Progress and Hope

Name: Progress and Hope
Uploaded: 2025-11-19T16:29:33.6066667Z
Duration: 1 h 51 min 4 s

November 19, 2025

Information

ID: 13636
To Cite: DCA Citation Guide

Download Transcript

00:04Good evening, everyone.
00:05It's so wonderful to see
00:07you all here today. Thank
00:08you so much for coming
00:09out.
00:10You know, today, we're we're
00:12all here because,
00:14we all have some,
00:17connection to,
00:18interest in,
00:20or some other relationship with
00:22lung cancer.
00:23I think many I know
00:24many of you in the
00:25audience, and it's really so
00:27fantastic to to have you
00:28here. We don't have a
00:29Zoom component, so we don't
00:31have virtual people listening in,
00:33but we are recording this
00:35so that we can
00:36you all can watch it
00:37again if you just thought
00:38it was so fantastic. You
00:39wanna see it a second
00:40time around, or, of course,
00:41other people can can watch
00:43it later on.
00:45So I'm Sarah Goldberg. For
00:46those of you who don't
00:47know me,
00:48I'm one of the co
00:49directors for the Center for
00:50Thoracic Cancers here at Yale.
00:52I'm a medical oncologist.
00:55I've been here for almost
00:56fourteen years. We've done this
00:58program for many years
01:00now, and I think it's
01:02probably one of the highlights
01:04of the year for many
01:05of us.
01:07I think it's just so
01:08special to be able to
01:09see all of you in
01:10this setting,
01:11and to share the excitement
01:13that we have over what's
01:15been happening
01:16in research in for lung
01:18cancer and in the advances
01:20in so many ways and
01:22and to just to to
01:23be able to,
01:25to show you what we
01:26work on kind of behind
01:27the scenes when we're not
01:28in the office with you
01:29all.
01:30We we do a lot
01:31of work here and lots
01:32of other places do too
01:34to try to make lung
01:35cancer
01:36better, to try to understand
01:37it better, to try to
01:38figure out better treatments and
01:39better ways to take care
01:40of of our patients and
01:42their families. So we're really
01:43excited to be able to
01:44share all of that with
01:45you.
01:46I wanted to introduce two
01:47other people. One person is
01:49standing right next to me.
01:50This is doctor Katie Politti.
01:52She is a cancer biologist.
01:54We work very closely together
01:56in all those behind the
01:57scenes things, so trying to
01:58understand lung cancer better and
01:59figure out better treatments. Katie
02:01is the scientific director for
02:03the Center for the Rest
02:04of Cancers,
02:05and she's you're gonna hear
02:06from her in a minute.
02:07I will also introduce someone
02:08who's not here right now.
02:10He will be shortly.
02:11Doctor Justin Blasberg. He's a
02:13thoracic surgeon, another one of
02:14the directors of the center.
02:16And, again, we all work
02:17together to,
02:18to take better care of
02:19our patients and to advance
02:21our scientific mission,
02:22help educate our trainees, and
02:24and do all sorts of
02:25things to to make things
02:26better for for this disease.
02:29So
02:30look at my notes to
02:31make sure I'm not missing
02:32anything. I think that was
02:33all that I was supposed
02:34to say.
02:34I will just briefly show
02:36you what we're gonna be
02:37talking about this evening. This
02:39is our agenda. You might
02:40have seen it hanging up
02:41on the walls in the
02:42clinic or gotten an email
02:43to you.
02:44Our our goal is to
02:45focus on exactly what this
02:47title is, progress and hope,
02:48to show you how far
02:50we've come and what we're
02:51hoping for in the future.
02:53And so
02:54we will be first hearing
02:56from doctor Roy Harps. Katie's
02:57gonna introduce him, so I
02:58won't go into details, but
02:59he's gonna, I think, give
03:00you a great talk. Unfortunately,
03:01he's not here tonight, but
03:02he's gonna join us virtually.
03:04Then a lot of people
03:06last year told me they
03:06wanted to hear more about
03:07what's coming next. What are
03:08the really exciting drugs coming?
03:10And so we're gonna take
03:11a little bit of a
03:12closer look at some emerging
03:14therapies, and we have some
03:15great speakers there,
03:17to get you excited about
03:18what's coming,
03:19in the next couple of
03:20years, what's in trials now.
03:22And then we we always
03:23think it's so important to
03:24talk about screening, lung cancer
03:26screening, because
03:27as the title says, early
03:28detection saves lives. So, we're
03:29gonna have a panel about
03:30that. You'll hear from some
03:31people about that. I'll moderate
03:33a panel on lung cancer
03:35clinical trials and why they're
03:36so important in our progress.
03:38And then we're gonna talk
03:39about bridging expertise, so bringing
03:41it all together, all the
03:42different disciplines and people that
03:43help to take care of,
03:45people who in their fam
03:46people who have lung cancer
03:46in their family. So you'll
03:47hear from lots of different
03:48people about that.
03:49So I think that was
03:51all I wanted to say.
03:51I will turn it over
03:52to Katie to say hello
03:53and introduce
03:55our first speaker. Thank you
03:57all so much again for
03:57being here.
04:03Thank you very much,
04:05Sarah.
04:07It really is a pleasure
04:08to be here tonight, and
04:09thank you very much to
04:10all of you for coming
04:11and participating
04:12in this event.
04:14Before I introduce our first
04:16speaker, I'd,
04:17really like to thank Emily
04:20Montemerlo
04:21and Renee Gaudette
04:23who helped put this together
04:25and everybody who's also
04:28at the tables to give
04:29you information on lung cancer,
04:31lung cancer screening, smoking cessation.
04:33So thank you,
04:35to everybody.
04:37So, it really is my
04:39pleasure to introduce our first
04:41speaker who's gonna be speaking,
04:43virtually. Doctor Roy Herbst is
04:45the deputy director at the
04:47Yale Cancer Center. He's an
04:49Ensign professor of medicine and
04:51the chief of medical oncology
04:53and hematology
04:54here.
04:55Doctor Herbst is a pioneer
04:57in lung cancer care and
04:59treatment,
05:00and really has advanced our
05:02knowledge of lung cancer over
05:04the years, running clinical trials,
05:06innovative
05:07science, and really leading the
05:09field. And we're so lucky
05:10that he's been here at
05:11the Yale Cancer Center,
05:13for many years and all
05:15have had the opportunity
05:16to to to work with
05:17him. So,
05:19tonight, he's going to tell
05:20you about advances in
05:22cancer immunotherapy and the things
05:24that have happened over the
05:25past decade
05:27in, in lung cancer immunotherapy,
05:30in the the lung cancer
05:32immunotherapy field. So thank you
05:34very much, doctor Herbst.
05:36I'll turn it over to
05:37you.
05:39Thanks, and welcome to everyone.
05:41I'm really sorry that I'm,
05:43not with you tonight. If
05:44we could have the first
05:45slide, please.
05:47A little well, you're a
05:49little bit quiet. I'm just
05:50maybe give us one second
05:51to see if we can
05:51make you louder.
05:53Sure.
05:58I can go get some
05:59earbuds too.
06:01I'm not sure. What do
06:02you all think? Can you
06:02hear them okay, or should
06:03we work on the volume?
06:05Up. They're saying up. Let's
06:07see.
06:11How's this now?
06:14About the same.
06:16Well,
06:18what to do?
06:19We're working on it from
06:21our end, seeing if we
06:21can make you louder. Should
06:22I do someone here, you
06:23think?
06:24I think my data Oh,
06:25here we go. Do you
06:26wanna go ahead to the
06:27next session?
06:29Oh, I think this might
06:30work. Hold on. Try now.
06:32Hello?
06:34I like that. Thank you.
06:36Okay. I they're trying to
06:38mute me. Well, listen. If
06:39we can have the first
06:39slide, I'm so honored to
06:41be,
06:41joining. I've I've been to
06:43this event
06:44pretty much every year since
06:45I've been here, which is
06:46almost fifteen years. And if
06:47we can have the first
06:48slide
06:49Working on
06:51it. Technology.
06:53Okay.
06:54Okay.
06:55So, what I thought I'd
06:56do is talk about advancements
06:58in immunotherapy. I bet there
06:59are some people in the
07:00audience who are on immunotherapy,
07:02who know someone who's on
07:03immunotherapy,
07:04who have seen immunotherapy
07:06on TV. So I just
07:07talk a little bit about
07:08what it is and why
07:10it's important to get us
07:11started tonight and and to
07:13show you that we are
07:14making progress. The next slide,
07:15please.
07:16So the reason I'm not
07:17there is I'm actually in,
07:19New Mexico, Albuquerque
07:21at at a conference that
07:22I'm coleading,
07:24which is, used to be
07:25called diversity in clinical trials.
07:27Now if you hit it
07:27again, please,
07:29Sarah, now it's called excellence
07:30in clinical trials given the
07:31current,
07:32you know, climate in the
07:33United States, but still the
07:35same thing. We're teaching eighty
07:37students,
07:38young faculty, how to do
07:40clinical trials in the community.
07:42And, actually, we have five
07:43people from Yale here with
07:44me, including Soyeon Kim, who
07:46I'll be seeing in a
07:47few minutes, one of our
07:48lung cancer doctors. Next slide.
07:51So
07:52what Katie, myself, Sarah, and
07:54all the people here really
07:55do is translational research.
07:57What we're trying to do
07:58is take
07:59discoveries from the bedside on
08:01the left
08:02and and and and understand
08:04what we need and then
08:05go to the bench, the
08:06lab bench. Doctor Paletti has
08:08a lab where she's studying
08:09different models of lung cancer
08:10and then finding new therapies,
08:12and then we bring them
08:13back to the bedside so
08:14that we can help patients
08:15with this disease.
08:17The next slide.
08:20So what about immunotherapy?
08:22Next slide.
08:23So immunotherapy, if we click
08:25this twice,
08:26began over a hundred years
08:28ago,
08:29by a doctor Coley,
08:31in New York. What he
08:32used to do is he
08:32used to put bacteria
08:34and actually inject them into,
08:36tumors, and that would create
08:38an inflammation.
08:39And that inflammation brought in
08:41immune cells, and that was
08:42actually the first immunotherapy.
08:44But immunotherapy at Yale, if
08:46we can click again, began
08:47with actually doctor Mario Snow
08:49and, Mario who's actually leaving
08:51us and retiring this year.
08:53But Mario,
08:56sixteen, seventeen years ago, recognized
08:58that immune therapy was something
08:59that would help lung cancer,
09:01melanoma, a type of skin
09:03cancer, kidney cancer, and he
09:05brought some of the earliest
09:05trials to Yale. On the
09:07next slide.
09:09And then it's really been
09:10a team, and
09:11I'm sure doctor Gettinger is
09:13there, and he looks the
09:14same now as he did
09:15in this picture ten years
09:16ago. There's doctor Gettinger, doctor
09:18Snow, doctor Kluger, and then
09:20Liping Shen. These are really
09:22the pioneers here who who
09:23started working with immunotherapy at
09:25Yale in early phase trials,
09:27and some of you may
09:28have even been on them.
09:29Next slide.
09:30And Li Ping, who's highly
09:32honored scientist in all the
09:33national societies,
09:35really was one of the
09:36first people,
09:37top four or five in
09:38the world, who discovered what's
09:40called PD L1, which is
09:42what makes immunotherapy possible. And
09:44I'm gonna show you now
09:45on the next few slides
09:45what that is.
09:47So many of you have
09:48seen
09:49immunotherapy, but what is it?
09:51Well, the immune system is
09:52very special.
09:54It's specific. You know, you
09:55don't wanna make
09:57a reaction against something that's
09:58normal. Otherwise, you'll have something
10:00like poison ivy. You'll have
10:01a very bad problem.
10:02The immune system has memory,
10:04meaning once you have a
10:06reaction, once you have antibodies,
10:07they stay around, and it
10:09can be adaptive. It can
10:10change depending on the circumstance.
10:12So what you see here
10:13is you see the tumor
10:13cell. And see that little
10:15red dot? That's the abnormal
10:17tumor protein on the tumor
10:18cell. So So what happens
10:19is, if you click click
10:21again, please,
10:22the immune system, the t
10:24cell, can recognize through a
10:26very specific mechanism.
10:27It can recognize that that
10:29tumor cell,
10:30and you would want that
10:32to to kill it. But
10:33that doesn't happen because if
10:34you look at the next
10:35click,
10:37there's there's a loop. There's
10:39a feedback loop that protects
10:41the immune system from killing
10:42that tumor. And see that
10:44little red line? That's an
10:45inhibition that occurs through something
10:47called PD one.
10:50So the bottom line, when
10:51you hear about a PD
10:52one inhibitor or a PD
10:53l one inhibitor, what it's
10:55trying to do, if you
10:55click again, please,
10:57it's trying to block that
10:58interaction.
10:59These drugs that one gives
11:00to a patient that some
11:01of you might take, that
11:02your friend or family member
11:04takes, it blocks that interaction.
11:06And what that does is
11:07it allows the immune system
11:08to do its thing against
11:09the tumor. It recognizes the
11:11tumor as a foreign invader.
11:12And if you click again,
11:13you'll see that, it can
11:15have amazing results.
11:17So Maureen shown here, and
11:18she might even be in
11:19the audience,
11:21was one of the first
11:22patients who was treated. And
11:24you can see that, you
11:25know, she's now fifteen, fourteen
11:27years in, and she received
11:29a phase one trial. So
11:30that's the beauty of a
11:31place like ours at Yale,
11:33the top clinic at Smilow,
11:35is we have drugs that
11:36are early drugs that were
11:38clinical trials. Now they're the
11:40standard of care.
11:41Twenty, thirty million people have
11:43been treated worldwide with these
11:44drugs. But the first trials
11:46were done here at Yale
11:47with great effect.
11:48That's the good news. The
11:49bad news is they don't
11:50always work quite as well
11:51as we want. Like any
11:53process in nature,
11:54tumors learn how to become
11:55resistant, and that's why we're
11:57continuing to fight find cancers
11:59earlier and use these drugs.
12:01Next slide.
12:03This is actually another drug.
12:05It was originally a phase
12:06one trial, MPDL thirty two
12:08eighty. Now the drug is
12:09known as atezolab. Atezolizumab,
12:12we did some of the
12:13earliest studies with this drug
12:14at Yale. You can see
12:15on the top someone with
12:16lung cancer. See those red
12:17lines? Those are lung tumors.
12:19And look look how well
12:20they responded
12:21just after eight to ten
12:22weeks on the drug. You
12:23don't see there's nothing where
12:24those arrows are on the
12:25right.
12:26If you look at the
12:27lower left, what you can
12:28see is CD eight cells,
12:29which are the killer T
12:30cells, the ones we want
12:31to upregulate.
12:33You can see they're very
12:34low pretreatment,
12:35but posttreatment, there are a
12:36lot of them. So this
12:38is what we can do.
12:39We can reactivate the immune
12:40system
12:41with these, checkpoint inhibitors. It's
12:44really fantastic.
12:45I've never seen anything like
12:46that. In fact, I'm gonna
12:47be talking to the students
12:48here at at this course
12:50tonight in my opening lecture
12:52about the progress we've made
12:53in lung cancer, and this
12:54is just part of it.
12:55And you're gonna hear a
12:55lot tonight. You're gonna hear
12:57about what we're doing, and
12:58and you're gonna hear about
13:00advanced disease, early disease, and
13:02about screening and prevention. On
13:04the next slide.
13:06And then this is just,
13:07doctor Goldberg, you know, who,
13:09you know, professor Goldberg now.
13:12Doctor Goldberg, actually, when she
13:13came here, in her early
13:15career working with doctor Kluger,
13:16the melanoma,
13:17leader, and doctor Chang, who's
13:19our neurosurgeon, some of you
13:20might know her. She does
13:21all the the the radiation
13:22to the brain. They did
13:23a study where they actually
13:25took a drug, pembrolizumab.
13:27Some of you might know
13:27it as Keytruda, and did
13:29the very, very first study
13:30where they took patients that
13:32had brain disease,
13:33cancer in the brain, and
13:34they didn't radiate those patients.
