Q&A with Dr. Larry Frase, Medical Oncologist, Texas Oncology–Longview Cancer Center
Innovations like immunotherapy, CAR-T, proton therapy (an ultra-precise form of radiation), and new medicines are transforming cancer care. Dr. Larry Frase, medical oncologist at Texas Oncology-Longview Cancer Center, highlights the future of cancer treatment in the below Q&A.
Are you seeing seismic shifts to greater use of other types of treatments in lieu of or in combination with chemotherapy?
While chemotherapy is still the main modality for therapy, cancer treatment is becoming more targeted at specific gene mutations, also referred to as genomic medicine or personalized medicine, through specific targeted agents or immunotherapy. Through this, we look at the patients’ genes to determine what therapy is going to work best. Ten years ago, very little of this existed.
CAR-T therapy is an exciting development in immunologic therapies. There are only a few centers in the country that offer it, including Texas Oncology–Baylor Charles A. Sammons Cancer Center. CAR-T has had a major impact in lymphomas, leukemias, and is probably going to have an impact for other cancer types as time goes on.
Are there any other non-chemotherapy treatment advances lately?
Radiation oncology has advanced significantly. The technology is light years ahead of where it was 10 to 15 years ago, so we're able to treat the patients with less toxicity and achieve the same outcome. In the past, metastatic stage IV cancer patients could be treated but not cured. Now we can use stereotactic body radiation therapy (SBRT) to treat those patients. Combining that with immunotherapy is a very good approach to treating those scenarios. Proton therapy – a more precise form of radiation – is another treatment option for some patients. In sum, we’re using more multi-modality therapy in which chemotherapy is paired with other treatments like immunotherapy, SBRT, proton therapy, and/or radiation therapy.
Patients are excited to have treatment options that sometimes work better than chemotherapy with less toxicity. They're very receptive to newer technologies and newer drugs. They feel better knowing that we’re treating their tumor, not just treating a generic lung cancer or ovarian cancer."
Larry Frase, M.D., Medical Oncologist
Texas Oncology–Longview Cancer Center
How do these advances affect treatment planning?
In the past, we looked at a number of markers to determine whether a patient should receive chemotherapy. Now, we have a genomic test that provides guidance on whether people will benefit from chemotherapy for certain types of cancer.
Additionally, there are specific drugs that work with specific mutations for lung cancers, melanoma, and really most cancers now, but we utilize those to tell us the best treatment for each patient. For a melanoma patient, we’re not just treating melanoma. We treat that particular patient's melanoma – and we base their therapy on genomics that are going to help guide us to treat them better. This leads to much better outcomes. Generally, there's much less toxicity with a number of those treatments, and patients get a longer duration of benefit with some of these newer agents.
Why is it better for patients?
We're treating their cancer, not just a lung cancer or a melanoma. We're treating their melanoma, their lung cancer. A number of these therapies are more effective than chemotherapy, with less toxicity, and oftentimes they don’t require long visits to the clinic. The newer, more targeted therapies frequently have better outcomes than standard chemotherapy alone. But there are still cancers that don't have the genetic makeup for some of these targets, meaning chemotherapy is still the only option.
How are patients reacting to the opportunity to leverage different types of treatment?
Patients are excited to have treatment options that sometimes work better than chemotherapy with less toxicity. They're very receptive to newer technologies and newer drugs. They feel better knowing that we’re treating their tumor, not just treating a generic lung cancer or ovarian cancer. Obviously, they want the most advanced, best therapy available, and it's nice that we can provide this in a community setting at Texas Oncology. People don't have to be in an academic center to get this kind of care.
What does the future in cancer care hold?
We're going to see less chemotherapy and more targeted therapy, immunotherapy, and vaccine therapy. Chemotherapy is still going to be a major player in the way we treat a number of patients, because a lot of these targeted therapies may only benefit a small percentage of people.