Rad Onc Twitter

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Chartreuse Wombat said:
Did not include nodes in this study.

pubmed.ncbi.nlm.nih.gov

Phase 1 trial of neoadjuvant radiation therapy before prostatectomy for high-risk prostate cancer - PubMed

Neoadjuvant RT is feasible with moderate urinary morbidity. However, oncologic outcomes do not seem to be substantially different from those with selective postoperative RT. If this multimodal approach is further evaluated in a phase 2 setting, 54 Gy should be used in combination with...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Bigger issue is that no one wants to do preop (because is screws you on the backend if salvage XRT is needed)
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Isn't this argument true with any neoadjuvant treatment (i.e. sarcoma, rectal)?

Is it possible neoadjvuant RT would mitigate the need for salvage with prostate? (honestly asking)
 
thecarbonionangle said:
That pic of Ron D with the proton grift mafia really is quite something folks! im loving the guy rocking the seersucker!
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NY Proton center will rob you blind and then ask you to let them proton you to give half your money back.

it's quite the grift.
 
NotMattSpraker said:
Immunotherapy works SUPER well in many trials, like, 10-20% of the time 🙂
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That is not completely accurate. 5-year OS in metastatic melanona is now 50% compared to 5% (?) about 20 years ago. It comes with a price though, combining Ipi+Nivo will cause Grade 3 toxicity in something like 60% of patients.
 
Palex80 said:
That is not completely accurate. 5-year OS in metastatic melanona is now 50% compared to 5% (?) about 20 years ago. It comes with a price though, combining Ipi+Nivo will cause Grade 3 toxicity in something like 60% of patients.
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You know, I was on a virtual ASCO review and a medical oncologist speaker made a declarative statement that the 5 year survival for stage III lung cancer is 20% in the context of neoadjuvant chemoimmunotherapy and none of the medical oncologists bothered to corrected the speaker or reference the PACIFIC trial. I wonder if that is why they are "winning" and we are "losing".

So to fight fire with fire, yes, immunotherapy is usually expensive trash.
 
Lamount said:
Isn't this argument true with any neoadjuvant treatment (i.e. sarcoma, rectal)?

Is it possible neoadjvuant RT would mitigate the need for salvage with prostate? (honestly asking)
Click to expand...
The role of neoadjuvant therapy varies by site, right? Based on the design of prior trials.

The argument for neoadjuvant therapy for sarcoma is reducing the risk of late toxicity.

With rectal, it's acute and late toxicity benefit and the opportunity for TNT if you are in to that sort of thing.

In this trial, it seemed like the reason was because 1) surgeons can't resist operating on higher risk patients, 2) its hard to clean up the mess after surgery and/or 3) people aren't referred for adjuvant. Creative solution to a funny problem. Since it didn't work, what about a randomized trial of ADT/RT versus surgery? 🤣

(To be clear, I liked the cited phase 1 trial, good stuff)
 
Lamount said:
Isn't this argument true with any neoadjuvant treatment (i.e. sarcoma, rectal)?

Is it possible neoadjvuant RT would mitigate the need for salvage with prostate? (honestly asking)
Click to expand...

NotMattSpraker said:
The role of neoadjuvant therapy varies by site, right? Based on the design of prior trials.

The argument for neoadjuvant therapy for sarcoma is reducing the risk of late toxicity.

With rectal, it's acute and late toxicity benefit and the opportunity for TNT if you are in to that sort of thing.

In this trial, it seemed like the reason was because 1) surgeons can't resist operating on higher risk patients, 2) its hard to clean up the mess after surgery and/or 3) people aren't referred for adjuvant. Creative solution to a funny problem. Since it didn't work, what about a randomized trial of ADT/RT versus surgery? 🤣

(To be clear, I liked the cited phase 1 trial, good stuff)
Click to expand...
what about a randomized trial of ADT/RT versus surgery?

ClinicalTrials.gov

clinicaltrials.gov clinicaltrials.gov
 
theradiator said:
You know, I was on a virtual ASCO review and a medical oncologist speaker made a declarative statement that the 5 year survival for stage III lung cancer is 20% in the context of neoadjuvant chemoimmunotherapy and none of the medical oncologists bothered to corrected the speaker or reference the PACIFIC trial. I wonder if that is why they are "winning" and we are "losing".

So to fight fire with fire, yes, immunotherapy is usually expensive trash.
Click to expand...

Trash?

Dude what
 
theradiator said:
For the 80 to 90% treated with immunotherapy with no benefit with immunotherapy (whether in the definitive or adjuvant settings), yes it is trash without price regulation.
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Not sure how you think that only ten - twenty percent of patients derive benefit. For example the only subset that derives no benefit in PACIFIC is PDL1 0%

But anyways it’s clearly not trash in the metastatic setting either.

