Dr. Yelena Janjigian and Dr. Mark Lewis | Conquer Cancer, the ASCO Foundation

Dr. Mark Lewis:
This podcast is brought to you by Conquer Cancer, the ASCO Foundation. Our mission is to accelerate breakthroughs in life saving research and empower people everywhere to conquer cancer. Welcome to Your Story is a podcast where we hear candid stories from people conquering cancer. I'm your host, Dr. Mark Lewis.

The year was 1991. With the Soviet Union collapsing, hundreds of thousands of refugees fled to other countries. Among them was a teenage girl, who, along with her family, had escaped the small country of Azerbaijan, a former Soviet Republic, and who would eventually settle in California. Fast forward almost 34 years to June 1st, 2025. That young girl is now Dr. Yelena Janjigian, a highly respected oncologist and researcher standing on stage at a Chicago Convention Center. Now, as thousands of her peers look on, she's about to present results from a major clinical trial, one with the potential to change the treatment landscape for patients with gastric cancers. It is a moment set in motion, not by a single college degree or grant application or donation, but by an almost infinite series of decisions and choices, some hers, some by others, some major, some comparatively minor, but each of them significant for the role they played in where she is today. 

Not to mention the countless lives that will ultimately be saved as a result. Dr. Janjigian, thank you so much for being here with us today. It is truly an honor to have you on our show.

Dr. Yelena Janjigian:
Thank you, Mark, for these kind words of introduction and the honor is truly mine. Happy to be here. 

Dr. Mark Lewis:
I meant every word of it and you're richly deserving as we'll discuss. Before we get started, Yelena, tell us where you're joining from today. 

Dr. Yelena Janjigian:
I am a medical oncologist, and I work in New York at Memorial Sloan Cancer Center. 

Dr. Mark Lewis:
Wonderful, such a prestigious institution and your work continues, I think, a long and stellar history of truly practice changing studies to come out of your center. So congratulations for continuing that lineage. So first, I don't want to get too deep into the science of oncology research immediately because I know a lot of our listeners aren't researchers. But I do have to say as your peer, as someone that got to see you speak in Chicago, just how much I enjoyed genuinely your presentation earlier this summer during the ASCO annual meeting. What I tell my patients when I'm going to this meeting, Yelena, is it's like our Super Bowl. And yeah, it's just nice. 

Dr. Yelena Janjigian:
Yes, I say the same thing. Exactly. Well, I'm explaining it to my parents because they couldn't. 

Dr. Mark Lewis:
My mother once referred to ASCO as the science fair, which I thought was really quite adorable. So yes, whether it's our parents or our patients, we have got the shorthand. And my analogy goes on to say that if ASCO, the annual meeting as a whole is the Super Bowl, I think the plenary session is kind of like the halftime show because it gets the most eyeballs and ears.

And again, it's truly an honor for a researcher like yourself to be able to present practice changing data there. So again, colleague to colleague, but for our audience, tell us what's it like standing in front of that stage, in front of so many brilliant people in the audience, presenting work that you've done is truly the culmination of years of effort. I mean, can you explain at least for a listener who might not have even been to the meeting what that moment means, not just for your career, but also for patients and families who are facing this disease. 

Dr. Yelena Janjigian:
It's an incredible emotional moment that took probably close to eight years plus and know, thousand patient study, 984 patient study, but also probably not overestimating 100 people plus in staff and collaborators, investigators, to get to that point and even just coordination of submission of the data, having everyone okay with presenting this data in different formats and so forth. It was an incredibly emotional moment. In fact, and part of this halftime show like any other halftime show you practice and I'm incredibly lucky to have a supportive network of physicians because this is embargo data so you can't really tell anyone about it so you're you're keeping the secret and as you're supposed to polish your presentation and be really—I mean you only have less than you know barely 12 minutes to present this data—and you have to be perfect and it's going to be played over and over and over again. So all this key information has to be you know it's patient care so you have to get it just right.