13:36But they gave those patients
13:37this drug, Keytruda. And you
13:39can see, those two red
13:40lines that tumors in the
13:42brain responded. This was phenomenal
13:44because why take radiation when
13:46the immune therapy will do
13:47it? And I can tell
13:48you that I remember when
13:49they called Sarah and and
13:50Harriet about president Carter, you
13:52know, who had melanoma. For
13:53ten years, he lived with
13:54brain metastases because he got
13:56Keytruda pembrolizumab
13:58as per the routine developed
13:59here at Yale. Next slide.
14:01I'm just about done. So,
14:04we already saw this. Next
14:05slide. I should should have
14:06removed that. So we have
14:07a spore. Katie and I,
14:09lead a lead a a
14:10large grant here at Yale,
14:12so we're constantly trying to
14:13raise the bar. And if
14:14we just click quickly because
14:15my time is running out,
14:16we're studying
14:18on the first project, how
14:19how to work and and
14:21and do even better with
14:22immune therapy because we know
14:23sometimes the immune cells can't
14:24get to the tumor. There
14:25there's a force field, so
14:27we're figuring that out. We're
14:28also figuring out how to
14:29deal with targeted therapy that
14:31you'll hear about from Scott
14:32next. And next slide.
14:35Here's the group. This is
14:36my last slide. It's a
14:37team. I'm just so proud
14:39to have been a member
14:40of this team and being
14:41a member of this team.
14:42This is why, even though
14:43it's it's still pretty early
14:45here, I I wanted to
14:46make sure that I could
14:47get on, the call today
14:48to tell you how excited
14:49I have been am about
14:50this wonderful team that you're
14:52gonna hear from tonight. Thank
14:53you all for having your
14:54trust in us, and I
14:55look forward. I'm gonna watch
14:56the program for the next
14:57hour myself. So thank you.
15:04Thank you very much, Roy.
15:06And we have time for
15:07a couple of questions.
15:10Are there any questions? And,
15:12Katie, you might wanna tell
15:13them what this picture is.
15:15Oh, sure. This is a
15:17picture
15:18from,
15:19one of our lung spore
15:20meetings that we hosted here
15:23in June of twenty twenty
15:25four at Yale. So this
15:27is a specialized program of
15:28research excellence, and we hold
15:30one, a grant on this
15:32in lung cancer. And so
15:33we hosted all the other,
15:35lung spores from across the
15:37nation.
15:38And we took the opportunity
15:40in twenty twenty four to
15:42really recognize the anniversary
15:44of the of the discovery
15:46of eGFR mutations in lung
15:48cancer. They were discovered in
15:49two thousand and four, so
15:50it was the twentieth anniversary.
15:52And we hosted this event
15:54here and had all of
15:55the people who discovered the
15:57mutations and the people who
15:58developed the therapies,
16:00that are used now to
16:01treat EGFR driven lung cancer.
16:03So it was very a
16:04very special,
16:05occasion.
16:06It was quite a powerhouse
16:07of lung cancer experts. And,
16:09you know, whenever we take
16:10care of you, we're always
16:11asking others, you know, what's
16:12going on in other places.
16:14Look in the very upper
16:15left. That's Tom Lynch looking
16:16a little askance there. Top
16:18left, you know, our former
16:19director, but everyone came for
16:21this because they were so
16:22excited about the collaborations.
16:25So any questions?
16:27If not, I'm gonna ask,
16:29you a question, Roy.
16:31What are some of the
16:33other immunotherapeutic
16:34approaches that are being developed
16:36now? So what are some
16:37of the things on the
16:38horizon in terms of immunotherapies
16:40that we should be thinking
16:41about and keeping an eye
16:43out in lung cancer
16:44beyond immune checkpoint inhibitors?
16:47Right. So that's a great
16:48question. So the immune checkpoint
16:49inhibitors relieve the block. So
16:52that's the first step because,
16:53you know, in order to
16:55get the water in yet,
16:56you have to relieve the
16:57block. But then we need
16:59ways to bring more immune
17:00cells into the tumor. And
17:02now we have this whole
17:03field of what's called T
17:05cell engagers.
17:06They're they're molecules that actually
17:08go to the tumor, to
17:09the to the,
17:11the cells around the tumor.
17:12We call that the stroma,
17:13the microenvironment,
17:15and they actually attract T
17:16cells. We call them t
17:17cell engagers.
17:18You might hear them called
17:19bispecific antibodies.
17:21In small cell lung cancer,
17:22there's a drug that Anne
17:23Cheng is studying called tarlatinib.
17:25So those are very exciting,
17:27and keep your eye out
17:28for those.
17:29The other thing that we
17:30have are vaccines.
17:31Vaccines, I'm a strong believer
17:33in vaccine. I've had all
17:34my vaccines, but vaccines will
17:36work in cancer. The problem
17:37is we have to figure
17:38out first, you know, what
17:40the, what the protein is
17:42to target, and that requires
17:44a great deal of study
17:45and work. We're doing that
17:46here. But we're actually studying
17:47vaccines where you actually get
17:48a vaccine that stimulates
17:51the the right immune cells
17:52to go after the the
17:53the cancer. So that's ongoing
17:55right now as well.
17:56And then we're combining things.
17:57You know? It looks like
17:59we're gonna have to combine
18:00some chemotherapy with immunotherapy,
18:02maybe some anti vascular agents
18:04with chemotherapy.
18:05We're trying everything, and we're
18:06doing it in this in
18:07that bed to bench bedside
18:09way that I told you
18:10about to try to figure
18:11out what the best ways
18:12are. These will be where
18:13there might so many of
18:14these will be protocols.
18:15So be sure to ask
18:16when you're in the clinic
18:17if you need something else.
18:19What are the protocols? What
18:20are the studies? Because as
18:21I showed you, everything I
18:22showed you here, you you
18:23could only get at Yale
18:24ten years ago, and now
18:25it's standard of care. So
18:26now we're working on the
18:27next generation of studies.
18:30Thank you very much,
18:32Roy, and,
18:33enjoy the rest of your
18:35time in Arizona. Thank you
18:37very much. Thanks.
18:39Oh, New Mexico. Why is
18:40that thing Arizona?
18:42I wasn't gonna correct you,
18:43but they they look very
18:44similar. But it's not an
18:45accident. Correct. So, yeah, I
18:46don't know. I was like
18:47Yeah.
18:48So we,
18:50are going to move on
18:51to the next session. So
18:53we have, three talks that
18:55are on some new emerging
18:58therapies.
19:00And so we're gonna go
19:01through these three five minute
19:03talks, and then we'll have
19:04time for,
19:05some questions if you have
19:07questions for the speakers.
19:09So, our first presenter is
19:11doctor Rick Wilson.
19:14Rick is, doctor Wilson is
19:16a physician scientist.
19:18And so he works in
19:19the lab in addition
19:21to, practicing as a thoracic
19:23oncologist. And so he's gonna
19:25tell you about some of
19:26the newer targeted therapies
19:28that are emerging.
19:30So I'm gonna turn it
19:31over to Rick. Thank you.
19:39Great. Thank you, Katie,
19:41for the kind introduction, and
19:42thank you all for being
19:43here, this evening.
19:45So,
19:46I'm excited to have the
19:48opportunity to provide,
19:49a brief overview about recent
19:51developments in targeted therapies in
19:54lung cancer.
19:55So, these are therapies that
19:57are developed specifically
19:58to target gene changes or
20:00gene alterations
20:02that we find in subsets
20:03of lung cancers with the
20:05goal being to try to,
20:07stop those cancers from growing
20:09and spreading.
20:11And so, on the slide
20:13here on the far left,
20:14this is showing you some
20:15of those gene targets.
20:18And then to the right,
20:19what is being shown is
20:21a timeline showing you, the
20:23development of specific therapies against
20:26those gene targets.
20:28And the purpose of the
20:29slide is just to show
20:30you that over the last
20:31fifteen years,
20:32we've actually seen the development
20:34of many,
20:35new targeted therapies in lung
20:37cancer.
20:38And, of course, this is
20:39very exciting to us because
20:40we always want to have
20:41as many, treatment options as
20:43possible to consider for our
20:45patients.
20:47And in fact, when we
20:48meet new patients in the
20:49clinic and in the outpatient
20:51setting,
20:52especially those with a diagnosis
20:54of a specific type of
20:55lung cancer called lung adenocarcinoma,
20:59we're always thinking to ourselves,
21:00you know, is this patient
21:02potentially a candidate for one
21:03of these, targeted therapies?
21:07So, this is a pie
21:08chart showing you the frequency
21:10of some of these gene
21:12changes in lung adenocarcinoma.
21:15And you can see that,
21:16some of these gene changes
21:18are fairly common, such as
21:20KRAS shown in green in
21:22the upper right
21:23or EGFR
21:25shown in navy blue below
21:26that.
21:27Whereas there are other,
21:29oncogenic
21:30or the other gene changes,
21:32that are less common.
21:34One of these, less common
21:35gene changes is called, HER2.
21:38And we see gene changes
21:40in HER2
21:41in about
21:42three percent of our patients
21:44with lung adenocarcinoma.
21:46And we've never had any
21:48targeted therapies for our patients
21:50with lung cancer that have
21:52HER2 alterations.
21:54But that's changed,
21:55in just a few months
21:57ago. The FDA recently approved
21:59a new targeted therapy called
22:01zongertinib
22:03for patients with advanced lung
22:04cancers with HER2 alterations.
22:07And this is the first
22:08approved,
22:09oral targeted therapy, meaning pill,
22:12that can be taken by
22:13mouth,
22:14for our patients, with lung
22:16cancer with HER2 alterations.
22:20There are and and we're
22:21excited to be able to
22:22now offer this to our
22:23patients as part of standard,
22:25standard of care.
22:27But, there are actually,
22:29other agents,
22:30also in clinical development, and
22:32here at Yale, we actually
22:33have a clinical trial of
22:34one of these, new targeted
22:36therapies called ORIC one one
22:38four.
22:39This is being evaluated
22:41both in patients whose lung
22:43cancers have HER2 gene changes
22:46but also,
22:47in patients whose lung cancers
22:49have certain EGFR
22:51alterations
22:52as well. Making this a
22:53targeted therapy that is potentially
22:55relevant
22:56for two different, gene targets
22:58in lung cancer.
23:01I mentioned that one of
23:02the more common gene changes
23:04that we see
23:05in lung adenocarcinoma
23:07are KRAS gene changes. We
23:09see these in about thirty
23:11percent of our patients with
23:12lung adenocarcinoma.
23:15And this is a,
23:17gene target that we have
23:18known about for decades.
23:20But for decades, we have
23:22not had any targeted therapies
23:24against KRAS.
23:26That has recently changed in
23:27the last couple of years,
23:29with the development of an
23:31FDA approval of two targeted
23:34therapies.
23:35One called sotorasib and one
23:37called atagracib.
23:39These are approved
23:41for our patients with lung
23:42cancers, advanced lung cancers having
23:44a specific KRAS alteration
23:47called,
23:48G12C.
23:49And as you can see
23:50in the pie chart in
23:51the middle, G12C
23:53is the most common KRAS
23:55gene change that we see,
23:57in lung adenocarcinoma.
23:59But we're always trying to
24:01do better,
24:02and there are newer,
24:03targeted therapies,
24:06directed against KRAS g twelve
24:08c that are being evaluated
24:09in clinical trials that may
24:11work better, than these agents.
24:14And we currently have a
24:15couple of clinical trials looking
24:17at
24:17two different new targeted therapies
24:20for KRAS g twelve c.
24:22One called devarasib,
24:24one called olamirasib.
24:27Finally, if you look at
24:28the pie chart, one thing
24:29that you'll notice is that
24:30there are a lot of
24:32other KRAS gene changes in
24:34lung cancer that are not,
24:36g twelve c.
24:37And we currently do not
24:39have any FDA approved targeted
24:41therapies for these patients.
24:43But, again, there are new,
24:45treatments,
24:46in development that are being
24:47looked at in clinical trials,
24:49and we actually have a
24:50clinical trial here looking at
24:52one of these,
24:53new targeted therapies called direct
24:55sunrasib.
24:57One of the things,
24:58that is particularly
25:00interesting about this targeted therapy
25:03is that it can actually
25:04target
25:05multiple different KRAS gene changes,
25:09which is a a really
25:10innovative new development in KRAS
25:13targeted therapies.
25:14So this is just to
25:15give you an overview of
25:17some of the new, therapies
25:18that are coming down the
25:19pipeline, and we're excited,
25:21to be able to offer
25:22access to these therapies,
25:24to eligible patients here at
25:26Yale through our clinical trials.
25:29Thanks.
25:35Thank you very much,
25:37for that. Our next speaker
25:38is doctor Anne Chang.
25:40Doctor Chang is a thoracic
25:42oncologist
25:43and an expert, especially,
25:46amongst other things, on small
25:47cell lung cancer. And she's
25:49gonna be telling us about
25:50bispecific
25:51antibodies this evening. Doctor Chang?
25:53Thank you.
26:02Perfect. What a great turnout.
26:03I I spoke this weekend
26:05in New York at a
26:06at a patient, the Cure
26:07Lung Summit, and there's twice
26:09as many people here. So
26:10you guys turned out tonight.
26:12Thank you so much for
26:13coming.
26:14I know it's, it's at
26:15the end of a long
26:16day, so really appreciate your
26:18interest. And and, you know,
26:20one of the questions at
26:21that summit was, you know,
26:22how
26:23how how do we get
26:24folks to ask more questions?
26:25And and,
26:27what I said is that
26:28it's really important for us
26:30as doctors and us as
26:32nurses and your your care
26:33team, the more questions you
26:35you ask and the more
26:36you understand about what's going
26:38on, the easier it is
26:40for us to for us
26:41to do our job and
26:42for and, actually, the the
26:43better we can do our
26:44job. So thanks for coming
26:45tonight.
26:46So I have, been given
26:48the topic of bispecific antibodies
26:50in lung cancer.
26:51So I'll start with that.
26:52What is a bispecific antibody?
26:57So in in this
27:00I don't know if I
27:00can
27:01point to it here.
27:03Okay.
27:04No. Okay. Well
27:06oh, it was?
27:07Okay. Can you have a
27:08laser too on the Ah,
27:10can you see my laser?
27:12Yay.
27:13Okay. So an antibody
27:14so this antibody here recognizes
27:17a protein called CD three
27:19on the surface of the
27:20white blood cell,
27:22and this antibody in purple
27:24or red
27:25recognizes a protein called DLL
27:27three on the tumor cell.
27:29So bispecific
27:30antibody basically
27:31is an antibody that can
27:33bind to two different proteins,
27:35And here you see this
27:36this drug tarlatanab,
27:38an antibody
27:39that has and it binds
27:41both to,
27:43CD three, that's in orange,
27:44and in purple,
27:45the d l l three.
27:47On on so it brings
27:49together here the the t
27:51cell to the tumor cell,
27:54and this activates the immune
27:55system
27:56to attack the cancer cells.
27:58And this is so great
27:59because you notice here, there's
28:01no chemo involved.
28:02You're actually just taking
28:04your
28:05immune system and bringing it
28:07over to your tumor cells.
28:08So,
28:09so it's really exciting. You
28:11can avoid a lot of
28:12those toxicities that chemo has,
28:14and, that's why we're actually
28:16really excited about this.
28:18So there are already FDA
28:20approved bispecifics.
28:22So I I these are
28:23hard to say, but I'll
28:24try. Blinatumumab
28:26binds CD three t cells
28:28to CD nineteen b cells,
28:30and that's been approved for
28:32leukemia.
28:35Tembentafus
28:36targets g p, one hundred
28:39protein to anti CD three
28:40on on t cells, and
28:42that's approved for the use
28:44of melanoma in the eye.
28:46And then amivantamab
28:48is another FDA approved,
28:51non small cell lung cancer,
28:53drug, and it binds to
28:54EGFR
28:55and MET,
28:56and it's been approved for,
28:58EGFR exon twenty insertion mutation.
29:01So those patients. And and
29:02this is a waterfall plot.
29:03Each line
29:05is a patient and how
29:06much shrinkage
29:08of their tumor,
29:09has occurred. So we like
29:11all that shrinkage to be
29:12below the line. In this
29:13case, you have some folks
29:15who have a hundred percent
29:16shrinkage, which is fantastic.
