![\"Ian](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2026\/07\/Ian-Tannock-with-parents-and-sister-early-1960s-615x800.webp\" "\\"The")
Ian Tannock with his parents and sister<\/p>\n
There are people in oncology who are remembered for discovering a drug, leading a trial, changing a guideline, or building a program. And then there are people who change the way others think.<\/p>\n
Dr. Ian Tannock has changed the thinking of many oncologists, including me, who today are devoted to making sure cancer care is optimal for patients.<\/p>\n
When I met him a few months ago at the CReDO workshop, the first thing I thought was, \u2018Wow, he is very kind, humorous, and comforting.\u2019\u00a0Friendly, one would say. We indeed became friends, and proudly, I am one of the lucky ones who can now also call him a mentor.<\/p>\n
And through this article, you\u2019ll get to know him a bit better and understand the mindset in which each one of us makes oncology better \u2013 not by a clinical trial or an FDA approval alone.<\/p>\n
When I began by asking him to introduce his background \u2013 where he was born, how he grew up, how he decided to become an oncologist, and whether he always knew he wanted medicine \u2013 he smiled.<\/p>\n
\u201cThat\u2019s a lot of questions,\u201d he said.<\/p>\n
And then he began, not with a grand childhood dream of becoming a doctor, but with something much more aware.<\/p>\n
\u201cI did not always know that I wanted to do medicine,\u201d he said. \u201cIn fact, when I was in high school, I happened to be quite good at mathematics, and being a typical lazy teenager, I did what was easy for me.\u201d<\/p>\n
He was born in England, grew up there, and went to Cambridge University. He initially studied mathematics, then switched to physics.<\/p>\n
\u201cDuring the first year at Cambridge, I became aware that maths didn\u2019t lead to any sort of career that I was interested in. So, I switched to physics, which was relatively easy to do. I had then thoughts of doing medicine, but that would have meant giving up a university place and having no guarantee that I would get into medical school. So, I did math and physics, and then I did a PhD at the Institute of Cancer Research in London, which had a medical scientific background.\u201d<\/p>\n
His PhD was in medical biophysics, studying growth kinetics of tumors in experimental animals using thymidine autoradiography, a technique that had been developed around that time. After that, he was offered a position at MD Anderson in Houston as a postdoctoral fellow. It was there, while working in the lab and interacting with clinicians, that he made the \u201cadult\u201d decision, knowing, not thinking, that he wanted to become a medical doctor.<\/p>\n
Because of his scientific background, he completed medical school in three years at the oldest medical school in the States \u2013 University of Pennsylvania. Oncology then became a natural continuation of the work he had already been doing in experimental cancer research. Colleagues expected him to go into radiation oncology, but his attention moved elsewhere.<\/p>\n
\u201cI decided that the major problem with cancer was metastatic disease,\u201d he said. \u201cSo I instead trained in internal medicine and medical oncology.\u201d<\/p>\n
He came to Toronto as an intern, older than most interns at the time, and eventually joined the staff at Princess Margaret Hospital, now Princess Margaret Cancer Centre. Apart from a sabbatical year in France, he spent his career there.<\/p>\n
Ian Tannock with his parents and sister<\/p>\n
The Beginning of a Critical Eye<\/p>\n
When Dr.\u00a0Tannock started in oncology, the field was living through a time of great enthusiasm. Some cancers that had once been fatal were becoming curable with systemic therapy. Testicular cancer, Hodgkin lymphoma, lymphomas, and childhood leukemias were changing the way oncologists imagined the future.<\/p>\n
\u201cThere was a prevalent attitude that we\u2019ve defeated testis cancer and lymphomas, and it\u2019s only a matter of time before the same thing will happen where we can readily cure common cancers like breast, lung, and colorectal cancer,\u201d he said. \u201cAnd that, of course, didn\u2019t happen.\u201d<\/p>\n
What troubled him was not the optimism itself. It was the lack of criticism around the evidence.<\/p>\n
\u201cWhen I was a young oncologist, and I looked at the results of clinical studies, I was struck by people being not very critical about what they were finding,\u201d he said. \u201cI did start to write some critical articles around that time.\u201d<\/p>\n
