For Dr. Nancy Davidson, the spark that ignited a career was, at first, just a summer job.
Then a med student, Davidson had sought a research job at the National Cancer Institute near her parents’ home to explore her interest in cancer ― and to supplement her lean student’s bank account.
But she found something there that “captured her imagination,” she recalled ― new cell models of breast cancer that created a tangible link between lab and clinic, allowing researchers to develop potential new treatments in Petri dishes that could then be brought to patients.
“This was at a time when we could begin to see the relationship between biology that was being studied in the laboratory and how it was going to ultimately translate into care for people,” she said.
The passion for lab work that can directly impact patients’ lives has not left Davidson in the years since. The breast medical oncologist and researcher has built a worldwide reputation for her expertise and leadership in this field, for her work teasing out the role of hormones in breast cancer growth and her impact on the development of new standards of care that exploit the Achilles’ heels of breast cancer cells.
“Like most people who are fabulously empathetic physicians as well as very fine scientists, [people like Davidson] get the connectivities,” said friend Dr. Marc Lippman, now the deputy director of the Sylvester Comprehensive Cancer Center of the University of Miami but once Davidson’s mentor for that summer job. “Before ‘translational’ became a vogueish word, they understood there were implications for the work they did and there was a moral and ethical imperative to make things better for people.”
“Getting the connectivities” also hints at Davidson’s approach to scientific leadership.
As of Thursday, Davidson became the senior vice president and director of the Clinical Research Division of Fred Hutchinson Cancer Research Center; the president and executive director of Seattle Cancer Care Alliance, Fred Hutch's clinical care partner; and the professor and head of the Division of Medical Oncology of the University of Washington School of Medicine. Davidson will also be focused on strengthening connections between the research centers that make up the Fred Hutch/UW Cancer Consortium: Fred Hutch, UW School of Medicine, UW School of Public Health, Seattle Children’s Hospital and SCCA.
“I think by nature I’m a bridge-builder,” Davidson said. “That’s part of the reason I’m attracted to the position [in Seattle], and I imagine that’s one of the reason the leaders in Seattle thought I might be a reasonable candidate. This is what I’ve done for my entire career. I think that medical oncologists are very good at team science, and we’re very good at team care: It’s at the forefront of what we do.”
Prior to her new role, Davidson was the director of the University of Pittsburgh Cancer Institute, a position she has held since 2009. Dr. Edward Chu, who served as deputy director of the institute under Davidson, said that Davidson’s bridge-building style served the Pennsylvania institute well.
“She’s very inclusive, she very much wants to get input from the other senior leaders here at the center, the program leaders, the shared resource leaders, and also from the individual cancer members,” said Chu, who has known Davidson since early in their careers. “I think her view is, get critical insight from the people on the ground to hear what the strengths and weaknesses of whatever initiatives are being developed, and then come together and work with the leadership to come up with a decision that is well-reasoned and thoughtful and that can ultimately help to further the science that is being conducted by cancer center members.”
As proof of her style, he pointed to the institute’s success in two arduous cycles of review to renew its elite status as an NCI-designated comprehensive cancer center. The most recent renewal, Chu said, the Pittsburgh center got its best-ever score in the process.
“In truth, being a cancer center director is a very difficult position. It’s a very difficult job, because you have many different constituencies,” he said. “Every cancer center has different challenges and I think the key is how to work with different groups to come up with a solution that works for everyone … I think she’s been extraordinarily successful.”
Advancing breast cancer care from the lab through clinical trials
The daughter of two geologists, Davidson has always had science running in her veins. From those early summers spent camping out for her father’s fieldwork, she eventually found herself drawn to the excitement of biology for the insights it offered into how life works. Later, an undergraduate research experience in a liver cancer lab at MIT sparked her interest in cancer and sealed her decision to pursue medicine.
From her fateful summer in Lippman’s lab at NCI, Davidson kept her focus on breast cancer research, with the hormonal work she’d begun there forming a cornerstone of her career.
Hormones circulating in a patient’s blood, especially estrogen, can have a major effect on the growth of some types of breast cancer. Some breast cancer cells, for example, have receptors on their surface that recognize hormones. For these cancer cells, hormones like estrogen act like a fuel.
Davidson’s team was the first to describe how the activity of one of the estrogen receptor genes is regulated by epigenetic factors that affect how the DNA code is read and eventually translated into proteins. She also has contributed foundational research to our understanding of how estrogen deprivation and other therapies trigger breast cancer cells to kill themselves through apoptosis, or programmed cell death.
