Transcript Privatklinik Dr. Ursula Jacob GmbH

Ärztlicher Direktor
Dr. Ursula Jacob
Köln 2011
Therapiekonzepte in der
Onkologie
ONCOTRACE
ONCOTRAIL
ONCOCOUNT
TU profile
+
Case studies
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Case report for hypertheramia treatment and sensitivity testing:
• Patient C.O., born 13.10.72
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Diagnosis:
01/00 Hodgkin’s disease (nodular sclerotic).
Until 08/00
multiple chemotherapies and radiation with partial remission.
10/00
recurrence right axilla. No therapy.
02/01 progressive disease, chemotherapy with ESHAP.
Progressive disease.
03/01 change of chemotherapy.
06/01 progressive disease, high dosage chemotherapy, full remission.
02/02 progressive disease lymph node right axillary region. Radiotherapy.
08/03 progressive disease mediastinal, hilar lymph nodes, bilateral. CD30 antibody
treatment, without effect.
05/04 massive progressive disease in PET CT and clinically.
Start of Gemzar mono without effect. High-dosed Prednisolone.
08/04 in our treatment – chemosensitivity test showed Vinblastin in combination with
Procarbazin in combination with CD20 antibody Mabthera until 12/04.
Start of local chemotherapy plus systemic chemo, whole-body hyperthermia every few
months until now.
PET scan and MRI: full remission until now.
12/08 microtumor testing showed cells under the norm.
11/10 microtumor test: again cells under the normal limit.
Full remission
ONCOTRACE
2007
ONCOTRACE
2008
ONCOTRACE
2010
• History Patient female
D.F. dob.: 28.01.1947
• 2006:
Abnormal mammogram then MRI diagnosed
stage IV breast cancer with bone, liver and lymph node
metastases. Therapy – bilateral mastectomy (ER+, HER2 –ve)
then monthly Zometa, Femara
• 2008:
Hepatic recurrence, therapy changed from
Femara to Xeloda plus Herceptin (now HER2 +)
• 2009:
Progressive disease. Xeloda increased. Tycarb
commenced with initial beneficial effect but then further
progression. Therapy changed to Abraxane plus Carboplatin
(but reduced blood count)
• 9/2010
Markedly progressive disease on CT with massive
increase in hepatic tumour mass, therapy changed to
Abraxane, Zometa and Herceptin with partial remission
• 29.9.10-4.11.10
Treatment in the clinic
• Chemosensitivity test performed
• Local therapy – chemoperfusion/chemoembolisation
(Prof Vogl, Uniklinik Frankfurt), x3 (28.9.2010 Mitomycin C +
Avastin, 12.10.2010 Mitomycin C + Avastin,
29.10.2010 Gemcitabine + Avastin)
• Systemic chemotherapy – 2.10.2010 Navelbine 50 mg
(together with whole body hyperthermia )
• Antibody therapy – Thalidomide
• Anti-hormone therapy – Faslodex
• Other therapies – Zometa, Bondronate
• Supportive therapies – whole body hyperthermia (2.10.2010
[39.0], 8.10.2010 [39.1], 1.11.2011 [39.1]), photophoresis
• Given Medication
• Oral – quercetin, Immune plus, vitamin D
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil
• Parenteral – thymus/spleen extract,
