The Future of Prostate Cancer Research and Treatment


Good afternoon and welcome to the latest YouTube
Live hosted by the National Cancer Institute. My name is Ana Fadich and I’m the vice president
at Men’s Health Network, a national non-profit educational health organization dedicated
to improving the health and well-being of men and their families. You can find us at menshealthnetwork.org. I welcome you to what promises to be an interesting
discussion about the present and future of diagnosing and treating prostate cancer, and
perhaps many things that you did not know about prostate cancer. In addition to the topics that will be discussed
in this broadcast, we have also provided links to videos that contain supplementary information
about both clinical trials and how to contact NCI’s cancer information service. To access these, please click the letter I
in the upper right hand corner of the screen and you’ll see the videos. Moving on, I am pleased today to be joined
by two experts in the field of prostate cancer research and treatment. First, we have Dr. William Dahut, the head
of Prostate Cancer Clinical Research Section, as well as the Center for Cancer Research,
clinical director at the National Cancer Institute. And also Dr. Heather Cheng, a physician and
assistant professor in the Division of Medical Oncology at the University of Washington. Welcome doctors Dahut and Cheng, thank you
for joining us.>>Ana, thank you very much. This is really a great opportunity to let
folks know exactly what’s going on in the world of prostate cancer, and particularly
about some of the more recent findings about the importance of what we call germline mutations,
or mutations actually that one is born with, and what impact that has actually on your
risk of cancer and also on how that may impact decisions you make it along the spectrum when
you have prostate cancer.>>Dr. Cheng, would you like to say a few
words?>>Yeah, so recent — I think recently, we
have discovered something that we have more information about what we’ve for a long time,
which is that men who have a family history of prostate cancer are at higher risk of prostate
cancer, and that’s something that’s been recognized for a long time. But we’ve been able to extend that further
by recent findings, looking at men with more advanced prostate cancers, those who develop
metastatic disease. And what we’ve learned is that those men actually
have a higher — many of them have an inherited, or germline, mutations that overlap with cancer
risks for other syndromes, or other types of cancer. So, in other words, having a family history
of breast cancer may actually increase your — his risk of prostate cancer because the
genes are related. And so, a really well-recognized set of genes
are BRCA1 and 2, which are best known for their association with breast cancer risk. And many of you may have heard about Angelina
Jolie and her kind of efforts at trying to prevent prostate cancer — or I’m sorry, breast
cancer development. And so, that is now feeding into our knowledge
about prostate cancer. And so, we know that those same genes confer
an increased risk of prostate cancer. And it’s exciting also because there are new
treatment opportunities for men who have prostate cancer with those genes, but it also means
that family members, or male relatives, nephews, sons and so forth, might also be thinking
about how they could screen for prostate cancer and detect prostate cancer earlier. And that might help us make a difference in
how we catch the disease, when we catch it, and what we can do to intervene and make a
difference.>>Okay. Well, thank you both for joining us. So, these days, you hear a lot about surveillance
when it comes to prostate cancer. Dr. Dahut, can — what can you tell me about
the role of surveillance in prostate cancer?>>So, I think prostate cancer is a very different
cancer in a lot of ways than many of the other solid [inaudible] one has. So, it’s different, I think, than pancreatic
cancer or lung cancers because many men will have prostate cancer but not actually die
from their disease. And they use the blood test, the PSA test,
for prostate specific antigen, led to a significant increase in detection of prostate cancer. But it’s highly likely that we also detected
prostate cancer in men whose cancer would never have had an impact on either the quality
of life, or [inaudible] survival. But the decision to not treat a prostate cancer
immediately is a very difficult decision for patients on many levels. There’s a very strong emotional component
to the word cancer and I think sometimes if we actually called our prostate cancer that
was not as aggressive by a different term that some of these decisions would be easier
for men to make. Currently, the way we really recommend what
we call surveillance is based on how much cancer one has in the initial biopsy and what
we call the grade of the cancer. And the grade of the cancer is really a score
that your pathologist gives to predict how likely the cancers escape from the prostate. Now traditionally, prostate cancer biopsies
were done what we call randomly. So, a urologist would biopsy certain areas
of the prostate that could safely be done that were areas that were likely to have prostate
cancer involved in it. More recently in many centers, including our
own, we’ve included something called parametric MRI imaging, which allows the urologist to
increase the ability to actually biopsy lesions where cancer may occur. And I think combining your biopsy material
and what the pathologist is is really the first step in deciding whether one should
