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Ronan Kelly, MD
RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified) )| Communities: Esophagus Cancer , Lung Cancer , Stomach Cancer | Answers: 8 |
| Member Since: Sep. 2012 |
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Professional Statement
Dr. Ronan Kelly is an Assistant Professor of Oncology at the Johns Hopkins Sidney Kimmel Comprehensive Cancer Center.
Dr Kelly is leading several research projects in upper GI tumors at Johns Hopkins and has a special interest in epigenetic and immunotherapies for gastro-esophageal tumors. He has recently been invited to become a board member and scientific advisor for the Esophageal Cancer Action Network which is the largest esophageal cancer patient advocacy group in the US.
Dr Kelly is leading several research projects in upper GI tumors at Johns Hopkins and has a special interest in epigenetic and immunotherapies for gastro-esophageal tumors. He has recently been invited to become a board member and scientific advisor for the Esophageal Cancer Action Network which is the largest esophageal cancer patient advocacy group in the US.
Professional Info
Credential: MD
Primary specialty: Oncology - Hematology/Oncology
Medical school: Royal College of Surgeons in Ireland
Residency: Royal College of Physicians in Ireland
Fellowship: National Cancer Institute in Bethesda, MD; Royal College of Physicians in Ireland
Areas of expertise: Esophageal Cancer, Gastroesophageal Cancer, Medical Oncology, Non-Small Cell Lung Cancer, Small Cell Lung Cancer, Thymic Carcinoma, Thymoma
Hospital affiliation: Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
Practice address:
401 N. Broadway
Baltimore, MD
21231
Practice phone number: 410-955-8893
RonanKellyMD Activities
If there is a clinical trial available, then I encourage all of my patients to participate in the trial. We need to continue to investigate novel therapies in this disease if we are to continue to make advances. If there is no available clinical trial near a patient then there are a number of standard of care chemotherapeutics that can be used. As previously mentioned HER2 should be assessed in all patients with metastatic disease to assess whether trastuzumab should be added to chemotherapy.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
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7 months ago
For patients with stage 3 disease who have been treated with trimodality therapy involving neoadjuvant chemoradiation followed by surgery, then an oncologist should follow the National Comprehensive Cancer Network (NCCN) guidelines which state that an asymptomatic patient should have a complete history and physical examination every 3-6 months for the first 1-2 years and then every 6-12 months for years 3-5. I prefer to get a CT scan every 3 months for the first year and then the interval of subsequent scans can be increased in the following years.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
7 months ago
The Trastuzumab for Gastric Cancer (ToGA) trial evaluated the addition of trastuzumab (Herceptin) to chemotherapy in patients with Her2-neu positive advanced gastric and gastro-esophageal junction (GEJ) cancers. Her2 positivity rates were 33% and 21% respectively, for patients with GEJ and gastric cancer. As this study included patients with GEJ tumors, we routinely assess all tumors in patients with metastatic esophageal cancer for HER2. The rates of HER2 positivity in esophageal cancer are approximately 20%. If the tumor is HER2 positive then trastuzumab should be added to chemotherapy. The role of trastuzumab in earlier stage tumors that have not metastasized is currently being evaluated in the RTOG 1010 trial where patients with HER2 positive disease will be randomized to two different arms. In one arm patients will receive chemoradiotherapy plus trastuzumab prior to surgery and then maintenance trastuzumab after surgery and in the second arm patients will receive standard chemoradiation prior to surgery without trastuzumab. At the present time guidelines recommend trastuzumab in advanced disease only if HER2 is positive. We need to await the results of ongoing studies to see if trastuzumab should be added in earlier stages of esophageal cancer.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
2
Answers |
7 months ago
My preference is to administer chemotherapy in the neoadjuvant (before surgery) setting for stage 2 and 3 disease. There are a number of chemotherapies that have been investigated and that can be used including cisplatin, carboplatin, paclitaxel, docetaxel, irinotecan, 5 flourouracil, and oxaliplatin. The treating oncologist usually picks two of these drugs and gives them concurrently with radiation. We do however lack a biomarker to help us predict which chemotherapy should be used in which patients. We are currently enrolling patients at Johns Hopkins to a clinical trial which involves assessing a certain gene for a characteristic called methylation. Patients who have methylation of this gene receive one type of chemotherapy and patients who are not methylated receive another type of chemotherapy. We hope that this will lead to an improved response to treatment but we will not know this until the end of the study and the data is analyzed.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
7 months ago
Patients with stage 2 esophageal cancer in the United States are usually treated with neoadjuvant chemoradiation (before surgery) rather than adjuvant therapy (after surgery). Some centers in other parts of the World may favor adjuvant therapy but this is not standard practice in the United States.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
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7 months ago
Patients with stage 1 esophageal cancer do not routinely receive adjuvant chemotherapy unless the preoperative staging of the tumor was incorrect and upon review of the post surgical pathology, the tumor was more advanced than originally thought.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
7 months ago
A patient with esophageal cancer should meet a medical oncologist if chemotherapy is warranted. Patients with very early esophageal tumors can be treated with local therapy alone either through the endoscope or via surgery. Once an invasive tumor is identified and it is determined to be more advanced than stage 1, then a patient should meet a medical oncologist. A medical oncologist can ensure that all of the necessary investigations required to adequately stage a tumor are performed and he/she can decide whether neoadjuvant (before surgery) chemotherapy, usually given concurrently with radiation, should be given. Due to the complex nature of treating esophageal cancers, a multidisciplinary approach is favored whereby a medical oncologist is involved from a very early stage.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
7 months ago
This depends on where a patient goes for treatment as different approaches are taken in a private practice setting versus a large academic teaching hospital. At Johns Hopkins we have recently introduced a multi-disciplinary (multi-D) clinic for all newly diagnosed patients with operable esophageal tumors. At this clinic the patient meets and discusses their treatment with the team of doctors who will be looking after them throughout the course of their treatment. This consists of the medical oncologist, the radiation oncologist and the thoracic surgeon. Prior to meeting the patient the team reviews all of the investigations performed to date including the endoscopy (EGD) and the endoscopic ultrasound (EUS). We also discuss with the pathologist the results of the biopsy and we review all of the imaging including the PET and CT scans with our allocated radiologist. By the time a patient with esophageal cancer meets me at this multi-D clinic I have reviewed all of this information. I then explain why all of these investigations have been performed and what we have found in terms of what the stage of the tumor is (how advanced is the tumor). Finally I explain how we will treat the tumor. My colleagues in radiation oncology and surgery also explain how they will treat the tumor. We also discuss at this meeting whether a feeding tube for nutritional support is required. In patients with metastatic disease the patient usually does not see the surgeon as these tumors are considered inoperable.
New answer by RonanKellyMD (Physician - Oncology - Hematology/Oncology (Verified))
1
Answer |
7 months ago
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