JOHN CLELAND was a 23-year-old newlywed college student when doctors diagnosed him with testicular cancer in November 1973.
Despite surgery and a round of chemo, his cancer came roaring back, and treatment did nothing but make him sicker.
At one point, he weighed a ghostly 106 pounds, and the sores in his mouth were so painful that he sometimes spit his saliva into a cup rather than swallow it.
Some 95 percent of young men who were diagnosed with the disease in the 1970s would die from it, and it looked like Cleland would suffer the same fate. But on September 27, 1974, Cleland’s young Indiana University oncologist, Lawrence Einhorn, MD, offered one last option.
“I’d had a chest x-ray in the morning and he sat me down and showed me the chest films,” Cleland says, recalling the details as if it were yesterday. “Even someone who’d never looked at chest films before would probably know that this guy was in serious trouble. The chest x-rays almost looked like Swiss cheese. He told me at that time that there wasn’t much more that he could do for me. As I sat there thinking, my head spinning and my heart pounding out of my chest, he finally said, ‘Well, there is one other thing we could try. You could be one of the very first people to ever try a new chemotherapy.’”
Unable to tell his parents and wife he was giving up, Cleland agreed, and Dr. Einhorn added the experimental agent Cisplatin to the chemotherapy drugs bleomycin and vinblastine. A miracle ensued. His cancer seemingly melted away, and it did not return. For the first time in history, a solid, metastatic tumor had been cured.
Cleland and hundreds of thousands of other men around the world are alive today as a result. This past fall marked the 40th anniversary of the life-changing discovery. As survivors, trainees, colleagues and friends celebrated the milestone, Dr. Einhorn seized the opportunity to announce his latest focus: a new research program that seeks to spare survivors from the “burden of the cure” – long-term, sometimes life-threatening side effects of chemotherapy. His vision is to use gene sequencing technology to evaluate each patient’s risk for potential side effects. A customized treatment plan would then be developed that reduces some toxicities and manages other unavoidable complications throughout the patient’s life.
A total of $700,000 to launch the survivorship program has been contributed by multiple grateful patients and friends of Dr. Einhorn. This includes a leadership gift of more than $500,000 from A. Farhad Moshiri. Moshiri previously established the Lawrence H. Einhorn Chair with a $2 million gift. The Einhorn Chair will be held by the survivorship program director.
“I think Dr. Einhorn realizes that cancer survivorship is the new frontier,” says Lois Travis, MD, ScD, of the University of Rochester Medical Center, one of the world’s leading authorities on the long-term effects of chemotherapy. “We have now in this country about 14 million cancer survivors. They constitute about 4 percent of the population, and we still do not understand all the late medical and psychosocial sequela of cancer and its treatment, especially as they age. So I think it is so logical for Dr. Einhorn, who cured testis cancer patients, to now be concerned about them very long term.”
Following in His Father’s Footsteps
Larry Einhorn grew up in Dayton, Ohio, and he knew fairly early on that he planned to pursue a career in medicine. His father was a family practitioner with an office attached to the family home. “When I was in high school I used to make rounds with him at the local hospital in Dayton,” Dr. Einhorn says. “I admired and respected him a great deal. Even back then I felt medicine was a noble profession.”
He left Ohio for Northwestern University, but soon transferred to Indiana University. It was there that he met his future wife, Claudette Phillips, when his roommate set them up on a date. She was struck by his sincerity and honesty. “And we were a couple ever since,” she says.
After attending medical school at the University of Iowa, Dr. Einhorn returned to IU for his internship and residency. His plan had been to focus on cardiology and move back to Dayton to work alongside his father. But his father had a heart attack and stopped practicing, closing that door.
Fortuitously, another door opened. During his internship, Dr. Einhorn completed an elective in hematology/oncology. “I really became seduced by the specialty,” he says. “There seemed to be an opportunity to make a difference in the field, which was really a nascent field.”
Following his residency, the Einhorns moved to Texas so he could complete a fellowship at MD Anderson, one of only a handful of places in the country that offered advanced training in oncology at the time.
It was then that he first truly witnessed the tragedy of testis cancer. While in the first year of his fellowship, a third-year fellow named Jeffrey Gotleib developed testis cancer and died from it.