have surveillance. Now I think surveillances is really important
to realize it’s a very dynamic term. So, it’s not like the old watchful waiting
term one year used years ago, which is simply an idea that your cancer was never be treated
no matter what. And anywhere along the line, there can be
a change in the patient’s prostate cancer risk that would really change one’s opinion
about whether or not one should actually go forward with more definitive treatment. So, making a decision on surveillance often
is a combination of the number of positive biopsies, and again, the grade of the tumor. But there are other variables which we look
in in order to help me determination. Some are very personal decisions. For some men, the avoidance of any side effects
at all from local treatment sort of trumps the potential ability for surgery or radiation,
you know, to delay metastasizes or are having [inaudible] survival. But I have to admit, there’s a lot of gray
area between deciding who should be a candidate for surveillance and who we should recommend
for treatment. And I think some of this increasing new information
about genomics, and also defining what’s meant by a family history and in a way that’s more
than simply my brother or uncle had prostate cancer is very important. Because what happens in families is that one
person in the family has prostate cancer that often leads to the search for additional prostate
cancer in other family members. And simply by additional biopsies in additional
patients, because we know the incidence of prostate cancer is so high, one is likely
to find more prostate cancer, and then thus, one has a family history. And this is actually very different than having
a — what we call a germline mutation, or really a finding into one’s DNA that one’s
born with that gives one a propensity for cancer.>>Okay, great.>>Dr. Cheng, do you have anything to add
to that?>>Yeah, I think those — Dr. Dahut makes
excellent points in terms of the family history and not all family history being equal. I think one of the things that we that we
– that we begin to recognize is really just having a family history of prostate cancer
is not enough. We should encourage our patients to ask about
the details of that and if – was it a low grade cancer. For example, a low Gleason score, was the
PSA lower, was it higher? Did that family member develop more aggressive
disease? And those are pieces of information that are
important for the – as many members of the family to know about to help inform the risk
because having a brother with Gleason’s 6 disease may be very, very different from having
a brother who had metastatic disease. And then we’re still learning about how to
better assess that, but certainly getting that information. And the same can be said for family history
of other cancers, knowing who in the family had breast cancer and at what age, and how
— to the best of our ability to find — to try to assess how aggressive that is because
cancers that are screened for can be detected at different stages and may reflect different
biology. More aggressive or less aggressive than that
can also be, in turn, helpful in understanding a person’s risk, knowing how aggressive their
family member’ cancers might have been.>>Dr. Cheng, what can you tell us about prostate
cancer and germline mutation?>>Yeah, so that’s related to what we were
just talking about and germline mutations — and Dr. Dahut alluded to this before, are
mutations, or variants, let’s say, genetic changes or genetic findings that we all carry,
some of which are — change the function of certain genes that do certain things and other
findings or other alterations are neutral. So, some of that is – it’s the blueprints
of who we are. Some of the changes make us unique and may
create an extra risk — or additional risk for cancer, but other things may be — other
findings may be neutral. So, certain — for example, nucleotides may
be just part of the background and not harmful or helpful in function. And others may be disruptive of gene function,
which can lead to an increased risk of cancer. So, when we talk about germline mutations,
it’s really what you inherit from mom and dad, and it’s what you were born with. And every cell in your body starts with those
blueprints. And over time, and over a lifetime, things
happen where mistakes are made and that can lead to cancer. So, when we about tumor specific mutations,
those are mutations that arrive only in the cancer and are perhaps related to the development
of cancer. But there are also certain people who inherit
a risk of cancer because one of the copies of their genes — because we have two copies
of every gene — may be slightly altered from the beginning. So, it doesn’t mean that people will definitely
develop cancer, but it may mean that an individual who inherits that might be at higher risk. And that is what we’re learning about more
in prostate cancer in terms of certain mutations now conferring a higher risk. So, we now know that there are some gene mutations
that lead to an especially high risk so that perhaps we should be paying more attention
and thinking about that in screening in early detection for cancer.>>Okay. Anything you would like to add Dr. Dahut?>>No, I think it’s important that traditionally,
we hadn’t really thought of prostate cancer as a familial disease in the same way as we
think of other cancers. And a lot of that is because it’s such a common
disease. Although the numbers are going down somewhat
