Chapter 18: A Future in Personalized Treatment
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Description
Dr. Komaki begins this chapter by asserting the importance of MD Anderson’s focus on personalized treatments for cancer, then sets radiation therapy in this context: radiation treatments should be determined by much more than anatomical features of the person and tumor. Advanced need to be made to determine exact histology, specific mutations, and dimensions of the patient’s situation. She goes on to talk about her own work establishing criteria for treating tumors with prophylactic cranial irradiation.
Identifier
KomakiR_05_20190221_C18
Publication Date
2-21-2019
Publisher
The Making Cancer History® Voices Oral History Collection, The University of Texas MD Anderson Cancer Center
City
Houston, Texas
Interview Session
Topics Covered
The University of Texas MD Anderson Cancer Center - MDACC in the Future; Discovery and Success; The Researcher; Overview; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.
Disciplines
History of Science, Technology, and Medicine | Oncology | Oral History
Transcript
T.A. Rosolowski, PhD:
What’s the future of radiation oncology in this mix of personalized treatment?
R. Komaki, MD:
I think every patient we have –well, the most important thing is prevention and early detection, because once it gets too advanced there is not much we can do. Every patient we see with a diagnosis of cancer, we always have to find exact the histology and any mutation or breast cancer, like a hormone receptors. We have to treat cancer patients based on every piece of evidence we have, and we have to treat the patients based on the most advanced knowledge, so on we don’t treat every patient the same way. The way we are treating patients now is more based on histology, anatomical information: location of the tumor the size of the tumor, and the patients factors such asage, maybe performance status and so on, which are important. But also, we always have to think about --like lung cancer for example, small cell lung cancer needs to be treated by a different way from NSCLC. It’s not the same as non-small cell lung cancer. Non-small cell lung cancer, there are three major categories; squamous, which is usually caused by smoking, adenocarcinoma, unlikely related to the smoking, and undifferentiated large cell, which is kind of mixed adenocarcinoma and squamous carcinoma . Some of the surgeons, even small cell lung cancer, they try to operate. That’s right unless it is carcinoid tumor. Small cell lung cancer is usually so undifferentiated that the majority of the patients, 85 percent of the small cell lung cancer, they already have spread of cancer somewhere else. Very few patients --small cell lung cancer-- have limited stage, and in those really limited stage by doing MRI of the brain and a PET scan, CT scan, and we cannot find any spread of cancer. Those patients, we can cure by radiation treatment with chemo, and the surgeons, they don’t need to remove those tumors unless this is like an atypical small cell lung cancer. Or the more well differentiated type, which is very rare, but basically, when we see the patient, like lung cancer, we have to treat the patient based on histology and also genetic mutation and everything, rather than just stage. That’s what all the physicians who are involved by patient care, and the treatment, of course the diagnosis and the treatment, they always have to have knowledge, how the cancer spread and where they failed. I have established prophylactic cranial irradiation for limited stage, small cell lung cancer, because that’s the place they always fail. Even if they did not have any brain metastasis at the beginning, if we don’t give prophylactic cranial irradiation, within two years, if they are alive, 85 percent of them, they fail in the brain.
T.A. Rosolowski, PhD:
Interesting.
R. Komaki, MD:
It has been published from NCI, and the VA Hospital, Bethesda based on autopsies. Those patients who died two years after their treatment for the limited stage small cell lung cancer underwent autopsy. According to Dr. Rose and Dr.Mary Matthews at the VA Hospital, they published a paper showing that 85 percent of the patients had microscopic brain metastasis in two years. We know that, and so many years, I kept saying those patients with low dose of radiation, it does not cause any cognitive deficiency. We have done neurocognitive tastings before PCI and after PCI, and there was no real change of the cognitive deficiency, like forgetfulness or dementia. But a lot of medical oncologists, they were so afraid of the effects of the radiation treatment, which is a very low dose of the radiation. But they always tried to blame it on radiation instead of vincristine, which causes neurotoxicity, and even cisplatin, and of course Adriamycin. It does cause some cognitive deficiency and neurotoxicity. So we really have to figure out what’s causing what. But prevention is more important than treatment for the brain metastasis. Once they develop brain metastases, there is no cure unless it is only one of a few brain metastases, which is very rare from small cell lung cancer. [Unfortunately the majority of patients of brain metastasis have multiple brain metastasis --more than several lesions, which require whole brain radiotherapy with much higher dose compared to PCI. Higher dose of whole brain radiotherapy will cause neuro toxicity.]
Recommended Citation
Komaki, Ritsuko MD and Rosolowski, Tacey A. PhD, "Chapter 18: A Future in Personalized Treatment" (2019). Interview Chapters. 1299.
https://openworks.mdanderson.org/mchv_interviewchapters/1299
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