Cancer disruptors: Jerome Yates on optimism and the ALGB

Jerome Yates became a cancer doctor during a time when medical oncologists were thought to be what he describes as “the garbage collectors of medicine.”

“The attitude among physician colleagues was, why are you wasting your time doing this? Not only are you wasting your time, but you’re making the patients sicker,” said Yates, 85, a retired oncologist who has practiced and administered research at Roswell Park Comprehensive Cancer Center, the University of Vermont, NCI and the American Cancer Society.  “Some of them get very sick from the chemotherapy, because there are a lot of side effects with the normal tissues.” 

During his internship at San Bernardino County Hospital, Yates, then 29, encountered a metastatic testicular cancer patient around his age. The young man was admitted to the hospital with congestive heart failure. 

“They were going to let him die,” Yates said to The Cancer Letter. “I said, ‘If he came in and you didn’t know that he had metastatic cancer, you would treat him for his congestive heart failure.’ I convinced the attending. We treated him, and it bought him another four or five months. I thought it was an important four or five months.”  

The prevailing attitude toward cancer treatment was depressing—“That if somebody had metastatic disease, had cancer spread around the body, that they were going to die, and why would you want to prolong their agony?”  

In 1965, Yates encountered an optimistic article, “​​Obstacles to the Control of Acute Leukemia” in the CA: Cancer Journal for Clinicians, written by James Holland, an oncologist at Roswell Park Comprehensive Center.  

He said that they were on the pathway to cure acute leukemia. “The way it was structured, and the timing—I was taking care of some chronically ill patients—and it just sounded like it was exciting,” he said. 

Yates joined Holland at Roswell Park in 1968 and began conducting clinical trials with members of the cooperative group Acute Leukemia Group B cooperative group, the ALGB. This group, renamed the Cancer and Leukemia Group B in 1976, conducted clinical trials using two, three, or four-drug combinations. This strategy was not received kindly by the mainstream medical community. 

“There was a general attitude that we not only didn’t know what we were doing, but what we were doing was potentially harmful to many patients,” Yates said.  

Rather than embrace the work of the ALGB, cancer doctors largely adopted the thinking of William Dameshek, an influential hematologist at Harvard who was a mentor to many oncologists. 

“His attitude was that we were poison pushers, that we were cowboys, that we were doing things that weren’t in the best interest of the patient,” Yates said. “Because he was extremely influential, we were viewed as outliers.” 

Still, Yates remained hopeful—“because, as a physician, taking care of these patients—it made you feel good.”