Rachna Shroff, MD, MS, FASCO, is the division chief of hematology and oncology and co-leader of the gastrointestinal clinical research team at the University of Arizona Cancer Center. Her path to specializing in gastrointestinal (GI) oncology began unexpectedly during her fellowship at MD Anderson Cancer Center, where a transformative mentorship with Dr. Bob Wolff pivoted her focus from hematology to pancreatic cancer research.
In this interview with GI Oncology Now, Dr. Shroff discusses her journey from MD Anderson to leading innovative clinical trials at the University of Arizona. She shares the rewarding challenges of expanding clinical research programs, integrating cutting-edge science into patient care, and the vital role of community outreach in oncology. Dr. Shroff also delves into the impact of the ASCO Leadership Development Program on her approach to leadership and mentorship in the field.
What initially drew you to specialize in GI oncology, and how has your focus evolved over the years?
Dr. Shroff: My path toward GI oncology was actually a little bit circuitous because my plan when I first started my fellowship in hematology-oncology was to be a stem cell transplanter. So, when I joined the fellowship at MD Anderson Cancer Center, I was focused primarily on malignant hematology, and I did my GI oncology rotation early on in my first year of fellowship. I met my long-term mentor, who was also the fellowship program director and is a world expert in pancreatic cancer, Dr. Bob Wolff.
I did his clinic, and I saw him take care of pancreatic cancer patients. I realized the incredible need for better treatments, opportunities, and options for patients with pancreatic cancer. So, I completely pivoted, dropped hematology, focused on medical oncology, switched my continuity clinic to Dr. Wolff’s clinic, and learned how to take care of pancreas cancer patients over the next few years. Knowing that I wanted to stay in academic oncology and really focus on doing research and developing novel therapeutics, I really felt like GI oncology was a space that needed a lot of help because there were not great treatment options available to patients with GI cancers.
Can you describe your past experience as the chief of the section of GI medical oncology at the University of Arizona Cancer Center?
Dr. Shroff: I was 8 years into being on faculty at MD Anderson Cancer Center and perfectly happy doing my clinical research in pancreatic and hepatobiliary cancers. I got a call from the University of Arizona Cancer Center saying that they needed to recruit somebody to be the chief of GI oncology and to really regrow the clinical and research programs in GI cancer. The University of Arizona Cancer Center has a storied history of being a mecca for GI cancers, and so it seemed like an opportunity to build something, create a legacy that was going to be impactful, and serve the patients of Arizona with GI cancers.
So, I started here in 2018, and at that time, we had two or three other people doing GI medical oncology with me. I came in with a lot of passion to basically grow the clinical research program, specifically because it’s my belief that as an NCI-designated Comprehensive Cancer Center, it is our role and responsibility to have clinical trials available to the patients that come to see us and to ideally have a trial available to every single patient that walks through the door, to be able to offer them something cutting-edge, different, and innovative.
When I got here, the clinical trial portfolio was very slim. We had very few trials. I think the year before I got here, we had only put 7 patients in GI oncology on trial. So, my first focus was to really make sure that we brought in more trials and to mentor everybody into developing a niche within research. And so, we immediately kind of divvied up the GI tract. We had one person focus on colorectal, another on upper GI cancers, and then I was really the pancreas and hepatobiliary person. By doing that, we were able to really focus on bringing in trials in those specific diseases to match the patients that we were seeing.
Over the first few years, we steadily grew our portfolio and had more and more clinical trials open to our patients that were more reflective of the types of patients we were seeing. We see a lot of pancreas cancer patients here, for instance, and it was really important that we had trials available to those patients. Step by step, we increased our accruals to clinical trials, and we are now actually the most active team in the cancer center. We are the highest-accruing team to clinical trials, and we have increased our total accruals by almost tenfold in terms of the number of patients that we’ve put on trials. We’ve really cultivated and mentored people.
So, the people that were here who were junior when I first started are now kind of our mid-career people and are the leaders actually running the GI cancer program, now that I’ve moved on to being the division chief of all of hem-onc. It’s been really wonderful to see because we’ve cultivated a culture of academic GI oncology. What that means is bringing in trials, writing and designing our own trials, working with our scientists to do translational research and bring some of that University of Arizona science into our clinics, applying for grants, and working across the multidisciplinary space. We’ve partnered with our surgeons, radiation oncologists, gastroenterologists, and all the other people that take care of patients with GI cancers to make sure that we think about trials for all of the patients along the continuum of GI cancers.
How do you integrate your research findings into your clinical practice to enhance patient care?
