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Community DC MPTC Dr. Matthew Ferris Maryland Proton Treatment Center · Community D.C.

• 0:06
  Speaker 1: Good morning, and welcome to another edition of Community d C.
• 0:08
  Speaker 1: I'm your host Dennis Glasgow. This morning, we welcome back
• 0:11
  Speaker 1: to the program doctor Matthew Ferris. He is the medical
• 0:14
  Speaker 1: director for the Maryland Proton Treatment Center and specializes in headneck,
• 0:19
  Speaker 1: and skin cancers and is here to talk a lot
• 0:21
  Speaker 1: about proton treatment and its therapy and some exciting new
• 0:24
  Speaker 1: data about the treatment and survival rates that has just
• 0:27
  Speaker 1: come out. Cancer effects almost all of us, directly or indirectly,
• 0:31
  Speaker 1: so I think you'll find this conversation educational and also inspiring.
• 0:35
  Speaker 1: Here's my conversation with doctor Ferris from the Maryland Proton
• 0:38
  Speaker 1: Treatment Center. I hope you enjoy it as much as
• 0:40
  Speaker 1: I did. Good morning, doctor Ferris.
• 0:42
  Speaker 2: Good morning Dennis. How are you good.
• 0:43
  Speaker 1: It's great to have you back on Community DC in
• 0:46
  Speaker 1: years past, and I don't know if technology or data
• 0:49
  Speaker 1: has changed, but we're here to talk to you about
• 0:50
  Speaker 1: that when it comes to MPTC, and i'd like to
• 0:53
  Speaker 1: do this if we could. Even though we've had you
• 0:54
  Speaker 1: on the show before, and we've had other guests on
• 0:56
  Speaker 1: the program from your facility, I think it's always great
• 0:59
  Speaker 1: to add educate our listeners that are new to MPTC
• 1:02
  Speaker 1: and what it is and what proton therapy is. So
• 1:05
  Speaker 1: how long has actually the center been around for?
• 1:07
  Speaker 3: So we've been We opened in twenty sixteen, and we
• 1:11
  Speaker 3: were really the first institution on the East Coast with
• 1:15
  Speaker 3: the modern iteration of proton therapy, which is something called
• 1:18
  Speaker 3: pencil beam scanning. There was you know, protoons have been
• 1:22
  Speaker 3: around for a long time in terms of our ability
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  Speaker 3: to deliver them for you know, health purposes, usually cancer,
• 1:29
  Speaker 3: but the early days was a sort of more rudimentary
• 1:34
  Speaker 3: version that was called passive scatter tech technique and that
• 1:38
  Speaker 3: was good and had some advantages and some use cases,
• 1:41
  Speaker 3: but it really took a lot of computing developments in
• 1:46
  Speaker 3: order to get to the modern version which we have today.
• 1:49
  Speaker 3: And that's what we have at Maryland Proton Treatment Center.
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  Speaker 3: And we opened in twenty sixteen and it's been going
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  Speaker 3: strong since then.
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  Speaker 2: We treated over six thousand patients.
• 1:58
  Speaker 1: At this point, absolutely using it and remarkable and very cool.
• 2:02
  Speaker 1: There's a lot to talk about with you. I know
• 2:03
  Speaker 1: there's a paper coming out very soon. At the taping
• 2:08
  Speaker 1: of our recording of our show, it's coming out, and
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  Speaker 1: I want you to talk about that. I know there's
• 2:12
  Speaker 1: some new data, and also we want to talk about
• 2:15
  Speaker 1: the type of cancers that are treated with proton therapy.
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  Speaker 1: But I think we've got everybody's attention saying, well, I've
• 2:21
  Speaker 1: kind of heard of proton therapy, but I really don't
• 2:23
  Speaker 1: know what it is. So when you kind of put
• 2:25
  Speaker 1: it into Layman's terms and proton therapy, what exactly is it?
• 2:29
  Speaker 2: Proton therapy is a very advanced form of radiation therapy.
• 2:34
  Speaker 3: So radiation therapy is a common way to treat many
• 2:39
  Speaker 3: cancers in some benign conditions as well. You know about
• 2:43
  Speaker 3: half of cancers will require radiation therapy, it can, you know,
• 2:48
  Speaker 3: and half of those we're treating for cure. The other
• 2:51
  Speaker 3: half where maybe relieving symptoms or palliating. And there's multiple
• 2:56
  Speaker 3: different particles that we use and deliver radiation therapy. So
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  Speaker 3: electrons are a particle that is a very small, negatively
• 3:04
  Speaker 3: charged particle that are good for stuff that's really superficial,
• 3:07
  Speaker 3: like skin cancers. Photons are really what people think about
• 3:12
  Speaker 3: when they think about getting radiation therapy. Historically it's been
• 3:15
  Speaker 3: mostly photon radiation, and these are high energy X rays
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  Speaker 3: much stronger than what is used for diagnostic purposes. Like
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  Speaker 3: if you break your hand or something like that.
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  Speaker 2: That's widely available.
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  Speaker 3: It's been around for you know, the most of the
• 3:32
  Speaker 3: latter part of the nineteen hundreds, in the two thousands,
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  Speaker 3: and it got better over time, so you know, even
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  Speaker 3: that is very sophisticated now and we still heavily use
• 3:41
  Speaker 3: it even in our institution where we have access to
• 3:43
  Speaker 3: that and proton therapy.
