Massive Shaft of Light for hormone-refractory prostate cancer?

I have metastatic prostate cancer, but shortly after starting hormone
therapy last December there came a dramatic drop in my PSA from plus
30 to 0.02. As my interest in living a bit longer at age of 81 was not
least so that I could continue to be around for my ill-wife, this was
amazingly encouraging. And several in the group, including Alan, have
suggested this remission could continue for years despite my G9.

Yet, in the background of my undoubted delight there has always been a
lurking shadow. It is the certain knowledge (as far as I'm concerned)
that if, or when, hormone-refractory Pca develops, the barbarian now
skulking on the bottom as it wilts under attack, will realise the
depth charges are fading, and will up-schnorkel and find it has new
and nastier pathways of assault.

That is perhaps the prime reason I was always reluctant to start
hormone therapy. And I never saw, in all the medical literature,
anything that gave genuine hope that could be avoided, should the
treatment become refractory.

Has this now dramatically changed?

Only a small trial. But as I read the report from the Mayo Clinic,
reported in The Times today, also at
http://tinyurl.com/kka4gk I am prepared to believe a decidedly bright
shaft of light has been beamed onto a hitherto murky area of our hopes
and expectations.

Now - you persistent, pestilential parasites - looks like just when
you think the battle's yours, we're gonna bend that schnorkel and
shove it up - you'll find out where!

Speed of research today still encourages me to believe that similar
results may be forthcoming sooner than is believed, for all our
comrades' varying levels of development.

Kindest regards and best wishes to all.

MikeHi

On Jun 20, 8:47 am, Mik...@anon.com wrote:
> I have metastatic prostate cancer, but shortly after starting hormone
> therapy last December there came a dramatic drop in my PSA from plus
> 30 to 0.02. As my interest in living a bit longer at age of 81 was not
> least so that I could continue to be around for my ill-wife, this was
> amazingly encouraging. And several in the group, including Alan, have
> suggested this remission could continue for years despite my G9.
>
> Yet, in the background of my undoubted delight there has always been a
> lurking shadow. It is the certain knowledge (as far as I'm concerned)
> that if, or when, hormone-refractory Pca develops, the barbarian now
> skulking on the bottom as it wilts under attack, will realise the
> depth charges are fading, and will up-schnorkel and find it has new
> and nastier pathways of assault.
>
> That is perhaps the prime reason I was always reluctant to start
> hormone therapy. And I never saw, in all the medical literature,
> anything that gave genuine hope that could be avoided, should the
> treatment become refractory.
>
> Has this now dramatically changed?
>
> Only a small trial. But as I read the report from the Mayo Clinic,
> reported in The Times today, also athttp://tinyurl.com/kka4gk I am prepared to believe a decidedly bright
> shaft of light has been beamed onto a hitherto murky area of our hopes
> and expectations.
>
> Now - you persistent, pestilential parasites - looks like just when
> you think the battle's yours, we're gonna bend that schnorkel and
> shove it up - you'll find out where!
>
> Speed of research today still encourages me to believe that similar
> results may be forthcoming sooner than is believed, for all our
> comrades' varying levels of development.
>
> Kindest regards and best wishes to all.
>
> MikeHi

The nefarious deception by cancer cells is that they maintain a kind
of "cloaking" behavior whereby they remain resistant to the normal
immune system attack cells. The immune system is arranged to attack
"non-self" cells while bypassing "self" cells. The cancer cells shield
themselves by appearing as "self" to the attacking T-cells. Ipilimumab
or "ipi" breaks this self-nonself barrier. The immune system then is
free to attack any cell that may be non-self, such as cancerous cells,
as well as many cells which are in fact normal and useful. This makes
the side effects of ipi significant and serious when they occur. Often
described as "immune breakthrough events" or IBE, these can include
liver, skin, lymph and other system problems. The patient on ipi must
be monitored very closely.

>On Jun 20, 8:47 am, Mik...@anon.com wrote:?
>>
>> Only a small trial. But as I read the report from the Mayo Clinic,
>> reported in The Times today, also at http://tinyurl.com/kka4gk I am prepared to believe a decidedly bright
>> shaft of light has been beamed onto a hitherto murky area of our hopes
>> and expectations.


