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Old 07-19-2013, 04:48 PM   #21
Andrea Barnett Budin
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Re: Cancer secret to success?! Finding your match!

Just wanted to bump this up. I truly believe it is so important. And little known.

When I had by abdominal biopsy laparoscopic surgery recently, I said to the surgeon, I THINK THERE'S LESS THAN 1% CHANCE I HAVE CANCER -- BUT SINCE YOU'RE GOING IN THERE, JUST IN CASE, COULD YOU TAKE SOME TISSUE FOR ME TO GIVE TO A LAB..........

He waved his hand, I am not taking any extra tissue out!

I wasn't happy. But -- I truly did not believe I had cancer, so it was sort of a non-issue.

The surgeon did say he liked my positive attitude. Amazed he noticed it, as he was always in such a hurry to get to his next patient, and the one after that, so he could go do surgery!

I hope never to have to see him again. I think he did a good job.

AND I GOT EXCELLENT RESULTS! BENIGN. NO EVIDENCE OF DISEASE...

Ellie, I still go for a transvaginal pelvic sonogram every year. I want them to tell me I am boring, and my ovaries are beautiful. Couldn't get a better compliment!!!

ANDI
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'95 post-meno dx Invasive LOBULAR w/9cm tumor! YIKES + 2/21 nodes. Clear mammo 10 mnths earlier. Mastec/tram flap reconst/PORT/8 mnths chemo (4Adria/8CMF). Borderline ER/PR. Tamoxifen 2 yrs. Felt BLESSED. I could walk and talk, feed and bathe myself! I KNEW I would survive...

'98 -- multiple mets to liver. HER2+ 80%. ER/PR- Raging, highly aggressive tumors spreading fast. New PORT. 9 mnths Taxotere Fought fire w/fire! Pronounced in cautious remission 5/99. Taxotere weekly for 6 wks, 2 wks off -- for 9 mnths. TALK ABOUT GRUELING! (I believe they've altered that protocol since those days -- sure hope so!!)
+ good old Vit H wkly for 1st 3 yrs, then triple dosage ev 3 wks for 7 yrs more... The "easy" chemo, right?! Not a walk in the park, but not a freight train coming at 'ya either...

Added Herceptin Nov '98 (6 wks after FDA fast-tracked it for met bc). Stayed w/Vit H till July '08! Now I AM FREE! Humbly and eternally grateful for this life-saving drug! NED since '99 and planning on keeping it that way. To hell w/poor prognosis and nasty stats! STOPPED VIT H JULY '08...! REMAIN STABLE... Eternally grateful...Yes is a world & in this world of yes live (skillfully curled) all worlds ... (e e cummings) EVERY DAY I BEAT MY PREVIOUS RECORD FOR # OF CONSECUTIVE DAYS I'VE STAYED ALIVE. Smile KNOWING you too can be a miracle. Up to me and God now...
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Old 07-20-2013, 08:01 PM   #22
KristinSchwick
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Re: Cancer secret to success?! Finding your match!

I didn't read all the previous posts, so I'm sorry if I am repetitive. I read the requirements for sending your tumor type off to get tested and they need about a gram of viable, fresh tumor AND you need to be off chemo/radiation for 2-4 weeks prior to harvest of the tissue. Yikes, It sounds so perfect, I just wish they could do it with less tissue, a needle biopsy won't cut it, and I can't give them a chunk of my bone mets to test. Hopefully they will learn how to perform similar analyses soon using mRNA assasys and will require tiny amounts of tumor.
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Aug 2010: diagnosed stage 3b, 4 mo. after birth of son. 29 yrs old and breastfeeding, ER/PR-, Her-2+ started Neoadjuvant therapy: 4x FEC, 10x abraxane & Herceptin
Feb 2011: L mx with recon. Path. showed only DCIS but 4/10+ nodes.
March 2011: 6 wks rads.
Mother passed, lower back pain.
Late May 2011: Bone mets but organs clear; Tykerb, Xeloda, Xgeva. Stopped Herceptin. Implant infected: removed implant.
October 2011: Bone progression; Gemzar and Carboplatin & restarted Herceptin.
Jan 2012: Progression, re-classified as ER+; Tykerb, Herceptin, Zoladex & Femara. Anti-E is working!
May 2012: ovaries out, markers stable but elevated. Cont. Herceptin, Tykerb, Xgeva & Femara.
Dec 2012: aromasin
Jan 2013: faslodex, herceptin, tykerb
Jun: Kadcyla
Aug: Rads to hip, then Perjeta, Herceptin & Taxotere
Nov 2013: Perjeta, Herceptin, Halaven
Early 2014: Affinitor, Aromasin, Perjeta, Herceptin.
June 2014: Estradiol, Perjeta, Herceptin
Aug 14: Tamoxofin, H & P
http://kristin-notdying-blog.blogspot.com/
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Old 07-20-2013, 08:16 PM   #23
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That's a very good question to bring up on this subject Kristin! There are very good reasons for having a minimum of viable tumor specimen. Doing anything less than that will not have the "accuracy" this type of phenotype analysis has. It has to do with the microenvironment contributing critically to drug response.

