May 13, 2026 • 20 mins
On this DocTalk episode, we chat with Dr. Joseph Roswarski, the lymphoma/leukemia attending at MedStar Georgetown University Hospital and the Georgetown Lombardi Comprehensive Cancer Center. Dr. Roswarski’s medical career includes clinical care and research in hematologic malignancies, particularly lymphoma and multiple myeloma.
For an interview with Dr. Joseph Roswarski, or for more information about this podcast, contact MedStar Georgetown University Hospital Manager Media Relations, Ryan.M.Miller2@Medstar.net. Learn more about Dr. Roswarski.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
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(00:06):
Comprehensive, relevant,and insightful conversations about health
and medicine happen here on MedStarHealth Doc Talk.
Real conversations with physician expertsfrom around the largest healthcare
system in the Maryland DCregion. At MedStar Health,
our malignant hematologic oncologyprogram located at MedStar Georgetown
University Hospital brings togetherworld-class specialists and all types of
(00:28):
blood cancers. When you're diagnosed,you need the expertise of an integrated
team who has extensive knowledge andexperience in caring for
your particular disease.
Part of the MedStar Georgetown CancerInstitute, we provide comprehensive,
highly individualized blood cancercare using cutting edge technology and
research, including clinicaltrials. Our research engine,
(00:48):
Georgetown LombardiComprehensive Cancer Center,
is the only national cancer institutedesignated comprehensive cancer center in
Washington, DC. Through this partnership,we're dedicated to evaluating new and
better ways to treat blood cancers byserving as principal
investigators for phase one, two,and three clinical trials. Our research
helps us better care for our patients,allowing us to translate our findings
(01:08):
into effective treatment options.
Welcome to MedStar Health Doc Talk.
I'm Ryan Miller and I'll beyour host for today's episode.
I'm joined by Dr. JosephRoswarski, lymphoma,
leukemia attending at MedStar GeorgetownUniversity Hospital and the Georgetown
Lombardi Comprehensive Cancer Center.
His medical career includes clinicalcare and research and hematologic
(01:29):
malignancies, particularlylymphoma and multiple myeloma.
Thank you for joining uson MedStar Health Doc Talk.
Thanks so much for havingme here. Really excited.
What do we mean when we say bloodcancers? What are they? I'm not an expert,
so you'll just want todumb this down for me.
Yeah. Loosely, what we're talkingabout are disorders of the blood cells,
right? So that can be yourleukemias, your lymphomas,
(01:52):
and some other rare conditionsof other types of blood cells.
What is multiple myeloma?
So multiple myeloma is a cancer of theplasma cell, which is another, again,
type of white blood cell.
How do you determine what type ofblood condition or cancer someone has?
Yeah,we have a various utility of different
diagnostics that we can use depending onwhat the type of blood
(02:13):
cancer we're looking at.
So for a lymphoma that wemight detect by imaging,
either CAT scans or PET scans,we want to get some type of
sampling of that lymph node,whether that's a needle biopsy or
more preferably an excisional biopsy.
So we're actually taking out part of thatlymph node or the whole lymph node so
(02:34):
we can dice it up and do special stainson it to figure out what type of blood
cell is in it to comprise the lymphoma.
If we're looking at more of a leukemia,we might be looking at the blood
or at the bone marrow to again,do special studies on that to determine
what the actual cancer cell is and beable to further refine from there.
If somebody wants a second opinion,what is usually your advice to them?
(02:56):
Yeah.
So one of the main utilitiesof a place like Georgetown,
which is a tertiary care center isto lend expertise to the surrounding
community. So my expertiseis in leukemia and lymphoma.
So very frequently either patientsthemselves or referring providers from the
community are reaching out to meto gain insights and expertise in
(03:19):
either lymphoma or leukemia.
And sorry, go.
Ahead. Just to expand upon that,my general thought about second
opinions is that they're invaluable.
Blood cancers are not as common asthe things that especially community
colleges see every day likelung cancer, colon cancer.
So these are rare diseases and tohave people with specific expertise in
(03:40):
them can be very useful.
What led you to get intothe blood cancer realm?
Great question. So we allgo through fellowship.
I did mine at Walter ReedNational Military Medical Center.
When I was in my lateryears of fellowship,
I spent time at the National CancerInstitute under the lymphoid malignancies
branch and I reallyenjoyed working with them.
(04:01):
I thought they were some ofthe smartest docs around.
I thought whenever you'regoing into medicine,
you want to pick out your mentors,the people that inspire you.
Who do you want to be like whenyou're practicing on your own?
And for me, when I was working withthat group, I was like, "Oh yeah,
that's the group ofpeople I want to be like.
