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ASCO 2018: The Pace of Research Quickens for Personalizing Care for Lung Cancer Patients

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Published on June 5, 2018

On location at the 2018 ASCO meeting in Chicago, Patient Power host, Esther Schorr, talks with leading lung cancer expert Dr. Nicholas Rohs from Mount Sinai Chelsea about the latest developments in lung cancer care and treatment research. Dr. Rohs discusses the data presented for both branches of lung cancer; small cell and non-small cell lung cancer, and the momentum toward more personalized medicine. Dr. Rohs also explains how understanding genetic mutational status has influenced treatment strategy, promising immunotherapy and combination therapy approaches in current studies, and potential crossover therapies that may treat more than one cancer.

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Transcript | ASCO 2018: The Pace of Research Quickens for Personalizing Care for Lung Cancer Patients

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Esther Schorr: 

Hello there. This is Esther Schorr from ASCO in Chicago, and I have with me a wonderful gentleman who we're going to talk to. Why don't you introduce yourself. 

Dr. Rohs: 

Hi everybody. I'm Nick Rohs, a medical oncologist specializing in thoracic oncology at the Tisch Cancer Institute, Mount Sinai in Manhattan. Primarily work out of the cancer institute downtown. We’re having a fantastic ASCO 2018. There’s a lot of exciting stuff happening in cancer. 

Esther Schorr: 

So, great. That's what we want to talk about. So I understand from the last couple of ASCOs that as the years have gone on there have been some exciting things happening with lung cancer and in particular areas of lung cancer research and discovery. What's happening this year that is the most exciting? 

Dr. Rohs: 

I think what we're could go is we're building on the momentum that we've had the last couple years. The pace of things is staggering. We starting to answer deeper questions and really get into that Holy Grail of personalized medicine. We're really figuring out what the best therapy is for each patient based on the molecular and biological characteristics of their tumors, so to give them best care that's going to give them the best response. And not only give them the right care but spare them the wrong care, make sure they're not getting the treatments they don't need and getting the ones they do. 

Esther Schorr: 

That makes total sense if you can talk about precision medicine, which is kind of what you're talking about. But we have people starting to talk about various subtypes for cancer. Can you talk a little bit about where things are going? 

Dr. Rohs: 

Absolutely. So my clinic always talks about lung cancer being a sort of a big name for a lot of different things. The first branch is small cell versus non-small cell. I think the non-small cell space is where we've had the most exciting changes recently. And then the next branching point is adenocarcinoma, squamous cell carcinomas and rare subtypes. But really adenos and squamous are the ones that are the majority of cancers that we see. And I think in adenocarcinomas we're getting really good at molecular subtyping of these, the EGFRs, ALKs, KRAS. There's some new exciting data about RET mutated adenocarcinomas. But then in the squamous cells we're actually--I think we're lacking the data a little bit as far as what we do change. We have some new exciting data about that combination of chemotherapy with immune therapy, which is really exciting. 

Esther Schorr: 

So really what you're telling me about is personalizing the approach to cancer based on genetic profiling, right? 

Dr. Rohs: 

So genetic profile, immune—genomic profile, immune profile and then also the context of the patient and where they're at, right therapy for them. 

Esther Schorr: 

So what should a lung cancer patient do at diagnosis? What are the questions they should be asking their doctor so they go down the right path?

Dr. Rohs: 

That's true, yes. So I think one of the most important things to do is probably make sure you see a lung cancer expert because of the pace of the technology and the pace of the research that things are changing so quickly that it's really nice to see a specialist. We can always get care in the community, but to see a specialist and make sure that you are getting the exact right kind of care is really important. 

I think the questions you want to be asking is what type of lung cancer I have because again we're really subdividing it, particularly genetic mutations that you may have. Another really important question is what is my immune expression. The way that we usually define this is PD-L1 level, but a new way that we're defining this is tumor mutational burden or TMB. That's a new area of research. So tumor mutational burden is similar to PD-L1. So PD-L1 is sort of an immune expression on the tumor, while tumor mutation burden how many mutations are in this particular cancer potentially predicting how well you might respond to an immune therapy. 

