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David Reardon, MD
DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified) )| Communities: Brain Cancer | Answers: 8 |
| Member Since: May. 2012 |
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Professional Statement
Dr. Reardon is Clinical Director at the Center for Neuro-Oncology at Dana-Farber Cancer Center and Associate Professor of Medicine at Harvard Medical School.
Dr. Reardon is an active researcher with special interests in the design and implementation of clinical trials for neuro-oncology and the preclinical evaluation of promising therapeutics for central nervous system tumor patients. His work includes using innovative clinical therapeutic agents to improve the cure rates in patients with brain and spinal tumors, with particular focus on the use of novel “tumor-targeting” therapeutics, including anti-angiogenesis agents for patients with primary brain tumors. He is also actively involved in clinical trials using immunotherapy, cytotoxins, and convection-enhanced delivery.
Dr. Reardon has co-authored 138 peer-reviewed manuscripts focused on neuro-oncology and 15 additional articles and book chapters. He has also co-edited a neuro-oncology textbook in 2010.
Dr. Reardon is an active researcher with special interests in the design and implementation of clinical trials for neuro-oncology and the preclinical evaluation of promising therapeutics for central nervous system tumor patients. His work includes using innovative clinical therapeutic agents to improve the cure rates in patients with brain and spinal tumors, with particular focus on the use of novel “tumor-targeting” therapeutics, including anti-angiogenesis agents for patients with primary brain tumors. He is also actively involved in clinical trials using immunotherapy, cytotoxins, and convection-enhanced delivery.
Dr. Reardon has co-authored 138 peer-reviewed manuscripts focused on neuro-oncology and 15 additional articles and book chapters. He has also co-edited a neuro-oncology textbook in 2010.
Professional Info
Credential: MD
Primary specialty: Oncology - Hematology/Oncology
Medical school: Tufts Medical School
Residency: Johns Hopkins Hospital
Fellowship: University of Michigan Hospital
Areas of expertise: Brain and spinal tumors, Clinical trials in neuro-oncology, Targeted therapies, Anti-angiogenic treatments, Immunotherapy, Convection-enhanced delivery.
Hospital affiliation: Dana-Farber Cancer Institute
Practice address:
450 Brookline Avenue
Boston, MA
02215
Practice phone number: 617-632-2166
DavidReardonMD Activities
Long term side effects of brain tumors and their associated therapies occur very commonly, but vary considerably from patient to patient. Most of these side effects are due to the cumulative effect of the tumor and its infiltration into the normal brain, as well as from surgery, radiation therapy, chemotherapy and the inflammatory reaction/scarring that frequently follows treatment. Tumor location is a critical factor associated with many long-term side effects.
Long term side effects can affect many aspects of normal brain function. Many brain tumor patients are frustrated by not being able to think, remember and process information as rapidly and sharply over time as they used to. In particular, nearly every patient describes difficulty with short term memory, while longer term memory is often preserved. Most patients also state that they must concentrate or focus more intently to accomplish mental tasks than they did previously. There are well validated tests to measure different aspects of our ability to think, process information and remember. I recommend that my patients consider these evaluations, called neurocognitive testing, once every 1-2 years in order to assess changes in their higher level, cognitive abilities. Based on the results of such testing, there are an increasing number of interventions and medications that may help some patients.
Long term side effects can also affect the ability of the brain to regulate the body’s hormones. Many of these hormones affect our metabolism and if low, can result in diminished energy and fatigue. Monitoring the status of these hormones involves standard blood tests which should be monitored at least on an annual basis among brain tumor survivors.
Unfortunately many chemotherapy agents can affect fertility long term. If possible, sperm or egg banking are important considerations before chemotherapy is started, particularly for younger brain tumor patients. Finally, radiation therapy can increase the risk of long term stroke or secondary cancers. This is another important reason why brain tumor survivors should follow-up with their oncologist on a regular basis.
Long term side effects can affect many aspects of normal brain function. Many brain tumor patients are frustrated by not being able to think, remember and process information as rapidly and sharply over time as they used to. In particular, nearly every patient describes difficulty with short term memory, while longer term memory is often preserved. Most patients also state that they must concentrate or focus more intently to accomplish mental tasks than they did previously. There are well validated tests to measure different aspects of our ability to think, process information and remember. I recommend that my patients consider these evaluations, called neurocognitive testing, once every 1-2 years in order to assess changes in their higher level, cognitive abilities. Based on the results of such testing, there are an increasing number of interventions and medications that may help some patients.
