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Hi, everyone,
Here is another company that can provide biomarkers lab tests.;and it may be more advance according to this article segment than the “Target Now “report.(please see below)Roche’s cobas EGFR Mutation Test received a CE mark. The regulatory stamp means the test will be commercially available as a companion diagnostic to identify non-small-cell lung cancer (NSCLC) patients with EGFR mutations who may benefit from anti-EGFR tyrosine kinase inhibitors.
Roche itself has a tyrosine kinase inhibitor for NSCLC, Tarceva. The drug was approved by the EC in September as first-line monotherapy in patients with locally advanced or metastatic NSCLC with EGFR-activating mutations.
Carried out on a section of tumor, the real-time PCR-based cobas EGFR Mutation Test detects 41 mutations across exons 18, 19, 20, and 21 of the EGFR gene. The firm claims the assay has a higher degree of sensitivity than Sanger sequencing and delivers test results within eight hours.
The cobas EGFR Muation Test is the third cobas oncology diagnostic to be granted a CE mark this year. It joins the cobas BRAF Mutation Test for metastatic melanoma and the cobas KRAS Mutation Test for advanced colorectal cancer. All assays are carried out on the cobas 4800 system v2.0.
God bless.
Patti77 wrote:We are so grateful for the extra time we have with Bruce and are anxious to share some of the things Bruce has done or is willing to do to provide for a longer, better quality life. Bruce was originally told that he had less than 6 months. It has now been 26 months and he is doing very well at the moment.If I were to sum up in a short list of recommendations, based on our family’s collective experiences, I would say this:
(PLEASE NOTE THAT SOMEHOW MY ORIGINAL POST WAS DELETED…SO THIS LIST MAY BE SOMEWHAT DIFFERENT THAN WHAT WAS HERE ORIGINALLY. But to the best of my recollection…here goes!)
1. RESEARCH like crazy. Use the internet as a tool. Turn over every stone. Sites like this one (http://www.cholangiocarcinoma.org) have been a God-send for information and for support.
2. ALWAY GET SECOND OPINIONS. If you hear something that rocks your world, make sure that you are getting the same prognosis from as many sources as possible.
3. BE YOUR OWN BEST ADVOCATE & CHECK ALL OPTIONS! My brother Bruce was originally told he was totally inoperable…by many doctors!!! But he finally found one (Dr. Wallis Marsh at UPMC in Pittsburgh) who WAS willing to operate…and he saved Bruce’s life!)
NOTE: When Bruce was operated on, we had Dr. Marsh send tissue samples to TargetNow (a lab in AZ) that will determine what treatments (chemo & other) work best to eradicate your specific instance of cholangiocarcinoma. For instance, we found that there were many chemo’s and alternative therapies that will work to fight Bruce’s CC. Thus providing, as Bruce likes to phrase it, “more arrows in my quiver!”
4. EAT LIKE YOUR LIFE DEPENDED UPON IT. It does!!! Books like: Anticancer, A New Way of Life by Dr. David Servan Schreiber; The China Study; Forks Over Knives; etc. give similar information about following an anti-cancer diet with great success. Bruce has been eating like this for over 2 years, and is doing well…he was originally given 4-6 months.
5. LET YOUR FRIENDS & FAMILY HELP. Allow your friends and family to help you. Your friends and family are looking for things to do to assist you…they love you. Let them in! We had friends/family members cooking (using anti-cancer recipes), holding prayer vigils, writing cards (get-well card campaigns with 100’s of cards), sending organic fruit, attending chemotherapy appointments, and more. It is a great way to make them “feel better” so that you can “feel better”.
6. PRAYER WORKS! Keep praying and solicit others to pray, too. It does work! My brilliant youngest brother found a scientific article that is now providing proof that prayer works.
7. LAUGHTER! Use humor as a weapon…It is healing! (Proven fact!) Do everything possible to keep your spirits up…stay around optimistic and joyous people. It has been proven that there is a positive impact from this. We, as a family, have looked for ways to lighten and brighten Bruce’s day…from sending him funny movies in the mail, to playing mild practical jokes.