Dr. Shroff: I think the primary role and responsibility of a clinical researcher is to think through exactly that question: How can the latest developments in research be applied Monday morning when you see patients in the clinic? I’m about to go to ASCO, and there’s going to be all of this new data that comes out. The first question I’m going to ask myself is, can I do something different for my patient when I see them the next day in the clinic?
I think we do that really well as a team. First of all, I really am proud of the team that we have built between the research staff, the clinical staff, and the providers, the physicians, the nurse practitioners. We all really are in constant communication about making sure that we’re staying up to date on the research developments and how we can take those things and build them into our algorithms, if you will, like the way that we approach patients. For instance, taking pancreas cancer as an example, if we’re going to give preoperative treatment to a potential surgical candidate, what clinical trials can we have to ask the important questions of, “Is this the right approach?” Then, when that data comes out, do we need to pivot? Do we need to change what we’re doing in terms of how we approach these potentially curable patients? So, I feel like we think about it every single day when we’re in the clinic.
As co-leader of the gastrointestinal clinical research team at the University of Arizona Cancer Center, what are the biggest challenges you face in conducting clinical trials, and how do you address them?
Dr. Shroff: I think the biggest barriers that we sometimes have are really related to knowing what patients we see so that we can find the right trials for those patients. In this era of targeted therapies, for instance, we have a lot of biomarker-driven trials that are available to us out there, but it’s also really important to have what we call all-comer trials. Just a newly diagnosed patient with colorectal cancer, can we have something for every single one of them? That’s what myself and my co-leader, who, like I said, has really grown into this leadership role, have really focused on: What can we do to make sure we have the right fit for our patients?
Some of the other barriers are really that we serve a very diverse community. Forty percent of the University of Arizona Cancer Center’s catchment area is Hispanic. We have a large population of Native American patients as well because we sit on a number of tribal lands. Making sure that we have the cultural awareness, the cultural literacy to be able to speak to these patients about clinical trials when there’s a historical component to that, it’s been a learning curve, and it’s involved a lot of training of the investigators as well as the staff in terms of how can we make this understandable, digestible, and palatable to every single patient that we see, and how can we make sure that underrepresented populations are actually represented in clinical trials?
Because we need to have those patients enrolled in trials for us to know how these drugs work in different populations outside of the traditional White patient. So, that’s been a lot of work in progress that we’ve really tried to work hand in hand with the cancer center leadership on. It has been really rewarding because, like I said, these are the patients that we actually serve in our community.
Can you share details about some of the current clinical trials or research projects you’re leading at the University of Arizona Cancer Center?
Dr. Shroff: We have, obviously, a vast number of trials open right now across the different GI cancer tumors that we see. A lot of them are brought to us from sponsors, from industry sponsors, from pharma, and are big, large global studies. But we also have a number of investigator-initiated trials that I’m really proud of. One that I run is looking at stage 4 pancreas cancer patients who have progressed on traditional therapies. It’s an investigator-initiated trial that was born out of science here at the University of Arizona in one of my collaborator’s labs who was looking at patient-derived organoid models of pancreas cancer and found that a combination of a targeted therapy, cabozantinib, with an immunotherapy, atezolizumab, actually seemed to cause tumors to die in the lab.
Immunotherapy has really not worked in pancreas cancer. So, this idea of trying to find the right combination that could make immunotherapy effective in pancreas cancer is a huge focus for research right now. So, we’re looking at that combination, this cabozantinib and atezolizumab combination in patients with stage 4 pancreas cancer. First of all, it’s just great to be able to offer something to those patients who have exhausted traditional therapies or standard-of-care therapies. But also, what’s really great about this study is it involves some reverse translation.
So, there’s pre-treatment and on-treatment biopsies, and what we’re doing is taking patients who have been on the study and creating patient-derived organoid models out of their samples, out of their biopsies to look at what’s happening in the immune microenvironment in response to this combination. And so, we hope it works, but God forbid it doesn’t work, we want to know why it doesn’t work. It could be hypothesis-generating for the next study. So, we’re really excited about that.
We have another investigator-initiated trial in gastric cancer patients that’s looking at a similar concept of kind of modulating the immune microenvironment using a phosphodiesterase inhibitor called Tadalafil in combination with chemotherapy. So, patients who have potentially curable gastric cancer get what we call a “window.” It’s a window trial where you give the Tadalafil, and then you give the traditional chemotherapy. So that way, again, we get pre-treatment and then surgical specimens for us to see what’s happening in the immune microenvironment. Those are some trials that I’m really proud of because they’re really based on the science that our phenomenal basic scientists are doing here at the cancer center.
What role does community outreach play in your work, and can you provide examples of successful initiatives you’ve led or been part of?
