Powered by Giving Conversations:
Celebrating 40 Years of Caring and Innovation
at NorthShore Kellogg Cancer Center

 
 

Transcript

Erin: Hello everyone. And welcome to this Powered by Giving Conversation. I am Erin Diehl, your host and your moderator. And I'm so excited to have you here. We have some fantastic conversation about to happen today. So thank you so much. For joining us for celebrating 40 years of caring and innovation at NorthShore Kellogg Cancer Center.

But first before we get started a few quick housekeeping reminders. So this program is hosted by the NorthShore University HealthSystem Foundation for our donors. We are so grateful for all of your support and if you are not donor, please consider making a gift to support the Kellogg Cancer Center or another program.

And you will continue to receive invitations to our Powered by Giving Conversations. So also do not worry my friends. You are not on camera, just this lovely crew of panelists star. And we won't be able to hear you, but I will introduce this team in just a moment. You can submit questions via the chat feature on your screen.

And we are recording this virtual event and the Foundation will let you know where you can find the recording to view again, later or to share with others. And the recording will include closed captions. So you'll also be invited to take a survey about the event. So please give us your feedback so that we can continue to bring you more power by giving conversation.

That meets your interests. So this year, everyone at home, we are so excited because we are celebrating the 40th anniversary of Kellogg Cancer Center, which opened in 1981 as the JL and Helen Kellogg Cancer Center at Evanston Hospital. Now, in addition to the primary and original location, Kellogg is now at Glenbrook and Highland Park Hospitals.

And we provide cancer services at our newest network hospitals, Swedish Hospital and Northwest Community Hospital. Now, before we get into all of the many ways that cancer care has evolved in the past 40 years, I would like to introduce this fantastic panel of experts. Who are all NorthShore Kellogg Cancer Center physicians.

We have an oncologist and hematologist and a surgeon here who all have unique perspectives informed by their disciplines. So we're going to start with you, Dr. Bruce Brockstein. Welcome. He holds the Kellogg Scanlon Chair of Oncology and is the medical director of NorthShore Kellogg Cancer Center. He is the head of the division of hematology and oncology.

And Dr. Brockstein has been with NorthShore for nearly 22 years. He specializes in head and neck cancer, bone and soft tissue, sarcomas and malignant melanoma. Welcome Dr. Brockstein. So excited to have you here. I know what's in store and I know our viewers at home are in for a real treat, so much information to unpack here.

So next we have Dr. Lynne Kaminer. Welcome. Dr. Kaminer holds the Virginia and James Cozad Chair of Hematology/Oncology, and is the head of NorthShore's section of hematology. She's been at NorthShore for more than 29 years. And as a hematologist, Dr. Kaminer is a specialist who cares for patients with blood cancers. Such as multiple melanoma, as well as nonmalignant blood blood diseases. Dr. Kaminer,  thank you so much for being here too.

Dr. Kaminer: My pleasure. Thank you very much for having me.

Erin: Oh, we're I, again, I can't wait to get into our topic. So many great things coming our way from you. And finally from Dr. Katherine Yao, who is the chief of NorthShore's division of surgical oncology.

She joined NorthShore over 12 years ago. She leads research projects on breast cancer, including multiple clinical trials, translational translational research projects. That's a tongue twister and clinical outcome studies. Dr. Yao again, so excited to have you join us.

Dr. Yao: Thank you, Erin. I'm very excited to be here.

Erin: I love it. So I'm going to start this discussion with Dr. Brockstein, and Dr. Brockstein, I want us to look back at 40 years ago at the founding of NorthShore Kellogg Cancer Center. That's awhile. Right? So what's the thinking that led to the creation of a dedicated Kellogg Cancer Center to serve the area.

Dr. Brockstein: Thanks, Erin.

I was graduating high school at that time, but I could look back on it from what I know historically. And and from the people who've kind of transmitted the history. So the cancer program existed here at what was then Evanston hospital. And there were a team of cancer clinicians, including Ed Scanlon, who was the chair of surgery and Dave Winchester, who was another prominent surgeon and doctor  who was head of medical oncology.

And there was a volunteer. Jackie Kellogg was very dedicated. She was volunteering within the surgery and she was of the Kellogg family, married to the great grandson of the founder of the Kellogg cereal company. And she had not personally been affected by cancer, but her family was she was very interested in seeing cancer care, carried out to the highest level in the community.

And that was a vision that, of course, Dr. Scanlon and Winchester and Dr. Khandekar shared and together, the four of them put together what they thought would be the plan for a multidisciplinary care multidisciplinary Cancer Center with all the pieces together, including all the supportive care needed.

And they took this proposal to the Kellogg Foundation through Jackie Kellogg's family. And that really was what led to the initial funding  and founding of the Kellogg Cancer Center, 1981, there were many people involved. And the actual grand opening was attended by then former vice former president, Gerald Ford and Betty Ford.

That was 1981. A lot of things got going after. Yeah.

Erin: Tell us a little bit about that. What happened since 1981? What happened and how have things rolled out since then?

