Immunotherapy researcher and oncologist Dr. Edus H. Warren works on the front lines of a revolution.
In his 24 years at Fred Hutchinson Cancer Research Center, Warren, who goes by the nickname “Hootie,” has contributed to jaw-dropping discoveries in harnessing the immune system to fight cancer. Today immunotherapy is considered the most exciting advance in decades, joining surgery, radiation therapy and chemotherapy as a fourth pillar of cancer care.
Now, as the new head of Fred Hutch Global Oncology, he is set to lead a revolution that could be just as transformative: improving cancer care in sub-Saharan Africa and other regions that do not always have access to even the first three pillars.
Fred Hutch President and Director Dr. Gary Gilliland announced Warren’s appointment in a campus-wide email Thursday.
“I am particularly proud that after an extensive international search, guided by an external firm, our star candidate and new program head is one of our very own,” Gilliland said. “Hootie’s appointment highlights his exemplary accomplishments as well as Fred Hutch’s leadership within the rich global health research community for which Seattle is renowned.”
In the global health field, Fred Hutch Global Oncology stands out for its focus: Most academic institutions and nongovernmental organizations working in sub-Saharan Africa concentrate on infectious diseases such as HIV, tuberculosis and malaria. Until recent years, few were aware of cancer’s toll in low- and middle-income countries, even though more than 70 percent of cancer deaths worldwide occur there.
The Fred Hutch program, now a cross-divisional effort led by the Hutch’s Vaccine and Infectious Disease Division, grew out of a small 2004 research project with the Uganda Cancer Institute, or UCI, in Kampala, Uganda. That project led to a formal alliance in 2008. In 2015, the state-of-the-art UCI-Fred Hutch Cancer Centre opened in Kampala to house research, training, laboratories, and adult and pediatric outpatient clinical care.
At the alliance’s beginning, Uganda had only one oncologist serving a country of more than 40 million people. Today, a dozen young Ugandan doctors have trained in Seattle and returned to practice at the UCI. The alliance has completed more than 30 research projects on five cancers — Kaposi sarcoma, Burkitt lymphoma, cervical cancer, breast cancer and Hodgkin lymphoma. It has enrolled more than 1,800 study participants and archived more than 160,000 research specimens.
“We are very excited to have Hootie assume the leadership of Global Oncology,” said Fred Hutch Senior Vice President and VIDD Director Dr. Julie McElrath. “He is a superb and compassionate oncology physician and an outstanding translational scientist and mentor. Hootie brings inspiration and essential talent to launch the Global Oncology program to its next phase of growth and success.”
Warren aims to build on the Uganda work as well as look for synergies with other Fred Hutch international efforts, including its China Initiative and a cutting-edge Hutch immunology laboratory in Cape Town, South Africa, built to do HIV vaccine research.
He also hopes to engage oncologists, infectious disease doctors, epidemiologists and other researchers from across the Hutch, the UCI in Kampala and elsewhere toward a goal he has nurtured since childhood — using science to help people around the globe.
“We produce breathtaking science on a daily basis here,” he said. “The problem is that much of the world’s population doesn’t have access to it. One of our major goals is to think outside the box, to figure out how we can adapt the incredibly exciting work that’s done here so that it can benefit people all around the world.”
Warren was first drawn to Seattle not because it was a global health hub — that was still years away — but because of Dr. E. Donnall Thomas’ Nobel Prize–winning work in bone marrow transplantation.
Warren was in his fourth year at Harvard Medical School, a Harvard University doctorate in neurobiology already under his belt, when he picked up the Boston Globe on Oct. 9, 1990, and read about Thomas’ Nobel Prize. The idea that an immune system could be successfully transplanted into another person’s body to fight and often eliminate cancer was “mind-boggling,” he recalled thinking. It is still “one of the clearest examples of successful immunotherapy we have in medicine.”
The decision to specialize in oncology was reinforced during his residency at Massachusetts General Hospital. He took care of a young man with HIV who had developed a high-grade lymphoma, one of a small number of cancers known as AIDS-defining malignancies. At the time, there was no treatment yet for HIV and nothing to stop the cancer. The patient died.
