Marileila Varella Garcia, PhD: Get to Know Your Tumor Before Treatment

Marileila Varella Garcia, PhD gives an overview of lung cancer tumor type testing from the research scientist perspective.

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 at the 14th World Conference on Lung Cancer, WCLC, which is organized by the International Association of the Study of Lung Cancer, the IASLC, in Amsterdam, the Netherlands.  Our discussion begins with Doctor Marileila Varella Garcia.  Welcome.  Doctor Garcia is Professor of Medical Oncology in the Department of Medicine at the University of Colorado, Anschutz Medical Campus in Aurora, Colorado.  Hello, Dr. Garcia.

Marileila Varella Garcia, PhD, Assoc. Dir. for Education, University of Colorado Cancer Center:

Nice to be here.

Selma R. Schimmel:

What percentage of cancer patients, non-small cell lung cancer patients, have this mutation?

Marileila Varella Garcia:

It’s about 5% of non-small cell lung cancer, but non-small cell lung cancer has 2 big subgroups- what we call adenocarcinoma and what we call squamous-cell carcinoma.  If we only take adenocarcinoma it’s about 10%.

Selma R. Schimmel:

Which is more… so that is more common?

Marileila Varella Garcia:

Yes, adenocarcinoma is 60% of the non-small cell lung cancer.

Selma R. Schimmel:

So, a patient, before they get treated today, has to get tested?

Marileila Varella Garcia:

Yes, because there are specific inhibitors for disrupting the ALK protein as well as there are specific inhibitors for a number of other proteins already.  But patients whose tumor depends on ALK is driven by ALK, when they take this inhibitor, this inhibitor is pretty specific.  So what the inhibitor does is it destroys that specific protein, nothing else.  So only destroying the cells that are damaging, that have the mechanism of gene expression without control.  Only the cells that are growing, driven by ALK is going to be effected by the ALK inhibitors, and in the patient the tumor shrinks.  When we learn that ALK inhibitor was shrinking lung cancer in advanced stage it was unheard of, and shrinks the tumor to 80%, sometimes to 90%.

Selma R. Schimmel:

To test for the mutation, is it blood or tissue that the doctor works with?

Marileila Varella Garcia:

It’s tissue.  It’s tissue because the abnormality only happens in the lung tumor tissue.  In the lung tissue that turns into the tumor.

Selma R. Schimmel:

And the way in which the pathologist does the analysis would be through a biopsy?

Marileila Varella Garcia:

It can be a resection if the patient was surgically resectable.  It can be a biopsy- any type of biopsy, current needle biopsy aspirates.  It does not matter for the testing.  And it’s possible that we also get pleural effusion, for instance.  So there are multiple biological sources of tumor cells that can be used for the test.

Selma R. Schimmel:

Where they can take aspiration of liquid and do it?

Marileila Varella Garcia:

Exactly.  And then, if the pleural effusion contains tumor cells we can find the abnormality of that cell.

Selma R. Schimmel:

So, what does this mean for our understanding of lung cancer, in general, for the future?  So, now the ALK pathway in this mutation has been identified, which is really changing the way in which patients get treated because now it’s not just arbitrary treatment, there is a methodology involved.  Where is research going in the identification of other pathways that could be influential in lung cancer?

Marileila Varella Garcia:

We have been focusing on multiple pathways, but before we get there, when we develop any test and we discover this… so, this test was completely discovered less than 3 years ago and the first process is to do standardization because we don’t want to be the only institution, or a few institutions only, that are able or qualified to do the test.

Selma R. Schimmel:

Is there only one method of testing?  One test, I believe it’s called FISH assay.

Marileila Varella Garcia:

It’s fish assay, but today, to enter the clinical trials that are open there is only this test.  But is it the only test that will be worth it to try?  We don’t know.  We are now in the process of first, standardizing technologies, second, comparing technologies.  Because in biology nothing is black and white.  All the variables in biology are continuous variables, so when we call positive and negative we are put in a line and are going to say this is negative and this is positive but there is that little grey zone.  So we very likely need more than one test to clarify the grey zone.

Selma R. Schimmel:

I imagine that for the medical community at large it’s so much information and things change with such speed that right down to whether, from the academic center to the private practice, all of this requires big shifts in the way physicians have treated their patients and run their practices because now there is a whole new step in the care of a lung cancer patient.

Marileila Varella Garcia:

Yes, you are absolutely right.  And then we have to be very open minded to all of those because those changes are really improving the quality of life of the patient.

Selma R. Schimmel:

And also, it’s increasing the responsibility on the patient too to be able to know that if treatment is ever suggested to them prior to being tested, for whatever reason, if that were to happen it’s the patient that has to say, ‘oh but wait a minute, I want to make sure we’re doing these mutational studies on me before you decide my treatment.’

Marileila Varella Garcia:

Exactly.  You know, the academic institutions usually are ahead of the private practice because the academic institutions are in charge of the discovery.  And so usually, if the patient goes to an academic institution that uses state of the art technology, the patient is going to be offered but if the patient goes to a local hospital or a private practice clinic it is… some of them are very aware but they don’t have the tools, they don’t have the… these tests are not simple.  We are still working in the standardization, in certain nomenclature setting, treatment, times, etc.  So it’s a very… it requires updates from everybody including the patient.

Selma R. Schimmel:

So, as… with the number of biomarkers and pathways and mutations that we now have already identified, how many therapies are there available today to correspond to these molecular changes that we now know about in lung cancer?

Marileila Varella Garcia:

There are about a dozen that have been opened or some… few, very few are a proven treatment.

Selma R. Schimmel:

And others are clinical trials?

Marileila Varella Garcia:

But the other ones are in clinical trials that we are enrolling our patients for this study, lung cancer mutations consortium.  In the pipeline of the company is already our phase 1 trial, we have an enormous amount.

Selma R. Schimmel:

You’ve really built a case for the importance for lung cancer patients to know that they need that second opinion from an academic center.

Marileila Varella Garcia:

I would say yes.

Selma R. Schimmel:

That before they start treatment they have got to take advantage of a place that can tell them what is happening in the area of research to be sure that they’re matching their treatment to be in sync with their tumor type.

Marileila Varella Garcia:

According to the molecular profile of the tumor, exactly I fully agree.

Selma R. Schimmel:

Exactly.  And we spoke how lung cancer as a multidisciplinary disease, you are one of the components, being a research scientist, sort of, everybody working together alongside.

Marileila Varella Garcia:

I classify myself as a biomarker developer.

Selma R. Schimmel:

You are doing your research at the most really exciting time that will change the future of, not just lung cancer, but all cancers.

Marileila Varella Garcia:

Yes, it is because the improvement of quality of life, and it is dramatically significant for each one of us also, is the feedback improves the quality of life of the patient and gives something back that we need to pursue.  It is harder and harder.

Selma R. Schimmel:

Thank you, Doctor Marileila Varella Garcia.

Marileila Varella Garcia:

Thank you.

Selma R. Schimmel:

Professor of Medical Oncology in the Department of Medicine at the University of Colorado, Anschutz Medical Campus, Aurora, Colorado.

Marileila Varella Garcia:

Thank you.

Selma R. Schimmel:

You’re welcome.

END OF VIDEO

 

 

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