Precision Medicine Approaches to Lung Cancer
Jyoti Patel, MD, is the medical director of thoracic oncology and assistant director for clinical research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University. In this episode of the Better Edge Podcast, she discusses emerging treatments for lung cancer, including the introduction of seven new therapies approved by the FDA this year. She shares how treatment of lung cancer has evolved to become more personalized with both biologic and immunotherapy options and how new therapies will continue to shape the standard of care for lung cancer.
Featured Speaker:
Learn more about Joyti Patel, MD
Joyti Patel, MD
Jyoti Patel, MD, is Professor of Medicine at Northwestern University and Associate Vice-Chair for Clinical Research in the Department of Medicine. She is also Medical Director of Thoracic Oncology and Assistant Director for Clinical Research in the Lurie Cancer Center.Learn more about Joyti Patel, MD
Transcription:
Precision Medicine Approaches to Lung Cancer
Melanie: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and joining me today is Dr. Jyoti Patel. She's the Medical Director of Thoracic Oncology and an Assistant Director for Clinical Research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and she's a world-renowned expert in the treatment of lung and thoracic cancer. She's joining us today to discuss emerging treatment options available for lung cancer. Dr. Patel, it's a pleasure to have you join us today. Before we get into all of this, start by telling us a little bit about yourself, your area of expertise and why they're calling you a world-renowned expert? I think that's so cool.
Dr Patel: Thanks so much. It's such a pleasure to be here. So I'm a medical oncologist who specializes in the treatment of patients with lung cancer. I've been in the field for a couple of decades and have had the privilege of really seeing therapies for our patients improve significantly in terms of curative therapies in patients with early-stage disease, better therapies for patients with more advanced disease and screening technologies.
I have had the privilege of getting to focus on one thing. And with that, I have been able to dive deeply into drug development, really bringing translational research from the bench to the bedside for patients and impacting patient's outcomes. It's been a time of tremendous biologic discovery that's really underpinned by our understanding of basic cancer biology and has translated to better lives for a lot of people.
Melanie: That's absolutely wonderful. So in the last year, as we segue into this beautifully, the FDA has approved seven new drugs for the treatment of lung cancer. Speak to us about the significance of these new options and your role in the development process.
Dr Patel: It's really astounding to have seven drugs approved in a single year. When I think about when I started this over 20 years ago, we might see a new drug once every seven years. But it really is understanding cancer biology, the commitment of looking at tumor tissue and understanding biologic reasons cancer develop to a long road to drug development.
The work that we really did in the first part of the century in cataloging the human. genetic code and understanding why cancers developed helped us develop drugs that are targeted and are very effective for certain patients. I think that's been the greatest tale in the early part of the century, is that we've learned about targeted therapies that hit particular aberrations in cancer and cause profound responses.
More recently, our gains have been in developing immunotherapies for patients and lung cancer is a cancer in which there are these two different modalities that have really come to clinic and changed outlook for our patients and personalized therapy. This idea of understanding the genetics and using targeted therapies, as well as using the promise of immunotherapy to eradicate disease in some individuals.
Well
Melanie: then, give us a little brief history of the standard of care for lung cancer and how these new options will change treatment protocol for lung cancer. How has it evolved? And what are these drugs that we're talking about? Which one of them are you most excited about?
Dr Patel: Most of our patients with lung cancer, unfortunately still have advanced disease. So most drug development happens in patients with more advanced disease in which curative therapies have not really been an option for years. When we look back even a decade ago, we'd offer patients chemotherapy, and the chemotherapy could be really effective, but it was sort of one-size-fits-all. We didn't really understand the nuances of different kinds of cancer.
Now, every time we meet a patient, we do a genetic analysis on the tumor tissue. And we understand if there are predictors of response to particular drugs. And based on that, we developed different options for patients and it's much more personalized than it's ever been. It's about the right drug at the right time for the right patient. And so there are all these factors, the patient factors and the drug factors that help us get to the right therapies.
For people with a particular mutation, we generally feel that a targeted therapy is best. And some of these targets may occur in one or 2% of all people, but we've found that since lung cancer is so common, it affects over 200,000 people every year in the United States alone, even a tumor type that might be in 2% of people has a profound impact. That's a huge number, thousands of patients that we would interact with in a lifetime. And these drugs, such as two new drugs that block a fusion protein called rat have been approved this year in the United States. These drugs cause tumors to shrink in the vast majority of individuals and keep them at bay from much longer than we had ever hoped.
