Latest / Becker’s Healthcare - Clinical Leadership Podcast / Marwan G. Fakih, MD - Medical Oncologist, Professor, Department of Medical Oncology & Therapeutics Research, Deputy Director, City of Hope Comprehensive Cancer Center, Division Chief, GI Medical Oncology, Co-director, Gastrointestinal Cancer Program

Transcript

Marwan G. Fakih, MD - Medical Oncologist, Professor, Department of Medical Oncology & Therapeutics Research, Deputy Director, City of Hope Comprehensive Cancer Center, Division Chief, GI Medical Oncology, Co-director, Gastrointestinal Cancer Program · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Hi, and welcome to the Becker's Healthcare Podcast.
• 0:03
  I'm Elizabeth Gregersen, a reporter here at Becker's,
• 0:07
  and I'm thrilled to interview doctor Marwan Sakhi
• 0:10
  on the podcast today.
• 0:12
  Thank you so much for joining me. I'm
• 0:14
  so grateful to share your insights with our
• 0:16
  podcast audience.
• 0:18
  Thank you, Elizabeth. It's a pleasure to be
• 0:19
  here today.
• 0:21
  Perfect. And before I dive into all of
• 0:23
  my questions, I'd love if you could take
• 0:25
  some time to introduce yourself,
• 0:27
  tell us a little bit about City of
• 0:29
  Hope, where you serve as deputy director of
• 0:32
  the Comprehensive Cancer Center and division chief of
• 0:36
  GI Medical Oncology, and maybe a bit about
• 0:38
  your background as well.
• 0:40
  Well, absolutely. So,
• 0:42
  as you stated, I serve as the deputy
• 0:45
  director of the
• 0:47
  Comprehensive Cancer Center, City of Hope, Comprehensive Cancer
• 0:51
  Center. We're an NCI designated cancer center. We
• 0:55
  are a top 10 US Health News,
• 0:57
  cancer center in The United States and we
• 0:59
  serve the
• 1:01
  Southern California,
• 1:03
  area.
• 1:04
  But we are also a national,
• 1:07
  cancer center.
• 1:09
  We serve,
• 1:10
  Phoenix,
• 1:11
  Arizona,
• 1:13
  and, Atlanta, Georgia, and she Chicago,
• 1:16
  as well.
• 1:18
  So we do have not only a California,
• 1:21
  footprint, but we do have a national footprint.
• 1:24
  And our mission,
• 1:26
  is really to improve,
• 1:29
  cancer care, across The United States,
• 1:33
  anywhere from, drug discovery to translational
• 1:37
  science, getting those drugs into,
• 1:40
  the clinic,
• 1:41
  finding better options and cures for our patients.
• 1:46
  I treat patients with colorectal cancer predominantly.
• 1:50
  I serve as the division head of the
• 1:53
  GI oncology,
• 1:55
  division.
• 1:56
  I have been in practice for twenty five
• 1:59
  years,
• 2:01
  treating patients with GI malignancies.
• 2:03
  And,
• 2:05
  I
• 2:06
  graduated,
• 2:08
  from University of Pittsburgh,
• 2:10
  served there as assistant professor,
• 2:12
  moved to Roswell Park Cancer Institute in Buffalo,
• 2:15
  New York where I, led the section of
• 2:19
  GI oncology
• 2:20
  for
• 2:22
  approximately nine years
• 2:23
  and from there on,
• 2:25
  moved to University of Michigan,
• 2:27
  where I call that the GI program.
• 2:30
  I have been at City of Hope in
• 2:32
  California
• 2:33
  for the last
• 2:34
  thirteen, fourteen years,
• 2:36
  where
• 2:37
  I have the
• 2:39
  pleasure and honor of,
• 2:41
  taking care of patients,
• 2:43
  in Southern California
• 2:44
  and,
• 2:46
  serving,
• 2:47
  patients with cancer.
• 2:50
  Amazing. Thank you for being here and and
• 2:52
  for sharing the background, not just about today
• 2:54
  of hope, but about you as well. I
• 2:56
  feel like that sets the stage perfectly for
• 2:58
  for our discussion.
• 3:00
  Today, we're talking about colorectal cancer cases, but
• 3:04
  particularly among young adults.
