Piloting Melanoma Research and Local Cancer Care: An Oncology Data Advisor® Editorial Board Spotlight Interview With Richard Carvajal, MD

Oncology Data Advisor: Welcome to Oncology Data Advisor, I'm Keira Smith. In this interview, we're kicking off a new series spotlighting the Oncology Data Advisor Editorial Board. Today I'm joined by board member Dr. Richard Carvajal, who is the Director of Medical Oncology at Northwell Health Cancer Institute.

Dr. Carvajal, thank you so much for joining today, and congratulations again on your new role at Northwell.

Richard Carvajal, MD: Thank you. It's been about three months, and it's really exciting.

Oncology Data Advisor: To start off, what led you to become a researcher in the field of oncology and melanoma?

Dr. Carvajal: Cancer is such a devastating and life-altering diagnosis. Early on, when I was a trainee during my residency program, I had the opportunity to manage and treat a number of patients with cancer. Of course, it became very clear at that time that our current therapies fail our patients all too often. At the same time, the science and the information on the biology of cancer, and the interface of the immune system in cancer, was ever-increasing.

I think it's those two things—the incredible need for better cancer therapies and the increasing science and the ability to potentially create those therapies—that really led me to this field. I would also say, from a physician standpoint, having the opportunity to care for patients and their family members is such a vulnerable time of their lives to help them through this process. It's a challenge, but it's definitely a privilege, I think, to help people through that process.

Oncology Data Advisor: Definitely. As far as your research, what are some of the specific areas that you focus on?

Dr. Carvajal: Very early on in my training—again, this is now back into fellowship—I had the opportunity again to care for a number of patients who, as I said before, had those standardly available therapies fail them. These were people who really had very limited treatment options left. I had the good fortune to work with a number of mentors and investigators who were heavily involved in phase 1 clinical trial development, and we saw a number of those patients who really wanted access to these novel therapies.

I learned how to do these early-phase trials and became very, very interested in trying to optimize the development of these clinical trial designs. How do we make them more efficient? How do we better select the patient population we think is going to benefit from these therapies, really making sure that we're giving the patients the highest likelihood of benefit from these very investigational therapies?

Now, around the same time, a number of the patients I was seeing were patients with these very rare subsets of melanoma. As you know, the therapies that we have for melanoma are amazing now. When I started treating cutaneous melanoma, for instance, in the early 2000s, we didn't have the checkpoint inhibitors. We didn't have the effective targeted therapies. Basically, we had dacarbazine and temozolomide, and the idea of being able to cure patients with advanced melanoma wasn't really there. Everything was palliative. Now, at least with cutaneous melanoma, we're curing 50% of the patients that we're treating.

Now, the patients that I saw back then in training were patients with extracutaneous melanomas, ocular melanomas, uveal melanomas, and melanomas arising from the mucosal surfaces of the body. A large part of my research focus has been trying to develop therapies for those unique clinical and genetic subsets of disease that even today are not benefiting from the therapies that have been developed for cutaneous melanoma.

Oncology Data Advisor: In your role as Director of Medical Oncology at Northwell Health, what are some of your current initiatives?

Dr. Carvajal: So, I've recently joined the Northwell Health Cancer Institute, and there are a lot of incredible things about this organization. It has an incredible footprint of 10 cancer centers spread across an enormous geographic range. In the system, we see 20,000 new cancer diagnoses a year, which gives us an incredible opportunity to care for these patients. It's an incredible obligation to do that, and the challenge is how to give the highest-quality cancer care across this large geographic footprint to a very diverse patient population.

What drove me here was to help establish those standards so that everyone gets the very best cancer care regardless of whether they're way out on the east end of Long Island or up in Westchester, so that they don't have to travel into Manhattan or the city. I want patients to get the best cancer care in their neighborhood, not having to travel for that. That includes standard therapies, and that also includes clinical trials.

Here at Northwell, we have a collaboration, a formal partnership, with Cold Spring Harbor Laboratories so that we can translate the science that's being developed at Cold Spring Harbor and bring that to our patients. We collect the valuable patient samples and the clinical data and bring that back to Cold Spring Harbor to do the translational science that all large cancer centers want to do. I think we have the new, unique opportunity to capitalize upon that huge, incredibly diverse patient population and use the extremely strong science that we have at the Feinstein Institutes at Northwell, as well as Cold Spring Harbor, to advance cancer care for everyone.

Oncology Data Advisor: Awesome. So, you touched on how the field has evolved throughout the course of your career. What are some of the upcoming advances that you're looking forward to seeing?

Dr. Carvajal: It's been remarkable. I've been doing this since—I guess I'm getting old now, I just turned 50 this year—but throughout my career, I've really seen the growth and development of precision oncology, targeted therapies, immuno-oncology, and the checkpoint inhibitors, and I think those are certainly going to continue. But taking advantage of everything cellular therapy has to offer, I think, is going to be the next decade of where we're putting in our energies. Having the first commercial tumor-infiltrating lymphocyte (TIL) product in melanoma, lifileucel, which hopefully will become available shortly, is a major, major advance. That idea is actually being able to achieve cancer cure by using the immune system. We still have a lot of work to do, and I think cell therapy will be a big part of that.

Oncology Data Advisor: Fantastic, thanks so much for sharing all of this. It was so great to hear about your research.

About Dr. Carvajal

Richard D. Carvajal, MD, is Deputy Physician-in-Chief and Director of Medical Oncology at Northwell Health Cancer Institute in New York, where he is also the R.J. Zuckerberg Chair in Medical Oncology. Dr. Carvajal's research is focused on the development of novel therapies for patients with melanoma and other cancers, including uncommon clinical and molecular subsets such as those arising from the eye (uveal melanomas), mucosal surfaces of the body (mucosal melanomas), and palms of the hands, soles of the feet, or under the fingernails (acral melanomas). He has been the principal or co-investigator of over 500 clinical trials and has authored or coauthored over 200 peer-reviewed manuscripts, books, and book chapters. In addition, Dr. Carvajal serves as Co-Chair of the International Rare Cancer Initiative Uveal Melanoma working group, a joint initiative between the National Cancer Institute, the European Organization for Research and Treatment of Cancer, and the Cancer Research UK to enhance international collaboration in clinical trials for uveal melanoma.

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Transcript edited for clarity. Any views expressed above are the speaker's own and do not necessarily reflect those of Oncology Data Advisor.