Tag Archive for: Dr. Anna Pavlick

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

/in , , , , , , /by

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan from Patient Empowerment Network on Vimeo.

Are there key questions that advanced non-melanoma skin cancer patients should ask about their treatment plan? Dr. Anna Pavlick provides expert advice, emphasizing the importance of discussing treatment milestones and exploring alternative options if needed.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

Advanced Non-Melanoma Skin Cancer Research Update

Advanced Non-Melanoma Skin Cancer Research Update

 How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

 Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Transcript:

Katherine:

What questions should patients be asking about their proposed treatment plan? 

Dr. Pavlick:

I think it’s important to obviously know everything that you can about the medicine that you’re going to be given. What are the side effects? How does it work? Is it pills? Is it IV? Are you injecting something into me? In addition to that, I think patients also need to ask, “Well, how are you going to know that it’s working? When do we do scans? When do I get reevaluated?” Because again, not everybody is going to respond to every therapy. If we did, listen, I would retire and open up a dog reserve. But what is the milestone? 

How many cycles or how long before we determine this is working or this isn’t working? And many times, because patients have visible lesions on their skin, it’s not really hard to know whether something is working or not because you’re going to watch it get better or you’re going to see it get worse.

And many times, when patients ask me that, my answer is we have to see as we go along. But if we see it getting better, we keep going until it’s gone or it just stops shrinking. And then we talk about maybe removing it. On the contrary, if we give patients medicine and after let’s say two treatments, this spot on their skin has increased in size and looks like it’s growing, well, maybe we want to stop and reconsider what we’re doing and change to something different.  

What Are the Advantages of Seeing a Specialist for Skin Cancer?

/in , , , , , , /by

What Are the Advantages of Seeing a Specialist for Skin Cancer? from Patient Empowerment Network on Vimeo.

What are the advantages of seeing a skin cancer specialist? Dr. Anna Pavlick highlights how specialists offer expertise in managing complex cases, like large lesions or tumors with associated lymph nodes, ensuring up-to-date treatment and collaborative care with local physicians.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

 Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Transcript:

Katherine:

What is the advantage of someone seeking care or to have an appointment with the skin cancer specialist?  

Dr. Pavlick:

Although for me, skin cancer is my life, skin cancers to the point where they require a medical oncologist are not all that common. Basal cell cancer and squamous cell cancer are very, very common in our population, but many times, they are managed by the dermatologist where you have an excision or you have a Mohs procedure. You don’t ever need to see an oncologist. However, if you have a very large lesion or you’ve got a lesion and you’ve got an associated lymph node or you’ve got a lesion that has what we call satellites or little tiny, I call them cousin tumors surrounding the primary lesion, you’re going to get referred to a medical oncologist.  

And many oncologists in the general community may or may not be very familiar with the up-to-date management because it’s not very common. The common cancers out there are breast cancer, lung cancer, colon cancer, prostate cancer. And general oncologists are very well-versed in how to manage those. I tell most patients you may not need to come to a big skin cancer referral center, but it may benefit you to come for an opinion and have a skin cancer oncologist work with your local doctor.  

And I do this all the time. Folks will come in and say, “You’re in New York City, but I live out in New Jersey. And coming into the city is just such a hardship. Is there any way I can do this outside?” And many times, my answer is if you’re not going to be participating in a clinical trial which is being run at my institution, I am more than happy to talk to your oncologist and work with them.

And it’s a collaboration. Many of us in academia are not looking to steal patients. We’re just looking to provide patients with the highest quality standard of care and are very, very happy to work with anybody that will provide that care to the patient to make sure that the patient can also get that care in a non-stressful setting.  

Treating Non-Melanoma Skin Cancer With Targeted Therapies

/in , , , , , , /by

Treating Non-Melanoma Skin Cancer With Targeted Therapies from Patient Empowerment Network on Vimeo.

