MD/PhD Student First Author on Major Paper on Kidney Cancer

The first cancer patient Nick Salgia saw during his gap year working at an oncology research center had a rare and hyper-aggressive subtype of kidney cancer. Fortunately, a novel immunotherapy had just been approved by the Food and Drug Administration, and the patient was among the first to get it.

That experience sparked in Salgia a passion to learn about and study kidney cancer, an interest that has only strengthened since he entered the MD/PhD program in the Jacobs School of Medicine and Biomedical Sciences in 2020.

Salgia works in the lab of Jason Muhitch, PhD, associate professor and co-chair of the Genitourinary Translational Research Group in the Department of Immunology at Roswell Park Comprehensive Cancer Center, a partner of the Jacobs School. 

Last week, Cancer Cell, one of the most respected journals in the field, published a study that helps explain why the subtype of kidney cancer that afflicted Salgia’s first patient is so susceptible to immunotherapy. Salgia is first author and Muhitch, Salgia’s faculty adviser, and Eric Kauffman, associate professor of oncology in the departments of Urology and Cancer Genetics & Genomics at Roswell Park, are senior authors.

The information about this cancer’s susceptibility to immunotherapy helped the researchers create a first-of-its-kind tool to guide treatment decisions for advanced kidney cancers. The new insights arose from observations about sarcomatoid renal cell carcinoma (sRCC), an aggressive subtype comprising 5% of all kidney cancer cases. While this subtype, typically diagnosed in the late stages, is resistant to most anti-cancer therapies, a type of immunotherapy called immune checkpoint blockade (ICB) has proved to be the exception. ICB approaches have greatly improved survival among patients with both sRCC and the most common type of kidney cancer, clear cell renal cell carcinoma — but patients with sRCC have benefited disproportionately.

More information on the study is available on the Roswell Park web site.

Thanks to this immunotherapy, the patient Salgia knew is now fully recovered and doing well. “Knowing that that patient had this type of cancer was one of the reasons I felt so impassioned to study it,” he says. “It’s a great story and it can give patients a new source of hope.”

The fact that Salgia was able to not only participate in such impactful research but also had the opportunity to be first author is noteworthy, says Marc Halterman, MD, PhD, senior associate dean and executive director of the Office of Research in the Jacobs School.

Muhitch describes the excitement in the lab as the research proceeded. “We started,” he says, “with an interesting question: How can a very aggressive form of kidney cancer also be susceptible to immunotherapy? The fact that Roswell Park patients gave us permission to study cells from their kidney tumors gave us a rare opportunity to decipher the clues of immune sensitivity. 

“As the project matured, Nick would harness the large datasets that we were generating to perform innovative analysis that revealed the intricacies of these patient tumors,” he continues. “We have a door in the lab where we post newly generated figures. It seemed every day Nick would contribute new ‘door data’ on these sarcomatoid kidney tumors that we would discuss as a lab. It was such an exciting time for each of us, and Nick was at the center of all of it.”

Halterman agrees. “Nick’s Cancer Cell publication is a remarkable achievement and reflects the caliber of research our students engage in during their PhD training,” he says. “His work under the mentorship of Dr. Muhitch, a leader in tumor immunology and graduate education at our partner institution Roswell Park, exemplifies how rigorous scientific inquiry, when supported by strong mentorship and institutional commitment, can yield insights with translational potential.”

Growing up in a family of physicians and scientists, it wasn’t surprising that Salgia was drawn to biomedical research. He majored in neuroscience at Ohio State, but as graduation grew closer, he began to think about working with patients as well.

“In my senior year, I felt like I was missing out on the interpersonal part,” he says, “Having the perspective of both a clinician and a scientist would help me have more of an impact and improve societal outcomes, too.”

That’s what inspired him to apply to MD/PhD programs. “The most important thing about an MD/PhD program is that you really develop expertise on both sides,” he says. “You talk to both basic researchers and clinicians and you feel like you really belong in both conversations. It allows you to be a bridge between the scientist and the patients, between basic discoveries and ways that you can really improve the lives of patients.”

Salgia knew he needed to be in a program with a connection to a comprehensive cancer center, which UB has through its partnership with Roswell Park. He also was focused on a medical school that could provide a variety of clinical exposures.

“That’s one of the strengths of UB: You’re not just at Buffalo General and Oishei, but you’re also at Roswell Park, at Erie County Medical Center, at the VA and at suburban outpatient clinics,” he says. “That diversity was a big draw.”

It also didn’t hurt that Salgia, who has lived across the country, is fond of Buffalo and was familiar with it since he has family connections here. 

“One of the strengths of training at UB and at UB-affiliated institutions is the kindness and relatability of mentors here,” Salgia adds. “The mentors put the trainees’ interests first. I think that’s very unique to this institution.”

Between the first and second year of the program, MD/PhD candidates do laboratory rotations, which helps guide them in deciding who to choose as a mentor. For Salgia, it was an easy decision.

“Within a day of being in Dr. Muhitch’s lab, I felt incredibly comfortable,” he says. “I was really interested in the direction of the science and I felt like my opinions were really valued.”

Salgia is excited to continue working on kidney cancer. The goal, he adds, is to find out about how biologically conserved interactions between the immune system and cancer can be leveraged to improve outcomes for all patients with cancer. “What’s next,” he says, “is to bring this to the clinic and directly test our findings in patients getting care at Roswell Park and other centers around the country.”

The MD/PhD program at the Jacobs School is one of more than 100 MD/PhD programs in the United States, which typically take six to eight years to complete. Students graduate with both degrees and typically pursue careers as clinical translational scientists. At UB, MD/PhD students can do their doctoral work in the Jacobs School, the School of Public Health and Health Professions, the School of Engineering and Applied Sciences or Roswell Park.