mesenchymal growth factors
• Ongoing therapy at home
• Chemotherapy – Navelbine 50 mg 2-3 weekly (dependent on
blood picture)
• Antibody therapy – Thalidomide
• Anti-hormone therapy – Faslodex 250 mg fortnightly
• Oral – quercetin, vitamin D, Bondronate, Immune plus, Kwai
(garlic extract), Chlorella, selenium, Hepamerz, CoQ10,
probiotics, fish oil, B complex, Viromax
• Parenteral – Lektinol, thymus, mesenchymal growth factors
• 25.1.2011-7.2.2011
Treatment in the clinic
• Local therapy – chemoembolisation/chemoperfusion
(Prof Vogl, Uniklinik Frankfurt) with Mitomycin C + Avastin
(31.1.2011)
• Systemic chemotherapy 27.1.2011 Navelbine 50 mg (together
with whole body hyperthermia )
• Antibody therapy – Thalidomide (ceased 25.1.2011) replaced
with Herceptin (3 weekly)
• Anti-hormone therapy – Faslodex
• Other therapies – Zometa, Bondronate
• Supportive therapies – whole body hyperthermia (27.1.2011
[39.7], 3.2.2011 [39.0], photophoresis
• Given Medication
• Oral – quercetin, Immune plus, vitamin D plus Vayara
(Boswellia), CoQ10, melatonin, Bactoflor,
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil plus Artemesinin,
Agaricus phalloides D4
• Parenteral – thymus/spleen extract, lektinol
Ongoing therapy at home
• Chemotherapy – Navelbine 50 mg 2-3 weekly
(dependent on blood picture)
• Antibody therapy – Herceptin 3 weekly
• Anti-hormone therapy – Faslodex 250 mg fortnightly
• Oral – vitamin D, Bondronate, Immune plus, selenium,
Hepamerz, CoQ10, probiotics, fish oil, B complex plus
Detoxolite, Agaricus phalloides D4, melatonin, Vayara
(Boswellia), Aniflazyme, Nattokinase
• Parenteral – Lektinol, thymus, mesenchymal growth factors
• 10.3.2011- 8.4.2011
Treatment in the clinic
• Local therapy – chemoembolisation/chemoperfusion
(Prof Vogl, Uniklinik Frankfurt) with Mitomycin C + Avastin
(14.3.2011)
• Antibody therapy – Removab 16.3.2011 (5 mcg), 21.3.2011
(10 mcg), 28.3.2011 (10 mcg)
• Anti-hormone therapy – Faslodex
• Other therapies – Zometa,
Given Medication
• Oral – Immune plus, vitamin D, Vayara (Boswellia), CoQ10,
melatonin, Bactoflor, Detoxolite
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil plus Artemesinin,
Agaricus phalloides D4
• Parenteral – thymus/spleen extract, lektinol, mesenchyme
growth factors
Staging – PET CT – 6.4.2011
total remission in bones and lungs, good
partial remission in liver
Ongoing therapy at home
• Chemotherapy – Navelbine 50 mg 2-3 weekly (dependent on
blood picture)
• Antibody therapy – Herceptin 3 weekly
• Anti-hormone therapy – Faslodex 250 mg fortnightly
• Oral – vitamin D, Immune plus, Hepamerz, CoQ10, fish oil, B
complex, Agaricus phalloides D4, Vayara (Boswellia),
Aniflazyme, Nattokinase
• Parenteral – Lektinol, mesenchymal growth factors
• 20.5.2011-28.5.2011
Treatment in the clinic
• Local therapy – chemoembolisation/chemoperfusion
(Prof Vogl, Uniklinik Frankfurt) with Mitomycin C + Avastin
(19.5.2011)
• Systemic chemotherapy 27.1.2011 Navelbine 50 mg