Dr. Anna Pavlick discusses targeted therapy, specifically hedgehog inhibitors for basal cell cancers, explaining how these therapies block cancer growth pathways, their rapid effectiveness, and potential side effects.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

 What Are the Advantages of Seeing a Specialist for Skin Cancer?

What Are the Advantages of Seeing a Specialist for Skin Cancer?

Transcript:

Katherine:

How do targeted treatments to treat non-melanoma skin cancer?  

Dr. Pavlick:

Targeted therapies are approved for basal cell cancers in particular. They are certainly not for squamous cell or Merkel cell, but basal cell because basal cell cancers use a pathway called the patched and the smoothened pathway to multiply and metastasize or spread to other parts or just continue to grow.

And hedgehog inhibitors will inhibit that or block that particular pathway. These pathways are so highly overexpressed in basal cell cancers that we don’t even need to check when we do a biopsy. We don’t routinely check and send the biopsy to see if these tumors have those pathway alterations because 99.9 percent of them do. 

And so, we can easily give this targeted therapy to a patient with basal cell cancer. The nice thing about giving a targeted therapy is like shutting off a light switch. If the light is on and the cancer is using this pathway, if you shut the switch or block that pathway, things get better very, very quickly. Part of the downside to some of these hedgehog inhibitors are some of the side effects. Because basal cell cancers occur in older populations, these are patients that may in fact be sicker or more frail. And two of the side effects that can occur from hedgehog inhibitors is alteration in taste and the feeling that you’re just not hungry. 

So, anorexia and if you’ve got a thin frail patient and now you give them something that’s going to deter them from eating even more, they may be problematic. And not everybody gets those, but those are the most concerning. Patients do have a chance of having hair thinning or hair loss with hedgehog inhibitors. Another reason why many people just will say to me, “I don’t want them even though it will respond faster. I’d rather be treated with immunotherapy because then I’m not going to lose my hair.” And for a lot of women no matter what your age is, hair is an important part of who you are.  

Katherine:

Yeah.  

Dr. Pavlick:

And the last other significant side effect of hedgehog inhibitors is muscle cramps. And many times, this will happen in the middle of the night. People get really bad charley horses. 

I have patients who say they get cramps in their fingers or cramps in their hands. It’s not as easy to manage. We do know that sometimes by giving patients a medicine called amlodipine which is commonly used for blood pressure, this may help resolve or reduce the number of cramps they get, but it doesn’t work for everybody.

And so, you kind of have to balance out how quickly do you need this cancer to go away or respond? Because if you do use a hedgehog inhibitor, you’re going to get a very rapid response. If you use immunotherapy, just think about it. You’ve got to wake up your body’s immune system. You’ve got to get those T cells to get moving. And so, responses are not going to be in a matter of days. It’s going to more in a matter of weeks. With the hedgehogs, your responses are seen in a matter of days. 

Katherine:

Wow. So, sometimes, it could be a difficult decision to make?  

Dr. Pavlick:

Yeah, you have to weigh out pros and cons. Sometimes, you have patients who can’t swallow pills. Well, if you can’t swallow a pill, then a hedgehog inhibitor is not on your list of things that you can take. And to the contrary, some people are just really averse to having to come in and get an infusion because they may have needle phobia or they just don’t want an IV infusion. And then a hedgehog inhibitor is your first line of therapy.  

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

/in , , , , , , /by

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer? from Patient Empowerment Network on Vimeo.

How does immunotherapy treat advanced non-melanoma skin cancer? Dr. Anna Pavlick delves into the mechanisms of immunotherapy and common side effects.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

 Advanced Non-Melanoma Skin Cancer Research Update

Advanced Non-Melanoma Skin Cancer Research Update

 Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Transcript:

Katherine:

Dr. Pavlick, would you explain how immunotherapy uses a patient’s own immune system to treat cancer in the body? 

Dr. Pavlick:

Sure. Immunotherapy is very, very different than chemotherapy. As you know, with chemotherapy, chemotherapy is designed to attack rapidly dividing cells. And so, cells that are rapidly dividing are also some of your immune cells. 

