Keith Kerr, MD: The Role of Pathology in Lung Cancer

Keith M. Kerr, MD, ERCPath, discusses the role of pathology in lung cancer treatment at the 14th Annual World Conference on Lung Cancer 2011 in Amsterdam.

The Group Room at the 14th Annual World Conference on Lung Cancer (WCLC) was made possible, in part, by:

 

VIDEO TRANSCRIPT

Selma R. Schimmel, Founder & CEO, Vital Options International:

This is Selma Schimmel for The Group Room at the 14th World Conference on Lung Cancer, WCLC, organized by the IASLC, the International Association for the Study of Lung Cancer; we are in Amsterdam.  I’m now joined by Professor, Doctor Keith Kerr who comes to us from Aberdeen University Medical School in Scotland where you are Professor of Pathology.  Thank you for being with us.

Prof. Keith M. Kerr, MD, ERCPath, Consultant, Dept. of Pathology, Aberdeen Univ. Med. School, Scotland:

Pleasure to be here.

Selma R. Schimmel:

I’m very happy to finally be able to speak to someone about pathology because as we learn more and more about these genomic changes and these mutation drivers, the area of lung cancer it is time to get the pathologist out of the lab, raise the profile and introduce the pathologist to the patient because you are becoming really one of the most important key players in the diagnosis and the identification of the genomic characteristics that will help design the appropriate treatment for the patient.

Keith M. Kerr:

I agree with you completely.  I think that the pathologist has always been regarded as something of a background boy, perhaps, providing a service but not really being involved terribly much in frontline care of patients.  Of course, we always did have our own play in frontline care, but the importance of pathology has really grown tremendously in the area of lung cancer recently and this is both in terms of what we’ve always done, which is looked at the tumors and classified them in certain ways, but the evolution of the importance of molecular biology in addition has really put us, I suppose you could say, in the spotlight.  And this of course, is good for patients, it’s good for the better management of patients and, of course, it’s good for pathology.

Selma R. Schimmel:

A long time ago pathology was limited to the microscope.  Today, a microscopic analysis of tissue and of cancer cells is hardly sufficient when we’re capable of doing a molecular genotyping and screening of our tissue.  I would doubt that we’re going to do away with the microscope but I would think that there’s this amazing collaboration between what you see under a microscope and what you’re able to look at with molecular means.

Keith M. Kerr:

Absolutely.  I think that the correlation between what we see under the microscope, the morphology, how the tumor looks, and the molecular picture that we can gather from that particular tumor, putting those things together, we stand to learn an enormous amount more about how these tumors develop, how they evolve, and of course, how they can be treated and targeted.  I agree also with you that I don’t think the microscope is going to disappear.  Many of the molecular advocates have told me often in the last few years that I’m going to be out of a job in a few years’ time; I don’t think so.  I think that morphology will always have a part to play.  Apart from anything else, it is required to select or to understand which parts of the sample that comes from the patient have to be tested.  So we have to marry the two together and one does not replace the other.

Selma R. Schimmel:

What is the technical process when you get down to that genomic level?  It’s much more complex than just looking under a microscope and making a slide.  How is that analysis performed?

Keith M. Kerr:

You can actually perform the analysis in a number of different ways; the two major ways that you can perform the analysis is by looking for something in the tumor on the slide by targeting, using molecular techniques to target a particular feature of characteristics so that you can look down the microscope, but rather than just looking at the patterns and the morphology, you’re actually looking for signals that you’ve created in that tumor which are driven by the molecular characteristics.  The other way that you can measure things at a molecular level is by extracting the molecules from the tumor tissue and those may be proteins, they may be nucleic acids, including things like DNA, and then you have to analyze the DNA or the proteins in different ways; depends which question you’re asking.  There are an enormous number of different molecular aberrations that may be present in cancer cells.

Selma R. Schimmel:

I believe there’s around ten different mutations now, the common ones, that we most relate to when it comes to lung cancer?

Keith M. Kerr:

At least, I guess.  The ten common mutations that are spoken of are particularly mentioned in relation to the commonest type of lung cancer, which is, what we call, adenocarcinoma.  There are, of course, other types of lung cancer.  Adenocarcinomas are probably, around the world if varies, but about half of all the lung cancers.  And now we’re learning that ten mutations appear to be absolutely critical in about half of those adenocarcinomas and when one of those critical mutations is present and driving the cancer, the others generally will not be there.  So they seem to be unique and individually key mutations for these tumors.  And of course, the important thing about these mutations is that, if they are so important in driving the cancer they can be drugged, they can be targeted by a drug and switched off.

Selma R. Schimmel:

So this is really the root of personalized medicine?

Keith M. Kerr:

Absolutely.

Selma R. Schimmel:

That said, there seems to be a growing responsibility on the patient to be sure that once they’ve had tissue resected that that tissue is properly examined by a pathologist that is able to look deeper beyond the morphology of the tumor but the genomic characteristics.  And I think that that is a message we need to drive home, that patients have to be sure that their tissue is being properly analyzed for these new mutations that we are aware of.

Keith M. Kerr:

I’m absolutely sure that that is the case and it is an important consideration.  The analysis of these cases is very important.  It has to be done in the proper way- the samples have to be prepared in an appropriate way, and we need to have, of course, enough material on which to do what is an increasingly long list of tests.  And we’re in a curious environment in way because other developments in medicine have really been geared towards less and less intervention for the comfort and benefit of the patient.  We talk about minimal intervention techniques and minimal intervention often, not always, but often means that the samples in which the pathologists have to work are getting smaller and smaller, and yet the amount of information that we have to provide is getting more and more.

Selma R. Schimmel:

So the role between the thoracic surgeon and the pathologist seems to be extremely intimate and important.

Keith M. Kerr:

Very important, and this is one of the other reasons why the point you made in your very first question about the pathologist coming out of the laboratory and working in, what we call, multidisciplinary teams with the oncologists, the physicians, and the surgeons; everybody learning what everyone else does.  It’s been very interesting as we’ve become involved in these things how little some of our colleagues have understood about what pathologists actually do, but they’re catching up.

Selma R. Schimmel:

Well, this was a great primer.  I hope that we will meet again and do something to help, as you call it, the laboratory to get the pathologists more visible, raise the profile, not just amongst your peers and colleagues but directly to the patient to understand how pivotal the role is of their pathologist.  Thank you, Doctor, Professor Keith Kerr: Professor of Pathology at Aberdeen University Medical School in Scotland.

Keith M. Kerr:

Thank you very much.

Selma R. Schimmel:

Pleasure.

END OF VIDEO

 

 

Comments