• 3:07
  You know,
• 3:08
  the incidence has nearly doubled in adults 50
• 3:12
  for colorectal cancer over the past two decades,
• 3:15
  but most health systems or most states, I
• 3:18
  guess, still have screening protocols that start at
• 3:20
  forty five. So
• 3:22
  as someone who covers oncology news, you know,
• 3:25
  frequently, I'm covering studies about new incidence
• 3:28
  statistics,
• 3:29
  about
• 3:30
  younger and younger,
• 3:31
  adults
• 3:32
  coming
• 3:34
  to health systems with colorectal
• 3:36
  cancer in a more advanced stage.
• 3:39
  I'd love for our audience, which, you know,
• 3:41
  isn't just
• 3:43
  oncology
• 3:44
  specific. We've got health system executives
• 3:46
  from the full c suite who listen.
• 3:49
  How do you think they should be thinking
• 3:52
  about updating their screening
• 3:54
  or maybe changing their screening strategies
• 3:57
  and risk stratification
• 3:59
  programs to kind of get ahead of this
• 4:01
  trend if that's at all even possible?
• 4:04
  Yeah. No. That's a great question.
• 4:06
  And, we we actually do sleep over this
• 4:09
  every day, seeing patients in their thirties and
• 4:11
  early forties,
• 4:13
  coming into the clinic.
• 4:16
  You know, it's important to know that, you
• 4:18
  know, screening guidelines are based on,
• 4:22
  feasibility
• 4:23
  and making the biggest impact possible.
• 4:26
  There's no question that we are seeing a
• 4:29
  significant
• 4:30
  trend in an increase
• 4:33
  in the incidence of colorectal cancer in younger
• 4:37
  adults. And the incidence over the last,
• 4:40
  you know, twenty five years has
• 4:43
  almost doubled.
• 4:45
  But it's also important to realize that
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  the
• 4:49
  percentage of patients with colon cancer
• 4:52
  that is younger than 45 remains relatively small.
• 4:58
  And
• 4:58
  and so when you are,
• 5:01
  you
• 5:02
  know, implementing a screening strategy, it has to
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  be,
• 5:07
  efficient
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  and
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  identify
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  enough cases
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  without
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  causing significant
• 5:16
  risks to patients. Right? The best screening strategy
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  as we all know is colonoscopy.
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  And the next best probably
• 5:25
  is, you know, fecal testing with a test
• 5:28
  Cologuard. It's called Cologuard,
• 5:30
  which really looks at,
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  you know, a combination
• 5:33
  of,
• 5:35
  microscopic amounts of blood and then DNA in
• 5:38
  the stools and
• 5:39
  identifies patients
• 5:44
  with with high risk polyps
• 5:46
  and colon cancer, but it's not as good
• 5:48
  as colonoscopies and finding polyps which are precancers.
• 5:51
  Now if you're if the incidence is very
• 5:54
  low, it means you're gonna be subjecting a
• 5:56
  lot of patients
• 5:57
  to a lot of screening and there's risks
• 5:59
  to colonoscopies and there is risks for false
• 6:01
  positive tests also
• 6:04
  when the incidence is low. Now what we
• 6:06
  really need is more research in patients younger
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  than 45
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  so that we have tests that are easy
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  to implement
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  associated
• 6:17
  with low chances of false positivity
• 6:22
  and also have acceptable,
• 6:25
  you know,
• 6:28
  cost to the society.
• 6:31
  Right?
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  If you
• 6:33
  screen
• 6:34
  a a million people for colon cancer who
• 6:37
  are younger than 18,
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  you may only find one case. Right? It's
• 6:43
  it's very, very rare to happen that early.
• 6:46
  So there is an incremental risk of the
• 6:48
  incidence for colon cancer with aging, but it's
• 6:50
  just increasing a little bit more in the
• 6:52
  younger adults and it's not increasing the older
• 6:54
  adults.
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  We have about one hundred and fifty thousand
• 6:57
  cases of colon cancer a year. I think
• 7:00
  the,
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  screening guidelines
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  have
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  changed,
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  appropriately,
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  in the last,
• 7:09
  decade or so
• 7:11
  to recommend that we start screening patients at
• 7:13
  age 45 and older.
