Lung Cancer is the leading cause of cancer death in both men and women. City of Hope is a recognized leader in lung cancer research.
There is extensive collaboration between lung cancer clinicians and researchers to develop and evaluate new therapies designed to improve survival and quality of life outcomes
Listen in as Ravi Salgia, M.D., Ph.D. explains all of the new therapies available if you or a loved one has been diagnosed with lung cancer.
Selected Podcast
Lung Cancer – New Therapies
Featured Speaker:
Prior to joining City of Hope, Dr. Salgia served as tenured professor of medicine, pathology and dermatology; director of the Thoracic Oncology Program and the Aerodigestive Tract Program Translational Research Lab in the section of hematology/oncology; vice chair for translational research in the department of medicine; and associate director for translational science at the University of Chicago Comprehensive Cancer Center in Chicago.
Learn more about Ravi Salgia, M.D., Ph.D.
Ravi Salgia, MD
Ravi Salgia, MD is professor and chair in the Department of Medical Oncology and Therapeutics Research and also serves as the associate director for clinical sciences in the Cancer Center. He is bestowed with the title of Arthur & Rosalie Kaplan Endowed Chair in Medical Oncology.Prior to joining City of Hope, Dr. Salgia served as tenured professor of medicine, pathology and dermatology; director of the Thoracic Oncology Program and the Aerodigestive Tract Program Translational Research Lab in the section of hematology/oncology; vice chair for translational research in the department of medicine; and associate director for translational science at the University of Chicago Comprehensive Cancer Center in Chicago.
Learn more about Ravi Salgia, M.D., Ph.D.
Transcription:
Lung Cancer – New Therapies
Melanie Cole (Host): After years of modest gains in the field of lung cancer--the leading cause of cancer-related deaths throughout the world--doctor and researchers say significant advances in treatment and screening practices point to very good news. My guest today is Dr. Ravi Salgia. He's a professor and Chair in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Salgia. So, tell us a little bit about what's going on. What treatment advances do you expect for lung cancer patients in 2016?
Dr. Ravi Salgia (Guest): So, we've come a long way for lung cancer. We know that, initially, when we started treating lung cancer patients, especially metastatic disease, that we only had one or two options. Those were really in the context of palliative care and chemotherapy, such as platinum-based chemotherapies, as well as if we needed to for symptom relief, radiation therapy. But, over the past decade, especially over the past few years, we really have made incredible strides in terms of understanding lung cancer, in terms of the genetics of lung cancer, the proteomics of lung cancer, and then, based on that coming up with various therapeutics. So, we're very excited about what are called “precision medicines” for lung cancer, especially, for example, tyrosine kinase inhibitors, as well as immunotherapies.
Melanie: So, let's start with immunotherapies. How is that working to advance the lung cancer treatment?
Dr. Salgia: You know, when I was at Harvard a while ago, we had done some immunotherapies for lung cancer and we didn't have striking results. Over the past few years, what's happened is that immunotherapy has had huge breakthroughs, initially coming, for example, from melanoma, but really being applied to lung cancer as well as bladder cancer. Especially for lung cancer, what we wanted to do is to really engineer various therapeutics so that our own T cells, for example, can be revved up. So, as an example, there are these checkpoint inhibitors known as PD-1 or PD-L1, that have been brought to clinical fruition and they have been already approved by the FDA for us to utilize in our clinics. There are lots of other immunotherapies in terms of immunotoxins, as well as CAR T cells, so a lot of research is going on. Unlike before, where we only saw a handful of patients responding to immunotherapy, we're seeing a large number of patients respond to immunotherapy and really sustained responses to immunotherapy. So, we're quite excited by that for our patients.
Melanie: So what is adoptive T cell therapy and how does that work to treat cancer?
Dr. Salgia: So, T cell therapy is really looking at our own immune cells. So, our own immune cells, what they do, is they fight off any kind of foreign cells or our own cells that potentially have gone awry. So, adoptive T cell therapies really involve engineering these T cells and giving it back where one can really look at how you can engineer the immune system to really fight better.
Melanie: So, what do you do with the T cells? Do you remove them from the patient and sort of teach them to fight the tumor? Or, did they have blinders on? What goes on with them?
