nanoknife IRE for pancreatic cancer

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RE: nanoknife IRE for pancreatic cancer

by Mkk2018 on Mon Feb 17, 2020 05:44 PM

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This is great. I will closely at all of this. Any input on radiation And immunotherapy combination for pancreatic?? This is the route we are headed I believe now

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Mon Feb 17, 2020 07:22 PM

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Mkk2018 & Others:
          Don’t head that way, unless there is at least a Phase 1 trial indicating effectiveness.  The selection of one path often obviates another path.  This is a swiftly moving parade.  One misstep, and you cannot go back and take a path previously forsaken.
          Radiation is a focal therapy, not a systemic one, somewhat irrational for metastatic disease.  Nevertheless, seek proof via a completed, reported clinical trial.
          Study my Decision Guide thoroughly, available top-right on the following web page:
https://pancreatic.altervista.org/ 
          And study thoroughly my posts for the past 2 years, including the ASCO symposia reviews.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by DavesGirl70 on Tue Feb 18, 2020 02:33 AM

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On Feb 14, 2020 2:03 PM Mkk2018 wrote:

Hi! I thought it was my fault sending it to a wrong email! Could I resend from a gmail account? Would that be better?

I re-sent my email but guessing it didn't go through. Perhaps trying from Gmail will help :) I did test my email sending to a friend and it is working. So bizarre!

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Thu Feb 20, 2020 11:56 AM

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Mkk2018 & Others:
          My replies are delayed by the forum for several days because they contain weblinks.
          Immunotherapy plus radiation.  Don’t head that way, unless there is at least a Phase 1 trial indicating effectiveness.  The selection of one path often obviates another path.  This is a swiftly moving parade.  One misstep, and you cannot go back and take a path previously forsaken.
          Radiation is a focal therapy, not a systemic one, somewhat irrational for systemic, metastatic disease.  So, seek proof via a completed, reported clinical trial (that is, a human trial, not an animal study).
          Study the Pancreatic Cancer Decision Guide thoroughly, available top-right on the following web page:
https://pancreatic.altervista.org/ 
          And study thoroughly my posts for the past 2 years, including 2 years of ASCO symposia reviews.
         PhilipJax

Everyone:
          The link to the Pancreatic Cancer Decision Guide has not copied well in the previous postings.  If the link immediately below does not work, there may be two other options:
http://jaxelection.altervista.org/pancreatic/ PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/ PJaxDecisionAlg
1. If the above link fails, add PJaxDecisionAlgorithm.pdf to the end of the following link:
http://jaxelection.altervista.org/pancreatic/
2, And, if that approach fails, Google the term “PJaxDecisionAlgorithm.pdf ” which may get you the downloadable file.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by Mkk2018 on Sat Feb 22, 2020 03:28 AM

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I’m not sure how else we should proceed. The GTX chemo we were on does not seem to be stopping things the way it should be. And the liver metastasis is growing. Where else do we realistically go from here ... either BRCA mutation. We need to be acting quickly.

RE: nanoknife IRE for pancreatic cancer

by Mkk2018 on Sat Feb 22, 2020 03:29 AM

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With a BRCA mutation **

RE: nanoknife IRE for pancreatic cancer

by Mkk2018 on Sat Feb 22, 2020 03:57 AM

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Just sent a new email :)

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Tue Feb 25, 2020 07:14 PM

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Mkk2018,
          Have you studied the Decision Guide and my last 2 years of posts as yet?  That means studying every line and every reference.  It takes a lot of work.  But, there are rewards: If there is an answer, that is where it will be found.
          I prepared the Guide and created the CancerCompass posts (taking scores of hours of work) to answer such questions as yours.  The best answer is within those two sources.
          For example, using those sources (1) a patient recently pursued a peritoneal metastases therapy; (2) another added Cisplatin to a common combination; (3) others have taken advantage of the new willingness to treat metastases when they are few; (4) another has enrolled in the hard-to-enter BATs trial, and (5) another is investigating hepatic arterial 5FU infusion combined with systemic chemotherapy. 
          You do not have to limit yourself to BRCA targeting.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Feb 26, 2020 01:42 PM

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2020 Gastrointestinal Cancers Symposium
Installments, Part 3

Everyone,
          This installment continues my review of abstracts from the 2020 GI Cancers Symposium, held January 23-25, 2020 in San Francisco.  There are at least 50 relevant abstracts; so, over a period of several days or weeks, I will cover the “best”.  If you can’t wait, the abstracts are found here:
http://pancreatic.altervista.org/downloads/GI20PancreaticCan
          The order in which I present the abstracts does NOT signify their importance.  I am merely beginning with the first abstract meeting my search criteria.
          Be sure to study my Decision Guide, downloadable at
PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg " target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg
or use Google to find the file: PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">PJaxDecisionAlgorithm.pdf
         PhilipJax

