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This October we are proud to present Martine Extermann as our Faculty Member of the month. She is Associate Professor of Oncology and Medicine, University of South Florida, US, and Attending Physician in the Senior Oncology Program at H Lee Moffitt Cancer Center, US.

In this Q&A, Martine shares the highlights of working as clinical investigator and passes on top tips for early career researchers to help them advance within their chosen field.

What triggered your interest in oncology?

I fell in love with oncology during a rotation in my internal medicine residency. I progressively realized that I wanted a subspecialty that involved both scientific and human challenges and depth.

During my oncology rotation, it all came together and I knew I had found where I wanted to go. I knew I would have meaningful rapport with my patients, and that I would not be doing the same medicine twenty years down the road.

Can you tell us a little bit about your work?

I am a clinical investigator. I love the balance between seeing patients, teaching, and conducting research. It is a hard to keep balance though. I do geriatric oncology research. Half of cancers happen beyond the age of 70, yet we still have a lot to learn about how to treat patients with wildly varying health conditions. Each person deserves the best treatment for them, no matter what their age. This is why my research focuses on generating evidence to personalize cancer treatment in older patients.

I am focusing on the impact of comorbidity on cancer behaviour and treatment, and predicting tolerance to chemotherapy, increasingly exploring methods to use Big Data to address these issues. A trial I am passionate about is a randomized study of a real time expert electronic consultation of the Total Cancer Care database (more than a half million patients).

This can provide oncologists throughout Florida, and beyond, with matching cases for older cancer patients with multiple problems for which no good clinical trial evidence is available. It could bring a qualitative jump in our way to treat older cancer patients.

We are in the funding seeking phase. Another trial, ongoing, is a translational project to understand why the prognosis of ovarian cancer worsens so much with age. Understanding those mechanisms could lead to a better use of targeted therapies to reverse that trend.

What would be one of the biggest challenges that you have to overcome to get to where you are today?

My biggest challenge was to transfer from Switzerland to the US as a young investigator. I came for a post-doctorate in geriatric oncology after having completed my oncology training in Switzerland. The idea was initially to go back to Switzerland.

After a year, I was offered a Faculty position at the University of South Florida. Through various steps, I came to recognize that working as a group of researchers on the topic would be more effective than each of us going at it alone, and would therefore benefit patients both here and globally.

Yet, it took 18 months of paperwork, and multiple obstacles before I could finally be hired by my university (thankfully without having to redo any fellowship). There were several administrative and regulatory challenges even after that for several years.

This took up a lot of time and energy that could have been focused on research. For the sake of world medicine and research, we need to find better ways of transitioning qualified foreign physician researchers.

You are investigating how the general health of a patient can influence cancer behaviour and its treatment. Please can you summarise your findings so far.

First, we discovered that older cancer patients can and do often have other significant health issues (on average 3 comorbidities per patient). We also discovered that a comprehensive geriatric assessment independently adds to the prognostic prediction of classic oncology predictors.

In fact, in formal multivariate analysis, predictive scores for the risk of toxicity from chemotherapy (such as our Chemotherapy Risk Assessment Scale for High-age patients (CRASH score)) combine geriatric and oncology predictors. We also found that despite often experiencing grade 3-4 side effects from chemotherapy, older patients usually remained quite functional throughout treatment.

I designed decision help models for the use of adjuvant chemotherapy (treatment given after surgery) in hormone positive breast cancer, including comorbidity (one or more additional disease co-occuring with the primary disorder, and another one for older acute myeloid leukemia patients.

Increasingly, we are finding that comorbidity also influences the behaviour of the cancer. For example, diabetic patients are more likely to relapse from a colon cancer, all other things being equal. This is a fascinating and very underexplored research area. Big Data could be a splendid tool for this field.

What career advice would you like to pass on to early career researchers?

My number one advice is: Find a good mentor”. It does not necessarily mean ’the top hot shot at the top institution’. If that person is a poor teacher, or already has 6 mentees in attendance, you may not get the best mentoring. Choose a good researcher at a good institution in a field that sparks your interest, someone who has time and projects for you.

My second advice is: “Develop the EPIC qualities of a researcher: Enthusiasm, Perseverance, Integrity, and Creativity”. My third advice is: “Networking, networking, networking”. The truth is that when people look at speakers for conferences, collaborators for projects, authors for book chapters, or committee members, the first place they will look into is their memory.

And you never know whose expertise you may need to help you in the future. Interacting with smart people in your field also sparks ideas.