" So that led me to doing someextra research and lymphoma,
(04:24):
spending some time at theNational Cancer Institute,
running a clinical trialin multiple myeloma.
So I knew pretty early on that that wasthe type of cancer that I wanted to gain
more expertise in that I enjoyed takingcare of and that I was passionate about.
What type of patients do you oftensee here at MedStar Georgetown?
So under the veil of blood cancer,again, I do mostly leukemia and lymphoma.
(04:46):
So when we talk about lymphoma,that's a very, very broad umbrella.
Roughly speaking, that's theHodgkin and non-Hodgkin lymphomas.
So those I see very frequently. So whenwe think about non-Hodgkin lymphoma,
follicular lymphoma,the aggressive lymphomas like diffuse
large B-cell lymphoma and Burkettlymphoma. Chronic lymphocytic leukemia
is very closely related. Again,that's a leukemia, but it's
(05:06):
of B-cell origin. Currently,I'm also working on some of
the more acute blood cancers.
So that's something like acute myeloidleukemia or acute lymphoblastic leukemia.
So a pretty wide net within blood cancers.
Are these common cancers orwould you say they're rare?
So on a whole, right whenwe talk about B-cell,
(05:27):
so your non-Hodgkin's lymphomasand Hodgkin lymphomas,
they roughly account for I thinkabout 120,000 cases a year.
So that's a sizable portion ofnew cancer diagnosis a year.
Within that umbrella though, there arespecific diseases that are quite rare.
What are the symptoms to watch out forwhen it comes to blood cancers and is
(05:47):
there any way to notice them?
For some cancers, yes. For others, no.
So certain types of symptoms thatare sometimes more specific for blood
cancers that don't happen as much inother cancers would be what we call
constitutional symptoms or B symptoms.
So these are things like fevers,night sweats, unintentional weight loss.
(06:08):
These tend to happen morein leukemia and lymphoma.
They can happen in otherwhat we call solid tumors,
but those are definitelythings that when we see them,
we start to think aboutblood cancers immediately.
There are a lot of cancers though thatare picked up incidentally, right?
So a patient goes to their primary caredoc and they've got an elevated white
blood cell count,they feel totally fine and we will
do further testing and they've gotchronic lymphostatic leukemia.
(06:33):
They would not have knownotherwise because they don't
to their disease.
Other things related to lymphoma wouldbe swollen lymph nodes or glands,
right? So these can occur in theneck, the armpit, in the groin region.
By the time it's noticeable,is it pretty far advanced?
So yeah, that's a common misnomer.
(06:55):
Most blood cancers we think aboutdifferently again than solid tumors.
So we still use a staging system similarto solid tumors like breast cancer or
colon cancer, but very oftenthese are systemic diseases.
We have blood all throughout our body,our bone marrow, our lymph nodes.
For example, one of the more common lowgrade lymphomas, follicular lymphoma,
(07:18):
very frequently stage threeor four when we diagnose them.
So this concept ofcatching it early, again,
it's kind of a misnomer becauseat that time when they develop,
they are systemic, right? They'reall over the body by nature.
Are there blood cancer screeningtests that folks can do?
I know there are things like Cologuardfor at-home rectal cancer screening,
(07:42):
but there's nothing along thoselines for blood cancers, right?
There really isn't.
There are companies that are comingup with advanced diagnostics.
The company GRAIL comes to mind,which can test for I think around 50
different cancers by a blood-based test,but know that technology is imperfect
and leads to a frequent false positiverate,
(08:03):
but there's no specific testing that isdone to screen for leukemia and lymphoma
at this time.
What about minimal residual diseasetesting after somebody has beaten one of
these cancers? Is thatsomething you all do?
Yeah, depending on the cancer,it can either be standard of care to do
this type of measurable residual diseasetesting or not.
(08:23):
It is becoming increasingly importantboth in knowing how good of a remission
someone's in or are theyin remission at all,
being able to think about whatadditional therapies can be
recommended for them.
Currently have a clinical trial hereat Georgetown for diffuse large B-cell
lymphoma where after patientscomplete their primary therapy,
(08:44):
they're offered measurableresidual disease testing
their lymphoma at all. Ifwe can't, that's great.
They're very likely cured basedon that platform sensitivity,
but if we can still detect it,could we act on that earlier and
try to offer cure before theyactually have a relapse?
(09:06):
So this is the Alpha-3 trialthat we have through AlloGene,
which is a really kind of cutting edgeclinical trial platform and design that
I'm very interested in.
And how do you let a patient know ifthey're a candidate for one of these
clinical trials you're involved with?
