Recent Treatment Advances in Small Cell Lung Cancer

Transcript

00:00 --> 00:01Funding for Yale Cancer Answers
00:01 --> 00:03is provided by Smilow Cancer
00:03 --> 00:05Hospital and AstraZeneca.
00:07 --> 00:09Welcome to Yale Cancer Answers with
00:09 --> 00:11your host, doctor Anees Chagpar.
00:11 --> 00:13Yale Cancer Answers features
00:13 --> 00:15the latest information on cancer
00:15 --> 00:17care by welcoming oncologists and
00:17 --> 00:19specialists who are on the forefront of
00:19 --> 00:21the battle to fight cancer. This week,
00:21 --> 00:23it's a conversation about lung
00:23 --> 00:25cancer with Doctor Anne Chiang.
00:25 --> 00:27Doctor Chiang is an associate professor
00:27 --> 00:30in medical oncology at the Yale School
00:30 --> 00:33of Medicine where Doctor Chagpar is
00:33 --> 00:35a professor of surgical oncology.
00:35 --> 00:38Let's start at the beginning.
00:38 --> 00:40I think a lot of
00:40 --> 00:42people know about lung cancer,
00:42 --> 00:44but this whole differentiation
00:44 --> 00:46between small cell, non small cell
00:46 --> 00:49tell us a little bit more about that.
00:49 --> 00:51What exactly is the difference?
00:51 --> 00:53How many people are affected by each?
00:53 --> 00:55And why should we care?
00:55 --> 00:59I think that the basics about
00:59 --> 01:01lung cancer are that they form in the lung.
01:01 --> 01:03There's mainly two different types,
01:03 --> 01:05small cell, that underneath the microscope
01:06 --> 01:08the pathologist looks at the cells and
01:08 --> 01:11they're very small and round and blue,
01:11 --> 01:14and everything else which is non small cell.
01:14 --> 01:16The small cell kind is typically
01:16 --> 01:18a little bit more aggressive.
01:18 --> 01:19It grows more quickly.
01:19 --> 01:21It tends to spread.
01:21 --> 01:23There are different types that I typically
01:23 --> 01:25tell my patients are like chocolate,
01:25 --> 01:26vanilla and pistachio.
01:26 --> 01:28There is adenocarcinoma,
01:28 --> 01:29squamous cell carcinoma,
01:29 --> 01:31and other types,
01:31 --> 01:33and they really are simply
01:33 --> 01:36different types that act a little bit differenlty.
01:36 --> 01:39They look a little bit different
01:39 --> 01:41underneath the microscope,
01:41 --> 01:43and sometimes there are molecular
01:43 --> 01:47markers that can help us to understand
01:47 --> 01:49a particular subtype that might
01:49 --> 01:52be responsive to taking a pill,
01:52 --> 01:56for example, instead of IV medication.
01:57 --> 02:00Of all of these types the first
02:00 --> 02:02question is which type are
02:02 --> 02:03the most common.
02:07 --> 02:09You say the small cells are a little bit
02:09 --> 02:12more aggressive than the non small
02:12 --> 02:14cells and even within that there's
02:14 --> 02:17a whole bunch of different types.
02:17 --> 02:18What type is most common?
02:19 --> 02:20What's the distribution
02:20 --> 02:22in terms of these cancers?
02:22 --> 02:25The most common type is
02:25 --> 02:28non small cell and pretty much
02:28 --> 02:2980-85% of lung cancer
02:29 --> 02:32is non small cell and then
02:32 --> 02:3515-20% is small cell
02:35 --> 02:37and so we know that smoking
02:37 --> 02:40is related to lung cancer,
02:40 --> 02:42but are there specific risk factors for
02:42 --> 02:45getting each of these different types,
02:45 --> 02:49or is it kind of all just a mishmash
02:49 --> 02:54and which type you get is luck of the draw?
02:54 --> 02:57Smoking is definitely a risk factor for
02:57 --> 03:00both non small cell and small cell.
