Lung Cancer Clinical Care and Research at Yale: The Thoracic Disease Center

March 09, 2021

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Yale Cancer Center Grand Rounds | March 9, 2021

Hosted by: Dr. Roy S. Herbst

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00:09OK, why don't we get started?
00:11Welcome everyone to Cancer
00:13Center grand rounds.
00:14I'm Roy Herbst and I'm broadcasting
00:16here with Paula Pike from the
00:18North Haven Care Center, which is
00:20actually the home of the main campus.
00:23Thoracic oncology right now and today is
00:25going to be a very special presentation.
00:28'cause I think there will
00:30be something for everyone.
00:32All the way from the clinic
00:33to the lab and back,
00:35and we're going to actually have
00:37a relatively large panel where
00:38we're going to hear from some
00:40of the members of the thoracic
00:41center and and get their thoughts.
00:43And there's also some exciting
00:45breaking news on lung cancer
00:46for anyone who has a nap,
00:48they've probably seen the articles in the
00:50Times and other CNN just in the last hour,
00:52so we we knew about that.
00:54So we're going to talk about that.
00:57So welcome everyone,
00:57I'm going to introduce the panel at the end,
00:59but I'm going to show a few
01:01slides just to get us warmed up.
01:08PowerPoint.
01:17So I'm really excited to be here
01:19and I'm I'm really just here.
01:21I'm I'm in the conductor of an amazing
01:23orchestra of wonderful people that
01:25really make up the program that
01:27you're going to hear about today.
01:29That's been in existence for some
01:31time where we're just going to
01:33try to expand it out to even more
01:35places with the same expertise,
01:37caring quality that we've come to expect.
01:39So I'm going to talk about the lung,
01:42cancer, clinical care and research program,
01:44and I'm going to introduce the
01:46Thoracic Disease Center.
01:47Something many of you have
01:50heard about in recent days.
01:53These are my disclosures.
01:57So we're talking about lung cancer and lung
02:00cancer has an amazing burden worldwide,
02:03with over 2,000,000 cases worldwide,
02:05an 1.76 million deaths.
02:07Still, the number one cause of cancer death,
02:10perhaps more breast cancer or prostate
02:13cancer, are diagnosed skin cancer.
02:15For screening for lung
02:17cancer is still in the US.
02:19You can see 135 thousand plus
02:21deaths despite all the improvements
02:23you're going to hear about today,
02:26most of lung cancer,
02:2784 percent is non small cell.
02:3050% of small cell.
02:31The majority of the non small cell
02:34is adenocarcinoma and more than
02:36half presents already metastatic.
02:38And that makes it even more
02:41difficult to treat.
02:42And of course, tobacco,
02:43and we're going to talk
02:45about screening in a moment,
02:46the single largest preventable cause,
02:48leading to 30% of all cancer deaths there.
02:50About 20 cancers that you
02:52can track back to tobacco,
02:54but in those who are non smokers,
02:56especially in lung cancer,
02:57you can see the potentially actionable
02:59mutations for which we now have
03:01drugs either in trial or for the
03:03most part as approved agents.
03:04What a change from 1520 years ago,
03:06and there are even data now for K
03:09wrasse targeted drugs will talk
03:10a little bit about that for those
03:12who have smoked.
03:13The adenocarcinoma is about 12%
03:15now have a target.
03:19Weather or twality for this disease
03:21is really improving and you can.
03:24You can see that here both
03:26for men and for women.
03:28This is the data from the American Cancer
03:31Society and the rate of lung cancer.
03:34The incidence is decreasing by 2.6%
03:37a year and the mortality by 4.3%
03:39in in men and women. One point,
03:422% incidents and three point 1% mortality.
03:45This is the result I would contest
03:48of better prevention.
03:49Primary prevention not smoking.
03:51Secondary prevention.
03:51You know the cat scanning will talk about
03:55that, but also some of the therapies.
03:57Some of them that had their origins
04:01here with science and studies at Yale.
04:05Well, here's the history of
04:07the Thoracic Oncology program,
04:08and I'm a relative newcomer to some
04:10of the group that's been here.
04:12Look in the bottom left and Lynn
04:15Tanui really had the idea for this.
04:17Working with Lynn Wilson and
04:19my friend and many of yours.
04:21The late John Urine,
04:22and this is actually ground ham,
04:24and so he was a great surgeon,
04:27but he was not a thoracic. Only surgery.
04:30Did cardio cardiac disease as well.
04:32So Lynn got some money and had the
04:34idea to recruit US thoracic surgery.
04:37Specialist and build a section
04:38of thoracic surgery.
04:39And of course you recruited Frank.
04:42And that happened.
04:43Then you can.
04:44You can see that the group here.
04:46Then you can see the tip program
04:48that we've come to know and love.
04:51And John to Chomsky.
04:51And a team that can do interventional
04:53techniques along biorepository.
04:55Actually Lens set that up with
04:57Frank Susan main.
04:58Now one of the ranking members
05:00of the FDA with Susan was here
05:02working with Bonnie Gould,
05:03Rothberg, David rhyming,
05:04Kurt Shopper if any of the scientists
05:07in the audience need tissue, we have it.
05:09Then I came around 2011,
05:11about 10 years ago.
05:13Actually, exactly 10 years ago today,
05:15and you know,
05:15we work very hard to even build further,
05:18and we develop the yell spore in lung cancer.
05:21P50 the lung nodule screening
05:22program is a robust and going
05:24strong and here's a recent retreat
05:26about two years ago that Dan Buffa
05:28organized and you can see the
05:30numbers of people that are involved.
05:32This is truly a team effort.
05:36And here you can see a bit of the
05:38evolution and you know people
05:39have aged quite gracefully.
05:41I think you know.
05:42So here is 2004.
05:43Now at the very origin Scott I just
05:45come know he's done an amazing job.
05:47He came to work with John.
05:49John passed away in his first month
05:51with Scott, took on the Helmand,
05:53and he's going to join me in a second.
05:56He's dancing a patient and I'll tell you
05:58about his early work in immunotherapy.
06:00Then, of course,
06:00here's the group in 2008,
06:02already quite robust.
06:03You know, building this doctor Decker.
06:04Then in 2012, this is the referral.
06:07First retreat that I helped organize.
06:09With with with with Lynn
06:10and Frank and this was
06:12over there at the up on Prospect St.
06:15And then here's our more recent group.
06:19Well, what I really want to talk to you
06:21about is multi modality care and how
06:24multi modality care makes a difference
06:26and that's why we're even working harder
06:29now to promote the thoracic center.
06:31So what you can see is you know there are
06:35so many aspects of multi modality care,
06:37including screening.
06:39Pulmonologists radiologists, surgeons,
06:40medical oncologists social workers.
06:42Of course, the clinic administration the
06:45wonderful nursing and support staff.
06:47It really is a village and we
06:49had it all here.
06:51I can tell you,
06:53having worked at many great
06:55hospitals over the years,
06:57it's all here expert care at all sites.
07:00Common practice patterns will do even
07:03more of that protocols available
07:05in all disciplines at all sites,
07:07and quality and compassionate care.
07:10And we're just going to do more of that with
07:12this new iteration of the thoracic center.
07:15Now thoracic research and I've
07:16given grand rounds that my my
07:18team have given grand rounds.
07:19I just want to introduce
07:20that research can be basic.
07:22In the lab we have tons of that.
07:24Yeah, it's the best in the world
07:26translation or the lab to the clinic.
07:28I think that's the special sauce.
07:29Being able to take that back and forth.
07:31Of course to the clinic and clinical studies
07:33and not to forget outcomes in the community.
07:36You know we have proteomics.
07:37We have genomics right now.
07:38The key is community omics.
07:40We gotta get out to the community.
07:42We live in New Haven.
07:43We've gotta get out to the New Haven.
07:45Car door you've gotta get outta
07:48to Trumbull to Bridgeport.
07:49Up North we have to do all that.
07:54So what is the major accomplishments?
07:56Again, just a few.
07:58Immunotherapy Scotts get out.
07:59Hopefully arrive soon and tell us about this.
08:02You know,
08:03before I even knew Scott or a new bout.
08:06Yeah I.
08:07I heard about immunotherapy
08:09happening here with Marios Nolan and
08:11Harriet Kluger Scott taking over
08:13the first or second patient ever
08:15treated with lung cancer on a PD,
08:18L1 and PD1 inhibitor here at yeah.
