Dr. Victoria Mandilaras – Montreal

Dr. Victoria Mandilaras
Dr. Victoria Mandilaras

BRAS DDP Clinical Fellow 2015 – 2017

What brought you to The Princess Margaret Cancer Centre?

One of my mentors at McGill, was Dr. Jeremy Sturgeon. He had trained and worked on staff at Princess Margaret until 2006 when he left to take on the position of the Chief of the Medical Oncology Department at the McGill University Health Centre. We had worked together in the gynecologic oncology clinics and he sparked in me a special interest in this subspecialty. He said: “If you want to learn about gynecological cancers, you MUST go to Princess Margaret.” He put me into touch with Dr. Amit Oza and the rest is history…

Why did you wish to become a doctor?

Growing up, I was naturally inclined towards the sciences. I liked things that were logical and explained how things worked. I knew I wanted to do something that could incorporate this interest, but I also wanted to interact with people rather than sitting behind a bench or desk all day. Medicine was the perfect way of combining the two.

What is your work of expertise?

My practice focuses mostly on the treatment of gynecological cancers but not many people know that I treat tumours of the central nervous system as well (I keep that part low key).

Do you treat each site differently?

Brain tumours and gynecological cancers are fundamentally quite different in terms of their treatments but are both devastating diseases for patients and their families. Although treatment algorithms are different, better treatments are desperately needed. The common thread for both these sites is that there is a huge amount of cutting-edge research being generated for both of them. It’s in exciting time to be practicing in either field.

Do you feel we are making progress in the war against cancer?

I do, and I don’t just say that because I’m an oncologist. We’re learning more about tumours beyond the anatomical site from which they stem. No two ovarian cancers are the same, for instance. As close as even 10 years ago we lumped the treatment of all of them together. That’s wrong and now we understand that. Things like molecular profiling have changed the field, enabling us to be more precise in our treatments and tailoring them to the patient and not the tumour. Now we’re adding even more complexities to this like epigenetic assessment and the patient’s immunologic landscape.

What is immunotherapy?

Immunotherapy is a therapy that makes use of the patient’s own immune system to fight their cancer. This may be a vaccine therapy where you stimulate the immune system to recognize a part of the tumour, or an antibody therapy where you activate the immune system in hopes that it will recognize cancer in the body as an intruder and target it. It has revolutionized the treatment of lung cancer and melanoma among others. It is in the very early stages of development in gynecological cancers and brain tumours but hopefully will have a large impact as well.

Is there any interaction with other major cancer centres in the world?

Princess Margaret is part of the Princess Margaret Consortium made up of other cancer centres in Canada and we collaborate in early phase clinical trials with other large centres in the United States. As part of Bras Drug Development Program, I’m exposed to many trials that are led by these consortia. Of course, there are also collaborations around the world with regards to recruiting patients, but also for collaborating on research within the realm of these studies. We have studies that involve sending out tissue collected from patients on study, to laboratories across the world to make use of an expertise that only they may have for the purpose of advancing this science.

The population of any one trial globally is quite large?

The trials range in size from a cohort of 50 patients up to thousands depending on the stage of drug development. Newer drugs are tested in smaller cohorts to make sure they are safe and effective before moving on to larger confirmatory trials. These smaller trials are often offered to patients where treatment options are limited and may offer new options where standard therapies are lacking.

What are some of the major advances in the last few years, any challenges?

We have redefined cancer on a genetic level. For example: The changes we find in the tumour DNA which may have helped the cancer to grow, versus where in the body the cancer originally developed, has definitely advanced the field. This has enabled more precise treatments. For instance – the treatment of ovarian cancer with a mutation in the BRCA gene with a class of drugs called PARP inhibitors. These drugs exploit the deficits in the cancer cells caused by the BRCA mutation which causes them to die.

The challenges remain further defining these mutations. The knowledge we have now is only the tip of the iceberg.

Are we seeing newer cancers?

In a way, yes. Again because we are becoming so much more precise with the way we classify these cancers based on their genetics which we are starting to group into smaller and smaller categories. These categories may have an impact on the way we treat the cancers within each one.

What is great about working in The Bras Drug Development Program at The Princess Margaret Cancer Centre?

The Bras Drug Development Program is definitely unique in that it’s a well-oiled machine. It’s made up of a large number of individuals who each play an integral part. As a fellow, I’ve always felt well supported and I have the resources to be successful in my research. During my time here, I’ve been able to develop protocols and see them to fruition because of the resources at my disposal.

What inspires you to continue on in your work?

My patients inspire me. My interactions with them, getting to know them on a personal level and being a part of their story is what encourages me to continue the work that I do. I can’t cure them all but I can help them to the best of my abilities.

What are you going to doing at the end of your two years?

At the end of my two years, I’ll return to work in my home city of Montreal, Canada. I will also start my MBA degree, as if I did not have enough training! I’ll be moving on to my next interest of determining how to best administer healthcare in the future within the economic constraints we face in the public healthcare system, and the ever-increasing cost of cancer care. I will keep my ties with Princess Margaret, however, and look forward to collaborating in the future.