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The Latest Research in Precision Oncology

The University of Alabama at Birmingham is joining a growing network charged with implementing the National Institutes of Health's All of Us Research Program, an ambitious effort to advance research into precision medicine.

In this segment, Eddy S Yang, MD, PhD, discuss precision oncology and what it may mean as a blue print for future research.
The Latest Research in Precision Oncology
Featured Speaker:
Eddy S. Yang, MD, PhD
Eddy S. Yang, MD, PhD, received his MD and PhD from the University of Miami School of Medicine and continued post-graduate training in the Department of Radiation Oncology at Vanderbilt University as a Holman Pathway Resident Research Scholar.

Learn more about Eddy S. Yang, MD, PhD
Transcription:

Melanie Cole (Host): Precision Oncology is an innovative approach to cancer treatment that ensures treatment is specifically designed and targeted to each unique form of cancer. It’s the science of using each patient’s individual genetics to create a treatment protocol just for them based on those genetic mutations. Here to tell us about Precision Oncology, is Dr. Eddy Yang. He’s the Deputy Director of the Hugh Kaul Precision Medicine Institute of UAB Medicine. Welcome to the show, Dr. Yang. What is Precision Oncology? Define it for us, and explain a little bit about the evolution of it.

Dr. Eddy Yang (Guest): Sure. Precision Oncology is really to treat cancer patients with the right drug at the right time, and really understanding as much information about the cancer from using the genomic sequencing to even patient information to get the appropriate therapy for the patient.

Melanie: What are some of the challenges of defining Precision Oncology as you have, and applying this concept than to treating cancer?

Dr. Yang: I think the biggest challenge right now, is gaining enough evidence to show that Precision Oncology is a cost-effective method to improve outcomes for our cancer patients.

Melanie: So, if you are looking at some of these challenges, how do you know when to implement, Dr. Yang? Is there an advantage to testing early in the treatment course of patients with advanced cancer or giving them the advantage of being able to plan for the timing of enrollment in clinical trials or administration of other targeted therapies?

Dr. Yang: Yeah, so currently, I think that a lot of institutions utilize Precision Oncology efforts at the time when patients do not have any other option. We believe that getting that information earlier may be helpful just to be able to act at the right time. Having that information early on allows us to do that more effectively and more efficiently.

Melanie: Dr. Yang, is there a practical case against Precision Oncology? Is there a question of whether it positively affects clinical outcomes? What are some of the studies you’ve read?

Dr. Yang: Yeah, so there are several studies that show there is a benefit. One from MD Anderson showed that if they treated patients according to their genomic profile of the tumor compared to just traditional chemotherapy, there was a benefit in terms of prolonging the patients’ progression-free survival. There are other studies similar to that. It thinks the biggest challenge, though, is that is it cost-effective? Many insurance companies do not currently pay for the testing. There are only specific situations where the insurance companies will pay for that.

Melanie: With the rise of commercial tests, do you worry about data consistency, reproducibility, are there limitations of the current testing methodologies and reports and such? What do you see?

Dr. Yang: Yeah, so, I think the reproducibility and the way each company reports the data is – there are standardized ways of doing this. Whether a patient goes through testing with one company or another right now, really there are no guidelines for that.

Melanie: What do you want to happen along those lines if there are no guidelines? I’ll ask you the blueprint for future research question in a little bit, but if there are no guidelines, how can you be sure that some of these things will work or that they’re going to have the approved outcomes?

Dr. Yang: I think we have to utilize a testing platform that’s been tested and provide enough evidence to show that what they’re finding is correct. It is an evolving area where we’re trying to gather enough data to support this.

Melanie: Do you think that the genome era that you’re seeing now as an oncologist poses clinical development challenges? Are you – people are looking at genetics now -- and genomics – and trying to figure out the best way to use these targeted therapies. What do you see are some additional challenges along those lines?

Dr. Yang: Well, I think we need to have more information and start thinking – I think the future of the way we see cancer itself is not where the cancer is coming from but rather what is driving that cancer. As an example, with the recent FDA approval of one of the immunotherapies, it’s what we call tumor agnostic, meaning that it can be tumor from any site of the body, but as long as there’s a genomic profile that’s called microsatellite instability or MSI, then patients could receive that immunotherapy. It’s that way of thinking that’s evolving from a specific cancer like a prostate or a breast cancer to now, a cancer that is MSI. That’s I think a challenge where we have to think of cancer in a different manner than what we traditionally thought of cancer.

Melanie: What does current research indicate for some of the future developments if you’re talking about primary cancers, metastases, and using all of this Precision Oncology to target – whether it’s immunotherapy or targeted therapies, whatever you’re using – what do you see, in your opinion, is going to happen in future research? Do you feel like Precision Oncology is going to work?

Dr. Yang: Yeah, I think Precision Oncology is going to work. I think the future is if you’re giving out the proper and appropriate combinations of treatment, and incorporating other biomarkers besides just the DNA mutations, but incorporating other biomarkers that can help inform us on how to treat the patient better and more effectively. Part of that is really incorporating more information about the cancer and about the patient in a cost-effective manner.

Melanie: Are there some treatments or research that you’re doing at UAB that other physicians might not be aware of?

Dr. Yang: Yes, we are part of what’s called the ASCO TAPUR study. It is a 16-arm study that’s based off of the mutation profile of the cancer and we couple that with the genomic sequencing of the tumor to then allow enrollment into this trial. Some of the early efforts appear to be promising because we’re able to continue to enroll patients in this study.

Melanie: What else would you like to tell other physicians about Precision Oncology and Precision Medicine in general, that they might not be aware of and when they should probably refer to a specialist, such as yourself.

Dr. Yang: I believe that when patients – I think nowadays, they want to know the genomic profile of their tumor. A lot of times the appropriateness of ordering this test is not yet determined. It’s times like these where I think it’s appropriate to refer to a large academic center so that we can have these types of discussions and where we do have these sequencing efforts available for these patients. Additionally, at times when there are patients that already receive the genomic sequencing, but there aren’t therapies available, we would have those therapies available because of the involvement in these clinical trials.

Melanie: Tell us about your team. Why is UAB so great to work with?

Dr. Yang: I love the collaborative nature of UAB, and the team really communicates well and works well together. And really, we’re all in it for the same reason, which is to impact patient care and patient outcomes. It’s all about the patient here at UAB. Everything else kind of falls in line once we have that priority set.

Melanie: Thank you so much, for being with us today. What a fascinating topic. You’re listening to UAB Med Cast. A physician can refer a patient to UAB Medicine by calling the MIST Line at 1-800-UAB-MYST. That’s 1-800-822-6478. For more information on resources available at UAB Medicine, you can go to UABMedicine.org/Physician, that’s UABMedicine.org/Physician. This is Melanie Cole. Thanks so much for listening.