Dr. O. Mool Gupta, and I want to thank you for joining me on another episode of Medicine Mentors, where we interview masters in medicine, leading physicians at the top universities across the United States to learn from their experiences and derive key insights, traits, and best practices that can guide medical students and residents. They were honored to host Dr. Rachna Shroff. Dr. Shroff is the chief of the Division of Hematology oncology and Associate Director for Clinical Research at the University of Arizona Cancer Center, where she also serves as the Associate Dean for Clinical and Translational Research with the University of Arizona College of Medicine. She is a clinical and translational investigator focused on developing novel targeted therapies and immunosariphes for pancreatic and hepatobiliary cancers, and has led multiple clinical trials, including the first randomized phase three trial in biliary cancers in the United States. An internationally recognized expert, she is one of three women to achieve the prestigious 2022 Women in Oncology Award, and this year was recognized at ASCO with the Helio Women Disruptor of the Year Award. Thank you so much, Dr. Shroff, for being on. What an incredible opportunity to speak with somebody who's truly a celebrity in medicine. Thank you so much for having me. I'm so excited to be here. I'm honored. You know, I've had a chance to look through a bit about your life, and we always love to start early on. Understand a little bit about your childhood, what it was like, who are some of the role models and maybe an inspiring event that has really dictated and defined your career trajectory. Sure. What people don't always know about me is that I'm at the University of Arizona, but it was essentially a homecoming. So, I grew up in Tucson, Arizona, which is where the University of Arizona is. And my father was on faculty at the University of Arizona. My mother is a retired physician who took care of many kidney patients. She's a nephrologist. And so, growing up here, she was probably my role model. She was in the 1980s, a woman of color and a physician who would be in the doctor's lounge and often be told that she didn't belong there. So, if she was really somebody for me that shattered glass ceilings without me even really realizing it, I think, because I don't think at the age of eight, I truly understood what she was doing and the trailblazer that she was. And then even when I was in high school here, I actually worked in a lab at the Arizona Cancer Center. So, my first exposure to cancer and cancer biology and cancer research, happened when I was 14. And I was placed in the lab of a woman, Dr. Margaret Briel, who was an incredible mentor and really helped me get bitten by the bug in terms of an interest in science and the science of cancer. And then when I came home in 2018, she was actually one of the leaders, one of the cancer center leaders and oversaw our cancer research training and education group. And so, it was really exciting when I came home and I reached out to her and told her, "I don't know if you remember me. My name was Russia Trevetti when I was here." And she was like, "Not only do I remember you, I have a picture from that summer together." And so, we met and had lunch and we actually continued to develop a mentor-mentee relationship. So, it was a really great childhood in the sense, but also a very full circle moment. That is amazing. The touch of mentors early on in life. You came from a family of physicians. You saw your mom early on in life as you progressed into medicine. Any challenges that you faced early on, times that you feel reflecting now back on, that you learned a lot out. Yeah, I think for me, medicine was, you know, I was definitely committed to becoming a doctor early on, but I don't know that I truly knew what that meant because I had really only seen one flavor of it, if you will. And that was my mother who was in private practice and was a solo practitioner. And so, I would watch this woman round and work seven days a week. She would round on patients at multiple hospitals. And the only time off she really talked, the only time she didn't see patients is when we were physically traveling, when we were on vacation. And obviously, medicine in that era was different. It was beepers and you were not accessible 24/7. She worked really hard. And so, in my understanding of medicine, I assumed that would be the type of doctor that I would become. And as I think the science of medicine really started to intrigue me more and more, it's really when I started to understand that medicine is a really catch-all phrase and that there are so many different ways to see in a cat and so many different ways to be a doctor and to have an impact on patients, that the humanity of oncology and the art of taking care of a cancer patient is not something I really recognized until I was at medical school and maybe even residency. And so, it's been a, it's been sinusoidal in the sense of how I come to oncology and cancer research, but it's really been something where I've had to learn that there is not necessarily just one path within medicine and you should not necessarily have a narrow focus on exactly who you want to be and what you want to be and really keep it open mind because not to bring up mentors again, it's actually mentors that drove me in the directions that I ended up taking. And when you talk about like finding this path, a lot of us have a challenge. You were fortunate and probably put an incredible amount of hard work, but fortunate to be exposed to the lab, find something that you really