Broadening Our Horizons
An interview with Sheng Yang, MD
Dr. Sheng Yang came to the attention of the IFP fellowship nominators for how he sets the bar high at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (also known as the National Cancer Center of China and the National Clinical Research Center for Cancer of China), where he currently serves as associate chief physician in the Department of Medical Oncology. His work involves patient clinical management and clinical trials.
Each week Dr. Yang spends two mornings and one afternoon in the outpatient department, consulting with 20 to 30 patients during each of these half-day sessions. (As a comparison, the average number of patients seen by oncologists in the U.S. during a full day of work is 20, according to a 2020 survey published in Cancer Therapy Advisor.)
The rest of Dr. Yang’s time is devoted to treating hospital inpatients. Additionally, he leads one routine round each workday and participates in one grand round, one teaching round and one multidisciplinary discussion each week. Clinical trial matters are dealt with before lunch, while late afternoons are reserved for reviewing medical records.
Along with all this, Dr. Yang finds time to conduct research, amassing a growing list of published studies that includes a recent report in the European Journal of Cancer on the results of a phase 1 study to determine the safety and clinical efficacy of toripalimab in patients with advanced or recurrent malignancies.
A graduate of Tongji Medical University (Bachelor of Medicine) and Peking Union Medical College (Doctor of Medicine), Dr. Yang served his residencies at Hanyang Railway Hospital and at the Cancer Hospital, where he works today. He is a member of several academic organizations, including the Chinese Society of Clinical Oncology; the International Association for the Study of Lung Cancer; and the China Anti-cancer Association, for which he serves on the chemotherapy and lymphoma committees.
We recently interviewed Dr. Yang (via email) on his experience as an IFP Fellow.
What was your most memorable experience as an IFP Fellow?
It was a great experience, full of excitement. The Society for Translational Oncology (STO) and Chinese Society of Clinical Oncology (CSCO) joint fellowship program provided me with a valuable opportunity to study the new advances in clinical practice and clinical trials in oncology, especially in the field of precision medicine and immune-oncology. In the three months, I learned a lot in various fields such as clinical trials, bioinformatics and academic writing.
In my opinion, the most memorable experience as an IFP Fellow was meeting with Dr. Joseph R. Bertino and Dr. Bruce A. Chabner, whom I have admired for a long time. Dr. Bertino’s research on drug resistance led to lifesaving new treatments for leukemia and lymphoma. He was an early pioneer in the area of translational research. Dr. Chabner played a key role in the development of paclitaxel and high-dose methotrexate, and he changed clinical practice. He is also the editor of such classic textbooks as Cancer Chemotherapy, Immunotherapy and Biotherapy and Harrison's Manual of Oncology. Dr. Chabner founded and presented at the Society for Translational Oncology Fellows' Forum (STOFF) and Chabner Colloquium, and I learned a lot from his insightful lectures.
What was your main takeaway from this fellowship, and what impact has it had on your career?
First, from serial lectures and meetings such as Discover Brigham (an annual poster session organized by the Brigham Research Institute) and the CAHON (Chinese American Hematologist Oncologist Network) annual meeting, I got to learn about new trends and novel techniques in precision oncology and immunotherapy, such as CRISPR-Cas, epigenetics, big data, CAR-T and microbiome.
Second, by attending the STOFF and the Alliance meeting, and visiting the NCI and FDA, I got a whole picture of how clinical trials are designed and conducted.
Finally, the fellowship experience kindled my enthusiasm for statistics. Before the fellowship, I studied statistics but only deemed it a research tool. Dr. Jipang Wang showed me statistics as a means to describe and understand the real world and introduced R, a powerful language for statistics, bioinformatics and visualization. After the fellowship, I spent more time learning statistics and have a deeper understanding of its application in medicine.
In summary, I obtained new knowledge, skills and resources, and have applied what I learned in the three months to my daily work and research. This fellowship, especially the professors I met, have guided my career development and benefit my daily clinical management.
During your fellowship, did you note any differences that medical professionals in China versus the U.S. take in their approach to patient care and/or research? If so, how might this observation affect your own work today?
Yes. I noticed that medical professionals in China have only limited time for each outpatient, because of the large patient population. In America, it takes typically 20 to 30 minutes to communicate with each patient. Furthermore, patients in China may wait for hours in a hospital before seeing a doctor. Long-time waiting and limited time in consulting may leave them with bad feelings.
What I try to do now is to convey information more concisely and clearly in a limited time, and show empathy for patients. Also, to prevent the potential spread of COVID-19 related to patient crowding, many hospitals in China have arranged medical appointments and shortened patient waiting times.
Another difference is how some American doctors can spend several months each year in a laboratory, something I think is a luxury for most Chinese oncologists. Usually, our doctors are required to work clinically full-time throughout the year. Still, I usually try to set aside some time each week for research and to keep close cooperation with scientists in our institute.
What additional training have you pursued since your fellowship?
Translational research and precision medicine demand senses in both fundamental science and clinical practice. After the fellowship, I received training on clinical trials from Peking University Clinical Research Institute, the Good Clinical Practice (GCP) program, and clinical symposiums held by our hospital and the Chinese Anti-cancer Association. I also took courses in preclinical research. In addition, I bought some books on R and spent time with them.
What do you know now that you wish you knew five years ago?
I have come to understand the thoughts and ideas of scientists and gotten to know how to communicate and collaborate with them. I know more about the clinical application, toxicity management and predictive biomarkers of immunotherapy. I have more experience in study protocol development, funding application, clinical trial conducting and result reporting. For instance, I participated in a phase 1 trial of the first approved Chinese anti-PD-1 antibody.
What can you tell us about your latest research?
My latest research involves clinical trials and translational studies in targeted therapy and immunotherapy. As a sub-investigator, I am conducting several registration studies, including phase 1 trials of multi-target kinase inhibitors and checkpoint inhibitors targeting PD-L1 or LAG-3. I just completed phase 3 trials of a biosimilar in non-small cell lung cancer and of a third-generation EGFR inhibitor. Also, I am conducting some investigator-initiated trials on lymphoma, head and neck cancer, and lung cancer. Biomarker analysis was concurrently conducted with these clinical trials.
Of the projects you’re focused on today, is there one that you are particularly interested in?
I am particularly interested in a phase 2 trial exploring an ADC (antibody-drug conjugate) targeting EGFR in advanced lung cancer. EGFR protein has been tested as a potential target in lung cancer. In contrast to EGFR TKIs, antibodies archived limited success in the treatment of lung cancer. I postulate that the addition of a toxin to an antibody may improve efficacy and represents a new strategy in lung cancer.
What is your next professional goal?
I plan to further improve time management and knowledge structure, deepen my understanding of oncology and to develop interdisciplinary collaboration to make discoveries beneficial for cancer patients.
How important do you think that international experiences and exchanges of talent and ideas, such as what the IFP fellowship offers, are to medical professionals and research — and ultimately to patients?
I think international experiences are of critical importance for us to broaden our horizons and learn new techniques. Also, international experience provides a unique perspective on health care in China by comparing it with that in America.
The IFP fellowship fits the need of medical professionals and researchers with interests in clinical and translational oncology. It covers various areas of precision medicine, clinical trials and bioinformatics.
I think the knowledge and practical skills I learned in the IFP fellowship will benefit my patients substantially.