Podcasts about Cisplatin

A splashy large study and two small studies suggest IV Mg in pre-hydration fluids can decrease the risk of cisplatin kidney injury. Gupta et al. JAMA Oncol (2025): doi:10.1001/jamaoncol.2025.0756 PRAGMATIC. ESMO Open (2022): https://doi.org/10.1016/j.esmoop.2021.100351 Yamamoto et al. Anticancer Res (2015): https://pubmed.ncbi.nlm.nih.gov/25862878/

Send us a textJoin us for this Simply Oncology is Back in Bladder Cancer with the amazing Prof Rob Jones.Part 1 of 2 on a free ranging overview of metastatic bladder cancer treatment in the UK.Cisplatin vs CarboplatinRole of IO2nd line chemo?

Interview with Shruti Gupta, MD, MPH, author of Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury. Hosted by Vivek Subbiah, MD. Related Content: Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury

Interview with Shruti Gupta, MD, MPH, author of Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury. Hosted by Vivek Subbiah, MD. Related Content: Intravenous Magnesium and Cisplatin-Associated Acute Kidney Injury

What John Morley originally thought was a urinary tract infection turned out to be a diagnosis of bladder cancer.  At first, he was told it was a mild form of the disease.  Then the diagnosis was upgraded to T2 Muscle Invasive Bladder Cancer, requiring a radical cystectomy meaning he would need to get his bladder removed.  His care team next told John he would also have to get his prostate taken out.  Next a mass was detected on his spleen, which meant that it, too, would have to be removed.  Treatment and recovery were tough, but he now urinates into a bag known as an ileal conduit, has become acclimated to it and leads a healthy lifestyle.   John Morley of Haymarket, Virginia is a Navy veteran who enjoyed scuba diving, hiking and other outdoor activities when in late 2021, he noticed blood in his urine.  He sought medical attention with his primary care physician, who upon learning of John's symptoms, referred him to a urologist.  The urologist called for cystoscopy, a procedure in which a camera is inserted in the patient's urethra, and based on its results, said a biopsy would be needed.   John received a blend of bad and good news.  He was told he had bladder cancer, but because it was T1 Non-Muscle Invasive Bladder Cancer, the cancer had not spread from his bladder.  John and his wife felt like celebrating and went out to dinner.   However, a short time later, John Morley was called back into the doctor's office.  He and his wife were told a followup check of his pathology report showed his cancer had been upgraded to T2 Muscle Invasive Bladder Cancer.  Not only did this mean John would have to undergo a radical cystectomy to remove his bladder, but the procedure would have to be preceded by two or three months of chemotherapy, a regimen that would include cisplatin and gemacitabine.   As he wondered what life would be like without a bladder, the news for John got worse.  He was told he would have to undergo a prostatectomy for the removal of his prostate.  Then a mass was detected in his spleen, and the spleen would have come out as well, all three in the same surgery.   The multi-faceted surgery was a success, but John had to decide how he was going to urinate.  Over two other options, he chose an ileal conduit.  It was attached to his stomach, close to his navel.  The urine drained into a urostomy bag.   Following the operation, John relied on walking to help him slowly regain his strength.  He has a good command of his use of the urostomy bag, and though it wasn't what he enjoyed pre-diagnosis, John Morley has returned to a healthy lifestyle that includes scuba diving.   Additional Resources:   Support Group: The Bladder Cancer Advocacy Group: https://www.bcan.org   John Website: https://www.beatbladdercancer.org            

Diana Ash had suffered from irritable bowel syndrome much of her life, but in 2019, she believed the IBS symptoms she felt were something altogether different.  Her concerns were proven correct when an ultrasound indicated a mass near her abdomen the size of a “mini football.”  Not long after that, she was diagnosed with Stage 1C Ovarian Cancer.  Diana underwent an oophorectomy, a surgical procedure that successfully removed one ovary and one fallopian tube.  After the surgery, she had to undergo BEP chemotherapy, an extremely aggressive regimen.  However, she achieved survivorship and has written a book about her experience.   Diana Ash led an active lifestyle in her hometown of Ottawa, Ontario, Canada.  She enjoyed hiking, running and diving; but ever since she was a small child, Diana dealt with irritable bowel syndrome.  In 2019, in addition to IBS' typical symptoms, she experienced fatigue and loss of appetite.  When she sought medical attention, she was told her problem was IBS and nothing more.  To Diana, that was not a satisfactory response.   She insisted on blood work and an ultrasound.  The latter revealed a mass near her abdomen.  It measured 10 X 16 cm, or as she said, “the size of a mini football.” Diana pressed doctors for more information and accurate information, and she was eventually diagnosed with Stage 1C ovarian cancer.  She was shocked with the diagnosis, but relieved that her cancer had been caught at an early stage, which is not typical for those diagnosed with ovarian cancer.   Diana underwent an oophorectomy, a surgical procedure which removed one of her ovaries and one of her fallopian tubes.  The surgery was a success, but her surgeon said the procedure was the easy part of her treatment.  Next up was an extremely aggressive chemotherapy regimen.  BEP chemotherapy includes cisplatin, bleomycin and etoposide.  Diana experienced the usual side effects, but was even more difficult was her being told that she would no longer be able to run or dive.   There was also the matter of childbearing.  She received a Lupron injection, which meant she had to deal with its side effects while dealing with the side effects from her chemo regimen.  She was eventually able to freeze some of her eggs, which will enable her to have kids.   Diana Ash achieved survivorship and wants to help others diagnosed with cancer.  Fueled by a message emphasizing optimism and self-advocacy, she wrote “Take Back The Power,” available on Amazon.  The book was written in English, but as a bilingual Canadian, she hopes to one day translate the book into French.   Additional Resources:   Diana's Book: “Take Back The Power,” a guide for young women with cancer      

In late 2018, Samina Cepal went in for her routine pap smear, but her visit turned out to be anything but routine.  It led to a CT scan, a pelvic ultrasound and a diagnosis of cervical cancer.  Samina underwent a grueling regimen of chemotherapy and radiation therapy.  She experienced acute fatigue, weight loss, hair loss and despair, but three months later, her doctor said she had no evidence of disease.  These days, Samina can exercise, which includes vigorous use of a hula hoop, and has regained her appetite and her pre-diagnosis weight.

What Rebecca Esparza thought was fibroid tumors led to a diagnosis of ovarian cancer at age 30.   Unbeknownst to her until after her surgical procedure, doctors performed a radical hysterectomy.  In addition to a difficult chemotherapy regimen, Rebecca had to deal with all of the above with no health insurance.  Rebecca made it to survivorship only to learn years later, she had papillary thyroid cancer.   However, she again made it to survivorship and is a tireless cancer advocate.

In this podcast, Dr. Robert I. Haddad, from the Dana-Farber Cancer Institute in Boston, MA, USA, and Dr. Kevin Harrington from the Royal Marsden NHS Foundation Trust in London, UK, share their clinical experience and provide their perspectives related to cisplatin ineligibility in patients with locally advanced squamous cell carcinoma of the head and neck, discuss the limited clinical evidence for adjuvant treatment of patients with resected, high-risk disease, and highlight ongoing clinical trials that have the potential to provide new treatment options in this setting.   This podcast is published open access in Targeted Oncology and is fully citeable. You can access the original published podcast article through the Targeted Oncology website and by using this link: https://link.springer.com/article/10.1007/s11523-024-01101-9. All conflicts of interest can be found online.   Open Access This podcast is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The material in this podcast is included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

Theralase Technologies CEO Roger DuMoulin-White joined Steve Darling from Proactive to announce a significant advancement in cancer treatment. The company's lead drug formulation, Rutherrin, has demonstrated a remarkable ability to enhance the efficacy of Cisplatin, a commonly prescribed chemotherapy drug, in treating chemotherapy-resistant Non-Small Cell Lung Cancer in a preclinical animal model. DuMoulin-White detailed the experimentation process, where mice were divided into two groups: a control group treated with Cisplatin alone and an active group treated with a combination of Cisplatin and Rutherrin. The results were striking. The mice in the active group showed a significantly higher enhancement of Cisplatin efficacy, marked by a notable increase in overall survival compared to the control group. The statistical significance of these results highlights the potential impact of Rutherrin in improving treatment outcomes for patients with aggressive NSCLC. Theralase Technologies believes that the efficacy of Rutherrin could be further improved by combining it with additional treatments such as radiation or Metformin, which could activate Rutherrin® while it resides in NSCLC cells. This promising preclinical data lays the groundwork for future studies and potential clinical applications, offering new hope for patients battling resistant forms of lung cancer. #proactiveinvestors #theralasetechnologiesinc #tsxv #tlt #otcqb #tftff #MedicalResearch #HealthcareInnovation #PatientCare #CancerResearch #ProactiveInvestors #invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews#invest #investing #investment #investor #stockmarket #stocks #stock #stockmarketnews

In this podcast, authors discuss the evolving role of platinum-based chemotherapy in patients with advanced urothelial cancer in the context of EV-302 trial results and describe practical considerations in patients receiving first-line cisplatin- or carboplatin-based chemotherapy followed by avelumab maintenance therapy. This podcast is published open access in Advances in Therapy and is fully citeable. You can access the original published podcast article through the Advances in Therapy  website and by using this link: https://link.springer.com/article/10.1007/s12325-024-02922-w. All conflicts of interest can be found online. This podcast is intended for medical professionals. Open Access This podcast is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The material in this podcast is included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

Drs Park and Sonpavde discuss the CheckMate901 trial, which showed survival improvements with nivolumab plus chemotherapy in metastatic urothelial cancer.

