Medical Oncology

Medical oncologists of The Herbert Irving Comprehensive Cancer Center of NewYork-Presbyterian Hospital/Columbia Presbyterian Center specialize in treating a wide range of cancers through the use of medical treatments such as chemotherapy, stem cell transplant, hormonal and biologic therapies, and gene therapy.

Within the Medical Oncology division, two physicians, Drs. Mark Stoopler and Harry Raftopoulos, specialize in the treatment of patients with lung cancer. Dr. Robert Fine is also involved in the care of lung cancer patients, specializing in experimental therapeutics. These physicians are supported by a talented core of post-graduate fellows who both contribute to the care of patients with lung cancer and co-manage various research projects.

At Columbia Presbyterian Center, the role of the medical oncologist is pivotal in our multi-disciplinary approach to lung cancer. More than simply administering chemotherapy, the medical oncologist is part of a team comprising thoracic surgeons, radiation oncologists, pulmonary medicine specialists, radiologists, and pathologists. Often the medical oncologist is the physician who coordinates and "tailors" the ever-expanding diagnostic and therapeutic options available to each patient.

In caring for our lung cancer patients, members of the team conduct regular conferences to review the progress of patients with complex management issues. Coordinated by Dr. Raftopoulos, these meetings enable all team members to examine the most recent clinical/bronchoscopy findings, X-rays, pathology reports, and to assess the progress of combined treatment modalities prescribed for each patient.

Participation from other attending physicians, including the doctor(s) who may have referred the patient to our care, is encouraged and CME credit is available. Fellows and medical students attend as part of their rotation in the lung service. These meetings have served to improve patient management by facilitating multi-modality approaches, i.e. where various treatments are combined to ensure the best chance for the patient's recovery.

Chemotherapy in lung cancer is considered for all patients. In small cell lung cancer (SCLC), chemotherapy is the standard of care, used alone for patients with extensive disease, or combined with chest radiation in patients with limited-stage disease. Although initial responses are extremely good, many patients relapse and worldwide research efforts, including those at Columbia Presbyterian Center, are focused on strategies to prevent relapse.

In non-small cell lung cancer (NSCLC), the use of chemotherapy in advanced disease has become routine with the advent of more effective drugs such as Gemzar‚ Navelbine‚ Taxol‚ and Taxotere. The challenge is to find the best combination and sequence of these drugs, and this emerging science is actively under study.

Patients with NSCLC that has spread to lymph nodes in the chest, but who are still recommended for surgery, will benefit from chemotherapy given prior to their surgery. The role of chemotherapy, using the many new drugs now available, following complete surgery in less advanced disease is currently under analysis. Your Columbia Presbyterian medical oncologist will advise you on all the latest findings that can affect your treatment.

In addition to specific therapy for lung cancer, the lung cancer team is concerned with the patient's quality of life and provide supportive measures such as pain management, anemia treatment, and use of bisphosphonates, as well as other maneuvers to relieve local symptoms. Referral to the extensive complementary medicine services at Columbia Presbyterian Center is also available.

As part of our mandate as a National Cancer Institute-accredited comprehensive cancer center, we currently offer several clinical research trials available to patients with lung cancer. These open studies include:

	The role of chemotherapy after surgery for early lung cancer. This is a randomized study conducted in conjunction with a co-operative group, the Southwestern Oncology Group (SWOG).
	Phase I study of a matrix metalloproteinase inhibitor (MMPI) in combination with Taxol and carboplatin in treating NSCLC.
	Phase III study of a different MMPI following treatment in patients with SCLC.

In addition several new studies are pending approval:

	Several Phase I studies of new agents in advanced NSCLC
	Chemotherapy prior to surgery in patients with node-positive NSCLC.
	The role of gene-transduced CD34+ cells following regular dose chemotherapy in NSCLC.
	Molecular-epidemiologic study to examine the increasing incidence of lung cancer in women. This study is under the direction of Regina Santella, Ph.D., of the Columbia University School of Public Health.