By examining drug-induced cell death events in native-state 3D (three dimensional) microclusters, the functional cytometric profiling platform has the unique capacity to capture stromal, cytokines (chemokines), macrophages, lymphocytes, vascular and inflammatory cell interactions with tumor cells, known to be crucial for clinical response prediction.

The microclusters recapitulate the human tumor environment, while the "3D" advancement recreates the extracellular matrix (metalloproteinases). The platform studies cancer response to drugs within this microenvironment, enabling it to provide clinically relevant predictions to cancer patients. It is this capacity to study human tumor microenvironments that distinguishes it from other platforms in the field.

What about the fibroblast matrix, the lymphatic vessels, the infiltrating monocytes, the T-cells, the B-cells and neutrophils: the vast complexities of the human tumor microenvironment? Real-life cancers grow as a complex organism that includes both malignant and non-malignant components.

It may include fibrous tissue, mesothelial cells, fibroblasts, endothelial cells, etc. In order to exhibit its most characteristic behavior patterns, a cancer cell needs to be surrounded by a colony of other cells, both normal and malignant.

Tumors are very complex organisms. Ignoring this complexity, most studies of human cancer in culture have focused upon individual tumor cells that have been removed from their complex microenvironment.

Some previous methods of assays limited their analysis only to isolated tumor cells and failed to incorporate the crucial contribution of non-tumorous elements to the cancer phenomenon. Each of these microspheres contains all the complex elements of tumor biosystems that are found in the human body and which can impact clinical response.

Doing anything less is doing it on the cheap! And that doesn't help the cancer patient.
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Old 07-21-2013, 04:52 AM   #24
KristinSchwick
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Re: Cancer secret to success?! Finding your match!

I can sense you have a great deal of background on this subject, are you a researcher yourself? Myself, I have a Doctorate in Immunology, so I completely agree with you on a research level, but from a BC patient perspective, I believe more options are needed because not all cancers are solid, and are able to be sampled in this fashion. It sounds like the dream clinical trial, but it would need to be done on breast tissue from early stage patients (I-III), as there would be too many variables in other organ metastases. As a former researcher, I think this is a awesome idea, and I have participated in some projects looking at the tumor micro environment and it is an area that needs more attention as it is so complex.

I would just like to see some microarray trials soon to see if on a mRNA level, we can learn about drug sensitivity that way too.

Cheap to the researcher and cheap to the patient are two different things. For me personally, I can not donate a whole gram of my pelvis while alive, but would gladly donate my primary tumor of the breast except it is in paraffin and not viable. Hopefully they are able to collect enough specimens to fulfill this study, as the results could benefit all cancer patients like you said.

Kristin
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Aug 2010: diagnosed stage 3b, 4 mo. after birth of son. 29 yrs old and breastfeeding, ER/PR-, Her-2+ started Neoadjuvant therapy: 4x FEC, 10x abraxane & Herceptin
Feb 2011: L mx with recon. Path. showed only DCIS but 4/10+ nodes.
March 2011: 6 wks rads.
Mother passed, lower back pain.
Late May 2011: Bone mets but organs clear; Tykerb, Xeloda, Xgeva. Stopped Herceptin. Implant infected: removed implant.
October 2011: Bone progression; Gemzar and Carboplatin & restarted Herceptin.
Jan 2012: Progression, re-classified as ER+; Tykerb, Herceptin, Zoladex & Femara. Anti-E is working!
May 2012: ovaries out, markers stable but elevated. Cont. Herceptin, Tykerb, Xgeva & Femara.
Dec 2012: aromasin
Jan 2013: faslodex, herceptin, tykerb
Jun: Kadcyla
Aug: Rads to hip, then Perjeta, Herceptin & Taxotere
Nov 2013: Perjeta, Herceptin, Halaven
Early 2014: Affinitor, Aromasin, Perjeta, Herceptin.
June 2014: Estradiol, Perjeta, Herceptin
Aug 14: Tamoxofin, H & P
http://kristin-notdying-blog.blogspot.com/

