Episode 4 Part 2: A Day In the Life of a Medical Oncologist

[0:00:00 Speaker 0] We’re a resource for learners, including every member of the live strong cancer institutes on track Educational pipeline, from middle school to residency. We’re growing collection of interviews, talks and experiences the uncover the myths and the uncertainties of cancer and careers and cancer in order to empower and inspire generations of thinkers and leaders. This is cancer uncovered, uneducated in an empowerment podcast by the live strong cancer institutes.

[0:00:40 Speaker 1] Hello and welcome to Cancer uncovered. I’m Nick Smith Stanley with electron cancer institutes. During Part one of Episode four of our podcast, we were able to learn about the typical day of a medical oncologist by shadowing Dr Anna Capasso. Dr. Capasso is an M D PhD. An assistant professor in Del Medical School’s Department of Oncology, she is a medical oncologist who focuses on gastrointestinal cancers as well as a cancer researcher and the Livestrong Cancer Institute Developmental Therapeutics Lab. For Part two of this episode, I sat with Dr Posso Toe learn about what led her to cancer, more about her research and her experiences as a woman in oncology research and academics. This is cancer uncovered.

[0:01:37 Speaker 3] You’re obviously not from here.

[0:01:39 Speaker 2] I’m not. You can tell from my beautiful English accent.

[0:01:43 Speaker 1] Eso Can you tell us a little

[0:01:46 Speaker 3] bit about before coming over here? And what made you come over to the United States? Definitely your story.

[0:01:52 Speaker 2] Yeah. So I was like, I’m originally from Italy. My parents are from Italy. I was actually lucky enough that my dad is also physician and he didn’t experience many, many years ago when he was in his thirties. So back in the eighties and United States and my mom and my sister, I have an older sister. They moved here with my dad for a couple of years, so actually was born in the United States. But then I moved back to Italy, and I grew up there. I come from the southern part of Italy. The city is called Naples, which I suggest everybody to visit because it’s a beautiful seaside city, really close to Thea Amalfi Coast, which is probably really well known beautiful area of Italy. And I did like all my schools there, my medical training there, my fellowship in medical oncology. But then I was really interested in actually going and taking some time off from the clinic and doing research experience and Unfortunately, in Italy, we don’t have an M D Ph. D program within the medical school, so you have to do your medical school first and then a PhD that its a three years and my professor back in Italy, New Gil Eckerd really well. And she is the director of the lips tongue cancer institutes. And she’s a well known expert in G I tumors, especially in colorectal cancer, which I was interested in because

[0:03:00 Speaker 3] I did

[0:03:01 Speaker 2] some research back in Italy doing my fellowship and also doing my medical degree. So I was lucky enough to meet her, had a conference and asked her if I could join her lab during my PhD experience, and she actually allow me to join her lab back in 2014. And so I moved from Italy in July of that year, and I was able to join her in Denver on did some research there, and then she was actually recruited here to start a cancer center, and she was at that time also very like nice to me and actually like you know, she’s been my mentor for the past 67 years almost now, and she actually recruited me here and asked me to join her team here in Austin.

[0:03:43 Speaker 3] Can you tell us about your family here in Austin?

[0:03:47 Speaker 2] Yeah, sure. I definitely So I waas I’m very lucky, I want to say, because when I decided back in 2014 to move to the United States, I had my boyfriend. We’ve been together for a very long time Before getting married. My boyfriend became my husband, just like two weeks before I moved to the United States. My husband name is Sergio. He’s always been very supportive because, like, at that point in, like, I wanted to move. And so he is actually ah, computer scientists. And he actually told me I want to join you. So go, go and do it. And we got married. He was able to join me, just like a week later. So we decided to both move here, and it’s ripping. Great for me because it’s nice to have some family with you when you move so far from home. In January 2018, I was recruited here in Austin. We moved here and then I got pregnant that September. So I have a baby now. He’s actually gonna turn 16 months pretty soon. His name is Giovanni. He’s a troublemaker. Really, really cute. A little Italian baby, I would say. Like my husband and I are both from Italy. My husband is from my dad’s hometown. So we’re sort of, you know, coming from the same culture, Same Origen, same. You know, small cities and our families are really close. That’s really nice. So when we go back home, actually, we don’t have to argue. Where are we going to go? And we’re gonna visit first because they all they’re all there. So that makes it really easy, because I’m very close to my family and I want to try to spend as much time with them as possible. And so we live here and I’m pregnant now. I’m expecting a second baby girl. She’s gonna be here probably before Thanksgiving. So this year, So we’ll see. It’s gonna be a challenge for sure, But I’m very, very lucky. My husband is super supportive. He’s my best friend. He’s my partner. He’s a great dad. He does such a great job with Gilani. So and all I’ve done in the past few areas is also because of his support and help because I would have never been able, you know, if I had somebody that didn’t really understand the how much I love my job and how important is to me that he really knew that this was a great opportunity for me and for my career and for my training. And so it’s been great to have him, you know, on my side. So and I’m a medical oncologist. That means by training I did actually go to medical school that got my degree in medicine. And then I did my fellowship in oncology. And after that I actually decided also to do a research experience. And so I decided to start my PhD. And so I’m gonna MD PhD, but really, what I do here? I’m an assistant professor. So I do work with the the other of course, oncologist that are on the team on the clinical side, but also within the research group. So I’m one of the P. I slept principal investigator within our laboratory.

