Choosing a career in immunology means embracing a discipline in constant evolution. New diseases are being described, established ones reclassified, and the therapeutic landscape — from monoclonal antibodies to cytokine inhibitors and the adoptive cell therapies like CAR-T — is expanding at a pace that makes the specialty demanding, competitive and stimulating in equal measure. For physicians in training looking for direction, the most important question is: how do you build a foundation of knowledge solid enough to withstand whichever direction the field takes?
For Dr. Giulio Cavalli, there is no single answer. His own path proves the point: a medical degree and residency in Allergy and Clinical Immunology at Vita-Salute San Raffaele University (UniSR), then a PhD in the Netherlands, a postdoc in Colorado, a return to the San Raffaele campus as a physician-scientist and principal investigator, and finally a senior role in translational medicine in the pharmaceutical industry. A trajectory that maps what a career in immunology can become when driven by curiosity.
We interviewed Cavalli at «From Discovery to Impact», the Early Spring Meeting organised by UniSR in collaboration with Utrecht University and the Eureka Institute for Translational Medicine.
For Cavalli, the choice of specialty was not purely strategic — it grew through direct engagement with the subject and with daily clinical work. «I think immunology remains one of the most intellectually stimulating fields in medicine,» he says. «It is an area where research is constantly evolving, new drugs are continuously being developed and new diseases are being addressed with increasingly effective personalised treatments.»
Part of what makes clinical immunology so vast, complex and challenging is that the immune system does not respect organ boundaries. It interacts with every part of the human body. This means no medical condition is entirely independent of the immune system — not even brain diseases, contrary to what was believed until a few years ago. For physicians drawn to complexity, this is not a problem. It is precisely the specialty’s strength.
The residency programme in Allergy and Clinical Immunology is a four-year track covering the physiology and pathology of the immune system, advanced diagnostic techniques and the latest immunological and pharmacological therapies. What sets this training apart at UniSR, however, is not so much the curriculum as the context: residents work within the same environment where clinical research takes place.
Questions that arise on the ward when facing a disease that is difficult to diagnose or treat can become a research hypothesis. Laboratory results can influence clinical decisions. This continuous dialogue between patient care and scientific investigation is at the core of medical education at Vita-Salute San Raffaele University. And it is a skill that, as Cavalli explains, proves valuable well beyond residency. «At UniSR I had the privilege of training with outstanding physicians and scientists working on the immune system, which became my main scientific passion,» he recalls.
Learning to navigate clinical practice and research also means learning to manage a complexity that does not resolve on a set timeline. Diagnoses in immunology are often uncertain at first, treatment responses variable, biological mechanisms still being mapped. Developing the ability to work rigorously within this uncertainty is probably the most transferable skill a clinical immunology residency can offer, regardless of the professional direction one eventually chooses.
After completing his residency, Cavalli did not move straight into the pharmaceutical industry or translational medicine. He first devoted himself to clinical research. A PhD at Radboud University in the Netherlands, followed by a postdoc at the University of Colorado, gave him the tools to formulate original questions and develop the scientific independence that senior translational roles in pharma require.
Back at San Raffaele, he worked simultaneously as a clinician and as a principal investigator leading his own research group — a combination that defines the physician-scientist profile, increasingly sought after in both academic and industry settings.
Among his most significant contributions is the identification of the mechanism behind the massive cytokine release in Erdheim-Chester disease, a rare and complex inflammatory condition. By demonstrating that oncogene-driven activation of trained immunity in macrophages sustains pro-inflammatory cytokine production, his work opened new avenues for targeted treatment — translating a clinical observation into a discovery with concrete therapeutic implications.
It is precisely within this continuity between clinic and research that opportunities in the pharmaceutical industry also emerge, when the goal is to move candidate drugs from preclinical stages into early clinical trials.
Immunology has multiple options of career paths. It accommodates physicians who prefer to stay close to patients, researchers who want to work at the molecular level and professionals who aim to help design therapies that will reach hospitals in the future.
A few things are worth keeping in mind when choosing how to enter the field. Early exposure to both clinical practice and research — even before knowing which direction one will take — builds a foundation that is hard to acquire later. International experience, whether a PhD, a fellowship or a research collaboration, carries significant weight in both training and career development. And staying genuinely curious in a field that is still being written, year after year, is probably the most important thing of all.
For physicians considering a residency in Allergy and Clinical Immunology, the UniSR programme offers the kind of integrated training Cavalli describes as essential: clinical practice and biomedical research running in parallel, within IRCCS San Raffaele Hospital — the only Italian member of the European University Hospital Alliance (EUHA), a network of eleven leading university hospitals across Europe. A programme designed not only to train competent clinicians, but to prepare physicians capable of advancing immunology, whichever direction they choose to take.