Gloria Borges, colon cancer survivor, sits down with Selma Schimmel in The Group Room. They discuss the non-profit she founded, The WunderGlo Foundation and The Wunder Project.

This interview was filmed at the American Society of Clinical Oncology Annual Meeting in Chicago 2013.

Advocacy and educational support provided at ASCO 2013, in part, by:

The Group Room at the 2012 European Society for Medical Oncology (ESMO) Congress in Vienna was made possible, in part, by:

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel for The Group Room at the ESMO 2012 Congress happening now in Vienna.   And we’re joined now by Professor Hans-Joachim Schmoll, Head of the Department of Oncology/Hematology at the Martin Luther University, Halle-Wittenberg Institution in Germany.  Hello.

Prof. Hans-Joachim Schmoll, MD, PhD:  Head, Dept. of Hematology/Oncology, Martin Luther Univ. Halle-Wittenberg, Germany

 Hello, Selma.                                

Selma Schimmel, Founder & CEO, Vital Options International

Tell us if there are any compelling studies or data that you feel we should tell our views about.                   

Prof. Hans-Joachim Schmoll, MD, PhD:  Head, Dept. of Hematology/Oncology, Martin Luther Univ. Halle-Wittenberg, Germany

There is a constant improvement of treatments and new drugs, new combinations and options for colorectal cancer.  So what is new in comparison to the last 6 months, first of all the [INAUDIBLE], which is now registered in the United States and probably soon also in Europe which is regorafenib; it’s a kinase inhibitor, a tablet which has activity in the end-line, last-line treatment of advanced colorectal cancer which is a difficult situation to have an active one.  But this drug is active, it’s a little like the angiogenesis inhibitors, it has some other features.  It is well-tolerated and it will be given to more patients after they’ve been through the standard lines.  And research is ongoing how this can be incorporated in first-line, second-line, third-line.

The other new thing is many new targeted drugs which are in early stage development and intermediate stage of development.  One of them is a new class of immunotherapy or immunostimulator which is a synthetic DNA element triggering the T-cells which kill the tumors.  And we have done the first study in this.  It was maintenance, it means patients had stable response after the first-line chemotherapy and then they went on a placebo or this immunostimulator.  It is, again, well tolerated.  It has immune-stimulating functions and indeed the time to progression was significantly improved by this drug which is very early… 50-patient study, but this will be further evaluated now.  So it’s another piece under evaluation that a first time an immunotherapeutic approach seems to be a benefit in colorectal cancer.                                          

Selma Schimmel, Founder & CEO, Vital Options International

This is research that is also developing at your institution.

Prof. Hans-Joachim Schmoll, MD, PhD:  Head, Dept. of Hematology/Oncology, Martin Luther Univ. Halle-Wittenberg, Germany

Yes, the first authorized is my former fellow, Dr. [INAUDIBLE].  There is hope that we go the same pace of development of new drugs and targets in colon cancer.                                  

Selma Schimmel, Founder & CEO, Vital Options International

Thank you very much Professor Hans-Joachim Schmoll who is the Head of the Department of Oncology/Hematology at the Martin Luther University in Halle-Wittenberg, Germany.

Prof. Hans-Joachim Schmoll, MD, PhD:  Head, Dept. of Hematology/Oncology, Martin Luther Univ. Halle-Wittenberg, Germany

Thank you.                             

END OF VIDEO

Dr. Heinz-Josef Lenz discusses the colorectal cancer highlights at ASCO 2012.

This interview was filmed at the American Society of Clinical Oncology Annual Meeting in Chicago 2012.

Heinz-Josef Lenz, MD is Professor of Medicine and Preventive Medicine — Associate Director, Clinical Research — Chair, GI Oncology Program — Co-director, Colorectal Center  — Scientific director, Cancer Genetics Unit at the USC/Norris Comprehensive Cancer Center.

The Group Room at the American Society of Clinical Oncology (ASCO) Annual Meeting 2012 was made possible, in part, by:

VIDEO TRANSCRIPT:

Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel in Chicago at the annual ASCO meeting and we are now joined by, Dr. Heinz-Josef Lenz- Professor of Medicine and Associate Director, Clinical Research of the Kathryn Balakrishnan Chair for Cancer Research at USC, The University of Southern California, Norris Comprehensive Cancer Center.

Heinz-Josef Lenz, MD, Chair, GI Oncology Program, USC/Norris Comprehensive Cancer Center:

Good morning, Selma.

Selma Schimmel:

Good morning.

Heinz-Josef Lenz, MD:

I’m very excited to be here.

Selma Schimmel:

Are there any major treatment highlights that came out for colorectal cancer at this meeting?

Heinz-Josef Lenz, MD:

So, there are sessions where the most important new data are discussed and presented showed very interestingly that when we treat with Bevacizumab in first line…

Selma Schimmel:

… which is Avastin.

Heinz-Josef Lenz, MD:

… which is Avastin, we can maybe continue with either Avastin or other anti-angiogenic drugs.  So, we have drugs which target tumor blood vessels.  All 3 drugs at trials showed a positive impact on overall survival in second and third line.  So, one of the messages is that to really target tumor blood vessel information is important beyond the first line treatment.

The benefit we can discuss- is 1.4 month enough?  Should we be satisfied with 1.4 month?  And the answer is clearly, no.  So, how do we do that?  And I think the key, we know, some patients will benefit substantially and others will not.  The 1.4 is a median.  Who wants a median?  Everyone wants a treatment which works for them, not for a median population.  I think that has to be the challenge and our molecular understanding should be able to do smart clinical trials to figure out who should get continuous treatment with this therapy.

Selma Schimmel:

What is really different this year from last year?