because there is less screening going down, roughly between 160,000 to 200,000 patients
are diagnosed a year with prostate cancer. So, to actually look at the subset of men
that would have a have very high risk of prostate cancer because of the germline mutation, that’s
not always as easy to detect as in some cancers we see in pediatrics, or other more rare tumor
types. But I think the population of men who do have
these particular mutations are very important. And I think as Heather mentioned, the fact
that the family history may not be a prostate cancer family history, but maybe actually
cancers — often on their mother’s side, whether it’s ovarian cancer, breast cancer, or pancreatic
cancer, there may be clues that there’s — this is simply more than a – than a sort of a typical
screen detected prostate cancer. And I know Heather has spent some time actually
looking at clinics to sort of a look at families in some more details, and I know whether she’d
be able to sort of describe some of the work she’s doing out at Washington.>>Yeah, so we — thank you for that lead-in. We – so I – we recently launched a — in response
to the — these new developments and findings in prostate cancer and family, the importance
of family history, we have now a prostate cancer genetics clinic at the University of
Washington in Seattle Cancer Care Alliance. And it’s really in response to these findings
and many families, and many men, are well aware of the prostate cancer family history,
or breast cancer family history, or ovarian cancer family history, and are wondering where
to go and so this is to help guide — the clinic is set up to help keep pace with the
developments that we are learning about. So, this is rapidly changing. We’re still learning as we go. There’s a lot of excitement and a lot of unanswered
questions. And so, I think for people who are interested
in learning about these things, the updates get – or the developments are changing quickly. And for example, we know that in — I’m a
medical oncologist so we’ll get to this later, but there are also important treatment implications
for some of these mutations. But in thinking about prostate cancer risk
for sons and nephews, for example, that’s often an unanswered question in terms of thinking
about early detection, thinking about active surveillance. So, our clinic is really designed to incorporate
considerations of prostate cancer treatment in to — in with genetics. And we have a genetic counselor who’s available
to see patients at the same visit, and that’s something that is relatively new, I think,
to the field of prostate cancer, much more well established for colon cancer and breast
cancer, for example, where the familial associations and the actions that we do in response to
that are much more developed. So, I think that hopefully it’s going to really
lead to improvements in how we care for men with prostate cancer, and how we look for
cancer in their family members, but that is — that is the reason for the clinic. We also have a family study — or family studies,
where we’re looking at families where the genetic cause, or the gene, the specific gene,
is not yet known. So, you know, if we look back 20 years ago,
we may have recognized — at that point — that certain families had a high incidence in breast
cancer, for example. And we have now solved some of those families
with breast and ovarian cancer risk genes, and now we know that those overlap with prostate
cancer risk in some cases as well. So, we’re making — we’re identifying new
genes, some of which have been known to be associated with breast and ovarian cancer. But it’s also the case that we probably haven’t
identified all of the genes that are known. And so, for — what we can do is we can test
individuals who have a strong family history for known genes that are associated with cancer
risk. And the panels now can encompass a number
of different known risk genes and we are adding the whole field more genes that we know to
be associated with different cancer risks. So, while in the past, we’ve said, oh, there’s
breast cancer risk and ovarian cancer risk, now it looks like there’s an — it really
– there are genes that now have newly been associated with newer type of cancer. So, in other words, it’s not — breast cancer
is not limited to a cancer risk for breasts. It can also affect the men in the family for
their prostate cancer and may also confer risk for other cancers, such as pancreatic
cancer. And so, I think we’re learning with our new
tool, the importance of this. And so, we are able to refer our patients
also for pancreatic cancer studies, where they are looking for early detection of pancreatic
cancer, breast and ovarian cancer prevention. So, we’re really trying to help both the patients
with prostate cancer, but also think ahead for their family members if they have any
risk that we can potentially intervene on, or involve them in clinical trials, where
we can advance our ability to screen for other types of cancers. But we’re also — the family study is looking
at solving new genes as well. So, we test for the genes that are known,
we also look for families where the gene — we recognize that there is a familiar association,
but we don’t yet know what the genetic cause is and we can try to use family studies to
try to learn about new genes and identify new genes that then will become part of standard
testing.>>So, what can we learn about drugs and pathways
from other diseases?>>So, I think a couple things. One, I thought the whole idea of finding one
drug for one pathway is a very complicated topic. And what we have learned from other diseases