03:00 --> 03:03That being said, there are folks who
03:03 --> 03:05are never smokers, a small population
03:05 --> 03:07of never smokers or light smokers
03:07 --> 03:12who may develop mutations in specific
03:12 --> 03:18genes called EGFR or ALK ROS1.
03:18 --> 03:21Some of these mutations are
03:21 --> 03:25called oncogenes and these mutations
03:27 --> 03:30tend to lead to lung cancer.
03:30 --> 03:33A specific kind and because it's
03:33 --> 03:36not sort of the same as the lung
03:36 --> 03:39cancer that comes from smoking where
03:39 --> 03:43repeated exposure and inflammation to
03:43 --> 03:47carcinogens caused lung cancer,
03:47 --> 03:49those patients with, for example,
03:49 --> 03:52a mutation in EGFR can actually be treated
03:52 --> 03:55with a targeted therapy that targets EGFR,
03:55 --> 03:58and that, as I said before,
03:58 --> 04:01is often in the shape of a
04:01 --> 04:04pill that you can take daily.
04:04 --> 04:07So it's really important when
04:07 --> 04:09you're diagnosed with lung cancer
04:09 --> 04:11to understand the pathology and
04:11 --> 04:13specifically the molecular pathology.
04:13 --> 04:16That means the kinds of mutations
04:16 --> 04:17that might be available.
04:17 --> 04:19Especially if
04:19 --> 04:20you've never smoked,
04:20 --> 04:23or if you have a very light history
04:23 --> 04:25or remote history of smoking
04:26 --> 04:29For the people who have never smoked or
04:29 --> 04:31have a very light history of smoking,
04:32 --> 04:34are they more likely to get one
04:34 --> 04:37type of lung cancer in terms of small
04:37 --> 04:40cell versus non small cell than others?
04:40 --> 04:41And these mutations that
04:41 --> 04:42you're talking about,
04:42 --> 04:44are they more common in small
04:44 --> 04:47cell or non small cell or does it
04:47 --> 04:48make a difference at all?
04:48 --> 04:50So these mutations that I spoke
04:50 --> 04:53of are more common in non small
04:53 --> 04:55cell and those folks who are light
04:55 --> 04:57or never smokers are more likely
04:57 --> 05:00to develop non small cell lung
05:00 --> 05:03cancer than small cell lung cancer.
05:03 --> 05:05Typically it has rarely happened
05:05 --> 05:07that I've seen patients who never
05:07 --> 05:10smoked develop small cell cancer,
05:10 --> 05:12but typically there is a history
05:12 --> 05:13of smoking.
05:13 --> 05:15You mentioned earlier that
05:15 --> 05:17small cell were more aggressive.
05:17 --> 05:19Tell us about the prognosis.
05:19 --> 05:22So it sounds to me like if you're going
05:22 --> 05:25to have a choice you would prefer to
05:25 --> 05:28have a non small cell lung cancer.
05:28 --> 05:31But how bad is one versus the other?
05:32 --> 05:34I think that the key thing to
05:34 --> 05:37know for both is that there have
05:37 --> 05:39really been a lot of advances such
05:39 --> 05:42that we've actually seen improvements
05:42 --> 05:45in the outcomes for both non small
05:45 --> 05:48cell and small cell.
05:48 --> 05:50And this was just published last year
05:50 --> 05:53in the New England Journal of Medicine
05:53 --> 05:56that the incidence of both
05:56 --> 05:58these and the outcomes of both
05:58 --> 06:00these types of cancers are improving.
06:00 --> 06:02So I think that's a
06:02 --> 06:06really important message to know.
06:06 --> 06:09The other aspect of how
06:09 --> 06:11you're going to do
06:11 --> 06:12with this particular cancer
06:12 --> 06:15has to do with staging,
06:15 --> 06:17and that just means the geography
06:17 --> 06:20of where the cancer is in your body
06:20 --> 06:22when when you're diagnosed with it.
06:24 --> 06:26If you have tumors that are just
06:26 --> 06:29in the lung or have migrated
06:29 --> 06:31into very nearby lymph nodes,
06:31 --> 06:34then you maybe have a stage one
06:34 --> 06:36or stage two cancer.
