Head and Neck Cancer and Immunotherapy with Dr. Trisha Wise-Draper at the 2020 CRI Virtual Immunotherapy Patient Summit

Immunotherapy offers exciting new treatment options for patients with cancers of the mouth, throat, voice box, sinuses, nose, and salivary glands—especially those with HPV-related cancers. Conventional treatments have potentially devastating side effects for speaking, swallowing, and expression, so new options that preserve these functions are vital. At the 2020 CRI Virtual Immunotherapy Patient Summit, we hosted a special breakout session on head and neck cancers and immunotherapy to educate and empower patients, caregivers, and advocates.

Trisha Wise-Draper, MD, PhD, the medical director of the University of Cincinnati Cancer Center Clinical Trials Office, discussed what patients with head and neck cancer need to know about immunotherapy and answered audience questions.

Dr. Wise-Draper opened the session with an overview of head and neck cancer, explaining it is the sixth most common cancer worldwide and is commonly caused by smoking, alcohol use, and human papillomavirus (HPV). Historically, head and neck cancer treatment relied on surgery, radiation and chemotherapy, but more recently immunotherapy has become a “fourth” modality to treat cancer.

Dr. Wise-Draper explained how cancer cells can escape the immune system by expressing a protein called PD-L1 that binds to the PD-1 receptor on the surface of a T cell and shuts it off. Immunotherapies have been developed to prevent to block this PD-1/PD-L1, thereby allowing T cells to kill the cancer cells. She then reviewed the history of immunotherapy for head and neck cancer over the last decade, focusing on a breakthrough in 2016 when PD-L1 checkpoint inhibitors were first approved to treat and potentially even cure head and neck cancer.

Today, scientists are researching how to improve head and neck cancer patients’ response to immune checkpoint inhibitors by combining therapies in promising clinical trials, as well as how to personalize treatment for each patient using genomic sequencing.

Dr. Wise-Draper answered questions from the audience, including:

• Is immunotherapy recommended for initial diagnosis or better suited for those patients with reoccurrence?
• I don’t think my doctor is giving me the best medication. I have asked about clinical trials and he doesn’t seem knowledgeable. Do you recommend getting a second opinion?
• Is immunotherapy now standard of care for patients who have HPV-related head and neck cancers?
• Which types of head and neck cancer are most commonly caused by HPV?
• How long are patients treated with immunotherapy? Does the length of time vary based upon the effectiveness?
• After scans indicate no evidence of disease, how long is it advised to continue immunotherapy treatments?
• If immunotherapy does not work, can a patient return to chemotherapy treatments?
• What are common side effects of immunotherapy for head and neck cancer patients to look out for?
• If immunotherapy is stopped due to onset of autoimmune side effects, can one restart the immunotherapy once the side effects have resolved?

HEAD AND NECK CANCER AND IMMUNOTHERAPY SESSION TRANSCRIPT

Tamron Hall: Welcome back. If you're just joining us right now, it's my pleasure to welcome you to the Cancer Research Institute first ever Virtual Immunotherapy Patient Summit at our breakout session on head and neck cancer. I'm delighted to introduce to you Dr. Trisha Wise-Draper, who is here to share the latest on head and neck cancer treatment and answer your questions. Dr. Wise-Draper joins us from the University of Cincinnati College of Medicine, where she is an Assistant Professor of Medicine and Medical Director of the University of Cincinnati Cancer Center Clinical Trials Office. Brian Brewer from the Cancer Research Institute will be sharing your questions with Dr. Wise-Draper. So please be sure to put them in the Q&A.

Dr. Trisha Wise-Draper: Thank you for the kind introduction. As was mentioned, I'm Trisha Wise-Draper. I am an Associate Professor of Medicine at The University of Cincinnati Cancer Center, and I'm delighted to be here to talk about head and neck cancer and immunotherapy. Let me go ahead and start my sites. So I first wanted to start with just a little bit of background on head and neck cancer. So head and neck cancer encompasses pretty much everything from the head except for the brain down into the airway is where they start. So it includes the larynx, as well as the oral cavity, your tongue, the back of your throat, as well as the nasal cavities in your sinuses.

