Dec 20, 2017
By Jack Lambert, ASCO Integrated Media & Technology
It’s 9 AM on a Tuesday and Jaime G. de la Garza, MD, is calling in from the offices of the Instituto Nacional de Cancerología, Mexico’s National Cancer Institute.
Internationally recognized as the pioneer of medical oncology in Mexico, Dr. de la Garza served for a decade as the general director of the Instituto Nacional de Cancerología and is a founding member of the Latin American and Caribbean Society of Medical Oncology (SLACOM) and of the Mexican Oncology Board. He has lectured internationally at more than 1,000 events and wrote the book on Mexican oncology, Un Relato Histórico de la Oncología Médica en México.
Sixty years into his career, with more awards and recognition than most, Dr. de la Garza continues to work a couple of days a week.
“I have so many friends all around the world,” Dr. de la Garza said. “As you can see, this young fellow at 83 years old is doing alright for himself, and I will never stop.”
Dr. de la Garza was born in Monterrey, Nuevo León, on December 12, 1934. He is the youngest of three children born to Elisa Margarita Salazar and Juan B. de la Garza Guajardo. Dr. de la Garza’s mother died when he was 10 years old, most likely due to a uterine tumor.
Despite initial concerns about the cost of schooling, Dr. de la Garza received his medical degree from Universidad Autónoma de Nuevo León-Monterrey in 1959. Focusing on internal medicine, Dr. de la Garza took a residency position at South Texas Medical School in San Antonio in 1959, whose policy mandated physicians refer patients with terminal disease to hospice care.
One afternoon, coworker William Wilson, MD, FASCO—later one of the founders of ASCO—asked why Dr. de la Garza sent a patient to hospice, as the patient was part of a new study conducted by the Central Oncology Group (COG). They agreed to bring the patient back to the hospital; 3 months later, the patient walked out in remission.
During his third year of residency, Dr. de la Garza and Dr. Wilson began working together on studies that examined using medical oncology as opposed to surgery or radiotherapy for cancer treatment. One of those studies examined the application of hexamethylmelamine in lung and ovarian cancer. The night before one of the COG meetings hosted by Dr. Wilson, his wife called saying he was sick and could not attend. Could Dr. de la Garza give the talk on his own?
The presentation impressed senior physicians in the audience, including ASCO cofounder Harry F. Bisel, MD, FASCO. Dr. Bisel was one of the first trainees to graduate from the Memorial Sloan Kettering Medical Neoplasia Center; he became the head of medical oncology at the Mayo Clinic and later served as ASCO’s first president. He asked Dr. de la Garza to join his institution.
“I said, ‘Well, I’ll have to fill out a lot of papers,’ and he said ‘No, you are already contracted to come with me to the Mayo Clinic,’” said Dr. de la Garza. “I said, ‘When do you want me to leave?’ and he said, ‘Tomorrow.’”
Dr. de la Garza spent the next 2 years working on the forefront of oncology and was offered a staff position at the hospital.
“The weather in Rochester, Minnesota, is terrible in the winter,” Dr. de la Garza said. “My wife, Melba, she was from Texas. I told her they wanted me as a staff doctor at the Mayo Clinic. My wife didn’t say much—we had two daughters, Judith (5 years old) and Jessica (1 year old)—but the next day she had three plane tickets to go back to San Antonio.”
Seeking a compromise, Dr. de la Garza decided to continue his career with his family in Mexico.
Creating Mexican Oncology
Dr. de la Garza, ASCO’s first member from Latin America, began working for the Oncology Hospital of the National Medical Center (IMSS) in Mexico in 1967, specializing in the treatment of inflammatory breast cancer. Still, he had to win over skeptical patients unaware of medical oncology.
“For that type of patient, you would mention to them that there is nothing that can help anymore,” Dr. de la Garza said. “But then I would say, ‘If I give you something it may help you.’ I don’t remember any patients that refused that help.”
In 1970, Dr. de la Garza lobbied for the use of fluorouracil (FU) in the treatment of inflammatory breast cancer, a treatment he first studied under Dr. Bisel at the Mayo Clinic. As he wrote in his book, the first patient treated with 5-FU in Mexico was an 70-year-old woman with inflammatory carcinoma in the left breast and obesity. He started 5-FU for 5 days, followed by weekly doses and 3 months of radiation therapy. The response after the third month was clinically complete, something rarely seen at the time.
The results of this study were published at ASCO’s 1977 Annual Meeting and later confirmed in a similar study conducted at the University of Texas MD Anderson Cancer Center.
