Cancer’s biggest enemy
For nearly two decades, Richard Pazdur has been the country’s key figure in approving new cancer treatments. But when his own wife was diagnosed with the dreaded disease, his job took on a whole new meaning
By Kristen Hannum
Richard Pazdur (MD '76) has been called the closest thing this country has to a “cancer czar.” As a leader in the Food and Drug Administration’s oversight of oncology treatments, Pazdur has wielded great power and influence in approving or denying new drug therapies for cancer. In 2015, his work at the FDA even landed him on Fortune magazine’s list of the 50 greatest world leaders. But for Pazdur, 2015 will be remembered for a much more significant event—the loss of his wife after a battle with ovarian cancer.
The couple had met in 1979, the first day of his oncology fellowship on a cancer ward at Chicago’s Rush Presbyterian Hospital. Mary Bagby (BSN ’74, MSN ’78) was an oncology nurse there. Though the two attended Loyola at the same time, they’d never met on campus. “I loved my time at Loyola,” says Pazdur, who recently spoke at the opening of the University’s new Center for Translational Research and Education in Maywood. “We had that common bond from the beginning.”
The couple wed in 1982, and they forged a notable partnership in modern American medicine, with Mary taking a job working in oncology at the National Institutes of Health Clinical Center. “We knew the same people and would talk about the same professional issues,” Pazdur says. “We shared the same friends.”
While some nurses she worked with left the emotionally grueling field, Mary stuck with oncology. Her husband says she stayed, at least in part, because she wanted to maintain their unity.
He joined the FDA in 1999, first as director of the Division of Oncology Drug Products. In 2005, he was named director of the newly formed Office of Hematology and Oncology Products (OHOP), which was created to consolidate the review of cancer treatments. Now Pazdur has again been tapped to lead a new effort—he was recently named the first acting director of the FDA’s Oncology Center of Excellence, part of Vice President Joe Biden’s Cancer Moonshot initiative to accelerate cancer research and make more treatments available to patients.
Through it all Pazdur, 64, has crafted and managed the country’s approach to approving drugs that treat cancer—drugs that might give precious extra years to someone stricken, drugs that are the last hope for families in the midst of loss. There are also drugs that might not help cancer patients at all, but rather increase suffering because of their toxicity. If approved, these drugs can make pharmaceutical companies billions. Cancer is feared, deadly, and widespread, and health insurance and government programs pay for expensive treatments that have been approved by the FDA.
According to the American Cancer Society, nearly 1.7 million new cancer cases will be diagnosed in the United States in 2016; more than half a million will likely die of the disease over the course of the year, making cancer the country’s second leading cause of death. That’s despite a steady stream of breakthroughs, new treatment techniques, and new drugs that are chipping away at the disease.
Pazdur’s tenure at the FDA has put him in the firing line in places as public as a series of columns in the Wall Street Journal’s editorial pages (which excoriated him as being an obstructionist) and as personal as letters from indignant investors and desperate families. On the flip side, consumer advocates have complained that the FDA has been swayed by the relentless lobbying, the pleas of cancer patients—and now, the death of Pazdur’s own wife from cancer.
Ultimately, he has told his staff to go by one metric: At the end of the day, is the American public going to be better with this drug than without it?
The data shows, according to a New York Times article, that under Pazdur’s leadership the OHOP began approving new drugs at a faster rate: at an average of five months instead of six. He says much of the change is because the drugs themselves are better—some of them “slam dunks.” Congress also passed the FDA Safety and Innovation Act of 2012, the same year that Mary Pazdur was diagnosed. It’s a bill that allows the OHOP to work with researchers and act with greater urgency. Still, Pazdur admits his wife’s cancer has changed his thinking.
“Her death underscored for me the importance of getting drugs out sooner to patients,” he says. “It also made me understand the importance of drug toxicities. Until you’ve lived with those drugs’ toxicities on a 24-hour basis, you don’t really understand what it’s like.”
Standard product labels, he says, don’t give an accurate picture. He has championed FDA initiatives to include patients’ descriptions of toxicities, written in language people with cancer and their loved ones can understand.
Pazdur notes that cancer drugs are significantly improving and patients are living longer. “This is a dramatic time,” he says. “After years of basic science working to better understand diseases, we have a better understanding of the immune system and can tailor the drugs.” That’s a vast improvement over the previous roulette wheel approach many trials took.
But advances aren’t cures. “I want to make sure we’re not overly optimistic,” he says.
The Pazdurs’ understanding of that reality gave them an advantage when Mary was diagnosed. “We’d seen the movie, we’d read the book,” he says. “Now we were trapped in the story.”
Mary’s friends described her as supportive, practical, and compassionate. She brought that to her final months as well, even though she knew from the beginning of her illness that there was a poor prognosis for her survival. Only about 45 percent of women with ovarian cancer reach the five-year mark after their diagnosis.
She fought to take part in one experimental study with a class of treatment that her husband had no authority over, but when it and other treatments failed, Mary recognized and accepted it. She eventually asked her attending physician to put her in hospice.
“One of the greatest gifts my wife gave to me was how she approached her disease,” Pazdur says. “Cancer can bring out the best or the worst in people. Because of who she was and her religious background, she approached it with great courage.”
A strong faith is another thing the couple shared, and Pazdur recalls a conversation after Mary’s death with a priest who knew the couple well. Pazdur, in his understated way, explains their exchange. The priest told him, “Rick, you’ve gone to Catholic schools, you’re part of a long Catholic tradition. You know that this isn’t the end. Think about it this way: Mary has gone on a long trip to New York. You’ll see her again.”
The priest’s words stuck with Pazdur. He remembers his response, too.
“I said, ‘Father, I hope she’s having fun in New York; I hope she’s maxing out the credit cards. I hope I’ll see her soon. But not too soon.’”