And so, patients can get anemia. They can get problems where they’re at risk of infection because the bone marrow if moving very quickly. Immunotherapy on the other hand really doesn’t affect any cells that are rapidly dividing. I like to tell patients it wakes up their immune system. We all have what we call T cells that are living in our lymph nodes.

And immunotherapy really stimulates the body to produce more of those killer T cells and those memory cells and those cells that are out there to go and attack cancer and also creates memory. If, in fact, there is a cell that may be hiding or what we call dormant, if that cell were to decide it’s time to wake up and start growing, your immune system is going to remember the proteins that are on that particular cell and wake up your body’s immune system again to attack that cancer cell before it becomes a tumor. 

And so, that’s what we see with immunotherapy is when people have very dramatic responses and their immune system is able to eradicate their cancer, many times it’s a lifelong durable process. And so, because that immune system is constantly upregulated and on surveillance, we think that this translates into why people do so well for so long.  

Katherine:

So, which advanced non-melanoma patient type is immunotherapy right for? 

Dr. Pavlick:

Pretty much all of them.  

Anti-PD1 therapy, this is the most common type of immunotherapy that we use for non-melanoma skin cancers. And they’re approved for squamous cell cancer, basal cell cancer, Merkel cell, all very, very highly active and produce really impressively good results with long-term durable responses. So, sometimes when we talk about basal cell cancer, there are two types of therapies that we can talk about when it comes to basal cell.

We talk about immunotherapy, but we also talk about targeted therapies which are the hedgehog inhibitors. And there are pros and cons to both types of treatments, but when it comes to basal cell, we’ve got those two options. When it comes to Merkel cell and squamous cell, our first go-to option is really immunotherapy with anti-PD1 agent.  

Katherine:

But I wanted to know what the common side effects are for using immunotherapy to treat non-melanoma skin cancer. 

Dr. Pavlick:

Sure, when it comes to what we call adverse events or side effects from immunotherapy, when we give patients these single-agent anti-PD1 medicines, the chances of them having side effects are probably in about the 20 percent range. So, there’s a very large proportion of patients who are coming into the office getting these treatments and never have one side effect. But if you’re going to have any side effects, the most common side effects can be rash or itching.  

They don’t need to be together, so you can have a rash that doesn’t itch. You can itch and not have a rash. Those are really the skin toxicities. Sometimes with prolonged treatment, some patients may develop an underactive thyroid gland because the immune system will also attack some of the thyroid cells and slow down its function.

And so, those patients need to be given thyroid medicine. Fortunately or unfortunately, that’s one of the side effects that is a not-reversible side effect. And so, if we slow down your thyroid, you’re going to be committed to taking thyroid medicine for the rest of your life, which is essentially one tiny little pill every morning. But patients do need to know that. These drugs get metabolized by the liver and the kidneys. 

And so, before we give patients their infusion, we always check their liver and their kidneys to make sure that the immunotherapy hasn’t caused an inflammation of the liver or an inflammation of the kidneys making it not safe to give immunotherapy at that point in time. It doesn’t mean that we can’t go back and give it again. We just need to let those organs recover. Give them medicines to calm down the inflammation and then we can resume treatment.

Any time you give patients an immunotherapy, the side effects can be very vast because they cause inflammatory side effects. So, anything that you can put an -itis on the back of it, so dermatitis meaning inflammation of the skin, colitis meaning inflammation of the colon which can lead to diarrhea or bloating or a feeling of some baseline nausea if it affects the small bowel instead of the large bowel. 

Pneumonitis is an inflammation of the lungs. Any kind of -it is, one of the more rare things is what we call uveitis and it’s an inflammation of the back of the eye where it makes it difficult for patients to see, very easily diagnosed by an ophthalmologist and treated with either steroid eye drops or a short course of oral steroids that will get everything calmed down. And even if that happens, it doesn’t mean that you can’t go back and retreat those patients. So, any type of inflammatory symptom is a potential side effect.  

