Dr. Ludimila “Ludi” Cavalcante has a love for medicine, art history, literature and language.
She’s fluent in Portuguese, Spanish and English, having lived in Brazil, Venezuela and the United States. She also speaks Italian and a little French, aussi. (Yes, that’s an amazing five languages, for anyone counting.)
Italian was a bit of a challenge. After a few years of conversational practice, Cavalcante still felt she was lacking the fluency she desired. She decided the best way to learn was full immersion in Tuscany, Italy.
“I went to a small village, and most people did not speak English there,” she said. “I had to really try to survive on my own.”
After a month in Italy, Cavalcante returned home with improved language skills and other important lessons learned, too: a reminder that big payoffs can result when you try new things, and the takeaway of the kindness and support strangers showed when she stepped outside her comfort zone.
There’s a common thread between Cavalcante’s personal life as an explorer of things unknown and her professional life. As director of oncology developmental therapeutics at Novant Health Cancer Institute – Elizabeth in Charlotte, she helps develop and study new drugs for cancer treatment. Testing these medications in clinical trials, research that evaluates the human outcomes and effects of new medications, means venturing into uncharted territory with the possibility of major improvements and learnings as a result.
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Bringing her passion
After studying and working in many regions of the U.S., Cavalcante made the move to North Carolina and joined the Novant Health team in March 2023. At the Cancer Institute – Elizabeth, she provides individualized treatment and care options for patients with sarcoma and melanoma skin cancers, as well as GI cancers.
She’s also focused on her passion: bringing new phase 1 clinical trials to Novant Health cancer patients, with her sights set on the end of 2023 to begin them. Phase one trials are the first step of testing new drugs for their potential to help treat patients. The medications undergo rounds of testing and evaluation from there that could lead to FDA approval.
Patients who’ve undergone treatment and whose cancers have not fully responded are the typical candidates. An oncologist helps a patient determine if a specific clinical trial is a good option, and ensures the patient is completely informed of all the potential risks and benefits.
What’s exciting is that new developments in cancer medications are “changing the treatment paradigm,” Cavalcante said. Advancements in precision oncology are allowing researchers to develop medications that are specifically targeted to a cancer’s genetic makeup, giving cancer patients more choices earlier in their treatment process.
Scientific research, however, never assumes a new treatment will be better than the patient’s other options. Phase 1 of a clinical trial involves blood testing and detailed monitoring to document how the new medication affects the body and measure the success of the medication against the side effects.
Because there’s a hefty time commitment, the FDA recently issued new guidance to decentralize clinical trials. The goal here is to make participating in a clinical trial as accessible as possible, removing distance and transportation barriers. Cavalcante said she is proud that Novant Health is at the forefront of this effort.
“We are going to leverage being in the community so that we can bring drugs to the patients and not have them drive hours to come to us,” she said.
Embracing the unexpected
Cavalcante didn’t set out to be a cancer doctor. After graduating from medical school in Brazil in 2009, she thought she would be a rheumatologist. Oncology didn’t appeal to her because she was discouraged by the lack of options for patients.
“In Brazil, all that I saw of cancer patients was people really with no options and no one able to do much for those patients,” she said. “There were not a lot of treatments available for them, especially not in the public health system.” (In Brazil there are both public and private health care systems.)
The turning point came during Cavalcante’s medical residency at Mount Sinai Medical Center in Miami Beach, Florida, from 2011 to 2014. There, she said, her perspective transformed as she witnessed significant developments in immunotherapy drugs, which are cancer treatments that stimulate the body’s immune system to fight the disease.
“I saw patients with previously rapidly lethal widespread cancers living years, and all these advances that were coming during my residency years,” she said. “My experience was completely different.”
Also integral in her unexpected change of course were people who supported and guided her. “I had excellent mentors in residency, very caring, intelligent people who were doing amazing things for patients,” she said. She’d found a new calling.
Dealing in optimism
Through two different medical fellowships, where Cavalcante really found her niche was in developmental therapeutics, the development of new medicines. Cavalcante accepted a job in 2018 building phase 1 programs for a large health care company that spans southeast Florida and began opening clinical trials with immunotherapy medications.
One patient from her time in Florida really stands out in Cavalcante’s memory: a person undergoing melanoma treatments. His cancer had metastasized to his brain, adrenal glands and pancreas. Cavalcante recommended he enroll in a phase 1 clinical trial for a new immune modulating drug.
“And the disease just melted away,” she said. “He went into remission. That was the first time that I had witnessed that with a completely new agent. That was amazing.” Now, she says, this patient is four and a half years in remission. He once had 20 lesions on his brain, and now he lives a normal life. He regained his ability to drive and live independently.
Cavalcante stresses that not all patients who enroll in clinical trials experience this level of success. She is upfront with all her patients about the fact that they are venturing into unknown territory, with the support and guidance of caring doctors and their colleagues.
“I think I deal in realistic optimism,” she said. “I don't overpromise or oversell. But I say, ‘I'm offering you something that may work and that you have not tried for your cancer before.’ The process is complex and resource demanding. It requires immense cooperation and collaboration with a fabulous diversity of scientists, physicians and many disciplines.”
When a novel agent does work, as it did with the man with such advanced melanoma, researchers seek to understand how and why. Doctors aim to replicate the same result in other patients with the same condition. If they can, this has the potential to be a medication that will make a difference in people’s lives, far and wide. This, Cavalcante said, is what keeps her motivated and excited in a field that centers around exploring the unknown.
“That's what makes me tick,” she said. “That's really what drives me. Finding the next blockbuster that's going to help people. What we achieve here at Novant Health can benefit people across the world.”
Most recent paper by Dr. Cavalcante
A recent publication by Cavalcante and others performed an in-depth analysis of the molecular and immune landscape of patients with uterine and prostate cancers, from a large real-world database.
Findings showed that patients with mutations in the SPOP gene had opposing molecular and immune landscapes, providing a rationale for tailoring therapies in these patients. These findings could lead to future clinical studies with therapies specifically targeting these patient populations.