Duke Department of Medicine is honored to recognize March as Women’s History Month, celebrating the many women who have made significant contributions to move medicine forward.
Walking through the hallways of Duke’s Seeley G. Mudd building is a constant and comforting reminder to Niharika Mettu, MD, PhD, Associate Professor of Medicine in the Division of Medical Oncology, of where her journey started. “I had my White Coat Ceremony 25 years ago in August of 2000 in the basement of Mudd.”
It’s also where she was matched to Duke’s Internal Medicine Residency program. “I was holding my 5-month-old daughter when I opened my match envelope with my husband, and my parents. It’s surreal to remember this is where my training began,” Dr. Mettu said. Her office is now located in the very same building.
Dr. Mettu treats oncology patients with solid tumors at the Duke Cancer Center Gastrointestinal (GI) Clinic twice a week. “Patient care brings so much fulfillment and purpose to my life. I am continually learning and refining my expertise in GI oncology to make a meaningful impact on the lives of others, which is extremely rewarding,” she said. Dr. Mettu has served as director of the Phase I Clinical Trial program at the Duke Cancer Institute since 2022. The program offers patients the chance to participate in trials testing novel drug therapies.
“Every patient is different. Every family is different. I may have treated pancreatic cancer a thousand times, but the patient before me has never gone through this before. Being there for someone at a very critical, vulnerable, and scary time, is a privilege, a challenge and a calling,” said Dr. Mettu. “I love knowing that I am helping educate patients about the science and clinical care of a cancer diagnosis, and doing it with compassion, encouragement, and hope.”
Medicine is a field she’s been drawn to since she was 5 years old. “I knew I wanted to pursue a career in medicine as a child and never deviated from that goal,” Dr. Mettu said. She graduated from Johns Hopkins University’s pre-medical program and was admitted to the Duke University School of Medicine’s Medical Scientist Training Program.
“I remember holding a liver full of tumors in my pathology course and thinking, ‘this is disgustingly fascinating.’ That was my first exposure to gastrointestinal oncology,” she said. That fascination was amplified during her second year of medical school while on the upper gastroenterology surgical rotation.
“On my first day as a second-year med student, being the only other person in the operating room with my attending surgeon, retracting and cauterizing, and seeing the abdomen and how all the organs fit perfectly into a place, was simply beautiful,” Dr. Mettu said. That day inspired her to pursue a career in GI medical oncology.
With her longstanding love of science, Dr. Mettu earned a PhD in molecular cancer biology. “I was extremely interested in cell signaling pathways, which is how cells talk and take advantage of these pathways to develop into tumors.” But she began to miss the aspect of patient care while working on her dissertation.
“My PhD training honed my critical thinking skills but also reminded me that my passion first and foremost is patient care, and the continuity of care medical oncologists provide,” Dr. Mettu said.
After completing the Duke Internal Medicine Residency Program, she matriculated to the Duke Hematology-Oncology Fellowship Program and began training in clinical research in 2012. Under the direction of mentors, Herbert Hurwitz, MD, adjunct professor of Medicine and James Abbruzzese, MD, professor emeritus of Medicine, she learned how to write clinical trial concepts and protocols and serve as principal investigator on studies.
Dr. Mettu has led over two dozen GI and solid tumors clinical trials since joining Duke faculty in 2014. “I have seen advances in how we treat various GI cancers and other solid tumors, and that’s because preclinical science is getting better at identifying therapeutic targets and strategies, that we carry forward into clinical trials offering these novel therapies to patients,” Dr. Mettu said.
“I always tell patients to have one foot on the balance beam of hope, and the other on the balance beam of realism,” Dr. Mettu said. “Even though an investigational novel drug therapy may not end up benefiting an individual patient on a clinical trial, patients get satisfaction in helping contribute to finding better therapies for others like them,” she said.
Additionally, she has worked extensively to identify and utilize biomarkers by using blood tests. Prognostic biomarkers tell providers whether a patient will survive and if disease will reoccur. A predictive biomarker tells providers whether a patient may respond to a given therapy. “You've got to see what the similarities are with patients that do really well on a clinical trial and figure out if there's a commonality there,” she said.
Dr. Mettu wouldn’t change anything about her journey. “I wouldn't choose any other field or line of work. Every step, in some way, has helped point me in the right direction in my career. I take much joy in knowing that I have been taken down the right road over the last 25 years,” Dr. Mettu said.
Now, she’s looking forward to furthering her own development as a mentor. “My message to trainees is, pay attention to the things that pique your interest, but also pay attention to the things that don't. Each of these observations has an important message if you're willing to find and listen to it,” Dr. Mettu said.