The Mayo Clinic approach for serious and complex medical conditions focuses on teamwork and communication, shared Dr. Brian Costello, a medical oncologist consultant at Mayo Clinic in Rochester, Minnesota. “One of the central pieces of what we do at Mayo Clinic, which is simple but very powerful, is speaking to each other. Different teams and specialists talk to each other, share ideas and put our heads together to solve complex conditions so that we can bring the best care to the patients we are seeing and do the best evaluation that we can.”
In an interview, Dr Costello, who specialises in genital urinary cancers, discusses the latest updates in the field of oncology. Excerpts:
What is the Mayo Clinic model of care?
The Mayo Clinic model of care speaks to an integrated medical practice, where the centre of everything we do is the patient and their needs. This requires an integrated team approach and communication with both patients and colleagues so that we bring the best care to patients and their family members when we’re doing evaluations, treatment and care at Mayo Clinic.
What type of expertise does Mayo Clinic, and do you personally, have in rare cancers?
We have broad-ranging expertise in rare cancers and complex medical conditions. In more uncommon malignancies, it does take a team approach, including behind-the-scenes physicians like radiologists and pathologists. But we also collaborate with all of our clinical teams, including radiation oncology, medical oncology and surgical specialities. For example, we have expertise in uncommon cancers such as sarcomas and GYN malignancies, among others.
Even the more common tumour types, there are rare cancers. For example, in my practice in genital urinary cancer, I specialise in testicular cancers, which is an uncommon disease in general but the most common solid tumour in young men. So, for example, it’s important to get it right in terms of the diagnosis and treatment for young men with testicular cancer because they will have a long, fruitful life after appropriate therapy.
What new developments are on the horizon in cancer care?
There are a lot of exciting developments in cancer care. A few things to highlight would be the advent of immunotherapy, which has come on the scene in solid tumour oncology in the last several years. So, we will see a more expanded use of immunotherapy and combining immunotherapeutic agents with novel therapeutics and new drugs in the future.
Another area that I think we’re going to see more of is integrated practice for cancers, meaning if we look at breast cancer or stage three colon cancer, those diseases have always been multidisciplinary types of malignancies requiring different specialists. We haven’t always had that paradigm in other malignancies, but we’re seeing that more and more a variety of specialities are getting involved in different tumour types earlier in the disease for high-risk disease and even when a disease spreads or becomes metastatic. That’s evolving into a multidisciplinary type of situation, and I think we’ll see more of that in the future.
The other thing that’s been talked about a lot is CAR-T therapy. CAR-T therapy is chimeric antigen receptor T cell therapy which uses the patient’s T cells, so they’re drawn off by apheresis. Then they’re sent to a laboratory and altered in a way that helps to target their particular malignancy. Those T cells are then reinfused back to the patient so that there’s a more specific targeted type of treatment. This is a very exciting area. We’ve seen approvals for CAR-T therapy, mainly in hematologic malignancies, including ALL and multiple myeloma and some lymphomas.
We do not yet have CAR-T therapy available as standard practice in solid tumours, but there are clinical trials going on. So, CAR-T therapy is a very exciting wave of the future and one that will play more and more of a role in cancer care in the future.
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