(together with whole body hyperthermia )
• tumour specific targeted antibody therapy on 22.5.11
• Anti-hormone therapy – Faslodex
• Other therapies – Zometa, Bondronate
• Supportive therapies – whole body hyperthermia (23.5.2011),
photophoresis
Given Medication
• Oral –Immune plus, vitamin D, Vayara (Boswellia), CoQ10,
melatonin plus Biobran
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil, Artemesinin, Agaricus phalloides D4
• Parenteral – mesenchymal growth factors, lektinol
Ongoing therapy at home
• Chemotherapy – Navelbine 50 mg 2-3 weekly (dependent on
blood picture)
• Antibody therapy – Herceptin 3 weekly
• Anti-hormone therapy – Faslodex 250 mg fortnightly
• Oral – vitamin D, Bondronate, Immune plus, Hepamerz,
CoQ10, fish oil, Agaricus phalloides D4, melatonin, Vayara
(Boswellia), Aniflazyme, Nattokinase
• Parenteral – Lektinol, mesenchymal growth factors
• 10.09.2011 – 06.10.2011
Treatment in the clinic
• Local therapy – chemoembolisation/chemoperfusion
(Prof Vogl, Uniklinik Frankfurt) with Mitomycin C + Avastin
(13.9.2011) and 23.9.11 (with Gemcitabine) – initial MRI
shows progressive hepatic disease
• Antibody therapy – Removab (5 mcg 18.9.11, 10 mcg 28.9.11)
• tumour specific targeted antibody therapy 7/11 and 09/11
• Anti-hormone therapy – Faslodex, changed to Tamoxifen
22.9.11
• Other therapies – Zometa, Bondronate, Pantozol
• Supportive therapies – whole body hyperthermia (15.9.2011
[38,7], 26.9 [39,2]),
Given Medication
• Oral –Immune plus, vitamin D, Vayara (Boswellia), CoQ10,
Nattokinase, Aniflazyme, Arcoxia (changed to Arthrotec),
Membrain, glycine, Venalot, Cimetidine
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil, Artemesinin, Agaricus phalloides D4,
DCA, zinc
• Parenteral – thymus extract, lektinol, methylcobalamin, Iecur
growth factors
• Staging PET CT (5.10.11)
full remission
Tumour markers
CEA
CA15-3
CA27,29
CA125
05.01.2010*
510
1812
1222
22.07.2010*
494
1040
04.08.2010*
676
1516
1437
21.09.2010*
943
2394
1927
Tumour markers
CEA
CA15-3
CA27,29
CA125
22.11.2010*
119
01.12.2010*
107
13.12.2010*
121
03.01.2011*
132
12.1.11*
149
385
369
341
309
298
Tumour markers
CEA
CA15-3
CA27,29
CA125
14.03.2011
169
288
20.04.2011*
137
09.05.2011*
167
299
355
Tumour markers
CEA
CA15-3
CA27,29
CA125
11.07.2011 27.07.2011 13.09.2011
208
235
369
676
433
421
17,7
13,8
24.05.2011
243
379
13,6
02.11.2010 17.11.2010*
360
130
951
524
377
24,1
26.01.2011
197
285
09.02.2011*
107
286
265
01.06.2011*
164
10.06.2011
163
20.06.2011
195
378
364
364
CEA
1000
900
800
700
600
500
CEA
400
300
200
100
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
3000
2500
2000
1500
CEA
CA15-3
CA27,29
CA125
1000
500
0
CST comparisons
(Antibody therapy 22.5.11)
Genes
CES1&2 (carboxylase)
E2F1
p180
p27
DPD
UP
NP
TP
Gamma GC
p53
p16
VEGF
FGF
PDGF
COX2
5-LOX
MMP
TS
DHFR
SHMT
GARFT
NFκB
IκB (a,d,e)
Ribonuclease reductase
DNA methyltransferase I
DNA methylase
O6-methylguanin-DNA-tran.
