“I pursued this career because I knew I would never be bored in it. Nearly every day we see rare and newly described entities, and these provide endless opportunities to expand my knowledge and learn about the fascinating biology of these rare tumors”, says Dr. Elizabeth Demicco on her experiences in Bone and Soft Tissue Pathology.
Having started out completing an MD/PhD (with a PhD in biochemistry), she knew early on she didn’t want to be a full-time researcher, and being a patient-facing clinician didn’t appeal to her. She admits that she is easily bored by the bread and butter of routine clinical care, so she went into pathology after being introduced to it through a friend already training in the field. She now specialises in bone and soft tissue pathology.
Dr. Demicco has been studying Solitary Fibrous Tumors (SFT) since her fellowship. SFT are a type of sarcoma - rare tumours formed by abnormal growth of cells arising most commonly in connective tissues (known as a mesenchymal tumour). Although SFT can occur anywhere in the body, the most common sites are in the lungs, cranial meninges, and abdominal cavity. “We usually treat them with resection with or without radiation, but up to 10 – 30% of tumors may metastasize, and once that happens there is little we can do,” she explains.
Her research focuses on predicting the behavior of these tumors, and what drives them when they become aggressive. She devised one of the most effective models to predict this aggressive behaviour, now known as the Demicco-Score.
Research into these tumours has been challenging. “We know more about what doesn’t work so far, than what does, but it is still scientific progress!” Due to the rarity of the tumours, she only sees around 10 new cases a year. As metastases may arise after many years, and may be very slow-growing, devising clinical trials and recruiting patients is difficult. Due to the surgical practice at Mount Sinai Hospital, the tumor database is heavily biased towards SFT from the nose and throat area (extrathoracic), or around the brain and spinal cord (extrameningeal), limiting certain types of studies.
A large part of her work, as well as that of fellow specialist at Mount Sinai Hospital, Dr. Brendan Dickson, is to consult with, and advise others, on bone and soft tissue tumours. As some of the few experts in the country, they are in constant demand for talks and advice. As the largest of the three designated sarcoma centers in Ontario, Mount Sinai has recently expanded with the addition of new LMP faculty member Dr. Lingxin Zhang.
Dr. Demicco has been part of the leadership of many of worldwide sarcoma organizations, including having served a term as a member of the Board of Directors for the Connective Tissue Oncology Society, one of the biggest multidisciplinary research groups for sarcoma.
She is also a member of the Discovery and Translation Committee for the Sarcoma Alliance for Research through Collaboration (SARC). This committee is devoted to providing guidance to those doing clinical trials on how to incorporate more science correlatives into their studies.
SARC has recently inaugurated its first meeting devoted to sarcoma science and fostering collaboration and the formation of new ideas in small group settings. As she helps plan their first meeting set for September, she explains, “It's hard to get people together and collaborate and come up with ideas at some of the larger meetings, so we hope by keeping it small we can really discuss what kind of deliverables we can achieve if we collaborate on different projects within our sphere of interest”.
One of the many international collaborations Demicco is involved in is the National Cancer Institute (NCI)’s Clinical Proteomic Tumor Analysis Consortium (CPTAC) as Clinical Co-Lead of their Sarcoma Working Group. They collect tumour samples which undergo molecular analysis at The Broad Institute in Massachusetts, among other Proteomic Characterization Centers.
Through integration of proteomic analysis – a snapshot of the biochemistry of tumors cells and their surrounding tissue with genomic and other molecular features - they hope to better understand tumors, particularly in terms of identifying features which may be exploited to improve patient care. “We've been having some challenges with sarcomas because there is no ’normal tissue’ to compare the tumours to, as one would normally do with other tumours, to determine what aberrant features are present. Many sarcomas don't have a normal equivalent as they are driven by abnormal gene fusions and have a phenotype that you won't see anywhere else. They're very unique tumors in that way”.
As a clinician and a scientist, Demicco loves the collaboration needed in her unique area of pathology. “It's really nice being able to work with people who are experts in their field. I don't know anything about proteomics, but I know a lot about sarcomas. And so, when you collaborate with people who do the basic science, you can learn so much and apply it to your own field. Working together, we can synergize and create a meaningful study that has relevance to clinical practice as well as to basic science. I enjoy being able to talk to the people who do the really complex stuff that I can't do,” she laughs.
In addition to her clinical and research work, Demicco loves to teach. She is involved in the United States and Canada Academy of Pathology (USCAP), on committees and teaching such as small group microscopy courses. She also teaches Pathologists’ Assistants on LMP’s MHSc in Laboratory Medicine and often supervises summer students. Her main teaching role, however, is with postgraduate trainees in LMP. “It’s great to see more residents doing bone and soft tissue rotations, we’re also getting them with us earlier in their training – a great opportunity to expose them to this fascinating branch of pathology.”
Regarding her promotion, Demicco commented, “it is an acknowledgment of my contributions to the field of sarcoma research, and I hope that it can inspire other women faculty to seek promotion as well to get the recognition they deserve.”
