Podcasts about metastases

Drs Camidge and Lin discuss Dr Lin's work with brain metastases, her role in developing targeted therapies for breast cancer, the importance of systemic therapy for managing brain metastases, and the significance of mentoring the next generation of oncologist.

In this episode of SurgOnc Today, Dr. Julie Hallet, chair of the HPB disease site working group, and Dr. Callisia Clarke, member of the SSO board of directors, are joined by Dr. Jessica Maxwell and Dr. Alexandra Gangi to explore the evolving field of surgery for neuroendocrine tumors liver metastases. They discuss patient selection, pre-operative optimization, and unique surgical techniques to optimize perioperative and oncologic outcomes.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/ZPG865. CME/NCPD/CPE/AAPA/IPCE credit will be available until March 2, 2026.Fine-Tuning the Selection and Sequencing of HER2-Targeting Therapies in HER2-Positive MBC With and Without CNS Metastases: Expert Guidance on How to Individualize Therapy Based on Latest Evidence, Disease Features, Treatment Characteristics, and Patient Needs and Preferences In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and GRASP. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/ZPG865. CME/NCPD/CPE/AAPA/IPCE credit will be available until March 2, 2026.Fine-Tuning the Selection and Sequencing of HER2-Targeting Therapies in HER2-Positive MBC With and Without CNS Metastases: Expert Guidance on How to Individualize Therapy Based on Latest Evidence, Disease Features, Treatment Characteristics, and Patient Needs and Preferences In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and GRASP. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/ZPG865. CME/NCPD/CPE/AAPA/IPCE credit will be available until March 2, 2026.Fine-Tuning the Selection and Sequencing of HER2-Targeting Therapies in HER2-Positive MBC With and Without CNS Metastases: Expert Guidance on How to Individualize Therapy Based on Latest Evidence, Disease Features, Treatment Characteristics, and Patient Needs and Preferences In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and GRASP. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/NCPD/CPE/AAPA/IPCE information, and to apply for credit, please visit us at PeerView.com/ZPG865. CME/NCPD/CPE/AAPA/IPCE credit will be available until March 2, 2026.Fine-Tuning the Selection and Sequencing of HER2-Targeting Therapies in HER2-Positive MBC With and Without CNS Metastases: Expert Guidance on How to Individualize Therapy Based on Latest Evidence, Disease Features, Treatment Characteristics, and Patient Needs and Preferences In support of improving patient care, this activity has been planned and implemented by PVI, PeerView Institute for Medical Education, and GRASP. PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an educational grant from Pfizer.Disclosure information is available at the beginning of the video presentation.

CME credits: 1.00 Valid until: 06-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/optimizing-treatment-selection-for-her2-breast-cancer-patients-with-brain-metastases/29950/ The development and availability of HER2-directed therapies has dramatically improved outcomes for patients with metastatic breast cancer (MBC). Moreover, emerging data indicate that these therapies also improve outcomes for those with brain metastasis. In this educational series, expert faculty differentiate the available HER2-directed therapies for MBC, assess their efficacy in disease with brain metastasis, and review treatment selection and sequencing considerations for these agents. Please stay tuned for additional content to this program available for credit. The maximum amount of credits available for the entire activity is 1.00.

CME credits: 1.00 Valid until: 06-02-2026 Claim your CME credit at https://reachmd.com/programs/cme/systemic-management-of-brain-metastases-in-her2-bc-emerging-strategies-and-treatment-approaches/29949/ The development and availability of HER2-directed therapies has dramatically improved outcomes for patients with metastatic breast cancer (MBC). Moreover, emerging data indicate that these therapies also improve outcomes for those with brain metastasis. In this educational series, expert faculty differentiate the available HER2-directed therapies for MBC, assess their efficacy in disease with brain metastasis, and review treatment selection and sequencing considerations for these agents. Please stay tuned for additional content to this program available for credit. The maximum amount of credits available for the entire activity is 1.00.

In this episode of the Radiology Podcast, Dr. Lauren Kim speaks with Dr. Lama Dawi about a groundbreaking study comparing liquid biopsy and CT imaging in assessing tumor burden. They explore the strengths, limitations, and future of liquid biopsy in cancer diagnostics and precision medicine. Can it replace CT scans? Liquid Biopsy versus CT: Comparison of Tumor Burden Quantification in 1065 Patients with Metastases. Dawi et al.Radiology 2024; 313(2):e232674. 

Interview with Michael A. Postow, MD, author of Intracranial Outcomes of Ipilimumab and Nivolumab in Melanoma Brain Metastases After Progression on Anti–PD-1 Therapy. Hosted by Vivek Subbiah, MD. Related Content: Intracranial Outcomes of Ipilimumab and Nivolumab in Melanoma Brain Metastases After Progression on Anti–PD-1 Therapy

Interview with Michael A. Postow, MD, author of Intracranial Outcomes of Ipilimumab and Nivolumab in Melanoma Brain Metastases After Progression on Anti–PD-1 Therapy. Hosted by Vivek Subbiah, MD. Related Content: Intracranial Outcomes of Ipilimumab and Nivolumab in Melanoma Brain Metastases After Progression on Anti–PD-1 Therapy

Host: Jacob Sands, MD Guest: Aaron Lisberg, MD Unfortunately, brain metastases are very common in patients with non-small cell lung cancer (NSCLC). That's why the phase 3 TROPION-Lung01 trial examined the efficacy and safety of datopotamab deruxtecan (Dato-DXd) for advanced non-squamous NSCLC with brain metastases. Joining Dr. Jacob Sands to share the results presented at the 2024 ESMO Congress is thoracic medical oncologist Dr. Aaron Lisberg.

The incidence of brain metastases is higher in patients with non-small cell lung cancer (NSCLC) than in patients with most other cancers, and the development of brain metastases is associated with poor prognosis. The objective of the podcast is to provide information about current and future treatments for brain metastases that develop in patients with EGFR-mutated NSCLC. The panel discusses surveillance and management of patients with brain metastases, different types of currently used treatments, and recent data on the intracranial efficacy of antibody–drug conjugates (ADCs). The panel also discusses current and future studies of ADCs in patients with EGFR-mutated NSCLC with brain metastases. This podcast discussion, among four oncologists (two thoracic oncologists, one radiation oncologist, and one neurologist/neuro-oncologist), is for healthcare professionals (HCPs) at community practices and research institutions.   This podcast is published open access in Oncology and Therapy and is fully citeable. You can access the original published podcast article through the Oncology and Therapy website and by using this link: https://link.springer.com/article/10.1007/s40487-024-00315-1. 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/.   This podcast is intended for medical professionals.

This guideline was created as an educational tool to guide qualified physicians through a series of diagnostic and treatment decisions to improve the quality and efficiency of care for adult patients with Brain Metastases treated with Immunotherapy. J. Bradley Elder, MD Jeffrey J. Olson, MD D. Ryan Ormond, MD, Phd

In this inaugural episode of the Surgical Oncology Insight series of SurgOnc Today®, Dr. Shishir Maithel, Editor of Surgical Oncology Insight, SSO's open-access journal, discusses with Dr. Brett Ecker the results of a systematic review and meta-analysis characterizing the incidence of cfDNA-positivity after resection of colorectal cancer liver metastases  with quantification of its sensitivity and specificity for postoperative recurrence, as reported in his article, "The Prognostic Role of Post-operative cfDNA after Resection of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis."

In this podcast, we bring you the latest insights into managing brain metastases, with expert commentary from Minesh Mehta, MD,... The post Latest updates in managing brain metastases appeared first on VJOncology.

