Bonus: Colon cancer awareness: ‘I should have gotten my colonoscopy, that’s the lesson’

and cancer will never define me. Hi. Everyone, I'm Katie Curic and this is next question. You know, March maybe calling cancer Awareness month, but as many of you know, my mission has been to increase awareness of this second leading cancer killer every day of the year. So we've put together a special episode on this topic with the hopes that it will motivate many of you to call your doctor and get screened. As a lot of you all know, my first husband, Jay died gosh twenty three

years ago. He had been diagnosed with stage four calling cancer. He battled the disease for nine months and then died at just forty two. I've been advocating for early detection ever since I even got a colonoscopy on television. I'm a little nervous that in our normal well today. I wanted to see where we are in terms of research, detection, and treatment, and also understand why our country still has such vast health disparities that leave black of Americans more

susceptible to this disease than others. You'll be hearing from two of the top scientists in this area a bit later, but first I wanted to start with my friend Donna. Early detection is so important. Donna Otis is the CEO of a private golf club in San Diego, and a couple of years ago we got to talking and I learned about her calling cancer diagnosis and preparing for this episode. I asked if she would be willing to share her story, and she bravely agreed. I did not get a colonoscopy

at fifty. I did one of those um colonnaise, you know, just kind of those quick tests, and nothing came up. I was in San Francisco at the time. I was fifty one, and I actually so not to get to graphic, but it's reality. I had blood in my stool and I got did eat something wrong? And so I did the let the hospital know. They sent me a kit and it came back negative. So I said okay. And then fast forward another year and I was fifty two

and I noticed again it had stopped. And then I noticed again, so I went back to the hospital and they said, okay, try try another stool um sample. Tests I did that came back negative. And then one day in August two thousand eighteen, I just started to feel like my stomach wasn't right um and I was in some pain in the intestinal area. And then I said, well, let me just go see and check it out. Go to the doctors. And that's when they said, you know,

let's let's do a pollnoscopy. And you know when I woke up and they said, h we see something in a little strange um. Let's let's take a look at it a little closer, and let's get a biopsy. And you know, it took a couple of months to get all the biopsies and the tests done, and I, oddly enough, I happened to be driving to Santa Barbara, UM with with a friend of mine and you know, you can

open everything up on your on your chart. It's the day and age of technology now you can opt not to look at it and say I'm going to wait until the doctor preasum into the office. But everything, your test results, your CT scans, all of that comes right to your phone now. And I opened it up in clear as day, there's that word cancer. I put my phone down and I didn't want to say anything, and I opened it back up again, and not only was it cancer, but it was labeled as stage three, and

I thought crap. I didn't want to call anybody. I just wanted to try and digest it. And my I went in to fight flight mode, like okay, what am I going to do with my twenty two year old daughter? She was twenty at the time, and how am I going to take care of things? And that's just that was my immediate reaction, like crap, I'm not ready. And the appointments, biopsies and CT scans that followed, Donna got more bad news. Sorry, it's now it has traveled to

your liver. And then the next blow after the full um CT scan was well we think it's in your lungs too, So um I said, okay, this really can't be happening. So I went into this whole disbelief mode. UM, and then being a single mom. You know, what am I going to do with my job? And how am I gonna live? You know, just all those things come rushing through um, rushing through your head. And someone said to me, you know, Donna, you really don't know how strong you are until the only thing you can be

is strong. Donna's co workers and friends rallied around her. She asked for help and gathered her village. Meanwhile, she got her treatment plan, and before she knew it was on the cancer diagnosis roller coaster ride. This started chemo in December of two thousand eighteen, and then I did chemo all the way through till September. Of My first round of chemo was okay. UM. The second round, I had a severe allergic reaction. I couldn't walk or talk.

