COMMENTARY

Mark Kris: 'Don't Be Afraid to Use the Word "Cure" When It's Possible'

Mark G. Kris, MD

Disclosures

August 06, 2018

This is Mark Kris, MD, from Memorial Sloan Kettering, commenting on what I believe are the major themes and concepts that came out of the 2018 meeting of the American Society of Clinical Oncology. For me, they both were put forth in the opening session.

First, in the Presidential Lecture, Bruce Johnson talked about the concept of reimagining the treatment of various cancers—in his case, lung cancer, near and dear to my heart. I think it is overdue that we need to reimagine how we treat all cancers, not only lung cancer. There were some very good examples of that in the presentations that followed.

It's very interesting that, in many different diseases, they reach the same conclusion. In the session on nephrectomy in renal cell cancer, a key message was that even where resection appears to be the right thing, you need to think in a multimodality way. You need to pull together all the different possibilities that could lead to a good outcome for your patients.

The Karnofsky Lecture featured Ralph R. Weichselbaum, MD, one of the pioneers of [an approach] that was totally counterintuitive to me when I first began my training in oncology: that treating a metastasis in the setting of widespread metastases would have benefit for a patient with metastatic disease beyond the administration of systemic therapy. In the Karnofsky Lecture, he showed example after example of how treating metastases, even in the setting of widespread metastatic disease, leads to benefit.

I went to one of the prostate sessions and I was amazed to see that the same conclusions were true there as well. For people with high-risk, localized prostate cancer, they're thinking about using multimodality treatments right from the get-go, just on the basis of risk, and even in the absence of metastatic spread. That same theme [was heard] throughout: Use everything we have at our disposal to fight those cancers to get an improved outcome [for patients]. We now have a huge amount of discussion about the use of immunotherapeutics, further increasing the opportunities to bring in modalities.

The other very important concept came up in remarks during the opening session by Ned Sharpless, MD, the director of the National Cancer Institute. At the end of his talk, he challenged us and reminded us that what our patients truly ask when they come to us for care is for a cure. They want that, they deserve that; and, of course, we as oncologists want more than anything to give them that chance for cure.

I think a lot of us are afraid to say that and we are afraid to even propose it as a goal. We think it's too bold. We have to be very careful because where there's no precedent for cure, we cannot put that forth as a likely outcome for a patient. But where there is precedent and where there are tools to lead to cure, we need to clearly make that the goal of care.

I learned in the various sessions I went to—Dr Weichselbaum's talk, the talk by Mary-Ellen Taplin, MD, in the prostate session—that the goal is cure, even in high-risk or metastatic disease, but it has to be realistic. To achieve cure, you have to bring all modalities together.

Reimagine the treatment of whatever cancer you're treating. Lung cancer is a good example of how we've made great strides by reimagining [treatment]. Think about cure—is it a realistic goal? The strategies and possibilities for [cure] change [over time].

Those of you who have treated patients with immunotherapeutics have seen that you've changed the natural history of that disease. Strategies that were inappropriate in the era of only cytotoxic chemotherapy are suddenly appropriate now. Local therapy makes sense in the setting of widespread metastatic disease for selected patients.

Think about cure, think when it can be delivered, and make it a goal of care. That's the goal your patient wants. You should share that goal with them whenever it is realistic. Of course, when it is not, you need to be very clear about what your goals are and about what you can deliver. But don't be afraid to use the word "cure" when it's possible, and to use every tool that you have to reimagine the treatment of the cancers we face.

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