50 Years of Cancer Progress: Medical Oncology

Transcript

00:00 --> 00:01Funding for Yale Cancer Answers
00:01 --> 00:03is provided by Smilow Cancer
00:03 --> 00:04Hospital.
00:05 --> 00:07Welcome to Yale Cancer Answers
00:07 --> 00:08with the director of
00:08 --> 00:10Yale Cancer Center, doctor Eric
00:10 --> 00:10Winer.
00:11 --> 00:13Yale Cancer Answers features conversations
00:13 --> 00:15with oncologists and specialists
00:15 --> 00:17who are on the forefront
00:17 --> 00:18of the battle to fight
00:18 --> 00:19cancer. This week, it's a
00:19 --> 00:20conversation about lung cancer with
00:20 --> 00:23doctor Roy Herbst. Doctor Herbst
00:23 --> 00:24is the Ensign Professor of
00:24 --> 00:26Medicine and Medical Oncology and
00:26 --> 00:27Professor of Pharmacology
00:28 --> 00:29at the Yale School of
00:29 --> 00:29Medicine.
00:30 --> 00:31Here's doctor Winer.
00:33 --> 00:34I like to just start
00:34 --> 00:36off hearing a little bit
00:36 --> 00:38about what brought somebody to
00:38 --> 00:39a career in
00:39 --> 00:41cancer medicine and cancer research.
00:41 --> 00:42And maybe you could spend
00:42 --> 00:43just
00:43 --> 00:45a minute or so telling
00:45 --> 00:47us about what motivated you
00:48 --> 00:49when you were in medical
00:49 --> 00:51school or even before medical
00:51 --> 00:52school to go into
00:52 --> 00:53this area.
00:54 --> 00:56Well, my mother always wanted
00:56 --> 00:57me to be a doctor
00:57 --> 00:58and she brought me up
00:58 --> 00:59here to Yale
00:59 --> 01:00quite a few years
01:00 --> 01:02ago. And I was very
01:02 --> 01:04interested in science, and I
01:04 --> 01:04liked working with people.
01:07 --> 01:08So when I got to Yale
01:08 --> 01:09as an undergraduate,
01:11 --> 01:13I studied molecular
01:13 --> 01:14biophysics and biochemistry
01:15 --> 01:16in the lab and I knew that I
01:18 --> 01:18wanted to go for a
01:18 --> 01:19career in medicine.
01:21 --> 01:23But my career in oncology really
01:23 --> 01:24began when I was an
01:24 --> 01:26MD PhD student in New
01:26 --> 01:27York City at
01:27 --> 01:29Cornell and Rockefeller universities.
01:30 --> 01:31And I was
01:31 --> 01:32working in a lab studying
01:33 --> 01:34gene expression,
01:34 --> 01:36and my mother developed breast
01:36 --> 01:37cancer at that time. I
01:37 --> 01:37don't think I've ever told
01:37 --> 01:38you this. And in the
01:41 --> 01:43late eighties, and
01:44 --> 01:45I sought opinions
01:46 --> 01:47at my hospital and elsewhere.
01:47 --> 01:48I went and reviewed her
01:48 --> 01:48pathology,
01:49 --> 01:50and I just became fascinated
01:50 --> 01:52in oncology and
01:52 --> 01:53some of the
01:53 --> 01:54new therapies that were available
01:54 --> 01:55at that time and the
01:55 --> 01:56research that was going on.
01:56 --> 01:57So I knew I wanted
01:57 --> 01:58to work in cancer, not
01:58 --> 01:59lung cancer. I can tell
01:59 --> 02:00you how that happened. But
02:00 --> 02:01but I knew I wanted
02:01 --> 02:02to be an oncologist, and
02:02 --> 02:04from then on my
02:04 --> 02:05training was focused in that
02:05 --> 02:05way.
02:06 --> 02:07Well,
02:07 --> 02:08perhaps
02:09 --> 02:10not so good for women
02:10 --> 02:11with breast cancer, but very
02:11 --> 02:12good for people with lung
02:12 --> 02:13cancer.
02:13 --> 02:15You became a lung cancer
02:15 --> 02:15specialist.
02:16 --> 02:18And maybe you can just
02:18 --> 02:19tell us a little bit
02:19 --> 02:19about
02:20 --> 02:20what
02:21 --> 02:22lung cancer was like back
02:22 --> 02:23when you
02:24 --> 02:25first were
02:25 --> 02:27a young lung cancer doctor.
02:27 --> 02:28I always wanted to
02:28 --> 02:29train in Boston, so I
02:29 --> 02:30did my
02:31 --> 02:33residency and fellowship in Boston,
02:33 --> 02:34and I was at Dana
02:34 --> 02:35Farber, Cancer Institute.
02:37 --> 02:38And in those days
02:38 --> 02:39actually everyone wanted to
02:39 --> 02:40work in the area of
02:40 --> 02:42breast cancer or leukemia and
02:42 --> 02:43lymphoma. You know, HER2 had
02:43 --> 02:45just been described
02:45 --> 02:46and all the different drugs
02:46 --> 02:48and markers in leukemia and
02:48 --> 02:48lymphoma.
02:49 --> 02:50But there was a job
02:50 --> 02:52available in lung cancer.
02:52 --> 02:53And I actually
02:54 --> 02:55had two wonderful mentors,
02:56 --> 02:57Tom Frye, actually a
02:57 --> 02:58Yale graduate, one
02:58 --> 02:59of the founders of oncology.
03:00 --> 03:01He was in his later
03:01 --> 03:02years and Arthur Skarin, and
03:02 --> 03:03they encouraged me to work
03:03 --> 03:05in a lung cancer clinic.
03:05 --> 03:06And back then, I must
03:06 --> 03:07tell you,
03:07 --> 03:08the reason that job was
03:08 --> 03:10available is because there really
03:10 --> 03:11wasn't much we could offer
03:11 --> 03:12in lung cancer.
03:12 --> 03:13If someone came
03:13 --> 03:14in and the lung cancer
03:14 --> 03:16had already spread, we had
03:16 --> 03:17some chemotherapies
03:17 --> 03:18that were
03:19 --> 03:20moderately effective and
03:20 --> 03:22that's being generous.
03:22 --> 03:23There was no gene therapy,
03:24 --> 03:26targeted therapy, immune therapy, and
03:26 --> 03:26it really was a tough
03:26 --> 03:28time. But I was struck
03:28 --> 03:29by the science and the
03:29 --> 03:30fact that there was a
03:30 --> 03:31good deal of research going
03:31 --> 03:33on in growth factor receptors.
03:34 --> 03:35So I specialized in lung
03:35 --> 03:36cancer for a year.
03:37 --> 03:37And I did
03:37 --> 03:38an extra year as an
03:38 --> 03:40instructor up at Harvard. And,
03:40 --> 03:42I also took a course
03:42 --> 03:43in a program in clinical
03:43 --> 03:45investigation, a master's program there.