Dr Rotow discusses data that demonstrated the central nervous system activity of datopotamab deruxtecan and osimertinib in patients with NSCLC.

With new advances in the treatment of brain cancer, patients have more options than ever. This week, Faith talks with Dr. Kathryn Beal, a radiation oncologist at NewYork-Presbyterian and Weill Cornell Medicine, to explore how breakthroughs in immunotherapy and stereotactic radiosurgery can successfully treat metastatic cancer in the brain. In recognition of Glioblastoma Awareness Day, Dr. Beal also explains treatment options for gliomas, and her hope for the future for patients with brain tumors and brain metastases.

Description: Host Dr. Narjust Florez and two esteemed international clinicians discuss the unique characteristics of CNS metastases in patients with non-small cell lung cancer and small cell lung cancer. Guest: Dr. Sarah Goldberg is an Associate Professor of Medicine in the section of Medical Oncology at the Yale School of Medicine. She is the Division Chief of Thoracic Oncology, the Research Director for the Center for Thoracic Cancers, and the Associate Program Director for the Medical Oncology-Hematology Fellowship Program at Yale Guest: Dr. Ernest Nadal is a medical oncologist and the director of Thoracic Tumors Section at the Catalan Institute of Oncology, an Associate Professor at the University of Barcelona, a vital member of the Spanish Lung Cancer Group and an expert in clinical trial development and interest in response and use of immune checkpoint inhibitors for the management of CNS metastases.

In this episode of SurgOnc Today, Alexander Parikh, MD, MPH, from the University of Texas – San Antonio and Chair of the SSO HPB disease site working group, and Laleh G. Melstrom, MD, MSCI, from City of Hope National Medical Center, are joined by Timothy Newhook, MD, from the University of Texas MD Anderson Cancer Center and Andreas Kaiser, MD, from the City of Hope. We will be discussing the management of synchronous rectal cancer with liver metastases.

Rick Greene, MD, discusses with Jean-Nicolas Vauthey, MD, a comparison of different surgical approaches to synchronous liver metastases from rectal cancer and their analysis of both clinicopathological and biological tumor factors associated with completion of the reverse approach. Professor Vauthey is the senior author of, “Hepatectomy Before Primary Tumor Resection as Preferred Approach for Synchronous Liver Metastases from Rectal Cancer.” Dr. Vauthey is Professor of Surgery and Chief of the Hepato-Pancreato-Biliary Section, and the Dallas/Fort Worth Living Legend Chair of Cancer Research in the Department of Surgical Oncology at The University of Texas MD Anderson Cancer Center in Houston, TX.

CME credits: 1.00 Valid until: 01-03-2025 Claim your CME credit at https://reachmd.com/programs/cme/case-treatment-selection-for-ros1-rearranged-nsclc-patient-with-brain-metastases/18162/ This program aims to raise awareness of approved and emerging targeted therapies and practice guidelines for ROS1+ NSCLC. It is critical to create a greater understanding of the limitations existing agents have with acquired resistance mutations and intracranial penetration and the potential advantage new and emerging agents offer to resolve and evade these challenges.

When and how often do NETs spread to the bones or brain? How are they found? What is the treatment? Dr. Robert Ramirez of Vanderbilt University addresses concerns surrounding bone metastases (or “mets”) as well as rare brain metastases.MEET DR. ROBERT RAMIREZ, DO, FACP Dr. Robert Ramirez is a medical oncologist specializing in the treatment of thoracic and neuroendocrine malignancies and an Associate Professor of Medicine at Vanderbilt University Medical Center in Nashville, TN.  He earned his medical degree from the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine. He completed an internal medicine residency at Cooper University Hospital in Camden, New Jersey. He then completed a hematology and medical oncology fellowship at the University of Tennessee Health Sciences Center in Memphis, Tennessee and served as chief fellow. He is a Fellow of the American College of Physicians, and a member of American Society of Clinical Oncology, the International Association for the Study of Lung Cancer (IASLC), and the North American Neuroendocrine Tumor Society (NANETS).  He serves on the Board of Directors for NANETS as well as the Scientific Review and Research Committee.His clinical and research interests include neuroendocrine tumors (NETs) and lung cancer.  He has a specific interest in NETs of the lung ranging from diffuse idiopathic pulmonary neuroendocrine tumor cell hyperplasia (DIPNECH) and carcinoid tumors to small cell lung cancer and other high-grade neuroendocrine carcinomas. He is active in clinical trial design including investigator-initiated trials. He enjoys teaching residents and fellows and has multiple publications and given many lectures for the scientific community on the topics of NETs and lung cancers.TOP TEN QUESTIONSBone mets:1. When and how often do NETs spread to the bones? 2. Where in the bones are tumors? What does it mean when NETs spread to the bones? How does this compare to other cancers?3. How are bone spots found and monitored? Should they be biopsied?4. What is the treatment for bone mets? Should I have radiation? Would radiation limit my ability to get PRRT?5. Should I be on bone strengthening medication? Am I at higher risk for fractures (or breaking my bones) if I have NETs in the bones?6. Do bone mets respond to PRRT?7. Does having bone mets put me at a higher risk of MDS?Brain mets:8. When and how often do NETs spread to the brain? Do all types of NETs have the potential to spread to the brain?9.    How are brain mets found and monitored? When should I suspect this?10.  How are brain mets treated? What does having brain mets mean for my life?*Bonus: What final words of hope do you have for the neuroendocrine cancer community?For more information, visit LACNETS.org.

What do you call NETs in the liver? How often do NETs spread? What causes NETs to spread? How do you determine if surgery is an option? Dr. Xavier Keutgen from University of Chicago brings clarity to NET tumors found in the liver and describes how surgery fits in with other treatments for metastatic NETs.ABOUT DR. XAVIER KEUTGENXavier M. Keutgen MD is a board-certified, double-fellowship trained surgeon who specializes in the treatment of gastro-entero-pancreatic neuroendocrine tumors and neoplasms of the thyroid-, parathyroid- and adrenal glands. A native from Belgium, Dr. Keutgen graduated magna cum laude from the University of Heidelberg Medical School in Germany and completed a general surgery residency and surgical oncology research fellowship at New York Presbyterian Hospital-Weill Cornell Medical Center.  He then completed a hepato-pancreato-biliary fellowship at the University Hospital of Zurich in Switzerland as well as an endocrine oncology and surgery fellowship at the National Cancer Institute, National Institutes of Health (NIH) in Bethesda, Maryland. Dr. Keutgen currently serves as the director of the Neuroendocrine Tumor Program, director of the Endocrine Research Program and co-director of the Von Hippel-Lindau Clinical Care Program at the University of Chicago Medicine.Throughout his career Dr. Keutgen has developed a particular interest in clinical, translational and basic science research. His laboratory specializes in investigating the role of radiation therapy and DNA damage repair in pancreatic, lung and small bowel neuroendocrine tumors, discovering new actionable molecular targets for neuroendocrine tumors, and elucidating new mechanisms of drug delivery for endocrine malignancies.TOP TEN QUESTIONS What is liver NETs? How often do NETs spread? Is it expected that NETs will eventually spread?If the primary tumor was already removed, do you now call this liver NET or do you still refer to it by the primary site of origin – and why? How is this different from liver cancer?What causes NETs to spread? Is there anything that is done to cause NET tumors to spread? Is there anything that can be done to keep them from spreading?How do you determine if surgery is an option? What is involved in evaluating metastases? What scans or labs are needed?How do you decide what the “tumor burden” is?How do you weigh the grade or ki67?  How do you weigh tumor size? Is there a cut-off for tumor size or the number of tumors that is too much to operate?How does one decide between surgery versus other options? How often can surgery or other treatments be done? How safe is liver surgery?How do you approach surgery for someone with liver tumors who also has tumors in the tail versus the head of the pancreas?When someone has had a Whipple surgery and later is found to have tumors in the liver, what are the options?What advances in the field are you most excited about? For more information, visit LACNETS.org.