08:20This woman three times refractory
08:22to lung cancer,
08:23squamous cell disease prognosis
08:25here would have been months just
08:28saw her couple of months ago.
08:3010 plus years amazing.
08:33This is the curve.
08:34This is from Scott's first study,
08:36published this.
08:37It's one of the more cited papers
08:40last year or two years ago in JCO.
08:42Look at the tail of this curve.
08:44Now we of course want to do better,
08:47and for anyone watching this
08:48and you're thinking.
08:49Of course we have to do better,
08:51but five year overall actual survival comma.
08:54Sure this is 16%.
08:55This is the tale of the curve
08:58simply transformation ull.
09:00We have innovation.
09:01This is an investigator initiated trial.
09:03Very proud of this,
09:04this was a collaboration between
09:06the Melanoma group.
09:07They have a Sport 2 led by Harriet Cougar
09:10Marcus and part of that's more as well,
09:12but this was a while back.
09:14Sarah Goldberg and Veronica Chang,
09:16of course, who's a neurosurgeon
09:17who does the Gamma knife?
09:19Here's a patient with Brain Mets
09:21with with lung cancer who was going
09:23to be candidate for immunotherapy.
09:25We could have radiated the brain
09:27here and two weeks of radiation
09:28would have probably resulted
09:30in some cognitive impairment.
09:32But instead this patient was
09:33treated with immunotherapy,
09:34and in this very first study,
09:36it was shown that patients
09:37actually respond in the brain,
09:39and this actually was before
09:40any of the clinical trials were
09:42allowing this and anyone was
09:43doing this in clinical practice,
09:45innovative and Carla studies from this,
09:47maybe Kurt will tell us a bit
09:49about that when we call on him.
09:52And papers again not meant to be in detail.
09:54I don't want there is so many papers.
09:56One of the things we're going to
09:57do as part of this new disease
09:59center is keep a full lot.
10:00Again, and quantify all these,
10:02but we've published it,
10:03builds the scientific literature.
10:05It helps get this to other places.
10:07It builds our reputation.
10:10Basic science, I'm actually.
10:12We have amazing basic science,
10:14just one of our sport projects.
10:16Project 2 Katie and Sarah both
10:18here working with Mark Lemon from
10:20the Cancer Biology Institute.
10:22Mechanistic approaches to counter TKI
10:23resistance and easier from lung cancer.
10:26So here's the team this.
10:27I think this is in the library in the
10:30brain room working to develop their
10:33methods to counter EGFR resistance.
10:36Publishing well,
10:36changing the field we've had.
10:38We have a long slow retreat here a few
10:40years ago that Katie ran with Christine.
10:43Lovely from Vanderbilt,
10:44this is what we need to do more of
10:47our continuing to bring the best
10:49science to bear on this disease.
10:51And then what about translational science?
10:53This is the area where I have
10:55put most of my time,
10:57but we built a lung spore.
10:59It took us a few years,
11:01but in 2015 we became only the
11:03third lung Spore.
11:04Here we are celebrating and then we
11:06renewed it on our very first try in 2020.
11:09Why?
11:09Because we had impact in smoking
11:11cessation in immunotherapy and
11:12targeting EGFR resistance.
11:13And we continue to go strong.
11:18This is our current spore iteration.
11:20We have projects right now and you'll hear
11:23about this new new targets for immunotherapy.
11:26Everyone in the world is using
11:28Leaping's first discovery.
11:29Now we're working on one of his.
11:31Others were working on brain metastases with
11:33Don when a wonderful addition to this team,
11:36Katie and her team.
11:38As I mentioned, Sarah and Mark working
11:40on each year for a pathway resistance,
11:43or continuing to look at
11:45prevention with smoking.
11:46Is this trial Bentall and Lisa Fucito.
11:48And others,
11:49this trial Brenda and others is
11:51about to unveil its results.
11:56And again, publishing well
11:58in high profile journals.
12:01These drugs and this is just
12:03the list I could think of.
12:04You know, in the last night when I
12:07was making the slide with Doctor Joe
12:09who helped me with these slides,
12:11you can see all these drugs.
12:13Their first uses.
12:13How to use them, the mechanism,
12:15the biopsy studies all really with some
12:18origins here at Yale Cancer Center.
12:19Very proud of that.
12:20People could come here.
12:22I still recall with that as
12:24Alisme AB nine years ago.
12:25Patient coming from New York because
12:27they couldn't get immunotherapy in
12:29New York that getting in here at Yale.
12:31I'd like to see us do more of that
12:33with the next generation of either
12:35targeted therapies or immuno therapies.
12:37And with surgical techniques and
12:39with other types of treatments.
12:42We have a dark eyed disease
12:44align research team.
12:44This is a picture from
12:46our last weeks meeting.
12:47Some of the leaders will be on there.
12:49I guess I must have taken a phone call in
12:52the middle of the call and they caught me.
12:54You never know when you're
12:56on the zoom button.
12:57Amazing amazing group of people.
12:58These are the people that make it happen.
13:00I hope I know many of them are watching
13:02and I appreciate their work so much
13:04and really fantastic and our leaders.
13:06Jennifer Pope incera public.
13:08Just amazing team.
13:09Are accruals you know these are the
13:11cruise without the phase one patients
13:13'cause a lot of lung patients go to phase
13:15one but this has been pretty decent.
13:17I would like to see this go higher.
13:19How are we going to make this higher
13:21by bringing more patients here and by
13:23having more trials and being more efficient.
13:25I'm not a skier.
13:26If I was a skier, this would be the
13:28biggest slope I'd ever want to go on.
13:30And I gotta tell you,
13:31we gotta fix this a little
13:32bit of a downturn last year.
13:34Some of this is kovid.
13:35Some of this is, you know,
13:36the current environment,
13:37but we're going to bring this up and this.
13:39This is where our tissue samples come from.
13:41This is our innovation.
13:42This is how we help more patients.
13:45But our trials are very nicely divided.
13:47Very proud of this 40% or so of
13:50our accruals are the care centers.
13:52The lung team really is already
13:54multidisciplinary and already
13:55working between the care centers
13:57and you can see while 37.8% are
13:59industry were very active in the NCT.
14:02N with leadership in the in the swag.
14:06Several of the group have
14:08leadership committees.
14:08Leadership position in the lung
14:10Committee that Decker has leadership
14:11myself and several others that
14:13Cappelletti and you can see
14:14investigator initiated trials.
14:16About 10% we're going to do even
14:19more of those for the future.
14:21This just opened,
14:23I think Scott's probably downstairs
14:25putting someone on so this is
14:27an investigator initiated trial
14:28with the drug cyclic 15.
14:30What does it mean?
14:31Investigator initiated Yell holds the Ind
14:34Yell is fully responsible for this trial.
14:36We're getting the drug from next cure.
14:38A company that leaping has been
14:41involved with and we're getting the.
14:44Where the phase one studies were
14:45initially run and we're getting
14:47the Pebble is a map from work,
14:49but we're pulling out altogether.
14:50We're getting the biopsy.
14:51The biopsies will be picked up in the clinic
14:54by one of our team to go to David's lab.
14:56Will go to Kurt Slab.
14:58Only pings lab.
14:59This is how science has to be done.
15:01The best treatments and then
15:02understanding the mechanism.
15:03All that happening through the system.
15:06Just to finish up, we have a wonderful
15:08program in small cell lung cancer.
15:10This is led by and Chang, you know,
15:12small cell is a community type disease.
15:14I think it's one of the reasons why
15:16Anna smoking related to these two.
15:18Why we have so much care?
15:19Center accrual because some of her
15:21innovation with the care centers
15:23in this small cell program.
15:24And then lung cancer screening.
15:26I'm going to Clint Ocus in a bit
15:28but this is just been a phenomenal
15:30labor of love from Lynn and the team
15:32to get screening at multiple sites.
15:34And again it couldn't be more timely
15:37Cousins going to tell us a little
15:39bit about how screening is not only
15:41being done but it's being expanded.
15:44Community outreach and engagement.
15:45I mentioned that you know our lung map trial.
15:47Here I am with Doctor Joe talking
15:49to the Cultural Ambassadors the way
15:51you get trials out to the community
15:53as you go to the community,
15:55you talk on the radio programs.
15:56You go to. The churches were doing that.
15:59You were donating masks were creating.
16:00Navigators were going to do more of this.