“Jeff was a friend of Larry’s, a colleague of Larry’s, and I think it was a very traumatic moment in Larry’s life to see someone his age die of cancer,” Claudette Einhorn says. “I think that influenced him a great deal in terms of where he would begin to do research. The fact that this young man in his 30s died and no one could do anything about it was fairly traumatic and I think set the course for Larry.”
AN UNLIKELY HERO
Dr. Einhorn returned to the Indiana University School of Medicine in 1973 as the first oncologist on faculty. He was just shy of his 31st birthday.
He treated patients with all types of cancer, but he was especially interested in tumors that had shown some response to chemotherapy: leukemia, lymphoma, testicular cancer and small cell lung cancer.
Testis cancer might not typically be a disease on which a doctor would stake his career. Though the leading cancer killer of young men at the time, it is nonetheless rare. The average physician might only see patients with the disease in dribs and drabs.
But the IU School of Medicine was different.
Young men with the disease were flocking to University Hospital from around the United States because John Donohue, M.D., offered radical, heroic surgery that other urologic surgeons wouldn’t even consider. He even managed to save 20 percent of patients whose disease had spread to the abdomen. But many of the patients he operated on still developed a recurrence.
“In then walked a young Larry Einhorn, who had, as John would describe him, a pimply face and a plaid shirt and paisley pants and was a most unlikely hero,” says Patrick Loehrer, MD, director of the Indiana University Melvin and Bren Simon Cancer Center. “Quickly Larry talked to him and said, ‘I’ve got an idea for testis cancer. Would you allow me to work with some of your patients?’
And that began the partnership that would change this disease forever.”
His idea involved the experimental drug Cisplatin. The drug contains the metal platinum and helps prompt the death of otherwise immortal cancer cells. When Dr. Einhorn set his sights on it, Cisplatin had been tested on a wide range of cancers as part of an early phase trial. It proved terribly toxic, and the results weren’t spectacular. It might have been permanently shelved, but Dr. Einhorn noticed that the drug was killing cancer cells in a very small subset of patients with testis cancer.
‘I Think You’re Gonna Make It”
With all this in mind, Dr. Einhorn offered John Cleland this brand new therapy. Cleland didn’t know that only one other person with advanced testis cancer had tried this particular combination of drugs; he died. “We had no idea whether this was going to help for a couple days, a couple weeks, a couple months, let alone cure the disease,” Dr. Einhorn says.
Cleland had already endured four previous kinds of chemotherapy, each seemingly more brutal than the last. The new regimen was equally wretched. He would undergo five days of treatment, take three weeks off, and then do it all over again. On the first day of each course, the average patient would throw up 12 times. In fact, the very thought of coming to the hospital would cause anticipatory vomiting.
On October 20, 1974 – less than a month into the treatment – it didn’t seem that it was working. In fact, Cleland felt downright awful. His fever spiked above 104, and his wife and some friends drove him from his Lafayette home to the emergency room at IU. Doctors ordered a chest x-ray.
The next day, as he lay in a hospital bed, the door to his room ajar, he saw Dr. Einhorn and his nurse, Becky Furnace Bond, exit the elevator. “I knew just from their body language and body motions that somebody had some good news or something was happening that was pretty happy,” he says. “They just kept coming toward my room and coming toward my room, and finally they walked in and Dr. Einhorn said, ‘John, I think you’re gonna make it.’”
When he told me, it was like I was floating in the air. I know I was touching the mattress, but it sure never felt like it. It felt like I was 6 inches off the mattress. Probably the best feeling I’ve ever had in my life. Sheer bliss.
His chest x-rays were clear.
“When he told me, it was like I was floating in the air. I know I was touching the mattress, but it sure never felt like it,” says Cleland, who went on to have three children with his wife Judy and to work as a high school teacher for 31 years. “It felt like I was 6 inches off the mattress. Probably the best feeling I’ve ever had in my life. Sheer bliss.”
Of course, the response of a single patient doesn’t qualify as a cure. The cancer could have come back, and others might not have responded the same way. Dr. Einhorn continued testing the combination, almost always with the same improbable results.
A few years later, he was invited to present his results at the annual meeting of the American Society of Clinical Oncology, the world’s premier organization of cancer specialists. Until then, Claudette Einhorn didn’t fully comprehend what her husband had accomplished. “I think that’s when it first hit me how dramatic this was, that it wasn’t just a positive research study but a lifesaving research study,” she says.
Her next thought was less grand: “I think he needs a new shirt.” They rushed out before his presentation to buy one. “He probably still has it,” she quips.
