The art and science of cancer care

Lynn Schuchter, MD, recently completed her term as the 2023-2024 President of the American Society of Clinical Oncology (ASCO)—the leading professional society for cancer care—as part of a career that began at Penn Medicine 30 years ago.

Over those three decades, Schuchter has witnessed remarkable progress in cancer care and survivorship, particularly in her own specialty of melanoma, where many patients—but not all—are living longer than ever before. This weekend, the oncology community came together under Schuchter’s leadership at the ASCO Annual Meeting to share the latest advancements in cancer science while recognizing that there’s still more work to be done.

Amazing advances in melanoma treatment—but not for everyone 

When Schuchter began at Penn, most of the time she spent caring for patients with advanced melanoma involved supporting them with palliative care to manage side effects and enrolling patients on hospice so they could spend their final months and days as comfortably as possible, surrounded by those they loved. At the time, the available treatment options were powerless against metastatic melanoma, which took the lives of most patients once it spread.

That began to change in the early 2010s, with the advent of a class of targeted therapy drugs known as BRAF inhibitors for their ability to target the BRAF mutations that had recently been discovered to be prevalent in melanoma.

“I remember leaving my Christmas vacation early because I was so excited to enroll the first patient in a Phase I clinical trial at Penn,” Schuchter recalled. Immunotherapies followed closely on the heels of targeted therapy’s success in melanoma, and suddenly the prognosis for advanced melanoma changed. Patients with stage IV melanoma—even those whose cancer had spread to their brain, as melanoma often does—were seeing their cancer disappear and living longer lives without side effects from their cancer or treatment. The five-year survival rate for stage IV melanoma more than doubled from less than 15 percent in the early 1990s to 35 percent by the late 2010s.

Still, not all patients saw the benefit. For some, the new therapies still didn’t work—or only worked for a short time before their cancer returned. Today, Schuchter and her colleagues spend their clinic days celebrating with some patients and family members and navigating difficult questions with others.

“I did not think in my lifetime I would see the kinds of advances in cancer that we’re seeing today. That’s the power of science—we’re curing patients with stage four cancer, which is amazing,” Schuchter said. “At the same time, we’re not curing everyone. And that’s where the art of care comes in.”

Leaders among leaders in cancer research  

This dichotomy is at the heart of the 2024 Presidential Theme for the American Society of Clinical Oncology (ASCO) Annual Meeting: “The Art and Science of Cancer Care: From Comfort to Cure,” and for Schuchter, who directs the Tara Miller Melanoma Center at Penn Medicine’s Abramson Cancer Center (ACC).

More than 40,000 oncology physicians, researchers, and other professionals from across the world attended the ASCO Annual Meeting, this past weekend in Chicago. As president, Schuchter developed the theme for the meeting and shaped the organization’s education, research, professional development, and advocacy priorities during her term.

“Dr. Schuchter’s election as president of ASCO is a tremendous testament to her leadership in the field of oncology,” said Robert H. Vonderheide, MD, DPhil, director of the Abramson Cancer Center. “As cancer physicians and researchers, we always look forward to the ASCO Annual Meeting as an opportunity to learn about and discuss the latest research and issues facing our field and our patients. We are incredibly ‘Penn Proud’ to see one of our own lead this year’s meeting and share her vision for the future of cancer care.” 

Penn Medicine and the ACC’s leadership visibility at the ASCO Annual Meeting also extended to several other important roles: Angela DeMichele, MD, MSCE, the Mariann T. and Robert J. MacDonald Professor in Breast Cancer Care Excellence, was the chair of the Scientific Program Committee; Charu Aggarwal, MD, MPH, the Leslye M. Heisler Associate Professor for Lung Cancer Excellence, was the chair of the Cancer Communications Committee and is an incoming elected member of the Nominating Committee; and Neha Vapiwala, MD, a professor of Radiation Oncology, is also an elected member of the Nominating Committee.

Inspired by a special patient  

As Schuchter delivered her presidential address to open the meeting, the audience included a family near and dear to her heart—and to the theme of the meeting—the Miller family.

When Tara Miller was diagnosed with stage IV melanoma in 2013 at the age of 28, the tide was just beginning to turn for melanoma research and treatment. Tara researched all the latest advances.  Unfortunately, the most advanced treatments available at the time were not enough to cure her cancer, and Tara passed away in October 2014.

In those 15 short months, Tara did everything possible to fight the cancer, and Schuchter grew close to her and her family. After Tara’s cancer aggressively spread to her brain and after several brain surgeries, Schuchter remembers the difficult message she had to share with Tara ’s mother when it was time to let her go.

“We had a really hard conversation, and then they brought her home, where we arranged hospice care,” Schuchter says. “As devastating as it was—and still is, for her family—she wasn’t in the hospital, she wasn’t in the ICU, she was at home with her family. Tara was where she wanted to be, with everyone she loved around her.”

Miller’s inimitable spirit made an outsized impact on other patients, families, and her doctors. Her positivity, infectious love for life, sense of humor and determination to make the best of it are evident in her namesake foundation, which has raised more than $7.5 million for melanoma research since 2014.

“Tara’s legacy is about funding research that will change the odds for those who come after her,” said Tara’s twin sister Lauren. “Like Tara, there are patients who still don’t respond to available therapies today, so while we celebrate the progress, we know there is still more to do.”

Across the cancer system 

Schuchter wants to be sure all oncologists have the tools and training they need to practice the difficult art of knowing how and when to talk to seriously ill patients about the state of their cancer and their personal goals for their end-of-life care.

“It’s even harder to watch patients, especially in the ICU, who have no idea how sick they are, receiving highly toxic treatment at the end of life,” she said. “We need to make sure care teams are equipped with the communication skills they need to help patients in these situations understand their prognosis, so that patients can make decisions about their treatment options and we’re able to plan care together according to their wishes and values.”

Across the Penn Medicine cancer system, clinicians and researchers are also applying science to late-stage and late-in-life cancer care. At Penn Medicine Princeton Health, Ramy Sedhom, MD, a clinical assistant professor of Hematology-Oncology and co-leader of the Geriatric Oncology service line, is leading an innovative program to ensure holistic, patient-centered care for older adults with cancer. In the Penn Center for Cancer Care Innovation, Ravi B. Parikh, MD, found that machine-learning-triggered reminders quadrupled rates of advanced care planning conversations, while decreasing potentially harmful therapy at end of life by 25 percent.

“It is truly a privilege and a calling to care for patients at their most vulnerable time,” Schuchter said. “As we continue to push forward more cures for more patients, we should also focus on those who don’t benefit from scientific advances, and the difference that words during this time can make for these patients and their families.”