So patients who have higher mutational burden, their tumors have more mutations in them, are more likely to respond to these therapies, and also for TMB, or tumor mutational burden, they actually have longer responses, which is exciting. 

Esther Schorr: 

So when you have more than one mutation, are you not figuring out the bad actors in that?

Dr. Rohs: 

So this is a little bit separate from these targetable mutations that we're looking at. These can be is sort of not clinically applicable mutations as far as drugs we can give you, but these are mutations of the tumor that can help us predict how well you're going to respond to these therapies. So it's not your EGFRs and your ALKs, it's the other you mutations that are there that are going to help predict just how you're going to do with these therapies. It may also help guide which exact therapies you may get. 

Esther Schorr: 

So where do you think this is all going?

Dr. Rohs: 

Some really exciting places. I think that we, as far as immune therapy we're getting really good at doing combinations because immune therapy is such an exciting field and such a great addition to lung cancer and cancer care in general, but we need to get better at getting better responses, improving the response rates that we see and predicting who is going to respond to these therapies because, again, we want to make sure that the right patients are getting the right therapies. So I think that's sort of where we're going in making sure that we are able to predict who is going to respond, how well they respond, and what the best combinations with other therapies are like chemotherapies. 

And then I think in the non-immune therapy, chemotherapy, the patients who have these targetable mutations the slice of the pie that we don't know is getting so much smaller. The vast majority of lung cancers we can one subdivide into different types, and most of those or many of those have targetable or drugs that we can give them now. So trying to make that pie even, even smaller and making sure that everybody can have personalized treatment is really where all this is going. 

Esther Schorr: 

Sounds great. I have one other question. Maybe just a little bit off the pace specifically for lung cancer, but what I understand is that there are some of these mutations that are in more than one type of cancer…

Dr. Rohs: 

…yes. 

Esther Schorr: 

Versus breast cancer, versus lung cancer, versus prostate cancer. But can you talk a little bit, is there some evidence of crossover between, say, lung cancer and some subtypes and mutations in there, and that there is some cross-pollination of treatment?

Dr. Rohs: 

Absolutely. We're finding that when, I think when we started out cancer care, we just said you have cancer. And then we started you have breast cancer, lung cancer, prostate cancer and then subdividing into these smaller categories, and now we almost getting back to more—you have this molecular driver in your cancer cell. HER2 is a good example. 

Esther Schorr: 

Breast cancer. 

Dr. Rohs: 

Yeah, it's in breast cancer, it's a big thing, but now it's coming into lung cancer. It's not as prominent and we're not seeing quite the same amount of response, but we definitely can extrapolate some of that data and that information to bring it into lung cancer and to other different fields of oncology. And we're seeing that, you know, lung cancer and melanoma have a lot of crossover. If we see things not working there maybe not work as well in lung cancer and vice-versa. So we absolutely have to pay attention to all the other areas of expertise that are happening to make sure that we can build off their knowledge and expertise to make sure we're doing the best job on our end. 

Esther Schorr: 

That sounds like change the nature of the team or oncology team when somebody is getting diagnosed. 

Dr. Rohs: 

That's such an amazing thing that I can do at Sinai, because I have so many other experts around me we just spend time talking about all the things that are happening in our different fields of expertise and playing off of those and saying, oh, yeah, we see the same thing or I saw this a little bit differently, and yes, being able to have those groups—oncology groups talk and learn from each other is so important. 

Esther Schorr: 

It happens at ASCO too I think. 

Dr. Rohs: 

Yeah. This is the best place to do it. 

Esther Schorr: 

Thank you so much, Dr. Rohs for being here and being patient with the technology. 

Dr. Rohs: 

My pleasure. 

Esther Schorr: 

This is Esther Schorr from ASCO 2018. And remember, knowledge can be the best medicine of all. 

Dr. Rohs: 

Absolutely. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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