nanoknife IRE for pancreatic cancer

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RE: nanoknife IRE for pancreatic cancer

by miami on Fri Aug 16, 2019 07:50 PM

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Should I consider Dr. Robert Donoway?  I believe he trained at Sloan Kettering.

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Sat Aug 17, 2019 01:58 AM

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miami
          You would do well to download and study my decision guide here
https://pancreatic.altervista.org/
          It will take you a day of hard work to get up to speed.  Along the way you will learn how your case is classified, learn the best treatments and learn the names (and read the training guides) of IRE leaders in the USA.
          PhilipJax
         

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Aug 28, 2019 11:50 PM

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2019 ASCO Annual Meeting, July 2019
Installments, Part 1

Everyone,
          Today, in installments I begin reviewing abstracts from the 2019 ASCO Annual Meeting, which was held in July, 2019.  Over a period of several weeks, I will cover the “best”.  If you can’t wait, the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
          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.
         PhilipJax

Abstract e15781: A retrospective analysis of antibiotics usage and effect on overall survival and progressive free survival in patients with metastatic pancreatic cancer
          MD Anderson researchers speculated that antibiotic use would “alter the tumor and gut microbiota diversity” for the better, and would improve chemotherapy and immunotherapy outcomes for patients.
          They retrospectively reviewed the records of 148 METASTATIC patients, finding 135 who had received antibiotics for more than 3 days.  The results:
1. The median Overall Survival (OS) for patients taking macrolides (a class of antibiotics) was 541 days compared to 341 days for patients not taking macrolides.
2. Median Progression Free Survival (PFS) for patients taking macrolides was 178 days versus 124 days in those not taking macrolides.

Abstract 168385: The effect of antibiotic use on survival of patients with resected pancreatic ductal adenocarcinoma
          To determine the impact of antibiotic exposure on RESECTED patients, MD Anderson and the University of Kentucky performed a similar retrospective study, this time reviewing the records of 342 patients with resected PDAC.
          Antibiotic exposure was defined as the use of antibiotics for ≥7 days between diagnosis and surgery.  A total of 147 patients (43%) met the presurgical exposure criterion.  The review results:
1. The median OS for patients with antibiotic use was 1,007 vs. 940 days for those without antibiotic use. The median PFS was 374 for patients with antibiotic use and 313 days for those without.
2. Not all antibiotics were helpful.  “Tetracycline use in resectable PDAC patients was associated with clinically significant decreased PFS and statistically significant worse OS.”
          Much more can be learned from previous posts about the roles of bacteria and antibiotics in pancreatic cancer, including landmark research by New York University downloadable here:
http://jaxelection.altervista.org/pancreatic/MicrobiomePromo

Abstract: e15765: Adjuvant therapy with gemcitabine and stereotactic body radiation therapy versus gemcitabine alone for resected stage II pancreatic cancer: A prospective, randomized, open label, single-center trial
         
A Chinese medical school and associated hospital sought to learn whether, for resected patients, the adjuvant therapy Gemcitabine combined with Stereotactic Body Radiation Therapy (SBRT) performed better than Gemcitabine alone.
          Of 40 patients, 21 were randomly assigned to the Gemcitabine group and 19 to the Gemcitabine plus SBRT group).  The outcome:
1. The median Recurrence Free Survival (RFS) was 12.4 months in the Gemcitabine group and 14.7 months in the Gemcitabine plus SBRT group.
2. However, the more important median OS was 21.7 months for the Gemcitabine group and less, 16.9 months, for the Gemcitabine plus SBRT group.
3. Oddly, the median locoregional recurrence-free survival (LRFS) was better for the Gemcitabine group: 18.2 months for Gemcitabine alone vs 13.1 months for the Gemcitabine plus SBRT group.  SBRT, because it focuses on the primary tumor, should have performed better for local control.
          The researchers concluded: “Adjuvant SBRT neither provided a survival benefit nor improved local disease control in resected stage II pancreatic cancer.”
          Much more information on the performance of radiation therapy and SBRT is found in previous posts, many of which question the value of radiation therapy.
          If, after several failed therapies, the medical oncologist refers you to a radiation oncologist, that means that your physicians have run out of ideas.  Do not wait for that to happen.  Be sure to download the Decision Guide at my website.  After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          At least one more installment on the ASCO Annual Meeting will soon follow.
         PhilipJax