Heinz-Josef Lenz, MD:

I think you can see a wave of molecular classification; this sort of discussion from Europe, like in breast cancer, if you have 5 subgroups never known before, should we treat them the same? Makes no sense, but what is the specific treatment for these 5 subgroups?  I’m sure we will see that in the next year or the after in the plenary session.  That is where the advances, where you get very excited.  It’s not there in the clinic, but it will come.  You can see the whole surge and move in this direction.

Selma Schimmel:

The other area of real profound interest is the role of the pathologist.

Heinz-Josef Lenz, MD:

Yes. So, I think with our more and more sophisticated technology, tissue handling is critical.  Sometimes we need fresh frozen, sometimes we need paraffin embedded.  But if a tissue sits for 3 hours on the bench in the O.R. your specificity and what you can do for the tissue is going out the window.  And I think pathologists need to be part of the development of this test that they know how critical this is.

Selma Schimmel:

The other thing that I really have learned at this meeting is that a patient may have an initial molecular analysis of their tumor, but along the way they may need to have a second look and maybe you can elaborate on that.

Heinz-Josef Lenz, MD:

That’s a very good point and I think that is what is missing and lacking in our understanding.  They usually take the primary tumor at the diagnosis.  Patients are treated for 1, 2, or 3 years and treatment may fail, and we use the molecular make up from the past.  The exposure to treatment, of course, will have an impact on the tumor.  Some cells will die because they are sensitive and others will not.  So the cells who survive will not be the same in the original diagnosis.  So I think in the research community the scientist and physicians recognize that we may need to do an additional biopsy to see what molecular changes happened.  Some will have gained some of the functions and some will have lost.  And I think that is the misunderstanding of our new drug development because we combine new drugs here based on a molecular diagnostic here; and then we think, why did it not work?  Well, what happened here may explain all the differences.

Selma Schimmel:

I think it’s one of probably the most important parts of our discussion here for patients to really hear that.

Heinz-Josef Lenz, MD:

Yes.  You know, I think it’s very funny, about a year ago or 2 years ago I tested Kvass and I resected a patient.  I sent it back to the same diagnostic lab and they said, ‘you don’t need to do it, you did it about 8 months ago.’  I said, ‘yes I do because I don’t know if it changed.’  So, we all are so convinced this is what we need and we don’t need to be re-challenged.

Selma Schimmel:

Dr. Heinz-Josef Lenz: Professor of Medicine and Associate Director of Clinical Research at the USC Norris Comprehensive Cancer Center, the Kathryn Balakrishnan Chair for Cancer Research.

Heinz-Josef Lenz, MD:

Thank you very much, Selma.

Selma Schimmel:

Thank you, Dr. Lenz.

END OF VIDEO

Dr. Heinz-Josef Lenz discusses the importance of diet in colon cancer, specifically related to red meat consumption.

This interview was filmed at the American Society of Clinical Oncology Annual Meeting in Chicago 2012.

Heinz-Josef Lenz, MD is Professor of Medicine and Preventive Medicine — Associate Director, Clinical Research — Chair, GI Oncology Program — Co-director, Colorectal Center  — Scientific director, Cancer Genetics Unit at the USC/Norris Comprehensive Cancer Center.

The Group Room at the American Society of Clinical Oncology (ASCO) Annual Meeting 2012 was made possible, in part, by:

VIDEO TRANSCRIPT:

Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel in Chicago at the annual ASCO meeting and we are now joined by, Dr. Heinz-Josef Lenz- Professor of Medicine and Associate Director, Clinical Research of the Kathryn Balakrishnan Chair for Cancer Research at USC, The University of Southern California, Norris Comprehensive Cancer Center.

Heinz-Josef Lenz, MD, Chair, GI Oncology Program, USC/Norris Comprehensive Cancer Center:

Good morning, Selma.

Selma Schimmel:

Good morning.

I must give you the opportunity to give your plug about issues with meat.

Heinz-Josef Lenz, MD:

Yes.  So I think – I’m not a vegan, okay, I’m not even vegetarian – but I think we have significant data that we clearly understand that red meat is not good for GI cancers.  So I put all my patients on a no red meat diet.  Now there are issues about, health issues about other meats; I’m not 100% sure and I don’t force them to be vegan or vegetarian but I think it’s an active movement because they may have different impacts and outcomes for other diseases- heart, lung and so on.  So, I think that this is what the patient can do, the issue about diet and supplements are very important because it’s in the control of the patient and the healthy lifestyle.  Mediterranean food and exercise, we know impact/outcome for patients with metastatic disease; impact/outcome for patient after resection.  No doubt about it.  So they have responsibility to do all what they can do on their lifestyle and eating patterns.

Selma Schimmel:

And does the same thing apply to the leaner meats, let’s say lamb?

Heinz-Josef Lenz, MD:

Yes, so we do not fully understand the molecular mechanism, we think it’s a protein in the red meat, not the fat; in the beginning we thought it was fat.  So there is still a lot of ongoing research but that has been certainly the one which seems to be highly linked.

Selma Schimmel:

And chicken?

Heinz-Josef Lenz, MD:

Chicken is fine.  I think, so far I don’t think there is any data… Now, when you look in the movie Forks Over Knives, I’m not sure, you may lose all your appetite for meat.  But I think chicken, there is no data… I think it is important that these are not hormonally treated… you know organic, I think that is very important.  Because this whole hormonal and antibiotic treatments, I think may impact, we don’t know but I think we should avoid that.

Selma Schimmel:

And obviously, fish is a good thing?

Heinz-Josef Lenz, MD:

Ya, but you know there was a recent health, in the LA Times, I don’t know if you saw it, about health impact and the fish was not as good as chicken. So I don’t know, but I think fish usually has a very good impact because of the omega-3 and so on.

Selma Schimmel:

Well they talk about say the salmons and the fatty fish and we obviously have issues with the mercury from a fish like tuna.

