At a Glance:
- Title: Director of the Division of Nuclear Medicine
- Fellowships: Memorial Sloan Kettering Cancer Center, nuclear medicine and immunology
- Residency: Memorial Sloan Kettering Cancer Center, nuclear medicine
- Masters of Public Health: Mailman School of Public Health at Columbia University
A renowned leader in the use of molecular imaging with PET/CT, and highly regarded for her expertise in the radionuclide treatment of various cancers, Shields joined UVA Health as the Director of the Division of Nuclear Medicine in 2019.
Leading the Way to Advance Molecular Imaging
You are originally from Turkey. What made you decide to pursue your residency in the U.S.?
When I graduated from medical school, I was reaching out for something aspirational and something that would lead to a top-tier performance in my field. America was offering the best medical training, and I just wanted to get the best. It was a perfectionist and idealistic approach. I didn’t have any family here and I still don’t. I didn’t know any individual in the U.S. It was just an ideal for me. In the end, I reached my goal and it felt very exciting. It certainly was the right thing for me.
I spent 30 years of my career in New York City, so I’m considered a New Yorker in many ways. But you reach a point when you feel some things are not fulfilled, and before ending your career, you have a strong desire to reach those goals. Again, it was an internal push to achieve what you haven’t achieved in your career. For me, that was combining research along with clinical care. To be part of a research team, to take clinical medicine to a higher level and expand it — that’s what I was aiming for.
What attracted you to UVA?
UVA has highly dedicated cutting-edge translational imaging core lab and highly qualified clinicians and researchers. That was really something I wanted — to integrate myself into that highly skilled team and also pursue clinical practice. I’m so pleased to be part of this progressive team. Everyone is so open to novelties and expansion with little hesitation. This is a big plus for the entirety of the team because some physicians and investigators may be conservative; this is not the case at UVA with the oncology with neurosciences groups.
What are your goals as the director of the division of nuclear medicine?
In general, my goal is to expand and increase the awareness of advanced molecular imaging at UVA and in the community. More specifically, before I joined UVA, I was in discussions regarding the launch of a peptide receptor radionuclide therapy program (PRRT) for neuroendocrine tumor patients. Dr. [William] Grosh helped significantly to start this program and, together, we succeeded to get it up and running. We are so proud to have this targeted treatment program in place at UVA. So far, we have treated so many patients with Lutathera® therapy and we’re marching forward.
Lale Kostokoglu-Shields, MD on Lutathera Treatment from UVA Link on Vimeo.
As with many other targeted treatment programs, this is a multidisciplinary program. Nuclear medicine and oncology physicians are working closely together. We are in the process of integrating radiation oncologists, pathologists and surgeons to our team. We have the core in place, so it shouldn’t be that difficult to expand the UVA PPRT program to other cancer subtypes such as prostate cancer.
These are exciting times for nuclear medicine and molecular imaging. We are pushing molecular imaging to the forefront of cancer management. Consequently, the oncologists, radiation oncologists and surgeons are all as excited as the medical imaging team. We are now providing crucial information that will change the patient management paradigm.
Prostate-targeted imaging and therapy will transition into clinical practice very soon in the USA. In this context, PET imaging of PSMA [prostate-specific membrane antigen] will identify those patients who have biochemical recurrence of disease, but present with undetectable tumors utilizing currently available imaging techniques. PSMA PET imaging provides a very high sensitivity to detect small deposits of tumors that are otherwise undetectable. Oncologists and radiation oncologists are looking forward to using this targeted imaging test to design their treatment approach, adjust their treatment fields, as well as monitor to determine response. All of these developments are very exciting and innovative in the quest of overcoming cancer progression and making it a chronic disease rather than a fatal disease. Overall, it is our main agenda to help move toward personalized medicine.
What research efforts will you be involved in at UVA?
We are working hand in hand with oncology in this era of expanding applications of immunotherapy, using the body’s own immune system to fight against cancers. However, there are still so many unknowns. Is there sufficient immune response built up in the body to counteract cancer progression? How much more treatment does one need to fight against a particular tumor? Although still in investigational phases, we have immune imaging molecules with which we are planning to open trials at UVA in patients undergoing immune treatments. In these trials, we will investigate whether or not we can image immune T-cells and determine if sufficient amounts of cells accumulate within tumors after a patient receives immune treatment.
Outside of UVA, I am serving as the co-chair for the lymphoma and myeloma committees of ECOG-ACRIN, which is a large national cancer collaborative group. We are designing cancer treatment protocols, integrating advanced imaging, mainly PET/CT as a means to monitor treatment efficacy and predict ultimate patient outcome. Novel targeted PET imaging molecules are also making their way into these cancer trials as more specific means to characterize tumor behavior and predict treatment effectiveness.
Another big part of nuclear medicine research, especially at UVA, is the investigation of traumatic brain injuries [TBI] with new imaging probes. PET imaging provides high sensitivity for investigating small molecular changes in the brain after TBI. With the imaging core lab and the neuroscience group at UVA, we are investigating the inflammatory response in the injured brain parenchyma after TBI. The imaging probes that are developed for this purpose at UVA — under the direction of Kiel Neumann — are used to dynamically monitor the inflammatory response after TBI in a noninvasive manner. This method will improve the understanding of the inflammatory process after TBI, and also help in vivo monitoring strategy for anti-inflammation therapy of TBI.
What would you like referring providers to know about your practice?
I think it’s important to understand the breadth of advanced imaging services we offer, particularly the PET/CT domain. We, at UVA, have particular expertise in imaging for cancer staging, treatment response assessment and restaging. This is true for more established FDG PET imaging, as well as relatively novel PET imaging molecules such as Ga-68 DOTATATE [somatostatin receptor imaging], F-18 FES [breast receptor imaging], Cu-64 DOTATATE [somatostatin receptor imaging], PSMA and Axumin [prostate cancer imaging]. Of note, for cardiology, we are offering ammonia PET cardiac perfusion imaging, as well as the conventional perfusion imaging with MIBI SPECT and metabolic imaging with FDG PET.
We are prepared to offer the PSMA imaging for prostate cancer as soon as the approved agent or agents are approved, likely in the first or second quarter of 2021. In addition to PRRT, we are already offering Xofigo (Radium 223) treatment for bone metastases in prostate cancer patients.
As an academic medical center, we have the expertise to accurately interpret the established imaging studies. We are also well-versed in novel targeted imaging agents because we are following the literature very closely and also participating in large trials before these agents are FDA approved. More importantly, we have a tightly knit scientific relationship with our oncologists, surgeons and all other clinicians, which is the main ingredient to better understand disease processes and interpret imaging studies accordingly.
To refer a patient to UVA Health, call UVA Physician Direct at 800.552.3723.