DR. HASAN BIT
Medical Oncologist and Hematologist
Conemaugh Cancer Care Center
Q: Dr. Bit, tell us a little about your background.
A: I went to medical school in Spain. I finished from there. Then I went back to my country, Jordan, original country. I did my internship and residency. I was working as internist for a while. Then I came to my residency and fellowship in hematology/oncology. I did my residency in St. Louis, Missouri in internal medicine and then I did my fellowship in hematology/oncology at the Medical College of Wisconsin, Milwaukee. … Then I worked for a while in Parkland Health Center in Missouri until 2002, and then I went back to Jordan. I used to work at tertiary care cancer center. It’s probably one of the best in the Middle East. It’s called King Hussein Cancer Center. I used to be the head of the Medical Oncology Department as well as --- Medicine Department there. I worked until 2005 when I went to my private practice, until I jointed Memorial Medical Center this year.
Q: What success are we seeing when it comes to treating brain tumors and other types of cancer?
A: You know, I believe, I strongly believe in the multi-modality treatment for the cancer. That means all cancer specialties should, you know, interfere in the management of the cancer patient. In other words, like I like the joint discussion and consultation with my colleagues from other branches such as the radiation, oncology, and surgeons.
Usually the patient with brain tumors start by seeing either a neurologist or his primary care physician who, you know, order like MRI or CT scan of the brain on him, and once they find any spot in the brain then he will be transferred to the neurosurgery department for biopsy.
Once, you know, we get the biopsy and it’s proved to be cancer, then the next question is it dissectible --- to ask. Is it dissectible or not? If it’s dissectible then the surgeon will go ahead and do a resection of the tumor. We are making a lot of progress in terms of types of surgery nowadays compared with a few years ago. You know, technology is very advanced here and resection is doable in a higher percentage of patients now compared with even five or six years ago and then after that, we have like a tumor board that we discuss the cases together and even if that patient case was not discussed in the tumor board, usually they send a consult I mean, to our department here in medical oncology as well as the radiation oncology.
A few years ago we used just to do a resection and follow up by radiation or do just radiation if the tumor is very advanced but now we have, you know, like new agents, chemotherapeutic agents that they help a lot, I mean in eradicating, you know, and terminating the cancer from the brain and usually we give chemo concomitantly at the same time with radiation therapy. We have new agents that just came, I mean to the market and we have target therapy that we have been using. We have plenty of chemotherapies that they are effective in the treatment of brain tumors.
Q: Are treatments today having an impact on patient’s survival?
A: Yes. I mean the cure rate is higher now compared with before. Even if you cannot cure the patient, we can control the disease for a longer time. We can prolong the survival of patients with a brain tumor nowadays as well as patients with other types of cancer but specifically with the brain tumors now, they live longer and if we cannot, you know, prolong the survival then we can palliate their symptoms, make them pain-free, you know, we can do that. And we can prevent also recurrence because giving radiation and chemotherapy together that will decrease the chance for recurrence in the brain because as you know, brain tumors or any cancer, I mean there’s still a good chance, even after resection, to come back. So we give what is called adjuvant treatment after resection, especially if the tumor is high grade or the size was big enough or if there was any residual tumor after resection. So we can, you know, eradicate a residual tumor by chemo and radiotherapy.
Q: Has progress also been made in treating the side effects of cancer treatments?
A: Yes, we know that toxicity with chemotherapy is a lot but nowadays, I mean we have more control to the side effects of chemotherapy. The most common side effect as we know is nausea and vomiting and I mean we have good drugs for that. Usually we pre-medicate patients before giving them the treatment and most of cases, they barely have any symptoms related to that. Then we’ll come to the issue of bone marrow suppression secondary to the chemo and we have also new tools, you know, that we can give like Neulasta or growth factors that they can prevent bone marrow suppression, leucopenia and the potential infection complication from the treatment.
So nowadays the treatment is really very, you know, it’s simple and easier than before. The side effects are less than before. It used to be a torture to give a patient like Cisplatin like 20 years ago with a lot of nausea and vomiting. Nowadays, it’s not that --- it’s not existing anymore. I mean we’ll try to make the life of our patients easier, pain-free, nausea and vomiting-free as much as we can and I think we are successful in most of cases, if not in like 99 percent of the cases to control those side effects.
Q: What new treatments are available for treating brain tumors?
A: Some areas in the brain are very hard to reach by surgery. But now, I mean we have more techniques in radiation treatment for those tumors that are located down like in the brain stem or other areas and we can localize the tumor and give the proper dosage to the tumor area and try to save as much as we can, the neighbor areas of like healthy tissue around the tumor. So now with the new machines and new stuff that we have I think, I mean, we --- the chance to develop complication from damaging the healthy structure is less than before but still existing, you know.
And in terms of the chemo we give that --- I mean through the vein or central orbital vein. Usually we don’t give chemo inside the vein unless in very rare occasions such as in CNS lymphoma and even with that we can give high dose of chemotherapy and you know, in the peripheral via central vein and it can get really good concentration in the brain tumor.
Q: Is this an exciting time for medical oncology? It seems like there is a lot happening.
A: Yes. I’m enjoying my job. I love to cure patients. This is my target if I can. Then I few can’t then try to control the tumor, you know, try to prolong the survival of the patient if cure is undoable and in case of --- in cases of resistant tumor, then we have to go by palliation, just to palliate symptoms either by chemo or by radiation and we have, I mean for pain we have you know, a lot of drugs that really are very effective in controlling the pain of those patients.
Q: What do you see coming down the road? What excites you about future treatments?
A: You know, it’s I think the future is for targeted therapy. You know, even chemotherapy, I mean the trend now is doing for targeted therapy. Just to find the marker on the surface of the cell and try to give monoclonal, you know, antibodies or if there is like any enzyme like tyrosine kinase. We use tyrosine kinase inhibitors. It just kills the cells, the malignant cells without affecting the other cells.
I think the future is for two things, the targeted gene therapy and for oral therapy more than intravenous. This is very important. I mean, I mean the pharmacology of cancer now is switching to oral more than intravenous and that is, you know, easier for the patient to take oral pill instead of coming back and forth like every week or every two weeks. I mean, they would be absent from their work, they have to bring somebody, you know. I mean, it’s very costly and very time consuming also to give intravenous and have the patient come here. So, switching to oral, that might help patients a lot.
The future is also is for gene therapy. This is very important, important field, you know, to test and to work on that because I think --- this is my imagination in the future. Each cancer should be, you know, located on one of those genes, one of the chromosomes, should be mapped, you know, and if we can target that area by gene therapy, probably we may have better chance to cure those cancers.
In terms of prevention of a tumor, I think the best thing is early detection, you know, like screening. Unfortunately, we don’t have screening for most of the tumors but for just few and let’s put it in this way, tumors such as prostate cancer, colon cancer, breast cancer in females, we have early screening for that but from studies on several thousand patients, we don’t have screening, good screening procedures on other patients, like lung or gastric or other type of cancer.
Another issue is too, if we feel that the tumors start early, like young age, the tumor runs in the family, then we have --- we can detect some tumors that they are, they have like genetic background such as BRCA1 and BRCA2 and we have good tests for that and then we can screen the family and we can detect earlier tumor. We have other choices such as removing the ovaries for breast cancer or removing the breast if the patient agrees with that, just to prevent it.
Like if you have a patient, her sister has breast cancer, her aunt, her mom, then we can check on BRCA1 and BRCA2 and find out of the patient is a carrier for that. Then we’ll sit down and talk to her about the options and we have too many options to --- I mean to have her like tumor-free in terms of breast cancer for the whole --- for the rest of her life.
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