29:19So this is a slide,
29:20actually, I got from from
29:21doctor Goldberg,
29:23and it's a little complicated,
29:24but basically, I'm gonna walk
29:25you through it. So all
29:26of these are different targets
29:28on the surface of cells.
29:30And so bispecific
29:31antibodies
29:33are are targeting any number
29:34of these, including
29:36ones that are associated with
29:37tumor cells,
29:39ones that are involved with
29:40the immune cells, and ones
29:41that also,
29:43target
29:44PD one, PD L one,
29:46like doctor Herbst was mentioning,
29:48etcetera.
29:49And so these are the
29:50number of antibodies that have
29:52been developed. Each line is
29:53a different antibody.
29:55In this, this tells you
29:56that in two thousand eleven,
29:57there were twelve clinical trials
29:59with bispecific antibodies.
30:01In two thousand twenty three,
30:03there were sixty two, and
30:04now I think there's upwards
30:06of a hundred and some.
30:07And, these are all the
30:09different tumor types. So lung
30:11non small cell lung cancer
30:12is at the top there
30:13with sixty two trials.
30:15So
30:16very exciting area.
30:18Okay. Now I'm gonna switch
30:19for a moment to small
30:20cell because this drug was
30:22just approved last year. And
30:24this bispecific, again, makes a
30:25lot of sense here in
30:26small cell because this slide
30:29here
30:29on the on the left,
30:32the blue cells are tumor
30:33cells, and this is a
30:35baseline biopsy
30:36before treatment. And what you
30:38can see there, there are
30:39a lot of tumor cells,
30:40but there aren't pink or
30:41yellow cells. Those are the
30:43white blood cells.
30:44And and then this is,
30:47this is not specifically tarlatanab,
30:49but the idea here is
30:50you can see massive
30:52infiltration of a lot of
30:53different,
30:54white blood cells, and that
30:56we think is what is
30:57helping to activate the immune
30:59system to recognize cancer cells.
31:01So
31:03the the this drug in
31:05small cell lung cancer, this
31:06was the Delphi three zero
31:07one trial that led to
31:08FDA approval. Just pay attention
31:10here. So in in
31:13forty percent of the patients,
31:14they had shrinkage of their
31:15disease.
31:17Another thirty percent had stable
31:19disease, so that means about
31:20seventy percent of the patients
31:22were responding to this drug.
31:24And all of those patients
31:25had already been treated with
31:27two different lines before that
31:29of treatment. So this is,
31:32on the basis of this,
31:34this drug was approved by
31:35the FDA last year, and
31:37then another
31:39trial
31:41in June confirmed the results
31:43and actually showed if you
31:44compared
31:45patients treated with tarlatanab
31:47to patients with chemotherapy,
31:49there was really a positive,
31:52to extend the overall survival
31:53by five months. So really
31:55exciting.
31:56And the other thing I
31:57didn't mention is that those
31:58those patients who are responding,
32:00the median duration of response
32:02is is almost ten months.
32:04So you're not just saying,
32:05let's just let's push it
32:07out a couple couple months
32:09before you have something that's
32:10popping up. It's really ten
32:12months, so that's really great.
32:15So
32:16briefly about some of the
32:17side effects of these kinds
32:18of drugs,
32:19is is cytokine release syndrome.
32:21So if you think about
32:23activating your immune system, if
32:24you get a vaccine shot,
32:26flu, COVID,
32:27sometimes you get,
32:29some fever and chills that
32:30night. You feel a little
32:31achy, really tired,
32:34you know, over the over
32:35the course of the next
32:36day. And so this is
32:37similar, but so here,
32:40over half the patients had
32:41CRS,
32:42mostly low grade one or
32:44two, symptoms of fever, chills,
32:46maybe the blood pressure was
32:47a low a little low,
32:48the the oxygen a little
32:50low. These can these symptoms
32:52can be treated with Tylenol,
32:53IV fluids,
32:55oxygen, and steroids.
32:57Only one percent of those
32:58patients had,
32:59more severe grade of grade
33:01three CRS that went into
33:03the the ICU for monitoring
33:05there. And this CRS usually
33:07occurs,
33:08again, like that flu vaccine,
33:10within twenty four hours of
33:12the first two infusions. So
33:13week one and week two
33:14right now, we admit patients
33:16into the hospital for monitoring
33:18overnight. They can go home
33:19the next day, and then
33:21the rest of the,
33:23infusions can happen every two
33:25weeks in in the outpatient
33:27setting in the clinic.
33:29And we're working on a
33:30a pilot to do this
33:32outpatient as well
33:33safely. So what's next? Well,
33:35you heard from Doctor Herbst.
33:37When you have active drugs,
33:39we want to try to
33:40move them earlier in treatment,
33:41either first line or in
33:43maintenance or after you have
33:49or in early stage. So
33:51that those those trials are
33:52happening now. There are also
33:56lots of bispecifics and even
33:57tri specifics,
33:59and this shows you one
34:00where not only is there
34:02the CD three and, DLL
34:04three, but but the antibody
34:06also recognizes
34:08albumin, which is basically protein
34:10in your body, and it
34:10helps to extend the half
34:12life. So there's lots of
34:13ways to augment this,
34:15and, right now, they're being
34:16used in combinations with standard
34:18of care and other novel
34:19drugs. Super exciting.
34:22Keep your eyes out for
34:23this. And again, I love
34:24it because we're just avoiding
34:26chemo altogether. So,
34:28alright. Thanks. That's it for
34:29me, and I'll I'll, and
34:31thanks for your,
34:32attention.
34:36Thank you, doctor Chang. So
34:38last but not least in
34:39this session is doctor Scott
34:41Gettinger. Doctor Gettinger is a
34:42thoracic oncologist. And as you
34:44heard from doctor Herbst, he
34:46led,
34:47some of the, early immunotherapy
34:49trials here. So thank you
34:51very much.
34:54There we go. So I
34:55can just advance it here.
34:59Nice.
35:00Hello, everybody.
35:01It's great to see all
35:02of you
35:03here, and some of you
35:05well, I met you over
35:06ten years ago, so it's
35:07really a different world in
35:09lung cancer. So
35:11I, welcome everybody.
35:15So I was, asked to
35:16discuss antibody drug conjugates, and,
35:18initially, my plan was to
35:20show you a video
35:21that I think,
35:23describes antibiotic conjugates very well.
35:25But, my colleagues told me
35:27you don't come here to
35:28see a video. You come
35:29here to see us talk.
35:31So,
35:33I'm I put some slides
35:34together to to, to illustrate
35:36this, but at the end,
35:36I'm gonna show just a
35:37truncated version of the video
35:39and just to see how
35:40I did.
35:42Okay.
35:43So on the right here,
35:44you can see a tumor.
35:45So what is a tumor?
35:46So you have one cell
35:48in an organ, let's say,
35:49the lung. One cell that
35:50does its business day by
35:52day. And then for some
35:53reason, that one cell becomes
35:54two, becomes four, becomes a
35:56million. And that happens because
35:58of mutations in the DNA
35:59of that cell.
36:01The immune system
36:03distinguishes
36:04a tumor cell from a
36:05normal cell based
36:08upon proteins that are expressed
36:09in the surface. We've heard
36:10about this. We call them
36:11antigens.
36:12Okay? And that's how you
36:14initiate an immune response to,
36:17to different things, whether it's
36:18tumor or viruses.
36:20So
36:21there are two types of
36:22antigens,
36:22tumor antigens. One is a
36:24tumor specific antigen
36:25which is different patient to
36:27patient. So very hard to
36:28target these antigens because we'd
36:29have to figure out the
36:31difference in each patients and
36:32then would have to create
36:33an antibody.
36:34And then there are the
36:35tumor associated antigens. These are
36:36antigens that are preferentially
36:38expressed on tumor cells,
36:40and these might occur in
36:42anywhere from ten to twenty
36:43five percent of lung cancers.
36:46So here on the left,
36:47you see an antibody. And
36:49what an antibody is supposed
36:50to do,
36:51let's just pretend this is
36:52not a tumor cell. Let's
36:53pretend pretend this is a
36:54cell that's infected with COVID.
36:56And let's say you've been
36:57exposed to COVID before.
36:59So when COVID infects a
37:00cell, it takes over the
37:01machinery of the cell, and
37:03it starts making all sorts
37:04of proteins. And some of
37:05these proteins are
37:07expressed. Let's see here.
37:11Not sure how to show
37:12it, but you see these
37:13these bright
37:15oh, yeah. So you can
37:17see these. So one of
37:18these might be a COVID
37:19associated antigen.
37:20And so
37:21when that happens,
37:23we have antibodies that are
37:24made by our own immune
37:26system, by our b cells,
37:27and they come and they
37:28recognize,
37:30this infected cell and they,
37:32they flag the immune system
37:34to destroy the cell.
37:36So you've heard a lot
37:37about antibodies and the antibodies
37:38that you heard about tonight
37:39are ones that we create.
37:41So in a case of
37:42a tumor
37:43associated antigen, we might not
37:45have antibodies because these antigens
37:47might have been expressed on
37:48normal cells early in development
37:50or on some rare normal
37:52cells now in low degree.
37:54So we have made antibodies,
37:57against some of these antigens.
37:58We initially just started making
38:00antibodies and there's one for
38:01example called Cetuximab.
38:03Anyone remember Martha Stewart? She
38:05went to jail because of
38:06Erbitux. Okay. So that was
38:07an antibody. It's one of
38:08these, one of these antigens
38:10and promise it doesn't it
38:11didn't work that well. At
38:12least in lung cancer, it
38:13didn't work that well. So
38:15we need to do better
38:16and,
38:17technology has allowed us to
38:19modify antibodies in all sorts
38:21of ways.
38:22So these are the three
38:23components of an antibody drug
38:25conjugate.
38:26K? You have the
38:29you have the antibody, we
38:30call it a monoclonal antibody
38:32that's created,
38:33and then we have a
38:33linker
38:34that links a warhead, in
38:36this case, chemotherapy
38:37to the antibody.
38:39So now you can have
38:39the antibody that's gonna circulate
38:41around the body. It's gonna
38:42find the the tumor cell,
38:44and it's gonna bring this
38:45chemotherapy
38:46smart bomb along with it.
38:48So blowing this up a
38:49little bit, let's just start
38:50here. So let's say,
38:53you know, you know, in
38:54clinic, I have a big
38:55arrow so I can see
38:56it. I can't see it
38:57here. But anyway,
38:59you probably see it.
39:00It's they make fun of
39:01me. But,
39:02so so this is the
39:03tumor. Right? And here are
39:04some antigens on the tumor,
39:05and this is the ADC
39:07that you get through an
39:08IV infusion. And let's say
39:09this is an ADC that
39:10recognizes something on a tumor
39:12called TROPE two.
39:13K? So here you see
39:14in brown,
39:15this is TROPE-two. So the
39:17antibody drug conjugate
39:19binds to this antibody,
39:21binds this antigen,
39:22and then this causes the
39:23cell to take in the
39:25antibody in a process called
39:26endocytosis.
39:27And once in the cell,
39:30the
39:31antibody inside an endosome,
39:33merges with a lysosome which
39:35allows cleavage
39:36here of
39:37the chemotherapy
39:39from the antibody and now
39:41the chemotherapy can do its
39:42effect, can kill the cancer.
39:44There is another potential effect
39:46called the bystander effect. So
39:48the once this, chemotherapy is
39:50is
39:51is released, it can permeate
39:53into nearby cells regardless if
39:55those cells
39:56express that particular trop two
39:57antigen or not and cause
39:59cancer cell death.
40:01So currently there there are
40:03many of these antibody drug
40:04conjugates in development
40:06for non small cell lung
40:07cancer on the left and
40:08small cell lung cancer on
40:09the right. Three of them
40:11are currently FDA approved and
40:14I can see one person
40:15who's on one of them.
40:17One is for a protein
40:19called cMET and here you
40:20can again see this is
40:21the surface of the cell,
40:23and here are the antigens
40:24that are expressed. One is
40:26for TROKE two, and then
40:27one is for HER2.
40:29So we here are
40:31running several clinical trials looking
40:33at new antibody drug conjugates.
40:35And now that I've gotten
40:36to this part, I'd like
40:37to show two minutes of
40:38a video. Is that okay?
40:39Yeah. That's it. Because I
40:40think it it if I
40:41can figure out how to
40:42do this.
40:44Oh, boy.
40:48Yeah. There we go. Antibody
40:50drug conjugates or ADCs
40:52are a kind of cancer
40:53treatment approved to treat a
40:55variety of cancers.
40:57ADCs were created as a
40:59way of delivering chemotherapy drugs
41:01directly into cancer cells with
41:03the goal of minimizing damage
41:04to healthy cells.
41:06You can think of them
41:07as a kind of targeted
41:08chemotherapy.
41:09As their name suggests, each
41:11antibody drug conjugate is comprised
41:13of an antibody,
41:15a drug,
41:16and a linker that holds
41:17them together.
41:18Antibodies can precisely locate and
41:21bind to specific proteins found
41:23on the surface of cells.
41:24So the antibody component of
41:26an ADC is designed to
41:28precisely locate and bind to
41:30a specific protein found mainly
41:32on whatever type of cancer
41:33cell is being targeted.
41:35This antibody serves as a
41:37guided missile to deliver to
41:38the inside of the cancer
41:40cell tiny payloads in the
41:42form of a potent chemotherapy
41:44drug.
41:45Because the chemo is being
41:46delivered directly to the cancer
41:48cells,
41:49ADCs can use a very
41:50low dose of a more
41:51powerful type of chemotherapy than
41:53the kind of chemo that
41:54is delivered throughout the body.
41:57Finally, the linker is designed
41:59to help prevent the chemo
42:00from releasing until it reaches
42:02the target cells.
42:04ADCs are delivered through an
42:05IV.
42:06The antibody component of the
42:08ADC
42:09seeks out cancer cells by
42:11looking for the protein it
42:12was designed to identify.
42:14When the antibody binds to
42:15this protein, the cell responds
42:17by pulling the ADC
42:19inside the cell.
42:20Once inside the cancer cell,
42:22the laker breaks down.
42:24This releases the chemotherapy payload
42:26so it can destroy the
42:27cell.
42:29Now within a tumor, there
42:30may be cancer cells that
42:32don't have the target protein.
42:34Some ADCs are able to
42:36destroy these cells too.
42:38That's because their chemo payload
42:39can seep out of the
42:40targeted cells to reach neighboring
42:42cells as well. This is
42:44called the bystander effect.
42:46There are more than a
42:47dozen ADCs approved for
42:50That's enough. I was gonna
42:51show longer initially, but
42:52alright. Thank you, guys.
42:59Thank you all. So I'd
43:01like to invite,
43:02doctor Wilson, doctor Chang, and
43:04doctor Goettinger to just come
43:05up here,
43:07so that we can they
43:08can answer some questions.
43:11Does anybody have a question?
43:15Yes.
43:17I don't know if I
43:18need the microphone.
43:19Well, I'm gonna I'll give
43:20you the mic. I'll pass
43:21it down. Yeah. My question
43:22is, regarding,
43:24heated heated chemotherapy.
43:27I read something probably in
43:28the Cure magazine that is
43:30gonna be a game changer.
43:31So is that something that
43:32you folks are working on?
43:34Or
43:36Certain spaces we we have.
43:44So there there's certain spaces
43:45in the body, like the
43:46pleural space, which is, you
43:48know, a bag that's around
43:49the lung. We have the
43:50the peritoneum, which is sort
43:51of a bag around all
43:52the organs in the in
43:53the abdomen.
43:55And in those situations,
43:56we sometimes
43:58will will try to well,
43:59we won't, but it's been
44:01done where you heat a
44:02chemotherapy and you put it
44:03into that space
44:04or you put some other
44:05thing into that space, whether
44:07it's another immunotherapy,
44:08and that can cause cell
44:10death, you know, within that
44:11area.