It's about the six most common cancer worldwide, not as common here in the US. But in most of head and neck cancers are going to be squamous cell carcinoma of origin. So the other histologies can be involved in the head and neck, but most of what I will discuss today will be relevant to squamous cell carcinoma. Common causes of head and neck cancer are smoking, as well as alcohol use. And addition, human papillomavirus or HPV is a common risk factor for certain types of head and neck cancer. Historically, treatment for head and neck cancers have always used a multidisciplinary approach. So we involved head and neck surgeons that do the surgery, as well as radiation oncologists and medical oncologist such as myself, giving chemotherapy. Recently, and today in the state of age, we now have what I would recommend or call a fourth modality of immunotherapy, where we're actually using a patient's own immune system to fight the cancer.

Next slide please. So in general, I think of immunotherapy as a therapy as I mentioned that uses a patient's own immune system to fight the cancer. So, sometimes, cancers form because the immune system doesn't recognize them as foreign. And that happens in some patients because they're expressing a protein that's called PD-L1 that binds to PD-1, a protein that is on immune cells and shuts off the immune system. These proteins are important normally. So say you have the flu or another virus, and you need to be able to tell your immune system to shut off. These proteins interact between other immune cells or normal tissues in immune cells that normally kill bacteria, viruses, and cancer. And when these proteins bind, the immune cells can not recognize the tumor is formed. So what happens in tumors is, they actually upregulate this PD-L1 protein. So in the normal situation, say, as in the flu as I mentioned, you want these proteins to interact because you need to turn your immune system off. But in cancer that can be a bad thing. And so the immune system just can't recognize the cancer as a problem and doesn't attack it.

Next slide, please. So fortunately, over the years, antibodies have been developed that either block PD-1 or PD-L1 and keep these two proteins from interacting, which allows the immune system to once again recognize the cancer as foreign. Next slide.

And when this happens, when the immune cells now recognize the cancer is formed, your own immune system can clear the tumor, which is remarkable and a great advance that we've seen in many types of cancers.

Next slide. So, in head and neck cancer, historically when cancer had come back, meaning it either recurred right where it was, or it's moved and become metastatic, moving to your lung or liver bones, historically, we've always used chemotherapy to treat these cancers. But chemotherapy, as many of us know, can have side effects. It's not very specific for your cancer. And although it works and a good portion of patients, the effect doesn't last. So it'll work for a while, but then it starts to fail. So these patients when they received chemotherapy would have survival somewhere around four to six months from when the cancer came back, which wasn't great.

However, in 2011, Cetuximab, another drug, that sometimes can be also considered a partial immunotherapy, but it's also an antibody that recognizes something called EGFR, which is epidermal growth factor receptor, which is often also on a bunch of head and neck cancers, that when it was combined with chemotherapy, for the first time, we saw an increase in response rate, meaning more patients responded to the therapy and had a good response. And they also had a longer response to treatment, which meant that their survival was longer, more in the nine to 11 month range, depending on what treatment they received.

But then in 2016, we finally had a real breakthrough. So pembrolizumab or nivolumab, which many know is Keytruda or Opdivo, had already been investigated in melanoma and some other cancers, but it was found that they also work in head and neck cancer. And so the first time we were seeing what was called durable responses. Meaning, a patient not only responded to the therapy, but they continued to respond. In fact, we have some patients that had metastatic disease in multiple places that are now more than five years out with no evidence of disease, meaning it's completely gone. We're careful to say cure, but you never know. We may have actually cured some of these patients.

And then in 2018, because nivolumab was initially given every two weeks, they were able to show that nivolumab could be actually given every four weeks. That was important because now it's better for patients. Now, you only have to come every four weeks instead of every two weeks to get this life saving therapy.

