Development opportunities cultivate more complete pediatric oncologists

“It’s back, and it’s metastasized, hasn’t it?” When I was 15 years old, that’s what I had asked my parents as they sat my siblings and me down to talk about my grandmother. I remember that week vividly, as I was considering a future in veterinary medicine, but sitting in my room at night, searching — “What kind of doctors treat cancer?” and “How do you become a doctor that treats cancer?” 

I shelved those questions and kept them to myself, never voicing them to my family. My introversion made me question if I was capable of becoming a doctor. The intensity of medical school, the exposure to gross anatomy, and the expectation to connect with people in their most vulnerable moments all felt daunting. I stuck with the plan to go to vet school but realized I couldn’t get the idea of treating cancer out of my head. As I finished my undergraduate animal sciences degree, I switched gears, took the MCAT and set a course to medical school at the University of Alabama at Birmingham (UAB) with the plan of becoming an oncologist. 

The experiences I had on my journey to my current position as a Pediatric Hematology/Oncology fellow at St. Jude have helped me define the type of oncologist I want to be. For example, I met a pediatric oncology fellow at UAB who suggested I shadow him on his clinic days. I absolutely adored seeing the relationships with families, and I was surprised by how positive the energy was. That planted the first seed that I wanted to work with children. 

Fueling a desire to learn 

Forming relationships with families is so rewarding and is central to why I chose pediatric oncology. But during my residency and fellowship at St. Jude, I also met families whose outcomes weren’t what anyone hoped for. Those experiences stayed with me and were often hard to carry. They instilled a drive in me to do more than the status quo. Research became both a way to process those moments and a way forward, an opportunity to step back, to learn and to be a part of something that can make outcomes a little bit better. 

As part of my residency, I got to work with Hiroto Inaba, MD, PhD, Pediatric Hematology/Oncology Fellowship Program director, on a retrospective analysis of patients treated on the Total 15 and Total 16 clinical trials. We looked at outcomes for two B-cell acute lymphoblastic leukemia subtypes to improve risk stratification and showed that low-intensity therapy can be effective for a subset of these patients. This work was published in Blood, and that experience, along with my time working alongside the leukemia clinical team, motivated me to continue my journey at St. Jude through the Pediatric Hematology/Oncology Fellowship. 

The first year of the fellowship was very clinically oriented as we rotated through the hematology, solid tumor, leukemia and transplant divisions. We spent 12 days on, 2 days off for an entire year learning to care for the breadth of patients represented in pediatric hematology and oncology. We then transitioned to having a lot more protected time for research. 

Learning the trade of scientific research 

That’s when I joined the lab of Jeffery Klco, MD, PhD, Department of Pathology. I didn’t have an extensive lab background before I joined, so I knew I was going to need a lot of help. This felt like it would be a great environment to learn, and I did so by sorting through relapsed/refractory acute myeloid leukemia (AML) trials that had been completed. For example, we have patient samples with RNA, DNA and single-cell sequencing. My goal has been to analyze that data to determine how we can better predict which patients will respond to a type of therapy called XPO1 inhibition and which patients will not.

I also began developing my own translational project to carry forward. With a focus on XPO1 inhibition, I wanted to explore ways to enhance the efficacy of these inhibitors in pediatric AML cells. We performed a screen and identified several metabolic enzymes as possible targets, aligning with established paradigms that exploiting altered cancer metabolism can be a powerful therapeutic approach. I was excited about this potential direction. 

I spent time validating the hits that I was interested in. The data continued to look promising, and so, we wrote a proposal for a Physician Scientist Instructor (PSI) position at St. Jude. The PSI is a 3-year faculty position where a former fellow can work as an independent physician on the clinical side and a postdoc on the research side. I was ecstatic when the proposal was approved. 

On the other side of uncertainty and doubt 

After my fellowship ends in July, I’ll be ready to practice independently as a clinical oncologist. The PSI role will allow me to spend 20% of my time as an attending physician, and it recognizes that I’m not quite ready to be independent in a lab-based research career. So, 80% of my time will be protected for dedicated research, where I’ll be able to learn many of the practical skills that I wasn’t formally trained in. The PSI will give me time to explore the right balance of patient care and lab work for me. One thing I really appreciate about pediatric oncology training and careers at St. Jude is that everyone’s trajectory looks different — you have the space to find what works for you. 

When I think back at my initial hesitancy to become an oncologist, I am reminded not to put limitations on myself. Whatever path you choose, it’s going to take time, work and investment, and there will be parts that scare you. That doesn’t mean that you can’t or shouldn’t do it. I know now that if you’re passionate enough about something, then you’re going to grow and stretch in ways that allow you to become the person that the journey requires you to become.