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Advanced Prostate Cancer
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Dr Sartor and Immunotherapy for Prostate Cancer

Here's an article about immunotherapy called "Desperation Oncology" from today's NY Times. What do you all think? nytimes.com/2018/04/26/heal...

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Wish the guy referenced in this article that had the incredible results was in this group! I wonder what mutation he has. In time, immunotherapy may be a first line treatment. Part of the cocktail.

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If the odds are 1% it will work for me and the out of pocket cost is 100K or so, count me out. I'm not going to take a big chunk out of my saving that my wife will depend to live comfortably.

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Immunotherapies have been especially disappointing for prostate cancer. Ipi and Prostvac do not work, at least not as monotherapies. Provenge extended survival by a few months, but not if used too early. Certain biochemical changes have to occur before an immunotherapy will work. Prostate cancer seems to look too much like "self" to the immune system. I am hopeful that some cocktail of immunotherapies may work better than single agents (albeit with greater risk of fatal runaway autoimmune reaction). I am also hopeful that immunotherapy combined with radiation or chemotherapy may be synergistic. Fortunately, immunotherapy clinical trials are being heavily funded by NIH and pharmaceutical companies.

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Tall_Allen You state that "Provenge extended survival by a few months, but not if used too early". At what point in the treatment sequence should I begin Provenge? Thank you.

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Tall_Allen,

I realize that you are not addressing natural-sourced immunomodulators when you refer to "disappoiinting" results for prostate cancer. See my posting below on beta glucan and consider this passage from Dr. Vaclav Vetvicka's paper on "Beta 1,3-D in Cancer Treatment":

"Among individual types of tumors found to be sensitive to the glucan treatment are lung cancer (Abe et al., 1985), hepatoma (Abe et al., 1984), squamous cell carcinoma (Arika et al., 1986), ovarian cancer (Chen et al., 1991), sarcoma (Diller et al., 1964), prostate cancer (Fullerton et al., 2000), bladder cancer, cervical cancer (Nakano et al., 1996) and breast cancer (V etvicka and Y vin, 2004).

The mechanisms of glucan’s effect on cancer development are still not fully elucidated. The most pronounced and most known effects of glucans consist of augmentation of phagocytosis and proliferative activities of professional phagocytes, such as granulocytes, monocytes and macrophages. These cells recognize and bind glucan via a number of different receptors such as TLR-2 (toll-like receptor 2), Dectin-1, CR3 (complement receptor 3), lactosylceramide and probably others. Binding of glucan to any of thereceptors activates macrophages. The activation consists of several interconnected processes including increased chemokinesis, chemotaxis, degranulation, adhesion to the endothelium and migration. In addition, glucan binding also triggers intracellular processes, such as the respiratory burst after phagocytosis of invading cells, increasing activity of hydrolytic and metabolic enzymes and signaling processes leading to activation of other phagocytes and secretion of cytokines and other substances. Persons interested in an excellent review regarding interaction of glucans with macrophages should read (Schepetkin and Quinn, 2006)....

And the discussion continues. To review the entire paper go to,

thescipub.com/PDF/ajisp.201...

In my posting previously, I am probably unfair to allopathic medicine. Beta 1, 3-D Glucan" is undergoing clinical trials widely in the U.S.'s leading cancer centers as adjuvant therapy with many different traditional chemo drugs.

CalBear74

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I am very jealous of mice - everything works for them! It's when they test in actual human beings that it usually falls apart, sadly.

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Tall_Allen,

I can appreciate your skepticism. However, don't let it work against you.

First, a definition:

"The edible mushroom Lentinus edodes is known as shiitake in Japan and xianggu in China.1 It originated in East Asia, where it grows on decaying trees and figures prominently in traditional medicine, but it is now widely cultivated around the world."

From Dr. Vetvicka we learn about lentinan (i.e., shiitake mushrooms) and advanced prostate cancer,

"In contrast to other glucans, Lentinan is usually ineffective when used orally. Recently, a superfine dispersed Lentinan with high oral effectivity was introduced. First studies showed not only safety, but significant effects on advanced prostate cancer (Shimizu et al., 2009) and in advanced colorectal cancer (Hazama et al., 2009).

