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	Editor’s Note
	Big Fish in a Big Pond

In a small town there’s no question that you’re a big fish in a small pond, and it’s extremely important for us to maintain humility. If patients can’t make it in to the office because they’re sick and dying, I think it's still important for us to go to their home, even if the only thing you do is hold their hand. That’s what doctors did a hundred years ago — hold the patient’s hand and allow them to die with peace and dignity. That part of the art of oncology sometimes gets lost, but it's still a critical role.

— James N Atkins, MD

Wandering through this year’s ASCO poster sessions, I was fortunate to meet James Atkins, a true champion of clinical research. What initially sparked our conversation was Jim’s ASCO poster reporting an encouraging Phase II study of oxaliplatin and pemetrexed in the treatment of metastatic colorectal cancer. The regimen proved to be so well-tolerated, that the next step may be to evaluate it in elderly patients. However, it was what I learned about Jim’s background and dedication to clinical research that was intriguing and motivated me to interview him for this series.

Dr Atkins’ oncology practice is based in the North Carolina “metropolis” of Goldsboro (population 30,000). Yet each year, he and his partners, Drs M Ernest Marshall and John Inzerillo, enter about 150 patients in clinical research protocols. Jim also travels around the country running seminars on how other community-based physicians can incorporate clinical trials into their practices.

If you were looking for a role model for oncology fellows to emulate, you would not need to look farther than Dr Atkins, as his zeal for patient care is readily apparent. When I asked him what he liked most about being an oncologist, he answered without hesitation, “I love the patients. They are very friendly, kind, warm and extremely appreciative of everything you do.”

One of the most important things Jim regularly does is enroll his patients in protocols, and other speakers in this issue address the many recent advances in colorectal cancer that have resulted from clinical research. Dr Howard Hochster comments on the evolving role of oxaliplatin and brings to light some fascinating new research from France on the use of magnesium and calcium infusions to reduce the rates of neurotoxicity.

Dr James Abbruzzese discusses evolving Phase III research evaluating the oral fluoropyrimidine prodrug, capecitabine, in combination with oxaliplatin. These trials are significant in that they may soon provide more patient-friendly treatment alternatives that do not require prolonged intravenous infusion. Dr Al Benson notes that the availability of new combination options correlates with an increase in survival rates for metastatic disease. He also points out that agents such as oxaliplatin are now being tested in other GI tumors including pancreatic cancer, and Dr Abbruzzese notes that capecitabine is being evaluated in both pancreatic cancer and cholangiocarcinoma with encouraging early results.

The global approach to clinical research in these disease states relies on community-based oncologists, like Jim Atkins, for successful and timely accrual. Every time these physicians comfort a dying patient, their hope is that if the pace of clinical research can continue to accelerate, such tragedies can be prevented in the future.

— Neil Love, MD