7.03.2018

Immunotherapy as a Star Wars Movie

Before I start going off the deep end with my pursuit of a magical clinical trial, let me break down immunotherapy and immunotherapy combination trials to a 4th grade level. Or better yet, in terms of Star Wars, since this is how I explained it to my young Padawans.

As Mick (my almost 5th grader) will gladly tell you, cancer is just a bunch of normal cells gone bad. Sounds like the Republic, huh? Cells have an off switch and know when to stop growing, unless the pull of the Dark Side is too great. This is the case for cancer cells. A switch has been flipped and they continue to grow until they have taken over the galaxy.

Normally your immune system (the Rebellion) would see these cells growing when they shouldn't be, and rush in to destroy them. But like the Republic, cancer is a stealthy bastard and uses a force field to make it invisible to your immune system (the Rebellion). Immunotherapy works by sneaking on board a Star Destroyer and deactivating the force field, enabling the Rebellion to see it, and sending in X-Wing Fighters to destroy it.

Immunotherapy breaks down cancer's ability to hide from the immune system, the immune system sees it, recognizes it as a foreign invader, and attacks and kills it like it's perfectly capable of doing.

In my world of colorectal cancer there are two types of tumors: MSI and MSS. In keeping with the 4th grade level here, I'm not going to explain the two, other than to say that roughly 10-15% of colorectal cancer patients have MSI tumors - which have responded well to immunotherapy trials. The rest of us schmucks have MSS tumors, and we don't respond to immunotherapy alone.

Enter a combination therapy. The general idea behind combination therapy is the immunotherapy gets the Republic to drop its force field, and allows the Rebellion/chemo/cancer drugs to do their job far more effectively with far less work.

At this point I'm awaiting a combination clinical therapy trial to open up and biding my time by revisiting current standards of care I've already been on. The trials I seek are our there, just not at one of the three National Cancer Institute comprehensive cancer centers in my backyard (University of Minnesota, Mayo Clinic, or University of Wisconsin). And as I continue live with my "good stable disease," there's no panic to start the first trial that comes alone. Given the exclusion criteria that can potentially exclude me from future trials, I feel I must be very careful before venturing out on the barren planet of clinical trial Hoth with my Tauntaun.



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Anonymous said...

I was diagnosed with Inoperable stage 4 esophageal cancer nearly 2 years ago. Spread to distant lymph nodes and the liver made me likely never a candidate for surgery. An esophagectomy is a terrible and traumatic surgery anyway, in some ways I am glad I'm not a candidate for it.

I was put on a clinical trial combining immunotherapy with chemotherapy. Within 4 weeks the majority of my symptoms greatly improved, and after 8 weeks the primary tumors were almost gone. The last infected lymph node went away after about a year, and I have now been "N.E.D." (no evidence of metastatic disease) for nearly one year. Immunotherapy doesn't seem to work for everybody, but the people it does work for it tends to work well.

I was not expected to live much more than a year after my diagnosis, nearly 2 years later I am as close to normal as anyone in my condition can be.

Colon and esophageal cancer are similar, in fact some of the same drugs are used to treat both. Once they turn metastatic any cancer is deadly, but gastric ones, especially pancreatic, tend to be the worst.

I stay "NED" much longer, I am considering doing a "watch, wait and see" approach and stopping treatment.

I thought my 40+ treatments already was too much, and well over a year ago you had already been through WAY more than me...and raising kids on top of it.

I'm glad you are doing well, and I will pray for you going forward.