How are people with liver mets doing?
Comments
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@intolight - I think that's a real good thing that your oncologist goes to the tumor board when you have progression. I'd never heard of that before, and it would be like getting a second opinion. Best thing is that your oncologist is obviously open to both doing it, and the opinions of those on the tumor board. She sounds really good. My oncologist did suggest the consultations, so I too essentially got second and third opinions. I think his original intent in suggesting them though, was to encourage me to be more amenable and confident about doing a localized liver therapy. I had been wary and wanted more positive information, while he wanted to arrange for some sort of procedure down the line when progression hit. I think he was a bit taken aback by what the surgeons had to say, but at least he was open to their assessments and suggested to me that it looks like their opinions are the ones to go with.
Getting routine CT and bone scans with contrast later this morning and am of course hoping for nothing new. It's always so scary, stressful, and anxiety producing to get these scans!
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@threetree I'll be thinking of you today as you go through your routine scans and praying they come back clear. The scanxiety is very real for all of us. An interesting note about the tumor board is that other physicians, etc., in my health system can view the tumor board meeting video. My PT who was an oncology specialist PT told me she saw my case reviewed and was able to customize my therapy accordingly. I would love to be able to see it but probably can't for FEMA laws. Still, I think there are some good medical things happening.
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@intolight - I really appreciate your good wishes for me for today. I'm sure you know all about the trepidation that comes with getting them. That's really interesting too about how your tumor board can be viewed on video by others. I haven't really heard much at all about my facility's tumor board lately. Maybe I'll ask around. I'd never heard of a PT being privy to things like tumor board meetings. Very interesting and makes sense. Thanks again for all the positive thoughts and energy - I will carry it with me on this dreary rainy day we are having here.
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3Tree, Thanks for relaying the essential information from those experts, and I suppose it makes sense given that in addition to the known mets, there may well be many micromets too small to be detected in scans, so no significant benefit to local treatment. However, as indicated in the article below there are quite a few reports now that histotripsy can be a strong adjuvant to immunotherapy, or may even have effects in the absence of checkpoint inhibitors, and because of the unique way it destroys the tumors the neoantigens are left more intact to allow the immune system to prime off of them and set off an abscopal effect where something of a systemic immune attack may happen. It doesn't get around the issue of the need for ultrasound detection, however the effect could be in principle be accomplished with ablation of just one or a few tumors, and I wonder if, with time, some tumor(s) might become detectable by ultrasound?
https://www.sciencedirect.com/science/article/pii/S1040842825004421
Abstract
Histotripsy is a novel, non-thermal ultrasound-based technology that utilizes focused acoustic waves to mechanically destroy tumor tissue. This review examines histotripsy’s potential to overcome immunoresistance and treat metastatic cancers by inducing potent innate and adaptive anti-tumor immune responses. Tumor destruction releases tumor-specific antigens and damage-associated molecular patterns, facilitating immune activation and transforming the tumor microenvironment from immunologically “cold” to “hot”. Preclinical studies show increased CD8 + T cell infiltration, macrophage repolarization towards a pro-inflammatory phenotype, and both local and distant (abscopal) tumor regression. Clinically, patient trials in hepatic tumors report high procedural success and safety, with initial reports of abscopal responses suggesting significant potential systemic benefit. Histotripsy offers potential benefits over radiation therapy, which rarely induces a systemic response, and immune checkpoint inhibitors, which are associated with severe systemic adverse effects. Although further clinical validation is needed, accumulating evidence positions histotripsy as a promising advancement in minimally invasive, immunomodulatory cancer treatment.
Highlights
- •Histotripsy utilizes non-thermal ultrasound to mechanically ablate tumors.
- •Histotripsy can shift the tumor microenvironment from "cold" to "hot".
- •Histotripsy can induce a potent systemic anti-tumor immune response.
- •The abscopal effect has been observed in human hepatic tumor clinical trials.
- •Histotripsy limits collateral and systemic adverse effects seen in other therapies.
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Dear @threetree , thanks a lot for such a detail descriptions of your visits to liver specialists. Statistically speaking they are absolutely right and their comments are very sobering, especially about the "untreatabillity" (ehm, what is this word?) of BC liver mets:/ Thing is - we separately usually don't fit one or another statistics' figure and therefore we have a " personalized treatment plan". In your case, knowing the whole history and big success while treating you, I'd go for biopsy and genetic testing (don't know if you have done that before or not) and reconsider systemic treatment to knock mets back. What do you think? Saulius
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@bsandra - Hi Saulius. I did have a biopsy and it showed that I have some sort of AKT1 (?) mutation that is not good. Apparently it makes the lesions and any "daughter cells" they have more aggressive. What the doctors tell me, is like you say, that systemic treatment, i.e. drugs, are probably the best and only route now.
@cure-ious - Thanks for all of the interesting info. I'm not really able to comment right now, because I'm feeling pretty bad from scans I had yesterday - both from the results which don't look good, and something like a "hangover", maybe from the contrast or something. I've got a headache, all over body aches, and lots of fatigue today; the day after a CT and bone scan. Never felt like this afterward before, but just can't think real well and pull thoughts together very much. I want to read more of what you posted and comment further at a later time. I do remember reading myself about the possible "extended immunity" that might come from histotripsy treatment, but I don't know much about it. The histotripsy surgeon I spoke to did bring it up also, but primarily as a "theoretical only" kind of thing. I could be wrong and maybe my memory is off, but I think what he said was that there were early indications of the extended immunity effect, but that it hasn't really played out very well in practice now over time. It wasn't anything that he could say definitely happens or would be a reason to give histotripsy a try. Again, I'm vague about what I remember, but I just know it wasn't encouraging in the least, given what had to say about the immunity thing.
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