An ultrasound revealed a large mass in Melinda Bachini's liver, and that led to a diagnosis of cholangiocarcinoma, a form of bile duct cancer.  Doctors removed two thirds of her liver.  Unfortunately, her cancer returned three months.  Melinda was hoping to take part in a clinical trial, but when insurance wouldn't cover a clinical trial, settled for a chemotherapy regimen.  When the chemo didn't help but left her with a bunch of awful side effects, she decided to end the chemotherapy treatment and live as long as she could.  Then she and her husband found out about another opportunity for a clinical trial, pursued it, qualified for it.  The trial led to her achieving survivorship.

Fennec Pharmaceuticals joins to talk about ototoxicity (hearing loss) caused by the chemotherapy drug Cisplatin. Sponsored by Dee's Nuts. Use code "nutcheck" at checkout on https://grabdeesnuts.com Want to be a guest? Apply here: ⁠https://www.testicularcancerawarenessfoundation.org/it-takes-balls-submissions⁠ Follow Testicular Cancer Awareness Foundation: ⁠https://www.testescancer.org https://www.twitter.com/testescancer⁠ ⁠https://www.instagram.com/testescancer https://www.facebook.com/tca.org/⁠ For more information on Fennec: https://fennecpharma.com Follow Steven Crocker: https://www.twitter.com/stevencrocker https://www.instagram.com/stevencrocker https://www.facebook.com/steven.crocker2 Theme song: No Time Like Now - Tom Willner www.tomwillner.com

Hearing loss is a very well known side effect and long term effect that survivors of Pediatric Cancer must be aware of, especially if they are being treated with Cisplatin during Chemotherapy, which is a very effective medicine in helping to save lives of these children and adolescents . Holly Reames and Eric Meyer, who work at Fennec Pharmaceuticals will talk about the ramifications of this hearing loss, which if it happens, is always permanent. 

Medical science has come a long way in the last century. Little more than a hundred years ago, doctors treated many maladies by bloodletting! Now there are so many targeted medications, they have to get creative with the names . . . like Cisplatin, Moxifloxacin and Pancuronium. Today on A NEW BEGINNING, Pastor Greg Laurie says we should treat our spiritual ills with a kind of targeted, effective treatment. Treatment recommended by our Maker. Listen on harvest.org --- Learn more and subscribe to Harvest updates at harvest.org . A New Beginning is the daily half-hour program hosted by Greg Laurie, pastor of Harvest Christian Fellowship in Southern California. For over 30 years, Pastor Greg and Harvest Ministries have endeavored to know God and make Him known through media and large-scale evangelism. This podcast is supported by the generosity of our Harvest Partners.Support the show: https://harvest.org/supportSee omnystudio.com/listener for privacy information.

Medical science has come a long way in the last century. Little more than a hundred years ago, doctors treated many maladies by bloodletting! Now there are so many targeted medications, they have to get creative with the names . . . like Cisplatin, Moxifloxacin and Pancuronium. Today on A NEW BEGINNING, Pastor Greg Laurie says we should treat our spiritual ills with a kind of targeted, effective treatment. Treatment recommended by our Maker. Listen on harvest.org --- Learn more and subscribe to Harvest updates at harvest.org . A New Beginning is the daily half-hour program hosted by Greg Laurie, pastor of Harvest Christian Fellowship in Southern California. For over 30 years, Pastor Greg and Harvest Ministries have endeavored to know God and make Him known through media and large-scale evangelism. This podcast is supported by the generosity of our Harvest Partners.Support the show: https://harvest.org/supportSee omnystudio.com/listener for privacy information.

David Freyer, DO, MS provides a review of hearing loss as a serious and permanent side effect caused by cisplatin chemotherapy, recent research regarding its prevention, and its relevance for young people treated for osteosarcoma.David R. Freyer, DO, MS is Professor of Clinical Pediatrics, Medicine, and Population and Public Health Sciences at the Keck School of Medicine, University of Southern California. He currently serves as Director of the Survivorship and Supportive Care Program in the Cancer and Blood Disease Institute at Children's Hospital Los Angeles, and as Director of the Cancer Survivorship Program and Co-Director of the Adolescent and Young Adult Cancer Program, both at the USC Norris Comprehensive Cancer Center. Dr. Freyer's clinical care and research are concentrated in cancer survivorship, cancer control/supportive care, and AYA oncology with interests in treatment-related toxicity, survivorship care transition, cancer care disparities, and patient-reported outcomes. He had the privilege of leading ACCL0431, a randomized Children's Oncology Group study and pivotal trial leading to FDA approval of sodium thiosulfate as the first proven agent to prevent cisplatin-induced hearing loss in young people treated for cancer.

Cisplatin is the mainstay for concurrent chemoradiotherapy in Locally Advanced Head and Neck Cancers. What happens to that significant group of patients who cannot have cisplatin? Michael and Josh focus on this challenging subgroup of patients. Can docetaxel be used as an alternative? This week, they debut a small but significant segment of our humble podcast called "Spotlight", where we dive deep into a single potentially practice-changing trial. Enjoy!Links to studies discussed in this episode (subscription may be required):Docetaxel as a radiosensitiser: https://ascopubs.org/doi/abs/10.1200/jco.22.00980#:~:text=We%20found%20that%20the%20use,of%20life%20of%20the%20patients.For more episodes, resources and blog posts, visit www.inquisitiveonc.comPlease find us on Twitter @InquisitiveOnc!If you want us to look at a specific trial or subject, email us at inquisitiveonc@gmail.comArt courtesy of Taryn SilverMusic courtesy of Music Unlimited: https://pixabay.com/users/music_unlimited-27600023/Disclaimer: This podcast is for educational purposes only. If you are unwell, seek medical advice. Hosted on Acast. See acast.com/privacy for more information.

Jeff Knapp twice survived a form of tongue cancer.  His journey was arduous and multi-faceted.  It included radiation, chemotherapy, his jaw being cut in half and the removal of part of his tongue, ending his career as an actor.  But Jeff's life is as full as can be, including travel and marathon running with his wife, Robin.

The Michigan State University Research Foundation has been enhancing research, encouraging innovation, supporting entrepreneurship, and facilitating economic development through modern commercialization practices, venture creation activity, and innovation partnerships at Michigan State University and across Michigan for 50 years. Executive Director David Washburn reflects on the foundation's history, mission, and impact and on challenges and opportunities ahead for the next 50 years.  Conversation Highlights: (2:26) – “We had flown under the radar for many decades. And when you unpack the story of the foundation, it was like ‘Holy Cow.' There aren't many organizations like this that exist in North America.” (3:02) – “In the late 60s and early 70s, most public universities came to the realization that state support probably wasn't going to be able to keep pace with the growth and expansion of public universities.” (6:13) – “One major inflection point that happened at the foundation was the discovery of Cisplatin and Carboplatin cancer therapeutics.” (7:08) – “Faculty researchers here at MSU discovered a cure for cancer.” (12:07) – “Many faculty in university decided ‘Well, what if we just start new companies and go out and raise venture dollars to see if we can build up a product or service here locally with some local venture dollars?'” (13:30) – “Our focus now at the foundation is in a couple areas. I would refer to them as more venture creation…a lot of states and municipalities are trying to figure out how to create new jobs and an innovation ecosystem. That's the space we're playing in a lot with Spartan Innovations.” (15:40) – “The board approved it and we put together Red Cedar Ventures and have invested in close to 120 start-up companies. We've deployed close to $10 million out of Red Cedar Ventures, and those companies have gone on to raise hundreds of millions of dollars from the venture markets in the state and around the Midwest and on both coasts.” (16:20) – “Between Michigan Rise and Red Cedar Ventures, we have close to $40 million in two robust captive venture funds.” (18:10) – “We built a headquarters for TechSmith because they have a very robust student intern program, and over half of their employees are MSU alumni. They wanted to be closer to campus…They're trying to compete with the Googles and Amazons of the world. And they thought if they had a cool campus, they would have a shot. I think that's helped them.” (18:58) – “We're building spaces so as we start up new companies, not only do we want to help them with their business plan and early-stage funding, but we're trying to find them a home in and around our ecosystem. We think that combination leads to economic development, job growth, and economic diversity. That's really the place where we collaborate and help MSU.” Listen to “MSU Today with Russ White” on the radio and through Spotify, Apple Podcasts, and wherever you listen.