And then in 2019, so last year, because a lot of these therapies were being used after you've failed other chemotherapies, for the first time they brought immunotherapy into what's called the first line metastatic and recurrent setting. Meaning as soon as you were found to have either recurrent disease or metastatic disease that you could use this immunotherapy plus chemotherapy and patients had a dramatic response, as well as a better survival than we had seen in the past.

And then in 2020, similar to the nivolumab. Pembrolizumab was found to be able to be given every six weeks. So now if you get pembrolizumab, you can actually be getting it every six weeks and not have to come in so often. And both pembrolizumab and nivolumab are those PD-1 inhibitors that I described earlier.

Next slide. So what are we doing today? So now we know that these therapies work, but they don't work in everyone. So about 20%, so one out of five patients respond to these PD-1 inhibitors. So the question now is, how do we make that response better? What can we add to the PD-1 inhibitor? Can we try other combinations of targeted agents? How can we improve on what we've done so far? The second is how can we personalize therapy? How can we take the person and their tumor, understand exactly what went wrong in the tumor, as well as maybe what went wrong in their immune system? And how can we take advantage of that and actually tailor a therapy to an individual patient? A very difficult thing to do, but a place that we really want to get.

And then finally, can we move the immunotherapy into earlier settings? So I mentioned right now, it's used in that metastatic and recurrent setting, but why are we waiting until the cancer comes back? How do we bring it into that first line when we're trying to cure the patient the first time? A lot of trials are ongoing right now to investigate that exact question and the jury is still out, but we need to understand, can we be using it earlier? That's all I have and I would be happy

Happy to take questions.

Brian Brewer: Dr. Wise-Draper, thank you so much for joining us to talk about immunotherapy for head and neck cancers. Before we jump into the questions, I would like to remind everyone who's watching today that if you have a question for Dr. Wise-Draper, you can submit it through the Q&A box. And if you have not yet signed up for a confidential free one-on-one clinical trial navigator consultation, those are available to you at any time and we'll go ahead and follow up with you on that as well. So, that's it, Dr. Wise-Draper, thank you again. I just really quickly, one of the questions was is immunotherapy recommended for initial diagnosis are better suited for those patients with recurrence?You mentioned there is an approval as a frontline treatment. I just want to confirm that's only in stage IV, as you've just said, right?

Dr. Trisha Wise-Draper: Yeah. And talking about stages, that's important, because in head and neck cancer, unlike other cancers, stage IV doesn't mean incurable. So stage IV A and B are still curable cancers, but stage IV C, meaning that it's moved to the lungs, liver, et cetera, that's what we really mean by the metastatic cancer, incorrect. So, right now, it's only approved in the metastatic or recurrent setting, meaning they've failed curative intent treatment, but we're investigating it. Can we use it more upfront? In fact, in Cincinnati, we have one of those trials where we are using immunotherapy even before surgery and seeing what is their response at time of surgery and then using it after surgery. And so far the results look really good, but we're waiting for the data to be a little bit more mature, meaning we have to wait to see how patients are going to do for a longer period of time to understand… And then of course, test it against the standard of care currently and understand can we use it for more patients?

Brian Brewer: Mm-hmm [affirmative]. Okay. So, we have our first question coming in. "I don't think my doctor is giving me the best treatment. I've asked about clinical trials, he doesn't seem knowledgeable. Do you recommend getting a second opinion?"

Dr. Trisha Wise-Draper: So, this is always a tough question to answer, because it depends where you're at. First of all, of where could you possibly look for different trials? And my main piece of advice is that any physician, including myself, should never be offended by a second opinion. So, I would start there and say, "Ask your doctor? Is there someone who might be knowledgeable about clinical trials that you would refer me to? If that makes you uncomfortable, then you can ask maybe the staff, the nurses, or if you have a nursing navigator, where have other patients gone to understand what kind of clinical trials they'd be available for?"