Rick Greene, MD, discusses with Sean Cleary, MD, cytoreductive hepatectomy for neuroendocrine tumor liver metastases; specifically, perioperative outcomes and operative trends, rates and duration of symptomatic relief, and long-term survival and predictors of prognosis. Dr. Cleary is the senior author of, “Neuroendocrine Tumor Liver Metastases: Long-Term Follow-up Evaluation of More Than 500 Patients.” Dr. Cleary is the Bernard and Ryna Langer Chair of the Division of General Surgery in the Department of Surgery at the University of Toronto, Toronto, Canada.

As the Radical Thoughts Podcast is no longer active, I am making these old bonus episodes from Patreon publicly available so that listeners don't have to pay for an inactive podcast. - Patrick n this Patron-only bonus episode, Patrick interviews philosopher and psychoanalyst Adrian Johnston on the work of Slavoj Žižek, Lacanian psychoanalysis, theories of materialism, and more. This episode follows our discussion of the work The Metastases of Enjoyment, so you may want to listen to that episode first. NOTES: -Johnston's article on Lacan in the Stanford Encylopedia of Philosophy  -Less Than Nothing by Žižek -Self and Emotional Life: Philosophy, Psychoanalysis, and Neuroscience by Adrian Johnston and Catherine Malabou

This episode of SurgOnc Today®, features guest faculty, Astrid Botty Van Den Bruele, MD, and Meghan Flanagan, MD, MPH. In a contemporary group of patients diagnosed with contralateral axillary metastases (CAM), those selected for treatment with presumed curative intent experienced improved OS when compared to stage IV (M1) patients. The current literature, as well as some forthcoming data, adds additional support for re-evaluating the stage IV designation, in favor of N3, and consideration of curative intent treatment in this disease entity.

Dr. Iyad Alnahhas interviews Drs. Priya Kumthekar and Jeffrey Raizer about their recent manuscript entitled: A phase I/II study of intrathecal trastuzumab in human epidermal growth factor receptor 2-positive (HER2- positive) cancer with leptomeningeal metastases: Safety, efficacy, and cerebrospinal fluid pharmacokinetics", published online in Neuro-Oncology in March 2023.

Neurosurgeon Dr. Nam Tran from Moffitt Cancer Center talks with us about RF ablation for painful spinal metastases, including patient selection and the importance of a multidisciplinary approach. --- CHECK OUT OUR SPONSOR Medtronic OsteoCool https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html --- SHOW NOTES In this episode, neurosurgeon Dr. Nam Tran and our host Dr. Michael Barraza discuss minimally invasive procedures to treat both primary spine tumors and spine metastases. Dr. Tran describes the flexibility that kyphoplasty and spinal ablation can grant patients who are not suitable candidates for open surgical decompression. These minimally invasive procedures can reduce hospital stays from 4-5 days to just one night. Dr. Tran views ablation not only from a palliative pain reduction perspective, but also from an oncologic perspective that aims to reduce tumor burden. Dr. Tran says the ideal candidate for ablation is a patient who has isolated disease to the anterior column of the spine. With larger lesions, Dr. Tran relies on his neurosurgical background to take an aggressive approach in treating the entire vertebra. The doctors also discuss research studies that have made ablation more widely accepted and available (all articles are linked below). --- RESOURCES OPuS One Study: https://pubmed.ncbi.nlm.nih.gov/33129427/ CAFE Study: https://www.clinicaltrials.gov/ct2/show/study/NCT00211237

Interview with Sean P. Pitroda, MD, author of Integrated Clinical-Molecular Classification of Colorectal Liver Metastases: A Biomarker Analysis of the Phase 3 New EPOC Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Integrated Clinical-Molecular Classification of Colorectal Liver Metastases

Interview with Sean P. Pitroda, MD, author of Integrated Clinical-Molecular Classification of Colorectal Liver Metastases: A Biomarker Analysis of the Phase 3 New EPOC Randomized Clinical Trial. Hosted by Jack West, MD. Related Content: Integrated Clinical-Molecular Classification of Colorectal Liver Metastases

August 2023 Journal Club Podcast Title: Neoadjuvant Arterial Embolization of Spine Metastases Associated With Improved Local Control in Patients Receiving Surgical Decompression and Stereotactic Body Radiotherapy To read journal article: https://journals.lww.com/neurosurgery/Fulltext/2023/08000/Neoadjuvant_Arterial_Embolization_of_Spine.10.aspx Author: Brad Elder Guest faculty: Ziya Gokaslan Moderator: Haydn Hoffman Co-chair: Rafael Vega

CME credits: 1.00 Valid until: 17-07-2024 Claim your CME credit at https://reachmd.com/programs/cme/how-do-brain-metastases-affect-your-choice-of-systemic-treatment-in-a-patient-with-hrher2-low-mbc/15792/ This program explores new evidence that challenges the binary paradigm of HER2+ versus HER2- disease. Evidence is now available that specific antibody-drug conjugates (ADCs) have demonstrated benefit not only in HER2+ disease but also in a new group of “HER2-low” patients. Clinicians will learn how to reframe their diagnostic and treatment paradigms, moving from a siloed view to a more nuanced assessment of breast cancer characteristics. Episodes will provide a greater understanding of how ADC targets and payloads, such as HER2 and Trop-2 can significantly improve a patient's quality of life and extend their survival by increasing the pool of patients who may now benefit from ADCs. Aspects of diagnosing, treatment, and sequencing are discussed so that clinicians better understand how current and emerging ADCs address the unmet needs of patients with pretreated metastatic disease. Video education created for patients is available for this topic. Visit www.mymededge.com to “prescribe” education that helps patients and caregivers learn more about this condition.

Dr. Steven Yevich from MD Anderson Cancer Center talks with us about his approach to Treatment and Management of Painful Extra-spinal Bony Metastases. --- CHECK OUT OUR SPONSOR Medtronic OsteoCool https://www.medtronic.com/us-en/healthcare-professionals/products/spinal-orthopaedic/tumor-management/osteocool-ablation-system-rf.html --- SHOW NOTES In this episode, Dr. Steve Yevich joins Dr. Michael Barraza to discuss treatment of extraspinal painful bony metastases. Dr. Yevich tells us about his training in interventional oncology at Gustave Roussy Cancer Campus in Paris, and we discuss how he adjusted to identify the individual needs of the hospital when he came back to the US. We explain how to go into a case with either curative or palliative intent. Dr. Yevich shares when he would do soft tissue ablation around nerves and the location of the metastases he commonly treats. We emphasize the anatomic considerations to determine if ablation for the extraspinal bony metastases is feasible. We discuss some of the advanced techniques Dr. Yevich learned in Paris and the two types of cases that may need pre-ablation embolization. We discuss advancements in technologies and devices that have allowed for more creative solutions in IR.

Arun D. Singh, MD, Director of Ophthalmic Oncology at Cleveland Clinic Cole Eye Institute, joins the Cancer Advances podcast to discuss metastases to the eye. Listen as Dr. Singh talks about the common types of cancer that metastasize to the eye, symptoms, treatment options, and the importance of looking out for metastases in patients.

