Meditations of an oncology geek

Archive for December, 2016

16 Favorite Images of 2016

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31 December 2016

Hi Everyone,

I am going to take a slight diversion from my normal science / bio blog, and make a post about my 2016, as described through my camera’s viewfinder. As some reading this may know, back in college I was a staff photographer at the New University newspaper at UC Irvine, and especially in recent years I’ve been making concerted efforts to again explore describing life experiences through photographs. While the cliche about photographs being worth 1000 words may be true, I will add a few more for context to each of my 16 favorite of ’16.

17 January

I remember riding my bike this morning up the coast, and being completely blown away by how much the surf had picked up. The swell period was unusually long, and I suspected that Blacks Beach might be really shining with better tides later in the day. I had the most pleasant experience sitting for a couple hours atop the cliffs in the Scripps Reserve, watching groomed liquid avalanches methodically emerge from the depths of the deep underwater canyon, the rumbling echoing off of the cliffs as braver souls than I attempted to dance with the ocean on this day.

01 March

My mother tragically passed away 15 years prior to this day. I opted to re-visit the San Diego (Quail) Botanical Gardens that she really loved. I was not to be disappointed. While the enormity of the experience is a bit too much to describe here, I did a lot of just standing or sitting silently, which also had the effect of making small flighted animals more comfortable with my presence. I am including two photos from this day in my 16 of ’16. The first was a monarch butterfly that really liked an angularly appealing plant against a black backdrop. In many respects, this was a lucky shot. I shot this with my telephoto and did not have time to properly select the right aperture, but I was happy with the outcome!

The second one from 01 March was taken about half an hour later. This hummingbird was hovering just a few meters away from me and really seemed to like this group of flowers (it probably thought I was a tree or something). While slightly out of focus, I thought it was a fitting photograph for the day as well. The hummingbird hovered around me for what felt like five whole minutes, and I feel like we had a good time together.

06 May

A good friend of mine had recently gifted me a philodendron, which has been a great addition to my back patio. I took this photo amid what was a really heavy week of gray marine layer. I noticed that brief breaks in the gray would light up the underside of the leaves, so I grabbed my camera and waited. It’s one of those things that counterintuitively looks a lot better to a camera than to the eye, and I was really pleased with the result from a day dominated by gray sky palate.

07 June

My trip to Chicago this year was a bit of a turning point in my professional life. Days before we had published the results of a cross-sectional cohort study evaluating a biomarker that will be put to use to extend the lives of men with advanced prostate cancer. I was in Chicago with my research team at the American Society of Clinical Oncology (ASCO) annual meeting to present on this research and other exciting research. The last day I was in Chicago I was able to catch a late flight home, and did some exploring around Millennium Park. Coming from San Diego, what really struck me about Chicago is that there is no natural landscape by which the architecture defines itself, no mesas or canyons or inlets or mountains, and instead is a blank canvas for man-made form, function, and expression. This first photograph was taken when I get on a bridge of unknown (to me) destination. The angles seem to suggest it goes on into the horizon of buildings in the distance, and the pedestrians give a sense of destination as well. The bridge wound up leading me to the Art Institute of Chicago, a fitting destination! While not the most visually stunning photograph, it is nonetheless one that really captures a curious moment and experience of a formative trip.

This next one was from the same day, just a few hours later. I was walking back from the Art Institute of Chicago, through Millennium Park, and was surprised to find myself suddenly in about half an acre of lavender! I was not the only one there, as many bees were hopping from flower to flower. A particular aspect that draws me to this photo is the utter surprise I felt, not expecting to find myself in such a setting!

01 August

A couple months later I found myself on the east coast, racing my bike at the USA Cycling track nationals in Trexlertown, PA. While I have many fun action photos from the experience, I also feel that this photo from the flight home encapsulates a lot of the essence of the trip and experience: here the pilot is literally dodging thunderstorms. I feel that it is somewhat symbolic of the punctuated dynamic of track racing. It was a lot of work, and the racing had its fair share of drama, but at the end of the day we did find clear horizons and I am so glad my team and I went. This photo is from the plane window, deliberately shot at f/4.0 with focus at infinity, right up against the glass, to best avoid blemishes from the plane window.

