THE CANCER WARRIOR

GAYLE PERRON WAS THIRTY-THREE when doctors found the tumor in her breast. Seeing no other alternative, she had a mastectomy, followed by five weeks of radiation therapy, and was told the cancer was gone. She thought everything was fine and resumed her life.

Almost five years later. Perron noticed a recurrent pain in her shoulder. An X-ray revealed that the cancer had spread into her bones. She was told that there was no cure.

Unwilling to give up. Perron decided to seek a second opinion at Houston’s M.D. Anderson Hospital, where a friend had been treated for cancer. She remembers Dr. George Blumenschein. then chief of the medical breast section, calmly explaining to her how he intended to treat her cancer.

Blumenschein’s treatment-a combination of radiation, hormone, and chemotherapies-was punishing. Perron’s hair fell out. She felt weak most of the time. The nausea was so bad she tried hypnosis to control the vomiting that would follow each dose of chemotherapy. When the treatments finally ended more than a year later. Perron was physically and mentally exhausted. But she was alive, and the cancer was in remission.

Ten years later, Gayle Perron feels great. Every six months she checks in with Blumenschein. who now is in private practice at the Arlington Cancer Research Center. For Perron and thousands of women, the fifty-one-year-old oncologist is a “white knight” who beat the odds of what was considered to be terminal breast cancer. They come from around the world, often waiting hours to see him and convinced that he is their last hope.

“He is clearly a leader,” says Dr. Marc Lippman, director of the Vincent T. Lombardi Cancer Center at Georgetown University. “He is a terrific clinical oncologist who is well known for doing a good job.”

Nancy Brinker, who founded the Susan G. Komen Foundation for the Advancement of Breast Cancer Research in honor of her sister, calls Blumenschein “the most charismatic doctor I’ve ever met.” Blumenschein treated Komen in the final stage of cancer that ended her life in 1980. Three years later, Brinker opted for Blumenschein’s aggressive therapy when she discovered a tumor in her breast. “’George is great,” she says. “But he is unorthodox.”

Sixty percent of Blumenschein’s patients show “significant improvement” after his treatment. Of course, that means 40 percent do not. Still, his charisma and eagerness to explore new techniques have made Blumen-schein a celebrity of sorts in the oncology field, adored by his patients and admired by many of his peers nationwide. But those same traits also have made him controversial. When Biumenschein arrived in Dallas three years ago to open a private practice, most local oncologists cringed. Blumenschein was regarded as an egotistical physician who was often overzealous in his treatment of breast cancer patients.

Brinker. who watched her sister suffer an agonizing death, learned the painful lesson that is commonplace in cancer treatment: often, the treatment can be worse than the disease in the short term. Doctors and patients must decide how much treatment to give to a terminal patient, and there are no exact guidelines.

In a field where experts do not share a consensus on treatment methods. Blumenschein has drawn fire for boldly charging ahead with his own battle plan. The doctor admits that his methods of chemotherapy usually result in more side effects and a higher risk of toxicity. His patients lose their hair, including eyebrows and lashes, an emotionally devastating experience for a woman who has already undergone a mastectomy. But Blu-menschein believes that intensive doses-even for treatment of early-stage cancer patients-are necessary to save lives. If all doctors followed his methods, he says, up to 20,000 lives would be spared each year.

Instead, he says, many doctors lower doses enough to prevent hair loss. “They give it in a way that still creates toxicity but does not lower the patient’s risk of dying,” says Blumenschein. ’”In essence, they are killed with kindness.”



BLUMENSCHEIN BROUGHT TO DALLAS the legacy of his twelve years at M.D. Anderson, one of the premier comprehensive cancer centers in the world. “Most Texas doctors don’t like M.D. Anderson because it is too aggressive and too controversial,” he says. “Most of all, it did things differently, and that made it suspect.”

As chief of M. D. Anderson’s breast center, he saw several Dallas patients, including some prominent cases that created a stir in medical circles. His treatment of Karen Lat-timore, whose mother and sister had both died of cancer, put him at odds with the Dallas medical establishment.

“Five years after I started treating her and we were feeling fairly comfortable about our success, we were having a discussion about her mother,” Blumenschein says. “Karen had always assumed her mother had died of breast cancer. But going through the medical records, she discovered that her mother had actually died of ovarian cancer.”

Blumenschein, leery of the family’s susceptibility to cancer, told Lattimore she needed to go home to Dallas and have her ovaries removed.

But Lattimore’s gynecologist recommended that she wait, telling her a hysterectomy wasn’t necessary at her age and that removal of her ovaries would be destructive to her overall health. It would age her, ruining her skin and her beauty for no valid reason, her doctor said.

