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IN MEMORIAM |
Yale School of Medicine
A gentle giant has left the stage of oncology. Paul Carbone passed away unexpectedly at the age of 70, leaving the whole field stunned and saddened. I first met Paul Carbone in 1963 at the Medicine Branch of the National Cancer Institute (NCI) during a very heady time in the history of oncology.
While many studies of chemotherapy had been done, the crucial hypothesis under test in those days was whether cancer drugs could cure, not just palliate, advanced cancer. This was very controversial at the time and required clinical studies of a certain and different design. The crucible for the design of these unique trials was the medicine branch of the NCI. The "cure hypothesis," using leukemia and lymphoma as model systems, withstood the test of experimentation, and one of the major lynch pins in the history of cancer treatment became a reality. This proof led to the ability to use chemotherapy where it had not been possible before and allowed the field to support the then novel adjuvant studies in other tumors that have had such an important impact on the outcome of more common solid tumors. Paul played a major role in these studies, and his place in the history of this era is secure.
But that was just the beginning for him.
As a consequence of this work, the field of medical oncology began its decade-long gestation period to recognition as a subspecialty of medicine, with Paul leading the way.
Present at the founding meeting of the American Society of Clinical Oncology, he ultimately became its president in the formative years and remained a major leader of the organization for life. He also was president of the American Association for Cancer Research and chair of the Eastern Cooperative Oncology Group for many years.
While at the NCI, he began his lifelong interest in sharing his expertise abroad. It was Paul Carbone who established the medical unit in Kampala, Uganda, East Africa, so we could pursue the riddle of Burkitt's Lymphoma.
Paul played a major role in getting adjuvant studies in breast cancer started. He linked the NCI to the National Surgical Adjuvant Breast and Bowel Project (NSABP) by designing and starting the famous first L-PAM study, initially done at the NCI, and then extended into the NSABP. Adjuvant studies were still controversial. No single U.S. institution would take on the follow-up "new" combination chemotherapy adjuvant trials, so he used his international links to develop a contract with the Istitiuto Tumori in Italy, with Gianni Bonadonna, for the testing of the early CMF breast cancer studies, after CMF had been developed at the NCI's clinical crucible. In fact, he never lost interest in international affairs and was in Singapore helping the government to build a cancer center when he passed away.
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What all of us remember about Paul in those days was his gentleness and kindness as a person, a trait that marked him throughout his career. He was gentle and kind with his friends, his trainees, and most of all with his patients who loved and respected him.
Then he went off to Wisconsin where he did much the same thing. He helped build the Wisconsin Cancer Center into one of the finest in the country, and began his trek around the world to help establish effective Cancer Center programs everywhere. He was a natural builder of programs and a natural trainer of young, talented people. People trained by Paul number in the hundreds and are strewn all over the world's medical landscape.
A death, particularly a premature death, makes us sad. It also brings back a flood of memories. I have to admit that in thinking of Paul these past few weeks, there are moments when a smile crosses my face at the memory of the trips we took together in the early years. Paul broke me in as a foreign traveler in Europe. I recall his surprise and amusement when his Italian, which had been laundered from Southern Italy via White Plains, New York, proved unworkable in Rome. I remember when we met with the founding father of medical oncology in Great Britain, the late Gordon Hamilton Fairley, to help him establish that field in the UK. Paul also introduced me to the social structure of the British in East Africa during the early Uganda days. On our trips there, we fished in the Nile a good bit. This brings to mind the time we caught a monster 125-pound Nile Perch, straining a gaff between us (I have a picture to prove it). And I remember how good we all felt sharing the Albert and Mary Lasker Medicine Research Prize for cancer chemotherapy with a group of physician scientists, many of whom had worked in the crucible. I know that around the world, many sad colleagues and former trainees are also reliving the pleasant memories they have of their association with Paul Carbone.
We all send Mary and the Carbone family our deepest condolences and prayers and hope that the palpable warmth and affection for Paul being expressed around the world is of some comfort to them.
Yes, a gentle giant has left the stage of oncology, but he has left behind a rich tableau of scenery and characters and a treasure lode that will long be remembered, enjoyed, and appreciated.
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