Dr. Brockstein: Ah, thanks. Yeah, so yeah, 1981 put in place by the early 1990s. The same model of care was brought to Glenbrook Hospital  and Glenbrook Kellogg Cancer Center and the early two thousands, the same model to Highland Park Kellogg Cancer Center those original centers were then really kind of started back from the ground up physically with a new building the one that you kind of saw at the beginning of the video at Evanston in 2010 and then 2011 at Glenbrook in 2012 at Highland park had services, although not a Kellogg Cancer Center at Skokie hospital and in Gurnee and are now partnering is Erin pointed out with, with our new hospitals, it's Swedish Hospital and Northwest Community, ultimately to have Kellogg centers there at some point we built a lot of relationship and have physical care, many other places, including our breast centers where you're physically seeing Dr. Yao. At Glenbrook radiation oncology, et cetera that was you know, some of the physical beginnings research has played a huge role along the way since 1990, 1983, when we got our first National Cancer Institute grant called a CCOP which  continued for over 30 years, allowed us to bring a lot of clinical research to the cancer center and to the community and allowed us to be.

Other types of research ultimately having a lot of laboratory research and translational research in the various disciplines of of cancer as well as collaboration with a lot of partners, both in industry University of Chicago and some of our other academic partners. We have implemented a vast array of patient support services.

Many of these supported by philanthropy, including social workers, nutritionists, navigators at patient financial aid. Multiple other things, which we'll talk about I, through Dr. Khandekar and his vision and the concept of medical genetics and personalized medicine began almost 20 years ago which was very we were very at the forefront of that.

That was not a concept as seen, even in a lot of the academic centers at that time, Dr. Khandekar initiated the vision partially by bringing Dr. Henry Lynch here onto the professional staff. He was one of the fathers of medical studies. And initiated a lot of the clinical work that we're doing.

You also advocated for molecular pathology as part of the pathology program. And we had one of the first like a pathology labs doing clinical work hired a lot of key researchers within genetics and ultimately have a division of medical genetics, and the now The Mark R. Neaman Center for Personalized Medicine philanthropy's played a big part of it all along the way. And we're happy to have the program that we have.

Erin: That is so cool. And then how many physicians do you have and what's the current state of the cancer program there?

Dr. Brockstein: Yeah, so it's grown from what was a few back in 1981. Now there's a approximately 80 who are fundamental people taking part in the cancer program about 25 medical oncologists, four radiation oncologists, a number of surgical oncologists a full-time surgical oncologist whose specialties touch on cancer supportive care through palliative care, interventional radiology as a subspecialty pathologists. So all in all about 80 and that's not including the key support people, which is actually several hundred throughout the, the physical cancer centers and the key personnel in surgery and radiation on call.

Erin: That is fantastic. So thanks for that background, especially with the philanthropy piece, what were some of the standards of care for cancer around that time? Can you tell us a little bit about that?

Dr. Brockstein: Sure. So early 1980s cancer was now ingrained as a, oncology, as a specialty at cancer surgery had been and remained and still remains the key to eradication of many cancers and chemotherapy was a couple of decades into being used for some cancers, for most of them at that time, chemotherapy provided some benefit, but not nearly what we would. It was used in the postoperative setting to help some people prevent cancer recurrence, and sometimes to help people shrink tumors or have patient's tumors shrink and prolong lives.

But it wasn't quite at the state we wanted. But it was right about that time. I would say that the biggest impacts that were happening were happening in the blood-based malignancies, leukemia lymphoma, and so on. And a lot of the exciting things that have had. Started about that time bit before we can continue to roll out. Really, I would say within the expertise of Dr. Kaminer, so maybe a good time to transition to Dr. Kaminer's expertise and perspectives.

Erin: Yeah. So, Dr. Kaminer can you tell us, I know we have the hematological and malignancy blood cancers. What were some, those were some of the first for which we found as effective therapies. But can you talk about a little bit about historically how the treatment for leukemia and lymphoma has evolved and some landmarks at the KCC?

Dr. Kaminer: Sure. So I was sort of fellow in the early 1980s. So I was sort of at the, sort of the burgeoning of the whole understanding of the relationship of specific genes to specific cancers.

And the story was started actually at the University of Chicago in large part with the disease, chronic myelogenous leukemia, where they. Discover the specific gene mutation that was associated with that malignancy. And one of the things that sort of fascinates fascinated me as a fellow was already beginning to see the interplay between what was happening in the lab and how that was translating into patient care.

So over the years, as the Philadelphia chromosome, It was sort of identify people then were able to identify which genes were involved in the change of the chromosomes. And that then led to the development of a very specific medication called Imatinib or Gleevec which was on the cover of time magazine and all this sort of popular press as there, the magic pill for chronic myelogenous leukemia.

And so it was sort of the understanding of. What the genes were that sort of allowed the development of this very specific medication that has sort of made that a disease where people, you know, died from it within four or five years to essentially live a hundred percent the normal life life. That was one major advantage and that kind of concept has sort of continued in hematology.

So there's another leukemia promyelocytic leukemia, which also sort of by understanding the gene mutation developed, allowed for the development of a very specific non chemotherapy based approach. So understanding how the gene interfered with how the cell works allowed for two medications. That are just now oral medications that allow them put people into the subtype of acute leukemia into remission and has a 99% cure rate. So it's a fairly amazing sort of by understanding the biology behind things has allowed us to sort of move forward.