So I can tell you again, you know, when we were practicing during some of the last practice sessions, actually during the acknowledgement slide, I would become, I became emotional. And, and so that then I was so worried that I was going to start crying on stage in front of 20,000 people. So it's, it's, it's a buildup. And it's this moment of really doing, you know, cause I'm just, a representative of so many more patients and people and caregivers and so forth. So I wanted to get it just right. of course, I always put too much pressure on everything. So it was quite a moment, incredible, incredible.  

Dr. Mark Lewis:
Well, again, you're being very self-effacing because I think you're casting yourself as a mouthpiece and you certainly did a fantastic job of explaining the study, but you also were sort of the prime mover in the entire investigation. I'll tell you a couple of things.

One is, you know, the sort of synthesis of your head and your heart came across. I mean, yes, you were explaining data with a great degree of scientific rigor, but it really was obvious to us how much it meant to you. It's become almost a trope, actually, I think a welcome one at the end of these presentations for researchers to thank the patients. I think you did a particularly admirable job of that and it really came across to me as authentic. And then finally, you know, we use this term practice changing data. I think that's exactly what this was. Am I correct in remembering? Did you have a simultaneous publication in the New England Journal of Medicine you also had to prepare in sync? 

Dr. Yelena Janjigian:
Yes. Yes, so that's perfect coordination of again making sure everyone's happy and sort of feels that the presentation was just so but also the paper and the timing of the presentation in the New York Journal of Medicine. just again an incredible experience and coordination of all of these pieces was something to get through and still try to hold on to that moment. I think as oncologists, as physicians and so forth, we know these moments are so rare to come by. in any lifetime. And so I wanted to actively enjoy it and remind myself to enjoy it. But I don't know if I did, you know, was just too much. 

Dr. Mark Lewis:
Yes. Right. Yeah, no, I and I'm glad like you said, I'm glad it's recorded and documented. So at some point even you can go back and watch it. As we alluded to in the intro, Yelena, you this is sort of the culmination of a lot of things that have happened, not just in your career, but in your life. And it's such an inspiring story. I'm sure there's much more to your narrative than we can cover in a single episode, but. As I was sort of going through your very synoptic biography, it's impossible not to hear that and wonder, where would you and your family be today in every sense had you ultimately settled anywhere else? I mean, do you ever wonder about that, sort of the sliding doors moment, and if so, do you have any answers? 

Dr. Yelena Janjigian:
Yeah, you know, I think it depends on where, know, as an Armenian individual growing up in Azerbaijan, and again, going by my parents and my family's experience, I don't think I would have had an opportunity to be a physician in that country because again, there was a clear limitation of who got to be a physician and it's prestigious position anywhere in the world. And so to be a relative minority, you wouldn't be able to do that.

I think my parents certainly that courage it took to leave and to come to a foreign country. you know, again, I couldn't have become anything but what, you know, they were really, you know, were aspired us to be, which is successful researchers and scientists. If I think if I stayed, probably my plan was to become a more of a linguistic kind of literature person. I've always loved. Yeah, I always write. So I think I was going to go down the path of either being, you know, professor somewhere teaching, you know, writing or staying in sort of the softer, the less hard sciences. But I always very interested in that piece and was good at languages and writing and so forth. 

Dr. Mark Lewis:
Yes. Yes. But as you said, it's one thing to do the science and it's completely another to communicate it, both to patients and to your peers in a manner that can immediately be used in clinics. So I think your gift for words, I think it still comes across just in a different arena. And it's interesting, I really hesitate to draw too many parallels between us because I don't want to come across as arrogant.

What I will say is that as an immigrant myself, my whole entry into the world of oncology kind of hinges on us. moving to this country, which is how I found out about my father's cancer. So I often wonder, you what would life have been like if I had remained in United Kingdom? Actually, funnily enough, I like to think I would have been either a minister and or an author, which might be flattering myself. But it is weird to think about these alternate realities, both in terms of our families and our careers, you know? So this, yeah, you were totally fine. Well, this is a part where I elapsed into my Scottish accent. So I'm Scottish and I'm... 

Dr. Yelena Janjigian:
Totally. Interesting. Where did you immigrate from? Sorry, I know you're in... Wow! 

