By Jocelyn Selim

Bench to Bedside

A young physician learns to balance petri dishes and patients

By Jocelyn Selim

Occasionally, Sarat Chandarlapaty wonders about paths he might have taken. He could have had a cushy career as a suburban dermatologist, or opted out of medical school altogether and focused on research in a field where the issues are less complex and the chances of successful outcomes higher than oncology. But those thoughts don’t last long—every time Chandarlapaty sees patients, he’s reminded of just how important his work is. And nothing brings that home so much as the disease coming into your own home, Chandarlapaty says. “My father was recently diagnosed with lung cancer. It’s something that I think about constantly. Knowing what it’s like to go through this experience as a family member firsthand isn’t something I had to deal with before, and it’s a big motivator, both in helping me with patients and in the lab,” he says.

It is this sense of purpose that keeps Chandarlapaty, 35, working long hours, six days a week. As both a full-time physician and a full-time researcher, he is one of a small group of young oncologists who are devoting their lives to blurring the lines between research and real therapies for patients. Most of his time is spent in a laboratory on the 12th floor of a Memorial Sloan-Kettering Cancer Center skyscraper on Manhattan’s Upper East Side, growing cancerous cells in lab dishes and trying to understand why some tumors are resistant to certain drugs.

Chandarlapaty’s work focuses on the 20 percent to 30 percent of breast cancers that make too much of a protein called HER2, which is found on their cells’ surfaces. This high-HER2 subset of breast cancers is particularly aggressive: The protein works like a cancer “on” switch, telling the cells to grow, divide and metastasize. Tumors that overproduce HER2 tend to grow faster and are more likely to return than tumors that don’t overproduce the protein. In women with this kind of cancer, the drug Herceptin (trastuzumab) can dramatically stop the disease’s spread and lower the chance of recurrence by blocking HER2. Yet some breast cancer patients with HER2-positive tumors don’t benefit from Herceptin, and other women eventually develop resistance to the drug. Chandarlapaty is trying to figure out why.

Progress is slow. Answers in oncology are rarely simple, and Chandarlapaty admits the research can be grueling. “It’s not good odds,” he says. “We expect to fail 70 percent of the time, but doing these kinds of experiments is the only way to get closer to figuring out what’s happening and how to fix it.” He has weekly reminders of the importance of solving the problem. Every Tuesday, as part of his clinical fellowship at Memorial Sloan-Kettering, Chandarlapaty morphs back into his physician role. “I’ll see patients, and when you see how tragic and devastating the disease can be for them and their loved ones, it pushes me to get into the lab and try to do something.” Many of his patients have the exact type of aggressive tumors that Chandarlapaty is trying to demystify.

In fact, some of the cells Chandarlapaty has grown in his research have come from biopsies of his patients. “Something that strikes me is how much patients care about other patients—even patients who aren’t sick yet,” says Chandarlapaty. “I will explain clearly to a patient who I’m asking for a biopsy that the procedure isn’t going to help them directly, but that it might help patients who develop a similar disease years from now,” he says. “And they say yes. They almost always say yes.”