How I Became a Genitourinary Oncologist and Clinical Researcher

Dec 14, 2023

Regina Barragán Carrillo, MD, is a postdoctoral fellow at the Genitourinary Clinic at the Medical Oncology and Medical Therapeutics at City of Hope in Duarte, CA. “I initially did my medicine, internal medicine, and oncology training in Mexico, so I came here a little later in life than the usual profile of applicants,” Dr. Barragán Carrillo said. “Typically, this position is filled by medical graduates preparing for residency or fellowship. In my case, it was not until I finished my training that I decided to spare some extra dedicated time for research in my area of interest, genitourinary malignancies.”  
Describe your typical day as a postdoctoral fellow. 
RBC: Usually, the day-to-day activities vary a lot. The night before, I scroll around clinical charts to look for candidates for any protocols we could be accruing for. For example, we are currently working on a protocol for patients with metastatic renal cell carcinoma in the first line using a natural extract from an Amazonian berry called camu camu. Usually, during the morning, I will be either in clinic with one of the attendants, seeing patients, or working on writing a manuscript, a protocol, or in a database. Whenever I am writing and need to clear my mind, I enjoy walking around the City of Hope’s main campus; it has some beautiful gardens that are good areas to refresh and get creative.  
During the day, we often meet or call to discuss updates on our main projects. On Wednesdays, the research team has dinner while discussing everyone’s research updates and any difficulties we might be experiencing with our research to try to solve them immediately. I appreciate that my mentor, Dr. Sumanta Pal, sets apart those 2 hours for his mentees every week, as he doesn’t let any difficulties remain unsolved.  
After the meeting, everyone usually goes home to spend quality time with their families and themselves. In my case, I really like reading murder mysteries, so I might have a book waiting for me when I get home, and as a non-native English speaker, that has improved my speaking and writing skills in a way that I was not expecting. Finally, before bed, I call home to check in with my loved ones; distance adds an additional layer of difficulty to maintaining personal relationships, so there is always some time set apart for family and loved ones.  
How did you initially choose your current career path? Were there any unexpected detours along the way? 
RBC: Like many others, I was inspired by a phenomenal oncologist back in Mexico. Her name is Dr. Cynthia Villarreal-Garza, and her area of expertise is breast cancer. As a medical student, I spent 1 year doing research with her centered on the study of breast cancer in young women in Mexico, which really made me fall in love with the craft. I would see the passion poured into every project and the fact that what we were doing mattered to patients, and it was bringing us a better understanding of their disease and their needs and expectations. That year was a turning point in my career—that didn’t just make me pursue a career in oncology as a clinician but also opened my eyes to the impact of research in patient care. In some countries, including Mexico, pursuing a clinical and academic career is quite a challenge, as resources allocated for research by trainees are basically nonexistent, and all the time you want to dedicate to something additional to patient care comes from your own free time. However, the fact that I had already experienced the impact of research on patients’ lives helped me stay on track with my personal and professional goals.  
What excites you most about your career in oncology? What is the most challenging aspect of pursuing a career in oncology? 
RBC: From a scientific viewpoint, oncology is a field of medicine continuously evolving, so there is always something new going on. That probably has a lot to do with the fact that I am absolutely convinced that some of the brightest minds I have met are involved in studying cancer. As a medical doctor, oncology is a very fulfilling area to be involved in because you build lifelong relationships with your patients and are allowed to share some of their most challenging and happiest moments.  
What initially spurred your interest in genitourinary cancers and how did you decide to focus on this specialty in your clinical and research career?  
RBC: As I mentioned, I started my research career in breast cancer in young women and stayed on that track during my residency. To put it into perspective, around that time, the first initial results on the use of immunotherapy in solid malignancies, mainly in kidney cancer and melanoma, were coming out, which, to my mind as a medical trainee, were completely astonishing; not so long ago, every textbook was describing the poor prognosis patients usually face with these diagnoses. Once I started my oncology career, immunotherapy research was already far ahead, and that had quadrupled the survival in patients with metastatic renal cancer, so the panorama looked full of potential. In addition, genitourinary oncology allows you to interact with an array of patients, from very young men with testicular cancers that get treated with one of the most active chemotherapy combinations we have had in the last 40 years, to elderly patients with bladder neoplasms who benefit from a combination of immunotherapy with an antibody drug-conjugate that was presented at the most recent ASCO Annual Meeting.  
Can you share more about your experience presenting at the 2023 ASCO Genitourinary Cancers Symposium and its impact on your career? 
RBC: At the 2023 Genitourinary Cancers Symposium, we presented a poster looking at the impact of race and ethnicity and the use of either a partial or radical nephrectomy in patients with renal cancer in the state of California. It had been previously described that racial and ethnic minorities experience disparities in their cancer care in multiple malignancies, and kidney cancer was no exception. Our analysis concluded that, even under similar circumstances of gender, age, comorbidities, and payor status, race and ethnicity impact the selection of either partial or radical nephrectomy in patients with renal cell cancer. From a career point of view, we still have to find more granular data to really understand the complex reasons that might be interplaying in this type of difference in patient care. Still, it is a stepping stone to justifying more dedicated research in that area. And presenting in such an important venue really gives you a huge opportunity to find other perspectives on your work, from weaker points you might not have considered initially to the next steps with your research. In our case with that poster, we hope that with the publication of the whole manuscript, more people will start looking at these disparities. 
What advice do you have for trainees interested in following a similar career path to yours? 
RBC: Probably the best advice I ever got when trying to model my career path was to really do your homework and get into the nitty gritty to understand which program and which team would be a better fit for your goals and your working style. And that is an experience that, many times, for me, was a bit of a trial and error, so it is crucial to put yourself out there and be very honest with your expectations while seeking mentorship. Finally, it is essential to evaluate the mentor-mentee relationship every so often to determine whether expectations are being met on both sides and, if not, to make the pertinent adjustments or, very validly, cut everyone’s losses and end things in the best way possible.   
What or who has shaped your professional journey and led you to where you are today?  
RBC: It is pretty hard to pinpoint a single interaction that could have shaped my professional career, but I have two significant figures to mention. I can’t give enough credit to the fantastic mentors and sponsors I have been lucky enough to find in my early career. One significant one is Dr. Narjust Florez from Dana Farber, who is the founder and leader of the Florez Lab, and within the lab, she has built a real sense of sisterhood among the members. Having a mentor with whom you culturally identify on many levels helps you feel represented and validated in many circumstances. I remember my first encounter with her at the Latin American Workshop on Clinical Oncology Research in 2021 in Colombia. From the first moment, she was extremely personable and genuine and very open with some advice I still carry to date. One that resonates with me is that if my grandmother would be afraid of something I were to do, I better not do it.  
The other crucial mentor and sponsor in my career has been Dr. Pal, or as he encourages us to call him, Monty. Just to give you some background on him, he has a bright mind, is a highly caring and competent physician, is one of the most influential figures in kidney cancer in the world, is a fantastic dad, and is a garage band musician. He is very generous with his knowledge and does not hesitate to share his thoughts and concerns. Without exaggerating, there is not a day you stop learning with him. Additionally, being a very relevant figure in academia, he is very candid about sharing the positives and the negatives of an academic career, and that honesty has allowed me to realistically build a career plan without losing my enthusiasm for research in academic medicine. 
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