Dr. Mark Lewis:
Yeah, I got, got to Madoka a bit before you, but I got here in '87 from, from Scotland. and now our audio engineers will, will tell me to go back to American because otherwise people won't understand what I'm saying. But, yeah, I, I do know what it's like. And I think there's, again, I might be reaching here, but there's this like spirit of adventure that really, I think our parents are admirable and sort of picking up an entire family from one, one country and relocating them. I think that's very sort of intrepid and brave. And, you know, again, I'm pushing the metaphor of it. I think. Some research is again, sort of venturing into the unknown. And like you said, it doesn't always yield dividends. So when it does, that is something to be celebrated. in that sort of vein, so these are unsettling times for scientists and particularly those of us who are in oncology research and particularly when comes to funding.

And again, I know on some level it might seem almost gauche to talk about money. But I know that you have had success through the years when you've needed to secure funding for your work. And that's included grants from Conquer Cancer. And of course, each grant, whether directly or indirectly, can catalyze you forward. So again, like we were saying for your life story, it's these steps towards kind of the ultimate result that makes treatment breakthroughs happen. Looking back to when you got your first Young Investigator Award, what was the impact of that early funding on your progress? 

Dr. Yelena Janjigian:
The impact is incredible. I still remember that feeling. I was in clinic as a fellow and I got the phone call from Concord Cancer saying that my grant was funded. Back then they called you on your, it was a flip phone, my cell phone. I remember the moment. I remember what I was wearing. It's really weird because it's very vivid. And it's, you know, it was a very fragile time in my life because I was finishing up my fellowship. I was about to start applying for jobs. And I had a really young kid at home and trying to do this whole mom and researcher and clinician and working at Memorial Sloan Kettering and not knowing what my next steps would be.

So just that phone call and someone telling you that, you know, that proposal you put in is really good and we're going to fund it, somehow just solidified something really, like really on some very deep, basic level where I'm like, okay, I have... You just feel like all of a sudden your root is grown and you're like, okay, I'm going to do this. Somebody thought that I am my ideas or what I'm how I'm approaching a problem is worth the investment. And it's, it's, you know, it's these little moments that kind of crystallize. Cause I think for many clinicians who are in that watershed area where the decision is made about where to go. and inherently, this is uncertain times, they may not stay in academia if they don't get a moment like that. And it's as simple as, and they can get other moments from other situations, feeling  rewarded by a patient interaction or clinical interaction or something else and it will steer them away from one path, for example, from research path maybe into private practice or clinical care, which is still okay, but we will be losing because doing research, many of us who go into medicine, probably you included, we're good at the patient care. 

Dr. Mark Lewis:
Yes. Yes. 

Dr. Yelena Janjigian:
Right? We love it. I get, you know, so much positive reinforcement from just taking care of patients. But doing research while taking care of patients is so difficult because it's big and you're not really, really clear about if it's going to be successful. And so just having that funding kind of gives you that pat on the back that all of us need. 

Dr. Mark Lewis:
Right. Yes, no, so well said. First of all, I love the fact that you remember the flip phone to my teenagers. That might as well been you found out by telegram, you that really puts it in a certain era. But again, look at the the time between that moment and then you being on on the plenary stage. And I love the word catalyst that we just use. That's that's pretty incredible. I hear you. It's not just about the dollars and cents that you need to do the work. It's also the validation.

And I love your comment, too, about because patient care to me is it's such a human experience. Like when we boil down healthcare, at the end of the day, it's you and me, usually in a room, in a very private setting with the patient in front of us. And that to me is the core of everything. On the other hand, that is such a emotionally rich setting, whereas scientific review, I would argue, is almost entirely the opposite. It's an impartial overview of your work and its likely plausible outcome. And I think that's your right. It's very rewarding. again, for like a jury of your peers to look at your idea and say, is where, of all the things that we could fund, this is where funding. So I can understand why you would derive significant motivation from that.

We talked, we started off talking about your groundbreaking work in gastric cancer, but you also have done a lot of work in rare cancers, which tend to be underfunded. Well, it's not particularly surprising that the more prevalent tumors get more research funding allocated to them. It's also unfortunate. Because we know that funding rare cancer research is an impact that extends beyond single diseases, almost into the kind of realm of histology agnosticism. Can you talk about the challenges of pursuing research that's focused on rare cancers and along with that why funding that work is so important? 

