July, 2024
July 2024
Blending Science and Compassion: Exclusive Conversation with ASCO President-Elect Eric J. Small
Jul 4, 2024, 11:33

Blending Science and Compassion: Exclusive Conversation with ASCO President-Elect Eric J. Small

The inaugural issue of OncoDaily Magazine had the privilege to feature an exclusive interview with Dr. Eric Small, the President-Elect of ASCO, hosted by OncoDaily’s Editor-in-Chief Dr. Gevorg Tamamyan, discussing Dr Small’s career and dedication to oncology, his motivation and experiences in prostate cancer research, emerging treatments, mentoring, and his vision for the future of cancer care, including his upcoming role as the president of ASCO.

Who is Eric Small?

Dr. Small started his academic journey by earning a Bachelor’s in Biology from Stanford University (1976-1980), followed by a medical degree from Case Western Reserve University School of Medicine (1980-1985). During 1982-1983 Dr. Small took Pathology Residency Training Program at the Case Western Reserve University. Then, he completed his residency in Internal Medicine at Beth Israel Deaconess Medical Center (1985-1988) before undertaking a Fellowship in Hematology/Oncology at the University of California, San Francisco (UCSF).

Before his present role, Dr. Small served as the chief of the UCSF Division of Hematology and Oncology for a decade. Dr. Small has been elected as ASCO president for the term spanning 2025 to 2026. He is an active ASCO Board of Directors member and leads four External Advisory Boards for other NCI-Designated Cancer Centers.

Throughout his career, Dr. Small has been deeply committed to advancing gender and ethnic equity in medicine. As chief of the UCSF Division of Hematology and Oncology, he focused attention on gender equity by expanding the faculty and promoting gender parity in leadership roles. Additionally, his commitment to addressing prostate cancer disparities among African American men is the basis of his research and community engagement efforts targeting underserved populations. Notably, Dr. Small co-developed the MERIT (Minority Enrollment and Recruitment into Trials) initiative, aiming to enhance inclusivity in clinical research for underrepresented groups.

Dr. Small’s impact on prostate cancer is profound, evidenced by his extensive publication record of over 430 peer-reviewed articles. His research primarily focuses on understanding the mechanisms underlying resistance to systemic therapy in advanced prostate cancer. Notably, his pivotal work led to the development and FDA approval of Abiraterone, an androgen signaling inhibitor (ASI), and apalutamide, a novel ASI.

Furthermore, Dr. Small established a prostate cancer metastasis biopsy program, supported by a $10 million grant, spanning six institutions. This initiative has yielded insights into prostate cancer subtypes and resistance mechanisms, guiding the development of targeted therapeutics and informing clinical trial strategies.

On December 13, 2024, Eric Small has been elected as President of ASCO. Dr. Small will assume the role of President-Elect following the ASCO Annual Business Meeting in Chicago on June 3, 2025.

On this occasion, Dr. Small said, “I am honored to serve ASCO as President to advance its mission of conquering cancer. The next decade will be undoubtedly pivotal for our profession. While we are well into an era of significant advances in diagnostics and therapeutics, cancer care providers are facing increasing administrative burdens and resultant burnout, and access to our tremendous advances is far from equitable, either at home or around the world. I look forward to helping ASCO rise to meet these challenges.”

Learn more about Eric J. Small on OncoDaily’sOncologist Near Me” initiative.

Read the interview below.

Eric Small

“Eric, your journey has been truly inspiring. Could you share with us what sparked your interest in oncology and led you to dedicate your life to this field?

In retrospect, Oncology seems like a natural choice. Just as it is today, at the time I entered the field, Oncology clearly was at the cutting edge of applied science. At the same time, I have always very much been a “people person”. I grew up in a multi-cultural environment – born in Mexico City to American parents, and grew up with friends from around the world.

So in addition to being a somewhat outgoing (some might say loud!) kid, being around people who were not necessarily from the same background as me became second nature. Oncology to me offered a career that blended the best of both worlds – an exciting scientific environment, and the opportunity to work with people.

I have always loved that oncology allows us to be highly focused on a specific problem, while retaining the view of the “whole patient”.

Your passion for prostate cancer research is evident. What drove you to focus your career on combating this specific type of cancer?

Unlike my decision to go into oncology, choosing GU oncology and in particular Prostate Cancer was serendipitous! During my fellowship in hematology and oncology at UCSF, I spent several years working in a lab. While I had done some laboratory research in college and medical school, I really wanted to immerse myself in molecular biology, to really understand the research that was already leading to important clinical discoveries. I happened to be working on a project on integrins (adhesion molecules), that at the time were known to be important in the behavior of some hematologic malignancies.

One of my presumed negative controls was a prostate cancer cell line, but it kept coming up as strongly expressing an integrin. Prior to that point integrins had never been described on a solid tumor. I attributed the result to what I presumed was my faulty laboratory technique, but long story short – it turned out not to be an error. The observation that adhesion molecules could be found on solid tumors got me thinking about the metastatic process, including adhesion and invasion, and in particular in prostate cancer! Once I began to focus on prostate cancer, I realized that there was very little known, either clinically or biologically, and it just snagged my interest.

