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Robert Maki, MD, PhD
RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified) )| Communities: Sarcoma | Answers: 8 |
| Member Since: Jun. 2012 |
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Professional Statement
Dr. Robert Maki is Chief of Pediatric Hematology/Oncology and Medical Director, Sarcoma Cancer Program, at The Tisch Cancer Institute at Mount Sinai Medical Center. He is also Professor of Medicine, Pediatrics, and Orthopaedics, and the Steven Ravitch Chair in Pediatric Hematology-Onocology. He has published more than 100 articles on sarcoma treatment and basic science research, having worked on studies related to sarcoma since 1985. He treats adults and children with sarcomas (connective tissue cancers of bone, cartilage, muscle, fat and other soft tissue) and has an interest in translational research and the biology that leads to different types of sarcomas.
After his MD/PhD at Cornell Medical College in New York City, he was a resident at Brigham and Women's Hospital in Boston before a medical oncology fellowship at Dana-Farber, and was on staff at Dana-Farber before starting at Memorial Sloan-Kettering in 1999. In March, 2011 he moved to the Mount Sinai Medical Center to develop the effort in adult sarcoma therapy and research.
After his MD/PhD at Cornell Medical College in New York City, he was a resident at Brigham and Women's Hospital in Boston before a medical oncology fellowship at Dana-Farber, and was on staff at Dana-Farber before starting at Memorial Sloan-Kettering in 1999. In March, 2011 he moved to the Mount Sinai Medical Center to develop the effort in adult sarcoma therapy and research.
Professional Info
Credential: MD
Primary specialty: Oncology - Hematology/Oncology
Secondary specialty: Pediatrics - Hematology/Oncology
Medical school: Cornell University Medical College
Residency: Brigham and Women's Hospital
Fellowship: Dana Farber Cancer Institute
Areas of expertise:
Bone Cancer
Chemotherapy
Chondrosarcoma
Chordoma
Ewing's Sarcoma—Child
Osteosarcoma—Child
Rhabdomyosarcoma—Child
Soft Tissue Sarcoma
Hospital affiliation: Mount Sinai Medical Center
Practice address:
Ruttenberg Treatment Center 1190 5th Avenue, Main Level
New York, NY
10029
Practice phone number: 212-241-6756
RobertMakiMDPhD Activities
This is a very good question, one I am asked surprisingly frequently. It turns out that anything called “sarcomatoid carcinoma” as seen in breast, lung, and elsewhere is still a carcinoma. It is generally treated with carcinoma (e.g. breast cancer) drugs. As we learn more about each of these unique subtypes of cancer, we are finding out each may also have a molecular signature that predicts for one or more unique drugs that may be of use. This is another rapidly evolving area and a good reason to both do your own research, as well as ask for a second opinion (but not necessarily 4, 5, and 6 opinions!) to do your due diligence and make sure the right thing is being done. Since there are changes we hear about essentially weekly, it is prudent to remain a good student.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Triple Negative Breast Cancer, Metaplastic Triple Negative Breast Cancer, Sarcomatoid Features, Metaplastic Breast Cancer, Treatment Options, Carcinoma, Carcinoma Treatment, Triple Negative, Triple Negative Breast Cancer Treatment Options, Carcinoma Treatment Options, Triple Negative Breast Cancer Treatments, Metastatic Triple Negative Breast Cancer, Breast Cancer, Breast Cancer Treatment Options, Sarcomatoid Carcinoma, Metastatic Breast Cancer, Triple Negative Treatments
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10 months ago
The lungs are the most common spot for most sarcomas to travel (metastasize) and cause a person’s death from sarcoma. Other common sites are liver and bone. For unclear reasons the kidneys are generally spared, as are lymph nodes. Treatment options for sarcoma, like other cancer, include surgery, radiation, chemotherapy, and now immunotherapy (vaccines, engineered white blood cells too). Surgery is one way of achieving cure, but is ultimately successful in too few people. If there are more than a handful of nodules to cut out, you can be a few more are lurking not far behind and just have not made themselves evident yet. When surgery is not possible we tend to use chemotherapy since (1) radiation can only be used on small areas of the lung, otherwise too much lung is damaged and (2) there are no approved immunological agents in sarcoma, except for the agent mifamurtide (MTP-PE), which was shown to improve survival for people with an initial diagnosis of osteosarcoma, not after it has recurred. As with other cancers that have spread, cures are very uncommon (but do occur) with chemotherapy alone, or in people receiving chemotherapy and surgery for remaining tumor. Since the anatomy of each tumor varies in its pattern of spread, and since there are so many sarcoma subtypes, each person has to be addressed unique to this complex set of variables, a reason to be seen in centers that see a lot of people with these rare diagnoses.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Metastatic Cancer Treatment Options, Metastatic Sarcoma, Treatment Options, Lung Metastasis Treatment Options, Metastatic Sarcoma Treatment Options, Sarcoma Treatment Options, Metastatic Cancer Treatment, Metastatic Cancer, Sarcoma, Lung Metastasis
1
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10 months ago
It is highly dependent on the type of sarcoma involved. Maybe this is where tumor genetics can help us choose treatments.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Chemotherapy Medications, Sarcoma Chemotherapy Treatment Options, Treatment Options, Treatments, Chemotherapy Treatment Options, Sarcoma Treatment Options, Chemotherapy Treatment, Sarcoma, Chemotherapy
1
Answer |
10 months ago
One of the most common sarcomas, GIST, responds well to “kinase-targeted therapy”, a new type of drug that does not damage DNA but blocks protein function to try to make the cell commit suicide. These drugs have shown particular use recently in forms of leukemia and dramatically, but briefly, in melanoma. Other very rare sarcoma subtypes can respond to such kinase-directed agents, but the most common ones in adults do not respond so well to these drugs. That said, the drug pazopanib was just approved in the US and Europe for use in sarcomas except liposarcoma and GIST, since in these relatively unselected tumors there appeared to be at least a radiological benefit (tumor stabilization) with the use of pazopanib vs placebo. However, we do not know how pazopanib works in a given tumor, so it is a bit of an untargeted approach with a targeted agent. The term targeted therapy is misleading, as many of the drugs developed in the are indeed targeted as well, for example paclitaxel or vinorelbine targeting the microtubule or methotrexate poisoning a particular step in DNA synthesis. The targeting is also relative. We talk about “cleaner” or “dirtier” drugs based on how many targets a drug hits. More targets means more chances to do something effective, but greater chances for side effects too.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Targeted Therapies, Sarcoma Treatment Process, Sarcoma Targeted Therapies, Targeted Treatments, Targeted Therapies New Developments, Sarcoma Targeted Treatments, New Developments Sarcoma Treatment, Sarcoma Treatments, Treatments, Sarcoma
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10 months ago
The recent series in the New York Times gives a good snapshot of where we are in mid-2012 with clinical, patient specific-genetics, in a very well written set of articles, which I think is the crux of your question.
