Forging a New Role to Make Curing More Cancers a Reality

A Conversation With Nancy E. Davidson, MD

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Understanding the evolutionary changes that take place in tumors and learning more about why tumors become resistant to drugs will be among the big areas of research in metastatic disease over the next 5 to 10 years.
— Nancy E. Davidson, MD

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For more than 3 decades, Nancy E. Davidson, MD, has dedicated her clinical and research career to better understanding the molecular mechanisms driving the development of breast cancer and to the discovery of more effective therapies to treat the disease. The recipient of an ASCO Young Investigator Award, Dr. Davidson’s early research in breast cancer focused on the role the ErbB2 protein plays in driving the onset of HER2-positive breast cancer and to the investigation of new drugs targeting the protein, including trastuzumab (Herceptin).

More recently, Dr. Davidson’s laboratory and clinical research focused on the role of epigenetic changes in the biology and treatment of breast cancer. Her lab has explored the impact of gene silencing by DNA methylation and histone modification as well as ways to reverse these changes. These preclinical findings have been translated into clinical trials studying the bioactivity of a histone deacetylase inhibitor in early breast cancer and the activity of combination epigenetic modifiers for the treatment of advanced breast cancer.

Dr. Davidson has been recognized for her contributions in breast cancer research and in improved patient care with numerous awards and honors, including ASCO’s Gianni Bonadonna Breast Cancer Award, the American Association for Cancer Research’s Women in Cancer Research Charlotte Friend Memorial Lectureship, the Pennsylvania Breast Cancer Coalition’s Potamkin Award, Johns Hopkins University Alumni Association’s Distinguished Alumna Award, and the National Cancer Institute’s Rosalind E. Franklin Award for Women in Science.

Dr. Davidson served as President of ASCO from 2007 to 2008, a position she has said helped her “think more broadly about the totality of cancer and how we need to approach it going forward,” and is the current President of the American Association for Cancer Research. She is an elected member of the National Academy of Medicine and the Association of American Physicians as well as a fellow of the American College of Physicians. She serves as a member of the scientific advisory boards for the Breast Cancer Research Foundation, the V Foundation for Cancer Research, and the Sidney Kimmel Foundation for Cancer Research.

Continuation of a Stellar Career

This past December, Dr. Davidson began her new positions as Senior Vice President and Director of the Clinical Research Division at Fred Hutchinson Cancer Research Center (Hutch); Professor and Head of the Division of Medical Oncology at the University of Washington (UW) School of Medicine; and President and Executive Director of the Seattle Cancer Care Alliance. These three positions encompass her overarching role as Executive Director of Oncology at the Fred Hutchinson/University of Washington Cancer Consortium, which includes the Hutch, UW Medicine, Seattle Cancer Care Alliance, and Seattle Children’s Hospital.

Prior to joining the Fred Hutchinson/University of Washington Cancer Consortium, Dr. Davidson was Director of the University of Pittsburgh Cancer Institute. She previously served as Professor of Oncology at Johns Hopkins University School of Medicine and Director of the Breast Cancer Program at Johns Hopkins Oncology Center.

The ASCO Post talked with Dr. ­Davidson about her new roles at the Fred Hutchinson/University of Washington Cancer Consortium, the progress she sees being made in more effective therapies for cancer as well as more potential cures for the disease, and her advice for young oncologists just starting their careers.

An Offer She Couldn’t Refuse

What led to your decision to leave the University of Pittsburgh Cancer Institute and move to Seattle to serve as a leader in the Fred Hutchinson/University of Washington Cancer Consortium?

I wasn’t expecting to make this change, but I was presented with the opportunity to come to an exciting institution at a critical time in the fight against cancer and decided to go for it. Fred Hutchinson is a world-class center in every aspect of blood malignancies, hematopoietic stem cell transplantation, and immunotherapy, as well as in research initiatives in the causes of cancer and cancer-prevention strategies, all of which are attractive to me.

I loved my time at the University of Pittsburgh Cancer Institute and think we did a good job of advancing its cancer research, patient care, and education mission. But I decided that the opportunity was too exciting to pass up.

Life is not a sprint, and you have to look at your long-term career path and be willing to make adjustments as your situation changes to succeed in your life and career.
— Nancy E. Davidson, MD

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At Fred Hutchinson, we are positioned to lead in some very key areas of basic and translational science and in clinical research, and it is very exciting. I’ve had wonderful experiences at the University of Pittsburgh and at Johns Hopkins, and I’m looking forward to taking what I’ve learned from those distinguished institutions and applying that experience and knowledge here.

I’m also excited about living in Seattle. In addition to being in a first-class medical and academic environment, I like being close to all the corporate leadership headquartered here, including such companies as Microsoft and Amazon. Hopefully, the proximity of these enterprises will lead to a more synergistic relationship between the biomedical community and the corporate community over big data.

