People v. Cancer

Everyone and Candice Montgomery senior vice president and general manager of a landslide and welcome to our annual people versus cancer summit we are so glad you could join us today. How to bring together to medical providers scientists survivors and patience for an in depth conversation on Izzy's remains one of the world's most complex and legal she even missed a global pandemic progress continues to be made. Not only toward treating cancer and extending lives but toward creating a more robust holistic ecosystem of care. This afternoon we'll explore the latest science and a critical ways in which prevention diagnosis treatment and well being are interrelated. There's a lot to talk about but before we dive in I want to thank our underwriters Bristol Myers Squibb. GSK Pfizer and Takeda for their support of the Atlantic journalism today. Also I want to remind all of you at home that you can participate in the conversation by the queue in a task. Please tell us where you're from and if you ask the question for speakers we can incorporate them into the conversation now let's get started. For our first conversation we're revisiting the war on cancer please welcome Karen canoed since CEO of the American cancer society dead Sharpless director of the national Cancer Institute. With Atlantic staff writer Sarah Jiang. Good morning doctor doctor shuffles- near speaking sure in twenty twenty one which is almost exactly fifty years after Congress passed the national interest. Institute of the I'm supercharging you search engine is an evil friend wasn't so if the leading cause of death so it's been about fifty years The Simpsons with so called war on cancer and I thought I just begin by asking to. Reflect a little that turn also the title session- soldiers lost both of you is this war still the right analogy and so are we doing it's not about what is that. Doesn't matter anthology- make three Dr Sharpless the concert he was the current head of the. National Cancer Institute. Sure being thank you deputy on this so. It and just is the fifty anniversary and- and I think that Cancer act. Room create this for my- cancer interest we added that's made. Cancer progress poss. The war on cancer is easy. Analogy I think- for many reasons doctors don't like to use around patients patients the volunteer B. soldiers in this war right. It has as some baggage and I think in in in many ways it is. Not a useful- in talking to say advocacy in specific patient populations. It still has some value though in speaking to Congress Congress understands the idea of a- campaign that requires marshalling resources and everybody pitching in. And so I think that's why it persists is that a it is- peeling to some legislators and it is. A good way frankly to talk about. The kind of trans governmental commitment we need to really fight cancer and so I think that- you know what will probably still talk about the war network. The. Future even though. I we try to use that that now less. But what I for is- you know really the important point about this is that- this is. An effort has been going on for awhile. I think in many ways we've had some tremendous successes. But was always ago we're still six thousand American dot Americans dying of cancer every year. A cancer to be imposed a tremendous tragedy honor societies entrance costs. So we and we still need a concerted effort that involves. Patients and scientists and doctors and caregivers in Congress and everyone working together to try and- advance progress for patients. A doctor can send your grandfather yeah I very much agree with that I very much agree with the concept that the patients and families did not sign up to be soldiers in the fight- but fight. Fight on we do and it is the case that- I agree with everything that Dr Sharpless said. I appreciate the concept that we have made. Significant progress and the more that we have learned the more cancers we have so the fact that there are two more than two hundred different cancers is actually in advance in this fight. Let's call it that to be a little less I controversial- and it is the case that we're doing better on some of those fights than others and so will really marshaling our resources moving forward. And is next a set of years I think will be. Aligned toward the areas where we still. Need to make significant progress. Well let's about some of. Significant advance and your mansion your honor old has. In thirteen years and how much know about cancer treatment- if I could just ask what is the one biggest thing that you think is chag how we treat cancer in the past fifty years. Yeah I think Karen already alluded to it you know when I when I started this business we got I thought there was one kind of breast cancer and so we treated everybody breast cancer more less the same. And now we appreciated their many many different subtypes of breast cancer or- any cancer that matter. Where where the sort of because of the cancer we detected the cancer were treated cancer. For all predicated on the molecular events that underpin that cancer so this. Appreciating in embracing the heterogeneity of cancer I think is the major change in my lifetimes on colleges. And that's allowed us to develop highly effective therapies for very very specific subsets rather than try to have a- silver bullet the treats all of cancers we got we got a lot more success. Developing you know us therapies first smaller subsets of cancer. And that that paradigm is working and the evidence for that is that we see. Declining cancer mortality we see increasing rates of FDA approvals we see. Very active new agents demonstrate an acquittal trials so you know there's a combination of a body of evidence. Suggesting that net amount of shift is really working. And I would add two things to that one as we can directly attribute that advance to research. Argues that we looked at what the trajectory had been in this is something the American cancer society does every year reports the nation in partnership with the NC I and a few others. It's the case that how that trajectory continued we would have expected much hir mortality from cancer. Than we're seeing now. So the benefits of investing in science. And then investing in converting the science into activities that actually benefit patients is palpable it's measurable so it's really not time for us to declare. To slow down but really to push on that accelerator we've seen success. And just as as Dr Sharpless alluded to in breast cancer understanding of breast cancer is not one disease. And we have to treat it according to the subtype that it is. And then seeing that success then come later in other disease types. Has to be replicated so that the research needs. To go on without question. And the other compounds. I would say it on th- well we've made successes treatment. We've also. Got a can back. Right against papillomavirus. Answer for the first time we really have an opportunity. To significantly reduce incidence and mortality of cervical cancer. As well as head and neck cancer and a few other HPV driven cancers. So we really have turn the page as- as a population and being able to not just more effectively treat some cancers but- prevent others. Yes you're saying there's like an instrument is very efficient and has sometimes you're really really effective therapies some sorts of some types of cancer and we're finding that you know as yoe saying breast cancer is not one type. My responded one treatment one one one person another person might not- why don't we not meet progress in some other forms of cancer for example accurate cancers something that still is now pretty darn. Tired your- maybe also on this in the paper cancer for a- is one that that you know for which is very difficult to screen. So early detection starts to become an issue and that we know died better outcomes are attributed to earlier detection. So there are advances that are coming along. With regard to earlier detection of disease through blood analysis and through the concept that. It is may be may be possible to show clinical benefit of detecting cancers earlier when cancer DNA is detectable in the blood stream we'll see how those modalities for counter top. Biopsies yes liquid biopsies and multi cancer early detection testing- but it is the case that we are learning some things about pancreatic cancer for example- you know the risks to those that might carry a Brock alteration. Or development of pancreatic cancer so understanding. Die cancer risk as soon as associated with development of the screening or care plan that's right for that individual I think is. A fertile ground of both advancement and where we will continue. To see a refinement. Yeah I think of you. If you can give to the that can. Hundreds of different is. Than not. Your gonna make progress against some and not others that's just the way it works and fortunately. There are cancers where we've had not as much success integrity cancer glioblastoma few few others. But he he integrity can for example use the major target in that disease turns out to be- K. rasta specific oncogenic event the drives that came through the vast majority of the steamers and- and this year we've seen the first successful FDA approval became rest targeted therapy. After looking for decades so we are you seeing progress even in this area are also rare subtypes of necrotic. Cancer where the prognosis been much better so. You know that say para of. Five a- first. Subsets of. Cancer will be eventually I believe begin to work in that disease as well as it has an office. The product kind of some of these like cutting edge technologies that were not- no bring to bear on cancer just looking forward what are the most. Exciting and promising therapies or or prevention strategies that you see going forward. WellI you Karen mentioning the multi guess really such as we believe that is very promising I mean that that if applied to the population level could reduce against more talented in in a fairly substantive in rapid way. But there a lot of issues the issue of over diagnosis and over treatment and you know cancer detection tests are are tricky business that. That require really well designed clinical trials but I find it. Very very exciting one other I would mention quickly especially at the case where you we are healthy person you don't think that you're sick you still might get this test to see if like something. That I think that's where you know both the American cancer society the NCI are very well aligned in saying that this is at a fertile ground for investigation but needs to be shown to have clinical benefit because as you correctly point out as a healthy person that would be receiving this information. So would like to make sure that whatever your treatment or- screening modalities was was chosen downstream is actually the right thing to do and brings benefits health benefit to the patient. Yeah it's to be clear it's not enough just to find cancer with screening test is refined into what cancer looks like a harming individual that that doesn't do to many bens so. Really it's important these tests are shown to reduce mortality over at an overtime period in the screen population that is at. A different study designed it takes longer it's hard to do. But I believe that's the that's the approach will eventually need to and at also there are many of these technologies is not one or two in so we'll have to have some way of comparing them to really. Decide where the strengths weaknesses but I and it's a very exciting area another very exciting hearing is. You know college he clearly works we can clearly get the immune system to attack a patient's cancer help them. But we were really in the infancy of that technology we I think we can make up a lot better I think we can make that work for a lot more patience I think we can reduce the toxicities of those therapies. And so I think that's an area where they'll be his tremendous a future growth. Yeah I am the only one I very much agree with both of those the only one I may add there is. Increasing the number of therapies that are targeted to a particular genetic alteration as opposed to the tissue type. You know we think of carbon headers as being- you know it really beautiful legs sampe. For this for. Was into. By on having a- repair alter. That may make it to. On responsive to apartment. In irrespective of the two. Type s. Are really. Advances and I think. Again an indication of what happened when research that. That the- first in a human genome project but also the basic research to understand fundamentals of things like DNA repair. Were actually pretty rapidly translated into clinical clinical benefit. So again pushing forward the importance of continuing to discover. So that when we identify an Achilles heel. On any particular tumor type. Were ready and armed. With what type of therapy may work. Given the number the understanding of the biology. Yeah I think that's a great point of basic science research you might not know what direction to go in but- you know it's gonna end up. Taking leading us and she on inspected I knew there please- Dr Charles Chuck was when you were talking about diagnosed as you. Mentioned this problem of you know we can detect the cancer but we know if this is actually going to be a look at one that's going to cause. Trouble he toppled about the research into trying to make that distinction as as we are getting better and better ways of finding early cancers how. Do we know these are ones for treating. Right in the- what we of the key to that. Is under. This molecular by. Of the tumor in in helping to deter. Indolent verses not into one cancers. And this is really critical for the topic of cancer screening so we have validated cancer screening now for lung cancer for several games for colon cancer for breast cancer. I think we can do more there are some cancers like pancreatic cancer dimension where we believe screening as- a significant opportunity but really understanding. That your screen for. Indolent cancers worst inverses severe I dangerous cancers are critical issue here and so. The science is undecided underpinning that you were is easy easy G. A. decision and then also. The right kind of long clinical investigation. This is an area where- do you know the- perfectly we designed to. Have before in they just take. Yeah they're they're working can't setting up see myself very much agree that you know there are ways to jobs I need trial so that the end of the evidence of clinical benefit show. So you know we I think we have cautious enthusiasm about about the easy I think this. I don't know. What you think about it Dr Sharpless but for me this is where the field is going to go this technology is going to com and it some level be able to. Demonstrate for us what is an indolent tumor that might be detected verse is something that that- is requiring of intervention. Are back I think we do have to hold. The community to the standard of real truly showing that it gives clinical benefit for patients. If I could add I think the investigation of the person's genetics may be helpful here so you know germline genetic testing in patients. Or subjects rather people who are healthy in any should they get. In a prostate cancer screening with the test like PSA might. That might not be a good idea for all many on students research certain age but it might be good in specific populations are genetically defined for example so these. These are this is the issue of polygenic risk scores of usg you know multi genetic gene testing. The trying decide who will benefit most for screening. Is a very exciting idea that also needs to be you know tested effort at all. Yeah and you know the prosecutors are example which is actually my area is a really good one so you know PSA testing brings no inherent harm you know to a patient it's what you do with that information and shore and ensuring that it's only. Acted upon- if it's the case that a patient actually really requires intervention. For their prostate cancer that said. This is an incredibly important screening tool. Given that prosecutors are is the number two leading cause of cancer death in this man in of men in this country and we have not made significant advances toward that number. Are improving that number it is the case that a number the biology has given us a number of. Life extending therapies that we can get to men with metastatic disease but there is no cure of durable cure. For metastatic prostate cancers early detection and intervention when appropriate and shown to give clinical benefit which I think the prosecutor field has. Shown very well- is incredibly in important. It is also a- of a language of communication that occur just walk to lunch and I think maybe there's impeached here's why cancer might yeah in their case and right not acting- seems like they make you shifting how we talk about the week just big of a cancer is more before moving a sense that morning to fifty ago well we have some million cancer survivors right now in this country so we have a lot of people living with cancer and there needs to be attended to at in their needs need to be attended to as well and that's that's an entirely and other important area of research on the other side of the cancer. Continuing that we can talk about. Pourtant but more than just the- I think that require. Some you know good knowledge of how to be their own advocate what's the right screening program for me. What do I know about my family history. We don't do I know my genetic risk of cancer how to be your own best advocate is really important. Also the medical community- you know needs to. Have a certain amount of fluency especially when you're in the primary care setting where the vast majority of these decisions about screening- are made. Thank for the call back medication it is very challenging here- I should mention one of the important things national Cancer acted fifty years ago. Would make cancer disease we can talk about the government a lot of the stigma of this disease and really the worker Mary Lasker another advocates. Broadcasted for front is it is it in our culture missed made something that was not an embarrassing or shameful diagnosis it was something that. Individual people free to talk about that really began this process a better communication- turns out it's hard to communicate around cancer is cancer so complicated heterogeneous. But it's- is certainly an area we've seen tremendous progress. Are lost fifty years thanks the national Cancer. Yeah I couldn't agree more. And I think you know that communication and clarity is all the more important because as much as we've talked about the wonderful advances that have happened here in. In the last fifty years with cancer what we do know is unfortunately. Not everyone is benefitted equally from that knowledge. So ensuring that there is access to these advances I think it will be an important step forward it's something that we work very hard for an advocacy arm at the American cancer society- it to. I think we have a long way to go. In the country to ensure that all individuals have an equitable chance to prevents- detect or survived cancer. We've been talking a lot about prevention obviously we've been living for a Democrat the past. Of year and a half and a lot of people have. The is going to the doctor to talk with. The of COVID on I'm John treatment and what. Also would. Make changes by forward. The store care with. A C. is about initiative this is very. In so. New and was very this the K. care now I think research. Continued pretty well actually better than I would have predicted basic science was very productive during the 201-920-2020 twenty one. BuI didn't care was disrupted significantly since screenings were down mammography colonoscopy lung cancer screening. Pap smears I as well as diagnosis so that you individuals going to the doctor for me symptom the newfound Afghans was it one point reduced on the over fifty percent. There's no reason to believe that the incidence of cancer declined fifty princes in the United States we think what's gonna happen is cancers can be diagnosed at later stages. In the items modeling suggested we might see as much as a 1% increase mortality over the next decade of excess cancer deaths related to- the destruction the pandemic in either for disease that kills six hundred thousand Americans year. A 1% excess mortality is significant so I think we as a community really to talk about this week we need to be I don't think we can make up the missed the ten million. Miss screening events solely we have to a frankly in bed at eight minutes that there has been some affect. On the public health from the pandemic all that is beyond just- source could be to also known cancer diagnosis. And work collectively as a community. This and a- this and so I it's very good to see. Groups like American is. You know groups. Talk about returning to screening in in not miss it. And returning usual care a very forceful advocate on this topic by the way he's been the First Lady who I think is spoken. As a real Clarion voice on the need to return the screening and it did court Good Morning America recently I'm a mockery for example. So it's been a real friend of our- our communication efforts in this regard. Yeah I very much agree with everything Dr Sharpless said I could not be. You know more enthusiastic about doing everything we can. To get patients returned to screening. So before I came to the American cancer society I was leading cancer care for a large sixteen hospital system in Philadelphia and South. And South Jersey. My own experience in not wise. Every time we had to keep the peak of COVID there is an inverse decline. In screening and that's what we can easily measure colonoscopy mammography things that are very easy to track and electronic health record. Those numbers were staggering and yet didn't include things that are hard to track. We talked about men and PSA screening before it's very hard to parse out to actually don't know how many men. Will be diagnosed with later stage advanced prostate cancer due to not going in for their screening check. So there have been concerted efforts by the NCI designated cancer centers. Up by the American cancer society by the NCI itself to try to message. Out to the community very broadly about the importance of cancer screening and really. Work together through one voice is a call to arms. But we have also at the ACS are developed a return to screening and initiative with are. In areas that we knew to be already challenged by cancer screening even before the pandemic. Are cancer screening numbers were not what they should be in many areas of this country. So we've taken those tools we have duplicated and amplified them. With the goal of allowing health systems to have everything that they could possibly need at their fingertips- with regard to implementation strategies. To enhance cancer screening we've seen the benefits of those work. Are and we are. In the process of doing what we can to further enhance that across the country but are very grateful for the partnership and the NCI as well as other partners who have helped us in this regard returned to screening initiative. It is a major effort that will continue well beyond this pandemic. Yeah I think those are all great things to keep in mind unfortunately we're out of time. Two days I think they'll be around thank you to both of you docked shuffles and doctor. And the day. Thank you thank you so much. And now for a session produced by our underwriters Fizer. And now and thank you for being with us today it's really great to be here and conversation with and the smell global president and general manager of five there on holiday and we're going to discuss today how buys there is bringing scientific collaboration- anthologies and healthcare more generally and the greatest fear thanks for being here. How are you. I'm doing very well Haley great to be here. Great I'm I'm gonna kick it off with a quick question and we'll get started. So in thinking about this conversation and the that the pandemic really has disrupted our lives so many ways there's no way not to start with that but there's also some valuable lessons that we can take from the pack what do you see as the biggest learning that you can take away from. From the past eighteen months. For me the biggest lesson is really the power of collaboration. The reality is the health care system came together to bring multiple COVID. Vaccines to market in really matter months and this simply wouldn't have been possible without. Remarkable and rapid collaboration between bio pharma companies regulators academic institutions really a host of other players- engage with regulators was streamlined accelerating. Companies made their research findings available on open source platforms for the broader scientific community to really share learnings real time. Large company share development and manufacturing expertise to support smaller companies to organise experienced. Arm so it really. Was an impressive moment in time. Originally there were it comes to deliver of care- the lack of partnership really still stands in the way of the progress that we need to make on a range of issues access to medicines value based care and health equity. And I think we really need to ask ourselves how can we leverage it happened in the same collaboration model from the COVID experience. To improve delivery of care. I when you make really good points about collab. Of and check make reading. And so in that case what do you as the main issue how delivery. That partnership could really help address. I think are. Too many. Issues with health care system to. The first Israel to in Santa. Today's are for me of the healthcare ecosystem are all about more more doctor visits more tasks more kills. Rather than having incentives online on the best possible outcome for the patient and this leads to perverse decisions an entrenched behaviors they can make it really hard to work together. For example take biosimilars we happen to have a large portfolio of oncology biosimilars advisor are biosimilars or generic some biologic medicines and could save U. S. patients and taxpayers a hundred billion dollars over the past five over the coming five years. But the healthcare system doesn't. Have an- that addresses law practices that impede access and one of these is this concept of failed first which is a pair policy in place today that means patients have to fail on a more expensive name brand medicines. Before they can even try to lower cost biosimilars this policy just needs to be reversed. A second issue beyond incense is lack of access to quality care read about it all the time too many people lack access to quality care can't afford their treatments based on age race where they live. All of this leads to worse outcomes when you give me an example black people have the highest death rate in shorter survival of any racial or ethnic groups for most cancers in the U. S. living in segregated communities in areas where the community is predominantly black. Has been associated with increased chances of getting diagnosed with cancer after it spread after its metastasized higher death rates in lower rates of survival specifically for breast and lung cancers which are to the most predominant cancers. This clearly needs to change. Yeah Apolo. Thirteen talking about Haiti care and how individuals are are being treated these days let's talk about some of the biggest opportunities. Are more collaborations to improve that improve patient care what can be done in the public sector for example. I believe public private collaboration. Which is critical for their response the pandemic that's needs to be maintained accelerate in other areas of medicine so one promising example on the novel public private partnership. Is the harmony alliance it happens to be in Europe it's an alliance between the European Commission the commission in bio pharma companies in the objective is to harness big data to speed the development of new blood cancer medicines. So as a member of this alliance visors working with nice in the UK to see if we can use real world data to create a synthetic control arm for multiple myeloma clinical trials now I know it sounds complicated. But the goal is really simple accelerating clinical trials to bring new medicines to patients faster. In trials that use traditional randomized control arms take much longer to complete. A with the synthetic control arm concert by reducing or eliminating to the world the need. To enroll control patient. You can cut down time. Lowered costing speech. Potentially life after to market. So that's one example another in the US is a collaboration- in the oncology patient advocacy ecosystem divisors tapped into we're partnering with forty five patient advocacy leaders representing organizations across the cancer landscape. These leaders have provided important feedback to focus our efforts where we can make the most impact and it's enabled- targeted efforts under way today in twenty twenty one on healthequity health literacy and engaging patients in clinical research. This is what we need to do going forward. Yeah that absolutely example how do we need to move the needle around value based care which you mentioned earlier and how can we move the needle in a way that we're reducing costs and making healthcare. More we really need to change the incentives in the health care system to prioritize value over volume quality over quantity. In an ideal world all participants in the system including bio pharma companies will jointly be accountable for achieving health outcomes. But despite many of these stakeholders invested in progressing value based approach the reality is we have fewer bona fide examples because of the antiquated fee schedule for health care services for diagnostics for medicines it really comes from Medicare and which commercial health plans generally follow. That's said adviser we continued we continue to strive to partner with others to convey in our approaches to value based care while at the same time we're advocating for policy change. An example specifically that we have on the right now is a warranty program called visor pledge for one of our One cancer medicines and with this program patients who stop treatment before filling their fourth prescription so they're fourth month on One therapy due to some clinical reason- that doctor they in their- treating oncologist decide is appropriate. Both the patient and the pair can be refunded for the cost of treatment. Now this program is still in its infancy it's a pocket concede the pilot it's a model for the baby can partner with payers to ensure our medicines have the intended effect for patients. And if they don't patients and the healthcare system won't have to pay for them it's a simple as that. Yeah and tell me how to enable more effective partnerships. In cancer care moving forward. Unfortunately disease that touch all. All over locks. But if we can work to on COVID. Then we should be to do the same for the one in for Americans who are unfortunately to be diagnosed with cancer in their lifetimes. Particularly if we focus on the common denominator that aligns all of us emancipation after all were all vested evil in the best possible outcomes for the patients we serve. And my hope is that this global pandemic will be a catalyst for change that's long overdue. Together I'm optimistic we can really fix this broken health care system. Thanks so much for joining us and it's great to chat with you. Thank you have a. Next for a conversation about the front lines of research please welcome Vinod Balachandran surgeon at memorial Sloan Kettering cancer center Jill o'donnell Tormey CEO and director of scientific affairs at the cancer research institute here to lead the conversation is Atlantic live contributor John donvan. Good morning everybody and good morning to the- two terrific doctors who were gonna join us in this conversation on the panel I just want to explain that what one of the panelists. We just learned was having some internet connectivity problems so we are going to hear. Dr Donald Torme rather than see her- but- thanks very much for rolling with that a doctor Donald for me and all of you out there. We just heard. Through the morning so far- words like progress coming up in advances- also