Multidisciplinary care, access to clinical trials, and genetic and molecular testing all are hallmarks of sarcoma treatment at the University of Colorado Cancer Center, which averages nearly 300 new sarcoma patients each year.
“I tell patients that sarcomas are like snowflakes,” says CU Cancer Center member Breelyn Wilky, MD, associate professor of medical oncology at the CU School of Medicine. “No two patients are the same. You’re dealing with an age range that’s very broad, from young patients who are treated at Children’s Hospital Colorado to 100-year-old patients I’ve had in clinic at UCHealth University of Colorado Hospital. Sarcomas can be anywhere on the body, head to toe. That’s why it's so important for patients to get a complete evaluation and have a customized treatment plan for their exact situation.”
Sarcoma is the general term for a broad group of cancers that can form in various locations in the body, including the bones and the soft tissue (also called connective tissue) that connects, supports, and surrounds other body structures. This includes muscle, fat, blood vessels, nerves, tendons, and the lining of the joints. Most sarcomas occur in the arms, legs, or trunk of the body but can occur anywhere from head to toe. There are more than 150 different types of bone and soft tissue sarcomas.
Multidisciplinary care
At the CU Cancer Center’s sarcoma multidisciplinary clinic (MDC), patients receive an “all in one” approach to clinical care. In one daylong visit, they are evaluated by specialists including medical oncologists, surgical oncologists, orthopedic oncologists, radiation oncologists, interventional radiologists, pathologists, radiologists, nurse practitioners, physician assistants, nurses, social workers, nutritionists, and others, who collaborate on care. The team also works with plastic surgeons, urologists, cardiologists, and thoracic surgeons to provide each patient with the optimal course of treatment and follow-up care.
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Visit curesarcoma.org to learn more about Sarcoma Awareness Month in July and how you can support sarcoma patients and research.
The CU Cancer Center takes part in the Race to Cure Sarcoma, coming up in Denver on October 26 at Berkley Lake Park. |
“Our sarcoma tumor board always has a thoracic surgeon involved, which is a really great asset to our program since the most common site of metastasis for sarcoma is the lungs,” says CU Cancer Center member Steven Thorpe, MD, FACS, chief of the musculoskeletal oncology program. “We develop multidisciplinary treatment plans for patients that take into account the specific type of sarcoma and patient-specific needs and goals, and it’s great that we have all those different disciplines represented at the sarcoma multidisciplinary clinic.”
Located on the CU Anschutz Medical Campus, the CU Cancer Center is just 15 miles from Denver International Airport (DIA), means the tumor board often is reviewing the cases of patients who fly in to be treated by CU Cancer Center sarcoma specialists.
“By being so close to DIA, people across the region and nation can reach us easily,” Thorpe says. “They get their scans in the morning, we review those at the tumor board, and then based on that review, they'll get placed with certain providers in the sarcoma MDC. Say there’s a patient with a large thigh soft tissue sarcoma, they would see a sarcoma surgeon like me, a sarcoma specialized medical oncologist like Dr. Wilky, and a sarcoma radiation oncologist like Dr. Ryan Lanning as we work together to plan the best treatment course. They get to meet all of us in one setting, which is helpful if you’re coming from afar.
Remote support
The sarcoma team also works through telehealth and with local providers to assist patients in remote or rural areas of Colorado and in other states, Wilky says.
“For our patients who live in the corners of Colorado, for example, where there might not be an airport and it’s a six-hour drive to get here, we do a lot of virtual care,” Wilky says. “That might mean their local team reaches out to us and says, ‘Hey, I have a patient with sarcoma; can you give me some input about what I need to do to get this patient ready to come see you?’ or, ‘Is there a way we can do this closer to home for this patient who may not have the resources to drive six hours for chemotherapy every three weeks?’ We see it as our mission to make sure everybody has access to a sarcoma opinion.”
Research and trials
In addition to treating current patients, many sarcoma specialists at the CU Cancer Center conduct research and lead clinical trials to develop new and more effective treatments that will help the patients of today as well as those of tomorrow. Wilky recently led a trial at CU for sarcoma patients with metastatic disease, looking at the effectiveness of adding the immune system-boosting drugs called checkpoint inhibitors to the standard chemotherapy administered for the disease.
“Checkpoint inhibitors are transforming outcomes across many different types of cancer, and there is evidence from other studies that chemo plus immunotherapy can be effective,” Wilky says. “People think about chemotherapy suppressing the immune system, but there’s this sweet spot where, when the chemo is first given, it creates a very potent stimulus to the immune system, almost like a virus. We’re playing off that mechanism with this trial, and we’ve seen benefit in patients where we wouldn’t have expected to see benefit.”
Sarcoma researchers within the CU Cancer Center are looking at other types of immunotherapies as well, including CAR T-cell therapy and tumor-infiltrating lymphocytes.
“I think the big advance over the next five to 10 years is going to be those types of treatments for patients,” Wilky says. “We are active in a global tumor banking program called ORIEN, where patients who are having surgery for other reasons can opt to have their tumor sent to be sequenced. That genetic data is deposited in a very large database across multiple institutions so we can ultimately learn more about cancer drivers and how to treat those cancers.”
Help throughout the journey
When sarcoma patients come to the CU Cancer Center for care, they receive assistance throughout their entire journey — not just diagnosis and treatment, but psychosocial care through support groups, clinical trials aimed at improving quality of life for cancer patients and survivors, and the nurses and navigators within the sarcoma program.
“One of the things that’s so incredible about our program is the support that patients have every step of the way,” Wilky says. “That starts with Erica Becker, the physician assistant who coordinates and runs our multidisciplinary clinic. She’s the first contact for patients, and that includes getting the story about where they’re coming from, making sure we have all the records, all the tissues, all the scans we need to review that patient’s case. She’s the introduction to the entire system, and she makes sure that the loose ends that turn up during their first day are tied up for patients.”
For Thorpe, a new arrival to the CU Cancer Center sarcoma team, the institution’s research focus and dedication to multidisciplinary care all add up to an environment that can make an enormous difference for patients with sarcoma, a cancer that accounts for only about 1% of all adult cancers and about 15% of cancers in children.
“What’s so unique about sarcoma care is that, because it is a rare disease, we have to partner across different disciplines. It's a team event,” Thorpe says. “The goal is working together in system to take care of them. The clinical trials and the research that’s going on here was a huge attraction for me to come to the CU Cancer Center. As a surgeon, I strive to do the best surgery I can, but that’s not everything. We need to work together and bring in our different disciplines to treat these patients. Being at a center that offers trials and novel immunotherapeutic approaches to treating these patients is huge."