Last edited by KristinSchwick; 07-21-2013 at 04:57 AM.. Reason: More detail
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Old 07-21-2013, 07:15 AM   #25
gdpawel
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Ironically, one of the contributors to and the owner of cancerfocus is a Doctorate in Immunology. He found me over six years ago and wanted me as the moderator. I've been involved with internet cancer research for seventeen years and have studied cell function analysis over the last twelve years. Of course cell function analysis holds no boundaries across the various cancer types and helps in being a moderator of a cancer information website that deals with all the various types. It's been some of the best learning experience in my life, other than studying Laver Curves in the '70s.

As you know, microarrays examine what genes are expressed in cancer cells. It is mainly used for screening/gene discovery work. You screen thousands of genes to discover an association and then you focus in on only a few hundred or so for more careful study by some other method like RT-PCR (real time polymerase chain reaction). But all the gene mutation or amplification studies can tell us is whether or not the cells are potentially susceptible to this mechanism of attack. It doesn't tell you if one drug is better or worse than some other drug which may target this.

It is whether the capacity to judge phenotypes will be easily achieved at the genotype level.

Genotype analysis measures gene expression by microarray. The microarray test looks for genes in the tumor that are associated with treatment options. It is tumor analysis coupled with clinical literature search, which tries to match therapies to patient-specific biomarker information to generate a treatment approach. They never actually test the tumor specimen against any drug agents. So based on this analysis, they identify "potential" therapies for patients and their treating physicians to discuss.

Phenotype analysis takes the tumor with the surrounding tissue (intact and live) and then puts drug agents on it to see which actually kill the cancer cells. It measures biological signals rather than DNA indicators. It "actually" measures the response of the tumor cells to drug exposure, the integrated effect of the drugs on the whole cell, measuring the interaction of the entire genome. No matter which genes are being affected, phenotype analysis is measuring them through the surrogate of measuring if the cell is alive or dead.

The former is testing for mutations, while the latter is testing for drugs. System's biology suggests that the simple knowledge of a gene's presence or absence does not confer a biological behavior. Biology is not linear.

The idea of simply finding a mutation and then picking an appropriately targeted drug seems like a nice idea. However, not every key that looks like it will fit a lock will actually turn it. There are numerous common mutations in various tumor types, but they don't know that all those mutations are going to turn out to be relevant, as many of them are essentially bystanders.

Why don't all the mutation positive patients respond and why do some mutation negative patients respond? Cancer biology is complex. Molecular biologists can only seek and identify that which they know a priori. There are numerous mutations, insertions and deletions.

A gene mutation, deletion, translocation or amplification could disrupt many cell functions, leading to drug resistance, or could inactivate or damage the doors through which a drug enters a cell.

Cancer arises not only from gene mutations but also from small fragments of RNA that can up- or down-regulate normal genes in abnormal ways. The fact that normal genes can function abnormally under the control of these small RNA sequences is just one more example of the genotype-phenotype dichotomy that cannot be adequately examined on static contemporary genomic platforms.

BTW. Speaking of clinical trials, you know the "gold standard" for all diagnostic tests are clinical correlations. However, some private laboratory oncologists are working (again) on randomized clinical trials, but this time a good three-armed clinical trial: physicians' choice (or typically called trial-and-error) vs molecular profiling vs functional profiling.

Back in 2011, in the first head-to-head clinical trial comparing gene expression patterns (molecular profiling) with personalized cancer cytometric testing (functional profiling or chemosensitivity testing), personalized cancer cytometrics was found to be substantially more accurate (Arienti et al. Journal of Translational Medicine 2011, 9:94).

It is hoped that something like the Arienti, et al study would be proposed at one of the GOG meetings. It was and was accepted. The process of funding has been ongoing. Personally, after twenty years, I would like to see this "battle-of-the-bands" three-armed trial. Let's put it all out there and see what's best!
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Old 07-21-2013, 03:56 PM   #26
KristinSchwick
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Re: Cancer secret to success?! Finding your match!

GDP, you are preaching to the choir. I did not mean to start a debate, I agree with all you have pointed out. I just selfishly want microarrays to hit the consumer as I cannot donate a large chunk of my pelvis, as I have bone only mets, and my primary tumor is long gone. What is your advice there? What specimen could I send without drastically weakening my bones and negatively affecting my quality of life. I know there are rumors that surgery can aid metastasis if the cancer has been sequestered and controlled by our natural defenses. Hello immune cells. It mixes the pot, so to speak, causing inflammation.

