Mar 24, 2020
In this special podcast series, guest host Dr. Miriam Knoll, radiation oncologist at the John Theurer Cancer Center at Hackensack Meridian Health, interviews a wide range of oncologists who reflect on their diverse experience, greatest challenges, and the unforgettable moments that have shaped their careers. In this episode, Dr. Knoll speaks with Dr. Gilberto D. Lopes of the Sylvester Comprehensive Cancer Center about his inspiring career that has taken him across the globe.
Dr. Miriam Knoll: Welcome to the ASCO Daily News Podcast. I'm Dr. Miriam Knoll, and I'm delighted to be the Daily News guest host for this special podcast series that will explore the spectrum of oncology careers. I'm a radiation oncologist, and I'm an early career oncologist, and I'm really interested in interviewing oncologists from a variety of oncology careers. In this series, you'll hear from a wide range of guests about their diverse experience, greatest challenges, and the unforgettable moments that shaped their careers.
In today's episode, I'm thrilled to welcome Dr. Gilberto Lopes, a medical oncologist and the Medical Director for International Programs and Associate Director for Global Oncology at the Sylvester Comprehensive Cancer Center. He's also an associate professor of clinical medicine at the University of Miami Miller School of Medicine. Dr. Lopes and myself report no conflicts of interest relevant to this podcast. Full disclosures relating to all Daily News Podcast can be found on the episode page.
Dr. Lopes, welcome to the podcast.
Dr. Gilberto Lopes: Hi, Miriam. It's great to hear from you. How are you?
Dr. Miriam Knoll: Good. So of course, you and I met for the first time on Twitter.
Dr. Gilberto Lopes: We did. And then we met in real life.
Dr. Miriam Knoll: Yep. Yep, which is always amazing. I always find, I don't know if you agree with this or not, but I'm always surprised when I meet someone that I first met through Twitter that you really feel like you know them, like you really know them, like, it actually is a real relationship. Isn't that amazing?
Dr. Gilberto Lopes: It is. It is amazing, and it is true, because we tend to share so much similar medical Twitter accounts that it is like you actually have been part of our lives.
Dr. Miriam Knoll: Exactly. Exactly. I find the only thing that surprises me always is I'm always surprised by someone's height. No matter what, I thought they're either taller or shorter in real life.
Dr. Gilberto Lopes: I love that. I really love that.
Dr. Miriam Knoll: Right? And it's not like I remember thinking, like, hmm, I thought that person was tall or short. It's always taller or shorter than whatever it is I had in my head.
Dr. Gilberto Lopes: And I was going to say that's not the type of social media we actually disclose that type of information.
Dr. Miriam Knoll: Exactly. Exactly. So today, I wanted to talk to you about your career and what advice you have for really, anyone that's listening, all of our ASCO members, but also specifically for trainees and early career oncologists. So, my first question is, what advice would you have for someone who's interested in getting involved in global oncology? And maybe you could also give us a short intro into what global oncology is.
Dr. Gilberto Lopes: Absolutely. And this is something that a few years ago we wouldn't have anybody asking us about. And we are extremely happy that it is becoming an area of academic interest, and it is becoming an area where not just ASCO, but also the NCI and a number of academic institutions have actually been putting a lot of effort and also money in so that we can continue to develop global oncology.
So global oncology is actually a very broad term. We had the challenge of actually trying to define exactly what global oncology is for ASCO. We were part of a task force that was called the Academic Global Oncology Task Force, which actually tried to make sense of what it is. And I'm going to quote, and I'm going to actually get the formal definition that we came up with so that I do not deviate from what the group actually came up with.
And Julie Gralow was the chair for that task force, and we actually do have those coming out in a forthcoming issue of the Journal of Global Oncology. And we do have some of it already out in ASCO Connection if people want to check it out. And the gist of it is that global oncology is the discipline that actually studies all worldwide aspects of cancer care. And here we, of course, always mention delivery of care implementation science related to being able to deliver the best cancer care possible in resource-constrained settings.
But we also like to remember particularly that global oncology is also about learning the biological differences in between cancers that we see in developed countries and developing countries. So why is it that yes, cancer patients do better in certain parts of the world and worse in others? Why it is that we have so many gall bladder cancers in the Andes region, in the Americas, and also in Asia. So, these are all the important and interesting questions. Of course, it does intersect with policy, with health economics, pretty much with anything that has to do with delivering cancer care around the world.
Dr. Miriam Knoll: And what advice would you have for someone who's interested in getting involved, who hears about what you're sharing with us and thinks, wow, that's fascinating, I want to do that, I want to be a part of that?
Dr. Gilberto Lopes: It absolutely helps to find a mentor. And we had a survey of NIH-funded institutions in NCI-designated Cancer Centers, and more than half of the centers actually had somebody working in international projects and works in projects that we would classify as having to do with global oncology. So, reaching out to somebody in your institution would be a great way to start.
