Unlocking the Mysteries of Cardiac Cancer: A Journey through Rare Diseases with recent PhD graduate, Aparna Subramaniam, PhD

Aparna Subramaniam, PhD, an epidemiology researcher, earned her PhD in Epidemiology in the Fall of 2023 at UTHealth Houston School of Public Health. Her PhD thesis focused on angiosarcoma, a rare type of blood vessel cancer. Her research characterized the epidemiologic, clinical, and genomic profile of primary cardiac angiosarcoma, commonly referred to as cancer of the heart.

Subramaniam's journey began with a passion for studying rare cancers. She said, "I was interested in studying rare cancers as they are often overlooked as a research focus. Due to the lack of research studies on treatment and management, rare cancers  pose a considerable burden on the healthcare system. Trying to understand rare cancers and exploring the treatment strategies to improve survival for patients was my main goal. A PhD in epidemiology would equip me with the skills to pursue my research in the field."

Subramaniam shared vital discoveries from her research. Primary cardiac angiosarcoma predominantly impacts White males in their 30s and 40s, displaying a grim prognosis with a three-year overall survival rate of only 18%. The research highlighted the critical role of systemic therapy in managing this aggressive cancer. Specific mutations were identified, emphasizing the need to tailor treatments to the unique genomic profile. Adopting multimodality treatments, combining systemic therapy, surgery, and radiation, emerged as a critical predictor for improved survival outcomes.

Subramaniam's research showcased that systemic therapy significantly enhances survival in primary cardiac angiosarcoma patients, not only for those with resectable disease but also for those with advanced conditions. The findings outlined effective systemic therapy regimens and treatment modalities, paving the way for adopting standardized management protocols across institutions. This shift can bring treatments closer to patients, reducing costs and enhancing their overall quality of life. The insights gained can also guide the management of other primary cardiac sarcomas.

Navigating the unforeseen challenges of the COVID-19 pandemic was a significant hurdle during Subramaniam's PhD journey. Collecting patient tissue samples required for the thesis became difficult during this period. Effective communication with collaborators and adapting to online meetings helped overcome these challenges.

Mentorship played a pivotal role in her academic journey. "My dissertation supervisor, Dr. Vinod Ravi, a professor in the Department of Sarcoma Medical Oncology at MD Anderson Cancer Center, significantly influenced my research. He helped tailor my dissertation to rely on my clinical medicine strengths while learning new skills to expand my genomics knowledge. He provided opportunities to design smaller studies independently during my PhD, the experience of which will hold me in good stead in my post-PhD career. He has introduced me to the various facets of clinical research essential for a successful career as a physician-scientist," said Subramaniam.

She has some sage advice for future PhD candidates on balancing work and personal life. "Communication is key to achieving a semblance of balance between work and personal life during a PhD program. I did not shy away from asking for help at work and home when I felt burdened by responsibilities and could not do justice to both if I tried to do it all by myself. My advice would be not to get overwhelmed when there is a lot on your plate and instead break down tasks and enlist help from those around you. I relied on taking time out for yoga and spending time with my dogs as my main strategy for self-care during my doctoral studies."

In her post-PhD career, Subramaniam will continue her research in angiosarcoma, expanding the focus to other sarcoma types. She will be using the knowledge she gained to design more extensive studies on characterizing the genomic profile of sarcomas.

Reflecting on her PhD journey, Subramaniam takes pride in successful collaborations across institutions, leading to significant data collection for the thesis. Her research's recognition at the Connective Tissue Oncology Society 2023 annual meeting in Dublin marks a notable achievement.

In the short term, Aparna Subramaniam aims to continue angiosarcoma research, identifying novel agents through clinical trials. Her long-term goal is to contribute as a physician-scientist, advancing therapeutic options for rare cancers.