Advances in Lung Cancer

March 29, 2021

Information

March 28, 2021

Yale Cancer Center

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00:00Support for Yale Cancer Answers
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00:07hope for people living with cancer.
00:10More information at astrazeneca-us.com.
00:14Welcome to Yale Cancer
00:16Answers with your host,
00:17Doctor Anees Chagpar. Yale Cancer Answers
00:20features the latest information on
00:22cancer care by welcoming oncologists and
00:24specialists who are on the forefront of
00:26the battle to fight cancer. This week,
00:28it's a conversation about lung
00:30cancer with Doctor Roy Herbst.
00:32Doctor Herbst is
00:33Ensign Professor of Medicine
00:34and medical Oncology,
00:35an professor of pharmacology at
00:37the Yale School of Medicine,
00:39where Doctor Chagpar is a
00:42professor of surgical oncology.
00:44Maybe we can start off by talking
00:47a little bit about the Epidemiology
00:49of lung cancer, is it still
00:51one of the leading
00:53cancers and the leading
00:55cause of cancer related death?
00:57Lung cancer still is
00:59unfortunately the number one cause of cancer
01:02death worldwide with maybe 1.6, 1.7
01:04deaths a year by incidence.
01:06It's not the number one cancer diagnosed
01:09more breast cancer is diagnosed in women,
01:12and prostate cancer in men,
01:13but by death, it certainly is the major
01:16killer because it tends to present in
01:19a metastatic way, already having spread.
01:21But you know, we're making great inroads
01:24now with early screening for lung cancer
01:26and hopefully will find it earlier.
01:29And we have seen improvements in
01:31survival but there is still work to do.
01:33I wanted to start off there and
01:36certainly will get into some of the recent
01:38advances in screening and treatment.
01:41But you know, lung cancer used to be
01:43the number one cancer, and we saw that
01:46breast cancer and prostate cancer kind
01:49of pulled ahead several years ago.
01:52And in part, I think that that was
01:54related to some advances that were
01:57made in terms of lung cancer.
01:59Primary prevention.
02:00In other words,
02:01not getting lung cancer to begin with.
02:04Do you want to kind of talk
02:07about some of that?
02:08Particularly where it
02:10pertains to smoking cessation?
02:12Right, the best way to
02:15treat lung cancer still is to prevent it,
02:18and certainly even though there
02:19is a very real group of patients
02:22with a non smoking lung cancer,
02:24as many as 15% or more of patients in the
02:27United States about double that in Asia,
02:30still smoking is one of the primary
02:33reasons for causation and lung cancer.
02:35So major efforts have been underway over
02:37the last 50-60 years in the United States
02:40since the initial Surgeon General's report
02:42to stem the tide of smoking.
02:45We've gone down from 50% of Americans
02:48smoking, perhaps to less than 20%,
02:50maybe 18% or so,
02:51differing among different groups
02:53in different states,
02:54but we still need to do better.
02:56But smoking clearly is a cause and now we
02:59worry as we've really worked on smoking
03:02both with education and
03:04with medications, with counseling.
03:05Now we see this big surge in E-
03:08cigarette use and we worry and I'm
03:10very involved with the American
03:12Association of Cancer Research, actually.
03:15The task force on tobacco control.
03:17We're actually looking very carefully
03:19at E-cigarettes because we worry
03:21that these are being used now by
03:23children and young adults
03:25and they're filled with nicotine,
03:26and nicotine is the addictive
03:28substance in cigarettes,
03:29so people are getting addicted to nicotine.
03:31And then they go to what's
03:33called dual use and start to use
03:35combustible cigarettes, the
03:37type we're most familiar with.
03:38And then of course
03:40the story is all too familiar,
03:42and this is important
03:45to tell you here in New Haven where we live
03:48the rates are probably a
03:50bit higher than the national average
03:53and we're doing a lot of work
03:56with community programs
03:58as part of our long funded research
04:01through the National Cancer Institute,
04:03we just completed a large trial when
04:06patients came into the hospital,
04:08some with problems, some for screening.
04:10We tried to use new methods to help them
04:13to stop smoking, new messaging tools,
04:16so that's still such an important part
04:18of this field to not smoke also we have
04:21to worry about other risk factors.
