Documentary Captures 'Heroics' of Oncologists, Patients

Zosia Chustecka

March 26, 2015

This week, cancer centers across the United States have been hosting private screenings of the Public Broadcasting Sysytem's (PBS') "Emperor" documentary on cancer, ahead of the public release next week.

The documentary — Ken Burns Presents Cancer: The Emperor of All Maladies, a Film by Barak Goodman — is a three-part, six-hour television series that will air on PBS stations on the evenings of March 30, 31, and April 1.

"The film is very moving, and there is a great message of hope" says Gary Schwartz, MD, chief of the Division of Hematology and Oncology at Columbia University's Medical Center, in New York City.

"I think it will raise awareness about what cancer is all about and make people better appreciate the work of cancer specialists," he said.

"I think there is an underappreciation of the work of oncologists and of the heroics that have been involved in cancer research," Dr Schwartz told Medscape Medical News. The film shows many of the heroes, such as the scientists and doctors who have worked for years, sometimes in the face of resistance and many failed attempts, to discover news ways of treating the disease. But it also highlights the altruism of patients who have committed their lives to clinical trials, often knowing that their participation will not help them personally but will increase knowledge of the field that may help future patients.

"Cancer is the biggest scourge in the world, killing millions of people, but we have a way forward," says Dr Schwartz. The films touches on some of the very latest research in cancer, including targeted therapy, immunotherapy, and cellular therapy with engineered T-cells, and it leaves the audience with the message that "there is great hope," he says. "The whole world should watch it."

Dr Schwartz spoke to Medscape Medical News after a preview screening of the documentary for journalists earlier this week at Columbia University, after which a panel of experts discussed the film. In a star place on the panel was Siddhartha Mukherjee, MD, assistant professor of medicine at Columbia University, who is the Pulitzer Prize–winning author of the book that forms the basis of the documentary, The Emperor of All Maladies: A Biography of Cancer.

Medscape Medical News has featured interviews with Dr Mukherjee about writing the book, which took him 6 years, and also about the journey of how the documentary came to be made.

At the Columbia screening, Dr Mukherjee said that success stories in cancer research are "becoming less rare" and added that cancer research is now moving along at a faster pace than ever before. He gave the example of BRAF inhibitors for melanoma, which moved from discovery of gene mutation to targeted therapy in just 3 years.

"Such breakthroughs are not rare anymore," he said, "but we have to keep moving."

Also on the speaker panel was William Nelson, MD, PhD, director of the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins. He is also vice-chair of the scientific advisory committee of Stand Up 2 Cancer (SU2C), which first promoted the idea of making a film out of the book, and collaborated closely with both PBS and WETA (a Washington DC public television affiliate that coproduced the documentary).

Dr Nelson made the point that the discovery of genetic mutations as drivers of cancer has had a big impact on clinical trials, and there is now a "lower human cost." When participants for a clinical trial are enrolled only if they are found to have the driver mutation that is targeted by the investigational drug, they are more likely to benefit from the therapy being tested, he explained.

Dr Nelson also said that watching the latest research efforts depicted in the documentary leaves the viewer with the message that there is "great promise ― you can't watch the film without feeling that."

Excitement Over Current Cancer Research

"Sit back and watch ― you are about to see an amazing time in oncology," Dr Schwartz said at the briefing.

In an interview, he elaborated further on the excitement that has been building in cancer research for some years, and is now at a crescendo.

"I never thought I would be this excited about oncology," he said.

Dr Schwartz has watched firsthand the clinical impact that research breakthroughs have had on patients, being a medical oncologist specializing in melanoma, the cancer that has seen the most action in recent years.

There has been the breakthrough of targeted therapy with drugs such as vemurafenib (Zelboraf, Plexxikon/Roche), aimed at BRAF mutations (which are found in about 50% of melanomas), and later the combination of BRAF and MEK inhibitors, which further improve outcomes. Then there was the tremendous impact from manipulating the immune system with therapeutics that act as immune checkpoint inhibitors ― such as the ipilimumab (Yervoy, Bristol-Myers Squibb), and more recently the programmed death inhibitor drugs nivolumab (Opdivo, Bristol-Myers Squibb Company) and pembrolizumab (Keytruda, Merck Sharp & Dohme Corp).

Each new therapy has pushed survival upwards, so much so that at a recent meeting of the Society of Melanoma Research, another expert in the field, after tracing these developments, concluded that "we have cure in our sights."

Dr Shwartz said that this immunotherapy approach is still in its infancy, and there are huge research efforts under way to explore other immune checkpoint sites at which novel drugs could act, both switching on and switching off various pathways.

One big problem with the immunotherapies is that, although the responses can be dramatic, they are seen only in a minority of patients (in melanoma, long-term responses are seen in about 10% of patients receiving ipilimumab and in about 30% receiving PD-inhibitors).

Dr Schwartz highlighted a new research development that may help to identify which patients are likely to respond, and which has also brought the fields of mutation targeted therapy and immunotherapy closer together. The new research, which was published only weeks ago (Science, published online March 12, 2015; abstract) and was reported at the time by Medscape Medical News, suggests that it is the tumors with the larger mutational loads that respond best to immunotherapy with PD-1 blockers. Further, it suggested that these tumors with the higher mutational load can be identified by neoantigen epitopes that are located on mis-sense DNA; these proteins appear to correlate with the mutational burden of the tumor, and they could be used as markers to predict response to therapy. This would bring the personalized approach to immunotherapy, he commented, and it opens up a whole new field of "precision immunotherapy."

"This is a brand new idea, this research is hot off the press," Dr Schwatrz emphasized, and it opens up many new possibilities for the treatment of cancer ― we are beginning to see cancer as an attack on the body that we can fend off by manipulating the immune system, he said.

Tell us what you think ― Next week, during each of the 3 days that the documentary airs on PBS (March 30 to April 1), Medscape Medical News will be hosting a Live Chat from 11:00 am until 11:30 pm Eastern Time. Please join in and tell us what you think about the film and the issues it raises about the future of cancer care.

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