A Sense of Culture and Community Sparked a Passion in Genitourinary Oncology

The influence a patient has on a clinician can go deeper than ever imagined. Carrying their stories, either of triumph or defeat, allows for the improvement of care for all other patients to follow. Over his nearly 50-year career, Christopher J. Logothetis, MD, has had many of these patient interactions. Through these experiences, he has begun to think about a more patient-first approach by accommodating their needs rather than having one mindset of treating their cancer to prolong life.

Logothetis is the Roy M. and Phyllis Gough Huffington Clinical Research in Urologic Oncology, Distinguished Chair, and professor in the Department of Genitourinary Medical Oncology, Division of Cancer Medicine, as well as the director of the Department of The David H. Koch Center for Applied Research of Genitourinary Cancers at The University of Texas MD Anderson Cancer Center (MD Anderson) in Houston. His career has spanned a multitude of successful clinical trials in testicular cancer exploring randomization and clinical trial statistics. He has also been working on creating personalized therapies that are individualized for each patient.

Although Logothetis has had an expansive career, he has no plans on slowing down and is still passionate about teaching and passing on as much knowledge as he can. “I want to transfer what I’m doing to the next generation. To try to understand and teach them where my failings were, what advances we have, and make sure that we address the challenge of a process-driven health care system [is important].”

Pushing the Genitourinary Cancer Field Forward Starts With Mentorship

It was Logothetis’ work with the late Melvin Samuels, MD, at MD Anderson that taught him to believe that anything was possible. Under Samuels’ direction, he worked on creating a cure for testicular cancer. He described Samuels as an old-fashioned clinician who expected nothing less than 100% dedication and who gave everything to his profession.

He met his other mentor, Gardidas, in Greece. Gardidas was trained in the US and taught Logothetis how to best prioritize opportunities to focus on. “He taught me [to surround myself] not with the ones who are active and industrious, but the ones who always search for the meaning beneath. He was like that. He had this way of doing impactful things. [He] was intellectually efficient and a role model for us,” Logothetis said.

Teaching the current generation of clinicians so that they are more knowledgeable than he was when Logothetis began his career is a personal goal of his. Most are inundated with information and opportunity, which he equates to a kid in a candy store. Determining which information or technology to use among all the distractions can be hard, and his job is to guide them and help them decide which prospects to pursue.

When Logothetis first dove into testicular cancer research, the field was transitioning from empirical research to randomized clinical trials. Through this switch, robustness, honesty, and clarity were gained. A series of trials taught Logothetis that P values and randomized studies are important, but it’s about how they inform clinicians on the average patient and how to apply it as individualized therapy. This is specific research he is now looking to try to correct.

His biggest impact in the field, he noted, was his work in germ cell tumor therapies. He worked with traditional approaches, such as cisplatin-based chemotherapy, which can now cure patients. One such trial evaluated CISCA (cisplatin, cyclophosphamide, and doxorubicin) vs MVAC (methotrexate, vinblastine, doxorubicin, and cisplatin) for patients with advanced metastatic urothelial tumors.1 The trial assessed 110 patients, and the combined complete response and partial response rate was 65% in the CISCA arm vs 46% in the MVAC arm (P < .05).

Other groundbreaking trials that he’s contributed to focus on the evolutionary response and plasma genome sequencing in prostate cancer2; high-volume, dose-dense chemotherapy in patients with nonseminomatous germ cell tumors3; and an update to the National Comprehensive Cancer Network guidelines on prostate cancer treatment, of which findings were published in ONCOLOGY®, a sister brand to OncLive.4

He is humbled to say that he has worked in any way to help evolve the genitourinary field. One of his biggest “aha” moments came when he was working with colleagues and realized cancer was a binary event. Meaning being cancer free was not synonymous with good health and having cancer was not always the dominate problem. He translated this to prostate cancer and found that if all patients were treated with the same paradigm, the survival rates would not reflect what was in the Surveillance, Epidemiology, and End Results databases.

“His impact on the field of genitourinary oncology has been amazing. It resonates throughout the US and the world [he] is well known in the field,” Nizar M. Tannir, MD, FACP, professor and Ransome Horne, Jr. Professorship for Cancer Research in the Department of Genitourinary Medical Oncology, Division of Cancer Medicine, at The University of Texas MD Anderson Cancer Center, said ofLogothetis. “He continues to give his time and expertise to anybody who seeks it.”

Greek Culture’s Link to Medicine

Opportunities looked different for Logothetis in his early life than for most. Both of his parents grew up on the Greek island Karpathos. With World War II looming, his father went to the US and joined the US Navy, whereas his mother stayed on the island and withstood the German occupation.

While his father was in the Navy, Logothetis was born in Mannheim, Germany, and he eventually moved to France and northern Italy. He noted that there was a strong cultural obligation, so he returned to Greece each summer with his parents to visit the island and his relatives.

