Embracing the Charm of Uncertainty in Lung Cancer Research

Tony S.K. Mok, MD

In the dark days of World War II, a 12-year-old boy dodged the Japanese soldiers who occupied his neighborhood in Hong Kong, slipping around corners and into alleys to sell cans of kerosene he’d converted from diesel oil to support his widowed mother.

When the occupation was over, he learned English in night school and rented a typewriter so he could make money exporting cheap toys to the West. Eventually, his import-export venture did well enough that he could afford to buy the typewriter outright.

Six decades later, his son, internationally recognized oncologist and investigator Tony S.K. Mok, MD, keeps that same typewriter in his office. Mok calls it his daily reminder to follow his father’s example of “entrepreneurship and diligence.”

Mok’s groundbreaking research into treatment options for lung cancer subtypes that are driven by genetic mutations is credited with producing a paradigm shift in fighting the world’s deadliest malignancy.

One look at his resume hints at a curiosity that compels him to seek out experiences not in the average oncologist’s day: He’s not just a world-renowned cancer investigator and clinician, but he’s also the host of several seasons of televised food shows, and he’s written a news-paper column for the past 14 years.

His face is so familiar in Hong Kong that an elderly patient, meeting him for the first time, assumed he was just an actor. “Are you a real doctor?” she asked skeptically, Mok, 60, recounted with laughter. How does he make time for it all?

“When an opportunity comes along, 2 things come to my mind: Am I going to like it? And am I going to make a positive contribution to the community? If the answer to both questions is ‘Yes,’ I find the time,” he said.

He was born Shu Kam Mok. When his parents enrolled him in an English-speaking secondary school, the school insisted he take a Christian name. A tutor picked “Tony” and the name continued to make sense for the next chapter of his life, when his parents sent him to college in Canada at age 16. He received his fellowship training in medical oncology at Princess Margaret Cancer Centre in Toronto, Ontario, having chosen oncology because it seemed to be a field on the cusp of major new developments.

In 1995, he took a tour of the Prince of Wales Hospital, the main teaching hospital of the Chinese University of Hong Kong. At the end of the tour, the head of oncology surprised him with a job offer.

Hong Kong was starting to experience a “brain drain” of physicians worried about the impending transfer of the British colony to China. Mok’s credentials as a seasoned oncologist who spoke Chinese made him an attractive candidate, despite his lack of research experience.

Accepting the offer would mean giving up his comfortable life in Canada and taking a big financial hit. On the other hand, he’d get to work with Chinese researchers and he was enchanted by “the charm of uncertainty.” Staying in Toronto meant his life would follow the very predictable path of a suburban physician.

He took the plunge and accepted the offer. He was 36, older than most of his peers, he didn’t have a single publication to his name.

Mok noticed that few investigators in Asia were looking lung cancer. The lethality of the disease was discouraging, and its mysteries seemed impenetrable. Where others saw a brick wall, however, Mok saw opportunity.

“One of the reasons to go into a field where little is known is because that is exactly the field where you’ll learn more and create more,” he said. “I thought, ‘This is a great area where there is going to be great progress.’ ”

A Modern Renaissance Man

His early research tackled a grab bag of topics, including pancreatic, colon, and lung cancers, as he tried to catch up with his colleagues. Much of his research has focused on the role of the EGFR gene mutation in non–small cell lung cancer (NSCLC). Mok was the lead researcher for the pivotal phase 3 IPASS trial. Investigators randomly assigned 1217 previously untreated patients with advanced lung cancer in East Asia to gefitinib (Iressa) or carboplatin plus paclitaxel.

For patients with the EGFR gene mutation, gefitinib was clearly superior to standard chemotherapy; for patients without the mutation, chemotherapy was superior.

The data, published in the New England Journal of Medicine in September 2009, remade the world of lung cancer treatment and remains 1 of the most cited publications in the field. Based on that data, physicians would test patients with newly diagnosed lung cancer for genetic mutations before choosing a treatment. Lung cancer, so slow to relinquish its secrets, had entered the age of personalized medicine.

While Mok is accessible and friendly by nature—and funny, as well—colleagues say that beneath that convivial exterior is a serious intellect. His presentations at professional conferences are known for delivering not just the latest developments in research, but for put-ting that research into a broader context that every attendee can grasp, even those outside the immediate field of lung cancer.

He’s also a wine connoisseur and foodie who makes it a point to know the best restaurants in every major city. At the American Society of Clinical Oncology (ASCO) Annual Meeting, Mok traditionally arranges a big dinner with friends where shop talk is discouraged.

All his activities—the university teaching, the columns in the Hong Kong Economic Times, his work in the clinic, and his research—make for a very full plate. He wouldn’t have it any other way, explaining that being busy fits into his philosophy of life.

“The way I see life, the way I define a happy life, is this: At the end of the day, how many happy moments have I collected? So if I collect enough moments, I can call this a happy life,” Mok said.