7-Year Lung Cancer Survivor Interviews His Doctor, Should I Be Hopeful?

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Topics include: Patient Stories , Understanding and Treatments

In this program sponsored by the Seattle Cancer Care Alliance, Randy Broad, a 7-year lung cancer survivor, sits down with his own doctor, Dr. Renato Martins, thoracic oncologist at SCCA, at the ASCO 2015 meeting in Chicago.  Randy asked him to relate the ongoing theme at this year's ASCO. The answer? Immunotherapy.  Dr. Martins explains how he and his colleagues will be "busy for years to come" with two new classes of medications, checkpoint inhibitors and stimulatory molecules. Dr. Martins and Randy also explore some of the pros and cons associated with clinical trial participation. While one of the negative aspects of a clinical trial is toxicity levels, Dr. Martins is quick to point out that not only are these levels unlikely, the patient is "receiving today the treatment of tomorrow."

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Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff 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.

Randy Broad:

Dr. Martins, welcome.  Here we are at ASCO.  

Dr. Martins:

Thanks for having me. 

Randy Broad:

As a thoracic oncologist at Seattle Cancer Care Alliance, you've treated hundreds of patients like myself.  I happen to be one of them, right?  

Dr. Martins:

Yes. 

Randy Broad:

Well, you shared that one time in a presentation recently that you don't know all of your patients.  I just wanted to make sure that you remembered that I was there.  Anyway, so here we are at ASCO.  

Dr. Martins:

Mm-hmm.  

Randy Broad:

What would you say the biggest theme of this year's ASCO is? 

Dr. Martins:

There's no question that the big theme is immunotherapy.  If you look across multiple diseases, different types of immunotherapy are having a tremendous impact in the outcome of patients, at this point still with advanced disease, but obviously the next step is to take into more early stage diseases and see if we can increase the percentage of cure rates on that basis. 

Randy Broad:

What's this next step? 

Dr. Martins:

From the standpoint of someone that is in academic medicine, I can assure you that we will be busy for many years to come because, as you pointed out, there are multiple drugs, and there is an enormous interest in combination therapies.  The drugs that have been approved so far are in the category of checkpoint inhibitors.  They take the brakes out of the immune system to fight the cancer.  There are also stimulatory molecules that are coming to clinical trial now.  Those are the ones that are going to step on the gas of the immune system. 

So obviously it makes sense to combine something that takes the brake off with something that steps on the gas.  The problem is will the immune system go too fast and end up crashing the patient.  You know, as you know there are a lot of autoimmune diseases.  Lupus is one of them.  Rheumatoid arthritis is another one of them.  And we are seeing toxicities that have to do with the overstimulation of the immune system. 

Randy Broad:

Okay.  

Dr. Martins:

So we're going to be very busy trying to understand how these combinations will work as well as trying to tailor the toxicities in a way that can be tolerable. 

So in the plenary session, which I came from to talk to you, we saw a combination of two drugs that again removed the brakes of the immune system having a response rate of 60 percent in patients with advanced melanoma.  So I'm old enough to tell you that until about 10 years ago nothing was better than the single agent chemotherapy from the 1980s, which had the response rate of like 8 percent in melanoma, and that has—you know, seeing a trial that shows a 60 percent response rate is just unbelievable. 

Randy Broad:

Yeah.  And you brought up clinical trials.  Can you just touch briefly pros, cons?

Dr. Martins:

When I was in fellowship in the mid-1990s, all the clinical trials that we had were variations of chemotherapy, and, quite frankly, they all were terrible.  That's not the case anymore.  So if you are at the Seattle Cancer Care Alliance or a large academic medical center that [is] doing these trials that are really changing the landscape of lung cancer, the biggest advantage is that you will be receiving today the treatment of tomorrow because these drugs are being approved at an amazing rate. 

You know, the clinical trials today, they are so much better because we have so much better therapies to offer early on, and I think that one should definitely consider understanding all their options, including the options in the context of a clinical trial.  You know, the downside of being in a clinical trial, it's obviously it's a clinical trial…

Randy Broad:

Right. 

Dr. Martins:

…and there's always the possibility that it will be worse than not being on a clinical trial, but I would say that particularly with the targeted therapies, you know, these are not, you know, random chemos that we don't know how they work.  These are drugs that have been designed to do what they do.  And although some unexpected toxicities are always a possibility, it is not likely that we're going to be blindsided by something terrible just because the way they've been developed.  

Randy Broad:

One time you said when you were talking on this subject—this was about a year ago—you said it's the beginning of the end.  

Dr. Martins:

Mm?hmm. 

Randy Broad:

Do you still feel that way? 

Dr. Martins:

The analogy that I like to use is that, you know, my daughters don't know anyone that died of AIDS, and that's because we do a much better job in taking care of AIDS patients.  Still, it's a huge problem… 

Randy Broad:

Right. 

Dr. Martins:

…worldwide.  You know, people still get AIDS, people still die of AIDS, but I'm telling you that my daughters don't know anybody that has died of AIDS.  And I'm hopeful that my grandchildren, their kids, won't know anyone that died of lung cancer.             

Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, its medical staff 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 August 4, 2016