It would be really great for this study to get some national recognition before patients/physicians decide to toss tumor samples. I am guessing (and correct me if I'm wrong) that when looking for clear margins they actually waste much of the specimen as they cut through the tumor to get to the borders.

Furthermore lymph nodes which provide many immune cells and mobilized cancer cells could provide lots of information, but they are flash frozen during surgery to determine if they are + or - for cancer. Much to the benefit of the patient on the exam table, of course.

Thanks for taking the time to type up all this information, your doing your wife a good justice.

Kristin
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[B]Kristin
Aug 2010: diagnosed stage 3b, 4 mo. after birth of son. 29 yrs old and breastfeeding, ER/PR-, Her-2+ started Neoadjuvant therapy: 4x FEC, 10x abraxane & Herceptin
Feb 2011: L mx with recon. Path. showed only DCIS but 4/10+ nodes.
March 2011: 6 wks rads.
Mother passed, lower back pain.
Late May 2011: Bone mets but organs clear; Tykerb, Xeloda, Xgeva. Stopped Herceptin. Implant infected: removed implant.
October 2011: Bone progression; Gemzar and Carboplatin & restarted Herceptin.
Jan 2012: Progression, re-classified as ER+; Tykerb, Herceptin, Zoladex & Femara. Anti-E is working!
May 2012: ovaries out, markers stable but elevated. Cont. Herceptin, Tykerb, Xgeva & Femara.
Dec 2012: aromasin
Jan 2013: faslodex, herceptin, tykerb
Jun: Kadcyla
Aug: Rads to hip, then Perjeta, Herceptin & Taxotere
Nov 2013: Perjeta, Herceptin, Halaven
Early 2014: Affinitor, Aromasin, Perjeta, Herceptin.
June 2014: Estradiol, Perjeta, Herceptin
Aug 14: Tamoxofin, H & P
http://kristin-notdying-blog.blogspot.com/
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Old 07-24-2013, 08:10 AM   #27
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Re: Cancer secret to success?! Finding your match!

http://www.vanguardcancerfoundation.org/

The foundation that is raising money to further functional profiling. An important step toward personalized medicine.

I just read one of the new posts that talks about 20,000 potential targets in genetic profiling.

http://her2support.org/vbulletin/showthread.php?t=58649

Maybe it is time to narrow it down with a study on functional profiling and help to funnel research money into treatments that will benefit patients years sooner.

If anyone has connections, this might be a big help to us. Anyone good at manifesting $?
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Old 08-23-2013, 08:55 AM   #28
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World renowned Oncologists are challenging the cancer industry to recognize a Chemo-Screening test (CSRA) that takes the "guesswork" out of drug selection. One of the reasons medical oncologists don’t like in vitro chemosensitivity tests is that it may be in direct competition with the randomized controlled clinical trial paradigm. http://vimeo.com/72389724
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Old 08-24-2013, 06:30 PM   #29
Andrea Barnett Budin
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Re: Cancer secret to success?! Finding your match!

Once again, thank you GD...!

THRILLING CANCER SURVIVOR STORY...

It's about time the our doctors focus on the patient before them! There are secrets locked in the tissue samples of cancer patient. Each is different, even with the same diagnosis. General standard of care options may not be well received by all patients.

There are labs that focus on cancer cell death vs cancer cell growth -- with remarkable revelations! THE perfect match for the patient can save their life! WHY DID I NOT LEARN ABOUT THIS UNTIL THE LAST 6 MNTHS?! GW led me to the book OUTLIVING CANCER, and my eyes were opened.

Every cancer patient is unique. Cancer treatments must be personalized, on the cellular level. AND ALL PERSONALIZED MEDICINE TESTING SERVICES ARE NOT THE SAME. Chemosensitivity and chemoresponse are tested in various ways. One is highly successful, whereas the other is not so much...

Apparently, there are advantages of cytometric profiling versus gene testing. It's my understanding that tThe latter is known as molecular testing or target profiling and attempts to link surrogate gene expression to a theoretical potential for drug activity. This is nearly the opposite of WHOLE CELL CYTOMETRIC PROFILING in which living cancer cells obtained from each patient actually are exposed to dozens of candidate chemotherapy drugs and the true cell killing ability of each drug is measured. Guess that's a world of difference!

