In this episode of the Futurist Society, host Dr. Awesome converses with Dr. Diana Azzam and Jim Foote, co-founders of First Ascent Biomedical. They discuss the groundbreaking advancements in the future of targeted cancer treatment. Diana, an assistant professor at FIU with a doctorate in biochemistry, and Jim, a CEO with extensive tech industry experience, reveal their platform that shows an 83% improvement for patients with refractory cancer. They explain the concept of precision medicine, repurposing FDA-approved drugs, and the technological innovations that allow them to deliver personalized treatment plans within 10 days. Tune in and learn the potential future transformations in the biotech industry specifically in the future of targeted cancer treatment.

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The Future Of Targeted Cancer Treatment – A Conversation With Jim Foote And Dr. Diana Azzam

Hey, everybody. Welcome back to the Futurist Society. I’m your host, Doctor Awesome. And as always, we are going to be talking in the present, but talking about the future. And today we have two awesome guests. We have Diana Azzam and Jim Foote, both co-founders of First Ascent Biomedical. Who are doing some really amazing things with cancer therapies. Diana is an assistant professor at FIU, and she’s also having a doctorate in biochemistry. And Jim Foote is a CEO and knows all things about the biotech industry and has helped bring a really significant therapy to market, which is one of the reasons why I wanted to speak with them. So, for those of you guys who aren’t familiar, one of their research articles was recently published in Nature, which is a really big impact factor journal. And I really think it’s cool what they’re doing. So tell us a little bit about what you guys are doing, Jim, as well as how it’s going to help patients in the future.

Thanks for the opportunity. What we were able to demonstrate and publish in Nature Medicine is that by combining biology and technology, we were able to produce a platform that benefited patients with refractory cancer 83% better. So their cancers came back and they benefited 83% better than had they just stuck with the standard of care and doctor’s choice.

Yeah, Diana, tell us a little bit about the science behind it, because it’s very easy to say that the therapy was effective, but how is this different from existing therapies that are on the market?

Precision Medicine Explained

Everybody knows that precision medicine is commonly used to find the right drug for the right patient at the right time. This is used for cancer patients, but what’s commonly used today is using DNA-only testing and trying to look for a drug that works for every patient. But what we’ve added here is this drug testing component, where we can test hundreds of drugs directly on the patient’s own living cancer cells and identify the right treatments for each individual patient, especially those patients that have exhausted standard of care. The idea of repurposing FDA approved drugs to identify what works for each patient is really the foundation of the science behind the platform.

I don’t have as much experience with cancer as more run of the mill type of infections and things like that. And for those types of pathologies, I feel like it’s very much one size fits all. You throw this antibiotic on it, maybe you might tailor that once you get an antibiotic susceptibility test back based on the bacteria that have been growing in an infection.

That’s the right analogy. You got it right.

How is it different with cancer, though? Because not everybody knows what precision medicine is. And I think that you’re probably at the cutting edge of this biotech industry. But for a layperson, what would they be looking for to be asking their doctor if they had some cancer, that they wanted to have this therapy and make sure that it’s available to them as well?

Challenges in Cancer Treatment

You really touch on something that’s important. Most people think that when they’re diagnosed with cancer, the doctor comes up with an individualized treatment plan based on the biology and the genomics of their individual cancer. What they don’t realize is that cancer is basically treated based on the standard of care. It’s a recipe book that was established, sometimes decades ago, and that they modified and adapted over time. But if you look at the three of us on this call, we are biologically different. We have different genders, we also have different national backgrounds. But if we all got the same cancer, we would all be treated exactly the same way, with the exception that it would vary a little bit based on our age and our weight.

And what we’ve done is we’ve absolutely turned that model upside down and said, while that’s worked, and it’s worked for decades, the reality is one in three cancer patients still die. In 2024, over 33% of the cancer patients diagnosed with cancer will die. So if all three of us got it, one of us wouldn’t be here tomorrow. What we’ve done is we’ve said, let’s base it on your biology. We take a biopsy of your tumor. We figure out what drugs work for you, we analyze it with AI. We come back with a personalized cancer treatment plan in about 10 days. And like Diana said, it is about the right patient with the right drug at the right time.

I actually spoke with someone who is in the biotech space a little while back, and they were saying that precision medicine, the turnaround time can be weeks to months. And I think one of the things that I saw in your study that was published in Nature was that you have a much shorter turnaround time, correct?

