In Practice: Rom Leidner, M.D.
As part of an ongoing series, Providence profiles Rom Leidner, M.D., a medical oncologist and researcher at Providence Cancer Center Oncology and Hematology Care Clinic-Eastside.
Clinical and research focus
Oral, head and neck; esophageal cancers
Medical oncology fellowship and then faculty member, Case Western Reserve University, Cleveland; chief resident, Virginia Mason Medical Center, Seattle; medical degree, Tel Aviv University, Israel
Why did you choose to focus on oral, head and neck cancers?
This is a group of orphan diseases, and while we’ve seen breathtaking technical advances in the surgical and radiotherapy fields, there is substantial room for progress in medical oncology. Cisplatin, approved in 1978, still remains our current backbone.
There’s a growing appreciation of the interplay between the immune system and the frontline defense function of the epithelium in the upper aerodigestive tract. This is in line with the dramatic demographic shift underway in head and neck cancer, which is moving away from an association with tobacco and alcohol and toward human papillomavirus.
Why practice here?
Providence has made a formidable commitment to basic cancer research infrastructure while avoiding the multiple intervening layers of a large university center. Perhaps as a result, we have the advantage of being more agile in translating laboratory research to clinical trials. We can drive innovative correlative study design by constant and impromptu exchanges of ideas.
In my case, for example, I walk by the liquid nitrogen tanks in the laboratory space every day to get to my office. I share the break room with folks from the lab. The group at Providence has brought at least two compounds that I am aware of – all the way from the initial discovery through animal testing, patent filing, FDA investigational new drug submission, first-in-human studies, licensing and commercialization. Most university cancer centers would be delighted to be able to point to a successful track record spanning the entire drug development process from discovery to commercialization.
Currently we’re focused on in-house cancer vaccine research and development. For oral, head and neck cancer, we are routinely taking samples of patients’ tumors, with their permission, and establishing cell lines in vitro. As new discoveries are made, being able to go back and analyze these cancer cells while knowing the clinical course of those patients is an invaluable resource. You can’t do that at a regular hospital.
Through a multicenter partnership with New York University and the University of California-San Francisco, we also are isolating DNA from tumor brushings in patients with oral cancer, a minimal and painless outpatient office procedure. This will validate a prognostic biomarker signature initially identified in discovery-phase-array CGH genomic profiling.
What are we learning about genetics and esophageal cancer?
We’ve observed familial aggregation in Barrett’s esophagus and esophageal adenocarcinoma (EAC), but a specific genetic locus common across the affected families has been elusive. This remains a rare disease, and we’re a long way from culling any clinical treatment targets from current genetic epidemiology work.
Landmark studies in familial breast cancer found an exceedingly high association coefficient along a narrow stretch of chromosome 17, which led to the identification of the BRCA1 gene. We’ve not been as fortunate with EAC.
The other issue that has dogged research is that there appears to be no readout for early onset in the EAC families. This leads me to think that the real discovery may lie in the epigenome rather than the genome. Nonetheless, the research continues through familial registries and consortium-level coordination among international research groups.
These cancers have poor prognoses. How do you deliver bad news?
This is important and I will try to be specific. I deliver bad news slowly, in single sentences whenever possible, interrupted by frequent pauses to listen carefully.
The information is overwhelming, so I let the participants set the pace. I get the most guidance from the patients’ responses, even if that’s an awkward silence at first.
The other thing that helps is to tactfully acknowledge emotions, for example saying, “It’s OK to cry,” if someone’s eyes are moistening. Pretending not to notice emotions doesn’t work well.
When questions inevitably get asked, it lets me know one of three things: I can go on to the next piece; I should circle back and better explain; I should be attentive to something that was off my radar. This may include questions such as, “Will I be able to fly to an upcoming family function?” Or, “Will hospice cost a lot of money?” I can’t anticipate those concerns, but they are easy to address once asked.
What have your patients taught you?
They’ve taught me a lot about courage, altruism and grace. I’m awed again and again by the altruism of patients who participate in clinical research, knowing that their experience will contribute to overall scientific knowledge that may not help them directly. The notion that someone in the future may benefit gives meaning to a very difficult course of treatment, and it summons reserves of strength and courage that are awesome to observe.
Why did you go to medical school in Tel Aviv?
My father’s side of the family is Israeli, so I wanted to get in touch with my roots. At first I was concerned that an education there might not match up to standards in the United States, but that turned out to be unfounded.
During the clinical rotations in the hospital in years three and four of medical school, we were not allowed to be taught by interns or residents. We were taught only by senior physicians and primarily by the department chief. In that system, medical students were prized possessions. As a result, we were spending several hours each day being directly taught by very seasoned physicians.
You once traveled the Inside Passage by kayak. Why?
I was about to go to medical school, and I thought this was my last chance to do something like that. A high school friend put together this trip and asked me to come along as an EMT. It took us two months.
If you weren’t a doctor, what would you be?
Probably a computer engineer or a composer.
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