In the following Q&A, Dr. Edelman explains why he decided to return to the University of Maryland after being gone for only a year and what sets UMGCCC apart from other cancer centers in lung cancer research and patient care.
Q: You left UMGCC in 2013 to accept a position at the University of New Mexico Cancer Center. What made you come back?
I left for professional growth reasons, and it was the right decision at the time. But I quickly realized that UMGCCC and its truly world-class, multi-disciplinary and collaborative approach to medicine allowed me to do the work that really motivates me—developing treatments for lung cancer, in part by designing and conducting new clinical trials, and mentoring new faculty. Ideas are easy. It’s making an idea into something that is actually clinically testable that’s challenging. That’s what I like doing, and UMGCCC has the infrastructure in place to make it happen. It’s funny, actually—my first day back marked what would have been my 15th anniversary with the University of Maryland, had I not left. It feels great to be back.
Q: What do you mean by a “truly world-class, multi-disciplinary” approach to medicine? How is it different from the approach of other cancer centers?
Taking a multi-disciplinary approach means that medical, surgical and radiation oncologists weigh in on a patient’s diagnosis and treatment plan. While many cancer centers do this to varying degrees, few on the east coast truly integrate all modalities like UMGCCC does. When it comes to lung cancer, our specialists hold clinics together every Friday, so we physically see patients together all at the same time. This is a huge strength, and it provides terrific benefit to patients because specialists from all three areas come together to determine the best course of treatment. This combination of modalities is especially critical for curing locally advanced cases.
Q: As a national expert in the field, what do you see as the most significant recent advancements in lung cancer research and treatment?
Over the last two years, I have seen dramatic changes on two fronts. First, our improved ability to identify actionable molecular targets in lung cancer — meaning we can treat them — has really made a dramatic difference primarily for the 10-15 percent of lung cancer in people who never smoked or had minimal tobacco use. Most people, including most physicians, are not aware that lung cancer is a major disease in never-smokers. By itself, it would be one of the 10 leading causes of cancer death in the United States. They tend to be younger, they tend to be women, and incidence in this population is increasing. Though these patients tend to respond very well to treatment, almost all ultimately develop disease that is resistant to the drugs. We need to keep working to find new and better treatments for these types of lung cancer.
The second major change I’ve seen, which was completely unexpected, is the rise of immunotherapeutics for lung cancer. We have a number of trials underway at UMGCCC and are working with industry to integrate this approach and learn more about how it can improve lung cancer treatment. There are number of questions we need to answer: Should it only be used in patients with advanced disease, or should it be brought in earlier? Should it be combined with radiation? How do we deal with side effects? These are the big questions that we’re trying to answer right now.
Q: UMGCCC has been a pioneer in combining radiation, chemotherapy and/or surgery for treatment of lung cancer, and you have led much of this effort. How has your work furthered the field?
I have been involved in a number of ways — everything from simple participation as a clinician to the planning stages and national leadership to being on the data safety monitoring boards for numerous lung cancer trials sponsored by both government and industry for the past three decades. Though progress has seemed slow, it has been significant. Through clinical trials, we have learned that we can increase the cure rate in some patients with certain types of cancer by combining some or all of these treatment modalities. For example, for patients who undergo surgery to remove localized disease but run the risk of recurrence, treating them with adjuvant chemo can increase the cure rate by 10-15 percent. That means, for a patient with a 4 cm tumor and no lymph node involvement, their chance of cure goes from about 50% to 60-65%.
For patients with locally advanced disease, meaning there is cancer in the lymph nodes in the center of the chest or tumor involvement of major structures, the combination of chemotherapy and radiotherapy can cure 20-30 percent of patients. I would emphasize that this does not require surgery. Therefore, “inoperable” does not mean “incurable. ”
The most experimental treatment right now in local advanced (stage 3) lung cancer is surgery. For many years, University of Maryland has been a leader in the integration of all three modalities. Two national studies have been based upon our institutional results, and we are exploring how and when to integrate surgery into the treatment program to improve patient survival.
Q: Using personalized medicine to improve patient outcomes is of particular interest to you. What work are you doing in this area?
We have identified several molecular features that are linked to patients with lung cancer and other cancers that may help guide treatment. For example, we have been working with Dr. Ginette Serrero, who is a UM faculty member and leads AG Pharma, a company that is developing a protein, called GP88, which may be both a marker of disease activity as well as a potential target for therapy. I have been involved with targeting COX-2 and other aspects of the eicosanoid pathway, which has led to several national studies. With Dr. Amy Fulton, we are investigating a downstream receptor, called EP4, which may be important for metastases. I would emphasize that these are targets that may be applicable to a broad range of cancers, including breast, prostate and colon in addition to lung. In addition to our own institutional trials, we are very active participants in studies with both the National Clinical Trials Network and industry at all phases. Many of these studies are directed at specific features of disease, including mutations, immune competence etc.
Q: What are your goals for advancing the lung cancer program at UMGCCC?
When it comes to cancer, gains are only truly made through clinical trials. UMGCCC has a very robust clinical trial program, and the more clinical trials we have for lung cancer, the better. My goal is to have a clinical trial available for virtually any lung cancer patient. Specifically, we are very focused on the development of therapeutics that specifically target a particular patient’s disease and reduce toxicity. At a very minimum, patients will be able to participate in studies that help us explore and evaluate the biology of their diseases without any change in the therapeutic approach.