Fernando Cabanillas, MD, medical director of the Auxilio Mutuo
Cancer Center, in San Juan, Puerto Rico, and clinical professor at The
University of Texas M.D. Anderson Cancer Center, is also an editorial board
member for HemOnc Today. In his spare time, Cabanillas enjoys
traveling to Latin America and Spain and considers himself a fervent and
What do you enjoy doing when youre not practicing medicine?
I love to analyze data that we generate from our in-house
clinical trials. I consider it a hobby, probably my favorite one. My wife calls
it playing with the computer, but she knows there is more to it
than playing. Nothing is as gratifying to me as identifying a new,
previously unrecognized finding.
Another thing I love to do is collect and organize music that I can
listen to and later share with my friends. I downloaded my entire music
collection to my iPod and now have over 4,000 songs stored. I also try to find
time to read Latin American literature.
If you hadnt gone into hematology/oncology, what would you have
Sometimes I am terrified to think that I once considered law school.
However, had I decided to go into that field, I am sure my practice would have
been concentrated in helping the underprivileged, as well as those whose human
rights have been violated. I cant conceive of myself as a corporate
What is the best advice youve ever received?
The best advice came from a high school nun. She discovered I was
considering law school and wanted to know why in the name of heaven I was
flirting with that idea when my forte was in science. I never stop thanking
What would you consider one of your biggest successes in your
My biggest success is developing a series of salvage regimens for
relapsed lymphomas and developing curative therapy for indolent
non-Hodgkins lymphomas. I first started working with ifosfamide-based
combinations shortly after I completed my fellowship at M.D. Anderson Cancer
Center. Dr. Victorio Rodriguez and co-workers had identified the single agent
activity of ifosfamide in relapsed lymphomas.
Hemorrhagic cystitis, sometimes extremely severe, was very common during
those days, and in order to be able to complete the treatments, we frequently
had to go to the extreme of admitting the patients to the hospital in order to
push fluids and produce a massive diuresis that would lower the urinary
concentration of the ifosfamide metabolites. We also inserted Foley catheters
into the bladder to keep it as empty as possible to diminish the contact time
of the metabolites with the bladder.
Ifosfamide was clearly not headed for FDA approval, and had it not been
for Dr. Norbert Brock, a German scientist and also the person who discovered
ifosfamide, the drug would have been abandoned. He knew something had to be
done to save it, and he was personally responsible for discovering that mesna
had the property of inhibiting the toxic effects of acrolein, the ifosfamide
metabolite responsible for hemorrhagic cystitis.
Once that drug was added to the regimen, and that hurdle was surpassed,
the next step was to convince Bristol-Myers Squibb that the drug was an
important addition to our armamentarium. The person at Bristol-Myers Squibb in
charge of the development of that drug had the erroneous idea that ifosfamide
was a me too drug, which was essentially the same as
cyclophosphamide. Over time, we were able to prove ourselves correct, and it is
now one of the most important agents in the salvage therapy of aggressive
lymphomas, as well as for testicular carcinomas.
I was fortunate to have been given the freedom to develop the drug
further with the help and guidance of Dr. Gerald P. Bodey and Dr. Rodriguez.
This led us to first combine it with methotrexate and vincristine and later on
with etoposide. The combination with etoposide was the most successful and
continues to be used. Other salvage regimens we developed later were based on
the synergism between [high-dose cytarabine] and platinum (DHAP and ESHAP)
More recently, when I moved to Puerto Rico, we started developing
gemcitabine in combination with rituximab and oxaliplatin. We are now in the
process of modifying it further in order to improve this successful salvage
combination, whose toxicity is one of the lowest.
Who do you consider a mentor?
The influence of Dr. Emil J. Freireich and Dr. Bodey on my career is
astounding. Dr. Freireich was the chairman of the department of Developmental
Therapeutics at M.D. Anderson Cancer Center, and Dr. Bodey was the head of
Infectious Diseases and Solid Tumors sections.
I have never met anyone who could stimulate you intellectually as much
as Dr. Freireich. Not only was he an extremely motivating mentor but also a
very challenging boss. Indolent lymphomas were considered incurable during
those days, and he actually challenged me to cure them. That was my homework.
Many of Freireichs fellows became celebrities in cancer medicine.
Under Dr. Bodey, I first learned how to write a solid and
well-structured scientific paper. He also taught me about fairness, and this
was one of the virtues I most admired about him. He was a role model as a
superb clinician and scientist, and I have always tried my best to follow his
What do you think will have the biggest influence on
hematology/oncology in the next 10 years?
There is no question that this field is heading into the use of
biological agents and away from cytotoxic chemotherapy. As we learn more about
the inherent biological and molecular features of lymphomas, we will see more
of these biologic agents introduced into the clinical arena.
What is the last book you read and why?
I love to read Latin American literature, and I love the style known as
magic realism, whose best proponent is Gabriel García
Márquez. Latin America is full of magical elements blended into daily
real life. I also like any literature that has to do with Puerto Rico.
I love Latin music, and I am currently reading a book in Spanish called
Partiré Canturreando. It has to do with the history of
Puerto Rican popular music. Its a fascinating book, full of anecdotes
about composers and musicians.
What kind of diet and exercise regimen do you have?
I dislike strict diets. I love all types of food, and I am very
adventurous. I am ashamed to admit that I dont exercise enough, but I
dont use elevators at the hospital and instead climb the stairs.
What is your favorite travel destination?
My favorite is Spain followed by several Latin American countries. Spain
is a fascinating country, and I have visited it at least 40 times. Its
not one country but rather a number of different countries, each with a unique
culture and many of them with their own language in addition to Spanish. Spain
is one destination that I dont turn down when invited to speak.
What is your favorite restaurant?
In Puerto Rico, its Compostela, but there are many other superb
restaurants on this island, such as El Chayote, among others. In the United
States, my favorite is Le Bernardin in New York, but I have to save money ahead
before making a reservation there. by Christen Cona