Hunter Gaudio - Dr. Cristofanilli, Dr. Elemento - Summer Immersion Week 3

I spent a majority of this week reviewing clinical notes and research articles focused on liquid biopsy tests for metastatic breast cancer management. Monday evening, we met with Dr. Wang to provide an update on our experiences, thus far. Tuesday, I attended our weekly BME meeting where we learned about the important attributes of a mentor/mentee relationship. I spent the rest of Tuesday and all day Thursday in the clinic shadowing Dr. Massimo Cristofanilli and Dr. Caterina Gianni. A mix of new patient consultations and repeat visits provided insight into the different stages of oncology patient care. 

New visits help me understand the interpretation of medical images and biopsy results, and which treatments are most likely to cause benefit with limited harm. In cancer treatment, managing the toxicity of treatment seems to be as challenging as treating the disease itself. Many of these patients are geriatric and have underlying conditions that need to be considered when building their treatment plan. Many of the chemotherapies and other hormonal therapies can induce damage to the heart and the liver, and can cause osteoporosis. Based on initial conditions, alternate therapies may need to be considered. 

Repeat visits provide perspective on blood tests used to monitor toxicity in the patient. White blood cell count, along with other liver markers are routinely evaluated and sometimes indicate the need for a treatment break or dose reduction. Dr. Cristofanilli always takes time to listen to every patient's concerns and complaints regarding symptoms either from the disease or the treatment of it. 

I am still waiting to receive whole exome sequencing data from the primary tumors of breast cancer patients who underwent Signatera liquid biopsy testing. Additionally, Dr. Gianni approached me about a project focused on evaluating flow cytometry data to associate the tumor-immune microenvironment with the sequencing results of a biopsy of the primary tumor from inflammatory breast cancer patients. We are now initiating a data transfer from BostonGene for this work. 

On Friday, I began a literature review of flow cytometry data processing in context of analyzing the tumor-immune microenvironment. I am also learning more about the symptomatic and genetic presentation of inflammatory breast cancer. I am looking forward to receiving this data and building bioinformatics pipelines to elucidate mechanisms of disease from very large, sometimes convoluted, data sets. We have scheduled a meeting for Monday morning to discuss the retrieval of this data and outline an analysis plan.