44:12It's particularly used for mesothelioma,
44:15but we're beginning we have
44:16a program here,
44:17a guy who does mesothelioma
44:19for the peritoneum, and he
44:20wants us to do this
44:21in the pleura. So we're
44:22beginning to do this,
44:24but it's really a local
44:25effect. And there might be
44:26some subsequent immune activation,
44:29but it's it's more local
44:30right now. So when you
44:31say local, that means just
44:33to
44:34say per se, like, the
44:35the log here. In that
44:36cavity, you know, where the
44:37cancer cells line that cavity
44:39and often you have fluid
44:40that's produced because that that
44:41cavity, those lining has holes
44:43in it and you get
44:44pleural effusion. Some of you
44:46might know what that is
44:46where you get fluid around
44:47the lung or fluid around
44:49the abdomen ascites. It's really
44:51supposed to treat local disease.
44:53But once you get cell
44:54death, you can have an
44:55immune response, and that immune
44:57response can extend beyond that
44:58area.
44:59Thank you. Can I ask
45:01one more question?
45:03AI.
45:04Where are you folks at
45:05in in that whole process
45:06of getting that fully implemented
45:08at Yale?
45:10Are you at the beginning
45:11stages? When do you expect
45:12it to be fully functional?
45:15It's not me.
45:18So AI is super interesting
45:20now, and there's so many
45:21ways that it can be,
45:23used. I think that right
45:24now,
45:26there are there's a lot
45:27of interest, for example, in
45:29pathology.
45:30So,
45:31there is work being done,
45:33where you can you know,
45:36we talk a lot about
45:37mutation targets like eGFR,
45:40and and how you can
45:42sequence and look for that
45:43DNA. There's work around looking
45:45at the pathology slide, the
45:47digital pathology slide, and being
45:49able to determine whether or
45:50not you have an EGFR
45:52mutation
45:53just from looking at the
45:54slide
45:54and teaching folks to do
45:56that. And so you could
45:57imagine that would be really
45:58important in places where you
46:00don't have access to the
46:01pathologist or to the sequencing.
46:04So that's one area where
46:05it's really,
46:06important and and active.
46:08Another area is with radiology.
46:10Right? So you have right
46:12now, we have radiologists looking
46:14at the scans,
46:15but if there's a way
46:16that we can help to
46:17augment that by,
46:19you know, training
46:21training AI to look and
46:22see if there are their
46:23particular characteristic
46:25patterns of cancer.
46:27And especially if you're looking
46:28at a scan maybe after
46:29you have surgery or, you
46:31know, could you look at
46:32that and and have,
46:35see a pattern that might
46:37put you at more risk
46:38of developing recurrence or less
46:40risk. And then you could
46:41dial you could, you know,
46:44do more therapy or or
46:46monitoring or in the high
46:47risk patient or vice versa.
46:49And that's something that was
46:50just presented at
46:53ESMO, recently. And so there's
46:55a lot of activity, you
46:56know, utilizing AI in all
46:58sorts of the things that
46:59we we do, and I
47:00think it's it's sort of
47:02rapid learning and,
47:04you know, we're all trying
47:05to put our heads around
47:06that and see if it
47:07can help us in our,
47:09and help patients.
47:11I think we have time
47:12for one last question.
47:14Yes.
47:24Has immunotherapy,
47:25reached the level where it's
47:27used, only by itself and
47:28not in conjunction with chemotherapy
47:30as well?
47:31Is it, always used with
47:33chemotherapy?
47:35Yeah. That's a great question.
47:38There are some situations where
47:39we might use,
47:41immunotherapy
47:42alone. We do use it
47:43sometimes in combination,
47:45with chemotherapy.
47:47One of the, what we
47:48call biomarkers that we use
47:50to kinda help us to
47:51determine what the likelihood
47:53is of a patient with
47:55a certain type of lung
47:56cancer called non small cell
47:57lung cancer
47:59of benefiting from the immunotherapy
48:01is looking at the tumor
48:02PDL one expression. We've heard
48:04about PDL one, tonight. And
48:06sometimes that can give us
48:08a sense of what the
48:09likelihood of benefit is to
48:11immunotherapy
48:11alone.
48:13It's not a perfect biomarker,
48:15and there's a lot of
48:16research
48:17going on, not only looking
48:18at PD L1, other biomarkers
48:20as well, genetic
48:22characteristics
48:23of the cancer,
48:24that can be important in
48:26helping to kind of formulate
48:28the optimal
48:29treatment plan for a given
48:30individual patient,
48:32and that might involve immunotherapy
48:34alone. It might involve,
48:36immunotherapy
48:37together with chemotherapy, and there
48:39may be certain
48:40contexts or situations where immunotherapy
48:43isn't a good choice for
48:44an individual,
48:46patient.
48:48Thank you very much. So
48:49thank you very much for
48:50the speakers in this session.
48:52I think you heard about
48:53some new emerging therapies that
48:55are really exciting and things
48:57for us to keep an
48:58eye out. Thank you very
49:01much.
49:06Alright. Next, we have a
49:07panel and,
49:09that is going to be
49:10moderated
49:11by doctor Justin Blasberg
49:13who
49:14is right here.
49:29How are you guys?
49:30So, this is actually the
49:31keynote part of the presentation,
49:33so
49:34welcome to,
49:36our session. We're gonna,
49:38talk about lung cancer screening,
49:39early stage lung cancer, and
49:40a few topics, and we'll
49:42have the group introduce themselves,
49:43and,
49:44we'll run through some questions.
49:46We surveyed
49:47a thousand people to look
49:48for the most important
49:50questions that you guys wanna
49:51know about, and we'll review
49:52some of those things today.
49:57Sure. Hi. Gavett Woodard. I'm
49:59a thoracic surgeon here at
50:00Yale, and we treat a
50:01lot of lung cancer in
50:02our practice.
50:04Polly Sather. I'm a nurse
50:06practitioner,
50:07and I coordinate our lung
50:08cancer screening program.
50:11Hi. I'm Lynn Tonoye. I'm
50:13a pulmonary critical care physician,
50:15and I direct the lung
50:16cancer screening program.
50:18And I also see a
50:19lot of patients with lung
50:20cancer.
50:22Good evening. I'm Christina Foos.
50:24I'm a cardiothoracic
50:25radiologist, and I read all
50:27these lung cancer screening CDs.
50:30So this is a modest
50:31group. If you're having lung
50:33cancer screening anywhere in our
50:34system, probably this group touches
50:36your scan in some form.
50:38That's thousands of scans and
50:40a pretty impressive encatchment. So,
50:42we're fortunate to have this
50:43group today. I wrote my
50:44questions down,
50:46so that we can be
50:47timely. We're gonna start with
50:49Polly. Polly is,
50:52sort of the keeps the
50:53wheels from falling off the
50:54bus of the lung cancer
50:55screening machine,
50:57and,
50:58we were gonna start with
50:59some questions
51:00mostly about, where we are
51:02today with lung cancer screening.
51:04Many of you may understand
51:06may know who qualifies for
51:07lung cancer screening, but we're
51:08going to review that quickly
51:09and then sort of talk
51:10about where we are in
51:11twenty twenty five with the
51:12success of our program, which
51:14has evolved over time,
51:16and, what the future looks
51:17like. So why don't we
51:19just start with an update
51:19on lung cancer screening and
51:21and who qualifies?
51:23Sure. So my job kind
51:24of is to keep you
51:25guys having a lot of
51:27free time so we don't
51:28have to talk about those
51:29ADCs and give you guys
51:31a lot of business. But,
51:33so lung cancer screening,
51:35we've had recommendations in the
51:36United States since two thousand
51:38fifteen. But really in March
51:39of two thousand twenty one,
51:41the recommendations
51:42by the United States preventative
51:44task force were updated
51:45to broaden the eligibility criteria,
51:48which right now includes anybody
51:50fifty years to eighty who
51:52smoked,
51:53cigarettes a pack a day
51:54for the equivalent of twenty
51:56years still smoking or quit
51:57within fifteen years.
52:00So that's the current eligibility
52:01criteria, and the way we
52:03screen is with a low
52:04dose CAT scan that your
52:05group reads. And we're very
52:07fortunate here at Smilow to
52:08have a dedicated group of
52:10chest radiologists
52:11that,
52:12read these scans. It's not
52:14a general radiology group that
52:15reads them. So that improves
52:17our sensitivity and our specificity
52:19of these tests.
52:21Lung cancer screening, though, has
52:23really been slow in the
52:24uptake. Like, the current,
52:27nationally, we're only screening about
52:29eighteen percent of the eligible
52:31population
52:32unlike breast, which is about
52:34eighty percent get mammograms.
52:36For colorectal screening, it's closer
52:38to, like, seventy percent. Prostate's
52:40a little lower, about thirty
52:42six percent.
52:44But I'm really happy to
52:45say that in Connecticut, we
52:46are number two in the
52:48country in terms of our
52:49lung cancer screening rates. That
52:51data just came out from
52:52the American Lung Association.
52:53We're just behind our small
52:55little neighbor of Rhode Island
52:57to the north.
52:58And we do have scanners
52:59from, like, Warwick all the
53:01way down to Greenwich, and
53:02we have coordinators,
53:04at all those sites. Some
53:05of them are here. Krista
53:07from New Haven. Emily's here
53:09from Greenwich. Stephanie from Bridgeport.
53:12So we've come a long
53:13way in terms of our
53:14screening, and we're screening, you
53:16know, about three thousand people
53:17now a year.
53:19And in,
53:21the lung cancer screening trials
53:23that we often,
53:25think about, talk about, and
53:26that have shown a benefit
53:27to lung cancer screening. One
53:28of the biggest
53:29parts, the most important parts
53:31is not just coming in
53:32to get that initial scan,
53:33but it's the follow-up. It's
53:35getting patients to come back
53:36for the second and third
53:37scan so that we follow
53:39nodules that may be growing
53:40or changing and how have
53:42we or what have we
53:43been doing to help patients
53:45with adherence for those recommendations
53:47because those scans seem like
53:48they're as important as that
53:49initial scan.
53:51Yeah. So adherence is really
53:52worth talking about because in
53:54the lung cancer screening trials,
53:57the majority of the lung
53:58cancers that were found were
54:00not in the initial screen.
54:01It was in the subsequent
54:02screens. So people will have
54:04a normal screen, and then
54:06they do need to come
54:06back every year.
54:08So,
54:09before their initial screen, all
54:11the coordinators
54:12and I, we call everybody,
54:14and we do what's called
54:15a shared decision making visit,
54:16and we talk a lot
54:17about adherence and the importance
54:19of coming back.
54:21We do also have a
54:22pretty sophisticated
54:23tracking system within our,
54:26EMR, our epic system, where
54:28we know when people are
54:29late. We know if they
54:30have critical findings, and we
54:32are going to find you
54:34and make sure you get
54:35something done about it.
54:37We also just set up,
54:39a self scheduling option in
54:41the MyChart if we have
54:42MyChart users to help people
54:44schedule their scans and to
54:46improve our adherence rates.
54:48Great. Thank you.
54:50So, doctor Tanui, I'm hoping,
54:52can help us with,
54:54probably the most important
54:56question tonight, which is, why
54:58do you think it's important
54:59that people
55:00what's the most important reason
55:02that people who are at
55:03risk for lung cancer should
55:04have lung cancer screening?
55:06So I'm I wanna ask
55:07the audience a question.
55:09How many of you have
55:09had breast, colon, or prostate
55:12cancer screening in the past
55:13five years?
55:15Yeah. So you are motivated,
55:18educated bunch,
55:20and,
55:22the whole point of screening
55:23is to find a cancer
55:24early.
55:25Because if we can find
55:26a cancer early before it's
55:28causing any symptoms, so you
55:30wouldn't know to go to
55:31the doctor.
55:32Right? You're healthy, feeling fine,
55:34but you go for your
55:35mammogram,
55:36do your colon rec colon
55:38screening. And PSA, the prostate
55:40specific antigen has had some
55:41controversy,
55:42but most of you men
55:44out there are having it
55:46monitored.
55:48If you had a cancer,
55:49one of those three cancers,
55:51the likelihood,
55:52if it was detected by
55:53screening, that you would be
55:54alive in five years is
55:56more than ninety percent.
55:58And so early detection is
55:59the reason we're doing screening.
56:02Right now, all these fancy
56:04drugs, these exciting science that's
56:06going on is really
56:07directed at advanced stage.
56:10They're getting used more and
56:11more in earlier stage,
56:13but three quarters of people
56:14with lung cancer
56:15now are diagnosed at advanced
56:18stage where surgery
56:20or radiation
56:22are not gonna be your
56:23best options. You need systemic
56:24therapy, and so we need
56:26all these drugs that have
56:28really revolutionized lung cancer care
56:31for that seventy five percent
56:32of people who have advanced
56:34stage disease at the time
56:35of diagnosis.
56:37So if we can get
56:38lung cancer
56:39screening embedded in the community
56:42so that instead of
56:44being glad that it's twenty
56:46percent now instead of zero,
56:48what that means is eighty
56:49percent of people still aren't
56:50being screened.
56:51We can shift the needle
56:53to where breast is, for
56:54instance, where,
56:56I don't know, eighty percent
56:57of people are diagnosed at
56:58early eighty percent of women
57:00are diagnosed at early stage.
57:02And so breast cancer has
57:03become a like, I'm a
57:05survivor. It's a chronic disease.
57:08I go get checked for
57:09it every year or two,
57:11but I'm not afraid that
57:12I'm gonna die because I
57:13know that if something happens,
57:15I will be detected early
57:16again. And we have to
57:18shift the needle for lung
57:19cancer
57:20there because it right now
57:22is the leading cause of
57:23cancer death
57:24in both women and men.
57:26And I'm gonna say something,
57:28which is a little shocking,
57:29which is that in the
57:30US, for the last two
57:31to three years,
57:33more women have been diagnosed
57:34with lung cancer than men.
57:36And that shift in the
57:38curve is gonna keep getting
57:39more pronounced.
57:41And so all you women
57:42out there and all you
57:43men, if you have friends
57:44who should be screened, please
57:46tell them to go.
57:49Awesome.
57:51I think for our radiology
57:53experts,
57:54as a as a segue
57:56to that,
57:57patients are getting lung cancer
57:58screening CTs. They're getting CT
58:00scans
58:01in the ER for shortness
58:02of breath, they're getting calcium
58:03scoring CT scans, their scans
58:05happening all the time, information
58:07is being released to patients
58:07immediately, they see all sorts
58:09of
58:10findings on Epic on MyChart.
58:11They don't really understand what
58:13those things mean,
58:14and that must be
58:16equally a burden or a,
58:19an extra amount of workload,
58:21in reading these scans, for
58:23our radiology colleagues.
58:25How do you distinguish
58:27incidental findings on lung cancer
58:28screening, CT scans, low dose
58:30CT scans? How do you
58:31determine what's clinically meaningful? How
58:33do you determine what's background
58:34noise? How do we reassure
58:36patients
58:36that this little spot that
58:38just popped up on the
58:38scan is is actually okay
58:40to watch?
58:42You bring up an excellent
58:43point. And to everybody who
58:44ever had a CT
58:46with a report that scared
58:47you, I apologize
58:49that this scared you.
58:52And I would really encourage
58:54you if this happens in
58:55the future,
58:56don't be scared and talk
58:58to the ordering provider
58:59before you go down the
59:00rabbit hole of the Internet.
59:02Please do that.
59:04We are legally obliged to
59:06put certain things in the
59:07report because otherwise, they're considered
59:09missing.
59:10Having said that,
59:12there are things that we
59:13see on lung cancer screening
59:15CTs that are not related
59:16to lung cancer screening that
59:18are important.
59:19As we know,
59:20smoking does not only affect
59:22our lungs,
59:23but it only also affects
59:25our vessels.
59:26All vessels in our chest
59:28can be affected, particularly the
59:30ones around the heart, the
59:31coronary arteries.
59:32And so if we read
59:34lung cancer c cleaning CTs
59:36and we see a lot
59:37of coronary artery calcifications,
59:40which is a marker for
59:42coronary artery disease, we will
59:43comment on that. And if
59:45you haven't seen a cardiologist
59:48in the past for that,
59:49there will be a note
59:50in the report saying,
59:52maybe you should see a
59:52cardiologist and be worked up
59:54for that. So this is
59:55something that we would not
59:57just
59:58forget.
59:59The same is the large
01:00:00vessel that comes out of
01:00:02your heart, the aorta,
01:00:03can be also affected and
01:00:05it can get large. And
01:00:06so we also comment on
01:00:07that.
