Oncology, Etc. – On Leadership and Pearls of Life with Dr. Susan Desmond-Hellmann (Part 1)

Part one of this two-part Oncology, Etc. episode features an inside look at the amazing career of Dr. Susan Desmond-Hellmann (spanning from early AIDS research in Kenya and drug development at Genentech, to serving as UCSF Chancellor and CEO of the Bill and Melinda Gates Foundation). Hosted by Drs. Patrick Loehrer (Indiana University) and David Johnson (University of Texas). Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 11/04/21   TRANSCRIPT [MUSIC PLAYING]   SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. DAVE JOHNSON: I'm Dave Johnson. I'm a Professor of Medicine here at UT Southwestern Medical School in Dallas, Texas. PAT LOEHRER: I'm Pat Loehrer. I'm Director of the Centers of Global Health at Indiana University Melvin and Bren Simon Comprehensive Cancer Center. DAVE JOHNSON: We have a remarkable guest today, Dr. Susan Desmond-Hellmann. She's like the Wonder Woman of oncology who's done many amazing things during the course of her career. It would take us more than an hour or more just to read off her CV. But very briefly, Dr. Hellmann is a graduate of the University of Nevada, Reno where she got both her Bachelor and her medical degrees. She received her medical training at the University of California, San Francisco. And then after that, did something really interesting. She went to Uganda for a couple of years and worked at the Ugandan Cancer Institute where-- maybe we can delve into that a little bit later during the course of this discussion to find out what she did while she was there. After which, she also did a couple of years of private practice and then joined industry, first at Bristol Myers, where she was instrumental in the development of a very important drug for a lot of different diseases-- paclitaxel And then in the mid-90s, she joined this little biotech company called Genentech, first, I think, as a clinical scientist. But over the course of a few years, she rose to the level of president of product development and really was instrumental in developing many drugs, including trastuzumab and bevacizumab. In fact, I think it was Forbes magazine that named her as one of the world's seven most powerful innovators, which we have to ask her more about that later, about being a powerful innovator. After really a stellar career in the industry, she then went back into academics. She became the chancellor of the University of California, San Francisco, and I believe the first woman to hold that position, if I'm not mistaken. During her tenure, many remarkable things happened at UCSF, including growth of their campus in the Mission Bay. She was responsible, with a committee put together by the National Academy of Sciences, of producing the report entitled Toward Precision Medicine, Building the Knowledge Network for Biomedical Research and a New Taxonomy of Disease. In March of 2014, I believe it was, she took yet another position, this time in the world of philanthropy, where she became the chief executive officer of the Bill and Melinda Gates Foundation, a position she held until December of 2019. And that's certainly something we want to ask her about. Dr. Hellmann has many, many accolades. I can't list them all, but she's a member of the Biotech Hall of Fame, the American Academy of Arts and Sciences, the National Academy of Medicine, and she's even received an honorary science degree from Princeton University. They won't even invite us to the campus, Pats. I'm not sure what it takes to get an honorary degree, but Sue, welcome to Oncology, Etc. And thank you so much for agreeing to this interview. SUSAN DESMOND-HELLMANN: Well, thank you for having me. I'm really glad to be here and look forward to our conversation. DAVE JOHNSON: Pat, why don't you ask the first question. PAT LOEHRER: So Sue, if you could tell us a little bit about yourself from birth until your early career and what shaped your early directions. SUSAN DESMOND-HELLMANN: Well, I'm actually a California native and grew up in Reno, Nevada, thus the University of Nevada connection. I'm one of seven children. I'm number two. And my affinity for science and medicine and all things regarding patients came from my dad, who was a retail pharmacist. And that's how we moved from California to Nevada. My dad and his partner Jim opened up one of those Rexall Owl drugstores-- if you ever remember those with the owl picture-- and were partners for many years, ran a pharmacy in Reno, Nevada which, when we got there, was a really small town. And I often