The Triple Threat Against Lung Cancer: Gifted Clinician, Teacher and Clinical Trialist

In medicine, we often regard those we hold in highest esteem as being “triple threats,” excelling in the tripartite missions of academic medicine of patient care, teaching and scientific inquiry. The person I am nominating for the Lung Cancer Heroes® award, Dr. Roy H. Decker, embodies these three missions more than anyone I have been blessed to know or work with. He is a lung cancer hero — a “triple threat” in lung radiation oncology as a clinical innovator, teacher and ground-breaking clinical trialist.

Dr. Roy H Decker at PER® 15th Annual International Lung Cancer Congress. Photo by Corey Sandler.

First, he led the early development of stereotactic body radiotherapy (SBRT) for early-stage lung cancer and was the first to adopt it in the state of Connecticut. This clinical innovation has saved and improved countless lives compared to prior conventional radiotherapy. Dr. Decker has refined how to safely and effectively treat patients with SBRT, publish- ing innovative clinical research in high-impact journals such as the Journal of Thoracic Oncology and Journal of Clinical Oncology.

Dr. James B. Yu. Photo provided by Yale School of Medicine.

For example, in 2012, he was the senior author of the manuscript, “Stereotactic body radiotherapy for central lung tumors,” published in the Journal of Thoracic Oncology. In 2012, because we were still learning how to treat lung tumors with SBRT, the treatment of these central lung tumors close to the mediastinum and central structures was considered unsafe, given reports of extraordinary toxicity from SBRT. Dr. Decker was able to open the door to safe SBRT treatment of central tumors — through careful clinical research — by modifying treatment parameters and prescription to balance biologically effective radiation dose and toxicity. Thousands of patients have benefited from this realization.

Second, as a teacher, he selflessly taught others around the state how to perform SBRT and, as a result, life-saving radiosurgery has been available throughout the state regardless of practice affiliation. It is difficult to remember the days when SBRT for early lung cancer was a treatment without a textbook, with only the steady and reassuring hand of an experienced clinician such as Dr. Decker.

He also serves as former program director (now, associate program director) of the radiation oncology residency program, teaching the next generation of radiation oncologists how to treat patients with the highest quality of care. He has received numerous teaching awards in recognition of his efforts. And speaking of textbooks, he has co-authored the definitive chapter on lung cancer in the “Perez and Brady’s Principles and Practice of Radiation Oncology,” the textbook of record for radiation oncology.

Dr. Roy H. Decker. Photo provided by Yale School of Medicine.

Finally, Dr. Decker has pushed the envelope by investigating the intersection between immunotherapy and radiation for lung cancer. At Yale, he conducted a phase 2 study that examined Keytruda (pembrolizumab) and SBRT for progressive or metastatic non-small cell lung cancer. He used a mass cytometry by time-of-flight analysis on peripheral blood of patients and elucidated subpopulations of peripheral immune cells that were correlated with treatment response. Holding a Ph.D. in addition to an M.D., he is able to bridge the gap between basic science and clinical medicine. Therefore, he is the ideal translational investigator. Proof of his leadership lies in his directorship of the Yale Cancer Center Clinical Trials Office as well as the Radiation Oncology Committee for the Southwest Oncology Group, a National Cancer Institute cooperative group. Through these roles, he guides and mentors faculty who are engaging in clinical trials throughout the entire Yale Cancer Center network.

In summary, Dr. Decker is a consummate clinician, teacher and clinical trialist. His vision guides the Yale Cancer Center Clinical Trials Office. He is a giant in the field of lung radiation oncology and is truly a lung cancer hero.

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