03:46 --> 03:46Ironically, I now lead a
03:46 --> 03:48master's program here at Yale
03:48 --> 03:49in a very similar way.
03:49 --> 03:50And during that time, I
03:50 --> 03:51really became fascinated by lung
03:51 --> 03:53cancer. I learned all I
03:53 --> 03:54could about that so that
03:54 --> 03:55when I got my first
03:55 --> 03:57job at MD Anderson Cancer
03:57 --> 03:58Center in Texas,
03:58 --> 04:00I was ready to roll
04:01 --> 04:02with an amazing dynamic group,
04:03 --> 04:04that was just beginning to
04:04 --> 04:05study epidermal growth factor and
04:05 --> 04:07some of the new targeted
04:07 --> 04:08therapies in the disease. So
04:08 --> 04:09it was a tough time,
04:09 --> 04:10but as we'll talk about,
04:10 --> 04:12there's been amazing progress now
04:12 --> 04:13in the last twenty, thirty
04:13 --> 04:14years.
04:14 --> 04:16Before we get to lung
04:16 --> 04:18cancer treatment,
04:18 --> 04:19maybe you could say a
04:19 --> 04:20few words about
04:21 --> 04:22what causes lung cancer. I
04:22 --> 04:24think many people know that
04:24 --> 04:26tobacco is a huge
04:27 --> 04:27carcinogen,
04:28 --> 04:30but maybe you could quantify
04:30 --> 04:31that and tell us just
04:31 --> 04:33how many people develop lung
04:33 --> 04:35cancer each year and
04:35 --> 04:35how much of that is
04:35 --> 04:37related to tobacco use?
04:38 --> 04:39Well, that's changed during the
04:39 --> 04:40course of my thirty year
04:40 --> 04:42career. So when I started
04:42 --> 04:43seeing patients with lung cancer,
04:43 --> 04:44and this was an era
04:44 --> 04:46before we had electronic films,
04:46 --> 04:47people would come
04:47 --> 04:48from Maine or from
04:49 --> 04:51Connecticut or from wherever they
04:51 --> 04:52came to Boston and they'd
04:52 --> 04:53bring a packet of x-ray
04:53 --> 04:54films and you'd often be
04:54 --> 04:55able to smell the smoke
04:55 --> 04:57on those those films because
04:57 --> 04:58it was a disease
04:59 --> 05:00where most people
05:00 --> 05:02were smokers. About eighty percent
05:02 --> 05:04of people smoked, and smoking
05:04 --> 05:05still is the number one
05:05 --> 05:06cause of lung cancer.
05:06 --> 05:07But, since the
05:07 --> 05:09last twenty five years, we
05:09 --> 05:10now know that there are
05:10 --> 05:11people who have not smoked
05:11 --> 05:12or have smoked very little,
05:12 --> 05:14they get lung cancer too.
05:14 --> 05:15And interestingly, it's a very
05:15 --> 05:17different type of lung cancer
05:17 --> 05:18that we treat in very
05:18 --> 05:19specific ways. Other causes of
05:19 --> 05:21lung cancer would be radon
05:21 --> 05:22gas, something many of us
05:22 --> 05:23have to think about, especially
05:23 --> 05:24if you have a basement
05:24 --> 05:26here in Connecticut. I
05:26 --> 05:26know I have a little
05:26 --> 05:27detector down there. I'm not
05:27 --> 05:28sure it works, but I
05:28 --> 05:29got one. And then, of
05:29 --> 05:30course, asbestos,
05:31 --> 05:32another thing we have to
05:32 --> 05:32worry about in some of
05:32 --> 05:34the old homes here.
05:34 --> 05:35And then, of course, pollution
05:35 --> 05:36and where you
05:36 --> 05:38live. But, really what we
05:38 --> 05:39now do is whether you're
05:39 --> 05:40a smoker or nonsmoker, we
05:40 --> 05:41have treatments for lung
05:41 --> 05:42cancer, but they are different.
05:44 --> 05:45And if somebody smoked in the
05:45 --> 05:47past and they've stopped smoking,
05:48 --> 05:49does the risk for lung
05:49 --> 05:51cancer go down? Does it
05:51 --> 05:51persist?
05:52 --> 05:53Oh, it goes
05:53 --> 05:54down.
05:54 --> 05:54And,
05:55 --> 05:56that's why, you know, I
05:56 --> 05:58was very fortunate. So I
05:58 --> 05:59I went to work
05:59 --> 06:00in Houston with a fellow
06:00 --> 06:01named Juan Quihan,
06:02 --> 06:03who was very focused on
06:03 --> 06:05chemo prevention and smoking cessation.
06:06 --> 06:07And he used to talk
06:07 --> 06:08about those good citizens, the
06:08 --> 06:10people that would stop smoking
06:10 --> 06:11and how we could get them to
06:12 --> 06:13stop smoking. And yes, if
06:13 --> 06:15you stop smoking after twenty,
06:15 --> 06:17thirty years, your risk does
06:17 --> 06:18come back down, but it
06:18 --> 06:19takes a long time.
06:20 --> 06:21And it's never quite back
06:21 --> 06:23to the baseline. But, certainly,
06:23 --> 06:25the most important thing is
06:25 --> 06:26smoking cessation, and we've
06:26 --> 06:27done a lot of work
06:27 --> 06:28with that, with
06:28 --> 06:30AACR, with ASCO, the other
06:30 --> 06:31organizations, the societies.
06:31 --> 06:32Here at Yale, we have
06:32 --> 06:34a major smoking cessation program.
06:34 --> 06:36So that's the best way
06:36 --> 06:37to deal with lung cancer,
06:37 --> 06:38to never get it and
06:38 --> 06:40to not smoke.
06:40 --> 06:41That's something that we've
06:41 --> 06:42really focused on and it
06:42 --> 06:44does reduce the risk.
06:45 --> 06:46And if lung cancer is
06:46 --> 06:48caught really early,
06:50 --> 06:52that's a time when surgeons
06:52 --> 06:53get involved as well?
06:55 --> 06:56Yeah, and that's one of the
06:56 --> 06:57things that always attracted me
06:57 --> 06:58to working in this field.
06:58 --> 07:00It's a true multimodality
07:01 --> 07:02field where the medical
07:02 --> 07:04oncologists like myself,
07:04 --> 07:05we give chemotherapy, immunotherapy,
07:06 --> 07:07targeted therapy, work with the
07:07 --> 07:09surgeons and even radiation
07:09 --> 07:10oncologists. And then of course,
07:10 --> 07:12all the science that's involved
07:12 --> 07:13in identifying what type of
07:13 --> 07:14lung cancer there is, but
07:14 --> 07:16yes, early lung cancer can
07:16 --> 07:17be treated with surgery.
