On Target to Cure Cancer

The biomedical engineering major is driving the direction of next-generation cancer treatments with a tireless effort to link researchers with resources. Previously Bristol-Myers Squibb's global oncology business development lead, Azmat now guides a more collaborative approach as CBO of San Diego-based Turnstone Biologics. Azmat was determined to pursue cancer research after losing her father to gastric cancer when she was 11.

At Dartmouth, she studied tumors as a Howard Hughes medical intern and therapeutic targets for pancreatic cancer as a Presidential Scholar, then entered the healthcare industry as a consultant to global biopharma clients. Fast-forward a dozen years and she's managing teams to support a pipeline of cancer immunotherapies, directing theoretical advances toward applications. "It's important for me to drive the science to move the needle in a real-world setting and not just as an academic exercise," she says.

What is your role as chief business officer?

One of the primary functions is business development. Turnstone is focused on developing immunotherapies for oncology, specifically tumor-infiltrating lymphocytes (TILs). Our lead TIL product is currently in a phase I clinical study, and we also have a pipeline of preclinical programs. So, I think strategically about partnering opportunities, whether it's talking to big pharma partners to ask, "Are you interested in collaborating on or licensing our technology?" or seeking out strategic collaborations with other biotech and academics, saying, "We have certain specialized expertise and you have certain specialized expertise so why don't we partner together, share some financials, and really develop an asset together." We do a lot of that work because it's not efficient to always own and develop every relevant technology in the space. We can tap into so much more innovation if we can leverage another partner's complementary technology or expertise.

I also spend a lot of time working on our corporate strategy and financing initiatives. The focus here is to help potential investors better understand our technology, data, overall vision, and positioning so we can continue to raise capital to develop our assets. It's important to be able to break down the science and help investors understand our story and why our technology has the potential to be transformative for patients.

The other side of the business, which I have evolved into over the course of the past two years, is the operational side. I have program leadership and management reporting to me, [areas] driving cross-functional teams to advance our programs. We've got research, clinical, manufacturing—and they need to operate as a single team so everybody is talking to each other and joined at the hip and moving things forward. We want to make sure we're talking about all the right risks and all the right mitigation strategies.

What drew you to Turnstone?

When I joined at the end of 2019, the company was very interested in accelerating its strategic growth. I was coming from Bristol-Myers Squibb, where I looked at hundreds and hundreds of oncology companies over the course of several years. My first goal at Turnstone was to see if we could expand our portfolio and have multiple technologies—because cancer is a hard problem, and you may need multiple shots on goal to be able to solve this.

Most of 2020 I spent seeking out and reviewing technologies we could add to our portfolio that would be synergistic and transformative for the company. My efforts culminated into a transaction around a small company that was developing a TIL technology. It was still very nascent and in preclinical development at the time. We acquired that company, integrated the technology into our portfolio, and advanced its development into the clinic. Fast forward to today and our leading clinical asset is based off this TIL technology and is the biggest value driver for the company.

What are some of the qualities you look for in a collaborator or investor?

It really depends on who you’re collaborating with. When it comes to academics and biotechs, it's really about innovation. Are they doing something that's exciting that we couldn't do ourselves? Can we collaborate to develop a better asset and a better program for cancer patients? When it comes to pharma partners, it's very different. Are they interested in taking risks and driving toward novel, complex therapies? Most pharmas like to keep it simple, such as small molecules and antibodies that are easy to manufacture. But to drive the next wave of innovation, they need to have an appetite for complexity—we've tried the simple solutions for cancer and many of them don't work after decades failure.

The investor mindset differs. Venture capitalists have to believe, fairly early on, in the potential of not only the science, but also the vision of the company to bridge the gap between early innovation and when the science may be mature enough for pharma or the public markets to be interested in funding further development. When pharma evaluates an opportunity, they are thinking, "If we invest in developing this therapy today, can we commercialize in five, 10, or 15 years?" The investor time horizon is shorter in comparison, typically less than five years. Ultimately, biotech investors take the risk early because they share in your vision and believe what you're doing is going to generate something that has meaningful value for patients and, subsequently, value from a financial perspective.

