After 8 years with the national oncology organization, Richard L. Schilsky, MD, FACP, FSCT, FASCO, is hanging his ASCO hat up for good.
Schilsky is retiring as the chief medical officer and executive vice president of ASCO. He was formerly the chief of hematology/oncology in the Department of Medicine, as well as the deputy director of the University of Chicago Comprehensive Cancer Center. In 2018, he was named a Giant of Cancer Care® recipient in Community Outreach/Education.
“ASCO brings together, in many ways, the best features of academic, clinical research in terms of innovation and collaboration, with a certain degree of nimbleness that you often don’t have in an academic medical center environment,” said Schilsky.
In an interview with OncLive just weeks before his retirement, Schilsky sat down to share his proudest moments and obstacles throughout his career with ASCO, as well as advice for his successor, Julie Gralow, MD, who will step into the position on February 15, 2021.
OncLive: In the 8 years you have been with ASCO, how have you seen the organization change?
Schilsky: From my point of view, thinking of it in terms of what I tried to accomplish at ASCO, one of the biggest changes has been how [the organization] has now positioned itself and developed the infrastructure, the staffing, and the capability to actually participate in and generate research findings. [This is so that,] hopefully, we can help to answer questions that are important to oncologists and patients, as opposed to our traditional role of disseminating the research findings developed by others.
Think about what ASCO and most medical professional societies do: We put on meetings, we have journals, we have other vehicles through which we disseminate information that is developed by the community that we represent. ASCO continues to do that and do it exceptionally well, but what ASCO is now doing is actually conducting its own research, and contributing that research to the cancer community, as well as highlighting the research of others.
Reflecting on your career with ASCO, what have been the most rewarding aspects of it?
I have had great colleagues inside ASCO, and it’s been tremendously fun and productive. The key things that I’m particularly proud of are developing, launching, and continuing to oversee ASCO’s first clinical trial, the TAPUR study. This has been and is still generating important results that we believe will contribute substantially to the knowledge base of how oncologists use targeted therapies, particularly in circumstances where the target of the treatment is present in a patient’s tumor, but the drug is not already FDA approved for use in that tumor type.
That’s the whole essence of TAPUR: to generate information about how these approved drugs perform outside of the labeled indications when their genomic target is present in the patient’s tumor. That was a huge undertaking. The study is now operating at 125 sites in 24 states. We have more than 2100 patients enrolled, and we are generating results as quickly as we can crank them out. To do all that, we had to build an entire team within ASCO; we now have a team of 15 full-time ASCO staff [members] whose only jobs are to work on TAPUR, and determine how to put together the whole national infrastructure that is necessary to conduct a multicenter clinical trial.
Having done that strengthens ASCO’s position to do other kinds of clinical trials in the network of sites that we’ve now assembled as the TAPUR Network. These are all outstanding clinical trial sites around the country, and they have the interest and the capacity to conduct additional studies that ASCO might be able to generate in the future. That was a big focal point of my activities in my first few years at ASCO, but having built that team and developed that trial, it became clear that we could do more than that if we organized our staff and our activities around the theme of data analysis and research.
That led then, in 2017, to the formation of a new department in ASCO: The Center for Research & Analytics [CENTRA]. Through that department, we have put together a team of about 25 individuals. What they now have the capacity to support is not only prospective clinical trials, but prospective observational studies of survey research, [and other] data that will be of interest to our members. [It also involves assisting] other students that go in their own research, planning and research, and analysis and presentation of their research results. Having put CENTRA together has positioned us to do things fairly quickly, [such as] launch ASCO’s coronavirus disease 2019 [COVID-19] registry; we did this over the course of about 1 month, last April.
That registry, which is still enrolling patients from around the country, now has more than 1600 patients who have a diagnosis of cancer and a confirmed diagnosis of COVID-19. We are beginning to use those data to gain a lot of insight into which patients are at greatest risk from COVID-19 infection, what their outcomes are, how their cancer treatments might have been disrupted during the pandemic, and what the impact of that will be. All this and much more that we’ve done really has been, for me, a huge amount of fun.