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  Speaker 2: Proton therapy.
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  Speaker 3: It's a bigger, positively charged particle, and it has some
• 3:49
  Speaker 3: advantages when we use it to deliver radiation therapy for patients.
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  Speaker 3: It sort of has this unique property where depending on
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  Speaker 3: the energy you give the protons, you can shoot it
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  Speaker 3: to a specific depth in the patient and it steps
• 4:02
  Speaker 3: really abruptly abruptly, so that that's really why it's advantageous.
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  Speaker 3: You can shoot it and there's no exit dose, and photons.
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  Speaker 2: Can't really do that.
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  Speaker 3: They just continue to pass through the patient and kind
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  Speaker 3: of mitigate gradually as they go through. But with protons,
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  Speaker 3: we can aim it to the target and stop it
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  Speaker 3: on a dime and prevent some of that unnecessary dose
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  Speaker 3: that's past the target. So that's why it's a useful
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  Speaker 3: technology for treating cancers.
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  Speaker 2: That's why the center was.
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  Speaker 3: Built and you know, more and more of them are
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  Speaker 3: popping up around the country.
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  Speaker 1: You've touched on it a little bit, but how many
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  Speaker 1: cancers can be treated with proton therapy right now?
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  Speaker 3: It's many solid tumors can be treated with proton therapy,
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  Speaker 3: so we don't do as many radiation therapy in general.
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  Speaker 3: It doesn't have the biggest role in blood cancers like leukemias.
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  Speaker 3: But you know, most when people think of cancer, most
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  Speaker 3: of those can be treated with proton therapy. So that's
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  Speaker 3: you know, anywhere from head to toe, breast cancer, lung cancer,
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  Speaker 3: you know, anal cancer, rectal cancer, liver cancer. We treat
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  Speaker 3: brain tumors, I do most you know a lot of
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  Speaker 3: head and neck cancer. So it's a it runs the gamut,
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  Speaker 3: and it just sort of depends on the case and
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  Speaker 3: the cancer type whether proton therapy is you know, how
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  Speaker 3: much better it might be for that case compared to
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  Speaker 3: a photon great course of radiation. So it's highly dependent
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  Speaker 3: on the case and the cancer type. But broadly, we
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  Speaker 3: treat almost anything when the situation calls for it.
• 5:33
  Speaker 1: So when it comes to the actual therapy and the
• 5:36
  Speaker 1: procedure to be done, and I realize that everybody's different.
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  Speaker 1: I understand that completely, but going in usually how long
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  Speaker 1: does the procedure take and is it painful for some people?
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  Speaker 3: All radiation generally starts with a planning session that lets
• 5:50
  Speaker 3: us design.
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  Speaker 2: The treatment plan.
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  Speaker 3: So everybody's case is designed specifically for them.
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  Speaker 2: They it's a CT scan.
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  Speaker 3: They get in, We put them into position they're going
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  Speaker 3: to be treated in during treatment, and we keep them
• 6:02
  Speaker 3: very still. There's a variety of things we do to
• 6:05
  Speaker 3: keep them still during the treatment course, and then when
• 6:08
  Speaker 3: we scan them, it gives us essentially a three D
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  Speaker 3: map that we can design the radiation plan on. So
• 6:16
  Speaker 3: that scan gets imported into some very sophisticated software.
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  Speaker 2: I and you know my team, we.
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  Speaker 3: Basically draw out in three dimensions the areas that need
• 6:28
  Speaker 3: to get targeted, the areas.
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  Speaker 2: That need to need to get avoided, and then.
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  Speaker 3: That software is manipulated, it's linked to our treatment planning rooms,
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  Speaker 3: and the software is manipulated to determine where the BAM
• 6:41
  Speaker 3: angle is going to come in, how much energy is
• 6:43
  Speaker 3: going to be delivered from these BAM angles. And it's
• 6:45
  Speaker 3: a really sophisticated and pretty labor intensive process, and that
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  Speaker 3: can take, you know, several days to design for each
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  Speaker 3: patient and so once that's done, we're ready to start
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  Speaker 3: and you know, the patients would start their daily treatment.
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  Speaker 3: There's different regimens that are used for radiation therapy.
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  Speaker 2: And it depends on the situation that cancer type.
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  Speaker 3: They're pretty standardized in terms of nationally, so you know,
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  Speaker 3: what distinguishes us is just you know, how we deliver
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  Speaker 3: the radiation, but the course, the courses themselves are pretty
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  Speaker 3: standardized for a national on a national basis, and that
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  Speaker 3: can range as few as you know, five treatments for
• 7:24
  Speaker 3: certain situations all the way up to thirty five treatments.
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  Speaker 3: Moost Patients would have a daily appointment during that period
• 7:32
  Speaker 3: of time, and the appointments themselves last maybe you know,
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  Speaker 3: thirty forty minutes where the patient is laying there and
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  Speaker 3: you can't feel it, it's just energy.
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  Speaker 2: It does feel like getting a scan.
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  Speaker 3: So the room, you know, looks it looks like you're
• 7:46
  Speaker 3: in some space vehicle or something because there's a lot
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  Speaker 3: it's it's really cool looking and they're even more you know, going.