Yes, exactly. And that’s very important, especially when physicians or the doctors want to make a decision on the next treatment for the patient. And these patients are already progressive, which means they’ve gone through many lines of treatment. They don’t have any more options. So time is of essence. They have to make a decision quickly. So by getting a biopsy and testing hundreds of drugs and giving results back quickly to the doctors, that really helps change the course of treatment for that patient quickly. And that’s important when we’re dealing with patients that have exhausted the standard of care.

It’s about sending things back in a clinically actionable timeframe, and that’s the really important part. We know that mortalities go up by 10% for every 30 days you delay treatment. And so it’s absolutely important for us to return results in a clinically actionable timeframe. And that’s part of what we published.

And when cancer comes back, it gets more difficult to treat. And that’s why when, you know, after patients have gone through many different treatments and their cancer returns, what we need to do is to be able to provide quick treatment options for those patients, because it’s not the first time or the second time. It’s after many lines of treatment.

Personal Stories

So, personal story. Both my parents passed from cancer, and they were refractory cases that were enrolled in clinical trials, and it was not the best experience, and certainly it ended in a poor outcome. I mean, an inevitable outcome, which was them passing away. But that being said, I think going into this, there was so much hope for immunotherapy. There was so much hope for genetics. Like, have we really moved the ball forward with cancer treatment? You’re saying, Jim, that a third of all people have passed away. Is that getting better or is that, at least in your eyes, getting closer to being better?

There was so much hope for immunotherapy.

Yeah, it is. I mean, when you look at genomics, and again, this is why Doctor Awesome, we’re so excited about our results, because when you look at genomics, genomics actually helped move the needle forward. When you do DNA and RNA sequencing, find a biomarker and try to map a drug to that biomarker that ultimately treats the patient, what we were able to show in our study is that patients benefit 10% of the time. They move the needle forward 10%. But what we were also able to demonstrate is that when you combine functional drug testing like we do with genomics, that the patients benefit almost 60% of the time. While the genome was mapped 20 years ago, we really believe that the functional precision medicine approach is that next quantum leap forward. And again, patients will benefit from that. That’s what we were able to demonstrate in our study.

I want to add that the other aspect, like you mentioned, there are so many drugs approved now by the FDA that are promising immunotherapy, and we have over 200 drugs approved by the FDA for treating cancer. What we’re saying is all these drugs are there, they’re available, can we use these drugs in different indications? Especially when patients run out of options. And this whole idea of repurposing these drugs when patients run out of options is very promising. There’s always going to be options, and hopefully, our platform will consistently provide physicians options for their patients.

And it’s interesting that all of the things that you’ve mentioned, Doctor Awesome, because that’s really it. Everybody’s looking for the silver bullet. “Oh, it’s in immunotherapy”, or “It’s in the organoid”, or “the answer is in this silver bullet”. And what we really said is, “yes, that may be, but it’s about using the right bullet”. We have enough drugs. They’re just not being used in the right way. So an example would be… it’s called off-label use. So part of what our platform can identify is, say, for example, you had leukemia – what we can find is a drug that’s specifically for you and very effective against your leukemia, and perhaps that’s a lymphoma drug. The ability to test hundreds of FDA approved drugs. These are drugs that the oncologists are already familiar with, but they wouldn’t ever think about using a lymphoma drug on leukemia. But when they see the data, why the drug works, and they see the underlying mechanisms of why that drug’s working, they’re like, “Oh, my gosh, I would have never thought about that.” And that’s really the power of bringing biology and technology together. It’s providing the data in a way that a doctor can make better decisions about your treatment options.

We’ve had patients that respond to non-cancer drugs. We had an osteosarcoma patient that responded to an allergy medication. So these non-cancer drugs, there’s evidence that they can be effective in treating cancer. Our test gives that evidence and that data to the physician to say, “Okay, maybe we can have a combination of an allergy medication with chemotherapy.” That’s what we show in our study, is that when that happens, patients respond.

Study Insights and Future Directions

When you say respond, I think what you had mentioned in the study was that it was like the extension of life for people that had tried everything. Right? Having been in that situation, I can tell you firsthand that is something that is of value. To have a year with my parents versus 6 months with my parents is very valuable. And so I get that. That being said, I was just kind of wondering how do we know that that’s causation not correlation. How do we know that those people might not have survived longer? I know you had compared in the study to average numbers, but just from a layperson’s perspective, how would it be quantifiable for them to understand that, “Okay, I am getting more life back with my family member, as opposed to not.”?