Erin: So cool. Thank you so much for sharing that. And you know, our viewers at home, I mean, that's fantastic. So fantastic and such great news, but I wanna, I wanna kind of switch gears a little bit and talk about breast cancer, which has been a great example of solid tumor care that has evolved significantly in general at the KCC.

So I'm gonna bring in Dr. Yao, right now, Dr. Yao, can you outline some of the highlights and how this all impacts our patients today?

Dr. Yao: Sure. So when the KCC started, I wasn't even born. I'm just kidding. I wish I wasn't even born, but I was born, I was alive and well. But I just want to tell a funny story about the beginning of the KCC that I talked to Dr. Khandekar about, and he worked very closely as Dr. Brockstein mentioned with Dr. Scanlon, who was the department of surgery chair at the time to start the Kellogg Center. And this was maybe a year or two before Kellogg actually started Dr. Scanlon, Dr. Khandekar were looking at a grant opportunity to look at adjuvant therapy, chemotherapy, so forth and so on for breast cancer.

And they consulted with some of their colleagues at Memorial Sloan Kettering. And at that time, this is the 1970s, 1980s. Surgery was really the main stage for controlling cancer and these colleagues and memorials. You're crazy. Surgery is really the way to control cancer and these adjuvant therapies aren't going to work.

Dr. Scanlon said, no, I really think we should apply for this grant and look into adjuvant therapies. They applied for it, they got the grants and then it really set the stage for, for starting adjuvant therapy programs and the Kellogg. So I always thought it was so ironic that a surgeon was actually advocating for adjuvant therapies way back then.

But it really just showed the vision that Dr. Khandekar,  Dr. Scanlon and Dr. Winchester had for cancer care in our community. I think a big change since Kellogg started in the 1980s for breast cancer. And of course I'm speaking from a surgeon perspective. Is the deescalation of surgery for cancer particularly breast cancer and other cancers as well.

We've gone from a large radical mastectomy, which was a large procedure, very disfiguring, lots of morbidity. And now we've taken it to a breast conserving procedure. We've gone from removing all of the lymph nodes to just removing a couple lymph nodes. And this really happened because we had  leaders, like. Dr. Scanlon, Dr. Winchester Dr. Steven Sener that participated in landmark trials, looking at breast conserving therapy, looking at Sentinel node biopsy and  and publishing some of the first studies in these areas. And really showing that these, this deescalation of surgery was going to provide the same exact outcome as a more radical, more morbid surgery.

So that has been the biggest change that I've seen, at least in my area. I think another area that Dr. Brockstein had mentioned research, that's been a key part of, of any cancer program across the country. And Kellogg has done tons of research. I think we sometimes forget some of the big leaders that we've had in research.  Dr. Winchester was medical director of the American College of Surgeons Cancer Programs for almost 15 years. And he started the national cancer database, which is one of the largest databases across the world. Collecting data on cancer patients. Dr. Steven Sener was present with American Cancer Society and was part of a publication that really guides us in how to follow patients at high risk for breast cancer and Dr. Willard Fry, a thoracic surgeon. Started some of the nodal staging for lung cancer. So these were all really leaders and we stand on their shoulders now.

Erin: That is so cool. Thank you for sharing that. And what a, what a way we have come. I mean, so fantastic. I know maybe somebody listening to here today has somebody who has gone through breast cancer or perhaps is a surviving breast cancer patient or lung cancer patient.

And so to know where science has been and where we've come. It's so cool. And I want to highlight that. I want to, I want to open this up to all three of you. I'm going to start with Dr. Brookstein. I want, Dr. Brockstein. What are some of the major highlights you've seen in your career that has impacted patient outcome and, or the process of patient care?  What have you seen?

Dr. Brockstein: Thanks, Erin. I guess first I want to kind of build on something Dr. Yao was talking about and speak a little bit from the medical oncologist perspective. She referred to adjuvant therapy or adjuvant chemotherapy or, or medicines that we give after an operation, knowing that surgery cures a lot of people, but not everybody. And that's because there's cancer still in the system that the cancer that's you know, at the cellular level that are certain organs. And by giving certain, certain medicines, we can eradicate that and having seen the evolution of that and how that's evolved really from even before Kellogg, you know, 1967 to this point, it's really been amazing. Breast cancer is a great model for it because it's so precise. It's it's a common disease. It's a disease where a lot of attention has been played placed on that big clinical trials where a lot of volunteers women, and in some cases, men with breast cancer volunteer to be in trials.

And that's allowed us to go from here to here. It's you know, without clinical research, without people participating in trials, we don't we actually don't advance the bar at all. And in the field of breast cancer, for example, and you could translate that to a lot of other cancers. We can divide the cancers into those that are treated, you know, in type A, B and C D.

So for example many, many patients with breast cancer or some require no additional treatment after surgery, some can be treated with just hormonal therapy. Based on specific molecular markers, some can be treated with a class of drugs, which we'll talk about called monoclonal antibodies with a drug called Herceptin and variants of that, that target a specific molecular marker.

And now we have additional ones both in the postoperative setting and then the setting where cancers have spread so that we can really take somebody now predict based on the usual factors, how big is the tumor or their lymph nodes, and then very precise. Diagnostic tests that look at certain genetic or molecular factors to say you do, or don't need treatment. And that treatment should be this, this or this, and you should have it for this long. The ability to to be more precise has really been rewarding because number one, you hate to get there, put everybody in the same bucket and say, you are need this very hard treatment because some people don't need it.