Dr. Salgia: Exactly. So, you really-I like that word, "teach them." So, you really take the T cells, engineer them so that they become much more in the attack mode, or the fight mode, so then they can recognize the cancer cells and then ultimately kill off the cancer cells.
Melanie: And when those T cells are put back in, do they recruit other cells to help them fight? How does that work?
Dr. Salgia: Yes. So, there is what's called a tumor milieu in stroma that surrounds the tumor cells. So, you need a lot of fighter cells, and so T cells are one component of it, but there are lots of other cells in the immune cells that have to group together and come together to be able to recognize the cancer cell, then be able to attack the cancer cell, and then to kill the cancer cell. And, ultimately, actually remove the debris from the cancer cells that have died.
Melanie: So, will this improve the patient experience or the patient outcome? Are there side effects to these types of therapies?
Dr. Salgia: Every therapy we give, unfortunately, has side effects, so we have to watch out for them and it's really important that we can't truly predict the side effects that the patients will get until, if the patients develop that, we have to be able to manage that. Most side effects that we see with these types of therapies, especially immune therapies, and even non-immune therapies, can be handled. They can be handled in terms of having expertise in being able to recognize it, but then to be able to provide that supportive care.
Melanie: And, do you think that early detection, thanks to screenings and new screening techniques will help with this if it's caught earlier?
Dr. Salgia: Lung cancer, as you know, occurs in four different stages. So, Stage 1 is the earliest stage of lung cancer that can happen. Basically, what that means it's a small tumor that's within the lung, no lymph node, no metastasis, especially metastasis, for example, to the other parts of the lung or the lymph nodes or to the bone or to the liver or brain or adrenal gland, as an example. But, we know that early stage disease, especially Stage 1 lung cancer, if detected, as well as Stage 2 lung cancer--that involves lymph node involvement--if detected, can really be cured and a sustained cure. So, early detection, early screening are important tools. We are recommending screening for patients of the right criteria and that has been approved by the CMS as well.
Melanie: Do you think at some point lung cancer may become a chronic disease? Where do you see it going in the future?
Dr. Salgia: Ultimately, we want to cure cancer. We want to prevent lung cancer, but we'll also take a chronic disease. For example, metastatic breast cancer, metastatic prostate cancer has already arrived at this chronicity level and patients can live for a long time with even metastatic disease. However, lung cancer, there are only sub-sets of those patients who have metastatic disease that can live a long time, potentially as "chronic disease"; that is, to be able to control the disease with the various therapeutics and monitoring, but, ultimately, our goal is for lung cancer to become a chronic disease. One of the things that we have to really lookout for, though, lung cancer is a sub-set of a sub-set of a sub-set, now. We think of lung cancer as two major categories: small-cell lung cancer and non-small-cell lung cancer. We treat them differently. And then, in non-small-cell lung cancer, it can be adenocarcinoma, squamous cell carcinoma, as well as large-cell carcinoma. Then, in adenocarcinoma, as an example, you can have an EGFR mutation, or an [7:38] translocation or an RS-1 translocation, or a [7:42] translocation. So, we have to take all of those into account for us to be able to guide us to say which sub-sets of lung cancer will become chronic disease? Ultimately, we want everything to be potentially manageable for a long period of time but we have to be able to figure out which therapeutics for what disease.
Melanie: So, in just the last few minutes, give your best advice to patients that have recently been diagnosed with lung cancer, which is a very scary diagnosis at the outset. Give them some hope on what you're doing in research and why they should come to City of Hope for their care, or a second opinion.
Dr. Salgia: Oh, absolutely. You want to really not be afraid if one has a diagnosis of lung cancer because there is so many therapies available. What you have to do is find the experts. You have to be able to define what the stage of the disease is, you have to incorporate your primary care physician, as well as your local oncologist, as an example, but also have that expert opinion from those people who've been doing lung cancer for a long time. For me, for example, a lung cancer medical oncologist for the past 25 years, and this is what I do for a living. So, we know the nuances that have to go into our therapy decision-making. What we really want to be able to do find out are there potential clinical trials? What clinical trials mean is that, are there therapies that are better than what are the current existing therapies? Can you be monitored even more closely? Can you think about the future and try to come up with that what you call "chronic disease" or even a cure for lung cancer? So, why City of Hope? City of Hope is a really important player in the context, of course, having those experts available who only do certain sets of diseases. Let's say, for example, I'm a lung cancer physician. Then, we also have breast cancer physicians, we have prostate cancer. So, really, this is a specialty within a specialty and then, at the same time, there are a lot of clinical trials that have come to fruition here at City of Hope where one could think about for lung cancer patients, is it appropriate? Will this make a difference? Will the survival be better? Will the quality of life be better? And so, I think this is why it's important to not be afraid, even if you have a diagnosis of lung cancer, but to seek out the experts.
