Teaming Up Against Sarcoma Recorded on: April 4, 2013 Darin Davidson, MD, MHSc, FRCSC Assistant Professor, Department of Orthopaedics and Sports Medicine University of Washington School of Medicine Robin Jones, MD, MRCP Associate Professor, Division of Medical Oncology University of Washington School of Medicine Please remember the opinions expressed on Patient Power are not necessarily the views of Seattle Cancer Care Alliance, 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. Hello and welcome to Patient Power sponsored by the Seattle Cancer Care Alliance. I'm Andrew Schorr. Sarcoma is a very rare type of cancer. Actually, we know that there are many subtypes now, and so in this age of precision medicine it is so important that you get the sarcoma treatment that is right for you. To help us understand the latest we have two experts from the Seattle Cancer Care Alliance. We have with us, surgeon Dr. Darin Davidson, a sarcoma specialist, and medical oncologist Dr. Robin Jones. Doctors, thank you for being with us on Patient Power. Dr. Davidson, let's start with you. Please define sarcoma for us.
Sure. Well, sarcomas are a very rare form of cancer. In fact, the rarest form that affect our connective tissues, which includes a variety of different tissues, such as bone and soft tissues like muscle, fat, blood vessels, nerves. Dr. Jones, I know, now, it is not just one rare cancer but many subtypes. Tell us about that. There are many different types of sarcoma, and in fact there are probably 60 to 70 different histological subtypes that we know of, and each of these different subtypes have their own clinical behavior, their own biology, and also, their own response to systemic treatment. Wow. I know how important it is to understand exactly what you're dealing with. At the University of Washington and Seattle Cancer Care Alliance, what tools do you have now, so you know exactly what a patient's specific situation is? Yes. There's a new diagnostic tool called UW-OncoPlex, which is basically a panel of mutations where we can test the patient's individual tumor and assess whether there are precision drugs that we can use to treat the individual patient. So, Dr. Davidson, the results come back, maybe from the UW-OncoPlex, from imaging studies, perhaps, you put it all together. Surgery, which you do, may be part of it, but I understand there's a whole team involved. Sarcomas are such rare forms of cancer that it's really essential that patients are treated from the beginning by people who are specialized in treating these rare forms of cancer, and that includes a multidisciplinary team that at the forefront are the people that patients more frequently interact with are medical oncologists, radiation oncologists and surgical oncologists, but it also includes radiologists and pathologists and nurses, all specialized in providing care for these people to give them the best possible chance of having the best possible outcome from their rare form of cancer. What might not be known to a lot of people, is that because these cancers are so rare most oncologists don't treat very many people with a sarcoma over the course of a year or the course in 2
fact of their career, and it's really important that people get their treatment by people such as those at our center who are specialized in this and do this day in and day out. How do you come up with a treatment plan recommendation for a specific patient? As Dr. Davidson mentioned, we have a full multidisciplinary team at the University of Washington and Seattle Cancer Care Alliance, and we review the pathology and radiology for each individual patient prior to seeing the patient, and in these multidisciplinary meetings we formulate a plan for each patient based on their imaging and pathology findings. Essentially it's a team approach with individualized treatment for a patient. Dr. Jones, I know you've heard this saying in cancer care, that your first shot is your best shot. Given that, what would you recommend to patients with this rare cancer to make sure that they get the right treatment for them? Yes, you're right. We do see people who have been treated elsewhere, and I would really urge patients and their families to come to a specialist, multidisciplinary center such as the University of Washington and the Seattle Cancer Care Alliance for treatment of their sarcoma. There are studies that have shown that treatment at a specialist center is associated with a much better outcome, so the earlier patients are seen by us, the better. Dr. Davidson, I know one of the approaches to help people have the highest quality of life with sarcoma is limb-sparing surgery. That's something you do, right? That's absolutely right. I think one of the myths that may exist for a lot of patients is that if they have a sarcoma in their arm or their leg, that the only surgery that's going to be possible is an amputation, and in the current day and going forward into the future, that's just not the case. The majority of our surgeries are limb-sparing or limb-salvage surgeries to remove the cancer safely while maintaining as much function as possible in the affected extremity, and that really goes to the importance of having sarcoma-specific physicians providing care for patients, because that's 3
going to allow for the best chance at limb-salvage surgery as well as the best function following their surgery. Looking toward the future, what hope can you give people who are facing sarcoma? Well, I think what we're experiencing, world-wide, is that the outcomes for people treated for sarcomas has never been better than it is now, and with the promising areas of research and molecular diagnoses and molecular treatments that the future will, most likely, be even better outcomes than it is currently today. We're definitely moving forward in the right direction, and it's essential for patients to be treated in sarcoma-specific centers so that they get the most cutting edge treatments, both as far as radiation therapy, chemotherapy and surgery, so that they have the best chance, not only of being cured from their cancer, but also having the best functional outcome after their treatments are completed. Dr. Jones, when you consider the research that's going on today, are you confident that patients can be given specific treatment that's right for them? Yes, I am optimistic, and one of the major ways forward is for patients to enter clinical trials. And more and more in sarcoma there are subtype-specific clinical trials, and it's important that patients take part in such trials so that we can actually improve further the outcomes for patients with these rare diseases. Are you optimistic? Yes, very hopeful. I want to thank both of you, Dr. Darin Davidson and Dr. Robin Jones, for being with us on Patient Power. Thank you both for your devotion to patients with sarcoma. 4
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 Seattle Cancer Care Alliance, 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. 5