Advanced Prostate Cancer
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Broad Survey of the State of Prostate Cancer Diagnosis and Treatment in a recent Article in the New England Journal of Medicine

Broad Survey of the State of Prostate Cancer Diagnosis and Treatment in a recent Article in the New England Journal of Medicine by Dr. Sartor (Snuffy Myers pal)

"We review studies that are changing the standard of care, and we offer a conceptual perspective for addressing ongoing challenges and opportunities."

Seems to cover pretty much everything.

nejm.org/doi/full/10.1056/N...

Patrick, any thoughts or comments on this article?

EDIT: The above link worked for me, but is not working for everyone. I found an alternative link here:

sci-hub.hk/10.1056/NEJMra17...

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Read it--and it was up to date--but today I feel much of our research efforts and new protocols will come from Immunology, targeted therapies for PARP Inhibitors, selected for each particular Mutation to allow for DNA repair. The training of T cells--more commonly referred to as Car-T--and I am real excited about the work with PSMA, if found on the Pca cell wall--using Lu-177. There are a number of agents that can be attached to the Lu-177, these then hook to the PSMA, and usually kill the cancer cells.

What they do not discuss is that there is a major war going on for the group, Individual, or company that comes up with the Salk Vaccine for Pca. There is so much work going on, I am afraid not for the glory, but for the billions and billions of dollars that will be rewarded to those discovers. This is not 1970----we are getting cures, that are not written about, but are not ready for prime time--they are still on the researchers lab bench--and they cannot figure out how to produce.

Give one example--I go to a Center of Excellence for My Oncology. My Doc. is head of prostate cancer research, at this large facility that has over 100 Doctors treating every Cancer. I am in for my 3 month visit last year and we get into conversation, because my Doc knows I come from a research background, be it a different discipline--so we respect each other. Get this; he tells me: That a month prior to my visit he gets a call from a researcher---he would not tell me who or who the researcher worked for--said he had a few grams of a material, developed at his lab, tested on mice,--and wondered if my doc could use a few milligrams on patients that were 4th stage near death. Well my doc agreed--and obviously patients had to sign their lives away to be experimented on--but they were going to be dead within 6 months anyway. I do not know if this stuff was a liquid, a powder, or how it was applied to the body.

My doctor had enough for 6 near death patients. 5 had 100% cures, the other died of a heart attack.

So stupid me--I asked how do I get some? Doc said based on what was available and only from a lab bench--that it would cost about 500,000 dollars a dose, and would need multiple doses--well I just said I would have to sell my Rolls Royce--just joking. But the point is--it is nice to have these summaries, from New England---I look to the future, to the unknown, and the untested--and the unknown researchers of the world looking to make that billion dollar discovery--for they are out there, and they are getting closer--we just have to live long enough.

Nalakrats

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"...new protocols will come from Immunology, targeted therapies for PARP Inhibitors, selected for each particular Mutation to allow for DNA repair."

Nalakrats, what of these to your knowledge, are currently available to people with metastatic prostate cancer, or can reasonably be expected to be approved for payment by insurance companies and/or Medicare in the next year?

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cesanon---I cannot study every mutation, or mutational combination.

I can only talk about mine. As I may have mentioned somewhere on this site in answering another individual--I was Gene Mapped only 3 months into my Pca, after DX.

By talking to Clinical Trial Navigators--not that I was eligible for any trial--I was told to get Gene Mapped---that they could see most of the trials were heading towards Immunology types, including vaccines. So I got proactive--and got Gene Mapped. I had 340 Gene evaluated, and found that my Mutations were BRCA-2 and PTEN. Since two years ago, a matter of fact about a year ago it was determined by the Meta Data of the Company[Foundation One], that did my evaluation that a new drug for BRCA-2 was working fairly well with women with Breast Cancer, but not approved for Prostate Cancer.

So for one of my Mutations we have a drug--Olaparib. I can use off label. And if I need it for free there is a process, to obtain---and if you heard the State of the Union, Trump wants to make the country a right to use country---that means no one can be denied unapproved drugs if the need it there to use. Right now about 30 States are right to use. And there is a process depending on your State to Obtain these Drugs.

