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Access to needle biopsy of cancer metastasis, best integrative approach? Please help

cancer lung nagourney biopsy pd-1 genome gene therapy immunotherapy

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#1 studentlost

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Posted 03 December 2014 - 08:54 PM


My dad, a non smoker, was diagnosed with Stage 4 lung cancer beginning of 2013. He had one primary tumor in his lung, and one metastasis in his hip. Did great on carbo/alimta/avastin combo. Both the hip and lung nodule are incredibly small now and stable/shrinking. However, now, has lymph node growing in neck. This lymph node was slightly enlarged from the beginning but remained stable until now.
 
 
They are going to do a needle biopsy next week. How can this be utilized to full potential? Right now I am thinking:
 
Dr. Robert Nagourney for functional profiling 
 
Whole-exome sequencing / CNV screenings
 
Check for PD-1 target for nivolumab trial
 
HDAC inhbitor response testing?
 
What would you recommend? Should RNA sequencing be done? Just DNA? What's a good way to find out all mutation drivers to help target it better? And maybe a comparative toxicogenomics panel?
 
Please tell me your opinions, which you would pick, why, and where is the best place to have the testing done.
 
Thank you so much for your help


#2 joelcairo

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Posted 04 December 2014 - 12:50 AM

I think Dr. Nagourney needs a sizable sample, more than they will probably yield from this biopsy.

 

I'm not sure what HDAC inhibitor response testing is. Are you talking about what specific genes are re-expressed after exposure to HDAC inhibitors? That can be done in theory but I don't know if we're anywhere near the point where that information is useful clinically.



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#3 studentlost

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Posted 04 December 2014 - 12:54 AM

There's no way a needle biopsy can get a sizable sample for Nagourney!? What other options do I have? What's the next best thing?

#4 seivtcho

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Posted 04 December 2014 - 01:20 PM

Why not they get the entire lymph node out? Maxillo-facial or head and neck surgeon can take out the lymph node.



#5 resveratrol_guy

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Posted 04 December 2014 - 05:50 PM

Make sure that whoever is doing the needle biopsy knows WTF they're doing. You have to pump the needle back and forth several times to minimize the chances of tumor seeding (artificial metastasis). So give them an open-ended question about how they prevent tumor seeding, and look for a sophisticated answer along these lines (or something better). This is especially relevant if you need a large sample volume for all your proposed tests. Google around for details.

 

If it were me, I probably wouldn't biopsy it at all, unless it were for the sake of determining which drug would be most effective. Beyond that, I'd be searching for cancer prevention all over this forum. In addition to the double-edged sword of chemotherapy, there are some promising natural remedies (e.g. graviola, paw paw, caloric restriction, pterostilbene, etc) and synthetic (nicotinamide riboside, c60oo, etc).

 



#6 joelcairo

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Posted 04 December 2014 - 11:37 PM

More specifically, the Nagourney lab website says they need one gram of viable malignant tissue for evaluating solid tumors. Just for that chemosensitivity test. That seems like kind of a lot to extract, but for a better answer you could talk to whoever is interpreting the imaging or doing the biopsy.

 

http://www.rationalt...candidates.aspx

 


Edited by joelcairo, 04 December 2014 - 11:37 PM.


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#7 seivtcho

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Posted 04 December 2014 - 11:45 PM

Taking out lymph nodes for biopsy is an absolutely standart procedure in the head and neck surgery. If you talk with the doctor, I don't see a reason why not a small part of the entire lymph node to be redirected for other things except hystologic exam. Several grams are nothing.


Edited by seivtcho, 04 December 2014 - 11:46 PM.


#8 Kalliste

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Posted 05 December 2014 - 07:44 AM

Locked antioxidants have some ability to prevent metastasis. MitoQ for instance.

 

Is Tumor Metastasis Prevention On The Horizon?

http://www.science20..._horizon-142136


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#9 resveratrol_guy

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Posted 05 December 2014 - 06:22 PM

Taking out lymph nodes for biopsy is an absolutely standart procedure in the head and neck surgery. If you talk with the doctor, I don't see a reason why not a small part of the entire lymph node to be redirected for other things except hystologic exam. Several grams are nothing.

 

Because on the way between the skin and the tumor there are blood vessels and other structures. In theory, I single malignant cell on the tip of the needle/knife could migrate from the tumor into the blood, and go just about anywhere from there. I believe this was found to occur in certain forms of breast cancer, for example; by and large, it seems to be an unstudied open question (because we probably don't want to know). Granted, a few malignant cells do not guarantee metastasis, and not diagnosing the type of tumor could be even more dangerous. My only point was that there is no excuse for anything less than state-of-the-art techniques to be used here.

 

@ studentlost: Personally, my preference would be to fry the tumor in situ with focussed ultrasound thermolysis or irreversible electroporation and no biopsy at all, but finding a place to do that would be difficult, to say the least. I have a friend who fried some lymph node tumors in his neck with radiation therapy. A few years later, he's alive and cancer-free, although it destroyed his salivary glands.