references to the sense that the front lines are moving forward and we're gonna take a deeper dive into that with the two individuals who are deeply deeply involved in the research- that's leading to those advances and I want to start with you Dr Donald for me- is it. But my sense is that- the rate of discovery- and this and discovery of useful successful knowledge and treating cancer is really actually accelerating that even in the tough at the time that you have been in the field. That probably you have seen some enormous changes in the right direction that I just want to check in with you- I on on yours. Of that. Yes I been at the research institute from a thirty five years so I have seen an amazing amount of progress- we asked if we are I focused all specifically in the area of cancer immunology immunotherapy. So if any field has shown what has happened- in the last to get fifteen years we've really seen that. The belief that our organization is have from a seventy year that your immune system can be used to treat controlling potentially cure cancer. I think we now have that proof of principle and I think everyone will believe in the right patient at the right time. For certain cancers. Of youth union system can do an amazing job of treating cancer obviously in the it with an eye with the I'll lands. We are still just at the beginning we now have to figure out how do we get this to work in all cancer patients. So and I did acknowledging. Your card did. Not from descent I just in the way that you phase to determine authoritarian away sort of have to fight for respect for or recognition of its power- to many. Of those fifty years that you're talking about- certainly. I mean I think were very few. Especially medical oncologist that believed you could develop even immunotherapies that would have any impact on cancer so. It was really and I really very proud that the cancer research institute served as kind of a lone voice in the wilderness for many years. Supporting excellent science mostly taking very long view. Warng research on the immune system and understanding first have the immune system works and then being able to understand how it interacts with cancer. And it's only I guess is really the last you know just about the decade that with- when. The delay for- you know was first shown that you can actually be used to treat melanoma and with the first treatment that never had. Any difference in a survival for late stage melanoma that was discovered by doctor Jim Allison who got the Nobel Prize in two thousand eighteen. And then following that we learned about the other checkpoint inhibitors of PD one in the PDL one. And this has changed the landscape of a cancer treatment as well as cancer research. I was gonna ask you did has immunotherapy had its breakthrough moment and it sounds as though your answer to that is going to be S. it did have a breakthrough moment. I think that as I go back to prove to people that for a look. Things like non small cell lung cancer and melanoma that patients can get long term benefits and overall survival by. Basically taking the brakes off the immune system which is what checkpoint inhibitors do. But we understand that this doesn't work for all patients for all cancers. And that's where research comes in. I wanna let everybody who's watching I know that we would love to have you be part of the conversation and you can do that by putting a question into the queue in a tap and stuff I'll try very very hard to work your- question into the conversation and- I'm- I'm guessing. Absolutely your questions will make this a better conversation one more question for you doctor torque Donald for me. Is what what what sort of support in terms of funding and further research does the field of immunotherapy. For cancer treatment need right now what it what do you what would you be looking for. Well I think we all we mean it all comes down to money a lot of the times I mean we there is an- awful lot of. Great people out there with great ideas and they need support. Obviously the federal government is our major. Source of support but I think not for profits like the cancer research institute of playing a bigger and bigger role. Especially in risky you know high risk high reward that perhaps- the federal government you know the and C. I. N. I. H. may not be willing to fund. But it's where these new discoveries coming giving you know. Novel ideas a chance and taking big risk and that's where- progress comes from. So I want to bring a Dr Balachandran of doctor where your work is actually. You know. Take taking the idea all the way to the possibility of a vaccine. Vaccines for cancer. And really interesting thing we've we've sort of all learned about. MRNA vaccines this past year. And you are working with the firm violent Tech which- developed the **** what we're all going to Fizer vaccine. To bring about a cancer vaccine or several. Dental possible cancer vaccine. Talk to us about. About that technology what is it about the and whether I've described what you're doing correctly. What is it about the- mRNAs that you feel. Hold so much promise for treating cancer. Thanks John so I think Dr o'donnell Tormey sort of frame this question very importantly that data you know we now know through decades of research that there is that we can use the immune system to fight cancer and the current immunotherapies that we have. Working about a subset of these cancers about 20% of cancers but for the rest of the 80% of cancers. We haven't exactly found the right immunotherapy approach yet but this is exactly what- New research in new ideas are really needed for and you know one of these well we think it is a cancer vaccination. There's a long history of cancer vaccination studies were certainly not the first group to intended to look into this. The community has been really focused on this for decades now mostly because no vaccines as a as a medicine have had such a profound impact on human health for prevention of infectious diseases of the idea that you can don't. Bring to bear this this- impacted vaccines of had for other diseases on to cancer has really been but the community for very long- more recently you know we've discovered some new ways that we may be able to vaccinate against cancers and we think MRT vaccines are. One really powerful way that we can now take these ideas newer ideas of cancer. Vaccination and taken to cancers. And what what what benefits- what's what does the mRNA vaccine possibility open that wasn't there before this technology was available. Right so it was a one of the key difference is that we think of in terms of- vaccinating against cancer. Versus tab vaccinating against pathogens such as a virus or a bacteria. Is that there are current understanding is that cancer vaccines require them to be custom made. So every patient would require their own individual vaccines may. So for this you need a technology that is a simple is fast and effective so that you can really make these vaccines really quickly in real time. And be able to give it to patients you know on a time frame that's clinically meaningful so that patients are not waiting around for their vaccines- and morning vaccines it really are able to do this- they're very fast- and they're able to be very flexible. In terms of- incorporating a variety of different targets in two. If I think of many when you when you say fair fat you mean fast to reduce or fast to act. Well fast to produce because so if you in order to custom make a vaccine what this. Involves is having to take a piece. Of the tumor a biopsy or through surgery and then based upon- an analysis of the tumor to then make a vaccine individually and custom. For the individual patient so you need to go from biopsy to vaccine manufacture and delivery. Within you know- short time frame so that patients can get their treatment relatively quickly. And you know mRNA vaccines we know are there pandemic is of course- proof of proof of principle for this that you can really generate these vaccines very fast so- so that was really that way I think one of the- major exciting things of mRNA vaccines is that. We now know that they work for infectious disease and now we're really excited to see about bringing these. That this new technology. To vaccine against cancer. So to the principal you to be laying out is that an end of patient could have an individual you tailored vaccine not just for the type of cancer but that into. That very individuals cancer- and that this could be turned around in a week something like that two weeks. Right so you're exactly right so it did this would be a vaccine that is individually made for that individual patient not for the individual cancer- but we're not at this. Scale where this could be turned around in weeks yet. So we're talking about more on the order of a few weeks to a few months. But this is still very fast and much progress compared to what we thought it would take you know many years ago so. I think we're sort of at the beginning of this- unlocking the potential of how how much we can go with mRNA vaccines and- additional clinical testing of course will will. Allow us to understand that and also improve on the current platforms that we have. I would put you put in this position but I'm really curious to know whether. You know you've been also in this field a long time does it feel like this is it I mean. The details haven't been worked out that this path of immunotherapy. And individual vaccines is gonna be. One the details are worked out that's going to be how cancer is treated and treated successfully. Ten fifteen thirty years from now. Well we're we're certainly very excited about it- because of the effect that back scenes of had for other diseases and- you know it certainly allows us to now testes new exciting medicines to treat cancer in ways that. You know we were hoping to do previously but I didn't really have the technology to be able to do it and now we have the technology to be able to do it thank you to and morning vaccines so. I think it's a very exciting time for oncology I certainly for tumor immunology as in the upcoming years small now learn about. You know how we can develop these and I am already technology to treat cancer you know I have to vaccines are potentially through other strategies as well. And last question on this topic is what what what are the road blocks to this being it what. What I don't mean to say what could go wrong but I am in a sort of way saying. What out there might be an unexpected obstacle to this process ultimately working. For all cancers is it just. Needing to know how all campuses function or could it be something else. Well I think we need a lot more more. Winds in in in in the laboratory- I think both of this will- these two areas will really help us understand you know what. Else do we need to be able to effectively vaccinate against a cancer using these. New technologies so- I think that the stage is set for us to sort of- to work on this and learn more from this and over the years. You know with more clinical trials and more testing and will now I understand you know more about what is actually needed to be able to. Induce immune response. To these cancers- using mRNA vaccines in patients were sort of and still very at the very early stage of this- but- you know it's exciting times ahead. It's interesting that that but both your lab. Dr Balachandran and also the cancer research institute- are. Quite focused on camp creek thank god answer. Which as most people know is one of the more challenging forms of cancer and when I come back to you doctor Donald twenty what why is that what. What's the focus on. Anchieta cancer About and- what are you hoping. To learn and to develop from that focus. Well obviously we all know pancreatic cancer is one of the most difficult cancers to treat especially if it the Vance so I think it is a major- you know medical on men's need. And we also know thate checkpoint inhibitors which I referred to before which have kind of the major interest in what has revolutionized immuno therapy than many people think that's only the type of immunotherapy they are. They on their own have not proven to work very effectively impacted a cancer cell I think this is where the science comes in you have to ask the question of why- that's the major question I think immunotherapy these days. We we've heard from- talk about Chandra that 20% of patients seem to respond to the current immunotherapies. The other 80% that don't the big question is why do the same page about looks like the same patients same. Same to the same stage why one respondent one dozens of these immunotherapies. And in pancreatic cancer this is. An area that I'm at needs and there's this question of what does will it take. To get. Checkpoint blockade to work in pancreatic cancer and this is where combination therapy comes in one of the potential these using a vaccine in combination with the checkpoint inhibitors. But there's a lot of stages that take place in terms of getting an effective immune response against any cancer and we're just coming to understand how we can measure what is. The step that's missing in patients when they don't respond to the current immunotherapies sense of pancreatic cancer is the place we can ask these questions and will understand biomarkers of response to non response. And actually also deliver. Major needed. Treatment. For their patients with pancreatic cancer. Again to all of who are. Joining us someone to read you you can ask. Into look questions in the conference. Just in the our way and I'll bring him into the conversation- in fact I just received one now from Nigel Brockton. Who asks is there potential to target mRNA vaccines. To common genetic features of pre malignant lesions Dr Balachandran. I am not sure that I understand the question so I'm hoping that you interpreted layman's terms for me and then go for the answer. Yeah no that's a that's a great question and it's just sort of. The concept of can you generate or develop. A vaccine to prevent cancer even before it a curse because we know cancer is a disease. That occurs when you develop mutations are breaks in the DNA in a normal cell. That Dan converge to normal cell to become an abnormal cancer cell and dividing growing to a cancer. So and we also know that one of the main things that the immune system sees as foreign in a cancer are these mutations so. In theory if you could find a mutation where you could actually- effectively vaccinate against. You could in theory vaccinated before cancer is even developed. So this is certainly- I a- a long term goal fighting for the coal community we're not quite there yet because we're sort of still at the- early stages of understanding how we can generate an immune response against these mutations. But as we learn more about that than of course this will be another area that the field I will focus on I'm sure. Paul Millman asked this question begins with a statement developing RNA vaccine is very expensive can you estimate the cost of developing. Individual an individually tailored vaccine I think this question refers to. Not the future when the therapy has become regular life regular- regular eyes but rather. What is it going to cost to get to that future how much research funding is going to be needed. We're talking billions of dollars of. More well- I don't think you'll be billions of dollars but I certainly do think this does require a concerted effort in collaboration between academia biotechnology companies and more federal funding to be able to support these types of clinical trials- you Clinton trials are expensive and particularly in clinical trials where you're testing novel ideas which require personalized therapies such as their and Marnie vaccines for cancer that is also expensive but I know I think it's a very worthwhile- investment because by doing these studies is how we will learn about how to. Bring immunotherapy to bear on these other cancers which have been traditionally not really responsive to the current ones that we have. Well not not billions this sounds pretty encouraging actually- so I think there's some optimism and that- Victor ciclos on ask the question- can each of you speak to the state of the state and early detection and prevention. Research- apps even commenting on precision medicines a role in this- Dr o'donnell Tormey can you take that on this prevention issue. Yes I think we all know the earlier cancers detected the better chance of the patient has focal for long term survival so I think it all comes down to and I think this is a technology question I think we've seen that there's an explosion and technologies all the- makes the single cell analysis that you can learn so much about the genetics and epigenetics of. Of wet and proteomics of what's going on in the cell I think one of the way using that now certainly on the research side in terms of analyzing samples from patients that are on clinical trials. I think one of the challenges will be how do you bring this to be useful in the clinic for patients in terms of really being able to diagnose early or sunset patients and know which patients need which treatments as we move toward personalized immunotherapy. And I think that's the real challenge I productive Balachandran has a nother viewpoint of the actual clinicians. Yeah yeah to. Break great senator the question you. Yeah I'll add to that- you know I think of particularly for pancreatic cancer which is sort of the area that I focused on you know one of the challenges even with early detection is the need for effective treatments so I'd like to just sort of- highlight that as well that of course early detection is extremely important however what is also needed are better treatments. For many cancers particularly one such as pancreatic cancer pancreatic cancer soon to become the second leading cause of cancer related death in the United States in only the next three years so more cancer deaths from pancreatic cancer then cancer deaths from colon cancer from prostate cancer from breast cancer from ovarian cancer from melanoma. So it really high unmet medical need and for pancreatic cancer we're still using therapies which have been developed you know decades ago and because of this is one of the reasons why it's going to become the second leading cause of cancer related death survival rate with current best treatments only at 9% so a lot of room to improve here- so brutally putting at. A highlight on that that what we do need are better treatment in addition to early detection. Right to not necessarily mutually exclusive priorities I want to thank both of you for the conversation for showing us where we're going in a rapidly accelerating rapidly approaching. Of future yeah it was very optimistic conversation and we're going to leave it right there thank you. Thank yo. Welcome to a session produced by our under writer G. as K. hi everyone great to be at people versus cancer. Our focus today's how we applying technology to improve cancer treatment. I'm joined by my friend and colleague Theodore Arnold he's professor of molecular and cell biology at UC Berkeley and director of technology and translation at the end of its of genomics institute. Founded by his colleague Jennifer down. Zero also spearheaded the creation of all joint not deliberately for genomics research with UCSF UC B. I. N. G. S. K. I've known Philadelphia as he's passionate for pushing the boundaries I'm thinking out of the box. Is really ambitious the patience. Zero one of the technologies we're working with is functional genomics perhaps you can explain what we mean by that and in particular by Christopher. Tony cancer is a disease of our DNA. There are culprits in our genes that courses to develop cancer. Crisper and functional genomics allow us to do unprecedented quality M. speed detective work to track down those culprits. In a way we've never been able to do before. I am thrilled to be working out. With you on the lavoratori for genomics research. Because it really gives us a remarkable opportunity to put crisper and functional genomics to its full use to track down. If you will the criminal in our DNA that causes us to develop cancer zero left we certainly feel the imperative to improve success rates. Agency in cancer is high. We know the field can do better. Today even with major advances in cancer care less than 30% of patients respond to certain immuno oncology therapies. Importantly we're already using this technology that allows us to discover new biology to understand counts the batter in just a single experiment. Is massively accelerates our knowledge base what used to take decades formal we now do in a single well designed experiment this means we will discover new targets more quickly and they'll be better matched to patients. Tony I'm deeply affected by this number you just gave two out of three people don't respond. I know we can do better. To me. Marrying science innovation. In the academic sector which of course is what we at Berkeley UCSF and the world over do so well with that unique technology capabilities that GSK brings and the science on your end as well is basically the way to create a if you will staying with the detective work analogy Sherlock Holmes Dr Watson superhero team to tackle this take take this on. How do you think about science V. technology in developing new cancer medicines. Yes thank you look at GSK we see our mission at the intersection of science and technology as you've described a great example of that is functional genomics. It's generating vast amounts of data to describe the disease if you like to generate the evidence. So we can unlock new insights they will have a positive impact on cancer research and treatment. Now within not artificial intelligence is essential to interpret those data and help point the way this will build a new bridge between the lebar tree in the clinic I call this digitized ation of biology. Not fatal perhaps you might tell us just a little more about how Christie fits into this story Holly using it to improve the search for new oncology medicines in general at the Isle jail. If you continue to think about. Cancer as a crime against our DNA then step one of course is to gather all the evidence and Christopher is an extraordinary magnifying glass it allows us to zoom in on literally individual letters in our genetic code to both the normal cells. And cancer cells and track down the full information set if you will about what drove a particular normal cell to change its DNA and then become cancerous. Okay well you've gathered the evidence so now what well you basically need to the modern day equivalent of a Sherlock Holmes like intelligence. To filter parse through all of that to get to actionable information. And this of course is where artificial intelligence comes and we can't rebuild Sherlock Holmes but we can on some level to better because computers as we've learned. Are can be oftentimes a lot more powerful than any individual human mind. I'm excited for the fact that the border of genomics research is really a venue for this where we can bring it all together in the same space. To do this. One of a kind. First ever DNA sleuthing. To get to the sources of cancer and understand how to treat it better. I'm Katie- perhaps to get a little more specific about some of those cases as you already know way doing it with you at the algae all. Two of our projects are in oncology. Inside JFK over the past two years and he's completed more than one hundred. Crispus screens for an asset within our portfolio not was about looking for. New indications and you potential combinations. And most recently something that I'm excited about is a collaboration with king's college London he is the objective is to create digital twins using and I am now to match the right patients to the right medicines. In the immuno oncology sector to move that 30% success rate upwards. Cefiro to finish let's talk about how to applying advanced technologies in partnership. Will ultimately benefit patients. I've been thrilled to work with GSK because I have witnessed time and time again this remarkable moment of creativity where one person finishes another person sentence and the sentence that comes out of last. Sounds really good so in practical terms we're very mindful here at UC Berkeley and UCSF at the innovative genomics institute. That in order to make our insight and innovation resonate in the real world we need this tested in the real world. And so this acceleration that you allude to. Is thrilling for all of us here because we will gets to the cancer sooner which of course is what we're all expiring to do. Greitens substrate- what you're saying. Is that we can do more together than apart I evidently agree with that. It helps us to do even more and imagine new treatment opportunities for the futur. At GSK. 30% isn't good enough. Where applying advanced technology such as CRISPR in day I am now. And we're working with people like you Theodore and academics around the world to solve that problem. This will mean a new medicines will be back to Taylor to patients and will reach them more quickly. Zero thank you so much for joining us today look forward to working with you in the future. Tony thank you here's to our joints detective work uncovering you actionable clues to bring better cancer treatment to patients. Next up the discussion about screenings for all I'm joined by ginger Gardner vice chair of hospital operations for the department of surgery at memorial Sloan Kettering cancer center. And Christopher escalate that chief clinical access and equity officer at the Dana Farber Cancer Institute network and assistant professor of medicine at Harvard. Hello the pandemic underlined that there are inequities in health care and we're going to talk today about how that specifically manifest itself in cancer screening Dr late then the doctor garden it's great to have you with us. A doctor later let me start with you are there racial disparities in who get screened for cancer. Absolutely I think there are racial and class. Disparities in the all tend to go in parallel so they're definitely structural barriers that impact our historically marginalized communities so there's no dt that that's been there for over time in continues to exist right now even with the technology that we- Dr Gardner you were chair of the foundation for women's cancer and I wonder if in some groups. You've noticed a particular hesitancy to get screened for cancer is associated with the female reproductive system. Absolutely gene and gonna qlogic cancers we face some unique challenges. Of one in five individuals will be diagnosed with gynecologic cancer every five minutes. So it's a huge statistic it's a very frequent diagnosis and we need to raise the national dialogue about gynecologic cancers. We recognize that for some of the historically marginalized communities we have a really specific need specifically in endometrial cancer cancer of the uterus. We are seeing increasing rate of diagnosis and particularly troublesome cell types aggressive subtypes for this population. The so what you're saying is the disparities are particularly alarming because of the incidents and also the aggressiveness of some of these cancers in some of these populations were less likely to be screened. That's exactly at in gonna qlogic cancers there are five tumor types that we face ovarian cancer uterine cancer cervical vaginal and vulvar cancers. And these are sometimes hard cancers to talk about- and so we recognize that and we need to increase the awareness about gynecologic cancers. And that these diseases amongst women. This is particularly a challenge for historically marginalized communities and really the issue is awareness and to bring this to the national dialogue so that women can get the information they need. For appropriate screening symptom recognition and early treatment. I'd like to dig a little deeper with each of you about the reasons for these disparities Dr late then you mentioned that geography could be a factor that relates to access but is economic access also huge barrier here. Yes still if you look at the institute of medicine report that was published in two thousand and two so it's a long time ago they talked about these barriers being all the way through our system so certainly structural barriers. Economic challenges so how do you get there do you pay for parking now what is it can you get a screening and then can that screening turned into a diagnostic procedure and then you get billed for it that's something that you can see with. With that when you look docked B. screens correct answer and you know if you look at lung cancer which is number one cancer killer you look at the under utilization of are. Most at risk. Populations in again you're talking about a black and brown to. Indigenous community. And also- world blue collar communities all races all of them says he suffered from. A lack of access and a lot of it is due to the financial barriers you have to get there. You have to figure out how you're gonna pay for the time when you're not at work. So if you are have your an hourly employee. To get your screening you know for colorectal cancer screening you need to take two days. Think about it if you get it yes dictate. And you have to take day of the procedure so that's money that it costs you in many many many people have multiple. Other competing things that they're dealing with and that makes it even harder to go to the screen you such to simple as- you know take care of your health and go do that. It's really being held down by the financial. Constraints well. Dr Layton is. Also of. Or miss. And has the mistrust grow. In time speak. Of mis and dis in. There is no doubt we can. The individual patient copy matter and that there store member. All challenge and I think you know we don't have to wait of making of them all of our key of color but specifically for African. Indigenous people there are very specific. Patterns that would over a hundred of years so yes there's try issues here's what we know if you talk to your community if you listen to your community and COVID has taught us this then the community leaders your engagement- community you can start to ameliorate some of these trust issues I worry sometimes that we put up the trust issue as shields and well. People don't trust is that's not what's happening you have to really engage in this and it takes time to build trust we know if you trust your provider you will try to get these some of these procedures. Done in some the screening. Well our reminder draw would like your quest use the Q. a tab put them in get to many of as we possibly can up doctor Gardens- Gardner it was it was- feared that the pandemic would have a negative impact on screenings did you see that materialize and has been true in some populations more than others. It was definitely a challenge I mean so much of our lives shut down with the pandemic. And justice articulate and said it's largely about logistics. You think about it for women's cancer many women are seen as the caretaker of the family and called in so many different directions. And for screening and prevention we just have to stop. And look at ourselves and take care of our own. Our home health at some level. And garnered the important information about awareness and prevention for gynecologic cancers to take that action but just X. plays a big role and getting out the message so for the foundation for women's cancer. What we've done is set up a national team this campaign this year called move the message. And move the message is all about knowing about the five gynecologic cancer subtypes. Because the biology is different for each of them the symptomatic mission the screening tests are different for each of those fined five kind of qlogic cancers. So move the message has been our platform. To provide patient free patient education resources online that includes brochures online tutoriales. Webinars all free for any patient anywhere to help bridge the gap and provide that awareness and information into communities of need. In addition move the message is to partner with local advocacy groups. Partner with community groups in cancer centers across the country. Because we have to move the message we have to provide not only the patient education materials knowledge is power. But