Chapters Transcript Video Lung Cancer Screening: Critical Conversations with LUNGevity Lung cancer has shown a decrease in incidence and mortality in recent decades. However, it remains one of the cancers with the highest incidence and still ranks first in cancer related deaths in the United States. Advancements like molecular interpretation of lung cancer has substantially changed the classification and the treatment of these tumors becoming an essential component of the diagnosis and the therapy decisions throughout the recognition of novel biomarkers such as epidermal growth factor receptor mutations and anaplastic lymphoma kinase translocations. It has become possible to identify the subset of patients who will benefit from targeted molecular therapies. Thank you for joining us. Welcome to the Baptist Health Doc doc podcast. A conversation for physicians by physicians providing insight on the latest in medical practice, research, technology and innovation in health care on the doc doc podcast. Hello, I'm Doctor Manm Aalia, chief scientific Officer, chief of medical oncology, deputy director and the Fernandez family in Doshi in cancer research, the Baptist Health Miami Cancer Institute. And joining us for our discussion is Doctor Opal Basu Roy, executive Director of longevity Research. Dr Roy spearheads longevity translational research programs and patient focused research center. Thanks for having me man, we are so excited. You are sharing this afternoon with us the importance of lung cancer screenings and who should consider them? Can you enlighten us about that? Absolutely. So lung cancer screening is a life saving tool that's available for people at high risk of developing lung cancer. And I think there are three questions to keep in mind when someone's considering lung cancer screening for their patients. The first question is, how old is the person? Lung cancer screening is available for people between the ages of 5080. The second question is, does the person have any history of tobacco exposure? And for how long? So lung cancer screening is typically available for patients who have at least a 20 pack year of tobacco exposure and that's 20 pack years of cigarette smoking. And the final question, and the third question is for how long has the person smoked? And right now, lung cancer screening is available to someone who is either a current tobacco user or someone who's quit within the past 15 years. As you know, this lung cancer screening was actually broadened in 2021. How have you in your work throughout the country? Seen an uptake in terms of lung cancer screening, man? Me, I wish I could say that we've seen an uptake in lung cancer screening. But even as we speak, despite the US PST F changing the lung cancer screening guidelines in 2021. As we spoke speak today. The current update for lung cancer screening is about 4.5% nationally. And in the state of Florida, it's even lower with about 2.4% of people who are eligible for lung cancer screening actually receiving screening. Yeah. So I think you bring up a very eloquent point that we all can do much better. Absolutely. Even the states like Massachusetts, which are on the top of the podium, they're only doing around 16% or so. So we are all have a lot of opportunity to serve our patients because lung cancer screening actually saves lives. Absolutely. And one of the other things that we've been very excited at Baptist Health, South Florida in our partnership with Longevity is the real potential of a partnership of establishing the first Hispanic Lung cancer screening program because as you know, the minorities tend to screen at a lower rate compared to the white cow patient population. And what we found out at least when we looked at our data here in South Florida, in Miami area where 70% of our patient population is actually Hispanic, that those screening rates are only around 2%. And I know you've also done some work with related to African Americans in other places. Do you want to share with the audience the programs that you've done at one or two other institutions in Northeast and then talk a little bit about our partnership. So let me tell you a little bit about a partnership specific to New York City in the Bronx, particularly. And again, the Bronx is a very diverse community and the African American community within the Bronx is particularly minoritized and only 1 to 2% of the African American community receives lung cancer screening. So again, through a partnership with the Mon your Einstein Cancer Center in the Bronx, we made concerted efforts through community engagement to ensure that first community members are aware about lung cancer screening. And secondly, they can actually access lung cancer screening, which then brings me to the partnership with the Miami Cancer Institute. Again, this is very near and dear to our heart because again, man, me through your point, you mentioned that uh members of the Hispanic Latinx community do not receive lung cancer screening. So we as a patient group, we were very interested through this partnership to first figure out why. And secondly, using that information, how can we improve lung cancer screening and care linkage, which is essentially the focus of our partnership. And it's been really great working with the MC I team to further your efforts in in bringing this life saving technology to the Hispanic Latinx community