07:17 --> 07:18That means you have to
07:18 --> 07:19find it early.
07:19 --> 07:20The problem with lung cancer
07:20 --> 07:21is more than fifty percent
07:21 --> 07:23of the time at diagnosis,
07:23 --> 07:24it's already spread
07:24 --> 07:26to the liver, the bone,
07:26 --> 07:27the other lung,
07:27 --> 07:28dare I say the brain.
07:28 --> 07:29So there are a
07:29 --> 07:30lot of concerns there, so
07:30 --> 07:31we have to find it
07:31 --> 07:33early.
07:33 --> 07:34know, the thing that, you
07:34 --> 07:35The thing we're doing now is
07:35 --> 07:36screening.
07:36 --> 07:37The screening has become a
07:37 --> 07:38major
07:38 --> 07:40force in this field
07:40 --> 07:41and, of course, you know,
07:41 --> 07:42many of the hospitals do
07:42 --> 07:43it. We do it here
07:43 --> 07:44at Yale. And it's very
07:44 --> 07:45important to find it early
07:45 --> 07:46because if you find it
07:46 --> 07:48early, not only can you
07:48 --> 07:50cut it out, and hopefully
07:50 --> 07:51get it all out, there's
07:51 --> 07:52still a risk of recurrence,
07:52 --> 07:53but we have other therapies
07:53 --> 07:54that we can now do
07:54 --> 07:55in a personalized way to
07:55 --> 07:57reduce that as well. So
07:57 --> 07:58early detection is clearly the
07:58 --> 07:59key
07:59 --> 08:00to treating lung cancer as
08:00 --> 08:01it is, of course, with
08:01 --> 08:02almost every cancer.
08:03 --> 08:04We'll get back to
08:04 --> 08:05screening a little bit later
08:05 --> 08:07because I think one of
08:07 --> 08:08the unfortunate things is that
08:08 --> 08:09not everyone
08:09 --> 08:11gets screening who should get
08:11 --> 08:11screening.
08:12 --> 08:12But
08:13 --> 08:14are there patients now who
08:15 --> 08:16have early enough lung cancer
08:16 --> 08:18that they just get surgery?
08:18 --> 08:19Yeah.
08:20 --> 08:21You know, lung cancer is in
08:21 --> 08:23stages one, two, three,
08:23 --> 08:24and four. I don't need
08:24 --> 08:24to go through all the
08:24 --> 08:25details. But let's say you
08:25 --> 08:26have a stage one lung
08:26 --> 08:28cancer. That's commonly found you're
08:28 --> 08:29going in for a hernia
08:29 --> 08:31repair or some other procedure.
08:31 --> 08:32You get a chest X-ray.
08:32 --> 08:33You're found that you have
08:33 --> 08:35a small nodule
08:35 --> 08:37in the lung, maybe it's
08:38 --> 08:39a centimeter or two,
08:40 --> 08:41those would be stage one
08:41 --> 08:43disease assuming there's no spread
08:43 --> 08:45locally to lymph nodes.
08:45 --> 08:47That has about an eighty,
08:47 --> 08:49ninety percent chance of cure.
08:49 --> 08:50So,
08:51 --> 08:52those patients might just have
08:52 --> 08:53surgery alone, and then we'll
08:53 --> 08:55follow them on a every
08:55 --> 08:56six month or yearly basis.
08:56 --> 08:58The problem is oftentimes we'll
08:58 --> 09:00find some evidence of spread,
09:00 --> 09:01maybe a local lymph
09:01 --> 09:02node, one of the way
09:02 --> 09:03stations where the cancer cells
09:03 --> 09:04might
09:04 --> 09:05deposit,
09:06 --> 09:07or we might find that
09:07 --> 09:07the cancer has gone to
09:07 --> 09:09a lymph node on the
09:09 --> 09:10other side of the lung.
09:10 --> 09:10And then we have to
09:10 --> 09:12sort of evoke, you know,
09:12 --> 09:13the full multimodality
09:13 --> 09:15approach, bring in
09:15 --> 09:16chemotherapy and
09:17 --> 09:18radiation
09:19 --> 09:21therapy. But now, of course,
09:21 --> 09:22we would profile
09:22 --> 09:23the tumor and we would
09:23 --> 09:24try to understand, can we
09:24 --> 09:24treat it with one of
09:24 --> 09:26these new targeted agents,
09:27 --> 09:28which are more commonly used
09:28 --> 09:29in people who have smoked
09:29 --> 09:31very little?
09:31 --> 09:33And when you say profiling the tumor, what
09:33 --> 09:34exactly do you mean by
09:34 --> 09:35that?
09:35 --> 09:37Well, you know, it's really
09:37 --> 09:38not lung cancer. It's lung
09:38 --> 09:39cancers.
09:39 --> 09:41Everyone's cancer is a little
09:41 --> 09:42different, and,
09:42 --> 09:44you know, the engine that's
09:44 --> 09:45causing that tumor to grow
09:45 --> 09:46is different.
09:46 --> 09:48There might be an abnormality
09:48 --> 09:49in one piece
09:49 --> 09:51of DNA versus another.
09:51 --> 09:54So nowadays, in twenty twenty
09:54 --> 09:55five, we didn't
09:55 --> 09:57know this in nineteen ninety
09:57 --> 09:58seven when I started this.
09:58 --> 09:59But in twenty twenty five,
09:59 --> 10:00we can actually take the
10:00 --> 10:02tumor. We get a biopsy.
10:03 --> 10:03We send it off to
10:03 --> 10:04the lab. It takes about
10:04 --> 10:05a week, maybe a
10:05 --> 10:06week and a half or
10:06 --> 10:07two. And we actually
10:08 --> 10:09can look at a whole
10:09 --> 10:11series of genetic alterations
10:11 --> 10:12that we know can cause
10:12 --> 10:13this lung cancer.
10:14 --> 10:15And then it really is
10:15 --> 10:16a personalized treatment we can
10:16 --> 10:18give the patient because it's
10:18 --> 10:19the right treatment for the
10:19 --> 10:21right abnormality at the right
10:21 --> 10:22time. And that
10:22 --> 10:24includes mutations in
10:24 --> 10:25a gene, for example, that's
10:25 --> 10:27called epidermal growth factor receptor.
10:27 --> 10:29We actually just celebrated twenty
10:29 --> 10:30years last year,
10:30 --> 10:31of the discovery of the
10:31 --> 10:32mutation,
10:32 --> 10:33which has truly changed the
10:33 --> 10:35way we treat this disease.