 

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Sep 04, 2019 08:51 AM

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2019 ASCO Annual Meeting, July 2019
Installments, Part 2

Everyone,
          This is the second installment on abstracts from the 2019 ASCO Annual Meeting.  I cover the “best” therapy advances.  All of the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
          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.
          First, below is a better link for the landmark research by New York University, cited in the first installment, on the role of bacteria in pancreatic cancer:
http://jaxelection.altervista.org/pancreatic/MicrobiomePromo

Abstract 4015: Final report of a phase I/II study of veliparib (Vel) in combination with 5-FU and oxaliplatin (FOLFOX) in patients (pts) with metastatic pancreatic cancer (mPDAC)
          This Phase 1&2 research NCT01489865 applies specifically to patients who harbor DNA damage response (DDR) mutations, present in approximately 21% of metastatic patients.
https://clinicaltrials.gov/ct2/show/NCT01489865
          Because such DDR patients usually respond (to some extent) to platinum (Oxaliplatin) and to PARP-inhibitor therapies, researchers at four USA universities sought to quantify the impact from the combined therapy: PARP-inhibitor Veliparib (Vel) plus modified FOLFOX6 (mFOLFOX6) which contains Oxaliplatin.  Veliparib was previously called ABT-888.
          In this rather small study patients with the DDR mutation (16 patients) were compared to 41 patients who lacked the mutation.  The outcome was dramatic.
1. Patients with the DDR mutation had a Response Rate (ORR) of 50%, a Progression Free Survival (mPFS) of 7.2 months, and an Overall Survival (mOS) of 11.1 months, compared to ORR 17%, mPFS 3.5 months and mOS 6.8 months for patients without the mutation.
2. For DDR patients who were platinum-naïve the outcome was slightly better: ORR 58%, mPFS 8.7 months and mOS 11.8 months.
          The poor performance of non-DDR patients MAY be due partly to the relatively weak mFOLFOX6 compared, for example, to mFOLFIRINOX.
          DDR mutations include BRCA1/2, PALB2 and ATM.  And, beneficiaries may include those with a family history of breast and ovarian cancer syndrome.
          Veliparib inhibits an enzyme called "PARP" which helps to fix damaged DNA.  By inhibiting this enzyme, Veliparib prevents cancer cells from repairing the damage caused by mFOLFOX6.
          This research strongly supports the recommendation, urged 2 years ago, that all pancreatic patients undergo genetic testing.
         There are currently no open trials employing the Veliparib + platinum combination to treat DDR mutations. There are, however, several trials using a PARP inhibitor, but none combining the PARP inhibitor with a platinum-based chemotherapy.

Abstract No: 4014: Randomized phase II study of second-line modified FOLFIRI with PARP inhibitor ABT-888 (Veliparib) (NSC-737664) versus FOLFIRI in metastatic pancreatic cancer (mPC): SWOG S1513.
          In contrast another Veliparib trial NCT02890355 did not produce good results, which may be due, not to Veliparib, but to the trial design.
          When 123 patients were randomly assigned to either Veliparib plus FOLFIRI or to FOLFIRI alone, there was no OS or PFS benefit for Veliparib.
          However, unlike the other Veliparib trial (Abstract 4015 above), the DDR-defect patients (35 of 123 patients) were NOT assigned exclusively to the Veliparib group, but were randomly distributed to the test group and to the control group.  So, the impact of Veliparib on DDR patients could not be extracted from the data.
          In addition, no platinum therapy (like Oxaliplatin) was used, a therapy especially helpful in DDR cases.
          So, it is possible that this Veliparib trial does not negate Veliparib performance, provided that Veliparib is employed together with a platinum regimen (for example FOLFIRINOX) in DDR cases.
          We may know more in 6 months.  A similar trial, employing Veliparib and a platinum drug is in the works.  It is Active, but Not Recruiting:
https://clinicaltrials.gov/ct2/show/NCT01585805
          Be sure to download the Decision Guide at my website.  After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          Another installment on the ASCO Annual Meeting will soon follow.
         PhilipJax

         

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Sat Sep 14, 2019 11:14 AM

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2019 ASCO Annual Meeting, July 2019
Installments, Part 3

Everyone,
          This is the third installment on abstracts from the 2019 ASCO Annual Meeting.  I cover the “best” therapy advances.  All of the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
         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.

