Dr. Jekwon “Jay” Yeh, Medical Director of Radiation Oncology and Cancer Services at Adventist Health Glendale discusses the case of a 65-year-old male with an obstructing prostate tumor causing a urinary obstruction and necessitating nephrostomy tubes. Patient was treated with standard therapy, yet the tumor continued to progress. Hear how a specialized course of immunotherapy and radiation subsequently produced an excellent response, allowing the patient to walk again.
My name is Doctor Jaquan J Ye. I'm a radiation oncologist and I serve as the medical director of the Cancer Center here at EvanS Health Glendale, and I'm in my second year here. Our cancer program here at EvanS Health Glendale is quite strong. We're always in an expanding, um, you know, momentum. So in terms of medical oncology, a large majority of all our patients get what's called next generation sequencing on their tumors. What this allows is it allows us to look at the tumor, the actual DNA genetic makeup, so we know exactly what form of chemotherapy or immunotherapy to target the cancer. Also we have very strong breast surgery team. We have very strong medical oncology team and we're also growing our pulmonology lung cancer program. Um, and we also feature, uh, a true beam, variant true beam linear accelerator at our cancer center which can do things like radiosurgery for tumors in the brain that can't be removed by surgery. We can treat lung tumors without surgery and almost any tumor in the body we can safely treat with our radiation technology. So cancer is becoming a lot more personalized now. We now know that certain patients don't need chemotherapy that in the past we were just giving chemotherapy to probably too many patients who didn't need it. So now with these new tests we're able to see exactly what type of tumors they are. Are they gonna be aggressive? Are they gonna be less aggressive? So now we can actually custom tailor our treatment. We have a 770 year old gentleman who was actually diagnosed with prostate cancer about 6 months ago. We, we had done imaging. We used a PSMA scan which is specific for prostate cancer. It's a type of PET scan. We found that the tumor had already spread from the prostate to the lymph nodes and the retroperitoneum. So he was given standard therapy, which is commonly anti-testosterone therapy to help control the tumor, and usually 95-99% of cancers, prostate cancers, they respond to this type of therapy, but his situation was much more different. He got the therapy, yet the tumor continued to progress. His PSA blood levels kept going up. We repeated the PSMA scan that showed that the lymph nodes were larger. His prostate cancer had grown. In fact, it had grown so much that it was obstructing his urine that he actually needed nephrostomy tubes to help divert the urine out through his back. We ran the next generation sequencing tests and we found that this type of tumor actually had very high tumor mutational burden and was responsive to certain types of immunotherapy so our medical oncology team, we started the immunotherapy last month when we first gave it to the patient he had very little response. The cancer didn't change at all. Afterwards I started to do some research into prostate tumors with high tumor mutational burden and found that it actually works better when the immunotherapy is combined with the radiation. So in this patient with prostate cancer we're using what's called arc therapy, which is a type of uh radiation therapy that actually an arc actually spins around the patient 360 degrees and it spins around another 360 degrees treating the tumor and avoiding the healthy tissue at the same time. So despite you know several fractions of radiation, this patient actually has no side effects whatsoever from the radiation therapy. The radiation is almost like cracking the egg of the tumor. You crack it, you release antigens, and now the immunotherapy can actually work a lot more effectively. So now just last week we started his radiation, and after 3 treatments, the tumors already shrunk by 20%. He was actually having orthostatic hypotension when he stood up. Due to the obstruction of the inferior vena cava, so he couldn't walk, had no quality of life. Just this weekend we hear that he's been working with physical therapy is actually walking around. Not only that, he's already starting to actually urinate out from his bladder again. So just in a few treatments with our personalized treatment, um, you know, he's having a very, very remarkable response. So the the tumor should continue to shrink. He should be able to be discharged or should be able to go home and and resume these, uh, treatments as an outpatient.