liked. A lot of us do things that we don't like and then you know, it's kind of a mystery. What do we do next? How do we find this path? What advice do you give to your mentees who are in the middle of this perplexing decision-making? Yeah, I think the most important question and I don't know that it's necessarily something that you think of immediately, but you have to understand your why. And I say that to my faculty, I say that to my trainees, I say that to my children, I think you need to figure out your why. And for me, it was the intersectionality of the fact that cancer patients have this incredibly dark and scary journey ahead of them and I want to be able to hold their hand mixed with the fact that we haven't cured cancer. So clearly, we need more research in that space and we need to bring in novel drugs and bring hope to these patients in a very smart and scientifically driven way. But that's me and everyone is a little bit different and you know, we have in my faculty, for instance, people who are just master clinician educators and they're why is helping grow the pipeline and develop the next generation of oncologists and that why is what you need to find and then let that drive you? Because like I said, the correct path for me is not necessarily the correct path for you. And how you find the why? I really think it's just by being open-minded and trying all kinds of different activities and opportunities. And I hate to say it like this, but a little bit of throwing darts at a dartboard and seeing what sticks and going with your gut, I say all the time I make a lot of my decisions based on my gut instinct. And that is how I ended up in GI on collagen because my plan was to be a stem cell transplanter and my gut instinct kicked in when I found the right mentor and I was like, never mind, this is what I want to do. And so sometimes you have to just trust yourself and trust your instincts. And when you go through these cycles and are figuring this out, ultimately, how do you know that you're successful? Is it that paper? Is it that mentor? Is it that feeling? What does this success really mean to you that tells you, yes, I'm on the right path. I feel fulfilled. Yeah, I'll let you know when I'm successful. I think for everybody, again, the other question is what do you want your legacy to be? And I think that is another--it's a different question than what is your why. And I think once you understand what you want your legacy to be, I think that is how you can create metrics for success. And for me, my legacy, I would hope, is going to be to improve outcomes for patients with pancreas and hepatobiliary patients and also basically creating and developing and mentoring the next generation of oncologists to be more successful than me so that they can carry the baton forward because I don't know that we're going to necessarily cure the diseases I treat in my lifetime, but I want there to be people smart enough once I retire who can keep doing that, right? And so that, for me, would be my metric of success. I think about one of my mentors who was at MD Anderson when I was still there, and for him, it was getting drugs to the FDA. That was his legacy that he wanted for clangiopersonoma patients to be able to get drugs FDA approved. And so I would imagine, for him, that would be his metric of success. You know, you have these very crystal clear approaches to some very complicated questions. I'm really--I'm surprised the language you speak. Do you read a lot? Well, what's the secret behind developing this clarity? You know, I think it just comes--I may--I'm an extrovert. I am a people person, and I feel like I derive energy from being around people, and I just try my best to learn from everyone that I'm around. And you take the good, and you leave the rest. And so, you know, I think about my mentors that I had, say, at MD Anderson, and that I still have now in life, and each of them have such a unique skill set, and each of them brings something so incredibly valuable to the table, and I try my best to take those things and make them part of my fabric. You know, I think, for me, Dr. Wolf, Dr. Bob Wolf, I'm honored that he thinks that I would be great for this podcast, because he is my--I called him my Yoda. He's my mentor. He's my lifelong mentor, and he is my--my Norse, and so when I start to feel that I'm straying, I call him up, and I ask Bob for a gut check, and I ask him, you know, you need those types of people, those people who will tell you when you're doing something right and be the first to tell you that you're doing something wrong. And I think it really comes from the people of the network and the family, if you will, that I created in my workspace. And so asking them, asking them for help, for advice, reaching out at the appropriate times. Can you talk to me about one of the most monumental impacts that mentors had in this journey? I was at MD Anderson for 11 years. I was a fellow there for three years, and I was on faculty there for eight years. My kids were born in Houston. My husband was in practice. I mean, we were perfectly comfortable, and so when the opportunity to come to the University of Arizona came, and it was a leadership opportunity, an opportunity to grow and build a GI cancer program here. There were a lot of people who were thinking, "Why would you do that? You're at the number one cancer center in the country. You've been successful here. You've got great mentors here. You've got great friends." And Dr. Will and Dr. Kihan, who has passed away, but was at the time that I was a fellow and in my early faculty, was our division of cancer