Pioneer in Combination Chemotherapy, Vincent T. DeVita, Jr, MD, Changed the Face of Modern Oncology

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Vincent T. DeVita, Jr, MD

Combination drug therapy at that time was considered bad medicine. We had a hard time convincing the oncology community that combination chemotherapy was a reasonable treatment. Even after we reported the very impressive results from the first study, physicians wouldn’t use the regimen the right way.

— Vincent T. DeVita, Jr, MD

As a young boy growing up in the Bronx, Vincent T. DeVita, Jr, MD, admired the local iceman, a thick-muscled guy known as Nunzi, who used to carry a big block of ice on his shoulder with a set of tongs, and effortlessly slide it into the DeVitas’ icebox. “A friend once asked me what I wanted to be when I grew up, and I said an iceman like Nunzi. My mother was standing nearby. She panicked at the thought and said, ‘No way, Vincent wants to be a doctor.’ And from that day on I said I wanted to become a doctor and never deviated from that goal,” said Dr. DeVita.

Dr. DeVita speaks with a courtly, inward voice that belies the sense of power behind the man. But despite his long and illustrious career, he remembers where he came from. “I had a lot of guardian angels. Although I was a capable student, my high school principal, a terrific man named Hank Richards, felt I was slipping a bit. He met with my mother and me and explained that I was fooling around too much, not working to my potential. I was impressed by the way he handled himself. It was a turning point, and I thank him to this day.”

Dr. DeVita ventured to college across the Mason-Dixon line at William & Mary—a Southern culture shock for the city-smart New Yorker. “I was a good student, finishing fourth in my freshman class. But in my sophomore year, I joined a fraternity and started partying a bit too hard. A chemistry professor, Alfred Armstrong, who was keeping his eye on me, stopped me one morning as I was crossing the campus. He gave me quite a lecture. Once again, someone who cared made an impression. I pulled myself together and graduated near the top of my class,” said Dr. DeVita.

Path to Medicine

After earning his Bachelor of Science degree in 1957, Dr. DeVita, following his lifelong dream of becoming a doctor, enrolled in the George Washington University School of Medicine in Washington, DC. “When I entered George Washington, the university had just hired a new Chair of Physiology, C. Adrian Hogben. He assigned a paper on a scientific subject, and I decided to write about active transport, which was new at that time,” said Dr. DeVita, “I really didn’t think I did well, but Dr. Hogben gave me an A-plus and asked if I’d like to do research with him over the summer at the Mount Desert Island Biological Laboratory in Bar Harbor, Maine. I hesitated, but he made me an offer I couldn’t refuse. He hired my wife as his secretary, so off we went to Maine.”

The summer research position proved instrumental in Dr. DeVita’s career path. “At the lab, I met Dr. David Rall who was Chief of Chemical Pharmacology (that’s what it was called at the time) at the National Cancer Institute [NCI]. I’d really aced pharmacology in medical school. I almost hit a perfect score on my national boards, and Dr. Rall was so impressed that he invited me to the National Institutes of Health [NIH] as a clinical associate. Frankly, I wasn’t sure what the NIH was, but the Vietnam War was raging and NIH service was equal to military service, so I decided to go to the NIH instead of the jungles in Vietnam,” said Dr. DeVita.

From Cardiology to Oncology

Dr. DeVita explained that in the 1960s, oncology was a field on the outskirts of medicine; cancer posed a daunting clinical conundrum that few were willing to tackle. Instead, cardiology was the center of gravity in medicine; implantable mechanical devices, heart transplants, and superstar surgeons like Michael DeBakey and Christiaan Barnard were the buzz.

Dr. DeVita began his career as a cardiology resident, doing catheterizations and writing papers; one, in fact, was heavily cited in the literature for more than a decade. However, he was still drawn to pharmacology and asked Dr. Rall if he could work in the laboratory on the heart drug digoxin. “The chief, being a wise person, said, ‘Sure, work on anything you like,’ and suddenly I was surrounded by these wildly enthusiastic people doing cancer research,” Dr. DeVita said. “But that lasted about 2 weeks, because the challenge of oncology hooked me, and that’s essentially how I chose my career path,” said Dr. DeVita.