The other piece is immunotherapy, and that's really harnessing one's own immune system to fight the cancer. I think that's what's really been exciting as in some patients who had progressive disease, we've seen tumors melt away for a long time with few toxicities. How to marry both of these strategies, as we look forward, I think is the area that I'm most excited about how can we really see these durable tumor remissions in patients?
Melanie: So what are the next steps then? What are some future directions for this work? Give us a little blueprint of what you see or hope to see happening in the next few years.
Dr Patel: We've made conservable inroads in the treatment of patients. But I think we still have a lot of work in predicting how to deintensify or intensify treatments. So that may be that we're over-treating some individuals, that maybe their cancer's particularly sensitive to one intervention like immunotherapy.
Do they also need radiation and chemotherapy? I don't think we know that yet. Or are there times in which we're giving a targeted therapy and there's some cells that we can't detect on CT scans that are becoming resistant? And is there a way to intensify therapy to treat those cancer cells at a very low level?
So the world I sort of look for is again, personalization along the spectrum. So not just at the time of diagnosis, but throughout the treatment trajectory. We're doing things like doing blood-based biopsies to look at circulating tumor cells and fragments of DNA that now impact our decision-making. It would be so great if we could do this more often and to understand resistance before anything becomes clinically detectable. So to preserve really good quality of life and minimal disease and really back to function for many of our patients.
Melanie: So interesting the work that you're doing, Dr. Patel. As we wrap up, what else would you like other providers to know to take forward to optimize patient outcomes? And as you're speaking about that, tell us why it's so important for a multidisciplinary team to treat these particular patients?
Dr Patel: So as patients are living longer and doing better, we know that all of our gains are the result of clinical research. And so understanding that participating in clinical research at diagnosis is so important. It's not looking for a clinical trial after multiple treatments. Standard treatments haven't worked because standard treatments from even before five years ago now are obsolete. You know, we've really changed and grown significantly. And so early referral for clinical trials is absolutely essential for us to continue our progress.
The other piece about multidisciplinary trials, I think, is essential for us to recognize that patients now are living longer and better than ever before, and we have multiple techniques. We have minimally invasive surgery. We have much better radiation techniques than we did a couple of decades ago, and so because we have multiple chances at goal. Even in a patient with advanced disease, we may come back for local therapies. We do repeat biopsies to see how tumors have changed in response to certain therapies and integration of all of these modalities, a robust discussion about around each patient and options for therapies I think has really led to a much better outcome for our patients. And we see it with the improvements that we've seen in lung cancer survival.
Melanie: Thank you so Dr. Patel. I hope you'll join us again and come on and tell us some updates as you learn more. Thank you again. To refer your patient, please visit our website at cancer.northwestern.edu to get connected with one of our providers.
And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. Until next time. I'm Melanie Cole.
Precision Medicine Approaches to Lung Cancer
Melanie: Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole and joining me today is Dr. Jyoti Patel. She's the Medical Director of Thoracic Oncology and an Assistant Director for Clinical Research at the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, and she's a world-renowned expert in the treatment of lung and thoracic cancer. She's joining us today to discuss emerging treatment options available for lung cancer. Dr. Patel, it's a pleasure to have you join us today. Before we get into all of this, start by telling us a little bit about yourself, your area of expertise and why they're calling you a world-renowned expert? I think that's so cool.
Dr Patel: Thanks so much. It's such a pleasure to be here. So I'm a medical oncologist who specializes in the treatment of patients with lung cancer. I've been in the field for a couple of decades and have had the privilege of really seeing therapies for our patients improve significantly in terms of curative therapies in patients with early-stage disease, better therapies for patients with more advanced disease and screening technologies.
I have had the privilege of getting to focus on one thing. And with that, I have been able to dive deeply into drug development, really bringing translational research from the bench to the bedside for patients and impacting patient's outcomes. It's been a time of tremendous biologic discovery that's really underpinned by our understanding of basic cancer biology and has translated to better lives for a lot of people.
Melanie: That's absolutely wonderful. So in the last year, as we segue into this beautifully, the FDA has approved seven new drugs for the treatment of lung cancer. Speak to us about the significance of these new options and your role in the development process.
Dr Patel: It's really astounding to have seven drugs approved in a single year. When I think about when I started this over 20 years ago, we might see a new drug once every seven years. But it really is understanding cancer biology, the commitment of looking at tumor tissue and understanding biologic reasons cancer develop to a long road to drug development.
The work that we really did in the first part of the century in cataloging the human. genetic code and understanding why cancers developed helped us develop drugs that are targeted and are very effective for certain patients. I think that's been the greatest tale in the early part of the century, is that we've learned about targeted therapies that hit particular aberrations in cancer and cause profound responses.