Yeah. So very frequently for our patientsthat we're currently treating here at
Georgetown, we're bringingthat up to them directly.
(09:26):
I've had patients and their familiesreach out to us directly because they know
the power of these tests andthey want to get involved.
So I had a patient that came becausethey had heard about this trial in
particular and the fact that we were usingvery sensitive MRD testing and wanted
to have that for their family member.
What are the cancer therapies that arecurrently available at MedStar Georgetown
(09:47):
for leukemia and lymphoma?
At this time, we have a widearray of treatment modalities.
I think anything that'sconsidered standard of care
specifically in leukemia,we do offer allogeneic stem cell
transplant for our lymphoma and myeloma.
In addition to standard of carechemotherapy and novel targeted therapy
(10:08):
approaches, we have thingslike bispecific antibodies,
which we are using regularly.
We have CAR T-cell therapy both forour lymphoma and myeloma patients.
So anything that's considered standardof care cutting edge is something that we
have here at Georgetown, which isexcellent. In addition to that,
going beyond standard of care, we offera diverse clinical trial portfolio,
(10:30):
which is asking what isbetter, what is newer,
what is going to be the standardof care in the future, right?
So patients at Georgetown haveaccess to tomorrow's medicine.
That's incredible to hear. Whenwe talk about targeted therapy,
what is that and how does it work?
Especially lymphoma,this has been a revolutionary
class of medications.
(10:52):
So the first one actually wasdeveloped for chronic myeloid leukemia.
So when we think about the initial drugthere, it was called imatinib or glibec.
So that's a targeted moleculethat inhibits the pathway
survive.
Turning that from a fatal disease intoone that is very manageable with just a
pill. So that's the power of targetedtherapies. Geez. Yeah, it's incredible.
(11:14):
So that was revolutionary in the early2000s when that drug got approved.
The advent for that in lymphomastarted to happen with the BTK
inhibitors. So the firstdrug being ibrutinib.
And since then we've had numerous othersthat target the pathways within B cell
malignancies. Again, a lotof the non-Hodgkin lymphomas
(11:35):
So these are often pills.
They have a different side effectprofile than traditional chemotherapy and
often they're more effective.
How do you approachgiving a patient bad news?
So when I was in training, my mentortold me, if you've got bad news to share,
never go into the room without a plan.
You always need to beprepared for delivering the
(11:57):
to pivot to, I've got something.
Solution to the problem.
Solution to the problem. SoI've taken that to heart.
And so anytime I'm thinkingthis is potentially bad news,
I'm going to share.
I'm doing my homework and making surethat I'm thinking about what is that next
best option or first option sothat we can focus the conversation,
not on the bad news, but aboutwhat are we going to do about it?
(12:19):
Exactly. And is that the most commonquestion you get from patients? What next?
Depends on where they'reat in the disease process.
Very frequently for the newlydiagnosed patient with a blood cancer,
a lot of the time we'reclearing up misconceptions.
People have a thought in their headwhen they hear the word cancer and it's
usually doom and gloom.
They're thinking the worst and sometimesthat's just not the case at all.
(12:41):
So really setting expectationsand trying to educate them
about what does this actualcancer mean for them specifically,
that can be a lot ofthe conversation, right?
Before even getting to what'snext and what are we going to do,
you really need to educate and make surethat they understand what this means
for them. I can't emphasize that enough.
(13:03):
Most people do not have a lot ofunderstanding or education about
cancer. So what gets dramatizedon TV is a lot of doom and gloom.
Right?
And that's not always applicable to them.
A lot of these are manageable cancers.
Very much so.
Why should patients choose ourmalignant hematologic oncology program?
The reason to come to Georgetown formalignant hematology is that we have
(13:27):
specific expertise in these diseases.
That really does set us apart froma lot of other centers, again,
that are trying to treat everysingle disease at the same time.
That is a very difficult job.
So our job here at Georgetown is tohave specific expertise in what we're
treating. With that,we know what is the best standard of
cares for these cancers. And again,this is a rapidly evolving field.
(13:50):
We have access to cutting edge therapiesto include bispecific antibodies,
CAR T, allogeneic stem cell transplant,the newest FDA approved therapies,
as well as the clinical trials, again,which can be hugely important
in blood malignancies.
Can you tell us about themalignant hematologic oncology
(14:11):
with MedStar Georgetown's stem celltransplant and cellular immunotherapy
program?
Yeah,we work together hand in hand every day
and we kind of overlap in some ways.
We are frequently identifying patientsthat need these types of cellular
therapies or stem cell transplant andworking with our colleagues to get them
established so we can get them rapidlythose therapies when they need them.
