Profiles in GU Oncology: Yasser M. A. Ged, MB BS

Dr. Yasser Ged has come a long way, both figuratively and literally in his career journey, starting with his studies in North Africa, then traveling to Europe for his postgraduate training, and finally moving to the US to advance his career in genitourinary oncology. Today he practices in medical oncology and serves as Co-Director, of the Kidney Cancer Research Program at Johns Hopkins Medicine, and Assistant Professor of Oncology at Johns Hopkins University in Baltimore.

That Dr. Ged was able to move from his home country, Sudan, and adjust so successfully to working overseas was in large part facilitated by his father, who played a big role in helping and advising him during his career, he explains. His family lived by the country’s main seaport, Port Sudan, on the Red Sea, where his father worked as a shipping captain. “My father had had the options of going into medicine or marine studies, but opted to study for a degree in marine law and he was successful in this field,” he recalls. “He inspired me along my pathway and advised me about my career since I was young,” he acknowledges. In high school, Dr Ged excelled in science, “so with my love of science, particularly biology, and inspiration from my dad, that’s how I ended up in medicine,” he relates.

Medical School Beginnings in Sudan

Dr. Ged began his studies at the University of Khartoum Faculty of Medicine, the oldest medical school in Sudan. The school opened in 1924, during the British administration of Sudan and was originally called the Kitchener School of Medicine (after senior British Army officer and colonial administrator, Horatio Herbert, 1st Earl Kitchener). In 1951, the school was amalgamated into the University of Khartoum, the largest and oldest university in Sudan. Since gaining independence in 1956, Sudan has experienced cycles of political instability and economic crises, but Dr. Ged recalls that during the time he attended medical school, Khartoum, the capital of Sudan, was relatively calm.

Medical education at Khartoum in part reflects its British origins in that students enter directly from high school and, after successfully completing 6 years, are awarded the MB BS (Bachelor of Medicine, Bachelor of Surgery) degree. Dr Ged gained his MB BS in 2005, graduating in the top 10 of his class, and went on to an internship in internal medicine at Al Jawda Hospital in central Khartoum. Then, taking advantage of the Faculty’s connections with European and US professional institutions, Dr. Ged chose Ireland as the location for his residency, which he began, under the auspices of the Royal College of Physicians of Ireland, in 2009. His rotation took him to many parts of the country, including Dublin, Galway, Waterford, and Limerick. Adjusting to Western culture wasn’t very difficult, he says, “I used to go abroad to conferences, but also since my dad was a shipping captain we used to travel a lot with him to Europe. So adapting to the culture was kind of easy.”

While trying to decide whether to specialize in oncology, rheumatology, or pulmonology, he did 6 months of training in rheumatology. “I didn’t think that was for me, so I changed to oncology and I loved it!” he recalls. During his oncology rotation, he became interested in genitourinary cancers, in particular kidney cancer. “I saw an interesting case where a patient with stage IV kidney cancer underwent a spontaneous resolution of metastatic disease after nephrectomy, which only happens once in a thousand cases,” he recollects. “I became intrigued about kidney cancer and that’s why I wanted to pursue a career in genitourinary cancer and focus on that.” Before he left Ireland, he gained his Certificate of Completion of Specialist Training (CCST):and board certifications from the Royal College of Physicians Medicine (Ireland) in internal medicine (2011) and oncology (2017). Dr Ged speaks of Ireland fondly. “I still have many friends there,” he says, He also retains a love of Irish music and rugby football.

Continuing a Career in Oncology in the US

He decided on a Fellowship in the US and in 2019 began an Advanced Medical Oncology Fellowship at Memorial Sloan-Kettering Cancer Center (MCKCC) in New York, focusing on genitourinary oncology, mainly clinical training and research in kidney cancer. There, he met kidney cancer pioneer Robert J Motzer, MD Section Head, Kidney Cancer, Genitourinary Oncology Service; Jack and Dorothy Byrne Chair in Clinical Oncology. “I had been reading his work and then I ended up actually working with him and training under him,” Dr. Ged recollects. Another mentor was Martin H. Voss, MD, Clinical Director of the MSKCC Genitourinary Medical Oncology Service. Working in the US turned out to be a very happy experience and Dr. Ged decided to stay. “I love the way the cancer research goes in the US and the hybrid in academia of caring for patients and developing research,” he says. He points out that he is just one of a number of Sundanese-born physicians pursuing successful careers in the US.

In 2020 Dr Ged moved to Johns Hopkins, where most of his clinical practice is focused on kidney cancer and the remainder on testicular cancer, seeing patients at the Skip Viragh Outpatient Cancer Center in Baltimore. He co-directs the Kidney Cancer Research Program with Nirmish Singla, MD, MSc, Assistant Professor of Urology and Oncology in the Brady Urological Institute and Director of Translational Research in Genitourinary Oncology. Their projects are mainly focused on three areas: furthering the understanding the biology of kidney cancer; studying biomarkers for clinical efficacy of specific interventions, primarily immunotherapy. and therapeutics-based clinical trials and preclinical studies.

