Alec Ford of Karius On The 5 Things Everyone Needs To Know About Cancer

An Interview With Savio P. Clemente

…As many people are touched by cancer, think of someone you know who’s going through this. Reach out to them. Call them. Listen to them on the phone for 30 minutes. Bring their family some food. Tell them that you’re thinking about them. And help them during this difficult journey.

Cancer is a horrible and terrifying disease. There is so much great information out there, but sometimes it is very difficult to filter out the noise. What causes cancer? Can it be prevented? How do you detect it? What are the odds of survival today? What are the different forms of cancer? What are the best treatments? And what is the best way to support someone impacted by cancer?

In this interview series called, “5 Things Everyone Needs To Know About Cancer” we are talking to experts about cancer such as oncologists, researchers, and medical directors to address these questions. As a part of this interview series, I had the pleasure of interviewing Alec Ford, CEO of Karius.

Alec has over 30 years of experience in the genomics, pharmaceutical, and biotechnology industries. He is currently CEO of Karius, maker of the Karius Test, which can detect over 1,000 pathogens in a single blood draw from immunocompromised patients with cancer — without the need for invasive procedures. Before joining Karius, he spent a decade at Myriad Genetics, most recently as Chief Operating Officer. Myriad Genetics is a molecular diagnostic company, with a focus on identifying and preventing inherited cancers.

Thank you so much for joining us in this interview series! Before we dive into the main focus of our interview, our readers would love to “get to know you” a bit better. Can you tell us a bit about your childhood backstory?

I grew up in Chicago, one of three kids. My relationship with my family, especially my sister, helped shape how I think about cancer and especially inherited disease.

What or who inspired you to pursue your career? We’d love to hear the story.

I’ve been inspired by lots of people over the years. Working for so long, as I had, with the focus on prevention of inherited cancers, I heard from so many women and their families about the impact of cancer on their lives. One in four hundred women have mutations putting them at increased risk of breast or ovarian cancer, but only about 10–15% of those women have any idea. Many don’t even know until the first malignancies show up.

But on a personal level, like so many of us, I lost a sister nine years ago to inflammatory breast cancer. She was a brilliant epidemiologist at the University of Texas, and had a profound impact on the focus of my work over the last decade. Cancer touches everyone — and it changed how I think about preventable cancer, and mortality associated with cancer.

I’d spent much of my career working in both infectious diseases and cancer. My focus now is preventing deaths associated with infections in people with cancer. Many people fail to realize infections are a leading cause of mortality among people with cancer.

This is not easy work. What is your primary motivation and drive behind the work that you do?

I see myself as a facilitator of change. You can have extraordinary focus on a mission that you think is important. But at the end of the day, that mission has to translate into a very specific behavior change, in this case in how medicine is practiced. If that change doesn’t happen, it’s all just talk.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

At Karius we have a couple of areas of focus. One is increasing peoples’ understanding of the threat infectious diseases pose to patients who are immunocompromised. Our top goal is to provide education to health systems, clinicians, physicians in hospitals and other providers, helping them understand the magnitude of the problem associated with infections among immunocompromised populations and how often the current tools fail.

Our second pillar is providing a solution that addresses many of the challenges in diagnosing these infections in immunocompromised patients. As you might expect, immunocompromised patients have some unique challenges when it comes to infection. For the vast majority of them, when they are threatened by infection, they endure multiple, often invasive tests over a prolonged time. Many of those diagnostics tools fail to provide information that tells doctors exactly how the patient should be treated. With our technology, we can help providers cut through a significant amount of the delay, treatment failure, and other implications of not having a clear diagnosis.

For the benefit of our readers, can you briefly let us know why you are an authority about the topic of Cancer?

There are many others who are a greater authority on cancer itself than me. But cancer and infection go hand-in-hand. I mentioned earlier that a leading cause of mortality in people with cancer is infection. Over the last two decades, we’ve seen a tremendous investment in new technologies, advanced diagnostics, and novel cancer therapies pay off, accelerating progress against the cancers themselves. But at the same time, the technologies used to understand infections in people with cancer had been at a relative standstill.

