Faculty Profile: Angela DeMichele, MD, MSCE, is involved in various studies of breast cancer, including research on "triple negative" patients
JUNE 30, 2008
Angela DeMichele was born and raised in St. Louis, MO. The oldest of four children, Angie was the first person in her family to attend college full time. After graduating from Brown University in Providence, RI in 1987 with a BA in biochemistry, Angie returned to St. Louis where she began her medical training at Washington University.
In between her 3rd and 4th years of medical school Angie was a scholarship recipient in the Four Schools Physician Scientist Program in which she had the opportunity to attend one of three other institutions for a year of medical research experience (Johns Hopkins in Baltimore, Duke University in Durham, NC or the University of Pennsylvania). She chose Penn and spent the year engaged in Hematology-Oncology research and decided that upon completing medical school she wanted to return here for her internship and residency. Angie's interest in translational research was piqued at this time as she worked on a project that involved women who had experienced multiple miscarriages. Her research involved investigating a possible link between antiphospholipid syndrome and the production of antibodies to placental cells. During this year, Angie received firsthand experience with all aspects of clinical and translational research from working directly with research subjects and collecting data in a clinical setting to bench science in the laboratory.
Upon completing her MD at Washington University in 1991, Dr. DeMichele returned to Penn to complete an internship in obstetrics and gynecology as well as her residency. After her residency, she spent a year as a visiting clinical fellow at the Istituto di Ematologia Seragnoli, Universita degli Studi di Bologna in Bologna, Italy. Dr. DeMichele pursued her fellowship training in Hematology-Oncology at Penn from 1995-1998.
From 1996-2001, Dr. DeMichele worked on completing an MSCE degree and in 1999 was appointed Assistant Professor of Medicine in the Department of Medicine and in the Department of Biostatistics and Clinical Epidemiology in the University of Pennsylvania SOM. She is currently the course director for a graduate-level course (EP815, Clinical Trials and Translational Research) in the CCEB, a thesis advisor, a research mentor for the Hematology/Oncology fellowship program, a mentor for the Department of Medicine Scholarly Pursuit Rotation and a mentor for the Undergraduate Honors Thesis Program. Last year, she received the Alavi Award for Excellence in Cancer Research at the Abramson Cancer Center.
Dr. DeMichele was drawn to a career in oncology by the potential to powerfully impact the lives of patients and their families. To illustrate, she recounted a case of a young patient that she cared for during her second month of internship. The young patient was a male who was about her age whose wife was expecting their first child. The patient was diagnosed with acute promyelocytic leukemia and at that time, in 1991, there was no cure. Consequently, the clinical team asked the young patient what his goals were and how they could help him reach them. The patient stated that he just wanted enough time to see his wife deliver their child and to hold his child before he died. By giving the patient blood products they were able to wheel him down from his hospital room to his wife's delivery room and he was able to achieve his dream of holding his infant before he passed away.
This concept of setting goals and helping patients reach them is a significant part of Dr. DeMichele's clinical work. She has to give bad news � a lot. This is one of the occupational hazards associated with working in oncology. Communicating this bad news to patients and assisting them in setting realistic goals is very important to Dr. DeMichele. She was fortunate to have learned from her mentors during her fellowship how to deal with this aspect of the job.
Dr. DeMichele's face instantly lights up when asked about how she deals with the stresses of working in her field. She doesn't hesitate for a second before stating how her family helps her to keep balanced and to see what is important in life. Dr. DeMichele is married to fellow CCEBer Robert Gross and together they have two sons, Elliot (11) and Jesse (8). Her eyes sparkle as she talks about her relationship with each of her sons and how they are the sole reason both she and her husband aren't complete workaholics. She is also just as quick to point out though that she's human and the stresses of work do sometimes get to her. She recounted a story about a particularly rough day during her first year as an attending where she lost a patient to whom she was very attached. She drove home and was sitting inside not realizing just how distracted she was when she looked across the street and wondered why the car that looked just like hers was sitting in the middle of the neighbor's yard. Apparently she had forgotten to engage the parking brake when she returned home.
In addition to her clinical work, Dr. DeMichele is currently the PI of numerous clinical trials and epidemiologic studies. She is a co-PI of the national I-SPY trial, a multicenter study examining molecular and novel MRI imaging response profiles of patients receiving neoadjuvant therapy for locally-advanced breast cancer that is co-sponsored by the American College of Radiology Imaging Network, The Cancer and Leukemia Group B, and Specialized Programs of Research Excellence mechanisms. Work on I-SPY is currently in its final stages and investigators are using data in designing I-SPY II.
Dr. DeMichele also collaborates with fellow CCEB faculty on various clinical research trials. Working with Drs. Tim Rebbeck and Richard Aplenc, the team is investigating which patients will respond to breast cancer treatment and among those survivors, who will have late effects from this treatment. They are looking at the pharmacogenetics of metabolizing these anti-cancer drugs and the interaction between the immune system (specifically IL6, which is a growth factor for breast cancer) and clinical outcomes.
Along with Dr. Jun Mao, Assistant Professor of Family Medicine and Community Health, Dr. DeMichele is investigating links between use of aromatase inhibitors, cytokine receptors and arthritic syndrome to look for markers associated with this clinical syndrome and resistance to endocrine therapy. With Dr. Irene Su, a junior faculty member in reproductive endocrinology here at UPHS, Dr. DeMichele is investigating markers of early menopause and bone loss among premenopausal patients receiving adjuvant chemotherapy.
Dr. DeMichele is also working with Dr. Mark Rosen, Assistant Professor of Radiology, using very novel imaging, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), to examine basal phenotypes of breast cancer in women who are "triple negative" (lacking estrogen receptors, progesterone receptors and human epidermal growth factor receptor 2). The most successful treatments of breast cancer target these receptors; without them, tumors generally do not respond to receptor-targeted treatments. This research is focusing on Avastin, historically used primarily in colorectal cancer yet approved in 2008 for use in late-stage breast cancer patients. This research will examine these "triple negative" patients and their response to Avastin in combination with a novel taxane, Abraxane.
In discussing breast cancer, Dr. DeMichele indicates that for all of the attention and press that it receives, breast cancer remains underappreciated. Although she admits there have been GREAT strides, she is just as quick to point out that there are still WAY too many women (especially young women under 40 years old) who are being diagnosed with Stage 4 breast cancer who are living for a few years but still dying too young. She suggests that there is a need for better predictors so people don't relapse and a need for better screening for younger women.
To keep grounded, Dr. DeMichele exercises, running in particular. She also plays tennis with a group of women from Penn once a week and loves cooking and gardening. Her favorite movie is When Harry Met Sally and her guilty pleasure is her DVR and catching up on HGTV shows early in the morning before the rest of the family can claim the television.