Some people might not benefit. And some people need something more. So. That tailored treatment play out as great that we still have a long way to go. We really do, but, but I've, I've felt confident seeing the advances in my twenty-five years or so in oncology to know that there's more to come and then we're going to continue to move that bar forward.

That's a, that's a very general statement, but also specific to breast cancer that I wanted to highlight. But in terms of some things that I've really seen in my field, so I'll kind of narrow it. Probably the biggest is something in the last 10 years, which is what we refer to as immunotherapy.

Immunotherapy is the concept of using various parts of the immune system to eradicate cancers. So we all should really not get cancer because our immune system should see any DNA change, any bad cell as something that should be eradicated, but it doesn't always happen. Could take two hours to explain the story, but let's just say prior to 2011, the attempts that using immunotherapy didn't work so well.

2011, a drug called Ipilimumab came along very targeted monoclonal antibody, a protein that gets injected into the body through the bloodstream, and it allows the immune system to recognize cancer as being foreign. Very interesting biology. We can talk about another time. And that drug was the first that actually was able to take melanoma, malignant melanoma, and cure it only 20% of people, but a great proof of principle.

And since then in that disease in melanoma, the additional drugs have come along. Can now cure about 50% of people who would otherwise not have survived at all. And the treatments are generally much more mild than than typical chemotherapy. So that's been probably the most rewarding that started with melanoma.

And now we use it for almost every cancer various degrees of benefit, but almost every cancer can be positively affected by that. I would say that's one of the big, big ones Dr. Kaminer talked about Gleevec or Imatinib, which is used now to essentially cure CML, chronic myelogenous leukemia. But that same drug took a disease that I treat something called gastrointestinal stromal tumor. That's a sarcoma of the intestines and took that from a cancer that was uniformly fatal if it's spread. So again, being one that we can not necessarily cure, but we can treat and add many years of lives to to people with a drug that's actually turns out to be one of the easier treatments to say handle very few side effects. So that's been very gratifying, uncommon disease, but that same principle then has translated. To dozens of different types of cancer with probably close to a hundred different drugs that are targeted, meaning we take a tumor, we do genetic testing and it called next generation sequencing or translocation studies, other type of a sophisticated studies.

We identify a specific marker. And then we pair that up with a drug. We still have a long way to go, but there's a lot of examples now where we can make a huge difference. As Dr. Dow had pointed out in the postoperative adjuvant setting, we give a drug to prevent the recurrence of a cancer or one has spread to help people live a better life or live longer. So that's been another gratifying thing. I would say another, I think really interesting example relates to changing of the nature of a cancer. So throat cancers or cancers in the back of the pharynx, the back of the throat typically were all caused by tobacco and alcohol. And we saw a shift of that becoming less common as tobacco use, and became less prevalent, but the disease got more common and ultimately it was discovered that that was caused by a virus, HPV essentially a silent virus that 30 years later can cause cancer of the cervix or the, or the throat.

And although that wasn't a treatment that was just a diagnostic change, recognizing that some cancer is caused by A and some by B allowed us to treat A and B differently along with, along to prognosticate and tell people what their prognosis would be. But even more importantly allowed us to say, Hey, HPV causes cancer, let's vaccinate people to prevent it. And that's been, you know, the initiative for the last 15 or so years. Now being able to hopefully prevent cervical cancer, throat cancer, and some others that are caused by HPV. So the, the concept of people not having to ever come to see Dr. Yao myself or Dr. Kaminer, that's gonna be the most gratifying thing when we put ourselves out of business by proving.

Erin: That's cool. That's cool. I mean, I don't want you to be at a business. I want you to be at, but I would like less of that. So that's awesome. And I'm, I'm gonna, this is a good segue to Dr. Kaminer. So Dr. Kaminer what are some of the major highlights you've seen in your career that has impacted the patient outcome or the process of the patient care?

Dr. Kaminer: All right. Well, I spoke a little bit about the the genetics in terms of leukemia, but similar major changes have happened in the field of lymphoma. So about 25, 25 years ago, now the drug rituximab became used in clinical practice that they monoclonal antibody to B lymphocytes in the origin is a B lymphocyte and the different subtypes thereof. But through clinical trials, we read, there was a huge trial that looked at the addition of rituximab to standard chemotherapy and across the board with the addition of rituximab, no matter when you gave it in the regimen, it improved both the complete remission rate as well how long people stayed in remission and were essentially cured of their lymphoma. So that sort of model has sort of continued with other monoclonal antibodies for different subtypes of lymphoma. So they're now monoclonal antibodies that can be used in T-cell lymphomas or a whole series of monoclonal antibodies that different monoclonal antibodies that can be used. Both in lymphoma and acute leukemia. And that sort of concept is now sort of the concept between, or what Dr. Brockstein was talking about with the immunotherapy and sort of taking a monoclonal antibody and the immune system, and sort of juxtaposing them in one molecule to sort of continue to eradicate sort of more advanced leukemias and lymphomas and the whole CAR T cell therapy. So that's something that we're looking to start and are actively beginning that process.

