Carl Gay, M.D., Ph.D.
2019 Heme/Onc Fellowship graduate discusses the role the fellowship played in his success as an academic physician scientist.
The goal of the Hematology and Oncology Fellowship is to train leaders in oncology. We recognize that these leaders may achieve in a diverse range of domains, including cancer prevention, health policy, clinical care, patient-based translational research and basic science.
With world class laboratory and clinical research faculty, renowned expert clinicians and a patient base that is unmatched anywhere else in the world, we are uniquely positioned to train a new generation of experts in each of these areas.
Our fellows are given the structure and supervision required to ensure that each is a well-trained, competent oncologist, and are given the protected time required to build the beginnings of an academic career. During this protected time, fellows can choose to work in a basic science laboratory, develop skills in clinical and translational research, pursue a master’s degree, train in quality improvement methods, develop teaching skills required to be a physician educator, or a variety of other pursuits.
Two of the most unique components of our program are weekly protected dedicated time to learning during Academic Tuesday, and instruction and support for grant writing, particularly pursuing awards such as the Young Investigator Award.
Ultimately, our success is judged by the ability of each fellow to excel in their own defined professional goals.
IN THE SPOTLIGHT:
Dr. Kaysia Ludford, Class of 2020, was reconginzed by the American
Association of Cancer Research for her work in the interplay between
ethnicity and biology in response to checkpoint inhibition.
Researchers from The University of Texas MD Anderson Cancer Center have developed the first comprehensive framework to classify small-cell lung cancer (SCLC) into four unique subtypes, based on gene expression, and have identified potential therapeutic targets for each type in a study published today in Cancer Cell.
SCLC is known for rapid, aggressive growth and resistance to treatment, which leads to poor outcomes. While recent advances in immunotherapy and targeted therapy have improved survival for non-small cell lung cancer (NSCLC), progress for SCLC has been limited.
“For decades, small-cell lung cancer has been treated as a single disease because the tumors all look similar under the microscope, even though they behave very differently,” said Lauren Averett Byers, M.D., associate professor of Thoracic/Head & Neck Medical Oncology and senior author of the study. “Our study provides a transformative new system to define four major groups of small-cell lung cancer and, for the first time, an avenue for personalized treatment of the second most common type of lung cancer.”
Four major subtypes of SCLC
Although previous research identified three possible subtypes of SCLC based on transcription factors, which indicate whether particular genes are turned “on” or “off,” a large number of SCLC tumors didn’t fit into one of the three groups. Rather than trying to apply a hypothesis to the remaining tumors, Byers’ team took an unbiased bioinformatics approach—letting the data from a large set of SCLC tumor samples speak for itself. This led to a 1,300 gene “signature” that confirmed the three previously observed groups (A, N and P), plus a previously unrecognized fourth group (I) with a unique immune landscape.
The first three groups are defined by activation of the ASCL1 (SCLC-A), NEUROD1 (SCLC-N), and POU2F3 (SCLC-P) genes. The fourth type, SCLC-I, is characterized by an inflamed gene signature with a high expression of multiple immune genes, including significantly greater levels of genes indicating the presence of CD8-positive cytotoxic T cells.
“Our paper shows that the inflamed group has a distinct biology and environment and tends to be more responsive to immunotherapy,” Byers said. “Identifying the inflamed group is very important because so far there have not been any validated biomarkers for small-cell lung cancer that predict which patients get the most benefit from immunotherapy.”
Based on recent clinical trials, immunotherapy has become part of the standard of care for SCLC. However, all clinical trials for SCLC, including those using immune checkpoint inhibitors, have had limited success. This study could help explain why, as the results suggest different classes of drugs may be more effective in specific subtypes. For example, in the samples from this study, SCLC-I was most sensitive to immune checkpoint blockade, SCLC-A to BCL2 inhibitors, SCLC-N to Aurora kinase inhibitors and SCLC-P to PARP inhibitors.
