近大腫瘍内科を創設
日本の腫瘍内科の礎を築く

The first professor of medical oncology, who established Japan’s first full-fledged Department of Medical Oncology.

FUKUOKA Masahiro was born in 1940 in Nara Prefecture—just one year before the outbreak of the Pacific War.
“I lived in a rather rural part of Nara, so we weren’t bombed. But I do remember seeing Osaka burning in the distance,” he recalls.
Between January and August 1945, Osaka was bombed thirty times, and 27 percent of the city was reduced to ashes, leaving a scorched wasteland.
His maternal grandfather had been an internist.
“Watching him, I came to believe that being a doctor was a job that truly helped people. Apparently, even in elementary school, I was already saying, ‘I’m going to be a doctor.’”
After graduating from the Faculty of Medicine at Osaka City University in 1966, FUKUOKA entered the First Department of Internal Medicine, which handled both cardiology and respiratory medicine.
“I was inspired by senior colleagues in the respiratory group and wanted to begin research in graduate school. But then the campus uprisings broke out, and I ended up withdrawing.”
In January 1968, interns and residents at the University of Tokyo went on an indefinite strike, demanding better working conditions. This was the beginning of the Todai Struggle, which spread to universities nationwide. Osaka City University was no exception.
After leaving graduate school, FUKUOKA decided to undergo domestic training at the National Cancer Center in Tokyo to learn bronchoscopic techniques.
“It was about ten years after the Center had been founded. The members there were outstanding. Among them was Dr. IKEDA Shigeto, who developed the flexible bronchoscope, and trainees were coming from all over Japan. I was deeply impressed by the passion for research at the Cancer Center at that time, and I resolved to follow this path.”
That “path” meant pursuing cancer research while remaining a practicing clinician.
Here, let us briefly touch upon the history of cancer treatment.
Initially, the mainstays were “local” therapies: surgical removal of tumors, and radiation therapy. By the early 1950s, thanks to these localized approaches, it was said that about one in three cancer patients could survive. But beyond that point, survival rates plateaued. That was when systemic “drug therapy (chemotherapy)” emerged.
“Cancer drug therapy began after the Second World War. The very first anticancer drug was nitrogen mustard, derived from mustard gas used in warfare.”
Most anticancer drugs indiscriminately destroy cells and are thus called “cytotoxic anticancer agents.” Specifically, they take advantage of the fact that cancer cells divide more rapidly than normal cells, killing the malignant cells preferentially.
Yet there was a serious drawback.
“Because bone marrow cells, the mucous membranes of the mouth and intestines, and hair follicles, also divide rapidly like cancer cells, they are easily damaged. That’s why anticancer drugs cause such severe side effects. Preventing and overcoming those side effects—that became one of the most important tasks for us as oncologists,” FUKUOKA explains.
In 1972, FUKUOKA Masahiro became an assistant in the First Department of Internal Medicine at Osaka City University. By 1982, he had advanced to become the head of the Second Department of Internal Medicine at Osaka Prefectural Habikino Hospital. There, he joined the “Suemasu Group,” a Ministry of Health–sponsored national cancer research project organized by the National Cancer Center, and participated in clinical trials of chemotherapy for small-cell lung cancer, which accounts for about 10–15 percent of all lung cancers. Although small-cell lung cancer is initially highly responsive to chemotherapy, it is known for its extremely rapid growth and its prognosis remains poor. In collaboration with five institutions nationwide, FUKUOKA and his colleagues compiled data from 300 cases and presented their findings at an international conference.

Given the characteristics of cancer, cross-organ treatment is the most rational approach.