also the access in the information to the people that need it the most. So working within community says Dr Layton said to raise the awareness and move the message specifically in gynecologic cancers which in itself is a disenfranchised population. Of for the reasons mentioned for. Dr les did you to see that the pay. Happened that and on so. Yes I think anecdotally we definitely saw that I'm among cancer clinicians. Brooklyn colleges I see people coming and generally more fantasies we did notice that there were you know there is a plant. The presentation of folks coming up more advanced now the anecdotal I know that there's some other this mother data that shows that the error happened there's a delay people going to get their their screenings and so I think we expect I know certainly you know. The American cancer society also expects that there's gonna be an increase in late stage diagnosis for. Cancer so seen anecdotally and also indicates early indicators say that we're going to see an increased. Cancer because- I that that's definitely true. Hey does this delay inst because of the pain in a general reserve to screening in some populations does that explain why outcomes could be so different for different groups of people Dr later. So yes but I think it's only one part of it so as you heard you know and understand their terror couple things here so yes it's true that you know access screening is really important but I want to push back again on what we're doing here we're kind of pushing get back on the patients and you guys. You can't make it here for these reasons and the reason that we see this difference is because you're not getting straight is because people don't get screened and even when they get screened. Treated the same way and then they're cold you know the other risk factors the habit is where the lives and with their socioeconomic status and the history of structural racism classism all those things impacted so it is a part of. And we need to break down barriers and I liked what doctor nursing about despite directional conversations with community so all of the. Impacts it's not just that one thing. I want to follow up that because I think. You really for. Re in this. Space is so important. It's about patient education it's awareness it's an interactive dialogue with communities absolutely. And it's also about finding the research that we need. To understand how to best close the gap. And to best understand under by law biology at play for example. From the foundation for women's cancer we give out over half a million dollars in grant funding. Related to gynecologic cancers and we set up to New. Research mechanisms. To find. In in innovative research specifically about. Health equity diversity and inclusion. And this may tackle issues related to. Different cell types cancer subtypes within you during cancer as an example. Access barriers we need to study that and figure out how we can best close the gap with scientific inquiry and discovery so from the foundation prevents cancer. This is an expanded portfolio of our research engine. Related to diverse population. Diverse. Populations and communities. Our doctor we have a question for you coming in for Mary Lear she asked Dr Gardner where can I find the free information you mentioned on the memorial Sloan Kettering's website. Move the message dot org move the message. Dot org is from the foundation for women's cancer that is the national advocacy and research arm of the society of gynecologic oncology so I really wear two hats here this morning. I am a gynecologic oncologist which means I'm a specialist in the care of women at risk of war with a gynecologic cancer. And I'm also the current chair of the foundation for women's cancer which is our national organization connected to our scientific specialty of. Gynecologic oncologist those are those of us in the field that dedicate her life to kind of collided cancers so foundation women's cancer it move the message dot org has a lot of that and of course in this case I out links as well. A doctor let alone to follow something- that talk Gardner earlier about technology and it being a way of communicating with people- telemedicine certainly- is another aspect of this that got a lot of publicity in mentioned during the pandemic- are those solutions. Or are the access to technology are there so many problems around the access to technology that that is not going to do the job that needs to be done. That's a great question I think the technology is a tool and like a tool it can be useful and it also can be used. To brighten- specific so if you look at the during the pandemic people went to virtual visits some of those virtual visits for telephone visit to some of those virtual visits were using different platforms. To engage patients and being able to visualize. So what we know is older patient population the brown are your patient population. The more rural your patient population. The less likely you're gonna be able to the virtual. All calls and show there is a digital divide in this country is getting another access issue and I think that sometimes we as clinicians become enamored with technology to solve the problems technology is just another tool is a we need need to be able to figure out what do you do when someone speaks different language. And give them this platform how do we set this up so that we can help people utilize these platforms that we don't end up with you know because also because our okay but that's not a great way to talk about a new diagnosis or something. Right so I think the technology is great I think there's been a rush to say this is going to fix it and like what we've seen time and time again is initially the rollout of the technology will exacerbate disparities and still we put in policies that make sure that it's equal access and. We can help the folks who have less access. Dr Bernard we also to think of where we delivered. Absolutely chain it's so important I mean I started early consent of the rural communities are are also disenfranchised sat and we do see a higher mortality rate of cancers especially those for which there are early screening and- symptom recognition opportunities we see a higher mortality rate for those cancers and- more world population so it is it's very important- we see a similar of finding within our own bearing cancer population. Where access to a large cancer center with specialty gynecologic oncologists- for the management of a new cancer really has been shown in the data to be a treatment that it follows NCCN guidelines and pays dividends. In terms of the oncologic outcome. So your apps right and logistics is a challenge but the more we can have this dialogue together create the information the information available. Can help to drive the message through move the message for gynecologic cancers and in our collective work. To really eliminate disparities and improve health outcomes for all. Dr later do you want to weigh in on this question of location and also potentially transportation. Absolutely I think I just want to first on a resonate with what doctor Gardner says at you know location in our rural communities and then think about and the cultural components for indigenous communities right on top of that so there is in isolation that can happen their decision to. Distance and so yet there's no doubt that how we deliver care we need to think about it we do think about where we deliver care but there's also another component here is you know there's also ours are check it's more more Heinz specialized how do we disseminate. Some key expertise that's centralized in certain places. Hi I went. In C. cancer center I. On working argue. Sites as well to try bridge that gap because I think the problem. We say we need to figure out how to deliver all this year- and just and some of we can do we need to innovate think about how would you. Like me to bring the same out innovation we bring to the development of drugs to dissemination trucks right. But we also need to figure out. How do we triage what needs to go to specialty areas how do we get access to these specialty interpretation medicine these are all big policy decisions there's no doubt. That where you are in relation to your specialty center matters sign a petition. For you our way the quality of the care that you might receive is less. Effective follow up on that- in our in our department- one of my colleague September in line to be key and colleagues is looking at the concept of financial toxicity. And this is the increasing hot topic in the- access to cancer care is really important we have our eye on that. In addition as an institution we recognize the importance of regionalization creating access points that are beyond- of the urban center and expanding our footprint in meaningful ways. As a community so. This is ongoing work- at our institution and as as part of the problem as the foundation of women's cancer. It's really a similar effort in terms of bridging the distance in the logistics. Of patient information awareness and research. That's where we are for the foundation for women's cancer making these available tools educational tools available. Accessible for all free and driving the research engine behind opportunities. To close the disparities gap. Dr are you do used to for financial talks is. What does that. Basically when we look at drug or new search approaches we frequently look at the side effects of these interventions. Side effects can be something like nausea from chemotherapy or a rash. From a different type of drug. I side effects be a complication of Sir and or procedure. And we also recognize that there are signs of care on the topic of financial a is record the this is a side effect of some of the woods. Challenges that faced various populations in seeking access and treatment for cancer so it's not an emergency area an important took to study especially related to some of our discussion here this morning. Dr later on are you optimistic that things are going to change and that these current inequities particularly as regards to screening are going to normalize. How many gives a very honest answer to you which is I am hopeful that the tragedy of COVID will allow west's you change the rhetoric as you can hear from doctor Gardner myself there's a lot always been a lot of great conversation. These are not new. Problems and we've been talking about and I think we need to switch to your accountability and thinking about really bringing the will to make. The policy changes the waves disseminate and with. Access to our kids. And I just want to add a little bit about you know twenty to toxicity so. Majority of the research that it after Gardens mentions has talked about when I would say is how cancer. Into giving having cancer. Cancer which for some of the work that we've looked at and it was it's over almost. Ten years ago now is what happens when you're already for. Cancer and is less research on that right about what we deal with the financial distress of people. With cancer and I think part of that is because of the way that we think about our research and you know describing and identifying. This problem so we can focus. Allegation program that some that a lot people in the in certain would you. I want to that that's a- that's a really. A way for us to check died. Here in toward. Actual and then I might. Even more hope but I'm hopeful that the dialogue exchange. And we're gonna have to leave it there a doctor late and then doctor Gardner thank you both for joining us. Thank you for having us. The break we encouraging network with other attendees and visit our expo booths to participate select the networking icon located on the left hand side of the screen. Next click join you'll be randomly paired with another attendee for about five minutes. If you wish you can exchange virtual information with each other and keep in contact via direct message within the platform. You can also click the explorer icon to visit our virtual expo booths. Here you can explore more resources from the Atlantic. And our underwriters related to today's event we'll see you shortly after the break. In. And. The welcome to a session produced by our underwriter Bristol Myers Squibb. Also based on the cost of some of the most exciting next generation personalized medicines that can potentially cure some of the toughest to treat cancers. That is why I am so grateful to lead this discussion to take a look back at the past decade of advancements in cancer research and explore the latest innovations in cancer prevention diagnosis and treatment. With that I'm pleased to introduce the panelists we have here with us today joining us from a range of organizations representing different aspects of cancer care should we have doctor Nina Shaw professor of clinical medicine. In the division of hematology oncology at the university of California San Francisco disco. Dr sauce research focuses on multi myeloma clinical trials specifically immuno therapy and cellular therapy. From MD Anderson center is Dr Pam Sharma. Dr Sharma is the professor genitourinary medical oncology and immunology and the division of cancer medicine. Who has focused her research primarily on immunotherapy including collaborating with Dr James P. Allison to explore combination therapies to more effectively treat a variety of cancers. ALDS also joining us is Patricia goldsmith chief executive officer of cancer care Trish is advocating for those impacted by cancer on a daily basis she was recently named to Forbes fifty over fifty vision list which highlights women over the age of fifty who achieved significant success congradulations tres Trish. Now let's jump into questions we have so many questions for steam panel as we all know over the past year and a half. The global COVID nineteen pandemic has really had a significant impact on people living with cancer everyone but certainly people living with cancer to quite frankly the supply of medicine and the way clinical trials and research is being conducted. I would like to hear from each of you to understand really what is been the biggest impact that COVID has had on cancer care let's start there. Doctor shot. Thank you for having me today- for to participate in this panel at indeed COVID has had an impact on the experience of patients with cancer. And I think one of the most- important things that we are seeing is that patients are really worried about how their music is going to function in the setting of getting chemotherapy. Understanding if they're even going to make a response to vaccines- and trying to understand their risks so there's an added level of anxiety that our patients have to deal with now- and many of them actually can't mounds. Responses to the COVID vaccine based on the treatments that they're getting so there's a little bit of a hate heightened anxiety for these patients- in addition to maybe how they might have changed getting their care whether they like to make more visits are less visits or- maybe engage in zoom or other. Virtual platforms more frequently. That's fascinating you doctor shoppers sharing that doctor Sharma in addition to you know fears about coming in for treatment and- you know uncertainty about what the not the vaccine will actually work. In your cancer patients what have. You seen- or fourteen but in a fights the biggest impact the COVID nineteen is had on the care of cancer patients. I think one of the biggest things that we've seen in our- center has been the fact that we had to have a- short shutdown of clinical trials right because we were not able to continue. A clinical trial research during the time of the pandemic and because of that our patients who are participating on these clinical trials were receiving their therapies on these clinical trials. Had this break in their treatments and we had to come up with new ways of how to make sure that they were still getting treatment. Even though they weren't making it into the hospitals and how to continue to monitor patients. Offer side effects and toxicities while they're not making it to the clinic for visits so I think those are very trying times and of course anxiety provoking times for all of us. You know the clinicians who are conducting these clinical trials the pharma companies or whose expertise clinical trials are very important to understand whether or not their drugs are having. The benefits they expect and of course our patients who are really relying on these therapies. To be their next treatment or the bridge to their next treatment- for their cancer. Thank you doctor Sharma interest can you provide your perspective on this as well. Certainly I'm happy to and again I am so pleased to be with everyone today so it cancer care for us as an organization we don't deliver clinical care but rather we support the patients. And their journey through treatment through bereavement and many other aspects of cancer cancer diagnosis. I would say that for cancer patients during COVID it exacerbated so many issues that were already in place. But if I had to rank order them what I would say is that. The feelings of isolation the feeling of fear and the entire support system in many circumstances fell apart so matching cancer patients that we're accustomed to having a loved one or a care giver go to a visit with that. Often interpret listen and help them make decisions those individuals were no longer there. Many individuals that had relied on either mass transit friends or other transportation to and from treatment. That system fell apart for individuals. Then we can talk about job losses potential loss of income for the household it was absolutely absolutely devastating in fact in the early days of COVID in the early months of COVID we were fielding ten thousand calls a month. And the level of desperation and fear and intensity was unlike anything that we had ever experienced. In our seventy seven year history. Thank you for sharing that you know the with the words that you use to isolation and fear desperation- doctor Sharma you talked about disruption to clinical trials Dr Shah you talk about destruction to care. Those were were all some of the difficulties that we experienced during COVID but I'd like to ask a question specifically view Dr Sherman doctor Shaw- what changes have been made to cancer care and research due to COVID that actually may be beneficial. In the long run such as remote care for patients have you identified different or better ways to really popped in my eyes clinical trial participation as result of the pandemic. Dr chamas with you. Yeah that's a really important silver lining hopefully from all of this is that we've now been able to facilitate and make easy or easier for patients to engage with specialist who they may not have had access to the remote platforms and I really hope this is one of the things. That will carry forward after the pandemic because this actually is eventually going to improve and increase access to clinical trials for patients who otherwise do not have access to nearby specialty centers and if nothing else. They will at least learn more about the malignancy and understand the other opportunities that they could participate in for clinical trials and on the flip side I think that there's a lot more motivation- from investigators in industry our counterparts. To maybe make these clinical trials more accessible from a day to day perspective maybe we can do remote labs are remote visit also people who are further away can participate. In these very promising clinical trials. Thank you for sharing that Dr Sharma. I think again the silver lining. And I have to say that COVID really brought all of us together from so many different disciplines if you're thinking about virology immunology are clinicians- cardiologists all of us became involved in this- fight against COVID from a scientific standpoint and I think that silver lining is what we need to take forward with us and we need to do that for cancer patients as were bringing together. Different groups at the table the how can pharma companies help was to make sure that we're getting clinical trials out there into the community not just at academic centers on how can we make sure telemedicine and other technology enabled- devices give access to patients who did not previously have access to these types of clinical trials how do we make sure that we have more diversity equity and inclusion within clinical trials which we've you know had discussions about in the past but didn't really deliver on that unfortunately. But this is the time to do it now the conversations have changed other people at the table are now more of the partners that we need to make sure that those conversations can really deliver on impactful changes and policy changes that will make a difference for all of our patients. Thank you thank you so much for sharing that night growth you cover certainly has catapulted us into a future world and it requires that we do better. I'd like to pay that just for. A moment and move away from COVID and the impact that it's had on cancer. To talk about innovation and in particular I'd like to start in speaking about immunotherapies. And when we think about immunotherapies they really do represent exciting field of research. That has really expanded our understanding of the underlying mechanisms of cancer and importantly how which tree it. And I would say in addition to that the thought of personalized. Therapies including cell therapies is certainly rapidly growing and transforming how treatments could be manufactured for and- delivered to patients on an individualized basis. So with that context in mind doctor Sharma how do you see the research. Into immunotherapy since cell therapies involving over the next let's say five to ten years. So thank you I feel that you know immunotherapy has clearly changed the paradigm for how we're treating cancer patients. For many many years we relied on surgery radiation chemotherapy but we didn't really have impactful immuno therapy or you know practice changing email therapy and with the advent of immune checkpoint therapy. Which is really this new- type of immunotherapy to takes advantage of understanding the basic mechanisms of how T. cell responses and he's helping the soldiers of the immune system. How these responses are really- can be taken advantage of and driven towards helping our patients with cancer. So the immune checkpoint therapy agents can be given systemically and because they're targeting the immune system they're not targeting the cancer cells themselves we've now seen the patients with many different cancer types are benefiting right these are patients with. Melanoma lung cancer bladder cancer- many many other tumor types that are now benefiting and it's great for patients but they're only subsets of patients are benefiting and how do we take advantage of what we've learned. From the basic science and translated into the clinic to make it even more- for more patients should say to have that kind of benefit. What we seen as that combination therapies are the way to move forward and that means combinations that can drive immune responses- when you take advantage of chemotherapy killing these tumor cells. And the immunotherapy agents than driving that immune response for further so we're looking at multiple types of Congress combination therapies now immuno therapy plus immunotherapy as well as immunotherapy plus chemotherapy radiation therapy and surgery even and I think that's going to be a benefit that we see. The evolution moving forward that including the fact that the immune system that we study from a basic science standpoint. Had really been about T. cells and what we've learned is that the immune system has so many other cell types that participate in tumor rejection. So we're needing more signs more basic science about these other cell types including myeloid cells and case. Cells dendritic cells and so that will also Dr the future of immunotherapy for peace. Thank you for that when you talk about the future of amino therapy is this certainly so exciting for- all scientists were involved in the research and for those of us on the industry side who are involved- and helping to develop and bring these therapies to market. But I'd really like to ask the question from the perspective of the patient so Trish when you think about immunotherapies and personalized therapies such as carts T. cell therapies how have they changed the patient treatment journey and what I'm that needs really still remain through the lens of our patients and how do patients navigate all of their options. As so I guess in a general sense what I'd like to say is what these therapies have done is brought hope to patients. One thing I know we can agree upon universally. Every individual in this world hopes for a cure for cancer. Hopes for a better outcome a longer life. To live with cancer as a chronic disease. That is only going to happen through the pharmaceutical and biotech industry. And in many ways I think Most patients know that. And so hope is so key when a patient here's- personalized therapy. It to them. They may not understand the mechanisms of action. And all of the clinical data behind it but what it does imply is something that is personalized to them. And their disease and that is so critically important what I also have to say is. Every day we talk to patients where there's a huge gap in understanding what these therapies are. What how where they might be able to access them or even how to talk to their clinical team. About these therapies and the potential for them. And we know that cancer is still a disease of the elderly. Those are individuals that were raised to not question a physician. To just say of the doctor says this is the treatment for me that's probably the right answer. As opposed tension Lee proactively asking about other types of therapies seeking a second opinion at center. So it is absolutely critically important that we as organizations find the way. To get these wonderful advances to patients. There are a lot of barriers out there. No the speaking of- you know doctor Dr the comments around you know combination therapies being the future and this concept of personalized therapies are removing barriers for patients one of the things we often talk about is the concept of the right therapy for the right patient. At the right time to doctor shop what would it mean. To really be ableo have personalized medicines for all patients that are living with cancer and is that even a feasible reality. Yeah in some ways it's already happening right so we have things like American engine receptor T. cells or car T. cells which are made from a person's own T. cells and out ways personalize we also have things. Like vaccine there be that are made in in part from his own tumor lysate or or tumor. Proteins that those things are happening now but understanding exactly which patients are going to respond to which there please I think that's probably a more. Widespread clinically applicable way to get personalized there be that is choosing the right therapy for the right patient and one of the things that has been great about. Understanding that need is that a lot of our industry partners have been doing a lot of correlate of science or looking at patient profiles to understand which patients respond the best and if we could even figure out a third of the patients in a trial that did the best and maybe. Focus on those that 33% so that those can be really successful cases in the future in the real world we will slowly move towards picking the right- cancer treatment for the right patient even within the same cancer you might have the same cancer between two patients. But one patient will benefit more and so I really look forward to keeping the conversation going both between the investigators other patients as well as industry sponsors to get these correlated data out there. Thank you for that thank you for that and so you know let's I want to continue to build on this concept of the right therapy for the right patient. At the right time. And ask a question about research in the context of cancer care. So one when I think of researching cancer care I think that has become so advanced. And we're seeing the use of partnerships data sharing. Even machine learning and other sophisticated approaches to deliver. Those critical insights that that help to inform the development of new therapies and- technologies- with the hope that allows for innovation to happen. And guiding kind of the next generation of their bees that we hope- will be available. For patients in the near future. So thinking about researching. Cancer care. Doctor Sharma what are you currently most excited about in cancer research. I think the cancer research- field is really bringing together some of the best minds now as we move forward with this idea of becoming a Tory L. therapies. When you think about it we were in the air of genomic medicine for quite awhile before we hit on this error of immuno. Engine numbing medicine we're looking at driver mutations that really allow for oncogenesis process to take off and for some of these cancers to really. Become the cancers that they are today in the patient so what we can do is target those driver mutations based on sequencing the patient's tumors with new drugs and therapies that were don't develop for those specific mutations. And now we can think of combining those with immunotherapies but there are many other areas of science that we're seeing now it's also important for driving immune responses and for cancer therapies. And I'm thinking more along the lines of epigenetic agents for example where we understand the epigenome better and how those are driving tumor cells or immune cell responses. And so for me it's really this combination of were taking pieces of cancer science that have been done whether it's in immunology whether it's an epigenetics whether it's in genomic medicine whether it's in radiation oncology. They're different scientific our research areas that are now coming to the table that is allowing us to say Hey how can we combine this. And even if you think about it areas outside of cancer for example such as autoimmunity that's teaching as what is an immune response when it's gone too far. On which is what we're trying to get to happening cancer how do we learn from that area and bring out also into cancer research I think their pieces there that we can take advantage of. And we're seeing more and more of that so that's what I'm most excited about and also of course using the technology. To engineer the therapy said that they do become more personalized and learning from all of this data because we have bioinformatics and computational biology. Learning from all of that that we can now understand which patients will potentially benefit from each of these different call the nation's. Thank you for sharing that Dr Sharma said Dr shop building- what doctor Sharma just mentioned you know epigenetics- and you know therapies targeted therapies in various combinations thereof. You know if COVID taught us anything it taught us the need to accelerate and so how can we accelerate really optimize our current research in cancer- to advance these breakthroughs more quickly so that we can get these combinations this innovative medicine to patients. Yeah this is a really important point in and one that I even struggle with because we want to make everything safe and make sure everything's effective and have good and points for that but sometimes those endpoints take a long time. Especially to get regulatory approval and that ultimately is what guides whether patients have access to medications so because of that I'm really looking forward to ways that we can that innovative and points. That might be sooner- then maybe waiting for survival data so for example in multiple myeloma we may use things like minimal residual disease or sustained minimal residual disease I to understand that a person is doing well from a particular therapy. And maybe pushing that there be towards approval based on that and point instead of waiting years and years for survival changes how we are at it we are trying to bring all of these there is there peace to the- forefront and- doing one at a time is. Is difficult in the doing the combination is even more difficult so we can make this faster