And then I would look for academic centers that are close by. So, most clinical trials are going to be run out of academic centers. They are run out of other private centers too. And it's often the same study, but if you want to understand what new trials are coming out, look for the university hospital and look to see which doctors specialize in head and neck cancer. And then there's also a website called clinicaltrials.gov. It is difficult to navigate, but you can put your type of cancer in and then see what might pop up. And you can email a contact on those. And although it might not be a trial you qualify for, they might be able to help you as well.

Brian Brewer: And that's where our free navigator service comes in handy for those looking for a clinical trial, because those can be very tough to navigate. So, thanks for that. We have a question from a patient. "I have nasal pharyngeal carcinoma, I've done a clinical trial with a checkpoint inhibitor. I had a good response, then it progressed. Is there anything new out there that can help me get a better immune response? Any other combination perhaps?

Dr. Trisha Wise-Draper: So, not approved yet. However, there are clinical trials that are studying different combinations, both in nasal pharyngeal cancer specifically, as well as other cancer types. So, nasal aphasia pharyngeal cancers, it depends if you have what's called an EBV driven cancer. So, I talked about HPV, EBV is Epstein-Barr virus and is a different virus that causes nasal pharyngeal cancers. There are some targeted therapies that I think are really exciting. Where they take lymphocytes that are engineered to recognize that specific virus, and then combine it with more traditional chemotherapy that you may have already received to try to more specifically target your tumor. Those are some of the exciting options I see coming out, but there are other options out there too that take advantage of combining immunotherapy with other targeted agents or other types of immunotherapies, but they are all in clinical trials right now.

Brian Brewer: Thanks. Question: Are HPV cancers more likely to respond to immunotherapy than other types of head/neck cancer?

Dr. Trisha Wise-Draper: So, that's a very controversial question. HPV cancers in general do respond better to most treatment modalities, whether that be surgery, radiation, or chemotherapy. In the case of immunotherapy, we've seen mixed results. There are some studies that show HPV cancers do seem to respond better. And then there are some studies that show really HPV positive and negative have about the same results. I think there is some explanation behind that, why we see different survival rates on both and mixed results. HPV, since it's a virus, it gives you something for your immune system to recognize. So, on one hand, it makes sense why HPV viruses would be better responders to immunotherapy. On the other hand, smoking and alcohol use can cause more mutations in your tumor. And so, interestingly, if you have a lot of mutations in your tumor, which would normally be a bad thing, for immunotherapy, it might be a good thing, because the more mutations you have, the more foreign things that are being expressed from your tumor for your immune system to recognize. So, I think it's really complicated and we don't really know if HPV positive patients respond better or not.

Brian Brewer: Another patient's asking right now, "Are there types of head/neck cancer that aren't caused by any of the factors you've listed?"

Dr. Trisha Wise-Draper: Yeah, so I'll start on the reverse to that question. So, EBV causes nasal pharyngeal cancers, not all, but a good portion of them. HPV positive tumors are mostly going to be in the back of your throat. So, the base of your tongue, that deep part of your tongue that you can't really reach, or in the tonsils, or in the soft palate, so the part that feels softer in the back. So, that's where most of the HPV positive tumors are going to occur. The other head and neck tumors are more likely to be either smoking related or alcohol related. In other countries, there are some different types of nuts that actually can cause head and neck cancers. That's not very common here, but there are some cancers that occur that we just can't explain. We don't know. They don't have any risk factors. We don't know why they get it. And there's a lot of research still to be done to understand that.

Brian Brewer: Thanks. A question coming in. "How long are patients treated with immunotherapy and does the length of time vary?"

Dr. Trisha Wise-Draper: Great question as well. So, immunotherapy is… When we first developed immunotherapy and started giving it to patients, the thought was is that you would give it forever. Now, we're questioning that. So, some patients have a response, they have a complete response, tumor's gone, or their tumor responds really well to where it's really just a small little seed that's left and probably not live tumor that's being kept at bay. We're questioning now, "Can we stop the immunotherapy earlier?" So, it's very variable right now, because of some of the drugs that are out there, such as pembrolizumab. The standard right now is to give it about two years. And then there's others where the drug hasn't been stopped yet and we don't know if you can stop it. It's only been stopped really in patients that might've had a side effect. So, I have a couple of anecdotal cases where I've stopped the immunotherapy early and some patients continue to do fine.

