In my introduction on the abscopal effect, we left off with the concepts of ensuring the effect and lastly, prolonging the effect. At his time, I would like to review possible ways to ensure/expand the abscopal effect.
In the article, they discussed using GM-CSF during treatment. GM-CSF is Granulocyte-macrophage colony-stimulating factor, a glycoprotein that stimulates production of white blood cells, macrophages, and platelets. The ability to increase production of wbcs and macrophages makes it a good candidate to be given after a treatment that results or could result in the abscopal effect IMHO. Why afterwards you ask?? At that point in time, immune cells have been exposed/activated by neoantigens of dying cancer cells to attack cancer cells, and GM-CSF could potentially expand the amount of those cells leading to an expanded abscopal effect.
Next, I'd like to take a look at vaccines and how they might play a role prior to giving treatments that could result in an abscopal effect. But why prior you ask?? In my opinion, this may be similar to priming the pump. By exposing the immune system to neoantigens early (priming the pump) prior to treatment then you might both expand and prolong the effect. What vaccines would be good candidates?? Any of the ones that I listed previously in the posts below and possibly Provenge:
Third, a new drug coming onto the scene in Australia—Veyonda. Veyonda has been shown to enhance the effect of radiation to tumors, but in preclinical models, it was shown to enhance the abscopal effect.
Lastly, the use of smart radiotherapy biomaterials (SRBs) loaded with immunoadjuvants is an up and coming possibility for ensuring and prolonging the abscopal effect. New cutting edge research on the development of materials that could be used to replace fiducials, or spacers loaded with immunoadjuvants. These would replace those items doing the role of those items, and at the same time, release substances over time to enhance the immune response.
Three cheers indeed... Now, if they can get the rate of response to 50% or more and for about 180 days or so, then that cure for oligometastatic patients looks more promising... there is a new trial coming with an oncolytic virus that looks good... prolonged immune response with radiation to the tumor after injecting the virus...I got my peepers on it...
While maybe not qualifying as the result of an Abscopal Effect, per se, about a year ago I discussed the inexplicable nature of my improving CLL blood cancer status being possibly related to the 8 weeks of IMRT I received back in 2014. That was about the time that my WBC (which is universally elevated in untreated CLL) took a noticeable nosedive from its previous 3x upper normal range peak a year earlier. WBC and ALC both dropped precipitously (by about 50%) within months after completing the IMRT.
Over the next 8 years white counts continued to improve - and at my June labs, all were in normal ranges for the 1st time since I was diagnosed in 2006. As opposed to an Abscopal Effect, I would characterized the benefit as being from the cumulative effects of the +/- 40 low dose radiation treatments to the blood flow & lymphocyte turnover in the radiation target area.
I also started major dietary and lifestyle changes plus the initiation of an extensive supplement and plant powder regime just prior to my RALP surgery in 2013. Until I noticed the IMRT/CLL improvement correlation, I had attributed the improvement to those changes. I now deem it possible that the combination of them all might have created a positive synergy that has resulted in my surprisingly improving disease status. In my discussion with my CLL Oncologist, she mentioned the possibility of an abscopal effect when I brought up the IMRT, but did not elaborate or cite any research that would support it. I have since searched Pubmed and can find no research that would support a benefit for IMRT to the prostate/pelvic area as being beneficial for blood cancers. (Altho' white cell blood cancers do often manifest themselves in the lymphatic system.)
Important to note that all the lymph nodes removed for the RALP, while testing negative for PCa, did test positive for CLL - so the RT might well have reduced the CLL cancer burden as an unintended benefit. It didn't stop my PCa from resurfacing in a BCR 3 1/2 years later, so thinking that i got a RT benefit for the CLL makes one think it was worthwhile after all.
All this is n=1 personal experience and not specific to PCa, but does maybe support a sort of cumulative abscopal effect at work. As a 2 x cancer victim, I gladly take any benefits, large or small, wherever and whenever I can find them.
Thanks for bringing up a topic that the patient community needs to be aware of. I have heard Dr. Andrew Weil describe the abscopal effect in treatments unrelated to radiation. Heal thyself is the first order of business for the human body, We just need science to give us the tools to do that.
I believe your hypothesis has merit...Irradiation of the lymph nodes could have resulted in a positive effect on your CLL....it makes sense to me... It may have been that you killed 2 birds with one stone...
Figuring out treatment sequencing with radiation and immunotherapy--vaccines or check point inhibitors, will be key to advancing the Science. As I say, it is advancing faster than people think....Good luck on your retest... awaiting results here... the down side of ordering your tests is the waiting for results, but information to make decisions and drive my ship far outweighs the negative of waiting... relaxing here... off to grab some exercise soon...
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