Relying on gene patterns is nothing more than a theoretical predisposition. No actual anti-cancer drug activity is ever demonstrated by the tests.

If I was having recurring tumors, failing over and over with this chemo combo after a few mnths of remaining stable, I would travel across the country to Larry Weisenthal, in Huntington Beach, Calif.
WEISENTHAL CANCER GROUP Specializing in the most important patient...you.
In searching the Internet, I came across these very edifying sites, and the name of our good friend GDPawell seems to keep popping up. How blessed we all are to have this man to turn to re this amazing answer to repeated failure.

Yet the medical profession, steeped in establishment thinking, conservative/mainstream thinking and bureaucracy is ready to leave us to fight the pharmaceuticals and the insurance companies and we stab our way to survival.

We need docs with vision, with open minds, with the ability to change decades old ways of seeing cancer and start using $$ from research toward real success. Isn't it time to take the guesswork out of the equation -- when it is YOU, AND ME AND OUR SISTERS on the line??

CSRA's | Cancer Survivors Network

2011 ASCO Annual Meeting | ASCO Daily News | Treatment for Patients with Solid Tumors
Andi
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'95 post-meno dx Invasive LOBULAR w/9cm tumor! YIKES + 2/21 nodes. Clear mammo 10 mnths earlier. Mastec/tram flap reconst/PORT/8 mnths chemo (4Adria/8CMF). Borderline ER/PR. Tamoxifen 2 yrs. Felt BLESSED. I could walk and talk, feed and bathe myself! I KNEW I would survive...

'98 -- multiple mets to liver. HER2+ 80%. ER/PR- Raging, highly aggressive tumors spreading fast. New PORT. 9 mnths Taxotere Fought fire w/fire! Pronounced in cautious remission 5/99. Taxotere weekly for 6 wks, 2 wks off -- for 9 mnths. TALK ABOUT GRUELING! (I believe they've altered that protocol since those days -- sure hope so!!)
+ good old Vit H wkly for 1st 3 yrs, then triple dosage ev 3 wks for 7 yrs more... The "easy" chemo, right?! Not a walk in the park, but not a freight train coming at 'ya either...

Added Herceptin Nov '98 (6 wks after FDA fast-tracked it for met bc). Stayed w/Vit H till July '08! Now I AM FREE! Humbly and eternally grateful for this life-saving drug! NED since '99 and planning on keeping it that way. To hell w/poor prognosis and nasty stats! STOPPED VIT H JULY '08...! REMAIN STABLE... Eternally grateful...Yes is a world & in this world of yes live (skillfully curled) all worlds ... (e e cummings) EVERY DAY I BEAT MY PREVIOUS RECORD FOR # OF CONSECUTIVE DAYS I'VE STAYED ALIVE. Smile KNOWING you too can be a miracle. Up to me and God now...
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Old 08-24-2013, 07:21 PM   #30
gdpawel
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Re: Cancer secret to success?! Finding your match!

Yes Andrea! Why didn't I learn about them until after Ann's death? They were available back in 1996. In fact, I educated Ann's thoracic surgical oncologist about them and she would want to have them done if she ever developed cancer. She didn't know about them either in 1996. Heck! My PCP use to hang around with Dr. William R. Grace's (whose been using them in his private practice for over 20 years) younger sister when they were children, and and he didn't even know about them, or he would have had them done for us. Why my 17 year advocacy!

It's a shame Drs. Burstein and Ajani have no knowledge of the CSRA's like most medical oncologists don't. The oncologists who don't believe in assay testing most likely are ones who only have knowledge (if any knowledge at all) of the old technology that uses cell-growth endpoints, a technology that hasn't been used in private labs for over twenty years, who use cell-death endpoints. Good review papers exist on cell culture assays and are increasingly appreciated, understood and applied by the private sector and European clinicians and scientists (as well as elsewhere).

Not many medical oncologists understand the scientific method of assay validation and clinical evaluation, based on using real-time, real patient data, under real-world conditions, to guide medical evidence. In short, it is a complex and thorough analysis. Until the controlled, randomized trialist approach has delivered curative results with a high success rate, the choice of physicians (and patients) to integrate promising insights and methods like the assays, remains an essential component of this kind of research and treatment technology.

Why Oncologists Don’t Like In Vitro Chemosensitivity Tests?

http://her2support.org/vbulletin/showthread.php?t=59243
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Old 08-25-2013, 11:58 AM   #31
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Re: Cancer secret to success?! Finding your match!