10:35 --> 10:36Because if someone has that
10:36 --> 10:36abnormality
10:37 --> 10:38and we find it in
10:38 --> 10:40the advanced state, we can
10:40 --> 10:41use an oral drug
10:41 --> 10:43and prolong their life
10:43 --> 10:44or in the early stage,
10:44 --> 10:45you can even use that
10:45 --> 10:46drug to potentially even cure
10:46 --> 10:48their cancer. So, it's really
10:48 --> 10:50important that we know exactly
10:50 --> 10:51what type of lung cancer
10:51 --> 10:53someone has. Now, someone who
10:53 --> 10:54might've smoked a lot or,
10:54 --> 10:56had smoked in the past
10:56 --> 10:56and stopped
10:57 --> 10:58and doesn't have any of
10:58 --> 10:59these actionable, what we call
10:59 --> 11:00mutations,
11:00 --> 11:02still has a great
11:02 --> 11:03chance at good therapy now
11:03 --> 11:04because they're someone we might
11:04 --> 11:06use immunotherapy for.
11:06 --> 11:07And we'll get to immunotherapy
11:08 --> 11:09because you've done a lot
11:09 --> 11:10of work in that area,
11:11 --> 11:12in just a few
11:12 --> 11:13minutes or maybe in the
11:13 --> 11:15second half of this show.
11:15 --> 11:16But
11:17 --> 11:19eGFR, which was the
11:19 --> 11:21first of these genetic changes
11:21 --> 11:22that was identified
11:23 --> 11:24is present in
11:25 --> 11:26what percentage of patients with
11:26 --> 11:28lung cancer in the United
11:28 --> 11:29States? Because it's different in
11:29 --> 11:31different countries around the world.
11:31 --> 11:32Oh, absolutely. In the United
11:32 --> 11:33States, it's about
11:34 --> 11:36ten to fifteen percent
11:36 --> 11:38of lung cancers, which
11:38 --> 11:39if you think of lung
11:39 --> 11:40cancer, you know, which is
11:40 --> 11:41still the number one cause
11:41 --> 11:43of cancer death being two
11:43 --> 11:44hundred and fifty thousand,
11:45 --> 11:46patients a year in the
11:46 --> 11:47United States. That's a lot
11:47 --> 11:47of patients.
11:48 --> 11:48So we look for it
11:50 --> 11:51and there are
11:51 --> 11:53about nine other similar
11:53 --> 11:54alterations.
11:54 --> 11:55I won't go through every
11:55 --> 11:57one in detail today, but
11:57 --> 11:58that if we know about
11:58 --> 11:58it, we can try to
11:58 --> 11:59pair a patient with a
11:59 --> 12:01specific drug. But, by the
12:01 --> 12:02way, if you go to
12:02 --> 12:04China or Japan,
12:04 --> 12:06Vietnam, the rates can
12:06 --> 12:07be as high as thirty
12:07 --> 12:08percent or more. So there's
12:08 --> 12:10something about, East Asia. We're
12:10 --> 12:11still trying to figure that
12:11 --> 12:12out where it's much more
12:12 --> 12:13common.
12:14 --> 12:15And those other
12:16 --> 12:17nine or the other eight,
12:20 --> 12:21in total, are they similar
12:21 --> 12:22to eGFR?
12:23 --> 12:24No. Well, they're similar in
12:24 --> 12:26that the majority of them,
12:26 --> 12:27we see the same response,
12:27 --> 12:28meaning we can give the
12:28 --> 12:30pill and the patient benefits.
12:31 --> 12:31But,
12:31 --> 12:33they're much less frequent.
12:33 --> 12:35The next one down
12:35 --> 12:36from eGFR is something called
12:36 --> 12:38ALK, and
12:38 --> 12:39then a little bit less
12:39 --> 12:40than that RAS one. But
12:40 --> 12:41then we're getting into one
12:41 --> 12:42to two percent.
12:42 --> 12:43Now ALK is like
12:43 --> 12:45four percent? Three or four
12:45 --> 12:45percent.
12:47 --> 12:48And aggregate, they all get
12:48 --> 12:50to about twenty percent. Now
12:50 --> 12:51this is important.
12:51 --> 12:52Even if it's
12:52 --> 12:53only one percent, one percent
12:53 --> 12:54of two hundred and fifty
12:54 --> 12:56thousand patients a year, and
12:56 --> 12:57worldwide, two million patients a
12:57 --> 12:58year, is still a lot,
12:58 --> 12:59but we have to find
12:59 --> 13:00it. And I'll leave you
13:00 --> 13:01this. We have to find
13:01 --> 13:02it in all patients. No
13:02 --> 13:03matter where you live, who
13:03 --> 13:05you are, if we don't
13:05 --> 13:07get the cancer biopsy and
13:07 --> 13:08send it to the lab,
13:08 --> 13:09we'll never have these options.
13:09 --> 13:10So the most important thing
13:10 --> 13:11I can leave you with
13:11 --> 13:12tonight is we really need
13:12 --> 13:13to find a way to
13:13 --> 13:15screen all patients so that
13:15 --> 13:16we know who has these
13:16 --> 13:17abnormalities so we can treat
13:17 --> 13:18them in more specific ways.
13:18 --> 13:19And that's a big part
13:19 --> 13:20of our research here at Yale.
13:21 --> 13:23There's still plenty of patients
13:23 --> 13:25in the United States alone
13:25 --> 13:26who don't get this kind
13:26 --> 13:28of detailed evaluation of their
13:28 --> 13:30lung cancers.
13:30 --> 13:31Better than it used to be because
13:31 --> 13:32people know to refer patients
13:32 --> 13:33with lung cancer. But there
13:33 --> 13:34are many patients who might
13:34 --> 13:35never get a biopsy, never
13:35 --> 13:37may never get a profile.
13:37 --> 13:38I'd say there are fifteen,
13:38 --> 13:39twenty percent still that
13:39 --> 13:41don't have that. And it's
13:41 --> 13:42really important to know that
13:42 --> 13:43because this is how we
13:43 --> 13:44treat in the most aggressive
13:44 --> 13:46way. Now it might be
13:46 --> 13:47that someone's so sick they
13:47 --> 13:48never get the biopsy, but
13:48 --> 13:49this is why finding it
13:49 --> 13:51early, getting the biopsy and
13:51 --> 13:53then using that information to
13:53 --> 13:55treat, that's what really raises
13:55 --> 13:56the bar and improves care
13:56 --> 13:57for all patients.
13:58 --> 13:59Well, we're gonna
13:59 --> 14:01take just a very brief
14:01 --> 14:03break, and we will be
14:03 --> 14:04back in a minute
14:04 --> 14:05and spend
14:06 --> 14:08some additional time with doctor
14:08 --> 14:09Roy Herbst
14:10 --> 14:10who is
14:12 --> 14:13the Ensign professor of medicine
14:14 --> 14:15at Yale School of Medicine.