http://www.nytimes.com/2012/07/10/health/genetic-test-changes-game-in-cancer-prognosis.html
You CAN get DNA testing of your tumor, but will it really matter? There are already baby versions of DNA and other marker tests like Mammaprint or Oncotype DX for breast cancer, which can be somewhat helpful in those diagnoses, but there aren’t similar tests for sarcomas to help either tell you that you have a particularly worrisome or particularly innocuous tumor. We use specific DNA mutation testing to some degree in GIST, where a mutation in the KIT gene both can predict for risk of recurrence as well as sensitivity to the typical first drug we use to treat GIST, imatinib. These sorts of tests can be done to a greater or lesser degree for greater or lesser cost, on the order of $5000 to $50000, though the cost is coming down month by month. For some sarcomas it does not make a lot of sense, but for others, in which we have no clear leads to therapy, it is a potentially useful approach.
http://www.nytimes.com/2012/07/10/health/genetic-test-changes-game-in-cancer-prognosis.html
You CAN get DNA testing of your tumor, but will it really matter? There are already baby versions of DNA and other marker tests like Mammaprint or Oncotype DX for breast cancer, which can be somewhat helpful in those diagnoses, but there aren’t similar tests for sarcomas to help either tell you that you have a particularly worrisome or particularly innocuous tumor. We use specific DNA mutation testing to some degree in GIST, where a mutation in the KIT gene both can predict for risk of recurrence as well as sensitivity to the typical first drug we use to treat GIST, imatinib. These sorts of tests can be done to a greater or lesser degree for greater or lesser cost, on the order of $5000 to $50000, though the cost is coming down month by month. For some sarcomas it does not make a lot of sense, but for others, in which we have no clear leads to therapy, it is a potentially useful approach.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Sarcoma Pathology, Genetics, Sarcoma Biology, Biology, Cancer Genetics, Pathology, New Developments Sarcoma Treatment, New Developments Sarcoma Genetics, Sarcoma Treatment, Cancer Biology, Sarcoma Genetics, Sarcoma
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10 months ago
We usually use scans to track disease, be they CT scans or MRI. PET scans are probably overused, as the vast majority of data you can obtain with a PET scan is already available on a good IV contrast enhanced CT scan or MRI. If the tumor is cut out entirely and people are getting prophylactic chemotherapy to prevent recurrence, we do not have blood markers like CA125 for ovarian cancer, CEA for colon cancer or lung cancer, or PSA for prostate cancer to see how people are doing without scanning them. This is because sarcomas come from types of tissues different from other cancers that make these markers. For the same reason we cannot use “circulating tumor cells” to track how a sarcoma is doing on treatment, as the markers don’t yet exist to perform such an analysis like one can for more common cancers like breast, lung, colon, and prostate cancers.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Sarcoma Treatment Process, Tracking Side Effects, Monitoring Side Effects, Sarcoma Treatment Monitoring, Sarcoma Treatment Side Effects, Diagnostic Tests, Sarcoma Tests, Side Effect Monitoring, Tests, Treatment Process, Sarcoma
1
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10 months ago
First, how the cells look under the microscope, smaller, larger, normal cell nuclei or not, and the like. After that it is typically necessary to examine specific proteins to tell two or more of the 75+ types of sarcoma apart. This is called immunohistochemical staining, and gives a fingerprint of sorts of common proteins to classify sarcomas and tell them apart from other cancer or benign conditions. Next is the molecular or DNA testing, to find out if there are characteristic DNA changes that make an iron clad diagnosis of a specific sarcoma. Finally, we are just on the verge of looking for molecular changes specific for a particular person’s tumor, which may affect the choice of treatment of a specific person with a specific cancer type.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified)) in topic(s) Sarcoma Typing, Sarcoma Pathology, Sarcoma Diagnosis, Pathology, Diagnostic Tests, Sarcoma Tests, Tests, Diagnosis, Sarcoma
1
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10 months ago
The most important approach is to get tissue for a biopsy. Scans will tell you something, but it is necessary to look at the tissue itself to determine the diagnosis. Usually a “core needle biopsy” will suffice. A fine needle aspirate does not give enough material for more sophisticated diagnostic techniques available today.
New answer by RobertMakiMDPhD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
10 months ago
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