Nina Shah, MD
Multiple myeloma expert Nina Shah, MD, was born and reared in the Northeast. During grade school, she developed a passion for science that would lead to an early decision to pursue a career in medicine. “My ninth-grade biology class really got me interested in human biology, and that’s when I began thinking about becoming a doctor,” said Dr. Shah. “Although I was very interested in the sciences and math, I also liked developing people skills. Although I didn’t realize it at first, I was an outgoing and friendly person, which ultimately played a big role in my career path to oncology.”
Biology Leads the Way
After graduating from high school in Connecticut in 1994, Dr. Shah went to Harvard University, where she received a bachelor’s degree in cognitive neuroscience with a joint major in biology and psychology. “While at Harvard, my curiosity in biology continued to grow. Perhaps it was the ‘people part of me’ talking, but that’s why I decided to include psychology in my major. My thesis was on the influence of religious experience on endogenous immunoglobulin levels. I also became interested in how the body-mind connection might influence the immune system,” said Dr. Shah.
“After I graduated from Harvard,” she continued, “I went to the New York University (NYU) School of Medicine to get my medical degree. I’ll never forget a December afternoon in my first semester, when we had a lecture by a pediatric hematologist. For some reason, what she said simply grabbed me, and I knew I wanted to go into hematology/oncology,” she noted.
“I followed up with her, and we discussed various opportunities in pediatric oncology. I did very well in medical school, and everything seemed to be falling into place as far as my choice of specialty. But during my third year, I realized that I enjoyed internal medicine and loved caring for older patients. So, I went into internal medicine again, with my eye on the prize of becoming an oncologist.”
Career-Changing Experience in the Lab
After earning her medical degree at NYU, Dr. Shah completed a residency in internal medicine at Columbia University Medical Center. “Before moving on to a fellowship, I spent 2 rewarding years in the laboratory of Dr. Raphael Clynes, who introduced me to basic science and immuno-oncology, with an emphasis on dendritic cell biology and antibody-mediated toxicity. Most important, Dr. Clynes sparked my interest in how immunotherapies might change the face of cancer care in the coming years. Getting my hands dirty in the lab—working with mice and cell cultures—was an eye-opening experience. It was a formative period that enriched my appreciation for research and ultimately helped shape my career,” said Dr. Shah.
Patient symptom control, patient-reported outcomes, and other quality-of-life issues became my career within a career, which again let me use my people skills.— Nina Shah, MD
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Although Dr. Shah had become captivated by cancer immunotherapy, there was one problem: it was 2005, and interest in immunotherapy was minimal. “People were interested in antibody drugs like trastuzumab and rituximab, but investigating T cells and dendritic cells just wasn’t on the radar in mainstream cancer research. However, I was convinced there was a role for me in the field of immunotherapy, and I was determined to find it. To this day when I run into Raphael at a conference, I tell him that my experience in his lab changed my life.”
A Change of Scenery
After her transformative years in the lab, Dr. Shah was ready for a fellowship. “At that time, my husband and I had two little kids, and we were struggling with money issues, so we decided to give up on the Northeast and have a change of scenery. As it happened, my husband, who’s a urologic oncologist, and I were accepted for fellowships at The University of Texas MD Anderson Cancer Center. So we packed up our minivan and headed off to Houston,” said Dr. Shah.
During her 3-year hematology-oncology fellowship, Dr. Shah had another career-changing experience. “I met my mentor, Elizabeth J. Shpall, MD, the head of MD Anderson’s Department of Stem Cell Transplantation and Cellular Therapy. I can’t say enough good things about her as a mentor. She taught me the science of cellular therapy, which at the time wasn’t taken seriously. People actually laughed at me, saying work in this field was a pipe dream. But Dr. Shpall wouldn’t let any amount of negativity dissuade me. She was always upbeat and positive about the potential of cellular therapy. She was the first translational investigator I ever worked with—a clinician-researcher who took things from the lab to the bedside,” said Dr. Shah.
In 2008, Dr. Shah collaborated with Dr. Shpall on a research project looking at natural killer cells derived from umbilical cord blood, which were reinfused into patients with cancer. “It was very early on in cellular therapy, but after several years, we actually got funding from a biopharmaceutical company. The product went into humans on a randomized trial, which was published in 2017,” she said.