medicine chief and was like a father figure type of person to me as much as Dr. Will is. And those were the two people. And I went into Dr. Will's office who I went in very tenuous. I was almost cheerful because I was scared to tell him that I was thinking of leaving. And both him and Dr. Han separately and individually told me, "We have grown you, and it's time to leave the nest. It's time to spread your wings. It's time to go and create an impact somewhere else." And Bob said, "That is still the MD Anderson legacy. You are our legacy. Go fly, soar, hopefully, and create that legacy somewhere else with the footprint that we've given you here." And that to me, I think, is what gave me the courage to accept the job. I needed to hear it. I needed to hear it from someone like Dr. Will and someone like Dr. Han, who I very much respected and who I knew. Those two always had my best interests at heart. It wasn't about the institution. It wasn't about a specific research study. It was about what is best for Regina Shroff. And that was the turning point, and that's what led me to accept the job. And absolutely, as I don't doubt, was the right move at the time. Amazing. And is it happenstance to come across people like the Dr. Wolf? How does somebody who's not in that program find a Dr. Wolf and then build that kind of relationship? Is there a science behind it? I don't know that there's a science. I think it's Brownian motion, which I guess is science. I think it's really related to building your team and your network of people who can introduce you to the Dr. Wolf's, right? Or to the other people that could potentially play that role in your career. And I think it's my job as a mentor right now to recognize that I cannot be an all-encompassing mentor to everybody. And so if I can't be, who can I introduce that person to? And how could I leverage my network so that my mentee can benefit from it? Because as a sponsor and a mentor, I really think my job is to pay it forward, to do what Dr. Wolf did for me, for somebody else. And so I don't know that there's a science, but I do think that A, you have to seek it out. You have to be that person that kind of puts yourself out there a little bit and says, like, you know, I'm looking for somebody to help guide me in X arena and help advise me on things. And with the recognition that there is not usually one mentor, right? It's a team of mentors that one person needs. And asking once you find one how that can be a domino effect, can that person then introduce you to somebody else? I mean, I think about Jim Abruzis, who was the department chair for GI oncology at MD Anderson when I joined the faculty. And he left within a couple years and was the chief of oncology in Duke. And I jokingly tell him I will never let him forget me. And so every year at ASCO, I make him have coffee with me. Why? Because as a mentee, you know, I have to put it a little bit of work as well. And as such, he is still the person that I can call even though he and I have not been at the same institution for probably 10 years. And I put in that a little bit of effort to be able to maintain those relationships. So once somebody introduces you to the Dr. Wilson, the Dr. Abruzis, then as the mentee, do the work, do the maintaining of connections. That is actually, to all my advice, I was going to ask you next, like, once you find these individuals, how do you get them invested in your journey? And I love what you said about maintaining the connection. Is there anything else that, because they can't be the same to all, right? There's something different about a mentee, Dr. Shaw, from somebody else. What is that difference? I think, first of all, a good mentor hopefully should not need you to keep them or pull them in or keep them invested. They should be automatically invested in your success, I would hope. I think there is, and I used to walk this fine line and always feel a little strange where, you know, I would want to text Dr. Abruzis when something good had happened with me, and I was like, I hope he doesn't think I'm bragging. You know, like, I'm not trying to brag. I just want to keep him updated on letting him know that this study that he helped me open as an investigator initiated trial is now a large randomized phase three trial. Not because I'm like, oh, look at me and how amazing I am. But really, Dr. Abruzis, I hope you know the impact that you had by helping me early on, I am now the national PIs for a swag study. And I think that is really, for me as a mentor, when somebody tells me about their success, I most certainly do not think of it as them bragging. And in fact, I look at it as, okay, so something I did actually had impact, I'm going to keep doing that. I'm going to make sure that I keep doing that for that individual, as well as for anybody else that needs it. And so I think sometimes as a mentor, you don't need the pat on the back. But what you want to know is that the effort that you're putting into something is paying off dividends for that person. And so I think that is fantastic. It will also tell you, I mean, I had this, the Helio Woman Disruptor of the Year award. I had no idea how I got nominated. I was shocked and I was in a category with Monica Burdagnoli and Dempat and all these incredible women. And I was so honored and humbled by it. But apparently I was nominated by a woman that I mentor from afar. She's at University of Chicago. And she, after I got the award, she reached out to me and was like, "Dr. Shroff, I'm so excited you got this, I'm the one that put your name in." And I loved that. I loved hearing from her, not because