Beyond the Cancer Diagnosis: Dialogue with Alicia Zhou, Hosted by Adrian Pogacian

In the current episode of ‘Beyond the Cancer Diagnosis’, Adrian Pogacian approaches the challenges and opportunities within cancer research with Dr. Alicia Zhou, CEO Cancer Research Institute.

Dr. Alicia Zhou, PhD, serves as the Chief Executive Officer of the Cancer Research Institute (CRI), a premier global nonprofit driving transformative advances in cancer immunotherapy. Under her leadership, CRI is at the forefront of harnessing the immune system to fight and ultimately cure all cancers.

Before joining CRI, Dr. Zhou was the Chief Science Officer at Color Health, where she led initiatives to improve patients’ access to cancer prevention and screening towards better patient outcomes and population health. Additionally, she played a key role as a Steering Committee member and Principal Investigator for the National Institutes of Health (NIH)’s All of Us Research Program. This landmark initiative aims to ensure equitable and accessible precision medicine for all Americans.

Dr. Zhou’s exceptional leadership and contributions were recognized in 2021 when she was named one of San Francisco Business Times’ 40 Under 40 and featured on Fierce Healthcare’s Most Influential Minority Executives List.

Dr. Zhou holds a B.S. in Biology from the Massachusetts Institute of Technology, a Ph.D. in Biological and Biomedical Sciences from Harvard University and completed her postdoctoral research in cancer biology at the University of California, San Francisco.

Adrian Pogacian, MS Psychology, clinical psychologist with executive education in Psycho-oncology, holding a degree in Global Health Diplomacy from Geneva Graduate Institute. Currently, researcher and associate lecturer with focus on Impact of Cancer Diagnosis on Couples and Families, Communication in Cancer Care and Posttraumatic Growth. His expertise is on Coping with Cancer and managing Fear of Recurrence.

Additionally, Founder of INCKA Psycho-oncology Center, Host of Beyond the Cancer Diagnosis Interview Series as well as Writer and Host Content in Psycho-oncology at OncoDaily.com, co-author of the first Romanian Multimodal Care Guideline in Pediatric Onco-hematology, active contributor to the International Psycho-oncology Society, presently IPOS Fear of Cancer Recurrence SIG member and IPOS Early Career Professionals in Psycho-Oncology Committee founder member.

Adrian Pogacian: Hello everyone, nice to meet you again to a new edition of Beyond the Cancer Diagnosis interview series. Today is my pleasure to welcome Alicia Zhou, the new appointed CEO of Cancer Research Institute. Alicia, nice to meet you, thank you for joining us today.

Alicia Zhou: Thank you, thank you for having me.

Adrian Pogacian: And being the new appointed CEO of such an important institute, our discussions will be related more with challenges, but also the opportunities that cancer research has or should have in this world out of balance, as I like to mention. But before this, before to enter on the discussion, I would like you briefly to describe the history and the mission of the Cancer Research Institute for our audience and also your vision as CEO for your mandate.

Alicia Zhou: Yeah, thank you. Yes, the Cancer Research Institute is an amazing organization. We are a non-profit organization that globally funds cancer research.

We’ve been around for about 70 years, so we have a very long legacy. And specifically, we have been at the forefront of fundings and the basic research that has gone into the development of immunotherapy and immuno-oncology as a field. And so actually, if you look back at some of the work that we funded, we funded some basic immunology questions.

Certainly we fund a lot of the translational work and we’re very proud to have been there at the forefront as the immunotherapies became first-line therapies for a lot of cancers that are treated today. So our mission is very much to fund the research that helps to drive innovation. We always talk about CRI as having three major pillars, people, biology, and data.

The way we think about that is we fund scientists, the people, instead of projects. And that’s the thing that’s very unique about the way we fund. We really invest in our investigators.

We believe that they are going to be the ones to have the next breakthrough discoveries. Of course, we believe deeply that the biology is where the questions really need to be answered. And especially in the space of therapeutics, I think we have to really think about how we go back to the basic mechanism, the biology, really deeply understanding how cells interact with one another and how that is perturbed by different types of drugs.

And then data is a new sort of cutting edge where the field is going. I think in general, life sciences is seeing that data-driven discovery is the future. And so instead of having sort of the hypothesis-driven world that we’ve all come from, we are seeing now that a lot of new innovations are really coming through data-driven, data mining, large data sets with advanced computational methods like machine learning and AI being used to help derive novel insights.
And so that’s really sort of the mission for CRI. And for me, I’m very excited to help bring this organization into that data-driven era.

Adrian Pogacian: You mentioned immunotherapy as a focus point of your activity, of the Institute activity. Nowadays, from a psychological perspective or my field of expertise, it is very difficult for patients to understand that majority of disease and especially cancer can come from, as you mentioned, biology, molecular immunotherapy, because they were used like the classical medicine to go to hospital, to the common symptoms. And since our title of the interview is challenges in cancer research, could you mention them or at least the most important?