One of those articles appeared in the very first issue of the Journal of Clinical Oncology. It was critical of the way trials were being conducted and how claims were being made.<\/p>\n
Cancer of the Big Toe<\/p>\n
One of the most memorable examples of his work is the famous \u201cCancer of the Big Toe\u201d paper.<\/p>\n
When I asked him about it, he immediately laughed.<\/p>\n
\u201cI got lots of frequent flyer miles out of that article,\u201d he said.<\/p>\n
The idea came from disappointment. Even in respected journals, he saw papers using methods of reporting that made treatments look better than they really were.<\/p>\n
\u201cOne way, of course, is to take some real papers and to criticize them,\u201d he said. \u201cBut you\u2019ll soon make a lot of enemies that way.\u201d<\/p>\n
So instead, he and a younger colleague created a hypothetical clinical trial. The disease was cancer of the big toe, which, as he pointed out, barely exists. The treatment regimen was called CABOOM.<\/p>\n
They reported the same fabricated data in two different ways. In one version, biased methods made the treatment look beneficial. In another, more appropriate analysis showed no benefit. Then they explained how different reporting methods could lead to completely different conclusions from the same dataset.<\/p>\n
\u201cThe article had three parts,\u201d he said. \u201cIt had a paper suggesting benefit, a paper suggesting there was no benefit, and then an analysis of why you could come to different conclusions based on the same data set.\u201d<\/p>\n
\u201cIt\u2019s probably the only paper that\u2019s ever been accepted where the authors stated in the submission letter that every piece of data was fabricated,\u201d he said. \u201cWe even had false journal references like references to the \u2018New Scotland Journal of Medicine\u2019 as a parody. The paper was accepted, and of course, it got a lot of publicity because it was highly unusual.\u201d<\/p>\n
It was satire, but it had a serious purpose. It showed how easily the language and structure of a paper can influence what readers believe. And it did so in a way people remembered.<\/p>\n
\u201cI have in my possession photographs that people sent me of patients who actually had a cancer of their big toe. I think a couple of them were metastatic cancers from cancer of the kidney. And people have encouraged me to do a follow-up on that, maybe looking at adjuvant therapy but we haven\u2019t got around to doing that.\u201d<\/p>\n
I hope he does.<\/p>\n
\u201cThat was the first of a number of papers that led to some critical analyses of how clinical trials were being reported in the literature,\u201d he said. \u201cI do think things have got better, but there\u2019s still a long way to go.\u201d<\/p>\n
What Oncology Still Gets Wrong About Progress<\/p>\n
Dr. Tannock points to signs of progress, including the recent work from Common Sense Oncology on guidelines for the design, analysis, and reporting of clinical trials.<\/p>\n
\u201cI think it\u2019s quite possible to write critical articles,\u201d he said. \u201cThe problem is that it often falls on rather deaf ears.\u201d<\/p>\n
Several biases still appear (maybe even more than before) in modern trials, but the bigger change, in his view, is who controls the trial agenda.<\/p>\n
When he was a young oncologist, most randomized phase III trials that changed practice were conducted by cooperative groups: SWOG, ECOG, EORTC, the Canadian Trials Group, and others. These were largely academic groups asking clinical questions.<\/p>\n
Over time, that changed.<\/p>\n
\u201cOver the last 30 or 40 years, gradually, the funding and organization of clinical trials has been taken over by pharmaceutical companies,\u201d he said. \u201cIt\u2019s not that pharmaceutical companies haven\u2019t developed some good drugs. Obviously, they have,\u201d he said. \u201cWe have drugs like trastuzumab. We have immunotherapy and others.\u201d<\/p>\n
But he also makes the central conflict very clear. When profit becomes the priority on the agenda, doing the best clinical trial is not always concordant.<\/p>\n
A trial may be positive. A drug may be approved. A guideline may include it. But that does not automatically mean the treatment provides meaningful benefit to patients.<\/p>\n
\u201cI think it is recognized, at least by many oncologists, that there are a variety of biases that are used in clinical trials, such as the use of inappropriate control groups that are not the current optimal standard of care, the use of endpoints that are stated as surrogate endpoints, but they\u2019re not actually very good surrogate endpoints for what you want to do, which is to improve either survival or its quality for your patients. <\/p>\n