she was like, "Oh, just FYI, you got the award because of me." But it just, again, it was like a feeling of her wanting to do something to recognize my efforts in her career and the way that I've supported her career. And it was a small thing that she did just by sending me a quick email. But it was, again, it was about maintaining that connection and making me feel like I clearly have somehow impacted her and that she wanted to somehow show me recognition or appreciation for that. It's truly beautiful. And, you know, a lot of people talk about this, that how difficult it is to be successful as you're doing this work, as you're trying to find new cures, do new research, go into kind of unchartered territory. What is the secret to being successful in this line? If somebody were to ask you to reflect back on the last 10, 20 years and tell them one advice as they're starting a career in clinical investigation, what would you tell them? I would tell them what Dr. Bruzy's told me and that it's a marathon, not a sprint. And you need to have patience and persistence and diligence. I wish I could say that like most drugs that we get FDA approved are due to just pure genius and intelligence. Absolutely. That is part of it. Don't get me wrong. But it is also a lot of willingness to just keep trying and to keep pushing. And I think I used to when I was a junior faculty member, I used to be like somebody, give me something on a silver platter, give me a trial. I'll take it. And, you know, Dr. Bruzy's told me the advice he gave me was first learn how to take good care of patients. If you're smart as a clinician, you will recognize the need. The questions come from the clinic. So when you recognize the needs of biliary cancer patients, that's when you will think of the smart research question. And so learning how to be a good doctor is what he said to do with number one. And that takes time. Yes, fellowship is amazing, but I still was so scared day one of being attending where there was nobody to double check my chemo orders. And that patience of learning how to take care of these patients, then recognizing the gaps, then going and pitching your idea and finding either an industry sponsor or somebody to support a concept that is your quote unquote own. That takes time. I mean, the investigator initiated trial then led to my swag study. I give my fellows a lecture here every year during the boot camp on my journey. That's what they asked me to talk about. And I pitched the concept to pharma in 2013. And then the study was presented at ASCO, just the phase two in 2017. And then was published in 2019. And then swag opened. And I just read, you know, presented the results of GISCO in 2023. So it was a decade. It was 10 years on one project. And it was a negative study. You just, and that does that mean that I'm just going to like throw in the towel? Of course not. We haven't pure ability rate cancer. So what is the next study? You know, that is the question. But I think there needs to be a recognition that persistence and diligence and hard work and patience absolutely pays off because, you know, in the same span of time, we've gotten five, six drugs FDA approved for clanger carcinoma change the face of these by working together in a teen science collaborative fashion and just by continuing to try. Wow. Dr. Shroff, this has been such an incredible session. I really want to thank you for coming on, sharing all this wisdom with us. I want to summarize a few things that I'm taking away from this session with you. I'd say the very first thing is you talk about your why and understanding it and having it drive your decision making. Oncology is the intersection between compassion and science, but just the same way having that clarity and being able to say, this is my why. And then the second question, which I really enjoy is this is my legacy. This is where I'm aiming to leave the work for the next person to pick up. So I think that thinking about these questions is probably the first start for all the listeners here. And then the next step is finding the mentor. In your life, you have shared the number of mentors who almost every question I've asked you, I think the seven or eight now, it references some mentor with some advice with some impact, right? And that just goes to telling us how significant it is to have the right people on board and what you call a network. And you share with us one of the secrets to maintaining this network, which is staying connected, right? Asking them for coffee every time you see them at ASCO. And so I think that this is a critical point updating them when positive things happen in our life. I'd say the second pearl that I'm taking is stay connected with mentors. Keep them updated with what's going on. And then the last thing is, while you are one of the most renowned clinical investigators, you emphasize, especially for us at the stage we're at right now, to first take care of patients, because that's where the questions start. And I think this advice of learn how to take good care of patients, identify that questions come from the clinic. And then go and pitch these ideas and recognizing that it's a long period of time. 10 years for this study that you're working on just tells us the virtue of patients and persistence in really achieving excellence in this field. So I want to thank you for coming on and sharing all this wisdom with us. Of course, it was a pleasure to be here. Thank you. To our audience, thank you for tuning in with us here on the Medicine Mentors. Thank you for joining us as we learn from the Masters of Medicine. (gentle music) You
