Why Cancer matters

Authors

  • Fadlo R. Khuri MD, FACP

    Corresponding author
    1. Editor-in-Chief, Cancer
    • Winship Cancer Institute, Department of Hematology and Medical Oncology, Emory University, 1365 Clifton Rd, NE, Bldg C-3000, Atlanta, GA 30322; Fax: (404) 778-1267
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  • This editorial is dedicated to the memory of Dr. Raja N. Khuri, a great human, mentor, and scientist, and to the enduring influence he had on my academic career. It benefited greatly from careful reading and indeed editing from Lamya Khuri, Esmeralda Buchanan, Carissa Gilman, Judie Wells, Anthea Hammond, and Suresh Ramalingam.

Abstract

This is Dr. Fadlo Khuri's introductory editorial as Editor-in-Chief of Cancer.

“To follow knowledge like a sinking star, Beyond the utmost bound of human thought.” Alfred Lord Tennyson, “Ulysses,” 18421

Illustration 1.

I was 10 years old the first time I caught a glimpse of the phrase inscribed in my father's perfect handwriting beneath the glass cover of his steel desk. I was instantly taken by it, as I had always been by my father, Raja N. Khuri, a physician scientist of rare stature, foresight, and generosity in our native Lebanon. There was something different about this phrase, for there was always something different about Tennyson. The phrase was both inspirational and affirmative. Ulysses sought to challenge death by pursuing knowledge, even after he crossed over to the other side. He rejected comfort or any form of surrender to time or indeed to dogma. The latter portion, I would come to see, was the lot of the scientist, regardless of our field of specialty. Years later, in the presence of 2 pioneers of modern cancer research, Drs. Waun Ki Hong and Reuben Lotan, whose dual influence reinvigorated my own career, I was stunned that the data we had generated on retinoid receptors contradicted every part of our hypothesis.2 “Your data always trump your hypothesis, assuming you performed the experiment well,” the sage Dr. Lotan declared, “and these experiments were carefully designed, replicated, and well performed.” This followed hard on my discovery during my prior article, published in Cancer in 2000,3 that the younger patients with adenocarcinoma of the lung did indeed present with more advanced disease, but when matched for stage, sex, and other parameters with older controls, they did better and lived longer. Most surprising was the finding that 27% of these younger patients were never smokers, the finding that piqued my interest in the first place. Subsequent astute observations by a series of outstanding clinical investigators4-7 of lung cancer would identify these young nonsmokers with lung adenocarcinoma as the very same patients with driver mutations of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK). Science, like Ulysses's seafaring, never ceases to yield surprises.

I was hooked on science and indeed medicine at a young age. With 2 parents as role models (my mother is a mathematician), an infinitely more intellectually gifted younger brother (a mathematical physicist), and most importantly, my wife, my intellectual and emotional superior (a nutritional biologist), science was always my inspiration and destination of choice. My experience with Cancer and with the American Cancer Society (ACS) was critical to my development. I obtained my first peer-reviewed grant from the ACS (a Clinical Oncology Career Development Award, under the dual tutelage of Drs. Hong and Lotan), and learned the importance of evidence-based medicine from several stellar mentors, including my predecessor as Editor-in-Chief of Cancer and long-time friend, Dr. Raphael Pollock, who is and remains a paradigm of the thoughtful, evidence-based surgeon scientist. It was Raphael Pollock who asked me to assume responsibility as Cancer's Section Editor (SE) for Lung Disease, and it was Raphael again who convinced me to apply for the honor of succeeding him, and before him the great Dr. Robert Hutter, as Editor-in-Chief of the cancer research community's original and most august research journal. Cancer's history is replete with original descriptions of disease states, observations of novel therapies in new populations, and epidemiologic trends describing the susceptible and the most resistant of peoples. The journal remains a powerful engine of modern discovery and new knowledge even as it retains the treasure trove of our past scientific accomplishments, our trials and tribulations as a society of collegial, competitive, but ultimately dedicated strivers for new frontiers of knowledge. Cancer remains vibrant, well positioned, and forward-looking thanks to a succession of outstanding editors. But even the most successful enterprises of our 21st century must adapt to change, and evolve to excel.8

The evolution will be substantial, as we collaborate and compete with a number of stellar journals in this era of instant information and online communication. Part of that evolution will be a necessary changing of the guard. Cancer has been well served by a great number of superb SEs, some of whom have served their terms in full and will have moved on in their careers by the time you read this editorial. To them, I convey my, Dr. Pollock's, and the journal's gratitude for outstanding service well rendered. These departing SEs include Drs. Raphael Pollock, Randal Weber, Melissa Bondy, Lisa Newman, Robert Bresalier, Brian Rini, and Janet Abrahm. We have enticed some of the brightest stars of cancer biology, medicine, and population science onto the Editorial Board to replace them. We are delighted to welcome an incomparable crew of internationally renowned leaders. Drs. Suresh Ramalingam, Chan Raut, Robert Ferris, Mona Fouad, Steve Curley, Lynne Wagner, Walter Stadler, and Electra Paskett are the new SEs for Lung Disease, Soft Tissue and Bone Sarcoma, Head and Neck Disease, Disparities Research, Gastrointestinal Tract tumors, Symptom Control and Palliative Care, Genitourinary Disease, and Epidemiology, respectively. They, along with the superb core of stellar SEs led ably by my 2 Deputy Editors for Translational Research, Drs. Robert Bast and Alex Adjei, respectively, who continue with us from Dr. Pollock's tenure as Editor-in-Chief, will help ensure that the peer review process is both expeditious and, above all, fair. A major focus will be shortening the time from submission to publication, with all that entails. This team is crucial to the aspirations that fuel the ongoing transformation of this already great journal.