So I would say the monoclonal antibodies, the small molecules that Dr. Brockstein was talking about and also just being more precise in general.

Erin:  Love it. Love it. Thank you so much for that info. And I want to ask the same question to Dr. Yao. So what are some of the major highlights you've seen in your career that has impacted the patient process or patient outcomes.

Dr. Yao:  So, you know, listening to Dr. Brockstein talk. I, I think he really wanted it to be a breast medical oncologist

So I would say, like I mentioned before, the deescalation of surgery obviously has been a huge change. We have now come to robotic surgery for cancer. And going from a large abdominal incision to remove a pancreatic cancer now to...to four or five small little incisions, it's just really revolutionized the way that we operate on cancer.

And the morbidity of the operation has dramatically changed. We are one of five sites across the country that will be participating in a robotic mastectomy trial, looking at the robot for mastectomies and we now do robotic surgery for prostate cancer, pancreatic cancer, lung cancer, some of the gynecologic cancers.  So it's quite prevalent. And I think that's just going to increase, I think, another major change. I mean, just as Dr. Brockstein and Dr. Kaminer mentioned the targeted therapies, the immunotherapy, I mean, that has revolutionized survival rates and outcomes for breast cancer patients. But another area that has really changed things, at least for us as surgeons is genetics.

And we've always been at the forefront of genetics with our center for medical genetics that Dr. Khandekar developed. And we've been very facile with genetics. We have a great team that we work with and we've discovered many genes that have obviously a role in cancer. And now as surgeons, we perform a lot more prophylactic surgery to prevent cancer for these patients who are gene carriers. And that has really dramatically changed over the years. And, and just the access to genetic testing has changed. And genetic testing used to be a $4,000 test. When I was a surgical resident was $4,500 to get your BRCA one and two gene tests. Now you can get it for a couple of hundred dollars. So it's just amazing how much has changed.

And we have processes in place that you can get genetic testing through your primary care physician. We don't always have to wait six months to see a geneticist or genetic counselor. Dr. Peter Hulick, who is our director of the center for medical genetics is wonderful to work with. And he is he's launched these initiatives to bring the primary cares on board with genetic testing, because we need to provide it to everybody out there, not just the very select patients that happen to get an appointments.

 For breast cancer neoadjuvant therapy is another major change. This means that we give some patients who have newly diagnosed breast cancers. We treat them first before we do surgery. And the reason that we do this, as we have targeted therapies, you want to see how the therapies are working. And it gives us a lot of information, how the tumor responds to the therapies.

And that has really dramatically changed the way that we treat cancers. It's sort of shifted when surgery is performed and it's really solidified this close relationship that surgery and medical oncology has always had. And it's really now become a partnership working close together to coordinate all this case. But that has really changed survival rates for patients. It's helped us select which patients need maybe more aggressive therapies to give them better outcomes. So I would say that's kind of a quick snapshot of all the changes that I've seen.

Dr. Brockstein:  If I could comment to at something that Dr. Yao was kind of mentioning at the end, which is the whole concept of multi-disciplinary care we've alluded to, but informally, so it's no longer a case where just the surgeon or just a medical oncologist, a radiation oncologist, or any specialist can take care of a patient. There's a rare patient who only needs one type of specialist. So we come together and what's called multidisciplinary teams. And in some cases, actually physical multidisciplinary clinics where we sit.

But even when we don't physically sit together to see patients at the same time we do so virtually. And we do so at one of our 11 regularly scheduled tumor boards. So with the concept of tumor board is, you know, we see a patient, Dr. Yao may see a patient who has breast cancers identified and she'll then present the case. Or I would present a case or Dr. Kaminer presents a case at our specific conference for that type of tumor, which is attended by the whole group of specialists, typically anywhere from 10 to 20. We present that history of what happened. We present the actual pictures from the biopsy the slides and present the pictures from the scans.

And we get input from the key physicians, as well as the supportive care people on the team supportive care person on the team and also attended by our research personnel so that we could then at the end of that meeting, come up with the framework for a plan, may change a bit still. So a framework for a plan with everybody's input into how to carry out their care.

You know, things like what Dr. Yao talked about we may choose in this setting something with breast cancer to remove just the tumor or if appropriate, to have risk-reducing a bilateral mastectomy. And that may come out of a conversation that happens at a tumor board. And so those things are important to do upfront and that's been probably one of the most gratifying things. And I think what I really love practice. At NorthShore in Kellogg center is because we really have a dedicated group of people who want to practice as a team. We want to bring in the best evidence to care who want to bring in research and bring it to the patient and then to do it in an expeditious manner, which is why we have the, the conference, weekly or every other week to get this care done the right way.

Erin:  Love it. Love it. Thank you so much for that too. I think one thing I want to just come in on is anybody attendees participants on the line today? If you have questions or comments about anything that has happened. Feel free to put it in the chat. This is for you. So let us know if there's anything we can also ask. I'm gonna jump to my next question, which is sort of a follow-up to this one. Let's talk about education, our students, our residents, our fellows. What are some of the major highlights that you're seeing? I'm going to start with you, Dr. Yao, what are some of the major highlights you've seen?

