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Donald Lee Morton
Saint John’s Health Center
Obituary
Donald Lee Morton Surgical oncologist who developed sentinel node biopsy. Born in Richwood, WV, USA, on Sept 12, 1934, he died in Santa Monica, CA, USA, on Jan 10, 2014, aged 79 years. Donald Morton is best known for the development and clinical application of sentinel node biopsy which, to quote a 2006 statement from the American College of Surgeons (ACS), “transformed the surgical management of…melanoma and breast cancer”. Less familiar is Morton’s longstanding concern with the training of doctors in cancer surgery and the use of immunotherapy in cancer medicine. In these areas his achievements may have been less dramatic, but they were no less noteworthy. The son of a coal miner in a small town in the Appalachians, Morton grew up in poverty but escaped it to achieve a place at the University of California and medical training at its San Francisco campus from which he graduated in 1958. He did his postgraduate studies there and at the Surgery Branch of the National Cancer Institute in Bethesda, before embarking on a research career. This took him, 10 years later, to the University of California, Los Angeles (UCLA) School of Medicine, first as head of general surgery and then as professor of surgical oncology. Among his patients during this time was John Wayne, then suffering from the advanced stomach cancer of which he died. When the Wayne family decided to commemorate the actor by setting up a UCLA cancer clinic in his name, they sought Morton’s help. In 1991, in need of more space, the clinic and Morton himself moved to St John’s Health Center in Santa Monica to form what is now the John Wayne Cancer Institute (JWCI). 778
It was in the late 1970s that Morton set out to do something about the large proportion of melanoma and breast cancer patients who were having their lymph nodes removed unnecessarily. He reasoned that if one could identify the first lymph node to which metastasising cells from a primary tumour would be carried, and then check if this node was free of such cells, the more extensive surgery required to remove further nodes could be avoided. Using first a blue dye and then a radioactive label he demonstrated the practicability of an approach that both spares patients unnecessary surgery and also saves money. “It has revolutionised the treatment of melanoma and breast cancer”, says Mark Faries, Director of the Melanoma Research Program at the JWCI. “It’s now a standard staging technique for patients with intermediate or high risk melanoma, and it provides the most important prognostic information. It’s been investigated in other conditions as well.” Speaking of Morton’s interest in immunotherapy for cancer, Dave Hoon, the JWCI’s Director of Molecular Oncology, describes his colleague of 30 years as a pioneer. “When he first became interested in immunotherapy people didn’t really believe in it. Now it’s a hot topic.” Morton’s focus for many years was on a melanoma vaccine derived from three killed melanoma cell lines and given to patients as an immune stimulant. “This vaccine went through a series of very encouraging phase 1 and 2 trials”, says Faries. “Then there were two large phase 3 trials on stage III and IV melanomas. Those trials didn’t show a benefit to the vaccine.” It was abandoned. “I’m sure he was extremely disappointed because he’d poured so much effort over so many years into its development and testing”, Faries adds. “I’m sure he must have felt crushed. But you couldn’t tell.” Morton never gave up on immunotherapy, not least because although the vaccine itself appeared to be without benefit, all the patients in his trials did better than might have been expected, possibly on account of the BCG used as an adjuvant. “In the last few years of his life in the lab he focused on BCG”, says Hoon. “There are responders, and he was trying to predict which patients would be responsive. He kept on pushing at it.” When Morton joined UCLA in the 1970s, surgical oncology was not recognised as a subspecialty. He changed that, creating a Division of Surgical Oncology in his medical school. “Dr Morton’s division essentially proved a model for other medical schools to duplicate”, according to the ACS. “He was a good teacher”, says Hoon. “He loved to train people.” At the JWCI he directed its thriving Surgical Oncology Fellowship Program. He didn’t forget his humble origins either, says Faries. “He was very much a father figure for everyone here and for all the people he’d trained over the years.” He was as proud of their success as of his own. Morton leaves a wife, a daughter, and four children from a previous marriage.