(14:33):
We're also doing our own clinical trialsin the cellular therapy space trying to
become principal investigator ona new CAR T product that targets
two different antigens at the same time.
This is a novel construct that lookslike it might be better than our
existing standard of care CAR-T productsthat are commercially available.
(14:53):
So yeah, we work hand in handwith our cellular therapy team.
Some of us are on the cellular therapyteam as well as doing primary clinical
work for patients with blood cancers.
Dr. Rosworski,you are a decorated military veteran
who has received numerous awards duringyour time of military
service as a medical officer.
How has this valuable experience andcomplex cases been an asset for your
(15:16):
patients?
I think my military time was invaluableto shaping me to who I am today.
Being in the arms services instillsin you a sense of duty, honor,
and responsibility and I bring that topatients and I bring that to patient
care.
Sounds like that shapedyour philosophy of care.
Yeah, 100% it did. I want to make surethat I'm doing right by my patients,
(15:37):
making sure that they're getting the bestof what I can give them with my time,
with my expertise, withmy compassion. Again,
I feel very much duty andresponsibility bound to them.
That's wonderful to hear and I knowthey're lucky to have you as their doctor.
Can you break down phaseone, two, and three?
So clinical trials are donein phases for a reason.
(15:58):
As we're trying to develop newtherapies or combinations of therapies,
we need to first establish that they'resafe. So that's a phase one trial.
Just establish, are the drugs orthis new novel platform, is it safe?
Once we've established that andwe know we have a safe drug,
then we move on to a phase two study.
So when we get to phase two studies,what we're trying to establish is what
is the efficacy of the new regimengenerally but not always these are
(16:21):
non-randomized studies where we're justtrying to see how efficacious
is this new platform.
Once we've established that and it lookslike this is potentially a promising
drug,then we move to phase three where that
is generally a randomized study againstwhat's considered a standard
of care. So new platform,new agent versus today's current
standard of care. So those are generallyrandomized studies and those are the
(16:45):
ones that generally will lead to FDAapproval for new drugs.
Thank you for that.
Is there a specific clinical trialthat you're most excited about?
Yeah, there's a trial that we're currentlyenrolling on right now that I'm very
excited about.
This is a partnership with MemorialSloan Kettering in New York and our
consortium partner in New Jerseyat the John Thur Cancer Center.
(17:09):
Here we're looking at using abispecific antibody called mosinatuzumab
and frontline meaning patients thathave not been treated before follicular
lymphoma. This trial is not beingdone at a lot of places. Again,
this is just three centers that aredoing this, including Georgetown.
We know that this antibody,bispecific antibody works incredibly
well in follicular lymphoma.
(17:30):
It's currently approved in the thirdline setting and when anything works as
well as most edutuzumab did and in thethird line setting, the question is,
should we be moving it up?
Should we be taking it to secondline or first line therapy? So again,
this is a first line study. We'vealready enrolled a lot of patients on it.
Patients are responding well to therapy.
The current standard of care infirst line follicular lymphoma is
(17:52):
chemoimmunotherapy, so chemo plusantibodies. So with this trial,
we're asking a question which ishow does a bispecific antibody,
so not utilizing any chemotherapy,how does that work for patients?
And the results that we've alreadypublished at the American Society of
Hematology are incredibly encouragingwith response rates and complete response
(18:12):
rates very similar to chemoimmunotherapy.
So I've had many patients fromthe region ask about this trial.
Sounds like a game changer.
Yeah. I think most of us in the lymphomafield are starting to think that
are we entering in a future wherechemotherapy is kind of a wayside?
We're getting there and it's trialslike this, follicular lymphoma,
(18:35):
especially where we're startingto ask those questions,
can we start to pivotaway from chemotherapy?
There are cancers where we'vealready done that, right?
In chronic lymphocytic leukemia, again,we're using these targeted therapies
almost exclusively for patients becausethey work better than chemotherapy and
these types of concepts are moving toother B-cell malignancies
in rapid fashion.
(18:57):
Dr. Rosworski, how do you feel aboutthe future of blood cancer care?
Hearing you talk aboutthose clinical trials,
it sounds like there's alot of reason for optimism.
There is a ton of reason for optimism.
It's just getting better and better.
I frequently will tell patients whenI'm meeting them for the first time,
depending on what the cancer is, right?
There's no better day to getdiagnosed with this blood cancer.
That's a great attitude to have.
(19:18):
So for certain cancers, our curerates are already very high.
The future is that we're going topush those cure rates even higher.
There are some cancers we cannot cure,but we hope to change that, right?
I think we're developing the toolswhere we can start to cure more and more
blood cancers. Well.
The future is bright.