Dr. Yao: 00:34:59 Yeah. So we've always had a very close relationship with our academic partners and we work with medical students, residents, and fellows. And we also work very closely with students that are doing a gap years, wanting to learn more about research and maybe trying to buff up their CV so they can apply to medical school or apply for a PhD program.

And we have these trainees in our clinics, in our operating rooms, we have a simulation lab where we can teach trainees how to interact with patients and also how to learn about new procedures. And we have now a robotic surgeon. Her name is Dr. Melissa Hogg. She is a very well-known pancreatic robotic surgeon did some of the first pancreatic robotic surgery. And she has developed a curriculum for our surgical residents to learn about robotic surgery in the simulation lab. And I think the simulation lab has really dramatically changed training, at least for the surgical residents. They spend, they have regular rotations, just like they rotate on the breast service, they rotate in the SIM lab and they always comment that SIM lab has just been dramatically, dramatically helped their education. And they're always very impressed with the facility and with the teachers in the SIM lab.

Erin:  That is awesome. That's awesome. Well, I got what I asked for. I have so many questions in the chat now, so thanks everybody for submitting your questions. I'm going to start, I want to answer this question here and this can be to any one of you, so feel free. Pick a number. How do you see in the mRNA vaccine development as a promising next generation technology for creating new class treatment for cancer? And this can go to anybody.

Dr. Brockstein:  It's a great question, I don't know if I have the answer for the next steps, but I think there are people that are building on that technology. Some of it is the reverse too, which is, I think a lot of things that came out of cancer research actually set the stage for understanding mRNA, and it's, you know, it's possible a power as the vaccine technology.

So, you know, sometimes you don't really know what research, you know, can be divided into basic research and research that's being done with a specific goal in mind, and sometimes that basic research. Just provides a tool that people wait or pick up on. And I think that is a, is a real example of what happened with mRNA technology.

It wasn't brand new mRNA. Understanding is not brand new nor was the vaccine technology, but this was the first example where it was used and because the background was all there, it was put in place very quickly. And the same could be said about a lot of cancer advances that may be involving mRNA.

Dr. Kaminer:  I may, I may be speaking out of turn, but maybe the Regeneron monoclonal antibody in terms of treatment of the COVID virus was sort of developed out of some of the earlier advances, even though it doesn't specifically in terms of sort of advancing it in terms of new therapeutic. Well, in terms of the mRNA vaccination, but in terms of sort of therapeutic approaches to COVID, the, some of the background work was already, as Dr. Brockstein mentioned was already done.

Erin: 00:38:40 Very cool. Very cool. I have more questions from our viewers here, so I'm going to jump right to them. So let me ask you this. And this is for anyone. Do you always do genetic testing on tumors after surgery?

Dr. Brockstein:  I'll take that one. Cause we're in the midst of a big clinical trial as is funded through philanthropy and through the Neaman Center for Personalized Medicine. So the answer is in many cases yes. And moving towards yes, for everybody at some point. So for some cancers the pathways are well-defined and specific genetic testing isn't necessarily necessary every time. Especially if the cure rate is high and the treatment and the answers to the genetic testing, won't change the treatment.

You think of genetic testing in two ways. One is, are we testing for, what's called the germline, the genes that you're born with inherited from your parents that you may pass on. And we do that for certain cancers where it may look like there is a hereditary component of the cancer. So breast cancer is the most common.  Though not yet done uniformly, but a lot of talk about doing that uniformly for breast cancer. And then there's the other type of genetic testing, which is called somatic, meaning looking at the genes inside your specific cancer, you weren't born with them, but something evolved in a cancer cell. And those genes may, as I alluded to before, may play a role in the choice of treatment.

So if it's not going to play a role in the choice of treatment and the cure rates are high, we actually don't necessarily do that for everbody, but in advanced cancers, like cancer that has spread. While sometimes there is a pathway for the first treatment or second event at some point it cancer may, there may not be an additional treatment that's very effective and that's where genetic testing becomes important.

So the genetic testing may form some specific standard treatments for two for breast cancer, for example B BRAF for melanoma. There's all kinds of examples I can talk about. EGFR for lung cancer. So those are standard for some of these cancers. We always do that upfront. And then, and other cancers, when people bypass the standard treatments, we'll do genetic testing where we're saying, wait, we hope we find something we can treat. We don't necessarily even know what we're looking for. Right now we're doing that. We have a grant for for doing this type of testing next generation sequencing and initiated testing on 500 people that initiated in April. And so we basically ask patients do they want us to perform this on their cancer?  Recommended and then we're able to to go to our tumor board to serve as the basis for an outcomes research paper at the end of this, looking at how we've utilized 500 people and It allows them to get this testing without costs because there'll be funds for the costs.

Erin: And there was a little technical audio glitch at the end there, but we heard you so just know. I think, I think we're good. I think we're good. And we're moving on. I think we're good. We heard what you said, and that was fantastic. And thank you so much for that. I have more questions unless Dr. Yao or Dr. Kaminer want to pipe in on this one? There, the chat is hot right now. We have a hot chat. So thank you. Thank you to everybody for your questions. These are so fantastic. Fantastic. So here's another one in each of your specializations, what are the tractable cancers and the greatest challenges for diagnosis and treatment

Dr. Kaminer:  we lost you a little bit

Dr. Brockstein:  Yeah, what was the first part of the question I missed the first part?

