BRAS DDP Clinical Fellow 2015 – 2017

What is a fellow?

In the medical field, a Fellow is a doctor who has completed or is at the final stages of completing specialty training, and is undertaking additional subspecialty training. In the case of the Bras Drug Development Fellows, we are all qualified medical oncologists, coming together from all over the world (Italy, Israel, Burma, Australia, Jordan and Canada) to learn about the research and development of new cancer drugs in early phase clinical trials, typically over a one to two-year period. With supervision and mentorship from the staff, we are involved in the daily care of patients. Alongside clinical experiences, we also each have research projects in our areas of interest.

Why did you become a medical doctor?

I have wanted to be a doctor for as long as I can remember – probably since primary school. I love working with and relating to people, as well as solving problems and science. I also wanted to work in a field where I can be of service to the community. These were the main reasons behind my motivation to pursue medicine. I still remember the feeling I had when I learnt I got into Medicine at the end of high school. I was over the moon and very very grateful!

Why did you choose oncology?

I get asked this question a lot when I meet people and I always fumble for an answer. Oncology was my first clinical rotation as a medical student and I decided then it was the specialty for me. I think there are several aspects that attract me to this field. Firstly, it’s an area of need. Secondly and probably most importantly, it’s the human side of oncology. While it’s challenging, it is also incredibly rewarding. Lastly, the science of cancer is fascinating. It’s also a very exciting time to work in this field as scientific discoveries are moving at an extraordinary pace.

Where is home?

I’m from Melbourne, a coastal city in the south-eastern part of Australia. It’s the second largest city, otherwise known as the dining, coffee, sport and shopping capital of Australia (but I’m biased).

What has insipred you since you’ve been here?

What inspires me are the people I work with every day – the patients and my colleagues. Patients and their families, who despite what they’re going through, constantly amaze me with their strength, grace and kindness. They teach me perspective and humility.

Teamwork is a major factor behind the success of the Bras Drug Development Program and Princess Margaret. My colleagues – scientists, nurses, doctors, pharmacists, allied health staff, coordinators and administrative staff – are dedicated to and passionate about their work. We may have differences in opinion at times, but we all have a common goal. We frequently come early, stay behind and work on weekends, because we believe in what we do.

What is personalized cancer medicine?

I think medicine has always been personalized in a way. We have treatment algorithms and guidelines, but good clinicians will tailor treatments to suit their patients’ individual circumstances and wishes. More recently, technologies (for example, by looking at tumor DNA) are allowing us to learn more about how cancers form and evolve over time and in response to treatment.

We are also learning about how the molecular makeup of each patient’s cancer is unique and as such may be vulnerable to different treatment strategies. The hope of truly personalized medicine is that we will be able to tailor treatments to each patient (down to the genomic and molecular level), thus potentially improving the chances of success and minimizing side effects. However, while there have been some major advances, we’re only at the beginning of uncovering the complexities of cancer and how best to address these therapeutically.

What are some of the advantages of being a BRAS DDP fellow?

The BRAS Drug Development Program has an international reputation, not only as a leading phase I program, but also for its excellent fellowship program. I feel very fortunate to have had a wonderful experience over the last two years. It’s a very hands-on fellowship. We are exposed to all aspects of drug development, including assessing patients, managing side effects, writing trial protocols and working with sponsors. Our mentors also make sure we have opportunities to develop and work on our own projects. Despite working hard and often feeling out of my depth, I’ve never felt unsupported or alone. Another huge advantage is being able to meet and work with other fellows from around the world. I’m confident many will become life-long colleagues and friends. On a personal note, it’s been wonderful and eye-opening to live in Toronto. My husband and I have both fallen in love with this multi-cultural and dynamic city.

What are ‘Phases’? How many are there?

Testing of new drugs occurs in sequential stages, or ‘phases’. The preclinical phase refers to research done by scientists in the laboratory in human cells or animal models. When new drugs have shown promise in the laboratory, they might move on to Phase I testing or ‘first-in-human’ trials, which is a main focus of the BRAS Drug Development Program. The main purpose of a phase I trial is to see if a new drug or new combination of drugs is safe in humans. If this is proven, then a drug may get taken forward to Phase II and III trials, where we’re looking at whether it is effective or not and how it compares with the current standard therapy. Depending on these results, regulatory authorities will make a decision about whether the drug will be approved, licensed and made available to patients. Phase IV research refers to the post-marketing study of drug safety and effects, including long-term effects. Generally, as we progress from phase I to IV trials, greater numbers of patients are involved. Drugs that are unsuccessful in early phase testing (unfortunately the majority) will not enter late phase development.

How long does this process take starting at Phase I and ending at Phase III?

This can vary depending on multiple factors and there’s no standard time. Previous research showed that the time period averaged 7-9 years from first-in-human trials to regulatory approval for oncology drugs. More recently, drugs which have shown convincing efficacy early on in the development process, such as targeted drugs and immunotherapy drugs, have been approved in much shorter timeframes.

What are the advantages of being a participant in a Phase I trial?

Clinical trials offer patients more options and access to novel treatments beyond the standard therapies that are available to them. If patients join a Phase I trial at Princess Margaret, the phase I team including staff, fellows and nurses will take over their oncological care, which means patients will have the benefit of and access to a dedicated around-the-clock clinical team. Many patients are also motivated to participate in early phase trials to contribute to science and to benefit others, which is tremendously generous and altruistic.

There is a big banner outside this hospital: “WE WILL CONQUER CANCER IN OUR LIFETIME.” In your lifetime, do you believe this will happen?

A similar banner caught my eye when I came to interview in 2013. At the time I thought it was ambitious, but also bold and full of hope. The field of cancer medicine is moving rapidly with innovations and breakthroughs happening all the time. So much progress has occurred, even just in the last few years. In my lifetime, I have no doubt we will be able to prevent, control and treat cancer much more effectively, using safer and ideally individualized treatments, such that patients will be able to live longer and better.

When your fellowship is finished, wheare are you going and to do what?

I don’t have concrete plans yet. The opportunities in medicine are so vast, so who knows! My hope is to combine clinical work with research in my future role. The experiences and the knowledge I have gained working at the Bras Drug Development Program has had a huge impact on me and will always stay with me. I also hope to establish future collaborations with my colleagues and mentors here.
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