And if you don't, as I mentioned, it's very easy to find many of us on the Twitter, of course, and on other social media. I have always been surprised in my career, especially when I started more than 20 years ago, how the people who tend to be the most active are also the nicest. And it was extremely rare that I would reach out to someone by email—when I started there was no such thing as a Twitter or Facebook, and we reached out to people by email.
And actually, I even had a period in my career where you reached out to people by letter or phone. And I just dated myself, no? But it is something that you can do. So, reaching out to somebody that works on it always helps.
But one big piece of advice—whenever you reach out to somebody, come in with an idea. If you just reach out to people and say, I want to do work in global oncology, it really doesn't get you to move much because people are busy. And even though most of us would love to help, it's extremely hard to just come up with some project out of nothing.
So always think about those things that your strengths are, where you're from, where you have contacts, where you have worked, and what is it that you can do in that environment, what is that you can do with the specific strengths that your institution has? So always try to think about the issue a little bit before you actually move forward.
So, for instance, in Miami, we do have a large population that has migrated from the Caribbean, from Latin America. And that has helped us actually ask a number of interesting questions. What are the differences in epigenetics, for instance, of Haitian patients were diagnosed in Miami versus patients in Caribbean? So, we have a number of projects that have come out of the curiosity that we had for seeing things that we're seeing on a daily basis. So always think about the strengths you have in your center and what it is that you're curious about that you would like to try to do.
Dr. Miriam Knoll: Yeah, I absolutely agree, and I think that's great advice. I don't know if you read Sheryl Sandberg's book Lean In.
Dr. Gilberto Lopes: I did.
Dr. Miriam Knoll: Yeah, so you know how she says there the way that you get a mentor is not by asking someone, can you be my mentor, right? So, mentorship is an organic process. It's something that happens over time. It's a relationship that you develop with someone. Let's say someone says they are interested in global oncology - and I -
Dr. Gilberto Lopes: That's right.
Dr. Miriam Knoll : —don't know anything about that person, and it's really easy to sort of forget to write back because you don't even know where to start.
That's very, very different than an email from someone that says, hi. I'm a third-year medical student. I'm really interested in this and this, and I'd like to do a review of this topic. Do you have time to talk? That's an email that's—
Dr. Gilberto Lopes: Absolutely.
Dr. Miriam Knoll: —a whole lot easier to respond to.
Dr. Gilberto Lopes: It's very hard to say no to an email that actually comes with an idea.
Dr. Miriam Knoll: Right. Amazing. So, such great advice, thanks so much. And I also wanted to ask you about your MBA. When and why did you get an MBA? And do you feel that that's a degree that has helped you in your career?
Dr. Gilberto Lopes: I get that question a lot, and it definitely has. So, I was in my second year of post-fellowship when I got my MBA. I was in Singapore, and I did my MBA at a British school that actually had a overseas campus in Southeast Asia. And the reason I thought I needed to do it is because in medicine we learn nothing about the world. We pretty much just learn about medicine as we train.
And we learn nothing about how things are run. We learn nothing about how to manage people. We learn nothing about finance, how to do budgets, how to invest. So, we pretty much see not at all from all those aspects that are extremely important when you start actually having a career in academic medicine.
As you move from just being a physician, which is extremely important and many of my brightest colleagues just want to do that, they just want to be physicians with patients, but if you do intend to have a career in any institution that is larger than just a small physician group, it is extremely interesting and important if you want to be in a leadership position to consider doing an MBA or any other types of programs that will give you a little bit of the background, the vocabulary. And it helps you learn about the language of management and business.
So, I realized that for me to continue growing in academic medicine, I wanted to become a director for clinical trials first and then a medical director for a cancer center. Eventually, I actually became chief medical and scientific officer for the largest practice in Brazil. So, I was in Singapore after finishing fellowship for about seven years. And I actually thought, at some point, that I would never come back to the West.
And I got this invitation from a growing group in Brazil that eventually became one of the largest practices not just in Latin America, but also around the world. Today, there's more than 450 oncologists in the group. And they invited me to come in and be their chief medical and scientific officer because I had a background in both being a clinician, doing research, and also in management. So, it has been invaluable for me to learn a number of things that I had no idea about to actually get the MBA.
And people do MBAs for different reasons. So, one of the main reasons people do MBAs are for the networking, for the people that you meet that can then help you in consulting ventures, and business ventures, and so on. For me that was never the most important thing. For me it was really learning about how to manage people, how to make sure that your budgets make sense, how investments work, how you actually get people to put money in different endeavors, and things of that sort. So, it is absolutely a must if you intend to be in leadership positions in any institutions that has thousands of people.
