♪ ♪ THE LUNG CANCER REMAINS THE LEADING CAUSE OF DEATH FROM CANCER IN THE UNITED STATES, THERE IS HOPE AND CAUSE FOR OPTIMISM ON THE HORIZON.
PLEASE JOIN US AS WE TALK TO ONCOLOGIST Dr. JASON CHESNEY ABOUT DECREASING THE MORTALITY RATE FROM LUNG CANCER NEXT ON KENTUCKY HEALTH.
HISTORICALLY THE DIAGNOSIS OF LUNG CANCER WAS ASSOCIATED WITH OVERALL POOR PROGNOSIS.
HOWEVER IN WHAT HAS TO BE SEEN AS A TRIUMPH OF BOTH PUBLIC HEALTH POLICY AND NEW TREATMENTS, THE MORTALITY RATES FROM LUNG CANCER HAVE BEEN DECREASING.
WHILE LUNG CANCER SCREENING MAY HAVE PLAYED A ROLE, UNDOUBTEDLY THE REAL CHAMPIONS ARE A DECREASE IN CIGARETTE SMOKING AND THE USE OF MORE SPECIFIC AND TARGETED THERAPIES.
SPECIFICALLY, I REFER TO THE DEVELOPMENT AND UTILIZATION OF TREATMENTS TARGETED AT GENETIC ALTERATIONS.
TO DISCUSS THE CHANGES AND THE TREATMENT OF LUNG CANCER AND GIVE US A GLIMPSE INTO WHAT THE FUTURE HOLDS, WE HAVE AS OUR GUEST TODAY Dr. JASON CHESNEY.
Dr. CHESNEY IS A MELON MEDICAL ONCOLOGIST AND DIRECTOR OF THE UNIVERSITY OF LOUISVILLE HEALTH BROWN CANCER CENTER.
Dr. CHESNEY EARNED HIS BACHELOR DEGREE, Ph.D. AND M.D.
FROM THE UNIVERSITY OF MINNESOTA, COMPLETED A RESIDENCY IN INTERNAL MEDICINE AND ONCOLOGY AT THE MEMORIAL SLOAN KETTERING CANCER CENTER AND CORNELL UNIVERSITY MEDICAL COLLEGE NEW YORK HOSPITAL AND DID A CLINICAL FELLOWSHIP IN THE DIVISION OF IMMUNOLOGY AT THE WHILE CORNELL COLLEGE.
WHAT HAVEN'T YOU DONE?
>> WELL, IT'S VERY IMPORTANT TO GET THE TRAINING IN UP FRONT SO YOU CAN DO THE JOB YOU WANT AND I HAVE TO ADMIT, THAT I ADVISE ALL THE JUNIOR FACULTY THAT THEY NEED TO GET FELLOW SHIPS AND I HEARD THAT YOU DID A FELLOWSHIP ON NUTRITION AT THE NATIONAL CANCER INSTITUTE.
>> WE TRY.
>> WE HEAR THE TERM LONG CANCER BUT WHAT DOES IT REALLY MEAN WHAT IS LUNG CANCER?
>> IT'S A CONSTELLATION OF MULTIPLE DIFFERENT TYPES OF CANCER THAT ORIGINAL ORIGINATE IN THE LUNG.
WE TEND TO DIVIDE THEM INTO SMALL CELL AND NON-SMALL CELL LUNG CANCER AND TREATED VERY DIFFERENTLY.
IT'S VERY IMPORTANT IF A PATIENT COMES IN WITH A TUMOR SOMETHING WE CAN SEE ON A CAT SCAN OR CHEST EXPRAI TO GET A BIOPSY BECAUSE WE CAN DO MOLECULAR TESTING TO FIND OUT WHAT KIND OF LUNG CANCER IT IS AND SEQUENCE THE DNA AND FIGURE OUT IF WE CAN GIVE TARGETED THERAPIES THAT CAN SELECTIVELY KILL THE CANCER CELLS AND NOT HAVE AN IMPACT ON THE NORMAL CELLS.
WE DO MOLECULAR TESTING FOR I AM UN LOGICAL MARKERS, THE BIG ONES ARE PDL 1 AND TUMOR MUTATION BURDEN BUT THEY DEMONSTRATE WHETHER OR NOT CERTAIN IMMUNOTHERAPIES WILL WORK TO PREVENT THE TUMOR FROM GROWING AND SPREADING BUT THERE ARE MULTIPLE TYPES OF LUNG CANCER.
THEY'RE NOT ALL THE SAME.
>> WHEN YOU TALK ABOUT NON-SMALL CELL VERSUS SMALL CELL.
WHAT IS THE DISTINCTION AND DOES THAT AFFECT PROGNOSIS AND IS ONE MORE COMMON THAN THE OTHER?