I've been talking with Dr. JosephRosworski at MedStar Georgetown University
(19:40):
Hospital in Washington, DC.
Thank you for sharing your expertisewith us today on MedStar Health Doc Talk.
Thanks, Ryan. It's been great to be here.
For more information about our malignanthematology oncology group, please call
202-444-5209.
Comprehensive, relevant,and insightful conversations about health
and medicine happen here on MedStarHealth Doc Talk.
Real conversations with physician expertsfrom around the largest healthcare
system in the Maryland DCregion. At MedStar Health,
our malignant hematologic oncologyprogram located at MedStar Georgetown
University Hospital brings togetherworld-class specialists and all types of
(00:28):
blood cancers. When you're diagnosed,you need the expertise of an integrated
team who has extensive knowledge andexperience in caring for
your particular disease.
Part of the MedStar Georgetown CancerInstitute, we provide comprehensive,
highly individualized blood cancercare using cutting edge technology and
research, including clinicaltrials. Our research engine,
(00:48):
Georgetown LombardiComprehensive Cancer Center,
is the only national cancer institutedesignated comprehensive cancer center in
Washington, DC. Through this partnership,we're dedicated to evaluating new and
better ways to treat blood cancers byserving as principal
investigators for phase one, two,and three clinical trials. Our research
helps us better care for our patients,allowing us to translate our findings
(01:08):
into effective treatment options.
Welcome to MedStar Health Doc Talk.
I'm Ryan Miller and I'll beyour host for today's episode.
I'm joined by Dr. JosephRoswarski, lymphoma,
leukemia attending at MedStar GeorgetownUniversity Hospital and the Georgetown
Lombardi Comprehensive Cancer Center.
His medical career includes clinicalcare and research and hematologic
(01:29):
malignancies, particularlylymphoma and multiple myeloma.
Thank you for joining uson MedStar Health Doc Talk.
Thanks so much for havingme here. Really excited.
What do we mean when we say bloodcancers? What are they? I'm not an expert,
so you'll just want todumb this down for me.
Yeah. Loosely, what we're talkingabout are disorders of the blood cells,
right? So that can be yourleukemias, your lymphomas,
(01:52):
and some other rare conditionsof other types of blood cells.
What is multiple myeloma?
So multiple myeloma is a cancer of theplasma cell, which is another, again,
type of white blood cell.
How do you determine what type ofblood condition or cancer someone has?
Yeah,we have a various utility of different
diagnostics that we can use depending onwhat the type of blood
(02:13):
cancer we're looking at.
So for a lymphoma that wemight detect by imaging,
either CAT scans or PET scans,we want to get some type of
sampling of that lymph node,whether that's a needle biopsy or
more preferably an excisional biopsy.
So we're actually taking out part of thatlymph node or the whole lymph node so
(02:34):
we can dice it up and do special stainson it to figure out what type of blood
cell is in it to comprise the lymphoma.
If we're looking at more of a leukemia,we might be looking at the blood
or at the bone marrow to again,do special studies on that to determine
what the actual cancer cell is and beable to further refine from there.
If somebody wants a second opinion,what is usually your advice to them?
(02:56):
Yeah.
So one of the main utilitiesof a place like Georgetown,
which is a tertiary care center isto lend expertise to the surrounding
community. So my expertiseis in leukemia and lymphoma.
So very frequently either patientsthemselves or referring providers from the
community are reaching out to meto gain insights and expertise in
(03:19):
either lymphoma or leukemia.
And sorry, go.
Ahead. Just to expand upon that,my general thought about second
opinions is that they're invaluable.
Blood cancers are not as common asthe things that especially community
colleges see every day likelung cancer, colon cancer.
So these are rare diseases and tohave people with specific expertise in
(03:40):
them can be very useful.
What led you to get intothe blood cancer realm?
Great question. So we allgo through fellowship.
I did mine at Walter ReedNational Military Medical Center.
When I was in my lateryears of fellowship,
I spent time at the National CancerInstitute under the lymphoid malignancies
branch and I reallyenjoyed working with them.
(04:01):
I thought they were some ofthe smartest docs around.
I thought whenever you'regoing into medicine,
you want to pick out your mentors,the people that inspire you.
Who do you want to be like whenyou're practicing on your own?
And for me, when I was working withthat group, I was like, "Oh yeah,
that's the group ofpeople I want to be like.
" So that led me to doing someextra research and lymphoma,
(04:24):
spending some time at theNational Cancer Institute,
running a clinical trialin multiple myeloma.
So I knew pretty early on that that wasthe type of cancer that I wanted to gain
more expertise in that I enjoyed takingcare of and that I was passionate about.
