FM Talk 1065 Podcasts
Time for a Check Up with Dr Reece Jones from Southern Cancer Center
[MUSIC] >> This is midday mobile with Sean Sullivan on FM Talk 1065. >> Welcome back to midday mobile and time for a checkup. And good to see Dr. Reese Jones from Southern Cancer Center back in studio. Thanks for coming in. >> Thank you. >> I got this one here. We've talked to him over the last few weeks about the just so many different ways you can look at cancer. It could be called this cancer, but it reacts this way in one person, this way in another person. Let's talk about the confusion on how cancer is treated once it moves in the body. So now we're in one person, but for example, this question of woman's breast cancer moves to her lungs. Is that still breast cancer or is that lung cancer? >> Yeah, the cancer is still always turned by the side of origin. So a breast cancer that moves to the bones is metastatic breast cancer to the bones. It's not a bone cancer. >> Okay. >> So there's a lot of misnomer, so. >> Does it look, if you took a sample of that cancer, somebody who had bone cancer started without breast cancer, and he looked at that. And then he looked at breast cancer that went to the bones. Would they look similar or would it still have the signature of that breast cancer? >> It still has some of the signature. So if you take, let's say you have a metastatic breast cancer. So if you take tissue from the primary breast and then tissue from the bone, there will certainly be similarities, but there could be differences as well. >> Okay. >> Because as cancer spreads there, again, we talked about it mutating, and so it will acquire mutations and change. >> But so if it moves to the bones, but it's still metastatic breast cancer, it's in the bone. >> Yeah, it's just stage four breast cancer. >> Wow. >> So lung cancer that spreads through the brain is lung cancer. >> Okay. >> Because it's always the point of origin. >> Right. >> Is that, this is kind of a strange question, but if you go into somebody that has cancer in multiple places, how can you figure out where it started? >> I mean, most of the time, just based on the clinical scenario, and the imaging helps, the tumor tissue most of the time by the staining pattern pathology will get the tissue and stain it and do various studies on it. And most of the time the staining pattern will point towards a particular cancer or at least. >> This one was first, and that it was at least it can rule out a few. >> Okay. >> And then you have to combine that with the imaging. So if I have a cancer, let's say they're not quite sure if it's a lung or a bile duct cancer, I'd use that. If you get a scan and there's a 10 centimeter lung mass, you're like, okay, this is a lung cancer, but if you get a scan and there's nothing in the lungs, but you see a mass, say, in the pancreas, you're like, okay, this is probably pancreatic cancer. So sometimes they do. >> Do they grow at the same pacing like a cancer in the bile duct and the cancer in the lung would they, if you started them on day in an individual, I know individuals are different, but in one person, that cancer starts, the bile duct, the cancer starts in the lung, do they pace grow at the same time? >> Most of the time a bile duct is going to be one of the more aggressive cancers, bile duct cancer, pancreatic cancer. >> So it would grow faster, even if they started on day one, growing in the two places it might get. >> No, there's, that may not all, let's say lung cancer, one of the one, luckily it's the least common, but a small cell lung cancer grows fast. >> Okay. >> So a small cell lung cancer, pancreatic cancer, I mean, I don't know exactly what the growth rate would be. >> People grow faster than that in that same person, another kind of cancer somewhere else. >> Okay. >> And we see people with multiple cancers. >> Right. >> At the same time. >> But back to our initial question, because of how we look at it, and I don't know what this does for treatment, does it matter where it started, like, if you're going to treat that cancer now that's a bone cancer, but it's metastatic breast cancer that's in the bone, do you treat that differently than if it was just bone cancer on its own? >> Yeah, so, but let's say the term bone cancer, as an oncologist, if I hear bone cancer, that would imply a primary cancer of the bone, and they're certainly sarcomas and different things that can arise within the bone. >> Okay. >> Those are not very common, but we do see them. But a breast cancer that metastasizes to the bones is treated as a breast cancer, and we have algorithms that, you know, we know are effective for that disease. So the look, where it is, actually it is, doesn't matter all that much, it's just a matter of where it started and what the stage is. >> Okay, so as you look at this, you still have to go back and say this is a breast cancer that's moved into the bone, so there's certain things that were true about treating the breast cancer that go into that algorithm of how to treat it now in a bone. >> Correct, and so, you know, we have standard first-line treatment you treat until the disease progresses. Now, because of, we're able to do next-generation sequencing on cancers now. >> Explain that to me, that was happening. >> Cancer research has really gone into, you know, we talked about the growth pattern of cancer, and if you look at the steps of growth, there's mutations and other things that are gained along the way by the cancer to stimulate its growth. So now drugs are being developed to target those individual steps. >> Okay. >> Okay. >> And so, what we're able to do a lot of times is take cancer cells, and this gets into a whole nother discussion, but actually you can do liquid boxes, too. You can take the blood, and if the cancer is shedding enough cancer cells into the blood, you can pick up those mutations on the blood itself. So, but let's just use the cancer tissue, because that's still the most reliable way to do it. You run what we call next-generation sequencing, and it does a full molecular panel. And so, there's a lot of mutations that it picks up that we don't know what to do with yet, because there's not been targeted drugs against those. So, if it has one of those mutations that we have a drug targeted for, it's going to tell you