Heinz-Josef Lenz, MD:

Exactly, so I think it’s like that it comes also back on the source where the fish and the white meat comes from.

Selma Schimmel:

Alright, well thank you for… you are one of the few doctors that will actually get into the dietary area.

Heinz-Josef Lenz, MD:

Now one of my patients, Gloria Borges, 30 years old, metastatic colon cancer, an incredibly active person, created a blog site called wunderglo.com, incredible website for information.  She changed our diet in our hospital.  We have now vegan and vegetarian as our top choices, not as you know, hidden, you can order it but go through a bit of trouble.  But she also puts in her blogs all her experiences and treatment options.  So we are forcing from different sides information.  And I think this video access to patients is a wonderful platform in order to spread the word and give more access to better information.

Selma Schimmel:

Dr. Heinz-Josef Lenz: Professor of Medicine and Associate Director of Clinical Research at the USC Norris Comprehensive Cancer Center, the Kathryn Balakrishnan Chair for Cancer Research.

Heinz-Josef Lenz, MD:

Thank you very much, Selma.

Selma Schimmel:

Thank you, Dr. Lenz.

END OF VIDEO

Dr. Adeyinka Laiyemo discusses the increased incidence of colorectal cancer among African-Americans and his desire to close that gap at the American Association for Cancer Research (AACR) Annual 2012 meeting in Chicago.

Adeyinka O. Laiyemo, MD, MPH, Division of Gastroenterology, Department of Medicine, Howard University College of Medicine, Howard University Cancer Center.

The Group Room at the American Association for Cancer Research (AACR) Annual Meeting 2012 was made possible, in part, by:

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International

This is Selma Schimmel in Chicago at the AACR annual meeting. AACR is the American Association for Cancer Research, it’s their annual meeting, and we’re now being joined by Doctor Adeyinka Laiyemo, who is Assistant Professor of Medicine at Division of Gastroenterology in the Department of Medicine at Howard University, College of Medicine. Hello.

Adeyinka O. Laiyemo, MD, MPH, Division of Gastroenterology, Howard University Cancer Center:

Thank you very much for having me.

Selma Schimmel:

Thank you for coming to talk to us because we really need to some education and outreach to a particular patient population and in this case, we’re going to talk about the increase in colorectal cancer burden amongst African-Americans and we’re going to touch on access, utilization of services and medical care and the biology; we find that the biology of cancer can differ amongst patient populations.

Adeyinka O. Laiyemo, MD, MPH:

Dealing with gastroenterology I focus more in colorectal cancer. Now one of the things we notice is that you have the African-American community have the highest incidence and highest (inaudible) deaths from colorectal cancer. But what is really troubling is the fact that colorectal cancer is actually one of those cancers that we know that you can prevent to a good extent, that there are many things you could do to reduce your risk. But unfortunately there’s been suggestion that the rate of cancer deaths and incidence is going down, we continue that is lacking behind in the African-American community. So my research has been focusing on understanding why this disease and what we can do.

Selma Schimmel:

Do you think that the likelihood is that it is under-utilization of screening or actually a different biological characteristic of colorectal cancer in this community?

Adeyinka O. Laiyemo, MD, MPH:

That’s a great question; actually don’t know the answer. Because the problem is multi-factor, there are multiple things moving at the same time. First we know that African Americans are less likely to be screened. A majority of the patients, a lot of people don’t have insurance and colorectal cancer screening is an elective procedure meaning it is not an emergency. So if you don’t have a doctor or if you don’t have insurance the likelihood is that you won’t get screened. So that’s one angle to treat.

But also some studies have shown that African-Americans tend to get colon cancer at younger ages, that they are also more likely to die from colon cancer, which also, and they are more likely to have right sided tumors; all these things point also that there may be some differences in the biology. But understanding the differential contributions that which one is contributing more can be challenging because many of the studies don’t cut across all these parameters to actually look.

Selma Schimmel:

The average recommended age for screening in the US is 50. For a patient population that might be at higher risk would you like to see screening, maybe at 45?

Adeyinka O. Laiyemo, MD, MPH:

Actually, the American College of Gastroenterology and the ESG – American Site of Gastro-endoscopy both came up with the recommendation that African-Americans should begin screening at age 45 because of the increased prevalence of colon cancer and deaths from colon cancer in this population.

Selma Schimmel:

And every five years? What is your guideline for higher-risk patients?

Adeyinka O. Laiyemo, MD, MPH:

For the average risk age patient, which is where most people will belong, if you get a colon cancer screening it depends on modality, so I focus on if it colonoscopy, which is the more common these days,  if it is negative, that is no polyps removed you come back in ten years.

Now for those who have family history of colon cancer then especially in the first degree relative – that is your dad, your mom, your brother or your sister, then those people you have them come back in five years. For other people it’s a function of what type of polyps removed. If it was a small polyp that doesn’t show those advanced changes, as we like to call them, then the person can come back within five to ten years. If you have one that has one or two removed, if you have three or it’s a big polyps we say you should come back in three years. So but screening modality because using stool tests is also acceptable but that one is to be done every year so if you are getting stool tests, which is non-evasive then you’re supposed to be screened every year.

Selma Schimmel:

Doctor Laiyemo, now that we’ve discovered that there is a type of genetic mutation, that BRCA mutation derivative in African-Americans and we know that it can also lead in addition to breast and ovarian, prostate and colorectal cancer is there any connection in your mind that there are perhaps other mutations like BRCA that could increase one’s risk in this patient population for colorectal cancer?

