On knowing your value, ‘feel inspiration not intimidation’ from others
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Editor’s Note: This is part three of a three-part Healio Exclusive series on Women to Watch. Part one and two can be read here and here.
Arielle J. Medford, MD, is working diligently to further refine individualized treatment for patients with breast cancer with the use of circulating tumor DNA and genomics at large.
“I am grateful to get to do this work and lead many of the efforts in this new space — circulating tumor DNA [ctDNA] is a compelling tool with a lot of hope,” Medford, attending physician at Mass General Cancer Center, and instructor at Harvard Medical School, told Healio. “The goal of my research is to increase the number of patients who may achieve cure by identifying those who benefit from additional therapy, as well as those who perhaps don’t need as intensive therapy and may be able to achieve cure without prolonged courses of treatment.”
Planting a footprint
Medford has had an interest in the humanities in parallel with science for as long as she could remember.
“That combination organically led me to a career in oncology where there is this incredible infrastructure of scientific study alongside an equally important space for human connection and empathy,” she said. “When I went to college, I knew I wanted to pursue the sciences for the rest of my life, so while completing my scientific coursework and working in a lab, I also majored in English. In the lab of James Zimring, MD, PhD, now professor of experimental pathology at the University of Virginia, I ended up studying how platelet transfusions impact candidacy for future bone marrow transplants. That research fueled my interest in academic research.”
She later attended medical school at Johns Hopkins where she extended her time to work in the lab of Ben Ho Park, MD, PhD, now director of the Vanderbilt-Ingram Cancer Center.
“At the time, Dr. Park ran a lab at Johns Hopkins performing research with liquid biopsy. I was specifically studying ctDNA, and that is when I became very interested in this field. My interest in scientific inquiry blended with my interest in the human experience of patients living with cancer that I had met during my medical training,” Medford said. “When I later came to Boston, I began working with Aditya Bardia, MD, MPH, now director of the Breast Cancer Clinical and Research Programs at UCLA, in a clinical translational space with ctDNA and breast cancer.”
After becoming a fellow at the Dana Farber Cancer Institute, Medford continued working alongside Dr. Bardia and also established a co-mentorship with Gaddy Getz, PhD, professor in the department of pathology at Harvard Medical School and an internationally recognized leader in cancer genomics research at the Broad Institute.
“There I was able to plant a footprint in the clinical translational area looking at genomics and ctDNA, and that has been an amazing experience,” Medford said. “As I’ve evolved into a practicing medical oncologist, having this role in the translational space — particularly with ctDNA and genomics at large — has been a truly meaningful balance and I am grateful to get to pursue that task.”
Current efforts
Current research efforts for Medford center around the use of molecular residual disease (MRD) in the early detection of breast cancer after tumor removal.
“These new MRD assays are fascinating in that they are so sensitive and a new technology that has just reached patients,” she said. “I am now running a clinical trial where we’re testing an intervention of therapy escalation in patients that have detectable ctDNA. The reasoning behind that is that current research shows that if a patient has ctDNA detectable after definitive therapy, unfortunately that means that the chance for recurrence is high. We are trying to intervene and increase the number of patients who are cured based on this molecularly guided therapy escalation.”
Parallel to those research efforts, Medford is also working to identify where exactly the ctDNA is coming from and how to learn from it in terms of mechanisms of resistance.
“Patients have a standard-of-care therapy that they receive after a cancer diagnosis, but it’s a uniform therapy based on clinical and pathologic characteristics,” she said. “What I’m researching is how to use this molecular piece to further refine the patient population and the treatment they receive. The goal is to narrow in on the patients who absolutely need escalated therapy because they are at highest risk for recurrence and identify what the best type of targeted therapy would be.”
Medford hopes to use this technology to further refine how patients are treated, making treatment even more individualized to each patient’s experience.
“I am so grateful to get to do this work,” she said. “There’s a lot of hope here, and I am grateful to get to lead many of the efforts.”
Know your value
Acknowledging the incredibly driven and inspirational individuals she is surrounded by as one of the greatest benefits of her career, Medford also acknowledged the importance of not being intimidated.
“We can be tempted to look at the people around us and think that we don’t have the same amount to contribute,” she said. “It is important to constantly remind yourself about the value that you add to team science and team patient care. Don’t be intimidated, but rather inspired by the people around you. Borrowing a phrase that I heard often throughout residency and have used ever since, ‘Don’t compare your insides to other people’s outsides.’ I have been fortunate to get to work with some of the most amazing researchers and clinicians, and the best way I have overcome concerns over my own value is to feel inspiration rather than intimidation. It is such a gift to be able to do that.”
Another bit of advice she had for other female oncologists is to build your community of people you trust.
“Those individuals may be fellow trainees, mentors, friends and/or family,” Medford said. “The individuals that lift you up, hold on to them and continue to nurture those relationships because they will strengthen you as you go along your journey. There’s so much to be said about building community. When caring for patients with cancer, there are incredible celebrations when things go well, but unfortunately there is also sadness. Being able to externalize those feelings with our chosen community can be a source of strength for us personally as well as those around us.”
For more information:
Arielle J. Medford, MD, can be reached at amedford@mgh.harvard.edu.
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