You physically cannot touch anything remotely cold, not even a door knob, this huge, painful, tingling sensation. My eyes completely shut because of the nerve endings. You go like this and you get a handful of hair. I couldn't take care of myself. I really just wanted to die. I think at that point I just said, okay, let's let's pack it up. Let's let's get anything situated, let's get a living will. And UM. I had those tough conversations with my daughter to say, listen, UM, we're going to

fast track your life a little bit. You're going to have to be an adult fairly quickly here, and you forget about things like teaching your kid some of your old mom's recipes. Um, you forget to teach your kid, or you think about it like, well, I can always teach her. You know how to sew a button on a shirt. Donna found the strength as she has at every turn, and the treatments continued. I went through radiation,

thirty rounds of radiation. Skin turn start extremely painful. After you leave, you have to wear a pump for forty eight hours. So you know, when you go to work and you see the tube hanging and everyone's looking at me like you're doing okay, And I said, don't feel sorry for me, don't treat any different. I've gone through two surgeries. Um. The first surgery was to remove part

of my liver, to remove my rectum. The post surgery and waking up to this bag that is out of your body and you can see your intestine which is out of your body as well. Um, it's pretty difficult. And the type of clothes you have to wear, you can only wear certain very bad you know, loose and baggy clothes, and you have to time your release of your bag at a certain time because sometimes it could just really blow up. But this I made this bag define me. Um, and it took over me for for

about a year. Um, pretty feeling pretty sad, feeling sorry for myself. But then um, but then my daughter said to me, but Mom, you wake up every day on this side of the world. Don't worry about the bag. And then my second surgery was in November of to do the reversal, meaning put my intestines back, get everything all attached. And then after radiation, um, you know, you

do the surgery and then you go into chemo mode. Um. And so after one chemo treatment your body gets sort of immune to it, and then they shift you to another. And then the other was another strong poisonous chemo that reaked havoc um. But I had to do it, and that almost left me with complete hair loss. And then from there, you know, we're just fighting for time. And so I got the final news was not the final news. But the news was, Donna, you will never be cured

of cancer. You will have to do chemo for the rest of your life until you pass. And we can't determine whether it's two or three years. Um, it's hard to say. And so you know, you keep on getting. You know, you're like one of those um those toys as a kid that's a plastic thing. It's got a base and you keep on knocking it over, but it stands right back up. Well, I felt like I was. I was one of those um but I got right

back up because I had no choice. Recently, Donna got the chance to join an immunotherapy trial, which marks a new experimental face of treatment, one that's giving her and everyone who loves her hope. We're going to see how it goes. The doctor's like, hanging there, Let's just try this immuno therapy, blast out that tumor and then uh, and then we'll kind of take it from there. So here I am today, and I'm gonna live till tomorrow, and I'm gonna keep on going. This May, Donna is

taking an important trip. She'll travel to Kentucky and watch her daughter graduate from college. A huge emotional milestone for both of them. That was what I was living for. That was my first target was when they gave me two years and I was like, crap, I won't be able to see her graduate and that was in my head. So um, so that's done pretty quick here in a couple of months, and then my my next target is is to to try and get to If I can get to sixty years old, that would be. That would

be that's my next school. After after she graduates, we'll be right back. We begins tonight with the sudden and very tragic debt sending shot waves across the country devastating and shocking news that actor Chadwick Boseman has died at forty three after a valiant four year fight. Chadwick Boseman lost his battle with colon cancer Friday. For four years, Chadwick Boseman had been quietly fighting colon cancer, making something

like seven films while enduring countless surgeries and chemotherapy. When the Black Panther actor died in August of it was devastating to those who loved him, as well as his legion of fans. It's not just a loss that we're feeling we're going to feel his absence. His absence, but his death at such a young age also put colon

cancer and some grave statistics in the spotlight. One that more young people are being diagnosed with colon cancer than ever before, and two that Black Americans are more likely to get colorectal cancer and more likely to die from it. Black Americans have the highest colorectal cancer incidents and mortality rates of all racial and ethnic groups in the United States.