There is failure to provide optimal care at the end of a trial, whose endpoint might be progression-free survival, which is one of those commonly used endpoints that doesn\u2019t predict survival that well.<\/p>\n
And factors like informative censoring, where patients drop out; they don\u2019t drop out at random, and that can create biases in the analysis of trials. Others have written about how spin can influence how trials are viewed.<\/p>\n
\u2026We have a lot of drugs out there that can be prescribed that have not improved survival or its quality for patients,\u201d he said. \u201cAnd I think that\u2019s a great pity.\u201d<\/p>\n
Critical appraisal and clinical trial interpretation should be core pillars of oncology training\u2026 medical training.<\/p>\n
\u201cI think the only way it could be fixed is through education. There are quite a number of people out there who are fairly critical, but many oncologists just go with the stream.\u201d<\/p>\n
![\"Ian](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2026\/07\/ian-Tannock-Rachel-Riechelmann-in-clinic-2005-800x600.webp\" "\\"The")
Prof. Ian Tannock and Rachel Riechelmann in clinic in 2005<\/p>\n
When Effective Drugs Do Not Reach Patients<\/p>\n
One of the most important parts of our conversation was access.<\/p>\n
Even when drugs are truly effective, they often do not reach the people who need them. This is especially true in low- and middle-income countries, but as Dr.\u00a0Tannock pointed out, even high-income countries are not immune.<\/p>\n
\u201cDrugs have become obscenely expensive,\u201d he said. \u201cI remember when I led the trial of docetaxel for prostate cancer, we thought the drug was extremely expensive when it cost about 2000 US dollars for a three-weekly injection. Now that\u2019s actually cheap compared with most of the drugs that can easily run to 10, 15,000 US dollars a month,\u201d he said.<\/p>\n
That kind of pricing makes treatment inaccessible in many parts of the world. And even in the United States, where there is no public healthcare system, many patients do not receive optimal treatment.<\/p>\n
So how much scientific progress is really progress?<\/p>\n
\u201cThere\u2019s no easy answer to that,\u201d he said.<\/p>\n
But he mentions important research happening today in India, studying lower doses of drugs that still show effectiveness.<\/p>\n
\u201cMany of the drugs that have been developed are used at much higher doses than are needed for their effectiveness,\u201d he said. \u201cAnd this is particularly true of immunotherapy.<\/p>\n
There\u2019s been the Delhi study using lower dose nivolumab. And just published in the Annals of Oncology, a study in triple negative breast cancer showed that pembrolizumab, instead of being used at 200 milligrams every three weeks, 50 milligrams every six weeks gave very similar results to the trial using higher doses. That type of research is helping.\u201d<\/p>\n
Still, cost is only one part of the issue.<\/p>\n
\u201cDoing research in low- and middle-income countries isn\u2019t just a function of the cost of drugs,\u201d he said. \u201cYou also need the structure and the ability of the clinicians, oncologists and support staff to do the research in those countries.\u201d<\/p>\n
It is a common misconception that LMICs do not need research and that providing basic care should be prioritized instead. This has been the strategy for too long. But if even basic care in HICs is not accessible everywhere, maybe investing in a research environment and clinical researchers who question the status quo and build care appropriate for their settings will be the route to improving basic care?<\/p>\n
Trials That Asked What Patients Actually Felt<\/p>\n
When Dr. Tannock began working in genitourinary oncology, the field looked very different. Today, GU sessions at ASCO can fill large rooms. Back then, he said, the audience could be 30 people in a room built for 100.<\/p>\n
He became interested in prostate cancer, particularly metastatic prostate cancer in older men. And he focused on the problem that mattered most to them.<\/p>\n
\u201cThe biggest problem for men with metastatic prostate cancer is bone pain,\u201d he said.<\/p>\n
So instead of only asking whether tumors shrank, his first trials asked whether patients\u2019 pain improved. He and Canadian colleagues studied mitoxantrone and prednisone compared with prednisone alone, with pain improvement as the endpoint.<\/p>\n
\u201cWe found a significant difference in pain control,\u201d he said.<\/p>\n