GD...thank you so much for being so passionate and for having the brain that you do. I feel a bit better knowing you exist. God forbid this thing comes back, but if it does, you have armed me with knowledge that could potentially save my life. For that, I am ever so thankful.
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Old 08-25-2013, 04:35 PM   #32
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Re: Cancer secret to success?! Finding your match!

Another study has shown better result of CSA. As the study concludes, “CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial.”

Pol Przegl Chir. 2013 Jun 1;85(6):340-7. doi: 10.2478/pjs-2013-0051.

In Vitro Chemo-Sensitivity Assay Guided Chemotherapy is Associated with Prolonged Overall Survival in Cancer Patients.

Udelnow A, Schönfelder M, Würl P, Halloul Z, Meyer F, Lippert H, Mroczkowski P.

Abstract

The aim of the study.
The overall survival (OS) of patients suffering From various tumour entities was correlated with the results of in vitro-chemosensitivity assay (CSA) of the in vivo applied drugs.

Material and methods.
Tumour specimen (n=611) were dissected in 514 patients and incubated for primary tumour cell culture.
The histocytological regression assay was performed 5 days after adding chemotherapeutic substances to the cell cultures. n=329 patients undergoing chemotherapy were included in the in vitro/in vivo associations. OS was assessed and in vitro response groups compared using survival analysis. Furthermore Cox-regression analysis was performed on OS including CSA, age, TNM classification and treatment course.

Results.
The growth rate of the primary was 73-96% depending on tumour entity. The in-vitro response rate varied with histology and drugs (e.g. 8-18% for methotrexate and 33-83% for epirubicine). OS was significantly prolonged for patients treated with in vitro effective drugs compared to empiric therapy (log-rank-test, p=0.0435). Cox-regression revealed that application of in vitro effective drugs, residual tumour and postoperative radiotherapy determined the death risk independently.

Conclusions.
When patients were treated with drugs effective in our CSA, OS was significantly prolonged compared to empiric therapy. CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial.
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3-11 Appendectomy - visually O.K., a lot of puss. Final path result - not cancer.
Start Vitamin D3 and Calcium supplement (600mg x2)
10-10 Stopped Exemestane due to r. hip/l.thigh pain OKed by Onco 11-08-2016
7-23-2018 9 mm groundglass nodule within the right lower lobe with indolent behavior. Due to possible adenocarcinoma, Recommend annual surveilence.
7-10-2019 CT to check lung nodule.
1-10-2020 8mm stable nodule on R Lung, two 6mm new ones on L Lung, a possible lymph node involvement in inter fissule.
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Old 08-25-2013, 06:13 PM   #33
gdpawel
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Re: Cancer secret to success?! Finding your match!

"CSA guided chemotherapy should be compared to empiric treatment by a prospective randomized trial."

How many times have we heard that before? The same people who maintain that assay-directed therapy should not be used until proven in prospective randomized clinical trials, are the same people whose entire careers are utterly dependent upon mega-trials 100% funded by pharmaceutical companies (that, plus fees from speeches they give for these companies), are the same people who control the clinical trials system, the grant review study sections, and the journal editorial boards. That, and trying to invent brand new criteria for validating a laboratory test. Tens of thousands of scientists pushing a goal of finding the tiniest improvement in treatment and fostering redundant problems and rewarding academic achievement and publication above all else.

Even in this age of molecular gene testing and targeted treatments, a first of its kind head-to-head clinical trial comparing gene expression patterns with personalized cancer cytometric testing (also known as functional tumor cell profiling or chemosensitivity testing), personalized cancer cytometrics was found to be substantially more accurate than molecular gene testing (Arienti et al. Peritoneal carcinomatosis from ovarian cancer: chemosensitivity test and tissue markers as predictors of response to chemotherapy. Journal of Translational Medicine 2011, 9:94).

http://cancerfocus.org/forum/showthread.php?t=3490

But lets go back to the real standard of validation when it comes to diagnostic tests in cancer medicine: The "Holy Grail" is clinical correlations. The standards used to judge the utility of "all" laboratory and radiographic tests have always been (1) acceptable "accuracy" of clinical correlations and (2) clinical utility, in the judgement of the physician ordering the test.

The preponderance of available evidence (correlation between test results and clinical outcomes) certainly indicates that chemoresponse assays are usefully accurate in taking a long list of drugs with average probabilities of providing clinical benefit and sorting them into drugs with above-average and below-average probabilities of benefit.

