Charles A. Coltman Jr., MD,

Honored with Karnofsky Award

This year's winner of ASCO's David A. Karnofsky Memorial Award Lecture is Charles Arthur Coltman, Jr., MD, who has led a long-time distinguished career in clinical cancer research and served as ASCO President in 1988-1989. The Chair of the Southwest Oncology Group (SWOG) since 1981, Dr. Coltman directs a network of 4,000 investigators conducting cancer research at more than 256 institutions in 41 states, Canada, and Korea. He has shared his clinical trials expertise as one of the founding directors of the ASCO/American Association of Cancer Research (AACR) Joint Workshop, Methods in Clinical Cancer Research, which has introduced hundreds of beginning oncologists to the principles of good clinical trial design. Fittingly, clinical trials is the subject of his Award Lecture, "Is There a Future for Federally Supported Clinical Cancer Research in the U.S.? What Can be Done to Ensure It?" (See Section A for coverage of Dr Coltman's lecture.)

"When I received notification of the Karnofsky Award, I was overwhelmed," says Dr. Coltman. "After reviewing the list of intellectual giants listed as prior awardees, I was totally intimidated. Each had a huge body of scientific work to present. I spent a long time casting about for my body of work and concluded that it had to be related to cancer clinical trials, something I've spent most of my professional life conducting and administering: not your average body of scientific work."

Dr. Coltman's lecture focuses on the future of clinical trials.

Dr. Coltman has been at the Cancer Therapy and Research Center in San Antonio, Texas since 1977, serving as the President and Chief Executive Officer of the Center for the last five years. He is a 35-year member of SWOG and is currently involved with a SWOG study on the prevention of prostate cancer, which is the first large-scale intergroup test of finasteride, which inhibits conversion of testosterone to dihydrotestosterone (10 times more potent) in the prostate. The hypothesis: reducing the androgenic milieu in the prostate gland might lower the incidence of prostate cancer. For seven years, 18,882 male subjects have been taking either finasteride (a 5-alpha-reductase inhibitor) or a placebo. Now beginning end-of-study biopsies, SWOG will measure the prevalence of prostate cancer at seven years of treatment, comparing the two groups of men.

Dr. Coltman is also the principal investigator for SWOG's large new intergroup prevention trial for prostate cancer, which is taking place at 438 sites in the U.S., Canada, and Puerto Rico. The SELECT clinical trial will enroll 32,400 healthy men and randomly assign them to selenium, vitamin E, selenium and vitamin E, or a placebo. Supported by the National Cancer Institute, the 12-year study has a $177 million budget and is expected to launch this month.

After earning an MD degree at the University of Pittsburgh School of Medicine, Dr. Coltman was an intern at Delaware Hospital (Wilmington), then entered the U.S. Air Force. Following his training in internal medicine and hematology/oncology at Ohio State University, he became Chief of Hematology and Oncology at Wilford Hall USAF Medical Center in San Antonio. On his retirement from the Air Force in 1977, he became Director of Clinical Medical Oncology at the University of Texas Health Science Center at San Antonio, where he has served as Professor of Medicine since 1970. He was an American Cancer Society Professor of Clinical Oncology for six years (1977-1983).

Leukemia and lymphoma were Dr. Coltman's first research interests. In 1967, his team at the Southwest Cancer Chemotherapy Study Group (the former name of SWOG) was in the first cooperative group test of a new drug, cytosine arabinoside (Ara-C), for acute myelogenous leukemia. Comparing a two-day and a five-day continuous infusion of Ara-C, along with equivalent toxicity, yielded startling results: the complete response rate rose quickly from 6%, with prior standard 6-MP, to 20% (two-day infusion) and 38% (five-day infusion).

"One-fourth of those who achieved complete remission had a very long survival." says Dr. Coltman. "Now the standard of care for acute myelogenous leukemia, using cytosine arabinoside in combination therapy, has a 70-80% complete response rate in adults."

Dr. Coltman's next focus was non-Hodgkin's lymphoma. His team began treating patients with a combination chemotherapy regimen developed at the University of Texas, M.D. Anderson Cancer Center. Numerous studies demonstrated that CHOP (cyclophosphamide, hydroxydaunorubicin, Oncovin [vincristine], and prednisone) cured about 30% of patients with aggressive non-Hodgkin's lymphoma-the best results that had ever been achieved with that population.

In the mid- 1990s, under the leadership of Dr. Richard I. Fisher of Loyola University, SWOG launched a major intergroup trial in which CHOP was compared with three newer, highly touted regimens (m-BACOD, MACOP-B and ProMACE-CytaBOM) for non-Hodgkin's lymphoma. SWOG's research detected no differences in response rate, response duration, or response survival. "The recent high-dose intensive treatments were found to be more toxic and no more effective than CHOP," Dr. Coltman explains.

Dr. Coltman has been actively involved with ASCO, holding a position on the Board of Directors from 1983 to 1986. As ASCO President, he encouraged the Board to invest in strategic planning for the first time. Among the important outcomes of that planning was a determination to meet the needs of oncologists in both academic and private practice settings. In 1996, he helped to develop the ASCO/ AACR Joint Workshop, at which 100 young professionals each year learn how to create and conduct cancer clinical trials that will yield clear, definitive results. The success of the Workshop spawned a European counterpart of the course, established in collaboration with the Federation of European Cancer Societies (FECS), headquartered in Brussels. The FECS/ASCO/AACR Workshop presents a similar program, with an international faculty and participants from all over the world. Dr. Coltman has participated in all five U.S. Workshops as well as the two held in Switzerland.

Dr. Coltman's work has earned him several honors and awards. Among them is the 1987 Outstanding Achievement in Clinical Research Award from the Association of Community Care Centers, given to him in recognition for his excellence in clinical research and responsiveness to community clinical oncology programs, whose participation in cancer research he has encouraged for decades.

Carol Milano

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