1.1 The Beginning

Genius is 1 percent inspiration and 99 percent perspiration: Thomas Edison

There is one thing common among all those who have met and worked with Dr. Baum: their description of Prof. Baum’s work ethics and dedication. His associates fondly describe him as a person with unmatched physical and mental strength, allowing him to work for 16–18 h every single day, 7 days a week.

Dr. Baum’s passion for learning and making a difference in the lives of patients and their families was very much evident from the early days of his career. Many know Dr. Baum as a “Nuclear Medicine Physician” par excellence but only few are aware of his internal medicine and emergency medicine skills (see CV of Dr. Baum towards the end of this chapter). During some close interactions with Dr. Baum, he fondly remembers the time he spent providing emergency services. Armed with his special skill set, and his passion for targeted therapies using state-of-the-art radiolabeled antibodies and peptides, Dr. Baum made his presence felt in this special domain of cancer treatment in 1997 when he first introduced PRRT in Germany.

All great personalities and pioneers in this world always have someone whom they personally consider as their hero. Prof. Baum’s personal hero is Prof. Paul Ehrlich, a nobel prize-winning German physician scientist, for providing the concept of amboceptors which ultimately paved the way to immunology. Spellbound, as all good ardent followers are when they speak about the enormity of a discovery which they personally feel pathbreaking, Dr. Baum often starts his lectures for students and audience of all ages and faculty with a slide showing his great admiration of Dr. Paul Ehrlich. It is important to understand why Dr. Baum liked what he saw in the concept of amboceptors. Based on his personal experience, he realized during the early stages of his medical career that chemotherapy, a generalized way of treating cancers without essential looking at the presence or absence of “targets”’ on the cancer cells is only applicable to certain percentage of patients. This blanket treatment approach, still a mainstay of management in oncology, is more often than not associated with toxicity, which, sometimes can be extreme. Realizing that there has to be a better way for treating cancer patients, Dr. Baum started utilizing the concept of targeted radiopharmaceutical therapies in his early stages by using antibodies labeled with beta-emitting I-131 and Y-90. Dr Baum is one of the few physician scientists who strongly believed in “treating what you see” to maximize therapeutic efficacy by minimizing toxicity. His patients’ quality of life (now a central issue in almost all good clinical trials) centered approach is known to all. With the conviction and motivation only few people possess, Dr. Baum chooses to keep the following principle above all, even if that meant going against the “main streamline” oncology:

“Aegroti salus supreme lex” which means “the health of the patient is the supreme law”.

1.2 The Impedance

Both Galileo and Socrates were aware of the consequences of proposing and following an approach or scientific principle against the general accepted norms of the society in that particular era. Despite that, they continued their course as that was the right thing to do. Dr. Baum’s approach using the principles of Theranostics was not really well understood among the oncologists in Germany in mid-nineties. Part of that was because those radiopharmaceuticals were not really tested in a rigorous clinical trial. In fact, there were practically no pharmaceutical companies interested in including radiopharmaceutical therapy in their portfolio in the late nineties and early 2000. However, that did not deter him from going ahead and treating patients with peptide receptor radionuclide therapy under the German medicinal product law described under the paragraph 13.2b. His conviction and motivation were rewarded when he successfully treated a child with debilitating metastases from paraganglioma/pheochromocytoma using PRRT in 1997. This child, who had exhausted all approved therapeutic options approved at that time, not only tolerated therapy with somatostatin receptor radioligand kindly provided by Dr. Helmut Maecke from Basel, but also showed dramatic improvement in his quality of life. The child who was on crutches and unable to walk started playing football. This might appear to be a “one-off” success but that was enough to drive Dr. Baum’s conviction several notches higher. Finally, “the impedance” met its own “resistance” and a new era started in the world of Theranostics which touched the life of several hundreds of patients from the world over, by one person!

1.3 The Fertilization

When “knowledge” marries a deserving hard-working person, offspring is a benevolent “success”. Enriched by his enthusiasm and thirst for knowledge, multiplied by the success of his treatment approaches, Dr. Baum embarked on a journey few would have fathomed or dared to walk the path. It is important to remember that the time frame is roughly 25 years back, when in general in Germany, Nuclear Medicine was more diagnostic than therapeutic. It takes a visionary to do what he did: Dr. Baum left University Hospital in Frankfurt and joined a hospital in the eastern part of Germany. This hospital was so remotely placed in the middle of a jungle in the state of Thueringen, in a small town of 8000 people, that anybody else would have termed this step as insane. Well, people who are in love sometimes get infatuated, and there was no doubt that Dr. Baum was in love with “Theranostics”. He needed a “Castle” to build the “Empire of Theranostics” And so came into existence, the Department of Nuclear Medicine at the Zentralklinik Bad Berka, Germany. A “Theranostics Empire” was rising under the governance of Dr. Baum: this empire was destined to lead various first in human Theranostics applications at the global stage.

1.4 Hard Yards

Sometimes it is not easy to appreciate what it takes to start a monumental project in Germany in a non-academic private hospital setting, with no “tax paid” money for research grants. Dr. Baum’s tireless, almost inhumane efforts lead to the establishment of a GMP radiopharmacy with fully functional cyclotron, a PET/CT Centre, and 22 bedded radiopharmaceutical therapy ward within a space of 10 years of his joining. During all this time of continuous change in his department, one thing remained constant: his consultation time per patient referred for therapy. All his fellows, residents and attending who have accompanied him during the ward visit or patients have learned a lot from his communication skill and the art of patient consultation. Dr. Baum is methodical, his reports are elegant and as complete as they can ever be. During a personal communication with one other giant in the field of Theranostics, Dr. Helmut Maecke fondly remembers some of the patients' reports which he used to get from Dr. Baum as the best ever.