On the flip side, what have been some of the biggest challenges throughout your career that you had to overcome?
It is a challenge that I’ve confronted in every organization in every part of my career, and that is establishing priorities. That is always a challenge, because there’s always more that you would like to accomplish than you have resources available to accomplish in a reasonable period of time. [This is especially true if] you are leading a big national organization, such as ASCO; or a leading a cancer center, like I did at the University of Chicago; or leading a cooperative group, like I did when I was chairman of the [Cancer and Leukemia Group B] for many years.
There are always more ideas, more constituencies, and more needs identified than your organization can address. Therefore, the question always is: How do you establish priorities? How do you remain focused on those priorities? ASCO is so different in that regard; we try to meet the needs of all oncologists working all around the world, in every care setting, with a variety of different resources available to them. There are always things that people think that ASCO can or should be doing, and we would like to be able to do all of them, but we can’t.
Therefore, we have to set our priorities. We’ve done that over the past few years by developing a strategic plan that was approved by the ASCO board, and then trying to use that to guide our priority setting.
Knowing everything that you know through this position, what advice can you provide to Julie Gralow, MD, as she begins to take over as chief medical offer?
I have already started to give her some advice. To a great extent, the only advice I can give someone who is as experienced and accomplished as [Dr. Gralow], is to take the time to listen and learn. ASCO is a large and complex organization; it is really a family of organizations. There is the professional society we call ASCO, and there’s the ASCO Association [for Clinical Oncology], our more recently formed 501(c)(6) organization. There is Conquer Cancer, our philanthropic arm, and there is CancerLinQ, which is a separate governance structure.
The chief medical officer of ASCO has his or her fingers on all these entities that comprise the real ASCO that most people don’t even know or think about. [I remember] when I came in to ASCO, having been a member since 1980, having served on the board of ASCO, having been a past president of ASCO, and thinking, ‘Well, I already know everything I need to know about ASCO to do this new job.’ It was clear that there was far more to learn about ASCO than what I knew from being a volunteer leader and I’m sure the same will be true for Julie.
The best thing for her to do is to bring the benefit of all her experience, expertise, and passion to the job and listen to her colleagues who’ve been working at ASCO for many years. Listen to our members to understand what they need and what they value from ASCO. It will take her a number of months to get fully up to speed, but she’ll do a great job.
What are going to be your short- and long-term retirement plans? What is next for you?
I view this as I’m retiring from ASCO, and I’m retiring from full-time employment. However, I don’t feel like I’m retiring from working in the oncology community; there is still a lot more I’m interested in doing. I hope to be able to do it at a more leisurely pace and to focus on those projects that are going to be the most fun and the most impactful.
One thing I’m very pleased about is that ASCO is allowing me to continue as the principal investigator of the TAPUR study for at least another year, and maybe beyond. That is a study that I’ve invested so much time and effort in, and it is really just beginning to generate a lot of results. I will continue to be involved in leading it in the foreseeable future. For other entities that I’ve been working with over the years, [include being on] the board of directors of Friends of Cancer Research, and the board of directors of the Reagan-Udall Foundation for the FDA; I will continue in those roles. I’m on the editorial board of the New England Journal of Medicine, and I will also continue to do that. Then, I’ll see what else surfaces as an opportunity for me to continue to contribute in ways that I will find interesting and engaging and, hopefully, [have a] high impact.
Looking at the field of cancer care, what would you love to see happen over the next 5 years?
It’s sort of a big question, right? One of the things that we have to be sure of and has been a major focus of our current president at this time, Lori Pierce, MD, is [to ensure] that every patient with cancer has the opportunity to obtain the best possible cancer care. We still have significant disparities in access to care in this country that have led to [varied] outcomes for different populations.
