HJAR Mar/Apr 2024

HEALTHCARE JOURNAL OF ARKANSAS I  MAR / APR 2024 53 David Kuperman, MD Medical Oncologist CARTI might be related to their treatment in or- der to address those issues promptly and appropriately. Closer to a (complex) cure We still can’t fully predict how benefi- cial immunotherapy will be for individ- ual patients, particularly those who have mutations that interfere with DNA repair, or whose tumors have a higher mutation burden. Different cancers have different amounts of sequencing information avail- able, limiting our understanding. And some cancers are less sensitive to immunothera- pies than others. So how do we achieve more positive outcomes going forward? It won’t be with one tool. It will be with every tool. All of the different cancers will require all of the dif- ferent combinations of treatment — chemo- therapy, radiation, surgery, targeted therapy, immunotherapy, andmore — finding just the right plan for each cancer and each patient. Even so, immunotherapy is a huge step in the right direction. n David Kuperman,MD, is amedical oncologist serving patients at CARTI.He earned amedical degree from the University ofArkansas for Medical Sciences and completed residency in internal medicine at the Johns Hopkins Hospital in Baltimore as well as a fellowship in hematology/oncology at Barnes-Jewish Hospital and Siteman Cancer Center ofWashington University School of Medicine in St. Louis. He is board-certified in internal medicine, hematology, and medical oncology. life. Anyone who has seen a patient ravaged by cancer treatment, even successful treat- ment, can appreciate the value of powerful, precise medicine with a gentler touch. That being said, these drugs are not be- nign. Immunotherapies activate the immune system to attack cancer, but sometimes they attack the patient, and that can lead to all kinds of unusual side effects: problems with the lungs, heart, and adrenal glands; rashes and itching; diarrhea; changes in liver func- tion. About 10% of immunotherapy patients will have thyroid problems. Years ago, I had a patient receiving immunotherapy for mel- anoma who was having trouble walking and talking. I initially thought the cancer had spread to his brain, or that he’d had a stroke. Actually, the immunotherapy had interfered with his thyroid function. Most of the time, we can control those side effects. However, some very serious things can happen; fortunately, that’s the exception rather than the rule. So, patients receiving immunotherapy must be closely monitored. In addition, it’s important for providers — all providers, not just oncologists — to re- member that immunotherapy can lead to symptoms we don’t typically associate with cancer treatment. While we might expect a cancer patient to experience pain, fatigue, anemia, and vomiting, immunotherapies can lead to other symptoms entirely. It’s im- portant to listen carefully to what patients are saying and consider how symptoms join the fight. By targeting specific recep- tors to program cell death, we ideally stop the cancer in its tracks. Rendering it unable to grow. Unable to spread. Immunotherapy treatment is usually given every fewweeks, and the effects will often last several months. Of course, using the immune system to help the body attack cancer is not new. We’ve been doing it for years. But the explo- sion of sequencing data, and the ability to process that data, has led to much greater insight, newmedications, and more success. Enough so, in fact, that for some patients, immunotherapy can actually be a cure. In 2022, for example, an immunotherapy drug generated a 100% remission rate as a standalone treatment for a specific form of rectal cancer in a study led by Memorial Sloan Kettering Cancer Center. Yes, the study was small — only 12 patients. And those pa- tients were carefully selected based on the most favorable expected outcomes, all with rectal tumors classified as mismatch repair deficient. But 100% remission as a stand- alone treatment? Talk about promising! Pros and cons Obviously, efficacy is the gold standard of benefit in cancer treatment, and immuno- therapy, for some cancers, in some patients, has proven wildly successful. But it also pro- tects healthy cells and has fewer side effects when compared to traditional cancer treat- ments, providing an easier treatment experi- ence for patients while improving quality of