Methodology is central to science. Similarly, standardized operating procedures (SOP) are essential benchmarks of any Centre of Excellence. Prof. Baum’s hand-picked team consisting of some excellent nursing staffs, radiochemists, medical physicists, and senior consultants contributed with great pleasure in writing SOPs for all procedures including PRRT. As his first research fellow, I am privy to the fact that several renowned centers who started doing PRRT in Europe, Asia, and USA have either directly or indirectly used his SOP. In this way, he democratized practical dissemination of knowledge for the ultimate benefit of patients.

Dissemination of knowledge is a great service for the enhancement of science. There was always a long list of researchers, clinicians, physicists, and chemists who wanted to visit Prof. Baum’s Centre and profit from the freely available elixir of knowledge. It has never been disclosed before, but due to his open science policy and passion for theranostics, the quality of research in other academic centers around his empire started to increase and patients’ advocacy groups became aware of the worthiness of this unique field of nuclear oncology. Hard yards in the field of radiopharmaceutical therapy, which started with PRRT in neuroendocrine tumors, started giving offshoots, slowly but continuously, and soon percolated in other areas of unmet clinical needs in oncology. Patients and their relatives, friends, and colleagues around the world were about to witness the expansion of the field of Theranostics.

1.5 Expansion of the Empire

Success of somatostatin receptor ligand therapy for neuroendocrine tumor patients has to thank few centers in the world, Dr. Baum’s Centre was one of them. A passion and dedication for PRRT which started in 1997 took a real big turn when companies like Novartis and Advanced Accelerator Applications (AAA) started taking notice of the novel therapy. Prof. Baum started treating patients from all over the world, including, USA, India, and China, and his ward was always full, performing more than 1000 radiopharmaceutical therapy cycles every year. Managing such patients’ data for research purposes was never going to be easy. As early as in 2004, he started thinking about 5, 10, and 15 years of follow-up of patients to generate sufficient data for proving the worthiness of theranostics approach. For that purpose, he developed an Access Databank which contributed to more than 40% of data in some national register studies for NET patients. At the same time, Rotterdam group paved the way to initiate a phase three clinical trial with the support of AAA. Dr. Baum’s Centre contributed significantly to the trial and the rest is history. Lu-177 DOTATATE got approved for gastroenteropancreatic neuroendocrine tumor. But this was the beginning of next phase of expansion.

As soon as University Heidelberg, Germany, showed the diagnostic potential of prostate-specific membrane antigen, Dr. Baum was quick enough to grasp its potential and started treating patients with Lu-177 PSMA. His Centre had since then many firsts in the magnificent history of PSMA radioligands therapies, which included the first overall survival and response data published in the Journal of Nuclear Medicine. This was a major breakthrough, both at personal as well as scientific life of Dr. Baum.

Dr. Baum’s close observational prowess together with excellent clinical skills made him soon realize that it is not always the dose of radiation which decides response to radiopharmaceutical therapies. This forced him to ask the basic question “why?”

That is when Dr Baum started diving more into the genetic and genomic make up of tumors to understand why some patients respond so quickly and achieve complete remission whereas others continue to progress despite achieving absorbed radiation dose of more than 100 Gy. At the same time, he expanded the use of alpha radiopharmaceutical therapies with Ac-225, as well as novel radioisotopes like Tb-161. One of the hallmarks of all great empires and good governance is that they are not limited to one place only. Embarkment on a new research path necessitated some changes, and change was about to come.

1.6 New Capital

Time is the fiercest competitor of the human race. After having spent more than 20 years in his empire at Bad Berka, it was time to move on. Another place was waiting for him, the “Advanced Center for Radiomolecular Precision Oncology (RPO) at Curanosticum Wiesbaden-Frankfurt, Germany” where he joined as Senior Consultant in 2020. Just like his move from Wolfgang Goethe University Medical Center, Frankfurt/Main to Bad Berka raised skepticism and eyebrows, this move was also seen as a “small step towards retirement”. But great minds, dedicated doctors and good teachers never retire. Within an year of joining the Curanosticum, Prof. Baum got his GMP Radiopharmacy and a new PET/CT. Patients followed him from around the Germany and globe to Wiesbaden. Ony capital had changed, but the empire remained.

Teaching and expanding Theranostics worldwide has been Prof. Baum’s passion. An academy was needed for this purpose. Dr. Baum’s initiative resulted in the formation of International Centers for Precision Oncology (ICPO) Academy as well as the ICPO Scientific Committee. He was expanding fast. Sino-German collaboration was conceptualized. ICPO Academy produced its first “Teaching Module” and started teaching next-generation Theranostics enthusiasts, researchers, physicians, medical physicists, radiochemists, nurses, and technologists. Under the presidentship of Dr. Baum, ICPO Academy is armed to produce next-generation skilled, well-trained “Theranostics Experts”. One man’s dream and passion are transforming many hundreds of young brain. Hope for cancer patients around the world is increasing and many have to thank Dr. Baum for this.

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