After returning from his residency stint at Yale, Dr. DeVita became Chief of the Solid Tumor Service at NCI. “I didn’t have any senior faculty so I recruited George Canellos and Bob Young. Then Bruce Chabner joined us, and not long after that I reached out and got Phil Schein to sign up. We became known as ‘The Gang of Five.’ We were all around the same age, give or take a few years. It was an intense relationship. We used to meet in the solarium on the 12th floor, pushing a blackboard on wheels. We’d write out protocols for studies, and it got pretty vocal at times, so much so that the trainees actually thought we were mad at each other. By the time we’d hashed out a protocol, it usually ended up being pretty good. We stayed together for about 6 years; we started lymphoma programs, ovarian cancer programs, and breast cancer programs, things that are still making a difference today. To this day, they remain friends of mine.”

Combination Chemotherapy

It was during this fecund period of research at the NIH when Dr. DeVita would take his place in history, doing research in combination chemotherapy. Although this was a barrier-breaking concept, it was met with huge skepticism. “Everybody thought we were totally off base,” Dr. DeVita said. “Combination drug therapy at that time was considered bad medicine. We had a hard time convincing the oncology community that combination chemotherapy was a reasonable treatment. Even after we reported the very impressive results from the first study, physicians wouldn’t use the regimen the right way.”

Despite the negativity, Dr. DeVita and his colleagues developed practice-changing regimens: the CMF (cyclophosphamide, methotrexate, and fluorouracil) regimen in breast cancer and the four-drug MOPP (mechlorethamine, vincristine, procarbazine [Matulane], and prednisone) regimen, which became the curative treatment for Hodgkin lymphoma. “To this day,” he said, “the( MOPP paper is the most cited article in the history of the Annals of Internal Medicine.”

Asked if MOPP was the highlight of his career, Dr. DeVita said, “There have been many highlights, but seeing people who are 40 years out after a diagnosis that prior to MOPP was essentially fatal is certainly at the top of the list.”

An Illustrious Career

In 1980, President Jimmy Carter appointed Dr. DeVita as Director of the NCI, a position he held until 1988. He was the first director to set cancer mortality goals for the nation. “There’s always been a gap between what is theoretically attainable and what can actually be accomplished in a country as large and diverse as ours. The government has a problem of setting up programs without having the tools in place to measure the results. So I gathered about 300 consultants, and we set some measurable mortality goals for the year 2000. At the time, statisticians projected cancer mortality would increase in a linear fashion, when in fact mortality did drop, and more than expected.”

Dr. DeVita left the NCI in 1988 and served as Physician-in-Chief and Attending Physician at Memorial Sloan Kettering Cancer Center until 1993. From there, he became Director of the Yale Cancer Center, a position he held from 1993 to 2003. Dr. DeVita is still with Yale University, serving as the Amy and Joseph Perella Professor of Medicine and Professor of Epidemiology and of Public Health.

Dr. DeVita recently wrote a book about the war on cancer for the lay public, called The Death of Cancer. His daughter, Elizabeth DeVita-Raeburn, a science writer, worked on it with him. Dr. DeVita said, “Elizabeth keeps me honest about communicating on a human level with nonmedical people.”

Over the course of his illustrious career, Dr. DeVita has received numerous awards including the Lasker–Debakey Clinical Medical Research Award (1972), the American Association for Cancer Research (AACR)–Richard and Hinda Rosenthal Memorial Award (1986), the Pezcoller Foundation–AACR International Award for Cancer Research (1988), the Armand Hammer Prize for Cancer Research (1990), and the FREDDIE International Health & Medical Media Award (2007).

Dr. DeVita is the author or coauthor of more than 450 scientific articles. Most notably, he is one of the three editors of Cancer: Principles & Practice of Oncology, the premier textbook in the oncology field. The textbook, first published in 1982, is now in its 10th edition. 

Dr. DeVita said he remains firmly “an optimist” in the war on cancer, despite some qualms about what he considers a movement toward government-driven paradigms that may stifle innovation. He used achievements in breast cancer therapy as an example of where optimism can lead. “Years ago, women with all stages of breast cancer had radical mastectomies, leaving just tissue over bone and a painful swollen arm. Then they died,” he said. “Look how far we’ve come.” ■