Tag Archive for: NTRK

Thyroid Cancer Research and Treatment Highlights

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Thyroid Cancer Research and Treatment Highlights from Patient Empowerment Network on Vimeo.

What are the latest thyroid cancer research and treatment highlights? Dr. Lori Wirth discusses recent advancements, including successful clinical trials with newer therapies, and ongoing research into the latest targeted treatments for advanced thyroid cancer.

Dr. Lori Wirth is the Medical Director of the Center for Head and Neck Cancers at Massachusetts General Hospital. Learn more about Dr. Wirth.

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Transcript:

Katherine:

Dr. Wirth, what are your research areas of focus? 

Dr. Wirth:

Here at Mass General in Boston we focus on clinical trials looking at new therapies for patients with advanced thyroid cancer including iodine refractory thyroid cancer, anaplastic thyroid cancer, medullary thyroid cancer.  

We also have a big program in studying in the laboratory what makes thyroid cancers tick in order to try to come up with new angles for new drug therapies based on preclinical work that’s being done.  

Katherine:

Okay. In terms of thyroid cancer are there research developments that are showing a lot of promise that you’re excited about? 

Dr. Wirth:

And so, Katherine, I’m so glad you’re asking that question because we’ve actually had some really big successes in clinical trials for patients with thyroid cancer recently. One of the big successes was a study called COSMIC-311 which looked at the drug cabozantinib (Cabometyx) in patients with iodine refractory thyroid cancer who had progressed on the first-line therapy.  

Most commonly that’s lenvatinib (Lenvima), but you can have other first-line therapies as well. And that study was a randomized Phase III study that was done in an international setting and showed that cabozantinib had very good activity in the second line following progression on first-line therapy.

So, we now have treatments lined up for patients for the first line, but then also we have good treatment for patients who’ve progressed on the first-line therapy and need further treatment. So, that was one major success. Another major success recently was the LIBRETTO-531 trial. So, that was a randomized Phase III trial also done internationally in patients with progressive RET-mutated medullary thyroid cancer.  

And that study randomized patients to receive either the RET specific therapy selpercatinib compared to a multikinase inhibitor either cabozantinib or vandetanib (Caprelsa). And the LIBRETTO-531 study showed that selpercatinib is much better than the older standard of care therapies in terms of response rates, durability of response. And we’re even seeing that it looks like there’s a signal where the overall survival is longer with serpercatinib compared to the older standard of care therapies.

So, whenever we have a strongly positive Phase II trial in oncology it’s a big win. And those are two examples of big wins recently. Another study that I would highlight has come out of Germany looking at the combination of pembrolizumab which is an immunotherapy drug in combination with lenvatinib the multikinase inhibitor in patients with anaplastic thyroid cancer.  

And it was a relatively small study. It was a Phase II trial, but this Phase II trial in Germany showed very good activity with this combination of pembrolizumab (Keytruda) and lenvatinib in people with anaplastic thyroid cancer. So, that is very promising for the future for those patients as well. 

Katherine:

Dr. Wirth, is there anything you’d like to add about the evolution of thyroid cancer care? Are you excited about anything that we haven’t already talked about? 

Dr. Wirth:

I am so excited about our recent evolution in thyroid cancer care where we’ve gone from only having old fashioned IV chemotherapy which really doesn’t work very well in thyroid cancer to having really effective multikinase inhibitors for thyroid cancer patients. And now we even have gene specific targeted therapies that work even better in certain specific situations. And so, this evolution over the last 10 years has really changed the landscape of therapies available to our patients. And we now have drugs for almost all of our patients with thyroid cancer.  

They have a good likelihood of working really well for a really long period of time. And that’s changed in my lifetime, taking care of people with thyroid cancer. And the progress that we’ve seen in the last 10 years is really only accelerating before our very eyes. One of the targets that we didn’t talk about earlier is the BRAF V600E mutation.

And I just want to talk about that very briefly because that’s actually the most common potentially targetable gene alteration in thyroid cancer. But thyroid cancer patients share that gene mutation with other cancers as well including melanoma, a subset of people with lung cancer, a subset of people with colorectal cancer as well. There are a lot of new drugs that are being studied in clinical trials targeting that BRAF V600E mutation and other cousins within that pathway of gene alterations that drive cancers.  

