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Clinician Spotlight: Dr. Benjamin Herzberg

*February 2024*

This month we have the honor of featuring Dr. Benjamin Herzberg MD, who is a medical oncologist at Columbia University, Herbert Irving Comprehensive Cancer Center in New York.

Dr. Herzberg attended the 2023 EGFR Resisters Research Summit and was awarded the Distinguished Young Investigator for his work, ATR Inhibitors Can Target Osimertinib Resistance in EGFRm NSCLC. ATR (ataxia telangiectasia mutated and Rad3-related) is involved in DNA damage repair, and ATR drugs inhibit the growth of tumor cells by limiting their ability to repair damaged DNA. This is an emerging strategy in treating cancer. 

Thanks to young investigators like Dr. Herzberg, the future of lung cancer research and treatment is bright!

What motivated you to get involved with lung cancer research?
My father died of a cancer when I was in college, but he had been diagnosed when I was around age nine and did very well for a long time because of exceptional physicians taking care of him. I had a real sense from the time I was in college that a really good use of my life would be taking care of cancer patients and “paying forward” what I received. I gravitated to lung cancer for a lot of reasons – I really like lung cancer patients; I really like the type of medicine I can practice, ranging from patients cured with surgery to patients dealing with very late-stage cancers; and I am filled with a constant sense of hope by the progress in the field since around 2008. Thingsworkin lung cancer. Not well enough – which is why the research is so needed – but there is a real momentum.

What research have you done that would have the most impact on our members with the EGFR mutation? What new projects are you working on?
Most of my research focuses on targeted therapies and resistance to targeted therapies in lung and other cancers. Much of this has come in the form of clinical trials of novel targeted therapy medicines, trying to develop new options for specific mutations. But I think the big, overarching, million-pound-gorilla question in EGFR lung cancer is – where does resistance to EGFR TKIs come from? And how are we going to beat it? We have a fantastic, well-tolerated medicine which has broken new barriers in a lot of ways (osimertinib). And yet our traditional tools that got us to osimertinib (finding the T790M mutation, making a covalent molecule to overcome it) are faltering when it comes to making the next generation of ground-breaking medicines. I’ve been thinking about thewaysin which resistance develops and whether those might be targetable, which is a paradigm I don’t think has come up much before.

What was treating lung cancer/lung cancer research like when you first started to practice?
I’m starting year three of practice and even in that short period we have seen massive waves of innovation – immunotherapies in early-stage cancers; multiple new targeted therapies; etc. Even 3 years and things are moving.

What do you think lung cancer treatment will look like five years from now?
Tough one. I think much of it will look the same, but my real fundamental conviction is that we neednew medicinesand not just better ways to use old ones. I am hopeful that we will have that in EGFR and other lung cancers (KRAS, etc.) as we learn more “tricks” of drug design. There are all sorts of new ways to make molecules and I am hoping some of these will lead to real, previously-unheard-of breakthroughs.

What treatments/research of interest do you consider will make a significant impact in the not-too-distant future?
In the short term, I think we will see lots of answers in the next few years to important “management questions” with medicines we already have – we’ve already seen things like osimertinib for early-stage lung cancers with the ADAURA data, and I think we’ll get similar answers by moving on to ADAURA2, neoADAURA, and the FLAURA2 trials. I think we are going to have to find new medicines, focused on specific targets in lung cancer, that use technologies like molecular glues, degraders, modification-targeting chimeras, and, most importantly, focus on theright targets.

How could treatment be done differently at this time to improve care?
First, I really hope everyone everywhere all the time at every moment gets molecular tumor sequencing and I am sometimes still surprised by consults I get where this is not the case. But it is much better than it used to be. Second, I am mildly obsessed with trying to use computers to improve care, especially when it comes to clinical trials and getting patients to good trials. There is no clinical trial “system” in the US and it is really up toindividual patients and providersto try and figure out what trials would be best for them, in a sea of potentially really poor options. We should have mandated systems to evaluate people for trials, we should have measurable outcomes as to how many people we are getting on trials out of a true number who would maybe have been eligible, we should have easily navigable systems to research these as patients and providers and we should have automated “nudges” helping doctors do this tied to other data we collect (chiefly sequencing).

Do you have advice for people considering clinical trials?
First, if you can participate in a trial without much downside to yourself, do it! It helps you and others. Second, there are lots of great clinical trials out there and lots of bad ones. It really depends on you and your situation, and your goals. Some people want – or need – “a trial most likely to help today.” Other people can go on speculative trials with low potential of working but, if they work, can work great and for a long time. Most generally, more peoplerun out of trial options before they want to. That’s important to keep in mind and should affect decisions when thinking about trials. And finally, it’s important to remember that there are things in life that are more important than trials and even more important than treatment. Sometimes when choosing between an onerous trial and a trip to Disney World, Disney can be the right decision.

Anything else to know?
I am in awe of lung cancer patients and advocates, and I think they have made the world a better place when they have had limited time, resources, and a bad disease to fight. Keep it up.