Dr Edith Mitchell is a professor and oncologist at the Sydney Kimmel Cancer Center at Thomas Jefferson University in Philadelphia. We asked her why why is the black community hit hardest by this disease? So nobody knows for sure. What is known is there is a word called red lining. Holic is on loans and the sale of properties, so that Blacks were relegated to certain parts of the city where there may have in a higher number of factories and other carcinogens, as well as poor water quality and

other socioeconomic conditions called the social determinants of health. There were fewer healthcare facilities, lack of supermarkets, drug stores, and other components of the healthcare arena. When I tell patients that I want them to eat fresh fruits and vegetables, but there are none nearby where they live, that's a social determinant of health. And consequently, all of these components

contribute to the development of cancers. So if we're going to as a country change healthcare display charities, we really need to focus on not only the disease process and medications, but on lifestyle that contributes to who we are. We are who we eat, and consequently, one zip code determines more effectively and more accurately how long you will live, as opposed to your genetic code, which you inherit from

your parents. So we've got to change that so that our zip code is not the greatest determining factor on the disease processes that are experienced in a community, as well as the duration of life. Dr Mitchell says it's important to highlight the fact that black men are forty seven percent more likely to die from calling cancer, partly because they are still not getting screened at the same rates.

Is culture. There is also the history the Tuskegee study had only black men, it was not discussed with them, and therefore they passed on the disease to other sexual partners and therefore put really three generations at risk. So black men have a history of mistrust, and one thing that we have to instill in people is trust of the health care system. Black men prefer going to black doctors, and yet for the United States of practicing clinicians in

only five percent we're black. Yet blacks constitute of the United States population. So therefore we need to develop more diverse clinicians so that there is a greater percentage of Blacks in the population. With so few black doctors, black

patients don't always get the care they deserve. Implicit bias are Explicit bias really affects the interaction between the patient and the physician as well as others on the healthcare team, so that we need to understand people who are different or who may look different from us, and we have to learn how to communicate effectively with all patients. It's well recognized that in many clinical situations that black patients

and other minority patients are treated differently. For example, there are studies that show that physicians and other clinicians spend less time in a examination room with a black patient as opposed to a white patient are to someone who doesn't speak English as their primary language. There was also a study UH and several studies showing that black patients did not receive the recommendations for treating an options as

white patients. For example, patients who had stage one lung cancer were offered different recommend nations and not surgery as often as white patients. And of course there could have been other reasons, but for stage one lung cancer, surgery is the major treatment and can be curative. Yet the black patients were not offered surgery. Black patients are offered clinical trials less frequently, and in many cases it's the implus said bias with the assumption that black patients won't participate.

So while you understand that there can be individual bias in health care delivery, there can also be institutional bias. So we really have to approach all of those topics to make sure that we have the three sixty that is a full circle of all of the potential areas where we can intervene to improve healthcare delivery. A new test is not going to change red lining are the lack of supermarkets and other potential components of the atmosphere.

It's not going to get rid of the factories and the exhaust We've got to look at the whole picture and make sure that individuals living in certain zip codes are not disenfranchised from a good healthcare arena, that they have a good place to live, and making sure that the overall community is healthy. And therefore we've got to change some of the social determinants of health so that everybody has equal opportunity to live in a healthy environment

and a healthy neighborhood. We have a moral imperative to fix this. Dr Charlie Fuchs is an oncologist who is now leading the hematology and oncology team at the biotech firm genem Tech. And it starts on many fronts, which is making sure that these communities have the proper access to information, education, nutrition, prevention, care, and I frankly, access to clinical trials. You know, we talked about how low the rate is in the US of patients in general

participating in clinical trials. You know, you look at all these trials across the realm and it's five eight percent, maybe ten percent African American. Well, we got to fix that, right, I mean, because I was involved in a study because the common perception and in fact is that Black Americans diagnosed with calin cancer who get treated have a worse outcome. And so what we did is we looked at a large clinical trial database that enrolled African Americans and whites.

And as you know, within a clinical trial, everything is prescribed, the treatment, the follow up, everything, because you've got to follow the menu because it's a clinical trial. And in the context of that clinical trial, there's no difference between white Americans and Black Americans, meaning that there is no biologic difference, and if they get access to proper care, they do just as well. So it's a moral imperative.