Abstract 4135: Clinical and immune responses using anti-CD3 x anti-EGFR bispecific antibody armed T cells (BATs) for locally advanced or metastatic pancreatic cancer
          In 4 sequential clinical trials six US institutions treated 5 phase-1 and 15 phase-2 locally-advanced and metastatic patients using immuno agent EGFR BATs as a means to activate T cells.  The BATs immunotherapy is employed after standard first line chemotherapy, and chemotherapy is utilized again following BATs infusions.
          For this unusual therapy the outcomes were rather good:
1. The median overall survival (mOS) for 17 evaluable patients is 31 months.
2. Four patients (24%) have stable disease (SD) for 6.1, 6.5, 5.3, and 36 months.
3. And, two patients (12%) have experienced complete responses (CR), which occurred when chemo was restarted after BATs.  In one case the subsequent chemo agent was merely Capecitabine.  That patient is still alive and off-therapy at 54 months, 24 months after stopping Capecitabine.
          Researchers conclude that EGFR “BATs may stabilize disease, leading to improved OS, as well as . . . immunosensitize tumors to subsequent chemotherapy”.
          This research is difficult to extrapolate to a larger patient population, due to the very small size of the research group.
          The results are noteworthy, with approximately one-third of patients doing well.  However, prospective patients must understand that MOST participants do not fare well, as in most trials.
          For example, in a recent conference presentation, called a poster, Table 1, Patient Summary tells of success and failure.  The poster is downloadable here:
http://pancreatic.altervista.org/downloads/BATsPCPoster2019A
          Some POSSIBLE observations from Table 1 are the following:
1. Both Complete Responses (CR) took place at KCI, one in Phase-1, and one in Phase-2, plus one very long term Stable Disease.  KCI is Karmanos Cancer Institute of Wayne State University, and UVA is University of Virginia.
2. The Overall Survival’s (OS) at KCI appear to be longer, but the patients in UVA’s Phase-2 are recent arrivals who have not been with the program very long.  (OS is not the same as median OS, which is the median survival when half are dead).
3. There are 2 patients at UVA who are Off Therapy with NO TTP, meaning there is no progression yet.  They are new arrivals with 3-8 months OS thus far.  TTP (Time To Progression) is the length of time from the start of treatment until the disease starts to get worse or spread.
4. In both phases the TTP is about the same (if we drop the extreme months) with 5.56 months for Phase-1 vs 5.21 months for Phase-2.
5. Overall there are 5 patients who did quite well.  So, the “response rate” is 5/16 or 31%, which is good.  And, 4 are still alive.
6. Three of the 7 KCI patients had prior surgery, which assures increased life spans, even if there is no subsequent therapy.  But one metastatic patient had no surgery, yet still achieved CP and is still alive, which is startling.  Of course, he could be the occasional super responder found in some trials.
          Regarding the zero TTP people, their Clinical Status is A (Alive), so there is apparently no disease progression.  And, based on their patient ID numbers, they are new arrivals.
          Overall it is always very discouraging to see the contradictory numbers.  Some patients die quickly and others linger for a long time – and there is the forever soul searching as to why some trial participants respond and other don’t.
          In Phase-1 all the good responders are now dead except one.  But, they lasted a long time.  Which is a worthwhile strategic action against this disease: Stay alive until the next best thing arrives.
          A related clinical trial is available at University of Virginia, Charlottesville.  Enrollment is limited to 22 subjects, who receive “standard of care” chemotherapy, then EGFR BATs infusions.  Prior chemotherapy is acceptable and wanted; so, patients need NOT be chemotherapy naïve.  “Standard of Care” may be FOLFIRINOX or Nab-Paclitaxel/Gemcitabine, better than the earlier FOLFOX6.
          However, there are eligibility restrictions.  If interested, act quickly; there is a waiting list for this expensive therapy.  Study the details at the link below.  Undertaking this trial does not prevent you from undertaking subsequent therapies (except perhaps immunotherapy trials).  See
https://clinicaltrials.gov/show/NCT03269526
          Be sure to download the Decision Guide at my website.  After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          Another installment on the 2019 ASCO Annual Meeting may soon follow.
         PhilipJax

 

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Thu Sep 19, 2019 12:56 PM

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2019 ASCO Annual Meeting, July 2019
Installments, Part 4

Everyone,
          This is the fourth installment on abstracts from the 2019 ASCO Annual Meeting.  I cover the “best” therapy advances.  All of the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
         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.

