In this episode, Dr. Geoff Oxnard, a thoracic oncologist, discusses his career journey into oncology and shares insights from his experience treating lung cancer patients and conducting research. He emphasizes the increasing role of precision medicine and genomic and biomarker testing in guiding treatment decisions, providing examples of how identifying specific mutations can lead to dramatically better outcomes with targeted therapies. Dr. Oxnard also highlights the changing narrative surrounding lung cancer, with emerging stories of remarkable responses and newfound optimism as treatments improve. He provides perspective on navigating clinical trials, especially for rare genomic subtypes, and shares his motivations for transitioning from academia to the pharmaceutical industry, driven by a desire to have a larger impact on drug development and patient care.

Key Highlights:

1. The increasing role of precision medicine and genomic testing in guiding lung cancer treatment decisions.

2. The changing narrative and renewed optimism surrounding lung cancer, as treatments improve and stories of remarkable responses emerge.

3. Dr. Oxnard's transition from academia to the pharmaceutical industry, driven by a desire to have a larger impact on drug development and patient care.

About our guest:

Geoff Oxnard, M.D., is the Vice President, Clinical Development, Global Head, Thoracic Cancer at Loxo@Lilly. Previously, Dr. Oxnard served as a thoracic oncologist and clinical-translational researcher at Dana Farber Cancer Institute and was also an Associate Professor of Medicine at Harvard Medical School. Dr. Oxnard received his BA in chemistry from Harvard University and his MD from the University of Chicago-Pritzker School of Medicine. He completed his residency in internal medicine at Massachusetts General Hospital and completed his fellowship in medical oncology at Memorial Sloan-Kettering Cancer Center. As an experienced oncologist, Dr. Oxnard is passionate about raising awareness of thoracic cancer and helping to make an impact on cancer care.

Key Moment:

8 minutes: “It starts with precision therapy, if I may, right? Once you have defined a specific molecular subtype, you've tried to sort of sift through the randomness of cancer care to find a group of patients who are going to behave in a similar way. Let's go into that for a moment, if I may, OK? EGFR mutations. If you give an EGFR inhibitor in the original studies to a bunch of patients on average with lung cancer, they live a couple months longer, but 10 % of those patients have fantastical responses that can last for a year or two or more. And so when you are a lung cancer patient, which are you looking for, by the way, to live on average two months longer or to have a fantastical response that can work for years? And of course, people are looking to be that outlier.”

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Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

In this episode, Kimary Kulig, PhD, MPH dives into the topic of cancer biomarkers. Kimary explains the difference between genes and proteins, germline versus somatic gene testing, and the critical importance of testing for both as biomarkers for treatment selection. She also describes the world of lung cancer biomarkers and the implications for treatment decisions. The conversation highlights the need for patients and their families to understand biomarkers and the impact those biomarkers have on treatment options. Biomarker testing in cancer patients is crucial for personalized treatment, but there are significant challenges and delays in the current system. The long turnaround time for biomarker testing can be harmful to patients with aggressive cancers who need immediate, targeted treatment. Kimary highlights that patients and their families need to be aware of the importance of biomarker testing and advocate for it.

Key Highlights:

1. Biomarker testing should encompass both germline and somatic gene alterations. Germline testing is sometimes called “genetic testing” and identifies inherited mutations that appear in every cell in the body, whereas somatic gene testing detects mutations just in cancer cells, some of which can be targeted with specific drugs.

2. There can be significant delays in biomarker testing results, which can be particularly harmful for patients with aggressive cancers. These delays often result in patients beginning chemotherapy while awaiting results, potentially impacting the efficacy of targeted therapies.

3. Kimary discusses the lack of “reflex” testing in the current system, where biomarker tests are not automatically ordered based on the type of cancer. Implementing reflex testing could speed up the process, ensuring timely and appropriate treatment for patients.

About our guest:

Kimary Kulig’s professional career has spanned the academic, non-profit, large pharma, start-up, and healthcare technology ecosystems. Kimary is currently Owner and Principal of Kulig Consulting, providing advice and service to biotech start-up, pharmaceutical, and medical device companies who develop oncology products. She also provides individual Biomarker Navigation services to cancer patients as My Biomarker Navigator™. Kimary applied her unique training in immunology, molecular oncology, and epidemiology for 12 years at both Pfizer and Bristol Myers Squibb. Her pharma career is highlighted by research on lung cancer biomarkers which are now standard of care companion diagnostics. Kimary was also Vice President at the National Comprehensive Cancer Network (NCCN) where she oversaw all operations of its Outcomes Research Database. At Verily Life Sciences, Kimary was Head of Oncology Clinical Research and led digital pathology machine learning and wearable device oncology application development. Kimary continues in her goal to bring AI tools to clinical practice as a member of the Friends of Cancer Research Digital Pathology Working Group. Kimary received her PhD from New York University’s Institute of Graduate Biomedical Sciences and her MPH from Columbia University’s Mailman School of Public Health.

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Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.

Dr. Kozower, a thoracic surgeon, discusses the role of surgery in lung cancer treatment and the use of surgery in the diagnosis of lung cancer. The conversation then shifts to the PCORI study on lung cancer surveillance, where Dr. Kozower explains that the intensity of surveillance, such as the frequency of CT scans, does not impact survival rates for lung cancer patients in retrospect. We also discuss the future of lung cancer treatments.

This episode was supported by the Patient Centered Outcomes Research Institute (PCORI) and features this PCORI study by Dr. Kozower.

Key Highlights:

1. Surgery is the primary treatment for early-stage lung cancer, serving both curative and diagnostic purposes.

2. Surveillance, including regular follow-up visits and imaging, is crucial for detecting new lung cancers, especially in individuals with a history of the disease. Screening, on the other hand, aims to detect cancer in its early stages in individuals without symptoms.

3. The narrative around lung cancer is changing due to advancements in molecular diagnostics, targeted therapies, and immunotherapy, offering more hope and optimism for patients.

About our guest:

Benjamin D. Kozower, MD, MPH is a Professor and Vice Chair of Surgery at the Washington University School of Medicine in St. Louis, MO. He completed his General Surgery training at the University of Connecticut in 2004 and his Cardiothoracic Surgery residency at Washington University in 2006. Dr. Kozower worked at the University of Virginia in Charlottesville, VA from 2006-2016 until returning to St. Louis in 2016. He is a General Thoracic Surgeon with a focus in thoracic oncology and directs the Thoracic Robotic Program at Barnes Jewish Hospital. He is also a clinical outcomes and health services researcher with funding from the Agency for Healthcare Research and Quality, the Patient Centered Outcomes Research Institute and the National Cancer Institute.

Key Moments:

At 7:29 "Surgery is the traditional treatment for early-stage lung cancer, patients who have small tumors typically confined to the lung when hopefully it can be curative."

At 14:50 "Everybody's followed after their cancer treatment. What's not clear is how often should we follow people?"

At 15:38 "The more frequently I'm seen, the earlier something could be detected and the better I'll do. Makes perfect sense. Unfortunately, I'm not sure it's true."

At 35:41 “Fortunately now we're starting to see the development of targeted therapies for specific [lung cancer] mutations. We're starting to see different types of therapies, and not just chemotherapy, but something called immunotherapy, which stimulates the body's immune system to help fight the cancer. So these things have dramatically changed the paradigm of how we treat lung cancers.”

Visit the Manta Cares Website

Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional health care services, including the giving of medical advice, and no doctor/patient relationship is formed. The use of information on this podcast or materials linked from this podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard, or delay in obtaining, medical advice for any medical condition they may have, and should seek the assistance of their health care professionals for any such conditions.