True to Davidson’s dedication to translational research, her lab studies paved the way for new clinical trials of drugs that exploit these pathways to kill breast cancer. She has also led several critical clinical trials that have advanced the care of breast cancer patients, for example, establishing a combination chemotherapy and hormone therapy regimen for premenopausal women with the disease.
Large-scale clinical trials are massive undertakings. They typically involve a network of investigators at multiple institutions around the country, even around the world, who must work together to secure funding, plan the trial, gather data, troubleshoot the inevitable glitches, and report the findings. Davidson led the committee that oversaw breast cancer trials for one such large cancer-research network, the Eastern Cooperative Oncology Group.
Davidson, Lippman said, is “a socially graceful person” with a “gravitational force” who is a natural at navigating these difficult and vitally important efforts.
“That progress that has changed the face of the disease, making it so that now the majority of women are cured … even though that’s true, it hasn’t happened because someone said, ‘Ah, here’s the magic solution.’ It’s been very incremental ― 5 percent here, 3 percent there, on these lengthy, complicated trials in which you see small benefits involving hundreds and hundreds of people, doctors and nurses and researchers.” Lippman said. “It’s a numbing amount of effort to get these incremental gains, and that’s one of her most remarkable contributions.”
‘She knows how to engage and empower’
In addition to her new leadership roles at the Hutch, UW and SCCA, Davidson will also be continuing what, for her, is one of the things she’s most proud of in her career: providing quality care to people with breast cancer.
“I hear from them [former patients] from time to time and I’m happy that I was able to touch lives in a positive way,” Davidson said.
One of these is Lancaster, Penn., resident Judy Ochs. Davidson treated Ochs’ breast cancer starting in the early 1990s.
Davidson was the first doctor Ochs had seen after her diagnosis that made her “feel safe,” she said, giving her confidence that she was getting the best care. The doctor has given her two gifts in life, Ochs said: empowerment and hope.
“She isn’t the type of person who says, ‘You’re going to be OK, this is going to be fine,’” said Ochs, who turns 72 this month. “She does it in a different way: her confidence, her knowledge.”
Ochs remembers how, after reviewing her file, Davidson pulled out a piece of paper and wrote down what was known about Ochs’ condition, the available treatments and ongoing clinical trials. The two talked about Ochs’ options and Ochs decided on a double mastectomy based on her cancer’s likelihood of recurring on the other side, as well as systemic treatment on a clinical trial.
“She has such a natural ability, she can not only educate you, she knows how to engage and empower,” Ochs said about her former doctor. “She allowed me to be part of my treatment.”
Ochs remembers that she was stunned when Davidson ― the founding director of the breast cancer program at the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University and later the university’s first chair of breast cancer research ― called her on a Saturday to see how Ochs was feeling on the new anti-nausea meds that she’d prescribed.
“I remember her saying, ‘There but by the grace of God go I; we could switch places,’” Ochs said. “She made herself very human to me. She never made me feel that I was in the presence of someone I had to treat a special way. It was a working relationship. She was easy to understand. If you asked her a question, she’d answer it, and if she didn’t have all the information, she’d say it.”
A wider view
For Davidson, serving as both a clinician and a researcher is a powerful way to ensure that her research is solving real patient concerns, and to bring science to bear to improve the care of her patients ― a “bidirectional flow,” she said.
“It allows you to understand the importance of your science. It allows you sometimes to see how scientific ideas can have an impact on the lives of individual patients. It’s allowed me to be a good clinical trialist, to think about how one can bring an evidence-based and hopefully research-focused, where appropriate, mindset to care in the clinic,” Davidson said. “And of course it also allows you to see the kinds of problems that you’re facing with individual patients in the clinic and think about how they can be elucidated.”
And with the opportunities she has been given throughout her career to serve as a leader, she said, she’s been able to think about how the thrill she experienced in the breast cancer lab years ago is spreading throughout all oncology, and how she can facilitate that.
“This excitement about this relationship between the biology in the laboratory and the things that you could do in the clinic ― that excitement over the last few years is if anything even more in melanoma, in kidney cancer, in lung cancer, in multiple myeloma, in diseases where for a long time we didn’t have a whole lot to offer. But because of our enhanced understanding of the molecular underpinnings for these diseases, there are now so many things you can do,” said Davidson who served as president of two national professional societies in cancer, the American Society of Clinical Oncology (2007 to 2008) and the American Association for Cancer Research since 2016.
“That kind of excitement is really what has driven me to think about the position [in Pittsburgh] and the position I’m going to be taking with [the Hutch and its partners].”
Susan Keown, a staff writer at Fred Hutch, has written about health and research topics for a variety of research institutions, including the National Institutes of Health and the Centers for Disease Control and Prevention. Reach her at skeown@fredhutch.org.
