TREATMENT OPTIONS:

Is surgery right for you?   

Surgery is typically an option for patients with stage 1 or stage 2 cancers, and sometimes stage 3. Surgeries have a higher level of risk to your body than non-invasive methods to eliminate tumors. But again, each case is different and you want what is best for you. That brings us back to getting more than one opinion, and you with your loved ones make the call.

Sometimes surgical removal in the earlier stages may be the best option. I would be very cautious on any surgery for stages 3 and 4. Once the cancer has advanced to stages 3 or 4 it means that your cancer has spread throughout your body within your bloodstream and can start to grow anywhere. Trying to do surgery for more than one location really drives up the risk. There are other techniques at these stages that are less risky.

Here’s one example: I helped a patient whose husband was going to have surgery on his brain to remove a tumor that metastasized there. I told her about a technique which could zap that tumor without surgery called Cyberknife (more on this topic later under “Radiation in cancer care”). I suggested they ask their doctor about that procedure. She did, and he had never even heard of it before because it was relatively new. I did help her find a location close to them that offered this procedure. They did go and it ultimately prevented her husband from having brain surgery.

In my case, I currently have 1 tumor in my left lung, 3 tumors in my chest, 5 tumors on my spine, and 8 tumors in my brain. I have never had to undergo one invasive surgery for any of them. These tumors are all still present, but either dead or dormant. I was treated with targeted oral medications, targeted chemo and targeted radiation … with no surgeries.

Chemotherapy options

Chemotherapy should by no means be the “standard” or “go to” procedure for everyone who has cancer. Chemo does kill cancer cells, but it also kills a lot of good healthy cells in your body.

Remember, chemo chemicals that are put into your body are harmful to your body and can lower or compromise your immune system, making you much more susceptible to other infections or diseases. However, if there are no other options, this may be the only treatment available to you.

Targeted chemo is a much better option. These are specific chemotherapy drugs that are targeted to hit cancer cells more than normal cells. Some are also specifically aimed at attacking cells specific to your type of cancer or DNA mutations.

Maintenance chemo is a long-term chemotherapy regimen after your initial chemo combo is complete. It is typically not as strong as your initial chemo treatments, and also more likely to be targeted chemotherapy, which is better. I will share later in the “Lessons Learned” tab where I went wrong with maintenance chemo.

Closing note on chemo: Most all chemotherapy will make you ill to some level. Typically, the first couple rounds are the worst. You could have serious side effects, or very minimal ones. Each person is different. There are numerous types of newer nausea medications available to you, if needed. Again, each person is unique and medications can affect each person differently. You know your body best, so you and your oncologist can make this decision better than anyone else.

Targeted Therapies

Without a doubt, targeted therapies are some of the best treatments for cancer patients! Typically, they’re the easiest to receive and one of the most successful treatment options to fight your specific cancer. Of course, you need the details related to your tissue and liquid biopsy results (precision medicine tests) to insure you have the targeted information you need. In my case, I originally took an oral pill Tarceva (designed for the EGFR mutation) for approximately 8 years. I am now on a newer medication called Tagrisso (which is designed for EGFR and T790 mutations). I believe this targeted approach saved my life. Use every option available for your specific illness.

NEW! (12-13-2019) Dana-Farber  explaining Precision Medicine and Immunotherapy for Cancer: What to Know.

NEW! (10-6-2019) National Cancer Institute (NIH)  explaining Targeted Cancer Therapies and treatment options available today that are approved by the FDA.

NEW! (9-4-2019) MD Anderson article describing Targeted Therapy which supports this fantastic direction for cancer patients.

Radiation in cancer care

Radiation oncology is another very important topic. Technology has changed drastically and in the right direction regarding your treatment options here. The latest radiation techniques have been greatly improved. It’s disappointing to hear, but today some doctors get in a rut on radiation oncology and choose the option of the older “standard techniques” or whatever they have locally in their institution.

Today there are many, many options available. You need to decide what option is best for you. Learn about the top 2 or 3 and then make your decision … again, with everyone’s input. I cannot express strongly enough the differences and importance of the various treatment options you have available.

Do not always accept “standard” radiation treatment. As I mentioned earlier, when I ask patients to question their doctor about these new techniques, some are unaware of the new technology … or know very little about it.

Below are a few video links that have previously been recorded for local ABC and CBS channels discussing the advanced and effectiveness of the Cyberknife option.