04:24Asbestos,
04:25radon gas is something we all
04:27think about here
04:28living in Connecticut,
04:29all these things can be a risk
04:31factor for future development of this
04:34disease. So I want to pick up on a couple
04:37of things that you said just quickly.
04:39So the first was your study looking
04:42at new messaging techniques.
04:47Roughly 20% of the population smoke
04:50and for many of them it is
04:53very difficult to quit.
04:55There are all kinds of things out there.
04:58There's quitlines,
04:59there's patches, there's gum,
05:00there's behavioral modification.
05:01Some people even advocate
05:03paying people to quit smoking,
05:05and some people are even suggesting
05:08that E cigarettes can be used as a
05:11bridge to help people to quit smoking.
05:13So for our listeners out there,
05:16the 20% who may be smoking
05:19as they listen to this,
05:21what's the best way to quit and
05:23where can they get help?
05:24Well, first of all,
05:25I would definitely ask for help.
05:27That could be your physician.
05:29That could be a nurse practitioner.
05:30Just whoever you see for
05:32your regular health checks.
05:33Some of these quit lines
05:34can be extremely helpful,
05:36and there are a number of
05:37ways to work on quitting,
05:39and now this is an addiction
05:40and it is hard to quit,
05:42especially if you've been using
05:44cigarettes for a long time.
05:45The nicotine is really hard to beat,
05:47so there are a couple of ways to do it
05:50here in our smoking cessation clinic,
05:52they will assess each person
05:54on an individual basis.
05:55There are certainly ways to substitute
05:57for the nicotine other than a
05:59combustible cigarette that you smoke.
06:02There are certain medications that can help,
06:05but then of course,
06:06behavioral modification and counseling,
06:07which I think is so important here at Yale,
06:10where we have an amazing center of
06:12emotional intelligence and there
06:14have been studies done to show
06:16that different types of messaging
06:17can be more effective than others.
06:19For example,
06:20many of you have seen
06:22cigarette cartoons.
06:23Not so much in the United States,
06:25but around the world where there
06:27are these horrible images of people
06:28and the consequences of smoking.
06:30Those are very negative type messages,
06:32but they're intended to scare
06:33people from not smoking.
06:34There's been some thought that more
06:36gain framed messaging where you
06:38might show well if you don't smoke,
06:40you'll feel better if you don't smoke,
06:42your skin will look better.
06:43That could be another way of doing it.
06:45We're testing some of those
06:47new methods here at Yale.
06:48The other thing we've done
06:49is a biofeedback approach,
06:50so we actually have an infrared
06:53device that can measure carotenoids
06:54in the skin and the health of the
06:57skin which we know actually can
06:59get somewhat destroyed with tobacco
07:01use and we actually are using that
07:03sort of biofeedback with patients to
07:05try to maintain them from using tobacco.
07:08So we've been working very hard on this.
07:10Lisa Fucito leads this effort now
07:12in our clinic and we're trying to
07:15serve as many patients as possible.
07:17And by the way,
07:18it's not just lung cancer.
07:20About 20 different cancers that
07:22all can trace their
07:23origin back to smoking and
07:25we are really trying to work on this.
07:27It's something that's now as
07:28part of our medical record.
07:30Everyone's asked the question
07:31about tobacco use.
07:32And primary prevention is just so important,
07:34but even if someone has smoked
07:36and many people have and they
07:37stopped they are still at risk
07:39of developing lung
07:40cancer and this is where screening
07:42comes in and the idea
07:44that you can do a low dose CAT
07:47scan to screen for lung cancer.
07:48And I'm very proud to say that
07:50even during this very difficult
07:52year with covid and clinics
07:53closed or moved,
07:54we've actually had a very strong
07:56year number wise in the
07:58number of patients in the
08:00area that we've screened.
08:06So screening patients and
08:07finding cancers early in people
08:09at high risk is also a very
08:11important tool that we're using.
08:14I think the last question
08:16before we move on from smoking
08:19cessation is I wanted to get
08:20your thoughts on taxation.
08:22So certainly in
08:23some parts of the world they've
08:26found that making
08:28it hurt in people's pocketbooks
08:31is often a deterrent to smoking.
08:34Where do you come down on that?