My other Mutation PTEN--they did not have anything--but they found later that about 10% of men taking Olaparib, had some positive results against PTEN---not great odds, but I was looking at one drug for both---IF NEEDED--RIGHT NOW I AM ON A DRUG VACATION.

Well last week there was an article on Immunology, and PARP & Checkpoint Inhibitors & other techniques---and hidden in this very heavy scientific paper, was a reference to those with PTEN, usually men with this; present with PD-L1. Well this is what anyone wishing to use Keytruda--the Immunology Drug that cured Jimmy Carter's Brain cancer, has to present with for the drug to be successful---I have not posted on it yet, but have written it.

So as I sit writing to you, I have for each of my Gene Mutations I have them very well covered with Olaparib, and Keytruda.

Hope you did not mind me using myself as an example--but it was the best way to answer you. Car-T is doing wonders with some cancers by re-training T cells to attack and kill cancer cells. There are other things--but I got to take the wife to eat, Valentines Day!

Nalakrats

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Thank you, Nalakrats, for using your own data as a vivid example. We appreciate such clarity and openness.

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How did you get the article?

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That link worked for me. I found an alternative link here:

sci-hub.hk/10.1056/NEJMra17...

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What is the name of the Gene mapping service or process that you used?

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Foundation One--go to Google--place in search bar---get 800 Number---call and you will get an advocate that will walk you thru the process, benefits, and how it is paid for--Medicare Covers it.

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Sorry, all I could open was the abstract. It stated that I needed to get a subscription to read the article proper.

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That link worked for me. I found an alternative link here:

sci-hub.hk/10.1056/NEJMra17...

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Thank you. I think think I looked up so many articles form the nejm that they think I am a heavy user. Thus they cut me off from getting articles free.

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Hi Nalakrats and all.

The article sounds very interesting, although I was unable to open it and read the full article.

Nalakrats, thank you for sharing your own data and experience with gene mapping and your positive thoughts on what the future may hold for people with prostate cancer.

I do think that for Paul, unfortunately, it is a little too late. I am not sure that he will live long enough to benefit from any of those new treatments or ideas.

When I asked our oncologist the other day what he thought about gene mapping and immuno therapy treatments he turned to me and said, "I think we have gone beyond that to be honest." And, to be honest, I think he may be right. We don't have time to mess around with treatments and have to use what is there and proven to work.

However, if we were to get Paul's gens tested, how and where would that happen? What is the process like?

Mel.

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Call Foundation One--get 800 number from their web page--they will walk you thru the process--hubby does not have to do much. If there is biopsy or surgical material left--usually kept for 10 years---Foundation One takes over. If not it can be done thru the Blood-------why is your Doc. so negative---Is or has anyone considered if your Hubby has a positive PSMA, on the membranes of his Pca cells if so---Lu-177, where they attach an agent--where the agent attaches to the Pca cell and the radiation of the Lu-177 then kills the Pca cell. Germany has been doing this for 2 solid years---and most of work is in Munich.

Your Oncologist needs to get a bit more fire under his ass from how you describe things.

Nalakrats

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Nalakrats, what basically has been the clinical study results from Lu-177 so far?

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Here is the study being run by Endocyte the is still recruiting, 200 patient phase 2

clinicaltrials.gov/ct2/show...

The results from a smaller Phase 2 (30 patients) are listed as

oncologypro.esmo.org/Meetin...

All patients were enrolled between 10/2015 and 12/2016 (median age 69 yr, ECOG 1; PSA doubling time 2.2 months) with 3 pts awaiting a final treatment cycle. 87% received prior chemotherapy, 47% cabazitaxel and 83% prior abiraterone and/or enzalutamide. Mean dose was 7.5 GBq (range 4.4 – 8.7 GBq) prospectively adjusted according tumour burden, renal function and weight. At this interim analysis, 17/30 pt (57%) achieved PSA decline >50%, including 11/30 (37%) with decline >80%. In 17 pt with soft tissue disease, objective response (RECIST PR+CR) occurred in 12 pt (71%).

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I do not have a synopsis--just hap-hazard--info---most of the major work in the world is in Germany --Munich to be exact, is the capital of Lu-177 Treatment for Pca.

We were late in following the Germans--but if I wanted to do a study--I would do it from German data--then have my computer translate, into English.