16:04Now we have a network no, I mentioned.
16:07I'm here 10 years ago.
16:08Little bit more than nine years ago we
16:11brought in the first group Mo H 21 doctors.
16:14Now we have 15 sites where
16:16care can be delivered.
16:18I believe this is Westerly RI.
16:20Be nice to have a boat so look at
16:22all these sites that we have and
16:24we need to now expand and deliver
16:27multi modality care innovative care,
16:29protocol driven care or at least the
16:32best standard of care at all these sites.
16:34We're doing that,
16:35but we're going to do it even
16:37better as we expand.
16:38So Kevin Vest,
16:39who I've known since I got here,
16:42who's done so much for this endeavor,
16:44has spoken to this group before
16:46about the disease centers,
16:48pulling together things into a clinical
16:50research and education component,
16:52and inclusivity,
16:52cons of the wheel or working together.
16:55I'm not going to go into this into
16:58much detail except to say thank you,
17:00Kevin,
17:01because you gave us the resources
17:03and the and the stimulus to
17:06take lung cancer to this level.
17:08So now we have our cabinet and by the way,
17:11this is no way to mean that if
17:13you're not listed on the cabinet,
17:14you're not critical.
17:15They're going to work.
17:16Streams are going to be subgroups,
17:18but this is just the start.
17:19As we launch this, I've agreed.
17:21I have plenty else to do,
17:23but I'm passionate about this.
17:24I think as you all know,
17:25and I can work all the different areas.
17:28I'm going to be the coordinator for now,
17:30and I'm starting out as a coordinator,
17:32but Dan Boffa remains the clinical director.
17:33He's doing amazing job with this Scott.
17:35Get challengers,
17:36our Chief of Thoracic Medical oncology.
17:37Sarah Goldberg will be the research director.
17:40And Katie Poletti,
17:41the scientific director.
17:42They only speak working very closely with
17:44Kevin and with administrative staff,
17:47and this cabinet is meant to
17:49represent different disciplines,
17:50but also different centers.
17:52Suggestions at Greenwich,
17:53Vinny is at Bridgeport and I'm going to
17:57introduce them all in just one moment.
18:00So here's our panel.
18:01I did what I wanted to do.
18:0320 minutes.
18:03I've invited all this group to be here today.
18:06It's a new way to doing to do grand rounds,
18:09but having been on most of the
18:10grand rounds the last year I
18:12missed the interactive format.
18:13I think it would be interesting to.
18:15I want to see plenty of questions.
18:17I'm going to ask each of these panelists
18:19to be careful with their time.
18:21Ask them one to introduce himself.
18:23To tell them to tell us what they
18:25do and then tell us a little bit of
18:28something that's really exciting in
18:30your area and perhaps how you think we
18:32can bring that to the disease center.
18:34Thoracic disease center
18:35throughout Connecticut.
18:36So with that, I think I'll stop.
18:38I just went over knowledge.
18:39We have so much support from from the team,
18:42but also philanthropy.
18:43This is all philanthropy that
18:44comes to lung cancer.
18:46More on the way I hope.
18:47And we have peer reviewed funding as well.
18:51So I don't let me see if Lynn is on the line.
18:54Lynn's not here yet, so.
18:57After sort of do a Bayesian approach here.
18:59So let me stop sharing.
19:02And I'm going to put the screen up
19:05and let me ask the panel members
19:08to unmute and welcome you all,
19:10and thanks for being here.
19:13I guess maybe that the first
19:15word I'd like to introduce.
19:17Dan Boffa,
19:17who's the clinical director and
19:19Dan Lynn's about to be here,
19:21and I want to save the screening
19:23discussion for her.
19:24Can you just introduce yourself?
19:25Tell us a little bit about some of
19:28the innovations in surgery and why
19:30multimodality care is so important.
19:32Sure,
19:33thanks Roy.
19:33So for those of you who don't know,
19:37I'm one of the thoracic surgeons and.
19:42There have been a number of innovations
19:45in surgery that really tie to
19:47care delivery in general that one
19:50of our research interests in the
19:53division of Thoracic Surgery has
19:55been networks and how networks can
19:58function better to provide care.
20:00Air throughout the network.
20:02We've really identified a number
20:05of opportunities where satellites
20:07are are not performing at the
20:10same levels as the main campus,
20:12and we believe we've discovered
20:15several ways to improve that.
20:17The things that that that I so I've,
20:21I've served as the clinical director of top,
20:25and I think that moving into the
20:29next chapter is how do we bring?
20:33Our multidisciplinary care model to
20:35other centers across the network and and
20:38I I really tried to image what does care,
20:41feel like across the network.
20:43You know it and really just
20:46comes down to care.
20:48Really needs to feel like it's connected
20:50so that all of our centers are connected
20:54and all of our clinicians are connected.
20:57Care has to feel navigated and we've
21:00totally revamped our entire nursing
21:02model so that we now have practice nurses.
21:05We've essentially doubled the number
21:07of practice nurses across the threats,
21:10conchology program,
21:11and so that really,
21:12there's going to be somebody holding
21:15your hand that's identifiable
21:16throughout your entire cancer journey.
21:19And when there's a handoff across modalities,
21:21it'll be to somebody who's on that team.
21:25And finally, it's gotta be expert care.
21:28Anne.
21:28You know there's experts in clinical trials.
21:32There's experts in complex surgery.
21:36Need to be experts.
21:37We need to have the expertise
21:39to manage the whole package,
21:42not just the tough parts,
21:44but the general well being.
21:46And so we're trying to refine what
21:48it feels like to be a a patient
21:52in the thoracic oncology program.
21:54Throughout the entire journey.
21:55So what
21:56are some of the innovations we
21:58hear about robotic surgery, vats,
22:00surgery, different techniques or are
22:01we using that throughout our system?
22:04Yeah, they actually.
22:05So all of the surgeons do
22:08minimally invasive surgery.
22:09The right now three of the six,
22:13we're going to 7 in July.
22:16Three of the six do robotics,
22:18but by by hopefully by
22:21December or January next year.
22:23Five of the six will be doing robotics,
22:27but everything is done.
22:29You know, we do.
22:31The vast majority of things
22:33minimally invasive Lee.
22:35Um? You know,
22:36we're we're trying to grow bigger,
22:39but we're also trying to grow
22:42safer and try to grow stronger.
22:44And so we believe the the robotics
22:47platform is an important part of that.
22:50It's.
22:50But I also think that maintaining
22:52the principles of oncology and in
22:55doing complete resections safely.
22:57You know that's where the and matching
22:59people with the most appropriate
23:01treatment to their goals of care.
23:04I mean,
23:05that's really where the art and science.
23:08Come together.
23:10Thanks Dan and will get
23:11back to you in a bit Lynn.
23:14I thanks for joining so I hope
23:16your ears were burning so I showed
23:18some of those slides you you you
23:20loan me about the origins of
23:22top and actually was fortunate.
23:23I met Lynn about 20 years ago when
23:26when I first came through and visited
23:28Yale and then actually one key hiding
23:30my mentor who is a very strong advocate,
23:32unfortunately passed away a
23:33few years ago of prevention.
23:35We know we talked,
23:36we actually met for a summer to
23:38talk about prevention efforts.
23:39So then I thought you could
23:41introduce yourself.
23:42Say a few words about what you do,
23:43but there was some news within the
23:45last hour on lung cancer screening,
23:46so I did show your first slide show.
23:48The second slide.
23:48I can put it up if you want,
23:50but tell us what's so exciting.
23:51It's in the New York Times right
23:53now as we speak.
23:54OK,
23:55so as of 11:00 o'clock this morning,
23:57the United States Preventive Services
23:59Task Force revised its recommendations
24:01for lung cancer screening.
24:02So Roy, if you could put up the slide,
24:06OK, Paul is going to help me here.
24:09And so if you already
24:11showed this slide I had,
24:12you know that we've been screening on
24:15the basis of the eligibility criteria
24:17of the national lung screening trial,
24:19which occurred back in 2011.
24:23Unfortunately CMS dinner.
24:32Really, with the help of policy there,
24:34who is the nurse coordinator
24:36for cancer screening program?
24:38We've really taken off an this new
24:41recommendation had been out for public
24:43comment last summer and there was
24:45a great deal of controversy about
24:48expanding the eligibility criteria.