06:36 --> 06:39You may be eligible for a local
06:39 --> 06:41treatment like surgery or radiation
06:41 --> 06:43in combination with chemotherapy to
06:43 --> 06:46really try to remove that tumor,
06:46 --> 06:49and that's when you have the best prognosis,
06:49 --> 06:51regardless if it's non
06:51 --> 06:53small cell or small cell.
06:53 --> 06:56Overall, folks with non small cell
06:56 --> 06:59do little bit better. But again,
06:59 --> 07:00having lung cancer,
07:00 --> 07:03it's definitely a treatable disease.
07:03 --> 07:05If you have stage four cancer,
07:05 --> 07:08which means that you've had disease
07:08 --> 07:10that has traveled outside of the
07:10 --> 07:12lung to a different organ such as
07:12 --> 07:15the liver or the brain or your bones,
07:15 --> 07:18then we take a different approach,
07:18 --> 07:20which is then we need to use
07:20 --> 07:21systemic therapy.
07:21 --> 07:23That means something that gets
07:23 --> 07:25into your bloodstream because every
07:25 --> 07:27single cancer cell anywhere needs to
07:27 --> 07:30have a blood supply and therefore
07:30 --> 07:31administering chemotherapy,
07:31 --> 07:33or more recently,
07:33 --> 07:36all these advances in immunotherapy
07:36 --> 07:41through the blood into the bloodstream,
07:41 --> 07:43that way those therapeutic
07:43 --> 07:46drugs can reach all of the cancer
07:46 --> 07:48cells that are in your body,
07:48 --> 07:49wherever they may be.
07:51 --> 07:52Well, it's certainly good news
07:52 --> 07:54that lung cancer,
07:54 --> 07:56which is something that I think a
07:56 --> 07:58lot of people fear, is becoming
07:58 --> 08:00a treatable disease and that
08:00 --> 08:02there are all of these advances
08:02 --> 08:04and I want to get into that.
08:04 --> 08:07But first something that you said really
08:07 --> 08:10struck a chord with me and has been
08:10 --> 08:13the case with a lot of cancers and that is
08:13 --> 08:15the earlier you find it,
08:15 --> 08:16the lower the stage,
08:16 --> 08:18the more treatable it is.
08:18 --> 08:21So if you have a stage one lung cancer that's
08:21 --> 08:25more treatable than a stage four lung cancer,
08:25 --> 08:27and I was wondering if you could talk a
08:27 --> 08:30little bit about advances that have
08:30 --> 08:32been made in terms of screening
08:32 --> 08:34that have helped us to find these
08:34 --> 08:37lung cancers earlier?
08:38 --> 08:40Screening is a hot topic now because
08:40 --> 08:42the US Preventive Services
08:42 --> 08:45Task Force just issued a different
08:45 --> 08:47recommendation or it altered their
08:47 --> 08:50recommendation on screening for lung cancer.
08:50 --> 08:54So previously, if you were aged 55 or older,
08:54 --> 08:57or if you had a 30 pack year history
08:57 --> 09:00of smoking and that means smoking one
09:00 --> 09:04pack per day for roughly 30 years,
09:04 --> 09:09then you would be eligible for a low dose
09:09 --> 09:12CT scan because you had a higher
09:12 --> 09:15risk of lung cancer
09:15 --> 09:18and being able to have a screening CT
09:18 --> 09:21scan allows us to pick up
09:21 --> 09:23things when they're very small and
09:23 --> 09:26you don't have any symptoms and often
09:26 --> 09:29help us to detect lung cancers when
09:29 --> 09:32they are in a very early stage.
09:32 --> 09:34So recently in March
09:36 --> 09:38the US Preventive Services Task
09:38 --> 09:39Force changed that recommendation
09:39 --> 09:43to drop the age to 50 and for
09:43 --> 09:45the pack year history to 20.
09:45 --> 09:49So the idea being, let's expand the
09:49 --> 09:52population of people that are being screened.
