Revolutionizing GI Oncology Around the Globe

In her early days at Trinity College Dublin in Ireland, Eileen M. O’Reilly, MD, submitted her name into a lottery for a United States visa. To enter, she just had to send in an envelope with her name and a postage stamp.

That stamp ended up being the first step in sealing her destiny as one of the leading gastrointestinal oncologists in the United States.

“It’s kind of serendipitous how I ended up here,” said O’Reilly, who is the Winthrop Rockefeller Endowed Chair of Medical Oncology, codirector of medical initiatives at the David M. Rubenstein Center for Pancreatic Cancer Research, and section head of hepatopancreaticobiliary and neuroendocrine cancers at Memorial Sloan Kettering Cancer Center (MSK) in New York, New York.

O’Reilly is also the 2023 Giant of Cancer Care inductee in gastrointestinal cancer.

REVOLUTIONIZING ONCOLOGY IN IRELAND BEFORE COMING TO THE STATES

O’Reilly completed her medical training in Ireland and started her residency under the tutelage of John Crown, MB, BCh, BAO, BSc, MD, MBA, a medical oncologist at St. Vincent’s University Hospital in Dublin and professor of translational cancer research at Dublin City University. At the time, there were only 4 medical oncologists in the entire country and they were in charge of treating not only approximately 30 or 40 patients with cancer daily, but also other individuals who came to the hospital with a wide range of conditions, such as strokes, heart attacks, and diabetic crises.

In short, there was never a dull moment. But O’Reilly was known for staying calm and levelheaded regardless of the difficult and wide-ranging patient situations she faced, Crown said, noting that she was analytical and reliable as well as a comforting presence to the patients and their families during their most difficult days.

“It was very obvious to me from very early on in our relationship that she was very special,” Crown said, noting that O’Reilly was an intern—called a registrar in Ireland—under Crown from 1993 to 1995.

“[O’Reilly was] probably the best trainee doctor I’ve worked with. She was destined for greatness and [that showed] during very difficult times when we were trying to get oncology set up in Ireland,” Crown said. “The culture of oncology was not very well developed. The idea that you would actually treat [patients with] cancer as opposed to sending most of them to hospice or giving them palliative care was still considered fairly radical and revolutionary.”

Crown said O’Reilly worked alongside him and other Irish colleagues to get the first cancer clinical trials in Ireland up and running.

Crown said it became evident that O’Reilly should continue her medical training in the United States to become even more specialized in oncology. In 1995, she went to MSK—where Crown had completed his fellowship—where she would become a fellow in research, medical oncology, and medicine.

“I told her to go to Memorial Sloan Kettering Cancer Center because I knew she’d be a fantastic ambassador for Irish oncology if she did, and she was,” Crown said.

When it came time to move to the United States, she already had her visa, thanks to the raffle years earlier.

“I really loved oncology.…One of my mentors said it wasn’t as formal here in Ireland. ‘You need to train outside of Ireland,’ he said. “Subsequently, I was connected here with the fellowship director [at MSK],” O’Reilly said.

BRINGING GLOBAL PERSPECTIVES TO CANCER CARE

But before crossing the Atlantic to continue her medical training, and even before she was a standout doctor-in-training at St. Vincent’s, O’Reilly was a young girl growing up in Ireland, which she called “a lovely, warm, people-focused, family-oriented culture.” All her life, she looked up to maternal aunts and uncles who were physicians and she admired their studies and the work they were doing.

“I remember spending time with them when they were in medical school and hearing about what they were learning. I decided that’s what I wanted to do and honestly never thought about or applied for anything else,” O’Reilly said.

Now, in the small amount of downtime O’Reilly has when she’s not conducting research or caring for patients, she loves to travel to see family and meet new people from every corner of the globe.

She holds 3 citizenships, Irish, US, and Lebanese, which she received after marrying her husband, Ghassan K. Abou-Alfa, MD, who is also an oncologist at MSK.

“We love to travel. Both our families are abroad, so every minute we have, we’re in Europe, the Middle East, or somewhere else,” O’Reilly said, noting that she and Abou-Alfa now have another place to visit as her 18-year-old son, Ayman, begins college at Cornell University this fall. O’Reilly said this is a major transition for the family but she is “thrilled and delighted for him for his next phase in life.”

Traveling, whether for work or for pleasure, has shaped the way O’Reilly approaches cancer care.

“I think it’s incredibly important in life to be exposed to a very wide diversity in every aspect of people, culture, and the way medicine is conducted.”

For example, O’Reilly said that in her experience in Ireland, patients rarely question their doctors, whereas in the United States, patients and their families tend to become extremely educated about their disease and seek out second, third, fourth, and more opinions.

O’Reilly also learned that the way families handle cancer can vary from culture to culture—and even from person to person. Some people, she said, are very private with their diagnosis and rely on family members and loved ones to make most major medical decisions, while others want to take their cancer care by the reins.