01:00:08If it's over a certain
01:00:10measurement,
01:00:11you should probably be seen
01:00:13by a vascular surgeon or
01:00:15by also by a cardiologist.
01:00:17Little things in the liver.
01:00:18We usually try to say,
01:00:20it's a little thing in
01:00:21the liver. Don't worry about
01:00:22it. And if we say
01:00:23in the report, don't worry
01:00:24about it, then please don't
01:00:26worry about it. We have
01:00:27to say that it's there.
01:00:29But, again,
01:00:30it has something to do
01:00:31with that we have to
01:00:32report these things.
01:00:34So
01:00:35in short,
01:00:36if you're worried,
01:00:38don't ask doctor Google.
01:00:40Ask your ordering provider. Ask
01:00:42your PCP.
01:00:44Ask your pulmonologist.
01:00:46Ask someone who knows,
01:00:48and please don't be scared.
01:00:51Thank you.
01:00:52I'm wondering if we could
01:00:53also just touch on emerging
01:00:55technologies. Someone asked about, AI
01:00:57and radiology and pathology and
01:00:59other emerging technologies in
01:01:01the radiology space that are
01:01:03useful for lung cancer screening,
01:01:05what we might expect on
01:01:07the horizon.
01:01:08Well, obviously, there's a lot
01:01:10of technological
01:01:11developments going on. One of
01:01:12the things that many people
01:01:14still fear is I'm doing
01:01:16screening
01:01:17with ionizing radiation. I'm exposing
01:01:20myself to something that is
01:01:21per se risky.
01:01:22And one of the reason
01:01:24why lung cancer screening actually
01:01:25made it to where we
01:01:27are today is because we
01:01:28were able to show that
01:01:29the risk from the radiation
01:01:31outweighs
01:01:32the risk or the benefit
01:01:33from being screened. Having said
01:01:35that, with our newer technologists,
01:01:37we're now able to reduce
01:01:39the radiation dose even further.
01:01:42So it gets now into
01:01:44the realm of maybe a
01:01:45couple of a handful of
01:01:46chest x rays,
01:01:48which are unfortunately completely useless
01:01:50to screen for lung cancer.
01:01:52But the CT is useful,
01:01:54yet the dose is
01:01:56similar.
01:01:57So that's significant change that
01:01:59we have on we are
01:02:01going to have that particular
01:02:03scanner I'm talking about next
01:02:05year. So I'm keeping my
01:02:06fingers crossed.
01:02:07I'm very excited about this.
01:02:10AI was mentioned. AI is
01:02:12ubiquitous.
01:02:12We have it at our
01:02:14discretion every day regardless where
01:02:16you are.
01:02:17We also have it in
01:02:18the reading room. There are
01:02:19some tools that look at
01:02:22patterns in CTs and try
01:02:24to recognize,
01:02:25is this bad? Is this
01:02:27good? Has this changed? Has
01:02:29it grown?
01:02:30Has it not? The challenge
01:02:31with these is
01:02:32that
01:02:33the
01:02:36no CT is the same.
01:02:37So if if one of
01:02:38you were to get their
01:02:39CT
01:02:41this year and then next
01:02:42year, even if you go
01:02:43to the exact same place,
01:02:45it will not look entirely
01:02:47hundred percent the same. And
01:02:48so we have to
01:02:50find ways
01:02:52to assess for the minute
01:02:53changes that are simply because
01:02:55it's a different CT to
01:02:56the changes that are actually
01:02:58true growth
01:03:00or true changes in what
01:03:02we describe density.
01:03:03That's a term that we
01:03:04use when we describe things
01:03:06in the lungs.
01:03:08So I'm excited. There's a
01:03:09lot of development at the
01:03:10end of this month. There's
01:03:11our big annual international meeting
01:03:14in Chicago, and I'm sure
01:03:15that the vendors are gonna
01:03:16be full with this.
01:03:17So I'll report back.
01:03:19Thank you. And then for
01:03:21doctor Woodard,
01:03:22maybe our last question before
01:03:23we ask the crowd if
01:03:25they have questions.
01:03:27Lung cancer screening, calcium scoring,
01:03:29CT scans, all of this
01:03:30imaging has generated a lot
01:03:32of,
01:03:33early stage business on the
01:03:35surgery side. And I'm wondering
01:03:36if you could tell us
01:03:37about how that has changed
01:03:39your practice in terms of
01:03:41volume of cases, the type
01:03:42of surgeries that you're doing,
01:03:44and maybe touch on the
01:03:45robotics program as we have
01:03:46built that up quite a
01:03:47bit with your help. Yeah.
01:03:49Thank you.
01:03:50As was mentioned previously by
01:03:52doctor Tanui, the goal is
01:03:53to shift a diagnosis
01:03:55from a cancer that would
01:03:56have been caught at a
01:03:57very late stage where the
01:03:59treatments are more challenging,
01:04:01our likelihood of cure is
01:04:02less, to a much earlier
01:04:04stage where it's a lot
01:04:06more easy for a patient
01:04:07to undergo a lung cancer
01:04:08treatment.
01:04:09So I'm a surgeon. If
01:04:10you're diagnosed with a stage
01:04:11one lung cancer or found
01:04:13to have a lung nodule
01:04:14that we don't even know
01:04:15what it is,
01:04:16the treatment for that is
01:04:17either going to be something
01:04:19like an operation that we
01:04:20would do, and I'll talk
01:04:21about that, or radiation therapy
01:04:23if you're not a surgical
01:04:24candidate.
01:04:25These are a lot easier
01:04:26therapies to endure than having
01:04:28systemic therapy. All the new
01:04:30cool chemotherapy drugs
01:04:32are great, but the ideal
01:04:34treatment for a lung cancer
01:04:35would be to catch it
01:04:36in this very early stage
01:04:38where we can take it
01:04:39out with a lot
01:04:41better health benefits to you,
01:04:43more likelihood of a cure,
01:04:45as well as, you know,
01:04:46not putting you through the
01:04:47systemic therapies.
01:04:48So we do most of
01:04:49our operations here with robotic
01:04:51surgery as was mentioned by
01:04:53doctor Blasberg who leads up
01:04:54our robotics program.
01:04:56And they're all small incisions
01:04:58on the side. I like
01:04:58to tell patients they're the
01:04:59size of my finger, and
01:05:00we basically put ports between
01:05:02your ribs. We put cameras
01:05:04and long instruments in between
01:05:06your ribs, and we're able
01:05:07to remove tumors that way.
01:05:09We can remove lobes, and
01:05:10most of our operations are
01:05:12done this way. Patients leave
01:05:13the hospital in a few
01:05:14days. They don't have these
01:05:16big incisions,
01:05:17and they do really well
01:05:18long term. And so the
01:05:20earlier we catch a cancer,
01:05:22the more likely it is
01:05:23that we're able to treat
01:05:24it with just these interventions
01:05:26alone. And stage one cancers
01:05:28at the moment are not
01:05:29getting any more systemic therapies.
01:05:30We're just treating you with
01:05:31this, and then you're done.
01:05:33And you go into a
01:05:34surveillance mode where you're basically
01:05:35getting your annual CT scan
01:05:38eventually just every year to
01:05:39monitor for any signs of
01:05:40recurrence.
01:05:41So it really does make
01:05:42a dramatic difference in what
01:05:43the treatments are like for
01:05:45lung cancer if it is
01:05:46caught at an earlier stage.
01:05:48And so that's why we
01:05:49we push these initiatives of
01:05:51lung cancer screening because it
01:05:52makes a difference in how
01:05:53people do in terms of
01:05:54outcomes, but it also makes
01:05:56the treatment a lot easier
01:05:57if you are found to
01:05:58have a lung cancer.
01:06:02Sounds great.
01:06:04I think just for the
01:06:05sake of time, does anybody
01:06:06have questions for this panel,
01:06:08this group?
01:06:10Do you have some some
01:06:12notion about the
01:06:13people who are not in
01:06:14the current,
01:06:16recommended group, you know, the
01:06:17fifty smokers,
01:06:19the earlier ones,
01:06:21and what the incidence is
01:06:23of that that group, and
01:06:25and is there any,
01:06:27thought about or or movement
01:06:29to expand that that pool?
01:06:32I have a little personal
01:06:33investment in that that my
01:06:34wife was diagnosed with early
01:06:36stage lung cancer because she
01:06:37tripped at home and thought
01:06:39she hurt her ribs, and
01:06:40the imaging showed up at
01:06:42early stage.
01:06:44It's a fascinating question. I
01:06:45think, maybe we'll ask doctor
01:06:47Tanui to expand,
01:06:49you know, the what about
01:06:51family history? What about exposure
01:06:53history, occupational exposure?
01:06:55Those those questions are are
01:06:57fascinating.
01:06:58So
01:07:00we,
01:07:02are stuck right now with,
01:07:04the criteria that Pali
01:07:06outlined, but we know that
01:07:08that's not gonna find about
01:07:10half of the people who
01:07:11will get lung cancer.
01:07:13And so,
01:07:15one thing is the American
01:07:16population
01:07:17is changing,
01:07:19and there are a lot
01:07:20more people who never smoked
01:07:22in this country than there
01:07:23were
01:07:24ten, twenty, thirty, certainly fifty
01:07:27years ago,
01:07:28but we're not seeing the
01:07:29lung cancer rates falling precipitously
01:07:32because of that, although they're
01:07:33coming down. So fewer people
01:07:35are dying.
01:07:36But because the population of
01:07:38the United States has gotten
01:07:39so much bigger,
01:07:40there are actually still a
01:07:41lot of people with lung
01:07:42cancer.
01:07:43And so there is a
01:07:44lot of interest in defining
01:07:46risk outside of cigarettes.
01:07:48And there are now
01:07:50really good models that can
01:07:52incorporate things like besides age
01:07:54and smoking,
01:07:56are you male or female?
01:07:57Do you have a family
01:07:58history? Were you exposed to
01:08:00asbestos or other carcinogens?
01:08:03And the future of lung
01:08:05cancer screening really is that
01:08:06there should be a way
01:08:07to combine all that patient
01:08:09individual information
01:08:11with blood tests.
01:08:12And so if we could
01:08:13find some of those
01:08:15gene genetic mutations in blood,
01:08:18and we know that somebody
01:08:20maybe demographically
01:08:21has more risk because they
01:08:23have a primary relative of
01:08:25lung cancer, that should then
01:08:27expand the pool of people,
01:08:29perhaps to the general population,
01:08:31who would then have that
01:08:32sort of
01:08:33relatively noninvasive
01:08:35testing. I mean, a PSA
01:08:37is a blood test after
01:08:38all. So this would be
01:08:38blood test with patient characteristics.
01:08:41And I think that is
01:08:42the way that this is
01:08:43headed, and hopefully, really within
01:08:45the next decade,
01:08:47your wife won't have to
01:08:48be diagnosed by accident.
01:08:52Any other questions?
01:08:56Yeah. I have a question.
01:08:57Just,
01:08:59smoking.
01:09:00I mean, what about toxics
01:09:02and other, you know,
01:09:04air stuff in the air
01:09:06could could cause
01:09:07tumors in the lungs as
01:09:09well. And, that's one part.
01:09:11And second is,
01:09:12why don't,
01:09:14medical doctors
01:09:16in the beginning check for
01:09:17this at a certain part?
01:09:19I mean, why does there
01:09:20have to be an incident
01:09:21for them to check to
01:09:22see if you have cancer?
01:09:24I mean, it's, I mean,
01:09:25in my case,
01:09:26I was kinda lucky. I
01:09:27just
01:09:28it's really falling down. If
01:09:30I didn't fall down, I
01:09:31wouldn't have known what I
01:09:32had. You know? Alright. Everybody
01:09:33go out and fall down.
01:09:34Alright?
01:09:36Because we have two falls.
01:09:38I I I think you're
01:09:39touching on what is really
01:09:40the challenge right now. We
01:09:41wanna screen everyone.
01:09:43But if we did we
01:09:44if we did a CT
01:09:45scan on everybody, then even
01:09:47with the tiny dose of
01:09:48radiation, we'd be exposing a
01:09:50lot of people to
01:09:52consecutive scans
01:09:54who will never get cancer.
01:09:56And so that these risk
01:09:58models that I was talking
01:09:59about do try to incorporate
01:10:00things like exposures,
01:10:02although it's really hard to
01:10:03quantify,
01:10:04to measure
01:10:06how much exposure I may
01:10:07have had from air pollution
01:10:09versus somebody else who lives
01:10:11in another city, for instance.
01:10:13And so I I don't
01:10:14I think we have to
01:10:14get more sophisticated than that,
01:10:16and that really is gonna
01:10:17be a biomarker
01:10:18blood test,
01:10:20so that we can screen
01:10:21the population.
01:10:22Like, you know, blood test
01:10:23tell you you have cancer.
01:10:25Well, we don't have it
01:10:26yet, but believe me, there's
01:10:27a ton of work going
01:10:28on,
01:10:29for that. Yeah. Yeah. So,
01:10:31you know, it's it's truly
01:10:33we I couldn't have said
01:10:34this ten years ago when
01:10:35we started screening that that
01:10:36was on the horizon, but
01:10:38it but it is. Yeah.
01:10:40Thank you.
01:10:43Alright. Great. Thanks to this
01:10:44panel and, to the audience
01:10:46for listening, and
01:10:47we'll move on to our
01:10:48last panel.
01:10:58Alright. So we are moving
01:10:59on to our next panel.
01:11:00We have two more panels.
01:11:02This one, I am moderating.
01:11:04So this one is called
01:11:05progression
01:11:07through participation.
01:11:09Lung cancer clinical trials matter.
01:11:12I don't see any panelists
01:11:13here with me. Be asking
01:11:15myself questions. Okay.
01:11:17So come up.
01:11:18Okay. Good. Here are my
01:11:19panelists in. Okay.
01:11:23Thought I was gonna have
01:11:24to ask and answer the
01:11:25questions.
01:11:27That was cool.
01:11:30Alright.
01:11:31So you have already heard
01:11:33during the last hour or
01:11:35so
01:11:37about clinical trials.
01:11:42And the reason for that
01:11:43isn't people have mentioned this
01:11:44all along is,
01:11:47the only way we learn
01:11:48more about
01:11:50cancer or any disease and
01:11:52how to best treat it
01:11:53is through trials. It is
01:11:54the literally the only way.
01:11:55We we sometimes can do
01:11:57other types of studies, but
01:11:58the best way to to
01:12:00make progress, to figure things
01:12:01out, to get the best
01:12:02treatments
01:12:03is to do studies. It's
01:12:04really the only way that
01:12:05that we learn more about
01:12:06it and also that the
01:12:07FDA
01:12:08recognizes
01:12:09a medication or a treatment
01:12:10that should become standard.
01:12:12And so at Yale and
01:12:14at really all cancer centers,
01:12:16major cancer centers where where
01:12:17there's research done,
01:12:19this is a
01:12:21really a primary goal because
01:12:23we, of course, need to
01:12:24treat everybody
01:12:25with cancer, but we also
01:12:27need to make progress. Right?
01:12:28We never really settle on
01:12:29where we are now. We
01:12:30always wanna do better. I
01:12:31always think until we're curing
01:12:32all cancer, all lung cancer,
01:12:34any cancer, we could always
01:12:35do better, and the only
01:12:36way to do that is
01:12:37through research. So we are
01:12:38all very dedicated to that,
01:12:40and we have a panel
01:12:41here of people that do
01:12:42research for lung cancer and
01:12:44work on trials and other
01:12:46types of research. And, really,
01:12:47everybody you've heard from today
01:12:48does that in some part.
01:12:49Really, everybody at Yale who
01:12:51works here in some way
01:12:52also works on research. So
01:12:53it's something we're all really
01:12:54passionate about. So I will
01:12:56let my panelists introduce themselves
01:12:58and tell you what they
01:13:00do and what role in
01:13:01research specifically they have, and
01:13:02then I will ask some
01:13:03questions and then open it
01:13:04up to all of you.
01:13:05So
01:13:06we have another microphone.
01:13:10Hey, everybody.
01:13:12I'm Mike Grant. I am
01:13:13a thoracic oncologist.
01:13:15I'm up in Waterbury, Connecticut,
01:13:19and I trained here,
01:13:21under Sarah and a lot
01:13:23of these people.
