Sonali Smith, MD: Personalized Medicine: How is it Shaping the Future?
Sonali Smith, MD discusses personalized medicine and how it is helping shape current and future cancer research.
Dr. Smith is Associate Professor of Medicine at the University of Chicago Medical Center. She is an expert in the care and treatment of adults with all types of Hodgkin and non-Hodgkin lymphoma. She has a special interest in new agents for lymphoma, as well as stem cell transplantation and its role in improving the survival of patients with relapsed lymphomas.
The Group Room at the 2011 American Association For Cancer Research Annual Meeting was made possible, in part, by:
Selma R. Schimmel, Founder & CEO, Vital Options International:
This is Selma Schimmel at ASCO 2011. Conversations are going on here and now we’re going to sit with Dr. Sonali Smith who was with us last year. You are Associate Professor of Medicine, University of Chicago Medical Center; you are also a member of the ASCO Cancer Communications Committee. I want to welcome you back.
Sonali Smith, MD, Associate Prof. of Medicine, University of Chicago Medical Center:
Thank you so much for inviting me back, Selma. I had a lot of fun with this last year and really enjoy being here again.
Selma R. Schimmel:
Let’s talk a bit about the press briefing that dealt with this whole area of personalized medicine.
It was a very exciting press conference covering- the title of the press conference was Experimental Therapeutics and so that’s just another way of saying ‘new drugs’. It covered four different diseases that are very different. There was a lung cancer presentation, there was one on melanoma, one on myelofibrosis, and then one on prostate cancer. And the theme, even though these were four very different diseases, as you just said, is that all four of these, we’re trying to have trying to match the right treatment to the right patient. And that was really exciting to see because I do think we’re getting closer, step by step.
So, one of the papers that was presented by Dr. Mark Kris had to do with lung cancer and lung cancer, it turns out, is a very complicated disease. Not only is it the most common cancer and it’s rising, I think it superseded breast cancer in women, it’s a very important disease to understand but really complicated when you look at it underneath the microscope. And so, what investigators did is that they actually took tumor samples from patients – they had 1,000 patients in this study – and in real time they sent that tumor tissue into a test where they looked for one of ten different mutations, biologic mutations within the cancer. If they had a mutation of EGFR, which is something that is abnormal in some breast cancers and some head and neck cancers, but if they found it in this lung cancer then those patient’s doctors were given that information within days and they were able to be treated with erlotinib. If they didn’t have that particular mutation then those patients were offered clinical trials that had targeted drugs for their mutation. So the results from the study is that 60% of patients have one of these ten mutations and that they were able to, not only give the right patients the erlotinib, but if they didn’t have the EGFR, those patients didn’t have to go on it. So they spared the patient having to take a treatment that really didn’t have a realistic chance of helping them. So, it’s early going with this particular study, but I really think that that is one of the more exciting abstracts in terms of trying to match the patient to the treatment.
The second study that was there had to do with metastatic melanoma. So melanoma, we’re all familiar with from the risks from the sun and from tanning salons, and one thing I’ll tell you, just from a doctor’s perspective, is that melanoma is a tough one. It doesn’t generally respond to chemotherapy and it doesn’t generally respond to radiation, and it’s really forced the medical community to look at other ways of treating this. And again, at this point we now know, going back to the biology, that there are some pathways within these cancer cells that are abnormal. And in fact, melanoma cells, cancer cells become addicted to one of these pathways. There is a whole field of addiction to a pathway, which we think of- it’s just fascinating to me that these cancer cells can just rely primarily on one or two different ways. And so, in this study investigators gave two different drugs that were pills, so take it twice a day at home. They came in once a month to be checked, they had patient diaries to make sure they weren’t skipping any doses, although most patients that were on the study were very motivated and wouldn’t have skipped any doses. And they found that these two drugs together were very safe, that they didn’t have a whole lot of side effects, and the early results are very, very encouraging in terms of how many patients responded. So again, this is something where knowing the biology, they restricted the treatment to patients who had abnormalities of that pathway; so again, they didn’t treat patients randomly. They really looked to see who has this abnormality, who has the potential to benefit.
Selma R. Schimmel:
I’m smiling because I’m thinking about just how amazing it is that we get to the point now that you can go home and take a pill and treat your cancer just by, orally.
Absolutely. I really do hope- I mean, cure is our first goal but if cure cannot happen, making something a chronic disease where you can manage it for years, if not indefinitely would be an amazing goal. And I do think that some of these studies really push us towards that goal.
So, one of the other papers that I thought was very exciting had to do, not so much with a treatment but, with a biomarker; and so, what is a biomarker? A biomarker is basically either a blood test or some other indication that tells you how a treatment might be working. And in this particular case they looked at men with prostate cancer that had spread, so they had metastatic prostate cancer and they were treated with a drug called abiraterone (ZYTIGA). The exciting part about this study is that they looked within patients and then they measured something in the blood called circulating tumor cells. These are pieces of the prostate cancer that have broken off and are traveling in the blood. And they look to see how many of these men had their circulating tumor cells go from high to low – they had a standard cut off – and they found that if their circulating tumor cells went down by a certain amount, that those men lived longer. Now the advantage there is that we might know sooner if a drug is working or not working. And this was a very large study. This was the first time a biomarker like this has been tested prospectively, as opposed to looking back. It was actually done forward thinking, and so the fact that it really strongly went along with how long somebody lived, I think, gives us an opportunity in the future to personalize treatment for somebody. If you see the circulating tumor cells getting better, then fine, continue with therapy, but if they don’t then perhaps it’s time to switch gears.
Selma R. Schimmel:
Just the idea that we can begin to hone in and perfect the science of treatment- every year that we talk it just is becoming more and more refined. I wish we could do this across all cancer types and maybe soon we will be.
I agree. I think it’s going to take a huge commitment to not lose what we’ve gained from, in terms of support for scientific advancements. I think we’re finally at a point where all of the investment in cancer research is beginning to pay off.
Selma R. Schimmel:
I think the challenge is going to be now helping the public understand. I think we need to see more visuals to begin to appreciate this mechanism of action, what goes on inside the body because, you put it in very simple terms for us, but it’s complex. It’s so different than what we’ve known from chemotherapy and radiation therapy. So there’s a big learning curve here.
Yea, I think the complexity of cancer is very humbling, it’s very, very humbling. But I do think we’re chipping away at it.
Selma R. Schimmel:
You’re on the younger side of the medical oncology community, which means as your career advances it’s your generation that’s really going to just prosper and benefit from all of this. You are very lucky to be the age you are, at the place you are in medicine. You have so many years ahead of you to be part of this really dynamic change.
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