Where the journey begins: perspective from a clinician in the lab

Amit Samani is a clinical fellow in Julian Downward’s lab, studying the genetic origins of cancer. On World Cancer Day, he explains how his time at the Crick, and previously in Sophie Papa’s group at King’s, showed him what happens long before treatments reach patients in the clinic. 

I’ve always been fascinated by the science that underpins what I see and do in the clinic. For this reason, I wanted to pursue an academic path alongside my clinical training.

Cancer research forms the start of the journey towards patients. It is a complex network of related disciplines including the study of signals within the cancer cells, how they interact with cells around them and how they make their energy. Every one of these provides a vital cog to keep the wheel spinning.

It’s always exciting for clinicians to hear about the latest drug approval. It means a chance to improve outcomes for patients. And we’re well aware that this success is hard fought. We know, for example, that only one in ten treatments that makes it to the first phase of clinical trials will ever reach the third and final phase. 

However, what we don’t hear about are the trials and tribulations of getting a drug anywhere near a phase I trial. How many hours in the lab, how many sacrificed weekends and how many Western blots, cell passages and mycoplasma contaminations directly or indirectly contributed to that milestone? I suspect the number would be mind-boggling.

My experiences so far have taught me much about these first stages of the journey. There are a few ingredients that I believe are key to accelerating the path from an idea in someone’s mind, to cells in a dish, to new treatments on our shelves.

In clinical practice, rewards and achievements can be somewhat predictable. In cancer research however, the rewards are far more uncertain.

The key components

Collaboration. It seems clichéd to talk about collaboration. Sometimes you feel it’s the only word you ever hear in science. However, collaboration also drives clinical medicine. Patients often have complex combinations of conditions that need expertise from a range of specialists working as a team. However, this is often driven by necessity rather than opportunity.

It’s not that as clinicians we don’t enjoy collaboration, but often one speciality simply can’t do what another can. You wouldn’t ask an brain surgeon to remove a malignant prostate for example. In science it’s different. There are often many different possible approaches to the same question and indeed many different questions to ask. This exciting and almost limitless possibility for questions and collaboration makes innovation possible, and provides a substrate for improving patient outcomes.

Resilience and reward. I am loving my time here but clearly, science has its own challenges. In clinical practice, rewards and achievements can be somewhat predictable. Finishing a busy clinic, receiving gratitude and of course the act of helping patients can all provide a boost on an almost daily basis. In cancer research however, the rewards are far more uncertain. 

One can spend three days on a Western blot and simply end up with a big black mess or, spend weeks or even months trying to ‘optimise’ an experiment only to find out the optimal results were actually the ones you got in week one! 

Scientists have to live with uncertainty on a daily basis. Uncertainty about whether their experiments will support their hypotheses, about being scooped, about funding, and the list goes on. Nonetheless, with enough resilience to ride through the tough times, the potential for reward is huge. That eureka moment, the satisfaction when a hard thought-out plan comes together or when an unexpected stroke of luck sets you down an exciting path is what I believe drives most scientists through the hard times.  

Those of us practising oncology know how lucky we are. We’re in a time of revolution.

Passion. I think this is the biggest driver to success in cancer research. The ‘reward’ as depicted above would not even be a reward if cancer researchers did not care so much about what they do. It is testament to their love of the subject that it is commonplace for researchers to spend evenings and weekends in pursuit of their experimental goals. 

I remember recently getting a chorus of approval from my lab when I suggested that scientists would be rich if they got paid overtime. The irony is that I have never heard any of them complain if they’ve had to stay late or be here on the weekend. Not everyone can or would give up their ‘free’ time like this but, I can say for certain, that we would not be where we are without the sacrifice and passion of cancer researchers like these. 

Where it all begins

Although I may be biased, I believe that oncology is the most holistic of the medical disciplines. In a typical clinic I can go from reading a pathology report detailing what makes a particular patient’s cancer tick at the molecular level, to then learning about their pets, where they’ve been on holiday and what really matters to them. We literally know our patients inside and out.

Those of us practising oncology know how lucky we are. We’re in a time of revolution. At the beginning of the last decade, metastatic melanoma was universally fatal and the only widely available option for most lung cancer patients was chemotherapy.

Now, with immunotherapy, more than half of patients with metastatic melanoma have ‘durable remissions’ (we’re not allowed to use the word ‘cure’ just yet) and a recent study showed long term survivors in lung cancer too.  

World Cancer Day is about raising awareness and inspiring action for a cancer-free future. Well, none of this would be possible without the daily (and nightly) graft of cancer researchers across the globe, combined with a bit of luck and occasional stroke of genius. Whatever my future holds, I feel privileged to be a part of this right now. Directly, or indirectly, it all makes a difference.   

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