During Lattimore’s next breast checkup, Blumenschein persisted with his recommendation. Again, her gynecologist dissuaded her. Finally. Blumenschein insisted that Lattimore’s doctor come with her to Houston, “I got the head of our gynecology department and we sat around a conference table and discussed her case for an hour. We finally prevailed upon them that this was appropriate.”

When surgeons performed the hysterectomy a month later, they discovered that Lattimore had stage-three ovarian cancer.

’Blumenschein was absolutely correct.” says Charles Lattimore, Karen’s husband. “She waited too long and it killed her.”



WHEN BLUMENSCHEIN MOVED TO Dallas to practice oncology, he expected some hard feelings. But he says he was unprepared for the reaction he received. Blumenschein’s application to practice at Presbyterian Hospital “met with a great deal of resistance,” he says, adding that he was never given a clear explanation of the problems. Eventually, Blumenschein withdrew his application.

When asked to comment on their reaction to George Blumenschein, most Dallas oncologists declined, including Baylor Hospital’s breast cancer specialists, Dr. Stephen Jones and Dr. Marvin Stone. Both are members of the Texas Oncology Physician’s Association, an umbrella practice to which many of the city’s oncologists belong.

Those physicians who would comment asked that their names not be used.

“’Some doctors feel that he is a little on the aggressive side,” says an oncologist at Presbyterian Hospital. “There is no doubt he is well published and very good in protocols for breast cancer. He is controversial because he’s not mainstream. And some physicians feel he does not have that necessary sense of balance in treating a patient as a whole being.”

The oncology debate is not unique to Dallas, nor is Blumenschein the only physician who practices aggressively. But what makes the debate over treatment more significant here is the fact that Dallas is in the midst of a major effort to become the comprehensive breast cancer center of the U.S. Last year, Baylor Hospital and The University of Texas Southwestern Medical Center at Dallas formed an alliance with the Susan G. Komen Foundation to focus on breast cancer research. Brinker spearheaded the unique triad, and her foundation has pledged $6 million in funding. The directors at Southwestern Medical Center are searching for a scientist who will help organize clinical studies. Eventually, they hope to attract some of the leading breast cancer specialists to come to Dallas to attend conferences.

Yet in this same medical community, one of the nation’s leading clinical oncologists apparently has been snubbed by his peers, and Blumenschein won’t accept any of the blame for the rejection. He says he approached Dr. Eugene Frenkel, head of oncology at Southwestern Medical Center, to offer his expertise. He was given a courtesy title of clinical professor, but has never been asked to attend a breast cancer conference there. Frenkel would not comment.



AS A STUDENT AT YALE UNIVERSITY and Cornell Medical School, Blumenschein assumed he would be a surgeon. But following a year of internship at Bellevue Hospital in New York City, his interest turned to research, and he spent two years with the National Cancer Institute. While continuing his medical training at Northwestern University, Blumenschein established an oncology program. Gradually he realized his niche seemed to be as a clinician. Searching for an institution where he could be at the center of developmental work in oncology, he chose M.D. Anderson.

Under his leadership the breast center expanded from three physicians to a group of eight doctors seeing up to 1,000 new patients each year. “The beauty of it was that all of us who worked on breast cancer worked out of the same office,” Blumenschein says. “We met three or four times a week to discuss protocol, and we observed one another practicing medicine. That guarantees consistency in the way things are done by different individuals. You need that when you are running clinical research, to know that the data you are generating is really the same data.”

In the Seventies, Blumenschein and his colleagues conducted research on the che-motherapeutic management of breast cancer, including use of the drug Adriamycin. But not all physicians use Adriamycin. which Blumenschein believes is the single most effective agent in the treatment of breast cancer. They are concerned about toxicity, Blumenschein says, including cardiac toxici-ty. risk of infection, and hair loss.

In Blumenschein’s view, doctors reluctant to use Adriamycin are still fighting the last war. refusing to employ a potent new weapon in defense of their patients. Blumenschein believes cardiac toxicity can be avoided by giving the drug by continuous infusion over three or four days instead of in one thirty-minute office visit. “This was published in 1978,” he says. “It’s well established. Yet many doctors consider it bunk.”

By 1985. Blumenschein was restless. New leaders in the teaching institution began to de-emphasize patient involvement on the part of clinicians.

“They tried to make changes in the medical breast service, and Blumenschein elected to leave,” says Dr. Emil Freireich, director of the adult leukemia research program at M.D. Anderson. “Frankly, I don’t think the medical breast service has ever recovered the level of achievement and momentum it had.”

