November 16, 2018
Lung Cancer Moon Shot team is learning the most from patients
BY Clayton R. Boldt, Ph.D.
Despite a plethora of new and promising treatments available, lung cancer remains the leading cause of cancer death in the United States, and will claim more than 150,000 lives this year. November is Lung Cancer Awareness Month, a time to bring the disease into focus and educate people about prevention, screening and treatments that save lives.
MD Anderson’s Lung Cancer Moon Shot™ team is committed to making new, patient-guided treatment options available for those that need them. The effort is part of MD Anderson’s Moon Shots Program™, a collaborative effort to accelerate the development of scientific discoveries into clinical advances that save patients’ lives.
Don Gibbons, M.D., Ph.D., associate professor of Thoracic/Head & Neck Medical Oncology, is one of the faculty leaders for the Genomic Marker-Guided Therapy Initiative (GEMINI) under the Moon Shot™. He spoke with Cancer Frontline about this project, which collects detailed clinical and molecular information from lung cancer patients that guides the Moon Shot’s integrated approach to treating lung cancer.
Q: Can you briefly describe the GEMINI project and its goals?
A: GEMINI is one of three flagship projects within the Lung Cancer Moon Shot, with the others focused on early detection and prevention. We see GEMINI as an engine for discovery and rapid clinical translation to patients. The overall idea is to profile all the lung cancer patients treated at MD Anderson, regardless of the type of treatment they get or who their physician is. All of the patient information then goes into the GEMINI database.
The idea is to document the patient experience as they go along and learn how they respond to their treatment. We then want to use the molecular data to learn from our patients and guide the most appropriate therapies. So, GEMINI is a large overall effort, with both laboratory and clinical research components, and clinical trials based upon what we’ve learned.
Q: What types of questions are you hoping to answer with the GEMINI database?
A: There is a rapidly changing landscape in lung cancer, with almost two dozen new treatment indications in the last several years. With that, we’re working to identify patterns and trends that tell us which of our patients are responding better to which drugs. This allows us to rapidly identify subgroups that don’t respond well to standard therapies so we can bring new agents forward quickly, through strategic discovery efforts and clinical trials.
Originally, we wanted to slice up the pie and define all the molecular drivers of lung cancer. Of course, now the pie has changed completely with the advent of immunotherapy. Now we’re trying to do the same things with immunotherapy that we’ve done with targeted therapies. For the 20 percent of patients that respond to immunotherapy, why do they respond? For those that don’t, why not? Can we identify molecular drivers that differentiate these groups?
So, we’re using the database in a variety of different ways. It’s the central database for all patients on standard-of-care therapy as well as MD Anderson trials and even multicenter trials. We have an entire series of immunotherapy-based initiatives, like the Immunogenomic Profiling of Non-Small Cell Lung Cancer (ICON) project as well as NEOSTAR and LONESTAR trials, which revolve around the GEMINI database. It’s always something central we can come back to, to learn the most we can to better treat our patients.
Q: What advances has GEMINI enabled so far?
A: GEMINI has been fantastic. One of the best examples is poziotinib, and that's really changed the standard of care for lung cancer patients with certain mutations in EGFR. We're hoping that in the next year, there will be an FDA approval around that.
We’re also really proud of all the immunotherapy-based efforts. With the ICON project, we’re working closely with the Translational Molecular Pathology Laboratory and others to perform immune profiling of early-stage patients who have surgery. We have a huge multidisciplinary team we’ve assembled to deeply profile all the tumors from these patients, and we’re following those patients over time to match up their immune profiles with their response to treatment.
From there, we’ve been able to launch the NEOSTAR, LONESTAR and other trials, using the infrastructure we’ve built through the Moon Shot. With these trials, we’re learning if different immunotherapy treatments or combinations should be used to treat early-stage patients to potentially cure more patients going to the operating room. This is the GEMINI effort around immunotherapy, and it’s allowed us to really start to bring these questions forward, rapidly translating new targeted and immune-based therapies into the clinic.
Q: What are future plans or goals for GEMINI?
A: Our future plans are really a continuation of where we are. This has been a rapidly expanding and evolving effort. One of our first priorities is to complete the trials we have ongoing now. We think that each of those are important in their own right and will potentially define a new standard of care, so a new baseline that we start from. Obviously, we're going to continue to push forward the immunotherapy space, especially in early-stage disease or in new combinations. We think this effort will be essential to that. We’ve also begun developing a whole panel of trials and efforts focused on adoptive T-cell therapies, which we’re very excited about.
Q: How has the Moon Shots Program enabled you to work in new or more effective ways?
A: First of all, the Moon Shots Program has enabled these big collaborations across the institution. Our trials are collaborations across multiple departments at MD Anderson, and our work would not be possible without the Moon Shots platforms, whether that is the Cancer Genomic Laboratory, the TRACTION platform, the Institute for Applied Cancer Science — the list goes on. Having this sort of in-house expertise has been absolutely vital to getting these projects moved forward.
I also think the Moon Shots Program has provided valuable support to projects that wouldn’t easily be funded through standard grant mechanisms. That’s in large part due to the scale of our work. These are enormous efforts requiring collaborations between many teams here at MD Anderson over several years. That’s the sort of thing you’re not going to get federal support for.
On the flip side, now that we have collected all this data, we can go out and get grants to answer specific questions, and that’s allowed us to really leverage the Moon Shots support. It’s also been critical in engaging with our industry partners. They see what we have in place with this database, and they know this data could help speed drug discovery or get the right drug to the right patients more quickly. It’s a real opportunity, and that’s brought a lot of partnerships forward. The Moon Shots Program has allowed us to really engage with partners, to do things more rapidly, to get the funding in place, and to have sustainable efforts in a way that would not have been possible otherwise.