On Sat, 20 Jun 2009 07:19:44 -0700 (PDT), tarhoosier7
<tarhoosier@carolina.rr.com> replied:
>. Ipilimumab
>or "ipi" breaks this self-nonself barrier. The immune system then is
>free to attack any cell that may be non-self, such as cancerous cells,
>as well as many cells which are in fact normal and useful. This makes
>the side effects of ipi significant and serious when they occur. Often
>described as "immune breakthrough events" or IBE, these can include
>liver, skin, lymph and other system problems. The patient on ipi must
>be monitored very closely.

MikeHi now:
This is an interesting - and evidently somewhat offputting
observation, Tarhoosier7.

Are you saying that as well as helping destroy tumors, iplimumbab
(whichthe story reveals is the key new ingredient in the trial) also
adopts a scattergun approach in destroying any other cells it fancies?
If so, has the trial team missed such an important fact in its
otherwise very positive reporting? It certainly offered no caution of
this kind.I'd be more than interested to know your sources please, T7,
if there is a genuine balance to be made here?

Thanks.

MikeHi

tarhoosier7 wrote:

> The nefarious deception by cancer cells is that they maintain a kind
> of "cloaking" behavior whereby they remain resistant to the normal
> immune system attack cells. The immune system is arranged to attack
> "non-self" cells while bypassing "self" cells. The cancer cells shield
> themselves by appearing as "self" to the attacking T-cells. Ipilimumab
> or "ipi" breaks this self-nonself barrier. The immune system then is
> free to attack any cell that may be non-self, such as cancerous cells,
> as well as many cells which are in fact normal and useful. This makes
> the side effects of ipi significant and serious when they occur. Often
> described as "immune breakthrough events" or IBE, these can include
> liver, skin, lymph and other system problems.

> The patient on ipi must
> be monitored very closely.


Why?

Are you such a patient? You'd likes to be monitored?

Well, I am and I should have died in july 2007, after living the longest
period the specialists gave me.
Believe me, I am alive and kickin'. Resting a lot, sleeping a lot, but also
play my favorite game of indoor bowls, twice a week.

Monitored?
Why?
To make shure you know out of first hand your time has come?
Stop worrying about yesterday, about what have been spoken or should have
been sayed.
Live!
Tomorrow could be a good day, if you give it a chance.

Frans (from Holland)

On Jun 20, 4:25 pm, "Frans" <i...@fromholland.invalid> wrote:
> tarhoosier7 wrote:
> > The nefarious deception by cancer cells is that they maintain a kind
> > of "cloaking" behavior whereby they remain resistant to the normal
> > immune system attack cells. The immune system is arranged to attack
> > "non-self" cells while bypassing "self" cells. The cancer cells shield
> > themselves by appearing as "self" to the attacking T-cells. Ipilimumab
> > or "ipi" breaks this self-nonself barrier. The immune system then is
> > free to attack any cell that may be non-self, such as cancerous cells,
> > as well as many cells which are in fact normal and useful. This makes
> > the side effects of ipi significant and serious when they occur. Often
> > described as "immune breakthrough events" or IBE, these can include
> > liver, skin, lymph and other system problems.
> > The patient on ipi must
> > be monitored very closely.
>
> Why?
>
> Are you such a patient? You'd likes to be monitored?
>
> Well, I am and I should have died in july 2007, after living the longest
> period the specialists gave me.
> Believe me, I am alive and kickin'. Resting a lot, sleeping a lot, but also
> play my favorite game of indoor bowls, twice a week.
>
> Monitored?
> Why?
> To make shure you know out of first hand your time has come?
> Stop worrying about yesterday, about what have been spoken or should have
> been sayed.
> Live!
> Tomorrow could be a good day, if you give it a chance.
>
> Frans (from Holland)

A Pilot Trial of CTLA-4 Blockade with Human Anti-CTLA-4 in Patients
with Hormone-Refractory Prostate Cancer
Eric J. Small1, N. Simon Tchekmedyian2, Brian I. Rini3, Lawrence
Fong1, Israel Lowy4 and James P. Allison5