And so there is a very active industry that is working on developing the next best therapy for all of these targets that we’ve talked about, NTRK, RET, BRAF mutations, immunotherapy approaches to people with all different types of solid tumors. And those kinds of clinical trials are being done now in advanced thyroid cancer.

Whereas 15 years ago it was really difficult to get a trial up and running for people with thyroid cancer because it was seen as such a rare cancer, kind of a niche cancer where there’s not a lot of money to be made in developing drugs compared to the numbers of women with breast cancer or numbers of people with lung cancer.  

It’s a different story now. There’s a lot of active drug development specifically for people with thyroid cancer. 

What Essential Testing Reveals About Your Non-Small Cell Lung Cancer

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What Essential Testing Reveals About Your Non-Small Cell Lung Cancer from Patient Empowerment Network on Vimeo.

What do lung cancer test results reveal to your healthcare team about your disease? Dr. Isabel Preeshagul provides an overview of essential testing for lung cancer and explains the difference between germline and somatic mutations.

Dr. Isabel Preeshagul is a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center. Learn more about Dr. Preeshagul.

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Non-Small Cell Lung Cancer Treatment | Clinical Trials and Research Updates

Transcript:

Katherine Banwell:

I’d like to turn to the clinical side of non-small cell lung cancer. What tests help you identify the type and stage of lung cancer? 

Dr. Isabel Preeshagul:

Obviously, you need a CAT scan. You need a CAT scan of the chest, abdomen, pelvis, and you need an MRI brain and a PET scan.  

Those are really the gold standards for determining clinical staging. In regards to pathologic staging, it’s really important to have tissue samplings. So, you biopsy a site of disease that’s concerning to you. If it looks like there’s only disease in the chest, you want to biopsy the site where there’s the tumor, and then you talk with your thoracic surgery or pulmonary team to determine the best way to sample the mediastinum for full staging.  

Katherine Banwell:

Why is an accurate diagnosis so important? 

Dr. Isabel Preeshagul:

So, an accurate diagnosis is so important, because lung cancer is by no means black and white anymore. There are so many histologic subtypes that we are learning about. There are so many different molecular drivers that we are learning about. So, making sure you have the right diagnosis, full and next-generation sequencing testing, all of the imaging that you need could really make or break your treatment plan.  

Katherine Banwell:

Dr. Preeshagul, let’s talk about biomarker testing. How is biomarker testing for lung cancer different from hereditary genetic testing? 

Dr. Isabel Preeshagul:

So, we do do hereditary genetic testing for lung cancer patients as well. So, I think let’s backtrack a little bit. When you’re doing on a patient, there are germline mutations and there are somatic mutations. And germline mutations are mutations that you might get from Mom and Dad that they got from their parents and so on and so forth that you could give to your children or your brother and sister or whatever. So, that’s germline testing that could be passed along.  

That would be like BRCA or any other APC gene, but we are learning more and more that there are mutations in lung cancer that do have a hereditary aspect to them. So, we are learning now that while we do somatic testing, which is to find a mutation that just spontaneously happened in your tumor all on its own, it’s really important to pair that with germline testing to make sure that there isn’t some kind of heritable mutation that’s also driving this lung cancer.  

Katherine Banwell:

You mentioned hereditary genetic testing. Should family members of people with lung cancer undergo genetic testing then just to be reassured? 

Dr. Isabel Preeshagul:

So, if there is a germline mutation, then they should – the family members should be referred to a geneticist to have that discussion.  

Katherine Banwell:

What are common lung cancer biomarkers? 

Dr. Isabel Preeshagul:

So, we have nine biomarkers within approval right now, but there are so many. There’s more than I could even talk about today. But some of the more common ones are EGFR, ALK, ROS1, MET exon 14. You have KRAS, KRAS-G12C, which is a newer one. We have NTRK. We have RET. The list goes on, HER2. I could talk for – there’s not enough time on this Zoom video to talk about all of the mutations. But there are nine mutations with approvals as of now to date, this very moment. That could change tomorrow.   

What Are Biomarkers and How Do They Impact Lung Cancer Treatment Options?

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What Are Biomarkers and How Do They Impact Lung Cancer Treatment Options? from Patient Empowerment Network on Vimeo.

What are lung cancer biomarkers, and how do they impact treatment options? Dr. Isabel Preeshagul defines biomarkers and explains how different biomarkers may help determine treatment options and aid in predicting treatment response. 

Dr. Isabel Preeshagul is a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center. Learn more about Dr. Preeshagul here.