>> NON-SMALL CELL IS DIVIDED INTO TWO GROUPS, BY FAR THE MOST COMMON TYPE OF LUNG CANCER.
IT HAS A MORE FAVORABLE PROGNOSIS THAN SMAWL CELL WHICH IS MORE AGGRESSIVE AND LEADS TO ME TASS IS.
WITH SMALL CELL HAVE YOU TO TREAT WITH CHEMOTHERAPY VERY AGGRESSIVELY VERY EARLY ON AND WITH THE NON-SMALL CELL, IT'S OKAY TO USE LESS TOXIC CANCER CHEMOTHERAPIES AND IMMUNOTHERAPY.
>> WHO IS THE PERSON WHO GETS LUNG CANCER.
>> MAJORITY ARE HEAVY SMOKERS.
INDIVIDUALS WHO SMOKE OVER30 YEARS A PACK A DAY ARE THE ONES WHO GET LUNG CANCER AND I SAW A YOUNG WOMAN TODAY WHO SMOKED FOR ABOUT 15 YEARS AND QUIT 23 YEARS AGO AND SHE HAD LUNG CANCER.
THAT'S NOT TO SAY THAT NON-SMOKERS DON'T GET LUNG CANCER.
WE HAVE A FAIRLY HIGH POPULATION OF PATIENTS COMING IN WITH LUNG CANCER.
IT'S IMPORTANT TO NOTE THAT BECAUSE LUNG CANCER IS THE NUMBER ONE CAUSE OF CANCER RELATED DEATH IN THE UNITED STATES.
ACCOUNTS FOR ROUGHLY A THIRD OF ALL THE CANCER DEATHS IN THE UNITED STATES AND THAT'S OVER 200,000 PEOPLE A YEAR WHAT ACCOUNTS FOR THE PEOPLE WHO ARE NOT SMOKERS THEMSELVES GETTING LUNG CANCER?
>> WELL, IT'S A COMBINATION OF EXPOSURE.
IF YOU THINK ABOUT WHAT IS GOING ON, YOU HAVE CELLS THAT LINE YOUR LUNG THAT ARE CONSTANTLY EXPOSED TO CARCINOGENS.
I LIKE TO TALK ABOUT THIS WITH MY MEDICAL STUDENTS BECAUSE I REFER TO THE WALK FROM THE BROWN CANCER CENTER TO THE LOUISVILLE SCHOOL OF MEDICINE AND I WALK OUT THE DOOR AND IT'S A SUNNY DAY AND I'M EXPOSED TO ULTRAVIOLET RADIATION THAT INCREASES MY RISK FOR MELANOMA AND STOP IN FRONT OF THE HOT DOG STAND AND PICK UP A HOT DOG FULL OF NITRATES THAT INCREASE MY RATES OF GASTROCARCINOMA AND THEN I WALK ACROSS JACKSON STREET AND WHEN I DO THAT, I'M EXPOSED TO THE DIESEL FUMES COMING OFF THE CITY BUS THAT DRIVES BY AND I HAVEN'T SMOKED A CIGARETTE OR ANYTHING BUT I HAVE EXPOSED MY LUNGS, PARTICULARLY CERTAIN CELLS IN THE LUNGS TO CARCINOGEN SO THAT IS WHAT IS HAPPENING TO THE NON-SMOKERS BUT ONE OF THE BIGGER CAUSES ARE INDIVIDUALS WHO ARE HEAVY USERS OF COOKING OIL, IN PARTICULAR THE ASIAN AMERICAN POPULATION WITH WOULD BEINGS.
WE SEE AND FRANKLY WHEN YOU GO TO JAPAN AND CHINA, YOU SEE THE SAME THING.
NON-SMOKERS WHO ARE EXPOSED TO VOLATILIZED ORGANIC COMPOUNDS THAT ARE CARCINOGENS.
SO EVERY BREATH WE TAKE, THERE IS THE POTENTIAL TO BREATHE IN CARCINOGENS EVEN IF YOU ARE NOT A SMOKER WHICH IS WHY ABOUT ONE IN SIX LUNG CANCER PATIENTS HAVE NEVER SMOKED A CIGARETTE.
>> I THOUGHT YOU WERE GOING TO BREAK OUT IN SONG.
TELL ME ABOUT RADON.
>> RADON, THERE HAVE BEEN A LOT OF EPIDEMIOLOGICAL STUDIES SHOWING THAT RADON WHICH IS COMING UP FROM THE BASEMENT, RIGHT?
A LOT OF TIMES FROM BRICK FOUNDATIONS AND SOIL CONTAMINATION, CAN INCREASE YOUR RISK OF A VARIETY OF DIFFERENT TYPES OF CANCER AND CERTAINLY LUNG CANCER IS ONE OF THEM.
