The People of George Clinical
Profiles in Passion
Nothing defines the unique character of George Clinical more than the people who do the important work of researching treatments and clinical practices that will shape medical policies and practices in every corner of the world. While our Scientific Leadership Team members are a diverse group from many countries and therapeutic areas, one thing they all share is a passion for making an impact on the treatment, and thus the lives, of the patients they serve. These are their stories.
Ralph Boccia, MD, FACP
Scientific Leadership Team, Oncology
Dr. Boccia is Medical Director of the Center for Cancer and Blood Disorders in Bethesda, Maryland, and Clinical Associate Professor of Medicine at Georgetown University in Washington, DC. He also serves as the Chief Medical Officer for the International Oncology Network (ION). He conducts research in exploring the latest advances in cancer treatment and offers individualized care to patients with focus on multi-modal treatment regimens.
What made you decide to become a doctor and choose oncology as a specialty?
I enjoyed science and knew that being a doctor would put me together with people. I really enjoyed everything I did between medical school and my residency — at first I thought I would be a cardiologist because I like procedures. But as a resident, you rotate through many specialities and every time I would think — okay THIS is what I’ll be. But when I got to the hematology oncology section at UCLA, there were such phenomenal teachers who inspired me — especially in the acute leukemia and bone marrow transplant units — I just fell in love with it and that’s how I chose it.
The reason I continue to like and enjoy oncology hematology is because it’s a very different relationship that you establish with your patients. Since it’s uncommon for oncology patients to go to their visits alone, you also typically establish a relationship with their families. So for me, it’s the ability to help people through a journey — whether it’s a curative journey or a palliative journey. It’s that aspect that really interests me — helping families understand what that journey is.
What is your main focus of interest?
My main focus of interest is clinical research because I’m dedicated to finding as many new, innovative, safe and effective drugs as possible for cancer patients. I don’t have a focus on any particular type of tumor — it’s more about striving to always have something else to offer patients who need or want something else — searching for as many options as possible for people.
We’re a community practice and, unlike a huge university, we have 50-60 clinical trials open at all times. I think our expertise is finding those innovative therapies. We get referred patients from big universities because we will find trials that they don’t have. There are lots of places that offer four or five trials, but here you can find something for many more cancer types. We have trials for solid tumors, hematologic tumors and supportive care drugs.
How was the experience at ASCO this year?
My first big conference was American Society of Hematology (ASH) in Atlanta, and then I went to ASCO. It was nice to be with people again because you can’t network virtually. It just doesn’t happen. Certainly the highlight was the Destiny-04-Breast study in patients with HER2-low Metastatic Breast Cancer — it’s the only time I’ve ever seen a standing ovation for a presentation and applause that went on for minutes. It almost brought tears to your eyes. That really took over the show.
On the colorectal trial that showed 100% remission — I agree that’s spectacular, but we certainly need more patients. 100% is great — you don’t see that in anything, so there’s definitely a good signal there. It’s an important study because we know that the upswing in younger patients presenting with colorectal cancer is alarming. It has changed my practice when I see a patient with iron-deficiency anemia, and unfortunately, that’s something that’s very common. Now if I see a patient who is close to 40 with this condition, I will be sending them for a colonoscopy. The guidelines have changed from 50 to 45 now because of all the younger patients we have identified with cancer — but I’m going down to 40 in my iron-deficient patients that are women. We don’t really know what is causing this. It could be dietary or environmental but we just don’t know.
What direction is oncology research going in now and in the near future?
Over time we have found more drivers of cancer in cases where mutations are the primary growth driver. Industry has done a great job of finding ways to inhibit that driving movement or finding a target that they can identify a drug to block. We’re now seeing many more different cancer types in any one organ system than we ever thought. Take for example lung cancer. Ten years ago it was non small cell and small cell lung cancer, and even though we knew there were different histologies within these cancers, it didn’t matter because we treated them all with exactly the same drugs.
Now we know that for non small cell lung cancer there are multiple different types of tumors and those all have a different biology. With so many different drugs that target those drivers, we have a relatively limited number of patients for each of these. So now we have to have multiple different types of clinical trials for any one tumor type because we’re finding that the therapies that we can offer each of these are very different than before and are now especially targeted.
Having drug development has brought us all these new innovations and allowed us to really individualize or “personalize” therapies for any one person. Two people who have colon cancer could have very different types of colon cancer in today’s way of assessing a person’s individualized cancer type, and therefore different therapies.
The main theme of ASCO was “Equitable Cancer Care for All”. What do you see happening to make that a reality?
I think people have to talk about it first and there is certainly a lot of chatter out there on this topic. In our own small way, we are doing something — working with South Carolina oncologist Dr. Kashyap Patel who is the CEO of Carolina Blood and Cancer Center and current president of the Community Oncology Alliance (COA). His special focus is on racial and ethnic disparities and end-of-life care and he has done a lot — from educating colleagues across the country about how inequitable medical care is for people of color, to work with ASCO, with medicare and also trying to introduce certain bills.
We’re working on implementing a plan with some large pharmaceutical companies and other partners to extend a couple of significant clinical trials in patients of color to try to gather more data. We’re also trying to recruit other sites to join us in this effort. We’re talking about large clinical trials in multiple sites. We know that certain types of cancers are more prevalent in certain ethnicities. Ethnicity does matter. So it’s important to include these populations in significant clinical trials.
What type of cancer networks are you currently involved in?
We have a small research program with ION — the International Oncology Network where I am Chief Medical Officer. And in our American Oncology Network, which is a partnership of community practices with about 35 sites across the country, we’re building out a research network with the Sarah Cannon Research Institute. Those are the ones I’m most involved in right now. And we are recruited by multiple CROs for all the trials we do. And before COVID I travelled 5-6 times a year to multiple steering committees for pharmaceutical companies during drug development. However, COVID shut a lot of that down. Most of my steering committee work is now for drug development in the US or either virtual. I do love to travel and to interact with my international colleagues. Those relationships stimulate a lot of discussion and a lot of collegiality.
With a clinical practice and all your research work, what do you do to relax and refresh your mind?
Especially over the last couple of years I’ve spent a lot of time with family. We have a daughter and a son — both of whom graduated from Georgetown. They are both close by at the moment so that’s nice. I play a little bit of golf — would love to play more — and in the wintertime we do a lot of skiing and snowboarding. In the summertime we like boating — cruising and visiting places in the Chesapeake Bay.