jfm1330 wrote: Concerning the fact that one tumor was 100% resolved and not the other ones. I will talk about my own case. As I said before, I will have two new traetments with Lu177-Dotatate, starting in mid-August. But in preparation for that and to have the green light, I had to pass three types of scans. First G68 PET scan to confirm the little progression of my cancer and to be sure my tumors were still catching the PDC through overexpression of somatostation receptors. After that, they sent me to pass a CT scan, to see if I did not have another type of cancer that they cannot see through Ga68 scan which shows only neuroendocrine tumors overexpressing somatostatin receptors. They did not see any new cancer on CT scan, but to be 100% sure, for the first time I passed a FDG PET scan able to see very tiny tumors based on their very high glucose intake. They did not see anything with this one either, so I will be treated.
So all that to say and show, once again, that doctors are aware that as a patient progresses in the disease, new cancer sub-types, genetically different from the original cancer can appear and that one type of treatment will likely not be able to treat them all. It is important to note that at this stage I am not considered to be an advanced patient. Sure I have metastatic cancer, but thanks to Lu177-Dotatate, doctors are able to stop the progression and have some tumor regression every two or three years. So I think I am relatively far from the type of patients they are enrolling right now. I am not without options and still in relatively good physical condition.
The important thing in my case is that I am lucky enough (in my basic bad luck) to have a cancer treatable with the only approved PDC, Lu177-Dotatate, that is coupled with an imaging brother, Ga68-Dotatate that allows doctors, with other imaging method, to assess to some extent the heterogenicity of my cancer. That does not mean my cancer is totally homogenous, it means that all my tumors are still overexpressing the somatostatin receptor, so they can all be treated by Lu177-Dotatate and this PDC works through beta radiations damaging DNA, so it is impossible to resist that.
In the case of TH1902, it is based on chemotherapy through docetaxel and we know cancer cells over time can become resistant to a chemotherapeutic drug, so if a patient has cancer cells still sensitive to docetaxel, and some that are clearly resistants, even to the higher doses TH1902 could allow, then you will have a diffrenciated response within the same patient, that not considering the possible variation in sortilin expression on cancer cells in a same patient. Marsolais said in the last CC that metastatic tumors have a tendancy to express more sortilin than non metastatic ones.
And to come back to my case, doctor told me many times through all my treatments with Lu177-Dotatate, that some tumors in my liver were shrinking and other stayed the same. Even two tears after treatment after Ga68 scans, they told me some tumors shrinked without treatment, while other ones grew a bit, but overall, my tumor burden in the liver was similar, they would call it stable. The doctor said to me that the biggest tumor I had, as they become bigger will miss oxygen delivery in the middle and cells ther will die of asphyxia and the tumor will collapse and look smaller on the scan. So cancer assessment through scan is a complex matter with many variables.
SPCEO1 wrote:
1.) In the patient who showed 53% tumor shrinkage on the targeted tumors, how many tumors were targetted. We know one tumor 100% resolved so, were there just two tumors being tracked and the other one barely shrunk at all? If so why would that be? Juniper88's wife saw pretty serious tumor shrinkage on some tumors but others grew. What explains these different reactions? If some tumors react and others don't what does that imply for TH-1902's future?