Their cancer did not come back. But then I've had a couple of patients where their cancer did come back, but not for like a year. So, they had a year of not needing immunotherapy and then the cancer started to come back. Fortunately, in those cases, the immunotherapy worked again. So, I was able to give it again in the tumor responded again. There are some cases out there where that doesn't happen though. And so, I think all of us are still, patients and physicians are still asking, "When can we stop and shouldn't we shouldn't we stop?" So, we don't know so that's why you're going to see a variation.

Brian Brewer: Okay. So that addresses the next question that came in is after my scans show no evidence of disease, should I continue my immunotherapy treatments?

Dr. Trisha Wise-Draper: In general, right now I'd say yes, unless they're having a side effect or it's a distance thing, they can't get in, then we might give them a chance to stop and see.

Brian Brewer: On the other side, here's another question here. If my immunotherapy is not working, should I go back to chemotherapy?

Dr. Trisha Wise-Draper:         Great question. Yes. I think that is a good idea. In fact, there are some studies now that show, for some reason, some patients respond to chemotherapy better after immunotherapy. Not exactly sure the mechanism of that, but taxanes especially. So paclitaxel and docetaxel seem to get a better response after immunotherapy. So I would definitely try that versus other clinical trials and newer options.

Brian Brewer: Okay. We're getting some questions about side effects. So why don't we discuss, what are some of the more common side effects in head, neck cancer? And does someone have to stop treatment if they're getting side effects?

Dr. Trisha Wise-Draper: So side effects are going to be very different than chemotherapy. So traditionally in chemotherapy, we worry about someone becoming immunosuppressed and getting infections. We worry about fatigue and hair loss. Getting sick, nauseous are more, the more common side effects with chemotherapy. Immunotherapy, in some patients that get no side effects. In fact, the majority don't, but the more common ones are all going to be auto immune related. Meaning that we've activated your immune system too well and now it's trying to attack normal tissues, which we obviously don't want. So the most common is still going to be fatigue because of feeling tired, but some of the other more common ones, especially in head and neck and it's mixed because we have some other factors that can cause this, but thyroid dysfunction can happen where you have to wind up being on thyroid replacement.

Other common ones are going to be skin rashes, sometimes some diarrhea, which is actually auto-immune in nature. Meaning you need steroids to reverse it rather than the traditional antidiarrheals. Those are going to be the more common. Very rarely we'll see a serious side effect, like it attacks the lungs or the heart or the liver or kidneys or even the brain. So those are obviously very serious and we have to treat them right away with high dose steroids to try to reverse them. And most of the time we are able to reverse those side effects. But as far as restarting the immunotherapy, it depends how serious the side effect was. If you have a very serious one where I put you in heart failure, for example, I'm not going to feel comfortable restarting the drug. If you have a simple rash or maybe just a lab abnormality that reverses pretty easily, I'll be more comfortable restarting it. And I've found with those more minor side effects that they don't usually recur, fortunately.

Brian Brewer: That's good to hear. A question from a patient. I have severe lymphedema from radiation therapy. Does immunotherapy make lymphedema worse or cause lymphedema? [crosstalk 00:21:24] So let's talk about that first.

Dr. Trisha Wise-Draper: So lymphedema or swelling because your lymph nodes have either been radiated or even removed. Sometimes you get that swelling because of surgery. That is a common side effect, as you mentioned, of the radiation and it can also be a side effect of surgery. As far as immunotherapy, it doesn't cause lymphedema itself. However, if you think about how immunotherapy works, the whole reason you get the swelling is because the fluid can't go back to where it's supposed to be. That's part of the function of your lymphatics. So it's taking all that excess fluid and it's getting back to your heart. When that's disrupted, that can't happen. So now we add immunotherapy and say, you're really responsive to it and your immune cells become really hyperactive, they might produce some extra fluid that can't get back to where it needs to be.

