This article was written for Magnify, a Duke University School of Medicine online publication.
Fifty years since the National Cancer Act of 1971 declared “War on Cancer” and a decade since the first drug, an immunotherapy, was approved to treat metastatic melanoma, a leading clinician researcher goes head to head with melanoma brain metastasis.
At age six, April Kelly Scott Salama, MD, already knew that she wanted to be a doctor when she grew up. Somewhere there’s photo evidence of her playing in a balloon hat that’s meant to be a scrub cap.
“No one knew why I wanted to be a doctor,” said Salama, now a medical oncologist. “No one in my family was a doctor.”
But two formative experiences that she had as a teenager further solidified the calling and led her to home in on the practice and science of oncology, specifically. First, her grandfather was diagnosed with lung cancer, got better, then declined and passed away—a heartbreaking experience for Salama. At the same time, her passion for molecular biology — critical to understanding how cancer works at the cellular level — was crystallizing in AP Biology at the public school she attended in Raleigh, NC, the city where she grew up.
Salama credits great mentorship — from her high school biology teacher, her undergraduate and medical school professors at UNC Chapel Hill, and her residency and fellowship mentors at the University of Chicago — for ultimately steering her toward a career at the intersection of cancer patient care and science. After completing her fellowship in the lab of Ravi Salgia, MD, PhD, an oncologist focused on translational lung cancer research, she made it her mission to return to her native North Carolina to care for patients and continue her research.
“I felt very, very, strongly about being able to serve patients in this area,” said Salama. “I really felt I owed a debt of gratitude to the state that had educated me and set me down this path.”
But, during her job search, Salama soon learned that there were no openings for a freshly-minted lung cancer clinician-researcher at any of the state’s research hospitals. Duke, however, was looking to fill a long-vacant faculty clinician position in the Melanoma Disease Group. Surgical oncologist Doug Tyler, MD, then director of the group, was ready to train her.
Tyler’s group was investigating immune checkpoint inhibitors, which work by helping the patient’s own immune system to recognize and destroy cancer cells. The first of these immunotherapy drugs (ipilimumab) was months away from FDA approval to treat metastatic melanoma. A second one (nivolumab) was showing signs of promise, and a third one (pembrolizumab) was about to start clinical trials.
Early-stage melanoma was being treated solely with surgery, but up until that point there had never been a drug trial that improved survival in patients whose melanoma had recurred and spread to other organs. It was an exciting time for metastatic melanoma researchers, and they wanted to bring Salama into the fold.
“As division chief of medical oncology, I had the great fortune to recruit Dr. Salama from the University of Chicago, where she had distinguished herself both clinically and academically during her fellowship. While her work had been in lung cancer, I was convinced she could transition into melanoma as a clinical investigator with mentorship from Dr. Tyler, our melanoma surgeon and leader of our melanoma program in the Duke Cancer Institute (DCI) and currently at the University of Texas Medical Branch at Galveston,” said Jeffrey Crawford, MD, George Barth Geller Distinguished Professor of Immunology.
Salama consulted her mentors in Chicago and together they agreed that pivoting from lung cancer to melanoma presented an undeniably exciting opportunity for her to be on the new front lines of cancer therapy research. Salama and her husband Joseph Salama, MD, whom she’d met while at the University of Chicago, packed their bags and headed south.