Dr. Debora Barton of CARISMA Therapeutics On The 5 Things Everyone Needs To Know About Cancer

An Interview With Savio P. Clemente

Prevention works — that includes wearing sunscreen, limiting smoking and alcohol consumption, following a healthy diet, exercising regularly, and being proactive by keeping up with necessary screening tests like colonoscopies, mammograms, and blood tests. Don’t let COVID-19 delay your cancer prevention.

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 Debora Barton, MD joined CARISMA Therapeutics in November 2019. She brings over two decades of oncology experience, both in academia as a practicing physician and in the biotechnology/pharmaceutical industry. Most recently, she served in key senior executive positions in cellular therapy and radiopharmaceutical biotech companies including Iovance Biotherapeutics and Advanced Accelerator Applications, acquired by Novartis during Debora’s tenure. She holds a doctorate of medicine from Pontificia Universidade Catolica Sao Paulo (PUC-SP) and completed her fellowship in Oncology at Federal University of Sao Paulo (UNIFESP) in Brazil.

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 Brazil and always wanted to be a physician, specifically an oncologist. As a kid, there were no cases of cancer in my family, so my interest in being an oncologist came from my curiosity in trying to understand this mysterious disease that shows up unannounced, puts up a fight, and sometimes takes people’s lives. Later on, after becoming an oncologist, I could really see why this disease is so fascinating and how each patient is unique and deserving of very individualized care.

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

I was inspired to pursue oncology initially due to my general curiosity about the diversity of cancers, and how they can significantly impact a person’s life. I wanted to learn why we are only able to get completely rid of cancer in some cases. Then, in medical school, I had a wonderful oncology professor, Dr. Gilson Luchesi Delgado, who fueled my interest even more in the space and taught me valuable lessons that I carry through with me today. Most importantly, my interactions with cancer patients in the clinic were invaluable in a way I cannot put in words. Their kindness and trust made me even more committed to always search for better solutions for them.

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

In oncology, every small win is a big win for the patient. If I can improve the life of a cancer patient even a little bit, from improving a symptom such as pain, insomnia or anxiety, or going as far as recommending a therapy strategy that ends up rendering that person cancer free, it is always a big win. My goal in life is to improve and prolong the cancer patient’s life and journey. I seek to better understand how the disease progresses, changes and reacts to its environment and treatment. That way, I better target the cancer and maintain the patient’s quality of life.

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

Currently, I am working on a different cell therapy that is being studied in humans for the first time. Some cell therapies are already more commonly known, such as CAR-T immunotherapies for the treatment of hematological malignancies (also known as “blood cancers”), but at CARISMA we are working with macrophages. Macrophages are very different from the cells used in CAR-T therapies, and we believe they can better address solid tumor patients’ specific needs. The innovation of doing this for the first time is extremely exciting and promising.

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

Throughout my oncology career of now 21 years, I have been on a quest to answer: what more can we do for cancer patients? I have remained steadfast in my dedication to addressing the unmet needs of patients — staring in clinic, treating cancer patients and enrolling some of them in clinical trials, to the biotech and pharmaceutical industry, building and leading medical affairs, clinical development and drug safety teams, and setting up infrastructure for the conduct of clinical studies of innovative therapies. Despite the pandemic, I have continued this journey, leading the CARISMA Therapeutics team to successfully dose the first patient in a landmark clinical trial (CT-0508) for a human epidermal growth factor receptor 2 (HER2) targeted chimeric antigen receptor macrophage (CAR-M) targeting solid tumors. Additionally, I remain committed to advocating for patient care through my volunteer work, such as my role on the American Cancer Society Manhattan Board, and the Tigerlily Foundation.

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?

All our organs in the body are made up from a collection of different cells. These cells need to multiply as we grow, and regularly renew as some cells die and new ones come up to replace them. Cancer is an unregulated growth of cells that are altered in a way that makes them not functional and immortal. This growth can rapidly spread and negatively interfere with normal bodily functions and organs.

What causes cancer?

You will frequently hear that cancer is a multifactorial disease — it takes many steps for a normal cell to become a cancerous cell. There are several different factors that come into play, which include exposures to environmental toxins such as asbestos, behavioral actions such as sun exposure and alcohol consumption or smoking, as well as genetic factors that can contribute to cancer. At the same time, some people with no genetic predisposition, who are not overly exposed to sun, don’t smoke and don’t drink, and otherwise live a very healthy and happy life, still may have cancer. It is part of its mystery.

What is the difference between the different forms of cancer?

There are two types of cell growth, otherwise known as tumors. One type is the benign tumor, where the cells grow only locally in the organ they originated and don’t spread through the body. These can be safely removed, and the patient is considered cured. The other type is the malignant tumor, which is called cancer because the cells grow uncontrollably and have the capacity to spread throughout the body. There are malignant cancer patients that can be considered cured if the disease is caught early enough and if all affected cells are completely removed or treated.

Both benign and malignant tumors can arise from virtually all organs in the body, and a microscopic evaluation after a biopsy procedure can specify the type of cells and if they are benign or malignant.