“That was 9 years of work,” she continued. “It was so all-consuming that I used to call it my third child. And along the way, Dr. Shpall helped me land my first job in 2010, which was as Professor in the Department of Transplantation at MD Anderson. I loved her so much that I nominated her for the Women Who Conquer Cancer Mentorship Award in 2017, which she won.”
Dr. Shah noted that her decision to specialize in myeloma reached back to her early love of science, medicine, and people. “Myeloma is a disease that encompasses all of those interests. You develop incredibly long-term relationships with your patients, and the science of myeloma is fascinating because it’s highly treatable but not curable. I also knew there would be a role in it for immunotherapy down the line,” she said.
“So, I pushed on with my cellular therapy project. While I was at that department, I formed other valuable mentorship bonds. I’d also like to note the incredible structural support I received from MD Anderson.”
When Dr. Shah became an attending physician, one of her predecessors, Sergio Giralt, MD, left MD Anderson to assume a position at Memorial Sloan Kettering Cancer Center. He left a huge research project looking at symptom burden in patients with myeloma undergoing transplant. “I just ran with that project, and we got a terrific randomized controlled trial out of it. We even got a second paper published looking at symptom burden and how it correlates with physical functioning. After that, patient symptom control, patient-reported outcomes, and other quality-of-life issues became my career within a career, which again let me use my people skills.”
If there were a 360-degree wheel of emotions and challenges, this job would be it.— Nina Shah, MD
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Another opportunity knocked when Dr. Shpall “basically insisted” that Dr. Shah become one of the leading principal investigators (PIs) on the trial of a dendritic cell vaccine for myeloma initiated by the Blood and Marrow Transplant Clinical Trials Network (BMT-CTN). “I wasn’t really confident about leading this major cooperative group trial, but [Dr. Shpall] literally pushed me in front of the planners and said, ‘Nina’s going to be one of your PIs.’ I became one of the three lead PIs on a project that encompassed about 15 different institutions across the nation, in which we were making personalized myeloma vaccines. It happened at a propitious time, as immunotherapy had finally caught on. Now we’re finally beginning to see mature exciting data.”
Dr. Shah also credits Dr. Shpall with getting her in the door to the BMT-CTN, which led to important relationships in societies such as the American Society of Hematology and ASCO. “She gave me the confidence, and the rest was on me. Collaboration in the oncology community requires one to reach out in a friendly, collegial manner—something not everyone is comfortable with.”
Time to Move On
Although her career was blooming, Dr. Shah said that in 2015 she was beginning to “get a little antsy.” She decided to change venues for a program that combined pretransplant treatment for myeloma and the transplant therapy itself. “Every institute does things differently, but that’s why I left MD Anderson and went to the University of California, San Francisco. Due to the generosity of my boss, Dr. Tom Martin, and my senior mentor, Dr. Jeff Wolf, I’m able to bring immunotherapies into clinical trials for patients with all stages of myeloma. It is an amazing experience, one in which no 2 days are the same, and each day is richer than the preceding one,” she said.
Dr. Shah mentioned one common thread running through each workday: she experiences the entire gamut of human emotions. “This morning I cried with a patient, and 2 hours later I was having a wonderful phone conversation with a leading investigator. Now I’m on a phone interview with The ASCO Post, and in between I was frustrated with an e-mail, then delighted at another. If there were a 360-degree wheel of emotions and challenges, this job would be it.”
Follow Your Passion
Asked what advice she would give a young medical school student pondering a career in oncology, Dr. Shah said, “This field has everything a doctor could dream of—clinical research, challenging scientific advances to keep up with, intimate patient relationships, and it gives you the opportunity over your career to grow and enhance every aspect of yourself as a physician and as a person.”
And what does a super-busy clinician-researcher do to decompress and avoid burnout? “First off, I think physician burnout is a real problem because of all that’s being asked of us besides our work in the clinic and laboratory. For me, the biggest challenge is my struggle to be there for every patient all the time, on every level possible. When I feel that I somehow could have done something better, it can cause stress. To avoid a sense of burnout, I exercise almost every day, and I make it a point to enjoy my time off on weekends. But in the end, I love going to work every day, and that in and of itself helps prevent burnout.” ■
DISCLOSURE: Dr. Shah reported no conflicts of interest.