Wir thematisieren mal wieder die HIPEC. Es geht um eine randomisierte Studie, in welcher der Einfluss unterschiedlicher intrabdomineller Drücke auf die Gewebeverteilung und Pharmakokinetik von Cisplatin untersucht wurde. Coole Studie aus Italien! Zudem sprechen wir über die Probleme und Notwendigkeiten beim Aufbau eines Peritonealkarzinosezentrums. Kusamura S, Azmi N, Fumagalli L, Baratti D, Guaglio M, Cavalleri A, Garrone G, Battaglia L, Barretta F, Deraco M. Phase II randomized study on tissue distribution and pharmacokinetics of cisplatin according to different levels of intra-abdominal pressure (IAP) during HIPEC (NCT02949791). Eur J Surg Oncol. 2021 Jan;47(1):82-88. doi: 10.1016/j.ejso.2019.06.022. Epub 2019 Jun 21. PMID: 31262599.

Discussing the EV-103 Cohort K study, which resulted in the FDA approval of Enfortumab Vedotin + Pembrolizumab FDA Approval in the Cisplatin ineligible advanced urothelial carcinoma patients. In discussion with the lead author, Dr. Jonathan Rosenberg - Chief of Genitourinary Oncology Service at Memorial Sloan Kettering Cancer Center.

Blurb In this posdcast Dr. Luigi Rolli, Dr. Chiara Ciniselli, Dr. Paola Perego and Dr. Giulia Bertolini discuss the biological role of the antimetastatic gene KiSS1 based on the results they obtained in Non Small Cell  Lung Cancer cellular models and in liquid biopsies obtained from patients and healthy subject

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.10.548401v1?rss=1 Authors: Chen, X., Sokirniy, I., Wang, X., Jiang, M., Mseis-Jackson, N., Williams, C., Mayes, K., Jiang, N., Puls, B., Du, Q., Shi, Y., Li, H. Abstract: While astrocyte-to-neuron (AtN) reprogramming holds great promise in regenerative medicine, the molecular mechanisms that govern this unique biological process remain elusive. MicroRNAs (miRNAs), as post-transcriptional regulators of gene expression, play crucial roles during development and under various pathological conditions. To understand the function of miRNAs during AtN reprogramming process, we performed RNA-seq of both mRNAs and miRNAs on human astrocyte (HA) cultures upon NeuroD1 overexpression. Bioinformatics analyses showed that NeuroD1 not only activates essential neuronal genes to initiate reprogramming process but also induces miRNA changes in HA. Among the upregulated miRNAs, we identified miR-375 and its targets, neuronal ELAVL genes (nELAVLs), which encode a family of RNA-binding proteins and are also upregulated by NeuroD1. We further showed that manipulating miR-375 level regulates nELAVLs expression during NeuroD1-mediated reprogramming. Interestingly, miR-375/nELAVLs are also induced by reprogramming factors Neurog2 and ASCL1 in HA suggesting a conserved function to neuronal reprogramming, and by NeuroD1 in the mouse astrocyte culture and spinal cord. Functionally, we showed that miR-375 overexpression improves NeuroD1-mediated reprogramming efficiency by promoting cell survival at early stages in HA even in cultures treated with the chemotherapy drug Cisplatin. Moreover, miR-375 overexpression does not appear to compromise maturation of the reprogrammed neurons in long term HA cultures. Lastly, overexpression of miR-375-refractory ELAVL4 induces apoptosis and reverses the cell survival-promoting effect of miR-375 during AtN reprogramming. Together, we demonstrate a neuro-protective role of miR-375 during NeuroD1-mediated AtN reprogramming and suggest a strategy of combinatory overexpression of NeuroD1 and miR-375 for improving neuronal reprogramming efficiency. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Drs Sumanta Pal and Sarah P. Psutka discuss the current quality-of-life research in bladder cancer, prehabilitation practices, helpful technology, and how this can be applied to renal cell carcinoma. Relevant disclosures can be found with the episode show notes on Medscape (https://www.medscape.com/viewarticle/984241). The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources Renal Cell Carcinoma https://emedicine.medscape.com/article/281340-overview Patient-centered Outcomes Research https://www.pcori.org/research/about-our-research/patient-centered-outcomes-research Bladder Cancer https://emedicine.medscape.com/article/438262-overview Bladder Cancer Advocacy Network https://bcan.org/ Translational Research Program https://trp.cancer.gov/ Bladder Cancer Chemotherapy https://bcan.org/bladder-cancer-chemotherapy/ ExerciseRx https://thesportsinstitute.com/our-work/exercise-rx/ Forty Years of Cisplatin-based Chemotherapy in Muscle-invasive Bladder Cancer: Are We Understanding How, Who and When? https://pubmed.ncbi.nlm.nih.gov/30392011/ Changes in Lean Muscle Mass Associated With Neoadjuvant Platinum-based Chemotherapy in Patients With Muscle Invasive Bladder Cancer https://pubmed.ncbi.nlm.nih.gov/30417052/ Sarcopenia https://www.cancer.gov/publications/dictionaries/cancer-terms/def/sarcopenia Current Role of Cytoreductive Nephrectomy in Metastatic Renal Cell Carcinoma https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057358/ Rural-urban Disparities in Geriatric Assessment (GA) Impairments and Mortality Among Older Adults With Cancer: Results From the Cancer and Aging Resilience Evaluation (CARE) Registry https://ascopubs.org/doi/abs/10.1200/JCO.2022.40.16_suppl.12012 sliceOmatic https://www.tomovision.com/products/sliceomatic.html Early Complications and Mortality Following Radical Cystectomy: Associations With Malnutrition and Obesity https://pubmed.ncbi.nlm.nih.gov/30417048/ Sarcopenic Obesity: What About in the Cancer Setting? https://pubmed.ncbi.nlm.nih.gov/35436691/ IO-IO vs IO-TKI Efficacy in Metastatic Kidney Cancer Patients: A Structured Systematic Review Over Time https://pubmed.ncbi.nlm.nih.gov/36333148/ Cytokine Storm https://www.cancer.gov/publications/dictionaries/cancer-terms/def/cytokine-storm Cytokines, Inflammation, and Pain https://pubmed.ncbi.nlm.nih.gov/17426506/ Assessment of Distress and Quality of Life in Rare Cancers https://pubmed.ncbi.nlm.nih.gov/30171792/

When 17-year-old Asa Newell felt acute pain in a testicle, pain that reached around to his back, first he hesitated, but then he went to get it checked out.  It didn't take a doctor long to determine that Asa had testicular cancer.  Asa wanted to minimize or eliminate the possibility of it spreading or returning, so he chose an aggressive, chemotherapy-based treatment regimen.  That, along with a positive attitude resulted in survivorship.

Cisplatin is a common chemotherapy drug used to treat several types of cancer in both adults and children. While effective, the drug can build up in the inner ear and cause permanent damage. The resulting hearing loss can affect young patients, potentially causing delays in learning and social-emotional development. Until recently, there were few options to prevent or slow that hearing loss. Sodium thiosulfate (STS), a drug studied for years by researchers at Oregon Health & Science University, has been shown to counteract the toxic effects of cisplatin in the inner ear. The FDA has recently approved its use for patients as young as 1 month old.OHSU audiologist Kristy Knight joins us to explain what the treatment could mean for pediatric cancer patients. We also hear from Jennifer Boesche, a Beaverton mother who petitioned the FDA to approve STS after it helped slow her daughter's treatment-based hearing loss.