So theoretically, you could have a little bit of worsening of lymphedema. I have seen that as well as what I call tumor flare a couple of times where your tumor because it's responding to the immune cells it actually gets bigger before it gets better and actually causes more pain and some of the discomfort temporarily. Sometimes we even have to give steroids to calm that down a little bit so you're not miserable, but it's actually a good sign because it means your immune system's working and that side effect goes away after a little bit. A few weeks usually.

Brian Brewer: Well, COVID is a big question right now. And certainly if you're in Ohio, a big hotspot there all over the state, I'm sorry to see. Is this a special concern for cancer patients around either their vulnerability to COVID or a lot of questions about should they take the vaccine?

Dr. Trisha Wise-Draper: All really great questions so I'll spend a little bit of time on that. As you mentioned, we are getting hit pretty hard in Ohio right now. We're all pretty concerned. So for my cancer patients first, the first thing I'm going to say is please protect yourself. Cancer patients in general, not just head and neck, are definitely more susceptible to severe disease. Meaning if they get the virus, they're more likely to have more complications. In fact, the COVID-19 and Cancer Consortium, the CCC19, which is actually international consortium that was built out of Vanderbilt is investigating a lot of these questions and I'm part of that. And we found that even if you have a history cancer, you are actually more susceptible to severe disease than even those that have active cancer. So both groups are more susceptible than patients who have never had cancer.

And probably part of that from what we talked about is if your immune system doesn't work well to fight cancer, it may not also work very well to fight a virus. And so it's the same immune cells that fight cancer that also fight viruses. So that might be part of the reason that you're a little bit more susceptible. We don't know that you're more susceptible to getting it, but we are concerned. And the reason we don't know if you're more susceptible of getting it is because we don't really have a great control group to compare that. So all we are looking at is our patients that have cancer or had cancer and have gotten COVID-19 and looking at the complications. But their complication rate is definitely higher than those that don't have cancer. That's been reported. And we found that certain therapies do seem to make them more susceptible to this severe disease.

And so I say take it with a grain of salt because we're looking at a very short time. We're taking just a relatively small amount of patients. And in reality, we're looking at 5,000 patients and that in itself is a little scary that we have had that many cancer patients with COVID-19 just in our consortium. But when we look at that group of patients, so far, immunotherapy does not seem to increase your risk of severe disease. The therapies that do though are the immunosuppressive therapies. So chemotherapy, for example. Some of the antibody drugs like rituximab that inhibit your CD20. So inhibit your B cells. That's also seems to be relatively high risk. So there are certain therapies that do seem to put you at more risk. But in the head and neck cancer group, the chemotherapy seems to be the biggest culprit. Radiation and surgery don't seem to have an impact.

With that being said, if you have curable disease and we're recommending chemotherapy and radiation to treat your curable disease, the risk of you dying of your cancer is much higher than getting COVID-19. So we are absolutely not saying don't get treated. You need to get treated. So if you see you have cancer, you need to listen to your physicians. So make sure you get your treatment because that's more of a concern than if you got these therapies. It may make some of us think twice about what therapies we offer for sure but that's really a discussion you need to have with your physician.

As far as the vaccines go, I definitely encourage you to get the vaccines, especially the ones that are out right now. They are not live vaccines, meaning they don't have live virus in them. In fact, some of the data that's showing right now is even if you got COVID-19, you should still get vaccinated because you actually produce a better protective antibody response to the vaccine than you do if you get it naturally, which is a little against what we're used to. And part of that is probably because part of the virus is actually making you immunosuppressed and not able to mount a response to it.