Advanced Non-Melanoma Skin Cancer Research Update

/in , , , , , , /by

Advanced Non-Melanoma Skin Cancer Research Update from Patient Empowerment Network on Vimeo.

Dr. Anna Pavlick highlights ongoing research into preoperative immunotherapy in non-melanoma skin cancer. Dr. Pavlick emphasizes the importance of clinical trials and provides guidance on how to inquire about participating in these studies.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

 What Are the Advantages of Seeing a Specialist for Skin Cancer?

What Are the Advantages of Seeing a Specialist for Skin Cancer?

Transcript:

 Katherine:

What research is showing promise? What are you excited about? 

Dr. Pavlick:

Oh, my goodness. Skin cancer research is really skyrocketing. 

We have been able to use immunotherapy. Again, we developed this in metastatic melanoma but have really looked at the large-tumor mutational burden that squamous cell and basal cell cancers have as well as Merkel cell and have been able to take immunotherapy from one setting and apply it to the next setting.

And we’ve seen some really spectacular results. Many times, we were just using immunotherapy to treat these malignancies, but the thought process has been well, what happens if we move it sooner and we give it to patients before we take them to the operating room?  

So, I think the thing that’s really been exciting has been looking at giving immunotherapy prior to surgery rather than giving it as prevention after surgery. 

And the reason we found that very meaningful is that we did a clinical trial giving patients somewhere between two and four cycles of preoperative treatment. And then we took them to the operating room which gave us the opportunity to look at that tumor and see what the immunotherapy did to the cancer. And a very high percentage, more than 50 percent of those patients were found to have no cancer whatsoever left in the specimen that was removed from their body.

And so, now we’ve got studies going on saying since patients have the potential to do so well with immunotherapy before surgery, A, do we even need to do surgery? B, if we do take them to the operating room, do we need to give them more preventive immunotherapy or can we just say you had such a great response, you’re done with treatment? 

 

And so, there is lots of exciting things that we’ll be identifying within the next few years that really, I think, is going to make a huge impact on patient’s lives. If we find out that immunotherapy can eradicate cancers, we may prevent people from having to go to the OR for resection. So, stay tuned for that, very exciting.   

Katherine:

How can patients learn more about research? What sorts of questions should they be asking their healthcare team?  

Dr. Pavlick:

I think research to me is always an opportunity because this is how we move science forward. 

So, I think whenever a patient is given a diagnosis of a cancer, whether it be an early-stage cancer or a later stage cancer, I think their physicians are obligated to really talk to them about clinical trial options for them.  

And sometimes, in early-stage cancers, there aren’t any. But sometimes there are prevention studies that may be taking place that once they get the diagnosis, they get treated for their cancer. They may be eligible to participate in prevention studies. So, I think that should always be a question that patients ask is, “Okay, other than the standard of care, are there any research studies that I may want to consider or need to know about?”  

How a Skin Cancer Expert Empowers Patients

/in , , , , , , , /by

How a Skin Cancer Expert Empowers Patients from Patient Empowerment Network on Vimeo.

 

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here.

What are steps does skin cancer expert Dr. Anna Pavlick take to empower her patients? Dr. Pavlick explains how self-education and being comfortable with your healthcare team are key components of patient empowerment.

 

Katherine:

Yeah. Dr. Pavlik, how do you empower patients? 

Dr. Pavlick:

You know, when I talk to patients I really do try to number one: educate them. I am big believer in bad artwork, because I’m a bad artist. And so I really try to draw out schematics to help patients understand how they therapy that I’m proposing is going to work, so they understand the mechanism. Patients will also go home with printed handouts so that they can go back and read about what we talked about, because many times patients absorb maybe one-quarter of what’s been said in a consult. 

I encourage people to bring their family members or friends so that they can hear; two sets of ears is always better than one. And I fully support them; if they want to go get a second opinion, my answer is, “Absolutely.” I do not get offended. I feel that if – because a lot of times the patient’s going to say, “I don’t want a second opinion, but my family does.” You’ve got to live with your family. Go get the second opinion. 99 percent of the time, experts who do this for a living all have the same answers. And so it just is going to solidify for your family that the right thing is being done, and then you can also decide where do you feel most comfortable?  

