In episode 10 of Knights Do That, we speak with Annette Khaled, a UCF College of Medicine professor and the head of the Division of Cancer Research at UCF. Khaled discusses her expertise on breast cancer research — specifically in breast cancer metastases. Khaled shares her personal experiences that drive the passion for her work, the collaborative culture of teamwork, optimism, and humanity at UCF, and some of the biggest mysteries of breast cancer that we’re still trying to solve.

Produced by UCF, the podcast highlights students, faculty, staff, administrators and alumni who do incredible things on campus, in the community and around the globe.

 

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Annette Khaled: We need to do research to better understand what happens when we don’t catch cancer early, when a patient now has metastatic cancer that has spread, and can we develop better ways of helping these patients.

Because that’s where death occurs. Death and breast cancer are linked to the cancer spreading. So, understanding that process is essential for research.

Alex Cumming: Hey Knight Nation, what an interesting and enlightening conversation that I got to have with Dr. Annette Khaled from UCF’s College of Medicine. Dr. Khaled is the head of the Division of Cancer Research at UCF and has been recognized for her breast cancer research specifically in breast cancer metastases. In today’s episode, we speak about the personal experiences that she’s had that drive the passion for her work, collaborative culture of teamwork, optimism, and humanity here at UCF, and some of the biggest mysteries of breast cancer that we’re still trying to solve. Let’s jump into.

So to begin, how did your interest with medicine, specifically working with breast cancer, develop?

Annette Khaled: Yeah, that’s a great question.

So my background — I’m a basic scientist. I really don’t work directly in medicine — I ask those basic biology questions. Why do things happen? Years back, I was working to understand how cells die. What causes a cell to die when it’s happily growing and suddenly all its growth signals go? What’s happening inside of that cell? And it really was in the process of understanding the molecular events that were happening in these dying cells that led us to discover what could potentially be a therapeutic for cancer. And that’s how we ended up now jumping into breast cancer and really working on both a therapeutic and a diagnostic for breast cancer. Moving from those basic discoveries to some application in medicine.

Alex Cumming: Wow. How cool?

So as of this year, the World Health Organization has found that breast cancer is the most common cancer globally. Can you share with me some of the importance of early screenings for breast cancer, as well as the need for continuous research of the disease?

Annette Khaled: Both those aspects are tied together. So early screening – cannot emphasize enough the importance. Any cancer, especially breast cancer, if you find it early, when it’s still inside the breast, it’s still localized to one place in the breast, it’s much easier to treat. You can remove it surgically. You can treat it, and outcomes are like 90% or 99% survival. So early screening is essential.

And then, why do we have to do research? Well unfortunately, for some people, they don’t catch it early. Sometimes they catch it when it’s already showing symptoms and spreading. It may be in the liver, it may be in the brain and the bones. And at that point we don’t have enough of an understanding about how that happened, why that happened. So we need to do research to better understand what happens when we don’t catch it early, when a patient now has metastatic cancer that has spread. And then can we develop better ways of helping these patients. Because that’s when death occurs. Death and breast cancer are linked to that cancer spreading. So understanding that process is essential for research.

Alex Cumming: Are there things you can notice within somebody that maybe they should say to themselves, “I should get checked because I’m having this symptom or I’m feeling this sort of lump or I am just feeling off.”

Annette Khaled: Cancer is hidden. Cancer is your own body. It’s your own tissues, doing bad stuff to you. And so it’s really hard to wait for symptoms. That’s why screening is much more important. You should be screening yourself. And there’s guidelines, you should be screening by a certain age, by a certain risk factors.

You can do genetic testing, but it’s only a portion of cancers that are linked to a genetic outcome. So from my perspective, and it’s my own personal opinion, I think early screening is the best way. Get your mammograms every year. When you’re due, get your mammograms. Don’t wait for the symptoms because sometimes when the symptoms show up, it’s too late.

Alex Cumming: That’s good to be proactive instead of being forced to be reactive, sort of getting ahead of the curve.

Annette Khaled: Exactly.