Dr. Ged has recently acted as site principal investigator (PI) for a number of clinical trials, including CONTACT-03 (NCT04338269), which investigated atezolizumab combined with cabozantinib versus cabozantinib alone after immune checkpoint therapy in patients with advanced kidney cancer.¹ “We expect the results to CONTACT-03 to be out next year,” Dr. Ged predicts. He is also site PI for LITESPARK-022 (MK-6482-022) (NCT05239728), a phase 3 study of pembrolizumab combined with belzutifan or placebo as adjuvant treatment of clear cell renal cell carcinoma (ccRCC),² and PROSPER RCC/EA8143, a Phase 3 study that compared priming the immune system with neoadjuvant nivolumab prior to nephrectomy, followed by adjuvant nivolumab in patients with high-risk RCC compared to surgery alone. Late-breaking data from the trial were presented during the 2022 congress of the European Society for Medical Oncology (ESMO).³

Dr. Ged has been interested in the effects of COVID-19 and is site PI for the natural history study, NCCAPS (NCI COVID-19 in Cancer Patient, NCT04387656), which is investigating the effects of COVID-19 on cancer patients. Researchers are collecting blood samples, medical information, and medical images from nearly 1800 cancer patients who also had COVID-19 and aim to follow them for up to 2 years. An initial report after 2 months of complete follow-up was presented at the 2021 American Society of Clinical Oncology (ASCO) annual meeting.⁴ Dr Ged is also responsible for site enrollment in the ODYSSEY RCC (Outcomes Database to prospectivelY aSSEss the Changing TherapY Landscape in Renal Cell Carcinoma trial NCT04919122) a prospective, observational phase 4 study to understand the cancer management and health-related quality of life in patients with metastatic RCC in routine real-world US clinical practice, including both community and academic treatment settings. “We actually have the highest enrollment in the country to date,” Dr. Ged notes. The upcoming randomized S2200 study, PAPMET2 (NCT05411081), a phase 2 trial sponsored by the National Cancer Institute and led by SWOG, will compare cabozantinib alone or with atezolizumab in patients with papillary metastatic RCC.

Recent Research and Studies

Dr. Ged recently initiated a pilot study looking at combined aerobic and resistance exercise with immunotherapy in patients with metastatic RCC (NCT05103722). The trial will investigate effects on quality of life, changes in physical activity levels, and the change in inflammatory myokines with the exercise intervention. The reason for this study, Dr. Ged explains, is that during one of his research studies at MSKCC, they found that patients with sarcopenia (weak muscles) did poorly when they were treated with immunotherapy, “There are some preclinical data to show that exercise can affect T cell activity and can enhance immunotherapy activity,” he adds. “So we are selecting kidney cancer patients who have a more sedentary lifestyle and would be expected to have weak muscles, and we are going to look at whether there is any hint of activity that exercise could influence immunotherapy outcomes or not.”

Apart from research and clinical practice, Dr. Ged’s other roles at Johns Hopkins include mentoring Fellows and promoting diversity in clinical trial enrollment. “I am the Johns Hopkins Equity Officer in one of the NCI grants,” he explains. “This is one of my interests in the field and it is a challenge everywhere,” he notes. “It should be made easier by using social media platforms, but implementation still needs a lot of effort. But right now, we have a lot of tools that we can incorporate to understand how better to promote it,” he asserts. Outside Johns Hopkins, Dr Ged’s professional activities involve serving as site representative on the National Comprehensive Cancer Network (NCCN) panel for kidney cancer. (The latest version of the guideline was issued September 22, 2022.⁵)

Away from medicine, Dr. Ged admits to being a music fan and a vinyl record collector. “I have about 2000 records so far,” he admits, and he travels to record shows across the country to add to his collection. His taste in music is broad, spanning rock and roll to electronic. He still keeps in touch with Sudan, although his closest relatives now live abroad, his mother and one sister in Cambridge, UK, and another sister in Ireland. The rest of the family remains in Sudan, and under current unstable conditions, most contact with them is online, Dr. Ged says.

Linda Brookes, MSc is a freelance medical writer/editor based in New York and London.

References

1. Pal SK, Albiges L, Rodriguez CS, et al. CONTACT-03: Randomized, open-label phase III study of atezolizumab plus cabozantinib versus cabozantinib monotherapy following progression on/after immune checkpoint inhibitor (ICI) treatment in patients with advanced/metastatic renal cell carcinoma. J Clin Oncol 2021; 39(6 suppl). Abstract TPS370. DOI: 10.1200/JCO.2021.39.6_suppl.TPS370
2. Choueiri TK, Bedke J, Karam JA, et al. LITESPARK-022: A phase 3 study of pembrolizumab + belzutifan as adjuvant treatment of clear cell renal cell carcinoma (ccRCC). J Clin Oncol. 2022; 16(suppl). Abstract TPS4602. DOI: 10.1200/JCO.2022.40.16_suppl.TPS4602
3. Allaf M, Kim SE, Harshman LC, et al. Phase III randomized study comparing perioperative nivolumab (nivo) versus observation in patients (Pts) with renal cell carcinoma (RCC) undergoing nephrectomy (PROSPER, ECOG-ACRIN EA8143), a National Clinical Trials Network trial. Ann Oncol. 2022;33(suppl 7):S1432-3. Abstract LBA67. DOI: 10.1016/j. annonc.2022.08.072
4. Korde LA, Best AF, Gnjatic S, et al. Initial reporting from the prospective National Cancer Institute (NCI) COVID-19 in Cancer Patients Study (NCCAPS). J Clin Oncol. 2021; 39(15 suppl). Abstract 6565. DOI: 10.1200/JCO.2021.39.15_suppl.6565
5. Motzer RJ, chair, Jonasch E, vice chair; NCCN Kidney Cancer Panel members. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Kidney cancer, version 3.2023 – September 22, 2022. National Comprehensive Cancer; 2022. Available at https://www.nccn.org/guidelines/category_1