said that her ASCO presidency influenced her decision to leave academia, noting that being in a leadership position in ASCO’s big platform informed her own desire to to make progress in multiple cancer types, and on a global front.

“I joined Genentech as the Global Head of Oncology/Hematology Clinical Development. During my tenure, we were fortunate in having five new drugs approved, which was very fulfilling. I also had the opportunity to participate in some groundbreaking developments, including Breakthrough Therapy Designation for drugs showing early promise of substantial benefit and pathologic complete response in early breast cancer as an endpoint for accelerated approval. I’ve really been impressed with the dynamic structure of the company and was thrilled when the opportunity arose that led to my current position as Chief Medical Officer and Head of Global Product Development. So I went from having about 200 people in my organization to 4,000 personnel around the globe,” said Dr. Horning.

Dr. Horning has authored or coauthored more than 300 peer-reviewed journal articles, book chapters, reviews, and editorials and has served on the editorial boards of several peer-reviewed medical journals, including the Journal of Clinical Oncology, Clinical Cancer Research, Clinical Lymphoma, Leukemia & Lymphoma, the Annals of Internal Medicine, and the American Journal of Medicine. She has been named a “Best Doctor in America” consecutively from 1992 to 2008 and received the 2010 Top Women in Bay Area Business Award and the 2014 Fierce Biotech Top Women in Biotech Award.

How has a career spanning small-town beginnings in Iowa to the presidency of ASCO and on to a leadership position at one of the world’s premier drug companies shaped her view of oncology’s future? Dr. Horning replied, “Advances such as molecular sequencing and cancer immunotherapy are changing the face of oncology. I’m extremely excited about how the convergence of science and technology is leading us to the next frontier in cancer research and drug development. With these new possibilities comes a lot of responsibility, but the oncology community is ready to collaborate and lead the way forward.” ■

Disclosure: Dr. Horning is Chief Medical Officer and Head of Global Product Development for Genentech.