Immunotherapy and Blood Counts

[tom67inMA]

This week was supposed to be the start of cycle 4 of my chemotherapy for neuroendocrine prostate cancer, but it got pushed back a week due to low neutrophils in a time of Covid-19. Part of my cocktail includes Atezolizumab which is an immunotherpy agent. I found my blood counts for the last two cycles interesting, and thought I'd share to see if anybody else has seen anything similar or has comments to add. In other words, it's something to talk about while avoiding people.

So, yesterday, and also three weeks ago at the start of cycle 3, I'm seeing that my lymphocytes (which include the killer cells that in theory are unleashed by the Atezolizumab to kill the cancer) are actually higher than my neutrophils. Historically, since my original diagnosis in 2018, my lymphocytes have been at or below the lower end of normal in the 0.5-ish range. This makes it impossible to have a "good" neutrophil to lymphocyte ratio (NLR) while having a healthy neutrophil count.

But now my lymphocytes have spiked to 0.9 while neutrophils are at 0.5, which means my NLR is <1. I'm guessing NLR isn't prognostic during chemo, but am happy to see a good lymphocyte number while taking a week off from chemo.

Thoughts? Similar experiences?

[LearnAll]

Tom.....rising lymphocyte count is always good when we have PCa. Lymphocytes are main component of cell mediated immunity which kills, eats and destroys cancer cells.

Interestingly, My absolute lymphocyte count doubled after 2 weeks of taking live attenuated cholera vaccine (vaxchora) boosting cell mediated immunity.

NLR below 1 is absolutely lovely number.

[tom67inMA in reply to LearnAll]

My NLR won't stay below 1 once my ANC recovers, but hopefullyit will be better than before. It will be very interesting to see where I am next week, with my marrow finally having a brief chance to get up to full speed.

[Haniff]

Hi Tom

Thanks for sharing, quite interesting especially about Atezolizumab being a immunotherapy agent. Will like to know more about this.

Take care and looking forward to replies from the good brothers here.

❤️

Haniff

[tom67inMA in reply to Haniff]

Hi Haniff, the way I've been explaining it is that the PD-L1 protein is a "name tag" that says to the immune system "Hello, my name is Tom". The immune system only wants to attack things that are foreign, so it leaves anything expressing PD-L1 alone. Some cancers, particularly neuroendocrine, tend to over express PD-L1, and in my mind I see them as covered name tags and thinking they're pretty clever.

Atezolizumab is a PD-L1 antibody, so in my analogy it rips name tags of off all cells. This potentially exposes all cells to immune attack, but there have to be other, redundant mechanisms for the immune system to identify friend or foe. If PD-L1 is the primary reason the immune system isn't seeing the cancer, it can be very effective. If the cancer is employing other methods to avoid the immune system, it won't work as well, and helps explain why combinations of different types of immunotherapy might be much more effective (and even more expensive!)

In a small minority of patients, immunotherapy seems to be producing complete and durable remissions. It's far from a universal cure, but it is making miracle recoveries much more common.

[Haniff in reply to tom67inMA]

Thanks Tom 😊

[Hotrod65 in reply to tom67inMA]

Tom,my case is highly documented in the Boston Medical Community, although PD-1 negative, I'm also not MSI-H, I do have a DNA proofread error, PTEN, TP53, VS4-11 varients , but my Unprecedented Response is from my HBM...High Burden Mutation..48 infusions of Pembrolizumab over 4 yrs with 2 to to.. Complete Durable Clinical Remission NED.

[tom67inMA in reply to Hotrod65]

That's awesome! Did you have bone mets? If so, how do they look now on a CT scan? My CT scan still shows lots of "lesions", and the MO says that bone healing and mets look the same on a CT scan. It sort of makes sense to me that bone tumors can't shrink in the same way liver and prostate tumors can.

It seems genetic testing only shows the probability that a treatment will work, but some patients will still respond without the corresponding mutation, while others with the mutation won't respond. In my twisted mind, such uncertainty is reason for optimism because any one of us could be the next unprecedented response to a new drug.

Thanks for sharing!

[Hotrod65 in reply to tom67inMA]

Tom, never had bone Mets, just pelvic nodes and bladder neck.