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Transcript:

Katherine Banwell:

Well, let’s define a few terms that are often confusing for patients. What are biomarkers?

Dr. Preeshagul:

Those are somatic alterations in the tumor just like EGFR, or ALK fusions, or MET exon 14, or MET amplification, or KRAS G12C.

These are all genes that are altered in the tumor. And these are genes that drive the tumor to grow. There are also other markers like PD-L1, which is a marker for response to immunotherapy. And there are various markers.

I could go on and talk about it for hours, but those are the more common ones that we know how to treat and how to handle and prognosticate.

Katherine Banwell:

And another term that’s sometimes confusing, what is a genetic mutation?

Dr. Preeshagul:

So, for genetic mutations, you have germline, and you have somatic. So, a germline mutation may be something like a BRCA1 or a BRCA2 that we see in patients with breast cancer or prostate cancer versus a somatic mutation which would be EGFR that I had mentioned or ALK fusion. So, germline mutations are the ones that we worry about being heritable.

And somatic mutations are those that are not thought to be heritable but thought to happen spontaneously within the tumor itself and cause the tumor to grow. We are constantly learning more about these though, however. But it’s really important to talk with your doctor to see if you have a germline mutation or a somatic mutation or if you have both.

And it is never wrong to seek an opinion with a genetic counselor to make sure that everyone in your family is safe, that you’re up to date on age-appropriate cancer screening, and that your family gets screened appropriately as well if indicated.

Katherine Banwell:

Are there specific biomarkers that affect lung cancer treatment choices?

Dr. Preeshagul:

Oh, definitely. One that I had mentioned is PD-L1. And this is a marker that we look for expression. So, based on FDA approval for pembrolizumab, if you have an expression of 50 percent or more, you are able to get immunotherapy alone in the upfront setting. If you have less than 50 percent, we often give you chemotherapy plus immunotherapy. And that’s based on a clinical trial known as KEYNOTE-189.

Other markers such as EGFR, as I had mentioned, ALK fusions, RET, NTRK, MET exon 14, ROS1, KRAS, HER2, you name it, those are alterations that we look for ideally in the upfront setting as well and can really affect treatment planning.

And those patients that harbor mutations like EGFR and ALK and ROS1 or MET exon 14, we know that these patients do better with targeted therapy upfront, not standard-of-care chemo. So, it’s really important to know about the presence of these alterations before you start treatment if possible.

What Key Tests Impact Lung Cancer Treatment Choices?

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What Key Tests Impact Lung Cancer Treatment Choices? from Patient Empowerment Network on Vimeo.

Dr. Isabel Preeshagul, a lung cancer specialist, provides insight about lung cancer subtypes and how test results may play a role in determining the best treatment option for patients.

Dr. Isabel Preeshagul is a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center. Learn more about Dr. Preeshagul here.

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Transcript:

Katherine Banwell:

When it comes to lung cancer, Dr. Preeshagul, what important tests should patients undergo that help in making treatment decisions?

Dr. Preeshagul:

So, it’s important to obviously confirm the diagnosis and make sure that it’s lung cancer, first of all. After that, you need to know the histologic subtypes. So, I mean, is this non-small cell, or is it small cell lung cancer?

And the difference between those two, it’s very important. They are not the same. Their treatments are different. Their prognosis is different. The staging is different. Everything is different. If you have non-small cell lung cancer, it’s important to know if you have adenocarcinoma or squamous cell carcinoma, large cell, neuroendocrine. It’s really important because the treatments vary. The prognosis varies. And how we approach those patients is different.

In addition to that, over the past 10 years, we have really come to understand the importance of next-generation sequencing testing, which I know we’re going to get to. But evaluating to see if your patient harbors any mutations or alterations that could be targetable because that would really change your treatment plan.

Katherine Banwell:

All right. So, let’s get to some of that testing. What is biomarker or molecular testing?

Dr. Preeshagul:

Sure. So, we use a lot of these terms synonymously. So, alteration, mutation, positive biomarkers, these are all basically one and the same. So, if you look at lung cancer 20 years ago, we really didn’t know about any of these. You had lung cancer, you got X, Y, and Z chemo. And that really was it.

But with the discovery of EGFR alterations and realizing that some patients harbor an EGFR mutation, and this mutation is what’s driving their tumor and then the discovery of erlotinib, or Tarceva, we realized that it’s important to evaluate for the presence of these mutations.