Are there any new or emerging treatments for prostate cancer that you find particularly promising or exciting? And as you look to the future, what are your hopes and dreams for the advancement of prostate cancer research and treatment?

Absolutely! We have spent a long time working on understanding the processes involved in the development of resistance to androgen deprivation therapy. I was so fortunate to help develop a Stand Up to Cancer Dream Team which developed an incredible repository of biopsies of metastases that has provided rich information about the genomics of advanced disease, with a focus on the genome, transcriptome, and methylome. Now, using similar infrastructure, many groups are starting to study the proteome, and in particular the surface proteome.

As surface targets are discovered, there is a growing matrix of payloads that are being explored, including radionuclides, antibody-drug conjugates, and multi-specific antibodies that allow engagement of specific immune cell subsets. There have already been some very exciting breakthroughs, and our challenges will lie in developing the best combination of target and payload (and in an iterative process, to understanding the mechanisms of resistance to these approaches.)

Can you share any patient stories or experiences that have particularly resonated with you throughout your career? What advice would you give to patients and their families when navigating a prostate cancer diagnosis and treatment journey?

Wow- that’s a difficult question to answer, since there have been so many defining experiences! There are countless stories to tell, but I think of a time when I brought my then 11-year-old daughter in to work on a “take your daughter to work” day. A patient who I was seeing for a routine follow-up visit consented to having my daughter listen to my routine “review of symptoms” discussion with him. What I didn’t fully appreciate was that he was in the clergy, was a powerful orator, and found great satisfaction in speaking to his congregation.

He basically took over the meeting, sat me down, didn’t let me say a word, and proceeded to talk one-on-one with my daughter. He told her that if there were times when her dad wasn’t home at the end of the day as early as she wished, or if there were times where she wondered where I was, that she should know that I was helping patients like him in a really scary time. And he thanked my daughter for sharing me with him. Needless to say, there was not a dry eye in the room! I think of him often as a reminder that what we do as oncologists is not “just a job”.

For patients and their families navigating a prostate cancer diagnosis, I point out that the knowledge base that we now have about prostate cancer is orders of magnitude more than it was 10 or 20 years ago, that we are gaining new approaches and understandings in an exponential fashion. In 20+ years of being in the field, I have never been more excited about the advances and potential advances before us.

As someone who wears many hats – a clinician, a researcher, and an educator – what do you see as the biggest hurdles we face in treating cancer today?

Perhaps somewhat simplistically, I think of the many challenges we face as being on two sides of an equation: in the delivery of cancer care, and in the receipt of cancer care. On the delivery side, it is clear that as a profession, we are facing unprecedented pressures.

There is a substantial oncology workforce shortage globally, and it is expected to become worse. When you ask, burn out amongst our peers is not primarily due to caring for cancer patients, it is largely due to how difficult our health care systems have made it for us to care for our patients.

In the US, the corporatization of medicine (and oncology is certainly no exception) has the potential to result in an alienated workforce, contributing to burn out. I think one of the more powerful antidotes to burnout is the nourishment that comes from our relationship with our patients – I worry that in many systems the primacy of the partnership between patients (and their loved ones), and their oncology health care teams is being eroded in the name of cost-effectiveness or efficiency.

On the receipt side: the amazing advances in cancer care that we are witnessing may in fact be heightening inequities, nationally and globally. Ensuring that the benefits of the molecular, immune, and data science “revolutions” are not confined to large academic medical centers in high income countries needs to be a priority for us.

Can you recall a moment in your career that stands out as especially memorable or fulfilling?

I’m not sure there is a single moment I would identify – I feel so fortunate to have had the opportunity to pursue a career doing what I love, surrounded by inspiring colleagues, and entrusted with the privilege of taking care of patients with cancer.

Your commitment to mentoring is very well known. What pearls of wisdom do you have for both young and senior oncologists?

We all stand on the shoulders of those who came before us. Consequently, we all have a responsibility to offer a helping hand to those who will come after us! I really do think that the defining characteristic of a great mentor is generosity. For some people, it comes naturally – we all know those genuinely kind people – and for others it needs to be a concerted effort.

And that’s OK! We may not all have those automatically generous responses imprinted in our DNA – in fact, it is probably epigenetically modified OUT of our instincts by the nature of our training and career advancement expectations! Consequently, it takes a conscious effort – and this holds true at every level of our careers – to stop and make a specific decision to provide someone an opportunity, even if it means a diminished opportunity for ourselves. When anyone I have advised or mentored thanks me, I tell them that I have only one requirement of them: that they pay it forward.

You like to say, “kindness always gives back”. Would you, please share a story related to this expression?

While I may have said “kindness always gives back” the phrase “kindness matters” feels a little less transactional! I guess this is a good rule for life, but it’s especially true if you happen to work in a competitive environment, where getting ahead at all costs is often rewarded. I don’t think academic or professional advancement in oncology is mutually exclusive of being kind.

What is leadership for you?

A leader helps define and articulate a shared common goal, and then helps people achieve their full potential in striving for that goal.

