Interviewer: What's the difference between using chemotherapy or targeted therapy for treating lung cancer? We're going to find out next on The Scope.
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Interviewer: Dr. Wallace Akerley is at Huntsman Cancer Institute. He's a lung cancer expert and we're going to talk today about some new, exciting, targeted therapies, and how that differs from chemotherapy, something that a lot of people are familiar with. So how do they differ?
Dr. Akerley: Chemotherapy is a broad therapy. It works on anything that grows fast. Cancers grow fast, so it's a great idea. In that sense, it's the best therapy possible. The problem is, part of us grow fast also. Any wet membrane in our body grows fast. We have wet membranes in our mouth, and it might give us mouth sores. We have a stomach that's a wet membrane. We could get nausea. My hair grows fast. I could easily lose my hair with most chemos. Most important, my white cells in my body that protect us from infection grow fast, so chemotherapy can take away my ability to protect myself from infection.
Interviewer: Those are all the side effects you hear associated with chemotherapy. I never realized that's why. It's the stuff that grows fast that you lose. The sores in your mouth, your hair . . .
Dr. Akerley: As well as the cancer. So that's where the treatment helps in terms of treating the cancer. It's uncontrolled, it grows quickly. It can make the cancer go away. We'd love to give a bigger dose of chemotherapy to get rid of that last bit of cancer. The big problem is, my body has parts of it that grow fast, and we can't handle it. So it's that differential between what the body can tolerate versus what the cancer can tolerate.
Interviewer: It's kind of a brute force attack, chemotherapy is.
Dr. Akerley: Absolutely.
Interviewer: Unfortunately there's collateral damage, which in a lot of cases is the person.
Dr. Akerley: Yes.
Interviewer: So targeted therapies, how do they differ?
Dr. Akerley: Targeted therapies are the new world. We actually look at cancers and try to understand what makes the cancer different from us. In the laboratory, if we can understand what particular pathway made the cancer the cancer, we can give a drug that blocks only that pathway. So now the treatment doesn't care about growing fast. It cares about what makes the cancer the cancer. In that case we can give a treatment that hurts the cancer selectively and has a whole different set of side effects. With chemotherapy, we mentioned just earlier, there can be risks to life and limb at any time. With these targeted therapies, there may be no side effects whatsoever. That's fantastic. Alternately, we may get lesser side effects, typically a skin rash or something, but nothing that's life-threatening like a pneumonia or an infection in the absence of white cells.
Interviewer: And do these targeted therapies actually do a better job of getting the cancer as well?
Dr. Akerley: They do a much better job in taking care of the cancer. The challenge is all cancers aren't the same. So lung cancer that I take care of was once called non-small cell lung cancer. If you listen to that word it says it's just anything that's not the small cell type under the microscope. We actually know that there are probably 50 cancers there. At this time we've picked out at least six, and the interesting part is those specific six cancers we used to say all behaved the same. Now that we've looked at their genes that make them the cancer, we can see that each of these behave a little bit differently.
More importantly, we have a therapy that can go after exactly what that gene is changing in our body. And the therapies aren't necessarily interchangeable, so at one time we looked at cancers and said, "The book says lung cancer should get this chemotherapy." Now we've completely reversed that. We look at the genes of the cancer and explore those, and if a lung cancer gene says take an EGFR inhibitor, then you get a standard lung cancer therapy. But if that lung cancer says you have a melanoma gene, a different kind of cancer, you can actually use a melanoma therapy that will treat that lung cancer in a way that has limited side effects and greater effectiveness.
Interviewer: That's exciting. Is that exciting for you? Did you ever dream of a day like this?
Dr. Akerley: It's completely changed everything that I was taught. We were always taught you do what the book says. What we've found now is you can let the cancer tell you what makes the cancer, and treat the cancer the right way. These things were promised to us to some degree in medical school, for me, 30 years ago, but we had no idea what tools we'd have at this point.
It is amazing. It's completely changed the way I practice, especially just in the last two years. These concepts are taking all the old dog physicians and asking us to retrain. Clinical research is the area where we are. We're probably trying to stay ahead by two years at any time, if we can, before these medications make it to practice. We're getting to use them in clinical trials at least two years early.
Interviewer: And seen a lot of success.
Dr. Akerley: Dramatic success. Better than anything I had hoped for.
Interviewer: If somebody wanted more information on targeted lung cancer therapies, where would you recommend that they go?
Dr. Akerley: There are some fabulous resources at the Huntsman Cancer Institute. The Cancer Learning Center is the place to go. They'll help you in person. HuntsmanCancer.org is another net-based resource.
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