In this episode of the Patient from Hell podcast, we speak with Dr. Milana Dolezal, an oncologist from Stanford University, and learn about cutting-edge advancements in cancer treatments, particularly antibody-drug conjugates (ADCs) and precision medicine. Dr. Dolezal shares her journey from childhood inspiration to a career in oncology, the evolution of cancer therapies, and how recent innovations are transforming metastatic cancer care. The conversation also delves into the intricacies of cancer biology, the impact of emerging treatments on quality of life, and the hope for a future where therapies are tailored not only to the disease but also to managing side effects effectively.
Key Highlights:
- Oncology Advancements: Dr. Dolezal explains the development of antibody-drug conjugates (ADCs) that deliver chemotherapy directly to cancer cells, reducing side effects compared to traditional treatments.
2.Cancer’s Complexity: Using vivid analogies, Dr. Dolezal illustrates how cancer evolves to resist treatments, comparing it to navigating New York’s subway system.
- Managing Side Effects: Dr. Dolezal emphasizes a "go low and go slow" approach in administering treatments to minimize side effects, tailoring doses to individual patients' needs to balance efficacy with maintaining quality of life.
About our guest:
Dr. Dolezal is a board-certified hematologist-oncologist with Stanford Medicine Cancer Center in Emeryville and a clinical associate professor in the Stanford School of Medicine, Division of Oncology. She strives to work with patients to develop care plans that are comprehensive and personalized to achieve the best possible outcomes and quality of life.
She also has extensive experience in research and drug development. She previously held positions as a clinical scientist, assistant medical director, and associate medical director in the BioOncology Therapeutics unit of the biotechnology company Genentech. She has conducted clinical research into fertility preservation in patients with breast cancer, advanced treatments for triple-negative breast cancer, and patients’ adherence to anti-cancer therapy. She has co-authored articles on her research findings that appeared in the Journal of Clinical Oncology, Cancer, and other peer-reviewed publications. She also co-authored the chapter “Progression from Hormone-Dependent to Hormone-Independent Breast Cancer” in the textbook Hormones, Genes and Cancer published by Oxford University Press.
Key Moments:
At 27:44 “I have an analogy around metastasis. I worked on an MD PhD in Philadelphia and I spent a lot of time in Manhattan, so I go to Manhattan almost every, every, every weekend. If you think about how to get around Manhattan. Let's say you want to go from Grand Central to the Met, the Metropolitan Museum of Art. There's a lot of ways you could go. You could walk up Fifth Avenue, go by the park. That's nice. Walk up Park Avenue. That's also nice. You could bike. You could take an Uber. These are all sort of above ground ways that you can go to the Met. Well, what does cancer do? It's really using Park Avenue and Fifth Avenue, so why don't we just shut those two down? We'll bring an antibody in. We'll bring a HER2 antibody in. We'll bring something in above the ground, what we call above the cell, extracellular. So you stop these things. Well, pretty soon I don't even care about underground and above ground, I'm just going to go underground, then you got the Lexington line. You can take whatever you want, right? And so that's how the cancer figures out by using things like PI3 kinase, AKT, mTOR, all these inside of the cell underground mutations. Now it's using the subway to move, to grow, little circulating tumor cells going around, so anyway, that's kind of how sneaky cancer can be. It's constantly figuring out detours, mutations, above ground, below ground.”
At 47:16 “The one thing I think that is an important take home is that when you start treating the cancer effectively, patients feel better and they have a better quality of life.The bottom line is when we start treating the cancer, you see pretty quickly within two or three cycles, so within four to six weeks, patients are spending less time in bed. They're less fatigued, so that's the seesaw balance of toxicity versus efficacy. If you have a drug that isn't working well in a patient, but that's just giving them toxicity, nobody wants to live an extra seven, eight months if the time is not quality and they're just going to be in bed the whole time suffering.”
At 48:43 “We start with dose reductions, because I would hate to overdo it and then miss a couple cycles because we're recovering from side effects. I'll start at a lower dose with the idea of possibly dose escalating, especially in older patients who are on a lot of other medications and are kind of frail, right? I'll start at a lower dose because I know I'm not going to cure the patient and we're going to be on this therapy as long as it works, both from a cancer fighting standpoint and from a toxicity standpoint.”
Disclaimer: All content and information provided in connection with Manta Cares is solely intended for informational and educational purposes only. This content and information is not intended to be a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
YouTube Chapters:
0:00-7:17 Dr. Dolezal’s start to oncology
07:18-22:28 Monoclonal antibodies, ADCs, and chemotherapy
22:29-30:57 The chess game of cancer therapy
30:58-35:36 How do clinicians stay up-to-date?
35:37-50:45 ADC side effects, quality of life, and palliative care
50:46-55:00 Hopes and aspirations for oncology in the next 5 years
55:01-55:55 Outro and disclaimer
YouTube Tags:
Manta Cares, cancer, cancer sucks, oncology, breast cancer, antibody drug conjugates, monoclonal antibodies, cancer treatment, metastatic cancer, precision medicine, patient care, global health, cancer research