Meet the Board

Sanjiv S. Agarwala, MD: Persistence has paid off for melanoma specialist

Sanjiv S. Agarwala, MD, is chief of medical oncology and hematology for St. Luke’s University Hospital & Health Network, based in Bethlehem, Pa, and professor of medicine at Temple University School of Medicine.

Agarwala, a member of the HemOnc Today Editorial Board, is a melanoma specialist. He will serve as program director of the HemOnc Today Melanoma and Cutaneous Malignancies meeting, which will take place April 13 and 14 at the Grand Hyatt New York Hotel.

What inspired you to go into hematology/oncology?

I have a very good friend who was a classmate in medical school who came down with adult acute lymphoblastic leukemia. I was doing a hematology rotation at the time, and I did his bone marrow for him. He had an identical match in his brother, and he had a bone marrow transplant and was cured. I remember being amazed at how he basically beat what was a horrible leukemia. This started my fascination with cancer in general.

What is your greatest professional reward?

Sanjiv S. Agarwala, MD
Sanjiv S. Agarwala

When I can give a patient hope when they think they have none — and, of course, when I am able to put a patient into remission and, maybe, even cure them, which is unfortunately still rare in my field.

What has been your biggest professional challenge?

Because I am a specialist and work at a referral center, I often see patients who are very sick and so advanced that their options are very limited. Trying to find a treatment for them, or sometimes having to tell them that treatment either is not possible or is not a good idea, is very challenging.

Whom do you consider to be your mentor?

My primary mentor was John Kirkwood, MD, a renowned melanoma specialist and a HemOnc Today Editorial Board member. I did my training with him at the University of Pittsburgh and he recruited me to be part of his team. We worked together for more than 15 years.

What is the best advice you ever received?

Not to give up when dealing with a very tough disease. I can remember, as recently as a year ago, wondering if I had made the wrong choice, as far as picking melanoma as the disease I should work with, after having 20 years or more of negative clinical trials. The advice given to me was: Don’t give up, one day there will be a breakthrough; and indeed it happened. The FDA approved new, very promising drugs for metastatic melanoma in 2011 — ipilimumab (Yervoy, Bristol-Myers Squibb) and vemurafenib (Zelboraf, Roche) and pegylated interferon (Sylatron, Merck) for adjuvant therapy.

What do you think will be the biggest breakthrough in your field in the next 10 years?

In oncology, in general, and in melanoma, specifically, we are moving toward a very personalized approach to treatment. One day, not to far in the future, each patient will get a specific test, probably on their tumor, that will determine the specific drug for that person, and it will be designed from the ground up for that individual. Although we give names to cancer, everyone’s cancer is unique; therefore, we are only going to be 100% successful in curing everybody if we find the right drug for each individual.

What advice would you offer to someone entering your field?

Oncology is very difficult. It’s easy to burn out. I would encourage them to stay with it, to maintain their sense of balance and compassion, and to never forget that most patients who develop cancer think they are going to die. Therefore, anything you do for them is very much appreciated.

Sanjiv S. Agarwala, MD
Sanjiv S. Agarwala, MD, is pictured with his family during a ski trip last year in Lake Tahoe.

Photo courtesy of S. Agarwala, MD

If you hadn’t become a physician, what career path would you have chosen?

That’s easy. I’d be a professional traveler, and food and wine critic. I want Anthony Bourdain’s job.

What do you do in your free time?

I travel, I am an amateur photographer and I like to bicycle. When I get time, I read, as well.

What is the last good book you read?

The Path Between the Seas: The Creation of the Panama Canal, 1870-1914, by David McCullough. The biggest hurdle to building the Panama Canal was not just the geography and the logistics, but the fact that — at that time — it was not known that yellow fever and malaria were caused by mosquitoes. Until they figured that out and eliminated the mosquito problem from the isthmus, they couldn’t build the canal. It was fascinating to think that a medical discovery was instrumental in the building of the Panama Canal.

Do you find your reading interests tend to lean toward nonfiction as opposed to fiction?

I haven’t read a fiction book in a very long time. I like to read about where I’m going to travel. In the last few years, every time I know I’m going somewhere, I get at least one or two good books to learn the history of the place before I go. Then, even a short trip comes alive.

What type of music do you enjoy?

I like all kinds. I’m not very picky. I like simple easy listening music depending on the mood I am in.

What is your favorite travel destination?

Iceland. It was the most beautiful place I have ever been to — rugged, remote, beautiful and unspoiled.

What can participants expect from the HemOnc Today Melanoma and Cutaneous Malignancies meeting?

As I mentioned before, three new drugs for melanoma were approved in 2011. Participants can expect to get an update on the data with these drugs and where they fit in. When you have nothing that works, actually it’s quite easy — put them on a clinical trial. However, now that we have options that actually work, the clinician who is sitting in the office needs to know who they treat with vemurafenib and who they treat with ipilimumab. If you can do both, which should you do first? Is it possible to combine them? What are the new drugs out there that might help these work better?

We are going to talk about injectable therapies and some other trials and experimental drugs that are being researched. Participants can expect to learn about what’s new in melanoma, how to use the new drugs that are approved, and also get a sense of future research prospects.