JCO PO author Dr. Shilpa Gupta, MD, Associate Professor of Medicine at the Cleveland Clinic and GU Medical Oncology Director, shares analysis on outcomes in real-world settings for metastatic urothelial carcinoma (mUC) patients. Host Dr. Rafeh Naqash and Dr. Gupta discuss the utility of tumor mutational burden (TMB) to determine treatment, and mUC patient response from immune checkpoint inhibitors (ICPI) as compared with carboplatin. Click here to read the article!   TRANSCRIPT Dr. Rafeh Naqash: Hello and welcome to JCO Precision Oncology Conversations. I am Dr. Rafeh Naqash, assistant professor of medicine at OU Stephenson Cancer Center. You're listening to the JCO Precision Oncology Conversations podcast.   Today I'll be talking with Dr. Shilpa Gupta, who is an associate professor of medicine at the Cleveland Clinic and also the GU Medical Oncology Director. And we'll be talking about their group's recent paper, ‘Tumor Mutational Burden as a Predictor of First-Line Immune Checkpoint Inhibitor Versus Carboplatin Benefit in Cisplatin-Unfit Patients With Urothelial Carcinoma'.   Full disclosures for our guest can be found on the article's publication page.   Hello and welcome to the podcast, Dr. Gupta. It's nice to have you here. For the sake of this podcast, we'll be referring to each other using our first names. So welcome and thanks for joining us today.   Dr. Shilpa Gupta: It's my pleasure to be here, Rafeh, I'm really excited about chatting about this paper with you. Thank you for the opportunity.   Dr. Rafeh Naqash: Thank you so much. So today we'll be discussing this interesting publication of yours, talking about biomarkers. And I often refer to biomarkers as the Pandora's Box for immune checkpoint inhibitors because definitely one size does not fit all. And reading through your paper, I saw a lot of interesting findings that you have defined in this publication. But for starters, what was the premise and background of why you wanted to study this question of tumor mutational burden as a biomarker in this patient population?   Dr. Shilpa Gupta: Yeah, that's a great question, Rafeh. The treatment paradigm for urothelial cancer patients has really evolved over the last many years. For example, patients who are eligible to receive cisplatin-based chemotherapy, that's the treatment of choice. And for patients who are not eligible to receive cisplatin due to a variety of reasons like chronic kidney disease, heart failure, peripheral neuropathy, poor performance status, or hearing loss, in the past, we used to treat them with gemcitabine and carboplatin, but outcomes were quite dismal with median overall survival less than six months or so. And then in 2017, the approval of pembrolizumab and atezolizumab as single agents was welcome news because these patients had more durable responses and survival was longer than historically with gemcitabine-carboplatin. And this is what became the standard of care based on the FDA expedited approval.   However, in 2018, the FDA restricted the use of immunotherapy only to those patients whose tumors had high PD-L1 or who were not eligible to receive carboplatin, based on the interim analysis from the phase three trials IMvigor130, which compared atezolizumab to gemcitabine-carboplatin, one of the cohorts for cis-ineligible patients, and KEYNOTE-361, which compared pembrolizumab to gemcitabine-carboplatin in the cis-ineligible cohort. And furthermore, recently, the FDA actually further restricted the label for pembrolizumab, because in the phase 3 study, even in high PD-L1 subgroups, pembrolizumab did worse than gemcitabine-carboplatin, regardless of their PD-L1 status. There were early deaths, lower response rates, and in the IMvigor130 study, we recently saw that atezolizumab was actually withdrawn for this indication altogether.   So there has been this attraction for PD-L1 for a long time, but now multiple studies in urothelial cancer have shown that PD-L1 is not a durable biomarker. And we wanted to see if there's other biomarkers which can be accessible at the point of care. And we wanted to study how tumor mutational burden can or cannot pan out as a treatment selection or complementary to clinical criteria. Right now, there's no biomarkers to guide treatment for patients in urothelial cancer for carboplatin or immunotherapy use. And that was the premise for the study.   Dr. Rafeh Naqash: Excellent. Thank you so much for that detailed understanding of why you decided to pursue this.   Now, from the listener standpoint when you define cisplatin-ineligible patients, in your practice, what is the percentage of patients that you see who are technically cisplatin-ineligible? Does comorbidity play an important role in determining which patients, or does it depend on your discussion with the patient? What are those factors that you would describe to define what cisplatin-ineligibility would constitute?   Dr. Shilpa Gupta: So historically, Matt Galsky and colleagues described cisplatin-ineligibility as patients with a creatinine clearance less than 60 mLs per minute, hearing loss greater than grade two, poor ECOG performance status two or higher, peripheral neuropathy, which is significant or significant heart failure. Now, those all make patients ineligible for cisplatin. Now, more recently, we know that we can safely give cisplatin as long as creatinine clearance is above 50. So for the real world, 50 is a threshold where we can use split dose cisplatin. And I'll say, given that bladder cancer or urothelial cancer is a disease of the elderly, median age being 71 years, a lot of our patients have these comorbidities, chronic kidney disease, diabetes, and whatnot, which precludes us from using cisplatin. So in the real world, I would say that around 50% of patients are ineligible to receive cisplatin.   Dr. Rafeh Naqash: Interesting. And that goes back to the point where not everything that resulted from clinical trials, or the data that we get, may not be exactly applicable to the real world patient population, as you have pointed out in this interesting paper. So going back to the manuscript now from a methodology perspective, what kind of data did you include to get to the results that we'll talk about next? What was the inclusion and what was the patient population in this analysis?   Dr. Shilpa Gupta: So the patient population basically were patients who had a confirmed diagnosis of metastatic urothelial cancer. And the databases we used were the US-wide Flatiron Foundation Medicine Clinical Genomic Database, which has patients who were listed as metastatic urothelial cancer. But in addition, they also had genomic testing performed from their tumors, and results were available. And we accessed the database between 2011 until April 2021. And all these patients had had genomic testing using Foundation Medicine assay. And this de-identified data was basically US-wide across 280 cancer clinics and that's around 800 sites of care. And there's a whole range of retrospective longitudinal clinical data that was available, derived from the electronic health records comprising patient-level structured and unstructured data and also their genomic information from the tumors. And there was clinical data including demographics, lab values, performance status, timing of treatment, exposure, as well as time of progression and survival.   We decided to include patients if they received a frontline single agent immunotherapy, no matter what it was, whether pembrolizumab, atezolizumab, Nivolumab, durvalumab or avelumab, or a carboplatin-based chemotherapy. And just for the readers, this is a retrospective review. So we just used these selected patients who got in these therapies. We also required that these patients had tumor mutational burden information available through the tissue biopsy and patients who received chemotherapy and immunotherapy together were excluded and details are present in the manuscript, but this was pretty much the broad selection criteria.   Dr. Rafeh Naqash: Thank you so much. And definitely a very representative patient population from a real world setting with different therapy and different other clinical variables that are relevant in the real world setting.   So from an analysis standpoint, you, from what I read, define both a predictive and a prognostic aspect to tumor mutational burden. Could you tell us more about those results and highlight some of the interesting findings from that perspective?   Dr. Shilpa Gupta: Yes, absolutely. So as you know, tumor mutation burden cut off of ten mutations per megabase is currently utilized by the FDA, whereby approval of pembrolizumab for tumor agnostic condition was made. So that's what we considered high versus low. And we found that in this, after propensity weighing in, the tumor mutational burden less than ten group, basically those patients did not benefit from checkpoint inhibitor single agent as compared to tumor mutational burden of ten or greater. And so basically, we found that patients who had tumor mutational burden ten or higher overall had more favorable progression-free survival time to next treatment, as well as overall survival when they got a single agent immune checkpoint inhibitor, as opposed to those who got carboplatin, and also when compared to those who had tumor mutational burden less than ten. So we also looked at PD-L1 information available from the genomic database, but it was only available for around 35% of patients and still we were able to see that PD-L1 did not correlate with any of these outcomes as we show in the paper.   Dr. Rafeh Naqash: I see. And as you mentioned, you show both time to treatment failure PFS being better in TMB high patients defined as ten mutations per megabase. I didn't specifically see results related to TMB high versus low in a carboplatin specific cohort. Is that analysis something that was looked at and trying to understand whether neoantigens in a platinum-based setting specifically make a difference whether high TMB is predictive there in the carboplatin setting. Was that looked at?   