The future of cancer treatment and immunotherapy with researcher Dr. Alicia Zhou

0:00With no fees or minimums on checking accounts, it's no wonder the Capital One bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how most Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends, it's pretty much all he talks about. In a good way. What's in your wallet? Terms apply. See CapitalOne.com slash bank. Capital One N.A. Member FDIC. Support comes from WISE, the smart way to manage the currencies you need around the globe. Fed up with losing out to hidden fees when you send money abroad with your everyday bank?

0:39Choose the smart way. WISE, you can count on the exchange rate you'd usually find on Google. No unwelcome surprises. Plus, ditch that where's my money feeling. Most transfers arrive in under 20 seconds. Join millions, saving billions on hidden fees. Be smart. Get WISE. Download the WISE app today. T's and C's apply. This episode is sponsored by Quince. This time of year, I tend to keep cooking really simple, lighter meals, fresh ingredients, and quick dinners that don't require a lot of planning. Lately, I've been cooking with Quince, and I've genuinely loved how thoughtfully made everything feels.

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1:53Elevate your kitchen this summer. Go to quince.com slash TEDHealth for free shipping on your order and 365 day returns. Now available in Canada too. That's quince.com slash TEDHealth for free shipping and 365 day returns. quince.com slash TEDHealth. This is TEDHealth, a podcast from TED, and I'm your host, Dr. Shoshana Ungerleiter. Lately, I've been reflecting on how cancer exists in two places at once. It exists in research labs and clinical trials, and it exists at our kitchen tables and late-night internet searches, in those quiet moments when we wonder what our family history might mean for our own future, or in the hard work that comes with the daily struggles of diagnosis and treatment.

2:45For many of us, cancer isn't a distant concept. It's woven into our personal stories. It may be a parent's diagnosis, a friend's biopsy result, or a genetic test that reframes how we think about our bodies and even our time. As a physician, I see how those experiences shape the way people move through the world. As a daughter and a member of a family carrying our own histories with cancer. I feel it too. At the same time, we're in an extraordinary era of possibility in medicine. Artificial intelligence is reshaping research. Immunotherapy is turning once-fatal cancers into chronic and treatable conditions.

3:27Data is flowing at a scale that would have seemed impossible just a decade ago. It can be hard to hold both realities at once. the deeply human fear and uncertainty that comes with cancer, and the breathtaking promise of science. But today's guest works at that exact intersection. Dr. Alicia Jo is the Chief Executive Officer of the Cancer Research Institute, one of the oldest nonprofits in the world devoted exclusively to cancer immunology and immunotherapy. She stepped into this role in August 2024 and is guiding CRI into a new chapter focused on expanding access to cutting-edge immunotherapies and building data infrastructure.

4:10Before joining CRI, Dr. Jo spent nearly a decade at Color Health, helping translate genomic science into real-world tools for cancer prevention and screening. She trained at MIT, Harvard University, and University of California, San Francisco, and along the way built a career that bridges molecular biology, big data, and patient impact. In our conversation, we'll explore how cancer care is changing right now, how AI may help us make faster, smarter moves, and what all this means for the listener who just wants to protect their own health and the people they love. Here's my conversation with Dr.

4:47Alicia Jo. Dr. Alicia Jo, welcome to TED Health. Thank you so much for having me. I'm so excited to be here. So you first became interested in cancer biology as a teenager in a research lab, I read. And now, yeah, you now you lead one of the world's leading immunotherapy organizations. So when you reflect on that journey, what has stayed constant in your motivation and what feels newly urgent at this moment? My career came in what I would say is a very organic way in that I think I just fell deeply in love with biology when I was in high school. It was just sort of the most mind-blowing and mind-opening thing to learn about the science of life and how we all exist.

5:32and to do so at a time when suddenly we were having tools that would allow us to deeply understand sort of the underpinnings of that with understanding molecular biology and DNA and RNA and protein and how does that all translate to how cells work. It just became this really fascinating topic for me. And so I sort of fell in love with biology and immediately asked myself, how do I apply that passion towards an area where I felt like I could make the most impact? And today at the Cancer Research Institute, our focus really is in the field of immunotherapy, which is this idea of how do we activate your immune system to treat cancer, which really is kind of a science fiction idea when you really think about it.

