This week we sat down with Dr. Ara Vaporciyan, Professor and Chairman of the Department of Thoracic and Cardiovascular Surgery at M. D. Anderson Cancer Center in Houston, TX to discuss why he chose to dedicate his career to lung cancer, what’s coming down the pipeline for research and the disease and what all women should be aware of when talking with their doctors.
What brought you to the field of lung cancer?
I had always wanted to be a surgeon but I also wanted to be more than just a technician. In many surgical fields the surgeon only intervenes after the diagnosis has already been made and treatment options have been discussed. However, oncology is one of those fields of surgery where the surgeon is an integral part of the patient’s team. Even more so, in lung cancer the surgeon can either lead or participate heavily in all aspects of lung cancer care. That is, he or she can be involved in the diagnosis, evaluation and treatment as well as the follow-up and prevention. To me this was what it means to be a doctor.
What is the most fulfilling part of working with the lung cancer community? The ability to make an impact in the life of a patient and their family. As a general thoracic surgeon treating lung cancer I can actually cure a large proportion of the patients I serve. And those that I do not cure alone with surgery I can impact tremendously through my collaboration with oncology, radiotherapy and pulmonology. That ability to significantly impact a life has tremendous value to me
What is the most important thing for women to know about their health as it pertains to lung cancer?
This disease is not a sideline to breast cancer. Yes, breast cancer certainly occurs much more frequently but the number one cancer killer for women is lung cancer! Also those individuals who never smoked but still develop lung cancer tend to be women much more commonly than men. Many women grew up at a time when the risk of lung cancer in women was a fraction of what it is in men. The assumption arose that these were not diseases that they should worry about. That has all changed. In addition, we are starting to learn that genetic factors among women may predispose them to the non-smoking variants of lung cancer as well.
What is in the pipeline for lung cancer, treatment, advancements and research? Where do you see the most promise?
This is probably the greatest time in the history of lung cancer therapy since the advent of safe surgery in the 60’s and 70’s. Just in my short career of 18 years I have seen palpable improvements, especially in the combination of therapies. Surgery has becomes safer, faster, and with less pain. What was previously done with a 6- to 8-inch incision and a week in the hospital is now routinely done with a 1.5-inch incision and a few half inch incisions and a stay of less than 4 days.
There are other exciting areas as well. The new area of unleashing the patient’s own immune system to fight their cancer is truly revolutionary. Over the next few years our group of oncologists, radiotherapists, surgeons and basic scientists will be not only further unraveling just what allows lung cancers to hide from the immune system but also actively testing multiple new drugs that seek to overcome those barriers to immune response. We are pushing to develop new and faster ways to assess the benefit of these drugs so we can get them to the most patients as fast as possible while still being safe and responsible.
In 10 years where do you see the landscape for lung cancer? How will things change? What is your hope?
I see us using more molecular and genetic data to decide on what treatment the patient should get. Right now, when a patient arrives we first confirm the presence of lung cancer then we stage the patient.With our rapid expansion in understanding genetic mutations in cancer and how they affect the cancer’s behavior I see us making more reliable predictions about a tumors behavior by incorporating that genetic data. In the future, instead of just looking at a cancer’s size and shape we will also use the data from genetic analysis to determine the best treatment.
Not only will this genetic data help us predict behavior better but it will also open up new opportunities to treat those patients. Already we have identified drugs which address the cancer at the level of its specific gene mutation. Still, only about 10% to 15% of the known genetic mutations encountered in lung cancer have a drug available for them. I anticipate that in the next ten years we will develop a whole palette of these types of drugs and address a wider and wider range of specific mutations we encounter commonly in lung cancer.
The last area I see considerable change in is the role of immunotherapy. While the targeted agents I discussed above specifically focus on a mutated gene in the tumor, immunotherapy uses the patient’s own immune system to attack the cancer. Cancers have developed ways to hide from the patient’s immune system and we are now discovering the keys to overcoming that resistance and let the immune system do the job it was designed to do.
What do you hope to see come from MD Anderson’s Moon Shots Program? Our 13 moon shots are focused on building team science. In every example of innovation that you see in the modern world you see examples of team work. Companies like 3M, Google and even Pixar have recognized that innovation will not come from the single scientist or inventor working in isolation but from groups of researchers working and sharing knowledge to identify truly novel and breakthrough ideas. The Moon Shots Program gives us the infrastructure to set up that type of collaboration.I see the moon shots as the way to break through to new innovative ideas. We have brought together basic scientists, surgeons, oncologists, radiotherapists, pulmonologists, radiologists and epidemiologists all working and sharing knowledge to come up with novel ideas aimed at curing lung cancer. It is the R&D of our efforts. Promising ideas identified through moon shots projects are spun-off to get additional funding from existing mechanisms, such as government and philanthropy so that the moon shot can continue to focus on innovation.
How do community events like Lung Love Walk Houston make a difference? How do you engage your colleagues to participate?
Events like the Lung Love Walk keep the importance of lung cancer and the work that is still needed at the forefront of those who are in a position to help. Despite our efforts to provide an infrastructure for innovation like the Moon Shots Program we will still need more resources to finish the job that starts within the moon shot. Events like the Lung Love Walk make the news, get out on social media and eventually make their way to policy makers who can then use that information to help decide how to allocate the funds that might be available. As I said earlier in this conversation many people, including those policy makers, are simply unaware of how common a problem lung cancer is. Showing the human side of this disease and showing that there is a broad community that it affects will hopefully help convince those policy makers of the importance and value gained by helping fund these innovations.
About Dr. Ara Vaporciyan
Ara Vaporciyan, M.D., is a tenured Professor of Surgery and Chairman of the Department of Thoracic and Cardiovascular Surgery at the University of Texas MD Anderson Cancer Center in Houston. Vaporciyan began his training in 1982 at the University of Michigan, where he earned an honors degree in cellular and molecular biology. He then attended medical school at the same institution. In 1989, he began his general surgery residency at The University of Texas Houston Health Science Center. Two of the next seven years were spent back at The University of Michigan in a postdoctoral research fellowship in the Department of Pathology, where he studied inflammatory mediators of lung injury. After completing his general surgery training in 1996, he began a two-year fellowship in cardiothoracic surgery, with an emphasis on general thoracic surgical oncology at MD Anderson. He joined the faculty there in 1998.