THERE ARE RADON ABATEMENT PROGRAMS AND I ENCOURAGE ALL OF MY PATIENTS TO GET THEIR PATIENTS CHECKED.
IT DOES COST A LOT TO FIX THIS.
IF YOU HAVE HIGH RADON LEVELS IN YOUR BASEMENT WHICH CAN CIRCULATE TO YOUR HOUSE, ON AVERAGE ABOUT $1500 TO FIX IT BUT THERE ARE PROGRAMS TO HELP HUT BATS A RISK LIKE EVERYTHING ELSE.
WE ARE CONSTANTLY EXPOSED TO RISKS.
THERE ARE THINGS THAT LEAD UP TO CHANGES IN THE DNA THAT CAN, IN TURN, TRANSLATE INTO CANCER CELLS AND EVERY LITTLE THING YOU CAN DO TO PREVENT THAT, YOU SHOULD DO.
>> TYPICAL PERSON WHO HAS LUNG CANCER COMES INTO YOUR OFFICE.
HOW DO THEY LOOK WHEN THEY COME IN THERE?
DO THEY COME DIRECTLY TO YOU OR THEY'RE SEEING THEIR PRIMARY CARE.
>> INCIDENTAL FINDING IN THE VAST MAJORITY.
THEY DON'T EVEN KNOW THEY HAVE LUNG CANCER.
GREAT EXAMPLE LADY COMES IN WITH A HERNIA.
HERNIA IN THE GROIN AND THEY DECIDE TO DO A SCAN TO FURTHER EVALUATE BEFORE THEY DO THE SURGERY AND THE SCAN INCLUDES THE BASE OF THE LUNG AND A NODULE IS PICKED UP IN THE LUNG THAT LEADS TO TO A DIAGNOSTIC SCAN OF THE LUNGS AND THEN WE SEE A LARGER TUMOR AND ENLARGED LYMPH NODES.
VAST MAJORITY ARE NOT SYMPTOMATIC.
THOSE ARE THE ONES WHO DO THE BEST.
THERE IS A POPULATION OF PATIENTS WHO GET LOW DOSE CHEST CT SCREENING IF YOU ARE A HEAVY SMOKER, I HIGHLY ENCOURAGE THIS.
IF YOU ARE A NON-SMOKER, IT'S NOT A BAD IDEA AND FRANKLY I'M PLANNING TO DO IT AND I JUST TURNED 52 AND I'M PLANNING TO DO THEM.
WHAT THEY ARE IS VERY LOW DOSE RADIATION GETTING THE CHEST C.T.
AND THERE IS CONCERN THAT WE ARE GOING TO CAUSE MORE HARM THAN GOOD.
IN CASE IT'S A VERY LOW DOSE NOTHING TO WORRY ABOUT NO CONTRAST AGENT.
IT CAN PICK UP LITTLE LESIONS THAT CAN BE FOLLOWED UP WITH A BIOPSY OR PET SCAN.
I THINK IT'S VERY IMPORTANT TO NOTE THAT VIRTUALLY EVERY TYPE OF CANCER IF IT IS CAUGHT EARLY IS CURABLE MEANING NORMAL LIFE SPAN AND SO AS WE GET MORE AGGRESSIVE WITH SCREENING AND DIAGNOSTIC IMAGING, I THINK WE'LL DROP THE DEATH RATE WHICH IS THE GOAL OF THE BROWN CANCER CENTER, DROP THE DEATH RATE FROM THE CANCER CENTER AND THAT DOVETAILS INTO A LOT OF OUR RESEARCH PROGRAMS WHERE WE ARE TRYING TO DETECT CANCER IN THE PERIPHERAL BLOOD, LOOKING AT CHANGES IN DNA BUT AGAIN TO ANSWER YOUR QUESTION, MOST PATIENTS, IT'S AN INCIDENTAL FIND.
THEY GO INTO THE E.R.
FOR SOMETHING ELSE.
THEY GET PNEUMONIA, STUB THEIR TOE, A FRACTURE, CHEST X-RAY, HAD A FEVER AND ALL OF A SUDDEN SOMETHING IS FOUND AND THEY GET REFERRED TO US AND WE DO A BIOPSY AND FIGURE OUT WHAT IS HAPPENING.
>> I WANTED TO ASK YOU ABOUT SOME OF THE NEWER TESTS OUT THERE AS FAR AS SCREENING.
I'VE HEARD THINGS USING BREATH ANALYSIS, SWABS EVEN IN THE TRACHEA, ET CETERA.
AND ALSO THE BLOOD TEST.
IS THIS SOMETHING THAT IS GOING TO BE READY FOR PRIME TIME, ANY OF THESE?
