Internationally recognized expert in neuroendocrine tumors and gastroesophageal malignancies, medical oncologist, steadfast researcher at the University of Pennsylvania's Abramson Cancer Center in Philadelphia, and Associate Professor of Clinical Medicine in the Division of Hematology and Oncology are but a few of the phrases that describe Jennifer Eads, MD. Her dedication to the development and execution of clinical trials earned this articulate and accomplished medical professional the distinction of being named ECOG-ACRIN Cancer Research Group's 2022 Young Investigator of the Year-one of the organization's highest distinctions.
A clinician-researcher working tirelessly to move the needle forward in cancer research, treatments and, ultimately outcomes, Eads is also a wife and mother of two children, ages 11 and 15; an avowed outdoor and fitness enthusiast; and proud owner of two dogs (a 115-pound Bernese Mountain dog and a 12-pound Bichon Shih Tzu mix "who runs the show").
Eads also likes to tap. "I don't know if I should admit this publicly, but I was a competitive dancer for more than 13 years. I did ballet, jazz, and tap-which was my favorite thing. I had fast feet," she revealed with a chuckle. "It took me a long time before I could sit at a desk without tapping my feet underneath."
Eads grew up in Paradise, CA. "It's a very small town that burned down about 4 years ago," she told Oncology Times. "I don't know if there are any other physicians who have come from Paradise. However, when I was growing up, there was a pediatrician who I shadowed on one occasion, and from then on, I thought I wanted to be a doctor."
Eads is a graduate of the University of California, Davis, where she earned the highest honors and a degree in genetics. "It was a very large school and I found myself sitting in a massive room with 450 other people who also wanted to go to med school. I was turned off by the competitive nature of it."
So, she went to work for a biotech company, which was one of the first next-generation sequencing companies. "I was sitting in a lab all by myself and I missed interaction with people. That's when I realized med school really was the right direction for me," she noted.
Eads went to Tufts University School of Medicine where she developed an interest in internal medicine. She completed an internship, residency in internal medicine, and a fellowship in hematology and oncology at University Hospitals Case Medical Center at Case Western Reserve University, where she was both a chief resident and chief fellow.
"I had thought I was going to be a gastroenterologist, but my first rotation in residency was hematology and oncology. It was brutal, but I loved it," she recalled. "I didn't really know anything about clinical research."
At the urging of her mentor, gastrointestinal (GI) medical oncologist Neal Meropol, MD, during her fellowship, she applied for a spot at the highly competitive ASCO-AACR Methods in Clinical Cancer Research Workshop and was accepted. "I was enamored with it all. I loved the people and the idea of doing clinical research," Eads recalled. "That experience completely changed my life."
Neuroendocrine Tumors
Meropol helped guide the budding researcher. Eads stayed on at Case Western and became a GI oncologist and clinical researcher. While there, she was asked to write a review article and decided to do it on neuroendocrine tumors because two new treatment options for pancreatic neuroendocrine tumors were in the news at that time.
"I subsequently read 100+ articles on neuroendocrine tumors...and because I then knew more about this disease than anyone else there, it became my primary area of expertise," Eads noted. At the same time, she began going to ECOG meetings and eventually started writing a clinical trial for high-grade neuroendocrine neoplasms.
"It took me 3 years to develop the clinical trial protocol. During that process, there were lots of reviews with the NCI, the Neuroendocrine Task Force, and various neuroendocrine experts. I got to know the field and the people in it on a national level," Eads explained.
The trial ultimately opened through ECOG-ACRIN (EA2142) and was the first large, randomized trial in the U.S. for patients with high-grade neuroendocrine neoplasms. Specifically, the trial sought to determine if temozolomide and capecitabine chemotherapy would perform better as frontline therapies than the standard chemotherapy agents-platinum and etoposide.
"It was a negative trial," Eads said, "meaning we did not demonstrate that was the case. However, there were a lot of biologic differences in the patients who had the tumors. So now we are looking at the pathology specimens and trying to parse out if there are any subsets of patients who respond better to one or another of these regimens. Even though the trial has ended, we are still learning."