Melanie: Great information and such a fascinating topic. We applaud all the great work that you're doing, Dr. Salgia, at City of Hope. Thanks so much for being with us today. You're listening to City of Hope Radio and for more information, you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Lung Cancer – New Therapies
Melanie Cole (Host): After years of modest gains in the field of lung cancer--the leading cause of cancer-related deaths throughout the world--doctor and researchers say significant advances in treatment and screening practices point to very good news. My guest today is Dr. Ravi Salgia. He's a professor and Chair in the Department of Medical Oncology and Therapeutics Research at City of Hope. Welcome to the show, Dr. Salgia. So, tell us a little bit about what's going on. What treatment advances do you expect for lung cancer patients in 2016?
Dr. Ravi Salgia (Guest): So, we've come a long way for lung cancer. We know that, initially, when we started treating lung cancer patients, especially metastatic disease, that we only had one or two options. Those were really in the context of palliative care and chemotherapy, such as platinum-based chemotherapies, as well as if we needed to for symptom relief, radiation therapy. But, over the past decade, especially over the past few years, we really have made incredible strides in terms of understanding lung cancer, in terms of the genetics of lung cancer, the proteomics of lung cancer, and then, based on that coming up with various therapeutics. So, we're very excited about what are called “precision medicines” for lung cancer, especially, for example, tyrosine kinase inhibitors, as well as immunotherapies.
Melanie: So, let's start with immunotherapies. How is that working to advance the lung cancer treatment?
Dr. Salgia: You know, when I was at Harvard a while ago, we had done some immunotherapies for lung cancer and we didn't have striking results. Over the past few years, what's happened is that immunotherapy has had huge breakthroughs, initially coming, for example, from melanoma, but really being applied to lung cancer as well as bladder cancer. Especially for lung cancer, what we wanted to do is to really engineer various therapeutics so that our own T cells, for example, can be revved up. So, as an example, there are these checkpoint inhibitors known as PD-1 or PD-L1, that have been brought to clinical fruition and they have been already approved by the FDA for us to utilize in our clinics. There are lots of other immunotherapies in terms of immunotoxins, as well as CAR T cells, so a lot of research is going on. Unlike before, where we only saw a handful of patients responding to immunotherapy, we're seeing a large number of patients respond to immunotherapy and really sustained responses to immunotherapy. So, we're quite excited by that for our patients.
Melanie: So what is adoptive T cell therapy and how does that work to treat cancer?
Dr. Salgia: So, T cell therapy is really looking at our own immune cells. So, our own immune cells, what they do, is they fight off any kind of foreign cells or our own cells that potentially have gone awry. So, adoptive T cell therapies really involve engineering these T cells and giving it back where one can really look at how you can engineer the immune system to really fight better.
Melanie: So, what do you do with the T cells? Do you remove them from the patient and sort of teach them to fight the tumor? Or, did they have blinders on? What goes on with them?
Dr. Salgia: Exactly. So, you really-I like that word, "teach them." So, you really take the T cells, engineer them so that they become much more in the attack mode, or the fight mode, so then they can recognize the cancer cells and then ultimately kill off the cancer cells.
Melanie: And when those T cells are put back in, do they recruit other cells to help them fight? How does that work?
Dr. Salgia: Yes. So, there is what's called a tumor milieu in stroma that surrounds the tumor cells. So, you need a lot of fighter cells, and so T cells are one component of it, but there are lots of other cells in the immune cells that have to group together and come together to be able to recognize the cancer cell, then be able to attack the cancer cell, and then to kill the cancer cell. And, ultimately, actually remove the debris from the cancer cells that have died.
Melanie: So, will this improve the patient experience or the patient outcome? Are there side effects to these types of therapies?
