Profiles in GU Oncology Now With Rana R. McKay, MD

Rana R. McKay, MD, is Associate Professor of Medicine and Urology and co-lead of the Genitourinary Oncology Disease Team at Moores Cancer Center, University of California, San Diego (UCSD). She speaks about how family experience and her training in internal medicine has led to a career in clinical practice and research encompassing the breadth of genitourinary oncology.

As a board-certified medical oncologist specializing in the treatment of genitourinary cancers, Dr McKay sees patients with kidney, prostate, and bladder cancer. Since arriving at USCD in December 2016, she has also been instrumental in building up the university’s Genitourinary Oncology Disease research program, designing and implementing clinical trials, often as principal investigator (PI). “Being a good clinician and understanding your patients, their diseases, and their tumors is imperative to being an excellent researcher,” Dr McKay maintains. “For me they go hand in hand, because the clinic is where all the creative thought comes from.”

Deciding on a Career in Medicine

Growing up in Florida, Dr McKay knew early on that she wanted to go into medicine. “My mom was diagnosed with breast cancer at an early age and her experience through her illness was a lot of the reason why I ended up going into oncology,” she explains.

Dr McKay attended the University of Florida (UF) School of Medicine in Gainesville, where she was accepted into the combined BS/MD Junior Honors Medical Program (JHMP, now HMP). The accelerated seven-year program is offered to undergraduates “who have demonstrated superior scholastic ability, commitment to serving others, and personal development during their first two academic years of enrollment.” Dr McKay describes it as “kind of a fast tract into the medical world.”

During her time at UF School of Medicine, Dr McKay was active in the American Medical Association (AMA) and in the Liaison Committee on Medical Education (LCME). “It was a fabulous place to train and I developed a love for the field of medicine in general, thanks to a lot of great mentors,” she says. The mentors she particularly credits were Gerold L. Schiebler, MD currently Professor Emeritus, Department of Pediatrics, Robert Watson, MD, currently Professor Emeritus and formerly Senior Associate Dean for Educational Affairs, and W. Patrick Duff, MD, Associate Dean for Student Affairs.. “They were all instrumental in my decision to go into internal medicine,” she explains.

Choosing to Specialize in Oncology

Dr McKay completed her residency in internal medicine at Johns Hopkins School of Medicine, Baltimore, “which had a remarkable program,” Dr McKay recalls. The Johns Hopkins program is divided into four equal units (“firms”), each named after a former director of the Department of Medicine. “I was in the Longcope firm [named after Warfield Theobald Longcope, physician-in-chief 1922-1946]. Charles Wiener, MD was program director at the time. It was really an amazing place to train, to learn the foundation of being a clinician, a detective, and researcher,” she recollects. Two mentors were instrumental in her decision to go into oncology: Judith E. Karp, MD, currently Professor Emerita of Oncology and Medicine, with whom she did research, and Robert A. Brodsky, MD, currently Director, Hematology Division and Professor of Medicine.

Dr McKay’s fellowship training took place at the Dana-Farber Cancer Institute in Boston, “an elite program where I learned the art of clinical research,” she says. She worked very closely with Mary-Ellen Taplin, MD, currently Director of Clinical Research, Lank Center for Genitourinary Oncology and Professor of Medicine at Harvard Medical School. “She still continues to be my mentor,” Dr McKay notes. Additionally, Dr. Toni Choueiri, MD “was instrumental in my growth and professional development.” Other individuals that helped shape Dr McKay into the clinician and research she is today were Geoffrey Shapiro, MD, PhD, and Philip W. Kantoff, MD (now at Memorial Sloan Kettering Cancer Center).

Planning a Career in GU Oncology

“During the first year fellowship training at Dana-Farber, I fell in love with the wide breadth of diseases that you treat in GU medical oncology,” Dr McKay recalls. Particularly attractive areas for research were immunotherapies and targeted therapies for kidney cancer; hormone therapies and biology of prostate cancer; and the treatment of testicular cancer “which is one of oncology’s medical miracles, with most patients being cured with intensive treatment.” She also observed that “you develop long-lasting relationships with patients,” She adds that in bladder cancer, “it has been great to see the field blossom, because when I first started my fellowship, it was still referred to as an ‘orphan’ disease, Now we’ve got so many treatment options and there’s a lot more research into bladder cancer.”

After deciding on genitourinary oncology. Dr McKay says that “the first thing I needed to learn was how to take care of patients and second, how to better understand the diseases themselves. From that clinical immersion stemmed my research questions.” After completing fellowship, Dr McKay remained on faculty at Harvard Medical School as an Assistant Professor Medicine. However, after in 2016, she decided to move to an institution where she would be able to participate in program development. Also, “my family was growing, so we had to decide where we were we going to put down roots. We settled on California and San Diego and it’s been wonderful.”

Clinical Trials in GU Oncology at UCSD

Since 2016, the UCSD genitourinary oncology disease program has nearly tripled in size and its clinical trials portfolio and translational program continue to expand. “It’s been really great to be at the pinnacle of helping shape a growing program,” Dr McKay acknowledges. She co-leads the program along with Aditya Bagrodia, MD (urology) and Brent Rose, MD (radiation medicine). On the medical oncology side, there are currently four medical oncologists, with a fifth in recruitment, and two advanced practice providers.