Super weird take.
 
DoctwoB said:
Estimated enrollment of 1200?

That seems . . . optimistic
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Could never pull it off in the US. I'd be interested to know more about how they offer this trial in the environment of socialized medicine.

Is it.... "Well... we really don't know which one is better.... would you like to participate?"

Or.... "You want treatment? Sign here.... "
 
NotMattSpraker said:
The role of neoadjuvant therapy varies by site, right? Based on the design of prior trials.

The argument for neoadjuvant therapy for sarcoma is reducing the risk of late toxicity.

With rectal, it's acute and late toxicity benefit and the opportunity for TNT if you are in to that sort of thing.

In this trial, it seemed like the reason was because 1) surgeons can't resist operating on higher risk patients, 2) its hard to clean up the mess after surgery and/or 3) people aren't referred for adjuvant. Creative solution to a funny problem. Since it didn't work, what about a randomized trial of ADT/RT versus surgery? 🤣

(To be clear, I liked the cited phase 1 trial, good stuff)
Click to expand...

Ha! Well clearly it didn't work...

Firstly, I want to acknowledge that I haven't treated prostate cancer in few years so I may be neglecting/forgetting some important nuances. I guess my thinking is, given that adjuvant/salvage RT is often needed with prostate cancer patients (HR or otherwise)... and given that one is often irradiating a theoretical "prostate bed" (the boundaries of which the expert opinion varies widely) and in the neoadjuvant setting, the target is much easier to define, it didn't seem like an unreasonable question to ask.

The benefits of neoadjuvant RT for rectal and sarcoma were revealed in phase III trials, which were preceded by earlier phase trials demonstrating feasibility and efficacy. This was merely a phase I trial... how do you know something does work unless you try it?

I am running a few phase I IITs right now and can't help but hope that, one day, these treatments will be evaluated in a phase III setting... and I imagine the investigators were hoping for the exact same thing.
 
jondunn said:
Not sure how you think that only ten - twenty percent of patients derive benefit. For example the only subset that derives no benefit in PACIFIC is PDL1 0%

But anyways it’s clearly not trash in the metastatic setting either.

Super weird take.
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Not worth my time to engage with the ad hominem king of probation but strictly for educational purposes:

jamanetwork.com

Eligibility for and Response to Checkpoint Inhibitor Immunotherapy Drugs for Cancer

This cross-sectional study estimates the percentage of US patients with cancer who were eligible for and who responded to checkpoint inhibitor immunotherapy drugs between 2011 and 2018.
jamanetwork.com jamanetwork.com

Also, have a look at the survival curves of the Pacific trial +/- immunotherapy.

If you would like to cheerlead for Big Pharma, might I suggest the Medical Oncology or Psychiatry forums.

See you at the other side of probation my friend!
 
theradiator said:
Not worth my time to engage with the ad hominem king of probation but strictly for educational purposes:

jamanetwork.com

Eligibility for and Response to Checkpoint Inhibitor Immunotherapy Drugs for Cancer

This cross-sectional study estimates the percentage of US patients with cancer who were eligible for and who responded to checkpoint inhibitor immunotherapy drugs between 2011 and 2018.
jamanetwork.com jamanetwork.com

Also, have a look at the survival curves of the Pacific trial +/- immunotherapy.

If you would like to cheerlead for Big Pharma, might I suggest the Medical Oncology or Psychiatry forums.

See you at the other side of probation my friend!
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People are quite feisty today. I think it’s the heat.
 
RadOncDoc21 said:
I blame the economy.
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This works so well for Radonc

1659024805023.png
 
Moonbeams said:
Yeah. That party is going to stop real soon, and it will spectacular when all this blows up.
Have some cash on hand. Will be some great deals for patient value investors in all sectors.
Those addicted to spending and debt are going to be in for a world of pain.
Click to expand...
Repos are up. Housing market is slowing. We're going from a period of free money, low supply, and high demand to the exact opposite. Winter is coming!
 
RSAOaky said:
Repos are up. Housing market is slowing. We're going from a period of free money, low supply, and high demand to the exact opposite. Winter is coming!
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When Americans, of all people, are skipping meals and eating smaller portions, you know we are getting into a really bad situation. Talk about a canary in the coal mine.
 
Moonbeams said:
When Americans, of all people, are skipping meals and eating smaller portions, you know we are getting into a really bad situation. Talk about a canary in the coal mine.
Click to expand...

Might reduce the national BMI if it goes on longer. Silver lining.
 