What characteristics define your industry?

The most important one for me is that people are still passionate about developing new treatments for cancer after decades of failure. I know that throughout my career I'm probably going to fail 10 times over. But that's okay because I'm resilient—and I love that resilience in the industry as well. I think there's no amount of money or value you could put on helping a single patient and changing how they've experienced cancer. I lost my father to cancer when I was 11 years old. He was diagnosed six months before he died; the time from his diagnosis to his death and the journey after that was incredibly difficult and quite traumatic for me, particularly at such a young age.

It's a big part of what has made it my life's purpose to save someone else from the pain of losing a parent or a loved one to cancer. But the other part of it is the intellectual problem, the magnitude and complexity of what cancer is. And what good intellect doesn't like a really complex problem to solve? So, what gives me hope is the level of excitement, commitment, and innovation around solving this complex problem, to help patients, and to work for something that is bigger than all of us.

What's your favorite part of the process in getting to where you are today?

When I was at Dartmouth I was purely focused on the sciences. I thought I was going to become a principal investigator and discover the cure to cancer in a lab somewhere. But what's drawn me to where I am today, and what keeps me hungry for more, is the intersection between science and business. It's really about taking an innovative scientific idea and turning it into a drug that can treat a patient—and that requires connecting a lot of dots across the scientific and business side—and gets the world believing, hey, we actually might have something that can help cure cancer.

For me, it's been more than a decade of evolution and learning to really understand how to turn a cool scientific idea into a drug. It’s a very expensive business and a painstakingly long process to yield results that by default have a higher chance of failure than success. It takes hundreds of millions invested across several decades and a whole army of expert drug developers to go with it just to develop a single drug. And the sad part is you know that there will be numerous setbacks along the way. As an industry, we just don't understand enough about the human body and biology to be able to predict what's really going to happen in patients in the clinic. So, there is still a ton of progress that needs to be made, and we have our work cut out for us. Therein lies the opportunity to develop better and more efficient solutions.

How does your engineering mindset help?

I think the mind of an engineer is always looking for the most efficient way to solve a problem, and it is always paired with a thirst of knowledge to better understand all systems involved. My focus has always been to learn as much of the technical subject matter I can—across both the science and business side—and then come up with the most efficient solution to solve the problem at hand. My time at Dartmouth was really foundational at helping me develop this skillset. I had the freedom to dive into the more traditional cancer biology and pursue lab-based research to really understand cancer as a disease. At the same time, I was building a rigorous problem-solving skillset across the standard engineering disciplines. Ultimately, I combined both in a way that has helped me build a path to where I am today.

I have a fierce passion for science and an unrelenting personal commitment to advancing cures for cancer—and it's important for me to drive the science to move the needle in a real-world setting and not just as an academic exercise. I am always trying to connect the dots. Oftentimes I'm thinking, "Hey, this is a really interesting technology. What if we combine this with this? Could that transform the end result?" The nature of business development is connecting the dots—but I also do it on the corporate and investor level. I'm always trying to distill what's most meaningful and what's most powerful for each audience. That's where the magic happens.

What do you see on the horizon that gives you hope?

Whether it's five years, 10 years, or 100 years from now, it is wonderful to think that it will be on our shoulders that others will be standing, just as we are standing on the shoulders of those that preceded us. That speaks to the enormity of the problem that is cancer and how it necessitates the collaborative nature of what we do and the patience for how long it can take. Every single person in this field knows they alone cannot solve this problem. They know it requires teamwork. This is why pharma collaborates with biotech, why investors put money in, why academics still do research.

We're all figuring out imperfect ways of working with each other. Yes, we're trying to differentiate from our competitors, but if you think in macro terms, we're still all on the same team, we're all still trying to cure cancer. And it's going to take a lot of really bright minds and a whole heck of lot of money to solve this problem. And if we fail, it's okay—you pick yourself up and you keep pushing forward. Because the solution is out there, and we will find it.