• 7:55
  Speaker 2: On behind the walls.
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  Speaker 3: So what the patient sees is actually you know, very
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  Speaker 3: little relative to the whole apparatus that is generating and
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  Speaker 3: delivering the beam, which is what lives behind the walls,
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  Speaker 3: and we have engineers from the manufacturer on site twenty
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  Speaker 3: four to seven to make sure that things are running
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  Speaker 3: and running smoothly. So but it doesn't hurt when they're
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  Speaker 3: getting treatment. There are side effects, you know, it's still
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  Speaker 3: a cancer intervention, so there's side effects related to where
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  Speaker 3: we have to treat.
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  Speaker 2: But those side effects are probably.
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  Speaker 3: Less for many situations than they would be with other technologies.
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  Speaker 1: All Right, I know it's a big general question about data.
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  Speaker 1: I'll ask you that just a little bit because I
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  Speaker 1: know there's a new paper coming out with the latest
• 8:39
  Speaker 1: data and how it's doing for proton therapy. But I
• 8:43
  Speaker 1: think we've got everybody's attention about proton therapy, how it
• 8:45
  Speaker 1: works and why it works. What about qualifying for the
• 8:49
  Speaker 1: proton treatment center? How does one do that?
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  Speaker 3: So anyone at any time can call us or a
• 8:54
  Speaker 3: consultation and you know, our doctors will review the case
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  Speaker 3: and meet with the patient and see if they're.
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  Speaker 2: A good candidate or not. And if they're not in there,
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  Speaker 2: you know.
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  Speaker 3: Suitable for a facility that you know is closer to
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  Speaker 3: their home, that's fine.
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  Speaker 2: We have other facilities even in our own practice.
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  Speaker 3: We can we can send patients too, but if they're
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  Speaker 3: good candidates for proton therapy, we were very happy to
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  Speaker 3: treat them here. And our insurance approval rates are very
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  Speaker 3: high in the state of Maryland, over ninety percent, so
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  Speaker 3: we have a good relationship with the insurance and it's
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  Speaker 3: not generally more expensive than other radiation.
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  Speaker 2: It's cost neutral in the state of Maryland, which is
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  Speaker 2: really nice.
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  Speaker 1: I don't want to go too deep on AI, but
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  Speaker 1: I did want to ask you about technology because I
• 9:35
  Speaker 1: know last time you and I talked, even though you
• 9:37
  Speaker 1: do this every day, miraculous things happen every day, and
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  Speaker 1: I know technology is moving very quickly, and I'm sure
• 9:43
  Speaker 1: you would admit from maybe a couple of decades to
• 9:45
  Speaker 1: go where it is now, it's absolutely amazing what's happening
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  Speaker 1: out there. With that said, I read like everybody else
• 9:51
  Speaker 1: about how AI is going to help the medical industry
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  Speaker 1: and all different kinds of treatments with diseases. Is AI
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  Speaker 1: becoming a play yet in p time therapy or will it?
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  Speaker 1: And what will it do to help you out?
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  Speaker 3: I have to think it will, just like it will
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  Speaker 3: for everything else. I mean, we have you know, even
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  Speaker 3: in our department some specialists in machine learning and even
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  Speaker 3: quantum computing, and I'm sure that will continue to evolve
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  Speaker 3: as time goes on. Admittedly, it's been for me fairly
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  Speaker 3: disappointing so far. I really wish it was making my
• 10:24
  Speaker 3: life easier and helping you know, my day to day,
• 10:27
  Speaker 3: but that hasn't really happened yet. In fact, all these
• 10:32
  Speaker 3: you know, AI models and chats that are available, I
• 10:35
  Speaker 3: find lead very much to be desired with respect to
• 10:39
  Speaker 3: like radiation in general. I'm not sure how that is
• 10:42
  Speaker 3: for other medical specialties, but it's it's a little lacking,
• 10:45
  Speaker 3: and we.
• 10:46
  Speaker 2: Do have some you know, auto.
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  Speaker 3: Some kind of rudimentary things that help us with generating
• 10:55
  Speaker 3: the radiation plan design. So you know, there's a softwares
• 10:59
  Speaker 3: that can and basically outline some of the normal organs
• 11:03
  Speaker 3: for us and save our medical disymmetrist some time. Like
• 11:06
  Speaker 3: for example, you know, when I'm treating a lung case,
• 11:09
  Speaker 3: the hard has to get outline the spinal core the lungs,
• 11:12
  Speaker 3: and you know, we have there's some programs that will
• 11:15
  Speaker 3: do some of that for us. But it's it's good,
• 11:18
  Speaker 3: it's not perfect. You know, it requires a fair bit
• 11:20
  Speaker 3: of editing. So I have to think that as time
• 11:24
  Speaker 3: goes on over the next ten or twenty years, that
• 11:27
  Speaker 3: it'll get better and better. Like I wonder how much
• 11:30
  Speaker 3: of my current job that'll take over. But so far
• 11:33
  Speaker 3: it has left, it hasn't really impacted me all that much.