And also, if there are challenges, for sure there are opportunities also.

Alicia Zhou: Yeah, yeah, of course. This is such an interesting question, right? Because I think on the one hand, I think all the problems that are solving are probably hard problems to solve, right?
And so I think challenges are kind of built in to breakthrough research. So let’s think about this. I think there’s a couple of different places to think about on the research side.

To your point, I think it can be difficult to connect the work that we do at the bench side, which feels very technical, very biology-driven, and figure out how to communicate that to the end user, the patient, the doctors. I think that oncology is the space we’re seeing the most promise for precision medicine. And in fact, it’s probably the space in which we’ve seen the most breakthroughs in precision medicine.

But that also means that we’re seeing quite a lot of new therapies coming to market. And so if you’re a patient, it’s a very large menu to choose from. And I think that can be very hard as a patient to feel like, oh, there’s dozens if not hundreds of agents that might be useful for treatment of certain types of cancer.
And then they come with different side effects. They come with different efficacy. And so I think that deluge of information can be quite challenging for a patient.

And I think even for the oncology community, the doctors themselves can sometimes feel like there’s too much to choose from. So I think in that aspect, I think it’s really important for us as an oncology community to start to help each other defragment the space. We don’t want to continue to sort of splinter off and have more and more sort of subcategories, companies popping up everywhere.
I think that’s actually going to hurt the space and it’s also going to make it harder for the patient. So I think it’s really important to help bring that back together. What’s the opportunity?

I think the opportunity is that we start to treat cancer patients more holistically, right? I think then we’re less talking about identifying a tumor, a mass, sequencing it, doing some molecular targeting or molecular profiling, and then finding specific drugs. I think now we’re talking about sort of being able to treat that person’s disease holistically in their body.

So instead of thinking about it as, oh, okay, this is breast cancer because it was detected in the breast, we’re actually thinking about what is the molecular signature of that tumor and how can we treat that tumor? And so I think there’s a real opportunity to sort of reframe the way we treat, diagnose, and cure cancer when we think about it in this more holistic way, in this more sort of molecular way, actually, rather than necessarily the way that we’ve always thought about it.

Adrian Pogacian: You mentioned holistic healthcare and about the partnership between patient and healthcare providers.

And a world free of cancer is a statement from some time now. A world free of cancer means multidisciplinarity or an integrated healthcare team with the patients and healthcare team, medical staff, the system. Where do you see the role of Cancer Research Institute in this, let’s say, team?

Alicia Zhou: Yeah, that’s a great question. I mean, I think that what the unique role that a nonprofit organization provides in this space is that we can be a convener, right? And so going back to what I said on the previous challenges, we are seeing more fragmentation in this space.

I think that Cancer Research Institute and nonprofits in general, our role is actually to help convene, help to defragment, help to hopefully deduplicate work and efforts in such a way that actually sees us accelerating the pace of innovation and the pace of discovery. So I think that’s one place. I think, let’s talk about immunotherapy, which is an area where Cancer Research Institute has been very deeply involved and invested for several decades.

This is a space where we know that immunotherapy becomes a part of treatment plan, depending on what the original diagnosis is. That treatment plan also includes things like surgery, radiation, and standard chemotherapy. And so it’s really important for a doctor, as well as a patient, to really understand, you know, what is the set of medications and interventions that we’re going to use in order to treat your cancer?

I think that’s really important. The partnership piece is really important. What’s really interesting is that we know that there are a lot of psychosomatic effects, right?

And if a patient can come in with a good attitude, ready to fight and ready to win, they’re more likely to have better outcomes than someone who’s coming in already feeling like they’re losing a battle. And so that’s really important. I think for us, our goal is to ensure that, you know, that oncologist and that patient, that team has the best tools at their disposal, the best medicines that can help treat and cure cancers.

And so that’s really where we point ourselves when it comes to helping the space.

Adrian Pogacian: You mentioned space. Space, it’s one of the issues that oncological patients fight, fight for or fight with. We as psycho-oncological specialists, we learn that the first needs of the oncological patient is to provide hope and time.
And now I would like to ask you two questions. First, as a person, Alicia, and the second one as specialist, but to start with the first one, how you define hope as a person, Alicia, who enter in contact with many oncological patients?

Alicia Zhou: Yeah, yeah, this is a great question. So I would say this. I think that cancer is a disease that when you first think about it is very, very scary.

And I think a lot of patients when they first hear about a diagnosis of cancer, they immediately think of the potentially the worst outcomes. But the reality of the situation is that for many cancers, the earlier we can detect it, the more likely it is that we are going to have great outcomes for that patient. So I think hope is really helping to frame the reality for a patient, right?

