Lisa Kachnic ushers in a new era for radiation oncology

Photo by Daniel Dubois

One year into her job as chair of Radiation Oncology, Lisa Kachnic, M.D., is leading Vanderbilt-Ingram Cancer Center into a new era for a century-old therapy.

Radiotherapy continues to be at the forefront of cancer research as doctors devise better ways to target tumors and understand how radiation interacts with some of the new immunotherapies.

Radiation, under controlled conditions, has been shown to enhance the immune response, setting the stage for a new treatment paradigm for a therapy that was first used on cancer patients in 1899. Scientists are now studying the interrelationship between radiation and the various biochemical and molecular components of the immune response. The overarching goal is to determine how to best administer radiation treatments along with some of the novel targeted immunotherapies, new drugs that are transforming cancer care by spurring patients’ immune systems to kill cancer cells.

“One of the most interesting and recent observations with radiation therapy is that a localized high dose radiation treatment may broadly stimulate the body’s immune system to fight cancer,” Kachnic said. “This ‘abscopal effect’ is a phenomenon in the treatment of metastatic cancer where localized radiation of one focus of the cancer not only causes a shrinking of the cancer in the irradiated area, but also a shrinking of tumors outside the field of the radiation. Case reports of the abscopal effect have been published for a variety of cancers, including melanoma, kidney and lung cancer, and investigators believe that it is radiation’s interplay with the immune system driving this response. However, how we best utilize and sequence radiation with these new and very exciting immune modulating cancer drugs is not known,” she said.

“One of the compelling attractions for my joining the faculty at Vanderbilt was the unique opportunity to discover the answer to this important question. Through trans-disciplinary collaboration with many of Vanderbilt’s internationally recognized scientists, we may unravel how we may best utilize radiation with our current cancer treatments to optimally boost this immune response.”

That research is only one of the initiatives on Kachnic’s list. She’s working with the Vanderbilt Institute of Imaging Science on investigating how novel imaging technologies may allow radiation oncologists to better understand the real-time cancer response to radiotherapy, so her team may be able to further personalize radiation treatments. “This is of paramount importance in optimizing cancer cure and minimizing radiation side effects,” said Kachnic.

Vanderbilt University Medical Center (VUMC) has invested in two new TrueBeam linear accelerators with sophisticated imaging capabilities that will also help in this regard to better target the cancers and minimize radiation doses to healthy tissues.

“These new state-of-the-art radiation treatment machines have incorporated very high-tech imaging devices so that we can see what your cancer is doing in real-time,” Kachnic said. “That affords us the opportunity to perform ‘adaptive’ radiation research allowing us to tailor the radiation dose and area of treatment to a patient’s cancer response.”

Another important initiative is that shorter radiation treatment schedules are already being offered for many cancer types such as brain, breast, lung, gastrointestinal and prostate cancers.

“Instead of the typical six weeks or 30 radiation treatments that many patients with breast cancer undergo, we are able to offer many patients one to 16 treatments, depending on their tumor size, age, receptor status and stage,” Kachnic said. “It provides patients the opportunity to return much more rapidly to the other important aspects of their lives such as family and career.”

VICC is embarking on similar options for men with prostate cancer — options that not only allow for much shorter treatment schedules than the typical seven-eight weeks of radiation, but also lessen the potential complications of impotence and incontinence.

“For prostate cancer, we are developing novel clinical trials examining very high dose, short schedule outpatient radiation treatments, many that may be given within a week, utilizing a very focused radiation that we call radiosurgery,” she said. “The word radiosurgery sounds invasive, but it is not. There are no knives involved, just a very high radiation dose from the new generation of radiation delivery machines that focus the radiation directly to the cancer while avoiding the normal surrounding organs and tissues.”

Kachnic and her staff have also been offering these special radiosurgery techniques for brain, lung and gastrointestinal cancers, including pancreatic cancer. In addition, radiosurgery is also provided with excellent results for many non-cancerous conditions such as benign brain lesions and tremors.

For patients admitted to VUMC, her department also offers novel palliative radiation services, most typically for pain management.

“We have developed a process by where we have a patient seen and treated within a timeframe of about three hours and often a single fraction of radiation, with the expectation that patients may experience some pain relief for their very advanced cancer within a matter of hours to days,” she said.

Kachnic came to Vanderbilt in September 2015 from Massachusetts where she was chair of the Department of Radiation Oncology and director of Multidisciplinary Research at Boston University School of Medicine. Now, she is professor and chair of Radiation Oncology at Vanderbilt University School of Medicine.

One of her first tasks at VICC was to supervise a clinic redesign to improve efficiency, safety and patient satisfaction. Those changes helped spur robust growth in patient volume as well as a very positive change in work culture. “In my short time here, I am most proud of how my entire staff has worked together to provide the absolute best and most compassionate care for our patients,” Kachnic said.

As a national leader in radiation oncology, Kachnic keeps up with what’s on the horizon. She is president-elect of The American Board of Radiology, the certifying organization for radiologists/radiation oncologists and medical physicists, and is in charge of the scientific program for the meetings of the American Society for Radiation Oncology. She also serves in leadership capacities within NRG Oncology and SWOG, two of four cooperative research groups for adults in the National Cancer Institute (NCI) National Clinical Trials Network. These many efforts have allowed Kachnic to do what she loves best — mentor the young and future leaders in cancer care and research. “I believe this is what I was brought here to accomplish — develop our next generation of cancer leaders and create a top 10 nationally recognized radiation department,” she said.