2015 ASCO Educational Book - The Future of Cancer Treatment with Molecular Medicine, with Edward S. Kim, MD, FACP

September 22, 2015
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In this podcast, Dr. Edward Kim discusses his article, “The Future of Molecular Medicine: Biomarkers, BATTLEs, and Big Data.”



ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors that care for people with cancer.

This podcast is part of a series featuring articles from the 2015 ASCO Educational Book. Produced annually, the Educational Book is a collection of articles written by ASCO Annual Meeting faculty and leaders from ASCO's other meetings. Each volume highlights the most compelling research and developments across the multi-disciplinary fields of oncology and serves as an enduring resource long after the meeting concludes.

In today's podcast, Dr. Edward Kim discusses his article, “The Future of Molecular Medicine: Biomarkers, BATTLEs and Big Data.” Dr. Kim is Chair of Solid Tumor Oncology at the Levine Cancer Institute, Carolinas HealthCare System in Charlotte, North Carolina. Molecular or personalized medicine relies on genetic differences in the cancer cells rather than the location or stage of the cancer to determine prevention, diagnosis, and treatment options for people with certain types of cancer. In this podcast, Dr. Kim discusses new work that is being done in the field of molecular medicine and envisions a future in which the extensive data that is currently being collected will lead to even better treatment options down the line. ASCO would like to thank Dr. Kim for discussing this topic.

Dr. Kim: Hello. My name is Dr. Edward Kim from the Levine Cancer Institute, Carolinas HealthCare System. I will be discussing my 2015 ASCO Educational Book article entitled “The Future of Molecular Medicine: Biomarkers, BATTLEs and Big Data,” and share with you what molecular medicine and the collection of big data means for patients with cancer. Lung cancer has certainly come a long way and the therapies that we have now have really changed our approach. In 2000, we used to think of all patients as equal than everyone with non-small cell lung cancer essentially treated with two-drug chemotherapy. This was not a great conclusion and health professionals felt very limited in what they could do for patients.

Thankfully today, there have been many breakthroughs in treatment options due to the advent of personalized molecular medicine. Simply put, molecular medicine uses a patient's genetic profile to guide decisions regarding the prevention, diagnosis, and treatment of many kinds of cancers, such as lung and breast cancers, melanoma, and hopefully more in the future. We pioneered this type of precision medicine while I was Houston in the BATTLE study. BATTLE stood for Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination. In this study, we, for the first time, mandated repeat biopsies in order to get the real tissue in patient's tumors that could be tested for genetic markers. We then use these markers to try and direct therapy. The importance of the study was that we were able to show that it was very feasible to re-biopsy people and therefore able to better characterize their tumor genetics.

In 2015, the government proposed a new initiative aimed at increasing our capacity to research and ultimately deliver precision molecular medicine for all types of cancer. Over $215 million has been designated to support many federal health organizations in this effort. Upwards of 1 million new patients could be enrolled in trials in which tissues and other data will be collected, stored, and analyzed. This data will be used to enhance our existing knowledge of molecular medicine and develop individualized molecular approaches to cancer treatment. Now, medicine is faced with this new concept of big data. How to collect, maintain, and thus, utilize this voluminous amount of information. Big data requires new techniques and algorithms to manage it as well as to extract the valuable hidden knowledge it contains. Many research organizations are working with these big data sets with the expectation that they will identify new opportunities for treatment, diagnosis, and prevention of cancers. These include biomarker studies.

Now, biomarker is a measurable substance whose presence could be indicative of an infection or a disease such as cancer. Once these biomarkers are identified, the mutations are matched with the associated treatments and or clinical trials giving patients more options for better care. Umbrella trials are another way to identify patient populations who have the best chances for improved outcomes and they focus on doing large screening. Master studies that include two National Cancer Institute trials that will analyze tumors from thousands of patients for abnormalities that may respond to targeted drug therapies. Non-traditional groups are also joining the excitement into this area including Google and financial institutions because their ability to collect a variety of data on large numbers of individuals and variables really helps add to the knowledge.

Because of these advances using molecular medicine, we're hopeful that patient outcomes may be improved substantially. These include shrinking the tumors, alloresponse rates and progression-free survivals, and we've seen that this has doubled over the past decade. In fact, progression-free survival for molecularly targeted therapies exceed the overall survival numbers for some of the traditional chemotherapies. Once all the data from these different efforts is collected, large amounts of data will be able to be analyzed with the hope of someday developing predictive treatment models for patients. The prospect of harnessing and processing this data is daunting, however, the potential rewards for patients make it worth the effort.

I would encourage people to discuss biomarkers and genetic testing with their doctors and health professionals. There are always clinical trials that are available and I always encourage my patients and or their friends to enroll or participate when possible. We know that molecular medicine requires both sides of the equation. Not only do you need the genetic side, but also the clinical aspects. This includes health maintenance such as smoking and exercise, we want to stop smoking and do more exercise and it's equally important for patients to have both sides of this equation. Please view my article online at asco.org/edbook for a more in-depth description of this topic. Thank you.

ASCO: Thank you Dr. Kim. Please visit asco.org/edbook to read the full article or visit www.cancer.net for more information on personalized medicine.

Cancer.Net is supported by the Conquer Cancer Foundation, which is working to create a world free from the fear of cancer by funding breakthrough research, sharing knowledge with physicians and patients worldwide, and supporting initiatives to ensure that all people have access to high-quality cancer care. Thank you for listening to this Cancer.Net podcast.