I think that would be good I also think that there is a lot of red tape in research- that maybe it's gotten to be a little bit too much- and I would love to see ways that we could make those things more efficient. Faster that we could get every trial done in and quickly unverified verses waiting for all of the things to be checked and re checked- if there were more efficient ways to streamline data. I think that would help instead of having so many- back and forth checks of this and we can really give the FDA a package that's quicker. Than maybe just waiting. For everything to be check three or four times. Thank you. For sharing and so you know what I just heard is this idea that. Combinations these innovative combinations are the future. But looking at innovative in points different endpoints removing red tape trying to simplify the system in order to get. These approvals more quickly- are that's really important- but as the daughter of- two parents both my mother and father. Had cancer my mother breast cancer my father prostate cancer I recall when both were diagnosed all they heard was cancer. And they were in a fog. Until they were able to step away and then they they got into active mode to do research and to ask questions. And so when we talk about clinical research and scientific advancements in cancer care some of that may feel very much outside the reach. For people when they- first get that diagnosis and they first hear you have cancer. So with the patient in mind Trish. With all of the scientific advancements that are being made certainly with the goal of improving cancer outcomes. What aspects of treatment and care a really most important to patients that we must be ever thoughtful about thank you top of mind. When we're developing the next generation of innovation in cancer care. I think it's important for us to remember that cancer is one component of an individual's life. It can seem all consuming but yet there is the life of family the professional white children etcetera you know when I think back on my long career my entire career. In academic medicine was in academic medicine until I joined cancer care as its CEO. And I remember during my ten year time at Moffitt cancer center. Many many conversations about challenges in a cruel to clinical trials which are critical to move the needle to advance the research. But never once did I really understand some of the barriers until I came to cancer care. You have no idea of individuals challenges with respect to affording transportation or paying for parking or paying for child care. Those are huge barriers for individuals I also had no idea. Of how much a three or four hundred dollar check could mean. To an individual to be able to afford that parking there was a fascinating article published recently. By Dr from eco Chino at memorial Sloan Kettering about the very issue of parking. The other thing that I want to say that it's critical that has only been exacerbated by COVID. Is the need for food assistance and food and security. So in our seventy seven years of providing financial assistance for many many years. Typically the number one request from cancer patients was for transportation to and from treatment for to a clinical trial. So our fiscal year close June thirtieth and we distributed almost eighty million dollars in financial assistance to cancer patients in active treatment. The number one request was food and food and security so we have to be mindful of the fact that we have all of these extraordinary advances but if an individual can put a meal on the table were afford to get to and from treatment or trial. It's not you know it's not gonna happen. No Trish you know thank you for sharing that I think would you just underscored is that. The absolute best data without the ability for patients to get access to that data is quite frankly just interesting. And I agree with your point of view that we have to balance or were be ever mindful that you know the future of cancer care certainly bright but it has to include. Opportunities for- but for everyone to have access to the innovation and I'd certainly like to- invite our audience to submit questions for our panel today. But before we do that I wanted to spend a few moments talking about this concept that you started talking about which is health equity. And I heard a statement several months ago that actually- it was both shocking and disturbing which is a person's zip coa. Is a stronger determinant of their health outcomes than their genetic code. And so if you think about that in the context of cancer patients on the importance of health equity from the community perspective and from the patient perspective we really cannot overstate the need to focus here. And it's really important that all populations are adequately represented in cancer research but but quite frankly goes beyond improving diversity in clinical trials and there's so much work that needs to happen not only in clinical trials but also in access to care once products are approved so I'd really like to hear from each of you- on- you know what critical steps can be taken. To ensure health equity and quite frankly adequate representation of all patients and communities and cancer research. And then certainly in the treatment landscape Trish mass start with you. Certainly so I think we've all heard the term it takes a village this is going to take a universe an absolute universe of collaborations among advocacy organizations among providers among industry to be able to solve for some of these issues and it really is multi pronged I get back to what I said earlier about financial assistance being a challenge. For individuals access we also have to understand and be very mindful of health literacy and how we communicate for individuals to be able to understand what to us are very simple concepts but it to others can be frightening. Not very understandable and quite frankly not necessarily providing information that's going to empower patients so there's no one right answer here what I'll say is this I'm I'm absolutely thrilled that we're finally coming to a place where were looking at issues of disparities and equities and saying we're going to do something about it. What I want to say is this we can't just talk we have to take action we have to look at pilot projects that can be replicable in other parts of the country with other patient populations and one coming back to what I said about a universe. This is going to take a lot of collaborations both existing and new and novel collaborations but I'm quite. Frankly very excited about that. Thank you your your your passion and certainly excitement on this topic is palpable doctor Shaw would say you about this concept of how do we ensure health equity for al. This is a really important topic and one of the things that I've been very hopeful about is that and worst of all we're talking about it and that's something that we hadn't done I'd even say. Five to ten years ago so I think that just talking about it is good and making a conscious effort so we can't just say oh we're gonna enroll patients on clinical trials and make it easier no we actually have to recruit people on clinical trials from other underserved areas. And that doesn't just have to mean our racial or socioeconomic but actually the as you mentioned zip codes- which might be. Another way for us to see how we're not doing a good enough job on some of the pharmaceutical companies have been doing this they've really been putting in effort for people to have more obvious. Representation from across the country of all the different areas in the country on clinical trials and this is actually going to make us do better cancer research because we're going to understand the true impact of these their views on all people. Not just the people that can make it to a central Medical Center with the you know with lard with in a large city so it has to be an active management status an active management approach to clinical trials to really get. A group of patients enrolled who truly reflect our country and not necessarily just provide people that can make. It to essential university. No that's really. Really helpful. Thank you so much doctor shot. Doctor Sharma I have to ask you to. To out weigh in on this. Topic because you actually first raised the issue. Of diversity inclusion equity in your earlier comments so. You know give us your perspective on you know whether not you think sufficient progress is being made on these fronts and it from your perspective what else must we do. So I have to echoed those statements that we you know we're lucky that we're able to have the conversations but I have to say conversations are not enough we have to do more- I'm really grateful for the fact that. Really a lot of people are having the conversations and it's much easier to have the conversations now than it was in the past- but we have to move these conversations along with the actual policy changes a few points I want to make one as- we need democratization of knowledge. Okay knowledge cannot just exist within our ivory towers. We do great research of these academic institutions and within the pharma companies they're they're wonderful places for science and research to get done. But then that knowledge has to be democratized it has to be moved all over the country in the world for everybody to have access to that knowledge and the access to that knowledge has to be. Exactly what we just heard in a way that people can understand it cannot be in jargon. It has to be in a way that people understand the benefits and the risks associated with these different treatments. Are how they were- developed or what the potential combinations may look like. So I think democratization is very important and for that we're going to have to rely on some of what we've seen during the pandemic is that access to telemedicine and technologies that can get our- data and our information. In real time from the academic centers and the farmer companies small community hospitals or small community clinics that are taking care of a majority of these patients. Who cannot afford to travel to the big academic centers for their care. So that that's going to require again some thought about how do we do that is it okay to start. Sharing patient information across these different universities and academic structures where we all you know tend to be in our own silos how do we get rid of the silos. So that that's one important thing the other thing is access to real world data. As you heard most of our clinical trials are collecting data we don't see that data for about five years later. I mean that's collecting data over a five year. It and then five years later we get to say okay this is what happened we need real world data we need access to now having the ability to enroll patients. And have them report back on their iPhone or their android device or whatever their smartphone is that they're using in their hand because- everybody seems to have a smartphone or at least we can provide a smartphone to a lot of these people. So that they can report back in on a daily basis and we can gather more information it's meaningful- for how these patients are really receiving their treatments and then make decisions about what to move forward with. So those two things I think- we don't have enough policies about how to guide democratization of information- because we tend to be very protective in our own little silos. And we don't have an enough information about how to collect real world data from patients because we're very. Careful and we need to be careful about protecting the security of patients are not just using any old device to collect that information but- I still think technologies come a far way and- medicine has not done a good enough job I should say medicine science not done a good enough job. Of partnering with the technology giants in the space- to make these things feasible. And let's face it there's and now for ways that we can really make all of this knowledge accessible to under represented communities. And do a better job we've had that for a while we just have not acted on it and so I would like to see more action in those areas. So doctors from making up a up with your common around the day. Of information and ensuring availability of information. At two two patients. In this is a question from one of our- participants Candace. Candace asks. How much does health literacy. Actually plan to health equity. So what's the relations. Job and how can we break down barriers they are. So I think health literacy is very important for making sure that we have equity the other thing I want to point out is very important that we have to have more physicians and scientists who look like the patients that they're trying to treat and take care of right. I mean that conversation we haven't had enough of as well the trust in medicine and science has to be remaining between the patients and their physicians and the people talking about the clinical trials. And for a long time now it's been very- which I saying not diverse at all we who we have a community that were trying to reach with a group of doctors and scientists who don't look anything like that Community- and that. That distrust is what we need to fix and that happens when you actually also allow for diversity equity inclusion within medicine and science to begin with and then extend that out to the patients and the communities. So that's one piece that we need to fix and that will help with the health literacy as well because then we have the language we understand culture we understand issues that need to be addressed in a different way for the communities that were trying to reach because we have the people within medicine and science. Who experience that who nobody who can guide us in how to have those conversations in a better way I think it's very important think about those two things together. Thank you for that context. If my phone is done getting the questions from the panel faith in my phone and my phone is it keeps blowing up so I just want to- actually. Ask a really important question. That came there from Janet. And I'd love for- everyone on the panel to answer this question Janet asks- first she says this is an important panel. And she'd like to know. What are the panelists doing. To shape the contextual. In intervening conditions necessary for underrepresented scholars. To thrive professionally. How can we better- how can we be better able to contribute to and expand. Health equity. Related to research and evidence to create a culture of health. Doctor shot can I start with you and Janet thank you for the question. Yeah as a doctor Sherman said it's not enough to talk about things you have to do things and this is been a personal challenge for me to try to understand how I might contribute to. Improving even with a little bit of time you know we're all strapped for time- but how do we incorporate this into our daily mission- I've been trying to work with more. A groups that actually. Work with this mission whether it's within each pharmaceutical company or actually within hours of advocacy groups that are that are obviously looking at this exact issue trying to include. On upper as brokers and minorities going to churches- going to webinars when out in the error of COVID- that reach these groups so that we can. Again have the conversation that makes it acceptable to everyone not just somebody o happens to read a scientific article so I'm trying to participate more in that but I really think I completely agree with doctor Sharma. We've got to do this at the medical school level at the college level we have to make more of us look more like everybody else so that everybody who's going to any healthcare professional. Feels like they're going to someone who represents that person so- I if there's any way that we can do a better job of getting more people and more diverse group of people going into medicine and science. I think that will really really help us to address these inequity issues a lot better. Thanks doctor shot love that more of us to look like more of our patients I think you friend that might be to flake. Trish what are your thoughts on this. Well obviously we're not a clinical or scientific organization but what I can say is. That we have a long history of supporting. A population that is under. Over 60% of the population that cancer care service. Is non white. Almost 20% of the population that we serve does not have access. To the internet so what is our job. Our job is to make sure. That we continue to do what we do best in terms of providing education. Psychosocial support. And many other services to individuals that need that. In order to get through their cancer treatment. I will say for us all as I always look for the silver linings. COVID has forced us to look at new and innovative. Ways of reaching individuals. We've launched a very successful case management program which launched a podcast series. A new innovative one of its kind program. Launched a week before COVID started ravaging New York City. R. Parker Graham we helped one thousand cancer patients. Maintain their hat. By paying for veterinary care boarding pet food. 38% of those individuals said there Pat was their only form of support. So what we can do is support individuals. To make sure that they have can mean maintain. Their life and obviously complete their cancer treatment. Thank you so much for that. We do have if we I think we have time maybe for one more question I think this is an important one based on the discussion earlier around innovative in points in this question comes from Caroline. Caroline would like to know to what extent are bureaus patient reported out comes included in clinical trials and can these serve as some of those innovative in points that you spoke of earlier. Doctor Shaw. Yes this is actually one of my- research foci and- we are trying to do that as much as possible I think this is one of the- major outcomes that should be at it. Like it was a primary and one secondary endpoint this is actually a primary endpoint. And I'm very happy that a lot of the immunotherapy protocols are actually including this as a very a standard approach and there are I'm happy that there are question here's a look at this. And I think the reason for that is that is one of the ways we're gonna go towards that personalized cancer care because if you know that something works from a clinical perspective sure the CT scan. Is better but how do people feel and if you know that people feel better you can better suit a certain- that there be versus another if you know that the response is good. And the quality of life is better and by doing this I think we can actually get better healthcare to everybody- understanding how that people are not only gonna feel as far as their disease goes. But as far as our entire person goes treating the- patient is not just a patient actually a perso. Thank you for that. I think we're actually coming up- on time inside like to thank you all. For joining us today and for sharing your rich insights. On and I'd like to certainly provide the last few minutes. To ask- each of you. What closing. Words or final thoughts would you like to share with our audience today regarding the current state. Order and- the future state of cancer care. Trish can I can I implore you to go first. Absolutely happy to so I am a cancer survivor or as what robin Roberts from Good Morning America say and the cancer thrive for. And I am so excited about the research and so excited about the innovation. At a time incidently where industry has been recognized for bringing a life changing and lifesaving vaccine. It's a wonderful wonderful time and again I'm so enthusiastic and so hopeful one thing though that has not been talked about today. That I think is a real challenge for. Advancements and access for patients is really what's happening in the insurance and benefit design industry and with PBMs it's something that I am so passionate about. Because every day we see individuals who don't have access to this life changing and lifesaving. Therapies and so it's something that I want us to be very mindful of- because it is such a threat to access to innovation which is what we all want. But I want to thank Bristol Myers Squibb and other industry collaborators for literally saving. And changing lives. Trish thank you for that Dr Sean. Yes thank you for allowing me to participate I used to think about cancer care as a linear format that you give treatment and people get better but now one of the things that I'm most excited about and I'm thankful for as an oncologist is that it's become a matrix that there are so many aspects of cancer care not only treatment but as we talk about peace reported outcomes. Access financial assistance on improving quality of life and taking patients opinions and incorporating patients in order to help us to bring cr care to more people and a better quality there- so I think that this collaboration between scientists and- them and clinicians and industry is just going to get better as we understand that we're actually all connected and it's possible for us to synergize and not just be linear- but rather. Multi dimensional. Thank you so much for that Dr Sean doctor Sharma. So I am taking away from this that there's a lot of hope because I really feel like we need to remember that where we were I would say ten years ago if you think about the first immune checkpoint therapy that was approved- in twenty eleven yeah you know you think about in the last ten years what we've done for patient care because of innovative science because of immuno therapy now being. A standard of care for cancer treatment it's just change the entire- you know a front forward looking views for most cancer patients who used to think of cancer is a death sentence and what I'd like to save cancer is not a death sentence. Because we do have treatments that can cure your patients and I'm very happy to use the work your even in stage four metastatic disease we've seen that patients now have ten plus years of living- you know because they're surviving their cancer went ten years ago we need did not see that. And so I want to say that the hope is there because we're doing better every day as a result of these new innovations in science and that what we've done in the last ten years is just the tip of the iceberg that we have even more- signs that you know the research is coming for. Better collaborations and greater participation from our patients themselves who are coming to us and asking us about the signs and wanting to participate in clinical trials and I think we just are going to do a better job every day and I so I'm looking forward to seeing what the next set of treatments look like. That we can have you know that work sure used more and more and maybe eventually they get rid of the word cancer. And well I'm how. And thank you thankful to each of you for what you're doing. To make that a reality thank you so much for your participation today and thank you for your come. Continue commitment to fight cancer. And thank you to all of our past. Have a great day. Thank you for. And now for discussion on eliminating prostate cancer please welcome Vincent lit down chief of surgery at the Josie Robertson surgery center at memorial Sloan Kettering cancer center al Roker weather and feature anchor at today and co host of the third hour of today. And Jonathan Simons of the prostate cancer foundation board of directors and medical director and chief science officer of the Marcus foundation here to lead the conversation is James Hamblin a contributing writer for the Atlantic. Hello thank you so much for joining us for this panel on eliminating prostate cancer which is a lofty goal. But we're gonna try to see we can accomplish. Given this esteemed panel we have we're discussing prostate cancer which is the most common cancer in men in the second leading cause of cancer death. In men- most of us have no people- who have dealt with face our lives been affected by it- and it's a it's a vexing problem and we are joined today. By al Roker who- some of you may have followed probably most of you have followed his story which he's- shared on the today show and- L. thank you so much for joining us. And I want to thirty first just in case anyone hasn't. Followed the G. follow your journey and your story. Is there a way to give a kind of. An abridged version of. How you learned your diagnosis and what that moment felt like. Last year- gosh I guess it was- you know in the in the- sometime in the late summer I'd gone in for a- physical and then the- make a long story shorf my doctor wasn't pleased with my- PSA numbers. Said well let's let's do a- an MRI take a look and see anything then maybe there let's do a biopsy they're very aggressive about of my urologist and- came back with the data they had found some cancer in the last of. The prostate and- we it really bore more- investigation and- that let me the doctor looked of- big a little more read a little mor. And so they can a of an aggressive form and so I just. You know rather than you know after doing to diligence now let me just. Have surgery and- was just about a year ago that- I had the surgery. And yeah so far so good ahead you know two blood tests I've got to do for another one the- next week. And hopefully everything's clear but- I kind of didn't. Don't regret the- the choices in the pretty pleased with the outcome. Yeah well it's great when you're doing well and what I understand. In the mall. At at. Get the do. You can. Maybe not even share with your why of a result. Not I mean I knew I. After you he was the age of. I was. Expecting to hear that news I didn't get that it wasn't a kind of a heads up that- by the way that it was a robber as scheduled let's go over the results of your biopsy. And doctor closed the door he said I would like to always like to give this kind of news in person and that was cash earlier the impact. The night before my words only want me to come with. Us with routine things a big dl yeah this was already on the books Prof so when he said that and started in on. What the diagnosis was I was ago and I'm only going to. Say is there anyway I could do this without telling. Deborah because she's going. Yes but she wasn't the for this- and course obviously. I had tolerance. And then she- the best at it doctor look down. To her a- journalistic skills when it over- morning Mr. Will need. But no no I never really gets which maybe for a man second maybe I can. Go in for. The know hang but then we. Yeah who knows in what to do and from like when you see it but three I ask is because gone the opposite direction really been V. public with your story- it just before going to doctorn here- you know. His his perspective on it I. To ask. You know what compelled you to be you know it's one thing I to keep you notice a we their what I you you you've it with with the country very publicly with you feel was important. Well look it's good so. To Iraq without sounding Los in a- those whose much as been given. Much of expected so. It would be I think you're kind of back for. But certainly will be a week up. Given the plan- in the re we have a P. to that shared it's not to be of- and so I just thought let's let's try to. Get some good out of this especially given that for men of color it's- it's the of the outcome is much more. Impactful yeah we we're we're affected by this especially African American men are affected by this more than white guys so- I thought let's let's try to do something good- with will make the best of not a great situation. I wouldn't be a bad situation because- the look at it's a- it was treated with called was treat. Are there a man people. Have far cancers with. Regular much less. Positive outcomes so you know when I. You take advantage of that now what thank you for doing not- doctor don't could you walk us through- in the surgical Act outcomes and how successful usually- are they in and it. Addressing press begins when someone comes to you in a similar. With a similar case- yeah al is a you know a fairly typical prostate cancer patient. His his that cancer was picked up. As you mentioned by the PSA the blood test that we use to help screen for prostate cancer. Prostate cancer is in a symptom driven diagnosis most men with proe cancer don't have any symptoms whatsoever 90% of manner R. are completely symptom free and the only indication our first indication is an abnormal blood tests. Were an abnormal digital rectal examination during a routine annual physical. And so at this is the story for their al. As far as risk factors that he had to be email obviously is one- needed typical age of. It five I don't want to give away outs age. Fifteen sixty seventy. I was gonna say the average age of died. Is sixty six that's the profile perfectly for that- so it is so it's being met male staff getting older- family history are often plays a role for men. In ALDS case d he doesn't to have have anyone in the immediate family with prostate cancer but there are other cancers in the family and we know that other cancers can be associated with prostate cancer for example in particular breast cancer and ovarian cancer. Because of the association with the bracket Jean. Can be associated with prostate cancer as well and then is L. mentioned African American for a race is it important to contributor and we don't really understand why that is but we know that African American men are diagnosed about. One and a half times more often. And have a- J. two times the chances of dying from prostate cancer. And if we look world wide African American men have forty fold the incidence of prostate cancer for example as compared with that at certain Asian countries Asian men in their native countries so there is quite a wide. Range with unfortunately African Americans being at the top of that- exactly why that is so you know we don't we don't necessarily- know all the reasons- that is it. Genetic is a dietary. We know that access to health care plays a role in all of that. But dad did this is sort of the yeah- typical story for prostate cancer and death you know I really respect out for coming out in telling his story. You know it our sort of the perfect spokesman for prostate cancer yes. Everybody likes alma one. And yeah- and did you know he is Dennis- about prostate cancer so he and Deborah you know certainly yep- do diligence when it came to sort of trying to understane diagnosis and understand the options before proceeding with treatment. And for men with prostate cancer there are a lot of options so while al chose to have surgery there's many other options depending on the at the level of the cancer at the time it's diagnosed. But certainly for al the other options would have been to consider radiation therapy in its many forms there's also something called focal therapy. And then there's their surgery which is ultimately what out chose- and that surgery like many the other forms of treatment have come a long way over the last. Decade or more- you know we've improved by making it more sort of what I'd say user friendly- it's less invasive. We use mainly invasive techniques such as the robot patients tend this state yet only one night in the hospital now a days- and the recovery back to work is much quicker- so there a lot of factors that go into what treatment an individual chooses. And I think as was mentioned- for many men it- treatment may be may be the right choice. Many men are diagnosed with a less aggressive form of prostate cancer that we think in most circumstances can be safely watch doesn't mean ignored but watch. Them it may also be a link there the other reason- and I found was very important to do that story was that it it- it gave the opportunity to use the clip from flash- moon river. Yeah that's sad it's comedy gold you can't ignore that have clickable benefit for that show yes that is death I don't think of this is the comedy heavy story but yeah that sounded like you know we find you find if you find your moments you find ways with a laugh yeah so it's a- doctor we don't get what you're describing is. If caught it you know early on. In eight generally. Treatable the- and yet it bring. The second leading of cancer death in men- and- is as me docked signs could could you. Elaborate on it