In this installment of the Living a Full Life series, guest editor, Jame Abraham, MD, FACP, spoke with Quynh-Thu Le, MD, Chair of the Department of Radiation Oncology and Co-Director of the Radiation Biology Program of the Stanford Cancer Institute, and one of the Group Chairs of the NRG Oncology Group. Part of the National Cancer Institute–supported National Clinical Trial Network, the NRG Oncology Group conducts large phase II and III studies on radiation therapy for patients with solid tumors. Dr. Le used to serve as Chair of the Head and Neck Committee of NRG Oncology. She also serves on the editorial board of several cancer-related journals.
Head and neck cancer specialist Quynh-Thu Le, MD, was born in Hue, a city in central Vietnam, close to the demilitarized zone, which was a battleground demarcation separating North from South Vietnamese territories during the Vietnam War. “My father was a urologist, who felt that it was his duty to stay in Vietnam after the 1975 fall of Saigon, now Ho Chi Minh City, and help rebuild the country. However, his idealism didn’t work out too well, and he ended up in a concentration camp. Then, as Vietnam went to war with Cambodia, they began drafting people as young as 16, which was near my brother’s age, so we decided it was time to escape. I was 12 at the time,” she related.
On escaping from Vietnam: “As part of the famous ‘boat people,’ we finally ended up on a beach in Malaysia after several days in perilous sea. We camped for a month on that beach with the support of the International Red Cross. I’m forever grateful for that organization.”
On the future of the clinical trial system: “First and foremost, we need to adapt a nimbler approach in our trial design and execution. Moreover, we need to do more biomarker-driven studies.”
Advice for a young oncologist: “As a career begins to build, it is easy to lose yourself in publishing and research, so you need to always remind yourself why you became an oncologist in the first place: to create better outcomes for our patients with cancer.”
Dr. Le continued: “At the time, the Vietnamese government was deporting Chinese-Vietnamese because the belief was that these people were corrupting the Vietnamese economy. So, we changed our name to Chinese and got fake birth certificates, which allowed us to leave Vietnam as part of the famous ‘boat people.’ It was quite perilous, as the sea was full of danger. We were met by Thai pirates, who stole our money but otherwise left us alone. We finally ended up on a beach in Malaysia after several days in perilous sea. We camped for a month on that beach with the support of the International Red Cross. I’m forever grateful for that organization.”
Saved by an Italian Ship on the High Seas
In response to the plight of the Vietnamese boat people, the United Nations convened an international conference in Geneva, during which many nations agreed to help abate the crisis by rescuing refugees and offering them asylum; Italy was among them.
“There were about 300 refugees in my group, and the Malaysians, being completely overwhelmed, put us back on a couple of boats and set us out to drift. However, three Italian vessels soon arrived and took us aboard. They gathered approximately 1,000 drifting boat people just like our group and took us all back to Venice, where we received the Pope’s blessing. I was raised as a Buddhist, but the sentiment was very gracious. We ended up staying in Italy for 2 years, where I completed middle school. It was a difficult time for my father, as there was no formal process in Italy for him to get a medical license to practice,” said Dr. Le.
Jame Abraham, MD, FACP
Following Her Father’s Passion
Dr. Le’s father, who spoke fluent English, settled the family in Northern California in 1981, so he could train to practice medicine in the United States. Dr. Le excelled in high school and entered the California Institute of Technology (Caltech) in 1985, majoring in biology and chemistry.
“I saw my father’s passion for medicine and caring for people, and to a large extent, that’s what triggered my desire to become a doctor,” said Dr. Le. “Caltech was an interesting experience for a number of reasons; one was the low percentage of female undergraduate students, with the ratio of men to women being seven to one, and another was the opportunity to meet incredible professors—some of whom were Nobel Prize winners—and work in their lab. At first, I thought about becoming an engineer, but I didn’t like the math and physics aspect of that career. I also was going to be a PhD in biology, but I still loved the idea of medicine. Working with mice in the lab is great, but it is not like working with people who need care, so I ended up applying to medicine and ended up at the University of California, San Francisco [UCSF].”
A Life-Changing Trip
Dr. Le shared an eye-opening experience she had while doing her undergraduate work at Caltech, which contributed to her decision to pursue a career in medicine and inform her worldview as a physician. At Caltech, Dr. Le participated in three summer undergraduate research fellowships and credits longtime professor of political geography, Edward “Ned” Munger, with inspiring her to go into medicine.
“Ned was instrumental in scoping my life, perhaps because he wasn’t a scientist. He helped send me to South Africa to work with a university and a hospital in Durban. I realized there that I loved people, that it was hard to see suffering, and that I wanted to devote my life to medicine,” said Dr. Le. “For the first week, I stayed with a White family, and because of apartheid, I couldn’t go to the same restaurant with them. Protests broke out in the streets, and I joined in. It was an incredible experience to be immersed in that kind of racial discrimination.”
