Steven E. Finkelstein, MD, FACRO

Steven E. Finkelstein, MD, FACRO

Florida Cancer Affiliates / The US Oncology Network

Panama City, Florida

Steven E. Finkelstein, MD, FACRO, is a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida. He has served as a Co-Chair on the NRG Immunotherapy Committee, Co-Chair of the 2018-2019 ACRO Scientific Program Committee, and Chair of the SWOG Radiation STG Committee. He currently serves on the Board of Chancellors for ACRO. Dr. Finkelstein has also served as National Director of Translational Research Consortium (TRC), the cutting-edge therapy arm of 21st Century Oncology in Scottsdale, Arizona. Inspired by his grandmother, a cancer patient, he became a dedicated cancer surgeon who found that radiation therapy could sometimes do for his patients what surgery could not. Dr. Finkelstein received his medical degree from the University of Michigan Medical School. He served a residency in General Surgery at Washington University in Saint Louis, Missouri, and was Chief Resident in Radiation Oncology at the Moffitt Cancer Center in Tampa, Florida. Dr. Finkelstein also served fellowships in Biologic Immunotherapy, Clinical Cancer, and Surgical Oncology at the Surgery Branch of the National Cancer Institute in Bethesda, Maryland. He is a member of the American College of Radiation Oncology, the American Medical Association, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the Radiological Society of North America, and the Radiation Therapy Oncology Group.

Disclosures:

Lectures by Steven E. Finkelstein, MD, FACRO

Radiation Oncology Perspective: Image-Guided Metastasis-Directed Therapy

Steven E. Finkelstein, MD, FACRO, radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses 3 unique cases of recurrence after robotic-assisted laparoscopic radical prostatectomy and bilateral pelvic lymphadenectomy and their clinical management from a radiation oncology perspective. He introduces the first case of a patient with a PSA of 5.4 ng/mL and a Gleason score of 5+4 at the time of initial diagnosis. Dr. Finkelstein states that the recurrence became apparent once the patient’s PSA rose from .15 to .9 and a negative bone scan led to the initially planned treatment of post-prostatectomy radiotherapy (XRT). He explains that next-generation imaging (NGI) was then ordered and showed increased tracer uptake in an area of the left pelvis, leading the patient to begin a course of intensity-modulated radiation therapy and daily image-guided radiation therapy (IGRT). Dr. Finkelstein then moves on to the second patient, who had a PSA of 4.4 ng/mL and a Gleason score of 4+4 initially and whose recurrence was identified once their post-treatment PSA rose from .25 to 1. He describes how a negative bone scan led to initially planning a post-prostatectomy XRT, but when NGI found a sclerotic lesion in the middle right iliac bone, his treatment changed to stereotactic body radiation therapy (SBRT). Dr. Finkelstein then introduces the final patient, who had a PSA of 4.4 ng/mL and a Gleason score of 4+4 and whose recurrence was identified once their post-treatment PSA of .25 increased to 1. He states that, again, a negative bone scan led to planning post-prostatectomy XRT for the patient. NGI proved that XRT would have been insufficient by identifying a sclerotic lesion in the middle right iliac bone and 5 other bone metastases. Dr. Finkelstein concludes by noting that, due to NGI, the patient also received SBRT.

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Update on New Approaches Combining Brachytherapy with Immunotherapy

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses the process of combining brachytherapy with immunotherapy, highlighting the need for better applicators. He begins the presentation by describing radical prostatectomy, external beam radiation (EBRT), cryotherapy, and brachytherapy, and then reviews data on each of their relapse-free survival results. A trial found that when comparing EBRT with surgery against EBRT with brachytherapy, treatment with EBRT in combination with brachytherapy has a higher rate of PSA progression-free survival, and including ADT increases the rate even more. Dr. Finkelstein then considers the “cogwheels of cancer practice,” i.e., the idea that the combination of guidelines, management, bias, patient preference, marketing, reimbursement, payer, and task force systems sometimes takes more precedence in treatment choice than data. He goes on to describe brachytherapy in detail, noting that it uses precisely-delivered radiation sources to treat cancer within patients through small applicators that are unable to apply additional therapeutic agents. He cites this shortcoming as support for a need for applicators for additional therapeutic approaches. Dr. Finkelstein continues with a detailed overview of radiation-driven immunotherapy. He discusses a study showing that radiation can induce unique cellular expression of MHC Class I adhesion molecules, costimulatory molecules, heat shock proteins, inflammatory mediators, immunomodulatory cytokines, and death receptors. He concludes with a discussion of “Immuno-Site,” an applicator designed to provide simple, effective, and isolated localized radiation therapy, including brachytherapy and immunotherapy simultaneously.

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Metastasis-Directed Therapy: Radiation Oncology Updates and Perspective

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses metastasis-directed therapy (MDT) as a potential treatment option for oligometastatic prostate cancer. He reviews typical management of metastatic cancer and describes how MDT can minimize the toxicity of systemic therapy, then addresses future treatment options with stereotactic ablative radiotherapy (SABR). Radiation and other local therapies are used for palliation of metastases but can also alter the course of tumor development. Dr. Finkelstein explains that MDT can be particularly beneficial in oligometastatic prostate cancer if the metastases are at a point where both the primary tumor and metastases can be treated together and likely cured. Lastly, he concludes that MDT via SABR could be employed concurrently with other treatments such as androgen deprivation therapy (ADT), chemotherapies, and radiopharmaceuticals, and that further research is necessary.

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New Approaches to Combining Brachytherapy with Immunotherapy

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, discusses the growing field of brachytherapy-driven immunotherapy and its potential role in prostate cancer treatment. He goes on to discuss the mechanisms behind radiation-induced tumor death, the growing evidence behind the immunostimulatory effects of radiation, and a patent describing a radiation-based applicator and potential method for administering immunotherapy agents to cancerous tissue.

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Safely Managing a Radiation Oncology Clinic in the Age of COVID-19

Steven E. Finkelstein, MD, FACRO, a radiation oncologist with Florida Cancer Affiliates in Panama City, Florida, provides guidance on how to safely manage a radiation oncology clinic during the COVID-19 crisis. He explains that it is important to screen patients for COVID-19 symptoms before treatments, and emphasizes that staff must be trained in how to safely work with potentially infected individuals. Noting that every practice will have to plan differently depending on its resources and the population it serves, Dr. Finkelstein also discusses how practices might minimize the number of patients seen, i.e. by deferring radiation treatments for prostate cancer in favor of increased duration of neoadjuvant ADT or active surveillance when appropriate. He observes that while alternatives to traditional radiation oncology like seed implantation could minimize clinic visits, many practices currently lack the resources to implement brachytherapy.

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