01:13:24And, you know, the the
01:13:26main
01:13:27involvement that I have is
01:13:28in clinical research. So
01:13:30seeing patients,
01:13:31in the clinic and then
01:13:32trying to think about the
01:13:34trials that we have open,
01:13:36Help, you know, use use
01:13:38help from our team and
01:13:39then match patients to clinical
01:13:41trials.
01:13:45How's this on? Yes.
01:13:46My name is Jennifer Pope.
01:13:47I'm the clinical research manager
01:13:49in our clinical trials office
01:13:51here at Yale.
01:13:52So I manage a team
01:13:53of Clinical Research Nurses and
01:13:55Clinical Research Coordinators,
01:13:58who you may have seen
01:14:00in the clinic,
01:14:01with our providers.
01:14:03And we work directly with
01:14:05clinicians
01:14:06and with patients in order
01:14:08to bring you clinical trials.
01:14:12Hi, everyone. My name is
01:14:13Ben Liu. Excuse me. I'm
01:14:16a physician scientist, and so
01:14:18I'm a medical oncologist who
01:14:19sees patients with lung cancers.
01:14:21And then I also,
01:14:22do research in a laboratory
01:14:24setting, so a little bit
01:14:25different than what,
01:14:26doctor Grant does. But,
01:14:28I like to ask questions
01:14:30and try and understand how
01:14:31our immune system interacts with
01:14:33tumor cells and particularly,
01:14:35what happens when tumor cells
01:14:36go into the brain? How
01:14:38can our immune system,
01:14:40how can we understand how
01:14:41that interaction works?
01:14:44Right. Superstar team. Ben, keep
01:14:46the microphone because I'm gonna
01:14:47ask you a question first.
01:14:49So
01:14:50a lot of people here
01:14:52and and,
01:14:53at Yale may have heard
01:14:55about a trial or have
01:14:56been asked to be on
01:14:57a trial or participate in
01:14:58a trial, but let's, like,
01:14:59rewind to the beginning. How
01:15:01does an idea even get
01:15:02into a trial in the
01:15:02first place? So you mentioned
01:15:04you're in the lab. How
01:15:05does something you're working on
01:15:06sells or whatever you're working
01:15:07on in the lab, how
01:15:09does that become an idea
01:15:10that then finds its way
01:15:11into trial? What's the the
01:15:13brief version of the process?
01:15:14Yeah. That that that's a
01:15:15terrific question. I think you
01:15:17all saw the end product
01:15:18with what Doctor. Herbst had
01:15:19mentioned earlier, what Doctor. Wilson,
01:15:21Doctor. Gettinger, and, everyone has
01:15:24talked about,
01:15:25these,
01:15:26what we define as successes
01:15:27in terms of new treatment
01:15:29options for patients.
01:15:31But Doctor Herbst also showed
01:15:32a picture of this huge
01:15:34team of people, and it
01:15:36really does take an entire
01:15:38community of clinicians,
01:15:40nurses, pharmacists,
01:15:42pharmaceutical companies,
01:15:43scientists,
01:15:45to be able to put
01:15:45that all of that work
01:15:46together. And part of the
01:15:47reason why,
01:15:48everyone celebrated that is because
01:15:50it it really does take
01:15:51such a long period of
01:15:52time for us to be
01:15:54able to ask the questions
01:15:55in the lab,
01:15:57show that this is in
01:15:58fact what happens,
01:16:01come up with the right
01:16:02medications to target those
01:16:04pathways and then to actually
01:16:05bring it to patients.
01:16:07And so, you know,
01:16:09for me as a human
01:16:10immunologist, it starts with,
01:16:12and as a physician scientist,
01:16:14it starts with learning from
01:16:15patients, learning where are
01:16:18areas that we need to
01:16:19improve upon and then taking
01:16:21that question back to the
01:16:22laboratory and seeing, Okay, how
01:16:24can we go about trying
01:16:26to answer? What is the
01:16:26fundamental
01:16:28issue here?
01:16:29What is a way that
01:16:30we can address this? And
01:16:31then once we've come up
01:16:32with a model like what
01:16:33Doctor. Felitti does in the
01:16:34lab that helps
01:16:37us understand
01:16:40whether or not we think
01:16:41this will work in patients,
01:16:42then bring it along into
01:16:44clinical trials and see whether
01:16:46or not we can bring
01:16:47it, as a new treatment
01:16:48option for patients.
01:16:50Great.
01:16:51Jenna, I'm gonna turn to
01:16:53you.
01:16:54How long have you been
01:16:54working on clinical trials?
01:16:57Fifteen years, I think. A
01:16:59long time. Great. So perfect.
01:17:00So I knew it was
01:17:01a while. I didn't know
01:17:02exactly how long. Tell us
01:17:03what you've seen change over
01:17:04the years because I've been
01:17:05doing this about a little
01:17:07around that amount of time
01:17:08too, and I I feel
01:17:09like things have really changed.
01:17:10So a lot of the
01:17:11work that you do is
01:17:12is the I mentioned this
01:17:14expression before, but really the
01:17:15behind the scenes. Right? Making
01:17:16all this work. So what
01:17:17what has changed in you
01:17:18from your perspective? And tell
01:17:19us a little bit about
01:17:20that behind the scenes, how
01:17:21things actually work with with
01:17:22trials.
01:17:24Sure. So,
01:17:25we talk about this a
01:17:26lot on our team that
01:17:28we used to have
01:17:29a sort of small handful
01:17:31of trials that we could
01:17:32offer to patients and it
01:17:33was more like we had
01:17:35a trial that we tried
01:17:36to fit every patient into.
01:17:37And now we kind of
01:17:38are able to take the
01:17:40the opposite approach where we
01:17:41have many options and we're
01:17:43really trying to find this
01:17:44the perfect option for each
01:17:46patient,
01:17:47and then many options along
01:17:48the way.
01:17:49So, right from your initial
01:17:52diagnosis
01:17:52through the process,
01:17:54through multiple lines of therapy,
01:17:56we're able to find specific
01:17:58trials that will work best
01:17:59in those situations. If you're
01:18:00a early disease or or
01:18:02later
01:18:03disease all along the way.
01:18:05And now our what we're
01:18:06looking at, the questions we're
01:18:07trying to answer are much
01:18:08more broad. So we're collecting
01:18:10you know maybe some additional
01:18:11blood samples from you, we're
01:18:13collecting some additional tumor when
01:18:14we're going in for a
01:18:15biopsy so we can
01:18:17answer these broader questions about
01:18:19why a treatment might work
01:18:20better for one person,
01:18:22than another.
01:18:24Thank you. I I always
01:18:25say that we always try
01:18:26to learn as much as
01:18:28we possibly can. It's not
01:18:29just does this treatment work,
01:18:30but why and how, and
01:18:33if it doesn't work, why
01:18:34not? So I I absolutely
01:18:35agree with that.
01:18:37Mike,
01:18:38tell us what it's like
01:18:39when you're seeing a patient
01:18:40in terms of how you
01:18:41talk to them about different
01:18:43options.
01:18:44When might someone wanna think
01:18:45about a trial? Is it
01:18:47you heard from the panel
01:18:48before. Is it only for
01:18:50people with advanced disease, or
01:18:51are we thinking about it
01:18:52at different stages? How do
01:18:53how do you think about
01:18:54it? Do you always think
01:18:54about it for patients also?
01:18:57Yeah. I do. I think
01:18:58that's that's the first step.
01:18:59You know, our our job
01:19:01as investigators
01:19:02and people that,
01:19:03have access to these trials
01:19:05and, you know, try to
01:19:06provide access to our patients
01:19:08is to know the trials,
01:19:09like, to know what we
01:19:10have open,
01:19:12to know, you know, to
01:19:14an extent the ins and
01:19:15outs of them and what
01:19:16criteria,
01:19:18how a patient would would
01:19:20potentially qualify for the study.
01:19:22And then,
01:19:23you know, that's that's what
01:19:24I'm thinking about when I
01:19:25see a patient is, you
01:19:27know, is there an option
01:19:28that I can provide for
01:19:29this patient,
01:19:31that is a trial that's
01:19:32better than what we can
01:19:33offer off the trial?
01:19:35Ultimately, what we're trying to
01:19:36do with research is really
01:19:38just build on the treatments
01:19:40that are available.
01:19:42Unfortunately,
01:19:43you know, there there's a
01:19:44lot of deficiencies in lung
01:19:45cancer treatment, and that is
01:19:47sort of what we're trying
01:19:48to use these trials to
01:19:49do to build on. So
01:19:51I think,
01:19:52yeah, every trial is trying
01:19:53to answer a question like
01:19:54Jen said,
01:19:56and every
01:19:57time that you have a
01:19:58patient in front of you,
01:19:59we're trying to fit the
01:20:01pay we're not trying to
01:20:02fit the patient on a
01:20:03trial.
01:20:04We're trying to find the
01:20:05right option for the patient,
01:20:06which may be a trial
01:20:07and which may not be
01:20:08a trial.
01:20:09So I think it it
01:20:10starts with how how we
01:20:12understand the trials, how we
01:20:13how we sort of work
01:20:14with our team to know
01:20:16what we have open,
01:20:17and then, you know, the
01:20:18rest is just conversations with
01:20:20patients.
01:20:23Alright. We're we're running a
01:20:25little low on time, so
01:20:25I I I might
01:20:28maybe I'll open it up
01:20:29to the the floor now,
01:20:30and then I I I
01:20:31could keep going. I have
01:20:31a whole list here. But
01:20:32does anybody have questions
01:20:35about clinical trials or anything
01:20:37else for this esteemed panel?
01:20:39Yes.
01:20:46How much of a collaboration
01:20:48is between your teams and
01:20:49the pharmaceutical industry? You work
01:20:50hand in hand
01:20:52collaboratively,
01:20:54or do you Who wants
01:20:55to take that one? Hand
01:20:56off
01:20:57trials to one another.
01:20:59Great questions.
01:21:01Mike, do you wanna take
01:21:02that one? Yeah. So,
01:21:05I think, you know, some
01:21:06of our trials that we
01:21:07have open at Yale are
01:21:09in come you know, in
01:21:10in,
01:21:11industry sponsored, so trials that
01:21:13we work with companies.
01:21:15Other trials are, in the
01:21:17context of cooperative groups, which
01:21:18are large organizations that,
01:21:21you know, try to answer
01:21:23practical questions in cancer care.
01:21:26So we have a mix
01:21:27of of these these things,
01:21:29and I think, you know,
01:21:30it's it's our clinical trial
01:21:32team and and doctor Goldberg
01:21:33who sort of,
01:21:35were always looking for opportunities
01:21:38to bring drugs that look
01:21:39promising. And sometimes this these
01:21:41are drugs that are very
01:21:42early in development
01:21:44and, that we can sort
01:21:45of work with pharmaceutical companies
01:21:47to bring them to patients
01:21:48in our clinics.
01:21:51You
01:21:55need this,
01:21:57they say.
01:21:58We'll try and make that.
01:22:01I don't know if they
01:22:02make it for us. So
01:22:03no. It's such it's such
01:22:05a great question, but I
01:22:06I'll just say something.
01:22:07You might not realize this,
01:22:09but there's actually lots of
01:22:10people from the pharmaceutical
01:22:11industry in this very room.
01:22:14So so we work incredibly
01:22:16closely together. I think
01:22:18so much of what we
01:22:19do, especially as medical oncologists
01:22:20where we're developing drugs and
01:22:22we're trying to make better
01:22:23drugs,
01:22:24is is so much in
01:22:25collaboration
01:22:26with people in the pharmaceutical
01:22:28industry. And a lot of
01:22:29our scientists are working on
01:22:30things. Maybe Ben is gonna
01:22:32tell us this about this
01:22:33now, and then work with
01:22:34the pharmaceutical companies to try
01:22:36to bring those to patients.
01:22:37So it is a kind
01:22:38of a a circle of
01:22:39of trying to work together
01:22:41to
01:22:42do you know, to to
01:22:43create better drugs, to develop
01:22:44better drugs, and then to
01:22:45bring the trials here so
01:22:46that we can can study
01:22:47them better. Ben, go ahead.
01:22:49Yeah. I I just to
01:22:51add to what doctor Gober
01:22:52said, you know, I think
01:22:53that
01:22:54pharmaceutical companies and our academic
01:22:57centers have very complementary roles
01:22:59in terms of the types
01:23:00of the,
01:23:02treatments they can bring to
01:23:03patients.
01:23:04One thing that I will
01:23:05say, and I I think
01:23:06it's particularly beneficial to be
01:23:08here at a u institution
01:23:09like Yale where, you know,
01:23:11the medical oncologists, the clinicians,
01:23:13and the scientists kind of
01:23:14stand side by side is
01:23:15that we do have the
01:23:16opportunity
01:23:17to ask, you know, probably
01:23:19more unique and,
01:23:22to us, interesting questions that
01:23:24pharmaceutical companies might not be
01:23:26necessarily thinking about, or we
01:23:28may have access to, you
01:23:30know, science that isn't as
01:23:32mature, but that we can
01:23:33help to develop.
01:23:35And so, you know, I
01:23:36I I do think that
01:23:37the roles are very complementary.
01:23:38Certainly, we do work with
01:23:40pharmaceutical companies, but, there is
01:23:42also a lot of access
01:23:43to clinical trials that,
01:23:45are independent of them.
01:23:50Nobody hurt themselves, please. I'll
01:23:52be quick.
01:23:53How do you work out
01:23:54the ethics,
01:23:55ethical questions that can arise
01:23:57between these kinds of collaborations?
01:24:00Good questions.
01:24:01Jen, do you wanna take
01:24:02that since you're holding the
01:24:03microphone?
01:24:04Or does anybody else would
01:24:05like to like to answer?
01:24:07I can talk just a
01:24:08a little bit about, like,
01:24:09the research, like, consenting process.
01:24:12So when when we pro
01:24:13when we present a clinical
01:24:14trial to a patient,
01:24:16we are required. We have
01:24:18institutional review boards that require
01:24:19this. There's federal regulations and
01:24:21laws,
01:24:22that require us to tell
01:24:24you about all the options
01:24:25that are available to you.
01:24:26So your
01:24:27provider will talk to you
01:24:29about
01:24:31so that that is yes.
01:24:32Exactly. Who's funding it? Who's
01:24:34funding it? Who's gonna ax
01:24:35have access to the information
01:24:37about you?
01:24:39All all of that is
01:24:40presented to you.
01:24:41I think, in my opinion,
01:24:43one of the the critical
01:24:44part is what are the
01:24:45other options. So this is
01:24:46the option that the trial
01:24:47is giving you. And then
01:24:49these are the other options
01:24:50that you should also be
01:24:50considering,
01:24:52at the same time.
01:24:54Yeah. I think I think
01:24:54it's such an important point,
01:24:56and
01:24:57we we
01:24:58and, really, everyone else tries
01:25:00to be very transparent about
01:25:02it because
01:25:03the pharmaceutical industry is
01:25:06for profit. Right? And that
01:25:08is something that you need
01:25:09to know about. And so
01:25:10in every
01:25:11trial and every consent form,
01:25:12it will talk about who's
01:25:14funding the study,
01:25:15if any of the investigators
01:25:17have any do do any
01:25:18work with that company. It's
01:25:19all in there. So it's
01:25:20required to be in there.
01:25:21It's not a Yale thing.
01:25:22So that that's part of
01:25:23it so that it's very
01:25:24transparent, and you can make
01:25:25it an educated decision about
01:25:27participating with that information.
01:25:30Hang on. Sorry.
01:25:32I I think another thing
01:25:34is that clinical trials,
01:25:36I think what doctor Grant
01:25:37said earlier is, that, you
01:25:39know, every clinical trial that
01:25:40we try to offer is
01:25:42really trying to build upon
01:25:43and not,
01:25:44on the standard of care,
01:25:46meaning care that you would
01:25:47get with your,
01:25:48providers outside of the trial.
01:25:51And I think one behind
01:25:52the scenes look at how
01:25:55we select the clinical trials
01:25:57is that, you know, doctor
01:25:58Goldberg and Jen and Doctor.
