Kim Dong-wook

Professor in Department of Hematology, Catholic University of Korea College of Medicine

Kim Dong-wook, once a bone marrow transplant expert, is now a noted hematologist and drug researcher. He was a student of Kim Chun-choo, the first doctor in Korea to perform a successful allogeneic bone marrow transplant in 1983.

Only 15 years ago, a diagnosis of chronic myeloid leukemia (CML) was a death sentence. The disease, a type of cancer that causes uncontrolled growth of blood cells in the bone marrow, killed two-thirds of those diagnosed within five years. Today, 94 percent of CML patients in Korea live for more than 10 years after their diagnosis, thanks largely to Glivec, a drug launched in 2001 by Novartis, a Swiss pharmaceutical firm. However, like any other drug, Glivec has side effects. According to Professor Kim Dong-wook of Seoul St. Mary’s Hospital of the Catholic University of Korea, more than one-thirds of Glivec users have experienced adverse reactions to the medicine. By the end of this year, a new CML drug that is safer and more effective will be available. “It took me 13 years to develop Supect,” the 54-year-old said in an interview. “I have great hopes and expectations for what the drug will do for patients.” Korea’s Ministry of Food and Drug Safety approved Supect last month, making the drug Asia’s first and the world’s fourth leukemia medicine. The drug is made from radotinib, the 18th medical compound developed in the country. “The drug has proved to be more effective and to have fewer side effects than Glivec and two other leukemia drugs currently available,” Kim said. Supect has a faster and stronger response to the disease than Glivec does, though it is still too early to conclude if the new drug improves patients’ long-term survival rates, he said. Considering the amount of medicine needed for a patient, he noted, it is fair to say Supect is 35 times more effective than Glivec. Additionally, the new drug is less likely to cause both serious side effects, such as cardiotoxicity and pleural effusion, and minor ones, such as muscle cramps and diarrhea. The biggest beneficiaries of Supect will be the patients who cannot take other drugs after developing a tolerance for them.

Kim found that Supect worked for 87.6 percent of those who were no longer responsive to Glivec. In Korea, Supect is expected to be provided at a lower price than Glivec, which costs 2.8 million won ($2,600) per month, Kim said. In the long run, Kim expects Supect to benefit many CML patients in some other countries as the new drug will stimulate price competition in the global leukemia drug market, which is dominated by only a few pharmaceutical companies.  Leukemia can simply be classified by how fast it progresses. Acute leukemia, which is caused by the rapid increase of immature blood cells in the bone marrow, could overrun the body within a few weeks or months. By contrast, chronic leukemia could progress over years but can suddenly transform into an acute one. CML accounts for about 15 percent of all adult leukemia patients worldwide. In Korea, more than 300 new people are diagnosed with the disease every year. Within 10 years, however, more than half of all leukemia patients are expected to be CML ones as their survival rates have stayed high since the introduction of targeted drug therapy, Kim said. Analysts believe the global market size of CML drugs is around $10 billion and will continue to grow.

Transplantation isn’t the solution

It is common for doctors to participate in developing new drugs as researchers or advisors. However, Kim, in partnership with Ilyang Pharmaceutical, is Korea’s first doctor to lead an entire drug development from start to finish as its director. Kim was once the most promising figure in the field of bone marrow transplantation. At the Catholic University of Korea’s medical school, he studied under Professor Kim Chun-choo, the nation’s first hematologist to successfully perform allogeneic bone marrow transplant in 1983. “He believed transplantation was the best and only solution to treating CML,” Kim Dong-wook said. “When I succeeded in performing an unrelated donor bone marrow transplant for the first time in Korea in 1995, he thought I must follow in his footsteps.” However, as Kim Dong-wook performed more operations at Seoul St. Mary’s Hospital, his faith in the effectiveness of transplantation eroded. “Many patients died after transplantation and some of those who survived could not live normally because of complications. Doubts grew in my mind over whether transplantation really was the best way to treat them,” he said. “Then, Glivec came out and saved thousands of patients from both CML and the risks of transplantation. I thought, ‘This is the way.’” He realized that CML is a disease that may not be completely cured but can still be managed for life with drugs. “But a vast majority of doctors, including Professor Kim (Chun-choo), were determined to stick to their belief that transplantation was the only right way. I disagreed, so I had to leave for other hospitals for a while,” he said. “It was a tough period because it became harder to recruit patients for my drug research. Besides, Kim was the one who led me to the field of hematology and cared so much about me. But I had no other options.” Leaving the school was a major career shift for Kim Dong-wook, but there was no turning back. His former colleagues were initially skeptical about his approach, but, as the results of his clinical tests revealed the effectiveness of his approach, they started to listen to his opinions. “Today, only about 1 percent of all CML patients get transplant surgery at our hospital, while most are on drug therapy,” he said. Kim eventually returned to the hospital and was received with a warm welcome. And in January, he won an award from the Catholic University of Korea for his contributions to the development of blood cancer treatment. “That was the most meaningful thing that I had ever won,” he said. “After years of struggle, my work was recognized by those who initially rejected my opinions.”

What’s next?

Kim is focusing on three things for his future research. First, he wants to find whether certain generic variations cause chronic leukemia to transform into an acute one; many patients with acute leukemia die within six months of their diagnosis. “Our team has been doing the research for 13 years. I think we almost got the answers,” Kim said. If everything goes well, it will be possible to identify which CML patients are at bigger risk of getting acute leukemia and prepare for the disease in advance, he noted. He also wants to develop a new drug that patients don’t have to take for the rest of their lives in order to live normally. In fact, some people have been doing well even after they stop taking CML drugs. “One of my patients has survived without considerable inconvenience since the person stopped taking the drugs voluntarily in 2004,” he said. During his study, Kim recently discovered that 70 percent of CML patients did not relapse after they stopped taking Glivec. He said he is trying to find what immunologic factors prevent blood cancer cells from growing back in their body. Finally, he wants to figure out what exact amount of drugs must be prescribed to each CML patient in order to safely maximize the effect of the drugs. “The recommended dosage of Glivec, for example, is 400 mg a day for all adult patients regardless of weight. This may be wrong,” Kim said. “The amount of drug must be based on a person’s weight. I’m working to prove the assumption with more solid evidence.”