chuckle when people say, oh, there's something sort of funny about growing up in Reno, Nevada. Did you go to casinos all the time? The fact of the matter is that my parents were very strict disciplinarians. We weren't allowed to work in the casinos as summer jobs, much less go to the casinos. I went to Catholic school for 12 years. Going to college was the first time I didn't wear a uniform to school, which was funny. But both my values and my passions came from worshiping my dad and the contributions he made to people feeling better. PAT LOEHRER: Love it. Love it. DAVE JOHNSON: It's fantastic. May I ask-- I presume you chose to go to UCSF for your medicine training because of your California connection. Is that right? Or was there other reasons? SUSAN DESMOND-HELLMANN: There were two main reasons. One is UCSF was far and beyond my number one choice because of its reputation. And when I interviewed there, I just was so astounded that I recognized the names of my medical textbooks among the faculty. That was a big deal for me. Holly Smith was a chair of medicine. I mean, it was the dream to go to UCSF. My dad was born and raised down the street from UCSF. And my grandma still lived there. And so, for me, it was also-- being the first time I had been away from home-- it was close enough to Reno that it wasn't crazy to drive back for the weekend. So a little bit more close to home and much more importantly, for me, the mecca where I would just get to be around so many talented people. PAT LOEHRER: When you were there, it was really at the early times of the AIDS pandemic. And there is some wonderful people there that I'm sure you interacted with, included Paul Volberding and the other group. So tell me a little bit about that influence. And that probably led, in part, to the transition to Uganda. But tell us a little bit about that part of your story. SUSAN DESMOND-HELLMANN: So my time at UCSF, first of all, I think it's, especially being in the midst of COVID-19, it made so many of us recall what it was like to be in San Francisco in 1982. It was really exhausting and terrifying to be a health care provider when so many of your patients-- first of all, they died quickly before antiretrovirals. But there was such a lack of understanding of what was going on initially. And so the medical program at UCSF, like a lot of programs of its nature, in New York, LA, led to Paul Volberding, Don Abrams, Laurie Kaplan, a lot of colleagues-- the oncologists became AIDS doctors and oncologists, because of Kaposi sarcoma and lymphoma and other maladies. And I remember I did an additional year as chief resident. And one of our concerns was whether or not the medical residents were overweight HIV and underweight kidney disease and hypertension. And there was a concern that people might not come for the residency because they were worried about catching AIDS. I mean, we were part of a study to test us. And happily, unless you had a needle stick, you really weren't at great risk. But the residency was very much influenced by that. I was very much influenced by that I had a lot of passion for caring for the patients. I think I had a lot of empathy for what they were going through. And think about this, go home and tell your parents you have HIV. And by the way, they didn't know you were gay, because a lot more people were closeted in those days. That's a really tough set of circumstances. So by the time I was an oncology fellow and then a faculty member, I saw, really, all the patients at UCSF at the University Hospital who had AIDS-related cancers. That became my specialty. And I was funded by the California State Task Force on AIDS to study Kaposi sarcoma. But when the Rockefeller Foundation came to UCSF to ask them to study heterosexual transmission of HIV, the late Merle Sande and Dick Root asked my husband, who's an infectious disease doc, and I to move to Uganda and accept this Rockefeller grant and study heterosexual transmission of HIV and Kaposi sarcoma. And I actually think it's a bit of a funny story. But it was less funny then, because I was so uncertain. I had never been east of Chicago at that point in my life. But we flew and moved to Uganda. So I became a global citizen quite quickly. And it was both the most important experience that my husband and I had had in medicine and life. And to say it was challenging would be an understatement. I mean, we did not have consistent electricity or running water. And we had this multi-page grant where we were supposed to do ELISAs and Western blots. It was a little crazy, but we got some