Pathologists can play a vital role at every stage of a clinical trial – from design and the recruitment of participants, through to analysing results and ongoing monitoring and evaluation. As we enter a new era of precision medicine where treatments are selected for patients based on their individual molecular signature, the need for more pathologists specialising in clinical trials has never been greater.
Together with the National Cancer Research Institute’s CM-Path initiative, The College is keen to support both trainees and consultants alike to get more involved in this work. On 9 February, we’ll be hosting ‘Clinical trial training: Training a new generation of clinical trial pathologists’ – the second in an annual workshop series. The day’s agenda features a series of expert-led sessions on navigating the academic career pathway, getting involved with the NCRI clinical studies groups (CSG), designing trials, using digital pathology in clinical research and much more.
Ahead of the event, we spoke to three pathologists in clinical research about the most rewarding aspects of their work, and the qualities needed to succeed as part of a study team.
I am lead breast histopathologist at Addenbrookes Hospital in Cambridge, and am fortunate to have dedicated programmed activities (PAs) for both clinical work and research. I am passionate about diagnostic histopathology, and clinical trials provide an excellent opportunity to combine it with research and impact directly on patient care.
One of my main interests is assessing breast cancer response to neoadjuvant chemotherapy. It is fascinating to actually see how treatment affects cancer cells, and some cases of complete response in patients who had large tumours with nodal disease are just remarkable. It gives you a good feeling as you know that treatment in these patients has made a real difference… and as the pathologist I have determined the primary endpoint using good old fashioned H&E slides!
When working as part of a study team, you need to be good at communicating and thinking outside the box. You also need to be prepared to do the background reading to make sure you are using the best methods available. Sometimes, it is just a case of solving practical problems – for example, I have worked closely with research nurses and surgeons to optimise fresh tissue collection. Streamlining the process has led to improved engraftment rates for patient derived xenografts, which provide a valuable model for future research.
Dr Elena Provenzano, Lead Breast Pathologist, Addenbrookes Hospital and Cambridge NIH Biomedical Research Centre
The most rewarding aspect of involvement in clinical trials as a pathologist is the opportunity to improve overall research data quality. Pathologists bring a unique perspective and skill-set to a diverse research team, and should be heavily involved from the planning stage through to the analysis and presentation of the data.
Pathologists involved in clinical research need to share their expertise with a range of non-pathologists including oncologists, scientists, surgeons and nurses. Being able to effectively articulate pathological issues – from subtle morphological differences to technical requirements or complex tumour classification systems – is, in my view, the most important skill you can hold. It also counters the widely held misconception of pathologists as poor interpersonal communicators!
My top tip to pathologists getting involved in clinical research – don’t be put off if the landscape of molecular medicine is unfamiliar to you. Seek opportunities to develop your understanding: complete online modules, go to talks, ask questions and get involved.
Dr David Moore, Consultant Thoracic and Molecular Pathologist, University College London Hospitals NHS Foundation Trust and Sarah Cannon Molecular Diagnostics
Being involved in clinical research is intellectually enriching and keeps me feeling fresh during my routine clinical work.
I actually began my career in research before I went to medical school, as a post-doc in Manchester studying T helper cell mechanisms. I was happy in the lab and loved designing and carrying out experiments – then one day, someone came to give a talk on complement deficient diseases and a new breakthrough in treatment that had resulted directly from their study. It was then that I decided to study medicine so that I could get involved in more patient-orientated clinical research.
My original intentions were a bit vague, but at medical school I discovered histopathology and realised it would allow me to study the mechanisms of disease at a cellular/molecular level. During my training, I became interested in women’s cancers and as a NIHR clinical lecturer I studied ovarian cancer. In 2014, I was involved in a pathology study as part of a trial designed to discover new blood biomarkers for ovarian cancer screening, and this work opened my eyes to the huge research opportunities for pathologists available from clinical trials.
I’ve met many pathologists who would like to get involved in this work, but don’t know where to begin. A good start would be to attend our clinical trials day to find out more.
Dr Jackie McDermott, Academic Gynaecological Pathology Consultant, University College London Hospitals NHS Foundation Trust