Long term side effects can also affect the ability of the brain to regulate the body’s hormones. Many of these hormones affect our metabolism and if low, can result in diminished energy and fatigue. Monitoring the status of these hormones involves standard blood tests which should be monitored at least on an annual basis among brain tumor survivors.
Unfortunately many chemotherapy agents can affect fertility long term. If possible, sperm or egg banking are important considerations before chemotherapy is started, particularly for younger brain tumor patients. Finally, radiation therapy can increase the risk of long term stroke or secondary cancers. This is another important reason why brain tumor survivors should follow-up with their oncologist on a regular basis.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
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10 months ago
Hearing loss is very common in medulloblastoma survivors and is likely due to the administration of radiation therapy and cisplatin chemotherapy. Although these treatments are very helpful to kill medulloblastoma tumor cells, they also can irreversibly damage the sensitive hearing structure of the inner ear called the cochlea. Hearing loss frequently begins at the higher frequencies and then gradually affects frequencies in the normal hearing range. The risk of developing hearing loss is related to the cumulative doses of radiation and cisplatin and is more common in patients who were younger when these therapies were administered. Hearing aids can help many patients. In addition, recent studies suggest that some patients with severe hearing loss following medulloblastoma therapy may benefit from cochlear implants (Roland JT et al. Laryngoscope 120(1):139-43, 2010).
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
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10 months ago
The process for determining the type of brain cancer affecting a given patient is dependent on careful microscopic evaluation of a sample of the tumor from surgery. This job is performed by neuropathologists. In addition to carefully studying a tumor sample microscopically, neuropathologists will often perform additional tests on the tumor material to help define it as accurately as possible. Different proteins are known to be expressed at different levels by specific types of brain tumors. Neuropathologists can test for these differential protein expression patterns using a technique called immunohistochemistry. In addition, neuropathologists are increasingly evaluating tumor samples for various mutations in specific genes known to affect different types of brain tumors. These additional tests involve molecular biology techniques. A thorough evaluation of a tumor sample, including immunohistochemical and molecular biology tests can take 1-2 weeks.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
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10 months ago
The blood brain barrier is a protective physical and functional boundary between the bloodstream and the brain. It is designed to naturally protect sensitive brain cells from potentially harmful agents. Unfortunately the blood brain barrier can prevent many cancer therapies from effectively reaching tumor cells in the brain. In some parts of many tumors, the blood brain barrier is at least partially disrupted. These parts of the tumor can be identified based on their ability to highlight intravenous contrast agents injected for brain MRI or CT scans. In other areas of the tumor, particularly those areas that do not highlight after intravenous contrast injection, the blood brain barrier is presumed to be intact. A growing number of oncology therapeutics are being designed to effectively penetrate the blood brain barrier, but unfortunately the ability to cross the blood brain barrier for many cancer reagents is still unknown.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
10 months ago
Metastasis of cancer to the brain is 10-15 times more common than cancers that originate in the brain itself. Importantly, the incidence of brain metastases is increasing, most likely reflecting improved overall survival of cancer patients. The most common types of cancer to metastasize to the brain are cancers of the lungs, breast, melanoma, colon and kidneys. Most patients develop multiple brain metastases. Isolated brain metastases can be removed surgically, but radiation therapy is typically used for many types of brain metastases.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
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10 months ago
Following receipt of a diagnosis of brain cancer, it is imperative that patients and families get informed. They should meet with their doctors and learn as much as possible. I encourage patients to do two specific things. First have the tumor sample reviewed by a second neuropathologist – ideally a neuropathologist with extensive experience and interest specifically in brain tumors. The diagnosis of each patient’s type of brain cancer is dependent on the review of the tumor by the neuropathologist; thus it is critical that this diagnosis be correct. Many times, brain tumors can be tricky to precisely classify. In these cases in particular, a second opinion from an experienced neuropathologist can make a major difference. Second, patients should get recommendations from cancer specialists who focus on brain tumors. This type of oncologist is called a neuro-oncologist. Most larger communities have cancer centers with dedicated neuro-oncologists. Neuro-oncologists are dedicated to brain tumor patients and therefore are often well informed regarding the most effective established therapies as well as promising new treatment approaches.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
10 months ago
Bevacizumab is the prototype of anti-angiogenic agents, a class of anti-cancer therapeutics that are designed to inhibit blood vessel formation by tumors. Bevacizumab specifically blocks the primary factor secreted by tumor cells that drives new blood vessel formation called vascular endothelial growth factor or VEGF. The exact mechanism of how bevacizumab helps to kill cancer cells is not clear, but laboratory research demonstrates that bevacizumab blocks the ability of tumors to generate new blood vessels that are otherwise required to provide nutrition and oxygen to the cancer. Without these new blood vessels tumors are less likely to grow and more likely to die.
