Dr Cristian Massacesi of AstraZeneca and Alexion On The 5 Things Everyone Needs To Know About Cancer

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 Cristian Massacesi, MD.

Cristian Massacesi, MD, has more than 20 years of experience caring for patients with cancer and conducting clinical research. He is the Chief Medical Officer of AstraZeneca and Alexion, where he is responsible for ensuring that patients, physicians, and regulatory agencies are provided with information on the safe and appropriate use of the company’s entire portfolio of medicines. He is also the Oncology Chief Development Officer at AstraZeneca, where he is responsible for the development of a broad portfolio of potential cancer medicines, and currently more than 150 studies spanning multiple Oncology indications.

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 was born and raised in a middle-class suburb in Italy, right by the sea. I have one younger sister and an extensive extended family that made life exciting and fulfilling as a child. I was one of the first kids born among my parents’ circle of family and friends, and I confess, while I enjoyed a lot of the extra attention during those earlier years, I also cultivated high expectations for myself, which pushes me to work harder and go further!

I did well in school and was the first person in my family to go to medical school, which was a big deal at the time. This eventually made me the first doctor in my family. As many first-generation doctor’s experience, I quickly became the go-to resource for all of my relatives seeking medical advice!

My parents certainly influenced my path to becoming a doctor from the very beginning. In fact, my mom was so inspired by the world’s first human-to-human heart transplant conducted by Christiaan Barnard, she decided I would be called the Italian version “Cristian” even before I was born!

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

My parents were both incredibly supportive in steering and encouraging me to pursue my career. When I was young, I admit that I initially wanted to become a literature or film critic. However, my dad pushed me to expand my horizons and to go into medicine as a better use of my skills, and I never looked back. I loved it from the start because of the strong connection between two of my passions — science and human connection.

After medical school and a successful start to my academic career, I switched focus to medicine development to seek better treatment options and moved my family from Italy to America. This took a lot of courage, which I drew from my mother. Since I was very young, my mother stood out as a pioneer — demonstrating the importance of tackling challenges and pursuing your passions. She always had a very entrepreneurial spirit and, during the 60s, opened her own fashion business. This was quite something for women in our community during the time, but she followed her passion — without any financial support — and succeeded. I feel I inherited some of her courage because I eventually uprooted myself from my stable academic job to pursue something new that I was passionate about — oncology medicines development.

Another source of inspiration are my daughters, who strengthen my desire to help others with advancing oncology medicines, and to give them a future where there is a cure for cancer.

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

Two things motivate me every day in the work I do.

The first is my love of challenges and curiosity of new things, and certainly — in my opinion — oncology is one of the most challenging branches of medicine where we are learning new things every day. When I first started in academia, there was very little to offer patients. There was solid science, but much of it wasn’t yet mature enough to deliver medicines and better options to these patients.

The second motivation is to help people — and in the case of cancer, this, unfortunately, was frequently people facing death. Still very vivid is the memory of when I witnessed a patient pass away for the first time during the first year of my medical fellowship in oncology. This was someone dying from gastrointestinal cancer in a ward of many other patients with cancer and similar prognoses. We had very little to offer them but comfort and pain relief. Being unable to do little else for this patient — and others — and accept they were going to die, filled me with deep sadness, frustration, and a determination to discover medicines that could change the course of this disease.

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

There are several cutting-edge, exciting projects we are working on at AstraZeneca that have significant potential to help patients with cancer. It’s impossible to cover them all in this interview, but a few are particularly close and relevant now.

There have been groundbreaking developments in breast cancer research. For example, at AstraZeneca, we have created one of the industry’s most diverse pipeline of cancer medicines. Our innovative breast cancer portfolio features more than 15 large late-stage breast cancer trials across five different medicines that have the potential to be first- or best-in-class treatments and could change current treatment practices to improve outcomes. Some of this groundbreaking research has been making headlines this year — such as the presentation of results from a clinical trial in one of the most aggressive cancers, HER2-positive metastatic breast cancer, which show potential to help patients live longer.

There is also significant progress being made in how we research and treat a range of resistant cancers, including non-small cell lung cancer (NSCLC), genitourinary cancers, gastrointestinal cancers, and many others where there are few treatments options available today. New treatments and combinations are being explored in these difficult-to-treat cancers, simultaneously targeting multiple biological pathways and the immune system, with the goal of improving response rates and the potential to extend benefit to greater numbers of patients.

In addition, there have been significant advancements in improving the experience for patients taking part in clinical trials. Even before the COVID-19 pandemic, AstraZeneca was spearheading innovations in clinical trials — from real-time analytics to remote “at-home” options for patients and much more — to make it easier for more patients to participate. The pandemic accelerated the implementation of these cutting-edge digital solutions and technologies that enable smarter patient enrollment and better ways to track how patients respond and also to keep them informed. This ultimately makes it easier and simpler for patients to take part in a clinical trial and alleviate the burden of participating in a clinical trial, while also allowing us to develop more new medicines for patients as effectively and efficiently as possible.

