This article appeared in the February 29, 2008 Jewish Advocate.
Q & A with Irving Fox, M.D.
by Susie Davidson
Dr. Irving Fox is Head of Inflammation Clinical Research and Distinguished Medical Fellow of Clinical Development at Millennium Pharmaceuticals, Inc., and a Clinical Professor of Medicine at Harvard Medical School. Formerly Professor in Internal Medicine and Biological Chemistry at the University of Michigan, he left academia in 1990 to become Vice-President of Medical Research at Biogen, Inc. in Cambridge. There, his clinical team achieved the approval of Avonex for multiple sclerosis in 1996, and he was involved in the development of Hirulog (approved as Angiomax) for Percutaneous Coronary Intervention, and Amvive for psoriasis. In 1999 he joined Millennium, where he was an advisor for the approval of Campath for Chronic Lymphocytic Leukemia (2001), and Velcade for Refractory Multiple Myeloma, which was approved by the FDA in 2003 for patients who have not responded to one or more other therapies. Millennium's Velcade, the first in a new class of anticancer agents known as proteasome inhibitors, is developed and marketed with a unit of Johnson & Johnson, and was recently granted priority review by the FDA for use in treating new cases of a form of blood cancer.
A Montreal native, Fox obtained his M.D. and B.Sc. degrees at McGill University. He lives in Wellesley with his wife, Gloria, who is a docent at the Museum of Fine Arts. They belong to Beth Elohim in Wellesley and B’nai Israel in Laconia, New Hampshire.
1) How did you become interested in pharmaceuticals?
When I was called by a headhunter in 1989 about an industry job, I didn’t think I'd be interested. But after the interview, I realized that in research and research administration, I would have an opportunity to have a major impact on improving medical care. I had conducted both clinical research on patients and basic research in the lab. I was using biochemistry to study the mechanisms of diseases and normal biological processes. I love clinical drug development because of the great opportunities for developing novel treatments. I’ve been involved with developing five drugs that were ultimately approved.
2) How do biology, technology, pharmacology, and business interact?
The whole approach to developing biological therapies is based on biology, new technologies and pharmacology, as well as medical science. For example, the evolution of molecular and cell biology and slicing DNA formed the basis for making therapeutic proteins, where live cells are engineered to grow in a culture medium. Pharmacology is the study of how a drug behaves in and affects the body. This science applies to therapeutic proteins or standard small molecules, as are found in a pill.
Biotech companies generally create novel, untested products designed to hit untested disease targets. In a business, as opposed to an academic environment, medicine and science are utilized to make discoveries that will make a difference in medical care. The company has to have products in order to stay in business, and to keep doing research. Also, shareholders put their investments at risk in the hope of achieving a profit. This leads to the development of new drugs that we all benefit from. Clinical trials are scientific experiments that involve time and money. Experiments have to be practical, run on time, and on budget. For every ten drugs started in clinical trials, only one may be approved. You have to pay for all the failures.
3) What exciting developments have occurred since you have been at Millennium?
In the last ten years, we've seen novel therapies to treat multiple sclerosis, and biological therapies to treat arthritis and inflammatory bowel diseases like Crohn's and ulcerative colitis, and psoriasis. There have been major advances in treating cancer such as Herceptin, Avastin, and Millennium's drug Velcade for multiple myeloma and mantle cell lymphoma. This is a whole new category of drugs for patients who were previously untreatable. Millennium is a leader in the use of biomarkers to predict response to drugs in patients - something unusual 10 years ago.
4) What developments are in store?
We're going to see continued breakthroughs in therapies for cancer and inflammatory diseases. A number of yet-unproven technologies may have an impact on diseases. Also, because of the recent success in sequencing the human genome, and single nucleotide polymorphisms (SNPs) and haplotype (groups of genes) mapping (SNPs can be used as markers of haplotypes), we are beginning to delineate the causes of many common diseases. We're also going to be able to determine subgroups of patients that respond best to specific treatments. Different sciences are now converging, all using DNA and human genome technology.
Despite being a small company, Millennium is on the cutting edge of novel therapies for cancer and inflammatory diseases. And Boston is one of the two major biotechnology centers in the U.S. (San Francisco is the other; San Diego is third). Major pharmaceutical companies have begun to move here. Besides the hundreds of statewide biotech companies, the presence of Harvard and MIT provide engines of scientific discovery, with great people in both basic and clinical research. This is one of the world centers for medical scientific research.