Cortes discusses the changing hematology landscape and the challenges of today’s cancer center

The landscape of treating patients with hematological malignancies has changed dramatically throughout the career of Jorge E. Cortes, MD. It used to be that the excitement may have centered around a handful of drugs, but now there’s 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 hematological malignancies. He has also played a role in this growth through the study of new tyrosine kinase inhibitors (TKIs) such as ponatinib (IclusigÒ; Takeda) and their place in the evolving therapeutic landscape.

In an interview with SOHO Daily News, Cortes discusses the strengths of these treatments for patients with conditions such as chronic myeloid leukemia (CML), acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL), and what he looks forward to when of the 10th Annual Meeting of the Society of Hematological Oncology (SOHO 2022). Additionally, he discusses the role he hopes the Georgia Cancer Center will play in expanding treatments for patients, as well as the challenges facing cancer centers today.

Daily news from SOHO: What do you see as the biggest challenge facing the cancer center today, and how do you see the Georgia Cancer Center seeking to overcome it?

CORTES: In terms of patient care, I think our models are changing quite significantly. One thing I realized when I left a larger institution, such as the MD Anderson Cancer Center at the University of Texas [in Houston]to a smaller facility with a completely different patient population is the difficulty in accessing cancer centers for patients. [Another challenge is] awareness [required] reach these populations [that] do not have the capacity to undergo cancer screening tests, pay for cancer care, or who have very different patient characteristics – and these patients represent a high percentage of the population [we serve]….Finding the right balance to provide adequate care to the entire cancer population is a major challenge.

What excites you most about your role as director of the Georgia Cancer Center?

I think that [it is] the challenge, on the one hand, of making it as strong an academic institution as possible, because we are, after all, an academic institution. We develop strong research programs; we are hiring [individuals] in the laboratory, in the clinic; [we are] increase our portfolio of clinical trials so that [patients] in the field may have access to better options for clinical trials and strong translational research. We are growing in stature and we have been able to recruit some very good [investigators] in this regard; at the same time, we want to be a resource that helps these communities [that] do not have access. We have an interesting balance here where I want to bring really good science to the cancer center, while we have to meet the most basic needs of some of these patient populations. It’s that balance that I see much more embedded in what I have to do every day, and it’s very exciting.

Now the goal is to get us to the National Cancer Institute [NCI] designation and there is [much] work to do. There are a lot of challenges with programs to build, 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 small institution that takes a lot of work and needs a lot of support. It’s a lot of selling your mission, your vision, to everyone. State authorities are supportive, but they want to understand exactly what you want to do, what resources you want, how are you going to accomplish [your mission]and how [those resources are] will help the population and the State.

During your career, what has changed the most in the treatment of patients with hematological malignancies?

For many years there has been so little progress. For most of my career, I’ve seen maybe 1 or 2 drugs approved in 20 years for hematological malignancies. There was a big deal when fludarabine was approved for chronic lymphocytic leukemia [CLL] and that was probably the big deal and nothing more after that. But then came this great explosion of knowledge about the molecular mechanisms of disease, and that resulted in the development of much more targeted, much more effective, and even safer drugs in many cases.

The way we treat patients [now] is very different from the way I treated them when I was on a scholarship or at the start of my career. [Treatment has] become much more effective, much more interesting and… much more challenging, because we are now beginning to understand how we combine some of these agents for patients with molecularly complex diseases. How to combine and sequence the different approaches?

You are now looking at very small subsets of patients, because each unique molecular subset is different from the others; it’s not just AML or LLC, it’s AML with these molecular abnormalities or LLC with or without a TP53 mutation. These small subsets make it much more complex, but much more biologically relevant and, of course, better suited to the specific needs of each subset of patients.

Since your work on TKIs, how has this therapy evolved? Do new TKIs excite you?

It changed the whole landscape of the CML, and I was lucky to be part of that transition. [I trained] through the days of interferon, which was a big breakthrough at the time, then the transition to TKIs, then the development of the next generation of TKIs. It has improved patient outcomes so much, but we still have gaps and luckily there are new TKIs.

We recently had a new TKI come to the clinic, and even with 5 TKIs we had, it’s becoming such a useful tool, not necessarily to replace everything we had, but because there are areas where you need an alternative. This one has a new mechanism of action, so it’s also rewarding that not only is it [not] just another TKI, but when we find another way to approach this tyrosine kinase integration [it can] overcome some of the limitations of the drugs we already had.

Is there any research you are currently involved in that excites you?

I’m involved in developing some of these new TKIs, but I’m also involved in researching some of these combinations with new agents and TKIs. There are many potential combinations, and it will be a bit difficult to decide which is the right one. I have a few essays that test these combinations; for example, one with a drug called KRT-232 and preclinical work [for it] is very exciting. We also work, develop and identify these combinations at the Georgia Cancer Center.

What is your presentation about at this year’s SOHO 2022 and what do you hope attendees take away from it?

I present in the Acute Myelogenous Leukemia (AML) session a tough question…whether you treat with imatinib (GleevecÒ; Novartis) or ponatinib, [which] are 2 good drugs. It’s sort of a third generation of drugs, and we’re trying to figure out which is the best. We also have a few studies presented in the general session, but we also present posters on part of the analysis on both the axitinib trials (InlytaÒ; Pfizer) and the ponatinib trials (Poster CML-129).

Much of my presentation is centered around these 2 drugs…the main message is that they are 2 wonderful drugs. I don’t see them as competitors; I see them as complementary. Try to find the right patient for each of these drugs [is important]. That’s why we want options, because you always have a patient that you think is a better fit because of their comorbidities or [other factors that impact treatment], and now we have valuable options. And it’s not against each other; this is how to better integrate them into your processing algorithm by having 2 valuable options.

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