09:53 --> 09:56I think that our insurers
09:56 --> 10:00are catching up with that but
10:00 --> 10:01the recommendations
10:01 --> 10:04have changed and I think that that's
10:04 --> 10:07going to be very positive in terms
10:07 --> 10:11of again being able to detect
10:11 --> 10:13lung cancers in earlier stages where they
10:13 --> 10:16might be able to undergo local therapy
10:16 --> 10:19such as surgery or focused radiation.
10:20 --> 10:23So important for people to
10:23 --> 10:25get screened because there are so
10:25 --> 10:28many advances in terms of treatment.
10:28 --> 10:30Just one clarifying question though,
10:30 --> 10:33and the other thing that
10:33 --> 10:36a lot of people have now done,
10:36 --> 10:38especially because we've seen
10:38 --> 10:40advances in things like smoking
10:40 --> 10:42cessation is to quit smoking.
10:42 --> 10:46So let's suppose that you have a 20-25
10:46 --> 10:48or thirty pack year history of smoking,
10:48 --> 10:50but you just quit.
10:50 --> 10:53You made it a New Year's
10:53 --> 10:56resolution and you quit maybe a year ago,
10:56 --> 10:58maybe six months ago.
10:58 --> 11:00Are you still eligible for screening?
11:00 --> 11:02Should you still be screened even
11:02 --> 11:04though now you're officially a
11:04 --> 11:06non smoker or a former smoker?
11:06 --> 11:09Yes, if you have a history of
11:09 --> 11:11smoking that's 25 pack years,
11:11 --> 11:13even if it was ten years ago,
11:13 --> 11:15you can still be eligible
11:15 --> 11:17for this screening.
11:17 --> 11:20I think it's a really important
11:20 --> 11:21message to folks that
11:21 --> 11:26wherever you are in your course of
11:26 --> 11:28stopping smoking and it's certainly
11:28 --> 11:30one of the hardest things to do,
11:30 --> 11:32it's always important to realize that
11:34 --> 11:36stopping or quitting smoking is going
11:36 --> 11:38to help you and help your lungs.
11:38 --> 11:41It's going to help your overall
11:41 --> 11:43health and you're going to do
11:43 --> 11:46better than if you continue to smoke.
11:50 --> 11:53There is data that even for folks who
11:53 --> 11:56have smoked a lot over the course
11:56 --> 11:58and maybe even 2 packs per day.
11:58 --> 12:00We certainly had
12:00 --> 12:03in our society a number of years
12:03 --> 12:05where everybody smoked and that
12:05 --> 12:06was really sort of run of the mill,
12:08 --> 12:10that was a very common thing,
12:10 --> 12:12so I think that it's really
12:12 --> 12:14important that wherever you are,
12:14 --> 12:15if you're a
12:15 --> 12:20one pack a day smoker, 2 pack a day
12:21 --> 12:25or you smoke a couple of cigarettes a week,
12:25 --> 12:27I think that stopping smoking
12:27 --> 12:31can really help you and we do have a
12:31 --> 12:33smoking cessation clinic here at Yale
12:33 --> 12:34that's incredibly successful.
12:34 --> 12:37There have been so many advances that
12:37 --> 12:39I can't even keep track.
12:39 --> 12:43It was just the patch and the lozenge.
12:43 --> 12:45And now there's so many different
12:45 --> 12:47options to help people stop and
12:47 --> 12:50and being able to do some of this
12:50 --> 12:52through Televisit consultation
12:52 --> 12:54either through video or phone,
12:56 --> 12:59can allow people to access this
12:59 --> 13:02kind of help and support
13:02 --> 13:03to really improve their health,
13:04 --> 13:06It is important to quit smoking and talk
13:06 --> 13:08to your doctor or call a quit
13:08 --> 13:10line to get the help you need.
13:10 --> 13:12We're going to take a short
13:12 --> 13:13break for a medical minute.
13:13 --> 13:16Please stay tuned to learn more about
13:16 --> 13:18small cell lung cancer with my guest
13:18 --> 13:19Doctor Anne Chiang.
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14:25 --> 14:25Welcome
14:25 --> 14:27back to Yale Cancer Answers.