This kind of testing may have utility at the time of initial therapy, in instances of severe drug hypersensitivity, failed therapy, recurrent disease and metastatic disease, by providing assistance in selecting optimal chemotherapy regimens.

And let's go to this brand new criteria invented to validate these laboratory tests. It was hoped that something like the Arienti, et al study (above) would be proposed at one of the semi-annual GOG meetings. Perhaps a good three-armed clinical trial: physicians' choice (empiric treatment) vs molecular profiling vs functional profiling?

This issue has been an ongoing saga for some 20 years now. The question that should be addressed is across the board assessment of the relative accuracy of different endpoints. They should answer all the questions at once, not one followed by another. A "battle-of-the-bands" so to speak.

Well, it was proposed, and it was approved, and is in the process of funding. Notwithstanding any help from NIH (and with sequestration upon us), searches for private funding are being pursued.

In the meantime, until the controlled, randomized trialist approach has delivered curative results with a high success rate, the choice of physicians and patients to integrate promising insights and methods like these chemoresponse assays, remains an essential component of this kind of treatment technology. Patients can't wait!
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Old 10-07-2013, 05:29 PM   #34
Andrea Barnett Budin
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Re: Cancer secret to success?! Finding your match!

If you haven't already -- please check out this propellor head discussion on finding the right chemo match for your particular cancer. Test it in a lab, not on you (needlessly)...



Tumor Profiling Lab Tests - HER2 Support Group Forums


Lots of good info here... And there... Stuff your doc won't tell you...

Yes, it's not for prime time, but frankly when Herceptin was fast-tracked out of clinical trials, cause women were being given 3 mnths to live and this was a viable possibility -- Herceptin was in its infancy too! And -- it's saved many lives!!!!!!!!!!!!! I am one!

Thank you Dennis Slamon. And the newer versions of Herceptin might work for those for whom Herceptin did not match their tumor's characteristics!

I was in uncharted waters and there were no studies to ask, How long do you stay on this? Or answer many of my questions. I moved ahead with faith and certainty anyway.
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Andi BB
'95 post-meno dx Invasive LOBULAR w/9cm tumor! YIKES + 2/21 nodes. Clear mammo 10 mnths earlier. Mastec/tram flap reconst/PORT/8 mnths chemo (4Adria/8CMF). Borderline ER/PR. Tamoxifen 2 yrs. Felt BLESSED. I could walk and talk, feed and bathe myself! I KNEW I would survive...

'98 -- multiple mets to liver. HER2+ 80%. ER/PR- Raging, highly aggressive tumors spreading fast. New PORT. 9 mnths Taxotere Fought fire w/fire! Pronounced in cautious remission 5/99. Taxotere weekly for 6 wks, 2 wks off -- for 9 mnths. TALK ABOUT GRUELING! (I believe they've altered that protocol since those days -- sure hope so!!)
+ good old Vit H wkly for 1st 3 yrs, then triple dosage ev 3 wks for 7 yrs more... The "easy" chemo, right?! Not a walk in the park, but not a freight train coming at 'ya either...

Added Herceptin Nov '98 (6 wks after FDA fast-tracked it for met bc). Stayed w/Vit H till July '08! Now I AM FREE! Humbly and eternally grateful for this life-saving drug! NED since '99 and planning on keeping it that way. To hell w/poor prognosis and nasty stats! STOPPED VIT H JULY '08...! REMAIN STABLE... Eternally grateful...Yes is a world & in this world of yes live (skillfully curled) all worlds ... (e e cummings) EVERY DAY I BEAT MY PREVIOUS RECORD FOR # OF CONSECUTIVE DAYS I'VE STAYED ALIVE. Smile KNOWING you too can be a miracle. Up to me and God now...
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Old 10-08-2013, 10:42 AM   #35
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Re: Cancer secret to success?! Finding your match!

Quote:
Well, it was proposed, and it was approved, and is in the process of funding. Notwithstanding any help from NIH (and with sequestration upon us), searches for private funding are being pursued.
GDP - I've not stayed up with you on this. You are saying that the FDA has approved a clinical trial for functional profiling. Is this the phase II trial that you've posted that posted results in the Anticancer journal?
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Old 10-08-2013, 11:09 AM   #36
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Re: Cancer secret to success?! Finding your match!

'lizbeth

The so-called "battle-of-the-bands" clinical trial that was proposed and approved by GOG is a phase III trial.

