Phillip J. Koo, MD

Phillip J. Koo, MD

Banner MD Anderson Cancer Center

Phoenix, Arizona

Phillip J. Koo, MD, is the Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona. Prior to this, he was Chief of Nuclear Medicine and Associate Professor of Radiology at the University of Colorado School of Medicine. Dr. Koo completed his transitional internship at the University of Pennsylvania Medical Center-Presbyterian, his radiology residency at Pennsylvania Hospital of the University of Pennsylvania Health System, and his fellowship at the Harvard Medical School Joint Program in Nuclear Medicine. He is a diplomate of both the American Board of Radiology and the American Board of Nuclear Medicine. Dr. Koo is an active member of multiple societies and has served as the Chair of Nuclear Medicine for the RSNA Scientific Program Committee, Chair of the Quality and Evidence Committee for the Society of Nuclear Medicine and Molecular Imaging (SNMMI), and Chair of the Prostate Cancer Working Group at the SNMMI. Dr. Koo has published on various topics related to radiology and nuclear medicine in multiple journals such as Radiology, Radiographics, the European Journal of Nuclear Medicine and Molecular Imaging, Urology, and the Journal of the American College of Radiology.

Disclosures:

Dr. Koo has received consulting fees from Lantheus, Blue Earth, Novartis, Merck, Pfizer, Janssen, Clarity, and Astellas.

Talks by Phillip J. Koo, MD

Practical Applications and Clinical Utility of PYLARIFY Injection: Implications for Urology and Radiation Oncology

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses the expansion of the role and utility of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the management of prostate cancer. He highlights the fact that this next-generation imaging (NGI) technology will lead to changes to diagnostic approach and management, explaining that a landscape change is imminent as NGI is poised to fundamentally change the medical management of prostate cancer.

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PSMA Targeted Therapies and the Role of the Urologist

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses PSMA targeted therapies for prostate cancer and the urologist’s role in using radiotherapy. He begins by looking at the results of the VISION trial of lutetium-177 PSMA-617 for metastatic castration-resistant prostate cancer (mCRPC), explaining that radioligand therapy significantly increased overall survival and radiographic progression-free survival. Dr. Koo then considers the TheraP trial of lutetium-177 PSMA-617 versus cabazitaxel which saw far better PSA response in PSMA arm than in the cabazitaxel one. He notes that the amount of imaging used in patient selection for TheraP would be impractical in a real-world setting. Dr. Koo also looks at the slate of upcoming clinical trials of PSMA, highlighting the number of combination therapy trials in the CRPC setting, as well as the number of trials looking at PSMA’s potential role in earlier phases of the disease. Finally, Dr. Koo discusses the role of the urologist in the new PSMA era, arguing that urologists need to understand and be comfortable with PSMA since it is an increasingly important tool for treating advanced prostate cancer. He recommends that urologists create advanced prostate cancer clinics featuring targeted radiotherapy clinics.

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PSMA: Current State of the Art and Future Vision

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, discusses current and possible future applications for prostate-specific membrane antigen (PSMA) as both a diagnostic and a theranostic radiopharmaceutical for prostate cancer. He begins by considering PSMA in the diagnostic setting and explains that its current state-of-the art use is in the area of detection of metastatic disease. Dr. Koo particularly highlights its role in detecting oligometastatic disease in cases of biochemical recurrence. He also notes that PSMA currently has a role in initial staging, and that this role is likely to expand in the future. He predicts that other future diagnostic applications of PSMA will include restaging/treatment response, primary lesion characterization, and potentially prognosis. Dr. Koo then moves to discussing PSMA in the theranostic setting, mentioning the current role of Lu-177 PSMA on the “thera-” side and looking at PSMA, FDG, and PSMA plus FDG on the “-nostic” patient selection side. He also considers the question of whether imaging is even needed considering the large percentage of patients who are PSMA-positive, though he argues for the benefits of imaging. Dr. Koo lists some potential future therapeutic applications of PSMA, such as in earlier treatment, retreatment, combination therapy, dosimetry, and with alpha particles. He concludes that there are many unanswered questions, that conventional wisdom and anecdotes are not evidence-based, and that there is a need for more clinical trials and more disease site specialization within nuclear medicine.

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Panel Discussion – Focus on PSMA

Phillip J. Koo, MD, Division Chief of Diagnostic Imaging and Northwest Region Oncology Physician Executive at the Banner MD Anderson Cancer Center in Phoenix, Arizona, leads a panel discussion focused on PSMA PET-CT’s expanding role in prostate cancer screening and diagnosis. The conversation begins with a look at how PSMA ligands are produced and distributed and what this means for access. Jérémie Calais, MD, MSc, Director of the Clinical Research Program of the Ahmanson Translational Theranostics Division of the Department of Molecular and Medical Pharmacology at UCLA, explains the differences between Gallium-68 PSMA-11 and 18F-DCFPyL, noting that the capacity of production and distribution is greater for the latter than the former. He argues, however, that the tracer used does not ultimately matter. E. David Crawford, MD, Professor of Urology at UCSD, observes that there have not actually been any comparative trials of gallium vs. PyL scans, and he suggests that there might be subtle differences in efficacy. Dr. Calais agrees that there is some disparity, but he does not think they are significant enough to affect staging or clinical management decisions. The discussion continues with a brief consideration of PSMA’s potential in theranostics and a look at whether PSMA scans can be trusted without confirmation from biopsy. Dr. Crawford notes that while biopsies are important and should be obtained when possible, as trust grows in the PSMA scans they may become less necessary. Dr. Calais and Dr. Koo then consider the potential for PSMA tests to be reimbursed, observing that they are not yet covered by Medicare but that there is a potential that they will be covered by insurance relatively soon. Dr. Crawford then asks whether the older CT and bone scans will be replaced by scans like PSMA, and the panelists conclude that they inevitably will but that costs will make this shift take some time.

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