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

I am a medical oncologist by training and started my career treating patients with breast cancer for more than ten years. However, I was very frustrated by the lack of treatment options available to my patients during this time. I became involved in cancer medicines development more than 20 years ago in the hope of bringing safe, high-quality, practice-changing treatments to patients today. Now, as Chief Medical Officer of AstraZeneca and Alexion, I am responsible for ensuring that patients, physicians, and regulatory agencies are provided with information on the safe and appropriate use of all our medicines — for cancer and for other conditions like cardiovascular and respiratory diseases. I am also Oncology Chief Development Officer, where I oversee the development of more than 150 studies spanning multiple cancer indications. Every day the oncology teams I lead are discovering better ways to translate exciting science into potential new treatments, conduct research, find new targets against the drivers of cancer, and identify novel strategies to fight resistance to cancer treatment.

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?

At its simplest definition, cancer is an uncontrolled growth of cells. However, to really understand cancer, first, it’s important to know about DNA, which makes up your genome. DNA provides the instructions on how to make the trillions of cells within your body. These instructions are also constantly being copied over and over again. During this process, errors can sometimes occur, known as genetic mutations. Sometimes these mutations are harmless, and other times they can lead to the development of cancer. DNA can also be damaged from external factors, such as sunburn or smoking. Either way, once cancer begins developing, it can continue to produce more of these cancerous cells that crowd out normal cells, which is typically when you can start noticing cancer symptoms. Once the cancerous cells rapidly multiply and invade your normal cells, this can be detrimental to the health of your body and prognosis of the disease.

What causes cancer?

Cancer is essentially a genetic disease. Some people are born with genetic mutations, which can increase their risk of developing cancers, like BRCA gene mutations that can lead to the development of breast and ovarian cancers. Others acquire genetic mutations — either from the process of aging or from activities like smoking, tanning, or other lifestyle habits — which can make it more likely that cancer will develop.

What is the difference between the different forms of cancer?

Cancer is a lot of different, complex diseases. Today, it is typically classified as either a solid tumor or hematological malignancy (also known as blood cancer). These are further classified based on their location in the body — such as lung cancer occurring in the lungs.

Different ways to classify the disease are emerging with a better understanding of cancer and its many drivers, and the proliferation of new medicines to address different cancer types. For example, HER2 is a gene commonly associated with breast cancer. We now have a wealth of various targeted therapies designed to specifically target HER2, and we’ve observed positive outcomes in patients with breast cancer.

However, HER2 is also associated with many other cancers like gastric, bladder, ovarian, and others. This means that drugs targeting HER2 may also offer the same promising results in these cancers, which is driving further research.

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

Research shows several cancers can be prevented through simple lifestyle changes — such as reductions in smoking and tobacco use to prevent lung and oral cancers, and reduced exposure to sun and ultraviolet (UV) rays to prevent skin cancer. Maintaining a healthy diet, lifestyle, and low alcohol consumption can also lower your risk of developing cancer.

HPV-related cancers, such as cervical, uterine, and throat cancers, are also becoming preventable thanks to the development of the HPV vaccine combined with regular pap smears to detect and then remove abnormal cells before they become cancerous.

Unfortunately, several cancers still cannot be prevented as of today, but they can be caught earlier. The earlier a cancer is caught, the earlier treatment can begin, which may improve the odds of survival. As a former practicing oncologist, I cannot emphasize enough the importance of annual check-ups and routine screenings to catch cancer early. If you have delayed seeing your doctor or postponed a screening due to the COVID-19 pandemic, I urge you to resume those health visits.

How can one detect the main forms of cancer?

Doctors regularly conduct screenings that can help catch many different types of cancers early. In addition, it’s important for women to get regular mammograms and pap smears to monitor for breast cancer or cervical cancer, respectively. For men, it’s important to have a routine prostate exam to monitor for prostate cancer. It’s also important for everyone to maintain routine colonoscopies to monitor for colon cancer. It’s also critical to listen to your body and don’t ignore signs from your body, like intense fatigue or anything unusual, which may be the warning signs of cancer.

Usually, people are in the habit of maintaining health check-ups, which has positively impacted overall cancer survivorship. However, since the start of the COVID-19 pandemic, research suggests people have postponed routine check-ups or delayed seeking medical attention for new symptoms out of fear of COVID-19 or perhaps because they cannot see a doctor in person. This puts people at risk and is a potential setback for the positive progress made to date in cancer survivorship. That’s one reason why AstraZeneca partnered with other organizations to launch New Normal, Same Cancer, to encourage people to continue their routine check-ups or see their doctor about new symptoms.

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

Throughout the past couple of decades, the odds of surviving some types of cancer have significantly improved due to improved cancer screenings catching the disease earlier and advances in treatment options for people diagnosed. While the survival rates depend on the specific type of cancer, overall, the death rate has fallen by 26% in the United States.

However, as mentioned earlier, the COVID-19 pandemic has had a negative impact on all of this. Near the end of 2020, cancer diagnoses fell by approximately 40%, which is believed to be due to people delaying routine check-ups or seeking medical attention for new symptoms — often out of fear of contracting the virus that causes COVID-19. Many patients diagnosed with cancer also discontinued treatment during the onset of the pandemic. As mentioned above, in partnership with more than 300 organizations, AstraZeneca launched New Normal, Same Cancer, to encourage people to continue their routine check-ups, see their doctor about new symptoms, or continue cancer treatments, which have made such a tremendous impact on overall survival since their discoveries.