14:27 --> 14:30This is doctor Anees Chagpar and I'm
14:30 --> 14:33joined tonight by my guest Doctor Anne Chiang.
14:33 --> 14:35We're discussing recent treatment
14:35 --> 14:37advances in small cell lung cancer
14:37 --> 14:39and right before the break you
14:39 --> 14:42were telling us about the fact that
14:42 --> 14:43there have been really exciting
14:43 --> 14:46advances both in small cell as well
14:46 --> 14:49as in non small cell lung cancer
14:49 --> 14:51that have really affected outcomes
14:51 --> 14:52for patients with these diseases.
14:52 --> 14:55So tell us more about some
14:55 --> 14:57of these exciting advances.
14:58 --> 15:00I'd love to. This is a really exciting
15:00 --> 15:02time for lung cancer.
15:02 --> 15:05I remember back to when I started at Yale,
15:05 --> 15:07which was almost 10 years ago,
15:07 --> 15:11and I put my first patient or one of my first
15:11 --> 15:15patients on a clinical trial and at that time
15:15 --> 15:17the standard of care was chemotherapy,
15:17 --> 15:20and in this case we were looking at treating
15:20 --> 15:23this patient with immunotherapy
15:23 --> 15:26and not doing chemotherapy first.
15:26 --> 15:28And he did extremely well.
15:28 --> 15:31And in fact, I saw him a couple of
15:31 --> 15:34weeks ago and he has been off trial
15:34 --> 15:37with no treatment for the past eight
15:37 --> 15:40years and he is contemplating retirement
15:40 --> 15:42and he's doing just incredibly well.
15:44 --> 15:47And that still sends shivers down my spine and I
15:47 --> 15:50know that it's not every single patient
15:50 --> 15:53that has that kind of result.
15:53 --> 15:56But I think the more that we can learn
15:56 --> 15:59through studying and through biology,
15:59 --> 16:00through clinical trials,
16:00 --> 16:02our aim is really to do the best for
16:02 --> 16:05our patients and push that edge as far
16:05 --> 16:07as it can go in terms of how they do.
16:57 --> 17:02One of the trials that I'm a national
17:02 --> 17:04Investigator on spearheading
17:04 --> 17:08is a trial called Insigna
17:08 --> 17:10and it's run through our cooperative groups,
17:10 --> 17:14that's groups that
17:14 --> 17:16help to do research, clinical
17:16 --> 17:18research in the communities.
17:18 --> 17:21This trial is open at about
17:21 --> 17:23850 different centers,
17:23 --> 17:26we're looking for 850 patients to
17:26 --> 17:30enroll on this trial and we're trying
17:30 --> 17:35to understand for PD L1 positive or for
17:35 --> 17:38patients who have this marker of
17:38 --> 17:42PDL one if they are treated with
17:42 --> 17:45either immunotherapy upfront or
17:45 --> 17:48immunotherapy combined with chemotherapy,
17:48 --> 17:50which group will do better
17:50 --> 17:52and then with those patients
17:52 --> 17:54who are treated with immunotherapy
17:54 --> 17:56alone if they progress,
17:56 --> 17:58can we then add chemo to the immunotherapy
17:58 --> 18:01to sort of boost the immune system?
18:01 --> 18:03And at the same time we're going
18:03 --> 18:05to be using the tissue and the
18:05 --> 18:08science that we can gather to try to
18:08 --> 18:11understand if there are biomarkers or
18:11 --> 18:13signatures that can help us understand
18:13 --> 18:15which people will benefit and which
18:15 --> 18:17people have less of a benefit.
18:17 --> 18:20that's a really exciting trial that is ongoing,
18:20 --> 18:23we're about 40% of the way through on that,
18:23 --> 18:26and I think that you know there are
18:26 --> 18:28thousands of
18:28 --> 18:30immunotherapy trials in cancer right now,
18:30 --> 18:32but I think this is one that
18:32 --> 18:34will really help us to understand
18:34 --> 18:37what's the right thing to do
18:37 --> 18:40up front.
18:40 --> 18:42We talk on this show
18:42 --> 18:44all the time about immunotherapy.
