Berks County Medical Society Medical Record Fall 2019 - 25

The MRI machine relays high-quality, realtime images of tumors as they're blasted with
radiation beams from the linear accelerator.
Both Penn State Health and Tower Health
have plans for these devices for the future.

Infusional/Oral treatments
As stated above, immunotherapy has
become a pillar in cancer care. This therapy
can turn on the immune system to fight
cancers.

TruBeam Radiotherapy System

Calypso Extracranial Tracking System
Radiolabeled microspheres are another therapy that is new,
gaining traction in Berks County. This technology allows the
introduction into the liver, via catheterization, of microspheres
radiolabeled with Yttrium 90 (Y90) with the intent to deliver lethal
doses of radiation directly to tumors in the liver. Not just liver
cancers, but cancers that have metastasized to that site as well. Berks
County is fortunate to have one of the United States' experts in this
technique at PSH-Saint Joseph.
Of note is the development of magnetic resonance based therapy,
known as MR-linac. This technology merges a magnetic resonance
imaging (MRI) machine and a linear accelerator into a single device.

Tumor cells have the ability to suppress
the immune response that may otherwise
recognize and kill cancer. We have tried to
utilize the immune system to treat cancer for
decades, with interferon, interleukin 2, and
other immune related agents. There are two
proteins on the surface of T cells, CTLA-4
and PD1, that help keep the body's immune
responses in check. Tumor cells can selectively
activate these proteins, thereby shutting off
the T cell response and allowing the tumors
to proceed unabated. The development of
agents that modify the on/off signal of the
T cell produces for us the ability to harness
the immune system to treat these tumors.
The toxicity profile is different from that of
chemotherapy, and in most cases somewhat
milder, but there are also some quite serious
side effects such as nephritis, pneumonitis
and colitis. Generally these are managed
with judicious steroid use. Most importantly,
these drugs have changed the paradigm as it
pertains to how patients view quality of life
during treatment. These drugs, in addition to
agents used in clinical trials, are available as
standard therapy for cancer patients in Berks
County.
Finally, I don't believe there has been
a more prolific time in oncology, with the
development of new drugs and new uses for
older agents, as we are currently experiencing. In addition, looking
at genomic alterations with Next Generation Sequencing has
allowed us to begin to tailor treatments against the drivers of cancer
development. Just a few examples of tumors that have acceptable
targets are lung cancers, melanoma, breast cancers, and thyroid
cancers.
This is an exciting time for cancer care in this country, and
Berks County is clearly at the forefront of some of the most exciting
treatments available.

FALL 2019

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Berks County Medical Society Medical Record Fall 2019

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Fall 2019

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