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How fast does adenocarcinoma grow??
Pancreatic Cancer | Last Active: Oct 20 7:03pm | Replies (43)Comment receiving replies
Chiming in here from Lake Tahoe, CA where I am visiting a stage IV patient and getting a better care and treatment plan in place to improve the potential of a better outcome.
In replying to the question about treating actively growing tumor cells and those that are quiescent and have a "stemness" to them, chemotherapy works by various drug agents breaking DNA and intercalating into the damaged DNA. This shuts down vital processes of the cell. Each agent works at a specific point of the cell-either in the G2 growth phase, the synthesis phase where new DNA is being synthesized or during the phase of Mitosis where the tumor cell splits and becomes two daughter cells with equal amounts of DNA.
Tumor cells can go into a quiescent phase having a stem-like quality. They are in a G0 phase-essentially in a steady state of no growth or synthesizing new DNA. So it is for this reason that standard of care chemo regimens are not effective. The concern I had when I was under treatment was in trying to eliminate any minimal residual disease (MRD) and allow cells to reach this quiescent state. I never had a break, pause or delay in treatment. Low WBC counts were immediately addressed with Neulasta. Doing full-dose Folfirinox of 24 cycles and 22 cycles of 5-FU in groups of six may have eliminated most if not all MRD.
What oncologists feel was the "tipping point" who have familiarity with my case feel that the excessive amount of oxaliplatin converted the immunologically cold pancreatic tumors to immunologically hot tumors. This means the oxaliplatin component caused the tumor cells to express neoantigens (new protein clusters) on the cell surface making them visible to one's immune system cells such as macrophages, dendritic cells, antigen presenting cells and tumor infiltrating lymphocytes TIL's).
The TIL's develop long-term memory. Using dendritic cell vaccine therapy works in similar fashion whereby TIL's recognize these new proteins and have long-term memory. Researchers have discovered that tumor conversion can be achieved using cytokines and chemokines. This is much easier on the patient than massive amounts of oxaliplatin. Dendritic cell therapy is on the verge of now being effective in pancreatic cancer because of the discovery in how to convert immunologically cold tumors to hot ones. Keep an eye open for trials using dendritic cell therapy. PennMedicine/Abramson Cancer Center at the Hospital of the University of Pennsylvania is likely going to become a leader in this area.
Replies to "Chiming in here from Lake Tahoe, CA where I am visiting a stage IV patient and..."
I was rereading your post from a one month ago, and I realized you made a very important comment that especially applies to those with pancreatic cancer that is very aggressive; as mine is. My original mutations were KRAS12D, TP53, and ATM (VUS or variant of unknown signifance). So many have the first 2, that I'm guessing that ATM (VUS) must be the aggressive factor driving this disease for me; but I digress. You say you never took a break from the chemo anf I too believe thst was your saving grace along with pushing the administration of chemo to its limits, and I believe you are an oral version of a chemo pill as you have the BRCA gene which seems to be forgiving compared to other types of PC mutations. When I was a newbie on this site, I had read how a few were able to take a break from chemotherapy and seemed to be fine. I tried the same, one in order to entertain some extended birthday celebration and the second was this year in order to accommodate moving from one home to another. The breaks were short - missing just 1-2 treatments each time, but apparently that was enough time to let my rapidly dividing cancer cells replicate like crazy paired with the fact that after 3 months of just being on gemcitabine (too weak to effectively kill all newly dividing cancer cells) created an environment of no return for me otherwise known as peritoneal cancer. The point that you made that I'm trying to emphasize after my long winded dissertation, is that chemo breaks are not always a wise choice and I agree with your assessment of how these cancer cells are attacked and how you must not give them a break if you a case of cancer cells that have a rapidly dividing cells and you know that when after surgery and completing your initial chemo regimen after surgery, if you even had one, that your CA19-9 starts climbing at a very past pace.
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Wow, @stageivsurvivor, I feel like I'm in the university bio classes again ( which I never studied real well when I was in college)! We are so grateful that you have this level of understanding of cell behavior and can share that with us. It sounds promising. I found out I have a peritoneal nodule abutting the appendix and will ask oncologist today if we can just abstract the appendix. I'm somewhat concerned about the idea of mutated cell transferrence or spreading of cancer cells to healthy areas once you are fiddling with procedures in the body- what is your opinion of the risk of this type of spread? Does it make sense to do a noninvasive procedure like appendectomy to remove the nodule. I feel like my current oncologist has checked out" and is not really watching the candy store anymore.