Dr. Miriam Knoll: Great. That's really a very interesting perspective. And I love how what you're saying is that you want to continue working with patients and being an oncologist, and that the MBA—
Dr. Gilberto Lopes: Absolutely.
Dr. Miriam Knoll: —really helped with that.
Dr. Gilberto Lopes: It did. And I can't imagine myself not seeing patients. Actually, that was one of the main reasons I moved back to the US from Brazil because here at the University of Miami, I have actually what I see as the perfect balance in my activities. I see patients about 45% to 50% of my time, and the other 50% I'm now dividing between global oncology and clinical research as well as the fellowship program. I became the director for our fellowship program on January 2. And everything that I learned in the MBA has been extremely useful helping develop careers of young oncologists and hematologists as well.
Dr. Miriam Knoll: Well, congratulations on becoming the program director. That's amazing. Can you tell us about—actually, a different position that I wanted to ask you about—
Dr. Gilberto Lopes: Sure.
Dr. Miriam Knoll: —is that you're editor-in-chief of the Journal of Global Oncology. So how does one become an editor-in-chief? I think that's something that a lot of trainees and early career oncologists look at and say, wow, I want to be an editor. How do I do that? So, was it something that you always wanted to do? And what was the path for you? And what could the path be for someone else?
Dr. Gilberto Lopes: I don't think anybody finishes medical school or high school thinking, someday I'm going to be editor-in-chief of a medical journal. But it is something that does come with the career, and it is something that is fascinating. We actually all get involved in things that eventually are basically to become an editor-in-chief.
So as soon as we start in academic medicine, we start reviewing works of our colleagues. So, whenever we actually publish an article anywhere, you start getting invitations from that journal, usually, to become a reviewer. And that's actually the first step for you to have a career in editorial boards and as editor of medical journals. And that becomes a very interesting endeavor as well.
It's a great way of actually seeing what your colleagues are working on, sometimes months before they come to the forum. And there's different ways of preparing. So, at ASCO, and especially at the Journal of Global Oncology, we created a new program called the Editorial Fellowships. And this is a very competitive process. We get hundreds of applications for between one and five positions every year.
We started that as a pilot at the Journal of Global Oncology. We got something called a PROSE award for innovation based on having the program, and the idea of the program was to train people to become better reviewers so that they could actually start that process of eventually becoming a member of an editorial board, and hopefully in the future also editors in chief for not just ASCO, but different international oncology journals as well. The program has been going on for a few years, and we now actually have five fellows, one for General of Global Oncology and four that are shared work from one of the other ASCO journals.
Also, good moment to remind everybody that ASCO journals now have a common name. They're all Journal of Clinical Oncology. Of course, we have the original JCO. And we now have JCO Global Oncology, JCO Precision, and JCO Clinical Informatics, as well as Practice, which used to be the JOP. So, this is a path that a number of colleagues have taken in the past.
What used to happen is that your mentors actually get you to meet people, and then you did more reviews. And if you do actually generate quality reviews, often you get involved in more reviews, and then you get invited to be part of an editorial board. And for the JGO, JCO GO in particular, this was a global process.
ASCO created a search. I was one of the original associate editors, so I was relatively young. I wasn't out of fellowship that long when I became associate editor. And then when Dr. Kerr, who was the original editor-in-chief for the JCO GO had to leave, there was a search.
And ASCO selected me as the second editor-in-chief for what was then JGO, and is now JCO Global Oncology. And I have just started the beginning of my second term. The second term is a five-year term, so I should continue being the editor-in-chief for five more years. And then it's time to pass the ball to the next generation.
Dr. Miriam Knoll: Great. So, what's the worst career advice that you've ever gotten?
Dr. Gilberto Lopes: Don't go to Singapore. That was the worst—that was the worst career advice I ever got. When I decided to move to Asia, it was such an easy decision to me. So, I had come from Brazil to the U.S. as a sixth-year medical student. Then I went back home, graduated, studied, worked a little bit so I could actually make enough money to take the steps.
Then I took the similar steps one and two. At the time, we didn't have the clinical skills assessment part of it. And then I applied to one place for residency because that's what I had money to travel to—I had money to travel from Brazil to Miami. And as I had spent time here as a student, I knew that this was the place I had the best chance of getting an internship in the U.S.
Dr. Miriam Knoll: Wow.
Dr. Gilberto Lopes: And I came to Miami as an intern, did my residency here. I was the chief resident. And then for fellowship, I did have a number of different options. My wife's job was here and was not quite portable, so we decided to stay in Miami for fellowship as well. And when I finished, I actually had a J-1 visa, so I either had to go back home for a few years, 2 years to be exact, or I needed to go to some area that would be considered underserved and through which I could get a waiver to stay in the U.S.
