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torrancememorial.org PULSE | 31 it [chemo and radiation] than if they had undergone a standard surgical approach," says Dr. Fuller. "ere are only a handful of hospitals that can do that surgery aer chemo and radiation. It's a very sophisticated way of treating patients." Equally encouraging is how chemo and radiation did not give Wood the intense side effects that his father and many others likely endured in the past. "From February 1st, I had 25 radiation and five chemo treatments administered by a team of five to six doctors, and everything went well. Only toward the very end of radiation did I get a sore throat. I found out later that's very common. It's hard to swallow. But I had a brief period of this—so very lucky," says Wood. "I'll be 72 soon, and I've got a full head of grey hair and only lost a little weight I probably needed to lose!" SMARTER MEDICINE While physicians have been able to fine-tune chemo and radiation levels to make them a bit more tolerable, much research is being conducted in alternative and targeted treatments. Many in the industry see a future when chemo and radiation are replaced by molecularly targeted treatments or checkpoint inhibitors—therapies that kill only cancer cells without touching healthy tissue or white blood cells, keeping immune systems intact. Chemo and radiation kill all fast- growing cells; targeted therapies will not. In fact, Hugo Hool, MD, a board- certified medical oncologist and hematologist with 15 years of experience in research and patient care, says he entered the field of cancer care due to these "glimmers of light" he saw while in early training and fellowship, suggesting "these days would come." "It's a paradigm shi. We've gone from the Stone Age to the Bronze Age and we want to modernize oncology using our genome as the guide," says Dr. Hool. "Instead of hitting people over the head, we can treat them with less side effects and with more efficacy. We can turn off cancers [with new treatments] and use the body's own immune system to our benefit." According to Dr. Hool, oncolog y is at the forefront of technolog y with ever-increasing tools and new tailored treatments. "I am most excited about the treatments that stimulate our own immune systems to fight cancer for us. A new class of drugs called checkpoint inhibitors, like those known as PD-1/ PDL-1 inhibitors/blockers, are very promising. Several have been approved in the past several months. While the cancer is trying to grow, these checkpoint inhibitors can stop the cancer from getting past the body's own surveillance system. is is how the body's immune system is suppose to prevent cancers from developing." Dr. Hool is currently using two PD-1 inhibitors called nivolumab and pembrolizumab with patients. He added that at the American Society for Clinical Oncolog y (ASCO) conference in June a phase III study was presented showing how effective nivolumab was—even besting chemotherapy in lung cancer. Targeted therapies are also proving to be valuable tools. A patient of Dr. Hool's with both breast and lung cancer is currently receiving a targeted medication tailored specifically for the exact mutation found in her tumor, the Epidermal Growth Factor Receptor (EGFR). "She had surgery to remove both her lung and breast cancer and now is going forward with a radiation protocol combined with this targeted agent that is specifically tailored for her mutation called Erlotinib. is is a pill she will take on a daily basis," explains Dr. Hool. "is is a new paradigm in the treatment of cancer to tailor therapy based on molecular or genetic mutations found in those cancers. Erlotinib, for instance, is proving in clinical trials to be better than chemotherapy when tailored to the patient's tumor genetics. It has less nausea and common side effects than standard chemotherapy, offering a better quality of life during treatment." David Chan, MD, a cancer specialist and author of the book Breast Cancer: Real Questions, Real Answers, is a lead investigator on multiple clinical trials and has firsthand knowledge of how quickly cancer care is evolving. "We are very excited to be involved in a national effort to develop a molecular blood test for breast cancer. ese kinds of tests, 3 6 0 0 O F CA N C E R CA R E Left: Hugo Hool, MD, participates in Torrance Memorial Medical Center's weekly Tumor Board, a discussion of complex oncology cases. Right: Patricia Sacks, MD, reviews tumor images to facilitate the board's discussion.