Shaking Up Gynecologic Cancer Treatment With Mentorship and Patient-Centric Care

Carol Aghajanian, MD

Women’s health and medicine, a space Carol A. Aghajanian, MD, described as full of “unmet needs, both clinically [and] scientifically,” was a space that she knew she wanted to be a part of. However, despite the wide range of specialties and disciplines within this field, she still had the desire to do something more.

“I went into medical oncology because I love the science. Oncology is a field where you’re really working right on the edge of translational science. [You’re] always learning [and] adapting new treatments,” she said.

Aghajanian has since taken the field of gynecologic oncology by storm and contributed to the treatment paradigm in big ways. Not only is she the recipient of the Boyer Award for outstanding young investigators at Memorial Sloan Kettering Cancer Center (MSK) in New York, New York, but she is also heavily involved in research, serving as the co–principal investigator responsible for MSK’s participation in the Gynecologic Oncology Group (GOG) and a member of the Phase I and Medical Oncology Committees of the GOG. Additionally, Aghajanian serves as chief of the Gynecologic Medical Oncology Service and Avon Chair in Gynecologic Oncology Research at MSK, where she also directs the research program in chemotherapy for patients with newly diagnosed ovarian cancer. These many awards and recognitions speak to Aghajanian’s dedication to her colleagues, her research, and, most importantly, her patients.

“The patients are our mission. We don’t take care of cancer; we take care of patients with cancer,” she said.

Fostering Relationships Through Mentorship

Aghajanian has had several mentors throughout her career, but it was her seemingly innate confidence that allowed her to tackle the then male-dominated field with what looked like ease, leaving a legacy in the field of gynecologic oncology.

Aghajanian with some of her mentors at a prior event

“I wasn’t really nervous. I had wonderful mentors in my early career,” she said. One of her earliest mentors was David R. Spriggs, MD, who now serves as a Professor in Residence in Medicine at Harvard Medical School and the director of the Gynecologic Oncology Program at Massachusetts General Hospital in Boston, Massachusetts.

“[Dr Spriggs] not only taught me about oncology, clinical trials, and pharmacology, but [he] also led by example. He really considered mentorship as a service and cared about it deeply,” Aghajanian said. “He was an incredibly generous mentor, and I really was grateful for that and adopted that style.”

Aghajanian also cited Larry Norton, MD, as an early mentor of hers when she was a fellow, giving him thanks for pointing her in the direction of gynecologic oncology. The 2 remain under the same roof at MSK, where Norton now serves as senior vice president of the Office of the President, medical director of the Evelyn H. Lauder Breast Center, and the Norna S. Sarofim Chair in Clinical Oncology.

“When I talked to [Larry] about my interest in women’s health and thinking breast cancer was the only option, he helped point out to me the opportunity in gynecologic cancers…. He’s been an incredible mentor to me for leadership and staying on the edge of science,” she said.

Aghajanian’s mentors played a pivotal role in shaping her own interest in mentorship, which has since become a valuable aspect of her professional life. Among all her academic and clinical achievements, the importance of mentorship is what she holds most dear. As her career as an oncologist advanced, Aghajanian sought to inspire and equip future oncologists with the same values that have driven her success.

Aghajanian, center, with her gynecologic medical oncology team at Memorial Sloan Kettering Cancer Center

Cultivating a culture defined by support and collaboration with her mentees has been something she is most proud of. Aghajanian shared that she is happy to have built a team of researchers who exemplify the same morals and ideals that her mentors imparted onto her at MSK. She added that one of the most fulfilling aspects of her job is coming to a work environment where everyone on the team is unified in their support of the idea that they are all there to further enhance science and better treat patients.

“I’m most proud of carrying forward that spirit of mentorship,” she said.

By carrying this spirit forward, Aghajanian strengthens the commitment to her and her team’s work, with the hope that when she retires, that positive influence will continue to be passed down and foster a network of other like-minded individuals who are equally ready and willing to shake up the gynecologic cancer treatment paradigm.

Remaining Committed to the Task at Hand

“I think the biggest advances I’ve made are in 2 areas: One is in early drug development…[and] the other is in doing large phase 3 trials that changed the standard of care for women with gynecologic cancers. That legacy lives on,” Aghajanian said.

One of the defining areas of Aghajanian’s research has centered around the development of PARP inhibitors, which are now a staple therapeutic approach in both the maintenance and recurrent ovarian cancer settings.