Interventional Radiologist Jason Levy and Radiation Oncologist Amir Lavaf discuss the benefits of a Multidisciplinary Approach in the Treatment of Spinal and Bone Metastases. --- SHOW NOTES In this episode, Dr. Jason Levy and Dr. Amir Lavaf join Dr. Michael Barraza to discuss their multidisciplinary approach to treating spinal metastases. We examine the collaborative efforts between IR and radiation oncologists, and we break down the indications for treating spinal metastases. We discuss pain control and local control rates, and how doctors are working to improve them. Dr. Levy and Dr. Lavaf tell us why they are able to get better survival numbers when they approach the primary and metastatic disease at the same time. We explain how to work with tumor boards and different groups of doctors to make spinal metastases treatment easier. We discuss how to reduce risk of delayed skeletal events and radiation failure after spinal metastases treatment. We go over some of the challenges of working with the tumor board, and why it is important to develop relationships with medical oncologists and the importance of continuing systemic therapies. --- RESOURCES BackTable Podcast Episode 68: RF Ablation Therapy for Bone Metastases https://www.backtable.com/shows/vi/podcasts/68/rf-ablation-therapy-for-bone-metastases

Rick Greene, MD, discusses with Dr. Giammauro Berardi, MD, PhD, FEBS, the outcomes of a large cohort of patients undergoing upfront surgery for resectable colorectal liver metastases (CRLM) to analyze the predictability and probability of early treatment failure using clinicopathological characteristics. Dr. Berardi is author of, “A Model to Predict Treatment Failure in Patients Undergoing Upfront Surgery for Resectable Colorectal Liver Metastases.” Dr. Berardi is attending at the Department of HPB Surgery and Liver Transplantation of the San Camillo Forlanini Hospital, Rome, Italy, and previous to that was a Surgical Oncology clinical fellow at Memorial Sloan-Kettering Cancer Center, New York NY.

Dr. Christian Capitini is an associate professor and the Jean R. Finley Professor of Pediatric Hematology and Oncology. He serves as co-leader of the Developmental Therapeutics Program at the University of Wisconsin Carbone Cancer Center and director of clinical innovation at the Forward BIO Institute. He has received many awards for his clinical and research contributions, including the Department of Pediatrics Gerard B. Odell Research Award, the Outstanding New Member Science Award from the Society for Pediatric Research (SPR), and the Janet Rowley Award from the Jonas Center Cellular Therapy Symposium at the University of Chicago. Nationally, Dr. Capitini is an active member of the Society for Immunotherapy of Cancer (SITC) and serves as at-large director. Additionally, he serves on the executive board for the Pediatric Real World chimeric antigen receptor (CAR) T Consortium. Dr. Capitini leads an NIH-supported laboratory focusing on development of cell-based immunotherapies, including natural killer (NK) cells and CAR T cells, for the treatment of pediatric solid tumors. The Capitini Lab also develops alternatively activated macrophages for complications of bone marrow transplant, including graft-versus-host-disease (GVHD) and acute radiation syndrome. Dr. Capitini was one of the site principal investigators (PI) for the first multicenter CD19 CAR T cell trial, which led to the FDA approval of tisagenlecleucel-T (Kymriah) for relapsed/refractory B cell leukemia. Currently, he is site PI for a Kymriah trial related to the upfront treatment of high-risk B cell leukemia and for a multicenter GD2 CAR T cell trial for neuroblastoma and osteosarcoma through the Pediatric NCI-Cancer Immunotherapy Trials Network (CITN). He is also a sponsor and PI for a University of Wisconsin clinical trial expanding gamma delta T cells in vivo using zoledronate after alpha beta T cell depleted stem cell transplant. --- What We Do at MIB Agents: PROGRAMS: End-of-Life MISSIONS Gamer Agents Agent Writers Prayer Agents Healing Hearts - Bereaved Parent and Sibling Support Ambassador Agents - Peer Support Warrior Mail Young Adult Survivorship Support Group EDUCATION for physicians, researchers and families: OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma MIB Book: Osteosarcoma: From our Families to Yours RESEARCH: Annual MIB FACTOR Research Conference Funding multiple $100,000 and $50,000 grants annually for OS research MIB Testing & Research Directory The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter. https://www.mibagents.org​ Help support MIB Agents, Donate here https://give-usa.keela.co/embed/YAipuSaWxHPJP7RCJ SUBSCRIBE for all the Osteosarcoma Intel

Dr. Iyad Alnahhas interviews Drs. Sherise Ferguson and Michael Davies about their recent manuscript entitled: "Changes in Outcomes and Factors Associated with Survival in Melanoma Patients with Brain Metastases", published online in Neuro-Oncology in December 2022.   Read Paper

On episode 11 of A Chat with Uma, inspired by my upcoming 4-year cancerversary and all that comes up this time of year - I share my full story + experience of living with cancer since I was 22. I talk you through the 6 months of misdiagnosis that led up to my diagnosis the day after my birthday, and I take you through the tumultuous journey of treatment that was shaped by further negligence, misdiagnosis, and mistreatment. I share the consequences of my delayed treatment on my prognosis, and I explain the reality of living with cancer rather than being in remission. I speak at length about the unique struggles of living with cancer as an AYA (adolescent + young adult patient), and I draw awareness to the experience of survivorship beyond treatment that is often completely overlooked by those in an AYA's life. I close with reflections about my experience, and a call to action + empowerment about sharing our true experiences in community with others - and allowing ourselves the chance to be truly seen + supported. Topics Covered + Timestamps: (00:00:00): Introduction to the episode, why l'm doing this episode, my upcoming 4-year cancerversary, dedication of this episode (00:09:44): Aspiring Scientists Coalition Presentation with Dr. Ben Rein THIS Thursday April 13, 9am PDT / 12pm EDT ⁠⁠Sign up for free HERE (00:14:00): Breaking Convention Presentation April 20-22 | University of Exeter ⁠Register to attend HERE⁠ (in person or virtual) (00:17:05): Digital CancerCon Presentation April 16-30, virtual platform Register HERE for free (00:19:58): Diagnosis & surgery Events leading up to my diagnosis 6 months of misdiagnosis Being diagnosed the day after my birthday The role of my young age Going through cancer surgery Consequences and effects (00:42:56): Negligence, radiation, metastasis Medical negligence after surgery Transitioning my care Highest risk of recurrence Radiation Discovery of distant spots of metastasis (01:01:20): What my cancer looks like now Current level of monitoring "Cancer suppressed" vs. in remission The role of my young age (01:07:31): The AYA cancer experience What AYA is: adolescent + young adult patients The worsened outcomes + prognoses for AYAs AYA awareness and self-advocacy (01:14:42): The reality of facing your mortality Isolation, fear, scanxiety Worsened mental health outcomes Toxic positivity and gratitude How to adequately support AYAs (01:19:27): Closing out the episode, integrating and allowing all parts of you to exist Connect with me! My website⁠: ⁠⁠⁠umarchatterjee.com⁠⁠⁠ ⁠Instagram:⁠ ⁠⁠⁠@UmaRChatterjee⁠⁠⁠ Twitter:⁠ ⁠⁠⁠@UmaRChatterjee⁠⁠⁠ TikTok:⁠ ⁠⁠⁠@UmaRChatterjee⁠⁠⁠ Email: ⁠⁠⁠hello@umarchatterjee.com⁠ --- Send in a voice message: https://podcasters.spotify.com/pod/show/umarchatterjee/message

"Nail changes in pemphigus and bullous pemphigoid: A single-center study in China." Cao, Shan, et al. Frontiers in Medicine 9 (2022)."Metastases to the nail unit and distal phalanx: a systematic review.” Curtis, Kaya L., and Shari R. Lipner. Archives of Dermatological Research (2022): 1-12.

