nanoknife IRE for pancreatic cancer

955 Posts | Page(s): Prev 12...90 91 92 93 94 ...9596 Next 

RE: nanoknife IRE for pancreatic cancer

by caseyzson on Thu Aug 09, 2018 04:38 PM

Quote | Reply

I can't respond to this thread..test

RE: nanoknife IRE for pancreatic cancer

by caseyzson on Thu Aug 09, 2018 04:47 PM

Quote | Reply

Hi PhilipJax,

Apologies for my previous post, but I kept getting errors trying to post.  I wanted to thank you for all of your dedicated research on pancreatic cancer.  You've helped my family so much already, guiding us towards treatments that show actual efficacy.  From the various facebook groups and forums I am a part of, you've helped more than you know.

Based on your research, I was wondering your thoughts on this possible treatment.  It seems this if low toxicity can be managed, than this could be effective for treating Stage 4 (which my mother has).

Combination of IRE + Low Dose Chemotherapy + Hydroxychloriquine

I used your research on IRE and saw that it is an effective way of managing the cancer (also The Guardian released an article on this yesterday, I will link in another comment).

Hydroxychloriquine acts as an autophagy inhibitor, and could aid to destroy the cells that barely survive from the IRE and chemotherapy.  Constant low dose chemotherapy after IRE could make this more effective, as previous IRE studies showed disease progression.

I'd be very intersted in your thoughts. Thank you so much!

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Thu Aug 09, 2018 09:51 PM

Quote | Reply

Metronomic plus Anti-Inflammatory Hydroxychloroquine

Dear Caseyzson,
          This reply will be delayed a few days due to its links.  Some items to consider:
1. If this is a trial, send me the trial number or the precise trial name.
2. The chemo agents are apparently delivered Metronomically, which is the administration of continuous, low-dose anticancer drugs.  What are the drugs?
3. There is some literature at my website on Metronomics, for which there have been very few clinical trials, and probably no new ones.  The website is here:
https://pancreatic.altervista.org/
          So, one must lean toward the established delivery schedules developed via clinical trials – what works best for most, might work for me. 
          We are prudent to avoid a decision based on REASON alone, and to stick to the schedules established by trials, because they have produced cold hard performance numbers (RR, PFS, OS).
4. What research have you found to support the proposed regimen?  The anti-inflammatory Hydroxychloroquine will likely do no harm and may help.
5. Regarding IRE, most metastatic patients won’t qualify, unless there are very few metastases.  And, interventional radiologists (not surgeons) are more likely to take a metastatic patient, so there will be less IRE treatment accuracy.  But, if few metastases, IRE is possible.  You are in the UK, I assume.
6. What is your mother’s ECOG ranking?  Refer to my Decision Guide, available here:
http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg
And, please tell other forums about the Guide.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by Masons on Tue Aug 14, 2018 04:55 AM

Quote | Reply
Does anyone know if there is any surgeon in Australia that considers doing Nanoknife (IRE) on a stage IV pancreatic cancer patient with liver mets that are responding to chemo and cancer marker is significantly reducing? It seems they do this procedure at a few places in the UK and US but having trouble finding it in Australia for Metastatic cancer. Thanks

RE: nanoknife IRE for pancreatic cancer

by Georginamhall on Tue Aug 14, 2018 05:30 AM

Quote | Reply

Hi, I don't know whether he works on stage 4 or not but there was a Dr Haghighi at St Vincent's Sydney that did open surgical nanoknife. I'm a bit out of date. You could try asking on the NanoKnife Surgery Warriors facebook group (you'd need to join it, which is no problem), which is international and has some well-informed members. I'm from New Zealand and two years ago my brother found it was necessary to go to UK for stage 3 treatment. Best wishes. 

RE: nanoknife IRE for pancreatic cancer

by Masons on Tue Aug 14, 2018 05:38 AM

Quote | Reply

On Aug 14, 2018 5:30 AM Georginamhall wrote:

Hi, I don't know whether he works on stage 4 or not but there was a Dr Haghighi at St Vincent's Sydney that did open surgical nanoknife. I'm a bit out of date. You could try asking on the NanoKnife Surgery Warriors facebook group (you'd need to join it, which is no problem), which is international and has some well-informed members. I'm from New Zealand and two years ago my brother found it was necessary to go to UK for stage 3 treatment. Best wishes. 