http://clincancerres.aacrjournals.or...full/13/6/1810

http://meeting.ascopubs.org/cgi/cont.../18_suppl/2510

On Jun 21, 11:21 am, tarhoosier7 <tarhoos...@carolina.rr.com> wrote:
> On Jun 20, 4:25 pm, "Frans" <i...@fromholland.invalid> wrote:
>
>
>
> > tarhoosier7 wrote:
> > > The nefarious deception by cancer cells is that they maintain a kind
> > > of "cloaking" behavior whereby they remain resistant to the normal
> > > immune system attack cells. The immune system is arranged to attack
> > > "non-self" cells while bypassing "self" cells. The cancer cells shield
> > > themselves by appearing as "self" to the attacking T-cells. Ipilimumab
> > > or "ipi" breaks this self-nonself barrier. The immune system then is
> > > free to attack any cell that may be non-self, such as cancerous cells,
> > > as well as many cells which are in fact normal and useful. This makes
> > > the side effects of ipi significant and serious when they occur. Often
> > > described as "immune breakthrough events" or IBE, these can include
> > > liver, skin, lymph and other system problems.
> > > The patient on ipi must
> > > be monitored very closely.
>
> > Why?
>
> > Are you such a patient? You'd likes to be monitored?
>
> > Well, I am and I should have died in july 2007, after living the longest
> > period the specialists gave me.
> > Believe me, I am alive and kickin'. Resting a lot, sleeping a lot, but also
> > play my favorite game of indoor bowls, twice a week.
>
> > Monitored?
> > Why?
> > To make shure you know out of first hand your time has come?
> > Stop worrying about yesterday, about what have been spoken or should have
> > been sayed.
> > Live!
> > Tomorrow could be a good day, if you give it a chance.
>
> > Frans (from Holland)
>
> A Pilot Trial of CTLA-4 Blockade with Human Anti-CTLA-4 in Patients
> with Hormone-Refractory Prostate Cancer
> Eric J. Small1, N. Simon Tchekmedyian2, Brian I. Rini3, Lawrence
> Fong1, Israel Lowy4 and James P. Allison5
>
> http://clincancerres.aacrjournals.or...full/13/6/1810
>
> http://meeting.ascopubs.org/cgi/cont.../18_suppl/2510

This trial from the Mayo clinic was for men who were considered
inoperable; thus, T3 or T4 likely stage at diagnosis. The institution
of hormone therapy, along with ipi would have been expected to produce
a dramatic lowering of psa, as happened in these two men, as well as
many of the others, I would presume. To say that the ipi was what
reduced the tumors when it had been started along with a known
prostate cancer treatment is going a bit far. These two men were
fortunate to have received the therapy and perhaps benefited from it.
Were they staged incorrectly? Was the success due to the hormone
ablation? What was it about these two and not the other 20 some
participants? The Mayo doctors themselves admit to being stumped on
this. This trial was open also to men post prostatectomy (no radiation
allowed) so what happened to those men? Surgery was not on the
treatment list for the trial so those two men were treated different
to all others. This is an unexplained result.
I, too, hope for the best. A treatment with such a small benefit, so
far, is unlikely to be approved.

tarhoosier7 wrote:
> On Jun 20, 4:25 pm, "Frans" <i...@fromholland.invalid> wrote:
>> tarhoosier7 wrote:
>>> The nefarious deception by cancer cells is that they maintain a kind
>>> of "cloaking" behavior whereby they remain resistant to the normal
>>> immune system attack cells. The immune system is arranged to attack
>>> "non-self" cells while bypassing "self" cells. The cancer cells
>>> shield themselves by appearing as "self" to the attacking T-cells.
>>> Ipilimumab or "ipi" breaks this self-nonself barrier. The immune
>>> system then is free to attack any cell that may be non-self, such
>>> as cancerous cells, as well as many cells which are in fact normal
>>> and useful. This makes the side effects of ipi significant and
>>> serious when they occur. Often described as "immune breakthrough
>>> events" or IBE, these can include liver, skin, lymph and other
>>> system problems.
>>> The patient on ipi must
>>> be monitored very closely.
>>
>> Why?
>>
>> Are you such a patient? You'd likes to be monitored?
>>
>> Well, I am and I should have died in july 2007, after living the
>> longest period the specialists gave me.
>> Believe me, I am alive and kickin'. Resting a lot, sleeping a lot,
>> but also play my favorite game of indoor bowls, twice a week.
>>
>> Monitored?
>> Why?
>> To make shure you know out of first hand your time has come?
>> Stop worrying about yesterday, about what have been spoken or should
>> have been sayed.
>> Live!
>> Tomorrow could be a good day, if you give it a chance.
>>
>> Frans (from Holland)
>
> A Pilot Trial of CTLA-4 Blockade with Human Anti-CTLA-4 in Patients
> with Hormone-Refractory Prostate Cancer
> Eric J. Small1, N. Simon Tchekmedyian2, Brian I. Rini3, Lawrence
> Fong1, Israel Lowy4 and James P. Allison5
>
> http://clincancerres.aacrjournals.or...full/13/6/1810
>
> http://meeting.ascopubs.org/cgi/cont.../18_suppl/2510

You don't get what I was saying, do you?
You don't know what it means, to be alive?
Why would I want another test? Then, why are there people, saying they study
mankind, but dare to give placebo's to dead sick people? Playing god, in
name of mankind?
My PSA is low, very low. So why would I bother to stop living for a while to
give those nitwits an insight about my illness?