Welcome to our 4th episode for our Spine Citation classics series. The goal of this episode is to go over the highest cited articles in the last 15-20 years on metastatic disease to the spine ! This is spearheaded by Dr. Sohum Patel, Jose Chacon , and Dr. Jay Fitts. Enjoy! Subscribe:

This episode is sponsored by BTG Speciality Pharmaceuticals. BTG provides rescue medicines typically used in emergency rooms and intensive care units to treat patients for whom there are limited treatment options. They are dedicated to delivering quality medicines that make a real difference to patients and their families through the development, manufacture, and commercialization of pharmaceutical products. Their current portfolio of antidotes counteracts certain snake venoms and the toxicity associated with some heart and cancer medications. --- Dr. Canter is a Surgical Oncologist with clinical expertise in the multidisciplinary management of sarcomas. He also runs a translational research laboratory which focuses on the therapeutic and mechanistic effects of combining natural killer (NK) cell immunotherapy with other treatment modalities to overcome NK dysfunction in the tumor microenvironment of solid tumors, including sarcomas in both humans and dogs. He serves as the co-leader of UC Davis Comprehensive Cancer Center's Comparative Oncology Program, and his laboratory is one of a select group of labs internationally which is studying canine NK cells, including first-in-dog studies of canine immunotherapy and adoptive transfer of NK cells in dogs with osteosarcoma. Dr. Rebhun is a an Associate Professor in the Department of Surgical and Radiological Sciences at the Center for Companion Animal Health at the UC Davis School of Veterinary Medicine. His research focus is in the field of comparative and translational oncology, with specific interests in metastasis and novel therapeutics. --- What We Do at MIB Agents: PROGRAMS: ✨ End-of-Life MISSIONS ✨ Gamer Agents ✨ Agent Writers ✨ Prayer Agents ✨ Healing Hearts - Bereaved Parent Support ✨ Ambassador Agents - Peer Support ✨ Warrior Mail ✨ Young Adult Survivorship Support Group ✨ EDUCATION for physicians, researchers and families: ✨ OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma ✨ MIB Book: Osteosarcoma: From our Families to Yours ✨ RESEARCH: Annual MIB FACTOR Research Conference ✨ Funding $100,000 annually for OS research ✨ MIB Testing & Research Directory ✨ The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter.

This episode is sponsored by BTG Speciality Pharmaceuticals. BTG provides rescue medicines typically used in emergency rooms and intensive care units to treat patients for whom there are limited treatment options. They are dedicated to delivering quality medicines that make a real difference to patients and their families through the development, manufacture, and commercialization of pharmaceutical products. Their current portfolio of antidotes counteracts certain snake venoms and the toxicity associated with some heart and cancer medications. --- Dr. Weiss is a Founding Member of the Musculoskeletal Oncology Research Initiative (MORI), Pittsburgh Cure Sarcoma (PCS), the Pittsburgh Sarcoma Research Collaborative (PSaRC), and the Pittsburgh Center for Bone and Mineral Research (PCBMR). He is a peer reviewer for multiple journals including the Journal of the American Academy of Orthopaedic Surgeons, BioMed Central Cancer, Sarcoma, Cancer Research, International Journal of Cancer, and others. He is a former member of the NIH's Center for Scientific Review Early Career Reviewer program. He has served on multiple National Cancer Institute Study Sections. He is a member of the Musculoskeletal Tumor Society (MSTS) for which he serves as Chair of the Research Committee and the Connective Tissue Oncology Society (CTOS), for which he has served on the Board of Directors. --- What We Do at MIB Agents: PROGRAMS: ✨ End-of-Life MISSIONS ✨ Gamer Agents ✨ Agent Writers ✨ Prayer Agents ✨ Healing Hearts - Bereaved Parent Support ✨ Ambassador Agents - Peer Support ✨ Warrior Mail ✨ Young Adult Survivorship Support Group ✨ EDUCATION for physicians, researchers and families: ✨ OsteoBites, weekly webinar & podcast with thought leaders and innovators in Osteosarcoma ✨ MIB Book: Osteosarcoma: From our Families to Yours ✨ RESEARCH: Annual MIB FACTOR Research Conference ✨ Funding $100,000 annually for OS research ✨ MIB Testing & Research Directory ✨ The Osteosarcoma Project partner with Broad Institute of MIT and Harvard ... Kids are still dying with 40+ year old treatments. Help us MakeItBetter.

Practical Radiation Oncology deputy editor James B. Yu, MD, Columbia University Irvine Center hosts a conversation on ASTRO clinical practice guideline on radiation therapy for Brain Metastases. Eric Chang MD of the Keck School of Medicine of USC and Veronica Chiang, MD, of Yale University School of Medicine discuss the recommendations in the four key areas: what are the indications for radiosurgery alone for brain metastases, what should be done before or after surgical resection of brain metastases, when and how should we do whole brain radiation, and what are the risks of radionecrosis. Two of the guideline authors, Jona A. Hattangadi‐Gluth, MD of the University of California, San Diego and Vinai Gondi, MD of Northwestern Medicine Cancer Center and Proton Center discuss the development process of the guideline and the evidence for the recommendations.