“It was my first time presenting at an international conference. Then came the question: what was the basis for choosing 300 cases? In truth, I had simply assumed that 300 would be enough. I had no statistical justification. On top of that, my English wasn’t strong, so I was unable to answer and was left standing there, speechless. Looking back now, I realize that setting the sample size is the most basic requirement when conducting a clinical trial. But at that time, Japanese medical schools did not provide any education on clinical trials or clinical oncology, so we simply hadn’t been trained to do it,” FUKUOKA admits.
A randomized controlled trial refers to a method in which subjects are randomly assigned to different groups for comparison. For example, in a clinical trial of a new drug, patients are divided into two groups: one receives the drug, the other is given a placebo. After a set period, the outcomes are compared. If the difference between groups is statistically significant, the drug is judged to be effective.
From that humbling experience, FUKUOKA Masahiro carried with him a lasting conviction: Japan’s medical schools must establish departments to systematically teach medical oncology.
“In Japan, society is said to be vertically segmented, and the medical world is no different. Respiratory, gastroenterology, gynecology, urology—each specialty treats both cancers and non-cancer diseases. But cancer is defined by diversity and heterogeneity. Different organs can harbor very different cancers, and cancers are not all the same biologically. At the same time, they do share common traits. A new finding in the diagnosis or treatment of cancer in one organ can apply to cancers of another organ with the same biological profile, meaning the same drug can be effective. From the standpoint of drug therapy, dividing cancers strictly by organ is not rational. Cross-organ treatment is the more logical approach.”
There was, however, one major obstacle.
“Until then, I had been working in general hospitals and had very little teaching experience. But my colleagues kept urging me, saying: ‘If clinical oncology is to advance in Japan, you need to step into the university setting,” he recalls.
It was at that time that a professorship opened in the Fourth Department of Internal Medicine—the Department of Respiratory Medicine—at Kindai University Faculty of Medicine.
“At the time, the president of Kindai University was Dr. NODA Kiichiro, a leading figure in gynecologic oncology and a man deeply knowledgeable about anticancer drug development. I had spoken with him on several occasions, and I felt that under his leadership, it might be possible to establish an internal medicine department specializing in clinical oncology. That convinced me to apply,” FUKUOKA recalls.
In 1996, FUKUOKA Masahiro was appointed professor of the Fourth Department of Internal Medicine at Kindai University Faculty of Medicine. The question now was how to build and expand a true department of medical oncology at Kindai. Soon after, a major opportunity arose.
In 2001, the government revised university establishment standards, restructuring the long-standing chair- and discipline-based system that had been in place since the Meiji era. Medical schools across the nation were reorganized—from the rigid “vertical” structure of department-based chairs into more functionally integrated organizations.
One day, President NODA summoned FUKUOKA.
“If I recall correctly, you once said you wanted to create a department of medical oncology. Why not take this opportunity to establish it?”
FUKUOKA recalls the moment vividly: “This is it.” He felt excitement but also foresaw resistance. The walls of the entrenched chair system loomed large.
“Cancer drug therapy was already being carried out across many specialties—internal medicine, surgery, gynecology, urology. If we created a dedicated oncology department, it would inevitably be seen as competition. Others would feel their territory was being encroached upon. Establishing an oncology department in Japan for the first time was only possible because of President NODA’s bold decision.”
In April 2002, the Division of Medical Oncology within the Department of Internal Medicine was established at Kindai University Faculty of Medicine, with FUKUOKA Masahiro as its inaugural professor. It was the first medical faculty in Japan to launch a full-fledged academic framework dedicated to the education, clinical practice, and research of internal medicine-based cancer treatment.(Strictly speaking, Hokkaido University Graduate School had created a Department of Medical Oncology six months earlier, but Kindai was the first medical faculty in the nation to launch such a division.)

Oncologists should serve as the command center of cancer care.