Alex Cumming: What you’re saying it sounds as though a lot of people are forced to enter that reactive phase due to maybe outside circumstances that prevented them from being proactive on the situation. And when you’re in that reactive phase, it sounds like you have go all in on focusing on how can I give myself the best opportunity to treat this. And it sounds like from what you’re saying is that a lot of people don’t go into this alone. They have these circles in these groups that support them and help them along the way.

And as mentioned, breast cancer is one of the most common cancers found globally, support to know that you’re not alone in this situation, you find that’s an important —

Annette Khaled: And not to be — it’s scary, right? You get a cancer diagnosis. I have cancer. “What did I do? Why has this happened to me? Did I do something?” Disease just happens sometimes. And having support, having an understanding that there are great therapies out there. The survival is so much better now than it was in the past for breast cancer. There’s lots of treatment options and just get the support you need. You’re not doing this alone. We have great support systems for breast cancer. So I’m glad you said that. We can do things if you have, unfortunately, that cancer diagnosis. There are many avenues available.

Alex Cumming: My grandmother is a breast cancer survivor, so breast cancer awareness is a very personal topic for me. Of course she had it, I’m so thankful that she survived, beat it. I was younger, so I wasn’t fully able to grasp how it affects somebody’s body, but I saw firsthand how it affects the lives of my own personal family and herself. I’m so thankful that she lives in Florida, so we’re able to visit her and to be there for her in this time. And I mean, there’s just this weight that comes off of just this collective of people when we found out that she had overcome it.

Annette Khaled: It’s beating it that gives you that, “Wow, this is not the end of my life. This is something that happened along my life.” And that’s what drives the research as well, as being able to advance that. Hopefully to the point where your grandkids will no longer see cancer as a threat. Cancer happens, there’s treatments. It goes away, we’re done. And hopefully take that threat from our lives.

Alex Cumming: When my grandmother was affected by it, she was in, I believe, late 60s, early 70s. And when she beat it she was in her mid, I believe, mid-70s. So, we have this joke, nothing’s going to keep her down. Nothing’s going to stop her from beating breast cancer in her 70s. It was a really just something that you don’t forget. You don’t forget that period of your life, where it was in the back of your head. We were like, “This could be just any day, this could happen.”

Annette Khaled: So true.

Alex Cumming: So to transition from that, and that you spent nearly a decade studying ways to inhibit breast cancer metastases, which happens when cancer spreads to all other parts of the body. What have been some of the most important discoveries that you’ve found?

Annette Khaled: I think the most important discovery we found, I was telling you earlier that we were studying this death pathway of cells and came up with a therapeutic. Trying to understand how, why the therapeutic was killing, really led us to discover a protein that hadn’t ever been associated with cancer before. And it’s a protein that helps other proteins fold – basically to get the right three-dimensional shape. Proteins have three-dimensional functionalities and so this protein that we found that our therapeutic was targeting was involved in this folding process. That had never been associated with cancer, and especially with metastatic cancer, like you said, the cancer that spread throughout the body. Really finding how this protein was working, how it was contributing to cancer spreading  – that has been probably one of the best discoveries that we have made in the last few years and really drives our research now.

Alex Cumming: Seeing that there’ss these links between parts of the body and how they react when cancer is discovered in the body, is that what you’re saying?

Annette Khaled: Yes. So you think about cancer when it’s inside the breast, when it’s localized, has certain needs, right? , but once the cancer leaves its home in the breast and it travels and it goes through the blood. I mean, the stresses in the blood are horrendous. Most cancer cells die when they hit the bloodstream. But if they do survive, and those that survive need different survival factors than they did when they were in the home, in the breast. And then think of that, they have to now land in a new place, like they end up in the liver and the liver is very different from the breast, and it’s very different from the blood. They have to learn to adapt to that new environment. So the protein that we’ve been studying, we think helps those cancer cells do exactly that — survive while they’re in the bloodstream, survive when they get to the new site in the liver to grow and colonize again.

That’s why it’s of interest to us. Because if what we’re discovering is true, then we do have a really great target as a therapeutic target for these types of metastatic cancers.

Alex Cumming: We spoke about the community aspect of this. Do you find the mental well-being of a patient can be akin to the medical wellbeing?

