November is Lung Cancer Awareness Month. Lung cancer has historically had a poor prognosis, but new immunotherapies and targeted therapies have provided improved outcomes for patients. We spoke with Stanford Cancer Institute Deputy Director, Heather Wakelee, MD, about her involvement in a practice-changing clinical trial, recent advances in lung cancer therapies, and more.
Dr. Wakelee is a thoracic oncologist and clinical research leader at Stanford School of Medicine. She serves as the Division Chief of Medical Oncology in the Department of Medicine. She also serves as the President of the International Association for the Study of Lung Cancer (IASLC).
How did you decide to become an oncologist?
I knew from a young age I wanted to be a doctor. In medical school I was drawn to oncology because I really admired their ability to have close relationships with patients as they travel through a cancer journey. I also felt like there was so much more that needed to be done in the field of oncology. I was particularly fascinated by the promise of immune based cancer therapy, and am thrilled to see how far that field has come.
Could you let us know about the lung cancer research you are currently involved in?
Most recently I was able to lead a practice changing trial with the immune therapy (PD-L1 antibody) atezolizumab for patients with early stage lung cancer that has been removed by surgery. This trial, IMpower010, enrolled patients with resected early stage lung cancer and, after they had chemotherapy, randomized them to get a year of atezolizumab or observation. The study showed that for patients with tumors that expressed the marker PD-L1 the atezolizumab significantly improved their progression-free survival. We think, with more time in follow-up, this could lead to an overall survival benefit. In early October 2021, the FDA approved atezolizumab for use in the adjuvant (post-surgery) setting for patients with resected early stage lung cancer that has PD-L1 expression based on these results!
Lung cancer has historically had a poor prognosis. What are you most excited about when you think about the latest advances in lung cancer therapies?
It is very exciting that we can individualize therapy for most patients with lung cancer. When I started in this field, we only had chemotherapy. Now, we have 10 molecular targets to look for in lung cancer with targeted therapy if we find the right tumor mutation. And we have immune therapy, which tends to work better against tumors that do not have molecular targets. We think about lung cancer as different types, and usually either have targeted therapy or immune therapy to offer in addition to chemotherapy. This has made a big difference for many patients. The idea of being able to personalize the therapy is what is most exciting (and of course taking what we learn from metastatic lung cancer and being able to use those treatments to cure more patients with early stage lung cancer as well).
As a leader in thoracic oncology and clinical research, what changes do you want to see at Stanford, as well as at other institutions, to encourage women to become leaders in medicine?
I think that awareness that there have been—and there still are—factors that have held women back from leadership positions is a really important step. Leadership training starting from early in career for more people can make a big difference, as well as people being willing to speak up if they see discrimination. Usually discrimination is pretty subtle, so we all need to be aware and take an extra pause to make sure we are thinking about ALL the potential qualified people whenever we are working on developing the participants (and co-leaders) on a project/paper, or developing a speaker list, or thinking of a new role. We need to give more women opportunities earlier in their careers and in the middle of their careers so they can climb the leadership ladder. It is a culture change, but one I do see happening.
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