PNA Spotlight: Dr. John Boockvar

This month the PNA Spotlight focuses on Dr. John Boockvar, vice chair in the Department of Neurosurgery and director of the Brain Tumor and Pituitary/Neuroendocrine Center at Lenox Hill Hospital in New York. He also serves as a professor of neurosurgery and otolaryngology/head and neck surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell in New York. In addition, he directs the Laboratory for Brain Tumor Biology and Therapy at the Feinstein Institutes for Medical Research.

Dr. Boockvar did his undergraduate work at the University of Pennsylvania and followed in his father, grandfather, and great-grandfather’s footsteps to earn his medical degree from SUNY Brooklyn-Downstate Medical Center. He completed a surgical internship and neurosurgical residency at the Hospital of the University of Pennsylvania. He then did postdoctoral research training in neuro-oncology at the University of Pennsylvania Cancer Center, supported by the National Institutes of Health. He later served as professor of neurological surgery at Weill Cornell Medical College/New York-Presbyterian Hospital where he was co-director of neurosurgical oncology, head of the Laboratory for Translational Stem Cell Research and director of the Brain Tumor Research Group.

Dr. Boockvar was kind enough to answer a series of questions from the PNA. His answers follow.

Tell us about your educational journey. What stood out to you about each of the places where you spent time studying?

I did my undergraduate training at the University of Pennsylvania, and I think that’s where I was really taught neuro-psychopharmacology.  There I met pharmacology professor Steve Fluharty, who really got me thinking about chemistry of the brain, pharma-therapeutics of the brain, and the blood-brain barrier.  That was really impactful for me, as an undergraduate studying biology.  Then I went to medical school at SUNY Downstate in Brooklyn.  This was during the HIV AIDS epidemic in the early 90s, and so our hospitals were overrun with HIV/AIDS patients. It was really an incredible time to be a student, and to be hands on, battling one of the most dangerous, challenging diseases ever known. It instilled in us a strong work ethic that served us well decades later during the pandemic. We were well trained for that. I went back to Penn as a neurosurgery resident, where I fine-tuned my surgical acumen.

Who were your mentors?

It started for me when I trained at the University of Pennsylvania back in the late 90s and 2000s.  Two ENT doctors (not neurosurgeons) named Dr. David Kennedy and Dr. Donald Lanza were really pushing the frontiers for endoscopic sinus surgery. They decided to try to get to the pituitary using an endoscope instead of cutting through the upper lip and using speculums.  I was lucky to be exposed to these trailblazers who taught me endoscopic skull-based surgery. That really piqued my interest in pursuing the technique of entirely endoscopic endonasal pituitary surgery.

When it comes to neurosurgery, the surgeons who train you become your mentors. You’re always a mosaic of the of the people that you trained under.  At Penn, brain tumor surgeons like Dr. Kevin Judy and Dr. Donald O’Rourke instilled in me the importance of doing research, not just doing surgery. They helped me truly understand the basic biology, the underpinnings of brain disease.  Now I run almost 33 human clinical trials, on pituitary and other brain tumors. That gives me the option to say to a patient that if I can’t cure you surgically, I can improve on the standard of care, whether it’s a new drug that targets ACTH in a Cushing’s patient or a new radioisotope that’s going to help cure a patient with acromegaly. These are the things that I learned from the people who trained me.

Please describe some of the pituitary-related clinical trials you’re involved in.

In one trial we are looking at radioisotopes like Lutathera, which is radio ligand that combines lutetium to dodatate, which is an imaging agent, and it basically binds to somatostatin receptors that are on the surface of the cell, and this allows us to not only image a patient with pituitary tumors, but potentially treat that same patient. Lutathera treatment has been FDA-approved for other types of human cancers, like neuroendocrine cancers, and has yet to be approved for pituitary and skull-based disorders. However, we are trialing it in patients, for example, with Cushing’s.  For acromegaly patients, we use other somatostatin analogs like Octreotide and Pasireotide, but there are newer agents that target somatostatin receptors that can be used for patients with acromegaly. Recently we were approached by a company for new antibodies to ACTH, which is the molecule that underlies Cushing’s disease. So, we see hope for patients with some of these incurable disorders.