This was a feasibility study. It’s how you design the study. Obviously, you have certain standards of how to quantify the data. The main question in that study, which is a feasibility study, was can this be done? Can we take cells from a patient, add drugs in the lab, give results back to the doctor quickly to make decisions on the next line of treatment? That was really our first question and we show that it’s feasible, it’s resource intensive, it’s a lot of work, but it can be done. 

Now, obviously, when we start comparing outcomes of patients guided by our platform versus those that were not guided, we see improvements in patients outcomes. But if you really want to completely remove all bias, that’s going to be the next clinical trial where we have it randomized, two arms, no bias, and then we compare outcomes of patients guided by our platform versus patients that were not. 

So there’s more studies and more clinical trials that need to still be done on a larger number of patients. But we believe our study is still very important because not only do we show it can be done, but the fact that we see improvement on patients that are already exhausted and very advanced. That alone is promising because we compared each patient to their own previous regimen. We started looking at how patients did versus how they did in their previous regimen, and we found improvement. We know when cancer returns, it’s worse. So you’re seeing an improvement in that when you’re comparing it to their own previous regimen. That’s why it’s promising. But obviously, you still need to do more clinical studies.

Diana touched on something. We’ll use EV9 as an example. You know, this was an osteosarcoma patient. She had failed three lines of treatment. Her tumor had returned and was aggressively growing. She had metastasis to, I believe, the spine and the lungs, and they’ve exhausted basically every standard of care. And what we found was Idarubicin, which is a traditional chemotherapy, and Montelukast, which is an antihistamine, with those two drugs combined, she had a complete response. The tumor went completely away. She ultimately died 84 weeks later. She got a year and a half of additional life. Another birthday, another Christmas. She didn’t die of cancer, but her immune system was so beat up that by the time we got to her that she died of sepsis. So that’s an example, though, of exactly the power of the platform. You may not know a lot about osteosarcoma, but it’s a very progressive disease.

We have osteosarcoma in the head and neck. I’m at least familiar with that aspect of it. And it is something that is a terrible disease. I guess my question is that life extension, which is something that had been highlighted and maybe I had not been reading it to the level that I needed to, maybe I wasn’t understanding it as much as I would understand, like, a randomized clinical trial, because this was a very early stage study. And so for me to parse out what was important, I think was a little bit more difficult than on something that is more late stage, which I think is very much more evident. Because I deal with having to look at the end-stage studies so that I can modify my own practice. And it’s very rare that I actually look at these feasibility studies that show me what’s coming down the pipeline. I think someone like Diana is probably reading those because you need to be keeping up on the cutting edge technology that’s out there. But as a practicing physician, I’m not going to that literature. I’m more into clinically relevant literature. And that’s what I really want to know from you guys, is just the clinical relevance, because I think that’s what patients want to know about. They want to know, is this going to help me? What does this mean for me, because everyone is also worried about… I can tell you, having treated cancer patients… everyone is also worried about the treatment or the cure being worse than the disease. 

I remember when my dad had metastatic melanoma. They put him on interferon therapy. He was a totally different person. He had memory lapses, mood swings, and then he got off the therapy and he was back to normal again. Who knows if it worked. But we tried it, because we’re like any other person in that position, going to throw the kitchen sink at this thing.

So that’s what we do. We get rid of trial and error with our platform. And the clinical data that we’re showing is that first we get rid of unnecessary treatments that if we don’t find those working on the cells in the lab, those will not work on the patient’s body. So we’re getting rid of treatments that may be toxic and unnecessary, and that’s really important. 

One of our patients had leukemia, and one thing that our platform was able to provide is a safer option. So in children, they believe the more drugs, the better. This whole notion that three or four drugs are better than two, and what we’re finding is that two were as effective as three drugs. So we were able to get rid of this drug that’s toxic to the heart and still have an effect on killing the cancer cells in 30 days, compared to 150 days in his previous regimen. And now he’s in remission for over 2 years. So, exactly what you’re saying, this is the data that physicians should look at. What I mentioned about randomized clinical trials is more large-scale efficacy data. But if you look at our clinical study today, as a treating oncologist, I can see that I can use this tool to help me make better-informed decisions for my patients, especially those that don’t have any more options. That’s what we’re showing.