6:16The idea is that your immune system exists to keep you healthy. It's always vigilant to make sure that if you ever are seeing a bacterial infection or a viral infection, it immediately responds. It helps you make sure that you are sort of getting rid of those pathogens. And it happens all the time. And the question is, can we do that same cycle? Can we activate that same pathway for cancer? And we had our first immunotherapy approval of a drug. And it turns out we can activate the immune system, and then the immune system will go after the cancer. It's become this amazing category of treatment that we have today now.

6:56And I think where the urgency really lies is that we know that when it works, it really, really works. And in fact, for some patients, like folks who have metastatic melanoma, these are patients that previously would have had a very low chance of survival. You know, talking about in the low teens, five-year survival rates. And stage four melanoma, we're talking about potentially just a couple months or maybe a couple years left in their lifetimes. Today, I know several patients that participate in that original immunotherapy trial. They are now in 20 years of survivorship and are thriving, right?

7:33And so that's the outcome that we can imagine with this category of treatment, but it doesn't work for everybody. And so there's a real urgency to understand why and how can we make it work better? That's incredible. And that sense of urgency really comes through. And I want to make sure everyone's on the same page about the science behind your work. You mentioned a little about immunotherapy. For someone who does not maybe follow the medical journals, how is immunotherapy fundamentally different from chemotherapy or say radiation? Yeah, that's a great question. So we have really four different ways that we treat cancers today, starting with surgery.

8:10Obviously, if we have a solid tumor, surgery is really the first place we go. And that's really just about finding that mass and cutting it out. And then usually after that, then you're looking at radiation chemotherapy or immunotherapy as your options. So with radiation, what we're doing is we're taking very high-powered radiation beams, and we're actually targeting them towards the cancer cells. The way that that works is that those really high-powered beams actually create a lot of DNA damage, and in doing so, it causes those cells that have been subject to that radiation to self-destruct. So it works really well, but it also works on all cells.

8:45So it works on the cancer cells, it also works on your normal cells, And so we have to be really careful and thoughtful about how we target that radiation treatment so that it's really only going after the cancer cells and we're trying to not get as much normal tissue along the way. Chemotherapy is actually really interesting. The whole thesis of chemotherapy is let's go after cells that are dividing really fast. And in this case, that's the cancer cells. And then hopefully it'll leave behind or not affect the cells that are dividing more slowly, which are the normal cells. Again, this generally works, although there are other types of fast-dividing cells in your body, like your hair follicles and your gut intestine, which both are turning over very quickly.

9:21And so when you have chemotherapy, a common side effect is that your hair might fall out or you might experience nausea and other gut symptoms. And it's because we're targeting these fast-dividing cells, irrespective of whether they're cancer cells or normal cells. Immunotherapy is, the best way to describe it is, we're not treating the cancer, we're treating the immune system. So what we're actually trying to do here is we're not trying to target the cancer cells per se with our drug. What we're trying to do is we're trying to target the immune system with our drug. And what happens is that when cancer is growing in your body, it actually starts out as a normal cell.

9:55And at some point over the course of accumulating many mutations over time, that cell becomes a cancer cell. And it starts to grow and proliferate uncontrollably. It starts to invade into other tissues. But it did start out as a normal cell. Your immune system is programmed to not attack itself, right? That would be autoimmune diseases, and you don't want that to happen. So for the most part, your immune system tries to look at everything around it and say, okay, you are self. I'm not going after you. I'm here to go after foreign pathogens that are coming from the outside. So what happens with cancer is that it can actually stay hidden for a really long time from your immune system.

10:31It's developed this way to say, oh, don't look over here. I'm normal. You know, I'm just self. Don't try to come after me. And so the way immunotherapy works is actually we've learned that there are certain proteins and cellular pathways that these cancer cells use to sort of hide from the immune system. And if we block that ability for the cancer to hide, suddenly the immune system is like, oh, wait, hold on. Like, you're here and I need to come after you. And so that's actually sort of the category of immunotherapy that has been developed that is most utilized are these immune checkpoint inhibitors.