is that sometimes drugs that we may be targeted against breast cancer, or pancreatic cancer,
or lung cancer, that the same pathway is found in patients with prostate cancer, may work
better than other drugs targeting just prostate cancer. Pathways, there’s really two different things
you need to think about, one is, you know, the genetics [inaudible] the patient was born
with, and also the genetics of the tumor itself. And these are — can be different ways to
go ahead and design treatments for patients. So, if one is born with a germline mutation
— and I think – well, Heather’s going to talk about that a little bit later — there
are certain populations – or excuse me, certain groups of drugs in which we’re seeing efficacy
in prostate cancer that we hadn’t really even thought about in years gone past. And also, when we find a similar type mutation
in the tumor, often we can come up with drugs that are targeted in a similar way. So, these are drugs [inaudible] that we talk
about in the DNA damage pathway and, again, [inaudible] or definitely very promising area.>>I might add also, along what – to expand
on what Dr. Dahut was saying, we recently did a study of men with metastatic disease
and found – when we sequence their tumors — that about one in four, one and five, have
defects, or mutations, in DNA repair, that he alluded to, half of which are inherited
— were associated with an inherited mutation, and half of which just erodes completely into
cancer itself, and would not be passed on to children. Both of those groups — all — men who have
tumors that have defects in DNA repair, we think will benefit greatly from treatments
that are used in other cancers. The DNA repair deficiency seems like it confers
sensitivity to platinum chemotherapies, as well as a class of drugs called PARP inhibitors,
that are used for breast and ovarian cancer, particularly ones also with the same types
of DNA repair mutation. And collectively, it looks like prostate cancer
patients who have tumors that have these mutations have an exceptional response to these treatments
that we haven’t previously been using for prostate cancer. So, the field is quite excited and there are
many clinical trials now open and coming, soon to come, that are involving looking for
— looking at tumors to see if they have these mutations to try to get them treated with
these more effective drugs. And there are also studies that are less prostate
specific, such as the NCI match trial, which are using this similar approach, where we’re
sequencing tumors of different types — not just prostate cancer — to try to look for
specific mutations that might lend themselves to treatment by — from other — that have
been studied in other disease types, for example, or for which there is the drug that targets
that gene mutation. [ Inaudible ]>>Yeah, I think actually, I’m going to see
if Dr. Dahut wants to come in on that first because I think he has – they have some pretty
exciting trials at the NCI, so I’ll let him start.>>Sounds great.>>Thank you. So, prostate cancer traditionally has been
a very difficult disease to assess response. And I’m really talking primarily about men
who has cancer, has spread, often progressed after hormonal therapy, so metastatic [inaudible],
castration-resistant prostate cancer. Prostate cancer, traditionally, has gone to
the bone and the bone is imaged by something which we call a bone scan. And a bone scan doesn’t actually measure the
tumor itself but actually measures uptake of a radioisotope, usually technetium. And changes on a bone scan then, don’t always
reflect changes in the cancer itself. So, a bone scan actually [inaudible] worse
or the cancer is getting better, or the bone scan can actually stay the same when the cancer
is – even though the cancer, again, [inaudible] better. And so, it’s been very difficult to really
assess the ability of new treatments to have an impact on the patient. And so, one thing that we’ve been studying
is usually — is using what we call molecular imaging and that is a more sophisticated way
of determining the ability — determining how much cancer one has, and hopefully to
come up with a way to measure response, and then perhaps to use the imaging as a way to
actually treat the patients. We’re using something more recently called
the PSMA scan, that stands for prostate specific membrane antigen. Again, even though it has the word prostate
in it, it is not totally specifically for prostate cancer. But opposed to some earlier versions of this
scan, it’s a — it actually allows one to attach a way to image it on the outside of
the prostate cancer cell. So, this is a sort of a [inaudible] what we
call a – like a PET scan. And by the injection of a – by this targeting
technique, one sees a significantly greater number of the prostate cancer lesions. And then it also has the ability to measure
the response of the treatment in a much more rapid fashion. So, some work was done in collaboration with
folks at Memorial Sloan-Kettering, and the University of Wisconsin, we’ve had the ability
to have sort of a very early readout of response in different imaging — this is in sodium
fluoride PET imaging. But again, with some of this molecular imaging,
you know, how well our treatments are working. And I think this has really the ability to
truly revolutionize the way we look at prostate cancer because it is a much more specific
to prostate cancer, and the ability to pick up prostate cancer lesions much earlier in
one’s course. And this may significantly impact how one
