Discover and read the best of Twitter Threads about #pcsm

Most recents (10)

In May 2019, Dr. @rschilsky & I co-chaired the #AAADV19 Workshop Plenary Session "Decentralized #ClinicalTrials: The Future is Now." An incredible group of panelists from academia, industry, govt, & patient #advocacy 👇discussed the rationale, challenges, & opportunities of DCTs. Image
No one knew yet that the #COVID19 #pandemic was just around the corner. In Mar 2020, FDA released a guidance on conduct of #clinicaltrials during the pandemic:…, & colleagues wrote about the impact on #OncTwitter trials:…. /2
FDA has now released a draft guidance on decentralized #clinicaltrials for drugs, biological products, & devices covering #telehealth, remote assessments, consent, shipping of IP, & more:…. #MedTwitter #regulatory #drugdevelopment Image
Read 5 tweets
Is there a role for Local Tx of the Primary Tumor for Patients with Metastatic Cancer?

🚫Many studies demonstrate no benefit.
📌We performed a MetaAnalysis to evaluate the average effect of Local Tx across various tumors.

A thread🧵#AMSM #PRIMETX…

Critics of Local Tx to the Primary Tumor

📌 Many providers think local control of the primary tumor in the setting of M1 dz is akin to “closing the barn door after the horse has bolted”
📌 Ian Tannock wrote a fantastic article on this back in 2000.

Supporters of Local Tx

📌Some support aggressive ablation of all sites due to the enhanced ability to detect occult disease with improved imaging technologies and 📉 toxicities with complete ablation.

Read 28 tweets
Oral boards for #RadOnc are approaching. Here is advice to anyone taking the exam.

@ARRO_org @ASTRO_org @ACRORadOnc @ACROresident
1, #RadOnc oral boards are the most clinically relevant exams (vs rad bio, physics, written exam, inservice, etc).
Many of the questions about management come straight from @NCCN guidelines, so use these as a primary reference.
2, have a prepared script of what to say for standard questions. eg, workup, setup, margins, doses

Here is an example for prostate ca history / workup
Read 23 tweets
Facility volume has been explored as a surrogate of quality of care in medicine.
In oncology, facility surgical volume is correlated with survival.

Work from @StoltzfusKelsey @LeilaTchelebi @DanTrifMD @NirajGusani in @JNCCN

Read 17 tweets
Salvage therapy for prostate cancer after prostatectomy: international consensus on evaluation and management

#PCSM ImageImage
Since the 2000s, the use of radical prostatectomy has been increasing for prostate cancer (vs external beam and brachytherapy).

@EUplatinum Image
The increase in prostatectomy includes all risk groups, particularly those with high-risk features

Read 30 tweets
I’m delighted to share the latest publication from the NCI GU Malignancies Center of Excellence, “Sequential prostate MRI in high-risk prostate cancer treated with neoadjuvant enzalutamide is predictive of therapeutic response” published today in @CCR_AACR…
Although most patients diagnosed with higher risk prostate cancer receive surgery or radiation a newer approach is to treat up-front with targeted therapy. We can determine how well the therapy worked by comparing the amount of tumor before treatment to the amount after treatment
Read 10 tweets
Another study of interest on systemic radiation in metastatic prostate cancer…

TheraP: randomised phase II trial of 177Lu-PSMA-617 vs cabazitaxel in progressive metastatic castration resistant prostate cancer (mCRPC) #ASCO20 #pcsm #radonc
ANZUP 1603 with @Prof_IanD et al evaluated radionuclide Lutetium-177 linked to prostate specific membrane antigen (177-Lu-PSMA-617) 6-8Gbq every six weeks x 6 vs. cabazitaxel 20 mg/m2 q 3 wks x 10 in men with mCRPC progressing after paclitaxel #ASCO20 #pcsm
200 men randomized to each drug stratified by prior abirateron/enzalutamide use, >20 metastases, study site. Median age 72 years old

Primary endpoint response rate, secondary PSA relapse free survival and overall survival.
#ASCO20 #pcsm #radonc
Read 6 tweets
TWEETORIAL of GETUG-16 and hormone therapy with SRT

I have been asked many times to discuss this paper and my views on the topic now that the GETUG-16 was updated. It is a great trial with numerous strengths. So here we go…
@MCWardMD @RTendulkarMD @subatomicdoc #PCSM
@MCWardMD @RTendulkarMD @subatomicdoc 2/
Overall the trial can be viewed as positive or negative. How is this?

Original primary endpoint: PFS = was met!

Sample size was increased to be powered for OS, which was not met. So the endpoint the trial was actually powered for was not met = negative.
@MCWardMD @RTendulkarMD @subatomicdoc 3/
PFS should really not be used for ph3 trials. PFS basically equals BCR, which will near always be improved w/ ADT as you are inhibiting the PSA-based endpoint you are measuring. Even in RTOG 9408 low risk pts have a BCR benefit. Signal finding not practice changing.
Read 15 tweets
So @ANZUPtrials #ENZAMEt #PCSM results fro #HRQOL were presented today at #ESMO19, here are some of the headline outcomes 1/5 #InternationalCollaboration #RCT
@ANZUPtrials Acknowledgements usually come last but we can't do these studies without #patients. So our very sincere thanks to the 1125 men living with mHRPC #PCSM who volunteered to take part, have the treatment, & fill out #HRQOL questionnaires! #ENZAMET @anzupartners #ESMO19 2/5
@ANZUPtrials @anzupartners In the @ANZUPTrials #ENZAMET study we measured #HRQOL using @EORTC_QLG's #QLQC30 (global qol, social, physical, emotional, functional domains) & Prostate Cancer module #PR25 at weeks 0, 4, 12, then 12-weekly until clinical progression #PCSM #ESMO19 3/5
Read 7 tweets
Radiation to the prostate for metastatic prostate cancer is now endorsed by NCCN 2019. This topic can be a bit confusing, so here is a tweetorial for residents & community practice #radonc docs (including my #CleClinicCancer colleagues taking oral boards soon). #pcsm 1/21
I recently pieced together some key points on primary prostate RT for M1 for a resident teaching session, which I thought I’d share here. Apologies in advance if any typos or errors in this thread. 2/21
First, some definitions. mCSPC = metastatic castrate sensitive prostate ca. MDT = metastasis directed therapy (surgery or SBRT to all sites). Oligomets = 1-3 or 1-5 mets. 3/21
Read 23 tweets

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