While the development of mentorship relationships is critical in launching and nurturing the academic careers of young investigators, it is also an essential component for continued success throughout their careers, according to Jennifer R. Brown, MD, PhD. Dr. Brown, Director of the CLL Center at Dana-Farber Cancer Institute, and Associate Professor in the Department of Medicine at Harvard Medical School in Boston, is currently mentoring Matthew S. Davids, MD, MMSc, Attending Physician in the Lymphoma Program at Dana-Farber and Instructor of Medicine at Harvard Medical School. Dr. Davids, a recipient of a Conquer Cancer Foundation of ASCO 2014 Career Development Award, is evaluating the investigational agent IPI-145 in combination with FCR (fludarabine, cyclophosphamide, and rituximab [Rituxan]) as a possible treatment for younger patients with chronic lymphocytic leukemia (CLL).¹ (See “A Conversation With Matthew S. Davids, MD, MMSc,” in sidebar.)

Dr. Brown said the experience of having mentors during her undergraduate and graduate laboratory studies in molecular biophysics and molecular genetics, and later during her residency in internal medicine at Massachusetts General Hospital and fellowship in hematology and medical oncology at Dana-Farber, was crucial in cultivating an early clinical and research interest in lymphoma. These experiences also helped steer her toward a subspecialty in chronic lymphocytic leukemia.  The support and encouragement she received from her mentors were so important to her academic career she continues to seek the guidance of mentors today. “The developmental needs change,” said Dr. Brown, “but we all need to be mentored to some extent throughout our careers.”

The ASCO Post talked with Dr. Brown about her experience as both a mentee and a mentor and how the partnership helps establish lifelong clinical and research careers in oncology.

Finding the Right Niche

Please describe how being mentored helped you launch your academic career.

I have had mentors throughout my medical career starting with laboratory mentors during both my undergraduate and graduate studies. I was also mentored during my residency at Massachusetts General Hospital by David Kuter, MD, Director, Center for Hematology at Massachusetts General Hospital, when I had an interest in benign hematology. Then as I moved toward fellowship in hematology and medical oncology at ­Dana-Farber, I became more interested in lymphoma and CLL. I worked with Arnie Freedman, MD, Clinical Director at Dana-Farber/Brigham and Women’s Cancer Center Adult Lymphoma Program, in clinical research as I transitioned to the faculty and decided to subspecialize in CLL.

One of my laboratory interests is in the heritability of CLL and lymphoma and what the genetics are that underlie the inheritance of these diseases—CLL is, in fact, the most heritable of the lymphomas—so specializing in this disease was a very good niche for me. It also gave me the opportunity to develop my own clinical research program in CLL at Dana-Farber, which has worked out very well.

Today, my Division Chiefs, Robert Soiffer, MD, Chief, Hematologic Malignancies, and Co-Chief of the Stem Cell Transplantation Program at Dana-Farber, and Margaret Shipp, MD, Chief, Division of Hematologic Neoplasia and Program Director for the Lymphoma Program, are good mentors to me, as are other specialists in the field such as John Byrd, MD, Director of the Division of Hematology and D. Warren Brown Chair of Leukemia Research at Ohio State University Comprehensive Cancer Center.

Novel Skills and Experiences

Would you say that maintaining mentorship relationships is important at every stage in an individual’s career?

Yes, absolutely. The developmental needs change, but I think we all need to be mentored to some extent throughout our careers. You move from mentor to mentor over your career depending on what your needs are at the time. You can also acquire different skills from different individuals at a given point, so oftentimes you need to collect a variety of mentors who can help you in various aspects of what you are doing.

Role as a Mentor

Please talk about your experience mentoring Dr. Matthew Davids in his research efforts and career development at Dana-Farber Cancer Institute.

Dr. Davids worked with me as a fellow on our in-patient service and he subsequently became interested in CLL (see Dr. Davids’ interview on page 127). He worked in the laboratory of Anthony Letai, MD, PhD, Associate Professor of Medicine, Hematologic Neoplasia/Malignancies, Dana-Farber Cancer Institute, and in the clinic with me. I am mentoring Dr. Davids on his study of IPI-145 in combination with FCR (fludarabine/cyclophosphamide/rituximab [Rituxan]) for which he received the Career Development Award. I have mentored him on several other grants as well.

We have been working together now for 4 years and it is a very satisfying, mutually beneficial relationship. I have the opportunity to help him develop as an academic physician, which includes being a specialist in CLL in the clinic as well as learning how to design protocols for clinical trials, write grants for clinical trials, oversee clinical trials, and then publish their results.

None of these academic-type activities are explicitly taught in medical school and oftentimes people aren’t exposed to them until they get to the end of their fellowships. They may have given a couple of talks or written an occasional paper, but usually not at the same systematic level that one needs to develop to succeed in academia.

Also, there are usually a lot of competing demands on physicians’ time.  If you are taking care of patients and running an inpatient service, obviously patients come first, so one has to take care of the patients, but also learn how to carve out some time for these academic activities. And having done that myself, I have experiences I can share in that regard as well as help junior investigators develop these necessary skills.

As a mentor, I can also provide support when there are too many things going on or a particularly stressful event happens. So it is very helpful for junior investigators to have the support of someone who can say, “That’s happened to me before,” or, “I’ve been there before and this is how I managed it.”

Today, it is harder and harder to do clinical research because of the regulatory environment and payer reimbursement issues, so getting established is difficult and it helps greatly, it is essential in fact, to have the support of someone in your institution, as well as support from other people around the country who work in your area.

How long have you been a mentor; and how many young investigators have you mentored?

I have been in mentorship relationships for about 10 years. And over that time, I have mentored between 10 and 12 young investigators and postdoctoral fellows.

Career Development Award

How important is it to a young investigator’s career to be awarded a Conquer Cancer Foundation Career Development Award?

This gets to the issue of the competing demands on the time of junior investigators both in the clinic and in the laboratory. It is very important during late fellowship or early faculty to be able to carve enough time out of the clinic to acquire the academic skills I mentioned earlier and really develop expertise. This is why grants like the Career Development Award are so important.

The Conquer Cancer Foundation provides a large number of grants to young investigators both as fellows and junior faculty members and that affords them protected time dedicated to research where they can concentrate on a project and develop the skills to succeed in academia.

It really is not possible to overestimate the importance of having that protected time to allow young investigators to pursue their research career, especially in the current environment where everyone is busier and busier and time is limited. Also, there are not as many sources of funding as there used to be, so getting that early foothold is really critical for helping people feel comfortable and develop the skills they need to succeed and want to stay in academia.

Dr. Davids’ grant in particular involves a clinical trial that arose out of some experiences I had with several patients with CLL. We believe his trial may lead to a potentially transformative treatment for a certain category of CLL, so we are very excited about it.

This is also an especially exciting time in CLL because of the potential of new therapies, and we are figuring out how best to combine the drugs with each other or with standard chemotherapies for maximum patient benefit. The study that Dr. Davids is doing is in that category, and we are hoping that the investigational treatment may prove to benefit patients more than is currently possible. ■

Disclosure: Dr. Brown reported no potential conflicts of interest.

Reference

1. A Phase Ib/II Study of IPI-145 Plus FCR in Previously Untreated, Younger Patients With CLL. ClinicalTrials.gov identifier NCT02158091.