Abstract 672: Neoadjuvant therapy (NAT) and its role for pancreatic adenocarcinoma (PC) in the current era: Institutional experience.
          Like a study reported in Installment Part 1, this research sought to resolve whether Neoadjuvant Therapy (NAT) is better than upfront surgery for resectable patients.  This time researchers at 3 Philadelphia institutions used their own experiences with 352 patients, rather than the National Cancer Database.  NAT was used for 225 (64%) patient, while 109 patients (31%) had upfront surgery.
          The NAT regimen consisted of chemotherapy (CTx) plus radiation for 48%, CTx alone for 8% and radiotherapy alone for 44% of pts.  Of those receiving CTx, 24% received triple agent therapy (perhaps FFX) while 51% and 25% received dual and single agent therapy, respectively.
          The researchers reported the following outcomes:
1. Surgical resection after NAT occurred in 79 of 225 patients (35%) with median overall survival of 26.3 months vs 19.7 months for those who had upfront surgery.
2. For NAT survival rates at year 1, 3, and 5 years were 94%, 34%, and 8%, but for upfront surgery 76%, 17%, and 11%.
          Researchers concluded: “Use of NAT is prevalent, yet only 35% of patients make it to surgical resection.  Survival was improved for patients who underwent resection following NAT versus upfront, although the difference was not statistically significant.”
         The conclusion is a caution: NAT had a debatable benefit for the 35% who make it to surgery, but the remaining 65% (nearly twice as many) might have done better to undergo upfront surgery immediately upon diagnosis. So, the resectable patient, if he selects NAT, would be wise to insist on very early CT and CA19-9 monitoring. If dramatic NAT improvement is not seen, the resectable patient might opt for immediate surgery.

Abstract 673: First-line drug selection versus sequential treatment in advanced pancreatic cancer: Does it really matter?  Multi-institutional Canadian perspective.
          Researchers from three Canadian institutions undertook a retrospective study of 231 advanced patients to determine the better induction (initial) chemotherapy: FOLFIRINOX (FFX) or Gemcitabine+NabPaclitaxel (GN).  The research findings:
1. “The median PFS (Progression Free Survival) of FFX was 5.5 months vs 5.1 with GN.
2. “The median OS (Overall Survival) with FFX was 9.3 months vs 10.2 with GN . . . There (sic, perhaps meaning They) were not statically significant.
3. “Patients who received first-line FFX or GN had similar PFS and OS even though (the) FFX group was younger with better PS (Performance Status).”
         Finally, it was observed that initial-FFX patients, because they are younger with good Performance Status, are more likely to continue to third-line and fourth-line therapies.

Abstract 681: Survival and quality of life after isolated upper abdominal perfusion [UAP] with chemofiltration (UAP-F) for stage III and IV pancreatic cancer
          German researchers performed UAP-F on 79 Stage 3 and 142 Stage 4 patients, to determine feasibility, safety, overall survival and quality of life.  Perfusion is the pumping of chemo agents into an organ.  In this case the agents were Cisplatin, Adriamycin and Mitomycin.  Chemofiltration is a simultaneous detoxification, process which removes excess Chemotherapy from the blood to reduce toxicity.
          The goal of UAP-F is to replace low-dose systemic chemotherapy with high-dose “regional” chemotherapy, thereby allowing increased toxicity at the tumor site but lower toxicity overall.  In this case the perfusion time was 15 minutes followed by 30 – 45 minutes of chemofiltration.  According to investigators, the research findings were:
1. “Median [overall] survival was 12.1 months and 8.7 months in stage III and IV respectively,” which is similar to harsher systemic therapies.
2. “One-year survival was 49.4% and 37% for stage III and IV, and 3-years survival 21.7% and 7.7% for stage III and IV respectively.”
3. “Resolution of ascites was achieved within two therapies in 33/36 cases with UAP-F.”

Abstract 682: Extent of lymph node resection and effect on pancreatic cancer overall survival
          To determine the impact of lymph node metastases on longevity researchers at Cedars-Sinai and Memorial Sloan Kettering examined the records of nearly 14,000 patients in the National Cancer Database, Stage 1-3 patients who underwent “curative resection.”
          As expected, they found that an “increased number of positive Lymph Nodes was associated with reduced Overall Survival.”  Consequently, the researchers urge “adequate nodal sampling” for resectable patients, noting that “if >16 Lymph Nodes were examined, patients had a 1.5-fold likelihood of better Overall Survival,” producing “an increase in Overall Survival of 2.8 months.”
          In a week or so the next 2020 GI Symposium installment will be posted.
          Be sure to study my downloadable Decision Guide.  Within a few days of hard work you will understand how to approach this terrible disease, based on your disease stage – and learn what therapies work and which ones don’t.  The Guide is downloadable at
PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg " target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg
          If the link doesn’t work, do a Google search for the file: PJaxDecisionAlgorithm.pdf " target="_blank" rel="nofollow">PJaxDecisionAlgorithm.pdf
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by Mkk2018 on Fri Feb 28, 2020 06:46 PM

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For sure I have studied it but not everyone follows under those guidelines. For example, we are not venturing with Cisplatin as we have too much neuropathy discomfort from previous Folfirinox. So that's done. 

We have done much research WITH our oncologist and team of experienced individuals and actually have data supporting phase 2 and 3 trials for SBRT in combination with immuno+parp. You have to step out of the box and standard of care if you want something to happen instead of following always the plans that others have done. Being BRCA does allow you to do this. Clearly. 

It isn't as if we just listen to the doctors and just agree right away with their plan - we always discuss options and plans.  Eventually after progression on standard of care you need to move on. In order to get to surgery we need to stop what is happening if it is not being done so by standard chemo. We need things to stop and be stable.

If you have information to support this, we'd welcome that discussion and conversation.

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