Prominent lung cancer surgeon and gene therapy and immunotherapy expert explains progress and future in precision medicine lung tumor treatment. Leading lung cancer surgeon explains lung cancer treatment gene therapy. Does Immunotherapy and gene therapy work for stage 4 lung cancer? There is a new immunotherapy for lung cancer stage 3 that can increase survival. Dr. Anton Titov, MD. Gene therapy for lung cancer is one of your interests. You did a lot of research and a postdoctoral fellowship on lung cancer gene therapy. You published virus-based approach to gene therapy for lung cancer. This is a very interesting modality of action. Dr. Anton Titov, MD. Could you please talk about your research in gene therapy for lung cancer? Yes. So my interest in lung cancer gene therapy has gone back now more than a decade. I did it in surgical training. And gene therapy in general is still finding its niche in cancer therapy. Lung cancer itself is not the best cancer to treat with gene therapy. Dr. Michael Lanuti, MD. Why? Gene cancer therapy. Dr. Anton Titov, MD. What is gene therapy and viral gene therapy? We're trying to identify something that can get to the cancer tissue and destroy it. And it's something that you would either inject, ingest, or put in the bloodstream. Many gene therapy models are tumors that are local. We used to use such gene therapy models. We would inject tumors with viruses. For example we would inject a modified virus, either a common cold virus, adenovirus or, more recently, a herpes virus. And those viruses would be manipulated. We have to make them less toxic to make you sick. But also we would put in suicide genes in viruses to help destroy tumor cells. The word that we use is "suicide gene therapy". Dr. Michael Lanuti, MD. Why do we use viruses? Viruses tend to replicate better in cancer cells that are dividing quickly. Viruses replicate more in cancer cells than in your native cells. So there's a predilection for infection of cancer cells. And so in the models that we've used, we've had some cancer treatment improvement. The tumors do get knocked down by gene therapy. We don't necessarily cure tumors with cancer gene therapy. So what I see is gene therapy in the future would be this. There are some tumors that are more conducive to gene therapy. It could be a tumor that is related to asbestos. It's called mesothelioma. It is a very fibrous tumor along the edge of the lung. Surgeons are only so good at the debriding or debulking of mesothelioma. Surgeons are good at partial resection of mesothelioma. And there's often tumor cells left behind. That's where we think maybe cancer gene therapy would help. You "wash the chest" with a virus that contains a suicide gene. I think the newest iteration of gene therapy is going to be now a combination with immunotherapy. Dr. Anton Titov, MD. Immunotherapy will stimulate the immune system to recognize tumor. Dr. Michael Lanuti, MD. Then we use the virus to destroy tumor. And you expose the tumor to the immune system as you destroy tumor with virus. So that the immune system recognizes non-self. Immune system then gets activated up by cancer immunotherapy. Clearly, the combination therapy often works in many diseases better than a single-agent therapy. So in that sense combination of the cancer gene therapy with the cancer immunotherapy is better. Dr. Anton Titov, MD. Yes, so it's under investigation now, including many labs, and some are showing good results. And the cancer immunotherapy is the hottest topic there is in cancer biology. Dr. Michael Lanuti, MD. And so I think it should be harnessed. So the next wave of cancer gene therapy would be a combination therapy with cancer immunotherapy.