“Immunotherapy plus chemotherapy is currently the backbone of treatment for all advanced small-cell lung cancer patients, but not all patients experience the same benefit,” said Carl Gay, M.D., Ph.D., assistant professor of Thoracic/Head & Neck Medical Oncology and lead author of the study. “Our results provide an opportunity to think about immunotherapy approaches that are specific to the inflamed group, which has a very different microenvironment, separately from combination approaches that might activate the immune response in the other three groups.”
Study methods and analysis
The research team first identified the four groups by applying non-negative matrix factorization to previously published data from 81 SCLC patients with surgically resected tumors. Most patients in this data set had early-stage disease, which is not typical. Because SCLC is so aggressive, it’s most often diagnosed at an advanced stage. To validate the four subtypes in late-stage disease, Byers’ team also analyzed data from 276 SCLC patients enrolled in the Phase III IMpower133 clinical trial, which established the current standard of care for advanced SCLC and represents the largest available SCLC data set to date.
“Looking at the bigger data set of what a more typical patient looks like, the four major groups came out very clearly again, including the novel inflamed group we identified,” Byers said. “We also showed that you don't have to use the full 1,300 gene panel. We have developed immunohistochemistry tests that we’re working toward adapting for the clinic to more quickly and easily classify SCLC tumors.”
One of the known challenges of SCLC is that it often develops resistance to treatment, even after an initial response. To determine if “subtype switching” causes resistance, the authors used single-cell RNA sequencing to evaluate tumor evolution in a series of patient-derived SCLC models. The study suggests that SCLC-A tends to switch to SCLC-I after being treated with chemotherapy, which could contribute to treatment resistance.
A path toward personalized treatment for SCLC
Using the SCLC subtype framework in future clinical trials will be necessary to verify the study findings, particularly regarding the therapeutic vulnerabilities for each group.
“Now we can develop more effective strategies for each group in clinical trials, taking into account that they each have different biology and optimal drug targets,” Byers said. “As a field, small-cell lung cancer is about 15 years behind non-small cell lung cancer’s renaissance of biomarkers and personalized therapies. This represents a huge step in understanding which drugs work best for which patients and gives us a path forward for personalized approaches for small-cell lung cancer.”
A full list of collaborating researchers and their disclosures is included in the paper. This research was supported by the National Institutes of Health/National Cancer Institute (CCSG P30-CA016672, T32 CA009666, R50-CA243698, R01-CA207295, U01-CA213273), The University of Texas Southwestern and MD Anderson Cancer Center Lung SPORE (5 P50 CA070907), Department of Defense (LC170171), Cancer Prevention & Research Institute of Texas (RP170067), The University of Texas MD Anderson Lung Cancer Moon Shots Program, Abell-Hangar Foundation, Andrew Sabin Family Fellowship, ASCO Young Investigator Award, The Hope Foundation, Khalifa Bin Zayed Al Nahyan Foundation and Rexanna’s Foundation for Fighting Lung Cancer.
Learn more about our current fellows.
Nishin Bhadkamkar, M.D.
Program Director ad interim
Associate Professor, General Medical Oncology
Kelly Casteel, M.D.
Associate Program Director, Hematology
Assistant Professor, Benign Hematology
Michael A. Davies, M.D., Ph.D.
Director of Research, Fellowship Program
Co-PI, T32 Research Grant
Chair, Melanoma Medical Oncology
Michael H. Kroll, M.D.
Professor, Benign Hematology
Robert A. Wolff, M.D.
Professor, GI Medical Oncology
We offer a fully integrated, three-year hematology and medical oncology program. The first 18 months of training incorporates 12 months of clinical rotation, which includes both solid tumors and hematologic malignancies with 6 months of benign hematology. The ACGME core competencies and milestones are achieved through a required set of rotations, a didactic curriculum and elective rotations designed to broaden the base of knowledge.