08:38Do you advocate that governments
08:40should put stiff taxes on cigarette
08:42purchases to make that less appealing?
08:46Well, that a
08:48tough one. You know,
08:49different states do different things.
08:51I still remember once being in a drug
08:53store in New York City and someone
08:55came in for a pack of cigarettes.
08:58And it could cost up to $15-20
09:00with some of the different taxes and
09:04I think people will find the cigarettes
09:07elsewhere.
09:09I think it's a useful technique but it would have
09:11to be a universal sort of technique.
09:13Otherwise people will find
09:15ways of getting cigarettes.
09:16I'm much more
09:17in favor of
09:18some of the approaches I mentioned,
09:20whether it be counseling, medications.
09:24I think that the E cigarettes as
09:25a substitute for someone who's
09:27tried everything else could
09:28work in that way,
09:30but it has to be studied in a regulated way.
09:33You know there needs to be a clinical
09:35trial and we're actually trying to do
09:37some of those here right now at Yale,
09:40especially now with some of the
09:41covid regulations.
09:42But it would be nice to see if we can
09:45use these cigarettes in a measured way.
09:47With a prescribed dose,
09:48as a tool, but
09:52there are other forms of
09:54nicotine replacement,
09:54but clearly stopping people from
09:56smoking whatever method is used
10:00because it's a National emergency
10:02despite the fact that it's
10:04so much better than it was
10:06Really the only good level of
10:08tobacco use is none.
10:11And you worry also about the E cigarettes
10:14being yet another addictive substance
10:16and we don't really know long term what
10:19the health consequences are of that.
10:21The other thing that you mentioned was that
10:24there are many lung cancers that happen
10:27for reasons outside of cigarette smoking.
10:30For example, you mentioned in Asia
10:33about 50% of lung cancers are
10:35not related to cigarette smoking,
10:38and I wonder whether you think
10:40that there are some environmental
10:43issues that we need to consider.
10:46I mean is this part of
10:49the pollution that
10:51we're seeing in terms of
10:56manufacturing and so on that might be
10:58greater in some industrialized parts
11:00of Asia that promotes lung cancer.
11:03Or do we not know why there's these
11:07disparities?
11:09We're talking about the non smoking lung
11:11cancer which initially was due to
11:14the epidermal growth factor receptor
11:16mutation that was discovered more
11:18than 20 years ago and those levels are
11:21much higher in Asia than in the US.
11:24About double. 30 to 40% versus 15 to 20%.
11:28I don't know that it's environment
11:29because if someone is born in
11:31Asia and moves to Southern California,
11:33it seems like they have the same higher risk.
11:36So I think there's something genetic
11:39which amazes me with all the
11:41tools we have now to sequence
11:43genomes and we can sequence
11:46dozens and dozens of patients each day.
11:48We still have not found what
11:50the link there is.
11:52What is the genetic factor?
11:53It's being looked at quite intensively.
11:55It's this cooperation between
11:57researchers around the world.
11:58But we still don't know exactly
12:00why these mutations in epidermal
12:02growth factor receptor are so much
12:03more common in Asia than the US,
12:05but we're looking for it and
12:08learning how to treat that type of
12:10cancer with oral agents.
12:12It's actually been historic.
12:13I think that's part of the
12:15reason we're seeing
12:16a couple percent a year decreases in the
12:19death rates from lung cancer because
12:20of what we call targeted therapy.
12:22But even when those drugs work,
12:24as you know, patients will become resistant.
12:27That's actually something we're
12:28studying very much here in our group. NOTE Confidence: 0.8304425
12:30Katie Politi and Sarah Goldberg
12:32and Mark Lemon actually is one
12:35of the projects on our big lung
12:37Spore Grant looking
12:38at mechanisms of sensitivity and
12:40resistance to these drugs so that
12:42we can help more patients develop
12:44newer and better,
12:45more effective and
12:46less toxic ways to treat this disease.
12:49Yeah, and as
12:52we kind of think about lung
12:54cancer and the fact that it no
12:56longer is the number one cancer
12:58in people thanks to reduction in
13:00smoking cessation and other things,
13:02it still remains the number one
13:05killer in terms of being the number
13:08one cause of cancer related morbidity
13:10and mortality. Has that reduced in
13:13recent years thanks to some of the
13:15things that we'll be talking about in
13:18terms of understanding the genomics
13:20and tailored therapy and so on.
