Diagnosing Lung Cancer Up-Front Through Biopsy Prioritization

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Topics include: Treatments and Understanding

On location at the World Conference on Lung Cancer (WCLC), we caught up with Dr. Edward Kim, Chair of the Solid Tumor Oncology Investigational Therapy Department at Carolina's Levine Cancer Institute.  Dr. Kim highlighted three of the most exciting changes occurring in the lung cancer field: new options and tools for patients, updated tumor classification by mutation and tumor type with new treatment options for each, and current clinical trials for "resistant mutation" medications.  As Dr. Kim puts it, in the past five years, the field of lung cancer has moved from "stale to exciting!"

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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.

Tamara Lobban-Jones:

Joining me is Dr. Edward Kim.  He is Chair of the Solid Tumor Oncology and Investigational Therapeutics Department at the Carolinas Healthcare System, Levine Cancer Institute.  Dr. Kim, thank you so much for joining me.  You've been here for a few days at the WCLC meeting.  What strikes you?  What are some of the highlights you feel are important for patients to take away from this meeting? 

Dr. Kim:

I'm glad that patients have interest in wanting to track what's happening in lung cancer and, of course, with any disease type they may have.  This is a meeting that happens every two years.  Actually, next it will go annually, so there will be this grouping of lung cancer experts from all over the world.  I think there's 6- to 7,000 attendees this year that are hovering down on Denver. 

You know, it's nice because we as physicians, advocates, the representatives who come are interested in lung cancer, the study of lung cancer, the diagnosis of lung cancer, the treatment, prevention, spanning really all of that spectrum.  And the meeting itself is very specialized to those aspects, so you would expect that the people who are attending have an interest in lung cancer.  There are also many patient advocates who are here, so they also are going to try and get this information and transmit it out there. 

It's tough.  Lung cancer, dare I say, has become a very exciting field regarding therapy and diagnosis in the last five years, and I mean that in a positive sense of options for patients, more tools to help them.  Having been doing lung cancer, the field, since 2000, I tell you, it was pretty stale the first five years.  The same chemotherapy that we had for the past 10 years would be who we would treat with to patients, and whether you had an adenocarcinoma of a tumor or squamous or large cell or any one of those subtypes, we basically looked at you and gave you the same treatment. 

And that's frustrating because sometimes the treatment works okay, and sometimes the treatment doesn't work as well.  And to try and differentiate those that it works well in is really the key, because they all have side effects.  The one guarantee we know of any type of therapy is that there [are] going to be side effects. 

So what's really exciting now is that we're able to classify tumors differently.  We need biopsies.  We use that tissue then not only to identify if it's a lung cancer but then also to classify if it's got this mutation, an EGFR mutation, or an ALK, A-L-K, translocation or ROS1.  Those are the common markers now that we test.  And although we've been having success with these markers and drugs that accompany them for about the last five years, there are now numerous other choices that exist for these specific markers.  

Tamara Lobban-Jones:

Biopsy prioritization, why is this a big deal?  

Dr. Kim:

Using tissue to find out what the molecular subtype is, that's essential, and not tiny little pieces.  The more tissue we can get, the better.  Of course, we have to balance the risk of doing the procedure, but that is the key to how we can identify specifically what a patient's tumor has in it and more importantly use that information. 

And these days about one in four, one in five patients will have a molecular driver, especially if their tumor is an adenocarcinoma subtype, and they'll have a pill to take instead of intravenous chemotherapy.  And they do better.  Head?to?head studies have shown these pills do better.  And what's also nice is there's not just one pill.  There's three pills for EGFR mutation.  There [are] three, coming a third, for ALK translocations.  And I haven't even touched on one of the more exciting areas that everyone has talked about, which is immunotherapy. 

But again that leads to your question about biopsies, we need them.  And not only do we need them to diagnose up front, but after a treatment stops working, that means a tumor has gained resistance to that treatment, whether that would be six months on treatment, a year on treatment, two years on treatment. We now say that we want another biopsy, because that biopsy is representative of a tumor now that has changed.  It's not the same tumor it was six months ago, a year ago after all the treatment. 

And what's nice is we've identified some resistance mutations or different mutations that have evolved after the treatment, and there are now drugs that target those mutations.  And those will probably be approved by the agency later this year.  So not only do you need a biopsy up front to determine if you have a mutation to get a pill, when the tumor grows after that drug stops working, you biopsy again and see if you have that mutation that has arisen from the treatment, 50 to 60 percent of people will in their tumors… 

Tamara Lobban-Jones:

Wow.  

Dr. Kim:

…and then there will be two drugs available that are pills, hopefully by the end of the year.  So it is so important to get these tissue biopsies. 

There may be a day where patients do not have to undergo repeat biopsies with needles into their tumors, through their chest or into their abdomen.  It could actually be needles just into their veins to grab some blood.  

Tamara Lobban-Jones:

How soon can you expect something like that?  

Dr. Kim:

Well, it's in active testing right now in a bunch of clinical trials, so these tests are out there.  The problem is none of them are right now close to being paired with a drug as a companion diagnostic, which is what the FDA uses to pair it with a specific compound.  But I have a feeling in the next several years we'll see it.  

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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Page last updated on October 13, 2015