Every scientist should meet a patient
Written by EpiPredict PhD fellow, Simone Borgoni (DKFZ, DE)
Studying breast cancer is a big challenge and does not only require hard work from scientists: patients can help as well to make progress. At the end of last year, with the EpiPredict consortium we organized as outreach event a science cafe meeting, where researchers and breast cancer patients exchanged their experience on breast cancer treatment. To learn more about patient-researcher interactions, I spoke with Dr Luca Magnani, who is regularly attending these events.
Who is Dr Luca Magnani?
Dr Luca Magnani received his PhD from Purdue University (USA). In 2013 he moved to the Department of Surgery and Cancer at Imperial College London (ICL, UK) to take up a Junior Research Fellowship. He is now a senior research fellow supported by a CRUK career development fellowship. He leads a team of researchers focused on the causes of resistance to hormone therapies in breast cancer.
Why did you decide to focus your research on breast cancer?
“After my doctorate I started working in a laboratory that focused on breast cancer and I found it really intriguing and challenging. When I had the opportunity to set up my own lab in ICL I decided to keep my research line on breast cancer, particularly trying to understand the role of epigenetics in the disease progression and resistance to therapies”.
With epigenetics you mean…
“Epigenetics is a layer of information on top of the ones written in the DNA sequence (genetics) that is essential to determine the fate and behaviour of our cells. The peculiarity of epigenetics is its dynamic and reversible property, in contrast to the DNA code that is fixed in our cells”.
One of the crucial issues that you focus on is resistance to drugs targeting the cancer cells. How do you see the importance of epigenetics over genetics in the context of therapy resistance?
“Indeed resistance to standard anti-cancer therapies is a major issue. For year researchers have studied genetics to find answers in the difference in the DNA sequence between patients. Investigating epigenetics on the other hand is relatively new and many resources are now flowing into this direction. I think that neither genetics nor epigenetics is uniquely important in tumour evolution and therapy resistance, but rather they influence each other. Increasing our understanding of both of them and particularly their interaction is essential to unravel the complexity of tumour evolution”.
Since 2015 you are involved in the EU Horizon 2020 funded EpiPredict consortium. This involves 15 partners, both academic and non-academic, across 8 different countries. What are the advantages of working in an interdisciplinary and international consortium?
“It is very stimulating to be confronted with others and working together to reach the same goal. I particularly like the feeling “to be out of the comfort zone”. For example in this consortium we are confronted with people from different countries and other ways to do science. Each of us has specific strengths and weaknesses and we all bring them to the table to be shared with each other. Combining our expertise, we make a great team. Last but not least, it is always much more fun working and joking together”.
As a scientist, your work is mostly confined in the lab, far from the clinic where breast cancer patients are treated. For this reason tissue availability is a major issue in scientific research. What do you have to do to get material you need to continue your research?
“Obtaining patient material to study is indeed a major problem. Such materials can be acquired by means of a biopsy, in which a surgeon removes a bit of the tumour cells. This procedure only takes place when it directly benefits patients, which makes it difficult for research. For us it would be best to have additional samples at various stages during the disease progression. But no surgery is performed when this is necessary for sole research purposes. Moreover all the biopsies are taken before drugs administration. This is not ideal, particularly in our line of research that involves understanding the mechanism of therapy resistance”.
Do you have any suggestions or maybe wishes on how to change this process?
“Ideally, the best sampling procedure for research purposes would involve 3 biopsies: one before surgery, one after drug administration for disease check-up and eventually one after recurrence development. Obviously I say this as a scientist. I know biopsies are invasive and are quite harsh on the patients. This is also the reason that at the moment the check-ups are mostly performed with imaging techniques as MRI. However, I think performing biopsies would benefit the patients as well by getting immediate and specific information on the molecular characteristic of the tumours. The depth of information that could be obtained from biopsies can hardly be achieved by the mere image obtained from MRI screening. In order to improve the way tissues are collected for research purposes there should be more crosstalk between scientists and clinicians to find a more structural strategy that could benefit both patients in the immediate term and research in the long term”.
To have a closer connection between research and clinic you actually started to meet breast cancer patients. How did this begin? And how are these meetings organized?
“The research in my lab is funded by several funding agencies, amongst others the EU Horizon 2020 and Cancer Research UK (CRUK). The latter has a patient engagement policy and therefore we set up lab visits for interested patients. During one of those visits I got to know some patients that set up a charity to bring (ex)-patients and researcher together. One thing led to another and I started to join these meetings. You should keep in mind that as a scientist you don’t usually get opportunities to interact with patients, but these meetings are exactly filling this gap. However meeting with patients is not trivial. We as lab researchers are not trained to engage people with serious illness and this can be difficult to deal with for both sides. To be prepared for this experience we first met with a Senior Nurse at CRUK who thought us how to approach and talk to patients”.
What are the additional values that this close contact with patients brings to your work?
“The main additional value is definitely motivation. In these meetings you are reminded why you are doing research. Sometimes in the lab you tend to forget that and you are producing results only for career purposes. This would be incredibly limiting as in the end we all started this job with the dream of new discoveries that will save lives. We are not expecting new ideas or biological inputs from the patients but more a personal social involvement that is sometimes lacking in our researchers’ daily work. Another practical advantage of these meeting is confronting on clinical trials. These are set up by clinicians and researchers without usually considering the opinions of patients on several issues: are they willing to give samples for research, and if yes what side effect are they willing to face, how many visits to the hospital do they want to go through for sampling and checking and so on. It is important that doctors and scientists can consider these variables as well when making decisions for new clinical trials”.
What are the challenges to get closer to patients?
“The challenges are mainly emotional. You are facing death: it is scary and overwhelming. We are working mainly with cell lines in a plastic dish and they don’t give back any reaction or feeling. You learn how to empathize with patients. Interestingly, not everybody reacts in the same way: different people approach these meetings in their own way. After all, I think it is really personal but it is a strong experience and every student should be exposed to it early in her or his career”.
This blog was established in collaboration with EpiPredict Partner Organisation Science Matters (www.science-matters.eu). The EpiPredict consortium (www.EpiPredict.eu) receives funding from the EU Horizon 2020 program under Marie Skłodowska-Curie grant Innovative Training Network agreement no. 642691.
Dr Magnani is an invited speaker at the conference Systems Epigenetics: Towards Precision Cancer Medicine, to be held in Amsterdam, the Netherlands, 27–30 November 2018, organized by the EpiPredict consortium. See the conference website here.