Dr. Shilpa Gupta: So yes, we looked at, in the Figure 4, for the comparison of the TMB and which we were looking at the checkpoint inhibitor versus chemo. So for TMB low the chemotherapy cohort had more favorable results. Is this what you were getting at?   Dr. Rafeh Naqash: Yeah, I think what I was specifically trying to look at, like you have shown in the paper, is TMB is predictive of benefit with checkpoint inhibitors and is also prognostic in the checkpoint inhibitor setting. So my question was more whether it had a prognostic implication in a carboplatin specific cohort. So meaning high TMB, whether it correlated with better outcomes with carboplatin therapy versus low TMB. So if that was looked at.   Dr. Shilpa Gupta: We didn't look at that specifically, we only compared whether high TMB did better with the immunotherapy or chemotherapy.   Dr. Rafeh Naqash: And some of the correlation of this in my mind comes from some data that people have looked at in the lung cancer setting, whether high TMB makes a difference and for example, resected lung cancer patients, which usually gets platinum-based adjuvant therapies. So that's why I was wondering if there's any correlation there. But this is definitely interesting.   Now, my next question was going to be in your manuscript you mentioned around 30% of patients had tumor mutational burden more than or equal to ten. Did you identify any other unique characteristics from any other mutational standpoint or a PD-L1 standpoint in the high TMB cohort?   Dr. Shilpa Gupta: Yes. So PD-L1 didn't really stand out to be a very steady biomarker in our experience. And this is also what was reflected in the phase three trials like DANUBE where they looked at the durvalumab and tremelimumab, IMvigor130 or KEYNOTE-361. So that was pretty consistent that these studies also showed TMB to be more useful in exploratory analysis. Of course, these patients were not stratified based on that. And we also looked at other emerging biomarkers, for example, F-TBRS and angiogenesis gene expression signatures as well as tGE3. And we need to evaluate them in a separate study to see what pans out.   But for now, I think as far as in the real world, we are looking at a lot of genomic testing being done and right now we really don't know how to use that for making treatment decisions, right? PD-L1 has really phased out as of any utility whatsoever. And using TMB; I think in addition to the clinical characteristics, like when possible, we should be offering patients carboplatin. There's no doubt about that for cisplatin ineligible patients. But there's those patients who, if they're refusing chemotherapy and we really can't make a case for giving them single agent immunotherapy, I think TMB can come in handy to justify and make sure that we're not doing them a disservice by not giving carboplatin. And I think future trials need to use this biomarker in a prospective setting to further establish its utility.   Dr. Rafeh Naqash: Definitely, I agree it's a case-by-case situation from a patient standpoint to determine what therapy is appropriate for the patient and what is most realistic, what is the expectation that the patient has, from that treatment.   Now, from a TMB standpoint, one of the ongoing debates is if it is a binary cut off or whether it could be tertiles for a certain tumor type or quartiles. Was there any subanalysis or any subsequent study that your team would be looking at from a TMB cut off standpoint? Maybe a higher cut off would mean a better outcome and maybe lesser duration of therapy in those patients. Is that somewhat of a consideration?   Dr. Shilpa Gupta: Yeah, that's a great question, Rafeh. And I think the reason we stuck to it as a binary end point is because that's the FDA definition, so people don't try to extrapolate based on anything higher or lower. But yeah, that's a great question. And I know in lung cancer they're looking at different ranges. As far as urothelial cancer, we just stuck to the ten mutations per megabase for now.   Dr. Rafeh Naqash: Of course. And one of the other interesting things I really like to see in the paper is your figure specifically on the ECOG performance status and how clinical trials sometimes do not include patients on the higher ECOG performance status spectrum. And your study obviously had a good representation on that standpoint. What were some of the findings from the ECOG standpoint that were somewhat different in your cohort than what you would see in clinical trials in general?   Dr. Shilpa Gupta: Yes, as we've shown in Figure 5, the ECOG in real world, it was quite an eye opener to see that there was a considerable number of patients who were documented as ECOG performance status three. And if you see the ECOG performance status two bar was around 50% and ECOG performance status one was also lower than what has traditionally been included in the phase three trials. And in the phase three trials, there's hardly any patients with ECOG performance status two compared to what we saw in the real world. And very few patients, in fact, hardly any had ECOG performance status zero in our real world analysis. So clearly the trials need to be more inclusive, as has been the ASCO message all along. And it's always very surprising to see the big gap between the real world and the clinical trial patient population.   Dr. Rafeh Naqash: Definitely, I think more and more, especially cooperative group trials that you and many others are leading, are trying to be as inclusive as possible, which is important to get a better understanding of how these therapies do in different patient populations. And one of the questions I wanted to ask you, and I've seen this a few times in different checkpoint therapy treated tumors, is this initial rapid progression in some patients where the chemotherapy arm does better, but the immunotherapy arm kind of falls rapidly and then starts plateauing. In your clinical experience, have you seen that? And if yes, what are the features of some of those patients that have this rapid progression from a clinical and both from a biomarker standpoint?   Dr. Shilpa Gupta: That's a great question, Rafeh, and we do see that every now and then, and especially in my experience, we've seen that in women in particular who have bone metastases are really challenging to treat with immunotherapy. And sometimes we find that the disease just rapidly blows through immunotherapy and we really need to do more biomarker work to understand what determines these biomarkers of hyper-progression, so to speak. I know there's a lot of work going on in the field and we are also trying to understand these by serially collecting blood and circulating tumor DNA from our patients during their treatment journey.   Dr. Rafeh Naqash: Exactly. Definitely work in progress and another unique patient population where more needs to be done to understand what are the events that lead to these hyper-progression aspects, whether it's in the bone or brain or any other compartment in the body.   Well, this has been exciting and interesting, but before we end, we try to know a little bit more about the investigator, the author. So, Shilpa, can you tell us a little bit about your journey in oncology and your journey as a trainee, your journey as faculty, as a clinical trialist, as a successful clinical trialist? And any advice for junior investigators listening to this conversation?   Dr. Shilpa Gupta: Yeah, thank you for asking. I think oncology always struck me as a very exciting field back in my residency days, 2005, 2006. And at the time, so much was going on, like just drugs like bevasizumab were just coming around for colorectal cancer and in lung cancer drugs like EGFR inhibitors were coming around. And that kind of really excited me. And talking with my mentor at the time, who was a really well-renowned transplanter, he said to me that if he had to do it all over again, he would love to get into solid tumor oncology with all the excitement that's going on. I was drawn to oncology also because of, not only it's a learning experience every day, but it can be very gratifying to see amazing responses and patients living longer despite having advanced disease, and also provides a lot of challenges every day when every patient is not the same. So I think that was the reason why I was drawn to oncology and provides us an opportunity to really develop new therapies as opposed to some of the other specialties because of how challenging the patient population is.   And as far as my journey, you know, I've now been in the US for almost 18 years and have been in a variety of places, and I think it's been a very rewarding journey despite multiple bumps along the way. And I'm really glad to be doing what I'm doing and trying to advance the field, clinical trials, and learning from people around me.   Dr. Rafeh Naqash: Thank you so much for giving us a little glimpse into your journey and your experiences. And it's always inspiring to listen to successful investigators and also try to emulate in some ways what you have done and what you've achieved. And thank you again for coming on this podcast. And thank you for choosing JCO Precision Oncology as a destination for your manuscript, and hopefully we'll see more of the same from you and your group in the subsequent years to come and more in this field of biomarkers.   Thank you for listening to JCO Precision Oncology Conversations. You can find all our shows, including this one, at ASCO.org/podcasts or wherever you get your podcasts. To stay up to date, be sure to follow and share JCO PO content on Twitter @JCOPO_ASCO. All JCO PO articles and series can be found at ascopubs.org/journal/PO.     The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.     Guest Bio Shilpa Gupta, MD, is Associate Professor of Medicine at the Cleveland Clinic and GU Medical Oncology Director.   Guest disclosures Stock and Other Ownership Interests: Nektar, Moderna Therapeutics Honoraria: Bristol Myers Squibb Consulting or Advisory Role: Gilead Sciences, Guardant Health, AVEO, EMD Serono, Pfizer, Merck, Loxo/Lilly Speakers' Bureau: Bristol Myers Squib

