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Treatment Paradigm Evolving in Early-Stage Lung Cancer

Gina Columbus @ginacolumbusonc
Published: Wednesday, Jan 03, 2018

This is what we refer to as ex vivo testing. [It involves] taking tissue out either through a biopsy or through surgery and then doing something to it; you can test whether those cancers are sensitive to different types of treatments. There are a lot of different ways of doing that. The simplest way is to culture it—to plate it in a Petri dish—but that changes the tumor a lot. That was the older way this was done. 

The most labor-intensive way is putting it into mice; the mice grow and you treat them with medication, but it takes a long time and it’s very expensive. There is something in between called a tissue slice culture, which takes little pieces of tissue, sections them, and preserves all the architecture of the cancer. However, it allows us to treat with many different medications and get an answer within just a few days about what the tumor is sensitive to. That is still a research procedure, so we don’t know exactly how that correlates with what happens in people. However, from everything that we’re learning about it, it seems like a very good tool that has a lot of potential. 

What do you hope to see in the next 5 to 10 years in this setting?

I would love to see all of the advances that we are making in the lab get translated to patients. The bottom line is that there are a lot of promising medications and new treatment ideas that take so long to get to patients who desperately need them. I would love to see more techniques like the tissue slice culture that can allow patients to match with more personalized therapies and experimental therapies and, if that facilitates development of new drugs, that would be wonderful. 

I would also love to see more early-stage patients being involved in clinical trials that test newer drugs. It is hard to test what we call first-in-human drugs in early-stage patients with lung cancer. However, there are a lot of drugs approved for other indications that could be helpful in these patients. For patients like these who are going to have their cancer removed, it’s a great opportunity to treat them with new drugs to see how the tumor changes and reacts to those medications. Unfortunately, we just don’t do a lot of those trials, but it’s a good opportunity. 
National Cancer Institute. The ALCHEMIST lung cancer trials. https://www.cancer.gov/types/lung/research/alchemist. Updated July 24, 2017. Accessed December 15, 2017.



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