Adeyinka O. Laiyemo, MD, MPH:

It’s a great question. The thing is that has not been clearly defined. There has been some studies comparing African-Americans to the white population, and comparing things like looking at things microsatelite instability, looking for (inaudible) mutation, all those things; they suggest that there may be differences but if we drill it down in terms of what will benefit people at this point in time the most I think we have to take care of them to getting access to even get screening in the first place. And ensuring that those who have health insurance and actually use them. Because it doesn’t do anybody any good if we are worrying about when you get cancer how do we treat them. When we can intervene early on to ensure that it doesn’t get to the point of cancer. So yes, there are lots of studies on-going to try and see if genetic markers are (inaudible) biology differences kind of explain some of this.

Selma Schimmel:

How much of an issue do you think trust is? We’ve talked about this a lot with the African-American community and the perception of health care and that trust is such a huge issue that keeps people away from utilization.

Adeyinka O. Laiyemo, MD, MPH:

It may play a role but by getting the education to the people – education, education, education – and making sure that we facilitate them coming to the hospital can really make a big difference, and of course if we’re able to reach one person – whether it’s the wife, the husband or the children – and they are advocates in the family because it’s a whole lot easier than when somebody from outside is talking to them.Everybody that can say a word should talk about colon cancer screening because I totally understand that anybody that can speak to anybody about it should do so. And in my talk this morning, I actually said that at the Thanksgiving dinner you should bring it up because you have all the family members there. I think the issue is the more we talk about it the more people will understand the need for it.

Selma Schimmel:

So, for our viewers who are listening saying ‘oh, I don’t know if I’m going to do that’, give us your closing thought.

Adeyinka O. Laiyemo, MD, MPH:

What I will say is this: yes, it can be one of those things that we don’t want to think about but this is one of those few things in medicine that we realize from good studies that this thing can save lives. Yes, maybe one day you won’t eat solid food because the doctor will ask you to be on liquid diet before your colonoscopy, and they make you drink this gallon of good stuff that may not taste the best of what you’ve tasted in your life, but we are getting better at that as well.

But the issue is this: if you get the colonoscopy you can be comforted that you’ve done your part, and that’s the key thing.

Selma Schimmel:

And after your colonoscopy you actually feel so….

Adeyinka O. Laiyemo, MD, MPH:

Lighter?

Selma Schimmel:

…oh yes, no doubt. Great way to start a diet.

I’ve enjoyed talking to you, Doctor Adeyinka Laiyemo.

Adeyinka O. Laiyemo, MD, MPH:

Nice talking to you too.

Selma Schimmel:

Pleasure.

END OF VIDEO

Prof. Hans-Joachim Schmoll, MD, PhD discusses the highlights in colorectal cancer research and treatments at the 2011 European Multidisciplinary Cancer Conference in Stockholm.

The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:

VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. Professor Doctor Hans-Joachim Schmoll, thank you for taking time to join us during this multidisciplinary meeting here in Stockholm. And you are certainly one of Europe’s leading physicians in the area of GI Oncology, and I’m hoping you can talk to us a little bit about what we’re learning at this meeting in regards to the GI cancers, and in particular about colorectal cancers.

Prof. Hans-Joachim Schmoll, MD, PhD, Head Dept. Oncology/Hematology, Martin Luther Univ. Halle-Wittenberg, Germany:

Thank you, it’s my pleasure to being here. This is a meeting which is not showing in GI cancer, brand new results of very big trails but a lot of consolidation in between results and some new results from trials which have been recently finished, as well as a lot of pre-clinical data mix and biology. But the most interesting probably new data from the colon cancer area, colorectal cancer, and advanced stages today was in a nice report from the Spanish trail on advanced colorectal cancer where maintenance treatment after induction chemotherapy was investigated was the antigenic agent, bevacizumab would be sufficient instead of continuing chemotherapy. And the look on the camera’s expression and the potential differences and they found out that indeed KRAS mutated tumors of patients with KRAS mutations in the tumor had a worse outcome under this chemotherapy. It was Celox plus bevacizumab than those with zalutumumab. There have been some ripouts before, contradictory results and this was now a very nice study with many patients favoring the prognostic value of KRAS erlotinib for the mutant. So this is a piece of information which is more relevant for the future, in particular the investigated also silk-letting tumor cells which is another biological parameter for prognosis and the treatment of advanced colorectal cancer.

Selma Schimmel:

Let me ask you a question because there has definitely been a shift in the way we’re treating this cancer from the days where we were very limited to purely chemotherapy. Could you maybe take us through a little bit of the evolution from where we were to where we are, and what is the state of genomics, and the biology and the molecular characteristics that we understand now about colon cancer?

Prof. Hans-Joachim Schmoll:

Years ago, many years ago, there was only one drug available which was given all patients, independent of biological or molecular subtype that was not known. And even with addition of different chemotherapeutic agents all patients have got the same. So now we know that at least one parameter, which is the KRAS expression of viable mutation in the tumor makes a difference for those patients who are going to get the EGF receptor antibodies it took some time to get the tumor.

In addition to this molecular marker there are many other molecular markers which can be identified, which is separating different biology of the tumors. But still we do not really know how to use them. Some of them are contradictory as us but in the next two, three, four, five years we will have many more subgroups in colorectal cancer, which is a b-rough mutations subgroup and so on and so on. Currently, and shown today again it was clearly shown from the Spanish group that silk-letting tumor cells together with the mutation of this gene RAS is an excellent indicator to put patients into different prognostic categories. It means based on the clinic but based on the RAS mutation and the circulating tumor cells in the blood before beginning the treatment, can identify the patient very, very precisely and the group has a much better outcome or less outcome or intermediate outcome. So this is the first time we have a biological score to guide to treatment decision. It is still too early to make this routine but it’s now showing that we are on the trek using these biological and molecular options to make patient definition to make better and more precisely and adequate treatment.

Selma Schimmel:

Personalized medicine.

Prof. Hans-Joachim Schmoll:

Yes.

Selma Schimmel:

Does that mean you are now combining the classic chemotherapy with these new biologic agents?

