What is your role at the ONJCRI?
I am in a hybrid role as one of the Clinician Scientist Fellows and I split my time between the ONJCRI and Austin Health, which are both on the same site. My clinical role is as the Medical Lead for Acute Leukaemias and Myelodysplasias, which are a group of very difficult-to-treat and aggressive cancers of blood cells that are crying out for new therapies and approaches, and so a lot of my time is spent in patient care. On the other hand, my research at the ONJCRI predominantly focuses on integrating that care for those patients with novel technologies that are being developed in the diagnostic laboratories, including the one at the ONJCRI. Applying so-called “next-gen” sequencing and other new molecular diagnostic technologies into routine patient care is a passion of mine, and we use some of these technology platforms to look for new cancer molecules that can be targeted with drugs in the future.
What are you working on right now?
Most of my projects are run through Austin Health’s Clinical Trials Program for Acute Leukaemias and Myelodysplasia, but the one particular thing that I am working on at the moment is using “next-gen” sequencing to follow minimal residual disease after treatment. When treating patients with cancer, the obvious aim is to try and get rid of as much of the disease as possible. Unfortunately, you only really need a small amount of cancer left behind for it to come back as a full-blown relapse. One of the ways in which we approach this problem is to track the presence of very small levels of disease, perhaps one cancer cell among 100,000 normal cells for example. If we detect minimal residual disease with these techniques, we can then decide whether to intensify therapy and, for instance, use bone marrow transplantations etc. At the moment, the standard technologies used for this kind of detection aren’t great and are rather limited, so we’re trying to overcome this by using new technologies that will be able to give us a better understanding of residual disease and how we might be able to target it.
How would these technologies be physically implemented in patient therapy?
A lot of our present testing uses material obtained from bone marrow biopsies from patients with Acute Lymphoblastic Leukaemia (ALL), which is the disease that I focus on. These bone marrow biopsies are already part of the current standard of care for monitoring and so we are exploiting this existing way of collecting patient samples in order to use them as the material that we analyze with new, more sensitive and specific technologies, such as “next gen” sequencing for example.
How would this benefit patients?
It’ll be more accurate and will allow us to look in greater depth at the amount of residual disease left over, eventually allowing us to stratify and personalise patient treatment. The overall aim is to ensure that patients receive the right treatment for the right amount of time at the right dose. This will reduce the side effects that patients often experience with their therapy.
Has leukaemia always been your primary focus in cancer research?
My work is different to that of my fellow medical oncologists at the ONJCRI, who are all focused on cancers affecting solid organs, as I’m a haematologist by training and I treat disorders of the blood and immune system. I’ve had a long-term interest in leukaemia as my clinical training has been predominantly in that field and I have studied leukaemia stem cells as part of my scientific training, so it’s been something that I’ve worked on for many years.
When did you realise that haematology was the scientific pathway that you wanted to pursue?
I’ve always been fascinated by genetics. This stems primarily from the way genetics was taught to me when I was in high school and then later medical school. Haematology and oncology were always the medical specialties that I was most interested in as cancers are driven by abnormal genetics and epigenetics. Genetics is the study of genes which contain the instruction manual for life; epigenetics is the study of how these genes are controlled, read and interpreted. Within understanding both is the key to curing cancer. For me, haematology eventually won out over oncology clinically due to simply meeting the inspiring patients whom I treated for acute leukaemia.
How is being a clinical scientist different to being a researcher?
I think that the research being undertaken at the ONJCRI is very important as it allows us to have a basic biological understanding of the diseases that we are treating, which is critical in understanding how to improve the way they are treated. One of the brilliant things about my position is that I am able to be a bridge between the two worlds of looking after human patients and bringing in some of the exciting new discoveries into the clinic. Being part of this interface has been really key for me in making the most of the work that I do here.
What is it like to have a role in two medical institutions?
I see both the ONJCRI and Austin Health as being complementary to one-another and I find that a lot of the work that I do in one organisation ends up dovetailing into the other. There are occasional administrative challenges, but I leverage the strengths of both organisations in order to make my work much more impactful at the end of the day.
What’s the hardest aspect of being a clinician scientist?
Finding the time to do everything and doing it well! It’s always difficult to make sure that I keep abreast of all the different developments within the clinical sphere whilst also staying ahead of everything happening in basic science. Whilst there is an intersection between the two, they’re often very separate and unique disciplines, so it’s definitely a challenge trying to juggle the two jobs whilst finding enough time to do them both right.
What do you love most about your job?
Seeing things that I’ve been involved in discovering come to the clinical trial phase. BET inhibitors, for instance, are a new class of drugs that I’ve spent a lot of time working on and which are now approaching use in very promising-looking Phase 3 clinical trials, so hopefully this new class of drugs that I’ve spent years working on will soon be used to change the outcomes of patients. It’s always great to see a light at the end of the pipette tunnel!