If Dr. A and Dr. B tell you the same thing, what environment do you feel most comfortable in, so in the event that you had questions, or you didn’t feel well, where do you want to go? So, I strongly encourage that. And if somebody comes back and says, “You know, I really think that this place fits me better,” my answer is, “That’s absolutely fine; thank you for letting me know. If there’s anything I can do, please reach out.” Because, again, bottom line is I just want the best outcome for the patient.  

What Do Advanced Non-Melanoma Skin Cancer Patients Need to Know About Treatment and Research?

/in , , , , , , , /by

What Do Advanced Non-Melanoma Skin Cancer Patients Need to Know About Treatment and Research? from Patient Empowerment Network on Vimeo.

What therapies are emerging for advanced non-melanoma skin cancer (ANMSC)? Dr. Anna Pavlick shares the latest in ANMSC research news, including developments in targeted therapy and immunotherapy. 

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here. 

Katherine:

Are there developments in advanced non-melanoma skin cancer treatment and research that patients should know about?  

Dr. Pavlick:

Well, I think when it comes to non-melanoma skin cancers, the developments over the last five years have been groundbreaking. 

I think the first major advancement we made was to identify that the hedgehog pathway is a pathway that basal cell cancers follow in order to spread to other parts of the body. And we found out that if we can block that pathway, we can control basal cell cancer very easily because more than 90 percent of basal cell cancers use that pathway to spread. So it’s like a roadblock. If you’re doing construction and you come to point where you’ve got the detour, well, you can’t keep going straight ahead – you get stopped. And that’s what targeted therapies do, and we found that there are hedgehog inhibitors that are these roadblocks for basal cell cancer.  

Dr. Pavlick:

So what has been evolved since then is looking at immunotherapy as a way to control non-melanoma skin cancers because, as you know, melanoma was the first place that immunotherapy really became paramount as the key treatment that makes the hugest impact on patients. And because of what we learned in melanoma, finding out that the number of mutations that melanomas have make it very susceptible to immunotherapy. We then went and looked at, “Well, what does squamous cell cancer have, what does basal cell cancer have?” 

Well, we found out that basal cell, squamous cell and Merkel cell cancer have a very high mutational burden, and translating that, we said, “Well, we now know this: these are cancers that should now response to immunotherapy as well.” And they do. And they do very, very beautifully. Unfortunately, like every story, it’s not 100 percent of the tumors that will respond. It’s basically in the 50 percent range. So although it’s still a very high number, you need to know that going into it when you treat a patient with locally advanced squamous cell cancer, only 50 percent are going to have a response. So, if you don’t see that tumor getting better pretty darn quickly, you better start thinking, “This might be somebody who’s not going to respond to immunotherapy, and what’s going to be my Plan B?”  

Katherine:

Right.  

Dr. Pavlick:

Because squamous cell cancers in general respond very, very quickly to immunotherapy. 

Usually within a matter of four to six weeks, you’re already starting to see improvement. When it comes to basal cell cancer on the other hand, basal cell cancers – because they develop very, very slowly over years – it takes months of immunotherapy to get them to respond. So I tell patients with locally advanced basal cell, “You really have to be patient, because we expect this to take somewhere between three and 6 months for us to start seeing something get better.” It doesn’t mean that it’s not working, it’s just basal cells just respond much slower. I think when patients are prepared and knowing that this is not a quick eight weeks – we’re going to know for sure whether this helps or not – it helps patients to be able to understand that, “I’m in this for at least six months –maybe longer.” 

Expert Advice for Newly Diagnosed Advanced Non-Melanoma Skin Cancer Patients

/in , , , , , , , /by

Expert Advice for Newly Diagnosed Advanced Non-Melanoma Skin Cancer Patients from Patient Empowerment Network on Vimeo.