• 7:16
  Before, the screening was 50 and older. Now
• 7:19
  we still have a problem because we are
• 7:21
  seeing cases between
• 7:23
  twenty five and forty five, but they're still
• 7:25
  relatively low in incidence. And I think what
• 7:28
  we are doing at City of Hope with
• 7:30
  the
• 7:31
  science and the research of our,
• 7:35
  researchers,
• 7:36
  we are evaluating
• 7:37
  blood based assays,
• 7:40
  with work by doctor AJ Gold, for example,
• 7:43
  to look at can you do a simple
• 7:45
  blood
• 7:46
  test that looks at
• 7:49
  certain biomarkers like methylation biomarkers and others
• 7:53
  that may identify,
• 7:56
  you know,
• 7:58
  colon cancer at a very early stage or
• 8:00
  precancerous lesions such as adenomas.
• 8:03
  But those need to be validated. I don't
• 8:05
  think those are streamlined today.
• 8:08
  My advice
• 8:09
  is education so at least we don't miss
• 8:11
  the 45 to 50 or the 45 and
• 8:13
  older.
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  Still an inadequate number of patients in their
• 8:17
  late 40s are being screened today.
• 8:19
  The second thing that we need to do
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  immediately is educate
• 8:24
  our physicians and our patients
• 8:26
  to really voice themselves when they have symptoms
• 8:29
  and to act on those symptoms. Over and
• 8:31
  over again, we see patients with rectal bleeding
• 8:33
  that has been occurring for about a year
• 8:35
  and a half that has been brushed off
• 8:37
  as a hemorrhoid
• 8:38
  when that same individual could could have had
• 8:41
  a sigmoidoscopy
• 8:42
  to address the symptoms and identify the tumor
• 8:45
  earlier. So a combination of research is needed
• 8:49
  to develop assays that are adequate for a
• 8:52
  lower frequency,
• 8:54
  you know, cancer in the younger adults than
• 8:56
  the older adults,
• 8:58
  and also awareness to address early symptoms so
• 9:01
  that they can be investigated and we don't
• 9:04
  miss a
• 9:05
  a potentially curable illness.
• 9:08
  Perfect. And I appreciate you kind of laying
• 9:10
  out the context as well as,
• 9:13
  with, you know, seeing those rising case numbers,
• 9:16
  but in the full context of the cases,
• 9:18
  what that, you know, represents
• 9:20
  as a patient population.
• 9:22
  Yeah. Yes. And I, you know, and I
• 9:23
  think we should be aware that it is
• 9:25
  a health problem, but Mhmm. But we also
• 9:28
  need to recognize that if we look at
• 9:30
  patients
• 9:31
  who are with colon cancer between ages 35
• 9:34
  and 44,
• 9:36
  those represent roughly about five percent of colorectal
• 9:39
  cancer cases.
• 9:41
  And and so the the
• 9:44
  not every single individual should be thinking that,
• 9:47
  k. I'm 30. I'm gonna get colon cancer
• 9:50
  tomorrow.
• 9:51
  But but you feel like you have a
• 9:53
  new symptom, please address it, talk to your
• 9:55
  doctor, and push forward for further investigation.
• 9:59
  Don't brush it off.
• 10:01
  Absolutely. And and you touched on this a
• 10:03
  little bit in terms of research. I know
• 10:05
  City of Hope is running multiple colorectal cancer
• 10:08
  trials across the entire national network.
• 10:11
  For health system executives
• 10:13
  who are sitting in their offices and weighing
• 10:16
  whether or not they want to expand their
• 10:18
  clinical trial capabilities,
• 10:21
  what value proposition would you give them about
• 10:24
  being part of kind of an a research
• 10:27
  network?
• 10:30
  I think it's accessibility to patients. You know,
• 10:32
  we owe it to our patients to provide
• 10:35
  cutting edge treatments,
• 10:38
  options when there are no standard options,
• 10:42
  and improvement on the current standards of care.
• 10:45
  And and to improve standard of care, you
• 10:47
  have to be involved in clinical trials.
