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Thread: Breaking down the stromal barrier may not be such a good thing

  1. #1
    Super Moderator Top User ddessert's Avatar
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    Breaking down the stromal barrier may not be such a good thing

    The title of this article is totally overstating the substance of the article. But essentially MD Anderson researchers propose that clinical trials using drugs meant to break down the pancreatic tumor's stromal barrier failed miserably because the stroma is actually a good thing.

    The previous thinking was that the stroma keeps chemotherapy drugs from penetrating to the tumor and that breaking it down would make the chemotherapy more effective. The stroma is 90% of the tumor mass while the cancerous tumor is the inner 10%. So a few trials (Hedgehog inhibitors, for example) were halted early because it was having the opposite effect.

    The new proposal from this researcher is that the stroma is actually the body's immune system trying to contain the tumor. And when you take that away, the tumor starts growing faster.

    The title implies that all drugs are ineffective, which is not the case. You'd only run into these stroma depletion drugs in a clinical trial.

    BRCA2 3398del5
    Dec 2010 - back/abd pain
    May 2011 - Unresectable stage III, 2.5cm tumor
    Jun-Aug 2011 - Gem/Cis, 9 rounds
    Oct-Nov 2011 - Radiation+Xeloda, 25 days in 5 weeks
    Oct 2011-Sep 2012 - shrinking tumor
    Feb 2012 - National Familial Pancreatic Study
    Aug 2012 - Downgraded to stage IIA, PGP
    Sep 2012 - Whipple, T3N0M0, 0.5cm tumor, 0/16 lymph nodes
    Dec 2012 - Quebec PanCan Study
    Sep 2012-Nov 2017 - NED
    Mar 2013-present - NCT01088789

  2. #2
    Interesting article. So, the ones who have a thinner stromal barrier will benefit from depletion. I guess biopsy would tell you that. Another question comes to mind, are all the tumors (say you have multiple) the same? Could one be thicker while the others are thin?

    It's good we are making progress. Damn slow, but we're going there. I'll have to check out the trials that are being done at WashU here in St. Louis. Just to inform myself of what's out there. See if I know any of the researchers/assistants. Most of my contacts are in the Colo-Rectal and Urology areas. I had planned on volunteering after a while as I can tolerate it. A few depts. have asked if I'd be willing. I really miss being in the thick of things.
    Oct 2013 CT shows .7mm mass on tail of pancreas
    Mar 2014 CT shows 1.8mm
    Apr 2014 EUS FNA after 2nd opinion showed cancer
    May 16, 2014 Open distal/splenectomy Stage 2B adenocarcinoma 3.1cm w/ local spread, clean nodes
    June 13, 2014 Baseline CT showed mets to liver, staged upped to 4, Will begin chemo June 20th Gemzar and Abraxane. Given 6m to a year.
    July 25, 2014 Happy Birthday to me! My tumor markers went from 212 to 32!!!!
    August 20, 2014 Pulmonary Emboli in both lungs, CT scan shows G/A combo not worth the side effects. Decided to stop chemo for now.
    Oct. 2014 CA19-9 now at 525, liver is swelling and so is pain.
    Dec. 2014 Started Hospice
    April, 2015 declining


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