13:22Are we seeing the needle move?
13:24Oh absolutely, and I've seen this myself,
13:27so I started working in this field
13:30about 20-25 years ago as a young fellow
13:33at Dana
13:35Farber Cancer Institute actually,
13:36and no one even wanted to work in this field.
13:40Back then, it was really a death sentence
13:41if you had lung cancer,
13:44we had surgery and radiation techniques,
13:46but if it had spread
13:48the chemotherapy was OK,
13:49but really didn't do much.
13:51And I think over the years
13:53we've really taken the five year
13:55overall survival for lung cancer,
13:56which was in the low teens 10-11%.
13:59And now it's as high as 19% or more.
14:02Now that's all across all stages,
14:04stage 1,2,3 and four.
14:06Four being the most advanced,
14:07but that's progress.
14:08But the real progress that we're
14:10seeing is identifying a more
14:12personalized approach to this disease
14:14and learning how to treat it with
14:16some of these new targeted therapies.
14:18Learning how to treat it with immunotherapy.
14:20And yeah,
14:21I've seen
14:23patients now in 2021
14:26who now
14:30come here to our clinics
14:33and they either get standard
14:34of care or clinical trials.
14:36And a smaller proportion increasing
14:37every day are doing better,
14:39so there is definitely progress
14:41visible progress in this field.
14:42And understanding the science,
14:46what drives the lung cancer,
14:48what's causing it to grow and how
14:50to treat it in more effective ways.
14:53We're going to talk all about
14:55that right after we take a short
14:57break for a medical minute.
14:58Please stay tuned to learn
15:00more with my guest. Doctor
15:02Roy Herbst. Support for Yale Cancer
15:04Answers comes from AstraZeneca working
15:06to eliminate cancer as a cause of death.
15:08Learnmore@astrazeneca-us.com. This
15:14is a medical minute about genetic
15:17testing which can be useful for
15:19people with certain types of cancer
15:22that seem to run in their families.
15:24Patients that are considered at risk
15:27receive genetic counseling and testing so
15:29informed medical decisions can be based
15:32on their own personal risk assessment.
15:34Resources for genetic counseling and
15:36testing are available at federally
15:38designated comprehensive cancer centers.
15:40Interdisciplinary teams include geneticists,
15:42genetic counselors, physicians,
15:43and nurses
15:44who work together to provide
15:46risk assessment and steps to prevent
15:49the development of cancer.
15:50More information is available
15:52at yalecancercenter.org.
15:53You're listening to Connecticut Public Radio.
15:57Welcome back to Yale Cancer Answers.
16:00This is doctor Anees Chagpar and I'm
16:03joined tonight by my guest Doctor Roy Herbst.
16:06We're talking about recent advances in the
16:09management of lung cancer patients and Roy,
16:12right before the break you were telling
16:14us that you have seen visible progress in
16:18terms of reducing lung cancer mortality.
16:20This remains the number one cancer
16:23killer of Americans, both men and women,
16:26but we're seeing progress.
16:28So there are so many different avenues
16:30that we've seen in terms of lung cancer
16:34management that have contributed to this.
16:36What do you think is the greatest
16:39driver?
16:42The ACS announced earlier this year a 2% decrease
16:45in deaths from lung cancer since 2013.
16:48So clearly something's happening.
16:49I think part of it is the prevention,
16:53either primary prevention by avoiding
16:55smoking and other toxins, or the screening.
16:58But I have to believe a lot of
17:00it's been the therapies that we've
17:02seen in the last several years.
17:05Understanding the molecular
17:06basis of this disease.
17:10That's not really true.
17:13Everyone's cancer is a little bit different,
17:15caused by a different mechanism,
17:17a different genetic background.
17:18So now what we're doing is we're
17:21taking the patients cancer and we're
17:23performing molecular techniques
17:24for sequencing.
17:24We're looking at what makes it tick now.
17:27What is driving that cancer?
17:29And now there are about seven or
17:31eight different different mutations,
17:32different markers that we
17:34can then pair with a specific drug.