24:49But the bottom line is after
24:52that period of open comment,
24:54the new recommendations are to
24:56screen people who are ages 50 to 80,
24:59so they've decreased the entry
25:01age from 55 to.
25:0350 and with at least 20 pack
25:05years of smoking,
25:06and so that was decreased from 30 to 20.
25:09And that recommendation really was
25:11based on the Nelson screening trial
25:14that was done in Europe and this much
25:16more aligns with the eligibility
25:18for that trial which was broader
25:20than the national screening trial.
25:22You still have to be currently smoking
25:25or have quit within the past 15
25:28years which is came out of the NOST.
25:31And what that means is that the
25:34number of people eligible for
25:36lung cancer screening in the US is
25:39going to double from about 8 to 9
25:41million to 16 to 18 million people,
25:44and one of the big push is behind the
25:47expansion of the eligibility criteria.
25:49Was that both and LST and the
25:52Nelson study showed that there
25:54was actually benefit for everyone
25:56but more benefit for women and
25:58for minority groups sent for us,
26:01that's you know.
26:02People who are African American an
26:05there's a lot of debate.
26:07Still as to whether women Anne,
26:09certain minority groups,
26:11including African Americans,
26:12are more susceptible to lung.
26:15Carcinogenesis from cigarette smoke,
26:17but it is clear that those groups
26:20benefit more than other groups
26:22when you screen them and the whole
26:25point of lung cancer screening is
26:27to find people early because early
26:30detection means better chance of cure.
26:32It also lets us have a chance to
26:35talk to those people about smoking
26:37cessation which is a big part
26:40of the decision support visit
26:43that's mandatory before every.
26:45Before the 1st initial Screening Study,
26:47an having had the chance to cover for Poly.
26:50Recently, Anne and talk to 8 people.
26:53One day about tobacco cessation,
26:54an one of them quit on the basis of that,
26:58I think that that's a huge
27:00opportunity that actually will be
27:01expanded as well because of the
27:03change in the screening criteria.
27:05So we're pretty excited about that.
27:07That's going to be a huge amount of work.
27:10We have some time before CNS approves that,
27:13but CNS will approve it.
27:15If USPS TF.
27:16Recommended it,
27:17so we're going to be gearing up right?
27:19Well, listen it all about access
27:21then people need to have access
27:22to get this done and they have to
27:24have insurance or CNS coverage,
27:26so hopefully this will help with that.
27:28How have we done this past year with Covid
27:30we continue to screen a lot of patience.
27:33So everything shut
27:35down outpatient for a few months,
27:37but after that Poly we open
27:39screening at Young Haven, doing it,
27:42doing the decision support visits remotely,
27:44and so we've been meeting across the system
27:47with the screening program at Lawrence,
27:50which is very well established.
27:52Run by Lou Massarelli.
27:53Vinny Mazes has got the program
27:56at Bridgeport up and running,
27:58and there's they're starting
27:59to accrue screening population,
28:01and Greenwich is still
28:02in the planning process,
28:04but has a nurse coordinator.
28:07And so I think we can standardize something.
28:09Some of this is regional specific because
28:12of the way that the community practices,
28:14but it's been great to actually
28:16all get together and talk about
28:18what we can standardize,
28:20what our goals are,
28:21you know, to have the nurse
28:23coordinators working together.
28:24I think this is really going to accelerate
28:27things we've been screening at Yale,
28:29New Haven between 4 and 600 people a year.
28:33Um and we are working really hard
28:34to try to acquire or develop an
28:37epic tracking system that will
28:38allow us to actually keep track
28:40of all these hundreds of people.
28:42Actually a couple thousand at this point
28:44that we've accumulated and we want
28:46to be sure that we follow properly.
28:49That's great, you know,
28:50as much as we have these new targeted
28:53therapies and immunotherapy's
28:54preventing lung cancer or catching it
28:56early will help so many more people.
28:58And actually maze surgery or
29:00surgery and then chemo radiation.
29:01But first with surgery,
29:02tell us a little bit what you do.
29:05You're at Bridgeport and actually so
29:07you have an amazing screening talk.
29:08A few months ago so you
29:10obviously doing a lot of
29:12it there. Yeah no thanks allot you
29:14asked to talk about the Four WS, what,
29:17where and why. I'm Vinny, you know,
29:19I'm one of the thoracic surgeons, one of 6/2.
29:21Soon to be 7 like Dan talked about and I'm
29:25the site director for thoracic surgery at
29:27the You know Bridgeport Park Ave area.
29:30Been on the staff now for three years and
29:33really appreciate the opportunity to expand.
29:35I think you know one of the exciting
29:38things that you you talked about.
29:40Roy was. You know it's about,
29:42you know, being present and that it
29:45takes a village and I think that's
29:47one of the things that is exciting.
29:50As as we expand.
29:52You know at Bridgeport it's
29:54understanding the regional differences
29:55that Doctor Tanui talked about.
29:57But also how do we continue
29:59to deliver the same stand?
30:00So that the standard of care at
30:03Bridgeport Park Ave is exactly the
30:04same like it is with in New Haven,
30:07New Haven County or at York Street.
30:09And that's been a source of many
30:11discussions and we, you know,
30:12we work to achieve that,
30:14and that's one of the exciting things
30:16that as we continue to expand at Bridgeport,
30:19we're starting to roll out the
30:20enhanced recovery after surgery,
30:22which was started at York Street.
30:23And we're going to start rolling that
30:25out at Bridgeport here this summer and
30:28the lung cancer screening started off.
30:29We started off with a small
30:31lung cancer steering committee.
30:33Um, about three years ago,
30:34and you know,
30:35there was about 10 people that were screened,
30:37and now we're up to about 100,
30:39and there's 160 orders that are currently
30:41in place for lung cancer screening,
30:43so it's going to grow quite quickly.
30:46Well, thanks, Vinny,
30:47and you know the multi modality
30:49care is so important. Justin white.
30:50Tell us where you are and why is
30:52multi modality care so important
30:54and what is the importance of
30:56tumor board and and and and all
30:58working together in this way?
31:01Thanks for having me Justin
31:03Blasberg thoracic surgery.
31:04I work for Vinny and Dan with Vinny
31:07and Dan and Fort Vinny and Dan.
31:10I. I've been at Greenwich since
31:12the beginning of the year,
31:14and like Vinny said,
31:15we've been working towards bringing
31:17our standard of the New Haven campus
31:20across the network and Vinny's done a
31:22really good job doing that over the
31:25past couple of years and my goal at
31:28Greenwich is to mirror that success.
31:30On all fronts,
31:31including an ear *** protocol.
31:33Developing lung cancer screening program,
31:35bringing robust robotic surgery to Greenwich,
31:38which granted already has that
31:40capability but will be able to sort
31:43of bring our expertise to that campus,
31:45which is great for patients and
31:47then also our multi disciplinary
31:49clinics similar to what we have in
31:52this sort of the New Haven campus.
31:55There's a critical mass there
31:57of thoracic support,
31:58both a sunley for medical oncology.
32:01Bruce mcgibbon.
32:01And others from radiation oncology
32:04and an opportunity for us to see
32:06patients in a common space and talk
32:08about multi multi modal approaches to
32:10treating patients with either early
32:12stage or local regional disease.
32:14And so all of those tools are
32:16in place at Greenwich.
32:17And it's an exciting opportunity
32:19for us to to treat patients there
32:21as if they were on the New Haven
32:24campus or the Bridgeport campus.
32:27But it's amazing. We have surgeons,
32:28medical oncologists across all the
32:30campuses and of course radiation oncology.
32:32And when I call in all radiation
32:34oncologist Roy Decker and when I first
32:36got here I used to fall asleep at tumor
32:38board and they really were you thinking.
32:40Oh boy but Fortunately was Leroy Decker.
32:42They were asking opinion of so Roy tell
32:44us a little bit about radiation oncology.
32:47What's exciting new techniques
32:48and I know you also have another
32:50role in clinical trials.
32:51We'll get to that later.
32:53So I have to say first Thanks, Roy.
32:56And when Roy and I see each other
32:59in the hallway we say hi Roy Roy
33:02and it has not stopped being funny
33:05yet so I just keeps on going.
33:08So I'm right Decker.
33:09I've been here many many years now
33:12there were two of us Lynn Wilson and I
33:15were the thoracic radiation oncologist.
33:17When when top was born and we now
33:19have a large network of fantastic
33:22thoracic providers that serve.
