Investing in future generationsSharon Murphy, MD, views pediatric oncology as a chance to affect an entire lifetime.

George Bernard Shaw once said “Youth is wasted on the young.” But for Sharon Murphy, MD, youth is in the hands of exactly the right people. As a medical student, Dr. Murphy was considering a career in internal medicine; doing rounds on the adult wards changed her mind.

“When you have a ward full of 80-year-old stroke patients, there’s just not much on the curative side that you can do for them,” she explained to Oncology News International.

So Dr. Murphy shifted gears and switched her focus to pediatrics. “Using the proper interventions, pediatrics offered the chance to affect an entire lifetime,” she said.

Dr. Murphy has since become one of the foremost authorities in pediatric oncology and the namesake for the St. Jude/Murphy Staging System for childhood hematological disorders, including lymphoblastic lymphoma and childhood non-Hodgkin’s lymphoma. Dr. Murphy is currently at the Institute of Medicine (IOM) in Washington, DC. She discussed her career highlights and her vision for the future with Oncology News International.

Life in the lab
Dr. Murphy grew up in suburban Chicago with no childhood dreams of becoming a doctor. “I didn’t form the notion of going into medicine until I was way into college. At that time, girls basically became secretaries, teachers, retail sales clerks, and nurses,” she said. “So based on no good reasoning I decided to become a nurse, and I enrolled in the University of Wisconsin School of Nursing. But I soon realized it was a mistake. Nursing simply was not me.”

However, Dr. Murphy had always had a yen for science, so she entered a baccalaureate program at the university and majored in the “new field” of molecular biology. She worked part-time as a laboratory technician in the oncology department at the Madison-based institution.

“I ended up working in the lab as an undergrad for three years and two summers. That experience cemented my interest in medicine,” Dr. Murphy said.

The 10% rule
In 1965, Dr. Murphy was accepted at Harvard Medical School, an experience she described as transformative. “There were 10 women in a class of 100. There had been 10 women the year before, and the year before that. It was a quota,” she said. During World War II, Harvard first began admitting women, but only so that they made up 10% of the student body. The university stuck with that formula for some time.

Asked if she was overwhelmed by her minority status, Dr. Murphy replied, “Oh no, I loved it!”

Challenging conventional wisdom
Sensing that general pediatrics was not challenging enough, Dr. Murphy gravitated to pediatric oncology. “It was a fabulous time to enter the field because it was just then that curative therapies for leukemia were being devised,” said Dr. Murphy, who graduated cum laude from Harvard in 1969.

Dr. Murphy completed an exciting training stint in pediatric oncology as a student at Harvard’s Jimmy Fund program, which later became the Dana-Farber Cancer Institute (Dr. Farber was still working!). She then finished her internship and residence at the University of Colorado Medical Center (1969-1971). She then did a double fellowship at the Children’s Hospital of Philadelphia (CHoP), University of Pennsylvania (1971 to 1973).

“This was before combined hem/onc certification, so I had to do separate fellowships in hematology and oncology to become board-certified in pediatric hematology/oncology,” she explained.

It was during her oncology fellowship that Dr. Murphy’s fearless nature truly came to light. She presented a case about a 10-year-old boy with T-cell lymphoma and, to her dismay, was told by her superiors to treat him with single-agent methotrexate because “it gets good results.”

“Methotrexate was the standard therapy we were using back during my time at Harvard’s Jimmy Fund program.” I asked, ‘Why use a single agent when there’s published evidence of superior outcomes with combination therapy?’”

Determined to examine those alleged “good results,” Dr. Murphy took it upon herself to conduct a 10-year retrospective review of all the non-Hodgkin’s lymphoma patients at the CHoP. “My review and subsequent paper showed that our results treating lymphoma (with methotrexate alone) weren’t all that good. But during that research, while studying the different patterns of disease extent, I developed what became known as the Murphy Staging System,” she said.

Risk-adapted treatment
It’s fitting that a career that was inspired by the lab should come full circle to clinical research. Dr. Murphy followed her passion as a clinical investigator and is credited with developing Total Therapy B for advanced Burkitt lymphoma. Use of Total Therapy B resulted in an overall 80% cure rate of children with a disease that once was uniformly fatal.

Asked about her major contributions to the field, Dr. Murphy said, “One overarching theme that I have recognized and contributed to is the notion of risk-adapted treatment for childhood leukemia and lymphoma. My work at St. Jude Children’s Research Hospital in Memphis, Tenn., proved that we could reduce the intensity and duration of treatment in kids with favorable localized lymphomas. This was at a time in the 1970s when institutions like Memorial Sloan-Kettering Cancer Center were treating childhood lymphoma with 10 drugs and 2.5 years of treatment. The toxicity and side effects were enormous.”

Dr. Murphy was recruited by Joseph Simone, MD, who was then head of the division of hematology/oncology at St. Jude.

Dr. Murphy also conducted seminal research in acute lymphoblastic leukemia (ALL), focusing on kinetics, surface markers, immunophenotype, karyotype, and ploidy. These studies led directly to improved classification and stratification for risk-adapted protocols.

“Beginning in the late ‘70s, in our very high-risk ALL protocol at St. Jude, we were the first to use epipodophyllotoxin treatment to intensify combination therapy in newly diagnosed patients. We tripled the survival,” Dr. Murphy said. “The results were exciting. You didn’t need a statistician to say you were doing something right!”

A lifetime of leadership
Dr. Murphy continued her work in translational research and clinical trials. In 1992, she was elected as chair of the Pediatric Oncology Group (POG), one of the clinical collaborative research groups, sponsored by the National Cancer Institutes, dedicated to childhood cancers. She also served as the chief of the division of hematology/oncology at Children’s Memorial Hospital and as a professor of pediatrics at Northwestern University Feinberg School of Medicine, both in Chicago (1988 to 2002).

After being involved in cooperative cancer group leadership for more than a decade, Dr. Murphy founded the Greehey Children’s Cancer Research Institute in San Antonio. She served as director from 2002 to 2008.

Along the way, Dr. Murphy has written more than 230 original articles, reviews, and chapters and has been recognized for her lasting contributions by the nation’s major oncology societies. In 2005, she became only the fourth individual to receive the ASCO Distinguished Service Award for Scientific Leadership.

At the center of debate
Less than a year ago, Dr. Murphy joined the IOM as a scholar-in-residence with an emphasis on healthcare issues such as comparative effectiveness.

“I’ve sort of reinvented my career again by coming to Washington, DC,” she explained. “I actually almost considered retiring, but I felt that with my energy and knowledge I still had something worthwhile to contribute. And even though it’s difficult to make changes in the healthcare delivery system, you’ve got to try.”

Daunting as the current economic crisis is, Dr. Murphy remains solidly optimistic that the ailing healthcare system can be fixed. She began her career during groundbreaking times in oncology, and she said she feels that it’s a very exciting time to be in Washington.

“Maybe it takes a crisis to create an atmosphere in which real healthcare change can be made,” Dr. Murphy said. “The IOM is positioned to be in the center of this debate, and I’m pleased to be part of it.”