Not the odd one out any more

[Justfor_]

A very knowledgeable source informed me about a multi-institutional UK trial using dose adjustment in ovarian cancer. Does it ring any bells to you?

"How does adaptive therapy work?

Resistance comes at a cost to cancer cells, and so they cannot grow as well when they are competing with non-resistant or sensitive cancer cells present in the tumour. Wiping out all of the sensitive cancer cells with high doses of chemotherapy removes the competition for the resistant ones, allowing their numbers to expand.

Instead of trying to kill as many cancer cells as possible, the goal of adaptive therapy is to maintain a small population of cells that are sensitive to chemotherapy throughout a patient’s treatment by using smaller drug doses and adjusting the dose accordingly as a patient’s tumour shrinks or grows. The sensitive cells that remain out-compete and suppress the growth of the treatment resistant cells, offering a long-term strategy to control the tumour and preserve sensitivity to the same drug.

Dr Lockley is the Chief Investigator and will lead the ACTOv (Adaptive ChemoTherapy in Ovarian cancer) clinical trial, which is the UK’s first trial to test adaptive therapy and the first global experience testing adaptive therapy in ovarian cancer patients.

ACTOv, which will be conducted by the CR UK & UCL Cancer Trials Centre, will recruit 80 patients with high-grade serous and endometrioid ovarian cancer (HGOC; the most common type of ovarian cancer) across nine hospitals in the UK (including St Bartholomew’s Hospital and University College Hospital in London). Half of the patients will receive six cycles of the same standard dose of a chemotherapy called carboplatin, while the other half will receive an adaptive therapy regimen of carboplatin.

In the adaptive therapy group, the treatment dose for each cycle will be guided by the level of a protein found in the blood of ovarian cancer patients, called CA125, which is a marker of tumour size. After each cycle, patients will have a blood test and if their tumour has shrunk (i.e. the level of CA125 has decreased), the carboplatin dose will be reduced and if their tumour has grown (i.e. the level of CA125 has risen), the carboplatin dose administered will be increased. By adjusting the chemotherapy dose in this way, the team hopes to preserve sensitivity to carboplatin in the cancer patients, while reducing the treatment dose required and associated toxicities."

bartscancer.london/general-...

[cujoe]

Almost sounds like they are following your lead. You may one day become a significant "outlier by design", which could prove to be a completely new n=1 category.

Sail on, Justfor_! And may the waters always be calm. Ciao- Kaptin K9

[addicted2cycling]

Almost sounds like an adaptation of the PCa BAT protocol

[cujoe in reply to addicted2cycling]

I think you may have that backwards. Gatenby was applying evolutionary/gaming models to cancer over 20 years ago.

moffitt.org/research-scienc...

[Seasid]

Why is the early chemotherapy the best? What is your opinion? Every treatment works better when introduced early.

[Justfor_ in reply to Seasid]

My opinion on treatments, any treatment, is that it should be quantitatively adjusted to achieve measurable results. This is what they are trying now in the UK. No less, no MORE, just as much as needed. The idea of the Maximum Tolerable Dosage is a disaster. Try to apply it to the power grid management and we will go back to oil lamps lighting.