New Recording 9

Garsiakalbiai

• Speaker 1 7552s · 0:21

1. 0:21

   Skyrius 1: Thank you. 303s · Speaker 1

   Thank you. Oh, yeah. What's my tower? Thank you very much. Anyway, we have a local reference to U.S.T.E.K.A.T. Thank you. Thank you. Thank you. That's why it doesn't... It doesn't... It doesn't matter. It doesn't matter. It doesn't matter. …

2. 10:01

   Skyrius 2: Exactly. · Speaker 1

   Exactly.

3. 20:02

   Skyrius 3: Around this, we can get a little bit, a little bit. 52s · Speaker 1

   Around this, we can get a little bit, a little bit. But it's not surgery. Surgery is not here, it's just medical medicine. For example, surgery is not gradation therapy. It's not systemic therapy. Do you want to go to the board? Do you want…

4. 25:09

   Skyrius 4: Thank you. 303s · Speaker 1

   Thank you. How are you? How are you? How are you? Thank you. Thank you. Thank you. Keep it, keep it. Thank you. That's why The name I know Assalamu alaikum. Good afternoon. My name is Guthamma Amr. I am the general manager of Merck and Sala…

5. 30:12

   Skyrius 5: patient population that may have been a bit overlooked with little, I would say, or like few therapeutic options. 301s · Speaker 1

   patient population that may have been a bit overlooked with little, I would say, or like few therapeutic options. And that meant we are really proud, glad that soon we will bring, I would say, one of the therapeutic options for those patien…

6. 35:14

   Skyrius 6: desmoid cases. 301s · Speaker 1

   desmoid cases. These cases are known to have an APC gene mutation, a germline one. So they do require germline testing and sort of genetic counseling. In terms of when a patient has basically FAP, the likelihood that they're going to develo…

7. 40:15

   Skyrius 7: and of course there is the psychological impact. 301s · Speaker 1

   and of course there is the psychological impact. If we're going to talk about the physical part, the spigament, these patients typically have enlarging masses that are difficult to control. The majority of them would actually present, unfor…

8. 45:16

   Skyrius 8: And of course, they should get on -road at this point surveillance. 300s · Speaker 1

   And of course, they should get on -road at this point surveillance. What's the best imaging modality? It is actually MRI. There are certain MRI characteristics for disjoint tumors and basically in the T2 signaling you get hypo -intense band…

9. 50:17

   Skyrius 9: difficult. 289s · Speaker 1

   difficult. Yeah, it is the same like Dr. Ali pointed. So I believe the initial part is the time of the biopsy. And because we do have MSK, which is the musculoskeletal team for the IR, for the extremities, and for the GI, the GI team, they …

10. 55:28

    Skyrius 10: Actually, for us, we are not doing the genetic tests on routine -based. 303s · Speaker 1

    Actually, for us, we are not doing the genetic tests on routine -based. We are selective regarding what we are looking for. Besides, it was not supported by a pharmaceutical company. So for a patient with sarcoma, I usually send for Pira, f…

11. 1:00:31

    Skyrius 11: it's not diagnostic until the patient has scans or have compression symptoms. 301s · Speaker 1

    it's not diagnostic until the patient has scans or have compression symptoms. This is why most of the intra -abdominal, you will see it's a bigger size or compressing or even invasion. The other one, which is in extremities, you will see a …

12. 1:05:32

    Skyrius 12: so based on that, you might do the working diagnosis, either let it slide borage or excise it. 300s · Speaker 1

    so based on that, you might do the working diagnosis, either let it slide borage or excise it. This is a fibrous dysmoid tumour and it's like in the root of the mesentery. We sent him to oncologist to start systemic therapy. Sometimes these…

13. 1:10:33

    Skyrius 13: Stable, resolve spontaneously, have cycle of progression and resolution or progression? 301s · Speaker 1

    Stable, resolve spontaneously, have cycle of progression and resolution or progression? Okay, so I think the majority of cases remain stable. For me, 40 % remain stable. Probably I would say 10 % result spontaneously. And 20 % cycles, progr…

14. 1:15:34

    Skyrius 14: should not do surgery like this. 302s · Speaker 1

    should not do surgery like this. So this is kind of what happened over the past years. I think it's the same also that maybe most of the patients, depending on the location, if they're in the same center, then we get a referral early. If th…

15. 1:20:37

    Skyrius 15: So I would say 80%. 302s · Speaker 1

    So I would say 80%. Yes. And general surgery, I think because of some of the symptoms, they don't have a surgical oncology. But there are some general surgeons as good as surgical oncology. What are the most common reasons surgeons refer dy…

16. 1:25:40

    Skyrius 16: regression and only about 40 % actually needed therapy. 302s · Speaker 1

    regression and only about 40 % actually needed therapy. ASCO, NCCN, and the Desmond Tumor Working Group does recommend active surveillance as standard initial therapy. As I mentioned before, Desmond Tumors have a highly valuable clinical co…

17. 1:30:42

    Skyrius 17: You don't have a biomarker, so you didn't recognize who's aggressive one or who is not. 297s · Speaker 1

    You don't have a biomarker, so you didn't recognize who's aggressive one or who is not. In your practice, if you have a case like this one and progress and still surgical proper, you will advise for system? If it's extremity, easily resecta…

