Mitesh Borad

Mitesh Borad
Mitesh Borad
Mayo Clinic
Can you tell us a bit about yourself?
I am a physician-scientist at the Mayo Clinic. My work involves both laboratory and clinical studies. I feel very fortunate to have wonderful colleagues both here and elsewhere, access to cutting edge resources, and a constant spirit of innovation and team science. I am always amazed by how courageous and altruistic our patients our in this journey and am always honored for them entrusting their care to our team. For better or worse, my endeavors are directed towards findings cures (and by that I mean collectively, not myself of course) for some of the most challenging cancers - liver and biliary tract cancers. In my spare time, I do enjoy traveling, cuisines of all types, cinema and kicking back with family and friends.
Can you share one or two of your specific research interests?
The human genome and gene therapy fascinate me at a scientific level. Ultimately, cancer is a genetic disease. It seems that we are only at the tip of the iceberg in the precision medicine era. I am hoping that we find magic bullets like imatinib (Gleevec) for all cancers. After arriving at Mayo Clinic, I was introduced to the notion of "oncolytic viruses", genetically modified viruses with propensity to infect tumor cells relative to normal cells and "armed" with anything in the scope of imagination - immunomodulators, targeted antibodies, toxins and reporter agents for imaging and tracking. In my laboratory, we have been endeavoring to create precision medicine enabled oncolytic viruses, in an effort to integrate these two fascinating landscapes. Broadly along these line, I am a firm believer that we will revisit Cancer Gene Therapy, a field that has fallen by the wayside, due to limitations in therapeutic delivery.
Why did you decide to specialize in hepatobiliary cancers?
Like the vast majority of things in my career, it was purely be serendipity. In 2010, At Mayo Clinic, with colleagues from the Translational Genomics Research Institute (TGen), we had launched one of the first efforts to perform whole genome and transcriptome sequencing in a real-time clinical setting. At the time, I had a number of treatment refractory patients with cholangiocarcinoma in my practice and had no idea what to do them. I enrolled them into the study, with considerable skepticism, not expecting to find much. To our surprise, more than half the patients had "actionable" findings, including FGFR2 fusions. There were no FGFR specific inhibitors at the time, but luckily drugs such as ponatinib and pazopanib had FGFR inhibitory activity and were available (after much pleading to pharma execs). Fortunately, all the patients we treated had some clinical benefit. Before I knew it, everyone was referring cholangiocarcinoma patients our way and it become apparent to me that I would need to learn more about the disease and its nuances, if I were to have any degree of credibility living up to the trust the patients were putting in us.
Can you describe one of the unforgettable moments in your patients care or research that has impacted your career?
There are definitely many "forgettable" moments. During my time at TGen, we were developing vismodegib, the world's first smoothened inhibitor, along with other institutions, in first-in-human studies. I had been treating a patient with metastatic basal cell cancer at the time and the heat shock protein inhibitor he had been on, had been ineffective. The timing was quite fortuitous as we had just opened the trial. After having to jump through innumerable hoops before the patient met the eligibility barricade, he was all set to go. The team quickly realized that this was a momentous occasion as he would be the first patient in the world treated with the drug. The next day, the research nurse, my good friend and colleague Dr. Raoul Tibes and the pharmacist clamored together to get a photo-op with "Patient 1". There was much friendly debate as to who should get the credit - the treating physician (myself), the nurse (for administering the drug) or the pharmacist (for ensuring accuracy of investigational drug product). Luckily, the patient settled the score and said he should get the credit because he was the one taking it, and of course, he was right ! It was a reminder that in our line of work, humility is absolutely essential. I always remember that incident when I see things going out of hand in this regards when "experts" in our field get carried away sometimes.
Can you tell us one thing collaboration with colleagues could accomplish that you could not accomplish on your own?
I was schooled in team science from the outset. As such, it is hard for me to imagine things one can really do on their own. Medicine and science have become vastly complex and the pace of knowledge and change has become exponential. It would be foolhardy to think that any one individual could have mastery over enough areas to credibly be an expert. I would want to give a shout out to all of the unsung heroines and heroes in this team sport - patients and their families, nurses, pharmacists, maintenance experts and many, many others. Without their selfless efforts, the scientific teams would not achieve any of the glories they are afforded.
If you had access to one resource that would move your research forward, what would that resource be?
If you thought, I would have said money, you are wrong. I wish there was more appetite for high-risk, high-reward research. All the things we do routinely now, came about through tectonic shifts, not through the safe and underambitious proposals that populate the research landscape after every big shift in the field. I also wish people could share their ideas more freely. Currently, this does not happen because folks want to hold something back so that can be the one to get the next grant, patent or credit for the big paper everyone will cite. I totally understand that this kind of thinking would be considered utopian and stating such things would make others wonder if I live in an alternate reality. There are many senior colleagues and friends who I know have done it all, and already made their mark. It would be quite refreshing to see this "been there, done that" group try to set a new trend towards achieving solutions faster by sharing their ideas openly and selflessly. I am certain our patients expect this of us and there is nothing like being a trendsetter once you have kind of plateaued in academia.
How did you learn about the Cholangiocarcinoma Foundation?
I was invited to participate in a Workshop some years ago by Stacey Lindsey, CEO and Founder of the Cholangiocarcinoma Foundation (CCF). She had assembled physicians and scientists from a number of institutions in Salt Lake City on that occasion. From what I can recall, we all went through these personality assessments, which I thought at the time, was quite peculiar. I think the goal of the exercise was to see if people with very different styles could actually work together to overcome a challenging problem such as cholangiocarcinoma. I don't think anyone from the group has remotely changed their personalities, but we have all learned to work together despite our idiosyncrasies, become good friends and are united by a common goal.
Can you tell us why you became a member of the ICRN?
About five years ago, at the Annual Cholangiocarcinoma Foundation Conference, Stacie Lindsey asked for ideas on how the Foundation could impact research in the field. Having seen the success of the Pancreatic Cancer Research Team (PCRT), that my mentor Dr. Daniel Von Hoff had started, I suggested consideration of initiating a clinical-translational research network. Being the go-getter she is, in quick order, Stacie corralled my good friend and colleague, Dr. Milind Javle from Anderson and myself, to launch the International Cholangiocarcinoma Research Network (ICRN). Enthusiasm for ICRN was incredible and before we knew it, institutions from all around the world had signed up. Expertise was across the board - translational science, surgery, transplant, interventional radiology, radiation oncology, gastroenterology/hepatology, medical oncology, diagnostic radiology, interventional radiology and pathology. Being a non-profit endeavor, this was largely a volunteer activity and it was really heartwarming to see what are generally incredibly busy folks, being so giving of their time. Here we are five years later. In my mind it is still an experiment in evolution and showcases the power of people working together, realizing that in an uncommon cancer, there is simply no other way.
If you are one of our Cholangiocarcinoma Foundation Fellowship awardees, how has this Fellowship impacted your career?
I did not have the good fortune of even being an applicant. However, I am now the proud mentor of one of the 2021 awardees (Dr. Alexander Baker). The impact CCF has made on supporting the bright, young minds who will solve the cholangiocarcinoma riddle, cannot be emphasized enough.