Matt Galski defends cisplatin admirably. 

Dr Shah discusses the FDA approval of sodium thiosulfate in pediatric patients with solid tumors treated with cisplatin, key efficacy and safety data from the SIOPEL6 and COG ACCL0431 trials, and the importance of multidisciplinary communication when prescribing and administering the agent.

Listen to a soundcast of the September 20, 2022, the FDA approved sodium thiosulfate (brand name Pedmark) to reduce the risk of ototoxicity associated with cisplatin in pediatric patients 1 month and older with localized, non-metastatic solid tumors.

On this week's The Sci-Files, your hosts, Chelsie and Danny interview Hariharan Ramakrishnan. Cisplatin is an incredibly powerful chemotherapy drug used to treat a variety of cancers. However, its side effects, such as kidney toxicity and painful neuropathy, may result in dose reduction or termination of treatment increasing patient mortality. Physicians must closely monitor the patient's kidney function during chemotherapy due to the high risk of kidney failure, and the patient's sensitivity, due to severe pain from peripheral neuropathy. Therefore, there is an urgent medical need for novel therapeutics that limit cisplatin's side effects. Adenosine receptors are involved in several kidney diseases and neuropathic pain pathophysiology. Hari hypothesizes that blocking adenosine receptors (AR) using Istradefylline, an FDA-approved AR antagonist will alleviate kidney toxicity and pain from cisplatin. He found that administering Istradefylline reduces both the pain hypersensitivity and kidney toxicity induced by cisplatin and the associated inflammation. Since the FDA already approves Istradefylline for treating Parkinson's disease, it can be quickly clinically applied to cancer therapy. You can learn more about the Laumet lab's research at their website. If you're interested in discussing your MSU research on the radio or nominating a student, please email Chelsie and Danny at scifiles@impact89fm.org. You can ask questions about future episodes here. Check The Sci-Files out on Twitter, Facebook, Instagram, and YouTube! 

Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we start our discussion on metastatic non-small cell lung cancer, focusing on NSCLC without driver mutations. * The approach to treatment of a patient with widespread metastatic NSCLC (mNSCLC) is very different than a patient without distant disease, which highlights why we do what we do:- Important to complete staging (discussed in prior episodes) to determine the extent of disease- Important to check molecular testing (looking for mutations in the cancer cells) and IHC for tumor proportion score (TPS) helps determine treatment options * Choosing a treatment is based on:- Histology - cannot use pemetrexed or bevacizumab in squamous cell - Platinum - Carboplatin is usually used (as opposed to our prior discussions about using Cisplatin because of LACE pooled analysis data)-- Why is Cisplatin not a great idea? Cisplatin should not be used if patients have (***high yield to know cisplatin eligibility criteria!!***): --- Poor performance status--- Patients with eGFR 50% can get IO monotherapy (spared chemotherapy)---- KEYNOTE 024: approval for pembrolizumab monotherapy in patient with PDL1>50%----- Study compared pembro to platinum doublet----- OS 70% vs. 50% at one year---- IMPOWER110: approval for atezolizumab monotherapy----- Study compared atezo to chemotherapy----- OS 64.9% vs 50% at 12 months--- Patients with score 50% WITHOUT SYMPTOMS: IO alone- In PDL1 >50% WITH SYMPTOMS: Chemo + IO- In PDL1

Dr Oh discusses the FDA approval of durvalumab plus gemcitabine and cisplatin in biliary tract cancer, the tolerability of the regimen, and the importance of using immunotherapy to treat this disease.

This week we go over warnings about a new social media challenge; treatment approvals in cisplatin-associated ototoxicity, cerebral adrenoleukodystrophy, MRI contrast agents and a generic version of tazorac. 

Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we round out our discussion of early stage lung cancer treatment!* When deciding if a patient can get surgery upfront or not, remember the three “Fellow on Call” criteria for early stage lung cancer: - Mass invading other structures or mediastinum- Central lymph nodes (single digit)- Tumor >7 cm* If surgery is NOT an option at this time, where do we go from here?- Treat with upfront concurrent definitive chemoradiation- Treat with “induction” chemotherapy or induction concurrent chemoradiation**If surgery is/may be possible***What are the goals of “induction” treatments? - Eradicate microscopic disease- Improved local control, possibly shrinkage- Adding radiation may allow you to downstage tumor or lymph nodes to have a possible improvement in surgical outcomes* What sorts of discussions are being had a thoracic tumor board in patients with newly diagnosed early stage NSCLC? - Is the patient a surgical candidate?- If the patient is not a surgical candidate, then what are the options:--Definitive concurrent chemoradiation (usually) followed by immunotherapy---Pearl 1: Always choose this if surgeon thinks the patient is unresectable in general even with an induction approach---Pearl 2: Always choose this if 2 out of 3 criteria we discussed above are met---Pearl 3: Always choose this if N3 disease- “Induction” regimen with either chemotherapy alone or concurrent chemoradiation followed by surgery * What's the idea behind “induction” chemo or chemoradiation? - There is a chance that patients with these high risk features may already have micrometastatic disease, so treatment upfront can help address that- There is a chance that after surgery, patient may suffer deconditioning, which may preclude the use of chemo +/- radiation (up to 90% of patients are often eligible for chemoradiation before surgery; this drops to ~60% after surgery)- Local disease control to achieve the best possible surgical outcome (R0 resection) and also prevent any microscopic residual disease from then having the opportunity to spread systemically, especially in areas where the mass may be adjacent to many blood vessels or lymph nodes* What to treat with in the neoadjuvant setting?- Platinum containing regimens (“platinum doublets”):-- Carboplatin + paclitaxel-- Cisplatin + etoposide-- Cisplatin + gemcitable-- Cistplain + pemetrexed- Can combine this with radiation* How does the data about chemotherapy+IO in the neoadjuvant setting fit in here (CHECKMATE 816)?- In patients with Stage IIB to IIIA (8th edition) WITHOUT EGFR or ALK mutation, treatment with NEOADJUVANT chemotherapy q3w x3 cycles (most got cisplatin based therapy) + nivolumab 360mg q3w x3 cycles resulted in improved event free survival (31.6 months vs. 20.8 months) AND pathological complete response was 24.0% vs. 2.2%- Current NCCN guidelines state that if nivolumab is used in neoadjuvant setting, it should not be used in adjuvant setting- There is still uncertainty about how this fits into treatment compared to “traditional” neoadjuvant approaches with chemo+/-radiation*So after neoadjuvant treatment, does everyone go to surgery?- Always re-assess the status of the disease; if there is progression of disease, then will go to definitive chemoradiation- Discuss with surgeons to confirm if the patient is still a surgery candidate* If patient undergoes surgery, then what?- If patient got neoadjuvant therapy and an R0, then they are done with treatment- If R0 resection was not able to achieved, then either radiation “boost” to the area (if they previously got radiation), a course of radiation (if they just got induction chemo) or re-resection- We discuss the adjuvant setting in more detail in Episode 026 (https://www.thefellowoncall.com/tfocpodcast/episode-001disclaimer-wfhgf-ml3b6-9m66a-8rrc4-k8w87-x7xdd-wrzye-4xg8x-t73gt-cxc5s-nmg8f-cfyd6-hgs35-5pcwx-tf6dh-trggt-xzkt7-923gg-rpjzx-6s36p-hk27n-bbpgx-jymml-9lfam-76m4s)** If surgery is not possible*** If patient cannot go through to surgery Definitive chemoradiation:- Same chemotherapy agents as above, but treatment course is longer.- For instance, for NSCLC, total 60Gy in 2Gy divided fractions (5 days/week, 6 weeks of treatment) with chemotherapy* Additional therapy after chemoradiation (PACIFIC Trial) - Found that “consolidation” durvalumab 44% PFS 18 months vs 20% 5year survival benefit 40% vs. ~30% without treatmentReferences:https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450 - NCCN Lung Cancer guidelines https://www.nejm.org/doi/full/10.1056/nejmoa1709937 - PACIFIC Trial (NEJM 2017)https://www.nejm.org/doi/10.1056/NEJMoa2202170 - CHECKMATE 816 (NEJM 2022) Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

How do we think about treatment of lung cancer? Recap on staging (see Episode 025) * Pro-tip: Highly recommend that you “forget” about the actual staging and focus more on the individual T, N, and M status * Tumor size:**T1a