things done and that was the important thing. DAVE JOHNSON: So Pat's never been further between Indianapolis and Chicago. So he resonates with him. [LAUGHTER]   DAVE JOHNSON: So you were there how many years? You were there two years, I think. SUSAN DESMOND-HELLMANN: Two years. DAVE JOHNSON: And did you accomplish the things that you set out to do while you were there? Or how did that go? SUSAN DESMOND-HELLMANN: We worked with our Ugandan colleagues and really transformed what you could do at Uganda Cancer Institute at the TB clinic in collaboration with folks from Case Western Reserve and for the AIDS program. So by the time we left, things just were dramatically better and different. We also did a lot of teaching, a lot of patient care. And so there was a service element to what we did, which was really essential that that be part of it. I had the opportunity, when I was at Gates Foundation in 2019, to return to Uganda. And the one thing you got at Cancer Institute, which was founded by NCI-- our National Cancer Institute, they are excellent at record keeping, all paper. And they dutifully pulled out some of the notes I wrote on my patients with Kaposi sarcoma with the references and citations. So this sort of nerdiness that we had at UCSF did transport to Kampala Uganda. DAVE JOHNSON: I hope they gave you some copies of those, with the name struck out of course, for your private collection. That's cool. SUSAN DESMOND-HELLMANN: It was actually pretty astounding to return. And now Fred Hutch has a collaboration with Uganda Cancer Institute and has done a lot of renovations and new science on the virology of Kaposi sarcoma. PAT LOEHRER: So before we skip from this and move to something else, if you could reflect a little bit about what you currently think the importance of global oncology is. It obviously had an influence on you. And how do you think it should fit in or does fit in now? UCSF has got its fingerprints around the globe now. I'm on their EAB. SUSAN DESMOND-HELLMANN: Well, let me just say from-- I'll speak to this sort of personally and then in a more big-picture way. Personally, I felt that the slogan of the Gates Foundation and every place can be too "slogan-y," so you always have to be careful about this. But the slogan that I just so had an affinity for is "all lives have equal value." All lives have equal value, for me, says that someone struggling or suffering, no matter where they are in the world, is worthy of our care and attention. And global oncology, I think, reflects that. So one of the things that I learned when I was there-- and I felt really good about this. I was glad that I learned from colleagues in Uganda and they learned from me. And so there was a real collaboration on figuring out-- I'll give you a real example. As you know, Kaposi sarcoma causes a lot of edema and lymphedema in the lower extremities. Well, if you've got lymphedema in your lower extremities, you can't farm, you can't dig, you can't feed your family. And we had bleomycin and vincristine. And with a combination of those two, in relatively small amounts to avoid toxicity, I could get someone back on their feet literally. And well, that's a great thing. And so the practical nature of symptom improvement, the avoidance of side effects, the attention to quality of life was amplified by my experience there. So I think those kinds of things-- I always like, in life, you give and you get. I gave. I contributed. I worked hard. And I got a lot of new knowledge and understanding. In addition, the deep understanding of pathophysiology that came from thinking about African Kaposi sarcoma, Mediterranean Kaposi sarcoma, age-related Kaposi sarcoma. There's just a lot of science, just a lot to learn if you were paying attention and probing what was going on. So I think global oncology is extremely important. And it's important that it be sustainable and appropriate and with, always, service and training as a component, not only research. PAT LOEHRER: Agreed. I agree. DAVE JOHNSON: We have so much to cover, I don't want to spoil everything. But I'm really curious when you left Uganda, you went into private practice, right? SUSAN DESMOND-HELLMANN: Mm-hmm. DAVE JOHNSON: How did that happen? SUSAN DESMOND-HELLMANN: We had to pay the rent. DAVE JOHNSON: There you go. SUSAN DESMOND-HELLMANN: Yeah. Yeah, when we came back, there was no global health. There was no place for us at UCSF. So we had one of those surreal academic experiences of sitting down with the new chief of medicine and him saying, there's no money for you. So you'll need to do