14:16 --> 14:18Funding for Yale Cancer Answers
14:18 --> 14:20comes from Smilow Cancer Hospital,
14:20 --> 14:21where their hematology
14:21 --> 14:24program offers comprehensive diagnosis and
14:24 --> 14:26treatment of blood cancers, including
14:26 --> 14:28lymphoma, leukemia, and myeloma.
14:28 --> 14:29Smilowcancerhospital
14:30 --> 14:31dot org.
14:33 --> 14:34There are over sixteen point
14:34 --> 14:36nine million cancer survivors in
14:36 --> 14:38the US and over two
14:38 --> 14:39hundred and forty thousand here
14:39 --> 14:40in Connecticut.
14:41 --> 14:42Completing treatment for cancer is
14:42 --> 14:44a very exciting milestone, but
14:44 --> 14:46cancer and its treatment can
14:46 --> 14:47be a life changing experience.
14:48 --> 14:50The return to normal activities
14:50 --> 14:51and relationships may be difficult
14:52 --> 14:53and cancer survivors may face
14:53 --> 14:55other long term side effects
14:55 --> 14:56of cancer,
14:56 --> 14:58including heart problems,
14:58 --> 14:58osteoporosis,
14:59 --> 15:01fertility issues, and an increased
15:01 --> 15:03risk of second cancers.
15:04 --> 15:05Resources for cancer survivors are
15:05 --> 15:08available at federally designated comprehensive
15:08 --> 15:09cancer centers,
15:09 --> 15:11such as the Yale Cancer
15:11 --> 15:13Center and Smilow Cancer
15:13 --> 15:13Hospital
15:13 --> 15:15to keep cancer survivors well
15:15 --> 15:17and focused on healthy living.
15:17 --> 15:20The Smilow Cancer Hospital survivorship
15:20 --> 15:22clinic focuses on providing guidance
15:22 --> 15:23and direction
15:23 --> 15:25to empower survivors to take
15:25 --> 15:27steps to maximize their health,
15:27 --> 15:28quality of life, and longevity.
15:29 --> 15:31More information is available at
15:31 --> 15:32yale cancer center dot org.
15:33 --> 15:34You're listening to Connecticut Public
15:34 --> 15:35Radio.
15:36 --> 15:36Hello again.
15:37 --> 15:39This is Eric Winer
15:39 --> 15:41here with Yale Cancer Answers,
15:41 --> 15:43and we're gonna be speaking
15:43 --> 15:44with
15:44 --> 15:46Roy Herbst, who is the
15:46 --> 15:47Ensign professor of medicine,
15:48 --> 15:50deputy dean of Yale
15:50 --> 15:51Cancer Center.
15:51 --> 15:53We're talking about lung cancer,
15:53 --> 15:55and we're talking about lung
15:55 --> 15:56cancer treatment.
15:56 --> 15:58So we were just
15:58 --> 16:00talking about some of the
16:00 --> 16:02genetic changes that lead to
16:02 --> 16:04targeted therapies for lung cancer,
16:05 --> 16:06talking about the fact that
16:06 --> 16:08it's really important to
16:08 --> 16:11sort out which genetic changes
16:11 --> 16:13are present in which patients.
16:13 --> 16:15And Roy, without this, you're
16:15 --> 16:16really functioning in the dark
16:16 --> 16:18if you don't have that
16:18 --> 16:18kind of profiling.
16:20 --> 16:21Oh, absolutely. You know, we
16:21 --> 16:23like to say science drives
16:23 --> 16:24the best care.
16:24 --> 16:26It's like
16:26 --> 16:27if you brought your car
16:27 --> 16:28in, you'd wanna know what
16:28 --> 16:29was wrong with the engine
16:29 --> 16:30and fix it in
16:30 --> 16:32the right way. So that's
16:32 --> 16:33what we're doing here. But
16:33 --> 16:34I just wanna say one
16:34 --> 16:36thing, Eric. As good as
16:36 --> 16:37these targeted therapies are, and
16:37 --> 16:38I was very
16:38 --> 16:40fortunate to be one of
16:40 --> 16:41the first to use these
16:41 --> 16:42when I was in Houston,
16:42 --> 16:43twenty five plus
16:43 --> 16:44years ago,
16:45 --> 16:47very rarely does someone go
16:47 --> 16:48forever on these drugs.
16:49 --> 16:51Tumors, unfortunately, are evil.
16:51 --> 16:52They learn how to
16:52 --> 16:54become resistant. So we're constantly
16:54 --> 16:56looking for ways to overcome
16:56 --> 16:57that resistance. And I'll just
16:57 --> 16:58say that's a big part
16:58 --> 16:59of our research, and that's
16:59 --> 17:00why clinical trials are so
17:00 --> 17:02important because we're always trying
17:02 --> 17:03to do a little bit
17:03 --> 17:06better. So, nowadays, you know,
17:06 --> 17:07we have clinical trials and
17:07 --> 17:08they're available throughout the country
17:08 --> 17:09around the world, but we
17:09 --> 17:10need clinical trials to try
17:10 --> 17:12to understand how to even
17:12 --> 17:13do better. So that's
17:13 --> 17:14part of the goal
17:14 --> 17:15of research in lung cancer
17:15 --> 17:16these days.
17:19 --> 17:20Even
17:21 --> 17:23sometimes the dumbest tumors
17:24 --> 17:26are smarter than the smartest
17:26 --> 17:26oncologists.
17:28 --> 17:29And that means that they
17:29 --> 17:30figure out ways to get
17:30 --> 17:32around the treatments that we
17:32 --> 17:34put in their way. Although
17:34 --> 17:34increasingly,
17:35 --> 17:37we're more and more successful
17:37 --> 17:38than we were at one
17:38 --> 17:40time.
17:40 --> 17:42So chemotherapy
17:42 --> 17:43used to be
17:43 --> 17:44the back bone of the
17:44 --> 17:45treatment or
17:46 --> 17:47the main treatment. Now it's
17:47 --> 17:48sort of playing
17:49 --> 17:50a secondary role. We still
17:50 --> 17:51use it, but
17:52 --> 17:53we think about these other
17:53 --> 17:54treatments.
17:54 --> 17:55Maybe we can turn now
17:55 --> 17:57and talk about immunotherapy.
17:57 --> 17:59You've been very involved in
17:59 --> 18:01immunotherapy clinical trials over the
18:01 --> 18:02years.
18:02 --> 18:04And lung cancer is one
18:04 --> 18:05of those diseases
18:06 --> 18:07or at least some lung
18:07 --> 18:08cancers where immunotherapy
18:09 --> 18:11has had a huge benefit.
18:12 --> 18:13Oh, it's incredible.
18:13 --> 18:14Well, you know, it's
18:14 --> 18:15actually funny. You talk about
18:15 --> 18:17the evolution of a career.