We have an opportunity to apply similar advanced technologies and solutions for this interwoven threat to cancer patients. In the cancer diagnostic world, tools like genetic sequencing, liquid biopsy, and somatic testing are commonplace. They’re used to identify tumors, understand what’s taking place inside them, and determine how to treat them. I’m committed to using these approaches to reduce morbidity and mortality among cancer patients in a different way.

Ok, thank you for all of that. Let’s now shift to the main focus of our interview. Let’s start with some basic definitions so that we are all on the same page. What is exactly cancer?

There’s a rote answer here about cancer being an umbrella term for a lot of different diseases where cells divide in an uncontrolled way. But because of my experiences, I tend to think about cancer from the perspective of the patient, and their families. To them, cancer isn’t just defined by the disease, but also by the treatment, the endless hours of surgeries, blood draws and scans, the waiting, the cycles of fear and hope.

What causes cancer?

There are a lot of different causes of cancer, including infections that can be detected in the blood like human papillomavirus, Hepatitis B, Epstein-Barr virus, and H. pylori.

Before joining Karius, I was focused especially on the prevention of inherited cancers. If you are born with certain mutations predisposing you to these inherited breast or ovarian cancers — it’s not a question of if you’ll get cancer, it may be when. That makes it crucial to identify people early. But even though the technology has been around for 25 years, we still have 85% of these women with a strong family history of cancer but no idea they’re at risk, and they may not find out they carry that mutation until after a malignancy shows up. It’s heartbreaking.

What is the difference between the different forms of cancer?

Cancers often get broadly categorized as blood cancers or solid cancers, but the reality is there are a lot of different subtypes. This has obviously made treating them a challenge, but a common denominator is that almost everyone treated for cancer will be immunocompromised for at least some time.

There are a lot of potential reasons for that. Some cancers themselves can impact your immune system, like lymphomas. Some patients may need treatment with a procedure like stem cell transplant or a medicine like chemotherapies and immunotherapies, which themselves may impede the immune system. There are even certain cancers that are just more common among patients who already had an immune disorder. That’s why infection is such a danger for patients with cancer overall, because no matter what kind of cancer you have, the threat reaches everyone.

I know that the next few questions are huge topics, but we’d love to hear your thoughts regardless. How can cancer be prevented?

When we talk about cancer prevention, most of the time we’re discussing lifestyle changes around smoking, diet, or exercise, and also environmental risks like sun exposure. Cancer screening can also aid in the early detection and treatment. Vaccines are crucial too — the HPV vaccine is reducing rates of both cervical and head and neck cancers, and the HBV vaccine similarly prevents liver cancer. But in my career, I’ve been very focused on cancers caused by germline mutations, which get passed down from parent to child. You can’t prevent those genes from being shared within families, though some women at high risk choose preventive surgeries to lower their risk.

How can one detect the main forms of cancer?

We’ve seen significant advances in early cancer screening in the last three decades. You can look at any type of cancer today and find we’re able to identify it at earlier and earlier stages, which can make these diseases much more treatable. It’s important that we elevate peoples’ awareness around screening tools like colonoscopy, as well as advanced technologies like liquid biopsies, for early detection. People need to talk about their cancer family history in discussion with their doctors, and take advantage of all available recommended screenings.

Cancer used to almost be a death sentence, but it seems that it has changed today. What are the odds of surviving cancer today?

With a few notable exceptions, mortality rates have declined across most cancers over the last 30–40 years as a result of better therapies and earlier identification, particularly in children. But as people survive the cancers longer, their time at elevated risk for infection may also increase.

Our understanding at Karius is that people will go through a variety of treatments, and irrespective of the kind of cancer that impacts them or the stage of that cancer, it’s very likely that their immune system will be threatened during the course of that cancer treatment. Given the significant risk of an infectious event, our focus has been making sure there’s technology available to identify the causes of those infections.

That’s not only so they can be treated successfully, but just as importantly, so that they can return to cancer therapy more quickly than they would have otherwise. And with it, hopefully, comes the chance to improve their long-term outcomes. We would love to be known as the company that gets patients back on their cancer treatment as quickly as possible, after interruption from an infectious event.

Can you share some of the new cutting-edge treatments for cancer that have recently emerged? What new cancer treatment innovations are you most excited to see come to fruition in the near future?