in, in, in South Florida. And I think to your point about under screening, I think people often forget that um lung cancer, uh the the the Hispanic Latinx communities often linguistically isolated and they don't access healthcare in English. Like most of the US population. And therefore, I think a pivotal piece of our partnership has been really ensuring that we have screening education materials awareness campaigns in Spanish so that it really meets the needs of the community. No, I think you bring up a very important point just as I had stated earlier. And I would like to re trade 70 percent of patients in the Miami Dade County are Hispanic and origin. That's the patient population. Actually, Baptist Health, South Florida serves in this four county area and almost 18 to 20% of them are linguistically isolated. So we have truly enjoyed our partnership with longevity where we actually formed or form the first Hispanic targeted lung cancer screening program and given and kudos to you and your group for providing the educational material to support our patients. And I'm very excited to share that our screening uh numbers have gone up tremendously as a result of our partnerships. In the last 3 to 4 years, we used to be less than 2000 patients that were screened for lung cancer screening. And this year, we are hoping that we will reach around 30,800 to 2, 4000 patients. That's fantastic when we to see that the program is actually having an impact. Yeah, definitely. The sheer numbers just speak to that because as they say, numbers don't lie. Absolutely. But what is interesting though is despite us serving 65 to 70% Hispanic patients. When we looked at our data still in lung cancer screening, only 40 to 42% of our patients are Hispanic and it's pretty much equally divided between males and females. So I still think there is work still to be done. Sure. Absolutely. Which lends us to a very interesting part that you and I have talked about and we are trying to get our primary care physicians involved, which is to work on grants to really get more partnership with the primary care. So can you share with since a large part of audience of this podcast, our primary care physicians, some of the things we can do in partnership with them. Absolutely. So anyone who is a primary care provider and listening in? Thank you for everything that you're doing or cancer preventative screening, because you are really the gatekeepers to ensure that our patients have access to all types of cancer preventative cancer screening. And one of the things that we've discussed doing now, the first partnership is very focused on the community. Now, the second partnership is going to be focused on ensuring that primary care providers, all of you have the necessary tools and the information to engage your patients with lung cancer screening programs in, in, in, in the community, in, in, in the South Miami, in the, in the Miami Dade County area. Yeah. Thank you so much. And again, I think, uh once again, I want to reiterate our huge gratitude for you and your group to partner with us. Because I think with the resources we were able to get of several grants that we have together, we've been able to get patient navigators who are critical, right? Because one of the challenges in the minority patient population is there's sometimes issues of education awareness, but also trust. So we are trying to specifically uh incorporate people who look like the patients that we serve, who are part of the community, who can actually go into the community. Go to the faith based organizations, uh organize awareness campaigns with several Baptist South Florida events that we are doing for people at large and, and man me, thanks for bringing up the role of patient navigators. I think we cannot underestimate how important patient navigators are to connect the community to the necessary care that they require. And and we really appreciate this partnership because of the fact that we really leverage the assets of the two organizations to create this program. And so for our primary care physicians out there and our general audience, I just want to make some points which really highlights why is lung cancer screening so essential to saving lives, most of our patients, unfortunately, still majority of our patients are diagnosed when they have locally advanced disease or metastatic disease. And typically the outcomes of these patients is only around 20 to 25% survival at five years. This contrasts to 60 to 65% survival at five years in patients who are diagnosed with early stage disease, where we can actually surgically remove the disease. And then now we have had a number of trials which have actually showcased the importance of targeted therapy and immunotherapy. So Opal, I know you've been involved with longevity for over 10 years. Now, I've been a medical oncologist in training and then in practice for close to 20 years. And I've really seen the field of lung cancer being transformed. Can you talk to our audience about the importance of biomarker testing and targeted therapies? Absolutely, man. When, when I started that longevity, we had just one targeted therapy approved for lung cancer for one type of mutation, the EJFR mutation and as we speak right now, we have targeted therapies for nine different molecular biomarkers and these are target mutations. And to your point man, me, why is molecular testing