An interview with Dr. Naren Ramakrishna from Orlando Health Cancer Institute in Orlando, FL, and Dr. Carey Anders from Duke University in Durham, NC, co-chairs on "Management of Advanced Human Epidermal Growth Factor Receptor 2 Positive Breast Cancer and Brain Metastases: ASCO Guideline Update." This guideline reviews evidence in both the local therapy management and systemic therapy management for patients with HER2-positive breast cancer and brain metastasis, and provides updated recommendations for these patients. Read the full guideline at www.asco.org/breast-cancer-guidelines.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines Podcast series brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Naren Ramakrishna from Orlando Health Cancer Institute in Orlando, Florida. And Dr. Carey Anders from Duke University in Durham, North Carolina, co-chairs on 'Management of Advanced Human Epidermal Growth Factor Receptor 2 Positive Breast Cancer and Brain Metastases: ASCO Guideline Update'. Thank you for being here. Dr. Ramakrishna and Dr. Anders. Dr. Carey Anders: Thank you. Dr. Naren Ramakrishna: Thank you. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Ramakrishna, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Naren Ramakrishna: No. Brittany Harvey: And Dr. Anders, do you have any relevant disclosures that are directly related to this guideline topic? Dr. Carey Anders: I do. I would just like to disclose that I receive research funding, compensated consulting roles, and royalties from several of our industry partners who are developing brain permeable compounds. Brittany Harvey: Thank you. Let's talk about the content of this guideline. So, Dr. Anders, what prompted an update to this guideline? And what is the scope of this guideline update? Dr. Carey Anders: Thank you for that question, Brittany. Our previous guideline in the management of HER2-positive breast cancer brain metastasis was published in 2018. And since that time, we've seen significant progress in both the local therapy management and systemic therapy management for our patients with HER2-positive breast cancer and brain metastasis. I think collectively, this body of work really prompted the panel to think through the changes that we could make to improve the care of our patients taking these updates into account. I'd love to hear Dr. Ramakrishna's take on the rationale for the update as he was also involved in the 2018 guideline. Dr. Naren Ramakrishna: Thank you, Carey. Well, it's really an exciting time right now for breast cancer brain metastasis treatment. And the recent data that Dr. Anders referred to has really opened up a whole new era in terms of therapeutic possibilities for breast cancer brain metastasis patients. In the past, we've relied on traditional methods of treatment like whole-brain radiotherapy, surgery, and stereotactic radiosurgery as mainstays of treatment. But this exciting data that Dr. Anders referred to, has resulted in the possibility of avoiding certain of the local therapy options in select patients, which has the potential to increase patient survival and quality of life, and is a major advancement. Brittany Harvey: Excellent. It's great to hear about those advancements. So, then next, I'd like to start by reviewing the guideline recommendations for our listeners. Dr. Ramakrishna, what are the key recommendations for local therapy for patients with HER2-positive breast cancer and brain metastases? Dr. Naren Ramakrishna: Since the 2018 updated guidelines, we've continued with our stratification of patients by prognosis by the number of metastases, size of metastases, and also whether they are symptomatic or asymptomatic. Overall, the changes include the offering of systemic therapy for patients after multidisciplinary review for asymptomatic metastases, particularly those less than two centimeters in size. In select cases, one might also offer it for patients with metastases larger than that. The other major change that we see in this update is an increasing reliance on stereotactic radiosurgery rather than whole-brain treatment as a local therapy option, both in the post-operative setting and for single or multiple metastases, for which surgery is not recommended. Finally, we see a significant change in the application of whole brain radiation, where whole-brain radiation is recommended typically for extensive disease, either with multiple, very large metastases, or many, many small metastases. We recommend whole brain treatment to always be administered with a neuroprotectant, and where possible, with what's called hippocampal sparing, which is thought to reduce the neurocognitive negative effects of whole-brain radiation treatment. Brittany Harvey: Understood, I appreciate those recommendations for local therapy and that overview that you provided. So then Dr. Anders, in addition to those recommendations, what are the key recommendations for systemic therapy for these patients? Dr. Carey Andres: Sure, Brittany, happy to review. I think some of the general principles from the 2018 guidelines remain in place. So, for instance, our patients who have progressive disease in the brain, are eligible for local therapy and have controlled extracranial disease, we still recommend continuing the current HER2-directed therapy along with the same algorithm for the treatment of patients with HER2-positive metastatic breast cancer. There are some interesting and exciting changes to the guidelines with the advent of several of the promising systemic therapies that Dr. Ramakrishna outlines such that we do have the option of leading with systemic therapy for our patients with small asymptomatic lesions in the brain predominantly based on the HER2CLIMB clinical trial which established tucatinib, capecitabine and trastuzumab in this setting. So, in concert with our local therapist, we have the consideration for moving to the HER2CLIMB regimen in the setting of active asymptomatic brain metastasis in concert with our local therapist. So, that's one key change from the 2018 guidelines. Another is the introduction of the compound trastuzumab deruxtecan, an antibody-drug conjugate, which has been shown in second line in the setting of metastatic HER2-positive breast cancer to be superior to our traditional T-DM1 therapy in this setting. In the study, the Destiny-Breast03 study that illustrated the superiority of trastuzumab deruxtecan patients with stable brain metastasis were included and illustrated in this compound, illustrated significant benefit for patients with stable brain metastasis. So, in addition to the HER2CLIMB regimen in the setting of stable brain metastasis, we also have the option of trastuzumab deruxtecan in this setting. And that was an update in our 2022 guidelines. So, we essentially have more systemic therapy tools in our toolkit to consider in concert with local therapy. And I just want to emphasize the importance of communication between the systemic therapy team and the local therapy teams, particularly when we're making the decision to move forward with the systemic therapy in the setting of progressive or stable brain metastasis. Brittany Harvey: Thank you. Yes, that multidisciplinary care is key, and I appreciate your reviewing those updates. So then, in addition to those what is recommended regarding screening for the development of brain metastases for patients with HER2-positive breast cancer? Dr. Carey Andres: So, this is a very active conversation. And in fact, I had this very conversation with two patients in the clinic just yesterday. So, should we be screening our patients with advanced HER2-positive breast cancer with brain MRIs in the absence of symptoms? I think the bottom line is we just don't have the data yet. I think we will have the data and in fact, there are ongoing prospective studies trying to determine whether or not screening brain MRIs in the absence of symptoms in this setting will improve our patient survival, and also improve our patients' quality of life. Until we have that data because we do have these new tools in the toolkit for systemic therapy treatment, the panel loosens the guidelines a bit to say that it's not that we no longer recommend screening in the asymptomatic state, but there's not enough data for or against. And I think this really will help the physician and patients as they're making decisions about their screening and restaging studies in a personalized manner. In addition to the lack of data, we also strongly recommend that clinicians and patients have a very low threshold to obtain a brain MRI in the presence of symptoms and this is really important with regards to communication about symptoms as subtle as they may be. I'd love to hear Dr. Ramakrishna's take on this challenging space where we clearly need more data. Dr. Naren Ramakrishna: Yes, Carey, I completely agree that it's quite challenging and the practice patterns are quite diverse throughout the country. It's also a source of a great deal of apprehension and anxiety for patients who automatically typically would assume that more frequent screening is better, especially when they do develop brain metastasis if that's to occur. So, we do look forward to better data for guidance. And it certainly is an area that should undergo multidisciplinary reviewing recommendations for any particular patient. Brittany Harvey: Understood, thank you both for reviewing the evidence as it states now and we'll look forward to that emerging data for perhaps a future guideline update. So then, Dr. Ramakrishna, what in your view is the importance of this guideline update and what does it mean for clinicians? Dr. Naren Ramakrishna: Well, this is a practice-changing update. I mean, I don't think that's an overstatement. Because for the first time, upfront therapy is going to include the possibility of systemic therapy. And this also means that there has to be multidisciplinary and multimodality discussions regarding local versus systemic therapy for a large proportion of HER2-positive breast cancer brain metastasis patients. So, practice patterns are going to shift as a result of the incorporation of systemic therapy into the treatment paradigm. And finally, the other very important, practice-changing local therapy change is that the use of whole-brain treatment will be reduced relative to stereotactic radiosurgery, but in some cases, also as a result of the use of systemic therapy, and when it is employed, it must be utilized with a neuroprotectant and/or hippocampal sparing. Brittany Harvey: Great and then finally, how will these guideline recommendations affect patients with HER2-positive metastatic breast cancer and brain metastases? Dr. Carey Andres: So, I would just echo Dr. Ramakrishna's comments about the advances that we've seen and the importance of multidisciplinary care. I think from a systemic therapy perspective, we have the wonderful problem of having multiple agents to consider in this space. And as we've seen, really an explosion of HER2-directed therapies that are now approved and available to patients. One of our challenges has been how to sequence these therapies. And so, we were hopeful that these guidelines will help clinicians and patients determine when to pick individual regimens that best fit the patient's scenario, whether or not their brain metastases are stable at that decision tree, or whether or not they're progressive at that decision tree. I would also point the listeners to the updated guidelines in the management of patients with HER2-positive metastatic breast cancer, as these guidelines will certainly complement the decision-making and systemic therapy, incorporating the presence or absence of brain metastasis. Brittany Harvey: Great, and yes, thank you for highlighting that companion guideline. Both are available at asco.org/breast-cancer-guidelines and in the Journal of Clinical Oncology. So, I want to thank you both so much for your work on these guidelines and for taking the time to speak with me today, Dr. Anders and Dr. Ramakrishna. Dr. Naren Ramakrishna: Thank you very much, Brittany. Dr. Carey Andres: Thank you! Thanks for the opportunity. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines Podcast series. To read the full guideline go to www.asco.org/breast-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines App available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   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.