One such trial is the phase 3 ARIEL3 trial (NCT01968213). ARIEL3 was a randomized, double-blind, placebo-controlled trial that evaluated treatment with rucaparib (Rubraca) maintenance therapy for patients with recurrent ovarian carcinoma who had been treated with at least 2 prior lines of platinum-based chemotherapy and were in complete or partial response to the last line of platinum. The results demonstrated that rucaparib significantly improved progression-free survival and prolonged the time to subsequent therapy. Now the agent is approved for use in this population as a standard-of-care option for those in need.

“These are ways that we are disrupting [treatment] in a positive way,” Aghajanian said. “It was a new treatment paradigm to give maintenance [therapy], whether it was bevacizumab [Avastin], PARP inhibitors, or immunotherapy. That has really changed things for these patients, [emphasizing] how important it is to keep an open mind.”

Aghajanian, center of front row, with colleagues

Among other things, Aghajanian is a strong proponent that the best scientific advances often arise from conversations with patients. “I love having new people come into the clinic,” she said. “They have not formed any biases and are open to new ideas.… We are constantly learning from one another.” This mentality has assisted in keeping Aghajanian at the forefront of innovation in gynecologic oncology.

Another area in which Aghajanian has been found at the center of advances is in the evaluation of immunotherapy, having helped successfully move the needle toward its implementation in combination with chemotherapy in women with endometrial cancer. According to findings presented at the 2024 Society of Gynecologic Oncology Annual Meeting on Women’s Cancer, the phase 3 NRG-GY018/KEYNOTE-868 trial (NCT03914612) may introduce a new standard of care with this combination approach. In the investigation, a total of nearly 1000 patients with stage III, IVA, or IVB recurrent endometrial cancer were randomly assigned to receive pembrolizumab (Keytruda) or placebo given with paclitaxel plus carboplatin. Following data readouts of the investigation, it was found that the combination of pembrolizumab and chemotherapy was favored over placebo and chemotherapy.

The regimen is now approved for use in this patient population, establishing this approach as a viable and reasonable treatment for eligible patients. This also demonstrates that Aghajanian’s involvement in the implementation of this approach has since impacted patients.

“When you’re in clinic…listening to your patients and paying attention to what’s going on, the science comes from that. When you stay on mission, you make your greatest successes,” Aghajanian said.

Fostering Relationships Both in and Out of the Clinic

Aghajanian with her sons and husband

In addition to the relationships that she has fostered within the hospital through all her research endeavors, Aghajanian shared that one of her greatest accomplishments and joys outside the lab is spending time with her family. It is through her large family that she finds pride and comfort—and not just her immediate family, but also her extended family and close-knit circle of friends.

That circle of friends extends to her book club, she says. However, if she had to single out her biggest supporters, Aghajanian said it would surely be her husband and their 2 sons. “They cheer me on through everything, and that’s always really important to me. That’s my biggest nonprofessional achievement,” she said.

Aghajanian shared that another one of her most significant achievements has been her contributions to expanding a “team science” approach throughout the field of oncology treatment, the origins of which she credits to her deep-rooted interest in service. This, she says, lent to the work she did with the National Cancer Institute and various trials; this was her passion. This passion project led to a strong commitment from Aghajanian as she began to contribute to national research efforts. She was able to expand these efforts as she focused on the GOG group early in her career, where she now holds a leadership role in the NRG Oncology group.

Aghajanian, third from left (second row), poses with extended family

“It’s been an enormous privilege to be able to work with investigators, including new investigators across that whole spectrum, and really understand how things are for women.... That’s…something I’ve really enjoyed doing,” she said.

This perspective has deeply influenced her approach to clinical trials, particularly in terms of inclusivity and identifying what needs remain within different communities. Committed to the continuous improvement of clinical trials, as shown in her ongoing participation in investigative initiatives, she says that streamlining the trial process is vital for future investigations. This work that she was able to contribute to was largely due to her participation with NRG.

“When you get to [this] point…the most important thing you start thinking about is legacy and how you want to spend [the remainder of] your career. [Therefore], your priorities [become even more] important to you. [Ensuring] the legacy of the service I have built here at MSK goes forward and succeeds—which I think I’ve done—[is the end goal],” Aghajanian said, reflecting on all her achievements over the years.