determines which treatment one chooses, whether when someone has more advanced disease, or
even at the time of initial diagnosis. So, it’s a very exciting field at this time.>>Great. Dr. Cheng, do you have any comments?>>No, I think we are very excited. I’m very excited. I’ve actually sent patients who have been
very interested in the PSMA technology and they’ve actually traveled to get on to those
clinical trials. So, I think that there’s a lot of excitement
and a lot of potential benefits.>>So, where can we go – or where can people
go who are interested in learning more about prostate cancer research and treatment? Dr. Dahut, do you want to start with some
resources?>>Yeah, so I think it’s always great that
people start with their own physicians and to discuss their disease, and look at options. But I think it’s — it’s really critical that
folks know there are opportunities throughout the country. And, you know, I think it’s something that
when the day of – obviously, you know, the ability to access throughout the country,
through the internet, and to go through sites, such as trials.cancer.gov, or simply calling
the 1-800 for cancer number will immediately give patients a great wealth of information
about clinical trials information throughout the country. And, you know, it’s incredibly important,
the value that one – we, who are involved in prostate cancer research — gain from the
time and effort the patients do by volunteering for clinical trials because oftentimes, what
we think makes sense in patients, as far as a treatment, once we’ve actually tested it
in a very rigorous fashion, the treatment might actually work better than we anticipated,
but sometimes does not work nearly as well as we had hoped. And so, it’s impossible to over-emphasize
the importance of clinical trials and really the gratitude we have to the patients who
become involved because, you know, without that — you know, the field would simply be
on a treadmill and not be able to make any opportunities going forward. You know, the discoveries that really led
to the understanding of the importance of abnormalities in what we call the DNA damage
pathway, all came from patients involved in clinical trials, you know, patients who really
volunteered to be involved in a trial, who volunteered to have their tumor biopsied and
sequenced. In other words, they [inaudible] the tumor
looked at in very careful way led us to learn that really what was driving prostate cancer
was actually different in many men than we anticipated, and really would lead one to
use a very different group of anti-cancer drugs than what were traditionally were being
used. So, again, using these numbers, the trials,
the 1-800 for cancer phone number or the trials.cancer.gov is really incredibly important. [Inaudible] program, we have many clinical
trials that we will be very happy to discuss with patients, or their physicians, really
a full breadth of prostate cancer clinical states, from newly diagnosed patients — and
again, some of the trials I talked about earlier on would combine immunotherapy and DNA damaging
agents. But – and again, clinical trials are not limited
to our campus, you know, throughout the country at cancer centers and physicians’ offices,
there are opportunities for clinical trials, which hopefully will help the patients that
are being treated that really can advance the field.>>And Dr. Cheng, what resources would you
like to put forward?>>Well, I support all of — or echo — really
would wholeheartedly and I echo what Dr. Dahut said, that none of what we have learned and
we — I think — have really made leaps and bounds in the last few years in our understanding
of prostate cancer and really through the efforts and the generous volunteering of our
patients, and their willingness to share their clinical course sometimes. And I would like to say some trials are interventional
trials, where people get treatments that are newer and exciting and we’re trying to learn
if they are more effective. But sometimes, there – there are circumstances
by which patients can’t participate in those types of trials, and there are other types
of trials, like registry trials for example, that can also be extremely valuable for the
field, and for other patients, and hopefully for the next generation. And this is particularly true, I think, in
— with our new understanding of germline mutation, so inherited cancer risk mutations,
and their association with prostate cancer. One of the things I’m – I see on a daily basis
in my clinic is really that patients who have these mutations are getting — perhaps considering
different treatments because of their awareness that their mutations that are both inherited
and in their cancer, but in the cases of the patients who have the mutations in their — that
are inherited, they are very interested in learning more about the cancer — in thinking
about the relatives, and thinking about their sons and their nephews. And so, the more we can learn about the biology
of a prostate cancer, or any cancer in the context of an inherited risk, may be something
that will be useful or will definitely be useful for the next generation in thinking
about how we can improve our treatment, and how we can do early detection. And there are also early detection clinical
trials available as well, so really being encouraged – or anyone who might be watching
this, to talk to their doctors and be proactive in learning about trial opportunities and
other resources that are available. I think cancer.gov is fantastic, the trial.cancer.gov
is a good site. And locally, I think most cancer institutions