We also have a good distribution of topics based on diagnosis, dermatology and cutaneous T-cell lymphoma. The participants will hear about some of the new diagnostic techniques that dermatologists are using and also some of the updates on other cutaneous cancers. – by Emily Shafer

Sanjiv S. Agarwala, MD, is chief of medical oncology and hematology for St. Luke’s University Hospital & Health Network, based in Bethlehem, Pa, and professor of medicine at Temple University School of Medicine.

Agarwala, a member of the HemOnc Today Editorial Board, is a melanoma specialist. He will serve as program director of the HemOnc Today Melanoma and Cutaneous Malignancies meeting, which will take place April 13 and 14 at the Grand Hyatt New York Hotel.

What inspired you to go into hematology/oncology?

I have a very good friend who was a classmate in medical school who came down with adult acute lymphoblastic leukemia. I was doing a hematology rotation at the time, and I did his bone marrow for him. He had an identical match in his brother, and he had a bone marrow transplant and was cured. I remember being amazed at how he basically beat what was a horrible leukemia. This started my fascination with cancer in general.

What is your greatest professional reward?

Sanjiv S. Agarwala, MD
Sanjiv S. Agarwala

When I can give a patient hope when they think they have none — and, of course, when I am able to put a patient into remission and, maybe, even cure them, which is unfortunately still rare in my field.

What has been your biggest professional challenge?

Because I am a specialist and work at a referral center, I often see patients who are very sick and so advanced that their options are very limited. Trying to find a treatment for them, or sometimes having to tell them that treatment either is not possible or is not a good idea, is very challenging.

Whom do you consider to be your mentor?

My primary mentor was John Kirkwood, MD, a renowned melanoma specialist and a HemOnc Today Editorial Board member. I did my training with him at the University of Pittsburgh and he recruited me to be part of his team. We worked together for more than 15 years.

What is the best advice you ever received?

Not to give up when dealing with a very tough disease. I can remember, as recently as a year ago, wondering if I had made the wrong choice, as far as picking melanoma as the disease I should work with, after having 20 years or more of negative clinical trials. The advice given to me was: Don’t give up, one day there will be a breakthrough; and indeed it happened. The FDA approved new, very promising drugs for metastatic melanoma in 2011 — ipilimumab (Yervoy, Bristol-Myers Squibb) and vemurafenib (Zelboraf, Roche) and pegylated interferon (Sylatron, Merck) for adjuvant therapy.

What do you think will be the biggest breakthrough in your field in the next 10 years?

In oncology, in general, and in melanoma, specifically, we are moving toward a very personalized approach to treatment. One day, not to far in the future, each patient will get a specific test, probably on their tumor, that will determine the specific drug for that person, and it will be designed from the ground up for that individual. Although we give names to cancer, everyone’s cancer is unique; therefore, we are only going to be 100% successful in curing everybody if we find the right drug for each individual.

What advice would you offer to someone entering your field?

Oncology is very difficult. It’s easy to burn out. I would encourage them to stay with it, to maintain their sense of balance and compassion, and to never forget that most patients who develop cancer think they are going to die. Therefore, anything you do for them is very much appreciated.

Sanjiv S. Agarwala, MD
Sanjiv S. Agarwala, MD, is pictured with his family during a ski trip last year in Lake Tahoe.

Photo courtesy of S. Agarwala, MD

If you hadn’t become a physician, what career path would you have chosen?

That’s easy. I’d be a professional traveler, and food and wine critic. I want Anthony Bourdain’s job.

What do you do in your free time?

I travel, I am an amateur photographer and I like to bicycle. When I get time, I read, as well.

What is the last good book you read?

The Path Between the Seas: The Creation of the Panama Canal, 1870-1914, by David McCullough. The biggest hurdle to building the Panama Canal was not just the geography and the logistics, but the fact that — at that time — it was not known that yellow fever and malaria were caused by mosquitoes. Until they figured that out and eliminated the mosquito problem from the isthmus, they couldn’t build the canal. It was fascinating to think that a medical discovery was instrumental in the building of the Panama Canal.

Do you find your reading interests tend to lean toward nonfiction as opposed to fiction?

I haven’t read a fiction book in a very long time. I like to read about where I’m going to travel. In the last few years, every time I know I’m going somewhere, I get at least one or two good books to learn the history of the place before I go. Then, even a short trip comes alive.

What type of music do you enjoy?

I like all kinds. I’m not very picky. I like simple easy listening music depending on the mood I am in.

What is your favorite travel destination?

Iceland. It was the most beautiful place I have ever been to — rugged, remote, beautiful and unspoiled.

What can participants expect from the HemOnc Today Melanoma and Cutaneous Malignancies meeting?

As I mentioned before, three new drugs for melanoma were approved in 2011. Participants can expect to get an update on the data with these drugs and where they fit in. When you have nothing that works, actually it’s quite easy — put them on a clinical trial. However, now that we have options that actually work, the clinician who is sitting in the office needs to know who they treat with vemurafenib and who they treat with ipilimumab. If you can do both, which should you do first? Is it possible to combine them? What are the new drugs out there that might help these work better?

We are going to talk about injectable therapies and some other trials and experimental drugs that are being researched. Participants can expect to learn about what’s new in melanoma, how to use the new drugs that are approved, and also get a sense of future research prospects.

We also have a good distribution of topics based on diagnosis, dermatology and cutaneous T-cell lymphoma. The participants will hear about some of the new diagnostic techniques that dermatologists are using and also some of the updates on other cutaneous cancers. – by Emily Shafer