Dr. Anna Pavlick provides three key pieces of advice for newly diagnosed advanced non-melanoma skin cancer patients to help them feel empowered in their care and treatment decisions.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here. 
 

Katherine:

What three key pieces of advice would you have for a patient who has just been diagnosed with advanced non-melanoma skin cancer?  

Dr. Pavlick:

I think the first one is number one: do your homework. Don’t just take anything for face value. You know, I tell my patients, “This is your life. If you go and do research about what appliance you’re going to put in your kitchen, I think you should also do a little bit of research about what doctor you’re going to allow care for you.” And so I always tell everybody, “Did you do your homework? Are you sure you’re in a place that is going to be able to provide you with the care that you need? Are the physicians that you’re seeing experienced in the disease that you have?” Because they may be brilliant physicians, but they may not have any expertise in that particular area. And so I think it really behooves people to – I tease my patients, I ask them if they go to “Google Medical School.”  

And really, find out a little bit about our backgrounds, find out about the institution that you’re going to, and learn a little bit about the disease. I’m certainly not saying come in and tell us what you want to have done, because I would hope that it takes many years of training and expertise to know how to make a good decision. But I think the more that patients know about the physicians that they’re seeing, and their level of expertise, and their interest, the better the outcome’s going to be. So that’s number one, number two is consider clinical trial. If you are a candidate for a clinical trial, consider it.   

Because we are taking promising agents and looking for ways to make patients have better outcomes. And so, many times when we talk about clinical trials, we know about the drugs, we know about their side effects, we know their efficacy, but we’re looking to find ways to make those drugs work even better. And sometimes it may be adding radiation to one of the standard drugs we have. It may be adding a different type of targeted therapy to the medicines that we have. Sometimes it’s actually taking a research medicine that looks really, really good and very promising, and adding that extra research drug to a standard drug to see if we can’t do better.  

So that I think is really – my second point of advice is really consider participating in a clinical trial if it’s applicable.  

Katherine:

Mm-hmm. 

Dr. Pavlick:

And so what’s my third one? My third one is to really make sure that you can communicate with your team, that you trust your team, and you feel comfortable with your team. You know, there are many of us who have the expertise, but we all have very different manners in which we communicate and talk to patients and speak with family members. If you’re not comfortable with the person that you’re seeing, there is absolutely nothing wrong with going to get a second opinion to find someone who has the same level of expertise who may just fit your personality better.  

You know, everybody’s different. You have to find the health care team that fits for you. And I think that’s so important, because you’re trusting us with your life. And if you don’t feel comfortable, then we shouldn’t be the ones taking care of you.  

Katherine:

Yeah. This is all about self-advocacy.  

Dr. Pavlick:

That’s right. 

Katherine:

The more you know, the better care you’re going to get, and the more comfortable I think you’ll feel with your treatment.  

Dr. Pavlick:

Correct. 

Katherine:

Yeah.  

Dr. Pavlick:

And again, I think treatment – yes, people come to us for our recommendations, but it really is a team effort. My feeling is the more that patients understand why we’re doing what we’re doing, and are part of that decision-making process, the smoother treatment goes.  

Katherine:

Sure.  

Dr. Pavlick:

I really think education is important – of the patient and the family.  

I think being able to ask your physician questions without feeling that you’re threatening – it’s something you should be able to do. And I think it just provides with better care.  

Katherine:

Dr. Pavlik, how do you empower patients? 

Dr. Pavlick:

You know, when I talk to patients I really do try to number one: educate them. I am big believer in bad artwork, because I’m a bad artist. And so I really try to draw out schematics to help patients understand how they therapy that I’m proposing is going to work, so they understand the mechanism. Patients will also go home with printed handouts so that they can go back and read about what we talked about, because many times patients absorb maybe one-quarter of what’s been said in a consult. 

