Interview with Heather Wakelee, MD
Dr Wakelee is Assistant Professor of Medicine in the Division of Oncology at Stanford University in Stanford, California.
Clinical trials evaluating targeted agents in the adjuvant setting
DR LOVE: What is known about bevacizumab or Avastin up to this point? Has it ever been used in this kind of a situation adjuvantly?
DR WAKELEE: It’s being studied in colon cancer and in breast cancer. And just this past weekend we heard some of the first results, which was from a colon cancer trial.
DR LOVE: We don’t know for sure whether it’s going to help in colon cancer and we certainly don’t know for sure whether its going to help in lung cancer, but the hope is that it might.
DR WAKELEE: Right. And that’s why we’re continuing with the study. Some of the other studies that are going on, there’s one looking at a pill drug called erlotinib or Tarceva. That is another drug we know works in patients with metastatic lung cancer and in this trial, patients going on can either have or not receive chemotherapy beforehand. And at the time they go on the study, they either go ahead and get this erlotinib pill for two years or they get a placebo pill for two years.
Another study is a vaccine trial looking at a protein called MAGE-A3. And that’s a protein that’s only in cancer cells. It’s not in any normal cells. But it’s not in all lung cancer; it’s in less than half. And so with this study, patient’s tumors are tested to see if they have that protein and if they do, they are then randomized, meaning coin flip, and half of them get injections of the vaccine and half of them get a placebo injections. So those are the three largest looking at newer treatments.
And then there are also trials that are ongoing trying to better customize, better personalize the chemotherapy itself and most of those are happening in Europe, one in the US. In those trials, half the patients just get chemotherapy, no direction to it, just like we would normally. And the other half they look for, again it’s certain proteins on the cells to see if they can better select a particular chemotherapy.
DR LOVE: And the study that you’re doing looking at bevacizumab I want to focus on a little more in terms of what the issues there are. But that’s being conducted by what’s considered a cooperative research group, in this case it’s the Eastern Cooperative Oncology Research Group of which you’re a part of. Can you explain what ECOG is and what a cooperative group is and how it works?
DR WAKELEE: Yeah. The cooperative group system is funded by the National Cancer Institute. There are four major cooperative groups within the United States. The Eastern Cooperative Group is one. Now I’m at Stanford, so it’s not all Eastern, but that was the name given to it and it’s predominantly East Coast institutions. And how it works is that the member institutions all work together to enroll patients onto these larger trials and the member investigators take turns as to one person leads one trial, another person leads another. We all work together to make sure we’re offering the best possible trials to our patients with this cooperative agreement.
The other cooperative groups, there’s the Southwest Oncology Group which tends to be geographically located in the Southwest, but a big range. And then the Cancer and Leukemia Group B is scattered throughout the country and then there’s a more focused group, the North Central, which is centered around the Mayo Institute in Rochester.