Nalakrats

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Mel , if genetic testing could be done with a blood test as they do at quadrant, it may be able to identify a mutation with a therapy that is proven to work, I have read where myers said he had a patient with weeks to live, they found the mutation,There is a 33% chance of a mutation being found .got the treatment and they guy went off hospice and was thinking of going back to work, so Try to get it done. For me to get a surgical biopsy og abdominal mets ,was way to much, ended up with a week in hospital and a much weakened state, I could handle a blood test though. I also agree with Nalakrats about lighting a fire under the MOs ass. It also sounds like a good idea to be tested for psam to see if LU177 would work. I sometimes feel like my expert has put me out on an ice flow, however my local is very good and willing to try anything, so I am going with her for now.

Dan

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To Nalakrats point, there is a ton of work in immunotherapy, CAR-T, inhibitors, etc.

This is visual I found of the landscape (and it is probably outdated, with new therapies added daily).

ctep.cancer.gov/forms/docs/...

Lots of these are initially NOT developed for prostate cancer. But if you Google drug names with 'prostate cancer' for example ("pembrolizumab and prostate cancer"), you will see trials ,like Keynote, that are starting to apply therapies and combo therapies to prostate cancer patients.

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Re: Keytruda, (if anyone shives a git)

As I mentioned before besides my Pca I also have stage IV melanoma of the left lung. Following is my treatment log using Keytruda at $30K per treatment every three weeks).Number 1 treatment with KEYTRUDA on Tuesday 02/07/2017

Number 2 treatment with KEYTRUDA on Tuesday 02/28/2017.

*Took CT body scan on Thursday, 04/06/2017

Number 3 treatment with KEYTRUDA on Tuesday 04/21/2017. (SKIPPED!)

Dr. said that my recent C.T. scan (04/06/2017) showed that the nodule on my left lung decreased in size.

Lungs: Decreased lower lobe metastasis:

Now 1.2 x 1.0 cm. previously 2.4 x 2.2 cm.

Pleura/pericardium: Resolved small left pleural effusion.

Number 3 treatment with KEYTRUDA on Tuesday 04/11/2017.

Number 4 treatment with KEYTRUDA on Tuesday 05/02/2017.

Number 5 treatment with KEYTRUDA on Tuesday 05/23/2017.

Number 6 treatment with KEYTRUDA on Tuesday 06/13/2017.

Number 7 treatment with KEYTRUDA on Thursday 07/06/2017.

*Took CT body scan on Tuesday, 07/18/2017.

Dr. said that my recent C.T. scan (07/18/2017) showed that the nodule on my left lung decreased in size.

Lungs: Decreased left lower lobe metastasis:

Measuring now 0.6 x 0.6 cm. previously 1.2 x 1.0 cm.

No new suspicious lung nodules.

Pleura/pericardium: No effusion.

Number 8 treatment with KEYTRUDA on Tuesday 07/25/2017.

Number 9 treatment with KEYTRUDA on Tuesday 08/15/2017.

Number 10 treatment with KEYTRUDA on Tuesday 09/05/2017.

Number 11 treatment with KEYTRUDA on Tuesday 09/26/2017.

Number 12 treatment with KEYTRUDA on Tuesday 10/17/2017.

*Took CT body scan on Monday, 10/30/2017.

Number 13 treatment with KEYTRUDA on Tuesday 11/07/2017.

Dr. said that my recent C.T. scan (10/30/2017) showed that the nodule on my left lung stayed the same size and that was a good sign.

Number 14 treatment with KEYTRUDA on Wednesday 11/29/2017.

Number 15 treatment with KEYTRUDA on Wednesday 12/20/2017.

Number 16 treatment with KEYTRUDA on Wednesday 01/10/2018.

*Took CT body scan on Friday, 01/26/2018.

I met with Dr on Wednesday, 01/31/2018 and based upon my CT Scan of 01/26/2018 he said that I do not need any more treatments for 3 months since my scan showed the following

LUNGS/AIRWAYS: Further decreased residual ill-defined left lower lobe metastasis, barely perceptible. No new suspicious nodules. Schedule for a CT Scan on 04/24/2018 and a consultation with Dr. on Tuesday, 05/01/2018.

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