01:26:00Grant, every single week, they're
01:26:02every single day, they're constantly
01:26:04looking to see, you know,
01:26:05what are the most exciting
01:26:07options that they can bring
01:26:08to patients. And so, you
01:26:10know,
01:26:11I think
01:26:13for them in their selection
01:26:14process, for us in our
01:26:15selection process,
01:26:17it really is about trying
01:26:18to find the best option
01:26:19and putting the patients first.
01:26:21Yes, there are ethical con
01:26:23con considerations
01:26:25when we are working with
01:26:26pharmaceutical companies, but I think
01:26:28it is it does take
01:26:29a thoughtful approach to,
01:26:31be able to present some
01:26:32of the options to you.
01:26:36K. I think maybe one
01:26:37last question, and then we'll
01:26:38move on to our
01:26:40next panel.
01:26:42Just curious if you have
01:26:43a notion about kind of
01:26:44how it breaks down what
01:26:45percentage of your, the clinical
01:26:47trials are that you are
01:26:49one part of a multisite,
01:26:52research that involves other, other
01:26:55research sites around the country
01:26:56and how much are kind
01:26:58of all housed here?
01:27:00Yeah. I maybe I'll answer
01:27:02that. So most of the
01:27:03studies that we do are
01:27:05not just here.
01:27:07Most of the studies are
01:27:08multicenter studies that enroll at
01:27:10many institutions, sometimes dozens or
01:27:13hundred around the country and
01:27:14around the world. There are
01:27:15a few studies that we
01:27:16have that
01:27:18are Yale studies
01:27:20developed by our investigators
01:27:22here.
01:27:23A lot of times based
01:27:24on science that comes from
01:27:25the laboratories and then we
01:27:26bring into the into the
01:27:27clinic, a lot of times
01:27:28those are just Yale studies.
01:27:29They tend to be small
01:27:30studies,
01:27:31but but, typically, they're the
01:27:33studies that we have are
01:27:34not just here.
01:27:36They're in collaboration with many
01:27:38others.
01:27:40Good question. Alright. Any last
01:27:42burning questions, or shall we
01:27:43move on?
01:27:44Okay. Thank you so much
01:27:46to our panelists and for
01:27:47all that you do. Thanks.
01:27:51Alright.
01:27:52I'm gonna introduce our last
01:27:54panel, which will be moderated
01:27:56by doctor Dan Baffa,
01:27:59who's the chief of thoracic
01:28:00surgery here at Yale,
01:28:02and he will
01:28:04introduce his panelists or have
01:28:05them introduce themselves. Thank you
01:28:06so much, Dan.
01:28:11Alright.
01:28:13Thank you so much.
01:28:14I'm the last, we're the
01:28:16last act here. So,
01:28:19hang tight, and, we'll try
01:28:20to make this a little
01:28:21bit more,
01:28:23engaging if we can.
01:28:26I'll I'll answer a couple
01:28:27of things that that came
01:28:28up just,
01:28:30you there was a question
01:28:31about AI
01:28:33and,
01:28:34how do drug companies
01:28:36discover
01:28:37new drugs. And just to
01:28:38give you a sense of
01:28:39how crazy
01:28:40the next five years are
01:28:42gonna be,
01:28:43that DeepMind did a collaboration
01:28:45actually with Yale to look
01:28:47at,
01:28:48different drugs
01:28:49to, have cancer cells show
01:28:52things on their surface that
01:28:53would make the immune system
01:28:55recognize them.
01:28:56And they tested, like, five
01:28:57thousand drugs and narrowed it
01:28:59down to, like, five, which
01:29:00is simulated
01:29:01AI experiments, and the five
01:29:02actually looked pretty good.
01:29:04And so the the amount
01:29:05of discovery that's gonna happen
01:29:07in the next five years
01:29:08is truly crazy. I mean,
01:29:09the the amount of the
01:29:11amount of information that's collected
01:29:12on patients every year is
01:29:14like a zettabyte.
01:29:16That's the equivalent
01:29:18to every book
01:29:20that's been published ever
01:29:22a million times.
01:29:24So we we collect that
01:29:25much data every year on
01:29:27patients, and and this is
01:29:29going to be used to
01:29:29totally change everything we know
01:29:31about medicine.
01:29:33So, with that,
01:29:35let me have, why don't
01:29:36you guys go ahead and
01:29:37introduce yourselves and say, something
01:29:39about yourselves? I'm a thoracic
01:29:40surgeon, Dan Boffa. Hi
01:29:43there. I'm Henry Park. I'm
01:29:44a radiation oncologist, and I
01:29:46I treat patients with, with
01:29:47with all stages of lung
01:29:48cancer, with with radiation therapy.
01:29:52I'm, Michael Cohen. I'm a
01:29:54thoraxic oncologist
01:29:55at the Trumbull and one
01:29:57day a week in Derby,
01:29:59where I treat lung cancer
01:30:00patients.
01:30:02Hello, everyone. I'm Chanel Charles,
01:30:04and I'm the social worker
01:30:05on the team.
01:30:08My name is Michael Glenenning.
01:30:10I'm a physician assistant with
01:30:11the medical oncology team, helping
01:30:13take care of patients while
01:30:13they're getting their treatments.
01:30:16So we we kind of
01:30:17have a loosely defined
01:30:19category here, and I I
01:30:20sort of think of it
01:30:21as
01:30:22survivorship.
01:30:23And survivorship is basically everything
01:30:26after you've been diagnosed and
01:30:27started treatment. It's the rest
01:30:29of your life, basically. And
01:30:31I I like to think
01:30:31of it as
01:30:33sur thrivorship because we don't
01:30:34want you just living. We
01:30:36want you thriving. And so
01:30:37all the things that we
01:30:38need to do to help
01:30:39you achieve
01:30:41all of your life goals
01:30:42between the time you're diagnosed
01:30:44and the rest of your
01:30:46life. And so
01:30:47that is the framing
01:30:48for this next, little session.
01:30:50And so I'll start with
01:30:52with Michael. And,
01:30:55and I I missed the
01:30:57first part. So if somebody
01:30:58wants to just quickly tell
01:30:59me what you guys talked
01:30:59about to be yeah.
01:31:03The,
01:31:04the, so
01:31:06the re the impact of
01:31:07research on lung cancer is
01:31:08truly crazy. I'm I'm sure
01:31:10somebody covered this, but the
01:31:11the cure rate for lung
01:31:12cancer
01:31:13has doubled in the past
01:31:15eight years. We used to
01:31:16get excited
01:31:18when you increase survival by
01:31:19two weeks. That was a
01:31:21New England Journal paper. If
01:31:22you if people live longer
01:31:24by two weeks, it was
01:31:25a New England Journal paper.
01:31:27Now,
01:31:28it is it's doubled in
01:31:29the past eight years. And
01:31:30so we have a lot
01:31:31more people
01:31:32that are living
01:31:34with lung cancer as a
01:31:35chronic disease.
01:31:36And,
01:31:38obviously, living is is preferable
01:31:41to the alternative,
01:31:42but
01:31:43some of these, patients are
01:31:45maintained
01:31:46on lifelong therapy. And so,
01:31:49Michael, just in terms of,
01:31:52say, targeted therapy, people who
01:31:53are spending a long time
01:31:55on targeted therapy,
01:31:57what are what is that,
01:32:00what what is that like
01:32:01and what are the ways
01:32:02that we can support them
01:32:03through that in terms of
01:32:05of making lifestyle changes, and
01:32:07and what does that look
01:32:08like?
01:32:10Me, Michael, or him.
01:32:12Me, Michael. Owner of them.
01:32:13Okay. G or c.
01:32:16We'll c. So
01:32:17I I agree with Dan.
01:32:18I mean, not only have
01:32:20we gone beyond the point
01:32:22of two weeks, but I
01:32:23mean, when we think about
01:32:25when I first went into
01:32:27oncology, less than five percent
01:32:28of people were living till
01:32:30five years, And now we're
01:32:31pushing over forty percent.
01:32:33I mean, it's really just
01:32:34happening in leaps and bounds.
01:32:36So as Dan said, then
01:32:38we have to think, well,
01:32:39what is life like on
01:32:41treatment? I remember going to
01:32:42a talk at ASCO last
01:32:44year,
01:32:45and there was a survivor
01:32:47who was on anti eGFR
01:32:49therapy.
01:32:50I'm treated a really interesting
01:32:51way of framing it, which
01:32:53was
01:32:55we think about side effects,
01:32:56and doctor Chang talked about
01:32:58this, grade one, grade two,
01:32:59grade three.
01:33:00But even a grade one,
01:33:02which we as oncologists don't
01:33:04tend to think about a
01:33:04lot,
01:33:05if they have it day
01:33:07by day, year after year,
01:33:09that's very impactful. And the
01:33:11way she described it is
01:33:13if you had a little
01:33:14pebble in your shoe
01:33:16and you're sitting around, it
01:33:17doesn't really bother you. If
01:33:19that little pebble in your
01:33:20shoe is with you on
01:33:21a five mile hike, that's
01:33:22a really big deal.
01:33:24And so we do have
01:33:25to entertain these things. You
01:33:27know, living with a little
01:33:28bit of diarrhea
01:33:30every day for years
01:33:31is impactful.
01:33:33And a lot of it
01:33:34is just communication
01:33:35between the treating team and
01:33:37the patient. What is tolerable
01:33:38to you? What is acceptable?
01:33:40How can we manage this?
01:33:43And for the most part,
01:33:44we can help alleviate
01:33:46almost every side effect,
01:33:48maybe with the exception of
01:33:49some, hopefully to the point
01:33:51where a patient says this
01:33:53is something I can handle.
01:33:55And they hopefully will feel
01:33:56free to advocate for themselves
01:33:58when they can't
01:34:00and say, I need a
01:34:01break. I need a dose
01:34:02reduction.
01:34:04I think that's really the
01:34:05partnership.
01:34:07Great. Was that was that
01:34:09Annabelle
01:34:10Grewich that gave that talk?
01:34:11I my friend. So Yeah.
01:34:13So
01:34:14I did not ask him
01:34:15to give that example. But,
01:34:17Annabelle just came out with
01:34:18a new book called The
01:34:19End of My Life is
01:34:20Killing Me, and it's about
01:34:21her lifelong battle with,
01:34:24EGFR mutated cancer. And she's
01:34:26gonna be here in March,
01:34:29giving a talk and doing
01:34:30a reading, so just,
01:34:31look out for that. She's
01:34:33amazing. But,
01:34:36so
01:34:38health care is expensive, and,
01:34:40Chanel, this is coming your
01:34:41way. So,
01:34:43health health care costs are
01:34:46the the number one cause
01:34:48of bankruptcy in the United
01:34:50States. And it is a
01:34:51big deal. It is, you
01:34:53know, people are missing work.
01:34:54And
01:34:56what what do you when
01:34:57you think of somebody that
01:34:58comes in with a diagnosis,
01:34:59how do we approach that?
01:35:00How do we support that?
01:35:02What are their options and
01:35:03etcetera?
01:35:05Make sure I get this
01:35:06right this time.
01:35:08Can you hear me? Yes.
01:35:10So,
01:35:11thank you for asking that.
01:35:12Now I am the nonmedical
01:35:14person on the team. And,
01:35:15of course, with the cancer
01:35:16diagnosis
01:35:17comes with a lot of
01:35:18psychosocial issues, including financial issues.
01:35:21And so
01:35:22we, there are grants that
01:35:24we can apply for for
01:35:26patients.
01:35:27We help patients,
01:35:29tap into resources in the
01:35:30community,
01:35:31from different agency. There is
01:35:33Connecticut Cancer Foundation. There's Cancer
01:35:35Care. So there are different
01:35:36organizations
01:35:37out there that we can
01:35:38apply to for grants,
01:35:40on behalf of patients. We
01:35:42also help
01:35:44government resources.
01:35:46Okay. I know. What is
01:35:49It's all the government. Okay.
01:35:50Thank you.
01:35:52That's for government resources.
01:35:54Right now and on.
01:35:56It's here. Here. Here.
01:36:00Thank you.
01:36:01Government resources.
01:36:03Some patients may be qualified
01:36:04for title nineteen
01:36:07or other, Yale has an
01:36:09assisted
01:36:10program, a program that they
01:36:11will assist patients pay for
01:36:12their care.
01:36:13So we explore all the
01:36:15options that are out there,
01:36:16whether through Yale or in
01:36:17the community to help patients
01:36:18pay for care. And just
01:36:20not just care, but,
01:36:22bills,
01:36:23household bills. That's a big
01:36:24factor. When someone is going
01:36:26through cancer, now you're no
01:36:27longer able to work, and
01:36:29so the bills fall to
01:36:31the wayside. So we assist
01:36:32patients with getting,
01:36:34monies to pay for
01:36:36bills.
01:36:37Yeah. I I think the
01:36:38most important thing is you
01:36:40gotta communicate that to your
01:36:42team. These are real things,
01:36:44and you gotta be open,
01:36:46and,
01:36:47it's all a part of
01:36:48the experience. And, sometimes it
01:36:51may mean that you get
01:36:52treated closer to home. I
01:36:54mean, I I personally believe
01:36:55you should get as much
01:36:56care as close to home
01:36:57as possible.
01:36:59I think you should have
01:37:00expert care, but I think
01:37:01you should have as much
01:37:02as close to home as
01:37:03possible. That's my opinion.
01:37:06Henry
01:37:10and and Michael, I think
01:37:11this is a fair question
01:37:12for both of you. When
01:37:12you're
01:37:14thinking about the goals of
01:37:15care, both of the things
01:37:17that you guys are offering
01:37:19could affect
01:37:20people's ability
01:37:22to do things
01:37:23in the
01:37:24recovery phase and the
01:37:27the after cancer phase.
01:37:29How do you think about
01:37:30that when you talk to
01:37:31people about treatment choices,
01:37:34about decision making and getting
01:37:37a good understanding of what's
01:37:38most important to them and
01:37:40and how you change your
01:37:41planning accordingly?
01:37:44So often for stage one
01:37:45cancer, for example,
01:37:47often the choice is between
01:37:48surgery or radiation therapy, as
01:37:49doctor Woodard had mentioned earlier,
01:37:51as as, you know, one
01:37:52local therapy,
01:37:53hopefully, without any need for
01:37:54systemic therapy as well. But
01:37:56there's they they really are
01:37:58both very, they're complementary in
01:37:59a lot of ways for
01:38:00different people in terms of
01:38:01who would benefit more from
01:38:03getting surgery and who would
01:38:04benefit more from getting radiation
01:38:05therapy. It's not so clear
01:38:07cut like an algorithm where
01:38:08you can say, you know,
01:38:09it's very obvious that you
01:38:11should go to surgery and
01:38:12you should go to radiation.
01:38:13Sometimes it's more obvious than
01:38:14others, but there's, we'd we'd
01:38:16we'd like to meet you
01:38:17and really discuss,
01:38:19what you are interested in
01:38:20in terms of the the
01:38:21side effects that you're concerned
01:38:22about,
01:38:23but the the, the kind
01:38:25of life you're looking to
01:38:26live for the remainder of
01:38:27your life as well, especially
01:38:28when we're in a in
01:38:29a mode where we're trying
01:38:30cure your cancers. We we
01:38:32have an early stage disease.
01:38:33We wanna make sure that,
01:38:34you know, we're fitting along
01:38:35with what the life's the
01:38:36life you're likely to live
01:38:37afterwards. Is that gonna look
01:38:39the way that you're hoping
01:38:40for? And and and which
01:38:41of the two options looks
01:38:42better to you overall.
01:38:44You know, some folks decide
01:38:45that they want to get
01:38:47surgery because they they have
01:38:48the cancer removed. I think
01:38:49psychologically, that makes a lot
01:38:50of sense. You know, we
01:38:51don't have a randomized trial
01:38:52yet to prove which is
01:38:54better, surgery or radiation. Often,
01:38:56if you can get surgery,
01:38:57many people do.
01:38:58Some, however, if if they
01:39:00are,
01:39:01candidates for surgery, but they
01:39:02don't don't necessarily
01:39:03want to undergo surgery, for
01:39:05whatever reason, then radiation therapy
01:39:07is a great option as
01:39:07well. But you have to
01:39:08understand the effects it can
01:39:09have on you both in
01:39:10the short term and the
01:39:11long term. So that's why
01:39:12we really try to get
01:39:13to know you in just
01:39:14that hour that we meet
01:39:15in consultation, and then you
01:39:16meet with the surgeon as
01:39:17well, because we want to,
01:39:19and then we wanna meet
01:39:20your family and and get
01:39:21to know what is,
01:39:23you you know, your your
01:39:24goals ultimately.