18:17 --> 18:18So I was
18:18 --> 18:19leading the lung cancer group
18:19 --> 18:20at MD Anderson for many
18:20 --> 18:21years and did a lot
18:21 --> 18:22of the early work with
18:22 --> 18:24targeted therapy, but I really
18:24 --> 18:25first learned about immunotherapy here
18:25 --> 18:26at Yale.
18:27 --> 18:29I'm here fourteen years now.
18:29 --> 18:30And when I came here,
18:30 --> 18:32Yale, maybe Johns Hopkins, those
18:32 --> 18:33were the places people were
18:33 --> 18:35coming back in two thousand
18:35 --> 18:36ten, two thousand eleven for
18:36 --> 18:37a drug known as nivolumab,
18:38 --> 18:39the first
18:39 --> 18:40inhibitor of
18:41 --> 18:43a checkpoint called PD1
18:43 --> 18:45And, basically, the idea
18:45 --> 18:46is that you have a
18:46 --> 18:48tumor, and you would think
18:48 --> 18:49that the immune system would
18:50 --> 18:51eliminate that tumor, and it
18:51 --> 18:52should because the tumor is
18:52 --> 18:54a foreign body in
18:54 --> 18:55the blood. But the tumor
18:55 --> 18:56has a force field
18:56 --> 18:57that keeps that immune cell
18:57 --> 18:58away.
18:58 --> 19:00And these drugs actually,
19:00 --> 19:02you know, attack and
19:02 --> 19:03overcome that
19:03 --> 19:04resistance.
19:04 --> 19:06And the first early trials
19:06 --> 19:07were done here, and
19:07 --> 19:08I remember when I first
19:08 --> 19:09arrived, I was
19:09 --> 19:11very fortunate with Mario Sznol,
19:11 --> 19:13Scott Gettinger, Harriet Kluger,
19:14 --> 19:15Lieping Chen, you know,
19:15 --> 19:16one of the discoverers of
19:16 --> 19:17PDL one had just arrived.
19:17 --> 19:18We had a nucleus of
19:18 --> 19:19people, and it's just been
19:19 --> 19:21wonderful running trials
19:21 --> 19:23and doing laboratory research to
19:23 --> 19:24really try to
19:25 --> 19:26help patients with lung cancer,
19:26 --> 19:28melanoma, renal cancer, many cancers.
19:28 --> 19:29But lung cancer is one
19:29 --> 19:30of the cancers
19:30 --> 19:32where immune therapy really does
19:32 --> 19:32have an impact.
19:34 --> 19:35I would say that we
19:35 --> 19:36can cure people with lung
19:36 --> 19:38cancer, with immunotherapy. The problem
19:38 --> 19:39is it's only about ten
19:39 --> 19:41percent.
19:41 --> 19:42We're constantly trying
19:42 --> 19:43to do better, but many
19:43 --> 19:45more patients do benefit.
19:45 --> 19:46And if we could figure
19:46 --> 19:47out how to even do
19:47 --> 19:49better, I think it'll be
19:49 --> 19:50tremendous.
19:51 --> 19:52You know, I often say
19:52 --> 19:54that what makes cancer so
19:54 --> 19:55challenging
19:56 --> 19:57is that it is both
19:57 --> 19:58a foreign body, but it's
19:58 --> 20:00also a foreign body that
20:00 --> 20:01came from us.
20:01 --> 20:03We gave birth to it.
20:03 --> 20:05It arose in us. And
20:06 --> 20:07maybe that's part of the
20:07 --> 20:09reason why cancer has figured
20:09 --> 20:10out how to
20:10 --> 20:12make these substances
20:12 --> 20:13that tell the immune system
20:14 --> 20:15to just stay away.
20:16 --> 20:17Right. If we
20:17 --> 20:17don't regulate
20:18 --> 20:20the immune system,
20:20 --> 20:22think about getting poison ivy.
20:22 --> 20:23That's an immune reaction. Imagine
20:23 --> 20:25if the immune system
20:25 --> 20:26went wild against normal
20:26 --> 20:27organs, it does. Those are
20:27 --> 20:28what we call autoimmune diseases,
20:30 --> 20:30thyroiditis
20:31 --> 20:32and lupus and other things.
20:32 --> 20:33So, yeah,
20:34 --> 20:35the body is just
20:35 --> 20:37fantastic how things present to
20:37 --> 20:38the immune system in the
20:38 --> 20:40context of self, but
20:40 --> 20:40there has to be
20:40 --> 20:41a way to regulate it.
20:43 --> 20:44It is amazing to think about the
20:44 --> 20:45evolution of this.
20:46 --> 20:47Yeah. And, of course, we
20:47 --> 20:49want the immune system
20:49 --> 20:51to attack the cancer
20:51 --> 20:52like crazy,
20:52 --> 20:53but we don't want the
20:53 --> 20:55immune system to start attacking
20:55 --> 20:55us.
20:56 --> 20:57Right. And you think
20:57 --> 20:58about it, the immune system,
20:58 --> 20:59what could be more specific,
21:00 --> 21:01what could be more adaptive?
21:03 --> 21:04And the key thing about the immune
21:04 --> 21:06system is memory. So it's
21:06 --> 21:06just like we give a
21:06 --> 21:08vaccine. We want a specific
21:08 --> 21:10and an adaptive
21:10 --> 21:11and a memory response.
21:11 --> 21:12We can get that in
21:12 --> 21:13cancer.
21:13 --> 21:14And and I'll tell you,
21:15 --> 21:16some of the early experiences
21:16 --> 21:17I had with immunotherapy here,
21:17 --> 21:19working with our team,
21:19 --> 21:21we were very fortunate because
21:21 --> 21:22one of the things we
21:22 --> 21:22were able to do is
21:22 --> 21:23we were able to get
21:23 --> 21:24biopsies on patients who are
21:24 --> 21:26getting these drugs because, you
21:26 --> 21:27know, we wanna see these
21:27 --> 21:29drugs work. But to understand
21:29 --> 21:29how they'll work for more
21:29 --> 21:31patients, we wanna understand why
21:31 --> 21:32they work in some and
21:32 --> 21:33not others. And by doing
21:33 --> 21:34some of this work
21:34 --> 21:36as part of our
21:36 --> 21:37SPORE, our specialized program of
21:37 --> 21:39research excellence in lung cancer
21:39 --> 21:40here, we actually have learned
21:40 --> 21:41what are some
21:41 --> 21:42of the markers that tell
21:42 --> 21:43you who might benefit more
21:43 --> 21:45or less. And over the
21:45 --> 21:46years, immune therapy
21:46 --> 21:47is really a staple
21:47 --> 21:48for most patients with lung
21:48 --> 21:50cancer. But interestingly,
21:51 --> 21:52in the smokers, not the
21:52 --> 21:53never smokers. So the people
21:53 --> 21:55that have never smoked tend
21:55 --> 21:56to have these other
21:57 --> 21:58mutations. They actually don't do
21:58 --> 22:00as well with immunotherapy.