TGF-b
EGF
IGF
Histone deacylase-dispeptide
Bcl-2
KISS-1-r
Nm23
Ras/Raf/MEK/Erk
mTOR
c-erb-B2
c-erb-B1
Bcr-abl
h-TERT (Human telomerase)
16.09.2010
Normal
Normal
30% over control
35% over control
Normal
Normal
Normal
Normal
Normal
35% over control
50% over control
60% over control
45% over control
40% over control
Normal
Normal
60% over control
Normal
Normal
Normal
Normal
30% over control
35% below control
Normal
30% over control
20% below control
Normal
35% over control
45% over control
Normal
Normal
Normal
45% below control
20% below control
50% over control
Normal
Normal
Normal
Normal
20% over control
03.06.2011
Normal
Normal
30% over control
35% over control
Normal
Normal
Normal
Normal
Normal
40% over control
65% over control
60% over control
40% over control
55% over control
Normal
Normal
40% over control
Normal
Normal
Normal
Normal
30% over control
35% below control
Normal
30% over control
25% below control
Normal
40% over control
50% over control
Normal
Normal
Normal
65% below control
40% below control
40% over control
Normal
Normal
Normal
Normal
15% over control
28.06.2011
Normal
Normal
30% over control
35% over control
Normal
Normal
Normal
Normal
Normal
40% over control
65% over control
45% over control
25% over control
40% over control
Normal
Normal
45% over control
Normal
Normal
Normal
Normal
30% over control
45% below control
Normal
15% over control
20% below control
Normal
25% over control
40% over control
Normal
Normal
Normal
25% below control
15 % below control
30% over control
Normal
Normal
Normal
Normal
15% over control
20.09.2011
Normal
Normal
25% over control
30% over control
Normal
Normal
Normal
Normal
Normal
40% over control
65% over control
65 % over control
30% over control
30% over control
Normal
Normal
40% over control
Normal
Normal
Normal
Normal
35% over control
50% below control
Normal
20% over control
20% below control
Normal
30% over control
55% over control
Normal
Normal
Normal
30% below control
10% below control
35% over control
Normal
Normal
Normal
Normal
10% over control
ONCOTRACE
16.09.2010
03.02.2011
03.06.2011
28.06.2011
20.09.2011
6,6
4,8
4,5
CTC
(cells/7,5 ml)
6,1 5,8
CTC (cells/7,5 ml)
7
6
5
4
CTC (cells/7,5 ml)
3
2
1
0
1
2
3
4
• History Patient female
V.B. dob.: 18.12.1957
• 11/2010: Diagnosed with ovarian cancer with peritoneal
carcinomatosis (Figo IIc).
• Treated with debulking surgery and hysterectomy (with
reduction in CA125) followed by 6 cycles of Taxol plus
carboplatin with further reduction of tumour marker.
• 1/2011 Chemosensitivity test performed
ONCOCOUNT
14.06.2011
• 16.06.2011 – 06.07.2011
Treatment in the clinic
• Staging PET CT 15.6.2011. ‘discrete residual activity of the
peritoneal carcinosis’ and 2 small liver metastases in left liver
lobe’
• Antibody therapy – Thalidomide, Removab (5 mcg 17.6.11, 10
mcg 22.6.2011 and 28.6.2011)
• Supportive therapies – whole body hyperthermia
(13.6.2011 [39.7]), photophoresis
• Given Medication
• Oral – quercetin, Immune plus, vitamin D, Boswellia, CoQ10,
Detoxylite, Nattokinase, Aniflazyme
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil, Faktor AF2, Viromax, B12/folate.
