Charles L. Loprinzi, MD
Charles L. Loprinzi, MD may have landed somewhat accidentally into the world of symptom management research, but once he arrived, he was there to stay.
Loprinzi has dedicated his medical career to oncology, including more than 3 decades at the Mayo Clinic in Rochester, Minnesota, where he currently serves as the Regis Professor of Breast Cancer Research. Underpinning much of his work, both at the bench and the bedside, is a dogged pursuit of interventions to provide patients with relief from the debilitating symptoms that often accompany a cancer diagnosis and its treatment.
“I was going to become a surgeon when I was in the first year or 2 of medical school ... but the very first clinical rotation I had was Internal Medicine, and I found that that was much more fun than sitting in medical school classes,” Loprinzi explained.
He said that he liked all of Internal Medicine’s subspecialties, and oncology offered him a way to touch upon many of them. Moreover, oncology was a field where the challenges were plenty: “We needed progress—there were a lot of questions that needed answering.”
Throughout his life, Loprinzi relished such challenges. Then he met Charles “Chuck” Moertel when he arrived at the Mayo Clinic in the mid-1980s. Moertel also chaired the North Central Cancer Treatment Group and was looking for someone to lead symptom-control research under the auspices of the Community Clinical Oncology Program (CCOP) because, as he told Loprinzi, “the treatment people don’t want to deal with such research.”
Loprinzi described the prevailing sentiment at the time more bluntly recalling what a highly respected colleague said to him during his days as an oncology fellow at the University of Wisconsin: “We don’t do puke studies here.”
Nevertheless, symptom management into the CCOP’s work in the area of cancer prevention and control, and Moertel saw in Loprinzi a promising researcher well suited to lead the effort.
Loprinzi agreed and has never looked back.
Prioritizing Symptom Research
A native of Portland, Oregon, and the second of 10 children born over a span of only 11.5 years, Loprinzi said he learned early how to make his own way and to figure things out. He worked at a young age, learned to save the money he needed for his education, and set off for college at Oregon State University, sight previously unseen, with only 2 “banana boxes” of belongings.
These early experiences helped to set the stage for a career dedicated to problem solving and tackling the side effects that patients with cancer often confront and that, for some, persist long after their therapy ends.
Symptom-management trials were virtually nonexistent when Moertel first approached him, but Loprinzi has since authored hundreds of studies focusing on oral mucositis, anorexia/ cachexia, hot flashes, and chemotherapy-induced neuropathy, to name a few areas.
Randomized clinical trials he conducted early in his career demonstrated that megestrol acetate can improve appetite and lead to weight gain in patients with anorexia/cachexia. The research also illuminated the agent’s toxicity profile. Additional research Loprinzi led showed that megestrol acetate was helpful at low doses at relieving hot flashes in women with breast cancer, another principal focus of his research over the years.
Loprinzi also sought to find a solution to oral mucositis, a frequent and debilitating side effect of 5-fluorouracil (5-FU) and other chemotherapies. Following up on a suggestion of one of the nurses he was working with in the early 1990s, he led a study giving patients snow cone-like ice chips starting 5 minutes prior to 5-FU administration and continuing for 30 minutes.
The result: a 50% reduction in mucositis, according to patient-reported outcomes; ensuing studies replicated the benefit. Cryotherapy is now recommended in guidelines from the Multinational Association of Supportive Care in Cancer—not only for patients receiving 5-FU, but for other chemotherapeutic agents as well.
Currently, Loprinzi’s research is largely focused on chemotherapy-induced peripheral neuropathy (CIPN), a big problem, he said, that can be particularly hard on patients when it persists after treatment ends. He has led multiple randomized clinical trials testing promising agents for prevention of CIPN and/or treatment of established CIPN, but, “unfortunately, neuropathy remains a major clinical problem.”
“There is a substantial minority of patients who have problems [with CIPN] later on, which can be crippling for them,” he explained, which means it is very important to watch these patients closely as they are receiving potentially neurotoxic chemotherapy and identify those more prone to it early on. At times, stopping neurotoxic chemo- therapy is in order.