8. TAKING CARE OF THE CARE-GIVER. We made sure that we were taking care of Bruce’s wife Andrea, too. She is there day-in and day-out facing grim news…and we knew that she couldn’t help Bruce if she was struggling herself. So we took time to relieve her for a few hours, a day, a week at a time, so that she could rejuvenate and come back to her role as Bruce’s prime support rested and in a better place.
9. REALIZE THAT THERE IS PROBABLY NO “MAGIC BULLET,” so use MANY alternatives to reach your goal…Yoga, diet, herbal treatments, tea, prayer, support groups, along with traditional medicine.
10. KEEP THE SPIRIT OF A FIGHTER IN YOU. Use determination and strong will to your best advantage. As Winston Churchill said: “Never, never, NEVER give up!”I believe that this was the essence of my original post. I will continue to review and add more if I find a particular recommendation that I missed…or if I remember a salient point.
I am also maintaining my brother’s website: http://www.brucehaney.org. The full story on Bruce is here: http://www.brucehaney.org/brucesstory.
Our entire family is wishing you all well in your journey and your battle!
With love and prayers,
Patti
Very good 10 points of how to deal with this horrible CCA,I wish you can repost it on discussion board as a “NEW TOPIC” or somewhere so more people can read this.
GOD BLESS.Hi,
I did agree with Dr.Ralph on the following statement.“He’s convinced that in our increasingly technologically driven world that it’s easy to overlook the low-tech solutions that are so readily available. While no one would deny the benefits that technology has brought to medicine, it is also extremely important to investigate inexpensive, naturally occurring substances that might be harvested and used for health.”
And i think this is not only apply to Saffron but also to other herbs as well. it is not surprising that ,according to one oral session about CAM at DDW 2011 I attended ,indicated that higher education is related to more CAM users.
God bless.Hi,
If the doctor prescribed Coumadin for thinning your husband’s blood while on Avastin,most likely it is for atrial fibrillation -A FIB(increase heart rate). About 1% of the patient have this problem while on Avastin. But to make sure,next time you see the doctor,ask him or her for sure.
INR =1.5 is a bit too low for AFIB management,please mention to the doc to see whether this is the INR value 1.5 is appropriate.(INR=2-3 is the normal range);but on the other hand ,hemorrhage is a more frequent side effect than A FIB. So, there is a balance act required to manage the two.
Nose bleed is ok as long as it can be managed ,but if it become heavy and very frequent,then call the doctor to see what they recommend.
God bless.Hi,
Yes ,if it works the chemo will give objective response (included complete (100%) or partial response(>25-30% shrinkage); not to mention the stable response ;the average effectiveness fox GEMOX is between 22-36% but result is better if your mum’s bilirubin is<2.5 the upper limit of normal. Normally the doctor will continue the GEMOX unitl it does not work and to judge that the oncologist will do CAT SACN or MRI or PET to confirm. I saw on this web site physicians switch to other chemo regimen as short as less than one chemo cycle because the adverse reactions of the regimen. But in general, it takes 6-8 cycles or after 2-3 months before the oncologist order scans to evaluate the effectiveness.
Tarceva does work well in the first couple months,then because of drug resistance,it’s effectiveness will be lost over time(like in months rather in years.)
My suggestion,I think the less needles your mom saw,the more happy she will be.So at this point I will not persuit the infusions of high dose of vitamin C ;homeopathic treatments and the like. so far I do not see any evident-based good result come from them. You can look under the experience forum of this web site for the current thinking of CAM(complimentary and alternative
Treatments. ) I know acupuncture and Yoga and Qigong helps the symptoms of nausea and vomiting.
I myself took maitake fraction PRO 4X extracts BID for 2 years,milk thistle
1000mg BIDand Celebrex 400mg BID FOR 2years and the intrahepatic CCA comes back.
In 13 randomized studies about Thymus extracts,5 suggested may have some benefits,however the low average methodological quality of the trials and overt contradictions in terms of outcomes prevented firm conclusion.Thymus preparations can cause severe allergic reactions and possibly serous infections when injection.—from May 2011 ,literature review version19.2 by upto date.com.
