Today at Moffitt Cancer Center I'm giving a short talk about Mathematical Oncology for a continuing medical education aimed at medical physicists and dosimetrists - though I think the talk is available to most folks with an interest in science and maths. It's a short talk (30 minutes) in which I hope to introduce the field, show some of the tools we use, and give a short example or two. I feel that this audience, in particular, is important to address because they have the skills needed to think like modellers, and work in cancer EVERY DAY.
My hope is to spread awareness of mathematical oncology, but also to lure some clever folks across the street from the clinic to the laboratory!
There are a host of great talks going on, many of which have their slides on line (I've been told) on topics as broad as #proton therapy, #StereotacticBodyRadiation, #cyberknife, #radiation toxicity, #HIV and cancer and more.
A full agenda can be seen here:
http://www.cvent.com/events/radiation-oncology-conference/agenda-e3a4aaf164cd41929f01194fa077be14.aspx
And here's my talk.
Showing posts with label Radiotherapy. Show all posts
Showing posts with label Radiotherapy. Show all posts
Friday, November 14, 2014
Monday, October 6, 2014
Memantine and WBRT
After the whole brain radiation review that my collaborators and I just published came out, my friend and colleague, Jack West, put a nice post up on his website Cancer Grace about it and asked a follow up question on twitter:
He was referring to the recent Radiation Therapy Oncology Group's trial of memantine (a drug for dementia) given during whole brain radiation: RTOG0614. So, to answer, I polled a couple of my friends who do nothing but neuro-oncology and reread the results of the trial (not out in published form yet, just as an abstract (paper #1 on this page) and the full talk from ASTRO).
As a quick summary: Whole brain radiation therapy (WBRT) is a treatment given to patients who have metastatic cancer in their brains. There are a number of situations in which WBRT is given and it improves survival and significantly improves the life of patients. On the downside, it has been shown to cause cognitive decline with as many as 60% of patients exhibiting measurable decline at 4 months after WBRT. So, to combat this, a trial of memantine during and immediately after WBRT, an NMDA-receptor blocker used to treat Alzheimer's dementia was proposed and carried out.
In this trial, about 500 patients were enrolled, stratified by their RTOG brain metastasis RPA class (they only enrolled class 1 and 2 patients) and given either 20mg of memantine or placebo daily for 24 weeks. A lot of their patients weren't able to be properly analyzed because of issues with survival (sadly, to be expected in this population), but those who were evaluable (~150) took a battery of 6 different cognitive tests. The primary endpoint was performance on a specific test at the 24 week point, the e Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) and there was NOT a significant difference in the results of this (but it 'teetered on the edge of significance', with a p-value of 0.059). Now, don't get me started on p-values. Oops, too late.
The all holy p<0.05 is an arbitrary cutoff level by which we determine 'significance'. I say again, arbitrary. What it has become, I fear, is a gold-standard for a 'positive study'. So in the case of this one, which technically did not meet its primary end point, many people are not swayed, because p wasn't less than or equal to 0.05. the secondary endpoint, cognitive decline (a measure using several other of the tests) was met with p=0.01 and, crucially, there were no difference in side effects or survival. My *suspicion* is that the primary endpoint will be met if they can accrue (and analyze) another 50 patients, and this debate will end. However, until then, the jury is out.
Personally though, even though it failed to meet its primary end point, I will be recommending memantine to patients in a favorable RPA class getting WBRT, or at the very least having this discussion with my patient.
As an aside, the two Neuro specialists I polled had opposite answers, so it is fair to say that this remains in the undetermined category. But, the drug has been shown to be safe, and now *likely* efficacious. In a situation where we don't have other options, I'm sold.
@CancerConnector Your review of WBRT for brain mets ( at http://t.co/Su9g4q3isf ) was terrific. What do you think of memantine's role now?
— H. Jack West, MD (@JackWestMD) May 5, 2013
He was referring to the recent Radiation Therapy Oncology Group's trial of memantine (a drug for dementia) given during whole brain radiation: RTOG0614. So, to answer, I polled a couple of my friends who do nothing but neuro-oncology and reread the results of the trial (not out in published form yet, just as an abstract (paper #1 on this page) and the full talk from ASTRO).