Annette Khaled: Oh, that is so true. I think just having hope. And I think that’s part of. I mean I really enjoy interacting and talking, like I am today with you, talking to anybody who interested in what we do. Because I think it gives people hope to know that my laboratory and all the other people in the cancer division, we’re all working hard on trying to find cures for cancer — that we have their back. We’re doing this because we want to be able to give them hope that maybe we can’t cure cancer today, but we’re working hard to find new discoveries that will lead to new treatments for cancer in the future.

Alex Cumming: I love what you’re saying about the hope and the optimism and to know every day students are waking up and going to places like UCF, where their focus is cancer research. And that there’s this generation of students worldwide who are working, again individual types of cancer, but that every day students are going and that cancer research departments are still prominent and are funded and are in a vital aspect of health departments at universities.

Annette Khaled: I love that you said that because that’s so true. Sometimes you forget because you’re taking classes and you’ve got deadlines and you’ve got to write your papers and your dissertation or whatever. But at the end of the day, what you’re doing is bringing hope to people.

It’s doing research that’s going to lead to new advances that one day, it may take five years, it may take 10 years, 20 years ,who knows how much it takes, but that someday you can say, “I was part of that,” or “I was there when that happened, I was contributing to that process.”

Alex Cumming: What’s so nice, and this goes to most, all forms of medicine, is that a lot of these kids are doing it between the ages of 18 to [when they become] doctor, maybe mid-to-late 20s.

Annette Khaled: Or early 20s. Yeah.

Alex Cumming: Have their whole lives to work, to develop all these various research and treatments and it’s so cool. And to repeat what you said, hope, optimism.

On top of all your own research and your duties as a tenured professor, you’re also the head of the Division of Cancer Research here at UCF. What’s it like to oversee such an important division?

Annette Khaled: Oh that’s a lot to say in one sentence. I really enjoy working with people and being part of helping to lead the cancer division. There’s about, I want to say 11 or 12 researchers that fall under that division. It’s part of what I do every day. It’s not separate. I do my own research, but I also have that eye on the division as a whole to bring them together. So it really integrates very well with my current duties. I don’t see it as a separate thing, but it really falls alongside the things that I do every day. I teach students, I teach classes, I run my own lab. But part of that process is also keeping that global idea of how I can help my fellow colleagues in the cancer division also be successful. And so it’s all aligned together.

Alex Cumming: That you have to manage and understand what’s going on with everybody outside of yourself, but then also focusing on your own work, I can imagine that’s a lot to juggle at some times.

Annette Khaled: Well, like I said, it happens in parallel. We’re very collaborative. And so, as I said, it’s not really more work for me. It just aligns with the work that I currently do. The success in my lab extends to the division and the division successes feed back into mine. It’s become like a synergy. We’re all in it together. One person’s success is everybody’s success.

Alex Cumming: I love that. I imagine in a cancer research department egos are probably set aside and there’s not this competitive drive because one person’s success is everybody’s success.

I mean, in my own theatrical experience, yeah there’s egos every now and then. But it’s like, if you’re good for the show and the show was good, that’s on everybody.

Annette Khaled: Yeah, we’re a team.  Everybody’s doing their research and their thing, but cancer is very collaborative. It’s a field where you really lean a lot on each other. Everybody’s got an expertise, I don’t have to be the expert of every single thing. I can go to my colleagues and say, “I want to do this experiment you’ve done it in your lab. Can you help me do it in mine?” And this is, the ideal situation you’ve got this great team of folks that all have that joint vision of, yeah, we’re going to cure cancer one day. Not today, maybe, but down the road that’s our very ambitious goal. But we’ll help each other today to do the things that we need to do.

Alex Cumming: It sounds like collaboration, teamwork and synergy are what helped you balance your responsibilities.

Annette Khaled: Exactly. You got it. Exactly.

Alex Cumming: That seems to be a running trend here at UCF. With all of the amazing people I’ve had the pleasure to speak with, is that UCF is just such a, and again this is not a new thought, but it’s just a great place for collaboration and teamwork are two of the big takeaways that you mentioned.

Everybody has their departments, but all the departments work together. And when all the departments are doing is great that just makes UCF look great.

