Jonathan Goldman, MD: Advanced Lung Cancer Update — ASCO 2013

Dr. Goldman sits down with Selma Schimmel in The Group Room. They discuss news for advanced lung cancer coming out of ASCO 2013.  In addition, they touch on young women, never smoker population who seem to have an increase in lung cancer incidence, and even some news for small cell lung cancer patients.

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

Jonathan Goldman, MD, Director, Clinical Trials in Thoracic Oncology and Associate Director of Drug Development at UCLA.

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

TGR ASCO 2013 Sponsor

VIDEO TRANSCRIPT

Selma Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel and you are looking live at the great city of Chicago which is once again playing host to the American Society of Clinical Oncology: ASCO.  This is ASCO’s 49th annual meeting and this year’s theme could not be more appropriate, Building Bridges to Conquer Cancer.  More than 30,000 of the world’s foremost cancer specialists are here and so is The Group Room making our 15th appearance at ASCO, and one of our very best.  Joining me now is Dr. Jonathan Goldman, Director of Clinical Trials in Thoracic Oncology, Associate Director of Drug Development at UCLA in our hometown, LA.  Hi, Dr. Goldman.

Jonathan Goldman, MD, Director, Clinical Trials in Thoracic Oncology, UCLA:

Thanks very much.  It’s always a pleasure to speak with you.

Selma Schimmel:

Talk about, what do we have for patients with advanced lung cancer?

Jonathan Goldman, MD:

I think the field is growing quickly of new drugs.  One of the discussions for tomorrow is of a CDK46 inhibitor that is looking exciting in a variety of fields, most famously now in breast cancer when combined with hormone therapy seem to be particularly important and effective.  In lung cancer we’re seeing that there also may be a role, and so we’ll be presenting that data.  This is an oral medication, generally well tolerated, some low blood counts, but for most patients, not noticeable.

Selma Schimmel:

And I’ve heard also that it’s being looked at for ovarian cancer.  What is this pathway, though?  Can you tell me a little bit more about it?

Jonathan Goldman, MD:

Absolutely.  So, when cancer… or, when all cells divide they go through a cycle and during that cycle more DNA is made, the cancer gets ready to split into… or sorry, the cell gets ready to split into two cells, and then that actual process of splitting occurs.  There are several points along that cycle where the cell gets a ‘go-ahead/don’t go-ahead’ signal.  And so, CDK46 is cyclin-dependent kinase, and the cyclin is referring to the cycle.  So, you are blocking the cancer cell’s ability to divide.  It’s interesting in actually it’s not so different than chemotherapy but it seems to be a whirl, which is nice for patients, and it seems to be better tolerated.

Selma Schimmel:

You know what I find so striking right now about lung cancer- for all the years this has been a stigmatized disease, a very pessimistic outlook at diagnosis.  It’s becoming sort of like the poster child for the future and an illustration of how powerful the world of molecular analysis, genomics, pathways, all of this, and what it means for the future of oncology.  And it’s just like this disease that was so dark has become a disease that is just spreading so much light.

Jonathan Goldman, MD:

Right, and it’s developing into other types of research, other understanding for other tumor types.  And I also think it then leads to the stigma being less.  It’s interesting, when you have better treatments, patients feel better, families feel better, and we hope that that message spreads.  I still do have some patients that come to me and say their doctor didn’t want them to get any treatment at all.  And I hope that we’re getting the word out that treatments are getting better all the time.

Selma Schimmel:

Sadly, this incidence of young adults, so many young women… do we know any more?  Do we have a greater understanding of why we’re seeing, in non-smoking young adults, this incidence of lung cancer?

Jonathan Goldman, MD:

I certainly don’t and I don’t think we do.  We have thought that, to some extent, it’s a numbers issue.  There used to be so many more active smokers.  Thankfully, active smokers are becoming less and less, at least among the age of 50-70.  And, so we’re seeing less cancer directly due to tobacco use, I’d say.  So, by the percentages it seems like there are more non-smokers.  But then, there certainly is this feeling I think that we didn’t perhaps used to see so many patients in their 30’s and 40’s.  And I think, my impression is that all cancer doctors now have at least one or two of these incredibly young, tragic situations, and I have many more than a few.  And I don’t think we know why; it’s not clearly associated with part of a country or a type of work.

Selma Schimmel:

And women- is there more data suggesting that there is, in this gender difference, the hormonal influence in women?

Jonathan Goldman, MD:

We do know that hormone receptors are present on lung cancer cells and it does seem that being on hormone replacement to have a small, but real increase in lung cancer risk.  And perhaps that can lead to some treatment options of, and we’re looking at that right now, blocking hormonal pathways with breast cancer drugs and giving that in addition to lung cancer chemotherapy.

Selma Schimmel:

Still, nothing for our small cell cancer survivors?

Jonathan Goldman, MD:

There are some trials that are coming along.  I’m involved in a trial of a very exciting new way to give a drug- it’s called an antibody drug conjugate, where an antibody is made to a protein that’s very common on small cell lung cancer cells, it’s called CD56.  And, an antibody that binds to that carries on its back, if you will, a very strong chemotherapy molecule.  And that chemotherapy was found to be too toxic to give directly to people but if you can give it in this kind of smart bomb, Trojan horse, whatever metaphor you want, we’ve seen in other cases it can be helpful.  And so that trial is underway now.

Selma Schimmel:

I’m very excited for at least our small cell lung cancer patients who listen and say there’s always something to talk about for non-small cell, what about us?

Jonathan Goldman, MD:

I’m happy to say that the small cell drugs that are looking promising are getting pushed forward because we need them so significantly.

Selma Schimmel:

Thank you, Dr. Jonathan Goldman- Director of Clinical Trials in Thoracic Oncology, Associate Director of Drug Development at UCLA.

Jonathan Goldman, MD:

Thanks very much, Selma.

Selma Schimmel:

Pleasure.

END OF VIDEO

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