• 11:37
  Speaker 1: Well, it's fascinating because I know in some areas it has,
• 11:39
  Speaker 1: but you know, it makes sense that you know, there's
• 11:41
  Speaker 1: some that it just hasn't affected yet, but that'll hopefully
• 11:43
  Speaker 1: come within the next five to ten years. I did
• 11:46
  Speaker 1: want to ask you about the procedure and patients moving
• 11:50
  Speaker 1: forward afterwards, and once again, in general terms, I understand
• 11:54
  Speaker 1: with proton therapy that it's not necessarily a curative for
• 11:57
  Speaker 1: all people. When you see somebody when you talk to them,
• 12:01
  Speaker 1: depending on their case, are there some people that do
• 12:05
  Speaker 1: get cured from the tumor or the cancer and then
• 12:08
  Speaker 1: somewhere it holds everything off. Can you talk in general
• 12:11
  Speaker 1: terms about that.
• 12:12
  Speaker 2: Yeah, it does really depend on the case.
• 12:15
  Speaker 3: So we're a lot of cases we're shooting for cure,
• 12:17
  Speaker 3: and often when we're doing that, sometimes we treat radiation
• 12:21
  Speaker 3: alone to very high doses, and that has curative potential
• 12:25
  Speaker 3: for some cases. A lot of times we're doing it
• 12:27
  Speaker 3: in conjunction with the course of chemotherapy that's called chema radiation,
• 12:31
  Speaker 3: and those lower doses of chemotherapy you can act as
• 12:34
  Speaker 3: a radiation sensitizer that sort of are synergistic with the
• 12:38
  Speaker 3: effects of radiation.
• 12:39
  Speaker 2: And improve cure rates.
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  Speaker 3: We do that a lot for head and neck and
• 12:42
  Speaker 3: lung cancer, which again or what I mostly treat. Sometimes
• 12:46
  Speaker 3: it's you know, we're doing course of radiation before.
• 12:49
  Speaker 2: Surgery or after surgery.
• 12:50
  Speaker 3: It really is dependent on the disease type, the cancer type,
• 12:55
  Speaker 3: and the case itself, so it is highly variable. But
• 12:59
  Speaker 3: we do cure a lot of patients with radiation. You know,
• 13:03
  Speaker 3: it's about half of our cases we're treating for a cure.
• 13:06
  Speaker 3: And you know, some things are more curable than others.
• 13:09
  Speaker 3: So there's things that we treat that are very stubborn
• 13:11
  Speaker 3: and very hard to cure, and you know, when we
• 13:13
  Speaker 3: treat those cases, we know that we're not going to
• 13:16
  Speaker 3: cure all of them, and it's it's frustrating for us
• 13:18
  Speaker 3: as a you know, clinicians, and I look forward to
• 13:22
  Speaker 3: advances that come in the medical space as my career
• 13:26
  Speaker 3: goes on, and hopefully we're budging those cure rates because
• 13:29
  Speaker 3: for a long.
• 13:29
  Speaker 2: Time we were not.
• 13:30
  Speaker 3: For a long time, mortality rates from cancer were not
• 13:34
  Speaker 3: really improving. We were making people live a little longer,
• 13:38
  Speaker 3: but we weren't really curing them many more people. Finally,
• 13:41
  Speaker 3: we're moving the needle with that, I think we're optimizing
• 13:44
  Speaker 3: our regimens and what we do better than we have
• 13:47
  Speaker 3: been before. There's been some new developments like immunotherapy that
• 13:51
  Speaker 3: have become available and starting to move the needle.
• 13:54
  Speaker 2: So but we.
• 13:56
  Speaker 3: Certainly cure a lot of patients, and you know, we
• 13:59
  Speaker 3: give them the very best.
• 14:00
  Speaker 2: Shot of cure that we can. My goal is to
• 14:05
  Speaker 2: not only cure.
• 14:06
  Speaker 3: Them, but leave them with as little side effects as
• 14:08
  Speaker 3: we possibly can from the cancer treatment because we want
• 14:11
  Speaker 3: to maintain.
• 14:12
  Speaker 2: That quality of life.
• 14:13
  Speaker 3: I don't want to cure somebody but at the expense
• 14:17
  Speaker 3: of chronic, significant t side effects that are bothering them
• 14:21
  Speaker 3: for the rest of their life after treatment. We want
• 14:23
  Speaker 3: to get in and get out. So we want to
• 14:25
  Speaker 3: treat them, get them through treatment, and there probably will
• 14:27
  Speaker 3: be side effects. We want them to recover as soon
• 14:29
  Speaker 3: as possible and get back to their daily lives. And
• 14:32
  Speaker 3: so that's really our mindset.
• 14:34
  Speaker 1: We're at the halfway point and I think it's a
• 14:36
  Speaker 1: good segue because you're starting to lead into talk about data,
• 14:38
  Speaker 1: and I do want you to talk about the paper
• 14:40
  Speaker 1: that's coming out. I want to be very clear to everybody.