Prof. Hans-Joachim Schmoll:

That we have done before as well but we have to treat most patients without selecting them. Now we could probably better define which patient has more and who has less benefit than just only toxicity of this combination.

Selma Schimmel:

How do you test – let’s say for one of these mutations, like the KRAS?

Prof. Hans-Joachim Schmoll:

This is done by pathology in the tumor tissue which has been taken out during the biopsy. This is a standardized method which most experienced pathologists in the world now can do reliably. Circulating tumor cells for example can be done also by a commercial available test which is doing well and reliable. So more and more of these genetic analyzes and biological additional tools can be done in the clinical team. However they are more expensive they are not effectively validated, so it takes time to put that in a clinical reality.

Selma Schimmel:

How many mutations have been identified to date for colorectal cancers?

Prof. Hans-Joachim Schmoll:

Those of clinical relevance we suspect a prognosis of potentially to select treatment is about five today. But we know there are many, many more, and probably many more highly relevant and in addition we look – we means all the clinical researchers, and pre-clinical laboratories and companies look – on geno-range window which probably more precisely and easily can combine all this factors in a single geno range and tell you are a very high risk you should deserve that treatment. So colon cancer is under way but it takes probably five, eight years to have arrived, which is on the stage which is for the patient beneficially.

Selma Schimmel:

So what is the gold standard today if the patient is…every patient in Europe now being tested for some kind of mutation before treatment is initiated?

Prof. Hans-Joachim Schmoll:

Oh, yes because the administration label for the EGFR inhibitors like cetuximab requires this testing before. But they’re only for KRAS. For the other mutations it’s still experimental or done in a clinical research setting, and not in our team.

Selma Schimmel:

And if I recall last time we talked it was like Foley Fox or…was that not the standard of care?

Prof. Hans-Joachim Schmoll:

Now it’s much more differentiated what is best first line treatment for a patient, and there was a European consensus which we have just finalized the first consensus describing what is the best treatment for a given patient in a given situation. And there all the options listed, and also recommendations are given what is better for that situation and worse. So the first time you have a uniform definition what should be or could be the best for a patient in this personal clinical situation.

Selma Schimmel:

May I ask you what you’re doing in your lab? What’re you doing research wise?

Prof. Hans-Joachim Schmoll:

We look on the combination of new drugs and look what is the best working in the different tumor types but with different gland, different biology of colorectal cancer cell lines to go then for the clinic, which is combinations. At moment but we also look on other biological regulators of the disease.

Selma Schimmel:

And I also imagine that the clinical trials arena is really global in this area, in the United States and Europe that these… and Asia, these are global clinical trials.

Prof. Hans-Joachim Schmoll:

Most of this trials very global. For example I just finished as chairman of the trial the international rectal cancer trial, looking for the better treatment, more cure. This is a thousand one hundred patients in several parts of the world from Australia to many parts of Europe and all of these trials are now very international and another time I have finished together with a company was going from Vietnam to Canada. So all of these trials need international cooperation to collect the patients in a short time because so many drugs, so many new options are there, and the need to be evaluated and we need all patients to do this. And the patients mostly have benefit because they are part of a new treatment option which could help them.

Selma Schimmel:

Thank you Professor Hans-Joachim Schmoll, who comes to us from Germany.

Prof. Hans-Joachim Schmoll:

Thank you.

END OF VIDEO

Prof. Hans-Joachim Schmoll, MD, PhD discusses things a patient needs to know when diagnosed with colorectal cancer, specifically in Europe. Questions for your doctor, age, risk factors, family history, diet and when to start screening are all covered.

The Group Room at the 2011 European Multidisciplinary Cancer Conference was made possible, in part, by:

VIDEO TRANSCRIPT
Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel at the Multidisciplinary Cancer Congress 2011 in Stockholm. Professor Doctor Hans-Joachim Schmoll, thank you for taking time to join us during this multidisciplinary meeting here in Stockholm. And you are certainly one of Europe’s leading physicians in the area of GI oncology. So do me a favor and talk to the patient that’s listening, who’s just been diagnosed. Doesn’t know anything yet of his or her biologic characteristics of the tumor. Talk us through what that patient needs to know and the discussion they can expect to have with their doctor.

Prof. Hans-Joachim Schmoll, MD, PhD, Head Dept. Oncology/Hematology, Martin Luther Univ. Halle-Witttenberg, Germany:

First of all I would recommend that all the patients look at this publication because even they can understand if they are affiliated with the disease and they should go with this to the doctor and show this, explain to me what is the best for me based on this. And you should ask the doctor what is this disease, what is the biology and so on. But then they should go to an expert, and not all doctors are experts in this depending where a patient is and which doctor is there treating him. But in research and treatment centers for cancers or more experienced clinics they will be informed about what is the best selection of treatment for the patient.

Selma Schimmel:

And what about age? More and more… I seem to be meeting younger people being diagnosed with colon cancer – younger meaning under 40.

Prof. Hans-Joachim Schmoll:

That’s true. We have two problems in our discussion of meta oncology, and in particular colon cancer – what to do in elderly patients, which is 70 and older. However with the metastatic disease there are no difference, in Atchuman disease early stage tumors we have to consider carefully what is good for a patient over 70, and should they get the full treatment or less treatment. But on the other side you are completely right. The young people… young patients emerge and we still do not know whether the biology of this disease in young patients is different – it’s probably worse because we see many patients with this disease. Still we have no different treatment for those patients.

Selma Schimmel:

Do we understand yet if there is a family relation? In other words, hereditary predisposition, if one’s parent has had colon cancer, does that raise the risk for the kids?

Prof. Hans-Joachim Schmoll:

Oh yes, there’s a minority fraction which have clearly inherited disease but there is a relatively large fraction of patients with familial risk is higher because of relatives having colon cancer without having genetic predisposition. And this is a very important since screening is done based on this. For example in United States and in Germany, these are the first countries where endoscopy of the colon rectum is free every ten years once age of 50. However if the patient had… if a person has in his family history colon cancer, colon cancer in one or two or three of his relatives then he’s at higher risk and he can start screening earlier.