Moonbeams said:
We might have a big problem here -- We can't have everybody else coming and crowding up the breadlines. Those are for rad onc!!!
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No we are in the artificial meat scrap line. Non inferiority trial just Published in the UK between bread and meat scraps pulled off the floor of the slaughter house and fortified with vitamins…enjoy
 
Fpg1245 said:
No we are in the artificial meat scrap line. Non inferiority trial just Published in the UK between bread and meat scraps pulled off the floor of the slaughter house and fortified with vitamins…enjoy
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Can we at least get the chocolate covered grasshoppers on doctors day?
 
RSAOaky said:
Repos are up. Housing market is slowing. We're going from a period of free money, low supply, and high demand to the exact opposite. Winter is coming!
Click to expand...

About time. Basic houses in my neck of the woods are up to 2.5 million. That's for something nice and tiny or relatively big and fixer upper. I thought things were out of control when I was saying that they were 1.5 million two years ago. Who can afford this?
 
RSAOaky said:
Repos are up. Housing market is slowing. We're going from a period of free money, low supply, and high demand to the exact opposite. Winter is coming!
Click to expand...
Not happening... Unfortunately we've been underbuilding since 2009, despite sales falling this summer, median housing price is still going up and at an all time high.

I would say housing inflation is our biggest problem by far (more than food, gas etc). It's no surprise that PE and a company backed by bezos are getting into the landlord game lately.

www.reuters.com

U.S. existing home sales slide again; prices hit fresh record high

Fast-rising rates and record-high selling prices are making buying a home too expensive for a growing share of American households.
www.reuters.com www.reuters.com
 
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medgator said:
Not happening... Unfortunately we've been underbuilding since 2009, despite sales falling this summer, median housing price is still going up and at an all time high.

I would say housing inflation is our biggest problem by far (more than food, gas etc). It's no surprise that PE and companies backed by bezos are getting into the landlord game lately.

www.reuters.com

U.S. existing home sales slide again; prices hit fresh record high

Fast-rising rates and record-high selling prices are making buying a home too expensive for a growing share of American households.
www.reuters.com www.reuters.com
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and foreign investors
 
jondunn said:
and foreign investors
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Russians and Chinese treat NYC, Toronto, Vancouver, heck even Miami condos as nice cash equivalents esp in a strong dollar climate like we are in now

Canada actually had the cajones to do something about it. Say what you will about that law, but i guarantee it cut down on that type of behavior
 
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medgator said:
Not happening... Unfortunately we've been underbuilding since 2009, despite sales falling this summer, median housing price is still going up and at an all time high.

I would say housing inflation is our biggest problem by far (more than food, gas etc). It's no surprise that PE and a company backed by bezos are getting into the landlord game lately.

www.reuters.com

U.S. existing home sales slide again; prices hit fresh record high

Fast-rising rates and record-high selling prices are making buying a home too expensive for a growing share of American households.
www.reuters.com www.reuters.com
Click to expand...

There is some compelling arguments that most of housing inflation is due to falling interest rates since the 1990s. I can’t find the original article I read showing this but see this one making the case.
 
Lamount said:
There is some compelling arguments that most of housing inflation is due to falling interest rates since the 1990s. I can’t find the original article I read showing this but see this one making the case.
Click to expand...
That's what caused the first bubble 2005-2007. Homebuilders and banks obviously got hosed and have been underbuilding ever since esp at the low end/first time sector of the market
 
Sorry David Carpenter if you are reading this. I just found the tweet by Duke, and lemmiwenks' response, to be kind of ... unintentionally funny.

David you will be fine and will go far.



 
Neuronix said:
About time. Basic houses in my neck of the woods are up to 2.5 million. That's for something nice and tiny or relatively big and fixer upper. I thought things were out of control when I was saying that they were 1.5 million two years ago. Who can afford this?
Click to expand...

The same people that have been screwing your and everybody else on this forum for years
 
TheWallnerus said:
Are radiation oncologists conspicuously absent from this press release because they're absent from radiopharmaceutical therapy in real life? I don't like.



Related:
Unsealed Source: Scope of Practice for Radiopharmaceuticals Among United States Radiation Oncologists
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How bout you guys lobby for better than 1.96 wrvu?

I also just ran our department’s finances for lutathera. CMS is now not even paying at cost despite us being 340b. While I would not be surprised if the coders are billing this wrong, it now seems to be a money loser on the technical side after Lutathera lost pass through status 7/1/21.

Edit: corrected date on loss of pass through.
 
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RickyScott said:
Radoncs are very much absent in real life in large academic systems, maybe with the exception of 1 or 2 centers. Neither unsealed sources or FLASH will save the field.
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Yeah I don’t get the fascination with radiopharm. It’s garbage. It’s keeps you in the game but at the end of the day it’s about dollars and cents and it just doesn’t add up

I mean if there a radio pharma agent out there that may increase survival substantially that it changes practice? Maybe but nobody is gonna bother looking for it.
 
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