A Remarkable Legacy
Dr. Einhorn had cured testis cancer. But that wasn’t good enough for him. In the decades that followed, he continued to refine the treatment to spare patients some of the most awful side effects. He also substantially reduced the length of the treatment, from two years in 1974 to a mere nine to 12 weeks today.
Cisplatin, once destined for the pharmacologic graveyard, is now used in the initial treatment for 11 types of cancer.
Meanwhile, Dr. Einhorn remains the international expert on testicular cancer, and patients seek him out from around the globe.
But that is only part of his legacy. He inspired a legion of cancer researchers and developed a road map for them to follow. He also dedicated himself to teaching as a way to impact cancer care well beyond Indianapolis, for years serving as the director of the school’s hematology and oncology fellowship program.
“There’s a line from a sappy Leonardo DiCaprio movie, The Aviator,” says Dr. Einhorn, a Distinguished Professor and the Livestrong Foundation Professor of Oncology. “Howard Hughes, when he crashes in a plane and he’s half-conscious, his words are, ‘I’m Howard Hughes, the aviator.’ I like to think I’m Larry Einhorn, the teacher. I love teaching and dealing with brilliant minds, lighting a spark in them to make a difference in their field. I hope my legacy lives on through others doing their chosen work.”
One of the fresh-faced doctors he helped mold was Dr. Loehrer, now the director of the IU Simon Cancer Center. Harvard’s Nikhil Munshi, MD, one of the world’s most recognized myeloma experts, was also one of Dr. Einhorn’s pupils. Still another was Charles Blanke, MD, who chairs SWOG, one of the largest cancer research cooperatives in the world, and who is responsible for some of the seminal research involving the drug Gleevec.
“He was and is a gifted teacher, not just in terms of the science of oncology, but as a doctor who treats patients,” Dr. Blanke says. “Much of my bedside manner, which remains a pale imitation of what Dr. Einhorn achieves and is beloved for, came from this period of my education.”
Fittingly, the children of prominent Indianapolis philanthropists Sidney and Lois Eskenazi recently pledged $300,000 to ensure IU continues Dr. Einhorn’s tradition and remains a leader in training the next generation of cancer specialists. Sandy Eskenazi, Dori Meyers and David Eskenazi, along with their spouses, established the Sidney and Lois Eskenazi Fellowship in Hematology/Oncology at the IU School of Medicine to honor Dr. Einhorn and celebrate their parents’ 60th wedding anniversary.Dr. Einhorn had the privilege of selecting the first Eskenazi fellow, Jill Kremer, MD.
‘The Best Job in Medicine’
Despite 40 years of celebrity in his field, friends and family note that Larry, as he’s known, remains the same modest, thoughtful person he was before he developed the cure. And though he has received offers from some of the most prestigious medical schools in the country, he has never given much thought to leaving, in part because he loves Indianapolis, but also because he truly believes there is nowhere better than the IU School of Medicine for him to have an impact.
He’s quick to give credit to his IU colleagues on the testicular cancer treatment team, saying that urologist Richard Foster, thoracic surgeon Kenneth Kesler and pathologist Thomas Ulbright are some of the best in the world at what they do.
“It’s very unusual to have such a cadre of people who specialize in a disease like that,” he says.
Outside of work, Dr. Einhorn plays tennis and the occasional game of bridge. He is a loyal fan of IU basketball and the Indianapolis Colts. But mostly, he’s devoted to his family. He and Claudette have two grown children and a 7-year-old granddaughter, Georgia.
“She can get her grandfather to do virtually anything that she wants him to do,” Claudette Einhorn says.
“My favorite is when he is the horse and she is the rider and he’s down on his hands and knees, whinnying and riding around with her on his back. And then, of course, he gets up and his back hurts him, but he would never refuse to let her do it. So she definitely has him wrapped around her finger.”
Otherwise, his life is focused on helping patients, whether through research or the expert care he provides. He still logs 12-hour days at the office, and he regularly takes phone calls at home from patients or other physicians seeking his guidance.
Dr. Einhorn turned 72 in September, but don’t bother asking about retirement. He has no plans.
“I’ve been very lucky that I’m healthy,” he says. “You never know what’s going to happen from day to day. I think oncologists recognize that more than others. I love the work I do. I really enjoy teaching, mentoring faculty and taking care of patients. For me, I have the best job in oncology, if not the best job in medicine.”