And to help someone understand that cancer is a disease that now we have a lot more specificity and treatment for. And in fact, for example, breast cancer, which is a very common cancer within women, we know that if you’re diagnosed in stage one breast cancer, your chances of survival are greater than 90%. And that’s great.
That’s amazing. And so I think that’s the thing that we have to be able to hold on to. Because I think sometimes patients, as soon as they hear the word cancer, they become very afraid.

And as a result, I think some people actually kind of don’t go to the doctor or don’t ask the question, they wait until the symptoms are too hard to ignore or are too painful. And that’s the reason they go into a doctor and ask if something is wrong. And the reality is if you’ve waited that long to get diagnosed, that’s likely to be later stage and it becomes much harder for us to treat and cure.

And so I think it’s really important for patients to understand being proactive and not being scared of that diagnosis, but realizing you have power in this decision. You have power in this timeline. The more quickly you get yourself or the more regularly you get yourself to the doctor to get your preventative treatments and screenings done, then this becomes a disease that becomes very manageable.

This becomes a disease that is not so scary. And so I think hope is recognizing that you have a role to play. You, the patient, have a role to play and that you’re not completely, you know, just left to the devices of specialists and a disease that you have no control over.
And so I think that’s what’s really important, the agency that the patient has.

Adrian Pogacian: The oncological patient doesn’t have time. This is his first or her first reaction. When the oncological diagnosis comes, this is the first reaction.

I don’t have time. And now to get back to the question as a specialist in immunotherapy, as a doctor, do you agree with this statement that there is no time? Generally speaking, not on specific cases, but generally speaking.

Alicia Zhou: This is a great question. So I guess I would answer this in two ways. I think there’s time is very important when it comes to a diagnosis.

Let’s talk about two different ways to think about time. One is how much good time do I have left? And this is a question that comes from this fear of maybe this is a terminal diagnosis.

Maybe this means that I’m not going to be able to do all the things that I hoped I would be able to do. And obviously this depends on what type of disease you’re diagnosed with and at what stage. But I think it’s really important for folks to not get into that kind of immediate mind trap of thinking about, oh, this is going to be a terminal diagnosis.

Again, going back to the concept of the psychosomatic effects, I think a person who’s able to come in feeling like, they’re going to beat this regardless of the odds. I mean, this is well studied. Those patients do much better than the ones who come in feeling like they have nothing to fight for.

And so it’s really important for the patient to feel that they have time and that they want to fight for that time. On the flip side, I think one thing that does happen and is important to call out is that sometimes when patients are diagnosed with cancer, their immediate thought is, I need to get as many great second opinions as possible, right? And then they’ll start to ask for friends to make referrals, potentially go and wait to see another specialist.

They might go to a couple different hospitals. And here I would say time is very important. Time to treatment, time from diagnosis to treatment is really important.
And so there, I would say, make sure you recognize, understand that time is of the essence, that time is not free. And so I think I sometimes advise patients and friends who come to me and they say, should I go get another opinion? And my answer often is no, because that’s going to take more time and you do not want to waste any time to getting your treatment.

So unless it’s a really complicated diagnosis or your first oncologist is saying, I’m not really sure what to do here, then yes, go get another opinion. But otherwise trying to wait to get two or three more opinions to see a couple more specialists, that’s the time that the cancer might need to potentially progress or grow. And so it’s really important as soon as you have a diagnosis to proceed with treatment.

So I think, I think both of those things are true about time.

Adrian Pogacian: Also with, also related to time, we discussed about, and you mentioned second opinion. I always, with every occasion, said this, that it is very important for patients to search information from reliable sources, because especially in IA, adolescents, young adults, where are a lot of changes in their emotion, their behavior, maybe it is a shame to ask for proficiency advice. So I always said this, that they should, everybody should look for reliable sources to be sure not to talk with friends, as you mentioned, to lose time.

Maybe the information is not correct. So instead of helping, it goes worse. And I guess this is one of the consequences of our chaotic life that I can say.
And this chaotic life, it’s not made, but it’s due to technological advances. And in the field of oncology, we are talking now only about digital intervention, e-health, artificial intelligence. Are these technological components or instruments useful in your activity at Cancer Research Institute?

Alicia Zhou: Yeah, I mean, I think in general, this is the future of healthcare is going to include digital health. I mean, I think even bigger than that, the future of our lives includes a digital component, right? This is true about everything that we do, whether that’s work, whether that’s the way we do our consumer shopping, whether it’s the way we do our banking, everything has been taken into the world.

So yes, of course, there’s a digital revolution coming for healthcare as well. I think that what the digital revolution can really help us with is I think there are, in many ways, it can break down barriers of access. I think that some of the things that currently exist today in terms of, you know, you only get really good care if you are geographically located close to one of these large, well-funded academic medical centers, and you get less good care if you’re in a rural setting, or if you only have access to community clinics.