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

There are many things that one can do to prevent cancer. One is to wear sunscreen for the prevention of skin cancers, such as melanoma. Another is to stop smoking and if one chooses to drink alcohol, to do so in moderation. Following a healthy diet and exercising regularly can also help to prevent different types of cancers. I also recommend complying with the recommended colorectal cancer screenings, which start at age 45. Other screening procedures, such as mammograms, can help diagnose a cancer on its earlier stages, so it can be more easily treated. You should always talk to your doctor so they can recommend the ideal screening tests for you, based on your personal and family history.

How can one detect the main forms of cancer?

The most frequent cancer types are breast cancer for women and prostate cancer for men. They can be detected early by going to a physician regularly and performing the screening tests that are required for your age group and risk level, such as mammograms and blood tests. Your doctor will let you know when you should initiate screening exams based on your personal and family history of cancer, and how often you should repeat them.

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

It is tough to put a general number on survival odds, but cancer is certainly not a death sentence. Three significant variables have to be taken into account when a cancer diagnosis is made:

Which type of cancer a person has and the currently available treatment options.

At what stage it is detected, and what size the tumor is. It’s also important to find out if the cancer has spread to other parts of the body.

The clinical status of the patient, such as their age and other diseases they may have such as hypertension, diabetes, etc. We need to know if their other organs are in good shape.

These three together will help the oncologist define if a radical treatment with curative intent is possible and if the patient will be able to tolerate it. The important message is that if we follow healthy habits and perform the cancer screenings that are in practice, the chances are that we can catch cancer early on. When cancer is caught early, there is a higher chance that it can be successfully treated. Also, it is very important that if you are experiencing any signs or symptoms of disease, you should go to the doctor and not wait. Currently with hospitals being overwhelmed with COVID-19 patients, people are postponing their regularly scheduled visits and screening tests. If you wait to go to the doctor, you may risk a diagnosis of a later-stage disease.

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?

A recent breakthrough in cell therapy is the use of CAR-T cells for the treatment of some types of hematological malignancies, or “blood cancers”. This treatment utilizes the patient’s own immune cells to treat their cancer. However, there are other types of cancer patients who are not benefitting from such therapies and still need more innovation, such as patients with solid tumors. Solid tumors behave differently than hematological malignancies; they are more heterogeneous and therefore require a different approach to be successfully treated. At CARISMA, we are working on a different cell type, CAR-macrophages (CAR-M), that are better equipped to treat solid tumors. Our CAR-M program is currently being studied in clinical trials, enrolling patients with HER2 overexpressing solid tumors, which include breast, gastric, pancreatic, ovarian cancer, and several others.

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

It’s very important that the patient develops a trusting relationship with their oncologist, so that they have the tranquility to focus on themselves and their healing. It is also important that each patient finds their personal “escape” mechanism that is not related to the treatment, so that they can have a better healing process — like meditation, yoga, a hobby or any other activity that they can enjoy. Finding healthy ways to cope with the diagnosis goes hand in hand with the success of the treatment.

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

In this age of the internet, reaching out to “Dr. Google” may not result in accurate information, and can generate further anxiety. Each patient’s diagnosis is unique; social and family circumstances are taken into account when they visit their oncologist and decide on a treatment plan. It’s important that if you have a loved one who receives a cancer diagnosis, give them support by checking in on them regularly and reassuring them that they are receiving the best care. Let them know that their physicians have their best interests in mind, so they can focus on healing.

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

The most important myth is that a cancer diagnosis is a death sentence. Often, cancer can be successfully treated if it is diagnosed early. Even when diagnosed at a later stage, there are multiple tools in the toolbox to control the disease and, if not curable, the quality of life can be significantly prolonged, in some cases for many years. It is very important not to postpone a visit to the doctor, so a proper diagnosis and treatment plan can be put in place as soon as possible.

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. Cancer is not one disease. There are hundreds of different types of cancer, and all are treated differently. Two individuals with the same cancer may receive different therapies depending on their general health and individual preferences.

2. Some forms of cancer are easier to treat than others, depending on the type of cancer and at what stage it is diagnosed. A cancer diagnosis is not a death sentence.

3. Prevention works — that includes wearing sunscreen, limiting smoking and alcohol consumption, following a healthy diet, exercising regularly, and being proactive by keeping up with necessary screening tests like colonoscopies, mammograms, and blood tests. Don’t let COVID-19 delay your cancer prevention.

4. It can be a scary moment in someone’s life to visit an oncologist. But oncologists are extremely committed to finding the ideal treatment plan for their patients, and ensuring individual needs are addressed and respected.

5. There has been significant progress in the understanding of cancer and in cancer treatments. There is a lot of innovation happening right now and new therapies are on the horizon. There is a lot of hope in the field of oncology.

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. :-)

Prevention. Prevention. Prevention. And early detection. There are some factors with cancer that are out of one’s control. But, if there is one thing I can instill in people’s minds that will make me the happiest as an oncologist, it would be sharing that there are some factors you can control that can prevent cancer from occurring or at least to catch it early enough.

How can our readers further follow your work online?

You can follow my work at CARISMA Therapeutics on LinkedIn.

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