Posted 12/11/2021 5:11 PM (GMT 0)
I had a thread running from through 2019 on BAT
https://www.healingwell.com/community/default.aspx?f=35&m=4077120#gsc.tab=0
I started a new one a year ago
https://www.healingwell.com/community/default.aspx?f=35&p=1&m=4228774#m4275173
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The Thread was slipping out of sight but I just got a post that I wrote a long response to and, as I was venturing into thoughts beyond BAT I decided to start this thread.
I'll begin by repeating a portion of the response I just left to the last message on the most recent thread
https://www.healingwell.com/community/default.aspx?f=35&p=1&m=4228774#m4275173
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MORE BAT AND THOUGHTS ON AVOIDING RESISTANCE
In one month I'll be at five year point after Dx of Advanced Stage IV PC. In June my PSA was 0.6 after intermittent application of Enza [PSA goes up -- go on it; PSA goes down -- go off it; PSA goes up . . . ]
I was cleared for two BAT treatments. After first month PSA was 4.9. I asked if I should get the second and was advised to. End of month 2 PSA=14. PSA then went down slowly but conisistently over several months to 6.4. Then in two weeks it popped to over 10. PLUS I was feeling noticeably fatigued that reminded me of how I felt prior to my initial diagnosis. I was certain the cancer was growing. I was right.
Had a PMSA scan yesterday. Good news: no new mets. Bad news: One met was raging [and PMSA was so accurate it found activity in old mets that we thought were non-avid].
Now, it's starting to get interesting: I started Olaparib [I am BRCA 2+] yesterday after the scan. Woke up this morning and felt noticeably less tired. It's entirely possible Olaparib stopped the progression in its tracks. We'll know in a couple of weeks when I get a PSA.
Now, was this round of BAT good or bad? I don't know. Obviously could be bad. OTOH: you can only kill the cancer when it's in mitosis. So, perhaps revving it up then slamming it was good -- or maybe not. No way to know.
My approach is that cancer always adapts to its current circumstances but can't anticipate change in circumstances. The ONC has the ability to change the circumstances. Accordingly I think you should get out of a med some time before resistance. I also think continuous dosing is not ideal for avoiding resistance. At this point the only med I'm resistant to is the ADT, which is to be expected.
I was on Abi for 7 months and my PSA was undetectable for 4. Then I went off Abi and did four rounds of BAT. My PSA peaked at 1.2. Then I was just on ADT and went resistant, but caught it right away with PSA max = 2.0. ONC was going to restart Abi but I asked for Enza. Worked spectacularly. 24 days and PSA - 0.2. I was then advised to stop Enza but restart when PSA went over 2.0 again. That took seven months! Then 12 days of Enza and it was 0.6 [advice I received was to not let it go below 1.0 because you want to preserve the non-resistant cells). Stayed there a bit and then I did the BAT described above.
I observe that they are doing trials now where people who have gone resistant to Abi are given BAT to prime the androgen receptors so that PC responds to Enza (which is normally cross-resistant with Abi). They're getting so-so results -- nothing like I got.
The above analysis is not original. It is adapted from the writings of Robert Gatenby and Jinsong Zhang, e.g. Applying Evolutionary Dynamics to Treatment of mCRPC.
My motto is "I don't necessarily want to be in a Clinical Trial -- I AM a Clinical Trial". The science is way ahead of practice, so all these decisions are crap shoots. Dr's are loathe to experiment on people -- except in Clinical Trials. Consequently, practice trails science by a fair bit. I prefer to roll the dice and avail myself of new meds and protocols that have not run the Phase III gamut knowing full well it might backfire. Of course, you need a cooperating ONC and that has not been easy.
If you know you're not going to achieve a kill why do you keep hammering the cancer with the same med until it fails? What you are doing is breeding a resistant strain. Better, I think, is when a med takes the PSA down then back off the med. Give the non-resistant cells a chance to survive. The cancer cells compete with each other for space and resources. The non-resistant cells are more evolutionarily fit than the resistant ones because the latter incur metabolic costs in maintaining resistance. PSA goes up when off med; then go back on. PSA goes down. Do that for a bit then get out before you go resistant.
As noted, I just went on Olaparib. Ola actually kills cancer cells since it interferes with mitosis. OTOH Enza drives them into senescence. So, I figure let's kill some of them before putting them to sleep.
FYI: I am concerned about bone marrow damage with Ola. I'm planning on staying on it maybe two months to hopefully kill some and throw the PC a curve ball by moving in and out of something before it goes resistant. So, at some point soon I expect to go off Ola and back to Enza -- on an intermittent basis with my PSA guiding the on/off. There is no data on this strategy but it makes sense and I go in knowing that it might be good or it might be bad. I am "playing the probabilites". I know what's going to happen if I stick with tried and true Phase III verified treatments and it's not good. Surely one can (MIGHT) do better availing themselves of newer treatments and protocols, knowing full well that you're proceeding with less data and therefore it might work out or you might mess yourself up.
I just want to fight this sucker with everything I've got [Aside: I even went on a plant based diet].
As I explained to one ONC: "I think I'm doing something and even if I'm not it's still good for me since it
keeps my positive attitude and fighting spirit up".
Stoykie mujic. ["Standing Man"]. For an Academy Award winning two minute [1:58 actually] performance by Mark Rylance in "Bridge of Spies" that introduces stoykie mujic see
https://www.youtube.com/watch?v=rRSIPvuYwOY
I personally find it inspiring. Attitude alone is a survival factor
It will be interesting when I go back on Enza to see if it's still as effective. I've only been on it a total of 36 days so I don't see how it would have developed resistance. Then again, cancer works in mysterious ways; nothing is guaranteed.
12/16 T4M1 GS=8,PSA=240.Mets:femur,ribs,pelvis,scapula,spine. ADT 2/17.Docetaxel:NADIR=0.7@13mos; PROSTVAC NCT02649855; PROVENGE 3/18. RALP/5/18; Zytiga 8/18-3/19. PSA=0@ 3 mo. BAT:3/19-6/19.Castrate resistant 5/20.PSA max=2.0. Enza(24 days 7/20) PSA=0.2.Stop Enza for 8 mo.Resume PSA=3.3; 12 days:1.1. Stop Enza, PSA goes to 0.6 So, I did almost one year with only 36 days on Enza. BAT July/Aug 2021.
PSA spikes to 14, goes down to 6.4 then spikes over 50% in two weeks. Start Olaparib 12/10/2021