>> IT'S IN CLINICAL TRIELSZ.
I BELIEVE THAT THE BLOOD TEST IS THE FARTHEST ALONG.
IT'S BEING COMMERCIALIZED WHICH IS ESSENTIAL BECAUSE YOU'VE GOT TO RAISE THE CAPITAL TO RUN, YOU KNOW, MULTICENTER TRIALS.
U OF L HEALTH IS NOW PART OF A LARGE MULTICENTER NATIONAL STUDY TO DETECT CANCEROUS DNA IN THE BLOOD OF HEALTHY INDIVIDUALS WHO ARE COMING IN TO GET THEIR BLOOD PRESSURE CHECK AND CHOLESTEROL CHECKED AND IF THERE IS ANYTHING DETECTED, THAT PATIENT IS REFERRED FOR A PAID PET SCAN WHICH IS A VERY SPSK DIAGNOSTIC IMAGINGS SCAN.
IT IT IS REAL.
IT IS HAPPENING I BELIEVE IN THE NEXT FIVE YEARS WHETHER YOU GO SEE YOUR PRIMARY CARE PHYSICIAN, THEY'RE GOING TO BE DOING THIS WE ARE DOING IT WITH A COLON CANCER TEST.
AND THAT'S JUST MEASURING DNA IN THE STOOL AND THE FACT THAT'S ALL CANCERS HAVE MULTIPLE MUTATIONS.
THE HIGHEST MUTATION IS MELANOMA, 10,000 MUTATIONS PER CELL.
LUNG CANCER IS JUST BEHIND IT AT ABOUT EIGHT TO 9 SO IT COULD BE DETECTED CIRCULATED IN THE BLOOD.
WE CAN DETEACT THAT TODAY AND IT'S JUST A MATTER OF APPLYING IT IN THE REAL WORLD SITUATION AND THAT'S, YOU KNOW, VERY DIFFICULT BECAUSE YOU ARE OR DEALING WITH PRIMARY CARE OFFICES TRYING TO DO A CLINICAL TRIAL RELATED TO CANCER.
>> BLOOD TEST IS TELLING AWE SPECIFIC TYPE OF CANCER YOU WOULD BE ABLE TO PICK UP?
>> WE REFER TO THIS AS A LIQUID BIOPSY.
ALREADY TODAY WE DO A LIQUID BIOPSY.
BASICALLY, IF YOU WANT TO DIAGNOSE WAS TYPE OF CANCER YOU HAVE, YOU COULD HAVE A LUNG MASS THAT COULD TURN OUT TO BE BREAST CANCER OR COLON CANCER, RIGHT SO WE TAKE OUT A PIECE OF THE TISSUE AND ANALYZE IT AND FIGURE OUT WHERE IT IS COMING FROM, WHERE THE TISSUE OF ORIGIN IS.
LIKEWISE, WHEN WE FREQUENTLY WHEN WE HAVE TO FIGURE OUT WHAT IS GOING ON WITH A PATIENT AND WE CAN'T GET A BIOPSY OR THE BIOPSY ISY QIF COL, WE WILL DO-- EQUIVOCAL, WE WILL DO A LIQUID BIOPSY, THAT IS TAKING BLOOD, AMIZING ANALYZING THE TUMOR DNA AND ASKING THE QUESTION WHAT MUTATIONS ARE THERE AND BASED ON THAT, WHAT TYPE OF CANCER IS THIS LIKELY TO BE?
AND IN FACT A LOT OF THOSE MUTATIONS ARE ACTIONABLE, WHICH MEANS THAT WE CAN TARGET THEM WITH ORAL AGENTS, WITH PILLS, BASICALLY.
AND WE DON'T EVEN NEED TO KNOW WHAT THE TISSUE OF ORIGIN IS.
SO WE CALL THAT TUMOR AGNOSTIC.
THERE IS GOING TO BE A TIME IN THE FUTURE WHERE WE DON'T CARE IF IT CAME FROM LUNG OR IF IT CAME FROM THE COLON OR THE BREAST OR THE PROSTATE OR MELANOMA.
WE-- WAS WE CARE ABOUT IS WHAT MUTATIONS THE CANCER HAS AND WHAT THE IMMUNEAL PHENO TYPE IS BECAUSE THAT DICTATES THE TYPE OF TREATMENT.
THAT IS HAPPENING TODAY ALREADY.
ANY TYPE OF CANCER THAT HAS A TUMOR MUTATION BURDEN BASICALLY HOW MANY MUTATIONS PER MEGA BASE OF DNA, WE'RE NOW FDA APPROVED TO GIVE A CERTAIN TYPE OF IMMUNEAL THERAPY.
IT DOESN'T MATTER IF IT IS BREAST CANCER OR LUNG CANCER.