That trial led to mitoxantrone becoming the first chemotherapy drug approved by the FDA and EMA for prostate cancer. More importantly, it was approved on the basis of a quality-of-life endpoint.<\/p>\n
\u201cIt\u2019s one of only two trials that I\u2019m aware of where a quality-of-life endpoint, a pain control endpoint, was used for licensing a drug,\u201d he said.<\/p>\n
Later, this work helped lead to the large docetaxel trial in metastatic prostate cancer.<\/p>\n
\u201cThe company that was marketing docetaxel approached me about helping them design a trial to compare docetaxel with mitoxantrone. Two of their medical staff came from Paris to Toronto and we spent two days in an office in the hospital writing the initial protocol for the TAX-327 trial. It was a large trial, 1000 patients or so, comparing two schedules of docetaxel with mitoxantrone.\u201d<\/p>\n
The endpoint was overall survival, but pain control and quality of life were still included.<\/p>\n
Docetaxel became the preferred chemotherapy treatment for castrate-resistant prostate cancer and remains so even many years later.<\/p>\n
But the lesson he draws from this story is not only about docetaxel. It is about how a major trial can begin with a very practical question.<\/p>\n
\u201cThat all came about from the original idea of doing a simple trial,\u201d he said.<\/p>\n
A simple trial, but not a small idea: can we reduce pain for men with metastatic prostate cancer?<\/p>\n
Mentorship and the Next Generation<\/p>\n
![\"Ian](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2026\/07\/IT-credo-800x600.webp\" "\\"The")
Prof. Ian Tannock and mentees at the CReDO 2026 workshop in India<\/p>\n
When I asked what keeps him invested in young oncologists, his answer was very direct and very satisfying for me.<\/p>\n
\u201cInteracting with young people like yourself is, I find, a very pleasant thing to do,\u201d he said.<\/p>\n
I might have set him up for that answer.<\/p>\n
\u201cI think it\u2019s very rewarding if I can have a small part to play in helping young people to advance their careers,\u201d he said, \u201cand particularly to develop their careers as critical people who really do have in their minds improving outcomes for patients.\u201d<\/p>\n
His advice to young oncologists is practical. Find a mentor. Find a research niche that is not overcrowded. Do not simply jump on a bandwagon.<\/p>\n
\u201cYou build a research career not by starting with doing a large randomized trial,\u201d he said. \u201cYou build a research career by answering simple questions.\u201d<\/p>\n
He used to keep a notebook where he wrote ideas that came to him in clinic.<\/p>\n
\u201cHow many phase II trials that give positive results lead to phase III?\u201d he said. \u201cTo what extent are drug interactions a problem?\u201d<\/p>\n
These are not glamorous questions at first glance. But they are answerable, useful, and connected to real practice.<\/p>\n
It may be one of the best pieces of advice for young researchers. Start taking notes.<\/p>\n
What He Would and Would Not Do Again<\/p>\n
Many physicians doubt their career choice at least once in their lifetime. I wondered if Dr. Tannock did too.<\/p>\n
\u201cNo, I don\u2019t think I ever considered quitting medicine,\u201d he said, with almost too much certainty.<\/p>\n
But there were roles that fit him less well. He led the Department of Medical Oncology at Princess Margaret for several years, and although he helped grow the department, he does not describe administration as his natural strength.<\/p>\n
\u201cWhen you lead a department, you get caught up in all sorts of committees and other administrative things,\u201d he said. \u201cThat really isn\u2019t my strength.<\/p>\n
I think my strength is much more in teaching and mentoring and doing clinical research.\u201d<\/p>\n
![\"Ian](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2026\/07\/Picture2-800x537.webp\" "\\"The")
Prof Tannock and his former fellows<\/p>\n
After stepping down from leadership, he returned to the things he enjoyed and felt he did best. He also became deeply involved internationally: EORTC, Institut Curie, ASCO, ESMO, the European School of Oncology, and clinical trial courses in different countries, often in low- and middle-income settings.<\/p>\n
He has now retired from active clinical practice, but not from teaching, writing, or pushing oncology toward better standards, luckily.<\/p>\n
Hope, But Not Blind Hope<\/p>\n
When I asked what makes him hopeful for oncology, he gave perhaps the most Ian Tannock answer possible.<\/p>\n
\u201cWell, you\u2019re assuming that I am hopeful,\u201d he said.<\/p>\n
