2013 San Antonio Breast Cancer Symposium (SABCS)

Careers in translational research

Dr Geoffry Shapiro - Dana Farber Cancer Institute, Boston, USA

It’s very important, I think, for young oncologists to try to get a broad based training so clearly one has to do a lot of clinical work and spend the requisite clinical time to become expert in multiple areas of oncology. But also the research and drug development are moving so fast that it’s useful for many oncology fellows also to spend some time in the laboratory getting to know what the research questions are maybe in a specific cancer type and learning some of the technologies, or at least becoming familiar with some of the technologies, in order to do this work.

Translational research is complicated because one has to define even what that is but usually right now if you use the NIH SPORE definition it’s research that’s really going to impact on patients, say within a five year period. There are so many facets to translational research, one can be a clinical triallist but then try to put in a lot of endpoints into the study that are scientific and research based that will augment the results from the study beyond just the clinical activity. So, for example, if we pick a specific genotype, a PI3 kinase mutation for example, and we’re trying to do a trial with a PI3 kinase inhibitor, one might want to design translational endpoints that would look at the degree to which the PI3 kinase inhibitor actually inhibited the pathway in patient samples. So that means organising tumour biopsies and working with pathologists to analyse those biopsies to assess the pharmacodynamics effects of the drug on the tumour.

But then one may have people who respond to the treatment and ones who don’t. All the patients may have a tumour that has a PI3 kinase mutation but the drug may only work in certain tumours and not others. So then one may want to put in translational endpoints that are, say, genomic in nature, for example whole exome sequencing, and try to really figure out what else in the genetic background dictated a response versus being resistant.

So those are just two translational endpoints that can be put into trials that are good for fellows to think about as they do clinical work and become involved with trials of new drugs. But translational work can have so many meanings and so many avenues it’s actually a rather exciting field. So as one starts one’s career, again, getting good clinical training, focussing in on the disease, the type of cancer one’s interested in and understanding the key clinical questions that are really critical to understand and to attack in that field in order to move it forward. Then obtaining at least some familiarity during fellowship with some of the genomics and some of the protein level work and the pathology work that’s necessary to answer important questions in clinical trials.

So each person has to carve this out independently; finding a good mentor is very important so that you can be helped through the process. Those are all things that are going to be keys to success.