Coming from a big family, Doctor Rishi Kotecha always knew he was destined to help children. In our revealing interview he shared career highs and lows in the pursuit of curing cancer in babies.
I can't even count the number of cousins I have, Dr Kotecha laughed. I come from a huge extended Indian family and even before medical school, I knew I wanted to work with children.
"When I did general paediatrics as part of my medical degree, I loved it," he said. "Helping little kids is incredibly rewarding particularly because they're so resilient and make a real impression on you."
However, paediatric oncology would present a catalogue of challenges for the young medico. Some that made him question if the specialty was for him.
"The first time I was introduced to oncology I found it really tough," Dr Kotecha said. "In other areas of medicine the drugs and treatments are fairly generic but cancer treatment protocols and chemotherapy were a whole new world."
"I'd gone from a position of seniority to a specialty where I knew nothing," he recalled. "I had to learn everything from scratch and eat a lot of humble pie along the way."
In those early days of his career, Dr Kotecha really didn't think the field of kids' cancer would be his path.
On a mission
Everything changed a few years later when he went back to oncology as part of his general paediatric training and met some of the patients he'd treated the first time around.
"They told me how I'd made a difference in their lives; that they'd remember me forever," Dr Kotecha smiles. "I thought that was amazing. I still get letters and emails from patients. Some of the children I treated are now at university and others have kids of their own."
Read more:In Focus: Telethon Kids Institute.
Cementing his calling was the introduction to six-week-old twins; becoming part of their cancer journey from the very first day they were admitted to hospital.
Initially only one of the babies was diagnosed with leukaemia. A more senior colleague insisted the other twin be tested despite the child being symptom free.
"She knew that because of their age, it was highly likely that the other twin would have leukaemia,” said Dr Kotecha. “Lo and behold the second twin was also diagnosed with the disease."
Sadly, one baby died. "That experienced really spurred me on,” Dr Kotecha said. “I found it so sad. I ended up doing my PhD on those twins; studying their genetic makeup. And that’s how it all started for me - I’ve carried on with the laboratory research ever since."
Tackling the hardest job
To date, childhood cancer research has focussed on finding solutions to help the biggest number of patients while rarer cancers, where there are smaller numbers, have largely been neglected.
"It's because we have had such good outcomes for the common forms of ALL that we can now focus on the rarer subtypes,” said Dr Kotecha.
ALL, or acute lymphoblastic leukaemia, was described as a death sentence for children in the 1950s. The five-year survival rate for standard risk patients now exceeds 90 per cent which is about as good as it gets in terms of cure as current therapies can have the unfortunate side effects of leaving young patients open to life-threatening toxicities.
The rare subtype Dr Kotecha is turning his attention to is infant acute lymphoblastic leukaemia (iALL). He describes current survival rates for this disease as ‘dismal’. Less than 40 per cent of babies diagnosed with high-risk features will overcome it.
Read more: Combinational therapeutics in high-risk infant acute lymphoblastic leukaemia.
"The chemotherapy drugs we currently use are really toxic to babies; many die from their side effects,” he shared.
"My aim is to get survival of iALL close to where other cancers are, by setting up my lab to discover kinder, more effective treatments,” said Dr Kotecha. “And I’m using my international collaborative networks to ensure that those discoveries will be considered for clinical trials as quickly as possible."
The father of one is well connected and a key member of the International iALL Clinical Trials Consortium charged with co-ordinating iALL trials for Australia and New Zealand.
If we can find drugs to improve outcomes for infants with cancer in our West Australian lab it will have an impact all over the world, he said.
Strength to carry on
Fighting to stop the loss of tiny patients is why the clinician-scientist works 80 hours a week, “Long hours, passion and dedication are needed if I’m going to make a difference,” he said.
When asked how he successfully juggles his roles he laughed, “That’s a question my wife keeps asking me!
Taking a more serious tone, Dr Kotecha quickly noted he could never do it on his own. He humbly listed all the people who help him on daily basis.
"Nick Gottardo and I are the two main childhood cancer physician scientists in Perth,” he said. “Nick has his office next to mine and we spur each other on."
Even though he specialises in brain cancer and I’m in leukaemia, he is my mentor and friend and we help each other,” said Dr Kotecha. “It’s fair to say I didn’t know how to use a pipette when I first met Nick!
He also attributes his supportive family to his success. My wife is fundamental to me being able to do what I do,” he said. “She works fulltime but picks our five-year-old daughter up every afternoon.
I get to spend time with my daughter in the mornings,” he continued. “I help her get ready and take her to school. She helps me get ready too, by picking out my shirt and tie. I seem to wear a lot of pink these days!
Believing in science
While the people who surround him give him strength and support, it’s the work itself that provides stimulus to keep aiming high.
Science gives me the ability to express myself, investigate, ask difficult questions, and explore,” Dr Kotecha says. “It’s a great counterpoint to the strict protocols we follow in the clinic.
"Then there is the ‘eureka moment’ - when you get the answer you’ve been searching for after a few failures. It’s the best feeling."
Naturally, funding is also a vital pathway to success. But as well as financing the work, there are some other surprising benefits. "The thing with science and research is that you never know if you can sustain the work,” Dr Kotecha said. “Grants that provide long-term security take a lot of the stress off. Knowing we can continue with the work to reach the objectives is hugely beneficial."
"Any type of funding is also a morale booster for the team. It means people are invested and believe what we are doing is worthwhile."
And what Dr Kotecha and his team are doing is incredibly worthwhile. He’s ultimately aiming to cure cancer in babies. And he’s in it for the long haul.
"Hopefully I will live another 30 years," he laughs. "But in that time, hopefully by then, there will be a cure."
Dr Rishi Kotecha image courtesy of the Community Newspaper Group.