• 10:50
  I think a clinical trial network is extremely
• 10:52
  important in
• 10:54
  getting those studies closer to home. Not every
• 10:56
  patient has the means
• 10:58
  to come to a faraway comprehensive cancer center
• 11:02
  to be enlisted in a clinical trial to
• 11:05
  get access to a novel treatment. Right?
• 11:08
  So, we owe it to our patients to
• 11:10
  get those studies closer to them. And at
• 11:13
  the same time, frankly, there is some efficiencies
• 11:15
  with those. Right? A a large cancer center
• 11:18
  that has,
• 11:20
  multiple
• 11:21
  network clinics
• 11:23
  and
• 11:24
  and other hospitals
• 11:26
  within their network,
• 11:28
  it makes more sense at that point to
• 11:31
  open certain studies because
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  the
• 11:34
  denominator of patients who are
• 11:37
  eligible for that study will increase.
• 11:40
  I think one has to be smart about
• 11:42
  which studies to open across the network and
• 11:45
  which studies that are more demanding that may
• 11:47
  not be feasible
• 11:50
  in our
• 11:51
  clinical network sometime to keep those within the
• 11:54
  comprehensive center. But there's no question our first
• 11:57
  line studies, second line trials, phase three trials,
• 12:00
  all of these should be accessible to our
• 12:02
  patients.
• 12:03
  I think
• 12:04
  having communication
• 12:06
  between the leaders of the different
• 12:09
  facilities within an enterprise would be extremely essential
• 12:13
  to build on those synergies that we have
• 12:16
  and the strength that we have.
• 12:19
  Absolutely. And and speaking of building, right,
• 12:22
  when we're talking about younger patients,
• 12:25
  particularly younger patients with colorectal cancer,
• 12:28
  they're presenting, you know, with different needs than
• 12:32
  maybe your 70 year old patient.
• 12:35
  How should health systems think about
• 12:37
  structuring or building even
• 12:40
  new care models
• 12:41
  and those multi multidisciplinary
• 12:44
  teams to address the needs of a younger
• 12:47
  cancer patient population?
• 12:50
  Yes.
• 12:52
  You you hit it on the nail here.
• 12:55
  You know, every cancer patient has needs. Right?
• 12:58
  And and those needs are beyond,
• 13:01
  you know, receiving
• 13:02
  therapy. And Right. And,
• 13:05
  the supportive care is extremely important. You know?
• 13:09
  Management of side effects of of
• 13:12
  treatment,
• 13:14
  support from the social perspective.
• 13:17
  Right?
• 13:19
  Relationships, dynamics with family members,
• 13:22
  you know, sexual function, fertility issues, etcetera.
• 13:26
  Some of these are more
• 13:29
  unique to younger patient population
• 13:31
  than the older patient populations who have also
• 13:34
  their own needs that need also to be
• 13:36
  addressed.
• 13:37
  Right. But the way to address that in
• 13:39
  the younger patient population is really to have
• 13:42
  an adolescent and a young adult program and
• 13:45
  to work with a supportive
• 13:47
  care team and social work teams and have
• 13:49
  some leadership involved in
• 13:51
  in really streamlining
• 13:53
  those services. So for example, in our
• 13:56
  center, we have a social worker who's dedicated
• 13:58
  to the young adults with
• 14:01
  colorectal cancer that meets those patients now in
• 14:04
  clinic on their first visit, has follow-up with
• 14:07
  them. We implement immediately
• 14:09
  assessment of fertility
• 14:11
  needs, social
• 14:13
  support, social work support,
• 14:15
  you know, sperm banking sometimes if radiation is
• 14:18
  needed for rectal cancer, ovarian transposition for females
• 14:22
  who
• 14:23
  desire to maintain their fertility,
• 14:26
  you know, couples counseling,
• 14:29
  you know, stoma care, body image, all of
• 14:32
  these are important. And and I think without
• 14:35
  having a dedicated team from a social worker,
• 14:37
  a psychologist, a psychiatrist,
• 14:40
  and, you know,
• 14:42
  it's hard to really serve the needs of
• 14:44
  all those patients.
• 14:45
  I think support groups are very important as
• 14:48
  well, and those could be done either virtually
• 14:50
  or within a center that has a large
• 14:52
  number of patients who are interested in
• 14:54
  forming these groups.
• 14:56
  So I think those are the things that
• 14:58
  we
• 14:59
  think about when we have our younger patient
• 15:02
  population.