Dr. Yelena Janjigian:
Right, well rare cancers for patients, I think is a big isolation and a challenge because those cancers may not have patient advocacy, they don't have champions, there may be some stigma associated with the cancer. So you're not going to have a well appearing, well spoken champion telling patients. you know, enroll in these studies because X, Y, and Z, or asking funding agencies to prioritize their disease because those, you know, patients may feel either isolated, marginalized, or they're just not enough of them that are feeling well to show up to fundraisers. 

Dr. Mark Lewis:
Yes. 

Dr. Yelena Janjigian:
And I found that that's very challenging for multiple reasons, mostly because of finding, also enrollment into clinical trials and lack of really expertise closer to home because many patients don't feel well enough to travel to a tertiary cancer center and get enrolled in these studies. And so we need to work even harder, come together, working through either cooperative groups or larger centers. coming together, of getting over the, well, this is my study, I'm going to be the lead for it and presenting everything and banding together.

I think ASCO and in general, I think some of the larger centers in US, but also globally, I think able to do these studies globally faster. the challenge is that industry may not be either aware of the targets unless we really kind of present to them and usually they need preliminary data until you know for them to jump into the study. And two, it may not be financially really solved, it may not be worth it for them to do these studies. So again we have to incentivize them for various reasons. I think that's the challenge. Certainly practicing at my institution and that's part of the reason why I would I really enjoy working at Memorial Sloan Kettering. I could do very boutiquey studies in subset of rare cancers and show a big effect and hopefully help patients worldwide. 

Dr. Mark Lewis:
So I'll say there's two sort of comments you made. I'll expand on one is this notion of what's an appropriate time horizon. So for instance, with Matterhorn, you mentioned I think it was an eight year sort of gestation period. And you're right. Let's go all the way back to pharmaceutical industries. If you're beholden to your stockholders on a quarterly basis, investment that you're quite literally making today might not actually prove worthwhile until almost a decade later. So that's tough to reconcile. And another thing I've noticed in the last several years particularly in the area of rare tumors, is a discovery made in one histology may turn out to be incredibly meaningful in another one.

And so for instance, I think about some of the fusions that we come across where actually a drug that was developed for a specific form of thyroid cancer might actually work in one of my biliria tract cancer patients. I think we are practicing and you specifically are researching an interesting time where there's this really fertile cross-pollination of ideas. And more importantly, treatments that can help patients, I think, even outside the silo of what we might consider a rare tumor. you know, when you do work in the rare tumor space, I think you're actually helping more people than the end might reflect. So I think that, again, your answer, I think, was a support for our call for support for rare tumor research.

As we mentioned more than once, again, these are challenging times for the scientific community. whether you're a physician scientist or I think even more personally a patient who desperately needs the resulting treatment and cures that those physician scientists are pursuing. What advice would you have for a scientific investigator out there right now, whether because they're so early in their careers or because they're so focused on an extremely rare disease, what would you say to someone who's struggling to find funding? 

Dr. Yelena Janjigian:
It's, I hear you. You know, it's really heartbreaking to get a rejection letter. And it's okay to be upset and to acknowledge your emotions and to give yourself a few hours or a day or even a week to just absorb it and realize it's not fair. 

You know, they didn't understand your idea or even if they did, maybe the funding line was not quite there. and try again. You just have to. And I've given myself this, I mean, I just given myself this pep talk as recently as, you know, three weeks ago. And I have a program director call with NCI, you know, my grant didn't get funded and it it stinks no matter how successful you are or how many grants you've before.

Rejection hurts. Let's admit it and let's pause there, but just do it again. I think, you know, that's one thing you realize in academia. If you have a fragile ego or a thin skin, academia currently, especially, is probably not the place, you know, to do that. And you just have to work on resilience and rethink about the problem, get better preliminary data, get better or different collaborators or the same collaborators and just clarify your ideas and you will get it. I promise you. 

Dr. Mark Lewis:
So it kind reminds me of your, you know, our, maybe our alternate realities where we, you know, are in the linguistic or literary world and we're writing. My first draft is never the final product. And I know for a fact, I benefit from other people reading my work and editing it and revising it. So you're absolutely right. know, reviewer number two is always going to sting. But I love your answer for a couple of reasons.