With three children in private universities and prep schools. Blumenschein opted for a private practice to increase his earnings. He also wanted a facility where he could call the shots. “I wanted control over my environment,” he says. “If I see a patient today. I may want to know the results of a tumor marker study tomorrow. In a large hospital they may batch those tests and do them once a week. So I may do the test Tuesday and not get the results until Friday or Monday. But if I control the lab, I can say, ’I don’t care what it costs, we are going to do this today and get the results tomorrow.’”

The Arlington Cancer Center satisfied his needs. As one of three partners, he is able to establish such innovative therapies as the autologous bone marrow transplants being tested at M.D. Anderson and a few teaching hospitals in the country. Though the technique-removing and storing bone marrow while the patient is given extremely high doses of chemotherapy-is standard for adult leukemia patients, only recently have oncologists tested it to improve the cure rate of metastatic breast cancer. Programs at some centers have proved too toxic, killing the patient during treatment. But Blumenschein says the M.D. Anderson program is less intensive.

Maggie Campbell was living in Louisiana three years ago when a doctor sent her to Blumenschein to treat her metastatic breast cancer. Campbell stayed in remission for two years and then had a recurrence in her lungs. Blumenschein gave her more chemotherapy and recommended an ovariectomy. At the end of six months, she was in total clinical remission. Then Blumenschein suggested the bone marrow program.

Campbell vividly recalls the horrors she endured. Once the bone marrow is removed, the patient in effect has no immune system, so the real danger is infection. For eight weeks Campbell lived in a ten-by-ten-foot room, visited only by hospital staff who wore sterile masks and gloves to deliver sterile food and water. Family and friends could .see her through a glass wall, but the only communication was by telephone.

At one point, Campbell was running a fever of over 106 degrees. Most of the time she was too sick to do anything but lie in bed. But, she says, she would do it again.

“At the time I had a two-year-old and a five-year-old,” Campbell says. “My children were the fruition of eight years of fertility drugs, and I wanted to be a part of their upbringing. I figured 1 could be inconvenienced by feeling ill for six months if Dr. Blumenschein could give my life back to me.”



GEORGE BLUMENSCHEIN CAN BOAST of many such testimonials from those he has helped, yet he continues to draw the lightning from critics. Perhaps his most controversial venture is his involvement with the Biological Therapy Institute in Tennessee, also called Biotherapeutics. Founded by two former clinical investigators with the National Cancer Institute, Biothera-peutics is a publicly held company that offers experimental cancer therapies-unproven methods that may represent the last roll of the dice for terminal patients. Many of the same therapies are offered by NCI and in teaching hospitals around the country, but Biotherapeutics differs in one significant way: patients are charged for the treatments.

Critics of such private research say it takes advantage of people in desperate situations. Supporters reply that the medical schools, since they do not charge patients, must turn people away because of lack of space. A for-profit center like the Biological Therapy Institute, however, can expand its services as much as the traffic will bear. When Biotherapeutics asked Blumenschein to set up a regional lab in Arlington, he agreed. To date, he says, his colleagues have treated ten patients-none with breast cancer-and only half have paid.

Ironically, the trend in cancer treatment seems to be toward the more aggressive tactics long advocated by Blumenschein.

Last spring, the NCI sent out an urgent clinical alert to oncologists, notifying them of the positive impact of chemotherapy or hormonal therapy for some early-stage breast cancer patients. It was the first time the NCI issued study results in the media before publication in medical journals. The reason: then NCI director Vince DeVita believed that the study would affect the treatment of 60,000 women each year who would not have received adequate therapy for their disease. The dosage dilemma also is discussed in a recent issue of the Journal of Clinical Oncology.

“You’re not going to find a right or wrong,” says Dr. Barbara Haley, a Dallas oncologist who supports Blumenschein’s methods. “A lot depends on the patient. Some want the very latest, some want standard therapy. Others want you to make the decision.”

Because of his reputation, Blumenschein often attracts desperate patients who have been told nothing can be done for them. “Every physician has developed an intuition about when it is no longer good to continue treatment.” he says. “I may have erred in my enthusiasm to treat late-stage patients. But just the other day, I saw on return visits three patients who had been given up by physicians as having untreatable, incurable cancer. All three are in remission.” Blumenschein calls such patients “minor miracles.” And minor miracles keep him optimistic.

“The disease can be dealt with, even in the worst circumstances,” he says. “You have an obligation to explain options to the patient, and to explain where you are and let them make the decision to continue. But 1 have found that most patients will opt to do something constructive. If you don’t do anything, the result is inevitable. I believe patients go to a physician for help.”