Dr. Joseph Siu-Kie Au: beyond immunotherapy—discovering new possibilities
Expert's introduction
Dr. Au (Figure 1) is a consultant clinical oncologist in Hong Kong Adventist Hospital. He has special interest in bioinformatics, translational research, clinical trials of new drugs and radiotherapy.
Previously, as the chairman of the Research Committee and the Coordinator of Research and Ethics Committee in Kowloon Central Cluster hospitals of Hospital Authority, he was the key person in the establishment of the standards of clinical research according to Good Clinical Practice (GCP) provided by ICH. He is also the President of the Hong Kong Lung Cancer Study Group and the co-founder of the Hong Kong Neuro-oncology Society. Both professional bodies are the most vital organizations in Hong Kong active in promoting education and research in lung cancer and neuro-oncology.
Editor’s note
The 4th Hong Kong International Oncology Symposium was held at Hong Kong Adventist Hospital (Tsuen Wan) and the City University of Hong Kong on 3–4 November respectively. An army of world-renowned experts in the field oncology was invited to share and study a number of clinical cases via this highly-effective academic exchange platform. The symposium can be claimed as a forerunner of new oncological management. Discussed topics included immunotherapy, pharmacogenomics, precision medicine, precision oncology and so on. At this symposium, we had the great honour to invite Dr. Joseph Siu-Kie Au, Hong Kong Adventist Hospital, to have an exclusive interview with us (Figure 2).
Interview (Figure 3)
ATM: We all know that you are a successful clinical oncologist. What makes you interested in clinical oncology?
Dr. Au: Being a clinical oncologist is very rewarding. We can follow up the patients from the diagnosis to the end of the treatment. We need to pay attention to their sufferings, in terms of the psychological impact, social impact and also the physical discomfort, the cause due to either the treatment of side effects or from the disease itself. Of course, some patients are fortunate that they can recover from cancer. Inevitably, some patients can benefit from treatment. Eventually, they may have disease progression. At some stages, some patients have to accept the fact of life that the disease is not curable. At that time, we may focus more on palliative care. However, we are still with the patients. Basically, we follow then and walk with them. We learn from them. We, ourselves, have not passed through this difficult journey of life. It is a good lesson for us as well.
ATM: What kind of challenges have you met in your research studies? For example, when you conduct clinical trials or do the analysis?
Dr. Au: Research nowadays is quite standardized. We have all the guidelines, like the ICH E6 standards for the ethical aspect in maintaining the standard clinical research. I think the challenge nowadays is to recruit an adequate number of patients for trials since we have so many undergoing trials.
ATM: What are the effects of immune checkpoint inhibitors on solid tumours?
Dr. Au: Undoubtedly, immune checkpoint inhibitors are the breakthrough. As you can see, nowadays, I estimated the immune checkpoint inhibitors are involved more than half of the clinical trials of cancer. There are certain advantages, for instance, they have very effective and durable responses in our subset of patients. Honestly, the immune checkpoint inhibitors cannot bring advantage to more than half of the patients. So, I think we should go to a higher level of immunotherapy, such treatment will also help other patients who were not benefited from immune checkpoint inhibitors previously. Some of the tumors have other mechanisms invading the immune system. Maybe their immune system itself is not intact and other unknown factors are involved as well.
ATM: How do you see the future of immunotherapy? What are the significances of it?
Dr. Au: The understanding of our immune system is still incomplete. There are many factors in our immune system in which we can explore further and develop the new treatment. In general, I think the immunotherapy is our hope dealing with cancers because it has a memory effect. Our immune system, theoretically, can cope with the changing clones of tumors cell. Compared with targeted therapy, most of the targeted therapies only have a temporary effect. After which, the drug resistance will develop. Theoretically, our immune system can adapt and cope with the changing genetics of cancer cell as the disease evolves.
ATM: You may organise a focused issue about this symposium in ATM journal. Would you have a few words to our readers?
Dr. Au: I think we are now at a turning point of the history of cancer management. In this new era, we will see that the practice of oncology will be quite different 10 years from now. Therefore, we need the patients and clinicians as well to keep themselves up-to-date about the new development. With this, the time between the discovery of this new knowledge and the applications to actual clinical practice can be shortened. Hence, more patients can be benefited from the advances.
Acknowledgements
None.
Footnote
Conflicts of Interest: The author has no conflicts of interest to declare.
References
- Cheung M. Dr. Joseph Siu-Kie Au: beyond immunotherapy—discovering new possibilities. Asvide 2018;5:625. Available online: http://www.asvide.com/article/view/25920
(Science Editor: Mike Cheung, ATM, editor@atmjournal.org)