Although there are little evidence to support an important role for Vitamin C and other anti-oxidants like co emzyne Q in cancer treatments,many patients take them anyway,but concern have been raised as to a potentially detrimental impact of vitamin C intake on the anti tumor efficacy of cytotoxic chemo agents
(Heaney M Let al. vitamins antagonizes the cytotoxic effects of antineoplastic drugs. Cancer Res 2008; 68:8031) With regard to hyperthermia therapy, sorry,I do not know anything about it
At this point,make sure you mom eats well,hydration more especially the day before and the day of treatment,it will make her veins easier to find and bigger.
Try to do things one day at a time as you may know already there are still a lot limitations on the conventional medical treatments.We can,including myself,can just do what we can to help ourselves,the rest is really depends on God’s grace and mercy.
God bless .Hi,Eli,
You can request the pathology dept. of the hospital your wife had the surgery for the Tissue block and slides. However, it is not the 5month I will worry about but whether the hospital will have ENOUGH of the tissue left for you to do the bio markers chemo sensitivity.But it won’t hurt to find out.
BTW,the tissue is preserved in paraffin and is good for years.
One thing is that ,I don’t know whether it will be worth it if you have to pay for it 100% by yourself and not by your government. If I were you,I will wait till the next scan to see if the current chemo is working or not. If it works,then You may not need to spend the thousands of dollars.Mine was paid by the insurrance.
The bio markers test are not 100% as useful as it seems to be partly because it is expensive and is not widely used by the physicians because of the limitations of the results .(ie: like the CA19-9 is a bio marker for CCA,but the sensitivity and specificity of the test is still debatable; mine CA19-9 never higher than 28.but as you know it is not correlated with the suggested normal range of<37. And it is different from extra hepatic CCA which you can expect a much higher value.)
God bless.Hi,
May I ask why he takes Coumadin?
Is it for controlling the heart rate or for thrombosis like DVT prophylaxis or other blooding thinning purposes? Did he got his PT/INR lab done to make sure he takes the correct amount or dosage of the Coumadin.What is his inr? Is it between 2-3. And how often he gets his INR DONE.
.Does he has nosebleeds often or rectal bleeding?How his blood pressure?Does he has shortness of breath? All these symptoms may be partially related to the side effects of Avastin an/or oxaliplatin. But I concern the most at this point is why he takes Coumadin and for how long? Coumadin can be used for heart rate problems ,chest pain and stroke , TIA and other heart related problems.
God bless.Hi,Peony,
May I ask what meds your husband still on? Is he still on Gem/cis,avastin ,Zomeda? it seems to me that he at times has shortness of breath(as mention on your 10/20/11 entry).Is he taking any meds for other health issues?
God bless.Hi,Gavin,
Thanks for the article.
For me,if this is proven to be correct,then after resection or surgery,I will wait until I fully recover from the surgery before I will use medications like Prozac,Zoloft and Remeron (SSRI) antidepressants for both of their indication and side effect(weight gain) usage.
Well,Gavin,the BEARS do not look good without number 6 QB. Local TV still think that we can go to the playoff. And it will take 4-6weeks before he can come back.
Make sure you say hi to your mum for me;Winter is coming and make sure your mum put an extra sweater on before venture outside.
I will be back to work at the end of December.God bless.
Hi,Eli,
thanks to show interest on this bio markers subject.
IHC (Immunohistochemistry) method used “positive” and “negative ” and microarrayillumia method used “under expressed”,”no change” and “over expressed” to describe the result.
The above study of the two platium drugs used the IHC methods and therefore they use the term positive or negative to describe their findings.The study did not use the microarrayillumia method.
So based on the IHC method,you are right that cisplatin is better for me because of the NEGATIVE RESULT.
On the other hand from the microarray analysis ,my overexpression ratio for ERCC1 gene is only3.11(ie: the ratio is the difference in expression for this ERCC1 gene between my tumor and the control tissues.) I think my ratio is on the low side of the scale but I need to ask my oncologist for his opinion due to lower nephrotoxicity of oxaliplatin.
For a person has no medical training , and can show such interest and understanding about the subject matter of CC. I have to tip my hat to you.
