We’re pleased to announce that the Genitourinary (GU) Oncology Program is expanding! Dr. Bishoy Faltas joined us on July 1st as an Instructor in Medicine and as an Assistant Attending Physician. He will see patients with bladder, prostate, testicular, and kidney cancers.
Dr. Faltas may already be a familiar face and name because he completed his Hematology and Medical Oncology Fellowship here at Weill Cornell Medicine and NewYork-Presbyterian Hospital in 2015. Additionally, he recently finished a one-year research fellowship in the laboratory of Dr. Mark A. Rubin and the Institute for Precision Medicine.
Dr. David Nanus, Chief of Hematology and Medical Oncology at Weill Cornell Medicine and NewYork-Prebysterian Hospital and genitourinary (GU) cancer expert, sat down with OncLive TV to discuss future research efforts and next steps for a new immunotherapy drug for patients with bladder cancer. This drug, atezolizumab (brand name Tecentriq), is the first new drug that has been FDA-approved for urothelial carcinoma – the most common type of bladder cancer – in over two decades.
Atezolizumab works by detecting a specific protein (PD-L1) on the surface of tumor cells, allowing the body’s immune system to recognize the cancer and attack it. Ongoing research on this treatment has revealed some complexities that have left physicians and researchers with questions ripe for scientific exploration, especially since this is a newer drug lacking long-term clinical data.
Two important questions remain regarding atezolizumab:
1. Are there biomarkers we can use for this drug?
2. For how long should this drug be administered?
The first question involves “biomarkers” or “biological markers,” indicators in the body that can be measured or tracked. In cancer treatment, oncologists use different biomarkers to glean information about a patient’s diagnosis and prognosis, as well as to monitor treatment effectiveness. Biomarkers can also offer information about safety of a treatment and signal which patients will benefit most from a certain drug. Currently, we do not yet have any biomarkers to predict whether atezolizumab will work. In a recent interview with OncLive TV, Dr. Nanus explains this uncertainty by saying, “There is not going to be one simple biomarker that is going to say to treat or not treat, so that is the unanswered question.”
The second question pertains to duration of treatment. Researchers and physicians are still working to find out when atezolizumab can be safely stopped without losing its benefit, and if the drug can be re-administered in the case of cancer recurrence or relapse. The “right” length of treatment is also linked with cost-effectiveness and accessibility for all patients in need since this drug is very expensive.
These questions are global issues that pertain to many new and emerging cancer treatments, especially immunotherapies that leverage the body’s own immune system to fight the tumors. Immunotherapies are drastically changing the way many cancers are treated, but we still have much more to learn. It is only with time and additional research that we will find the answers to both of these questions.
On June 29, Weill Cornell Medicine and NewYork-Presbyterian Hospital joined more than 270 institutions across the country in holding a Moonshot Summit. These summits were held in conjunction with Vice President Biden’s Moonshot initiative to fight cancer. On this national day of action, cancer experts throughout our institution, survivors, and advocates came together to share their ideas for increased collaboration and cures.
The summit conversation started with a constructive dialogue about clinical trials and the unfortunate fact that for many cancer types, the “standard of care” chemotherapies are not good enough. At Weill Cornell Medicine and NewYork-Presbyterian, immunotherapies and precision medicine are opening new doors in cancer treatment, but sadly not all patients currently have access to these types of cutting-edge treatments.
Clinical trials may have gotten a bad rap in the past, but they are a powerful tool to access innovative treatments. The speakers agreed that clinical trials should be easily accessible to all patients, but at times there are obstacles. These range from lengthy forms that deter enrollment, to bureaucracy that slows the timeline for opening new clinical trials, to disinterest and concerns about the treatments’ effectiveness. On a global scale, there has been a lack of adult participation in cancer clinical trials, while for children we actually see the opposite trend – very high enrollment. What can we learn from this information?
One of my colleagues Dr. Gail Roboz wisely stated, “I always tell my patients, be afraid of the disease, not the treatment.” She’s right in that we need to reframe the conversation to focus on making strides in increasing cure rates through new research that leads to new treatment breakthroughs across disease states.
We also talked about access to care. Not all patients are able to get a correct diagnosis quickly. This can be due to a variety of reasons including a lack of access to specialists, living in a rural area, or financial limitations. By increasing government research funding, as well as making it easier for patients to reach quality care, we can remove some of these barriers nationally. If we increase the number of people who are diagnosed with cancer early on, we can increase the cure rates. Additionally, as a country, we need to provide comprehensive care for patients and families and always put the interests of patients first. This includes offering supportive services beyond just the best medical care.
I felt so empowered by my colleagues and our patients’ great ideas about how we can overcome the challenges we face in cancer care. The Cancer Moonshot initiative is giving high hopes to many and will help ultimately change the world of cancer care as our country stands together with common goals and a renewed commitment to collaboration. By bringing everyone together at an event like this, we hear diverse perspectives and glean new insights. The fight against this terrible disease truly unites us all.