Why do patients choose certain treatment options and therapies over others? When should a patient choose surgery, chemotherapy, immunotherapy, etc.? Drs. Sapna Patel, Michael Wong and Mark Gimbel discuss how surgery is always the first thought of treatment, as it is much more ideal to extract the cancerous area. However, as history has shown, some cancers are known to come back 10 to 12 years later. When that happens, it is recommended to use other types of therapies such as immune therapy and chemotherapy, among others, to stop the spread of the cancer.
Produced in association with Melanoma Research Alliance and Patient Empowerment Network
Transcript
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Andrew Schorr:
So, Dr. Patel, we talked about the different mutations. And we saw a list of some drugs that match up with some of those. But we still have gaps, right? So chemotherapy is sort of a blunderbuss approach because it hits healthy cells, as well as cancer cells. But it still has a place for some people, doesn’t it?
Dr. Patel:
It does. When we’re treating somebody with advanced melanoma, you’re trying to really sense out what is their velocity of disease. How fast is it going? Then you decide whether you’re using a weapon that’s the tortoise or the hare. For some people, they can actually get away with the tortoise. They can get away with immune therapy. And the immune system is slow to kill cancer. It has to recognize the cancer, as Dr. Wong said. It has to be specific. That’s education. And that education takes weeks. And so if you need something to go faster, you use maybe a targeted therapy.
Well, what do you do for the 55 or 60 percent of people who don’t have a mutation? Chemotherapy may give you that little leading edge to get the disease under control, de-bulk them, perhaps just run the first half of the race as a hare maybe and then finish as a tortoise with the immune therapy.
Andrew Schorr:
Okay. And just one more show of hands just so we understand. If you’ve had chemotherapy, just raise your hand. So fewer people now. And just while we talked about immunotherapy, people have had what we were describing as immunotherapy, if you’d raise your hand. So quite a few people now. So there’s the chemotherapy story. But it doesn’t mean that medicine has failed you.
Dr. Patel:
Correct. That does not mean that.
Dr. Wong:
In our attempts to treat melanoma, we have actually done everything from using these as solo agents, interferon and interleukin-2, and combining them with chemotherapy. So this idea of bio-chemotherapy is one in which we combine the biologic therapies like the interleukin-2 and interferon in and interweaved with chemotherapy, standard chemotherapy. There are recipes developed, and some of them from MD Anderson, which have shown that some people do phenomenally well with this. And I just also wanted to pick up on something you said, which is chemotherapy is not a failure default button that you push because nothing else is working.
It is a real choice that we make. You said earlier on, Dr. Patel, that immunotherapy can use the word small volume of disease. And that’s code word amongst us immunotherapists to understand that when you have a lot of disease sometimes, it takes a lot to get your body to attack it.
I remind folks that none of the immunotherapy drugs work directly on the cancer. They work through you. And so our ability to make that tumor most responsive sometimes is to knock it down, to some extent, where the body has a chance to attack it. So that’s also part and parcel to this bio chemotherapy approach. Sometimes, we will wrap these things together in specific recipes to try and do exactly that.
Andrew Schorr:
Dr. Gimbel, you look at the cancer cells. You’re cutting it out. You’re seeing the tumors. Do you feel that these cancer cells, they’re kind of wily? When we talk about surgery, radiation, chemotherapy, immunotherapy that it’s kind of like we have to come at it from a lot of directions? That these are potent cells?
Dr. Gimbel:
These cells are killer cells. We know that. And so we’ve shown that to be able to treat melanoma effectively, you have to do it in a multidisciplinary way.
I, as a surgeon, cannot cure people alone. While I can cut out early tumors, as we’ve heard, they can come back 10 or 12 years later. And they can still be problematic. So we need to do things together. Having that team approach is really what’s important to effectively be treating the patients, whether it’s going to be radiation, whether it’s going to start with a biologic therapy maybe to reduce the amount of disease burden to maybe we can now cut it out to moving on to chemotherapy. There are so many ways to treat it. And the cells can be so resistant that we’ve got to use every modality that’s available to us.
Dr. Wong:
I just want to use a specific example of someone I saw very recently who came with a fairly large tumor deposit in their lymph nodes. And it would have been extensive surgery, but this gentleman was BRAF positive. So in multidisciplinary care, we understood that the proper thing to do would be to do the surgery.
But by using these drugs, we can make surgery easier and have a lower volume, less morbidity. And we actually did that to the point where it shrunk so extensively that the surgeon sort of actually said what am I going to cut out now? And then we went on to the radiation part of it because we understood that you still have to sterilize that area. It’s an example of using everything possible to get there. So my analogy because I’m Canadian, and I still play hockey, is like being a hockey player. There are just no rules. You just go for it. You go for the goal.
Published By :
Patient Power
Date :
Jun 14, 2015