It was funny, but also honest. I could\u2019ve predicted it.<\/p>\n
He does see reasons for hope. Immunotherapy has changed outcomes for some patients. Antibody-drug conjugates are promising in several areas. There are drugs and strategies that truly help patients.<\/p>\n
But his hope is not in technology alone. It is also in people and movements trying to make oncology more honest and more patient-centered.<\/p>\n
\u201cI\u2019m encouraged by a number of people who are doing research to try and improve the access to effective drugs for the world\u2019s population,\u201d he said.<\/p>\n
He is also encouraged by Common Sense Oncology<\/a>, where people have come together voluntarily to promote treatments that matter to patients.<\/p>\n \u201cWe really have to push for strategies that can both improve outcomes and spread those improved outcomes more widely,\u201d he said. \u201cAnd I think as more and more people become involved with that, we can influence editors of journals and so on. The Lancet Oncology has always been very much on side, the editor of which is David Collingridge. And we\u2019re beginning to see this with some other journals, like the Journal of Clinical Oncology\u2026<\/p>\n The current president of ASCO, Eric Small, whom I know well, because we were GU oncologists, has it very much in mind to improve cancer treatment everywhere. His speech at this year\u2019s ASCO was superb.\u201d<\/p>\n Books, Films, Walking, and Being \u201cFriendly\u201d<\/p>\n Isn\u2019t the best part of life human interaction? And isn\u2019t it even better to bond over art and creativity with someone else? So, I asked.<\/p>\n \u201cWell, I read a fair bit. I used to be quite a cinema buff. I liked going to the movies and particularly some of the older French movies with my wife. We do a lot of hiking. That may get more difficult as we get older, but fortunately I\u2019m quite fit. I used to run with friends. I have a group of friends, a group of older men, but we\u2019re fairly active old men and we walk. With this group of friends this afternoon, we will go to a pub together and watch the World Cup semifinal.\u201d<\/p>\n He was cheering for England, in case you were wondering, as Canada was eliminated. Of course, by now you know, Spain won the Cup.<\/p>\n On music, he grew up with the Beatles and the Rolling Stones, enjoys Eric Clapton and Cat Stevens, and goes to symphony and opera in Toronto.<\/p>\n \u201cI still think the Beatles are some of the best songwriters that we\u2019ve ever known,\u201d he said. I was hoping he would say that I was his favorite musician (although I love his music taste). I was kind of heartbroken, I won\u2019t lie.<\/p>\n When I asked him how he would like to be described in one word, he paused and then chose:<\/p>\n \u201cFriendly.\u201d<\/p>\n It fits.<\/p>\n Tolerance and the World Beyond Oncology<\/p>\n At the end, I asked him a difficult question: what can unite the world?<\/p>\n \u201cOh my gosh,\u201d he said. \u201cI\u2019m not sure that anything can unite the world given the vagaries of human nature.\u201d<\/p>\n But then he gave one word: tolerance.<\/p>\n He spoke about Toronto, where he lives, and described taking the subway with his wife and grandson after a birthday evening. The city, he said, felt like \u201ca United Nations.\u201d<\/p>\n \u201cThere were people getting on the subway of your age group,\u201d he said. \u201cEvery color, every racial origin, and all very friendly together.\u201d<\/p>\n That, for him, is part of what makes Canada one of the nicer countries in the world.<\/p>\n But he is not blindly optimistic about the world. He spoke about wars, political divisions, and the fact that, compared with 10 years ago, he does not think the world has become better. That\u2019s not the type of thing I like to hear, but it is very hard to argue otherwise these days.<\/p>\n When I asked whether we should still hope that it will, he answered carefully.<\/p>\n \u201cI think we can hope that it will,\u201d he said. \u201cBut whether the evidence is suggesting that\u2019s happening, I don\u2019t know.\u201d<\/p>\n Again, even hope had to meet evidence with him. I do hope that it will, and I think, in fact, that it will, because that is what I can do to make sure that it is where I am headed as a person.<\/p>\n And then, just when the conversation could have ended on a heavy note, it became light again.<\/p>\n I did tell him I was hoping his favorite music artist would be me.<\/p>\n![\"Ian](\"https:\/\/www.newsbeep.com\/ca\/wp-content\/uploads\/2026\/07\/Ian-Rosemary-Tannock-2011-800x600.webp\" "\\"The")
Ian Tannock and his wife Rosemary hiking in 2011<\/p>\n