Giants of Cancer Care Award in Breast Cancer Goes to Nancy E. Davidson, MD: The Introvert in the Front Row

Nancy E. Davidson, MD

Glance at her résumé and you might assume that Nancy E. Davidson, MD, has an outsized personality that commands the spotlight the moment she walks into a room.

After all, she is 1 of only 7 people to have been president of both the American Society of Clinical Oncology (ASCO) and the American Association for Cancer Research. She has run groundbreaking international clinical trials, contributed to more than 380 papers, and served on the advisory boards for 10 National Cancer Institute (NCI)–designated cancer centers.

Yet, such success is due in large part to her secret superpower: She’s an introvert.

Davidson has a natural aversion to drawing attention to herself. As a young researcher, she had to be advised by her mentor that when attending a conference, she should, “sit in the front row and ask a question.”

Yet quietly, subtly, she accomplishes what she’s set out to do, in part because of that very willingness to share the stage with others.

“She has that basic decency of listening to others,” said Marc Lippman, MD, professor in the departments of oncology and medicine at Georgetown University Medical Center and the mentor who gave her that “front row” advice.

That introversion, however, can prove frustrating when she feels it gets in the way of conveying her ideas, Davidson said. Still, she knows it is a powerful asset when convincing others to join her team.

“It allows me to draw others out so that they contribute and shine,” she said.

Collaboration is valued in modern-day cancer research, yet easier said than done when dealing with hard-driving intellectuals who each have turfs to protect. In such a milieu, think of Davidson as The Oncologist Whisperer.

She is now at the pinnacle of her career, having amassed an admirable record of her own research breakthroughs in breast cancer as well as leadership that boosts the work of others. She is now at Fred Hutchinson Cancer Research Center,

where she is a senior vice president and director of the clinical research division. She also has leadership roles at Seattle Cancer Care Alliance, the center’s nonprofit treatment arm, and the University of Washington.

When asked which of her research findings she views as the most significant, she cites the phase 3 ECOG 5188 clinical trial that established the benefit of endocrine therapy for premenopausal women with early-stage, hormone-responsive breast cancer.

The study tested the conventional wisdom that young patients wouldn’t benefit from adjuvant hormonal therapy. “There wasn’t any clarity that it would work in younger women,” she said. “We decided to challenge that.”

One lingering memory that encouraged her to go down that path was of reading the original article from 1896—yes, 1896—in The Lancet by the pioneering Scottish oncologist and surgeon Sir George Thomas Beatson, MD, MB, in the stacks of Welch Medical Library at Johns Hopkins University. His revolutionary technique of treating breast cancer by removing the patient’s ovaries signaled the dawn of an antihormonal approach to the disease.

That article, along with her own preclinical laboratory studies, helped Davidson realize that pathways of endocrine response are not age dependent, she said.

ECOG 5188 was a 3-arm, randomized, national trial that compared chemotherapy alone; chemotherapy followed by ovarian suppression with the luteinizing hormone–releasing hormone agonist, goserelin; and chemotherapy plus goserelin and tamoxifen.

It took years to complete, by design. Davidson wrote the study the year her son, Kevin, was born and published the findings the year he left for college.

When caring for younger patients with breast cancer, she noted that it isn’t particularly helpful to tell a 30-year-old her chances of living to 32. The trial followed patients for nearly a decade. The timeline was also lengthened due to the difficulty of enrolling premenopausal participants when the median age for receiving a breast cancer diagnosis was 63.

The results showed adding adjuvant tamoxifen to chemotherapy significantly improved time to relapse and disease-free survival compared with chemotherapy alone at 9 years of follow-up. The findings helped rewrite the rulebook for treating

premenopausal breast cancer. (And yes, she was one of the people who actually rewrote ASCO’s clinical practice guidelines.)

Davidson was the first to describe epigenetic regulation of the ESR1 gene, uncovering a pathway through which some endocrine receptor–negative breast cancers could be made to reexpress the estrogen receptor and resensitize those tumors to endocrine therapy. Further, she was part of the team that demonstrated the value of using trastuzumab (Herceptin) along with chemotherapy for treating early-stage HER2-positive breast cancer.

Lippman noted that Davidson’s research is of immense value but that her bigger achievement is getting—and keeping—her fellow investigators on task for lengthy studies.

That is quite a feat, particularly given the size of some of the egos involved. “She has the ability to work in large, contentious, and often narcissistic groups of doctors and [get them to] behave,” he said. “Some of them I couldn’t be in the room with for 10 minutes.”

And in one-on-one settings, Davidson is friendly and engaging, with a ready laugh.

“How would I describe her style? I would say it takes a while to get close to her,” said Steffi Oesterreich, PhD, an expert in lobular breast cancer whom Davidson recruited to UPMC. “But once you are close to her, you will never leave her inner circle again.”

Thinking About All Types of Cancer

The daughter of 2 geologists, Davidson was born in Colorado and moved to Maryland with her family when she was a teenager. As a girl, she fancied becoming an archeologist, until her father gently set her straight.

“He said, ‘That’s a nice idea, but what are you going to do to earn a living? I don’t think you can support yourself being an archeologist,’” she recalled.

She came of age just as many of the Ivy League universities went coed, expanding her choices for where to study molecular biology. Both her parents had liberal arts degrees, and her mother had attended a women’s college. So perhaps it was no surprise that Davidson ended up at Wellesley College in Massachusetts.