18:44 --> 18:46And it sounds like particularly
18:46 --> 18:48giving your anecdotal case with your
18:48 --> 18:50patient who's now nine years out,
18:50 --> 18:52it sounds like immunotherapy
18:52 --> 18:54really does have a role or a
18:54 --> 18:56potential role in lung cancer.
18:56 --> 18:57With your trial,
18:57 --> 19:01is it open to non small cell lung cancer,
19:01 --> 19:04small cell lung cancer, or any lung cancer?
19:05 --> 19:08So that trial is open for non small cell
19:08 --> 19:12lung cancer and it's for patients who have
19:12 --> 19:16stage four disease and who have a tumor
19:16 --> 19:19that has a positive marker for PDL 1,
19:19 --> 19:22which is an important molecule
19:22 --> 19:26in the signaling for immunotherapy
19:26 --> 19:29in terms of small cell lung cancer,
19:29 --> 19:32we have a number of clinical
19:32 --> 19:34trials also that are available,
19:34 --> 19:39and I think that the story for
19:39 --> 19:43small cell is that chemo plus immunotherapy
19:43 --> 19:47has been
19:47 --> 19:49approved in
19:49 --> 19:51the past couple of years.
19:51 --> 19:53That's how the landscape
19:53 --> 19:55of small cell has changed.
19:55 --> 19:58It was just previously treated with
19:58 --> 20:00chemotherapy and just in the past couple
20:00 --> 20:03of years we now treat with chemo,
20:03 --> 20:04plus immunotherapy.
20:04 --> 20:07And then the question is what happens after?
20:07 --> 20:09If that doesn't work anymore?
20:09 --> 20:12And I think we have a number of different
20:12 --> 20:15clinical trials that are available for that,
20:15 --> 20:17and we're trying to really
20:17 --> 20:19understand the biology behind
20:20 --> 20:23why people respond or why they
20:23 --> 20:26don't respond and in small cell it's
20:26 --> 20:28typically a tumor where there's
20:28 --> 20:30less tissue available to test,
20:30 --> 20:32and so we've put together
20:32 --> 20:34a really great team here for
20:34 --> 20:36studying the science that includes
20:39 --> 20:41PhD scientists working
20:41 --> 20:43on lung cancer as well as myself.
20:43 --> 20:45And, you know,
20:45 --> 20:49I think it would be too hard to go into
20:49 --> 20:52all of the details here,
20:52 --> 20:54but I think we're going to learn
20:54 --> 20:57a lot about how we can explore the
20:57 --> 21:00biology of small cell in order
21:00 --> 21:02to find out vulnerabilities in
21:02 --> 21:04order to target this disease.
21:05 --> 21:07It sounds like you
21:07 --> 21:10know, across the board in lung cancer,
21:10 --> 21:12whether you've got small cell or
21:12 --> 21:14whether you've got non small cell.
21:14 --> 21:17It sounds like immunotherapy is increasingly
21:17 --> 21:20becoming part of the arsenal that your
21:20 --> 21:23doctor may use to treat your disease.
21:23 --> 21:26And that really has made a
21:26 --> 21:28difference now, and is that the case
21:28 --> 21:31only for people who express PDL one?
21:31 --> 21:35We've talked on this show before
21:35 --> 21:37about checkpoint inhibitors like PDL one.
21:37 --> 21:40So is it the case that people who
21:40 --> 21:42present with metastatic lung cancer,
21:42 --> 21:45stage four, that they should be having
21:45 --> 21:48their tumors checked for that marker
21:48 --> 21:50and then treated with immunotherapy
21:50 --> 21:53or is immunotherapy something that
21:53 --> 21:56your doctor may use regardless?
21:56 --> 22:00For non small cell lung cancer you
22:00 --> 22:03definitely need to have your tumor checked.
22:03 --> 22:06If you have high levels of PDL
22:06 --> 22:09one so greater than 50% then you
22:09 --> 22:12may be eligible to be treated
22:12 --> 22:15with just immunotherapy alone.
22:15 --> 22:17Otherwise you really need to be
22:17 --> 22:20treated with a combination of chemo
22:20 --> 22:23and immunotherapy. For small cell, it is different.
