The landscape of treating patients with hematologic malignancies has changed greatly throughout the career of Jorge E. Cortes, MD. Once excitement might have centered around a handful of drugs, but now there is a much more robust variety of options.
Cortes, director of the Georgia Cancer Center at Augusta University, has seen the expansion of treatment for patients with hematologic malignancies. He also has played a role in that growth through the study of new tyrosine kinase inhibitors (TKIs) such as ponatinib (IclusigÒ; Takeda) and where they fit in the evolving treatment landscape.
In an interview with The SOHO Daily News, Cortes discusses the highlights of these treatments for patients with diseases such as chronic myelocytic leukemia (CML), acute myelocytic leukemia (AML), and acute lymphocytic leukemia (ALL), and what he is looking forward to at the 10th Annual Meeting of the Society of Hematologic Oncology (SOHO 2022). Moreover, he discusses the role he hopes the Georgia Cancer Center will play in expanding treatment for patients, as well as the challenges that cancer centers of today face.
The SOHO Daily News: What do you think is the greatest challenge to the cancer center of today, and how do you see Georgia Cancer Center looking to overcome it?
CORTES: In terms of patient care, I think our models are changing quite significantly. One thing I’ve realized as I moved from a larger institution, such as The University of Texas MD Anderson Cancer Center [in Houston], to a smaller institution with a completely different patient population is the difficulties of access that patients have to cancer centers. [Another challenge is] the outreach [required] to reach those populations [that] do not have the ability to have cancer screenings, afford cancer care, or that have very different patient characteristics—and these patients represent a large percentage of the population [we serve]….Finding the right balance where we can provide adequate care for the whole spectrum of the population that suffers from cancer is a big challenge.
What most excites you about your role as director of the Georgia Cancer Center?
I think that [it is] the challenge of, on the one hand, making this as strong an academic institution as it can be, because we are, after all, an academic institution. We are developing strong programs for research; we’re recruiting [individuals] in the laboratory, in the clinic; [we are] increasing our portfolio of clinical trials so that [patients] in the area can have access to better options for clinical trials and strong translational research. We’re growing our stature and we’ve been able to recruit some very strong [investigators] in that regard; at the same time, we want to be a resource that helps those communities [that] don’t have access. We have an interesting balance here where I want to bring very good science to the cancer center, while we must address the most basic needs for some of these patient populations. It’s that balance that I see a lot more mixed into what I have to do every day, and that’s very exciting.
Now, the goal is to get us to National Cancer Institute [NCI] designation and there’s [much] work to be done. There are a lot of challenges with programs to be built, and our budgets need to be increased, and a lot of things—but that excites me. It’s exciting what you can do with a smaller institution that takes a lot of work that needs a lot of support. It’s a lot of selling your mission, your vision, to everyone. The state authorities are supportive, but they want to understand what exactly you want to do, what are those resources that you want, how are you going to accomplish [your mission], and how [those resources are] going to help the population and the state.
Throughout your career, what has changed the most for treating patients with hematologic malignancies?
For many years, there was so little progress. For most of my career, I saw perhaps 1 or 2 drugs approved in 20 years for hematologic malignancies. There was a big deal made when fludarabine was approved for chronic lymphocytic leukemia [CLL] and that was probably the big one and nothing much after that. But then came that big explosion of knowledge about the molecular mechanisms of the disease, and that translated into the development of drugs that are much more targeted, much more effective, and even safer in many instances.
The way we treat patients [now] is very different than the way I was treating them when I was a fellow or during the early part of my career. [Treatment has] become much more effective, much more interesting, and…much more challenging, because now we’re starting to figure out how we combine some of these agents for patients who have molecularly complex diseases. How do you combine and sequence the different approaches?
You’re now looking at very small subsets of patients, because each unique molecular subset is different from the others; it’s not just AML or CLL, it’s AML with these molecular abnormalities or CLL with or without a TP53 mutation. These little subsets make it much more complex, but much more biologically relevant and, of course, better in terms of addressing the specific needs for each subset of patients.
Since your work on TKIs, how has this therapy changed? Do any new TKIs excite you?
That has changed the whole landscape of CML, and I was fortunate enough to be part of that transition. [I trained] through the days of interferon, which was a big advance back in those days, and then the transition to the TKIs, and then the development of the new generation of TKIs. It’s made the outcomes of patients so much better, but we still have gaps and fortunately there are new TKIs.
We recently had a new TKI that came to the clinic, and even with 5 TKIs that we had this becomes such a useful tool, not necessarily to replace anything that we had but because there are areas where you need an alternative. This one has a novel mechanism of action, so it’s also rewarding that not only is this [not] just another TKI, but when you find another way of approaching this integration of tyrosine kinase [it can] overcome some of the limitations of the drugs that we already had.
Is there any research you’re involved with now that excites you?
I am involved in the development of some of these new TKIs, but I’m also involved in the research of some of these combinations with novel agents plus TKIs. There are many potential combinations, and it’s going to be a bit challenging to decide which one is good. I do have some trials that are looking at these combinations; for example, one with a drug that’s called KRT-232 and the preclinical work [for it] is very exciting. We’re working on and developing and identifying these combinations at the Georgia Cancer Center as well.
What is the topic of your presentation at this year’s SOHO 2022 and what are you hoping attendees get out of it?
I am presenting in the acute myeloblastic leukemia (AML) session about a difficult question…whether you treat with imatinib (GleevecÒ; Novartis) or ponatinib, [which] are 2 good drugs. They’re sort of like a third generation of drugs, and we’re trying to determine which is better. We also have a couple of studies being presented in the general session, but we also are presenting some posters on part of the analysis both on the axitinib (InlytaÒ; Pfizer) trials and the ponatinib trials (Poster CML-129).
A lot of my presentation is centered around these 2 drugs…the main message is that these are 2 wonderful drugs. I don’t see them as competitors; I see them as complementing each other. Trying to find the right patient for each of these drugs [is important]. That’s the reason why we want options, because you always have a patient where you think that this one fit better because of their comorbidities or [other factors that impact treatment], and now we have valuable options. And it’s not one vs the other; it’s how do you better incorporate them into your treatment algorithm having 2 valuable options.