And what we actually showed in our study was that the microenvironment that we create based on the technology that Diana has invented and how the body actually responds to the drug – there’s a 98% correlation. And so, to your point, we’re not inventing a new drug. We’re not doing anything that the doctors are unfamiliar with. So what we’re actually doing is derisking it. We’re saying, here’s the drugs that are going to work on you. But by the way, those drugs may be different than what would work on Diana or on me, but here’s the precise drugs that’ll work on you, and here’s why. And I think that’s what really makes us different from anybody else, is because we can provide that level of detail, that being specific, and not rely on just grasping at straws to try to find the right drug or drug combination that will work.

Yeah, let me ask you a question about that, because I feel like I understand the efficacy now. I think that after hearing you guys speak, anybody would. Let’s talk a little bit about the treatment. So, from my understanding, if you take a biopsy, you’re able to either regrow the cells or create some sort of environment where you can actually test that sample of cancer with a whole panel of different drugs that are available. How is that even possible? How can you replicate the body’s environment to a 98% correlation? Just out of curiosity? We don’t need to get intellectual property or anything like that.

Technological Advancements in Drug Testing

I like to be asked this question, because the idea of testing drugs on tumor cells is not new. Anybody can think about it. It’s a very simple idea, and it started off years ago, decades ago. But then the data that we generated was based on primitive assays. We’ve made so much advancements in the way we culture tumor cells in the lab today, and advancements in how we dispense drugs. The technologies today are completely different from what we had 10 years ago. So this is why when we get the biopsy in the lab, what we do is we don’t grow the cells for a long term. We get them the way they are, mush them up a little bit, and then we keep everything in there. And what we show in our study is we had tumor cells, we had immune cells, we had stromal cells, all the mixed cell composition that’s usually available in a tumor. Obviously, we can make it better and better, but based on just doing that quickly and adding and dispensing 100 drugs, each at 10 different doses within a day, that we couldn’t do years ago, and today we can. So all these advancements in technology enable us to get those results quickly and give that data to doctors which we couldn’t do a decade ago. And this is why today, the data that’s coming out of this simple idea is much more powerful. And that’s what we try to explain. I’m a member of the Society for Functional Precision Medicine, which is a relatively new society, but really, our mission is to bring awareness and try to bring these functional assays as tools back to the clinic and let doctors know and treating physicians know that these technologies have advanced so much that you should start using them as tools for clinical decision making.

Here’s the important part, Diana said it, what we’re doing was not possible 10 years ago with the robot and the equipment that we have. It used to take a scientist 5 hours to do what Diana’s talking about. Now the robot does it in five minutes.

Through sound. Now we have technologies that dispense drugs through sound, and that’s how we can go down to nanoliters of drugs. Sorry, I just wanted to add.

That’s interesting. I didn’t know that drugs could be dispensed by sound. So futuristic, and that’s what I love talking about. So I’m glad that you added that.

Not just with sound, but very precise amounts of drugs. And again, that’s what allows us to get fidelity in helping treat these patients, because we’re using all of these advanced technologies. You look at AI. AI is finally, after decades, beginning to deliver against all of the promises that it’s made. And the cost of computing has come down. And all of this time, we’ve been testing and validating and publishing, and it really feels like the technology, the industry, everything’s kind of come together at the same time to make this available on a broader scale to virtually every cancer patient who fails a standard of care.

Market Forces and Bringing Products to Market

Tell me a little bit about the market forces that are at work behind the scenes. Because I feel like you guys are both in the biotech industry and you have an insight into this that I don’t have. You have a breakthrough like this. And you realize that there’s some value in it. You put a paper out that is in one of the most high-impact journals. It was on the cover of this journal. What is it like actually bringing a product to market? Is that something that is going to be like a decade from now? I don’t think that I know enough about the biotech industry, because on the one hand, you have the vaccines that came out for Covid within a few months, and then you have other drugs. There’s a particular bone grafting substitute that I have been looking at for years, and I’m waiting until it’s available, but it’s still not available to me. So if I’m a patient and I’m suffering through this, I would probably want to know, what is the timeline? Where can I get access to this kind of stuff?

