Interview with Heather Wakelee, MD
Dr Wakelee is Assistant Professor of Medicine in the Division of Oncology at Stanford University in Stanford, California.
Clinical research trials in NSCLC
DR LOVE: So one of the important options for a patient in this situation as an alternative to receiving chemotherapy as you’ve described, is to participate in a clinical research trial. And you’re the head of really one of the most important, probably the biggest trial right now that people are looking to in this situation. Can you explain in general what the concept is of doing research in this situation? What are the trials out there, including yours, that patients might participate in?
DR WAKELEE: So the reason that we need to do more research is we’re still only able to offer patients a five to ten percent benefit from chemotherapy. I usually point out that we wouldn’t know that giving chemotherapy gives us a five to ten percent benefit unless earlier patients had gone on trials, the trials that looked at either no treatment or giving chemotherapy, and because there were patients willing to go on the studies, we now know that we can offer other patients the benefit of chemotherapy. So we need to do the trials to move forward.
We’re no longer doing any studies that are just giving chemotherapy to people, yes or no. There are some trials that are trying to direct the chemotherapy, where they look at proteins that are in the tumor itself or differences between people.
DR LOVE: Now when you say that’s somebody is going to be in a clinical research trial though – because I think when people think about it they think about they’re going to get some kind of an experimental medicine and just a few people might receive it. Whereas these trials that you’re talking about are actually they’re trying to get thousands of people to participate.
DR WAKELEE: Right. So I should clarify more. The older chemotherapy trials were close to a thousand patients, one of the trials was almost two thousand patients and in those studies, after surgery people either went on to get chemo or not to.
DR LOVE: So it was random whether they got the chemo or not.
DR WAKELEE: Right.
DR LOVE: So they went into the study and the idea in that situation was kind of like a coin flip determining whether they get chemo or not and then see if the ones who got the chemo did better.
DR WAKELEE: Right. Exactly. And the trials that we’re looking at now are looking at adding other medications. So the study that we’re doing, everybody who goes on the trial gets chemotherapy. Half of the people, and this is picked at random, basically a coin flip as you said, in addition to standard chemotherapy will also get another drug called bevacizumab, which is also given by vein once every three weeks, and it’s what we call an anti-angiogenesis drug, a drug that is affecting blood vessel formation. This is a drug that we know can add to chemotherapy for patients where the cancer’s already spread; doesn’t cure in that situation, but can prolong time before the disease grows and help some people live longer. And so we’re looking at giving that drug in addition to chemotherapy for patients where the cancer has already been removed, hoping that that might improve cure rates. That’s one of the trials.