Chemotherapy Sensitivity and Resistance Assays

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ASTEPHENS33
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Chemotherapy Sensitivity and Resistance Assays

Postby ASTEPHENS33 » Sat May 05, 2018 10:38 am

Has anyone had any experience or thoughts on tumor testing to see if its worthwhile doing chemotherapy?

From https://csn.cancer.org/node/145884: Chemosensitivity assay is a laboratory test that determines how effective specific chemotherapy agents are against an individual patient's cancer cells. Often, results are obtained before the patient begins treatment.

I know insurance doesn't usually cover it, so its probably not a standard yet, but I'm not sure if its worthwhile. A friend had it done for breast cancer and it came back she would respond well to the chemo being proposed. But if it hadn't, not sure how safe she would have felt not doing the chemo.

NHMike
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Re: Chemotherapy Sensitivity and Resistance Assays

Postby NHMike » Sun May 06, 2018 6:15 am

I did a bunch of reading on it but didn't see any actual papers and this seems to have been around for a while as the thread that I looked at ended in 2011. I am curious as to how they do the testing against the new drugs that are very, very expensive as they would need the drug along with the biopsy. One thing about CRC that I found: radiation is very effective at killing cancer cells (it's good at killing just about anything). 5FU seems to be the magic formula for CRC but we all know that it doesn't work on everyone.
6/17: ER rectal bleeding; Colonoscopy
7/17: 3B rectal. T3N1bM0. 5.2 4.5 4.3 cm. Lymphs: 6 x 4 mm, 8 x 6, 5 x 5
7/17-9/17: Xeloda radiation
7/5: CEA 2.7; 8/16: 1.9; 11/30: 0.6; 12/20 1.4; 1/10 1.8; 1/31 2.2; 2/28 2.6; 4/10 2.8; 5/1 2.8; 5/29 3.2; 7/13 4.5; 8/9 2.8, 2/12 1.2
MSS, KRAS G12D
10/17: 2.7 2.2 1.6 cm (-90%). Lymphs: 3 x 3 mm (-62.5%), 4 x 3 (-75%), 5 x 3 (-40%). 5.1 CM from AV
10/17: LAR, Temp Ileostomy, Path Complete Response
CapeOx (8) 12/17-6/18
7/18: Reversal, Port Removal
2/19: Clean CT

rp1954
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Re: Chemotherapy Sensitivity and Resistance Assays

Postby rp1954 » Mon May 07, 2018 6:42 am

We had this done on a limited basis for conventional chemo binaries and a triplet (for 5FU-iri-oxi-gem mixtures) and then for some truly experimental mixtures. Chemo sensitivity tests appeared to work okay for my comparison of relative effectiveness, even with a subset of the full suite of tests.

Of course, we had a lot of bloodwork before and after to augment it...
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

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Shana
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Re: Chemotherapy Sensitivity and Resistance Assays

Postby Shana » Wed May 09, 2018 12:00 am

I started chemo January 2017 and had two bad reactions to 5FU.

I met with an oncologist at UCSF about a month after my surgery (June 2017) for a second opinion to discuss treatment options. He recommended genetic testing "UCSF 500" before starting chemo again to determine if I had any sensitivty as well as testing for mutations. Interestingly, the results showed no sensitivity to 5FU or to Irinotecan. Due to my poor outcome with 5FU we decided to switche to Irinotecan in addition to Erbitux. The response has been good although CEA has increased in the past few months so CT scan scheduled early to check for progression.

I felt better about starting Irinotecan knowing that I didn't have a measurable sensitivity to it though I was still wary since the 5FU issue was negative too. I am glad I had the test done since it also tested for many other mutations. The downside is that being MSS and without mutations means that Immunotherapy options are really not available for me as yet.

The article you linked to was almost ahead of it's time, it would be interesting to see more updated information. I think immunotherapy is the future path to treatment and cures. I will be attending an Immunotherapy Patient Summit in San Francisco on June 30th which is Organized by Cancer Research Institute and there is no charge to attend. I am hoping to find out about options and clinical trials for MSS patients.

http://www.cancerresearch.org/patients/ ... mit-series

Thanks for introducing this topic again to the forum!
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...

rp1954
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Re: Chemotherapy Sensitivity and Resistance Assays

Postby rp1954 » Wed May 09, 2018 1:30 pm

Shana, we haven't waited on new immune treatment developments to get therapeutic immune benefits now.

We have gotten distinct, incrementally improved immunochemo results with PSK, WGP and megavitamin D3 where the highest doses of vitamin D3 require some magnesium and vitamin K2 (menetetrenone) content. At least one paper linked CEA level to PSK performance. Also we've used the common reishi, maitake, shiitake mushroom extracts. Even though you're Kras wild, vitamin C repletion, at least 200 mg - 500 mg/day (vs IV megavitamin C for KRAS/BRAF mutants), for leukocyte performance might be useful.
watchful, active researcher and caregiver for stage IVb/c CC. surgeries 4/10 sigmoid etc & 5/11 para-aortic LN cluster; 8 yrs immuno-Chemo for mCRC; now no chemo
most of 2010 Life Extension recommendations and possibilities + more, some (much) higher, peaking ~2011-12, taper chemo to almost nothing mid 2018, IV C-->2021. Now supplements

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Shana
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Location: Sonoma, CA

Re: Chemotherapy Sensitivity and Resistance Assays

Postby Shana » Wed May 09, 2018 2:02 pm

rp1954 wrote:Shana, we haven't waited on new immune treatment developments to get therapeutic immune benefits now.

