By: Dr. Nikhil Wagle
Leader of The MBCProject, Komen-Funded Researcher
We recently caught up with Dr. Nikhil Wagle, leader of The Metastatic Breast Cancer (MBC) Project and Komen-funded researcher. In the Q&A below, Dr. Wagle answers questions about his personal motivation, applying for grants as a young investigator, and how he and his colleagues worked with patients to develop the groundbreaking MBC Project.What motivated you to pursue a career in breast cancer research?
I have been drawn to medicine and science for as long as I can remember. Once I started medical school, I became really interested in cancer research – largely because there was so much we didn’t know, yet it affects so many. We were (and still are) in desperate need of more treatments. Throughout my training as a medical oncologist, I saw many women and men with both early-stage and metastatic breast cancer. In some cases, we really understood the biology of a patient’s tumor and what was driving it. We could give those patients drugs to target the tumor, and those patients would do really well. Those were great moments. But so many times that was not the case. We didn’t know the biology, or didn’t have a marker or test to advise us as to which drug we should use. That’s what led me to pursuing a career in trying to understand precision medicine.
You were a recipient of a Komen Career Catalyst Research Grant – our grant mechanism aimed at helping young investigators start independent research careers. Tell me what it’s like to get funding as an early-career investigator.
One of the issues with a career in research is that even if you’re passionate and want to make a difference, it is challenging to realize that goal because you have to find funding. This is particularly difficult as a young researcher. I was very fortunate to have received a Career Catalyst Research Award from Komen at a key point early in my independent research career. That grant provided me with funding to pursue laboratory studies of treatment resistance in patients with ER+ metastatic disease. This ongoing project in my lab is now starting to yield important insights about how treatment resistance occurs and how we might overcome that resistance. This funding was critical in helping me launch this investigation just as I was starting out.
We at Komen were delighted to announce our support for the innovative Metastatic Breast Cancer (MBC) Project. How did the MBC Project come about?
There are some clear emerging patterns in cancer research. First, studying tumor samples from patients is essential. Tumor samples enable us to make really important discoveries and advances more quickly. Many of the major discoveries and novel treatments that have come out over the last five to 10 years have relied on these samples. Second, many academic cancer centers doing breast cancer research are only able to collect tissue from patients who are cared for at that institution, which accounts for only a small fraction of patients with breast cancer in the country.
By some estimates 85 percent of patients with cancer in the U.S. are cared for in community settings – not large academic cancer centers. That means the vast majority of cancer patients in the U.S. have never been asked if they would be willing to share their tumor samples and medical information for biomedical research.
We thought that if asked, patients would be very willing to participate in these studies. That’s what spawned this idea. In the era of social media, the internet, advocacy groups, and patient empowerment, we hypothesized that if we built something that would allow any patient to participate – regardless of where they live – together we could accelerate research and discover more about the biology of metastatic breast cancer, and even identify potential treatment strategies. So, last October we launched the Metastatic Breast Cancer Project and our website.
Dr. Nikhil Wagle"We knew from the beginning that this would be a different type of study, and felt really strongly that patients should have a voice in how this project should be developed. Our view was, if we were going to do a project that was all about the patient-researcher partnership, it should be true from day one."
Dr. Nikhil Wagle
"We knew from the beginning that this would be a different type of study, and felt really strongly that patients should have a voice in how this project should be developed. Our view was, if we were going to do a project that was all about the patient-researcher partnership, it should be true from day one."
How were patients involved in this project?
We knew from the beginning that this would be a different type of study, and felt really strongly that patients should have a voice in how this project should be developed. Our view was, if we were going to do a project that was all about the patient-researcher partnership, it should be true from day one.
During the San Antonio Breast Cancer Symposium in 2014, we met with as many MBC patients and advocates as we could find. We didn’t even have a name for our idea – just wanted to put it out there and gauge interest. Would they be interested in participating? Would they tell others?
We learned a lot from those discussions. First and foremost, patients and advocates supported the idea. But second, there were some concerns. They wanted to make sure what we were doing wasn’t redundant with other projects (which would just be a waste of energy and money). It was also important to the patients that, should we move forward, our work and learnings would not just benefit us, but the whole research community. So right there, at the conception of the project, we made a commitment that all data we collected would be publicly available for any researcher who could use it.
Those are just a couple of ways in which the patient perspective influenced us in the beginning, and continues to influence us today. Conversations with patients and advocates also helped guide the site design, messaging, images, and our overall process.
It’s amazing to have the patient voice integrated into everything we do every single day. We’re thrilled to have created a two-way dialogue between all of our patient participants and the researchers, regularly updating patients on where the project has been going, providing status updates, and what we’re learning. Many of our patients have told us how other studies they’ve participated in don’t provide any updates. They may not even be informed when a study they participate in has ended. So we do our best to make sure that our participants are always informed of the impact they’re making.
You mentioned that you share things you’re learning with the participants. Any learnings you can share with us? More than 2,900 women and men with breast cancer from the U.S., Canada and other countries have signed up to participate in the study, almost all of whom also opted to share information about their diagnosis, treatment, and experiences with cancer… This has allowed us to learn a great deal about MBC right from the start – before even going into the laboratory. For example, we were able to identify a group of patients who all had one thing in common – an extraordinary response to a specific treatment (for example, platinum chemotherapy). Knowing that these individuals share this unique quality raises the question, “Why?” Since we are obtaining saliva and tissue samples from patients, we can now analyze their individual samples to see if we can understand why this group of patients had a particularly good response to that chemotherapy. If we can answer this question, then maybe we can understand something that will apply to more people.
What’s the biggest challenge you’ve had to overcome in your career?
There are so many questions we want to answer! Not only that, there’s a strong sense of urgency to answer them, because people’s lives are at stake today. The challenge is that the research process tends to go more slowly than you hope. There are barriers – logistical, funding, data sharing – that can make research slower or less-effective. We are constantly trying to overcome these barriers and make research happen more smoothly. It’s part of what inspired this project. At least in some ways, this can help break down the issues of silos, and create a pool of knowledge to advance our understanding of metastatic disease.
What’s one thing you think many patients may not know about breast cancer research but you’d like them to know?
Significant progress is being made. I know there are questions about whether we are making progress, whether advances are happening – I hear it from patients often. From my vantage point, we HAVE made progress, and are now at an incredibly promising time in research – both with the kinds of technology available and new therapies on the horizon. I’m hopeful that we are going to make really significant advances in the treatment of cancer, and soon.
You are clearly very passionate about this research, and extremely busy working to make an impact in the lives of patients today. When do you sleep?
Life is busy and there’s a lot to do, but there are so many people who are dedicated and passionate about making a difference. It’s not just me (or any one individual)! There are countless individuals involved. The MBC Project is a multidisciplinary effort with my team collaborating with several other research teams, not to mention all of our incredible advocacy partners and patients. It’s a team effort to the extreme.
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