Selma Schimmel:

And what about more frequently? Ten years seems like a very long span.

Prof. Hans-Joachim Schmoll:

And a little bit more frequently, depending on the findings. But in general it’s extremely important to find early the tumor or at least the precursor – the benign precursors – of the tumor and eliminate these precursors or treat these tumors early to give it a high chance of cure.

Selma Schimmel:

And if a patient presents with polyps they will…?

Prof. Hans-Joachim Schmoll:

Precursor legion, which will be pulled out or cut out, and then the patient has no risk anymore as long as he does not have other polyps.

Selma Schimmel:

But that patient needs to screen more frequently.

Prof. Hans-Joachim Schmoll:

Right. So it is a positive family history should have high risk and should have more screenings but in general all persons in United States and in Germany above the age of 50 allowed to make a screening by endoscopy free of charge, which is a major step for it. And this will use the mobility and mortality automatically in the future.

Selma Schimmel:

Risk factors. Aside from the genetic predisposition or familial related cancers, what about diet? We hear in the United States that one of the culprits is heavy red meat consumption, and that’s being more and more discouraged. What’s the philosophy in Europe about diet and prevention?

Prof. Hans-Joachim Schmoll:

It’s the same. It’s fat and red meat, which is a problem… increases the risk, and lot of smoked food, which is typical for example in Germany and some parts of Germany – less typical here in the north of Europe, and is much less typical in Italy and Mediterranean countries. So the risk is higher in those countries where this type of food is taken very much. But the education on food, eating behavior is trying to change this.

Selma Schimmel:

And what about gender? Do we understand anything more about these GI cancers in women versus men?

Prof. Hans-Joachim Schmoll:

There’s now major difference in colorectal cancer and gastric cancer for the gender however there might be differences in response to chemotherapy. So this indicates there are some minor – or probably major – biological differences in the disease in the different genders, which we do not understand in the moment. For example it’s now clear for gastric cancer that Asian patients with gastric cancer have a different benefit from let’s say Bevacizumab in addition to chemotherapy than American or European patients. It’s a clear difference with no affect with this drug in Asian patients including China and Japan and Korea but has clear affect which is significant in western population. So we don’t know why it is. We just know that this is the case. So many things has been important to be investigated which I suspect to regional and genetical background differences.

Selma Schimmel, Founder & EO, Vital Options International

Professor Schmoll, what about the economics? The impact of economics on the treatments and the diagnosis of colorectal cancer?

Prof. Hans-Joachim Schmoll:

It is very good under economic reasons to make screening and identify those people on risk or patients very early because it is cheaper than treat patients, and probably without cure. And the patients live longer and longer because of the good treatments but they need more and more treatments which increases the cost for treatment. And then the new drugs in particular, more and more letting the exploding the economic part of the treatment. And this is a major concern in all the European countries – how we can pay the future of these drugs. And even now it’s a problem, and in particular Germany or UK are cutting down, and trying to select the patients who should get the drug, who deserves the drug really or do not? So the answer to this is biology – look on biological markers, molecular markers to identify these patients clearly.

Selma Schimmel:

And you probably have one other important obstacle to overcome, and that is getting people to go in and do their screening, and to go in and do their… in the US it would be a colonoscopy; you mentioned endoscopy here. But whatever modality you’re using how do you get people to overcome – especially men – who do not like it all going to the doctor?

Prof. Hans-Joachim Schmoll:

That is a very good question. The endosopy, colonoscopy is same, means the same. Germany, there’s a foundation which is done by a major media family based on a son of them who died early, it was 30 years from colon cancer. And they can involve all the stars and film and TV and trying to motivate people. So that’s very important part in this… everybody knows in this country about the possibility but again, the participation of this program is far too low, and should be increased. So it’s like United States and it needs a lot of education and continuous efforts to do this.

Selma Schimmel:

So I gather that there is truly a paradigm shift in the way we understand colon cancer, and the way colon cancer is being treated?

Prof. Hans-Joachim Schmoll:

And prevented by multiple screening of risk patients with people.

Selma Schimmel:

Thank you Professor Hans-Joachim Schmoll, who comes to us from Germany.

Prof. Hans-Joachim Schmoll:

Thank you.

END OF VIDEO

Heinz-Josef Lenz, M.D., FACP, is the Associate Director for Clinical Research and Co-Leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center. He sat with The Group Room at ASCO 2011 to discuss how to navigate your colon cancer diagnosis in the ever-changing clinical landscape.

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, where our discussion continues with some of the most noted oncologists and key opinion leaders reporting on different areas of cancer, all cancer types here at the ASCO meeting.  And now we’re with one of our Group Room regulars and favorites.  In fact, he is our GI Cancer key opinion leader, Dr. Professor Heinz-Josef Lenz; Associate Director for Clinical Research and Co-leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center, Professor of Medicine and Preventive Medicine at the Keck School of Medicine at the University of Southern California in Los Angeles.  Let’s start with an update about advances, since we last spoke, in the area of colorectal cancer.

Heinz-Josef Lenz, MD, Scientific Director, USC/Norris Cancer Genetics Unit:

So, for colon cancer, this year is a little bit disappointing because we have no new drugs but what we are seeing is that we understand more and more genetic alterations which play a role.  I think one of the interesting presentations so far is that when you know and test for this genetic alteration and you match new drugs to this genetic, the success of these drugs are much, much better.  We now know that certain mutations benefit from different dosing and different drug combinations. Then you have 2 genetic alterations that do better with 2 inhibitors which are connected to this, not just 1.  So it sounds very simple but it’s very important steps to come to understand the complexity of the interaction of the mutations we know are present in colon cancer, but to come up with the right treatment combinations for them.