So, these are somatic mutations that occur within your tumor and drive your tumor to grow, and some of these alterations are targetable.

But some of these alterations that we find, unfortunately, and the majority of them, we don’t really know the significance of them as of yet, or we know the significance of them, but we don’t have a magic bean to treat them. But that does not mean that there won’t be something in the future.

Expert Perspective: Exciting Advances in Lung Cancer Treatment and Research

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Expert Perspective: Exciting Advances in Lung Cancer Treatment and Research from Patient Empowerment Network on Vimeo.

What are the latest advances in lung cancer treatment and research? Dr. Isabel Preeshagul shares information about new treatment approvals, an update on targeted therapies, and new clinical trial approaches.

Dr. Isabel Preeshagul is a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center. Learn more about Dr. Preeshagul here.

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Transcript:

Katherine Banwell:

Dr. Preeshagul, when it comes to lung cancer research and emerging treatment options, what specifically are you excited about? 

Dr. Preeshagul:

So, honestly, I feel that my interest and excitement are getting pulled in a million different directions as of now. Over the past 16 months, we’ve had 10 approvals in lung cancer, which is unheard of. 

Katherine Banwell:

Wow. 

Dr. Preeshagul:

It’s been a very, very, very busy time for us as thoracic oncologists, which is really exciting. 

I feel that we’ve really come to the forefront of cancer research, which is outstanding. In terms of what makes me excited, right now, I think it’s probably two things. There have been genetic alterations, somatic, that have really been almost like the orphan child in lung cancer. And we have unfortunately had to tell patients, “Listen, you have this KRAS G12C alteration. We know that it portents a poor prognosis. We know it’s more aggressive, but we don’t have anything for you that can target that.” 

And as of recently, within the past two months, we had this approval for a drug called sotorasib (Lumakras). This is based on the AMG 510 study. And it is a targeted therapy for patients with KRAS G12C, and the responses have been excellent. 

So, finally, we have something. So, it makes me feel good that when I have a patient that unfortunately has this alteration, I no longer have to give them the same song and dance, that I can talk about sotorasib and talk about it with confidence and talk to them about the data. And the same thing is true for patients with an EGFR exon 20 alteration with amivantamab that just got approved. So, it is now, I feel, that research is now unveiling these orphan alterations that we are now having targeted therapies for. 

So, that makes me excited. Also, something else that’s making me excited is the fact that we’re realizing and learning to anticipate these resistance alterations. So, we know if you have an EGFR mutation for say, we know now that, unfortunately, at some point, the treatments that we’re going to give you, this targeted therapy, this pill called osimertinib (Tagrisso) in the frontline setting, for some patients, unfortunately, at some point, it’s not going to work for you anymore. 

And this is because the cancer gets smart. It develops these resistance alterations. It knows how to usurp the osimertinib, and resist it, and make an alternate pathway, or change its form, turn into small cell, or come up with another alteration that makes the osimertinib not work. 

So, we’re realizing to look for these alterations earlier, faster than when a patient starts progressing, and anticipating them. So, our trials are now being designed in a way with combination therapy to figure out a way to outsmart this cancer. We always have to be one step ahead. And unfortunately, cancer is still many steps ahead of us. But we are learning to be smarter. 

Lung Cancer Treatment Decisions: What Should Be Considered?

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Lung Cancer Treatment Decisions: What Should Be Considered? from Patient Empowerment Network on Vimeo.

What should be considered when making lung cancer treatment decisions? Dr. Isabel Preeshagul shares the factors that may affect treatment options, as well as how the patient can collaborate with their healthcare team for optimal care.

Dr. Isabel Preeshagul is a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center. Learn more about Dr. Preeshagul here.

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Transcript:

 Katherine Banwell:

Dr. Preeshagul, let’s start with you introducing yourself, please.

Dr. Preeshagul:

So, my name’s Isabel Preeshagul. I’m a thoracic medical oncologist at Memorial Sloan Kettering Cancer Center, which is a large academic cancer center in the Northeast. And I’m part of a group of 24 thoracic oncologists.

I specialize in treating patients with non-small cell lung cancer, small cell lung cancer, mesothelioma, and some other thoracic malignancies but most really just focused on lung cancer. I have a very strong research interest in predictive markers for response to immunotherapy as well as targeted therapy.

Katherine Banwell:

Excellent. Thank you so much. What are the considerations when choosing a treatment for lung cancer?