[0:06:28 Speaker 3] So you mentioned your dad was a physician. Was he an

[0:06:31 Speaker 2] oncologist? He’s not actually an apologist. And we actually curious people that have a kidney diseases so he’s in a completely different a specialty respect to mine. But he’s also in academia, so he actually works at the university. Back in Italy, he didn’t experience in the United States during his PhD, so he is interested in research as well. There’s a lot of basic and clinical research, so that actually sort of drove my career because I saw my dad’s career and get really fascinated from you know, what his job looked like. And when I was a kid, I was able to go to the hospital with my mom, especially on Saturdays and Sundays, because it was a good time for him to get to make extra money work on those days. But I would join him, and and so that was probably drove me also to decide to pursue, ah, medical career and, you know, like start to decide to go to medical school.

[0:07:21 Speaker 3] So how did you end up making a transition to being interested in oncology specifically?

[0:07:26 Speaker 2] Yeah, so Well, we had ah loss in our family. My my dad’s cousin was diagnosed at 38 years old with breast cancer, and unfortunately she died after two years, and she left three kids a three really young kids. That was pretty devastating for all our family. And we were all very close. And then, you know, when I started medical school, you know, the first exams, the first sort of like specialties that we were working on, really drove me to get really, really interested in the oncology world. And I felt like, you know, I really wanted to do research like my dad did. I wanted to be, ah, physician scientist. So I was interested in conducting some research, and I felt like at that time, oncology was sort of like, you know, getting bigger and bigger. People were starting to hear more about, like, cancer and cancer research, you know, like also the genetics that was related to cancer research and things that my dad didn’t do when he was back in medical school, because there was not such a thing like oncology back in the days. And so it was more like the internal doctor medicine doctors that then we’re sort of getting specialized in specific disease types. So I mean, it’s been sort of like a consequence, like, sort of like, you know, starting my training in medical school and then getting so closer to the research world. And then I did an experience back in the United States with an oncology team at the university. They were doing a lot of like, you know, translational research and cell signaling. So trying to understand how sort of, you know, like within the cells, the different proteins communicate one with the other and how they can sort of, like, increase the South growth. So that was really a fascinating I love the techniques. I love the idea that I could, you know, just do more research within the oncology field. And so I pursued sort of that specific discipline. And during my 30 of medical school, I joined a lab back in Italy. They were doing a lot of research and breast cancer, and I was so fascinated from, you know, like just the lab world. And like all the PhDs, all the students that were working in the lab, how much effort they were putting in your jobs really like, made me even more sure that that was sort of the field that I wanted to be in and sort of like, you know, get more specialized in.

[0:09:38 Speaker 3] So was it. Working with Gaelic are where you started to be more interested in in Giza subspecialty

[0:09:44 Speaker 2] that actually started already back in Italy because during the fellowship, so what I did like I did my thesis and like at the end of medical school, that’s something that we normally do back in Italy. So my thesis was like on preclinical work in breast cancer. But then I decided to switch, of course, to clinical because I wanted to get in the fellowship program, and that’s a five years program. So it’s pretty long. And during the Five Years program, I actually met this, my other mentor, professor, charge Yellow, and he actually did start also with doing a lot of research in breast cancer and lung cancer. But during that time he was focusing more colorectal cancer, so I was lucky enough to join also not only the clinical area and so like be trained from him clinically. But we were able in the afternoon and mostly at night because you have to find time for research. Of course, patients always come first, but, you know, at night I was able to join his team of researchers that were waiting their position as assistant professor and join them, you know, and doing some of the experiments. And I had some lab expertise, so they were very happy to have me there. So we started. I started joining them on a lot of the correct cancer projects, and then I was lucky enough also to join them in the clinical efforts. They started to have way more face to and face three clinical trials specifically and colorectal cancer. So that’s why I sort of like I became a little bit more like the expert and focused on Correcto cancer rather than other disease. Old Dole As a physician, we were seeing all types of cancers in the clinic, of course, but my research was more focused. And that’s one of the reason why. Actually, he thought for me that it would have been a good idea to join Dr Eckard in Denver because she was really big expert in the field. And also Dr Eckard was conducting first in human clinical trials. That means basically her lab was able to do some drug discoveries or like tests, um, drugs coming out of research and focus on trying to develop those drug to see if they were active in colorectal cancer and then try to translate those findings in clinical trials and tryto offer these new drugs new combinations to patients that were affected from colorectal cancer or any other disease and what we defined face one. So that’s basically the first level of the clinical trial sort of development.