• 14:42
  Speaker 1: At the time of this recording, the paper hasn't come
• 14:45
  Speaker 1: out yet, but at the time the recording is airing,
• 14:47
  Speaker 1: it will have. But before we get to that latest
• 14:50
  Speaker 1: paper in data, can you just give us overall statistics
• 14:52
  Speaker 1: And it doesn't necessarily have to be the DMV doctor Ferris,
• 14:55
  Speaker 1: But when we take a look at cancers, I think
• 14:59
  Speaker 1: you and I talked about this last time that almost
• 15:00
  Speaker 1: every family is directly or indirectly affected by cancer. It's
• 15:04
  Speaker 1: out there because there are so many and a lot
• 15:06
  Speaker 1: of people have got it and treated it. My mother
• 15:09
  Speaker 1: in law's had breast cancer, she had radiation treatment. She
• 15:12
  Speaker 1: has been clear, I think for about six seven years now,
• 15:14
  Speaker 1: so God bless her what she's gone through. In every
• 15:16
  Speaker 1: family like me, I think, has been once again affected
• 15:19
  Speaker 1: directly or indirectly. What kind of data overall are we
• 15:22
  Speaker 1: looking at cancer? And with your therapy and what you
• 15:26
  Speaker 1: see out there, it sounds like we're starting to make
• 15:30
  Speaker 1: a dent. Are we indeed doing that? In a positive
• 15:32
  Speaker 1: way we are.
• 15:33
  Speaker 3: And you know, some some cancer types slower than others.
• 15:37
  Speaker 3: But for example, I'll just give you one one specific example.
• 15:40
  Speaker 3: I treat lung cancer. And when I when I was
• 15:43
  Speaker 3: training in residency, which is a while ago at this
• 15:46
  Speaker 3: point we were treating when we had to do chemotherapy
• 15:50
  Speaker 3: and radiation together for you know, advanced lung cancers, the
• 15:53
  Speaker 3: ad the media and survival was about twenty seven months,
• 15:57
  Speaker 3: and that meant that you know, people have of the
• 16:00
  Speaker 3: people died before that point, have people lived longer than that,
• 16:03
  Speaker 3: But that was the media and the average of how
• 16:06
  Speaker 3: long people would live after treatment, And once we introduced
• 16:09
  Speaker 3: immunotherapy into the equation, that number has moved to closer
• 16:13
  Speaker 3: to like forty eight to forty nine months.
• 16:15
  Speaker 2: So it's essentially doubled over the last ten years.
• 16:18
  Speaker 3: And so there's many examples of that of us being
• 16:22
  Speaker 3: able to improve things. And another thing that you know
• 16:25
  Speaker 3: we're working on trying to improve is screening.
• 16:28
  Speaker 2: So in general, the earlier you.
• 16:30
  Speaker 3: Catch a cancer, the easier it is to treat, and
• 16:34
  Speaker 3: lung cancer screening again when I was in residency was
• 16:39
  Speaker 3: not even around yet or just being introduced, and now
• 16:44
  Speaker 3: people that have a certain amount of smoking history or
• 16:47
  Speaker 3: active smokers are recommended for like a yearly screening chest set.
• 16:52
  Speaker 2: And that is there's a lot of room for improvement
• 16:55
  Speaker 2: for that.
• 16:56
  Speaker 3: There's nowhere near the number of patients that should be
• 16:58
  Speaker 3: getting that screening that are actually getting it. But we can,
• 17:02
  Speaker 3: you know, with radiation or with surgery take care of
• 17:05
  Speaker 3: early stage lung cancers very readily.
• 17:08
  Speaker 2: And whereas if they you know, are.
• 17:11
  Speaker 3: Go undetected and cause symptoms, people end up in the hospital.
• 17:15
  Speaker 2: They need more advanced treatment.
• 17:16
  Speaker 3: Whereas it would have been an easy treatment, now it's
• 17:18
  Speaker 3: much more complicated. So through a combination of screening and
• 17:23
  Speaker 3: better therapies, we are making progress.
• 17:26
  Speaker 1: All right, Well, let's talk about data. I know there's
• 17:28
  Speaker 1: the new paper that I've teased that's coming out very soon,
• 17:31
  Speaker 1: and i'd love to hear about this and have you
• 17:34
  Speaker 1: expound on what the new data is, what it says
• 17:36
  Speaker 1: to you, and where we're going with the treatment. Can
• 17:39
  Speaker 1: you tell us a little bit about it.
• 17:40
  Speaker 3: Yeah, so they you know, when proton therapy was introduced
• 17:43
  Speaker 3: in this country, we all the big cancer centers you know,
• 17:48
  Speaker 3: sort of got together and we're running a lot of
• 17:51
  Speaker 3: these trials which we're randomizing patients between proton therapy and
• 17:55
  Speaker 3: photon therapy, and so we're trying to compare in a
• 17:58
  Speaker 3: head to head manner. You know, just what are the
• 18:02
  Speaker 3: benefits of proton therapy. Does it just look better on
• 18:04
  Speaker 3: the computer screen, or are these dose advantages that we
• 18:07
  Speaker 3: see leading to a clinical benefit. So that's been run
• 18:10
  Speaker 3: in a variety of disease sites and that data will
• 18:12
  Speaker 3: continue to come out. That's a nice preliminary results for
• 18:17
  Speaker 3: some of these tumor types. But one of the most
• 18:19
  Speaker 3: prominent results that has you know, recently become available is
• 18:22
  Speaker 3: the comparison for head of net cancer or a pharyngeal cancer,
• 18:26
  Speaker 3: so this is tonsile cancer based of tongue cancer.
• 18:29
  Speaker 2: Primarily, most of.
• 18:30
  Speaker 3: These cases were related to HPV, which is a common
• 18:34
  Speaker 3: virus in the population. So it's more than you know,
• 18:37
  Speaker 3: seventy percent of cases in the US or related to HPB.
