In the course of her day Associate Professor Clare Scott might go from a hospital round, examining a woman fighting a diabolical cancer diagnosis, to the laboratory, interrogating painstakingly genetically engineered mouse models for clues on the best strategies to fight the disease.
“I find it endlessly fascinating that when needing to understand a cancer in a patient, I can start to answer questions looking at mouse models. If I can do more in the mice, and get one step ahead for the woman, I know I’m doing something valuable,” Scott says. “That’s what drives me.”
In between or after hours she will liaise with international collaborators at the coalface of the research effort to beat the disease, sharing insights and ideas.
The ambit of the clinician-scientist is awesomely broad, from the bedside intimacy of the patient relationship to the objective dispassion of the laboratory bench. “It’s your understanding of a case, and how you design the experiment in the laboratory, that will bring insights to the field, and those will feed back for the next woman.”
Scott speaks about her work in each of these spheres with clarity, passion and at such speed that it’s clear there’s not a minute to lose in the urgent push to deliver long-awaited, effective treatments to women with ovarian cancer.
When she started studying medicine at The University of Melbourne some 30 years ago, Scott had no ambition to be a medical scientist. Her aim was to be a clinician. Then, in her second year as a junior resident at The Royal Melbourne Hospital, she started noticing people from the Walter and Eliza Hall Institute joining the ward rounds. She was intrigued and, on learning more, was soon hooked.
“It had become obvious to me that treating cancer patients was important – because you could improve their quality of life – but clearly there were also very big, hard questions that needed answering.”
Her focus as an oncologist was on solid tumours – breast and ovarian – and that was where she wanted to direct her research too. But after some investigation, Scott went the long way round, embarking in 1996 on a research PhD at the Walter and Eliza Hall Institute with Professor C. Glenn Begley looking into haematopoitic (blood) growth factors.
“Although I knew I did not want to do haematology – and in fact had no special love of haematology at all – I thought it would be the best training, because that is where outstanding research models already existed.” Her ambition was to equip herself to apply the insights fast emerging from blood models to understanding solid tumours and organs.
Her determination to seek out the best training available was quickly validated – “my first experiment in my first week was done with Andrew Roberts”. She worked in the laboratory run by her “great hero”, Professor Don Metcalf.
“The PhD really set me up for understanding model systems, understanding mouse models, and I’ve been strong in mouse models all my career. The expertise in the animal house that we obtain here really underpins the high quality and excellence of our approaches.”
This platform allows researchers to “really ask functional questions in the mouse. It’s like groundhog day, where you can relive the same day again and again, and that gives you incredible power to ask different questions in parallel.”
This gives investigators precious time that patients often don’t have. It’s this capacity that underwrites the new era of personalised medicine, refining treatments offered to patients to a custom fit to their disease, their genetics.
It also opens the door to collaborations with the world’s leading researchers – “people are always very happy to hear about our models, which are built in long, expensive ways that make them valuable, and always bring a novel approach, an ability to do something hard differently”.
Since setting up her ovarian cancer laboratory at the institute four years ago, Scott has used these models to demonstrate and describe patterns in high-grade serous cancer, the most common aggressive form of ovarian cancer. These patterns provide the insights for tailored, targeted responses. “We’ve had some consecutive light-bulb moments through the second and third year as all the patterns started to make sense. What it tells us is that there are some really strong biologic drivers there that we will be able to use to the patient’s advantage.”
What she foresees in the next five to 10 years are strategies for long-term management and containment of cancers, in which patients are closely surveilled – “like doing a CT scan, but at a minute scale” – and molecularly targeted therapies being applied at identified moments of opportunity.
Working at the interface of pure and clinical science, Scott has been particularly attuned to the ethical and practical issues genomic science raises for individuals. She was the instigator of the push to set up the institute’s formalised, high-powered expert consumer advisory panel. “Being transparent, and having genomic issues viewed by consumers, is important.”
Reflecting on the changes she has observed at the institute over almost 20 years of involvement, and the challenges ahead, Scott identifies careful and strategic collaboration – including with pharmaceutical companies – as critical to effective future endeavour and maintaining the institute’s heavy-hitting position. Such relationships will, she says, be key to overcoming the price barriers of ever changing technology.