Pediatric Cancer Center Leader To Retire in July

OKLAHOMA CITY -- For most, July 2020 may be an unremarkable space on the calendar. But for those in any way connected with pediatric hematology-oncology – the practice, the patients and families, providers - the date is significant, marking the end of an era. July 31 is when William Meyer, M.D., steps away from his practice at the Jimmy Everest Center for Cancer and Blood Disorders in Children at The Children’s Hospital at OU Health.

When considering the timing of his retirement, Meyer said he prefers to exit as a matter of choice, not necessity. The answer to why - “Because I am ready” - doesn’t fully convey the conflicting emotions that accompany this milestone. Meyer sees inevitable loss of relationships and work that has been deeply fulfilling, contrasting with the excitement of change and opportunity to pursue other interests. “I value my colleagues nationally and internationally. Those relationships will change, and in some cases, go away. But we’re looking forward to doing more of what we enjoy most.” Meyer and his wife expect to travel more extensively, and are excited about being on hand to welcome their third grandchild, due in July.

Meyer‘s two brothers, both retired, continue to ask, “Why are you still working?” The answer to that question unfurls through a career spanning more than 40 years, 23 spent at the Jimmy Everest Center. Meyer’s entire professional life has been dedicated to improving outcomes for children and adolescents with cancer. Looking back, Meyer cites achievements and the personal satisfaction of a richly diverse career that has kept him active and fully engaged.

“The patient practice is fun, as well as challenging, encompassing both the most positive and negative experiences of direct patient care. There is endless variety in intellectual, research, patient care and administrative activities.” In that administrative capacity, Meyer found valuable opportunities to help develop the Section of Pediatric Hematology-Oncology and his mentorship of junior faculty and trainees has been a rewarding part of that growth strategy.

In addition to travel and grandchildren, Meyer anticipates retirement for time to develop a range of interests including golf, photography and other hobbies that haven’t received adequate attention. He also intends to resume serious piano study and looks forward to spending more time with the Steinway he described as, “better than I am.” A classically trained pianist, Meyer seriously considered a concert career. Although he found opportunities as a professional musician, Meyer’s father urged him toward the field of medicine. A guaranteed spot at the combined Penn State/Jefferson College of Medicine accelerated program clenched his decision.

In 2000, Meyer became chair of the Soft Tissue Sarcoma committee for Children’s Oncology Group, a position of leadership he held for eight years. The group designs all soft tissue sarcoma trials and establishes treatment protocols. He continues to sit on the steering committee, finding it a great intellectual outlet. “Most of my publication record in the last 15 years has been through my work with this group. It also afforded opportunities for international travel.” He also is part of a small group working to create a robust international data base through combining U.S. and European studies of soft tissue sarcomas. “The reason we need to work more closely with our European colleagues is that, as results get better, ever-larger studies are required to detect differences,” explained Meyer. “Some of our last studies have been in cooperation with Europeans in order to understand if we’re moving the needle.”

Meyer recently has been invited to write two editorials, one published last year in the Journal of Clinical Oncology, focused on results of a European study that explored high-dose therapy for Ewing sarcoma, which did not improve outcomes. Preliminary early clinical trials are now aimed at the genetic abnormality present in this aggressive sarcoma. These trials hold promise as a targeted therapy where demand is huge. The second piece, for Lancet Oncology, helps define maintenance therapy as the new care standard for children with intermediate-risk rhabdomyosarcoma.

Meyer’s professional and personal lives collided unexpectedly when his year-old grandson was diagnosed with high-risk metastatic neuroblastoma. Because of the tumor’s biologic characteristics, a very aggressive therapy began. The awkward, emotional tension was inevitable with all Meyer’s staff helping to care for Beau.

Beau went to New York City, where an internationally acclaimed surgeon attempted to resect the tumor that encased major vessels in the belly. With Beau, the family endured surgery and the three-week period of recovery in New York. Tragically, Beau relapsed and died two months following the procedure. Meyer’s candid observation of this chapter in his life and practice: “There’s really good stuff...and there’s some really awful stuff, too.” 

