Heinz-Josef Lenz, MD: Navigating Your Colon Cancer Diagnosis
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