Dr. Shroff: Community outreach and engagement is a huge area of focus for us at the cancer center, and that’s really because, like I said, we have a catchment area of five southern counties of Arizona with a fair amount of underrepresented and underserved populations that we want to provide care for as well as rural and frontier populations. So, our Community Outreach and Engagement Office is a very strong program here at the cancer center, and as on the clinical side, we partner with them in a lot of different ways.
One is really on understanding the needs of the community that we serve. And so, there are a number of outreach and engagement events that are really focused on health literacy, health education, and screening, such as increasing and improving colorectal cancer screening, breast cancer screening, and lung cancer screening. And again, because 40% of the catchment is Hispanic, making sure that we’re doing these things in bilingual and accessible ways.
There’s been a huge population health survey that we’ve worked on to understand barriers to clinical research. When we understand those barriers to clinical trial participation, we can then think through what we can do better from a clinical trial office perspective to really help improve education around what clinical trials are, help improve the language that investigators use to help the patients understand the trials and feel more comfortable with the trials. So, there are a lot of different partnerships that we have with our, what we call our COE team, and it’s a work in progress. But it’s been great to see some of the things actually paying off in terms of really understanding our community better and serving our community better.
How do you manage to maintain a work-life balance given your numerous roles and responsibilities?
Dr. Shroff: My joking answer to that is do as I say, not as I do. I do believe more in work-life integration than I do in work-life balance. I think it’s very hard, especially as a woman in oncology, to juggle all the different roles. I’m privileged enough to be the mother of two children, a wife, a daughter, a sister, and all the other things that happen outside of work. What I try my best to make sure my faculty know now, as the division chief for hem-onc, is that this is the long game. This is what one of my mentors used to tell me, “This is a marathon, not a sprint.” And so as junior faculty, I was chomping at the bit, and I was like, “Give me something. Give me something. Give me a project.”
Dr. Abbruzzese, who was the chair of the department of GI medical oncology at MD Anderson who hired me as my first faculty position, told me, “Rachna, you got to have some patience and a little bit of persistence, because it’ll help you develop resilience.” Those are the words that stay with me all the time. So I just try to remind my faculty and my mentees about that because it’s not going to be what you did in the first 5 years. It’s going to be what you did over the arc of a career, and that arc includes sentinel and important things in your life outside of this space.
One of my other mentors used to tell me that there is a time and place for everything, and she chose to kind of take a step back in her career while her kids were at an age that she really wanted to make sure she was visible and present. I think those are really individual choices that you should never, ever question. You should go with what your North Star is and decide how you want to be and where you want to be. My kids tease me that I’m a bit of a workaholic. When we go on vacations, they’re like, “How long till mommy gets on a Zoom call?” But those are the choices I made, and thankfully, I have a partner and kids who see me and recognize my roles that I have in my workspace that are really important to me.
I do a lot of reminding people about the importance of self-care. For me, exercise—I exercise every single day. I start my day every single day with exercise. It’s really because it’s my one time in the day that it’s just me, and it’s my outlet. Then, I do my best to be, when I’m not at work, to be present where I am. I think that’s hard in this day and age with phones, being constantly accessible by email, social media, and all these things. But I try my best to remind everybody that whatever it is that’s important to you at this moment, give it your full attention.
How has your participation in the ASCO Leadership Development Program influenced your approach to leadership in oncology?
Dr. Shroff: The ASCO LDP was such a great program, and I will say that in general, ASCO has been so integral in my development as a leader and as an oncologist. I say all the time, it is, in my opinion, the best professional society that I’ve ever had the pleasure of working with. Everybody at the ASCO staff to the ASCO leadership, they just understand what the issues are that face oncologists today, and I’m so grateful for anything and everything that I’ve been able to do. It’s my favorite time of day, I always say, is whenever I’m doing something for ASCO.
But the LDP in particular, I think, was really great, because number one, it gave me a community. It gave me my class of people who are all interested in cultivating and developing leadership skills, and they are still my source sometimes. I go to them with questions as I encounter new challenges as a leader. That leadership training that we do through that program is really wonderful and provides skill sets that are applicable across so many different spaces. I tell everybody, “You’re a leader, even if you don’t know you’re a leader. You’re a leader in your clinic team. You’re a leader for your research trials. You’re a leader as a fellowship director.” There are all kinds of different ways to be a leader, and I think the LDP program gives you skill sets that are just generally applicable across all of those spaces.
Then, of course, for people who really want to be able to get that leg, that foot in the door with ASCO, it’s a wonderful opportunity, because you’re placed on a committee at the end of it, right? You get to work elbow to elbow with ASCO leaders and get to know what all the different ways are that you can give back to ASCO. So from so many different ways, it was such an important part of my development.
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