What is your educational background?
I’ve been in Birmingham since 2006 and graduated from the University of Birmingham in Medicine/Surgery, as well as an intercalated BMedSc in Clinical Sciences. I’ve trained as a junior doctor in the region through foundation programme (two years after medical school), Core Medical Training and I’m currently a trainee in Medical Oncology.
Why did you want to study at the University of Birmingham?
I knew the University well from my undergraduate days, and undertook a joint academic-clinical training route (Academic Clinical Fellow) which allowed me to have protected time out of clinical work to develop a project and apply for research funding later down the line. The research was carried out at Birmingham, and I’ve worked with a few different groups and have generally found most people very helpful and passionate about their work.
What attracted you to the CRUK PhD program?
I think oncology is one of the more academic specialities, both in the pace of change and constant stream of clinical trials and novel therapeutics, to the huge amount of basic science that is undertaken. I don’t see how you could function without a strong background and interest in the underlying science. My project is almost entirely lab-based and focuses on immunology and genetics. These are areas that as clinicians we are going to be constantly exposed to in the future, and increasingly will have to interpret the significance of genetic tests in patients. In oncology, we will have to identify targeted treatments and clinical trials for patients with ‘actionable’ mutations where we potentially have new drugs that could help them, based on their personalised genetic tumour make-up. This can even be done by ‘liquid biopsy,’ capturing DNA that has leaked out of the cancer cells into the bloodstream and monitoring how the cancer changes in response to treatment. Two years ago, I would have said this would be a decade away, but it’s already happening and is going to rapidly accelerate in the near future.
How much clinical work will you get to do during your PhD?
I do a clinic in colorectal cancer every Friday morning, and this has been really useful to keep up-to-date with changes in the field, as well as keep basic clinical skills fresh. I have also done some on-call work when we have gaps on the rota, but I think it’s important that you dictate this and make sure it fits around your research work, rather than the other way around.
What is your research focused on?
I’m researching colorectal cancer, which is particularly interesting as a model to study immunotherapy as we have two types of cancers that respond very differently. One type is really abnormally ‘hyper-mutated,’ and responds to immunotherapy well, probably because of all the mutations that are seen by the body as foreign. The second type that unfortunately makes up the majority of patients doesn’t respond at all. We are growing organoids (rather than growing cancer in the lab as a sheet of cells on plastic, these instead form spheres that function as mini-guts and are much more like the real cancers they come from) from colorectal cancer. We are using these organoid models to see how the cancer cells behave when we simulate attack by the immune system in the lab, and in particular how those foreign mutations are presented to the immune system. Hopefully, this will lead to ways that we can enhance this immune interaction, leading to better responses to immunotherapy in the future.
How will a CRUK PhD help you with your career?
Hopefully this will allow me to function much more independently as a researcher and my time has already given me a background in a number of techniques. In the future I hope to continue my research alongside my clinical work, and also move into clinical trials.
What advice would you give to someone applying for a PhD?
Find a project that interests you and supervisors that you get on well with, it’s likely you’ll be working together for at least three years!
What are you most proud of?
I think the emergence of immunotherapy over the last decade, particular in lung cancer and melanoma. These are cancers that were killing people quickly, and that our treatments with chemotherapy were toxic and actually really not very effective. When I was a house officer (1st year junior doctor) working on the oncology wards, we were getting the first few patients coming into the hospital with bizarre autoimmune side-effects from their new immunotherapy treatments. We have developed management protocols for these toxicities, an approach that was almost haphazard to begin with, as what we were facing was so different to chemotherapy. That said, in contrast to chemo, most patients were very well and didn’t have any of the usual side effects from chemo like mouth ulcers, infections and hair loss.
The pace of expansion has been remarkable, and some patients who had metastatic disease have been cured of their cancers. We still struggle with that ‘C word,’ and perhaps my biggest disappointment is that we are yet to really expand the fantastic benefit that we see in a few percent of patients to a larger group. Increasing response rates and predicting which patients respond to treatments must be the next hurdle to overcome in oncology, and will hopefully be something I am involved in.