22:01 --> 22:03It's because
22:03 --> 22:05their tumor is being run
22:05 --> 22:06by these one or two
22:06 --> 22:08mutations that they got genetically,
22:08 --> 22:10but there aren't enough abnormalities
22:10 --> 22:12to stimulate the immune system
22:12 --> 22:12as in someone who might
22:12 --> 22:14have smoked a lot.
22:14 --> 22:15Don't anyone go out
22:15 --> 22:16and start smoking. It's not
22:16 --> 22:17gonna help you with your
22:17 --> 22:19lung cancer treatment. But it
22:20 --> 22:21is really dichotomized
22:21 --> 22:23lung cancer treatment in into
22:23 --> 22:25different ways. And, we're actually
22:25 --> 22:26working out to figure out
22:26 --> 22:27how to use immune approaches
22:27 --> 22:28for people who have never
22:28 --> 22:30smoked as well. But I'll
22:30 --> 22:32tell you, I've seen people,
22:32 --> 22:33you know, thinking back to
22:33 --> 22:34my days in the Dana
22:34 --> 22:35Farber, who back then would
22:35 --> 22:36have gotten chemotherapy
22:36 --> 22:38with many side effects and
22:38 --> 22:39would have lived just a
22:39 --> 22:41very short period of time,
22:41 --> 22:42people that are coming back
22:42 --> 22:44three, four, five years later.
22:44 --> 22:45It really has made lung
22:45 --> 22:46cancer,
22:46 --> 22:48as for me as a
22:48 --> 22:49someone who comes in every
22:49 --> 22:51day excited to see patients
22:51 --> 22:53and do research, something where
22:53 --> 22:54we really can I
22:54 --> 22:56feel that progress myself during
22:56 --> 22:56my own career.
22:57 --> 22:59And to what extent have
22:59 --> 23:01lung cancer deaths gone down?
23:01 --> 23:02And some of it is
23:02 --> 23:04about the decline in smoking,
23:05 --> 23:05and some of it is
23:05 --> 23:07about more effective therapy,
23:08 --> 23:09but it has really had
23:09 --> 23:11a tangible effect.
23:11 --> 23:13Yeah. You know, these
23:13 --> 23:14data that come from
23:14 --> 23:15the American Cancer Society
23:16 --> 23:17tend to lag by about
23:17 --> 23:18four or five years.
23:19 --> 23:20The last big cut of
23:20 --> 23:21data we had showed incidence
23:22 --> 23:24decreasing by two, three percent
23:24 --> 23:25a year and mortality going
23:25 --> 23:26down by about three to
23:26 --> 23:27five percent a year. So
23:27 --> 23:29it's not just not smoking
23:30 --> 23:32and better public health,
23:32 --> 23:33but it's also the
23:34 --> 23:35drugs. And what we've seen
23:35 --> 23:36in the past is probably
23:36 --> 23:38just the targeted therapy approach.
23:38 --> 23:39I think the immunotherapy numbers
23:39 --> 23:40we'll probably see in the
23:40 --> 23:41next year or two because
23:41 --> 23:43really immunotherapy only became
23:43 --> 23:45standard of care in this
23:45 --> 23:45country.
23:46 --> 23:47It's barely ten years, but it
23:50 --> 23:52really has changed the
23:52 --> 23:52way we think of this
23:52 --> 23:53disease.
23:53 --> 23:55And it's important, therefore, that
23:55 --> 23:57one really understand
23:57 --> 23:58what type of cancer they
23:58 --> 23:59have,
23:59 --> 24:01and what multimodality
24:01 --> 24:02therapies they need.
24:02 --> 24:03One thing I wanna
24:03 --> 24:05bring up is we now
24:05 --> 24:06know that if we use
24:06 --> 24:07the immunotherapy in the earliest
24:07 --> 24:08stages of disease,
24:09 --> 24:10not when someone comes in
24:10 --> 24:11with a lung cancer already
24:11 --> 24:12having spread, and if that
24:12 --> 24:13happens, we can deal with
24:13 --> 24:14it. But if we find
24:14 --> 24:15the lung cancer, when it's
24:15 --> 24:17still localized in the lung
24:17 --> 24:18or perhaps to some lymph
24:18 --> 24:19nodes in the lung, we
24:19 --> 24:20can actually give the immunotherapy,
24:21 --> 24:22sometimes with chemotherapy,
24:22 --> 24:23before surgery.
24:25 --> 24:26We have a tumor board
24:26 --> 24:27here once a week, and
24:27 --> 24:28it amazes me when the
24:28 --> 24:28surgeons
24:29 --> 24:30tell us what they've seen.
24:30 --> 24:31They go into one of
24:31 --> 24:32these patients after they've had
24:32 --> 24:34this chemotherapy, immunotherapy,
24:34 --> 24:35and the tumor's gone. Or if there's
24:36 --> 24:37something there, when you look
24:37 --> 24:39at it in the pathology
24:39 --> 24:40lab, all the cancer cells
24:40 --> 24:41are dead.
24:41 --> 24:42So it really is a
24:42 --> 24:43very powerful treatment that you
24:43 --> 24:45can use before surgery to
24:45 --> 24:47really kill that tumor and
24:47 --> 24:48make for a much better
24:48 --> 24:50result. So this is why
24:50 --> 24:51multimodality
24:51 --> 24:53therapy, knowing what you're dealing
24:53 --> 24:54with, the right treatment at
24:54 --> 24:55the right time,
24:55 --> 24:56you know, it makes
24:56 --> 24:57a difference.
24:57 --> 24:58I think that
24:58 --> 25:00lung cancer is just, you
25:00 --> 25:01know, one of the most
25:01 --> 25:04prominent examples of how cancer
25:04 --> 25:05therapeutics have just
25:05 --> 25:07changed and been revolutionized over
25:07 --> 25:08the past
25:09 --> 25:11ten, fifteen, twenty years. But
25:11 --> 25:12we're not done. And
25:12 --> 25:13that's the thing.
25:14 --> 25:16It's not always apparent to people,
25:16 --> 25:17you know, because
25:17 --> 25:18you come in with that
25:18 --> 25:19cancer. You wanna find the
25:19 --> 25:21best therapy. So, again, I'm
25:21 --> 25:22gonna say it.
25:22 --> 25:23This is why the clinical
25:23 --> 25:25trials that we were running
25:25 --> 25:26here at Yale in two
25:26 --> 25:27thousand eleven are now the
25:27 --> 25:28standard of care immunotherapy.