Annette Khaled: I don’t know if it’s just because of the way — we’re a young institution, right? In many ways, even biomedical research is barely a decade old, so we are still building our reputation. We’re building our credibility in the state. And that part of that helps us lean on each other more maybe than if we were in a nice established, fully funded institution with all the bells and whistles. Most people can thrive on their own better, but you know here we really rely on each other to help each other move forward.

Alex Cumming: That’s why I love this place. A moment ago, we spoke about my personal experience with breast cancer, how it affected my life in my younger years. Have you been able to meet families of breast cancer patients through your work?

Annette Khaled: Oh, yeah. I work with two very important organizations for breast cancer in the state of Florida and in Orlando. The Florida Breast Cancer Foundation is a fantastic organization of folks, breast cancer survivors, as well as researchers, doctors, all sorts of individuals, who are really focused to eliminate breast cancer for the state of Florida. And so I’ve been working with that organization for a number of years and really get a chance to interact with all these folks — as I said, breast cancer survivors, breast cancer advocates, for folks that go all the way to Tallahassee and just do their best to get funds to help breast cancer survivors and breast cancer patients in the state of Florida, researchers like myself. So that’s a great organization, the Florida Breast Cancer Foundation.

But I also work locally with the Orlando Sports Foundation and they’re also an organization that’s led by Alan Gooch, who was one of our first football coaches at UCF. He runs this fantastic foundation that is really trying to use sport and sport venues, like football, golf, even bowling, all these venues to drive awareness for breast cancer and fund breast cancer as well, generate funds for breast cancer. So working through that organization. I’ve met great people who really have a big heart and want to make an impact in our community.

So, like I said, I’m really blessed to have those two organizations that I can interact with and meet people

Alex Cumming: You’re wearing the pink, most people won’t be able to see it, but we know wearing pink to signify, to recognize, to honor the work people have gone through and to recognize the hard work that still goes into breast cancer awareness. And to have individuals that promote breast cancer awareness is so special to see is. That this is not just underground, subculture. It is in the general, it is in the zeitgeist. Again, you run into individuals who have experiences with breast cancer, like myself. Most people would be totally unaware that affected me in my younger years. It’s not something that since then I often reflect, but it’s in my memories. And you run into people that you might not realize have had an experience, had a breast cancer scare, had a surgery to maybe remove a piece of themselves. And you don’t realize that wearing pink is so special because it just, it’s there, it exists. You want to recognize it, the pink bracelets that individuals wear. When you noticed it on somebody.

Annette Khaled: And it’s so true because it really says, “We’re here, you’re not alone. This is not a fight you’re doing by yourself and you’ve got all of us wearing pink because we all want to be part of that team, that big universal team that goes beyond Orlando beyond Florida.” That really is a global team that works toward, supporting, and helping, and eliminating in the long run breast cancer.

Alex Cumming: From the families and the patients that you have met, what have you been able to learn?

Annette Khaled: Well, a lot of how they cope. I remember sitting at a lunch one day and talking to a lady who had breast cancer. She’s a survivor and she’s [been] taking treatments for decades that give her hot flashes. Now, you’re young, you’re a man, you don’t know how hot flashes affect women, but I’m going through that and I can tell you it’s miserable. And I cannot imagine dealing for the rest of my life with hot flashes, but she has to because of the treatments she’s getting. And I remember sitting there going like, “Gosh, I wish I could make a therapeutic this woman could take in place of what she’s taking right now and help her have a better quality of life so that she’s not living with these hot flashes.”

It’s just things like that. But I found, just interacting with people made me appreciate really how it’s not just surviving.  It’s about quality of life, and making sure that what I do in my laboratory and the therapeutics and diagnostics that we move forward are always about quality of life as well. We don’t want to put something out there that is going to make people sick more than they are from the cancer that they’re dealing with.

Alex Cumming: That’s so special. To touch back on to the young students working to cure breast cancer, everybody has maybe their own motivations and their own stories of what inspires them, but it’s also this one larger goal.