Thanks for that

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Tue Aug 14, 2018 12:51 PM

Quote | Reply

IRE Practitioners, Worldwide List

Dear Masons et al,
          At my website you will find lists of IRE practitioners in every country.  However, those treating metastatic patients are not identified, nor is the disease specified.
          Nevertheless you will be able to identify the institutions which have IRE equipment and can inquire further.  The site is
https://pancreatic.altervista.org/
          And, be sure to download the Decision Guide whose link is near the top of the page, right side.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by caseyzson on Tue Aug 14, 2018 06:12 PM

Quote | Reply

On Aug 09, 2018 9:51 PM PhilipJax wrote:

Metronomic plus Anti-Inflammatory Hydroxychloroquine

Dear Caseyzson,
          This reply will be delayed a few days due to its links.  Some items to consider:
1. If this is a trial, send me the trial number or the precise trial name.
2. The chemo agents are apparently delivered Metronomically, which is the administration of continuous, low-dose anticancer drugs.  What are the drugs?
3. There is some literature at my website on Metronomics, for which there have been very few clinical trials, and probably no new ones.  The website is here:
https://pancreatic.altervista.org/ "" target="_blank" rel="nofollow">https://pancreatic.altervista.org/ " target="_blank" rel="nofollow">https://pancreatic.altervista.org/
          So, one must lean toward the established delivery schedules developed via clinical trials – what works best for most, might work for me. 
          We are prudent to avoid a decision based on REASON alone, and to stick to the schedules established by trials, because they have produced cold hard performance numbers (RR, PFS, OS).
4. What research have you found to support the proposed regimen?  The anti-inflammatory Hydroxychloroquine will likely do no harm and may help.
5. Regarding IRE, most metastatic patients won’t qualify, unless there are very few metastases.  And, interventional radiologists (not surgeons) are more likely to take a metastatic patient, so there will be less IRE treatment accuracy.  But, if few metastases, IRE is possible.  You are in the UK, I assume.
6. What is your mother’s ECOG ranking?  Refer to my Decision Guide, available here:
http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg orithm.pdf"" target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg target="_blank" rel="nofollow">http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg
And, please tell other forums about the Guide.
         PhilipJax

thanks everyone!  I joined the Nanoknife group on facebook!

PhillipJax to answer your questions:

1. It's not a trial, but designing our own type of trial similar to what this doctor designed for himself and is in remission for two years www.ncbi.nlm.nih.gov /pmc/articles/PMC6049054

2. My mother is a patient now at Brucnker Oncologst, which is a bit unorthodox but very good.  Our metronomic + Vitamin C schedule is based on a small Phase 2 study that they did.  Basically it's Gemcitbine + FOLFIRINOX, low dose

ascopubs.org /doi/abs/10.1200/JCO.2016.34.15_suppl.e15745

3. The trial was small and was a mix of recurrent / advanced, but OS at 11 months was 75%

4. The propsed regimien of hydroxychloroquine is based on the above paper by Dr. Bigelsen that he used on himself and also this study 

ascopost.com /issues/may-25-2017/hydroxychloroquine-boosts-antitumor-activity-of-neoadjuvant-chemotherapy-for-pancreatic-cancer/

5. There is a doctor out of Hollywood, FL, Robert Donoway who does IRE on metastatic patients that fit a particular criteria.  I am from the United States.  He posts in the nanoknife group and I have been following him.

6. My mother's ECOG ranking is 0-1.

I spoke with the oncologist yesterday, and we may add the Hydroxychloroquine sooner than later.  We are also thinking of using Y90 or SBRT for the liver mets first.  There is some good data in CRC Stage 4, and some very early studies in Stage 4 Pancreatic.  Hoping to stay one step ahead of this beast.

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Aug 15, 2018 01:50 AM

Quote | Reply

Where to Find Effective Chemotherapy
How to Select Chemo Regimens

Dear Caseyzson
          Naturally, if these regimes had performed well, I would have emphasized them on my website and in the Decision Guide (although an anti-inflammatory is indeed cited).
          It is very time-consuming to respond to every similar question: What about this drug?  What about that drug?  That’s why I developed the Decision Guide.
         However, I can make this a lesson in good decision-making. Below is some discussion on the three reports which you cite – and some research suggestions.