Despite the fact that Lentinan is an official drug, Japanese scientist continue with evaluations of new possible venues of lentinan effects. Advanced oral squamous cell carcinoma is a cancer known for a high resistance to chemotherapy. Lentinan used simultaneously with an oral fluoropyrimidine anti- neoplastic agent S-1 strongly suppressed the cancer growth, probably via induction of apoptosis (Harada et al., 2010). It seems that, as a drug, Lentinan has a significant future and we can only hope that this anti- cancer drug will eventually show up in Western medicine as well."

Thus, we may see another potent beta glucan become available for patients in the U.S. Our world of medicine in this country is smaller than we realize - and then we suddenly hear about Heidelberg, Tokyo, etc.

CalBear74

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It never works against the patient to rely on clinical studies rather than speculation and lab studies. It only works against him when he takes hypotheses and treats it as proven science. It sounds like you swallowed the Kool-Aid.

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count me in...I would try it

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When they tried it in men who were recurrent after prostatectomy, it conferred no survival advantage. So. men who were still hormone-sensitive and were not yet detectably metastatic did not benefit:

clincancerres.aacrjournals....

in men with metastatic, castration-resistant PC, treatment at the lowest possible PSA had the best results:

goldjournal.net/article/S00...

Palliative radiotherapy to mets may improve its efficacy because more antigens are presented to the immune system. Similarly, concurrent chemotherapy may work particularly well because of the extra dead cancer cells in the serum and because the immune augmentation may overcome the immune suppression from the chemo.

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can't say if it works or doesn't, but my husband developed a second cancer 6 years ago. he was given Opdivo and Keytruda for it, long after everything for his prostate cancer either failed or barely worked....casodex, lupron, zytiga and xtandi, along with radiation and spot radiation to his mets, docetaxel. he lived 13 years.

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Do you mean he lived for 13 years after he was first diagnosed with prostate cancer ??

Thanks for any reply you may care to give.

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During my most recent appointment with Dr. Sartor a couple of weeks ago he mentioned what an exciting time this is in the development of immunotherapy agents and that we look look back on this era as a turning point in cancer treatment. When I pressed him on what the next step would be should I become castrate resistant he said things are being developed so quickly that it hardly makes sense to discuss them in the present tense, that in 6 months we could have new agents to try.

He has done genetic testing on me and found two mutations both of which increased my likelihood of getting prostate cancer. One of them, a CHEK 2 mutation, I believe could be susceptible to Keytruda based on my research. He mentioned Keytruda and Provenge as two treatment possibilities as well as high dose T as possible next steps during our visit.

Meanwhile I'm hoping for a long run on my current regimen but if and when the time comes count me in if an immunotherapy drug if it is offered.

One More Cast...

Ed

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Think all patients should be told of the small chance of success and the risks of serious side effect and the doctor should make a recommendation but leave the decision as always to the patient

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Darryl,

Natural immunomodulators have existed in medicine for many years, especially among naturopaths - a fact that has probably contributed to allopathic disdain. The current buzz about "new immunotherapy drugs" overlooks the hard work of researchers like Vaclav Vetvicka at the University of Louisville Medical School. (It also typically downplays the success of the Japanese medical system in using natural immunomodulation in their licensed oncology since the 1980's.) I have been on an immunotherapy regimen following Dr. Vetvicka's protocol. I must emphasizet this is nonprescription drug you should combine with vitamin C (oral) and resveratrol. I recently added a baby aspirin to the mix. Go to vitawithimmunity.com for more information about Beta Glucan. Dr. Vetvicka is interviewed along with a number of other physicians. Please read his text to fully understand this option and the power of beta glucan. Because of the extensive, worldwide research on beta glucan, I use exclusively Beta 1,3-D Glucan (#300) from Transfer Point. I take 3 - 500 mg. glucan capsules, and two Nature's Answer resveratrol capsules (containing vitamin C, quercetin, and a proprietary blend of polyphenols.) on an empty stomach in the middle of the night. Dr. Vetvicka urges one dose only a day of 3 beta glucan capsules with the resveratrol and vitamin C. Some smart people have said go with 1 capsule for every 50 lbs of body weight.

