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Vince DeVita’s Oncology Opus

— Medicine and music share center stage in storied career

MedpageToday
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Credit: Yale School of Public Health

When he was 30 years old, MD, discovered what was to become one of his greatest passions in life outside of his family and career in oncology.

The man who was to become a pioneer in combination chemotherapy, a Lasker-awardee by age 37, the future National Cancer Institute director who led "the war on cancer," and one of the most respected and celebrated leaders in cancer research, education, and treatment, was lying in bed one afternoon and listening to the radio when a new love wafted into his consciousness.

"I was in Bethesda listening to Texaco's matinee opera hour playing , which I'd never heard of before in my life, and listened to the entire opera and then said, 'This is terrific, I have to go the opera,' which I did when I had a meeting in New Orleans and went to see Verdi's ."

After that DeVita was hooked. Referring to himself as an opera "maniac," he estimated that he's seen more than 1,000 operas over more than half a century, noting that his apartment in New York for 26 years is next door to the Metropolitan Opera. He also admitted to being a fan of Dixieland jazz.

In fact, DeVita, 82, spoke with app by telephone in July while he and his wife Mary Kay were at the festival in Cooperstown, N.Y., which they have faithfully attended annually for the last quarter century.

DeVita confessed that if he hadn't become an oncologist he would have liked to have been a composer or conductor, and said his greatest regret and disappointment was not having more musical training. He said he's a good listener and has done a lot of reading but really isn't talented. He played the guitar and sang in college, and claims that the ruler raps on his knuckles by Catholic school nuns had dissuaded him from continuing his piano lessons when he was a kid.

DeVita said that he had originally had his sights on becoming an ice man, like his childhood idol, Nunzi, who carried large chunks of ice and filled the family's ice box in their Bronx home in the 1930s and '40s. Since this career aspiration was not much to his mother's liking, she would tell others that her Vincent would become a doctor, and so it would be.

When it was time to apply for college, DeVita considered Columbia University, but another school loomed large in his family's heritage. His maternal grandfather had been talented at restoring antiques, and when he was working at the American Museum of Art, John D. Rockefeller Jr. discovered him and hired him for the restoration project of colonial Williamsburg in Virginia.

His grandfather established a restoration business in the town of Williamsburg, which was continued by DeVita's uncle with his mother's help, and so the boy from the Bronx matriculated at the neighboring College of William and Mary.

"Going to William and Mary was probably the best thing that ever happened to me. It polished me up, and I met my wife there, and my daughter [Elizabeth DeVita-Raeburn, with whom he co-authored ] also went there." He also remembered visiting colonial Williamsburg during college and seeing restored tapestries bearing his mother's name.

He defined "polished" as learning to slow down his fast-talking New York speech into a more understandable cadence, and getting his ducktail hair trimmed into the crew cut favored by his classmates.

He eventually became president of his mostly white Anglo-Saxon Protestant fraternity, which he further integrated with its first Jewish member. And before starting medical school at George Washington University, he took a short interlude with the Marine reserves, which, he explained, allowed him to have a car on campus, even though he cut most of the formal classes. One year following graduation he married Mary Kay, who taught elementary school while he attended medical school.

Today, Mary Kay is an accomplished artist, with some 34 paintings adorning the walls of their home. In addition to Elizabeth they also had a son Ted, who died at 17 of aplastic anemia (diagnosed by DeVita), and whose story, along with another patient, served as the inspiration for the 1976 TV movie, "The Boy in the Plastic Bubble," starring John Travolta. Ted's story was also depicted in Elizabeth's book, .

DeVita's original interest in cardiology switched to oncology after he blew an interview for the Heart, Lung, and Blood Institute, and with the Viet Nam draft looming, he joined the NCI in 1963 as a clinical fellow, where he got immersed in the pharmacology of anti-cancer drugs. He witnessed some of the early leukemia trials and worked with, among others, , MD, and , MD.

He left NCI briefly to continue his training at Yale-New Haven Medical Center and returned to the cancer institute in 1966 as a senior investigator, where he led development of the combination chemotherapy (mechlorethamine, vincristine, procarbazine and prednisone) regimen to treat Hodgkin's disease and diffuse large cell lymphomas.

The regimen's success helped establish combination chemotherapy as a standard cancer therapy, and he also developed the CMF (cyclophosphamide, methotrexate, fluorouracil) regimen for breast cancer with , MD.

During his interview, DeVita recalled how controversial combination chemotherapy was back then. "It was considered bad medicine by many, especially because the commonly held belief was that drugs were only effective as single agents and mixing them was somewhat dirty," he said.

But DeVita was encouraged by experiments using combination drugs on mice conducted at NCI by , PhD. Frei and Freireich also took notice and had started their (vincristine, doxorubicin, methotrexate and prednisone) regimen for children with Hodgkin lymphoma. DeVita recalled seeing kids who would previously die going into remission.

He noted that it was not easy being a young guy having to tell researchers 20 years his senior that they were doing something wrong -- at least that's how they took it -- and DeVita credited Frei for backing young innovative researchers.

At NCI, DeVita climbed the career ladder, and in 1980 was appointed NCI director by President Jimmy Carter, later reappointed by President Ronald Reagan.

He said that opera was very therapeutic during the high stress times on the job, and that he believes that to succeed, NCI directors have an obligation to be a spokesperson for the field and should speak up on clinical issues.

Leading the NCI requires understanding the clinical side as well as the laboratory aspects, DeVita said, and that it was very important that leaders know what they don't know and deal with it by listening to experts.

He is critical of the FDA's requirement that every drug be approved in a "one-at-a-time mode," greatly slowing down approvals of curative combination therapies, and noted that under today's regulations, the MOPP protocol would have taken 15 years to be approved.

"The FDA is approving a lot of drugs that are easy to approve two to three years later than they should be approved. A few years ago, everyone in the country who knew something about lung cancer knew that were the best drugs to come along in a long time, and although it was approved for melanoma and they knew the safety profile, it still wasn't available for patients to use off study."

He said that the FDA should approve drugs based on parameters other than survival as an endpoint, such as interim markers and response rates, and that even if a new drug is not necessarily superior to an existing one, it should still be made available since oncology needs all the tools it can get.

Following his tenure as NCI director, DeVita moved back to his hometown as physician-in-chief at Memorial Sloan Kettering Cancer Center. He was director of the Yale Cancer Center for 10 years, and continues as Amy and Joseph Perella Professor of Medicine at Yale Cancer Center and Smilow Cancer Hospital at Yale-New Haven.

In addition to the Lasker Award in 1972 he has received many other honors, and was president of the American Society of Clinical Oncology from 1977-78, and the last volunteer president of the American Cancer Society from 2012-13.

DeVita was treated for prostate cancer several years ago, and is recovering from knee surgery.

He intends to keep teaching, writing, and offering consultations, with two stipulations: that his work remains financially independent through his endowed professorship, and that he will never seek a job that would be more beneficial to the career of a less-senior individual.

He's currently editing the 11th edition of , and said that he and daughter Elizabeth are "nibbling" at working on a second book together.

"Working with her is a lot of fun, but she can be a real slave driver, and we have so much material," he said, revealing only that The Death of Cancer dealt more with history and the next one will be more instructive, focusing on his experience with medicine and "conveying wisdom more than history."