I encourage people to bring their family members or friends so that they can hear; two sets of ears is always better than one. And I fully support them; if they want to go get a second opinion, my answer is, “Absolutely.” I do not get offended. I feel that if – because a lot of times the patient’s going to say, “I don’t want a second opinion, but my family does.” You’ve got to live with your family. Go get the second opinion. 99 percent of the time, experts who do this for a living all have the same answers. And so it just is going to solidify for your family that the right thing is being done, and then you can also decide where do you feel most comfortable?   

If Dr. A and Dr. B tell you the same thing, what environment do you feel most comfortable in, so in the event that you had questions, or you didn’t feel well, where do you want to go? So, I strongly encourage that. And if somebody comes back and says, “You know, I really think that this place fits me better,” my answer is, “That’s absolutely fine; thank you for letting me know. If there’s anything I can do, please reach out.” Because, again, bottom line is I just want the best outcome for the patient.  

Where Do Clinical Trials Fit Into a Non-Melanoma Skin Cancer Treatment Plan?

/in , , , , , , , /by

Where Do Clinical Trials Fit Into a Non-Melanoma Skin Cancer Treatment Plan? from Patient Empowerment Network on Vimeo.

At what point should advanced non-melanoma skin cancer patients consider participating in a clinical trial? Dr. Anna Pavlick discusses the benefits of trial participation and how the eligibility process works.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here. 

 

Katherine:

Where do clinical trials fit into the treatment plan? 

Dr. Pavlick:

You know, for me clinical trials are something that patients need to see as an opportunity. 

It should always be the first question that a patient should say, “Hey doc, what about a clinical trial?” Clinical trials provide patients with such great resources to either get a standard therapy with something extra, or to look at a novel way of using a known therapy. I think it’s something that every patient should ask their physicians about – and not everybody is eligible, or should go on a clinical trial – but it’s certainly worth asking, “Is there a clinical trial that I could participate in?”  

Katherine:

So, who might be eligible? What’s the criteria? 

Dr. Pavlick:

Well, each trial has different criteria. So, depending on the trials that are available at the institution where you’re being seen – for example, if you have, let’s say, basal cell cancer – the clinical trial may be looking at two immunotherapies as opposed to one immunotherapy. So when we do a clinical trial, there are what we call inclusion and exclusion criteria, and those are pre-determined criteria that you have to check those boxes to make sure those patients fit that particular study.  

So it’s not a random, “You can’t participate because you’re wearing a purple shirt today.” It is, “You have basal cell, but you have never had this drug that the study says you have to have been treated with this drug in order to go on to this study.” So you can’t jump from A to Z. You have to go from A to B to get to C. So, it really is just checking the boxes, making sure that patients fit whatever the deemed criteria are, and make sure they also don’t fall into the exclusion criteria. 

You know, trials will also say, “If you have an unstable medical condition –,” you know if I have a patient who’s telling me that they’re in and out of the E.R. with chest pain because the doc thinks that they have unstable angina and may need a stint – well, that’s not a patient that you want to put on a clinical trial at that point in time. Not to say that it can’t be re-explored at a different point, but people with active other medical issues just add to the complexity of being able to determine what are the side effects, and what are the not – what’s related to study drug, and what’s related to underlying problem?  

How Is Advanced Non-Melanoma Skin Cancer Treated?

/in , , , , , , , /by

How Is Advanced Non-Melanoma Skin Cancer Treated? from Patient Empowerment Network on Vimeo.

Developments in advanced non-melanoma skin cancer treatment and research continue to evolve. Dr. Anna Pavlick reviews important treatment considerations and discusses targeted therapy options.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here. 

 

Katherine:

How is advanced non-melanoma skin cancer treated? 

Dr. Pavlick:

Everybody’s locally advanced non-melanoma skin cancer really has to be looked at as a personal type of management. 

There is no cookie-cutter answer to say, “Well you just cut it out, or you just radiate it.” Again, it’s going to be contingent upon where is this located, how extensive is it, what is the patient’s preference, what is the patient’s performance status? You know, when you talk about offering radiation, although it’s a very good therapeutic option for many of these tumors, there are some patients who can’t travel hours to get to a radiation facility, and radiation is given every day for several weeks. So that’s an option – though it’s a treatment option, it may not be a feasible option. And so I think there are multiple factors. If you cut it out, is the patient going to be left with a disfiguring outcome? 