Study Title:

A randomized study of outcomes between ovarian cancer patients receiving empirically-selected chemotherapy versus chemotherapy personalized on the basis of in vitro genomic profiles versus macrocell drug susceptibility profiles (functional cytometric profiling).

Study Aim:

Compare patient outcomes in response to treatment with chemotherapy regimens selected:

1. empirically (physician's choice, based upon best clinical judgment) versus:
2. identified via molecular (genomic) profiling (molecular best in vitro regimen) versus:
3. identified via cell culture whole cell profiling (cell culture best in vitro regimen).

Again, notwithstanding any help from NIH and with sequestration upon us, searches for private funding are being pursued.
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Old 10-08-2013, 11:41 AM   #37
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Re: Cancer secret to success?! Finding your match!

This GOG?

http://www.gog.org/

GDP, where are the Phase II results for this battle of the bands?

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Old 10-08-2013, 11:46 AM   #38
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Re: Cancer secret to success?! Finding your match!

Yes! The Gynecologic Oncology Group. I just want to point out that some private laboratory oncologists have been trying to have this clinical trial for over 20 years now. This hasn't been something new to them. What was recently new was the support by one of the members of the GOG group to have this clinical trial. That is one of the main reasons it was proposed in ovarian cancer. A clinician involved with ovarian cancer and the GOG group suggested that some private laboratory oncologists put forth a proposal. They did!
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Old 06-12-2014, 12:14 PM   #39
Andrea Barnett Budin
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Re: Cancer secret to success?! Finding your match!

I seem to recall seeing some labs that do this in the New York area.

At a glance, I am not seeing that.

If I missed it, and YOU see, please inform me.

If you know such labs in the New York area, please SHARE...
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Andi BB
'95 post-meno dx Invasive LOBULAR w/9cm tumor! YIKES + 2/21 nodes. Clear mammo 10 mnths earlier. Mastec/tram flap reconst/PORT/8 mnths chemo (4Adria/8CMF). Borderline ER/PR. Tamoxifen 2 yrs. Felt BLESSED. I could walk and talk, feed and bathe myself! I KNEW I would survive...

'98 -- multiple mets to liver. HER2+ 80%. ER/PR- Raging, highly aggressive tumors spreading fast. New PORT. 9 mnths Taxotere Fought fire w/fire! Pronounced in cautious remission 5/99. Taxotere weekly for 6 wks, 2 wks off -- for 9 mnths. TALK ABOUT GRUELING! (I believe they've altered that protocol since those days -- sure hope so!!)
+ good old Vit H wkly for 1st 3 yrs, then triple dosage ev 3 wks for 7 yrs more... The "easy" chemo, right?! Not a walk in the park, but not a freight train coming at 'ya either...

Added Herceptin Nov '98 (6 wks after FDA fast-tracked it for met bc). Stayed w/Vit H till July '08! Now I AM FREE! Humbly and eternally grateful for this life-saving drug! NED since '99 and planning on keeping it that way. To hell w/poor prognosis and nasty stats! STOPPED VIT H JULY '08...! REMAIN STABLE... Eternally grateful...Yes is a world & in this world of yes live (skillfully curled) all worlds ... (e e cummings) EVERY DAY I BEAT MY PREVIOUS RECORD FOR # OF CONSECUTIVE DAYS I'VE STAYED ALIVE. Smile KNOWING you too can be a miracle. Up to me and God now...
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Old 06-12-2014, 02:02 PM   #40
gdpawel
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Re: Cancer secret to success?! Finding your match!

'lizbeth

For some reason, I didn't get back to you on the Phase II results. It wasn't a "battle of the bands" Physician's Choice vs Molecular Profiling vs Functional Profiling, but it was Molecular Profiling vs Functional Profiling.

http://cancerfocus.org/forum/showthread.php?t=3955

As was the case for the last 20 years, lack of funding hampers the success of having a Phase 3 Cell Culture Assay Clinical Trail: physician's choice vs molecular assay-directed vs cell culture assay-directed. GOG is willing to consider the proposal for the trial ONLY if there is guaranteed funding in advance, which in this case would be $11 million. There is no possibility of getting this from investors or from peer review grant funding organizations (NIH, ACS). The only source is philanthropy. Anybody know a philanthropist willing to help out?

Andrea

I don't recall any labs doing functional cytometric profiling in the New York area. Although there are doctors in the New York area that avail themselves to laboratories in southern California. Once such private practice medical oncologist I know (and would have certainly traveled to NYC to have my wife treated by him if I had known) is William R. Grace.

http://weisenthalcancer.com/Home.html
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