“It was a formative experience,” Warren said, “It impressed upon me the limitations of what we could do then.”
He came to Seattle in 1993 as a medical oncology fellow at the University of Washington and a research associate in immunology at Fred Hutch. Working first with mentor Dr. Stan Riddell and then in his own lab, Warren focused on understanding at the cellular and molecular level how some, but not all, newly transplanted immune cells called T cells attacked leukemia cells. He discovered a way to isolate the ones that did, multiply them in a lab and give them back to the patient — a technique known as adoptive T-cell therapy.
He designed and led Fred Hutch’s first clinical trial on T-cell therapy for patients with leukemia. He also co-invented a powerful, next-generation sequencing technology that allows researchers an unprecedented, deep look at the millions of different T cells — and the diseases they target — in each individual person.
As excited as he was by this trailblazing science, Warren never forgot a lifelong dream of combining science with public service, of taking advances to places far from scientific hubs. He carries in his canvas briefcase a laminated photo of a childhood hero, Nobel Peace Prize–winning agronomist Norman Borlaug, the father of the “Green Revolution,” whose efforts to increase wheat yields saved millions from starvation. Another childhood hero was Albert Schweitzer, a theologian, philosopher and physician who won a Nobel Peace Prize, in part for his medical missionary work in West Africa.
Warren’s goal was best captured in a favorite quote from Dr. William Foege, a renowned epidemiologist with UW ties who is often called the “father of global health” for his role in eradicating smallpox: “There is something better than science, and that is science with a moral compass, science that contributes to social equity, science in the service of humanity.”
Warren’s dream gained new clarity when his brother and “best friend in the world” gave him what turned out to be a final gift of guidance.
Descended from a long line of North Carolina tobacco farmers, Warren grew up in New Jersey with his brother and two sisters in a family steeped in self-effacing humor and public service. (His nickname, “Hootie,” is a sibling-bestowed pronunciation of his middle name, Houston.)
His father, Edus Houston Warren Jr., sped up his first year at Harvard College so he could volunteer for the United States Army Air Corps — later the U.S. Air Force — as World War II was unfolding. Before he was 21, he had flown 100 combat missions as a fighter pilot. Surviving that experience left his father “resolutely determined to make the most of life,” his son recalled in a moving eulogy to the elder Warren, who died in April at 93.
Warren described his father, who completed his economics degree at Harvard and had a successful career in finance, in words others at Fred Hutch often use to portray him: “He was very humble. He was always quite self-effacing. He never made any fun of anyone but himself, and he was quite good at that.”
The other great influence on Warren was his brother, Ralph. “He had the most vigorous, powerful, far-ranging intellect of anyone I’ve ever met,” Warren said. “He was the quintessence of a Southern gentleman, a great physician and a great friend. I couldn’t have had a more wonderful brother.”
Five years older, Ralph also graduated from Harvard Medical School and trained at Massachusetts General Hospital. Then a relentlessly progressive, if episodic, neurological disorder set in during his last year of cardiothoracic surgical training. No longer able to provide the specialized care he had trained for, he worked as a trauma surgeon instead, including two tours of duty in Iraq with the Air National Guard.
As Ralph sought a way to make a difference despite his progressive disease, Hootie — who had previously worked on a short-term assignment with the Indian Health Service — urged him to go to New Mexico. Ralph spent the last nine years of his life working with the Navajo, Hopi, Zuni and Pueblo peoples. His death in 2009 at 55 devastated his younger brother but also impelled him toward the new challenge he is taking on today as head of Global Oncology.
“In the months before Ralph died, he urged me to do what I really wanted to do,” Warren said. “And this is what I really want to do.”
Taking his brother’s words to heart, Warren began to focus on Fred Hutch’s growing work with the UCI in Uganda.
He plunged into researching Burkitt lymphoma, the leading cause of pediatric cancer deaths in sub-Saharan Africa. (On the wall of his office hangs a photograph of Dr. Denis Burkitt, the Irish surgeon and missionary who first described the cancer that bears his name.) He also began working with Dr. Warren Phipps, a Fred Hutch faculty member who directs training and research on one of the three most common cancers in Uganda, Kaposi sarcoma.