33:24All of our sites,
33:26and I've recently turned over the
33:28clinical leadership of thoracic
33:29radiation oncology to Henry Park
33:31was not able to be here today,
33:34but Henry is done really an amazing
33:36job in creating a cohesive thoracic
33:38radiation unit that can offer all
33:40of our new technology and all of our
33:43exciting treatments at all of our
33:45sites in in a very uniform fashion.
33:48And so I give him a lot of credit for that.
33:53I am very excited to work with this
33:56group and and and I always have been
33:58and it has grown so amazingly over
34:00the last decade or more that it quite
34:03honestly it's it's difficult to keep up with.
34:05I remember we used to have discussions
34:07about what day the rest that clinic was,
34:10and I believe we are now a five day
34:12week operation so it's pretty exciting.
34:15Right, one of these protons I
34:17hear about it carbon and everyone
34:19wants the newest techniques.
34:21Are we moving towards any of
34:23those and are they better or
34:25do they need studies?
34:26Yeah, so so we are moving forward with
34:28a couple of new technologies so we are
34:31hoping to build a or planning to build
34:34a proton center that will serve our network.
34:38It will be a smaller proton unit,
34:42but it may benefit some of our
34:46lung cancer patients.
34:47So far, trials have not shown.
34:51A huge benefit to protons in lung cancer,
34:54at least not for all patients.
34:56But we think there may be a subset
34:58of patients that could benefit,
35:00and this is, you know,
35:02this is an enormous investment
35:03on the part of the hospital and
35:05and several of our partners,
35:07and we're excited to to to watch it grow.
35:10It's probably going to be 2
35:12years before we treat a patient.
35:14You know,
35:14we're also exploring other new
35:16technologies like biologically guided
35:18radiation therapy that will be very
35:19useful in the treatment of patients with.
35:22Metastatic disease so you know.
35:23Honestly,
35:24there's still exciting things coming from us.
35:27An excellent well let's let's take
35:29a little bit of a different tack.
35:31I'm going to get everyone but Katie
35:33Poletti know one of the reasons
35:35why I think were so strong on this
35:37long program with spores and stand
35:38up for cancer grants and more are
35:40ones that I can even count to press.
35:42Katie, you've been here over 10 years
35:44and really has formed the basis.
35:46You know with many other scientists but
35:48but is now our scientific Director and Katie,
35:50we've really seen the science
35:51of lung cancer grow.
35:53I know when when I went into
35:54this field 2025 years ago,
35:56no one wanted to work in this field, but.
35:58Anything, breakthroughs and only
35:59we only have a few minutes,
36:01but what's exciting about the science
36:03and how are you working to bring the
36:05science from the lab to the clinic and
36:07in your role as the basic science leader?
36:10Yes, thank you very much Roy. So I'm Katie
36:13politi. I'm a cancer biologist
36:15and have been at Yale for almost
36:1811 years now in the Department of
36:21Pathology and a medical oncology,
36:23and my laboratory focuses on
36:25understanding mechanisms of
36:26tumor initiation, progression,
36:27and the biology of lung cancer,
36:30as well as understanding
36:31sensitivity and resistance to
36:33different therapies in the disease.
36:35And I think that there are a lot of amazing
36:39things that we have seen developed.
36:41Over the years in lung cancer,
36:44an really here at Yale,
36:46we have amazing science that is
36:49happening in these different areas
36:51that are really making a difference
36:54in taking our findings in the lab and
36:57moving them to the clinic and then
36:59taking them into the community as well.
37:02And that goes from the identification
37:05of new targets for lung cancer therapy,
37:08whether they be targets that
37:10are inside the cell.
37:12The cancer cell,
37:13like EGF receptor for example,
37:15another oncogenic drivers or
37:17carass for example in the cell,
37:19but also that are tumor cell extrinsic.
37:22So targets in the micro
37:24environment and we have.
37:26You heard about this new next cure trial,
37:29for example, from Roy.
37:31That is an example of that.
37:34We also have a lot of groundbreaking
37:36studies in modeling lung cancer,
37:39so developing new and better models to
37:42study the biology of lung cancer and to
37:45study sensitivity and resistance to therapy.
37:48And again,
37:49this goes from really developing refined,
37:51genetically engineered mouse models,
37:53for example,
37:54that can be used to study.
37:56For example,
37:57the immune interactions between
37:59cancer cells and immune cells,
38:01with some of the pioneering work
38:04from various different groups here,
38:06like Nick Joshi like Leaping Chan
38:09like Richard Flavelle and others
38:11and also then to the development
38:14of models that
38:15can be used to really
38:17study the disease in patients.
38:19So patients arrived models where
38:22we can really study what is
38:24happening in those human tumors.
38:27And understand the biology of
38:28the disease in those contexts,
38:30and so with these different models,
38:32we can leverage them then to
38:35study mechanisms of sensitivity
38:36and of resistance to therapy and
38:38really get to some of these very
38:40difficult issues that are being
38:42faced by patients in the clinic.
38:44And so I think that those are just
38:47some examples of areas and things of
38:50work that is ongoing here at Yale,
38:52and I think this is a great
38:54place to really bring together
38:56this multidisciplinary research.
38:58Because of the really good
39:00size that we have of Yale.
39:02So at Yale where we have.
39:05The big clinical enterprise,
39:07but it's very,
39:08very connected also to the
39:10scientific enterprise,
39:11and so this is a really remarkable
39:14opportunity to bring everybody together
39:16and leverage the the infrastructure
39:19that is being developed through
39:21resources like this for for example,
39:23other projects that are
39:25happening here at Yale.
39:27Like the Generations Project,
39:29which is focused on germline
39:31sequencing in people individuals.
39:33For example the development of models
39:36and bringing these altogether.
39:38We're going to really work
39:40hard to leverage that and bring
39:42the science to the clinic.
39:46Thanks Katie, it's great to have
39:48worked with you and all of us.
39:51I appreciate that.
39:52But now we're going to really
39:54transform things even more.
39:55Scott Scott's just up from
39:57clinic I talked about.
39:58You already tell us about.
40:00You're here and how long
40:02are you at your now?
40:04You're on the screen. I've
40:07been here longer than most of you,
40:09Lynn's been here longer,
40:10but over over 15 years,
40:12and I've certainly seen dramatic
40:14change in our loan program.
40:17Great, now is that everyone
40:19sort of come together and
40:20then it's raster program.
40:21I think we're great model for other
40:24cancer groups because we have basic
40:25scientists are working with us.
40:27We have clinicians. We have things.
40:29We have all sorts of people working
40:31on the same same projects for me.
40:34My problem, my primary responsibility
40:36is treating my patients and we
40:38certainly have a good amount of
40:40patience and my second responsibility
40:41is to learn from my patients and to
40:44try to understand who responds and
40:46who doesn't respond so we can extend
40:49responses to all of our patients
40:51and for me, I do this with all of you
40:54and primarily with Katie Palladian.
40:56I we have a protocol where we we
40:59aggressively biopsy patients their tumors,
41:00their blood sites of toxicity,
41:02surrender stand. Who's responding?
41:03Why someone gets the
41:05toxicity to improve upon.
41:06What we have now and.
41:08I can tell you that from we have
41:11patients from early trials who
41:12are doing incredibly well now with
41:14immunotherapy's 10 years and plus
41:15how some people have never heard of.
41:17So my focus right now is to
41:20understand those patients.
41:20Why does a patient who has a
41:22prognosis of three months live 10
41:24years without any evidence of disease,
41:26and hopefully another 1020 years?
41:27Why can't we do that for all of
41:30our patients and with the help
41:32of Katie and everyone else,
41:33we're trying to get to that let me ask you,
41:36you've been here. You recruited,
41:37probably Wilson was director.
41:39Eddie Chu yeah.
41:40So tell me how did you get that first
41:42trial with Nivo Map was a trial that was
41:44being run with Mario tells the story.
41:46It's pretty exciting, no.
41:48So so I have my office is no Hall with
41:50Mario Show who's really a giant when it
41:52comes to immuno therapies for cancer
41:54and he one day just knocked on my door.
41:56Since I got this trial of this
41:58drug MDX 1106 and I said what is
42:01it Mario 'cause we certainly need
42:02things for our patients, he said.
42:04It's an immunotherapy and I said Mario,
42:06don't you know?
42:07Immunotherapy doesn't work for lung cancer?