Until we can be sure that every patient gets the opportunity to receive the best available therapy currently available, we’re not going to be able to ensure that everyone benefits from all of the robust research efforts of the past 50 years, so that’s a big issue: access to care.
Another part of that is access to participation in research. We have several initiatives going on to ensure that older people, minority populations, and other underrepresented groups participate in clinical trials. [Those efforts] will generate data that is used to guide the treatment of those groups of people in the future. If they’re not in a trial, then the trial data are not representative enough to know whether [the data truly] apply to these specific groups.
Many other clinical research initiatives [are ongoing]. As you may know, ASCO puts out its Clinical Cancer Advances report every year. The 2021 report is going to be coming out very shortly, within the next couple of weeks. A lot of them are focused on personalizing cancer care, which I’m proud to say was my theme when I was the president of ASCO and in many ways, was some prescient. The ASCO Annual Meeting occurred in 2009 [when I was president]. Here we are, 12 years later, and I was talking about personalized cancer care back then. Now, we’re actually able to do it, and we can do it better.
We have many aspects of care where there is uncertainty as to which patients will need a specific treatment—for example, adjuvant therapy. Many patients are cured by surgery, but not everyone. Therefore, how do we identify up front those patients who need and will benefit from adjuvant treatment and those who don’t need it and can safely skip it?
Once we have decided that a patient needs to have treatment, how do we determine the best treatment for that individual? Many of these decisions are guided by biomarkers that have been developed, but we need better, more specific biomarkers that really can help us direct the best possible therapy to each individual person.
You’ll also see in our Clinical Cancer Advances [for 2021], just to give you a little hint of what’s coming out, a statement about the potential of artificial intelligence to inform more precise cancer diagnosis, more accurate interpretation of cancer imaging, and the ability to collate large datasets in ways that lead to new insights. That is an area where there is enormous potential.
Every oncologist now has so much information that they have to assimilate; having tools that can guide them to a decision are going to be increasingly important. A big part of what I hope to see in the future is the development of decision support systems, artificial intelligence systems, and automated platforms. [These systems] will take in the information that oncologists have about their patients, their patients’ tumors, the genotype of the individual, the genotype of the tumor, and help the oncologist process enormously complex information [to formulate] a treatment approach that is highly personalized for each individual patient. I’m optimistic about all of that happening over the next 5 to 10 years.
In 2018, you were named a Giant of Cancer Care® winner in Community Outreach/Education. Looking back on that moment, how did it feel to receive that recognition that is bestowed upon by your peers?
You just hit the nail on the head. All of us, in a sense, who have lived in the research world and spend time in the academic community, value peer recognition probably more than anything else. That’s what is inherent in academic promotion. That is what is a key element of getting your grant funded, getting your abstract on the program at ASCO, or getting your paper published in a high impact factor journal. It really all represents various ways in which your peers are evaluating you and the work you do and determining it to be worthy of recognition. To a great extent, the same is true for any award that anyone might receive, but particularly one where you’re selected by your peers, because there’s no greater reward than having the people that you know and work with every day, and even those who don’t [work with you] but maybe you have influenced, recognize you for your accomplishments. That is one of the really nice things about that particular award.
Is there anything else you would like to share with the oncology community as you prepare to leave your post at ASCO?
ASCO is a great organization. It will continue to thrive; I’m quite confident its future is heavily dependent on the engagement and participation of its members. I would strongly encourage all oncologists to join ASCO, to participate in ASCO, to contribute to ASCO, and to benefit from being part of the ASCO family. That is what will ensure that ASCO continues to have its maximal impact for all of the rest of our community. Fundamentally, ASCO’s role in the cancer community is to ensure that oncologists have all the knowledge, tools, and resources that they need to deliver the best possible care to people with cancer. That requires the whole community of oncologists to come together and share information through an organization like ASCO, to be sure that everyone is equipped with the knowledge they need to do what’s best for each individual patient.