11:02And what they do is they actually kind of unblind the immune cell so that they can see the cancer cell. And so that way the immune cell can go after the cancer cell. So fascinating. I love the way you described that. More on my conversation with Dr. Alicia Jo after a quick break to hear from our sponsors. This episode is brought to you by Peloton. There's a particular kind of joy that comes from a really good workout. When your body feels free, your mind clears, and you remember why movement matters. Peloton built the Cross Training Tread Plus, powered by Peloton IQ, to help you find that feeling more consistently.

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12:26With no fees or minimums on checking accounts, it's no wonder the Capital One bank guy is so passionate about banking with Capital One. If he were here, he wouldn't just tell you about no fees or minimums. He'd also talk about how most Capital One cafes are open seven days a week to assist with your banking needs. Yep, even on weekends, it's pretty much all he talks about. In a good way. What's in your wallet? Terms apply. See CapitalOne.com slash bank. Capital One N.A. Member FDIC.

13:09you know i know you mentioned melanoma but beyond that cancer type what developments in immunotherapy today give them realistic hope that we're headed in the right direction here Yeah, there's so many new categories of immunotherapy treatment that have been under development over the last decade. This immune checkpoint category is the most commonly used immunotherapy today. Melanoma is one of the first use cases that we saw it in, but it's also used very commonly in lung cancer, in colorectal cancer, and actually in many, many cancers. Today, there's about 30 cancer types for which immunotherapy is an approved therapy.

13:46There's a couple new categories of immunotherapy that are really interesting and cool. One category is called CAR-T therapy, also known as engineered cell therapy. And the way that that works is your T cells, which are your immune cells, they are the sort of soldiers that go after and try to attack a specific target. What we can actually do with your T cells and with CAR-T cells is we actually take a patient's T cells out of their body. We program those T cells using sort of DNA technology to recognize the tumor. We actually grow up those T cells outside of the patient's body. For about six weeks, we grow them in a petri dish.

14:25And then we reintroduce those T cells back into the patient. And now those T cells are primed to go and attack the tumor. And then there's another area that I think is really cool that's up and coming, that is the cancer vaccine category. So we all have heard about vaccinations and immunizations for infectious diseases, whether that's COVID or flu or other things. the same idea can apply for cancer, which is how do we teach your immune system to recognize cancer? The same way we teach your immune system to recognize the flu. And the way we've been applying them so far has been in the context of a person has already had cancer, they have had treatment, and now we're trying to prevent a recurrence of that cancer.

15:05Or we're trying to add in this therapeutic vaccine to be able to go after that cancer. Wow, there is a lot going on in this space. And I want to talk about how CRI, your organization, is really building on that momentum. So I read that at CRI, you're advancing a framework that you call people times biology times data. And how does that philosophy translate into better care or hopefully better outcomes for someone who might one day become a patient? Yeah. So it's really interesting. CRI, the Cancer Research Institute, has been around for 70 plus years. And our goal has always been to fund the basic science that drives discovery in the field of immunotherapy.

15:49Ultimately, our mission is uniting for a world immune to cancer. And so our thesis is people biology data. We invest in people, in biology, and in data. I suppose it is obvious that you should invest in the biology. You know, that's the basic science of it all. But what I really love about CRI is that we actually have this very strong sort of people-first investment thesis. What I mean by that is that when we go to make our grants, we invest in postdoctoral fellows, we invest in mid-career faculty, we invest in early career faculty. These are academicians at the bench doing basic science research.

16:23And what we say is we invest in the scientist, not the project. It's similar to how a sort of venture invests in the founder and not the company. It's exactly that kind of thesis, which is that we recognize talent early and we invest in that investigator. and we're saying, hey, science is hard. Science is super hard. Someone who spends some time doing it, you make a lot of mistakes, you try different hypotheses, they turn out to be wrong, you have to rejigger your experimental design. You might even change entirely your hypothesis based off of the data that you collect. And so projects change.