Bevacizumab received accelerated approval by the US Food and Drug Administration for recurrent glioblastoma in May, 2009. This approval was based on a review of two clinical trials which showed that bevacizumab therapy increased the rate of radiographic responses (i.e. shrinkage of the tumor on MRI or CT scan) compared to previously existing data from other treatments. Importantly, many of the patients who achieved radiographic responses were able to maintain them for a prolonged period of time. Health Canada and regulatory health agencies of many countries also approved bevacizumab for recurrent glioblastoma based on these data. In contrast, the European Medicinal Agency did not grant approval, primarily because due to the lack of adequate control groups in these two studies. Two very large placebo-controlled phase III studies comparing standard radiation and temozolomide with either placebo or bevacizumab for newly diagnosed glioblastoma patients recently completed accrual and preliminary results from these studies are expected in the next 6-12 months. If these studies are positive, bevacizumab is expected to be fully approved by the US FDA and will likely be fully approved and therefore available for newly diagnosed glioblastoma patients elsewhere in the world.
Preliminary studies have shown encouraging outcome with bevacizumab among patients with recurrent grade III malignant glioma tumors (such as anaplastic astrocytoma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma), recurrent and progressive meningiomas and for patients with radiation necrosis of the brain. However, bevacizumab is not approved for patients with these conditions because definitive clinical trials for these indications have not been performed.
Bevacizumab received accelerated approval by the US Food and Drug Administration for recurrent glioblastoma in May, 2009. This approval was based on a review of two clinical trials which showed that bevacizumab therapy increased the rate of radiographic responses (i.e. shrinkage of the tumor on MRI or CT scan) compared to previously existing data from other treatments. Importantly, many of the patients who achieved radiographic responses were able to maintain them for a prolonged period of time. Health Canada and regulatory health agencies of many countries also approved bevacizumab for recurrent glioblastoma based on these data. In contrast, the European Medicinal Agency did not grant approval, primarily because due to the lack of adequate control groups in these two studies. Two very large placebo-controlled phase III studies comparing standard radiation and temozolomide with either placebo or bevacizumab for newly diagnosed glioblastoma patients recently completed accrual and preliminary results from these studies are expected in the next 6-12 months. If these studies are positive, bevacizumab is expected to be fully approved by the US FDA and will likely be fully approved and therefore available for newly diagnosed glioblastoma patients elsewhere in the world.
Preliminary studies have shown encouraging outcome with bevacizumab among patients with recurrent grade III malignant glioma tumors (such as anaplastic astrocytoma, anaplastic oligodendroglioma and anaplastic oligoastrocytoma), recurrent and progressive meningiomas and for patients with radiation necrosis of the brain. However, bevacizumab is not approved for patients with these conditions because definitive clinical trials for these indications have not been performed.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
10 months ago
The neuro-oncologist is the quarterback of the neuro-oncology team caring for brain cancer patients. Most neuro-oncologists trained originally as either neurologists, medical oncologists or pediatric oncologists, and then completed additional training in neuro-oncology. The United Council for Neurologic Subspecialties recently initiated formal testing to credential neuro-oncologists.
The neuro-oncology team frequently includes neurosurgeons, radiation therapists, nurses, pychologists, neurologists, psychiatrists, neuro-radiologists and neuropathologists. Each member of the team plays a critical role particularly during different phases of the course of the disease. It is the role of the neuro-oncologist to coordinate this team. In addition the neuro-oncologist typically oversees all chemotherapy and systemic therapies administered for patients. The neuro-oncologist also typically oversees appropriate follow-up and check-ups for patients.
The neuro-oncology team frequently includes neurosurgeons, radiation therapists, nurses, pychologists, neurologists, psychiatrists, neuro-radiologists and neuropathologists. Each member of the team plays a critical role particularly during different phases of the course of the disease. It is the role of the neuro-oncologist to coordinate this team. In addition the neuro-oncologist typically oversees all chemotherapy and systemic therapies administered for patients. The neuro-oncologist also typically oversees appropriate follow-up and check-ups for patients.
New answer by DavidReardonMD (Physician - Oncology - Hematology/Oncology (Verified))
1
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10 months ago
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