And I did have a few options, and I got an offer from Penn. I had a potential offer from UT at Southwest here in Dallas. But the potential to go to Singapore was actually the most interesting one. So, Hopkins had had a cancer center in Singapore and research labs for a few years, and they were looking for somebody to help develop their clinical trials program.
And my wife is of Chinese origin, so she always had the curiosity to live in Asia for a while. Then we decided to apply for it, and we went for an interview in Singapore. Loved the place, and then just decided, well, it was just such an easy decision to make that even though more than one person actually told me, don't go to Singapore, stay in the U.S. somewhere, it was definitely a very, very easy decision, and it's certainly a decision that I see today as being the beginning of my academic career. And it was certainly a great beginning. I have a lot to thank Singapore and Hopkins for.
Dr. Miriam Knoll: So, was that unsolicited advice that you got?
Dr. Gilberto Lopes: In a way, it was. But when I discussed plans in general with colleagues who were graduating fellowship or with mentors, there was actually only one who clearly saw that that was easy, very easy to decide and that was the best option for my career then. This was one of our breast cancer oncologists, Dr. Stefan Gluck. He was the one who actually was the only one who said, I have no doubt that this is the best option for you right now, and you should go and not think twice. And now—
Dr. Miriam Knoll: Was it hard to reject everyone else's, quote, "advice?"
Dr. Gilberto Lopes: Actually, it wasn't because in my mind, it was such an easy decision to make that I pretty much ignored everybody who was a naysayer about going to Singapore.
Dr. Miriam Knoll: Great. Well, it definitely sounds like you're—at that time and now, that it was the right decision.
Dr. Gilberto Lopes: Mm-hmm Absolutely.
Dr. Miriam Knoll: What was the best career advice that you've ever gotten?
Dr. Gilberto Lopes: Oh, there's a lot. So, there is something that everybody should read if you haven't read, and I think this was published back in 1999, and they're now known as the "Simone Maxims" for anybody working in academic centers. Joe Simone was and is an oncologist who has had a very big role in managing and developing people as well, and he came up with his maxims that everybody should try and read.
And I think it came out in Clinical Cancer Research more than 20 years ago or so. And these were things like the first one is the one that I always remember the most, and its institutions don't love you back. And that is something that is a little bit cynical, but it makes a lot of sense. Any place you work for, even though sometimes you think that that's your whole life, it has a different time horizon. They are going to be there when you leave, so you always have to think on what's best for yourself.
So, I grew up in medicine in a time when Brazil was coming out and was living its transition from dictatorship to democracy. And we were infused with a sense of public service and an ethos of serving the collective rather than the individual. And to me, it was always hard to realize that we have to be well, and we have to take care of ourselves so that we can actually serve. And that was one of the maxims that helped me realize that as I was becoming a little bit older.
But to finish just in terms of what the best career advice is, is that oncology is a team sport. You do not accomplish anything alone. So, you need to make friends. You need to collaborate.
You need to help other people's projects so that you can actually further your own. And that is the single most important advice I've gotten in terms of becoming an academic oncologist. And that advice I got from Caio [Max Sao Pedro] Rocha Lima, who used to be a GI oncologist in Miami when I was a fellow and who now works at Wake Forest.
Dr. Miriam Knoll: And you mean working with other oncologists and colleagues with their projects?
Dr. Gilberto Lopes: With colleagues in every arena, so not just oncologists, not just medical oncologists, with radiation oncologists. Collaboration is the only way we actually do anything that is worthwhile.
Dr. Miriam Knoll: Wow. That's great advice. So, what advice would you give to trainees and early career oncologists?
Dr. Gilberto Lopes: Get out there. Do everything that you can. Go to meetings. Get to see people. Get to know your fellow colleagues. They often will be partners for projects for your whole life.
Get to meet people in different institutions. Just get yourself out there. It's amazing how people will help you if you have an interest and if you show that you can actually get things done.
Dr. Miriam Knoll: Well, Dr. Lopes, thank you so much for this insightful and candid discussion. And thanks so much to our listeners for joining us for this special episode of the ASCO Daily News Podcast. We'd really love to have your feedback, so feel free to email us at DailyNews@asco.org. And of course, don't forget to rate and review us on Apple podcasts. Dr. Lopes, of course, can be found on Twitter @glopesmd. And I can be found on Twitter, too, @MKnoll_MD.
Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
Dr. Gilberto Lopes
Honoraria: Boehringer Ingelheim
Consulting/Advisory Role: Pfizer, AstraZeneca
Research Funding: AstraZeneca, Blueprint Medicines, Tesaro, Merck Sharp & Dohme, EMD Serono, Bavarian Nordic, Novartis, G1 Therapeutics, adaptimmune, BMS, GSK, Abbvie, Rgenix, Roche, Genentech, Lilly, Janssen