Today's Research, Tomorrow's Medicine for Melanoma

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Topics include: Treatment

“There’s an old saying that, you know, in a dark room better to light a candle than to curse the darkness,” says Dr. Michael Wong. He discusses with us how he chased the light all the way from Canada to the United States to further his knowledge through postdoctoral studies. He couldn’t live a life that accepted death from cancer so easily. Dr. Wong now runs a basic science research lab, among others, to make treatment available to those who need it. He wants to understand, more wholly, the genetic mutations of an individual’s melanoma, which can be trying, but he is determined to keep studying and fuels his efforts with as much research as possible.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

Andrew Schorr:

Hello.  I'm Andrew Schorr.  I'm with Dr. Michael Wong who is a professor at the USC Norris Comprehensive Cancer Center in Los Angeles.  He's head of the medical oncology solid tumor section and of course a specialist in melanoma.  Thanks for being with us. 

Dr. Wong:

Andrew, it's my great pleasure to be here. 

Andrew Schorr:

So you've been in oncology 18, almost 20 years. 

Dr. Wong:

Right. 

Andrew Schorr:

When you started there wasn't a lot to help people with in melanoma.  How far have we come? 

Dr. Wong:

Tremendous.  In fact, you speak to the very reason why I'm sitting here.  When I was a young doctor as an oncology trainee, I distinctly remember the day I decided to—you know, as you know, I'm Canadian—to come to the U.S. 

We were looking after a young man with melanoma, and after one round of chemotherapy went right to hospice.  And I said to my attending, “That's it?”  He goes, “Yeah, that's it.”  And I felt that I couldn't do a whole career of that.  And so—and so that's when I decided to sort of seek further knowledge and actually came to this country to do postdoctoral studies and the whole thing.  I had a PhD as well, so I was doing research and I felt that was the avenue to learning more things. 

There's an old saying that, you know, in a dark room better to light a candle than to curse the darkness, and it's been a tremendous change since that very day.  We've had so many new drugs in the past couple years that it's been incredible.  Sometimes I tell my patients my job is like being air traffic control.  Who goes first?  What's second?  And sometimes I see my job as to really maximize a number of opportunities my patients have to get therapy.  So it's been a—paradigm change is sort of an understatement.  It's more like a tsunami of change is a better way. 

Andrew Schorr:

And we'll talk for a second about what's here in the armamentarium you have now, but you also are involved in research.  You have labs there at USC. 

Dr. Wong:

Right. 

Andrew Schorr:

You correspond with people around the world.  How do you feel about what's coming? 

Dr. Wong:

Well, you know the analogy I've always used is water behind the dam, and it's a—it's a—I'm in a very lucky place in my life, and I'm privileged to be able to do this research.  I run a basic science research lab, post?op students, technicians, and we're really working at the very fundamental levels of biology and cancer science. 

And what I can tell you unequivocally is that the water is building up behind the dam.  Now, patients are on the other side.  They see this trickle, and they say, you know, we can't wait. But I can see it building and building and building.  So there are tremendous things coming.  The things that we can't even imagine are coming through, so the immunotherapies we have now, the checkpoint inhibitors we have now is just the beginning.  So when I give this lecture to audiences the last slide I have is just the words “This is the beginning of the beginning.” 

Andrew Schorr:

Okay.  So does that mean now with the therapies you're beginning to have that hopefully they'll be lasting, but they can also be a bridge to what's next? 

Dr. Wong:

Right.  So the amazing thing, just to be specific for a minute, is when we look at immunotherapies right now today it doesn't  seem that—it doesn't seem that failure of one immunotherapy to work is a—prejudices that patient against a response to subsequent immunotherapies. 

So that's what I mean by trying to make sure we sequence them appropriately.  Now, we don't know what the right sequence is.  They come out in a sequence only because that's how they were developed, but who knows what the right sequence is.  But you're a hundred percent right.  The things we have now, some of them appear very long lasting, and they—what's the word we use?  They play well with each other, and so part of the challenge is to understand how best to do that.  

Andrew Schorr:

Okay.  And is the key to this now understanding the biology, the genetic mutations of an individual's melanoma so that you can have a medicine that matches with that and then maybe a second-line medicine or a third-line medicine?  Is that what's going on?  So you do this work?up of people and can do, if you will, precision medicine?  

Dr. Wong:

Right.  So we have a new language now in—in oncology, and it's an alphabet soup of oncogenes.  And the funny part was when I was in the lab and doing my post-op the 24-hour scientists named these things, and we gave them crazy little acronyms never thinking one day they would be part of the language of medicine. 

Nevertheless, there's an alphabet soup of these checkpoint inhibitors coming down that emanate directly from the work we're doing in figuring out what's driving what.  What—it answers, you know—it comes from work in which you ask a fundamental question which is what makes that cell cancerous? And so those things that drive it to do so, called driving mutations, those are the ones that are most valuable to know about, and those are the ones that we're discovering more and more of, and those are the ones that we actually try to detect in patients' tumors so that we can actually give them that drug that will impact that.

So there [are] two parts of it, the discovery of these checkpoints—of these sort of, these little intra?kinase, things that happen inside cells that makes the cancer cancerous, and a whole sort of industry looking at ways to attack that. 

Andrew Schorr:

Right.  Let's talk about that attack.  So the best treatment would be your own immune system having surveillance for defective cells, either that you already have or ones you could otherwise develop, right?  So a lot of the work in this whole immunotherapy or immuno-oncology area is to help your immune system do what it didn't do when you developed cancer in the first place, right? 

Dr. Wong:

Um, yes, in some respect.  We've always asked the question in our field why is that our immune system will not recognize that cancer?  What's preventing it from doing so?  And so many of the drugs that are coming forth now are stimulate—stimulators of the immune system to try to break through that inhibition. 

So either the inhibition was intrinsic to our immune system, so these are the setale 4 ones or within the sort of interface between tumor and host where the tumor is actually putting up a defense.  We're looking at each of these places and asking the question, what's preventing that body's immune system from attacking it?  So that actually is sort of a way of answering your question. 

I don't know about defects, though.  We don't have such a good idea of how it happened in the first place.  That's a huge area of research, and one, which I think will be very profitable for patients once we understand how that works. 

Andrew Schorr:

Hmmm.  Then maybe be we could prevent it from occurring. 

Dr. Wong:

Prevention is always better; always better than coming to see me. 

Andrew Schorr:

All right.  Well, Dr. Michael Wong, thank you…

Dr. Wong:

Thanks, Andrew. 

Andrew Schorr:

…for all you do and your devotion to patients. 

Dr. Wong:

Appreciate it.  Thank you. 

Andrew Schorr:

Andrew Schorr with Dr. Michael Wong from USC in Los Angeles.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on May 8, 2015