Kenneth Hillan - Transcript Summary

Kenneth Hillan Vice President of Immunology, Tissue Growth and Repair, Clinical Development at Genentech, San Francisco

Interview location: Genentech, San Francisco
Interview date: Friday 16th November, 2007

Key Themes: Attributes of a Pathologist, Mentors and Influences, New Technologies, Research versus Clinical Work

 

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Section 1

  • Grew up in Scotland in a non-medical family, but “I was always intrigued by what doctors did... I was always passionate about what could be done for patients.”
  • Now working in industry with little direct contact with patients, nevertheless he believes his work can have an enormous impact on individuals.  “It's a very different perspective, but the benefits you can bring to patients are huge.”
  • Studied medicine with aim of becoming a surgeon. But a spell at a Paris hospital which combined surgery with research into transplantation of liver cells and the immune response ‘opened his eyes’ to the excitement of research.
  • Back in Glasgow he continued with the liver research in collaboration with pathologists. “I really became fascinated... I'd never thought of being a pathologist until then.”
  • Decides to switch from surgery to pathology: “I began to understand what morphological interpretation of things could bring in terms of knowledge.”
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Section 2

  • Did his training and continued to develop his interest in the liver -- discusses this organ’s unique powers of regeneration.
  • Translating what they learnt in the lab to clinical practice remains a challenge: “Liver cells in the spleen are likely to be killed very quickly by the host immune system.”
  • Discusses the interaction between the host immune system and transplanted tissues and organs. But this is just one of several challenges in scaling up stem cell research cells for wider clinical use. 
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Section 3

  • Talks about the training of pathologists – switching between diagnosis of surgical specimens and autopsy work.  Learning to interpret a huge variety of evidence takes a long time: “It's a very visual discipline...you have to be able to build pictures in your mind.”
  • In his view, because pathologists often work together to reach a diagnosis, a tradition has developed of “camaraderie” and “a terrific amount of mentorship in training”.
  • During training he saw the emergence of HIV and AIDS.  “Just being part of that whole period was pretty fascinating.” Tells the story of a colleague dying of the disease.
  • Anecdote about conducting a postmortem as a trainee in a remote Scottish town in a chapel with no electricity and only basic equipment – has a mishap with the brain!
  • Talks about hazards of doing autopsies: “As a pathologist you definitely expose yourself to risks.” He himself caught herpes simplex.
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Section 4

  • Explains how the opportunity came to make the move from Glasgow to the pharmaceutical industry in America.
  • Originally continued with his liver research, but became involved with breast cancer genetics, and the development of Herceptin.
  • Highlights the vital importance, both during trials and in clinical treatment, of identifying the patients most likely to benefit from a drug.  “If we had run clinical trials [of Herceptin] in all women with breast cancer, not selected for just those patients with HER2 amplification, the trials would still be running today.”
  • To do this, individual tumours have to be characterised.  “And it's characterised by the pathologist.” 
  • Describes the moment when data on Herceptin were presented at a key conference and an eminent scientist said: "Biology has spoken, and we should listen to it."
  • Discusses briefly the issue of public perception and misunderstanding of pathologists, and how the Alder Hey controversy affected morale in the UK.
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Section 5

  • In 1994 he took an opportunity to join the biotech company Genetech in the US.  Exciting things were going on including the Human Genome discovery programme in which Genentech played an active part. “When you cloned new genes, one of the important things is understanding where those genes were expressed in the body, in what cell types, and what happened when you had disease.  Being a pathologist, I was able to bring that expertise...”
  • A Cancer Genome Project followed.  Describes current work in field of diagnostics for breast cancers, and his role in “helping people to understand that these heterogeneous diseases will all need targeted therapies...”
  • Further discussion on the complexities of tumour identification.  Molecular technology has created an “explosion” of information -- “But the implication of the data isn’t absolutely clear.”
  • However, there is progress: “We began to recognise that different genetic mutations that we had recognised morphologically were driving these different tumour types.”
  • Makes the point that career opportunities in industry are opening up. “A lot of pathologists are beginning to collaborate with companies, and a lot of companies are beginning to build pathology departments.”
  • Discusses development of some of the new drugs, including Avastin and Lucentis.  Describes the excitement of exploring their clinical potential, and pays tribute to his colleagues:  “I work with lots of people who have great ideas.”
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Section 6

  • Enthuses about the beauty of the morphological images under the microscope. “Histopathology diagnostic microscopy is definitely an art form... The discipline of pathology, the learning that goes on behind that, is all about the science.  I think it’s definitely [a case of] matching the two.”
  • Another pleasure is the variety of his work: “every single week of your life, you'll see something you've never seen before.”
  • Returns to his point about the commitment of senior pathologists to their juniors: “Pathology's really a place where people look after each other... [In Glasgow] people cared a lot about the trainees, making sure we were well trained, well mentored.”


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Section 7

  • Defines molecular pathology and describes the role of the new technology in the categorisation of hepatitis viruses. This work underlined the vital importance of having access to archives of historical tissue samples.  Glasgow’s archive dates back to the 1800s – with a few gaps: “It turns out that paraffin wax is loved by cockroaches...”
  • The historical perspective gained from an archive reveals “just how different the patterns of disease were at different times”.

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Section 8

  • Discusses the working culture at Genentech – “work hard, play hard” – and his life in California.
  • He has a high level of job satisfaction, and feels that what he has learnt has implications beyond the professional:  “I guess [pathology] teaches you a lot about life [as well as] disease...  You should always treasure life, because you can never quite be sure when you're going to exit.”

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