WE ARE APPROVED TO GIVE IT.
>> YOU ARE NOT TREATING PERSON COMES IN, MASS IN THE BREAST, BOOM, THIS IS A BREAST CANCER YOU HAVE GONE WHICH IS THE OLD, OLD TECHNOLOGY THE WAY IT HAS BEEN DONE FOR HUNDREDS OF YEARS YOU ARE SAYING WE ARE TREATING THE CANCER CELL NOT THE CELL TYPE.
>> YES.
WE ARE TREATING THE GENETIC BACKGROUND, DNA AND WHAT THE CANCER CELL IS AND I LIKE TO TALK ABOUT THE FACT THAT, I ENDED UP SPECIALIZING IN LUNG CANCER BUT THE REASON I DID WAS I STARTED IN MELANOMA AND THEY, FROM A DNA PERSPECTIVE ARE VERY SIMILAR BECAUSE THEY HAVE THE HIGHEST MUTATION RATE AND RESPOND TO THE SAME IMMUNOTHERAPIES.
SO IT DOESN'T MATTER THAT ONE COMES FROM THE SKIN AND ONE COMES FROM THE LUNG FROM A MOLECULAR PERSPECTIVE AND TREATMENT PERSPECTIVE, THINGS ARE VERY DIFFERENT.
WHEN I SAY THAT, THAT'S FROM A SYSTEMIC PERSPECTIVE, ONCE THE CANCER IS SPREAD.
WHEN WE ARE TALKING ABOUT A ONE CENTER METER MASS IN THE LUNG VERSUS THE BREAST, WE ARE TREATING THOSE VERY DIFFERENTLY.
WE HAVE SUBSPECIALISTS WHO DO JUST BREAST CANCER SURGERIES AND SOME WHO DO JUST LUNG CANCER SURGERY AND MEDICAL ONCOLOGISTS AND RADIOLOGY ONCOLOGIST WHO SPECIALIZE IN DISTINCT CANCER TYPES AT THE BROWN CANCER CENTER.
>> WHAT IS THE DIFFERENCE BETWEEN CHEMOTHERAPY AND, TARGETED DRUG THERAPY AND IMMUNE OWE THERAPY.
>> GREAT QUESTION.
SO CHEMOTHERAPY WAS DEVELOPED REALLY TO TARGET THE VAST MAJORITY TARGET RAPIDLY DIVIDING CELLS BY DAMAGING THE DNA.
WHEN A CELL GOES FROM ONE CELL TO TWO CELLS, IT HAS TO ACTUALLY DOUBLE IT'S DNA BEFORE IT SPLITS INTO TWO CELLS AND WHEN IT DOES THAT, IT MASS TO MAKE A LOT OF DON SO MOST CHEMOTHERAPY GOES AFTER THAT PROCESS OF DOUBLING THE DNA.
MOST OF THE CELLS IN OUR BODY ARE NOT DOING THAT.
YOU ARE NOT GETTING BIGGER EVERY DAY, DEPENDS WHERE YOU GO TO EAT IN THEORY MOST OF OUR CELLS ARE NOT DIVIDING LIKE THAT WHEREAS CANCER CELLS ARE.
CHEMOTHERAPY IS USUALLY AND THERE ARE HUNDREDS OF CHEMOTHERAPY AGENTS ABOUT IT USUALLY SMALL MOLECULES THAT DAMAGE DNA WHEN THE DNA IS OPEN UP TO DIVIDE.
CLASSIC EXAMPLE IS A DRUG COMMONLY USED DRUG TARGETED AGENTS WHICH I WOULD GROUP YOU DID THREE DIFFERENT CLASSES BUT I WOULD GROUP THEM THAT GO AFTER GENETIC MU TITIONS AND TARGETED AGENTS THAT GO AFTER THE IMMUNE PHENO TYPE OF THE TUMOR SO THEY BOTH ARE SPECIFIC FOR A PROTEIN OR MUTATION.
THAT'S A TARGETED AGENT.
AND THE TARGETED AGENT THAT GOES AFTER A MUTANT PROTEIN IS A SMALL MOLECULE THAT BINDS TO A SPECIFIC PROTEIN AND SUPPRESSES ITS FUNCTION AND THE BIG WINNER HAPPENED IN 1998 WHEN I WAS AN INTERN AT MOISM SLOAN CANCER KETTERING CENTER AND IT TARGETS THE PHILADELPHIA CHROMOSOME, THE BCRA AND IT IS VERY SPECIFIC FOR THAT GENETIC TRANSLOCATION, THAT MUTATION AND IT WORKS WONDERFULLY.