His time in Greece during the dictatorship years was one with a culture of commitment, and he had to do something meaningful with his life. He could have chosen engineering or teaching, if not for his uncle who was a cardiologist. Logothetis said his uncle was admired in the community for his selfless work and for helping those who were less fortunate. It was then that Logothetis knew he wanted to go into medicine.

“I was intrigued by the puzzle of biology. I always tried to understand illnesses, and it was an easy topic for me because it had such an appeal. Trying to understand biology was never a chore,” Logothetis said. “It wasn’t like going to school and having somebody make sure you do your math, which was always difficult for me, but it was exciting to read. [These interests] converged, and that’s what happened over time—[it] was somehow instinctive.”

This led him to attend medical school at the University of Athens School of Medicine. One of the greatest lessons he learned there was intellectual efficiency—in other words, understanding what you will need to succeed. He worked as a trainee there and helped to treat pediatric patients with leukemias. During his time in Athens, he saw this patient population go from having a disease that was incurable to curable, which he describes as “Easter.” This is where he pinpoints the start of his interest in working with more challenging diseases.

He eventually transferred to Cook County Hospital in Chicago, Illinois, where he learned how to manage social and medical issues. Here, he developed his skills in biology, which led him to apply for a fellowship at MD Anderson, where he still works today. At MD Anderson, he began to gain experience in various parts of the genitourinary field. As a “drifter,” he would go to the diseases that others were not drawn to and try to figure out treatments or cures.

Running Full Speed Ahead at Curing Genitourinary Cancers

Although Logothetis is an accomplished clinician, he continues to set professional and research-focused goals for himself. He also wants to create more opportunities for those who don’t want to come to an academic institution that falls under a Center of Excellence. Logothetis found that the resistance to going to these centers isn’t based on money but rather an aversion to large academic centers. There needs to be a bridge in the gap to include these populations in research.

He noted that he frequently travels back to Greece to try to improve the quality of care and create more international alliances and skills in these communities. “Part of my dedication to helping them out [in Greece] is so all our intellectual resources [are combined. The patients and clinicians have] satisfaction in participating in the international effort to improve the outcomes of patients with these diseases,” Logothetis said. “It’s a huge satisfaction looking back [and seeing] that you contributed in a little way to this.”

Life Behind the Scenes as a Medical Oncologist

Logothetis lives a quiet life in Houston with his wife, Elizabeth, a former radiologist, and their 2 children, Richard and Irene. He and his wife met at MD Anderson when she began her training. He joked that he thinks he and his wife raised their children the same way, but they turned out complete opposites.

Richard is more of an introvert and loves music. His aspiration is to one day “be Mozart,” but he is seeking to be a composer. Logothetis tries to listen to classical music so he can be educated for his son, but he admits it is quite demanding. Irene, however, is an extrovert and is constantly surrounded by people. She attended the University of Colorado and completed a degree in biology.

“I’m lucky they were both healthy. They’re both good and properly motivated, searching for the meaning beneath, [and] struggling with designing opportunities,” Logothetis said.

In his free time, Logothetis can be found on either his boat in Texas or the one he has in Greece to sail around the Aegean Sea. He notes that the names for his boats are not creative and are called Meltemi (of which he’s had 4), which is a northeasterly wind that blows in the afternoon in the Aegean Sea.

For Logothetis, some quiet time with a good book is the highlight of his day. He spoke fondly about a recent read by Leo Tolstoy, A Calendar of Wisdom, which was a compilation of wisdom crafted by Tolstoy between 1903 and 1911. Logothetis took inspiration away from this book as Tolstoy spoke about various philosophers, thinkers, and writers but crafted his own conclusion on what they meant.

Although you won’t find Logothetis binge-watching any shows, he does enjoy British murder mysteries, and even named his dog Vera after one of the lead detectives and simultaneously the show’s name. He appreciates these shows because they aren’t “all about the glitz and glamor often seen in Hollywood, and real actors portray these different characters.”

Finally, Logothetis finds motivation every day by reminding himself that he has the gift of good health and a stimulating environment to work in. “It’s a fresh morning when your brain is freed and you’re ready to do something creative and novel,” he said.

References

1. Logothetis CJ, Dexeus FH, Finn L, et al. A prospective randomized trial comparing MVAC and CISCA chemotherapy for patients with metastatic urothelial tumors. J Clin Oncol. 1990;8(6):1050-1055. doi:10.1200/JCO.1990.8.6.1050
2. Ramesh N, Sei E, Tsai PC, et al. Decoding the evolutionary response to prostate cancer therapy by plasma genome sequencing. Genome Biol. 2020;21(1):162. doi:10.1186/s13059-020-02045-9
3. Fizazi K, Prow DM, Do KA, et al. Alternating dose-dense chemotherapy in patients with high volume disseminated non-seminomatous germ cell tumours. Br J Cancer. 2002;86(10):1555-1560. doi:10.1038/sj.bjc.6600272
4. Millikan R, Logothetis C. Update of the NCCN guidelines for treatment of prostate cancer. Oncology (Williston Park). 1997;11(11A):180-193.