So it would seem I'm posting much more frequently in my extra week between cycles. There is a sort of urgency to get things done before I go back into my chemo stupor next week. Later today I'll be doing an oil change on the pickup, but I digress. Is it even a digression if I haven't even started the main topic yet?
Okay, biopsies! Back in January I had a biopsy taken from my liver and received a paper copy of the pathology report from my MO, showing everything they tested for. It was also supposed to undergo genetic testing, but all I have to show for that is some vague verbal comments from my MO to the effect of "no actionable mutations found".
He also said something about running out of material from the biopsy. This is where chemo and getting lots of new information all at once leave me a lot more befuddled about things than I'm used to. But it would seem that each pathology or genetic test consumes a small amount of tissue from the biopsy. Has anybody else had a similar experience?
When the biopsy was done, I specifically told the doctor to take as much of the tumor as he could. Apparently I wasn't the first patient to make such a joke. Going back and getting more tissue probably isn't an option, as my liver tumors are shrinking and soon will likely be too small to biopsy. Of all the rotten luck
What has been everybody else's experience with genetic testing of a biopsy? Has it actually led to a treatment change that was effective? Did it change treatment but was ineffective? Or did it not change the treatment plan at all? Finally, did you respond to a treatment that genetic testing implied wouldn't work? I'm under the impression that all of these outcomes have occurred multiple times, but it's difficult to say how common each one is.
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it's very common that there is not enough material from a biopsy. They have to use the material wisely, in order of tests that are likely to lead to actionable treatments. Unfortunately, few results are actionable for prostate cancer. In order of importance are histology, IHC, and genomics. You are right that as your tumors shrink, getting enough tissue can be problematic, and CTC analysis (or cell-free DNA) is unlikely to show anything. You can get a cheap germline test from Color Genomics, which is usually uninformative too, but for $250, why not?
Thanks TA, I was hoping you'd reply. I did have a germline test, and all it found was a "significance unknown" mutation in BRIP1. Generally I have mixed feelings about the test results. It's nice to find something that opens the door to more treatments, but on the other hand, it also probably means the cancer is more virulent if you have such mutations.
I agree that it is a double-edged sword. Keytruda often has spectacular results if you are "lucky" enough to have MSI-hi/dMMR (less than 1% in PCa), and the PARP inhibitors seem to work primarily with certain BRCA mutations. Other than those, genomic treatments are in very early clinical trials. Certain subtypes are apparent on histology or IHC, but they are mostly useful for ruling out treatments that are likely to be ineffective.
Thanks for posting this, Tom, since I didn't fully understand what the procedure entailed. It kind of explains why our MO at Mass General didn't show much interest in pursuing a tumor biopsy for my husband. Ditto our local MO a couple weeks ago when my husband asked about getting one. He did have the Guardant360 test last summer, but it wasn't actionable.
Cancer is heterogeneous and changes over time, just look at the experience of Vindog29 below. When I first asked about genetic testing in 2018, the MO said the tests had gone from testing for less than 20 mutations to more than 30 recently, and we decided not to test at the time. When we did the germline test this year, it tested for something like 60 mutations.
Precision medicine is an interesting idea and shows promise but looks like it will be tricky with widespread metastases because it's not practical to biopsy every tumor.
As I often post my husband had 2 biopsies done,first one showed no mutations, 2nd one MSH2 and received Keytruda. PSA went to undetectable and has stayed there. Tumors shrunk and have stayed stable. Stopped after 2 treatments because of elevated liver enzymes. However just those 2 treatments were a miracle since docetaxel and Zytiga didnt work.He is one of the lucky ones,it will not be cancer that will kill him but other health and lifestyle he refuses to change. Best of luck and I pray you too find your miracle.Stay safe
Wow, that's an impressive story! The Atezolizumab I'm on is a PD-L1 antibody just like Keytruda, and hopefully will work for me as well. Thanks for sharing, it's very encouraging to hear the cancer can stay stable even if treatment gets interrupted in these pandemic times.
Hello Vindog29, I had a Decipher Genomic test from my biopsy,and it basicly just said, I am High Risk for metastases after Definitive Treatment in 5 years,etc,etc.Because 6,000 other men with similiar gene expressions had metastases in that time frame.(It doesn't seem to matter how they lived or diet after diagnosed )Thsts according to Doctors I have talked to about that - even though genectist said gene expression can change -so I am hoping to get another biopsy to see if my new lifestyle changed my risk factor )But back to the subject Genome test said Nothing about what mutations types,etc.I sent them a Medical release form to get a practional report to be sent to another company called Toolbox,(they suggested sending it)where I am waiting on a Epigenetic test results.Although, that may lead to nothing-i am new at it all.Would a germline test help me figure out anything?Does only men with metastases can get the genetic Immunotherapy drugs and PD-L1 inhibitors. What I am getting is in one hand, I should hurry up and get RT or RP because of my Genome score.69, but Genectic drugs or inhibitors -they do not see fit to talk about.They are saying RT or RP and hormone therapy is the only thing that's a solid move,for a newly diagnosed low to intermediate 3+4 Gleason. Grade2,Psa 3,guy, because of a high risk genomic score,but I am trying to make sure.
I also experienced not having sufficient tissue to perform genetic testing at the time of my initial biopsy in May 2018. After my prostate was removed in November 2018, there was plenty. This went to Foundation Medicine for an extensive and expensive genetic test. I also had a different genetic test using a saliva sample, which was done by color.com and was very cost effective (under $260). Both tests came back with BRCA2+ mutation. As a result, I was put on Olaparib PARP inhibitor, which has kept my PSA undetectable for over a year so far.
LOL! It got 7 quarts of Castrol 5W-20 that meets Ford specification yada yada yada. There's not as much difference between synthetics and dino-juice as there used to be.
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