Annette Khaled: Exactly. And I think it’s important. If I could just make one more plug here. I think it’s important that as a researcher, it doesn’t matter what discipline you’re working in — whether it’s infectious disease or neuroscience, whatever field you’re in — to always connect with the people, right. Connect with individual. You know that if you’re working in disease, Alzheimer’s connect with those. You’re working with infectious disease, connect with people, HIV, because that connection really brings your research home. It really helps you focus your research on things that are going to impact people, not just something that’s your own. Like you said, ego, right? It’s something that you’re doing to do that’s going to help the community. So I really love, not just for myself but also have my students connect with breast cancer survivors for that reason.

Alex Cumming: Humanity, that the individual in that room is not patient number 52. They are, John Doe from Longwood, Florida.

Annette Khaled: Exactly.

Alex Cumming: I have a personal experience with what you’re saying. My involvement at UCF I’m with an organization called Playback UCF, which we began with our focus, it’s people tell stories and we’ll present them back through an improvised form. And we started with students and of course, young college students have a lot of feelings. They feel things very strongly, and it was very special to perform back, to get to know my cohort better. But then we transitioned and we work indefinitely with the Aphasia House here in the UCF area. And really the one-on-one experience of people who live life with aphasia it touches you in a way that you don’t expect going in. You might have an idea, but once you’ve experienced it firsthand you don’t forget.

Annette Khaled: And I think it helps, put perspective to things. It really helps you say, “Okay, maybe what I was thinking wasn’t so bad. My own little problems in my own little world, I can give perspective to them.”

Alex Cumming: It does. It’s sort of, a humbling, but not in a humbling, “Like, oh man, now I feel bad.” It’s a humbling like, “Wow, I get to wake up every day and not worry about these sorts of things.”

Annette Khaled: And in value, when these individuals are waking up every day and they’re doing their lives and their things, and really the strengths that they have I always admire that tremendously.

Alex Cumming: Seriously to go back to another point, we have hope. The students have hope, but the individuals who are living with this day to day, their hope is what I want to believe. Their hope is what inspires the hope of the younger generations to continue to work. Because when they get afflicted by it, they don’t, sit down and say, “Well, let me count down the clock.” It’s, “No, I know that somebody is working for me. There’s somebody out there who has me on their mind.”

Annette Khaled: And getting to a point you addressed earlier about your patient’s point of view and individuals’ hope and point of view, your mental wellbeing. If you have hope that whatever treatments, whatever therapy, whatever you’re going through, you have a chance of doing better because your mental wellbeing is healthy. Right?

And so that’s why it’s so critical not just to have the treatments and then whatever you’re supposed to do, your doctor tells you is critical to do, but also along those same lines, you have the hope, you have the mental wellbeing because those two together — the treatments and the mental wellbeing — is what’s going to lead to ultimately a treatment outcome, a success.

Alex Cumming: I love it. Do you have any other experiences or stories that keep yourself inspired?

Annette Khaled: Oh, there’s so many of them. I have to pick and choose.

Alex Cumming: Any highlights?

Annette Khaled: It’s really just being a survivor, and then not knowing if a cancer’s going to come back. And that’s the other big thing is — somebody tells me, “I had breast cancer 20 years ago and then it came back and now it’s metastatic. And now I have five years, survival is really bad at this point, it’s 20% or less.” So it just talking to patients who have metastatic cancer and the way that they know they have almost a death sentence on their heads and yet they still have the hope, still have that enthusiasm. I’m going to be here for my grandkids. I’m going to be here for my daughter’s wedding. So many of those stores really inspire me and say, what we do every day. What we wake up in the morning, go to the lab, go to work, go to school, whatever we’re doing, thinking of those people is really what drives a lot of that for me

Alex Cumming: Humanity, the one common that we all have, we’re all humans.

Annette Khaled: Yep. When you’re faced with a crisis like that humanity is even stronger. It comes out more.

Alex Cumming: So I want to move on to this next question of what are some of the biggest mysteries of breast cancer that we’re still trying to solve?