Videos on link; ABC 1 (Dr. Kresl video), ABC 2 (Dr. Kresl & Joe video), CBS (Dr. Kresl & Joe video)

Other radiation techniques to investigate with your doctor are TrueBeam STx , other SBRT options, and Proton Therapy to name a few.  The point here is there are many options.  Ask your doctor(s) which is best for you, not what they have on hand at their institution.  It is 100% ok to go to the best radiation technique geared for your specific case.

Immunotherapy: The next wave

Immunotherapy — or I/O — is one of the most improved and promising research areas in the fight against cancer. This method uses your body’s own immune system to kill the cancer cells. There are approved immunotherapy drugs for many cancers, including melanoma and lung cancer.

There are other techniques like CAR T- cell technologies that were recently approved by the FDA. I believe this is the most promising area to watch for us all. For a moment, imagine not having to deal with major chemo. Then imagine the same for radiation therapy. We can get there!

This is another reason to Give It Your All and be there when these promising technologies will be ready. Just recently I watched a show called First in Human on the Discovery channel. This program documents the real life stories that are currently taking place in building #10 of the National Institutes of Health, where the first in-human studies are being conducted with these amazing immunotherapy techniques. More to come here!

There’s more information at these websites:

Memorial Sloan Kettering (MSK) – CAR-T Therapy

NEW! (3-1-2019) MD AndersonImmunotherapy Platform

Columbia University Medical CenterCAR-T therapy   Special note:  The Oncologist who saved my life back in 2005, (Naiyer A. Rizvi) who was at MSK at that time, is now the Co-Director of Cancer Immunotherapy at Columbia University Irving Medical Center in NYC.  He is an internationally recognized leader in the treatment of lung cancer and immunotherapy drug development. I mentioned earlier in my “Intro/My Story” section about weak, average, and great doctors.  Dr. Rizvi is in the great category.  He was the third opinion I got, and was the greatest. So again, always look for that 2nd and 3rd opinion to get the greatest doctor/institution that you can.

Dana FarberCell Therapy

There are many more new technology options not listed here … but they are out there and possibly available to you. Keep researching for your particular situation/options.  A couple more examples below:

Hormonal drugs: Taken from National Institutes of Health website:  “Hormones can encourage the growth of some cancers, such as breast and prostate. But, in some cases, they can kill, slow or stop cancer cells from growing. Hormone therapy usually involves taking medications that prevent cancer cells from getting the hormones they need to grow.”

Tumor Vaccines: Taken from the Dana-Farber Cancer Institute website: “Cancer vaccines represent another approach to marshaling the immune system’s disease-fighting forces against cancer.”

New Technologies to Watch as of June 2019   

NEW! (12-29-2018)  First Targeted Cancer Drug Approved Based on Mutation Rather than Tumor Type: This is Big Step Forward for Precision Medicine!  Please click on the link above for a more detailed explanation from Memorial Sloan Kettering.  In the past, you could only get a drug approved for your specific tumor type, i.e. breast, lung, pancreatic, etc. With this new approach based on mutation type, it would not matter where the cancer is in your body, again i.e. breast, lung, liver, etc. This particular approval is for cancers caused by a genetic mutation called a TRK fusion. This could be a life saver. Going forward more approvals using this technique based on mutation type will save many more lives of cancer patients. To know what mutation you may have, you must run the simple liquid biopsy test described in SECTION 1: DIAGNOSES under the TISSUE AND LIQUID BIOPSIES SECTION.

Tumor Paint: This is another potential breakthrough for surgical removal of tumors. This technique is amazing … and my best guess is that this will become mainstream in the near future. Typically when a tumor is removed by a surgeon they like to think, I got it all. In some cases they do get it all, but in many cases they do not. Cancer can be so small and unnoticeable in nearby locations of the tumor that is being removed.

This so-called “paint” will light up the tumor cells that are normally not visible to the human eye. This will definitely help with the removal of cancer in surgeries. It’s like when you put a black light on a scorpion in the middle of the night, it will light up thanks to luminescence. Using this technique will allow the doctor to remove tumor sections that he or she previously could not see … the paint lights up the abnormal cancer cells!

See examples here:   Example 1 from Seattle Children’s Foundation, and Example 2 from CNN.com.

Unsung Immune Cell that Could Change Immunotherapy : New development from Memorial Sloan Kettering.

