Week 4 - Projects and Patients

This past week, a large part of my time has been devoted to working on my project. My project is with Dr. Linda Vahdat, a medical oncologist who is an integral member of the Weill Cornell Breast Center. She works with patients who have metastatic breast cancer to determine which course of therapy – chemotherapy, radiation, etc. – is the best for them. She also has a fairly active research program that is based on clinical studies and clinical trials of new treatments.

The project that I am working on is a collaboration between Dr. Vahdat and Dr. David Lyden’s lab at the Weill Cornell Medical College. This December 2005 Nature paper is the basis of the work. Essentially, Dr. Lyden’s lab has discovered that bone marrow-derived hematopoietic progenitor cells that express VEGFR1 home to tumor specific pre-metastatic sites and form cellular cluster before the arrival of the tumor cells. The tumor cells then attach to the cellular clusters and form micrometastases which develop into new tumors. The idea that the site of secondary tumors is determined even before the tumor cells detach and circulate through the blood is new to me, and it is an idea that completely changes the way we think of cancer. One goal of the Lyden lab is to investigate different methods of preventing the pre-metastatic niche from forming. They have found that certain antibodies prevent the cellular clusters from forming, and therefore prevent the growth of micrometastases. An interesting article that presents an easy to understand version of the research can be found here.

The collaboration involves looking at patients with varying stages of breast cancer, who have undergone various treatments, to determine whether the levels of various cytokines and growth factors change in accordance with the formation of a pre-metastatic niche. Therefore, blood is drawn from patients throughout their course of treatment, and is analyzed by members of the Lyden lab for these certain markers. The person who was in charge of the clinical data (under Dr. Vahdat) went to medical school, and thus there has been a lapse in the collection of samples. My role on the project is to sift through electronic files to determine when the patients enrolled in the study will come back in to meet with their physicians, and to arrange for them to have blood drawn at that time, to be sent to the Lyden lab. In total, there are around 120-140 patients in the study.
While most of my work occurs on the computer, this past week I had the good fortune of being able to personally arrange one follow up sample. A patient was coming in to meet with my physician mentor, Dr. Tousimis, for her biannual checkup. I was able to meet with the patient during her exam, and then took her to have her blood drawn. During the blood draw, she asked several questions about the study which I was able to answer. She was very enthusiastic about participating. I also was able to play the role of courier, transporting the blood to the Lyden lab, where I was able to learn a little more about the project on their end.

In addition to my project, I also went to several lumpectomies and mastectomies this week. I observed my first mastectomy which had immediate reconstruction using adipose tissue from the abdomen. It was fascinating to watch two teams of surgeons working at the same time, on different parts of the body, without interfering with each other. I do not envy the head scrub nurse her job. These ladies (at least mine have all been female) truly make the OR run.

In the last weeks of immersion, I am working to set up times for me to shadow a genetic counselor and a breast cancer pathologist, as well as to shadow Dr. Vahdat and observe the treatment of metastatic disease. My goal is to have a complete story of breast cancer and all of the different ways it is treated and diagnosed before I leave.