In February 2016, I met with a 57-year-old gentleman who presented with weight loss. An endoscopy revealed gastric (stomach) cancer. With the tumor causing progressive obstruction, he was taken to surgery and tissue was submitted to our laboratory for EVA-PCD functional profiling.
The findings revealed several active drug combinations.
The patient obtained an opinion from a cancer center that offered participation in a 3-arm clinical trial comparing Pembroluzumab (Keytruda), a PD-L1 antibody, to FOLFOX chemotherapy or to the combination of FOLFOX plus Pembroluzumab. I encouraged him to pursue the trial.
After all, I knew that he was sensitive to the “control arm” (FOLFOX) and because Pembroluzumab is not FDA approved for gastric cancer, the trial offered him the opportunity to receive this novel immunotherapy agent alone or in combination with FOLFOX.
Unfortunately, he did not qualify for the study as he did not express the PD-L1 protein.
With Pembroluzumab removed from the equation, chemotherapy was now his only chance and he needed the best. That option, from the EVA/PCD function profile was FOLFOX & Irinotecan, known as FOLFIRINOX.
His trial physician didn’t agree.
He recommended FOLFOX alone suggesting that the Irinotecan should be kept as a fall back for future need.
With the stakes so high, having Stage 4 stomach cancer, I had no intention of compromising. I again recommended FOLFIRINOX and the patient agreed.
His Stomach Cancer Treatment
The patient tolerated the first dose but several days later developed intense crampy abdominal pain.
Concerned that there might be a post-operative complication, I obtained x-rays and blood tests. All were unrevealing.
Despite having undergone a CT scan only 8 days earlier I repeated the CT to rule out a perforation, diverticular abscess or other complication.
Surprising Results
The results were surprising, shocking even. The tumor had disappeared!
I examined the CT’s side-by-side. The large para-aortic and peri-caval lymph nodes were gone.
Gone! The tumor markers reflected this, falling from 1237 to 59.
The pain, it seemed was not a bad thing.
It was actually a good thing reflecting rapid tumor lysis, a condition that can happen when cancer treatment causes cancer cells to die quickly.
The rapidity of response presumably caused an inflammatory reaction.
As the chemotherapy drugs that he received are not highly immunosuppressive, that same inflammatory response likely contributed to the tumor shrinkage. We adjusted the doses and proceeded to cycle II, which he tolerated much better.
It now appears that he will achieve a complete remission reflected by his most recent CA19.9 of 22 (normal <34) and the soon to be conducted PET/CT. We are conferring with surgery for possible re-exploration and intra-peritoneal chemotherapy (HIPEC).
Lessons Learned
Several interesting points are raised:
Every cancer patient deserves the right treatment the first time, every time.
It is better to prevent a relapse than to withhold effective therapy and accept its inevitability.
Modern oncologists, trained to opt for palliation, too often remove the words “cure” and “complete remission” from their vocabulary.
Stage 4 gastric (stomach) cancer may be a curable malignancy, at least in some patients.
This is not the first time that we have managed a patient with Stage 4 stomach cancer, given no hope for cure, and achieved a complete remission. J.T. (whose Stage 4 stomach cancer testimonial can be found on our website here) remains in complete remission 2½ years after receiving a different chemotherapy regimen identified by our EVA-PCD functional profile.
Finally, cancers like gastric, pancreatic, lung, recurrent breast or ovary may be incurable in some but not in all patients. The so-called “tail” of the survival curve reflects that percentage of patients who beat the odds. Using our functional laboratory platform to enrich our skills, we can tip the scales in favor of our patients. Why should we or our patients accept anything less?
As always, I appreciate your thoughts and comments. Dr. Robert Nagourney, has been internationally recognized as a pioneer in cancer research and personalized cancer treatment for over 20 years. He is a TEDx speaker, author of the book Outliving Cancer, a practicing oncologist and triple board certified in Internal Medicine, Medical Oncology and Hematology helping cancer patients from around the world at his Nagourney Cancer Institute in Long Beach, California. For more info go to NAGOURNEYCANCERINSTITUTE.COM