Faculty Spotlight: Patient-Centric Research and Care With Aime Franco, PhD

Editor's Note: Welcome to our monthly Faculty Spotlight series, in which we sit down with faculty members at Children's Hospital of Philadelphia Research Institute to learn more about their research and roles. Through these spotlights, our readers meet the diverse, dedicated, and distinctive individuals who lead our research community in our mission to improve children's health. It's a new round of spotlights, and this time, we’re asking our featured scientists about how they encourage diversity, equity, and inclusion within their labs. In this QA, we meet Aime Franco, PhD, director of the Pediatric Translational Thyroid Cancer Laboratory at CHOP. Stay tuned for more from our Faculty Spotlight series throughout this year.

How long have you been at CHOP, and can you tell us about your research specialty?

I moved my research lab to CHOP in the summer of 2019 from the University of Arkansas for Medical Sciences.

My research is focused on understanding the differences between adult and pediatric thyroid cancer. We work closely with our clinical colleagues and, early in my career, one of our collaborators kept asking whether we could try to model pediatric versus adult-onset thyroid cancer to better understand why thyroid cancer presents differently between children and adults. We know that many of the same mutations are present in pediatric and adult thyroid cancers, but children often present with more metastatic and invasive disease than adults. Despite presenting with a disease that looks so much worse clinically, children with thyroid cancer have a low mortality rate. We hope that if we can discover more about the molecular switches that are activated between pediatric versus adult tumors despite sharing the same genetic drivers, we might be able to find ways to make pediatric tumors less invasive and less metastatic.

With a more thorough understanding of the molecular basis of thyroid cancer, we can discover new therapies that are equally effective in preventing mortality, but that can also preserve quality of life for patients.

Why did you choose to focus on that specialty?

I am a thyroid cancer survivor and was diagnosed during my senior year of college. Despite having a great outcome in regard to survival, thyroid cancer is often associated with morbidity; once you have your thyroid removed, you must remain on thyroid hormone replacement therapy for the rest of your life. Even though most patients with thyroid cancer survive, they will have a lifespan of monitoring and medication.

I want to put the patient back in the center of research for thyroid cancer to look not only at survival outcomes, but also at patient-centric outcomes. There is so much more to life than just being alive, and our group led the way for discovering novel therapeutic strategies for thyroid cancer that continue to have great survival outcomes but can also improve the quality of life for thyroid cancer survivors.

Focusing on long-term survival is important, especially for those diagnosed as children or in early adulthood. We still don’t understand all the long-term consequences of lifelong thyroid hormone replacement therapy. We need to re-focus our cancer research goals to try to cure disease and simultaneously preserve quality of life.

Can you tell us about a current or recent research project (or projects) that you are excited about?

We recently showed that pediatric thyroid tumors share many of the same mutations as adult thyroid tumors, but that the genetic mutations confer different risks depending on whether the cancer is in an adult or pediatric patient. Fusion-oncogenes confer the greatest risk of invasive and metastatic thyroid cancer in children, but BRAF gene mutations confer the greatest risk in adults. We still don’t understand why activation of the mitogen-activated protein kinase pathway through these different nodes confers different risks between children and adults, or why activation of the pathway through different nodes increases risk of invasion.

But these discoveries open doors for potential novel and tailored molecularly targeted therapies for pediatric and adult patients. In fact, we have just been awarded a new grant in collaboration with Theodore Laetsche, MD, pediatric oncologist and director of the Developmental Therapeutics Program at CHOP, to determine whether molecularly targeted therapies in pediatric thyroid cancer patients can re-differentiate thyroid tumors and increase sensitivity to radioactive iodine in these patients.

What are the long-term research questions you hope to answer?

We want to more precisely finetune our therapies and improve outcomes of survivorship for patients with thyroid cancer through a more thorough understanding of the molecular biology of the disease and why different nodes of pathway activation lead to different outcomes in children and adults. Through more precision medicine approaches to treat thyroid cancer, I hope that we can maintain the excellent prognosis for our patients in surviving the disease, improve their long-term survivorship, and preserve their quality of life.

How do you support diversity, equity, and inclusion among your research team?

Our patients come from all backgrounds, so we need to include the voices of stakeholders from different backgrounds at the table in research. We have always sought to include the patient voice in our research questions and to ensure that all voices are represented and heard. We cannot solve problems that we are not aware of, and each of us faces different challenges based on our experiences. My journey as a patient receiving care at a local, regional hospital was different than that that of patients who receive care at cancer centers. We need to understand all perspectives to make progress in providing equitable care to all cancer patients. I know that my cancer care journey was different because of the color of my skin, and that I will never understand the journey of others if they are not also at the table with us.

I established my lab based on the principle that we all have unique needs to succeed in biomedical research and science. We each view success and progress through a different lens, and respect for each of our perspectives is critical to maintaining a diverse, equitable, and inclusive environment. I started college thinking that my love of science required me to become a medical doctor because I did not know about careers in research, or that a college professor could not only teach undergraduate biology but also run a research laboratory. Each voice is important and critical to dissecting biological questions; the only way to make progress is through diverse, multidisciplinary teams.