you know what where we what is the missing link in there that is preventing us from catching more of this earlier on our our- our with at a catching and people don't access treatment. I'm the first for our- ochre is a hero for American cancer care in American cancer research and it shouldn't be like. Mike Pence said it shouldn't be ignored that. I'm telling one story that could get thousands and thousands of men who would trust him but may not trust people wearing white coats to get checked. This is a huge public health contribution so. Second thing is early detection still is the key it caught early- the survival rate now the United States for local and regional disease you know is a 99% at ten years o early detection and those men that are not. Engaged in the conversation starting at forty years old. In I'm thinking about prostate cancer in the same way women proactive about their health think about breast cancer is a key part of it so part of it is. More awareness and early detection. The second thing is we made an enormous amount of progress- here I've told you if early detection is key and earlier early detection is the forefront of all a lot of our research efforts so. He wouldn't be visualized by twenty thirty no man should die of prostate cancer caught early. On and so some of that is also very definitely access to care some of that is has to do genetics will probably get into that in a minute. But there is a form of prostate cancer that can spread very early and this. Can be aggressive. At the same time we cut the death rate. In the United States of the last two decades- from early detection better treatment by 52% using American cancer is. Pretty amazing right. That's that's it. Half of the number of men. For dying now that were twenty years ago because of research and development and then. Activation of awareness like- like Alan others. We still have work to do to develop new kinds of medicines for those patients where the disease is spread and that there's an enormous amount of optimism. With the human genome project in precision oncology- we can put prostate cancer as a cause of death. Into the history books by twenty twenty thirty if we really- focused now. On if you think about how many cancers do you go to. Your you've got and landing readership so some people are gonna go to a cocktail party how many cancers can you say with the death rates been caught cut in half. In their lifetime that's a pretty amazing amount of progress the week. We need to concentrate very heavily on. Again on just like L. said. Awareness in patients that when they turn forty and following screening recommendations on the one hand. And then delivering precision care at every basically every stage of tree. M. S. N. could you M. dot Linda could you you. Us through the PS guide because I think there is still a lot of confusion I mean they've changed regret rather dramatically the got the guidelines from the printer preventive services task force- people in twenty twelve got a message for the community don't. You know we will we over using a PSA test you don't need this much in and then. You have to contact the other direction- could you could you walk us through where we stand right now. Yes you're right. The guidelines for PSA testing have changed or perhaps evolved. Since PSA testing first came into beig back in the sort of media Edie's. So there's been you know been on a lot of research and- Iran PSA testing screening and that. And the public health consequences of that. And there's no question and in the past we over use PSA screening to some degree- the issue with PSA it's not a perfect test not all men that have an abnormal PSA actually have prostate cancer. And some of the men that are picked up. With prostate cancer by PSA testing having cancer that doesn't need treatment and in the past were over treated- and so- and as a result of those things the guidelines have had varied over the years- and we've become more sophisticated and we believe now we and selective screening. So screening men early screening men that are at risk- even earlier- and then on the basis of what their initial screening results are making recommendations for how often they should be screen going forward because it's not like every man in the United States needs to get a PSA every year. That's that's. You should go but we've learned that that's not the best way to proceed showed the guidelines essentially say that men in their forties should consider getting tested especially if they have tha. Risk factors and then on the basis of what their initial screen is a determination can be made as to how often they should be screened going forward as they get older. And how do you think about it that I guess I could do this to. Me that's ALCS you know. A message like that to the public can be difficult to send because you're saying this is a very important tastic and catch a cancer the E. U. you know might and it might save your life. But also you might not need it. Just yet or or very frequently you know how. That that sounds. Like it it'd be him it might be confusing to some people how do I think I think- no. Welcome the doctor. But I think you know you need to especially in your early mid forties. You get a baseline of PSA rating. And then. Working with your doctor- yh he'll he'll determine the via the jovial internet how often do you need to get tested- yeah maybe program here I don't have it depending on your- initial number. I would think all of bu. But I do. What again if I. Had those big. Them of the you know it it it would've been hard I think for the diagnosis figure okay while you were here a year ago. And now and it was a little bit more than a year because because the pandemic and I think that's one of those things things that- if I had there was a window where the things it kind of lightened up a bit pandemic walks. So I said well let me go get my physical yeah to do that and get my- head great one of the women and I did the first now if I just waited. And had not done the physical. I don't know what would happen because. There we've been locked down agai. Add a Bobby have been another sick seven my before able to get into the- so. I you and- to get you. Give me a if you haven't had one you gotta have. Otherwise you know the doctor would have an idea. Early in like measuring okay now you've got this number well what was it the year two years ago. M. as well that's just. Seems to be ever you know relatively a common sense kind of approach to you know kind of thread the needle. Yeah absolutely and I guess that kind of brings back to Iowa I want to come back to disparities were mentioned earlier as to what might. What might drive people to not get that baseline test- in what can be done more broadly across the system to help people. Just have a relationship with a doctor or feel you know comfortable going in when they're not sick which is not the way a lot of people relate to the healthcare system and go go in once year. Once you're bleeding or something as- painful and otherwise stay away. And that's a general question about him saying after most most men. Don't go they don't get what we're- good you're nagged by our significant others. To go to the doctor I'm a little different Justin that. Yeah because of. My family's history- even though they look will be. The good the good news is. Yeah you don't like to the doctor but you know no matter how much you don't like going to the doctor you hate the dentist more cell with the- nobody likes the dentist that just yet- and I don't even think. Dentists families like they've got to step it up to my dad is a dentist well there you go I'm sure you love your father but- I love him. A person yeah. There you go there you go. A deep cleaning is really good with again in- I think we just in in general don't as men don't go are not as- great an advocate for our our own health. At a change that so. That's the key that. If you start to talk to people about checking your tire pressure. It's an easier conversation but you think you think about it even checking the tire pressure once- starts a conversationn your mind about. Whether or not you're gonna need to tires or whether or not you're driving safe in week that's all about men's health and we are very good at it yet or we would. Have significantly higher- screening and detection and the second thing we don't talk about as a PSA test is like a smoke detector is not a fire detector doesn't have to be perfect alfalfa's been amazing and communicating. That is being proactive about your health right- but the- but the so much of this in the value even in this conversation in terms of reaching people is to get men to get checked to be proactive in the health to be partners. In their care. On the net an ongoing challenge in urology but that's an ongoing challenge in oncology and healthcare. Yeah need a check engine light yeah that's it. But that's it yeah he's in if it's right if you have breast cancer prostate cancer colon cancer bright pearl earring cancer in your family your check engine light for your prostate should be a Ford. That we know and that includes talking to your doctor about eight getting a PSA in beating father- and we haven't fully and we haven't fully reached every man rigt now United States let alone in the world that. That conversation needs to take plac. Well I guess we only about a few minutes left of the I guess the for the final thing is. Many of these problems of AP at notions of masculinity and getting men to admit vulnerability and changing you know- the social structures and medical disenfranchisement either huge social problems that I don't know where to begin. I mean I know where to begin to address but I don't have a meaningful solution so maybe is technology is there better test is there something we could go knock on people's doors and- could there be an apparatus there anything on the forefront. That would make the process even simpler than it's already simple I'm not. That mean it's a straightforward test at least but there's something people could do we don't have the sort of relationship with a doctor that. Al has or or for whatever reason don't. In both they're invincible but- do it if it were something that came in the mail. Well there's- no magic thing out there right now. And you know I don't think we should necessarily want to rely on technology to solve all our problems you know prevention- it is something that's available today for every one of us- you know exercising regularly. Eating healthy. Are trying to reduce stress those are things that have proven to impact one's chances of developing cancer or or or yeah overcoming it to some degree or living with it so these are things we can do right now. To prevent. So I. Yeah I'm sure we're gonna have better technologies no question yeah it's out there but that shouldn't be what the answer is- I guess we have to wrap up by a- that have a lot more curiosity and I'm and I know your stories of more complex maybe get into but thank you so much for sharing it thank you for the work that. All three of you are doing it thank you for your time today. Thank you Jeff thank you. And now for a session produced by AstraZeneca. I think we aren exciting moment in which we can merchants science and technology we- and we can continue to advance the field at a speech that we had never seen before. To be a visionary you have to be a disruptive almost by nature that's part of what made people uncomfortable around her saying you know change is painful he was to oncology development what jobs Williams spasms have all been to the areas there and quite honestly in the lab because they work harder than anybody beyond that she had these intuitive abilities that we just didn't have. What he got to mass general the place started to move and shake a little bit they were starting to pull some things off in terms of the kinds of studies that they were doing and it was a remarkable impact that he had not just. Sitting with them and. Also does the ripple effect of what's possible. It's not a- to say. That who's a leader puts. On the math is an area for oncology research. He was hiring new. People new oncology is for and you heads of the different departments. Is also trying to convince people to. Create anyone biomolecular on UNITA origin now makes. Ninety will on the part of clinical trials. He was always find. Things going and growing. We are in order to need to sure that all these not. Continues to be the ballads on apply to patients used to for himself that he was the people. Around him and that's the goal. I was very very clear with the- is making a difference for patients. It's important for me that people remember remember him as- someone who. Always prioritized his patients. Next for a conversation exploring why there's no cure for brain cancer yet please welcome Courtney Barnett survivor and patient advocate an internist and health partners and author of difficult. And Alex be Porter neurologist Mayo Clinic cancer center off the road navigating life with a brain tumor. Teklife contributor John donvan is back to lead the conversation. Good afternoon everybody good afternoon doctors and thanks for joining us on this panel- which I think maybe we can sum up with the phrase where's the hope because as was just pointed out in the introduction- ain cancer amg all the cancers being discussed today is not among those at the top of the list of cancers that are yielding to dramatic progress and breakthroughs in the last decade or so- it's still the case that one out of every hundred- diagnoses. Of cancer per year- is- malignant operator is a brain cancer. Up at the same time the rates of malignant- techno sees are declining but they were survival rates for those who are diagnosed particular playlist on the remain. On the challenging Lee- challenging low- so we want to talk about why that is and where's the hope and I want to start the conversation. With you- doctor Burnett you have. If a- really interesting story let's just put it that way if instant as if interesting is the word that captures it but tell us about. Your personal experience- with with the topic that is at hand here. Absolutely thank you John for having me and so I do have. An interesting experience with brain cancer and said my diagnosis which- did give you the very brief story I would I am a internal medicine physician in Minnesota and when I was finishing up my medical training I had about six months left until I finished my training which takes. Years and years. And I was over in Thailand- doing a global health elective and while I was there I was very ironically studying on the oncology service in a big hospital in Chiang Mai. And I started to have a very strange neurologic symptoms which ended up being focal seizures. And while I was in Thailand I ended up. Diagnosing myself with a brain tumor. And that was quite a story which is why I ended up writing a book called difficult gets about that journey- that brain tumor ended up being a malignant form of brain cancer a grade three anaplastic astrocytoma. Which is the- little sister of will blast on the one step below. And enter since that time that was back in February of twenty twenty since then I've had two brain surgeries- I've gone through chemotherapy radiation therapy. And I'm lucky enough to still. Be here speaking with all the today. And how are you doing our you feeling. Thanks for asking I you know I feel great- I feel very. Lucky to be here and to be feeling while I'm still able to practice medicine I'm still able to live- yeah I'm normal I don't know if it is the right word but I'm still able to live a very fulfilling life- I've had stable scans now for the past year and I think like you know one of the big reasons why we're here today to talk about brain cancer and- it's there's no cure- can you. You I will live my life with brain cancer as a chronic disease for however long I happened so it's an interesting one to happen took some adjusting and- I have a very new way of looking at life now. Hi is soon that you you know so often people are talking about using the term such and such diagnosis as a death sentence I. It sounds to me like you reject that. That description of brain cancer is that you said it's chronic. But you're rejecting the death sentence description sounds like you're really. Living land living and living. Yes I like that but I would add- I think that being a human is a death sentence could I say. We're all gonna die I think that people forget that- quite often and is one of the best lessons I've learned in my medical training was actually my last and becoming a patient and realizing that. Immortality does not apply to me or to anyone I might work with. And so- yes I think that there's a lot of hope for people with brain cancer I think you still die from it of course ending many people. Absolutely and there's there is- as far as cancers go I think that it is quite understudied and underfunded- partly because- arm often I think historically it wasn't a death sentence so to speak and I think now there's a lot more hope but they're still from weeks ago. Doctor Porter I. Eat in the- into my question I would love you to take thirty seconds to tell us your story in other words where you are in. In in in your career in in research and why you. Were drawn to this field but then the question I want you to dig in on. This why is why is breast cancer so after was brain cancer. It's so. Difficult in this regard. Thank you for that and thank you to Dr Burnett for sharing your story so eloquently. I am officially mid career I guess I've been. A practicing or oncologist for fourteen years. And I have the privilege of the practicing at Mayo Clinic one of the leading institutions. In the world. And so really what inspires me daily is it working with- folks like Dr Barnett. Who recognize that life is not promised to any of us yes we're talking about- at Sirius diagnosis. But what I find- in every circumstance is that- our patients are able to really- put their priorities at the forefront- and I'm able to help walk alongside them from appearing it either a place of- seer- to really One of empowerment. As they start to understand more about their health their health care in there. The treatment options that are available we really start to look at goals for some people it's the goal and getting to their- child's wedding for others it's a graduation- are particular you know taking a particular trip. And so the experience really does look better for everyone we know that there's as- heterogeneity. That occurs within brain cancers not all tumors though they may have the same name. Behave in the exact same way and that's really where the new wants has come in the last several years. Threats to understand some of those molecular differences between these various tumors. That one day will lead us to a point of being able to really- use personalized medicine understanding of where that genetic abnormalities lie in being able to target. Those abnormalities based on what each patient's genetic make up. Looks like up there particular tumor. It's been such as for us to mak. In this cancer because although this is what I do daily. It's rare we're still talking about a rare cancer it's much more likely to have the type of brain cancer that travels from elsewhere in the body recall that brain metastasis at the much more common circumstance- then the tumor that- doctor Burnett is living west and so. On it's hard for us to. Get the trials funded and done it's hard for us to find drugs that penetrate what's called the blood brain barrier we need the blood brain barrier because that's what helps protect us from- having inspections travel to operate every time we have a sinus infection for example- but the challenge there is that not. All medications and at penetrating Matt- blood brain barrier and so I'm often quite envious of my colleagues who practice and I had the breast cancer fielder in even the a lung cancer feels he's had new medications that come up. Annually we're still you using some of the same tools in our tool kit that we have for the last several years there are some nuances certainly- but that's one of the reasons why this is been such a challenge to. Essentially care. Everybody is watching I would remind you we would love to have you be part of the conversation and I really want to try to make room at the end of your questions so he used a Q. and a tab. To put in any questions to a doctor's border and- Burnett- seductive border I hear you saying the heterogeneity of the- presentations of cancer. The blood brain barrier that that these are challenges what if what about just the mere fact that. Surgical removal of a tumor in the brain is not like. Surgical removal or of the of a tumor in the muscle I mean. That's got to be an additional challenge. Yeah we don't have the luxury in the brain that other organs have where we can get margins. Meaning you take out to the- all of the tumor and a little extra tissue all around to ensure that there are no microscopic bits left behind within the brain we're talking about- serious realistic and so we don't want to add any at morbidity we don't add any neurologic deficit. With our respective surgery never the less we want to ensure that we're giving the patient the benefit of the maximal safe resection- and as Dr Burnett describe she's already had two surgeries are some patients because their tumor is in such as serious location. That they're not even able to tolerate One surgery and so that's really where where where challenged in where I believe the hope comes from I'm in our field as we start to think about advanced imaging techniques. And the opportunity to be able to figure out what are some of the genetic abnormalities within the tumor just based on imaging appearance and- the opportunity for radio tracers and all and so. The heterogeneity that I was referring to has to do with the tumor itself. We know that some regions of- these cancers may act in one particular way others may have an appearance that allows them to. Have more of an invasive- characteristic that we know can be even harder to cure them those that are more nodular. And so these aren't just- the same type of tumor and every single human and that's what makes it so challenging though there may be some. Common presenting symptoms seizures as doctor Barnett to- mentioned in her experience can be one for others their progressive headaches for some it might be changes with language or weakness or numbness on one side. Never the less the experience is different for each of us and that also brings apart so about some of the challenge because there's truly no screening. Mechanism for these brain cancers. Dr Burnett- hi I have to mention. Your moment of self diagnosis the Pete the process of yourself diagnosis first of all. The first symptoms. Appeared when you're far away from home. And then the fact that you. Know enough to diagnose yourself also. Probably indicates that you. Knew enough to be scared as hell about what you're going to be facing. At the same time as you went through the process of getting treatment. I imagine that. Your knowing the system and your understanding at least the framework of the medicine that you were going to be encountering put you in a different position for most people and I'm wondering. What do you what what is your view of the of the challenges for most people. When they're facing the issue of brain cancer what what are they up against not knowing everything that you do. Absolutely it's a great question John I want to- just do a quick update that and my name was spelled wrong for a minute I'm not Courtney Barnett About Courtney Burnette although I wish I were the singer Courtney Barnett mostly just thinking in the shower these days- thanks. Yeah I think your question John is really an important one and I do a lot of work now in brain cancer advocacy and raising awareness- because I do have a unique perspective and I think being actual vision. And being aware of. Exceptionally helpful. And in other ways was applying on the to cancer of any kind of the terrifying diagnosis for anyone but knowing you know how to read that scary literature that's out there knowing the worst case scenarios I've seen in patients who have gone through chemo and radiation and brain surgery was at another level- here. To me. But I think that. Looking back on it and- having insider so to speak information on what I was going to was incredibly helpful and for many people that's not the case for most people and I think about a big part of what I like to advocate for now is really knowing how. As a cancer driver patient survivor whatever you want to call it you know you have to know how to advocate for yourself as a patient- and you have to know how to find the resources- I was fortunate to be in a large urban city or I could get a great treatments and have access to a lot of resources that other people don't. But I think you know knowing the resources that are out there is super important and with brain cancer in particular. Because it's not a well known type of cancer and a doctor Porter so aptly pointed out it's very- divers at in how it presents and the different types there's not one sort of standard set of guidelines that a person diagnosed with brain cancer can. Follow and check off their list so. Finding resources that are out there finding a community who's been through various types of brain cancer is very important. Dr of Porter do we know anything about it any epidemiological pattern to brain cancer- it is that is there is there any sort of environmental impact geographical impact demographic impact anything like that in terms of the incidence of brain cancer. Yeah this cancer does not discriminate we know that men are more commonly affected than women- it tends to be more. Common in the- sixteen seven decades and it is- to- in earlier years but we know there's also a kind of a bi modal- impact and then to add children are commonly impacted adamant in terms of the at the relative frequency of cancer diagnoses of brain cancers- can be more common in children. And so- when it comes to the adult population there's been a lot of literature at a lot of studies that have looked into what are some of the risk factors- are their associations with prior head trauma are their associations. I kind of make the jokes if you stand too long in front of the microwave watching the popcorn poppers he views the Bluetooth device- and the truth is that this cancer does not discriminate. The only risk factors that we are well aware of our when I patients have a family history of significance giant cancers or on underlying genetic diagnoses such as North fibroma ptosis for example where- brain tumors. And it being a much more common. Short of that- it's the difficult to be able to determine. Who may be at risk in so that's one of the challenges that I was. Alluding to previously we don't have a screening exam like a mammogram or PSA for this sort of test certainly F. brain cancers run the family. Then yes it would be recommended that there's baseline screening imaging. Never the less we know that now patients more than ever have access to cat scans MRI eyes more so than I'm not previously in people. If they've had a trip and fall for example or a car accident they may incidentally on end up having. Some sort of- at brain tumor identified that way. More often than not though we talk about some of those symptoms that can- at raise that red flag but no there's not time on any particular demographic that Saddam add more risk than others. We know that about one in ten patients with glioblastoma that's the most aggressive most I'm not deadly form of brain cancer about one in ten. I tend to be long term survivors and understanding what it is that's different about those patients. That makes their tumors much more sensitive to the therapies that we're giving is really where on the hope comes from in the field. It's gates at its and like that was the beginning of the answer to the where's the hope question but we have some questions coming in from- people who are. Watching our conversation- Erin Johnson asks- do you sort of touched on a little those. Little bit doctor Porter what about regular ■MRI is just being for brain cancer with that help with early. Detection I- I think circle back to doctor part of it just does take doctor Burnett's. Take on that and then come back to you. I heard one I think you know as as many doctors in various specialties will tell you that emerging as a blessing and a curse I mean when you. Take a picture of someone's brain or any part of someone's body. Yes you can pick up on scary things you can also pick up on a lot of things that. Might scare a person but are really not medically significant and so. You know is it helpful to have all the information of every little. Blip that's wrong in your body I would argue for me personally I don't want to know all that- but I think that's- that's what can be difficult about. Deciding when to screen and who to screen- and in in brain cancer in particular thinking our doctor Porter mentioned and- without screening most of most of us are Mar diagnosed very late in the disease which is what makes this one so. Challenging that. Most people don't has major symptoms or when they finally do it something large like a seizure. And doctor Porter what's your take on that question I think a lot of people over but what would be asking that should be getting screened now should be getting screened regularly. Yeah I would say if you have a significant family history. I have first degree relatives. Then for peace of mind I do think that it can be worthwhile to have that baseline MRI- otherwise I. Worry that on any time as small. You know at a headache- missed. Word in the sentence. Could the rains that alarm for any of us and so understanding where we're starting I think in that regard can provide some reassurance. For those people who have a significant family history. Outside of that unless there's a neurologic reason to proceed with an MRI- then no I don't think that. I'm just a random screening is necessary. But certainly the conversation starts with their primary care physicians. And making sure that you're taking good care of. Yourself by checking in regularly. And then typically at that price- at the annual visits there will be some components of a neurologic examination that that primary care physician well- perform. That then will- let her know yes you need to go and have. Had an MRI done or some other- house format imaging if they feel it's- necessary. All right so there is some advice and we've- done some sense of where the hope is and I just wanna say the- previous panel we saw doctor al Roker. Being very open about his challenge with his- battle with prostate cancer- doctor Burnett Year of similarly. Being out there in such a way that helps so many people. Think about identify. Plan for be aware of- and at the expense of your privacy and sharing a story I just want to say thank you. From the rest of us and doctor Porter. You talked about being there walking along for the journey we need more views so I want to thank both of you for taking part in this panel on brain cancer. Back to. The program. Thank you. Thank you one break we that with ten and visit our expo booths to participate select the networking icon located on the left hand side of the screen. Next click join you'll be randomly paired with another attendee for about five minutes. If you wish you can exchange virtual information with each other and keep in contact via direct message within the platform. You can also click the explorer icon to visit our virtual expo booths. Here you can explore more resources from the Atlantic. And our underwriters related to today's event we'll see you shortly after the break. d now for a session produced by our underwriters G. S. K. hi I'm lieutenant and the founder and editor of Zimmerman report a biotech industry newsletter it's really my pleasure to moderate this session on immuno oncology- it really has been one of the positive stories in cancer development of the twenty years in which I've been. Privileged to up to cover developments in this field- now I think not that many people may realize it but- there has been a lot of steady overall incremental progress against cancer- cancer death rates have come down by about 30% over the past thirty years. Now