We have gotten distinct, incrementally improved immunochemo results with PSK, WGP and megavitamin D3 where the highest doses of vitamin D3 require some magnesium and vitamin K2 (menetetrenone) content. At least one paper linked CEA level to PSK performance. Also we've used the common reishi, maitake, shiitake mushroom extracts. Even though you're Kras wild, vitamin C repletion, at least 200 mg - 500 mg/day (vs IV megavitamin C for KRAS/BRAF mutants), for leukocyte performance might be useful.


Thank you for the recommendations p1954,

I'm not familiar with PSK and WGP and totally in the dark about mushroom extracts. I will need to do some reading. I will definitely discuss D3 dosage with my oncologist. I take magnesium and potassium supplements primarily because Irinotecan has a tendency to increase output and cause deficiencies for me. I can certainly add Vitamin C to my regimen.

I am also back with my endocrinologist because my previously well controlled Hashimoto's is no longer within normal range on my old dose. My endocrinologist is increasing my dosage conservatively (too conservatively in my opinion, but I'm waiting to see TSH results in June) There is some correlation on NIH site between TSH and rising CEA which would be reassuring if that's the case but my oncologist didn't think that is going to be a factor. I have also read about CEA and thyroid on another thread from dianetavegia who is fortunately NED.

As always, your input is much appreciated and encourages me to think outside of the box and ask more questions!

Shana
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...

Lsaliani
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Joined: Thu May 24, 2018 12:22 am

Re: Chemotherapy Sensitivity and Resistance Assays

Postby Lsaliani » Thu May 24, 2018 1:09 am

I started with 5-FU in March 2016. Switched to Capcetabine in August 2016 so I could go back to work. Hospitalized in October 2016 for systemic yeast infection of my port for 20 days. First normal CEA 2.3 in same month. Taken off of Chemo. CEA begins escalating in January 2017. Monitored through April. CEA doubling. Caris Molecular Study done on Tumor. PET/CT scan. Three active lymph nodes found in stomach. All clear everywhere else. Started Avastin/Irinotecan May 2017. Steady and rapid decline in CEA until reaching 8.6. CEA starts inching up by tenths of a point at a time. Switch to Erbitux November 2018. AMay 2018 NED, CEA today 1.7.
I would like to know if anyone else suffers with terrible stomach pain between their bellybutton and the V of their ribs? My pain starts as soon as the Irinotecan begins going into my veins! The nurse noticed when it starts.

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Shana
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Location: Sonoma, CA

Re: Chemotherapy Sensitivity and Resistance Assays

Postby Shana » Thu May 24, 2018 3:15 pm

Lsaliani wrote:I started with 5-FU in March 2016. Switched to Capcetabine in August 2016 so I could go back to work. Hospitalized in October 2016 for systemic yeast infection of my port for 20 days. First normal CEA 2.3 in same month. Taken off of Chemo. CEA begins escalating in January 2017. Monitored through April. CEA doubling. Caris Molecular Study done on Tumor. PET/CT scan. Three active lymph nodes found in stomach. All clear everywhere else. Started Avastin/Irinotecan May 2017. Steady and rapid decline in CEA until reaching 8.6. CEA starts inching up by tenths of a point at a time. Switch to Erbitux November 2018. AMay 2018 NED, CEA today 1.7.
I would like to know if anyone else suffers with terrible stomach pain between their bellybutton and the V of their ribs? My pain starts as soon as the Irinotecan begins going into my veins! The nurse noticed when it starts.


Hi Lsaliani,

Welcome to the club that no one wanted to join. I am on Erbitux and Irinotecan, I have felt some cramping pain on occasion but the nurse increases my dose of Atropine if I alert her and that works immediately. Your CEA is awesome, mine has never dropped below 33. Since you are new here and don't have a signature with your history yet it would be helpful if you also share what kind of CRC you have, surgery dates and results from your genetic tests etc. Congrats on being NED, that is awesome! How long does your oncologist plan on keeping you on chemo now? Are you just on Irinotecan?

Shana
DX - 12/16
MSS - KRAS wild
Well-differentiated adenocarcinoma at splenic flexure
Stage IV CC with liver mets
5FU - Failed twice - 1/17 and 3/17
Irinotecan + Cetuximab: 8/17
Irinotecan and Erbitux ran it's course. CEA rising
Primary tumor invaded tail of pancreas and spleen. Liver mets major concern
Y-90 radioembolization on 9/17/18, liver enzyymes have dropped. 10 Radiation treatments to primary tumor completed too. CT scan Nov to assess overall situation...


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