What type of patients do you oftensee here at MedStar Georgetown?
So under the veil of blood cancer,again, I do mostly leukemia and lymphoma.
(04:46):
So when we talk about lymphoma,that's a very, very broad umbrella.
Roughly speaking, that's theHodgkin and non-Hodgkin lymphomas.
So those I see very frequently. So whenwe think about non-Hodgkin lymphoma,
follicular lymphoma,the aggressive lymphomas like diffuse
large B-cell lymphoma and Burkettlymphoma. Chronic lymphocytic leukemia
is very closely related. Again,that's a leukemia, but it's
(05:06):
of B-cell origin. Currently,I'm also working on some of
the more acute blood cancers.
So that's something like acute myeloidleukemia or acute lymphoblastic leukemia.
So a pretty wide net within blood cancers.
Are these common cancers orwould you say they're rare?
So on a whole, right whenwe talk about B-cell,
(05:27):
so your non-Hodgkin's lymphomasand Hodgkin lymphomas,
they roughly account for I thinkabout 120,000 cases a year.
So that's a sizable portion ofnew cancer diagnosis a year.
Within that umbrella though, there arespecific diseases that are quite rare.
What are the symptoms to watch out forwhen it comes to blood cancers and is
(05:47):
there any way to notice them?
For some cancers, yes. For others, no.
So certain types of symptoms thatare sometimes more specific for blood
cancers that don't happen as much inother cancers would be what we call
constitutional symptoms or B symptoms.
So these are things like fevers,night sweats, unintentional weight loss.
(06:08):
These tend to happen morein leukemia and lymphoma.
They can happen in otherwhat we call solid tumors,
but those are definitelythings that when we see them,
we start to think aboutblood cancers immediately.
There are a lot of cancers though thatare picked up incidentally, right?
So a patient goes to their primary caredoc and they've got an elevated white
blood cell count,they feel totally fine and we will
do further testing and they've gotchronic lymphostatic leukemia.
(06:33):
They would not have knownotherwise because they don't
to their disease.
Other things related to lymphoma wouldbe swollen lymph nodes or glands,
right? So these can occur in theneck, the armpit, in the groin region.
By the time it's noticeable,is it pretty far advanced?
So yeah, that's a common misnomer.
(06:55):
Most blood cancers we think aboutdifferently again than solid tumors.
So we still use a staging system similarto solid tumors like breast cancer or
colon cancer, but very oftenthese are systemic diseases.
We have blood all throughout our body,our bone marrow, our lymph nodes.
For example, one of the more common lowgrade lymphomas, follicular lymphoma,
(07:18):
very frequently stage threeor four when we diagnose them.
So this concept ofcatching it early, again,
it's kind of a misnomer becauseat that time when they develop,
they are systemic, right? They'reall over the body by nature.
Are there blood cancer screeningtests that folks can do?
I know there are things like Cologuardfor at-home rectal cancer screening,
(07:42):
but there's nothing along thoselines for blood cancers, right?
There really isn't.
There are companies that are comingup with advanced diagnostics.
The company GRAIL comes to mind,which can test for I think around 50
different cancers by a blood-based test,but know that technology is imperfect
and leads to a frequent false positiverate,
(08:03):
but there's no specific testing that isdone to screen for leukemia and lymphoma
at this time.
What about minimal residual diseasetesting after somebody has beaten one of
these cancers? Is thatsomething you all do?
Yeah, depending on the cancer,it can either be standard of care to do
this type of measurable residual diseasetesting or not.
(08:23):
It is becoming increasingly importantboth in knowing how good of a remission
someone's in or are theyin remission at all,
being able to think about whatadditional therapies can be
recommended for them.
Currently have a clinical trial hereat Georgetown for diffuse large B-cell
lymphoma where after patientscomplete their primary therapy,
(08:44):
they're offered measurableresidual disease testing
their lymphoma at all. Ifwe can't, that's great.
They're very likely cured basedon that platform sensitivity,
but if we can still detect it,could we act on that earlier and
try to offer cure before theyactually have a relapse?
(09:06):
So this is the Alpha-3 trialthat we have through AlloGene,
which is a really kind of cutting edgeclinical trial platform and design that
I'm very interested in.
And how do you let a patient know ifthey're a candidate for one of these
clinical trials you're involved with?
Yeah. So very frequently for our patientsthat we're currently treating here at
Georgetown, we're bringingthat up to them directly.
(09:26):
I've had patients and their familiesreach out to us directly because they know
the power of these tests andthey want to get involved.
So I had a patient that came becausethey had heard about this trial in
particular and the fact that we were usingvery sensitive MRD testing and wanted
to have that for their family member.
