Rapid Tissue Procurement and Robust Biospecimen Data for Cancer Research

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Ann Nguyen:

Hi. I'm Ann Nguyen, Associate Conference Producer with Cambridge Healthtech Institute. This is a podcast for the 2015 Leaders in Biobanking Congress, July 14-16 in Toronto, Canada. We have not one but two interviewees today, Dr. Michael Roehrl, Director of the UHN Program in Biospecimen Sciences at University Health Network and University of Toronto, and Dr. Anthony Joshua, Staff Oncologist and Affiliate Scientist with Princess Margaret Cancer Centre. They'll be co-presenting a case study of their biobanker/biouser partnership. University Heath Network, meanwhile, is the co-host of the whole event.

Michael, Anthony, thank you both for joining us today.

Anthony Joshua:

No problem.

Michael Roehrl:

Thank you very much.

Ann Nguyen

Michael, you're a practicing academic physician-scientist and Anthony, you're a clinician-scientist. What led you to both take on those dual roles, and how do they shape your approaches to biospecimen management and data collection? Michael?

Michael Roehrl:

Being on both sides, if you will, of the aisle on the research side as well as the clinical practicing side is, to me, very fulfilling. It really mutually guides and influences the way I think about both patient care, as well as research. What I want to say is that working at a research hospital, as we do here in Toronto, taking care of patients – and I do this as GI pathologist every day where I look at biopsies and resection specimens of patients and try to understand what disease they have – and then taking that impression, knowledge and motivation back into the research laboratory is really a very fulfilling career. Being able to, then, ask questions in the laboratory about molecular aberrations, using the tissue and blood samples that we procure from our patients to ask deeper questions about the pathophysiology of cancer is a very important one.

Triangularly, as a team here in Toronto, to turn from the bench back to the bedside, and improving both diagnostics and, ultimately, treatment selections is something that fascinates me and really motivates me to go to work every day.

Ann Nguyen:

And Anthony?

Anthony Joshua:

I guess I echo those sentiments. I'm a clinician. I work in medical oncology, specifically genital and urinary oncology, and skin oncology, which is predominantly melanoma. The reason for combining that with the laboratory work is that there's a certain passion to help patients, and to bring them the latest, and to understand how best to treat them, which patients to treat, and when to treat them, and how to treat them.

There are so many questions. The field is so exciting and moving ahead in leaps and bounds. It's very difficult not to make your own contribution, or at least try to make your own contribution, to the field by being on the other side and liaising with my scientist colleagues at Princess Margaret to bounce ideas off each other, to develop proposals together. Michael and I work very closely together on such fields. It's a very exciting time. When you're face to face with a patient, you always think that you could help them more, you could contribute more, and sometimes that is an important motivation to develop experiments and to really drive the field forward.

In terms of how that shapes my approach to biospecimen management and data collection, I think it simply tells me that both biospecimen management and data collection has to be robust. It has to be exact if we're going to develop the biomarkers for treatment selection, or bio- –prognostic biomarkers, we have to be sure the data we're generating is good quality data. It demands a certain level of rigor in terms of data collection and partnership with broad variety of professionals in terms of information technology, pathology and bioinformatics that will ensure that what we do is world class, and ensure that what we do, ultimately, can be applied to patients because we know that the data is robust.

Ann Nguyen:

Can you describe your Rapid Autopsy Program: how and why it came to be, what's unique about it and how it's contributing to translational research? Anthony?

Anthony Joshua:

Sure. The Rapid Autopsy Program, or Tissue Procurement Program, at Princess Margaret is – it's an opportunity for patients to contribute to science. It came to be because there were so many questions that we had in the laboratory with regards to evolution of cancer, with regards to why cancer became resistant to drugs, and what we could do about it, what we could learn about it. We realized that there was a large gap in scientific understanding in that field. Really the only way to address it was to understand the phenotype of end-stage cancer. The best way to do that was to procure specimens from patients after they passed away.

