Why I chose to become a physician-scientist

Author: Cristiano Peron, MD

I had just enrolled at the university when one of my professors, a medical physicist, asked me to start working with him on a project to study cardiovascular modification under different conditions, like hypothermia. The project itself was conceptually easy, but I still clearly remember the sensation I felt whilst I was spending those days watching an ordinary red line moving on the computer screen. There was no book capable of providing me the right answer I was looking for, and understanding the meaning of that red line was up only to me and to the people working with me. The interpretation of those data, despite challenging, was strangely satisfying. At the time, I did not know that research was going to become an important part of my life. I simply wanted to challenge myself, and I loved the sensation of creating something new.

Cristiano Peron

After this first positive experience I decided to focus my efforts on cancer biology, for many reasons. Part of this decision was practical. I wanted to work in an animated field where, thanks to recent advancements in technology, interesting questions are currently properly addressed. Other possible areas of interest, in my view, included virology and stem cells. However, I ended up choosing cancer biology because it also picks up biology which is relatively encompassing of those fields, considering the presence of viral-induced tumours, or the stem cell-like biology of tumour cells. Over this practical point of view, I admit that I was also profoundly fascinated by the ability of tumour cells to adapt and thrive in different environments. The biological processes regulating metastasis formation and drug resistant phenotypes are still largely unknown, and I wanted to be part of the worldwide community of scientists that works every day to defeat such a formidable opponent.

As a medical student, I ended up joining the Institute of Hematology and Oncology “Seràgnoli” in order to learn more about these diseases, under the guidance of several professors. During my first year, I followed the research activities of professor Giovanni Brandi, an oncologist focused on gastrointestinal cancers like cholangiocarcinoma. Whilst part of his team, I had a chance to learn more about the clinical activity that physicians dealing with oncology patients usually have, while at the same time being involved in clinical research projects.

Going on doing clinical work, I would have been able to give those patients the gold-standard treatment, but this was not enough for me. I wanted to give them a chance. And, in order to do that, I had to focus on preclinical research.

During that time, however, I started to understand better the difficulties that patients and their families end up facing during such times. I was able to notice the fear in their eyes when, sometimes, they were pretending to forget their hat in our ambulatory, just to come back without their spouse and ask us some more information about their prognosis. On other occasions, the fear was not present. That was even worse. I will always remember a family in which the husband had a cholangiocarcinoma quickly relapsed after surgery. His wife had no job and they had two little children, of two and three years. He was speaking with us like everything was fine, like we would have been able to cure him, and perhaps he did not want to know the truth. His stage was too advanced, there was nothing we could do. I had trouble sleeping for a while after meeting with them, but the next day I still managed to bring myself to the clinic.

Another day, another patient. This time, it was the turn of an elderly lady recently diagnosed with small cell lung cancer, one of the most aggressive subtypes of lung cancer. She quietly listened to us while we explained to her which type of chemotherapy we were suggesting for her case. “Would that cure me?” she asked. No, it would not. Her prognosis, even with the best treatment, would have been in the range of 6 to 12 months. I noticed something behind her eyes, while she heard that. She was scared, as everyone would be, but her priorities were different from most people. “Could you please give me a pen? I need to take some notes, so I can present a brief summary of the situation to my children. I don’t want to scare them too much, however. Can you help me with that?”. She was slightly shaking, but she was too strong and too proud to cry in front of us. I helped her the best I could, while at the same time still feeling profoundly inadequate.

Was that the approach I wanted to keep? Going on doing clinical work, I would have been able to give those patients the gold-standard treatment, but this was not enough for me. I wanted to give them a chance. And, in order to do that, I had to focus on preclinical research. Because if the current treatments are unsatisfactory, we have to develop better ones.

It was during that time that Professor Piccaluga, a hematopathologist, asked me to start working under his supervision. His interests involved the pathobiology of hematological malignancies, especially lymphomas, and his preclinical approach suited me best. By using gene sets enrichment analysis on microarray data, we started studying the metabolic disarrangement that characterized B and T cell lymphomas, in order to exploit those differences to improve the diagnosis and the treatment of those diseases.

While still working with him, I was also able to spend two summers following the research projects of two US top institutions. In 2017, I was a visiting student at the Center for Lymphoid Malignancies at Columbia University Medical Center, evaluating the in vitro effects of new drugs for the treatment of cutaneous T-cell lymphomas (CTCLs). In 2018, I have been part of the Weinstock Laboratory at Harvard University. During my time there, I focused on the study of the apoptosis pathway and its relevance in peripheral T-cell lymphomas (PTCLs), evaluating the effects of apoptosis-inducing drugs in different PTCLs cell lines.

After obtaining my medical degree and all these experiences, I have finally felt ready to apply for a DPhil (PhD) in Oncology at the University of Oxford. I wanted to become one of those people capable of giving a concrete contribution to their own research field, by finding new therapeutic opportunities and consequently improving the prognosis of oncologic patients. And, with this goal in mind, I joined the laboratory of professor Kristijan Ramadan.