important? Molecular testing is incredibly important because that's the only way to identify if the tumor has a biomarker and then ensuring that the patient gets matched to the right treatment at the right time. So 10 years ago, when I started the need for molecular testing did not exist. But now molecular testing has become incredibly important and for both metastatic disease as well as early stage, non small cell lung cancer. Yeah. So again, uh you know, uh I would want to particularly focus on EGFR alterations because 70% of our patients are Hispanic. And what we do know is that EGFR mutant lung cancer is more prevalent in Hispanic patients compared to the white Caucasian involved Caucasian patients. It's only around 10 to 15%. But in Hispanic patients, it's like 40 to 50%. So can you share this journey that you have seen of this plethora of drugs now approved for fr mutant lung cancer? And again, you know, doing a little bit of a history lesson here when I started in it started my, my, my role at longevity, all of the drugs for egfr positive lung cancer were approved for metastatic disease, a disease that spread typically to the other lung or to the lymph nodes or to other parts of the body body. But um two years ago, there was this clinical trial called the Adora Clinical trial that read out in that suggested that if you use one of these Egfr drugs, Oyin, also known as the Grisso for early stage lung cancer and giving it to patients after they've had surgery as an adjuvant treatment, then it dramatically increases the cure rates. And this was something that's unheard of that was unheard of five years ago. But now we have these drugs for EJFR positive lung cancer available for patients diagnosed with early stage lung cancer. And and that's why I mentioned that again, testing for these biomarkers for early stage in early stage disease is critically important. So we can actually match patients to our drugs if the tumors have the mutation. Yeah, thank you so much for highlighting the Dora trial. I think it was a transformative study because it clearly showcased that if you did not give these patients anything, a placebo, their time to reference was around 28 months and if you gave them the drug, then it was over 60 months. So and the hazard ratio was 0.27. So our physicians know that if you are improving your chances of not having a cancer come back, uh decreasing it by four times, that's pretty impressive. So I think that's a great study. Also, I think similar work has been shown in, as you know, with elect and Elena trial in al translocated lung cancer, which is around 5% of all the lung cancers. We see where actually the data is not even mature to tell us how soon the tumor will come back. But the hazard ratios are again 0.25 or in that ballpark, that means is four times more less likely. Rather that tumor will come back if these patients are getting these drugs on the metastatic setting as well. Whereas, you know, I treat patients with brain metastasis from lung cancer. And we have seen a transformative change. And here actually, I'm going to use the example of out translocation lung cancer because when I started treating these patients close to 20 years back, someone who had out translocation, lung cancer with brain meds, they survived only around nine months, those very aggressive form of lung cancer. And now with these new drugs, like elect the outcomes of these patients is more than five years. In fact, the latest data that was presented, the crown study updated ASCO this year showed that for five years. Actually, the tumor is not even growing, which is just mind boggling and, and it gives me goose bumps just looking at how much difference we are making in the lives of our patients because of the advances in science. And you bring up a very good point. One mean about five years, survivors, 10 years ago, we did not have patients living for more than 1 to 2 years. But now we actually you have patients are living for more than five years. So we are in this era of transformation of innovation, of really sort of changing survival for our community. So one of the take home points in summary for this section of our talk is genomic testing is essential. Uh you know, we are living in an era of precision oncology, precision medicine where every patient is different. They need to know that and and that's the message for physicians and community at large that if you have a patient with lung cancer, they need to have molecular testing being done at Miami Cancer Institute. We actually use Carri Life Sciences, which has a whole exome as well. As a transcriptome because we believe having a comprehensive testing effort because if you don't test for it, you won't see it. And if you don't know, then you won't treat your patients with these targeted therapies. And another take home point is this egfr lung cancer patients, even those who have metastatic disease, that means their lung cancer has spread beyond lung to other parts of the body. If you treat those patients with chemotherapy, your outcomes are like 12 months. But if you start using targeted therapies like osimertinib, the outcomes are 38 to 39 months. So it's almost three times more and patients can tolerate these targeted therapies much better than chemotherapies. Because with chemotherapy, you can only give it to a certain period of time before the bone marrow starts getting infection. So