Abstract e15729: Efficacy and safety of FOLFIRINOX in elderly patients with advanced pancreatic adenocarcinoma
          Physicians hesitate to administer FOLFIRINOX (FFX) to elderly patients despite their holding good Performance Status.
          So, to learn the tolerance and outcome of first-line FFX for elderly patients South Korean researchers reviewed the records of 38 elderly patients (age ≥70) and 176 non-elderly (age <70).  The outcome of the retrospective research:
1. For locally-advanced patients the median OS was 13.5 vs 15.8 months, elderly vs non-elderly.
2. For metastatic patients the median OS was 9.8 vs 8.6 months, elderly vs non-elderly, even though more elderly patients received dose adjusted FOLFIRINOX than did non-elderly.
          Conclusion: There were “comparable efficacies.”  “FOLFIRINOX [can] be considered as the first-line chemotherapy for elderly patients with advanced PDA.”

Abstract e15794: Gemcitabine and nab-paclitaxel retreatment as a third-line therapy following second-line FOLFIRINOX for advanced pancreatic adenocarcinoma.
          Few third-line therapies (following NabP+Gem and FFX) are available (although my website identifies several possibilities).
          Thus, researchers at one USA institution sought to learn whether NabP+Gem (NG) might function as a third-line regimen, if it followed first-line NG and second-line FFX.  The records of 26 suitable patients were reviewed, 73% of whom had locally advanced cancer at diagnosis.  The patients had ECOG performance status of 2 or less.
          The findings for patients undergoing NG, FFX then NG again:
1. The median OS from the date of diagnosis was 39.0 months (range 34.0 – 66.0 months).
2. The median OS from third-line re-initiation of NG was 18.0 months (range 9.0 – 32.0 months), which are reasonably good numbers.
          Conclusions: “Retreatment with nab-paclitaxel plus gemcitabine is feasible, tolerable and effective in patients with a good performance status.”

Abstract 4125: PanCO: An open-label, single-arm pilot study of phosphorus-32 (P-32; Oncosil) microparticles in patients with unresectable locally advanced pancreatic adenocarcinoma (LAPC) in combination with FOLFIRINOX or gemcitabine + nab-paclitaxel (GNP) chemotherapies
          In the UK, Belgium and Australia researchers used endoscopic ultrasound guidance to implant radioactive P-32 Microparticles, a type of brachytherapy, into the pancreatic tumors of 42 locally advanced patients.  The outcomes of the combined chemotherapy-brachytherapy were the following:
1. The Overall Response Rate (the frequency of Partial Responses) was 31% (which is good), with median change in tumor volume from Baseline to Week 16 and to Week 24 of -38% and -27.5%, respectively.
2. The Local Disease Control Rate (the frequency of Partial Responses plus Stable Disease) at Week 16 was 90% and at Week 24 was 71%.
3. Ten (24%) patients underwent surgical resection following repeat staging.  Eight of the 10 patients had R0 margins.
          This was a pilot study with no control group, so it is not known whether the P-32 brachytherapy made a difference, or whether chemotherapy alone might have achieved the good outcomes.
          Details of the trial are given here:
http://clinicaltrials.gov/show/NCT03003078
          Be sure to download the Decision Guide at my website.  It now has a decision algorithm which identifies the best FIRST chemo regimen: FFX or NabP+Gem.  After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          The next installment will cover the anticipated new third-line therapy SM-88, to follow soon.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Fri Sep 20, 2019 01:08 AM

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2019 ASCO Annual Meeting, July 2019
Installments, Part 5

Everyone,
          This is the fourth installment on abstracts from the 2019 ASCO Annual Meeting.  I cover the “best” therapy advances.  All of the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
         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.