Selma R. Schimmel:

That said then, Dr. Lenz, with the majority of patients being treated in the community, what is colon cancer diagnosis 101?  Because patients, and especially if they have a more advanced colon cancer, need to be able to access some of these new technologies, diagnostic tests, clinical trials…

Heinz-Josef Lenz:

Yea, so I think it’s a very complex area because I think we need to distinguish between validated tests, which should be done, and the tests which are coming in the future; because ASCO is where the future may be in a couple of years.  But I think it is very clear, and the guidelines from the NCCN, which is very important, to make sure the quality of care is appropriate.  And all the communities recommends already that every patient diagnosed with metastatic colon cancer is tested for 2 genetic alterations; KRAS and BRAF, they have predictive and prognostic implications.  That is already in the guidelines and it’s actually very surprising that only about 30% of the patients in this country are tested for these.  So here is a significant need for education for patients and physicians to keep up with these dramatic fast changes in understanding of the molecular diagnostic.  This is not to blame the oncologist, it’s incredibly overwhelming and we need to develop better education parameters so that they understand what is going on to make the transit much faster.

Selma R. Schimmel:

There’s a real paradigm shift in medical oncology and so I would imagine that a medical oncologist who is a bit older, who’s been practicing for a very long time, this is not something they learned in medical school.  So I don’t understand exactly how overwhelming it has to be to try to get physicians that have never had to learn this to suddenly get up to speed.  How do you do that?

Heinz-Josef Lenz:

I think that’s a big challenge and I think we need, really, a lot of help from everyone from different educational environments, patient advocacy, to really voice this concern because the oncologists in the practice who see colon cancer, breast cancer, lung cancer, leukemias, lymphomas, how to keep up in all this sub-specialties when it’s difficult for me to keep up in colon cancer.  So I feel very committed that if they are to develop new frames in order to do webcasting or web pages for physicians and patients to be better informed, that they have something in their hand to act on it.

Selma R. Schimmel:

I don’t think there’s ever been a time before that the role of the patient… because, when you’re diagnosed with any kind of cancer you almost become childlike; you become frightened, you’re overwhelmed and you look to the physician to take care of you much like you would look at a parent when you’re a kid.  Unfortunately, the patient now has to move out of the emotional zone, into the intellectual brainy zone, and sometimes take real control and almost swap these physicians and become the navigator and the leader of their own care.

Heinz-Josef Lenz:

Yea, I couldn’t agree more.  So I think many of the advances at the moment come from the patients.  The problem and the challenges for a patient, in the type in colon cancer, it’s confusing, there are so much information.  So, what is real, what is not, what should I do, what I should not do?  Because the options and the promises and the genes and the tests being discussed are hugely overwhelming and it’s not easy to navigate through what is important, what are the prioritization, what should I do?  And we’ve had this discussion many, many times- I think that patients who live in major metropolitan areas should consult with a colon cancer specialist, should go to a cancer center, not because we think the quality of care in the oncology offices is bad, but just to be in touch with the new changes and uses that actually help also the community oncologists, which we all do.  We try to make sure that this information travels as fast as possible to the offices.

Selma R. Schimmel:

And in many circumstances, patients can have a consultant at an academic center and still be seen by their private medical oncologist.  And the private medical oncologist then learns from the patient by virtue of the relationship with academic guy.

Heinz-Josef Lenz:

And you know, if you have very good relationship in Los Angeles, or a lot of oncologists call, ‘is there something new, do you have a trial, should you do this, what do I do now?’  So, I think it’s starting and I think there is really a need to support our community oncologists because what they have to deal with on a daily practices with all the changes is really a huge amount of work and I don’t admire… I admire them that they have to deal with that.  I have deep respect for what they have as every day challenges.  I probably would not be able to do an oncology practice in the community anymore.

Selma R. Schimmel:

Take advantage of your academic center and try to find the balance between the convenience of being treated close to home and the advances that you can only find in a setting that has laboratories and active research.

Heinz-Josef Lenz:

So, I think there is actually one website which probably will become very important for these molecular changes, it’s called cancercommons.com.  It’s basically focused on the understanding what genetic testing of tumors mean and how that will translate into treatment opportunities.  It’s created by Marty Tenenbaum, an inventor from Silicon Valley.  His wife had melanoma and he actually encountered exactly what you are telling with, how do you do it, how can patients get information.  He saw there is a need and he developed this website and the first disease, obviously, is melanoma, online with flow diagrams for this disease, and if all other treatments are done, what genetic alterations will trigger early clinical trials?   And I will do that for colon cancer on that website.

Selma R. Schimmel:

Thank you Dr. Lenz, really, for being a forerunner in this area of research and for sharing your time with us.  Associate Director for Clinical Research, Co-leader of the Gastrointestinal Cancers Program, USC Norris Comprehensive Cancer Center, and Professor of Medicine and Preventive Medicine at the Keck School of Medicine at the University of Southern California.

Heinz-Josef Lenz:

And Selma, I couldn’t thank you more because I think this is so critical for your viewers to see what is going on and maybe feel a little bit of the excitement that there is so much to come, which all changes the lives of our patients.

Selma R. Schimmel:

Thank you.

Heinz-Josef Lenz:

Thank you.

END OF VIDEO

Heinz-Josef Lenz, M.D., FACP, is the Associate Director for Clinical Research and Co-Leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Cancer Center. He sat with The Group Room at ASCO 2011 to discuss new treatment options in colon 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 where our discussion continues with some of the most noted oncologists and key opinion leaders reporting on different areas of cancer – all cancer types here at the ASCO meeting. And now we’re with one of our Group Room regulars and favorites, in fact he is our GI cancer key opinion leader, Doctor-Professor Heinz-Josef Lenz, Associate Director for Clinical Research and co-leader of the Gastrointestinal Cancers Program at the USC Norris Comprehensive Care Center, Professor of Medicine and Preventive Medicine at the Keck School of Medicine at the University of Southern California in Los Angeles. Hello Heinz-Josef Lenz.

