Being an oncologist at the BC Cancer Agency has been a very fulfilling job, one I feel honoured to have. My days are varied and interesting and there have never been two days that were the same yet. Often, the schedule that is entered into my calendar means nothing, as surprises are the norm. A seemingly quiet day can turn exciting fairly quickly when someone needs to be assessed and treated urgently.
As a clinician, I spend most of my time with patients. As a specialist in chemotherapy, I typically meet with my patients every 3-4 weeks while they are going through treatment. I typically see them more than they see their family doctor, and in that time I get to know them and their families very well. This is certainly one of the best parts of my job.
In addition to treating patients, I am involved in research. Research can take many forms and I am mostly engaged in clinical trial research. This means patients who come to see me will often be eligible to participate in research studies. We often study new drugs or new combinations of drugs. With the advent of immunotherapy, we are now studying a variety of new agents that we hope will work to stimulate and target the immune system against cancers. This type of work is both very involved, for the physician and for the patient, and very exciting. The hope of finding better tolerated, more effective treatments that will help our patients live better and longer is what keeps me so interested in my work and is something important that we can offer the patients we meet.
Recently, thanks to the generous support of BC Cancer Foundation donors and the hard work of scientists at the Trev & Joyce Deeley Research Centre, we have developed the ability to grow and expand a patient’s T-cells removed from their cancer. These T-cells – which are an important component of the immune system – may offer a new form of cancer treatment, a form of adoptive cell therapy called Tumour Infiltrating Lymphocyte (TIL) treatment. TIL is particularly interesting because it’s based on the concept that T-cells found in tumours are likely trying to destroy cancer; if a whole army of T-cells with those features could be infused into a patient, then potentially the cancer could be finally overwhelmed.
We are going to study this as a treatment option here in British Columbia. The first trial will kick off this year for a small number of women, likely between 6-8 participants, with recurrent gynecologic cancers. We have carefully considered who should be treated, and feel that some markers on cancer cells may help us identify a group of patients who are more likely to benefit from this treatment approach; namely, cancers in which the immune system may already be playing an important role. This will include cervical cancers, as these are usually caused by HPV virus, something that the immune system works to eliminate. We have identified endometrial and ovarian cancers with evidence of DNA repair deficiencies (called mismatch repair deficiency), as we know that immune therapies appear to work well in such tumours. We are the first to design a trial of TIL treatment for this patient population in particular and are very excited to both prove that we have the necessary skills and expertise to do this and to evaluate how our selected patients will respond to the treatment.
Other work that I do includes the teaching of medical students and residents; something that I always enjoy. I can tell you I am enthusiastic about what these young people will bring to medicine. They are keen, smart and innovative and we have much to look forward to as they mature. We need to make sure they are supported and mentored and given encouragement and opportunities to shine.