One is there's almost always something constructive that can come out of that critique. If you look hard enough, provided it's not an ad hominem attack on your own character. And number two, for someone like you to say that, you know, when I first started going to ASCO annual meetings, my sense of imposter syndrome was so inflamed. And you look at the people on the plenary stage and you think, man, they only got there because every single experiment they ever performed, every paper they ever wrote was flawless. Again, the dominoes fell and now they're there. And in fact,  if you ask any single one of our peers who was up there, it's quite the opposite. It was a very grueling sort of a series of unpredictable results. Some things you thought were biologically plausible, didn't bear fruit. Some things that you thought weren't going to work did that kind of thing.

So I actually think it's really brave of you and I appreciate you sharing it. Listen, we've all been knocked down. actually have a poster from my office that says it's all fuel, meaning that, you know, when I have a success with a patient, that's great. That's inspiring. When I fail and I do fail a lot, what I try to do is just learn from that and do better for the next person, whether that's our clinical care or to your point, performing research and being really dogged in pursuing funding. Like if you believe in your idea and I know it's getting harder, hopefully you can find someone even in this climate who will give you that funding. And to your other point, your validation to get started. so Yelena, there's a question we always like to end the conversations on this podcast with, and it's just this. When you imagine a world where cancer has been conquered, what does that world look like? What does it truly mean to conquer cancer? And do you think we're on the path of doing so? 

Dr. Yelena Janjigian:
Conquer cancer to me really means that individuals, when they get the diagnosis of cancer, there's no more crying. There's no more the sense of loss and the sense of this is a death sentence. It's a disappointment and people say like, you know, well, that's, that's, going to sort of slow me down or derail some plants, but it's not a death sentence. So right now, I think most of our patients, if they get the big C diagnosis, it's the end of the world for them. 

I want to live, and we will, partly we already are there, live in the world where even in patients with advanced disease, this is a very manageable issue. They understand they need to find a doctor the same way that they would find a doctor for high blood pressure or heart failure and so forth, and just not be scared. I think that's the moment that is probably I find the most difficult for these patients is that first diagnosis when they hear this or read a piece of paper that says and I think the only the litmus test because you and I can talk about cures and living with this disease etc. but the way that I will know we actually cure in cancer is when now in the movies or so forth in the popular culture there's not this stigma of cancer.  Dr. Mark Lewis:
So well said. you know, my career has been relatively short. I left fellowship in 2012 and some of the treatments that I was trained to give, are completely obsolete. And I view that not as bad training. think that's actually a wonderful problem to have. think you and I and our peers are engaged in lifelong learning. That's why you go to these meetings and figure out iteratively how to get better. But I agree with you. First of all, when people hear the word cancer, especially when it's their new onset diagnosis, the phrase I've used, I think even in this podcast is the tinnitus of terror. just immediately the higher cortex shuts down, their amygdala kicks in, it's fight or flight. This is a lethal threat. I think what you and I are seeing, and thankfully our patients are living through, is a slow paradigm shift where some cancers really are better described as chronic illnesses. And then, you know, the burden is on us. 

As both scientists and clinicians to make managing that burden as tolerable as possible. I had a faculty member in my fellowship said, 'Mark, you can't make your patients live longer than normal people,' by which he meant people who were never diagnosed with cancer. But I do think the asymptote we're approaching is restoring their life expectancy, so their longevity. And also, this is the real trick, the quality of life to something approaching what it would have been like without their cancer diagnosis. And I completely agree with you. I think that's a beautiful vision for conquering cancer, but one that we get closer to all the time. 

Dr. Yelena Janjigian:
That's right. 

Dr. Mark Lewis:
So, Yelena, thank you so much again for joining us today. And thank you, our audience, for listening to this podcast brought to you by Conquer Cancer, the ASCO Foundation. Conquer Cancer is creating a world where cancer is prevented or cured and every survivor is healthy. You can make a gift at conquer.org forward slash podcast. The participants of this podcast report no conflicts of interest relevant to this podcast. Full disclosures can be found on the episode page on conquer.org. 

The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.

Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.