Our patients don’t have to travel far to get cutting-edge, quality cancer care. Their doctors are their friends and neighbors. Care doesn’t get more personalized than that.Linda T. Vahdat, MD, MBA
As Deputy Director, Linda T. Vahdat, MD, MBA, is helping transform the face of research and patient care at Dartmouth Cancer Center, and decoding the role of metals in cancer is the core of her achievements.
In this Q&A, she outlines her research journey from a high school science fair to her role in pivotal cancer drug development, how she cultivates a partnership with patients, and why she hopes to open the first metals in cancer institute at Dartmouth Health.
You recently celebrated one year at Dartmouth Cancer Center – congratulations! What led you to the field of oncology?
Vahdat: From early on, I was interested in cancer. My high school science fair project on radiation biology was a turning point. I saw that there was a lot of work to do. But I was also drawn to cancer patients. They’re usually very engaged. You can achieve a lot when you share the goal of getting rid of cancer and maintaining a healthy lifestyle. You form a special relationship.
I try to educate my patients on their options, what’s happened, and what should happen so they can recapture their sense of control. Knowledge helps reduce anxiety.Linda T. Vahdat, MD, MBA
You see patients in both Lebanon and Manchester. What observations can you share about Dartmouth Cancer Center Manchester specifically and Dartmouth Cancer Center overall?
How to stop the spread of cancer
Twenty years ago, our work in breast cancer began with a simple question, “how can tumors lie dormant for years and then return?" In that time, we've pinpointed the conditions tumors need to thrive. That has led to the discovery that metals, specifically copper, allow cancer to come back and spread.
We focused on breast cancer patients who were at an increased risk of tumor recurrence and created a copper depletion pill. Working with scientists and clinicians, we developed a clinical trial. That trial found our pill to be safe with minimal side effects. It is also affordable.
Additionally, the pill successfully changed tumor and patient-related factors so metastases couldn't occur. We found that this was an especially effective approach in a hard-to-treat cancer called triple negative breast cancer. Detailed scientific studies confirmed that we were removing the framework tumors often hijack to spread. These successes have led to more research to identify which patients benefit most from this treatment strategy.
We are really excited to open a randomized phase II study of copper depletion in triple negative breast cancer patients. We expect this trial to begin in the spring 2023 here at Dartmouth.
– Linda T. Vahdat, MD, MBA
Vahdat: The Manchester team is incredibly cohesive and is a "well-oiled machine." We have a great group of specialized care providers meeting to brainstorm and share knowledge on complex cancer cases. Their collaboration is bringing everyone together to improve therapeutic and supportive care in southern New Hampshire and across the entire Dartmouth Health system.
On the therapeutic side, we’re opening clinical trials. What is unique about clinical trials is that they provide patients with early access to therapeutics that eventually might be FDA approved. Through us, patients can receive this care without hours of travel to Boston.
For supportive care, we’re helping patients advocate for themselves. Stoic New Englanders might find it hard to acknowledge when they are not feeling well—whether from disease or from side effects of therapy. But patients who come armed with information are completely engaged and often achieve the best results.
Sometimes you need to look outside your world to come up with strategies for reducing side effects. A cold cap can reduce hair loss. Nicotine patches, for example, can help with swollen hands and feet. Cold mittens and booties can prevent numbness and tingling in the fingers and toes. We also have strategies for nail changes, eyelash loss, impacts to taste buds, and hot flashes.
I try to educate my patients on their options, what’s happened, and what should happen so they can recapture their sense of control. Knowledge helps reduce anxiety.
Including your own research around metals, which emerging cancer research and technology are you most excited about and why?
Vahdat: I’d like to eventually see the first metals in cancer institute at Dartmouth Health. Right now, I’m working on a copper depletion drug and we are starting a clinical trial to test its effectiveness in high risk for recurrence triple negative breast cancer. We know that tumors hijack normal infrastructure to spread and that metals are important for that process. Our idea is that copper depletion can interrupt the hijacking process and stop metastasis.
I’m also excited about the future of immunotherapy in breast cancer. Dartmouth scientists are contributing to our fund of knowledge in that area so that we can better understand how to use immunotherapy to care for our patients. Another area is antibody drug conjugates (ADCs) which are a big hit, too. An ADC is essentially a smart bomb that target tumors. I helped bring the first ADC for triple negative breast cancer to market, Trodelvy® (sacituzumab). Since then, ADCs have grown in popularity. One ADC that we are very excited to bring to Dartmouth Health targets the epidermal growth factor receptor (EGFR) gene. Since twenty-five to thirty percent of all triple negative breast cancers have this mutation, we are hopeful that this will help our patients. We’re beginning what will probably be the first drug trial in patients at Dartmouth Health.
What does the future of clinical trials look like at Dartmouth Cancer Center?
Vahdat: We have access to new therapeutics unavailable in Boston and New York because clinical trials can move through our system quickly. We’re doing the work to ensure a patient can join a clinical trial when they need it.
Ultimately, our patients don’t have to travel far to get cutting-edge, quality cancer care. Their doctors are their friends and neighbors. Care doesn’t get more personalized than that.
Linda T. Vahdat, MD, MBA, is a practicing breast oncologist, section chief of Medical Oncology and Deputy Director of Dartmouth Cancer Center. In her academic role, she serves as the Milham Professor and Professor of Medicine at Dartmouth’s Geisel School of Medicine. Vahdat has more than 20 years of experience in caring for people with breast cancer, with a particular focus on triple-negative breast cancer, metastatic breast cancer and breast cancer at high risk of recurring. She has been involved in the identification, conceptualization, design and conduct of Phase 0 through III clinical trials of new therapies in high-risk adjuvant and metastatic breast cancer patients since 1994. She has led efforts in FDA approval of three drugs active in metastatic breast cancer and continues to initiate new breast cancer clinical trials.