I think that has been great and obviously we had a couple of very exciting trials reporting in the last year or two. The Mariposa study, for example, now is is is now looking at combinatorial approaches. So as you know me, so one really showcase that aab along with laser did even better than OSER showing a seven month progression free survival benefit on top of what ERN was doing and when our patients with oser get progression, unfortunately, we know avante and chemotherapy is almost twice as effective than chemotherapy. So can you speak about some of the other efforts and other molecular typess of tumors that you have seen uh and, and what longevity may be supporting. I'm actually very thrilled. I'm going to go back to your point about the Mariposa trial and having options for people with Egfr positive lung cancer. You have options. Now, you have osimertinib as one treatment option. You have Oser plus chemotherapy as another treatment option. And then you have Avant and Laser as another treatment option. So three treatment options for people living with metastatic Egfr positive lung cancer as their first treatment option. This is unheard of when we, we did not have this in the past. And I think we are seeing similar trends in other types of molecularly targeted lung cancer. For example, you talked about out positive lung cancer and I, I want to go back to one point you made which I really appreciate um doing whole exam sequencing and hold and transcriptome sequencing because it's really important to sequence for the DNA and the RN A from the tumor because some of these, some of these molecular biomarkers, sometimes they show up in the DNA sometimes in the RN A and it's not just about matching patients to an out drug or an EJFR drug or a PR drug. It's also making sure that they don't get the wrong drug and chemotherapy, I wouldn't say is the wrong drug. But very often patients whose tumors have these molecular alterations, they do not respond well to immunotherapy. In fact, immunotherapy is almost contraindicated for these patients. So, molecular testing is not just about matching the right patient to the right drug. It's almost about ensuring that the wrong drug is also not given to the patient. And we are seeing that more and more for all of the different targeted therapies that we have now at our disposal. And again, you just alluded to one of the other transformative changes in outcomes of our patients and lung cancer has been due to immunotherapy. Do you want to enlighten our audience about the role of immunotherapy in early stage disease as well as metastatic diseases? Absolutely. So immunotherapy again, like targeted therapies is available both for metastatic lung cancer without any target or target mutations. And it's also available for early stage uh patients before or after surgery and sometimes given both before as well as after surgery. And I want to go back to the original goal of the conversation man, which is about the role and importance of lung cancer screening. As we speak, our technology to offer surgery has drastically improved and continues to improve. And we talked a lot about some of these new innovative treatments in early stage disease, targeted therapies, immunotherapies. Now we are combining surgery with targeted therapies or immunotherapies and the chances of a cure are higher than ever before. So the time is ripe to offer lung cancer screening to our community. Yeah, that's a very eloquent point, Paul and just for our audience out there as Dr Basu had alluded to you if you use immunotherapy, either before or before and after or after, what we have found out is that outcomes of these patients are improved tremendously. In fact, what we sometimes when you do chemo before surgery and then you take patients to surgery after that, that approach is called New Avant Therapy. And if you do it only with chemotherapy, the pathologic complete response, that means and how many patients, the tumor goes away completely is only around 4 to 5% with chemotherapy. But we are seeing that numbers now being 18 to 20% if we are using immunotherapy, either by itself or in combination with chemotherapy. So that's like four times greater chance of having a complete pathological remission or response on therapy. And then, as you mentioned, we even augmented typically with additional maintenance, immunotherapy for a year or two. And I think so overall, what we're really doing is we are giving people a second chance. Absolutely. And, and that's why we come back to the point that lung cancer is so critical because we want to in the next 5 to 10 years. And that's the effort that we are in partnership with longevity are really going for is going for cures. We are going to move these patients from stage four disease to early stage disease because that's where the cures are really possible. Now, obviously, we've done much better in how we take care of our patients with metastatic disease and immunotherapy has been quite transformative in that as well. You want to talk about some of the drugs or some of the treatments that are available and how much better are these patients doing? Absolutely. And again, going back to one of the points about molecular testing patients who were diagnosed with squamous cell, non small cell lung cancer or adenocarcinoma, again, which is a type of non small cell lung cancer, which does not have any molecular