WE WENT FROM PATIENTS HAVING A LIFE SPAN MEASURED IN MONTHS TO HAVING A NORMAL LIFE SPAN WITH ONE DRUG AND I REMEMBER VERY VIVIDLY WHAT WAS HAPPENING THEN BECAUSE EVERYONE WAS DYING AND THEN ALL OF A SUDDEN EVERYBODY WAS LIVING A NORMAL LIFE SPAN AND EVERYBODY, INCLUDING MYSELF, FELT THAT IF WE COULD JUST FIND THAT ONE KEY GENE THAT IS MUTE EIGHTED IN EVERY CANCER, LUNG CANCER, BREAST CANCER, ET CETERA, AND MAKE A GOOD DRUG AGAINST IT, WE WOULD BE ABLE TO REPEAT THE SUCCESS WE DID WITH THAT PARTICULAR TYPE OF CANCER WHICH WAS CHRONIC LEUKEMIA.
WE HAVEN'T BEEN ABLE TO REPEAT THE SUCCESS.
>> I WAS IS GOING TO ASK YOU ABOUT THAT BECAUSE NATURE IS WONDERFUL IN ITS INFINITE OF VARIETY OF PRESENTATIONS.
>> YES.
>> EVERYBODY THINKS CHEMOTHERAPY, HAIR IS FALLING OUT, SICK AS A DOG AND ALL THAT.
WITH USING TARGETED THERAPY, IMMUNOTHERAPY VERSUS CHEMOTHERAPY?
>> CHEMOTHERAPY IS MUCH MORE DIFFICULT FOR A PATIENT TO HANDLE TYPICALLY BECAUSE IT'S MUCH LESS SPECIFIC.
I JUST SAID THE TARGETED AGENTS GO AFTER ONE PROTEIN.
CHEMO GOES AFTER DNA.
I DIDN'T MENTION THAT ALL THE CELLS IN YOUR STOMACH AND COLON AND SMALL INTESTINE ARE DIVIDING, RIGHT, SO THAT'S WHY THEY GET NAUSEA AND THEY GET LOOSE STOOLS BECAUSE WE ARE DAMAGING ALL THOSE CELLS SO CHEMOTHERAPY IS MUCH MORE TOXIC THAN THE OTHER AGENTS.
THERE IS NOT TO SAY THERE IS NOT TOXICITY BUT IT IS TARGETED, SELECTIVE AND EASIER TO MANAGE FOR THE MOST PART.
WITH TARGETED AGENTS, FROM ELKLY IT'S INVOLVING OFF TARGET EFFECT OF THE DRUG SO YOU CAN HAVE A DRUG THAT LITS ONE MUTANT PROTEIN AND ANOTHER DRUG THAT HITS THE SAME ONE BUT HAVE DIFFERENT SIDE EFFECTS WITH IMMUNOTHERAPIES, THE WAY THAT THEY WORK IS BY ACTIVATING YOUR IMMUNE SYSTEM, T CELLS, THE SAME CELLS THAT GO AFTER SARS COVI CELL FROM THE COMMON COLD HERPES SIMPLEX 1 WHICH CAUSES COLD SOURCE, ET CETERA, THOSE T-CELLS ARE BEING ACTIVATED TO GO AFTER THE CANCER CELL AND KILL IT: SOMETIMES IN AT THE TIMER PATIENTS THEY GET ACTIVATED AGAINST YOUR NORMAL CELLS AND THAT CAN BE CELLS IN THE LIVER, CELLS IN THE COLON, THE LUNGS, THE SKIN BASICALLY ANY ORGAN IN YOUR BODY.
DEPENDING ON THE DRUG, IT HAPPENS IN 5% OF PATIENTS AND YOU NEED TO BE MANAGED, WHEN IT HAPPENS, IT'S SERIOUS, PEOPLE CAN DIE.
YOU NEED TO BE AT A CENTER THAT HAS NOT ONLY DEVELOPED THESE APPROACHES BUT HAS EXPERTISE IN HANDLING THE SIDE EFFECTS.
THAT'S THE KEY.
ANYBODY CAN GIVE THE DRUGS BUT WHEN YOU ARE PART OF THAT ONE IN 20 WHO GETS THE SIDE EFFECTS, YOU DO NOT WANT TO BE AT A PLACE WHERE THEY DON'T KNOW HOW TO HANDLE IT.
>> I'VE ALWAYS SAID I CAN PUT SOMEBODY TO SLEEP BUT I CAN'T WAKE THEM BACK UP AGAIN BUT IF THE CANCER IS STIMULATING OR HAS THE POTENTIAL TO STIMULATE IMMUNE RESPONSE, WHY IS IT OUR OWN BODIES HAVEN'T DONE SO ABOUT OF?
WHAT IS IT YOU ARE DOING TO KICK THAT INTO GEAR.
