Richard Bakst, now a chief resident in radiation oncology, came to his life’s calling via an experience with cancer that hit very close to home. During his medical school training at New York University (NYU) School of Medicine, Dr. Bakst’s younger brother, Harrie, then an undergraduate at NYU, was diagnosed with a rare salivary gland cancer called adenoid cystic carcinoma.
Coincidentally, two months earlier, Dr. Bakst had interviewed at Memorial Sloan Kettering to do his transitional-year internship at the Center. “I was amazed at the incredibly high caliber of the experts here,” recalls Dr. Bakst. “I knew that this was where my brother needed to be treated.”
Surgery with Jatin P. Shah, Chief of Memorial Sloan Kettering’s Head and Neck Service, was followed by six weeks of radiation therapy. Dr. Bakst was at a point in his medical school training that allowed him the flexibility to accompany his brother to nearly all his radiotherapy appointments. Before his brother’s illness, Dr. Bakst’s plan was to go into the practice of dermatology. “But after Harries’s experience I knew I wanted to pursue something else,” says Dr. Bakst. “I wasn’t quite sure what my direction would be, except that I wanted to give back to people in the same way that the doctors at Memorial Sloan Kettering had cared for my brother. So I entered my internship with that in mind.”
At the suggestion of his brother’s physician, radiation oncologist Suzanne L. Wolden, Dr. Bakst did an elective in radiation oncology at Memorial Hospital in April 2008. (Dr. Wolden co-directs — with radiation oncologist Joachim Yahalom — the Center’s radiation oncology residency program.) “I really loved it,” says Dr. Bakst. “I saw a unique doctor-patient interaction that I hadn’t seen in other fields of medicine. And as fate would have it, they needed another resident.” He began his residency at Memorial Sloan Kettering in July 2008.
Dr. Bakst cannot speak highly enough of his training. “You see a wide variety of cancers here that at another institution you’d only read about in textbooks. It enriches your education as a clinician,” he says. “You are also learning from the best. Your teachers and mentors are leaders in their fields. And one of the great appeals of the radiation oncology residency here is the opportunity to do research.”
The Memorial Sloan Kettering residency program includes a “protected” year during which residents can focus purely on research. Dr. Bakst had the opportunity in 2011 to work in the laboratory of head and neck surgeon Richard Wong. “It was an inspiring year and Dr. Wong has become a true mentor,” says Dr. Bakst. “I want to integrate research into my career.”
The research Dr. Bakst pursued has a direct relationship to his brother’s disease. “It is known that certain cancers spread along nerves, and the head and neck is rich with cranial nerves, which represent the pathway for cancer cells to spread to the brain,” he explains. “But the process of how these cells invade the nerves and ‘know’ to march back toward the brain is not well understood.”
Dr. Wong’s research revealed that molecules produced by the nerve cells attract the cancer to migrate along the nerve. Dr. Bakst was further able to show that “if you radiate the nerve to a low dose — but not the high dose we use to kill cancer cells — you can suppress the nerve’s ability to produce these molecules and, in turn, prevent nerve invasion by the cancer. This suggests we may be able to target the nerves with a low dose of radiation to suppress the nerve’s ability to produce these molecules and in doing so potentially prevent the cancer from spreading along nerves. If we can avoid giving patients very high doses of radiation we can minimize treatment-associated toxicity and offer them a better quality of life.” While Dr. Bakst’s brother made a successful recovery following radiation, Dr. Bakst says that “toward the end it was very difficult for him and I really wanted to see what we could do to make treatment better.”
Since November 2007, Rich and Harrie Bakst have run six marathons as members of Memorial Sloan Kettering’s Fred’s Team, directing the more than $30,000 they have raised to further research in head and neck cancers.