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Clinician Spotlight: Dr. Zosia Piotrowska

*June 2024*

This month, we are honored to feature Dr. Zosia Piotrowska, MD, MHS. Dr Piotrowska is a medical oncologist at Massachusetts General Hospital and an Instructor of Medicine at Harvard Medical School. Her research is focused on improving therapies for EGFR-mutant lung cancers. She has been faculty at the EGFR Resisters Research Summit since its inception and transitioned to Chair of the Summit in 2023. The EGFR Resisters are grateful for Dr. Piotrowska’s endless support and advocacy and appreciate her tireless efforts to advance EGFR Research and improve patient care.

What motivated you to get involved with lung cancer research? How did you do it?
I was drawn to the field of thoracic oncology for several reasons- first and foremost, because of the patients that I met in my clinic and on my inpatient rotations during my training. Lung cancer touches patients from all walks of life and all different backgrounds, and I found it very meaningful to get to know patients and their families and help them in their journey. Second, I did my oncology training at a time when targeted therapies had only recently become a standard part of lung cancer treatment and immunotherapy was on the horizon. It was a very exciting time to get involved in lung cancer research, which has only gotten more exciting in the years since I entered the field. I was fortunate to be mentored by many kind, generous and very successful lung cancer researchers in my early career who helped me establish my own career and find my path. Now I try to do the same and support young investigators and mentees to develop the next generation of lung cancer researchers.

What research have you done that would have the most impact on our members with the EGFR mutation? 
A major focus of my research has been to understand how EGFR-mutated lung cancers become resistant to currently-available EGFR targeted therapies. I started this work when third-generation EGFR inhibitors like osimertinib were just entering the clinic, not yet realizing that osimertinib would soon become our first-line treatment. We used tumor biopsies and blood samples taken from patients whose cancers had progressed on osimertinib and other similar drugs to study the biologic changes that were occurring at the time of resistance. We found that, in some cancers, new mutations, fusions, or other genomic changes had developed, while others underwent a histologic transformation and yet others had no changes that could be identified. These findings have helped to develop new treatment approaches aimed at these resistance mechanisms.

What new projects are you working on?
I am partnering with colleagues both at my own institution and others to develop better tools to test for resistance mechanisms in patients whose cancer progresses on osimertinib. We know that obtaining invasive tissue biopsies isn’t always possible and is not easy for patients, and we are hopeful that in the future we will have better and more comprehensive tools that rely on blood, rather than tumor, samples. I am also very interested in whether these tools can be used at the time of initial diagnosis to personalize treatments more effectively for patients. Over the past year, we’ve seen several studies which use a combination of an EGFR inhibitor and other treatments like chemotherapy or amivantamab. These studies have shown that such combinations can extend the time that patients are on their initial treatment but also lead to increased side effects. It will be important for us to develop better tools to personalize these decisions and determine which approach is best for each patient.

What was treating lung cancer/lung cancer research like when you first started to practice, and when was that?
I’ve been working in the field of lung cancer for over 10 years, and I am constantly amazed by how complex the care of lung cancer patients has become over the past decade. When I started working in this field, we had only a few available treatment options, even for patients with EGFR-mutated lung cancer. Now, we have multiple targeted therapy options, novel agents like antibodies and antibody-drug conjugates and many other therapies which are either already approved or being tested in clinical trials. These advances have made decision making in the clinic more complex, with more options available to patients. Despite all of these changes, one thing has remained the same in my opinion: The importance of keeping the patient at the center of the conversation and making treatment decisions together with patients, keeping their needs and goals in mind.  

What do you think lung cancer treatment will look like five years from now?
I think (and hope!) that our treatments will become more personalized and that we will have the tools to develop a deeper understanding of the biology of each patient’s cancer from the time of their initial diagnosis. For example, right now we consider all patients whose cancer has an EGFR exon 19 deletion to be candidates for the same initial treatment (osimertinib). In the future, I hope that we will have a better understanding of the differences that can exist even among cancers with the exact same EGFR mutation, and that this understanding will help guide treatment selection. For example, some patients with a favorable profile of co-mutations or other factors may still receive a first-line EGFR inhibitor like osimertinib, while for other patients, a higher risk profile may guide us towards a combination of osimertinib with chemotherapy (or other new drugs.)

What treatments/research of interest do you consider will make a significant impact in the not-too-distant future? 

So far, we have not had much success in utilizing immunotherapy for patients with EGFR or other oncogene-driven cancers. A lot of work is being done to understand why this is the case and to develop better tools to harness the immune system more effectively against these types of cancers. I hope that this will work and have an impact and give us better immunotherapy options in the not-too-distant future.

How could treatment be done differently at this time to improve care?

One of the most important things that we have to do as a lung cancer community is to ensure that all patients with non-small cell lung cancer have complete testing of their lung cancer using next generation sequencing, which is still not always the case (but is definitely becoming more and more common!) In addition, whenever possible, patients should have access to a multi-disciplinary care team including medical oncologists, radiation oncologists, surgeons, supportive/palliative care clinicians as well as social workers, nurses, pharmacists and so many others. Each of these members brings a different perspective to the care team, and together they can help patients make the best treatment decisions for them.

Do you have any advice for people considering clinical trials?
Clinical trials can offer access to new and exciting treatments and are an essential part of many patients’ journeys, but I recognize that participating in a clinical trial can also be a very intimidating and daunting process for patients and their caregivers. I think it’s essential for patients and caregivers to feel empowered to ask questions of their clinical trial team in order to gain an understanding of why the study is being done, what is known about the intervention already, and what the study entails. Ask questions, seek second opinions, and also trust your own instincts about whether the trial is the right fit for you.

Is there anything else you would like our readers to know?
It is a tremendous privilege for me, as a lung cancer researcher, to partner with patients and patient advocacy groups like the EGFR Resisters. The patient voice is essential to lung cancer research, and your input helps us perform research and design clinical trials in a way that is most relevant and impactful to patients. Thank you for all that you do as a community, and for welcoming me into it!