Our fellows, faculty, and program are continuously evaluated to ensure success in achieving these competencies, goals and objectives. For the remaining 18 months, the fellow is encouraged to pursue clinical research pursuits and to develop skills and projects to compete for national presentations and awards. Our program offers flexibility during this time period in which fellows can pursue a wide range of interests. Some of the opportunities include spending time in a basic science laboratory, developing skills in clinical and translational research, pursuing a master’s degree, training in quality improvement methods, developing teaching skills required to be a clinician educator, to name a few.
The general structure of the rotations is listed below, with each rotation lasting approximately one month. While most fellows double-board in hematology and medical oncology, some single board in medical oncology.
Medical Oncology Rotations:
Malignant Hematology Rotations:
Benign Hematology Rotations:
Fellows have formal education through clinical teaching, lectures, and conferences. Some educational highlights of the hematology and oncology fellowship program include:
Academic Tuesday: This is a half-day dedicated to fellow education. This time is protected from other clinical duties. Fellows attend the Division of Cancer Medicine Grand Rounds, then have 2-3 lectures taught by faulty on a rotating list of topics in hematology and oncology, covering a core curriculum while also highlighting the most recent work in each field. Fellows also give one lecture per year, either on an interesting case, a journal club, or a research presentation.
LBJ Clinic: While participating in the LBJ General Hospital Oncology clinic, fellows participate in a morning report designed to discuss all new patients and provide learning points. Faculty also lead a curriculum designed to build the fellows’ fund of knowledge. Fellows learn from faculty in the clinical setting as well. Finally, fellows participate in multidisciplinary tumor boards with several specialties with the goal of coming to a consensus for a patient’s care. Fellows are expected to be the one primarily responsible for a patient’s care at LBJ, offering a great deal of autonomy and a unique and valuable learning experience.
MD Anderson Board Review Course: MD Anderson hosts a week-long board review course each fall. Fellows are given course materials and are welcome to attend lectures, taught by leading faculty across the country.
Intro to Research Series: First-year fellows participate in an Introduction to Research Series, in which leaders at MD Anderson highlight research opportunities that fellows can pursue throughout their time in the program. Fellows hear from each department within the Division of Cancer Medicine about topics that include:
In addition to the common curricular elements required of all fellows, the program has developed educational tracks to hone the clinical and research outcomes of each fellow. All fellows must declare a training track at the beginning of their second year.
Master Clinician Track
Clinical Investigator Track
Physician Scientist Track
Clinical Educator Track
Following fellowship training, fellows may compete for entry into the Division of Cancer Medicine Advanced Scholar Program. This program provides for 100% protected time to concentrate their efforts intensively in an area of investigation and practice started in the fellowship program. Completion of the Advanced Scholar Program positions each scholar for success in a tenure-track position in academic medicine.
ERAS opens for new applications July 2021. Deadline for submission of applications for the 2022 Academic Year will be Aug. 31, 2021. Interviews will tentatively be conducted during the months of September and October 2020.
Applications are accepted through the Electronic Residency Application System (ERAS) only.
Required documents for all applicants:
The fellowship program does not accept H1-B Visas. At the time of application, applicant must have the appropriate Visa (J1).
Alexander Andreev-Drakhlin, M.D.
Hometown: Saint Petersburg, Russia
Residency: University of Pittsburgh
Meredith Pelster, M.D.
Hometown: Cleveland, TN
Residency: McGaw Medical Center of Northwestern University
Owhofasa Agbedia, M.B.B.S.
Hometown: Sapele, Nigeria
Residency: Howard University
Amy An, M.D.
Hometown: Miami, FL
Residency: University of Rochester
Madhulika Eluri, M.D.
Homestown: Chapel Hill, NC
Residency: Duke University
Max Gordon, M.D.
Hometown: Seattle, WA
Residency: Oregon Health and Science University
Andrew Jallouk, M.D., Ph.D.
Homestown: Oak Ridge, TN
Residency: Barnes-Jewish Hospital Washington University
Michael Nakazawa, M.D., Ph.D.
Hometown: Los Angeles, CA
Anmol Singh, M.D.
Hometown: Cary, NC
Residency: Duke University
Ajlan Al Zaki, M.D., Ph.D.
