Alan H. Bryce, MD

Alan H. Bryce, MD

City of Hope

Phoenix, Arizona

Alan H. Bryce, MD, is a medical oncologist and chief clinical officer at City of Hope in Phoenix, Arizona. Dr. Bryce holds an appointment as a professor with the Department of Medical Oncology & Therapeutics Research, with City of Hope, as well as an appointment as a professor of Molecular Medicine at Translational Genomics Research Institute (TGen), which is also part of City of Hope.

Prior to joining City of Hope, Dr. Bryce spent 12 years at the Mayo Clinic in Phoenix, where he served as chair of the Division of Hematology and Medical Oncology, as well as Director of the Mayo Clinic Arizona Comprehensive Cancer Center. Dr. Bryce received his medical degree from the Chicago Medical School, and then completed an internal medicine residency and a hematology and oncology fellowship at the Mayo Clinic in Rochester, Minnesota. During his time at Mayo, Dr. Bryce served as an international co-principal investigator on multiple clinical trials for prostate cancer, with his research focused on cancer genetics, novel therapies and immunotherapeutic approaches.

Disclosures:

Dr. Bryce has the following disclosures:
Consulting Fees: Astellas, Bayer, Novartis

Talks by Alan H. Bryce, MD

Point-Counterpoint: Neoadjuvant Chemotherapy Prior to Cystectomy – Con

Posted by | May 2022

Taking the con side in a point-counterpoint debate, Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, argues that offering neoadjuvant chemotherapy (NAC) to patients with invasive bladder cancer prior to radical cystectomy (RC) may not always be the appropriate decision. He begins by considering what the debate even is, explaining that the NCCN considers NAC followed by radical cystectomy a category 1 recommendation based on high level data. Meanwhile, Dr. Bryce notes, adjuvant chemotherapy is only considered a category 2A recommendation. However, he continues, the NCCN guidelines also mention that patients with “hearing loss or neuropathy, poor performance status, or renal insufficiency may not be eligible for cisplatin based therapy,” and if “cisplatin based therapy cannot be given, neoadjuvant therapy is not recommended.” Dr. Bryce also argues that while clinical trial data strongly favors NAC, real-world patient populations are different from trial populations. He cites a study based on real-world data which found that the patients in the SWOG trial of NAC were younger and fitter compared with national numbers, and which found the survival benefit with NAC to be slight in retrospective data. Additionally, Dr. Bryce observes that about 33 to 41% of patients are ineligible for cisplatin due to their baseline renal function status. He notes that those patients might benefit from adjuvant chemotherapy, but acknowledges there have been few randomized controlled trials in this setting. Dr. Bryce then highlights toxicity issues related to NAC, including increased creatinine, decreased neutrophil, peripheral sensory neuropathy, and tinnitus. He concludes that because real-world patients are older and have more comorbidities than trial populations, NAC perhaps should not be used as widely as guidelines indicate.

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Point-Counterpoint: Management of mCRPC

Posted by | Jan 2022

Rana R. McKay, MD, Associate Professor of Medicine at the University of California, San Diego, and Co-Leader of the Genitourinary Oncology Disease Team at the Moores Cancer Center, and Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, debate whether to treat metastatic castration-resistant prostate cancer (mCRPC).

Taking the pro position, Dr. McKay presents on why physicians need to treat mCRPC, as well as come up with additional treatment options to help improve survival for mCRPC patients. She discusses the goals of mCRPC treatment, improved quality of life and overall survival, and displays a chart that summarizes the current landscape of treatment for advanced prostate cancer as she details how androgen receptor (AR) targeting agents are enhancing treatment. Dr. McKay reviews FDA-approved agents in mCRPC, stating that the vast majority both improve overall survival and quality of life. She specifically states that the agents, outside of pembrolizumab, rucaparib, and sipuleucel-T, can potentially increase overall survival by 53.6 months and improve cancer-associated pain, disease-related urinary symptoms, and symptomatic skeletal events. Dr. McKay then shows a graph displaying mCRPC treatment in a clinical practice, suggesting that mCRPC is grossly undertreated based on the vast majority of patients not going beyond first-line treatment. She states that there is little reliable data on the cost effectiveness of treatment and concludes that mCRPC should be treated based on data showing that treatments improve overall survival and quality of life.

Taking the con position, Dr. Bryce makes an argument against treating mCRPC based on the differences between trial and real-world populations, and the challenges of extreme treatments. Dr. Bryce cites quality of life post-treatment, financial toxicity, and patient-centric treatment as cons of mCRPC treatment. He shows a graph of mCRPC treatment management in clinical practice and states that the rapid drop off after first-line therapy could be caused by patient drop outs instead of undertreatment. Dr. Bryce discusses the mCRPC treatment process in detail, focusing on how after the first line of therapy, treatment options become much more extreme and mostly consist of chemo, and most patients only have about a year left to live if they are beyond second-line treatment. He uses a case study of a 73-year-old patient to show how real-world patients can differ from selected trial patients due to how patient selection leads to optimized outcomes. Dr. Bryce reviews data showing that 20% of patients report financial toxicity, something which is associated with anxiety and depression. He concludes that clinicians should exercise prudent judgment in deciding whether or not to treat patients with advanced cancer due to trials testing beyond third-line therapy not reflecting real-world patients and financial toxicity being a significant issue.

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Point-Counterpoint: Management of mCRPC (Con)

Posted by | Jan 2022

Taking the con position in a point-counterpoint debate, Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic Arizona in Scottsdale, makes an argument against treating metastatic castration-resistant prostate cancer (mCRPC) based on the differences between trial and real-world populations, and the challenges of extreme treatments. Dr. Bryce cites quality of life post-treatment, financial toxicity, and patient-centric treatment as cons of mCRPC treatment. He shows a graph of mCRPC treatment management in clinical practice and states that the rapid drop off after first-line therapy could be caused by patient drop outs instead of undertreatment. Dr. Bryce discusses the mCRPC treatment process in detail, focusing on how after the first line of therapy, treatment options become much more extreme and mostly consist of chemo, and most patients only have about a year left to live if they are beyond second-line treatment. He uses a case study of a 73-year-old patient to show how real-world patients can differ from selected trial patients due to how patient selection leads to optimized outcomes. Dr. Bryce reviews data showing that 20% of patients report financial toxicity, something which is associated with anxiety and depression. He concludes that clinicians should exercise prudent judgment in deciding whether or not to treat patients with advanced cancer due to trials testing beyond third-line therapy not reflecting real-world patients and financial toxicity being a significant issue.

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Universal Germline Screening in Prostate Cancer: The Argument Against

Posted by | Jan 2021

Alan H. Bryce, MD, Medical Director of the Genomic Oncology Clinic at Mayo Clinic in Scottsdale, Arizona, argues against universal germline screening in prostate cancer in a point-counterpoint debate. While he agrees that identifying germline mutations is important and can have important implications for therapy and for patients’ families, Dr. Bryce observes that very few carriers are identified through germline testing. Approximately ⅔ of carriers are identified through family history-based screening, and while germline mutations are more common in men with metastatic cancer, they are uncommon in the total prostate cancer population. This means that among low- and intermediate-risk patients, 200-300 people must be screened to find one additional carrier, and among high-risk patients, approximately 50 people must be screened to find an additional carrier. Genetic testing costs money and takes up valuable counseling time, so Dr. Bryce argues that testing all patients is not a sensible allocation of resources.

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