An interview with Dr. David Schiff from the University of Virginia Medical Center in Charlottesville, VA, Dr. Michael Vogelbaum from Moffitt Cancer Center in Tampa, FL, and Dr. Vinai Gondi from Northwestern Medicine Cancer Center Warrenville and Proton Center in Warrenville, IL, authors on "Radiation Therapy for Brain Metastases: American Society of Clinical Oncology Guideline Endorsement of the American Society for Radiation Oncology Guideline." An ASCO endorsement panel endorsed the "Radiation Therapy for Brain Metastases: an ASTRO Clinical Practice Guideline," and the authors review the endorsement process and key points in this episode. Read the full guideline endorsement at www.asco.org/neurooncology-guidelines.   TRANSCRIPT Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows including this one at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. David Schiff, from the University of Virginia Medical Center in Charlottesville, Virginia, Dr. Michael Vogelbaum from Moffitt Cancer Center in Tampa, Florida, and Dr. Vinai Gondi from Northwestern Medicine Cancer Center Warrenville and Proton Center in Warrenville, Illinois, authors on 'Radiation Therapy for Brain Metastases: American Society of Clinical Oncology Guideline Endorsement of the American Society for Radiation Oncology Guideline'. Thank you for being here, Dr. Schiff, Dr. Vogelbaum, and Dr. Gondi. Drs. Schiff, Vogelbaum, and Gondi: Our pleasure. Brittany Harvey: First, I'd like to note that ASCO takes great care in the development of its guideline products and ensures that the ASCO conflict of interest policy is followed for each guideline product. The full conflict of interest information for this guideline endorsement panel is available online with the publication in the Journal of Clinical Oncology. Dr. Schiff, do you have any relevant disclosures that are directly related to this topic? Dr. David Schiff: No relevant disclosures, Brittany. Brittany Harvey: Thank you. And Dr. Vogelbaum, do you have any relevant disclosures that are related to this topic? Dr. Michael Vogelbaum: I have no relevant disclosures. Brittany Harvey: Thank you. And Dr. Gondi, do you have any relevant disclosures that are related to this topic? Dr. Vinai Gondi: Brittany, my only relevant disclosure is that I served as vice-chair of the guidelines that we're discussing today, but otherwise, no relevant disclosures. Brittany Harvey: Excellent! Thank you all. So, then starting us off, Dr. Schiff, what is the scope of this guideline endorsement? And how does it intersect with the recently published 'Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline'? Dr. David Schiff: Sure. A little bit of background, from the start of the joint ASCO and SNO guideline effort, we had the participation of radiation oncologists, in addition to neurosurgeons, medical oncologists, and neuro-oncologists. As we were getting underway, ASTRO reached out asking to participate formally as well. They had been planning to update their brain metastasis guidelines but were a year or two away from getting started. And they recognized it would be redundant for them to create comprehensive guidelines that covered chemotherapy, immunotherapy, and surgery as our guidelines were poised to do. By participating with ASCO and SNO, they were able to have their task force focus specifically on key questions related to radiation oncology practices. In particular, the ASTRO project went into considerable depth on issues of radiation and radiosurgery dose, fractionation schemes, and the risk of radiation complications. These were areas that our guidelines didn't address. Several members of the ASTRO task force including their chair, Paul Brown, and co-chair Dr. Gondi were members of our committee, and we added Dr. Brown as a co-chair to our committee when ASTRO came on board. The overlap between our two groups helped ensure that our recommendations were in harmony. Brittany Harvey: So, then, Dr. Vogelbaum, can you provide us with an overview of how the ASCO guideline endorsement process works? Dr. Michael Vogelbaum: Sure, Brittany. So, as Dr. Schiff mentioned, ASCO had convened a guidelines panel to develop the new 'Treatment for Brain Metastasis: ASCO-SNO-ASTRO Guideline'. And this was a multidisciplinary panel that he and I co-chaired and was anchored by a guideline specialist from ASCO, Hans Messersmith, and the process was that we had evaluated recent literature pertaining to the treatment of the brain metastases, and so, we had a very good understanding of what was supported by high-quality evidence and what was not there yet, as a group. So, when ASTRO came to ASCO and asked whether or not we would be interested in endorsing their guidelines, we were already prepared with all the evidence. And so, the same panel got together again, to evaluate the ASTRO guidelines. And we did this, again, in a very structured manner. We reviewed the guideline questions and recommendations, compared them to the evidence, and went through the same type of review and polling process that we had when we had developed our own original guidelines. In the end, we had a conversation with the ASTRO guidelines leadership about some of the points that we raised questions about, and we were able to reach an accommodation that allowed us to fully endorse the ASTRO guidelines. Brittany Harvey: Thank you, Dr. Vogelbaum for that overview of the endorsement process. So, then, Dr. Gondi, what are the key recommendations of the ASTRO guideline? Dr. Vinai Gondi: Thank you, Brittany. As Dr. Schiff and Dr. Vogelbaum outlined, ASTRO commissioned a list of key questions that they sought to address specifically to inform the radiotherapeutic management of brain metastases. And to address these questions, ASTRO not only convened a panel of expert radiation oncologists across the country but also engaged with the Agency for Healthcare Research and Quality (AHRQ) to create a comparative effectiveness evidence review, in addition to our own high-level evidence review to address these questions. The four key questions that were addressed in the ASTRO guidelines are: Number one: What are the indications for stereotactic radiosurgery alone for patients with intact brain metastases? Number two: What are the indications for observation, preoperative radiosurgery or post-operative radiosurgery, or whole-brain radiotherapy in patients with resected brain metastases? Number three: What are the indications for whole-brain radiotherapy for patients with intact brain metastases? Number four: What are the risks of symptomatic radionecrosis with whole-brain radiotherapy and/or stereotactic radiosurgery for patients with brain metastases? The recommendations that were made are based on a high-level review of a considerable amount of literature over the past several years that addressed these specific questions. I would encourage the listeners to this podcast to read through the guidelines to understand the specific nuances of each of those recommendations. Brittany Harvey: Excellent! Thank you for that overview. Then, in addition to what Dr. Gondi just said, Dr. Vogelbaum, were there any additional points of discussion raised by the ASCO endorsement panel? Dr. Michael Vogelbaum: Brittany, yes, there was an area of discussion where we needed to interact with the ASTRO guidelines leadership, as I mentioned earlier, and it really related to that key question one that Dr. Gondi described, which is what are the indications for SRS alone for patients with intact brain metastasis. The approach that had been strongly endorsed by ASCO was that there would be a multidisciplinary approach to decision making. And really the benefit of that, the value of that radiosurgery really comes in the form of the interaction between the radiation oncologist and the neurosurgeon. The way that the original proposal had been formulated, there was a size cut-off that was higher than we thought was appropriate for really endorsing that kind of conversation between the radiation oncologist and the neurosurgeon. And so really, we proposed that we bring that cut-off down further, there actually was another subpart to the guideline that had looked at a lower cut-off, but did not specifically call out that interaction between the neurosurgeon and the radiation oncologist. And we felt it would be more appropriate to insert that at that cut-off rather than the larger lesion cut-off. And after a conversation, there was agreement, that was really the only guideline or subpart of the guidelines where there was any real debate or discussion. For the rest of it, the comments that came up from the panel were easily addressed and it really just came down to this one modification. And fortunately, ASTRO agreed, and we were able to go ahead and complete the endorsement. Brittany Harvey: Great! It's great that this was able to be a complete endorsement of that guideline. So, then, Dr. Gondi, in your view, what is the importance of this guideline endorsement? And how will it affect ASCO members? Dr. Vinai Gondi: Thank you, Brittany. A number of responses to that. Number one is, as Dr. Vogelbaum, outlined the purpose of these guidelines was meant to be patient-centric and patient-focused, that we had patient champions who had navigated, who are part of the guideline development team, but also to be multidisciplinary. And so, the type of input and feedback we received from the ASCO team was super valued and valuable, as we were formulating these guidelines and Dr. Vogelbaum outlined a good example. Number two, it had been almost a decade since the last guidelines had come out from ASTRO related to brain metastases management. And much has happened in our field over the past several years that has been practice-changing. We have several novel and innovative radiotherapy technologies and techniques, such as the emergence of radiosurgery, the use of novel radioprotectants, such as hippocampal avoidance, and memantine, but also the emergence of innovative and novel neurosurgical interventions and CNS active systemic therapies. So, the modern management of brain metastases has really undergone quite a revolution over just the past few years, and it is important that these guidelines be updated to reflect those changes, but also to inform radiation oncologists on the contemporary management of brain metastases and in evidence-based care. So, we believe that these guidelines will significantly impact ASCO members. Certainly, those who are radiation oncologists, as brain metastases are some of the most common patients that radiation oncologists manage in the community and in academic centers, but also for other members of ASCO medical oncologists, surgeons to understand sort of the nuances of radiotherapy management that is evidence-based, so they can have a patient-centered, patient-focused, multidisciplinary discussion with their radiation oncologist as well. Brittany Harvey: Those are excellent points for clinicians on the management for brain metastases. So, then finally, Dr. Schiff, Dr. Gondi just mentioned how these guidelines are patient-centric. So, how will these guideline recommendations impact patients with brain metastases? Dr. David Schiff: Yeah, well, I think what I'm about to say is really going to echo what Dr. Gondi just said. You know, 20 years ago, patients diagnosed with brain metastases were typically immediately referred to a radiation oncologist, they almost always got whole-brain radiation therapy, the median survival was about four months, and many, if not most patients, died from their brain metastases. The situation has really changed recently. With the rapid advances in management from new therapies, and well-designed clinical trials in recent years, outcomes have markedly improved, it's probably less than a quarter of patients now who succumb to their intracranial disease. But at the same time, decision-making for patients has become much more complicated. Nowadays, medical oncologists may reach out initially to neurosurgeons for consideration of radiosurgery or surgical resection, or in some circumstances utilize systemic therapy as a first step. Conversely, a patient might see a neurosurgeon first, who may or may not be aware that there's appropriate immunotherapy or targeted agent that might make sense prior to going on to radiosurgery. It's obviously a challenge for sub-specialists to keep up with all the emerging clinical trial data and new drugs. Our two sets of guidelines provide a roadmap for physicians of different expertise to help determine what types of therapies or referral should be considered when brain metastases are found. The end result of all this is improved control of intracranial disease and improved quality of life for the patients. Brittany Harvey: Absolutely. Those are key points. It's excellent to see these guidelines, and the overarching 'Treatment for Brain Metastases: ASCO-ASTRO-SNO Guideline' be published. So, I want to thank you all for your time today, Dr. Schiff, Dr. Vogelbaum, and Dr. Gondi. Thank you for all of your work on these guidelines. Dr. Michael Vogelbaum: My pleasure. Dr. Vinai Gondi: Thank you for having us. Dr. David Schiff: Thank you, Brittany. It was great to participate in this important project. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast series. To read the full guideline endorsement go to www.asco.org/neurooncology-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in iTunes or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode.   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.

