Pieter Postmus, MD, PhD: Towards Personalized Medicine in Lung Cancer

Pieter E. Postmus, MD, PhD talks about the theme of the 2011 World Conference on Lung Cancer meeting held in Amsterdam. He also discusses the highlights at the meeting and how personalized medicine is the future of lung cancer treatment.

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.  And now I am joined by the President of this year’s meeting, Dr. Pieter Postmus from the Department of Pulmonary Diseases at the Vrije University Medical Center right here in Amsterdam, the Netherlands.  Hello, how are you?

Pieter E. Postmus, MD, PhD, President, IASLC – WCLC 2011, Amsterdam:

I’m fine.  Thank you very much.

Selma R. Schimmel:

Thank you for taking time out.  The ‘goals’ as you planned this conference or congress..?

Pieter E. Postmus:

The theme of the meeting is towards personalized medicine, which means better care for the individual based on all kinds of things; based on characterization of the patient, characterization of the tumor, also characterization of the people who treat the patient.

Selma R. Schimmel:

Personalized medicine in lung cancer is very personal, it’s very distinct because lung cancer is one of the cancers where the ability to identify genomic characteristics or certain pathways has really changed the face of how we treat lung cancer.

Pieter E. Postmus:

Oh, absolutely.  So, the way we now are able to characterize the tumor in a much better way than we could ten, five years ago, makes a change for a lot of patients – not for all, but a lot of patients.  But also, the way we can characterize the patient, the way the tumor is manifesting itself inside the patient, the way it is spread, makes it all possible to really tailor the treatment, more or less, to the patient.

Selma R. Schimmel:

Tell us of, maybe, a couple of the really top pieces of data or research that has excited you the most at this meeting or has yet to come.

Pieter E. Postmus:

I think the most important thing, I think the most important message for, really for everybody working in a high level institute or in a normal general hospital is, ‘if you improve the care you improve the outcome.  So, working together as doctors in a way that the patient really gets the benefit of what all these doctors together know makes the outcome much better.’  There is a UK study in which they demonstrate what is the outcome after they invested a lot of money in improving thoracic surgery.  It is dramatic.  It is really improving the outcome for the patient.  We’ve done a study, a retrospective analysis of all the patients who were referred to us for a second or a third opinion; in about a quarter we changed the treatment dramatically.  Some from palliative to curative care, some the other way, from curative intent to palliative care.  But then you spare, at least, dramatic treatments for the patients.  So, it’s really worthwhile if you put a lot of effort in working together as a multidisciplinary team for those patients.  That is a very important message.

Selma R. Schimmel:

And, I also thing what you just did in this moment is that you raised the bar of hope for all the patients you see.

Pieter E. Postmus:

Oh ya, because there are so many new things coming.  The CT screening presented last week in the New England Journal, it’s presented here as well.  The statement of the IASLC, this gives hope to all those who, especially to those who struggle to stop smoking, they stop smoking, but now they also should have the benefit of the way to have their tumor that might come, they still have a high risk of developing lung cancer, to be early detected, and then it is treatable and there are new approaches. There is the stereotactic radiotherapy for all of the very small tumors, which is almost a harmless treatment and very, very effective.  We’ve demonstrated that at one of the sessions, it’s also Wednesday at the presidential symposium.  The outcome of the stereotactic radiotherapy really made the outcome for patients over 75 so much better than we ever could have guessed.

Selma R. Schimmel:

I take great pleasure when I speak to doctors and there are certain moments when you all talk where you can feel your passion and you become animated, especially over a disease that you worked so long and so hard for, where finally you’re seeing the fruits of your labor, and it’s inspiring.

Pieter E. Postmus:

Absolutely, my career started in 1978 in lung cancer.  So I can more or less juxt what is the purpose.

Selma R. Schimmel:

A real paradigm shift.

Pieter E. Postmus:

Absolutely.

Selma R. Schimmel:

One of the things that has impressed me at this meeting is the role of the nurse in the treatment and the following of the lung cancer patient.  This is something you’ve been involved with as well.

Pieter E. Postmus:

Yes, the nurses are crucial for treating these patients.

Selma R. Schimmel:

Why?

Pieter E. Postmus:

Because they have a good ear, they usually have somewhat more time than the general doctor has, and they are really much more able in skills to coordinate care for the patient because lung cancer patients are almost always patients that need to be seen by a number of specialists from different backgrounds ranging from a medical oncologist, to pulmonologist, to radiotherapist, a surgeon, also the pathologist has a major role, people who do the imaging of the tumor.  All these things that need to be coordinated and that should be done in a short period of time because this is a dreadful disease which goes fast, so if you go one week to the pulmonologist, the other week to the radiologist, a week later to the nuclear medicine people, that is wasting time.  They should be fast and accurate.

Selma R. Schimmel:

Dr. Postmus, you’ve mentioned some of the characteristics of what distinguishes the lung cancer patient, but what are some of the other areas that make lung cancer a very different cancer type from the others and why the needs of the lung cancer patient are different than some of the other disease types?

Pieter E. Postmus:

Lung cancer is grouped together as one disease but it is in fact a multitude of diseases, so that makes it very difficult to give advice simply based on this is lung cancer.  You need to characterize the patient and the disease much more.  And then it is a disease that comes from, let’s say, the late 20’s age of the patient, to very old people.  Some have smoked, the majority smoked in the past, some are still smoking, but also a lot of patients never smoked and these are usually the younger, mainly the female patients, and they apparently have a different disease all under the title, lung cancer.