Dr. Preeshagul:

So, that is a very weighted question. And I could talk about that for forever. But to try to be as succinct as possible, the most important thing is to really look at who you’re treating in front of you and try to treat the patient as a whole. It’s not only their diagnosis and their histologic subtype and their stage that’s important.

You really need to think about what’s important to the patient. Is someone a concert pianist or a violinist and giving them a treatment that could potentially cause neuropathy, could that be life altering for them? Or, are they of child-bearing age? What are their priorities?

So, that’s really important to me. Social aspects of a patient’s life, religious aspects, beliefs, ethical beliefs, all of that you need to take into consideration. And then getting more granular, you need to know about the tumor biology.

Do they have any driver alterations? Do they have any other predictive markers that may help you plan your treatment? So, it’s a lot of different things that go into treatment planning.

Katherine Banwell:

Just remind us what neuropathy is.

Dr. Preeshagul:

Sure. So, neuropathy is when the nerves that are in, I guess you could say, your fingers and toes start to damaged.

This can happen from diabetes, from having glucose that is too high for too long, or it can happen from certain chemotherapy agents that can affect the fine nerves in your fingers and toes and cause them to go numb. And this can really be painful. It can be life-altering. It can keep you up at night. It can make your sensation decrease.

So, if you’re walking on the floor, you may not feel a fine, little nail, or you may not even really feel the floor. And if you’re really focused on using your hands for playing the piano or violin or sewing or even any other kind of activity, it can really affect how well you’re able to perform.

Katherine Banwell:

Yeah. What is the role of the patient in making treatment decisions?

Dr. Preeshagul:

So, I think every doctor will give you a different answer for this. But for my practice, I really make sure that the patient is part of the team as well as family members, as long as the patient gives permission. I run everything by the patient, of course. I give them all the possible options ranging from ones that I think would be most efficacious to ones that I think are other options and of course, the option of no treatment, which is always an option, and sometimes, the best options.

So, I really say these are the things that we can offer you, but what do you feel most comfortable with? What’s important to you? And sometimes, patients are taken aback by this question because some patients like to be told, “Well, this is what we’re going do, and this is when we’re starting,” and X, Y, and Z. That’s not how I practice.

And it’s really important to me that the decisions come from the patient but are guided by me and my team.

Katherine Banwell:

Why is it important for patients to feel like they have a voice in their treatment?

Dr. Preeshagul:

So, that is such a good question. And I think a lot of it comes from the fact that you have a patient that had a completely normal life and all of a sudden get delivered this life-altering news that they have cancer. And everything that they had control over just seems to completely go out the window just in a matter of seconds.

So, making sure that a patient is back in the saddle and has control again and feels like they know what the next steps and feels like they know what they can expect is really important to them from what I can see. And I think that is something that allows them to feel like they’re a little bit more like themselves again.

They come to meet me. They don’t know anything about lung cancer. Their world has been completely rocked. And when they know their treatment plan and they know their stage and they know what to expect and they’re kind of a little bit more on autopilot, I can see in some patients them being able to exhale a little bit and feel like they’re in control again, and they know what – every Monday, I’m going to come and see Dr. Preeshagul. I’m going to get my treatment. I might not feel so good the next couple days, but I know the week after and the week after that, I might feel a little bit better. And they kind of are back in control again.

Navigating Lung Cancer Treatment Decisions

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Navigating Lung Cancer Treatment Decisions from Patient Empowerment Network on Vimeo.

What steps could help you and your doctor decide on the best treatment path for your individual disease? This animated video walks through key considerations, including molecular testing results, lifestyle factors and patient preference.

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Diagnosed with Lung Cancer? An Expert Outlines Key Steps

Transcript:

Hi, I’m Kendra. I’m a nurse practitioner and I specialize in lung cancer.

When diagnosed with lung cancer, it’s important to take steps to get a deeper understanding of your disease, and the available treatment options, so that you can feel confident in your care decisions.

Before we walk through the actions that can help you decide on a treatment path, I want to remind you that this video is intended to help educate lung cancer patients and their loved ones and shouldn’t be a replacement for advice from your doctor.

OK, let’s get started.

The first step is to understand your diagnosis—including the type of lung cancer and stage of disease—so that you can find out what treatments are available to you. Your physician will use tests, including biopsies and imaging, such as X-rays and CT scans, to ensure you have an accurate diagnosis.