a lot more clinical care and earn your salary. And Nick, you're going to-- my husband-- you'll need to write at least two R01 grants. And so you better get moving. And we were disappointed that there really wasn't a place or mentorship or anything for us at UCSF. But we didn't have time to lick our wounds. So Nick is from Kentucky. And we moved back to Lexington, Kentucky and went into private practice. DAVE JOHNSON: Yeah, economic necessity has changed. SUSAN DESMOND-HELLMANN: I mean, I can make it a little more romantic and interesting, but it was economic necessity. And honestly, I love patients, I love oncology, and I thought that was fine. One of the learnings from that was how deeply I missed research and R&D. And I'm very academically oriented. And so both Nick and I realized, when we were there, that we did very well. People liked seeing us as clinicians. And we were well-trained and could take good care of people. But it wasn't the right fit. DAVE JOHNSON: So from there, if I remember correctly, you transition to industry. SUSAN DESMOND-HELLMANN: Yeah, actually it's a good story. So Nick got called up about from Bristol Myers Squibb, did he want to come and join their infectious disease group up in Connecticut at Wallingford. And he said, of course, I would love that. But I won't come unless you take my wife too. And they said, no, we have a nepotism rule. We won't take your wife. And he said, well, you haven't met her yet. They said, why do we want a private practice oncologist at Bristol Myers Squibb. We need serious clinical trials people. And so Nick was somewhat persistent. And he just said, I won't come. He's a good husband. That's it. PAT LOEHRER: Sounds like it. SUSAN DESMOND-HELLMANN: He still is. And so they hired me as a consultant. And they were really busy on Taxol. It had gotten approved for ovarian cancer but not yet for breast cancer. And so I like to say they stuck me doing drug safety. And saying, she's like an LMD, she's a clinician. We'll have her do drug safety. She can't cause too much harm over there. And I tell you, the opposite of going into private practice, which was just, like I said, not a great fit. I felt like I had died and gone to heaven. First of all, it is probably embarrassing and says something about me, I loved drug safety-- loved, loved, loved drugs-- it's like thinking like an epidemiologist, a clinician, a good physician. You know, I love statistics and epi. I had gotten an MPH at Berkeley while I was an oncology fellow. And I just love analytics and inference and all of that stuff. And so after a couple of months they had changed me-- they got a dispensation from the CEO so I could be a real employee. And I became the project team leader for Taxol, which was fantastic. It was such a great experience. I loved the colleagues at BMS. And we were making one of the first new oncology drugs in a while. DAVE JOHNSON: Yeah, I think, if memory serves me correctly, that's about the time we first met. SUSAN DESMOND-HELLMANN: Yes. DAVE JOHNSON: And paclitaxel was being investigated in lung cancer. And that really is our connection. But those were heady times. We thought we were on top of the world. SUSAN DESMOND-HELLMANN: Well, you know, it had been a while since there had been new active chemotherapies in oncology. And they were heady times. It was also just so interesting and hard to remember now how much the toxicity of paclitaxel had put it on the shelf, this hypersensitivity reactions and the collaboration with the National Cancer Institute. There was a lot about the product development of paclitaxel that I remember and learn from. And I was just really grateful to be with Renzo Canetta and people like that, who it felt like going to UCSF where I thought, OK, Floyd Rector in nephrology. Now I get all these folks who I was using bleomycin and platinums. And they had written those package inserts. DAVE JOHNSON: Yeah. PAT LOEHRER: Yeah Bristol Myers basically owned oncology. I mean, all the products were going on there. And at that time, as you guys know, there's only one or two drugs a year that got approved for oncology. And today it is vastly different where each week there's a new drug or a new indication for oncology. The world has just changed tremendously. SUSAN DESMOND-HELLMANN: Yes. PAT LOEHRER: Yeah, it's been incredible. So Dave, where do you want to go next on this one? DAVE JOHNSON: Well, I think one of the things that I think our listeners might want to learn about is Sue's transition to Genentech. I mean, it wasn't like the powerhouse organization it is today when