>> THIS GETS INTO SOPHISTICATED IMMUNOLOGY.
THE WAY THAT OUR IMMUNE CELLS OR SPECIFICALLY OUR T-CELLS TARGET THE CANCER CELLS IS THRUD A ROW TEEN CALLED CLASS ONE MHS-- MHC, AND THE CANCER CELLS WILL DELETE THAT.
SO THE CANCER CELLS LIVING IN THE SETTING OF OUR OWN IMMUNE SYSTEM THAT'S EVOLVED OVER MILLIONS OF YEARS, AN EVOLUTIONARY PROCESS HAPPENING EVERY MOMENT.
AS THE CANCER CELL DIVIDES, THE ONES THAT FIGURE OUT WAYS TO DELETE PORTIONS OF THEIR DNA TO EVADE THE IMMUNE SYSTEM WILL SURVIVE AND CONTINUE TO GROW AND I'M A BIG FARMER I HAVE A HALF ACRE IN THE HIGHLANDS OF GRASS.
AND SO I DEAL WITH EVOLUTION EVERY WEEKEND WITH WEEDS, RIGHT AND I VIEW THE WEEDS THE SAME WAY I VIEW CANCER CELLS AND I'M CONSTANTLY TRYING TO PREVENT THEM FROM MOVING FORWARD AND ALLOW MY GOOD GUY CELLS, I.E.
MY GRASS, TO GROW.
AND THAT'S FRANKLY WHAT IS HAPPENING IN REAL TIME.
NOW A HUGE DISCOVERY MADE THAT WAS REALLY TRANSFORMATIVE IN ONCOLOGY NOW ABOUT 15 YEARS AGO WAS A DISCOVERY THAT T-CELLS THAT ARE KILLING THE CANCER CELLS HAVE OFF SWITCHES.
SO WHEN I WENT TO GRADUATE SCHOOL AND DOING MY FELLOWSHIP IN IMMUNOLOGY, WE DIDN'T KNOW THIS, OKAY.
BUT A COUPLE INVESTIGATORS IN THE LAB WORKING WITH MICE FIGURED IT OUT.
THEY FOUND THE BIG PROTEIN WAS CALLED PD-1, PROGRAM CELL DEATH ONE DISCOVERED ON A CANCER CELL ACTUALLY AND THEY THOUGHT IT WAS IMPORTANT FOR THE DEATH OF THE CELL, PROGRAMMED CELL DEATH, A SIGNAL TO TURN THE CELL OFF AND WHEN THEY TOOK THAT GENE AWAY FROM THE DNA OF A MOUSE, THE MOUSE ENDED UP WITH HYPER ACTIVATION OF THE IMMUNE SYSTEM AND DEDUCED THAT GENE, I.E.
THE PROTEIN FROM THE GENE THAT IS, THAT MUST BE IMPORTANT FOR TURNING OFF THE IMMUNE SYSTEM AND NOW IS THE MOST USED THE TARGET OF THE MOST USED DRUG AT THE BROWN CANCER CENTER IT TARGETS PD-1.
BLOCKS THE OFF SWITCH OR BREAKS FOR THE IMMUNE SYSTEM.
UNTIL THAT HAPPENED AND FRANKLY IT WAS FDA APPROVED IN 2014 BUT WE WERE DOING TRIALS FOR THAT CLASS OF DRUGS IN 2006 AS EARLY AS 2006.
UNTIL IT GOT APPROVED, WE THOUGHT WE COULD ACTIVATE THE IMMUNE SYSTEM WITH GROWTH FACTORS BUT WE DIDN'T KNOW IT DIDN'T MATTER WHAT YOU DID THERE WAS AN OFF SWITCH LIKE A BRAKE IN A CAR HAVING AIL 2 X 4 IN FRONT OF IT AND NO MATTER WHAT WE DID TO HIT THE GAS, THE BRAKE WAS BEING PUSHED AND BY PUTTING THE 2 X 4 IN FRONT OF IT, THE DRUG, WE BLOCKED THE BRAKE FROM BEING PUSHED THAT CHANGED EVERYTHING WE BELIEVE WE HAVE A 30% REDUCTION IN THE CANCER DEATH RATE IN THE LAST 30 YEARS.
WE BELIEVE IN THE NEXT FIVE QUEERS WE WILL HAVE ANOTHER 30% REDUCTION IN THE CANCER DEBTED RATE.
WE WILL BE REPORTING IT IN FIVE YEARS.
PEOPLE ARE NOT DYING OF CANCER LIKE THEY USED TO BECAUSE THEY'RE GETTING AGGRESSIVE IMMUNOTHERAPY DRUGS TODAY.
>> I'M READING A PAY PAPER IN THE NEW ENGLAND JOURNAL FIVE YEARS FROM NOW.