 

Cosmicalstorm is absolutely right: you need to learn about antimetastatic research compounds. sodium ascorbate, lipidated vitamin C, and indole-3-carbinol come to mind in addition to the above. Personally, after chemo (if it's done at all), I would take several different antimetastatics at the same time because that way you minimize the possibility of the cancer figuring a way around any of them before it gets killed entirely. This increases both the risk of short term fatality and the probability of total remission, relative to the one-drug-at-a-time approach; it's a delicate tradeoff, to say the least.



#10 Kalliste

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Posted 05 December 2014 - 07:29 PM

He might want to look into fasting and HIT too. c60 if he feel speculative.



#11 niner

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Posted 06 December 2014 - 03:30 AM

Locked antioxidants have some ability to prevent metastasis. MitoQ for instance.

 

Is Tumor Metastasis Prevention On The Horizon?

http://www.science20..._horizon-142136

 

Glad to see Porporato et al. getting some press.  I think that is the most important paper I've seen in a long time.  On the basis of their results with MitoTEMPO and MitoQ, I'd expect C60oo to work even better.  We have a project funded by Longecity, Methuselah Foundation, and community support that will look at c60oo in one or more cancer models.


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#12 Kalliste

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Posted 06 December 2014 - 05:23 AM

It's an intriguing result. I worry there might be some weird addendum too it though. Lets say the c60 confers excellent protection to the primary tumor which can grow fat, while inhibiting the metastasis. That would still be better than no c60 since metastasis is what kills. Or maybe this is all speculation.


Edited by Cosmicalstorm, 06 December 2014 - 05:24 AM.


#13 seivtcho

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Posted 06 December 2014 - 12:16 PM

 

Taking out lymph nodes for biopsy is an absolutely standart procedure in the head and neck surgery. If you talk with the doctor, I don't see a reason why not a small part of the entire lymph node to be redirected for other things except hystologic exam. Several grams are nothing.

 

Because on the way between the skin and the tumor there are blood vessels and other structures. In theory, I single malignant cell on the tip of the needle/knife could migrate from the tumor into the blood, and go just about anywhere from there. I believe this was found to occur in certain forms of breast cancer, for example; by and large, it seems to be an unstudied open question (because we probably don't want to know). Granted, a few malignant cells do not guarantee metastasis, and not diagnosing the type of tumor could be even more dangerous. My only point was that there is no excuse for anything less than state-of-the-art techniques to be used here.

 

@ studentlost: Personally, my preference would be to fry the tumor in situ with focussed ultrasound thermolysis or irreversible electroporation and no biopsy at all, but finding a place to do that would be difficult, to say the least. I have a friend who fried some lymph node tumors in his neck with radiation therapy. A few years later, he's alive and cancer-free, although it destroyed his salivary glands.

 

Cosmicalstorm is absolutely right: you need to learn about antimetastatic research compounds. sodium ascorbate, lipidated vitamin C, and indole-3-carbinol come to mind in addition to the above. Personally, after chemo (if it's done at all), I would take several different antimetastatics at the same time because that way you minimize the possibility of the cancer figuring a way around any of them before it gets killed entirely. This increases both the risk of short term fatality and the probability of total remission, relative to the one-drug-at-a-time approach; it's a delicate tradeoff, to say the least.

 

 

If there is already a metastasis in the lymph node, better remove it fast before getting to other lymph nodes and spread the entire lymphatic system. If after the histology it appears not to be a metastasis, then be happy.
 

After a good ablastic operation chances for spreading the tumor are supposed to be minimal, and lower than the chances the tumor to spread further from the lymph node.

 

Once removed outside the body, a piece of the lymph node can be taken for other non - traditional treatments developments if you like.

 

Focused directed energy tumors destruction are only experimental today, and they don't guarantee the destruction of all tumor cells either.



#14 resveratrol_guy

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Posted 07 December 2014 - 01:56 AM


If there is already a metastasis in the lymph node, better remove it fast before getting to other lymph nodes and spread the entire lymphatic system. If after the histology it appears not to be a metastasis, then be happy.
 

After a good ablastic operation chances for spreading the tumor are supposed to be minimal, and lower than the chances the tumor to spread further from the lymph node.

 

Once removed outside the body, a piece of the lymph node can be taken for other non - traditional treatments developments if you like.

 

Focused directed energy tumors destruction are only experimental today, and they don't guarantee the destruction of all tumor cells either.

 

 

So at the opposite extreme of fine needle aspiration is complete tumor excision without even partial biopsy; this is essentially total biopsy. If it turns out to have been malignant, then the patient is spared the risk of tumor seeding, provided that the excision was done with proper positive margins around the surface. So I think complete excision is a good option here, vs. cutting out a piece of the tumor and leaving the rest intact. And of course you're correct that in this case, you would have plenty of tumor mass to run tests on.

