Published on January 22, 2019
How do driver mutations influence treatment decisions? Lung cancer experts Dr. Jhanelle Gray and Dr. Theresa Boyle, from the Moffitt Cancer Center, delve into the realm of personalized medicine to explain how doctors identify unique tumor biology, what genetic mutations are tested for and how mutational status can help patients find a suitable match for therapy. Tune in to find out more.
This is a Patient Empowerment Network program produced by Patient Power, in partnership with Moffitt Cancer Center. We thank AbbVie, Inc., Celgene Corporation, Foundation Medicine, and Novartis for their support.
Transcript | Lung Cancer Q&A: What Are Driver Mutations?
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All right. Well, we’re gonna delve into this personalized medicine world. And the doctors will help us understand. We’ll understand how it applies to patients like Ed or others who may be watching. So, let’s put up the personalized medicine slide.
So, help us understand—let’s start with you, Dr. Boyle.
This whole wheel around the right, what is this alphabet soup there? What is it?
Right. Right. Right. So, this is showing the variety of different genes that can have genetic changes in the tumor. And it’s focused on the genetic changes that have potential clinical action or proven clinical action. EGFR is probably a more familiar one because that one came out first with better responds to EGFR inhibitor therapy than chemotherapy and others have come along. Like with ALK, ALK inhibitor therapy works well. With MEK, XM14 has become important, METamplification.
Okay. These are genes that have gone awry that are driving someone’s cancer, right?
Correct. Right. Right. Right. And this wheel is trying to pick up on the driver mutations. There’s even more genes not on this wheel here that are passengers. Other mutations that might have some specs, but they might not necessarily be causing the tumor or driving the tumor but might be worth considering in terms of the therapy. In immunotherapy, tumor mutations burden has been something we look at. And they’re looking at many, many gene changes to see if there are more mutations than usual. And when that occurs, there might be a better likelihood of response to immunotherapy. So, we’re learning more and more everyday about all of these genes and more.
Okay. We’re gonna define this. And Dr. Gray, you can help us. These kinda big bubbles to the right.
So, first of all, a myth: All lung cancer tumors are the same. This right here says, “No,” right?
No. Absolutely. Yes. The fact is that each patient’s tumor has a unique biology. And the wheel on the left I think really helps to define this. That at the end of the day when we get a patient we’re concerned about, we get a biopsy, get a piece of tissue, send it over to pathology to Dr. Boyle’s team. She’s not only looking under the microscope to help us with, “What’s the diagnosis? What’s the origin of the tumor?” But we also want to look at, “What is driving your tumor?”
And so, how I’ve explained it to patients is in two ways. You have a computer that has all these different parts, but at the end of the day what drives the computer is really that hard drive. And if you open up the hard drive there’s this little piece of hardware that’s actually making everything run. And that’s what we’re doing with the tumors is going into the cell, looking at the DNA level and seeing what is turning on your specific tumor.
Another way of thinking about it is as a hub for an airline, for example. So, a lot of us know Delta has a very big hub in Atlanta. They have a lot of flights that go through there. But if you were to shut down Atlanta you would significantly impact the feasibility of Delta being able to function.
And that’s what we’re doing by looking at these driver mutations. We want to find what’s turning on your tumor and then match that patient to the correct medicine. So, if you have the EGFR mutation, I want to give you an EGFR inhibitor. If you have an ALK rearrangement, I want to give you an ALK inhibitor. If you have a MEK mutation, I want to give you a drug that targets MEK. What I don’t want to do is if you have an EGFR mutation give you an ALK inhibitor. I’m doing you a disservice.
And so, it is very important—I think you brought up a very good point at the beginning of this that the team approach for lung cancer is imperative so that we can all work together to get the right patient the right treatment at the right time.