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Latest Technology Analyzes Disease Progression from Patient Power on Vimeo.
Recorded on March 28, 2015
Mark Gimbel, MD
Surgical Oncologist
Banner MD Anderson Cancer Center
Michael Wong, MD, PhD
Head – Solid Tumors Section, Skin Cancer and Melanoma Clinics USC Norris Comprehensive Cancer Center
Carol Preston:
Is there a way to test the velocity or speed of progression of the disease?
Dr. Gimbel:
So yes, there is. And I think everybody who is presented with advanced stage melanoma knows that. We use imaging. And the imaging that we have has become much more sensitive. CAT scans, PET scans, and we can actually get volumetric amounts of disease that are present based on 3D reconstructions. And so we can do it up to a point for what’s beneficial for how many CT scans and radiation should you get within a year.
And then more importantly, or just as important, is how much is insurance going to cover you getting those scans, because you’re going to have to pay out of pocket if you don’t. So we can. And we usually follow typically every three to four months, depending on if you’re in the early part of treatment, you’re going to be screened more often to see is your disease progressing or responding? One of the things we talked about at lunch, which people have mentioned, is you go on some of the immunotherapy; the tumors actually swell or get bigger in the beginning. And you really have no idea what’s going on.
Am I having progression of disease, or is the tumor—am I getting a response? And that’s a very scary time. And sometimes, we push it out a little bit farther to say well, what’s the velocity of decrease? Would you agree to that?
Dr. Wong:
There are two parts to it. One is using velocity speed to make a decision early on about therapy. And I think what you’re driving at, as well, is using that calculation after therapy to assess whether or not they’ve had response. So we start with the second part, which is you’ve had therapy. Did you have response or not?
My tie-breaker for me is to look at that person. Look at that patient. I had a patient come back, in fact, from Arizona, played the best round of golf in her whole life, set her own personal course record, yet her CT scan showed the tumors were bigger. So we decided to wait. And then sure enough, next scan, everything shrunk. So a lot of it is looking at the person. If they’re bone-tired, and they’re starting to have symptoms and pain, and their quality of life is dwindling, I tell folks I sometimes don’t really care what the scan shows, we have a problem.
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And in the front half, when we try to use velocity of speed to determine immunotherapy, BRAF inhibitors in the beginning, we use a couple of CT scans to sort of try to figure things out and to sort of suss out whether or not we have time to use immunotherapy.
Published By :
Patient Power
Date :
Sep 02, 2015