• 18:40
  Speaker 3: And the good thing about those is they tend to
• 18:42
  Speaker 3: be a little more sensitive to treatment than in the
• 18:46
  Speaker 3: past when most of these head and net cancers were
• 18:48
  Speaker 3: not related to HPV.
• 18:49
  Speaker 2: But they still.
• 18:50
  Speaker 3: Require, you know, our usual intense treatment regimen, which is
• 18:54
  Speaker 3: chemotherapy and radiation together with an attempt to cure people.
• 18:59
  Speaker 3: So on this trial, which was run at you know,
• 19:01
  Speaker 3: many cancer centers throughout the country, it was four hundred
• 19:06
  Speaker 3: and forty patients. They were randomly assigned to get either
• 19:09
  Speaker 3: proton therapy or photon therapy. They went through their treatment
• 19:13
  Speaker 3: course and then in the aftermath they see how these
• 19:16
  Speaker 3: two groups compare. And this this paper which will be
• 19:20
  Speaker 3: you know, released in Lancet, which is a bit.
• 19:22
  Speaker 2: A very big medical journal. One of my colleagues, doctor
• 19:26
  Speaker 2: Jason Malataurus, is an author on this paper. He enrolled
• 19:29
  Speaker 2: a lot of patients on this trial.
• 19:31
  Speaker 3: And this is what it shows is actually, not only
• 19:33
  Speaker 3: were the side effects less with proton therapy, so low
• 19:37
  Speaker 3: blood counts were better with proton therapyrop problems swallowing were better,
• 19:43
  Speaker 3: less people relied on a feeding tube during treatment, and
• 19:47
  Speaker 3: so the side effects were better with proton therapy. But
• 19:51
  Speaker 3: actually also now that we've followed these patients for long enough,
• 19:54
  Speaker 3: it seems like they were living longer. The patients who
• 19:57
  Speaker 3: got proton therapy actually did had better overall.
• 20:00
  Speaker 2: Survival and this was statistically significant.
• 20:02
  Speaker 3: So the patients who got photon therapy, the survival at
• 20:06
  Speaker 3: five years was ninety point nine percent. The patients who
• 20:09
  Speaker 3: got photon therapy with eighty one percent, and so that's
• 20:11
  Speaker 3: an almost ten percent difference and overall survival on this
• 20:16
  Speaker 3: trial for the patients who got proton therapy. So finally,
• 20:19
  Speaker 3: you know, it's not just side effects that are lower,
• 20:22
  Speaker 3: it's potentially survival that is improving.
• 20:25
  Speaker 2: And why is that.
• 20:27
  Speaker 3: It could be because they have less side effects, less
• 20:30
  Speaker 3: side effects that get them into trouble and might you know,
• 20:33
  Speaker 3: lead to someone's death just because of side effects. But
• 20:36
  Speaker 3: it also might be and we're learning more about this
• 20:39
  Speaker 3: because protons sort of leave the immune system more intact
• 20:42
  Speaker 3: and more capable of fighting cancers. And it's sort of
• 20:45
  Speaker 3: a nuance of how proton therapy is actually delivered in
• 20:48
  Speaker 3: that there's less effective dose to the immune system when
• 20:53
  Speaker 3: you treat with protons versus photons, and that because and
• 20:57
  Speaker 3: that probably leaves the immune system more intact. Blood immune
• 21:00
  Speaker 3: cells are really sensitive to radiation, and if you knock
• 21:03
  Speaker 3: them out, your immune system is not as able to
• 21:06
  Speaker 3: fight cancers. And so some of these trials that were
• 21:09
  Speaker 3: running are sort of powered for just that purpose, like
• 21:12
  Speaker 3: the lung the Lung Cancer Trial and some of our
• 21:15
  Speaker 3: esophageal cancer trials they're looking at lymphipenia as one of
• 21:20
  Speaker 3: the main points of the trial to see if you know,
• 21:24
  Speaker 3: how protons might be advantageous for that. So you know
• 21:27
  Speaker 3: exactly why the patients live are living longer.
• 21:30
  Speaker 2: We're still teasing that out, but it might be a
• 21:32
  Speaker 2: combination of things.
• 21:33
  Speaker 3: But for you know, one reason or another, the proton
• 21:36
  Speaker 3: patients did better on that trial.
• 21:38
  Speaker 2: So you know now.
• 21:40
  Speaker 3: This this Uh, it's hard to argue with proton therapy
• 21:44
  Speaker 3: as being at least as good and maybe better than
• 21:47
  Speaker 3: photons for treatment of head and neet cancer.
• 21:49
  Speaker 1: All right, and the patients that you're talking about it,
• 21:51
  Speaker 1: And I don't know if the data has offered it,
• 21:53
  Speaker 1: but did they give a demo of what kind of
• 21:55
  Speaker 1: age group and race color creed that they were looking
• 21:59
  Speaker 1: at men and women? That did it kind of break
• 22:01
  Speaker 1: it down for you? And I did have a follow
• 22:03
  Speaker 1: up question about that about different demos and different races
• 22:07
  Speaker 1: when it came to cancers. But did that data kind
• 22:09
  Speaker 1: of center around a certain sect of people or was
• 22:11
  Speaker 1: it wide ranging?