The next step is to understand the approaches available for YOUR individual disease.
Depending on your stage and type of lung cancer, treatments can include:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Targeted therapy or
  • Immunotherapy

Or, you may receive a combination of one or more of these treatments.

Other testing that can impact your treatment options is molecular testing, which is used to identify specific mutations that are unique to your lung cancer. This may help in deciding if targeted therapies are an appropriate option for you.

Before you start any treatment, it’s essential to ask your doctor if you have had relevant molecular testing.

Another option that your physician may discuss with you is clinical trials, which may provide access to treatments that are not yet approved. At different points on your path with lung cancer, it’s important to talk with your doctor about whether there is a clinical trial that could be right for you.

Once you understand the treatments that are available to you, it’s time to talk to your doctor about the risks and benefits of each option and walk through the goals of your treatment.

One of the most important factors that your healthcare team will consider is YOUR treatment goals. Remember, you are a partner in your care and have an active voice in finding the best treatment for you. Physicians also typically consider a patient’s age, overall health, and existing conditions before they suggest a course.

So, what questions should you address when you are discussing your treatment goals with your doctor? Consider asking:

  • Is the goal of the treatment to cure your disease or to obtain long-term control your disease?
  • How effective will the treatment be and how will it impact your quality of life and lifestyle?
  • What are the treatment side effects–both the short-term effects as well as long-term effects that may occur after you have completed treatment?
  • Is there a member of the team, such as a social worker, that can help you understand the potential treatment costs? And is there access to financial resources that can help you if needed?
  • Are there supportive care options that can help with symptoms and pain management at any stage of your cancer?

It also may be a good idea to consider a second, or even third opinion consultation with a specialist. And, if you don’t feel supported or you don’t feel heard by your healthcare team, then it is always best to get another opinion.

Finally, once you have gathered all the information, it may be helpful to talk it out with people you trust, such as a partner, friend or family member, to help you make a decision that you feel confident about.

Now, how can you put this information to work for you?

  • Make sure you understand your type and stage of your lung cancer and the goals of your treatment options.
  • Talk to your physician about what you’ve learned.
  • Consider a consultation with a lung cancer specialist.
  • Ask about molecular testing and what testing results mean for you.
  • Discuss whether clinical trials are an option for your cancer.
  • Visit credible online resources to stay up to date on lung cancer information.
  • Visit powerfulpatients.org/lungcancer to learn more about lung cancer.

Key Next Steps After a Lung Cancer Diagnosis: Expert Advice

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Key Next Steps After a Lung Cancer Diagnosis: Expert Advice from Patient Empowerment Network on Vimeo. 

Following a lung cancer diagnosis, the actions that a patient takes may impact their long-term care and treatment options. Dr. Erin Schenk, a lung cancer specialist, lists key steps a patient should consider post-diagnosis.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

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Transcript:

Dr. Erin Schenk:

As a medical oncologist who takes care of lung cancer patients, I would recommend that if you or a loved one are diagnosed with lung cancer, going to your meeting with the cancer doctor report the surgeon or the radiation doctor with a couple of main questions to ask in order to better understand your diagnosis and the treatment options.

So, the first one is what stage and stage is a descriptor that we use that talks about how far the lung cancer has spread if it’s spread at all. And sometimes, this involves additional testing to give you the best, most accurate answer. Oftentimes, patients are diagnosed with scans, but what’s also – excuse me, scans of the chest, but what’s also really important is better understanding whether or not lymph nodes in the middle of the chest are also involved.

This can require either a PET scan or occasionally procedures where tissue, the lymph nodes biopsied, and tissue samples are taken to see if the lung cancer has spread to those lymph nodes. PET scans are also able to better tell us whether or not lung cancer has spread outside of the lungs. And additionally, and MRI of the head can often be a really critical piece of information to better understand whether or not the lung cancer has spread to the brain. Unfortunately, lung cancer is one of those cancers that can spread to the brain tissue.

So, the first piece of information and more tests might be needed, is stage.

The second piece of information that’s very important is what type of lung cancer, and sometimes, this occurs hand-in-hand with better understanding stage. Usually, this involves a biopsy, so a sample of the tissue needs to be taken and then looked at underneath a microscope by a pathologist who are doctors who help us identify which type of lung cancer it is that a patient has. And then the final thing to ask your care team or your doctor is do I need additional molecular testing?