Nerve damage from chemotherapy can lead to lingering effects after treatment. There are several natural agents that can help. But, some can actually make it worse too! Listen in while Tina & Leah discuss how to prevent chemotherapy-induced peripheral neuropathy (CIPN) and what to (safely) do if you already have it.Chemotherapy drugs are designed to be toxic to cancer cells but sometimes they are also toxic to your nervous system. This can have long-term consequences. Take heart, there are ways to lessen the risk during treatment. There are also ways to improve peripheral neuropathy symptoms after treatment. Did you know that there is clinical trial data that shows this? (We may be creative, but not when it comes to recommending treatments.)Links we mention in this episode and other cool stuff:What drugs are most likely to cause chemotherapy-induced peripheral neuropathy American Cancer SocietyHigh-dose L-glutamine for taxane-induced peripheral neuropathy. Clinical Cancer ResearchOmega-3 fatty acids and taxane-induced peripheral neuropathy BMC CancerHigh dose L-glutamine in oxaliplatin-induced peripheral neuropathy The OncologistReview of natural agents & chemotherapy-induced peripheral neuropathy (CIPN) Nutrients (2022)Review of vitamin E studies - it only works for cis/carboplatin-induced CIPN (Frontiers in Cryotherapy)The ASCO guidelines for CIPN (We don't agree with doing nothing.) ASCOFrozen gloves (cryotherapy) for prevention of CIPN Annals of OncologyScrambler therapy for pain management Support Care CancerCytokines as targets in CIPN CytokineAlpha-lipoic acid alongside a taxane drug and doxorubicin Support Care Cancer (2022)Exercise counteracts CIPN symptoms Support Cancer CareReview of data on exercise and CIPN Cancer NursingWorse CIPN with the concurrent use of Acetyl-L-Carnitine J National Cancer InstituteSupport the show

The Landmarks of OncoPharm series returns to discuss 2 landmark studies (and 1 editorial) in head & neck cancer. Editorial: https://ascopubs.org/doi/pdf/10.1200/JCO.22.00274 EUORTC Study: https://www.nejm.org/doi/full/10.1056/NEJMoa032641 Intergroup Study: https://www.nejm.org/doi/full/10.1056/NEJMoa032646

In this penultimate episode of our podcast exploring treatment options for patients with advanced urothelial cancer, our experts discuss the latest data on immunotherapy options for cisplatin-ineligible patients. Learn when and how immunotherapy may be an appropriate treatment approach for your patients.

 In this episode of a series of podcasts exploring treatment options for patients with advanced urothelial cancer, our experts discuss the options for a patient who has previously undergone surgery, and is ineligible for cisplatin-based treatment. Learn about the latest treatment recommendations and the impact on patient outcomes.  

After being diagnosed with Stage 3B lung cancer, Gary Brausen went through a painful journey that included radiation, aggressive chemotherapy and the loss of a lung; but he survived, and now works hard to help others with their cancer journeys.

In this first of a series of advanced urothelial cancer clinical case discussions, two experts discuss the first-line treatment strategy for a newly-diagnosed patient who is eligible for cisplatin-based chemotherapy. Listen in to hear evidence-based views on the best treatment approach for this patient. 

A diagnosis of triple negative breast cancer interrupted Judy's career as an author.“Like for everyone else, it came at the worst possible time. But cancer really doesn't have a great time,” says Pearson. “I was a newlywed. I had met the man of my dreams. My youngest son had launched into a great career as an electrical engineer. And my oldest son is just retired, but he was career Air Force and was about to deploy to Afghanistan. And then I found the lump two months after a clean mammogram and through it all discovered that there is a condition that's much more well-known now called dense breast tissue. I tell everyone to never stop being vigilant about your health anywhere, but especially your breasts. It doesn't matter if you get a clean mammogram, you can still have things that mammography can't see through if you have dense tissue.“The fortunate thing was after my mastectomy, they found three other tumors that by the time I would have gone around to the next mammogram, I would not have survived quite probably. It was triple negative breast cancer, which is rare and very aggressive. And so I made a deal with God and the universe. If I survive this, I'm going to do something with it. I don't know what that is, but just guide me and I will do something.”Pearson talks about why she chose to attend MSU and how the university has impacted her. While many of Judy's friends from her small hometown of South Haven thought MSU might be too big for them. Judy was attracted to the “hum” at MSU.“I had high school classmates who came to school here and found it too big. They felt lost. There were myriad issues, but always surrounding its size because South Haven then and now is only about 5,000 people. We had 200 kids in our graduating class. For me, there was a different feeling partially because I was familiar with the university, but partially because I just love the hum of it.”Recognizing that healing is helping, Judy founded A 2nd Act.“A Second Act celebrates and supports women survivors of all cancers who are giving back to the greater good using their experiences and their life span, whatever those days are, to give back to the greater good to the world around them.” Discovered at MSU, Cisplatin would become the backbone of combination chemotherapy. Pearson believes it saved her life.“My oncologist sat me down after my mastectomy and said, ‘Okay, this treatment is going to be really rough. And usually people have to have a three or a four week span in between treatments. You're very healthy other than that little bit of cancer. We're going to make that an every other week occurrence.' And even though I had no evidence of disease once the breast was removed, with triple negative cancer, I had had a 30 percent chance of it coming back without the chemotherapy. So I thought that was just too great of a chance. And she said, ‘We're going to hit you with three drugs' then told me the names of the drugs. One of was Cisplatin. “Then I go back home and two days later, the MSU alumni magazine arrives in my mailbox. And one of the featured articles was about Dr. Rosenberg, who invented Cisplatin here in 1965. And it wasn't until after my own treatment that I wrote an article talking about the fact that Dr. Rosenberg saved my life. When it was discovered, it was miraculous.“It was the first platinum-based chemotherapy drug. And it's not without side effects, severe side effects, like horrible nausea, hair loss, and joint damage afterwards. But I would take all of those in exchange for my life. It was well worth it. The other really interesting connection is in 1971, Richard Nixon was facing a very iffy reelection and his aides came to him and said, ‘There's a bill making its way through Congress called the National Cancer Act. If you sign that, we are quite certain you will be reelected. It's a bipartisan issue. Democrats and Republicans both fear it, and we'll even toss in that we'll cure the disease by the Bicentennial.' He signed it. It infused $1.8 billion, which is $8.4 billion today, into research. And at that time, Cisplatin was in final clinical trials. I don't know for certain, but I'm quite sure that some of that money went into the final trials for Cisplatin. Ironically in 1971 when Nixon signed that bill, I was an incoming freshman at Michigan State.”Pearson talks more about her cancer diagnosis and journey through treatment as a survivor and not a victim.“The diagnosis comes like a thunderbolt. It's like any catastrophic event. I read an article one time about the top 10 stressors in life. And besides the death of a loved one and a divorce, catastrophic illnesses is the next one. And so you get that kind of why me sort of thing. And I was actually talking to a pastor and asked why me? And he said, ‘When people ask that, I respond to them by saying, why not you? Should it be him? Should it be her? Why not you?' And I thought, well, that's a good answer. I'm a researcher by profession. I very carefully researched my disease, my treatment, and my reconstruction. At no time did it occur to me to research survivorship. I didn't even think it was a thing. And that surprises me because I thought myself fairly well read. On the other side of all the treatment I started having unexpected and really quite frightening issues like night sweats, severe joint pain, chronic fatigue, insomnia, and brain fog, which for a writer is a really bad thing.“When I went to my oncologist and asked why I hadn't been told, it wasn't like I wouldn't have taken the treatment. She said, which was very common 10 years ago, ‘It wasn't important to talk about. We were busy saving your life.' I now know. And all of the folks that I interviewed for From Shadows to Life who were the architects of the cancer survivorship movement, their whole focus has been on making sure that survivorship is considered part of the cancer continuum. There's diagnosis and there's treatment. There may be adjunctive types of treatments after the main treatment's over, but survivorship is every bit as much of the cancer continuum. It's the rest of your life. The treatment is really a year, maybe a little longer, to get you to the rest of your life. Why not spend as much time focusing on learning about these issues and learning how to move beyond them?“And that was why the survivorship movement launched and became so successful. Before the National Coalition for Cancer Survivorship was founded by 23 people, all with a connection to cancer, and before they launched the cancer survivorship movement, we were called victims in the newspaper. And even after their 1986 founding, the newspaper articles all said victim. And even if the article was about them and the headline read survivors, not victims, the writer continued to call us victims in the article. It was hilarious. And so at first, the term survivor was a little foreign to me because I felt like I'd won the lottery by beating cancer. If you said to Vince Lombardi or George Patton ‘Wow, you survived that,' they would have punched you in the face. I don't want to just be a survivor. I want to be a winner.“And then I realized I was swimming upstream. Survivorship was already coined and I'm happy with that. I get it now. I totally get it. The other interesting thing about the idea of survivorship is if you experience a heart attack, boy, from the moment you have recovered or had whatever corrective surgery, they're starting to talk about rehab. They're starting to talk about you getting back to your life and what we're going to do to make sure that the rest of your life is quality of life. And they never did that for cancer, which I find so interesting. Now it's true cardiac issues kill more people every year, but there are more cancer survivors in the country, 17 million as of this year just in America. It's a much bigger population that absolutely should learn how to deal with their disease and its long-term effects.”Judy Pearson's latest book is titled From Shadows to Life, A Biography of the Cancer Survivorship Movement. It's part medical history and part inspirational biography. This is the story of a social movement that continues to improve life for millions.“I mentioned I'm a storyteller and after cancer, I just couldn't find the next great story to tell. I started asecondact.org, and through A Second Act was introduced to a woman called Susan Ley, who lives in Tucson, which is about two hours from Phoenix where I live. Susan is one of the founders of the cancer survivorship movement and became the inspiration for the book From Shadows to Life. And the shadows part of the title is that Nixon designated all that money and people actually started surviving. Before the Seventies, more than half of the people diagnosed died. So it was a grim diagnosis. Cancer was still thought to be contagious.“You couldn't tell people that you'd gone through cancer treatment because even though you might have no evidence of disease or been cured, like they used to say, people were terrified that you still had the germ. And so you could be fired. You couldn't join the military. You couldn't adopt children. College students couldn't get roommates because their parents feared that they would catch cancer. It was a horrible life. So you went through this God awful diagnosis and then were just left behind. One of the architects of the movement, Dr. Fitzhugh Mullan, said it's as if we had invented sophisticated treatment to save people from drowning. But once we dragged them to the dock, we left them there to cough and splutter on their own. And that's exactly it. That was just it. We're done. You're saved. Now go be. So it was a really monumental task to bring cancer out of the shadows. And that's what this group did.”People really thought that cancer is contagious?“Isn't it crazy? It's nuts. It's just what they were fed. If you went to someone's house, you were fed on paper plates. It was really crazy. By the Eighties, that was pretty much dispelled. Like every other old wives' tale, it took longer in other parts of the country to dispel. But even in the Eighties after it was no longer thought to be contagious, employers could ask if you'd ever had cancer. Employers didn't want to hire survivors for fear that they would have a recurrence, that they would die, and that they would be a puny and sickly lot. And it was just a bizarre thought.“This was on the heels of the AIDS movement. And they took a page from that and started testifying before Congress and made sure that the Americans with Disabilities Act included cancer survivors.” Are you optimistic about a cure for cancer one day?“We don't use the word cure. The other part of survivorship is that you couldn't call yourself a survivor until you passed five years. And then it was 10 years, or maybe it was three years. There was some moving goal line and then you could be a cancer survivor. Well, what happened if you got diagnosed again the day after you hit the five-year mark? Are you no longer a survivor? So sort of the same thought is there with cure because we still don't know all there is to know about the disease. But what we do know is that it's not one disease. It's not like the polio vaccine. Polio had three or five cousins that they had to kind of deal with, but mainly it was one thing. Practically any cell in your body can become cancerous, any cell anywhere.“It's hundreds of diseases. What we have learned and what's so brilliant is we now much better understand cell structure and DNA and the human immune system. And in fact, the COVID vaccine research was based on the infectious disease research. The National Cancer Institute had a great deal of genetic research that they've been working on now for decades that really pitched in and helped with the COVID vaccine creation. So that word cure is not even in my vernacular. What I know is that if my cancer, for example, metastasized or I had another primary cancer, that I'm in a much better place today than I was even 10 years ago because they can use my immune system. “Ten years later, there have been massive leaps forward, and the research that's being done here at Michigan State that I just learned about in the lab, man, it's really wonderful. The hope is that someday we can actually prevent cancer cells from developing.”Pearson shares her three key takeaways from our conversation.“First of all, you are your own best advocate. Listen to your body. Don't be dissuaded by a doctor who says he or she has done everything and now doesn't know what to do. They say you're fine. That's just not good enough. Keep going until you have an answer. I did that. I'm about to do it again with a heart issue. Don't ever back away from that diagnosis you don't have, or that prognosis. You don't have to be rude. Just go get a second answer.“Secondly, for people who do have an illness, be it cancer or anything else, find someone to help advocate for you. You become your own advocate. In the throes of the diagnosis and the flurry of treatments and everything that comes along with that, you get pretty muddle brained. Find someone who can be your advocate, who can come to appointments with you, take notes, and ask the questions you may forget to ask. Do that. Ask for one if you're the patient. And do that for somebody if you're looking for some way to help. “And then the third thing is live every day. Get rid of toxic things, not only the chemicals in your house, but maybe the people in your life, too, and maybe your job. Don't waste a minute of life because it is so precious. As I tell my grandchildren, even if you're having a bad day, it's not forever. It's just for now. Look at tomorrow as a brand new day.”MSU Today airs Sunday mornings at 9:00 on 105.1 FM and AM 870 and streams at WKAR.org. Find “MSU Today with Russ White” on Spotify, Apple Podcasts, and wherever you get your shows.