The fix here is not complicated. It's access to care, it's access to education, it's all the things that are plainly obvious. When we come back, we'll have more with Dr Charlie Fuchs. We'll talk about the COVID effect on cancer screening as well as new research and treatment. That's right after this. I've known Dr Charlie Fuchs for a few years now. He's a trusted and respected oncologist who

has worked with us at Stand Up to Cancer. He was the director of the Yale Cancer Center, but he recently made the jump to the research and product development end of the health spectrum at the biotech firm Genete Tech in San Francisco. So he is I think the perfect person to sit down and talk about where we are now with colon cancer and what the future looks like.

Here we are after the pandemic or on the verge of being post pandemic, and so many people did not get screened and that is translating to a lot of cancer deaths if we don't really sound the alarm. So are you concerned about this period of time and about people putting off screening and what is the impact of that? No, Katy, I'm I'm really concerned. The fact is is that if every year American Cancer Society puts out the cancer statistics

for the year, you know cancer in particular. Last January was cancer statistics, and you know, as you know, in January, we didn't know what we were about to get ourselves into with the pandemic. And I was actually interviewed um about the statistics in January which showed this progressive decline in cancer mortality decline and cancer incidents, and one of those was colon cancer. Right, We've made so much strides over the past three decades with early detection, with treatment, UM,

with understanding the genetics and UM. You know, we were looking forward to continue declines. We're clearly not going to see that next year because the data are compelling. For instance, study showed that in the first three months of the pandemic, there was an eighty percent drop in cancer screening. So we're at of where we would have been the year before, and you just don't rapidly recover from that. And I can tell you, you know, what are we seeing. We're

seeing people not getting screened. We're gonna be seeing sadly, people who are now presenting with cancer colon cancer at later stages, and we're going to see a backtrack. I don't think, you know, I think we need to be prepared for that reality. And what we have to do is just focus on what can we do today, which

is returned to screening. And as you know, the American Cancer Society, a number of organizations, even the Biden administration is now pushing that, and we have to remind people that it is safe to go back, that it's safe to get screened, that patients who are concerned about symptoms need to follow up with their doctor. Patients who are being treated for cancers shouldn't hesitate to get get their

therapy on time in its full course. And these are the things that we have to do, while at the same time we have to make sure that we enable all our researchers to continue their work despite all the complications of the pandemic. You should get your first calling oscarpy or your first calling cancer screen at at age five, according to the American Cancer Society and other organizations. Um,

why was that lowered? That's exactly right, And just to be clear clear, it's age forty five for an averageous person because we could talk about what happens if we have a family history, which should be younger. But um, it was fifty, and why is it now forty five? Because as you know, there's this very alarming trend of an increase in younger people with calling cancer that is under fifty, under forty and there's only speculation as why that is. But it's rising at a rate faster than

probably any other cancer that is calling cancer under age fifty. So, thank goodness, various organizations, American Cancer Society among others, have now reduced it and hopefully that will have an impact. But this trend is alarming. It's alarming, and it's also sort of maddening that you all, no offense, Charlie, haven't figured it out why this is happening. I mean, I

know there's a lot of people studying this. This has been going on for a couple of years now, and why are we closer to understanding why this is happening. I've heard obesity, you know, for years that that was one of the culprits. But it seems to me there must be other things going on here, and what's taking so long to figure it out. I think it's a

fair criticism. I think part of it is obesity. Now, when I say that, when I give a lecture to allay audience, I will tell you invariably I people appropriately come up to me at the end of my talk and say, much like you mentioned earlier, you know, my relative who was diagnosed at a young age was not obese. So I'm not suggesting to you that obesity is the only explanation. But I think we have to recognize and not to not the fact that obesity is a real

risk factor for this malignancy. That there's no question that child had. Obesity is an issue and has been an issue over the past several decades in this country that has to be dealt with, but it's not the only answer. We recently completed analysis and I will tell you it's complicated. It's a very the people under age fifty with colon cancer, it is a very heterogeneous group, and we're trying to look at the subsets understand the genetics. Part of it