“From the confirmation of my results in MD Anderson with that study,” Dr. de la Garza wrote, “the treatment, prognosis, survival, and quality of life of these women changed radically worldwide. We were pioneers in treatment and concepts—neoadjuvant and [monotherapy]—that were accepted later.”
Dr. de la Garza began cultivating a network of oncology professionals, both inside and outside of Mexico, to improve cancer care. He was president of the Mexican Oncology Society from 1980 to 1981 and founded the Mexican Oncology Board in 1998, which now has more than 1,500 certified medical oncologists. He also created the first fellowship in medical oncology in Mexico in 1977.
Gabriel N. Hortobagyi, MD, MACP, FASCO, of the University of Texas MD Anderson Cancer Center, began flying to Mexico to work with Dr. de la Garza in the mid-1970s. The two formed a friendship centered on improving cancer care.
Dr. de la Garza is “viewed throughout Latin America as one of the granddaddies of oncology,” said Dr. Hortobagyi, who served as 2006-2007 ASCO president. “What he’s done—it takes a special personality. It takes a somewhat different approach to your career, your life, and everything else.”
Mariana Chavez-MacGregor, MD, MSC, of the University of Texas MD Anderson Cancer Center, met Dr. de la Garza as a medical student in Mexico City and worked under him at the National Cancer Institute. They established a formal and foundational academic relationship, in which “his mentorship and support were key for my career,” she said.
“I’m always happy when I see him, and I know he’s very happy for what I have accomplished; he takes pride in it since he knows he has contributed to that,” said Dr. Chavez-MacGregor.
Current Cancer Care in Mexico
Dr. de la Garza, general director of the Instituto Nacional de Cancerología from 1993 to 2003, was awarded ASCO’s Distinguished Achievement Award in 2014 and invited Dr. Abelardo Meneses García, current general director of Instituto Nacional de Cancerología, as his guest to the ceremony.
“I mentioned in my speech that we should develop some molecular therapies and some molecular biomarkers because this is not the future, it is the present,” Dr. de la Garza said. “Ever since, we have had a department of molecular biology at the Cancer Institute and we have translational medicine.”
Dr. de la Garza is optimistic about Mexico’s National Cancer Registry, the first population-based tool including all patients who have a diagnosis of cancer, as well as new cases detected. The database, implemented in 2017, follows up with patients for 5 years to better understand the behavior of different tumors.
“All of the pathologists in Mexico from 1993 to 2003 used to send information for diagnosing cancer by histology,” Dr. de la Garza said. “But that’s just the histology of cancer. We didn’t have any information about age, style of life, or other things.”
Seguro Popular (Popular Health Insurance), implemented in 2004 to help cover the roughly 50% of Mexicans not previously enrolled in traditional insurance programs, has improved cancer care in Mexico. It is credited with improving health outcomes, increasing doctor's visits, and reducing health care–related bankruptcies. Still, identifying potentially cancerous tumors remains a problem.
“One of the things we are really fighting is education,” Dr. de la Garza said. “We hope to soon have programs on TV and radio and in newspapers to educate patients that if you have a lump in the breast, make an early diagnosis.”
A Lifelong Passion for Oncology
Dr. de la Garza continues to coordinate and assist with the Best of ASCO® meeting in Cancun, Mexico, while also attending oncology meetings around the world.
“I saw [Dr. de la Garza] in Cancun for Best of ASCO,” said Chandra P. Belani, MD, of Penn State Cancer Institute. “His passion for oncology is unwavering and he continues to develop young physicians and provides them with words of wisdom. I said, ‘Are you going to the European Society for Medical Oncology meeting?’ and he said, ‘Yes, of course I’m going to the European meeting.’ He continues to feel young, whereas I would say, ‘Why take the trip to Madrid from Mexico?’
“He continues to be present everywhere and develop himself, as well as young talent. Jaime is one of the giants in oncology and a great leader.”
Sandra M. Swain, MD, FACP, FASCO, of the Washington Cancer Institute of MedStar Washington Hospital Center and 2012-2013 ASCO president, helps organize the annual Best of ASCO event in Mexico. Dr. Swain presented the Distinguished Achievement Award to Dr. de la Garza in 2014.
It is striking, she said, how many young physicians revere and admire Dr. de la Garza at ASCO and other oncology meetings. “He has so much enthusiasm still for oncology. He obviously loves it. He’s passionate about oncology, he’s passionate about learning,” she said.
A passion for oncology and the ability to share his knowledge motivate Dr. de la Garza to keep working. He has published more than 230 works in national and international journals and has more than 2,227 citations.
“Why do I write so many books and articles?” he said. “Because I learned from [ASCO’s founders]. I learned from Bill Wilson and Harry F. Bisel.”