Abscopal Effect

[scarbrtj]

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I wrote this in a patient note today. Wish I (we) understood it.

This is a fellow who completed high dose hyperfractionated radiation monotherapy for his laryngeal CA on August 9, 2016. In general he’s doing pretty well. Really no new problems or complaints whatsoever. He told me a pretty fascinating history today that he began having moles falling off his face after the radiation therapy completed. There was one especially prominent one behind his left ear and once it fell off moles all over his body starting drying up and regressing. They used to hurt and itch and pretty much all of them are going away over time. Again a pretty fascinating outcome from the radiation therapy. He’s eating and swallowing fine. Breathing fine. Not coughing up any blood. No ear pain.

 

[seper]

Are you sure he did not get cetuximab?

 

[evilbooyaa]

I think the consensus is that it works for melanoma (I agree that we don't fully understand it), so I'm not surprised that it worked for non-melanomatous moles.

A big interest now is in seeing if those results can be clinically replicated in other disease sites, particularly in the recurrent/metastatic setting. Essentially combining immunotherapy and RT.

 

[deleted18755]

I wrote this in a patient note today. Wish I (we) understood it.

This is a fellow who completed high dose hyperfractionated radiation monotherapy for his laryngeal CA on August 9, 2016. In general he’s doing pretty well. Really no new problems or complaints whatsoever. He told me a pretty fascinating history today that he began having moles falling off his face after the radiation therapy completed. There was one especially prominent one behind his left ear and once it fell off moles all over his body starting drying up and regressing. They used to hurt and itch and pretty much all of them are going away over time. Again a pretty fascinating outcome from the radiation therapy. He’s eating and swallowing fine. Breathing fine. Not coughing up any blood. No ear pain.

I wrote this in a patient note today. Wish I (we) understood it.

This is a fellow who completed high dose hyperfractionated radiation monotherapy for his laryngeal CA on August 9, 2016. In general he’s doing pretty well. Really no new problems or complaints whatsoever. He told me a pretty fascinating history today that he began having moles falling off his face after the radiation therapy completed. There was one especially prominent one behind his left ear and once it fell off moles all over his body starting drying up and regressing. They used to hurt and itch and pretty much all of them are going away over time. Again a pretty fascinating outcome from the radiation therapy. He’s eating and swallowing fine. Breathing fine. Not coughing up any blood. No ear pain.

Incredible ... about a month ago I treated a 98 year old gentleman with metastatic NSCLC. I just treated him with 5Gy x 5 to the relatively small mass causing SCV syndrome. I saw him in follow up yesterday and his symptoms are greatly improved but his daughter kept saying that his mild skin reaction cleared up in no time but then his skin now looks better than ever. I didn't think that much of it but after reading your post I just called her out of curiosity and she tells me that the skin outside the field and especially on his face and scalp looks "less moley and really old man like"!

 

[Palex80]

I've also had a weird case a couple of years back.

88 year old male patient with chest pain caused by a new diagnosed 8 cm big T3 NSCLC growing through his chest wall. I was called to treat him before they sent him off to hospice to die. Several metastatic nodes in the mediastinum too, all PET positive. Med oncs didn't want to treat him.

I gave him 4 x 5 Gy to the primary only, he went to hospice. I didn't want to cause amy esophagitis, so I didn't treat the mediastinum.

One year later I get called up to go to the emergency department. The same gentleman had fallen down the stairs at home, broke a couple of ribs (on the opposite site of the primary).
They did a CT. The primary was 3 cm big now, he had no pain any more. The mediastinal nodes had all shrunk considerably. No treatment after the 4 x 5 Gy a year ago...

 

[seper]

What makes you say that? Was there a randomized study of RT alone vs immunoRT?

Looks like the early results from RT+ipilimumab et al trials have abscopal effects about 20% of the time. Would be great to boost that.

 

[Brim]

You should advertise this. Painless mole removal without cutting! It's gonna be HUUGE!

- Moooooooole!

 

[evilbooyaa]

Looks like the early results from RT+ipilimumab et al trials have abscopal effects about 20% of the time. Would be great to boost that.

What do you mean by 'boost that' in this scenario?

Not to rain on anyone's parade, but my question with abscopal effect is always this:

Immunotherapy is given as a systemic treatment. It works on it's own (at least sometimes), otherwise it wouldn't have been given. Does RT improve the success rate of IT across a population?

Haven't done a ton of background research into this area, but like for melanoma, is it proven that giving ipilimumab alone has worse outcomes, on a population basis, than patients who got ipilimumab + RT?

Don't think there will ever be a trial looking at RT Alone vs immunotherapy + RT for anything, but at least some comparisons of IT +/- RT that are prospective and/or randomized, would be great.

 

[evilbooyaa]

At least there's something like this to convince people to do it for melanoma:

https://www.ncbi.nlm.nih.gov/pubmed/27905824

Time to attempt similar feats in non-melanoma cancers?

 

[Krukenberg]

Don't think there will ever be a trial looking at RT Alone vs immunotherapy + RT for anything, but at least some comparisons of IT +/- RT that are prospective and/or randomized, would be great.

This field of research is in its early phases but there are many phase I and IIs underway for immunoRT determining the optimal sequencing and fractionation schemes for multiple cancer types, and will eventually have phase III trials of inmuno vs. immunoRT. I would expect a large number of the early phase trials to complete followup this year and next year, hopefully with pubs about a year after that.


Sent from my iPhone using SDN mobile app

 

[evilbooyaa]

This field of research is in its early phases but there are many phase I and IIs underway for immunoRT determining the optimal sequencing and fractionation schemes for multiple cancer types, and will eventually have phase III trials of inmuno vs. immunoRT. I would expect a large number of the early phase trials to complete followup this year and next year, hopefully with pubs about a year after that.


Sent from my iPhone using SDN mobile app

I've seen the various, mostly single-institution trials currently running; if anyone happens to come across any randomized data, I'd love to see an update to this thread comparing immuno vs immunoRT, especially in non-melanoma cancers.

EDIT - for example, interesting would be in NSCLC where immunotherapy is likely the most commonly seen. Is there a benefit of adding RT to patients getting nivolumab?

 

[seper]

I've seen the various, mostly single-institution trials currently running; if anyone happens to come across any randomized data, I'd love to see an update to this thread comparing immuno vs immunoRT, especially in non-melanoma cancers.

EDIT - for example, interesting would be in NSCLC where immunotherapy is likely the most commonly seen. Is there a benefit of adding RT to patients getting nivolumab?

Opdivo and XRT have overlapping life-threatening toxicities (lung, GI). Accepted standard practice seems to be avoidance of concurrent use in NSCLC (wait for 3-4 weeks for "washout" of either modality).

 

[evilbooyaa]

Opdivo and XRT have overlapping life-threatening toxicities (lung, GI). Accepted standard practice seems to be avoidance of concurrent use in NSCLC (wait for 3-4 weeks for "washout" of either modality).

Good point. Maybe stick with pembrolizumab then as it seems to be better tolerated.