22:24 --> 22:26There's very little PDL one
22:26 --> 22:29expression to start with and
22:29 --> 22:32for the trials that have been done,
22:32 --> 22:37they've looked at all comers
22:37 --> 22:39so it doesn't matter if you have PDL one
22:39 --> 22:42expression or not because it's so low anyway,
22:42 --> 22:44but all of the small cell patients
22:44 --> 22:45that are diagnosed are treated
22:45 --> 22:46with chemo plus immuno.
22:48 --> 22:51It is interesting how that kind
22:51 --> 22:54of plays out between the
22:54 --> 22:55two disease types.
22:55 --> 22:59So tell us a little bit more about other
22:59 --> 23:02advances that have occurred?
23:02 --> 23:05Before the break you were telling us
23:05 --> 23:08about an alphabet soup of markers,
23:08 --> 23:11things like EGFR and others.
23:11 --> 23:12ALK, for example.
23:12 --> 23:15How have these really changed the landscape?
23:15 --> 23:17Are oncologists
23:17 --> 23:21using them to kind of target their
23:21 --> 23:24therapies to personalize things as it were?
23:26 --> 23:29Great question. So as I was
23:29 --> 23:31talking about before the break,
23:31 --> 23:33if you for example have an EGFR
23:33 --> 23:36mutation which EGFR stands for
23:36 --> 23:38epidermal growth factor receptor,
23:38 --> 23:40I think that the key is that
23:40 --> 23:43what we found over the years is
23:43 --> 23:46that if you have a mutation in
23:46 --> 23:49that you really respond to
23:49 --> 23:53taking that EGFR directed therapy.
23:53 --> 23:54In this case,
23:54 --> 23:56it's a drug called osimertinib
23:58 --> 24:01and you should do that off the bat
24:01 --> 24:03if you have stage four disease.
24:03 --> 24:06If you have stage one disease or
24:06 --> 24:09stage two disease or you've had or
24:09 --> 24:11stage three that you've had surgery,
24:11 --> 24:14there has been a very new advance in
24:14 --> 24:17the past year and it was
24:17 --> 24:19led by Doctor Roy Herbst of Yale,
24:19 --> 24:21our team that basically
24:21 --> 24:23says that after you
24:23 --> 24:25have that surgery,
24:25 --> 24:28you benefit from taking that oral therapy.
24:32 --> 24:34And I think it's important also
24:34 --> 24:36to mention that these trials,
24:36 --> 24:38such as the ADURO trial,
24:38 --> 24:40were offered not only in
24:40 --> 24:42our main academic campus,
24:42 --> 24:43in New Haven,
24:43 --> 24:46but also in all of our Smilow
24:46 --> 24:48care centers across the state.
24:48 --> 24:51And we have 15 of them,
24:51 --> 24:53so we've been able to
24:53 --> 24:57allow patients who are in
24:57 --> 24:59all parts of the state participate
24:59 --> 25:01in these types of clinical
25:01 --> 25:03trials that can really,
25:03 --> 25:06really give access to cutting
25:06 --> 25:09edge drugs or to help to advance
25:09 --> 25:11science for all patients.
25:11 --> 25:14And that's the case across the
25:14 --> 25:16country, that many of these
25:16 --> 25:19large trials are offered at
25:19 --> 25:21academic centers that are offered at
25:21 --> 25:24community centers and that really people
25:24 --> 25:27should talk to their doctor because
25:27 --> 25:29trials, whether they were led by
25:29 --> 25:31Yale or led by investigators at
25:31 --> 25:33other centers are often available
25:33 --> 25:35for patients across the nation.
25:35 --> 25:36Isn't that right?
25:36 --> 25:37Absolutely, and I think
25:37 --> 25:39that you know, in the past clinical
25:39 --> 25:42trials you though, Gee,
25:42 --> 25:44I will try a clinical trial if everything
25:44 --> 25:47else has failed and it's not working for me,
25:47 --> 25:50so I'm going to try something experimental.