alterations. Immunotherapy has been absolutely revolutionary. And immunotherapy is given to patients based on how much the tumor makes a protein, a protein called PDL one. And now we have six different immunotherapy combinations available for patients. And, and each of these are highly effective and patients who respond to these drugs have a really, really good response rates. And again, going back to that point about five years survivors, but we have five years survivors, patients who have no evidence of disease called ned after immunotherapy. And that has never been seen in lung cancer before. No, absolutely. Just to drive home. The point when I started, which was almost like 20 years back as a medical oncology fellow. The outcomes of stage four lung cancer was less than 5% at five years. And now with all the transformative changes that has come because of testing thyroid therapies, immunotherapies, 20 to 25% of our patients, at least at academic centers are surviving at five years. And I feel in the next five years that number will be improved even more. But coming back, I think one of the other importance of our effort in terms of lung cancer screening is because it deals well with the Biden Moonshot, which is to decrease the cancer mortality by 50% in the next 25 years. And I think critical for that is uh screenings biomarker testing and making sure that the minorities are getting screenings and treatments on clinical trials. So in the next couple of minutes, can you talk about some of the efforts that are being done in terms of ensuring that minorities are not only getting screened or getting appropriate treatment on clinical trials and what longevity is doing to further enhance that effort? And I'll start by saying that as a patient group, our goal is to make sure that every patient or I would say every high risk individual and every patient gets the best care possible no matter who they are and where they live. And and the reality is this is a very complex and systemic issue man. So we as a patient group, as a patient advocacy group, we've taken a multi pronged approach and we are doing local level efforts such as our partnership with the Miami Cancer Institute to bring lung cancer screening to the Hispanic Latinx community in in Miami. Then we are doing state level efforts. For example, we have a campaign very, very focused on uh in, in the minority community looking at bio market testing, which we talked about and in in, in Georgia, in the Atlanta area, that's a state level effort. And then of course, we also believe that at the end of the day, policy level change is the biggest way to make an impact. And that is the reason why longevity is very focused on, on driving policy level change that removes barriers to innovation and removes barriers to access. And as an example, and we will again use lung cancer screening. We've been champions for ensuring that lung cancer screening is covered by all private, as well as public insurance, all public and private payers in the United States. And we are moving in that direction a couple of years ago, the State of Florida uh did not, the Medicaid population was not covered by lung cancer, not lung cancer screening was not covered in the state of Florida, but that has changed. So we are seeing some of the some of our efforts leading to what we want to see. So, thank you so much for your groundbreaking work in the field of lung cancer. I really want to thank you and your organization for, you know, making sure that we can cure more people. But I would also want to summarize by at Miami Cancer Institute. We certainly believe in that we are addressing these gaps in disparities of care for minority patient population. So we believe in a clinical trial for anyone who walks through our doors in Miami Cancer Institute, as well as with the focus on increasing minority enrollment to clinical trials. Because I think that is going to be the key if we can really further the work of the cancer Moonshot program to really serve the community and decrease the mortality by 50% over the next 25 years. So with that, I would really want to thank uh Opal for making the trip to Miami to visit us. Pleasure. Thank you for having me, man and for your partnership. And I look forward to working with you and your organization for next several decades. Thank you very much. Recent innovation in the treatment of lung cancer has come with improved understanding of molecular profiles as they relate to which patients will get better benefit from which kind of therapy for some patients who have oncogenic driven tum. We are now using targeted therapies. As we saw in our discussion for patients who do not have those alterations, immunotherapy has truly transformed the outcomes of these patients. And we have a number of our patients who are living five years and beyond. We are encouraging patients to learn more about their lung health by offering special pricing on lung screenings through the month of November patients without health insurance or whose insurance does not cover the test can receive a lung cancer screening for $35 a prescription is required this Lung Cancer Awareness Month stay on top of your lung health by visiting Baptist health.net slash L screening or call 8335962473. To find out more about the topics covered on the dock to doc podcast. Please visit physician resources dot Baptist health.net. Created by