What are the cancer therapies that arecurrently available at MedStar Georgetown
(09:47):
for leukemia and lymphoma?
At this time, we have a widearray of treatment modalities.
I think anything that'sconsidered standard of care
specifically in leukemia,we do offer allogeneic stem cell
transplant for our lymphoma and myeloma.
In addition to standard of carechemotherapy and novel targeted therapy
(10:08):
approaches, we have thingslike bispecific antibodies,
which we are using regularly.
We have CAR T-cell therapy both forour lymphoma and myeloma patients.
So anything that's considered standardof care cutting edge is something that we
have here at Georgetown, which isexcellent. In addition to that,
going beyond standard of care, we offera diverse clinical trial portfolio,
(10:30):
which is asking what isbetter, what is newer,
what is going to be the standardof care in the future, right?
So patients at Georgetown haveaccess to tomorrow's medicine.
That's incredible to hear. Whenwe talk about targeted therapy,
what is that and how does it work?
Especially lymphoma,this has been a revolutionary
class of medications.
(10:52):
So the first one actually wasdeveloped for chronic myeloid leukemia.
So when we think about the initial drugthere, it was called imatinib or glibec.
So that's a targeted moleculethat inhibits the pathway
survive.
Turning that from a fatal disease intoone that is very manageable with just a
pill. So that's the power of targetedtherapies. Geez. Yeah, it's incredible.
(11:14):
So that was revolutionary in the early2000s when that drug got approved.
The advent for that in lymphomastarted to happen with the BTK
inhibitors. So the firstdrug being ibrutinib.
And since then we've had numerous othersthat target the pathways within B cell
malignancies. Again, a lotof the non-Hodgkin lymphomas
(11:35):
So these are often pills.
They have a different side effectprofile than traditional chemotherapy and
often they're more effective.
How do you approachgiving a patient bad news?
So when I was in training, my mentortold me, if you've got bad news to share,
never go into the room without a plan.
You always need to beprepared for delivering the
(11:57):
to pivot to, I've got something.
Solution to the problem.
Solution to the problem. SoI've taken that to heart.
And so anytime I'm thinkingthis is potentially bad news,
I'm going to share.
I'm doing my homework and making surethat I'm thinking about what is that next
best option or first option sothat we can focus the conversation,
not on the bad news, but aboutwhat are we going to do about it?
(12:19):
Exactly. And is that the most commonquestion you get from patients? What next?
Depends on where they'reat in the disease process.
Very frequently for the newlydiagnosed patient with a blood cancer,
a lot of the time we'reclearing up misconceptions.
People have a thought in their headwhen they hear the word cancer and it's
usually doom and gloom.
They're thinking the worst and sometimesthat's just not the case at all.
(12:41):
So really setting expectationsand trying to educate them
about what does this actualcancer mean for them specifically,
that can be a lot ofthe conversation, right?
Before even getting to what'snext and what are we going to do,
you really need to educate and make surethat they understand what this means
for them. I can't emphasize that enough.
(13:03):
Most people do not have a lot ofunderstanding or education about
cancer. So what gets dramatizedon TV is a lot of doom and gloom.
Right?
And that's not always applicable to them.
A lot of these are manageable cancers.
Very much so.
Why should patients choose ourmalignant hematologic oncology program?
The reason to come to Georgetown formalignant hematology is that we have
(13:27):
specific expertise in these diseases.
That really does set us apart froma lot of other centers, again,
that are trying to treat everysingle disease at the same time.
That is a very difficult job.
So our job here at Georgetown is tohave specific expertise in what we're
treating. With that,we know what is the best standard of
cares for these cancers. And again,this is a rapidly evolving field.
(13:50):
We have access to cutting edge therapiesto include bispecific antibodies,
CAR T, allogeneic stem cell transplant,the newest FDA approved therapies,
as well as the clinical trials, again,which can be hugely important
in blood malignancies.
Can you tell us about themalignant hematologic oncology
(14:11):
with MedStar Georgetown's stem celltransplant and cellular immunotherapy
program?
Yeah,we work together hand in hand every day
and we kind of overlap in some ways.
We are frequently identifying patientsthat need these types of cellular
therapies or stem cell transplant andworking with our colleagues to get them
established so we can get them rapidlythose therapies when they need them.
(14:33):
We're also doing our own clinical trialsin the cellular therapy space trying to
become principal investigator ona new CAR T product that targets
two different antigens at the same time.
This is a novel construct that lookslike it might be better than our
existing standard of care CAR-T productsthat are commercially available.
(14:53):
So yeah, we work hand in handwith our cellular therapy team.