More recently, our gains have been in developing immunotherapies for patients and lung cancer is a cancer in which there are these two different modalities that have really come to clinic and changed outlook for our patients and personalized therapy. This idea of understanding the genetics and using targeted therapies, as well as using the promise of immunotherapy to eradicate disease in some individuals.
Well
Melanie: then, give us a little brief history of the standard of care for lung cancer and how these new options will change treatment protocol for lung cancer. How has it evolved? And what are these drugs that we're talking about? Which one of them are you most excited about?
Dr Patel: Most of our patients with lung cancer, unfortunately still have advanced disease. So most drug development happens in patients with more advanced disease in which curative therapies have not really been an option for years. When we look back even a decade ago, we'd offer patients chemotherapy, and the chemotherapy could be really effective, but it was sort of one-size-fits-all. We didn't really understand the nuances of different kinds of cancer.
Now, every time we meet a patient, we do a genetic analysis on the tumor tissue. And we understand if there are predictors of response to particular drugs. And based on that, we developed different options for patients and it's much more personalized than it's ever been. It's about the right drug at the right time for the right patient. And so there are all these factors, the patient factors and the drug factors that help us get to the right therapies.
For people with a particular mutation, we generally feel that a targeted therapy is best. And some of these targets may occur in one or 2% of all people, but we've found that since lung cancer is so common, it affects over 200,000 people every year in the United States alone, even a tumor type that might be in 2% of people has a profound impact. That's a huge number, thousands of patients that we would interact with in a lifetime. And these drugs, such as two new drugs that block a fusion protein called rat have been approved this year in the United States. These drugs cause tumors to shrink in the vast majority of individuals and keep them at bay from much longer than we had ever hoped.
The other piece is immunotherapy, and that's really harnessing one's own immune system to fight the cancer. I think that's what's really been exciting as in some patients who had progressive disease, we've seen tumors melt away for a long time with few toxicities. How to marry both of these strategies, as we look forward, I think is the area that I'm most excited about how can we really see these durable tumor remissions in patients?
Melanie: So what are the next steps then? What are some future directions for this work? Give us a little blueprint of what you see or hope to see happening in the next few years.
Dr Patel: We've made conservable inroads in the treatment of patients. But I think we still have a lot of work in predicting how to deintensify or intensify treatments. So that may be that we're over-treating some individuals, that maybe their cancer's particularly sensitive to one intervention like immunotherapy.
Do they also need radiation and chemotherapy? I don't think we know that yet. Or are there times in which we're giving a targeted therapy and there's some cells that we can't detect on CT scans that are becoming resistant? And is there a way to intensify therapy to treat those cancer cells at a very low level?
So the world I sort of look for is again, personalization along the spectrum. So not just at the time of diagnosis, but throughout the treatment trajectory. We're doing things like doing blood-based biopsies to look at circulating tumor cells and fragments of DNA that now impact our decision-making. It would be so great if we could do this more often and to understand resistance before anything becomes clinically detectable. So to preserve really good quality of life and minimal disease and really back to function for many of our patients.
Melanie: So interesting the work that you're doing, Dr. Patel. As we wrap up, what else would you like other providers to know to take forward to optimize patient outcomes? And as you're speaking about that, tell us why it's so important for a multidisciplinary team to treat these particular patients?
Dr Patel: So as patients are living longer and doing better, we know that all of our gains are the result of clinical research. And so understanding that participating in clinical research at diagnosis is so important. It's not looking for a clinical trial after multiple treatments. Standard treatments haven't worked because standard treatments from even before five years ago now are obsolete. You know, we've really changed and grown significantly. And so early referral for clinical trials is absolutely essential for us to continue our progress.
The other piece about multidisciplinary trials, I think, is essential for us to recognize that patients now are living longer and better than ever before, and we have multiple techniques. We have minimally invasive surgery. We have much better radiation techniques than we did a couple of decades ago, and so because we have multiple chances at goal. Even in a patient with advanced disease, we may come back for local therapies. We do repeat biopsies to see how tumors have changed in response to certain therapies and integration of all of these modalities, a robust discussion about around each patient and options for therapies I think has really led to a much better outcome for our patients. And we see it with the improvements that we've seen in lung cancer survival.
Melanie: Thank you so Dr. Patel. I hope you'll join us again and come on and tell us some updates as you learn more. Thank you again. To refer your patient, please visit our website at cancer.northwestern.edu to get connected with one of our providers.
And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. Please remember to subscribe, rate and review this podcast and all the other Northwestern Medicine podcasts. Until next time. I'm Melanie Cole.