A Focus on Patient-First Care Drives Breast Cancer Investigator to Success

Joyce A. O’Shaughnessy, MD

Joyce A. O’Shaughnessy, MD, may be an accomplished clinical investigator, researcher, and educator, but ultimately her patients drive her passion. “Every week, I am inspired by my patients; I wouldn’t be able to do it otherwise,” O’Shaughnessy said in an interview at the time of her Giants of Cancer Care^® award reception. “The clinical care and the patients motivate me. [That] has kept me right where I am, and it is what gets me out of bed every morning.”

Her commitments in the clinic also fuel her desire to share knowledge with others, said O’Shaughnessy, who was named the 2016 Giant of Cancer Care® for Community Outreach/Education. She has served as a leader at numerous conferences and meetings, including as program chair for the International Congress on the Future of Breast Cancer^®. She also helped to establish the School of Breast Oncology^®, a meeting hosted by Physicians’ Education Resource^®, LLC (PER^®). She will continue to serve as the program director as the meeting enters its 21st year.

“I find my peers and colleagues turning to me, and I turn to them for help and guidance. It is usually about patient [treatment]; the goal is really about trying to help the individual patient,” said O’Shaughnessy, who is the Celebrating Women Chair in Breast Cancer Research at Baylor University Medical Center, Texas Oncology, and chair of the Breast Cancer Program at US Oncology Research. “I see the impact that education can have as I talk to [individuals who] have an experience that I haven’t had and I, in turn, help teach and give suggestions to other doctors dealing with challenges that I have had.”

What Inspired Her Passion

The first patient to motivate O’Shaughnessy was her sister, Teri, who received a diagnosis of acute lymphoblastic leukemia at age 5 in 1970, when O’Shaughnessy was in high school. She was treated in clinical trials and for a time did well. O’Shaughnessy wanted to better understand the disease her sister was fighting and soon became interested in the biology of leukemia.

When Teri died in 1975, O’Shaughnessy had just started attending College of the Holy Cross in Worcester, Massachusetts. Her sister’s death intensified her interest in fighting cancer, and although she was only a freshman biology student, O’Shaughnessy started conducting leukemia research with the Worcester Foundation for Experimental Biology (now called the Worcester Foundation for Biomedical Research).

“It was a bit unusual, but I made it a priority,” said O’Shaughnessy. “It was very important to me. It was my No. 1 priority to get into cancer research immediately, and I wasn’t going to wait until graduate school.”

In 1978, O’Shaughnessy completed her undergraduate degree and continued studying leukemia at Yale School of Medicine in New Haven, Connecticut. After graduating in 1982 and completing her internship and residency at Massachusetts General Hospital in Boston in 1985, O’Shaughnessy did her oncology fellowship at the National Cancer Institute (NCI). There, in 1990, she made the switch from leukemia to breast cancer, where her focus remains today. She remained with the NCI until 1995 and then briefly worked at what is now the CBC Group Louisville in Kentucky, before transferring to Texas Oncology/ US Oncology in 1997.

At first, the switch was based primarily on opportunity. She was working in a laboratory studying tumor virus biology when she was offered a chance to work as a senior investigator, running her own human clinical trials in the Medical Breast Cancer Section at NCI.

She soon realized that breast cancer was the field for her. “I really liked the breast cancer work; I loved it, I had a wonderful time,” O’Shaughnessy said. “I developed the beginnings of clinical and research expertise in breast cancer. Once I had completed 5 years that were totally dedicated to breast cancer, I just decided to stay with it.”

Career Highlights

O’Shaughnessy has become known as an influential leader in several areas within the disease. She was instrumental in the design of tissuebased risk reduction protocols in women at high risk for breast cancer. She was also heavily involved in bringing capecitabine and gemcitabine to the market—cytotoxic agents that were approved by the FDA over 20 years ago and are now among those most widely used in treating breast cancer.

Despite her success, O’Shaughnessy is quick to praise others, including Joanne L. Blum, MD, PhD, of Texas Oncology, and Kathy S. Albain, MD, of Loyola Medicine, who worked with her on capecitabine and gemcitabine, respectively.

“It is always teamwork,” O’Shaughnessy said. “Fortunately, I’ve been involved with the team that was primarily responsible for moving those agents ahead as quickly as possible. Those were gratifying experiences because we had a lot of like-minded [individuals] really working together effectively and as efficiently as possible. Focusing on patient recruitment, especially when you know a drug well, once you know that you’ve got a signal, getting it through the definitive phase 3 trials and, finally, FDA approval, is an exhilarating experience because you’ve got so many [individuals] giving it their all to get the job done. It is highly collaborative.”

O’Shaughnessy says many colleagues and mentors have inspired and supported her. These include Stephen Jones, MD, who kick-started her career at Texas Oncology by making her his protégée and sharing his breast cancer clinical trial work and practice with her, as well as Ken Cowan, MD, PhD, her mentor and a senior faculty member when she worked in the breast cancer section at the NCI.

She also credits Daniel D. Von Hoff, MD, a Giants of Cancer Care® recipient in gastrointestinal cancer, and Gary J. Kelloff, MD, as influential team members on a project she considers one of her career highlights—participating in a large working group to come up with new agent approval end points for the treatment of precancerous lesions called intraepithelial neoplasia. “It was a big national effort that led to a publication that I still think is important today,” O’Shaughnessy said.

O’Shaughnessy’s contributions to the breast cancer armamentarium include key research into the chemotherapy agent eribulin mesylate; the CDK4/6 inhibitors abemaciclib (Verzenio) and ribociclib (Kisqali); the immune checkpoint inhibitor pembrolizumab (Keytruda); and numerous targeted therapies including HER2 and PARP inhibitors.

Over the past 3 years, the breast cancer landscape has seen a surge of approvals and O’Shaughnessy looks forward to integrating these advancements into clinical practice. “It’s truly an exciting and hopeful time in breast cancer because many of the novel agents recently approved and in late-stage development will ultimately improve the long-term outcomes of patients with high-risk early-stage [disease], thereby decreasing the global burden of metastatic breast cancer—and there’s no indication that the pace of discovery will slow down any time soon,” she said in a recent interview with OncologyLive^®.

Focusing on the Future

Although she has accomplished so much in her career, O’Shaughnessy doesn’t show any signs of slowing. She does, however, make time for friends and family.

Her current research is focused on trying to understand the molecular subtyping of triple-negative breast cancer (TNBC). Her goal is to understand the molecular biology of the subtypes and develop clinical trials to test the hypothesis on how to treat patients for whom there are no curative tools. This requires understanding how deficits in DNA repair in TNBC can be exploited to enhance the efficacy of novel agents such as immunotherapies.

Clinical trials also continue to be important to O’Shaughnessy. “As oncologists, patients are coming to us with a big problem and they are calling on us to solve that problem,” she said. “The only way you can problem solve is with the right diagnostic and therapeutic tools. For some cancer situations, we do have the tools [but] we can successfully problem solve. But then there are cancer situations that we do not have the tools for and we cannot problem solve. The only way to develop those tools is by clinical trials. You’ve got to come up with new strategies, new diagnostics, and new therapeutics.”

However, O’Shaughnessy sees herself as a physician first and still credits her patients, especially those not responding to available treatments, as her primary motivation. It can be difficult to see patients and not be able to find a treatment that works for them, said O’Shaughnessy. “It is immensely frustrating to be asked to problem solve for a patient and not have the tools.”