As a quick summary: Whole brain radiation therapy (WBRT) is a treatment given to patients who have metastatic cancer in their brains. There are a number of situations in which WBRT is given and it improves survival and significantly improves the life of patients. On the downside, it has been shown to cause cognitive decline with as many as 60% of patients exhibiting measurable decline at 4 months after WBRT. So, to combat this, a trial of memantine during and immediately after WBRT, an NMDA-receptor blocker used to treat Alzheimer's dementia was proposed and carried out.
In this trial, about 500 patients were enrolled, stratified by their RTOG brain metastasis RPA class (they only enrolled class 1 and 2 patients) and given either 20mg of memantine or placebo daily for 24 weeks. A lot of their patients weren't able to be properly analyzed because of issues with survival (sadly, to be expected in this population), but those who were evaluable (~150) took a battery of 6 different cognitive tests. The primary endpoint was performance on a specific test at the 24 week point, the e Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) and there was NOT a significant difference in the results of this (but it 'teetered on the edge of significance', with a p-value of 0.059). Now, don't get me started on p-values. Oops, too late.
The all holy p<0.05 is an arbitrary cutoff level by which we determine 'significance'. I say again, arbitrary. What it has become, I fear, is a gold-standard for a 'positive study'. So in the case of this one, which technically did not meet its primary end point, many people are not swayed, because p wasn't less than or equal to 0.05. the secondary endpoint, cognitive decline (a measure using several other of the tests) was met with p=0.01 and, crucially, there were no difference in side effects or survival. My *suspicion* is that the primary endpoint will be met if they can accrue (and analyze) another 50 patients, and this debate will end. However, until then, the jury is out.
Personally though, even though it failed to meet its primary end point, I will be recommending memantine to patients in a favorable RPA class getting WBRT, or at the very least having this discussion with my patient.
As an aside, the two Neuro specialists I polled had opposite answers, so it is fair to say that this remains in the undetermined category. But, the drug has been shown to be safe, and now *likely* efficacious. In a situation where we don't have other options, I'm sold.
Thursday, June 26, 2014
Impact of vascular patterning on radiation response - contributed talk from ECMTB 2014
So - I meant to try to use +Camtasia Studio to record my voice during this talk, which would have made following along much easier, but somehow, the meeting was so chock-a-block with content and excellent social outings, that I failed to download and sort it out. Next time...
For now, here is a short presentation that I gave as a contributed talk at #ECMTB2014 in Goteborg. It represents the meat of the second chapter of my growing (fingers crossed) DPhil thesis. My hope is that by finding a metric (Ripley's K) that predicts radiation response in our CA model (based on a simplification of a CA I worked on previously with +David Basanta which we published here), that we (or someone!) could translate this into histopathologic sections from patient samples.
This is essentially an extension to a poster I presented at the #PSOC meeting in DC in early April which I blogged about previously. Please feel free to ask questions or make comments. I'll let everyone know once there is a proper #preprint available, and in the mean time I'll try to learn to use camtasia.
'Till then, here's the presentation:
For now, here is a short presentation that I gave as a contributed talk at #ECMTB2014 in Goteborg. It represents the meat of the second chapter of my growing (fingers crossed) DPhil thesis. My hope is that by finding a metric (Ripley's K) that predicts radiation response in our CA model (based on a simplification of a CA I worked on previously with +David Basanta which we published here), that we (or someone!) could translate this into histopathologic sections from patient samples.
This is essentially an extension to a poster I presented at the #PSOC meeting in DC in early April which I blogged about previously. Please feel free to ask questions or make comments. I'll let everyone know once there is a proper #preprint available, and in the mean time I'll try to learn to use camtasia.
'Till then, here's the presentation:
Thursday, May 2, 2013
Review of Whole Brain Radiotherapy for Brain Metastases
Just a quick post to let you know about a review I published with two collaborators today in Surgical Neurology International. The heavy lifting for this was done by +Emory McTyre, a very bright and motivated medical student who has recently matched into radiation oncology at Wake Forest. This is a comprehensive review of the use of whole brain radiotherapy in the treatment of brain metastases. It is written for a clinical audience, but since it is #openaccess anyone can read it and use the information therein. The corresponding author is a friend and radiation oncologist at Moffitt Cancer Center, Prakash Chinnaiyan.
Here is a link, enjoy and feel free to share.
http://www.
Here is a link, enjoy and feel free to share.
http://www.
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