News & Information | START In The News

June 28th, 2010
San Antonio Business Journal
By: Sandra Lowe Sanchez

Profiles in Oncology: Amita Patnaik, M.D.

If Amita Patnaik, M.D., can point to one incident that led her to be a research oncologist, it occurred in the intensive care unit at Princess Margaret Hospital in Toronto. Patnaik was a resident in internal medicine when she came across a young patient with metastatic breast cancer. The woman was dying, on a ventilator as the cancer had overtaken her lungs.

“She had two small children who would not leave her bedside and although the patient could not speak as she was ventilated, she would periodically raise her fist to show that she was not going to give up,” Patnaik recalls. “The memory of this dying woman has remained with me as one of the most tragic but also poignant images that ... has inspired me to seek out the field of drug development so that there can be more therapies for such patients and so there may be one less young mother who will have to leave her small children behind.”

Today, as a top researcher and oncologist for South Texas Accelerated Research and Therapeutics, Patnaik sees those results. She is the top investigator on 13 drugs, several of which she believes are contenders. Typically, life expectancy for people referred to START, a clinical trials practice group, is less than a year. For clinical trials, life expectancy must be at least three months.

“When you see these people go on from week to week, and then month to month, and (year to year), I think that’s clear and incontrovertible proof that our treatments are working,” Patnaik says.

One of the co-founders of START, Patnaik sees 30-35 patients per week. A typical clinical trials patient has a rare or aggressive tumor that has not responded to standard treatments.

While Patnaik’s earlier work in research led to the development of numerous chemotherapy drugs, today’s researchers are testing targeted therapies. “The vast majority of our treatments are noncytoxic therapies,” she explains. “They’re biologic or therapies that specifically target a key abnormality that may be driving the cancer. I think this is the wave of the next generation of oncology for us. It’s all going to be about personalized medicine and discovering the genetic defects that are characteristic to an individual’s cancer and tailoring the treatment accordingly.”

Patnaik herself became a two-time breast cancer survivor, an experience that has only strengthened her resolve to find treatments to help others live longer. “I have had a first-hand glimpse of the journey that my patients are on and it is beyond humbling to think that I might have the opportunity to share some of their deepest fears and concerns as fellow human beings living with cancer,” she says.

Position: Co-founder, researcher and oncologist

Practice: South Texas Accelerated Research Therapeutics (START), part of the START Center for Cancer Care. The START Center for Cancer Care is the parent group for START, a clinic trials research practice, and South Texas Oncology and Hematology, a traditional oncology practice.

Age: 41

Family: Husband, Muralidhar Beeram, M.D., (Medical Oncologist and clinical investigator at the South Texas Oncology and Hemotology, part of the START Center for Cancer Care); one son and one daughter

Education: Undergraduate medical education (M.D.), post graduate medical education (Internal medicine, Medical Oncology), University of Toronto. Fellowship in drug development, University of Texas Health Science Center at San Antonio/Institute for Drug Development; Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC); Board certified in Medical Oncology 1997 (recertification 2007).

On growing up: I was born in India and moved to Toronto as a child. I grew up in a very humble household with my parents and younger brother. My father moved to Toronto for a scholarship to complete a doctoral degree in statistics. My mother was a home maker and always made sure that we were loved and supported unconditionally. My parents surrounded us with love and always nurtured our curiosity and our minds. Although they were not always able to invest in material comforts, they invested whatever they had in our intellect. My father’s favorite saying was, “If you aim for the stars, you will shoot higher than the trees but if you only aim for the tree tops, you may never get off the ground.” I have embraced this philosophy whether it be in elementary school where I won the gold medal for speech arts, in high school where I received the David Suzuki Award for highest achievement in science and a four-year full scholarship to the University of Toronto, in medical school where I graduated at the top of my class, and in residency/fellowship where I was awarded an American Society of Clinical Oncology Merit award.

