Brandon Hayes-Lattin, MD: Young Adult Cancer Update ASCO 2011
Brandon Hayes-Lattin, MD gives an update on young adult cancer research and programs at ASCO 2011. Brandon Hayes-Lattin, MD is the Medical Director, OHSU Knight Cancer Institute Adolescent and Young Adult Oncology Program.
Dr. Hayes-Lattin’s patient care training and experience is in treating blood cancers and in stem cell transplants. However, as a young adult cancer survivor and a doctor who cares for many young adults with blood cancers, Dr. Hayes-Lattin has become a leader in developing the new discipline of adolescent and young adult (AYA) oncology. He is the first medical co-chair of the Lance Armstrong Foundation’s LIVESTRONG Young Adult Alliance, a coalition of over 100 organizations that conduct research and serve young adults (aged 15-40) with cancer.
The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:
VIDEO TRANSCRIPT
Selma R. Schimmel, Founder & CEO, Vital Options International
This is Selma Schimmel at ASCO 2011 in Chicago, and we are sitting and talking with physicians and key opinion leaders on different subjects, cancer types, issues that impact the cancer community. And now we’re going to talk about young adults with cancer; a very specific patient population as I’m joined by Dr. Brandon Hayes-Lattin, Associate Professor of Medicine and the Medical Director of Adolescent and Young Adult Oncology Program at Oregon Health and Science University, Knight Cancer Institute in Portland, Oregon. So what I want to discuss with you is, sort of an overall picture of where we’re at with young adult oncology, what needs to be done, what’s happening at this ASCO meeting on behalf of this very special patient population?
Brandon Hayes-Lattin, MD, Med. Dir., OHSU Knight Cancer Inst. Adolescent & Young Adult Oncology Program:
Thinking back of where we were with the field of Young Adult Oncology when we first met, a lot has changed and I think this ASCO actually highlights a lot of those changes. When we first met it was around defining what the issues were for young adults. So, the fact that young adults have a different set of common cancers than older adults, the fact that the survival outcomes had not been improving the same way pediatric cancer, or older-adult cancer had been. And a whole range of unique medical needs like fertility preservation, unique type of social needs, and really a part of our task was just to raise awareness that these were things that needed to be studied.
Coming to ASCO in 2011, I think we’ve made incredible progress. The Lance Armstrong Foundation actually partnered with ASCO to create continued medical education series called ‘Focus Under 40’. They’re education modules around specific cancer types that occur in young adulthood and issues like fertility preservation, key space discussions that are available on ASCO University. Not only has it sort of risen to that level of attention and the premier oncology society in the United States, but even taking the bus from the hotel to the meeting you can see it highlighted in terms of ASCO’s promotional activity.
Selma R. Schimmel:
Do you think the fact that with – and today is his official first day as ASCO President – Dr. Link, do you think that having someone who comes out of pediatric and adolescent arena of medicine is going to help change the fabric or highlight the issues of young adults with more clarity?
Brandon Hayes-Lattin:
Yeah, I think it’s really important to highlight the issues here in adulthood to see a pediatric oncologist as the president of ASCO. And in fact we have worked with Dr. Link and his colleagues to help highlight those issues. ASCO’s published a special issue of “The Journal of Clinical Oncology” focused on adolescent and young adult issues.
Even at this meeting one of the plenary session presentations had to do with the treatment of A.L.L. and a particular arm of the children’s oncology group trial that’s an effort led by pediatric oncologists. But when Dr. Tomin gave the discussion around the abstract presentation he was clear to highlight that more than 40% of patients with A.L.L. in the United States are over age 20, and actually brought in the young adult issues from the pediatric perspective. So I hope that having Dr. Link leading ASCO is yet another step to sort of bring that science to bear.
Selma R. Schimmel:
It sure feels that way. What do we understand about the biology of young adult cancer, and how, in this patient population there are really important differences in the other age groups?
Brandon Hayes-Lattin:
So, one of the exciting things that’s happened in the last few years is a focus in biology and actually some publications that have demonstrated that in, at least in some cancer types, the common presentation, young adulthood has different biological features than either pediatric or older adult cancers. In fact the National Cancer Institute published the findings of a workshop that focused on the diseases – acute lymphoblastic leukemia, breast cancer, and colon cancer – which highlighted distinct biology.
Selma R. Schimmel:
Do you think that because when you’re a young adult and you have raging hormones and all of that, do you think there may be some hormonal impact unique to this patient group?
Brandon Hayes-Lattin:
It’s certainly an intuitive hypothesis to think ‘well there must be hormonal differences’. And in fact, that’s definitely true in diseases like breast cancer where the differences between pre-menopausal and post-menopausal breast cancer are well understood to be distinct biology with distinct responses to treatment. But we think that that’s probably a paradigm that could expand even beyond sort of hormonally sensitive tumors like breast cancer. There may also be changes with the processing and metabolism of drugs, so chemotherapy, pharmacodynamics, and pharmacokinetics may in fact be quite different in the young adult versus the child or an older adult.
