Making an Impact in the Fight Against GU Cancers as Scientist, Physician, and Teacher

Dean F. Bajorin, MD

Long before Dean F. Bajorin, MD, would travel the world as a renowned expert in genitourinary cancers—presenting at international conferences, working with major task forces, and changing the paradigms of care for patients in every corner of the globe—he began with a decidedly shorter journey: to college.

The College of the Holy Cross in Worcester, Massachusetts, was a good school, but Bajorin chose it not so much for its academic reputation as its proximity. It allowed him to be a “day student” and save money by living at home.

Bajorin enrolled in the premed program, but becoming a doctor was not top of mind. He saw himself as a scientist and majored in physics with a minor in math. He also spent a good deal of time working with what was then a novel technology: computers. “Back in the ’70s, that was really unheard of,” he said. “In fact, we used punch cards to do linear accelerator experiments in physics.”In retrospect, that early background as a scientist tackling new technology seems a fitting prelude to his future career.

“When I wanted to get into medical school, people looked at me and said, ‘You know, they don’t need people who are mathematical and do computer programs,’” Bajorin recalled.

Bajorin subsequently graduated from New York Medical College, followed by a residency at Hartford Hospital in Connecticut. His initial interest was in cardiology, so he was happy to be at a hospital that had a major interventional cardiology program. His future, though, turned on a broken arm. He was performing an OB/GYN rotation, but he couldn’t work in the delivery room with his injury.

The head of his program scrambled to find a spot for him. “The only [opening] at the time was in oncology, and so he said, ‘Sorry, that’s where you’re going,’ ” recalled Bajorin

That apology turned out to be unnecessary. Bajorin loved the rotation so much that he eventually altered his plans and the course of his career.

Finding His True Path

When he considers why he made the switch from cardiology to oncology, Bajorin explained that it had to do with the relationships he was able to build with patients as an oncologist.

Cardiologists, of course, have relationships with patients, but Bajorin said the immediacy and emotional impact of a cancer diagnosis changed the quality of his doctor-patient relationships.“With cancer, everything is on the line, and it’s immediately on the line,” he said. “It was like ICU care, but in the outpatient setting. Everything was magnified.”

While a fellow, he and colleagues also sought to figure out why there was such variation in terms of survival among patients with testis cancer. One group of patients was likely to survive, so minimizing toxicity was key. Other patients were at high risk for death and required very intensive therapy.

Distinguishing between the 2 groups, therefore, became critically important. Unfortunately, the 4 major staging systems used to make treatment decisions were woefully flawed.

“I took the same group of patients and I applied each [system]—and I showed how dramatically different they were,” he said. “So the results that those investigators were publishing were not because of their chemotherapy, but because they selected different populations of patients.”

It was a transformational moment, Bajorin said. “Now, instead of risk stratification purely based on anatomical sites of disease, we’re including biomarkers, and it has made a difference for all men with testis cancer in the world.”

Bajorin said the new criteria helped physicians better tailor treatment and minimize toxicities for patients with testis cancer, allowing low-risk patients to choose less intensive treatment.

On the Cutting Edge

Bajorin has spent his career pushing forward the field of genitourinary cancer by developing new treatments, forging new paradigms in multimodal therapy, and searching for biomarkers and their clinical implications. He led phase 2 trials of chemotherapy drugs including docetaxel, pemetrexed, and the combination therapy of gemcitabine, carboplatin, and bevacizumab (Avastin).

Bajorin was convinced he could improve upon predictive factors beyond just staging systems to construct a better way to assess potential therapies. This work led to a breakthrough in 1999: Karnofsky performance status and visceral metastasis could be predictive of patient survival times. Those risk factors became known as the “Bajorin criteria” and emerged as a tool for patient stratification in clinical trials for bladder cancer.

In 2016, he and colleagues published widely cited research assessing atezolizumab (Tecentriq). That work helped lead to the accelerated approval of the drug in 2017 for patients with locally advanced or metastatic urothelial carcinoma who were ineligible for cisplatin-based therapy. The following year, he coauthored the results of the KEYNOTE-045 study, which found that pembrolizumab (Keytruda) was superior to chemotherapy as a second-line therapy for patients with advanced urothelial carcinoma.

The FDA later limited both agents to use in patients who are not eligible for cisplatin-containing therapy and whose tumors express PD-L1 or who are not eligible for any platinum-containing chemotherapy regardless of PD-L1 status. They also are approved in progressive disease settings.

In addition to seeing himself as a scientist, and then as a clinician, Bajorin said one other role is central to the way he thinks about his contributions to the field of oncology: teacher.

“That’s been my major emphasis in terms of my career—training the next generation of physicians, medical oncologists, physician-scientists, and clinical scientists,” he said.

In fact, Bajorin has taught at MSK since graduating from medical school in 1986. He has also led the center’s fellowship in medical oncology/hematology since 1994, making him the longest-tenured oncology fellowship director in the United States. When he first started, he said he worked to develop new standards and new opportunities for translational scientists who could provide top-tier clinical care while also performing research at the highest level. “We needed to create that infrastructure and support mechanisms for that,” he said.