Keith Kerr, MD: Biomarkers and Personalized Medicine in Lung Cancer

Prof. Keith Kerr, MD, FRCPath discusses the emerging role of biomarkers and targeted therapies in lung cancer and how personalized medicine is truly the future of cancer treatment.

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 that Multidisciplinary Cancer Congress 2011 in Stockholm. Hello, Professor Doctor Kerr, how are you?

Prof. Keith Kerr, MD, FRCPath, Aberdeen Royal Infirmary, Aberdeen, Scotland:

I’m very well, thank you.

Selma Schimmel:

And I’m hoping you can talk to us a little bit about your perspective on what’s happening at this meeting and a little more updates from our last discussion.

Prof. Keith Kerr:

I think that this congress has added a little more to the story that we have seen evolving over the last few years around the emergence of new treatments for patients with lung cancer. Based upon the identification of a biomarker, and it comes back to story of personalized medicine, which is evolving in many different cancer types. And in lung cancer this is good news because for many lung cancer patients there has not been much good news in past years. So little bits more added to the story around emerging markers and emerging drugs, and just more data coming along.

Selma Schimmel:

I think that we talked about with so many physicians that as we can identify biomarkers and understand the molecular characteristics of cancer it’s such a huge paradigm shift in how we treat these patients, and lung cancer represents probably one of the most dynamic cancers – others too – where the integration of these new technologies in the diagnostic and analytical process of tissue is imperative.

Prof. Keith Kerr:

Yeah, that’s absolutely true. It’s a matter of trying to identify sometimes the target for the drug, or sometimes it’s a factor in the tumor which affects the metabolism of the drug or the effect the drug in some other way. So one way or another these molecular characteristics seem to influence the efficacy of the drug.

Selma Schimmel:

Professor Kerr, for care for patients who are listening, or viewing this interview, what are the things that you could tell them that are probably the most important talking points that they need to have with their physicians to help them understand – even the patient role in being sure that certain tests are being conducted on tissue so they can maximize their treatment options?

Prof. Keith Kerr:

Well I think the discussion has to be based upon the particular disease, the particular tumor that the patient has because as you’ve mentioned already lung cancer is a very heterogeneous mixture of different cancer types, and depending on the cancer type as defined by our traditional diagnosis different molecular targets may be more or less likely to be present. So a conversation would be appropriate around having the tumor tested for what would be the appropriate markers of the targets in that particular case. That conversation has to go along with a discussion on whether actually there is the material available to carry out the test. One of the problems that we have in patients who have lung cancer is actually obtaining enough material in terms of the biopsy sample to allow all of the tests that we would like to do. And in the future this is going to be an even greater problem as more and more markers emerge, more and more questions need to be asked on behalf of the patient from the same – unfortunately – often very small samples.

Selma Schimmel:

If a patient has already initiated treatment, and as new molecular markers and biomarkers become known, is it possible to go back and take tissue and re-sample tissue, even if treatment has been initiated? Is there tissue that stays in like a paradigm block or something that a doctor can go back and access?

Prof. Keith Kerr:

Yes, absolutely. The standard practice is if a patient has had a biopsy and a diagnosis of cancer is made from that sample, the sample is then stored in the pathology lab, and it becomes the regulations vary from country to country but certainly in my own country, in the UK, it becomes part of the patients’ record and it’s kept forever. So it’s available, in theory, forever. It sometimes, of course, gets used up to make the diagnosis in the first place if there isn’t very much there. And if it’s a complex diagnosis we often have to do more work so we may use it up, but for most patients samples will exist in the path lab, and they can be re-interrogated if new markers become available; we can go back and look at them.

Selma Schimmel:

It sounds like where we are today in lung cancer, ideally, a patient does not want to initiate treatment until they have been tested and their tissue analyzed to see what biomarkers or mutations might present.

Prof. Keith Kerr:

Well I think that’s very much becoming the standard of care now that as well as a diagnosis being made on the sample that’s taken from the patient. Then in consideration is made of testing for a number of different biomarkers. The truth is that in lung cancer this extra bit of investigation to some extent in its infancy. We don’t have so many biomarkers that are well-established and are used as a matter of routine but those biomarkers are increasing in number. I mean there are probably several that have emerged as really likely candidates even in the time since we last spoke. So it’s a very rapidly changing environment.

Selma Schimmel:

So with the number of new biomarkers being identified and hopefully new targeted therapies coming in the pipeline here, what is the role of chemotherapy? Where do you see chemotherapy going in regard to combination therapy with some of these new targeted agents?

Prof. Keith Kerr:

Well it’s interesting. There have been a lot of discussions and I take part in these discussions as a pathologist – I’m not directly involved, obviously, in prescribing chemotherapy – but I have an interest in a lot of the decisions that go on leading up to it. And there is a debate, certainly, and there’s around whether chemotherapy will be replaced by targeted agents against a variety of molecular markers or will these molecular markers or rather the drugs that are selected by these molecular markers will they be used in conjunction with chemotherapy, so will the patient receive both? Or perhaps the patient will receive one followed by the other. And I think there are lots of questions still that have to be answered in that regard. Certainly, as of now there are some targeted agents that are the preferred drug of choice to be given instead of chemotherapy because they have been shown to be superior. Some other targeted agents appear to be best deployed in conjunction with chemotherapy. Some of them may be given after chemotherapy has been given. We already know some of this, but I think there are many possible combinations that still have to be worked out.

Selma Schimmel:

You know in fields like lung cancer is almost like the poster child disease for personalized medicine. It’s just the perfect example of how rapidly personalized medicine is changing the profile of a disease.

Prof. Keith Kerr:

Well it’s certainly a rapidly progressing issue in lung cancer, there’s no question. The way of course was lead, probably by breast cancer is the best example, and colorectal cancer, one or two other tumors but given the particular complexities that we have to work with in lung cancer there would appear to be many opportunities for different targeted agents given the variety of different molecular abnormalities that appear to be present in different lung cancers. But there are still a lot of questions to be answered.

Selma Schimmel:

Thank you very much, Professor Kerr for sort of zooming in a little bit with a magnifying glass on what’s happening at this meeting, and I hope that we’ll be speaking to you again perhaps at the ESMO meeting.

Prof. Keith Kerr:

My pleasure, thank you very much.

END OF VIDEO

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