Hematological cancer treatment in the era of targeted therapy, immunotherapy, and stem cells
“We consider suitable treatment, prioritizing the effectiveness of the treatment and the quality of life of patients.”
Thirty years ago, cancer specialists in Thailand were far and few in between. Now, there are many treatment modalities for cancer and increasing numbers of cancer specialists. While many still are terrified of getting cancer, current treatments can provide a high chance of cure for many types of cancer, such as lymphoma and leukemia.
In this issue of MedPark Stories, we talk with Dr Udomsak Bunworasate, an oncologist specializing in hematology who pioneered and developed stem cell transplantation in Thailand. He also played a pivotal role in innovating new treatment modalities for hematological cancer. Let us delve deeper into his narratives.
Becoming an oncologist: Inspiration from someone he idolized and respected
After graduating with first-class honors in Doctor of Medicine from Chulalongkorn University, Dr. Udomsak set sight to pursue further studies in the United States. However, he had to change his plans due to unforeseen circumstances. This shift led to new learning opportunities and unexpected motivation.
"During that time, my grandmother fell ill with colon cancer, so I paused my studies to care for her. I took her for treatment with Assoc. Prof. Narin Voravud, an oncology professor, recently returned from abroad. Noticing I had free time, he invited me to assist with cancer research. Subsequently, when my grandmother recovered, I geared up to go to the US.
"One day, I had the chance to discuss with Prof. Sinn Anuras, now the CEO of Medpark Hospital. I asked if he could turn back time, and what specialty he would choose to study. He answered, 'Oncology.' Respected his vision, I decided to further my study in this area."
Dr. Udomsak pursued a residency in internal medicine at the Chicago Medical Center of the University of Illinois, followed by a Hematology and Oncology fellowship at the Roswell Park Cancer Institute in New York, as well as a fellowship in Stem Cell Transplantation at Vanderbilt University in Nashville, Tennessee, spanning a total of 7 years.
"I learned about every type of cancer during that time. I attended weekly clinics with my advisor, a hematology specialist treating leukemia. Seeing many cured leukemic patients sparked my interest. I wanted to focus on blood cancers and delve deeper into stem cell transplantation."
Stem Cells: Trailblazing Blood Cancer Treatment
Upon returning to Thailand, Assoc. Prof. Thanin Intragumtornchai, head of the Hematology Department at Chulalongkorn University at the time, invited Dr. Udomsak to collaborate on developing a Bone Marrow Transplantation (BMT) program at Chulalongkorn Hospital, as well as methods for harvesting blood stem cells. Their successful efforts brought hope to patients with leukemia, lymphoma, and multiple myeloma, eagerly awaiting advanced treatments at that time.
"Previously, the process was cumbersome, requiring patients to undergo sedation before bone marrow aspiration. I developed a method to collect stem cells from peripheral blood instead, known as blood stem cell transplantation. This method can treat various types of cancer, including non-cancerous blood disorders. Chulalongkorn Hospital collaborated with the Thai Red Cross Society National Blood Centre, recruiting hundreds of thousands of stem cell donor volunteers. This initiative resulted in a significantly increasing number of patients achieving cures."
Dr. Udomsak also applies this approach to autoimmune diseases, conditions causing systemic inflammation and fibrosis, disrupting the patient's life. He was the first to treat this type of disease successfully in Thailand. However, there were still relatively few specialists in stem cell transplantation at the time.
"I wish that doctors learn about effective, international-standard treatment modalities. I also wish that patients all over the country can access treatment more quickly, not waiting in long queues at large hospitals. That was why I headed the development of a curriculum for adult peripheral blood stem cell transplantation, certified by the Medical Council of Thailand to train doctors interested in this field."
Dr. Udomsak hopes to increase the number of doctors learning this advanced treatment method to maximize cancer patient survival. With the indomitable spirit of a researcher and discoverer of cancer knowledge, he continues to pioneer innovative treatment approaches using Chimeric Antigen Receptor T-cell therapy, abbreviated CAR-T cell therapy. He is determined to push the treatment envelope forward along the way he did with his past work on stem cells.