Please understand I am not in anyway claiming this approach is equivalent to the type of immunotherapy using proprietary physician-managed drugs being discussed in the article. Bill48162 points out the big barrier to trying out this approach.

I have read a case study in the third edition of Dr. Vetvicka's text (not available from Amazon as it apparently has sold out) from a breast cancer patient, a retired physician in Florida, who believes that her cancer is in remission (she calls herself "cancer free") because of beta glucan. All other traditional medical treatments had been exhausted and her cancer was unrelenting.

abebooks.com/Beta-Glucan-Na...

These articles are intriguing:

ncbi.nlm.nih.gov/pubmed/217...

ncbi.nlm.nih.gov/pubmed/108...

Please note the above investigators used maitake mushrooms for extraction of the glucan; research has indicated Transfer Point's glucan derived from baker's yeast is consistently more potent.

Glucans are derived (polysaccharide long chains) from a number of different sources. This is an interesting review of these bioactive compounds:

ncbi.nlm.nih.gov/pubmed/288...

Your happy vegan, CalBear74

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Dr Sartor was my Dad's doctor. He is amazing! The clinical trial Dad was in did extend his life, I feel, however it did not ultimately get approved for Prostate Cancer (XL-184). Unfortunately, Dad succumbed to PCa 5 years ago at age 72.

Dr Sartor was very compassionate and available, unlike Dad's local medical oncologist. Dr Sartor always seemed to have an open mind about what worked and what didn't. I would recommend him to anyone.

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Interesting article. I think this is the second article from the Times that has put a questionable bias on immunotherapy. Not sure why. I guess people are expecting an overnight miracle cure. My take is, it has been shown to work, but is not repeatable with confidence. We need to understand it more, but I am not discounting the line of treatment.

A decision to move forward is always up to the patient, and the doctor should lay out the pros and cons and go from there.

In terms of 'it's a long shot...", that make me chuckle a bit. It is a long shot I am in this situation.

1 in 9 men are Dx with PCa - I beat those odds

Only 5% are Dx mid-40s - I beat those odds

Based on my pathology, and GL 3+4, odds were 85% of no BCR within 5 yrs, 75% in 10 - Beat those odds, with BCR in 2 yrs

Now looking at 70% chance for 5yr+ durable remission - Really, really hoping to be with the odds on this one.

Who knows, maybe down the road I need treatment where the odds aren't in my favor :)

Overall, I think they are on the right path with this treatment, it will just take time to figure it out.

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Emak1

What medications are you taking now?

Rich

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Just ADT (firmagon) and almost done with salvage radiation Hoping this does the trick but who knows

Was mainly commenting on immunotherapy in general

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I know this is sort of off topic... but the Keytruda I take has "eliminated" my Lung melanoma. I just saw my melanoma oncologist (today) and after being on a three month "vacation" she's given me another three months. She determined this after viewing my Pet Scan (Pleura/Pericardium - NO ABNORMAL UPTAKE). As far as my Pca I'm still fighting the son-of-a-bitch.

Good Luck and Good Health.

j-o-h-n Tuesday 05/01/2018 5:22 PM EDT

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In 5-10 years I hope immunotherapy is one of the first choices, not a last-resort, , even for fast-growing metastatic PC. At $100K insurance will not cover this for me unless I’ve exhausted chemo.

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When you're out of other options why not try it? You need full disclosure obviously and you don't want to bankrupt the family but is you can get it covered why deny the patient the choice?

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Can I reply to you

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Can I reply to you

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Yes

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My uncle was treated by Dr Sartor for a couple years. He had very advanced prostate cancer and tried anything and everything offered by Dr Sartor. My uncle passed away in Nov 2018. If anyone has specific questions regarding treatment, direct message me and I will get answers from my aunt (she was 99% involved in the treatment, all the way up to taking the meds).

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