[0:11:55 Speaker 3] We’ve talked about some of your clinical work. I want to talk about your research. Can you tell us specifically about what you’re researching? And then, you know, maybe a little description about the differences between phase 12 and three? Sure,

[0:12:10 Speaker 2] So I’m actually, as I’m doing some pre clinical work and then also some clinical trial actually work. So for my pre clinical work, I do focus mainly on clay rectal cancer. And you know, in the past few years in the oncology world, we have the approval of immuno therapies that it’s been sort of really revolutionizing the treatment for a lot of patients. And then those drugs have got approved for people that are affected from lung cancer, from melanoma and from other a lot of other diseases, and they’re actually working really, really well and that’s really encouraging, unfortunately specifically for colorectal cancer. And we’re not able right now to offer those treatment to all our patients. But just to ah, little portion of patients, those patient has specific mutations that make them what we say illegible or like just receiving the drug. Actually, the drug works in their case, and that’s only 5% of the entire metastatic population. And we see, unfortunately, a lot of metastatic patient. That means, you know, people that have a cancer that originated from the colon but then spread elsewhere in their body. And so this is one of sort of the things that I’m focusing on, trying to understand for this other 95% of patients and people how I can improve. And now I can actually come up with smarter combination with immunotherapy to try to make them more acceptable and like sensitive to the immunotherapy drugs. And that’s really what we’re trying to do in the lab space. And that’s where the clinical trials come in. As you like. You were asking me about, like phase 12 and three. So, basically, these are the three phases for a drug to be developed and before it gets approved. The first step is what we defend, the first thing human. And that’s because that’s basically a drug for the very first time we’re now testing in the human population. And so usually we have all comers. That means, like people with different diseases, and we test the drug, and we try to understand who’s gonna sort of benefit from the treatment or not. But those trials air really especially the Phase one trials, because it’s a really first time we’re testing and and people. And of course, we follow these patients and we see how they’re doing it. They’re responding or not, so we can actually extrapolate also some efficacy data out of those trials. And then usually what happened is like if we see specific patient that to respond to those drugs, then we go and face to that. It’s usually more like, sort of like focus on specific disease types where you have like more people with the same disease, and the same probably mutations are sort of like things that we sort of like. We’re able thio identify in the preclinical study, but also in the face one studies and then you like, sort of like be more dedicated in those trials. And then the phase three usually like you, do a comparison between placebo that it’s basically sugar. So really nothing, just to see if the drug is really better than placebo on it. We’re really going to give some effects. And those patients then before gets than FDA approved or like in the face for that. It’s basically the marketing part of the development. Or sometimes there is, like already, like a drug, that it’s well well known to work in that specific cancer type in that specific cancer population. And you just do sort of comparison to see if the new drug that you’re using its equivalent, or even better,

[0:15:21 Speaker 3] what’s the average amount of time it takes a drug to go through from phase one to be approved therapeutical

[0:15:29 Speaker 2] Well, it takes years. It does take serious really variable. It depends, you know, from how much time the study takes to recruit the number of patient that they sort of decide to recruit because, you know, of course, when you design a study, you have to have all the statistical analysis behind it. And like a protocol is not that you just like, you know, decide to get a patient in the trial, and that’s it. It’s really highly regulated, and there’s a particle you have to follow and usually like. It takes, like a couple of years for the first study. But then you have to wait for the results before moving you, like in the next study. So it takes a while. It’s pretty variable, I would say from a study to another. Some studies air just quicker than other is some other just, like take a little bit longer? I would say I I don’t have an accurate number, but probably like at least I would say, like between 6 to 8 years. Um, yeah. And actually, the interesting thing is like if you look at the data from the preclinical development of the drug to the FDA approval back in the days, it would take more than 10 year Isa now the immuno therapies they’ve been. So it’s been such an exciting world and exciting sort of feel to work on because they are been so effective in so many patients at the time between, you know, like the identification of their role in the clinical setting and then the clinical drive than their approval has shortened a short and like ridiculously like it’s probably like five years or less than that