Translating Research Into Better Patient Care

You have many leadership roles in your new position. Could you talk about what each role entails and whether you will still care for patients with breast cancer?

The roles are all tied into achieving a single goal: to work to develop the best possible clinical and research oncology enterprise through the partnership that already exists among Fred Hutchinson, the University of Washington School of Medicine, the Seattle Cancer Care Alliance, and the Seattle Children’s Hospital. So I look at each of my titles as various dimensions of my central job as Executive Director of Oncology at Fred Hutchinson/University of Washington Cancer Consortium.

I’m also happy to say that the state of Washington just issued me a medical license to practice here, and I can now take up a focused clinical practice caring for patients with breast cancer as part of the medical team at Seattle Cancer Care Alliance.

Please describe some of your responsibilities as a leader of the cancer consortium.

My goal, and I think the reason I had the opportunity to come here, is that maybe I’m the right person, in the right place, at the right time. I am someone who can work with others to think about how to align all the parts of various institutions to translate research discoveries into the clinical arena, optimize clinical care, and support our educational mission.

This is an academic center that is well known for its expertise in bone marrow transplantation and in the emerging field of immunotherapy, so obviously we want to advance those approaches and take them to the next practice-changing levels. In addition, personally, I’m focused on epithelial cancers, and there are a lot of research strengths in those types of cancers here, including in our prostate, breast, and gastrointestinal cancer research programs, particularly within the framework of precision oncology. Our challenges are how to optimize our research structures and activities to advance progress in oncology care.

And although our job is largely focused on research and treatment, I’m also hoping that we will be able to take our enormous knowledge about cancer prevention, such as weight loss, diet and exercise, and immunization for human papillomavirus (HPV) and hepatitis B virus (HBV) to prevent HPV- and HBV-related cancers, and transfer that information to the clinic and also have an impact on public health-care policy.

Finding More Cures for Cancer

The aim at Fred Hutchinson is to find more cures for cancer. How realistic is that goal, and is it likely that more cancers will be converted to chronic diseases than actual cures?

Our tag line is “Cures Start Here,” and our President, Gary Gilliland, MD, PhD, believes that many types of cancers will have curative therapies within the next 10 years. He has made curing cancer an aspirational goal of the institution, and we all support that goal.

We are curing more cancers now, including testicular cancer, early breast cancers, early colon cancers, and some types of blood cancers and lymphomas. The question is, how can we make even greater progress in cancer cures in the near future?

Immunotherapy and Targeted Therapy

In line with that, what progress do you see being made in more effective therapies for cancer, especially in the metastatic setting, over the next decade?

There is enormous enthusiasm now in trying to understand the possibilities for immunotherapy in cancer care, and research in that area is underway at many academic centers, including our own. The hope is that immunotherapy will be effective for many individuals with metastatic cancers. The question is whether there might also be a place for the therapy earlier in the course of the disease.

Trying to understand the optimal use of targeted therapies in the cancer continuum, and when and how they should be applied, remains a crucial part of research. And, especially in the metastatic disease setting, it is fertile ground for us to think about the concepts of the longitudinal evolution of a cancer and how to deal with that evolution and monitor those changes to make informed choices that can be effective in curing that cancer.

So understanding the evolutionary changes that take place in tumors and learning more about why tumors become resistant to drugs will be among the big areas of research in metastatic disease over the next 5 to 10 years. Of course, our hope is that with early detection, diagnosis, and therapy, we will be able to prevent metastatic disease, which would be the best possible solution.

Taking the Long View

At ASCO’s 2016 Annual Meeting, you and two other Past Presidents of ASCO, Julie Vose, MD, MBA, FASCO [Professor in Internal Medicine at the University of Nebraska Medical Center] and Sandra M. Swain, MD, FACP, FASCO [Associate Dean for Research Development at Georgetown University Medical Center and MedStar Health] participated in a networking session titled How to Manage It All. What advice do you have for young female oncologists starting out in their career?

My wish for young oncologists just launching their careers is the same regardless of gender: I hope you are absolutely passionate about the field of oncology and the spark you have for your profession gets you up and excited to go to work every morning. It’s also important to be focused and directed in the areas of medicine in which you want to make a difference and to strive for a work-life balance.

My personal goal is to be really, really good at everything I do: I want to be the best possible doctor, the best possible researcher, the best possible mother and wife, and the best possible supportive and respectful member of my family. But sometimes you have to settle for what I call “good enough.”

Life is not a sprint, and you have to look at your long-term career path and be willing to make adjustments as your situation changes to succeed in your life and career. The decisions I made in my career when my children were young are different from the decisions I’m able to make now, so you need to have a long-range view to accomplish your personal and professional goals and to be successful and happy in all dimensions of your life. ■

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