President's Pick for NCI: Monica Bertagnolli, MD

President Joe Biden has selected Monica Bertagnolli, MD, a world-renowned surgical oncologist in the Dana-Farber Brigham Cancer Center (DFBCC) and at Brigham and Women's Hospital (BWH), both in Boston, MA, to lead the NCI. Bertagnolli will be organization's 16th director and the first woman to hold the position since its founding in 1937. She will succeed Norman “Ned” Sharpless, MD, who helmed the agency for nearly 5 years before stepping down at the end of April, and Douglas Lowy, MD, who has been serving as its acting director.

Professionals across the cancer community applauded Biden's decision. “Everyone I've talked to so far has been excited and thought that she's the right person for the position,” said Bertagnolli colleague Pasi Jänne, MD, PhD, of Dana-Farber Cancer Institute (DFCI) in Boston, who called her “a champion for patients with cancer,” adding that, as NCI director, “she'll make sure that we move cancer science forward.”

At DFCI, Bertagnolli treats patients with sarcomas and gastrointestinal tumors. Her research focuses on APC, a gene tied to an inherited condition called familial adenomatous polyposis that promotes the development of colorectal cancers and desmoid tumors. In addition to working with animal models, she has conducted clinical research on the prevention and treatment of these tumors.

Throughout her career, Bertagnolli, a professor of surgery at Harvard Medical School, has taken on numerous leadership positions. She has led the Alliance for Clinical Trials in Oncology, an NCI-funded cooperative group, since its inception in 2011. She is a former chief of the Division of Surgical Oncology at BWH and DFCI, and from 2018–2019, she served as president of the American Society of Clinical Oncology. Last year, she was elected to the prestigious National Academy of Medicine.

These roles “will help her in her role as NCI director,” said Jänne. “She'll surround herself with the right team. She knows what's needed to make a large organization work.”

The NCI is the nation's largest biomedical research institute, currently funded at $6.9 billion, and is its principal funding agency for cancer research. As its leader, Bertagnolli will also partner with the White House on the reignited Cancer Moonshot program, which received 7 years of financial support from Congress under the Obama administration and will undoubtedly need additional monies.

Another funding challenge, says Elizabeth Jaffee, MD, deputy director of The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, MD, revolves around the Advanced Research Projects Agency for Health (ARPA-H), a new biomedical research agency intended to accelerate research against multiple conditions, including cancer. Does this mean that ARPA-H will take money away from the NCI?

“She's going to have to explain this to Congress so that they understand that this shouldn't impact the NCI budget,” says Jaffee, chair of the President's Cancer Panel and a former president of the American Association for Cancer Research (AACR). “It clearly has a different role than what the National Cancer Institute's is.”

Given Bertagnolli's keen awareness of the need to increase paylines and her experience and success in applying for individual RO1 grants and large cooperative group grants for the Alliance, “I think she's going to be a really effective force in lobbying Congress for more money,” predicts Eric Winer, MD, director of the Yale Cancer Center in New Haven, CT, who previously worked with Bertagnolli at DFCI. She has “lots of experience in clinical research, and that will put her in a great position to be an advocate for clinical research.”

That sentiment was echoed by Chandrajit Raut, MD, MS, also of BWH and DFBCC, who credits mentoring from Bertagnolli in helping him to take her place as the chief of its Division of Surgical Oncology. “She's been in the trenches,” Raut explained. “She will continue to have that perspective and ask what she can do to advocate for each patient.”

When talking about “each patient,” Raut said, Bertagnolli includes those who don't live near large academic medical centers like BWH and DFCI. “She's interested in real-world outcomes and what's happening in the community.” One lesson he learned from her is to make sure that cancer care is something that can be scaled. In the case of a new program or technology, “you need to make sure that it can be implemented anywhere. If it's something that's really expensive, it's not going to be broadly adopted.”

“Perhaps this comes from growing up in Wyoming,” Raut continued, “but she wants to reduce disparities and wants to make sure that cancer care can be delivered anywhere.”

“I believe that Dr. Bertagnolli's understanding of equitable health care barriers can help NCI tackle health care disparities and the lack of diversity in clinical trials, which are issues rooted in systemic racism, discrimination, stigma, and misinformation,” said Amelie Ramirez, DrPH, of The University of Texas Health Science Center at San Antonio, a health disparities expert.

A past chair of the AACR's Women in Cancer Research Working Group, Ramirez said that Bertagnolli “will inspire women…to pursue more leadership roles in their careers” and “bring fresh perspectives to help solve multifaceted issues in health care and beyond.”

“It's not that there aren't enough women in cancer research—it's that we don't have enough women who are leaders,” commented Jaffee. “There are [some] women who have led cancer centers, but this is on a national level.” Bertignolli, she said, “has crashed that glass ceiling. She will be a role model and someone that we can all look up to.” –Suzanne Rose

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