Some of us are on the cellular therapyteam as well as doing primary clinical
work for patients with blood cancers.
Dr. Rosworski,you are a decorated military veteran
who has received numerous awards duringyour time of military
service as a medical officer.
How has this valuable experience andcomplex cases been an asset for your
(15:16):
patients?
I think my military time was invaluableto shaping me to who I am today.
Being in the arms services instillsin you a sense of duty, honor,
and responsibility and I bring that topatients and I bring that to patient
care.
Sounds like that shapedyour philosophy of care.
Yeah, 100% it did. I want to make surethat I'm doing right by my patients,
(15:37):
making sure that they're getting the bestof what I can give them with my time,
with my expertise, withmy compassion. Again,
I feel very much duty andresponsibility bound to them.
That's wonderful to hear and I knowthey're lucky to have you as their doctor.
Can you break down phaseone, two, and three?
So clinical trials are donein phases for a reason.
(15:58):
As we're trying to develop newtherapies or combinations of therapies,
we need to first establish that they'resafe. So that's a phase one trial.
Just establish, are the drugs orthis new novel platform, is it safe?
Once we've established that andwe know we have a safe drug,
then we move on to a phase two study.
So when we get to phase two studies,what we're trying to establish is what
is the efficacy of the new regimengenerally but not always these are
(16:21):
non-randomized studies where we're justtrying to see how efficacious
is this new platform.
Once we've established that and it lookslike this is potentially a promising
drug,then we move to phase three where that
is generally a randomized study againstwhat's considered a standard
of care. So new platform,new agent versus today's current
standard of care. So those are generallyrandomized studies and those are the
(16:45):
ones that generally will lead to FDAapproval for new drugs.
Thank you for that.
Is there a specific clinical trialthat you're most excited about?
Yeah, there's a trial that we're currentlyenrolling on right now that I'm very
excited about.
This is a partnership with MemorialSloan Kettering in New York and our
consortium partner in New Jerseyat the John Thur Cancer Center.
(17:09):
Here we're looking at using abispecific antibody called mosinatuzumab
and frontline meaning patients thathave not been treated before follicular
lymphoma. This trial is not beingdone at a lot of places. Again,
this is just three centers that aredoing this, including Georgetown.
We know that this antibody,bispecific antibody works incredibly
well in follicular lymphoma.
(17:30):
It's currently approved in the thirdline setting and when anything works as
well as most edutuzumab did and in thethird line setting, the question is,
should we be moving it up?
Should we be taking it to secondline or first line therapy? So again,
this is a first line study. We'vealready enrolled a lot of patients on it.
Patients are responding well to therapy.
The current standard of care infirst line follicular lymphoma is
(17:52):
chemoimmunotherapy, so chemo plusantibodies. So with this trial,
we're asking a question which ishow does a bispecific antibody,
so not utilizing any chemotherapy,how does that work for patients?
And the results that we've alreadypublished at the American Society of
Hematology are incredibly encouragingwith response rates and complete response
(18:12):
rates very similar to chemoimmunotherapy.
So I've had many patients fromthe region ask about this trial.
Sounds like a game changer.
Yeah. I think most of us in the lymphomafield are starting to think that
are we entering in a future wherechemotherapy is kind of a wayside?
We're getting there and it's trialslike this, follicular lymphoma,
(18:35):
especially where we're startingto ask those questions,
can we start to pivotaway from chemotherapy?
There are cancers where we'vealready done that, right?
In chronic lymphocytic leukemia, again,we're using these targeted therapies
almost exclusively for patients becausethey work better than chemotherapy and
these types of concepts are moving toother B-cell malignancies
in rapid fashion.
(18:57):
Dr. Rosworski, how do you feel aboutthe future of blood cancer care?
Hearing you talk aboutthose clinical trials,
it sounds like there's alot of reason for optimism.
There is a ton of reason for optimism.
It's just getting better and better.
I frequently will tell patients whenI'm meeting them for the first time,
depending on what the cancer is, right?
There's no better day to getdiagnosed with this blood cancer.
That's a great attitude to have.
(19:18):
So for certain cancers, our curerates are already very high.
The future is that we're going topush those cure rates even higher.
There are some cancers we cannot cure,but we hope to change that, right?
I think we're developing the toolswhere we can start to cure more and more
blood cancers. Well.
The future is bright.
I've been talking with Dr. JosephRosworski at MedStar Georgetown University
(19:40):
Hospital in Washington, DC.
Thank you for sharing your expertisewith us today on MedStar Health Doc Talk.
Thanks, Ryan. It's been great to be here.
For more information about our malignanthematology oncology group, please call
202-444-5209.
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