Selma R. Schimmel:

We’re more and more understanding the biologic or the gender differences in the biology of lung cancer between men and women.

Pieter E. Postmus:

Ya, that is improving.  That is over the last five years that we are looking at that. We’re getting the skills now and the techniques are coming.

Selma R. Schimmel:

But I think it’s a surprise to many people to learn that there actually may be biological differences based on gender.

Pieter E. Postmus:

There is, and there’s also differences in the tumor if it is caused by smoking or if it is a non-smoking lung cancer.

Selma R. Schimmel:

Speaking of smoking, here in the Netherlands, what is going on with the public with smoking and smoking cessation here?

Pieter E. Postmus:

There are still quite a large number of people who smoke and they are really addicted.  They want to smoke in the pub and even the government allows it, which is in fact a shame.  By law, by European law, it is not allowed anymore in pubs and restaurants but they found a way to escape from that in the smaller pubs.  So, for visitors who smoke, they still have their space to go to, which is a shame for the country.

Selma R. Schimmel:

But it really does go to the point of how addictive it is.

Pieter E. Postmus:

It is very addictive.  This morning’s session on the epidemiology, there was a very interesting statement that there is also a genetic basis for the degree of being addictive.  And that makes it even more difficult for those who start smoking to stop smoking.  So, government should take that into consideration and support these people much more than they do now instead of taking it out of the insurance, they should put it in, these stopping programs.  Because there are now possibilities for those who smoked, and might get cancer later on, to get it early detected as well.

Selma R. Schimmel:

It is an uphill battle because on the other side the person who is so addicted and loves their cigarette will say you can’t tell me what I can and can’t do.

Pieter E. Postmus:

But still, if you want to stop smoking, everybody can do it.  There are a number of techniques to help patients.

Selma R. Schimmel:

You have to really want to stop.

Pieter E. Postmus:

You have to do it yourself, absolutely.  You have to want it yourself, that’s true.

Selma R. Schimmel:

There is a suffering… I wouldn’t want to make anyone think we don’t appreciate how hard it is.

Pieter E. Postmus:

It is very hard.

Selma R. Schimmel:

But having lung cancer is harder.

Pieter E. Postmus:

It’s a dreadful disease.

Selma R. Schimmel:

Which really comes to why the work of the International Association for the Study of Lung Cancer is so important- it’s such a unifying force for clinicians.  So talk to us a bit about the benefits for membership for those involved in IASLC and your own personal feelings.  Obviously, this WCLC meeting is the most important meeting that IASLC produces.

Pieter E. Postmus:

It’s now every two years and it is in fact the only meeting in the world where people from all over the world related to areas in which lung cancer is diagnosed, is treated, the preclinical work… so, it goes from the biologist to the palliative care doctor and everything in between.  They’re all gathered together in the IASLC’s meetings.

Selma R. Schimmel:

I’ve noticed that you do these meetings every couple of years throughout the world and you make it very easy for your membership to attend.  It’s not only in one place, you go from one region of the world to another.

Pieter E. Postmuus:

Ya, we do it now every other year we do a big meeting or a world meeting, but the other years we have a meeting in Asia, a meeting in Europe, a meeting in South America, a meeting in North America that are a bit shorter.  The number of people attending there is a bit lower but it’s more for the region, so also those who are not able to come to the big meeting, they kind of have their teaching over there.

Selma R. Schimmel:

So, for one moment, if you would please, speak to your colleagues about the importance of membership.

Pieter E. Postmus:

It is very important to be among those who are really in the forefront of lung cancer treatment and diagnostics, and you should do that through the IASLC.  The IASLC has the best journals addressing lung cancer, all aspects of it, and it’s a cheap organization, very cheap, $200.  The US dollar, we know, is not that expensive for Europeans.

Selma R. Schimmel:

I hear you did some magnificent things for the opening ceremony.  Were you in a costume?

Pieter E. Postmus:

I was.  Together with my co-chair, Nico van Zandwijk, we were more or less hidden within the Night Watch, which is the famous painting of Rembrandt, which is in the Rijksmuseum here in Amsterdam. And there are a number of groups in the Netherlands who make the live Night Watch.  So we were part of the Night Watch.  This was a spectacular experience, dressed in a, more or less, golden century dress, the 17th century, and stepping out of there was, to some people, a shock, or a surprise, or both.

Selma R. Schimmel:

How fun, that you were able to balance all the scientific component with a little levity.

Pieter E. Postmus:

Ya, but that is typically for this organization.  This is a, more or less, a family of people who are involved in lung cancer.  There are a lot of friendships that are there for 30-40 years, I’ve known people in this organization.

Selma R. Schimmel:

What did it mean for you to be the President organizing this meeting?

Pieter E. Postmus:

It’s a terrific honor for me.  It is really something you want to achieve.  It’s a one-time experience to have it.  It’s only every 6 years it’s in Europe so being the candidate and being selected as the one who does it, that’s a great honor.

Selma R. Schimmel:

Thank you, Dr. Pieter Postmus- Department of Pulmonary Diseases at the Vrije University Medical Center right here in Amsterdam, the Netherlands, and this year’s World Conference on Lung Cancer President.  I wish you much success in your ongoing efforts.  Thank you so much.

Pieter E. Postmus:

Thank you very much.

END OF VIDEO

 

 

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