week2 upper gastrointestinal malignancies

I'm Chengqi Xu, a graduate student at Elemento Lab at Weill Cornell Medicine. This week I shadowed with Dr. Manish Shah, and the physician assistant Dr. Marina in the GI oncology Program at WCM and NewYork-Presbyterian. GI program is dedicated to providing state-of-the-art and personalised care across the entire spectrum of cancers of the digestive system. GI oncologists are actively involved in biomedical research to advance drug development for GI malignancies, leading worldwide clinical trials and collaborating with the field laboratories to bring new treatments to patients. I am deeply impressed that behind every number/data, there is an eager hope for survival of every patients and their families.

With my clinical advisors, I saw more than 15 patients during the half day, some of whom are diagnosed with locally advanced/metastatic esophageal cancer. There is a case where a 65~ year-old woman diagnosed with Siewert type 1 adenocarcinoma is currently involved in a clinical trail. At that time, her disease had already progressed to clinical stage III. At this stage, the tumor has broken through the vessels and begun to invade nearby lymph nodes, just before spreading to other parts of the body. In this case, the treatment plan most patients receive is a combination of chemotherapy and radiation plus surgery to remove the tumor. 

But doctors told the patient that the tumor is more resistant to drugs, making it difficult for chemotherapy to effectively combat such a tumor. As for surgery to remove the tumor, the doctor again said the location of the tumor in her body was not suitable for surgery. So, she joined a small clinical trial. 

The trial is being conducted at WCM-NYP in New York City, where patients are treated with the research study drug Pembrolizumab in combination with Cisplatin and 5-Fluorouracil. Pembrolizumab is an immune drug used to stimulate the body's immune response to tumor cells. Specifically, tumor cells originally had some tricks to evade the immune system. For example, T cells have a surface protein called PD-1, which triggers apoptosis when combined with the ligand PD-L1 - a mechanism designed to prevent T cells from attacking "their own". However, tumor cells can also synthesize PD-L1 and bind to PD-1 to suppress the attack of T cells. Pembrolizumab is a PD-1 antibody that binds PD-1, thus blocking the interface of PD-L1 with PD-1 and bringing back the T-cell killing activity activated.  The patient comes to the clinics regularly for physical examination, endoscopy, PET and MRI imaging. We hope to see the treatment works in this clinical trial.