Q&A

On Cancer: Five Questions for Sarcoma and Melanoma Expert Mark Dickson

Mark Dickson is a medical oncologist who specializes in the treatment of sarcomas of the soft tissue and bone, Kaposi sarcoma, and melanoma. Learn more about why he believes clinical trials are important and his vision for the future of cancer treatment.

How did you get interested in oncology and end up specializing in sarcoma and melanoma?

When I was in medical school and deciding what specialty to pursue, it became quite clear to me that treating cancer was going to be the great public-health challenge of the 21st century. I wanted to be part of that effort. Although more people are being cured of cancer and more patients are living longer lives with cancer, the burden of these diseases on our society remains substantial. And as the population ages, that burden is expected to increase.

Once I decided to specialize in oncology, I became interested in new drug development for rare diseases. This led me to focus on cancers of the skin, soft tissue, and bone. Sarcomas are a diverse group of more than 50 cancers. Each is different in its appearance, symptoms, treatment approach, and outcome.

It’s a complex field full of nuance that has practical implications for patient care. Putting new knowledge to use to treat our patients has been incredibly rewarding.

What is the most important thing you tell patients when they come to see you?

Most patients arrive at the first meeting with a medical oncologist feeling a significant amount of fear and anxiety. They’re afraid of the diagnosis of cancer, what it means for their future, what the treatment might entail, and how it may affect their quality of life.

I try to reassure all of my patients that they are not alone and that we are in this together. We will work together to develop the best treatment plan for each individual patient and make sure that treatment is delivered with the utmost competence, care, and compassion.

What is special or different about being a medical oncologist at MSK?

Unlike a general academic hospital where the oncology division may be just one of many clinical efforts, at Memorial Sloan Kettering treating cancer is our central focus. As an oncologist here, I have the privilege of being part of a large team with a single-minded focus on controlling and conquering cancer. This institution is full of brilliant scientists and clinicians who make it such a stimulating work environment and who help to catalyze progress.

How is research contributing to better treatments?

Research is essential to finding better treatments. In fact, I think it’s the only way we make progress. This includes clinical research, basic science research, translational research, public health, prevention, and epidemiology.

The best treatments that we have today are the result of this research engine at work, and the newer and better treatment options that we expect to have in the future will result from the research we do today.

For many of our patients, the best treatments are provided in the context of a clinical trial. Whenever appropriate, we encourage patients with cancers that are difficult to treat to participate in research since it is in the best interest of each patient — and of all of us.

Where do you see your field going in the next five to ten years and how will that affect patient care?

Two major revolutions are happening in cancer now that I think will affect patient care in the next decade. The first is technological advances that allow us, for the first time, to do deep DNA sequencing of each individual’s tumor on a large scale and find out which mutations in which pathways drive that tumor’s growth.

This will allow us to develop new drugs that block these pathways and use them in combinations that previously had not been envisaged. This era of so-called precision medicine will take time and a huge amount of intellectual effort to realize its full potential.

The second is the now-mainstream use of immunotherapy to treat some solid tumors. The idea of harnessing the immune system to attack cancer has moved from the theoretical to the practical. We have seen major advances in melanoma, kidney cancer, lung cancer, and other tumor types, and we hope these successes will continue in other cancers such as sarcoma in the near future.

Comments

I'm a patient of Dr, Jose Guillem. In 2004 I was diagnosed with F.A. P. , Gardners Syndrome. After my surgery I was then diagnosed with a soft tissue Sarcoma on my small intestine which weaves its way around the vital organs. I had Chemotherapy twice in '07 and 2012. It won't take the sarcoma away as I was told from Dr. D'Angelo and other medical team members. It can help with the pain and maybe keep it at bay. Since, both my children share this rare disease and my daughter must now have her Ampula Vatar removed on 8/19/14. I was wondering if there is something other than Chemotherapy to help with the Sarcoma and advancing F.A.P. ? If so can you keep us notified?

Elizabeth, we recommend that you speak with Dr. Guillem, Dr. D'Angelo, and the rest of your Memorial Sloan Kettering medical team about this. Thank you for your comment.

Have you treated many cases of MPNST? (Involving all the nerves sheaths on one side of the sacrum, the sacrum & pasois muscle.) What is the most common treatment for this?

Dear Carol, the standard treatment for malignant peripheral nerve sheath tumors is surgery, and the surgery is difficult because the tumors often surround crucial nerves. Our very experienced team of soft tissue sarcoma experts work closely together to provide the best treatment plan for each individual patient. We are also conducting research that may help improve treatment options for people with this disease.

Here is a link to a clinical trial we currently have open that may be of interest: http://www.mskcc.org/cancer-care/trial/11-104

If you would like to learn more, please call the number offered in the trial description. Thank you for reaching out to us.

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