Dr. Salgia: Every therapy we give, unfortunately, has side effects, so we have to watch out for them and it's really important that we can't truly predict the side effects that the patients will get until, if the patients develop that, we have to be able to manage that. Most side effects that we see with these types of therapies, especially immune therapies, and even non-immune therapies, can be handled. They can be handled in terms of having expertise in being able to recognize it, but then to be able to provide that supportive care.
Melanie: And, do you think that early detection, thanks to screenings and new screening techniques will help with this if it's caught earlier?
Dr. Salgia: Lung cancer, as you know, occurs in four different stages. So, Stage 1 is the earliest stage of lung cancer that can happen. Basically, what that means it's a small tumor that's within the lung, no lymph node, no metastasis, especially metastasis, for example, to the other parts of the lung or the lymph nodes or to the bone or to the liver or brain or adrenal gland, as an example. But, we know that early stage disease, especially Stage 1 lung cancer, if detected, as well as Stage 2 lung cancer--that involves lymph node involvement--if detected, can really be cured and a sustained cure. So, early detection, early screening are important tools. We are recommending screening for patients of the right criteria and that has been approved by the CMS as well.
Melanie: Do you think at some point lung cancer may become a chronic disease? Where do you see it going in the future?
Dr. Salgia: Ultimately, we want to cure cancer. We want to prevent lung cancer, but we'll also take a chronic disease. For example, metastatic breast cancer, metastatic prostate cancer has already arrived at this chronicity level and patients can live for a long time with even metastatic disease. However, lung cancer, there are only sub-sets of those patients who have metastatic disease that can live a long time, potentially as "chronic disease"; that is, to be able to control the disease with the various therapeutics and monitoring, but, ultimately, our goal is for lung cancer to become a chronic disease. One of the things that we have to really lookout for, though, lung cancer is a sub-set of a sub-set of a sub-set, now. We think of lung cancer as two major categories: small-cell lung cancer and non-small-cell lung cancer. We treat them differently. And then, in non-small-cell lung cancer, it can be adenocarcinoma, squamous cell carcinoma, as well as large-cell carcinoma. Then, in adenocarcinoma, as an example, you can have an EGFR mutation, or an [7:38] translocation or an RS-1 translocation, or a [7:42] translocation. So, we have to take all of those into account for us to be able to guide us to say which sub-sets of lung cancer will become chronic disease? Ultimately, we want everything to be potentially manageable for a long period of time but we have to be able to figure out which therapeutics for what disease.
Melanie: So, in just the last few minutes, give your best advice to patients that have recently been diagnosed with lung cancer, which is a very scary diagnosis at the outset. Give them some hope on what you're doing in research and why they should come to City of Hope for their care, or a second opinion.
Dr. Salgia: Oh, absolutely. You want to really not be afraid if one has a diagnosis of lung cancer because there is so many therapies available. What you have to do is find the experts. You have to be able to define what the stage of the disease is, you have to incorporate your primary care physician, as well as your local oncologist, as an example, but also have that expert opinion from those people who've been doing lung cancer for a long time. For me, for example, a lung cancer medical oncologist for the past 25 years, and this is what I do for a living. So, we know the nuances that have to go into our therapy decision-making. What we really want to be able to do find out are there potential clinical trials? What clinical trials mean is that, are there therapies that are better than what are the current existing therapies? Can you be monitored even more closely? Can you think about the future and try to come up with that what you call "chronic disease" or even a cure for lung cancer? So, why City of Hope? City of Hope is a really important player in the context, of course, having those experts available who only do certain sets of diseases. Let's say, for example, I'm a lung cancer physician. Then, we also have breast cancer physicians, we have prostate cancer. So, really, this is a specialty within a specialty and then, at the same time, there are a lot of clinical trials that have come to fruition here at City of Hope where one could think about for lung cancer patients, is it appropriate? Will this make a difference? Will the survival be better? Will the quality of life be better? And so, I think this is why it's important to not be afraid, even if you have a diagnosis of lung cancer, but to seek out the experts.
Melanie: Great information and such a fascinating topic. We applaud all the great work that you're doing, Dr. Salgia, at City of Hope. Thanks so much for being with us today. You're listening to City of Hope Radio and for more information, you can go to cityofhope.org. That's cityofhope.org. This is Melanie Cole. Thanks so much for listening.