Dr. Larry Norton, Honored at 2013 Breast Cancer Symposium, Calls For A Return to the 'Exploration of Concepts'

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Larry Norton, MD, of Memorial Sloan-Kettering Cancer Center, is the recipient of the 2013 Gianni Bonadonna Breast Cancer Award, which he received at the 2013 Breast Cancer Symposium. The Symposium is sponsored by ASCO, the American Society of Breast Surgeons, the American Society of Radiation Oncology, the National Consortium of Breast Centers, and the Society of Surgical Oncology.

Dr. Norton is Deputy Physician-in-Chief for Breast Cancer Programs, Medical Director of the Evelyn H. Lauder Breast Center, and the Norna S. Sarofim Chair in Clinical Oncology at Memorial Sloan-Kettering Cancer Center, New York.

Among Dr. Norton’s many accomplishments is the refinement of a mathematical approach to studying cancer. During the 1970s, Dr. Norton collaborated with Richard Simon, ScD, at the National Cancer Institute, to formulate the Norton-Simon Hypothesis. The hypothesis contends that the rate at which a tumor shrinks in response to therapy is proportional to its growth rate. This led to the concept of dose-dense drug delivery, which maximizes the killing of cancer cells while minimizing toxicity.

Coevolution of Clinical and Basic Science

In accepting the award, Dr. Norton commented on what he called “the coevolution of clinical and basic science in oncology.”

“Having been involved in cancer research since the 1960s, I have witnessed immense changes in all aspects of the mission. Some are obvious, mostly related to the vast expansion of our knowledge of biology and chemistry and the revolutionary advances in our ability—via electronic means—of storing and sharing information,” he said.

“But others are more obscure although equally important,” he continued. “One is our willingness to openly discuss societal needs, such as reducing the costs of care, on an at-least-equal footing, with the needs of individuals, such as the personal benefits of earlier diagnosis of disease,” he continued.

“Another is the evolution of a complex system of producing, testing, and distributing new cancer treatments (and linked diagnostics) that might now, as times have changed, become suboptimal for further progress. This may be illustrated by a contrast between the invention of postsurgical adjuvant dose-dense doxorubicin plus cyclophosphamide followed by paclitaxel plus trastuzumab and contemporary opportunities in the same space,” he said.

A New, Older Mindset

New clinical trial designs, new approaches to the collection and analysis of real-world clinical experiences, new business models for early therapeutic research and development, and new sources of funding for these endeavors may be “imperative” innovations, he said, but an even more sweeping change may be vital to the future of optimal cancer care: “a return to an older mindset—the exploration of concepts rather than an exclusive focus on the testing of agents.”

Dr. Norton said the accomplishment of this new mindset, “especially in a time of limited governmental resources, an exigent commercial environment, and the emergence of evidence-based decision tools as rules rather than guidelines,” will be a major challenge.

Fellowship Award

In conjunction with Dr. Norton’s award, the 2013 Gianni Bonadonna Breast Cancer Research Fellowship was awarded to Aki Morikawa, MD, PhD, of Memorial Sloan-Kettering Cancer Center, in recognition of her research on brain metastases in patients with breast cancer. She will be conducting her Fellowship under the tutelage of Dr. Norton and Andrew D. Seidman, MD, also of Memorial Sloan-Kettering. ■