Halfway through her studies, she sought more exposure to laboratory work at the nearby Massachusetts Institute of Technology. She laughs when she recalls a simpler era, void of voracious competition and lightning-fast internet applications. Her technique? She talked to her boyfriend’s fraternity brother, who worked in a laboratory.

That lab focused on liver cancer research, which she said got her thinking about cancer in general. Upon graduation, she went to Harvard Medical School.

The summer after her first year of medical school, she went back to Maryland to save money and applied for summer work at the nearby National Cancer Center (NCI). When breast cancer research titan C. Kent Osborne, MD, called with a job offer, she recalls bluntly asking, “Does it pay? He said yes, and I said, ‘I’m in.’ ”

Seeing the interplay between laboratory research and its “bench to bedside” potential that summer hooked her.

After graduation and internal medicine residency, Davidson was a medical staff fellow at NCI for 3 years and then moved to Johns Hopkins University School of Medicine, where she was a faculty member in the Department of Oncology from 1986 to 2009 and served as director of the breast cancer program from 1994 to 2009.

In 2007, she began a term as president of ASCO. Leading the world’s largest professional oncology organization broadened her perspective. She realized that the exciting progress she’d witnessed in breast cancer was occurring in other cancers as well.

“I thought, ‘Wow, cancers like melanoma and kidney cancer, which were therapeutic deserts for medical oncologists, were now areas that were really up and coming with a lot to investigate,” she recalled. “That year made me decide that I wanted to think about all types of cancer. And I wanted to do it in a way where I’d have a larger leadership role.”

Overseeing research in those areas would mean becoming a director of an NCI-designated cancer center. Even today, there are only 71 such facilities in 36 states and director-level jobs are rare and highly coveted. Furthermore, taking such

a job would mean relocating, and Davidson and her husband, Thomas Kensler, PhD, also a cancer researcher, felt it would be unfair to uproot their then-teenagers while in high school.

Her opportunity to lead an NCI-designated center came in 2009, when the University of Pittsburgh had an opening. From 2009 through 2016, Davidson was director of the UPMC Hillman Cancer Center as well as a professor of medicine at Hillman and associate vice chancellor for cancer research at Pittsburgh. Hillman is one of 51 NCI-designated comprehensive cancer centers. The NCI recognizes comprehensive centers for their leadership and resources, as well as their depth and breadth of research and commitment to transdisciplinary research that bridges scientific areas.

The timing was good because her 2 children, Caroline and Kevin, had finished college—and Davidson and Kensler had promised them the family wouldn’t move until after they graduated. Of the handful of open leadership jobs, Davidson found Pitt the most appealing because it was routinely among the top recipients of National Institutes of Health funding and its health system was the dominant provider of care across western Pennsylvania. In addition, Pitt actively recruited her husband, who joined the faculty of the Department of Pharmacology.

There, she spent a lot of time recruiting talent, building up the center’s breast cancer laboratory science, bolstering an already-strong immunology group, and beefing up the cancer epidemiology team.

Going Home With A Broader Perspective

There was still time in her career for one more move, and with it, the chance to fulfill a lifelong wish to return to the West, where she was born. She was already serving on the advisory board at Fred Hutchinson Cancer Research Center in Seattle, Washington, when they called to tell her about a job overseeing clinical research and care that she might find intriguing.

The job appealed to her because she could expand her own knowledge of cancer treatment. She’d focused on solid tumors in her career, but Fred Hutch, as it is colloquially known, has an international reputation as a leader in investigating and treating blood cancers and conducting transplantations. Davidson talks with obvious relish about the chance to learn about those fields in almost the same way a top chef would talk about learning a new ethnic cuisine.

“I knew it was going to be a growth opportunity for me,” she said.

She still sees patients a half-day each week. She finds it gives her a taste of the challenges her colleagues and patients face. Converting to electronic records has a very different feel in the examining room than in the CEO’s corner office.

“It’s useful to put your boots on the ground now and then,” she said.

Davidson’s curriculum vitae overflows with stints on advisory boards, national cancer charities, and NCI research committees. With a finger in so many pots, she noted that “one of the challenges of being a leader is when you go home at the end of the day, sometimes you’re not quite sure what you did.”

Davidson also makes time for mentoring.

“She is so busy,” said Oesterreich, whose research Davidson had encouraged even before they became colleagues at Pittsburgh. “Yet if I want something—advice, guidance—her door would be open.”

Davidson said her secret is setting priorities by sometimes saying “No” or a brilliant variation of that: “Not now.” That allows her to fold new activities into her schedule when others reach their natural conclusion.

That’s how she thrived in her career while married to another hard-working investigator and raising 2 children in an era that wasn’t always supportive of working mothers. One welcome change over the years has been seeing childcare become a family issue instead of a woman’s issue. Her advice to both women and men: “You can do everything. You just can’t do it all at once.”

She also makes time for vacations that truly take her far from the world of cancer. That childhood fascination with archeology has persisted: She and her family have visited all 7 continents, as well as toured major historic sites such as Machu Picchu, Angkor Wat, and the Taj Mahal. She has trekked in Tibet and gone on safari in Africa.

Oesterreich said Davidson’s penchant for travel represents a conscious approach to self-care in a field whose demands can be unrelenting: “She told me, ‘It’s really important to forget about breast cancer for a while. It’s not an easy job.’ ”