is I think genetically driven, there's no question. Part of it I think has died and lifestyle and then there's an element we have to sort out. And I don't deny the fact that we have some catching up to do. In the meantime, I think, what can we do. We can make sure we're taking excellent family histories at the primary care setting, right. I mean the problem is when I take a family history and I'm an oncologist, that's too late. Right. That needs to happen at the primary

care setting, right before any cancer. Definitely we need to do that. We need to work on obesity. We got to get screening earlier, and let's be let's be honest with ourselves. You know this because you authored the Katie Curic effect for colin oscarpies. Getting people who are older to get colin oscary was work. It's not going to be easy to get younger people to do it, and that's something we got to work on. I want to

talk about screening in just a minute. But you know, are there any other theories that are being studied right now? I remember uh that there was some thought that it might be the over prescription of antibiotics that might somehow affect gut health or inflammation. What are what are scientists looking at as possibilities? Because, um, when you say genetic, that doesn't necessarily just mean a family history of colon cancer. It could be a family history of other glandular cancers.

To write, you know, if you have a history of breast cancer, for example, Jay, my late husband's mom had ovary and his grandmother had breast and there may be some kind of length between all these cancers. Are among all these cancers and a family correct? Absolutely, that's a

great point. I think what we're realizing is we started with what were the means that we were decidedly in the biology of colon cancer, and we are that we've been identifying those genes, but we've now realized to your point. We did an analysis looking at the broca genes the breast cancer genes and found that potentially four and a half percent of colon cancers were associated with that gene,

which isn't on the list. And so we really need to think, we have to really question our assumptions about these genes and realize, yeah, if somebody's got a distinct family history of of colon cancer of of breast cancer, rather that colin's now probably on the list. And then there are there are sort of subtle genes, not these sort of high press penagence genes, these genes that you know are at risk, but genes that are a little more subtle in their effect that probably account for a

lot of this. And not to get in the weeds, but genes like check two and some of the others that get talked about. That's these genes are probably accounting for a substantial number of colon cancers. We're just not fully appreciating this. So we have our work cut out in terms of understanding the genes. And you know, I was going to say, there are a lot of genes that just haven't been discovered, right, that are floating around people's biologies and we just just don't know what they

are and the role they might play in cancer. But but what are what are some of the things that you're looking at and other people like you, Charlie, are looking at in terms of this alarming increase among young people. Well, we're doing very large population studies and we're obviously getting lifestyle data, we're getting family history data, we're characterizing the tumors genetically. We're at the same time also trying to understand um the outcome is it is it a different disease?

And we actually have an analysis that we're hoping to publish in the next several months about all some of these things. So we I don't have an answer, I think that, but I will tell you in our last analysis what was abundantly clear is this is a mix of causes of calm cancer. And I think part of the reason, Katie, we don't have an answer is because there isn't going to be one answer here. There's gonna

be several. And that is the lesson in cancer, Right, It's not one disease, it's probably a hundred diseases and in a hundred different well really millions of diseases, and million different different biologies, and I think that's one thing, right, is so the way I react to or I don't even like to talk in the hypothetical, but the way one person reacts to maybe uh, potential cancer or sell mutation or something happening that kicks off camp cancer in his or her body is a lot different than the

other person's biology. So it's really this delicate interplay between the disease and the host, if you will write the host organism. Oh, absolutely, you know, And we had I was talking to something about this recently. We did a study because let me just track back. You know, there are people who will tell you who get colon cancer who said, I don't understand this. I had a colonoscopy less than five years ago, and how could that be?

Was there a mistake? This is a real phenomenon. So we actually did a study, Katie, of cancers that we're diagnosed less than five years after a colonoscopy. And I don't want to alarm people with that or tell them not to get the colonosopy, because it works, but it's not perfect. And when we look at those cancers that happened within five years of a colonoscopy, they are biologically different.