As I have indicated, my role as the current Editor-in-Chief of Cancer will be evolutionary rather than revolutionary, as the past Editors-in-Chief have set the journal on a firm foundation. The next step will be the enhancement of focus and selectivity to publish only potentially high-impact articles. Reducing the total number of peer-reviewed articles published in Cancer is a priority. A smaller, more selective journal is the right step forward. This will require a regular and consistent level of communication with the SEs, the Editorial Advisory Board, and most importantly, the readership of the journal. We will engage both young and senior faculty invested in the long-term success of Cancer, infusing the editorial process with a profound sense of transparency and ownership. Cancer is fortunate to have a stellar editorial staff led by Journals Director Esmeralda Buchanan and Managing Editor Carissa Gilman and a superb pair of partners in Wiley-Blackwell and the ACS. We intend to engage our SEs, Editorial Advisory Board members, and best reviewers more frequently by asking them to write short online commentaries or review articles, the best of which will appear in the print version. These will be peer reviewed, and should accelerate the engagement of our community. While some approaches will be of necessity experimental, the major issues to address initially are: 1) how to get the very best articles possible published in Cancer, 2) how to accelerate and improve the process of peer review, 3) how to maximize transparency in the review process, and 4) how to best partner with our colleagues in publishing and at the ACS to enhance our shared mission.

I mentioned that my first article as a corresponding author was submitted to and accepted by Cancer during Dr. Hutter's aegis. I understood the responsibilities of being the corresponding author as above all else to accept responsibility for the quality and integrity of the data in that article. This is an even greater responsibility and an increasing challenge for all of us in the age of the Internet. I believe in and will work with our superb editorial office to stringently apply Committee on Publication Ethics (COPE) and International Committee of Medical Journal Editors (ICMJE) guidelines to ensure that scientific integrity is paramount. Conflict of interest issues are becoming even more challenging when selecting appropriate reviewers who do not have competing interests. We at Cancer select our reviewers carefully, choosing people who are objective, fair, and not conflicted through a personal or professional relationship with a pharmaceutical or device company.

Cancer is a worldwide disease. Cancer is fundamentally an international journal with several international versions, one that is read both online and in print across the globe, even as it is grounded in its relationship with the ACS. The top journals in the United States are routinely targeted by the very best researchers from other countries, which is why the New England Journal of Medicine is the premier journal of all, exceeding by some margin The Lancet. Over the last decade, I have been privileged to personally witness a transformation in the quality of cancer research in China to include high-quality, creative studies. Increasingly, the top publications from Eastern Asia are being targeted to major North American journals, including Cancer. For many years, basic research in Japan has been at a very high level; however, recently clinical research and cancer epidemiology in Eastern Asia have also reached a very high caliber. Therefore, although we will become more selective over the years to come, we will focus on publishing more high-quality work. While seeking to publish the very best work from North America, Europe, South America, Asia, and Australia, we will reach out to scientists and physicians of the highest quality in Africa and the Middle East who already aspire to publish in Cancer. We will do so while nurturing a strong focus on the cancer biology and epidemiology emerging from developing nations, such as those in Africa, the Middle East, Southeast Asia, and Central America. The ACS sponsors cancer scholars in the developing world to train and enhance their focus at academic institutions in the United States. Better collaboration and alignment with the ACS will help identify these future stars of the developing world who can become cancer experts and Cancer aficionados. As Tom Friedman, whom I met as a university student while he was pursuing his first Pulitzer Prize in war-torn Beirut, has written, “The world is flat.”8

Cancer is one of the premier journals in the field of oncology. Its success is built on solid foundations, including long-standing readership, growth in its impact factor from 3.6 to 5.4 over the last decade, and more than doubling of its Internet online usage over the last 5 years. We will work on better linking our print and Internet versions of the journal with an accelerated plan to develop both CancerScope and our Web site. The online edition will develop highly selected commentaries, discussions, debates, and blogs about selected articles that we publish. We will enhance the Web site with more interactive features and topical reviews of meetings, as well as commentaries and reviews on subjects that are being published in Cancer. Finally, the ACS has funded more than 100 members of the US National Academies of Sciences and almost 50 Nobel Laureates at key junctures in their careers. We will reach out vigorously to the ACS and its scientific community to referee, review, and comment on selected articles published in Cancer. This feature will be launched with upcoming editorials from ACS leaders and luminaries including Drs. Otis Brawley, Chief Medical Officer; Michael Thun, Vice President Emeritus, Epidemiology and Surveillance Research; and others. We are proud of our strong linkage to the ACS and we will show it.

In summary, it is an honor and a privilege to assume the role of Editor-in-Chief of Cancer. As the recipient of an ACS Career Development Award (1996-1999), a former member of the Peer Review Committee for Cancer Drug Development (2005-2008), a current member of the ACS Council for Extramural Grants (2009-2012), and an individual who has published no fewer than 20 articles in Cancer, including my very first senior authored article,3 I am deeply committed to the success of the journal. I know that the Editorial Board, reviewers, and most importantly, our authors and readership are every bit as committed. I am honored by this opportunity to serve as your Editor-in-Chief. After all, I share your belief that, for our students, scientists, care providers, and perhaps most importantly, our patients, Cancer matters.

FUNDING SUPPORT

No specific funding was disclosed.

CONFLICT OF INTEREST DISCLOSURES

Dr. Khuri is supported by a lung cancer P01 grant (1P01 CA 116676) from the National Cancer Institute and has received funding as a Georgia Cancer Coalition Distinguished Scholar.

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