"I work with a team of hematologists and immunologists from the Faculty of Medicine, Chulalongkorn University, and a team of physicians from Japan to develop CAR-T cell therapy. We genetically modify T lymphocytes to target specific cancer cells, successfully destroying lymphoma cells. This achievement marks one of the first in Thailand. We are committed to further developing this therapy to increase the chances of patients achieving cancer cures."
Treating cancer involves more than just surgery, radiation, and chemotherapy.
Patients with hematological cancers often have a high chance of cure and typically respond well to treatment. However, they tend to dwell on the negative. As a doctor, his goal is to help them get through this period.
"I always reassure them that cancer treatment today is much more effective than before. Beyond chemotherapy, we have molecular insights, genetic information, targeted therapies, oral drugs, and biologics that specifically destroy cancer cells. We have successfully modified immune cells like CAR-T cells, which are highly specific and effective in treatment. We tailor treatments to each patient, prioritizing effectiveness and improving their quality of life."
Dr. Udomsak emphasizes that, unlike traditional treatment and targeted therapy, some are oral medications with minimal side effects, such as nausea and vomiting. Moreover, we have monoclonal antibodies developed over many iterations.
“When patients come to us, we must diagnose the type of cancer they have and then search for suitable targets to treat. We have state-of-the-art laboratories and precision nuclear medicine tools that accurately assess the spread of cancer. Once we have the data, we plan the treatment, selecting targets and medications that best suit the patient, prioritizing effectiveness and improving quality of life.”
Currently, Dr. Udomsak is an oncology staff of the Medical Oncology Center at MedPark Hospital, playing a pivotal role in advancing treatments for hematological cancers and implementing cutting-edge therapies such as stem cell transplantation and immunotherapy for cancer patients. Dr. Udomsak believes that within three years, Thai and international cancer patients will consider MedPark Hospital as their first destination for treatment.
"We assemble a team of hematological cancer specialists, comprehensively caring for patients with every type of cancer. We provide effective diagnosis and treatments, including stem cell transplantation. I have been with the team for only four months, and we have already achieved remarkable success in treating acute leukemia patients.
“I am impressed with our medical team, nurses, and staff at every level. We provide compassionate care to our patients, treating them like family. Crucially, we have the back of management that fosters unity, making us feel like one cohesive family."
Complete remission and cure are like divine nectars soothing the soul.
Dr. Udomsak recounts a situation, whether a coincidence or not, from his experience in treating cancer patients that impresses and motivates him to continue his work.
"Shortly after paying homage to the Phra That Phanom pagoda, a female teenager from Nakhon Phanom came to me with mediastinal lymphoma involving the thymus gland in the middle of the chest. This type of cancer is rare and often responds poorly to treatment. We performed a stem cell transplant and successfully cured her. A few years later, another male patient came with the same disease, in the same anatomical location, and with the same cell type. It turned out that he was her brother, and he also received treatment and was fully cured."
Apart from this sibling pair, there was another patient from Nakhon Phanom who had a type of leukemia refractory to every treatment. In this case, Dr Udomsak treated the patient with the stem cells of the patient's mother and succeeded. His faith in the potency of Phra That Phanom has been strengthened even to this day.
"In my spare time, I often run and exercise at home, teaching myself to play the piano. At about 4 am every day. I wake up and meditate for half an hour to maintain mindfulness in daily life. My patient care guiding principles are the four divine abodes of loving-kindness, compassion, empathetic joy, and equanimity; we will help patients overcome the suffering caused by cancer and extend their lives towards achieving their goals.
"For instance, many patients have recovered and become doctors to treat others. Some want to see their children graduate or succeed or even have grandchildren. We do our utmost, but sometimes, despite our best efforts, we must let go. Nonetheless, we must continually study and learn new ways of treatment. We should not rest on our laurels."