16:56But really, the best scientists, the best scientists are able to follow the data and change their project and their hypothesis to ask the right question. So we think about investing in the person, not necessarily the project. And then the last pillar is about data. And this is something I feel really strongly about. We all know that AI is changing everything in our lives. It changes the way we communicate with one another, changes the way we acquire knowledge. Certainly it will change the way we do drug discovery and basic science research. At the end of the day, they only work well if they are trained on a foundation of data that are very clean and grounded in truth.

17:36With these models, it's garbage in and garbage out. And so we know that ultimately, if the compute is there, the ability to make these foundation models is getting better and better from a software engineering standpoint. But if the biology data isn't there to train those models, then we're still just going to end up with a junk model. And so for us on the data side, We're very invested in helping to generate the right data set that will help then propel us into the sort of AI driven, AI first future. Wow, that is both absolutely fascinating and then so frightening at the same time, right? Because it is so important, right, to get that foundation right.

18:14And so I love that you're doing this work. Sustaining all of this work requires something that isn't always guaranteed. And you've spoken about the importance of protecting research funding, especially in uncertain times. Why is it so important to keep investing in basic science, even when the results may take years, decades to show up? Yeah. I mean, it's so interesting when you really think about it. Right now in biology, we're experiencing an explosion, an acceleration in technology and discoveries similar to the way that physics experienced that explosion maybe 100 years ago. And the reason is because right now in biology, we finally have the real understanding of the molecular basis of biology, right?

19:01If you think about it, the structure of DNA was discovered something like 50, 60 years ago. And before that, we really didn't understand the molecular underpinnings of how any of this works. But now we really do. Now we have tools at our disposal. We have sequencing. We have transcriptomics. We have spatial technology to look at cells, talk to each other in time, in space. So I think for that reason, you've seen a real acceleration of discovery coming out of basic science research. So that's why we invest in basic research. I think what is important is to be able to close the distance in both time and effort between a basic science discovery and a application towards human health.

19:41And I do think that that is happening. Right now, of course, unfortunately, we don't have as much certainty on science funding from the federal government. And so one of the things that CRI has really thought about is how do we ensure that the foundation of scientists remains solid? And one of the things that I think we are most concerned about is we're worried that there are young people, trainees, who are sort of in that crossroads in their career where they're coming out of doing their postdoc and saying, okay, I was planning to be an academic scientist, but I'm not sure. There's so many brambles in the road to do that.

20:16maybe I shouldn't do this anymore. Maybe I shouldn't be an academic scientist. Maybe I should go do something else and change vocations. Or maybe I should do this outside of the United States. Maybe I should go somewhere else to do this. And if that happens, that would be an incredible loss of talent for us and irreversible. And so for us, that's really where we're saying, we have to double down on making sure that we have the right investments in these young trainees, post-actual fellowships, junior faculty, and early career research grants. These are the places where we're putting a lot of our resources right now.

20:49I want to talk about something related to funding and certainly related to access in another way that this shows up and matters to a lot of people, and that's clinical trials. They can feel or sound intimidating for a lot of people. They might worry about the unknown or feel like they're being experimented on. How can we make clinical trials easier to understand, more welcoming, better suited to what everyday people actually need? This is definitely a problem that needs to be solved. And I don't think we have a clear solution right now because I think the reality is, you hit the nail on the head, the more that we are able to understand human diseases, the more specific the therapies we develop become, which is great because isn't that the promise of personalized medicine or individualized medicine which is that you get a specific ailment and then there's a sort of tailored treatment that works just for you works super well on your ailment has no side effects and cures you of that disease that's the idea of individualized medicine in order to achieve that future it means that there are more and more drugs that are coming to market so it means that whereas before there maybe was three options for your treatment or just one option for your treatment.

22:07Now, suddenly, as a patient, there's maybe a dozen options in front of you. Some of them are already standard of care approved. Some of them are clinical trials. And now you're asking, well, how am I supposed to know which of these clinical trials should I consider participating in? That's a super tough question. It has become ever more important, I think, for your bench scientists and doctors to take very seriously scientific and medical communications with patients and with lay audiences. I think that we have spent too long feeling like we should be using as many acronyms as we can to be the most expert person in the room and be unapproachable, right?