Before long, Warren was traveling to Kampala at least twice a year. Today, about half of his lab focuses on Uganda-based research projects, with an emphasis on the immunobiology of Kaposi sarcoma and lymphoma.
“Dr. Warren brings to the collaboration a strong motivation backed by the requisite scientific knowledge and skills gained over the years,” said UCI Director Dr. Jackson Orem in an email from Kampala praising Warren’s appointment to lead Global Oncology. “He has matching leadership skills and commitment to building capacity at the UCI through the collaboration.”
As one example of that commitment, Warren and Ugandan physician-researcher Dr. Abrahams Omoding in 2015 set up the Lymphoma Tumor Board, which meets every Friday via Skype at 2 p.m. in Kampala, 4 a.m. in Seattle. Physicians, pathologists, nurses, pharmacists, researchers, and laboratory staff attend, with Ugandan clinicians presenting patient case reports. Discussion follows on how to best diagnose and manage various adult and pediatric blood cancers.
“It’s grown to the point that now we routinely have not just UCI but additional sites within Uganda dialing in,” said Andrea Towlerton, Warren’s lab manager, who wakens early to attend the meetings not because Warren requires her to but because he inspires her.
“He is one of the nicest and most caring individuals I’ve ever met,” said Towlerton, who has worked for Warren for seven years. “A lot of people in the world are good at being a scientist or at being a physician. He throws his whole heart into both. He’s so approachable, so accessible and positive. And he has that one thing you can’t teach someone: compassion.”
Omoding noted in an email from Kampala that Warren’s “friendship, selfless commitment, astronomical intellect and mentorship” have both inspired his Ugandan colleagues and challenged them to become better clinicians and researchers.
“I know this [appointment] will further leverage his already vested effort toward the development of robust cancer care and expert cancer personnel in Uganda and throughout the globe,” Omoding said. “I am not surprised that he has earned this position because global oncology has always been at the center of his heart.”
Global health is not only at the center of Warren’s heart, it remains a family affair.
He met his future wife, pediatrician Dr. Linda Warren, at Harvard Medical School and was enthralled when she spent three months working at the Albert Schweitzer Hospital in Gabon, central Africa. Sharing his passion for global service, she has taken time away from her Bainbridge Island practice to help with tsunami relief in Indonesia and recently worked as a Peace Corps volunteer teaching pediatrics at Gulu University/St. Mary’s Lacor Hospital in northern Uganda.
The couple’s two daughters, Katherine and Sylvia, and son, Houston, each pursued global interests in college, whether starting a student global health think tank or undertaking projects in Cambodia and Thailand. Named a Truman Scholar in 2012 and a Rhodes Scholar in 2014, daughter Katherine credited both parents for being “incredibly passionate and generous people” in traveling the world to help those in need. (She also cited another inspiration: her beloved Uncle Ralph.)
When Linda Warren worked in northern Uganda this past year, Warren was able to video chat with her twice a day from Seattle using FaceTime.
That experience, he believes, holds lessons for cancer care.
Skipping landlines for cell phones “let you leapfrog all these 20th-century technologies,” he said. “If you can put medical applications and even laboratory diagnostic devices on a mobile phone, you can revolutionize patient care all over the planet.”
Warren knows that many low-income countries lack even basic health care infrastructure, much less the blood products, intravenous lines, new drugs and sophisticated equipment needed to support high-intensity care. But, he points out, what scientists are learning here about the immune system can still be adapted to improve care half a world away.
“We’re not going to be doing bone marrow transplants and T-cell therapy in sub-Saharan Africa this year,” he said. “But we can take the principles we’ve learned about immunotherapy and develop better treatments for cervical cancer or endemic Burkitt lymphoma or Kaposi sarcoma. We can adapt the breathtaking discoveries and advances that we make here so they can benefit the other 7 billion people in the world more than they do now.”
With a lifetime of enthusiasm, he added, “I can’t wait to get started.”
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Mary Engel is a former staff writer at Fred Hutchinson Cancer Center. Previously, she covered medicine and health policy for the Los Angeles Times, where she was part of a team that won a Pulitzer Prize for Public Service. She was also a fellow at the Knight Science Journalism Program at MIT. Follow her on Twitter @Engel140.