BRAS DDP Clinical Fellow 2015 – 2017

Where is home?

This is a question that I always find hardest to answer. I am very fortunate to have had the opportunity to live and work in a number of different places in my life. I was born in Indonesia and spent my childhood there before moving to Singapore to complete the final years of my secondary education. I graduated medical school and completed internal medicine training in Melbourne, Australia before moving to Newcastle – also in Australia – to complete my medical oncology training. As part of my medical and specialty training, I have had the chance to live and work in a few rural and regional Australian towns including Horsham, Mount Beauty, Warnambool, Geelong, Sale and Tamworth. And then I came to Toronto! Thanks to family, good friends and colleagues, I have felt at home in all the places that I have been. So my definition of home is a place where I can live and work with people I care for, who also care for me in return.

Why Oncology?

The most rewarding aspect of my medical career is my interactions with my patients. I think it is a true privilege that, as medical oncologists, we get to be there through what is most often the most difficult times in our patients’ and their families’ lives. My patients and their families have shown me how the human spirit can triumph through the most trying of times. This gives me the hope and encouragement that together, we will, and we have to, find ways to cure cancer.

What are your main areas of interest?

My main areas of interest are head and neck cancer and Phase l clinical trials. Head and neck cancer patients strike me as particularly stoic, given how disabling the disease is and how tough the treatment is. We treat the majority of patients with curative intent, but the disease relapse rate is unacceptably high. I think molecularly it is a fascinating disease. There remain a lot of unanswered questions, and a lot of room for improvement, especially from the systemic treatment point of view.

Many times since starting my medical oncology training, I have been seated across patients with incurable cancer, explaining to them that we have no further treatment options to offer. Even though there are currently many exciting developments in medical oncology, for this one patient, we are not moving fast enough. I share my patients’ sense of desperation.

My undergraduate research thesis was in the preclinical development of a novel therapeutic agent for glioblastoma multiforme. The prostate cancer arm of the drug went on to Phase l clinical trial. I find the science behind this very intriguing, and I wanted to investigate what makes a drug work, what makes them fail, and what can we do to make them both effective and safe to administer to patients.

Why did you choose to come to The BRAS Drug Development Program?

It was my mentor, Dr. Stephen Ackland in Australia who suggested I apply for a fellowship with Dr. Lillian Siu. He knew that I was interested in Phase l clinical trials and head and neck cancers, and advised that I go to learn from the best! The Princess Margaret Cancer Centre’s BRAS Drug Development Program is one of the world leaders in early phase clinical trials. They are at the helm of development of new oncological therapeutics. During my first visit here, the passion is almost palpable. Certainly this has proved the case the whole time I have been here.

What are some of the distinctive qualities of The Princess Mrgaret Cancer Centre?

At the Princess Margaret, I find that the staff not only strives to provide excellent medical care, but they also work with a sense of hope. I think this comes from the passion with which the staff here, in particular my mentors, conduct their research. They are looking after not only the current patients, but also patients of the future. This hope keeps us going, and I think it is because they are doing this for the right reasons, that the Princess Margaret is one of the top cancer centers in the world! They are doing this for the patients.

There is a long-standing culture of nurturing young oncologists here at the Princess Margaret. Fellows have the opportunity to be involved in all manners of research: retrospective, reviews, systematic reviews or meta-analyses, and prospective clinical trials. From the research point of view, my mentors have taught me to ask the right questions, design the right trials and make sure it is safe and always in the patients’ best interest, and carry it out to the end. This applies to trials that are both sponsored by industry and initiated by investigators. This level of dedication to teaching and mentoring is absolutely invaluable, and is very difficult to find indeed.

Where do you think we are going?

In the past decade we are making strides in improving our understanding of the molecular basis of cancer. In some cancers, we are now breaking out of the blanket treatment approach and moving towards individualized treatment. While, for some patients we have achieved great outcomes, even long-term disease control, there remains a lot of work to be done to increase the number of people who would benefit from treatment, while minimizing toxicities and futile treatment.

The human body is an ecosystem of processes with important and constant interactions among all its parts.By adopting a more integrative approach to include all aspects of medical science: such as genetics, epigenetics, proteomics, metabolomics, we can make it all come together. With an increased understanding of the scientific basis of cancer, we would no longer compartmentalize our efforts, but would operate in a more “holistic” way.

What have you found most rewardign about your fellowship?

Learning from and working with my mentors is one of the most rewarding aspects of my fellowship. In medicine, patients always have to come first. Without the right approach, the long hours that we put into working, studying and caring for our patients, can really take a toll. My mentors, therefore, have been absolutely essential in shaping me into the oncologist that I am today.

I have absolutely enjoyed looking after my Canadian patients, increasing my clinical and translational research experience and know-how, and getting to know all the staff and other fellows from all over the world. It truly has been a fantastic few years.

When will you return home?

I am completing my fellowship on May 1, 2017 to continue my work in Sydney, Australia. My work and research focus will continue to be head and neck cancers and early drug development. It is very sad to leave the fantastic team here at the Princess Margaret, who have really made me feel at home. I hope to continue the collaboration and friendship that have been developed here.