17:36So we're personalizing the therapy,
17:38and that's nice
17:39because these are oral therapies,
17:40that you take by mouth and are
17:43much less toxic than the
17:45chemotherapy we used to use,
17:46and we see the tumors shrink in
17:48a large percentage of patients.
17:50So many of these started
17:51out as clinical trials,
17:53and now they're moving
17:54forward to standard of care.
17:55So I think that's having a great benefit.
17:58I've seen it myself.
17:59Over the last 15-20 years,
18:00certainly within the last decade,
18:02many approved drugs in this space,
18:04so you really want to make sure
18:06that your cancer is analyzed in
18:07this way so that you have access
18:09to these drugs now.
18:11Like everything else,
18:12nothing is perfect with time
18:13the tumor will get smart and learn
18:15how to override these blockages.
18:17But that's why we're doing research.
18:19All of us that are at different
18:21centers to try to figure out
18:22one of the next steps and,
18:24and we're continuing to raise the bar,
18:26but that's certainly been
18:27one of the major advances.
18:29The second has been immunotherapy,
18:31and the idea that we can
18:33use the body's own immune system
18:34to attack the cancer really began
18:37in Melanoma and kidney cancer.
18:38But lung cancer being so common,
18:40we're seeing just amazing
18:42results that we can now actually
18:44take a cancer that's already spread
18:46throughout the body and we can treat
18:49with one of these immunotherapy drugs.
18:50And we're doing that now.
18:52And when we do that,
18:54actually in about 20% of
18:56the patients we see
18:57amazing results and the rest
18:58sometimes we see some
19:00activity and others we don't,
19:02so we have to do a little bit more,
19:04but these are patients who never
19:06before would have had any hope of
19:08doing well on some of these therapies.
19:10And then if that all was not enough,
19:12we're taking all these therapies
19:14that work in the most advanced
19:15stages and we're moving them
19:17earlier and earlier in disease.
19:19I can tell you one
19:20thing that I've seen
19:21over my career is the best drugs
19:23work best when they are used in the
19:26earliest possible stage after surgery,
19:27when the burden of lung cancer is the lowest.
19:30So now we're doing what's
19:32called adjuvent therapy,
19:33and I was very fortunate to actually
19:35present last year
19:37some data where an EGFR inhibitor used
19:39after surgery had really high impact
19:41on how patients did after that surgery,
19:44so the sky is the limit.
19:46Research in this area is paying off.
19:48We're seeing tangible benefits,
19:49but when I could also say and tell you,
19:52I'm sure many listening to this
19:54notice from their own experience,
19:56we still have to do even better,
19:58and that's why research, science,
20:00operative work working together
20:02is going to be so important,
20:04and that's the type of programs that
20:06we lead here at our center.
20:08Roy, let's dig into a few things
20:11that you talked about.
20:13So the first was targeted
20:15therapy and Genomics,
20:16and we've talked a lot on this show
20:19about kind of unpacking that concept
20:22in a variety of different cancers.
20:24and really trying to figure out what
20:27are the main drivers in lung cancer,
20:30so are all lung cancers kind
20:33of profiled in this way?
20:35And are there particular mutations that
20:37have druggable targets that you look for?
20:41Well, certainly all lung cancers
20:43when they've already spread
20:44from the lungs are what we
20:46call non squamous lung cancers,
20:48which the majority should
20:49be profiled in this way.
20:51And actually it's my belief we actually
20:53should probably profile all of them
20:55to understand one of the
20:57determinants that are causing that
20:59cancer to grow because that will allow
21:01us to match with the best therapy.
21:03Now I'm concerned you know one
21:05of the big issues we have is
21:07access to care and making sure all
21:09patients get this screening done.
21:11One thing we're doing a lot
21:14of work on is to try to get navigators
21:17out to all the different areas of the city
21:20to build trust.
21:22Within Connecticut we want every patient
21:24to have access to coming to a center
21:27where they can have their tumor profiled.
21:29But yes,
21:30if you profile the tumor,
21:31there's probably as much as a
21:3320% chance you'll find something
21:35that will allow you to match
21:37that patient with an oral drug,
21:39which in my opinion is certainly preferable
21:40to giving a nonspecific chemotherapy,
21:43so that's a huge advance.
21:44And we're continuing to find more of
21:46these and new combinations that can be used.
