INEN and MD Anderson: Sisters in the Fight to Cure Cancer

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On March 16, faculty and staff of MD Anderson and Instituto Nacional de Enfermedades Neoplásicas (INEN), as well as representatives of the government of Peru, met in Lima to formally sign a sister institution (SI) agreement.

Administered by MD Anderson's Global Academic Programs (GAP), SI agreements are a concrete expression of MD Anderson's belief that an institution is a valuable partner in the fight against cancer, as well as a willingness to engage collaboratively to further the aims of helping patients and eradicating cancer. In INEN's case, the development of this partnership has been nearly four decades in the making.

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When talking to major players in cancer care, especially leukemia, there is a name routinely referenced. For baseball fans it would be akin to speaking of Mantle, Ruth or DiMaggio, or to the physics crowd similar to discussing Planck, Feynman or Einstein. 

It takes a few discussions with prominent researchers before one realizes there are certain individuals who have had a comparable impact on the world of oncology. An impact, which throughout the remaining story of man will silently ripple, often imperceptible to those who would learn or benefit from it.

 In the field of chemotherapy, Emil J Freireich, M.D., D.Sc., is such an individual. In his 45 years at MD Anderson he also engaged other seeking minds who now are leaders at major cancer centers, including Carlos Vallejos Sologuren, M.D., director of MD Anderson's newest sister institution, Instituto Nacional de Enfermedades Neoplásicas (INEN).Freireich was the first scientist to use combination therapy to treat leukemia. The idea sounds simple, but before Freireich in the 1950s, there had been little rhyme or reason to how chemotherapy was employed and multiple drugs had not been combined to fight leukemia or any other cancer. Freireich's work on acute lymphoblastic leukemia (ALL) changed the disease from being a death sentence to as high as a 75% cure rate; it was the first therapy to cure a systemic cancer. 

Freireich and other notables, including Emil Frei, M.D., James Holland, M.D., and Donald Pinkel, M.D., established clinical cancer research as we know it. Over the subsequent decades, Freireich and his colleagues have gone on to demonstrate the effectiveness of, or to develop, more than 70 drugs and combination chemotherapies.

In the early 1970s a young physician from Lima, Peru, went to work with Freireich at MD Anderson as a fellow in the Department of Developmental Therapeutics. The research in which Vallejos engaged while working with Freireich instilled in him a distinct drive for his own efforts to enable Peru to benefit from, and contribute to elucidating, new cures and improved care.

"Working with Freireich and others at MD Anderson taught me the discipline of research and clinical management," Vallejos explains.

Vallejos returned to Peru and INEN and was appointed chief of the chemotherapy service. His first step toward engaging INEN in international collaborations came when the institution was provisionally admitted to the Southwest Oncology Group (SWOG) in 1975. SWOG is one of the largest National Cancer Institute (NCI)-supported cancer clinical trials cooperatives. 

Through this engagement, Vallejos and INEN were able to contribute to new treatment techniques in acute leukemia, multiple myeloma and malignant lymphoma. During this time, MD Anderson was a prominent member of SWOG. This allowed the two institutions to further the growth of their collaborative bond.

Vallejos, believes this contribution in clinical research, which has expanded to include additional working groups, has led to INEN's establishment as the preeminent cancer center in Peru and as a globally recognized contributor to cancer care and research. According to Vallejos these are the primary reasons for the codification of MD Anderson and INEN's association in the form of a sister institution agreement. 

For Vallejos, the goal is no longer his own research but to enable INEN to continue on its path, with ever-increasing involvement and contribution, in research intended to improve cancer patient care. The tutelage he received from Freireich rings out as clearly now as nearly 40 years ago. Cancer can be solved and effort and research are the tools to solve it. "Defeating cancer is and will be our goal," Vallejos states.

So MD Anderson and INEN have a common vision, sustained by the past and focused on the future. A delegation of MD Anderson faculty, led by MD Anderson Provost Raymond DuBois, M.D., Ph.D., and including Vicente Valero, M.D., Javier Adachi, M.D., Roberto Adachi, M.D., Michael Keating, M.D., and Oliver Bogler, Ph.D., visited INEN to participate in a two-day symposium and to sign the sister institution agreement at the Presidential Palace with the participation of Peruvian President Alan Garcia. 

The participating faculty represented programs that are already working with colleagues at INEN, including Valero's breast cancer program and Adachi's infectious disease group. New collaborations are being built in leukemia with Keating's involvement. Future visits will incorporate prevention, a new area of emphasis at INEN, as well as gastric and cervical cancers, two prominent diseases in Peru.

"I am very proud of Dr. Carlos Vallejos, who is a trainee and alumnus of MD Anderson, and whose leadership has been crucial in setting up this cancer center and the success that it has had so far," says DuBois, who outlined opportunities of how INEN and MD Anderson can work together to make an impact on cancer.


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