Sold a Bill of Goods                   May 6, 2013

By Leonard Zwelling

            I love my American Express card. Why? Because the company that backs that card provides first-class service when things go wrong. If you book a trip with them, they help if you are short of cash or lose your luggage in a foreign country. If a wrong charge appears on your bill, they contest it for you, suspend your need to pay and confront the vendor to clear up the dispute. When they say, “don’t leave home without it”, they mean it. That card costs me more and it costs the merchants with whom I do business a bigger chunk of their revenue, but at least I wasn’t “sold a bill of goods” with this card. AMEX never misrepresented or made false claims about what the company would deliver.

            The latest issue of The Cancer Letter has a truly striking first page with three MD Anderson-related headlines. The first leads the story about the failure of Aveo Pharmaceutical Inc. to gain FDA approval for its kidney cancer-targeted drug, tivozanib. An Oncologic Drug Advisory Committee in a lacerating rejection of the single phase III trial of the drug by a 13 to 1 margin buried the likelihood that this agent will ever see the market place. More than anything, it was the fact that there was a survival disadvantage for the patients treated with this Aveo drug compared with those treated with the approved agent sorafenib. A worse overall prognosis in the treatment of a lethal malignancy for which there are already a host of approved drugs may mean the kiss of death for the Aveo agent.

            This is now compounded by a law firm opening an investigation into whether or not Aveo executives broke US security laws (see http://www.reuters.com/article/2013/05/03/ny-bronstein-invstgte-idUSnPNNY07122+1e0+PRN20130503).

            The second headline links the fate of this drug to the drug development strategy of the MD Anderson president Ron DePinho which he employed as part of his successful drive for this prestigious position. Apparently it was his selling of his ability to commercialize new agents for cancer that sealed the deal with the University of Texas Board of Regents, DePinho’s real supervisors. This cozy conflicted arrangement between Aveo, DePinho and DePinho’s wife, MD Anderson faculty leader Lynda Chin, was supposed to lead to new revenue streams and breakthrough cancer treatments. Obviously, the first test of this strategy was unsuccessful.

            On a happier note, the final headline announces that Dr. Raphael Pollock, one of the leading cancer surgeons in the world who was recently fired from his leadership role at MD Anderson has found a great position with the Ohio State Comprehensive Cancer Center where he will start on September 1 after his retirement from Anderson following 31 years of exemplary service. As a friend and colleague, I wish him the best.

            What a mess!

            CNBC and self-dealing on television (were the Aveo execs aware of the trial’s weaknesses back then?), conflicts of interest requiring special waivers of MD Anderson policy for DePinho, a strange and convoluted relationship between Dr. DePinho as president and Dr. DePinho as husband (isn’t this nepotism?), and now questions have arisen about that heavily touted drug development business acumen purported to make DePinho and Chin such terrific catches for MD Anderson and the UT System.

            There has got to be some question in the minds of the Regents as the purchasers of this leadership talent as to whether or not they were “sold a bill of goods”. At best, they paid for a platinum card and got a run-of-the-mill MasterCard from the local branch bank. And the bill is coming due.

             Now, more than ever, it is crucial that all of the facts in this case be unearthed immediately starting with when did Dr. DePinho became aware of the Aveo trial’s problems, particularly in relation to his inappropriate comments on national television while appearing as the MD Anderson president, not a member of the Aveo board (there’s that conflict of interest thing again). In addition, has all the Aveo stock owned by Dr. and Mrs. DePinho been placed in the promised blind trust yet? What was its value going in and what is it now (we can know this since we know what’s in the trust, thus belying the “blindness” of the trust)? Was any sold in the interim? If so, under whose direction and when?

            To put this into an historical context, return to 1974 and the Watergate hearings  To quote the great Republican senator from Tennessee, Howard Baker: “what did the president know and when did he know it?”