Cancer is a disease where new drugs are always in demand—an area defined by unmet medical needs. FUKUOKA Masahiro took the initiative by launching one of the earliest clinical trial groups, the forerunner of the West Japan Oncology Group (WJOG), and actively carried out clinical trials of new anticancer drugs.
“Whenever a new drug appeared, we proactively joined industry-led trials,” he recalls. “At one point, people even mocked me as a drug hunter. But soon enough, it became, ‘If there’s a new drug, call Dr. FUKUOKA first.’ I suppose it was because people recognized how seriously I devoted myself to clinical trials.” He chuckles at the memory.
It was this very groundwork that enabled Kindai University Faculty of Medicine to play a central role in the clinical trials of the EGFR inhibitor Iressa (gefitinib).
“For Iressa, trials were launched simultaneously in the United States, Europe, and Japan. I served as the lead investigator for Asia. In Japan, Kindai University and the National Cancer Center took the lead. It was a once-daily oral drug with relatively mild toxicity, so at first, we were skeptical. ‘Surely a drug like this can’t work,’ we thought. But within weeks, we saw tumors vanish before our eyes. I was astonished. It was a moment when I truly felt we were witnessing a paradigm shift in cancer care,” he recalls.
One patient in particular stands out in his memory: a man from Fukuchiyama in Kyoto Prefecture.
“He had lung cancer, and the drug worked dramatically well for him. He would travel five hours each month from Fukuchiyama just to collect his medication. He told me it felt like winning the lottery. We had already noticed that this drug worked particularly well in Japanese patients, but it later became clear that the real reason was the presence of mutations in the EGFR gene—mutations found more frequently in East Asians. Unfortunately, it was an American research group that made this discovery. Still, Japan soon took the lead in conducting joint studies with other East Asian countries, and we became the first country in the world to approve the drug.”
There were, however, painful lessons.
“The media began calling it a miracle drug for cancer, and when it was released, everyone and anyone started prescribing it. In Japan’s medical system, any physician can prescribe anticancer drugs. Then we began to see severe cases of interstitial pneumonia as a side effect. It became a social issue, and I was often called to testify in court. Through this experience, I learned firsthand both the importance and the difficulty of developing new drugs.”
For FUKUOKA, the deeper problem lay in Japan’s failure to train physicians with specialized knowledge of medical oncology. That is precisely why he poured his energy into nurturing the next generation. The country’s largest cancer research society, the Japan Society of Clinical Oncology (JSCO), had more than 16,000 members, but over 70 percent were surgeons; internists accounted for barely 10 percent. As a result, systemic drug treatment was often neglected. To address this imbalance, in 2003, FUKUOKA and his colleagues took decisive action: they founded the Japanese Society of Medical Oncology (JSMO), with the clear mission of fostering expertise in drug-based cancer therapy.
“In an era when one in every two Japanese will develop cancer, of course surgical oncologists are essential. But the shortage of internists and radiation oncologists involved in cancer treatment is a critical issue. What we need is a balanced, well-structured system,” he insists.
To achieve that balance, JSMO established a new board certification system for specialists in cancer drug therapy (medical oncologists). FUKUOKA became the first chairman of the board responsible for the system. Drawing on curricula from Europe and the United States, he completed Japan’s own framework for training specialists in cancer drug therapy, laying the foundation for a new generation of medical oncologists.
The progress of cancer drug therapy—chemotherapy—has been nothing short of remarkable.
Where once medicine could only strike blindly, today researchers identify the very genes and proteins that drive cancer’s growth and target them with precision medicines known as molecularly targeted therapies. Then, in 2014, came a revolution: immune checkpoint inhibitors, which unleashed the body’s own defenses against the disease. To deliver such treatments safely and effectively, physicians with specialized expertise—medical oncologists—became indispensable.
FUKUOKA Masahiro also believes medical oncologists must serve as the commanders of cancer care, coordinating across departments and professions to provide each patient with the most appropriate treatment.
It has now been 23 years since the Department of Medical Oncology was founded at Kindai University Faculty of Medicine. Today, under the leadership of its third chair, Professor HAYASHI Hidetoshi, the department continues to train specialists, and its alumni can be found practicing across Japan. FUKUOKA feels a real sense that Kindai University has become a hub—a “Mecca”—for medical oncology. Yet he remains modest. “I worked hard to establish medical oncology, but the journey is only halfway complete. I want the younger doctors to carry it forward and build on it,” he says.
For him, the responsibility of Kindai University is clear: to continue producing medical oncologists who face cancer with sincerity, lead their teams with conviction, and advance the field for the benefit of patients everywhere.