Your wife is lucky to have you on her side.
God bless.Hi,
Did you ask for interventional radiologist consult with regard to radioembolization using Y 90?
Base on the message board and some articles I read,Mayo Clinic first recommendation is radioembo.before chemoembolization and RFA for CC involving such a large areaof the liver.But again,this is only applied to CC that did not metastasized. And make sure the nurse flush the port with enough saline between oxaliplatin and Gemara to minize the problem.
God bless.Hi,
I took gemzar for 14month with no problems except mild nausea and vomiting toward the end of the 14month treatment.
Yes,Gemzar did not cause any pain for me at the site of injection,a little burning feeling at times. Gemzar should be diluted down to total volume of 250ml -300mgof saline(ie:mine is 1750mg in saline 275ml- the drug volume+the 250mlsaline) and yes,it should give it within 30 min for the whole thing.One way to avoid the injection site problem is to get your mom an IV injection port so she doesn’t need to be stick every time.
God bless.Hi, everyone,
For those who are interested in the bio markers subject,this is the continuation of my research based on my own results.On the” Target Now” biomarkers report,my ERCC1 is negative by the IHC method but overexpressed by the microarrayillumina method.
This ERCC1 marker is used for testing the chemo sensitivity on cisplatin,carboplatin and oxaliplatin.(the platium group).
Usually when ERCC1 is overexpressed,the platin group is not recommended.
but my” Target Now “report said this group(the platium group) is associated with clinical benefit and is ok to use them because I think my ERCC1 by IHC method is NEGATIVE and supported by the following study that I dug up from my research.(see below).
God bless.Different relation between ERCC1 overexpression and treatment outcomes of two platinum agents in advanced biliary tract adenocarcinoma patients.
Meeting:
2010 Gastrointestinal Cancers Symposium
Abstract No:
178
Author(s):
I. Hwang, J. Jang, G.National University, Jinju, South Korea; College of Medicine, Dong-A University, Busan, South Korea;Abstract:
Background: Several clinical studies have shown that excision repair cross-complementation group 1 (ERCC1) overexpression is associated with resistance to platinum-based chemotherapy and poor prognosis in several tumors. However, these studies have never been tried on biliary tract cancer. The aim of this study was to evaluate the association between ERCC1 expression and treatment outcomes in advanced biliary tract adenocarcinoma (ABTA) patients treated with platinum-based chemotherapy. Methods: 106 patients with histologically confirmed adenocarcinoma of biliary tract were enrolled at 5 institutions between January 2002 and September 2008. Of 106 patients, 93 were assessed by immunohistochemistry from biopsy specimens. 65 patients were treated with cisplatin and the other 28 were treated with oxaliplatin. Results: ERCC1 expression was positive in 47 out of 93 specimens (51%). 20 (22%) of 93 patients showed response (including complete response and partial response). Among 20 patients who obtained response, eleven (55%) were positive for ERCC1 expression and nine (45%) were negative (p = 0.621). In subgroup analysis, ERCC1 expression of oxaliplatin treated adenocarcinomas was 13 of 28 specimens (46%). 6 (21%) of 28 patients achieved response. In patients treated with oxaliplatin, six (100%) were positive for ERCC1 and none (0%) were negative (p = 0.005) among the 6 patients who obtained response. With a median follow-up of 7.3 months (range, 0.8-47.5 months), median progression-free survival (PFS) and overall survival (OS) were 3.6 months and 7.3 months, respectively, and there were no significant differences of median PFS and median OS between ERCC1 negative and positive patients for the total study population (PFS, 4.2 versus 2.9 months, p = 0.116; OS, 7.0 versus 7.8 months, p = 0.143). In patients treated with cisplatin, the median OS was significantly longer in the ERCC1-negative group than in the ERCC1-positive group (9.1 vs 7.3 months, respectively; p = 0.017).
Conclusions: Patients with ERCC1-positive ABTA show a response benefit from oxaliplatin-containing chemotherapy. On the other hand, patients with ERCC1-negative ABTA show a survival benefit from cisplatin-containing chemotherapy.