Erin:  Is the audio, is it okay? What are the most intractable cancers and the greatest challenges for diagnosis and treatment?

Dr. Kaminer:  Can you hear me?

Dr. Yao:  I can answer for breast cancer. There are certain different types of breast cancer. That's what we've learned over the years. There is a type of breast cancer called a triple negative breast cancer.

That means that all three tumor markers are negative. And that can be a difficult cancer to treat because all the markers are negative. We have nothing to target and we have seen higher recurrence rates, those types of cancers. There's a lot of work, a lot of clinical trials looking at role of immunotherapy for those types of cancers and other treatments.

When we talk about greatest challenges for diagnosis there are some cancers that don't present well on a, on a mammogram. So there are a lot of studies now looking at different ways to screen patients, particularly patients who have dense breast tissue. That's been a very hot area. We do 3d mammogram on all of our patients.

That's most up-to-date technology. We also have a screening breast ultrasound program for patients who have dense breast tissue. And we are looking at other types of screenings, such as different types of MRI to screen our high risk patients. So I'd say those are kind of major challenges of the many that we haven't in the breast cancer realm.

Dr. Kaminer:  Yes.

Erin:  Go ahead, Dr. Kaminer, did you want to jump in.

Dr. Kaminer:  Well, in terms of diagnostics, I think sort of continuing to identify genes that are what are called actionable, so that there's a specific mutation we serve in the leukemia realm. Now have three or four specific treatments above and beyond chemotherapy for leukemias that have specific mutations, but we certainly, but it's still, you know, in the vast majority of patients, unfortunately not curable.

You know, I think in, in the lymphoma realm, sort of subdividing the different subtypes of lymphoma and sort of we, we can sort of look at there's different sort of gene expression, profiles and lymphoma, but there's not quite yet different treatments dependent on those different sort of subtypes.

So I think that is clearly a developing area. And one that's still challenging. There've been lots of trials that have attempted to answer that, but we haven't quite hit on the magic bullet.

Erin:  Got it. Thank you. That's great insight. And we, I, like I said, we have so many great questions. Thank you so much for submitting these. I'm going to go to one more. Are there blood tests to detect leukemia or lymphoma that I can get as a part of an annual physical exam.

Dr. Kaminer:  So really that's I'm for sure my question. So essentially a CBC is the best we have at this point. But it is interesting to me, obviously, as a hematologist, how much information one can gather from the CBC. So you can look to see if, you know, the white count is normal. The hemoglobin is normal. It's the platelet count is normal. You can look at the subtypes of white cells and so, and you can actually do some of the next gen sequencing. You can really sort of look at a CBC and get a tremendous amount of insight into sort of the workings of the, the hematologic system.

So it's, there's no genetic testing. And I have lots of patients that ask for like, with a family history of lymphoma or a family member with chronic lymphocytic leukemia, which has some hereditary component. Is there something to test for, but really is in terms of sort of looking forward is really just looking carefully at the CBC with a differential.

Erin:  Got it. Very cool. Thank you for that. I knew that was your question. So I stuck with you there. This is one more question from our viewers. Is there any advice for cancer patients who didn't respond to the COVID vaccines, especially as the Delta variants become more common?

Dr. Kaminer:  So I think that that is clearly something that is going to be investigated on a, you know, a big national level. You know, trying to assess whether a third vaccine or booster vaccines are helpful, whether they're, with, there is recently something I think was published about the nature of looking at the T-cell and the memory T-cells and with even a little bit of exposure to the virus.

I think that's clearly, you know, something that is devastating for patients that have been vaccinated and don't have a response and see the rest of the world around them opening up and don't know how safe they can feel. So we, we all really feel for that.

Dr. Brockstein:  And I want, I want to study that we have here,  the question of which cancer patients respond and which don't and how do they respond is, is a huge one.

And of course we're only about two or three months into knowing this because it only was February, March before non-medical personnel started getting vaccinated and then. You know, a few weeks or months after that, before we started being able to test for antibodies, finding out that certain patients don't respond, a lot of Dr. Kaminer's patients with hematological malignancies don't respond at all to be have the vaccine, others getting chemotherapy, don't respond. So we have a site. It just is getting started within the last week where we will follow seventy-five patients with three different types of cancers out for 12 months to see what happens to their antibody levels over time and how that matches up to a standard healthy person, not getting chemotherapy. In addition to that alluded to T-cells. So the, the testing of the blood test for antibodies, which is the results of B cell function, T-cells are the other main part of the immune system. And maybe that, that T cell function is actually going to take care of the virus, even when the measured by the B cells is not so good.

So this test will look over 12 months of antibodies and then EMT quantifications too, to get some idea of how our cancer patients respond. It'll be one of a few efforts going on throughout the country to try to quantify that. And only then might we, along with knowing, does the booster shot help?

We'll be able to tell our patients you do or don't need a booster. We don't really know kind of, you know, still in that zone where it starts to know whether we need to do that.

Erin:  Sure. Sure. Great answers. Great questions. Thank you so much to everybody listening right now. I want to, I want to end with one question I'm going to pose to all of you.

So you've all treated thousands of patients over the years. Think of that thousands. How cool is that? Is there someone that sticks out as having impacted you as a clinician? That's. Can you tell us about them and then what gives you hope for the future? Anybody could go, anybody could go.

