Hatim Husain, MD, assistant professor of medicine, Moores Cancer Center, University of California, San Diego, discusses the utility of liquid biopsies versus tissue biopsies in non—small cell lung cancer (NSCLC).

While in many cases tissue biopsy and liquid biopsy results reveal similar findings, there are some instances where a genomic aberration is found in one but not the other, explains Husain.

Regarding liquid biopsies, predicting where sites of metastasis are likely to occur may aid in effective detection of circulating tumor DNA in the plasma, says Husain. Additionally, patients on therapy may experience less tumor shedding which may influence the liquid biopsy results.

Lastly, genomic findings in the plasma may mimic tumor indicators as a result of clonal hematopoiesis in genes that derive from bone marrow cells, Husain concludes.

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Hatim Husain, MD, discusses the utility of liquid biopsy versus tissue biopsy in non–small cell lung cancer.

Dr. Husain on Liquid Biopsy Versus Tissue Biopsy in NSCLC

Hatim Husain, MD, assistant professor of Medicine, Moores Cancer Center, University of California, San Diego, discusses plasma-based testing in lung cancer.

There is a lot of interest in understanding the clinical applicability of plasma-based testing. Right now, plasma-based testing is FDA-approved when tissue is not obtainable, inadequate for testing, or unsafe. Husain advises that clinicians ensure that the tissue has been adequately addressed if a patient’s plasma test comes back negative. Plasma tests can be negative in relation to tumor mutational burden. Patients who have more contained and defined tumor burdens may have less detectability with plasma-based tests, says Husain. Plasma-based testing may also be limited in certain sanctuary sites such as the brain or bone.

A number of research projects are being done to understand the detectability of plasma and the dynamic changes of circulating-tumor DNA in plasma through time on therapy. Researchers believe that they will be able to understand the evolution of cancer and how through time, resistance can be identified early. Further work will address how one can intervene or better understand how to intervene and what metrics to look at in the face of identified resistance mechanisms.

Dr. Husain on Plasma-Based Testing in Lung Cancer

Hatim Husain, MD, assistant professor of Hematology-Oncology at the University of California San Diego Moores Cancer Center, discusses the future of monitoring the emergence of EGFR T790M circulating tumor DNA in urine from EGFR-mutated non–small cell lung cancer (NSCLC). 

There is an active interest looking across both plasma and urine and better understanding how technologies in these types of spaces better anticipate resistance as well as treat resistance if it occurs, explains Husain. 

It is important to find a way to chronicle how the evolution of the tumor changes and develop strategies and algorithms to better treat and combat those evolutionary pathways, states Husain.

Hatim Husain, MD, assistant professor of Hematology-Oncology at the University of California San Diego Moores Cancer Center, discusses the future of monitoring the emergence of EGFR T790M circulating tumor DNA in urine from EGFR-mutated non–small cell lung cancer (NSCLC).

Dr. Husain on the Future of Monitoring T790M in Lung Cancer

Hatim Husain, MD, assistant professor of Hematology-Oncology at the University of California San Diego Moores Cancer Center, discusses a study on monitoring the emergence of EGFR 

-mutated non—small cell lung cancer (NSCLC).

Husain explains that 25% of lung adenocarcinomas are driven by the 

, which is found in over 60% of patients. Second-line therapy focuses on targeting molecular resistance based on the detection of 

Tissue-based testing is a widely accepted method to detect patients who are resisting therapies due to the acquisition or evolution of 

. There have also been further developments to improve the analyses of circulating tumor DNA through both plasma and urine. Husain studied patients who received a first-line anti-

 inhibitor. He demonstrated that in 10 out of 13 patients, it is possible to detect 

Hatim Husain, MD, assistant professor of Hematology-Oncology at The University of California San Diego Moores Cancer Center, discusses his study on monitoring the emergence of EGFR T790M ctDNA in urine from EGFR-mutated NSCLC.

Dr. Husain on Monitoring the Emergence of T790M in Lung Cancer

One of my mentors once told me that it was unrealistic to expect to excel in research and simultaneously excel in the clinic. Initially, I had a hard time believing this idea. In fact, I had evidence on my side. He is a leader in his field, and I saw him maintain a very busy clinic schedule, while he was also involved about some of the most interesting research. I thought that he was voicing his frustrations about his own experience of needing to be in 2 places at the same time. But now, at the end of my fellowship, I can far better appreciate his advice to me.