42:08We've been doing it
42:09for decades. All the trials are negative and
42:12Mary said just just believe me,
42:13just try this.
42:14A different type of immunotherapy.
42:15So we put a few patients on
42:17trial and the first thing I
42:19noticed was that these patients
42:20were tolerating therapies
42:21incredibly well. Most of
42:22patients back then were
42:23going on phase one trials,
42:25which were very harsh.
42:26You know combinations of
42:27chemotherapy and targeted therapies.
42:28The first thing these patients
42:29really where we're having detriment
42:30in their quality of life.
42:32And then we started seeing the responses.
42:34That was about 10 years ago and
42:36we still a patient from that
42:37first trial who are
42:38doing well after finishing their course
42:40of therapy over a year or two now.
42:428-9 years later,
42:43without any evidence of cancer,
42:44so I attribute that to Mario,
42:46who introduced me.
42:47And then from there it was
42:48easy with what we needed
42:49to do. I still remember going to Scott's
42:51office when I was interviewing here.
42:53Can you show me some of those films and?
42:57Again, they were not doing
42:58this at MD Anderson.
42:59They were not doing this at memorial back.
43:02Bring it here to my board every every week.
43:04We have a tumor board.
43:05We probably need more of them as we expand.
43:08We look at radio radiology
43:09Isabel so you have a hard job.
43:11In fact, we hit you with like 20
43:13cases on a Friday and you have to
43:15look at all the films on the weekend.
43:18You and your team tell us
43:19a little bit who you are,
43:21what you do and tell us about
43:23radiology in lung cancer.
43:25Thank
43:25you for having me here.
43:27I miss about quarter past.
43:29See, I've the section chief of
43:31Thoracic Imaging here at Yale.
43:33First started here in 2010 when
43:35when working with Lee and Anne
43:38Frank back then with Amanda and.
43:40Trying to do the first cases
43:42of lung cancer screening,
43:44there was challenging, so I
43:46think we have been involved in all
43:48aspects in terms of thoracic malignancies,
43:50from screening to assessment of treatment.
43:52We work closely together with laying with
43:55the surgeons with Frank on their screening.
43:57We provide the reports in a
43:59way that can help declination
44:01with the lung RADS evaluation.
44:03We also have worked a lot
44:05on incidental findings
44:06which was a big problem when
44:08you first start scanning.
44:09A lot of people you see all the other
44:12things thyroid nodule adrenal nodule.
44:14Coronary calcium and what to do with those?
44:17So we try to implement that
44:19on our report to guide their
44:22referring physicians who may not
44:24know what the next step would be.
44:26We have been expanding the lung
44:28cancer screening as well,
44:29together with that special
44:31clinical to trying to reach
44:33more and more sites. We sister
44:35started here. I think we evolved
44:37a lot when in Mar imaging of
44:40thoracic malignancies as well.
44:41Since 2010 we have been applying
44:44more MRI for mediastinal tumors in
44:47characterizing anterior mediastinal,
44:48particularly thymoma,
44:49and versus dynamic hyperplasia,
44:50or the differentials
44:52before surgical excision.
44:53Before treatments.
44:54We had recently start looking at MRI,
44:57the ability
44:58to assess post radiation
44:59changes in lung cancer,
45:01in combination with pets,
45:03so there is a lot of
45:05research going on that as
45:07well. If you can be better or complementary
45:11to pet City, which is hard with.
45:13All the information for radiation and
45:16the other area that mean radiology
45:19is always quickly evolving.
45:20We have a lot of machine
45:23learning artificial intelligence. One of
45:25the fields that we think
45:27could be applied is that.
45:30As Scott, without some patients get
45:32document the immunotherapy or the therapy
45:35and they get progression on imaging.
45:37But later on you go back and
45:39was actually pseudo progression.
45:41So we're trying to see if we can
45:44come up with machine learning model.
45:46They can analyze additional
45:48texture analysis of
45:49these cancers on that city that our
45:52eyes cannot do an if we can try to
45:55differentiate pseudo progression versus
45:57true progression early on in therapy.
46:00Always about, you know.
46:01Expertise in radiology across the
46:02whole network is is critical and
46:04we have a tumor board every week.
46:06As I said, Rob Homer is a constant there.
46:08Looking at that issue you've been
46:10doing this since I've been here.
46:12Robin and will have Kurt Chopard speak a
46:14little bit about more research pathology,
46:16but tell us, Rob,
46:17you know what is your role.
46:19So you do you review all the
46:20pathology before we treat before
46:22we make a diagnosis here?
46:23Even if it's from the outside.
46:25First of all, I
46:26wanna thank you for letting me talk today.
46:29That's really great.
46:30Lynn Tanui, I have the old folks.
46:32I've only been in jail since for 42 years,
46:35so not here my whole life.
46:37But so far so the role pathology really
46:40is sort of central to the whole process.
46:43Everything sort of narrows
46:44down through the you know,
46:46the eyes of some histopathologist somewhere.
46:48It's actually make a diagnosis.
46:49So clearly I represent a lot of
46:52people behind me. It's like.
46:53There's a lot of people in not just at Yale,
46:57but at other places.
46:58Cytology, other his pathologists.
46:59And so you know the case of the
47:02wind up in tumor board course.
47:03Do most of those go through some pathologist?
47:06I might May may not review all of them.
47:08Certainly any cases that are
47:10little unusual or exceptional.
47:11I've tried to put my eyes on and I
47:13know that pathology language is not
47:15something that is not English, right?
47:17It's sort of even even for doctors.
47:19It's sort of funny language,
47:20and so there's a certain amount of
47:23interpretation that needs to go in.
47:24And a little bit of spin to help explain,
47:26because some things are very straightforward,
47:28somethings not so much.
47:29So of course,
47:30the other things we're looking
47:32forward to in terms of what's new,
47:34what we're excited about.
47:35Small cell is really kind of been sort of.
47:37Not much going on with it for forever,
47:40and we're kind of excited that subsets
47:42of small cells sort of shown up.
47:44I've been involved in a little bit of that.
47:46I expect that we're going to be
47:48giving that up into something more,
47:50hopefully more approachable,
47:51and in terms of the Department.
47:53You know, we've moved.
47:54We had used a relatively small
47:56panel from most lung cancers.
47:57Now we've sort of moved to
47:59a much larger panel for a.
48:01Of genetic abnormalities that
48:02we can do on a routine basis,
48:04which is great,
48:05and with,
48:06you know the assistance of the new
48:08chair of the Chen and the hospital.
48:10We're hoping to move digital
48:11pathology into the features so we
48:13can actually do a better job of
48:15sharing images across the network.
48:17You know,
48:17moving physical pieces of glass around
48:19to seems very antiquated and hopefully
48:21we're going to sort of move forward in that.
48:23And that's really going to,
48:25you know,
48:25that's really going to open up,
48:27you know,
48:27in the same way that Isabel talked
48:29about digital image analysis,
48:31or.
48:31In a computer assisted work for radiology,
48:33that's really the first step to start
48:35doing the same thing for pathology images,
48:37which we hope to get to
48:39at some point as well.
48:41Yep, thanks Robin for everything
48:43you do and it's good to know.
48:45Every Monday morning we might not be there,
48:47but you're there and and you know really,
48:49keeping the tumor board running
48:51and no will do more of that.
48:53So you know when I when I
48:55came here to build us for,
48:56it's really based on tissue.
48:58Yeah, strong statistician.
48:59You of course need a science.
49:00So I was fortunate to meet
49:02David Rim in David Rim.
49:04As you all know, is involved in all
49:06the sports here at Yellow Three.
49:08Now they all rely on David and David.
49:10Still very involved with us but.
49:12Um, what is it?
49:13Current 4-5 years ago, he said,
49:14I've got this this guy in my lab is great.
49:17We've got to keep him here.
49:18I don't want to go back
49:20to Chile and he did it,
49:21and that skirt shopper in Kurt's just
49:23been a wonderful collaborator or
49:24scientifically and therapeutically in
49:26his lab and the Corps 'cause you gotta,
49:28you gotta collect that issue and
49:29get it in the right place and
49:31get it from all these centers so
49:33Kurt tell us a little bit about
49:35yourself and what you do.
49:36And thanks for being here today.
49:38Thanks
49:39Roy. So I'm Kurt chopper.
49:40I'm a pathologist,
49:41an immuno oncology researcher.
49:43I joined us an assistant professor
49:45and was appointed in 2015 and
49:47we have had a very active.