Dr. Kaminer:  Hmm. Okay.

You're asking about a specific patient story or a specific patient that touched us

Erin:  Yeah. Something that touched you that you now say, you know, because of this story, I have hope for moving forward with where we are. Did I get you? Did I stump you all?

Dr. Kaminer:  There are many, there are many, it's hard to pick out the one.

Dr. Yao:  I think it's hard to think of one patient's story. We have so many patients that give us hope and I think that's part of the reason why we continue doing what we're doing, because. There is so much hope and cancer. There's so many studies and research, and there's been so much advancement in the treatments and the surgeries all of those things.

And I think that's part of the reason why we love doing what we do. I think at Kellogg because the teams we work with, we are all very interested in the next up-to-date treatment. And. At least in breast cancer, I can speak to breast cancer. I mean, treatments and clinical trials are coming out every week and we've made dramatic changes.

And I feel that all of my patients, I, I feel hope with even the ones that have very aggressive cancers and may not end up with the best outcome. I still feel hope for them. I still feel that we can give them. Very good care and patient centered care, and we can help them through the process. I mean, I can't always promise everybody a hundred percent survival of course, but I can also, but I can certainly promise a hundred percent support and we're there for our patients to help.

Erin:  Can we tweet that? Can we, can we have that tweeted? I can't predict a hundred percent survival, but I can predict a hundred percent support. Soundbite.

Dr. Yao:  Maybe I should rethink my profession. What do you think?

Erin:  I know a career you could join. I know a career.

Dr. Brockstein:  I can think of a couple anecdotes unless you want to move on to another question. But I'm going to just tell two quick anecdotes, little of different sides of that. The first you know, we, as Dr. Yao pointed out, not that everybody has great news and I remember this was maybe 10 years ago. I was chatting to a very nice woman. She was ninety.  And, you know, many patients want to be us to be very honest and, and we're obliged to do so, so we should. And, you know, she asked me what her prognosis was from a very bad cancer. And you know, I said to her in the most compassionate way, I could explain that she wasn't going to survive her cancer and told her the timeframe, which was relatively short.

And she looked me in the eye. And she said, Dr. Brockstein, does your mother know what you do for a living?

Erin: Yeah. So, my God, I was getting verklempt right here and I'm like okay that's good. 

Dr. Brockstein:  Is what's really impressed me about so many patients is that as is horrible things that, you know, people go through, you know, they don't think about us.

It's a hard job. And then Just on the opposite side real quick. Going back to immunotherapy seeing people

Erin:  We're going to shed tears. This is real. We're going to do that because this is real life and these are real lives we're talking about. So we're, we're going to hold hands, everybody at home. Hold hands. Here we go. Keep going, keep going.

Dr. Brockstein:  Yeah, no. I mean, a lot of examples that I can think of and the count people who are actually cured, but if the Connections magazine, I think somebody may get the Connections magazine and, and Erin or at the beginning of some of the circulating pictures were from that.

One of them was a patient of mine, first person that that we gave him Ipilimumab too and his disease went away. Cured 10 years later. And another one I can think of very that also made some Connections magazine, the young woman in her forties at the time three kids had a horrible cancer and she got immunotherapy with a specific drug. It took, took care of all of her cancer except one tumor, her liver,  Talamonti,  the head of surgery took out that tumor, cancers never come back in four or  five years.

Dr. Yao:  So, so that just proves Bruce, that, you know, surgery really is the more important part of this story, much more important than the chemotherapies,  right. I think that's what that story shows.

Dr. Brockstein:  The surgery was very important, but it turned out the cancer was actually a dead tumor, which which was actually a great proof of principle. That we actually sometimes don't know. And so actually the surgery was key cause we would've kept treating her for something she didn't need treatment for she got the tumor out and shortly after that, she ran her first marathon.

Erin:  Wow. That is fantastic.

Dr. Brockstein:  The second part of that a year later, She actually last October, she ran across the finish line with me to help me finish my third marathon..

Dr. Yao:  Oh my gosh.

Erin:  Okay. I'm so glad I wore mascara today. And I, that story is so amazing, and that is why we are all so grateful for the work that the three of you do. And everyone at the Kellogg Cancer Center in NorthShore, we are just without you, we wouldn't have some of the people still in our lives. So thank you. And I'm crying, everybody's crying, everybody at home is crying we are all crying.

We have to end, so Dr. Kaminer I'm, I'm sorry, I didn't get to your answer, but I just shows that you are changing and helpinglives. You're all three so fantastic. So thank you so much for your energy, your stories, your answers, answering our viewers questions.

I'm going to wipe my eyeballs now. But everybody viewers at home please respond to the survey. It really does just help us with philanthropy, driving innovations, like the ones that we're talking about today. Thank you so much for tuning in on this Thursday. We will be taking a couple of months off, but we plan to come back  in the fall..

Please join us in the fall. We're Powered by Giving Conversations on behalf of myself and NorthShore and the viewers at home. Dr. Yao, Dr. Brockstein, Dr. Kaminer. Thank you so much.

Dr. Yao:  Thank you.

Dr. Kaminer:  Yeah.

Dr. Brockstein:  Hey, appreciate all you do. Thank you.

 

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