They're different in terms of the appearance they're they're flatter, they're hard to see, and they have different genetic ideologies, different genetic underpinnings. And so to your point, each of these cancers, in this case col is it's a Schmoor gess Bourg of genetic diseases. And that's the opportunity, right If long as we're prepared to say, hey, you know what, I'm willing to develop a therapy where it's only going

to work for five of calling cancer. Admittedly as peculiar as that sounds, if we know what that five is, we're gonna make real progress, you know, Charlie. For so long I was the colonoscopy queen, and I still believe colonoscopies are the gold standard for detecting and treating and preventing colorectal cancer. But a lot of people can't afford them.

A lot of people aren't getting them. One in three people are not getting any kind of tests, you know, when they're when their age appropriate in this case forty five. What about some of these other tests. I've been working with Exact Sciences, for example, a little bit on their at home stool tests. And you know, one of the things I realized is best test is actually the one

that gets done. So can you talk to us a little bit about the differences between some of these like fecal occult blood tests and fit tests and um these at home tests, and if you feel comfortable for certain people recommending them. Absolutely, I mean I think to your point, people just have to get screened, because I think the latest statistic, Katie, is that about sixty percent of people who should be screened for colon cancer aren't. Wow, so it's much higher than I thought. Yeah, so you know

roughly about you know, people are not getting screened. We should be screened. Oh I was right, I said that. Sorry, Yeah, so it's it's um But you know, the third of the population not getting screened is a problem, and that's of any test. And to your point, there are a panoply of tests. Colin Oscarby saves lives. It's an important test, it's safe. And I'm just gonna be clear, if if you have access to colin ouspy and everyone should, that's

what you should do. And I think you taught this nation and Frank of the world of value a lesson by volunteering to do that on television. And that's for me, that's the lesson. If somebody is gonna ask me what tests, that's it. And I just you know, I got a call in ouspy during the pandemic, because, like you, I want to send a message that it's safe to be screened and it's important. But if you can't, there are

other tests. One is, we know that calling cancer is a disease of genetic mutations in the tumor, and those those cells shed into the stool, and so you could detect those mutations in the stool, and so Exact Sciences, among other places, have now developed tests where you can detect the mutation in the stool using very sensitive techniques. And I think it's it's a good test. It's an at home test, particularly important in the middle of a pandemic.

It picks up a substantial number of colon cancers, not all of them. It's not great for picking up polyps, which is, as you know, the precursor. And frankly, what do we really want to find with a colonospy. We don't want to find a cancer. We want to find a polyp and remove the polyp, right, So you don't get cancer. And to be the other aspect of the test of the stool is whether it be mutations or testing for blood in the stool or things like that.

If it's positive, well you still have to get a colonoscopy. So I think people should be aware of the fact that, yes, you can do the DNA test, and that's great because we want you to get a test whatever it is. You're prepared to do it, but if it's positive, you gotta get their colonoscopy, right, But it could weed out people who maybe are nervous about getting a colonospy or don't have access to it, or can't afford it right, or don't don't have health insurance, and it could weed

out those people. So they know, well, I'm okay for now at least, right, but you're right to be able to remove a polyp is ideal And in the middle of a pandemic, we have to be thinking about home testing, right because right now our health systems are extremely text We're trying to reduce congestion in clinics, right, we have to. So I'm I'm a proponent of whatever tests you can get, but um, when we're all back to normal and we're all vaccinated. Katie, I'm gonna be on my you know,

on my soapbox, get a colonoscopy. I'm thrilled that we're working on DNA detection technologies for calling cancer. And listen, I hope that, you know, Dr McCoy comes out with this tri quarter and that's that's gonna be the test. But in the meantime, it's still a calling scarp. Are we any closer to better treatments for people who do have pulling cancer that is advanced, maybe stage three or even stage four, which was Jay's situation when he was diagnosed.

It was all over his liver and it was on the march north to his long and then the back of his eye and to his brain, and as you can imagine, it was harrowing. I was so livid that the treatment he received was the same treatment that had been around since the fifties, five of you and LUKEA. Warren, and I was really really frustrated by that that was twenty three years ago. Are there better uh chemotherapeutic agents?