21:49So yes,
21:50that's what we call precision guided
21:52therapy and for the patients who
21:54don't have one of these mutations,
21:57do they get standard chemotherapy
21:59and have there been any advances
22:01in terms of standard chemotherapy
22:04for those people who either don't
22:06have a druggable target or who have
22:09a druggable target, and who recur?
22:11Well, incredibly, the
22:12answer is yes.
22:13So I mentioned immunotherapy already.
22:15So if someone does not
22:17have one of those targets,
22:19we actually can look for another target,
22:22something called PDL1,
22:23now PDL1 actually was in part
22:26discovered by Lieping Chen, NOTE Confidence: 0.80644786
22:28a professor here at Yale,
22:30and he's one of our collaborators,
22:32but we actually can measure
22:34PDL one and tumors.
22:35And if the level is very high,
22:37that tells us that the
22:39immunotherapy might work alone.
22:40So we give those patients immunotherapy,
22:43assuming they don't have
22:44some reason we can't.
22:45Sometimes you can't reactivate the
22:47immune system because someone might
22:49already have some bad arthritis or
22:51know what we call an autoimmune
22:53disease that precludes that.
22:54But for the rest of these, again,
22:56unless they have a contraindication,
22:58we're giving immunotherapy in
22:59combination with chemotherapy.
23:00Would have been what I would have
23:03guessed would have been such an active
23:05therapy, but for whatever reason,
23:07when you give chemotherapy
23:08and immunotherapy together,
23:09you at least have an additive effect,
23:11meaning the chemotherapy kills
23:13some of the tumor cells,
23:14releases some of the proteins
23:16that activate the immune system,
23:18and then use these drugs that
23:19we call a checkpoint
23:21inhibitor that unleash the power
23:23of the immune system and that's
23:25become a standard of therapy.
23:26Now I'll tell you that
23:28those results are really
23:30good and much better than
23:32what we've had in the past.
23:33But in my opinion we still
23:35have to raise the bar,
23:37so that's where clinical trials come in,
23:39and it would be my my big hope that
23:41in that room when a patient and a
23:44physician or nurse practitioner or
23:45whoever is there are meeting. someone
23:48brings up, is there a clinical trial?
23:50Is there something new that's
23:52looking at a new agent?
23:53A new drug,
23:54something that might even be more active?
23:56And of course,
23:57that's investigation,
23:58but that's really how we
24:00continue to do better and better,
24:03and we're inching up the
24:06benefits from therapy in lung cancer.
24:11So certainly clinical trials.
24:13I mean, we've talked on this show a
24:16lot about clinical trials and the
24:18fact that people who participate
24:20in clinical trials tend to do
24:22better than people who don't.
24:24Are all of the clinical trials in
24:27lung cancer now really geared around
24:29targeted therapies and immunooncology
24:32or are there any clinical trials that
24:35are looking at advances in standard
24:38chemotherapy for people who may not
24:40be eligible for those other therapies?
24:43Either because they don't have a
24:46target or because they don't have
24:49a tumor that's expressing PDL 1.
24:52Well, standard chemotherapy
24:53clearly has its place,
24:55and certainly in earlier stages of
24:57disease before the tumors have spread
24:59from the lung we're using chemotherapy
25:01with radiation therapy, for example,
25:03and that can be curative therapy.
25:05We often add immunotherapy in afterwards,
25:08but I actually personally think
25:09we've pretty much come as far
25:12as we can with chemotherapy.
25:14It's somewhat nonspecific.
25:15It can have a number of side effects.
25:18However, we're finding new
25:19targets like right now,
25:21just in the last several months,
25:23there's been data on a new target
25:26against something called Kras.
25:28Now Kras, which is an oncogene,
25:30actually first came from a rat model.
25:34Kras actually is about
25:3612 to 20% of lung tumors.
25:38The actual variant of this that
25:40now has multiple drugs that are
25:42out there is what we call G12C.
25:45Probably doesn't mean much to a
25:47lot of those who are listening,
25:49but it's a specific abnormality that
25:52occurs in 12% of lung cancer patients.
25:54That's a lot of patients.
25:56Remember,
25:56I told you it's 1.6, 1.7
25:58worldwide and there are actually agents now,
26:00not approved yet,
26:01but that are in clinical trials
26:03showing positive results that
26:04can make those tumors shrink.
