Joey Wahler (Host): It is a treatment growing in development and use. So we're discussing Radiopharmaceuticals for Cancer Patients. Our guest is Dr. Rod Ellis. He's Director for Clinical Research at Tampa General Hospital. This is Community Connect presented by Tampa General Hospital. Thanks for joining us. I am Joey Wahler.

Hi there, Dr. Ellis. Welcome.

Rod Ellis, MD: Hi Joey. Thank you so much for inviting me to talk with you guys today. Really excited to be here.

Host: Yeah. We really appreciate the time and important topic indeed. So, speaking of which, first, what cancer patients specifically are currently able to be treated with this radiopharmaceutical therapy?

Rod Ellis, MD: Well, it is a fairly new technique. You know, radiation classically meant patients came in each day, Monday through Friday for treatments, and we treat most all cancer types. But the radiopharmaceuticals is really exciting because we can give it as a radiation by a liquid IV and treat metastatic or cancers that have spread.

Right now there's only two types of cancers that are approved. It's either prostate cancer or some of the neuroendocrine cancers that you get in your gastrointestinal tract.

Host: And so how much of a rise in use of this are you seeing recently?

Rod Ellis, MD: Well, the research has been going on, really for decades, and there's about at least 20 new compounds that are in clinical research trials right now that are all going to be coming out. But we expect in radiation oncology over the next five years to almost double our growth and revenue, specifically just through radiopharmaceuticals.

Host: Interesting numbers for sure. So how exactly does this work?

Rod Ellis, MD: Well, as I say, when you're providing the radiopharmaceutical as an injection, it's able to attach to the targeted cancer cells wherever they may be located in the body. And this allows it to deliver a very high dose of radiation only to the cancer throughout the body without giving excess doses to healthy tissue.

And this helps to limit the side effects for the treatments for patients.

Host: And that leads me beautifully into my next question. What if any side effects or risks are there from this?

Rod Ellis, MD: That's really remarkable. The first clinical trial that was done for one of the first agents, (Xofigo®) for men with metastatic prostate cancer, they actually showed in a two to one randomization that patients who got the placebo, which was just water, had more toxicity than the therapeutic agent. So often the side effects are pretty limited.

Usually it's decrease in blood counts, maybe some fatigue, or occasionally some mild GI symptoms.

Host: And so how many treatments are typically given to a patient and how frequently does that occur?

Rod Ellis, MD: The clinical trials have been worked on so far are generally limited to six treatments done every month or maybe every four to six weeks. And then after they complete that cycle of six treatments, they may go on to other types of therapy, whether it's traditional chemotherapy or local radiotherapy.

Host: So this is being done in conjunction typically with other more traditional, if you will, forms of treatment.

Rod Ellis, MD: Yeah, right now where this is mostly being used is in patients that have what's considered to be incurable disease and that other standard treatments aren't working as well for them anymore. So for example, prostate cancer, usually you'll start with some hormonal therapy blockade, but eventually you'll become resistant to that.

Then they've got a couple of different chemotherapies you can use. It's very exciting now that these newer agents have now been approved even before you get systemic chemotherapy, as long as you've had hormonal therapy. But we integrate them in somewhere along the course of treatment to try and maximize the benefit and limit the side effects that patients have to suffer going through cancer treatments.

Host: And since you mentioned the type of patient that's typically being exposed to this, does that make it easier for them to buy in considering that they don't have many, if any other options?

Rod Ellis, MD: Well, I think they were certainly very excited to find out there's a treatment option that doesn't have a lot of side effects and be given of say, six months or more and avoid maybe, with chemotherapy as much benefit as patients get out of being treated with chemotherapy, sometimes the toxicities get to the point where they just need a break, and so a radiopharmaceutical may be break in treatment for six months to let them recover from some of the previous courses and be ready to continue their journey in fighting their cancer.

Host: Gotcha. So when you say break, tell people please, what does that mean exactly in terms of the difference regarding whatever impact it's going to have on them, be it physically or otherwise?

Rod Ellis, MD: Sure. So again, let's take prostate cancer as the typical because I think that's where the largest majority of patients are. And they'll come in, they'll be diagnosed and either get surgery or radiation. If they're progressing and the disease spreads to the bones, that's when they start hormonal therapy and when they become resistant to the hormonal therapy, that's when they start chemotherapies.

But these patients can live a decade or two, but as they become more involved with the disease, they get more symptoms. And anything they could do that slows it down, but doesn't cause many side effects; they're very appreciative of, and that's where the radiopharmaceuticals really have a promise because it's taking that high dose of radiation, putting it into the vein, but then making it attach to the site where the cancer cells are at, and deliver the radiation there while you're not really getting very much radiation to the normal healthy tissues.

And so that's where it gets such a great response to the cancer with few side effects for the patient.

Host: Sure. So if this has fewer side effects than what patients would normally undergo it be undergoing, from other treatments that they're having, what here, will they not experience as much in the unpleasant department?

Rod Ellis, MD: Yeah. Unfortunately with chemotherapies, as effective as they can be at saving lives and prolonging people's lives with cancer, they do carry some side effects. And they're different depending on the agent. You might have hair loss, you might have nausea and vomiting. You might be more susceptible to secondary infections.

All of these things are associated with chemotherapy, but most of those are not readily associated with radiopharmaceutical therapy.

Host: Gotcha. That's what I was wondering is what are some of those things that they've had to endure with other treatments that won't be as much if at all, the case here. A few other things for you, doctor, since it is a form of radiation therapy, what precautions should patients or their family or caregivers be aware of here?