• 22:12
  Speaker 3: It was wide ranging, and it would typically mirror the
• 22:16
  Speaker 3: demographics of who gets that cancer in the first place.
• 22:21
  Speaker 3: I actually don't have that in front of me, But
• 22:23
  Speaker 3: in the paper when it comes out, it'll there's always
• 22:26
  Speaker 3: a table one in these papers, and it'll describe the
• 22:29
  Speaker 3: exact breakdown for you know, who was enrolled on the trial.
• 22:32
  Speaker 3: There's usually a slight mail preponderance. It's usually patients who
• 22:35
  Speaker 3: have HPV related disease. It sort of peaks in the sixties,
• 22:39
  Speaker 3: so the typical patient would probably the median age is
• 22:42
  Speaker 3: surely in the sixties, but there's a range. You know,
• 22:44
  Speaker 3: we see patients in their forties and fifties all the
• 22:46
  Speaker 3: way through their seventies and sometimes eighties who have this cancer.
• 22:50
  Speaker 3: But the average patient is probably sixties. It's probably slightly
• 22:54
  Speaker 3: male predominance, and there's probably a skewed towards being although
• 23:00
  Speaker 3: probably not different than the demographics of the.
• 23:02
  Speaker 2: US as a whole. But the paper, we'll break that
• 23:05
  Speaker 2: down when it's published, all right.
• 23:06
  Speaker 1: And my other follow up just about some of the
• 23:08
  Speaker 1: cancers that you treat in general. When you're a little
• 23:12
  Speaker 1: bit younger, I imagine you have more energy and strength,
• 23:15
  Speaker 1: but does that mean you can fight out certain kind
• 23:17
  Speaker 1: of cancers better or does it just depend on who
• 23:19
  Speaker 1: you are in general terms? And then the kind of
• 23:22
  Speaker 1: therapy that you do get as.
• 23:23
  Speaker 3: We age, you know, we accumulate more genetic mutations, we
• 23:28
  Speaker 3: get more exposures through the environment, through things we're eating,
• 23:32
  Speaker 3: things were exposed to. And cancer is the combination of genetics,
• 23:37
  Speaker 3: age and exposures. So as we as we age, we're
• 23:41
  Speaker 3: just more have accumulated more of these mutations. Your immune
• 23:45
  Speaker 3: system also wanes a little bit as we age, and
• 23:47
  Speaker 3: so that's why most cancers do peak kind of later
• 23:51
  Speaker 3: in life. There's some that are of course unique to
• 23:53
  Speaker 3: like pediatrics and adolescents, and less common in adults, but
• 23:56
  Speaker 3: in general, most cancers are you know, more common as
• 24:00
  Speaker 3: as we age, and in terms of being able to
• 24:02
  Speaker 3: tolerate treatment, you know, proton therapy is certainly recommended, including
• 24:08
  Speaker 3: in the National Comprehensive Cancer Network for treatment. Anytime we
• 24:12
  Speaker 3: have to think about treating pediatrics or adolescent cases. These
• 24:15
  Speaker 3: patients are going to go on to live many decades.
• 24:18
  Speaker 3: We want to expose them to as little radiation as possible.
• 24:21
  Speaker 3: But it's also really useful for adults just in terms
• 24:24
  Speaker 3: of minimizing side effects. And you know, we treat many
• 24:27
  Speaker 3: patients that are you know, in their elderly age bracket,
• 24:31
  Speaker 3: and there's cases that I do that I can get
• 24:35
  Speaker 3: them through treatment, and I really would struggle to get
• 24:38
  Speaker 3: them through treatment with any other technology, just because I
• 24:41
  Speaker 3: know they'll do okay with you know, treating them with
• 24:44
  Speaker 3: proton therapy, and they're going to struggle a lot more
• 24:47
  Speaker 3: with other techniques. So it does really expand who's a
• 24:50
  Speaker 3: candidate for you know, helpful radiation doctor Paris.
• 24:54
  Speaker 1: I've got about four minutes left. I do want to
• 24:55
  Speaker 1: get some final thoughts and we'll give the website, phone number,
• 24:58
  Speaker 1: all the contact information for MP. But I did want
• 25:01
  Speaker 1: to ask you about this. I know that you have
• 25:03
  Speaker 1: a lot of tough conversations and see a lot of
• 25:05
  Speaker 1: tough things, no names, no specificity, but do you have
• 25:08
  Speaker 1: a good story to share with us about something that
• 25:10
  Speaker 1: was either miraculous or just made happy that when he
• 25:12
  Speaker 1: came in? This is why we get up every day,
• 25:14
  Speaker 1: and you had a good experience with the patient who
• 25:16
  Speaker 1: either got cured or something really really cool happened that
• 25:19
  Speaker 1: you can share with us.
• 25:20
  Speaker 2: It happens every day.