Selma R. Schimmel:
Yeah, the dosing issues.
Brandon Hayes-Lattin:
Right.
Selma R. Schimmel:
What are the most common young adult cancers?
Brandon Hayes-Lattin:
So the most common young adult cancers are hymnologic malignancies like leukemias and lymphomas, sarcomas, so bone and soft tissue tumors, germ-cell tumors, skin cancer like melanoma, which has also been a highlight at this year’s ASCO, and thyroid cancer. Those are the most common subtypes, but when you look at all of oncology, particularly all the adult oncology, each of those ends up being a relatively rare cancer. So for instance, I had testicular cancer when I was 28-years-old. For a 28-year-old man, testicular cancer is the number one cancer.
Selma R. Schimmel:
Yeah, and it’s interesting. I had breast at 28.
Brandon Hayes-Lattin:
So, young adults. But testicular cancer is a rare cancer and yet it’s the most common for young adult men.
Selma R. Schimmel:
What about Hodgkin’s disease?
Brandon Hayes-Lattin:
Same thing. So, Hodgkin’s disease is also a common young adult cancer but in the world of oncology, compared again to colon cancer or something, it’s rare.
Selma R. Schimmel:
Dr. Hayes-Lattin, how important is it for young adults to seek out medical oncologists that have a particular understanding, maybe even a subspecialty, which has been part of the discussion – can young adult oncology become its own specialty?
Brandon Hayes-Lattin:
Yeah, well there are certainly important treatment aspects to taking care of a young adult that require special attention. Right now there are certain centers that have a focus in adolescent, young adult who can bring that to bear. So things like early attention to the needs of fertility preservation, or other ways of balancing the treatment and adherence to treatment around the rest of the young adults’ life. There’s also access to clinical trials. So for instance, we were talking about the children’s oncology group – the Children’s Oncology Group actually has some clinical trials where the age of eligibility is up into the thirties. You would need to find a center and a team that has access to those kind of clinical trials. And then even outside of clinical trials there’s a level of being familiar with again, what are common young adult cancers but maybe rare in general practice.
Selma R. Schimmel:
What do we need to do, and if there is a young adult viewing this, newly diagnosed, what do we tell that young adult and how do we harness that person’s energy to become involved in a movement to really instill change that needs to be made clinically?
Brandon Hayes-Lattin:
The message is, they’re not alone. There are a great number of both professional, medical, and other supportive care societies focused on young adults. There are also a great number of advocacy groups and support groups, non-profits that are focused on young adults. And over the last five years we’ve seen a real coming together of all those groups, particularly through Livestrong and a program called the Young Adult Alliance where there’s now about a 150 organizations each of whom have a role to play to support young adults who’ve come together.
Selma R. Schimmel:
Is it an important question for a young adult to ask their medical oncologist how much experience he or she has had treating young adults?
Brandon Hayes-Lattin:
Yeah, it’s definitely true for any cancer patient that they need to feel comfortable with the team who’s taking care of them has the expertise and experience to do what’s right. And I think it’s absolutely fair game to ask questions about experience, taking care of young adults, or experiences with those particular cancers. Again, one of the things we highlighted earlier in our program was the concept of risk to fertility and fertility preservation. That’s an issue where it’s very timely. The best time for that discussion is before active therapy starts, and that really can require some self-advocacy on the part of the patient.
Selma R. Schimmel:
And I also am noticing that there are a growing number of cancer center programs developing throughout the United States that are focusing on young adult oncology.
Brandon Hayes-Lattin:
We are trying to put together the tools to help cancer centers and private practices better address the needs of young adults. And the partnership with ASCO to do that I think, has been really fruitful.
Selma R. Schimmel:
Are there any other points or thoughts or studies being presented here that you want to take a minute to highlight?
Brandon Hayes-Lattin:
What we see is, often some of the major lessons that we learn in all of oncology actually come from the study of either rare situations, rare tumors, rare patients, or in particular, young adults. So again, if you just look at the plenary session at this year’s ASCO, you see issues of melanoma, which is a common young adult cancer, and the need to actually drill down into the molecular biology to see what’s really distinctive about melanoma and how can we target those? Then again, you see this example of acute lymphoblastic lymphoma where we’re seeing incremental advances through the careful protocols of the children’s oncology group but those principles of pediatric therapy are now being applied to the older adolescents and young adults. So we think that taking that model and moving it not only focus on young adults but where the young adults are within diseases is really going to be a powerful way forward.
Selma R. Schimmel:
Thank you Dr. Brandon Hayes-Lattin, Associate Professor of Medicine, Medical Director of Adolescent and Young Adult Oncology Program at Oregon Health and Science University – Knight Cancer Institute, Portland, Oregon, a member of the Livestrong Young Adult Alliance, and really one of the pioneers and rising stars in the areas of young adult oncology.
Brandon Hayes-Lattin:
Thanks, Selma. I really appreciate all of your support to the Adolescent Young Adult Oncology Movement.
Selma R. Schimmel:
Thank you.
END OF VIDEO