The Future of Radiation Oncology: Q+A with Lisa Kachnic, MD
Throughout her longstanding career in radiation oncology, Lisa Kachnic, MD, has remained on the forefront, fueling advancements in the field, including working on new techniques to deliver tailored, highly-customized radiation therapy to cancer patients. She joined the Herbert Irving Comprehensive Cancer Center (HICCC) at NewYork-Presbyterian/Columbia University Irving Medical Center on September 1 after leading the radiation oncology departments at the Vanderbilt University School of Medicine and Boston University School of Medicine.
Dr. Kachnic focuses on gastrointestinal cancers, specifically optimizing sphincter-preserving chemoradiation therapy for locally advanced anal and rectal cancers. Her last national clinical trial showed that a specialized type of radiation, known as intensity modulated radiation therapy (IMRT), which effectively focuses the radiation dose on the tumor and not on the surrounding normal structures, was effective in reducing the high rate of normal tissue toxicities associated with chemoradiation for anal cancer. Now IMRT has become standard practice both in the United States as well as in other countries for this disease. Dr. Kachnic has also been developing a human papillomavirus (HPV) targeted vaccine therapy.
“It is my hope that such efforts will significantly improve both outcomes and the quality of survival for our patients,” says Dr. Kachnic, the new chair of the Department of Radiation Oncology at the Columbia University Vagelos College of Physicians and Surgeons and chief of the radiation oncology service at NewYork-Presbyterian/Columbia.
Joining Columbia at this time has also afforded Dr. Kachnic a chance to be closer to family members. Originally from Yonkers, NY, Dr. Kachnic is happy to return to the Empire State and join her parents, brother, and several relatives already rooted in the area, including her daughter, who recently relocated to Brooklyn. She adds, “I especially look forward to Friday night extended family Italian dinners.”
Learn more about Dr. Kachnic, her start in radiation oncology, thoughts about the future of radiation oncology research, and how she once had her sights set on a journalism career.
Q: You’ve been in the radiation oncology field for more than two decades. What are some of the most exciting ways that the field of radiation oncology has advanced or changed?
A: We have gotten incredibly precise in targeting the tumor and minimizing the dose to the normal surrounding tissues in recent years. Coupled with improved imaging capabilities on the treatment machines, we are often able to deliver the radiation in one to five high dose fractions (also known as radiosurgery) in select cancers instead of the more traditional six to eight weeks, which is much more convenient for patients and often results in improved outcomes. As the field of radiation oncology advances towards these fewer fraction radiation regimens for a number of disease sites, defining the optimal use of radiosurgery will be critical. We will be working on this at NewYork-Presbyterian/Columbia University Irving Medical Center. To this end, experiments to examine the concomitant use and sequencing of immunotherapy combined with radiosurgery in both the local and metastatic setting will be paramount. Emerging data for radiosurgery in the metastatic setting is extremely intriguing. Radiosurgery to the primary or one/few metastatic sites may improve survival when combined with immunotherapy.
Q: Where is the field headed?
A: An exciting new avenue of research is comprehensive adaptive precision radiation which is defined as individualizing a patient’s radiation treatment plan to account for ongoing changes in anatomy (e.g. tumor shrinkage or growth, weight loss, physiology), as well as tumor biology or function “near real-time” at each radiation treatment. Currently our radiation oncologists anticipate changes and/or monitor daily “on-board” imaging data sets and schedule periodic “re-planning” of a patient’s treatment. With currently-available technology, this is clinically and technically resource- and cost-intensive.
My former Vanderbilt Radiation Oncology physics faculty have begun to work with an international radiation technology vendor to develop artificial intelligence-driven workflows for the next generation software to support this potentially transformative treatment approach. I hope to lead the clinical trial studies at CUIMC.
Q: What are some of your goals as the new chair of radiation oncology and associate director of cancer network strategy at the HICCC?
A: Columbia’s Radiation Oncology Department has outstanding faculty talent. My initial charge will be to link the cancer center as well as the Center for Radiological Research efforts with our Department’s clinical and translational radiation programs. An immediate step towards this goal will be to bring in increasingly more sophisticated radiation machines and treatment modalities, as well as increase the number of clinicians and physician-scientists on our team.
Longer-term goals will be to usher growth in clinical volumes, foster excellence and leadership in education and mentoring; build a professional culture of excellent and accountable multi-disciplinary patient care and referral outreach; set national standards for radiation safety, quality care and outcome metrics; programmatically distinguish Columbia Radiation Oncology through an adaptive precision radiation oncology approach, and further the growth and development of the HICCC and Columbia Radiation Oncology network, with further expansion into Westchester County and Northern New Jersey. The overarching goal for the CUIMC Department of Radiation Oncology and HICCC is to achieve destination treatment status in the Northeast, offering adults and children from throughout the region the benefit of highly advanced comprehensive treatment modalities and clinical trials that only we can offer.
Q: What do you enjoy outside of work?
A: Outside of the hospital, I am an alternative music enthusiast (love my collection of eighties albums!). I come from a large musical family based in New York. My father earned a living as a member of a doo wop band prior to my birth before becoming a firefighter, and my younger brother is the founder and lead guitarist of a speed metal band, interestingly named Malignancy.
I am also an avid spectator sports fan. My favorite teams are the New England Patriots, Celtics, and Nashville Predators. I have been able to go to the Superbowl to cheer for Tom Brady and my beloved Patriots the last several years. I am very excited to return to my NY Mets and Rangers roots as well. I share my love of sports with my husband, Steve Englert, an NCAA Division 1 college and Cape Cod League baseball coach whom I met at Boston College, and our daughter, Sammi.
Q: What attracted you to the field of radiation oncology?
A: It began with a little divine intervention. During my Catholic high school years, my passions were journalism, science, music and sports. One day, the school’s principal, Sister Mary Margaret, summoned the top 10 academic students to her office. We were placed against the wall akin to a police lineup. Sister Mary Margaret then tapped each of us with her long ruler and assigned our lifelong vocations. I happened to be anointed the ‘physician’ of the group.
Although the proclamation scuttled my plans to become a big city news anchor, or even better, an MTV VJ, I dutifully dug into this new career and loved it. I excelled in the lab and began extracting and analyzing DNA while still in high school.
In my third year of medical school, I was on an oncology rotation where I met a fellow medical student who thought I might be very interested in a career in radiation oncology because he knew that I was especially fond of the lab, enjoyed surgical procedures and loved taking care of patients with cancer.
I credit a number of mentors for meaningfully impacting my career. An early, and continuing, role model was Anthony Zietman, MD, of the Harvard Radiation Oncology Residency Program. He stressed the radiation oncologist’s role was so much more than pushing a radiation machine button to destroy cancer cells. Instead, he counseled, the most effective way to contribute to care is to address the whole patient and learn what is most valued by that patient and their family. I’ve embraced this important lesson throughout my career and strive to share these skills with our future generations of radiation oncologists.
-Interview by Melanie A. Farmer