Immunotherapy: the new challenge for oncology | Chris O'Brien Lifehouse
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Medical website 6minutes spoke to Prof. Michael Boyer about immunotherapy. 6minutes is a website delivering breaking news in medicine, politics and clinical practice, as well as an insider’s look at the profession as a space for doctors to have their say.

Immunotherapy: the new challenge for oncology
27 June, 2016 Professor Michael Boyer AM

As a senior medical oncologist at Chris O’Brien Lifehouse in Sydney, Professor Boyer mainly treats patients with cancer of the lung or the head and neck. He also has a busy administrative role as their Chief Clinical Officer and then there is research, where he is involved with several clinical trials.

I’ve been thinking

In our field the big thing at present is the use of immunotherapy drugs. I’m thinking about the right way and time to use them. Obviously we have some data, but it’s still evolving. In that context, how do you most appropriately use them in a situation where there is enormous media and popular press hype, both about the appropriate indications – which are melanoma and to a slightly lesser extent, lung – and inappropriate ones.

You get patients wanting to have these drugs despite the lack of evidence that they’ll do anything. I want to make sure that the people who need them get them, and that people who are never going to benefit from them, don’t.

I’ve been reading

There are the papers that relate to the immunotherapy drugs. There are also papers relating to third generation tyrosine kinase inhibitors which are important for EGFR-mutated lung cancer. That’s a type of lung cancer that’s very easy to treat with a tablet but inevitably it becomes resistant, so this is the next generation of drugs that can potentially overcome that resistance.

I’ve been researching

Because of my administrative roles I’m doing less research, although I’m still involved in many clinical trials, mainly with the immunotherapy drugs and the third generation tyrosine kinase inhibitors. Within the next 6-12 months we will have some of those results.

The other “big picture” piece of research that I’m doing, with a group of collaborators within Sydney Catalyst, is looking at how we translate evidence into practice.

My top must-reads

There are two books I think anybody working in Oncology should read because they give context to what we do. One is “The Emperor of all Maladies”. It’s not a scientific book – it’s popular writing – but if you work in the cancer space, it’s really good to understand where the field of oncology has come from.

The second book is by Atul Gawande, a Boston surgeon, who has written three books that I’ve found interesting and thought-provoking. The most recent is called “Being Mortal”. It’s about modern health care, end of life, how much should we do and when to stop providing care. It’s not a cancer-specific book although many of the examples are about cancer. It makes us think about what we are doing in 21st Century medical practice.

Finally, for fun, there’s a book called The House of God written in 1978 by Samuel Shem. It’s a good grounding because it’s a very cynical view of medicine. It keeps your feet on the ground.

What I’m worried about

I don’t worry about day to day stuff. But I am worried about the increasing complexity of healthcare and what that means for patients, doctors and the next generation of doctors. There are a lot of things happening that make even simple tasks more complicated. Our ability to intervene is greater and that means there are more things to be considered.

The way we access drugs, in oncology at least, is getting more complex, sometimes because of regulation, sometimes because of the way that drugs are brought to market. You end up filling in a lot of pieces of paper to do the right things for your patients.

The amount of time that it takes to do a good job with patients is going up. It’s not a bad thing, but it does mean that people tend to spread themselves very thin. I’m concerned about how younger doctors are going to get the right balance in their lives.

What I’m pleased about?

I’m pleased about the same things I’m worried about. I’m pleased because almost all the things I just complained about are the consequence of there being more options available for treatment and more things we can do for patients.

How do you maintain balance in your life?

I’m hopeless at limiting my hours during the working week, so I disappear on holiday. I have a number of major interests outside of work. I love skiing, so I ski as much as I can both here and overseas. I spend lots of time looking at art. And I spend as much time as I can with my family. I do think a successful medical career requires a successful non-medical career!

My message for GPs

There is more and more we can do for patients, so preconceived ideas of what works, what doesn’t work, what’s worth treating, what’s not worth treating, are changing very rapidly. It’s important for GPs to communicate with us when they are not certain if we can do something for a patient. Good cancer care is a partnership between oncologists and GPs (and other people obviously). So GPs have a really important role to play, but they can only play it if they are up to date with what’s going on.

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