Abstract e15714: SM-88 therapy in high risk poor prognosis pancreatic cancer (PDAC)
          SM-88 is an oral monotherapy intended principally as a third line therapy, to be used after the failure of FFX and NabP+Gem.
          The preceding Phase 1 of this trial is described here:
JCO 37, 2019 supp 4; 200. JCO 37, 2019 supp 4; 310
          In this Phase 2 trial heavily pretreated patients having poor Performance Status (ECOG ≤2) were randomized to 460 or 920 mg/dy SM-88, and all patients also received phenytoin 50 mg, methoxsalen 10 mg and sirolimus 0.5 mg.
          SM-88 consists of a tyrosine derivative, an mTOR inhibitor, a CYP3a4 inducer, and an oxidative stress catalyst
          In this Phase 2 trial there was no control group, which is the basis for a class action lawsuit, details of which can be found by searching the terms: Pomerantz and “Tyme Technologies”.
          The findings of the current Phase 2 trial are the following:
1. The median Overall Survival of 38 evaluable patients is currently 6.4 months, although the median overall survival for the ITT population (49 patients) is currently 3.6 months.
          In an ITT population, everyone who is randomized in the trial is considered to be part of the trial regardless of whether he or she is dosed or completes the trial.  In ITT analysis, estimate of treatment effect is generally conservative.  A better application of the ITT approach is possible if complete outcome data are available for all randomized subjects, but that is not always possible.
2. The Stable Disease rate was 44%, 11 of 25 of patients.  The trial reports fail to claim Partial Responses, so likely there were none.
3. A median reduction of 63% in CTC (Circulating Tumor Cell) burden was observed in evaluable patients.  The 10 of 24 patients with available data reached an 80% CTC reduction or greater.  And, 56.3% (9/16) patients with CTC decreases had OS of at least 180 days (6 months).
          CTCs have long been known to exist in cancer patients' blood, with a clear correlation established between the number of CTCs and disease progression.
4. Female patients achieved greater overall survival.
          The 920 mg/day dose has been selected for further evaluation in anticipated future trials.
          SM-88’s June 2019 ESMO poster presentation gives more information, available here:
http://pancreatic.altervista.org/downloads/SM-88_ESMO22Jun20
          The following document contains all news and press releases on SM-88:
http://pancreatic.altervista.org/downloads/SM-88AsOf09Sep201
          Details on the Phase 2 trial design are available here:
http://clinicaltrials.gov/show/NCT03512756
          Underway is a Phase 3 SM-88 trial at 20 locations, which will accept 250 participants.  The trial is randomized, so half will not receive SM-88, but instead will receive some combination of Capecitabine, Gemcitabine, and 5-FU:
https://clinicaltrials.gov/show/NCT03512756
          Be sure to download the Decision Guide at my website.  It now has a decision algorithm which identifies the best FIRST chemo regimen: FFX or NabP+Gem.  After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          There may be another installment to follow soon.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Sun Sep 22, 2019 10:54 AM

Quote | Reply

2019 ASCO Annual Meeting, July 2019
Installments, Part 5

Everyone,
          This is the fifth installment on abstracts from the 2019 ASCO Annual Meeting.  I cover the “best” therapy advances.  All of the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
         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.

Abstract e15714: SM-88 therapy in high risk poor prognosis pancreatic cancer (PDAC)
          SM-88 is an oral monotherapy intended principally as a third line therapy, to be used after the failure of FFX and NabP+Gem.
          The preceding Phase 1 of this trial is described here:
JCO 37, 2019 supp 4; 200. JCO 37, 2019 supp 4; 310
          In this Phase 2 trial heavily pretreated patients having poor Performance Status (ECOG ≤2) were randomized to 460 or 920 mg/dy SM-88, and all patients also received phenytoin 50 mg, methoxsalen 10 mg and sirolimus 0.5 mg.
          SM-88 consists of a tyrosine derivative, an mTOR inhibitor, a CYP3a4 inducer, and an oxidative stress catalyst
          In this Phase 2 trial there was no control group, which is the basis for a class action lawsuit, details of which can be found by searching the terms: Pomerantz and “Tyme Technologies”.
          The findings of the current Phase 2 trial are the following:
1. The median Overall Survival of 38 evaluable patients is currently 6.4 months, although the median overall survival for the ITT population (49 patients) is currently 3.6 months.
          In an ITT population, everyone who is randomized in the trial is considered to be part of the trial regardless of whether he or she is dosed or completes the trial.  In ITT analysis, estimate of treatment effect is generally conservative.  A better application of the ITT approach is possible if complete outcome data are available for all randomized subjects, but that is not always possible.
2. The Stable Disease rate was 44%, 11 of 25 of patients.  The trial reports fail to claim Partial Responses, so likely there were none.
3. A median reduction of 63% in CTC (Circulating Tumor Cell) burden was observed in evaluable patients.  The 10 of 24 patients with available data reached an 80% CTC reduction or greater.  And, 56.3% (9/16) patients with CTC decreases had OS of at least 180 days (6 months).
          CTCs have long been known to exist in cancer patients' blood, with a clear correlation established between the number of CTCs and disease progression.
4. Female patients achieved greater overall survival.
          The 920 mg/day dose has been selected for further evaluation in anticipated future trials.
          SM-88’s June 2019 ESMO poster presentation gives more information, available here:
http://pancreatic.altervista.org/downloads/SM-88_ESMO22Jun20
          The following document contains all news and press releases on SM-88:
http://pancreatic.altervista.org/downloads/SM-88AsOf09Sep201
          Details on the Phase 2 trial design are available here:
http://clinicaltrials.gov/show/NCT03512756
          Underway is a Phase 3 SM-88 trial at 20 locations, which will accept 250 participants.  The trial is randomized, so half will not receive SM-88, but instead will receive some combination of Capecitabine, Gemcitabine, and 5-FU:
https://clinicaltrials.gov/show/NCT03512756
          Be sure to download the Decision Guide at my website.  It now has a decision algorithm which identifies the best FIRST chemo regimen: FFX or NabP+Gem.  After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          There may be another installment to follow soon.
         PhilipJax