Dr McKay is heavily involved in various cooperative groups and consortia that run clinical trials, including the Alliance for Clinical Trials in Oncology and the National Radiation Oncology Group. She acts as co-chair of the genitourinary clinical trial working group of the Hoosier Cancer Research Network (HCRN), an independent nonprofit contract research organization that specializes in early phase multicenter, investigator-initiated oncology clinical trials. She also serves as the site PI for the UM1 at UCSD, so is involved in the National Cancer Institute’s Experimental Clinical Trials Network (ETCTN), which is dedicated to early clinical evaluation of innovative cancer therapies, and in the Prostate Cancer Clinical Trials Consortium, the nation’s premier multicenter clinical research organization specializing in cutting-edge prostate cancer research.

Dr McKay’s primary research interests are kidney cancer and prostate cancer. She recalls that one of the first research questions that she developed at Harvard and is still working on, derived from the observation that many kidney cancer patients with bone metastases had poor outcomes. Among the ongoing trials led by Dr McKay that are seeking to improve treatment in these patients is the RaDical trial (NCT04071223), a phase 2 trial of radium Ra 223 dichloride plus cabozantinib versus cabozantinib alone.¹

Key research in prostate cancer has been trials of new intensified treatment strategies for localized disease. With Dr Taplin, Dr McKay investigated the efficacy of neoadjuvant hormone therapies in patients with high-risk localized prostate cancer. We are now learning that 10-15% of patients with localized prostate cancer harbor germline or somatic BRCA1 or BRCA2 mutations. Dr McKay and her colleagues have hypothesized that in patients with germline alterations such as a BRCA1 or BRCA2 mutation, giving a PARP inhibitor in the same setting will significantly improve pathologic response. This will be tested in the NEPTUNE trial, a biomarker-focused neoadjuvant trial testing a poly(ADP-ribose) polymerase (PARP) inhibitor, olaparib, in localized prostate cancer. Other similar trials in development at UCSD will investigate treatment with nivolumab plus cabozantinib (CANOPY) and abiraterone plus abivertinib (MAVERICK).

Studying the Effects of COVID-19 in Cancer Patients

Dr McKay also serves as UCSD/Moores Comprehensive Cancer Center PI and funding co-chair for the COVID-19 and Cancer Consortium (CCC19). When the pandemic first started, there were many questions about how COVID-19 would affect cancer patients. “The CCC19 is a grassroots consortium formed in March 2020 by people who wanted to get answers to these questions,” Dr McKay notes. It maintains a large centralized registry of patients with confirmed COVID-19 who also have a current or past diagnosis of cancer.

Records are submitted by 129 institutions in the US and Canada and, to date, the registry contains over 12,500 completed records. UCSD is recognized for its outstanding overall and ongoing contributions to the registry. “We’ve been collecting and publishing data and leading a lot of the landmark work that’s happening on outcomes in patients with COVID-19 and cancer,” Dr McKay explains. A recently published retrospective analysis of CCC19 data indicated that patients with cancer are at increased risk of mortality and severe illness due to SARS-CoV-2 infection.³

Importance of Mentoring Women in Urologic Oncology

Currently, Dr McKay is one of a minority of women practicing in urologic oncology, and reports have also highlighted disparities in income and underrepresentation in leadership positions among female urologic oncologists.⁴ “I do think that there are inequities in the medical profession and not just with respect to women,” Dr McKay acknowledges. “My take-home message for that is, we need to be inclusive, everybody needs a seat at the table. We need to get rid of our bias, even if it’s unconscious, and everybody needs to be on the same level playing field without different standards based on gender or race.”

Dr McKay adds, “For me it’s been a real joy to mentor other young female trainees, medical students, residents, and fellows and help guide them and show them that even though nobody has that perfect balance, you can be successful in your profession, and you can be a wife and mother, or whatever it is that you want.  You can do these things while breaking the glass ceiling. You don’t have to live within the confines of a construct that someone else has generated for you. It’s been very important for me to mentor the next generation, because mentorship was huge for me in getting to where I am now and giving back is critical to help develop the next generation of clinicians and researchers.”

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

References

1. Testing the addition of a new anti-cancer drug, radium-223 dichloride, to the usual treatment (cabozantinib) for advanced renal cell cancer that has spread to the bone, the RadiCaL study. gov Identifier: NCT04071223.
2. McKay RR, Ye H, Xie W, et al. Evaluation of intense androgen deprivation before prostatectomy: a randomized Phase II trial of enzalutamide and leuprolide with or without abiraterone. J Clin Oncol. 2019;37(11):923-931. DOI: 1200/JCO.18.01777
3. Kuderer NM, Choueiri TK, Shah DP. et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. Lancet. 2020;395(10241):1907-1918. DOI: 1016/S0140-6736(20)31187-9.
4. Nettey OS, Fuchs JS, Kielb SJ, Schaeffer EM. Gender representation in urologic subspecialties. Urology. 2018;114:66-70. DOI: 1016/j.urology.2017.12.034