cancer is still the number two cause of death in the U. S. as though there's a lot of work to do and a lot of unmet needs but some there are now seventeen million cancer survivors in the U. S. alone. And a lot of that is because of early detection precision diagnostics more effective treatments things that were- hearing about- at this event today- but it in terms of megatrends- it was about ten years ago that- scientists really got that first- convincing evidence that you can unleash the immune system. To fight cancer specifically now this idea has been around for a long time and had never really borne fruit but- as I say about ten years ago people hold it on this idea that there are checkpoints that dampen the immune response to tumors and if you could release the so called breaks a couple of different ways. Then you could unleash the power of the immune system to seek out and destroy cancer cells like- foreign invader like a virus and so this has been a revolution in cancer R&D and care the last. Ten years of and- the drugs that have come out against targets the CTLA four and PD one PDL one which you'll hear about today- are now approved against. Multiple tumor types are more than a- and in we're seeing more them- coming along so it's not confined to just one type of mutation for one specific type of cancer. Are now these treatments do not work for everybody it is important to say that- but out when they do work we often see. Long term durable remissions and I think one of the best known examples of that people may remember- Jimmy Carter- about. Six years ago I believe was diagnosed with a very severe form of metastatic melanoma and it hit even spread to his brain. Was a very poor prognosis especially for someone of his age- he was one of the early people to get- one of the- immune therapies that we're gonna talk about. And it wiped out his tumors completely and he's still here with us age ninety seven- cancer free. Cell up success stories like that- are becoming more common and I think we can expect more of more stories like that to come. Okay so get started we've got this great panel today- hi I want to hear from. From their first on where we're going- so it's Hesham Abdullah from G. S. K. salons Peters a researcher for in Switzerland and- Andrea Ferris of patient advocate president CEO of lungevity foundation- all. So I think just to start it because I have some- can we start with you and you know can you could take us back to ten years ago when that- that realization occurred immuno therapy was. Was looking like it was for real and how did you. Look at that landscape and think what are some ways that we as a company can can continue to contribute in a big way to this this new shift in cancer treatment. Yeah well. Thank you very much and it's certainly a pleasure to have the opportunity to be up apart this conversation specifically just around. The potential that immunotherapy get help- offer- you know in cancer across on different different types of pop of tumor types as well too. Also a pleasure to be a part of this panel conversation with my skin colleagues Andrea and salons as well as want to. You know it's interesting I kind of thought reflect back to you know- what's happened over the past ten years I mean no doubt- I think we've- you know we've come a long way in this era of personalized medicine- we're making significant strides and progress- and- to me. It all has to do with our evolving understanding of the science- in the biology- and I think that really underpins. Everything that we do in terms of oncology research but also development as well too. So as a reflect on where we've come from- in terms of you know starting out first- years ago with- you know our- at least initial approaches. To prosecuting- cytokines are a class of you know minute therapies- initially- for- kidney cancer and melanoma- and some of the challenges that they offered- in terms of- not necessarily having- be the selectivity and specificity per se- and really having you know challenges with. The toxicity burden that they have on on patients as well to necessitating administration and in a hospital in a hospital setting. And now where we've come to SharePoint- you know we're looking at this class of checkpoints- you know specifically targeting certain types of immune cells. Called T. cells- it's certainly a you know a different way to you know think about how we can really harness the activity and specifically the persistence. Of of the immune immune system- a lot of progress is being made no doubt- and we've seen these drugs specifically targeting PD. One PDL one- access- improve answer. Across and of to Georgia. And especially in those patient- that- you know have more advanced forms of cancer- but what I would say is- they're still probably more opportunities for us to. Think about- you know what's to come- and specifically- around how we can better leverage and utilize these agents. Especially in in patients with earlier stages of disease I think to me that's going to be the next opportunity to watch- it's going to be an area where you know we're already starting to see some progress and lung cancer. Also in melanomas want to and I think they can certainly have the potential to change the therapeutic paradigm- especially as we start thinking about. Ways that we can better tackle- screening earlier screening for cancer- we heard from some of the panelists from earlier conversations today- talk a little bit about this- you know novel ways to you know. Make that screening process- a bit more- I would say- rapid accessible- and at the same point time starting to shift the conversation from. Having more advanced diagnoses to actually thinking about earlier diagnosis earlier intervention and then- possibly introducing some of these agents. On into these earlier stages of disease ultimately altering what long term outcomes for patients. Of may potentially be. Great has thanks so it'- what do you say that do you- do there's been a lot of progress with- as often happens with cancer you start with the sickest patients getting their third or second round of treatment. Did you see opportunity in moving into newly diagnosed and less aggressive malignancies- were what about combinations as well people been talking about that for years where do you see the scientific opportunities. Thanks a lot so that yeah it's to compete Beyonce Europe of his time I think it's quite people since two relied that like everything we do in that you know the team strategies in cancer. We need to start first over from the biology and from the discovery here we speak human therapy so the discovery of the what we call the union check pollen sources breaks. Which make that cancer can survive despite a strong immunity from the patients against cancer cell to at the from e biological discovery of these breaks to number price is right. Describing the security for and the and the and the PD one as being at the State immune check fines so starting from the biology. To is a difficult step moving to the Uman you're moving to Z. demonstrations that he twerks so in oncology we have to bush was a strange pass. Offers going to be some swore out of any treatment option- first of all that he's feasible it's called the phase one. And then to move some visibility demonstrated some safety demonstrated to stop to try to move to show it is active. So of course we start from late night no we don't even see a situations where no treatment options available. To consider seventy larger I would say more important step in larger populations of patients so that's what we did with the North after we started from these fees one for safety. Trying already finding and identifying somebody send weather surprisingly long benefits rights. To move to lake signs of treatment so once you have done the traditional to chemotherapy lines. To move to front signs sometimes as one of their yes sometimes in combination so drunk they up question now. Immunotherapy has to be given frontline as was as a man down to repair a meter in some diseases speaking of alkaline can stressing about Trina can. About melanoma and very students thinking about also some J. malignancies so it's quite important to describe. His fast which is you take decas is quite five north because rather five ten years but very. And not use. Once you have. That the make. Disease Saudi which spread over the bar of the- can be. With the- can even read. What because of I acted. Something we cannot be cured. Into sometime something which can be. For or years. You you that you don't know with of or ten years. You can to try to needs to the many state I would say the bill of the U. DZ which is. Or radiation you patients get nothing the gross. So now we are moving we you may not happy in easy. I can be gastric can the French. In Milan que states my on the line. We starting to me nothing I feet after all right to be so. In the context of small these. And surprising we see show. Benefits I would give allow than. Streaming up nappy is now closed to. That's why it to be tested for down you know he- but in some the- it has be given even a math class at the setting old. You should lose approach. Of known to benefits so very fast I would see a pass for the- to get from a to Z. he's twenty disease. Hasn't that always been the X. that email. Was likely to more if. In P. with earlier this. Or or less- medicine. Disease so it's essentially moving a direction where it's even more likely to succeed. Well probably for two reasons first of all when you have a vision for the new disease. Is usually more fix what I mean is the immune system is probably more I would say dynamic in solids in mounting the fasting in response. As compared to someone who we have lost wage would. That would have will be weakened by one two or three rounds of chemo states about. Z. very stron. Gains I would say. So you know system which can be. Store the maximal extends right that's why thing yeah this is something describing colleague from U. K. John is one. Yushin said that the- do. You have more open to says you have. The more different They Might Be recorded call now the emergency if you stop to speak once one of the other one. They become different over time for the most says you have. Say less I would say tweet. And they are so list similar they are meaning that it's a huge effort for you even system to be the response to each of these different centers. So he how much anything you can find in the small disease might be the best setting to develop a strong and maybe. Better more comprehensive. Immune response against cancer set. Very interesting now. Andrea as patient advocate- you're into with a lot of with lung cancer they've heard about these treatments are. What are you hearing from people on the ground in terms of like how is this- what's the side effect profile the tolerability of these treatments and how are they able to- you know go about. Living their lives. Yes thank you for having me and- thanks for the question I think- you immunotherapy in the lung cancer space certainly has been transformational. I think we do need to be somewhat careful though and it was brought up by the first speaker shop. Where if they don't work for everybody and they're not always appropriate for everybody either so I think that it's hugely important for people to have a conversation with their doctor. About what is right for them- for example in the like cancer space if you have a driver mutation a targeted therapy might be approached more appropriate first then the immunotherapy. That's sad for the people will have for whom I mean a therapy works. It generally has worked very well at least for periods of time and some people- haven't even reached that and point yet of where where they stop working. Being and the side effects are better but it is also really important I think for us to educate people about what that side effect profile looks like oftentimes particularly if it is working for a person. They might not see their oncologist- on a regular basis and their general practitioner might not be familiar with some of the side effects and attribute it to something else so I think that education about the side effects. Is hugely important and I think that the for some diseases where it is a newer mortality where there's also an unknown in terms of what some of those late onset side effects may be- as well as- you know what to look out for or the longer duration once. That said- I think the thing that's really exciting in a patient communities for the most part. The side effects are treatable if somebody knows what to look for and how to manage it so that you can stay on therapy longer so I do think that- immunotherapy has completely transformed. A certain diseases especially lung cancer- and it is it is a amazing- treatment there's still a lot more to be done in terms of finding out how to make people who don't respond respond. To it how do we combine it it with others there. For longer data. But I do think that it's- very tolerable under effective which is very exciting for the patient populations at you know. In general. That that is good news- I want to come back to this point about- drugs not working for all patients I know that a lot of effort in trying to get the right drug to the right patient to predict which patients. Are likely to respond to these immunotherapies all what kinds of things do you see happening in the industry now and are you optimistic that- that we're going to- to be able to direct people to the most likely treatment. That that's going to succeed for them. Yeah I mean it's a really it's a really good point- look I would I would first start off by saying you know- you're absolutely right I mean. These trucks don't necessarily work for everyone- if I had to say 2230% of patients- you know derive benefit from single agent use for example of PD one PDL one targeting agents as well to- however- if you look at like for example over the past. You know several years- you know they've no doubt started at least being used investigation only- in many and numerous trials. You know as part of either single agent exploration or more commonly company accommodations are promontory approaches- there is- you know- an article that I was reading. More recently as of late last year there's more than thirty five hundred clinical trials on going out with this class of agents PD one PDL one targeting agents and over a hundred and development is want to. Know like I said the majority of these trials are now starting look at Commodore the purchase. Is company for approaches could look at- exploring a combining these agents with- current or existing standard of care including chemotherapy including radiation therapy- and just wander. Certainly as part of additional you know standard of care treatments including of course. You know surgery earlier in earlier stages of diseases water. To me- if I had to kind of think about some of the key I'm gonna call them opportunities moving forward. I think better understanding what's happening within the tombs and what we call referred to as being the tumor micro environment. Is really important- in terms of getting us a better sense of who will are possibly will not respond to immunotherapy often times. Looking at the tumor and what's happening within the tumor specifically. Is no doubt quite complex. But gives us a sense of whether or not- there are currently immune cells infiltrating the- you know the tumor itself- are there additional variables that may be- the tumor is using to help. You know- if they eat. Or escape from. You know hi- the- the immune cells exist or there no Indians. Press even within the marker environment then into. We have to think about alter approach. That could help at least create that- more immune on a college in flames. At least environments within- within the tumor. Itself is want to and that in turn helps. You know dictate possibly for us investigation like. The different types of hypotheses that me back we may want to explore. On depending on. What the tumors you know characteristics you know look like- and then at the same point in time. Also what the patients- own individual immune. Status is as well to- and I would just like the highlights to me I think that. At least the two key areas that we have to focus on are. Really better immune profiling of patients to better understand you know. What the status of their existing immune system is- and potential for immune responses. And then the second really is figuring out what's happening within the tumor. Micro environment is want to- in addition there are or on post you know clinical characteristics that might contribute to whether or not a patient response or not- but at the end of the day that. Will dictate how we think about different combin Torvill broaches- as alluded to whether it be with existing standard of care agents targeted agents or- novel next generation- you know checkpoints as well too. So we're now starting to see. A few of these a next generation- agents emerging- and of for example- there is this. You know axis of checkpoints called the CD to CD two to six axis- along this axis there is a number of different targets- they include ticket- the rake. And CD. Ninety three role on but they play on MTV the immune cells including. T. cells including natural killer cells as well as want to- and we're starting to see this constantly at least investigational emerge- and- in the case of ticket- possibly start demonstrating some. Preliminary clinical activity of interest- that could help is then think about how we can build on the existing backbone with PD one. PDL one targeting agents- and the looking at the expression profiles of these different types of targets- you know within. The immune cells in the tumor- to better- figure out. How to best combine them with- with- with additional you know checkpoint inhibitors like PD one PDL. One and of course as well so. This has some I mean when you get into cancer. It's so fast you you see how- there might be one checkpoint that dampens the immune system and you can release that break but then you know the tumor has a way of throwing up another break some of those targets that you mentioned- sell people on the farm Simplicio looking at ways to. You know hit more than one of these checkpoints to kind of lower more of those defenses- but then there's also this other stuff going on in super micro environment it's like hypoxic low oxygen so it's hard for T. self third. Infiltrates in high pressure and there's all this art stroll mods it's a collect cartilage like barricades so like are there to the other drugs that you can give in combination that. You know not down one or two of those other obstacles to make it a little easier for the an author. That the immune cell to get in there and do its job. Of making the tumor from up a cold situation as it's that into a hot tumor that that- that you can inflame as you say. All but no- but people would agree at this. The P. one. Ones are. The backbone therapy for all whole lot of different malignancies that is they're just. In the standard of care in the recommendations- it not not all the way across the board like chemotherapy is for so many cancers. Where water salons Dick do you see a future when. We can get rid of chemotherapy when of will will use backbone therapies like PD one PDL ones. In combination with some of these other things. Well I am. Do I see a future without chemo well it would be it probably. Once will have understood that the for the biology of the demand system and the canisters interaction what I mean is it yes I see your future across some patients and not needing chemo to treat the cancer and maybe benefitted on the from I- but like- I would seem very nice yeah yeah hi stressed and- maybes something I should have added in the beginning. As at the time being we are far from being able to say that immunotherapy works full patients of course I don't know if you can make the comparison but we have been defining north even against of a dozen melanoma in the recent years. To deepen new strategy one is you know therapy yeah the one you want to go talk to keep them happy which I ordered. Correcting when you use is over drugs you have the mutation yes. On the- my- is to be delivered efficacious are not the black white. Let me know that he's not and white check on. On something should work a little bit stabbing lighting the- and somebody said it was. Was a- for of. Year these. To and again all lex. But we see don't know. What the Space what there at years telling you. Because on the- but they asked know live that would be. I need just one. Right the fifteen twenty. But this may be the- where the bombing this doesn't like me some. But the problem is that he told a month. You may not correct. What I see by that is of course to try would not the only. In order patients the benefit twice. In all popular but the course was three. By easy space said when demo. So date magnitude of the I think he's driven by. The of the right patients so we be able to get to the people yes but on in this one's. We should- who. Benefit a lot can we have a five year. I would say. Q. or or- control of the disease which again is a minority. So it's a markets meaning that he's trying to for people from the- or commenced. Have a blind including Houston that of gas in organised. So you need to communicate back to patients that do not directly is a continuum in some of its secrecy. Somebody should we have an amazing benefits and some will not. Of course as monotherapy he says a probably use lowers and we use a combination use combination of came when I- you can benefit from one. From the other one of from Bose beds you increase your probability right but when I mean need that maybe to tend to be sunset. We see struggled to identify. The patients who will have the most important benefits are long term benefits. Of the strategies what over. I would say much modesty that he must have in front of the huge market which we prescribe I ought to or commenced. I. Challenge the awards these chemo and or the other or distracted you who knows maybe one day retaliation and so on. The first need to identify who on the station's to re extract at the time being the best been. It's a great point and Andrea brought this up as well earlier about get starting with the information. Right so if you find out for sent instance if you have lung cancer and that you have a driver mutation the couple the best known ones are ichi FOR and- A. L. K. or ALC. If and there are good drugs that specifically target those driver mutations so in that case. You wouldn't naturally jump to the concln that you know immunotherapy is right for this person at least at first you probably wanna try something else first- is that what you're seeing entry like are people kind of following the science or- you know people. Maybe you know they say see commercials on TV and they get a little carried away with this immunotherapy things asking the doctor for it. I think it's a little both- I think when the immunotherapy first was- you know approved it on the market there absolutely was a lot of excitement there was a lot of noise around it. And people were going to their doctors saying Hey is this right for me. But I think what we've heard throughout today as well is that there is no one size fits all approach to treating people now we very much have to take a personalized. Medicine approach to- individuals into their cancers in lung cancer you know you mention EGF are an ALC they're probably eight others K. Ross being the biggest one that. Now drivable that wasn't before but the science is evolving so fast in so many of these diseases. That it's really hard to keep up and it's hard for a lot of the you know Community or general oncologists to keep up with all of the advancements. So is it something that patients at want and ask about yes is it something that they also need to be educated about and careful to understand that there is no one size fits all. And I think going forward it's probably going to become even more fractured and fragmented when we are able to discern who will benefit exactly from what. Treatment or what combinations of treatments going forward. If I would just I didn't just build on what someone and Andrea. Just just mentioned as well to look and say. I think part of the challenges- you know of course and it's an obvious one. Part of the challenge with immunotherapy is you know you're targeting the immune system. And just- underscoring you're also having to you know also think about. What's happening within within the tumor and there's some number to walk there's a number of different variables. That could affect you know the likelihood of a patient responding or not. You know including predictive biomarkers you know- at like like tumor mutational burden like and that's highlight. Video one expression. You know we talk about you know. How we get a better sense of you know characterizing you know resistance mechanisms right. Some patients might have some of these primary resistance mechanisms that might not necessarily up front respond or direct drive benefit from immunotherapy- there is you know certain patient you know genomics. At the time at the genomic characteristics that might be a place there is an element around you know microbial factors right and you know and possibly whether or not you know they- they could have. On you know certain- you know a certain role in and not in any really helping define. You know how a patient's immune system you know response are you know to two minutes thirty and then there's of course also set of clinical characteristics. Including a possibly you know things like tumor burden- that could. Impact you know. Either whether you know whether we think about treating a patient with- you know keep my- immunotherapy alone or possibly is part of a combination regimens lunch venture. Chemotherapy plus immunotherapy- as well too so there is a host of different variables I mean ideally the world that we bike to get to. Is you know to help you know both physicians and patients of course- you know be properly informed on about you know how best to. Personalize you know deep treatment decision and maybe provide even what is cut a panel. Of different. Outcomes you know that include like I said clinical. You know translational correlates- and- you know. In edition. You know- genomic you know Journal McCallum. That could then inform the best. As on and certainly Taylor. You know the type of treatment that each patient gets- in terms of competent combinations as well to- or not. You know for that you know for that matter depending on. Our own understanding of my guest at the biology and the science- and each patient's characteristics as well to. You know it's just hearing you say that it reminds me Hall many variables there are at work and just how hard it is to tease everything apart you know everybody would like it to be just that could point me to that one mutated gene and the knock that down and- if only it were that simple. It's so rarely as- we've got some. We need to keep in mind that even the mutation Rituxan all rights is black or white if you look at the Europe landscape in potentially on the half of the patients who might needr some mutation testing excellent control and I know my on the half of them have access to that to date so imagine and I fully agree with you some down. Your biomarkers which we need to study because they we can economy not that happy but the complex and expensive so we also have to make the you to excellence at a bichon send that you are destined for all of these biomarker because they need to be able to makes its journey. Following the right troops the right road of treatment and sixty the challenging biomarker testing you see one of the main bottleneck. Some that's a great point. These are. Medicine I want to throw this to you. Because have been question in pre- sessions today about. With hello how are we doing with inequities in terms of access to. The immunotherapies in in your world I mean. Who's getting it and who's not. How much time do you have- yeah I think you know look at inequities are across the board- from access to their appropriate treatments but dislodges point you know really it all starts with access to the comprehensive biomarker testing up front. To ensure that you know what treatment you should be getting so I think that there huge inequities there- thankfully there are now a lot of organizations and companies and people and governments looking at how to resolve that but- absolutely still remains an issue and I think it's beyond the I mean if there is I think it's to guideline adherent care you know to best care for people- it's even more basic than just accessing the immunotherapies. Yeah it starts with that information which not everybody is getting their their tumor profile so- it it has to start there and then. Not as many people are even aware of what might be available in clinical trials- that that's not the mission files is a whole other thing I you so in the long you know the salons can walk through the process but in the long space. Many of the clinical trials are actually first line so you know often times you get your best care through clinical trial as your first treatment- so but if you're not made aware of the clinical trials or they're they're not near you you can't get to them or your clinician can't get you to them- you know that that that. Also is a huge barrier and is causing a lot of disparity issues also. During this. Pandemic Andrea we've heard about a lot of clinical trials going on hold or a lot of. It just routine cancer screening care being delayed. What are you seein. So I think absolutely the screenings- have been delayed because often times you know the hospitals were overwhelmed and sometimes the screenings were considered optional- so they were they were delayed both by the hospital systems but also then by the person who was to be screened because y didn't want to go in. Or they were afraid to go outside so absolutely with respect to that I think with respect to the clinical trials- you know kudos to the regulatory agencies and all of the trial sponsors who really. Pivoted and tried and figured out how to keep them going and how to decentralize them in a way that- we were able to deliver and not stop these vital treatments- for people for whom they were working but also to not stop the progress that was being made- so I think there was a blip. From what we've seen in the clinical trials was really more as people are just trying to figure out how to do it how to your best how to do assessments via telehealth or how to get that therapies to people. When they needed and how they needed them. It's interesting that you- that you highlight that I mean to me in one of the biggest learnings that we had. You know going through this was really the US you know bringing the life what is the concept of decentralized clinical trials- and- I do think that the- COVID pandemic is kind of giving us a lot of great experiencn that respect. Whether be with on telemedicine- at least services that we can provide to patients- home. Home nursing- at shipments of you know certain drugs- oral. Orally administered drugs to patients- out directly as well to the opportunity to think about. Ways that we can- allow- you know- and permits and any in it certainly is on cooperation of course with the health authorities. But allow patients to be able to access local labs for testing. Local imaging centers for testing and- work for a valuation and assessment- has a you know in some ways- allowed us to. Continue to you know at least. This the seamless conduct execution of clinical trials- and ensure that you know that they're still available to patients. You know who are you know- considering them as well as well to- and I think that's a strong. Forward yet. Can you go me an example of how that my affect an end of. Page in a trial so- another unilateral inner trial you can you got to go to Boston to get on a plane to stand up and sell you get interviews every once every three weeks or something it's- it's a pretty big. Deal and now when you talk about decentralized clinical trials how does that lighten the burden. Eight eight it does very much so and your your point- a lot of times patients are trying to access. You know sites where the simple trials are being conducted. Some of