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Subspecialties Oncology, Clinical care, Profession

Career Snapshots with Monika Lamba

Tell us a little about your career in clinical trials…

I’m a pathologist-scientist and I work for CellCarta, a rapidly growing clinical research organization that provides a network footprint for global clinical trials with its laboratories in the USA, Belgium, China, and Canada. I work at the Belgian site. I’m also the principal investigator or sub-investigator on some of these trials, from evaluating hematoxylin-eosin sections to quantifying biomarkers, providing pathology input for assay and AI algorithm development, and training other pathologists, working at CellCarta is fulfilling and challenging.

Working in the clinical trials space was a perfect culmination of the diagnostic training I had during my education as a pathologist and the research experience I gained during my PhD in molecular pathology. With the opportunity to work in many different countries and setups – tertiary cancer hospitals, research centers, university hospitals – I thought the clinical trials space provided a perfect platform to use both my diagnostic and my research experience.

What’s unique about working in clinical trials?

Pathologists form an integral part of the clinical research team and our input is crucial. They make sure that the diagnosis and staging are correct. The data from pathology parameters, which come from prognostic and predictive studies, can be used to enroll, stratify, and randomize patients. Pathology parameters can also be used as primary or secondary outcome measures – either as standalone classifiers or in combination with clinical data. Now, the concept of minimal residual disease (what we call “pathologic complete response”) is also routinely incorporated into clinical trials. So I feel that pathologists have a very unique position in that they have the expertise to deliver this important information – and they know the limitations of laboratory testing.

Why don’t more pathologists consider careers in clinical trials?

That’s a very interesting question. I was speaking to some trainee and early-career pathologists regarding a career in clinical trials a couple of weeks ago and I was surprised that not many were aware of this line of work. I guess we need to educate and make them aware of career in clinical trials, and also probably train an entire generation of clinical trial pathologists. That is important.

I feel sometimes there is a mindset that working in the clinical trial space is only about research and not about diagnosis. In fact, working in clinical trials provides a perfect platform for using both your diagnostic and research skills. We see cancer patients all over the world now living longer lives and enjoying better quality of life because of the drugs that have been approved after going through these clinical trials. A patient’s eligibility for a clinical trial – and evaluating their therapeutic response – is very important and that is done by the pathologist.

I also feel that, sometimes, it’s a question of delayed gratification. A surgeon might feel happy about a skill that helps patients when he performs surgery and the patient improves. A cardiologist might feel happy with a patient comes to her after a near-fatal myocardial infarction and then improves with treatment. Similarly, a pathologist might get this kind of high from a good diagnosis that allows a surgeon or a medical oncologist to make appropriate clinical decisions. In clinical trials, this can be a little delayed until you realize that, for instance, a biomarker you have been working on is finally approved as a companion diagnostic.

What’s your favorite part of your work?

The fact that what I do is crucial and ultimately impacts patient care is very important to me. My work typically focuses on oncology and immuno-oncology. As we enter the era of precision medicine, cancer therapies are now more individualized than ever, depending upon the patient’s individual molecule signature. Pathologists have a vital part in that.

When I evaluate slides, I know that my work will help in clinical decision-making or overall data quality for cancer research. That is very important to me. I also like to collaborate and to provide pathology input on AI algorithms, because we are seeing a paucity of pathologists not only in clinical trials, but elsewhere as well. I think, in the future, AI will be providing an important tool to pathologists.

What is the most unique thing you’ve experienced in your work?

The most unique thing is also the most challenging. Tissue biomarkers are not only important for scientific research, but also for diagnosing disease and looking at treatment responses. I see many of these biomarkers every day and each one comes with its own scoring strategies, pitfalls, and challenges. Navigating between these biomarkers while trying to juggle the scoring strategy in your head and deliver an optimal result on each slide is challenging, but also unique.

What one key thing would you like to share about what you do?

I think the ever-expanding portfolio of clinical trials will continuously demand more pathologist engagement – so you need to think out of the box. In the clinical trials space, the pathologist works as a part of a team; you routinely communicate with technologists, surgeons, oncologists, imaging scientists, and other healthcare providers, so it’s important to communicate well and articulate the pathology behind the disease. Also, because you are a part of a team, it’s important to have good teamwork skills and flexibility. Apart from that, I also feel that it’s important to keep abreast of recent advances in molecular medicine. This can be done by attending conferences, taking courses, or even exploring online learning. It’s time for pathologists to think out of the box – and it’s also time for us to be at the forefront of clinical research.

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