Just published this past week in JAMA Oncology it nicely goes through the processes behind selection of immune therapy in melanoma, which is the gold standard immunotherapy model we know the most about. Do not get bogged down in the details. Understanding the complexity by which therapeutic decisions are made and the outcomes they produce is enough to realize we have a very long way to go before we control the cancer response to such agents. In my field of pancreatic cancer we have so much more to learn before we reach the point melanoma has been at for years. The more we know, the more questions arise and once again our hubris is put in check.
Robert Donoway,MD,FACS
AtlasOncology.com
https://jamanetwork.com/journals/jamaoncology/fullarticle/2770701?guestAccessKey=c0567c82-dd7b-46b2-b3cb-6290a510b065&utm_source=fbpage&utm_medium=social_jamaonc&utm_term=3747225616&utm_campaign=article_alert&linkId=100392313&fbclid=IwAR16ZWh1dB_N7iD2vMaj54Cmcea9yg1nqlEGKgiMvfCFe1M-hdz0FaIXz2g
JAMANETWORK.COM
Rationale for Immune Checkpoint Inhibitors Plus Targeted Therapy in Metastatic Melanoma
This recently published research from a Harvard group has identified one of the differences in those resistant cancer cells that survive chemotherapy. Though this was identified in a leukemia cell line it will not be long before it's translated into other cancer types. The key here is that this becomes a new target that could lengthen the times effective therapy can be administered so that further attempts at cytoreduction could lead to improved cancer control, whether by surgery, radiation, immunotherapy or even further chemotherapies. Certainly this ground breaking research will be worth following closely.
Robert Donoway,MD,FACS
ATLASOncology.com
AskDrDonoway@Gmail.com
Acinar Cell Carcinoma represents less than 2% of diagnosed Pancreatic cancers. Though surgical resection remains the mainstay of treatment for curative intent new genomic targets have been identified that offer additional options to standard chemotherapy. This case report and review describes a Tail of pancreas lesion and isolated Hepatic segment 6 metastasis treated by the minimally invasive lap-robotic approach which is gaining fervor for readily amenable and easily treated cancers where fear of contamination and dissemination are less frequently experienced.
Robert Donoway,MD,FACS
ATLASOncology.com
https://lookaside.fbsbx.com/file/Robot-assisted%20pancreatectomy-hepatectomy%20for%20ACC.pdf?token=AWz8dhIm7AMLFyYPVqEPnLKGXV6rHaYfxfNZLv_p-XdAXvUTD68ZX66Fgu4Aeyon_Fvy8Acy3b2TVcLfzvUL58TJMLIXxhTAPTYqgFxwCmEAi0if-1UXQ2chgRHaFBhxtYr1kE_AYHZ25vvOELvVhYpKBr86MI1kha5WJQ67euQslsp1pGtOki2Zcvbr5SZEBSwrpwhqFor125sAn7GCQ5GK
21st Century technology may afford better Tumor testing to select more effective chemotherapy drug combinations.
Robert Donoway,MD,FACS
ATLASOncology.com
Robert Donoway
June 21 at 7:24 AM ·
Now we're getting somewhere. For over three decades we have used various"tumor tissue" based platforms (eg, OncoTech) to identify both tumor sensitivity and resistance to various drugs. I had used it in the mid 1990's as newer drugs were emerging and becoming available but trials had lacked support for their use. Unfortunately intra-tumoral "contaminants" such as structural connective tissue would dilute the assays and question the testing validity. These current investigators using an Artificial Intellgence based platform may be able to break the barrier. This testing along with identifying and integrating Repurposed drugs with unsuspected anti-cancer benefits into mainstream cancer care may lead to some of the most significant applications and advances in the coming years.
Robert Donoway,MD,FACS
https://stke.sciencemag.org/lookup/doi/10.1126/scisignal.aay1451
Again we find diet having a significant impact on cancer therapy. More to come.
Robert DonowayMD,FACS
Atlasoncology.com
Robert Donoway
June 9 at 6:14 AM ·
This is an interesting and easy to read article posted earlier this morning. It again shows the importance subtle dietary changes can have even on the effect of chemotherapy. This is an area that warrants tremendous investigation as so many of the differences in response to therapy may be contingent on our own dietary manipulations that we do unwittingly in the course of each day. Artificial Intelligence platforms such as those that are researching how “Repurposed medications” effect cancer therapy and response will need to be used as each individuals microbiome is so unique that differences in individuals based on genetic differences may have significant bearing- person to person. So this is an exciting area to keep you’re eye on.
Robert Donoway,MD,FACS
Atlasoncology.com
https://www.jpost.com/health-science/cancer-treatments-significantly-affected-by-diet-researchers-find-630749
This is a useful point of reference for those looking at adding Y90 in treating their Pancreatic Cancer "Liver Metastases" from a leading authority. I will discuss in greater detail in a future post and provide a more extensive list of references for Liver specific targeted therapies including Y90, TACE and HAIP.
Robert Donoway,MD,FACS
ATLASOncology.com
https://interventionalnews.com/y90-radioembolization-metastatic-pancreatic-cancer/
If anyone would like to ask questions anonymously you may email:
AskDrDonoway@gmail.com
and I will incorporate them into a followup answer.
Patients and caregivers who are considering IRE/NanoKnife of the Pancreas, Liver and Retroperitoneum are welcome to check out the
NanoknifeSurgeryAnswers FaceBook site where more technical explanation and references are posted.
This study which compared the more favorable outcome of patients who received chemotherapy following surgical resection and debulking in colon cancer with peritoneal metastasis. This has been found ito Bd true in other GI and GYN malignancies with a similar trend being seen in Pancreatic cancer from studies using PIPEC in Japan. The importance of chemotherapy following surgical resection for curative intent cannot be stressed enough as that is the best time to control occult micro-metastatic disease rather than waiting for it to be visualized CT imaging.
Robert Donoway,MD,FACS
AtlasOncology.com
https://jamanetwork.com/journals/jamaoncology/article-abstract/2768020?utm_source=facebook&utm_medium=social_jamaonc&utm_campaign=article_alert&utm_content=automated_rss
JAMANETWORK.COM
Adjuvant Systemic Chemotherapy vs Active Surveillance Following Resection of Colorectal Metastases