Molecular testing is a critical piece of information in order for doctors like me to help take care of lung cancer patients. Molecular testing lets us know what role immunotherapy might play in your diagnosis. It also lets us know whether or not targeted therapy which are oral pills we sometimes call TKIs are appropriate for your disease and your stage. These pieces of information, so stage, what type of lung cancer, and if molecular testing is necessary, these are, I think, the three critical pieces that you need going forward to help your cancer doctor and team better formulate a plan that is right for you.

Finally, I’d like to add in that if you are in a situation where you would like a second opinion, or you would like to get more thorough answers, I would encourage you to look for an academic center or a large medical center that has specialists who focus in on lung cancer. We are often very happy to see patients and talk with them about their treatment plan if any other tests or evaluations are needed to help you feel confident in the plan that your doctors closer to home have put together. That’s it.

Why You Should Consider a Clinical Trial for Lung Cancer Treatment

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Why You Should Consider a Clinical Trial for Lung Cancer Treatment from Patient Empowerment Network on Vimeo.

Dr. Erin Schenk, a lung cancer expert and researcher, explains why patients with lung cancer should consider a clinical trial and the role trials plays in clinical care.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

See More From the The Pro-Active Lung Cancer Patient Toolkit

Transcript:

Dr. Erin Schenk:

We have a very active clinical trial practice in the lung cancer world for one reason alone, and that’s that while our current therapies are good, we can still do better. Lung cancer accounts for significant cancer-related deaths in the United States and the world. And we wanna work to try and improve how well patients do and also improve how many patients we are able to cure. Clinical trials can be at any step of your workup or treatment.

So, even patients with earlier-stage disease meaning lung cancer where we can resect it with surgery, there are a number of clinical trials going on right now to try to better improve the outcomes we see with our normal standards of care. So, whether you are having a lung cancer removed by surgery whether you’re receiving chemotherapy and radiation and immunotherapy whether your lung cancer has happened to spread outside of the lungs, there are clinical trials available at every step in the game.

And I would really encourage you to ask your cancer care team or your doctor about whether or not clinical trials might be available in your area. Because often, they can help identify new targets or other ways of trying to attack the vulnerabilities of your lung cancer.

If you are considering a clinical trial, there are a number of important questions to find out from the clinical trial team as well as your cancer care team. Some of the things are really practical, logistical questions and one of those is, “How often do I need to come to clinic? How many more schedule visits do I need?”

Usually, with clinical trials, upfront so before you get on the clinical trial or once you start receiving the clinical trial medicine or therapy, often there are more frequent visits in that initial time period. But after things are – after you’ve had several treatments with the trial medicine, often it becomes more standard of care meaning visiting once every three weeks for blood work and a visit with your team and then infusion.

So, it’s often a little more work up front, and then it gets back to the usual expectations of how often you have to be in our offices. So, I think those logistical concerns are very real because especially for larger institutions, sometimes, coming to our campuses can be a bit of a challenge. So, that would be one. I would recommend discussing logistics. Discussing with your team as to why they think this would be a trial for you is important.

Occasionally, we are able to screen for certain markers or certain things that are expressed on the cancer cells and then match you with clinical trials that try to target those specific molecules or proteins or flags that are on the surface of the cancer cell. So, oftentimes, we try to match patients up to a specific clinical trial, so better understanding why that one was recommended. And then I would ask your team to also discuss what are the side effects that have been noticed.

Often with these clinical trial medicines, we don’t have a lot of experience with how well patients do on these therapies. But sometimes, we can give you an idea in terms of what we expect and what we will watch closely for. So, I think logistics are important, why your doctor or your cancer team thinks this is a good trial for you, and then finally, what sort of side effects have been noticed as best we can tell with this new trial medicine.

Lung Cancer Treatment Advances: What are Antibody Drug Conjugates?

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Lung Cancer Treatment Advances: What are Antibody Drug Conjugates? from Patient Empowerment Network on Vimeo.

 Dr. Erin Schenk, a lung cancer expert, discusses emerging research around antibody drug conjugates (ADC) and how this therapy works to treat patients with lung cancer.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

See More From the The Pro-Active Lung Cancer Patient Toolkit

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Lung Cancer Treatment: What Is Immunotherapy?

Why You Should Consider a Clinical Trial for Lung Cancer Treatment

New and Improved Lung Cancer Treatment Options

Transcript:

Dr. Erin Schenk:

Some interesting research that’s coming to the forefront in the lung cancer field are using new medicines called antibody-drug conjugates. And so, these medicines, I think of as another type of targeted therapy. So, what happens is that cancer cells express certain proteins or certain flags on their surface that aren’t often found on other normal cells.