• 15:03
  Treatment
• 15:04
  may be also a little bit different for
• 15:06
  our younger adults. They may be more interested
• 15:08
  in sphincter saving procedures sometimes when feasible. They
• 15:12
  may want
• 15:13
  radiation sparing procedures and are more interested in
• 15:16
  clinical trials.
• 15:17
  And and so,
• 15:19
  you know, at at the heart of that,
• 15:21
  I think is also the medical oncologist who
• 15:23
  should be able to navigate and champion all
• 15:26
  these issues.
• 15:27
  But from a healthcare system, from a institute
• 15:30
  perspective, I think putting the resources behind those,
• 15:33
  putting the funding behind these
• 15:35
  is extremely important because that's really
• 15:40
  the essence of taking, you know,
• 15:42
  care of our patients, you know. And at
• 15:44
  at City of Hope, we say, you know,
• 15:46
  there's really no,
• 15:47
  you know, the the you wanna save not
• 15:50
  just the patient, you wanna save the soul.
• 15:51
  Right? And and so you you really
• 15:54
  have to address all the, not only physical
• 15:57
  issues, but all the psychosocial issues and social
• 16:00
  issues
• 16:01
  associated with cancer.
• 16:04
  Absolutely. Yeah. And I I I love the
• 16:06
  way you phrase that of kind of these
• 16:08
  supportive services are actually the essence, you know,
• 16:10
  of taking care of a patient. So,
• 16:13
  so grateful for for your insight there. Really
• 16:16
  quickly, I know we're almost wrapping up with
• 16:18
  time, but
• 16:20
  I always get excited about the innovation in
• 16:22
  oncology, and I always, you know, love to
• 16:24
  end our conversations
• 16:26
  focusing on, you know, the future.
• 16:29
  There's genetic mutations
• 16:31
  that
• 16:32
  were considered untreatable
• 16:34
  long not too long ago for many cancer
• 16:37
  types that are now able to be treated.
• 16:41
  With how quickly innovation is happening in oncology,
• 16:44
  whether that's, you know, through treatment or diagnostics,
• 16:48
  if you could give one piece of advice
• 16:49
  to health system leaders, what should they
• 16:52
  be prioritizing right now to kind of avoid
• 16:54
  their oncology programs falling behind?
• 16:58
  I think a think tank, you know, within
• 17:01
  oncology within your team and access to clinical
• 17:04
  trials is vital vital.
• 17:06
  And and I do agree there is an
• 17:08
  explosion of new treatments. And I think the
• 17:11
  future is bright anywhere from RAS,
• 17:13
  KRAS targeting or what we call RAS targeting
• 17:16
  now because we can target many KRASs
• 17:19
  to antibody drug conjugates, immunotherapy
• 17:22
  with novel checkpoint combinations to cellular therapies.
• 17:26
  You know, the field is moving quickly and
• 17:29
  and,
• 17:30
  you know, supporting your staff so that they
• 17:32
  are involved in research,
• 17:34
  Support your staff so that they are really
• 17:37
  reaching out and and, you know, visiting into
• 17:41
  visiting
• 17:42
  different conferences and being involved in symposia, but
• 17:45
  putting a lot of resources behind clinical trials.
• 17:48
  You need a platform that is really efficient,
• 17:51
  and you need a large portfolio to serve
• 17:53
  your patient population. But you can always start
• 17:56
  small and build up. So that would be
• 17:58
  my advice.
• 18:00
  Perfect. Well, thank you. I'm excited to
• 18:03
  to speak with you again in the future,
• 18:05
  and I can't thank you enough for joining
• 18:07
  me and and taking the time to have
• 18:09
  such an informative
• 18:10
  discussion for our listeners. Oh, it was a
• 18:13
  pleasure to be here, and thank you very
• 18:14
  much, Elizabeth.
• 18:16
  Thank you. And I invite our listeners to
• 18:18
  tune in to more podcasts from Becker's HealthCare
• 18:21
  by visiting our podcast page at beckershospitalreview.com.
• 18:26
  Thank you again, doctor Fakih. I hope everyone
• 18:29
  has a great rest of their day. Thank
• 18:31
  you.