Doctor Awesome, great question. I call them gatekeepers. There’s so many gatekeepers in this ecosystem. Ultimately the patient has to decide, I want a better chance at my survival. Under the Right To Try, which was passed in 2018. If you fail the standard of care, as a patient you have the right to try whatever means you need to save your own life, provided you can support a claim of efficacy. And that’s really where we come in. Patients are one of the gatekeepers. Doctors, believe it or not, are one of the gatekeepers. And then ultimately insurance companies and pharmaceutical companies. 

Oh, they’re definitely gatekeepers. But I do want to talk about how doctors are gatekeepers? Is there still a dogma of using protocols that… when I think about oncology, I think about, “Okay, this person has x. I need to look at protocol y, and then that’s how we treat them.” And then after the treatment fails, then we start going into different stuff. Which is something that I feel realistically has benefits to it. I think that there are benefits to trying the more studied stuff. First, if somebody goes through, let’s say, two rounds of standard protocol, having been in that situation myself, the doctors would come to us and say, “Let’s try this clinical trial, let’s try this. Let’s try that.” What is your experience? Because I just genuinely want to know about it.

Doctors’ Skepticism and Clinical Studies

I’ll start out and then I’ll let Diana fill in. If you look at the Gartner innovation curve, I don’t know if you’re familiar with that, but there are early adopters, early majority, majority, late majority, late adopters. What we find is it’s a mixed bag. Doctors are naturally skeptical. They’re skeptical by design. You go to medical school, and I think one of the things that they teach you is to be skeptical. And rightfully so. There’s a lot of companies out there that are making all of the same claims that we’ve made, but they’re missing one thing, the clinical evidence. They’ve done retrospective studies, they’ve looked at data retrospectively, ours is prospective. And so doctors are naturally skeptical. 

When they see what we’re able to do, and they see how the patients respond, and they see the insights that we’re able to give them quickly, they instantly get on board. And so if you look at our two clinical studies that we’re running out of, Nicholas Children’s Hospital and Cleveland Clinic, Florida, we’ve absolutely been overrun with patients because the doctors are sending us more patients than we have the capabilities to handle.

If we just focus on those early adopters, that still represents probably far more patients than our company can even handle for the next year. 609,000 cancer patients die every year in America. 15,000 patients is only 1.7% of the total population that will die next year. And if we can support them, we can help a lot of patients and really unlock a lot of value for our company. 

So you asked another question. If I’m a patient, when’s this going to be ready? So right now we’re going through CLIA validation at the FIU lab. Once that lab is CLIA validated, that gives us the freedom to help patients outside of a clinical study. So that means if I got cancer tomorrow and we have that CLIA validation, a patient can come to me and say, “I need help”, and we can be able to help them by collaborating with the lab. And so we’re targeting July. But one of our challenges has been, because of the success of our clinical study, patient care comes first. We’ve actually had to delay some of the validation because we’ve been overrun with patients. So I’ll pause there. And, Diana, if you want to add anything, feel free.

I think you covered everything. I think it’s all about the early adopters. That’s been my experience with early adopter physicians. And when they start using this tool, there’s a lot of back and forth between scientists and the doctor. So we have a fine needle biopsy, right? Get it from a patient. It’s a small biopsy, but we can still test 50 drugs. So we go back to the physician, what are your thoughts? What are you thinking? What do you want to test? And it’s become a very dynamic experience where we would get physician feedback and we would start testing the drugs that doctors are thinking about. And then we tell the doctor, you know what, out of these 50 options, those are the best. And that has gotten more and more physicians to start adopting this approach, That interaction that takes place in real time. And so I believe as we do this and we continue to do this, we’ll be able to convince more doctors to use these tools and technologies to inform clinical decisions.

I have a lot of friends who are oncologists, and everybody has that skepticism that you were talking about, Jim. I think that everyone waits for someone that they respect to do something before they’re willing to jump on board. At least I can say that from even my own personal experience, I’m not going to jump into a new surgical treatment without somebody that I respect at least giving me their experience and it being a positive one. That being said, if you guys get your certification and an oncologist wants to start using your treatment, then they just contact you? Or is it the patient that contacts you? How does that happen?

So basically the patient or the doctor can contact us directly. We send them a kit because the kit has to be prepared in a very special way to allow us to achieve the results. We have to get a fresh biopsy within 24 to 48 hours. The beauty of what we’re able to do… and in fact, we just got a grant to close health disparities in minority communities… because what we’re able to do is the patient doesn’t have to travel to a cancer hub. They can be treated locally in their local hospital by their local doctor, but they can have this world-class protocol precisely telling them what drugs to use. But it’s just as simple as they’d contact us. We would send them a kit. We have a patient care coordinator who would work with the surgeon and the hospital to make sure that we get the biopsy appropriately shipped to us and the rest is ours.