 

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Mon Sep 23, 2019 10:11 AM

Quote | Reply

2019 ASCO Annual Meeting, July 2019
Installments, Part 6

Everyone,
          This is the sixth installment on abstracts from the 2019 ASCO Annual Meeting.  I cover the “best” therapy advances.  All of the abstracts are found here:
http://pancreatic.altervista.org/downloads/2019ASCODetails1.
         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.

Abstract: Non-Selective β-Adrenergic Blockage [Beta-Blocker] Impacts Pancreatic Cancer . . . Improves Patient Survival
          Johns Hopkins researchers undertook a prospective records examination of resected (pancreatectomy) patients to determine the impact of antihypertension drugs.  Of 1,933 patients, 397 patients were taking β1-selective-blockers, and 60 received non-selective β-blockers.  The research findings:
1. Patents taking non-selective beta blockers showed significantly decreased perineural invasion compared to patients on beta-1 selective blockade and those with no documented beta blockers.
          Perineural is the connective tissue that sheathes a bundle of nerve fibers.  Perineural invasion is more likely to lead to nodal metastases, lymphovascular invasion, and high-grade tumors.
2. Median overall survival was significantly longer among patients taking non-selective beta blockers (26.1 months), compared with those on beta-1 selective blockers (18.5 months) or not taking any beta-blockade (18.8 months).
2. "People on non-selective beta blockers are more likely to have heart failure, hypertension, or other medical conditions, and were older, and yet they survived better.”
          Non-selective or nonspecific beta-blockers block both beta1 and beta2 receptors and thus affect the heart, lungs, vascular smooth muscles, kidneys, GI, etc.  Examples include Propranolol, Nadolol and Carvedilol.
          The beta blocker prevents adrenaline from reaching these cancer cells and enhancing tumor growth.  So, if the patient is in a stressful state, his adrenaline levels are going to be elevated which could actually foster faster tumor growth.
          More details of the research are available here:
http://meetings.ssat.com/abstracts/2019/345.cgi

Abstract 4129: Metformin use and pancreatic cancer survival in U.S. veterans with diabetes mellitus: Are there racial differences?
          To test the benefits of Metformin, an anti-diabetes drug, American researchers undertook a population-based retrospective cohort study of 3,811 pancreatic cancer patients.
          The findings:
1. Researchers observed no associations between metformin use and pancreatic cancer survival.
2. However, researchers found “noted improved survival (limited to non-Hispanic White patients) among patients who were metformin naïve at the time of pancreatic cancer diagnosis.”
          Be sure to download the Decision Guide at my website.  It now contains a decision algorithm which identifies the best FIRST chemo regimen: FFX or NabP+Gem.
          After several days of hard work you will up to date on therapies, strategies and care management.  Begin at:
https://pancreatic.altervista.org/
          This likely concludes my review of the 2019 ASCO Annual Meeting.  However, if I discover other useful abstracts, I will post them.
         PhilipJax

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