Guest: Dr. Suman B. Rao
Presenter: Neal Howard
Guest Bio: Suman B. Rao, MD, is a medical oncologist board certified in hematology and medical oncology as well as internal medicine. Fellowship-trained, Dr. Rao is experienced in treating a wide range of cancers. Her clinical interests including lung cancer and breast diseases. A member of the American Society of Clinical Oncology, Dr. Rao is a strong proponent of clinical trials and encourages eligible patients to take advantage of the many opportunities to participate in such trials at MedStar Franklin Square Medical Center.
Segment overview: Suman B. Rao, MD, an oncologist, discusses biomarker testing, how it works, and why it’s important for lung cancer.
Health Professional Radio – Biomarker Testing and Lung Cancer
Neal Howard: Hello and welcome to the program, I’m your host Neal Howard, thank you joining us here on Health Professional Radio. Our guest is Dr. Suman B. Rao, she’s a medical oncologist board certified in hematology and medical oncology as well as internal medicine and she’s here today to discuss biomarker testing, how it works and why it’s very important as far as lung cancer is concerned. Welcome to Health Professional Radio, doctor.
Dr. Suman B. Rao: Thank you very much Neal, thanks for having me today.
N Lung cancer is one of the more aggressive types of cancer. Are you a specialist in lung cancer or are you just passionate about lung cancer among other cancers that you have experienced with?
R: So Neal, I’ve started my fellowship actually at the University of Texas in Dallas Southwestern Medical Center and then I’ve been practicing in Baltimore in Maryland and edify at the Medstar Franklin Square Hospital. I started out actually seeing more breast cancers than lung cancers but more recently, my practice has been geared more and more toward lung cancer. I think it’s just been my passion in a way, and there’s some, the more I see, the more it’s been heartening to treat patients with lung cancer more today than it was many years ago since it have a lot of new developments with lung cancer treatment and it is exciting actually to be able to see these developments and make a difference with lung cancer treatment for patients today.
N: Dr. Rao, what is Biomarker Testing for our listeners who aren’t familiar with the term or the technology?
R: So biomarkers, with cancers in general, we look for biomarker. Biomarkers are substances that can be markers for the disease and they’re found in normal tissue as well as in cancer tissue. It sometimes helps us with diagnosis. Sometimes we use those stains to say ‘Okay just makes the diagnosis of lung cancer that helps us make diagnosis sometimes. But more often than not, what we use biomarkers in clinical practice is basically to help the treatment. So there’s substances which are present in normal as well as cancer tissue but the cancer tissue can depend on these molecules, like they’ll be genetic alterations or certain chemical pathways that are utilized by the cells to help the cancer grow and prevent destruction. So that has become a very important part of practice.
N: Does the effectiveness of these biomarkers depend on a person’s age?
R: Not at all. The biomarkers are not anything that’s inherited. It is the cancer that … these pathways, so to speak. For example the path, the EGFR, the ALK mutations, the … mutation, these are something we use in practice today and these are genetic alterations within the cancer cells. So it’s not something that passed on from generation to generation, it’s a cancer that uses these mechanisms, these are normal cells psycho mechanisms, but the cancers then become dependent on them. So they act as a driver for the cancer, these genetic mutations. So that’s something we test from clinic and treat if they’re positive then we can use drugs that are specifically targeted to block these mutations. Of course, more recently immunotherapy has been more in the news and immunotherapy has become an important part of lung cancer treatment and at the end of the biomarker, we look for is PD-1 or PD-L1 pathway and the PD-L1 Testing is useful to help determine which patients seemed to benefit more from immunotherapy. So these are, all of our treatments are to some extent have side effects and they don’t work for everybody. The idea of biomarker testing is so that we can use the right treatments for the right patient and make it as effective as possible for that patient.
N: How recent of a development is this Biomarker Testing technology?
R: So biomarkers have been around for, I would say about 20 years now. The first biomarker in lung cancer that they found was the KRAS that was about 20 years ago, that was discovered. Recently, the developments had been much more rapid. 20 years ago we just knew the KRAS was mutated in lung cancer. Now we have about and we know at least about 15 specific mutations for lung cancer that can I to be what we called ‘driver mutations’ which means that the cell is totally dependent on that mutation or like PD-L1 pathway help the cells sort of camouflage and prevent destruction. In the last 5-10 years we have really made a lot of advancement in detecting these biomarkers.
N: Can you determine the side effects (if any) and the severity of those side effects with these biomarkers on a patient-by-patient basis?
R: Yes. So, not always. We know specifically that with the EGFR Testing if we have a patient that has EGFR mutation and more likely to get side effects from the treatment that is targeted to that, but at the same time it is also more efficacious. So with the PD-L1 pathway, not so much. We don’t know that the side effects are dependent on the PD-L1 pathway being there or not. That is not as clear cut, so sometimes it has and some not so much.
N: And would you please tell our listeners where they can go online and get some more information about biomarker testing and how it relates to lung cancer?
R: So we’re today specifically about the testtalktakeaction.com, if you go to that website, the website is clear list out more information about biomarker testing that patients can use. It also has a guide for patients to then talk to their physicians if they have specific questions that they can and discuss with the physicians and it’s always very important for the physicians to discuss it but sometimes it is complicated treatment and it’s always good for the patients to be prepared when they go to the doctor’s office.
N: Thanks for coming in and talking with us today doctor, it’s been a pleasure.
R: Thank you, it’s good to be here.
N: You’ve been listening to Health Professional Radio, I’m your host Neal Howard, in studio with Dr. Suman Rao. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.