Is there a research project about bloodstains on the train rails: If a
bridge is higher, are the stains of those, who trown themselves in front of
the train, further away?

Have a live.

Don't ever forget that this is a support group. So if and when your message
don't contains support, it is OT here.

Wish you well, my friend.

On Sun, 21 Jun 2009 08:38:15 -0700 (PDT), tarhoosier7
<tarhoosier@carolina.rr.com> wrote:

..
BIG SNIP
>>
>> http://clincancerres.aacrjournals.or...full/13/6/1810
>>
>> http://meeting.ascopubs.org/cgi/cont.../18_suppl/2510
>

> This is an unexplained result such a small benefit, so
>far, is unlikely to be approved.

T7 you seem to be comparing a set of trials with different
combinations of treatment, for different cancer objectives, one
happening in 2006 the other in 2007 with the trial now reported in
June 2009. They have a common factor- ipilimumab - and they're all
called 'trial' - but that's it.

The logic in your post meanders all over the place and your
understanding of what the trial indicated is similarly obfuscated.

You write regarding the Mayo trial:
>The institution of hormone therapy, along with ipi would have been expected to
>produce a dramatic lowering of psa,'….

Well, yes, it might well. And lo, it did. Especially as the trial
treatment also included radiation. And radiation combined with hormone
therapy is hardly new. So as expected the PSA did drop, so that
surgery could be attempted.

But that had about as much to do with the 'surprise' expressed, which
made the trial so noteworthy, as a packet of winegums.

These men had, " aggressive tumours that had grown into abdominal
areas." The big surprise was, as Mayo surgeon Michael Blute
explained: ""The tumours had shrunk dramatically. I had never seen
anything like this before. I had a hard time finding the cancer."

You write:
>To say that the ipi was what
>reduced the tumors when it had been started along with a known
>prostate cancer treatment is going a bit far.

In the mix creating such astonishment, there was only one new
ingredient - ipi.

So yes, it's the mix wot does it; but no, it is not going too far to
say that it is ipi that caused the fuss.

Btw How many trials have you ever heard of where the specialist
remarks he'd never seen a result like it before?

So: we guys on hormone therapy, and those already experiencing hormone
refractory problems, still believe! The Mayo's was a small trial. And
the grindingly long march to Trials III has barely commenced. But this
little acorn has got oak written all over it.
Believe -we're all gonna get better.

Kind regards and best wishes to all.

MikeHi

Kind regards and best wishes to all.

I certainly don't mean to rain on the parade here, but
I think Tarhoosier's caution is probably warranted.

What I'd be most inclined to conclude from the studies
is that positive effects have been demonstrated. I'd
be reluctant to use the word "massive" and just say that
a "shaft of light" has appeared. The effect may have
been massive in the two Mayo Clinic patients. But we
can't conclude to much from it yet.

The studies are preliminary. In the study cited by
Tarhoosier at:

http://clincancerres.aacrjournals.or...full/13/6/1810

14 men were treated. Only 2 showed a PSA response >= 50%.

Is this good? Well, yes it is, especially since only one
patient experienced serious side effects. If it were me,
and I were hormone refractory, and Ipilimumab were offered
to me, I'd be inclined to go for it. I would hope to be
one of the ones with a good response, but I'd also try to be
realistic and be prepared to have very little response.

Is the new therapy better than abiraterone? We don't know
yet. Abiraterone might still be my first choice for
follow on treatment. I just don't know. I doubt if anyone
does.

However, I still think Mike that your excellent response to
hormone therapy is a really, really good sign. You might
go many years on it. If and when it fails, the fact that
your cancer proved so hormone sensitive might mean that
other hormone therapies, including abiraterone, might provide
excellent follow on treatment.

Best of luck.