Heinz-Josef Lenz, MD, Scientific Director, USC/Norris Cancer Genetics Unit:

Hello. I’m always happy to see you, and this is a very exciting time for development of new drugs and the theme of ASCO this year is personalized medicine, and we have a lot of reasons to believe that it will become reality in the not-so-far future.

Selma R. Schimmel:

One of the reasons I love talking with you and being able to bring you directly to our viewing audience is that not only are you a medical oncologist, but you have your own lab, and now must be the most exciting time to have your own laboratory.

Heinz-Josef Lenz:

Yes, I think it’s an incredible time to be a witness the changes – what’s going on with the opportunities of treatment options for our patients. From five, six years ago with one or two drugs, we have five drugs and we are on the verge to really crack down the code of different cancers, how we can attack. And we see again at this meeting, we are getting closer and closer. There may not be one miracle drug, changing everything and curing colon cancer or lung cancer, and breast cancer with same treatment. But we understand more and more the key players in these cancers and have developed now drugs to interfere with these players and see dramatic, clinical changes.

Selma R. Schimmel:

Dr. Lenz, one of the things we keep hearing about are the identification of these new pathways. With all kinds of acronyms and letters that identify these pathways, the problem is it’s very complex for the general consumer and patient to understand. What I would love to have you do is try to in simple English, explain this mechanism and how these pathways actually lead to the development of targeted therapies that attack these different pathways and proteins and enzymes and things like that.

Heinz-Josef Lenz:

You know, it’s not complicated only for patients. It’s the same complexity for the practicing oncologist at community. The news are travelling so fast, it’s not easy to really understand all the interactions of the genetic changes. But in order to simplify it it’s very easy, actually. You visualize a highway-free map of Los Angeles, or New York, or Chicago. You have a map, all these freeways are connected. We all know, living in Los Angeles, where the key intersections are in the city, where there is always a traffic jam. We know that other freeways are less frequently used and you have less intersection problems. But this connection of different freeways is the network information of a cancer cell. And you know if you develop one drug which may be interferes with one intersection, or one major exit. We know how to detour it. We know if we get off Ave 53 and go on at Ave 72, and the cancer cell can do that too. So it is very important not to know only what the most important intersection is, we need to know all the intersections – how they communicate with each other, and the level of traffic. If there is no traffic on this freeway inhibiting this freeway, it doesn’t make any sense. In order to be successful, when you live in LA, you have to shut down the 10 freeway, or the 490 in Chicago. And if you’re able to do that, then you see the progress and the success in the tumor.

Selma R. Schimmel:

My cancer manifests differently, even though it may be the same diagnosis in the general sense as the person next to me, but our pathways, we may have the same pathways but they manifest differently? Or they jam up differently like one’s on the 405 and one’s on the 134?

Heinz-Josef Lenz:

Yes, so I think you’re hitting a very important point. To identify one of this genetic alterations is not giving us the answers. They may meet differently in breast cancers versus colon cancer, and why would that be? Because the interaction of this molecular change, or this intersection of freeway, means completely something different when you change the environment. Now we have learned over years that every tumor has about six to eight major intersections, not more. But this intersections are not the same from one colon cancer to the other. Here is the challenge in the future of drug development. We need to identify these, what we call ‘driving mutations’. The ones who make the tumor grow and metastasize, and we are getting close to do that. If we know the variations of these six to eight driving mutations we will be able to really personalize treatment. So what does it take? It takes the drug developed and it takes the selection of the patients. A target drug without selection of the patient will not work. We need to understand the molecular make-up, we need to know what major intersections drive the tumor, we test for this, we need to know where the traffic and intersections are. And then pick the medications which interfere with this special network of mutations.

Selma R. Schimmel:

So while we understand this network, or this highway, different pathways equivalent to the highways, one’s personal genomic profiling will then influence the direction that they need to take to get home.

Heinz-Josef Lenz:

Yes, you know I think there is a lot of progress because we were so optimistic with the targeted drug with one specific target, or two, each have receptors. But these are one major exit. To be successful you have to shut down the freeway, and not one exit alone.  And we have learned to see that how to do that because all these freeways communicate. But the variations from one cancer to this other cancer in another patient, even if it’s still colon cancer, can be traumatic. So we need to know what drives an individual tumor to do the individual treatment. We are getting closer and closer. We can now do under $1000, whole genome sequencing. The challenges are not that we cannot find it. We still don’t know all the individual traffics and how they are connected and what that means to specific treatments. But we are getting close so fast that the data we are generating is almost too much to consume and understand in the same time frame.

Selma R. Schimmel:

Are you still doing your blog?

Heinz-Josef Lenz:

I’m still on C3 Coalition.  I’m trying to update that when there’s a new gene, a new treatment, new concepts in order to really communicate that with patients because I think going on websites is very confusing. And I think to give some guidance is very, very critical.

Selma R. Schimmel:

Thank you Dr. Lenz, really for being a forerunner in this area of research and for sharing your time with us. Associate Director for Clinical Research, Co-leader of the Gastrointestinal Cancer’s Program, USC’s Norris Comprehensive Cancer Center, and Professor of Medicine and Preventive Medicine at the Keck School of Medicine at the University of Southern California.

Heinz-Josef Lenz:

And Selma I couldn’t thank you much because I think it’s so critical for your viewers to see what’s going on and maybe feel a little bit of the excitement that there is so much to come which all changes the lives of our patients.

Selma R. Schimmel:

Thank you.

END OF VIDEO