02 August

Just the next day I found myself in a place both familiar and somewhat unfamiliar. While I had raced all spring and summer at the San Diego Velodrome to get ready for track nationals, I had the fun experience of being on the other side of the railing and among the stands instead. I added a little bit of motion to this photo, using a slower shutter speed and a little bit of a speed pan. Again, not the most visually stunning photograph, but I feel that it captures the essence of a savored experience.

26 September

This day was the hottest I have ever seen at the coast in San Diego. The mercury reached 106F! It made for an especially pleasant walk on the beach later in the day. The surf and the way the sand had moved around lead for great conditions to finally capture a good reflection of the iconic Scripps Pier.

This one is my favorite of all year. Again, from 26 September. The most charismatic sandpiper was dancing with the ebb and flow of the light surf, and eventually turned to walk right toward me. It’s really the reflections that make this photo for me, alongside the sandpiper’s posture and swagger. I wish I would have shot it with a slightly wider depth of field, but sometimes it’s the slight blemishes that make a photograph seem real (or at least that’s what I tell myself!).

01 October

This one was from an impromptu trip up Nate Harrison Grade, a dirt road rising from 1000ft to about 6000ft of elevation on the western side of Palomar Mountain. About halfway up I realized that the encroaching marine layer from was starting to fill in some of the western valleys closer to the coast. It’s a shot that I’ve had in my head for many years, and was very gratifying to be able to capture.

16 October

I remember having to work most of this Sunday, and taking a break mid-day to just go sit by the Torrey Pines Glider Port. A light storm had just passed overnight, leaving a textured canvas against which gliders hovered. I remember sitting for about an hour, and suddenly one approached fairly close, and was able to capture it against the sun as well.

05 November 2016

My best friend from college visited me this weekend, resulting in a lot of surfing, taco eating, and also an impromptu trip out to the Anza Borrego Desert in search of ancient Kumeyaay pictographs. Along our hike we came across this view, looking south toward Mount Laguna in the distance, which a few months later would be capped in snow (see below photograph). A green desert oasis is even barely visible at the desert floor. The view was completely unexpected, and took my friend James by such surprise that he fumbled his phone, which wound up falling about 50 feet down the dry waterfall. Incredulously, he found a way to climb down to retrieve it, and both he and the phone wound up unscathed!

27 November

The geographic diversity of San Diego County never ceases to amaze me, and not even a month later the first snow fell on Mount Laguna (6000ft). In this case, the first snow caught many plants by surprise, including this oak tree. Amid a backdrop of snow, a leaf displays a fitting amount of chromatic heterogeneity for the rapidly changing alpine seasons.

29 December

I like this photo for both the scene, and the amount of work I had to put in to get there! This was 4 miles and 2000 vertical feet into my hike up El Cajon Mountain on a very clear day (two days post-rain). Visible on the right is Point Loma and downtown San Diego, with the Coronado Islands (Mexico) in the distance on the left. I am really a bit of a geographic geek at heart, and love the expanse and range of the corner of the world I call my home.

Thanks for reading. It was fun to share!


Written by Ryon

December 31st, 2016 at 9:28 am

Posted in Science Blog

Chemistry in Context: AR-V7 in Metastatic Prostate Cancer

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23 December 2016

Hi Everyone,

I have some great news to share:

Recently, the work of my colleagues and collaborators was accepted and published in the prestigious journal European Urology. A retrospective analysis of the cohort presented in Scher et al. JAMA Oncology, this study investigated the scoring criteria of the AR-V7 biomarker in circulating tumor cells. We found that the AR-V7 is predictive of drug class-specific survival when the AR-V7 protein is localized to the nucleus of circulating tumor cells in metastatic prostate cancer patients: that patients who had these types of CTCs survived longer on taxane chemotherapy instead of androgen receptor signaling inhibitors like abiraterone, enzalutamide and apalutamide.

