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Meet Dr. Lukas Kalinke, Clinical Research Fellow for the EARL Trial

Meet Dr. Lukas Kalinke, Clinical Research Fellow for the EARL Trial

Thanks to a generous three year grant from our long-term supporter, the Rosetrees Trust, Clinical Research Fellow Dr. Lukas Kalinke has been recruited to deliver the world's first ever Electrocautery Ablation for the pRevention of Lung cancer (EARL) Trial. This trial sets out to discover whether squamous cell lung cancer (SQCC) can be prevented with early treatment of pre-cancerous lesions. We caught up with Lukas to find out more about his role and the work that he is doing.

Please can you tell us a little bit about the EARL Trial

We are trying to prevent a type of lung cancer called squamous cell lung cancer (SQCC) by treating it early. This lung cancer type accounts for around a third of all lung cancers. It develops when the cells that line our normal airways change shape and start to invade the surrounding areas. Before they start invading, the cells go through a series of structural stages that can be detected by looking at them under a microscope. Groups of these abnormally shaped cells are called pre-cancerous lesions. Pre-cancerous lesions are classed as low-grade or high-grade depending on the risk of them developing into cancer; 50% of high grade lesions (HGLs) will develop into cancer. Cancer occurs when these abnormal cells have invaded the airway wall.

These preinvasive lesions can be detected using a special camera placed in the airway called autofluorescence bronchoscopy (AFB). Some centres treat these HGLs with surgery but their central location means lots of lung often needs to be removed and some of these HGLs will not even develop into cancer so in some instances, this will be pointless surgery that has its own risks.

Treating these lesions using a bronchoscope removes the need for surgery, is cheaper and is also less risky for the patient. Electrocautery (EC) involves delivering an electric current to the lesions using a bronchoscope. Small studies have suggested EC is effective in reducing the risk of airway HGLs becoming cancer. This is the first ever randomised control trial in the treatment of pre-cancerous airway lesions and if successful, could not only prevent patients from getting squamous cell lung cancer but could also lead to a global change in how we manage these lesions.

How long have you been involved with the EARL Trial and what is your role in it?

My involvement started in October last year, thanks to funding from UCL Hospitals Charitable Foundation and the Rosetrees Trust. I have been involved in trial design; producing the trial protocol and documents for submission to gain ethical approval for the trial. Dr Ricky Thakrar, the principle investigator on the trial, and I will soon travel to the VU Medical Centre in Amsterdam to learn the electrocautery technique from Dr Hans Daniels, who is a co-investigator on the trial. Dr Hans Daniels is the Director for Interventional Bronchoscopy at the VU Medical Centre and he is highly specialised in this area, with over ten years of experience in using electrocautery to treat pre- cancerous lesions. The EARL trial is due to open in the Autumn and will run for 6 years.

This is the first ever trial of its kind in the world, how does it feel to be working on something so ground-breaking?

I feel very privileged to be doing so. We have a great team who are all looking to achieve the same goal. In addition to treating these pre-cancerous lesions, patients who take part in the trial will also donate research samples from their airways. These will be analysed in the Lungs for Living laboratory to try and unravel why some of these HGLs progress to cancer whilst others don’t. I will be undertaking some of the laboratory work. We hope this laboratory research may provide new targets for future therapies. With the advent of new laboratory technologies that are exponentially increasing in sophistication, we are beginning to understand what is happening in each cancer cell. It is certainly an exciting time to be involved in lung cancer biology and I am lucky to be immersed in it.

What is it that you love most about your job?

I love that I can actively participate in a potential new discovery. I am constantly learning new things and developing different analytical skills. It is fascinating to watch my scientist colleagues who think so laterally to design experiments to answer specific questions. Before my PhD, I was working as a respiratory registrar, seeing and treating patients. I think the skills I learn during my time here will complement the diagnostic
reasoning attributes I have accrued so far as a doctor.
We are grateful to Lukas for taking the time to talk to us and we wish him all the very best with the commencement of the EARL Trial.