nanoknife IRE for pancreatic cancer

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RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Wed Jan 25, 2017 10:23 PM

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Read the Post Script of the PhilipJax post above.

RE: nanoknife IRE for pancreatic cancer

by Jkelly on Thu Jan 26, 2017 04:29 AM

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Hi Georginamhall, Unfortunately, I was not in any shape to receive any chemo treatments post Nanoknife. I know Dr. Martin would have liked me to have some, but I just wasn't fit enough at that time. I would definitely read PhilipJax's post about follow up chemo treatments and discuss with your Oncologist and surgeon to see what they all would recommend. My journey was like a roller coaster, many ups and many downs, which I'm sure anyone going through this would have to agree with. A few things I would suggest: #1) get off all narcotics that he may be taking as quickly as possible. #2) If he has feeding tube, realize it's a good thing. It's there to help supplement his diet and he will hopefully recover more quickly. Also, try to eat as healthy as he can. #3) Try to get some sort of daily exercise. I was a couch potato and I ended up with a couple of blood clots, which just added more complications. #4) have follow up scans regularly. #5) enjoy everyday and pray a lot. I probably took the supplements regularly for a few years after the Nanoknife. Praying your brother has a speedy recovery!

RE: nanoknife IRE for pancreatic cancer

by dessmo on Fri Jan 27, 2017 06:34 AM

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On jan 25, 2017 10:23 PhilipJax wrote:

Read the Post Script of the PhilipJax post above.

PhilipJax,

Read through this very long thread that contains a lot of useful information about pancreatic cancer in general and especially nanoknife/IRE. I am impressed with your expertise about the disease. You seem to be a source of knowledge about pancreatic cancer to include new/soon to come treatment options.

I am 51 years old, with excellent health in general, but was recently diagnosed with Acinar Cell Carcinoma (ACC) in the pancreas with metastases to the liver. I understand this is a very rare form of cancer in the pancreas, and I am searching for advice from your expertise. I live in Norway where there is limited experience with pancreatic cancer in general, and only around a handful are diagnosed with the ACC version yearly.

Naonknife is currently not available I Norway, and the general approach is to treat ACC the same way as the more typical adenocarcinoma. I therefor have started up with FOLFIRINOX, and have done one cycle. The plan is to do 12 cycles, pending the effect of the treatment.

Do you know who has the expertise in using nanoknife in treating pancreatic cancer in Europe?

My tumor is located in the tail, and according to my medical team it could be removed if it wasn’t for the metastasis. Do you think nanoknife is an option, and what are the medical preconditions for nanonknife – must the metastasis be removed first?    

With all your knowledge about pancreatic cancer (acinar cell carcinoma) with metastases, what kind of treatment do you think is the most effective? In other words, if you where in my shoes - what kind of treatment would you go for?

Sincerely,

Magnus

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Fri Jan 27, 2017 02:28 PM

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Dear Magnus,

          As you likely suspect, my knowledge of ACC is very limited.  But, you seem to be a good researcher.  And, Thank Goodness the Internet is available.
          There is reluctance among many surgeons to treat a metastatic patient under the old assumption that prospects are not good.  This does not happen to metastatic colon cancer patients.
          However, IRE offers some prospects not considered in the old thinking.  And prospects for ACC patients are better than those for adenocarcinoma, so persuade the physicians.
          If you can find the IRE surgeon who will take you, both tumor sites could be addressed at the same time or nearly the same time.
          For therapy information PubMed and direct Google searches work well.
          As you probably have noticed, based on a rapid search, the agent Oxaliplatin (developed 15 years ago in France) appears to be an active agent.  See
https://www.karger.com/Article/FullText/441414
https://www.google.com/search?q=pancreatic+%22Acinar+Cell+Carcinoma%22+oxaliplatin&ie=utf-8&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a
          In addition, if your CES2 is low, you MAY not benefit from Irinotecan, the IRIN in FOLFIRINOX.  The CES2 test is described in a previous post.
          Regarding Clinical Trials, the following search presents possible therapies.  And, the trials denoted with “Study Results” may reveal some chemo agents that work or don’t work.
https://www.clinicaltrials.gov/ct2/results?term=metastatic&type=&rslt=&recr=&age_v=&gndr=&cond=%22Acinar+Cell+Carcinoma%22&intr=&titles=&outc=&spons=&lead=&id=&state1=&cntry1=&state2=&cntry2=&state3=&cntry3=&locn=&rcv_s=&rcv_e=&lup_s=&lup_e=
          The IRE practitioners outside the USA are listed here.  Not all treat pancreatic cancer.  And, many are Interventional Radiologists, not surgeons – better to have a surgeon.
http://jaxelection.altervista.org/pancreatic/FacilitiesUsing
http://jaxelection.altervista.org/pancreatic/NanoknifeFacili
http://jaxelection.altervista.org/pancreatic/NanoknifePracti
          Surgeon Matthias Birth of Germany has a practice emphasis on IRE and pancreatic cancer.  See
https://translate.google.com/translate?hl=en&sl=de&u
https://www.researchgate.net/profile/Matthias_Birth/publicat
https://www.youtube.com/watch?v=jizQ0e_Hslc
          Don’t rule out treatment in the USA.  ObamaCare is still accepting enrollees, and you need a specific visa to allow eligibility.  This is covered in a previous post.
          Be sure to study the last 2 years of posts, which address therapies, care management, avoiding hospital-acquired infections, clinical trial selection and other helpful topics.
         PhilipJax

RE: nanoknife IRE for pancreatic cancer

by Georginamhall on Fri Jan 27, 2017 11:21 PM

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Philip Jax - thank you !   Positive news about the capcitebine and gemcitabine combination post-surgery.