“It was interesting, and perhaps somewhat challenging in the beginning [of my career] to have these different types of expectations,” she said. “But that allows you to just be very accepting regarding how people approach cancer and how families as a unit approach cancer.”

O’Reilly said travel helped her shape her worldview and be more compassionate, skills that are particularly important as a clinician in New York, which is extremely diverse. The New York City Department of Cultural Affairs says approximately 67% of the city’s population is made up of people of color, and 2022 Census data note that 36.6% of residents in the Big Apple are foreign-born.

“We live in such a wide community with so many cultures and cuisines,” she said. “It’s really a key part of life.”

O’Reilly does not have to hop on an airplane to make a difference in the lives of patients with cancer all over the world. Her contributions to the field have changed the way patients with pancreatic, gallbladder, bile duct, liver, and gastrointestinal neuroendocrine cancers are treated.

IMPRESSIVE ADVANCEMENTS IN DIFFICULT-TO-TREAT CANCERS

Some of O’Reilly’s recent research involves targeting KRAS mutations in patients with pancreatic ductal adenocarcinoma who have already gone through curative intent surgery, chemotherapy, and radiation. She is also the primary investigator of an ongoing randomized phase 1/2 trial investigating durvalumab (Imfinzi) and stereotactic ablative radiotherapy for the treatment of patients with locally advanced pancreatic cancer (NCT03245541).

“She picked a very difficult disease (pancreatic cancer) to work with,” Crown said. “She has, like many of us, made the complete transition from a field that was dominated by chemotherapy to one that requires a high level of sophisticated understanding of molecular diagnostics and molecular medicine.”

Crown said that when he was working with O’Reilly in the late 1990s, access to the internet for cancer-related information was practically nonexistent. Instead, they would rely on a copy of the Journal of Clinical Oncology that arrived via mail approximately a month after it was published.

“(O’Reilly) made a huge effort to stay up-to-date with the burgeoning field of oncology knowledge,” Crown said. Now O’Reilly is adding to that knowledge base, authoring or contributing to more than 350 peer-reviewed research articles.

She played a major role in what is now known about tumor-based genetics in pancreatic cancer and how that is applied to treatments, in both the clinical trial setting and everyday practice.

Her collaboration on the use of platinum-based therapies, PARP inhibitors, and immunotherapy for these patient subsets led to changes in the National Comprehensive Cancer Network Guidelines and the American Society of Clinical Oncology guidelines. For example, she was the coauthor of the POLO trial (NCT02184195), which showed that olaparib (Lynparza) improved outcomes for patients with BRCA-mutant metastatic pancreatic cancer.

Findings from this trial led to the 2019 FDA approval of the PARP inhibitor. She was the senior investigator of the phase 3 NAPOLI-3 trial (NCT04083235) of NALIRIFOX compared with gemcitabine/nab-paclitaxel in advanced pancreas cancer.1 NALIRIFOX is under review by the FDA for regulatory approval in pancreatic cancer.

However, O’Reilly emphasized that there is still more work to be done.

“Over the last 20 years, I think there have been huge changes in the disease understanding in terms of the biology,” she said. “I think it’s fair to say we’ve yet to catch up in terms of the actual translation of that [understanding] to major improvements in outcomes.…But [improved outcomes are] coming, it’s coming in these diseases.”

O’Reilly will continue to be a part of these advancements that are coming down the pipeline, both directly through the work that she is doing and by being a mentor for the next generation of oncologists.

“I love working with medical students, high school students, fellows, and junior faculty, and helping to support their development, their choices in medicine and oncology, and career trajectories,” she said.

Crown said that the promising young O’Reilly that he once trained has come full circle.

“She has become a great teacher and mentor. [She’s a] role model research investigator, with huge career success wrapped up in a fabulous human being,” he said. “The patients love her.”

While O’Reilly’s resume is impressive, it’s the grace of her patients and their families that inspires her to don her lab coat and stethoscope every day and continue to work—even on the toughest of days.

“I think one of the most gratifying things that I take from the privilege of what we do is that in a very difficult set of circumstances, when a patient or the family turns around and says, ‘thank you,’ [it’s their] grace,” she said. “To me, that’s everything. Even in the very difficult settings that we see, most people are just so grateful for the fact that we do what we do and [acknowledge] that we need better answers. And that, of course, underpins it all.”

Editor's Note: Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.

Reference

Wainberg ZA, Melisi D, Macarulla T, et al. NAPOLI-3: a randomized, open-label phase 3 study of liposomal irinotecan + 5-fluorouracil/ leucovorin + oxaliplatin (NALIRIFOX) versus nab-paclitaxel + gemcitabine in treatment-naïve patients with metastatic pancreatic ductal adenocarcinoma (mPDAC). J Clin Oncol. 2023;41(suppl 4):LBA661. doi:10.1200/JCO.2023.41.4_suppl.LBA661