• 25:22
  Speaker 3: I think one of the valuable things about being an
• 25:25
  Speaker 3: oncologist and something that helps keep you going is seeing
• 25:28
  Speaker 3: the patients and follow up. Because if I just saw
• 25:31
  Speaker 3: the patients, you know, who were actively under treatment. I mean,
• 25:34
  Speaker 3: it takes a lot of work to get these patients
• 25:36
  Speaker 3: through treatment. I mean they're experiencing a lot of side effects,
• 25:40
  Speaker 3: it's a lot of coordination of care, and it's a
• 25:42
  Speaker 3: really tough time in people's lives. But you know, in
• 25:45
  Speaker 3: our follow up clinic, when we're seeing people, you know,
• 25:48
  Speaker 3: three six, nine months after treatment and onward, it's really
• 25:53
  Speaker 3: gratifying because you know, we have patients that have gone
• 25:57
  Speaker 3: on and they're traveling, or they're seeing their grandkids or
• 26:00
  Speaker 3: who knows what, they're back to work. They are unaffected
• 26:03
  Speaker 3: and they're so grateful for the care that we've offered.
• 26:07
  Speaker 2: So that's really gratifying.
• 26:08
  Speaker 3: And it's almost hard to even pinpoint like a particular
• 26:11
  Speaker 3: case because it happens every day.
• 26:12
  Speaker 2: Yeah, and even.
• 26:14
  Speaker 3: You know on the cases where it isn't an ideal outcome,
• 26:19
  Speaker 3: because that's going to happen in oncology, you know, we
• 26:23
  Speaker 3: do our best to shepherd them through what's a tough
• 26:25
  Speaker 3: period of their life and support them as best we
• 26:29
  Speaker 3: can during the treatment course, and you know, hopefully we
• 26:32
  Speaker 3: improve their symptoms and hopefully we extended their lifespan.
• 26:37
  Speaker 2: Even if it wasn't a cure.
• 26:38
  Speaker 3: And so you know, seeing people over time and knowing
• 26:42
  Speaker 3: that you helped keep them with their family longer and
• 26:44
  Speaker 3: keep them living life and doing the things they're supposed
• 26:47
  Speaker 3: to is gratifying.
• 26:49
  Speaker 1: Very cool. Well, let's do this a few minutes, Levet,
• 26:51
  Speaker 1: let's get some final thoughts from you. Let's give the
• 26:53
  Speaker 1: website for everybody, and the floor is yours, doctor Fars.
• 26:56
  Speaker 2: Our website is asked for protons dot com.
• 26:59
  Speaker 3: Our phone number is four to one zero three six
• 27:02
  Speaker 3: nine five two zero zero, and if you have any questions,
• 27:05
  Speaker 3: just feel free to reach out. We're very happy to
• 27:08
  Speaker 3: weigh in. And you know, all of our docs are
• 27:10
  Speaker 3: plugged in with the multidisciplinary care teams through university and
• 27:15
  Speaker 3: Maryland School of Medicine. We're all faculty you know at
• 27:18
  Speaker 3: University Maryland School of Medicine. And you know, even if
• 27:22
  Speaker 3: radiation is not the right answer, we can get you
• 27:24
  Speaker 3: plugged in with the person that you need to see
• 27:27
  Speaker 3: and in cases generally get discussed in our multidisciplinary tumor boards.
• 27:31
  Speaker 3: So it's not just me, for example, making your treatment plan.
• 27:34
  Speaker 3: It's me plus my colleagues and the other specialties that
• 27:38
  Speaker 3: are sitting and talking at cases, talking about cases as
• 27:41
  Speaker 3: a group and deciding the appropriate treatment plan. So it's
• 27:44
  Speaker 3: a lot of brain power thinking about everybody's case. And
• 27:48
  Speaker 3: you know, I think we give world class care at
• 27:51
  Speaker 3: our facility, integrated with you know, University of Maryland School of.
• 27:55
  Speaker 1: Medicine, and after visiting with you a couple of times,
• 27:57
  Speaker 1: there is nothing to fear when it comes to proton
• 27:59
  Speaker 1: therapy there.
• 28:00
  Speaker 3: We've done a good job of it for a long time.
• 28:03
  Speaker 3: It's a very sophisticated tool. There's a lot of institutional
• 28:06
  Speaker 3: knowledge that builds up over the years, and I know
• 28:10
  Speaker 3: that we are delivering proton therapy that is on par
• 28:13
  Speaker 3: with any other you know, health system in the entire world.
• 28:16
  Speaker 3: It's it's really excellent, you know, our stat it's a
• 28:19
  Speaker 3: team Eve heard, it's you know, we've got excellent physicists,
• 28:22
  Speaker 3: we've got excellent dose symmetris, We've got excellent physicians, and
• 28:26
  Speaker 3: so you know, our expertise at dealing with the most
• 28:28
  Speaker 3: complex cases rear radiation, you know, treating people who've had
• 28:33
  Speaker 3: radiation to the same area all over again. You know,
• 28:36
  Speaker 3: it's a broad expertise and we see the whole gamut
• 28:39
  Speaker 3: in terms of cases and you know, situations.
• 28:44
  Speaker 1: Let's give the website just one more time for everybody.
• 28:46
  Speaker 2: Ask for protons dot com.
• 28:48
  Speaker 1: Understanding doctor Ferris, It's great to speak with you again.
• 28:51
  Speaker 1: I really appreciate how busy you are and making time
• 28:54
  Speaker 1: for all of our listeners on community d C. Thank
• 28:56
  Speaker 1: you so much, and happy holidays to you.
• 28:57
  Speaker 2: Dennis, thanks so much, and happy holidays to you.
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