In one of your favorite books, “Dare to Lead” by Brene Brown, the author cites the expression from the Amy Poehler’s web series “Smart Girls: Ask Amy”, which says “It’s very hard to have ideas. It’s very hard to put yourself out there, it’s very hard to be vulnerable, but those people who do that are the dreamers, the thinkers, and the creators. They are the magic people of the world”. What’s Eric Small’s vulnerability?

Wow, this is a tough-hitting interview! Let me start by saying that I have far more than just one vulnerability! It’s very kind of you to ask about just one!

That said, as it pertains to your earlier question about leadership, because my leadership style is inclusive and supportive, I tend to shy away from difficult conversations. I work on acknowledging and articulating that difficulty even as I embark on the discussion. It’s a work in progress!

Who is the role model for you? Both in personal and professional life.

My role model, as for many, I suspect, has been my parents. Both, in their own way, made it very clear to their three sons that since we are given but one life, that we should use it to do everything we can to make a meaningful difference for others. It informs everything I do.

What are the top 3 books and movies you would recommend to read and watch, respectively?

Books: “Dare to Lead by Brené Brown”, “One hundred years of solitude (Cien Años de Soledad) by Gabriel Garcia Marquez”, “Caste: The origins of our Discontents by Isabel Wilkerson”.

Movies: “Roma”, “Everything, everywhere, all at once”, “Nomadland”.

Do you consider yourself an optimist or a realist?

Unabashed optimist.

Outside of your professional life, what are your hobbies or interests that help you maintain balance and well-being? Say, I don’t know… pastries and pets?

Well, you do have a good sense of me. I love to bake. While I have always done some baking, during the pandemic, I upped my game. While I enjoy making cookies, especially for people in my clinic, I especially like baking bread. Never really gravitated to sourdough which a lot of people seem to have done during the pandemic – instead I like enriched breads, like Mexican sweet bread (Conchas), Brioche, Portuguese/Hawaiian sweet bread, even tried my hand at Croissants.

I also love hiking. Living in San Francisco there are many opportunities near me, but if time is short, I walk the hills of SF! And yes, I am a bit of a cat lady, currently with 3 in the house!

What motivates you to continue your work in oncology, and how do you stay inspired during challenging times?

For me it’s pretty easy – when I am feeling overwhelmed, I put myself in the position of one of my patients or their loved ones. I think many of us have been touched in one way or another by cancer, or know someone who has, and how devastating it is.

I want to do my small part to attack it. That helps put things in perspective for me.  I think that taking care of cancer patients is almost a sacred privilege – we are being entrusted with the care of a patient (and their loved ones) at their most vulnerable time. It is so easy to forget in the middle of our busy clinical lives, and so easy to just revert to being purveyors of facts (“we will use regimen X that has a Y% chance of shrinking the cancer”), as opposed to purveyors of hope. Even in patients in the terminal phases of their disease, there are hopes and fears to address.

Please, could you tell us about your family? How do you make sure to dedicate enough time to the family?

I am the proud father of two adult daughters. Both have chosen to make the SF Bay Area their home, so I am fortunate in being able to see both relatively often.

My youngest daughter Sarah is a recent Law School graduate, who is working for a community organization doing grass roots environmental law.

My older daughter Rebecca is a Nurse Practitioner in women’s health. That they have chosen careers where they have direct impacts helping others makes me immensely proud.  I have separate rituals with each, where we routinely get together for whatever the event might be. These include food, hiking, and cats!

Eric Small 20 years ago and 20 years later …

Amazingly enough, 20 years ago I served as the ASCO Scientific Program Committee Chair, and was the founding chair of the ASCO GU (then Prostate Cancer) Multidisiciplinary Symposium. It was really my first real insight into what a spectacular organization ASCO was!  20 years hence? Don’t know! Maybe will have reinvented myself once or twice!

Finally, the elephant in the room. You are the president-elect of ASCO for 2025-2026 term. Without disclosing too many exciting details, how do you envision ASCO during that one year of your presidency?

Fortunately, I have my president elect year (June 2024-June 2025) to further develop the theme for my presidency year (June 2025-June 2026), but I know I want it to reflect both my conviction that translation of scientific discovery is essential to our progress, and, reflecting my growing up in Mexico, ASCO’s commitment to global impact.

I am beyond excited to have recruited two Program Committee Chairs for the annual meeting that will reflect these core beliefs: Dr. Jo Chien is a talented translational clinical breast oncologist from UCSF who has agreed to serve as Scientific Program Committee Chair, and Dr. Erika Ruiz-Garcia who is an educator, and a translational scientist and clinical investigator in GI oncology, from the National Cancer Institute of Mexico, in Mexico City, who has agreed to serve as Education Program Committee Chair.”

by Gevorg Tamamyan, the Editor-in-chief of OncoDaily, Chairman and Professor of the Department of Hematology and Pediatric Oncology at Yerevan State Medical University, CEO of the Immune Oncology Research Institute, President-Elect of the International Society of Pediatric Oncology Asia Continental Branch (SIOP Asia) the Pediatric Oncology East and Mediterranean (POEM) Group.