	Some of the skills that are essential for advancing in clinical education are similar to the skills needed for the successful practice of structured research. With careful attention to detail and conscientious efforts, those clinical skills are likely to be transferable from clinical education to meeting research goals. But in order to make this transition possible, you must be patient, constantly reading, willing to collaborate, open to suggestions, forward thinking about your goals, and not afraid to spend long nights in either the clinic or the lab (or both).

	Aside from the overlapping skills needed to succeed in clinic and research, I believe that the key to being successful in a hybrid translational role is the use of effective time management skills. Translational medicine is becoming more popular as physicians get involved in hybrid roles. There are tremendous opportunities in designing clinical trials, contributing to early drug discovery, learning regulatory principles, and engaging in biomarker related work. There are variations on aspects of all of these opportunities in academia, industry, regulatory agencies, and the government.

	I would like to share my thoughts on 5 time management skills that I have found to be fundamental elements for succeeding in clinical medicine and laboratory-based research.

	Acknowledge that you cannot bend the laws of physics to be in 2 places at the same time. You cannot attend 2 lectures simultaneously, and it is not feasible to be in the lab when you have a busy clinic waiting for you, or need to be with a patient who is not doing well. It is very important to prioritize your commitments, and the sooner you do this, the more efficient you may become in managing your time effectively. Many people have found the smart phone app Things useful in helping to manage daily tasks for small and mediumsized projects. This app can be particularly useful as a note-taking tool since it allows you to connect audio, image, and text notes with a certain task or project. Find the organizational tool that works for you and use it consistently.

	Take every possible opportunity to learn. Utilize your down time to attend as many lectures as possible and make time to read clinical publications and the biographies of the speakers who will be presenting throughout the week. You might be surprised to find a rewarding educational experience that you did not expect. The smart phone app ReQall will allow you to take video or audio notes (when permitted) to replay at later times to reinforce oncology information recall.

	No matter how busy you are or how many competing clinical and research tasks you are juggling, it is very important to find a way to keep some balance in your life. This means that you have to make a determined effort to schedule time for exercise, to eat a healthy diet, and to spend time with your loved ones. Especially when it seems hardest to carve out time in your schedule for these things, this valuable time will allow you to recharge yourself. With this down time, you are better able to be your best with your patients. Be flexible and willing to consider alternate strategies when things do not go as planned. The ability to redirect and revise your plans when things are not going as anticipated will help you throughout your professional and personal lives. Keep your schedule on your computer and/or your smartphone so you can set electronic notifications, reminders, and alarms. These alerts can be critical to keeping you on target and on schedule. This way, you can optimize your time, which will also make it possible to schedule and keep your appointments for quality time for personal commitments.

	Sometimes it’s hard to recognize how much time we can waste and how undermined our efforts can be because of miscommunication. As your schedule fills up and you take on increasingly demanding responsibilities, the skills of writing, presenting, and effective communication are more important than ever before. Speak to mentors in your field and ask for their advice on building strong communication skills. Study successful techniques until you find the tools that work best for you. Also, check into any available resources or education that might be available through a university professional development office that could help you in developing these skills to meet your goals.

	This is usually far easier said than done; and we all likely have some room to improve in this arena. Once you are making frequent use of your electronic calendar and reminders, take it to the next step and plan all of the necessary steps before the deadline or appointment. Plan to complete the initial tasks well in advance, and assign yourself a deadline for each step of the process. Make frequent lists, on paper or electronically, whichever will work most consistently for you. Divide large jobs and daunting projects into smaller pieces and keep them on your to-do list. Make use of your scheduling system to send you alerts and reminders of each step of the process. This way, you are not faced with 3 days’ worth of work to do, 1 day before a deadline. Force yourself to get into good habits of planning ahead and chipping away at your tasks each day. With good time management techniques, you will be able to increase your productivity, expand your skill sets, and be more successful in translational medicine. You will also greatly reduce your stress, since you will have a plan of how to manage larger tasks over time. We have more technology available now than ever before that can increase our efficiency. Utilizing these tools effectively in training provides a solid foundation (and good habits) that will help you to implement them throughout your career. With less stress and more productive hours, you will expand your horizons of successful growth in translational medicine.

Articles

With careful attention to detail and conscientious efforts, clinical skills are likely to be transferable from clinical education to meeting research goals.

Hatim Husain, MD

Articles

Dr. Husain on Liquid Biopsy Versus Tissue Biopsy in NSCLC

Dr. Husain on Plasma-Based Testing in Lung Cancer

Dr. Husain on the Future of Monitoring T790M in Lung Cancer

Dr. Husain on Monitoring the Emergence of T790M in Lung Cancer

Time Management: Balancing Clinical Education With Scientific Research