22:46The reality is, especially as the number of options increases, it's really on us to communicate clearly with the patient and their family about what their options could be. And right now, the way clinical trials are structured is they're just full of alphabet soup. Even me, who's an expert, when I read these clinical trials, I still have to squint and read it three times to really understand who's eligible and what does the experimental therapy do. So I do think there's a real opportunity there. One of the things that we do at CRI is we actually have a clinical trial finder. And so all of the clinical trials that exist in the United States, they actually are already available to you on this website called clinicaltrials.gov.

23:27And it's this massive list, alphabetized, that gives you every single clinical trial that's open in the United States. It's unapproachable. It feels like this complete sort of monolith of a list. And so what we do at CRI is we have a clinical trial finder where you input what your diagnosis is, where you are in your care journey, what treatments you've already had. And then we go and on the back end, we find you the clinical trials that you are eligible for. So that way, at least we've cut through some of that. But I do think there's still an opportunity there. I don't think that's the end solution.

24:01That's one solution. But if we really are going to realize the promise of individualized medicine, we actually have to do a much better job of this. I like what you said a lot and couldn't agree more about science communication, not only at the bedside, but sort of in general and throughout media. And that's one of the reasons I do this job, you know, because I think it's so, so important to talk about. Not that I am an expert at it, but every day I'm trying. On that, though, I do think we as scientists and doctors, we get trained to become expert in a very specific thing, especially as a PhD scientist.

24:34We are told, you know, you do a PhD in a thing, you're now the world's leading expert in that thing. The thing that you're a world's leading expert in is like a tiny little piece of science, but you feel really, really expert about it. And then we do this thing where we kind of defer expertise anytime that somebody asks a question that's slightly outside of who we are. And the reality is that depending on the audience that you're talking to and depending on the room that you're in, everyone should represent science and truth to the extent that they can. Like you are a scientist. You're no longer representing your very specific thesis.

25:06You're not representing your very specific department. You're representing science at large. You're not even just representing biology. You're representing physics, mathematics, chemistry. Right. And I think that's the thing that we have to do better is that we have to be able to know when to put on our expert hat and how to be really clear about what is ground truth in science and medicine when we get asked these questions instead of deferring. And I think that's one of the places I would like to see us strengthen scientific and medical communications for our trainees. We'll be right back with more of my interview after this quick break.

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27:32Alicia, I want to shift to you for a moment because there's a side of your life that might surprise people. And I read on a personal note that you're a fourth degree black belt in taekwondo. And I'm curious about the relationship between your martial arts practice and your research. Tell us about that. Yeah. So I always wanted to do martial arts. I fell in love with the idea of martial arts when I was probably like five or six years old. I was watching the Power Rangers, and I decided that I needed to become a Power Ranger. And the only way to do that, as far as I could tell, was that you needed to learn martial arts.

28:07So I never got my opportunity to do it until I went to college. So when I was a freshman in college, I was just very focused on joining a martial arts club. And I certainly had no intent to become so embedded in it and to become so good at it. I really just wanted to try it. I went to MIT as an undergrad. I know that we're not known for our martial arts, but MIT actually has a very strong Taekwondo program. And I fell in love with it for two things. I think one, there was an amazing community that was around Taekwondo at MIT. And then the other thing about it was that I think I have learned in order to be a high functioning cerebral intellectual person, you really need to figure out how to take care of your body, but also give yourself breaks so that your brain can come back to a problem and think about it fresh.

28:57If you want to be mentally very sharp, I find being physically sharp helps you. A lot of times I learn about a lot of my problems and solve them when I'm working out or I'm on a run. And so that's one piece. And I think the other piece is Taekwondo really taught me about leadership and really taught me about how to communicate. I became a fourth degree black belt. And at some point I was an instructor. So I was actually teaching the beginners. And I remember the first time I ever taught a class, I was like, I can't get anybody to pay attention to me. I am this slight little Asian girl. I was 20 years old, but looked 12.

