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5 min Sarcoma Talk with Shushan Hovsepyan and Leo Kager
Mar 14, 2024, 18:42

5 min Sarcoma Talk with Shushan Hovsepyan and Leo Kager

Welcome to the world of sarcoma with the first episode of ‘5 Min Sarcoma Talk’ on Oncodaily. In this episode, host Dr. Hovsepyan and esteemed osteosarcoma expert Prof. Leo Kager discuss the latest advancements and challenges in sarcoma care and research. Discover the promising agents under investigation, Prof. Kager’s inspiring path to pediatric oncology, and more. Join us for an informative and inspiring journey into the sarcoma field.

About Leo Kager

Professor Leo Kager, MD holds board certificates in Pediatrics and Pediatric Hematology/Oncology. He is the head of the Outpatient Department of Hematology and Oncology at the St. Anna Children’s Hospital the head of the Children’s Cancer Research Institute in Vienna, a Professor of Pediatrics at the Medical University Vienna, and an active member of the Austrian Mountain Rescue Service. His research focuses on pediatric sarcomas, pediatric renal tumors, and rare hematological diseases. Moreover, he is an osteosarcoma expert. He has acted as a reviewer for the NEJM, Lancet Oncology, Annals of Oncology, Leukemia, etc., and published 100+ articles in Pubmed.

About Shushan Hovsepyan

Dr. Shushan Hovsepyan is a pediatric oncologist and adjunct assistant professor at the Yerevan State Medical University. She earned her medical degree (M.D.) from the same university’s General Medicine faculty, where she was awarded the Nominal Student Scholarship. Currently, she is a clinical research coordinator at the Yeolyan Hematology and Oncology Center. She completed a clinical fellowship lasting over a year at the pediatric oncology unit of the National Institute of Cancer in Milan, Italy, with a primary focus on pediatric sarcomas and rare tumors. Additionally, she was a clinical observer at the pediatric oncology unit of St. Anna Children’s Research Hospital in Austria for six months. Furthermore, she held a research fellowship position at the European Organisation for Research and Treatment of Cancer in Brussels, Belgium. Dr. Hovsepyan also completed the Postgraduate Harvard Medical School’s Effective Writing for Healthcare program, focusing on writing and reviewing medical-scientific manuscripts. Dr. Hovsepyan is a member of the POEM Training Committee and a graduate of the College of the European School of Oncology. She is a former co-chair of the SIOP Global Health Network Education and Training Working Group. Additionally, she is a member of several professional organizations, including SIOP, ASCO, ESO, and EpSSG.

About OncoDaily

OncoDaily.com was founded in 2023. It is a US-based oncology media platform, which features the latest news, insights, and patient stories from the world of oncology. Within a short period, it became one of the leading oncology media platforms globally. OncoDaily gathers content from various sources, including social media posts from renowned oncologists from all over the world, news from oncology societies and cancer centers, patient and survivor stories, and career-related information for professionals. The mission of OncoDaily is to empower patients, survivors, and professionals with the knowledge and inspiration they need to fight cancer. The motto of OncoDaily is “Cancer doesn’t take a day off – neither do we.”

Follow the transcript below

S.H.: Just all right. So, hello everyone, and welcome to our first episode of Five Minute Sarcoma Talk on Onco Daily. I’m Shushan Hovsepian, a pediatric oncologist from Armenia, and I’m thrilled to be your host today. Today, we have the privilege to speak with Professor Leo Kager, who is a world-renowned osteosarcoma expert and heads the Saint Anna Children’s Research Institute and outpatient clinic at Saint Anna Children’s Hospital in Vienna, Austria. Hello, Professor Kager, how are you?

L.K.: Hello, Shushan. Good to see you. It was a great time having you here in Vienna.

S.H.: Thank you. I had the pleasure to work with Professor Kager for a short time in Vienna. He’s an excellent expert in the field and also a wonderful personality. So, let’s start with our questions to shed some light on the challenges of osteosarcoma treatment and research. So, a little bit of history. How has the approach to treating pediatric osteosarcoma evolved in the last three decades?