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 has been so much progress made with cancer treatments in the past couple of years, so it’s hard to pick. If forced to focus on one, though, I’m very excited about the promise of antibody drug conjugates (ADCs).

These innovative molecules can directly target cancer cells, potentially sparing healthy ones. To do this, a cancer-killing drug, such as chemotherapy, is attached to a monoclonal antibody via a linker. This monoclonal antibody then binds to the cancer cell and releases the drug directly into the cancer cell and neighboring cells, limiting damage to healthy cells. This translates to a highly powerful punch as conventional chemotherapy, but with potentially fewer side effects.

These ADCs can be engineered to target known oncogenes, such as HER2, as well as those associated with some of the hardest-to-treat cancers. It really feels like we are on the road to a revolution in cancer care.

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

Healing is very personal and unique to every patient. Their singular experiences cannot be quantified or described as a one-size-fits-all solution. I’ve found that it’s most important to ask each patient about what matters most to them and what will help them on their treatment journey — and to truly listen to them so you can provide them with the support they need.

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 my experience, the best way to support someone close to you who is affected by cancer is to listen. Every person has different ways of dealing with and coping with their diagnosis and treatment. Most people just want to feel heard and understood, especially when they are dealing with cancer.

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

One of the biggest myths about fighting cancer is that we’ve already discovered everything there is to advance cancer care. Although we’ve made enormous strides in fighting cancer, we are learning new things every day. We learn from every piece of clinical research that we conduct, and that others conduct. Even if a trial does not deliver the results we’d hoped, we take those learnings and apply them to the design of future studies. There are many examples of where this perseverance and adapting studies based on what we learned has paid off. We’ve gone on to deliver trials that otherwise may not have proved successful and delivered new treatment regimens that provide patients with better outcomes.

Another myth is that cancer can be treated with a single medicine. We have learned that cancer is a complex disease that evades destruction through several means. This requires a multi-prong approach to attacking cancer cells, and AstraZeneca has prioritized driving innovations with novel combination therapies that hold promise in this area. It is humbling and exciting to be working alongside brilliant and dedicated colleagues on this mission.

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.

Cancer is such a complex disease that impacts people differently, so choosing five key takeaways isn’t easy. But when considering crucial information for patients and caregivers, I think the key areas that researchers and healthcare providers must focus on to continue revolutionizing cancer care are:

1. Identifying cancer earlier is becoming possible. The earlier we can detect and treat cancer, the closer we are to offering the potential for a cure for an increasing proportion of patients. Regular cancer screenings are one of the most important ways we can achieve earlier detection, and new screening technologies enable the use of blood tests to identify patients who are most at risk of having their cancer return.
2. Earlier treatment intervention could have a profound benefit. This goes hand-in-hand with early diagnoses. We are pushing the boundaries of science to potentially change the prognosis for patients with early disease and making great progress in achieving better response rates and outcomes. Between the development of novel medicines, combinations, and trial designs in multiple disease settings, we have more options than ever to treat patients early on with the goal of redefining survival, enhancing outcomes, and improving quality of life.
3. Precision medicine allows us to deliver medicines to patients who are most likely to benefit from them. Every patient is unique, which means every cancer is unique. We can’t adopt a one-size-fits-all approach to treating cancer. However, comprehensive biomarker testing can help us crack the code behind each patient’s cancer, so we can offer the appropriate individualized cancer care with the right treatment options.
4. Digital tools are revolutionizing clinical trials for patients. Simplifying participation in clinical trials will allow more patients to enroll and will allow us to more efficiently identify the next wave of potential new treatment options for a wide range of cancers. By increasing the use of remote data collection, electronic consent, automated home delivery of medications, and user-friendly apps, we can reach more patients more efficiently and reduce the burden of participating in a clinical trial.
5. Researchers are pushing the boundaries of science every day for patients. We are on the brink of further significant breakthroughs in oncology research and care. By following the science, being bold, and building on our research (especially learning from the trials that don’t deliver the results we’d hoped for), we hope to deliver on our objective to help patients live longer and cancer-free. That’s something that is hugely motivating in coming to work every day.

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 want to continue the work I’m doing now and keep driving for better and better results. As I said earlier, I like a challenge, and there are clearly many areas of cancer where we are making good progress but where unmet need remains. As a leader, I want to motivate and inspire others to do their best work — bringing teams together to solve some of these challenges, giving them the space and encouragement to be bold and take smart risks. We are on a mission, and I want to continue finding new medicines — unlocking new approaches towards researching and treating cancer so that one day, no patient has to hear that they have exhausted their treatment options. We’re leading a revolution in cancer care, and that’s something we can all get behind.

How can our readers further follow your work online?

I encourage you to visit our AstraZeneca Youtube page to hear from our leaders and learn more about AstraZeneca’s efforts in hard-to-treat cancers. You can also read more of my thoughts on the exciting cancer research being conducted at AstraZeneca on my LinkedIn.

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