49:48I got any program actually look up today
49:51and we have 64 publications since 2015.
49:53More than 20 trainees and a lot of grants
49:56including a number of NIH and DoD grants.
49:59So we have been VC. But it's a.
50:01It's a great environment
50:02to be able to achieve this.
50:04The other thing we have been
50:06focusing on is trying to enhance
50:07our capacity to do sort of further
50:09molecular analysis of samples,
50:11and we have implemented a lot of technology
50:13to be able to be ahead of the game,
50:16and now we're trying with Dave Rim.
50:17Actually,
50:18to move some of these technologies
50:20into the clinic with the goal of
50:22having diagnostics that no one
50:24else has in that we're focusing on.
50:26The other aspects of my function within
50:28the top program has been to oversee
50:30the biospecimen repository that was,
50:32as you mentioned,
50:33initiated by link to New Years ago,
50:36and we have been able to grow it at
50:38infrastructure and also be able to
50:40disseminate the samples and we have
50:42a very rich repository that I would
50:45love everyone to use at some point.
50:48And finally the other aspect of
50:50what I've been doing is after a
50:52lot of effort from from Euro in
50:54Mario at Gaston Dave Ramon.
50:56Also,
50:56they'd have to.
50:57We have created a platform that
50:59we can use to be able to use some
51:01of these molecular methods in
51:03the context of clinical trials
51:05and really learn from them.
51:07And over the years since 2015
51:09we have actually been able to
51:10work with seven clinical trials,
51:12three of which are IIT's and
51:14we have been collecting,
51:15processing and analyzing samples in ways
51:17that very few people can in the world.
51:20I'm hoping to have a, you know,
51:22learn from it and be able to
51:24go to the next stage,
51:25so again, it has been busy.
51:27It has been very happy,
51:28very productive,
51:29and I'm very proud of being part of
51:31this team. Thank you.
51:32Thanks for all you've done and all
51:34the men tease know that I hope this is
51:36coming out all the students and medical
51:38students and fellows that are working
51:40with these labs and the basic labs.
51:42The clinical labs working between the
51:43different areas of a few more minutes.
51:45Vanna Dest, so operations and the
51:47clinic and the nurse practitioners
51:48I'm sitting up here because someone
51:50is finishing up the clinic for me.
51:52We were team.
51:53We work together and that has been a glue.
51:56Tell us a little bit about your
51:59thoughts about expanding thoracic
52:00cancer unit to all the different areas.
52:02With a multi modality
52:04flare. Avana Sir,
52:05thanks right?
52:05So I'm the senior program manager of
52:08this Milo Aips and I've been here.
52:10It's Milo and working as a
52:12thoracic oncology ATP since 2013.
52:14I do represent the patient care services
52:16on this thoracic oncology cabinet and
52:18the goal of patient care services,
52:20which is directed by Kim Slusser.
52:23Is really to advocate and to support for
52:25the growth of the Thoracic Oncology Center.
52:28In? With that, we're trying to improve
52:30the system issues workflow issues,
52:32providing the infrastructure that
52:33we need to expand and succeed,
52:35as well as continued
52:37recruitment in education.
52:38It really takes a dedicated and
52:40experienced team to deliver this expert,
52:42compassionate care to our patients,
52:44and I have to echo what
52:46everyone else has been saying.
52:47We have a very gifted team that is
52:51formed a multidisciplinary partnership.
52:53Our services include surgical oncology,
52:55radiation oncology, medical oncology,
52:57pulmonary pulmonary intervention,
52:58pulmonary screening,
52:59smoking cessation and our team is huge.
53:01I mean, as everyone has been saying,
53:04it really does take a
53:06village to make this work.
53:08It's not just one particular
53:10Department or one particular
53:12specialty that makes it all happen.
53:14So our team is made up of
53:16physician and nursing leadership.
53:18Our providers,
53:19both physicians and the advanced
53:20practice providers are new patient
53:22coordinators practice nurses.
53:24Our clinical trial team,
53:25which is outstanding.
53:26Our medical assistants and
53:28ambulatory care associates and
53:29the other partners of our team,
53:31which are the infusion nurses.
53:32I mean,
53:33they're really with our patients
53:35side by side when it comes to
53:38other medical oncology patients.
53:40Pharmacy social work.
53:41Palliative care.
53:41The checkout people that people that
53:43are doing the financials radiology
53:44interventional radiology pathology
53:46laboratory in our clinical secretaries.
53:48I mean,
53:48we truly have a world class team and
53:51I'm really happy to be apart of it.
53:53I mean,
53:54I think our goal is really to bring
53:56what we have at smilow to all the
53:59other delivery networks and to make
54:01sure that we have that one signature
54:04care for all of our patients.
54:07Absolutely a fully integrated team
54:08and with the best innovation of
54:10science and technology and and now,
54:12I'm sorry I didn't forget you.
54:14I was saving you for last.
54:15So Sarah Goldberg is our research
54:17director and I still remember you're
54:19here about eight years now, right?
54:21Sarah or so.
54:22I still remember I was on a trip
54:24spending hours trying to recruit Sarah
54:26to get her to calm down Lincoln.
54:28I really desperately wanted her to come
54:30from mass general and get a farmer.
54:32So Sarah tell us a little bit
54:34about you know and I'd like to
54:37introduce Kuraan Jennifer too.
54:38About the the lung research team and
54:40how we meet in and and how we're
54:42staying on the cutting edge and
54:44some some some thoughts and then
54:46well then we'll open for questions.
54:48Well
54:49thanks right?
54:49This is an amazing forum to bring everybody
54:52together and talk about our program.
54:54I'm Sarah Goldberg, a medical oncologist.
54:56I've been here for almost 9 years now, right.
54:59And so I think you've heard from
55:01from so many people in the group.
55:03We have this amazing team and I think
55:06so much of what many of us have.
55:08Not really all of us focus on is is
55:10advancing the care of patients with
55:12lung cancer and so much of that is
55:15through clinical trials and basic
55:17and translational research that helps
55:19inform our clinical trials and so.
55:21We've done so much over the last
55:23few years to improve the care
55:25of patients with lung cancer or
55:27targeted therapies have come so far.
55:28We have, you know,
55:30so many more therapies that we can offer.
55:32Patient Scott mention immune therapy
55:34were starting to understand resistance
55:35and how to overcome it and so now it's
55:37really bringing that to the next level
55:39and advancing things even further.
55:40And so, as I mentioned,
55:42we have this amazing research team we meet.
55:44We used to have one meeting a week and
55:46now we we have so much to discuss.
55:49I think we're up to like 2-3
55:51meetings a week where we all.
55:53Get together and discuss various aspects
55:55of our clinical research program.
55:57So huge driving forces behind that
55:59are key Republican Jennifer Pope
56:01from the clinical Trials Office.
56:03And they've done so much to help us make
56:05our clinical trials of reality open up.
56:08You know,
56:09the best trials,
56:10I think for our patients and
56:12keep things running smoothly.
56:13So I'm turning it over to them
56:16to introduce themselves and.
56:18And tell us about what
56:19they do. OK, very good
56:21once you go 1st Gen. Hi
56:23everybody, I'm Jennifer Pope.
56:25I am the clinical trials team manager
56:28for the Thoracic group and I'm
56:30relatively new to this team but not
56:32new to the clinical trials Office.
56:34And I am looking forward to continue
56:37to work with Doctor Gettinger and work
56:40more closely with Doctor Goldberg
56:43and hoping to bring some more trials
56:46open quicker and to try to find
56:48the best trials for the patients
56:51that we have across the network.
56:53So looking forward to that.
56:55Yeah, thanks for
56:56all you've done and will continue to do KERA.
57:01Hi everyone, thank you for
57:03having me and your public.
57:04I've been at Yale now for 12 years.
57:07This year, eight of which which
57:08had been in the clinical Trials
57:10Office and I've had the pleasure of
57:13working with many of those on the
57:15panel over the last several years.
57:16I'm currently one of the assistant
57:18Directors of clinical trials operations
57:19in the Clinical Trials Office,
57:21under Director Joyce Tool.
57:22So I'm responsible for the lung Melanoma,
57:24therapeutic radiology and head and neck
57:26clinical trials disease teams from
57:27an operational compliance standpoint.
57:29I work closely with the research team,
57:31the team leaders, managers, regulatory.
57:33Our hospital partners.