What is the turnaround time for results?

Ten days.

Oh, wow.

Yeah.

Faster than my biopsies come back.

That’s right. Yeah. And again, it has to be done in a clinically actionable timeframe.

That’s great, man. Well, all the best of luck to you guys. And it is something that I’m personally keeping an eye on because I have a vested interest in it. Just from my history that I kind of shared with everyone. 

I wanted to ask just about any more evidence, because I know that we had talked before we started about other preliminary results that you guys were having. Is there anything that is available for people who are in maybe their first stage of cancer therapy? Because I can just tell you from my experience with head and neck cancer right now, for whatever reason, head and neck cancer is on the rise and it’s getting more aggressive, especially hitting younger populations. And the 33-year-old patient that comes in to see me, does he have to go through failed treatment first beforehand, is there any value for him to do this test upfront? I’m just not sure about any sort of opportunity that’s available for patients that have really aggressive disease that you want to throw the kitchen sink at them right off.

I’ll take a first stab at this, and this is going to be a little bit different than probably what Diana’s going to answer. 

So, under the clinical studies, the study design has been written for patients whose cancer has returned. From our perspective, from a First Ascent perspective, outside of a clinical study, if this is where the patient, the doctor and First Ascent all come in together. And we have a doctor who ultimately is going to have to make that decision, do I treat based on standard of care? Do I treat based on this protocol? That’s the decision the doctor has to make. We can provide them with all of the evidence, and if we have doctors that are interested and patients that are willing to do this as a first line of treatment, I don’t think there are any barriers to keep us from doing that except lawyers.

And honestly, I’m going to just add that our goal, and my personal scientific goal is to set up clinical trials for patients that are newly diagnosed. Because I truly believe, based on the data that we’re seeing, if we start early, we really prevent a lot of toxic effects of the trial and errors that come with drugs that are not going to work. And the earlier we start, the more effective this is going to be. And I believe that we will show it. That’s our goal. We’re going to get grants to fund clinical trials on newly diagnosed cancer patients. Let’s say head and neck, osteosarcoma types of cancers that are just brutal in terms of their treatment. And I’m very optimistic about the data.

I mean, I’m sorry to hear about your parents. I lost a son to cancer. And that was really the genesis behind me saying, “I know this is a solvable problem.” Nothing’s worse than taking a kid through 8 months of grueling chemotherapy and amputating a leg and calling it limb-salvage, only to have their cancer come back and ultimately take their life. And so Diana mentioned that we want to fund an osteosarcoma study because we really believe that that’s a really brutal disease. We really believe that ultimately we can help change the standard of care. By the way, that hasn’t changed in 40 years. And so that’s part of what we’re trying to do. We also have a pancreatic cancer study, because pancreatic cancer is just really a difficult one to treat. And the patients are getting younger, so we’re working with, believe it or not, a healthcare system, an insurance company. They want to sponsor a health economic study, because what we were able to show was that with the patients that we treated, a number of them, not only did they have better outcomes, but we significantly reduced the cost.

Interesting.

Cheaper drugs, more accessible drugs.

Cheaper drugs, more accessible drugs.

I look forward to that data coming out, and certainly any head/neck cancer-oriented data you guys can feel free to send my way and I’ll try to disseminate it. It’s just such a tough thing to talk about because it touches everybody’s lives. I can only imagine what you’ve been through, Jim. I feel like there’s some solace in watching your parents pass away. But, man, just watching your kid pass away, that’s on another level. Should be the other way around.

I hate to end on such a sad note. I really appreciate what you guys are doing, but we are getting close to the end of our time. I always end with three questions that I ask all of my guests, which are supposed to inspire a lot of hope and hopefully kind of make sure that we think about the future in an optimistic light. The idea of making the future, building the future, just like what you guys are talking about, really comes from inspiration. And I always ask all my guests, what is your inspiration? I’m sure that Jim would say that his experience with his son is probably his, but, Diana, I didn’t get to ask you. I’m sure that there’s some pretty interesting stories behind why you do what you do.