Today, Eads makes her professional home at the University of Pennsylvania where she became a dedicated medical oncologist in a well-established and functional neuroendocrine program. "It was a perfect fit," she said. "It's academically and scientifically rich, and everyone wants to do research."
Eads sees patients with neuroendocrine, esophageal, and gastric cancers in the clinic 2 days a week. "From a research standpoint, we have more esophageal/gastric research ongoing only because neuroendocrine research is difficult to do because of the rarity of the disease," she explained.
"The types of neuroendocrine tumors I see generally start in the bowel or the pancreas. They are generally slow-growing and patients often can live with them for several years. Steve Jobs and Aretha Franklin both had pancreatic neuroendocrine tumors. However, only about 10 percent of pancreatic tumors are neuroendocrine. It can often be managed for many years and it can be cured if it's a localized tumor. Most of the treatments we use to care for these patients have been developed just since I started doing this work. We've made a lot of progress in the last 10 years. However, as with other types of cancers, when it spreads to other parts of the body, it is no longer curable."
Eads said there are several national neuroendocrine trials ongoing now through cooperative groups, "and that makes the space quite crowded. But we try to participate in those trials when possible. I have been involved in some pharmaceutical trials looking at a variety of agents, but so far none of those have led to practice-changing outcomes," she said.
Avoiding 'The Big Blast'
"I have several trials in esophageal and gastric cancer underway. Probably the biggest one (EA2174) is a national cooperative group trial for which I am the study chair," Eads noted. "We are looking at the role of immune checkpoint inhibitor therapy in both neoadjuvant and adjuvant components of treatment for localized esophageal and gastroesophageal junctional cancer. It has been fully accrued; we have about 275 patients enrolled. We are waiting for results and from that data we will decide whether to expand the study."
Eads said there is an urgency surrounding esophageal/gastric cancer because, while it is less common, it is "a highly fatal disease; most people still die in a relatively short period of time. Worldwide, it's a huge problem-the sixth leading cause of cancer death on a global scale. It's more of a problem in Asia [despite a healthier diet], even more so than here in the U.S. It is probably because they eat a lot of smoked foods, many people smoke, etc. There are both genetic predispositions and environmental issues. However, we are making progress, and we have determined that immunotherapy has a role to play."
The researcher said the trials are steadfastly "looking to improve the current treatment standard in the hopes of improving life expectancy and making treatment more tolerable and less toxic. Some of the drugs we've used in the past were very bad," Eads noted. "If we can replace them with more tolerable drugs, patients will have a better quality of life during however much time they have left. We are investigating drugs that are targeted therapies selected for patients based on their biology, instead of just blasting a tumor with some toxic agent. A variety of treatments-immunotherapies, antibodies, CAR-T cells, etc-are helping us to avoid the big blast of toxic agents."
Eads also noted that, because neuroendocrine tumors are not particularly sensitive to chemotherapy, alternative treatment modalities are vital. "We now use peptide receptor radionuclide therapy. It is a treatment wherein we inject patients with IV radiation therapy that is tagged with a molecule that targets the cancer," Eads explained. "It results in localized delivery of radiation to the cancer cells and a localized killing effect. It is not utilized in many cancers, but it is becoming more actively investigated for use in other diseases. It generally does not act quickly, so it would not be appropriate for patients with a fast-growing cancer that requires a quick response. However, a similar therapy-prostate-specific membrane antigen-has already been developed for prostate cancer."
When asked to pinpoint an overarching message she'd like to share with fellow oncologists, Eads said, "I urge them to really encourage enrollment in clinical trials. Currently, less than 10 percent of patients participate in them. We need to complete these trials in order to make improvements. I know it is time-consuming to put patients on trials; it's a lot of work. But it is everyone's responsibility. It takes a group effort to move the field forward.
"Particularly with rare diseases, such as neuroendocrine tumors, it is very difficult to do research on your own due to the scarcity of patients," Eads added. "Large collaborative efforts are required. I am very much a product of the cooperative group system. The results that come out of many cooperative group studies oftentimes change practice. These trials are incredibly important."
Valerie Neff Newitt is a contributing writer.