A Conversation With Joyce A. O’Shaughnessy, MD
As a child in Beverly, Massachusetts, Joyce Ann O’Shaughnessy enjoyed science and her home chemistry set. Still, she didn’t give much thought to pursuing the subject beyond the confines of her school—until she faced a tragedy.
After her youngest sister, Teri, was diagnosed with leukemia, 14-year-old O’Shaughnessy demonstrated the seriousness and determination that have since shaped her career as a physician and cancer researcher. Frustrated by her inability to help, the teenager vowed to fight cancer by becoming a doctor.
When Teri died 5 years later, at the age of 10, O’Shaughnessy was a freshman biology student at Holy Cross College in Worcester, Massachusetts. She reacted to the loss by reinforcing her commitment to fight the disease.
“I wanted to immediately start doing research, but as a 19-year-old that wasn’t as common back then,” O’Shaughnessy recalled. “I went to the dean and said, ‘I need to start doing cancer research. Can I do it here, or do I need to transfer to a big university?’ ”
The dean provided funding to support the fledgling researcher, who studied tumor virology and wrote a senior thesis on leukemia before going on to earn a medical degree, cum laude, from Yale University and launching a career devoted to fighting breast cancer.
Since 1997, O’Shaughnessy has worked as a medical oncologist within a practice of more than 400 physicians, Texas Oncology, and has served as co-chair for breast cancer research at US Oncology, a physician practice management company that cares for about 20% of the nation’s cancer population and brings oncologists together to do clinical research. Based in Dallas, O’Shaughnessy is also the Celebrating Women Endowed Chair in Breast Cancer Research at the Baylor- Charles A. Sammons Cancer Center at Baylor University Medical Center.
In the 25 years since she began that first research project, O’Shaughnessy has treated thousands of patients with breast cancer while evaluating new therapeutic strategies to fight the disease. Her accomplishments include designing and leading investigations of capecitabine and gemcitabine, cytotoxic agents that were approved by the FDA about a decade ago and are now among those most widely used in treating breast cancer. O’Shaughnessy also led recent studies of iniparib, a novel drug for patients with metastatic triple-negative breast cancer and other cancers.
“Breast cancer is, in a sense, a very hopeful disease—we have a lot of success in treating breast cancer, and this spurs you on to crack the code of the breast cancers that are not yet curable,” O’Shaughnessy said. “There are many different subtypes, and clinician investigators are working to match patients’ genotypes to the most promising therapies for them.”
ONC: You regularly plan and oversee clinical trials designed to improve care for breast cancer patients. What are some of your current projects?
O’Shaughnessy: I’m the principal investigator on a US Oncology trial being done in collaboration with the Translational Genomics Research Institute (TGen) and Life Technologies within which TGen is conducting whole genome sequencing on tissue obtained from metastatic triple negative breast cancer patients.
The objectives of the study are to determine the key driving mutations in these patients’ cancers, and to then refer patients to the appropriate clinical trials to receive treatment with agents that target these key driving mutations. It’s an important effort in that there has been only one patient whose metastatic triple negative breast cancer has been fully sequenced and published, and it is critical that we develop an understanding of the main molecular abnormalities in these aggressive cancers.
In addition, I’m serving as a co-investigator in a US Oncology trial known as the TC-TAC trial. TAC is a standard chemotherapy regimen for high-risk early breast cancer patients: docetaxel (Taxotere), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). But for HER2-negative breast cancer, which is this trial’s focus, we really don’t know if patients need the doxorubicin, which can cause congestive heart failure and leukemia. We’re conducting this large randomized phase III trial to try to answer the question of whether doxorubicin is needed in treating ER or triple negative breast cancers. If the answer is no, we can give patients the same chemotherapy regimen without doxorubicin and get equally good results with less toxicity.
Leading Groundbreaking Trials
During a typical week, O’Shaughnessy discusses the design of diagnostic and therapeutic studies with clinical research specialists across the country, considering: biologic mechanisms; which patients, and with which forms of breast cancer, should be included in trials; and whether compounds should be tested as single agents or in combination with other treatments. After helping to develop new agents for the treatment of metastatic breast cancer, O’Shaughnessy often works to bring the therapies to patients with less-advanced forms of the disease, in the preoperative or adjuvant setting.