25:29 --> 25:30And you can only get
25:30 --> 25:31immunotherapy from two thousand eleven
25:31 --> 25:32to two thousand,
25:33 --> 25:33fifteen
25:34 --> 25:35on a clinical trial. So
25:35 --> 25:36that's why you
25:36 --> 25:37and I both know it's
25:37 --> 25:39important to ask good questions
25:39 --> 25:41and continue to add new
25:41 --> 25:43drugs or understand mechanisms of
25:43 --> 25:44cancer growth better so that
25:44 --> 25:45we can be even more
25:45 --> 25:45effective.
25:46 --> 25:47And I think
25:47 --> 25:48people need to understand that
25:48 --> 25:50although progress has been made,
25:51 --> 25:52we still have a lot
25:52 --> 25:53of work to do, and
25:53 --> 25:54this is the time not
25:54 --> 25:55to put on the brakes,
25:55 --> 25:57but to step hard on
25:57 --> 25:59the accelerator of cancer research
25:59 --> 26:00because that's how we're gonna
26:00 --> 26:02really change the field even
26:02 --> 26:04further in the next two
26:04 --> 26:05decades.
26:05 --> 26:06I've been telling our students and
26:06 --> 26:08fellows, you know, cancer is
26:08 --> 26:09not a political
26:10 --> 26:12disease. It's not Republican or
26:12 --> 26:14Democrat. It's personal. Everyone
26:14 --> 26:15can be touched by cancer,
26:15 --> 26:16so we have to put
26:16 --> 26:17all of our efforts to
26:17 --> 26:18fight this disease in
26:18 --> 26:18the most
26:19 --> 26:20aggressive way.
26:20 --> 26:22So let's circle back
26:22 --> 26:23to lung cancer screening.
26:24 --> 26:25We've known for a number
26:25 --> 26:27of years that for people
26:27 --> 26:29who have smoked and are
26:29 --> 26:31at higher than usual risk,
26:31 --> 26:33that screening really makes a
26:33 --> 26:33difference.
26:34 --> 26:36But pretty few people get
26:36 --> 26:37screening. It's not like mammography.
26:37 --> 26:40It's not even like colonoscopy
26:40 --> 26:41or other techniques that we
26:41 --> 26:43use to screen for colon
26:43 --> 26:43cancer.
26:43 --> 26:44Only the
26:45 --> 26:46smallest minority of people get
26:46 --> 26:47lung cancer screening.
26:48 --> 26:49Tell us about that and
26:49 --> 26:51and why you think that
26:52 --> 26:53more people don't get screening.
26:54 --> 26:55Right. Well, first of all,
26:55 --> 26:57the data are quite
26:57 --> 26:58clear, both
26:58 --> 27:00from the US as well as
27:01 --> 27:02international databases
27:02 --> 27:03that if you find cancer
27:03 --> 27:04early,
27:04 --> 27:05especially now with all the
27:05 --> 27:06new treatments we're talking about,
27:06 --> 27:08we can make a difference.
27:08 --> 27:09And right now in the
27:09 --> 27:11US, most recommendations would say
27:11 --> 27:12people ages fifty to eighty
27:12 --> 27:13years old
27:13 --> 27:14who have smoked at least
27:14 --> 27:16twenty pack years, meaning one
27:16 --> 27:17pack a day for twenty
27:17 --> 27:18years or two packs a
27:18 --> 27:19day for ten years, and
27:19 --> 27:21they're either a current or
27:21 --> 27:22a former smoker within fifteen
27:22 --> 27:24years, should get screened. You
27:24 --> 27:25can make a case that
27:25 --> 27:26you should expand that, but
27:26 --> 27:27let's just focus on this
27:27 --> 27:29group. And why are only
27:29 --> 27:30five to seven percent or
27:30 --> 27:31so of eligible patients getting
27:31 --> 27:32screened?
27:32 --> 27:33A lot of reasons.
27:34 --> 27:35You know, as opposed
27:35 --> 27:37to colon cancer screening, which
27:37 --> 27:39everyone should have,
27:39 --> 27:41or breast cancer screening, which
27:41 --> 27:42we would recommend.
27:42 --> 27:44Lung cancer screening, when you
27:44 --> 27:46find something, it's
27:46 --> 27:47not as easy to go
27:47 --> 27:48in and do a
27:48 --> 27:50sampling. NOTE Confidence: 0.9217854
27:50 --> 27:51In colonoscopy,
27:51 --> 27:52usually, you wake up and
27:52 --> 27:54they tell you, well, we
27:54 --> 27:55found something. We've taken it
27:55 --> 27:56out. We've made the determination.
27:57 --> 27:59With breast cancer biopsies, I
27:59 --> 28:00I'm talking to you. You
28:00 --> 28:01know better than me. But,
28:01 --> 28:02in my experience,
28:02 --> 28:03you can do a biopsy
28:03 --> 28:04sometimes right in the clinic
28:04 --> 28:05that day, even do an
28:05 --> 28:06ultrasound and do
28:06 --> 28:07the biopsy. But with lung
28:07 --> 28:08cancer, it's a little bit
28:08 --> 28:09more complicated.
28:09 --> 28:10I also think that we
28:10 --> 28:11we need
28:11 --> 28:13to spread the word more,
28:13 --> 28:15and that's important. Until recently,
28:15 --> 28:17it wasn't fully reimbursed, but
28:17 --> 28:19many insurers now and,
28:19 --> 28:22Medicare does reimburse it. We
28:22 --> 28:22we need to do more
28:22 --> 28:23screening because
28:24 --> 28:25it was if we screen
28:25 --> 28:27patients and found the lung
28:27 --> 28:28cancer early, we'd have more
28:28 --> 28:29impact on this disease than
28:29 --> 28:30all the therapies we've talked
28:30 --> 28:32about during the last twenty,
28:32 --> 28:34thirty minutes.
28:34 --> 28:35Doctor Roy Herbst is the Ensign Professor of
28:35 --> 28:37Medicine and Medical Oncology and
28:37 --> 28:39Professor of Pharmacology at the
28:39 --> 28:40Yale School of Medicine.
28:40 --> 28:42If you have questions, the
28:42 --> 28:43address is canceranswers
28:43 --> 28:44at yale dot edu,
28:45 --> 28:46and past editions of the
28:46 --> 28:48program are available in audio
28:48 --> 28:49and written form at yale
28:49 --> 28:50cancer center dot org.
28:51 --> 28:52We hope you'll join us
28:52 --> 28:53next time to learn more
28:53 --> 28:54about the fight against cancer.
28:55 --> 28:56Funding for Yale Cancer Answers
28:56 --> 28:58is provided by Smilow Cancer
28:58 --> 28:59Hospital.

Download Audio Download Transcript

Information

50 Years of Cancer Progress: Medical Oncology with guest Dr. Roy Herbst March 16, 2025

Yale Cancer Center

visit: https://www.yalecancercenter.org

email: canceranswers@yale.edu

call: 203-785-4095

12888

Guests

Roy Herbst

To Cite

DCA Citation Guide