Courtney D. DiNardo, MD, MSCE, Associate Professor in the Department of Leukemia at the MD Anderson Cancer Center, talks about the value of mentorship and her research on hereditary cancer predisposition syndromes.
When did you know you wanted to be a physician? I always knew I enjoyed science, and my love of medicine came soon thereafter. I would say by middle school or high school, I was pretty set that when I got older, I was going to want to be in the medical field and most likely a physician. I think it became a truly cemented desire when, in college, I was going through biology courses and thinking about pre-med classes. My grandmother, who I was very close with growing up, developed a type of a bone marrow disorder called aplastic anemia, and her diagnosis and treatment during my college years really solidified my desire to go into medicine—and more specifically into oncology.
How did you choose hematologic oncology as a specialty and leukemia specifically? The story I just shared is what really focused me toward oncology—malignant hematology in particular. I think everyone has life events that can point them toward a future career path, even though you don’t appreciate it at the time. I had a friend who was unfortunately diagnosed with acute leukemia during our school years. Then my uncle was diagnosed with and unfortunately passed away from colon cancer. Cancer was part of my experience growing up, and these were impactful experiences that really made me wish there was something more I could do to help.
Who would you say helped guide your career path? Did you have any mentors? I have had several phenomenal mentors throughout the years. When I was in medical school, Liz Petty, MD, was instrumental in showing me how to get involved in clinical research. I was young and motivated but didn’t know how to even get started. And as a woman in medicine, she was such a wonderful resource for a successful academic physician. Then as I transitioned to my training years, my internship and fellowship, Selina Luger, MD; Martin Carrol, MD; and Allison Lauren, MD, at the University of Pennsylvania, were just outstanding mentors, guiding and supporting me. Since I have been a faculty member at MD Anderson Cancer Center now for 10 years, Marina Konopleva, MD, and Hagop M. Kantarjian, MD, have been my mentors. As you transition into a faculty member, there’s a whole bunch of new issues and questions as you’re trying to develop into a successful independent investigator, and you need mentors to learn how to do that well and how to navigate the world of academic medicine.
What do you think makes a good mentor? A good mentor is passionate about your success. They help guide your path and keep the focus on the big questions about shaping your future career and academic development. In the early training years, you are just trying to get all your work done and check all your boxes, and sometimes just trying to make it through the day. You need your mentors who are invested in you and helping you see past that to become who it is you’re meant to be, career-wise.
How did you come to focus some of your research on hereditary cancer predisposition syndromes? It actually was not an anticipated focus. When I was at the University of Pennsylvania, there was a woman by the name of Monica Bessler, MD, who was a wonderful resource, and she saw patients who were younger or had unusual presenting characteristics or made you think there could be something inherited. So we would see patients and then refer them to Dr. Bessler for an evaluation for an inherited bone marrow failure syndrome. When I got to MD Anderson, we had these same patients, so I was trying to figure out who to refer them to. And I came to realize this person just didn’t exist when I got there 10 years ago.
So I started figuring out how to order telomere length assays for short telomeres or how to order a clastogen assay to see if a patient has Fanconi anemia. By learning how that process worked, by default, other people started referring their patients to me because I knew how to do it. I found these patients super interesting, and I loved getting to know them and their stories, and it just turned into something that I became the local expert in.
What work still needs to be done for acute myeloid leukemia (AML) patients, and what would you like to see in terms of treatment development for this disease in the future?I don’t want to sound pessimistic because there has been so much that has happened—so many good things over the past decade or so. I would cite the genomic revolution, where we can now understand each and every cancer, each and every leukemia, and realize how they’re different. We can figure out the specific genetic changes that have ultimately led to this malignancy and determine what is the best way to treat that. We’ve come a long way, but we still have so much further to go.
We have almost a dozen new approvals for AML, and many of them are targeted therapies. The way our approval process happens, we prioritize safety, and that’s the right thing. But the approval process for new therapies and investigational work happens slowly. You get approvals for single agents in the relapsed setting, and then you have to figure out how to use them best and how to put them together into smart combinations. I think that process is happening now where we’re really trying to figure out what is the best way to put all these therapies together, how to sequence them or combine them, and hopefully, cure the majority of our leukemia patients because we’re unfortunately still not curing the majority of our patients.
Where do you think the field of hematologic oncology is headed from a treatment perspective? My interest and focus are on the personalization and the individualization of treatment for patients. We are realizing that a one-size-fits-all approach is not going to work—you want and need to personalize and tailor your treatment based on the cancer the person has. That’s just starting, and I think over the course of my career, we’re going to see things really change in this direction. There are many new targets coming into play for AML that we don’t have approvals for yet—a lot of exciting clinical trials of completely new mechanisms of action. For example, trying to figure out how to use immuno-oncology wisely and successfully, I think, for our leukemia patients, is going to be the next step.
How do you spend your time outside of work? I have two daughters who are 11 and 14 years old, and my husband is a global health physician. Our girls just started sixth grade and ninth grade, respectively, and they keep us busy. We’re an active family; we love being outside. We love taking trips and exploring new parts of the world—going hiking and camping, for example.
What is one thing most people would be surprised to learn about you? My husband and my girls love animals. So we have a husky and a tabby cat of our own, along with a revolving door of foster animals, often kittens who need a few weeks to gain weight before they can go up on the adoption floor, or rescue dogs, etc.
Courtney D. DiNardo, MD, MSCE, is an Associate Professor in the Department of Leukemia at the MD Anderson Cancer Center.