A Cure in Sight, in collaboration with the Ocular Melanoma Foundation, is joined by TriSalus Life Sciences to bring you a presentation on Barriers to Immunotherapy: Success for Uveal Melanoma Liver Metastases. The slides from this presentation can be found to follow along here on Youtube.   In this presentation, we will be hearing from three of the experts involved in the PERIO-01 Clinical Trial.   The Pressure-Enabled Regional Immuno-Oncology (PERIO-01) clinical trial is studying a new investigational drug, SD-101, delivered intravascularly by the TriNav® Infusion System using the Pressure-Enabled Drug Delivery™ (PEDD™) method of administration. The study is evaluating if this platform approach can improve the performance of systemic checkpoint inhibitors in treating patients with uveal melanoma liver metastases by overcoming two major challenges of treatment: immune response suppression and ineffective drug delivery.   First up, you'll hear from Dr. Richard D. Carvajal, MD, Associate Professor of Medicine, Director, Experimental Therapeutics, Director, Melanoma Service, Columbia University Irving Medical Center; Investigator, PERIO-01 Clinical Trial. Dr. Carvajal will discuss Successes, Challenges and Emerging Strategies in the Treatment of Metastatic Uveal Melanoma.   Following his presentation, Dr. Steven C. Katz, MD, FACS, Chief Medical Officer, TriSalus Life Sciences will discuss Barriers to Immunotherapy Success in Uveal Melanoma Liver Metastases.   To conclude you'll hear from Dr. Joshua L. Weintraub, MD, Executive Vice Chairman, Department of Radiology, Chief, Division of Vascular and Interventional Radiology, Columbia University Irving Medical Center about the Pressure-Enabled Regional Immuno-Oncology (or PERIO-01) Clinical Trial for adults with uveal melanoma liver metastases. After their presentation, Ashley Moody from TriSalus Life Sciences joins in to aid in the Q and A. Ashley is a Nurse and a Clinical Research and Immunotherapy Project Manager. She will answer logistical questions surrounding trial involvement (eligibility, trial flow, treatment logistics, travel reimbursement, if applicable, etc.) following the presentation. Information on the PERIO-O1 Clinical Trial can be found at www.PERIOtrial.com ********* Be sure to follow us on Facebook, Twitter, or  Instagram @acureinsight, for more stories, tips, research news, and ideas to help you navigate this journey with OM! *A Cure in Sight is a 501c3 organization. All donations made can help fund our podcast to educate patients, fund research, aid patients, and more! Donate $10 $15 $20 today to help A Cure in Sight in their quest to find a cure. LINKS TO PAYPAL OR VENMO  The Eye Believe Podcast is brought to you by Castle Biosciences. Castle Biosciences is a leading diagnostics company improving health through innovative tests that guide patient care. The Company aims to transform disease management by keeping people first: patients, clinicians, employees and investors.  This podcast was hosted by Danet Peterson and produced by Agora Media.

This is a new stop in our ongoing series Road to a Cure. From the start, our goal for this series was not only to educate and give hope to every listener  but also to ensure that  each of these special interviews feels like an intimate conversation with our smartest friend who also happens to be an oncologist researcher. Co-hosts Victoria Goldberg and Dr. Paula Jayne sit down with neuro-oncologist Dr. Priya Kumthekar to talk about leptomeningeal metastases: what they are, how are they treated, and what research is upcoming, including a discussion on ANGled, the new Phase 3 trial for MBC patients newly diagnosed with leptomeningeal metastases.  We end this episode on a hopeful note with  a little Dash of Joy  from our Creator and Senior Producer Lisa Laudico.More info is available on our website:   www.ourmbclife.orgGot something to share?  Feedback? Email:   ourmbclife@sharecancersupport.orgSend us a voice recording via email or through speakpipe on our website.  Follow us on Facebook, Instagram, and Twitter @ourmbclife