Gynecologic oncologist’s mission is to serve the underserved
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Nathalie D. McKenzie, MD, has dedicated much of her career to serving the underserved in the U.S. and Haiti.
Patients in low- to middle-income countries have limited access to some of the most effective targeted cancer therapies, and those in the U.S. with insurance may also encounter challenges as copays and deductibles make certain drugs beyond their grasp, McKenzie, a gynecologic oncologist, and program director of the gynecologic oncology fellowship at AdventHealth Cancer Institute, said during an interview with Healio.
“A combination of my work in the U.S. and mission work in Haiti exposed me to these disparities and ignited a desire to continue to innovate to find affordable treatments with activity in gynecologic cancers,” she said. “The culmination of different life experiences enabled me to think differently about opportunities for affordable treatment options for patients.”
McKenzie spoke with Healio about the importance of affordable cancer treatments for all patients, her ongoing mission work in Haiti and her plans for future research efforts.
Healio: Why is affordable cancer treatment so important to address?
McKenzie: Although it is imperative that pharmaceutical companies continue to be incentivized to develop new drugs, it is equally important for patients to be able to afford these lifesaving treatments. For health care systems, and also for low- to middle-income countries, having an affordable drug on hand will equip physicians with strategies that can actually save lives.
Healio: How did you become involved in mission work in Haiti?
McKenzie: I first got involved in mission work back in 2005 while at the University of Miami through Project Medishare, which was founded by two physician colleagues, Barth Green, MD, and the late Arthur Fournier, MD. The University of Miami has always had a close relationship with Haiti because there are many Haitians in the area and they are in close proximity to each other, so it was feasible to do mission work there.
During a formative time in my career and training in Miami, I had the opportunity to go on missions with the organization. I loved the opportunity to give back as a physician in that way and found it meaningful. Haiti is the poorest country in the Western Hemisphere with some of the deepest needs. Being there, especially in rural places, I was able to make a lasting impact on the care of children, women and communities that, in turn, made a lasting impact on me. As I got busy in my profession and life, I didn’t have the chance to go back to Haiti until I settled into my career as a gynecologic oncologist. When my babies weren’t babies anymore and didn’t immediately need me, the hunger to get back to mission work returned.
At that point, I reached out to previous colleagues who remained involved in the work, including a good friend, Vince De Gennaro, MD, whose father was part of the mission work in Project Medishare. As it turned out, Vince created his own mission for women with breast and cervical cancer, known as Innovating Health International, which perfectly fit my expertise. He expressed his interest in having me involved, especially for gynecologic cancers, and so I joined the cause.
As soon as I arrived in Haiti, I noticed the country was quite resource limited and lacked radiation therapy. The center I volunteered at had only a few cancer drugs available, and I witnessed firsthand how inexpensive drugs can make a huge difference in patient care. Oftentimes, treatment does exist, but it’s beyond the hospitals and patient’s reach because it’s too expensive. This is why continuing to research repurposing medications is so important. If we can take a drug that already exists and find a use for it in cancer care, we have the potential to save many lives.
Healio: What exactly does your mission work in Haiti involve?
McKenzie: In my practice, I perform complex gynecologic surgeries for patients with cervical cancer, such as a radical hysterectomy. Haiti does not currently have trained gynecological oncologists. Instead, they have general OBGYNs who have not had training to perform these types of very complex medical procedures.
We started a basic training program, where I would visit and perform these procedures pro bono. Simultaneously, a group of general OBGYN surgeons living in Haiti would assist during these procedures, allowing me to teach the surgeons. After being a part of this training program and seeing first-hand the work that’s performed, I know my instruction has made a difference in improving the health care that Haiti offers.
The program eventually gained the recognition of the International Gynecologic Cancer Society, and they have created a more formal program, which now has many sites worldwide.
Healio: What does the mentorship program entail?
McKenzie: Our work is meant to be sustainable. The mentorship program enlists us to train and educate the physicians on the ground with some of the same training and knowledge that we as subspecialists receive in higher resource countries. As a supplement to our on-site instruction, we continue to mentor the Haiti physicians virtually once per week for about 1 hour. During our virtual visit, we discuss cases and care management.
Healio: Can you talk about your involvement in the study that assessed the safety of a repurposed HIV drug for cancer treatment?
McKenzie: During my time at University of Miami, I supported research for a phase 1 clinical trial published in Cancer in 2021, where we examined the use of nelfinavir, a generic drug originally invented as an HIV treatment in 2004. Researchers previously realized the molecular makeup of this drug had anticancer properties. When they tested it on cancer cells in the lab, they found it killed cancer cells. Researchers at University of Pennsylvania then used that molecular structure for radiation in mice models and found it enhanced the effect of radiation therapy for head and neck cancers. I thought that if this drug has anticancer properties, including HPV-related cancers, and is a radiosensitizer that nelfinavir could have an impact on cervical cancer. This is what led to the phase 1 trial in which we found it to be safe. From there, researchers in India took our phase 1 data and initiated a phase 3 clinical trial separately. It was exciting to see somebody using our data to save lives.
Healio: Why is it important to repurpose treatments for cancer care?
McKenzie: By repurposing drugs, we can provide a more inexpensive alternative and affect more lives in a positive way. I’ve been in clinic in the U.S., where there’s a fancy new drug that I’m excited to offer but patients come back a few weeks later and say it’s not affordable. It’s heartbreaking, especially when the drug could make a difference in their survival. The opportunity to be able to quickly mobilize an inexpensive drug to help a large group of patients, hospital systems and a country is a win/win for all.
Healio: What future efforts do you have planned?
McKenzie: Future efforts include being able to innovate in limited-resource settings, such as Haiti, and figure out ways to do things differently with limited access to treatment. We need more data in low-resource countries to discover whether performing more radical surgeries and administering chemotherapeutic drugs can lead to survival outcomes that are similar to high-resource settings, which is where research comes in to provide answers.
Nathalie D. McKenzie, MD, can be reached at nathalie.mckenzie.MD@adventhealth.com.
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