Kaumudi Bhawe, PhD
To shed some light on the importance of caring for the whole patient and his or her caregiver, as well as the role of cellular aging and oncogenesis, The ASCO Post recently spoke with Kaumudi Bhawe, PhD, a clinical scientist with Cancer Commons in Mountain View, California. Dr. Bhawe has more than 15 years of experience in drug development and in the biotechnology industry, where she has led cross-functional research projects in multiple companies in the San Francisco Bay Area. Cancer Commons is a nonprofit virtual network of patients with cancer, physicians, and scientists dedicated to improving patient outcomes through the coordinated delivery of precision oncology. According to its mission statement, the overriding goal of Cancer Commons is to ensure that patients are treated in accord with the latest knowledge and to continually update that knowledge based on each patient’s response to care.
Work With Cancer Commons
Please tell the readers of The ASCO Post a little bit about your current position and work with Cancer Commons.
I serve as a clinical scientist with a team of other experts who aid patients with cancer and their caregivers in navigating the multiple treatment options and challenges they may face during the continuum of care. We draw on the most up-to-date research, as well as input from other leaders in oncology, to help patients better partner with their oncologists in the decision-making process. Sometimes, we work with a patient’s oncologist, by providing in-depth research and data that busy community oncologists might not have time to access. To that end, we can help patients with cancer locate clinical trials that might be tailored to their specific cancer.
“We draw on the most up-to-date research, as well as input from other leaders in oncology, to help patients better partner with their oncologists in the decision-making process.”— Kaumudi Bhawe, PhD
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Moreover, with the emergence of personalized oncology, it’s also important for patients with cancer and their oncologists to sort out the myriad treatment options and be able to identify molecular diagnostic testing to guide those treatments. Once a patient with cancer is registered with Cancer Commons, we reach out on a regular basis to assist and address any questions or concerns that arise. It’s a comprehensive partnership between our team and the patient with cancer, which, given our virtual approach, enables us to reach out to anyone in the United States who has Internet access.
Cellular Aging and Cancer Development
You’ve examined cellular aging as it relates to oncogenesis. In a nutshell, what are the similarities between the processes of cellular aging and the development of cancer?
As we know, cancer is predominantly a disease of aging. Although advancing age is a cause of cellular aging, it is not the only cause. In fact, the process of cellular aging happens in cells during human embryo development. So, the central questions are what exactly is cellular aging, and what does it have to do with cancer development?
We know that aging cells can be described by accumulated damage to macromolecules, such as DNA and proteins. Certain molecules in a cell are designated to repair DNA damage during cellular division. If the damage cannot be repaired, an aging cell either dies or cannot divide and goes into irreversible cell-cycle arrest. Once an aging cell enters irreversible cell-cycle arrest, it can stay alive for months, as we’ve demonstrated in the lab. Not only can the cell remain alive, but it can also evolve based on the signal from its microenvironment, and, importantly, it can alter the environment. Research shows that such senescent cells have an abnormal metabolism and secrete hundreds of different signaling molecules including proteins and lipids.
Some of the ways in which cells can be induced to undergo senescence include the slow natural aging simply caused by multiple cell cycles, leading to telomere shortening; exposure to toxic chemicals including chemotherapy and radiation; exposure to reactive oxygen species; and activation of oncogenes. As a cancerous tumor is forming, or even during cancer treatment, senescence mechanisms are at work in at least some of the cancer cells as well as some of the noncancerous stromal cells, such as fibroblasts, blood vessel–forming cells, and immune cells.
Three key common features shared between aging cells and cancer-developing cells are accumulation of DNA defects, altered metabolic activity, and an increase in secretion of environment-modulating molecules. As researchers, our challenge in this important domain lies in discovering and cataloging the specific details of each of these three features to identify true molecular similarities and differences, as well as antagonism and cooperation between the processes of aging and cancer development. Deeper knowledge of these processes will help in the prevention and treatment of certain cancers.
I remember an analogy a mentor of mine used to describe the processes of cellular aging and carcinogenesis, which I think is a great way to look at it. Think of a cell as a symphony orchestra continuously playing a musical score. Imagine some of the musicians getting tired and their instruments becoming worn out, both of which greatly increases the chance of the musicians playing off key, until eventually the composition becomes discordant, and the music is lost. Then, we come in and try to understand the events that led to this loss of melody and music, which are going to be slightly different in the case of aging and cancer initiation, but the three common features remain constant. It’s an exciting area of research for sure.
Personal Encounter With Cancer
You had an early exposure to cancer. Please tell us about that and how it influenced your life and career path.
I was 10 years old when my father died of lung cancer. Despite the hardships and sorrow I endured as a young kid, watching my father go through such a difficult physical ordeal, he taught me the values of faith and tenacity in the face of adversity. My mother was by his side every step of the way as the primary caregiver, and her example also taught me how important it is for a patient with cancer to have someone there not only for care but for emotional support.
Cancer really shook up our lives when I was young, but it also paved the way for my lifelong quest to be on the front lines of research, doing the work to understand cancer and help develop treatments from multiple angles. So, that’s how I pursued my career. Prior to joining Cancer Commons, I gained experience in signal transduction, target validation, assay development, companion diagnostics, and clinical development of novel cancer therapies. The best part of my journey so far is that I can now use this understanding to help patients with cancer navigate the difficult and often perplexing decisions they face.
Families Facing Cancer
You’ve written about issues families facing cancer have. In brief, what should families in this difficult situation do?
Doctors do everything they can to help families cope with the multiple issues that arise after a loved one is diagnosed with cancer. However, doctors are limited by time and resources. Having been there myself, and then having seen many families go through this process, I identified a few solid recommendations that might help other families facing the same situation mine did.
To begin, it’s important to know that you are not alone, because dealing with cancer on any level, whether as a patient or a family member, can feel isolating. Talk to your children. Depending on their age, be as open to them about the disease as you can. If it is difficult for you to talk to them, make sure you identify an adult who can do so in a friendly, knowledgeable way. Provide an outlet or a “safe space” for every member of the family including yourself. This is so much easier said than done, which is why it is important to be connected to “a village” that can help you and your family get through this phase of life. And reach out to support and advocacy organizations such as Cancer Commons, where a whole team of professionals has come together precisely for one cause—to help patients with cancer and their caregivers.
Please share some closing thoughts on the state of cancer research and care moving forward.
I’ve been very fortunate to have seen the field of oncology evolve from the grassroots level. We’ve made great progress, especially in our understanding of the disease on genetic and molecular levels. But, as we all know, we have a long way to go. To that end, I think one of the most important things is for us to better leverage well-designed longitudinal studies to fully understand the underlying predictable patterns of tumor evolution that are consistent across patient populations. On the patient side, as treatment options become increasing complex, we need to do more to help patients with cancer partner with friendly, knowledgeable advocates to help them navigate the path from diagnosis to survivorship. We’re on the right track.
DISCLOSURE: Dr. Bhawe reported no conflicts of interest.