How has neurosurgery changed since you started? And where’s it going from here?

I know this sounds cliche, but much like your iPhone is better every six months, our technology is better every six months, so the optics of the endoscope, the lighting source of the endoscope, means we can do things in three dimensions now, not just in two dimensions.  In addition to an endoscope, we now have something called an exoscope, which is a three-dimensional field.  We can now use colors to identify tumor cells, whether it’s using fluorescein or a drug called 5 ALA to track tumors in real time. Those are real game changers when it comes to the efficacy and success of surgery. Our imaging is also better because we now have the ability to localize and find smaller tumors, whether it’s for Cushing’s or acromegaly.  Now we have these radio ligands that can be used as not only diagnostic agents, but for therapeutic material.  And this doesn’t even get into the advantages of artificial intelligence when it comes to everything from imaging to pathology to data collection, publication, and distribution of information to the general public.

What would you like people to know about your practice and your organization’s values?

I run the Pituitary and Neuroendocrine center at Lenox Hill Hospital and Manhattan Eye, Ear, Nose and Throat Hospital, both of which are part of Northwell Health, which is New York State’s largest health care provider. I think that we are one of the few brick and mortar standalone pituitary centers that has dedicated staff in its building, not only including neurosurgery and ENT, but neuro-ophthalmology, neuroendocrinology, neuro-radiology, neuropathology, neuropsychology, and nutrition.  We focus on making it easy for the patient so they don’t have to run around town once they get these diagnoses, which can be traumatizing. We have a great navigation system. Our nurse-navigator will help them through a very complex process.  Once patients see me, they have to get films, get the lab work done, see an endocrinologist, see the ophthalmologist if they had vision changes, and they have to get cleared for surgery. Then after the procedure, they have to be followed by the ENT. They have to get post op imaging and post op endocrinology.  It can be very challenging.  Here we have built a one-stop shop. If they need to be enrolled in something novel, or a clinical trial, or something other than the standard of care, we make sure that they’re exposed to that as well.

By the way, we produced two Netflix shows that highlight some of these cases. The shows were called Lenox Hill and Emergency NYC. We’re filming our third season now. In fact, we just filmed a pituitary patient for the third season. It’s called Lenox Hill 2. Patients can go to those Netflix shows if they want to see us in action.

What has been your involvement with the PNA? Why did you get involved?

The PNA is one of the few pituitary resources, both for patients and providers. It’s a two-way street, so we need foundations and organizations like PNA to help patients get to doctors that specialize in pituitary and neuroendocrine disorders, as well as skull-based tumors. We need them to provide not only social connection but resource support, whether it’s information, reading material, videos, online ratings, whatever is required for those patients, and importantly, their caregivers. The PNA is one of the few resources that patients have. A lot of times patients with pituitary disorders get left out in the cold. Ther are tons of cancer support groups, foundations and organizations. It is great that the PNA is focused on the many patients diagnosed with pituitary disease. This gives our patients and providers the resources that they need to help navigate the process.

In the past, pituitary patients would wander around for 10 years getting the wrong diagnoses.

I still see that sometimes, but we hope that it’s less and less, particularly the Cushing’s patients because they are the ones who suffer the most.  When I see acromegaly patients on the subway, I’ll give them my business card.  But for Cushing’s patients, there still remains a lot of sexism in the field, so a lot of these young women are going to doctors who say, “Oh, you just gained weight because this is the time of your life you’re supposed to gain weight, and you’re not exercising.”  And then the patients get passed around for two or three years before somebody astute looks at their pituitary. We see a ton of patients who have been told they have PCOS, or they’re not exercising enough, or they’re put on Ozempic. Hopefully that is changing, but we need the PNA and their public education campaigns to make sure people are aware of pituitary disease.