that. >> Okay. >> And then that will guide your treatment as you move along through the cell. >> Because you now have this chink in the armor or something of that cancer, right? You know, okay, we've got something that can deal with that specific mutation. >> Right. And then we talked about immune therapy, like there's something called a PD-L1 level, which predicts your response to immune therapy. If you have a PD-L1 level of 80%, you have a very good chance of responding to immune therapy. If it's 1%, you have less of a chance and don't mean you won't. >> So, is there, in layman's terms, when you look at that PD-L level, what shows somebody being having a higher than what makes it what makes you go, this person's going to respond better to immune? >> Well, let's take a lung cancer, a lung cancer with a PD-L1 of over 50%. You can treat those patients with immune therapy by themselves without chemo. >> Okay. So, which is when you get that number, though, you take a say, how do you get the data that gives you that PD-L1? >> Yeah, you just send, so you take the tumor tissue, there's different labs that do this next generation sequencing. And so, we order the test, the labs are mostly in California. We tell them we want the test. They contact pathologies. At one of the hospitals, they get the blocks sent to them, the tissue block. They take the tissue, they run the testing two weeks later. >> And it tells you that this person, because of what was in this sample, that we know that this person has at 50%, 80%, 1% chance of it. >> So, they'll look at the PD-L1 level and then they'll look at these specific mutations that potentially have a drug that can target them. And so, then you'll get, I get a sheet of paper that has a list, and it just tells me what they have. And it tells me what they don't have, which is important as well. >> Okay. >> And so, then, that helps me determine what's going to be the best treatment for, well, the best treatment for that cancer, now there again, that doesn't necessarily apply to the patients sitting in front of the patient. >> Right, because now you've got to do that, you're looking at that data, and you know the patient as well. >> Right, so you have to combine the two. So, you've got to make sure you're going to give a treatment that's not going to make things worse and so better. >> Sure. >> And so, the other thing I'll mention is, I talked about cancer changing. So, let's say you have a metastatic breast cancer, and you do this testing, and so you have a frontline treatment that works for some period of time and then quits working, all of a sudden, let's say, they develop a lesion in the liver. >> Okay. >> And that's still there again, the same- >> Stereomatostatic breast cancer- >> Stereomatostatic breast cancer. >> Stereomatostatic liver, still breast cancer, however, what we try to do is rebob-seat that. >> So, you want to- >> You think I'll show you a different mutation or something that may be different? >> And that you might have something that could- >> Right. >> And so, something that was not there previously can become there, or vice versa, something that you were targeting, you can lose that. >> Right. >> So, then if you use a drug to target that, it's no longer there, so it's not going to be effective. >> But there may be this new thing because of that move to the liver that gives you a chance to treat metastatic breast cancer in the liver. >> Right. So, we always like to rebob-seat. >> Right. >> And then I mentioned the liquid-bobs you think, you know, that's easy, they can come in, you can do a blood test, because if the cancer is right to the liver, you may be shedding enough cancer cells into the bloodstream to pick it up that way. >> Yeah. >> So, what I'll typically do is send the liquid-bobsie and do the tissue testing. Because if it's not there on the liquid-bobsie, it can still be there in the tissue. >> Yeah. >> Now, most of the time, if it's in the tissue, it's going to be there in the liquid, if that makes sense. >> Yeah. Yeah. And- >> But the cancer is ever-changing, and so, it's important to know what it is at that moment. >> That's why, as I've heard you talking to Dr. Jones, it's like you're getting an update. >> Yes. >> You know, briefing. You're getting a briefing- >> Right. >> On the cancer, in a way, because that changes as you go through this treatment. >> No, not 20 years ago, it didn't matter, because all I had was- >> It was just the most part. >> It was just give them chemo and see what happens, because we didn't really have that target of therapy. And we didn't really have the ability to do the next-race sequencing, but that's all change. And, you know, DNA was sequenced, it changed, though, everything. >> And we think about how many things we talk about, it changes, but just watching, you know, from you, your Patriots, Dr. B. Shad, the things at Southern Cancer Center, it seems like it may be more, but it seems like every year or two, you've gone through a quantum leap in the technology. >> Really, nowadays, every month or two. >> Wow. >> Yeah. And if you're not keeping up, you're getting behind. >> Yeah. >> I mean, it's ever-changing. You know, that's the fascinating thing about the field. You know, it makes it fun, it's not the right word, but more rewarding to practice oncology now than it was when I first started, because not only- >> You have more tools that you have more tools that are, you know, they work well, they're better tolerated, and then, you know, to see a lung cancer patient that- >> I saw lady the other day, she had stage four lung cancer, she's six years out. >> Wow. >> You know, and you don't- >> Twenty years ago, she wouldn't be- >> No, yeah. >> Ten years ago. >> Wow. >> You know, 12 to 18 months, and so it's just fascinating to see, and it's rewarding to see. >> It's rewarding for your patients. I know that in their families. >> Oh, I understand that. You know, obviously the most important part of this. >> I have to get you to come back soon, because if we wait two weeks, it sounds like there'll be a whole bunch of new innovations. >> Yeah, it probably doesn't happen. >> All right, good stuff. We'll have a date for you to come back and do it again. >> I'd love to. >> All right, Dr. Reese Jones from Southern Cancer Center, right here on Time for a Checkup. (upbeat music)