Journey from oncologist to cancer survivor and patient advocate in the era of precision medicine

In 2013, the American Association for Cancer Research (AACR) introduced the “Precision Medicine Series” of symposia. The goal of these conferences is to “highlight the incredible technology and advances in cancer research that together are enabling treatments that are precisely targeted to the unique molecular and genetic characteristics of an individual's cancer.” This new series of AACR conferences reflects how patient treatment has evolved and continues to progress toward personalized treatments/medicine. It was in May of 2013 that I was diagnosed with a rare form of bladder cancer, plasmacytoid variant, for which survival statistics were grim, and the only genomic information available was the frequent somatic CDH1 loss-of-function mutation consistent with aggressive clinical behavior. The CDH1 gene encodes for E-cadherin, which plays a role in cell–cell adhesions and acts as a tumor suppressor when expressed normally. This information was subsequently published, but not until April 2016 (Al-Ahmadie et al. 2017. Nat Genet 48: 356–358). At the time, I was a practicing medical oncologist and, ironically, urologic cancers had been my area of interest, dating back to my fellowship at Memorial Sloan Kettering Cancer Center (MSKCC) in 1981. I decided to return to MSKCC for treatment based on their experience with rare urologic cancers as well as my own personal connection.