My individual contributions were lead biostatistician and drafting the manuscript. The open access article is available here: Nuclear-specific AR-V7 Protein Localization is Necessary to Guide Treatment Selection in Metastatic Castration-resistant Prostate Cancer


Written by Ryon

December 24th, 2016 at 9:51 am

Posted in Science Blog

Nerd Nite, Liquid Biopsies, and the Future of Cancer Diagnostics

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14 December 2016

Hi Everyone,

Last week I had the privilege of being an invited speaker at Nerd Nite. From Wikipedia:

Nerd Nite is an event usually held at a bar or other public venue where 2-3 presenters share about a topic of personal interest or expertise in a fun-yet-intellectual format while the audience shares a drink. It was started in 2003 by then graduate student (now East Carolina University professor) Chris Balakrishan at the Midway Cafe in the Jamaica Plain neighborhood of Boston and spread to New York City in 2006, where Matt Wasowski was tasked with expanding Nerd Nite globally. Nerd Nite is held at more than 80 cities worldwide.

One of those cities is San Diego, where the venue started up a few months back, held just outside the Liberty Public Market, right next to Stone Brewery. The Wikipedia description is apt, as most of the audience has a beer in hand. While the outdoor venue and proximity to Lindberg Field lead to some noisy interruptions, it seems to be a custom to raise one’s drink and take a swig when the speaker is momentarily drowned out by jet noise.

All in all, there were about 40 people present of diverse intellectual curiosities and backgrounds, and when mixed with beer, lead to some really fun public discussions about the intersection of science and science fiction.

I gave a talk titled “The Future of Cancer Diagnostics: The Liquid Biopsy” where I outlined three main areas of cancer diagnostics (see photo) that can be revolutionized by emerging rare blood analyte technologies, especially those that can detect and characterize circulating tumor cells. In particular, I discussed our recent work on CTC-based AR-V7 protein as an emerging treatment selection biomarker in advanced prostate cancer. The next step will be clinical studies to investigate the clinical utility of monitoring resistance (i.e. once a patient gets a drug, not just before a patient gets a drug) using the same or similar types of tests.

The key advantages of liquid biopsy are accessibility, repeatability, and fewer side effects; no one will get a collapsed lung from observing circulating lung tumor cells, and there is no drill required to see circulating tumor cells from a bone metastasis in prostate cancer. Blood draws also do not require trips to hospitals, and can be repeated with much, much higher frequency than tissue biopsies, enabling the potential for sequential monitoring of cancer, which is a disease that evolves over time in cancer patients.

The challenges facing the use of circulating tumor cells lie in the sensitivity of detection, for which I discussed emerging technologies in tandem with established literature suggesting that there is biological feasibility for early detection of cancer using CTCs, and that the main hurdles right now are organizational (i.e. funding and time) required to run the clinical studies and clinical trials to expand clinical utility into the “early detection” area of cancer diagnostics. While treatment selection and recurrence monitoring are very important unmet needs in oncology, and are in late phases of clinical development, it is the early detection of cancer that could extend patient lives by decades, not just years.

It’s a tantalizing vision of the future of oncology, but it is important to underscore that oncology is not changed by technology alone, but by the application and testing (i.e. clinical trials) of technology: do the benefits outweigh the potential harms and costs? What patients benefit, and how much? Emerging technology and studies have clearly demonstrated that the scales can be tipped well into the patients’ favor, at least in the treatment selection area of advanced prostate cancer. It’s a great proof of concept, and this rigor of clinical studies will need to be applied to the recurrence monitoring and early detection areas of oncology diagnostics as well.

…and this is where I got of my soapbox and had a sip of my beer! I really enjoyed the vibe, and will be a regular at Nerd Nite, and it’s so incredibly important to have these types of public discourses about science and technology. Already looking forward to next month!

Written by Ryon

December 14th, 2016 at 9:29 am

Posted in Science Blog