Key personnel making an impact in the world of lung cancer - 6:
Professor Gilberto de Lima Lopes Jr, Associate Director for Global Oncology, Sylvester Comprehensive Cancer Centre and Associate Professor of Clinical Medicine, University of Miami in Florida
Prof Gilberto Lopes is a medical oncologist and has dedicated his career to thoracic cancers and the issues of cancer control and access to medications in low and middle-income countries.
He is the editor in chief of the American Society of Clinical Oncology’s (ASCO) Journal of Global Oncology, associate editor for the ASCO University Editorial Board, 2016-2017 chair of the International Clinical Trials Workshop Working Group, and global health track leader for the Cancer Education Committee.
What first motivated you to work in lung cancer treatment?
Cancer made my mother an orphan at 17 years of age. Her mother died of breast cancer and her father had died of a heart attack shortly before. It changed my mother’s life. Once I was at medical school, going into cancer medicine was a natural choice.
My interest in lung cancer developed while I was training. I was fortunate to be a young oncologist at a time of exciting new developments in cancer treatment. We were learning about cancer cells and how they respond to the immune system, and it seemed like an area with real promise for new treatments. I began volunteering in oncology clinics, did laboratory research and it became my career.
What have been the biggest advances in medical oncology, in terms of how we have improved outcomes for people with lung cancer?
There have been two major advances that have revolutionised how we treat patients today: tyrosine kinase inhibitors (TKI) which work by blocking cancer growth, and immunotherapies which use our body’s immune system to fight cancer.
Working with new TKI treatments we noticed that some patients, notably women, non-smokers and people of Asian descent, had a much better response to their treatment, with their lives being considerably extended.
What we learnt, thanks to the work of two teams in Boston, was that these different responses reflected the role that different genetic mutations in cancer cells (in this case EGFR) play in determining how these cells respond to treatment. This ushered in a new way of ‘targeting’ cancer treatment to particular mutations in cancer cells such as EGFR, ALK, ROS1 and B-RAF, which control the way the cells grow and thus how cancer cells can be treated.
Third generation TKIs, osimertinib and crizotinib, for example, target EGFRs and ROS1 proteins and based on this targeted approach, we’re seeing patients living longer – up to three years, rather than three months, after diagnosis. This really is an amazing development.
We’ve also seen new immunotherapies such as nivolumab and pembrolizumab being used in lung cancer and we’ve again seen patients doing much better than with chemotherapy alone. These treatments target particular cancer cells that have high levels of proteins called PD-1 and PD-L1.
Today we’re learning more about how to use immunotherapy and chemo therapy in combination, which is improving survival even further. We are finding that single treatments are no longer the most effective options for all patients.
What do you see as the most significant challenges in continuing to improve lung cancer treatment?
Cancer resistance is a major challenge. We need better understanding of why cancers become resistant to treatments, and then we can work out how to keep resistance away.
Funding for lung cancer research is also a problem. We know that lung cancer gets less than its fair share, relative to other common cancers. We need more investment in research so we can improve the treatment and care we provide to patients.
What are you most excited about in your field?
Molecular therapies are a game-changer. With further advances in treatment, I believe we can make metastatic lung cancer a chronic disease. We are still a long way off, but one day we will get there.
What role do you see international collaboration playing in advances in lung cancer treatment?
I’ve been lucky to study and work in different countries, so I have seen the way different health systems are confronting lung cancer. International collaboration is paramount. Without international trials and studies, we will not advance as quickly as we could. We have to work together if we’re to make real progress for patients.