these sites are it big academic institutes centers others aren't certainly are. At sites that might be more- wn the community but they're not always within a reasonable distance right. And so patients have you know are certainly having to labor travel- and at times of course you know spend time considerable time. You know receiving her treatment- you know away from home- and with the concept of decentralized clinical trials we're trying to do is. Really figure out ways that we can- create a network a local network- you know for patients- that are within you know what is a reasonable vicinity. For them to be able to conduct you know some of the- routine testing. Assessments that would take place typically out these a clinical research sites- in order to decrease the burden of travel- and certainly you know. During you know what were the COVID you know lockdowns start on shut downs if you wanna call not- it. It it helps at least. You know a decrease their exposure. You know as well as well to- from from the travel of course itself- and- in addition. Of course providing these at home. You know- health services more digitalization- you know for example you consent forms. D. patient reported outcomes. Devices as well to help collect that type of data instead of having. To certainly- collected on paper- and other means- you know of. Digital you know- communication- have certainly been you know helpful on in being able to at least decrease the patient burden. On and the travel- especially during you know during the pandemic of course. Okay so there's- for sexual G. here to bring some efficiencies. Go ahead salons. At amnesty prom I just middle of its to come. The to your the phone up to the to try. And I'm in Johnson have in Europe is now somehow this. Because last country where people can. More easier but you have the support us on the from dispute. Try be able to com. With just would like to because we are here dialogue with them. To really freeze out the of come. Because as you know trouble for a can you go to. Is for State what kind of where we saw wherever you are. Which have a jury you have to travel to go to center. First of all because of the content COVID second. It imposes. I would say personal find. Comey to right need to the- and of wl have to seen you never center a- to the- of a- disease. This where reluctant come to the hospital and now we just kind of over when. Speech in terms of new Kentucky. With the used to be that. So that he's on to a feature. Trying to is if you try to take charge and it really you could try but there's- a challenges the work. The include and piece is broken. For them so what and the week together make. The scene very very good and again. More than any. Any crisis is to trigger a and- I would say stressed or worsened any kind of inequalities so in everything we do we have to be a lot of attention that. We can could you was clinical trials and then we can offer as much as before the support you need to. Run all the elements I have given just question that so. The efforts were used to continue now we have to potentially put even some more. I would say commitments in making sure that you can access insufficient access is. Is it given to clinical trials and I'm really worried about you I don't know about the summit I will be destruction. Suffering is. To come you right. Virtual platforms. Yeah we can never we can never removed from can you can trials some physical visits right so we shouldn't move from these different seating in a clinical trial is mean more travels to the hospital local hospital constraints- and into time although of course he swayed more worries for the patiens right so. Whenever we do. And burden of set we need to. Removed from a become you more about how much you both to in this us to get access to innovation but may once we were not X. in addition hour after the Seine. Once Community with patients right we were not present enough to end them to confide them into the care we have to give to them right. Well I think it went that many ways but although has from. But I'm sorry what no I was just added on on your right into the to after in for. And communication around these double trials a storm- you know I can't tell you at least from our experience you know during the pandemic and especially during the early stages of it as well o look I would say. The research institutes that said look you know we're we're in a challenging situation now- you know it's difficult for us to you know possibly on in the world you patients- but what we can do is continue taking care of our existing patients as well to- a knowledge and some of the limitations and challenges. And as we've seen of course you know vaccines and therapeutics start to roll out for the you know support for COVID nineteen- things have started normalizing once again but- I certainly agree. And the line was launched on the need to have the right dedicated support you know especially in a clinical trial look- site level around- you know certainly up resources infrastructure communication with patients. Is no doubt important- and this right balance between you know of course- and salons please feel free to chime in between you know day to day patient care but also clinical research and clinical trials on going. On is quite is quite important. Okay well we- we could go on about the challenges with the access and communication with patients we know that it's a real issue we've only got a couple minutes left I'd like to hear from each of you just briefly- if you could pick up. The coming back to the beginning of this you know that we are- in the middle of this. Exciting times powers. With the nort. A lot of going to happen in the next five to ten year. What what do you think X. you most. About of. What cancer care is gonna look like. In five or ten years. Not even about one minute each. Okay Sir so I think for me what's most exciting in print patients in general is really a few things one is learning how to- to make people who are not responding to me to therapy response to immunotherapy how do we combine immunotherapies to be more effective in to last longer and really how do we move it into an earlier disease sets such that. If you find cancer early lung cancer any others and then you can treat it proactively with an immunotherapy such that it doesn't come back- and then we can really talk here I think all of those are doable and I think that they're very exciting to the patient communities. Great salons. One of the most exciting point for me I'm heading here the medical oncology and I'm a young cancer physician is it has changed our job right immunotherapy has changed the way we configurations because unexpected some of them will not have the same fate as described in the five by just local news is and so on so we have to change the way we speak to place and we have to debate with them what to do what not to do what we know what we don't know but I'm convinced that we have to make a lot of research and politics. It's about sustainability sustainability is defining biomarkers which means that we can choose and pick the right position for the right treatments and politics is about making sure that Zeke's will permit and allow access to be green of the sent to all the patients who needs being new drugs new compounds and open market and a better definition of patient selection so I think it's time for research politics but. Abuse your new job press. That's to take of a hearty debate over of. Time all. Has download you close what X. you about the next five ten years. While the you know for me like I I've been doing develop and on. For the past seventeen eighteen years and to me the past ten years in some ways I thought like a renaissance- you know specifically just in terms of. Seeing what the potential you know the continued potential targeted therapies but also now you know therapies can bring to- to patients- and I would say you know we've made a lot of great progress with the first generation of checkpoints on enemy immuno oncology- but there is. A number of different opportunities that probably continue to exist and specifically thinking about you know how to better characterize this you know complex dynamic interplay between what's happening in the tumor. Immune system- and I would say- you know figuring out how to better personalize immunotherapy moving forward- and what the next you know at least wave of innovation through combinations will bring- I alluded to earlier that I think you know certainly there's- this next generation of checkpoints that's emerging. Along the city two two six access- I do think that you know finding better ways for us to not only think about the utility of T. cells but also natural killer cells moving forward and different types of immune cells will be really important- I think we focused on T. cells because T. cells are. You know certainly the you know funny called in the big brothers you know- you know big sister- but but we have to start thinking about everything else you know that the immune system can offer- and I think there are a number of different approaches now. That we're thinking about- at least to help us you know better maximize and leverage- at least the activity and persistence- of our own human bodies. And through the immune system as well s. It's great thank you all for your time today I'd is a very exciting time seeing what- is possible now with- with- coaxing Army in system to fight cancer- but great. Great- discussion thank you all. Thank you thank you bye thank you. Next up but conversation focused on the youngest patients please welcome Amanda Ferraro survivor and patient advocate and Elizabeth fox senior vice president of clinical trials research at St Jude children's research hospital. Atlantic staff writer Amanda mall is here to lead the conversation. Good afternoon- today we're going to be speaking with Dr Elizabeth boxing Amanda Ferraro and we're gonna take some time now to try and cover a tough topic- which is how cancer can impact children young people. And what progress the scientific community is making towards protecting. Hi doctor Elizabeth fox in Amanda Parus thank you for coming today. Thank you for having me. Could you be here this afternoon she- I'm- Amanda looks start with your story- your two time acute myeloid leukemia survivor internal cancer free- you're also an advocate for other young people experiencing cancer can you tell me a little bit about. What went through your mind when you first learned that you had cancer- well it was quite unexpected and it was scary- I went from being a full time stay at home mom to needing full time care- so for me in my life completely that a one eighty a- completely switch. And it's scary- not just. Her you know young cancer patients an old cancer patient for everyone that cancer diagnosis you know it's a scary word and- it's very traumatizing to be diagnosed with cancer. What what what what did you think. First in that moment when you when you found out. My first thought was who's gonna take care of my son I was scared I was very scared I was my son was three so I was a mom to a young little boy when I was first diagnosed. It and from that moment forward what was your what was your journey like in- in getting treatment and- and progressing to now which is- cancer free- so I was diagnosed- may of two thousand seventeen I had induction chemo. About two days after my diagnosis on that with a thirty three day hospital stay- I went home and then I was back every other day to the hospital to have blood work done- testing making sure you know everything was going back up- and then I had for consolidation therapies in each consolidation therapy was a week. In the hospital of February of two thousand eighteen I was told I was cancer free which was amazing. We went on with my life I you know I was home with my son and doctor appointments where you know few and far between- and then September eleventh of two thousand eighteen. From where women for a toothache had blood tests done and they told me there was a blast so I had a bone marrow biopsy and then I went into will relapse- I had another induction chemotherapy which was another thirty four days and then- my doctors told me I needed a stem cell transplant in order to save my life- so through be the match- when in my doctors found a donor and I will be three years cancer free November twenty. Year amazing congratulations. How did how did that journey compared to the promises that you received at the beginning. In the beginning- I kind of felt like okay I have cancer I you know I was trying to have the mindset of I can do this my sister had brain cancer when she was six years old- my grandfather had lung cancer my aunt had Ewing sarcoma so and unfortunately I've been. Around people who have had cancer so I kind of understood what I needed to do were like what this would be like- but I didn't expect to relax in it was a lot harder than I thought it was going to be. On just being sick and the pain and- the mental physical and emotional anguish that you feel being diagnosed with cancer I wasn't ready for all of that but I'm so lucky to have many friends and family members. You know by my side and that's why I'm a patient had tickets today because I've been through it and I know you know that there are some places that lag help and support for cancer patients. Hello were you when you were. I was twenty eight years old and I was dying inside. Okay of Dr fox- now some questions for you- what's critical research happening today to help young people like Amanda- a few years ago they were you were named head of clinical trials research at Saint Jude children's research hospital how to Saint Jude's. Work with patients like Amanda. So first and foremost thank you so much Amanda for sharing your story with us and- congratulations on being in remission I think one of the most important things to remember about cancer. In children and young adults is that it is a rare of match. And that actually colors how we see cancer and how the world sees cancer in children. So we know that you know of one point eight million adults with cancer in the United States- there only about sixteen thousand children diagnosed with cancer each year in the United States so when we think about the research. We think about it in two ways one is what's happening in the adult world with adult style cancers which can be very different than pediatric cancers. And what is unique to the cancers that happen in young people and so exciting things that are happening the research world are things that we've heard about during the day. You know the genetics and genomics of the cancer itself and the therapies are particularly targeted therapies for those- types of changes in the cancer. An interesting and important especially important for young people in the space of genetics is the predisposition to cancer that can be detected on by testing patients with cancer and at this point we know that about 7210% of people who are diagnosed with cancer. As young adults or children actually have a predisposition so looking not only at the ways to treat cancer what about the ways that we can understand what could happen to a patient and screen them. As they move forward with their lives is it an important part of the research. That's happening in childhood cancer. Right righ- what are the most common type of cancers affecting young people. So the most common type of cancer in young people and- this is our leukemia acute lymphoblastic leukemia- followed then by all cancers that occur in the in the central nervous system or brain tumors are the other types of cancer are. Much less common with occurring about 5% of children with cancer and include. Cancers that are very specific to children like neuroblastoma and retinoblastoma and kidney cancer in children is called Wilms tumor it's very different that kidney cancer in adults- tell me about bit about seat. Primary areas of research and what you believe holds the greatest promise engines of progress. So Saint Jude's areas of research are for children with cancer primarily but also children with other catastrophic diseases within cancer- we are. We have large efforts in treating our children and young adults with leukemia as well as other solid tumors and a large effort in the brain tumors are particularly trying to link the genomics of most cancers- with the outcome of those patients so that we can tailor the treatment as we heard earlier today. Do precision treatment on those patients to try to reduce the late affects of the cytotoxic chemotherapy the transplants and so forth that Amanda talked about- so that we have fewer late effects and can you are more children with cancer. Thank you doctor box- Amanda I'm to turn back to you our- for a moment you as you said you underwent induction therapy chemo and a stem cell transplant- Kitami us more about- those treatments he receives and what the experience was like not just for you but also for your family. Sure so the first induction chemo was- I believe state terror bean. It was a hard just because I was in you know doctors can tell you what to expect or what you're going to go through. But you don't really understand it until you're going through- so that's why I really love peer to peer connection because I was able to find people. Who work went through that with me kind of because they were through before they were able to tell me what I was going to yell- I was tired a lot of the time I was in a lot of. Means I was very sick- during most of my chemo- the going to trans. Which was a lot harder than my chemotherapy once actually for me- I had days I was very depressed and my body. I had a hard time going through it and- I was very fatigued I had a hard time eating- a lot of it was emotional because- you know when you are not all. When you're not mentally there and your mindset is very weak or your upset. It definitely does take a toll on you know what you're going through and for me it was hard I was a mom I miss the signs- stem cell transplant was like my third time being in the hospital for you know a few weeks. So a lot of emotions were going through my head and it really took a toll on my body so for me and just being a patient advocate I advocate a lot or you know having a strong mind because the definitely does help. During your cancer- how does it affect your family obviously you had a very young son at the time and- how would you were you able to juggle you know your duties as a mom and that. Of course the necessities of your treatment. So I was lucky enough to have a wonderful fiance at whom- my family is wonderful- my fiance's family is wonderful so I need to schedule at the hospital for myself. That I would wake up in the morning- my son was put into day care so I would call make sure he was. Eating breakfast- we would facetime going you know for him going into school so I could be there. And to see that. And we had my son go into play therapy so that he was able to discuss what was going on- with mommy. We talked about it I had an amazing patient advocate of the hospital my social worker was amazing- we you know we gave little bits and pieces of what I was going through what he would expect. Mom is a little upset- right now or- my hair will be going online- you know little things. Made for his age because he was very young he was three when I was diagnosed- so it was just. Basically a short- little things of what I was was going through but my family took it. Very well they were really helpful- I was able to like I said make a schedule plan my day around what was happening with my son. It was easier for me going through the hospital because I had my date that. For me so that was very helpful and I find it helping other patients do that is great for them also because it you're not just sitting in a hospital bed watching you know TV and being. You know feeling sorry new have a schedule to maintain and really help. Rate of doctor parks I wanted to switch back to you for a moment how typical is it for young patients to receive this type of combination of multiple types of treatment. So one of the ways that we've been able to advance and- achieve an 80% your rate for most children and young adults- with cancer is through what we refer to as multi modality therapy. That means using not only cytotoxic chemotherapy but also using radiation and surgery when appropriate- to treat the patient and it's from these are treatments that we- achieved a good outcomes in patients. Of course not every child. Has a complete response or is cured from this but we have increasing numbers of patients who are cured what that has resulted in is all of that there are people of the of the Maureen's better mentality. Of a number of years ago we are we are giving you know high doses of chemotherapy multiple transplants what that has resulted is at a population of survivors with cancer who have very significant health. Arm conditions because of the treatment they received secure them from cancer for example we know that- for survivors of childhood cancer who are now about fifty years old about half of those people. Have at least one severe health condition as a result of their treatment. And that's why we're so interested in bringing new therapies to children with cancer and young adults with cancer to decrease those- late effects one of the most important things that's happening is as we bring the targeted therapies to children were trying to also think about. Beginning now to set up registries and ways to track those children who received the new drugs so that we can better predict what the late effects of those new medicines may be. On patients who. Right we have a from the audience- she says I'm a parent of a childhood cancer patient. Are there any new treatment breakthrough approaches for adult cancer that you believe will eventually be beneficial to pediatric. So it I think that. Historically most of the treatments that we evaluate and treat- for children with cancer have come from the- discoveries an adult cancers- but most recently there has been legislation to help us get more new therapies and to children with cancer and that legislation is called the race for children back. Its research to accelerate chores and equity for children and what it has done is I was the world of oncology medications have shifted. To be molecularly of mechanism based meeting- although we can develop drugs for lung cancer in adults there often being developed for very specific changes in the DNA in the cancers of lung. Tumors what this legislation does is it says it's not changing DNA is relevant to changes in DNA in childhood cancer that drug has to be tested. In some way in childhood cancers or models of childhood cancer to determine if it can be used- and beneficial to those children we have a number of. Studies that have been completed in the immuno. Oncology space- you know checkpoint inhibitors have for the most part been disappointing in terms of improving the outcome for children with cancer- but as we just heard in the last topic doctor bill of. Combining immune checkpoint inhibitors with other T. cell enhancers could be in court. One of the important roles- that we're seeing in treatment for childhood cancer is the cellular therapies so using the antigen signals on the outside of cancer cells to direct T. cells toward those- cancer cells. And have outcomes particularly in Kenya but now also increasingly in solid tumor to begin to bring cellular. Therapies to children with cancer. Thank you- we time for one more so. I wanted to pose it to you- you have mentioned a couple times- how important it was for you to find support- through this process- how did you- find the path from cancer survivor to advocate and what do you think it's possible- advocates are advocate. In helping other patients. So I it I found that- being have at the hospital there was a lack of. You know when you're of pediatric are from my sister's ordeal as having you know my younger sister cancer at six years old. I saw it as you know there were so many people helping out where there was a lot of people always around- and just showing their support in helping a young cancer patients more you know like young adults- I was among so the intention was more you know like on my child I was at the hospital wait by myself- in dealing you know with a cancer diagnosis up there- so I felt like it was. I didn't have the people I wanted to speak with and I could always you know talk to my friends and my family- and the doctors but it's not the same as someone who's been through it who can say yeah this thank. You know I was through it also. So for me even you know going through my cancer journey I would talk about the things that were difficult to hear or difficult to speak about or you know nobody wants to hear that you throw out some time. But you know it it happens and if I talk about it maybe someone else well so that's really where I became an addict. Where I was saying you know it's okay to have these bad days and you don't have to put a smile on if you don't feel like it. And if you feel kind of crummy it's okay to feel like. Your allowed to like that you're going through cancer right now so. I call it like the gray area of cancer and that's where I really advocate for like I feel sometimes you know you have to put a smile on her face make your family feel like you're okay or you know children are so resilient and they're always. Having a smile on their face they're playing but it's okay if you're gonna have back from the dead it's really all right and if you feel like staying in bed and just watching movies on TV that's okay sometimes we need to take a mental day even going through cancer. It happens so as an advocate I would love to see more of that mental health talk and more of the gray areas of cancer spoken. Wonderful before we leave here I wanted to ask you both if you could just briefly give us your words of advice. For young cancer patients and their families- Amanda can you go first. I would love to go I religious say remain positive there is a whole community of cancer patients. Who are availableo talk with you- life coaching is amazing. Your connection- there's so many places and people out there who are willing to sit and talk with you. I know social media is absolutely huge right now. And even though we have this pandemic going on the virtual world is amazing so keep fighting remain positive. And if you need to talk to somebody please reach out because there's always someone there to talk. Thank you and Dr fok. Great well I think that's great advice from Amanda Amanda- I would add to the decision to being positive ask questions ask questions about what's happening to you on what the future holds and what you should be thinking about as you go through treatment- and beyond and stay in touch with your doctors health care is so important not only during your initial treatment but as you're followed up for cancer it is important that you remain healthy and do all the things in life. That keep you healthy including exercise and positive thinking and the support system that Amanda has talked about. She what about for. Documents what about for- it's- who are especially with pediatric cancer in cancer young young people I'm sure that can be particularly difficult. I think it's particularly difficult for parents- and I know that COVID nineteen made it even more difficult for parents because the hospital which used to be a safe place was no longer a safe place and I think it puts parents in the position of having to advocate for their children not only as you know the developing human beings that they are but also with this. This initial burden on them and as I'm Amanda says you know staying positive and being resilient giving your chil dren- the ability to do that and doing it yourself you know I often tell of parents of children with cancer you have to take care of yourself in order to take care of your child so remember that as they go through. Treatment and beyond. Wonderful wonderful Dr Elizabeth. And indifferent thank you so much for joining us today we really appreciate it. Thank you for having me. Thank yo. Next up for a conversation on new innovations and the future of lung cancer care I'm joined by Benjamin Krillin operatic oncologist with the H. Lee Moffitt cancer center and Martin Edelman chair of the lung cancer foundation of America's scientific advisory board. And I'm thrilled to have both of my guest with me for a conversation about lung cancer Dr Martin Adleman is chair of the lung cancer foundation of America's scientific advisory board Dr Benjamin Krillin thoracic oncologist at the H. Lee Moffitt cancer center. Dr element let me start with you if I might why is lung cancer still the deadliest cancer in the United States. So it's first it's extremely common- it would be it is the second most common cancer in both men and women- and other be about two hundred twenty five thousand new cases each year. And the natural history of the disease since it. Most frequently presents either locally advanced or advanced disease. Screening is useful- it has been clearly demonstrated be beneficial but it's up taken the community has been fairly poor- lasted just two guys saw showed that only about. 