There are a lot of new cancer treatments to get excited by, and what we see in the clinic and just past the horizon hold so much promise for patients. But again, we look at them through the lens of the infection threat to patients with cancer. For example, some newer therapies work by tagging in the immune system itself to fight cancers, but they might require cotreatment with an immunosuppressant.

There’s been a significant improvement in the personalization of cancer treatment over the last 25 years. Clinicians use therapies based on identifying genetic mutations in a tumor that are causing a malignancy. People can better select therapies that are more likely to produce a successful outcome. The common thread is, they can still have an impact on overall immune function. That’s one reason why I’m excited about our work. If we can improve infectious disease treatment through better and earlier diagnoses, it improves the chances that the next personalized, targeted, or advanced cancer treatments will extend patient lives, regardless of whether it impacts their immune systems.

Healing usually takes place between doctor visits. What have you found to be most beneficial to assist a patient to heal?

Between visits, and between treatments, many patients are keen to continue as much of their life as usual, when feasible. And that’s really important for their mental wellbeing, but some precautions may be needed. First of all, patients need to have a clear understanding of their immune status — if you’re not sure, your oncologist can help you understand when you are or will be most at risk.

When your immune system is weakened, you may be susceptible to any number of pathogens that might not ordinarily be able to infect you. You also might not display the typical symptoms that help identify a type of infection. These infections can really throw off the course of a cancer treatment plan, or worse.

When it comes to infections in immunocompromised patients, the only thing better than catching them early is preventing them. Especially living as we have through this pandemic, we’re all familiar with a number of general ways to protect against infection — masks, social distancing, thorough hand-washing, avoiding people who may be ill, and vaccines. Patients should heed the advice directly from their medical teams, but I bring this up as well for their family members, who can effectively form an outer wall of additional defense against infection.

From your experience, what are a few of the best ways to support a loved one, friend, or colleague who is impacted by cancer?

From my personal experience, it seems that many people think that they can handle this themselves, or on behalf of their loved one. We have to reach out constantly to the people in our lives who are impacted, and tell them they’re not alone. Try to join with them as often as you can, be with them on that journey — listening, supporting, asking questions not only about how they are taking care of their family member, but how they are taking care of themselves.

Cancer puts an enormous burden on any family — I’ve seen it in my own. It’s important to focus on the people providing the support as well as the person going through treatment.

What are a few of the biggest misconceptions and myths out there about fighting cancer that you would like to dispel?

There’s a misconception that cancer by itself is the greatest threat to patients’ health. People may not understand the role that infections can play not only in disrupting cancer treatments, but also causing suffering and mortality in cancer patients.

Thank you so much for all of that. Here is the main question of our interview. Based on your experiences and knowledge, what are your “5 Things Everyone Needs To Know About Cancer? Please share a story or example for each.

1. The number one cause of mortality in the United States of people who are battling cancer is actually infections, not the underlying malignancy.
2. Every single minute in the U.S., five people are admitted to a hospital due to an infection who are also being treated for cancer. Even before the pandemic, respiratory diseases like pneumonia and influenza were the most common infectious threats.
3. One of the greatest threats to children receiving stem cell transplant or other therapies for cancer are infections. In instances of childhood leukemia, many kids can see long-term benefits after receiving bone marrow stem cells from a healthy donor. But the process can weaken their immune system for months.
4. The technology we use to diagnose infections in hospitals today is much the same that was used 40 years ago, and there’s a significant opportunity to make that better. Take biopsies: they are still used today to detect the kinds of deep-seated infections that are more commonplace in patients with cancer. But they require removing a sample of tissue for analysis, which can range from painful to dangerous. Thankfully, advances in blood-based testing are shrinking the reliance on these methods.
5. As many people are touched by cancer, think of someone you know who’s going through this. Reach out to them. Call them. Listen to them on the phone for 30 minutes. Bring their family some food. Tell them that you’re thinking about them. And help them during this difficult journey.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)

I would focus on two things: one, that providers and patients understand the risk that infections play in successful cancer treatment. The second is that every person who has cancer in their family writes that cancer family history down, and takes it to their doctor to discuss how their care should be different.

How can our readers further follow your work online?

You can come to Karius’s web site to learn about how we’re trying to contribute to the successful treatment of cancer through the successful treatment of infectious diseases.

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.