Tim Kruser

#Radonc, brain tumor & lung cancer specialist
@TurvilleBay
Outspoken advocate for my patients & field.
Dad. #btsm #lcsm

[Tim Kruser @TimothyKruserMD]

I think we need to all just need pause & reflect.
A football field worth of oncologists are here to hear a REAL DEBATE on a question we wouldn’t have asked 10 years ago.
CURING metastatic disease with RT + IO??
What an exciting time to be an oncologist! #astro19

[Justin Z. Wang @justinzw]

Lastly, we were also able to utilize the RTOG-0539 clinical trial cases for biomarker discovery and build multiple molecular predictive models of response to RT that were able to predict PFS following RT in meningiomas better than WHO grade alone including being able to identify RT-resistant meningiomas in each WHO grade

[Justin Z. Wang @justinzw]

Glad to share some of my PhD work on using molecular classification to predict outcomes following surgery and radiotherapy in meningiomas published in @NatureMedicine.

Grateful to @gelarehzadeh and @FarshadNassiri for helping guide this work and to our collaborators, reviewers, and funding agencies.

https://t.co/TJxyqhUib5

[Elliot Servais, MD, FACS @ElliotServaisMD]

The Lahey Lung Cancer Screening program has surpassed 30,000 scans

10,500 patients scanned
382 lung cancers detected
Cancer detection rate of 3.65%

0.0095 rate of any invasive procedure in patients without cancer

Lung Cancer Screening is SAFE and EFFECTIVE

[Jonathan Sharrett @DrJohnnyRadOnc]

Radiation is so toxic they say. Yep, tell me and this guy more

[Tim Kruser @TimothyKruserMD]

@DavidSherMD Been using too. FWIW the brand (Now foods k12 probiotic) was specified in the trial, and I’ve directed patients to it on amazon where it’s available for $21 a bottle. A 6-7 treatment course is like 2.5 bottles. Anecdotally also seems efficacious in my experience.

[Shankar Siva @_ShankarSiva]

What I learned in 🇨🇱 today … $5mill = one #radiotherapy machine☢️, can treat 10k patients. $5mill = 135 patients worth of trastuzumab. 🧐
@TheLancetOncol - https://t.co/qyAG8X6Rdq “an essential pillar in multi-D oncology…an inexpensive modality” - 👏🏽 well said @TargetingCancer

[Tim Kruser @TimothyKruserMD]

@jryckman3 @ElliotServaisMD @DrChowdharyMD @FordePatrick @JeffBradleyMD @safaviaa @DoctorJSpicer If its suggested that surgery is supported by one post-hoc analysis (while not acknowledging the concluding line of one of the other RCTs) then surely at least we’d agree no pneumonectomies would be performed, right?
But—25% of stage III pts in Checkmate got pneumonectomies so 🤷‍♂️

[Tim Kruser @TimothyKruserMD]

@ElliotServaisMD @DrChowdharyMD @FordePatrick @JeffBradleyMD @safaviaa It was in quotes in my tweet and in the abstract of an RCT. Not random, and Albain is a negative study.

[Tim Kruser @TimothyKruserMD]

@ElliotServaisMD @DrChowdharyMD @FordePatrick @JeffBradleyMD @safaviaa It was a direct (abridged) quote from the conclusion of the EORTC RCT, Van Meerbeeck JNCI 2007. One of the other 2 well-designed and run RCTs that did not show PFS difference. PMID: 17374834.

[Tim Kruser @TimothyKruserMD]

@FordePatrick @JeffBradleyMD @safaviaa There are at least 3 RCTs ran with a design to show superiority of arm including surgery—all failed to meet their endpoints (and showed higher morbidity when surgery was included) those countries were admirably adhering to the science. ChemoRT is the evidence-based local modality

[Tim Kruser @TimothyKruserMD]

@StephenVLiu @LungCaJournal The framing is wrong. RTOG, Alliance, NRG have run dozens of RCTs to establish the SOC for brain mets, inclusive of EGFR patients. The question is “Now that we have TKIs, should we run a non-inferiority trial to show we might NOT pursue upfront local RT?”
Burden on drug, not RT

[Shankar Siva @_ShankarSiva]

3/ There are >dozen clinical trials of SABR for primary RCC – outlined in @ISRSy practice guideline - https://t.co/ih9Fr6gSG8 – compared to zero for thermal ablation. The weight of evidence is with SABR, not TA, and is arguably the preferred modality for non-surgical therapy

[Shankar Siva @_ShankarSiva]

Some like it hot! See oncoscan commentary on the subject ➡️ https://t.co/sx00Hp5jSF

@DrewMoghanaki @UCD_radonc @TimothyKruserMD @MeredithGiulia1 @IJROBP 🐺#radonc

[Douglas E Wood @DouglasEWood1]

So let me get this straight. More people in the U.S. die of lung cancer than die of breast, colorectal, and prostate cancer combined, and lung cancer screening rates are lower, yet @TODAYshow fails to mention it in their cancer screening segment? Who is their medical consultant?

[RaleighLab @LabRaleigh]

I'm increasingly escalating RT dose for high-risk #meningioma in my practice @UCSF @UCSFCancer @NeurosurgUCSF. There is retrospective data in support of this approach, and now we have prospective data from @maxiydeng1994 in @NeuroOnc! Summary here: https://t.co/WGGSYJ5U0x

[Matthias Guckenberger @Mat_Guc]

Randomised CURB trial published in The Lancet:
👉 PFS increase by factor of FOUR (!) in oligoprogressive metastatic NSCLC pts by SBRT plus SoC vs SoC systemic Tx only
👉 SBRT with minimal added toxicity 16% G2+

Precision local SBRT🤝precision systemic TX
https://t.co/EKSoTzSa2e

[Fabio Arcidiacono @FabArcidiacono8]

@EricLehrer @JCO_ASCO @ASTRO_org 📢Do you remember this excellent letter? it seems like so little time has passed..similar trial omitting RT in BM 🟰same answer!!
"caution against overinterpretation of Atezo-Brain study and its impact on the management of intracranial disease in NSCLC patients"

[Eric Lehrer, MD @EricLehrer]

https://t.co/GRzoO5NP0p

Thank you @JCO_ASCO for publishing our letter regarding the recent Atezo-Brain trial. @ASTRO_org #btsm #radonc

[Tim Kruser @TimothyKruserMD]

@FabArcidiacono8 @EricLehrer @JCO_ASCO @ASTRO_org @PDBrownOnc @DanTrifMD @ISRSy @ESTRO_RT Instead this approach gets trumpeted in a high impact journal…while 80% of authors had Roche COI 🤷‍♂️
IRBs, DSMB, and ultimately referees and editorial teams are supposed to curtail these unsafe approaches and safeguard patients.
It is pretty clear patients were harmed here.

[Tim Kruser @TimothyKruserMD]

@FabArcidiacono8 @EricLehrer @JCO_ASCO @ASTRO_org @PDBrownOnc @DanTrifMD @ISRSy @ESTRO_RT Nice letter. A few points:
@JCO_ASCO allowed the authors to state “only” 5/40 pts with brain mets (not offered RT) suffered gr 3-4 neuro events including seizures and hallucinations.
1+ of events should’ve resulted in DSMB shutting down the trial.