29:33There was nothing about me that said you should listen to her. And I felt like everybody in the room expected me to either be Chuck Norris or Mr. Miyagi. And I did not look like either of those paradigms. And so I had to really figure out how do I capture your attention and your respect in my mastery of this sport that I'm about to teach you. And I learned this idea of how do you influence an audience in these subtle ways. And so it's been a very useful skill for me. Mm. That discipline sounds like it extended well beyond the mat for you. That's wonderful. You know, many of our listeners have a personal connection to cancer, whether it's a parent, a sibling, their own genetic testing.

30:15In my own family, conversations about mutations and inherited risk have really reshaped how we think about our future. So when you sit with families facing those questions, what do you most want them to understand about risk versus destiny? Oh, yeah. This is a thing that I think we can all do a little better at, which is that we can be much more proactive about our health. And when it comes to cancer, I think that we have a lot more knowledge about the risk factors, especially the genetic risk factors. And what we know is that Some folks are born with a set of genetics that increases their likelihood of developing cancer in their lifetime.

30:56And I think some patients are very scared of that idea of knowing that. And I can see why you would be scared of knowing that if there is nothing to be done. But the reality is that we can do something about it. And so knowledge becomes power then because knowledge becomes action. Action that can lead to actually prevention rather than waiting until something has happened. And so I think that's the hump that people have to get over is sort of that fear of knowing something. If you have an increased likelihood of developing cancer because of your genetics, that is categorically true whether you know it or not.

31:31If you know it, now you can do something about it. And that means we have the tools today. We have screening that we can do at an earlier age. We have more specific screening for people who are high risk. And we have interventions that we can also do with patients that are truly high risk. And I think this is an area where there's a lot of developing new technology in the area of prevention and early detection. And I think you're going to see a lot more of that technology evolving, getting better and coming to market. But I also think that the more you know about these types of risk factors ultimately will better inform not just the prevention, but the treatment if you end up with a diagnosis of cancer.

32:09I think the other thing that's really important to recognize and understand is that cancer is really no longer a death sentence. And for some cancers, depending on stage of diagnosis, that can be a much higher number. For example, in breast cancer, which is the most commonly diagnosed cancer in women, we know that if you're diagnosed with a stage one breast cancer, your chance of survival is 99%. That's great. But it means that you have to be trying to be diagnosed at stage one. And the only way to do that is to be really vigilant and on top of your screenings. And I think that folks sometimes will put that off, right?

32:41We're not as proactive or we don't want to know. We tend to not undertake our preventative health measures because we're so busy dealing with things that are on fire. We say, oh, I feel great. I don't think I need to go to the doctor. I don't think I need to get my mammogram done. The reality is you should just do it because the earlier that you detect something, the much better the outcomes. Okay, I want to end by looking forward. So let's look ahead 10 years and imagine a family sitting in a doctor's office talking about cancer risk or treatment options. What do you hope will feel different about that conversation because of the work that you and your colleagues are doing right now?

33:23My hope is that we can change cancer from a conversation about survival or mortality to really just a conversation about managing a chronic illness. We've seen that happen, for example, in HIV, where it went from truly a scary and mortal diagnosis to a chronic disease that is managed and managed quite well. I do think that that's possible. And there's plenty of biology still to be done. But that's the future that I would like us to get to. Dr. Alicia Jo, this was a really fascinating conversation. And I just have to tell you, you're a power ranger in my book. Thank you. I love it.

34:07And that's our show for today. Thanks so much to Dr. Alicia Jo for joining us. Thank you so much for listening. TED Health is a podcast from TED. And I'd love to hear your thoughts about this episode, send me a message on Instagram at ShoshanaMD. This episode was produced by me, Shoshana Unkerleiter, and Jess Shane. Edited by Alejandra Salazar and fact-checked by Vanessa Garcia-Woodworth. Special thanks to Maria Lages, Farrah DeGrange, Daniela Balarezo, Constanza Gallardo, Tansika Sangmarniwang, and Roxanne Highlash.

34:49Thank you.

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