Interview by: Dr. Rachana Punukollu
In November 2022, I had the opportunity to shadow Dr. Chawla, a hepatopancreatobiliary surgical oncologist. I rotated on his Surgical Oncology service at Northwestern Central Dupage Hospital for a month. Since then, Dr. Chawla has been a great mentor and source of support. I learnt a great deal of background on pancreatic cancer from his teaching in the OR and in the clinic. During my time on the service, I interacted with patients and their families who were affected by pancreatic cancer, and this sparked my interest in the disease. As I delved deeper into the statistics surrounding the pancreatic cancer and its dismal outcomes, I became increasingly motivated to raise awareness about its significance. Therefore, I decided to interview Dr. Chawla to gain a better understanding of pancreatic cancer and to help educate others about its importance.
Dr. Akhil Chawla is a Hepatopancreatobiliary and Gastrointestinal Surgical Oncologist at Northwestern Medicine, Chicago, Illinois. He received his undergraduate degree in Bachelor of Science and graduated medical school from University of Cincinnati. He completed his General Surgery residency training from Case Western Reserve University. He completed a two-year National Institutes of Health funded research fellowship focusing on solid tumor immunology at MD Anderson Cancer Center. He completed his clinical fellowship in the Harvard Combined Complex Surgical Oncology Fellowship Program at Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Massachusetts General Hospital.
He is director of the Northwestern Medicine Surgical Oncology Tumor Bank, Biorepository and Translational Research Laboratory in the West Region. He is a transitional researcher and Principal investigator of multiple oncology related clinical trials within Northwestern Medicine as well as nationally with a focus on pancreatic cancer.
- What made you choose General Surgery during medical school?
I liked the aspect of being able to critically think, spend time in the operating room, utilize my technical skills, and think not just about the disease process, but being able to simultaneously act on them. There’s a great deal of gratification in watching a patient clinically improve just a few days after an operation after coming to the hospital very ill. I love spending time in the operating room; it is the one place where I can be completely focused on what I am working on without any outside distractors. I also love to teach in the operating room, which attracted me early on.
- What drew you to pursue a career in Surgical oncology?
During my time as a junior resident, I found myself spending a great deal of time with the families of patients afflicted with cancer. I was really interested in explaining the disease process in detail and discussing the rationale for surgery. Though it was challenging to deliver tough news, I found this experience gratifying. During my time in the basic science oncology lab at MD Anderson, I realized surgical oncology has a little bit of everything – the ability to spend time with patients, do complex technically challenging operations and to scientifically investigate ways to enhance care and outcomes for the patients. As a senior resident, I spent a long days performing hepatobiliary and pancreatic surgery in the operating room. Working in these complex operations was highly intriguing to me; I then knew that this would be a great field for me.
- You are a high volume pancreatic cancer surgeon with a research interest towards pancreatic cancer. What sparked your interest in this area?
Pancreatic cancer is a very challenging malignancy to treat. It requires a great deal of persistence and expertise in the operating room. It is a very humbling disease, which propels me to work harder as an investigator and as a surgeon, pushing me to do better every day. Pancreatic cancer is the third most common cause of cancer death in the United States and is expected to be the second most common cause by 2030. This is because we don’t have adequate treatments, with a limited understanding of why some patients respond well to treatments while others don’t. That’s what my research really focuses on. Some of the treatment strategies that have shown promise in other malignancies have not really panned out in pancreatic cancer. Trying to understand why all those limitations exist is very interesting to me. I also enjoy the multi-modality treatments that are available and feel that there’s great opportunity within this cancer.
- Can you elaborate on your research in pancreatic cancer and how it will impact the treatment of pancreatic cancer?
My primary areas of investigational focus are clinical trials, liquid biopsy, response assessment of cytotoxic and immune systemic therapies. My goals are to find ways to individualize therapies afflicted with pancreatic cancer. We are starting to gain a better understanding of molecular subtypes in pancreatic cancer as well as circulating biomarkers, which are areas I focus on with my research. I hope to be able to move the needle in terms of being able to change the way we think about pancreatic cancer treatment and systemic therapies.
- Pancreatic cancer is one of the leading causes of cancer deaths in the United States with low five year survival rates. How can we improve these statistics?
There are usually two groups of patients. One group that has potentially curative disease with localized pancreatic cancer. The other group is patients that present late with metastatic disease.
- For the first group, we need to increase the number of patients that ultimately have long-term survival (>5 years) by individualizing therapies to enhance sensitivity to systemic therapies.
- For the latter subgroup of patients with metastatic disease, we need better methods of earlier detection, by using circulating biomarkers and screening patients that have a higher risk based on family history, germline mutations, other clinical and demographic factors which would enable us to identify pancreatic cancer sooner.
The primary challenge in the early diagnosis pancreatic cancer is its asymptomatic nature and its late presentation which makes it difficult to cure. Being able to identify those patients earlier, puts them in a potentially curative setting (the first subgroup I mentioned), hence improving the survival rates.
- Is pancreatic cancer research appropriately funded, compared to the other areas in oncology?
I think we’re starting to catch up a little bit. The challenge lies in the fact that the preclinical data is very difficult to obtain for pancreatic cancer. Larger grant agencies would like to see strong data before they’re able to fund larger studies. There are only a finite number of patients that are diagnosed with pancreatic cancer, and it’s very difficult to get tissue particularly in the preoperative setting. Most centers do not have a research process in place to obtain additional tissue from the primary tumor at diagnosis. But, I do think that there has been an increased emphasis on pancreatic cancer over the last 5 to 10 years and an increased level of funding available for pancreatic cancer research is encouraging.
- Do you have any advice for med students or residents who are interested in the field of surgical oncology or pancreatic cancer?
Surgical oncology is a field where you have the ability to utilize your technical skills in the operating room, use your thought process to treat cancer patients in the clinic, and also maximize your ability to scientifically approach the challenges with scientific investigation.
I think much of the research that I have done in my early career has really focused on ideas that I have had based on learning from others in the field, then forming my own hypothesis and thoughts on how to investigate the question at hand. It’s certainly a very challenging field – the patients, the anatomy, the disease biology. So it’s very important to be broad-minded and be able to come at it from different angles.
With regards to pancreatic cancer research, there’s so much new momentum that has changed the field in the last 10 years. When I began studying circulating tumor DNA (ctDNA) in pancreatic cancer 2 – 3 years ago, some told me pancreatic cancer does not shed ctDNA. But now the question has become which assay should we use to gain the best sensitivity to detect the ctDNA, because we now know it certainly sheds, even in early stages. So don’t believe everything you hear, it further, and find ways to dispel those beliefs. Because, in reality, they may not be true. There’s probably more to the story.
Rachana Punukollu is originally from India. She graduated medical school from Konaseema Institute of Medical Sciences, India. She is currently a Research Scholar at Mayo Clinic, Arizona in the Division of Transplant Surgery.
Rachana is deeply passionate about General Surgery and its subspecialties. She is looking forward to pursuing her residency training in General Surgery in the United States.