We’re all touched by cancer, but thankfully, I wasn’t nor my family was touched by cancer. What inspired me was, as a scientist, I realized we make all these amazing, state-of-the-art discoveries in the lab. But when I looked at how many of these are available for treatments on cancer patients, I realized that very few are. And that’s where I was like, okay, no, this is crazy. We’re making great discoveries in the lab that don’t really get to patients, and that’s what inspires me. I want to be able to be part of that mission. My mission is to try to work on bringing these state-of-the-art technologies to patients.

That’s crazy, what the disconnect is. There are two things that I wish that people knew about from this podcast. Number one, other than the standard protocol, there are other treatment options, at least dozens, most likely hundreds. I don’t think a lot of people realize just the amount of drugs that have been researched out there that aren’t even used for anything, or they might be used for something else. Or they’re orphan drugs. And even the idea where you were talking about genomics. I mean, we’re curing sickle cell these days. There are lots of treatment options that are even just outside of drugs that might be effective, but we don’t have a way of quantifying that. And I appreciate the fact that you guys are doing that. That being said, I don’t think the general public knows that there are more treatment options than the first treatment option that’s available to them. And the second thing I don’t think that they know about is precision medicine. Everybody thinks that we’re in the future because we have iPhones in our hands and WebMD is able to give them a full detailed rundown of exactly what’s specific for them. Most people are treated by standard protocol, and the benefit of that is the safety. This is something that’s tried and true. It’s been used, it showed effectiveness, but I think that everybody thinks that they have a doctor who’s looking specifically at their genetic structure and their physiology, and they’re getting a treatment that’s specific for them, and that’s just not the case. And that’s certainly an inspiration because you’ve seen a need and now you’re trying to fix that problem that you see. So I really appreciate that.

Future of Biotech and AI Integration

The second question that I ask everybody is where do you see your field in 10 years? I’ve had people on about AI, I’ve had people on about robots, I’ve had people on about space exploration. But biotech specifically is important to me because I live just a few blocks from MIT. You can see the picture of it behind us, and that’s the biotech capital of the world. So where do you guys see it? Because you’re actually in the trenches in the arena doing this stuff to make the world better. How do you see biotech in 10 years? I’ll start with you, Jim.

I think the biotech industry is one of the last industries that’s ready for digital disruption. So I think doctors know it, the FDA knows it, the patients know it, and it’s just really a matter of how we get there. I believe that technology will enable doctors to make better decisions by assimilating petabytes of information and clinical data and functional drug testing and all of that, and putting it in their hands so that they can make better decisions. I hope we never get to the point where AI or some technology is making the decision for a doctor. I always want you to make decisions about me, but I want to be able to put as much data in your hands so that you can take all of your knowledge and all of your experience, and you can read that data and you can take action on it. So that’s where I see it going.

Diana, where do you see biotech in ten years?

I would add that with the AI… so now that the way we’re doing this, we’re integrating AI. So, think about the data set that’s being generated over time. You’re talking from every cancer patient we’re going to know your genomics, your RNA sequencing, drug response, and then put all that data into an AI engine. So what I feel, like, in 5-10 years we may not even need a biopsy to predict. This AI engine, based on your sequence, based on your biology, will predict the right treatments for each patient. So that’s where I see it. I believe that will really transform the way we manage cancer.

We’re building a data set that does not exist, because it’s going to have genomics data, but it’s going to have hundreds of drugs tested against a biologically diverse patient population. It just doesn’t exist. And then adaptive AI will allow us to use all of that history in situations where we can’t get a biopsy and make a better prediction on how that patient should be treated so that the doctor can look at that data and make those decisions faster.

Personal Inspirations and Future Visions

Interesting. Can I give you my idea of where I hope the industry goes and you guys tell me if it’s realistic? And this is us speaking as a surgeon, so there’s a certain amount of self loathing that’s associated with this question, but I would love to be in a situation where we don’t need to operate on people anymore. What really blew my mind was when they cured sickle cell. If we can do that, the possibilities are endless. Surgery, to me, is such an elegant thing, but it’s also a very brutal thing. And you know what I’m talking about, Jim. The recovery is tough, and I just feel like maybe I’m naive, but we have so much more understanding now than we did even when my parents were alive. And I feel like we’re on the cusp of something, and I don’t know what that is. And that’s why I like to talk to people like you, that kind of gives me some insight. But is that unrealistic? Are we talking, like, 50 years before that happens?

