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An Expert's Perspective on Advancing Treatment Progress for Blood Cancers

Topics include: Treatment
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Dr. Steven Rosen, from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University in Chicago, expresses his excitement about advancements in blood cancer treatments presented at the 2012 American Society of Hematology annual meeting. Dr. Rosen explains one of the key factors for determining the best treatment course is understanding the genetics of each individual's cancer. As survivorship increases, the paradigm of care is shifting to focus on long term disease management and maintaining quality of life.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of Northwestern Memorial Hospital, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hello and welcome to Patient Power.  I’m Andrew Schorr.  This program is sponsored by Northwestern Memorial Hospital. 

We’re on location in Atlanta, where there is the annual meeting of thousands of hematologists and oncologists from around the world.  Among them is the director of the Lurie Cancer Center, Dr. Stephen Rosen.  Dr. Rosen, what are you excited about at this meeting and for the benefit of patients? 

Dr. Rosen:

The therapy of the blood cancers, the entire spectrum of hematologic malignancies, has just exploded.  We have so many new targets in the entire spectrum of different diseases.  These targets allow us to induce remissions in patients who historically the patient would be refractory to treatment.  It allows us to both prolong life, and in some instances we anticipate cures of diseases. 

Andrew Schorr:

Dr. Rosen, I guess a key factor now is understanding the genetics of an individual patient’s cancer. 

Dr. Rosen:

That’s been the major advance, and that’s been what I would consider the greatest transformation, that we’re not treating everybody the same, even within a diagnostic group.  We’re looking at what are the unique biologic features of that individual’s tumor, and then we’re putting together a protocol or approach that will address the unique aspects of that person’s cancer, and hopefully by putting together this cocktail of targeted agents you can induce very significant response and remission with very good quality of life. 

Andrew Schorr:

Now, I know one of the things that’s been happening is the development of, I think, what you call small molecules, pills that people can take to control their cancer. 

Dr. Rosen:

The small molecules you alluded to are part of it.  There are also antibodies, which are very effective in treating cancers.  These are proteins that actually target the cancer and bind to unique molecules that are on the surface of the cancer. 

For the small molecules, the ones that can be taken orally, first there’s obviously ease of administration.  You don’t have to have an intravenous started.  You don’t necessarily have to come to the clinic to take your medication.  The medication itself has been tested just as intravenous medicines, so we know their efficacy and we know their side effect profile.  The fact that it’s oral doesn’t mean it’s less toxic.  That’s one thing to be aware of, that’s something that we continually assess. 

Oral medications also require the individual to be diligent about taking the medication and not forgetting.  We do find that there’s sometimes compliance issues.  And there are some unfortunate economic considerations related to oral medications where in some instances coverage may not be as complete as if you’re taking something intravenous. 

Andrew Schorr:

Of course when someone can take a pill, powerful medicines, as you say, the patient has to remember to take them and understand the benefits even though they may feel great. 

Dr. Rosen:

Correct.  And human nature is what it is.  Individuals who are feeling well, who have been on the medication for a prolonged period, it’s natural to at times forget. 

On the opposite extreme, some patients will have side effects of medications, oral medications, and neglect to tell their physician, and rather than having an alternative strategy, just decide they’ll abandon that particular treatment, and so that can have also serious consequences. 

Andrew Schorr:

Dr. Rosen, is it your feeling that now more and more CML, CLL, maybe myeloma, some of these blood-related cancers, we’re truly making it chronic so people can live a longer and a full life? 

Dr. Rosen:

That, as you say, is probably the most important shift in paradigm, is the realization that we may not be able to cure disease immediately, but yet can control it for prolong periods.  And by controlling it for prolonged periods there are an assortment of different issues that come up that have to be addressed, all the very practical issues of how you live with an illness for 10, 20 years in some instances on constant therapy but with good quality of life, how do you balance the treatment of your disease with all the other important things that you want to accomplish and all the unique relationships that you have. 

This is evolving into an important field in oncology which we refer to as survivorship.  And survivorship keeps growing and growing, and for many diseases we currently define survivorship is from the moment you’re diagnosed to the rest of your days. 

Andrew Schorr:

As you say, we’re in this new age of cancer survivorship, so it would seem that if patients can have a relationship with their doctor for many years then they have a partnership there, and that’s really important to have that open communication. 

Dr. Rosen:

It is.  You become very close to your patients.  You become part of each other’s families.  The patient has to feel comfortable they can call on you at any time if they have an issue.  The issue doesn’t necessarily have to be directly relevant to the cancer itself but relevant to their health that you can help with, and it’s what makes oncology the most rewarding field in medicine. 

Andrew Schorr:

The bottom line, are you encouraged about where we’re headed, where we are now? 

Dr. Rosen:

It’s stunning to see how rapidly the fields are evolving, that you can provide hope for just about every individual you see even at the different stages of the disease.  And I just regret that I’m not 20 years younger to take advantage of everything that’s going on and to see how it will evolve in the next few decades. 

Andrew Schorr:

It would seem that there is some responsibility for patients now to get educated and to seek out a specialist such as yourself so the best care is brought to bear for them. 

Dr. Rosen:

That’s without question the most important thing.  With the evolution of care, particular in the blood cancers, and with some of the difficulty in making the original diagnosis and then knowing even after you’ve made the diagnosis what are the therapeutic options, you need to be in the hands of experts who treat those diseases, who have an understanding of how to sequence the treatments, how to control the side effects and how to maximize the potential for cure or control of the disease and minimize side effects. 

Andrew Schorr:

Dr. Stephen Rosen, thank you for your devotion to patients.  Great advice. 

On location in Atlanta as we understand the latest in the treatment of blood-related cancers and how it can benefit you, I’m Andrew Schorr.  Remember, knowledge can be the best medicine of all. 

Please remember the opinions expressed on Patient Power are not necessarily the views of Northwestern Memorial Hospital, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on December 12, 2013