New Investigator Spotlight: Nina Sanford, MD

December 06, 2024

Dr. Nina Sanford is the Chief of Gastrointestinal Radiation at University of Texas Southwestern Medical Center in Dallas, Texas and an Associate Professor. She is a Boston native who graduated from Harvard Medical School and completed residency at Massachusetts General Hospital/Brigham and Women’s Hospital in 2018. Within NRG, she leads the pancreas working group and is PI of an upcoming randomized trial assessing radiotherapy in locally advanced pancreas cancer.

Q1: How did you get involved with NRG?

I think it was during my second year as attending when Dr. Ted Hong suggested I start going to NRG meetings. Ted is one of two co-chairs of the NRG GI Committee and was one of my attendings/mentors during residency. I didn’t really know what NRG was at the time or comprehend how big a role the cooperative groups play for radiation trials, but I enjoyed listening in to the discussions on clinical studies. At first, I was too scared to sit “at the table” so relegated myself to the peripheral chairs. I think my first real role at NRG was “chat box moderator” when the meetings became virtual. So that forced me to actually speak, and over time I’ve become more comfortable voicing my opinions.

Q2: What kind of research are you currently engaged with?

My main research endeavor through NRG is a Phase III randomized trial in locally advanced pancreas cancer where we are assessing whether the addition of dose-escalated radiotherapy improves overall survival (or quality of life) as compared to current standard treatments. We are finalizing the protocol and anticipate opening the trial in mid 2025. This trial is NRG-GI011, also known as LAP100 (100 referring to target biologic effective dose level (in Gy) in the experimental arm).

Q3: What is a recent accomplishment you are proud of in regard to your research/career?

I recently led development of a contouring atlas for pancreas cancer radiation. This was an international effort where we convened ~20 experts in pancreas cancer to put together essentially a set of instructions on how to delineate target volumes and make treatment plans for dose-escalated pancreas radiotherapy. Anatomy has always been my weak point so when my mentor, Dr. Bill Hall, suggested the project, I was a bit scared, hesitantly agreed, but really hoped he would forget about it. I am happy he didn’t though, because I really did learn a lot from the process of putting together the atlas and hope it will be a useful tool for practitioners. Also, I think anyone can agree that submitting a paper with more than 20 co-authors is a Herculean effort – which I have joked was perhaps more difficult than the actual project itself.

Q4: What are you most interested in achieving through your research/career and through NRG?

My first short-term goal is to successfully open and accrue to NRG-GI011/LAP 100 and then eventually to publish the findings. Of course, I hope the trial is positive, but even a negative trial, if done well, is useful. On the other hand, a positive (or negative) trial that is poorly executed raises more questions than answers, helps no one, and is a waste of precious resources (including patients’ time). Our trial team has been working hard to try to avoid this latter scenario.

Outside of this individual trial, I lead the NRG pancreas working group. We have several other study concepts under development, and my goal here is to help each of the study chairs in shaping their trials for presentation (and hopefully approval) by the NCI CTEP GI Steering Committee. This requires a different skillset in terms of guiding others and seeing how different concepts fit as puzzle pieces into the NCI study portfolio. 

On a broader level, as I learn more about the radiation oncology trial landscape, it’s clear that the cooperative groups are so critical for advancing our field. At the same time, cooperative group trials can be costly, complex, and oftentimes slow endeavors. The requirements can feel onerous, dissuading patients from enrolling and making data collection incomplete and/or less reliable. And unfortunately, by the time a trial’s findings are presented, standards of care have sometimes already changed, rendering the results less relevant. One way the NCI has responded to these challenges is through instituting a “streamlined” trial initiative whereby only “relevant” information (i.e. data directly related to a prespecified endpoint) is collected. I have likened this effort to the DOGE of clinical trials, and NRG-GI011/LAP100 will be one of the first under this category. I think this is one of several steps the cooperative groups can take to decrease the operational burden of studies, and I look forward to potentially help brainstorm other solutions to make our studies more efficient and impactful.

Q5: What inspired you to become involved in cancer research and/or specifically your field?

One observation that motivated me to become involved in radiation oncology research is that I saw a disconnect between what trials were reporting (or even researching) and the actual benefit of radiation therapy for patients. For example, in pancreas cancer, even though almost every recent randomized study has been negative, most physicians would agree there are subsets of patients across all stages of the disease – from resectable to metastatic – for whom radiation can help. However, for these treatments to be approved and made accessible, we need positive trials rather than anecdotes or consensus opinions.

So, at first, I thought about reasons why these studies haven’t been negative – is it patient selection? The chosen endpoints? Are the trials too small? Are they not asking the “right” questions? Then at some point after pondering these issues for a bit, I decided it was time to try to put my thoughts into action.

Q6: What has been your experience engaging in the radiation oncology community and with NRG?

Working with NRG has been a great experience. The organization is incredibly supportive of junior investigators and folks have really gone out of their way to be helpful with all endeavors. It’s a fun group too, and I look forward to catching up with everyone at the semi-annual meetings.

With regards to the radiation oncology community, I think most are trying to do the best for our patients. There are dissonant opinions on how to achieve this goal and particularly now with our changing healthcare environment, it’s important to listen to broad perspectives, including those who think differently.  One thing I really do like about NRG is that the network of participating hospitals encompasses both academic centers and community practices. So trials have to take into account different practice settings, which hopefully will also broaden the reach of our work.