Sbrt may speed up Mets?l

[RickyScott]

Wasn’t on my bingo card of future threats to radonc

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[Neuronix]

Are we sure Ralph turned the beam on?

 

[NotMattSpraker]

View attachment 380937
Wasn’t on my bingo card of future threats to radonc

"I hope you get a chance"

 

[metallica81788]

I always thought abscopal was made up, but now in reverse! The humanity

 

[theradiator]

I always thought abscopal was made up, but now in reverse! The humanity

I have an open mind but am skeptical.

Several of the oligometastasis randomized trials demonstrated improved progression free survival and even the negative trials did not show worse survival or progression with RT. However, hyperprogression with immunotherapy has been reported so it is theoretically possible for a beneficial treatment for the entire population to still negatively impact a small subset.

 

[Ray D. Ayshun]

I have an open mind but am skeptical.

Several of the oligometastasis randomized trials demonstrated improved progression free survival and even the negative trials did not show worse survival or progression with RT. However, hyperprogression with immunotherapy has been reported so it is theoretically possible for a beneficial treatment for the entire population to still negatively impact a small subset.

Hyperprogression with immunotherapy? Is there a paper on this?

 

[medgator]

View attachment 380937
Wasn’t on my bingo card of future threats to radonc

View attachment 380937
Wasn’t on my bingo card of future threats to radonc

(Wreck-it Ralph)

 

[ramsesthenice]

Highly skeptical. You can show me specific cases. We all have them. But, as said above, there have been countless prospective studies and there is no even wimpy signal that I am aware of.

 

[RickyScott]

Let me guess, Evercore funded the work?

 

[drowsy12]

https://x.com/rweichselbaum/status/1732754159697355212?s=20

https://x.com/rweichselbaum/status/1745605783289569774?s=20

 

[NotMattSpraker]

https://x.com/rweichselbaum/status/1732754159697355212?s=20

https://x.com/rweichselbaum/status/1745605783289569774?s=20

Wangcancer

 

[Ray D. Ayshun]

Wangcancer

Only applies to oligoprogressive penile cancer? This should cost me at most 1 referral.

 

[RadOncMegatron]

Tell me this is an early April fools thread.

 

[thesauce]

Keep trying to stay relevant Ralph

 

[StIGMA]

So we get to prophylactically re-treat the periphery of all of our SBRTs now?

 

[Palex80]

Highly skeptical. You can show me specific cases. We all have them. But, as said above, there have been countless prospective studies and there is no even wimpy signal that I am aware of.

Are we talking about the abscopal effect again?

 

[Mandelin Rain]

Are we talking about the abscopal effect again?

 

[ramsesthenice]

Are we talking about the abscopal effect again?

I wasn’t intentionally but it goes both ways yes! Nothing in my experience or the vast majority of prospective studies I have seen suggest metastasis directed SBRT consistently affects the growth (good or bad) of out of field macromets. Consistent being the key word.

 

[evilbooyaa]

Hyperprogression with immunotherapy? Is there a paper on this?

Rare but something all oncologists should be aware of. TL;DR is that the ICI basically makes the tumor grow faster than it normally would.

Assessment of Hyperprogressive Disease During Cancer Treatment With Immune Checkpoint Inhibitors

The systematic review and meta-analysis examines differences in the criteria and definitions used for hyperprogressive disease in studies assessing patients receiving immune checkpoint inhibitors for cancer.

jamanetwork.com

Incidence 6 -43% depending on the study - anecdotally seems relatively rare (5-10%)

 

[NotMattSpraker]

Rare but something all oncologists should be aware of. TL;DR is that the ICI basically makes the tumor grow faster than it normally would.

Assessment of Hyperprogressive Disease During Cancer Treatment With Immune Checkpoint Inhibitors

The systematic review and meta-analysis examines differences in the criteria and definitions used for hyperprogressive disease in studies assessing patients receiving immune checkpoint inhibitors for cancer.

jamanetwork.com

Incidence 6 -43% depending on the study - anecdotally seems relatively rare (5-10%)

Great link, thanks. I had an immunotherapy specialist med onc on our patient podcast and we talked a lot about hyperprogression. Some of our discussion was whether it is even real (she thought so) and then how you react to it. You can imagine how something as specific as growth rate kinetics doesn't really help you in clinic when you are deciding to ride it out or switch therapy.

I agree but even 5% seems like a high estimate... 1 in 20? That seems like way more than my experience in my career.

I wonder if it is because the people we see are the ones we radiate. Maybe radiation helps prevent hyperprogression

 

[evilbooyaa]

Great link, thanks. I had an immunotherapy specialist med onc on our patient podcast and we talked a lot about hyperprogression. Some of our discussion was whether it is even real (she thought so) and then how you react to it. You can imagine how something as specific as growth rate kinetics doesn't really help you in clinic when you are deciding to ride it out or switch therapy.

I agree but even 5% seems like a high estimate... 1 in 20? That seems like way more than my experience in my career.

I wonder if it is because the people we see are the ones we radiate. Maybe radiation helps prevent hyperprogression

Think about all the folks who start ICI for their horribly metastatic cancers who go immediately to hospice due to non-response of initial therapy with subsequent performance status hit. Lots of them out there. Lots of folks that we'll never be aware of.

 

[SneakyBooger]

"Pseudoprogression"!