September 10, 2010
5 min read

Fernando Cabanillas, MD, helped develop relapsed lymphoma salvage regimens

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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 adventurous foodie.

What do you enjoy doing when you’re 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 hadn’t gone into hematology/oncology, what would you have done?

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 can’t conceive of myself as a corporate lawyer.

What is the best advice you’ve 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 her.

What would you consider one of your biggest successes in your specialty?

My biggest success is developing a series of salvage regimens for relapsed lymphomas and developing curative therapy for indolent non-Hodgkin’s 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.

Fernando Cabanillas, MD
Fernando Cabanillas

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) regimens.

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 Freireich’s 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 example.

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. It’s 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 don’t exercise enough, but I don’t 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. It’s 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 don’t turn down when invited to speak.

What is your favorite restaurant?

In Puerto Rico, it’s 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