01:39:26So, that's for stage one.
01:39:27You know, for stage three,
01:39:28stage four, same same kind
01:39:30of idea that, you know,
01:39:31here are the expectations of
01:39:32what this treatment can provide,
01:39:34but here's also some downsides
01:39:35because there's always gonna be
01:39:37some potential downsides here, for
01:39:38any of the treatments that
01:39:39you undergo.
01:39:40So just the understanding of
01:39:42what it could look like,
01:39:43which could vary a lot
01:39:44depending on the person, but
01:39:45knowing what your risk factors
01:39:47are in terms of what
01:39:48factors may make you more
01:39:49prone to certain side effects
01:39:51And what really matters to
01:39:52you a lot, some people
01:39:53say, you know, that being
01:39:54on oxygen is okay with
01:39:55them if they needed to
01:39:56be on it. Other people
01:39:57say I'd really,
01:39:58that that that would really
01:39:59impact my the the lifestyle
01:40:01I wanna live, for example.
01:40:03Right? There's, you know, if
01:40:04I ever needed steroid medications
01:40:05down the road, oh, I've
01:40:06been on that before. No
01:40:07big deal. Other people say
01:40:09if I can at all
01:40:10avoid that whatsoever, I really
01:40:12wanna wanna do that. So
01:40:14all these things we need
01:40:15to hear about and learn
01:40:16about from you during the
01:40:17consultation. We we don't walk
01:40:19in with a clear, we
01:40:20already know what we're gonna
01:40:21do for you, right, because
01:40:22of the fact that and
01:40:24we wanna have options like
01:40:25that because each individual person
01:40:26can be treated differently even
01:40:28if you have the exact
01:40:28same scan on the screen
01:40:30or the exact same stage
01:40:31of of cancer, same type
01:40:32of cancer. Each person is
01:40:34gonna be different in terms
01:40:35of what they're looking for.
01:40:37Michael,
01:40:39please, if if you add
01:40:41to that or I or
01:40:41I will give you another
01:40:42one. That's fine.
01:40:45I mean, the conversation makes
01:40:46me think a lot about,
01:40:47a a great talk that
01:40:48I listened to from a
01:40:49clinician who focused on palliative
01:40:52care, but they talked about
01:40:53when they were meeting their
01:40:54patients that
01:40:55one of the things they
01:40:56really
01:40:57started out with was asking
01:40:59them
01:41:00what tell them one thing
01:41:01about them that was just
01:41:03really important for them to
01:41:04know that they wanted their
01:41:05clinician or their physician to
01:41:06know,
01:41:07about their life, their lifestyle,
01:41:09things that were meaningful to
01:41:10them so that they could
01:41:11have conversations and get to
01:41:12know each other a little
01:41:13bit better,
01:41:14and understand
01:41:15what those important things were
01:41:17and how they might be
01:41:17impacted by the therapies that
01:41:18we're being offered.
01:41:20And so I think that
01:41:21that is a great point.
01:41:22I think that spending time
01:41:23and I think it's what
01:41:25all of us try to
01:41:25do when we're interacting with
01:41:27our patients is spending time
01:41:29getting to know them, spending
01:41:30time trying to understand the
01:41:31things that make a difference
01:41:32in your lives,
01:41:34and thinking carefully about the
01:41:35things that we are doing
01:41:36to you to try and
01:41:38help you, but also hopefully
01:41:39not to impair you from
01:41:40doing the things that are
01:41:41so important to you. Whether
01:41:43it's playing instruments that could
01:41:45be impacted by the neuropathy
01:41:46from certain chemotherapies,
01:41:49fatigue that devastates you and
01:41:50prevents you from exercising in
01:41:52the ways that are super
01:41:53important to you, and any
01:41:54variety of other things. I
01:41:55think it's just that idea
01:41:56that we really wanna get
01:41:57to know you well and
01:41:58understand the things that are
01:41:59important to you to make
01:42:00those choices with you and
01:42:01for you that are best
01:42:02going to serve your long
01:42:03term goals.
01:42:06Well, I could keep going.
01:42:07If anybody in the audience
01:42:08has questions, I wanna give
01:42:09you guys time.
01:42:11Here we go.
01:42:14Actually, I don't have a
01:42:15question. I'm Steve Ham. You
01:42:17two guys saved me
01:42:19a year ago, and I
01:42:20just wanna thank you so
01:42:21very much.
01:42:22Okay?
01:42:27Well, thank you for saying
01:42:29that. I I commonly,
01:42:31get asked, like, what it
01:42:32is about
01:42:34us and our team, and
01:42:35it is seven fifteen.
01:42:37And if you look in
01:42:38that row right back there,
01:42:41there are
01:42:42four five of our five
01:42:44of our nurses are here.
01:42:46Six
01:42:47can just
01:42:48can can our team just
01:42:50stand up? I just I
01:42:51want you guys to just
01:42:52see this is the type
01:42:53of commitment. This is what
01:42:54separates us. This is how
01:42:55we're able to do
01:42:57the things that we're able
01:42:58to do.
01:43:01So that is that is
01:43:02really the that is the
01:43:03Yale difference right there.
01:43:09Well,
01:43:10I'll tell you. So a
01:43:11question
01:43:12I commonly get asked is
01:43:14what can you what can
01:43:15I do
01:43:16to make treatment work better?
01:43:18Should I eat an all
01:43:19blueberry diet? Should I, you
01:43:21know, I and and I
01:43:22don't know.
01:43:24Do you guys have any
01:43:25thoughts about things that people
01:43:27can do? You're diagnosed with
01:43:28cancer.
01:43:29What can they do to
01:43:31make the treatment work better,
01:43:32to make the cancer not
01:43:34come back? Or is there
01:43:35anything that they can do?
01:43:36Stop. Stop. Okay.
01:43:38That's a hundred percent. So
01:43:40the the the side effects
01:43:41of chemotherapy
01:43:42and treatment are less if
01:43:44you stop smoking.
01:43:45The recurrence rates are lower.
01:43:47It's actually
01:43:48as
01:43:49powerful
01:43:50as immunotherapy
01:43:52in terms of mortality reduction,
01:43:53quitting smoking. So quitting smoking
01:43:56at any age, at any
01:43:57stage,
01:43:59will make you live longer.
01:44:02As active as possible.
01:44:05Go expand on that.
01:44:08Just being active is is
01:44:10critically important. We know there's
01:44:11a lot of research that's
01:44:12ongoing,
01:44:14a lot of research that's
01:44:14been gathered over the years.
01:44:16People who
01:44:17are active, and it doesn't
01:44:18mean running marathons or lifting,
01:44:21you know, three hundred pound
01:44:22bench presses,
01:44:24But being active on a
01:44:25regular basis really impacts how
01:44:27you tolerate therapy.
01:44:28It impacts survival and how
01:44:30you will do in the
01:44:31long term, and it impacts
01:44:32you in ways that can
01:44:34counteract the effects of the
01:44:35therapies that you're on. So
01:44:36it's really important,
01:44:38to find ways that you
01:44:39enjoy being active and that
01:44:40you can be active. And
01:44:42if you're in doubt about
01:44:43what you should or could
01:44:44do, talk with your clinicians
01:44:45about that. They can help
01:44:46guide you, for the appropriate
01:44:48kinds of activity for your
01:44:49particular cases.
01:44:54Yeah. I'll just add to
01:44:55that. I often get asked
01:44:56about diet. We we have
01:44:57we do have dietitians in
01:44:58both medical oncology and radiation
01:45:00oncology who definitely can help
01:45:02with that in terms of
01:45:02how to get enough nutrition
01:45:04in, especially if you're, you
01:45:05know, some some forms of
01:45:06radiation, especially with larger field
01:45:08radiation close to the esophagus.
01:45:09If a large length of
01:45:10esophagus is covered, then sometimes
01:45:12we'll have, you know, patients
01:45:13will have difficulty being able
01:45:14to maintain their weight. So
01:45:16we're we're we're actually of
01:45:17the and and I think
01:45:18with with
01:45:20trying to keep people
01:45:22at at at steady weight,
01:45:23which is maybe this may
01:45:24be different from other parts
01:45:26of your life where you're
01:45:26trying to lose weight. Here
01:45:27we're trying to keep you
01:45:28from losing weight as much
01:45:29as possible, but also to
01:45:30keep on muscle and to
01:45:31keep on, you know, your
01:45:32ability to, to to move
01:45:34and and function,
01:45:36well, also. So, you know,
01:45:37I think with with, with
01:45:39with just good exercise, good
01:45:41diet, as much as is
01:45:42reasonable. Right? Like you're saying,
01:45:44not everyone can do everything.
01:45:46But but but trying to
01:45:47maintain and kinda push yourself
01:45:49to to some degree, not
01:45:50not over tire yourself, but
01:45:52push yourself to take those
01:45:53steps.
01:45:54You you know, there there's
01:45:55there's some people who use
01:45:56Fitbits to try to keep,
01:45:57you know, or or even
01:45:58the eye for the phones
01:45:59now can can track the
01:46:00number of steps you take.
01:46:01So even things like that,
01:46:03simple things like just taking
01:46:04walks and such, you you
01:46:05may feel pretty down with
01:46:06your treatment sometimes and wanna
01:46:08just lie around the the,
01:46:09you know, to to to
01:46:10watch TV all day and
01:46:11and and and be in
01:46:11your house all day. As
01:46:13much as you can just
01:46:13do kind of daily errands,
01:46:15things like that, it'll keep
01:46:16you both mentally and physically
01:46:18sharper.
01:46:20And I I think also
01:46:21it's really critical, again, just
01:46:23communicate with your care team,
01:46:25especially when we think about,
01:46:28complimentary
01:46:29treatments that a lot of
01:46:30patients will take and they
01:46:32think sometimes they're afraid to
01:46:33bring up with their caregivers.
01:46:35As many
01:46:36very valuable and very safe
01:46:38complimentary treatments as there are,
01:46:39there are some that are
01:46:40harmful
01:46:41or that are detrimental because
01:46:43they counteract with the chemotherapies.
01:46:45Talk to us and we
01:46:46will go through
01:46:48each, you know, naturopathic
01:46:51thing that you're taking. We
01:46:52can refer to our integrative
01:46:54medicine specialists.
01:46:55I mean, we wanna know
01:46:57everything because we're open to
01:46:59that. We know that there's
01:47:00always room to add to
01:47:02the care of our patients
01:47:04and that sometimes we need
01:47:05to think outside of the
01:47:06box.
01:47:10I'd like to comment more
01:47:10on the complimentary alternative medicine
01:47:12aspect. You know, we've we've
01:47:13done some studies here on
01:47:15on that as well, and
01:47:15I think it's important to
01:47:16understand what the difference is
01:47:17between complimentary and alternative.
01:47:20They're often linked together, but
01:47:21alternative really means instead of
01:47:24some part of your care.
01:47:25Right? That's recommended from other
01:47:27the cancer related care that's
01:47:28recommended either whether it's chemotherapy,
01:47:30immunotherapy, radiation surgery. If you're
01:47:32omitting all of it or
01:47:34some of it, that's would
01:47:35be considered alternative, whereas complementary
01:47:37is really more in addition
01:47:38to. So I just want
01:47:39to make sure we understood
01:47:40the the definitions
01:47:42of this as well. There's
01:47:43a lot of misinformation out
01:47:45there. Right? I think it'd
01:47:46be just yeah. I do
01:47:47wanna spend a little time
01:47:48on this because,
01:47:49you know, if if you
01:47:50open any social media anytime
01:47:51or the news or anything,
01:47:53you're going to see a
01:47:54lot of information out there
01:47:55that's very difficult to elucidate.
01:47:57Well, to figure out what's
01:47:58fact and what's fiction,
01:48:00especially with just the news
01:48:01cycle these days. It's very
01:48:02hard to tell sometime. I
01:48:03mean, not making any any
01:48:05any judgments, you know, specifically.
01:48:06Just just saying that it's
01:48:08sometimes very hard to separate
01:48:09fact from fiction and almost
01:48:10anything these days. Right? So
01:48:12I think,
01:48:13when someone tells you something
01:48:14in a very convincing way,
01:48:16it's it's hard to know
01:48:17where is that coming from.
01:48:18So ask those questions no
01:48:20matter who it is. Even
01:48:20if it's your physicians who's
01:48:21who are telling you something,
01:48:23ask the questions that are
01:48:24are making you wonder, is
01:48:26this true? Right? How do
01:48:27you know this is true?
01:48:28How sure are you about
01:48:29this? Right? We can explain
01:48:31that to you as much
01:48:31as best as we can.
01:48:33Other people should be able
01:48:33to explain this too. Right?
01:48:34If they're writing just because
01:48:36someone wrote a book about
01:48:37something doesn't mean that that's
01:48:38true. Right? Just because something's
01:48:39in the in the the
01:48:40mainstream news versus, you know,
01:48:42some alternative source,
01:48:43you know, that doesn't mean
01:48:44it's true or false either.
01:48:45So, it it but it's
01:48:47very difficult to distinguish sometimes,
01:48:48and and we'll try to
01:48:49help you through that. Again,
01:48:50and don't be shy about
01:48:52bringing something up that you've
01:48:53read about. Even if you
01:48:54feel like it will sound
01:48:55silly to you or or
01:48:56your family or to us,
01:48:57we wanna hear about it
01:48:58because that's something that we
01:49:00can help you sort through
01:49:01it.
01:49:02If it's on TikTok, it's
01:49:04pro.
01:49:06The,
01:49:07just and I think we're
01:49:09at the time. I just
01:49:09wanna give one last plug
01:49:11to research.
01:49:13The there's been a lot
01:49:14of talk about research being
01:49:16cut. There's been forty percent
01:49:18NIH cuts, and I just
01:49:20I just,
01:49:21people don't commonly realize how
01:49:23good we are at research
01:49:24in the United States. We
01:49:26not only have the most
01:49:27Nobel prizes in medicine,
01:49:29we have more than three
01:49:30times more than second place.
01:49:32That fuels the economy. Every
01:49:34dollar the NIH spends brings
01:49:36two dollars back to the
01:49:38United States,
01:49:39and it's we get early
01:49:41access to drugs,
01:49:43and new devices. And so
01:49:45I really do believe research
01:49:46is, the best way to
01:49:48turn hope into miracles. So
01:49:50thank you guys for coming.
01:49:51I don't know if,
01:49:58So I'll I'll just say
01:50:00two last comments, and then
01:50:01we can break for the
01:50:02evening.
01:50:03I wanted to first thank
01:50:05all of the
01:50:06speakers
01:50:07and panelists
01:50:09and people who helped organize
01:50:11this, Emily and Renee,
01:50:13and,
01:50:13all the other team members
01:50:15who are in the audience
01:50:16who are here as Dan
01:50:17pointed out. Thank you for
01:50:18doing that. We have such
01:50:19an incredible team, and I
01:50:20love, this is selfish, but
01:50:22I love this this that
01:50:23this,
01:50:24session that we do because
01:50:25it brings us all together,
01:50:26and it reminds me again.
01:50:29I know this every day,
01:50:30but it reminds me even
01:50:30more how amazing our team
01:50:32is, and I am so
01:50:32proud of everybody and to
01:50:34be part of this. So
01:50:35that's the the first comment.
01:50:36The second is to thank
01:50:37all of our patients and
01:50:38families. We are all here
01:50:40because of all of you.
01:50:42And, again, it's so amazing
01:50:44to see you all here
01:50:44in person, and hello to
01:50:46everybody who's watching this later
01:50:47on, you as well. Thank
01:50:48you for for listening.
01:50:50And, again, thank you for
01:50:51for being here and for
01:50:52your interest. And,
01:50:54again, we're here for you.
01:50:55So come up and talk
01:50:56to us afterwards. Find us
01:50:57in clinic when you have
01:50:58questions.
01:50:59And, I think that's it.
01:51:01Any last comments from anyone
01:51:02else? Okay. Thank you so
01:51:04much again.