Homestown: Abu Dhabi, UAE
Residency: Stanford University
Igryl Cordero-Hernandez, M.D.
Hometown: Quebradillas, Puerto Rico
Residency: University of Pennsylvania
Christopher Ferreri, M.D.
Hometwon: Hermitage, PA
Residency: Duke University
Jin Guo, M.D.
Hometown: Stony Brook, NY
Residency: New York Presbyterian Hospital. Weill Cornell Medicine
Darya Kizub, M.D.
Hometown: Kyiv, Ukraine
Residency: University of Washington
Chijioke Nze, M.D., MPH
Hometown: Abuja, Nigeria
Residency: Brigham and Women's
Bingnan Zhang, M.D., MBA
Hometown: Ningbo, China
Class of 2018
Roman Groisberg, M.D. - Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
Prateek Gulhati, M.D., Ph.D. - MD Anderson Cancer Center (Advanced Scholar), Houston, TX
Boyu Hu, M.D. - Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
Paul Koller, M.D. - City of Hope, Duarte, CA
James Link, Ph.D., M.D. - Dignity Health/Marian Regional Medical Center, Santa Maria, CA
Hossein Maymani, M.D. - Rocky Mountain Cancer Center, Longmont, CO
Meredith McKean, M.D., MPH - Sarah Cannon Research Institute, Nashville, TN
Pavlos Msaouel, M.D., Ph.D. - MD Anderson Cancer Center, Houston, TX
Maliha Nusrat, M.D. - Memorial Sloan Kettering, New Yourk, NY
Amanda Parkes, M.D. - University of Wisconsin School of Medicine and Public Health, Madison, WI
Christine Parseghian, M.D. - MD Anderson Cancer Center, Houston, TX
Patrick Pilie, M.D. - MD Anderson Cancer Center, Houston, TX
Shiraj Sen, M.D., Ph.D. - Sarah Cannon Research Institute, Denver, CO
Class of 2019
Aydah AlAwadhi, M.B.B.S. - Tawam Hospital, United Arab Emirates
Melody Becnel, M.D. - MD Anderson Cancer Center (Fellow), Houston, TX
Kelly Casteel, M.D. - MD Anderson Cancer Center, Houston, TX
Jad Chahoud, M.D. - Moffitt Cancer Center, Tampa, FL
Katherine Clifton, M.D. - Washington University, St. Louis, St. Louis, MO
Ryan Huey, M.D. - MD Anderson Cancer Center, Houston, TX
Daniel Johnson, M.D. - Ochsner Medical Center, New Orleans, LA
Amy Jones, M.D. - University of Texas Southwestern, Dallas, TX
Andrew Laccetti - Memorial Sloan Kettering, New York, NY
Oluchi Oke, M.D. - MD Anderson Cancer Center, Houston, TX
Paolo Strati, M.D. - MD Anderson Cancer Center, Houston, TX
Jason Willis, M.D., Ph.D. - MD Anderson Cancer Center (Advanced Scholar), Houston, TX
Catherine Butler-Gunn, J.D.
Division of Cancer Medicine GME Programs
Division of Cancer Medicine
UT MD Anderson Cancer Center
1400 Holcombe Blvd., Unit 463
Houston, TX 77030
MD Anderson Cancer Center is committed to encouraging good health and staying true to our mission to end cancer. If you are applying for a GME fellowship or residency program starting on or after July 1, 2016, please be advised that MD Anderson will have instituted a tobacco-free hiring process as part of its efforts to achieve these goals. If you are offered an appointment, you will be subject to a Pre-Employment Drug Screen for tobacco compounds in compliance with applicable state laws. If you do not pass the urine drug screening which includes testing for tobacco compounds, you CANNOT be appointed at MD Anderson. Should you fail to meet this contingency, MD Anderson will withdraw your offer of appointment for the academic year. You may reapply for the following academic year, but there are no guarantees that you will be offered a position as many of our programs are already filled for several years out.