Geoff Watts www.thelancet.com Vol 383 March 1, 2014
Obituary
Donald Lee Morton Surgical oncologist who developed sentinel node biopsy. Born in Richwood, WV, USA, on Sept 12, 1934, he died in Santa Monica, CA, USA, on Jan 10, 2014, aged 79 years. Donald Morton is best known for the development and clinical application of sentinel node biopsy which, to quote a 2006 statement from the American College of Surgeons (ACS), “transformed the surgical management of…melanoma and breast cancer”. Less familiar is Morton’s longstanding concern with the training of doctors in cancer surgery and the use of immunotherapy in cancer medicine. In these areas his achievements may have been less dramatic, but they were no less noteworthy. The son of a coal miner in a small town in the Appalachians, Morton grew up in poverty but escaped it to achieve a place at the University of California and medical training at its San Francisco campus from which he graduated in 1958. He did his postgraduate studies there and at the Surgery Branch of the National Cancer Institute in Bethesda, before embarking on a research career. This took him, 10 years later, to the University of California, Los Angeles (UCLA) School of Medicine, first as head of general surgery and then as professor of surgical oncology. Among his patients during this time was John Wayne, then suffering from the advanced stomach cancer of which he died. When the Wayne family decided to commemorate the actor by setting up a UCLA cancer clinic in his name, they sought Morton’s help. In 1991, in need of more space, the clinic and Morton himself moved to St John’s Health Center in Santa Monica to form what is now the John Wayne Cancer Institute (JWCI). 778
It was in the late 1970s that Morton set out to do something about the large proportion of melanoma and breast cancer patients who were having their lymph nodes removed unnecessarily. He reasoned that if one could identify the first lymph node to which metastasising cells from a primary tumour would be carried, and then check if this node was free of such cells, the more extensive surgery required to remove further nodes could be avoided. Using first a blue dye and then a radioactive label he demonstrated the practicability of an approach that both spares patients unnecessary surgery and also saves money. “It has revolutionised the treatment of melanoma and breast cancer”, says Mark Faries, Director of the Melanoma Research Program at the JWCI. “It’s now a standard staging technique for patients with intermediate or high risk melanoma, and it provides the most important prognostic information. It’s been investigated in other conditions as well.” Speaking of Morton’s interest in immunotherapy for cancer, Dave Hoon, the JWCI’s Director of Molecular Oncology, describes his colleague of 30 years as a pioneer. “When he first became interested in immunotherapy people didn’t really believe in it. Now it’s a hot topic.” Morton’s focus for many years was on a melanoma vaccine derived from three killed melanoma cell lines and given to patients as an immune stimulant. “This vaccine went through a series of very encouraging phase 1 and 2 trials”, says Faries. “Then there were two large phase 3 trials on stage III and IV melanomas. Those trials didn’t show a benefit to the vaccine.” It was abandoned. “I’m sure he was extremely disappointed because he’d poured so much effort over so many years into its development and testing”, Faries adds. “I’m sure he must have felt crushed. But you couldn’t tell.” Morton never gave up on immunotherapy, not least because although the vaccine itself appeared to be without benefit, all the patients in his trials did better than might have been expected, possibly on account of the BCG used as an adjuvant. “In the last few years of his life in the lab he focused on BCG”, says Hoon. “There are responders, and he was trying to predict which patients would be responsive. He kept on pushing at it.” When Morton joined UCLA in the 1970s, surgical oncology was not recognised as a subspecialty. He changed that, creating a Division of Surgical Oncology in his medical school. “Dr Morton’s division essentially proved a model for other medical schools to duplicate”, according to the ACS. “He was a good teacher”, says Hoon. “He loved to train people.” At the JWCI he directed its thriving Surgical Oncology Fellowship Program. He didn’t forget his humble origins either, says Faries. “He was very much a father figure for everyone here and for all the people he’d trained over the years.” He was as proud of their success as of his own. Morton leaves a wife, a daughter, and four children from a previous marriage.
Geoff Watts www.thelancet.com Vol 383 March 1, 2014