And what these ADC drugs are able to do is that they’re able to seek the cells that express certain flags, and then deliver a chemotherapy payload directly to those cancer cells. One trial from the recent ASCO annual meeting from this year, 2020, was looking at an ADC that targeted HER2 which can sometimes be over-expressed by lung cancer cells.

And they had good initial reports in terms of patients being able to have disease control for some time and minimal side effects.

So, I think in general the idea of ADCs or looking for surface markers on the cancer cells to try to in a more targeted fashion deliver the chemotherapy payload, I think this is a really exciting area of investigation as well as a new potential therapy for our patients with lung cancer.

Lung Cancer Treatment: What Is Immunotherapy?

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Lung Cancer Treatment: What Is Immunotherapy? from Patient Empowerment Network on Vimeo.

Dr. Erin Schenk, a lung cancer specialist, provides an in-depth explanation of what immunotherapy is, and its role in treating lung cancer.

Dr. Erin Schenk is an assistant professor in the division of medical oncology at the University of Colorado Anschutz Medical Center. Learn more about Dr. Schenk and her lung cancer research here.

See More From the The Pro-Active Lung Cancer Patient Toolkit

Related Programs:

 

Lung Cancer Treatment Advances: What are Antibody Drug Conjugates?

Diagnosed with Lung Cancer? An Expert Outlines Key Steps

Transcript:

Dr. Erin Schenk:

Immunotherapies are powerful new medicines that we available to us as medical oncologists and especially within patients with lung cancer. Immunotherapies are medicines that help to activate your body’s own defenses to go seek out and kill the cancer cells.

So, immunotherapies prevent stop signs on the cancer cells.

What happens is that as the cancer cells grow and as they become more resistant to your body’s natural defenses, it puts up certain stop signs. And these stop signs prevent your body’s immune system from attacking them. Immunotherapies, basically, it cuts off that stop sign so that your immune cells can go and attack the cancer cells.

Immunotherapies play a role in the treatment of many lung cancer patients, nearly all. So, immunotherapy has recently found a role in curative-intent therapy meaning we give these treatments to you to try and cure you of your cancer completely. And that’s in patients who have advanced lung cancer that they can’t surgically resect, or it’s not safe or feasible to cut out, but it hasn’t spread to anywhere else in the body.

So, often, those patients receive chemotherapy and radiation together, and then they receive immunotherapy for a year. So, that’s one set of patients we treat with immunotherapy. And then most other patients with lung cancers especially metastatic lung cancer or cancer that’s spread elsewhere in the body, immunotherapy plays a role in treatment regardless of what type of lung cancer that you have with a couple exceptions which I’ll get to.

So, first, if patients have small cell lung cancer that has spread in other parts of the body, immunotherapy’s an important part of the initial treatment regimen combined with chemotherapy. That’s one of the first advances in decades for patients with small-cell lung cancer. The other situation where we use immunotherapy in metastatic disease is with non-small cell lung cancer. And here we have data and studies to support the use of immunotherapy either alone or in combination with chemotherapy medicines.

And the determinate, there’s a number of factors we use to help determine whether a patient can get immunotherapy alone or immunotherapy in combination with chemotherapy, that’s based on PD-L1 status. So, that’s the immunotherapy marker that we look for on cancer cells. If the PD-L1 status is high enough on the cancer cells, we can discuss with our patients using immunotherapy alone.

If that PD-L1 marker on the cancer cells is not high, then we can use immunotherapy plus chemotherapy in our patients. One area where we’re still not quite sure how to best use immunotherapy are in patients with driver mutations or some of these mutations that we look for with special molecular testing like EGFR, ALK fusions, ROS1 fusions.

What we’ve been learning over time is that immunotherapy alone does not appear to help patients do better for longer. We’ve also been learning through clinical trials that immunotherapy combined with TKIs which is the targeted therapy patients receive if they have one of these driver mutations, that does not appear to be effective or safe from some of these early clinical trials.

There’s some debate right now amongst my national/international colleagues as to whether or not giving immunotherapy plus chemotherapy is the right choice for these patients after TKIs or targeted therapies stop working. It’s really up to the discussions that you have with your doctor and whether or not they think immunotherapy and chemotherapy could be right in that situation.