I know many times I get sent older patients because this is a disease many times of older patients, where they have these very large lesions and the thought of doing a surgery – not that you can’t – but can the patient withstand such an extensive procedure? What are they going to look like and what kind of functional deficits are you going to leave them with? You know, all of this really has to come into play, and then again, is the patient well enough tolerate a medical therapy that I have to offer? So this is why when you deal with these cancers, it really is a group effort. We all know the patient. We all get to see the patient. 

And then we all get together and say, “Okay, what are the pros and cons, and really what is the optimal way for us to best serve this patient to get rid of their cancer but also preserve their quality of life?”  

Katherine:

So other than surgery what other options are available to patients? 

Dr. Pavlick:

So surgery’s obviously the first and foremost because if you can take it out, it’s a one-and-done, patient can heal, patient can move on. 

But again, depending on location, depending on extent of the disease, sometimes we consider radiation therapy, sometimes we consider medical therapy, which would mean using different types of systemic therapies, whether it be pills – depending upon the type of cancer it is – or even intravenous immunotherapy to help either control this disease and shrink it up, then allowing the surgeon to go in and remove it. Or, best case scenario is that the immunotherapy will completely eradicate the tumor and spare the patient from having to undergo any type of procedure.  

Why Do Advanced Non-Melanoma Skin Cancer Patients Need a Multidisciplinary Care Team?

/in , , , , , , , /by

Why Do Advanced Non-Melanoma Skin Cancer Patients Need a Multidisciplinary Care Team? from Patient Empowerment Network on Vimeo.

Skin cancer expert Dr. Anna Pavlick explains what it means to have advanced non-melanoma skin cancer and discusses why patients should seek a multidisciplinary care team.

Dr. Anna Pavlick is a medical oncologist with over 20 years of experience treating patients with skin cancer and is the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. To learn more about Dr. Pavlick, visit here.

 

Katherine:

Let’s start with some basic information for patients. What is advanced non-melanoma skin cancer? 

Dr. Pavlick:

That’s actually a really good question, because many people think skin cancer is just skin cancer is just skin cancer. But when it comes to non-melanoma skin cancers, those are the types of cancers that are really much more common than melanoma. So we’re talking about your basal cell cancer, your squamous cell cancer, and even a more rare type of cancer called Merkel cell. Locally advanced non-melanoma skin cancers mean that these are lesions that are not easily removed by the dermatologist. So, it’s not a tiny little thing where you go in, you usually have a Mohs procedure for most of these types of cutaneous malignancies.  

And a Mohs procedure is where a dermatologic surgeon will go and take thin layers – layer by layer – and look at it with a pathologist in order to determine if they’ve successfully cleared out the cancer. It allows for us to be very meticulous in how we take things out, but it also allows us to have a nice, clean, smaller resection area, so healing is also much nicer than if you had to cut out a big chunk of tissue.  

But when you have locally advanced disease, sometimes that includes having such extensive disease that maybe cutting the lesion out is going to cause disfigurement, or they may be involved lymph nodes, and so we’re afraid that maybe this cancer can now go to other parts of the body. You know, it is just not a simple cut it out and you’re done kind of cancer. 

It’s a kind of cancer that really requires a multidisciplinary team to really think about what are the best ways to manage this for the patient that’s going to provide the patient with the best cosmetic outcome, and long-term outcome control as well.  

Katherine:

Who’s on that team?   

Dr. Pavlick:

So in our academic center that team, or even in a community setting, that team should include a dermatologist, a medical oncologist, a surgeon – depending on where that cancer is located – many times it’s on the head and neck, so it would be a head and neck surgeon. If it’s an extremity or a trunk lesion, then it may be an oncologic general surgeon. Radiation oncology is also important to include because sometimes these are very radiation-sensitive tumors, and radiation may be a part of the whole treatment plan.