It's unique because I think it's probably the largest program in the world in its scope. We are accepting tissues from all common cancers. Michael might know more in terms of how it compares to other facilities programs than myself. The tissue is being applied to cutting-edge scientific research across of number of mechanisms, internally, Princess Margaret, externally, globally, in global alliances with other scientists investigating tumor heterogeneity resistance with regards to both local and international grant mechanisms. I think that the use of the tissue will continue to accelerate given the potential it has to help us to understand, particularly, the resistance mechanisms to an increasing array of targeted therapeutics in cancer.

Those are, I think, the reasons that it came to be. It's relatively unique globally, that and how it's contributed to translational research. Michael, I’d also value your thoughts.

Ann Nguyen

Michael, what can you add about it?

Michael Roehrl:

Thank you. Yes, as you heard, I think this is a really worldwide unique program. We are not aware of any other major center in the world that takes as global an approach as we do. The Princess Margaret Cancer Centre program, the Rapid Autopsy Program, is available to every patient who is cared for at the Cancer Centre, no matter what the underlying disease really is. We have seen broad visibility at a number of meetings, especially in pathology meetings, really, some of the other big centers in the world approaching us, trying to learn from us, how to develop such a program, how to set it up.

You heard already from Anthony a little bit about the really unique use of these samples. We are now about a year and a half into the program. We've collected over 6,000 frozen samples, thousands of paraffin-embedded tissue blocks, hundreds of well-annotated blood samples that go with this. We can now, really – and we have started already – a number of projects to detail molecular interrogation through sequencing approaches, transcriptomic approaches, and increasing our subproteomic approaches to try to look at disease heterogeneity, to understand what happens in advanced cancer and vitally metastatic disease that we see at these autopsies, including some very unusual metastatic science. For example, metastases into the heart and other organs that, if you will, in traditional research are, essentially, never biopsied, never asked for. Why certain tumor subpopulations go to certain niches in the body? What makes that unique?

Then, really, tying also – what interests me a lot is really tying these autopsies, if you will, as ultimate molecular readouts into ongoing clinical trials and ongoing direct development, and trying to understand what leads to ultimate resistance mechanisms in the disease. What leads to selection of certain subclones, and why they are resistant to treatment.

Really, together with our bigger biospecimen program that focuses on collection of specimens from living patients, from surgeries and biopsies, as well as blood sampling for circulating tumor markers, to try to understand the dynamics of cancer evolution, under treatment, especially. What happens over time, and really having access to the appropriate sampling of these tissues at autopsy, I think, adds enormous value to being able to ask those questions.

If you look worldwide, again, very few programs or hospitals have tried anything like this. Usually it was very focused to one or two diseases specifically. I think the scope and the infrastructure that we've built and the level of detail in terms of clinical annotation of these samples, matching these samples to radiologic imaging and to disease dynamics that's observed clinically while the patient's under treatment, all these things add up to an enormously rich database, both in terms of specimens, physical specimens, as well as data that annotates these samples.

I think this is a unique program. It also is a real opportunity for many of our patients who express the explicit wish to contribute to cancer research as they are seen here as patients. Many of them, unfortunately, at this point still fail ultimate therapy, but many of these patients have approached us with the idea, "Can we contribute to research?" I think – "Can we leave a legacy, a scientific legacy?" – I think this program, again, has engaged our patient population, our families who follow their loved ones being treated here, and really have engaged the Princess Margaret community, if you will, at large in this program. I think it's a scientific success, but, in addition, I think it has changed somewhat the dynamics of interacting with our patients.

Ann Nguyen

It's clearly really exciting and important, far-reaching work. Thank you again for this glimpse of it so far. We're looking forward to learning a lot more from you this summer in Toronto.

Michael Roehrl:

Thank you very much.

Anthony Joshua:

No problem. Thank you very much.

Ann Nguyen

We were just speaking with Michael Roehrl of University Health Network and University of Toronto and Anthony Joshua of Princess Margaret Cancer Centre. They'll be co-presenting during the session on Biosamples, Biomarkers and Clinical Trials at the Leaders in Biobanking Congress happening in Toronto, July 14-16.

To learn more from them, go to www.BiobankingCongress.com for registration details and enter the keycode, "Podcast".

This is Ann Nguyen. Thank you for listening.

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