[0:16:49 Speaker 3] is that just because more investigators air interested and

[0:16:52 Speaker 2] there is

[0:16:53 Speaker 3] more funding,

[0:16:54 Speaker 2] well, I mean, it’s probably that’s true, but it’s also true. I think it’s just like for the efficacy of the drugs. Those drugs have been sort living, like, tremendously effective in some country types that it’s been just like, you know, like easier and then their development just because they’ve been really changing numbers in terms of survival of a lot of patients with specific cancer types. So it’s been sort of like, really, really fast.

[0:17:18 Speaker 3] So much of this podcast is really geared towards learners of all ages, and I think a lot of what you talked about would be beneficial to anyone up to your current colleagues. But I think specifically for high school and middle school students and even undergraduate students. I think we’re really gonna learn a lot about what it takes to be a physician. When we talk about, you know, if you have a student or a learner who’s interested in this field, whether it’s just medicine or oncology, what do you tell them?

[0:17:48 Speaker 2] This is a great question. So first of all, you know, when you talk about mentorship, I just want to mention that I’m very lucky. Very, very lucky, because I have. You know, Dr Eckard is my mentor. She’s been my mentor for the past seven years and, you know, it’s really, really hard to find somebody that it could be a good mentor. And she is amazing. I mean, like, I feel like all that I’m talking about all I do. It’s because of her. You know, people work in this field that we are all motivated. Of course, we all want to do our job at our best. But when you find somebody that can really give you the right sort of, you know, like advice is and how to pursue that pathway and really follow you, even she’s so busy because she’s so busy. I don’t know how she does it, but it’s just I mean, I mean, like, none of the mentees that I met, and she’s been mentoring over 50 people. I think in her career, none of them have not been successful, So I feel like you know, everything that I do today. If I’m you know, a little bit successful, it’s really because of her. So that’s something that I wanna mention to everybody, especially for students, because I think really the best thing that you could do to do something good about your career is really find a good mentor, and that’s like something. It’s just like, priceless. And of course, I try to make them also understand that you have to be passionate about what you dio, and that’s something that I suggest to everybody. I mean, like, you can be great in your job, but to be great, you really have to love it because your job is going to take a lot of time from you. It’s going to take time from your personal life, from your family from yourself, a swell like there’s a lot of sacrifice behind all that we do. And you know work is great, but when you have to spend like months really working hard, sometimes you get to a point where you know, you get a little tired and some people get exhausted. Some people get burnt out, so I feel like the only way to maintain a good life balance. What makes you know a difference? Being able to have this really, really dynamic life and work because, you know, whatever I do, I feel like there is like, It’s so interesting. It’s so like, exciting at all the projects that we work on and really, I try to share with them that really? Of course, I tell them it’s gonna be hard. It’s gonna be a lot of work, and there’s gonna be good times and bad times, especially when you work in research. There is a lot of like, great times, but there’s a lot of frustration. I try just always to be positive and try to communicate that positivity with everybody, because I think everybody should have that opportunity. I don’t think there is, especially for high school kids, like some people think, Oh, yeah, but your dad was a doctor, so that’s why you already sort of had an idea. And some people come from family where your parents are not even don’t even have, like, you know, a college degree or that doesn’t mean anything, like if you want to do something in your life. You can do it as long as you want. Thio

[0:20:30 Speaker 3] This podcast has already shown that we’re not afraid to talk about some of the tougher issues. We did an entire podcast, just about someone systemic racism that’s going on in our country and in our field. And we also have created programs that specifically addressed the disparities and the lack of women in health care and research. Are there specific challenges that you have faced as a woman? Um, either in the clinical side or the research?