Annette Khaled: It comes back to what I was telling you, cancer recurrence, why after you’ve had treatment and the cancer was removed and you got all this therapy and you were given a clean bill of health — and then whammo five, 10, 20 years later, it comes back. We really do not know why, what changed. And a lot of times when it comes back, the treatments that work the first time don’t work anymore. It really is a real challenge for physicians to know what to do for these patients. So that’s one. And then the other one is the last few years immunotherapy, that’s basically taking your body’s immune system and turning it on so it can kill cancer cells, has really been an exciting new research and therapeutic direction and great successes for patients. But it doesn’t work for all patients. In fact, it works for maybe under 30% of patients. When it does work it’s amazing, it’s a cure, but why doesn’t it work for everybody? That’s the other big question. Why can’t we get this immunotherapy that has been so successful in this group of patients to work for everybody? How can a doctor know, do I give my patient immunotherapy or not?

Those are kind of the two big things for me, is that, why does cancer come back and then how do we figure out to give the patients their best treatments?

Alex Cumming: Those are both two things that are, what a wild thing to think about. So what advice would you give to somebody who wants to do what you do?

Annette Khaled: Oh, you have to have a passion for it. Doing research is not something that you can just open the door and do. I think you really have to have a passion and a love for discovery and have a thick skin that you can put up with disappointment and struggle and the negative parts of it. But always have that passion for discovery and know that those moments when you have that, “Aha, well we just discovered something really cool.” To be able to live for those moments and enjoy them. So I can say it’s a vocation almost to do research.

Alex Cumming:

Annette Khaled: Yes, endurance, lots of things that go with it — and surprisingly optimism. I think you also have to have an optimistic mind frame because if you’re pessimistic and you look always at the hole and not the donut, you’re going to struggle. I think having a little bit of optimism is always good.

Alex Cumming: Yeah. I believe that translates to most everything that people do. Is there a profession you can have where you can just be a pessimist? If you’re like a critic?

Annette Khaled: Yeah, you can be a critic. I think there’s some professions that work well with that, but I would say definitely in ours, because we have so much pessimism and there’s so much negativity sometimes associated with doing medical research that I think, every little bit of optimism you can bring to it is important.

Alex Cumming: Totally. So what’s one thing that you’re still hoping to do here at UCF, and then on a personal level?

Annette Khaled: Actually those two things are tied together. We’re building a new cancer center and this has been something that’s been in the works for now going on three years. I’m hoping to be able to be part of the process that we build our cancer center and hopefully make it a place that’s not only a place for students, a place for professors, like myself, to do research, a place for patients to come and get cutting-edge therapies. Really a place where all that’s integrated, where we really have a flow of knowledge from all these levels of students, to professors, to patients, to doctors, to everybody involved in treating a cancer patient.

So really it’s ambitious, but I do see hope one day that we can be sitting here maybe 10 years down the road and saying, “Yeah, that Lake Nona Cancer Center that’s one of the top 10 cancer centers in the country for everybody to come to.”

Alex Cumming: I’m looking forward to it. I love the sound of a place where just knowledge healing growth is all just wrapped into one, based out of here in central Florida.

Annette Khaled: And has that unique University of Central Florida culture, right? We were talking about earlier that collaborative culture that infuses our cancer system.

Alex Cumming: True that. I think everything we spoke about today can be found at UCF, the collaboration, the teamwork, the optimism, the growth for the future, the humanity, it’s all here at UCF.

So Annette, I want to say thank you so much for speaking with me today. loved our conversation. Thank you for letting me speak about my own personal experiences and for sharing your own experiences. It’s been such a pleasure to get to learn more about something that I’m aware of, I have memories of, but to dive a little deeper into it. To get a better understanding of it. So it’s been a pleasure to get to speak with you and thank you for coming on.

Annette Khaled: Well, thank you for asking me. I really enjoyed it. And I’m so happy to hear about your grandmother.

Alex Cumming: She’s still here. I’m certain she’ll love this episode.

Annette Khaled: Wish her well for me.

Alex Cumming: I certainly shall. Thank you.

Annette Khaled: Okay. Thank you. Take care.

Alex Cumming: Hey, thanks for listening. I’ll see you, you, on the next episode of the Kights Do That podcast. If you’re doing something cool, whether that’s at UCF or somewhere, you took UCF that we should know about. Send us an email [email protected], and maybe we’ll see you on an episode in the future. Go Knights and Charge On.