Crispr:  CRISPR technology is a simple yet powerful tool for editing genomes. It allows researchers to easily alter DNA sequences and modify gene function.

Tumor Mutation Burden (TMB) Unlocking Cancers Genetic Fingerprint:  This site is a bit more technical than most, and I would not expect the average person to understand these details. But the idea here is just to be aware of new technologies going on today.  It could be something you can ask your oncologist about, and if this technology could potentially help your specific case.

Here is a quote from the site:  Tumor mutation burden (TMB) is a measurement of the number of mutations carried by tumor cells and an emerging area of focus in biomarker research. By comparing DNA sequences from a patient’s healthy tissues and tumor cells, and using a number of complex algorithms, scientists can determine the number of acquired somatic mutations present in tumors but not in normal tissues. “It’s important because that’s a marker in the cancer itself. By measuring TMB, the cancer cell now has a unique fingerprint of natural and mutated proteins.”

Early Detection Blood Tests: Today scientists are taking the existing liquid biopsy test and developing an early detection blood test. Today’s liquid biopsy test is only used after the cancer cells have spread in stages 3 and 4. With this new technology, scientists want to identify cancer cells much earlier, in stages 1 and 2. This test is in the early phases of development, but is proving to be very promising.

NEW! (4-14-2019) CancerSEEK  is another Early Detection noninvasive test that can detect cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung, or breast.  This was developed by Researchers at the Johns Hopkins Kimmel Cancer Center.  From the site: This test represents the next step in changing the focus of cancer research from late-stage disease to early disease, which can  be critical to reducing cancer deaths in the long term.

NEW! (6-6-2019) DEFI  yet another early detection blood test showing great promise.  I love the direction we are going.  Finding cancers earlier, which will lead to more successful outcomes for patients. From the site – DEFI  (DNA evaluation of fragments for early interception) — accurately detected cancer in 73% of cancer patients overall, and only misclassified four out of 215 patients, meaning it had just a 2% error rate.  It is worth the read to understand how this process works.  Similar technology as liquid biopsies, but analyzed in a different way to detect 7 different cancer types.  I could see this simple test being run each time you get a yearly checkup

NEW! (11-21-2018)  Poliovirus Therapy for Glioblastoma: Phase 1 study of Duke therapy shows long-term survival benefit for a lethal cancer.

NEW! (4-14-2019) Radioembolization (Y90)(from the site RadiologyInfo.org) – Radioembolization is a minimally invasive procedure that combines embolization and radiation therapy to treat liver cancer. Tiny glass or resin beads filled with the radioactive isotope yttrium Y-90 are placed inside the blood vessels that feed a tumor. This blocks the supply of blood to the cancer cells and delivers a high dose of radiation to the tumor while sparing normal tissue. It can help extend the lives of patients with inoperable tumors and improve their quality of life.  For a video which explains this procedure Click here

NEW! (7-20-2019) FDA’s (Food and Drug Administration) Project Facilitate Will Assist Requested Access to Unapproved Cancer Therapies.  From site – The two-pronged program is called Project Facilitate, run by the FDA Oncology Center of Excellence, and Expanded Access Navigator, which is operated by the Reagan-Udall Foundation for the FDA.  I believe this is a great step forward where patients could have access to life saving drugs even if not yet approved for their specific cancer.“The (FDA) Expanded Access (compassionate use) program permits patient access to investigational products outside clinical trials,” the researchers wrote.

Treatment options will continue to get better.  I will try to add significant new options on this site.  But also look for your specific/personalized info (cancer type and DNA mutation type) and continue to research new developments pertaining to your case.

 

Clinical Trials

Another available option is a clinical trial. When and if needed, you should discuss this option with your oncologist. Typically this happens when existing treatment methods are not working, or your case is very unique, or you are looking for additional options with the latest technology. This is best described in the following two links:

Description of Clinical Trials: A good overview from American Cancer Fund.

NIH database of Clinical Trials: A service from the National Institutes of Health.

 

Closing comment on all treatment options:

Again, get all the information you can, but I strongly suggest getting another viewpoint/opinion from another institution. If they match, great. But in some cases they do not. This can be a life and death decision if you choose the wrong treatment plan. There is nothing wrong with validating the first doctor’s opinion on treatment options. Be strong, and be informed! It could save your life.