Pantozol, Periplasmal
• Parenteral – thymus extract, mesenchymal growth factors,
bone marrow extract, Abnoba pini, filgastrim, erythropoetin
• Ongoing therapy at home
• Antibody therapy – Thalidomide
• Oral – quercetin, Boswellia, vitamin D, Immune plus,
selenium, Hepamerz, fish oil, Nattokinase, Aniflazyme,
chlorella, Detoxylite, Ribomunyl, Delimmun
• Parenteral –mesenchymal growth factors, Faktor AF2,
• Abnoba pini
• Intravenous- vitamin C, glutathione
ONCOCOUNT
16.09.2011
• 13.09.2011 – 06.10.2011
Treatment in the clinic
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•
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Remains well
Noted to have elevated TSH (4.70) and subsequently elevated
TPO (141), though vitamin D levels optimised
Staging PET CT 16.9.2011. ‘previously described peritoneal
and hepatic changes are no longer traceable. Present activity
level does not differ from the surrounding, so that one can
speak of a complete remission’
Antibody therapy – Thalidomide, Removab (5 mcg 17.9.2011,
10 mcg 26.9.2011)
Dendritic cell vaccination – 22.9.2011
Supportive therapies – whole body hyperthermia
(14.9.2011 [40.2]), photophoresis
• Given Medication
• Oral – quercetin, Immune plus, vitamin D, Boswellia, CoQ10,
Detoxylite, Nattokinase, Aniflazyme, glycine, Membrain,
Kreon
• Infusion – HepaMerz, vitamin C, selenium, Neurium,
ProNeuroplus, Tationil, zinc, Agaricus, Artesunate, Periplasmal
• Parenteral – thymus extract, mesenchymal growth factors,
thyroid extract, Abnoba pini, filgastrim, erythropoetin
Ongoing therapy at home
• Antibody therapy – Thalidomide
• Oral – quercetin, Boswellia, vitamin D, Immune plus,
selenium, Hepamerz, fish oil, Nattokinase, Aniflazyme,
glycine, Membrain, Delimmun, Labolife 2HERP, Labolife 2EBV
• Parenteral –mesenchymal growth factors, thyroid extract,
Abnoba pini, Zylexis
RGCC
ONCOTRAIL
28.01.2011
08.06.2011
14.09.2011
5,7
4,8
3,6
CTC (cells/ml)
CTC (cells/ml)
CA125
6
120
5
100
4
80
3
CTC (cells/ml)
60
2
40
1
20
0
CA125
0
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8
Viral activity and
cancer
What can we learn
from this?
CFS Test
• History Patient male
M.M. dob.: 29.07.1968
• Diagnosis:. 07/08 Lennert’s lymphoma (Hodgkin’s disease),
stage IV, diagnosed through a lymph node biopsy left cervical
region, with multiple mediastinal, abdominal and
retroperitoneal lymph nodes, as well as hepato- and
splenomegaly. (Histologically lymphoma Popema-Lennert, CD
20 positive, CD 30 negative.)
• 04/2009: Full remission in PET CT.
Thalidomide from 04-06/09.
Treatment in the clinic
• 10/08-12/08 chemotherapy with BEACOPP-14 plus Mabthera
with full remission ( 4 cycles )
• 12/08 consolidation therapy with Mabthera until 03/09
• 03/09 Thalidomide until 08/09
• 08/09 Finished Thalidomide and Mabthera
• Microtumor test showed an decrease of the tumor cell
amount
• CFS Panel showed an increased RT-PCR for EBV virus in the
cell
• The autoimmune panel showed no signs of autoimmune
disease
Tumour markers
Thymidine kinase (<7)
β-2 microglobulin (0,71,8)
15.09.2008 18.11.2008 27.02.2009 09.12.2009 05.11.2010
8,9
12,4
13
7,9
4,7
2
2,2
2,3
1,1
1,6
Thymidine kinase (<7)
14
12
10
8
Thymidine kinase (<7)
6
4
2
0
1
2
3
4
5
6
β-2 microglobulin (0,7-1,8)
2.5
2
1.5
β-2 microglobulin (0,7-1,8)
1
0.5
0
1
2
3
4
5
6
09.03.2009 17.08.2009 30.09.2009 11.05.2010 10.11.2010 18.08.2011
CTC (cells/ml)
3,7
2,9
2,2
0
0
<1
CTC (cells/ml)
4
3
2
1
CTC (cells/ml)
0
CTC (cells/ml)
24.08.2009
CLINICAL RESULTS
• The scientific base of micro-arrays analysis of gene
expression is confirmed by the clinical data that
we collect from our patients. This information has
been organized into
DATA TABLES OF CANCER PATIENTS’ RESPONSE TO
SUGGESTED SCHEMES THROUGH CHEMOSENSITIVITY – CHEMO-RESISTANCE TESTING