Paul E. Oberstein, MD, an assistant professor in the Department of Medicine, joined NYU Langone Health’s Perlmutter Cancer Center in 2018 as director of gastrointestinal (GI) medical oncology. Dr. Oberstein also is assistant director of the Pancreatic Cancer Center, which is directed by Diane M. Simeone, MD, the Laura and Isaac Perlmutter Professor of Surgery in the Department of Surgery and professor in the Department of Pathology.
Dr. Oberstein conducts translational and clinical research in GI cancers and guides clinical implementation of innovative trials with a focus on pancreatic cancer. In addition to developing and initiating novel investigator-initiated trials, Dr. Oberstein is building collaborative groups and teams to help advance clinical research at Perlmutter Cancer Center, with support from a Cancer Clinical Investigator Team Leadership Award he received from the National Cancer Institute in 2019.
He discusses his strategy for clinical trials for GI cancers, his work at the Pancreatic Cancer Center, treatment options for people with pancreatic cancer, and more.
You have opened a number of clinical trials in the last year. What can you tell us about your strategy for clinical trials for GI cancers?
In the Gastrointestinal Cancer Disease Management Group, we emphasize opening clinical trials that are relevant for a broad spectrum of people with GI cancers. We really want to have options that are available for as many people as possible to help give them access to innovative therapies that might improve their outcomes. We have focused on pancreatic cancer, and one of our goals is to have a pancreatic cancer trial for almost every, if not every, patient in our center. We’ve been very engaged in collaborative clinical trials, including internal collaborations with clinical and basic science partners and external collaborators. We are trying to build up networks to help increase the impact of our clinical trials so that we get answers faster, which we share with other clinicians.
For example, Perlmutter Cancer Center is one of the lead sites for a large international phase 3 trial in patients with a new pancreatic cancer diagnosis that is evaluating the addition of a novel agent called CPI-613 that targets a new pathway in pancreatic cancer, cancer metabolism, in combination with chemotherapy. Our hope is that this will answer a very new question in pancreatic cancer, whether this pathway is something we can target, and whether this can help potentially many more patients.
Another trial in pancreatic cancer that we’re excited about is looking at what is called third-line treatment for pancreatic cancer, meaning people who have already had two types of chemotherapy and now need another option. There are no approved medications for patients in that category, so this trial is very exciting because we’re hoping to test something new that would potentially give people with pancreatic cancer another option. It’s also a multicenter collaborative trial in which Perlmutter Cancer Center is one of the lead centers. The trial involves an oral medication called SM-88. Our hope is that through these kinds of trials, as well as many other trials that we’re running, that we can expand the therapeutic options available to people with pancreatic cancer.
Both of these trials are very innovative mainly because there are very few treatment options for either the patients who have third-line cancer or a treatment that is a novel strategy in patients with a new diagnosis. These may turn out to be significant changes in how we treat people who have pancreatic cancer. We don’t know what these trials are going to show, but I think being engaged in these trials is very exciting, and they’re really something patients are very eager to have as an option.
You serve as assistant director of Perlmutter Cancer Center’s Pancreatic Cancer Center. Tell us about your work there.
I work closely with Dr. Simeone, the director, in many domains. I think one of the really wonderful things about our work together is that it’s collaborative on multiple levels and truly multidisciplinary. We see patients together in our multidisciplinary clinic and work together very closely in clinical work and patient care. We manage care together, and we communicate and discuss patient care very frequently and with great ease together, which is helpful for us and helpful for our patients. We also work very closely together on clinical trial development, including with Precision Promise℠, the Pancreatic Cancer Action Network’s new clinical trial platform that aims to accelerate treatment options for people with pancreatic cancer. Precision Promise℠ is part of our bigger effort to have a very comprehensive clinical trial program that offers clinical trial options for every patient and to be involved in the most advanced research to bring new agents to the clinic.
We also work on building additional patient-centered infrastructure by enrolling all patients with pancreatic cancer in a registry to evaluate their demographics, the features of their disease, and their response to treatment so that we can learn from all our patients. We evaluate patients’ tumors to understand tumor genetics, and we routinely obtain germline testing, which looks at a patient’s own genetic changes (mutations). Together, Dr. Simone and I are trying to make it something that happens for all patients.
Another really exciting part of our collaboration is that we work together on preclinical research, things that are not yet in patients, to help design and guide not only laboratory research, but especially what’s called translational research, where we’re taking ideas from the laboratory and working to put them together in a clinical trial to test them and use them and make them available for patients. The translational aspect of our work together is something that will lead to future clinical trials and future options for our patients and for people with pancreatic cancer in general.
Pancreatic cancer is a disease that’s not diagnosed until it has become advanced, generally, and the prognosis is typically not very good. What do you say to patients who come to you?
What you just said is true. Unfortunately, pancreatic cancer is often a cancer that is diagnosed very late or when patients have a substantial amount of symptoms. We definitely discuss those realities, but we also discuss all of the components that we use to treat their symptoms. So we focus on the best chemotherapy and the best clinical trial for that patient and being able to deliver care quickly and clearly so that patients know exactly what they’re getting. They’re going to be able to start treatment quickly, and we’re going to try to streamline the process for them as much as possible.
We also involve our pain management and palliative care teams in almost every patient’s care. We work very closely with nutrition and social work specialists as well as other physicians to try to optimize symptom control and help quality of life to the extent that we can.
In many cases we see patients who have had symptoms for weeks or even months before the diagnosis was made and before they came to us. For example, we recently had a young patient with significant weight loss and fatigue, and he came to us with advanced disease. We were able to start him on chemotherapy quickly, and his symptoms improved over a period of months with marked improvement in his quality of life. Unfortunately, most of the time chemotherapy will lose effectiveness over time, but for this person, we were able to improve his symptoms and help him. When he needed to switch therapy, he was feeling much better and was able to enroll in a novel clinical trial that has provided substantial benefit.
By approaching every patient with our multidisciplinary approach, we are able to rapidly provide a diagnosis, initiate therapy, and explore all options for each person.