have good resources as well, to look — to tap into.>>Great. Well, at least on behalf of Men’s Health Network,
we have all those resources on our website that direct people to where they need to go. You can visit that at menshealthnetwork.org. We also have an online men’s health center
that has a lot of different disease state information, so patients are able to go in
and view the different disease topics. We do a lot in prostate cancer but handle
all of men’s health and that can be found at www.menshealthresourcecenter.com. Men’s Health Network, also, we go into the
communities where people live, work, play and pray, so we have a lot of resources that
are in schools, and churches, and health clinics. So, we’re all over the country so if anybody
has any questions about that, in addition to the resources that were already mentioned,
please feel free to contact us at Men’s Health Network. So, we’ve got in a couple of questions from
Twitter and the first one here, open to anyone who wants to answer; is there a difference
between active surveillance and watchful waiting?>>So, I’ll answer that. So, yes there is. So, active surveillance is where a decision
is made that immediate treatment is not needed but that the patient needs to be followed
because at some point, treatment may be indicated. And so, that can be done many ways. Sometimes that’s done with biopsies done over
a period of time, sometimes that’s used doing an MRI, sometimes with a PSA, or a combination
of things. Watchful waiting is really for patients whose
cancer, and probably overall medical condition, would be a situation where it’s highly unlikely
that the side effects of the treatment would outweigh the toxicities. So, this would be applicable for patients
potentially of a shortened life expectancy, either due to age or comorbidities, or for
patients that would potentially never be a candidate for treatment because for other
reasons. So, I think they really are different.>>Dr. Cheng, is there anything you wanted
to add to that?>>No, I think that — I think Dr. Dahut did
a good job of explaining the difference but I do think — agree with him that they are
different, one is much more involved and requires close interaction between the patient and
their physician.>>Now the final question from Twitter said
– asks — could germline mutations affect treatment after diagnosis?>>Maybe I’ll start by answering that one. That is very clearly yes. I think at many stages – currently, the — probably
the area where there’s the most impact in terms of understanding how a germline mutation
may affect a prostate cancer patient’s care is in the setting of advanced disease, where
we’re looking at platinum chemotherapy and PARP inhibitors, and combinations. And so, those two classes of treatment are
felt to be exceptionally effective or hypothesized to be or we think are going to be much more
effective. The early data suggests that they are and
so I think that that is a clear indication for an all an additional treatment arm in
addition to the current armamentarium, or current toolbox treatments, that may be especially
effective for those patients. So, being aware of that or finding out about
whether or not you have — a patient has a germline mutation, which would involve talking
to their physician, considering going to a genetic counselor, and getting that testing
done, which is often either a blood test or saliva test – spit test — to try to learn
about whether or not they have an inherited cancer risk mutation that might inform their
treatment. The other part of that of course is people
who have the mutations only in their cancer, which is another portion of that population
that might benefit from those DNA repair targeted treatments. So, I think the other part of it is that as
we grow in awareness, we are looking at those same treatment strategies earlier in the disease
course. So, there are now efforts and interest in
looking at whether we can intervene at the time of diagnosis. Maybe knowing about those mutations might
lead us to be more inclined to do — less inclined to do active surveillance, or more
inclined to take a different approach. Or, for example, there are trials of looking
at treatment right before surgery, or combination treatments with multiple strategies to try
to improve the odds — or improve the likelihood of cure. So, these are all things that will be — continue
to be important, are currently very exciting, but will continue to be developed as we move
forward.>>Dr. Dahut, any comments around that?>>No, I think that was a great summary of
the current state. I think as we learn more about the treatment
of patients that have germline mutations, we may be able to give a bit more definitive
advice, either at diagnosis or perhaps, you know, when in their treatment course, once
you begin drugs, that, you know, target the specific pathway, which is the germline mutation
impact. So, we’re not there yet but I think it’s really
important information, particularly with men with more advanced disease.>>Well, that’s all the time we have today. So, thank you that — for spending the time
with us, Doctors Dahut and Cheng. Before we sign off, I’d like to remind viewers
to click on the letter I that is in the upper right hand corner of the screen to view the
National Cancer Institute videos that contain supplementary information about both clinical
trials and how to contact NCI’s cancer information service. We hope you enjoyed this YouTube Live. Shortly, this entire video will be available
on the NCI YouTube channel. Thank you and goodbye.