Dr. David Dodington is in the 4th year of his Anatomical Pathology residency in the Department of Laboratory Medicine and Pathobiology in the Temerty Faculty of Medicine.
He has just been awarded the Starr Medal and the Joseph M. West Family Memorial Fund in recognition of his research. Working with Dr. Shamini Selvarajah, a clinical molecular geneticist at the University Health Network and Assistant Professor in LMP, David is looking at the molecular aspects of bladder cancer.
Bladder cancer is the 5th most common cancer in Canada with 12,000 new cases and 2,500 deaths reported annually. David tells us how he hopes his research will help in the diagnosis and treatment of this disease.
What attracted you to do residency training in Anatomical Pathology?
I discovered pathology in my first two years of medical school at the University of Toronto. I liked that pathology was the bridge between basic science and medicine - we get to actually look inside a patient’s tumor, figure out what it is and how best to treat it. I started my education with a real interest in research, so it appealed to me.
What are you looking at in your research?
Bladder cancer can be categorized as non-muscle invasive (NMIBC), where the tumour is confined to the superficial layers of the bladder, and muscle invasive (MIBC), where the tumour has invaded deeper into the muscles.
With NMIBC, we typically have a few treatment options, such as intravesicular Bacillus Calmette–Guérin (BCG). Most patients opt for the BCG induction, which works for many, but up to 50% will fail that treatment. This results in a recurrence, requiring more BCG, or it will progress to MIBC. Once an individual has MIBC, treatment options are much more limited and usually involves complete removal of the bladder.
What we’re doing is finding biomarkers that will tell us whether the tumor is likely to respond to BCG or not before treatment begins. We’re looking at adaptive immune resistance, which is a mechanism that tumors employ to evade the immune response and develop resistance to our body’s natural defences. Using whole-genome RNA sequencing technology, we’ll look at the RNA profiles of the tumors between two groups of patients – those who have responded well to BCG, and those who haven’t. Looking at the expression of all the genes across the genome, we’ll be able to see if there's any difference in expression of immune resistance genes between the two groups which could translate into a test for which tumors will likely respond to BCG.
How will this make a difference for patients?
It will hopefully alleviate some suffering and even save lives. Being able to test whether a treatment is going to work in advance means, for those whom the BCG is not going to work, they can avoid unnecessary treatment. Once someone has MIBC, the chance of metastasis, i.e. the cancer spreading to other organs, is very high, so the sooner we can remove the bladder, the better chance the patient has to survive.
Having a test that provides the necessary information gives clinicians the evidence they need to help make those treatment decisions.
How do you balance your research with your clinical work?
We complete rotations throughout various hospitals across the GTA, so most of our time is spent doing clinical work. Although we do occasionally have research rotations, I mostly have to find ways to fit my research into my day-to-day routine. To do that I set mini-goals to accomplish each week and do my best to manage my time wisely. It also helps that I really enjoy what I’m doing so it doesn’t always feel like extra work.
What does receiving these awards mean to you?
The awards are very helpful. I'm hoping for an academic career as a clinician and a scientist, so this helps me build my portfolio. Having these helps me in applying for a fellowship and future grants.