 

You're right that directed energy treatments are no guarantee of total destruction, but they do an excellent job of shrinking the tumor size (often to the point of nondetectability on MRI or CT) without the massive systemic stress of chemotherapy, or the risk of surgical excision, which is nontrivial if we're talking about lymph nodes in the neck.

 

Either way, it's good that we've provided the OP with some important issues to consider here.



#15 resveratrol_guy

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Posted 07 December 2014 - 02:13 AM

It's an intriguing result. I worry there might be some weird addendum too it though. Lets say the c60 confers excellent protection to the primary tumor which can grow fat, while inhibiting the metastasis. That would still be better than no c60 since metastasis is what kills. Or maybe this is all speculation.

 

I find it hard to believe that c60oo (or MitoQ etc.) would protect a Warburg-dysfunctional cancer cell to the same extent that it would protect a normal cell with a healthy electron transport chain, simply due to the differing levels of ROS produced. OTOH if the cancer still had "normal" mitochondria, then the protection should work, but in that case antiangiogenic drugs could shrink it (by cutting off the oxygen supply) until it discovered anoxic energy production, which would then leave it less protected than normal cells, and thus more susceptible to therapy. Either way, it looks like mitochondrial antioxidants are a sound plan.

 



#16 YOLF

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Posted 13 December 2016 - 12:17 PM

If anyone hasn't already mentioned it, supplementing with Sage is associated with a 54% risk reduction for lung cancer... don't know if that will help you after you get it though. But I'd consider it a good lead. Also a potent age breaker apparently.


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#17 joelcairo

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Posted 23 December 2016 - 01:44 AM

.


If anyone hasn't already mentioned it, supplementing with Sage is associated with a 54% risk reduction for lung cancer... don't know if that will help you after you get it though. But I'd consider it a good lead. Also a potent age breaker apparently.

 

I agree with whoever rated this post as "needs references". I'd be very interested in a cite for that study. I searched around for a few minutes but couldn't find it.


Edited by joelcairo, 23 December 2016 - 01:44 AM.


#18 YOLF

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Posted 23 December 2016 - 03:17 AM

.


If anyone hasn't already mentioned it, supplementing with Sage is associated with a 54% risk reduction for lung cancer... don't know if that will help you after you get it though. But I'd consider it a good lead. Also a potent age breaker apparently.

 

I agree with whoever rated this post as "needs references". I'd be very interested in a cite for that study. I searched around for a few minutes but couldn't find it.

 

Well, this quote comes from the WebMD "Insufficient evidence for" section:

 

  • Lung cancer. People who regularly use sage as a spice seem to have a 54% lower chance of developing lung cancer compared to those who don’t use sage.

 

Add to this the AGE breaking activity demonstrated by Red Leaf Sage Extract (BASF Study using it cosmetically for this purpose), and the spectrum of evidence starts to mount.

 

Here's a review from pub Med that mirrors my thoughts and provides lots of links to studies. There is a section specific to cancer, but as an AGE breaker it's going to have a broad spectrum of benefits. I've read of doses that were as high as 5g/d being used and use an extract that yields a 2.5g/d equivalent. It made me vomit at first and I got a little sick for a few days, but the mild poison in it is metabolized in a similar manner as alcohol, so you can quickly build a tolerance to it. Alcohol is a speedy depressant for me, however, this stuff has shown me no depressive side effects. I'm happy go lucky, though it is a very mild sedative when you first start taking it, but that goes away as you build a tolerance to the thujone in it. I don't respond as well to caffeine either, I think it contains some stuff that is caffeine competitive? Caffeic acid? So you won't get as much stimulant value from your caffeine. You'll taste the thujone initially, it's a toxic minty flavor that will permeate your lungs for the first few days. People who drink regularly probably won't have side effects at all. Historically, it was used by Sages (wise old people) who often had a love of alcohol.

 

You'll also notice that it's packed with a spectrum of substances that have been demonstrated independently to work against and prevent cancer such as rosmarinic acid.

 

Among my benefits, I've seen an evening of skin tone and even a very slow regression of some deeper wrinkles usually, but perhaps not exclusively attributed to glucosepane, though it does not have demonstrated efficacy against this. I've also seen an improvement in joint flexibility. I use it along with cold shock showers and 25% blueberry anthocyanins and a few other things. The scientific name of the species, Salvia, means whole and healthy.


Edited by YOLF, 23 December 2016 - 03:17 AM.


#19 joelcairo

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Posted 23 December 2016 - 04:09 AM

Thanks.



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#20 joelcairo

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Posted 23 December 2016 - 08:23 AM

I found the study! It's actually a study of cancer and the Mediterranean diet, and sage is one of the common elements studied. There is a lot of multivariate analysis in the study because so many ingredients in the diet are interrelated, but olive oil and sage stood out as the two most protective foods.

 

http://encognitive.c...Lung Cancer.pdf


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