you went there. I mean, not that it was a hole in the wall, but it wasn't the biomedical powerhouse that it is. What attracted you? I'd love to hear from you, what brought you to Genentech? SUSAN DESMOND-HELLMANN: So I would say three things. The first thing was Art and his ambition. And so Art-- DAVE JOHNSON: You might want to tell people who Art is. SUSAN DESMOND-HELLMANN: So Art Levinson, who then was the head of R&D and later became the CEO of Genentech, so Art Levinson worked in Mike Bishop's lab at UCSF. And so he, in many ways, showed up as a molecular oncologist as the head of R&D at Genentech. And his ambition was that Genentech would be an oncology company. When I talked to Genentech, they had precisely zero oncology drugs. The furthest along was gamma interferon in their pipeline. So it didn't actually look very promising at the time. But Art was very compelling to talk to, and his dream. The second thing was research. Bristol Myers Squibb was fantastic. But especially being in Connecticut, where you were sort of removed from the research enterprise, I saw BMS as fantastic clinical development organization and sales organization. They did a lot of licensing deals. That was their claim to fame was they were really good at licensing. And I respected that a lot. But the ability to sit down with the research folks and think about what you would do with an anti-HER2 or an anti-VEGF-- and I just really respected Genetech's research capabilities and organization. And the third thing was we made the decision-- which wasn't an easy decision to make. We had built a house in Connecticut. We were happy there. I don't know if you remember the winter of '94 was huge blizzards in Connecticut. Before we moved to Connecticut, I didn't even own a winter coat. So it was rough to experience winter in the Northeast. And my family was in Reno and San Francisco. And so moving back here was compelling. PAT LOEHRER: Not the romance that you had in Christmas in Connecticut with Bing Crosby. It just wasn't the same, was it? SUSAN DESMOND-HELLMANN: Well, I did love fall. I'll tell you, nothing like autumn in Connecticut. There's a lot to like about Connecticut. So it wasn't an easy move. But coming back West was a good thing. DAVE JOHNSON: Well, what was the first really successful product that you worked on with Genentech? I should know, but I don't remember. SUSAN DESMOND-HELLMANN: Oh, the first successful product that I worked on with Genentech was a collaboration with IDEC on Rituxan. And rituximab was really interesting because there's some real heroes at Genentech, including a business development guy, David Ebersman, who heard that maybe an antibody could work, even a chimeric antibody could work for lymphoma. And so with Antonio Grillo-Lopez and the rest of the folks at IDEC, we got the first antibody approved in 1997. And that made a massive difference. I don't think people recognize how important rituximab was for trastuzumab, which was really only a year later-- less than a year later-- approved for HER2 positive breast cancer. But for me, that opened the era of antibodies and made people believe you could repetitively give a patient with cancer an antibody and they would tolerate it. DAVE JOHNSON: How confident are you that would work? SUSAN DESMOND-HELLMANN: I was very confident that rituximab would work. There was a lot of information. I wasn't sure we could make it. That required a lot of biotech manufacturing expertise that Genentech had, which was great. But I felt good about that. But there was a myth, at the time, that you could treat a liquid tumor, you could do heme, lymphoma or leukemia with an antibody. But there was this big worry you couldn't get into the tumor with a solid tumor. So I was not at all confident about Herceptin. Trastuzumab was not a give-me. But rituximab I was confident about. PAT LOEHRER: This concludes part one 2-part interview with Dr. Susan Desmond-Hellmann. It was a wonderful discussion. In part 2, we'll talk a little bit more about Dr. Desmond-Hellmann's incredible leadership roles, including her time as chancellor at UCSF and the CEO of the Bill and Melinda Gates Foundation. Thank you to all our listeners for tuning into Oncology, Etc. an ASCO Education Podcast where we'll talk about anything and everything. If you have an idea for a topic or a guest you'd like to see on the show, please email us at [email protected]. Thanks again. And just remember anything, because Dave doesn't. SPEAKER: Thank you for listening to this week's episode. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.