Why did you decide to work in oncology?
During my second year of medical school, I remember learning how to read peripheral blood smears and distinguish between the different types of blood cells. With the beautiful variety of colors present in the smear, I thought it looked like a painting. So, it was fun for me, as I felt like I was taking an art history course as well as a science class. As part of the same course, we had to memorize all the different subtypes of lymphomas, and for some reason I enjoyed that, while the majority of my classmates hated it. It was then that I realized I had an interest in oncology and lymphomas in particular. Clinically, oncology provides an opportunity to develop long-term relationships with patients and their families; that for me is the most rewarding part of the job.
What is your area of clinical specialty and why? Tell us about the condition(s) you specialize in for clinical care.
My areas of clinical specialty include non-Hodgkin lymphoma, Hodgkin lymphoma, and chronic lymphocytic leukemia (CLL). These conditions are all under the umbrella of lymphoid malignancies. With over 60 different subtypes of lymphoid neoplasm, I feel that I am constantly learning and challenged on a daily basis. In general, the vast majority of lymphomas respond well to currently available treatments, with the possibility for long-term remission and even cure. Even if a particular lymphoma is not curable, it is gratifying for me to see my patients' quality of life significantly improve over a sustained period of time with our treatments.
What are the main challenges in this area? How do you address these challenges with patients/families?
While all subtypes of lymphomas keep me on my toes, the diversity of lymphomas can make the diagnosis and prognosis confusing for patients and their families. When I meet with a patient and their family for the first time, I do my best to help them understand exactly what kind of lymphoma they have and what that means in terms of their prognosis and treatment options.
Describe your research work/other areas of expertise. Why is this an area of interest for you?
My research focus is clinical, and I have experience with both observational and clinical trial based studies. My previous area of research focused on the mental health, suicide in particular, of Hodgkin lymphoma patients. Along with the German Hodgkin Study Group, we found an increased risk of suicide in Hodgkin lymphoma patients despite an overall excellent prognosis. Although it is unclear as to the cause of this increased risk, there may be an association with an increased rate of severe cancer-related fatigue in Hodgkin lymphoma patients that can persist for years after the end of treatment. I am also currently working with one of my colleagues at Dana-Farber on developing a clinical trial for initial treatment of mantle cell lymphoma that uses only targeted agents, with the goal of minimizing toxicity while maximizing efficacy.
What are you most excited about in your area of expertise? What holds promise for patients?
There has been a tremendous increase in the number of treatments over the last 5-10 years that are not cytotoxic chemotherapy and instead are targeted to a specific signaling pathway in an underlying lymphoma. This has resulted in additional treatment options for patients with lymphomas resistant to traditional multi-agent chemotherapy. One of the most exciting and promising of these new therapies is chimeric antigen receptor (CAR) T-cell therapy. A CAR T-cell therapy was recently approved by the FDA in October 2017 for patients with relapsed or refractory diffuse large B-cell lymphoma who have received at least two prior lines of therapy. In the clinical trials leading to its FDA approval, complete response rates were reported to be over 50 percent, with durable remissions seen in those responding to therapy.
What do you like to do when you're not caring for patients/doing research? What do you do for fun?
I enjoy playing tennis with my wife and my friends. It is a great workout and way for me to recharge. I have recently started playing the piano again. The piano has always been an artistic and emotional outlet for me. The hard part is making the time to practice regularly!