No, I think it’s sooner than that. I really do think it’s sooner than that. And again, like Diana said, we may never eliminate the need to do a surgery, but if we can do it in as least invasive of a way, a fine needle biopsy, to be able to allow us to recapitulate these cells to the point that then we can, with a high degree of precision, come up with the right drugs for the right patient at the right time, without having to go in and do a big biopsy or limb salvage or something very invasive. I think ultimately, that’s that next stepping stone.

What about you, Diana?

We have robotics right now that… I think you’re right. Maybe we will be able to get robotics that will replace it.

I think I’m better than a robot right now, but I don’t know if that’s ego talking. I hope that we do have better outcomes through robotics. But I can tell you firsthand, the technology isn’t there for that right now. It’s going to be a while for that to happen. But I did want to talk about something that is very similar to what you’re saying. 

Closing Thoughts and Final Questions

My last question always is, what are you guys interested in outside of your own particular field? There’s so many different technological revolutions that are happening in the midst of what’s happening in biotech. I am so fascinated by them. I cannot wait until I have a helper robot that’s able to do my dishes and fold my laundry. I’m like, I’m going to be the first person in line for that robot. So anytime I see, like, Atlas robot or Boston Dynamics is a few cities away, I take a look at what they have to offer. Just my own personal interests and no financial interests whatsoever. But what about you guys? Because you’re in a very cutting-edge, technology-driven field. You’re building the future. What other aspects of the future are you excited about? 

Part of my DNA is solving complex problems. And so what gets me excited is that juncture between biology and technology. So, for example, to be able to take a cadaver heart, flush all the cells out of it, use it as a scaffolding, 3D print living blood cells back into that heart, give it a spark and have it start beating. I’ve seen that done. And I met the woman who spent 25 years of her life doing that. But so you start thinking about that, because, again, if we start interstellar travel, we go to Mars. You can’t do a heart transplant on Mars, but you can 3D print one. So I think that these amazing people are solving these complex problems. That’s the stuff that interests me.

Oh, my God, I can’t beat that. I’m a scientist. I go in every day and I think how realistic it is to solve a problem every day. So I really don’t have anything that I thought about that.

Yeah, no worries to speak to what Jim was saying, just a few months ago, they actually transplanted a kidney from a pig devoid of all immune responding cells and markers and put it into a human being. Unfortunately, it did not go well for the patient. The patient has since passed away, but at least they’re trying it, right, like that didn’t exist 30 years ago. The idea of building in the body is a very difficult thing. And that’s speaking from first experience. It’s very easy to take things away. It’s very easy to mimic other things or wrap things around so that it is functional, but to build something, that’s pretty cool. 

If I could add one more thing. I’m sorry, but the other thing I think that’s exciting is a lot of these innovations aren’t coming from scientists like Diana. They’re coming from technologists like me or others that bring an engineering background into biology, and it’s really bringing those two things together. So a lot of that innovation is actually coming from outside of the sciences field, which I think is amazing because you’re getting the best of both worlds.

Well, I think that to speak to what you said earlier about gatekeepers, there’s a lot of gatekeepers in academic science. And I’m sure that Diana will say that even just to get her PhD, there were probably so many things that she had to jump through to get that just. It starts you out at a disadvantage. Like, you’re starting your true career in your 40s and 50s, your true impact in your 40s and 50s, whereas industry is something totally different. A 20-year-old can come up with a revolutionary technology that changes the way that we live. That I think is really profound and I’m excited about it. I think that industry is where the impact factor is right now. 

And so kudos to you guys for taking the science and making something out of it. I don’t think it’s easy and I know how long of a process it is by following some other therapies that I’m looking at. And so the fact that you guys actually got something to actually in patients hands, it’s able to help patients. Kudos to you guys. 

That being said, for anybody who is a cancer survivor or someone who is undergoing cancer themselves and wants to get in contact with First Ascent Biomedical, we’re going to have all that information here under the comments section and so will hopefully get them to that next level of actually being able to predict and treat cancers in the first stage as opposed to in these later stages. So thank you guys for doing what you’re doing. 

And thank you to everybody that’s listening out there. Please like and subscribe as always. And for the people who are regularly listening, we will see you again in the future. Thanks everybody.

Important Links

• Jim Foote – LinkedIn
• Diana Azzam – LinkedIn
• First Ascent Biomedical 
• Feasibility of functional precision medicine for guiding treatment of relapsed or refractory pediatric cancers

About Jim Foote and Dr. Diana Azzam