Dr. Young Kwang Chae, MD, MPH, MBA, Medical Oncologist at the Lurie Cancer Center at Northwestern Medicine, talks about an aggressive form of thyroid cancer and the treatments.
Interview conducted by Ivanhoe Broadcast News in April 2022.
Let’s just go straight to Vivian. When you met Vivian, she had a very rare cancer. Can you tell me a little bit about that?
DR CHAE: Yes. So, she had very aggressive cancer. It’s a rare cancer. It’s called poorly differentiated carcinoma of thyroid. And thyroid cancer, we see it as a more indolent cancer, but it becomes very aggressive when it becomes poorly differentiated. It’s a histology subset that makes the cancer grow and spread very fast.
How do you normally treat something like that?
DR CHAE: So we try different medical therapies. It’s called chemotherapy, radiation or targeted therapy, but very limited options. We have just a couple available therapies, and if there’s no response, then a lot of times because thyroid is right here, a patient can suffocate to death because all these organs are going to be crowded with cancer, including the airway.
And so what is nor – I don’t want to say normal, but typical diagnosis for a patient like Vivian.
DR CHAE: Yeah. I would say most people do not make it to one year and it’s more a few months then rather than years for the aggressive form of thyroid cancer.
And this is like one of those cases that we were talking about before that you can treat it, but you just don’t know how long you’re going to delay it. And for Vivian, it was just less than a year…
DR CHAE: Most likely.
How did it return for Vivian?
DR CHAE: So most of the medical therapy worked for a while or it didn’t work well. And she, you know, was suffering side effects from each therapy. And when I saw her, she, you know, was experiencing all these local symptoms and she also had systemic symptoms like pain in her body.
Is that a clue that maybe it’s spread? And it did for Vivian, right?
DR CHAE: Right. And we had imaging studies that showed that cancer not only was in her thyroid, but it had spread to multiple organs.
How did you end up personalizing her care?
DR CHAE: Right? So she, you know, followed-up after our care in our developmental therapeutics clinic. So we call it developmental therapeutics because we develop therapies as we go by, and we tailor our therapies based on patient’s genomic profile. We look at a patient’s DNA profile to see if there are any actionable mutations that we can target.
Can you tell what chemo or drug is going to work better than that drug?
DRCHAE: Right. Based on different profiling, we do it from tissue. We do it from her blood. And we look at the dynamics of how her mutation clones change. And we really find the right drug for her, whether it’s clinical trial or experimental therapeutics. We deliver that therapy.
What did you find for Vivian?
DR CHAE: So she had a unique mutation. It’s called PTEN, and that is a tumor suppressor gene. And when you have the mutation, there’s a certain pathway that gets activated. And that pathway activation through PTEN has never really been described for this type of aggressive thyroid cancer. So there is really good data, you know, behind rare tumors anyway. So we really attack one pathway through a relevant targeted therapy and for her it really worked for her.
What’s the name of the drug?
DR CHAE: It’s called Temsirolimus. Temsirolimus is the drug that we applied as a targeted therapy.
Is that an infusion? Is that a medication? Is that a pill?
DR CHAE: It’s an infusion drug.
And what was her – like, was it every day for a week, or how did that work?
DR CHAE: Oh, it was a weekly infusion. So she would come in every week.
For how many weeks? Do you remember?
DR CHAE: Several. Many.
What did you start seeing?
DR CHAE: Oh, we were seeing that her pain disappear night and day. And she…
Quickly, would it?
DR CHAE: Quickly. Within, I would say, days.
Of the first infusion?
DR CHAE: Couple or a couple up to couple weeks. Then we’d see a stark difference in her symptoms, her energy level, how she felt, the pain quickly disappeared. So…
Did that mean that cancer was disappearing?
DR CHAE: The cancer was becoming less active or indolent or, you know, whatever terms you want to use it. And it did shrink significantly. And we had ways to measure the activity. It’s called PET Scan PET, and that showed also a very impressive response.
And are — were you surprised, I mean, surprised at how well that worked? Or is that just part of your job?
DR CHAE: I was happy and excited for her. And it’s not common, It’s not also too rare. But I’ve seen enough of these good responses in patients where I applied personalized medicine or you call it precision medicine, whatever you want to call it. It’s a therapy delivered based on patient’s genomic profile. And a lot of times these therapies were developed in common tumors. Because I do clinical trials and develop therapies, I do see rare tumors. And to see that this targeted therapy approach worked for her and her rare tumor was still a rewarding and satisfying moment.
Now, I don’t know if this is true. I’m just going to ask you this, but how long have you been a doctor?
DR CHAE: Oh, I’ve been a doctor for many years, but especially just this field of medical oncology where I see more refractory patients, I’ve been doing this more than eight years.
So I was just thinking, you know, like 15 years ago or 20 years ago, this like kind of – there were movies about it, right? There were shows about it. What was that show? It was like where a team would focus on one person, and it was so unusual the team would be together in the hospital focusing on that one person. And today it’s really caught on to where that’s what everyone wants. They want the personalized precision care. Do you think this is just the wave of the future? Like, do you feel like you were, you know, starting something that is just now expected?
DR CHAE: Right. Yeah. So during my training, I – we thought that would be like a far future, but now it’s reality. It’s my daily practice and it’s other oncologists like myself working in, I guess, more academic institutions where we have access to these drugs and clinical trials. And the collaboration that I have with pathologists. And we do have a program called OncoSET, where, you know, oncology cancer sequence and treat sequencing is your, you know, know patient’s molecular profiles, DNA profile of your tumor and then treat based on that. So I think it’s prevalent. It is not future, it’s reality. But just to applying that in my clinic and seeing patients benefit from this is such a joy.
END OF INTERVIEW
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