5% of- a potentially eligible- individuals are actually screened the this is an approach that clearly can reduce mortality from lung cancer. But even with early detection still a larger percentage of patients. Will present with advanced disease- so you know I think that would be by basic answer your question it remains both common presents are frequently in advanced stage. And despite considerable advances in treatment and I'm sure we'll discuss shortly- still the overwhelming number of patients- will ultimately- succumb to their disease- in the advanced stages. Dr Krillin are there some positive trends in terms of incidence and mortality. I think there are and is Marty just mentioned- you're talking about lung cancer screening increasing mortality rates are increasing survival for patients by twenty percent. Compared to no screening we randomized. Five fifty thousand patients with a history of smoking to either get screen or not basically. And the patients who got screen with a low dose CT scan. At the you know you're talking about them living 20% more than the not so- the uptake for this has been very. Five regional throughout the country the American lung association just released their State of lung cancer report today. And it shows the map of the United States in some states have very low screening rates some states have fairly high screening rates. All of them at the end what explains that let me ask you both what explains that low rate in some places and how do we improve that. So now will start- I think a lot of it is a continue degree of nihilism and you know one of the things I would like to emphasize is that. You know though I started out in. What many would say it's sort of a negative view that this remains a very difficult and sees. There has been unquestionably- a decrease in mortality from lung cancer that's been rather- that is significant to in quite dramatic actually in the last- ten to twenty years- both to- get dances in screening as well this is certainly advances in therapy. However amongst many in the community there remains a completely. Nihilistic view of the disease that- screening will not help. Despite it outstanding evidence is- doctor Krillin mentioned the national lung screening trial done in the United States that randomized fifty thousand patients in this been. Validated by trials have been done in Europe and Asia that have shown similar if not better- levels of- improvement in. Decrease mortality not just from disease specific in terms of decrease mortality from lung cancer. But excuse me but actually a decreased. Level of overall. Mortality- with screening. And also about there's this persistence- nihilism I think amongst. Many practitioners are lack of awareness of screening a feeling that it doesn't work- it's interesting screening for lung cancer is actually more effective in terms of the numbers of lives saved. Per screening- where the numbers of screenings that you need to save a life- than breast cancer than than mammography for breast cancer. Dr Krillin let me ask you you asked me has Q. I will ask you. For your ideas on how we improve these numbers again how do we up the number of people being screwed. That's a great question Jean. You know I get it if you're in primary care you're getting hammered with a lot of different things to do. And you have fifteen minutes to see one patient. Explaining how to do long cancer screening is not a top priority for any patient visit. Because there's other we can be having other things going on. But I think if our payers could incentivize this amongst primary care I think that would make a big difference the same way that they incentivize colonoscopy mammogram. Cardiac screening. I think that would make the biggest difference. And like you say- like Marty said long cancer is stigmatized. Lot of people think patients smoke they brought on themselves it's something they did to themselves that's garbage because- not only that that's not not true. You know bond cancer is the seventh most common cause of cancer in never smokers. So a lot of the patients we see. You know almost almost- you know a fifth or six of them have never even touched a cigarette. So Dr Kremlin if smoking isn't the only because what are some of the others. You know you have a set of lungs you can get lung cancer just like any other organ you know there isn't necessarily have to be a cost for every single cancer a lot of just just random chance. But beyond smoking or stopping smoking I should say Dr Adleman other other things someone can do to preserve their lung health. And lessen their chances of lung cancer. I think number one is if someone's a smoker stop smoking- and then again you can stop smoking I mean those are there you know there's nothing one can do better. For one's health than to stop smoking if one is a smoker- other causes of lung cancer- exposure to was fastest which- you know has use it's a lag time in decades so you know one is exposed. In their teens or twenties or thirties and infrequently in industry fortunately- federal law prohibits the use of asbestos anymore- but there are still certain other rarer aspects but it's you know been said there. Was certainly a substantial number of people who never smoked you know will get one cancer- and by the way they don't fall in our current screening paradigm either so that's- something that we're gonna have to involve our knowledge base- are over the next several years but- you know I think just good general cardio pulmonary health always helps but- you know- how they put it as as president Kennedy once put it life is unfair and- I think anyone. Interested conchology in the last twenty years has seen a growing number of individuals who never smoked- and have frequently live lives of good cardio pulmonary health- so you know like with all diseases and- you know we just heard about pediatric cancer. There's a lot of unfairness. Bad luck in the world. Let's turn to the treatment side of it a doctor Krillin has our understanding of the genetics of lung cancer led to some new treatments and is that changing the landscape. Absolutely and that was when the things that attracted me to attend this field is. You know really dice of getting down into the what makes that tumor actually- drives that. And we've learned that there is these genetic mutations. That can. Really are driving the growth and proliferation of these cancers and that there the you can block it put a monkey wrench into that machinery and stop the cancer from growing and put some of these patients into remissio. How did these treatments lose their effectiveness over time. That's the thing about them is that at the end of the day they don't Kew or anyone they work very well getting Most patients into remission but the clock is ticking and eventually almost every patient relapses with this type of targeted therapy. A detail man I'm wondering if we at this point have a full genetic picture of what's going on with lung cancer- is there still a lot to learn. There's a massive amount to learn- you know it's interesting I've I've watched this from the very beginning on now and- you know thirty plus years. Of doing this and the level of progress if one views it historically is remarkable I mean. We went from you know being able to just tell some differences based upon what things look like under the microscope to this. You know incredible genetic panels with four five hundred different genes. We have specific targeted therapies for drivers in. You know eight or nine of these currently and that's a growing last- we have immunotherapy which is a completely different approach- you know. This is been remarkable but we every day we learn something different I mean- you know the various genetic changes that modify- the susceptibility in the activity in the durability of. Our responses of our drugs both the targeted therapies chemotherapy immunotherapy. I mean there's definitely more arrows in the quiver but- you know still the majority of patients- will you know they're disease ultimately develops resistance. And recurrence- though I have to say with some of the patients in interestingly the ones that don't respond well to targeted therapies but- immunotherapy which tends to work. Better in sort of more traditional smoking lung cancer. There we are beginning to see what. I be a little. And something I never thought I'd have the opportunity to say. I think that there are actually some patients will be cured of their advanced lung cancer with immunotherapy. It's a small number but it's a real percentage and- I see these people now every day it's actually made my clinics kind of crowded. I'm I'm wondering if every cancer patient the patient gets the testing. And the treatment. Of that is available the can can everyone take advantage of these treatments that you've been discussing. Dr Krillin wanting to take that first. Well it's true- actually another factor that came out of this report today was that- for example amongst- the civic islanders and Asians- the percentage presenting with early stage is 23% less than Caucasians. And same for- by Spanish Americans as well. And so I don't think that every population or every group of people is taking advantage of the resources available. Are there maybe access issues there may be- the lack of understanding about you know what this type of cancer isn't been how treatable it really is. At the end of the day long cancer is not a death sentence that it used to be- for a lot of patience since that as Marty just mentioned some patients going to remission for years with the treatments that we can provide. But charter adamant I'm wondering if. I could be really helpful. Of doctor animal I'm wondering if the age of the patient or the age of the practitioner has some impact on whether they get the latest car. It's interesting so my colleague- doctored trillion dried and I actually looked at this with a flat iron database. And which assembles a substantial amount of data amongst you know thousands of patients and- remarkably probably a third of elderly patients in of those over sixty five. I'd never get any treatment at all- it's also others have seen that the penetration of obtaining the proper- you know genetic analysis and other testing. Is remarkably poor in this country so- they're still- an awful lot of- you know- treatment options that are available to people that are not being- utilized yet. I haven't seen anything about the age of the practitioner- you know- I'm getting a little older there so- you know but- I a I wouldn't be surprised you know I think that. Folks these days are much more used to getting the data and interpreting it the other thing is sometimes we see misinterpretations of the data I mean it's actually very complicated the reports that you get- they run sometimes to pages- you know several pages in length- the genetic data can be presented in many different ways- I will certainly say there sometimes. I get these reports and I need a quiet you know time and sometimes little bit of literature search to see. You know is this mutation meaning or not. Luckily I have said to- fox chase some very good- genetics people to talk to if I really run into trouble- but it's say increasingly. Complicated area. We have a inspection. We have an audience question have the COVID treatment informed your treatment of lung cancer doctor grilling you want to try that one. Yeah it's interesting because the COVID nineteen vaccines were originally developed for cancer these are any vaccines that we actually. Got the stolen from the cancer world and used for vaccines fortunately now we're kind of taking it back into the cancer world. And trying to learn how we can make our immune system better at recognizing the foreign proteins that are present inside or cancer. So far vaccination strategies by themselves haven't shown. Overwhelming results against cancer but perhaps in combination with other types of a mew therapies. These could be a very promising technique. A doctor Edelman what remains to be done you said earlier you were optimistic but where is there room for improvement and where's the most promising place do you think to look for that. No I don't know of any area that there isn't room for improvement- and you know what. The Lou Reed of. Positive studies in progress in the last few years has been remarkable so where have we improved you know I want to. Leave an audience with the idea that you know this is an area of amazing progress so within the last. You know twenty years let's start in two thousand in two thousand there was no molecular testing the begin just the very beginnings of targeted therapies since that time we've identified. You know beat nine plus your specific molecular targets for which we have very usually well tolerated oral therapies that are highly effective at least initially an instructor Krillin mentioned- you know- the problem with those is that disease develops resistance are our problem there is. How do we need teen- those responses or then get around the secondary and tertiary resistance mechanisms you know with chemotherapy- that remains a cornerstone of many treatments so for. Patients who present with resectable disease you know the use of chemotherapy prevents recurrence security stations it's still a fundamental part of treating. Locally advanced disease in concert with radiation and surgery- you know so all of those areas. Have substantial progress but you know as as we get better you know if you if you've gone from say when I was at the beginning of my career 5% of patients with locally advanced disease were cured in our it's a at. 3540% well that still leaves sixty percent- left to go on in advanced disease- you know in again it's the same issue how do we extend. You know the population that benefits from these treatments be they targeted therapies immunotherapy chemotherapy how do we best combined them in for those who do benefit and respond. How do we deepen and prolong those that that benefits- you know all we have to this of enormous. Research now. And we have to leave it there doctor it'll minute Dr Krillin thank you both so much for joining us. Thank you. And now for a session produced by our underwriter Takeda. Welcome I am so excited about this panel discussion today I'd like to thank my two panelists garret Hampton president of the oncology clinical sequencing division at thermo Fisher scientific is based on San Diego California and Jeff Allen president of friends of cancer research based in Washington DC. So in order to kick off this conversation this very important conversation today I think we have to first start with the why why is precision medicine and diagnostics so important to advancing the mission of oncology. Yeah thanks for the question Chris you know I think the key is in the friends right precision Manson's the capability of being able to treat more precisely and settled what does that mean. You know there's been a huge shift in the way we're looking at cancers are diagnosing cancers from seeing to cancer samples a look the same under the microscope. All the way now to being able to classify cancers according to their molecular profile over the past two decades we've seen remarkable progress in being able to develop. Drugs small molecules are antibodies against these targets that shot the cancer cell down we know the genetic alterations we know we have therapeutics against them not for every patient but for many. But we also need the diagnostics to screen that patient cancer identify which is the right by mark and then treat accordingly years ago we thought of cancer as one uniform follow and we treated it that way by using things that could. Be a cytotoxic or kill those cells but that also came with an inability to differentiate between cancer cells and normal cells making these therapies extremely toxic by understanding the biological underpinnings of cancer what's driving that abnormal growth. Has enabled a new generation of therapies in order to target the actual abnormality of the cell differentiating it from the normal cells leading to better outcomes for patients. So the next question is really about the gaps what are the existing gaps today in applying precision medicine efficiently to the oncology space so that we can in the end bring our treatments to patients faster for me it's really about- as we are early in development we're learning about our drugs understanding where they work which patients they work in. And in order to do that effectively we need to apply a lot of different technologies. And so a- cost of tech. Becomes absolutely critical because the more expensive the technologies are the harder it is to apply them early in our- clinical trials so really partnering with. Diagnostic companies and providers out there with these great technologies. That in the clinical trial setting that we can apply them in a cost effective manner I think is really important yeah I think precision medicine has led to a number of very important advances in oncology. But there certainly are still gaps that need to be addressed I'm one of those is that while we've seen a number of different cancers- I have. New therapies become available because of the understanding of their biology we thought we've also seen some cancers that haven't had the same response so continuing the research in order to. Characterize different biological markers will be important for those cancers that still represent a large unmet medical needs a second area is around access. Making sure that patients have access to the appropriate diagnostic testing as part of their care. To be able to help select the right treatments for them. In the third area I think it's around understanding mechanisms of resistance while targeted therapies have shown a great deal of improvement for a number of different cancers. Often times over time they t cancer cells continue to a change changing can adjust to the drugs that. They're being treated with and unfortunately that can cause resistance to therapy in some cases. So another frontier into understanding and applying targeted therapies is going to be understanding how cells can become resistant to them and identifying even new targets to help prevent that resistance or continue to treat the therapy if continue to treat the cancers. For which other therapies will be beneficial to those patients. Yeah and I think that that brings up on the theme that Garrett- alluded to earlier about how important it is to really study that molecular phenotype rather than the location of the tumor. If I look at the landscape here in the United States and outside the United States well only about 20% of patients are actually having any type of next generation sequencing testing done. My belief is and my team's believe says here that you have to get 280% in order for precision medicine to really make a- big difference across the globe. And we need to get taste testing as close as we possibly can to the patient. If we can get the genomic information quickly then clinicians will use that information to make a treatment decision Vare. As opposed to waiting when you know the cancer patient is already on therapy but I think speed to result is really key. For success for the patients. Beyond that technology such as NGS you know I think it's about awareness. Awareness of next generation sequencing and molecular technologies. Education so that we understand what to do with them yeah great perspective Garrett thank you for that. And finally my last question is around we all represent different segments of the industry working together to. Use apply precision medicine to get therapies to patients as quickly as possible how can we better work together- across our enterprises as well as with other important organizations around the globe. To address these gaps I wholeheartedly believe that we will get further faster by working together on some of these large challenges through this improved understanding of biology were able to move faster drugs are being developed faster. Diagnostic tester coming online sooner and we need to streamline af these processes by working together in order to get those medicines that are going to benefit patients to them as quickly as possible. And I think we can do it through unique collaborations it just is stance to resign map by harness the power of science in identifying common challenges in working to address those together will be able to find the solutions faster than if any. One organization more to try and do it alone and certainly faster than if every organization was trying to do it in silos. Yeah I can't agree with you more I think in order for us to go as fast as possible we have to work together we have to work together in a pre competitive way. And organizations like yours Jaff are so important to us being able to pull the right players together around the table so we can all work together in a collaborative way. What's your perspective on this topic. You know I completely agree with Jeff and I completely agree with your summary Chris I think that working together. The some of the whole is just it's going to be so much easier for us to push forward because we all have the same aspiration to get to get. The right drugs to the patients at the right time there are many occasions in which we've been able to get together with other members of the industry. You know identify standards. For what's the gold standard but I think that you know began working together as Jeff said as you said Chris you know that's going to be key and in order to be able to push this forward. And with that I'd like to thank Garrett and Jeff for your time today for your tremendous insights as we discuss this hot topic in oncology. It takes a village to bring cancer treatments to patients and I'm really looking forward to continuing to partner with both of you as well as all of our partners in the industry to make this a reality for all patients thank you. For our final conversation of the afternoon we're exploring finding hope. I'm joined by Alli Brunelle survivor and founder of the prestige. And Marlene Myers director of the Perlmutter cancer center survivorship program. At NYU Langone. Cancer diagnosis is always a shock regardless of the Diodora prognosis. And if forces patients and their loved ones to grapple with e of the most basic questions about life and death. For this final session we're going to talk about one of the most essential parts of the cancer experience. Finding hope. Alley you were twenty eight when you were diagnosed with triple negative breast cancer. What was the first thing that went through your mind. Yes getting a cancer diagnosis at twenty eight was definitely a shock- meet my family at that point we had no known history of cancer I was healthy so. You know your mind go through all the work places do you think. Well I live to see my twenty ninth birthday well I live to do the things that I want to do it was definitely scary and isolating being so young. How did it change your life and shift your priorities. Yeah I can't- diagnoses definitely give your life to all of your priorities I mean- I had just gotten married back before my cancer diagnosis and I knew we wanted to have kids but the way in which we are going to have it looked different I'm happy to say I just had my first baby last year in April but- you know your whole life is. Flipped upside down you know. Many eight you're thinking about your- and potentially buying a house and relationship you're not thinking about. Him out there B. and radiation and surgery and- all of those heavy things so- definitely shift your priorities definitely help you with the kind of will be staying in the moment and take one step at a time. A doctor Myers you work with cancer patients and their families as part of the cancer survivorship program at NYU Langone health. What role does help hope played both psychologically and physically. I think hope it plays a tremendous role both in the way of people. Get through the experience and in terms of them being able to network and to speak to other people- I'm- breast cancer oncologist so I certainly understand- you know at least shock of going through everything but the hope is tremendous hope is the thing that drives you through treatment the thing that leads you to see. It to see things are going to make you feel better- exercise good nutrition it gives you something to strive for and I think being optimistic and there is certainly so much reason for hope and as we corrected during that many panels today- so much hope for cancer in general and particularly for breast cancer. That it is definitely an integral part of what we what we hope to give our patients. In surviving and. Going through this experience. Is there sometimes a false sense of hope and can that do harm. I think there I don't know that there's such a thing as a false sense of hope I think it's more that sometimes people are not educated either by their health care team or are not ready to hear the facts so I think I think how much hope one has and what time period you're you're ready to hear it. Certainly has the trajectory- I know in my practice I like to be very optimistic and I think that's very different than giving people a false sense of hope because you know it's often said where there's life there's hope and that is in fact true- and we as as practicing physicians or nurse practitioners. Not a single one of us can predict the future you can have as much education as you want you can be as knowledgeable as you want you still don't have that ability to predict in individual what's going to happen so I think our job and what we try to give our patience is. The ability to get the best treatment out there and to be optimistic and hopeful about it. But you have to be realistic at the same time. Alley was hope of a what you- mobilized to power you through your experience. Yes absolutel I look to other people who had been through it and fifteen people at the end of their active treatment or if he others result from surgery or thing other people moving on to the next stage of treatment definitely gave me hope I'm connecting with other young people finding a community definitely- got me through some of the hardest. Thank is that the only reason why finding that community of people was so important for you. Not the only reason a big reason but I think you know a young person diagnosed with cancer specifically breast cancer there is a whole different. Subsets concerns and worries and them down and I was fortunate to have such an amazing medical team that I trusted but at the same time. Medical advice is very different than patient experience and connecting with other people who had been through it allowed me to know more about my options. And allowed me to understand what quality of life delighted with different options and so you know. Hope unity all of those things definitely allowed me to have a mindset the power through great man empower through those really tricky difficult time. And are the things that led you to create your organization the Prestes. Yeah like I said being diagnosed so young with definitely isolating and I connected with so many other people affected by breast cancer through friends and family but they were much older than me they were. Thirty forty sometimes even fifty years older than me and you know although the relationship professional again my concerns my worries my- quality of life lessons were different and so I actually turned to social media to look for other young people because I thought I can't be the only twenty something going through that. And so I connected with other people and that is the inspiration to how the practice in to be myself Michael founder at one point in our journey with cancer felt alone and we're looking for the poor and at that time. That's all inclusive support for our specific situation but like it did in a bit so we set out to create it and I found the back. You need to be. All of a reminder to the audience love your- so put them in in the queue and tab if you would. I'm doctor Meyer let me ask you about the support groups I'm sure you've observed many of them- as well as as- having the cancer survivorship program. Do you really see that they make a significant difference not just to the patients but also to their families. I think support groups can make a significant difference but the important thing to remember is that there is no one size fits all. And I think in in people looking for support groups number one you want to you certainly want to join a support group and that may sound like a- like a silly thing to say but not everyone is immediately open to. Joining a support group and being with others or or talking so openly and freely. So you sort of have to know yourself a little bit you have to make sure. That the support group is right for you- we tend to divide support groups into early stage breast cancer late stage breast cancer or early stage cancer in general. There are support groups that. That are more for women or men that are broccoli positive with breast cancer or other cancers. So I think they can be certainly very helpful but this is it's not right for everybody some people do better with. One on one discussions and some people have a very very strong support system within their community with their family or friends and don't necessarily. Feel the need to have the support group from the get go it doesn't mean that down the line the me not want to. One thing that we see in cancer survivorship. Is often the most difficult time period is that completion of therapy where after you've seen your health care team and you're so busy and the cancer center and you're coming back and forth so frequently. Sometimes six months eight months a year and then all of a sudden you're done in Bowman you know your healthcare team is saying. Okay you know see what three or four months. That is often a very sensitive delicate time for people where they may have increased anxiety they may feel very alone. And that's a pivotal point where people made them want to join a support group or. Many of the other kind I. So I seen support. Beach how. For our family now. For the patient- there are support groups of family members in general sometimes support groups. Empower the patient and the family which is which is very helpful. But is not one size fits all and I think. It's our obligation to really help our patients decide what works best for them and their familie- alley we just her doctor Meyer talk about the end of treatment and how that could be a point where you're really need support have you felt that are using people within your group who have hit. That stage. Yeah I. Mean you you said it perfectly I think that after what I'm quote. Is typically the hardest part it was for me I'm going to active treatment like you said Marlene you know. You have this. To do list- markets back with the things that you need to get done. In it again the other side. You know he knows Jack radiate in fact third jury back. And there's no time to really at least there wasn't for me no time to process. All the emotions behind a cancer diagnosis. And so when everything finally calm down an active treatment over I what they don't my doctor my- there was that. Time to really process and everything kind of hit me. At once like a ton of bricks and- that was the point where my anxiety was at an all time high. I would fearful I was worried and I just felt alone despite having an amazing family friends support network around me- and I find that you know being a part of the back he's been a part. Of a community all affected by cancer this is typically the case for those. That. I've come across in those five minutes. We do have an idea question who says a breast. So I'm more in. In finding the car. What are we doing about prevention Dr Meyer you want to take that. So working very very actively on finding the causes and it's a little it's a little different in terms of finding the causes versus finding prevention services to slightly different things- we know about some genetic we can never say something directly. Cause breast cancer but we can say that various conditions for example having a strong family history being up rocket carriers make sample increases. One's risk of breast cancer we can never definitively say that that was the thing actually cause breast cancer. So we do know that there are things that can be done for prevention as we do know the optimal screening. So for example we're coming to learn more and more now about lifestyle in terms of nutrition exercise avoiding alcohol abuse are all things that we can do- we learned many years ago that the risk of car replacement therapy and its relation to breast cancer. So these things are being are being looked at very very carefully love to be able to prevent breast cancer but we also know that in the setting. Where someone has a high risk of breast cancer that we have excellent tools in terms of breast imaging as I mentioned lifestyle team changes we can certainly. Reduce the risk- I don't think there's going to be a cause of breast cancer I think it's going to be multifactorial. From everything we've seen every kind of cancer now it seems very multi factorial. But certainly the research community is working very hard at minimizing the risk to many different kinds of cancers sometimes it's with better surveillance and sometimes is with what's called chemo prevention. Which in the case of breast cancer may be using hormone blockers to reduce the risk of someone getting. Breast cancer down the line. We today's program talking the war on. And I'm wondering alley if that sort of warrior approach to this was helpful to you as a patient or not. You know it's tricky and I think what Marlene said earlier there's not a one size fits all approach you how you deal with a cancer diagnosis I think for me personally that language I fluctuated and how it made me feel I think back- the term warrior and fighter I really resonated with it because I needed. Something to hold on to I wanted to feel strong and then when I was kind of through active treatment my feelings on that changed because when I was having a hard day if I didn't feel like getting out of bed if I was too weak to get out of bed. I didn't live up to that warrior title so I think I think it depends on how you're feeling it depends on who it is and how you're dealing with your diagnosis and what your support system looks like and- how you're feeling. On any given day but I think. You know I think a lot of people and with whom that when. Warrior fighter if warrior mindset- Nandi is helpful but I think for comedy it could be a form of toxic positivity on well- but again not one size fits all I think everyone's different and resonate with these different terms. I'm in a different way. Alber melon doctor Myers we're going to have to leave it there thank you both for joining us I'm so appreciative. And thank you all- thank you also to everyone at home for tuning in we'd like to thank our underwriters for their support of the Atlantic's journalism they include. Bristol Myers Squibb. G. S. K. Pfizer and Takeda. And please do visit our website the Atlantic dot coms forward slash live. For more information on future live events I'm Jeanne Meserve thanks so much for joining us. The break we encouraging network with other attendees and visit our expo booths. To participate select the networking icon located on the left hand side of the screen. 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Published: Tue Nov 16 2021