In the midst of devastating and intensely personal losses, other experiences continue to fuel passion and drive momentum. Meyer recalls a very young patient he treated in the late 70s. A time came when the only available treatments were highly experimental research-driven-protocols with a dismal success rate. The family’s choice, perhaps the best choice, was to take their child home to die. Meyer formed a strong bond with the family but lost contact when he left the region. Nearly a decade later, the family contacted Meyer, asking him to treat their other child, a teenager diagnosed with Hodgkin lymphoma. “Today, that patient is a long-term survivor, with a Ph.D. in educational psychology, currently working at a highly regarded cancer center in another state.” The Meyers attended the wedding of the former patient. The patient and family came to support the Meyers at Beau’s funeral service.

Meyer treated another patient who relapsed just short of a five-year remission. Enrolled in a COG study, her case became so complex, hope dimmed and survival was unlikely. “But she finished the therapy, graduated from high school and is pursuing a college degree. Recently, she had her ‘off-therapy’ date tattooed on her arm at the site where so many blood draws were taken.”

Meyer said the future of pediatric oncology must be intertwined with efforts nationally and internationally. He acknowledged the struggles with limited success, frustrations and outcomes that are tragically disappointing. “But I remember when half of the children we treated died. We’re curing more than 80% of them now, and about 90% or more with acute lymphoid leukemias.”

Physicians recognized decades ago that drugs could be used to achieve remission, but it was obvious that no single healthcare system or institution could see and treat enough patients to develop consistent protocols or group trials. “Collaboration will always yield more promising results than competition. As I began training in pediatric cancer, I saw physicians learning to leave their egos at the door.”

The National Cancer Act of 1971, which established the National Cancer Institute in its current form, made federal funding available for cancer research, and cooperative groups began. “We will continue to enroll children in cooperative group studies, pilot studies with pharmaceutical companies, and we design investigator-initiated pilot studies on occasion. Most of our work, however, will be collaborative.”

He said most experts in the discipline of pediatric oncology believe that aggressive multi-agent, classic cytotoxic chemotherapy has reached the limits of its potential to fight cancer. Treatment has relied heavily, if not exclusively, on chemotherapy drugs, most of which have been in use for decades, using various combinations to achieve improved outcomes. Most improvements are related to better management of side effects and toxicities, and while there are high hopes for targeted therapies to treat cancer, these aren’t easily translatable to children’s cancers. Meyer explained childhood cancers do not have the same targets found in adult cancers and occur in statistically small numbers, fewer than 16,000 cases per year in the United States, or one in 285 children. Because research and development are historically volume-driven, the massive investment required would never generate returns. “There’s little enthusiasm for simply throwing around more cytotoxic chemotherapy. At this point, we have fewer good, targeted drugs available than we hoped, but we still hope they’re going to come.”

Meyer drew a comparison between card games and the treatment of rhabdomyosarcoma in an editorial he entitled, “Playing Bad Cards Properly.” The editorial acknowledges that we hold limited cards in our hand and must learn to play them well. “We hope to cure every child we treat. We work with what’s available and the results will be the best we can offer at the present time. At the same time, our approach is one of compassionate support for the patient that considers the values of parents and families.” 

Meyer strongly supports both basic research and clinical trials to find new therapy approaches. He said most families actively seek out opportunities to participate, sometimes desperate to find hope and new opportunities for their children. Pediatric oncologists share a concern about a therapeutic misconception that exists when you talk to families about enrolling patients in new phase I studies or relapse studies. The objective may be to discover more accurate dosing, rather than actually improving outcomes. Meyer said it is understandable that the discussion may be heard as “this will help my child,” but explained extreme care is taken to ensure participation isn’t misrepresented. “We seek to balance their hopes and desires, while having appropriately realistic discussions over the course of many months. Those discussions may take on a different tenor based on all the variables.”

Meyer considers all that has been accomplished during his career and feels a sense of wonder at the successes achieved. The long-term outcome for most childhood cancer patients is that 80 percent are going to survive. However, like others who achieve, he isn’t oblivious to the daunting challenges that cancers of all kinds continue to present. “The human part of us is where we weigh the factors, make the decisions, do the treatment. This is the ‘art’ in medical arts.”

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