Are there? Is there any progress being made in immunotherapy, which is helping people in so many other cancers, or and monoclonal antibodies, and all the different kind of approaches is monoclonal antibodies the same as immunotherapy, Charlie, are different. Immunotherapy is one of the approaches of using monoclon out

of bodies, but there are much broader approaches. But let me just step back, Katie and say, look, Um, given the tragedy that you and your family went through with Jay, it's so admirable of what you decided to do and take on this cause and the wake of that, and and you've made a big difference and I hope you know that on so many different fronts in terms of funding cancer research, in terms of building awareness and getting

people to screen. I mean you, you've done it all and we owe you a lot for that, particularly in the wake of what was such a challenging time for you and the family and what Jay went through. But I do think we've made progress. Now. That was twenty three years ago, and I would say at a real inflection point in colon cancer that people should you are

where is? It was two thousand four And in two thousand four, Um, the first of a series of mono clone l antibodies came out, which was a drug that actually realized that you could block the blood supply to tumors and impact therapy. That's it. That isn't that an anti anchio genesis? Are you talking about a baston? You're good, Katie, Maybe you should be Maybe I should be interviewing you. It was approved for calling cancer and it was a game changer, um and and and it was a game

changer in so many different fronts. Firstly, one, it opened up a field which is blocking the blood supply matter, which opened up a litany of investigation. This works due to Falkman's original work. Ultimately the drug developed by Jennet Tech. And but but not only that, it was really the move to biologics, right because you know this because five floor URSL was the only drug. And what we learned was, you know what beyond andered cytotoxic chemotherapy, cell killing chemotherapies.

By understanding the biology, we can develop drugs that target the biology of monoclonals. Because of Aston, as you know, is a monoclone lantibar. Will you explain for our listeners, because I actually could use a refresher what exactly you mean when you say a monoclonal antibody. Absolutely, So we

make we all make antibodies to block infection. And these are little molecules that are coded to cover the target the surface of something, be at a bacteria or some other microorganism that shouldn't be in our bodies, right, somebody

you know, something that affects us. But what people realize is you could develop antibodies in the lab that, instead of targeting a bacteria, can to target some other surface that's relevant to cancer, be at the surface of a cancer cell, or the surface of a molecule that stimulates blood supply for tumors. And so what a vast it is. It's an antibody that's designed in the lab that targets a molecule that makes that helps cancers develop a blood supply.

So it essentially grabs it, blocks it degrades it, and um so you take that away from the cancer. The cancer is now starved. If it's blood supply, it's It was really revolutionary at the time, but what did it do. It essentially tripled the longevity of people with metastatic advanced calling cancer. Tripled it and it's still not where we want to be. We still have a long ways to go. But you know, Katie, to your point earlier, when I first started this field a long time ago, longer than

I could or admit. When I would meet a new patient and family with advanced calling cancer, I would look at the patient and in my mind, I think, you know, what if if I have this person sitting in my office a year from now and feeling good, that's an accomplishment that I'll be glad I could get to. And I'm not joking. That was my aspiration because the average survival for a new patient with colon cancer when I started this game was nine to ten months, which is ridiculous,

totally inadequate. And so you know, we're a lot longer now, but we got a ways to go. And each of these incremental steps teaches us about how do we leverage the biology, how do we develop new therapy. So we now have multiple antibodies hitting different targets. We have I think, new drugs that are focused on really what was the biologic target as opposed to some random drug off the shelf.

And we also know that calling cancer is not one disease, but a subset of diseases where there's a specific gene gene that's driving in we're targeting that dreen gene. Now, the the major advances that really we saw this tripling of survival in colon cancer and advanced calling cancer was really I would say between two thousand and four and

two thousand twelve. And I'll be honest, I think we've languished a little bit since then because you mentioned immunotherapy, which is a different type of monoclaudal that activates our immune system, which has frankly revolutionized cancer therapy, truly revolutionized lung cancer, melanoma, variety of difficulty treat cancers. However, that approach works for four of calling cancer patients don't benefit

from it. Why because somehow the calling cancers are hostile to our immune system, and we got to figure out how to convert those cancers to being more a menable, more inviting to our immune system such that we can leverage these drugs to attack the cancer. But why has it been so successful in other cancers? What is it about colorectal cancer that makes immunotherapy less effective? So I think the other thing we've learned over the past two decades is we used to only focus on the cancer cell.