Wondering if you know of any information - is this combo better than - Folfirinox or Abraxane in this situation ?  Best wishes and thank you for your previous posts too !

 

RE: nanoknife IRE for pancreatic cancer

by Georginamhall on Fri Jan 27, 2017 11:28 PM

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Hi JKelly. Thank you. We will keep these ideas in mind and put them into practice as from today !

RE: nanoknife IRE for pancreatic cancer

by Chippindale on Sat Jan 28, 2017 12:41 AM

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In all due respect to those thinking of undergoing Nanoknife IRE please keep in mind that it is not a cure for pancreatic cancer. Surgery is the possible cure. Electrical ablation can double survival time. Not everyone medically qualifies. It is smart for it to be redone to take care of tumor margins. Interventional radiologists do this procedure but one typically needs to obtain an oncologists referral and then qualify through the IR unit. It it is a go, it is a fantastic opportunity. Still, most places having the equipment are located at major metropolitan medical centers. There are exceptions, of course. Feel free to defend or oppose what is noted here. If a pancreatic patient has resulting mets into the liver, it may possibly be treated with ablation, as well, and successfully depending upon medical staff opinion decisions. Tumor activity, size, scans, etc. form part of the decision. Some tumors with rapid large growth may not be candidates. Only your doctors have the answer but personal research into this is a positive patient and caregiver approach.  

RE: nanoknife IRE for pancreatic cancer

by Clarisax82 on Sat Jan 28, 2017 02:35 AM

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On Jan 25, 2017 2:13 PM Esrph wrote:

Just curious, did your mom had radiation and if so was it before or after nanoknife. The reason I am asking is that Dr. Joseph Herman who was at Hopkins, now at MD Anderson said he disagreed with Dr. Martin and thought Sbrt radiation should be done before Nanoknife where Dr. Martin wants it before. I just noticed Judy Kelly had it before, as did my son. Maybe phillipjax can chime in on this.
My mom had her radiation before the nanoknife procedure. She wasn't strong enough for chemo afterwards, but still had it and that nearly killed her...but somehow didn't! She lived 3 years 4 months post nanoknife.

RE: nanoknife IRE for pancreatic cancer

by Jennybobenny on Sat Jan 28, 2017 02:56 AM

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Hello Phillip Jax , I appreciate the research and knowledge you share with us.  There is so much to absorb and nothing is more important. My husband is scheduled for IRE with Dr Birth in a few weeks. He has his last chemo apt scheduled next week.  The question is when to start chemo again,  some who have previously treated by Dr Birth were told to wait 3 months post surgery to heal, oncologist at home want us to continue right away, their are many different messages on Web sights.   My husband has been on Folirinox and the tumor grew then on Abraxan and Gemitcabine to stabilize. He is also using holistic supplements. After an IRE surgery what protocol would you Recommend?  As far as follow up?  We are spending money on supplements , mistletoe,vitamin c ...all I'm saying is how do we plan for future treatments after the first IRE ? We live in Canada and none of this is covered by OHIP or private insurance.

RE: nanoknife IRE for pancreatic cancer

by PhilipJax on Sat Jan 28, 2017 03:06 AM

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Dear Everyone & Chip,

          Perhaps you have not studied the past 2 years of posts, which address most of your concerns.  I will suggest some items, which may be considered maxims.
1. IRE is part of the larger therapy, to render the patient resectable through knife surgery, and to improve margins.
2. The preferred IRE practitioner is a surgeon, a surgeon who devotes much of his practice to IRE and pancreatic cancer.
3. No oncology referral is necessary.  The patient and care manager must seek the practitioner and therapy themselves, and do not rely on anyone else, including medical staff, to undertake the research.  That includes gathering and sending medical reports.  If you do not seek the better therapy, you will not get it.
4. Resectability depends very much on the skill of the surgeon.  What is wanted are highly-specialized, high-volume surgeons.  Most people realize that a Babe Ruth is better than a bush league ballplayer.  But, then assume that all physicians are equally skilled.
          Life-taking diseases should be treated at one of the top US News-ranked cancer centers.  Local facilities are for broken bones and stitches.
5. It is NOT correct that only doctors have the answers.  It depends on which doctors.  If the physician disagrees with the consensus of medical literature, the physician is WRONG.
          And, physician anecdotal experience is not superior to the findings of sizeable clinical trials.  For example, you will find today medical oncologists who are NOT sending metastatic (and Stage III) patients to the PEGPH20 trials.  And, you will find that, for some time, they will not prescribe the new post-surgery regimen below.  Why not?  Because there are some physicians who “write the books” on therapy, and those who won’t find the time to read them.
          PhilipJax
PS: Dear Georginamhall, often EITHER Capecitabine OR Gemcitabine is prescribed as maintenance therapy after IRE or surgery.  Dr Martin, I understand, often urges Gemcitabine monotherapy for such maintenance.  Something more effective is needed.  So, the COMBINATION (which now has solid evidence) is a step forward.
          The choice should be the most effective chemotherapy that the patient can endure, and the Capecitabine + Gemcitabine combo is probably not the most effective, but it may be all the patient can endure for a while.
          Then, because there are very likely micrometastases, there should be a switch to more effective therapy as soon as tolerable.  Too many PC victims undergo IRE with some resection and still don’t make it, ultimately – the reason: Micrometastases.

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