26:06So before I pull off some chemotherapy,
26:08which by the way we will do and
26:09we do need to use and sometimes we
26:12even use it as we're waiting for a
26:14clinical trial to become available.
26:16We are beginning to study and
26:18use these Kras drugs,
26:19and I think that's going
26:21to be the next paradigm.
26:22So we've gone from chemotherapy
26:24to targeted therapy,
26:24to immunotherapy, and now Kras
26:26which is another target.
26:27But it's a broad target
26:29and it always was
26:30the Holy Grail,
26:32there's been so many
26:34approaches and ways to try to target it.
26:36It's a very difficult target for
26:38a cancer because I don't want
26:40to get into too much detail here,
26:42but just to say that the pocket that
26:44we have to block with a drug is so
26:47narrow that it's very hard to get a
26:49drug in there to block that.
26:52But scientists and chemists have
26:53figured that out. Another example of
26:55science drives innovation,
26:56science brings new agents to the clinic.
26:58Then we test them in the clinic
27:00and we test them using samples
27:03from patients and a series of
27:05very careful studies to bring new
27:08new things to standard of care.
27:10So amazing progress but
27:12more that needs to
27:13happen. And this brings me
27:15to the whole area of clinical trials.
27:18For many patients historically
27:20they always thought that clinical trials
27:22were what you tried when there was nothing
27:25else left when you had exhausted all
27:28other options when the cancer was metastatic NOTE Confidence: 0.856393
27:31and had spread all over the body,
27:34but you're really talking about
27:36clinical trials as being
27:40state of the art medicine and
27:43that might actually be helpful,
27:45particularly in patients who are so
27:47fortunate as to have detected their
27:49cancer early when it's not metastatic.
27:52Can you talk a little bit more about that?
27:59Clinical trials really are
28:03the best way and in many cases
28:06to you know, treating cancer,
28:08especially when you're dealing with
28:11a situation where you know it is
28:14incurable and you're not able to
28:16treat with the standard of care,
28:18I still remember the example of the
28:21patient, has to be about 8 years ago,
28:23we were studying a drug in clinical trial,
28:26one of these immune checkpoint inhibitors
28:28and he came in with advanced lung cancer.
28:30He had already been to see several
28:33other practitioners around
28:35the state and we had one slot left
28:37in this trial and you know we went
28:39back and forth and he decided to
28:41go on this study and he went on
28:44this drug that is now approved and
28:46did very well.
28:47Eight years later,
28:48I still get emails from him.
28:50He's a photographer.
28:51He sends me pictures from the wild.
28:53This is where a clinical trial
28:55can really pay off now,
28:57because now many years before
28:58approval of a drug,
28:59someone took a chance on this trial
29:01that the alternative would have
29:03been standard of care therapy.
29:04So we're not keeping anything
29:06from this patient,
29:07but bring that trial to bear
29:09on that patient really helped him
29:11and helped him live a quality life.
29:13So that's what we hope for.
29:15That's why clinical trials are so important.
29:17And now I think, as you're alluding to,
29:19we're using these clinical trials
29:21in the earliest stages of disease,
29:22so I know you're a surgeon,
29:24so you cut out tumors,
29:26but still there's a chance it will recur
29:29even if you've gotten everything out.
29:30So now what we're doing is we're taking
29:33these best therapies in lung cancer,
29:36the immunotherapy that targeted therapy
29:38when using them after surgery even
29:40when we see that there's no disease.
29:41Knowing that these are high risk
29:43of recurrence and those data,
29:45some of them are already showing
29:48positive results so
29:49the field of research and clinical
29:51care are one and the bottom line
29:53is we want to give the best
29:55care for patients at the best
29:57possible time.
29:59Dr. Roy Herbst is Ensign Professor of Medicine in Medical Oncology
30:00and professor of Pharmacology
30:03at the Yale School of Medicine.
30:05If you have questions,
30:06the address is canceranswers@yale.edu
30:08and past editions of the program
30:10are available in audio and written
30:12form at yalecancercenter.org.
30:14We hope you'll join us next week to
30:16learn more about the fight against
30:19cancer here on Connecticut Public Radio.