Friday, March 02, 2007

Roy Hertz and the triumph over choriocarcinoma

Today's history of medicine class was a combined affair: first- and second-year students heard Dr. Lynn Loriaux's talk on his old friend and colleague Dr. Roy Hertz, M.D., Ph.D., M.P.H. (1909-2002), endocrinologist and developer of the parabiotic technique, co-developer of the first successful chemotherapeutic treatment for a metastatic cancer, discoverer of avidin/biotin bonding (a precursor to radioimmunoassay), and early pioneer of the birth control pill.

Loriaux opened the talk by noting that Hertz "was not well-loved" (this being a wild understatement, we gather) and a "reluctant clinician" who had intended to study comparative literature until a C in Latin poetry caused him to change his major to biology. His brilliance as a researcher was immediately apparent, however: as part of his graduate research on the role of the pituitary gland, he developed the parabiotic technique in which two animals are joined and made to share a single blood supply.

When the newly-created NIH began recruiting scientists, Hertz was hired on in the physiology division, where he was given 18 beds to do with as he pleased. He soon turned to an investigation of choriocarcinoma, a malignant placental tumor with a nearly 100% fatality rate. Hertz was not the one who first suggested the use of methotrexate in the treatment of choriocarcinoma, however. It was Dr. Min C. Li, who had participated in earlier research to determine methotrexate's effect on estrogen levels, who first saw the possibility of exploiting the drug's suppression of cGH to treat this aggressive and deadly cancer. Li had been hired as clinician for Hertz' ward, and together they went on to test the drug on three patients.

In this day and age of IRBs, such a study would never have happened. They didn't know what the dosages should be, they weren't even sure it would work--but it did, and three women were completely cured of their cancer. It was the first apparent cure of metastatic cancer by chemotherapy.

Hertz went on to test the drug in men; when these tests proved unsuccessful, Hertz realized that choriocarcinoma in women is a fetal transplant, with some paternal genetic material--and hence, some component of immune system rejection. This was the beginning of the understanding of the role the immune system in cancer biology.

Largely on the basis of Hertz and Li's success with the treatment of choriocarcinoma, President Richard Nixon declared a "war on cancer" in 1971.

Loriaux noted that Hertz' temperament made him many enemies over the course of his career, and that as a result, he wound up moving from post to post, each of which "ended in grief" after a short period. His legacy was already fading into obscurity. It was due to Loriaux's efforts that Hertz was finally brought back to the NIH as an emeritus scientist, and allowed to fill out the rest of his days there, pursuing AIDS research.

But he will not be entirely forgotten: we have an oral history interview with Roy Hertz here in the PNW Archives Collection, in which we hear, in his own words, the story of his brilliant career. It was conducted by then-student Jonathan Yarris, shortly before Hertz passed away in 2002.

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