[0:20:58 Speaker 2] It’s a great question, and I want to say that it’s such an important topic, especially like in the medical world or even in a academia world. I want to say that unfortunately, women are not well represented, like in terms of leadership, and you’re like being at the very top of, you know, of the like a team. But going back to my mentor, I was lucky enough to meet with her. She’s a woman. She’s a really strong woman. I heard like a lot of stories from from her, and I know that she’s been sort of struggling during her career. I feel like having a woman mentor. It was a gift for me because she understands a lot about that and she is 100% supportive. So personally for me, for my career, I never felt like any sort of obstacle, like or having any issue, because I think I was lucky enough to have, like, the like, my leader being so supportive, like women and medicine or women in research and women women in leadership. So I was really lucky. But with that said, there has been times where other people have, sort of, you know, shared or, you know, sort of made me feel I don’t want to say uncomfortable, but sort of like the fact that you’re young researcher, young faculty member and you have like so much to do when you have a kid home that, like you are also a mother, it’s something that sometimes comes out and people think like it’s hard to manage all that you have to do, and that’s true. Definitely, it’s hard. You can be a dad and be very busy as well. And if you share rolls home, you can both like both can be very busy. So you know, I don’t think that that can really interfere with your job. I think if you really love your job and you do a good job at work, then you should have the time to go back home and spend time with your family and still feel good at what you’ve done.

[0:22:42 Speaker 3] Great, alright, rapid fire questions, right? What is the most difficult part of your job?

[0:22:49 Speaker 2] The most difficult is when I have to give that news.

[0:22:51 Speaker 3] What’s your favorite movie?

[0:22:53 Speaker 2] I actually have to. I have to say Postino, that it’s a really old movie, beautiful movie that was recorded back in a beautiful Sicilian island, and I would suggest everybody to look it up. It’s called Il Postino, and then the other one is the one from Roberto Benigni, which you actually won the Oscar for La Vita Bella. Life is beautiful. I just love everything about that movie. It’s just like, sort of like gives me, you know, that motivation of saying you like you have to be serious about what you’re doing, but at the same time you want to play with your life because it’s so precious.

[0:23:24 Speaker 3] I would agree with that. What is your favorite food?

[0:23:27 Speaker 2] Oh, my favorite food So I love mozzarella, which unfortunately I cannot find here in United States, there is no way you can find a good one. Cheese in general, I love cheese and I’m Italian. Everybody would think that I love pasta. It’s good, but cheese is so much better.

[0:23:45 Speaker 3] What is your favorite band?

[0:23:47 Speaker 2] Okay, so my favorite band, that’s hard. But I want to say that the band that really made me fall in love with my husband is Guns N Roses. So we just love guns and roses actually have my husband. The way I save his name on my phone is Axl Rose s O. But yes, we child of mine is one of probably, like are sort of, like, you know, in November, Rain is the songs like Really like I love. And just like when we started dating, we were started talking about music and he was really surprised. I love guns and roses that he’d love country roses. So I think that was the sort of the connection, like I mean, like, it helped me connect with him. He was a really cute guy, had a really a lot of girls around, so it was tough to sort of like, you know, you could

[0:24:29 Speaker 1] have given make a million guesses and I never would have. Yeah,

[0:24:32 Speaker 2] but roses Yet

[0:24:33 Speaker 3] What is your favorite dessert?

[0:24:35 Speaker 2] So my favorite dessert is a dessert that we make back in Naples. It’s called Baba. It’s sort of like it’s a very spongy cake. And then it’s like, you know, sort of like you have to put some Ah, water, sugar, water and rum on it, too, just to make it a little more spongy. And then you can add cream or like whipped cream. Oh my gosh, it’s so good. So Baba

[0:24:57 Speaker 3] Baba. Yeah, you are a rock

[0:24:59 Speaker 2] star, E. I appreciate

[0:25:01 Speaker 3] you doing this. And

[0:25:02 Speaker 1] actually, I have one more question. What is your favorite part of your

[0:25:05 Speaker 3] job?

[0:25:06 Speaker 2] Oh, the best part of my job is actually like talking to people. And as you can tell, I talk a lot. So even with the patient in the clinic, and I do love to laugh with them and talk to them and know more about them as people and their families And then, of course, also with the preclinical team. I like being able to interact with other people It’s like something that I really, really love.

[0:25:27 Speaker 1] I hope you enjoyed learning more about Dr Capasso in the work that she and her team do at the Livestrong Cancer Institutes again. When I think Dr Capasso for spending some time with us over the last couple of weeks, I hope you can join us next month where we will discuss the role nutrition plays in patient centered cancer care. This is Nick Smith Stanley with the Livestrong Cancer institutes, and this has been cancer uncovered. For more information on the live strong cancer institutes, check out del med dot utexas dot e d u. You can follow our director on Twitter at S Gail Eckhart Eckhart is spelled E c k h a R D t. If you have questions or topics of ideas that we can uncover, email us at LiveStrong cancer institutes at del med dot utexas dot e. D u. Please make sure that institutes is plural and if you like the podcast to make sure you subscribe, this is cancer uncovered. Thanks for joining