Advances in Chemotherapy
Dr. Frederick M. Briccetti joined NH Oncology-Hematology 29 years ago and has been the Medical Director for the Payson Center for Cancer Care for two years. As Concord Hospital celebrates its 20th anniversary of the Payson Center for Cancer Care, Dr. Briccetti shares the advances in treatment and testing that have occurred over the past two decades.
How have oncology treatment options for people with cancer evolved over the past 20 years?
Twenty years ago, medical oncology treatment options consisted of chemotherapy and hormonal therapy along with a few immune therapies. There are many more options today. We still provide chemotherapy and hormonal therapy, but now there are more specific therapies, which target the molecular drivers of cancer and also ones that help stimulate the immune system to fight cancer.
Advances in testing have had a major impact on determining an appropriate treatment plan. For example, the Oncotype DX test can help us eliminate chemotherapy treatment for many patients with early-stage estrogen receptor-positive breast cancer. This test evaluates the genes that are present in an individual woman’s tumor to predict the risk of recurrence and the need for adding chemotherapy to hormonal treatment. Another breakthrough test, next-generation DNA sequencing, evaluates genes present in cells of many other cancer types, in order to identify potential therapies targeted to their particular tumor’s genetics.
What are some advances in treatment options that have emerged?
The two biggest advances in treatment have been biologic–targeted therapy and immunotherapy. Biologic therapy involves using medications – often pills – that are targeted at specific mutations that are driving the cancer. Immunotherapy stimulates the immune system to recognize and attack cancer. We use these agents to treat many cancer types either alone or in combination with chemotherapy.
What types of treatment are offered at the Payson Center for Cancer Care?
We can treat people with most types and stages of cancer. We have a wonderful assortment of expert surgical colleagues and many patients with cancer who first receive surgery for their problem and are then referred to us. As medical oncologists, we use hormonal therapies, chemotherapies, targeted therapies and immunotherapies.
Depending on the type of cancer, some people are better off receiving treatment at a large cancer center, which we are fortunate enough to have a choice in our area. We have good relationships with many of them with whom we share the care of our patients.
Are there types of cancer that can only be treated using chemotherapy?
Based on how extensive the cancer is, people with most types of cancer will receive some form of systemic therapy. Sometimes that involves only treatment with chemotherapy. For other treatments, we use different agents, including hormonal therapy, targeted therapy or immunotherapy or a combination of these.
We have learned over the years that there are some types of cancers in certain stages that respond better to treatment if given a combination of both radiation therapy and chemotherapy, plus or minus immune therapy. For example, standard treatment for individuals with some stages of head, neck, mouth, larynx, tonsils or tongue cancer will receive this combination. Individuals with stage three lung cancer often receive chemotherapy and radiation together, followed by immune therapy.
People may also be treated with a sequence of therapies, such as those with stage II or III breast cancer, who may be treated with surgery, followed by chemotherapy, then radiation.
Have the side effects from chemotherapy improved over the years?
There has been significant progress achieved with easing the immediate and delayed side effects of chemotherapy. Immediate nausea is treated using intravenous therapies given just before chemotherapy, while pills, taken at home, are used to manage delayed nausea.
Interestingly, a common medicine used to treat schizophrenia called Olanzapine was found, a few years ago, to have an incredible suppressive effect against nausea. It is now prescribed to patients routinely, in an effort to minimize nausea and vomiting.
What types of cancer services are not offered at the Payson Center?
The Payson Center for Cancer Care does not treat pediatric cancer. It is evident from multiple studies that this type of cancer is best managed at a larger cancer center, such as Dartmouth-Hitchcock Medical Center or Boston Children’s Hospital.
Studies show that younger, medically fit people with acute leukemia treatment are better off receiving treatment at a large cancer center. They require highly specialized and trained staff to treat this form of cancer. In addition, the frequent transfusion needs of these patients outstrip the capacity of community hospital blood banks. Patients who require certain kinds of specialized surgery or who have certain cancer types, such as sarcoma, are better off being treated at large cancer centers.
Other types of treatment that are not provided at the Center include, stem cell transplants, (from the patient themselves or from another person) and chimeric antigen receptor (CAR-T) treatment, which is another common form of immune therapy used to treat lymphomas and some leukemias. The Payson Center for Cancer Care has close relationships with the large cancer centers in our area to help facilitate these treatments for patients.
What will the focus be in the future on cancer treatment options?
Molecular medicine will continue to revolutionize advances in cancer treatment. NH Oncology-Hematology has an active clinical research program, which has helped in the effort to enhance treatment options for patients over the years.
Another focus for the future of cancer treatment is human genetics. Using a blood test or by taking cells in the inside of the cheek, we can examine a person’s genetics, looking for abnormal genes that may put them or their family at an increased risk for cancer. We have a very active genetics clinic on campus, through a corroborative agreement with Dana-Farber Cancer Institute.