First job: Clinical investigator for the Institute for Drug Development/Cancer Therapy and Research Center

On your career: I came to San Antonio as a fully trained and board certified medical oncologist, having done my training in Canada. I came to work with some of the greatest minds in drug development, including Drs. Anthony Tolcher, Gail Eckhardt and Daniel Von Hoff. Although my intent was to take my training back home and start a program in drug development in Toronto, after spending two years in San Antonio, I fell in love with drug development and could not leave the work that I was doing here. The exciting new molecules that were coming through the clinic and the opportunity to work hands-on with some of the most cutting edge compounds that would eventually make the lives of cancer patients better was too captivating. I was beginning to see that our treatments were making an impact on the lives of our patients by reducing the burden of suffering.

I started my first job as a clinical investigator at the IDD/CTRC where I became acquainted with a number of new molecules, many of which went on to FDA approval.

After spending a few years as a researcher at the IDD, I realized that we needed a new paradigm for drug development, one which placed the interest of the patients first by reducing the amount of time it took to bring new drugs into the clinic. With the explosion of knowledge in molecular biology and pathways driving cancer growth has come the greater availability of new targeted therapies. If one could accelerate the development of more new compounds and compress the approvals process by reducing inefficiencies associated with the development of drugs that are usual in the academic setting, one could in effect greatly increase the availability of these compounds to very needy patients. In February 2007, myself and three other colleagues co-founded START. Our mission was to accelerate the development of new anticancer agents in an effort to prolong life and improve survival for our patients but to do this in the shortest time frame possible so that there would be more benefit to the community.

Research impact: ... I was one of the first investigators to work with erlotinib, gefitinib, sorafenib, panitumumab, temsirolimus, lapatinib, vorinostat, pemetrexed, all of which have been approved by the FDA in the past decade, as well as drugs such as cabazitaxel, abiraterone and ridaforolimus, which are on the threshold of approval.

On your job today: I am the principal investigator on 13 Phase I clinical trials and spend my time caring for patients on research studies and providing guidance related to the conduct of Phase I clinical trials. I collaborate with investigators in Canada, Denmark, Spain, Israel and China. As a principal investigator, I help design and conduct scientifically meaningful studies and ultimately identify the toxicities and characteristics of new drugs as well as a dose and schedule that can then be taken forward into pivotal disease-directed trials. Phase I trials represent the cornerstone of the new drug approvals process. My job is to help patients gain access to such studies and to decide if drugs have merit and are worthy of being taken forward into future studies by characterizing the toxicities, pharmacokinetics, dose and schedule that are the most optimal for patients.

Like best about your work: The most wonderful part of my job is to care for my patients and see concrete and incremental gains through novel therapies that result in better quality of life and survivorship.

Like least about it: Having to deal with the limitations imposed by the very aggressive diseases that we encounter where it may not be possible to help a patient.

Business philosophy: Place value and belief in people rather than institutions.

Guiding principles: Giving up my today for all your tomorrows; never let go; hope; optimism

Yardstick of success: Within three years of creating START, we have become the largest program (in Phase I oncology clinical trials) in the country and arguably the world. The international community wants to emulate our success. Multinational studies from two continents come to us to do first in human studies.

Challenges you have overcome: My son was born at 25.5 weeks gestation and spent his first three months in the NICU. Despite all the physical challenges he had to overcome, he is a very happy and energetic child who loves and embraces every element of life. Bilateral breast cancer, requiring four operations, radiation and hormonal therapy. Although I have had a life threatening illness which has caused moments of extreme sadness, desperation and fear with flashbacks that I might be that woman lying in the intensive care unit with my small children next to me, it has also given me a gift that I can only appreciate as I move forward and treat patients, with whom I now have a familiar kinship.

Proudest accomplishment: Having my children in the face of personal adversities

Biggest passions: Spending time with my children and husband, drug development, photography, running

Mentors: Brenda Shapiro (high school chemistry teacher who taught me the value of critical and independent thinking but whose life was cut short by cancer); Dr. Joan Vaile (one of the first women in Canada to certify as a specialist within Internal Medicine); Alan Weatherley (research scientist at University of Toronto who introduced me to internal medicine and medical oncology); my parents, who taught me the value of honest/sincere perseverance which could overcome nearly any obstacle and to never forget my humanity as I was striving for success; Dr. Anthony Tolcher, who taught me that drug development could be exhilarating and also fun.

Heroes: ... my husband. ... He taught me that it is OK to laugh even if it is followed immediately by a good cry.