Being a pediatric oncologist may seem to some like a heartbreaking profession. But for Dr. Noah Federman, a researcher at UCLA’s Jonsson Comprehensive Cancer Center who cares for children and young adults with cancer, it is anything but.
“I go home every single day knowing that I’ve made a difference,” said Federman, who joined the UCLA faculty in 2008. “Yes, treating children with cancer can be depressing and sad, but those moments remind you of why you’re doing what you’re doing. Then there are the moments when you’ve helped, when you’ve cured a patient, that feel amazing. Getting a hug from a kid in chemotherapy, running down the hall to see me, is only second to getting a hug from my own child.”
Federman attended medical school at Mount Sinai in New York and did his residency in pediatrics. He’d always been interested in blood diseases and bone marrow failure syndromes, so he decided to specialize in cancer.
At UCLA, Federman splits his time, doing research about 75 percent of the time and seeing patients in the clinic the remaining 25 percent. He’s working with colleagues to establish a multi-disciplinary bone and soft tissue cancer program for children and young adults.
“When I started as a first year fellow, I saw that there had been many developments treating blood cancers and bone marrow failures,” he said. “I was taking care of a patient with bone cancer who ultimately died, and I realized that these patients do not do well in general and that we had not made the improvements we needed to make. I wanted to change that.”
In his program, the pediatric and young adult patients with bone and soft tissue cancers are seen by a team that includes oncologists, pathologists, radiologists, physical therapists, a nurse manager and orthopedics specialists, as well as a social worker who can help with funding, home schooling and other family needs.
“I enjoy having a big team of people to work with,” Federman said. “No one is dispensable. In this program, patients don’t get lost in a large academic medical center, going from specialist to specialist with no one coordinating their care. We come to them.”
In the lab, Federman is working to develop for pediatric patients the types of molecularly-targeted therapies available to adult cancer patients. He’s studying the use of nanoparticles to deliver chemotherapy and targeted drugs, homing in on the cancer cells and leaving the healthy cells alone, avoiding the debilitating and potentially life-altering side effects of chemotherapy and radiation.
The nanoparticles are coated with specific antibodies that recognize the antigens on tumor cells and can distinguish them from the normal cells. They’re also flourescent, so they can be detected by imaging to ensure that they arrive in the tumor and are killing it.
Eventually, Federman hopes to transfer his work from the laboratory to the clinic and find better and more effective ways to treat bone and soft tissue cancers. In his clinical practice, Federman is already running clinical trials, testing novel agents for osteosarcoma and Ewing’s sarcoma. He also was involved in a study of an inhibitor of the insulin growth factor receptor which pairs a monoclonal antibody with chemotherapy. He recently opened a study using PET (Positron Emission Tomography)and CT (Computed Tomography) scanning to evaluate response to treatment and tailor therapy to individual patients.
He said he loves the collaborative environment UCLA provides, where he can work side by side with scientists from other disciplines. His immediate goal is to develop one of the biggest pediatric and young adult bone and soft tissue programs and improve overall survival in patients using less harmful targeted therapies.
“That’s the holy grail, to end this plateau we’ve been experiencing for the last two decades,” he said. “I want to be able to tell a child with sarcoma that survival is the rule and not the exception.”
Federman is even more motivated since the birth of his daughter nearly two years ago. Having a child, he said, changed everything.
“It changed how I talked to the patients and how I talked to their parents,” he said. “It changed how I practiced medicine. I’d like to say I was empathetic before, but I had no concept what it was like to be a parent of a child with cancer and how scared they must be.”
But things are changing, even if slowly. Federman was recently asked to write a college recommendation letter for a young woman he’d treated, who had graduated from Georgetown University and was getting ready to attend business school. Another of his patients has graduated from Johns Hopkins and is now going to film school.
“These kids are amazing and they become part of your family,” he said. “We need to do a better job treating these cancers so these kids can go on to live out their dreams.”
By Kim Irwin, 2010