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Please tell us about your career trajectory. Help us understand how you became a medical oncologist and what led you to pursue managing the side effects of chemotherapy?

When I entered medical school, I did not know what specialty I wanted to pursue, and I enjoyed anatomy and thus thought about becoming a surgeon. The first two years of medical school consisted of substantial bookwork and very little clinical practice experience. After the first two years of medical school, the first rotation I had was internal medicine, and I found it much more interesting than just reading books. Seeing patients with real diseases and reading about them made medicine come alive for me. I didn’t start a surgical rotation until my last year of medical school, and by that time, I had chosen internal medicine as my specialty.

What is chemotherapy-induced peripheral neuropathy (CIPN), and why is this important?

CIPN is primarily a sensory problem where a patient can’t feel things as well as they should and, thus, can’t do things, like buttoning, as well as they should. CIPN is associated with numbness and tingling, and pain. The problems usually start in the distal hands/feet and then can move more proximally. 

CIPN is caused by several chemotherapy drugs commonly used in practice, such as paclitaxel and oxaliplatin. It is a problem that generally develops while a patient is getting such chemotherapy drugs and can persist for a long time after the chemotherapy has been completed. 

With some chemotherapy drugs, the majority of people get CIPN to some degree. It can interfere with the ability to give chemotherapy because doctors know that it can be a severe side effect that may not resolve, and they don’t want patients to suffer from it for years.  

What made you want to pursue mechanisms to reduce the side effects of CIPIN? 

I got involved with research related to chemotherapy-induced neuropathy because it is such a substantial clinical problem. We do not have good means for preventing the problem (other than not giving the chemotherapy drugs which we want to give to kill cancer), because we do not have good ways of treating the problem after it has become established, and because it can be a persistent problem that lasts for years after chemotherapy has been stopped.  

What ways do we have to try to prevent chemotherapy neuropathy with the research that’s gone on? 

The American Society of Clinical Oncology (ASCO) has developed guidelines for preventing and treating chemotherapy neuropathy. These guidelines state that we do not have a good way of preventing chemotherapy neuropathy other than not giving the chemotherapy. Such an approach will avoid getting chemotherapy-induced neuropathy, but it also prevents the benefits of shrinking the cancer, something that we do want. 

The ASCO guidelines note that it is important to think about neuropathy when an oncologist considers chemotherapy. If the patient already has neuropathy (potentially from diabetes) before starting such chemotherapy and/or a strong family history of neuropathy, then the oncologist should strongly consider not giving chemotherapy that might worsen neuropathy. There are some chemotherapy drugs that do not cause neuropathy and, in this sort of situation, should be considered instead of the more standard chemotherapy drugs that can cause neuropathy, even if the alternative drugs might not work as well against the cancer process.  

Over the past decade, small studies have supported that this approach might decrease CIPN. At this point, the data looks promising, but this treatment approach has not been definitively shown to be able to safely diminish CIPN.

When was the last time something challenged your way of thinking?

Oh, I get my way of thinking challenged all the time– I’m married – I have a wife! It happened today, and it happened yesterday. I’m used to that. I grew up with seven sisters, so that’s kind of the norm. My way of thinking is challenged all the time.

So many people have said that you can’t do that, and you can’t do that; at times, I have just said, watch my smoke. However, challenge is good, and it keeps you on your feet and makes you rethink things.

What has been exciting and interesting about your career?

I have been involved with a group that has had a number of breakthroughs over time regarding studies involved with the prevention and/or treatment and/or better understanding of symptoms associated with cancer and/or cancer treatment.

My team has had the opportunity to look at a number of non-estrogenic treatments to manage hot flashes, a prominent clinical problem in patients with breast cancer and or prostate cancer. We’ve been able to do about 20 studies, looking at thousands of patients, most of them randomized, placebo-controlled trials. These trials have researched non-estrogenic ways of treating hot flashes, including trials that have established that multiple antidepressants, gabapentin/pregabalin medications, and oxybytynin can markedly decrease hot flashes.   

Another career highlight for me was being the founding editor of the Art of Oncology section of the Journal of Clinical Oncology. This journal section addressed how oncologists could better have appropriate communications with their patients and how to be honest and truthful in a way that is not overbearing for patients/families but can answer hard questions and work through difficult decisions. 

What do you hope to have accomplished at the end of your career? 

Some people say I’m pretty old and that I should be close to the end of my career, and I agree that I’m much, much closer to the end of my career than the beginning of my career or the middle of my career. I have worked to try to improve the quality and quantity of life of patients, working more on the quality part. I think that some of my work has accomplished my goal of improving patient care.

Thank you, Dr. Loprinzi, for your time, and for the work you are undertaking to improve the lives of oncology patients.

Please be sure to tune in to our Patient-Centered Care lecture on April 13, 2022, where Dr. Lorinzi will discuss Cryotherapy for Preventing Chemotherapy-induced Neuropathy: Proven, Promising-appearing, or Hogwash?