Medical science has come a long way in the last century. Little more than a hundred years ago, doctors treated many maladies by bloodletting! Now there are so many targeted medications, they have to get creative with the names . . . like Cisplatin, Moxifloxacin and Pancuronium. Today on A New Beginning, Pastor Greg Laurie says we should treat our spiritual ills with a kind of targeted, effective treatment. Treatment recommended by our Maker. View and subscribe to Pastor Greg’s weekly notes. --- If you would like to receive daily devotions written by Pastor Greg, sign up here A New Beginning is the daily half-hour program hosted by Greg Laurie, pastor of Harvest Christian Fellowship in Southern California. For over 30 years, Pastor Greg and Harvest Ministries have endeavored to know God and make Him known through media and large-scale evangelism. This podcast is supported by the generosity of our Harvest Partners. Support the show: https://harvest.org/support See omnystudio.com/listener for privacy information.

Medical science has come a long way in the last century. Little more than a hundred years ago, doctors treated many maladies by bloodletting! Now there are so many targeted medications, they have to get creative with the names . . . like Cisplatin, Moxifloxacin and Pancuronium. Today on A New Beginning, Pastor Greg Laurie says we should treat our spiritual ills with a kind of targeted, effective treatment. Treatment recommended by our Maker. View and subscribe to Pastor Greg’s weekly notes. --- If you would like to receive daily devotions written by Pastor Greg, sign up here A New Beginning is the daily half-hour program hosted by Greg Laurie, pastor of Harvest Christian Fellowship in Southern California. For over 30 years, Pastor Greg and Harvest Ministries have endeavored to know God and make Him known through media and large-scale evangelism. This podcast is supported by the generosity of our Harvest Partners. Support the show: https://harvest.org/support See omnystudio.com/listener for privacy information.

Medical science has come a long way in the last century. Little more than a hundred years ago, doctors treated many maladies by bloodletting! Now there are so many targeted medications, they have to get creative with the names . . . like Cisplatin, Moxifloxacin and Pancuronium. Today on A New Beginning, Pastor Greg Laurie says we should treat our spiritual ills with a kind of targeted, effective treatment. Treatment recommended by our Maker. View and subscribe to Pastor Greg’s weekly notes. --- If you would like to receive daily devotions written by Pastor Greg, sign up here A New Beginning is the daily half-hour program hosted by Greg Laurie, pastor of Harvest Christian Fellowship in Southern California. For over 30 years, Pastor Greg and Harvest Ministries have endeavored to know God and make Him known through media and large-scale evangelism. This podcast is supported by the generosity of our Harvest Partners. Support the show: https://harvest.org/support See omnystudio.com/listener for privacy information.

This episode covers cisplatin and carboplatin!

Dr. Andreas Rimner of Memorial Sloan Kettering Cancer Center joins us to discuss a clinical trial "Testing the Addition of Targeted Radiation Therapy to Surgery and the Usual Chemotherapy Treatment (Pemetrexed and Cisplatin [or Carboplatin]) for Stage I-IIIA Malignant Pleural Mesothelioma." Dr. Rimner is a radiation oncologist specializing in thoracic cancers. He in interviewed by Mary Hesdorffer, expert nurse practitioner and executive director of the Mesothelioma Applied Research Foundation. Patients who need help with their diagnosis can contact Mary Hesdorffer, NP through the organization's website. The Mesothelioma Applied Research Foundation is the only national nonprofit organization dedicated to eradicating mesothelioma by providing patient services and education; funding peer-reviewed research; and advocating for government funding of mesothelioma research. More information about the organization is available at www.curemeso.org.