Rod Ellis, MD: Yeah, I normally educate patients with radiation oncology, they're normally coming in every day and getting a treatment. They're in a room by themselves that's making the x-rays and delivering the treatment to that part of the body that needs the treatment. And then they walk out, but they're not radioactive. When we use liquid radiation and inject it, the patient does become for a period of time, radioactive. And so they may have anything that's a body fluid, whether it's sweat or urine or anything, is going to have some radioactive material in it that's going to be detectable and could be passed to someone else potentially.

So for at least the first three days, usually up to a week after each treatment, we make sure they're aware of those precautions and let their families and loved ones know what things need to be done to prevent any exposure of radiation to other people. It's mostly fairly simple things like for the first week after your treatment, we're going to assign your bathroom at your house and you're going to use that. You're always going to sit down when you go to the restroom and you're always going to flush twice and you're always going to wash your hands very well. If any body fluids get on your clothes, we're going to recommend that you wash those clothes separately from someone else's clothes, again for the first week after the treatment.

But it's generally common sense precautions like that, that are fairly easy for patients to comply with.

Host: Yeah, definitely sounds like it. How about any misconceptions patients typically have about radiation therapy in general, from your experience that maybe you can clear up here.

Rod Ellis, MD: Yeah, I, think radiation oncology, both those words are pretty formidable words, and people are, are scared about radiation exposure. They're scared about cancer, and when you put them together, it's just a scary black box. Something a lot of people don't understand and know a lot about. It's fairly simple with the external beam radiation to limit the radiation to just the area you want to treat it, but it's a little bit more inconvenient that you have to come back and forth each time for another treatment.

And whether that's only five treatments or as many as 40 treatments, it's been done different ways over the years. The advantage to this therapy and what's different about it's because it's a liquid therapy, like a chemotherapy, it doesn't have the standard side effects that you see with chemotherapy.

You don't have to come daily for it, but it does cause you to become radioactive temporarily, while you're receiving your treatment. So it just adds those different cautions that I just described. Otherwise it's fairly simple and routine for patients, and I think they like it better because they don't have to come every day for a period of weeks for the treatment.

They just come in once every four to six weeks, get blood counts repeated prior to the next dose to make sure everything's stable and then continue on through their six treatments.

Host: Yeah, because people undergoing any kind of medical treatment on a regular basis away from home at a facility, oftentimes the travel and the wear and tear involved with that, whether it's the time taken or arranging for a ride if, people don't drive, what have you, all those little seemingly minor details can be very stressful for a cancer patient can't they?

Rod Ellis, MD: Exactly, exactly. Especially in an area as big as Florida, there's a lot of cancer patients, but they all don't live very close to the big cities. So we see a large number of patients that travel from all up and down the peninsula, even across the coast here at Tampa General Hospital, in our cancer service lines.

Host: What about this targeted therapy approach being developed for other types of cancer as well?

Rod Ellis, MD: Well, that's what's so exciting about this is we know it works very well for men with prostate cancer. We know it works for men and women that have a neuroendocrine gastrointestinal tumor, but there's so many other types of cancers that we don't have great chemotherapies for, for example, sarcoma. And this is being developed to treat sarcoma patients as well.

And many other types of cancers are being developed as well to come into this radiopharmaceutical line. So we're just really super excited that in the one year since I joined Tampa General Hospital, we've been able to get two of the three available agents approved and ready to deliver to patients. We should the third agent up running by the end of this quarter. And as new agents come aboard, it will be easier for us to adapt them into the workflow because we've already got the experience with the first three that are FDA approved now.

Host: So finally, doc, in summary here, when you talk about being excited about this, which you've mentioned a couple of times during our chat here, and you talk about the ease with which this is administered, how rewarding is it for you being involved in oncology in this area to be able to bring this to patients?

Rod Ellis, MD: Yeah, I've been doing this for quite a number of years because with the first agent was Xofigo, when it came out, I was the Director at University Hospitals at Case Western Reserve and ran their program. And the benefits I was seeing with patients with the reduction in pain and fewer symptoms during the period that they had the treatment was fantastic. But that agent was kinda limited that it only could treat disease that was in the bone. If the disease went to soft tissues like a lymph node, we didn't really have a great agent for it. The PLUVICTO® now has that targeted ability to treat both the bone and the soft tissues. So that opens up a whole new group of patients that are going to benefit. And it's exciting to me because I think clinical trials and letting patients find out about new data express their interest in being on a study is really what's made me excited about academics, in the 30 years I've been doing this. It's interesting to see if you can make a new pathway that helps not only the people that are on that clinical trial, if it's a positive trial, but has a wider impact globally if you get good data showing that you found a better way to treat patients.

Host: And to be doing it for 30 years or more as you have, and to still have things like this come along that get you pumped up to get up and go to work each day. That's gotta be a great feeling, helping people this way. Yes?

Rod Ellis, MD: It really is. Nothing makes my day better than getting up in the morning, having my cup of coffee, and thinking about what I can do today to help this community.

Host: That's great. Your passion definitely comes through, Doctor. Well, folks, we trust you are now more familiar with Radiopharmaceuticals for Cancer Patients. Dr. Ellis, keep up all your great work and as the web spreads of ways in which this is being used, hopefully we can chat again down the road.

Rod Ellis, MD: Oh, I'd really look forward to that Joey, thank you so much. Appreciate your time.

Host: Same here. And for more information, please do visit tgh.org/cancer. If you enjoyed this episode, please be sure to like, subscribe, and follow Community Connect, presented by TGH on your favorite podcast platform, and share it on your social media. I'm Joey Wahler, and thanks again for being part of Community Connect presented by TGH.