The Weill Cornell Clinical and Translational Science Center (CTSC) is thrilled to congratulate Babak Navi, MD, MS, a KL2 scholar in the Clinical and Translational Education Program (CTEP), for being awarded a K23 Career Development Grant from the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institutes of Health (NIH). These highly competitive grants help emerging physician-scientists make the leap to becoming independent clinical investigators by providing three to five years of support for supervised study and research.
The K23 grant will help Dr. Navi, a neurologist, shed new light on the mechanisms underlying the increased risk for ischemic stroke in cancer patients. Based on his preliminary research, Dr. Navi hypothesizes that both cancer and its treatments may create a hypercoagulable environment in patients that facilitates the formation of blood clots (emboli) that cause stroke. The stroke risk may be greatest during chemotherapy and with advanced disease. His project has three specific aims intended to illuminate our understanding of the mechanisms of stroke in cancer:
- Using longitudinal data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, an NIH-funded prospective cohort study with a strong representation of individuals living in the American South, Dr. Navi will seek to confirm that active solid tumor cancer increases ischemic stroke risk independently of other factors. This study will help identify risk factors for ischemic stroke in cancer patients and may help affirm the suggestive findings of an earlier retrospective study using Medicare data to assess stroke risk in cancer patients.
- The K23 will also support a prospective, cross-sectional study that will enroll three groups: patients with active cancer and acute ischemic stroke (n=55); those with active cancer and without stroke (n=55); and those with only acute ischemic stroke (n=55). The study will seek to elucidate the mechanisms and markers associated with cancer-mediated hypercoagulability using a number of modalities, including RNA gene profiling, coagulation function testing, and transcranial Doppler microemboli studies.
- Finally, Dr. Navi will examine Medicare data to assess the effects of chemotherapy and radiation on stroke risk in cancer patients.
Dr. Navi became interested in the topic of stroke in cancer patients as a neurology resident.
“All good research comes from clinical observations,” he observed, citing his experience working with cancer patients with stroke at the Memorial Sloan Kettering Cancer Institute. “There has been progress in answering questions about stroke in the cancer population, but the underlying mechanisms and best treatment practices are still poorly understood. From a diagnostic perspective, the heart seems to be a common source of the blood clots responsible for ischemic strokes in cancer patients, although this has been hard to prove.”
Nevertheless, the current standard of care incorporates preventive approaches that reduce cardiovascular risk in the general population, such as aspirin, statins, and anticoagulation therapies, but these treatments may be controversial in patients who are dealing with the additional clinical and physiological issues related to cancer. Dr. Navi’s K23 studies will contribute new insights into these questions and will help to conclusively establish cancer as an independent risk factor for ischemic stroke, with substantial implications for patients and health professionals.
As an emerging physician-scientist, Dr. Navi acknowledged the importance of programs such as the CTSC’s KL2 scholars program, which facilitates the training necessary for a K23, thereby setting the path to eventual research independence. “Certainly as a junior attending (physician) I’ve worked harder than I’ve worked in my life,” he said. “The main challenge is time management: carving out protected time to do research and having to put on a lot of hats as a junior investigator. The CTSC KL2 provided me a tremendous opportunity. Having grant money and protected time is a huge relief. You can focus on what matters—doing the work.”
Dr. Navi praised the Clinical and Translational Education Program’s Master’s degree in Clinical and Translational Investigation and educational experiences such as the structured mentorships and the CTSC Scholars Honors Grant Writing Program, that are part of the KL2 program. The CTEP credits the importance of having excellent mentors, such as Lisa DeAngelis, MD; Constantino Iadecola, MD; and Katherine Panageas, DrPH, who supported Dr. Navi through the KL2 program. “I had some training in clinical research, but having more structured training and exposure to other teachers and trainees was very helpful,” he reflected. “The (CTSC Core) Clinical Trials class here is excellent.”
For more information about the CTEP and educational opportunities available through the CTSC, please visit http://weill.cornell.edu/ctsc/training_and_education/.