MDNews - Cleveland-Akron-Canton

Once cancer is detected in an elderly patient, the question becomes how aggressively should we treat it. Studies are showing that you need to look at the patient based on their physiologic and not chronologic age. So, for example, I treated a 92-year-old patient with aggressive chemotherapy plus radiation, and he tolerated all of his treatments. Except for his cancer, he was healthy — he looked like he was in his late 60s — and he was working 40 hours a week. So he was physiologically much, much younger than his chronologic age. Conversely, patients who are in their early 60s may be physiologically similar to an 80-year-old due to co- morbidities like diabetes, heart or lung problems. These patients may not be able to tolerate aggressive therapies like chemotherapy or radiation or surgery. So we don't just consider the patient's age when determining treatment. We try to provide individualized, tailored therapies for each patient, regardless of their age. Within the next 10 years, tailored therapies will be all the vogue — the 'revolutionized' cancer therapy. Right now, there are tailored therapies for breast cancer and colon cancer. For breast cancer, we can perform prognostic tests and predictive tests on cancer cells to determine the best therapy. We've had prognostic tests, which indicate a patient's chances of survival, for years. Predictive tests were developed more recently. These tests, performed on the patient's tumor cells, may predict whether or not a new drug will work in a particular patient, or whether or not it's worth even trying a new drug or therapy. For example, in colorectal cancer there's a mutation called K-Ras which we test for with all of our colorectal cancer patients whose cancer has spread. If they do not have the mutation, then there's a certain type of therapy we offer which has shown to improve the effectiveness of chemotherapy. If the cancer cells have the mutation, this therapy isn't worthwhile and would just lead to excess toxicity. There are similar predictive tests in breast cancer and studies are looking at these in many other cancers, too, like lymphoma. With these new tailored therapies, if a certain marker shows that a certain drug may work better in this tumor than another and have more specifi c effects and fewer side effects the patient ben- efi ts. So that's been the biggest change in medical oncology — a move away from nonspecifi c cytotoxic therapy and a move toward a more tailored rational approach for the treatments of cancer. Therapies for cancer have signifi - cantly changed. For example, 10 years ago, we basically had two drugs available for colorectal cancer with response rates ('response' correlates with 'survival') of about 15-20%. Now we have several drugs with response rates in the 60% range. With these higher response rates in metastatic colorectal cancer, we've been able to shrink down some of the tumors — for example, tumors that have spread to the liver — take the patient to surgery and resect the tumor, which in the past we were never able to do. It's incremental, but there's defi nitely been a change for the better in terms of therapeutic options. Cancer has become so complicated and so complex, we need subspecial- ists as well as specialists to plan each patient's care. We have tumor board meetings during which medical, surgical and radiation oncologists, along with radiologists, medical geneticists and other specialists meet to discuss each case and develop a plan of care. At MetroHealth we have eight tumor boards. The Commission on Cancer requires at least 10% of cases be presented to a tumor board. Last year, we presented 74% of our cases. I think that's very unique to our institution. It's a real team approach, which defi nitely improves the quality of care for our patients. Clinical trials also enhance care, because they offer patients access to the newest therapies. MetroHealth is a member of the Eastern Cooperative Oncology Group (ECOG), one of the largest clinical trials consortiums across the country. As a result, we're currently involved in 74 clinical trials, and they're open to all of our cancer patients regardless of age. We also have investigator-initiated trials here. Some are not open yet, but they will be soon. Fo r mo r e inf o rmat i on a b out MetroHealth Cancer Care Center, visit www.metrohealth.org/cancer. To refer a patient, call 216-778-5802. n To improve the quality of care for patients, Dr. O'Brien and MetroHealth's Cancer Care team present 74% of all cases to disease-specifi c tumor boards. The Commission on Cancer requires only 10% of cases be presented to a tumor board. NOVEMBER-DECEMBER 2011 MDNEWS.COM MD NEWS Cleveland-Akron-Canton | 35

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