Jonathan Goldman, MD: Immunotherapy and Lung Cancer

Dr. Goldman sits down with Selma Schimmel in The Group Room. They discuss the exciting news in immunotherapy for 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 SponsorVIDEO 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:

Dr. Goldman, let’s talk a little bit about what’s happening with immunotherapy in lung cancer.

Jonathan Goldman, MD:

It’s been a real year for the immunotherapies.  It’s a very exciting, and for many people including myself, completely unanticipated treatment option for our lung cancer patients.  We had in the past had weaker immune therapies and it seemed that the benefit was nonexistent or perhaps very small.  A couple years ago a trial with a drug called Ipilimumab, which has since been approved for melanoma, looked to not be effective for non-small cell lung cancer.  However, we’ve developed a newer immune therapy called PD-1 inhibitors and there are several available now.  There are also, sort of, a partner target called PD-L1 and there’s an antibody against that.  And basically, what all of them are doing is they’re taking the brakes off of the immune system.  Naturally and normally there are a lot of brakes on our immune system so that there is not inflammation of our body all the time.  But cancer sabotages and takes over that system to prevent the immune system from fighting the cancer.  And so these antibodies block that brake, basically and it thereby turns on the immune system.  It’s not helping everyone, but even in patients that you would have thought to be refractory from all known therapies, we are seeing some benefits.  And if I may say one thing, what’s most exciting to me is that the benefits are not short lasting, we are seeing benefits lasting several years.  We don’t normally say that.  Several years, and then even a period off of treatment, still under control; it’s very exciting.

Selma Schimmel:

You know the concept of immunotherapy, vaccine therapy, it’s so logical, it’s so appealing, and we all want this.  I’m baffled at how challenging it’s been to bring these drugs, not only to fruition, but to true efficacy.  And there are studies going on at Penn now for ovarian, melanoma for whatever reason has been early-on responding, now we’re looking at lung…  Why do you think the field of immunotherapy and immunology as it applies to cancer is so challenging?

Jonathan Goldman, MD:

I think it’s a very complex question.  If I were to make a hypothesis, I think that we initially approached it as if we were fighting an infectious disease.  And there, vaccines of course have many examples of success, but the infectious bacteria or virus is very different than our own cells, our own body cells.  And so there were several brakes on the system to prevent an immune response against our own body cells.  And it was only when we developed the ability to affect those brakes, to take off the inhibition on the immune system, that we were able to take these steps forward.  Very interestingly, I just now walked from a session where it looks like you might be able to combine these new therapies with vaccine type treatments with other older immune stimulants that didn’t work, but now maybe they’ll work.  There is early evidence that they might work.  And also, we saw a few examples of combining these new immune therapies, possibly to really important success.

Selma Schimmel:

Unfortunately, because of the challenges associated with bringing these drugs to market, you know, it’s not been easy for industry to develop these compounds but it appears that there’s a shift happening and that there’s a revived interest or greater acceptance in reinvesting in research.  Am I right about that?

Jonathan Goldman, MD:

You are right and it’s driven by the success.  Early on there were reports of about 30% of heavily pre-treated patients, patients that had received many lines of chemotherapy, getting major responses.  And when those responses are not lasting a few months, but lasting a few years everyone gets very excited.

Selma Schimmel:

This could be one of the greatest shifts in oncology and impacting long term patient survival.

Jonathan Goldman, MD:

It certainly feels like it and it can be difficult to make those predictions, but it feels like it.  And you can certainly imagine and conceive perhaps treating patients even earlier.  A patient that has a large lung cancer removed by surgery, we know that the risk of it coming back may be as high as 75%.  If we give them an immune therapy at that time it is conceivable that we could greatly improve that patient’s survival.

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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