18. 1:35:51

    Skyrius 18: Sootint, two -year PFS was actually quite high at 81%. 300s · Speaker 1

    Sootint, two -year PFS was actually quite high at 81%. We have Glivik or Imatinib, low projected response rate at 11%. Cytotoxic chemotherapy, which is going out of fashion nowadays. I have used methotrexate and vinplastine as a weekly infu…

19. 1:40:51

    Skyrius 19: Majority of subgroups actually favored neurogesis stat, whether they received TKI or did not receive TKI, or whether they received chemotherapy or not. 300s · Speaker 1

    Majority of subgroups actually favored neurogesis stat, whether they received TKI or did not receive TKI, or whether they received chemotherapy or not. This is the waterfall part. Impressive. The majority of cases have had downward objectiv…

20. 1:45:52

    Skyrius 20: we have to be highlighted and in the meantime we should have a clarification from the company why is and it was explained by dr as well that because of the um the biological part of the drug it's different than general and if it is labeled on the medication and we are not highlighting this because some patient even 75 they will resume but still 25 they were not so we have to put this in consideration I think it will be one of the major challenges in using the drug because the appreciation that this is a denying tumor and we are going to give the medication. 301s · Speaker 1

    we have to be highlighted and in the meantime we should have a clarification from the company why is and it was explained by dr as well that because of the um the biological part of the drug it's different than general and if it is labeled …

21. 1:50:54

    Skyrius 21: rash was low -grade. 300s · Speaker 1

    rash was low -grade. All of my patients I've treated never complained to me from diarrhea. Hypofosthemia. The diarrhea is managed with Lopramide, so it's okay. conditions. So you may get pediatric patients with dysmoid. They do have a more …

22. 1:55:55

    Skyrius 22: then your preference is your preference from a 4th and Marie standard as first -line rather than second -line or third -line. 301s · Speaker 1

    then your preference is your preference from a 4th and Marie standard as first -line rather than second -line or third -line. Which patient do you decide about systemic therapy, surgery or local region? So I agree with Dr. Kanan. The abdomi…

23. 2:00:56

    Skyrius 23: I think those who are stable for asymptomatic and in a location as mentioned, which is not like risky locations, so those who are stable. 301s · Speaker 1

    I think those who are stable for asymptomatic and in a location as mentioned, which is not like risky locations, so those who are stable. symptomless or burden of symptoms is this location is safe, not nearby with any vital structure, not c…

24. 2:05:57

    Skyrius 24: For me, it's all of the above. 300s · Speaker 1

    For me, it's all of the above. smart location um create the greatest clinical concern um in your practice into abdominal head and neck extremity nerve um neonerve vessels or joint abdominal wall superficial side ANC, intro, abdominal, and e…

25. 2:10:58

    Skyrius 25: He was having lesion intra -abdominal and was stable. 300s · Speaker 1

    He was having lesion intra -abdominal and was stable. And every time he's coming for his visit, he was, I should go for any type of treatment. So the point is that he is every time telling that I do have pain, I do have symptoms. And by ima…

26. 2:15:58

    Skyrius 26: I mean, the single most. 300s · Speaker 1

    I mean, the single most. But in many cases, they cannot do it with safety markets. And I think all is important, but complete resection, as Uqbal Khayr mentioned, is the most important. Tayyip, in your practice, how common is recurrence aft…

27. 2:20:59

    Skyrius 27: is the combination of Dr. 301s · Speaker 1

    is the combination of Dr. Ribison, the carbazine, and Dr. Canaan mentioned. It has more than 50 % response, but it's small studies. And I actually used it, and I had a response on the patient. So it works, chemotherapy works, but it's too t…

28. 2:26:13

    Skyrius 28: Surafel also is terrible, but we have to adjust the dose for some patients. 300s · Speaker 1

    Surafel also is terrible, but we have to adjust the dose for some patients. Which outcome from the study are the most clinical and meaningful? I think PFS. The PFS and even the response rate. What did that make you consider Neogrethate? Ear…

29. 2:31:13

    Skyrius 29: Thank you, Dr. 301s · Speaker 1

    Thank you, Dr. Ashwar. And thank you, everyone, and especially Merck for... giving us this opportunity to get together into this benign tumor actually I'm very happy that it's benign and you are not having a lot of death or issues and with …

30. 2:36:14

    Skyrius 30: besides the deformities that he had, is the pain, the nerve -related pain and the pain. 299s · Speaker 1

    besides the deformities that he had, is the pain, the nerve -related pain and the pain. So with the chemo, he, like with some doctor, he said he tolerated well. In terms of symptoms, his symptoms were controlled. However, he started having …

31. 2:41:14

    Skyrius 31: So I don't know if he uses that one. 285s · Speaker 1

    So I don't know if he uses that one. He has no other toxicity. So for such thing, we decided with Dr. Aisha in our center that we are going to put in the guidelines that this would be the first -line medication for this benign tumor. And we…

32. 2:46:46

    Skyrius 32: Dr. Ashwag, for you, for me, so the better pronunciation, when his name is Neeru, Jack came to us and got the suffix of sister. 252s · Speaker 1

    Dr. Ashwag, for you, for me, so the better pronunciation, when his name is Neeru, Jack came to us and got the suffix of sister. I don't think this is something will make us not using the network. And the duration, this is very important. I …