From Bench to Bedside: O'Shaughnessy Keeps Patients in Focus

Joyce A. O’Shaughnessy, MD

Joyce A. O’Shaughnessy, MD, may be an accomplished clinical investigator, researcher, and educator, but at the end of the day, it’s her patients who drive her.

“I am inspired by my patients; I wouldn’t be able to do it otherwise,” said O’Shaughnessy, the medical director and director of Breast Cancer Research at the US Oncology Research Network. “It is the clinical care and the patients who motivate me. It has kept me right where I am, and it is what gets me out of bed every morning.”

It is her commitment to patients that also drives her to share her knowledge with others, said O’Shaughnessy, who was named a 2016 Giants of Cancer Care^® award winner in the Community Outreach/Education category. She has served as a leader at numerous conferences and meetings: as program director for the School of Breast Oncology^®, now in its 15th year; as chair of the International Congress on the Future of Breast Cancer^®, which will feature its first East Coast version in New York City in July along with its traditional West Coast conference in San Diego; as a member of the Program Committee for the American Society of Clinical Oncology’s Breast Cancer Symposium; and as a co-chair for the American Association for Cancer Research Chemoprevention Annual Meeting Symposium, just to name a few.

What Inspired Her Passion

“I find my peers and colleagues turning to me, and I turn to them for help and guidance. It is usually about patient management, so the goal is really about trying to help the individual patient,” said O’Shaughnessy. “I see the impact that education can have as I talk to people who have an experience that I haven’t had and I, in turn, help teach and give suggestions to other doctors dealing with challenges that I have had.”The first patient to motivate O’Shaughnessy was her sister, Teri, who was diagnosed with acute lymphoblastic leukemia at age 5 in 1970, when O’Shaughnessy was in high school. She was treated on clinical trials and for a period of time did well. O’Shaughnessy wanted to better understand the disease her sister was fighting and soon became very interested in the biology of leukemia.

When Teri died in 1975, O’Shaughnessy had just started attending The College of the Holy Cross in Worcester, Massachusetts. Her sister’s death intensified her interest in fighting cancer, and although she was only a freshman biology student, O’Shaughnessy started conducting leukemia research with the Worcester Foundation for Experimental Biology (now called the Worcester Foundation for Biomedical Research).

“It was a bit unusual, but I made it a priority,” said O’Shaughnessy. “It was very important to me. It was my number one priority to get into cancer research immediately, and I wasn’t going to wait until graduate school.”

In 1978, O’Shaughnessy completed her undergraduate degree and went on to continue studying leukemia at Yale University Medical School. After graduating in 1982 and completing her internship and residency at Massachusetts General Hospital in 1985, O’Shaughnessy performed her oncology fellowship at the National Cancer Institute (NCI).

It was there, in 1990, that she made the switch from leukemia to breast cancer, where her focus is today. She remained at the NCI until 1995 and then briefly worked at Kentuckiana Medical Oncology Associates in Louisville, Kentucky, before transferring to Texas Oncology/US Oncology in 1997.

At first, the switch in tumor study areas was based primarily on opportunity. She was working in a laboratory studying tumor virus biology when she was offered a chance to work as a senior investigator, running her own human clinical trials in the Medical Breast Cancer Section at the NCI.

She soon realized that breast cancer was the field for her.

Career Highlights

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“I really liked the breast cancer work, I loved it, I had a wonderful time,” said O’Shaughnessy. “I developed the beginnings of clinical and research expertise in breast cancer. Once I had completed 5 years that was totally dedicated to breast cancer, I just decided to stay with it.”In the more than 25 years that O’Shaughnessy has been working in breast cancer, she has become influential in a number of areas. She was instrumental in the design of tissue-based risk reduction protocols in women at high risk for breast cancer. She was also heavily involved in bringing capecitabine and gemcitabine to the market; these cytotoxic agents were approved by the FDA more than 15 years ago and are now among the most widely used therapies in treating patients with breast cancer.Despite her success, O’Shaughnessy is quick to praise others, including Joanne L. Blum, MD, PhD, of Texas Oncology, and Kathy S. Albain, MD, of Loyola Medicine, who worked with her on capecitabine and gemcitabine, respectively.

“It is always teamwork. Fortunately, I’ve been involved with the team that was primarily responsible for moving those agents ahead as quickly as possible,” said O’Shaughnessy. “Those were gratifying experiences because we had a lot of like-minded people really working together as effectively and as efficiently as possible. Focusing on patient recruitment, especially when you know a drug really well, once you know that you’ve got a signal, getting it through the definitive phase III trials and, finally, FDA approval, is an exhilarating experience because you’ve got so many people giving it their all to get the job done. It is highly collaborative.”

O’Shaughnessy says many colleagues and mentors have inspired and supported her throughout her career. These include Stephen Jones, MD, who kick-started her career at Texas Oncology by making her his protégée and sharing his breast cancer clinical trial work and practice with her, as well as Kenneth H. Cowan, MD, PhD, her mentor and a senior faculty member when she worked in the breast cancer section at the NCI. “He was very, very instrumental in giving me the opportunity and helping me learn about breast cancer and clinical trials,” said O’Shaughnessy.

Focusing on the Future

She also credits Daniel D. Von Hoff, MD, a 2016 Giants of Cancer Care® award winner in gastrointestinal cancer, and Gary J. Kelloff, MD, as influential team members on a project she considers 1 of her career highlights: participating in a large working group to come up with new agent approval endpoints for the treatment of precancerous lesions called intraepithelial neoplasia. “It was a big national effort that led to a publication that I still think is important today,” said O’Shaughnessy.Although she has already accomplished so much in her career, O’Shaughnessy doesn’t show any signs of slowing down soon. She does, however, make time to spend with her friends and family, including traveling with her husband to see her daughter, who is in medical school at Yale; her son, who lives in Los Angeles; and family in Boston.

Her current research is focused on trying to understand the molecular subtyping of triple-negative breast cancer (TNBC). Her goal is to understand the molecular biology of the subtypes and develop clinical trials to test hypotheses on how to treat patients, for whom there are no curative tools. This requires understanding how deficits in DNA repair in TNBC can be exploited to enhance the efficacy of novel agents like immunotherapies.

Clinical trials also continue to be important to O’Shaughnessy. “As oncologists, patients are coming to us with a big problem and they are calling on us to solve that problem,” she said. “The only way you can problem solve is with the right diagnostic and therapeutic tools. For some cancer situations, we do have the tools, we can successfully problem solve. But then there are cancer situations that we do not have the tools for and we cannot problem solve. The only way to develop those tools is by clinical trials. You’ve got to come up with new strategies, new diagnostics, and new therapeutics.”

However, O’Shaughnessy see herself as a physician first and still credits her patients, especially those who are not responding to available treatments, as her primary motivation. It can be difficult to see patients and not be able to find a treatment that works for them, said O’Shaughnessy. “It is immensely frustrating to be asked to problem solve for a patient and not have the tools.” But she is still often inspired by her patients. For example, one of O’Shaughnessy’s patients, who is only 33 years old, has been battling liver metastasis from TNBC for several years. After undergoing maintenance chemotherapy for more than 3 years, she had no evidence of disease in her liver and recently made the decision to stop therapy; if the cancer doesn’t recur, she plans to try to become pregnant with her second child.

“She has been one of these exceptional responders,” said O’Shaughnessy. “These are the kinds of patients that really keep hope alive.”