1, Regarding: “Hydroxychloroquine Boosts Antitumor Activity . . . “
http://ascopost.com/issues/may-25-2017/hydroxychloroquine-bo
          Hydroxychloroquine is an anti-inflammatory drug (trade name Plaquenil) used in the treatment of rheumatoid arthritis and malaria and lupus erythematosus. 
          Because pancreatic cancer is driven in part by inflammation, this agent could be helpful.  A chemo regiment, containing the anti-inflammatory Anakinra, is cited in the Decision Guide: Abstract 449 of the 2018 ASCO GI Symposium.
          However, neither the Phase 2 trial you cite, nor the one I cite offers any proof that the anti-inflammatory itself plays a significant role in the study outcomes.  In fact, in the trial you cite NO life-extending results are given at all.
         There is reference only to “histopathology,” which is the microscopic study of tissue. That study did not address the hallmark indicators of performance: Response Rate (%), median Progression Free Survival (months) and median Overall Survival (months), so has little value.

2. Regarding: “An open-label phase II trial of G-FLIP . . . “
http://ascopubs.org/doi/abs/10.1200/JCO.2016.34.15_suppl.e15
          The (questionable) results of this Phase 2 trial are intentionally hidden from reviewers.  A Disease Control Rate (DCR) of 73% is claimed, but the more important components of the DCR are hidden.  We are never told the more important Complete Response rate or the Partial Response rate.
          One must assume that their percent values are very low, or the researchers would reveal them proudly.  That means that the Stable Disease rate is close to 73%, and Stable Disease means “no improvement”, and that no-improvement lasts only for awhile.  A 75% OS at 11 months is not impressive.
          It is notable that the Conclusion makes no mention of efficacy.
         This Phase 2 trial report is dated 2016. Thus, if there is no Phase 3 now underway, then the researchers or FDA discontinued this regimen’s human testing.

3. Regarding: “Evidence-Based Complimentary Treatment . . . “
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6049054/pdf/cma
          Many of the “alternate therapies” do no harm.  However Vitamin D, which MAY provide a gateway into the stroma, may also provide a gateway for cancer cell out-migration.  See page 88 or 89 of this forum.
          The supplement setback arises when the family care manager spends time acquiring and administering the supplements, when that time should be spent on getting the best proven standard therapy for the patient.
          Too many care managers are afraid to press the physician for the best therapies, and instead waste that energy on supplements.
         Proven therapy is therapy supported by successful clinical trials. Truth and Falsity in medicine are established by clinical trial. No amount of physician anecdotal “evidence” can replace the significance of clinical trials.

Decisions By The Numbers
          All therapy selection must be made on the NUMBERS: The Response Rate, Progression Free Survival and Overall Survival.  Be suspicious when those performance numbers are missing.  A painstaking discussion of prudent trial selection is available here.  Please study it.
https://pancreatic.altervista.org/ 
          Further, a patient with ECOG 1 should be able to endure the modified FOLFIRINOX or Gemcitabine + Nab-Paclitaxel + Cisplatin.  And add Anakinra if you can achieve it, in the manner described in Abstract 449.  Consider also Abstract 358.  Both have impressive numbers.  And, the Cisplatin may be especially helpful if the patient suffers the BRCA defect:
http://jaxelection.altervista.org/pancreatic/Abstr449BaylorH
http://jaxelection.altervista.org/pancreatic/Abstr358HonorHl
          Still, there are several other potential regimens outlined in the Decision Guide.  And, the Guide also identifies Emerging Therapies (see if you are eligible) and it addresses the roles of pancreatic bacteria and remedial antibiotics in pancreatic cancer.
http://jaxelection.altervista.org/pancreatic/PJaxDecisionAlg
          Finally, if you do brief research on Y90 you will find that the procedure rarely provides lasting benefits, and the embolization and radiation are not fully successful even at the target sites.  There are better radiotherapy technologies than SBRT.
          So, for liver metastases (assuming they are few) I suggest you review the related eradication methods described in the Decision Guide and my website.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by caseyzson on Wed Aug 15, 2018 06:35 PM

Quote | Reply

Thank you so much PhillipJax for your response.  It is hard sometimes as a desperate care-giver to find the true avenues with efficacy.  And thank you again for your decision guide.  The one thing I would like to ask...and again, I am sorry for the one off questions, is the ability for TACE (transarterial chemoembolization) in pancreatic liver mets.

There is a doctor / surgeon by the name of Rober Donoway in Florida who has suggested TACE in other forums, and there appear to be good international (albeit small) studies on them (with overall surival mentioned)

www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov /pubmed/29221632
www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov /pubmed/21975434
www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov " target="_blank" rel="nofollow">www.ncbi.nlm.nih.gov /pubmed/28099930
Thank you again
955 Posts | Page(s): Prev 12...90 91 92 93 94 ...9596 Next 
Subscribe to this message board discussion

Latest Messages

View More

We care about your feedback. Let us know how we can improve your CancerCompass experience.