But if you look at a tumor under the microscope. It's not just cancer cells. It's a variety of cells, imune cells, other types of cells that the cancer in some respects are recruiting for their own benefit. Now, one of those is our blood vessels, right, the cancer is recruiting blood vessels. What else is it recruiting. Colon cancer is clearly recruiting cells, our own cells that suppress an

immune response. And it might see simple, well, let's just turn in those cells off, but it's not so simple how we do it. We don't fully understand how colon cancer recruits those cells to the tumor and how we turn that signal off. But I think we're a lot closer in understanding that there's a number of new targets, new drugs to do that that hopefully we then combine with the immunotherapies to make them work. So stay tuned. I I you know, I've been doing this for a while.

I'm really optimistic of what this decade is going to do in cancer in general, but I think in colon cancer, because I think we're on the precipice now of taking these understandings of immunotherapy, of the of the micro environment within a tumor beyond the cancer cell within understanding biologics with targeted therapies, with genetics, and that's like, isn't that epigenetics sort of the coding on the cell itself, right, that that sometimes protects the cell from the medication. Right,

it's weird. It's like the cell has a little survival mechanism that's hard to penetrate. Well, there's that, and there's that because these are cells that are able to mutate. They are even when therapies work, the cells figure out how to become resistant. They develop in a second, third, fourth mutation, which I know seems almost impossible to beat. It's like whack a mole. But it's we Actually, I think our understanding the underlying processes like epigenetics as you

describe it, where I think we can beat it. Um You know, cancer is the great challenge of the twenty one century. You know, in the beginning of the last century was infectious disease, which is how ironic is we're in the middle of a pandemic now. But once we get past this, because we've done so much to eliminate infectious disease as the major killer of Americans, it's now cancer, and I really feel like we are poised to truly make a difference. Before we wrap up, I wanted to

end with some thoughts from my friend Donna. After the colonoscopy and during the testing phase and biopsy and all, the doctor said that that tumor had to have been growing for the past two years, that it wasn't a young tumor. It was a tumor that was about two years old. So I just know from a personal experience that I should have at fifty gone in and got my connoscope. That's the lesson learned. So for those that are listening or however way the message is delivered, early

detection is going to be a lifesaver. It truly is going to be a lifesaver. So, UM, I encourage you all. I mean, if it's forty five, as soon as you go on your birthday, if you have to when you turn forty, go get the test um. But you know, but I'm I'm not going to look back, because um, that's not that's not the message. The messages is that I've learned a lot and I can help those that are going through it. Um and the messages go get

tested and if you're nervous about getting a colonoscopy. Well, I've had a few, and I'm telling you it's really not that bad. And I've got an insider scoop on the best way to prep. Back when I did my first colonoscopy, gosh, twenty one years ago, I had to drink this gallon of nasty, salty, chalky, cherry flavored water. I put on a pretty good show for all of you. M looking forward to it. Here goes nothing, but it

was terrible. What I didn't show in the pieces. I actually threw up the last glass all over my kitchen floor. So instead it's your favorite flavor of Gatorade with Mary Lax. Donna agrees, I'll do that again. H recommend. Thank you again to all my guests today. Donna otis Dr Edith Mitchell and Dr Charlie Fuchs. Now you all know what to do. Talk to your doctor and go get tested. Next Question with Katie Kurik is a production of I Heart Media and Katie Kurk Media. The executive producers Army,

Katie Couric and Courtney Litz. The supervising producer is Lauren Hansen. Associate producers Derek Clements Adriana Fassio and Emily Pinto. The show is edited and mixed by Derrick Clements. For more information about today's episode, or to sign up for my morning newsletter, wake Up Call, go to Katie currect dot com. You can also find me at Katie Courrect on Instagram

and all my social media channels. For more podcasts from I Heart Radio, visit the I heart Radio app, Apple Podcasts, or wherever you listen to your favorite shows,