This type of disparity in access is the type of thing that can be ameliorated by the digital revolution, by having digital health. So I think this is super important. And there’s obviously a component of healthcare that requires in-person care, right?
At the end of the day, there’s going to be a piece of it that requires a doctor to have eyes on a patient and to actually be able to have hands on that patient as well. And I think in oncology, that’s very true. But I think this is the world that we’re moving towards in every aspect of our lives, and certainly in healthcare, is a hybrid world where you’re going to be able to try to accomplish as much as you can at the convenience of the patient.

To our earlier question about time, I think digital platforms are going to help decrease the amount of wait time that a patient might have between seeing specialists or between having scans done or being evaluated for intervention. So I do think this is super, super important. On the research side, we know that using advanced machine learning methodologies is going to transform the way discovery is done.

And in fact, this year’s Nobel Prize in Chemistry went to AlphaFold, which on the one hand, there was a true sort of chemistry prize given. And on the other side, it was actually a compute prize, really, because it was a prize for the algorithm that was able to accelerate the pace of discovery for protein folding. So it’s here, the digital revolution is here, both on the treatment side and on the research side.
And so I think we have to embrace that.

Adrian Pogacian: After this explanation, I have to ask this. Also, because I saw it on Cancer Research Institute website that you put patient first, and you developed very nice, the issue of new technologies. Do you think that the meaning of life is changed?
Or will it remain the same in this technological life that we expect? Because this is the main, let’s say negative impact of technologies from the point of view of psychological issues. Because what happened with the meaning of life of patient?
If we are going too much on artificial intelligence, on digital, digital has the potential to change its meaning of life?

Alicia Zhou: Yeah. That’s a great question. I mean, so I guess there’s a couple of ways I would answer this.
I think that if you think about digital as a tool and a platform, I think that there are in many ways, the ability for us to improve and to add to a person’s definition of meaning of life, in that there’s a world in which we can all leave behind a legacy, a digital footprint, a digital legacy. And I think you’ll see there are a lot of rare disease, terminal disease patients in the world who have shared their stories up until the last minute, because they were able to access a digital platform in a way that allowed them to share their stories. And I think that’s been very touching.

I think that it’s been very useful for that patient, probably a nice way to release their emotions and share it with the world. And certainly has brought a lot of awareness to all sorts of terminal illnesses and rare diseases. So I think on the one hand, I think it’s been a great platform actually for patients to really capture the meaning of life, right?
And to leave behind a legacy. It’s much more accessible than like writing a book or telling a story to your family. So that’s on the one hand.

On the other hand, I think that it can be a complete time suck, right? We’ve all fallen down the digital rabbit hole of spending too much of our time idling on the internet. And so I think it comes down to an individual’s ability to interface and control their digital consumption.

And so I think to the extent that you’re in the driver’s seat, I think it can augment your meaning of life. To the extent to which you’re in the passenger seat and you’ve given over the driving seat to the internet, then it can really suck away from that. So I think you have to have agency.

Adrian Pogacian: Since we don’t have much time, I would like to ask you like the last questions from your position as CEO of Cancer Research Institute. How you see the future of cancer research in the next decade? Start with what we mentioned during this interview.

Alicia Zhou: Yeah, I mean, I think absolutely the next 10 years of cancer research is going to be accelerated by machine learning and AI. In order for that to be true, it has to come from a foundation of data because that compute powder has to be put on top of really good data. And so I think what’s really important is across all life sciences, you’re going to see investment in data generation and then subsequent investment in compute to be able to mine that data for insights.

So I think that’s definitely going to be true. I think the other piece of cancer research is I do think that the future is going to see us be more collaborative and less siloed in the work that we do because what we’re discovering is that when you perturb a system, even though you think you’re perturbing it in isolation, there’s knock-on effects on all the other systems because, of course, a human holistically has many different feedback mechanisms.

And so with that in mind, I think right now, the way cancer research is a little bit siloed into sort of molecular therapeutics, immuno-oncology, and the folks who are actually doing radiation therapy and innovations on that side are separate from the people who are thinking about diagnostics. I think in general, this space is going to become more collaborative, less fragmented, just simply because we’re going to realize that all the work that we do actually has effects on everybody else in the field. So I think those are the two big things you’re going to see.

You’re going to see more collaborative science and you’re going to see very accelerated data-driven discovery.

Adrian Pogacian: Of course, putting the patient first.

Alicia Zhou: Of course, always, yes.

Adrian Pogacian: Thank you very much, Alicia, for being with us today. Thank you for your very interesting opinion. Good luck in your new position and good luck to Cancer Research Institute to provide as many outcomes as they do and they will do in the future.

Thank you very much.