57:33It really does take a village is
57:35so many of you have already said
57:37and I want to say to that the
57:39investment of the research team is
57:41really inspirational on this team.
57:42The Link team is fortunate to have some
57:44really incredible and veteran team members.
57:45They have two research nurses who
57:47are as dedicated as they come.
57:48They've been here for years series
57:50who are dedicated to doing the
57:52right thing for the patients.
57:53Gen Pope,
57:53who's new and who's been an excellent
57:55addition to the team and I just want
57:57to really take time to recognize
57:59all of their efforts as well as
58:01our regulatory partners in our
58:02regulatory manager, Christine Lee.
58:04It really does take the hard work of
58:05everyone to make what we do possible.
58:07Thanks Kera Ed captain,
58:09I don't know if you want to light
58:11up your camera, but I just want.
58:13I just thank you for all you do for
58:15for multiple teams with certainly
58:17the lung Groupon and the lung Spore.
58:19And if you are able to say a
58:21little bit about big data and how
58:23we're using the database at Yale.
58:28Hi Roy, I wasn't expecting
58:29to be on camera here.
58:30I have the sun in my eyes
58:31and I gotta get you in
58:32front of me.
58:34Yeah, so Wade Schultz with the
58:36hospital has been working very
58:37hard to get his computational
58:39health platform up and running,
58:40and I think we finally have. Have
58:43it to a point where we can start
58:46to use it with with our science with
58:48our patients, so it should be exciting.
58:51He just gave a presentation last
58:53week on the new C bio portal
58:55implementation that he has there.
58:56So a lot of our data will be going
58:59into that system that we can,
59:01you know, sort of democratize our
59:03our data for research purposes.
59:04So that should be good.
59:08We have a few questions where we're at time,
59:10but you know this is like having
59:12our first Cabinet meeting.
59:13It's great, so I'm going to say
59:15there are three great issues that
59:17we have to attack tackle access.
59:19Um community and impact.
59:20Now these are three things I'd love to see.
59:23This team really, really tackle.
59:24I'm noticing the last three or
59:26four minutes anyone from the
59:28panel want to give me some ideas,
59:29something that how we get it.
59:31How we do that, how we get more
59:33patients treated here on protocol?
59:35How are we going to have even
59:37a bigger impact in our work?
59:38And how are we going to do seoi?
59:41Which is just so important?
59:42Treat the people that live in our in our
59:45community and want to comment on that.
59:49I'll say and in terms of clinical trials.
59:51You know, we've done a lot of this
59:53over the last few years already,
59:55and I think it's worked incredibly
59:57well where you showed our clinical
59:59trials numbers. I think we.
01:00:00I don't feel like we could do better,
01:00:02but we I think we've been doing very
01:00:04well in trying to bring our trials
01:00:06to the community as much as possible
01:00:08and a huge part of that is, there's.
01:00:10People in all of our care centers.
01:00:13Or maybe I'll say most of our care
01:00:15centers who really join in our weekly
01:00:17meetings and their part of the team
01:00:19they you know they give input on to
01:00:21what trials we should open and what
01:00:23would be good to have in the Community.
01:00:25And I think we all make every effort
01:00:27to open trials and bring the protocols
01:00:29to the care centers whenever we can,
01:00:31and when that's not possible,
01:00:32I think having all the clinicians
01:00:34informed about what's available at the
01:00:36main campus is also really important
01:00:37and we try to do that as well.
01:00:39So I think that brings.
01:00:41And best carrot,
01:00:42I think most of us agree is on a
01:00:43trial it to to the places where the
01:00:45patients are being treated and an if
01:00:47not bringing the patients to the trials.
01:00:50Any other comments or thoughts?
01:00:53Vinny, you're in Bridgeport.
01:00:54That's an area that certainly I
01:00:56would hope you'd want to reach
01:00:57out to the community and help
01:00:59people to navigate and get in. How
01:01:00are you guys doing
01:01:01that? Yeah, I think you know you in
01:01:03your introductory you showed a picture.
01:01:05I think you were at a church
01:01:07or you were out there.
01:01:08You know getting to know the community,
01:01:10and I think that's you know,
01:01:12that's one of the key things
01:01:13is in order to improve access,
01:01:15you have to get out their boots
01:01:16on the ground to understand
01:01:18what some of the obstacles are,
01:01:20what some of the knowledge deficits are.
01:01:21So you know, we've had.
01:01:23You know I've had a lot of you know,
01:01:26you know, lunch meals that you know the,
01:01:28you know we've been fortunate enough to
01:01:31get out there pre covid to meet people,
01:01:33meet different primary care doctors.
01:01:35I've given a couple talks.
01:01:36One was at the home for the Brave,
01:01:39a place in Bridgeport that actually
01:01:41houses homeless veterans to talk about
01:01:43lung cancer screening to kind of learn,
01:01:45not just give a talk, but to learn about,
01:01:48you know what the access issues are to
01:01:50get those folks plugged into our system,
01:01:53'cause sometimes they.
01:01:54They just don't know.
01:01:55There are still people in the
01:01:56community that think that the Yale
01:01:58is just down in New Haven and it's
01:02:00getting out there to educate them
01:02:01that you know we're right next door.
01:02:03You don't have to go far,
01:02:04so that's that's one of the
01:02:06methods boots on the ground.
01:02:08Hey, any other accounts,
01:02:09if they have one final question,
01:02:10I see Vince DVD on the line so we had
01:02:12a grand rounds three or four years
01:02:14ago when we talked about actions,
01:02:16disease and curing that
01:02:17can we cure lung cancer.
01:02:19What do people think, Scott?
01:02:22Depends on how you define cure,
01:02:24but yes. Radeker yes, I think so.
01:02:31In what way with chemo radiation
01:02:33or with the targeted therapies,
01:02:34the immunotherapy? I
01:02:36mean, I think ultimately we're going to
01:02:37turn this into a chronic disease, right?
01:02:40So you will see that over
01:02:41the course of your careers,
01:02:42what do you think Katie from the lab?
01:02:44What's the most exciting thing
01:02:46coming out of the lab? Well,
01:02:48I think we're releasing some
01:02:50drugs that are now showing efficacy
01:02:53on some targets that have for
01:02:55a long time been thought to be
01:02:58undruggable targets, for example,
01:02:59like drugs that are targeting carass,
01:03:02which accounts for quite a
01:03:04large subset of lung cancers.
01:03:06And so when we start to see things like that.
01:03:10So our understanding and having drugs
01:03:12that can target these undruggable
01:03:15targets an you add on to that then.
01:03:18Other modalities of treating this
01:03:19disease and then bringing it into earlier
01:03:22stages and screening and detection.
01:03:24I think we're going to see even
01:03:26more improvements in survival than
01:03:28we have seen in the past few years.
01:03:31I agree we have to end,
01:03:32but Vince just run in the chat.
01:03:34You already are in a few cases
01:03:36which coming from him means a lot.
01:03:38I think that we're making a difference,
01:03:40but it only matters if we get access.
01:03:42If we screen people and
01:03:43we find these mutations,
01:03:44we figure out how to treat resistance
01:03:46and then of course immunotherapy.
01:03:47And we need to personalize that Kurt.
01:03:49I think some of the work you're doing,
01:03:51you know with all your quantitative
01:03:53unit chemistry with David and
01:03:54others that that perhaps could
01:03:55have our role there, correct?
01:03:57Yeah, you know, I think Roy,
01:03:59I think that it's critical to
01:04:01understand the patients better,
01:04:02not only have new drugs have being able
01:04:04to use the drugs in the right patient,
01:04:07and that I think is what
01:04:09we're achieving and expanding,
01:04:10and that will certainly
01:04:11contribute to better care.
01:04:13Well, listen, it's been a great panel
01:04:15and we've had our first Cabinet meeting
01:04:17in public and will do more of these.
01:04:19And we're going to.
01:04:21The goal is to raise the bar for patients.
01:04:24Uh, and and do it. We have all
01:04:26the pieces in place at the center.
01:04:28We're going to do this in
01:04:29other disease areas too.
01:04:30Thank you Kevin.
01:04:31Best for all your help and
01:04:32inspiration to all the team.
01:04:34And really there are so many other
01:04:35people that aren't on the panel that are
01:04:37part of this and we're really thankful.
01:04:39Thank you all and see you next week
01:04:42at grand rounds.
01:04:43Thank you.