L.K.: Coming back, the very first important step was the Myers trial in the US, where the advantage of chemotherapy compared to surgery alone was proven. Two years ago, I started working for two years in Memphis, Tennessee, and my former boss, Bill Evans, who became director of Saint Jude, asked me, “Leo, can you tell me your work in the field of osteosarcoma? What have you achieved in the last 15 years?” And actually, I said, “Which drugs do you use?” And I said, “We use MAP and Ifosfamide and VB 16.” And he said, “But that was used 20 years ago.” And I had to confess, “Yes, and now, 22 years later, we still use the same drugs as standard.” So from the systemic treatment approach, there was not much progress. However, when it comes to the local therapy, there was really progress made in radiotherapy because osteosarcoma, compared to Ewing sarcoma, is more radio-resistant. But when you use carbon ions and protons, especially in combination, you can really achieve a local tumor control.

S.H.: Yeah, that’s a little bit frustrating not to have a treatment option for so long. But, we need to work on that to improve the systematic treatment. Building on that point, what are the current critical gaps in the research field that, in your opinion, need special attention?

L.K.: Yeah, I think it’s wise to look at osteoclasts and Ewing sarcomas. So in Ewing sarcomas, we have made progress. So when a treatment intensification is shown by the Koc group, with the addition of ifosfamide vp16 to the standard backbone, that resulted in significant improved survival. The same was true when we did the compressed treatment. So this is now the standard to compress the chemo treatment and local control rate in a five-year event-free survival in patients with Ewing sarcoma and localized disease is about 87% or so. And in osteosarcoma, it’s 60%. So there is a huge gap. And now we have to figure out what is the difference. Why do osteosarcoma cells migrate so often to the lung? What is the difference in comparison to Ewing sarcoma cells? So in Ewing’s, at least in osteosarcoma, when you have a relapse, you have a second chance. In Ewing sarcoma, it’s very hard to become a long-term survival when you relapse. To figure out what are the mechanisms behind that gives rise to such a high number of metastases? I think this is a very important task ahead.

S.H.: Yeah, that’s true. But, is there anything transformative and a breakthrough in the treatment maybe also from the preclinical field, is there something that is really promising for the future?

L.K.: Yeah. There is one group of drugs, the TKIs, especially Cabozantinib. And the CoC is planning or is performing already a trial with frontline Cabozantinib. And here in Europe, we have founded the Foster Consortium to fight osteosarcoma through European research. First time that we have almost all countries in Europe participating in such a consortium. And we are happy that we can also now go into a trial with a chemo backbone, plus Cabozantinib add-on treatment.

S.H.: That’s an incredible progress to have a consortium working specifically on osteosarcoma after this long time. And, I always think that collaborative effort will always pay off. So, hopefully, we will have results very soon. And now, as we are wrapping up our conversation and stepping from research, I would like to ask you about your personal experience. What motivated you initially to specialize in osteosarcoma research and treatment?

L.K.: As I started more than 30 years ago, we had two different wards. One was for solid tumors and the other was for liquid malignancies. And that was why I started to become more involved in solid tumors. And then it was, of course, the fantastic environment of the CoC group and the many other friends throughout the world. And now, it’s kind of I’m close to retirement, and now it’s very important, we can cure many patients already. But now it’s high time to have this also for our osteosarcoma patients. So, very simply, why I came into the field, but why I stick now in the field is to get adequate treatment for the osteosarcoma patients.

S.H.: Thanks. Thank you very much for sharing your perspectives. And also, I think it is very interesting for young oncologists to learn from personal experience of the experts. And thank you for accepting our invitation. Thank you for being with us today. And we hope that our episode, our listeners will find informative and engaging. And let’s continue to learn, grow, and support each other on this journey. Thanks a lot, everyone, for listening.

L.K.: Thank you very much and warmest greetings to all friends in Yerevan.

S.H: Thanks a lot.