So, I absolutely recommend, especially to our immunosuppressed cancer patients, that they get this vaccine. It is just a small… It's called an MRNA, and the two that are getting ready to be distributed. It's a small MRNA, which is actually the part of the virus that makes a protein. And so, it can't integrate into your DNA. It's not possible. It's not going to mutate anything in your body. It's short-lived, meaning that once it gets what's called translated into the spike protein, it can't be reproduced. It'll be gone out of your body.

And when it produces that spike protein, that's what causes the antibody response and protects you from getting COVID-19. So, you want that to happen. Your body will clear the protein, it will be gone, but you will have long-lasting antibodies that will protect you. So, I absolutely recommend that you get it.

Brian Brewer: How has the pandemic affected your practice in treating patients, especially those with immunotherapy, you mentioned there were some differences perhaps in susceptibility, based on the type of cancer treatment. It's good to hear that non-immunosuppressive immunotherapies, like in this case, they're more advantageous. So, I'm just curious if that affects from patient to patient or certainly your practice.

Dr. Trisha Wise-Draper: Yeah. So it's definitely affected my practice a lot in a lot of different ways. One, just, I don't want my patients coming in unless they have to.

So, we're doing a lot more telehealth if they're able to. If they're not getting treatment, I'm asking that we just talk over the phone. Don't come to the ER, unless you absolutely have to; call me first so that we can go over your symptoms and maybe see you in our clinic where it's a little safer. The ER is a war zone right now. I really don't want anyone in there. So, that is one of the ways that it's impacted me.

As far as therapy choices, and head and neck, it hasn't impacted me much because of, I know that I can cure a lot of head and neck cancers. And so I'm going to give you the treatment that's recommended, because I'm not going to sacrifice the chance of curing you, but I am going to tell you to please protect yourself, stay away from people, wear your mask, don't go to big events.

So, that that's really how it's affected my practice. And certainly, just in general, it's affected us all. We don't have the staff that we need sometimes because everyone's on quarantine, so there's been a lot of effects.

Brian Brewer: Well, I know we're all going through this. So, as long as… It's good to hear that your patients are still getting the treatment they need. Let's end on another note. I'd love to hear, given all the evolution that you've seen now in the way head and neck cancers are treated, what's your general outlook for the future?

Dr. Trisha Wise-Draper: Good, actually. I never thought this early in my career that we would have seen the breakthrough we did with immunotherapy and so many different therapies are coming out and just really novel ways to treat cancer, and I think that's the most exciting part. As a scientist myself, I just love understanding the different ways that therapies work and how we can make a better future for all of us and hopefully get to the point of preventing cancer. That's the real goal, so it's a good outlook.

Brian Brewer: Do you think we'll ever get to preventing cancer?

Dr. Trisha Wise-Draper: Some types. We'll prevent HPV types of cancer for sure. Just take the vaccine. So yeah.

Brian Brewer: Very good. Well, that's all the time we have Dr. Tricia Wise-Draper from the University of Cincinnati Cancer Center. Thank you so much for joining us today and sharing your time with us.

Dr. Trisha Wise-Draper: Thanks for having me.

Tamron Hall: Dr. Wise-Draper, thank you for joining us today and sharing your expertise, your discussion, as well as all of those from our doctors today was lively and informative.

As we wrap up day three of the first CRI Virtual Immunotherapy Patient Summit. I would like to thank all of you for attending and participating. We hope that this was an empowering experience for you and that you leave us with a better sense of what immunotherapy is and how to talk with your healthcare team about whether it's a good treatment option for you or a loved one.

Once again, I'd like to thank our sponsors for their generous support of this educational program. And we would like to thank our host institutions for their support, as well as the incredible doctors who joined us throughout the event.

Finally, we will be sharing all of today's slides, video recordings, as well as the CRI resource guide, which includes valuable information from our partners, as well as details on how to access CRI's free immunotherapy clinical trial finder service. We encourage you to use and share these resources with your network. I'm Tamron hall, and it has been an honor to join you as your host for this important and potentially life-saving event. Be safe and be well.