Destined for a Career in Head and Neck Cancer
Asked about her decision to enter the challenging subspecialty of head and neck cancer, Dr. Le replied: “When I arrived at UCSF, I wanted to pursue a path to medical oncology. However, I was told that in order to do well in my internal medicine rotation, I should do a radiation oncology rotation, because they teach you how to do the history and physical exam. During my rotation, I met Dr. Karen Fu, who used to be the RTOG Head and Neck Committee Chair. Karen is just a force of nature. She took me under her wing, and I was so wowed by her focus on patient care, that it really changed my focus and my life; I decided I wanted to go into radiation oncology. That was it, and I’ve never once regretted that decision.”
Dr. Le mentioned that she met her future husband at Caltech when he was there doing graduate work. “I got engaged after Caltech and married soon after I graduated from medical school. My husband is a chemist, and his work took him to the Bay area, so we really needed to be there. I wanted to go into academic oncology and lucked out because I was offered a clinical instructor’s position at Stanford. I always wanted to do head and neck radiation oncology, but at the time, there wasn’t an opening in the department, so I began focusing on brain and lung cancers,” said Dr. Le.
Dr. Le noted another mentor, Amato Giaccia, who brought her into his laboratory and provided her with research training and mentorship. “Amato was an amazing mentor, who encouraged me to do my own research. I didn’t have any funding, of course, but Dr. Richard Hoppe, the department chair at the time, provided support so I could hire a technician. I soon became a project leader of a program project grant and then obtained my own R01 grant. Things really moved ahead for me after that, and when Dr. Hoppe stepped down as Chair of the Stanford Department of Radiation Oncology, I applied for the position and was appointed as his successor. Stanford is my first and only job, and I’ve never left,” she stated.
In addition to becoming the department chair in 2011, Dr. Le was also appointment Chair of the Head and Neck Cancer Committee of the NRG Oncology Group in the same year. “The first 5 years were challenging, as I was juggling two major positions at the same time. I focused on building my leadership team and expanding the programs both at Stanford and NRG Oncology. But I’ve always had terrific division chiefs at Stanford and amazing colleagues in NRG Oncology. I am also given a lot of freedom to innovate by both organizations, that allows me to invest in people and opportunities to accelerate our growth and mission. So, neither position was a chore. They are great opportunities,” she explained. In 2021, Dr. Le was elected to become one of three Group Chairs for NRG Oncology, and thus, stepped down from her Head and Neck Committee Chair position.
Back to the Lab
Along with her multiple administrative duties, Dr. Le also runs her own lab. “I have only four people in my lab, but they’re all senior postdoctoral fellows or research scientists who have the knowledge and freedom to pursue their own specific areas of interest. Being in the lab is exhilarating, and I want to spend more time on my research. I’m very fortunate to have a wonderful and supportive husband, who is now retired. Both my kids are out of college and on their own, so life is a little bit easier than 10 years ago. I have more time to focus on the things I choose, which is really great,” she said.
How does a super-busy oncology leader decompress and avoid potential burnout? “I am an avid walker and usually listen to music or a podcast to help me tune out of work mode. When the kids were younger, there were always school and sports activities to pull me away from work and give me some time to center myself. My husband and I also love to travel, which has been interrupted by COVID, but the signs are positive, so we can resume our love of traveling soon. Above all, it is important to find ways to clear your head and step away from work. It makes you a better doctor in the long run.”
Nimbler Trials Needed
Asked about the future of the clinical trial system, Dr. Le commented: “First and foremost, we need to adapt a nimbler approach in our trial design and execution. Moreover, we need to do more biomarker-driven studies. Currently, we spend 10 years running a large cancer trial and then another 10 years waiting for results that may or may not change the standard of care. With the advent of personalized medicine, gains in cancer survival over the long term could be improved by running smaller, faster trials with the smart use of biomarkers.”
In addition, Dr. Le emphasized the need to find ways to give early-career investigators the opportunity to grow. “For instance, there’s a proposal in NRG Oncology to create a platform to allow early-career investigators to pitch their idea before the committee leaderships, something that would fill a known gap,” she shared. “If the idea sticks, we look for ways to support it. Approaches like this can help to jump-start careers and research efforts. As you know, there are many challenges in the trial space, but it is absolutely vital that we continue to build a better and more efficient system with new ideas.”
The Rewards of Oncology
When asked what advice she would give to a young oncologist, Dr. Le responded: “I would stress the importance of being a complete physician, which sounds easy but takes work and dedication. As a career begins to build, it is easy to lose yourself in publishing and research, so you need to always remind yourself why you became an oncologist in the first place: to create better outcomes for our patients with cancer. That said, I would also stress the importance of building a research component to your career, one that helps to translate into clinical care, where you can really make a difference. Oncology is a difficult career, but I cannot think of a more rewarding field in all of medicine.”
DISCLOSURE: Dr. Le owns stock in Aldea; has served as a consultant or held an advisory role with GRAIL, Nanobiotix, Roche, and Coherus Biosciences; and has received travel accomodations and expenses from Genentech and Merck.