Alan

tarhoosier7 wrote:
> On Jun 21, 11:21 am, tarhoosier7 <tarhoos...@carolina.rr.com> wrote:
>> On Jun 20, 4:25 pm, "Frans" <i...@fromholland.invalid> wrote:
>>
>>
>>
>>> tarhoosier7 wrote:
>>>> The nefarious deception by cancer cells is that they maintain a
>>>> kind of "cloaking" behavior whereby they remain resistant to the
>>>> normal immune system attack cells. The immune system is arranged
>>>> to attack "non-self" cells while bypassing "self" cells. The
>>>> cancer cells shield themselves by appearing as "self" to the
>>>> attacking T-cells. Ipilimumab or "ipi" breaks this self-nonself
>>>> barrier. The immune system then is free to attack any cell that
>>>> may be non-self, such as cancerous cells, as well as many cells
>>>> which are in fact normal and useful. This makes the side effects
>>>> of ipi significant and serious when they occur. Often described as
>>>> "immune breakthrough events" or IBE, these can include liver,
>>>> skin, lymph and other system problems.
>>>> The patient on ipi must
>>>> be monitored very closely.
>>
>>> Why?
>>
>>> Are you such a patient? You'd likes to be monitored?
>>
>>> Well, I am and I should have died in july 2007, after living the
>>> longest period the specialists gave me.
>>> Believe me, I am alive and kickin'. Resting a lot, sleeping a lot,
>>> but also play my favorite game of indoor bowls, twice a week.
>>
>>> Monitored?
>>> Why?
>>> To make shure you know out of first hand your time has come?
>>> Stop worrying about yesterday, about what have been spoken or
>>> should have been sayed.
>>> Live!
>>> Tomorrow could be a good day, if you give it a chance.
>>
>>> Frans (from Holland)
>>
>> A Pilot Trial of CTLA-4 Blockade with Human Anti-CTLA-4 in Patients
>> with Hormone-Refractory Prostate Cancer
>> Eric J. Small1, N. Simon Tchekmedyian2, Brian I. Rini3, Lawrence
>> Fong1, Israel Lowy4 and James P. Allison5
>>
>> http://clincancerres.aacrjournals.or...full/13/6/1810
>>
>> http://meeting.ascopubs.org/cgi/cont.../18_suppl/2510
>
> This trial from the Mayo clinic was for men who were considered
> inoperable; thus, T3 or T4 likely stage at diagnosis. The institution
> of hormone therapy, along with ipi would have been expected to produce
> a dramatic lowering of psa, as happened in these two men, as well as
> many of the others, I would presume. To say that the ipi was what
> reduced the tumors when it had been started along with a known
> prostate cancer treatment is going a bit far. These two men were
> fortunate to have received the therapy and perhaps benefited from it.
> Were they staged incorrectly? Was the success due to the hormone
> ablation? What was it about these two and not the other 20 some
> participants? The Mayo doctors themselves admit to being stumped on
> this. This trial was open also to men post prostatectomy (no radiation
> allowed) so what happened to those men? Surgery was not on the
> treatment list for the trial so those two men were treated different
> to all others. This is an unexplained result.
> I, too, hope for the best. A treatment with such a small benefit, so
> far, is unlikely to be approved.

You don't get what I was saying, do you?
You don't know what it means, to be alive?
Why would I want another test? Then, why are there people, saying they study
mankind, but dare to give placebo's to dead sick people? Playing god, in
name of mankind?
My PSA is low, very low. So why would I bother to stop living for a while to
give those nitwits an insight about my illness?

Is there a research project about bloodstains on the train rails: If a
bridge is higher, are the stains of those, who trown themselves in front of
the train, further away?

Live!

Don't ever forget that this is a support group. So if and when your message
don't contains support, it is OT here.

Wish you well, my friend.

Thanks Alan. Your comment studied and rounded as ever.

Whether just a "ray", or "massive", to describe the results. I think
for me the results were the "ray". And the quite unusual astonishment
expressed by the surgeons led to an intuitive "massive".

Maybe 'intuitive 'is a bit lower in the indicator scale even than
'anecdotal'... but...hope springs eternal.....and a few buckets of it
now and again are a wonderful start to the day.

Kind regards, and best wishes to all

MikeHi

"Frans" <im@fromholland.invalid> wrote in message
news:13fc$4a3e5d84$5ed1a2eb$32624@cache100.multika bel.net...

: You don't get what I was saying, do you?


: My PSA is low, very low. So why would I bother to stop living for a while
to
: give those nitwits an insight about my illness?

That's great news, Frans. I was a little worried with your April reading.



--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA undetectable since; last checked on 06/04/09
Illegitimati non carborundum