Interview with Edward S. Kim Chair, Solid Tumor Oncology and Investigational Therapeutics, Levine Cancer Institute – Speaker at PMWC 2018 Silicon Valley

Kim, you are the chair of Solid Tumor Oncology and Investigational Therapeutics and the Donald S. Kim distinguished chair for cancer research at the Levine Cancer Institute, Carolinas HealthCare System in Charlotte, NC.

Q: What are some of the activities of the Levine Cancer Institute to address the current needs for cancer care?

A: We have developed Levine Cancer Institute (LCI) to be an academic-community based hybrid model which serves patients across North and South Carolina. Our efforts are grounded in conducting novel early phase clinical research with a focus on translational genomic studies. Additionally, we have developed several programs unique to the region including a Supportive Oncology Program, a large comprehensive patient navigation program, as well as the first mobile lung CT screening unit in the United States. To facilitate our regional-based approach, we have developed our own clinical pathways (EAPathways) which serve as a vital resource to our providers.

What are today’s challenges of oncology care? What are some of the challenges of clinical research?

Q: How can we address those challenges to improve oncology treatments?

A: As the field of oncology is changing rapidly, we will be constantly challenged by numerous factors affecting delivery of care, clinical research and costs. I think what we can control most effectively is the delivery of up-to-date clinical medicine. This includes implementing changing biomarkers and therapies based on FDA approvals. Clinical research is about access for patients. This includes not only having a number of trials available, but also to reshape the way we write studies with regards to exclusion criteria. Many have numerous eligibility criteria that exclude patients that could potentially enroll otherwise, such as renal insufficiency, history of brain metastases, age or concurrent malignancies. I have been heavily involved in an effort to modernize eligibility criteria with ASCO and Friends of Cancer Research to revise and implement expended eligibility criteria for clinical trials.

There are a number of unmet clinical needs not addressed by current methods when it comes to proper therapy selection and disease management.

Q: How can these needs be addressed and how will and can precision medicine help?

A: The implementation of biomarker-based approaches to determine appropriate treatment has really propelled the field forward. This has allowed us to optimize therapy for efficacy and even reduce unnecessary toxicity.

Q: How will ctDNA applications help with disease management?

A: Tissue is still the gold standard. However, the feasibility and difficulty in obtaining adequate as well as serial samples have impeded progress. Blood-based evaluation, especially with ctDNA, will allow further evaluation of tumor status and response to therapy. This could eventually lead to less radiographic imaging and better assessment of disease status.

Q: What are some of the challenges of community-based practices and how can we overcome them?

A: I have had the privilege of spending over a decade at MD Anderson Cancer Center and over 5 years here at LCI. Both experiences have given me the perspective of challenges that exist on both sides, academic and community. We know that the majority of care is delivered on the front-lines in the community and that many patients prefer not to or have the opportunity to travel long distances for care. I believe it is imperative that we are able to deliver cutting-edge care and clinical trial opportunities for patients treated in the community-based setting. We are seeing more regional based care delivery systems which highlight collaborations between institutions.

The Levine Cancer Institute (LCI) has an active role in the TAPUR study, the first ever clinical trial conducted by ASCO.

Q: What is the significance of the TAPUR study?

A: TAPUR is the first ever study conducted by ASCO (PI Richard Schilsky). When I was the Chair of the ASCO Cancer Research Committee, Dr Schilsky brought forth this idea and I really liked it and supported it. LCI was one of the first institutions to open the study and we have placed a high priority in screening and enrolling patients. The trial is challenging as it requires centers to coordinate genomic testing, biomarker matching, as well molecular tumor board discussions. The trial fits very well with providers as it allows us to test targeted drugs in molecular subsets in patient who otherwise would not have access to these drugs. It is really one of the first studies that has coordinated relationships well between community-based centers, ASCO, industry, regulators and patient advocates.

Q: What is the goal of the study and what is LCI’s role in it?

A: We want to identify patients in whom these drugs can be effective based on the tumor profile. LCI is one of the lead sites on the study and have been committed since the study opened to support it. I serve as the chair of the trial steering committee and several other members of LCI serve on other committees for the study.

Q: Is there anything else you would like to add?

A: As the Precision Medicine field is changing rapidly, it is important to have forums for discussion among multiple stakeholders. As I represent Levine Cancer Institute, it is important for me to demonstrate what type of care delivery can be accomplished in an academic-community based hybrid model for our patients with cancer.