25:50 --> 25:52Now that paradigm is completely shifted,
25:52 --> 25:54so it may be that you have your
25:54 --> 25:56first treatment that you're
25:56 --> 25:58going on a clinical trial.
25:58 --> 26:00And it really is to try and
26:00 --> 26:02better the outcomes for each of
26:02 --> 26:04the recommended treatments
26:04 --> 26:07that are recommended approaches,
26:07 --> 26:09standard approaches so that we can
26:09 --> 26:11push the envelope and
26:11 --> 26:14really do the best for our patients.
26:15 --> 26:18And in terms of these targeted therapies,
26:18 --> 26:20whether it's a
26:20 --> 26:22drug that's targeting an EGFR,
26:22 --> 26:25whether it's a drug targeting ALK or
26:25 --> 26:27whatever, this is across the board.
26:27 --> 26:29Is that right between small
26:29 --> 26:31cell and non small cell?
26:31 --> 26:34And so the question that I have is if
26:34 --> 26:37that is the case then for everyone
26:37 --> 26:40who has lung cancer it sounds like
26:40 --> 26:43they should have their tumor profiled
26:43 --> 26:45with regards to all of these
26:45 --> 26:48mutations so that their doctor can
26:48 --> 26:50better inform what might be the
26:50 --> 26:52therapy that works best for them.
26:52 --> 26:53Is that right?
26:53 --> 26:55So the the mutations that
26:55 --> 26:58I talked about EGFR and so forth are
26:58 --> 27:01really much more common in non small cells.
27:01 --> 27:04So we do as a matter of fact test all
27:04 --> 27:07of our non small cell samples
27:07 --> 27:10and look for
27:10 --> 27:13these mutations. For small
27:13 --> 27:15cell it's a little bit different.
27:15 --> 27:19We don't have typically
27:19 --> 27:22mutations in EGFR or ALK,
27:22 --> 27:23specifically for small cell.
27:23 --> 27:26However, because we still think
27:26 --> 27:28that it's important to test for
27:29 --> 27:31those and typically not up front,
27:31 --> 27:35in other words, when you're first diagnosed,
27:35 --> 27:37but if you are treated with
27:37 --> 27:39chemo and immunotherapy,
27:39 --> 27:42and perhaps it typically works very
27:42 --> 27:46well in 80 to 90% of the cases
27:46 --> 27:50you have a very good response
27:50 --> 27:52but that disease may come back when
27:52 --> 27:55you have stage four disease,
27:55 --> 27:57it's typically not something that you're
27:57 --> 28:00going to cure because you
28:00 --> 28:02don't have the option of cutting out
28:02 --> 28:04or radiating every microscopic cell.
28:04 --> 28:06So if the disease regrows,
28:06 --> 28:07if and when,
28:07 --> 28:07unfortunately,
28:07 --> 28:09the disease regrows,
28:09 --> 28:11we want to have options and
28:11 --> 28:13really develop more tools is
28:13 --> 28:16what I tell my patients to be
28:16 --> 28:18able to manage their disease,
28:18 --> 28:20and that's why we
28:20 --> 28:22do work so much with clinical
28:22 --> 28:25trials and feel that that's
28:25 --> 28:27incredibly important to be able to
28:27 --> 28:29advance outcomes for our patients.
28:29 --> 28:30Doctor Ann Chiang
28:30 --> 28:33is an associate professor and medical
28:33 --> 28:35oncologist at the Yale School of Medicine.
28:35 --> 28:37If you have questions,
28:37 --> 28:39the address is cancer answers at
28:39 --> 28:41yale.edu and past editions of the
28:41 --> 28:43program are available in audio and
28:43 --> 28:45written form at yalecancercenter.org.
28:45 --> 28:48We hope you'll join us next week to learn
28:48 --> 28:51more about the fight against cancer.
28:51 --> 28:53Here on Connecticut public radio.
28:53 --> 28:55Funding for Yale Cancer Answers
28:55 --> 28:58is provided by Smilow Cancer
28:58 --> 29:00Hospital and AstraZeneca.

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August 22, 2021

Yale Cancer Center

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