>> EXACTLY.
>> BRIEFLY IF YOU WILL HOW DO YOU DEVELOP THE DRUG THERAPY?
>> IT INVOLVES LITERALLY HUNDREDS OF THOUSANDS OF RESEARCHERS ACROSS THE WORLD BUMPING INTO EACH OTHER.
>> YOU ARE DEVELOPING THIS STUFF.
>> AND PEOPLE WORKING ON-- WE, AT THE BROWN CANCER CENTER, WE ONLY HAVE ABOUT 100 SPONSORED INVESTIGATORS DOING THIS BUT IT'S ACROSS THE ENTIRE WORLD.
A LOT OF WHAT WOE DO, SO THAT OUR OWN SCIENTISTS ARE DEVELOPING DRUGS THAT ARE GOING INTO PATIENTS IN EARLY PHASE TRIALS BUT MORE IMPORTANTLY FOR US, WE ARE A MAJOR CENTER IN THE COUNTRY NOW FOR STUDYING AND TESTING NOVEL IMMUNOTHERAPIES AND THAT'S BECAUSE WHERE WE ARE.
WE ARE GEOGRAPHICALLY LOCATED IN THE CENTRAL UNITED STATES.
WE ARE NOT ON A COAST.
YOU KNOW, WE ARE NOT IN TEXAS.
WE'RE NOT IN NEW YORK.
WE ARE NOT IN CALIFORNIA.
WE ARE NOT IN FLORIDA AND SO THERE IS A HUGE POPULATION OF PATIENTS WHO NEED TO BE PART OF THESE TRIALS BECAUSE IT CAN MEAN THE DIFFERENCE BETWEEN LIFE AND DEATH.
>> LESS THAN ONE MINUTE SUMMARY AND TAKE HOME POINTS WHERE WE ARE FOR LUNG CANCER?
>> I BELIEVE LUNG CANCER IS GOING TO BE A CHRONIC DISEASE PEOPLE LIVE WITH LIKE THEY LIVE WITH DIABETES, HIGH BLM AND HEART DISEASE IN THE NEXT FIVE YEARS AND I'M SEEING THAT TODAY.
>> IMMUNOTHERAPY AND TARGET DIRECTED.
>> I BELIEVING THE TARGETED THERAPIES ARE GOING TO BE LESS IMPORTANT THAN THE IMMUNOTHERAPIES.
TARGET THE THERAPY.
WE HAVE ABOUT A 10 TO 15% POPULATION THAT HAS ACTIONABLE MUTATIONS WE CAN USE TARGETED THERAPIES.
THE OTHER 85 TO 90%, THAT'S WHERE THE IMMUNOTHERAPIES WILL HELP.
AND EVERY DAY I COME TO WORK, IT'S A MIRACLE HAPPENING EVERY DAY AND I SEE PATIENTS WITH SMALL CELL, THE MORE AGGRESSIVE CANCER, DISTANT, AGGRESSIVE, ADVANCED SMALL CELL LUNG CANCER WHO WOULD HAVE HAD A SIX TO EIGHT MONTH LIFE PAN WITH SCANS EVERY THREE MONTHS WITH NO EVIDENCE OF DISEASE WHILE THEY'RE ON IMMUNOTHERAPIES.
>> ONE DAY YOU WILL HAVE A YARD FULL OF NOTHING BUT GOOD GREEN GRASS.
Dr. CHESNEY, I WANT TO THANK YOU VERY MUCH FOR BEING WITH US.
ADMITTEDLY NOT ALL CASES OF LUNG CANCER ARE CURRENT SMOKERS BUT BECAUSE THE VAST MAJORITY ARE ASSOCIATED WITH SMOKING, ANY DISCUSSION ABOUT DECREASING LUNG CANCER MORTALITY MUST BEGIN WITH PREVENTION.
IF YOU HAVEN'T STARTED SMOKING, DON'T.
AND IF YOU ARE A SMOKER, QUIT.
FOR MANY REASONS PEOPLE WILL GET LUNG CANCER AND WE MUST BE ABLE AND WILLING TO TREAT THEM.
IT IS GOOD TO SEE BOTH THE DIRECTION IN WHICH NEW TREATMENT MODALITIES ARE HEADED AND THE PROMISE OF CURE THAT THEY'RE OFFERING.
DO TALK TO YOUR HEALTHCARE PROVIDER IF YOU FEEL HAVE YOU SYMPTOMS OF LUNG CANCER OR QUESTIONS ABOUT TREATMENT OPTIONS IF YOU WANT TO WATCH THIS SEGMENT AGAIN OR SEE PAST SHOWS GO TO ket.org/KENTUCKY HEALTH.
I WANT THE TO YOU FOR JOINING US AND I LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH AND