Cancer treatment: “One size doesn’t fit all”

José Batista da Costa is a urologist at the Hôpitaux Robert Schuman. Photos: Provided by Hôpitaux Robert Schuman/Shutterstock. Montage: Maison Moderne

José Batista da Costa is a urologist at the Hôpitaux Robert Schuman. Photos: Provided by Hôpitaux Robert Schuman/Shutterstock. Montage: Maison Moderne

In April 2023, Luxembourg’s ministry of health presented four researchers with a grant that would allow them to conduct clinical research. Delano sat down with one of them--José Batista da Costa--to hear more about his research on the molecular profiling of cancer.

José Batista da Costa, a urologist working at the Hôpitaux Robert Schuman, grew up in Luxembourg, did his medical studies and residency in Paris, and carried out bladder cancer research during a postdoc in Vancouver, Canada. He then worked as an associate professor at a university hospital in France before returning to Luxembourg, where he “mainly” does clinical work.

“My focus point is more oncology,” he explained during an interview with Delano. “So bladder cancer, prostate cancer, kidney cancer. But from a research perspective, my interests are rather focused on bladder, mainly, and prostate cancer, because it’s a quite frequent type of cancer.”

What will the government grant help with?

The grant money coming from the government is not actually there to pay for the research project itself, said Batista da Costa. “It is money that is there to compensate the time you work on the research project. For instance, I applied for 20-30% working balance between clinics and research, which I kind of like,” he explained.

It’s quite nice to have this kind of equilibrium between research and clinical work
José Batista da Costa

José Batista da CostaurologistHôpitaux Robert Schuman

“When I spent one year in Vancouver, one of the things I quite missed was actually the clinic activity. I still like to see patients and operate, but it’s quite nice to have this kind of equilibrium between research and clinical work.” The grant will give “proper, protected time” to work on research projects.

The project itself: molecular profiling

The title of Batista da Costa’s research project is “molecular profiling of bladder and prostate cancer (MP-BPC): prospective cohort using tissue, blood and urinary samples in Luxembourg.” So what does all that actually mean?

“When you work in the lab, and you do work with cell lines, organoids [editor’s note: a mass of cells grown in a laboratory that mimics a particular organ] or even mouse models, anything that you produce, you can’t just go and apply it to the human being.”

This is where the cohort data comes into play. The data comes from patients in Luxembourg who are being treated for cancer, but the data collection doesn’t change the patient’s treatment in any way. All data is completely anonymised and complies with GDPR rules, said Batista da Costa. “It’s just data collection with tissue collection.”

“A cohort is nothing else than putting together patient data--with, in this case, tissue attached to it,” he explained. “Then you profile the patient’s tissue.”

Quality means good clinical data, good follow up data, and good tissue handling
José Batista da Costa

José Batista da CostaurologistHôpitaux Robert Schuman

Early diagnosis of tumours--using genomics, for example--is something that is getting more “in vogue,” said Batista da Costa. “The cohort is something that gives us something to work on, and it’s an investment also in the future.”

For instance, it could give researchers the possibility to check hypotheses and ideas. “They can go to the human tissue of patients who have been treated and look: is it true that this-and-this gene is overexpressed in that type of cancer? Yes, no. Is it true that if FGFR3 [editor’s note: a gene where mutations can lead to diseases such as bladder cancer] is hyper-expressed, the outcomes are bad or good?”

Such cohorts also enable participation in studies with other research groups, facilitating the exchange and improvement of knowledge, he added.

“One size doesn’t fit all”

“One size doesn’t fit all,” said Batista da Costa regarding potential real-life applications of his research. Patients might have cancer types and clinical characteristics that “look alike,” but then the clinical behaviour is “completely different.” A treatment that works for one patient might not necessarily work for another.

It doesn’t make sense to expose a patient to a potentially toxic treatment if, based on the molecular characteristics of their tumour, it will not be effective for their type of cancer. Looking at these molecular markers--not just tumour morphology or phenotype--will be important for treatment in the future. “It’s a long-term future investment,” Batista da Costa said of his research.

“Quality is the most important thing”

Luxembourg is a small country, Batista da Costa pointed out. “So you can’t really try to have huge numbers. And there, I find quality is the most important thing. Quality means good clinical data, good follow up data, and good tissue handling. And since in Luxembourg, it’s centralised over the LNS [Laboratoire National de Santé], that’s something that is quite straightforward to do. And at this point, I have to say I have had a lot of support from the LNS in elaborating this project.”

For the moment, it’s more of a project between Batista da Costa’s urology group and the LNS. The idea is to extend the partnership to the Luxembourg Institute of Health or the university, but all of that is right now “in the starting blocks.”

The collection, handling, transport, annotation and anonymisation of patient data and tissue requires an “entire infrastructure,” and there are still a few administrative steps before patients can start being included in the study. However, Batista da Costa said he’s hoping to “realistically” start doing so in the second or third trimester of 2024.

Research in Luxembourg vs other countries

Batista da Coasta also talked more broadly about the state of research in Luxembourg compared to countries like France, Germany, Canada or the US, where people working in clinics often have an affiliation to a research lab. These countries have a long history of research, and things are more “integrated.”

One learns from each other… it’s a team effort
José Batista da Costa

José Batista da CostaurologistHôpitaux Robert Schuman

But this is not the case in the grand duchy. “It doesn’t make any sense to have one researcher isolated in the hospital without a research group behind or with them,” he said. “One learns from each other. A basic researcher has no clue about clinics, as I have no clue about most wet lab work. It’s a team effort.”

Get out of the “Luxembourg is too small” mindset

That being said, there are a lot of projects going on in Luxembourg, in colon cancer for instance, and “there’s definitely a will, I think, politically, and also from people working here, to expand and improve this.” Batista da Costa gave the example of the NCTCR, the National Centre for Translational Cancer Research in Luxembourg, which is a project that aims to gather the country’s healthcare actors.

“We have to get out of this bubble of saying, ‘Well, Luxembourg is too small, [it] doesn’t make any sense to make research here,” he said. There are roughly 850,000 patients covered by Luxembourg’s Caisse nationale de santé [editor’s note: National Health Fund], which is about the size of a mid-level French city, many of which have university hospitals and research.

“You don’t necessarily need a huge volume, I find, if you can get quality and good cohesion,” continued Batista da Costa. Luxembourg is a small country where the connections are “short.” “I’m pretty optimistic in that regard.”

“The only thing I do regret is that in most countries, when you do research, you also do teaching. And I find that this goes kind of along. I do some teaching for the med students at, but that’s completely out of all these activities--it’s completely separate from my clinical activity and separate from the research activity, which I find is a shame.”

“Through teaching, you can also find people to come in and do research projects,” noted Batista da Costa. This would also be a way to attract people who have left Luxembourg because of a lack of research opportunities, as well as attracting foreign scientists.